Are Pharmacists Prepared for America's Worst Natural Disaster?

“When, not if” is a repeated phrase experts use when they refer to the Cascadia subduction zone rupture, which will create North America’s worst natural disaster in recent history.

The Cascadia fault line—which may be lesser known than the San Andreas Fault, but has the potential to produce more damage—runs from the area around Cape Mendocino, California, through Oregon and Washington, and ends near Vancouver Island, Canada.

Pharmacists should be aware of this fault line because there is a 1 in 3 chance that a big earthquake with a magnitude of 8 to 8.6 will occur in the Pacific Northwest within the next 50 years, The New Yorker reported. The odds of the next full-margin rupture (between an 8.7- and 9.2-magnitude earthquake) occurring in the next half-century are about 1 in 10.

When the full-margin rupture occurs, the Pacific Northwest will experience not only a massive earthquake, but also a tsunami roughly 15 minutes later.

One of the most-cited quotes from The New Yorker article on the Cascadia subduction zone came from Kenneth D. Murphy, the Federal Emergency Management Agency (FEMA) regional administrator for Region X, who stated, “Our operating assumption is that everything west of Interstate 5 will be toast.”

On its website, FEMA describes the Cascadia subduction zone earthquake and tsunami situation as “one of the most complex disaster scenarios that emergency management and public safety officials face in the Pacific Northwest.”

Every 200 to 500 years, on average, an 8- to 9-magnitude earthquake occurs along the 800-mile territory, according to FEMA. The last major earthquake and tsunami occurred in 1700.

If the earthquake and tsunami had hit on February 6, 2016, at 9:41 AM, around 13,000 individuals would have died and 27,000 would be injured, FEMA told The New Yorker. The agency is currently planning a 4-day exercise in June to coordinate governmental agencies with the private sector on responses to this emergency situation.

Awareness and preparation are crucial for those residing in the Pacific Northwest. Here’s how pharmacists located in states on the West Coast can help prepare themselves and their patients for this natural disaster, starting with Washington State.

Washington

Michael Loehr, chief of emergency preparedness and response for Washington State, told Pharmacy Times that local and state emergency managers have led efforts to educate the public, business community, government agencies, and elected leaders about the Cascadia subduction zone rupture.

While Loehr did not have details on what percentage of homes or structures have been built or retrofitted to withstand earthquakes, he did note that efforts are continuing to retrofit critical infrastructure, especially bridges.

He described pharmacists as key health care providers who can play an important role in helping patients prepare for this disaster.

“Pharmacists can encourage their patients to create a disaster supplies kit, have all prescriptions written down in a safe place so that the list can be taken with the person in the event they need to evacuate, encourage patients to have contact information for health care providers readily available, and ensure to the greatest extent possible that an extra supply of critical medications can be maintained at home,” Loehr said.

California

Jon R. Roth, CAE, CEO of the California Pharmacists Association, told Pharmacy Times that he did not believe most Californians, including pharmacists, were aware of the earthquake predictions.

“A lot has been done in the public health and safety communities to build an infrastructure to help warn communities of impending disasters, such as tsunami warning systems,” Roth said. “But, by and large, the threats of living in these areas and the thought of ‘the big one’ are not top-of-mind for most people.”

Roth noted that pharmacists could play a critical role in disaster recovery during and following emergencies. However, pharmacists should first make sure that they have a plan for their own family so that they can help with broader community recovery efforts while ensuring their family is safe.

Roth also cited the following recommendations from the US Department of Homeland Security:

1. Get a kit of emergency supplies that includes food, water, and medications.

2. Make a plan for what you will do in an emergency.

3. Be informed about what might happen.

4. Get involved in preparing your community.

“Pharmacists can be leaders in preparing their communities by advocating these preparations with their patients and even going further to sell pre-made emergency survival kits in their pharmacies,” Roth advised. “While pharmacists have a lot of important information they are communicating with patients during mediation counseling sessions, reminding patients with in-store signage or prescription bag inserts can be helpful to raise awareness to these types of threats.”

Roth also suggested that California pharmacists enroll in the Disaster Healthcare Volunteer Statewide Registry (www.healthcarevolunteers.ca.gov), which mobilizes health care professionals as volunteers. Pharmacists can select their volunteer preferences and record what kind of skills or services they can perform. If a disaster strikes, the registry notifies the pharmacist of how he or she can help.

Other ways pharmacists can get involved include establishing and overseeing emergency medication dispensaries, providing mass vaccinations to the public or first-responders, performing patient assessments, and being part of triage teams. In addition, Roth pointed out that pharmacies can serve as emergency shelters, medical triage facilities, and safe gathering places for first responders or community members.

A resource on the California Seismic Safety Commission’s website notes that accounts from Native Americans say there were tsunami waves around 60 feet high in past Cascadia earthquakes.

The last time the Cascadia subduction zone ruptured, the tsunami affected areas from Humboldt County, California, up to Canada.

Some tips on the safety commission’s website include:

· If a strong earthquake lasts 20 seconds or more, there is a risk for a tsunami to follow.

· While the earthquake is occurring, duck, cover, and watch for falling objects.

· Move to higher ground and travel away from the coastline if possible. Leave on foot if possible, as well.

· Tsunami waves may continue after the first wave hits, and later waves may be even higher than the first.

· Remember that tsunamis move faster than a person can run and they are not “surfable.”

· Find access to a radio for information.

· Do not return to the evacuation zone until officially notified.

Oregon

Fiona Karbowicz, RPh, a pharmacist consultant for the Oregon Board of Pharmacy, provided Pharmacy Times with a few items that the board has distributed via newsletters.

Oregon pharmacists should note the following from the board:

• A state law passed in 2013 allows Oregon pharmacists to administer vaccines to patients aged 3 years and older in emergency situations. Pharmacists who can immunize patients should expect to be informed by the board of such a situation through email, phone, and/or fax.
• Pharmacists in corporate chains will likely be notified by their management on how to proceed in emergency public health situations.
• Pharmacists may want to sign up with the Oregon Health Alert Network, which is funded by the US Centers for Disease Control and Prevention. This network will notify health systems, emergency responders, and public health personnel of emergencies and hazards.
• During a declared emergency, pharmacists can dispense medications without prescriptions in the following cases: Pharmacists can dispense a refill up to a 30-day supply. After consulting with a prescriber, pharmacists can initiate or modify drug therapy and dispense medications to meet patients’ health care needs until patients can see their physician. This is contingent on the pharmacist acting with professional judgment and keeping records of the dispensed medication. Pharmacists must also tell the patient that the medication is being dispensed in the absence of a valid patient-prescriber relationship, but that a prescriber was consulted.
• There are 74 pharmacists in the State Emergency Registry of Volunteers in Oregon, which is designed to verify qualifications of health care providers before an emergency occurs. In disaster situations, it is often difficult and time-consuming for authorities to determine who is qualified to treat patients, so pharmacists who register will be able to help immediately.

A 2007 study found that almost half of the 2193 public schools in Oregon had a high or very high potential for collapse during a major earthquake.

A 2013 “Oregon Resilience Plan” from the state government said that if the rupture occurred tomorrow, it would take 1 to 3 years to restore the drinking water and sewer service in the coastal zone. It would also take around 18 months to restore health care facilities in the valley zone and 3 years or more in the coastal zone. In addition, it would take around 6 to 12 months to restore “partial function” of the most important highways in the valley zone.

Considering this long-term damage to health care facilities and disrupted access to major highways, if the local pharmacy survives, it could become a hub for patients to get the health care they need.

^{Oregon Department of Geology and Mineral Industries}