Are We Really Ready? Preparing for Disasters

The United States has managedto escape a repeat ofthe severity of the hurricanesof 2005. Although hurricanes pose amajor threat, they are not the onlydisasters (natural or unnatural) thatpharmacists may encounter. Examplesof potential disasters thatpharmacists need to be aware of andprepared for can be found in theTable.¹

Now would be an excellent timefor pharmacies to take an assessmentto ensure that they are preparedin the event of a disaster. Manypharmacies may need to develop orupdate their emergency-preparednessplans. This article will focus ongeneral ideas and resources that willhelp tailor a plan to prepare pharmaciesin case a disaster strikes.

Resources

A great starting point is to contactcity and county managers, utilizingthem as a resource for informationon the highest probability threats tothe area. They should already have anemergency-preparedness plan in placeand are generally willing to share it sothat pharmacists can see what theirstores can expect with regard to localassistance. Pharmacy managers also areencouraged to contact their state boardsof pharmacy regarding rules and regulationsabout disaster preparation. Someboards of pharmacy may require proof ofemergency plans or mandated reportingof damaged products after a disaster.

After obtaining information from localgovernment officials and state boards ofpharmacy, the next step would be toevaluate current practice sites and developor update an emergency-preparednessplan according to the highest probabilitythreats to the region. To helpdevelop or update this plan, pharmacistsmay seek additional information fromthe following resources:

• American Pharmaceutical Association:www.aphanet.org
• American Society of Health-SystemPharmacists: www.ashp.org
• Centers for Disease Control andPrevention: www.cdc.gov
• Federal Emergency ManagementAgency: www.fema.gov
• Joint Commission on Accreditationof Healthcare Organizations: www.jointcommission.org

Critical Purchases

When creating or updating an emergencyplan, one should anticipate severalfactors from most disasters. Purchasinga few basic items ahead oftime may go a long way in helpingwith the most frequent problemresulting from disasters: power outages.Pharmacists should considerpurchasing a portable or permanenton-site generator. The size and typeof generator will depend on theneeds of the pharmacy. Those pharmaciesdependent upon automationfor a majority of their prescriptionprocessing may want to consider alarger or permanent generator. If agenerator does not fit within thepharmacy's budget or needs, coolersand ice may be warranted for refrigeratedproducts such as insulin. Acquiringa manual (ie, nonelectric)typewriter may be beneficial for theproduction of prescription labels.Flashlights, batteries, a fire extinguisher,and hard copies of druginformation and identification resourcesmay also be helpful.

Communication

Communication tends to be problematicin the first few days followinga disaster. The pharmacy manager mayconsider maintaining an updated telephonelist of pharmacy staff contactinformation, which would consist ofaddresses, home phone numbers, cellphone numbers, and family contacts.This list may also include anyone who isan essential employee who is expectedto report to work either before or after adisaster. Contact information for localhospitals, fire departments, policedepartments, local doctors, and countyemergency management headquartersshould also be readily available.

Drug Inventory

While your daily operations may beimpaired during a disaster, those of primarywholesalers may be impacted aswell. Therefore, pharmacy managersshould obtain contact information forwholesalers and inquire about theiremergency-preparedness plans. Items todiscuss with wholesalers may includehow to place an order during a disaster,delivery process and schedule changes,what to do in the event of a total loss ofinventory, and lifting limitations on acredit line. If a pharmacy does notalready have a secondary wholesaler, itshould consider contracting with one?preferably one that is not located in thesame region as the primary wholesaler.That secondary wholesaler will be beneficialin the event that the primary wholesalercannot supply medication.

To safeguard current inventory, it isrecommended to cover all drug productswith waterproof material. Those productsthat are in low-lying areas of thepharmacy should be moved to a higher,safer location if flooding is a potentialthreat. Should a disaster be on the levelof Hurricane Katrina, drug inventoriesmay be quickly depleted or nonexistent.Pharmacies should plan to operate withoutreceiving a shipment of medicationsfor 2 to 3 days. Stockpiling should occuronly at pharmacies that are part of a localor state emergency-preparedness planand will be relied on to provide largenumbers of these medications. If federalassistance is granted after a disaster,then certain critical medications andsupplies will arrive in 50-ton PushPackages from the Strategic NationalStockpile. These packages contain onlyantibiotics, antitoxins, intravenous fluids,and airway-management supplies.^1,2Maintenance medications should still beobtained from your wholesaler.

Physical Structure

Imminent disasters can provide anopportunity to secure the physical structureof a pharmacy. For example, if apharmacy is located in a hurricane-proneregion, all windows should be coveredwith either hurricane shutters or plywood.Pharmacists should arrange inadvance to have an alternate site or touse an on-site trailer, should the pharmacysuffer significant damage.

Computers/Software

Daily backup of file information on allcomputers is recommended. In theevent of an imminent disaster, 2 backupdisks should be created: one that ismaintained in a safe area of the pharmacyand another that is taken off-site bythe pharmacy manager. An additionalbackup disk may not be necessary if filesare maintained through a corporatedatabase. If flooding is a potential threat,computers should be unplugged, movedto a safer area, and covered with waterproofmaterial. Part of the emergencypreparednessplan should include how todeal with the loss of computers and systemsoftware, and inquiries to the systemsoftware company regarding thismatter should be made in advance.

Emergency Dispensing

Because computer files and hardcopies may be inaccessible following adisaster, an emergency-preparednessplan should include procedures regardingdispensing of emergency prescriptions.Pharmacists should check with theirstate boards of pharmacy for refill provisionsin the event of a disaster. In addition,it is advisable to check with majorpharmacy benefit managers to determinetheir protocols for emergency refills.

Transportation

Transportation may be impacted duringa disaster. Employers may considerdeveloping a plan to ensure the safearrival of employees to the pharmacy. Inaddition, pharmacies that have a deliverycomponent as part of their daily operations(eg, long-term care pharmacies,home infusion pharmacies) will need todevelop a backup plan on how to delivermedications to their patients.

Volunteering

Disasters affect everyone, and pharmacistsplay a vital role in emergencyresponseteams. Pharmacists who arewilling to volunteer for these teams areencouraged to be trained and certified inbasic first aid, cardiopulmonary resuscitation,and immunizations. Team involvementmay occur at the local, state, andnational levels. Pharmacists interested involunteering can contact their countyemergency-management officials, whocould put them in touch with state andnational officials.

No one can always be prepared foreverything during a disaster. Everypharmacy has different needs to consider.No cookie-cutter approach existsto planning for a disaster; therefore,each pharmacy manager should use allavailable resources to create the bestplan for his or her pharmacy. Having aplan in place in advance will minimizeconfusion and enhance the ability todeal with most situations that resultfrom a disaster.

Mr. Gregory Brown is a pharmacy managerat Sav-On Pharmacy/Albertsons.Dr. Dana Brown is an assistant professorof pharmacy practice at the Lloyd L.Gregory School of Pharmacy, PalmBeach Atlantic University.

References

1. Teeter DS. Disaster preparedness and pharmacy: an important partnership. US Pharmacist.2004;29. Available at: www.uspharmacist.com/index.asp?show=article&page=8_1217.htm. Accessed October 17, 2006.

2. American Society of Health-System Pharmacists. ASHP statement on the role of health-system pharmacists in emergency preparedness. Am J Health-Syst Pharm. 2003;60:1993-1995.