- Email: [email protected]
Call to action: Integrating student pharmacists, faculty, and pharmacy practitioners into emergency preparedness and response
SPECIAL FEATURE
Call to action: Integrating student pharmacists, faculty, and pharmacy practitioners into emergency preparedness and response Lisa Joanne Woodard, Brenda S. Bray, David Williams, and Colleen M. Terriff
Received October 29, 2009, and in revised form January 28, 2010. Accepted for publication January 28, 2010.
Abstract Objectives: To describe the pharmacist experience in emergency preparedness and response and to provide information and resources to help practitioners engage in this public health effort in their local communities. Setting: Spokane, WA, health care community, 1998 through 2009. Practice description: The College of Pharmacy at Washington State University, Spokane, has developed partnerships with local public health and community providers to address emergency preparedness and response needs. Working through the Metropolitan Medical Response System has created opportunities to participate in emergency preparedness planning and exercises. Collaboration with local agencies has provided opportunities for faculty and student pharmacists to respond to meet emergency needs in the community. Practice innovation: Emergency preparedness and response education, training, and service implemented in partnership with public health and community providers prepared student pharmacists and experienced pharmacy practitioners to respond to emergency needs in our community. Main outcome measures: Not applicable. Results: Not applicable. Conclusion: Colleges and schools of pharmacy can take a lead in preparing student pharmacists for this role by incorporating emergency preparedness training into curricula. Community pharmacists can develop their knowledge and skills in emergency preparedness through individualized continuing education plans and integration into community teams through volunteerism. Partnerships developed with local public health and emergency response agencies provide opportunities for pharmacists to become integral members of planning and response teams. Training exercises provide opportunities to test preparedness plans and provide professional education and experience. Actual emergency response activities demonstrate the value of the pharmacist as an important member of the emergency response team. Keywords: Public health, emergency preparedness, emergency response, experiential training, collaboration, pharmacists, pharmacy education, collaborative practice. J Am Pharm Assoc. 2010;50:158–164. doi: 10.1331/JAPhA.2010.09187
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Lisa Joanne Woodard, PharmD, MPH, is Clinical Assistant Professor; and Brenda S. Bray, BPharm, MPH, is Clinical Assistant Professor, Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane. David Williams, BPharm, is Clinical Pharmacist and Immunization Specialist, Safeway Pharmacies, Bellevue, WA. Colleen M. Terriff, PharmD, BCPS (AQ-ID), is Clinical Associate Professor, Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane. Correspondence: Lisa Joanne Woodard, College of Pharmacy, Washington State University, PO Box 1495, Spokane, WA 992101495. Fax: 509-358-7744. E-mail: woodard@ wsu.edu Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria. Acknowledgment: To Professor William E. Fassett, PhD, for his mentorship in the development of this article. Previous presentation: American Association of Colleges of Pharmacy Annual Meeting, San Diego, CA, July 8–12, 2006.
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he pharmacist is a trusted health professional with great patient accessibility throughout our health care system. Pharmacy is the third largest health profession in the United States after nursing and medicine. More than 200,000 pharmacists currently serve the public in community pharmacies, hospitals, and other settings. Approximately 50,000 professional-degree student pharmacists are enrolled in Doctor of Pharmacy programs,1 and only five states do not house 1 of 113 currently active Doctor of Pharmacy programs.2 Upwards of 300,000 pharmacists or pharmacists-in-training are well positioned to respond to public health challenges. The wide distribution of pharmacists in urban, suburban, and rural areas and their ready access to patients3 strategically positions pharmacy to apply professional competence in meeting critical needs in emergency preparedness and response. Involvement of pharmacists in local emergency preparedness planning has been documented in reports on the Omaha Metropolitan Medical Response System (MMRS)4 and the Spokane, WA, citywide preparedness plan.5 A compelling example of pharmacists in action can be found in the aftermath of Hurricane Katrina, during which pharmacists provided tri-
At a Glance
Synopsis: The Washington State University College of Pharmacy (COP) implemented programs in partnership with public health and community providers to prepare student pharmacists and pharmacy practitioners to respond to emergency needs in Spokane. COP was actively involved in planning and implementing the Washington State Bioterrorism Exercise in 2007, and the college was able to apply these skills during a real-life snow emergency in January 2008 and again during the recent H1N1 influenza pandemic. These experiences demonstrate that colleges and schools of pharmacy can prepare student pharmacists to engage in emergency preparedness and the value of the pharmacist as an important member of the emergency response team. Analysis: Valuable lessons have been learned by COP during its collaborations with community partners during the previous several years, including the following: testing specific exercise objectives such as clinic set up, communications, or movement of resources is best done by keeping other elements of the test as simple as possible; assessing the community’s response to triage and treatment/prophylaxis requires added complexity, such as pediatric and special-needs patients or two different medications; contacting pharmacies directly via telephone during normal business hours resulted in nearly 100% willingness to provide requested information, and the majority of pharmacies expressed willingness to participate further as needed; and the importance of possessing an open mind and willingness to step outside expected roles if needed.
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age, treatment, and refills for hundreds of patients displaced by the hurricane who needed chronic medications.6 Evidence suggests a substantial need to supplement the existing health care workforce with additional trained professionals in the event of a disaster or public health emergency. Recent studies have demonstrated that as little as 48% of the health care workforce might be available and actually report to work, depending on the nature of the disaster.7,8 The range across these studies is 48% to 98%, depending on locale and the nature of the emergency. Colleges and schools of pharmacy are fortuitously positioned to provide a potential reserve of trained individuals to respond to public health emergencies and to use the planning and training process, as well as actual emergency response, as opportunities to train student pharmacists and current practitioners.
Objectives This article summarizes the experience of the Washington State University (WSU) College of Pharmacy (COP) as it implemented programs in partnership with public health and community providers to prepare student pharmacists and experienced pharmacy practitioners to respond to emergency needs in the community. We also provide information and resources to help practitioners engage in this public health effort in their local communities.
Pharmacists skilled to meet the challenge The American Society of Health-System Pharmacists (ASHP) has recognized the key role that the pharmacist should play in the planning and execution of preparedness plans.9 Additionally, the impending possibility of an influenza pandemic brought several pharmacy organizations together to develop A Pharmacist’s Guide to Pandemic Preparedness, which was published jointly in 2007 by the American Pharmacists Association (APhA), ASHP, and the National Association of Chain Drug Stores Foundation.10 These organizations recognize that pharmacists possess valuable skills that uniquely position them to play key roles in emergency preparedness, including: ■■ Developing diagnosis and treatment guidelines. ■■ Managing medication distribution systems. ■■ Managing health care system resources. ■■ Managing medication therapy of individuals. ■■ Addressing community communication needs. ■■ Delivering individualized education.
Meeting community needs
Spokane’s MMRS In 1996, the Department of Health and Human Services founded MMRS, which currently operates under the Department of Homeland Security. Spokane is 1 of 124 cities or jurisdictions across the country participating in this federally funded program. A multidisciplinary MMRS committee, with members from law enforcement, fire, hazardous materials, medical examiner’s office, public health, hospital, transport/emergency medical services, and pharmacy, was formed. The committee www.japha.org
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was charged with integrating and enhancing existing response systems for a mass casualty event, incorporating customized incident planning and specialized training and exercises, and acquiring personal protective equipment, medical supplies, and pharmaceuticals. Although specific mass casualty event planning may anticipate bioterrorism, chemical terrorism, radiological dispersal devices, and/or improvised explosive devices (IEDs), MMRS programs are encouraged to have an “all-hazards” approach.11 Pharmacists have played an integral part in strategizing for pharmaceutical purchases, storage, distribution, and rotation and are encouraged to volunteer services and maintain involvement in this program. This created opportunities for WSU student pharmacists to assist the committee pharmacist with stockpile maintenance and training opportunities and participation as victims in citywide full-scale exercises. Memorandum of understanding for pharmacy resources The Spokane Regional Health District (SRHD), which is the lead public health agency for Spokane County and seven surrounding rural counties, serves more than 400,000 people in Spokane County alone. Organizing prehospital and community health resources to reduce morbidity and mortality from major emergencies and disasters is an important emergency support function for public health. At monthly MMRS meetings and during exercise planning, it became apparent that COP offered an important resource to citizens and the communities. A memorandum of understanding (MOU) titled Providing Pharmacy Students and Faculty Resources for Public Health Emergencies, Disasters, or Terrorism Response Efforts was composed by SRHD and COP (Table 1). The MOU establishes the recruitment of student pharmacists and faculty to respond to a major event if needed. Depending on student pharmacists’ status in the program and their past and current experience, they are expected to assist with dispensing prophylaxis medi-
cations, administer vaccines, counsel during the triage, monitor for adverse drug events or vaccine reactions, and assist with postevent public education campaigns. Faculty are to be used as preceptors and consultants in their area of expertise (e.g., pediatrics, geriatrics, infectious diseases) or for general assistance. The MOU is activated by a request for pharmacy resources by SRHD or local emergency management officials to an identified point of contact (e.g., dean, department chair) in COP. The COP contact will, in turn, confirm approval from appropriate university officers (e.g., the provost). The COP agrees to: ■■ Encourage student pharmacists and faculty to volunteer. ■■ Suspend or modify pharmacy program requirements as needed to allow participation. ■■ Ensure adequate preceptor coverage and ensure that student pharmacists and faculty are properly credentialed and are in good standing with COP. SRHD has agreed to provide: ■■ Basic volunteer training. ■■ Exercise participation opportunities. ■■ 24/7 contact information. ■■ Liability coverage. ■■ Sufficient information to the dean to distribute to student pharmacists and faculty to make an informed consent to participate. Communication systems Upon implementation of the MOU, COP developed a communication system for alerting potential participants to an urgent need (e.g., 50 student pharmacists and 5 faculty volunteers needed for a point-of-dispensing [POD] clinic in 30 minutes). The COP information technology department created a Webbased system in which student pharmacists and faculty could enter emergency contact information. This system was tested during the Spokanthrax exercise in fall 2008 (described below).
Table 1. Components of a memorandum of understanding between a pharmacy resource (i.e., organization, business) and a health district (local, regional, or state) Title. Example: Providing Pharmacy Students and Faculty Resources for Public Health Emergencies, Disasters, or Terrorism Response Efforts Background. A few paragraphs to explain the recognition of need for this pharmacy resource, the agencies involved (and area of coverage), and general public health responsibilities and efforts. Understanding. What will be requested (i.e., personnel to volunteer), scope of work, and general responsibilities. Activation process. Request steps (including if permission or authorization is necessary). Responsibilities of pharmacy resource. Statement on encouragement of volunteerism and what steps are necessary to free up personnel (i.e., college/school: suspend coursework), specific responsibilities of resource to ensure minimum requirements or competences and communication (i.e., 24/7 three-deep contact list) specifics. Responsibilities of health district. Areas provided during or in preparation for emergency or situation such as training, opportunities for participation, 24/7 three-deep contact list, state labor and industry insurance, liability coverage, and adequate timely information to pharmacy resource to ensure informed consent of volunteers. Implementation. Event scope for which this agreement may be implemented (i.e., training and exercises, nonemergency events versus local or state declared emergencies), relevant state laws and codes for emergency volunteers, and when memorandum is effective and how and when it can be terminated. Signatures to agreement. This includes signatures and dates of both parties’ top officials or administrators. 160 • JAPhA • 50 : 2 • M a r /A p r 2010
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Table 2. National and international resources for emergency preparedness and response Resource American Red Cross American Society of Health-System Pharmacists (ASHP) Centers for Disease Control and Prevention
Department of Health & Human Services
Department of Homeland Security Environmental Protection Agency Federal Emergency Management Agency Food and Drug Administration
Metropolitan Medical Response System Department of Veterans Affairs
World Health Organization
Contact/access information www.redcross.org http://symposia.ashp.org/emergency/ overview.asp www.cdc.gov www.bt.cdc.gov www.bt.cdc.gov/stockpile www.hhs.gov www.hhs.gov/disasters www.oep-ndms.dhhs.gov http://pandemicflu.gov www.dhs.gov www.dhs.gov/files/prepresprecovery.shtm www.epa.gov www.epa.gov/emergencies/index.htm www.fema.gov www.fema.gov/hazard/index.shtm www.fda.gov www.fda.gov/emergencypreparedness/ default.htm www.mmrs.fema.gov www1.va.gov www1.va.gov/emshg www.who.int www.who.int/topics/disease_outbreaks/en
COP has also collaborated with our local professional pharmacy organization, the Spokane Pharmacy Association (SPA), to establish communication links with pharmacists and pharmacy technicians in the community. SPA uses e-mail via ConstantContact (Waltham, MA) to communicate regularly with approximately 300 pharmacist members and 40 pharmacy technician members and uses a “blast fax” system to reach 115 pharmacy locations. SPA maintains current phone numbers for institutional and community pharmacies. In spring 2009, a team of student pharmacists was assembled and used the contact list to quickly compile information about current inventory levels of antiviral medications (e.g., oseltamivir, zanamivir) in the region.
Training opportunities
Emergency preparedness and public health response COP has, since 2000, required student pharmacists to become certified to administer vaccines as part of the core curriculum. Following the mass immunization exercise in 2005 (described below) and COP’s expanded involvement with local emergency preparedness and response activities, an elective course (Emergency Preparedness and Public Health Response: The Role of the Pharmacist) was positioned in the third year of the professional curriculum to help student pharmacists gain adJournal of the American Pharmacists Association
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Comments Disaster services Disasters and emergency response: ASHP Research and Education Foundation Main page Emergency preparedness and response Strategic National Stockpile Main page Disasters and emergencies National Disaster Medical System Pandemic influenza Main page Preparedness, response, and recovery Main page Emergency management Main page Disaster information Main page Emergency preparedness and response Disaster and emergency information Main page Emergency Management Strategic Health Care Group Main page Emergencies: disease outbreaks
ditional essential knowledge about emergency preparedness, introduce/reinforce multidisciplinary collaboration, and motivate student pharmacists to become active practitioners in emergency preparedness. A variety of emergency preparedness and response tools were consulted originally and are routinely used in course design and modification (Tables 2 and 3). Current community practitioners will find these resources valuable as they develop personalized continuing education plans for emergency preparedness. Key topics covered in the course include foundational information on biological and chemical bioterrorism agents, review of pandemic influenza, discussion of leadership in crisis, personal preparedness strategies, guest lecturers and discussion panels from the emergency response community, tabletop exercises, and hands-on experiences such as participation in an exercise. The course is modified annually to reflect the current emergency preparedness and response needs or activities in the Spokane community. Since fall 2007, the course requires each student pharmacist to participate in a communitywide activity. Student pharmacist course evaluations and reflections have been positive and indicate that they value the experiences provided during the class. Bio- and chemical terrorism and IED training Beyond the Doctor of Pharmacy curriculum, COP faculty have partnered with local emergency preparedness groups for forwww.japha.org
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malized training activities. Throughout the previous decade, didactic lectures and interactive discussions on bio- and chemical terrorism were delivered to hundreds of physicians, nurses, pharmacists, pharmacy technicians, paramedics, and fire, hazmat, and security personnel. Scheduled for spring 2010 is a series of training sessions on managing disasters and injuries involving IEDs. Two COP faculty and two third-year student pharmacists are participating in the development and delivery of the workshop curriculum and plan to use a human patient simulator with injured limbs and other body parts to simulate the care of patients who have been victims of an IED.
Emergency preparedness exercises Based on COP experience, the most important element of preparing to respond effectively to an actual emergency is participation in full-scale exercises. Since 2005, COP has participated as an important player in three major exercises. Each emergency preparedness exercise represents an opportunity to practice and evaluate the mechanisms for collaboration between all participating agencies. Each exercise described below has provided valuable feedback for improving the plan and execution of a response effort. Mass influenza vaccination exercise Mass immunization clinics provide a unique venue to test emergency response systems and, from the SRHD point of view, are indistinguishable from bioterrorism preparation because vaccines, antitoxins, and other injectable medications are key tools in mitigating bioterrorism attacks. Participation in a mass immunization exercise during fall 2005 included widespread participation from COP faculty, staff, and students. The postevent evaluation concluded that mass prophylaxis can be provided in the event of a communicable disease outbreak through collaboration of health districts and community partners and that student pharmacists are effective participants in a mass vaccination effort. The positive results of this first emergency preparedness exercise resulted in COP faculty, staff, and student pharmacists becoming recognized as integral to the emergency response efforts in our community. Washington State bioterrorism exercise The Spokane MMRS committee, along with other community partners, participated in a full-scale, state-coordinated exercise to test both state and local community response to bioterrorism attack with receipt and distribution of strategic national stockpile and set up of multiple-site mass vaccination clinics. The Washington State Bioterrorism Exercise (WASABE) took place on November 1, 2007. COP was actively involved in planning and implementing this exercise, with a faculty member serving on the planning committee and as the clinical operations director for a medication center site. WASABE provided a multifaceted educational opportunity for student pharmacists. Student pharmacists from the emergency preparedness elective course were activated to serve as vaccinators, educators, and medical screeners for vaccine eligibility. The exercise also provided a learning opportunity for a postgraduate year 2 infectious disease pharmacy resident to provide guidance and vacci162 • JAPhA • 50 : 2 • M a r /A p r 2010
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nation expertise and to precept student pharmacists in vaccine administration. Student pharmacists and faculty completed education and training before the exercise. This event demonstrated the successful involvement of the pharmacists employed by a grocery store chain in a public health emergency, which emerged from an ongoing partnership between Safeway Pharmacy and COP. Safeway Pharmacy operates 11 pharmacies in Spokane County, all of which offer immunization services. Since 2004, Safeway has been participating in seasonal influenza immunization campaigns and has continued to expand the vaccinations offered to include all Advisory Committee on Immunization Practices (ACIP)-recommended vaccinations for patients 11 years of age or older, with intranasal influenza vaccination offered for patients 5 to 49 years of age within ACIP guidelines. Safeway’s immunizing pharmacists are APhA trained, adhere to all state and Occupational Safety and Health Administration requirements, and are trained to respond to emergency situations including cardiopulmonary resuscitation and epinephrine administration in the event of anaphylaxis. Safeway personnel participated in the year-long planning for this event and managed the immunizing area of WASABE. Spokanthrax The Spokane branch of the U.S. Post Office began planning for a full-scale bioterrorism exercise in early 2008 (Spokanthrax) to test mail-sorting and biodetection equipment and response efforts. COP was integrally involved in the planning, execution, and evaluation of this successful exercise. Included during the exercise was the opportunity for COP to test its Web-based communication system and ability to run a POD clinic. Student pharmacists taking the emergency preparedness elective played the role of postal employees and were on site to be evacuated, decontaminated, transported to, and run through a POD clinic. These mock employees ran through the clinic multiple times, posing as patients with a variety of needs (e.g., dialysis, pregnancy, hearing impaired, limited English proficiency). Other COP student pharmacists played the role of prescription dispensers at the POD. These student pharmacists and two COP faculty members were on the WSU campus the morning of the exercise and were prepared to help staff the dispensing clinic as screeners, dispensers, educators, and clinic supervisors. As the exercise unfolded, a request for pharmacy resources was transmitted to COP. The emergency contact information system was activated, and details such as POD location were sent to the off-site student pharmacists and faculty to test both the communication system and response time. Student pharmacists and faculty responded and were directed to move to the POD site. This exercise demonstrated that the emergency response system could be successful in contacting and mobilizing volunteers to meet an emergent need.
Real-life emergencies
Weather-related emergency called Spokane received a record 40-inch snowfall in January 2008. The following month, high winds created blowing snow and deep Journal of the American Pharmacists Association
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Table 3. Online courses/training and sample tabletop exercises for emergency preparedness and response Agency Centers for Disease Control and Prevention: emergency preparedness and response Emergency Management Institute, Department of Homeland Security Drinking Water and Wastewater System: Environmental Protection Agency Northwest Center for Public Health Practice, University of Washington Office for Domestic Preparedness, Department of Homeland Security Center for Public Health Preparedness, University of Minnesota Center for Biopreparedness, Creighton University and University of Nebraska Medical Centers Center for Food Security and Public Health, Iowa State University Center for Public Health Preparedness, School of Public Health, University at Albany
Contact/access information www.bt.cdc.gov/training
Comments Specific types of emergencies or audiences (public health, clinicians, and laboratories) training and education Main page www.training.fema.gov http://training.fema.gov/ Introduction to the Incident Command System for EMIWeb/IS/is100HC.asp Healthcare/Hospitals http://cfpub.epa.gov/safewater/ Training courses, meetings, and workshops/webcasts watersecurity/outreach.cfm for water security www.nwcphp.org/training/ Variety of tabletop exercises and online modules courses-exercises www.agpreparedness.org Agroterrorism resources and training http://cpheo.sph.umn.edu/ umncphp/online/home.html http://bioprepare.org
Medical, first-responder, public health, and business/ industry resources and live and Web-based training
www.cfsph.iastate.edu
Veterinary disease resources and continuing education
www.ualbanycphp.org
Public health and community response partners resources and e-learning center
drifts, closing roads both south and west of the city. The Office of Emergency Management became concerned that homebound individuals would be unable to access crucial items such as prescription medications. On a late Friday afternoon, a COP faculty member was called by Spokane’s Emergency Operations center with a request to coordinate a medication-need triage and transportation of important medications from a pharmacy to the patient. COP quickly implemented emergency response plans. A message was sent via the blast fax and e-mail systems asking Spokane pharmacists for assistance. In addition, two faculty members handled phone calls from stranded patients throughout the weekend. Community pharmacists responded to our communicated alert and volunteered their assistance as needed. H1N1 influenza pandemic Rapid response to the H1N1 pandemic through mass vaccination of priority groups allowed COP to work with SRHD and other local agencies to once again put into action plans that had been laid previously. SRHD activated our MOU, and our internal COP communication system was used to communicate clinic details and recruit participants. Working under a collaborative practice agreement established with the SRHD medical director, intramuscular and intranasal H1N1 immunizations were delivered to more than 3,500 community members. These vaccine doses were administered at clinics held at the local sporting arena, YMCA, and area homeless shelters.
Lessons learned COP’s collaborations with community partners during the previous several years have provided the following valuable lessons: Journal of the American Pharmacists Association
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■■ Testing specific exercise objectives such as clinic set up, communications, or movement of resources is best done by keeping other elements of the test as simple as possible (e.g., use M&M candies to simulate one medication, provide only one type of vaccine). ■■ Assessing the community’s response to triage and treatment/prophylaxis requires added complexity, such as pediatric and special-needs patients or two different medications (e.g., doxycycline and ciprofloxacin or intramuscular and intranasal influenza vaccinations). ■■ Community colleges are potentially useful facilities for clinic sites, but turnout of community college students to test vaccination efforts was relatively low, as they were generally unwilling to pay for vaccination. ■■ Data from e-mail systems such as Constant Contact reveal that only about 40% of recipients read the e-mail within 3 days (S.E. Fassett, personal communication, October 2009); these systems may be inadequate for immediate responses but quite useful for encouraging enrollment or gauging interest if time allows. Electronic alert systems that connect through the participant’s cell phone are likely to be more effective in emergencies. ■■ Contacting pharmacies directly via telephone during their normal business hours resulted in nearly 100% willingness to provide requested information, and the majority of pharmacies expressed willingness to participate further as needed. ■■ Bring drug information resources in both hard copy and electronic format to events. ■■ Participate in just-in-time training. Arm yourself with knowledge. www.japha.org
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■■ Possess an open mind and flexibility. Be willing to step outside your expected role if needed.
Preparing pharmacists for roles in emergency preparedness
References
Pharmacists can take the following steps to prepare for emergency response needs in their communities: ■■ Complete immunization certification through APhA or other certification programs ■■ Maintain current life-support certification (e.g., American Heart Association Basic Cardiac Life Support for Health Care Providers) ■■ Complete Federal Emergency Management Agency–Incident Command System level 100 training ■■ Complete emergency preparedness training for pharmacists ■■ Contact your local health district to identify needs for pharmacist involvement ■■ Establish a MOU between the local health district and your organization ■■ Establish a collaborative practice agreement with your local public health officer ■■ Encourage and support local pharmacy schools in immunization and emergency preparedness education for student pharmacists ■■ Participate in health district educational activities (tabletop exercises, drills, just-in-time training)
1. American Association of Colleges of Pharmacy. About AACP. Accessed at www.aacp.org/about/Pages/default.aspx, July 28, 2009.
Conclusion
10 American Pharmacists Association, American Society of HealthSystem Pharmacists, and National Association of Chain Drug Stores Foundation. A pharmacist’s guide to pandemic preparedness. Accessed at www.ashp.org/Import/PRACTICEANDPOLICY/ PublicHealthResourceCenters/Influenza/PharmacistsGuidetoPandemicPlanning.aspx, October 20, 2009.
With proper education and training, pharmacists and student pharmacists are uniquely positioned to play integral roles in emergency preparedness and response efforts in their communities. Successful strategies adopted by WSU COP to prepare future pharmacists to participate in emergency response include education and training, creation of an organizational infrastructure for rapid communication, and engagement with community organizations for training and service. Including emergency preparedness content in Doctor of Pharmacy curricula is an important step to expanding the role of the pharmacist by training the next generation of practitioners. Colleges and schools of pharmacy can leverage their faculty and student pharmacist resources to serve communities during public
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health emergencies. Pharmacists living in communities without local pharmacy schools can mobilize their individual and collective resources to contribute to public health demands.
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2. Vlasses PH, Wadelin JW, Travlos DV. Accreditation Council for Pharmacy Education: annual report. Accessed at www.acpe-accredit.org/pdf/Annual_Report.pdf, July 28, 2009. 3. Knapp KK, Paavola FG, Maine LL, et al. Availability of primary care providers and pharmacist in the United States, J Am Pharm Assoc. 1999;39:127–35. 4. Massoomi F. Pharmacists in the Omaha Metropolitan Medical Response System. Am J Health Syst Pharm. 2005;62:1290–8. 5. Terriff CM, Tee AM. Citywide pharmaceutical preparation for bioterrorism. Am J Health Syst Pharm. 2001;58:233–7. 6. Richard C. In the eye of the storm: pharmacists respond. Pharmacy Today. 2005;11(10):1. 7. Qureshi K, Gershon RRM, Sherman MF, et al. Health care workers’ ability and willingness to report to duty during catastrophic disasters. J Urban Health. 2005;82:378–88. 8. DeSimone CL. Response of public health workers to various emergencies. AAOHN J. 2009;57:17–23. 9. American Society of Health-System Pharmacists. ASHP statement on the role of health-system pharmacists in emergency preparedness. Am J Health Syst Pharm. 2003;60:1993–5.
11. U.S. Department of Homeland Security. History of the Metropolitan Medical Response System (MMRS): the first decade: 1995-2005. Accessed at www.cabq.gov/envhealth/pdf/HistoryoftheMMRS.pdf, October 20, 2009.
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Call to action: Integrating student pharmacists, faculty, and pharmacy practitioners into emergency preparedness and response Lisa Joanne Woodard, Brenda S. Bray, David Williams, and Colleen M. Terriff
Received October 29, 2009, and in revised form January 28, 2010. Accepted for publication January 28, 2010.
Abstract Objectives: To describe the pharmacist experience in emergency preparedness and response and to provide information and resources to help practitioners engage in this public health effort in their local communities. Setting: Spokane, WA, health care community, 1998 through 2009. Practice description: The College of Pharmacy at Washington State University, Spokane, has developed partnerships with local public health and community providers to address emergency preparedness and response needs. Working through the Metropolitan Medical Response System has created opportunities to participate in emergency preparedness planning and exercises. Collaboration with local agencies has provided opportunities for faculty and student pharmacists to respond to meet emergency needs in the community. Practice innovation: Emergency preparedness and response education, training, and service implemented in partnership with public health and community providers prepared student pharmacists and experienced pharmacy practitioners to respond to emergency needs in our community. Main outcome measures: Not applicable. Results: Not applicable. Conclusion: Colleges and schools of pharmacy can take a lead in preparing student pharmacists for this role by incorporating emergency preparedness training into curricula. Community pharmacists can develop their knowledge and skills in emergency preparedness through individualized continuing education plans and integration into community teams through volunteerism. Partnerships developed with local public health and emergency response agencies provide opportunities for pharmacists to become integral members of planning and response teams. Training exercises provide opportunities to test preparedness plans and provide professional education and experience. Actual emergency response activities demonstrate the value of the pharmacist as an important member of the emergency response team. Keywords: Public health, emergency preparedness, emergency response, experiential training, collaboration, pharmacists, pharmacy education, collaborative practice. J Am Pharm Assoc. 2010;50:158–164. doi: 10.1331/JAPhA.2010.09187
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Lisa Joanne Woodard, PharmD, MPH, is Clinical Assistant Professor; and Brenda S. Bray, BPharm, MPH, is Clinical Assistant Professor, Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane. David Williams, BPharm, is Clinical Pharmacist and Immunization Specialist, Safeway Pharmacies, Bellevue, WA. Colleen M. Terriff, PharmD, BCPS (AQ-ID), is Clinical Associate Professor, Department of Pharmacotherapy, College of Pharmacy, Washington State University, Spokane. Correspondence: Lisa Joanne Woodard, College of Pharmacy, Washington State University, PO Box 1495, Spokane, WA 992101495. Fax: 509-358-7744. E-mail: woodard@ wsu.edu Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria. Acknowledgment: To Professor William E. Fassett, PhD, for his mentorship in the development of this article. Previous presentation: American Association of Colleges of Pharmacy Annual Meeting, San Diego, CA, July 8–12, 2006.
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he pharmacist is a trusted health professional with great patient accessibility throughout our health care system. Pharmacy is the third largest health profession in the United States after nursing and medicine. More than 200,000 pharmacists currently serve the public in community pharmacies, hospitals, and other settings. Approximately 50,000 professional-degree student pharmacists are enrolled in Doctor of Pharmacy programs,1 and only five states do not house 1 of 113 currently active Doctor of Pharmacy programs.2 Upwards of 300,000 pharmacists or pharmacists-in-training are well positioned to respond to public health challenges. The wide distribution of pharmacists in urban, suburban, and rural areas and their ready access to patients3 strategically positions pharmacy to apply professional competence in meeting critical needs in emergency preparedness and response. Involvement of pharmacists in local emergency preparedness planning has been documented in reports on the Omaha Metropolitan Medical Response System (MMRS)4 and the Spokane, WA, citywide preparedness plan.5 A compelling example of pharmacists in action can be found in the aftermath of Hurricane Katrina, during which pharmacists provided tri-
At a Glance
Synopsis: The Washington State University College of Pharmacy (COP) implemented programs in partnership with public health and community providers to prepare student pharmacists and pharmacy practitioners to respond to emergency needs in Spokane. COP was actively involved in planning and implementing the Washington State Bioterrorism Exercise in 2007, and the college was able to apply these skills during a real-life snow emergency in January 2008 and again during the recent H1N1 influenza pandemic. These experiences demonstrate that colleges and schools of pharmacy can prepare student pharmacists to engage in emergency preparedness and the value of the pharmacist as an important member of the emergency response team. Analysis: Valuable lessons have been learned by COP during its collaborations with community partners during the previous several years, including the following: testing specific exercise objectives such as clinic set up, communications, or movement of resources is best done by keeping other elements of the test as simple as possible; assessing the community’s response to triage and treatment/prophylaxis requires added complexity, such as pediatric and special-needs patients or two different medications; contacting pharmacies directly via telephone during normal business hours resulted in nearly 100% willingness to provide requested information, and the majority of pharmacies expressed willingness to participate further as needed; and the importance of possessing an open mind and willingness to step outside expected roles if needed.
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age, treatment, and refills for hundreds of patients displaced by the hurricane who needed chronic medications.6 Evidence suggests a substantial need to supplement the existing health care workforce with additional trained professionals in the event of a disaster or public health emergency. Recent studies have demonstrated that as little as 48% of the health care workforce might be available and actually report to work, depending on the nature of the disaster.7,8 The range across these studies is 48% to 98%, depending on locale and the nature of the emergency. Colleges and schools of pharmacy are fortuitously positioned to provide a potential reserve of trained individuals to respond to public health emergencies and to use the planning and training process, as well as actual emergency response, as opportunities to train student pharmacists and current practitioners.
Objectives This article summarizes the experience of the Washington State University (WSU) College of Pharmacy (COP) as it implemented programs in partnership with public health and community providers to prepare student pharmacists and experienced pharmacy practitioners to respond to emergency needs in the community. We also provide information and resources to help practitioners engage in this public health effort in their local communities.
Pharmacists skilled to meet the challenge The American Society of Health-System Pharmacists (ASHP) has recognized the key role that the pharmacist should play in the planning and execution of preparedness plans.9 Additionally, the impending possibility of an influenza pandemic brought several pharmacy organizations together to develop A Pharmacist’s Guide to Pandemic Preparedness, which was published jointly in 2007 by the American Pharmacists Association (APhA), ASHP, and the National Association of Chain Drug Stores Foundation.10 These organizations recognize that pharmacists possess valuable skills that uniquely position them to play key roles in emergency preparedness, including: ■■ Developing diagnosis and treatment guidelines. ■■ Managing medication distribution systems. ■■ Managing health care system resources. ■■ Managing medication therapy of individuals. ■■ Addressing community communication needs. ■■ Delivering individualized education.
Meeting community needs
Spokane’s MMRS In 1996, the Department of Health and Human Services founded MMRS, which currently operates under the Department of Homeland Security. Spokane is 1 of 124 cities or jurisdictions across the country participating in this federally funded program. A multidisciplinary MMRS committee, with members from law enforcement, fire, hazardous materials, medical examiner’s office, public health, hospital, transport/emergency medical services, and pharmacy, was formed. The committee www.japha.org
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was charged with integrating and enhancing existing response systems for a mass casualty event, incorporating customized incident planning and specialized training and exercises, and acquiring personal protective equipment, medical supplies, and pharmaceuticals. Although specific mass casualty event planning may anticipate bioterrorism, chemical terrorism, radiological dispersal devices, and/or improvised explosive devices (IEDs), MMRS programs are encouraged to have an “all-hazards” approach.11 Pharmacists have played an integral part in strategizing for pharmaceutical purchases, storage, distribution, and rotation and are encouraged to volunteer services and maintain involvement in this program. This created opportunities for WSU student pharmacists to assist the committee pharmacist with stockpile maintenance and training opportunities and participation as victims in citywide full-scale exercises. Memorandum of understanding for pharmacy resources The Spokane Regional Health District (SRHD), which is the lead public health agency for Spokane County and seven surrounding rural counties, serves more than 400,000 people in Spokane County alone. Organizing prehospital and community health resources to reduce morbidity and mortality from major emergencies and disasters is an important emergency support function for public health. At monthly MMRS meetings and during exercise planning, it became apparent that COP offered an important resource to citizens and the communities. A memorandum of understanding (MOU) titled Providing Pharmacy Students and Faculty Resources for Public Health Emergencies, Disasters, or Terrorism Response Efforts was composed by SRHD and COP (Table 1). The MOU establishes the recruitment of student pharmacists and faculty to respond to a major event if needed. Depending on student pharmacists’ status in the program and their past and current experience, they are expected to assist with dispensing prophylaxis medi-
cations, administer vaccines, counsel during the triage, monitor for adverse drug events or vaccine reactions, and assist with postevent public education campaigns. Faculty are to be used as preceptors and consultants in their area of expertise (e.g., pediatrics, geriatrics, infectious diseases) or for general assistance. The MOU is activated by a request for pharmacy resources by SRHD or local emergency management officials to an identified point of contact (e.g., dean, department chair) in COP. The COP contact will, in turn, confirm approval from appropriate university officers (e.g., the provost). The COP agrees to: ■■ Encourage student pharmacists and faculty to volunteer. ■■ Suspend or modify pharmacy program requirements as needed to allow participation. ■■ Ensure adequate preceptor coverage and ensure that student pharmacists and faculty are properly credentialed and are in good standing with COP. SRHD has agreed to provide: ■■ Basic volunteer training. ■■ Exercise participation opportunities. ■■ 24/7 contact information. ■■ Liability coverage. ■■ Sufficient information to the dean to distribute to student pharmacists and faculty to make an informed consent to participate. Communication systems Upon implementation of the MOU, COP developed a communication system for alerting potential participants to an urgent need (e.g., 50 student pharmacists and 5 faculty volunteers needed for a point-of-dispensing [POD] clinic in 30 minutes). The COP information technology department created a Webbased system in which student pharmacists and faculty could enter emergency contact information. This system was tested during the Spokanthrax exercise in fall 2008 (described below).
Table 1. Components of a memorandum of understanding between a pharmacy resource (i.e., organization, business) and a health district (local, regional, or state) Title. Example: Providing Pharmacy Students and Faculty Resources for Public Health Emergencies, Disasters, or Terrorism Response Efforts Background. A few paragraphs to explain the recognition of need for this pharmacy resource, the agencies involved (and area of coverage), and general public health responsibilities and efforts. Understanding. What will be requested (i.e., personnel to volunteer), scope of work, and general responsibilities. Activation process. Request steps (including if permission or authorization is necessary). Responsibilities of pharmacy resource. Statement on encouragement of volunteerism and what steps are necessary to free up personnel (i.e., college/school: suspend coursework), specific responsibilities of resource to ensure minimum requirements or competences and communication (i.e., 24/7 three-deep contact list) specifics. Responsibilities of health district. Areas provided during or in preparation for emergency or situation such as training, opportunities for participation, 24/7 three-deep contact list, state labor and industry insurance, liability coverage, and adequate timely information to pharmacy resource to ensure informed consent of volunteers. Implementation. Event scope for which this agreement may be implemented (i.e., training and exercises, nonemergency events versus local or state declared emergencies), relevant state laws and codes for emergency volunteers, and when memorandum is effective and how and when it can be terminated. Signatures to agreement. This includes signatures and dates of both parties’ top officials or administrators. 160 • JAPhA • 50 : 2 • M a r /A p r 2010
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Table 2. National and international resources for emergency preparedness and response Resource American Red Cross American Society of Health-System Pharmacists (ASHP) Centers for Disease Control and Prevention
Department of Health & Human Services
Department of Homeland Security Environmental Protection Agency Federal Emergency Management Agency Food and Drug Administration
Metropolitan Medical Response System Department of Veterans Affairs
World Health Organization
Contact/access information www.redcross.org http://symposia.ashp.org/emergency/ overview.asp www.cdc.gov www.bt.cdc.gov www.bt.cdc.gov/stockpile www.hhs.gov www.hhs.gov/disasters www.oep-ndms.dhhs.gov http://pandemicflu.gov www.dhs.gov www.dhs.gov/files/prepresprecovery.shtm www.epa.gov www.epa.gov/emergencies/index.htm www.fema.gov www.fema.gov/hazard/index.shtm www.fda.gov www.fda.gov/emergencypreparedness/ default.htm www.mmrs.fema.gov www1.va.gov www1.va.gov/emshg www.who.int www.who.int/topics/disease_outbreaks/en
COP has also collaborated with our local professional pharmacy organization, the Spokane Pharmacy Association (SPA), to establish communication links with pharmacists and pharmacy technicians in the community. SPA uses e-mail via ConstantContact (Waltham, MA) to communicate regularly with approximately 300 pharmacist members and 40 pharmacy technician members and uses a “blast fax” system to reach 115 pharmacy locations. SPA maintains current phone numbers for institutional and community pharmacies. In spring 2009, a team of student pharmacists was assembled and used the contact list to quickly compile information about current inventory levels of antiviral medications (e.g., oseltamivir, zanamivir) in the region.
Training opportunities
Emergency preparedness and public health response COP has, since 2000, required student pharmacists to become certified to administer vaccines as part of the core curriculum. Following the mass immunization exercise in 2005 (described below) and COP’s expanded involvement with local emergency preparedness and response activities, an elective course (Emergency Preparedness and Public Health Response: The Role of the Pharmacist) was positioned in the third year of the professional curriculum to help student pharmacists gain adJournal of the American Pharmacists Association
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Comments Disaster services Disasters and emergency response: ASHP Research and Education Foundation Main page Emergency preparedness and response Strategic National Stockpile Main page Disasters and emergencies National Disaster Medical System Pandemic influenza Main page Preparedness, response, and recovery Main page Emergency management Main page Disaster information Main page Emergency preparedness and response Disaster and emergency information Main page Emergency Management Strategic Health Care Group Main page Emergencies: disease outbreaks
ditional essential knowledge about emergency preparedness, introduce/reinforce multidisciplinary collaboration, and motivate student pharmacists to become active practitioners in emergency preparedness. A variety of emergency preparedness and response tools were consulted originally and are routinely used in course design and modification (Tables 2 and 3). Current community practitioners will find these resources valuable as they develop personalized continuing education plans for emergency preparedness. Key topics covered in the course include foundational information on biological and chemical bioterrorism agents, review of pandemic influenza, discussion of leadership in crisis, personal preparedness strategies, guest lecturers and discussion panels from the emergency response community, tabletop exercises, and hands-on experiences such as participation in an exercise. The course is modified annually to reflect the current emergency preparedness and response needs or activities in the Spokane community. Since fall 2007, the course requires each student pharmacist to participate in a communitywide activity. Student pharmacist course evaluations and reflections have been positive and indicate that they value the experiences provided during the class. Bio- and chemical terrorism and IED training Beyond the Doctor of Pharmacy curriculum, COP faculty have partnered with local emergency preparedness groups for forwww.japha.org
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malized training activities. Throughout the previous decade, didactic lectures and interactive discussions on bio- and chemical terrorism were delivered to hundreds of physicians, nurses, pharmacists, pharmacy technicians, paramedics, and fire, hazmat, and security personnel. Scheduled for spring 2010 is a series of training sessions on managing disasters and injuries involving IEDs. Two COP faculty and two third-year student pharmacists are participating in the development and delivery of the workshop curriculum and plan to use a human patient simulator with injured limbs and other body parts to simulate the care of patients who have been victims of an IED.
Emergency preparedness exercises Based on COP experience, the most important element of preparing to respond effectively to an actual emergency is participation in full-scale exercises. Since 2005, COP has participated as an important player in three major exercises. Each emergency preparedness exercise represents an opportunity to practice and evaluate the mechanisms for collaboration between all participating agencies. Each exercise described below has provided valuable feedback for improving the plan and execution of a response effort. Mass influenza vaccination exercise Mass immunization clinics provide a unique venue to test emergency response systems and, from the SRHD point of view, are indistinguishable from bioterrorism preparation because vaccines, antitoxins, and other injectable medications are key tools in mitigating bioterrorism attacks. Participation in a mass immunization exercise during fall 2005 included widespread participation from COP faculty, staff, and students. The postevent evaluation concluded that mass prophylaxis can be provided in the event of a communicable disease outbreak through collaboration of health districts and community partners and that student pharmacists are effective participants in a mass vaccination effort. The positive results of this first emergency preparedness exercise resulted in COP faculty, staff, and student pharmacists becoming recognized as integral to the emergency response efforts in our community. Washington State bioterrorism exercise The Spokane MMRS committee, along with other community partners, participated in a full-scale, state-coordinated exercise to test both state and local community response to bioterrorism attack with receipt and distribution of strategic national stockpile and set up of multiple-site mass vaccination clinics. The Washington State Bioterrorism Exercise (WASABE) took place on November 1, 2007. COP was actively involved in planning and implementing this exercise, with a faculty member serving on the planning committee and as the clinical operations director for a medication center site. WASABE provided a multifaceted educational opportunity for student pharmacists. Student pharmacists from the emergency preparedness elective course were activated to serve as vaccinators, educators, and medical screeners for vaccine eligibility. The exercise also provided a learning opportunity for a postgraduate year 2 infectious disease pharmacy resident to provide guidance and vacci162 • JAPhA • 50 : 2 • M a r /A p r 2010
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nation expertise and to precept student pharmacists in vaccine administration. Student pharmacists and faculty completed education and training before the exercise. This event demonstrated the successful involvement of the pharmacists employed by a grocery store chain in a public health emergency, which emerged from an ongoing partnership between Safeway Pharmacy and COP. Safeway Pharmacy operates 11 pharmacies in Spokane County, all of which offer immunization services. Since 2004, Safeway has been participating in seasonal influenza immunization campaigns and has continued to expand the vaccinations offered to include all Advisory Committee on Immunization Practices (ACIP)-recommended vaccinations for patients 11 years of age or older, with intranasal influenza vaccination offered for patients 5 to 49 years of age within ACIP guidelines. Safeway’s immunizing pharmacists are APhA trained, adhere to all state and Occupational Safety and Health Administration requirements, and are trained to respond to emergency situations including cardiopulmonary resuscitation and epinephrine administration in the event of anaphylaxis. Safeway personnel participated in the year-long planning for this event and managed the immunizing area of WASABE. Spokanthrax The Spokane branch of the U.S. Post Office began planning for a full-scale bioterrorism exercise in early 2008 (Spokanthrax) to test mail-sorting and biodetection equipment and response efforts. COP was integrally involved in the planning, execution, and evaluation of this successful exercise. Included during the exercise was the opportunity for COP to test its Web-based communication system and ability to run a POD clinic. Student pharmacists taking the emergency preparedness elective played the role of postal employees and were on site to be evacuated, decontaminated, transported to, and run through a POD clinic. These mock employees ran through the clinic multiple times, posing as patients with a variety of needs (e.g., dialysis, pregnancy, hearing impaired, limited English proficiency). Other COP student pharmacists played the role of prescription dispensers at the POD. These student pharmacists and two COP faculty members were on the WSU campus the morning of the exercise and were prepared to help staff the dispensing clinic as screeners, dispensers, educators, and clinic supervisors. As the exercise unfolded, a request for pharmacy resources was transmitted to COP. The emergency contact information system was activated, and details such as POD location were sent to the off-site student pharmacists and faculty to test both the communication system and response time. Student pharmacists and faculty responded and were directed to move to the POD site. This exercise demonstrated that the emergency response system could be successful in contacting and mobilizing volunteers to meet an emergent need.
Real-life emergencies
Weather-related emergency called Spokane received a record 40-inch snowfall in January 2008. The following month, high winds created blowing snow and deep Journal of the American Pharmacists Association
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Table 3. Online courses/training and sample tabletop exercises for emergency preparedness and response Agency Centers for Disease Control and Prevention: emergency preparedness and response Emergency Management Institute, Department of Homeland Security Drinking Water and Wastewater System: Environmental Protection Agency Northwest Center for Public Health Practice, University of Washington Office for Domestic Preparedness, Department of Homeland Security Center for Public Health Preparedness, University of Minnesota Center for Biopreparedness, Creighton University and University of Nebraska Medical Centers Center for Food Security and Public Health, Iowa State University Center for Public Health Preparedness, School of Public Health, University at Albany
Contact/access information www.bt.cdc.gov/training
Comments Specific types of emergencies or audiences (public health, clinicians, and laboratories) training and education Main page www.training.fema.gov http://training.fema.gov/ Introduction to the Incident Command System for EMIWeb/IS/is100HC.asp Healthcare/Hospitals http://cfpub.epa.gov/safewater/ Training courses, meetings, and workshops/webcasts watersecurity/outreach.cfm for water security www.nwcphp.org/training/ Variety of tabletop exercises and online modules courses-exercises www.agpreparedness.org Agroterrorism resources and training http://cpheo.sph.umn.edu/ umncphp/online/home.html http://bioprepare.org
Medical, first-responder, public health, and business/ industry resources and live and Web-based training
www.cfsph.iastate.edu
Veterinary disease resources and continuing education
www.ualbanycphp.org
Public health and community response partners resources and e-learning center
drifts, closing roads both south and west of the city. The Office of Emergency Management became concerned that homebound individuals would be unable to access crucial items such as prescription medications. On a late Friday afternoon, a COP faculty member was called by Spokane’s Emergency Operations center with a request to coordinate a medication-need triage and transportation of important medications from a pharmacy to the patient. COP quickly implemented emergency response plans. A message was sent via the blast fax and e-mail systems asking Spokane pharmacists for assistance. In addition, two faculty members handled phone calls from stranded patients throughout the weekend. Community pharmacists responded to our communicated alert and volunteered their assistance as needed. H1N1 influenza pandemic Rapid response to the H1N1 pandemic through mass vaccination of priority groups allowed COP to work with SRHD and other local agencies to once again put into action plans that had been laid previously. SRHD activated our MOU, and our internal COP communication system was used to communicate clinic details and recruit participants. Working under a collaborative practice agreement established with the SRHD medical director, intramuscular and intranasal H1N1 immunizations were delivered to more than 3,500 community members. These vaccine doses were administered at clinics held at the local sporting arena, YMCA, and area homeless shelters.
Lessons learned COP’s collaborations with community partners during the previous several years have provided the following valuable lessons: Journal of the American Pharmacists Association
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■■ Testing specific exercise objectives such as clinic set up, communications, or movement of resources is best done by keeping other elements of the test as simple as possible (e.g., use M&M candies to simulate one medication, provide only one type of vaccine). ■■ Assessing the community’s response to triage and treatment/prophylaxis requires added complexity, such as pediatric and special-needs patients or two different medications (e.g., doxycycline and ciprofloxacin or intramuscular and intranasal influenza vaccinations). ■■ Community colleges are potentially useful facilities for clinic sites, but turnout of community college students to test vaccination efforts was relatively low, as they were generally unwilling to pay for vaccination. ■■ Data from e-mail systems such as Constant Contact reveal that only about 40% of recipients read the e-mail within 3 days (S.E. Fassett, personal communication, October 2009); these systems may be inadequate for immediate responses but quite useful for encouraging enrollment or gauging interest if time allows. Electronic alert systems that connect through the participant’s cell phone are likely to be more effective in emergencies. ■■ Contacting pharmacies directly via telephone during their normal business hours resulted in nearly 100% willingness to provide requested information, and the majority of pharmacies expressed willingness to participate further as needed. ■■ Bring drug information resources in both hard copy and electronic format to events. ■■ Participate in just-in-time training. Arm yourself with knowledge. www.japha.org
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■■ Possess an open mind and flexibility. Be willing to step outside your expected role if needed.
Preparing pharmacists for roles in emergency preparedness
References
Pharmacists can take the following steps to prepare for emergency response needs in their communities: ■■ Complete immunization certification through APhA or other certification programs ■■ Maintain current life-support certification (e.g., American Heart Association Basic Cardiac Life Support for Health Care Providers) ■■ Complete Federal Emergency Management Agency–Incident Command System level 100 training ■■ Complete emergency preparedness training for pharmacists ■■ Contact your local health district to identify needs for pharmacist involvement ■■ Establish a MOU between the local health district and your organization ■■ Establish a collaborative practice agreement with your local public health officer ■■ Encourage and support local pharmacy schools in immunization and emergency preparedness education for student pharmacists ■■ Participate in health district educational activities (tabletop exercises, drills, just-in-time training)
1. American Association of Colleges of Pharmacy. About AACP. Accessed at www.aacp.org/about/Pages/default.aspx, July 28, 2009.
Conclusion
10 American Pharmacists Association, American Society of HealthSystem Pharmacists, and National Association of Chain Drug Stores Foundation. A pharmacist’s guide to pandemic preparedness. Accessed at www.ashp.org/Import/PRACTICEANDPOLICY/ PublicHealthResourceCenters/Influenza/PharmacistsGuidetoPandemicPlanning.aspx, October 20, 2009.
With proper education and training, pharmacists and student pharmacists are uniquely positioned to play integral roles in emergency preparedness and response efforts in their communities. Successful strategies adopted by WSU COP to prepare future pharmacists to participate in emergency response include education and training, creation of an organizational infrastructure for rapid communication, and engagement with community organizations for training and service. Including emergency preparedness content in Doctor of Pharmacy curricula is an important step to expanding the role of the pharmacist by training the next generation of practitioners. Colleges and schools of pharmacy can leverage their faculty and student pharmacist resources to serve communities during public
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health emergencies. Pharmacists living in communities without local pharmacy schools can mobilize their individual and collective resources to contribute to public health demands.
www.japha.org
2. Vlasses PH, Wadelin JW, Travlos DV. Accreditation Council for Pharmacy Education: annual report. Accessed at www.acpe-accredit.org/pdf/Annual_Report.pdf, July 28, 2009. 3. Knapp KK, Paavola FG, Maine LL, et al. Availability of primary care providers and pharmacist in the United States, J Am Pharm Assoc. 1999;39:127–35. 4. Massoomi F. Pharmacists in the Omaha Metropolitan Medical Response System. Am J Health Syst Pharm. 2005;62:1290–8. 5. Terriff CM, Tee AM. Citywide pharmaceutical preparation for bioterrorism. Am J Health Syst Pharm. 2001;58:233–7. 6. Richard C. In the eye of the storm: pharmacists respond. Pharmacy Today. 2005;11(10):1. 7. Qureshi K, Gershon RRM, Sherman MF, et al. Health care workers’ ability and willingness to report to duty during catastrophic disasters. J Urban Health. 2005;82:378–88. 8. DeSimone CL. Response of public health workers to various emergencies. AAOHN J. 2009;57:17–23. 9. American Society of Health-System Pharmacists. ASHP statement on the role of health-system pharmacists in emergency preparedness. Am J Health Syst Pharm. 2003;60:1993–5.
11. U.S. Department of Homeland Security. History of the Metropolitan Medical Response System (MMRS): the first decade: 1995-2005. Accessed at www.cabq.gov/envhealth/pdf/HistoryoftheMMRS.pdf, October 20, 2009.
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