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Disaster Planning and Emergency Preparedness: Lessons Learned
PHARMACY ADMINISTRATION AND MANAGEMENT
Disaster Planning and Emergency Preparedness: Lessons Learned At the scenes of the 9/11 terrorist attacks and the mass prophylaxis response to the subsequent anthrax scares, pharmacists provided comfort and helped save lives. For all those old enough to remember them, the televised images and events of September 11 and fall 2001 are indelibly imprinted. But for some 200 U.S. Public Health Service (PHS) pharmacists who were deployed during the terrorist attacks and anthrax crises, the images they recall are real, the faces they remember heartrending, and emotions they feel overwhelming. RADM John Babb, RPh, MPA, CDR Robert Tosatto, RPh, MPH, MBA, and LCDR James Hayslett, PharmD, MPH, were central figures in the federal response plans at the World Trade Center in New York City, at the Pentagon in Virginia, in a coalmining region of Pennsylvania, and in the locations where anthrax was later detected. They shared their experiences at APhA2002 in presentations that ranged from cold, very hard statistics to touching images of those tragic days.
9/11 Within hours of the attacks on the World Trade Center and the Pentagon, and the airliner crash in western Pennsylvania, the Federal Response Plan had been implemented, RADM Babb said. As 1 of 12 agencies involved in that plan, the U.S. Department of Health and Human Services (HHS) took the following actions to assist in New York City: ■ Activated the National Disaster Medical System ■ Activated the PHS Commissioned Corps Readiness Force ■ Deployed disaster medical, veterinary, mortuary, and chemical/biologic teams Based on presentations by RADM John Babb, RPh, MPA, director, Commissioned Corps Readiness Force, Office of Emergency Preparedness, Rockville, Md.; CDR Robert Tosatto, RPh, MPH, MBA, senior international health officer, Office for Europe and Northern Eurasia, Office of Global Health Affairs, Rockville, Md.; and LCDR James Hayslett, PharmD, MPH, epidemic intelligence service officer, Centers for Disease Control and Prevention, Austin, Tex.
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Supplement to the Journal of the American Pharmaceutical Association
■ Deployed 35 epidemiologists from the Centers for Disease
Control and Prevention (CDC) ■ Delivered, for the first time in history, medications and sup-
plies from the National Pharmaceutical Stockpile, which arrived in New York City within 7 hours Dozens of PHS pharmacists were deployed to Ground Zero as part of this effort, and there they played many roles. One was the team leader of a 43-person medical team, several supported the National Pharmaceutical Stockpile, others worked with the Management Support Team, and yet more functioned as preventive medical officers, who screened recovery workers to identify problems before they became serious. A PHS pharmacist also was on board the U.S. Navy ship Comfort, docked by the Statue of Liberty to provide a place for tired workers to take refuge from the recovery scene, shower, eat hot meals, sleep, and talk to a mental health provider. RADM Babb shared several passages written by PHS officers during their deployment to Ground Zero. This is how the scene felt to one provider, a physician: “Our medical tent sits under the front of the once-elegant Millennium Hilton, about 50 yards from the edge of the pile. The noise is constant—generators, diesels, grinding sounds—you have to shout to be heard across the tent. The smell is acrid, full of plastic and formaldehyde. You can sometimes taste the grit in the air. Small groups of men walk purposely, having long since given up avoiding mud puddles and rubble piles. Their clothes tell a story—urban search and rescue, crime scene investigation, special response team, Federal Bureau of Investigation, Port Authority Police, U.S. Coast Guard, firefighters from Seattle, Phoenix, Los Angeles, everywhere. But it’s the New York Police Department and the Fire Department of New York that dominate the scene, and their eyes tell a story. Their buddies are in that pile. They died running up stairwells, pulling hoses, helping people, responding to a call.
September/October 2002 Vol. 42, No. 5, Suppl. 1
Disaster Planning and Emergency Preparedness PHARMACY ADMINISTRATION AND MANAGEMENT
They died doing what every police officer and firefighter would have been doing had they just been closer.”
Anthrax Anthony A. Williams, mayor of Washington, D.C., was one of many high-profile patients who needed antibiotic prophylaxis in the days after an anthrax letter was opened in the Senate offices of Majority Leader Tom Daschle (D-S.D.). In a radio interview about his wait in line with hundreds of concerned and frightened U.S. Postal Service workers, Williams commented that, once he got to the health care workers, he received the most comprehensive pharmacy counseling services of his life. CDR Tosatto described this and other experiences from the response to the anthrax letters that shocked a country already reeling from the 9/11 attacks. In providing pharmaceutical care to those potentially exposed on Capitol Hill and at several U.S. Postal Service facilities, CDR Tosatto and his colleagues faced a number of barriers. “The prevailing mood was fear,” he said. “More anthrax was being found daily, people were dying, and we really didn’t know what was going to happen next. To overcome this barrier, we had to provide adequate and up-to-date information to our patients about the situation and about the medications. This helped to reduce their fear and anxiety. If patients were fearful, they wouldn’t hear what we were saying, and they could die if they didn’t take the medications as directed. I am convinced that, in a large-scale bioterrorist attack, the simple lack of adequate pharmaceutical care could lead to mass casualties.” CDR Tosatto said that, despite the deaths and the tremendous expense caused by the anthrax letters, America learned much from this unfortunate situation. “Morbidity and mortality were low, anthrax is not communicable, and the incidents provided a valuable learning opportunity that helped prepare us for the next bioterrorist attack,” he concluded.
Public Health Service Treatment Clinic, Ground Zero.
signs of an emerging epidemic or bioterrorist attack, LCDR Hayslett explained, “Pharmacy is a natural in public health. We have strong community ties, unique academic training, and pertinent practice activities.” Pharmacists in all settings—community, academia, industry, hospital, long-term care, and associations—are important parts of our nation’s emergency preparedness, he added. Because of these events, which required large numbers of pharmacists to respond to a bioterrorism event, HHS has asked the national pharmacy organizations to sponsor teams of pharmacists that would serve as members of the National Disaster Medical System. These teams could be “federalized” during a response that would require chemoprophylaxis or immunization of large numbers of people. This federal status would provide participating pharmacists with a salary while deployed and other benefits, including per diem and travel expenses, liability insurance coverage, and job protection after a 2-week deployment. These teams are being formed now.
Pharmacists’ Roles LCDR Hayslett, only the third pharmacist-trained disease detective in the CDC’s Epidemic Intelligence Service, had primary responsibilities in tracking down when, where, and how Brentwood (D.C.) postal workers were exposed to anthrax spores. During 4 months of deployment to the nation’s capital, he emerged as a principal investigator when a truncated regimen of anthrax vaccine (with an additional 40 days of antibiotics) was offered to postal workers concerned about the possibility of delayed anthrax infection. Because of his own work in the Brentwood facility prior to closure, he took a regimen of antibiotics for 100 days—and he elected to take the three-dose regimen of anthrax vaccine. In encouraging pharmacists to be alert for possible warning
Vol. 42, No. 5, Suppl. 1
September/October 2002
Summary ■ Following the terrorist attacks of September 11, 2001, the
federal response plan was activated immediately, with most efforts focused on helping recovery workers at Ground Zero in New York City. ■ Comprehensive pharmacy services were critical in protecting the health of those potentially exposed to anthrax at U.S. Postal Service facilities and the U.S. Capitol. ■ Responding to anthrax attacks taught many valuable lessons to emergency workers on how to manage a bioterrorist attack. ■ Because of its central place in the life of many American communities, pharmacy is a natural and important ally of public health.
Supplement to the Journal of the American Pharmaceutical Association
S51
Disaster Planning and Emergency Preparedness: Lessons Learned At the scenes of the 9/11 terrorist attacks and the mass prophylaxis response to the subsequent anthrax scares, pharmacists provided comfort and helped save lives. For all those old enough to remember them, the televised images and events of September 11 and fall 2001 are indelibly imprinted. But for some 200 U.S. Public Health Service (PHS) pharmacists who were deployed during the terrorist attacks and anthrax crises, the images they recall are real, the faces they remember heartrending, and emotions they feel overwhelming. RADM John Babb, RPh, MPA, CDR Robert Tosatto, RPh, MPH, MBA, and LCDR James Hayslett, PharmD, MPH, were central figures in the federal response plans at the World Trade Center in New York City, at the Pentagon in Virginia, in a coalmining region of Pennsylvania, and in the locations where anthrax was later detected. They shared their experiences at APhA2002 in presentations that ranged from cold, very hard statistics to touching images of those tragic days.
9/11 Within hours of the attacks on the World Trade Center and the Pentagon, and the airliner crash in western Pennsylvania, the Federal Response Plan had been implemented, RADM Babb said. As 1 of 12 agencies involved in that plan, the U.S. Department of Health and Human Services (HHS) took the following actions to assist in New York City: ■ Activated the National Disaster Medical System ■ Activated the PHS Commissioned Corps Readiness Force ■ Deployed disaster medical, veterinary, mortuary, and chemical/biologic teams Based on presentations by RADM John Babb, RPh, MPA, director, Commissioned Corps Readiness Force, Office of Emergency Preparedness, Rockville, Md.; CDR Robert Tosatto, RPh, MPH, MBA, senior international health officer, Office for Europe and Northern Eurasia, Office of Global Health Affairs, Rockville, Md.; and LCDR James Hayslett, PharmD, MPH, epidemic intelligence service officer, Centers for Disease Control and Prevention, Austin, Tex.
S50
Supplement to the Journal of the American Pharmaceutical Association
■ Deployed 35 epidemiologists from the Centers for Disease
Control and Prevention (CDC) ■ Delivered, for the first time in history, medications and sup-
plies from the National Pharmaceutical Stockpile, which arrived in New York City within 7 hours Dozens of PHS pharmacists were deployed to Ground Zero as part of this effort, and there they played many roles. One was the team leader of a 43-person medical team, several supported the National Pharmaceutical Stockpile, others worked with the Management Support Team, and yet more functioned as preventive medical officers, who screened recovery workers to identify problems before they became serious. A PHS pharmacist also was on board the U.S. Navy ship Comfort, docked by the Statue of Liberty to provide a place for tired workers to take refuge from the recovery scene, shower, eat hot meals, sleep, and talk to a mental health provider. RADM Babb shared several passages written by PHS officers during their deployment to Ground Zero. This is how the scene felt to one provider, a physician: “Our medical tent sits under the front of the once-elegant Millennium Hilton, about 50 yards from the edge of the pile. The noise is constant—generators, diesels, grinding sounds—you have to shout to be heard across the tent. The smell is acrid, full of plastic and formaldehyde. You can sometimes taste the grit in the air. Small groups of men walk purposely, having long since given up avoiding mud puddles and rubble piles. Their clothes tell a story—urban search and rescue, crime scene investigation, special response team, Federal Bureau of Investigation, Port Authority Police, U.S. Coast Guard, firefighters from Seattle, Phoenix, Los Angeles, everywhere. But it’s the New York Police Department and the Fire Department of New York that dominate the scene, and their eyes tell a story. Their buddies are in that pile. They died running up stairwells, pulling hoses, helping people, responding to a call.
September/October 2002 Vol. 42, No. 5, Suppl. 1
Disaster Planning and Emergency Preparedness PHARMACY ADMINISTRATION AND MANAGEMENT
They died doing what every police officer and firefighter would have been doing had they just been closer.”
Anthrax Anthony A. Williams, mayor of Washington, D.C., was one of many high-profile patients who needed antibiotic prophylaxis in the days after an anthrax letter was opened in the Senate offices of Majority Leader Tom Daschle (D-S.D.). In a radio interview about his wait in line with hundreds of concerned and frightened U.S. Postal Service workers, Williams commented that, once he got to the health care workers, he received the most comprehensive pharmacy counseling services of his life. CDR Tosatto described this and other experiences from the response to the anthrax letters that shocked a country already reeling from the 9/11 attacks. In providing pharmaceutical care to those potentially exposed on Capitol Hill and at several U.S. Postal Service facilities, CDR Tosatto and his colleagues faced a number of barriers. “The prevailing mood was fear,” he said. “More anthrax was being found daily, people were dying, and we really didn’t know what was going to happen next. To overcome this barrier, we had to provide adequate and up-to-date information to our patients about the situation and about the medications. This helped to reduce their fear and anxiety. If patients were fearful, they wouldn’t hear what we were saying, and they could die if they didn’t take the medications as directed. I am convinced that, in a large-scale bioterrorist attack, the simple lack of adequate pharmaceutical care could lead to mass casualties.” CDR Tosatto said that, despite the deaths and the tremendous expense caused by the anthrax letters, America learned much from this unfortunate situation. “Morbidity and mortality were low, anthrax is not communicable, and the incidents provided a valuable learning opportunity that helped prepare us for the next bioterrorist attack,” he concluded.
Public Health Service Treatment Clinic, Ground Zero.
signs of an emerging epidemic or bioterrorist attack, LCDR Hayslett explained, “Pharmacy is a natural in public health. We have strong community ties, unique academic training, and pertinent practice activities.” Pharmacists in all settings—community, academia, industry, hospital, long-term care, and associations—are important parts of our nation’s emergency preparedness, he added. Because of these events, which required large numbers of pharmacists to respond to a bioterrorism event, HHS has asked the national pharmacy organizations to sponsor teams of pharmacists that would serve as members of the National Disaster Medical System. These teams could be “federalized” during a response that would require chemoprophylaxis or immunization of large numbers of people. This federal status would provide participating pharmacists with a salary while deployed and other benefits, including per diem and travel expenses, liability insurance coverage, and job protection after a 2-week deployment. These teams are being formed now.
Pharmacists’ Roles LCDR Hayslett, only the third pharmacist-trained disease detective in the CDC’s Epidemic Intelligence Service, had primary responsibilities in tracking down when, where, and how Brentwood (D.C.) postal workers were exposed to anthrax spores. During 4 months of deployment to the nation’s capital, he emerged as a principal investigator when a truncated regimen of anthrax vaccine (with an additional 40 days of antibiotics) was offered to postal workers concerned about the possibility of delayed anthrax infection. Because of his own work in the Brentwood facility prior to closure, he took a regimen of antibiotics for 100 days—and he elected to take the three-dose regimen of anthrax vaccine. In encouraging pharmacists to be alert for possible warning
Vol. 42, No. 5, Suppl. 1
September/October 2002
Summary ■ Following the terrorist attacks of September 11, 2001, the
federal response plan was activated immediately, with most efforts focused on helping recovery workers at Ground Zero in New York City. ■ Comprehensive pharmacy services were critical in protecting the health of those potentially exposed to anthrax at U.S. Postal Service facilities and the U.S. Capitol. ■ Responding to anthrax attacks taught many valuable lessons to emergency workers on how to manage a bioterrorist attack. ■ Because of its central place in the life of many American communities, pharmacy is a natural and important ally of public health.
Supplement to the Journal of the American Pharmaceutical Association
S51