Title: A Tale of 2 Cities Disaster Relief from 1,100 Miles Away
1A Tale of 2 Cities Disaster Relief from 1100
Miles Away
- Christopher Arendt PharmD
- Pharmacotherapy Coordinator
2Disclosure
3Objectives
- After attending this lecture the participant
should be able to - Describe the system used to provide maintenance
medications to disaster victims. - Understand the lessons learned in preparing for
Mass dispensing. - Recognize the importance of the chain of command
during a disaster. - Describe the ideal supply chain and distribution
system in a disaster
4The Scenario
Sept 21st 2005
Aug 28th 2005
Jan 28th Feb 3rd 2007
Katrina Photo Jeff Schmaltz MODIS Rapid
Response Team NASA/GSFC Rita Photo Jacques
Descloitres MODIS Rapid Response Team NASA/GSFC
5Mayo gets a phone call from the State of Minnesota
- Thousands of Refugees will be sent to Camp
Ripley in Northern Minnesota in the next 3 to 5
days. Be ready to receive by September 5th 2005. - Need Medical attention. Primary care needs.
Medications. Food. Shelter. Staff. Mental Health.
Social workers. Security. - Operation Northern Comfort
6Mayo Responds
- Sent Computers Guardian Rx Printers Labels
Office Supplies - Sent Pharmaceuticals
- Arranged Wholesaler Cardinal Delivery onSite
through Carrier. - Sent Pharmacy Supplies
- Established contacts and supply chain network
- Established Pharmacist/Tech commitment from Mayo
and other MN pharmacies MPhA
7Mayo Responds
Operation Northern Comfort Camp Ripley 9/5/2005
8We were ready and they never came to Minnesota.
9ACT 2
- The Louisiana Office of Public Health asks Mayo
for assistance Sept 9th 2005.
10The Mayo Response
- Mayo looks for volunteers in key areas
- Logistics/ Security/ IT
- Nurses/Care Assistants/Clerical Support
- Providers/NP/MD
- Mental Health
- Internal Med/Family Med/Peds
- Infectious Disease
- Pharmacy
- Pharmacist/Technician
11The Mayo Response
- Mayo in conjunction with University of Minnesota
and College of St. Katherines established the
Minnesota Lifeline Medical group. - Team 1 left Monday 9/12/05 morning w/ 9 vans
- Team 2 left 9/14/05 Wednesday on Commercial
Flight out of MSP with U of M folks. - 2 Trucks with supplies headed south 9/12/05
12The Pharmacy Response
Robust Supplies. Repackaged Alphabetically into
numbered totes for ease of retrieval.
13The Pharmacy Response
Alphabetical labeling and Pharmaceuticals
14The Pharmacy Response
Code Supplies
Formulary
15The Pharmacy Response
Scheduled Drugs and ability to account for them
16The Pharmacy Response
Personal Packs Ciprofloxacin 500 mg tabs BID x 3
days Disp 6 Loperamide Imodium 2 caps now.
Then 1 cap after each loose stool. Max 16 mg/24
hrs. Disp 30. Alcohol Based Sanitizer Drug
Info Sheet
If Allergy Got Azithromycin ZPak
17The Pharmacy Response
- Computer system and Labeling system Guardian
Rx. Zebra Thermal Printer Laser Printer - Pharmacy supplies vials ovals beakers
- Misc Supplies Calculator pens marker tablet
cutters grinders mortar and pestle scissors
forms drug info resources drug info stapler
Pharmacy tape dispense note pads baggies etc.
18The Pharmacy Response
- Vaccine
- Pneumococcal
- Hepatitis A B
- Influenza
- Tetanus
- MMR
- Needle Stick Emergency Kit
- Lamivudine Zidovudine Combivir
Hepatitis B confirmed in the water supply.
Used to supplement Public Health Supplies of
Vaccine
Lets Talk Dos and Donts
19Pharmacy Teams
- Pharmacist Tech
- 8 Weeks of support 4 teams 2 weeks/team
- Support of department/Inst
- Whatever it takes
- Pharmacy Job Assembled managed and ordered drug
supplies day and night - Helped administer at vaccination sites
- Opened a Disasterrelief OutPatient Pharmacy out
of an RV
20No Transcript
21Where did the supplies come from?
- Public Health
- Mayo
- Private Donations
- Manufacturers
- Wholesalers
22Protect your assets
23What do you do when another disaster strikes
during your relief effort?
24What is your communication back up plan?
25Lessons Learned
.
26Communication is critical
- Establish ONE phone contact number
- But always have a backup
- Calling Tree and Phone Rosters at your finger
tips - Know key players throughout your profession
- Boards of Pharmacy
- State Health Officials
- Industry
- Suppliers
- Data/IT/IS
- Have 24 hour contact lists
27Communication is critical
- Establish collaborative agreements right away
- Therapeutic Substitution
- Rx Writing
- DEA List/RX Pads Info Get info predeployment
- Know State Requirements/Get Medicare Medicaid
Provider info upfront - Contact Local Pharmacies for Support
- Set up time to call facilitate communication
w/in chains. IeCVS Walgreens WalMart - Talk with the DEA right away
- Suppliers need permissions up front to ship ALL
meds.
.
28Communication is critical
- Establish supply chain rules
- Must go through one contact for all donations and
purchases of pharmaceuticals - Minimize Dumping of expired meds
- Allows better inventory accountability
- Reduces time spent Discovery followup
disposal - Have a disposal plan
- Have a redistribution plan
- IeCharitable Pharmacy
29Team
- Send people in pairs Buddy System.
- Send people with similar interests and
personalities. - Send people without young children.
- If it involves drugs include pharmacy up front.
[Vaccine fiasco] - Establish sound chains of Team Command. Give
everyone a copy. - Recruit more help from others.
30Team
- Help monitor each others stress and exhaustion
levels Buddy system - If you set up a meeting time stick to it.
- Recognize the roles and responsibilities of other
team members. Help each other if you can or at
least offer to help. - No job is beneath any team member. No job is
above any team member. - Starting at 5AM and ending at 2AM..a really bad
idea - Mix up teams makes greater satisfaction
31With or without walls it can become a pharmacy
MN Comfort Camp Ripley MN
32With or without walls it can become a pharmacy
Mobile Pharmacy Lafayette LA
33If you pile it they will come
Camp Ripley MN
- Set up Stock rules
- Entry point in ONE Location
- Wasted time tracking down items. Some items
turned up weeks later. - Establish delivery lines and times
- Fed Ex
- UPS
- Distributor
Heyman Center Pharmacy LA
34TotesPush Packs and GoKits
- Standardize the pack
- Pack by Therapeutic class not by drug name.
- Always use both generic and trade names to label
items in the Therapeutic Class. - Less is more
- If items require refrigeration buy more
refrigeration coolers make ice and check
multiple times daily to ensure its done.
35TotesPush Packs and GoKits
- Split the work between multiple people
day/eve/night - Set ground rules in the beginning
- You restock pack or you fill out the stock
request form let us know what you used. - Establish ownership of the kit with providers
- If you need something new let me know early so I
can try to get it here by tomorrow. - Remove redundancy 1 item per class
- Set up a FORMULARY
- Ie..you dont need 5 different ACE Inhibitors.
36Team Prescriptions
- Personal packs
- Great idea.
- Could go with Bulk Bottles to save time/effort.
- Get allergy list predeparture for Emergency
- Was a method of taking attendance
- Bus Med Bag
- Nausea Headache Travel Sickness and Back pain
Kit. - Sent legend drugs dont get back after c/o
motion sickness - No Legend drugs with last bus.
- Send with bus Charge person. Inform Team of Bag
on Bus - Employee Prescriptions
- No problem but if it requires refrigerationNo.
37Emergency Supplies
- Code Cart
- Nice to have there but not used
- Was never unwrapped from Shrink wrapping
- No one performed daily checks
- Sent documentation log with modified procedure
- Need self diagnostic style machines AED Pro
- 4 AEDs also sent out with teams
- Should send AED with each team make sure they
know how to use. - Need more AEDs
- Contacted MFRBackfilled our needs.
38Lessons for Incident Command
- One person needs to coordinate the phone list
- More Phones and Computers for Group
- Keep the All Inclusive morning meeting
- Keep the Round Table approach to Q/A
- Get a bigger table room Many players.
- Give the Command Structure and Contact list to
EVERY Team Member lanyard around neck
39Pharmacy Services
- Think outside the rule laden box.
- InPatient and OutPatient Pharmacy collaboration
achieved remarkable results. - Even the best drawn plans are merely sketches.
- Be open and ready to explore alternative methods
of accomplishing a task. - Be willing to ask for help.
- Having one person responsible for coordination is
a must. - Keep the staff aware of what is going on.
40The Ideal Supply Chain
- Central point of Distribution/ repackaging
- Real time shipping status
- Mobile Distribution units
- Real Time counts/Use reports
- Direct from supplier shipping 24/7
- Portable med management system /Drug info
resources - Language resources
- Financial support
- Teamwork
WEB PDA
41Can Technology Bridge the Gap?
- YES But
- Need power
- Need Communications
- Need User Understanding JIT Training
- When we go to a sticks and stones mentality this
wont work.
42Summary
- Be Fluid Flexible and try to have Fun
- Communication Communication Communication.
- Solid scheduled and redundant.
- Know your ChainofCommand and follow it
- Pharmacy involvement early on makes the logistics
easier - While the Ideal Supply Chain does not exist good
support can make a major difference
43Thank you
Contact Information Christopher Arendt
PharmD Pharmacotherapy Coordinator Mayo Clinic
Saint Marys Hospital 1216 2nd ST SW Rochester MN
55902 5072550384 w arendt.christopher@mayo.ed
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