A Tale of 2 Cities Disaster Relief from 1,100 Miles Away


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A Tale of 2 Cities- Disaster Relief from 1100
Miles Away

• Christopher Arendt PharmD
• Pharmacotherapy Coordinator

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Disclosure

• Nothing to disclose.

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Objectives

• 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

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The 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
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Mayo 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

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Mayo Responds

• Sent Computers Guardian Rx Printers Labels
  Office Supplies
• Sent Pharmaceuticals
• Arranged Wholesaler Cardinal Delivery on-Site
  through Carrier.
• Sent Pharmacy Supplies
• Established contacts and supply chain network
• Established Pharmacist/Tech commitment from Mayo
  and other MN pharmacies MPhA

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Mayo Responds
Operation Northern Comfort Camp Ripley 9/5/2005
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We were ready and they never came to Minnesota.
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ACT 2

• The Louisiana Office of Public Health asks Mayo
  for assistance Sept 9th 2005.

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The 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

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The 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

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The Pharmacy Response
Robust Supplies. Repackaged Alphabetically into
numbered totes for ease of retrieval.
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The Pharmacy Response
Alphabetical labeling and Pharmaceuticals
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The Pharmacy Response
Code Supplies
Formulary
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The Pharmacy Response
Scheduled Drugs and ability to account for them
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The 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
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The 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.

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The 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
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Pharmacy 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 Disaster-relief Out-Patient Pharmacy out
  of an RV

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No Transcript
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Where did the supplies come from?

• Public Health
• Mayo
• Private Donations
• Manufacturers
• Wholesalers

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Protect your assets
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What do you do when another disaster strikes
during your relief effort?
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What is your communication back up plan?
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Lessons Learned
.
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Communication 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

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Communication is critical

• Establish collaborative agreements right away
• Therapeutic Substitution
• Rx Writing
• DEA List/RX Pads Info- Get info pre-deployment
• Know State Requirements/Get Medicare Medicaid
  Provider info up-front
• Contact Local Pharmacies for Support
• Set up time to call facilitate communication
  w/in chains. IeCVS Walgreens Wal-Mart
• Talk with the DEA right away
• Suppliers need permissions up front to ship ALL
  meds.

.
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Communication 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 follow-up
  disposal
• Have a disposal plan
• Have a re-distribution plan
• IeCharitable Pharmacy

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Team

• 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.

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Team

• 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

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With or without walls it can become a pharmacy
MN Comfort Camp Ripley MN
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With or without walls it can become a pharmacy
Mobile Pharmacy Lafayette LA
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If 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
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Totes-Push Packs and Go-Kits

• 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.

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Totes-Push Packs and Go-Kits

• 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.

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Team Prescriptions

• Personal packs
• Great idea.
• Could go with Bulk Bottles to save time/effort.
• Get allergy list pre-departure 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.

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Emergency 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.

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Lessons 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

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Pharmacy Services

• Think outside the rule laden box.
• In-Patient and Out-Patient 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.

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The 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
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Can 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.

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Summary

• Be Fluid Flexible and try to have Fun
• Communication Communication Communication.
• Solid scheduled and redundant.
• Know your Chain-of-Command 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

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Thank you
Contact Information Christopher Arendt
PharmD Pharmacotherapy Coordinator Mayo Clinic
Saint Marys Hospital 1216 2nd ST SW Rochester MN
55902 507-255-0384 w arendt.christopher_at_mayo.ed
u