Veterinary Pharmacy During Disaster

1. Veterinary Pharmacy During Disaster CDR Shayne Blackmon, PharmD Federal Detention Center – Honolulu, HI LT Selena Ready, PharmD Winslow Indian Health Care Center – Winslow, AZ

2. Introduction • Over half of American families are pet-owners. • Oftentimes, pet-owners will refuse to leave their pets during a disaster. • It is estimated that 100,000 animals, pets and livestock are separated from their owners and/or lost during a major natural disaster.

3. Animal Care and Handling: Stressed or Injured Animals

4. Animal Care and Handling: Stressed or Injured Animals

5. Animal Care and Handling: Stressed or Injured Animals

6. U.S. Pets Evacuation and Transportation Standards Act (PETS) • In the fall of 2006, Congress passed H.R. 3858, the Pets Evacuation and Transportation Standards Act of 2006 (PETS Act). On Friday, October 6, 2006, President Bush signed the PETS Act into law. • What does the PETS Act do? • When is the PETS Act in operation? • How does the PETS Act work operationally?

7. Objectives After this presentation, the audience should be able to: • Have a basic understanding of the supportive care necessary for animal patients during a disaster setting   • Understand how to assist with the triage and physical assessment of an animal patient • Have a basic knowledge of common veterinary drugs and disease states used in a disaster • Have a basic knowledge of how to administer drugs to an animal patient • Be able to identify additional sources of information regarding veterinary emergency preparedness

8. Animal Care and Handling: During Disaster • Recent Scenarios • Extreme Weather • Mongolia • Flooding • Tennessee • Earthquakes • Haiti • Chile

9. Triage and Physical Assessment • Personal Protection • Wear gloves when handling sick or wounded animals. • Consider use of goggles or face protection if splashes from contaminated surfaces may occur • Do not allow rescued animals to “kiss” you or lick your face. • Whenever possible, caretakers should have completed a 3-dose prophylactic vaccination series for rabies.

10. Triage and Physical Assessment • Basic Triage and Physical Assessment • ABCs • Broken Appendages • Sources of Hemorrhage • Levels of Consciousness

11. Common Veterinary Drugs Used During Disaster • Animal identification • Date of treatment • Name of product administered • Name of the individual administering the product • Name of the supervising veterinarian Records of individual animal treatments should be kept and include:

12. Common Veterinary Drugs Used During Disaster • Vaccinations • Flea and Tick Treatments • Diarrheal Disease • Disinfectants and Antiseptics • Pain Management • Behavioral Meds • Euthanasia

13. Common Veterinary Drugs Used During Disaster • Core Vaccinations • Dogs • Rabies • Personnel should be aware that rabies vaccines may take as long as 28 days to become effective. • Distemper, Hepatitis, and Parvovirus • Kennel Cough Vaccination (intranasal) • Against Bordatella bronchisepta and parainfluenza

14. Common Veterinary Drugs Used During Disaster • Cats • Viral Rhinotracheitis, Panleukopenia and Calicivirus • Feline leukemia • Leptospirosis risk • Higher in flood-ravaged areas • Zoonotic • Adverse reactions may be higher than for some other vaccines

15. Common Veterinary Drugs Used During Disaster • Diarrheal Disease • Separate from healthy animals • Nosocomial agents of concern that may be transmitted by feces include parvovirus, panleukopenia, Giardi, and intestinal parasites. • Zoonotic agents of concern for small animals include Campylobacter and Salmonella, which are highly infectious and have been associated with outbreaks in shelters and veterinary clinics.

16. Common Veterinary Drugs Used During Disaster • External and Internal Parasite Treatment • Ectoparaciticides and Anthelmintics • Flea, tick, and worm coverage • Spot-on, injectible, and oral formulations

17. Common Veterinary Drugs Used During Disaster • Antiseptics and Disinfectants • Rubbing Alcohol • Chlorhexidine • Iodine Tincture • Povidone-Iodine • Hydrogen Peroxide 3%

18. Common Veterinary Drugs Used During Disaster • Pain Management

19. Common Veterinary Drugs Used During Disaster

20. Common Veterinary Drugs Used During Disaster • Anti-inflammatory Agents

21. Common Veterinary Drugs Used During Disaster

22. Common Veterinary Drugs Used During Disaster • Behavioral Medications

24. Common Veterinary Drugs Used During Disaster Euthanasia • In regard to animals -the act of killing an animal in a humane manner. • The primary objectives of animal euthanasia are: • relieving pain and suffering of the animal(s) to be euthanized • minimizing the pain, anxiety, distress, and fear the animal experiences before consciousness is lost • inducing a painless and distress-free death

25. Common Veterinary Drugs Used During Disaster • Cats and Dogs • Barbiturates, inhalant anesthetics, CO2, CO, potassium chloride in conjunction with general anesthesia • Birds • Barbiturates, inhalant anesthetics, CO2, CO, gunshot (free-ranging only), N2, argon, cervical dislocation, decapitation, thoracic compression (small, free-ranging only) • Horses • Barbiturates, potassium chloride in conjunction with general anesthesia, penetrating captive bolt

26. Vet Medication Administration Techniques • Wrapping in a blanket or towel is a great restraint technique • Marshmellows, peanut butter, or cream cheese • Pill gun • Oral Syringe

27. Veterinary Pharmacy Resources • Handbook of Veterinary Drugs – for PDAs, Smartphones, iPhones • The Merck Veterinary Manual • VMAT information

28. References: • http://www.avma.org/disaster/emerg_prep_resp_guide.pdf • http://veterinarynews.dvm360.com • http://news.nationalgeographic.com/news/2005/09/photogalleries/hurricane_katrina_pets/index.html • http://www.avma.org/disaster/petsact_faq.asp • http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/160201.htm • http://animalsindisasters.typepad.com/wspa/animals-in-disasters/ • http://www.petalk.com/drug-dosages.html#Code

30. USPHS LCDR Lauren Davidson Arctic Crossroads 2009

31. Arctic Crossroads 2009 • USCG/PHS mission to Barrow, AK, and surrounding villages • Rabies prophylaxis and vet care provided • 5 North Slope Borough village trips • 113 vet clinical appts. seen • Approx. 300 rabies vaccinations and 150 distemper/parvovirus vaccines given • 26 surgeries performed

32. Arctic Crossroads 2009 • 9 euthanasia procedures/3 after hr. emergenc. • Pharmacist assistance provided by PHS CAPT Paulson, USCG • Primary meds used • Isoflurane – gas anesthesia • Tiletamine/zolazepam (Telazol) – inj. anesth/tranq • Pentobarbital/phenytoin - euthanasia i.v. soln. • Praziquantel/pyrantel (Drontal Plus) – int. parasites

33. Operation Pacific Angel 2010 Phase 1 - Philippines

34. Operation Pacific Angel • 13th AF joint op. with the Phil. armed forces, national police, civilians, and non-gov orgs • Two mobile veterinary services teams served 41 local villages • Provided vet. care to 3360 animals/ incl. de-worming and vitamin vacc. to more than 3300 cattle, goats, and caribou

35. Operation Pacific Angel • Primary meds used • Ketamine (Ketalar, Ketaject) 100mg/ml general anesthetic; high conc. for cattle, swine, etc. • Zinc gluconate (Neutersol) – chemical castration • Albendazole, atovaquone, ivermectin, quinacrine - antiparasitics

36. Pacific Partnership 2008PP08 Team in Timor-Leste • USPHS, U.S. Marines, Navy, Army, Air Force, Navy civilian mariners • Armed forces of Australia, Canada, India, Indonesia, Portugal, & Republic of Korea USPHS CDR John Gibbon with Indian Army colleagues

37. 1 VIETNAM 19-29 Jun PHILIPPINES 29 May-17 Jun 2 5 MICRONESIA 22 Aug-1 Sep TIMOR LESTE 12-25 Jul 3 4 PAPUA NEW GUINEA 4-17 Aug PACIFIC PARTNERSHIP 2008 USNS Mercy

38. USPHS LCDR Bryan Buss Continuing Promise 2009

39. Continuing Promise 2009 USNS Comfort • PHS, Navy, & Army joint op. with military and govt. officials of Haiti & Dominican Republic • On-site trng. of college students & local vets. • Provided host nation vets. disease-specific presentations on 40 animal dz of importance • 43 general audience presentations – zoon. dz • Provided vet. care to 1849 animals/12 species • Performed 6366 procedures

40. Continuing Promise 2009 • Primary meds used • Pyrantel (Strongid T, Nemex) – deworming for dogs/cats • Rabies, Distemper/Parvo vaccines • Exotic Newcastle Disease (PMV-1) vaccine (poultry) • Fipronil (Frontline) – fleas and ticks • Ivermectin – orally for internal and external parasites (poultry), horses; inj. form for goats/swine/rabbits • Hog Cholera (Classical Swine Fever) vaccines

41. Continuing Promise 2009 • Primary meds used (cont.) • Vaccination for Clostridium C and D, & Tetanus • Vitamin ADE, B12, and iron inj. – goats and swine • Anesthetic premedication and anesthesia • Tetanus toxoid – horses • Leptospirosis vacc. – cattle • Moxidectin (Cydectin) – top. for int/ext parasites cattle • Brucella abortus vaccine – heifers 3-8 months

42. Be flexible – systems will be overwhelmed; human/animal pts. Disaster/humanitarian missions Demand for services ↑↑↑ People love their pets Train, train, train – Ft AP Hill 09, RDF 2010, Humanitarian missions Vets, pharmacists get involved earlier in the planning process – pre-deployment site survey teams, etc Advanced look at zoonoticdzs in the region (rabies, brucellosis, tuberculosis, tularemia, etc.) Helps avoid supply shortages/expired meds – common problem (AC09, CP09, etc.) Engage host nation representatives as to their needs/wishes for the mission Lessons Learned:

43. Establish partnerships – DOD, state MRCs (locals - lay of the land) U.S. Army Vet Corps PACOM – Dev. inventory templates for regions throughout the Pacific Plan early – many pharmaceutical needs are unique to veterinary medicine and cannot be easily obtained thru normal military supply channels Ex. High conc. Ketamine (100mg/ml) – pigs, buffalo Pack light Bring tools Plumb’s Veterinary Drug Handbook http://www.cdc.gov/nczved/ http://www.aavpt.org/ Lessons Learned:

44. Questions?