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

A Tale of 2 Cities- Disaster Relief from 1,100 Miles Away. Christopher Arendt, PharmD Pharmacotherapy Coordinator. Disclosure. Nothing to disclose. Objectives. After attending this lecture the participant should be able to:

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

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  1. A Tale of 2 Cities- Disaster Relief from 1,100 Miles Away Christopher Arendt, PharmD Pharmacotherapy Coordinator

  2. Disclosure • Nothing to disclose.

  3. 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

  4. 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

  5. Mayo gets a phone call from the State of Minnesota • Thousands of Refugee’s 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”

  6. 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)

  7. Mayo Responds Operation: “Northern Comfort” Camp Ripley 9/5/2005

  8. We were ready… …and they never came to Minnesota.

  9. ACT 2 • The Louisiana Office of Public Health asks Mayo for assistance Sept 9th, 2005.

  10. 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

  11. The Mayo Response • Mayo in conjunction with University of Minnesota and College of St. Katherine's 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

  12. The Pharmacy Response Robust Supplies. Repackaged Alphabetically into numbered totes for ease of retrieval.

  13. The Pharmacy Response Alphabetical labeling and Pharmaceuticals

  14. The Pharmacy Response Code Supplies Formulary

  15. The Pharmacy Response Scheduled Drugs and ability to account for them

  16. 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)

  17. 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….)

  18. 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 Let’s Talk Do’s and Don’ts

  19. 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

  20. Where did the supplies come from? • Public Health • Mayo • Private Donations • Manufacturers • Wholesalers

  21. Protect your assets!

  22. What do you do when another disaster strikes during your relief effort?

  23. What is your communication back up plan?

  24. Lessons Learned .

  25. 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

  26. 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. Ie…CVS, Walgreens, Wal-Mart • Talk with the DEA right away • Suppliers need permissions up front to ship ALL meds. .

  27. 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 • Ie…Charitable Pharmacy

  28. 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.

  29. 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

  30. With or without walls it can become a pharmacy! MN Comfort Camp Ripley, MN

  31. With or without walls it can become a pharmacy! Mobile Pharmacy Lafayette LA

  32. 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 If you pile it they will come… Camp Ripley, MN Heyman Center Pharmacy, LA

  33. 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 it’s done.

  34. 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 don’t need 5 different ACE Inhibitors.

  35. 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 (don’t 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 refrigeration…No.

  36. 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 AED’s also sent out with teams • Should send AED with each team & make sure they know how to use. • Need more AED’s • Contacted MFR…Backfilled our needs.

  37. 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)

  38. 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.

  39. 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

  40. 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 won’t work.

  41. 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

  42. 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@mayo.edu

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