The United States has managed to escape a repeat of the severity of the hurricanes of 2005. Although hurricanes pose a major threat, they are not the only disasters (natural or unnatural) that pharmacists may encounter. Examples of potential disasters that pharmacists need to be aware of and prepared for can be found in the Table.1
Now would be an excellent time for pharmacies to take an assessment to ensure that they are prepared in the event of a disaster. Many pharmacies may need to develop or update their emergency-preparedness plans. This article will focus on general ideas and resources that will help tailor a plan to prepare pharmacies in case a disaster strikes.
A great starting point is to contact city and county managers, utilizing them as a resource for information on the highest probability threats to the area. They should already have an emergency-preparedness plan in place and are generally willing to share it so that pharmacists can see what their stores can expect with regard to local assistance. Pharmacy managers also are encouraged to contact their state boards of pharmacy regarding rules and regulations about disaster preparation. Some boards of pharmacy may require proof of emergency plans or mandated reporting of damaged products after a disaster.
After obtaining information from local government officials and state boards of pharmacy, the next step would be to evaluate current practice sites and develop or update an emergency-preparedness plan according to the highest probability threats to the region. To help develop or update this plan, pharmacists may seek additional information from the following resources:
When creating or updating an emergency plan, one should anticipate several factors from most disasters. Purchasing a few basic items ahead of time may go a long way in helping with the most frequent problem resulting from disasters: power outages. Pharmacists should consider purchasing a portable or permanent on-site generator. The size and type of generator will depend on the needs of the pharmacy. Those pharmacies dependent upon automation for a majority of their prescription processing may want to consider a larger or permanent generator. If a generator does not fit within the pharmacy's budget or needs, coolers and ice may be warranted for refrigerated products such as insulin. Acquiring a manual (ie, nonelectric) typewriter may be beneficial for the production of prescription labels. Flashlights, batteries, a fire extinguisher, and hard copies of drug information and identification resources may also be helpful.
Communication tends to be problematic in the first few days following a disaster. The pharmacy manager may consider maintaining an updated telephone list of pharmacy staff contact information, which would consist of addresses, home phone numbers, cell phone numbers, and family contacts. This list may also include anyone who is an essential employee who is expected to report to work either before or after a disaster. Contact information for local hospitals, fire departments, police departments, local doctors, and county emergency management headquarters should also be readily available.
While your daily operations may be impaired during a disaster, those of primary wholesalers may be impacted as well. Therefore, pharmacy managers should obtain contact information for wholesalers and inquire about their emergency-preparedness plans. Items to discuss with wholesalers may include how to place an order during a disaster, delivery process and schedule changes, what to do in the event of a total loss of inventory, and lifting limitations on a credit line. If a pharmacy does not already have a secondary wholesaler, it should consider contracting with one?preferably one that is not located in the same region as the primary wholesaler. That secondary wholesaler will be beneficial in the event that the primary wholesaler cannot supply medication.
To safeguard current inventory, it is recommended to cover all drug products with waterproof material. Those products that are in low-lying areas of the pharmacy should be moved to a higher, safer location if flooding is a potential threat. Should a disaster be on the level of Hurricane Katrina, drug inventories may be quickly depleted or nonexistent. Pharmacies should plan to operate without receiving a shipment of medications for 2 to 3 days. Stockpiling should occur only at pharmacies that are part of a local or state emergency-preparedness plan and will be relied on to provide large numbers of these medications. If federal assistance is granted after a disaster, then certain critical medications and supplies will arrive in 50-ton Push Packages from the Strategic National Stockpile. These packages contain only antibiotics, antitoxins, intravenous fluids, and airway-management supplies.1,2 Maintenance medications should still be obtained from your wholesaler.
Imminent disasters can provide an opportunity to secure the physical structure of a pharmacy. For example, if a pharmacy is located in a hurricane-prone region, all windows should be covered with either hurricane shutters or plywood. Pharmacists should arrange in advance to have an alternate site or to use an on-site trailer, should the pharmacy suffer significant damage.
Daily backup of file information on all computers is recommended. In the event of an imminent disaster, 2 backup disks should be created: one that is maintained in a safe area of the pharmacy and another that is taken off-site by the pharmacy manager. An additional backup disk may not be necessary if files are maintained through a corporate database. If flooding is a potential threat, computers should be unplugged, moved to a safer area, and covered with waterproof material. Part of the emergencypreparedness plan should include how to deal with the loss of computers and system software, and inquiries to the system software company regarding this matter should be made in advance.
Because computer files and hard copies may be inaccessible following a disaster, an emergency-preparedness plan should include procedures regarding dispensing of emergency prescriptions. Pharmacists should check with their state boards of pharmacy for refill provisions in the event of a disaster. In addition, it is advisable to check with major pharmacy benefit managers to determine their protocols for emergency refills.
Transportation may be impacted during a disaster. Employers may consider developing a plan to ensure the safe arrival of employees to the pharmacy. In addition, pharmacies that have a delivery component as part of their daily operations (eg, long-term care pharmacies, home infusion pharmacies) will need to develop a backup plan on how to deliver medications to their patients.
Disasters affect everyone, and pharmacists play a vital role in emergencyresponse teams. Pharmacists who are willing to volunteer for these teams are encouraged to be trained and certified in basic first aid, cardiopulmonary resuscitation, and immunizations. Team involvement may occur at the local, state, and national levels. Pharmacists interested in volunteering can contact their county emergency-management officials, who could put them in touch with state and national officials.
No one can always be prepared for everything during a disaster. Every pharmacy has different needs to consider. No cookie-cutter approach exists to planning for a disaster; therefore, each pharmacy manager should use all available resources to create the best plan for his or her pharmacy. Having a plan in place in advance will minimize confusion and enhance the ability to deal with most situations that result from a disaster.
Mr. Gregory Brown is a pharmacy manager at Sav-On Pharmacy/Albertsons. Dr. Dana Brown is an assistant professor of pharmacy practice at the Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University.
1. Teeter DS. Disaster preparedness and pharmacy: an important partnership. US Pharmacist.2004;29. Available at: www.uspharmacist.com/index.asp?show=article&page=8_1217.htm. Accessed October 17, 2006.
2. American Society of Health-System Pharmacists. ASHP statement on the role of health-system pharmacists in emergency preparedness. Am J Health-Syst Pharm. 2003;60:1993-1995.
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