Understand the Emergency Management Assistance Comp

Pharmacy TimesNovember 2023
Volume 89
Issue 11

This interstate agreement can empower pharmacists to respond to large-scale emergencies

After the devastation of hurricane Andrew in 1992, some Southern states came together to find a way to make it easier for states to provide resources to one another during times of emergency and disaster. The Southern Governors’ Association (SGA) and the Virginia Department of Emergency Services created the Southern Regional Emergency Management Assistance Compact, which was adopted by several states in 1993.1

Man open disaster and emergency response plan for reading -  Image credit: Vitalii Vodolazskyi | stock.adobe.com

Image credit: Vitalii Vodolazskyi | stock.adobe.com

In January 1994, the SGA decided to remove the “Southern Regional” label and allow all states to join the compact.1 Since creation and adoption of the Emergency Management Assistance Compact (EMAC), tribal nations, US territories, and all 50 states have been able to request and provide personnel and material aid to each other in times of disaster. At the state level, legislatures adopted measures authorizing participation by their states. So how does this aid come about, and how are pharmacists involved?

There are 5 phases to EMAC. Phase 1, pre-event preparation, happens before crisis strikes. During this phase, all procedures for if and when an emergency occurs are drafted, resource allocation is determined, training and exercises are completed, and mission ready packages with cost estimates are created.2 These should all be routinely reviewed and updated.

Phase 2 is the activation phase.2 If an emergency or a disaster is likely, a states can preemptively open an event file in the EMAC operations system.2 For a state to be able to receive resources through EMAC, its governor must declare either a state of emergency or a disaster.2

Phase 3 is the request and offer phase.2 When the “requesting state” declares an emergency/disaster, the resources start to be sourced from the closest “assisting states.”2 All assisting states determine whether they can provide resources while at the same time continuing to protect themselves.2 When the states come to an agreement, they sign an EMAC Resource Support Agreement, which is legally binding.2

Phase 4 is the response phase.2 This is when personnel and resources are mobilized, deployed, and demobilized.2 Before being deployed to the field, personnel receive an EMAC Mission Order Authorization Form, education, and briefing. They maintain contact with their home state about the ongoing situation throughout their deployment.2 Demobilization is when personnel have completed their mission and can return to their home states.2

Phase 5 is the reimbursement phase.2 All personnel who were either deployed or provided resources submit a reimbursement form to the assisting state.2 These forms are then audited and sent to the requesting state, where an audit is completed, and reimbursement is provided to the assisting state.2

These 5 phases are crucial for moving resources to emergency and disaster areas. It is important to note that EMAC is the means of having resources transferred and moved and is not the entity providing the resource.3 Personnel involved in response to the emergency can be from the private sector, nongovernmental nonprofit organizations, local government or state agencies, or any other entity that provides resources for EMAC.4

Pharmacists and pharmacy technicians are typically part of the medical support team that assists in shelters.5 All licenses, certifications, and credentials are to be honored by the requesting state.5 Pharmacists and pharmacy technicians should have at least 2 years of experience before being deployed through EMAC and have completed Basic Disaster Life Support certification.5 All pharmacy personnel must also complete Federal Emergency Management Agency Independent Study courses 100 (Introduction to the Incident Command System), 200 (Basic Incident Command System for Initial Response), 700 (National Incident Management System, An Introduction), and 800 (National Response Framework, An Introduction), as well as participate in Occupational Safety and Health Administration (OSHA) training for hazardous material awareness.5,6,7 Pharmacists must have additional OSHA training for respiratory protection and blood-borne pathogens.7

Once deployed in the field, the members of the pharmacy team can distribute and dispense medications; provide recommendations on medication selection, dosing, interactions, and adverse effects; counsel patients; consult with providers about patient care; and maintain accurate records and documentation of activities.6

Pharmacists are crucial members of the health care team and are needed during all times, including emergencies and disasters. They can continue patient care, providing recommendations, and work together with other practitioners to provide the best care in all times of need. Through EMAC, pharmacists and pharmacy technicians can provide care to patients during what may be the most devastating times of their lives. In the face of continuing natural disasters and other emergencies, it is important to remember that pharmacists and technicians can be a resource for care and, through EMAC, they are able to travel and provide it to those in need.


Ashley L. Weaver is a PharmD candidate at the University of Kentucky College of Pharmacy.

Joseph L. Fink III, BSPHARM, JD, DSC (HON), FAPHA, is professor emeritus of pharmacy law and policy and former Kentucky Pharmacists Association Professor of Leadership at the University of Kentucky College of Pharmacy in Lexington.


  1. Select events and historical landmarks. Emergency Management Assistance Compact. Accessed October 11, 2023. https://www.emacweb.org/index.php/learn-about-emac/emac-history
  2. The EMAC process. Emergency Management Assistance Compact. Accessed October 11, 2023. https://www.emacweb.org/index.php/learn/how-emac-works
  3. Preparedness guide and deployment tips for state, local and tribal public health and medical personnel. Emergency Management Assistance Compact. Accessed October 11, 2023. https://www.emacweb.org/index.php/files/69/Educational-Resources/87/Public-Health-and-Medical-EMACBrochure.pdf
  4. Resource provider and deployed personnel EMAC standard operating guidelines. Emergency Management Assistance Compact. March 2022. Accessed October 11, 2023. https://www.emacweb.org/index.php/files/69/Educational-Resources/171/Standard-Operating-Guidelines-for-Resource-Providers-and-Deploying-Personnel.pdf
  5. Mission ready package companion document. National Emergency Management Association. Accessed October 11, 2023. https://www.emacweb.org/index.php/files/87/Public-Health-and-Medical-MRP-Templates/67/EMAC-MRP-Companion-Document.docx
  6. Resource typing definition for public health, healthcare, and emergency medical services. Federal Emergency Management Agency. November 2019. Accessed October 11, 2023. https://rtlt.preptoolkit.fema.gov/Public/Resource/ViewFile/12-508-1242?type=Pdf&q=Pharm
  7. Position qualification for public health, healthcare, and emergency medical services. Federal Emergency Management Agency. February 2023. Accessed October 11, 2023. https://rtlt.preptoolkit.fema.gov/Public/Position/View-File/12-509-1063?type=Pdf&q=pharm
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