Field Pharmacy Practice

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Field Pharmacy Practice
Presenters Louis R. Flowers, CDR, USPHS, FDA,
CDER Mark R. McClain, CDR, USPHS, FDA, ORA

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Field Pharmacy Practice

• Panelists
• CDR David Bates, Chief Pharmacist, Zuni
  Comprehensive Health Center,
• Zuni, New Mexico
• CDR Andrew Meagher
• Regional Pharmacy Officer, U.S. Coast Guard
• CDR Nate Yale
• Gallup Indian Medical Center
• CDR Mark Strong
• Chief of Pharmacy Services, USP Leavenworth
• CDR Bradley M. Bishop
• Tucson Area Indian Health Service
• CDR Mark R. McClain
• U.S. Food and Drug Administration

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Objectives

• Describe the Federal Emergency Response System
• Summarize Deployment Operations
• Explain the U.S. PHS Tiered Team Structure
• Describe Field Pharmacy Practices

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Federal Emergency Response System
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National Response Framework for providing Federal
support

• Perhaps the most widely known authority under
  which Federal assistance is provided for major
  incidents is the Stafford Act.
• When an incident occurs that exceeds or is
  anticipated to exceed State, tribal, or local
  resources, the Federal Government may provide
  assistance under the Stafford Act.
• In those circumstances, a Governor may ask the
  President to declare an emergency or major
  disaster.

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National Response Framework for providing Federal
support

• Before making a declaration request, the Governor
  must activate the States emergency plan and
  ensure that all appropriate State and local
  actions have been taken or initiated.
• The Governors request is made through the
  Federal Emergency Management Agency (FEMA)
  Regional Administrator and includes information
  on the extent and nature of State resources that
  have been or will be used.

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National Response Framework for providing Federal
support

• The FEMA Regional Administrator evaluates the
  damage and requirements for Federal assistance
  and makes a recommendation to the FEMA
  Administrator.
• The FEMA Administrator, acting through the
  Secretary of Homeland Security, then recommends a
  course of action to the President.
• In extraordinary circumstances, the President may
  unilaterally make such a declaration to expedite
  the delivery of lifesaving assistance.

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National Response Framework for providing Federal
support

• Following a Presidential declaration, the
  President appoints a Federal Coordinating Officer
  to execute Stafford Act authorities.
• The Federal Coordinating Officer represents the
  FEMA Administrator in the field and uses the
  structures and process specified in the National
  Response Framework to manage the response and
  recovery efforts.
• While the Stafford Act may be the most familiar
  mechanism for Federal support, it is not the only
  one.

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Steps for requesting Stafford Act assistance

• Step 1 Tribal and/or local emergency personnel
  respond and assess the situation.
• Step 2 Governor activates the States emergency
  plan and ensures that all appropriate State and
  local actions have been taken or initiated.
• Step 3 The State and Federal officials conduct
  the preliminary damage assessment in coordination
  with tribal/local officials.
• Step 4 Governors request for assistance is
  submitted through the FEMA Regional
  Administrator.
• Step 5 The FEMA Administrator, acting through
  the Secretary of Homeland Security, recommends a
  course of action to the President.
• Step 6 The President issues a major disaster
  declaration and appoints a Federal Coordinating
  Officer to execute Stafford Act authorities.

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15 Emergency Support Functions
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ESF 8 Public Health and Medical Services

• ESF Coordinator Department of Health and Human
  Services
• The Secretary of HHS leads the ESF 8 response
• ESF 8, when activated, is coordinated by the
  Assistant Secretary for Preparedness and Response
  (ASPR)
• Once activated, ESF 8 functions are coordinated
  by the Emergency Management Group (EMG) through
  the Secretarys Operations Center (SOC)

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Commissioned Corps Deployments

• Commissioned Corps Directive 121.02
• Authority to activate Corps for deployment
• President
• Secretary
• Assistant Secretary for Health (ASH)
• Command and Control
• The ASH through the Surgeon General or
  designee(s) shall exercise field command of
  officers during deployments.

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Commissioned Corps Deployments

• Needs of the mission are matched with the skills
  and qualifications of officers on the rotational
  ready roster.
• Agencies are informed that officers from the
  roster are needed.
• Officers are contacted.
• Supervisory release is obtained.
• If necessary, travel orders and arrangements are
  prepared.
• Teams/Officer (s) are deployed.

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USPHS Commissioned CorpsTier 1

• 5 Rapid Deployment Force (RDF) Teams
• Report within 12 hours
• 1 Team on call every 5 months
• 8 pharmacist slots for a RDF Team

• 10 Incident Response Coordination Teams (IRCT)
• Report within 12 hours
• 2 Teams on call every 5 months

• 5 Emergency Management Group (EMG) Support Teams
• Report within 4 hours
• Support EMG at Secretarys Operation Center

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USPHS Commissioned CorpsTier 2

• 5 Applied Public Health Teams (APHT)
• Report within 36 hours
• A team on call every 5 months

• 5 Mental Health Teams (MHT)
• Report within 36 hours
• A team on call every 5 months

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USPHS Commissioned CorpsTier 3

• Active Duty Commissioned Officers
• Not Assigned to Tier 1 or Tier 2 Teams.
• Officers assigned to Tier 3 are expected to
  report to a point of departure within 72 hours of
  notification.

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PHS Rotational Roster
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Field PharmacyTeams, Supply Chains, Roles
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The Spectrum of Care Federal Medical Resources
Medical Reserve Corps/Volunteers
NDMS Hospitals
DMATs
VA/DoD
US Public Health Service
Federal Medical Stations
ARC Shelter
Basic First Aid
Outpatient Care
ICU/Trauma Critical Care
Emergency Departments
Hospital Inpatient Care
Nursing Home Care
Pre-hospital Care
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How PHS Teams Interface

• RDFs staff FMS
• PHS may work on the NDMS to supply DMAT Teams
• NDMS supports DMATs, VMATs, DMORT (all civilians)

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Federal Medical StationAttributes

• Scalable to the incident
• Modular configuration
• Mobile for maximum geographic distribution
• Quickly integrated to the site
• Predictable resources
• Modeled for all age populations
• Requires a shelter of opportunity

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Pharmaceutical Supply Chain

• NDMS
• Push Packs
• FMS
• PHS Go-Bags
• SNS
• Make-Shift (donations)

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Strategic National Stockpile (SNS)

• It is a national stockpile of antibiotics,
  chemical antidotes, antitoxins, life-support
  medications, IV administration, airway
  maintenance supplies, and medical/surgical items
  for Bioterrorism or Chemical attacks.
• The SNS is designed to supplement and re-supply
  state and local public health agencies

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Pharmacy Push Packs(from SNS)

• Pharmaceuticals, antidotes, and medical supplies
  on site within 12 hours
• Designed for ill defined threat in early hours of
  an event
• Rapid delivery for an ill defined threat in the
  early hours of an event.

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The National Disaster Medical System(NDMS)
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Locations of NDMS Caches

• Pharmacy Caches are pre-positioned at four
  classified Logistic Centers in the United States.
• LC-Georgia (4 DMAT Rx Caches)
• LC-Texas (4 DMAT Rx Caches)
• LC-California (5 DMAT Rx Caches)
• LC-Hawaii (2 DMAT Rx Caches)

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The NDMS Pharmacy Cache(What does it contain?)

• 2 Tri-walls
• Pelican case
• Cooler
• Forms

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NDMS Pharmacy Tri-wall
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The NDMS Pharmacy Caches
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NDMS Controlled Substances Cache

• Inventoried at each shift
• All Rx and stock orders must be signed by a
  physician and contain DEA Number
• All Rx or patient treatment records must be
  returned to LC, MD
• Loss/Theft requires DEA notifications with Form
  106, incident report

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Pharmacy Caches
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The DMAT Cache

• Disaster Response Team is fully accountable for
  their Pharmacy Cache
• Personal Custody/Record Hand Receipt (Form 439)
  must be signed when accepted.

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Common medical conditions among FMS patients
data from FMS _at_ Waco, Marlin, and Meridian NAS
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Five Common Behavioral Health Conditions Seen in
Disasters
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Roles of Pharmacists in Emergencies and Disasters

• Set up Field or Mobile Strike Team pharmacies
• Back-fill deployed pharmacist positions
• Give vaccinations, chronic medications
• Assist in triaging patients
• Act as Information resource

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PHS Primary Care Clinic, New Orleans, Canal
Street 11-16-2005
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Camp Phoenix Pharmacy Baton Rouge, LA
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Mobile Strike Team Daily Cache
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Practicing Field PharmacyLouisiana 10/2005
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Disaster Scenarios

• Avian Flu Outbreak
• Tidal Wave/Hurricane/Tornados
• Earthquakes
• Power Grid Failure
• Biological Research Accident
• Germ Warfare
• Nuclear/Chemical Attack