DISASTER PLANNING FOR YOUR PHARMACY

(IS ALWAYS A GOOD IDEA)

ILE A LA CROSSE – FOREST FIRE – MAY 1998

• EVACUATION STARTED OUT AS VOLUNTEER AND LED TO A FULL EVACUATION

• FIRE FIGHTERS, RCMP AND HEATH CARE PERSONNEL STAYED BEHIND AS ESSENTIAL SERVICES

• CHALLENGES – HIGHWAY CLOSURES, HEAVVY SMOKE LEADING TO AIRSTRIP CLOSURES, DAYS WITHOUT POWER AND DWINDLING MEDICAL SUPPLIES

PELICAN NARROWS FIRE AND “QUARANTINE”

• FOREST FIRE AND HEAVY SMOKE JULY 2008

• VOLUNTEER EVACUATION CALLED

• 1000 PEOPLE AND A FEW DAYS LATER 300 MORE

• POWER OUTAGES, HEAVY SMOKE AND WATER WERE THE MAIN ISSUES.

• GROUP A BETA HEMOLYTIC STREP PNEUMONIA

• A DECISION WAS MADE TO QUARANTINE PELICAN NARROWS. A ROAD BLOCK WAS CONSTRUCTED AT THE BRIDGE TO ENTER/EXIT THE COMMUNITY

• NO MAIL, NO GAS, NO FOOD OR DRUGS ENTERED THE COMMUNITY

CUMBERLAND HOUSE VILLAGE AND CREE NATION FLOODING 2013

• THE SEVERITY OF FLOODING THAT OCCURRED HAD NOT BEEN SEEN IN 100 YEARS. A STATE OF EMERGENCY AND EVACUATION WAS CALLED ON A SATURDAY. 2200 PEOPLE WERE EVACUATED AS FEARS AROSE THAT THE ONLY ROAD TO ACCESS THE COMMUNITY WOULD BE WASHED AWAY.

• THE RED CROSS WAS HEAVILY INVOLVED AND ON SITE IN NIPAWIN.

• MEDICAL STAFF, RCMP, MAYOR AND COUNCIL AND THE RED CROSS WORKED CLOSELY WITH THE PHARMACY TO ENSURE EVACUEES HAD MEDICATIONS BEFORE THEY WERE FORWARDED ONTO EVACUATION CENTERS THROUGHOUT THE PROVINCE.

HARBOUR PHARMACY FIRE – 1 YEAR AGO(YES, FOR REAL)

ABOVE ALL, PATIENT CARE

TEMPORARY PHARMACY AT LA RONGE HEALTH CENTERTHIS WAS ESTABLISHED IN 72 HOURS WITH THE INCREDIBLE DEDICATION

OF STAFF, HELP FROM MCKESSON AND SCP.

TEMPORARY PHARMACY # 2IT WAS HERE THAT WE SET UP CAMP FOR THE NEXT 8 MONTHS AND THOUGHT THE WORST WAS BEHIND US……

JUNE 6TH THE SUMMER OF FIRE BEGINS

TIME TO LEAVETHIS WAS TAKEN ON LARONGE AVENUE ON THE SUNDAY BEFORE WE EVACUATED. IT WAS 3:26 IN THE AFTERNOON. A FULL MANDATORY EVACUATION WAS NOT DECLARED UNTIL THE FOLLOWING SATURDAY.WHEN EVACUATION WAS DECLARED, 13,000 PEOPLE WERE MOVED OUT OF THE NORTH TO SOUTHERN SASKATCHEWAN AND ALBERTA.THESE PEOPLE WERE BEING TOLD THEY HAD 20 MINUTES TO ½ HOUR TO LEAVE THEIR HOMES.OTHERS WITHOUT TRANSPORTATION LINED UP FOR BUSES. THEY COULD TAKE 1 BACPKACK AND HAD TO LEAVE ALL PETS BEHIND.

WHEN YOU NEED TO CLOSE YOUR STORE….• NOTIFY ALL MEDICAL STAFF/ MEDICAL GROUPS IN YOUR COMMUNITY AND REGION.

• USE ALL SOURCES OF MEDIA TO COMMUNICATE CLOSURE TO THE PUBLIC. YOU STILL HAVE AN OBLIGATION TO CONTINUE TO PROVIDE CARE TO YOUR PATIENTS.

• NOTIFY SCP (INFO@SASKPHARM.CA) AND SASK HEALTH OF CLOSURE AND REOPENING.

• MEET WITH YOUR STAFF AS SOON AS POSSIBLE. GET CELL NUMBERS OF EVERYONE.

• ENSURE ALL PATIENT INFORMATION IS PROTECTED AND SECURE. THINK PRIVACY!

• SECURE YOUR PHARMACY IF POSSIBLE OR HIRE SECURITY TO MONITOR IT IN YOUR ABSENCE.

• LIASE WITH OTHER AGENCIES: HEALTH REGIONS, RED CROSS, RCMP, MAYOR AND COUNCIL, CHIEF AND COUNCIL, FIRE AND EMERGENCY SERVICES.

• TRY TO BACK UP YOUR DATABASE IF POSSIBLE!

SO THIS IS A DISASTER…WHAT CAN A PHARMACIST DO?

OUR JOB, WE CAN DO OUR JOB.• MAKE YOURSELF AVAILABLE. PUBLISH YOUR CONTACT INFO. YES, YOUR NUMBER ON FACEBOOK. YOUR NUMBER ON YOUR STORES ANSWERING MACHINE. DO IT!

• YOUR PATIENTS WILL NEED TO FIND YOU. CAREGIVERS IN OTHER HEALTH REGIONS AND PROVINCES WILL NEED TO FIND YOU. YOUR DOCTORS WILL NEED YOU.

• WORK WITH DOCTORS AND NURSES TO PROVIDE MED PROFILES. PIP AND PIP RESPONSIVELY BUT PIP! THEY WILL RELY ON US FOR DRUG KNOWLEDGE.

• CONNECT WITH ALL AGENCIES ON THE FRONT LINE SO THEY NOW YOU ARE THERE. FIREFIGHTERS, PILOTS, ARMY, RED CROSS. INCLUDING VOLUNTEERS: SANDBAGGERS, COOKS

• PROVIDE EMERGENCY SUPPLY RX’S (INHALERS, EPIPENS). DO INTERIM SUPPLIES (CANT ACCESS MEDICATIONS) AND DO YOUR MINOR AILMENTS PRESCRIBING! DO IT, DO NOT TURN PATIENTS AWAY. MANY PEOPLE INCLUDING HEALTH CARE PROFESSIONAL STILL DO NOT KNOW OUR SCOPE OF PRACTISE.

• PATIENTS LOOK TO US FIRST. WE ARE THE MOST TRUSTED, MOST ACCESSIBLE HEALTH CARE PROFESSIONAL.

• GO ABOVE AND BEYOND. COME IN AFTER HOURS, DO THE DOOR KNOCKING, FEED THE DOGS AND FILL THE SANDBAGS ALONGSIDE YOU NEIGHBORS. THIS IS YOUR COMMUNITY.

EMERGENCY PHARMACY AT THE AMBULANCE BASE

PROMOTE YOUR PROFESSION

So, some nice stories…but do I need to help??Umm, Yes…Yes you do.

SCP Code of Ethics states “A pharmacist shall hold the health and safety of the public to be the first consideration in the practice of his profession rendering each patient the full measure of his ability as an essential health care practitioner”

If the disaster is a natural disaster, a man made disaster or disease outbreak related, we are expected, by our Code of Ethics, to report to work. (Even in the face of personal risk.)

STAND ON GUARD FOR THEE – U of T Joint Center for Bioethics Pandemic Influenza Working Group. – Identified 10 values to guide us in how to provide health care during and emergency.

Individual liberty, Protect the public from harm, Proportionality, Privacy, Duty to Provide Care, Reciprocity, Equity, Trust, Solidarity and Stewardship.

STAND ON GUARD FOR THEE SUMMARY:PHARMACISTS HAVE A SPECIALIZED BODY OF KNOWLEDGE WHICH INCREASE OUR OBLIGATION.BY CHOOSING A PROFESSION TO CARE FOR THE ILL, WE ASSUME SOME RISKS.THIS PROFESSION HAS A SOCIAL CONTRACT THAT EXPECTS ITS MEMBERS TO BE AVAILABLE IN TIMES OF EMERGENCIES.BUTEMPLOYERS, AND REGIONAL HEALTH AUTHORITIES SHOULD PROVIDE RESOURCES AND SUPPORT TO PROVIDE AS SAFE A WORKING ENVIRONMENT AS POSSIBLE. WE MUST ALSO PROTECT AND SUPPORT VULNERABLE PHARMACISTS.

EMERGENCY PREPAREDNESS RESOURCE KIT FOR PHARMACISTS EST. JULY 2015

• DUTY TO CARE PRINCIPLES - SUMMARY• WE HAVE A DUTY TO PROVIDE CARE USING APPROPRIATE SAFETY

PRECAUTIONS, OUR EMPLOYERS AND HEALTH REGIONS SHOULD ASSIST US THE BEST THEY CAN. WE MUST PROVIDE THAT CARE UNTIL SUCH A TIME THAT WE ARE REDEPLOYED. WE ARE TO BE INVOLVED IN INFORMATION SHARING WITH STAKEHOLDERS.

• EMPLOYERS, REGULATORS AND HEALTH AUTHORITIES NEED POLICIES AND PROCEDURES TO SUPPORT SAFETY AND MINIMIZE RISK FOR HEALTH CARE PROFESSIONALS.

• HEALTH CARE PROVIDERS ARE STILL EXPECTED TO PROVIDE THE BEST CARE POSSIBLE. THEY MUST NOTIFY THEIR EMPLOYER AS SOON AS THEY CAN NO LONGER PROVIDE CARE.

• WE MUST WORK WITHIN THE SCOPE OF OUR PRACTICE, AND WE MUST WORK COOPERATIVELY AND RECOGNIZE THE SKILLS OF OTHER HEALTH CARE PROVIDERS.

• LASTLY, WE ARE EXPECTED TO WORK WITH REGIONAL HEALTH AUTHORITIES WITHIN PROVINCIAL AND FEDERAL DEPARTMENTS.

HEALTH AUTHORITY PARTNERS WITH ARMY.

EMERGENCY PRESCRIPTIONS • EMERGENCY SUPPLIES.- NEEDED TO BE DONE THIS SUMMER. SOME PHARMACIES DID GREAT, OTHERS REALLY DROPPED THE BALL. MANY CALLS CAME NORTH TO MYSELF AND THE PHYSICIAN GROUP FROM PATIENTS TURNED AWAY FROM PHARMACIES. MANY WENT WITHOUT INSULIN, PRADAXA, NITRO PATCHES AND SEIZURE MEDICATION WHILE THEY TRIED TO FIGURE OUT WHERE TO TURN FOR HELP.

• REVIEW:• IF THE PATIENTS PHARMACY IS CLOSED DUE TO A DISASTER A PHARMACIST CAN WITH

PATIENT CONSENT CHECK PIP AND FILL THEIR NEEDED MEDICATION. THEN THE PHARMACIST MUST NOTIFY THEIR PRESCRIBER AND ANY OTHER RELEVANT HEALTH CARE PROVIDER (HOME CARE, RED CROSS, LTC FACILITY)• PHARMACIST SHOULD HAVE A MEDICAL HISTORY AND BE SATISFIED THIS

MEDICATION IS A STABLE CHRONIC ONE.• EACH “EMERGENCY” SHOULD BE LOOKED AT INDIVIDUALLY• ALL USUAL DOCUMENTATION MUST BE COMPLETED.• NARCOTICS AND BENZOS MUST NOT BE PROVIDED. EVERY EFFORT MUST BE MADE

TO OBTAIN A NEW RX…….BUT• CDSA MEDICATION CAN BE USED IF IT IS FOR SEIZURE TREATMENT (WHEN GOING

WITHOUT THE MEDICATION MAY CAUSE A WITHDRAWAL SEIZURE) OR IF THERE IS REAL CONCERN FOR LOSS OF PAIN CONTROL AND DANGERS OF OPIOID WITHDRAWAL. IN THIS INSTANCE THEIR PHYSICIAN MUST BE NOTIFIED AS SOON AS POSSIBLE AND A PRESCRIPTION OBTAINED.

• ALL NEW MEDICATIONS DISPENSED SHOULD BE LABELLED “EMERGENCY SUPPLY”

USEFUL LINKS• PHARMACISTS SHOULD KEEP ON TOP OF THE LATEST NEWS AND

DEVELOPMENTS FROM TRUSTED RESOURCES. • WWW.HC-SC.GC.CA• WWW.GOV.SK.CA/• REGIONAL HEALTH AUTHORITIES• GLOBAL/CTV/CBC• FACEBOOK, TWITTER AND INSTAGRAM ARE NOT YOUR FRIEND OR YOUR

PATIENTS FRIEND.• ALMOST EVERY EMERGENCY WILL EVENTUALLY RESULT IN RATIONING

YOUR DRUG SUPPLY. DECISIONS WILL NEED TO BE MADE THINKING OF THE PATIENT POPULATION AS A WHOLE INSTEAD OF AN INDIVIDUAL. • HTTP://MEDSASK.USASK.CA/PROFESSIONAL/DRUG-SHORTAGES/INDEX.PHP• HTTP://WWW.RXFILES.CA/RXFILES/ THIS RESOURCE WAS VERY VALUABLE. WE

USED IT IN THE CUMBERLAND HOUSE FLOOD FOR VOLUNTEERS LEFT BEHIND IN THE FLOOD ZONE AND LAST SUMMER FOR PATIENTS STRANDED IN STANLEY MISSION. BOTH COMMUNITIES HAD NURSING STATIONS WITH LIMITED FORMULARIES AND DRUGS WE COULD ACCESS.

PHARMACY MANAGERS – ACTION LIST

• HOLD A STAFF MEETING, EDUCATE YOUR STAFF ON THEIR ETHICAL OBLIGATION AND WORK NOW TO ENSURE WHEN THE TIME COMES THEY HAVE ACCESS TO NEEDED EQUIPMENT TO PROTECT THEMSELVES.

• MAKE YOUR STORE PHONE LIST, PUT IT IN YOUR PHONE. (DO THIS MONDAY)

• HAVE A BUSINESS CONTINUITY PLAN IN PLACE IF YOU NEED TO CLOSE YOUR STORE.

• HAVE A PLAN TO DEAL WITH DRUG SHORTAGES

• LEAD BY EXAMPLE

RESOURCES:SCP: PHARMACIST’ ETHICAL DUTY DURING AN EMERGENCY, DISASTER OR PANDEMICSCP: EMERGENCY PREPAREDNESS RESOURCE KIT FOR PHARMACIES