By Mary Beth O’Connell, Pharm.D., BCPS, FASHP, FCCP, FNAP, AGSF, professor, Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, Detroit
Every year, disasters and public health threats affect various populations and geographical areas. Since 1953, Michigan has experienced 37 disasters (see Figure 1).1 During disasters and threats, healthcare is needed to meet acute, chronic and preventive health needs. Paid healthcare and government employees coordinate and oversee these healthcare services, but most of the care comes from volunteers for medical, technical, and logistical tasks. Medications play a critical role in overcoming disasters and public health threats; therefore, pharmacists, pharmacy technicians and student pharmacists are needed at these events. Having a database of volunteers facilitates the engagement of personnel and resources in a timely and organized manner. What follows is information about disasters and public health events and how to join the Michigan Volunteer Registry database. Pharmacy personnel are a critical component of interprofessional healthcare teams to improve the health and well-being of citizens during disasters, so registering with the database is incredibly important. Currently about 325 pharmacy personnel are in the registry, but the goal of MSHP/MPA is to have 1,000 pharmacy-focused volunteers by the end of the year. Non-pharmacy volunteers are also needed, so sign up with a colleague, family member, friend or alone. Join those of us who have accepted this important healthcare obligation. When you are called on to volunteer, you will make an important contribution to society, but if you are not available at the time you are called, you can always say you are unable to volunteer at this time.
Figure 1. Number and Location of Michigan Disasters1
9 Severe storms
1 Toxic substances
Disasters are common and are classified as natural, technological and man-made. Natural disasters include hurricanes, tornados, fires, earthquakes, floods, etc. Technological disasters can include power grid outages or computer problems. Man-made disasters can be intentional or unintentional including biological terrorism, disease outbreaks, nuclear, radiologic or chemical terrorism, and violence from bombs and mass shootings. As Virginia Zimmerman, Coordinator of the Michigan Volunteer Registry states, “It is not a matter of if but when” a disaster strikes. For example, in 2017 there were four hurricane created natural disasters. During the initial response phases for these four hurricanes, 4,674 personnel were deployed to help 36,370 patients!2 During these disasters people experience trauma or new illnesses, find themselves without their chronic medications due to evacuation or fleeing, or are unable to get more medications due to destruction of community pharmacies. During Hurricane Katrina 68 to 80 percent of shelter evacuees needed replacement medications.3 During Hurricane Sandy, 95 percent of ambulatory care clinics in the affected area needed to close or relocate.4 Only 37 percent of the community pharmacies in that area had a back-up generator; therefore, most pharmacies were not able to operate fully. Seventy-four percent of the pharmacies had damage limiting pharmacy services, and 44 percent of the pharmacy staff had transportation issues getting to work. As demonstrated, during most disasters, temporary community pharmacies are needed with additional pharmacy personnel. Sometimes the need results from the spread of a contagious disease such as the hepatitis A outbreak in the Southeast Michigan area, which required public health events to mass immunize large numbers of citizens at risk of getting the disease. In cases of bioterrorism, a stockpile of medications exists that would require mass dispensing of antibiotics or antidotes quickly. You have the skills and expertise to help during these times.
Can you see yourself helping out? Pharmacy personnel have unique skills that other healthcare professionals do not have that are needed during disasters and public health events. The major categories of pharmacy activities during disasters and public health threats are medication supply, patient management, policy coordination and response integration.5 A recent review of literature has expanded these categories to professional practice, population health planning, direct patient care, legislation and communications.6 So many roles and steps exist, such as setting up an emergency based pharmacy, procuring and storing medications, managing pharmacy volunteers, doing patient interviews to identify and resolve medication related problems, labeling, dispensing and administering medications, counseling and educating patients, answering healthcare professional's drug information questions, providing team care, assisting with computer support, prehospital triaging during mass-casualties, enhancing communications, and decreasing panic and fear with patients, families and providers. Some pharmacy curriculums are even adding emergency preparedness to pharmacy student training. Many pharmacy organizations are adding this type of training to their annual meetings. All pharmacies are encouraged to have a plan for operations during a disaster.
Please join the Michigan Volunteer Registry at MiVoluntterRegistry.org. Michigan is fortunate to have such a registry. The registry is managed the Michigan Department of Health and Human Services. Dianne Malburg, Michigan Pharmacists Association (MPA) chief operations officer and Farah Jalloul, MPA emergency preparedness coordinator, are administrators for the database. The process required to enroll is done online and can be done in parts. You will need to enter your pharmacy license number and information about immunization, CPR and other types of certifications. The registry is dynamic, which means you can change your ability and responsibilities over time. Enrollment does not commit you to any disaster. If a disaster occurs, they might contact you and you can say “yes, I am available”, “no, I am not available”, or “I need to take care of my family or place of employment first.”
The value of an emergency preparedness database is state personnel can validate licensure to have practice-ready, licensed healthcare professionals they can call upon immediately versus trying to validate personnel during the actual disaster. The database can identify volunteers by skills so the appropriate people are requested by healthcare needs. Outcomes after a disaster are better for states that are ready and have plans and personnel ready to engage.6
Ready to volunteer but have some reservations? Watch the recruitment video that was developed for pharmacy personnel at https://youtu.be/OzdREGEsAc4. You can also visit to the MiVolunteerRegistry.org website and read the frequently asked questions sections as well as some of the references below. You are also welcome to contact Farah Jalloul, MPA emergency preparedness coordinator, at Farah@MichiganPharmacists.org for any additional information or question. Here are some answers to common concerns.
1) I don’t know enough. Incorrect. Each of us can assist during a disaster or public health threat by providing skills in the area of management, operations, supply chain, patient education, dispensing, etc.
2) I don’t have the time. You can volunteer for just a half day or for a couple days or a week – it’s all up to you.
3) I have a busy life. When they call, you can say sorry, I can’t volunteer this time.
4) I won’t be able to take care of my family. Incorrect. You can take care of your family first; remember this is a volunteer function that you have the right to say, “sorry, hopefully next time.”
5) I am uneasy about working with trauma patients or during a chemical or bioterrorism event. You get to choose what type of activities you volunteer your expertise. You can just list immunizations at a public health event and not volunteer for disasters.
6) I am not trained to do disaster care. At any disaster, medical experts and law enforcement are there to oversee the situation. They direct operations and assignments, so you always have resources and information during a disaster. They have access to safety gear and preventive health medications, if needed.
7) I’m afraid of liability issues. During disasters state and federal laws exist to cover healthcare professionals, with the coverage varying by profession. Some pharmacy malpractice insurance companies cover humanitarian efforts, so check your plan. MPA is working to get even greater coverage for pharmacy personnel during disasters. The rules are constantly changing. For information about insurance coverage, see reference four, and also the frequently asked questions at www.MiVOlunteerRegistry.7
8) My employer won’t let me volunteer. You should double-check with your employer to see if you can get release hours from work or could use vacation time. Some pharmacy chains actually set up their own pharmacy units so you might be able to work within your own company during a disaster.
9) I can’t afford to volunteer. That might be true. During these events you generally have to pay for your own travel, lodging and food. Volunteers are not paid for their services. Generally costs for local events are minimal and less than national events. Sometimes organizations donate food and discount lodging to keep costs affordable.
Using your pharmacy skills and training during a disaster will help save lives and improve healthcare outcomes. Wouldn’t you want the state of Michigan to have a plan to help you and your family in an emergency? In order for that to happen, we have to have pharmacy personnel from all counties in Michigan ready to step up and provide medications and save/improve lives and health outcomes. So please register today at www.MiVolunteerRegistry.org. We need you! Recruit others from your practice. Together we can make a big difference!!
1. FEMA. Data Visualization: Disaster Declarations for States and Counties. FEME website. https://www.fema.gov/data-visualization-disaster-declarations-states-and-counties.
2. Assistant Secretary for Preparedness and Response. ASPR Year in Review. Public Health Emergency website. https://www.phe.gov/about/Documents/2017-Year-in-Review-Infographic.pdf.
3. Carameli KA, Eisenman DP, Blevins J, d’Angona B, Glik DC. Planning for chronic Disease Medications in Disaster: Perspectives From Patients, Physicians, Pharmacists and Insurers. Disaster Med Public Health Prep. 2013;7(3):257-65.
4. Ford H, Dallas CE, Harris C. Examing Roles Pharmacists Assume in Disasters: A Content Analytic Approach. Disaster Med Public Health Prep. 2013; 7(6):563-572.
5. Arya V, Medina E, Scaccia A, Mathew C, Satrr D. Impact of Hurricane Sandy on Community Pharmacies in Severely Affected Areas of New York City: A Qualitative Assessment. Am J Disaster Med. 2016;11(1):21-30.
6. Alkhalili M, Ma J, Grenier S. Defining Roles for Pharmacy Personnel in Disaster Response and Emergency Preparedness. Disaster Med Public Health Prep. 2017;11(4):96-504.
7. Frequently Asked Questions (FAQ) About Legal and Regulatory Issues Pertaining to the MI Volunteer Registry. Michigan.gov website. http://www.michigan.gov/documents/mdch/LEGAL_ISSUES_258700_7.pdf.