Disaster planning should be priority for hospital pharmacists, experts say

Disasters should be defined broadly

The past decade has featured devastating hurricanes, floods, fires, and terrorist acts that have captured headlines often for weeks at a time.

What the nation's heightened awareness of disasters has shown is that every hospital, whether or not it's on the coastline, should have a disaster plan that includes the pharmacy department.

Hospital pharmacists also need to expand their personal definition of disaster to include events that could occur anywhere at any time, such as a pandemic flu outbreak, an anthrax terrorism attack, or even a highway jacking of spent plutonium.

"Tennessee has a disposal site for used plutonium, and I-40 is a huge corridor for taking spent plutonium to Nevada for burial, a final disposal," says Sharon S. Cohen, RN, MSN, CEN, CCRN, an emergency preparedness clinical nurse specialist/instructor trainer of Broward Health in Ft. Lauderdale, FL.

The bad guys could highjack one of those trucks, leading to a potential accident and disaster that would require focused and rapid medical mobilization, Cohen says.

While this is a remote possibility, the point is that all of those hospitals along the I-40 corridor have a potential disaster risk that they might not even be aware of.

This is why every hospital and hospital pharmacist should consider writing disaster plans that will work whether a disaster is weather-related, caused by terrorism, the result of a major viral outbreak, or caused by an unanticipated event, Cohen and other disaster planning experts say.

"You need to look at all disasters that can have a health impact," says Erin Mullen, RPh, PhD, an assistant vice president for Rx Response of Washington, DC. Rx Response (www.rxresponse.org) is a private sector partnership of pharmaceutical organizations that helps provide support during severe public health emergencies.

Rx Response provides a list for pharmacists of web sites and organizations that have additional information about disaster preparedness. (See list of disaster planning sites.)

"The number one thing that keeps me up at night is worrying about being prepared for pandemic influenza," Mullen says. "Pharmacists need to be aware and up-to-date on pandemic influenza."

Some hospitals are beginning to incorporate pandemic flu preparedness in their disaster plans, partly because infectious disease experts say these are cyclical and a big flu outbreak is due.

"There's a sense of history and a sense of urgency," says Carsten Evans, PhD, FASHP, an assistant dean in continuing professional education at Nova Southeastern University, College of Pharmacy, in Fort Lauderdale, FL.

"In 1918, there were more U.S. soldiers killed from flu than from World War I," Evans says. "It was remarkable how they piled up bodies in Washington and New York."

As the soldiers returned by boat from Europe, there were cargo ships full of the bodies of those who died from the pandemic, Evans adds.

Last year there were 50,000 deaths in the United States from the seasonal flu, Mullen says.

"We average 36,000 deaths a year from flu," she adds. "Last year was a bad year because the vaccine wasn't a good match."

But the point is that flu pandemic would have widespread public health and societal impact.

"Look at a pandemic and worst-case scenario, and you could imagine absenteeism as high as 40% in the hospital," Mullen says. "Employees would have to stay home because family members were sick and schools were closed."

For this reason, Mullen recommends that hospital pharmacists develop their own personal disaster plans before fine-tuning their professional disaster plans.

"Pharmacists need to make their own personal preparedness plans for their families, themselves, and their pets," Mullen says. "Then they need to educate themselves on what risks there are in their community, so once they're prepared for a disaster they can help their patients become prepared."

Mullen sees pharmacists playing the role of advocate for the overall health of patients, and this includes disaster preparedness.

"Even making sure someone is prepared for a power outage for three days is a significant part of a person's overall health," Mullen says. "It fits right in like refilling prescriptions on time and knowing your medications and conditions."

Pharmacists should talk with their patients about disaster preparedness and encourage them to fill their prescriptions in 90-day supplies, instead of 30-day supplies during hurricane season, if they live in coastal areas, she says.

Also, pharmacists could advise patients to write down their emergency contacts both in and out of their area, Mullen suggests.

"These are people who would check in on them in case something happens," she adds.

At the same time, pharmacists should know their pharmacy's or hospital's plans for restoring power in the event of a disaster, and they should make certain the pharmacy is a priority for restoration, Mullen says.

"The pharmacy is the most accessible point for health care," she notes.