Pharmacists assess their roles in the world of bioterrorism
Pharmacists assess their roles in the world of bioterrorism
Planning is the best way to help fight disaster
There’s a place in the unimaginable yet very real world of bioterrorism for the workaday pharmacist. Specialists in disaster preparedness say the time to prepare for handling a major crisis is now.
The American Society of Health-System Pharmacists (ASHP) has launched an on-line resource for counterterrorism information for pharmacists. ASHP created the on-line resource center to give pharmacists information and guidance on national emerging preparedness activities.
The site (www.ashp.org/public/proad/emergency/em_prep.html) lists citations to journal articles related to the role of the pharmacist during disasters, background and overview of biological terrorism, and chemical and biological agent-specific information. Also listed are federal government Web addresses and citations for documents detailing federal action, planning, and guidelines.
Content on the site is updated regularly by ASHP professional practice associate and retired U.S. Public Health Service Capt. Joseph H. Deffenbaugh, MPH. "Being involved in preparedness activities will involve tapping into supplies and distribution of antidotes, antibiotics, and other drugs to minimize casualties through preventive measures or to treat casualties. A federal stockpile of certain drug products is under development and would be available to some extent," he tells Drug Utilization Review. "Prior to being able to distribute this supply, though, communities would be on their own in responding to initial caseload. Civilians should know that, for some latent period, they would be on their own. Even after federal assets begin to kick in, there would have to be massive coordination efforts between emergency people in the area, such as fire, EMS, and public utilities.
"It’s very tricky because in the event of a biological weapon release, the patient cases may not start showing up until several days after the incident," he says. "Those initially exposed could be all over the country, exposing others. The problem is initial recognition, then treatment that involves drug products. Pharmacists can assist in the management of drugs for prevention and treatment of casualties, whether an attack is chemical, biological, or bombs." Depending on location, extent of damage, manpower, and other factors, Deffenbaugh says, pharmacists might be called upon to participate in immunization or other direct treatment of casualties.
Expand existing plans
Another arena where pharmacists could be especially helpful is in evaluating drug-drug interactions for those taking medications, whether for chronic or acute diseases. "Once an attack occurs and patients are treated with antidotes, they would have to be evaluated for drug interactions with the antidote," he says.
"Most hospitals already have emergency preparedness plans for regional tragedies," adds Deffenbaugh. "For example, those who live along the coast prepare for hurricanes; those in the Midwest prepare for tornadoes. This type of preparedness just adds another dimension to existing plans."
The government cannot afford to ignore the potential danger of terrorism, another planner says. "Such an attack would not necessarily be inside the United States. It could be overseas at an embassy in another country, says Richard Aghababian, MD, professor and chairman of the department of emergency medicine at UMass Memorial Medical Center in Worcester, MA.
"It’s often the superpowers that are targeted. The destruction that terrorists create is to gain attention for their cause. They typically don’t intend to hurt a lot of people," says Aghababian, who is involved in disaster preparedness programs in the United States and abroad.
He says pharmacists can play an important role in responding to disaster situations.
"In the case of a chemical or biological attack, pharmacists can help identify patterns of illness within a hospital or community and then relate patient symptoms to a pharmacological cause," says Aghababian. "The cause is not always obvious. Pharmacists can identify a common source for many people with the same symptoms."
Performing drug utilization reviews and observing patterns of drug use can help pinpoint sources of illness. Simply watching specific drugs empty off the pharmacy shelves can aid in identifying patterns.
"Pharmacists can also help by being aware of chemical agents that can be used as weapons," Aghababian adds. "Pharmacists who are well versed with the clinical picture, who can confirm the source, and then provide the pharmacological countermeasures are of great value."
Aghababian encourages pharmacists to study this area. Training on the chemical and biological agents and their related signs and symptoms is available through professional groups such as the American College of Emergency Physicians.
Seventeen countries are reported to have programs active for biological weapons. Not much skill is required, though, to produce effective biological weapons. A.F. Kaufmann of the Centers for Disease Control and Prevention in Atlanta writes in Emerging Infectious Diseases that the "greatest, but not insurmountable, hurdle in such an endeavor may be gaining access to a virulent strain of the desired agent. Production costs are low, and aerosol dispersal equipment from commercial sources can be adapted for biologic weapon dissemination. . . . Bioterrorists may not be constrained by the need for precise targeting or predictable results."1
The success of a biological attack depends on the agent used, method of dissemination, population exposed, availability of postexposure treatment, and potential for further transmission. Kaufmann reports in that "understanding and quantifying the impact of a bioterrorist attack are essential to developing an effective response."
The Defense Against Weapons of Mass Destruction Act of 1996 initiated involvement of several federal agencies in activities that "better prepare local communities for the consequences of a terrorist incident involving a weapon of mass destruction." A compendium of courses is offered by the federal government. Contact Patsy Garcia at (410) 436-7932 for more details.
Reference
1. Kaufman AF, Meltzer MI, Schmid GP. The economic impact of a bioterrorist attack: Are prevention and postattack intervention programs justifiable? Emerg Infect Dis 1997; 3(2).
Sources
• Richard Agababian, MD, Professor and Chairman, Department of Emergency Medicine, UMass Memorial Medical Center, Worcester, MA. Telephone: (508) 334-1000.
• Joseph Deffenbaugh, Retired U.S. Public Health Service Captain and ASHP Professional Practice Associate, Bethesda, MD. Telephone: (301) 657-3000.
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