Pharmacist Involvement in Veterinary Disaster Response ... · 12/01/2020 · against the most damaging animal diseases within 24 hours. The directive reflected the national concern

Pharmacist Involvement in Veterinary Disaster Response & Emergency Preparedness Julie Randall, PharmD, FSVHP

Clinical Veterinary Pharmacy Resident

North Carolina State University College of Veterinary Medicine

SVHP Annual Meeting, June 13th, 2019

Houston, TX

My Interest in Veterinary Disaster Response?

My thoughts as a P4 when my friends and I

thought it was a good idea to do our community

rotations in Florida during the month of September…

News forecast 5 days later

Objectives ! Classify disaster events ! Understand the importance of facilitating an efficient and effective disaster response to

animals ! Recognize challenges related to animal emergency management ! Describe potential roles for pharmacists and veterinary pharmacists in veterinary

disaster response and emergency preparation ! Recognize the future direction for pharmacist involvement in veterinary disaster

response and emergency preparedness

Classification of Disasters

What is a Disaster?

”From the standpoint of public health, a disaster is defined on the basis of its consequences on health and health services. A disaster is a serious disruption of the functioning of society, causing widespread human, material or environmental losses, that exceeds the local capacity to respond, and calls for external assistance.”

- CDC " Can be any emergency " Can vary from one jurisdiction to another

Natural Disasters

Man-Made/Hazardous Disasters

Importance of Disaster Response and Emergency Preparedness for Animals

Economic Impact

Texas A&M economists estimated ____________ in total damage to Texas Beef Industry caused by Hurricane Harvey?

A.  $13,950,000 B.  $23,000,000 C.  $55,800,000 D.  $93,000,000

$23,000,000 to weight loss or death

Economic Impact

https://www.agweb.com/article/thousands-of-texas-cattle-may-have-died-in-wake-of-harvey-naa-associated-press/

$93,000,000 in total damage to Texas beef industry

$55,800,000 in replacing cattle feed/hay

$13,950,000 replacing barns, fences, and other infrastructure

Environmental and Public Health Impact

North Carolina: 2nd largest hog industry; over 9 million hogs " Hurricane Floyd (1999): 26 hog lagoons ruptured; 45 damaged

"  Over 120 million gallons of hog waste flooded waterways

" Hurricane Florence (2018): 33 hog lagoons ruptured "  2.2 million gallons of hog waste from one lagoon alone dumped

into waterways

- North Carolina Department of Environmental Quality

Humans and animals exposed to dangerous pathogen contaminated water

NASA’s Landsast-8 image taken after Hurricane Florence showing pollutants and organic matter from lagoons flowing into the Atlantic Ocean

Arial image of mass swine casualty after Hurricane Floyd in 1999; over 21,000 hogs drowned

http://www.readyforsyth.org/about-us/

https://deq.nc.gov/news/deq-dashboard#animal-operations---swine-lagoon-facilities

https://krcrtv.com/news/butte-county/chico-municipal-airport-acts-as-animal-shelter

Animal Welfare Impact

Hurricane Katrina (2005) "  44% of residents failed to evacuate

due to not wanting to leave pets behind "  Even so, estimated 600,000

killed or abandoned

Glassey S. Did Harvey Learn from Katrina? Initial Observations of the Response to Companion Animals During Hurricane Harvey. Animals. 2018; 8(47):1-9.


H.R. 3858: The Pets and Transportation Standards (PETS) Act of 2006 "  Result of 2005 hurricane season*

"  Ensures local, state, federal plans for evacuation, rescue, and essential needs of “household pets” and service animals in wake of disaster

"  Does NOT include "  Reptiles (besides turtles), amphibians, fish,

insects/arachnids, farm animals (including equine), and animals kept for racing purposes

https://www.google.com/search?q=how+many+animals+were+abandoned+during+hurricane+katrina&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjrndL22NPiAhUPOq0KHfHaAMsQ_AUIESgC&biw=1284&bih=687#imgrc=Wmbo-Mt9vRfF9M:

*7/15 hurricanes that season > category 3 😳"


Hurricane Harvey (2017) "  Large scale rescue effort for animals

and humans " Mass displacement – long term " Many animals not microchipped " Many animals not reunited with

owners

Heartworm disease once endemic to coastal Southeast now present throughout the U.S.

https://capcvet.org/

Glassey S. Did Harvey Learn from Katrina? Initial Observations of the Response to Companion Animals During Hurricane Harvey. Animals. 2018; 8(47):1-9.

Challenges in Animal Emergency Management

Time

Do we think clearly under stress and when we’re short on time?

" Time-sensitive operations " High-stress situation

Preparation and organization is important to optimize efficiency

Pincock LL, Montello MJ, Tarosky MJ, et al. Pharmacist Readiness Roles for Emergency Preparedness. Am J Health-Syst Pharm. 2011; 68:620-623

Structure

Huge improvements over the past decades with incorporation of the National Incident Management and Incident Command Systems (NIMS/ICS) to align federal, state, and local responses "  Still many issues in less populated areas

" Preparedness plans " Clear roles " Mission " Terminology " Volunteers/freelancing

https://www.umaryland.edu/emergency/emergency-management-plan/national-incident-management-system-nims/

NIMS/ICS

PLUS OSHA TRAINING Respiratory Protection Hazardous Materials Awareness Bloodborne Pathogens

http://www.nims700.org/tag/nims-100/ NIMS Position Qualification for Pharmacists 2017

https://training.fema.gov/nims/

Standardized approach Scalable Flexible Improves integration

Critical Infrastructure is Aging " Roads, bridges, electrical grids, water

systems, rail transports, communications are aging

" Much less resilient during emergencies and disasters

" Direct effect on ability to evacuate and respond " Transportation " Resource access and storage " Communication

Ready or Not? Protecting the Public's Health from Disease, Disasters, and Bioterrorism, Trust for America’s Health, Issue Report, December 2017, http://healthyamericans.org/assets/files/TFAH-2017- ReadyOrNot-Fnl.pdf

Donation Management

“The second disaster”

" Too much of the wrong items " Not enough space " Other priorities " Medications?

Why? " Poor communication with

media from those on the front lines

" Donation fraud " Poor donation allocation

Health SE, Linnabary RD. Challenges of Managing Animals in Disasters in the U.S. Animals (Basel). 2015; 5(2): 173-192

Resource Accountability

Resource planning consistently described as an issue in literature (especially on local level)

"  Pharmaceuticals and medical supply availability "  Funding "  Storage

"  Facilities "  Mutual aid agreements

" Awareness of regulations affecting medical practice " Trained/qualified personnel


True or False:

It is illegal for an animal shelter owner to provide medical treatment to an injured or ill animal rescued from a disaster situation in the absence of a licensed veterinarian?

Answer: It depends!

Good Samaritan laws related to veterinary practice vary between

states

THIS WOMAN IS FROM GOOGLE IMAGES

Technology

Society is increasingly computer-based "  Widely relied upon for health care facilities

"  Controlled substance accountability "  Health records "  Communication

"  How do we manage when without it?


Requirements for an effective disaster

response

Effective Disaster

Response

Flexibility • Resources

• Duties

Organization • Clear Roles

• Mission

Communication

• Situational awareness

• Terminology • Documentation

Planning • Resources • Facilities

• Travel • Training

Accountability

• Partners • Personnel • Resources

Pharmacists in Disaster Response

Pharmacists in Disaster Response and Emergency Preparedness Uniquely positioned to render a general scope of health services " Widely available " Multitude of specialties

ABILITY TO CONTRIBUTE ON


EVERY PHASE

EVERY LEVEL

Defined Roles for Pharmacists: NIMS


NIMS Position Qualification for Pharmacists 2017

Roles for Health-System Pharmacists: ASHP Statement Pharmacists should play a key role in planning and execution of

" Pharmaceutical distribution and control " Development of guidelines " Selection of pharmaceuticals and supplies for national, regional, and local

emergency inventories " Ensure proper packaging, storage, handling, labeling, and dispensing of

emergency supplies " Ensure proper deployment of emergency supply pharmaceuticals

" Drug therapy management of patients " Ensure appropriate education and counseling " Advise public health officials on appropriate messages to convey to the public " Collaborate with physicians in managing drug therapy

American Society of Health-System Pharmacists. ASHP statement on the role of health-system pharmacists in emergency preparedness. Am J Health-Syst Pharm. 2003; 60:1993–5.

International Pharmaceutical Federation Statement on Pharmacists Roles

Pharmacists as a key participant in planning and execution " Education, training, experience, and legal responsibilities

" Expertise on drugs " Development of treatment guidelines " Selection for treatments/alternatives, vaccinations, stock piles and local inventory,

phases requiring different supplies and skills " Ensuring proper storage, handling, dispensing, deployment, allocation

" Readily accessible

Guidelines for pharmacist responsibilities based on practice setting

" National associations/governments, industry, hospitals, and community pharmacies

International Pharmaceutical Federation Responding to Disasters: Guidelines for Pharmacy 2016; https://www.fip.org/

Veterinary Pharmacy

Healthcare Ready (Rx Response)

Private sector established in the aftermath of Hurricane Katrina Provide essential tools for facilitating solutions during disasters

" Rapid access to governmental/private contacts

" Trusted, protected communications channels to share/react to sensitive info

" Reliable, tailored situation updates complied from public and private sources

" Subject matter expertise on policy and operational aspects of disaster response

Rx Open Map

https://www.healthcareready.org/

General Pharmacist Roles in Resource Planning

Considerations What do we need to prepare for?

What resources do we have?

What resources can we obtain through mutual

aid?

Strategies Stockpiling resources (> 72 hrs)*

Mutual aid agreements with

neighboring jurisdictions

Develop contracts with

vendors

*Individual stockpiles strongly discouraged (duplication of efforts)

Centers for Disease Control and Prevention (CDC)

Responds to public health emergencies

Manages Strategic National Stockpile (SNS) • Largest supply of potentially life-saving drugs

and medical supplies • 12- Hour Push Packages (Inventory)

•  Provided to any state within 12 hours •  50 tons of broad spectrum medical assets

• CHEMPACKS • Nerve-agent antidotes • Can provide to 90% of population within 1 hour

• Federal Medical Stations • Rapid deployment for up to 250 patients for 72

hours

Do we have a National Veterinary Stockpile?

National Veterinary Stockpile

Homeland Security Presidential Directive 9 established the NVS in 2004 to protect the nation's food supply by maintaining sufficient amounts of countermeasures capable of deployment against the most damaging animal diseases within 24 hours. The directive reflected the national concern that terrorists could simultaneously release animal diseases of catastrophic proportions that would quickly deplete available resources within the State, Tribe, or Territory and overwhelm the private sector's ability to support such a disaster.

National Veterinary Stockpile (NVS)

Deployable Countermeasures " 24 Hour Push Packs of PPE and decontamination supplies " Antiviral medications " Animal vaccines " Vaccination equipment and supplies " Poultry depopulation foaming units, CO2 carts " Animal handling equipment " 3D response support services

Defining Roles for Pharmacists and Veterinary Pharmacists in Veterinary Disaster Response and Emergency Preparedness

Julie A. Randall, PharmD Emily L. Sorah, PharmD,

DICVP Margo J. Karriker, PharmD,

DICVP Kenneth D. Royal PhD. MS

E.d.

Veterinary Pharmacists in Disaster Response FEW VETERINARY PHARMACISTS IN GENERAL

Most involvement at veterinary teaching hospitals and supporting university veterinary response teams

" Restocking drug cache, accounting for CS, donation management

Minimal involvement as first responders " One veterinary pharmacist actively involved with NVRT

Veterinary pharmacists have unique knowledge and training to help facilitate more effective veterinary disaster response

" Roles are undefined in literature

It is important that we be proactive in defining our roles

Pharmacists in Veterinary Disaster Response Only healthcare professional responsible to provide services to ALL SPECIES

"  Community pharmacist often a Segway between veterinarians and patients

Increasing investment of veterinary pharmaceuticals in retail pharmacies despite evidence of lack of veterinary pharmacology knowledge among most community pharmacists

"  National Association of Boards of Pharmacy’s Resolution (110-5-14)

Extent of involvement in veterinary disaster response and preparedness is not documented

Purpose

To capture veterinarians’ perspectives regarding potential roles for both pharmacist and veterinary pharmacist involvement in veterinary disaster response and emergency preparedness in order to determine how pharmacists and veterinary pharmacists can best help them facilitate more resilient disaster responses to animals.

Materials and Methods

Step 1: Literature Review and Consultation 1)  Literature review of common disaster

response roles for pharmacists 2)  Consultation with Veterinary Pharmacist

active on National Veterinary Response Team

… Our very own, Dr. Margo Karriker!

Step 2: Electronic Survey 1)  19 proposed roles for pharmacists vs

veterinary pharmacists with Likert-scale responses

2)  Veterinarian disaster response experience and demographics

Pharmacy Practice

• Regulatory • Drug Tracking • Drug Inventory • Drug Information

Interprofessional Practice

• Patient Care • Public Health • Education • Record Keeping

Administrative Practice

• Leadership •  Internal Communication • External Communication • Coordination

”To what extent would pharmacists and veterinary pharmacists benefit veterinary disaster response in the following roles?” “Never” “Rarely” “Sometimes” “Often” “Always” " 3 domains

" 4 subdomains for each domain

Step 3: Who, Where, and When

Population: Veterinarians affiliated with organizations that respond to animal disaster events in multiple states in the U.S. • Organization leaders distributed the survey to members • Participants invited (n=237) Timeline: Surveyed administered for 30 days with 1 reminder email to complete the survey at day 14 to ensure high response rate

Step 4: Collect Reponses for Analysis

Descriptive and inferential statistics performed

" Comparison of pharmacist vs. veterinary pharmacist responses using paired sample t-tests (two-tailed) and Wilcoxon signed-rank " P-value < 0.05 used to detect statistically significant difference

" Demographic variables compared to data using Chi-squared tests " P-value < 0.05 used to detect statistically significant difference

Analysis & Results

Results

Participants invited (n=237)

Total respondents

(n=81)

Total respondents

with complete data (n=56)

24% response rate

Results

All items statistically significantly different upon comparison of responses (P < 0.05) " Veterinarian perceptions of roles for veterinary pharmacist

involvement "  12 of 19 roles majority chose “Always” or “Often” beneficial

"  5 roles > 50% responded “Always” "  7 of 19 roles majority chose “Sometimes,” “Rarely,” or “Never” of benefit

" Veterinarian perceptions of roles for pharmacist involvement "  5 of 19 roles majority chose “Always,” or “Often” beneficial "  14 of 19 roles majority chose “Sometimes,” “Rarely,” or “Never” of benefit

Participant Experiences

Results for Veterinary Pharmacist and Pharmacist Roles by Domain

Results by Domain: Pharmacy Practice 1.80%

0%

5.40%

5.40%

0%

0%

1.80%

0%

5.40%

7.10%

16.10%

3.60%

3.60%

8.90%

1.80%

0%

14.30%

10.70%

17.90%

28.60%

14.30%

26.80%

19.60%

16.10%

21.40%

28.60%

35.70%

28.60%

30.40%

25.00%

35.70%

33.90%

57.10%

53.60%

25.00%

33.90%

51.80%

39.30%

41.10%

50.00%

MAINTAINING PROPER DEA RECORD KEEPING AND CONTROLLED SUBSTANCE SECURITY

MAINTAINING AWARENESS OF CURRENT LAWS AND REGULATIONS THAT MAY AFFECT PHARMACY PRACTICES DURING DISASTER

RESPONSE EVENTS

ENSURING DRUGS DISPENSED ARE DISPERSED APPROPRIATELY AMONG PATIENTS

ALLOCATING MEDICAL SUPPLY RESOURCES TO HELP MAINTAIN RESUPPLY DURING DISASTER RESPONSE EVENTS

ENSURING MEDICATION QUALITY AND INTEGRITY BY MAINTAINING PROPER STORAGE, HANDLING, AND DISPENSING

DEVELOPING A CACHE LIST OF NECESSARY MEDICAL SUPPLIES

COMMUNICATING WITH PHARMACIES AND DRUG DISTRIBUTORS TO HELP RE-ESTABLISH MEDICAL SUPPLIES TO THE VETERINARY

COMMUNITY

ENSURING ACCESS TO DRUG INFORMATION RESOURCES

RE

GU

LATO

RY

DR

UG

TR

AC

KIN

G

DR

UG

INV

EN

TOR

Y

DR

UG

IN

FOR

MAT

IO

N

PERCEIVED EXTENT OF UTILITY BY RESPONSE RATE

PR

OP

OS

ED

RO

LES

FO

R IN

VO

LVE

ME

NT

VETERINARIAN PERCEPTIONS OF VETERINARY PHARMACIST UTILITY IN VETERINARY DISASTER

RESPONSE: PHARMACY PRACTICE

Never Rarely Sometimes Often Always

= Key finding “Always” or “Often”

= Key finding > 50% “Always”

Results by Domain: Pharmacy Practice

7.30%

0%

20.00%

14.50%

3.60%

16.40%

16.10%

1.80%

12.70%

16.40%

25.50%

23.60%

12.70%

36.40%

27.30%

10.90%

14.50%

14.50%

23.60%

38.20%

21.80%

30.90%

38.20%

21.80%

23.60%

27.30%

20.00%

20.00%

20.00%

9.10%

10.90%

25.50%

41.80%

41.80%

10.90%

3.60%

41.80%

7.30%

7.30%

40.00%

MAINTAINING PROPER DEA RECORD KEEPING AND CONTROLLED SUBSTANCE SECURITY

MAINTAINING AWARENESS OF CURRENT LAWS AND REGULATIONS THAT MAY AFFECT PHARMACY PRACTICES DURING DISASTER

RESPONSE EVENTS

ENSURING DRUGS DISPENSED ARE DISPERSED APPROPRIATELY AMONG PATIENTS

ALLOCATING MEDICAL SUPPLY RESOURCES TO HELP MAINTAIN RESUPPLY DURING DISASTER RESPONSE EVENTS

ENSURING MEDICATION QUALITY AND INTEGRITY BY MAINTAINING PROPER STORAGE, HANDLING, AND DISPENSING

DEVELOPING A CACHE LIST OF NECESSARY MEDICAL SUPPLIES

COMMUNICATING WITH PHARMACIES AND DRUG DISTRIBUTORS TO HELP RE-ESTABLISH MEDICAL SUPPLIES TO THE VETERINARY

COMMUNITY

ENSURING ACCESS TO DRUG INFORMATION RESOURCES

RE

GU

LATO

RY

DR

UG

TR

AC

KIN

G

DR

UG

INV

EN

TOR

Y

DR

UG

IN

FOR

MAT

IO

N


PR

OP

OS

ED

RO

LES

FO

R IN

VO

VLE

ME

NT

VETERINARIAN PERCEPTIONS OF PHARMACISTS UTILITY IN VETERINARY DISASTER RESPONSE:

PHARMACY PRACTICE Never Rarely Sometimes Often Always


Results by Domain: Interprofessional Practice

3.60%

1.80%

19.60%

17.90%

7.10%

3.60%

5.40%

14.30%

10.90%

17.90%

28.60%

19.60%

16.10%

8.90%

23.20%

32.70%

35.70%

28.60%

41.10%

28.60%

12.50%

28.60%

20.00%

12.50%

19.60%

17.90%

26.80%

14.30%

30.40%

34.50%

58.90%

WORKING WITH VETERINARIANS TO DETERMINE PROPER TREATMENT PROTOCOLS AND ALTERNATIVES AS APPROPRIATE

COLLABORATING WITH VETERINARY AND NON- VETERINARY HEALTH CARE PERSONNEL AT CO-LOCATION SHELTERS

ASSESSING CURRENT POTENTIAL RISKS OF ANIMAL TO HUMAN DISEASE CROSSOVER

DEVELOPING PROTOCOLS TO MINIMIZE POTENTIAL OUTBREAKS OF ENDEMIC DISEASES

EDUCATING LOCAL PRACTICES ON PREPARATION FOR DISASTER EVENTS

EDUCATING RESPONSE PERSONNEL ON DISASTER PHARMACOLOGY AND JUST-IN-TIME REGULATORY AND PATIENT CARE TRAINING

MAINTAINING ACCURATE PATIENT RECORDS

PATI

EN

T C

AR

E

PU

BLI

C H

EA

LTH

E

DU

CAT

ION

R

EC

OR

D

KE

EP

ING


PR

OP

OS

ED

RO

LES

FO

R IN

VO

VLE

ME

NT


RESPONSE: INTERPROFESSIONAL PRACTICE



= Key finding > 50% “Always”

Results by Domain: Interprofessional Practice 34.50%

9.30%

40.00%

43.60%

40.70%

36.40%

12.70%

41.80%

31.50%

34.50%

30.90%

27.80%

21.80%

16.40%

16.10%

29.60%

18.20%

18.20%

22.20%

20.00%

16.40%

14.80%

10.90% 43.60%

WORKING WITH VETERINARIANS TO DETERMINE PROPER TREATMENT PROTOCOLS AND ALTERNATIVES AS APPROPRIATE

COLLABORATING WITH VETERINARY AND NON- VETERINARY HEALTH CARE PERSONNEL AT CO-LOCATION SHELTERS

ASSESSING CURRENT POTENTIAL RISKS OF ANIMAL TO HUMAN DISEASE CROSSOVER

DEVELOPING PROTOCOLS TO MINIMIZE POTENTIAL OUTBREAKS OF ENDEMIC DISEASES

EDUCATING LOCAL PRACTICES ON PREPARATION FOR DISASTER EVENTS

EDUCATING RESPONSE PERSONNEL ON DISASTER PHARMACOLOGY AND JUST-IN-TIME REGULATORY AND PATIENT CARE TRAINING

MAINTAINING ACCURATE PATIENT RECORDS

PATI

EN

T C

AR

E

PU

BLI

C H

EA

LTH

E

DU

CAT

ION

R

EC

OR

D

KE

EP

ING


PR

OP

OS

ED

RO

LES

FO

R IN

VO

LVE

ME

NT

VETERINARIAN PERCEPTIONS OF PHARMACIST UTILITY IN VETERINARY DISASTER RESPONSE:

INTERPROFESSIONAL PRACTICE Never Rarely Sometimes Often Always


Results by Domain: Administration

3.60%

10.70%

18.20%

1.80%

10.70%

12.50%

21.80%

8.90%

32.10%

35.70%

40.00%

41.10%

41.10%

19.60%

9.10%

25.00%

PROVIDING GUIDANCE AMONG PERSONNEL

MAINTAINING EFFECTIVE COMMUNICATION BETWEEN THE IMMEDIATE RESPONSE TEAM

EXCHANGING SENSITIVE INFORMATION APPROPRIATELY WITH EXTERNAL PERSONNEL, SUCH AS PUBLIC INFORMATION OFFICERS

COORDINATING WITH LOGISTICS AND OPERATIONS

LEA

DE

RS

HIP

IN

TER

NA

L C

OM

MU

NIC

ATIO

N

EX

TER

NA

L C

OM

MU

NIC

ATIO

N

CO

OR

DIN

ATIO

N


PR

OP

OS

ED

RO

LES

FO

R IN

VO

VLE

ME

NT


RESPONSE: ADMINISTRATION


= Key finding ”Always” or “Often”

Results by Domain: Administration

9.10%

23.60%

33.30%

12.70%

49.10%

16.40%

22.20%

18.20%

29.10%

29.10%

27.80%

32.70%

10.90%

16.40%

PROVIDING GUIDANCE AMONG PERSONNEL

MAINTAINING EFFECTIVE COMMUNICATION BETWEEN THE IMMEDIATE RESPONSE TEAM

EXCHANGING SENSITIVE INFORMATION APPROPRIATELY WITH EXTERNAL PERSONNEL, SUCH AS PUBLIC INFORMATION OFFICERS

COORDINATING WITH LOGISTICS AND OPERATIONS

LEA

DE

RS

HIP

IN

TER

NA

L C

OM

MU

NIC

ATIO

N

EX

TER

NA

L C

OM

MU

NIC

ATIO

N

CO

OR

DIN

ATIO

N

PERCEIVED EXTENT OF UTILITY

PR

OP

OS

ED

RO

LES

FO

R IN

VO

LVE

ME

NT

VETERINARIAN PERCEPTIONS OF PHARMACIST UTILITY IN VETERINARY DISASTER RESPONSE:

ADMINISTRATION Never Rarely Sometimes Often Always

Conclusion: Summary of Most Helpful Roles for Veterinary Pharmacists

• Maintaining proper DEA record keeping and CS security (Regulatory) • Maintaining awareness of current laws and regulations that may affect pharmacy practices during disaster

response events (Regulatory) • Ensuring medication quality and integrity by maintaining proper storage, handling, and dispensing (Drug

Tracking) • Allocating medical supply resources to help maintain resupply during disaster response events (Drug Tracking) • Ensuring drugs dispensed are dispersed appropriately among patients (Drug Tracking) • Communicating with pharmacies and drug distributors to hep re-establish medical supplies to the veterinary community

(Drug Inventory) • Developing a cache list of necessary medical supplies (Drug Inventory) • Ensuring access to drug information resources (Drug Information)

Pharmacy Practices Activities

• Maintaining accurate patient records (Record Keeping) • Working with veterinarians to determine proper treatment protocols and alternatives as appropriate (Patient Care) • Collaborating with veterinary and non-veterinary health care personnel at co-location shelters (Patient Care)

Interprofessional Practice Activities

• Providing guidance among personnel (Leadership)

Administrative Activities

Conclusion: Summary of Most Helpful Roles for Pharmacists

• Maintaining proper DEA record keeping and CS security (Regulatory) • Maintaining awareness of current laws and regulations that may affect

pharmacy practices during disaster response events (Regulatory) • Ensuring medication quality and integrity by maintaining proper

storage, handling, and dispensing (Drug Tracking) • Ensuring access to drug information resources (Drug Information)

Pharmacy Practice Activities

• Maintaining accurate patient records (Record Keeping)

Interprofessional Practice Activities

Discussion Strengths " Veterinary pharmacist on

NVRT helped determine proposed roles

" Included participants from governmental and non-governmental organizations on national, state, and local levels

" First attempt to define roles for pharmacists and veterinary pharmacists in veterinary disaster response and emergency preparedness

Limitations " Questions not evenly

distributed throughout subdomains

" Other important roles not address

" Vaccination capabilities

Comments from Participants

"I have worked with veterinary pharmacists in the field and they are amazing and a treasure to have on board.”

“We have a veterinary pharmacist on the NVRT. Her participation and input is really unique and helpful.”

“I have worked with a veterinary pharmacist and at first I was wondering why we had one but quickly I came to realize what a great resource she was.”

“I strongly believe our veterinary disaster teams need veterinary pharmacists.”

Possible Implications Both pharmacists and veterinary pharmacists can contribute Pharmacy Practice Activities rated highest for both " Regulatory awareness and CS accountability still required during

disasters " Mass Euthanasia

" Ready access to drug information with limited resources " Only veterinary pharmacists perceived as helpful in resource

planning roles Record keeping is a common interprofessional activity for the pharmacy profession Leadership among personnel is key to a functional team and integration with others

Moving Forward…

This research may provide guidance for those pharmacists and veterinary pharmacists that want to get involved Future research warranted to …

" Further refinement of roles " Assess pharmacists and veterinary pharmacist attitudes towards

involvement in veterinary disaster response " Determine roles for veterinary pharmacy and pharmacy technicians

Getting Involved!

ICS/NIMS training

Involvement with your

County/State Animal

Response Teams (CARTs/

SARTs)

Participation in State- and

Local- level exercises

Establishing mutual aid

agreements with local vendors

Involvement on point-of-

distribution level

Development of cache drug

lists, treatment protocols

Educating veterinarians/students on

disaster preparation

https://training.fema.gov/nims/

References •  https://www.cdc.gov/nceh/hsb/disaster/faos.htm •  https://deq.nc.gov/news/deq-dashboard#animal-operations---swine-lagoon-facilities •  https://www.aphis.usda.gov/animal_health/emergingissues/downloads/hazardsfull.pdf •  H.R. 3858: Pets Evacuation and Transportation Standards Act of 2006. •  Glassey S. Did Harvey Learn from Katrina? Initial Observations of the Response to Companion Animals During Hurricane Harvey.

Animals. 2018; 8(47):1-9. •  NIMS Position Qualification for Pharmacists 2017 •  Health SE, Linnabary RD. Challenges of Managing Animals in Disasters in the U.S. Animals (Basel). 2015; 5(2): 173-192 •  Pincock LL, Montello MJ, Tarosky MJ, et al. Pharmacist Readiness Roles for Emergency Preparedness. Am J Health-Syst Pharm. 2011;

68:620-623 •  https://www.umaryland.edu/emergency/emergency-management-plan/national-incident-management-system-nims/ •  Ready or Not? Protecting the Public's Health from Disease, Disasters, and Bioterrorism, Trust for America’s Health, Issue Report,

December 2017, http://healthyamericans.org/assets/files/TFAH-2017- ReadyOrNot-Fnl.pdf •  American Society of Health-System Pharmacists. ASHP statement on the role of health-system pharmacists in emergency preparedness.

Am J Health-Syst Pharm. 2003; 60:1993–5. •  International Pharmaceutical Federation Responding to Disasters: Guidelines for Pharmacy 2016; https://www.fip.org/ •  https://www.healthcareready.org/ •  "Standardized Emergency Management System (SEMS) Guidelines". State of California, Office of Emergency Services. Retrieved 16

July 2009.

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Pharmacist Involvement in Veterinary Disaster Response ... · 12/01/2020 · against the most damaging animal diseases within 24 hours. The directive reflected the national concern