Creating a Sustainable and Reliable Emergency Preparedness Program to Promote Appropriate Health Care Resources Use
Background: Over the past decade, the number of natural disasters, health care emergencies, and epidemics has increased significantly. These unpredictable and sometimes devastating events tax already stretched health care systems. The goal of this process paper is to share the experience of a pharmacy school in the development and implementation of a sustainable emergency preparedness and response support network (EPRSN) using an established student government infrastructure to support information sharing among community pharmacies, state emergency response teams, and community members.
Observations: There are more than 140 accredited pharmacy schools/colleges across the United States, employing more than 6,500 pharmacy faculty members and teaching more than 63,000 student pharmacists. The majority of schools/colleges provide free and volunteer-based health care services and collaborate with local, regional, and national entities, such as state boards of pharmacy and national and state professional pharmacy organizations. Student pharmacists are positioned across the country with reach to rural and underserved communities and have student organizational structures in place to manage student volunteers and support health care service opportunities. To address gaps in emergency and preparedness response, pharmacy students assessed and operationalized steps to develop the EPRSN. Pharmacies were identified and contacted by student pharmacists. Student leaders created student organization flowcharts and call charts with up-to-date pharmacist contact information. Organizational structure for collecting, capturing, updating, and sharing pharmacy data with state emergency response teams was developed and trialed.
Conclusions: Student pharmacists represent a sustainable resource, uniquely positioned to identify community needs, support emergency efforts, coordinate with local pharmacies, and work with pharmacists and others to ensure that patients receive the care they need during pandemics and other emergencies .
Observations
A question/answer format and time line approach was used to review the steps leading to EPRSN program development and establishment of project/model deliverables.
Identified gaps
Chronic disease management. According to interviews conducted by the National Center for Disaster Preparedness, people often inappropriately use EDs during disasters.8 EDs do not stock enough medications to refill prescriptions for patients outside of their emergent care needs and are typically ill-suited for patients’ chronic disease management. At the time of the earthquake in Alaska no specific place/organization had been established to collect, store, or disseminate information regarding available pharmacy resources in an emergency. Had such a system been in place to actively inform HCPs and community members which pharmacies were open and operational, it is likely that many negative consequences related to health care utilization could have been reduced or avoided, including the number of people inappropriately using EDs for chronic prescription medication refills. This would not only reduce the burden on the health care system but allow for patients with both emergency and chronic needs to be seen quickly and prevent unnecessary health care costs.
Pharmacists play a vital role in managing chronic diseases.9 Due to extensive education and training, they are considered medication experts, ideally suited to manage chronic medication therapy, help prevent or minimize disease exacerbation and/or progression, reduce preventable health care costs, improve patient quality of life, and reduce morbidity and mortality.9 Pharmacists are accessible and strategically located throughout communities and provide patients with continuity of care other HCPs may be unable to provide. For example, during the COVID-19 pandemic, pharmacies remained open when other primary care providers (PCPs) were not. In addition, during times of natural disasters pharmacies tend to remain open unless there are extenuating circumstances (eg, unsafe building infrastructure, unsafe drug supply).
Emergency Response. To determine the role pharmacists play in emergency preparedness efforts we looked initially to the peer-reviewed literature (search terms: emergency preparedness, natural disasters, pharmacy/pharmacies) then turned to materials and research produced by organizations outside of the traditional commercial and academic publishing channels; however, most emergency preparedness protocols and standard operating procedures (SOPs) did not pertain to pharmacies or acknowledge the contribution of pharmacists. Researchers urge both state and federal governments to foster relationships with and use community pharmacist’s expertise and expanded roles in order to improve the nation’s public health.10
Historically, pharmacists within the US Public Health Service (PHS) have responded alongside local HCPs to meet the needs of communities during public health emergencies. Pharmacists were pivotal in the 2009 response to H1N1 influenza and the 2015 Ebola response, both abroad and within the United States.6 Pharmacists screened and triaged patients, provided life-saving vaccinations, and supported community and health care system education initiatives. However, as the COVID-19 pandemic has demonstrated, responding to a public health crisis takes more than the 1,000 pharmacists serving in the PHS.11 The American Society of Health-System Pharmacists argues that all pharmacists should be involved in working with public health planners.12
Community and health-systems pharmacists are vital to current and future public health responses and represent a largely untapped resource. Pharmacists across the country, especially in rural and underserved communities, have the potential to significantly impact emergency preparedness and response efforts. The > 319,000 US pharmacists comprise a sizable portion of the population and can play vital roles during emergency situations or disasters.13 Often after catastrophic events, community pharmacists provide first-aid, emergency refills, medication counseling, point of care testing, triage patients and serve on emergency response teams.14 However, pharmacists alone cannot address all medication-related patient needs and student pharmacists likewise have a role in emergency preparedness and response efforts. By participating in these efforts and learning these roles as students, they are better prepared to engage in emergency efforts as pharmacists.
