Pharmacist Readiness Roles for Emergency Preparedness

Laura L. Pincock; Michael J. Montello; Matthew J. Tarosky; William F. Pierce; Calvin W. Edwards

Disclosures

Am J Health Syst Pharm. 2011;68(7):620-623. 

In This Article

Pharmacist Disaster-readiness Roles

Pharmacists could serve in a variety of disaster-response roles. Some of these roles are pharmacist-centric and others are more generic (e.g., administration, finance, communication, community assessment, epidemiology, liaison, logistics, medical records, public information, triage). This article focuses on roles that can only be filled by a pharmacist. The intent of defining these roles is to provide a foundation to improve the disaster-response capabilities of pharmacists individually and as a group.

The pharmacist disaster-readiness roles described herein are based on the authors' 70-plus years of combined experience in emergency preparedness that involved responding to over 30 public health emergencies. The list of competencies and proficiencies were initially developed through a small working group. The list was refined through an iterative process. In an effort to build broader consensus, we briefed our professional colleagues and circulated the roles to large numbers of public health pharmacists and other health professionals for comment. The roles were refined based on comments and recommendations received. We propose these pharmacist disaster-readiness roles to spark interest and further discussion among the broader pharmacy community. If interest is sufficient, a more-formalized approach to enhance and complete these roles can be undertaken.

The disaster-readiness roles are divided into two categories: "clinical" and "other." The clinical category includes roles that are primarily fulfilled by ambulatory care readiness pharmacists, pharmacotherapy readiness pharmacists, and critical care readiness pharmacists. The "other" category includes specialized clinical roles and nonclinical activities carried out by weapons of mass destruction (WMD)/pandemic readiness pharmacists, pharmacy readiness logisticians, and pharmacist readiness managers.

The ambulatory care readiness pharmacist is akin to a community pharmacy or outpatient clinic pharmacist in a traditional setting. His or her role may be considered equivalent to the pharmacist role described in the Federal Emergency Management Agency's "National Emergency Responder Credentialing System—Medical and Public Health" resource document.[12] The ambulatory care pharmacist could work in a variety of settings during a disaster, including a shelter, a hospital, a clinic, or an outreach site. The pharmacotherapy and critical care readiness pharmacists are more frequently, though not exclusively, found in a hospital-like setting. While there is a natural progression from one clinical readiness pharmacist role to the next, each role is considered independent and somewhat specialized. Therefore, a critical care readiness pharmacist may not be suitable for an ambulatory care readiness pharmacist position, and vice versa. The "other" pharmacist readiness roles are independent roles, with little to no interrelationship.

Each pharmacist disaster-readiness role includes a description of common practice settings and duties. In addition, specific competencies with associated proficiency levels have been drafted for each disaster-readiness role, but these competencies are not mutually exclusive. These competencies are interrelated skills that individually and collectively define the minimum skills required for each role. Specific information on the competencies and proficiencies for each pharmacist disaster-readiness role are provided in eTable 1 and eAppendix (available at www.ajhp.org). These documents are preliminary drafts and are shared here to stimulate further discussion on this important topic.

Pharmacists involved in disaster-relief efforts may work in various practice settings that are not mutually exclusive. Pharmacist responders may be called to serve in a number of roles or perform functions that are not familiar to them. These functions may include tasks that pharmacists do not normally perform in traditional settings. The only certainty in a crisis-response operation is the requirement to change and adapt to constantly evolving disaster conditions and medical-response capabilities. However, if a person does not have ambulatory care pharmacy experience in the traditional setting, then he or she may not be a good candidate to serve as an ambulatory care readiness pharmacist. For this reason, the primary competency for each pharmacist disaster-readiness role is experience and training for that role in the traditional setting.

Once the competencies are defined, proficiency levels can be used to evaluate each role. The proficiency level provides guidance in the skill level each pharmacist is expected to have to be either minimally qualified or fully qualified for each role. Proficiency levels required for a pharmacist to work in each disaster-readiness role include (1) novice (lowest skill level), (2) knowledgeable (intermediate skill level), and (3) proficient (highest skill level). A pharmacist can work in any readiness role, with appropriate supervision, as long as he or she has met the basic proficiency level for each competency within the pharmacist disaster-readiness role.

As stated earlier, competencies are not mutually exclusive. Therefore, a pharmacist should meet all minimal requirements to be able to practice within a specific role; likewise, he or she must be fully qualified in all competencies within a role to be considered fully competent in that area. The minimally and fully qualified proficiency levels are specified for each competency (eTable 1).

Disaster-response Practice Settings

Ambulatory care readiness pharmacists typically work in out-patient clinics or federal medical shelters. They practice pharmacy with members of community assessment teams, medical strike teams, or disaster medical assistance teams (DMATs). Their patients are generally ambulatory and have a low level of acuity. These pharmacists provide care in a disaster setting for patients with common chronic diseases (e.g., asthma, diabetes, hypertension) and for patients with mild-to-moderate acute conditions (e.g., diarrhea, headache, muscle pain, skin rash).

Pharmacotherapy readiness pharmacists typically work in a hospital or hospital-like settings during a disaster response. They practice pharmacy with DMATs, federal medical shelter personnel, and traditional hospital employees. Their patients generally have an intermediate level of acuity. They treat patients with common chronic diseases and moderate-to-severe acute conditions that require definitive care or hospitalization. In a bioterrorism event, these pharmacists assist in delivering definitive care to the affected population.

Critical care readiness pharmacists typically work in intensive care settings or settings in which the provision of emergency-support services is highly likely. They practice pharmacy with DMATs, emergency room staff, and critical care hospital employees. Their patients generally have a high level of acuity or need emergency-support services. These pharmacists may also be of value in primary and ambulatory care settings (e.g., federal medical shelter, medical strike team) where there is the occasional potential to provide emergency-support services.

Pharmacy readiness logisticians work in a variety of practice sites, both proximate and distant from the direct patient care setting. They work in hospitals, clinics, and central coordinating and distribution centers. In all settings, readiness pharmacists must anticipate, plan, and accommodate for working in a disaster setting with limited and frequently evolving resources, procedures, and formularies.

The National Response Framework calls for the creation of points of distribution (POD) for mass dispensing of prophylactic medications or mass administration of vaccines in response to natural or man-made large-scale disaster events.[13] Local authorities typically establish and coordinate POD locations and activities. Many local emergency operation plans call for using well-recognized public facilities such as community centers, malls, schools, and stadiums to serve as POD locations. WMD/pandemic readiness pharmacists serve as integral members or leaders within POD facilities. They may also serve in locations and roles outside of but supporting POD facilities, such as Strategic National Stockpile receipt and storage. Some pharmacists may be part of mobile POD units to serve individuals who are unable to receive care at a POD facility, such as nonambulatory patients, those with travel restrictions (e.g., individuals in prisons and quarantine facilities), and individuals deemed by local authorities as integral for public safety (e.g., first responders, police, firefighters, National Guard).

It is important to emphasize that a pandemic readiness pharmacist's primary role is to dispense prophylactic therapies to prevent or mitigate the development of disease symptoms in individuals at risk during a large-scale man-made or natural biological event. Definitive care for symptomatic patients will occur in treatment facilities (i.e., clinics, hospitals, or shelters).

A pharmacist readiness manager can work in a variety of settings providing leadership and guidance to pharmacy operations.

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