News from the ASHP Midyear Clinical Meeting
Pharmacists and counterterrorism planning
Since the Sept. 11 terrorist attacks, the American Society of Health-System Pharmacists (ASHP) in Bethesda, MD, has been evaluating the nation’s emergency response to terrorism — and pharmacists’ roles in that response.
On Nov. 9, the association convened an executive session on emergency preparedness that brought together more than 35 representatives from federal public health and preparedness offices, pharmaceutical manufacturers, wholesalers, group purchasing organizations, academic health science centers, community hospitals, and health organizations. The session identified significant weaknesses of the response system, including the need to include more pharmacists in emergency-response planning and to more easily deploy their services when needed.
"Drug products are central to every aspect of emergency planning, and pharmacists must be involved in ensuring that emergency plans detail how to disseminate the right medication to the right patient," says Henri R. Manasse Jr., PhD, ScD, ASHP executive vice president and chief executive officer.
At its Midyear Clinical Meeting in New Orleans in December, the ASHP issued a statement urging hospital and health-system pharmacists to exercise their responsibilities for counterterrorism, including a call for leaders of emergency planning at the federal, regional, state, and local levels to call upon pharmacists to participate in the full range of issues related to pharmaceuticals.
General principles
The statement included general principles about how pharmacists can assist in emergency planning and response:
• On the basis of their education, training, experience, and legal responsibility, pharmacists should have a key role in the planning and execution of:
(a) pharmaceutical distribution and control; and
(b) drug therapy management of patients in the event of homeland terrorist attack with weapons of mass destruction (WMD), especially chemical, biological, and nuclear agents.
• The expertise of the pharmacist must be brought to bear in:
(a) selecting pharmaceuticals and related supplies for national or regional stockpiles and local emergency inventories in counterterrorism programs;
(b) ensuring proper packaging, storage, handling, labeling, and dispensing of emergency supplies of pharmaceuticals;
(c) ensuring appropriate deployment of emergency supplies of pharmaceuticals in the event of a terrorist attack;
(d) developing guidelines for the diagnosis and treatment of victims of WMD; and
(e) ensuring appropriate education and counseling of individuals who receive pharmaceuticals from an emergency supply after a terrorist attack.
• Pharmacists must be in a position to advise public health officials on appropriate messages related to the use of essential pharmaceuticals after terrorist incidents, giving consideration to issues such as adverse effects, contraindications, effectiveness of alternative pharmaceuticals, and potential development of drug-resistant infectious agents.
• In the event of a terrorist attack, pharmacists should be called upon to collaborate with physicians and other prescribers in the drug therapy management of individual victims.
The statement also advises specific health care leadership areas: pharmacy directors, pharmacists, administrators, emergency preparedness planners, and state societies of health system pharmacists. ASHP’s advice to pharmacy directors and pharmacists includes the following directives.
Advice to pharmacy directors
Every hospital and health-system pharmacy director (or designee) should:
• Become thoroughly informed of federal, regional, state, local, and institutional plans for emergency preparedness, especially as related to the distribution, control, and use of pharmaceuticals.
• Ensure that the pharmaceutical components of the institution’s emergency plans are coordinated with the overall local preparedness plan involving other institutions, community pharmacies, and wholesalers, as well as coordinated with federal, regional, and state plans.
• Ensure that the appropriate pharmaceuticals and related equipment and supplies are in stock at the institution, consistent with the overall local preparedness plan, which should take into account the interim period between the occurrence of a terrorist attack and the receipt of federal or state assistance.
• Ensure that information regarding the appropriate use of pharmaceuticals in response to a terrorist attack is available to the health professionals in the institution.
• Ensure that the institution does not engage in stockpiling of pharmaceuticals without regard to local counterterrorism plans that are designed to meet the needs of the whole community.
• Ensure that pharmacy personnel are trained to implement the institution’s emergency plans.
Advice to pharmacists
Every hospital and health-system pharmacist should:
• Become well informed on the threats of chemical, biological, and nuclear terrorism, including potential agents that could be used in an attack and the related diagnostic and treatment issues.
• Share with professional colleagues and patients evidence-based information on pharmaceuticals used in responding to terrorist attacks.
• Act assertively to prevent and allay panic and irrational responses after incidents of terrorism.
• Strongly discourage individuals from amassing personal stockpiles of pharmaceuticals for use in the event of chemical, biological, or nuclear terrorism.
• Consider volunteering in advance of any terrorist attack to assist in:
(a) distribution of emergency supplies of pharmaceuticals; or
(b) collaborative drug therapy management of individual victims.
• Develop and maintain first-aid skills.
Bioterrorism drug reference manual
The ASHP also announced that it has published a manual that gives comprehensive drug information on medications that may be needed to counter a terrorist attack.
The AHFS DI Bioterrorism Resource Manual contains 21 monographs drawn from AHFS Drug Information that provide information on the vaccines and anti-infective medications that most likely will be used to treat patients who have contracted anthrax, smallpox, or plague. The monographs include discussions of the therapeutic roles of medications such as ciprofloxacin (for treatment of anthrax), gentamicin (for treatment of plague), and smallpox vaccine. In addition, the monographs include information on:
- drug interactions, toxicity, and cautions;
- dosage and administration;
- preparations, chemistry, and stability; and
- pharmacology and pharmacokinetics.
The manual also has the most current recommendations on prevention and treatment of infectious diseases. For information, call ASHP at (301) 657-4383 or visit the web site at www.ashp.org.
Finally, the ASHP announced that it has received an educational grant from AstraZeneca in Wilmington, DE, to create a guidance manual that will assist pharmacy directors and their staffs in the establishment and operation of bioterrorism preparedness programs. The grant will support development of a book tentatively titled Manual for Pharmacists on Bioterrorism, which will be released this summer.
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