Pharmacist’s role in disaster management

  The Phases of a Disaster:

• There are 3 phases of the disaster response:

– prevent planning.

–response to the event.

– post event restoration.

• The aim of each phase is to optimize the response and reduce potential losses.

Pre-event Phase:

Planning and Prevention:

• The pre-event phase is defined by anticipation, planning, and training for potential adversities.

• We must continually rethink both the estimation of the risk and our response to it to ensure a reliable response and we must expect setbacks and have contingency plans to counteract them.

• The primary objective of this phase of the disaster response is vulnerability reduction.

• Long before the event, risks are identified and defined, preventative measures are attempted; and response plans are developed and practiced.

• This phase revolves around a comprehensive risk assessment and measures of risk reduction, the basic concept behind disaster mitigation.

• Simply put, preparation reduces both the likelihood and consequences of disasters.

• The cornerstone of disaster preparation is an estimation of risk- It is not feasible to plan for every contingency of every possible threat.

• Pre-event planning must account for cost effectiveness and balance the allocation of resources for improbable events versus the risks of not being prepared

• Integration and Forming a Disaster Network.

Event Phase:

The Pharmaceutical Care Response:

• While the plans for the disaster response are detailed during the pre-event phase, they must be properly executed to achieve the goals of disaster mitigation.

• Disasters may strike with little or no warning and cause damages that limit or prevent an aid response.

• Despite adequate preparation, these events can easily overwhelm the healthcare system.

• A well-developed and executed plan for the delivery of aid, sustenance, and pharmaceutical care may be the most useful tool to minimize losses and preserve lives.

• The healthcare community must be familiar with local and federal disaster management plans as it will be called upon to be the first line of care during these situations.

• The medical responsemay involve multiplesimultaneous threats.

• However, while simultaneous events may occur it is more likely that one disaster will result insecondary events.

• For example, the destruction of a hurricane may cause damage to an industrial plant or toxin storage facility.

Post event Phase: Restoration:

• Ongoing mitigation efforts must be continued even after resolution of the event and its aftermath.

• The recovery process needs to start immediately to restore normalcy and function as quickly as possible.

• In this phase, the affected community must be rebuilt and efforts made to reduce future risks

Dengue Fever:

Preventory Measures:

·         Don’t drop waste into drain

·         Clear blocked drain if any

·         Dengue mosquito live in clean water, so check flush tanks and if required

·         Dispose empty cane, coconut shell, bottles, old tires etc

·         Ensure no water is stagnant in pots

·         Children attending morning school should be cautioned, when waiting for school bus as these mosquito usually at dawn and dusk

·         Mosquitoes can be repelled by following sprays

1.      Organo phosphate spray

2.      Pyriethroid

3.      N,N-diethyl-3-methylbenzamide (DEET)–

mosquito repellent spray

Fever Complications:

The complications of dengue fever are usually associated with the more severe forms of dengue fever, hemorrhagic and shock syndrome. The most serious complications, although infrequent, are as follows:

Ø  dehydration;

Ø  bleeding (hemorrhage);

Ø  low platelets;

Ø  low blood pressure (hypotension);

Ø  bradycardia;

Ø  liver damage;

Ø  neurological damage (seizures,encephalitis)

Ø  death.

Psychological Management:

• For each of these specific hazards, the psychosocial effects will create an additional area of significant healthcare needs.

• After any major disaster, an increased need for treatment of anxiety, posttraumatic stress disorder, neuroses, and depression can be expected

• Usage of drugs in these  situation is unavoidable.

• Reviewing the drug supply and dosage used in specific situation: diabetes, cardiac problems, pediatrics population etc.

• Education for the residents on sanitation, nutrition, personal hygiene, life skills.

• Prevention of respiratory tract infections

• Prevention of diarrheal diseases

• Educating on Women’s health issues.

What can be done to overcome the problem?

• Prepare the pharmacists with disaster management & train them.

• At academic level introduce the disaster management into the syllabus.

• Team work with other healthcare providers.

   Pharmacist’s Role In Earthquake:

Pharmacist can educate people to prevent from earthquake complications.

• Pick "safe places". A safe place could be under a sturdy table or desk or against an interior wall away from windows and bookcases, or tall furniture that could fall on you. The shorter the distance to move to safety, the less likely you will be injured. Injury statistics show that people moving as little as 10 feet during an earthquake's shaking are most likely to be injured.
• Practice drop, cover, and hold-on in each safe place. Drop under a sturdy desk or table and hold on to one leg of the table or desk. Protect your eyes by keeping your head down. Practice these actions so that they become an automatic response.
• Practice drop, cover, and hold-on at least twice a year. Frequent practice will help reinforce safe behavior. When an earthquake or other disaster occurs, many people hesitate, trying to remember what they are supposed to do. Responding quickly and automatically may help protect you from injury.
• Wait in your safe place until the shaking stops, then check to see if you are hurt. You will be better able to help others if you take care of yourself first, then check the people around you. Move carefully and watch out for things that have fallen or broken, creating hazards. Be ready for aftershocks.
• If you must leave a building after the shaking stops, use the stairs, not the elevator. Earthquakes can cause fire alarms and fire sprinklers to go off. You will not be certain whether there is a real threat of fire. As a precaution, use the stairs.
• If you're outside in an earthquake, stay outside. Move away from buildings, trees, streetlights, and power lines. Crouch down and cover your head. Many injuries occur within 10 feet of the entrance to buildings. Bricks, roofing, and other materials can fall from buildings, injuring persons nearby. Trees, streetlights, and power lines may also fall, causing damage or injury.
• Inform workers of the plan. Everyone in your workplace should know what to do if an earthquake occurs.
• Get training. Take a first aid class from your local Red Cross chapter. Get training on how to use a fire extinguisher. Keep your training current. Training will help you to keep calm and know what to do when an earthquake occurs.
• Discuss earthquakes with workers. Everyone should know what to do. Discussing earthquakes ahead of time helps reduce fear and anxiety and lets everyone know how to reponse.
  
  Role of Pharmacist in diarrhoea:
• He should provide suitable  home fluids immediately upon onset of diarrhoea in a child
  • Treat dehydration with ORS solution (or with an intravenous electrolyte solution in cases of severe dehydration)
  • Emphasize continued feeding or increased breast- feeding during, and increased feeding after the diarrhoeal episode
  • Use antibiotics only when appropriate, i.e. in the presence of bloody diarrhoea or shigellosis, and abstain from administering anti-diarrheal drugs
    
    
    Management
    
    
    Oral rehydration therapy:
    The risk of dehydration from diarrhoea is greatest in babies, and rehydration therapy is considered to be the standard treatment for acute diarrhoea in babies and young children. Oral rehydration sachets may be used with antidiarrhoeals in older children and adults. Rehydration may still be initiated even if referral to the doctor is advised.
    
    Other therapy:
    Loperamide: Loperamide is an effective antidiarrhoeal treatment for use in older children and adults. When recommending loperamide the pharmacist should remind patients to drink plenty of extra fluids. Oral rehydration sachets may be recommended. Loperamide may not be recommended for use in children under 12 years.
    Kaolin: Kaolin has been used as a traditional remedy for diarrhoea for many years. Its use was justified on the theoretical grounds that it would absorb water in the GI tract and would absorb toxins and bacteria onto its surface, thus removing them from the gut.
    
    
                            Management of Disaster
    • Disasters impact our health, community, and economy, they devastate the environment and significantly disrupt our daily life.
    • The fundamental goals of disaster mitigation are to understand and define the threat, limit our vulnerabilities, prevent the occurrence when possible, and minimize the effects and losses when they arise.
    • Aids from all over the world reached the site with millions of USD in term of medication
    • Doctor, nurses, Pharmacist & other volunteers.
    
    
    
    But where is the pharmacists?:
    He can play role in
    Drugs – a lot of almost expired or expired drugs
    Pharmacotherapy
    choiceof drugs for specificconditions
    Pharmacokinetics
    Not even focus due to lack of expertise.
    • Many healthcare providers mainly doctors and nurses contributed significantly during the catastrophe.
    • Unfortunately the role of pharmacist remains unclear, So far the involvement of pharmacists in this issue seems to be almost none
    • Contribution of pharmacist’s expertise should be there, as in most disasters, drugs are being used regularly and the counseling during such event almost not exist.
    
    
    Pharmacy system during disaster:
    • Pharmacy service set up during the event usually consists of:
    • Mobile pharmacy and temporary pharmacy related services.
    • Distribution of drugs and related medical care.
    • Educate the community on health, hygiene, and wellbeing.
    • Mental health assessment and community characteristic.
    • Quality of therapy would be increased with intervention from pharmacists.
    
    
    Limited Ability of Health Care System to Respond:
    • During disasters, the demand for healthcare will rapidly increase and likely exceed the capacity the local community.
    • At the same time, there will be loss of infrastructure further limiting the ability to meet this increased demand.
    • Healthcare providers are, in themselves, a limited resource and there is a shortage of doctors, pharmacists and nurses, especially in critical care.During disasters, especially in emerging infectious diseases, healthcare workers (HCW) may be disproportionately affected.
    • Disasters both increase the demand for healthcare and limit our ability to provide it.
    • The effect on the infrastructure reduces the medical response and increases our susceptibility to future events.
       
    Educational & Awareness programs:
    
    
    For the management of natural as well as disasters relating to human activities, pharmacist can play very critical role. Directly or indirectly all the disasters are result of human deeds & his activities.
    v  Pharmacist should arrange seminars & awareness programs to prevent many such incidents. He can educate people to stop frequent cutting of plants & forests for industries and housing facilities and he should encourage people to grow more trees & thus by forestation pollution can be easily controlled. Forestation can overcome the increased level of global warming gases e.g carbon dioxide and thus its outcome will be decrease in green house effect and global warming and the most common cause of flood would also be minimized.
    v  Due to global warming there is fluctuation in the temperature of almost all the regions in biosphere and there is chance for the insects & other pathogens to colonize the areas where these pathogens were not present in past. Pharmacist should acknowledge this issue to the authorities. He should also highlight these issues globally to prevent our global village from disasters.
    v  Pharmacist should also highlight the risks associated with the use of Chloroflorocarbons (CFC) as refrigerants.
    v  Pharmacist should aware the people to adopt healthy lifestyle & to control over pollution specially radiation pollution as occurred during tsunami in Japan & causing Nuclear power station damage and thus affecting a massive life in the region. Pharmacist should aware people and authorities about the risks associated with Nuclear power as source of energy because waste management is very low and it can ruin the whole world.
    Conclusion
    • Recent events have reminded us that disasters, both natural and manmade, can and will occur, often with little or no warning.
    • There exists a real threat and pharmacists must be prepared to provide a competent response and mitigate potential losses.
    • Previous events and the threat of future disasters reinforce the fundamental need for pharmacists preparedness- Disasters are inevitable, predictable, and expected; we must be ready to face them.