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Tucson Pharmacists Prepare for Bioterrorism Drill

Donna Young

Pharmacists and pharmacy technicians in Tucson, Ariz., will join faculty members and pharmacy students from the University of Arizona (UA) College of Pharmacy and pharmacy technician students from nearby Pima Community College in a large-scale dispensing drill on Nov. 22 at the city’s community center.

The drill is part of a three-day educational exercise to test the readiness of area hospitals and state and local agencies, including law enforcement, public health, and emergency management, in responding to a biological threat in the community.

Theodore G. Tong, Pharm.D., UA’s associate dean of pharmacy, said the exercise will give the community an opportunity to work with the National Pharmaceutical Stockpile, a federal repository of antiinfectives, chemical antidotes, antitoxins, life-support medications, i.v. administration and airway maintenance supplies, surgical items, and other medical supplies.

The Centers for Disease Control and Prevention (CDC) is responsible for managing the stockpile and coordinating deployment to disaster locations.

CDC will not deploy real stockpile supplies for Tucson’s drill, according to stockpile program spokeswoman Joan Morrissey. Instead, the agency will send a training, education, and demonstration (TED) package that simulates the contents of a 12-hour push package, a 50-ton container of drugs and supplies.

CDC has 12 push packages that are kept in environmentally controlled secured warehouses in secret locations around the country and are ready for deployment to reach any affected area within 12 hours of a federal decision to release the supplies. The stockpile, with its push packages, is designed to supplement and resupply state and local public health agencies in the event of a biological or chemical terrorism incident anywhere and at anytime in the United States or its territories, according to CDC.

Morrissey said each TED package contains 18 specialized cargo containers filled with bottles and placebo tablets that can be used to practice dispensing medications and repackaging drug products with the stockpile's equipment. Also included are patient-oriented drug information sheets.

The reason for using simulated supplies, she said, is to avoid compromising the effectiveness of the stockpile’s antiinfectives and other products.

CDC makes TED packages available to any state that shows a high level of preparedness to receive, manage, and use the stockpile and that develops a detailed proposal for training, Morrissey said, adding that Arizona has met those criteria.

The state’s health department is helping to coordinate the deployment of the TED package in Tucson and will also oversee a drill on the same day in Phoenix, according to Bryn Bailer, bioterrorism communications program coordinator for the Pima County Health Department in Tucson.

Tucson was one of the earliest communities in the nation, Bailer said, to initiate an emergency response program for acts of bioterrorism.

The Southwest desert community is one of 122 cities that receives federal funding under the Department of Health and Human Services (HHS) Metropolitan Medical Response System (MMRS), a program developed in 1996 that helps cities coordinate resources and prepare for a possible attack of weapons of mass destruction.

Tucson’s MMRS Project Manager Les Caid, a battalion chief with the city’s fire department and the person responsible for developing the community’s emergency preparedness plan, said that pharmacists play a key role in bioterrorism response.

A pharmacist, he said, might recognize an extraordinary increase in antimicrobial use and could be the first health care professional to warn the public health department of a possible biological threat to a community.

Pharmacists are a vital link in communicating with the public, Caid said, because they are frontline educators on proper drug use and could help prevent the spread of misinformation that, if left unchecked, worsens a public health crisis.

Shortly after Tucson was named an MMRS city in 1999, Caid recruited former Tucson trauma surgeon Richard Carmona—now the Surgeon General—to help develop the community’s bioterrorism response plan.

Carmona taught medicine at UA and had also been a member of the local sheriff’s department SWAT team, Caid said, and is considered an expert in bioterrorism response.

"He worked for me long before he worked for [President] Bush," Caid said.

Carmona is scheduled to participate in the first day of Tucson’s exercise.

Caid said that he and Carmona recognized the need to include pharmacy professionals in the community’s emergency preparedness effort. The two men convinced UA’s Tong to recruit area pharmacists for a pharmacy task force.

Tong and Carmona already knew each other. Tong was Carmona’s toxicology professor at the University of California at San Francisco several years before both men moved to the Tucson area.

Health and Human Services Secretary Tommy G. Thompson, speaking in August before a group of Tucson’s emergency responders, praised Tong for doing "tremendous work in building one of the finest public health task forces in the nation."

Thompson went on to acknowledge pharmacists—among other professionals, including firefighters, law enforcement officers, and public health administrators—as having "distinct professional callings" with a common goal to protect and serve.

"And you do protect and serve, everyday, with exceptional bravery and tenacity and compassion," he said.

The pharmacy task force, Caid said, helped area hospitals identify which drugs products and other supplies the pharmacy departments needed to stock and which wholesalers would supply the products in the event of a disaster.

In conjunction with Tucson’s MMRS team, Caid added, the pharmacy task force has helped recruit retired pharmacists and other health care professionals to be emergency response volunteers.

Elizabeth M. MacNeill, Pima County Health Department’s chief medical officer, said she is impressed with the commitment that local pharmacy professionals have made to preparing for November’s drill and contributing to the community’s overall emergency preparedness.

"I don’t know how we would get this tremendous job done without all their help in planning, as well as the actual hands-on work during the exercise, and in preparing for future bioterrorist events," she said.

Tucson’s exercise will serve as a national blueprint for other MMRS cities, Pima County’s Bailer said.

The city plans to have 1,000 residents volunteer as victims for the drill, she added.

"What makes this exercise different is how many people and how fast we can get them through the process with filling out paperwork, providing information, and dispensing [simulated] drugs," she said.

The city plans to complete the dispensing drill within four hours, according to Bill Fritz, M.S., UA associate pharmacy professor and associate director for clinical pharmacy services for University Medical Center.

To prepare pharmacists, technicians, students, and other drill participants, Fritz said, the pharmacy school is conducting training sessions and a dress rehearsal before the three-day exercise in November.

Caid did not want to divulge the types of simulated agents that responders will handle during the drill, but he said there would probably be more than one type of biological threat.

Fritz said pharmacists and technicians would receive training in the proper dispensing of antiinfectives, including doxycycline, ciprofloxacin, and amoxicillin, to counter a bioterrorist threat.

UA’s College of Pharmacy, in partnership with the Arizona Poison and Drug Information Center, MMRS, Pima Community College, Tucson’s fire department, and the county health department, has also offered pharmacists, technicians, and students a free continuing-education program on emergency preparedness. The program consists of two two-hour sessions—one session last Tuesday and the other one tonight.

Those who complete the program will receive four hours of continuing-education credit. The program has featured lectures from Caid, Tong, and representatives from the county’s health department and Office of Emergency Management and Homeland Security, Arizona Air National Guard Fire Department, Pima Community College, Northwest Medical Center, and Tucson MMRS. UA Clinical Associate Pharmacy Professor Michael Katz, Pharm.D., is scheduled to speak tonight about the prevention and treatment of illnesses from bioterrorist agents.

Pima Community College’s Public Safety and Emergency Services Institute also offers 35 courses related to emergency responses, according to Diane K. Hefty, the program’s deputy director.

The community college developed its Safety Technologies program at the request of Caid, Hefty said, to help local emergency responders, health care professionals, school district officials, and residents prepare for disasters and other emergency situations.

"We wanted a program that offered standardized training," Hefty said. "It has grown quickly and has taken on a life of its own."