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2/27/2003

Military Reserve Pharmacists Provide Vital Services

Donna Young

Pharmacists serving in military reserve units or the National Guard must be prepared to leave their civilian job and family at any time—especially during wartime, said Colonel Richard B. Lakes, Army Reserve pharmacy consultant for the Army Surgeon General.

A staff shortage at a pharmacist’s workplace is not a valid reason for a member of the reserves or National Guard not to serve when called for active duty, Lakes said, even if the person is a hospital’s or community pharmacy’s only pharmacist.

Increased reliance on reserves. Four days after the terrorist attacks on New York City and the Pentagon, President George W. Bush authorized a partial mobilization of up to 1 million reservists for homeland defense and civil support missions for up to two years of active duty.

As of February 12, 2003, a total of 150,252 members of the reserves and National Guard had been called to active duty, according to the Department of Defense (DoD). During the Persian Gulf War, President George Bush ordered 265,322 National Guard and reservists to active duty under a partial mobilization order.

Some members of the reserves, including pharmacy officers, have been sent to Afghanistan and Kuwait as part of the operation known as Enduring Freedom and for current military operations, Lakes said.

Since the military downsized its active-duty forces in the mid-1990s, reserve and National Guard volunteers play a major role in defending the nation and supporting military installations, including medical centers, Lakes said.

President Bill Clinton called up members of the reserves and National Guard for operations in Haiti in 1994, Bosnia in 1995, Southwest Asia in 1998, and Kosovo in 1999.

Lakes, a Virginia community pharmacist who spent nearly 11 years in the Army National Guard and has served 24 years in the reserves, helps to coordinate nearly 280 Army Reserve pharmacy officers. His position is unique, he said, because the Navy and Air Force do not have a reserve officer overseeing their reserve pharmacists.

Some reserve pharmacy officers, known as individual mobilization augmentees (IMAs), fill in for active-duty pharmacists at military medical installations who are sent to military operation sites overseas, Lakes said. IMA pharmacists, he noted, must generally complete two weeks of training per year at a particular military base.

“That is so, when an active-duty pharmacist is sent someplace else, like Afghanistan or Korea, the reserve pharmacist can fill that person’s shoes and be familiar with that medical center and know how that pharmacy operates,” Lakes said.

Pharmacists serving in reserve medical units must complete two weeks of training per year, plus serve one weekend per month with their unit training at a military base, he said.

Lakes is an IMA pharmacist and completes his annual two-week training at Brooke Army Medical Center at Fort Sam Houston in San Antonio, Texas.

When soldiers were sent to the Persian Gulf in the early 1990s, Lakes was deployed to Brooke for six months to fill in for an Army pharmacist who was sent overseas.

“During Desert Storm, more reserve pharmacists stayed in the United States,” he said, comparing that military mission with the more recent ones in which reserve pharmacists tend to serve outside the country, either with combat support hospitals or on State Department-sponsored humanitarian assistance missions. Lakes was deployed to Germany in 2000 to fill in for a pharmacist who was sent to Kosovo.

Lakes’s employer at his community pharmacy job, Rite Aid in Verona, Virginia, has been “reasonably supportive” when the Army has called him for active duty.

“They knew when they hired me that I could be called up at any time,” he said.

Lakes said that, when he went to Germany in 2000, Rite Aid posted a notice in the local newspaper, including his photo, which explained that the store would have to reduce its pharmacy hours for about three months until Lakes returned home.

Protections. There are many federal and state laws that protect members of the military reserves and National Guard.

The Uniformed Services Employment and Reemployment Rights Act (USERRA), enacted in October 1994 and updated most recently in 1998, provides reemployment protection and other rights for those persons who perform military service. USERRA applies to all employers in the United States, regardless of the size of their business.

The Soldiers’ and Sailors’ Civil Relief Act of 1940 places a limit, 6% per year, on the amount of interest that may be collected on debts of reservists during their period of military service. This provision, according to DoD, applies to all debts incurred before the commencement of active duty and includes interest on credit card debt, mortgages, car loans, and other debts. Under the law, a person serving in a reserve component of the military may receive delays for civil court actions, such as bankruptcy, foreclosure, or divorce proceedings. The law also protects reservists from eviction if their monthly rent is $1200 or less.

Donald Johnson, pharmacy chief for the Veterans Affairs Medical Center in Little Rock, Arkansas, said he was lucky when he was called to active duty as an Army reservist during the Gulf War because he could hire pharmacy students from nearby University of Arkansas for Medical Sciences (UAMS) to help take some of the load off of his staff while he was gone. Johnson served as an IMA pharmacist at Fort Sill in Southwestern Oklahoma.

Overseas service. UAMS Associate Pharmacy Professor Rob Richardson has served in the reserves and the National Guard, in addition to serving as a hospital corpsman and pharmacy technician in the Navy before becoming a pharmacist.

During the Gulf War he served with the National Guard’s 148th Evacuation Hospital in Saudi Arabia. His pharmacy there consisted of a compact metal building that folded out to be a 16 x 20 foot “instant pharmacy” complete with shelving and sinks, he said.

He currently serves with the Army Reserve’s 75th Combat Support Hospital based in Tuscaloosa, Alabama. He recently served in El Salvador, Guatemala, Costa Rica, and Belize for State Department-sponsored humanitarian assistance missions. Most humanitarian missions run for two to three weeks, he said.

“Pharmacists are an integral part of those types of missions,” Richardson said, because they are needed to repackage and dispense drug products purchased in bulk by the military.

“We see about 600 patients per day,” he said. “Most of our drugs come in containers of 500 or 1000 tablets.”

To dispense drug products during humanitarian missions, Richardson said, the Army uses self-sealing sandwich bags to repackage tablets, including antibiotics, cough and cold medications, and pain relievers. Some products, such as iron supplements, are packaged in bottles with child-resistant caps, he noted.

The containers are labeled in the appropriate local language used in the country where the mission operation is taking place, he added.

If Richardson’s unit is not activated to serve in the military’s current operation, he said, it will next travel to Ecuador to help provide health care services to residents.

But the 75th Combat Support Hospital’s main mission, Richardson said, is to provide medical and surgical care in combat zones during military operations.

During weekend training exercises, Richardson’s unit, which consists of pharmacists, pharmacy technicians, physicians, nurses, and other health care professionals, must also train on weapons use, protective gear, and decontamination methods, he said.

Bill Pickard, clinical pharmacist for Duke University Medical Center’s Division of Infectious Diseases, said the military reserve’s medical support units are an essential part of the peacekeeping process.

PickardIn Afghanistan, where Pickard recently served, “the warlords saw the good things we were doing, such as cleaning up the water and giving them health care,” he said. “So they knew that if we left, so would our services.”

Pickard, a lieutenant colonel in the Army’s 3rd Medical Command—the military’s senior deployable medical command—was a pharmacy consultant during Enduring Freedom from November 2001 until November 2002. He acted as the United States military’s medical liaison for Jordan’s Medical Field Hospital, the main military hospital in Mazar-e Sharif, Afghanistan.

Pickard was called to active duty on Thanksgiving Day 2001 and left the United States to serve in Afghanistan and Kuwait on Christmas Day 2001. He also served during the Gulf War as chief pharmacist for the 3274th USA Hospital unit and was chief pharmacist from 1985 to 1994 for the 312th Evacuation Hospital unit.

Having e-mail capability and a satellite phone during his most recent military activation helped Pickard stay in touch with his family and civilian workplace, he said.

“We did not have e-mail during Desert Storm,” he said.

Pickard also helped coordinate reactivation of the military’s anthrax vaccination process last fall for soldiers serving overseas, including in Kuwait. He used hand-held electronic scanners attached to laptop computers that linked directly to DoD’s medical information database to record information from a soldier’s identification badge and bar-code information from a vaccine vial.