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9/17/2004

Pharmacists Aid in Florida's Hurricane Response

Donna Young

As residents in Florida and other states in the Southeast wait to see if Tropical Storm Jeanne will pass them by or regain hurricane strength and blow apart their communities, U.S. Public Health Service (PHS) Commissioned Corps disaster-response teams, which include several pharmacists, are closing down their operation in Orlando and moving north to assist those people devastated by Hurricane Ivan.

PHS disaster-response teams have been in Florida for several weeks since being deployed to aid the state in preparation for and response to Tropical Storm Bonnie, which made landfall in the panhandle community of Apalachicola on Aug. 12.

The next day—Friday the 13th—Charley, a Category 4 hurricane, pounded Florida's Lee and Charlotte counties, crushing the waterfront town of Punta Gorda.

Charley was the strongest storm to hit Florida since 1992 when Andrew, a Category 5 hurricane, flattened much of the state's southern region.

After destroying homes, businesses, and lives along Florida's southwestern shore, Charley made a path through much of Central Florida, leaving behind a trail of flooded homes, downed trees, and debris.

Residents had hardly had time to dry out before Hurricane Frances hit Florida just north of West Palm Beach on Sept. 4, wreaking more havoc as it moved through communities in central areas of the state before weakening and moving north.

Ivan was not far behind. But instead of hitting communities in the southern and central regions of Florida, as weather services first predicted, it headed for the state's panhandle and other Gulf-Coast states, making landfall early Thursday morning in Gulf Shores, Ala., as a Category 4 hurricane.

Over the past month, PHS—the federal government's nonmilitary, uniformed force of health care professionals—has deployed about 460 Commission Corps officers, including 24 pharmacists, to assist hurricane victims and provide medical and pharmacy services, said Rear Adm. John T. Babb, who oversees PHS's disaster-response teams.

Several other pharmacists were deployed to support the Federal Emergency Management Agency (FEMA) in community-outreach and damage-assessment projects, he said.

PHS officers, he added, are lending a hand in an environmental health mission in Florida to assess water systems, evaluate food safety, and inspect buildings for mold.

Commissioned Corps officers were also called on this week to help airlift Americans and Canadians from the Cayman Islands, Babb noted.

PHS deployed teams earlier this week to Orlando where state and federal officials had established a "super" special-needs shelter at the Orange County Convention Center in anticipation of Ivan.

But the storm changed direction Wednesday and moved toward Alabama and Florida's panhandle.

So PHS had to also change its course, said Capt. Michael Montello, a PHS pharmacist whose day job is heading the protocol and information office for the National Cancer Institute in Maryland.

The ability of PHS officers to move quickly from one location to the next when dealing with the unpredictability of hurricanes is critical, he said.

"Change is always part of these crisis-response types of situations, and you always have to be able to adjust personally, as well as a team, to be able to accommodate whatever situation presents to you," said Montello, who is heading the PHS teams' activities in Orlando.

Three pharmacists from the teams deployed to Orlando are being redeployed today to Pensacola, Fla., to assist Sacred Heart Hospital, which has had a fourfold increase in emergency department visits after the coastal city was slammed yesterday by Ivan, Babb said.

Many of the PHS pharmacists serving in Florida over the past month work for the Food and Drug Administration (FDA), the Indian Health Service, the Centers for Disease Control and Prevention, and the Bureau of Prisons, Montello noted.

Cmdr. J. Lloyd Johnson, who has been heading the pharmacy operation in Orlando this week, said PHS officers must be ready to be deployed when called.

Johnson said he has been "fortunate" to have bosses at FDA's division of scientific investigations, where he works as a regulatory review officer, that have been "understanding" of his "important mission" to aid the public during times of crisis.

Babb noted that Johnson has served on several PHS disaster-response missions, including the agency's post-Sept. 11, 2001, operation in New York City.

Johnson said his participation in the Orlando operation has allowed him to be part of a "great collaborative effort" among a diverse group of federal and state agencies, which he noted includes firefighters from the U.S. Forest Service, whom he described as "experts in organization and logistics."

Military and Department of Veterans Affairs personnel and relief-organization workers were also part of the mix of people who participated in the operation in Orlando, he added.

"It's been nothing but a positive interworking relationship," Johnson said.

Even though Ivan headed north and the Orlando operation did not have the 8,000 patients that officials expected, Montello said, there were still about 200 peoplemany of whom had been displaced because of Charley and Francesthat PHS officers assisted this week at the special-needs shelter.

PHS pharmacists at the Orlando site dispensed medications, helped assess patients during triage, and assisted medical staff with medication decisions during patient rounds, Johnson said.

Many of the patients at the special-needs shelter had either left their medications behind when evacuating their homes or were unable to obtain refills because many pharmacies in their hometowns were closed, he said.

Risa Exum-Rahm, director of pharmacy services at Central Florida Regional Hospital in Sanford, which is located just north of Orlando, said residents also sought prescription refills at her hospital, which normally provides inpatient pharmacy services only, because local pharmacies were closed after Charley and Frances struck the area.

But, she said, because her hospital prepared for the hurricanes and had ordered extra drug products, it was able to meet the additional demand of providing refills for local residents.

Gregg Jones, pharmaceutical program manager for the Florida Department of Health's Bureau of Statewide Pharmaceuticals, said his agency has helped hospitals that have faced drug shortages as a result of the demand for refills from local residents by providing emergency contact information to major pharmaceutical suppliers.

The agency has also told the public which pharmacies are operational after a hurricane has struck their community.

One lesson Exum-Rahm learned from her experience with Charley was to be prepared with an extra supply of antibiotics.

After the hurricane struck, she said, the hospital's emergency room was filled with children who had ear, nose, and throat infections.

"We learned from Charley, and we were prepared for Frances," she said.

Stephen M. Kessinger, pharmacy manager at Cape Coral Hospital in Cape Coral, Fla., said tetanus toxoid is one product critical to have in large supply.

During the aftermath of a hurricane, he said, emergency rooms are filled with patients who have stepped on rusty nails or who have other deep cuts.

Kessinger noted that products to treat snake and insect bites, poison ivy, and fungal infections are also important to have on hand after a hurricane.

First responders and relief and construction workers, Jones said, are the people who have most frequently come to emergency rooms during this hurricane season and needed tetanus toxoid and antifungals.

"They are out working in water and debris, and they are the ones who get injured the most or who have been wearing wet boots for too long," he said.

Jones said his agency has provided hospitals in affected areas with additional supplies of the needed products.

One product in demand right now in the aftermath of Ivan is epinephrine to treat stings from yellow-jacket wasps, he said, adding that his agency is actively working to find supplies of the product.

Hurricane Charley also brought attention to medication storage issues when a facility has a power outage, Exum-Rahm said.

Even though Central Florida Regional Hospital has back-up generators, they did not provide enough power to run the facility's air-conditioning system, and the pharmacy, which she described as a small, confined space, got "extremely hot" during Hurricane Charley.

Exum-Rahm worried that the drug products that had to be stored at room temperature would be exposed to the heat.

"We brought in big fans," she said, to cool the area.

Staffing issues are also something to consider when preparing for a hurricane, said Kessinger.

His pharmacy department has divided its staff into two teams: Team A, which must stay at the hospital from 12 hours before a hurricane hits and complete a 72-hour shift; and Team B, which relieves Team A after their shift is over.

Unfortunately, Exum-Rahm lamented, she plans to keep her rollaway bed, which she takes to the hospital when she is required to stay during a hurricane, at the hospital for a little while longer.

"I took it home after Charley but had to bring it right back again," she said.

Exum-Rahm said her hospital has learned something new with each hurricane and has adjusted its disaster-response plan to meet newly identified needs.

Kessinger agreed that his hospital too has learned from the experience of enduring consecutive hurricanes this year. But, he added, he does not want to become an expert in hurricane response.

Even though her hospital regularly holds disaster drills, Exum-Rahm exclaimed, she doubts there will be a need to perform any more drills this year.