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Pharmacy
Topic Collection
November 19, 2024

Topic Collection: Pharmacy

Prescription medications are a critical part of effective healthcare. Shortages can arise from manufacturing or distribution issues, an increase in demand, or, in a disaster situation, lack of available distribution locations, damage to storage/distribution locations, lack of refrigeration, or a patient’s inability to access their medications. Medication shortages can cause inadequate treatment, and may require rationing and crisis care strategies. These situations are occurring more frequently in non-disaster situations due to production and inventory factors. Hospitals and retail pharmacies face numerous challenges when attempting to prepare for these shortages, particularly during emergency situations.

Community members with acute or chronic conditions may face challenges obtaining their medicine before, during, and after disasters due to insurance or access issues. These barriers can exacerbate their medical conditions, which can also increase the vulnerability of a population and the number of preventable medical care and emergency room visits. Community and hospital pharmacy staff may also be at risk of workplace violence (e.g., during community unrest, while working alone, and/or while working with potentially volatile patients).

The resources in this Topic Collection can help pharmacists and healthcare providers prepare for and respond to shortages and other pharmaceutical-related challenges that may arise during and after a disaster, as well as during non-disaster situations requiring resource allocation and crisis care strategies. This Collection also includes resources related to the role of pharmacists in disaster response, workplace violence, and strategies for partnerships between pharmacists/pharmacies and public health for public health emergency response. It was refreshed in September 2022.

Additional related resources may be found in the following ASPR TRACIE Topic Collections: Bioterrorism and High Consequence Biological Threats; Chemical Hazards; Emergency Operations Plans/ Emergency Management Program; Epidemic/ Pandemic Flu; Mass Distribution and Dispensing of Medical Countermeasures; and Radiological and Nuclear. Access our Access our COVID-19 Resources Page for related information.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

Must Reads

ASPR TRACIE. (2016). Emergency Prescription Assistance Program (EPAP): Overview Fact Sheet. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.

The Emergency Prescription Assistance Program (EPAP) is funded by the Stafford Act and designed to help disaster survivors access prescription medicines. EPAP can also be activated by the Public Health Service Act under the authority of the National Disaster Medical System (NDMS). The program utilizes normal business operations (e.g., electronic prescription claims processing, utilization of the normal pharmaceutical supply chain for distribution and dispensing) to pay for prescription medications for eligible persons.

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ASPR TRACIE. (2022). Disaster Available Supplies in Hospitals (DASH) Tool.

Disaster Available Supplies in Hospitals (DASH) is an interactive tool that can help hospital emergency planners and supply chain staff estimate supplies that may need to be immediately available during various mass casualty incidents and infectious disease emergencies based on hospital characteristics. Comprised of four modules (pharmacy, burn, trauma, and personal protective equipment), DASH recommends average par levels for specific supplies that acute care hospitals may need to have on hand to respond to a disaster in their community until resupplied. Recommendations are based on user inputs about the size of the hospital, risks in the community, regional role/designation of the hospital, and other factors.

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ASPR TRACIE. (2024). Intravenous Fluid Shortage Strategies.

During shortages of sterile fluids for intravenous (IV) injection, hospitals and healthcare providers must modify usual practices for administration to conserve product. The information in this tip sheet is derived from existing published resources, based primarily on previous shortage experiences.

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Association of State and Territorial Health Officials. (2018). Memorandum of Understanding Toolkit for Collaborations Between Public Health and Pharmacies in Preparation for an Influenza Pandemic.

This document provides guidance and templates for state and territorial health agencies charged with creating memoranda of understanding with pharmacies in response to influenza pandemics and other public health emergencies.

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Association of State and Territorial Health Officials. (2022). Emergency Use Authorization Toolkit.

The toolkit provides government officials, preparedness directors, and legal counsel with emergency use authorization-related educational, training, and planning resources to help prepare for and respond to emergencies. It provides information on the federal law that allows special uses for drugs, biologics, and devices during specified emergencies. It also includes information related to the storage, dispensing, and use of medical countermeasures. The EUA Toolkit is one of six toolkits in ASTHO’s Legal Preparedness Series: https://www.astho.org/advocacy/state-health-policy/legal-preparedness-series/.

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Bell, C., and Daniel, S. (2014). Pharmacy Leader's Role in Hospital Emergency Preparedness Planning. Hospital Pharmacy. 49(4): 398–404.

The objective of this article is to provide healthcare system pharmacy leaders with a practical approach in developing an emergency operations plan (EOP) that can be activated and help meet patient-centered needs in the event of a disaster. The authors address how pharmacy leaders should: 1) review government and community disaster responses and understand the movement of drug supply for each response; 2) create a pharmacy disaster plan; 3) list the essential medications and determine their inventory levels; and 4) establish a staff training program to enhance understanding and implementation of the EOP.

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Brown, D.W., Young, S.L., Engelgau, M.M., and Mensah, G.A. (2012). Evidence-Based Approach for Disaster Preparedness Authorities to Inform the Contents of Repositories for Prescription Medications for Chronic Disease Management and Control. (Abstract only.) Prehospital and Disaster Medicine. 23(5):447-57.

The authors of this study provide the first step in an evidence-based approach to inform the planning, periodic review, and revision of repositories of chronic disease medications, which would be helpful for rapid response to public health emergencies. The article identifies the most-prescribed medication classes of drugs as a start to outpatient planning.

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Carameli, K.A., Eisenman, D.P., Blevins, J., et al. (2013). Planning for Chronic Disease Medications in Disaster: Perspectives from Patients, Physicians, Pharmacists, and Insurers. Disaster Medicine and Public Health Preparedness.

The authors of this study discuss the imbalance between the high proportion of chronically ill Americans who depend on prescription medications and their lack of medication reserves for disaster preparedness. They examined barriers that Los Angeles County residents with chronic illness experience within the prescription drug procurement system to achieve recommended medication reserves.

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Centers for Medicare and Medicaid Services. (2024). Getting Medical Care and Prescription Drugs in a Disaster or Emergency Area.

This fact sheet is intended for Medicare patients and provides information about: how to see doctors and other providers; get prescription drugs and extended day supplies; pay Medicare premiums; and receive dialysis or chemotherapy in a disaster or emergency area. It also describes how to replace a Medicare card, or lost or damaged durable medical equipment or supplies that Medicare paid for.

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Healthcare Ready (formerly Rx Response). (2019). Rx Open.

This website helps emergency management teams and the general public locate operating pharmacies in areas affected by natural disasters or public health emergencies. The tool provides maps to identify the location of open and closed pharmacies using Google Maps. The website is free to the public when activated at the request of state or federal officials.

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Jhung, M.A., Shehab, N., Rohr-Allegrini, C., et al. (2007). Chronic Disease and Disasters: Medication Demands of Hurricane Katrina Evacuees. American Journal of Preventive Medicine. 33(3):207-210.

The authors of this study assess the relationship between actual medication demands and medical relief pharmaceutical supplies in a population of 18,000 evacuees relocated to San Antonio, TX after Hurricane Katrina struck the Gulf Coast in August 2005.

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National Association of County and City Health Officials. (2014). Local Health Department and Pharmacy Partnerships for Enhancing Medication Dispensing During Emergencies: Statement of Policy.

This document offers eight recommendations for local health departments on collaborating with pharmacy partners for public health emergency preparedness and response. It discusses how strong relationships between local health departments and pharmacy partners can increase the safe, fast, effective, and equitable distribution of medical countermeasures during a public health emergency, and are crucial to effective public health emergency response.

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Pincock, L.L, Montello, M.J., Tarosky, M.J., et al. (2011). Pharmacist Readiness Roles for Emergency Preparedness. (Requires log in to Medscape). American Journal of Health-System Pharmacy. 68(7):620-623.

The authors describe the various roles pharmacists could have in disaster readiness and divide them into two categories: "clinical" and "other." Clinical roles would primarily be fulfilled by ambulatory care readiness pharmacists, pharmacotherapy readiness pharmacists, and critical care readiness pharmacists. The "other" category includes specialized clinical roles and nonclinical activities carried out by weapons of mass destruction/pandemic readiness pharmacists, pharmacy readiness logisticians, and pharmacist readiness managers.

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Drug Shortages

American Society of Health-Systems Pharmacists. (2018). Drug Shortages as a Matter of National Security: Improving the Resilience of the Nation’s Healthcare Critical Infrastructure.

This article includes suggestions made by attendees of a September 2018 summit focused on the issue of drug shortages as a matter of national security. The non-consensus recommendations include those pertaining to policy and marketplace changes to prevent and mitigate drug shortages.

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American Society of Health-Systems Pharmacists. (2018). Drug Shortages Roundtable: Minimizing the Impact on Patient Care. American Journal of Health-System Pharmacy. 75(11): 816–820.

This article details discussions held at a November 2017 roundtable on drug shortages organized by the American Society of Health-Systems Pharmacists. Topics included: the role of the Food and Drug Administration in addressing shortages; drug shortage trends and causes; compounding outsourcing facilities regulated under Section 503B of the Food, Drug, and Cosmetics Act; and recommendations for preventing and mitigating shortages.

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American Society of Health-Systems Pharmacists and University of Utah Drug Information Service. (2017). Small-Volume Parenteral Solutions Shortages: Suggestions for Management and Conservation. U.S. Food and Drug Administration.

This fact sheet “summarizes the status of the current acute shortage of small-volume parenteral solutions and provides an outline of potential actions for organizations to consider in managing the shortage.” Included are strategies to assist physicians with conserving resources; inventory control strategies; pharmacy operational strategies; informatics strategies; and safety information.

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ASPR TRACIE. (2024). Intravenous Fluid Shortage Strategies.

During shortages of sterile fluids for intravenous (IV) injection, hospitals and healthcare providers must modify usual practices for administration to conserve product. The information in this tip sheet is derived from existing published resources, based primarily on previous shortage experiences.

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ASPR TRACIE. (2024). Partnering with the Healthcare Supply Chain During Disasters.

This document provides an overview of the emergency planning and response considerations of healthcare supply chain owners, operators, and end users, as well as insights for healthcare coalitions (HCCs) working with healthcare supply chain partners on preparedness, response, and recovery. It aims to capture key changes during serious or catastrophic events, compared to normal supply chain operations, as well as planning and response contingencies.

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ASPR TRACIE. (2024). Shortage Strategies and Resources: Peritoneal Dialysis Solution.

Medical product shortages and disaster-induced impacts from hurricanes and other extreme weather incidents can disrupt dialysis treatment and access to critical supplies. This tipsheet can help healthcare providers adapt to a shortage of peritoneal dialysis solution.

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ASPR TRACIE and ASTHO. (2017). Clinicians and Coalitions: A Conversation about Finding Solutions for Medication Shortages.

The speakers in this webinar: provided an overview of the medication shortages and their clinical impact; described coping strategies for scarce resources; and discussed the decision- making strategies states, coalitions, and healthcare facilities have used based on crisis standards of care principles. Speakers also responded to questions received from participants in a facilitated discussion (available here: https://files.asprtracie.hhs.gov/documents/aspr-tracie-medication-shortage-webinar-discussion-questions.pdf)."

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* Duke University Margolis Center for Health Policy. (2018). Identifying the Root Causes of Drug Shortages and Finding Enduring Solutions.

This webpage includes links to the agenda, speaker biographies, and presentation slides from a 1-day seminar held in November 2018 focused on drug shortages. Topics included: federal efforts to address drug shortages; economics of drug shortages; health impacts of drug shortages; manufacturing and supply challenges; drug purchasing and demand challenges; and strategies to reduce clinical and economic consequences of drug shortages.

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Erickson, A. (2016). Drug Shortages: Hospital Pharmacists Work Magic Behind the Scenes. Pharmacy Times. 22(5): 6-7.

The author highlights strategies offered by hospital pharmacists for managing drug shortages. These include: working closely with pharmacy buyers to manage inventory; securing as much product as possible for each hospital within a network and then reallocating supply across hospitals as needed; using a Drug Use Policy team of pharmacists who review all of the literature and prepare pharmacy and therapeutic drug reviews to identify alternatives; triaging available supplies; and having pharmacists work closely with physicians on the floors to ensure available clinical data supports decision-making for use of alternative options.

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Food and Drug Administration. (n.d.). FDA Drug Shortages: Current and Resolved Drug Shortages and Discontinuations Reported to FDA. (Accessed 7/20/2022).

This page shows the status of past and current shortages of drugs available in the United States.

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Food and Drug Administration. (2013). Strategic Plan for Preventing and Mitigating Drug Shortages Food and Drug Administration, October 2013.

This document addresses the Food and Drug Administration’s plan for identifying, preventing, and mitigating drug shortages.

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Fox, E., Sweet, B., and Jensen, V. (2014). Drug Shortages: A Complex Health Care Crisis. Mayo Clinic Proceedings. 89(3):361-373.

This article provides an overview of the causes of drug shortages, and the effects that they have on clinical care. The authors call drug shortages “a form of health care rationing,” and note multiple examples of medication errors that have resulted from drug shortages.

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Minnesota Department of Health. (2024). Recommendations for Ethical Allocation of Sterilized Fluids.

In 2024, Hurricane Helene damaged a Baxter facility that produced intravenous fluids and related products. This document provides a voluntary framework for the ethical allocation of these products until the shortage is resolved.

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National Academies of Sciences, Engineering, and Medicine. (2018). Medical Product Shortages During Disasters.

This document summarizes a conference held in 2017 in response to a shortage of intravenous saline solution (made worse during that year's hurricane season) during which experts discussed predicting, preventing, and responding to drug shortages.

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* Parenteral Drug Association. (2014). Drug Shortages.

This webpage includes links to a technical report issued in 2014, “Risk-Based Approach for Prevention and Management of Drug Shortages.” Included with the report is a template for a Drug Shortage Prevention and Response Plan.

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Scudder, L. and Jensen, V. (2014). Critical Intravenous Solution Shortages. Medscape.

This interview of drug shortage staff from the Food and Drug Administration, addresses the 2014 saline shortage. It provides recommendations for substitution of normal saline with other solutions and alternatives for mixing and administering medications.

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Shaban, H., Maurer, C., and Willborn, R. (2018). Impact of Drug Shortages on Patient Safety and Pharmacy Operation Costs. Federal Practitioner.

The authors share the results of a descriptive study with the primary outcome of characterizing the impact of drug shortages on institutional cost and patient safety events among Veterans Health Administration facilities.

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Supply Chain Security Steering Committee. (2018). Taking a Collaborative Approach to Secure Donated Medicines. (Registration necessary to download free report.) RX-360.

The Committee shares the benefits, problems, gaps, challenges, best practices, and the ongoing efforts to strengthen the supply chain for donated product.

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* U.S. Food and Drug Administration. (2014). Managing Drug Shortages.

This webpage provides links to a video and written transcript addressing the U.S. Food and Drug Administration (FDA) Safety and Innovation Act. The Act was passed by Congress in 2012, and provides new authorities for the FDA to manage drug shortages. In the video, FDA Drug Info Rounds pharmacists discuss the management of drug shortages and how the FDA’s role has changed in recent years.

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Ventola, C.L. (2011). The Drug Shortage Crisis in the United States: Causes, Impact, and Management Strategies. Pharmacy & Therapeutics. 36(11): 740-742, 749-757.

This article reviews the causes of drug shortages, drugs most susceptible to shortages, the impacts of drug shortages, and strategies for managing drug shortages. In addition, recommendations from a drug shortage summit in November 2010 attended by representatives of pharmaceutical manufacturers, wholesalers, group-purchasing organizations, health care providers, trade groups, and the federal government, are also included.

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Education and Training

ASPR TRACIE. (2020). Community Pharmacists’ Role in COVID-19.

Dr. Alfred L’Altrelli, PharmD, Administrative Director of Pharmacy, UPMC Presbyterian discusses how the role of pharmacists in has evolved in general—beyond product dispensing to patient-centered care—and how this has manifested during the pandemic.

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Capper, S., Hogue, M., and Thomas, C. (2007). The Pharmacist's Role in Disasters. South Central Preparedness and Emergency Response Learning Center.

This training course addresses the changing role of pharmacists in the public health system, and their specific roles during a public health emergency response. The presenters also discuss experiences of the pharmacy community during the aftermath of Hurricane Katrina.

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Centers for Medicare & Medicaid Services. (2022). Replacing DME & Prescription Drugs after a Disaster: Addressing the Needs of Medicare Beneficiaries. U.S. Department of Health and Human Services.

This training discusses access to durable medical equipment and prescription drugs after a disaster. It provides information on prescription drug programs through Medicare during recovery and contact information for the Centers for Medicare & Medicaid Services. In the description, it also contains links to current Medicare information since policies can change. The full report is also available: https://www.cms.gov/files/document/replacing-dme-and-prescription-drugs-after-disaster-student-manual.pdf

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Clark, P., Leman, R., Ramirez, J., and Miner, G. (2020). Emergency Preparedness, Response, and the Role of the Oregon Pharmacist. Oregon State University College of Pharmacy.

This 3-hour online continuing education course reviews basic emergency preparedness information; personal and business preparedness; the legal framework for pharmacists to respond within Oregon; and specific ways pharmacists can help their communities during emergencies/disasters.

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* Duke University Margolis Center for Health Policy. (2018). Identifying the Root Causes of Drug Shortages and Finding Enduring Solutions.

This webpage includes links to the agenda, speaker biographies, and presentation slides from a 1-day seminar held in November 2018 focused on drug shortages. Topics included: federal efforts to address drug shortages; economics of drug shortages; health impacts of drug shortages; manufacturing and supply challenges; drug purchasing and demand challenges; and strategies to reduce clinical and economic consequences of drug shortages.

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Gallegos, C. and Alstrup, G. (2017). Emergency Preparedness: Is Your Facility Prepared in the Event of a Disaster? University of New Mexico Hospitals.

These slides are from a presentation on the potential emergency response roles of pharmacists in public health emergencies and mass casualty incidents, medications needed during such events, and steps that should be taken to prepare for such events. Though it includes some New Mexico-specific information, much of the content is generalizable to other hospital pharmacy departments.

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U.S. Food and Drug Administration. (2016). Emergency Preparedness - Keeping Medications Safe.

In this video, FDA Drug Info Rounds pharmacists discuss the importance of being prepared for emergency situations and discuss the resources that pharmacists can rely on when advising their patients about keeping medications safe during emergencies and disasters.

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Woods, J. (2013). Emergency Preparedness: The Role of the Pharmacist. (Requires free registration.) South Central Preparedness and Emergency Response Learning Center.

This course familiarizes pharmacists and pharmacy technicians with the basic components of public health emergency preparedness and the role pharmacists play in disaster events. It addresses basic policies and directives related to public health emergencies, and reviews the federal and state resources available, with a specific look at the organizations involved in responding to a public health event in Mississippi.

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Emergency Prescription Assistance Program (EPAP) Resources

ASPR TRACIE. (2016). Emergency Prescription Assistance Program (EPAP): Hurricane Gustav Data Fact Sheet. U.S. Department of Health and Human Services, Assistant Secretary for Preparedness and Response.

This fact sheet provides a summary of the EPAP data collected and analyzed following Hurricane Gustav from September 2, 2008 to October 31, 2008.

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ASPR TRACIE. (2016). Emergency Prescription Assistance Program (EPAP): Hurricane Ike Data Fact Sheet. U.S. Department of Health and Human Services, Assistant Secretary for Preparedness and Response.

This fact sheet provides a summary of the EPAP data collected and analyzed following Hurricane Ike from September 12, 2008 to December 15, 2008.

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ASPR TRACIE. (2016). Emergency Prescription Assistance Program (EPAP): Overview Fact Sheet. U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.

The Emergency Prescription Assistance Program (EPAP) is funded by the Stafford Act and designed to help disaster survivors access prescription medicines. EPAP can also be activated by the Public Health Service Act under the authority of the National Disaster Medical System (NDMS). The program utilizes normal business operations (e.g., electronic prescription claims processing, utilization of the normal pharmaceutical supply chain for distribution and dispensing) to pay for prescription medications for eligible persons.

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ASPR TRACIE. (2016). Emergency Prescription Assistance Program (EPAP): Superstorm Sandy Data Fact Sheet. United States Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.

This fact sheet provides a summary of the EPAP data collected and analyzed following Superstorm Sandy for New Jersey and New York through October 30, 2013.

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ASPR TRACIE. (2017). Emergency Prescription Assistance Program (EPAP) Louisiana Floods Data Fact Sheet. U.S. Department of Health and Human Services, Assistant Secretary for Preparedness and Response.

This fact sheet provides a summary of the EPAP data collected and analyzed following the Louisiana flooding from August 19, 2016 to September 20, 2016.

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ASPR TRACIE. (2018). Emergency Prescription Assistance Program (EPAP): Hurricanes Irma and Maria, Puerto Rico Data Fact Sheet.

This fact sheet provides a summary of the EPAP data collected and analyzed following Hurricanes Irma and Maria for Puerto Rico only from November 2, 2017 to May 18, 2018.

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ASPR TRACIE. (2018). Emergency Prescription Assistance Program (EPAP): Hurricanes Irma and Maria, USVI Data Factsheet.

This fact sheet provides a summary of the EPAP data collected and analyzed following Hurricanes Irma and Maria for the U.S. Virgin Islands only from November 2, 2017 to September 15, 2018.

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ASPR TRACIE. (2019). Emergency Prescription Assistance Program (EPAP): Natural Disasters Activation 2018.

This document provides a summary of the EPAP data collected and analyzed for the following natural disasters in 2018: Hurricanes Irma and Maria, U.S. Virgin Islands; Hurricane Michael, Florida; Typhoon Mangkhut and Yutu, Mariana Islands; and California Wildfires.

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Office of the Assistant Secretary for Preparedness and Response. (2022). Emergency Prescription Assistance Program (EPAP). U.S. Department of Health and Human Services.

The purpose of the EPAP is to perform the activities related to processing claims for prescription medications, vaccines, specific medical supplies and certain durable medical equipment for designated eligible individuals in a federally identified disaster area. The activation of EPAP is requested through the states' department of health in their emergency management agency. The program can then provide a 30-day supply of covered drugs and medical supplies that can be renewed every 30 days for as long as EPAP is active.

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Stephen Buckner The information presented here is extremely useful and will be periodically reviewed for any updates. Thanks. Stephen Kelly Buckner, R.Ph.
4/20/2023 3:17:31 PM

Evaluation and Studies: General

Alkhalili, M., Ma, J., and Grenier, S. (2017). Defining Roles for Pharmacy Personnel in Disaster Response and Emergency Preparedness. Disaster Medicine and Public Health Preparedness. 11(4):496-504.

The authors conducted a literature review to characterize pharmacists' disaster preparedness and response experiences. They identified key activities that must be performed, and developed a classification scheme for pharmacy personnel “to enable pharmacy personnel working in diverse practice settings to identify and undertake essential actions that are necessary to ensure an effective emergency response.”

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Arya, V., Medina, E., Scaccia, A., et al. (2016). Impact of Hurricane Sandy on Community Pharmacies in Severely Affected Areas of New York City: A Qualitative Assessment. (Abstract only.) American Journal of Disaster Medicine. 11(1):21-30.

The authors of this study assessed the impact of Hurricane Sandy on both independently owned and chain pharmacies in New York City communities. They also proposed strategies to mitigate the effects of future storms and disasters on local pharmacies.

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Bell, C., and Daniel, S. (2014). Pharmacy Leader's Role in Hospital Emergency Preparedness Planning. Hospital Pharmacy. 49(4): 398–404.

The objective of this article is to provide healthcare system pharmacy leaders with a practical approach in developing an emergency operations plan (EOP) that can be activated and help meet patient-centered needs in the event of a disaster. The authors address how pharmacy leaders should: 1) review government and community disaster responses and understand the movement of drug supply for each response; 2) create a pharmacy disaster plan; 3) list the essential medications and determine their inventory levels; and 4) establish a staff training program to enhance understanding and implementation of the EOP.

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Brown, D.W., Young, S.L., Engelgau, M.M., and Mensah, G.A. (2012). Evidence-Based Approach for Disaster Preparedness Authorities to Inform the Contents of Repositories for Prescription Medications for Chronic Disease Management and Control. (Abstract only.) Prehospital and Disaster Medicine. 23(5):447-57.

The authors of this study provide the first step in an evidence-based approach to inform the planning, periodic review, and revision of repositories of chronic disease medications, which would be helpful for rapid response to public health emergencies. The article identifies the most-prescribed medication classes of drugs as a start to outpatient planning.

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Carameli, K.A., Eisenman, D.P., Blevins, J., et al. (2013). Planning for Chronic Disease Medications in Disaster: Perspectives from Patients, Physicians, Pharmacists, and Insurers. Disaster Medicine and Public Health Preparedness.

The authors of this study discuss the imbalance between the high proportion of chronically ill Americans who depend on prescription medications and their lack of medication reserves for disaster preparedness. They examined barriers that Los Angeles County residents with chronic illness experience within the prescription drug procurement system to achieve recommended medication reserves.

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D’Arrigo, T. (2017). Disaster Strikes! Are You Ready to Help Your Community? Pharmacy Today. 24(8): 34-37.

In this article, a pharmacist describes how his experience during Hurricane Andrew in 1992 inspired him to get involved with emergency preparedness and response within his community. Considerations for ensuring pharmacy preparedness for disasters are also discussed, including security of the facility and the need to maintain temperature control to avoid financial and time losses.

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D’Arrigo, T. (2017). Hospital Pharmacists Have a Seat at the Table in Disaster Planning. Pharmacy Today. 23(8): 4.

This brief article provides guidance for hospital pharmacists to help facilities prepare for emergencies. Pharmacists are encouraged to learn how to work within the Incident Command System; be part of the Emergency Management Committee; and prepare in advance by knowing what to order, in what quantities to order medications, and how extra medications will be stored.

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Edwards, C.J., Miller, A., Cobb, J.P., et al. (2020). The Pharmacist’s Role in Disaster Research Response. American Journal of Health-System Pharmacy. Volume 77, Issue 13, Pages 1054–1059.

This article describes the fourth workshop held in February 2019 by the National Institutes of Health Disaster Research Response (DR2) Program, which focused on opportunities for pharmacists to design, lead, and support disaster research in areas including clinical, operational, educational, and logistical aspects of pharmacy practice.

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Ford, H., Trent, S., and Wickizer, S. (2016). An Assessment of State Board of Pharmacy Legal Documents for Public Health Emergency Preparedness. American Journal of Pharmaceutical Education. 80(2): 20.

The authors conducted a quantitative content analysis to evaluate board of pharmacy legal documents (e.g., statutes, rules, and regulations) to determine how prepared states were to expedite an effective pharmaceutical response during a public health emergency based on the 2006 Rules for Public Health Emergencies (RPHE). The authors found low preparedness levels overall and suggested that the boards of pharmacy should consider adding the eight RPHE to their state pharmacy practice acts.

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Henkel, P.J. and Marvanova, M. (2020). Basic Disaster Preparedness of Rural Community Pharmacies in 5 States. (Abstract only.) Disaster Medicine and Public Health Preparedness. 14(3):329-334.

The authors of this study conducted a telephone survey with community pharmacies in three rural areas (North and South Dakota, West Virginia, and Southern Oregon/Northern California) regarding their level of disaster preparedness. Pharmacists in rural, low-income, or areas with higher levels of elderly residents reported lower levels of basic preparedness.

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Lavery, A.M., Patel, A., Boehmer, T.K., et al. (2018). Notes from the Field: Pharmacy Needs After a Natural Disaster — Puerto Rico, September–October 2017. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. 67(13):402–403.

This report provides pharmaceutical-related data from the Centers for Disease Control and Prevention after Hurricane Maria made landfall in Puerto Rico in 2017, such as the most prescribed drugs and the most common categories (cardiovascular, psychiatric, and analgesic). This information can help local pharmacists plan ahead and work with suppliers to ensure needs are met in the response and recovery phases.

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Marks, K., Chung, S., Li, J., et al. (2022). Experience of Pharmacy Involvement in a Disaster Simulation Exercise Within a Pediatric Hospital Emergency Department: A Pilot Project. (Abstract only.) American Journal of Health-System Pharmacy. 79(9):e124-e134.

The authors of this article conducted an observational study to examine pharmacist participation in multidisciplinary pediatric emergency department disaster simulation exercises. They used an evaluation tool to assess performance in the following areas: communication, pharmacotherapy, problem solving/decision making, and teamwork/organization. Results indicated that pharmacists were concise/prompt 66% of the time within the problem solving/decision making and communications domains, 88.8% of the time in the teamwork/organization domain, and 92.5% of the time in the pharmacotherapy domain.

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Moss, A., Green, T., Moss, S., et al. (2021). Exploring Pharmacists’ Roles during the 2019-2020 Australian Black Summer Bushfires. Pharmacy (Basel). 9(3):142.

The authors of this study conducted semi-structured phone interviews with ten community pharmacists who provided response efforts during the 2019-2022 Black Summer Bushfires in Australia. Analysis from these interviews were grouped into six main themes: collaboration; trauma and mental health; power and communication; acute presentations; triaging and emergency prescribing. Pharmacists worked closely with doctors and members of the local community, provided triaging services, timely health advice about chronic health problems, and managed acute issues, including wound and burn management and mental health support in traumatic conditions.

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Raza, M.A., Aziz, S., Noreen, M., et al. (2021). Role of Pharmacist in Disaster Management: A Quantitative Content Analysis Approach. Innovations in Pharmacy. Vol. 12, No. 4, Article 9.

The authors of this study discuss their analysis in reviewing existing literature that addresses pharmacists’ roles in disasters. They reviewed 106 reports and of those, only 20 were determined to meet their eligibility criteria. Table 3 depicts the summary of the proportion of literature that described pharmacist roles in disaster management including pharmaceutical supply (44%), patient management (20%), response integration (15%) and policy coordination (13%).

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* Romolt, C., Melin, K., Hardie, K., et al. (2020). Community Pharmacy Operations in Puerto Rico During the 2017 Hurricane Season: A Descriptive Analysis of Rx Open Data. (Abstract only.) Disaster Medicine and Public Health Preparedness. DOI: 10.1017/dmp.2020.339.

The authors examine the "Return to Open Pharmacy Operations" in Puerto Rico after Hurricane Maria and compare it to pharmacy recovery in Florida after Hurricane Irma.

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Rosenthal, M.S., Klein, K., Cowling, K., et al. (2005). Disaster Modeling: Medication Resources Required for Disaster Team Response. Prehospital and Disaster Medicine. 20(5):309–315.

The objective of this study was to develop a model that can help determine supply requirements for the National Disaster Medical System, Disaster Medical Assistance Teams, or other responding disaster medical teams in a civilian environment. Results proved that the model predicted the proportion of patient complaints and, therefore, the medicine and supplies needed for the management of these patients.

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* Rutkow, L., Vernick, J.S., Wissow, L.S., et al. (2011). Prescribing Authority during Emergencies Challenges for Mental Health Care Providers. The Journal of Legal Medicine. 32(3): 249–260.

This article addresses the issues associated with the prescribing abilities of mental health providers after a disaster and the implications for acute and chronic management of behavioral health issues.

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Schumacher, L., Senhaji, S., Gartner, B.A., et al. (2022). Full-scale Simulations to Improve Disaster Preparedness in Hospital Pharmacies. BMC Health Services Research. (1):853.

Four Swiss hospital pharmacies conducted two full-scale simulation exercises each at least four months apart. Two scenarios were used—a major road accident and a terrorist attack—each involving approximately 50 casualties. The authors of this article assessed whether personnel were better prepared for disasters after each successive exercise. Results indicated that the four hospitals accomplished 69% (± 6%) of the actions expected of them during exercise one, which increased to 84% (± 7%) during the second exercise.

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Tseregounis, I.E., Delcher, C., Stewart, S.L., et al. (2022). The Impact of California Wildfires on Patient Access to Prescription Opioids. Journal of the American Pharmacists Association. S1544-3191(22)00150-9.

The authors of this article conducted a retrospective study using ZIP code tabulation areas to assess whether the Camp and Tubbs fires in California were associated with disrupted access to prescription opioids for patients receiving long-term opioid medications. Access to prescription opioids was greatly challenging for patients living in areas that were most affected by the Camp Fire; disruptions due to the Tubbs Fire were far less severe.

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Watson, K.E., Singleton, J.A., Tippett, V., et al. (2019). Defining Pharmacists' Roles in Disasters: A Delphi Study. PLoS One. 14(12).

The authors of this article conducted a Delphi study to obtain consensus from a panel of 24 expert leaders regarding the various roles of pharmacists in disaster health. Online survey panelists were asked to rank their opinions on 46 roles using a 5-point Likert scale. Results indicated that 43 of the 46 items presented were accepted as roles that pharmacists are capable of undertaking in the various phases of a disaster.

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Evaluation and Studies: Pandemic

Aruru, M., Truong, H., and Clark, S. (2021). Pharmacy Emergency Preparedness and Response (PEPR): A Proposed Framework for Expanding Pharmacy Professionals’ Roles and Contributions to Emergency Preparedness and Response During the COVID-19 Pandemic and Beyond. Research in Social and Administrative Pharmacy. 17(1):1967-1977.

The authors developed a Pharmacy Emergency Preparedness and Response Framework to include recommendations for pharmacy professionals to become fully integrated within public health emergency preparedness and response efforts, such as the COVID-19 pandemic. They address how the roles of pharmacists can be expanded upon to provide improved patient care and population health interventions and ensure healthcare worker and public health safety.

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Belisle, C.D., Anger, K., Kanaan, D., et al. (2021). Non-Sterile to Sterile Compounding: An Unconventional Response During the COVID-19 Pandemic. Journal of Pharmacy Practice.

This article addresses the history, decision-making processes, and response to the critical medication shortages experienced during the COVID-19 pandemic. More specifically, it focuses on hydromorphone infusions and the steps taken to engage in non-sterile to sterile compounding.

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Burry, L.D., Barletta, J.F., Williamson, D., et al. (2020). It Takes a Village…: Contending with Drug Shortages During Disasters. Chest Journal. 158(6):2414-2424.

The COVID-19 pandemic has emphasized the need for a coordinated, multi-pronged approach to optimize medication availability. This resource addresses various factors that contribute to drug shortages during pandemics including issues related to supply (e.g., manufacturing difficulties, supply chain breakdowns), and variables that influence demand (e.g., volatile prescribing practices, anecdotal or low-level data, and hoarding).

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Carpenter, D.M., Hastings, T., Westrick, S., et al. (2021). Rural Community Pharmacies’ Preparedness for and Response to COVID-19. Research in Social and Administrative Pharmacy. 17(7):1327-1331.

The authors of this article conducted an online survey of rural community pharmacists to assess their preparedness level for responding to COVID-19. Results were evaluated from 62 pharmacists who completed the survey and indicated that 78% were interested in offering COVID-19 testing, but they needed personal protective equipment and training in order to do so effectively. In addition, only 10% of participants had received prior disaster preparedness training in the past five years. Study results also found that although 73% had disaster preparedness plans, 27% were deemed inadequate for the pandemic. Almost 70% experienced supply shortages.

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Fain, B.A., Koonin, L.M., Stoto, M.A., et al. (2014). Facilitating Access to Antiviral Medications and Information during an Influenza Pandemic: Engaging With the Public on Possible New Strategies. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 12(1):8-19.

The Institute of Medicine, with technical assistance from the Centers for Disease Control and Prevention, convened public engagement events in three demographically and geographically diverse communities to assess public perception of the alternative strategies for prescribing, distributing, and dispensing antivirals and disseminating information about influenza and its treatment. Participants at all three locations expressed high levels of acceptance for each of the proposed strategies, including pharmacists prescribing under Collaborative Practice Agreements with sponsoring physicians. Key findings from these sessions are discussed further in this article.

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Fitzgerald, T., Kang, Y., Bridges, C., et al. (2016). Integrating Pharmacies into Public Health Program Planning for Pandemic Influenza Vaccine Response. Vaccine. 34(46):5643-5648.

The authors analyzed reporting data from immunization and public health preparedness programs to assess their pandemic planning with pharmacies. They found that most jurisdictions include pharmacies in their pandemic vaccine distribution plans, nearly half have a process to recruit pharmacists as vaccinators, and nearly a third have formal relationships established with pharmacies.

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Gessler, C.A., Richardson, R.M., Hall, D.L., et al. (2021). Operationalizing Pandemic Vaccinations at a Regional Supermarket Chain Pharmacy. Disaster Medicine and Public Health Preparedness. 1-6.

During the 2009 H1N1 pandemic, community pharmacies were underutilized as vaccination locations. Pharmacies have since become a common place for seasonal influenza vaccinations. The authors of this article summarize the results of a strategic planning meeting conducted in 2017 that focused on operationalizing pandemic influenza vaccinations at a regional supermarket chain pharmacy.

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Lambrou, A.S., Redd, J.T., Steward, M.A., et al. (2022). Implementation of SARS-CoV-2 Monoclonal Antibody Infusion Sites at Three Medical Centers in the United States: Strengths and Challenges Assessment to Inform COVID-19 Pandemic and Future Public Health Emergency Use. Disaster Medicine and Public Health Preparedness. 14;1-32.

The authors of this article conducted a descriptive analysis from three sites at medical centers in the U.S. supported by the National Disaster Medical System to examine the monoclonal antibody infusion site process during the COVID-19 pandemic. The authors discuss several successes and challenges in implementing these sites.

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Merchan, C., Soliman, J., Ahuja, T., et al. (2020). COVID-19 Pandemic Preparedness: A Practical Guide from an Operational Pharmacy Perspective. American Journal of Health-System Pharmacy. 77(19):1598-1605.

This article addresses pharmacist preparedness practices during the COVID-19 pandemic and the operational strategies implemented at New York University Langone Health.

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Nelsen, G., Pigott, H., Hopkinson, C., and Formea, C. (2020). Considerations for Development of Pharmacy Support Models for COVID-19 Alternate Care Sites. American Journal of Health-System Pharmacy.

This article describes the planning considerations of one health system’s pharmacy department to support pharmacy operations at an alternate care site (ACS). Building upon the Federal Healthcare Resilience Task Force ACS Toolkit, U.S. Army Corps of Engineers ACS guidance web page, and crisis standards of care concepts, the pharmacy team developed resource lists to meet the needs of their expected patient population. Included in appendices and tables are: key assumptions and issues in medication list planning for an ACS, key medication-related and staffing questions to consider in alternate site care planning, and considerations and options for IV infusion pump use, staffing, and transitions of care at an ACS.

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O'Hagan, J., Wong, K., Campbell, A., et al. (2015). Estimating the United States Demand for Influenza Antivirals and the Effect on Severe Influenza Disease during a Potential Pandemic. Clinical Infectious Diseases. 60 (Suppl 1):S30-41.

Following the detection of a novel influenza strain A (H7N9), the authors modeled the use of antiviral treatment in the U.S. to mitigate severe disease across a range of hypothetical pandemic scenarios. The model included estimates of attack rate, healthcare-seeking behavior, prescription rates, and other related data. Based on these inputs, the total antiviral regimens estimated to be available in the U.S. (as of April 2013) were deemed sufficient to meet treatment needs for the scenarios considered.

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Pammal, R.S., Kreinces, J.B., and Pohlman, K.L. (2021). Importance of Pharmacy Partnerships in Effective COVID-19 Vaccine Distribution. Disaster Medicine and Public Health Preparedness.

The authors of this article address the importance of pharmacy partnership, federal support, and equity in order to attain an efficient COVID-19 vaccine distribution plan and achieve improved societal health outcomes. They provide several recommendations for future policy development.

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Pulk, R.A., Leber, M., Tran, L., et al. (2020). Dynamic Pharmacy Leadership during the COVID-19 Crisis. Optimizing Patient Care Through Formulary and Drug Shortage Management. American Journal of Health-System Pharmacy. 77(22):1874-1884.

The authors describe their approach during the COVID-19 pandemic to adapting a pharmacy leadership structure that addresses critical medication shortages through innovative data analysis, procurement strategies, and rapid implementation of medication policy.

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Rubin, S.E., Schulman, R.M., Roszak, A.R., et al. (2014). Leveraging Partnerships among Community Pharmacists, Pharmacies, and Health Departments to Improve Pandemic Influenza Response. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 12(2):76-84.

This article provides recommendations on how local health departments can most effectively develop and maintain relationships with community pharmacies. It also addresses how pharmacists can help provide a more coordinated and resourceful public health response to emergencies, specifically to pandemic influenza outbreaks.

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Schwerzmann, J., Graitcer, S., Jester, B., et al. (2017). Evaluating the Impact of Pharmacies on Pandemic Influenza Vaccine Administration. (Abstract only.) Disaster Medicine and Public Health Preparedness. 11(5):587-593.

The authors developed a model to estimate the effects of vaccine administration in retail pharmacies. They estimated that nationwide capacity to administer vaccines would increase to 25 million doses per week when retail pharmacies were included and that the time to achieve 80% nationwide vaccination coverage could be reduced by seven weeks.

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Wallis, N., Gust, C., Porter, E., et al. (2020). Implementation of Field Hospital Pharmacy Services during the COVID-19 Pandemic. American Journal of Health-System Pharmacy. Oxford Academic. 77(19):1547-1551.

This article describes the setup, implementation, and operations of the first field hospital established in the U.S. during the COVID-19 pandemic.

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Zuckerman, A.D., Patel, P.C., Sullivan, M., et al. (2020). From Natural Disaster to Pandemic: A Health-System Pharmacy Rises to the Challenge. American Journal of Health-System Pharmacy. Oxford Academic. 77(23):1986-1993.

This article describes the experience and lessons learned by Vanderbilt University Medical Center’s pharmacy department after a tornado destroyed the health system’s warehouse, which stored most of their clinical supplies. Response and recovery efforts were further impacted by the impending COVID-19 pandemic, which required a collaborative, innovative, and flexible team effort across all pharmacy areas and the entire medical center to maintain high-quality patient care.

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Guidelines and Protocols: General

* Association of State and Territorial Health Officials. (2018). Memorandum of Understanding Toolkit for Collaborations Between Public Health and Pharmacies in Preparation for an Influenza Pandemic.

This document provides guidance and templates for state and territorial health agencies charged with creating memoranda of understanding with pharmacies in response to influenza pandemics and other public health emergencies.

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Centers for Medicare and Medicaid Services. (2024). Getting Medical Care and Prescription Drugs in a Disaster or Emergency Area.

This fact sheet is intended for Medicare patients and provides information about: how to see doctors and other providers; get prescription drugs and extended day supplies; pay Medicare premiums; and receive dialysis or chemotherapy in a disaster or emergency area. It also describes how to replace a Medicare card, or lost or damaged durable medical equipment or supplies that Medicare paid for.

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Fox, E. and McLaughlin, M. (2018). ASHP Guidelines on Managing Drug Product Shortages. (Free registration required.) American Journal of Health-System Pharmacy. 75(21): 1742–1750.

The authors present guidelines “to provide a framework for healthcare teams in patient care settings that can be used to develop policies and procedures that minimize the effects of drug shortages on quality of care.”

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Maryland Department of Health, Maryland Board of Pharmacy. (n.d.). Emergency Preparedness Task Force. (Accessed 7/20/2022).

This webpage provides an overview of Maryland’s Board of Pharmacy Emergency Preparedness Task Force and their missions. It includes a link to their more detailed emergency protocols and other useful information.

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* National Association of Boards of Pharmacy. (2006). Emergency and Disaster Preparedness and Response Planning: A Guide for Boards of Pharmacy.

This guidance document was developed for the Boards of Pharmacy to assist them with developing robust emergency and disaster plans that complement local efforts. It also includes several appendices, which contain guidance information and templates for issues such as emergency planning, maintaining operations, and communications.

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National Association of County and City Health Officials. (2014). Local Health Department and Pharmacy Partnerships for Enhancing Medication Dispensing During Emergencies: Statement of Policy.

This document offers eight recommendations for local health departments on collaborating with pharmacy partners for public health emergency preparedness and response. It discusses how strong relationships between local health departments and pharmacy partners can increase the safe, fast, effective, and equitable distribution of medical countermeasures during a public health emergency, and are crucial to effective public health emergency response.

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Pincock, L.L, Montello, M.J., Tarosky, M.J., et al. (2011). Pharmacist Readiness Roles for Emergency Preparedness. (Requires log in to Medscape). American Journal of Health-System Pharmacy. 68(7):620-623.

The authors describe the various roles pharmacists could have in disaster readiness and divide them into two categories: "clinical" and "other." Clinical roles would primarily be fulfilled by ambulatory care readiness pharmacists, pharmacotherapy readiness pharmacists, and critical care readiness pharmacists. The "other" category includes specialized clinical roles and nonclinical activities carried out by weapons of mass destruction/pandemic readiness pharmacists, pharmacy readiness logisticians, and pharmacist readiness managers.

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* Rx Response. (2015). Stability of Refrigerated Drugs.

This chart details the stability of the most commonly dispensed refrigerated drug products (based on the U.S. top 200 prescription medications in 2014), and over-the-counter insulin products. The chart includes proper storage data, allowable temperature excursions and the length of time such excursions are permitted, and contact information for product manufacturers.

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U.S. Food and Drug Administration. (2015). Contact Information for Questions about Clinical Investigations Affected by Natural Disasters.

During a disaster, studies may be disrupted, subjects and study staff dispersed, and records damaged or lost. This webpage provides information on where to direct questions related to clinical investigations affected by natural disasters.

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U.S. Food and Drug Administration. (2017). Information Regarding Insulin Storage and Switching Between Products in an Emergency.

Insulin from various manufacturers is often made available to patients in an emergency and may be different from a patient's usual insulin. After a disaster, patients in the affected area may not have access to refrigeration. This website provides information for patients and providers regarding those issues.

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U.S. Food and Drug Administration. (2018). Disposal of Contaminated Devices.

This resource provides tips on checking medical devices for contamination and disposing of contaminated products in order to help pharmacies return to business as soon as possible following flooding or loss of power.

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U.S. Food and Drug Administration. (2019). Safe Drug Use after a Natural Disaster.

The Center for Drug Evaluation and Research (CDER) at the U.S. Food and Drug Administration offers information on the use of drugs that have been potentially affected by fire, flooding or unsafe water, and the use of temperature-sensitive drug products when refrigeration is temporarily unavailable.

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Legal/Regulatory Resources

Florida Senate. (2012). 2012 Florida Statutes: 465.0275 – Emergency Prescription Refill.

This Florida statute, which may be referenced by other jurisdictions to develop a similar statute, states: “In the event a pharmacist receives a request for a prescription refill and the pharmacist is unable to readily obtain refill authorization from the prescriber, the pharmacist may dispense a one-time emergency refill of up to a 72-hour supply of the prescribed medication.” However, in areas or counties included in an emergency order or proclamation of a state of emergency declared by the Governor, the pharmacist may dispense up to a 30-day supply given certain circumstances as indicated in this statute.

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Healthcare Ready. (2018). Controlled Substances in Emergency Situations and the 2017 Protecting Patient Access to Emergency Medications Act (PPAEMA).

This four-page fact sheet provides information about controlled substances in emergencies and the 2017 Protecting Patient Access to Emergency Medications Act (PPAEMA). It discusses how PPAEMA applies to Emergency Medical Services (EMS) Agencies, and Pharmacists and Patients, including how a pharmacist may dispense controlled substances during emergencies upon receipt of “oral authorization from a prescribing individual practitioner.”

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National Alliance of State Pharmacy Associations. (2018). Pharmacist Statewide Protocols and Prescriptive Authority.

This webpage provides links to resources that can help emergency planners understand the mechanisms by which states authorize pharmacists’ prescriptive authority (i.e., collaborative prescribing and autonomous prescribing). It focuses on autonomous prescribing, which primarily consists of statewide protocols (“conditions under which pharmacists are authorized to prescribe a specified medication or category of medications when providing a clinical service”).

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New Jersey Board of Pharmacy. (n.d.). New Jersey Board of Pharmacy Guidance Regarding Emergency Prescription Dispensing for Puerto Rico Evacuees. (Accessed 7/20/2022).

This document may serve as a reference for other jurisdictions in the development of guidance for pharmacists asked to fill refills for disaster evacuees from other states.

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* Rutkow, L., Vernick, J.S., Wissow, L.S., et al. (2011). Prescribing Authority during Emergencies Challenges for Mental Health Care Providers. The Journal of Legal Medicine. 32(3): 249–260.

This article addresses the issues associated with the prescribing abilities of mental health providers after a disaster and the implications for acute and chronic management of behavioral health issues.

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Substance Abuse and Mental Health Services Administration. (2015). Federal Guidelines for Opioid Treatment Programs.

This document describes the federal regulations standards opioid treatment programs must adhere to (e.g., “have current valid accreditation status, SAMHSA certification, and Drug Enforcement Administration registration prior to administering or dispensing opioid drugs for the treatment of opioid addiction”).

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Substance Abuse and Mental Health Services Administration. (2022). Become a Buprenorphine Waivered Practitioner.

This process allows physicians and other medical professionals to dispense or prescribe medications that are traditionally administered in the context of an opioid treatment program.

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Substance Abuse and Mental Health Services Administration. (2022). Statutes, Regulations, and Guidelines.

This webpage includes links to statutes, regulations, and guidelines on medication-assisted treatment.

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Texas State Board of Pharmacy. (2017). Hurricane Harvey Emergency Dispensing of Prescription Medications.

This document describes the law, and rules/protocol that allowed pharmacists in Texas to dispense 30-day emergency supplies of medications (other than controlled substances) following Hurricane Harvey in 2017.

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U.S. Department of Justice, Drug Enforcement Administration. (2022). DEA Forms & Applications.

This webpage includes links to new and renewal applications and registration tools and resources for various pharmacies and providers (e.g., retail pharmacies, hospitals/clinics, practitioners, teaching institutions, and mid-level practitioners).

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U.S. Department of Justice, Drug Enforcement Administration. (2022). Title 21 United States Code (USC) Controlled Substances Act.

The Controlled Substances Act passed in 1970 directs DEA in the development of rules and regulations that must be followed when prescribing, dispensing, administering, transporting, and storing controlled substances.

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* U.S. Food and Drug Administration. (2014). Managing Drug Shortages.

This webpage provides links to a video and written transcript addressing the U.S. Food and Drug Administration (FDA) Safety and Innovation Act. The Act was passed by Congress in 2012, and provides new authorities for the FDA to manage drug shortages. In the video, FDA Drug Info Rounds pharmacists discuss the management of drug shortages and how the FDA’s role has changed in recent years.

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U.S. Food and Drug Administration. (2017). Reporting Prescription Drug Sample Losses, Known Thefts, and Possible Diversion in the Aftermath of a Natural Disaster.

This guidance describes how reporting of drug sample known thefts and possible/known diversion remain subject to the investigative, reporting, and timeframe requirements of federal regulations.

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U.S. Government Publishing Office. (2017). Protecting Patient Access to Emergency Medications Act of 2017.

Part of this Act allows emergency medical services agencies to receive DEA registration in order to administer controlled substances (II-IV) “outside the physical presence of a medical director or authorizing medical professional.”

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Virginia Law Library. (2019). Waiver of Requirements; Declared Disaster or State of Emergency.

While state-specific, this example of codified law shows how the state board of pharmacy may issue a waiver during declared emergencies waiving certain requirements of the Drug Control Act and the Board’s regulations governing the practice of pharmacy. The law also explicitly states that it does not authorize the “administering or dispensing of controlled substances by persons whose scope of practice does not include such authority.”

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Lessons Learned

American Society of Health-System Pharmacists. (2021). Summary of ASHP Virtual Roundtables on Business Recovery and COVID-19: Considerations for Pharmacy Leaders and Healthcare Executives. (Added 1/11/2021.)

This toolkit compiles ideas from a May 2020 virtual roundtable among pharmacy leaders. The discussion centered on business recovery issues related to the COVID-19 pandemic.

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ASPR TRACIE. (2019). The Pharmacy Response to Patient Surge.

ASPR TRACIE interviewed staff from two hospitals that recently managed significant patient surge as a result of mass casualty incidents. They share their experiences, how the incidents affected staff, and how they are incorporating lessons learned into preparedness efforts.

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Bonner, L. (2016). Pharmacy Staff Share Lessons Learned during Orlando Mass Casualty Event. Pharmacy Today. 22(8): 55.

This article highlights lessons learned by pharmacists and pharmacy technicians after the Pulse nightclub shooting. Links to related resources are provided throughout.

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Coppock, K. (2018). Preparing for Medication Safety, Accessibility During a Natural Disaster.

This article reviews steps pharmacists can take to support their patients during a natural disaster, as well as key elements of business continuity that should be considered. Lessons learned from Texas-based pharmacists during Hurricane Harvey are also discussed.

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Fuller Moore, A. and Kenworthy, L. (2017). Disaster Relief: A Look Into the Pharmacist's Role. North Carolina Medical Journal. 78(3):195-197.

The authors advocate for the inclusion of pharmacists into post-disaster patient care teams, noting that pharmacists can provide care without an appointment; have been shown to be able to successfully manage chronic disease patients in the community; and can use their knowledge of alternative therapies to help facilitate patient care in resource-limited settings. Some specific experiences of pharmacists in North Carolina after Hurricane Matthew are shared.

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Hogue, M.D., Hogue, H.B., Lander, R.D., et al. (2009). The Nontraditional Role of Pharmacists After Hurricane Katrina: Process Description and Lessons Learned. Public Health Reports. 124(2): 217–223.

The authors of this article discuss the how Jefferson County (AL) Department of Health worked with a local school of pharmacy to develop a novel pharmacy plan to address gaps in service for evacuees after Hurricane Katrina. This plan may serve as a model for other municipalities and/or states interested in preparing a pharmacy response to future natural disasters.

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Horn, R. and Kirsch, T. (2018). Disaster Response 2.0: Noncommunicable Disease Essential Needs Still Unmet. American Journal of Public Health. 108(Suppl 3): S202–S203.

The authors note the strides that have been made in providers’ ability to manage patients with chronic disease during and after disasters, and describe challenges experienced during the 2017 hurricanes in Texas, Florida, and Puerto Rico to illustrate the need for enhanced preparedness to meet “noncommunicable disease essential needs.” Recommendations for reducing demand among individuals with chronic disease (e.g., improved availability of health information sharing and personal preparedness), as well as increasing system capacity (e.g., better access to pharmaceuticals and durable medical goods, and more special needs shelters), are offered.

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Howe, E., Victor, D., and Price, E.G. (2008). Chief Complaints, Diagnoses, and Medications Prescribed Seven Weeks Post-Katrina In New Orleans. Prehospital and Disaster Medicine. 23(1):41–47.

The authors examined associations between patient characteristics, chief complaints, final diagnoses, and medications prescribed at a post-Katrina clinic to better inform strategic planning for post-disaster healthcare delivery (e.g., charitable donations of medications and medical supplies). Results of the study indicated donations of certain classes of medications were more useful than others.

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Jhung, M.A., Shehab, N., Rohr-Allegrini, C., et al. (2007). Chronic Disease and Disasters: Medication Demands of Hurricane Katrina Evacuees. American Journal of Preventive Medicine. 33(3):207-210.

The authors of this study assess the relationship between actual medication demands and medical relief pharmaceutical supplies in a population of 18,000 evacuees relocated to San Antonio, TX after Hurricane Katrina struck the Gulf Coast in August 2005.

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Khrais, R. (2012). For Some Sandy Survivors, Medicine's the Big Worry. NPR.

The author of this article (and webcast) discusses the medical issues that some Superstorm Sandy survivors experienced after the storm. The storm caused many pharmacies to close, kept home healthcare aides from getting to their patients, and flooded many of the clinics people rely on. The article also describes one doctor’s mission to get medicine to people who did not have access to their doctors or could not get out of their homes.

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Lavery, A., Patel, A., Boehmer, T., et al. (2018). Notes from the Field: Pharmacy Needs After a Natural Disaster — Puerto Rico, September–October 2017. Morbidity and Mortality Weekly Report. 67(13); 402–403.

The authors analyzed retail pharmacy data from June-August 2017 to project what medications would be needed in Puerto Rico following Hurricane Maria. They found that the top categories of drugs prescribed were for cardiovascular (average = 21% of prescriptions filled), psychiatric (12%), and analgesic (10%) drugs. They note that their analysis could be improved by the inclusion of drug sales data to hospitals, clinics, and nursing homes, as well as information provided by third-party claims adjudication data.

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Louissaint, N. (2019). The Advancing and Evolving Role of Pharmacy in Preparedness and Response.

The author explains how the role of pharmacies and pharmacists in preparing for and responding to disasters has evolved markedly since Hurricane Katrina.

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* Romolt, C., Melin, K., Hardie, K., et al. (2020). Community Pharmacy Operations in Puerto Rico During the 2017 Hurricane Season: A Descriptive Analysis of Rx Open Data. (Abstract only.) Disaster Medicine and Public Health Preparedness. DOI: 10.1017/dmp.2020.339.

The authors examine the "Return to Open Pharmacy Operations" in Puerto Rico after Hurricane Maria and compare it to pharmacy recovery in Florida after Hurricane Irma.

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Santye, L. (2017). Pharmacists in Texas Provide Calm Amidst the Storm of Hurricane Harvey. Specialty Pharmacy Times.

In this article, the CEO of a pharmacy with locations across Texas shares lessons learned from his organization’s experience during Hurricane Harvey. Key lessons learned include: contacting patients in advance of a storm and ensuring that they have sufficient supplies of medications to last more than just a few days; tracking down patients after a storm using social media; using courier services to send medications to patients who cannot get to the stores; and using a wholesaler with robust back-up power and monitoring capabilities to store temperature-controlled medications.

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See, S. (2013). Rediscovering Community—Reflections after Hurricane Sandy. Annals of Family Medicine. 11(6): 571–573.

The author of this essay describes how she, as a pharmacy faculty member in a family medicine residency, helped with relief efforts in Hoboken, NJ after Hurricane Sandy. She recounts her experiences with managing the medication needs of community residents in the hurricane’s aftermath and some of the challenges figuring out what medications seniors were taking.

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Sylvester, K., Rocchio, M., Belisle, C., et al. (2014). Pharmacy Response to the Boston Marathon Bombings at a Tertiary Academic Medical Center. (Abstract only.) The Annals of Pharmacotherapy. 19;48(8):1082-1085.

The authors (from a tertiary academic medical center) discuss the pharmaceutical response to the Boston Marathon bombing, which focused on staffing, supplies, and communication.

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Tomio, J., Sato, H., and Mizumura, H. (2010). Interruption of Medication among Outpatients with Chronic Conditions after a Flood. Prehospital and Disaster Medicine. 25(1):42-50.

In July 2006, a flash flood affected more than 3,000 households in southwest Japan. The authors conducted a study to describe the prevalence of the interruption of medication among the outpatients in the flood-affected area and to determine associated risk and preventive factors. They found that among the evacuated, the elderly and those receiving long-term care services were at high risk for interruption of medication. They also discovered that “preparing to go out with medication” had a preventive effect.

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Pharmacy Workplace Violence

ASPR TRACIE. (2020). Civil Unrest During a Pandemic-Notes from Minneapolis.

On Monday, May 25, in Minneapolis, George Floyd died after a police officer held his knee on Mr. Floyd’s neck for close to nine minutes. Cellphone video footage of the death spread quickly, and protests began in Minneapolis, other cities across the U.S., and abroad. ASPR TRACIE’s Senior Editor, Dr. John Hick, also serves as an Emergency Medicine Physician for Hennepin County Medical Center, located in downtown Minneapolis. We spoke with him and Seth Jones, Hennepin Healthcare system’s Emergency Preparedness Program Manager, to better understand how days of civil unrest affected emergency management, the emergency department, emergency medical services, and the community hospitals, and how this factored into the hospital’s COVID-19 response.

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ASPR TRACIE. (2021). Healthcare Preparation for and Response to Local Civil Unrest.

Recent incidents of civil unrest have affected critical infrastructure components (including healthcare facilities) in many cities across the U.S. Several have recently experienced incidents, some just once or twice, some for an extended period, and many during the COVID-19 pandemic. Civil unrest can affect traffic; patient and staff access to the emergency department and other healthcare services; emergency medical services safety and hospital access; and patient and staff safety around and inside the hospital. ASPR TRACIE met with representatives from several cities who shared lessons learned from these incidents and, in some cases, how these lessons have been incorporated into their plans.

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ASPR TRACIE. (2021). Issue 14: The Impact of Civil Unrest and Workplace Violence on Healthcare.

The articles in this issue focus on three categories: healthcare preparation for and response to local civil unrest; trends, policies, and protocols related to workplace violence; and strategies for preventing and responding to violence in the emergency department.

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ASPR TRACIE. (2024). On-Campus Health Care Facility Armed Assailant Planning Considerations.

Health care planners can use this checklist to help prepare their facilities to mitigate, respond to, and recover from an active shooter or armed assailant situation on campus.

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Griebe, K., Jiang, C., and MacDonald, N. (2023). Assessing the Pharmacy Workforce's Preparedness for a Workplace Violence Event. (Abstract only.) American Journal of Health-System Pharmacy.

This after-action report describes findings from an exercise involving an armed assailant in an inpatient pharmacy department. Staff reported an increase in the “run, hide, fight” tactic and other related components of workplace safety programs. These findings can help health care facility pharmacy and emergency management staff improve communication and collaboration before an incident.

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Northwest Healthcare Response Network. (2021). Civil Unrest Tip Sheet.

This tip sheet can serve as a template for hospital emergency planners to use when preparing for civil unrest events in the community. It includes considerations for pre-planning and for when events occur with proximity to a healthcare facility.

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Occupational Safety and Health Administration. (n.d.). Pharmacy: Workplace Violence. (Accessed 11/13/2023.)

This webpage lists risk factors associated with violence in pharmacies and strategies for prevention and response.

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PBA Health. (2022). Patient Aggression.

This article summarizes findings from the 2022 National Pharmacy Workplace Survey which indicate increases in threats and harassment (in-person and online) from patients, consumers, and colleagues. A rise in robberies due to increases in people with opioid addictions was also noted. The article includes a case study and de-escalation and other strategies for pharmacists to use in the event of a robbery.

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Srikanth Bhagavathula, A., Obamiro, K., Hussain, Z., and Tesfaye, W. (2022). Workplace Violence Against Pharmacists: A Systematic Review and Meta-analysis. Journal of the American Pharmacist. 63(1):23-31.

The authors reviewed literature through 2021 to estimate global rates of violence against pharmacists. Of the six studies (n=1896 pharmacists) they reviewed, the estimate of pharmacists experiencing violence was 45%. Rates were higher for pharmacists in the community setting; the authors emphasize the need for more research, particularly in the U.S.

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Plans, Tools, and Templates

ASPR TRACIE. (2022). ASPR TRACIE Technical Assistance Responses - Pharmacy/Drug-Related Requests.

ASPR TRACIE responds to a variety of technical assistance (TA) requests. This section of the ASPR TRACIE TA Responses page provides links to multiple responses specific to pharmacy-related requests.

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ASPR TRACIE. (2022). Disaster Available Supplies in Hospitals (DASH) Tool.

Disaster Available Supplies in Hospitals (DASH) is an interactive tool that can help hospital emergency planners and supply chain staff estimate supplies that may need to be immediately available during various mass casualty incidents and infectious disease emergencies based on hospital characteristics. Comprised of four modules (pharmacy, burn, trauma, and personal protective equipment), DASH recommends average par levels for specific supplies that acute care hospitals may need to have on hand to respond to a disaster in their community until resupplied. Recommendations are based on user inputs about the size of the hospital, risks in the community, regional role/designation of the hospital, and other factors.

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* Association of State and Territorial Health Officials. (2018). Memorandum of Understanding Toolkit for Collaborations Between Public Health and Pharmacies in Preparation for an Influenza Pandemic.

This document provides guidance and templates for state and territorial health agencies charged with creating memoranda of understanding with pharmacies in response to influenza pandemics and other public health emergencies.

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Association of State and Territorial Health Officials. (2022). Emergency Use Authorization Toolkit.

The toolkit provides government officials, preparedness directors, and legal counsel with emergency use authorization-related educational, training, and planning resources to help prepare for and respond to emergencies. It provides information on the federal law that allows special uses for drugs, biologics, and devices during specified emergencies. It also includes information related to the storage, dispensing, and use of medical countermeasures. The EUA Toolkit is one of six toolkits in ASTHO’s Legal Preparedness Series: https://www.astho.org/advocacy/state-health-policy/legal-preparedness-series/.

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Basavaraju, S.V., Hunt, R.C., Vikas, K., et al. (2010). In A Moment’s Notice: Surge Capacity for Terrorist Bombings: Challenges and Proposed Solutions. Centers for Disease Control and Prevention.

The authors synthesized comments from a series of expert panel meetings on identifying innovative strategies hospitals could adopt to address terrorism-related surge issues. Surge Action Template 9 (Drugs and Pharmaceutical Supplies) addresses required resources and action steps to mobilize within 4 hours of an explosion “appropriate and adequate drugs and pharmaceutical supplies to treat 300 injured patients for up to 72 hours.”

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Centers for Disease Control and Prevention. (2021). Prescription Drug Monitoring Programs (PDMPs).

Prescription Drug Monitoring Programs (PDMPs) offer a potential resource for prescribers and pharmacists to view patients’ controlled substance prescription dispensing histories in near-real time, post-disaster. The PDMP is a statewide electronic database – updated in real time – that collects and stores data on controlled substances dispensed within the state and allows certified providers to view the electronic prescriptions of controlled substances in their state.

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Florida Pharmacy Association. (2022). Disaster Plan for Pharmacies.

This page contains a checklist for pharmacy staff in the State of Florida to use when preparing for disasters. It includes topics specific to communications, facility security, and controlled substances.

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Healthcare Ready. (2017). Pharmacy and Emergency Preparedness: A Landscape Analysis.

This issue highlights new/existing challenges pharmacy stakeholders face during emergencies; shares a "high-level landscape" of collaborations and resources that have been created to safeguard access to medications and medical supplies during emergencies; and features practices that can increase healthcare resilience. Links to helpful toolkits and templates are provided throughout the document.

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Healthcare Ready (formerly Rx Response). (2013). Rx On the Run.

This online tool can be used by the general public and enables users to print a personalized medication wallet card that documents prescriptions, dosages, and other important medical information. These cards can help people access their medical records or refill prescriptions after a disaster or public health emergency.

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Healthcare Ready (formerly Rx Response). (2019). Rx Open.

This website helps emergency management teams and the general public locate operating pharmacies in areas affected by natural disasters or public health emergencies. The tool provides maps to identify the location of open and closed pharmacies using Google Maps. The website is free to the public when activated at the request of state or federal officials.

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* National Association of Boards of Pharmacy. (2006). Emergency and Disaster Preparedness and Response Planning: A Guide for Boards of Pharmacy.

This guidance document was developed for the Boards of Pharmacy to assist them with developing robust emergency and disaster plans that complement local efforts. It also includes several appendices, which contain guidance information and templates for issues such as emergency planning, maintaining operations, and communications.

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National Association of Boards of Pharmacy. (2022). Boards of Pharmacy.

This webpage includes links to state boards of pharmacy. These boards may issue waivers that are activated after an emergency declaration has been made. These may include blanket waivers allowing pharmacists to refill a prescription without the original prescription, assuming the pharmacist exercises reasonable judgment. These waivers do not override federal regulations, including those of the DEA.

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Oregon Health Authority. (n.d.). Pharmacy and Local Public Health Authority MOU. (Accessed 7/20/2022.)

This webpage includes links to an outreach toolkit, operational guidance, and Memorandum of Understanding (MOU) template for use by local public health departments to enter into agreements with pharmacies under a “framework for timely, effective pharmacy response to public health incidents.”

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* Parenteral Drug Association. (2014). Drug Shortages.

This webpage includes links to a technical report issued in 2014, “Risk-Based Approach for Prevention and Management of Drug Shortages.” Included with the report is a template for a Drug Shortage Prevention and Response Plan.

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Pennsylvania Department of Health. (n.d.). Memorandum of Agreement (MOA) Between Pennsylvania Department of Health and Pharmacies. (Accessed 9/13/2024.)

This Memorandum of Agreement (MOA) was created for the Pennsylvania Department of Health to enter into agreements with pharmacies to coordinate influenza vaccine distribution during a public health emergency. It may be used as a reference for other jurisdictions wishing to create similar MOAs.

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* Rx Response. (2015). Stability of Refrigerated Drugs.

This chart details the stability of the most commonly dispensed refrigerated drug products (based on the U.S. top 200 prescription medications in 2014), and over-the-counter insulin products. The chart includes proper storage data, allowable temperature excursions and the length of time such excursions are permitted, and contact information for product manufacturers.

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Stratton, S. (2016). Access to Essential Medications During Disaster Events. Pre-hospital and Disaster Medicine. 31(6): 579-580.

The author of this editorial discusses the importance of assuring access to essential medications for chronic disease management during disasters. Included in the commentary is a table showing potential disaster-related medication access problems, showing risks of medication withdrawal by condition.

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U.S. Department of Justice, Drug Enforcement Administration. (n.d.). Emergency Assistance with a Domestic (or International) Disaster. (Accessed 2/23/2024.)

This webpage includes contact information for requesting DEA assistance in the aftermath of a disaster and links to state board assistance information for recent events.

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Vest, T.A., and DeAngelis, J.T. (2020). Steps to Ensure Emergency Preparedness. Pharmacy Purchasing & Products. Vol.17 No. 11 - Page 16.

This webpage provides considerations for pharmacists to plan for with regards to anticipated and unanticipated emergencies. Topics include staff, supplies, and recovery planning. It also includes case examples that address how pharmacists have played a role during various disasters.

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Yale New Haven Health System, Center for Emergency Preparedness and Disaster Response. (n.d.). Pre-Storm Checklist. (Accessed 7/20/2022.)

This checklist provides hospital emergency planners with guidance on preparing to withstand the effects of a storm. Actions to be taken 72 hours, 48 hours, and 24 hours prior to the storm is included for the following departments: Administrative, Clinical Laboratory, Clinical Services, Facilities, Food and Nutrition, IT/MIS, Pharmacy, Materials Management, Respiratory Care, and Safety and Security.

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Agencies and Organizations

American Hospital Association. Drug Shortages.

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American Pharmacists Association. Home Page.

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American Society of Health-System Pharmacists. Emergency Preparedness: Emergency and Disaster Resources.

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Centers for Medicare and Medicaid Services. E-Prescribing.

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Healthcare Ready (formerly Rx Response). Healthcare Ready (formerly Rx Response) (Home Page).

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National Alliance of State Pharmacy Associations. Collaborative Practice Agreements: Resources and More.

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National Association of Boards of Pharmacy. Boards of Pharmacy.

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The New York City Department of Health and Mental Hygiene. Healthcare Providers: Pharmacy.

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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. The Emergency Prescription Assistance Program.

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U.S. Food and Drug Administration. Current and Resolved Drug Shortages and Discontinuations Reported to FDA.

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This ASPR TRACIE Topic Collection was refreshed in September 2022. It was comprehensively reviewed in March 2019 by the following subject matter experts (listed in alphabetical order): John Hick, MD, HHS ASPR and Hennepin County Medical Center; CAPT Valerie Jensen, R.Ph., Associate Director, CDER Drug Shortage Staff, FDA; Nicolette Louissant, Ph.D., President, Healthcare Ready; and Mary Russell, EdD, MSN Healthcare Emergency Response Coalition, Palm Beach County Florida.

It was comprehensively reviewed in September 2015 by the following subject matter experts (listed in alphabetical order): Pamela Allweiss, MD, MPH, Medical Officer, CDC; Michael Bourg, Pharm.D., HHS ASPR; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Erin Mullen, RPh, PhD, CEM, Senior Consultant, Healthcare Ready (formerly Rx Response); and Mary Russell, EdD, MSN, Emergency Services, Boca Raton Regional Hospital.

Additional assistance provided by James G. Hodge, Jr., JD, LLM, Professor of Public Health Law and Ethics, Director, Public Health Law and Policy Program, Director, Western Region Office, Network for Public Health Law, Sandra Day O'Connor College of Law, Arizona State University.

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Featured Resources

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