A few years ago, I attended the Australian and New Zealand Disaster and Emergency Management conference. In networking with some of the other delegates, the common questions ‘what do you do?’ and ‘what brought you to the conference?’ came up. As I began explaining my research on exploring pharmacists and their roles and responsibilities in disasters, I received confused looks and the inevitable response ‘but do pharmacists really have a place in disasters?’
The short answer to this question is ‘yes, they do’. Pharmacists have always been assisting their communities during disaster and emergency events. However, their responses are often ad hoc in nature and depend on the individual pharmacist and the needs of the community. To date, pharmacists have not been included in the coordinated disaster health management preparedness planning or response and are left to devise their own disaster plans and responses. This poses the question: ‘Do pharmacists have a role in disasters and if so, what would that role be?’
A mixed-methods multi-phase study was undertaken by the author (Dr Kaitlyn Watson) as a doctoral thesis to determine where pharmacists fit within the disaster management cycle – prevention/mitigation, preparedness, response and recovery (PPRR) – and obtain consensus on what pharmacists’ roles should be during a disaster or emergency. An international and all-hazard approach was taken as there was little-to-no research available on this topic either for pharmacists working abroad on humanitarian missions or responding to disasters within their community. This multi-phased, mixed-methods study incorporated both quantitative and qualitative methods and included an international legislation review, surveys, interviews and a Delphi Study. International disaster health experts and key opinion leaders from a range of backgrounds (e.g. non-government organisations, government, pharmacy, military, public health, emergency services and disaster management) participated in this study to provide multiple perspectives on pharmacists’ roles in disasters. The Delphi Study identified and obtained consensus that pharmacists do have a place in disasters and that they have 43 key roles across the entire PPRR cycle.
This research study went an additional step and identified the four practice areas where these disaster pharmacists’ roles belong: logistics, patient care, governance and public health. Currently, due to the fragmented nature of disaster health management, pharmacists are typically pigeon-holed into the practice area of ‘logistics’. While pharmacists’ roles in logistics and supply-chain management are important and vital to the disaster response, they are by no means the only roles which pharmacists are capable of undertaking during a disaster. Pharmacists work across these four practice areas daily using their unique skillset as part of the multidisciplinary team. However, when a disaster or emergency strikes, this interprofessional nature of healthcare is forgotten and pharmacists are shunted into only managing the logistics of medicines. This undervalues the contributions pharmacists could bring to the formal disaster health response, prevents pharmacists from working to their full scope of practice, results in pharmacists responding on an ad-hoc basis, and ultimately the patients are denied the most accessible healthcare resource when they are at their most vulnerable.
Pharmacists are the third largest and the most accessible healthcare profession, being more accessible than supermarkets, banks or medical centres in Australia. By formally including them in disaster health management, the overall healthcare resources available in an emergency and the resilience of the healthcare system would be significantly increased. Therefore, it is proposed by this research that pharmacists should be accepted and acknowledged for their unique contributions to disaster health management and be equipped to transcend beyond the accepted logistics practice area. Figure 1 highlights these four practice areas and outlines the barriers and enablers identified for pharmacists in disasters found in this research study.
Logistics practice area
It is highlighted in this research that pharmacists excel at this role in managing logistics as they speak the different languages – they are able to speak logistics to those in the supply management field and clinical to those in the medical field. Pharmacists have historically been included in disaster management when the need for medicines is identified during the response phase and their contributions are often forgotten once the disaster or emergency has resolved. Consequently, pharmacists are not formally incorporated into the disaster health plans when preparing for potential disasters or emergencies and the cycle repeats.
Patient care practice area
Evidence has shown that patient outcomes are improved when pharmacists are incorporated into multidisciplinary teams involved in direct patient care. This is even more pronounced in emergencies and disasters as was highlighted in Australia by the Victorian Inspector-General for Emergency Management governmental review into the 2016 Thunderstorm Asthma event. The report suggested that without pharmacists responding, the mortality rate would have been worse.
Public health practice area
Pharmacists are on the frontline of healthcare in the community, providing essential services to their patients and the public. There is an expectation from the community that pharmacies will remain open and accessible during disasters and emergencies and that pharmacists will be a reliable and up-to-date information source for them during an emergency. Pharmacists are a pillar of public health in the community, providing care to the community on matters of public health (e.g. vaccinations, harm minimisation, patient safety, education, etc.). Due to their locality and accessibility in the community, pharmacists are ideally placed to provide mass vaccinations in disasters or emergencies to prevent and/or to treat the public. Pharmacists have been acknowledged in some jurisdictions as a key vaccinator in the current global COVID-19 pandemic when a vaccine becomes available.
Governance
Government and health departments often think of tertiary and ambulatory care when referring to disaster health management and often overlook the other aspects of the healthcare system or the professions that provide them. This lens has become too narrowly focused and outdated, missing the key contributions and locality of primary care (e.g. pharmacists, general practitioners (GPs), etc.). During disasters and emergencies, it is important that healthcare is kept in the community as much as possible – to free up the tertiary and ambulatory care for disaster-specific and acute care needs. Pharmacists are ideally positioned in the community to provide healthcare during disasters, they are highly accessible primary care providers and are sought after by patients and community members during a disaster for reassurance, supplies, information and care. Thus, pharmacists and pharmacy organisations need to advocate to government and health departments for better integration of primary care and their providers (e.g., pharmacists, GPs, etc.) into disaster health management.
Barriers and enablers
One of the often-misleading barriers to pharmacists’ roles in disasters is the suggested ‘turf encroachment’. It is repeatedly believed that to better include pharmacists in disasters you are taking away something from someone else. However, this is not the case. Pharmacists are an untapped and undervalued resource in disasters. Better integration of pharmacists in disaster health management increases the resilience of the healthcare system and increases the overall resources, capacity and capability of the healthcare system to effectively respond to a disaster. To address this barrier, greater awareness is needed of the undeniable value, roles and place pharmacists have in disaster health management teams. Pharmacists provide a unique perspective based on their roots in the community and their intimate knowledge of medicines. Their value in disasters and emergencies should not be underestimated.
Another barrier to pharmacists’ inclusion in disasters is the perception that they are not trained for disasters. However, the research identifies that pharmacists are often excluded in disaster preparedness meetings and from interprofessional multidisciplinary team disaster training and drills. Thus, this barrier is short-sighted, as pharmacists are already involved in responding to disasters as the community expects them to be, but they are not given the opportunities, resources or training for them to be better prepared. Pharmacists should be provided with access to disaster preparedness activities and training within the pharmacy curriculum and in their continuing professional development. A suggestion was made by participants in this research of including pharmacists in mass gathering events. Routine practice at large sporting events or festivals could hone pharmacists’ knowledge and skills in emergency medicine and simulate their roles in disasters. This would also provide a platform in which to showcase the value, knowledge and skills pharmacists have to offer in emergencies.
Conclusion
Pharmacists have traditionally been viewed as either an unnecessary resource or as a support service for health responses to disasters and emergencies. However, this mixed-methods, multi-phase international study has provided the evidence that this perception of pharmacy and disasters is distorted, outdated and undervalues the contributions pharmacists are making to disaster health response and recovery. Pharmacists are an untapped resource in disaster health management that if better integrated could significantly increase the available healthcare resources in a disaster and contribute to the healthcare system resilience.
As a disaster community, we need to wider our lens of disaster health and look beyond the obvious tertiary and ambulatory care to see the valuable contributions primary care has in mitigating, preparing, responding and recovering from disasters and emergencies.
Please refer to the doctoral thesis for references.
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