Communication between Pharmacists and Victims in a Disaster · Communication between Pharmacists...

Communication between Pharmacists and Victims in a Disaster

Mari HARADA

Department of Pharmacy, Japanese Red Cross Society Musashino Hospital

Vice-chair Disaster Relief Committee of Japanese Red Cross Pharmacist Association

Fundamental Principles

Humanity Impartiality Neutrality

Independence Voluntary Service

Unity Universality

ICRC

IFRC National Societies

International Red Cross & Red Crescent Movements

4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada

Japanese Red Cross Society


92 Red Cross Hospitals

JRCS Musashino Hospital Founded : Nov. 19. 1949 Location : Musashino city, Tokyo Medical district population : 947,000

• Beds : 611

(General 546, ICU 8, HCU 22, CCU 6, SCU 9, Infection 20)

• Clinical division : 24

223 Doctors, 736 Nurses, 35 Pharmacists

(Total 1,431 Staff)


talk about・・・

Lessons learned from relief activities in the Great East Japan Earthquake and Tsunami


Japan Earthquake & Tsunami 2011 Background:

• March 11. 2011 14:46

• Epicenter

latitude 38.0 N

longitude 142.9 E

• Depth 24km

• Magnitude 9.0

Features of the disaster：

triple incident disaster (Earthquake, Tsunami, Nuclear accident )

Large scale disaster


Situation in the disaster site


Number of death：15,883 people

Number of missing：2,656 people

Number of injured：6,145 people （June 9, 2013 National Police Agency of Japan）

Cause of deaths: 92.5% Drowning

65.2% of fatalities: over the age of 60


Situation Life Line × Weather Condition：cold, snowy, windy Evacuation Centers：more than 300 places Medical Facility： Ishinomaki Red Cross Hospital ○ Local pharmacy× Wholesaler × (for three days)

Situation of the disaster site

Cooperate with hospital pharmacy and community pharmacy

To cover the shortage of medicine


Situation at a hospital in the disaster site


Mission of medical relief team:

Set up aid station to treat triage green patients

protect hospital capacity ↓

save many lives

Aid station in front of the hospital

Lots of patients who need

regularly taking medication

A long cue for entering hospital

to get medicines 4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada

Living condition of affected people

Place to live: evacuation center

Lifeline: × Food : △ Water: △

Toilet, Sanitation:× Space & privacy: ×

At a school gymnasium

Lack of nutrition, Hypoglycemia

Dehydration, constipation Skin problem, Asthma,

Allergy Infection diseases, Stress, Insomnia,

Deep-vein thrombosis etc.


Vulnerable people in a disaster

• Babies and Children

• Pregnant and parturient women

• Elderly people

• Physical and/or mental disability

• People with chronic diseases

Diabetic Asthma epilepsy schizophrenia Cardiac disease Cancer Dialysis patient etc.


Difference between disaster and non-disaster phase

Medical Resource

Needs &

Patients

Medical Resource

Needs &

Patients

Best treatment for each Best treatment for many

Non-disaster phase Disaster phase


Difference between disaster and non-disaster phase

Non-disaster phase Disaster phase

Medicine ― Disaster relief medicine kit

Choice of medicine ○ limited

Days of prescription ○ Limited (depend on situation)

Chronic diseases medicine ○ △

Pediatric medicine ○ △

Patients request ○ △

Doctor examine Specific disease Variety of disease


Medical aid Station at evacuation center Temporary Medical Clinic

(24hours open)

2 medical relief teams(2 Pharmacists) & local medical staff

Junior high school （evacuees1,000）


Flow of the treatment at medical aid station


①Reception ②Waiting space

③Examination space ④Pharmacy

Make patient’s medical chart

Interview by nurse Vital check

Examination by doctor Treatment

Prescribe medicine

Dispensing by pharmacist Explain to patient


Roles of Pharmacist in a Disaster

• Management of medicines

• Dispensing medicines

• Assistance for prescribing medicines

• Provide medication information to Patients

• Advice on public health sanitation

• Cooperate with medical coordinator

• Collaborate with local stakeholders


22%

17%

5% 7%

3% 1% 3%

42%

The breakdown of consultation

呼吸器疾患消化器疾患精神疾患外傷皮膚疾患婦人科系その他常備薬希望

Data of medical aid station • Numbers of Patients： Ave. 230/day • Numbers of referrals: Ave. 5/day • who lost their regular medications：About 40%

Understanding medical needs ⇓

Activities according to the needs

Respiratory disease

Gastrointestinal disease

Psychiatric disease

External injury

Dermatological disease

Obstetrics

Others

lost their regular medications 4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada

Acute Phase(4-8days）

Sub acute Phase(12-15days)

Chronic Phase(28days-)

5

20

15

10

25

30

No

of

pre

scri

bed

(%

)

Changing Medicine needs and phase

（The Great East Japan Earthquake, JRCS Musashino hospital）

Chronic medicine As the time passed many health care facilities recover

Medicine for cold People live closely together in a small space

Anti-allergic Getting close to recovery phase, there is lots of dust.

Understanding medicine needs

Collect information about medicines ⇒ Analysis ⇒ Sharing information


0

10.000

20.000

30.000

40.000

50.000

60.000

70.000

80.000

90.000

100.000

No

of

med

icin

e

支援医薬品（3/12～4/3）救護班提供医薬品（3/12～6/30）

３８５,９９９１２２,４４４

Medicine used at medical relief teams donated Medicine

（Data from the Great East Japan Earthquake, Ishinomaki Red Cross Hospital）

Gap of donated medicine and medicine needs

Name of medicine category


Problems of medicine donation

Donated medicine which we cannot use

Enough to waste a

truck（4.5ｔ） of medicine

Gap between medicine needs information and donated medicine

Misunderstanding of medicine donation

Expired/short expiry medicine Medicine from overseas

(written with different languages) Problems with quality

Medicine not in hospital formulary Health insurance issues


Communication between teams Left over medicine

by medical relief teams

Internal med 119 External med 76 Injectable 68 Disinfectant 17

3 months activity several teams working together

Management of medicine by each teams ⇓

Management of medicine by unit of an medical aid station System of sharing information of medicine

Left over＝No needs Take it back with team


Point of medicine management

Medicine management from early stage

Sharing information

Unify Medicine management


Communication with doctors • Provide list of medicines

• Support prescribing medicine

• Days of prescription

• Set of medicines

• Rule of pediatric medicine


Advantage of Pharmacist Wide range of knowledge of medicine

Generalist &

Professional

Check point for prescription in a disaster

• Check

Medication history

Past history, Allergy, Side-effect

• Determination

- Necessary for continuation of medicine

- Temporary discontinuation of medicine

possible or necessary

Affected people’ living condition Limited stock and choice of medicine


Communication with patients • Understanding the situation of the disaster site • Understanding the change of affected people’ living condition • Consider the affected people’ emotional changes

Negative words× vague×

Advice on which possible for patients ○

Tell patients to go to health facilities when it is reopened.

Do not exaggerate anxiety Explain about medication

and give written information


Provide information to patients Sharing information between teams

× Fragmentary medical services ×

×telling patients different things by different teams ×tell each teams, same things every time is stressful

○ Consecutive medical services ○

○use medical chart, prescription, medication history book, bag of medicine to give written information to patients ○share information between teams 4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada

Communication tool with patients


• Medication History Book

Allergy Past history

Side effect Personal data

Medication information

Communication with local

Coordination meeting （medical staff meeting）

Local medical association Local pharmacy association Local public health nurse Medical relief teams etc.

Sharing information Situation changing

Medical needs changing Direction of activity

Locality based activities


Situation of the disaster site

lifeline ○ logistics ○ medical supply ○ Health care facilities: hospital △ pharmacy ○

Medical services gradually back to local

providers

Collaborate with local pharmacy association

Doctor of relief team prescribed ⇓

Dispensing medicine at local pharmacy by local pharmacist ⇓

Deliver medicine to patients living in evacuation center

check prescription by pharmacist of

relief team


Mobile Clinic To visit people who cannot come to

hospital or medical aid station

●evacuation center School, store, temple etc.

●where people gather Airport, train station etc.

●where people live House, elderly home etc.


Collaborate with local hospital Lots of people required chronic disease medicine

⇓ Difficult to respond to the requests

with limited stock and choice of medicine

Local hospital became an medicine supply center Consolidate information of medicine from teams


Collaborate with hospital pharmacists and community pharmacists

Visit evacuation center Interview patients about medication

Dispensing

Deliver medication to patients

Prescription

Mobile pharmacy


Exchange ticket Special prescription for disaster

Collaborate with local pharmacist and volunteer pharmacist

Working together

with medical relief team

Everything for

Affected people


Community Pharmacy BCP(Business Continuity Plan)

Medical Association

Pharmacy Pharmacy Pharmacy

Aid Station

Government

Hospital

Pharmacy Association


Medicine

Conclusion

Pharmacists’ Capabilities

Pharmacists Point of View

Collaborate & Cooperate

Everything for affected people 4 September 2013 fip 2013 JRCS Musashino Hospital Mari Harada

Thank you


Communication between Pharmacists and Victims in a Disaster · Communication between Pharmacists...

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