Introduction

In September 2017 Hurricane Maria made landfall in Puerto Rico. The Category 4 hurricane destroyed the power grid, communication networks, and caused significant flooding that left 3.4 million residents in the dark, unable to communicate, and with a contaminated water supply.

The evolving humanitarian crisis required a large-scale coordinated response and involved government and non-government humanitarian organizations. On arrival, aid workers were confronted with a large, heterogeneous population needing assistance with both acute and chronic medical issues.

Variables in the Disaster Response

A number of factors need to be considered when implementing an anesthetic pharmacy in an austere environment. They can be summarized as follows:

1. 
   

   1. Location – weather extremes, travel time, departure time

   
   
2. 
   

   2. Organization and regulation – procuring, transporting, and storing scheduled drugs

   
   
3. 
   

   3. Population – likelihood of pediatric, obstetric patients, endemic disease

   
   
4. 
   

   4. Duration – expected time on site, resupply likelihood, and supply chain method.

Considerations for an Anesthetic Pharmacy

The components of an ideal anesthetic pharmacy would be as follows:

1. 
   

   1. Adequate inventory of anesthetic drugs and ancillary medications (fluids, antibiotics, vaccines, etc.)

   
   
2. 
   

   2. Obtaining a reliable source for procuring and storing medications

   
   
3. 
   

   3. Mechanisms to ensure safe and secure handling of medications.

The austere environment that results from a natural or a man-made disaster presents a number of challenges to this ideal.

The most obvious challenge is a disruption to the supply chain. For example, in the aftermath of Hurricane Maria only 29% of local pharmacies were open.¹ Resupply was initially via an “air-bridge” of shuttle flights from the US mainland co-ordinated by FEMA.² The problem of supply disruption is twofold: first, there will be reduced ability to procure drugs from local resources that will be required for acute care, and second, the local population will likely be seeking ongoing treatment for management of pre-existing medical conditions. Often, first-responders and aid organizations are ill-equipped to manage chronic medical conditions.³ When arriving on site, it is vital to make contact with local hospitals, pharmacies, and wholesalers that can be used to resupply medications. When making an inventory, ordering or dispensing drugs, the generic or international non-proprietary name of the drug should be used. This allows for more consistent communication between arriving aid teams and local assets.

The absence or interruption of electricity will impact the ability to maintain a constant environment for the storage of drugs. Even with backup generators, the electricity supply cannot be guaranteed. This can be mitigated by selecting drugs that are less prone to degradation in variable temperatures; however, drugs such as insulin, vaccines, and blood products may require a cold chain with temperature data logging and reliable documentation. Small battery-powered monitors with RFID technology are simple to use, easy to transport and can be synced with electronic databases.⁴ The World Health Organization (WHO) recommends the use of water-containing ice-packs and filling the refrigerator or cool box with excess water bottles if space permits to give a buffer should power fail. The use of a top-loading refrigerator keeps the cool air in. Less sensitive drugs should be stored in a cool, dark, well-ventilated area.⁵

To minimize the risk of contamination, there should be as minimal handover of medications as possible. However, this needs to be balanced against the risk of the drug becoming unstable and therefore unusable. Where possible pre-drawn syringes should be sought. These are mixed in sterile conditions, are well labeled and are typically a standard concentration of drug.

In the immediate aftermath of a disaster there will likely be a degraded security situation. Often, there are several agencies working together who may have access to common areas. This can present problems with the secure storage of scheduled drugs. In hospitals, electronic dispensaries (e.g. CareFusion Pyxis) may not be functional or may be inaccessible to temporary staff. Portable safes are not always practical, given their weight. A secure area should be located and access controlled.⁵ Drugs can be stored in sealed plastic containers such as fishing tackle boxes that can be sealed with labeled, tamper-proof, pull-tie closing devices (Figure 23.1).⁶ When staff are required to be mobile, the drugs can be transported and kept on the person inside a fanny pack/bum bag (Figure 23.2).

Figure 23.1 Secure pull-tie sealing device and improvised drug storage box.

Figure 23.2 Personal bag containing pre-drawn drugs.

Specific Anesthetic Pharmaceuticals

The WHO provides a comprehensive list of medications to guide first-responder teams.⁷ It provides a detailed list of oral and injectable drugs, as well as non-medication supplies and equipment. In addition to the above list the following anesthesia-specific drugs are recommended.

Related posts:

Chapter 5 – Inhaled Anesthetics and Draw-Over Devices in Disaster Response Chapter 4 – Total Intravenous Anesthesia in Disaster Medicine Chapter 14 – Considerations When Working with Children and Families Chapter 15 – Chemical and Radiologic Exposures in Trauma and Disasters Chapter 12 – High-Altitude Physiology and Anesthesia Chapter 21 – Operation Tomodachi: Anesthetic Implications

Stay updated, free articles. Join our Telegram channel

Join