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leasons leared after 9/11
Hospitals in New York City and Washington, D.C., faced quite a test in the aftermath of the Sept. 11 assaults. St. Vincent's Hospital and New York Presbyterian Hospital in Manhattan handled most of the trauma and burn patients following the World Trade Center attacks, and pharmacists played an integral role.
At the December ASHP Midyear Clinical Meeting in New Orleans, Curtis Kellner, director of pharmacy at St. Vincent's, and Karol Wollenburg, v.p. and apothecary-in-chief at New York Presbyterian, shared their collective experience about the successes and failures of the system on that tragic day.
One message that came across from both pharmacy managers was that a hospital can never plan sufficiently for a catastrophic event. St. Vincent's, for instance, had conducted numerous disaster drills prior to Sept. 11, but it didn't really prepare the staff for this worst-case scenario. "We based our drills on a single subway mishap, for example," he said.
The WTC incident also underscored the need to include personnel from all shifts in disaster drills. Wollenburg commented that in the future, drills would include personnel from the pharmacy night shift.
"Although the pharmacy staff and the hospital staff in general handled things quite well on Sept. 11, I worry about the disaster skills of the staff on the night shift," Wollenburg said. Although there was plenty of pharmacy staff on hand when the attack occurred, the pharmacy had to consider, for instance, whether new staff would make it to work to refresh those there from the beginning. The problem on Sept. 11 was that nobody wanted to go home. "Everybody wanted to stay," she said.
Tragically, there were more fatalities than wounded victims in New York, but city hospitals were equipped and prepared to handle thousands of injured citizens if necessary. Most hospitals canceled elective surgeries and sent home anyone who could go home in order to free up beds. "We had hundreds of beds in New York City," noted Wollenburg.
The just-in-time drug inventory system also fared relatively well on Sept. 11, even though deliveries from wholesalers were hampered slightly when access to New York City was cut off due to security measures. New York Presbyterian had no problems with its drug supply. The hospital had an emergency supply of drugs on hand for disaster situations.
"We don't really operate a just-in-time system with some emergency supplies," said Wollenburg. However, one thing that will change in the wake of Sept. 11 is that the pharmacy will now require its drug wholesaler to maintain a list of emergency supplies that would be needed if a similar catastrophe were to occur. This would be valuable, she noted, especially if communication between the hospital and the wholesaler became a problem. "If we couldn't communicate with the wholesaler, those supplies would automatically be sent to the hospital," she said.
At St. Vincent's, located only a mile from Ground Zero, borrowing drugs from other hospitals and city agencies became a necessity. According to Kellner, St. Vincent's is reexamining its inventory-control practices. "What worked great for us was a nontraditional means of getting medications," he said. The goal now is to formalize the means of getting medications to the hospital in a crisis. That would include updating a list of appropriate contacts, he said.
Pharmacists in New York City hospitals helped out in a variety of ways on Sept. 11. In the first hours after the attack on the WTC, pharmacists at Presbyterian were called upon to remove medication from automated dispensing cabinets. Nurses who usually do that were busy tending to ER patients and didn't have the time to remove narcotics through the normal channels. Pharmacists also kept paper logs of all controlled substances dispensed to patients from substations created during the disaster. Dosing charts of agents commonly used in disasters were available in the ER. "In an emergency, you want to have information readily available in one place," said Wollenburg.
Other problems the hospitals had to face, according to Kellner and Wollenburg, included distracted staffers concerned about the well-being of their own families and friends, employees who could not get in to work, and the needs of patients who could not be discharged.
Tony Vecchione. Pharmacists relay lessons learned from Sept. 11.