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Drugs in the desert

  • Published
  • By Capt. Kellie Zentz
  • 332nd Expeditionary Medical Support Squadron
A pharmacist’s role is recognized as dispensing medications, counseling patients and maintaining a collaborative practice with providers. Over the past decade, pharmacists have steadily made advances to increase their presence in the medical field.


Studies show a correlation between insufficient pharmacist manning and substantial direct and indirect costs to an organization and its customers. These potential costs include failure to meet legal and regulatory requirements, increased medical errors and reduced patient safety.


Research also shows pharmacists reduce medication errors and their associated costs. Specifically, the landmark Institute of Medicine report, “To Err is Human: Building a Safer Health System,” cited the importance of pharmacists in reducing medication errors and recommended increased involvement of pharmacists in the pharmacy and patient care units.


In 2014, the Society of Air Force Pharmacy reported that at any given time seven out of 459 pharmacists and 12 out of 1219 pharmacy technicians employed by the United States Air Force were working in a deployed environment. While this seems to be a small percentage of the number of pharmacists and pharmacy technicians employed, each pharmacist and technician must be prepared for deployment settings.

In most circumstances these deployed environments are found to be positioned at sustained locations. However, pharmacy personnel are trained for the instance of an Expeditionary Medical Support (EMEDS) clinic, which is a rapidly deployable medical facility.  

Air Force pharmacists and technicians complete regular training on how to operate in an EMEDS environment. The mission of an EMEDS package is to have the capability to quickly deploy and provide forward stabilization medical care to war fighters and civilians when authorized. There are three EMEDS packages, the EMEDS basic package, EMEDS +10 and EMEDS +25.


The EMEDS Basic package provides acute intervention and primary care services to support a population at risk of 1,500 to 3,000 deployed personnel. EMEDS Basic also provides capabilities for medical command and control, preventive medicine and trauma resuscitation and stabilization. The Basic package has the ability to increase services to the other two packages by adding limited general and orthopedic surgery, critical care, primary care, aeromedical evacuation coordination, urgent care and dental capabilities.


As a pharmacist currently deployed with an EMEDS Basic package, I am able to speak to the benefits and challenges of being deployed in such a unique state. The obvious benefit is the opportunity to serve our Service members on the front line. Air Force pharmacists support a mission larger than ourselves every day by taking care of Airmen and their families. .


We have the resources to deliver the best care possible to our warriors and their support systems. There is no exception when deploying with an EMEDS team. The opportunity is the same; it is just presented in a different environment.


From my experiences thus far, the challenges of deploying with an EMEDS team are most important to address.  I don’t intend to highlight them because they are negative attributes to being deployed. I feel it is important to address them more so, because by discussing challenges, we are able to improve upon them. If we are unable to improve upon them, then we are able to allow each other to better mentally prepare.


The main challenge faced in this environment is the lack of technology. Imagine daily tasks of filling prescriptions, consulting with providers, ordering medications and ultimately dispensing to a patient without the use of a computer. Envision logging narcotic inventories and labeling medications to pass off to patients without the use of a printer. Technology is a commodity that we use so frequently throughout any given day that it is almost unfathomable to entertain the idea of not having it available to complete simple tasks.


From my experience technology will find its way into the setting. However, it is important to at least initially plan for not having it. In my own instance, preprinting the necessary forms was a lifesaver. Forms such as the AF 582, AF 579, and the AF 781 are necessities to bring with you to a clinic in the process of building from the ground up.


Bring a bundle of each and plan to make copies of the forms in the weeks to come upon arriving. Also, acquire some address labels and preprint prescription labels for patient baggies (baggies, not vials in this atmosphere).  Prepare for the worst case scenario, but realize that technology will find its way to you eventually even in the most basic environment.


The second major challenge I came across was inventory management. In my scenario, I deployed by myself as the pharmacy team. Let’s face it; we rely heavily on our pharmacy technicians. They are a wealth of knowledge we are accustomed to working with daily. They usually manage our inventories at home stations and then we can deploy to a location where we order our own medication supply.


Additionally, medication orders in the deployed setting are received anywhere from two to four-4 weeks of the order being placed. So, drug utilization is to be determined, while also ensuring an on-hand supply of at least one month is being maintained. Speeding up the delivery is out of the question.


However, begin anticipating medications that will most likely go fast. Plan to communicate with providers from the early stages of setting up to determine which medications they prefer to prescribe.


It’s important to use all resources available. For instance, determine which military bases are nearby and establish relationships to share supplies if necessary. Be proactive in collaborating with all military branches in this endeavor. We are all a part of the same military, the same team, regardless of branch.


The last recommendation I feel is helpful is not necessarily a challenge, but more so a piece of advice. Be willing to step out of comfort zones, ask questions, and have pride, but lose your sense of ego.


 Network whenever possible. Deploying in general is such a unique opportunity. Take the chance to learn about other career fields, but to especially gain knowledge on our own career field.  Take advantage of opportunities that pharmacists wouldn’t have at home station. Walk into a deployment with an open mind, and take the opportunity to leave a deployment as an improved Air Force Officer and medical provider.