Essential Medications for Patients With Suspected or Confirmed Ebola Virus Disease in Resource-Limited Environments.

BACKGROUND: In 2014, the U.S. Public Health Service (USPHS) Commissioned Corps deployed to Monrovia, Liberia, to operate a 25-bed Ebola treatment unit (ETU) constructed by the U.S. Military. The ETU was named the Monrovia Medical Unit (MMU) and was constructed from an U.S. Air Force Expeditionary Medical Support (EMEDS) unit with modifications on the basis of consultation from Médecins Sans Frontières, the World Health Organization, and expert panels from the U.S. Department of Defense and Department of Health and Human Services. From November 12, 2014, to April 30, 2015, 42 patients (18 confirmed Ebola virus disease [EVD] and 24 suspected EVD) from nine countries were treated by USPHS providers at the MMU. The medications used in the MMU were primarily procured from the EMEDS 25-bed pharmacy cache. However, specific formulary additions were made for treatment of EVD. METHODS: Using the MMU pharmacy dispensing data, we compared and contrasted the medications used in the MMU with recommendations in published EVD treatment guidelines for austere settings. FINDINGS: After comparing and contrasting the MMU pharmacy dispensing data with publications with EVD medication recommendations applicable to resource-limited settings, 101 medications were included in the USPHS Essential Medications for the Management of EVD List (EML) for an austere, isolated clinical environment. DISCUSSION/IMPACT/RECOMMENDATIONS: Because Ebola outbreaks often occur in remote areas, proactive planning, improved preparedness, and optimal patient care for EVD are needed, especially in the context of austere environments with a scarcity of resources. We developed the EML to assist in the planning for future Ebola outbreaks in a remote clinical environment and to provide a list of medications that have been used in an ETU. The EML is a comprehensive medication list that builds on the existing publications with EVD treatment recommendations applicable to supply-constrained clinical environments. As well, it is a resource for the provision of medications when evaluating donations, procurement, and may help inform estimates for product inventory requirements for an ETU. We hope the EML will improve readiness and enhance the capabilities of local and regional international responders.

A PHS pharmacist team's response to Hurricane Katrina.

PURPOSE: The challenges and victories that a team of Public Health Service (PHS) pharmacists experienced in establishing pharmacy operations at a federal medical station and conducting outreach missions are described. SUMMARY: The Gulf coast of Mississippi and southeast Louisiana were struck on August 29, 2005, by Hurricane Katrina, which caused widespread infrastructure damage, flooding, and loss of life. A team of 70 officers, which included 8 pharmacists, arrived on September 3 and 4 to establish a 480-bed federal medical station in an aircraft hangar at the naval air station (NAS) in Meridian, Mississippi. Numerous challenges were encountered, including identifying a secure space for a pharmacy, determining how to manage the immediate shortage of medications, devising a dispensing system specific to controlled medications, handling personal medications brought in by patients, and maintaining adequate pharmacy staffing to provide for hospital needs. Two outreach efforts were also undertaken. The first was to assist the NAS pharmacy department, which was overwhelmed with nearly 800 Navy and Coast Guard personnel who were displaced to the Meridian NAS. The second outreach effort was to augment the staff at a local free clinic in Meridian, which needed help to set up their clinic so they could handle the influx of hurricane victims who were arriving daily. CONCLUSION: A team of PHS pharmacists established a pharmacy, provided pharmaceutical care, and conducted outreach programs to aid victims of Hurricane Katrina.