When the Department of Veterans Affairs (VA) activated its all-volunteer clinician force to respond to Hurricane Michael, Sheryl Dezellem correctly guessed she would be serving on one of the department’s mobile pharmacy units in Panama City, Fla.
“It is exciting. You have to kind of be ready for anything,” Dezellem said of her weeklong deployment with VA’s Disaster Emergency Medical Personnel System (DEMPS).
Dezellem, a Clinical Pharmacy Specialist at William S. Middleton Memorial Veterans Hospital in Madison, Wis., was part of a relief team that staffed the mobile pharmacy during the final days of a three-week deployment that ended in early November. Also on that team was Robert Cyparski, Clinical Pharmacy Specialist at the VA Medical Center in Martinsburg, W.Va.
Both pharmacists, reached after they returned from Florida, said this was their second DEMPS deployment and their first time working in one of VA’s mobile pharmacy units. The pharmacy units are part of a fleet of customized vehicles that provide medical and supportive services to veterans during large-scale disasters and localized events that disrupt normal access to care.
“We greatly appreciate the volunteers. I think they did a great, outstanding job helping and serving the veterans and taking care of their needs at a difficult time,” said Rhonda Kvetko, Program Manager for VA’s emergency pharmacy services division.
Kvetko said volunteers at the mobile pharmacy unit in Panama City dispensed a total of 1,048 prescriptions for 494 veterans and family members.
The prescription total includes emergency fills for 35 community members who needed help after the storm.
“If someone came up and had a need, as long as we could verify that they did have a valid prescription, we could fill it under a humanitarian basis,” Dezellem explained.
The deployment was a change of pace for Dezellem, whose day-to-day work involves evaluating patients who are candidates for VA’s infusion services and helping to coordinate the care of those veterans.
“It’s kind of fun to get back to just the basics of helping people get what they need,” Dezellem said.
Cyparski’s usual work involves the management of anticoagulation, diabetes, hypertension, and hyperlipidemia in one of VA’s primary care clinics. He said he worked previously as a pharmacy technician and retail pharmacist but hadn’t been involved in dispensing for about four years before the deployment.
Both pharmacists recalled dispensing maintenance medications for patients with hypertension, diabetes, and dyslipidemia during the deployment. The mobile pharmacy units don’t stock controlled substances, but the staff dispensed other analgesics for people who suffered minor injuries during or after the hurricane.
“We did quite a bit of diclofenac gel and ibuprofen,” Cyparski said.
Dezellem said there was a late-week burst of activity filling prescriptions for nasal sprays, albuterol inhalers, and allergy medications, perhaps connected to airborne toxins from red tide off the coast.
According to the Florida Fish and Wildlife Conservation Commission, Karenia brevis, the organism responsible for red tides, can release respiratory irritants into the air and cause serious illness in people with chronic respiratory conditions. The commission reported high levels of K. brevis blooms near Panama City throughout October.
VA has operated mobile pharmacy units since 2007. Although the procedures for preparing and operating the units are well established, Cyparski said the volunteers are able to make adjustments to meet local needs.
“We had daily feedback at the end of the day, and we took whatever areas we thought we could improve on and pretty much implemented them the next morning,” he said.
One adjustment was positioning someone outside the pharmacy to direct confused veterans to their correct destination among VA’s mobile and temporary units — and to save veterans from having to climb the exterior staircase to reach the pharmacy’s service window.
When storms developed, the pharmacy team established a station at a desk inside the mobile outpatient clinic, which was often a first stop for veterans in need of a prescription. Cyparski said the team member communicated electronically with colleagues in the mobile pharmacy and worked with clinic staff to streamline the processing of prescriptions.
He said the clinic’s volunteers were willing, when appropriate, to change prescriptions to match drug dosages and formulations available in the mobile pharmacy so veterans could leave with their medications that day.
Dezellem said staff inside the pharmacy even walked mediations to veterans who were at the outpatient clinic sheltering from the weather.
Although Hurricane Michael caused widespread devastation in and around Panama City, the pharmacy’s relief team didn’t have much opportunity to see the extent of damage.
“We tended to travel in the dark both to the clinic and back to our hotel. We also weren’t quite in the area where the worst of the damage was,” Dezellem said. “But we saw piles of brush along the sides of roads, we saw blue tarps covering peoples’ roofs.”
For Cyparski, the deployment was a second opportunity to help veterans in a disaster zone. During 2017, he spent 28 days on a DEMPS deployment in San Juan, Puerto Rico, caring for veterans affected by Hurricane Maria.
“DEMPS in general is a great experience,” Cyparski said. He noted that in addition to helping veterans, the team members forged lasting connections with each other.
“I didn’t know anybody going out there this time around, except for one of the officers who was from my VA. But six, seven days later, it felt like everybody was family,” he said.
[This news story appears in the February 15, 2019, issue of AJHP.]