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From the emergency department to hurricanes, LCDR Shields stands ready

2014; Elsevier BV; Volume: 20; Issue: 8 Linguagem: Inglês

10.1016/s1042-0991(15)30759-3

2773-0735

Amy K. Erickson,

Pharmaceutical Practices and Patient Outcomes

It was August 2012, and Hurricane Isaac was barreling down on the Louisiana coast. LCDR Anastasia Shields, PharmD, MS, BCPS, a member of Rapid Deployment Force 5 of the U.S. Public Health Service Commissioned Corps, was put on alert. Within hours she was on the ground in New Orleans, helping to set up a federal medical station after the deadly and destructive storm. “In the wake of chaos, we were given the opportunity to make a positive difference in people’s lives,” said Shields. “We did this, and we did it well.” It was August 2012, and Hurricane Isaac was barreling down on the Louisiana coast. LCDR Anastasia Shields, PharmD, MS, BCPS, a member of Rapid Deployment Force 5 of the U.S. Public Health Service Commissioned Corps, was put on alert. Within hours she was on the ground in New Orleans, helping to set up a federal medical station after the deadly and destructive storm. “In the wake of chaos, we were given the opportunity to make a positive difference in people’s lives,” said Shields. “We did this, and we did it well.” Shields loves the adrenaline rush that comes with helping patients when they need it the most. Her bags are packed and she can leave at a moment’s notice to apply her expertise to humanitarian relief efforts for natural disasters such as earthquakes or hurricanes. When she’s not jetting off as a first responder, Shields works with the emergency department on overnight shifts at Tsehootsooi Medical Center in Fort Defiance, which is nestled in the remote northeastern area of Arizona. She also serves as the facility’s Pharmacy Residency Director. “I had no idea when I started school what a dynamic and exciting profession pharmacy could be, and I never imagined enjoying my life’s work as much as I do,” said Shields. “I look forward to each day and its challenges and rewards.” The city of Window Rock, located 7 miles from Fort Defiance, serves as the seat of government and capital of the Navajo Nation, the largest land-based sovereign Native American nation in North America. The 26 pharmacists and 15 technicians on staff at Tsehootsooi Medical Center provide care to patients in the hospital and at a pharmacy-based clinic in the area. “In the wake of chaos, we were given the opportunity to make a positive difference in people’s lives.” HIGHLIGHTS■LCDR Anastasia Shields applies her broad-based pharmaceutical knowledge during the overnight shift in the emergency department.■Shields is an officer in the Commissioned Corps and a member of Rapid Deployment Force 5. It’s not unheard of for the Native American population served by Tsehootsooi to hitchhike 50 to 100 miles for medical care. “A patient may come in to our pharmacy and say, ‘I need this medication, can you refill it today?’ “said Shields. “Some patients have hitchhiked 4 hours; some will walk 20 to 30 miles to receive health care. And these are not all young people.” Shields and the other pharmacists at Tsehootsooi Medical Center see all kinds of patients. “From an emergency department perspective, it is to some degree more challenging because we have to transfer the patients who need a higher level of care,” said Shields. “In the interim, we stabilize those patients for transfer, which can be at times challenging.” Shields is an officer in the Commissioned Corps and a member of Rapid Deployment Force 5, a team of roughly 160 people who are deployed in major disaster situations to set up federal medical stations and provide medical and pharmacy care. As part of the rapid deployment force, Shields needs to be ready to leave immediately. If a disaster strikes, Shields first receives an e-mail alert. “We are expected to have our bags packed all the time, and when we get an alert, it means it’s time to go home and start making sure we have everything together,” said Shields. “Once we are notified, we are expected to show up at the point of departure within 12 hours.” Prior to joining the Public Health Service Commissioned Corps, Shields was part of a nongovernmental organization based in Delaware. She was deployed to help after the earthquake in Haiti in 2010. “It was the first time I had deployed to a disaster scene, and I witnessed how helpful pharmacists can be on a disaster team,” she said. “We received drugs in from all over the world, and [the packaging] was written in various languages and packaged differently than what I am used to seeing in the states.” Shields was familiar with most of the pharmacy items thanks to her previous experience traveling, visiting foreign pharmacies, and studying the products on pharmacy shelves. “I have traveled a lot, and visiting foreign pharmacies has interested me because I like to see what they have and use. This was a huge advantage when working with foreign drugs sent to help with medical care in Haiti,” she said. Having a pharmacist on the response team is valuable in many ways. “We were able to organize the drug inventory, [and] track it and its usage,” Shields explained. “Since we had limited supplies with no resupply that was consistent, this was imperative to being able to maximize our resources without exhausting them too soon.” This required Shields to recommend a switch in therapy when a patient needed something that was out of stock or not stocked, and to find a viable substitute. Shields also worked to extend the drug inventory and supply during her deployment to Haiti. Without a pharmacist, the drug inventory would not have been maintained and regulated, and there would have been no one to make therapeutic recommendations based on what is available, instead of what is ideal. “I was able to obtain drugs we needed from local sources or other nongovernment organizations that were there helping and had medication that they could spare but we needed,” said Shields. “It was the simple things like iron tablets and multiple vitamins to help prevent nutritional deficiencies until the patients were able to obtain consistent food sources again.” Collaboration was critical in Haiti. “Most of the [medical staff] had only met once or twice in their lives, or never, but they were able to efficiently get the job done in a situation that could present chaos and was constantly changing,” Shields explained. “The group really worked as a team and helped each other, which made the atmosphere easier to adjust to and our work more effective.” Shields was deployed a second time to Haiti about 6 months later to help with disaster follow-up. Her work with a different nongovernmental organization took her to Nicaragua to provide general humanitarian assistance that following year. She is currently finishing up a master’s degree in public health focused on disaster management and humanitarian relief from the University of South Florida’s online program and has recently earned a master’s in pharmacy with a concentration in clinical toxicology from the University of Florida’s online program. Although Shields is a first responder, her “day job” is staff pharmacist and Pharmacy Residency Director at Fort Defiance. She prefers to work the overnight shift because that is when the emergency room is the busiest. “You need a lot of broad-based pharmaceutical knowledge to work in the emergency department,” said Shields. “There is not one type of thing you see there; you get everything, and most of it is not predictable.” Shields is in charge of the postgraduate year 1 residency pharmacy residents, usually one traditional resident and, this past year, one nontraditional resident. According to Shields, the nontraditional resident is someone who would be a good pharmacist and resident but can’t do a residency because of family, commitments, or financial constraints. The nontraditional residency allows a person to complete the requirements of a residency over 2 years instead of 1 year. The time is split between being a resident and being a staff pharmacist. “So we have some staff help, and in 2 years we have a pharmacist who is much more clinically skilled, so the facility benefits tremendously,” said Shields. The current nontraditional resident is about to graduate from the program and move to a remote area to run a pharmacy at one of the offsite clinics. “It’s phenomenal because usually it takes 10 years to get enough experience to go out 45 miles away from the main hospital to run a pharmacy. He’s doing it now,” said Shields. Other residents have launched a pharmacy-based diabetes clinic and asthma clinic. This year’s resident is working on a pain management project, noted Shields. “Each day is an opportunity to improve a patient’s medication therapy, improve a work process, or make a medication intervention that has significant impact on therapy,” said Shields.