Pharmacists on the front line


Blackouts, closed roads, lost homes and displaced families are some things pharmacists have had to tackle amid terror bushfire season

Aussie pharmacists are battling to care for patients in almost impossible conditions, as electricity blackouts and closed roads have impacted communications and medicines supply in areas affected by bushfires.

Jeffrey Soo, pharmacist in charge at Beachside Pharmacy in Ulladulla, has been working through the holiday season to support his community as flames engulfed the south coast of NSW on New Year’s Eve.

“There’s been quite a few in the community affected directly by the bushfires – losing homes and properties, and some people have lost their lives,” Mr Soo told AJP.

He said the power went off completely from about 1.30pm on New Year’s Eve.

“All the other pharmacies decided to close so we just kept trading in the dark basically,” said Mr Soo.

“We had a few staff members in the shop just to help people with getting Ventolin and emergency medicines.

“We luckily had a mobile phone so we could still contact pharmacies and doctors. We were just basically trying to do everything by phone and I suppose back to the old manual way of doing things.”

He also opened the pharmacy on New Year’s Day and has been attending the local evacuation centre and working with doctors and paramedics to make sure that people have access to medicines even if the shops are closed.

Bushfires hit the south coast of NSW recently. Eighteen people, including three firefighters, have died in the NSW bushfires since October. Source: NSW RFS/AJP

“I got some messages on my phone [on New Year’s Day] asking if there were any pharmacies open so we decided to come in and open the shop up for a few hours because that particular day was very smoky. I just knew that there would be quite a few in the community who might need puffers or even medicines and just general supplies,” he said.

Mr Soo said his team was working with a lot of the doctors and pharmacies to try and give people a full month’s supply.

“We’re trusting that people will send scripts through to us. But I think three days [for emergency supply provisions] is not enough in this situation … people could be trapped [in Ulladulla] for three days, seven days, maybe two weeks, so it would be good to maybe do something where you could give more – a longer period of emergency supply if needed.”

Tim Brook, pharmacist proprietor and pharmacist in charge at Orbost Pharmacy in Victoria also had a horror week as bushfires tore through the East Gippsland region.

He told AJP that the pharmacy experienced blackouts over several days and has had to run on a generator.

Many were advised to evacuate and “people have lost their homes in the surrounding areas” said Mr Brook.

Meanwhile, with roads intermittently closed between Orbost and other towns, the pharmacy has had difficulties receiving medicine orders and at one point Mr Brook was unable to drive to his home an hour away in Bairnsdale.

 
Victorians are under high alert with bushfires tearing through the East Gippsland region. Source: Vic Emergency/AJP

After a few days without any orders, Mr Brook took it upon himself to pick up medicines with a trailer to make sure supply was still coming through for his local area.

“Orders haven’t been coming in and I haven’t received a cold chain order in a week,” he told AJP.

“I actually had to call the courier to tell them they could bring the orders in.

“I have had to get some supplies from other pharmacies and have been providing some emergency supplies to people such as an insulin shot here and there.”

With people displaced by the fires into surrounding areas, pharmacist proprietor Elise Apolloni from Capital Chemist Wanniassa in Canberra says changes need to be made to the emergency supply provisions.

“There are a lot of people who are displaced at the moment whether they’ve been evacuated or that they’ve come up to Canberra with family and friends to stay here, to see out the fire season,” she says.

“We have certainly seen an increase in needing to supply emergency medicines.

“Three days is simply not enough for these situations where potentially someone is going to need access to medicines for much longer.

“Of course, the idea is that we’re able to access a prescriber within three days or their regular doctor but that’s not always possible,” she says.

PSA says it has written to the Health Minister requesting urgent legislative change to the emergency supply provisions.

“We have been in close contact with a number of pharmacists at the front line of the bushfire emergency, and we have been in close contact not only with the Minister for Health’s office, but with the Department of Health and Australian Defence Force to assist in logistical support,” said PSA national president Chris Freeman.

“At this time we need to focus on the immediate logistical support that pharmacists on the front line need, then we can focus on ensuring the need for adequate disaster planning involving community pharmacy, and reducing the barriers that pharmacists face in providing emergency supplies of medicines.”

The Pharmacy Guild said it has “long advocated for the expansion and streamlining of the provisions under which pharmacists can dispense essential medicines during emergencies and in the aftermath of disasters”.

“We will be renewing our efforts to achieve this objective in the wake of these unprecedented bushfires,” said a spokesperson for the Guild.

“The emergencies across multiple states in the past few weeks have highlighted the vital role of community pharmacies as frontline sources of primary health care – with countless stories emerging of pharmacists and their staff going above and beyond to help their patients.”

Under state and territory legislation, an approved pharmacist may supply a limited amount of medicines to a patient without a valid prescription, if they believe the patient has an urgent need for that medicine.

In most states, this is limited to a three-day supply of medication and cannot be claimed through the PBS.

Update (8/1/20):

On Wednesday, following pressure from pharmacist groups, special authority for emergency supply without a prescription in bushfire was announced by the NSW Chief Health Officer.

Under the authority, patients in bushfire-affected regions of NSW can now receive a supply of Schedule 4 medication without a prescription, where the pharmacist is satisfied there is immediate need.

The medicine must have been previously prescribed, be for continuation of current essential treatment and it is impracticable to obtain a prescription.

The quantity to be supplied is no more than:

  • For substances that are on the PBS, the standard Pharmaceutical Benefits maximum quantity, or
  • For substances that are not on the PBS, the quantity that is contained in the smallest standard pack in which substance is generally available.

In most cases, this represents a months’ supply of that medicine. This special authority will last until 31 March 2020.

See here for further requirements

Any similar changes to the usual arrangements in other states and territories would need to be considered and implemented by their respective governments, a spokesperson from the Department of Health told AJP.

Currently a prescriber may direct a pharmacist to supply a medicine to a patient without a formal prescription when the patient has an urgent need for that medicine, however this is specific to each state and territory.

For patients requiring urgent supply of oral contraceptives or cholesterol-lowering medicines, pharmacists may dispense a single PBS quantity (usually one month supply) without a prescription, the spokesperson said.

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