All items with an asterisk (*) are required for submission.
* Name:
* Position:
* Pick facility from list below
Other facility, if not listed above:
RESOURCES REQUIRED
The list below includes therapeutic categories, route of administration, and recommended drug or pharmaceutical supply. For simplicity, purchase and stockpile a single or limited number of drugs from each therapeutic category. By limiting the types of drugs available, care providers with little or no prior experience with the drug will find it easier to learn about and administer the drug. This document is a resource guide. Local needs, preferences, and capabilities of the affected communities may vary.
Analgesics
Anxiolytics
Antipsychotics
Antibiotics, broad spectrum with low allergy risk
Intravenous fluids
Drugs for intubation
Topical burn care agents
ENT meds for TM perforation
Ocular meds
Tetanus toxoid
Which of the above resources, if any, necessitated additional expenditures over those currently planned for your department?
Based on your experience implementing the template, what resources should be added to the "Required Resources" section?
Which of the above resources, if any, caused you the biggest concerns or problems? (Please explain.)
What were the most significant barriers you encountered related to the "Required Resources"?
ACTION STEPS 1. Identify community medical leadership and a committee to address near-term solutions. Discussion and decision by EMS, emergency medicine, trauma surgery, hospital pharmacy (PharmD), blood bank, hospital leadership, hospital nursing, emergency management, public health, and law enforcement (re: transport of pharmaceuticals).
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
2. Inventory drugs and quantities available at points of care (prehospital and hospital). Committee should delegate a point person to contact hospital pharmacists and EMS leadership and inquire about inventory.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
3. Identify gaps between drugs on hand and goal.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
4. Identify potential sources of drugs in the community besides prehospital and hospital supplies. Identification of additional sources should consider daily, routine needs of the community.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
5. Develop relationships with leadership at additional sources, ask for "snapshot" inventory of drugs, and establish "mutual aid" agreements to rapidly acquire drugs.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
6. Assess drugs available in the community by adding prehospital + hospital + community pharmacies + drug wholesalers/warehouses + physicians’ offices (through medical society).
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
7. If the drug supply is low, develop a plan for intercommunity mutual aid or rationing.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
8. Develop a plan to rapidly acquire drugs from additional sources and deliver products to points of care. This plan should include communications between point(s) of care and additional sources, mutual aid agreements with additional community sources, transport of drugs, and reimbursement.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
