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Military Pharmacists Face Unique Challenges While Deployed

Image of Military pharmacist counting pills. U.S. Air Force Capt. Candace Parker, 332nd Expeditionary Medical Group pharmacist, pours pills into a pill counting machine July 17, 2021, in an undisclosed location somewhere in Southwest Asia. Deployed pharmacists often have to work in areas where supplies may not be readily available. (Photo by U.S. Air Force Senior Airman Cameron Otte)

Tasked with having to know about hundreds of types of drugs and their interactions, equipment, and much more, pharmacists are vital in keeping warfighters healthy and ensuring that the U.S. military maintains a medically ready force.

For deployed pharmacists, they face unique challenges, as they don’t work in a traditional brick and mortar setting. Rather, deployed pharmacists can be on a ship in the middle of the ocean, or in a makeshift building in the Middle East or Africa. The deployed pharmacy workforce may have to take care of warfighters in abnormal situations or locations.

A deployed pharmacist is, “a pharmacist forward, in a hostile environment, supporting a broad range of contingency operations in support of our nation’s objectives,” said U.S. Army Maj. Lance R. Murphy, chief of ambulatory care pharmacy services at Tripler Army Medical Center, in Honolulu, Hawaii.

Typically, it’s the pharmacist’s job to screen, package, and distribute medication to patients, ensuring they are prescribed the correct dosage to treat their ailment. Yet while on deployment, it can be much more than that.

“A deployed pharmacist is the primary drug/medication expert for the management, storage, and acquisition of pharmaceuticals. Many times, you are the only pharmacist within your area of operation and will expected to be always available,” said U.S. Army Lt. Col. Norman Tuala, deputy chief of the department of pharmacy at Tripler Army Medical Center.

Tuala went on to explain that there are four positions for a deployed pharmacist: field hospital pharmacist, division pharmacist, medical logistics pharmacist, and theater pharmacy consultant.

He said, “You need to be proficient as an outpatient and inpatient pharmacist; however, you’ll need to be more familiar with logistics such as different ordering platforms, forward logistic elements.”

Challenges as a Deployed Pharmacist

Logistics and supply management can be one of the biggest challenges a deployed pharmacist may face, Tuala explained. “My biggest concerns were supply availability, controlled substance accountability, and management of refrigerated items. I didn’t always have what I needed, but I was able to pursue available logistics contacts to request what I needed. You cannot operate as you do while you are back in garrison and expect most pharmaceutical orders to arrive next day.”

Yet the conditions are manageable if the pharmacist plans ahead.

He also mentioned, “manpower, logistics, formulary changes, and varying missions,” as some of the biggest challenges while on deployment.

He recalled a time when he was deployed where logistics played a key factor.

“There was an outbreak of a gastro-intestinal parasite in Kuwait. I was responsible for ordering the medications to treat the infection and side effects. I was able to verify treatment and get the medications, as well as prevention medication, shipped out within two hours and delivered on site within 24 hours,” said Murphy.

Personal Experiences on Deployment

When deployed, everyone has a different experience, or way, that they prepare.

"Most of the preparation is mental. When preparing for a traditional deployment, brushing up on sterile compounding and critical care are top priority. For my job, it was more ‘on the job’ training and learning the logistics side of pharmacy and medicine," said Murphy. “I managed the U.S. Central Command formulary, ordered and shipped out all of the medications for the theater, developed and updated policies and procedures for the area of responsibility, and served as a clinical subject matter expert.”

Sometimes when deployed, a pharmacist might come across certain medications that they might not stock in a typical pharmacy.

“This will depend on the environment, but when I was in Afghanistan, we had snake antivenom, which was something I normally had not stocked within my pharmacy,” said Tuala. Murphy also mentioned that he was once responsible for procuring antivenoms to treat snake and scorpion bites, which was unique for him.

While serving on a deployed mission, you must prepare and plan for certain situation that you normally would, like “mass casualty, enemy fire, disrupted logistics channels and evacuations,” said Murphy. “My largest concern was making sure units had enough medications and had all their requirements in a timely manner. The last thing I wanted was for a unit to realize they were short on a medication/treatment while they were handling a mass casualty or under fire.”

A good understanding of not only one’s capabilities, but also those of the pharmacy and staff is important for a successful deployment, Tuala said, “Having a good understanding of your capabilities and the medical support expectations and mission will assist with your strategy to bridge the gap.”

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