California Pharmacist Spring 2025 - Flipbook - Page 41
decision-making process to determine
which patients received intravenous
fluids and which patients were stable
enough to go without fluids.
As detailed in the Laws & Regulation
column in this issue of
, the Board of Pharmacy issued an emergency waiver for
pharmacies affected by the LA wildfires
because they were put in a difficult position to maintaining necessary stock
for patients. The waiver allowed manufacturers, wholesalers, or third-party
logistics providers to deliver directly or
through a carrier dangerous drugs or
devices to alternate premises for pharmacies.7 This waiver ensured dangerous drugs and devices stock could be
maintained so patients could continue
to receive necessary medications and
devices.
When pharmacists do not have sufficient stock of medication and devices,
they must decide who receives them.
This would force pharmacists to triage
vital medications and allocate medications according to need. The waiver
addressed an essential aspect of disaster situations: mitigation of supply distribution to not exacerbate an already
tenuous situation for many victims.
Some ethical issues can arise from
triage that are not within the full
scope of this article but ought to be
mentioned. An ethical conundrum
of triage is that the process does not
usually consider the social utility of
victims in emergency situations. One
issue of social utility revolves around
disability ethics. Disability ethics
pertains to ensuring all individuals can
participate in society.8 Disability ethics
are a factor in triage because patients'
physical and cognitive impairment can,
unfortunately, count against patients
in implementing a triage algorithm. In
the case of an emergency or disaster
situation, patients who have some disability (physical or mental) may not be
given the same amount of time or care
as patients who do not. This unethical
action results in excluding the patients who have a disability from fully
participating in society and receiving
the care they deserve. Therefore, social
justice must be an element of every
triage algorithm.8
Preparing Ethically for the Next
Disaster Situation
The ethics of triage must be pondered
and discussed before emergency or disaster situations to ensure that the triage algorithm of an institution ensures
that all patients are treated ethically.
Every healthcare provider must be part
of the conversation, including pharmacists. We are responsible for dispensing
medications and disseminating our
knowledge about medications. We
must use our expertise to ensure that
triage is performed ethically and optimally for all patients and that medications are distributed ethically from our
most critically ill to the least affected
patients. Every patient matters, and
all patients must receive the care they
deserve for their medical condition.
References
1. Kimelman J. The LA County fires devastated homes in the wildland urban interface.
Here’s what that is. CalMatters. January 28,
2025. https://calmatters.org/environment/
wildfires/2025/01/la-county-fires-wildland-urban-interface/#:~:text=In%20just%20a%20
single%20month%2C%202025%20is,two%20
fires%20in%20the%20Los%20Angeles%20
area.&text=The%20fire%20damaged%20or%20
destroyed%20nearly%2020%2C000%20structures%20and%20killed%2085%20people
2. Beauchamp TL, Childress JF.
. Oxford University Press;
2009:279.
3. Aacharya RP, Gastmans C, Denier Y. Emergency department triage: an ethical analysis.
2011;11:16. https://doi.
org/10.1186/1471-227X-11-16
4. Chemical Hazards Emergency Medical Management. SALT mass casualty triage algorithm
(sort, assess, lifesaving interventions, treatment/
transport). U.S. Department of Health and Human Services. February 21, 2025. https://chemm.
hhs.gov/salttriage.htm
5. Moskop JC. Informed consent in the emergency department. .
1999;17(2):327–340. https://doi.org/10.1016/
s0733-8627(05)70062-6
6. Shah P, Thornton I, Kopitnik NL, et al.
Informed consent. Updated November 24, 2024.
In: StatPearls [Internet]. Treasure Island (FL):
StatPearls Publishing; 2025 Jan. https://www.
ncbi.nlm.nih.gov/books/NBK430827/
7. Important waiver information regarding
wildfires in LA County. Board of Pharmacy
notification. California State Board of Pharmacy.
January 10, 2025. https://www.pharmacy.ca.gov/
licensees/emergency_declaration.shtml
8. Jarman M. Disability studies ethics: theoretical
approaches for the undergraduate classroom.
. 2008;4(4). https://www.rdsjournal.
org/index.php/journal/article/view/241
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