1. Rescuing a Nation: Post Earthquake Pharmacy Operations and Patient Care Challenges in Haiti LCDR Aaron Middlekauff – US Coast Guard Air Station Miami, Florida

2. CPE Information and Disclosures The American Pharmacist Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. LCDR Middlekauff declares no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. To receive credit for this activity, participants will be required to actively participate in the entire session and complete an online evaluation and CPE recording form using the voucher code assigned to this session.

3. Learning Objectives 1. Describe the roles and responsibilities of a Coast Guard pharmacist 2. Discuss collaborative inter-agency cooperation efforts 3. Describe pharmacy logistical and operational surge during relief operations 4. Identify limitations and opportunities to excel during a time of crisis

4. Self-Assessment Questions 1. The roles and responsibilities of a Coast Guard pharmacist are multi-faceted. True or False. 2. Personnel processing through Air Station Miami required: a. Anti-malarial agent b. H1N1 c. Typhoid d. DEET e. All of the above 3. The Coast Guard AOR expanded to include transiting cutters and personnel from other agencies downrange into theater operations. True or False.

5. Coast Guard Mission & Structure Forces - Active Duty (42,000), Reservists (7,500), Auxiliarists (29,000), Civilians (7,700) Primary Missions – Humanitarian, SAR, Law Enforcement, Alien Migrant Interdiction Operations, Port Security, Ice Operations, etc. Medical Structure – health care is provided by Public Health Service Officers - 60 Physicians - 7 Mid-Level Providers (+30 CG) - 55 Dentists - 15 Pharmacists - 675 Corpsmen

6. My Introduction to the Coast Guard

7. Coast Guard Assimilation 1. 2.

8. Personal Background “The UPOC Guy”

9. Coast Guard Pharmacy 15 pharmacists (13 field billets and 2 admin) Ambulatory Care Clinics Collateral duty assignments Regional Pharmacy Executive (RPE) role Provide oversight for tech training, P&T, CSAB, logistics, inspections, AOR, and patient care.

10. Haiti Earthquake 7.0 Magnitude 16 miles west of capital Tuesday 12 Jan 2010 52 aftershocks greater than 4.5 by 24 Jan Estimated 230,000 dead Essential services and damage to infrastructure

11. Presidential Palace Before and After

12. Cathedral Before and After

13. Coast Guard Response - Evolution 12 Jan 2010 – earthquake occurred 13 Jan 2010 – four CG cutters and nine aircraft operating aid 13 Jan 2010 – CO of AS Miami interviewed by multiple news networks

14. Coast Guard Response - Evolution 15 Jan 2010 – four simultaneous emergency prime vendor orders to meet mission requirements 15 Jan 2010 – CGC Tahoma & Mohawk feedback 19 Jan 2010 – collaborative delivery arranged from ASCW/ASCC/ASM ~20 Jan 2010 – USNS Comfort arrived on scene

15. Force Health Protection Guidance Anti-Malarial Medication Typhoid Vaccine DEET Sunscreen IV Fluids Oral Rehydration Packs AMIO Supplies Rabies Immunoglobulin/Vaccine H1N1 vaccine

16. Other Issues and Concerns Coordinating with D-7 Incident Management Team (IMT) Positive control of narcotic delivery into theater Accounting Issues Coast Guard Strategic Priorities Medevac personnel Conduct port assessment Humanitarian supplies Deter mass migration

17. Answers To Self-Assessment Questions 1. The roles and responsibilities of a Coast Guard pharmacist are multi-faceted. True or False. 2. Personnel processing through Air Station Miami required: a. Anti-malarial agent b. H1N1 c. Typhoid d. DEET e. All of the above 3. The Coast Guard AOR expanded to include transiting cutters and personnel from other agencies downrange into theater operations. True or False.

18. Closing Remarks and Questions LCDR Aaron P. Middlekauff USCG Air Station Miami aaron.p.middlekauff@uscg.mil 786-999-4184