Therapeutic selection during an emergency response

Therapeutic selection in a postdisaster setting is described. Therapeutic selection is the process of assessing a patient's pharmaceutical requirements and selecting the appropriate therapy. Although the primary criteria for drug selection during a disaster response are the same as in usual pharmacy practice, there is a shift in emphasis created by communication and transportation limitations and by changes in the patient's general living environment. The cost of agents is no longer viewed in terms of dollars but in the context of limited inventories. A disaster may exacerbate health problems or make adverse drug effects more common and problematic. Drug administration and patient compliance will be hampered. Pre-established guidelines for appropriate patient care should be reviewed and approved by a group of representative health care providers. General policies for pharmaceutical care should include guidelines for a formulary, prescription refills, dispensing limitations, and prescriber approval. Therapeutic selection should involve obtaining a medical history, selecting a drug regimen, educating and counseling the patient, and documenting the process. Pharmacists should use familiar procedures that they are comfortable with to minimize stress and optimize outcomes. Procedures should be flexible to adjust to circumstances and individual patient needs. Therapeutic selection during a disaster response, although based on the same principles as traditional therapeutic selection, is more complex. Pharmacists will need to tailor their approach to the circumstances and to individual patient needs.