Last November, when the Woolsey Fire scorched Southern California, several long term and post-acute care communities were evacuated. Within seconds, quick decisions had to be made about where to house residents, how to contact their loved ones, and how to ensure there were no disruptions in their medication regimen.

From California to Tennessee, long term care operators across America have faced similar scenarios in recent years. During every wildfire evacuation, as staff rush to lead residents to safety, there is the risk of leaving behind the medication supply. 

The U.S. wildfire season high point is historically in the summer months, so it is imperative that owners and operators of assisted living communities and skilled nursing facilities develop or review plans now and work with their pharmacies to guarantee residents’ medication needs are met if an incident arises. While every community may be different, a few suggested protocols can help ensure a safe transition for patients.

Prior to a Wildfire Evacuation

Once there is an identified threat of wildfire in the immediate area, assisted living communities and skilled nursing facilities should be proactive and begin discussions with staff, their long term care pharmacy partner, and other key stakeholders such as residents’ family members and caregivers about the possibility of evacuation. Some necessary steps should include: 

■ Instantly establish communication with the Fire Marshal’s office. By receiving ongoing updates from the Fire Marshal’s office, operators and staff can use accurate, up-to-date information to evaluate the situation and options. This may help expedite the decision to evacuate and allow residents’ families and the partner pharmacy ample time to prepare.
■ Share the contingency plan. Operators should keep their staff and pharmacy partner abreast of all plans. The pharmacy will want to understand what will happen if operators are sheltering in place or evacuating so that medication contingency plans can be discussed.
– If evacuating, the pharmacy will need to be prepared with extra medications and the addresses for each resident’s temporary location.
– If sheltering in place, preparations should be made in the event of the loss of essential services such as power, heating, air, plumbing, and fresh water.
■ Select an ongoing point person to communicate with the pharmacy. Assigning one staff member to regularly correspond with a pharmacy representative via text or phone will ensure an organized response and that medication orders arrive promptly.
■ Emergency Refill Too Soon Procedure. Under normal circumstances, insurance does not allow pharmacists to refill medication prescriptions early. But during emergency disasters, most states implement an override often known as an Emergency Refill Too Soon Procedure. This permits insurance companies to authorize early refills before the current medication supply is depleted. The supply amount varies by state, and the pharmacy partner is the best source for this information. When a State of Emergency is issued and other legal requirements are fulfilled, pharmacists can dispense an extended supply of medication for the evacuation.

Once the Evacuation is Mandated

When the wildfire evacuation becomes imminent, communication and organization are key building blocks to ensure residents obtain and maintain medication while displaced. Following are actions to take once the evacuation is mandated.
1. Develop a master contact list.
To track the location of all residents, immediately begin updating a document listing the name of each resident, the location and address where they are moving, and any other significant contact information necessary. This document will help the pharmacy deliver medications and assist staff in sharing the resident’s location with family members and caregivers who may want to take them to their homes. With proper communication, pharmacies can plan to deliver prescriptions to patients wherever they are. For instance, if a community is evacuated beyond a service area, a pharmacy can transfer medications to another local pharmacy or, with advance notice, ship medications directly to them.
2. Package medications in individual units.
In a perfect world, communities would be able to carry med carts on buses; however, this scenario isn’t realistic during a wildfire evacuation. Plus, it is highly unlikely that an entire community will evacuate to the same location. That’s why it is important for each resident to have her own self-contained unit filled with medications and her Medication Administration Record (MAR). An easy solution is to put the resident’s medications in a brown paper bag and staple the MAR to the outside. This allows residents, whether they’re going with the community or with a loved one, to travel with medication and the MAR in hand.

For medications requiring refrigeration, have plenty of frozen packs and coolers available. This will maintain the temperature for a longer period during travel or in the event of a power outage.
3. Communicate the plan.
It is critical to communicate the evacuation plan and pickup time to loved ones and caregivers. Allowing residents to stay with a family member or caregiver during an evacuation is the preferred option because they are in a familiar setting and can have more one-on-one care.

If families choose this option, make sure they are aware of any special needs and drug allergies. Equip them with a complete list of medications with the dates and times of administration clearly marked. 
Fortunately, this information should be listed on the MAR. Before departing, provide each caregiver with the pharmacy phone number in case they have questions or need additional medication.
4. Maintain a high level of transparency.
When transporting residents during an evacuation, remember to communicate the destination and time of arrival to families and the pharmacy. This will reassure loved ones and help the pharmacy make necessary plans for shipping or delivering medications and supplies. 

Transparency also applies to pharmacy help. Make sure to let the pharmacy know if onsite help is needed. Their staff can be of great assistance during an evacuation as they are often a familiar face to residents and know their medical history and regimen. 

It should go without saying that all staff should maintain a calm and thoughtful demeanor throughout this process. Residents will follow their lead, and it is important they can maintain their peace of mind during this difficult time.

Returning After the Evacuation

Once officials give the all-clear, owners and operators need to alert staff that they can return to the property to help evaluate the conditions prior to the return of the residents. Staff should focus on the following: 

■ Conduct a thorough walk-through. Tour all facilities to assess any damage and to determine if normal operations can resume. With the exception of exterior and interior damage, the focus should be on restoring water and power. It is important to have a full picture of operations before telling family members and caregivers when residents should return.
■ Enlist the pharmacy to ready the medication supply. Connect with pharmacy staff and let them audit, organize, and restock medications and supplies. 
■ Develop a resident arrival plan. Before announcing an arrival time, owners and staff need to consider how residents will return. Will guests in memory care units, for example, be allowed to arrive earlier than those in the general population? Decide if bringing back residents in phases makes logistical sense. 

In the months after the Woolsey Fire was contained, pharmacy staff met with long term care communities to debrief about the incident, review the emergency preparedness and evacuation plans, and recommend changes to improve response efforts. Those steps, along with holding annual drills, are vital for pharmacy partners and operators to be prepared when a wildfire or unexpected natural disaster threatens medication access.
Ron Belville is president of Ron’s Pharmacy Services and Guardian Pharmacy of Anaheim, both partner pharmacies of Guardian Pharmacy Services, one of the nation’s largest long term care pharmacy companies. Belville can be reached at: 858-652-6900.