After the tragic events that have dawned upon the 21st century, one pauses to reflect and appreciate the people we love; the possessions we treasure; and the moments we cherish. Life is precious, yet so fragile. Embrace life while you can…

Farewell Princess Diana: Queen of Hearts…

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Pharmacists Unite

September 11, 2001

Justin wishes to offer prayers and condolences to all victims and families who have endured the pain and sorrow of human suffering… We shall never forget them…

Pharmacists: Heroes behind the scenes

In New York and Washington, D.C., pharmacists and pharmacies donated bandages and topical antibiotics for blunt trauma, saline solution for eyes stinging from smoke and debris, and OTC analgesics for wounds and sore muscles. In hospitals, pharmacists organized quickly to have medications at the ready for when more seriously injured victims arrived from the World Trade Center and the Pentagon. FDA approved an industry request to permit compassionate use of an investigational burn ointment at New York hospitals. When the Federal Aviation Administration (FAA) suddenly grounded airplanes that morning, pharmacists located near airports arranged for emergency medications needed by travellers stranded away from home or their original destination. And pharmacists everywhere provided assistance as the scope and immensity of the attack began sinking in.

All eyes were staring in the direction of the World Trade Center around 8:55 am on September 11. Curtis Kellner, director of pharmacy at St. Vincent’s Hospital and Medical Center in Manhattan had just emerged from the 14th Street Port Authority Trans-Hudson (PATH) station, located about three blocks away from the hospital. Rumors were flying that 10 minutes earlier a plane had hit the New York landmark and that flames were coming out of the building. "My first thought was that I had better run to the hospital," said Kellner. Upon his arrival, Kellner dealt quickly with several issues. "I had to make sure we had the required drugs on hand. Since it was unclear how many people were injured, the potential was in the thousands. Every time I listened to the TV, the news got worse and worse," he said. Kellner immediately sent one pharmacist to the emergency department to help prepare I.V. drugs and monitor controlled substances.

Kellner suspected a majority of the injuries would be blunt trauma, burns, and smoke inhalation. He made sure the shelves were well stocked with narcotic analgesics for deep wounds, silver sulfadiazine cream for burns, and albuterol (salbutamol) for smoke inhalation. The biggest challenge Kellner faced was keeping these and similar medications in stock. "Although the wholesalers we use have warehouses nearby in Massachusetts and New Jersey, the problem was that access to Manhattan had been cut off," he told Pharmacy Today. "The trucks were loaded and ready to roll, but they couldn’t get through. Fortunately, we had a police command centre set up inside St. Vincent’s, and we were able to speak with the New York Police Department and make sure that the trucks were permitted into Manhattan." Because of this and drug donations from area hospitals, St. Vincent’s did not have a problem with drug supply. Unfortunately, though, the number of injured people was far less than expected. "Most of the patients were brought in right after the planes hit," Kellner explained. "There just weren’t many survivors after the buildings collapsed."

Meanwhile, injured people and emergency service personnel were relying on pharmacies in lower Manhattan for bandages, water, and pain relievers. Most pharmacies in the immediate crisis area gave away first aid supplies, snacks, and dust masks to people on the streets. The CVS Pharmacy located on Fulton Street in Manhattan became an emergency medical treatment facility. "At first, local emergency medical and services personnel came in looking for water and bandages," said Todd Andrews, a spokesperson for CVS. "When the situation became more catastrophic, the emergency personnel were laying people down on the carpet, administering first aid, and using the pharmacy as a triage station."

Other pharmacies in lower Manhattan were also affected by the tragedy. Duane Reade, the largest pharmacy chain in Manhattan, operated a store at the base of the World Trade Center. The store was destroyed, but customers and employees were evacuated before the building collapsed. Other branches of Duane Reade in the city donated prescription drugs and supplies to support the relief effort. The parking lot of a Pathmark store located less than a mile from the World Trade Center was transformed into a command centre for rescue personnel.

Pharmacist Lorna Lagarde was in her office at the Pentagon when she heard the alarm bells at 9:45 am that inauspicious Tuesday morning. Walking leisurely toward the exit, she assumed it was a fire drill until she saw people running. "Everyone was running, so I ran too. Once I was outside, I saw the black smoke," she said. After the initial impact of hijacked American Airlines Flight 77, Lagarde, chief of pharmacy at the DiLorenzo Tricare Health Clinic located in the Pentagon, joined medical personnel outside on the lawn. Lagarde rushed to stabilize casualties by preparing meperidine (pethidine) and morphine for the nurses from an outdoor tent dispensary.

Emergency response teams from nearby northern Virginia hospitals soon arrived at the Pentagon, and area pharmacies and hospitals began a massive effort to transport medications and supplies. "When we found out what happened, we loaded trucks with drugs, I.V. fluids, pain medications, and silver sulfadiazine cream within 20 minutes," said Capt. Charlene Warren-Davis, pharmacist and formulary manager at Walter Reed Army Medical Center, located less than 10 miles away in Washington, D.C. Warren-Davis arrived at the Pentagon around noon on Wednesday, September 12. "By the time I got there, the fire had been put out and we were treating the rescue and relief workers for headache, nausea, dehydration, and eye irritation," recalled Warren-Davis. "Just even to be standing there was unreal, but we were there with a purpose, and we were there to help."

As medications were shuttled to the Pentagon from Walter Reed and a nearby CVS, Lagarde was in charge of dispensing controlled substances and doling them out to physicians to administer. "Things were happening so quickly there was no time to document everything. We looked in the emergency cart and handed the nurses medication rather than having the nurses look for it themselves," Lagarde told Pharmacy Today. "Having a pharmacist right there made the process faster."

While Lagarde was assisting victims and rescue personnel on the Pentagon grounds, most victims who initially survived the attack were rushed to the Virginia Hospital Center-Arlington for treatment. Dana Anderson, director of pharmacy, was on duty at the hospital and watched the terrorist attacks on one of the TV sets located in the pharmacy. "When we got the alert that we were going to be receiving casualties from the Pentagon, I mobilized my staff and deployed a Certified Pharmacy Technician and a pharmacist to the emergency room to staff the pharmaceutical inventory area. This helped to free up the nurses so they wouldn’t have to worry about finding medications," said Anderson. He instructed his staff of 33 pharmacists and Certified Pharmacy Technicians to assist in preparing medications and help the nurses deal with drug acquisition. "It was a big challenge to stay ahead of what we needed and at the same time support the patients we already had in-house," Anderson explained. "We kept part of the staff rested so they could keep things going after the initial crisis."

Within minutes of the attack on the World Trade Center, FAA officials began putting pieces of the attack puzzle together. Knowing that other hijacked aircraft were being reported, they grounded all airplanes in the United States and kept commercial jetliners out of the air for more than 48 hours.

Because of this, many travellers ran out of their medications or were stranded in hotels without them. In a scene repeated near other American airports that week, Michael P. Hornick, co-owner of Porter’s Prescription Pharmacy in Moon Township, Pa., provided travellers stranded at nearby Pittsburgh International Airport emergency medications. "We used common sense to make sure patients didn’t go without their medications," said Hornick.

The massive number of causalities from this catastrophic event also prompted FDA to permit use of an investigational cream for treating burns. Solvay Pharmaceuticals, located in Marietta, Ga., shipped 3,000 pounds of sulfadiazine/cerium (Flammacerium) to New York hospitals after FDA approved a label and a protocol.

Not yet approved by FDA, sulfadiazine/cerium is in phase III clinical trials in the United States and is currently marketed in Europe for the treatment of severe burns.

Pharmacy, as a profession, rose to the occasion and made a major contribution to treating patients during this terrible tragedy. The Pharmacists Society of the State of New York helped to coordinate a statewide donation of first aid supplies and helped get them to drop-off sites in Yonkers and Queens. The National Association of Chain Drug Stores, through its Charitable Foundation, made an initial donation of $100,000 to the American Red Cross, and many chain and community pharmacies are conducting a variety of in-store donation programs to help support the disaster relief efforts.

Pharmaceutical companies - including Novartis, Pfizer, Glaxo Smith Kline, Merck, and Bristol-Myers Squibb - donated millions of dollars to the Red Cross and relief funds. In addition to Red Cross donations, many drug companies and chain drug stores - including Walgreens, Eckerd, CVS, Rite Aid, Johnson & Johnson, and Procter & Gamble - have contributed OTC and consumer care products, such as analgesics, first aid products, eye saline solution, batteries, food, and bottled water, to the relief efforts and rescue personnel in New York and Washington, D.C.

"Every pharmacist in America, and many of our colleagues overseas, did what they could in the face of this tragedy," said John A. Gans, APhA executive vice president and CEO. "From emergency services at health facilities near the crash sites, to donating supplies, hosting donation sites, and supporting their communities when they needed it most, I am extremely proud of our profession and our nation."