Practice Spotlight: Military Pharmacists in Afghanistan
Operation Athena is the name used for the Canadian Forces’ participation in the International Security Assistance Force in Afghanistan. The Role 3 Multinational Medical Unit (R3 MMU) is the main medical facility in Afghanistan staffed by Canadians; it services a population of more than 14 000 military and civilian personnel of all nationalities. The medical unit is a multinational operation, and, as such, the hospital staff come from a variety of countries in addition to Canada, including the United States, the United Kingdom, Denmark, the Netherlands, Australia, and New Zealand. Canada supplies one complete surgical team (orthopedic, oral maxillofacial, and general surgeons, as well as an anesthetist) and Denmark supplies another. Canada also provides an intensivist, 6 general practice physicians, half of the dental team, a pharmacist, a physiotherapist, and a mental health team (consisting of a psychiatrist, a social worker, and a mental health nurse), as well as general duty, operating room, and critical care nurses, medical technicians, laboratory and radiology technicians, and administrative staff.
The military pharmacist divides his or her time between filling outpatient prescriptions (typically 50 to 80 per day) and caring for inpatients on the 12-bed ward and the 4-bed intensive care unit. Occasionally the ward is full to overflowing, but typically there are no fewer than 6 surgical-medical patients and 1 intensive care patient at any given time. During bedside ward rounds each morning, the team addresses the current issues and treatment plans for each patient. Most inpatients have had surgery of some type, so the main areas of focus for the pharmacist are pain control, prevention and treatment of infection, and re-establishment of proper bowel function. Because of the surgeons’ high workload, the team relies on the pharmacist to identify medical problems early and to present solutions that can be readily implemented with the resources available. Close working relationships among the staff members afford great opportunities for advanced practice. During a recent tour of duty in November and December 2007, Captain Allan Edwards worked closely with the anesthetist to provide a pain management service for all inpatients. The consensus among the physicians and nurses was that the majority of patients achieved faster and more consistent pain control when the pharmacist had a more hands-on role in their care.
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At R3 MMU, word may come down at any time of the day or night that trauma cases are “incoming”. At these times, the entire team swings into action to quickly and effectively triage, stabilize, and treat the wounded. The military pharmacist is often present to provide medication dosing advice and to ensure that all trauma teams, up to 7 at a time, have sufficient quantities of the medications needed for acute care. The pharmacist must also be willing to help out in any other way that might be necessary, such as acting as a stretcher-bearer to carry the wounded from the ambulance to the treatment bays, relaying messages to the surgical or administrative staff, replenishing medical supplies, or mopping blood off the floor in preparation for the next patient.