Characteristics of sources of evidence

The data collection form was created using the Covidence^TM software and is described in Table 1. The included studies and reports described pharmacists within EMTs responding to disasters or emergencies between 2001 and 2022. Of the 36 studies and reports included in the scoping review, 23 were academic peer-reviewed scientific studies, and 13 were reports sourced from non-academic sources or were not considered to fulfil the requirements of a scientific study. The term “sources” will be used throughout this paper to represent the included studies and reports extracted for inclusion in this scoping review. The included sources represented disasters or emergencies in various countries (USA [n = 23]; Afghanistan [n = 4]; Canada and Pakistan [n = 3 each]; Haiti, India, Bahamas, India, Sudan, Africa (n = 2 each) and Nepal, Japan, Peru, Saudi Arabia, Malaysia, Sierra Leone, Iraq, Serbia, Lithuania, Bosnia and Herzegovina, Armenia, Sri Lanka, Jordan, Germany, Australia, UK, New Zealand, Brazil, and China (n = 1 each). The geographical locations were expressed diagrammatically in Figure 2 utilizing Microsoft Excel®.

Figure 2. Locations of hazards described in included sources of Scoping Review. Figure 2 was created utilizing Microsoft ® Excel.

The type of hazard requiring disaster or emergency response was categorized according to the Hazards Information Profiles outlined in the UNDRR Report.¹⁹ Of the 36 sources, 7 included biological hazards, 2 discussed environmental hazards, 8 included geohazards, 17 included information on meteorological and hydrological hazards, and 5 discussed societal hazards. Seven sources discussed EMT response in disasters in general without specification of type of hazard. 35 sources contained information on pharmacist participants, and 7 sources included pharmacy students.

Results of individual sources of evidence

Among the 36 sources included in the scoping review, a delineation of 5 principal themes governing the role requirements of pharmacists engaged in EMTs during disaster response was ascertained. Each of these 5 overarching themes underwent additional categorization into subthemes, wherein the requisite skills and knowledge were delineated. The results are represented diagrammatically in Figure 5 in the section “Synthesis of Results.”

Role subtheme 1.1 medicine substitution

Nine sources described medicine substitution as a subtheme of supply chain management.Reference Bratberg^30, Reference Gaudette, Schnitzer, George and Briggs^35, Reference Kawataba^39, Reference Montello, Ostroff and Frank^41, Reference Setlak^44, Reference Thompson^47, Reference Vardanyan, Mosegui and Miranda^50, Reference Watson, Singleton and Tippett⁵² Sources describing this subtheme indicated that as the formulary of medicines cannot be extensive when taken to a disaster site. Substituting “similar medicines” for a patient’s diagnosis indication is required, guided by the pharmacist’s knowledge of appropriate medicine substitution.

Skills theme 1.1.1 knowledge of national and international stockpile inventory

Two sources further described that knowledge of the “national stockpile” of inventory is necessary for a pharmacist to have when making decisions about medicine substitution.Reference Setlak^44, Reference Watson, Singleton and Tippett⁵² The national stockpile can be described as the standardized inventory list of medicines that can be dispatched with EMTs in the event of an emergency or disaster. Knowledge of the national and international stockpile inventory is also a knowledge requirement to fulfil Subtheme 1.2 – Mass dispensing, as the national stockpile inventory will contain a standardized inventory of medicines for treatments.

Skills theme 1.1.2 – medical logistics training

Two sources referenced that medical logistics training was required to fulfil the role of medicine substitution within supply chain management.Reference Kobayashi^40, Reference Thompson⁴⁷ Medical logistics training can be described as specific training in accessing the national (or international) stockpile of standardized inventory of medicines. Medical logistics training also describes the knowledge requirement of managing donated stock, which is further described in Subtheme 1.3.

Role subtheme 1.2 mass dispensing

Eight sources described mass dispensing as an additional aspect of supply chain management.Reference Gershgol, Cantrell and Mutrux^4, Reference Alkhalili, Ma and Grenier^26–Reference Baig, Jyothi and Mudakavi^28, Reference Rasheed, Nawaz, Rao and Bukhari^42, Reference Setlak^44, Reference Watson, Singleton and Tippett^52, Reference Young⁵⁴ Mass dispensing indicates that fast distribution to a large population is required in the event of mass (or risk of mass) casualties.

Role subtheme 1.3 management of donations

Eight sources described donation management as a subtheme in supply chain management.Reference Currier, King and Wofford^33, Reference Hortman^38, Reference Kobayashi^40, Reference Rasheed, Nawaz, Rao and Bukhari^42–Reference Risoldi^43, Reference Vardanyan, Mosegui and Miranda^50, Reference Watson, Singleton and Tippett^52, Reference Young⁵⁶ Donated stock management is not outlined in the traditional stock chain management linear process and requires alternative procurement methods, quality assurance, and reporting rather than accessing national (or international) stockpile medicines.

Role subtheme 1.4 uphold and ensure policy, legal, and financial legislation

Five sources outlined this subtheme as a unique requirement in supply chain management, as the pharmacist’s role in distributing medicines or medical products by an EMT must comply with the national or international legislation at the location of the disaster response.Reference Ahmer Raza, Aziz and Noreen^25–Reference Alkhalili, Ma and Grenier^26, Reference Baig, Jyothi and Mudakavi^28, Reference Vardanyan, Mosegui and Miranda^50–Reference Villacorta‐Linaza⁵¹

Skills theme 1.4.1 knowledge of national and international legislation and policies related to pharmacists and medicines

Four sources stated that pharmacists may have differing role authorizations determined by national legislation compared with their organization’s country of establishment and must act according to the country of disaster or emergency response.Reference Alkhalili, Ma and Grenier^26–Reference Angelo and Maffeo^27, Reference Vardanyan, Mosegui and Miranda^50–Reference Villacorta‐Linaza⁵¹ Medicines, medical records, medical equipment, and consumables may also have different registration and importation legislation.

Role subtheme 1.5 – database management

Eight sources highlighted the requirement of database management to successfully fulfil the role requirement of supply chain management.Reference Alkhalili, Ma and Grenier^26, Reference Montello, Ostroff and Frank^41–Reference Rasheed, Nawaz, Rao and Bukhari^42, Reference Setlak^44, Reference Traynor^49–Reference Villacorta‐Linaza^51, Reference Young⁵³ Thorough and accurate record keeping is described as essential to fulfil the financial requirements of EMTs and produce reports, such as stock consumption reports and forecasting, and to ensure supply chain sustainability. Database management also includes the need for pharmacists to maintain patient clinical notes in patient medical records. This involves documenting the clinical assessment, management and treatment of patients using medical language that members of the multi-disciplinary team (MDT) can utilize as a communication tool to ensure continuity in patient care.

Skills theme 1.5.1 good use and knowledge of Information Technology (IT) systems

Utilizing electronic software to perform database management is listed as an essential skill in 2 sources.Reference Alkhalili, Ma and Grenier^26, Reference Traynor⁴⁹

Role subtheme 1.6 – quality control and assurance

Eight sources stated specifically that a requirement of supply chain management is to ensure that stock is reviewed for quality (within appropriate storage temperature, within the expiration date, visually homogenous), and that the quality will be maintained for the duration of prescribed use of the product.Reference Velazquez, Dallas and Rose^13, Reference Hassali, Dawood and Al-Tamimi^37–Reference Hortman^38, Reference Rasheed, Nawaz, Rao and Bukhari^42, Reference Shrestha, Kandel and Danekhu^45, Reference Watson, Singleton and Tippett^52–Reference Young^53, Reference Young⁵⁶ An example provided of quality control is cold-chain management, which is pertinent to ensuring the quality assurance of medicines that may be unstable outside of defined temperature parameters and also assessing the quality of medicines that patients may bring from home.

Theme 2: Role requirements – establishment and operationalization of a pharmacy

Twenty-five sources listed Theme 2 as a core role requirement of pharmacists within an EMT. This theme is described as finding a suitable location for the pharmacy (clean, sustainable electricity, appropriate storage, security, and ability to receive a high flow of patients).Reference Gershgol, Cantrell and Mutrux^4, Reference Velazquez, Dallas and Rose^13, Reference Alkhalili, Ma and Grenier^26–Reference Baig, Jyothi and Mudakavi^28, Reference Burnweit and Stylianos^31–Reference Kobayashi^40, Reference Rasheed, Nawaz, Rao and Bukhari^42, Reference Setlak^44, Reference Thompson^47, Reference Vardanyan, Mosegui and Miranda^50–Reference Young⁵⁶

Role subtheme 2.1 - management and leadership of a team

Twelve sources identified that to operationalize a pharmacy location, personnel management is required, including Human Resources (HR) and financial responsibilities, and the responsibility to ensure the team achieves the mission’s goals.Reference Gershgol, Cantrell and Mutrux^4, Reference Velazquez, Dallas and Rose^13, Reference Alkhalili, Ma and Grenier^26–Reference Baig, Jyothi and Mudakavi^28, Reference Cohen^32–Reference Feret and Bratberg^34, Reference Hassali, Dawood and Al-Tamimi^37, Reference Kobayashi^40, Reference Vardanyan, Mosegui and Miranda^50–Reference Villacorta‐Linaza⁵¹ The team may include other pharmacists, pharmacy students, and volunteers.

Skills theme 2.1.1 management and leadership skills

Five sources indicated that previous experience in management and leadership, or formalized training in this area, is necessary to fulfil the role responsibility of management and leadership of the team to operationalize a pharmacy within an EMT response.Reference Alkhalili, Ma and Grenier^26–Reference Angelo and Maffeo^27, Reference Currier, King and Wofford^33, Reference Kobayashi^40, Reference Vardanyan, Mosegui and Miranda⁵⁰

Role subtheme 2.2 – management of drug destruction

Three sources outlined the responsibility of ensuring that expired medicines, or medicines that are unused at the end of the mission, are appropriately destroyed due to potential exportation legislation, environmental, or safety risks.Reference Hortman^38, Reference Kobayashi^40, Reference Vardanyan, Mosegui and Miranda⁵⁰

Theme 3: Role requirements – stakeholder liaison and collaboration

Twenty sources outlined the pharmacist’s role in communicating with other members of the MDT or external organizations to contribute to the EMT successfully achieving its goals.Reference Gershgol, Cantrell and Mutrux^4, Reference Velazquez, Dallas and Rose^13, Reference Ahmer Raza, Aziz and Noreen^25–Reference Alkhalili, Ma and Grenier^26, Reference Baig, Jyothi and Mudakavi^28, Reference Cohen^32–Reference Feret and Bratberg^34, Reference Haffer, Rogers and Montello^36–Reference Hassali, Dawood and Al-Tamimi^37, Reference Kobayashi^40–Reference Rasheed, Nawaz, Rao and Bukhari^42, Reference Setlak^44–Reference Shrestha, Kandel and Danekhu^45, Reference Thompson^47, Reference Traynor^49, Reference Villacorta‐Linaza^51–Reference Watson, Singleton and Tippett^52, Reference Young⁵⁶ This theme is further subdivided into 3 subthemes according to the purpose of the communication.

Role subtheme 3.1 – Standard operating procedure (SOP) development and consultation

Fourteen sources discussed the necessity of the pharmacist utilizing pharmacy-specific expertise and training on medicines and legislation to ensure that consistent, transparent, ethical, and legal practices are adhered to by the entire MDT pertaining to medicines and pharmacy professionals within the team.Reference Gershgol, Cantrell and Mutrux^4, Reference Velazquez, Dallas and Rose^13, Reference Ahmer Raza, Aziz and Noreen^25–Reference Alkhalili, Ma and Grenier^26, Reference Baig, Jyothi and Mudakavi^28, Reference Haffer, Rogers and Montello^36–Reference Hassali, Dawood and Al-Tamimi^37, Reference Kobayashi^40–Reference Rasheed, Nawaz, Rao and Bukhari^42, Reference Setlak^44, Reference Thompson^47, Reference Villacorta‐Linaza^51–Reference Watson, Singleton and Tippett⁵² SOP describes the EMT “rules” of practice, which are also utilized as educational material to train new team members on expected standard practice while operating within the EMT

Role subtheme 3.2 – Liaison with government organizations, NGOs, and private-for-profit organizations

Fourteen sources described the requirement of the EMT pharmacist to communicate on behalf of the EMT with relevant external agencies, with examples such as communication with utility providers (to ensure electricity and water for the pharmacy location), medical representatives, local pharmacies, customs offices for importation of medicines, the media and local government offices.Reference Velazquez, Dallas and Rose^13, Reference Ahmer Raza, Aziz and Noreen^25, Reference Baig, Jyothi and Mudakavi^28, Reference Cohen^32–Reference Currier, King and Wofford^33, Reference Kobayashi^40, Reference Rasheed, Nawaz, Rao and Bukhari^42, Reference Setlak^44–Reference Shrestha, Kandel and Danekhu^45, Reference Thompson^47, Reference Traynor^49, Reference Villacorta‐Linaza^51–Reference Watson, Singleton and Tippett^52, Reference Young⁵⁶

Theme 4: Role requirements – direct patient care

Thirty sources discussed the pharmacist’s role in interacting directly with the patient in ways other than dispensing medicines within the supply chain management.Reference Gershgol, Cantrell and Mutrux^4, Reference Velazquez, Dallas and Rose^{13, 24–}Reference Alkhalili, Ma and Grenier^26, Reference Baig, Jyothi and Mudakavi^28, Reference Bratberg^30, Reference Cohen^32–Reference Feret and Bratberg^34, Reference Haffer, Rogers and Montello^36–Reference Young^53, Reference Young^55–Reference Young⁵⁶ This theme was subdivided into 9 subthemes and highlighted the key clinical knowledge recommended for pharmacists in EMTs.

Role subtheme 4.1 - management and assessment of diseases and health conditions

Twenty-two sources discussed the requirement of pharmacists to clinically assess casualties of emergency or disaster situations independently or collaboratively for pre-existing or new diseases or health conditions.Reference Gershgol, Cantrell and Mutrux^4, Reference Velazquez, Dallas and Rose^{13, 24–}Reference Baig, Jyothi and Mudakavi^28, Reference Feret and Bratberg^34, Reference Haffer, Rogers and Montello^36, Reference Kawataba^39–Reference Rasheed, Nawaz, Rao and Bukhari^42, Reference Setlak^44, Reference Thompson^46–Reference Traynor^48, Reference Vardanyan, Mosegui and Miranda^50, Reference Watson, Singleton and Tippett^52–Reference Young^53, Reference Young^55–Reference Young⁵⁶ The sources discussed that clinical assessment may include screening and triaging casualties for conditions, assessing chronic or acute disease or health condition state management, and then independently or collaboratively managing the condition utilizing pharmaceutical or non-pharmaceutical treatment.

Role subtheme 4.2 – patient counselling and education

Twenty sources stated that a core requirement of a pharmacist in an EMT response is counselling or educating patients on medicine usage, self-screening for symptoms of diseases, management of health conditions, management of potential adverse effects of medicines, and referral pathways for further care.Reference Ahmer Raza, Aziz and Noreen^25–Reference Baig, Jyothi and Mudakavi^28, Reference Bratberg^30, Reference Cohen^32–Reference Feret and Bratberg^34, Reference Haffer, Rogers and Montello^36–Reference Hassali, Dawood and Al-Tamimi^37, Reference Montello, Ostroff and Frank^41–Reference Setlak^44, Reference Traynor^48–Reference Watson, Singleton and Tippett^52, Reference Young⁵⁶

Skills theme 4.1.1 – disaster and emergency medicine training

Seventeen sources specifically described training and experience in the field of disasters and emergencies as unique knowledge necessary to fulfil Subtheme 4.1.Reference Gershgol, Cantrell and Mutrux^4, Reference Velazquez, Dallas and Rose^13, Reference Angelo and Maffeo^27–Reference Baig, Jyothi and Mudakavi^28, Reference Cohen^32–Reference Currier, King and Wofford^33, Reference Gaudette, Schnitzer, George and Briggs^35–Reference Haffer, Rogers and Montello^36, Reference Rasheed, Nawaz, Rao and Bukhari^42, Reference Setlak^44, Reference Thompson^46, Reference Traynor^48–Reference Vardanyan, Mosegui and Miranda^50, Reference Watson, Singleton and Tippett^52–Reference Young^53, Reference Young⁵⁵ Considering that disaster and emergency medicine training is a new field of medicine, such knowledge may be lacking from traditional pharmacy education and require addition to fulfil Subtheme 4.1.Reference Gershgol, Cantrell and Mutrux^4, Reference Velazquez, Dallas and Rose^13, Reference Angelo and Maffeo^27–Reference Baig, Jyothi and Mudakavi^28, Reference Cohen^32–Reference Currier, King and Wofford^33, Reference Gaudette, Schnitzer, George and Briggs^35–Reference Haffer, Rogers and Montello^36, Reference Rasheed, Nawaz, Rao and Bukhari^42, Reference Setlak^44, Reference Thompson^46, Reference Traynor^48–Reference Vardanyan, Mosegui and Miranda^50, Reference Watson, Singleton and Tippett^52–Reference Young^53, Reference Young⁵⁵

Skills theme 4.1.2 – knowledge of diseases and health conditions

Twenty-seven sources highlighted that to fulfil subtheme 4.1 and 4.2, the pharmacist must have clinical training or experience in the assessment and management of health conditions. This was subdivided into knowledge of 17 key medical fields listed in the following skills subtheme.Reference Gershgol, Cantrell and Mutrux^4, Reference Velazquez, Dallas and Rose^{13, 24–}Reference Baig, Jyothi and Mudakavi^28, Reference Bratberg^30, Reference Cohen^32, Reference Feret and Bratberg^34–Reference Hassali, Dawood and Al-Tamimi^37, Reference Kawataba^39–Reference Rasheed, Nawaz, Rao and Bukhari^42, Reference Setlak^44, Reference Thompson^46–Reference Traynor^48, Reference Vardanyan, Mosegui and Miranda^50–Reference Young^53, Reference Young^55–Reference Young⁵⁶

Skills subtheme 4.1.1.1 Clinical knowledge and experience in medical fields

Knowledge of 17 unique medical fields was identified in the included literature that pertains to diseases and health conditions: Chemical, biological, radiological and nuclear (CBRN) medicine (n = 14), first response training (n = 12), public health medicine (n = 10), epidemiology (n = 5), humanitarian principles (n = 1), infectious disease medicine (n = 12), administration of vaccinations (n = 10), pharmacokinetic and pharmacodynamic expertise (n = 4), critical care medicine (n = 2), psychiatric medicine (n = 2), sexual and reproductive health medicine (n = 2), psychological first aid (n = 2), dermatology medicine (n = 1), wound care management (n = 1), respiratory medicine (n = 1), laboratory and microbiological science (n = 1), and pediatric medicine (n = 1).

Role subtheme 4.3 – medicine administration

Medicine administration is not considered dispensing, and therefore is considered a separate role requirement under Theme 1 (n = 13).Reference Ahmer Raza, Aziz and Noreen^25, Reference Angelo and Maffeo^27, Reference Bratberg^30, Reference Currier, King and Wofford^33–Reference Gaudette, Schnitzer, George and Briggs^35, Reference Kawataba^39, Reference Montello, Ostroff and Frank^41, Reference Setlak^44, Reference Thompson^47–Reference Traynor^48, Reference Vardanyan, Mosegui and Miranda^50, Reference Watson, Singleton and Tippett⁵² Administration involves handing medicine to a patient and observing its intake, rather than the patient independently following the directions provided.

Role subtheme 4.4 – public health promotion

Nine sources described the pharmacist’s responsibility to promote public health to casualties of disasters or emergencies (to improve the overall health of the community).Reference Alkhalili, Ma and Grenier^26–Reference Baig, Jyothi and Mudakavi^28, Reference Hassali, Dawood and Al-Tamimi^37, Reference Rasheed, Nawaz, Rao and Bukhari^42, Reference Shrestha, Kandel and Danekhu^45, Reference Vardanyan, Mosegui and Miranda^50–Reference Watson, Singleton and Tippett⁵² Examples provided included the promotion of clean water, sanitation, and hygiene (WASH), and the use of personal protective equipment (PPE) to avoid disease transmission.

Role subtheme 4.5 – psychosocial support

Five sources stated that pharmacists are well-placed to provide informal psychosocial support to patients, such as reassurance.Reference Ahmer Raza, Aziz and Noreen^25–Reference Alkhalili, Ma and Grenier^26, Reference Hassali, Dawood and Al-Tamimi^37, Reference Montello, Ostroff and Frank^41, Reference Watson, Singleton and Tippett⁵² Psychosocial support is also described as screening patients for psychological distress and referring patients for formal psychosocial management by physicians or psychologists.

Role subtheme 4.6 – prescribing medicines

While the prescription of medicines is included in the supply chain management pathway, this role is traditionally undertaken by physicians or other accredited clinical team members according to local legislation. In a declared state of emergency, legislation may be altered to permit pharmacists to prescribe a defined list of medicines to help ensure that higher acuity patients are screened and prioritized to physicians for treatment prescription. Four sources described this scenario.Reference Angelo and Maffeo^27, Reference Shrestha, Kandel and Danekhu^45, Reference Watson, Singleton and Tippett^52, Reference Young⁵⁶

Role subtheme 4.7 – medication reconciliation

Four sources outlined medication reconciliation as a requirement of a pharmacist in an EMT response, which includes taking patients’ medication history and reviewing prescribed medicines to check for congruency, safety, and efficacy according to the patient’s medical history.Reference Gershgol, Cantrell and Mutrux^4, Reference Velazquez, Dallas and Rose^13, Reference Traynor^49, Reference Watson, Singleton and Tippett⁵²

Theme 5: Role requirements – response management and coordination (Incident Command System [ICS])

Five sources discussed pharmacists’ involvement in the ICS team.Reference Alkhalili, Ma and Grenier^26, Reference Baig, Jyothi and Mudakavi^28, Reference Cohen^32, Reference Kobayashi^40, Reference Shrestha, Kandel and Danekhu⁴⁵ The sources describe that the pharmacist may play a formalized role in the standardized international ICS emergency management structure, which is outlined in Figure 4.⁵⁸

Figure 4. The Federal Emergency Management Agency (FEMA) ICS Structure.⁵⁸

Role subtheme 5.1 – situational analysis and risk assessments

Four sources described that pharmacists were required to perform situational analysis and risk assessments for the establishment and operationalization of a pharmacy and for the entire disaster response.Reference Alkhalili, Ma and Grenier^26, Reference Cohen^32, Reference Kobayashi^40, Reference Shrestha, Kandel and Danekhu⁴⁵

Skills theme 5.1.1 – disaster and emergency medicine training

As ICS training is not within the traditional pharmacy curriculum, 3 sources discussed that formalized disaster and emergency medicine training is required to fulfil the role requirement of Theme 5.Reference Alkhalili, Ma and Grenier^26, Reference Cohen^32, Reference Kobayashi⁴⁰

The results of the individual sources of evidence have been collated and expressed in Table 2 within the Supplemental Appendix and in Figure 5.

Figure 5. Map of major themes and subthemes of role requirements and requisite skills and knowledge requirements. Figure 5 was created utilizing Canva Pty Ltd.