An elderly woman had run out of medicine to treat her pulmonary embolism. Another woman with diabetes was "sleepy with blurred vision" after running out of insulin. Others couldn't renew prescriptions or find nutritional supplements they depended on.
Not long into the unrest of April and May, when 13 pharmacies in Baltimore were closed after looting and fires, top officials at the Baltimore City Health Department realized they had a public health emergency on their hands — and turned to their training in hospital emergency rooms to deal with it.
"It quickly became apparent that the skills we use every day in the emergency department were critical," wrote health commissioner Dr. Leana S. Wen and assistant commissioner Dr. Joneigh S. Khaldun in a new peer-reviewed article published by the Society for Disaster Medicine and Public Health. "This was what we called a 'code' in the hospital: an emergency scenario with an acute situation requiring an immediate and coordinated response."
Wen, a physician who has worked in multiple emergency rooms — including caring for victims of the Boston Marathon bombings while at Mass General Hospital — said the unrest presented myriad needs all at once, much like what occurs at an emergency room during a crisis.
During the worst of the April 27 rioting, the health department was called on to coordinate safe routes through the city with hospital emergency planners. It also had to evacuate a health clinic at the intersection of Pennsylvania and North avenues, where a CVS pharmacy was set on fire. As the dust settled, the destruction of so many pharmacies became evident.
The department created a hotline for people to call for assistance filling prescriptions. It blasted out information on social media. And when it realized older people most in need weren't getting those messages, it's staff "walked door to door." The department sent "informational letters to all physicians in the state" informing them how they could help, and eventually distributed more than 200 prescriptions directly to the most vulnerable residents.
"Nobody would have predicted that pharmacies would be damaged to the point that they would be closed. We didn't know that was going to happen until it happened," Wen said in an interview. "We adjusted to these needs."
After the unrest, the department identified its weaknesses — including "the need for improved communication with state partners and volunteers" — and set about closing gaps and improving preparedness, Wen and Khaldun wrote with co-author Katherine E. Warren, a Rhodes Scholar who was special assistant to the commissioner over the summer.
"Will another 'civil unrest code' come in? We don't know and certainly hope not," they concluded. "But we are confident our team will respond with the same energy, dexterity, and compassion that make us so proud to serve in the Baltimore City Health Department every day."