How can GPs best prepare for – and respond to – disasters?

Australia is a land of fires, floods, cyclones and drought.
 
That, disaster medicine specialist Dr Penny Burns believes, puts GPs in a key role in responding to disasters – especially as an affected community goes through the long recovery.
 
But a key issue, according to Dr Burns, is that official responses to disasters often do not connect with or involve GPs, meaning GPs need to do their own planning for the likeliest events in their region.
 
‘The issue we have at the moment is that there’s an organised response that takes place, but it doesn’t link well to GPs. There’s lots of work going on right now to improve that linkage, but it’s only happening slowly,’ she told newsGP.
 
Dr Burns, Deputy Chair of the RACGP Specific Interests Disaster Management network, said communication between those running disaster response and GPs has improved considerably in the case of pandemics.
 
‘But for bushfires and floods, our messaging to GPs is still evolving,’ she said.
 
Dr Burns said New Zealand is ahead of Australia in terms of primary healthcare disaster communication.
 
Health boards around Auckland last year introduced software tools to streamline and prioritise information flows between government agencies and primary healthcare professionals like GPs and pharmacists.
 
For now, Australian GPs have to plan ahead for disasters and respond individually or within their practice.
 
‘The thing GPs do well in the recovery is continuity and coordination of care, especially when there’s chaos, with lots of different temporary healthcare providers – emergency responders, counsellors, case workers and NGOs [non-governmental organisations],’ Dr Burns said.
 
‘That’s when GPs have a key role in providing continuity of care.’

Dr Penny Burns said the effects of a disaster can be ongoing and many, such as drought, have a ‘long mental health tail’.
 
GPs also remain on the frontlines of a disaster well after the event itself has taken place.  
 
‘After a disaster is when GPs come to the fore, when the community is still recovering but everyone else has left,’ Dr Burns said.
 
Many disasters have a long tail, she said, with mental distress and illness, post-traumatic stress disorder (PTSD) and chronic diseases often trailing on for years after a major event.
 
‘Drought is a particularly difficult one, with that long mental health tail. GPs have a key role as a local, trusted health provider. When you’re in distress, people want to see a trusted face,’ Dr Burns said.
 
‘GPs are in a key position to identify who does need more help, from anxiety and depression to  traumatic bereavement or PTSD, to increased substance use or domestic violence.’
 
This does not mean, however, that GPs do not still have a crucial role in the early days as well, Dr Burns said, particularly in response to exacerbations of patients’ chronic conditions.
 
In the case of the 2013 bushfires in the Blue Mountains west of Sydney and the 2010–11 Brisbane floods, Dr Burns said many GPs responded immediately.
 
‘One GP was seeing patients in a church. He organised a small group of GPs who were then managing patients,’ she said.
 
‘In the first few days, there’s a lot of care needed around managing chronic conditions. Those with chronic conditions need their medications and may have an increased risk of exacerbations or deterioration, so they need monitoring. This is especially true for those with hypertension and diabetes.’
 
Dr Burns believes all GPs could benefit from doing a quick planning session to identify the disasters most likely to hit their communities, and map out how they might best respond.
 
‘At times of such high stress, you don’t usually problem-solve as well. So one of the ways we can help is to plan and to prepare,’ she said. ‘That’s why sitting down and going through the process helps.
 
‘Here I am, surrounded by bush, so the most likely [disaster] is a fire. Now, say it’s 9.00 am with patients in the waiting room and I get the message a fire is coming and we need to evacuate. What would I do?
 
‘You just need to do this once – who you’d call, where you’d go, what would you do.’
 
The RACGP has an Emergency Response Planning Tool (ERPT) designed to help general practices prepare for, respond to and recover from emergencies and pandemics.
 
Dr Burns said a rough plan on pen and paper is also worthwhile.
 
‘I spoke to a number of GPs after the 2011 Christchurch earthquake [in New Zealand]. Their recommendation was very strongly to sit down and do a quick and dirty one-page plan,’ she said.
 
‘They weren’t expecting that quake, but they had prepared for a SARS-like outbreak, and planning for that disaster built relationships with disaster response [personnel].
 
‘So when the quake struck, they were integrally involved.’  
 
It is also common for other health events to strike disaster-affected communities.
 
‘Other things hit after the initial event. After the fire, there might be flooding or a downturn in local industry. After the 2009 Victorian bushfires, there was the swine flu pandemic,’ Dr Burns said.
 
‘As GPs, you’re an important medical member of your community, walking through the ups and downs with them.’

disaster management disaster medicine emergency response ERPT