Applying lessons learnt in the Lismore floods

In disaster management they talk about the cycle of mitigation and prevention, preparation, response and recovery.
 
And to call it a cycle is accurate – we always learn lessons from one event that we can apply to another, and often the phases overlap as life goes on and new events happen while we’re still recovering from the last.
 
My town of Lismore knows this all too well.
 
Still recovering from the floods of 2022, like much of the East Coast of Australia, in March this year we were faced with the looming Cyclone Alfred and the real prospect of another flooding event.
 
My practice sits on the outskirts of Lismore, up on a ridge, and outside of the flooding zone.
 
While this gives us some protection from physical flooding, we are not immune to other impacts of severe weather events such as loss of power, damage to infrastructure or cutting off of physical access to the practice for both patients and our team. Let alone the social and emotional impacts.
 
Luckily Alfred’s impact wasn’t as severe as anticipated and while there was increased rainfall, the levee wall wasn’t breached, sparing the town from another devastating major flood.
 
Ultimately local systems weren’t overwhelmed. But we were able to apply lessons learned from the 2022 floods that had us better prepared to respond to Alfred and its potential impact on our community.
 
Some key themes stood out.
 
Preparation
Unlike 2022, this time we had warning and time to prepare – both as a practice and as a community.
 
Sandbags were filled. Evacuation centres were set up. People knew what to do and where to go. Our practice Emergency Response Plan was up-to-date, tested and enacted. We knew who in the practice team was going to be available and who wouldn’t be.
 
We were able to communicate with our patients in the lead up to and throughout the event. 
 
While the advance warning meant the community was prepared and potential impacts were mitigated, the prolonged anticipation of the cyclone caused stress and anxiety among residents, many of whom are still living with the impacts of the 2022 floods.
 
This event was triggering for many and a reminder of the need for ongoing supports in disaster effected communities, not just for infrastructure, but also for peoples’ physical and mental health.
 
Backup power supply
Our practice’s location on the power grid means we often loose power during weather events – severe or not.
 
Back in 2020 our practice invested in a backup power system which included solar panels, batteries and a back-up generator, all of which have allowed us to operate during power outages, and which got us through the days of Alfred.
 
The system has also minimised vaccine wastage by preventing cold chain breaches. 
 
As long as the sun is shining or we have petrol, we can continue to keep the doors open and consult with patients.
 
From a practice viability perspective, it is one of our best investments to date. 
 
Collaboration and collegiality
An unexpected privilege of being located on the ridge and outside of the flooding zone is our ability to provide infrastructure support for our colleagues on lower ground.
 
In preparation for potential flooding, our IT provider, knowing we had reliable backup power supply and space, asked our practice to host IT infrastructure from other healthcare providers within the flooding zone.
 
Thanks to an IT upgrade a few years back which involved swapping our large servers for smaller slimline devices, we had the physical space in our racks to accommodate this and servers from other practitioners were quite literally picked up and placed alongside our own.
 
This sharing of resources allowed multiple healthcare providers to continue operating during this period, meaning the Lismore community had continued access to essential healthcare throughout, and health records and practice data were protected.
 
Thanks to a well-established network of practice managers in the area we were able to keep up-to-date on how other primary care providers in the area were faring.
 
This was essential for ensuring appropriate referral and triage of our patients.
 
As many practices exist as standalone businesses that are not officially coordinated during the emergency response, established networks like these and their coordinating power are invaluable.
 
Continual reassessment and remaining agile
In the lead up to Alfred making landfall, and during those days of severe weather, our practice team conducted twice daily reviews of the situation.
 
We adjusted our operating hours and services based on the availability of our team members, our patient’s needs and the advice of emergency services.
 
As the rain increased some of our team couldn’t physically access the practice, so we had to reduce our availability.
 
With fewer patients able to get to the practice as well we could still provide necessary services safely.
 
Telehealth appointments were available for those who couldn’t make it in person, and we continually updated our website and phone message with our operating status and service availability.
 
Evacuation centre coordination 
One of the greatest improvements I witnessed and got to experience firsthand, was the coordination of emergency evacuation centres.
 
Before joining the RACGP Expert Committee for Practice Technology and Management earlier this year, I was able to share my experiences of volunteering in an evacuation centre in Lismore in 2022 as part of a project developing key recommendations for the inclusion of GPs into evacuation centres and information for GPs working in evacuation centres.
 
While I didn’t expect to see these in action only a year later, it offered an excellent opportunity to evaluate the resources and experience firsthand learnings being applied.
 
With early notice of Alfred’s approach, our local Primary Health Network sent out an expression of interest for GPs to volunteer at the evacuation centre. With my experience from 2022, I worked with them coordinating several volunteer GPs from my own and other practices, to ensure coverage over the critical weekend period.
 
With the main evacuation centre in Lismore based out of Southern Cross University we were able to gain access to the health clinic within the university building.
 
We used this space to great effect in 2022 and with knowledge of that success, and through the relationships we had built, we were again able to access the clinic early so we were fully operational before the critical weekend kicked off.
 
This provided a more appropriate environment for health consultations than the basketball court where the evacuees were congregated.
 
The Local Health District (LHD) provided crucial staff including community nurses, a drug and alcohol nurse practitioner, and mental health nurses to support the evacuation centre.
 
These services were crucial in managing minor injuries, wound care, and mental health needs and they were on the ground from day one.
 
With the LHD providing laptops, we were able to use the NSW Health Electronic Medical Record for documentation at the centre.
 
This was a significant improvement from the paper notes used in 2022 and allowed for better record keeping. Unfortunately, those records still don’t make their way to the patients usual GP and that is something that should be worked on before the next event to ensure continuity of care.
 
Our thoughts and prayers are with our colleagues and the communities of the Mid North Coast who have dealt with the impacts of yet another flood disaster.
 
I would also once again call for general practice to be formally integrated into the state emergency response apparatus.
 
The RACGP has developed a suite of resources to support general practices in the prevention of, preparation for, response to and recovery from emergencies and disasters, with a major update to the Managing emergencies in general practice resource.
 
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