Before and after a disaster: What GPs need to know

Amanda Lyons

3/12/2018 1:47:14 PM

newsGP spoke with Dr Penny Burns about how GPs can best prepare for and respond to disasters, at a time when extreme weather events are likely to increase.

Australia has entered the global top 10 for economic damage caused by natural disasters – with more likely to be on the way. (Image: QFES Media)
Australia has entered the global top 10 for economic damage caused by natural disasters – with more likely to be on the way. (Image: QFES Media)

Large parts of Queensland are currently engulfed by flames, with more than 100 bushfires burning across the state and an ongoing heatwave expected to make conditions worse.
Sydney experienced flash flooding and two deaths last week during its worst rain event in 44 years.
Far North Queensland watches and waits as a tropical cyclone takes form just off its coast.
Australia has now entered the global top 10 for economic damage caused by natural disasters and, due to a changing climate, extreme weather events in our part of the world are only likely to increase.
Disaster preparedness is increasingly vital at every level of Australian medicine, including general practice. Dr Penny Burns is passionate about the issue, and is currently undertaking a PhD at the Australian National University to investigate the health effects of disasters and GPs’ role in supporting the local community before and after.
GPs have a role during and after a disaster strikes.
Dr Burns has advice on the ways GPs are helpful on the ground.
‘A key priority for GPs is keeping usual business going during a disaster – as every-day health needs continue even [then] – and expanding flexibly to accommodate increased numbers or different presentations and patient needs,’ she told newsGP.
‘This helps take the load off EDs [emergency departments] and other responders.
‘In larger, more catastrophic disasters, GPs may be required to respond to the site or assist at a temporary medical clinic or evacuation centre.’
There can also be specific health concerns for which GPs need to keep an eye out, depending on the type of disaster taking place.
‘Two early issues for GPs to identify in an acute event are increase in blood pressure in those with and without hypertension, and medication compliance,’ Dr Burns said.
‘In smoke-related events like the recent dust storm in Sydney and bushfires in Queensland, effects on those with pre-existing respiratory conditions will need to be considered, with either early evacuation or advice to remain inside and review of management including medications.
‘Also, smoke and dust can cover hundreds of kilometres, so it is not just GPs in the immediate area that need to be aware of the risks for their patients but also those on the edges of these events.’

Penny-Burns-Article-(1).jpgDr Penny Burns believes GPs are key to providing disaster medicine during and after emergency events.
Once the disaster event has passed, GPs’ efforts within the community can be extremely helpful in the next phase of treatment.
‘GPs have a role in supporting patients in acute distress, and with immediate need for medications and management of acute changes in their pre-existing medical conditions and lower acuity injuries,’ Dr Burns said.
‘GPs can identify those most at risk and make sure they are reviewed, as well as those whose distress is continuing and require further management or referral.
‘They are also aware of the family and community context so are able to monitor those who may have experienced substantial loss or bereavement.’
However, there is much that can be done before the disaster strikes. One of the key concerns of Dr Burns’ research is ensuring GPs are better involved and linked in to wider disaster planning and response systems.
But there is also plenty GPs can do on an individual and a practice level to prepare, and Dr Burns emphasises it is best to ensure this is done sooner than later.
‘Disasters are not always predictable, so although it makes sense to be more prepared in certain seasons – say, when cyclones and heat waves usually occur – it is also wise to be prepared in general with a yearly review and update of any disaster plan,’ she explained.
‘It doesn’t have to be extensive – GPs from Christchurch [New Zealand] who experienced their unexpected earthquake advise that a quick-and-dirty plan done on a piece of paper with the whole practice is better than nothing.’
Dr Burns believes that disaster planning for general practice involves three levels.
‘The practice-level for business continuity where disruption may range from a large storm causing power outages and flooding damage to the building, to large bushfires where unpredictable, rapidly-moving flames and smoke may result in inability to use the usual practice, leading to a need for an alternative site,’ she said. ‘Some practices have co-located with another practice in this situation.’
‘Secondly, yourself and your staff should have personal plans ready.
‘And not least, the patients, in particular those more likely to need assistance – the elderly, the isolated, those with multiple co-morbidities, those with children, those with animals.’
The RACGP offers a number of resources available to assist GPs in disaster planning:

  • Emergency response planning tool – assists GPs and practices to create planning templates and emergency response plans.
  • Managing emergencies in general practice is a guide to help practices manage preparation, response and recovery in disasters. This resource is also complemented by a range of factsheets of specific emergency-related topics, from extreme weather to assisting with mental health issues.
  • The Curriculum for Australian general practice contains a contextual unit on disaster management.
  • The RACGP’s independent learning program, check, offers a variety of units and case studies relating to treatment before and after disaster events.

disaster emergency medicine Emergency response planning tool ERPT


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Chris D Hogan   4/12/2018 11:41:58 AM

The hardest part of a disaster is recognising that a disaster is occurring. It is human to be so absorbed by what is happening in front of us that we do not pause and look at the bigger picture. The transition from an emergency (provide all resources to the person in front of us ) to disaster (help as many as we can) is traumatic & counter intuitive.
The more complicated our world becomes, the greater scope there is for chaos.
The best thing we can do for ourselves & our communities is plan & imagine what we can do to help whom we can in extraordinary circumstances.
In chaos our best assets are a clear head, comprehension of events & clear communication. First aid & reassurance are more important than high level resuscitation skills.
I speak as someone who was an active member of SES for 13 years & then a site medical coordinator for disaster mitigation planning & disaster response for 15 years for a state government. I have seen my fair share from bushfires , floods, sieges, police incidents, toxic spills, major vehicle collisions, transport catastrophes & air plane crashes and others that I choose not to recall.

D Kolos   4/12/2018 11:48:14 AM