Bushfire disaster: How GPs can help

Matt Woodley

6/01/2020 6:06:41 PM

An unprecedented start to the bushfire season has pushed emergency services, communities and volunteers to breaking point.

Massive bushfire
The RACGP will this week meet with the Department of Health to raise the issue of greater support for GPs in affected communities.

Dozens of lives and hundreds of properties have been lost as out-of-control bushfires torch millions of hectares of land, while even major cities far removed from the immediate danger have been inundated with toxic smoke.
The widespread scale of the threat has led to five hospital relocations in NSW and, for the first time, Australian Medical Assistance Team (AUSMAT) specialists have been deployed domestically to help people in affected communities.
Thousands of Australians remain stranded in evacuation centres, some with no homes left to go to, while fears of a ‘mega-fire’ developing across the border of New South Wales and Victoria mean the worst may yet be to come.
In response to the crisis, state and federal governments have enlisted the Australian Defence Force (ADF), drafted in firefighters from the US, and provided 450,000 facemasks from the National Medical Stockpile.
However, there so far has been limited assistance or coordination for GPs providing medical care on the frontlines, or for those who would like to volunteer.
The RACGP will this week meet with the Department of Health to raise the issue of greater support for GPs in affected communities.
‘GPs should be included in emergency planning and responses, but are currently falling through the cracks because emergency planning and response is a matter for state governments, while general practice is covered by the Federal Government,’ President Dr Harry Nespolon told newsGP.

‘For years after the fires have been extinguished and the politicians have gone back to Canberra, GPs will be carrying the medical and mental support of those directly and indirectly affected by these extraordinary bushfires.
‘GPs have been doing truly amazing work under incredibly trying conditions. Yet reports from the frontline suggest there is an urgent need for more medical care in these areas, and the Government should be doing everything it can to help facilitate this assistance.
‘For example, there should be a comprehensive, centralised process to assist GPs who want to act as locums in affected areas so we can have medical care where it is most needed.’
Dr Nespolon said there also needs to be consideration of and advocacy for the financial and emotional toll the bushfires will have on rural practitioners.
‘GPs need to be able to provide quality care to those affected by fires without going broke themselves,’ he said.
‘Greater financial supports for GPs providing patient services to impacted people and communities, including through the Medicare Benefits Schedule [MBS], is one option.
‘The RACGP recognises climate change as a public health emergency. As fires like these become more common place due to climate change, it is important that we develop short-, medium- and long-term responses involving primary care to protect the health and wellbeing of our communities.
‘“Thoughts and prayers” are nice but we actually want to be there helping, and to do that we need information from people on the ground.

‘We will be contacting GPs in impacted communities to see how we can help, but I would also encourage any GP in need of more urgent assistance to contact the RACGP.’
Disaster medicine specialist Dr Penny Burns previously told newsGP one way GPs can help during disasters is to try and keep clinics running ‘as usual’ and, if possible, expand to accommodate increased numbers or different presentations.
‘This helps take the load off EDs [emergency departments] and other responders,’ she said.
‘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 … 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.’
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.’
More information for GPs impacted by bushfires can be found on the RACGP website, and the college can be contacted at 1800 472 247.
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Dr Linda Mann   7/01/2020 7:07:43 AM

I usually work in remote NT for a month a year. Kudos to the agency with which I have a contract for this, who have recognised my request to change that month to helping out in fire affected NSW. I am using RDN to find the right place

Dr Peter MacIsaac (rural locum GP)   7/01/2020 7:09:21 AM

Helping displaced people with ongoing medical review, scripts etc is something that many GPs will face - MyHealth Record is a potential source of information to cross check evacuee history and in similar disasters in the US such Health Information Exchanges have been invaluable. Time for all GPs to learn or dust off skills in accessing and contributing to MyHR.

Does the RACGP have an emergency response plan that it can immediately implement?
If so then the answers to many of the questions above would have been considered. If
Ask GPs about past emergencies, what they did, what was needed?

Talk to PHNs and rural workforce agencies - they have a role and are funded by Canberra to deal with GP input regionally. Last week I contacted a rural GP colleague outside the fire-zone, two regional hospitals and RWAV - still waiting to see where I can help individually.

Dr Morven Isla Crane   7/01/2020 8:57:46 AM

Medical staff who are sent in to assist need to be helped to do so through effective policies. One such policy is that individual General Practices should have an effective evacuation plan in case of the threat escalating in their immediate area. The medical staff going in will need accommodation and clear information about local referral networks. It will also be important to provide an opportunity for debriefing for these people.

A.Prof Christopher David Hogan   7/01/2020 9:19:53 AM

Australians shine in times of peril.
Harnessing & coordinating the incredible goodwill, experience & capability of General Practitioners is going to be a major task but oh so useful

Dr Irandani Anandi Ranasinghe-Markus   7/01/2020 11:24:35 AM

I am a Sydney GP but very happy to allocate some of my time to relieve our colleagues who have been under the pump dealing with victims of this crisis. Can we as a College please set up a volunteer roster on the college website where we may indicate our availability and where we can travel to so relief may be implemented?
Also, if the doctors on the frontline could possibly find a way perhaps through their practice staff to let us know if any medical supplies, drugs (which some of us may have in our sample cap boards) etc could be sent down, we could coordinate this too. I am happy to organise some of this. Please use my RACGP contact info to get in touch.
I am sure there are people on regular Anti-Hypertensives, hypoglycaemics etc which they’ve lost access to. Why don’t we coordinate our supplies and put our sample stocks to good use?
Fully support our president’s suggestion of an emergency MBS item that would be a relief to GPs doing a lot of this work.

A.Prof John William Kramer   7/01/2020 1:16:53 PM

GP's wanting to help in NSW should contact the NSW Rural Doctors Network on 02 4924 8000. A lot of work is happening right now to ensure that a coordinated response is made, particularly to address the medium and longer term needs that will continue long after the smoke and dust has settled. RDN, AMA,RACGP,RDA,ACRRM are all working together on this.

Dr Janice Faye Sheringham   7/01/2020 3:20:21 PM

In Victoria, GPs able to assist should contact RWAV and provide their contact details, experience/limitations and availability - for further details.

Dr Peter James Strickland   7/01/2020 7:43:00 PM

I want to remind the RACGP that there is no climate change emergency --- what is going on is climate VARIATION, and that goes in well-proven cycles outside Earth as well as here, and seen objectively by credible independent world scientists.
The problem with these fires is insufficient controlled burning in NSW, Vic and SA caused by policies of those State governments. The lesson was learned in WA in the Dwellingup fire in 1961, and ever since there has been few wild fires here in WA, i.e. due to controlled burning and use of heavy equipment to clear forest of excess debris and make fire-fighting tracks. My family was involved in this 1961 fire, and lives were definitely saved by my father-in-law (forestry officer) burning the large oval in Dwellingup for people to escape during that disaster. This 1961 history was forgotten ---regrettably!
The Commonwealth should fund ALL movement of medicos, pharmaceuticals and surgery facilities NOW as they did for me in Cyclone Tracy in 1974.

Dr Roger John William Parrish   12/01/2020 4:31:33 PM

I have recently retired (Oct. 2019) as a GP/Sports physician after 56 years of practice in Jamaica, Cayman Islands and Australia(50 years).
I would happily help within any areas of 100 km. of Wollongong which is where I live. I can no longer write scripts because I am officially off AHPRA list but see no reason why I could not use samples if they were available. Further more I would be "cheap" as unable to charge Medicare for my services!!

Dr Sameer Sikander Momin   14/01/2020 11:53:29 AM

I have contacted RWAV but was told they don't have a program to place me ( limited AON registration ) in Bush fire affected areas..