GPs on the firefront ‘ignored’ by authorities

Matt Woodley

7/01/2020 4:32:59 PM

Amidst the trauma, GPs have been forced to improvise ad hoc solutions to provide basic care for patients in need.

Bushfire evacuees
According to GPs on the ground, most people in need of medical are best served by GPs who know the community. (Image: AAP)

No insulin. Lost prescriptions. Minor scrapes. Smoke inhalation.
These are the typical presentations at most evacuation centres in areas around the country that have been devastated by this summer’s unprecedented bushfires, according to GPs on the ground.
Yet primary care has taken a back seat to services that appear to have received much greater logistical support from governments and disaster relief agencies.
‘What we’re finding is that the role of primary care isn’t really being integrated into any sort of emergency response … the role of the GP is again [being] ignored,’ Kangaroo Island GP Dr Tim Leeuwenburg told newsGP.
‘The response tends to be ambulance services, which are fantastic. But … we’re not overwhelmed with critically unwell people needing emergency consultants and retrieval specialists.
‘We need GPs on the ground who know the community.’
New Year’s Eve saw a fast-moving fire tear through around 100,000 hectares of bushland on the western end of South Australia’s Kangaroo Island, destroying dozens of houses and costing two lives. Dr Leeuwenburg wasn’t spared from the devastation – he lost a holiday home – but said it is nothing in comparison to the long-term impact it will have on many across the island.

‘We had fires in 2007 … but nothing on this scale. We lost a third of the island in about four hours,’ he said.
‘It was like an inferno, a nuclear bomb going off out there … there’s major, major damage to infrastructure. We’ve got farms that are devastated, and we’ve probably got 50 or more houses lost, with consequent homelessness.
‘The psychological impacts for a small community, the loss of tourism and farming, will probably affect us a lot more than some of those other places.
‘In a few weeks’ time the media will have moved on, the Australian Defence Force will have left, the emergency responders will have left, and [GPs] will be the ones counselling them through the trauma.’
Dr Leeuwenburg said it is this long-term connection GPs have with locals, combined with the high demand for primary care during disaster situations, which should see GPs embedded in emergency plans of all descriptions across the country – particularly in rural areas.
‘It’s very tempting to get focused on these big events – bushfire, tsunami, earthquake, cyclone – but you’ve got to start at a local level and that really means integration with state-based ambulance services,’ he said.
‘There are times when having a well-trained, particularly rural GP, somebody with a broad skillset, can value add on the scene of a local car crash, for example.
‘Now, once you’ve got that system established, it generates a resilient system for state-based emergencies. You generate that network, and then you’ve got a cadre of people you can call upon [during disasters] that are already part of the service.
‘At the moment we’re invisible.’
While not as directly affected by the flames, Nowra-based GP Dr Kate Manderson had a similar experience during her time volunteering at St Georges Country Club evacuation centre over the weekend.
‘We weren’t fully smashed like some of the other towns that had really active fires everywhere, but the centre manager said there were about 1000 people who came through,’ she told newsGP.
‘Saturday and Sunday we only had about 20 people that came to us that really needed any medical assistance. They were all primary care.’

Nowra-based GP Dr Kate Manderson has been frustrated by the lack of assistance GPs have received to help provide primary care to the community during the fires.

Dr Manderson said about half the presentations were related to the high levels of smoke blanketing the area, while about a quarter were people who did not have access to their usual medication.
‘The final quarter were minor trauma. [For example], a woman fell over and probably cracked her elbow, but rather than her driving 30 km into town, I put a plaster on it so she could wait until Monday for an X-ray to be open locally,’ she said.
‘Another was a firey who fell and cut his face open. So we stitched him up instead of having him go back into town, which meant he could go back out on his crew and keep fighting the ember attacks at Basin View.
‘There are a lot of things that could be better treated by a local GP, even when we’re not in disasters, which do end up in a hospital. But in times like this, when the clear direction from the emergency services is to stay off the roads … that’s definitely when you need to tap into GPs.’
Dr Manderson has been frustrated by the lack of assistance GPs have received to help provide primary care to the community during the fires, and has called for a standardised national framework for the engagement of GP teams in support of isolated communities during disasters.
‘That would include standardised clinical protocols and pathways, and legislation that allows collaboration with the hospitals and the ambulance services,’ she said.
‘It would also include standardised equipment so that if I had to go down to Sussex Inlet, the bag there is the same as the bag that’s in my clinic, is the same as the bag that’s in Townsville.’
Such a system would allow GPs to avoid the situation Dr Manderson found herself in over the weekend, where she was again reliant on an ad hoc solution just to get basic medications.
‘Things like antiarrhythmics, antihypertensives, hypoglycemic agents … I really need to thank Choice Pharmacy at Vincentia. The proprietor, Ali Nazim, rang me as soon as he heard that I was on call and he said, “Dr Kate, what do you need? What do you want?”,’ she said.
‘[Fortunately] I at least got them in the interim … [but] if this event can’t be a catalyst for our state and federal governments and professional bodies to get together and sought out something, then I don’t know what it’s going to take.’

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Dr Simon Mark Holliday   7/01/2020 10:54:31 PM

In the Taree fire crisis, our GP practice workforce was reduced to one GP Registrar and myself. Many of our practice’s patients needed remote support because they couldn’t get in to Taree and we were also trying to support out of area visitors who were unable to access their regular medications or service providers. As several of the other practices were closed, we were receiving requests from nursing homes to admit other practices’ patients who had been discharged from hospital. I also was dealing with patients of the public drug dependency clinic with similar problems.
We knew the Manning Hospital would be inundated. So, we rang and offered to take any patients presenting at the ED who could be seen by a GP. This achieved minimal results.
Since then, I wrote to Council and HNE Health to request establishing a regionally co-ordinated emergency response involving input from the public and private Hospital, GPs & nursing home for future disasters and the sequelae.