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In the event of mass casualties pray for help

By Anthony Bergin

Our healthcare services are inadequate and would not cope in the event of a large-scale disaster.

We've been very lucky in not having to face the big one; a catastrophic event that would produce extensive casualties such as a significant terrorist attack, large-scale industrial accident, a collapse of a city skyscraper, an air disaster, a tsunami hitting a big population centre or a flood in a densely populated area.

And we need to think about the health system's ability to cope with heatwaves. Heatwave is the silent killer, affecting the young, elderly and those with pre-existing illness. Last January's brutal heatwave in Victoria, when temperatures rose above 43C for three consecutive days, killed 394 Melburnians and many more across southeastern Australia. The three-day heatwave overloaded the health system and had a greater effect on the system than the bushfires at the time.

An ongoing heatwave, such as that experienced by Melbourne, that occurred across the country would challenge our healthcare services.

In developing our health recovery response to a disaster we face numerous constraints.

Most ambulance and hospital services are overstretched on a daily basis: overburdened operating theatres and emergency departments. Pre-hospital and paramedic capacity, along with medical and nursing shortages, will limit surge capacity for a large influx of the critically injured.

The number of Australian hospital staff and paramedics who have undertaken disaster training is extremely low. And we have very few people trained in higher level strategic leadership in health response to disasters and even fewer with hands-on experience in dealing with serious incidents.

Physical assets in Australian hospitals still don't meet US hospital preparedness benchmarks for mass casualty events.

Adequate numbers of ambulances will be a problem for most states in the event of a disaster. There are no formal protocols between the states for the deployment of paramedics and ambulances in a disaster.

We need comprehensive government surveys of national healthcare preparedness for large-scale disasters to be conducted on a regular basis.

National minimum standards for dealing with mass casualty disasters are essential.

Hospitals would then know what they were reasonably expected to be able to cope with and could plan appropriately. We won't know if we are ready for a catastrophe unless we really test the plans and resource capability.

The government should address inadequacies in national casualty airlift. These airlifts should be provided through contractual arrangements with one or more commercial carriers to supply suitably qualified flight crews and large passenger jets.

These commercial airframes must be rapidly transformed into large volume casualty transports by modifying them with critical care stretchers and other life support equipment and adequately trained staff.

Finally, we should establish a co-ordinated scheme whereby community based teams of volunteer medical and public health professionals donate their time and expertise to prepare for disasters at home.

According to an analysis by Munich Re, the reinsurance company, the number of weather-related disasters has more than doubled in the past 30 years. There were 828 weather catastrophes involving loss of life and economic damage globally last year, compared with 317 in 1980.

Disasters can't always be averted but we must do all we can to prevent the adverse health consequences that will flow from them.

Anthony Bergin is the co-author of Taking a Punch: Building a More Resilient Australia, published by the Australian Strategic Policy Institute.


Originally published by: The Australian on 04 Sep 2010