Anaesthesia and critical care in unusual and transport environments SIG
ANZCA AUSTRALIAN DISASTER RESPONSE TASKFORCE REPORT, FEBRUARY 2006
CG Merridew
Launceston General Hospital, Launceston, TAS
ANZCA Council accepted the Taskforce’s recommendations that ANZCA:
- Set up and manage a Disaster Response database of available Australian Fellows.
- Specify a set of field anaesthesia apparatus to be held in most teaching hospitals for regular use by Fellows who are likely to participate in disaster responses, and by trainees.
- Fellows responding to a disaster have support at least equal to that for ADF medical personnel in the Commonwealth Defence Rehabilitation and Compensation Act 2004.
- Promote the integration of private hospitals into disaster responses.
- Promote the inclusion (in all tendering jurisdictions) of senior Fellows at a senior point in the tendering process for anaesthesia, ICU and retrieval-related equipment.
- Council provide disaster-related advice to the Australian Health Disaster Management Policy Committee (AHDMPC) and state Chief Health Officers.
- Help develop large-scale mobile resuscitative surgery and retrieval facilities, without which disasters of only modest scale can be managed adequately.
- Involve its Developing Country Special Interest Group (SIG) and Anaesthesia, Critical Care, Unusual and Transport Environments (ACCUTE) SIG in pre-planning Disaster Response.
- Develop Disaster Response guidelines addressing domestic and international disaster response for individual Fellows and for hospital Departments of Anaesthesia.
- Allocate MOPS points for training with field apparatus and for work in disasters.
- Specify Field Anaesthesia as part of an advanced training module.
- Recommend that Disaster Response Fellows should be EMST-qualified.
- Recommend that Fellows with leadership roles in Disaster Response should have completed the MIMMS course or its equivalent, and be EMST-qualified.
- Collaborate with RACS to seek synergy in disaster policy.
- Promote standardised disaster response Conditions of Service for Fellows.
- Pre-plan accelerated credentialing of Fellows undertaking disaster-related work in public, ADF and private medical facilities in Australia and overseas.
- Assist the ADF to deploy civilian Fellows.
- Acquire medical intelligence about Oceanian and SE Asian countries which may seek disaster assistance from Australia, or offer their assistance to Australia.
- Forward to Hong Kong, Malaysian, Singaporean and South Pacific Anaesthesia and Intensive Care Medicine peak groups the ANZCA Council’s approach.
- Seek legal advice regarding ANZCA’s liability in assisting Fellows to serve in potentially dangerous circumstances associated with disaster relief.
ANZCA/JFICM strategies for effective sustainable disaster response
- Define the participatory roles available to Fellows in disaster response:
- Pre-disaster: Self-preparation; planning; teaching; equipment
- Response: Locations; starting time; roles; duty duration
- Post-response: Equipment return; report writing; system revision
- Establish and maintain a database of available Fellows
- Establish suitable conditions of service for Fellows who do disaster work (including that in private hospitals), by committee activity among ANZCA, JFICM, RACS, ASA, ANZICS, AAS and AMA, together with appropriate government bodies
- Assist preparing individual Fellows for disaster response
- Develop Fellow-mobilisation algorithms, to mesh with government plans.
- Assist in post-disaster support of individual Fellows, as required.
- Advise government disaster-response bodies about materiel relevant to anaesthesia/ICU/retrieval. ANZCA materiel-related advice includes:
- Generic lists, with commercial products specified when appropriate
- Expandable capability using modules (extra items; extra quantities)
- 1st Level: A basic set in each public hospital, for elective regular use.
- 2nd Level: An expanded set, held at Medical Retrieval bases.
- 3rd Level: In state stores, to hold and supervise modules, some of which have broader range of items and other modules merely of larger quantities
- 4th Level: Standardise equipment implementation Australia-wide
- Contribute to pre-planning large-scale facilities for resuscitative surgery and retrieval, eg in shipping containers, trains, ships and large civilian aircraft
ANZCA/JFICM Fellows’ Contributions to Disaster Response at Present
- The ANZCA/JFICM governing councils have no defined disaster-related roles.
- Australia-wide up to about 300 individual Fellows (independent of ANZCA/JFICM councils) have committee, command or clinical roles in:
- Civilian medical retrieval
- Hospital-based disaster structures
- City or regional disaster structures
- State Health Department structures
- The Australian Defence Force (ADF)
- Non-Government Organisations, eg ICRC, MSF
- The inaugural National Trauma Centre, a combined Federal & NT capability being developed at Royal Darwin Hospital
- Federal departmental structures, eg Emergency Management Australia
- Australia’s public hospitals have little reserve clinical capacity.
- The ADF has only limited ability to augment public hospitals
- Private hospitals can augment public hospitals even less than the ADF can, because disaster-related funding arrangements do not enable timely major recruitment of the large existing surgical and ICU capability of private hospitals
Current Deficiencies in ANZCA Training Related to Disaster Response
- EMST is not compulsory, despite its value in disaster trauma work.
- There is little emphasis on:
- Triage beyond EMST training. (Standards Australia’s inaugural triage algorithm for mass casualties will be promulgated in 2006).
- Drawover techniques, ketamine and clinical monitoring.
- Individual preparations relevant to deployment.
Major Incident Medical Management Support (MIMMS) leadership course
Taskforce members
- Dr George Merridew FANZCA, FFPMANZCA (Chair; co-opted to RACS)
- Dr David Scott FANZCA (Deputy Chair)
- Dr Kevin Baker FANZCA
- Dr Roger Capps AM, RFD, FANZCA
- Dr Bernard Hanrahan FANZCA
- Dr Ken Harrison FANZCA
- Dr Allan MacKillop FANZCA, FFPMANZCA
- Dr John Moloney FANZCA
- Dr Geoff Mullins FANZCA
- Dr Blair Munford FANZCA
- Dr William O’Regan FANZCA, FJFICM
- Dr Brian Pezzutti RFD, FANZCA
- Dr Diane Stephens OAM, FANZCA, FJFICM
- Dr Peter Tralaggan FANZCA
- A/Professor Bruce Waxman FRACS (Co-opted from RACS)
- Ms Cherie Wilkinson (Secretary)
Advice was available to the Taskforce from the following consultants:
- Dr Athanasios Flabouris FANZCA, FJFICM
- Dr Steve Kinnear FANZCA
- Dr Richard Morris FANZCA
- Dr Haydn Perndt FANZCA
Time of Presentation
Saturday 13 May 2006 - 1530-1700
