Providing care in an evacuation centre

• Surveillance and early recognition of emerging healthcare needs, including infectious or communicable diseases (eg COVID-19, influenza, gastroenteritis, scabies, wound infections etc). If seeing a number of cases, this would possibly require early notification and discussion with the public health unit

• Minor acute injuries (eg wounds, animal and insect bites, lacerations, soft tissue injuries, eye irritations, inflammatory skin conditions and rashes)
• Acute infections (eg cellulitis, upper respiratory conditions including otitis media/externa and tonsillitis)
• Non-severe respiratory conditions (eg croup, bronchiolitis, community-acquired pneumonia and asthma and chronic obstructive pulmonary disease)
• Gastroenteritis, urinary tract infections
• Chronic wound management where routine care is due and usual point of care is unavailable or there is acute deterioration
• Arthralgias and myalgias, including acute gout
• Medical emergencies as required at the time (eg withdrawal seizures, hypoglycaemia etc), noting the preference is to avoid these situations in an evacuation centre and, where possible, to refer at-risk patients early to other services for acute care management

• Management of distress, including provision of psychological first aid (PFA)
• Mental health first aid (MHFA) for deterioration of pre-existing mental health conditions such as anxiety or depression
• Trauma-informed care (TIC), acknowledging evacuees have experienced a traumatic event
• Referral to an onsite mental health team, or an individual’s local GP or other local community psychologists, where available

• Antenatal care and conditions
• Breastfeeding and bottle-feeding issues
• Review, management and referral of babies, infants and young children

• Management of people with exacerbations or deterioration of chronic or pre-existing medical conditions, particularly those at higher risk, such as people with:
  • diabetes (especially those with poor glycaemic control), gestational diabetes, type 1 diabetes
  • hypertension (especially those with an increased risk of myocardial infarction or stroke)
  • respiratory conditions exposed to environmental triggers, such as increased aerosolised particulate matter, contaminated water etc
  • older age (especially if any heat hazard, cognitive impairment, risk of falls, multiple comorbidities etc are present)

• If available, consider diphtheria–tetanus combination (ADT) vaccine in those with an immediate indication to administer. This may include recent injuries, especially where patients may be involved in clean-up activities.
• Where the close proximity of a number of people will increase the risk of spread of an infectious disease, awareness of vaccine-preventable diseases during the disaster will be important in an evacuation centre setting. Although it may not be practical to carry other vaccines onsite due to cold chain considerations, awareness of the potential risk of, along with knowledge of appropriate response to, the following will be important:
  • influenza
  • pneumococcal disease
  • COVID-19
  • locally relevant vaccine-preventable conditions such as measles.

• Provision and review of prescription medicines for continuity of routine chronic disease management. It is important to prevent the disruption of usual medicines that may have been disrupted due to:
  • reduced access or adherence to medicines due to evacuating without them or destruction in the disaster
  • reduced access to usual medicines and medical supplies, particularly those requiring special authorisation
  • acute exacerbations of chronic disease (eg increased blood pressure in those with hypertension, deterioration in glycaemic control in those with diabetes or deterioration of respiratory conditions particularly due to increased particulate matter from fire smoke)
• Provision of medicines for acute conditions, including tonsillitis and cellulitis, noting that local conditions following the disaster may mean that different organisations may be involved or specific specialist advice may be needed to manage appropriately (eg colonisation of wounds may not be due to the usually expected organisms)
• Occasionally, in certain circumstances, administration of medicines where pharmacy services are unavailable due to inaccessibility or service disruption, or when the safe storage of a particular patient’s medicines onsite is necessary (see Medicines management in evacuations centre under Recommendation 5: Supporting GPs to deliver care in an evacuation centre​)
• Dispensing of medicines needed to manage acute care needs, such as wounds exposed to flood water. Takeaway packs may be stored securely at the evacuation centre to use as clinically indicated and in line with local practises/specialist advice, noting limitations to prescribing as per Services that should not be provided in an evacuation centre

• Referral to other services, including:
  • services operating within the evacuation centre (eg St John’s Ambulance, mental health, alcohol or other drug (AOD), welfare/pastoral care)
  • the patient’s usual GP (possibly via telehealth)
  • another local, operational general practice
  • a local hospital emergency department for higher-acuity care
  • a relevant specialist or allied health provider (face-to-face or via telehealth), including pharmacists, physiotherapists, psychologists, community nursing and occupational therapists 

High-acuity injuries resulting from an emergency event should not be transferred to an evacuation centre for management by a GP. However, evacuation centres may be housing evacuees with unrecognised or emerging high-acuity injuries and medical conditions that then require triage and transfer for specialist care in a timely manner.

GPs have a variety of skills and experience, with some specialising in areas such as anaesthetics, obstetrics, palliative care and family planning. GPs should provide care that fits within their usual scope of practice.

In situations where GPs with additional specialised training are available, the services that can be provided safely in an evacuation centre may expand. Consideration should be given to the evacuation centre’s available resources, monitoring capability, patient privacy, infection control measures and the ability to respond to any complications or adverse reactions arising from this care.

On some occasions, telephone consultation with a specialist may enable further safe management in an evacuation centre. If in doubt, refer to a health service in a more appropriate setting. GPs attending evacuation centres are able to determine whether patients require additional healthcare that cannot be provided safely in an evacuation centre (or that is outside the scope of practice in an evacuation centre setting) and should be transferred to the relevant hospital or health service for assessment and management.

However, the following services are considered inappropriate in most scenarios and should be avoided whenever possible by GPs working in an evacuation centre:

• provision of high-acuity acute care that would normally require emergency department referral or tertiary healthcare services
• management of AOD withdrawal, including providing replacement prescriptions for methadone
• provision of routine care of a stable chronic condition that can be, and usually is, attended to by the patient’s usual GP or usual local outpatient department
• delivery of babies (unless it is unplanned, within the scope of practice of the GP and unavoidable in the situation)
• fracture management that requires imaging, plastering or specialist intervention unless unavoidable due to the situation and resources (eg plaster) are available
• management of patients with severe chronic conditions, including those that may sometimes be managed at home, but with particular specialised equipment (eg respiratory ventilator support at night); these patients should be relocated to an appropriate tertiary healthcare facility
• any service that is non-urgent and likely to be time consuming or use limited resources, impeding the care provided to other evacuees
• any service outside the scope or comfort of the attending GP

As part of providing care in an evacuation centre, you will need to document clinical consultations.

It is important to note in the initial hours or days of an evacuation centre’s operation, it may be challenging to take any record of clinical consultations. The benefit of providing emergency care to a patient may outweigh any risks from not documenting the encounter.

The way clinical care is documented will depend on the level of access to appropriate resources, including power and the internet. This may not be known until the evacuation centre is operational.

Consider the following options for documenting clinical consultations:

When electronic devices (eg smartphones, tablets or computers), internet and/or electricity are not available

• Use paper forms, which could be provided by the PHN. At least two copies are required (using carbon paper, a photocopier or other method). One copy would be kept by the consulting GP and included in their usual practice records and one copy would be provided to the patient to be passed on to their usual GP. It is important to maintain confidential storage of paper records at all times.

When internet, electricity and electronic devices are available

• Consultations can be recorded electronically on a local device. This may be on a template provided by the PHN or via a secure web form if no clinical information system software is available.
• If access to a clinical information system is available and a patient has a My Health Record, the consultation could be documented in the form of an Event Summary and uploaded to the patient’s record. It is then not necessary to provide a hard copy to the patient, unless feasible and requested by them. If a patient does not have a My Health Record, a copy of the consultation notes should be provided to the patient via a printed or emailed copy.

It may sometimes be necessary to maintain a deidentified list with the details of each consultation for tracking and administrative purposes. Some jurisdictions will require a copy to be provided to the local health authority (either as a complete record or as part of a summary list of patients consulted in the evacuation centre) for recording in the emergency medical system as a record of events. Any patient data is confidential and transfer to any other party needs to be carefully managed.

You can use an end-of-shift patient list form to handover to incoming clinicians or provide a verbal handover briefing at the end of your shift.