Key recommendations for the inclusion of general practitioners into evacuation centres

Key recommendations

Recommendation 5

Recommendation 5: Supporting GPs to deliver care in an evacuation centre

Providing care in an evacuation centre includes responding to emergencies, the appropriate management of medicines, documenting episodes of care and ensuring patient details are kept confidential and secure.

Healthcare provision by GPs should generally be reserved for evacuees taking shelter in the centre. An evacuation centre is not equipped to be a temporary emergency department, nor a makeshift general practice. Generally, GPs should not be responding to routine chronic care management unless delay would cause preventable deterioration in a patient’s health. Routine health matters should be managed by the patient’s usual GP face to face, or via telehealth, at a later time.

Organisations operating evacuation centres need to be aware that GPs providing care in evacuation centres will:

  • only provide care they feel comfortable with, and that falls within their normal scope of practice, similar to care they would provide in their usual practice or home visit setting
  • recommend the transfer of patients presenting with health issues that cannot be appropriately cared for in the evacuation centre to the nearest appropriate facility (eg hospital emergency department, acute care facility or operational local general practice)
  • avoid imaging and pathology requests due to challenges regarding the follow-up of results and continuity of care
  • refer any time-critical testing to a local emergency department or an operational general practice.

Patient safety and support during a disaster is important. Those who genuinely cannot access care elsewhere could receive care at their evacuation centre as a last resort.

Part B of this guide provides a comprehensive list for GPs on what services should and should not be provided in an evacuation centre.

I attended the evacuation centre in Bega during the 2019 Black Summer bushfires and the majority of clinical presentations were straightforward and involved such things as script replacements, psychological first aid, asthma exacerbations and eye problems. There were several logistical challenges, such as accessing incontinence pads for a disabled child or formula for an infant. I felt the main benefit of my visit was the calm instilled in the evacuees knowing there was a GP on hand.

– Dr Louise McDonnell


Managing medical emergencies in evacuation centres

The deterioration of medical conditions can happen in any setting. Medical emergencies such as cardiac arrest, seizures and acute drug withdrawal may occur within an evacuation centre.

To support GPs to respond to medical emergencies, evacuation centres should provide:

  • a defibrillator
  •  a physical environment that allows privacy for the patient and safe passage for emergency personnel to access them if required.

Although GPs can provide initial basic life support, these medical emergencies may require greater resources and access to tertiary healthcare, and should be escalated urgently via emergency services for transport to the nearest, or most appropriate, emergency department.

Medicines management in evacuation centres

Planning for the management of medicines within an evacuation centre needs to be done prior to a disaster or emergency event and should include:
  • resources required to store medicines securely onsite
  • protocols for offsite storage, including transportation, security and storage location
  • a dispensing register and protocols for Schedule 8 (S8) medicines.

Arrangements could be made for medicines to be stored offsite at a local pharmacy or operating general practice and brought into the centre during times when GPs are onsite.

Planners will need to consider that there may, however, be situations where the storage of personal medicines needs to occur in an evacuation centre. Although the management of personal medicines in these situations should be the responsibility of the evacuee, GPs and nurses may be called upon to provide assistance (ie where there are risks to the storage of some medicines, such as drugs of dependence [eg S8 medicines] or medicines requiring special storage, such as refrigeration).

In rare circumstances where an evacuee's personal medicines may need to be stored in an evacuation centre, and only when there is capacity to safely do so, the medicines should be:

  • kept within their original packaging or a pharmacy Webster-pak®/blister pack
  • marked clearly with the person’s name and date of birth
  • added to a register of stored medicines
  • safely locked away out of reach.

Access to the medicines should be restricted to GPs or other clinicians only and provided to the patient after their identity has been confirmed.

A lockable storage area and medicines register book/paperwork should be provided to enable this secure storage.

Documentation of clinical consultations at evacuation centres

Methods for documenting clinical consultation and handover (whether it is handover to another GP within the evacuation centre, back to the patient’s usual practice or to other medical services) should be considered during planning.

Planners should consider:

  • providing options for documenting clinical consultations, including paper forms (carbon paper) or electronic forms
  • how patients can access a copy of the consultation notes to provide to their usual GP, or a GP who will be providing them with ongoing care
  • that any patient data collected is confidential and needs to be secured to protect patient privacy.

More information about documenting clinical consultations in evacuation centres for GPs can be found in Part B – Section 4.2.3: Documentation of clinical consultations at evacuation centres.

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