The role of general practice in disaster response
Penny: So there's many different types of disasters – there’s natural disasters like bushfire, flood, thunderstorm. There's also infectious disease disasters like pandemics, and then unfortunately more recently there's things like terrorist events. So in a bushfire event, there would be some warning usually because you're coming up to the summer season and that's a really good prompt for when GPs should start to get ready and make sure they have a practice plan for something like that. But early on it would be a matter of talking to patients around whether they have a disaster preparedness plan themselves and are ready to evacuate if they need to. They would need to have medication for 3 to 4 days worth of supply, they need to have contact numbers for a specialist and family and friends and they need to have a plan of when they were likely to go.
From the practice itself - it also needs to have a plan. It needs to have a plan for if it's going to need to shut down or whether it's going to need to move in with another practice. But the important things in terms of health is that early on you'll start to get smoke coming through, and smoke’s probably the biggest issue in a bushfire. So it might be that you want to advise some of your patients who have respiratory conditions that they might need to stay inside a bit more with the windows and doors closed or they may need to think about leaving early.
So in bushfires, I think the important thing is to plan early and to be ready to go early if you need to. Then when the actual event happens it may be that the practice is able to keep going, and it’s really important that as a general practice we are able to maintain that normal continuity of care for patients.
GPs in Australia may also be faced by floods and there are different types of floods. There’s a slow flood that occurs where there's a lot more warning, and then there's the rapid flash floods which are much more dangerous acutely. And so for both of these there's obviously a lot of health effects to be considered. GPs again need to be really prepared in advance for this because if a flood happens there can be a lot of damage to power lines and to your electrical supplies and therefore business continuity. In terms of health in a flood, in a rapid flood, it's very hard to know that that's going to happen - and so that's a little bit of a matter of responding. In a slower rising flood it may be necessary to evacuate people and move them out. Some places have regular floods and so sometimes the practices there are actually ready for what's coming, and one of the issues that we see in floods are things like injuries, acute traumatic injuries, when people are trying to move around in floods where there's lots of debris. Things like snakes and spiders come out of the woodwork in floods so there's a risk of increased bites.
The other thing that happens in floods as well is pets - so pets are often being managed and moved and incidents of dog bites in particular, dogs and pets that bite their own owners is actually known to be increased during things like floods. As the days roll on with floods, GPs will often start to see more infectious things. They'll start to see cellulitis and more respiratory conditions, so there's a little timeline where initially you'll see acute traumatic injuries and then after a couple of weeks, you'll start to see the infectious diseases. And then as we go longer term with disasters, you start to see effects on chronic diseases where you can get deterioration of diabetes [and] things like herpes zosters have got a longer lag time for when they start to appear. And then cardiac events as well - so deterioration, hypertension and those sorts of things. GPs are seen as a really safe place to go, their waiting rooms are a really safe environment and that distress after a huge event like this is really normal. And so GPs have a really strong role to play in managing what we call subclinical conditions and distress. And we know there's a huge raft of mental health conditions that can occur after a disaster, as there is with physical health. We can get acute stress disorder, post-traumatic stress disorder, but also just exacerbation of pre-existing anxiety and depression. And one of the people we know that are at high risk after a traumatic event is those that lose someone, so the risk of complicated grief or prolonged grief is quite high when it's been a really traumatic event.
All of these things are things that GPs are really well placed to look for - so provide surveillance, identify early, manage early, and then prevent longer-term consequences. When a disaster occurs, we all know that there's that adrenaline charge and people rise to the task and GPs along with other responders are likely to want to be involved, want to help, want to do beyond what they normally do. And what's really, really important is to monitor that. So it's important to just make a point of taking stock and saying “how am I? Am I doing too much? Have I slept enough?” And also managing the practice as well because all the other members of the practice are going to want to be involved. So from my personal experience, I would recommend doing it every day, you know morning and evening just say “how am I tracking? Do I need to take time out?”