Providing care and support during disasters


General practitioners (GPs) are essential in supporting individuals and communities before, during and in the aftermath of natural disasters and emergencies.

Information on this page will be updated throughout the bushfire, flood and cyclone season of 2020/2021 in response to events.

Check back for updates.


Emergency planning and response resources

 


Providing care and support during disasters


A variety of people may be directly or indirectly exposed to disasters and their reactions may range from acute distress to denial and disbelief. Such shocking experiences may have an immediate impact for some, leading to acute and ongoing severe distress. Others may experience a temporary shutting off of feelings, revealing little external response. There is no right or wrong way to respond. Making sure people are physically safe, listening and comforting them are basic responses for general practitioners.

Experiences range from those with the most direct exposure to the disaster, to those with contact only through what they have seen on the media; both groups may be affected. Most people recover from such traumatic events but if distress continues people may need professional assessment, and possibly intervention. Those who seek help from a health professional will most often first present to a GP.
 


Distress, denial and disbelief are common reactions people may show for days and sometimes up to weeks after a disaster. In the initial hours and days, people may be stunned and dazed, particularly in response to a sudden and devastating disaster.


The most important provisions in the first hours to the first weeks after a disaster are safety, comfort and the support of family and/or friends.

GPs should ensure their impacted patients are safe and have the support of family members, friends and the community.

During the  first consultation with an impacted patient, GPs are advised to:

1. Listen, comfort and quietly accept information

  • Offer help and comfort.
  • Be quietly responsive. 
  • Some people may be helped by talking, for others talking may make it more difficult or, it may not be the right time. Let the individual guide you.
  • Identify support systems of family, friends and local community groups.
  • Remember the special things in families that may be important, e.g. pets.

2. Ensure survival, safety and security

A stunned mental state can leave people relatively unaware of their own safety and vulnerability.

A brief medical assessment allows:

  • Assessment of physical injuries
  • A review of changes to pre-existing physical and mental health conditions
  • Time for contact and talk
  • Gives reassurance and shows interest. Provision of a safe place to stay is important. If very concerned about someone's mental health, talk to a mental health professional.

3. Orient towards goals

Trauma and grief can leave a sense of chaos and fear. Activities that can help patients regain a sense of structure include:

  • Basic routines (meals etc)
  • An early follow-up appointment at 1 month and again if concerns at 3 months
  • Being in the company of others until the acute distress/denial subsides (hours to days)
  • Show patients things they can do themselves towards recovery
  • Practical tasks and everyday routine are helpful.
 

The main issues for patients in your initial consultation are fear, grief and loss, and dislocation.

It is common to experience grief and trauma after a disaster.

Feeling dislocated from one’s home and environment, due to the loss of a house or neighbourhood, are factors that can lead to ongoing distress.

Common themes that patients might express are:

  • Difficulty falling and remaining asleep
  • Anxiety
  • Uncertainty about the future and what they can do to feel safe, supported and happy again
  • Disruption to normal routines and patterns of life adding to uncertainty
  • Irritability, anger and frustration can be common

There are ways to help people reengage with the practical aspects of their lives, including:

  • Linking to others such as family, friends and neighbours. This could be done directly, through social media, or any other channels that work best for them.
  • Getting the best sources of information, including local radio and newspapers, media and call centres.
  • Helping people call upon their own personal strengths that they have used in the past or in difficult situations (everyone has these). This is a very powerful part of getting better.


It is important to identify those at greater risk of problems in the early weeks, months, or over a longer time. These include groups with the following experiences:

  • Belief that they were about to die
  • Loss of a loved one
  • Pre-existing and chronic health problems
  • Lack of support systems or connections
  • Very severe or disabling injury
  • Exposure to multiple deaths or injuries of others
  • Pre-existing vulnerabilities including socio­economic disadvantage

Vulnerable groups may include Aboriginal and Torres Strait Islander people, refugees, children, the elderly and single parents. 


Specialist help may be needed after one month if a person:

  • Still feels upset, very teary, or fearful most of the time
  • Has changed behaviour compared to before the trauma
  • Can't function in normal activities
  • Has worsening relationship issues.
  • Is overusing or abusing substances
  • Feels jumpy or disturbed sleep
  • Is dwelling on the event
  • Is unable to enjoy life; numbness or withdrawal
  • Is experiencing overwhelming grief that prevents functioning,

GPs should feel confident to assess and refer on for specialist mental health treatment those patients with persisting symptoms that disrupt daily functioning after the disaster.

 
  • Major depression
  • Major anxiety disorders
  • Post traumatic stress disorder (PTSD)
  • Substance abuse
  • Major behavioural change
  • Psychosomatic complaints
  • Panic disorder

Note that these may co-occur with physical health problems and that both should be assessed and managed.

 
  • Withdrawn, quiet
  • Whiny, irritable, angry
  • Headaches, stomach aches
  • Regression to younger behaviours- thumb sucking, bedwetting, baby talk
  • Clinginess
  • Over reactions to minor hurts, physical and emotional
  • Behavioural problems
  • Acting out.

If a child is so acutely distressed and unable to function continuing beyond the first week then an assessment by a mental health professional is required.

See this from the Australian Childhood Foundation


External mental health resources are available to support community and self in the wake of traumatic events:
 


Caring for yourself and accessing support during disasters


Remember that doctors themselves may be directly impacted by diasters and need to look after their own health and well-being. Doctors may also become overloaded by the traumatic experiences of others.
 
Early indicators that a doctor is affected by the traumatic experiences of their patients may include:

  • Heightened response to the patient.
  • Increased levels of arousal (sleep disturbance)
  • Avoidance (includes increased alcohol use)
To avoid being overwhelmed, doctors should consider:
  • Discussing distressing or difficult experiences with colleagues
  • Limiting their exposure to a tolerable level
  • Maintaining good general health with regular exercise, good nutrition and sleep habits
  • Seeking help if needed

GP support program

If you have been impacted by a disaster, please take care of your own health. Should you need support, don't hesitate to contact the RACGP.
 
The RACGP GP Support Program provides free and confidential psychological support to members.
 

DRS4DRS

You can also access support via the DRS4DRS website and state/territory based helplines.

DRS4DRS is an independent program providing confidential support and resources to doctors and medical students across Australia, by doctors.

Confidential phone advice is available 24/7 for any doctor or medical student in Australia via each state/territory helpline and referral service.
 

Australian Capital Territory

02 9437 6552

New South Wales

02 9437 6552

Northern Territory

08 8366 0250

Queensland

07 3833 4352

South Australia

08 8366 0250

Tasmania

1800 991 997

Victoria

03 9280 8712

Western Australia

08 9321 3098


CRANAplus Bush Support Service

CRANAplus’ Bush Support Services provides a free and confidential 24-hour/7-day-a-week telephone counselling service for rural and remote health practitioners. The service is staffed by psychologists, including two Aboriginal psychologists. CRANAplus membership is not required to access the service. Phone 1800 805 391.

 

Community support services

Other support services available to patients include:

Lifeline   

13 11 14

Kids helpline     

1800 551 800

Mensline

1300 789 978 

Suicide helpline

1300 651 251

 

Assisting in disaster-affected communities

Locum

If you wish to provide GP support in impacted areas, contact your local Primary Health Network (PHN) who link you with relevant local agencies. 

Find your local PHN using the map locator. 

 


Most medical defence organisations (MDOs) produced statements in early 2020, prompted by GPs providing emergency assistance in bushfire zones, clarifying that services provided by GPs in a voluntary capacity in such events were covered by their policies.

We suggest you contact your MDO directly regarding your coverage.


The Federal Government will continue to prioritise requests for GPs to be allocated emergency provider numbers to work as locums in disaster-affected areas to ensure we have GPs in areas where they are needed most.

The provision of emergency provider numbers to GPs will ensure a coordinated process so that GPs can work in areas where they are needed most.

Specialist GPs can request an emergency provider number through the Provider Digital Access (PRODA) website.

International Medical Graduates, Non-Vocationally Registered GPs and Registrars can request an emergency provider number through the Department of Human Services website.