{"id":26420,"date":"2016-05-06T12:30:36","date_gmt":"2016-05-06T02:30:36","guid":{"rendered":"http:\/\/www.aspistrategist.ru\/?p=26420"},"modified":"2016-05-05T11:25:33","modified_gmt":"2016-05-05T01:25:33","slug":"healthcare-preparedness-for-terror-and-disaster","status":"publish","type":"post","link":"https:\/\/www.aspistrategist.ru\/healthcare-preparedness-for-terror-and-disaster\/","title":{"rendered":"Healthcare preparedness for terror and disaster"},"content":{"rendered":"

\"\"\u00a0It\u2019s now commonplace for terrorists to use industrially available chemical explosives like ammonium nitrate or everyday technology like mobile phones to detonate improvised explosive devices. In a<\/span> recent op-ed<\/span><\/a> in <\/span>The Australian<\/span><\/i> with my colleague Jacinta Carroll, I looked at the \u2018<\/span>Improvised Explosive Device Guidelines For Places Of Mass Gathering<\/span><\/a>\u2019<\/span><\/i> guidelines issued last month by the Australia\u2013New Zealand Counter-Terrorism Committee. The document rightly notes that:<\/span><\/p>\n

\u2018Terrorist or insurgent attacks using explosives occur regularly around the world. Terrorists favour explosives because of their proven ability to inflict mass casualties, cause fear and disruption in the community and attract media interest. Explosives are also generally within the financial and technical capabilities of terrorists and IEDs can be assembled with relative ease and used remotely\u2019.<\/span><\/p><\/blockquote>\n

The guidelines provide general guidance to those operating places of mass gathering\u2014such as shopping centres, sporting arenas, theatres and railway stations\u2014in terms of emergency service requirements and security principles. The document provides useful guidance on detecting suspicious activity.<\/span><\/p>\n

One of the weaknesses of the guidelines, however, is its treatment of healthcare issues. There\u2019s no mention of post-blast planning and response, including the fact that the site of such an attack would be a crime scene, especially if injuries have occurred. In a post-blast incident there\u2019d also be implications for immediate first aid and rescue before emergency medical services arrive.<\/span><\/p>\n

The guidelines refer to \u2018injuries\u2019 and \u2018people hurt\u2019 but not that we\u2019re likely to see multiple fatalities and a correspondingly larger number of casualties in a terrorist bombing in one of our major cities. There\u2019s no discussion in the document of <\/span>longer-term<\/span><\/i> health issues: not all casualties will be immediately apparent and there\u2019ll be a need to record those who felt the blast effects for medical observation and monitoring.<\/span><\/p>\n

There\u2019s no discussion either of on the scene triage or on how venue mangers might work with emergency medical services to transfer the injured to definitive care.<\/span><\/p>\n

It\u2019s not at all clear if a workable plan for that situation in Australia has been tested for large numbers of seriously injured. And as I\u2019ve<\/span> pointed out before<\/span><\/a> (PDF), <\/span>we lack available air assets and retrieval teams across Australia that would be able to provide support and respond to mass casualty events. <\/span>The recent Defence White paper does, however, note that <\/span>the ADF will acquire enhanced aero-medical evacuation capabilities (Para 4.94).<\/span><\/p>\n

France\u2019s<\/span> health response after the recent Paris bombings was very good<\/span><\/a>: many of the lesser injured patients went to more peripheral hospitals and only the more seriously injured ones went to the major disaster hospitals.<\/span><\/p>\n

The fact is that we don\u2019t devote enough attention to the healthcare preparedness aspects of terrorism\u2014the medical issues related to terror attacks can be understood collectively as<\/span> \u2018terror medicine\u2019<\/span><\/a>\u2014or to mass casualties as result of a catastrophic natural disaster.<\/span><\/p>\n

The Director-General of Emergency Management Australia, Mark Crosweller,<\/span> recently noted at the launch of ASPI\u2019s Risk & Resilience program<\/span><\/a> that when it comes to natural disasters we don\u2019t do enough to prep for the \u2018Big One\u2019. EMA\u2019s leader pointed out that catastrophic events are complex and intense and we need to close the gap of surprise and be able to \u2018imagine and act when the time comes\u2019.<\/span><\/p>\n

Mark also pointed out that we don\u2019t:<\/span><\/p>\n

\u2018spend enough time looking at the potentiality of consequence. I think we look very much at before an event and try to risk manage and try to bring the risk down, but we don\u2019t look enough at what the manifest consequence may well look like and turn our minds to how we are going to manage that when it happens.\u2019<\/span><\/p><\/blockquote>\n

Mark\u2019s comments are highly relevant in the context of healthcare preparedness for both man-made and natural disasters.<\/span><\/p>\n

He\u2019s absolutely right that we need to change our approach to residual risk by understanding that rarity doesn\u2019t diminish consequence. There\u2019s very little \u2018no-notice\u2019 training going on in Australian hospitals to prepare for mass casualties.<\/span><\/p>\n

Several years ago, the Australasian Trauma Society and others\u2014most notably Dr John Graham, the former chairman of the medical staff council at Sydney Hospital\u2014<\/span>argued<\/span><\/a> that that the Commonwealth government should fund, with the states, a single \u2018disaster prepared\u2019 hospital in each state to prepare for mass casualties. That didn\u2019t occur.<\/span><\/p>\n

There\u2019s been no real action to address the findings several years ago of a<\/span> major study<\/span><\/a> in the Medical Journal of Australia of the surge capacity for people in emergencies in Australasian hospitals. It predicted that all hospitals in Australasia would be quickly overwhelmed in that 60\u201380% of seriously injured patients wouldn\u2019t have immediate access to operating theatres, and that there would be similar lack of access to ICU beds for critically injured and to x-Ray facilities for less critically injured patients. There\u2019s been no similar survey to refute these findings.<\/span><\/p>\n

As a first step to get more focus on this issue, it\u2019d be useful for those responsible for counter-terrorism and catastrophic disaster planning to engage those in our health system who understand what\u2019s required to manage a mass casualty event. A nation-wide desktop audit of what physical facilities are available would also be a good start: we\u2019d then be able to assess what actual preparedness is possible. It wouldn\u2019t be that hard.<\/span><\/p>\n

But it would require some goodwill and cooperation between the Department of Defence and the health departments of the Commonwealth and State governments.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

\u00a0It\u2019s now commonplace for terrorists to use industrially available chemical explosives like ammonium nitrate or everyday technology like mobile phones to detonate improvised explosive devices. In a recent op-ed in The Australian with my colleague …<\/p>\n","protected":false},"author":23,"featured_media":26428,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[1],"tags":[307,987,1580,127],"class_list":["post-26420","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general","tag-emergency-services","tag-health","tag-resilience","tag-terrorism"],"acf":[],"yoast_head":"\nHealthcare preparedness for terror and disaster | The Strategist<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.aspistrategist.ru\/healthcare-preparedness-for-terror-and-disaster\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Healthcare preparedness for terror and disaster | The Strategist\" \/>\n<meta property=\"og:description\" content=\"\u00a0It\u2019s now commonplace for terrorists to use industrially available chemical explosives like ammonium nitrate or everyday technology like mobile phones to detonate improvised explosive devices. 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