Emergency Medicine (2003) 15, 271–282

Blackwell Publishing Ltd.

Disaster Medicine
Disaster Medicine
Disaster
DA et al. in Australasia
Bradtmedicine

A strategic plan for disaster medicine in

Australasia
David A Bradt,1 Ken Abraham2 and Rodney Franks3
1Royal Melbourne Hospital, Melbourne, Victoria, 2Prince of Wales Hospital, Randwick,
New South Wales, 3Hobart Private Hospital, Hobart, Tasmania, Australia

Abstract

Disaster epidemiology reveals epidemic increases in incidence of disasters. Rare dis-

asters with catastrophic consequences also threaten modern populations. This paper
profiles natural disasters, transportation incidents, emerging infectious diseases,
complex disasters and terrorism for their historical and future potential impact on
Australasia. Emergency physicians are in a position to assume leadership roles within
the disaster management community in Australasia. The Australasian College for
Emergency Medicine is in a position to lead medical specialty advances in disaster
medicine in Australasia. To optimize its impact in disaster medicine, the specialty and
its College have opportunities for advances in key areas of College administration, intra
and interinstitutional representation, disaster preparedness and planning, disaster relief
operations, education and training programs, applied clinical research, and faculty
development.
Key words: Disasters, epidemiology, health hazards, health planning, technology.

Introduction The Society for Academic Emergency Medicine

in the United States undertook one of the first
Natural, technological and conflict-associated dis- such specialty assessments in 1995. 1 In Australa-
asters present major challenges to the medical and sia, the ACEM authorized its Standards Committee
public health communities responsible for managing to form a Disaster Subcommittee in 1999. This
the health consequences. While the literature on paper is the first to detail a conceptual framework
disaster management has expanded rapidly in for disaster medicine within Australasia and exa-
recent decades, the medical specialty societies have mines disaster epidemiology in Australasia, disaster
made few assessments of their roles in disaster management administrative arrangements, new techno-
medicine. logies and future expertise. The paper then makes

Correspondence: Dr David A Bradt, Department of Emergency Medicine, Royal Melbourne Hospital, Parkville, Vic. 3050, Australia.
Email: [email protected]
David A Bradt, MD, MPH, FACEM, FAFPHM, FAAEM, Staff Specialist; Ken Abraham, MBBS, FACEM, Staff Specialist and Department
Director; Rodney Franks, MBBS, FACEM, Staff Specialist.
The findings and opinions expressed in this article are those of the authors and do not represent the positions or policies of the Australasian
College for Emergency Medicine.
 DA Bradt et al.

recommendations for emergency medicine across seven

domains of professional activity.

Epidemiological overview
In Australasia, the terms emergency and disaster are
often used interchangeably. Disaster is defined as a
serious disruption to community life which threatens
or causes death or injury in that community and
damage to property which is beyond the day-to-day
capacity of the prescribed statutory authorities and
Figure 1. Global disasters incident by year. Source: International
which requires special mobilization and organization Federation of Red Cross and Red Crescent Scoieties. 5
Non-natural;
of resources other than those normally available to  natural.
those authorities.2 Emergency is defined as an event,
actual or imminent, which endangers or threatens to Natural disasters
endanger life, property or the environment, and which
requires a significant and coordinated response.2 Australia’s geography and climate render it vulnerable
This latter definition further contrasts with emergency to a range of natural disasters. Over the last century, the
as defined by the ACEM.3 Disaster medicine is defined leading cause of lives lost from natural hazards in Australia
as the study and collaborative application of various was heatwaves followed by tropical cyclones and floods.7
health disciplines to the prevention, preparedness, The average annual cost of disasters in Australia over
response and recovery from the health problems the past 30 years is estimated at $1.14 billion.8 In that
arising from disaster.4 period, 265 natural disasters had costs exceeding $10
Epidemiological surveillance of disasters is enhanced million.8 Three ranking hazards caused 80% of total
by surveillance definitions relying upon quantitative disaster costs in Australia in order of floods, followed
criteria. A widely accepted surveillance definition of by storms and cyclones.8 Approxi-mately a decade earlier,
disaster is an event meeting at least one of the follow- drought losses ranked second behind floods.9 The most
ing criteria: kills 10 or more persons; affects 100 or more economically costly disasters were Cyclone Tracy (1974),
persons; leads to a declaration of state of emergency; Newcastle earthquake (1989), and the Sydney hailstorm
or leads to call for international assistance.5 (1999). Excluding these three events, the average
From 1991 to 2000, an annual average of 242 000 000 annual cost of disasters to Australia was $860 million. State
persons were reportedly killed or affected by disasters and territory hazards ranked by economic losses are
and conflicts worldwide. Excluding conflict, the number presented in Table 1. Economic data confirm that annual
of recorded disasters worldwide has escalated over the disaster inci-dence in Australia is increasing.8 The current
decade (Fig. 1). Of 4703 non-conflict disasters over the national drought has caused billions of dollars in farm
10-year period, there were over 750 000 persons killed business losses and may ultimately be the most
and over 2 billion persons affected. Hydro-meteorological economically costly natural disaster in Australian history.
events (flood, storm, drought, fire) claimed over 90% of New Zealand’s principal natural hazards are floods,
natural disaster deaths during the decade. Moreover, volcanos, and earthquakes. Although natural disasters
the incidence of hydro-meteorological disasters doubled in New Zealand during the last decade were non-lethal,
from 1996 to 2000 and quadrupled since the 1960s.6 approximately 2 million people remain at risk for each
Disasters, at present, are epidemic. of those hazards.
From 1991 to 2000, Australia had an annual average Natural disasters are exacerbated by periodic
of 41 disaster associated deaths while New Zealand reversals in the Southern Oscillation Index during El
had 0 such deaths.5 Nevertheless, among Organisation Nino years. Of 23 El Ninos recorded in the 20th century,
for Economic Co-Operation and Development (OECD) the four strongest occurred since 1980. The effects of
highly developed countries, Australia experienced the associated drought in Australia were dramatic in 1983
world’s highest annual percentage of population with Ash Wednesday fires and in 1999 with Queen-
affected by disaster — 8.46% or 1 564 203 persons.5 sland crop failures. Despite uncertainty over precise
Prominent hazards in Australasia are profiled below. relationships of climactic cause and effect, evidence

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Table 1. Most costly hazard types and proportion of total disaster losses (1967–1999)*
State/Territory Most costly hazard types Proportion of total disaster losses (%)
New South Wales Floods, storms
66
Queensland Floods, cyclones
Northern Territory Cyclones, floods 13
Victoria Floods, bushfires 9
Western Australia Cyclones, storms 6
South Australia Floors, storms 4
Tasmania Bushfires, floods 2
Australian Capital Territory Bushfires, storms 0.02
*Source: Bureau of Transport Economics.8

suggests climate change mediated by global warming Epidemiological data clearly illustrate the substan-
underlies increasing frequency and severity of El Ninos. tial burden of motor vehicle crashes on the community.
Climate change will be among the most pervasive Emergency physicians must be prepared for the
environmental events of the 21st century.10 Changes clinical consequences which include mass casualty
are expected to be gradual with small changes in incidents complicated by spills of hazardous materials.
mean temperatures and precipitation. However, small
changes in means will induce dramatic change in Emerging infectious diseases
incidence of extreme events. Coastal flooding will be
an early manifestation for which Sydney is already Infectious and parasitic diseases are the leading cause
considered at risk.11 Overall, under current predicted of morbidity and mortality worldwide. They collec-
trends in climate change, a range of natural disasters is tively cause 25% of global burden of disease measured
expected to manifest itself unparalleled in modern times.11 by disability-adjusted life years (DALY) lost — more
than any class of diseases.15 The greatest number of
Transportation incidents lives lost in Australasia from one phenomenon was the
influenza pandemic of 1918–19 which killed over 10 000
Worldwide, the incidence of transport disasters has persons. At least three dozen infectious diseases
doubled in the last five years.5 Regional data indicate are now recognized as emerging (EID) defined by the
that transport disasters are the third most common US Institute of Medicine as ‘new, re-emerging or drug
disaster after floods and storms. Road traffic injuries resistant infections whose incidence in humans has
are the third leading cause of total burden of disease increased within the past two decades or whose incidence
in men aged 25–44 years.12 In Australia, injury is the threatens to increase in the near future’.16 Underlying
leading cause of death for persons under age 45 years causes for EID include altered population demographics,
and causes of 6% of all deaths.12 Road traffic death changes in human settlement, ecological changes, microbial
was the most common form of injury death in recent adaption, new industry and technology, breakdown in
decades in Australia until recently surpassed by public health measures and international travel.
suicide.13 With 9.3 road traffic deaths/100 000 United States Centers for Disease Control and Preven-
persons/year, Australia remains under the median of tion published a strategy to prevent EID through 10
11.7 for OECD countries.14 Nevertheless, in the 1990s, priority activities.17 One activity was establishment
approximately 2000 persons per year died and over of an Emergency Department Sentinel Network for
20 000 persons per year sustained serious injuries Emerging Infections (EMERGEncy ID NET) initiated
on Australian roads.14 There were nearly 5000 serious in 1995. Health authorities in Australia are presently
crashes per year in New South Wales and Victoria considering similar disease surveillance mechanisms.
each — excluding fatal crashes — with lesser figures Nevertheless, in the United States, the Surgeon General
in other states.14 The Bureau of Transport Economics has stated that ‘our [US] ability to detect, contain, and
estimated Australia’s total annual cost of crashes prevent emerging infectious diseases is in jeopardy.’18
at $A14.98 billion (1996 data).14 By contrast, the Dr Joshua Lederberg, 1958 Nobel laureate in medicine
concurrent Australian expenditure on health research expressed the view, ‘… pitted against microbial genes,
and development was $A853 million.12 we have mainly our wits.’19

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Complex disasters vulnerabilities in the emergency response system, as

well as the public health management of exposures,
Complex disasters present intertwined issues of in both countries. In the US, the Centers for Disease
government instability, macroeconomic collapse, civil- Control and Prevention have since prioritized pre-
military violence, population displacement and elusive paredness activities for biological agents based upon
political solutions. Complex disasters kill more people their terrorist potential against civilian popula-
globally than all other disasters combined.5 Australia tions.21 Concerns for smallpox, in particular, with its
has never experienced a complex disaster. It remains, high transmissibility and high mortality rates, have
nevertheless, burdened by them indirectly and directly. induced health authorities of many countries, includ-
The arc of instability in south-east Asia harbours ing Australia and the US, to reconsider smallpox
eight countries and territories with recent experiences vaccination policy.
in armed conflict. Indonesia, for example, experienced However, recent terrorist events have indelibly
six major provincial, civil armed conflicts in 2000–01 altered the perception of risk from terrorist events
with several persisting as complex emergencies. In and WMD. As risk perception influences risk reality
response to international appeals for financial, material, in the general public and professional communities,
and technical assistance, Australia has become a signi- probabilistic risk assessments are no longer sufficient
ficant intervenor in affected areas. Moreover, Australia to guide emergency managers for the burdens of pre-
has become an increasingly attractive destination for paring for terrorism and weapons of mass destruction.
refugees and asylum seekers — 16 800 such cases in 2000 The ALARP (as low as reasonably practical) threshold
up over 100% from the mid 1990s. Complex disasters of risk management becomes redefined in the new
are complex issues for participants, their countries of hazardscape. Medical specialty societies have an urgent
resettlement and their ultimate health providers. medical duty to embrace disaster medicine more
comprehensively than they have previously. Medical
Terrorism and weapons of mass destruction specialty societies have an attendant social duty to
contribute to informed public policy as well.
Recent terrorist events have demonstrated that a low
probability event may yield an enormously adverse Implications
outcome. The 2002 Bali bombing caused the greatest
Australian loss of life from a single incident since In the last decade, the International Red Cross
World War II. Hospitals in most Australian states estimates over 15 million Australians and 28 000
provided clinical care to bomb victims as the Aus- New Zealanders were affected by disaster. Natural
tralian port of entry, Darwin, was overwhelmed. The disasters were overwhelmingly the cause. Disaster
2001 World Trade Center destruction caused the single epidemiology indicates the disaster burden will
greatest loss of life from a criminal act in the history of exacerbate worldwide, regionally, and locally. Risk
the United States. Insured losses from direct damages factors in Australasia include increasing population
to the World Trade Center are estimated at $US15 density and proximity to known natural hazards such
billion with total costs of recovery exceeding $US60 as flood plains and cyclone paths; environmental
billion. This figure surpasses the 30-year loss estimate degradation exacerbated by population pressures and
for Australia’s entire disaster experience. global warming; expanding transportation networks;
Information on medical response to terrorism has production, stockpiling and transportation of
been widely disseminated in training manuals for hazardous materials; terrorism; plus, under-funded
hospital-based providers. The US Domestic Prepared- efforts at disaster preparedness and mitigation.
ness Program considers that biological and chemical In the face of such burdens, numerous scholars have
weapons are the most likely terrorist weapons of called for sustainable hazard mitigation22 — a shift
mass destruction (WMD).20 The Australian Medical in emphasis of disaster management, particularly
Disaster Coordination Group, in preparation for the of natural hazards, from loss reduction to systems
Sydney 2000 Olympic Games, utilized documents resiliency and environmental sustainability.22 Disaster
from military and civilian sources in several national epidemiology demonstrates the urgency of issues
WMD preparedness programs. Nevertheless, highly facing health providers who must enhance skills as
publicized anthrax cases in the USA followed by white well as engage public health and public policy officials
powder incidents in Australia have starkly illustrated about health implications of the hazardscape.

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management capabilities through development of

Disaster management administrative national strategies, production of best-practice manuals,
arrangements and provision of training courses. During disasters,
EMA coordinates the provision of Commonwealth
Administrative arrangements for disaster manage- technical and material assistance to States and Territories
ment in Australia are widely disseminated.23–25 The through the National Emergency Management Coor-
implications for emergency medicine have been less dination Centre (NEMCC) in Canberra. This assistance
well-characterized. is usually provided at no cost to States or Territories.
The Department of Defence held oversight respon-
National sibilities for EMA until 2001 when the Attorney
General’s Department assumed them. The EMA is led
The peak national body for emergency management by a Director-General and comprises numerous func-
policy coordination is the Australian Emergency tional units. There are no emergency medicine or other
Management Committee (AEMC). This committee medical specialists on staff or in representative cap-
has an advisory role which can be summoned as acity. Nevertheless, EMA has many advisory groups
needed by the Federal government. The committee is of which one with particular importance to emergency
chaired by the Director General of Emergency Mana- medicine is Commonwealth Advisory Panel of Experts.
gement Australia and comprises senior emergency This is a group of professionals from many fields who
management persons from each of the peak state and advise EMA on standards, education training packages,
territory emergency management bodies. There is no etc. The link to ACEM is typically via Commonwealth
formal emergency medicine or other medical specialty Department of Health and thus State Health.
representation. Of note for emergency medicine are the following:
The peak national body for emergency management • As a Federation, States and Territories do not
health issues is being reconstituted. Up to 2003, it have to comply with Commonwealth directives
was the Australian Disaster Medicine Group (ADMG). that are not part of the Constitution. There is,
The ADMG was authorized by the Australian Health however, a good working relationship in disaster
Ministers’ Advisory Council, on recommendation management between the Commonwealth and
from the NHMRC, and inaugurated initially as the States.
Australian Medical Disaster Coordination Group. • Except for the Australian Defence Force, the Common-
The ADMG worked to develop and maintain a wealth has no on the ground resources of its own.
comprehensive national capacity for the health Police, fire, ambulance, state emergency services,
management of disasters in Australia and its region of etc. are all controlled by the particular states/
interest. The ADMG had no formal emergency territories. The primary role of the Commonwealth
medicine or other medical specialty representation and is co-ordination of resources and for issues relating
no operational role in disaster management. In 2003, it to international responses.
is expected that ADMG will be disestablished in
favour of an Australian Health Disaster Management State and Territory level
Policy Committee (AHDMPC). The committee is
expected to have representatives from clinical and The peak body at State and Territory level differs by
emergency services as well as directors general of name as well as by local emergency management systems
health. However, the place for medical specialty (Table 2). These groups include representatives of
societies, including emergency medicine, on the numerous agencies including fire, police, ambulance,
committee remains unclear. Terms of reference are health, public works, communications, transport, comm-
under development. unity services, etc. Emergency medicine representation
commonly appears at the level of state or territory
Commonwealth department of health and extends down to local
hospitals. There are Local Emergency Management
The peak operational Commonwealth body for emer- Groups (LEMG), based on council boundaries, District
gency management is Emergency Management Australia EMG based on variable aggregations of councils, and
(EMA). Emergency Management Australia assists then the State EMG. The States then comprise part of
States and Territories in enhancing their emergency the Australian Emergency Management Committee.

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Table 2. Peak emergency management bodies in States and Territories*

State/Territory Peak emergency management body
Australian Capital Territory Emergency Management Committee
New South Wales State Emergency Management Committee
Northern Territory Counter-Disaster Council
Queensland State Counter-Disaster Organization
South Australia State Disaster Committee
Tasmania State Disaster Committee
Victoria Emergency Management Council
Western Australia State Emergency Management Advisory Committee
*Source: Emergency Management Australia.24

Implications postgraduate education and training of emergency

physicians in this vital area, and for graduates of such
There are opportunities for increased involvement training to play lead disaster medicine roles in hospitals,
of specialists in emergency medicine at all levels of health service networks and State/Territory level.
Australasian emergency management. Disaster medi-
cine is represented by individuals of variable training
and experience who make themselves known and New technologies
available. For those clinicians who become involved, a
number of underlying and consequential issues Professionalization in emergency management has
become apparent. steadily progressed over the past decade. Full-time,
One issue is the viability of State disaster planning paid emergency planners have emerged in municipal
and response — that within each State and Territory, and state bureaucracies. Their scope of work has
there should be a capacity within government to ensure broadened from ‘civil defense’ and episodic disaster
it has resources to sustain long-term viability of a disaster relief operations to roles in disaster prevention, pre-
management system. There is a need for medical paredness, mitigation and community recovery. Com-
specialists, and their professional organizations, to plex emergencies calling for international disaster
contribute to the robustness of their local disaster relief have further expanded the scope of work. While
management system — whether at hospital, health clear roles and responsibilities remain fundamental to
service, or state level. Disaster management is increas- disaster management, these concepts have expanded
ingly seen not only as a competency of technical special- to command, control, communications, computers and
ties, but also as a competency of good government. intelligence (C4I).26
Emergency physicians are in a position to highlight
ongoing resource needs in disaster management. Computer-mediated communications
A second issue is career development. Competency
in disaster medicine fields remains case-related, The World Wide Web has created an explosion in
individual-specific and difficult to verify. Ultimately, electronic information. Quantifying both the amount
there is no substitute for site-based, hands on, pro- of information available and its utilization remain a
longed and recurrent field experience. Australia’s rela- challenge. For example, the US Federal Emergency
tively low burden of disasters hinders the acquisition Management Agency (FEMA) presents nearly 10 000
of disaster medicine experience. Provision must be pages of web-available information. FEMA for US
made to foster interagency, interdisciplinary and domestic disaster information, and ReliefWeb for
multihazard awareness in disaster intervenors. The international disaster information claim millions of
process is clearly enhanced by international experience. hits per year. The worldwide distribution of the Natural
Moreover, among practitioners who have acquired Hazards Research and Applications Information
such experience, there is no organized mechanism Center electronic newsletter, ‘Disaster Research’, has
for succession within the disaster management work grown at a rate of 60% per year since its inception. In
environment. There are opportunities for enhancing face of such electronic successes, some print media

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communications in disaster management will convert of emergency medical services and hospital disaster
to exclusively electronic form such as InfoRecent issued management – particularly in coordinating numbers of
periodically by the Australian Emergency Management patients inbound with number of type of hospital beds
Institute. available. These areas are uniquely compelling for
hospitals proximate to disaster. Worldwide disaster
Geographic information systems experience reveals that most patients from hazmat
events self-refer without benefit of prehospital care –
Geographic information systems (GIS) refer to spacially triage, decontamination, or EMS transport – and most
referenced databases. The Canadian Geographical patients seeking hospital care postdisaster converge
Information System in the 1960s pioneered GIS with on the nearest facility. Moreover, the well-known
forest management. At present, most hazards in scenario persists of emergency physicians making
developed countries have been examined in digital serial phone calls to find beds in hospital for disaster
data layers for hazard mechanisms, impact zones, victims. Emergency physicians must become disaster
populations at risk, evacuation routes, damage decision-makers rather than facility data gatherers.
assessments and mitigation measures, etc. Geographic The DSS has the potential to facilitate the work of the
information systems tools have found applicability in hospital-based providers in disaster medicine.
many aspects of emergency management including
selection of evacuation routes, placement of emergency
shelters and population exposures to environmental Development of expertise
toxins and sentinel disease surveillance. Geographic
information systems can contribute to real-time The role for emergency physicians in disaster medicine
assessments of hazard emergence (clustering of cases is substantial. Emergency physicians need a mechanism
in syndromic disease surveillance as proxy indicator by which they can collectively work toward disaster
for bioterrorism) or hazard persistence (toxic plume management goals with input from external agencies.
dispersion and particulate fallout). In the future, it The Disaster Subcommittee of Standards will con-
is envisioned that technicians with laptops, GIS tribute to this aim by developing policy and advice
software, and plotters will appear at the disaster site to Council and by creating a forum for disaster issues
as information first responders — just as quickly as before the College. Selected areas for development in
conventional first responders. Moreover, advances in emergency medicine are highlighted below.
telecommunications will enable rapid digital trans-
mission of these findings via portable handheld units Education and training
and wireless application protocols to facility-specific
end users. Disaster medicine is an interdisciplinary body of
Geographic information systems also refer to remote knowledge. A conceptual framework for expertise
sensing technologies. While these technologies are in disaster medicine may be characterized by Fig. 2.
considered critical to early warning of certain natural
disasters, they are considered here beyond the scope of
immediate utility for health care providers.

Decision support systems

Decision support systems (DSS) are computer infor-
mation systems that integrate information from disparate
sources – data, statistics, maps, reports, artificial
intelligence and expert systems – to assist managers
with decision-making. Functions of computer-based
decision support systems are well characterized in
the evidence-based literature on clinical practice.27,28
The burden of patient volumes in disasters calls
for streamlined, efficient tools for decision-making.
The DSS, at present, are less contributory in key areas Figure 2. Conceptual framework for disaster medicine.

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Competencies in clinical medicine, public health and revising the Fellowship curriculum. There is scope for
disaster management are critical — necessary yet the development of performance indicators and bench-
individually insufficient. The clinical medicine role marks in achieving disaster competence. Numerous
in prehospital and facility care is self-evident. In factors constrain disaster education and training in
Australia, the emergency physicians have trumpeted Australasia:
their ascendancy in this role.29 In countries with • lack of widely held disaster expertise
different traditions of allopathic specialization and • lack of accepted curricula in disaster medicine
prehospital care, such as France and Germany, other appropriate for hospital-based specialists
specialties claim that role. Overall, specialty claims • relatively little attention paid to disaster medicine
to ascendancy in disaster medicine are empirically in emergency medicine training programs
founded, evidence-based only at NHMRC level 4 and • limitations of classroom setting to train interagency
lack international consensus. The most appropriate processes
provider in disaster medicine appears to be country • lack of disaster management rotations which satisfy
and locale-specific. In Australasia, this provider is service time to fellowship
most probably an emergency physician However, there • inadequacy of current fellowship testing methods
exists a growing group of colleagues in allied health to assess familiarity with disaster medicine issues
professions with skills and interests in disasters. • lack of disaster medicine fellowships in Australasia.
Regardless, skills sets in clinical care must be Remedies for the foregoing concerns include develop-
complemented by skill sets in public health and broad ment of a detailed disaster curriculum for Australasian
disaster management (Table 3). EM trainees. Such curricula, appropriate for hospital-
The ACEM sponsored training should aim to based specialists, have recently been promulgated by
produce an emergency generalist rather than a ‘single international organizations. Examples include ‘Curricu-
issue’ specialist. The challenge for ACEM is how lum: Education and Training in Disaster Medicine’ of
to fulfil its responsibilities for core competencies the International Society for Disaster Medicine30 and
while fostering interdisciplinary awareness of disaster ‘Guidelines for Developing Curricula for Emergency
medicine. Distributive, quality training of FACEM will Public Health in Schools of Public Health’, sponsored
best position them for special interest ‘natural selection’. by US Centers for Disease Control and Prevention.31
At present, the ACEM Training and Examination Moreover, best practice concepts in disaster manage-
Handbook contains Part XX dedicated to Counter ment should be incorporated into the ACEM examina-
Disaster Planning. The Board of Censors is currently tion process.

Table 3. Domains of expertise contributing to disaster medicine

Specialty Competencies
Emergency medicine Pre-hospital triage, tagging, treatment and transport
Emergency department triage, stabilization, care and referral
Facility-based specialty coordination
Public health Environmental health monitoring
Hazardous material handling and safety
Relief worker disease surveillance
Disease outbreak investigation
Disaster management Site security
Urban search and rescue
Incident command and emergency operations centre management
Hazardous materials management
Geographic information systems
Resource mobilization
Public information
Media relations

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Disaster preparedness and planning • notices of disaster courses, workshops, exercises

and conferences
As a hospital-based specialty, emergency medicine • disaster medicine discussion forum.
needs to understand the hazards and vulnerabilities
affecting hospital environments. Much impetus for
disaster awareness in the health sector is reactive Recommendations to advance disaster
after an unfortunate experience. The impact of the medicine in australasia
1985 Mexico City earthquakes on local hospitals
accelerated development of guidelines for facilities 1. ACEM administrative framework
mitigation against natural disaster in the hemi-
sphere.32 The 2001 World Trade Center disaster as 1.1 Support optimal Subcommittee function by develop-
well as anthrax exposures in the United States are ing explicit action plans, identifying barriers to
presently accelerating development of guidelines implementation within the College, and working
for hospital preparedness against terrorist events.33 to minimize those barriers.
Emergency medicine should emerge as a lead voice for 1.2 Propose the institutionalization of a College Chief
hospital-based disaster preparedness in Australasia. Information Officer.
The opportunity exists for the disaster specialists 1.3 Review current College policy, standards and guide-
to assist College representatives with disaster-related lines with a view to fostering College awareness
reference material for planning purposes and for the of disaster management.
appraisal of disaster-related developments emerging 1.4 Monitor progress in implementation of accepted
from other quarters of the College. Selected parts of recommendations through periodic progress reviews
technical planning and process documents may merit by Subcommittee and parent committee.
consideration from Standards Committee and Council
for adoption as College policy. 2. Intra and interinstitutional representation
(committees, workgroups, and liaisons)
Exercises and drills
2.1 Increase interaction between Disaster, Prehosp-
Emergency medicine involvement with prehospital ital, Rural and Regional and Public Health (sub)
providers — ambulance/police/fire and State Emergency committees.
Services fosters interagency communication and 2.2 Encourage emergency medicine input and represen-
cohesion. The interaction gained during disaster tation at local, state and national level in disaster-
exercises and drills cannot be substituted. Every effort related committees. Such disaster-related committees
must be made to maximally involve FACEMs and would span the spectrum of stakeholders includ-
trainees in tabletop exercises and site drills. Lessons ing AHDMPC, EMA, State Emergency Services,
learnt should be systematically disseminated within Australian Emergency Management Institute,
the provider community. Fire Services, Ambulance Services, Police Services,
Australian Defence Force, Rural Doctors Association
Information dissemination and Public Health Association.
2.3 Develop ACEM liaison with sister Colleges having
A disaster medicine web site linked to a parent disaster interests, for example, Australasian Faculty
ACEM site would assist in goals of education and of Public Health Medicine.
training, preparedness and planning and information
dissemination outlined above. Content could further 3. Disaster preparedness and planning
include:
• ACEM subcommittee membership/mission statement 3.1 Acknowledging the all hazards approach to the
• key disaster references to publications within the prepared community, identify specific hazards in
college, locally and globally the Australasian hazardscape for which management
• disaster planning aids (plans, templates, case studies) understanding /skill is seen a core competency in
• disaster-specific standards skill set of EM specialists.
• meeting times and minutes (password access) • MCI (transportation MCI and chemical/bio-
• links to national and international sources of expertise hazard releases)

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• natural disasters (floods, storms, and 5. Education and training programs

bushfires)
3.2 Disseminate hospital disaster plans, policies, 5.1 Obtain inclusion of core disaster journals within
standards, and guidelines through web posting to the ACEM library.
facilitate best practice management of common as 5.2 Modify the ACEM Fellowship curriculum through
well as catastrophic hazards. input to the Board of Censors to reflect state-of-
3.2.1 Australasian standardized nomenclature for the-art in disaster management.
hospital-based disaster responders, standar- 5.3 Develop instruction modules to address didactic
dized responsibilities for disaster managers, components of the modified curriculum utilizing
standardized activity lists on action cards AEMI bibliography wherever possible.
and standard report formats of generated 5.4 Identify key disaster management training courses
work product available during fellowship training to emphasize a skill-
3.2.2 supply, equipment and structural standards for building spectrum which encompasses BLS, ACLS,
emergency departments relevant to disasters ATLS, MIMMS, and Domestic Preparedness Programs.
3.2.3 policies and procedures for consequence 5.5 Develop a post-FACEM disaster management fellow-
management ship based at an academic medical centre in Australasia.
3.2.4 standardized reporting formats for disaster 5.6 Develop presentations, workshops, and courses
events as contribution to disaster management track of
3.2.5 no new plans, policies, standards or guidelines College scientific meetings.
without a dissemination plan through the
faculty fellows and trainees 6. Applied clinical research
3.3 Examine the relationship between emergency medi-
cine and civil defence at state level to clarify clinical 6.1 Identify gaps in disaster management knowledge
responsibilities after terrorist (CBR) threats events. base and develop a short list of pilot projects and
3.4 Encourage development of partner hospital research proposals meriting endorsement by health
relationships for purposes of joint training before funders and domestic research organizations.
disaster and burden sharing after disaster. 6.2 Encourage networking between established disaster
3.5 Undertake annual review of disaster management researchers and trainees of the College seeking to
issues with policy analysts in EMA. fulfil their research requirements.
3.6 Develop submissions to State and territory
governments (refer to Senate Standing Committee 7. Faculty development
recommendations):
3.6.1 recommending funding to hospital-based 7.1 Create network for information sharing via disaster-
disaster management specialists specific space on the ACEM website and links to
3.6.2 requesting liability cover for volunteers Australasian disaster sites, e.g. ADMIN.
responding to out-of-hospital disasters 7.2 Disseminate of state-of-the art tools by posting on
3.6.3 recommending national portability of pro- the website relevant documents, disaster plans,
fessional medical qualifications of medical hazard analysis.
responders to multijurisdictional disasters 7.3 Create an international consultant database akin to
that established by the Royal Australasian College
4. Disaster relief operations and project of Physicians (BACP) in service to AusAID and
management domestic non-governmental organizations (NGOs).
7.4 Promote disaster preparedness as EM professional act-
4.1 Provide technical consultancy in conjunction with ivity meriting non-clinical time compensated by depart-
National Communications Advisory Group to ment directors and reimbursed by 3rd party payers.
review hospital-based emergency communications
in disaster.
4.2 Create a domestic consultant database in service to Conclusions
EMA.
4.3 Offer after-action review of clinical care in Australa- Emergency physicians are in a position to assume
sian disasters as contribution to professional standards. leadership roles within the disaster management

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