The role of the GP in bushfire crisis management
Australia has been facing a relentless bushfire crisis this past summer, and rural and remote communities have been hit particularly hard. GPs have been engaging in the frontlines of bushfire cleanup and care, and rural and remote GPs have faced unique challenges in delivering care and repair efforts. The following piece is the result of our reaching out to Dr. Tim Leeuwenburg, one of Kangaroo Island’s most well-known GPs for his efforts to improve crisis infrastructure and training, after his community was hit particularly severely.
Sandpiper Australia - equipping Australia with a network of clinicians delivering clinical care in rural communities, from local incident through to national disaster
Formed in late 2019 by rural doctors, Sandpiper Australia is a not-for-profit organisation with the sole aim of supplying a standardised emergency medical equipment for rural doctors, supported by training in the delivery of emergency care out of the clinic or hospital setting.
Rural Generalist Dr. Tim Leeuwenburg is based on Kangaroo Island, one of many rural communities affected by bushfire. Like many other Islanders, he lost property in teh fire.
“I’ve been a part of the South Australian Rural Emergency Responder Network for over 10 years,” he says. “The RERN is a system of trained and equipped rural doctors who are paged by the South Australian Ambulance Service to respond to prehospital incidents in their rural communities, on the infrequent occasions where ambulance volunteer resources are limited and MedSTAR retrieval will take some time to arrive”
South Australia’s rural responder network is designed to ensure that rural patients do not suffer delays in the delivery of urgent clinical care.
“To date, most emergency responses are metrocentric, with emphasis on ‘helicopters and hospitals’ without the inclusion of the rural generalist skillset”
“The rural generalist clinician is well-placed to use their skills in emergency medicine or anaesthesia to deliver meaningful clinical interventions without the delay that waiting for the chopper or RFDS entails” says Leeuwenburg. “Typical interventions mights include assistance with advanced airway management, use of powerful pain relief or sedative drugs and of course an extra level of medical support in areas where ambulance workforce is limited".”
However, South Australia is the only State which has a coordinated system to involve the Rural Generalist workforce.
“It is concerning that other States have so far been reluctant to include the rural doctor workforce in emergency planning,” says Dr. Scott Lewis, another RERN doctor based in rural SA. “We saw this in the Kerang rail disaster, we’ve seen this in some locations in the recent bushfire response. But of course at a local level even a simple vehicle rollover or farm accident is a ‘disaster’ for a small community, where the rural doctor could and should be involved - providing he/she is suitably equipped and trained, with clinical governance. To date most emergency responses are metrocentric, with emphasis on ‘hospitals and helicopters’ without inclusion of the rural generalist skillset”
Sandpiper Australia was formed out of frustration with disinterest from State-based emergency organisations who failed to consider the role of primary care specialists in their communities. Dr. John Hall, President of the Rural Doctors’ Association of Australia, says “We surveyed rural doctors back in 2014 and found overwhelming support for a national emergency responder network - indeed, many rural doctors were already providing such care, but in an ad hoc manner and without appropriate equipment or training. In conjunction with the Australian College of Rural & Remote Medicine, the RDAA issued a position statement on the role of rural doctors in emergency and disaster response way back in 2016 - but again there was little interest from the States.
Meanwhile, even geographically-small countries such as the United Kingdom and New Zealand have well established systems to incorporate the primary care workforce into disaster planning - in stark contrast to Australia which has none, despite the tyranny of distance. “We looked at several systems overseas and were particularly impressed with the model in Scotland,” said Dr. Hall. “The Sandpiper Trust has raised funds to equip rural clinicians with a standardised Sandpiper Bag of essential emergency equipment, with over 1000 bags distributed across rural Scotland to date”
The UK Sandpiper Trust was established in 2001. Like many successes, it was borne from underlying tragedy. 14-ear-old Sandy Dickson died in a tragic accident in a remote area and emergency services were unable to respond in a prompt manner. In their grief, the Dickson family channelled their efforts into doing some good - specifically to ensure that timely help was available to rural communities despite difficulties in geography or available personnel. Sandpiper was chosen as the name of the charity - the sandpiper being a light-hearted, cheeky bird who plays near water, in memory of Sandy Dickson.
“The rural generalist clinician is the expert in rural medicine. They can provide emergency care to a high level - but are also able to coordinate local resources”
“The Sandpiper Trust charity supplies the bags,” says Dr. Hall, “and the Scottish arm of BASICS (British Association of Immediate Care Schemes) provides training in prehospital care. The Sandpiper Bag has become a rallying point for rural resilience - communities raise funds to equip ‘their’ clinician (doctor, nurse, paramedic etc.) with a Sandpiper Bag and the ambulance service now view the presence of a Sandpiper Clinician on scene as a valued asset in a prehospital incident. What a wonderful model for rural Australia.”
The UK Sandpiper Trust has given their blessing to setting up Sandpiper Australia. “We have only recently completed the paperwork as a charitable organisation,” says Dr. Leeuwenburg “but have been using the Sandpiper Bag as a focal point for training as part of ACRRM’s Prehospital and retrieval medicine course.”
The model is simple - Sandpiper Australia will raise funds to equip rural clinicians with a standardised set of medical equipment, the Sandpiper Bag as a focal point for local rural community emergency responders. Standardised training in a limited suite of meaningful interventions to ‘value add’ on scene when appropriate will ensure that Sandpiper Clinicians are a known quality for emergency services.
“We’re really having to build this ‘ground up’” says Leeuwenburg “out of frustration with current State-based emergency systems that appear blind to the role of rural doctors”
Many GPs have been involved in providing emrgency and relief care during bushfires in their community - there have been some amazing stories coming out of places like Mallacoota, Eden, Merimbula, Nowra, etc.” But whilst the focus of emergency responses has been on provision of ambulance officers, emergency medicine specialists and so on, many rural people want to maintain a connection with ‘their’ doctor. Cobargo GP Dr. Jeffrey Lee lost his clinic in the blaze, but established a makeshift clinic in his solar-powered motor home to provide essential services. Leeuwenburg says “Reportedly most of the immediate needs are on the either treatment of injuries, but importantly also on the mental health of rural people affected directly or indirectly by the fires. Chronic disease, particularly respiratory disease, is directly impacted and here the rural doctor - along with community pharmacist and nurses - are ideally placed to deliver care in affected areas…not having a focus purely on hospital-centric specialists or retrieval clinicians.”
“This is an important factor to consider,” says Dr. Hall. “The rural generalist clinician is the expert in rural medicine. They can provide emergency care to a high level - but are also able to coordinate local resources, such as nursing, pharmacy, mental health, and of course other primary care providers. We see the Sandpiper model as building incredible rural resilience - we can ensure the local doctor is involved in prehospital care to support ambulances for a simple vehicle crash…and then flex up to provide a cadre of clinicians with equipment, training, and expertise in prehospital care, from the roadside through to relief centres and - most importantly - the recovery phase of any incident”
“Rural clinicians are embedded in their communities. We will be walking the path with our patients long after the emergency services, ADF, and media have departed.”
This is echoed by Dr. Leeuwenburg. “Rural clinicians are embedded in their communities. We will be walking the path with our patients long after the emergency services, ADF, and media have departed. We are trusted by our communities and with skills in not just primary care but also emergency medicine, mental health and coordination, we can be there at every step of the journey - whether a local incident or a national disaster. We liken the rural clinician to the ‘swiss army knife’ of medicine. We are so excited that Sandpiper Australia is finally established and beginning to raise funds - a startup grant from the RDAQ Foundation has been helpful, but we will be raising more funds and hoping to engage with other agencies over time. Whichever way you look at it, we need to incorporate the primary care expertise into the planning and delivery of State-based emergency systems - sure, hospitals and helicopters are exciting and visible for politicians and the media, whereas good primary care is invisible. We will be with our patients every step of the way, ensuring responders are appropriately equipped and trained to work alongside existing services.
Dr. Kate Manderson, a GP in the South Coast area of Jervis Bay, has first-hand experience ofthe lack of coordinated support for rural primary care in emergency responses. “In our evacuation centre we were not permitted to collaborate with Ambulance NSW or the Local Health District hospitals because there was no approved policy or protocol. We managed to make interim arrangements through personal contacts at the PHN for the Merimbula team a few days later, but it’s not an enduring arrangement. Meanwhile, other PHNs around the country have been embedded in emergency planning with their LHD for many years, and have been able to support local GPs without any barriers at all.” Dr. Manderson agrees that a national organisation for equipment, training, standards, and representation is the only real solution. “We have Australian standards for clinic and professional accreditation and nationally accepted evidence-based clinical practice guidelines. The same evidence-based approach, with national standards, needs to be instituted in the primary care emergency response space. RERN SA and Sandpiper have pioneered this, and it’s time to roll it out Australia-wide.
Supplemental information and resources
For more information on the ways that hierarchies and protocols of disaster management have restricted GPs’ ability to assist response teams, Kate Manderson’s interview with the ABC can be accessed here.
The Rural Doctors’ Association of Australia, and the Australian College of Rural and Remote Medicine, have made their policy statement available here. The RDAA media release is also available here.
To learn more about how Sandpiper Australia is assisting rural and remote emergency response efforts, visit their website here.
To learn more about the Rural Emergency Responder Network (SA), visit their website here. If you are outside of SA, consider checking out the GoodSAMApp here.
To read more stories by GPs about what it means to deal with crises and emergency response as a GP, take a look at the stories on GPs Can.
What can I do about the bushfires?
Check out the #Bookthemout campaign - an initiative to boost tourism to Dr. Leeuwenburg’s Kangaroo Island, in order to boost the local economy to promote rebuilding in the community
If you have any money to give, please consider reading up on why the Volunteer Fire Fighters' Association are requesting donations.
If you’re considering donating money, items, or expertise, keep Sandpiper Australia in mind as a vital way to bolster rural and remote emergency response efforts.
If you’re considering donating money or items, Charity Navigator has a global fund designed to last after the media coverage fades away.
If you can volunteer your time to the environment, Conservation Volunteers has been nominated the national bushfire recovery coordinator, and have information on their site about ways you can help.
If you can volunteer your time or resources to the people displaced by the bushfires, Crisis App connects people needing resources directly to people donating them.
And finally,
Stay aware. Stay compassionate. This is still happening.
Media coverage may move on to different subjects or different crises, but as of the date of publication for this article the fires are still burning, communities are still experiencing extreme weather as a result of the fires, and displaced individuals are going to be experiencing the health and financial impacts of the fires for a long period to come. Accept help, and support each other.