Rescue

Emergency offshore deployments involving military medical services have brought rescue and relief to victims of the Mt Lamington disaster in Papua New Guinea (1951), to Rwanda in the aftermath of the civil war (1994-1995), to the drought and famine devastation in Irian Jaya (1998), and in recent months to the Aitape tsunami disaster in Papua New Guinea. RAAF health, rescue and reconstruction teams are deployed regularly to the Solomon Islands and other South Pacific nations after cyclone disasters.

By their nature, disasters disrupt the normal functioning of society, and extra and specialised training and skills are needed to equip doctors, nurses and other health professionals to operate in a devastated environment. Adrenalin surges are high, and the response team members must constantly face personal and collective risks. Relations at the interface between the defence force and civilians may become strained, and there are always political issues of cost, job demarcation and international liaison, and sometimes (as in Rwanda) armed conflict, which impinge on doctors involved in disaster response. After prior training and rehearsal of training systems, being a doctor in a disaster response team can be an experience of the greatest professional fulfilment. There is no better example of this than the health response to the 1998 Aitape tsunami disaster. What lessons have re-emerged from that deployment?

A disaster implies numbers of sick and injured that overwhelm the resources available for rescue and treatment. However, irrespective of the scale of a disaster, it is individuals who are dead, trapped or injured, and from each individual's point of view treatment is needed irrespective of whether or not there are a hundred or a thousand others in a similar plight. But the collectivity of individual victims of necessity changes the approach of the medical teams involved in disaster response. The skills (and heartbreak) of triage, the need for speed (the greatest good for the greatest number), and the importance of prevention of secondary trauma and disease are core themes in the repertoire of health teams responding to disaster. The articles in this issue of the Journal by Taylor et al and Holian and Keith illustrate well the importance of these themes.

One of the greatest resources for individuals and societies afflicted by disaster is the preservation of family units. By Day 8 following the Aitape tsunami disaster, all surviving orphan children were being cared for by relatives of their extended families; and surviving parents who had lost all their children had, in some cases, adopted the children who had been recently orphaned.

Before the arrival of medical teams, the application of simple first aid skills may often save lives and prevent serious complications of injury and disease. In the Aitape tsunami disaster many victims with fractures, impalements and lacerations had not had simple self-applied or buddy-applied first aid, with the inevitable consequences of unstabilised fractures, cellulitis, and gangrene and septicaemia of the wounds. Currently, 1 in 30 Australians are trained in first aid; this becomes a priceless resource when disasters strike. All military personnel are trained in the skills of first aid, but many civilian workers in non-government organisations are deployed without these basic skills. In the Rwandan emergency less than 20% of the civilian field workers possessed a current first aid certificate.

The most effective way in which Australian doctors can help in future disasters is by joining one of the three Services (as reservists) or one of the non-government organisations (such as the Red Cross or St John Ambulance, Australia). As part of a trained, properly equipped team they can then offer the necessary personal skills for emergency deployment. In the 1998 Aitape tsunami disaster, health reservists from the Royal Australian Navy, the Australian Army, and the Royal Australian Air Force served as essential members of the regular military teams. To these teams were added the Monash Medical Centre Surgical Team and health professionals of the defence forces of New Zealand and the United States. Such is doctoring at its best.

Major General John Pearn, AM, RDF
The Surgeon General, Australian Defence Force
c/- The Royal Children's Hospital, Brisbane, QLD

©MJA 1998
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