Dr Penny Burns

Disaster Medicine Specialist and general practitioner, Dr Penny Burns has championed the role of general practitioners in disaster response for close to a decade and been a decisive figure in helping primary health networks develop disaster management pathways.

In early January, as fires continued to rage across several states in Australia, the AMA called on the Federal Government to ensure local community GPs are involved in future disaster and emergency planning.

The AMA was responding to the frustrations of general practitioners working in bushfire-affected areas who felt the role of the GP was being ignored in the emergency response.

Health groups blamed the exclusion of GPs on bureaucracy and jurisdictional division; Disaster planning is the domain of State and Territory Governments, while general practice is the responsibility of the Federal Government.

“We need to put an end to any Federal-State divide – intended or unintended – to ensure there is seamless and immediate provision of quality primary health care for victims of disasters and the aftermath, including at temporary locations such as evacuation centres and disaster sites,” Dr Bartone said.

For Disaster Medicine Specialist, Dr Penny Burns, the AMA was singing a very familiar song. For more than a decade she has studied the important role GPs play in disasters.

“GPs manage the burden of healthcare throughout Australia, so when they go down it means the majority of healthcare just stops and that’s a really scary thought.”

Role of GPs

In her article “Where are general practitioners when disasters strike” (2015), Dr Burns explains that despite “the high likelihood of spontaneous involvement, formal systems of disaster response do not systematically include GPs.”

Her research found GPs have a high level of local knowledge and are a good resource for immediate medical treatment, but their role is not clearly defined in the current system of disaster management.

As trusted members of the community and with strong linkages to the local population, GPs are often first responders in a disaster. Patients often seek out the services of their general practitioner, and in return GPs have demonstrated a high level of willingness and capacity to respond.

“We’ve had a number of disasters – the bushfires in 2013, the Victorian bushfires in 2009, the Christchurch earthquake – where GPs on the ground commented on how their waiting room became much like a safe space.

“They had patients flooding into the waiting room in distress, not sure what to do or where to go. I remember one doctor saying some patients turned up still covered in soot, they had just lost their home, they had a high level of stress and they just wanted someone they knew and trusted to sit down with them and listen to help de-escalate that distress. That’s one of the crucial roles of GPs at these times.”

GPs have vital knowledge of patients and the community, she adds.

“One of the difficulties in the moment when a disaster strikes is that you have little understanding of what is happening on the ground across the disaster. Are hospitals open? Where are people needing help? What is happening to my own family and home? The local hospital and ED services are great but they don’t manage the chronic disease, the medications, and the preventative healthcare that is the realm of the GP.

In the response phase of a disaster, GPs can play a significant role by providing extended hours/afterhours services to take the load off EDs, accepting patients from affected neighbouring practices, providing prescriptions and care at evacuation centres, providing home care to help keep patients out of the hospitals, and assisting with surge in EDs if needed.

“GPs deal with the minor emergencies, we deal with the preventive stuff like tetanus injection treatment, which is needed because people are out trying to salvage things and cut themselves.”

She adds, GPs have an integral role to play in the recovery phase of a disaster – providing continuity of care in the medium to long term. There is also the risk of deterioration in chronic disease, or the emergence of new conditions, such as respiratory conditions, ischaemic heart disease, or hypertension. There may also be increased substance abuse problems or mental health conditions, such as anxiety, post-traumatic stress disorder.

“In terms of GPs involvement we’re still learning, but we have progressed a lot in the last decade that I’ve been involved.”

Background

Dr Burns initially became interested in the subject while doing her Master’s Degree in Public Health in 2009. Having worked as a general practitioner for almost two decades, she was surprised that the course did not include the role of primary care in disaster management.

And then she had her own first-hand experience with a natural disaster. While visiting her parents in Los Alamos, New Mexico in 2000, a wildfire forced the evacuation of 11,000 residents. More than 400 homes were destroyed.

“It was a very secure scientific community that they were evacuated from, and again the GPs weren’t involved. And I thought this just didn’t make sense.”

Soon afterwards, she reconnected with one of her former professors from the University of Newcastle, Professor Beverly Raphael, who had become a pioneer in the field of disaster medicine.

“She saw my curiosity and interest and said ‘come and work with me’.”

Dr Burns joined Prof Raphael and the Disaster Response and Resilience Research Group at the then University of Western Sydney Parramatta campus.

Together they visited the communities affected by the Black Saturday Bushfires in Victoria in 2009 – speaking with GPs and working with teachers and school principals in the area.

“That was a real eye opener for me and of course one of the things I’ve been thinking a lot about as we head back into school term. A lot of disasters happen in the holidays and there’s a lot of children who have been exposed to these bushfires who will be processing it in different ways.”

Bushfires of 2019/2020

Dr Burns says disaster management pathways were developed, released and adapted by many Primary Health Networks (PHNs) in November in anticipation of this bushfire season.

“Before these fires struck there was a lot of awareness of the high level of risk in this season that was coming up. So there was a lot of activity amongst various groups.”

According to Dr Burns, there is a perception that in a disaster, medical professionals and organisations all need to “rush down and help”, but often that’s not what’s needed.

“It’s really important there’s an assessment of what’s needed, and the right supplies and the right people are sent to the right place at the right time.

“It needs to really coordinated and it needs to be coordinated based on what the local needs are.”

The current system approach is to connect GPs via PHNs, which are linked to LHDs, which link to the broader disaster system.

The central idea is that if a PHN needs GP volunteers in places such as evacuation centres, they first use local volunteers, then if more are needed, they approach neighbouring PHNs.
This provides a systematic approach and helps protect the GPs by incorporating them as part of a system rather than as solo GP responders.

Dr Burns explains, “So for the flow of communication, and response and preparedness activity, the aim is to have it go through to the LHD to create a coordinated effect.”

She says it’s a new system and it’s happening better in some areas than other areas. Prior to PHNs, GP divisions operated in this area, followed by Medicare locals.

“The PHNs have just emerged and now they’re trying to work out their role in disaster management. So it’s an evolving space.”

In the latest bushfire disaster, that linkage and coordination worked particularly well in PHNs such as Nepean  Blue Mountains, she says.

She cautions that there is a difficulty in trying to compare what worked or hasn’t worked in response to disasters, because each one is so different.

“During this period, we’ve had disasters all up and down the coast – NSW, Victoria, South Australia, Tasmania. And the bushfires have occurred on areas of drought as well, so we’ve had areas with disaster impacting disaster.

“So it’s really hard to separate disasters out and know what’s worse and what’s better, and how we’re managing. But I feel we learn something new each time, and as long as we incorporate those lessons, then we do get better.”

One lesson to emerge from this bushfire crisis, is the need for improved means of communication.

“When these events happen, in the immediate 24-48 hours, we lose contact with what is going on, so it’s very hard to support people.

“We need to have a system by which we can have really early communication with GPs on the ground and help work out what they need.”