Lessons need to be learned to prepare us for natural disasters

Dear Editor, ‘ “Lessons learned”: a comparative case study analysis of an emergency department response to two burns disasters’ highlights the importance of disaster preparedness within our EDs. That article focused on the response to two ‘man-made’ disasters, and compared the lessons learnt from the first to assess how they helped improve the outcomes in the second. However, it is surely the response to natural disasters that poses a greater threat to our population in the advent of climate change. With a rapidly changing climate, the likelihood of natural disasters is set to increase. This will be in the shape of heatwaves, bushfires, storms and flooding, which might cause outbreaks of infectious diseases, particularly diarrhoeal illnesses. Are our EDs prepared? And how can we learn from each other to achieve a more streamlined ‘pan-Australian’ response? From personal experience of working in Melbourne during the heatwave of February 2009, it became clear that we were not well prepared for such extreme heat events. All EDs were on bypass for much of the weekend, finding it difficult to cope with the increase (overall increase of 12%) in patient presentations. The Melbourne area experienced an increase of 62% in all-cause mortality, which equated to approximately 500 excess deaths over the week of prolonged heat. A significant proportion of those who died did not reach an ED at all. Victoria responded with a ‘bottom-up approach’ by issuing a ‘Heatwave Plan for Victoria 2009–2010’. This document was aimed at the community level to increase resilience, particularly focusing on the most vulnerable populations, identified as the elderly in institutional care. South Australia focused their attention on increased communication capacity and early warning systems. What did we as emergency service providers learn? Although we all have disaster protocols in place, we encounter them infrequently and I suspect each is different in scope and approach. This highlights a need to for ED physicians and emergency service providers to collaborate and learn from each other to maintain a skill base in this area. No case series from EDs regarding the response to the heatwaves have been published. If climate predictions are to be believed, and the evidence is overwhelming, we are sure to have an increase in frequency and severity of heat extreme events. We should proactively combine our resources and expertise to achieve a common panAustralian plan so that any lessons learnt following a climatic change disaster can be quickly taken up by other hospitals. This will give an opportunity to systematically look at the effectiveness of our responses and evaluate their delivery in a similar way in which Little et al. have done. I believe it is our responsibility as emergency physicians, working on the front line of public health disasters, to carefully consider the new threats to our community due to climate change and to develop local as well as regional strategies to cope in both ‘natural’ and ‘manmade’ disasters.