“A nationwide Rural Emergency Responder Network should be developed to identify and document the location of rural doctors with advanced emergency response and retrieval skills to provide an additional level of community resilience in the face of pre- hospital incidents such as multi-trauma and State/National disasters. These doctors should be appropriately equipped and supported”
Disasters, natural or other, have a devastating impact on all Australian communities, especially those in rural and remote locations which may lack the formal ‘classic’ health infrastructure observed in metropolitan and regional areas. In the past decade alone, Australia has experienced many natural disasters and health disasters, from extensive bushfires, droughts and floods to the COVID-19 pandemic.
Each disaster has reinforced the maldistribution of health resources across our vast country, and the importance of utilising the experience, expertise and skill of rural and remote medical practitioners in disaster response. Whether this be pre-hospital medical events or natural disasters, rural and remote doctors are perfectly positioned to provide aid in a formal manner to their communities.
Typically, rural doctors who are rural generalists provide primary care services to their community, along with provision of emergency care through their local rural hospital. Many have advanced skills in anaesthesia and resuscitation, and are well-placed to assist in a disaster, both immediately at the scene (with provision of early and advanced clinical care) and in subsequent phases (links to local community, awareness of local resources etc.).
A joint position statement on The Role of the Rural GP in Disaster Response and Pre-Hospital Care’ from the Australian College of Rural and Remote Medicine (ACRRM) and the Rural Doctors Association of Australia (RDAA) in 2016 reported that rural doctors are often the frontline of the emergency response in rural and remote areas.
The recommendation was made that “A nationwide Rural Emergency Responder Network should be developed to identify and document the location of rural doctors with advanced emergency response and retrieval skills to provide an additional level of community resilience in the face of pre- hospital incidents such as multi-trauma and State/National disasters. These doctors should be appropriately equipped and supported”
“It is critical to include local doctors during a disaster response as they are best positioned and skilled to advise on local resources and community needs, particularly in rural and regional areas”
Whilst Australia has excellent ambulance and retrieval services, there are often significant delays in the ability to deliver care to patients with time-critical injuries or needing advanced clinical care. For rural communities, local ambulance services can be limited in terms of resources (often a single ambulance available) or capability (crews may be volunteer or paramedic level only). Additionally, many rural locations are vast distances from large population centres, meaning that specialist retrieval teams generally take time to arrive.
It is not uncommon for assistance to be requested by State emergency services from rural medical practitioners. In 2012, a survey of Australian Rural Generalist Anaesthetists (primary care doctors with specialist training in anaesthetics) indicated that almost 60% of respondents had been called to attend a pre-hospital incident in the previous 12 months. Importantly, many of these responses were ad hoc and occurred at times when ambulance resources were limited or the ability of specialist retrieval teams to arrive was too late for patients with time critical needs. This informal nature of disaster response is driven during times of need, in the face of existing barriers.
In much of Australia, the protocols and policies utilised by metropolitan based emergency and retrieval agencies are designed for metropolitan locations with commonly highly sub-specialised clinicians and exclude the role of rural clinicians. The exclusion of the expertise of rural clinicians can lead to significant inequity in ability to access timely care for rural patients or result in impromptu responses. It also fails to acknowledge the pivotal role rural clinicians have within their community, as a source of expertise to consult on local resources and needs during a disaster.
This lack of inclusion of local, experienced rural clinicians was outlined by the Victorian Coroners. Following the Kerang Level Crossing Collision, it was observed that various system inadequacies, such as the utilisation of local resources, likely had a negative impact on disaster response and patient survival.