Emergency preparedness – the role of family medicine

August, 2014

The topic for this month’s Policy Bite is inspired by three personal contacts. I have just been at the Royal College of New Zealand GPs’ conference, which was held in the city of Christchurch. This city was decimated by an earthquake in 2011 - 189 lives were lost, including some health professionals. More than three years later, there are still many parts of the city which await reconstruction. GPs were key to both the short term and longer term response, and did heroic work, albeit with major challenges1. Today, the whole of New Zealand routinely braces for further seismic destruction, and primary care teams rehearse on a regular basis so they can play their part.

During that visit I received an email from one of our most active WONCA advocates – Dr Atai Omoruto (Uganda), who is a member of the Organizational Equity Committee, and a key player in the WONCA Women’s Working Party for Women and Family Medicine. She is currently in Liberia as part of the Ebola health professional workforce from other countries dispatched to try to contain the spread of this deadly disease – which has already caused the death of some medical professionals in the last few days2.

In a selfish way, I hope against hope that Atai does not become included in this toll – just as I hoped for my friends’ survival when Christchurch was first hit. Both examples have also made me think about the overall role of GPs in ‘emergency preparedness’. In the UK we are not named as lead providers in any sort of emergency event – yet we know that in potential pandemics, local disasters, drug contaminations, and terrorist attacks, primary care providers are often expected to help, and become the first port of call both for those at risk and those who are affected by the psychological sequelae. It therefore behoves us to think proactively about our role.

For doctors or teams who already do emergency and urgent care, the physical side may seem less daunting. Rural and remote doctors, or those with hospital bed access, may be used to trauma care and organising people to urgent triage. But all GPs and their teams need to be ready for someone with injuries being brought into us – clean semi-sterile areas, comprehensive first aid kits, up to date IV fluids, defibrillators and oxygen, plus knowing how and when to use these are core skills and protocols that any GP should keep up to date.

Similarly, most of us work in an environment of uncertainty, but a new fever or respiratory tract symptoms take on a different meaning in a potential communicable disease outbreak – whether influenza, anthrax, or SARs. Triage areas, rapid assessment protocols to differentiate new cases from the ‘worried well’, dedicated ‘through routes’ and waiting areas, plus available supplies of handcleanser, masks and gowns if indicated may make a difference to your own risk and that for others.

At a national level, member organizations may be interested to know about the RCGP’s role in the last flu pandemic, and to check whether they are expected to play a similar role. Ably led by my colleague Dr Maureen Baker (then my predecessor as RCGP Honorary Secretary, now Chair of our Council), the RCGP used its 4 nations’ network to give daily communications about the latest figures on the outbreak; update vaccination and triage advice; support members and answer queries on email; and enforce communications to the public about what to watch for - and what to do - to prevent and manage illness.

Of course, the risk profile of our country and location will vary - natural disasters such as earthquakes and tsunamis3, chemical or physical infrastructure accidents, communicable disease outbreaks, and the local impacts of conflicts or terrorism all alter the situation, as do sudden migrations and displacements of people trying to escape danger. Governments and emergency services often expect health services to assist in major event prevention and management of the aftermath: however, rehearsals do not usually involve family doctor services, and in many lower resourced countries there may be little direct guidance or support even when an event occurs. This makes our own preparedness and resilience important. Planning for ‘business continuity’ in the event of loss of power, clean water, electronic communications, staff shortages, and medical equipment, can all make the difference in the first days and weeks of a problem. Psychological and practical preparations, mutual support, clear agreement as to who does what, debriefing and expert advice can enable a chaotic situation to move to one where family doctors can both protect and lead their teams while delivering effective help to those in need. So let’s give respect to all who act in hard times (as we all have, or shall sooner or later) – let’s learn from each other4, and also ensure our governments include us in advance if they expect us to do the best job we can for our patients and our own colleagues.

Amanda Howe
President Elect

Notes and References
1. Johal S et al. Coping with Disaster: General Practitioners’ Perspectives on the Impact of the Canterbury Earthquakes. PLOS Currents: Disasters 2014; 2 April online [doi: 10.1371/currents.dis.cf4c8fa61b-9f4535b878c48eca87ed5d
2. This version written 30/7/14
3. Previously WONCA news has covered issues such as the impacts on our Japanese and Phillipines colleagues of their own sad events… fourth report written in APril 2012 of Japanese Tsunami;  President's column presenting a very sobering report on The Japanese tsumnami three years on; Initial report on Philippines Typhoon
4. This is a good conference topic for parallel sessions and workshops!