OPERATION PHILIPPINES ASSIST 2013 · 06th Logistics ‘pack down’ team arrives 08th Visit by The...

OPERATION PHILIPPINES ASSIST 2013

Team Alpha and Bravo AUSMAT Deployments Report To The AHPPC

2

National Critical Care and Trauma Response Centre, Operation Philippines Assist 2013: Team Alpha and Bravo AUSMAT Deployments Report To The AHPPC, 2015.

This work is copyright. ISBN-10: 0994357419 ISBN-13: 978-0-9943574-1-0

More information is available from: National Critical Care and Trauma Response Centre Royal Darwin Hospital PO Box 41326 Casuarina NT 0811 Phone: +61 8 8922 6929 | Fax: +61 8 8922 6966 | Email: [email protected]

Website: http://www.nationaltraumacentre.nt.gov.au/

Operation Philippines Assist 2013

3

ContentsForeword 4

Executive Summary 5

Timeline of Key Events 6

High Level Conclusions 7

List of Alpha and Bravo Deployees 8

Background 10

Pre-activation Phase 11

NCCTRC Activation 12

Team Alpha Arrival In-Country 13

Field Operations 14

Administrative Arrangements for Alpha and Bravo 15

Remuneration 16

Governance Mechanisms 20

Demobilisation 21

Debriefing 21

Recommendations 22


4

Foreword

Dr Len Notaras AMChief Executive of Northern Territory Department of Health

I would like to commend this report entitled Operation Philippines Assist to Members of the Australian Health Protec-tion Principal Committee (AHPPC). The success of Operation Philippines Assist resides with the collaborative effort of all Australian jurisdictions, as well as New Zealand, and owes much to the support of AHPPC and the considered leadership of Australia’s Chief Medical Officer Professor Chris Baggoley. The support and assistance provided by the Department of Foreign Affairs and Trade, AusAID, Emergency Management Australia (EMA), and the Department of Defence, to name just a few, well secured the success of a mission that most def- initely saved lives and limbs, and did Australia proud. Finally, I commend the small but ever enthusiastic team at the National Critical Care and Trauma Response Centre (NCC TRC), enthusiastic individually, well bless-ed not only with boundless energy, but also the several attributes of relevant skills and a desire to engage in collaboration.

Dr Len Notaras AMMarch 2014


5

Executive Summary

On the morning of the 8th November, 2013, the category five Typhoon Haiyan made first landfall in Guiuan, Eastern Samar Province, Republic of Philippines. Known locally as Typhoon Yolanda, the ‘superstorm’ was estimated by experts to be the strongest ever to make landfall. Sustained winds of 235km/h and gusts of 275km/h were accompanied by a tidal storm surge. This resulted in a natural disaster combining wind damage with inundation. The official number of fatal-ities stands at 6190, with 28,626 injuries attributed to the event, and over 16 million people affected.

The Australian Medical Assistance Team contribution to Operation Philippines Assist represented a seminal event in the history of overseas medical disaster response for the Commonwealth Govern-ment. It was the first time that:

» Team composition included a health professional from every state and territory on a deployment;

» the Australian Government has de-ployed a civilian field hospital capability to an overseas disaster setting;

» a major deployment was undertaken under the National AUSMAT manual, endorsed in 2012;

» a fully self-sufficient, self-sustaining, trained and inoculated team of medical professionals representing Australia was deployed.

It was also the fastest deployment of a functioning civilian field hospital in recent memory.

During 23 days of operational activity, 2734 patients were seen, 238 operations were performed of which 90 were considered major procedures. The facility was seen as a critical hub in the overall emergency health response to the disaster.

The total cost of the operation represented a cost per patient of only $658 AUD, a remarkable figure. Of course, the value for the individual patients treated, the community of Tacloban City, the devel-opment of AUSMAT, the exposure for the Australian Government on national and international media, and the relationship between Australia and the Philippine governments far exceeded the total oper-ational cost.

The partnerships developed between ex-ternal stakeholders and AUSMAT were a key element to the mission. The partner-ship between AUSMAT Team Leadership and the Philippines Ministry of Health of-ficials, and our doctors and the Philippine clinicians working in the Eastern Visayas Regional Medical Centre (EVRMC), was critical in the delivery of a high standard, coordinated care package to the beneficia-ries. In addition, the support of the Phillip-ines Ministry of Health in embedding 15 nurses in the facility was invaluable.

The AUSMAT Team Leadership were seen as critical ‘go-to’ points during the initial phase of the response and during participation in Ministry of Health (MoH) coordinated Health Cluster meetings. The AUSMAT facility became a referral point for most of the major foreign government and non-government teams in the event of critical illness of their staff, including the service-men and -women of the US Mili-tary. All of these partnerships were critical in allowing a smooth handover of patients to either the MoH or Non-Government Organisation (NGO) run health facilities at the conclusion of our mandate.

Overall, the deployment proceeded smoothly and efficiently. There were no major critical incidents. Interaction with the major agencies (National Critical Care and Trauma Response Centre and Depart-

ment of Health, Emergency Management Australia and the Department of Foreign Affairs and Trade) was productive and largely in line with the National AUSMAT manual. Positive interaction with support agencies, such as the RAAF ADF Joint Operations Command and Customs and Quarantine, were enabling factors in the response.

Support from the Northern Territory gov-ernment, including the Chief Minister and Health Minister, as well as the Northern Territory Fire and Rescue service, was critical in the response.

Finally, the contribution of the New Zea-land Government through embedding an orthopaedic surgeon and logistician into the Bravo team and demobilisation teams respectively shows the close affiliation between AUSMAT and NZMAT as regional partners in the provision of emergency medical aid.

Whilst the deployment was an undoubted success, there are always valuable les-sons to be learned for future deployment. In view of this, the AUSMAT Working Group has been reconvened under the auspices of the National Health Emergency Man-agement Subcommittee (NHEMS) and the AHPPC to discuss and implement recom-mendations from the various post-deploy-ment reports and reviews.

This report has been structured to reflect the reporting and evaluation guidelines in the National AUSMAT Manual. Topics covered in some detail represent depar-tures or modifications to the guidelines in the AUSMAT manual.

Recommendations are referenced in the text as a numeral within parentheses at the conclusion of the paragraph to which the recommendation relates, and are written in full at the conclusion of the document.

It represents the opinion of AUSMAT Team Leaders involved in the deployment. It is to be read in conjunction with other reports and evaluations.

Dr Nicholas Coatsworth14th March 2014

Dr Nicholas CoatsworthExecutive Director


6

Timeline of Key Events

08th Typhoon Haiyan makes landfall

09th Request to Australian Government for assistance

10th Medical options paper presented to EMA by NCCTRC

11th IDETF gives authorisation to activate NCCTRC to

undertake 37 person AUSMAT deployment

11th AHPPC endorses composition and deployment of AUSMAT

Team Alpha

12th Team Alpha departure delayed, briefings continue

13th Temporary authorisation to practice granted by

Philippines Government

13th Team Alpha depart Darwin

13th Team Alpha arrive Cebu

14th Team Alpha split, half of team deployed as advance

party to Tacloban City Airport

14th Site identified for field hospital adjacent to Tacloban

City Airport

15th Clinical activity commences

27th Team Bravo depart Tacloban-Darwin

27th First contingent of Team Alpha depart Tacloban

29th Handover team from Team Alpha depart Tacloban

06th Outpatient service closes

06th Logistics ‘pack down’ team arrives

08th Visit by The Hon. Julie Bishop MP, Foreign Minister

08th Clinical activity terminates

09th Team Bravo main team depart Tacloban

11th Team Bravo clean up team depart Tacloban

13th All psychological debriefings complete

20th The Hon. Peter Dutton MP and Prof Chris Baggoley AM

visit Darwin to thank deployees

November 2013

December 2013

February 2014


7

High Level Conclusions

1. The Australian Government and Com-monwealth Department of Health can be confident that the AUSMAT deployment element of AUSASSISTPLAN can be effectively and efficiently deployed to a regional disaster as the medical element of a comprehensive aid package;

2. An AUSMAT deployment represents signif-icant value for money in terms of cost per patient treated and is an effective use of overseas aid funding;

3. Close collaboration between National Incident Room (NIR) and the National Critical Care and Trauma Response Centre guaranteed that the role assigned to the Department of Health in the AUSMAT deployment was fulfilled effectively and efficiently. In essence the NIR took on a strategic role on behalf of the AHPPC and the NCCTRC took on an operational role in guiding aspects of the deployment;

4. A body of work needs to be done to con- solidate procedures and processes post- deployment, particularly where pay and conditions are concerned. The Depart-ment of Health through the AHPPC, NHEMS and AUSMAT Working Group is best placed to review this issue given its understanding of issues surrounding pay and conditions across jurisdictions;

5. The value of AUSMAT training through the NCCTRC and the jurisdictions was well demonstrated and allowed close adherence to the new WHO guidelines for Foreign Medical Teams;

6. The governance structures outlined in the National AUSMAT Manual performed well during practical application and the opportunity exists to finesse these in the post-deployment period through ongo-ing debriefing and evaluation mecha-nisms. That the key agencies involved in AUSMAT deployment (Department of Health, Department of Foreign Affairs and Trade, Emergency Management Australia, NCCTRC) continue to devel-op a cadre of experienced operational staff with the knowledge and capaci-ty to complete key deployment tasks as set out in the AUSMAT manual;

7. The collaboration between Department of Health, EMA and DFAT made a significant contribution to the success of the deploy-ment;

8. The Department of Health via the NIR and NCCTRC, with the assistance of other Commonwealth Agencies and the Whole of Government mechanism of AUSASSIST-PLAN, is able to successfully execute a coordinated multi-jurisdictional deployment of health professionals during a disaster.


8

List of Alpha team members

Northern TerritoryAustralia

QueenslandAustralia

South AustraliaAustralia

New South WalesAustralia

DFAT

Adrienne DeansDoctor

Amanda LingwoodNurse

Andrew FentonAnaesthetist

Annette HolianDoctor

Annette KwiatkowskiParamedic

Brian SpainDoctor

Bronte DouglasNurse

Charles DouglasDoctor

Chriswinda LiusantoNurse

Catherine GaylardNurse

David ReadDoctor

Ian NortonDoctor

Karen WereNurse

Lisa MurphyNurse

Lynice WoodNurse

Malinda LeachNurse

Mark AnzinFirefighter

Mark HasteNurse

Marlene BallNurse

Petra StraightPharmacist

Ryan ClayFirefighter

Sheila McIntoshNurse

Simon HillFirefighter

Steven MalseedFirefighter

Terry TrewinFirefighter

Thomas RandellRadiographer

Wendy RogersNurse

William GleesonFirefighter

Yuri FukayaNurse

Ben De SouzaDoctor

Cliff CollettParamedic

Robert Cardwell Doctor

Timothy GrayDoctor

Roger Lye

Team Alpha | Deployment Philippines

Mark LittleDoctor

Angela JacksonNurse

James DoubeDoctor

Tracy CallananNurse | Paramedic

Jonathan David Ball

EMA

Charles Dymoke Thursby-Pelham


9

Northern TerritoryAustralia

New South WalesAustralia

Western AustraliaAustralia

Australian Capital TerritoryAustralia

TasmaniaAustralia

New Zealand

DFAT

EMA

Nicholas Richard CoatsworthDoctor

Philip BlumDoctor

Dan HolmesDoctor

William SargentDoctor

Mark De SouzaDoctor

Malcolm Johnston- LeekDoctor

Dianne BlackNurse

Rhiannon WakeNurse

Christopher BinksNurse

Abigail TrewinParamedic

Peter JonesFirefighter

Robert CrowellFirefighter

Kane PenleyFirefighter

Arullan NaidooPharmacist

Patricia DenNurse

Helen MeadDoctor

Jacinta O’LearyNurse

Jorian KippaxDoctor

Vaughan PoutaweraDoctor

Simon Puckett

Peter Willett

Justin WhiteLogistics

Team Bravo | Deployment Philippines

QueenslandAustralia

Megan ChandlerNurse

Peter WilkesLogistics

South AustraliaAustralia

Cea Cea Barbara MollerDoctor

Daniel EllisDoctor

Alexia BrookNurse

Paul McGowenLogistics

Ronlyn TaylorNurse

Anne CoyneNurse

VictoriaAustralia

Joanne GrindlayDoctor

Peter ArcherDoctor

Cindy SheersNurse

Dianne CrellinNurse

Ben SchmidtLogistics

Rebecca WeirNurse

Elizabeth HardingNurse

Bruce WicksteedNurse | Paramedic

Toby KeeneParamedic

List of Bravo team members

Katie NicholsonNurse

Casey Faust Lara Frantzen


10

Background

Typhoon Haiyan (Yolanda) made landfall on the 8th November 2013. Passing in an east-west direction through the Visayas group of islands, the storm was one of the most powerful and destructive recorded. The Philippines government declared a State of Calamity on 11th November. The World Health Organi-sation (WHO) declared the disaster a category 3 disaster (highest category, Emergency Response Framework ERF). The international disaster response was led by the Philippines Government with the assistance of the WHO. The registra-tion and deployment of disaster medical assistance teams took place using the International Classification and Guide-lines for Foreign Medical Teams (FMT) in disaster. Eighty-nine teams formally registered with the MoH as FMTs, and MoH were aware of a further 62 teams providing care in country.


11

Pre-Activation Phase

The capability of Australian Govern-ment, and the capacity of the NCCTRC to provide a field hospital was already well recognised, not only in Australia, but also at an international level. This facilitated early discussions and indeed the preparation process, in the lead up to a formal request. The ongoing work of the Australian Government via EMA and the NCCTRC in developing relationships, both through training, and leadership in key regional events such as the Austra-lia-Indonesia disaster response work-shop in 2013, bore fruit in the Philippines deployment and contributed directly to the streamlined and efficient way with which the team was able to be deployed (1).

However, given that a Category 5 cyclone system is one of the few natural disas-ters where reasonable intelligence is available prior to disaster-onset, there were opportunities for Commonwealth agencies to interact more effectively pri- or to the disaster to enable a more rapid deployment. It has been identified that DFAT had in-country officers and were discussing response options prior to the disaster, but that EMA and DoH were not part of those discussions at Canberra level. Although NCCTRC had effectively self-activated by the 8th of November, the delay between typhoon onset and full

activation of AUSASSISTPLAN meant that some of the procedures outlined in the National AUSMAT manual were mod-ified due to the constraints arising from the timing of activation.

The deployment of the AUSMAT team was preceded by the deployment of a DFAT Officer to Tacloban City, reporting to Canberra via Post in Manila. Of note, the perspective of a technical expert in disaster medicine and disaster response was not available in-country and prior to the arrival of the full team. Given the very high likelihood of an AUSMAT response, the predictability of the scale of the disaster, and the availability of senior AUSMAT operational staff for immediate deployment, it was surprising that the request was not forthcoming to deploy a disaster medicine specialist with the DFAT Officer. We note that there is scope in the National AUSMAT manual for a ‘forward team’ to be deployed. The presence of a disaster medicine special-ist would be complementary to the DFAT officers and allow an enhanced technical opinion on the health status and health needs of the affected population (2). The limitations placed on the initial de-ployment as a result of this decision are discussed below.


12

NCCTRC Activation

The NCCTRC was formally activated and tasked at 11am CST following the Inter-Departmental Emergency Task Force (IDETF) on the 11th November. NCCTRC activation proceeded in accor-dance with the National AUSMAT Manual.

As the magnitude of devastation became apparent, extensive discussions surround-ing the NCCTRC’s capacity to respond occurred. With preliminary agreement reached between the Chief Medical Officer and NCCTRC Executive Director, the AHPPC was consulted as per the AUSASSISTPLAN to endorse the deployment of a Common-wealth medical team.

The Health Emergency Operations Centre (HEOC) was activated and process began to select the team. Given the tasking to provide a Level 2 surgical facility, 37 personnel were identified (12 doctors, 14 nurses, 3 paramedics, 6 logisticians, 1 pharmacist, 1 radiographer).

The composition of Team Alpha and the deployment was endorsed by AHPPC.

The Alpha team was composed primarily of responders from the Northern Territo-ry, with smaller contingents from South Australia and Queensland. The speed with which the team was able to gather in Darwin validated the need to use human resources based at Royal Darwin Hospital for the initial phase of deployment and

was in keeping with the mandate of the NCCTRC to deliver ‘surge support’ to enable RDH to respond to national and regional incidents.

With sufficient lead-in time and the sup-port of the AHPPC, Bravo team was able to be selected with appropriate skill-mix and representation from every state and territory of the Commonwealth, and a rep-resentative from the New Zealand Medical Assistance Team (NZMAT).

NT Health was able to absorb the deploy-ment of 23 clinical personnel on Team Alpha. Approval was sought and given by both the NT Chief Minister and the NT Health Minister who were highly support- ive of the deployment throughout.

By midnight on 11th November, 35 of 37 personnel had arrived in Darwin ready for departure the following day.

All logistic equipment had been transport-ed to RAAF Base Darwin and packed for transport by midnight on 11th November.

Operational constraints, namely the secu-rity situation on the ground in Tacloban and the ability to access the airstrip, meant that departure was delayed until the 13th November.


13

Team Alpha Arrival In-Country Team Alpha departed RAAF base Darwin

on the morning of November 13, arriving in Cebu later that day. The Team over-nighted in Cebu in hotel accommodation. The delay was again identified as secu-rity-related, and the additional issue of aircraft night-operations restrictions. At this point the location of the AUSMAT field hospital had not yet been identified.

On Thursday 14th November, half of the AUSMAT Team departed with a split cargo for Tacloban City. Upon arrival at Taclo-ban City aerodrome, the AUSMAT Team Leader commenced negotiations with the local Ministry of Health regarding the best location for the field hospital. At this point there was still a possibility that the hospi-tal would be deployed to the city of Giuain (population 25,000) on the Island of Samar. The decision to locate the facility adjacent to Tacloban City Airport was finalised on the evening of the 14th of November. The remainder of the team and cargo arrived on the 15th of November, and clinical operations commenced that afternoon.

The devastation faced by Team Alpha upon arriving cannot be under-estimated. Ap-proximately 5000 refugees were gathered at the airport, the airfield had only just been secured, and cadavers were scat-tered around the site where the facility was to be located. The fact that the facility was operational within 4 hours of all the equipment arriving is testimony to the professionalism and skill that has been cultivated in AUSMAT.

Potential security issues related to the arrival of the first portion of Alpha team and subsequently the remainder of the team, in the context of an unsecured mili-tary airfield and 5000 internally displaced persons, were quickly resolved with the assistance of Philippine armed forces and the Marines of the United States 7th fleet. It should be noted that the NCCTRC had delivered a joint training package with the US 7th fleet in East Timor several weeks prior, and that individual relationships cultivated there assisted in the on-the-ground negotiation of security support.

The 48 hour delay between arrival in the Philippines and the set-up of the field hospital is a strong indicator of the need to have an AUSMAT disaster medical expert in country prior to the arrival of the main team. It is critical that decisions regarding the location of deployment of a 28 tonne medical facility and 40 personnel not be compromised by the limitations of distance and communication, and that a team of appropriate Australian Govern-ment representatives are discussing local health needs with receiving-government officials. The mix of a forward deployed team could be identical to the Mission Control Team as specified in AUSASSIST-PLAN.


14

Field Operations

Operational EffectThe Operations of the AUSMAT field hospital are detailed in the Daily Situation Reports and the FMT Exit Report.

Over a 23 day operational period from the 15th of November until the 8th of December, 2734 patients attended the facility, 238 operations were performed in theatre, and there were 541 patient-days of bed occupancy.

All private hospitals were inactive when Team Alpha arrived in Tacloban. The ma-jor public referral centre, Eastern Visayas Regional Medical Centre (EVRMC), had major structural damage (flooded ground floor and emergency department, no power to run theatres, top floor structur-ally damaged). The AUSMAT field hospital provided the following services to the relief effort in Tacloban:

» Trauma surgery – 2 tables, maximum throughput 24 procedures per day

» Sterilisation services – the EVRMC bought equipment for sterilisation on a daily basis during the Team Alpha deployment; this allowed EVRMC to provide critical obstetric surgical ser-vice, whilst AUSMAT took on the bulk of trauma-related and general surgery

» Outpatient services – Maximum visits 224 per day

» Basic obstetric services – 3 deliveries in the facility during the operational period

» High Dependency Unit – 4 bed HDU

» Paediatric ward

» Resuscitation area – the resuscitation area was considered the referral point for most foreign field staff, in the event of a medical emergency requiring ur-gent stabilisation prior to evacuation

Further detail regarding the type of pathology encountered is available in the Situation Reports. However, it is worth noting that three days prior to closing the facility the Philippines Air Force brought 4 casualties from a helicopter crash to the AUSMAT hospital, such was the regard in which the facility was held.

Staffing of the facility was achieved through long hours and the forbearance and capacity of AUSMAT deployees, most notably the nursing staff. Whilst this is to be commended and is expected of the personnel we select, the staffing ratios and rostering must match the specified clinical capability in the tasking order. In effect a heavy facility was staffed by a modified light team (3).

The partnership with the Philippine MoH was critical in the delivery of care. Firstly, the offer of the AUSMAT Operating The-atres to local surgeons when the EVRMC was not operational was extremely well received. Secondly, the provision of 2 rotations of 15 nurses gave translation, cultural awareness and clinical support to our nursing and medical staff.

Medical records were kept that were of adequate standard for the context. All patients attending the facility received a treatment card which they kept. All presen-tations were hand-recorded and reported to the MoH and WHO via the Disease Early Warning System (DEWS). All patient trans-fers were accompanied by a transfer letter and the inpatient notes.


15

Logistics and EquipmentThe facility met or exceeded requirements for a Level 2 facility under the WHO guide-lines. The superstructure of the hospital, namely the Alaskan shelters, Western shelters and Campmore shelters, provid-ed an acceptable working environment. The air-conditioned wards and operating theatres provided a high level of comfort for patients.

An early resupply was required and facilitated by the RAAF for two operational demands:

a) The high volume of surgical cases requiring medical consumable resupply.

b) The increased demand on camp infra-structure (including camp equipment and food) due to the number of non-AUSMAT personnel that were being supported. This was under instruction from the Mission Leader for Team Alpha.

Deployees have been given an opportunity to provide feedback on the equipment in the NCCTRC cache which is forming part of an ongoing review and resupply of the cache post-deployment (see evaluation summary). The value of constant training deployments undertaken by the NCCTRC (Surgical and Anaesthetic course, health deployments in the NT, Tour de Timor health support) was demonstrated by the familiarity of staff with the equipment used, particularly in the operating theatre, allowing surgical procedures to com-mence 4 hours after the hospital set-up began on 15th November.

SecuritySecurity briefings were provided as per the National AUSMAT Guidelines pre-de-ployment and during the mission. No critical security incidents occurred.

Field Operations

Conduct of StaffConduct of AUSMAT deployees was ex-emplary in trying conditions, and followed closely the AUSMAT Code of Coduct. There were no critical incidents to report.

Interaction with External StakeholdersThe AUSMAT leadership facilitated positive relationships with all external stake-holders. The key relationships were with the Philippines MoH Health Cluster chair-person, the leading medical officers at the Eastern Visayas Regional Medical Centre, and the medical officers from the Philip-pines Air Force who supervised aeromedi-cal evacuation to Cebu and Manila.

Secondary relationships were cultivated with WHO and affiliated agencies, and other government and non-government foreign medical teams. This was of most value during the demobilisation planning when patients needed transfer to other facilities.

The AUSMAT encountered a number of NGO’s that did not meet the WHO stan-dards. In particular a private Australian team, who wore a similar uniform to the NCCTRC, used the Australian flag and were deployed using RAAF assets, were providing primary care and nominated as a Level 1 team. It was clear from their recruitment and in-country processes that this team did not meet the standard that should be expected from an Austra-lian-government supported response. The real reputational risk to both AUSMAT and the Australian government of a potential confusion between official and unofficial teams need to be recognised, and the Whole of Government approach to disaster response must include an assessment of compliance with FMT Standards prior to any agency agreeing to support a team (4).


16

MediaMedia interest in the Australian Govern- ment response in the aftermath of Typhoon Haiyan was immense. Coordination of media leading up to the deployment was handled by the National Critical Care and Trauma Response Centre Media Unit in consultation with the Federal Department of Health, DFAT and Department of Defence.

The majority of deploying medical and logistical personnel was experienced in media however they were provided with a briefing before talking to media in Darwin.It was discussed with media represen-tation from DFAT prior to deploying that media opportunities would be available initially to the team leader and deputy leader and once in country that the media opportunities should be shared among personnel to ensure representation to audiences in each state and territory jurisdiction. With the deployment of Team Bravo this was changed to ensure that state/territory representatives are given exposure on re-quest before deploying. All media requests once the teams deployed were advised to contact the DFAT Media Unit in Canberra. The NCCTRC ensured liaison with relevant jurisdictional health departments with the deployment and return of both teams although this was refined with the deploy-ment of Team Bravo because of the large jurisdictional representation. Once in country, media management was handed to the DFAT unit with all media requests referred to DFAT media in Canberra.

For the first time in an overseas deploy-ment, the NCCTRC used social media – Twitter and Facebook, – as an infor-mation tool. The use of Facebook proved

very popular particularly with family and friends of deployed personnel. During the first deployment the response saw up to 20,000 people accessing the informa-tion via Facebook. The biggest single issue was ensuring that the content was regularly updated 24/7. Fortunately once the teams settled into a routine, they were able to get images back to the NCCTRC and provide information, however in future deployments this should be taken into consideration.

The deployment to the Philippines was a good news story for the Australian Government and demonstrated the good relationships between the NCCTRC, DoH, DFAT and Department of Defence to en-sure the messaging remained consistent and positive for the month long deploy-ment. The media coverage summary in the report shows the value and volume of coverage across both traditional media and social media.

Official VisitsA number of official visits took place during the deployment. The level of dignitary is testimony to the regard in which the AUS-MAT facility and deployees were held. The Philippine President and the Australian Foreign Minister The Hon. Julie Bishop MP were the highest ranking officials to visit. In the initial phases visits were accommo-dated on an almost daily basis. The chal-lenge for future deployments is to ensure that clinical activity and quality of care can take place alongside these important visits. This will be facilitated by continuing the relationship of AUSMAT and NCCTRC with DFAT operational officers to develop their understanding of clinical activity and field hospital function.

Field Operations


17

Administrative Arrangements for Alpha and Bravo

Transport of Deployees to departure pointThe NCCTRC Operations Manager liaised directly with EMA officers once the com-position of the team Alpha was finalised and individuals selected. EMA arranged the travel of most of the deployees to Darwin. Several deployees’ travel was arranged directly through NCCTRC. Ac-commodation for the majority of deploy-ees was arranged by the NCCTRC (5,6). All transport and accommodation for the Team Bravo departure was arranged by EMA. Feedback from individual jurisdic-tions indicated there are areas where communication between EMA and AUS-MAT focal points regarding travel arrange-ments could be improved, particularly given the lead time available to arrange domestic transport and accommodation for Team Bravo (6).

Commonwealth Indemnity and Allowance FormsIn the case of Team Alpha, these forms were signed in the field on the day prior to return to Australia. Team Bravo deploy-ees had the opportunity to read and sign the documents during briefing (6).

Medical ChecksPre-departure medical checks were con-ducted to cross-reference the usual medi-cal checks required prior to deployment. The NT uses standardised medical assessment forms that are completed by a General Practitioner nominated by the de-ployee. There was concern voiced by other jurisdictions who supplied members for Team Alpha that there was no standardised method for medical assessment. No medical issues were identified that pre-cluded deployment for either team (7,8)

VaccinationVaccination standards were adhered to as per the expanded schedule contained in the AUSMAT manual. In particular, all deployees must have had full primary rabies vaccination prior to deployment.It is acknowledged that this precluded a number of trained deployees from being considered, and that a variety of opinions were given as to the timing of rabies vac-cination courses. Opinion was sought and the position of the AHPPC was confirmed by the Australian Therapeutic Advisory Group on Immunisation (ATAGI).

Fitness ChecksThe standard 2.4km walking test as specified in the national AUSMAT manual was not conducted for members of Alpha or Bravo (9).

There were no instances where clinical capacity was compromised by a lack of physical fitness.

Heat AcclimatisationThe composition of Team Alpha with 30 members from the NT guaranteed a high degree of heat acclimatisation. There were no instances of heat illness recorded, however in both team deployees expressed a level of discomfort that may have been alleviated with appropriate acclimatisation.

Jurisdictions were provided with a Heat Acclimatisation protocol by the NCCTRC immediately after the composition of Team Bravo was determined (10 days prior to deployment). It is unclear whether non-NT deployees completed the proto-col (10).


18

Pre-departure briefingsConducted in accordance with the AUSMAT Manual. Limited information was available from the field (see previous recommendation regarding Forward AUSMAT Team) regarding the health situation on the ground. At the time of departure the location of the field hospital was still unclear.

The briefings focussed on dividing the team into clinical groups, selecting clin-ical team leaders (medical and nursing) planning rosters for clinical activity and briefing on commonly encountered conditions.

Improved information flow from the field (via DFAT post) to the deploying agency (NCCTRC) particularly regarding cultural issues and the need for translators would have been helpful in the Alpha deploy-ment. A more comprehensive briefing from Team Bravo was available and based on direct communication with the field.

Psychological briefingPhone briefing and psychological as-sessment undertaken by Response Psychological for each deployee. No points of concern identified or communi-cated to Team Leaders. It was noted that some members of the Mission Control Team underwent a different process for psychological assessment and debrief, and the recommendation was made by our psychologists that, in the interests of consistency, all members deployed with an AUSMAT undergo the same process.

Administrative Arrangements for Alpha and Bravo


19

RemunerationRemuneration arrangements differed substantially between state and territory and across professions. However, this did not substantially affect the total HR cost of the deployment.

It is clear from the Policy Guides associat-ed with AUSMAT that they have not taken into account the variables that occur in the awards and conditions of health profes-sionals across Australia.

It is to be noted that policies applying to single professions (e.g USAR, AFP) are not transferable to the health sector. This deployment has identified that the remuneration specifications in the EMA Deployment Guidelines and the Nation-al AUSMAT Manual are not sufficiently detailed nor tailored to the health sector. This creates confusion amongst the ju-risdictions, and an unrealistic impression from the Tasking Agencies that there is a simple resolution to the issues. Moreover, there is uncertainty whether Policy Guides can be used to override EBA’s in the case of an AUSMAT deployment.

In particular:

a) The 40 hour week payment as specified in the AUSMAT Manual is unrealistic in terms of the hours of work performed in the field by competent, trained profes-sionals, and is open to challenge by a deployee;

b) That in order to accord with state and territory EBA’s the issue of in-country allowances needs to be reviewed;

c) That the payment of various allowances stated in awards, particularly for medi-cal staff (e.g private practice allowances, managerial allowances, higher duties allowances) leads to substantial variability in the individual HR cost both within and between professions.

Given the urgent need for national agreement, and the specific requirements related to a National health sector deployment, the AUSMAT Working Group under the auspices of NHEMS and the AHPPC should undertake a wholesale review of remuneration practice for AUSMAT deployment to guarantee the future sus-tainability of such operations (11). It is rec-ommended that primary responsibility for this review rest with the Commonwealth Department of Health given its familiarity with the issues at hand.

It should be noted that the 10 hour/day deployment at base pay + state specified allowances that was paid on this occasion has not led to a complaint by any of the 74 deployees, despite working longer hours and under austere conditions. This could be a model for future deployments, after consideration by the AUSMAT Working Group and AHPPC.


20

Governance Mechanisms

The oversight of the mission proceeded in accordance with the National AUSMAT Manual.

AUSMAT GovernanceThe roles of the Team Leader and Deputy Team Leader were fulfilled as per the AUSMAT Manual. The additional role of Nursing Team Leader was of critical importance in oversight of nursing staff, rostering and overall design and flow of the hospital (12).

An ad-hoc internal ethical decision-mak-ing structure was formed in instances where critical ethical decisions needed to be made regarding individual cases. This consisted of the treating clinician, one of the leadership group and an independent clinician. This model allowed collective decision making around the more chal-lenging ethical cases in the field.

Mission GovernanceThe Mission Control Team (DFAT Mission Leader, EMA Liaison Officer, AUSMAT Team Leader) functioned effectively as a unit for both Team Alpha and Bravo. There was a good understanding that DFAT re- tained operational command of the mission, and the AUSMAT Team Leader had command of the facility and direct line management of AUSMAT Team Members.

Communication with Manila Post and Canberra was by and large timely and effective. On occasion parallel lines of communication through operational command structures (DFAT to Post, EMA to the Crisis Coordination Centre and AUSMAT to NCCTRC/NIR) resulted in duplication of messages, however, the communication within the in-country MCT meant that messages were consistent.

Several planning changes occurred for Team Alpha (eg. changes in structure and number of the handover team), consis-tent with the fluidity of the situation on the ground. Two instances of delay in response to a specific question resulted in some concern from Team Bravo. The first of these related to gifting of medical con-sumables and authorisation from Canberra at the conclusion of mission. The second related to the delay in approval of the demobilisation plan (13). Neither incident was particularly critical, though the delay in authorisation for gifting may have put at risk several thousand dollars worth of medical consumables due to delay in

obtaining adequate storage.

In Country GovernanceThe role of Manila Post in the DFAT command structure was unclear, however this lack of clarity did not affect the operation from the AUSMAT perspective. Should the focus of control and decision making in the event of disaster be at Post rather than Canberra, an AUSMAT trained disas-ter medical specialist should be embedded at Post to provide technical expertise to assist with mission oversight.

Australian-based GovernanceNIR/NCCTRC – The National Incident Room and the Operations Centre of the NCCTRC worked collaboratively during the deploy-ment to fulfil the functions assigned to the Department of Health in the AUSMAT Manual.

Daily meetings to discuss the sitreps were valuable in anticipating mission-critical needs in equipment and human resources (Team Bravo composition). The constant communication streamlined the infor-mation flow, allowing prompt and useful information to pass to the Chief Medical Officer and the AHPPC as required. This allowed, amongst other things, the effi-cient nomination, selection and endorse-ment of Team Bravo.

The NIR initiated daily meetings attended by DFAT and EMA operational representa-tives on Day +5 of operations. These were also valuable in discussing field needs and clarifying roles and responsibilities. Commencing these meetings earlier – potentially even sooner than when an IDETF activated the NCCTRC – may have further improved the efficiency of the deployment.

This model of collaboration between the NIR and the operational agency (in this case the NCCTRC) was effective and should be used in the future (14).

The National group of AUSMAT Leaders was leveraged to provide operational man-agement assistance with the deployment of key NCCTRC staff to Tacloban. The Vic-torian Department of Health contributed a senior health emergency manager who ran the NCCTRC HEOC for the duration of the Bravo deployment. This was a success in terms of building national capacity and inter-operability between AUSMAT.


21

Demobilisation

A post-deployment questionnaire was completed by all deployees.

Psychological debrief was provided to each deployee by the same clinical psycholo-gist that provided the initial consultation.

The gathering of interstate and NT team members in Darwin on the 20th February 2014 was an important part of the ‘return to home’ process. Positive feedback from all attendees has been received, who valued the opportunity to revisit their deployment experience with colleagues.

Debriefing

Demobilisation of all teams and the facility proceeded smoothly.

Outpatients closed on the 6th November. The final operation took place on the 7th of November. The transfer of patients to other facilities began 72 hours prior to closure on the 8th of December. The relationships developed with the MoH and NGOs (ICRC and Medecins Sans Frontieres in particular) allowed good quality take-over of care of the hospitalised patients.

Demobilisation of such a large amount of equipment required a third logistic ‘clean-up’ team to assist the Team Bravo logisticians. There was no doubt this was mission-critical to break-down the facility subsequent to the Foreign Minister’s visit on the 8th and final departure on the 11th.

The main portion of Bravo team departed Tacloban on the 9th of November, and then travelled commercially from Manila to Darwin. The clean-up team were support-ed by the AUSMAT Deputy Leader and the NCCTRC AUSMAT Operations Manager.

The interaction with RAAF was a major positive in the deployment as a whole, and in the transportation of the field hospital back to Darwin.

There were no major issues in the repa-triation of deployees to their home states, which was smoothly facilitated by EMA.


22

Recommen- dations

1. That relationships within national Ministries of Health, the WHO and senior operational leaders (eg. Director of Disaster Response, NCCTRC) continue to be cultivated and then leveraged during a disaster response

2. That the AHPPC, via the AusMAT work-ing group, strongly advocate for a Forward AUSMAT Team to be included in the initial assessment team where there is a high likelihood that a health-related response will be considered; and that this should be included in a revised version of AusAS-SISTPLAN

3. The HR structure of an AUSMAT surgi-cal deployment be revised to accurately reflect the skillmix and numbers required to support a 24 hour inpatient surgical facility

4. That all Australian government agencies involved in the disaster response recognise the need to apply FMT Standards when deciding on whether to support a medical team, either government or non-govern-ment, of Australian origin

5. That all agencies review processes during activation (Deployment Guidelines, National AUSMAT Manual, AUSASSIST-PLAN) to avoid confusion regarding roles and responsibilities

6. That the key agencies involved in AUSMAT deployment (Department of Health, Department of Foreign Affairs and Trade, Emergency Management Australia, NCCTRC) develop a cadre of experienced operational staff with the knowledge and capacity to complete key pre-deployment tasks as set out in the AUSMAT manual

7. That individual AUSMAT deployees retain primary responsibility for ensuring their pre-deployment health assessment is completed every 12 months, with the ju-risdictions retaining secondary responsi-bility for providing a standardised medical assessment form

8. That the AUSMAT Working Group revisit the NCCTRC Medical Assessment form for appropriateness as a standard national document

9. That in the event of sufficient lead-in time (ie. For Bravo or Charlie teams) fitness checks should be undertaken by jurisdiction AUSMAT leads, and regular fitness assessment be conducted on a year on year basis

10. That all jurisdictional AUSMAT leads hold primary responsibility for ensuring compliance with heat acclimatisation protocols

11. Given the urgent need for national agreement, and the specific requirements related to a National health sector deploy-ment, the AUSMAT Working Group under the auspices of NHEMS and the AHPPC should undertake a wholesale review of remuneration practice for AUSMAT de-ployment to guarantee the future sustain-ability of such operations

12. That the AUSMAT Nursing Team Leader be included as a position in the National AUSMAT Manual

13. That formal mechanisms be devel-oped to prioritise, transmit and respond to requests originating from the field, and incorporate this into the overall reporting framework during an AUSMAT deployment

14. That an AUSMAT trained disaster med-ical specialist should be embedded at the primary locus of operational control for the mission (either Canberra or at Post)

Date post:	05-Oct-2020
Category:	Documents
Upload:	others
View:	0 times
Download:	0 times

OPERATION PHILIPPINES ASSIST 2013 · 06th Logistics ‘pack down’ team arrives 08th Visit by The...

Documents