Psychosocial impact of the COVID-19 pandemic on 4378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic.

OBJECTIVES: This study reports preliminary findings on the prevalence of, and factors associated with, mental health and well-being outcomes of healthcare workers during the early months (April-June) of the COVID-19 pandemic in the UK. METHODS: Preliminary cross-sectional data were analysed from a cohort study (n=4378). Clinical and non-clinical staff of three London-based NHS Trusts, including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire. Secondary outcomes are probable anxiety (seven-item Generalised Anxiety Disorder), depression (nine-item Patient Health Questionnaire), post-traumatic stress disorder (PTSD) (six-item Post-Traumatic Stress Disorder checklist), suicidal ideation (Clinical Interview Schedule) and alcohol use (Alcohol Use Disorder Identification Test). Moral injury is measured using the Moray Injury Event Scale. RESULTS: Analyses showed substantial levels of probable CMDs (58.9%, 95% CI 58.1 to 60.8) and of PTSD (30.2%, 95% CI 28.1 to 32.5) with lower levels of depression (27.3%, 95% CI 25.3 to 29.4), anxiety (23.2%, 95% CI 21.3 to 25.3) and alcohol misuse (10.5%, 95% CI 9.2 to 11.9). Women, younger staff and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one's moral code) was strongly associated with increased levels of probable CMDs, anxiety, depression, PTSD symptoms and alcohol misuse. CONCLUSIONS: Our findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic.

A Program Profile of Air Medical Transport in Regional Central Queensland, Australia.

OBJECTIVE: The purpose of this study was to investigate the epidemiology of air medical patients and referral patterns in Central Queensland Hospital and Health Service (CQHHS). METHODS: Analysis of air medical transport from January 2010 to December 2014. Air medical tasks within the local health service boundary were included. All patients transported on rotor or fixed wing aircraft for medical purposes were included. Patterns of air medical tasks in and out of the region by referring and receiving location, aircraft type, flight priority, time of day, month, sex, age, illness, and referral indexes were analyzed. RESULTS: There were 11,456 air ambulance tasks in CQHHS region during the study period, an average of 2,291 retrievals per annum or 191 per month. Frequent referrals were to a tertiary facility, located 800 km across economic and political boundaries. Referral pattern indexes highlight a net patient flow of 1.2 to 1. Cardiology was the largest illness category (24%). Males represented 59% overall as well as patients 66 years and older (33%). Fixed wing aircraft carried out 87% of the tasks with a frequent response time of 6 to 24 hours. CONCLUSION: Air medical transports are an integral part of the health system in Central Queensland communities with vast geographic distances. Identifying regional referral pattern rates and ratios aid in the planning of resource allocation.

Exploration of the health risk-based definition for heatwave: A multi-city study.

BACKGROUND: As heatwaves are expected to be more frequent, longer, and more intense in the future, it is imperative to understand how heatwaves affect health. However, it is intensely debated about how a heatwave should be defined. OBJECTIVES: This study explored the possibility of developing a health risk-based definition for heatwave, and assessed the heat-related mortality in the three largest Australian cities. METHODS: Daily data on climatic variables and non-accidental deaths for Brisbane, Melbourne and Sydney during the period 1988-2009 were obtained from relevant government agencies. Several local heatwave definitions were tested by using percentiles (e.g., from the 75th to 99th centile) of mean temperature with duration ≥2 days across these cities. We examined the relative risks of mortality associated with heatwaves in each city using Poisson generalised additive model, after controlling for long-term trend, within-season variation, day of the week, and relative humidity. Then, Bayesian hierarchical model with segment-spline was used to examine the threshold for the heatwave-related impacts. RESULTS: A consistent and significant increase in mortality during heatwaves was observed in all three cities. The pooled data show that the relative risk of mortality started to increase around the 95th centile of temperature, increased sharply at the 97th centile and rose alarmingly at the 99th centile. Based on research findings, we proposed tiered health risk-based metrics to define a heatwave. CONCLUSIONS: Our findings provide supportive evidence for developing health risk-based metrics to assess the impacts of heatwave. These findings may have important implications for assessing and reducing the burden of heat-related mortality.

Analyzing the impact of severe tropical cyclone Yasi on public health infrastructure and the management of noncommunicable diseases.

INTRODUCTION: Traditionally, post disaster response activities have focused on immediate trauma and communicable diseases. In developed countries such as Australia, the post disaster risk for communicable disease is low. However, a "disease transition" is now recognized at the population level where noncommunicable diseases (NCDs) are increasingly documented as a post disaster issue. This potentially places an extra burden on health care resources and may have implications for disaster-management systems. With increasing likelihood of major disasters for all sectors of global society, there is a need to ensure that health systems, including public health infrastructure (PHI), can respond properly. Problem There is limited peer-reviewed literature on the impact of disasters on NCDs. Research is required to better determine both the impact of NCDs post disaster and their impact on PHI and disaster-management systems. METHODS: A literature review was used to collect and analyze data on the impact of the index case event, Australia's Severe Tropical Cyclone Yasi (STC Yasi), on PHI and the management of NCDs. The findings were compared with data from other world cyclone events. The databases searched were MEDLINE, CINAHL, Google Scholar, and Google. The date range for the STC Yasi search was January 26, 2011 through May 2, 2013. No time limits were applied to the search from other cyclone events. The variables compared were tropical cyclones and their impacts on PHI and NCDs. The outcome of interest was to identify if there were trends across similar world events and to determine if this could be extrapolated for future crises. RESULTS: This research showed a tropical cyclone (including a hurricane and typhoon) can impact PHI, for instance, equipment (oxygen, syringes, and medications), services (treatment and care), and clean water availability/access that would impact both the treatment and management of NCDs. The comparison between STC Yasi and worldwide tropical cyclones found the challenges faced were linked closely. These relate to communication, equipment and services, evacuation, medication, planning, and water supplies. CONCLUSION: This research demonstrated that a negative trend pattern existed between the impact of STC Yasi and other similar world cyclone events on PHI and the management of NCDs. This research provides an insight for disaster planners to address concerns of people with NCDs. While further research is needed, this study provides an understanding of areas for improvement, specifically enhancing protective PHI and the development of strategies for maintaining treatment and alternative care options, such as maintaining safe water for dialysis patients.

The impact of heatwaves on emergency department visits in Brisbane, Australia: a time series study.

INTRODUCTION: The acute health effects of heatwaves in a subtropical climate and their impact on emergency departments (ED) are not well known. The purpose of this study is to examine overt heat-related presentations to EDs associated with heatwaves in Brisbane. METHODS: Data were obtained for the summer seasons (December to February) from 2000-2012. Heatwave events were defined as two or more successive days with daily maximum temperature ≥34°C (HWD1) or ≥37°C (HWD2). Poisson generalised additive model was used to assess the effect of heatwaves on heat-related visits (International Classification of Diseases (ICD) 10 codes T67 and X30; ICD 9 codes 992 and E900.0). RESULTS: Overall, 628 cases presented for heat-related illnesses. The presentations significantly increased on heatwave days based on HWD1 (relative risk (RR) = 4.9, 95% confidence interval (CI): 3.8, 6.3) and HWD2 (RR = 18.5, 95% CI: 12.0, 28.4). The RRs in different age groups ranged between 3-9.2 (HWD1) and 7.5-37.5 (HWD2). High acuity visits significantly increased based on HWD1 (RR = 4.7, 95% CI: 2.3, 9.6) and HWD2 (RR = 81.7, 95% CI: 21.5, 310.0). Average length of stay in ED significantly increased by >1 hour (HWD1) and >2 hours (HWD2). CONCLUSIONS: Heatwaves significantly increase ED visits and workload even in a subtropical climate. The degree of impact is directly related to the extent of temperature increases and varies by socio-demographic characteristics of the patients. Heatwave action plans should be tailored according to the population needs and level of vulnerability. EDs should have plans to increase their surge capacity during heatwaves.

Development of health risk-based metrics for defining a heatwave: a time series study in Brisbane, Australia.

BACKGROUND: This study attempted to develop health risk-based metrics for defining a heatwave in Brisbane, Australia. METHODS: Poisson generalised additive model was performed to assess the impact of heatwaves on mortality and emergency hospital admissions (EHAs) in Brisbane. RESULTS: In general, the higher the intensity and the longer the duration of a heatwave, the greater the health impacts. There was no apparent difference in EHAs risk during different periods of a warm season. However, there was a greater risk for mortality in the 2nd half of a warm season than that in the 1st half. While elderly (≥75 years) were particularly vulnerable to both the EHA and mortality effects of a heatwave, the risk for EHAs also significantly increased for two other age groups (0-64 years and 65-74 years) during severe heatwaves. Different patterns between cardiorespiratory mortality and EHAs were observed. Based on these findings, we propose the use of a tiered heat warning system based on the health risk of heatwave. CONCLUSIONS: Health risk-based metrics are a useful tool for the development of local heatwave definitions. This tool may have significant implications for the assessment of heatwave-related health consequences and development of heatwave response plans and implementation strategies.

Proactive and integrated consultation-liaison psychiatry for older medical inpatients: A mixed methods description of training, care provided and clinician experience in the HOME study.

OBJECTIVES: To describe the practical experience of delivering a proactive and integrated consultation-liaison (C-L) psychiatry service model (PICLP). PICLP is designed for older medical inpatients and is explicitly biopsychosocial and discharge-focused. In this paper we report: (a) observations on the training of 15 clinicians (seven senior C-L psychiatrists and eight assisting clinicians) to deliver PICLP; (b) the care they provided to 1359 patients; (c) their experiences of working in this new way. METHOD: A mixed methods observational study using quantitative and qualitative data, collected prospectively over two years as part of The HOME Study (a randomized trial comparing PICLP with usual care). RESULTS: The clinicians were successfully trained to deliver PICLP according to the service manual. They proactively assessed all patients and found that most had multiple biopsychosocial problems impeding their timely discharge from hospital. They integrated with ward teams to provide a range of interventions aimed at addressing these problems. Delivering PICLP took a modest amount of clinical time, and the clinicians experienced it as both clinically valuable and professionally rewarding. CONCLUSION: The experience of delivering PICLP highlights the special role that C-L psychiatry clinicians, working in a proactive and integrated way, can play in medical care.

Are heat warning systems effective?

Heatwaves are associated with significant health risks particularly among vulnerable groups. To minimize these risks, heat warning systems have been implemented. The question therefore is how effective these systems are in saving lives and reducing heat-related harm. We systematically searched and reviewed 15 studies which examined this. Six studies asserted that fewer people died of excessive heat after the implementation of heat warning systems. Demand for ambulance decreased following the implementation of these systems. One study also estimated the costs of running heat warning systems at US$210,000 compared to the US$468 million benefits of saving 117 lives. The remaining eight studies investigated people's response to heat warning systems and taking appropriate actions against heat harms. Perceived threat of heat dangers emerged as the main factor related to heeding the warnings and taking proper actions. However, barriers, such as costs of running air-conditioners, were of significant concern, particularly to the poor. The weight of the evidence suggests that heat warning systems are effective in reducing mortality and, potentially, morbidity. However, their effectiveness may be mediated by cognitive, emotive and socio-demographic characteristics. More research is urgently required into the cost-effectiveness of heat warning systems' measures and improving the utilization of the services.

Universal access to ambulance does not increase overall demand for ambulance services in Queensland, Australia.

OBJECTIVE: To determine the impact of the introduction of universal access to ambulance services via the implementation of the Community Ambulance Cover (CAC) program in Queensland in 2003-04. METHOD: The study involved a 10-year (2000-01 to 2009-10) retrospective analysis of routinely collected data reported by the Queensland Ambulance Service (QAS) and by the Council of Ambulance Authorities. The data were analysed for the impact of policy changes that resulted in universal access to ambulance services in Queensland. RESULTS: QAS is a statewide, publically funded ambulance service. In Queensland, ambulance utilisation rate (AUR) per 1000 persons grew by 41% over the decade or 3.9% per annum (10-year mean=149.8, 95% CI: 137.3-162.3). The AUR mean after CAC was significantly higher for urgent incidents than for non-urgent ones. However projection modelling demonstrates that URs after the introduction of CAC were significantly lower than the projected utilisation for the same period. CONCLUSIONS: The introduction of universal access under the Community Ambulance Cover program in Queensland has not had any significant independent long-term impact on demand overall. There has been a reduction in the long-term growth rate, which may have been contributed to by an 'appropriate use' public awareness program.

Predictors of Post-Traumatic Growth in a Sample of United Kingdom Mental and Community Healthcare Workers during the COVID-19 Pandemic.

Experiences of adversity can generate positive psychological effects alongside negative impacts. Little research to date has evaluated predictors of post-traumatic growth in mental or community healthcare workers during the COVID-19 pandemic. Following a survey of 854 community and mental healthcare staff in the United Kingdom in July to September 2020, multiple linear regression was used to determine the association between hypothesised risk and protective factors (personal, organisational and environmental variables) and total scores on the Post-traumatic Growth Inventory-Short Version. Positive self-reflection activities, black and minority ethnic status, developing new healthcare knowledge and skills, connecting with friends and family, feeling supported by senior management, feeling supported by the UK people, and anxiety about the personal and work-related consequences of COVID-19 each significantly independently predicted greater post-traumatic growth. Working in a clinical role and in mental healthcare or community physical healthcare predicted lower post-traumatic growth. Our research supports the value of taking an organisational growth-focused approach to occupational health during times of adversity, by supporting staff to embrace opportunities for personal growth. Valuing staff's cultural and religious identity and encouraging self-reflective activities, such as mindfulness and meditation, may help to promote post-traumatic growth.

Emergency department presentations during the State of Origin rugby league series: a retrospective statewide analysis.

OBJECTIVE: To evaluate the effect of the State of Origin rugby league series on the number of emergency department (ED) presentations in Queensland. DESIGN AND SETTING: Retrospective analysis of Emergency Department Information System data from 25 Queensland EDs for game 10s and matched control 10s during the annual State of Origin series from 2005 to 2012. The Queensland team won seven of the eight series in this period. MAIN OUTCOME MEASURES: Number of patients presenting to Queensland EDs on 24 game 10s and 80 control 10s. RESULTS: Proportionally, a binomial test indicated there were significantly fewer ED presentations on game 10s (49,702) than on control 10s (172,351) (P<0.001). On average, there were 2,154 presentations per 10 on control 10s and 2,071 on game 10s, representing a 4% reduction on game 10s. CONCLUSION: We found that the State of Origin series was associated with fewer ED presentations on game 10s. We believe these results have broader implications for workforce planning and resource allocation.

The impact of heatwaves on mortality and emergency hospital admissions from non-external causes in Brisbane, Australia.

OBJECTIVES: Heatwaves can have significant health consequences resulting in increased mortality and morbidity. However, their impact on people living in tropical/subtropical regions remains largely unknown. This study assessed the impact of heatwaves on mortality and emergency hospital admissions (EHAs) from non-external causes (NEC) in Brisbane, a subtropical city in Australia. METHODS: We acquired daily data on weather, air pollution and EHAs for patients aged 15 years and over in Brisbane between January 1996 and December 2005, and on mortality between January 1996 and November 2004. A locally derived definition of heatwave (daily maximum ≥37°C for 2 or more consecutive days) was adopted. Case-crossover analyses were used to assess the impact of heatwaves on cause-specific mortality and EHAs. RESULTS: During heatwaves, there was a statistically significant increase in NEC mortality (OR 1.46; 95% CI 1.21 to 1.77), cardiovascular mortality (OR 1.89; 95% CI 1.44 to 2.48), diabetes mortality in those aged 75+ (OR 9.96; 95% CI 1.02 to 96.85), NEC EHAs (OR 1.15; 95% CI 1.07 to 1.23) and EHAs from renal diseases (OR 1.41; 95% CI 1.09 to 1.83). The elderly were found to be particularly vulnerable to heatwaves (eg, for NEC EHAs, OR 1.24 for 65-74-year-olds and 1.39 for those aged 75+). CONCLUSIONS: Significant increases in NEC mortality and EHAs were observed during heatwaves in Brisbane where people are well accustomed to hot summer weather. The most vulnerable were the elderly and people with cardiovascular, renal or diabetic disease.

Leadership and use of standards by Australian disaster medical assistance teams: results of a national survey of team members.

INTRODUCTION: It is likely that calls for disaster medical assistance teams (DMATs) will continue in response to international disasters. OBJECTIVE: As part of a national survey, the present study was designed to evaluate leadership issues and use of standards in Australian DMATs. METHODS: Data was collected via an anonymous mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 Asian Tsunami disaster. RESULTS: The response rate for this survey was estimated to be approximately 50% (59/118). Most of the personnel had deployed to the Asian Tsunami affected areas. The DMAT members were quite experienced, with 53% (31/59) of personnel in the 45-55 years of age group. Seventy-five percent (44/59) of the respondents were male. Fifty-eight percent (34/59) of the survey participants had significant experience in international disasters, although few felt they had previous experience in disaster management (5%, 3/59). There was unanimous support for a clear command structure (100%, 59/59), with strong support for leadership training for DMAT commanders (85%, 50/59). However only 34% (20/59) felt that their roles were clearly defined pre-deployment, and 59% (35/59) felt that team members could be identified easily. Leadership was identified by two team members as one of the biggest personal hardships faced during their deployment. While no respondents disagreed with the need for meaningful, evidence-based standards to be developed, only 51% (30/59) stated that indicators of effectiveness were used for the deployment. CONCLUSIONS: In this study of Australian DMAT members, there was unanimous support for a clear command structure in future deployments, with clearly defined team roles and reporting structures. This should be supported by clear identification of team leaders to assist inter-agency coordination, and by leadership training for DMAT commanders. Members of Australian DMATs would also support the development and implementation of meaningful, evidence-based standards. More work is needed to identify or develop actual standards and the measures of effectiveness to be used, as well as the contents and nature of leadership training.

Building Toward a Disaster Resilient Health System: A Study of Hospital Resilience.

OBJECTIVES: This research evaluated the resilience of 6 tertiary and rural health facilities within a single Australian Health Service, using the World Health Organization (WHO) Hospital Safety Index (HSI). This adaptation of the HSI was compared with existing national accreditation and facility design Standards to assess disaster preparedness and identify opportunities for improvement. METHODS: This cross-sectional descriptive study surveyed 6 hospitals that provide 24/7 emergency department and acute inpatient services. HSI assessments, comprising 151 previously validated criteria, were conducted by Health Service engineers and facility managers before being externally reviewed by independent disaster management professionals. RESULTS: All facilities were found to be highly disaster resilient, with each recording high HSI scores. Variances in structure, architectural safety, continuity of critical services supply, and emergency plans were consistently identified. Power and water supply vulnerabilities are common to previously reported vulnerabilities in health facilities of developing countries. CONCLUSION: Clinical, engineering, and disaster management professionals assessed 6 Australian hospitals using the WHO HSI with each facility scoring highly, genuine vulnerabilities and practical opportunities for improvement were identified. This application of the WHO HSI, intended for use primarily in developing countries and disaster-affected regions, complimented and extended the existing Australian national health service accreditation and facility design Standards. These results support the expansion of existing assessment tools used to assess Australian health facility disaster preparedness and resilience.

General Practitioners' Roles in Disaster Health Management: Perspectives of Disaster Managers.

INTRODUCTION: General Practitioners (GPs) are inevitably involved when disaster strikes their communities. Evidence of health care needs in disasters increasingly suggests benefits from greater involvement of GPs, and recent research has clarified key roles. Despite this, GPs continue to be disconnected from disaster health management (DHM) in most countries. STUDY OBJECTIVE: The aim of this study was to explore the perspectives of disaster management professionals in two countries, across a range of all-hazard disasters, regarding the roles and contributions of GPs to DHM, and to identify barriers to, and benefits of, more active engagement of GPs in disaster health care systems. METHODS: A qualitative research methodology using semi-structured interviews was conducted with a purposive sample of Disaster Managers (DMs) to explore their perspectives arising from experiences and observations of GPs during disasters from 2009 through 2016 in Australia or New Zealand. These involved all-hazard disasters including natural, man-made, and pandemic disasters. Responses were analyzed using thematic analysis. RESULTS: These findings document support from DM participants for greater integration of GPs into DHM with New Zealand DMs reporting GPs as already a valuable integrated contributor. In contrast, Australian DMs reported barriers to inclusion that needed to be addressed before sustained integration could occur. The two most strongly expressed barriers were universally expressed by Australian DMs: (1) limited understanding of the work GPs undertake, restricting DMs' ability to facilitate GP integration; and (2) DMs' difficulty engaging with GPs as a single group. Other considerations included GPs' limited DHM knowledge, limited preparedness, and their heightened vulnerability.Strategies identified to facilitate greater integration of GPs into DHM where it is lacking, such as Australia, included enhanced communication, awareness, and understanding between GPs and DMs. CONCLUSION: Experience from New Zealand shows systematic, sustained integration of GPs into DHM systems is achievable and valuable. Findings suggest key factors are collaboration between DMs and GPs at local, state, and national levels of DHM in planning and preparedness for the next disaster. A resilient health care system that maximizes capacity of all available local health resources in disasters and sustains them into the recovery should include General Practice.

Involving service users in intervention design: a participatory approach to developing a text-messaging intervention to reduce repetition of self-harm.

OBJECTIVE To engage a group of people with relevant lived experience in the development of a text-messaging intervention to reduce repetition of self-harm. BACKGROUND Contact-based interventions, such as follow-up letters, postcards and telephone calls, have shown potential to reduce repetition of self-harm in those who present at Accident and Emergency departments. Text messaging offers a low-cost alternative that has not been tested. We set out to develop a text-based intervention. The process of intervention development is rarely reported and little is known about the impact of service user involvement on intervention design. METHOD We held a series of six participatory workshops and invited service users and clinicians to help us work out how to get the right message to the right person at the right time, and to simulate and test prototypes of an intervention. RESULTS Service users rejected both the idea of a generic, 'one size fits all' approach and that of 'audience segmentation', maintaining that text messages could be safe and effective only if individualized. This led us to abandon our original thinking and develop a way of supporting individuals to author their own self-efficacy messages and store them in a personal message bank for withdrawal at times of crisis. CONCLUSIONS This paper highlights both the challenge and the impact of involving consumers at the development stage. Working with those with lived experience requires openness, flexibility and a readiness to abandon or radically revise initial plans, and may have unexpected consequences for intervention design.

Education and training of Australian disaster medical assistance team members: results of a national survey.

INTRODUCTION: Calls for disaster medical assistance teams (DMATs) are likely to continue in response to international disasters. OBJECTIVE: As part of a national survey, the present study was designed to evaluate the education and training of Australian DMATs. METHODS: Data were collected via an anonymous, mailed survey distributed via State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the 2004 Southeast Asia tsunami disaster. RESULTS: The response rate for this survey was 50% (59/118). Most of the personnel had deployed to the tsunami-affected areas. The DMAT members were quite experienced, with 53% of personnel in the 45-55-year age group (31/59). Seventy-six percent of the respondents were male (44/58). While most respondents had not participated in any specific training or educationalprogram, any kind of relevant training was regarded as important in preparing personnel for deployment. The majority of respondents had experience in disasters, ranging from hypothetical exercises (58%, 34/59) to actual military (41%, 24/49) and non-governmental organization (32%, 19/59) deployments. Only 27% of respondents felt that existing training programs had adequately prepared them for deployment. Thirty-four percent of respondents (20/59) indicated that they had not received cultural awareness training prior to deployment, and 42% (25/59) received no communication equipment training. Most respondents felt that DMAT members needed to be able to handle practical aspects of deployments, such as training as a team (68%, 40/59), use of communications equipment (93%, 55/59), ability to erect tents/shelters (90%, 53/59), and use of water purification equipment (86%, 51/59). Most respondents (85%, 50/59) felt leadership training was essential for DMAT commanders. Most (88%, 52/59) agreed that teams need to be adequately trained prior to deployment, and that a specific DMAT training program should be developed (86%, 51/59). CONCLUSIONS: This study of Australian DMAT members suggests that more emphasis should be placed on the education and training. Prior planning is required to ensure the success of DMAT deployments and training should include practical aspects of deployment. Leadership training was seen as essential for DMAT commanders, as was team-based training. While any kind of relevant training was regarded as important for preparing personnel for deployment, Australian DMAT members, who generally are a highly experienced group of health professionals, have identified the need for specific DMAT training.

Australian dust storm: impact on a statewide air medical retrieval service.

INTRODUCTION: The Australian dust storm during the week of September 22, 2009, resulted in the grounding of a large portion of the air medical retrieval fleet in Queensland. We sought to determine whether during this event an increase occurred in cases requiring retrieval as a result of the dust storm, and whether the grounding of the retrieval fleet resulted in any adverse outcomes as a result of its inability to respond. METHODS: A retrospective review of respiratory and injury cases referred to the Queensland Emergency Medical System Coordination Centre from September 8 to October 5, 2009 was conducted. All cases with any respiratory or injury complaints were included. The number of cases, priority for retrieval, and the ability to retrieve these cases within the allocated time were examined and compared with those for a similar time frame in the previous year. RESULTS: A 62.5% increase in respiratory cases was seen, and 13.3% increase in injury cases during the week of the dust storm event, when compared with the previous year. Neither of these results reached statistical significance, but they demonstrate a practically important difference. For the month surrounding the dust storm event, a 48.5% (P = .04) increase in respiratory cases occurred, but no increase in injury cases when compared with the previous year. Only one urgent case was unable to be air medically retrieved during the study period as a result of grounding of the aircraft because of the dust storm event, but contingency arrangements were made for alternative transport. No adverse events were recorded during the study period. CONCLUSION: An increased demand on retrieval services was demonstrated during the period of the dust storm event. Despite grounding of the air medical fleet, all cases except one were able to be retrieved within clinically appropriate time frames or by alternative transport methods. Contingency plans need to be developed to cope with the possibility of similar events in the future, to prevent adverse events from occurring.