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NATURAL DISASTER MANAGEMENT Collaborative Communities for Safer Futures
Report By Left Right Think-‐Tank QLD State Policy Report
Report Date: November 2013
WHO ARE WE?
Left Right Think-Tank is Australia’s first independent, non-partisan think-tank of young minds with a purpose to transform Australia through the ideas of young people.
We aim to help create a society where young people advise and are consulted on national issues of broad community concern, not just youth issues.
We are not-for-profit and all our staff are aged between 15 – 24 and volunteer their time for our cause.
We are:
• Independent of influence
• Politically non-partisan
• Young people aged 16 to 24
• Not-for-profit
• Passionate about ideas
• Committed to inclusive debate
We work to achieve our purpose through:
• Developing policy based on sound research across the public policy spectrum.
• Fostering discussion on the greatest challenges of our generation throughout the
community.
• Advocating policy ideals with various stakeholders and across Government; promoting
a new genre of thinking in the public policy cycle.
• Educating young Australians through various events and programs, motivating
individuals to harness their potential in contributing to public policy debates.
• Empowering the next generation of leaders by providing them with unique opportunities
for development.
ACKNOWLEDGEMENTS
Policy Fellows
Victoria Allen
Rhea Connolly
Jake Edwards
Angus Fraser
Catherine Garlick
Grace Enid Gowen
Nicholas Piper
Riley Thornton
Joel Van Veluwen
Queensland Staff Team Members
Brody Foy – State Director
Danika Maxwell – Deputy State Director, Consultancy Manager
Nathan Johnston – Policy Fellowship Manager
Samuel Brookfield – Policy Fellowship Officer, Policy Fellowship Manager
Peter Hwang – Communications Manager
Madeline Rodgers – Sponsorship Manager, Policy Fellowship Officer
National Policy Team Members
Connor Taylor – Chief Executive Officer
Lisa Bradley – National Policy Fellowship Director
Conrad Liveris – Western Australian State Director
Isobel Sloan – National Policy Fellowship Manager
STAKEHOLDERS CONSULTED Consultees
• Brian McMahon – Planning Engineer, Energex
• Carolyn Parsons – Australian Red Cross, Manager of Emergency Services
• Charlie Hawkins – Business Development Manager, CSIRO
• Dan Galligan – Chief Executive Officer, Queensland Farmers Federation
• Derek Tuffield – Chief Executive Officer, Lifeline Darling Downs
• Geoff Argus – Assistant Director of Psychology, Darling Downs Hospital
• Jeff Lassen – Principal, Synergies Economic Consulting
• Jill Elliott – Lifeline Volunteer
• Jim McGowan AM – Adjunct Professor, School of Government and International Relations, Griffith University, previously Director General of the Department of Community Safety and Emergency Service
• John Richardson – National Coordinator, Strategic Development for the Australian Red Cross
• Julie Molloy – Director of Social Engagement, Volunteering QLD
• Melanie Irons – Administrator, Tassie Fires – We Can Help
• Paul Pisasale – Ipswich Lord Mayor
• Tracey Arklay – Managing Editor, Australian Journal of International Affairs, Research Fellow at University of Queensland and Griffith University
Speakers
• Professor Alastair Stark – Lecturer in Public Policy, University of Queensland • Kyl Murphy – Queensland State Director, Committee for the Economic Development of
Australia • Kathleen Brophy – Former Queensland State Director, Left Right Think-‐Tank • Alexander McLaren – Consultant, KPMG’ • Amanda Yeates – Deputy Regional Director, Department of Transport and Main Roads • Patrick O’Callaghan – Senior Research Associate, University of Queensland • Robert Johnston – Former Chief Political Journalist, Queensland ABC
FOREWORD
The Queensland division of Left-‐Right Think-‐Tank is pleased and excited to present their 2013
Policy Paper on ‘Natural Disaster Management’. This paper represents the culmination of over
eight months of intensive research, wide-‐ranging consultancy and in-‐depth analysis. This was
achieved through the hard work and dedication of the nine policy fellows alongside the guidance
and support of the Left Right QLD Staff Team and the National Policy Team.
This paper is the fifth produced by the Queensland Team, and the culmination of the fourth
policy fellowship. I am pleased to say that the program continues to grow and develop each year.
This year saw the highest ever number of applications for QLD, and the overall quality and
enthusiasm of these amazed me. Bringing forward the ideas of young people needs to be an
important part of Australia’s future, and I personally feel privileged to be surrounded by a group
of young people who inspire me daily as they work towards this goal.
The topic of ‘Natural Disaster Management’, has been an incredibly complex and at times
paradoxical area for policy development. Particularly in QLD with the spate of natural disasters
in recent years, there is media saturation and strong conflicts in the literature on the issue.
However, despite there being so much discussion, very little appears to actually change in
implementation. This is worrying in an area that is so important, especially for a country such as
Australia, which experiences frequent and various natural disasters.
The fellows should be highly commended for their efforts. They have all worked incredibly hard
throughout the 8 month program, often balancing these commitments with work and study. I
also would like to extend a large thank you to the Queensland Policy team, Nathan Johnston,
Samuel Brookfield, Danika Maxwell and Madeline Rodgers. This team have devoted many hours
to guiding the fellows through the process of creation, consultation, writing and revision. They as
well should be commended for their efforts.
We are proud to help provide opportunities for young people to be involved in the creation and
advocacy of public policy, regardless of background or political views.
Sincerely,
Brody Foy
State Director – Queensland
TABLE OF CONTENTS
EXECUTIVE SUMMARY 1
BACKGROUND 3
QUALITY ASSURANCE 5
Recommendation 5
Background 5
Case Study: Inter-‐American Development Bank 6
BUSINESS CONTINUITY PLANNING 8
Recommendation 8
Background 8
Case Study: French Insurance Premium Reductions 10
PUBLIC HEALTH RECOVERY 12
Recommendation 12
TELEHEALTH 12
Background 12
Case Study: United States Subsidised Telehealth 14
DISASTER FIRST AID TRAINING 15
Background 15
VOLUNTEER MENTAL HEALTH RECOVERY PLAN 17
Background 17
CONCLUSION 20
REFERENCES 21
EXECUTIVE SUMMARY
Major disasters have a significant impact on the livelihood of Australians, hence it is the imperative of
policy makers to minimise their effect. Natural disaster management in Queensland has recently been
subject to much examination and although the performance of frameworks in Queensland has been
admirable, there remain to be challenges.
Given Queensland’s strong economic and population growth, Left Right Think-‐Tank proposes the
adoption of the following recommendations in order to place Queensland in a stronger, more resilient
position in the face of future disasters.
Recommendation 1
That the Disaster Management Groups in Queensland conduct more quantitative analysis of investment and
modifications to disaster management arrangements on prevention, preparation, response and recovery
efforts.
Recommendation 2
That the Queensland government should incentivise small and medium sized businesses to implement
business continuity planning (BCP).
I. Requiring BCP as part of business name registration with ASIC
II. Incentivising insurance companies to provide insurance premium discounts for local businesses
that undertake BCP’s
III. Where private negotiations are unsuccessful, providing tax relief to businesses undertaking
meaningful BCP
Recommendation 3
I. That the Australian Government introduce measures to reduce the mental health impact, and
subsequent economic and social impact of natural disasters by:
a) Expanding the Telehealth incentive scheme to allow neighbouring services to support victims of
disaster-‐related mental health issues.
b) Incorporating basic disaster preparedness into First Aid training in areas considered at above
average risk of experiencing a natural disaster.
II. That organisations using volunteers as a resource in their recovery operations take active measures
to mitigate any potential psychological harm suffered by these volunteers as a result of their
participation in the recovery effort.
Further details of these recommendations are detailed below. Additional background and briefing
material can be found in Left Right Think-‐Tank’s disaster management literature review.
BACKGROUND
Disasters can cause widespread damage to people, property, and the environment. The provision of
disaster management infrastructure before, during, and after extreme weather events greatly
determines how they impact Australian society. Effective public policy can significantly reduce
disruptions to affected communities and aid recovery from disasters when they occur. This policy paper
will be focused on the soft infrastructure component of disaster management, defined as the policies,
legislation and social systems used for supporting economic activity and meeting social and
environmental needs (Sustainable Planning Act, 2009).
The damage disasters cause is often distributed unevenly, with the most vulnerable people within a
society being the most affected (Keys, 1991). Equally, the responsibility for disaster response and
provision of infrastructure services is a complex network of government, private enterprise, and non-‐
government organisations (NGOs). Disaster management therefore concerns a broad range of
stakeholders. Effective policy must be directed at government, whilst also taking into account the
interests and needs of private businesses, non-‐for-‐profit organisations and local communities;
accounting for their complex and shifting relationships.
To understand and analyse Australia’s current approach to disaster management, it is first important to
understand the key pieces of legislation that have shaped and continue to shape the policy landscape.
However, as disaster management is commonly the responsibility of state-‐level government, the focus
will be on key pieces of legislation affecting Queensland. If more information and analysis is required,
Left Right’s literature review on this issue is also available.
The Disaster Management Act (Qld) 2003 is the chief piece of legislation in Queensland for disaster
management, establishing principles and guidelines and defining key terms. In the document, ‘disaster
event’ is defined in section 16 as ‘a cyclone, earthquake, flood, storm, storm tide, tornado, tsunami,
volcanic eruption or other natural happening; and a failure of, or disruption to, an essential service or
infrastructure.’ Furthermore, the Act identifies the key phases for disaster management as
arrangements for mitigating, preventing, preparing for, responding to and recovering from a disaster
(section 14).
Queensland has made considerable progress in ensuring comprehensive and progressive disaster
management arrangements. Systematic and operational flaws remain, however, stemming from
repetitive and redundant legislation. The Disaster Management Act prescribes inconsistent roles and
responsibilities at various levels, which change depending on the disaster response phase of an event
(O’Sullivan, 2010). Furthermore, the Auditor General’s recommendation that the State Plan be guided by
an all hazard risk management assessment has yet to be amalgamated in the State Plan, which
significantly impacts on State risk assessments informing strategic and policy decisions (O’Sullivan,
2010). Although the Act specifies that ‘district and State support responses and/or advisory and direction
initiatives must be actioned and implemented at grass-‐roots level in cooperation with or through local
arrangements’, there continues to be a lack of investment in Disaster Management arrangement at Local
level (O’Sullivan, 2010).
As mentioned previously, it is not only government interests that need be considered within disaster
management. Agencies that provide key disaster service delivery include NGOs and spontaneous
volunteers. NGOs are a vital and significant component of emergency mitigation and community
preparedness initiatives (Australian Emergency Management, 2013). There is a need for government’s disaster policy to capitalise on NGO strengths as a collective and further professionalise as a sector
(Australian Civil-‐Military Centre, 2012). This process should include analysis of core competencies and
expertise in order to identify common values and themes.
Whilst the efforts of spontaneous volunteers are often effective, there appears to be a need for more
emphasis on their management strategies (Orloff, 2011). It is recognised that more defined cooperation
between the different agencies is required. Equally, key issues have been identified by both
Volunteering Queensland and Volunteering Australia. These include how to manage the physical and
mental health of volunteers that assist in recovery efforts. Both Volunteering Queensland and Orloff’s
Field Manual acknowledge the role of preparing volunteers, and post disaster recovery for volunteers,
as key strategies in mitigating physical and mental health issues.
While Queensland outperforms many of the other states within the area of disaster management, there
are still many ineffective and redundant processes, and great potential for improvement. To continue
Queensland’s progress, the policy landscape and literature suggests that a more collaborative approach
to disaster management is required, with more quantitative benchmarking, long-‐term economic
planning and more active volunteer management.
QUALITY ASSURANCE
Recommendation
That the Disaster Management Groups in Queensland conduct more quantitative analysis of investment
and modifications to disaster management arrangements on prevention, preparation, response and
recovery efforts.
Background Queensland’s disaster management arrangements have recently been subject to several reviews. Whilst
the current framework provides sufficient guidelines, given the complex nature of disaster management,
challenges still persist (Queensland Police and Emergency Services Review Team, 2013). An important
consideration in any government funding decision is whether this allocation is prudent, efficient and in
the best interests of Queensland. The Queensland Commission of Audit (2013, pp.10) noted that:
“Public administration requires the highest standards of financial management, based on principles of
transparency and accountability, to ensure limited financial resources can be directed to meeting
government priorities on a sustainable basis”
Benchmarking, at all levels, will serve as the quantitative basis to review the effectiveness and value of
changes to the disaster management arrangements and investments. Benchmarking can provide a
transparent and evidence based platform to justify future amendments and investments and will ensure
that future government funding for disaster management projects is providing the promised value to the
citizens of Queensland.
Benchmarking is a strategic process often used by businesses to evaluate and measure performance in
relation to best practices of their sector (World Health Organisation 2007). The process provides policy
makers, planners and citizens with the information necessary to induce change in entities, often driving
growth and improvement (Economist Intelligence Unit, 2013). Benchmarking indicators and data
requirements should be designed in consultation with the local government areas that make up the local
disaster management groups. This will ensure that the best practice benchmark reflects local conditions
and accounts for different factors that determine disaster management performance.
Left Right recommends that the Queensland Government and Disaster Management Groups conduct
benchmarking assessments of disaster management performance in prevention, preparation, response
and recovery to ensure future capital heavy projects and radical changes to arrangements bring a
material benefit to Queensland.
It is important to note that although benchmarking is a technically difficult process for heterogeneous
events, a consistent and systematic approach that uses high-‐level data already collected could provide a
quantitative measure to determine whether changes in the framework or levels of investments are
justified. Further, by having low data requirements, the burden of creating and applying the benchmark
would be significantly reduced. Given that the Department of Community Safety, Emergency
Management Queensland Critical Infrastructure Providers and Disaster Management Groups all collect
and disseminate data, both in times of crisis and in their mandatory reporting routines, the task of data
collection may not be a resource intensive exercise.
Left Right would like to acknowledge that this activity could be undertaken at any of the Disaster
Management Group levels, or by a State Department. The recent Police and Community Safety review is
championing the creation of the new role of Inspector General Emergency Management and it is noted in
the review that benchmarking Queensland jurisdictions performance against best practice should be a
focus area for this new role.
Case Study: Inter-‐American Development Bank The use of indicators and benchmarking to quantitatively assess disaster risk and response has only
been a recent development in best practice disaster management. In 2005, Cardona at the Instituto de
Estudios Ambientales (IDEA) developed a system of disaster risk indicators for the InterAmerican
Development Bank (IDB) to allow it to perform a systematic and quantitative benchmarking of each
country in its jurisdiction over a time and between nations.
The indicators are designed to generate knowledge within the IDB and borrowing nations regarding the
importance of disaster risk management. Further, these indicators can help policy makers steer
financial, economic, environmental programmes at the national, regional and local levels towards more
effective disaster management.
When designing the indicators for disaster risk management, Cardona needed to ensure that all
methodology was easy to use and used several aggregate indicators that were of use to policy makers.
Cardona stated that the methodology would create three national impacts:
1. It should lead to an improvement in the use and presentation of information on risk. This will
assist policymakers in identifying investment priorities to reduce risk (such as prevention and
mitigation measures), and direct the post disaster recovery process.
2. The methodology provides a way to measure key elements of vulnerability for countries facing
natural phenomena. It also provides a way to identify national risk management capacities, as
well as comparative data for evaluating the effects of policies and investments on risk
management.
3. Application of this methodology should promote the exchange of technical information for
public policy formulation and risk management programs throughout the region.
In creating the index, Cardona aimed to create a framework that was transparent, robust, representative,
replicable, comparative and easy to understand. Based on this conceptual framework, the indicators are
transparent, easy to update in a timely manner and easily understood by policy makers.
Four components or composite indicators have been designed to represent the main elements of
vulnerability and show each country’s progress in managing risk. The four indicators are the Disaster
Deficit Index (DDI), the Local Disaster Index (LDI), the Prevalent Vulnerability Index (PVI), and the Risk
Management Index (RMI). The Disaster Deficit Index measures country risk from a macroeconomic and
financial perspective according to possible catastrophic events. The Local Disaster Index identifies the
social and environmental risks resulting from more recurrent lower level events (which are often
chronic at the local and subnational levels). The Prevalent Vulnerability Index is made up of a series of
indicators that characterize prevalent vulnerability conditions reflected in exposure in prone areas,
socioeconomic weaknesses and lack of social resilience in general. The Risk Management Index brings
together a group of indicators that measure a country’s risk management performance.
Reviews of the risk indicator framework have noted that these tools enabled Latin American countries to
improve their ability to quantify and evaluate the risk faced by their populations. Likewise, these tools
have been used to design interventions to limit financial and economic losses caused by earthquakes,
flooding and other natural phenomena, thereby preventing important funding for poverty reduction
being diverted in the face of a disaster (ELLA, 2012).
BUSINESS CONTINUITY PLANNING
Recommendation
That the Queensland government should incentivise small and medium sized businesses to implement
business continuity planning (BCP) by:
I. Requiring BCP as part of business name registration with ASIC
II. Incentivising insurance companies to provide insurance premium discounts for local businesses that
undertake BCP’s
III. Where private negotiations are unsuccessful, providing tax relief to businesses undertaking
meaningful BCP
Background
Local businesses are the crux of a community. They play a fundamental role in supporting a
community's resilience to disasters by providing resources, expertise and essential services on which
the community depends (Council of Australian Governments, 2009). Yet statistics from Volunteering
Queensland demonstrate that 50% of small and medium sized businesses within Queensland have no
disaster preparedness plan (Volunteering Queensland, 2012). The recent review into Police and
Community Safety found multiple examples of communities relying upon emergency responders and
other external support rather than generating systems of self-‐reliance (Keelty, 2013, p.144). Given the
increasingly widespread and indiscriminate devastation caused by natural disasters across Queensland
over the last five years, communities and private enterprise must take responsibility for their own
preparedness.
In the report, From Disaster to Recovery, the Regional Australia Institute found that business recovery is
central to community recovery and must be emphasised as a priority (2013). Business continuity
planning involves developing a practical plan for how best businesses can prepare for, and continue to
operate after a crisis (Queensland Government, 2013). Having risk management measures in place
ensures information security, adequate staff training in recovery procedures, and that adequate risk
identification and management measures have been implemented early. While larger firms will often
have the resources and staff to devote to business continuity planning and risk management, small and
medium sized businesses often do not. Consequently, our recommendation reflects this, choosing to
focus on small and medium businesses over large ones.
All new businesses are legally obligated to register their business name with the Australian Securities
and Investment Commission (ASIC). Following this, business names must be renewed at least every
three years. Left Right recommends that the Queensland government make the completion of a
business continuity plan a prerequisite to successfully register a business name with ASIC. This would
increase the numbers of disaster resilient businesses by improving their ability to prepare for, recover
from and continue to operate following a disaster.
The Australian Government website business.gov.au provides a good template that could be used to
implement a BCP. This is referred to as an Emergency Management and Recovery Plan and as an
example, includes the risk management table shown below of possible and likely disaster risks such as
flood and fires to your business.
Business risk Impact Likelihood Mitigation strategy Contingency plan
[Description of the risk
and the potential impact
to your business.]
[High,
Medium,
Low.]
[Highly
Unlikely,
Unlikely, Likely,
Highly Likely.]
[What actions will you
take to minimise/mitigate
the potential risk to your
business?]
[What is your
contingency plan in
the event that this risk
happens?]
Other components of the BCP template include: a critical business area analysis table (as shown below);
Rank Critical business areas Impact if failed Current protection strategies
1 [Description of what you can't
do without: people, suppliers,
documents, systems or even
procedures.]
[Describe the potential
impact on your
business if this critical
area fails.]
[What strategies do you have that minimise
the impact to your business? e.g. Training
employees in multiple areas of the business
will reduce key person risk.]
current insurance table of policies and coverage held and exclusions; property and infrastructure
assessment of vulnerabilities to potential damage such as overhanging branches; identified temporary
office accommodation to ensure business as usual such as mail forwarding; skilled staff retention and
updating skills; and data backup and security measures.
To further assist businesses in implementing BCPs, the necessary information and resources should be
made available on the Australia Business License and Information Service (ABLIS). This could be
efficiently done through simply linking to state government websites, such as the Queensland Business
and Industry online Portal. This site includes specialised guides and checklists for a variety of disasters
and also contains quick assessment tools for businesses to self-‐evaluate their disaster operation plans.
Case Study: French Insurance Premium Reductions
Left Right recommends that the Queensland government should approach insurance companies about
providing insurance premium discounts for businesses that undertake in-‐depth business continuity
planning.
As outlined above, the execution of BCPs for most small and medium sized businesses could be very
effectively implemented. However, currently over 50% of these businesses do not have a disaster
preparedness plan (Volunteering Queensland, 2012). By offering insurance premium discounts,
businesses would be provided with a long-‐term financial incentive to partake in resilience measures,
such as business continuity planning, which will ultimately aid disaster preparedness and recovery
Insuring against natural disasters is a complex process. While actuarial insurance pricing models like
those currently used in Australia, the United Kingdom and Germany will often provide the most efficient
solution, this is not always equitable (Picard, 2011). Some areas are inevitably more disaster prone than
others, which leads to differences in premiums that make insurance for many small and medium size
businesses infeasible or even impossible. Mandated property insurance programs similar to those in
France spread variation in premiums across society, and as a result create a more equitable solution for
stakeholders. However, this approach can create significant moral hazard and does not incentivise
adequate disaster preparedness and resilience planning (Jametti and von Ungern-‐Sternberg
2004)(Picard, 2011).
To overcome the shortcomings of these two approaches Left Right recommends a balanced
implementation, with private negotiations between businesses and insurers being preferred, and
government bridging this gap in some instances. For example, if it were the case that a business was
unable to acquire insurance due to being judged too high risk by private insurers, with the lodgment of a
detailed and in-‐depth BCP, Left Right suggests that the government extend a tax concession to that
business equal to the difference between the weighted average premium across Queensland and the
premium offered by the insurance company. As government is covering the gap between what would be
an equitable premium under the mandated insurance system and the private system, this enables those
deemed to be too a high risk to pay an equitable premium which is the benefit of the mandated system.
By being forced to lodge a detailed BCP, this addresses the downside of the mandated system by
incentivising disaster preparedness and resilience measures.
This approach encapsulates the better points of the private insurance system. By allowing businesses
and insurers to negotiate, those businesses that are deemed low risk will receive a low and efficient
premium offered by insurers.
In addition to the benefits for business, improved disaster preparedness, in the form of BCP, will reduce
the burden on government, insurance companies and financial institutions to provide post disaster
assistance.
PUBLIC HEALTH RECOVERY
Recommendation
I. That the Australian Government introduce measures to reduce the public health impact, and
subsequent economic and social impact of natural disasters by
a. Expanding the Telehealth incentive scheme to allow neighbouring services to support victims of
ongoing disaster-‐related health or mental health issues.
b. Incorporating basic disaster preparedness into First Aid training in areas considered at above average
risk of experiencing a natural disaster.
II. That organisations using volunteers as a resource in their recovery operations take active measures to
mitigate any potential psychological harm suffered by these volunteers as a result of their participation in
the recovery effort.
TELEHEALTH
Background Since the late 1990s, telehealth has been a burgeoning field in the Australian medical landscape.
Telehealth consists of using a range of telecommunication technologies for the transmission and storage
of health information in the delivery of both clinical and non-‐clinical health related services (RACGP,
2011; Sabesan, 2013). This emerging sector will have an impact on the administrative, preventative,
consultative and curative aspects of healthcare. Telemedicine provides convenient, site-‐independent
access to expert advice and patient information (Australian Government Department of Human Services,
2013). An exemplary telehealth transaction encompasses clinical consultation performed via a digital
medium, the transferring of information to a patient or a healthcare professional at a second location,
and finally the health care professional employs clinical skills and judgment to provide healthcare and
feedback to the patient.
Implementation of telehealth meets multiple longstanding needs of the modern Australian healthcare
system. Guidelines established by the Royal Australian College for General Practitioners (RACGP)
identify the benefits to the healthcare system, such as enabling fair and equitable access to health
(particularly to vulnerable demographics), improving efficiency, supporting sustainability, reducing
costs, and making better use of the professional health workforce. Patient benefits include educed
travel time and costs, increased access to local health services, improved timeliness of healthcare,
reduction in lost work days, reduced time away from home, and increased sustainability of rural
communities. Finally, telehealth also offers healthcare professionals reduced need for specialist travel
to rural and remote clinics, increased availability of medical specialist and specialized services,
provision of an alternative method of communication and supporting rural recruitment and retention of
healthcare professionals (RACGP, 2011; Sabesan, 2013).
Its potential to address future needs depends upon the evolution of policy made by the main health-‐
sector stakeholders such as the RACGP, video conferencing hardware and software vendors, the video
consultation industry, the Australian Government including the Department of Health and Ageing, the
National E-‐Health Transition Authority, and the healthcare workforce.
Despite its positive perception, telehealth technologies are underutilized in the Australian disaster
landscape (E-‐Unicare, 2013; Terry, 2013). More effective use of information technology after a major
disaster could significantly improve patient outcomes, according to a study by researchers at Weill
Cornell Medical College and the University of California, Davis (Healthcare in the News, 2012). When
one area is inundated or otherwise incapacitated by a disaster, telehealth technologies can spread the
health services demand across a range of neighbouring providers in the short-‐ and long-‐term. The
diverse modalities of transmission particularly eases the surge toll on local providers as they include
direct hard-‐wired connections over standard phone lines and specialized data lines, and “wireless”
communications using infrared, radio, television, microwave, and satellite-‐based linkages (Garshnek &
Burkle, 1999). Telehealth has the ability to reduce unnecessary hospital presentations, and to open up
collaboration between other health sectors and a diverse range of stakeholders. Telehealth enables
improved equity of care closer to home, or in the home (Jakowenko 2011). Merrell and Doarn (2012),
the editors of Telemedicine and e-‐Health, claim that the ‘failure to adopt telemedicine and e-‐health has
dominated much of our scientific consideration of telemedicine in the last 20 years.’ For technology to
work it must work for the people it is meant to help -‐ patients and the professionals providing care
(Garshnek & Burkle 1999).
It is recommended that the current Australian telehealth incentives scheme expand to include victims of
disaster-‐related health problems. With $30.9m already being devoted to telehealth over the next four
years, Left Right believes part of this should be attached to a disaster recovery program. This will
recognise the long-‐term social and economic impacts of natural disasters on communities, which can be
significantly reduced without additional financial input.
One of the main barriers preventing the integration of telehealth into mainstream health services is the
reluctance of physicians in particular to change the traditional approaches to care. In 2010 the
Australian Government announced the ‘Connecting Health Services with the Future: Modernising
Medicare by Providing Rebates for Online Consultations’ initiative (Australian Government Department
of Human Services 2013). This Medicare-‐based scheme provides financial incentives to eligible health
professionals and aged care services that help patients from targeted demographics have a video
consultation with a specialist, consultant physician or consultant psychiatrist (Medicare, 2013). The
current target group comprises patients in rural areas and aged care facilities, as well as Aboriginal and
Torres Strait Island patients.
A specialized program for sufferers of long-‐term issues, particularly mental health problems, in the
years following disasters could be easily and simply amalgamated into the current framework. If
disaster victims were included in the target groups, health care professionals would be incentivized to
treat them with telehealth technologies. As a vast demographic, the inclusion of disaster victims
suffering mental health problems could create a significant strain on this rebate initiative. This would be
avoided, however, by restricting the eligibility of disaster victims to attract rebates for healthcare
providers to a five-‐year period commencing when the patient first seeks treatment.
This simple addition to recent initiatives, using funding already allocated to the area, could provide
greater social and economic return, by focussing on the sub-‐population of communities affected by
natural disaster.
Case study: United States Subsidised Telehealth In 2012, the United States of America Department of Veterans Affairs provides subsidised telehealth
services for over half a million veterans. They commonly suffered from health problems such as diabetes,
chronic heart failure, depression or post-‐traumatic stress disorder. Technologies including virtual visits,
home monitoring, or a store and forward system, facilitated access to care and improved the health of
veterans. The Department found that patients easily learned how to use devices and were highly
satisfied with the process. Telehealth also significantly reduced VA’s costs. A combination of remote
patient monitoring and care coordination, for example, reduced hospital bed days by 25% and
admissions by 19%, according to a VA study (United States Department of Veterans Affairs 2012).
DISASTER FIRST AID TRAINING Background Recent disasters in Queensland have demonstrated that citizen involvement is inevitable and critical in
volunteerism. Good management and self-‐care is key to having a resilient volunteer workforce, and
community volunteers should ideally be trained prior to disasters.
Whilst the efforts of spontaneous volunteers are often effective, managing this resource can be a
significant burden when responding to a disaster (Volunteering Queensland, 2011). As early as 1989,
disaster management experts reported that, while volunteers are invaluable ‘the inundation of
unsolicited assistance’ following a disaster presents significant logistical issues for NGOs and volunteer
organisations (Auf der Heide, 1989). However, effective policy that addresses the burden of SUCV is
ostensibly limited, with a heavy reliance on the internal operations of NGOs to coordinate such volunteer
efforts. Emergency Volunteering CREW, an initiative of Volunteering Queensland, currently acts as the
‘shock absorber’ by reducing influx and placing potential volunteers with disaster response agencies,
local councils and community groups.
Key issues identified by Volunteering Queensland include potential physical and mental health issues arising from volunteer participation in recovery events. Both Volunteering Queensland and Orloff ’s
Field Manual identify volunteer preparation as a key strategy in mitigating physical and mental health
issues (Orloff, 2011). To that end, the Department of Families, Housing, Community Services and
Indigenous Affairs (FaHCSIA) in cooperation with the Australian Red Cross found that only
approximately 25% of volunteers acknowledged that they were appropriately trained to volunteer
(FaHCSIA, 2010). Similarly, in a Volunteering Australia national survey, volunteers most frequently
identified safer working environments and volunteer training as requiring the most urgent attention
(Volunteering Queensland, 2011).
An increased understanding of the impact of natural disasters has illustrated the need for education of
the general public on matters of disaster relief. To best take advantage of social capital and increase
public safety, improvement of basic disaster response skills and knowledge for spontaneous volunteers
(both within NGOs and as unaffiliated members of the broader community) is necessary.
In areas identified as being at risk of natural disaster according to the Queensland Government’s 2011
State-‐Wide Natural Disaster Risk Assessment Report 3, all first aid training should include incident
training for natural disasters that is specific to the area. Specifically, the obtainment of qualifications in
Workplace Level 1 Emergency First Aid (HLTFA211A), Workplace Level 2 Apply First Aid
(HLTFA311A) and Workplace Level 3 Occupational First Aid (HLTFA403C) should include course
material on emergency safety procedures in the event of a disaster, emergency evacuation planning,
hygiene precautions, identification of common dangers of that natural disaster and basic volunteering
conduct (such as advice on appropriate clothing or not removing property and debris from damaged
buildings). Moreover any first aid training should, where appropriate, be contextualised to address
situations arising from a natural disaster in that local area (such as addressing heat stroke or
dehydration in bushfire areas).
Further, simplified Psychological First Aid (PFA) should be included insofar as first aiders are aware of
the potential mental health impact of being affected by a disaster and can identify the signs of prevalent
issues such as Acute Stress Disorder and anxiety. Shock management is already taught in the most
common Apply First Aid course. An increase in people able to self-‐care, listen to distressed friends and
family and encourage them to seek professional help where appropriate would assist in remedying this
overlooked issue of disaster recovery. While it should not be treated as a substitute for an accredited PFA
course the education of the general public, particularly in areas at risk of natural disaster, is critical to
managing the spread of psychological issues in vulnerable demographics. In order to reduce the long
term impact on affected communities and the incidence of serious mental health issues such as
depression and Post Traumatic Stress Disorder, it is vital that there be greater mental health training,
albeit at an introductory level.
Those affected by the disaster training would include workplaces currently obliged to have trained first
aiders under a duty of care established by the Workplace Health and Safety Act 2011 (Cth). This means
that, at the very least, most workplaces will have access to a person with a current Apply First Aid
qualification (the minimum requirement for workplaces), and thus a requisite knowledge of disaster
safety. Such policy would not be a significant amendment to the current guidelines, as the Safe Work
Australia First Aid in the Workplace Code of Practice already recommends that training is dependent on
the context and location of the work, and that ‘additional first aid considerations may be necessary for
workers in remote or isolated areas.’ Additionally, any other individual or body that chooses to obtain
first aid qualifications will gain disaster training that can then be applied in their community.
Necessarily, not every person at risk of a disaster will receive disaster training, but the benefits of
providing persons already learning First Aid training with basic additional knowledge are significant.
Communities are strengthened when the skills to identify and address dangers from disasters are part of
their collective preparedness. Additionally, people may be more prone to volunteer with an NGO if they
feel a responsibility to apply the skills they have learnt, and there is a significant pressure lifted from
NGOs if volunteers have already received training. The burden on emergency service personnel and
professional volunteers is also reduced if the public can identify risks and assist with physical and
mental health issues prior to aid arriving. If people have received some basic form of PFA training there
is a reduced chance that long-‐term mental health problems will lay undiagnosed in the community and
be unresolved 12-‐18 months after the disaster and government aid has ceased.
VOLUNTEER MENTAL HEALTH RECOVERY PLAN
Background
There is international consensus on volunteering regarding certain key points. There is agreement that
civilian volunteer involvement in disaster response is inevitable and critical, that spontaneous and
unaffiliated volunteers must be integrated into organised efforts, and finally that good management and
self-‐care of volunteers is crucial to ensure a resilient volunteer workforce and responder community by
reducing the incidence of harmful physical and mental effects (Orloff, 2011; Swygard & Stafford, 2009).
The responsibility for this recovery process must fall primarily to organisations supporting volunteers
during their service, as government provisions are frequently unable to meet this need.
The Queensland Recovery Guidelines (2011) is a report issued by the State Disaster Management Group
(SDMG), which outlines the state’s long-‐term recovery provisions. These guidelines were implemented
in the Queensland 2013 Flood Recovery Plan, which details the state and local government’s response to
the damage caused by Tropical Cyclone Oswald. The Recovery Plan also aligns with many
recommendations made in the Australian Guidelines for the Treatment of Adults with Acute Stress
Disorder (ASD) and Post-‐Traumatic Stress Disorder (PTSD).
Elements of the long-‐term recovery guidelines, however, are not being implemented in current
government plans. The Guidelines cite the need for expanded rural mental health services, family
therapy and a plan to deal with the interconnectedness of socio-‐economic disadvantage and poor mental
health. These concerns are not explicitly addressed in the Recovery Plan, nor is it clear how services
which currently are provided for will continue to be funded beyond 2013. Therefore there is a
disconnect between the mental health needs of volunteers in disasters, as acknowledged by the SDMG
and Volunteers Australia, and provision of robust and long term services in this area.
The importance of volunteers in the disaster recovery process has received increased recognition in
recent years. During the 2011 flood, the Brisbane City Council (BBC) made specific provisions for the use
of ‘spontaneous volunteers’, defined as individuals who seek to contribute to the disaster recovery effort
on impulse but are unaffiliated with any recognised volunteer agencies (Brisbane City Council, 2012b,
11). Given the potentially disruptive effect these volunteers may have on co-‐ordinated disaster
management plans, the BCC relied on a framework contained in a Red Cross report titled Managing
Spontaneous Volunteers in Emergencies when incorporating the volunteers into the recovery effort
(Brisbane City Council, 2012b, 11). The Brisbane City Council also relied on Volunteering Queensland’s
existing volunteering management structure in directing spontaneous volunteers to the agency for
registration (Brisbane City Council, 2012b, 11).
Although the long-‐term psychological effects of natural disasters have been well documented in relation
to individuals who have suffered injury and personal loss, there is a paucity of information regarding
mental health and disaster volunteerism. The speed and unpredictability of natural disaster situations
obstructs effective monitoring the mental health of volunteers, and precludes the possibility of obtaining
useful data prior to the event.
Parallel research does help to understand this area, however. Volunteering Queensland reports (2011)
consistently highlight health and safety concerns as a key issue. The high prevalence of PTSD in fire
fighters is another indicator that exposure to stressful and traumatic events, like natural disasters, may
be detrimental to the health of volunteers. One international study analysed the health of volunteers
following Hurricane Katrina in the United States. Responders reported low usage of personal protective
devices and over 25% reported stressful psychological symptoms (Swygard & Stafford, 2009). Another
study found that following the World Trade Centre collapse, many volunteers developed respiratory
problems thought to be linked to the exposure of airborne pollutants. This led to the development of the
World Trade Centre Monitoring Program for rescue workers and responders. However this program
came about 9 months after the disaster. The available research suggests that exposure to a natural
disaster through volunteering may be detrimental to an individual’s mental and physical health.
It is therefore recommended that organisations using volunteers as a resource in their recovery
operations take active measures to mitigate any potential psychological harm suffered by these
volunteers resulting from their participation in the recovery effort. This would take the form of a six-‐
month recovery plan, following up with volunteers post-‐disaster. Increased efforts should be made to
identify and register contact information for spontaneous volunteers, incorporated into NGO’s existing
volunteer databases. The recovery plan would then communicate multiple times with those affected by
a particular disaster.
Primarily, briefing sessions and preparation materials for volunteers prior to deployment should refer
to the potential psychological effects of volunteering and available resources such as those produced by
the Department of Health. Subsequently, as the psychological effects of a traumatic event manifest over
time, it is important that the organisation maintains contact with their volunteers across the prescribed
six-‐month period. In the short term, this contact may take the form of a follow up email thanking the
individual for their participation, linking them to general mental health resources and normalising and
validating their potential mental health responses.
It is recommended that the subsequent email contain a ‘mental health check’. Email has been chosen as
the proposed method of delivery as it is the most reliable for potentially transient populations. The
‘mental health check’ is informative as opposed to diagnostic and should be inquisitively framed to
encourage individuals to consider if the criteria are relevant to their situation. The email should also
include a list of online resources and information about the mental health resources, which are available
through Queensland Health, and NGO’s such as Lifeline.
CONCLUSION
The implementation of higher standards of preparation and public health recovery in the event of
natural disasters in Queensland will greatly mitigate their impact, and empower communities with
ongoing resilience. A better understanding of the effectiveness of disaster management arrangements
in local areas will allow communities to better prepare for destructive events, and ensures that
government funds are used most effectively. At the private end, the BCP recommendation realistically
provides a method of preparation that significantly reduces the negative impacts that disasters can have
on a community. Natural disasters are unavoidable, therefore Left Right recommends emphasizing
public health to reduce their adverse effect.
In spite of the devastating disasters suffered in recent years, Queensland has remained strong in the face
of hardship. This is due to the dedication and collaboration of NGOs, government organisations and the
great many volunteers, which have provided enormous support to organized recovery efforts. In
furtherance of the support, well-‐being and resilience of the community, Left Right makes the above
recommendations set out within this paper.
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