natural disaster management

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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