Should New South Wales hospital disaster teams be sent to major incident sites?

Abstract

The aim of the present review was to assess the suitability of hospital disaster medical teams' training, personal safety and medical equipment for site casualty work at multiple casualty incidents (MCI), and to compare this with retrieval teams who routinely provide pre-hospital trauma care. The options for the provision of a site medical response based upon international and Australian disaster planning guidelines are also reviewed. A questionnaire was mailed to all doctors dispatched to the 1997 Thredbo disaster as part of trauma service (TS) hospital medical teams, medical commanders or Helicopter Emergency Medical Service (HEMS) crew. Doctors with Sydney retrieval services (SRS) experience were compared with those without SRS experience in regard to the reported level of relevant training and experience as defined by current Australian guidelines and the Education and Training in Disaster Medicine Curriculum, Scientific Committee of the International Society of Disaster Medicine. Familiarity with medical equipment was assessed, as was level of compliance with Australian guidelines for personal protective clothing and equipment. Responses were obtained from all 25 doctors. Nine had SRS experience. None of the 16 doctors without SRS experience met the criteria of the Education and Training Curriculum, compared with four of nine doctors with SRS experience (44%). All six SRS doctors using SRS equipment had personally used or checked their equipment within 2 weeks prior to dispatch to Thredbo, compared with none of the 19 doctors using hospital equipment. Of the 11 areas of personal safety equipment and clothing assessed, all SRS doctors using SRS equipment complied with the guidelines in five areas (45%). There was no area assessed in which all the doctors using hospital equipment complied. Hospital medical teams suffer from the same problems of inadequate training, experience and personal safety equipment that are identified in previous reports from disasters overseas. The continued focus on hospital medical teams in counter-disaster planning as the primary source of on-site medical services is inappropriate because, with the exception of retrieval doctors who routinely provide pre-hospital trauma care, appropriately trained and experienced doctors are unlikely to be available from within the hospital system.