Multi-Casualty Air Medical Capability in Asia Pacific Region

1. Multi-Casualty Air Medical Capability in Asia Pacific Region Dr Jane CocksClinical Director, MedSTAR Kids MedSTAR Emergency Medical Retrieval Service Adelaide, South Australia ANZCA-HKCA Combined Scientific Meeting 2011 Hong Kong May 14-17th 2011

2. Overview • Multi versus Mass Casualty Events • Definitions • Issues • Mass Casualty Management • Needs • Current Capability • Recent Disasters and responses • Issues • Future Directions

3. Definitions • Multi-Casualty • More than one victim • Numbers that can be managed by the resources of the local region • Mass Casualty • Large number of casualties • Produced in a relatively short period of time • Exceeds the capabilities of the local region

4. Asia Pacific Region

5. The Problem?

10. The Problem? • Natural and Man-made events • Increasing frequency and victims • Multiple victims • Alive (variable acuity) and dead • Health and Governmental Personnel • Infrastructure decimated • Access, Power, Sanitation, Water, Space • Duration of disaster • Lots of Willing Helpers • Politics, cultures, religions, language, expectations • Coordination of response • Local and External agencies

11. Changing Global Expectation • Media coverage and the Global Village • ‘Do Something’ • Foreseeable events? • International disaster assistance is now considered a humanitarian obligation • Relief claimed as a Right not a Charity • No longer an ‘ad hoc’ response • Political agendas • Military fears

12. What is required? • Access to help • Rapid <24hours post event • Later and ongoing assistance • Medical assistance • Advanced and wide range of skills • On scene and locally • Mobile – patients and staff • Destination – local victims vs travellers • Infrastructure support and rebuilding • Central control and coordination • Clear communication

13. What can we do now?Levels of response • Advance assessment teams • Urban search and rescue • Medical Assistance • Critical care medical assistance • Acute care medical assistance • Subacute medical assistance • Management local victims • Evacuation and repatriation • Humanitarian aid • Financial, infrastructure, supplies

14. What can we do now?Urban Search And Rescue (USAR) • 11 countries in Asia Pacific Region registered with the International Search and Rescue Advisory Group (INSARAG) • Australia; China; Finland; Japan; Kazakhstan; Korea; Malaysia; Saudi Arabia; Singapore; Slovenia; Tajikistan • Medical components • Team and initial evacuation of victims • Self sufficient for 10 days • Coordination and Communication • United Nations Office for the Coordination of Humanitarian Affairs, Field Coordination Support Section (UN OCHA (FCSS)

15. What can we do now?Medical Assistance Teams Military MedEvac, CCAT Government Civilian response AUSMAT (Australian Medical Assistance Team); DMAT (NZ); JDR (Japan) Non-Government Civilian response (NGO) Red Cross, WHO, Private insurance companies Self tasking; personal agendas Coordination and Communication Specific requests for assistance United Nations Disaster Relief Organisation (UNDRO)

16. Air Medical Capabilities • Regional vs International • Rotary Wing vs Fixed Wing • Civilian vs Military

18. Rotary Wing BK 117

19. Black Hawk

20. Black Hawk

21. NH90

22. NH90

23. Fixed Wing Pilatus PC12

24. Pilatus PC12

25. C130J Hercules

26. C130J Hercules

27. C17 Globemaster

28. C17 Globemaster

29. C17 Globemaster

30. Transport to the Airfield?

31. Recent Disasters and the Air Medical Responses • Bali Bombings – 12th October 2002 • 202 dead (including 88 Australians and 38 Indonesian), 240 wounded • Private agencies • ADF • Indonesian tsunami – 26th December 2004 • 230,000+ dead, 125,000+ injured • USAR 11 countries (Australia, Singapore, US), AUSMAT response • Samoa tsunami – 29th September 2009 • 170 dead, 140 injured • Australian AUSMAT and USAR • NZ response • Pakistan floods – July 2010 • 1980 dead, 2950 injured • USAR (UK); AUSMAT

32. Recent Disasters and the Air Medical Responses • QLD floods – 10th January 2011 • 18 dead • Australia USAR • Cyclone Yasi, Queensland, Australia – 2nd Feb 2011 • 1 dead • 333 pt moved within 24 hours to Brisbane; Boeing C17 and C130J Hercules, ADF medical response augmented by specialist medical reservists • Christchurch earthquake – 22nd Feb 2011 • 182 dead, 1500-2000 injured • Australia (USAR and AUSMAT), Japan (USAR), Taiwan (USAR), Singapore (USAR), US (USAR), UK (Fire SAR), China • Japan earthquake and tsunami – 13th March 2011 • 28,000 dead, 2800 injured • USAR – US, China, South Korea, Australia, NZ

33. Japanese urban search and rescue team in Christchurch, 24 February 2011

36. Issues • Political agendas • Fears of Military involvement • Central Coordination/Control • Rapid response • Multiple roles • Repatriation vs Local management • Equipment and Supplies • Training – teams and locally • Costs

37. What do we Need? • Politically independent • Centrally coordinated and controlled • Clear communication systems nationally and internationally • Self sufficient • Extended period of time • Immediate response capability • Ongoing assistance capability • Self funded

38. What do we Need?International Rescue?

40. "Do not pray for tasks equal to your powers but for powers equal to your tasks.“ Reverend Dr. John Flynn

41. ?

42. References • Disaster Medical Assistance Teams: A Literature Review. Health Protection Group, Anton Breinl Centre for Public Health and Tropical Medicine, James Cook University. April 2006. www.health.wa.gov.au/hpg Cited 9th May 2011 • INSARAG – USAR Directory. http://vosocc.uncha.org/USAR_Directory Cited 6th May 2011 • Civil-Military Coordination during humanitarian health action. Global Health Cluster – Position Paper, Provisional Version February 2011. http://www.who.int/hac/global_health_cluster/about/policy_strategy/position_paper_civilmilitary_coordination/en/index.html. Cited 6th May 2011