FINAL REPORT July 2010 to June 2015 Final Report July 2010 to June 2015 Final Report July 2010 to June 2015

Contents Foreword 3

Executive Summary 5

Section 1 - Response and Deployment 6

Section 2 - Field Hospital Development and Exercising 7

Section 3 - Royal Darwin Hospital (RDH) and the Trauma Service 8

Section 4 - Collaborative Relationships – Domestic Engagement 9

Section 5 - Collaborative Relationships – International Engagement 10

Section 6 - Education and Training 11

Section 7 - Research 12

© National Critical Care and Trauma Response Centre, Section 8 - NCCTRC Strategic Plan 2015 – 2019 13 Final Report July 2010 to June 2015, Australian Government Department of Health 2015. Annex A-B 14 This is a formal document that details the activities of the National Critical Care and Trauma Response Centre Annex A – Published Articles from July 2010 to June 2015 (Funding Period). Annex B – Performance against Key Performance Indicators (KPIs) This work is copyright.

ISBN-10: 0994357400 ISBN-13: 978-0-9943574-0-3

More information is available from: National Critical Care and Trauma Response Centre Royal Darwin Hospital PO Box 41326 Casuarina NT 0811

Phone: +61 8 8922 6929 Fax: +61 8 8922 6966 Email: [email protected] www.nationaltraumacentre.nt.gov.au/

2 Final Report July 2010 to June 2015 Final Report July 2010 to June 2015

Foreword Foreword

ealth emergencies are a reality of Australian Medical Assistance Teams hen the 2002 Bali Bombing the NT Centres for Disease Control a everyday life; care providers and concept and provided a focal point for occurred the Royal Darwin group of AusMAT trained Territorians H policy makers spend much time and jurisdictions to engage in training and W Hospital was a generalist and colleagues from southern states effort in planning and preparing to prevent deployment of their clinical staff. The institution. It had a small emergency provided a mass trachoma treatment or to respond to such emergencies. From enhanced cooperation that has developed department, an 8 bed intensive care unit for an entire indigenous community. those directly affected, through to care in the time of this funding period had and no specialist burns service. Whilst it This deployment well-demonstrated the providers, through to policy makers, they its greatest success in the deployment lacked the ‘on paper’ capability to respond versatility and value of the NCCTRC in can have a powerful impact. Australians of a truly multi-jurisdictional team to to this tragic event, the individuals within providing healthcare across a variety of have the benefit of a world leading health Operation Philippines Assist in the wake the RDH and the institution itself had a domestic contexts. Along with our major system that supports the provision of high of Typhoon Haiyan, late 2013. To me, this remarkable capacity, a capacity that I overseas AusMAT deployments, to the quality, timely, urgent care. Each and deployment demonstrated a capacity have noted since moving to the Northern Solomon Islands dengue fever outbreak every jurisdiction in Australia has proven to work constructively with a number Territory some 30 years ago, to go above and to the Philippines, the period 2012 – its ability to deal with health emergencies, of Commonwealth, State and indeed and beyond when faced with an extreme 2014 has been a sustained period of activity pandemics or mass casualty events. international agencies to successfully emergency. To give some perspective on for the NCCTRC. As well as response the However, even the strongest of systems respond to a major international those terrible days, the reception of 12 value of preparedness is inestimable. I can be overwhelmed at times and for our emergency. I have experienced first-hand seriously burnt patients to a quaternary have observed firsthand the quality and near neighbours, many of whom are still the strength of the relationship between hospital following the Black Saturday attention to detail of the AusMAT training developing robust health systems, this the NCCTRC and my own office, the Office bushfires was lauded as an extraordinary packages – they are of international happens all too frequently. of Health Protection and the Australian event. The doctors, nurses and allied staff significance. AusMAT courses have seen Health Protection Principal Committee of RDH received, treated and repatriated 55 over 600 doctors, nurses and health Australia continues to develop a unique (AHPPC). In particular, the way in which Australians, without losing a single patient. logisticians across the nation trained to Dr Len Notaras AM Professor Chris Baggoley AO national asset to respond to overwhelming the Centre has led through facilitation a uniform standard as medical disaster Chief Executive of Northern Territory health emergencies domestically and and coordination has marked its From this tragedy arose the concept of responders. The NCCTRC has developed a BVSc (Hons), BM BS, BSocAdmin, FACEM, Department of Health abroad. During the past three years I maturation into an effective operational the National Critical Care and Trauma 100 bed mobile field hospital equipped with FRACMA, DUniv(Flin) have observed the National Critical Care asset for the nation. Response Centre, and an enduring operating theatres, resuscitation suites, Australian Government Chief and Trauma Response Centre (NCCTRC), partnership between Northern Territory wards and an emergency department. Medical Officer based in Darwin, undergoing a period There is little doubt that health Health and the Commonwealth that It has taken the lead in international Department of Health of substantial growth in fulfilment of its emergencies, be they a result of natural or capitalises on the regional advantage of disaster response standards through the mandate to provide enhanced medical man-made calamity, will continue to affect Darwin and its proximity to one of the secondment of Dr Ian Norton to the World response capacity across the Top End of our region. The Commonwealth is well- world’s most disaster prone areas, and the Health Organisation. Australia as well as overseas. Building on served in having a major health response known capacity of Territorians to respond Australia’s strong tradition of humanitarian asset in the NCCTRC, and I look forward to to disaster. The NCCTRC celebrated its 10 Ultimately the NCCTRC has been able to assistance and government sponsored watching its development into the future. year anniversary in 2014. In that time it has combine local relevance with international civilian medical teams; the NCCTRC has become a unique feature in the Territory excellence and will continue to do so into been a driver of the development of the and Australian health landscape. The the future. I am committed to the ongoing Centre serves and indeed achieves the dual relationship with the Commonwealth and purpose of preparing the Royal Darwin NT Health that is the NCCTRC and the Hospital to receive Australian victims of custodianship of this vital national asset. disaster and as an overseas response asset for disaster healthcare offshore. As the Chief Executive of NT Health and before that the Executive Director of the NCCTRC, I have been immensely proud to see the Centre at the forefront of such a variety of health emergencies assisting such a broad range of patients in need. One of the lesser known deployments of the NCCTRC, and one of which I was particularly proud, was the 2012 deployment to Maningrida, in Arnhem Land. In partnership with

3 4 Final Report July 2010 to June 2015 Final Report July 2010 to June 2015

Section 1 Executive Summary Response and Deployment

ver the past five years the National his visit to Darwin, President Barack Highlights Medical Team arrivals. The AusMAT sent Critical Care and Trauma Response Obama met with the Executive Director of as part of Operation Philippines Assist » Operation Pakistan Assist II – Pakistan Centre has matured into a unique the NCCTRC, Dr Len Notaras. In 2012 we represented a substantial achievement in O Floods August - October 2010. 11375 and critical disaster response asset for were fortunate to host former Australian the deployment of the full field hospital patients treated during a seven week Australia. The growth and development of Prime Minister Gillard and former capability of AusMAT. During 23 days of civil-military deployment the NCCTRC has been enabled in no small Indonesian President Susilo Bambang operational activity, 2734 patients were part by its capacity to form sustaining Yudhoyono who viewed the field hospital » Dengue Fever outbreak – Solomon seen, 238 operations were performed relationships with a variety of key partners on full display. Islands April - May 2013. Infectious of which 90 were considered major in the sector. Of these the relationship Disease health emergency response to procedures. The AusMAT hospital was with the Commonwealth Department of Our unique education and training the Solomon Islands considered a critical hub in the overall Health has been the most critical. This packages focus on simulated emergency health response to the disaster. » Operation Philippines Assist – Tacloban funding period has shown that the environments to complement classroom City November – December 2013. relationship is more than that of a teaching. Through our partners we Philippines Assist was the first deployment deployment of the full field hospital in purchaser and provider, it is a true access world-leading educators of the of an AusMAT under the new Foreign the wake of Typhoon Haiyan, treating partnership where the NCCTRC and Office likes of Dr Chris Giannou, chief surgeon Medical Teams framework. At the time it 2734 patients of Health Protection have worked together of the International Committee of the Red was one of the fastest deployments of a in two key areas – the sustainable Cross, and Professor Skip Burkle, of the » Endemic Trachoma - Maningrida, East field hospital to a sudden onset disaster. development of trauma response Harvard Humanitarian Initiative. Be it the Arnhem Land, March 2013. Response The facility was visited by a number capability for Northern Australia, and the training of NT Health staff to respond to to the endemic eye disease trachoma of dignitaries including the President previously uncharted territory of civilian remote area trauma, or AusMAT with the Northern Territory Centres for Benigno Aquino of the Philippines and the medical team deployments on behalf of deployees, the feedback from candidates Disease Control Australian Foreign Minister, Julie Bishop. Dr Nicholas Coatsworth the Commonwealth. is consistently high. As a contrast to this sudden onset natural » Operation Pacific Assist– Vanuatu March Executive Director disaster, the Solomon Islands dengue 2015, deployment of rapid assessment, Our deployments are the most tangible To complement the deployable asset outbreak in 2012 was far more of a ‘slow initial treatment and rapid response demonstration of the investment in the and education packages we retain a close burn’ health emergency. In many ways it teams to the Cyclone Pam response, NCCTRC. We have worked alongside our clinical partnership with the Royal Darwin was a more challenging response as the treating 1540 patients state and territory counterparts in refining Hospital, Top End Health Services and NT local health system struggled under a the Australian Medical Assistance Teams Health. The NCCTRC directly services case burden of over 500 dengue patients ive major deployments were (AusMAT) concept. Despite the challenges RDH by providing the Trauma Service at per week. Two teams of 9 doctors, nurses undertaken over five years and of driving a multi-jurisdictional project a cost of $2.4 million annually. This has and logisticians were deployed by the underscore the range of activity AusMAT is now in a position to access the created the environment for accreditation F NCCTRC to embed within the National and capability available to the Australian very best in clinical staff from around the as a level 2 trauma hospital. The Referral Hospital in Honiara. The team Government. Deployments were either via nation for health emergencies. This was reciprocal agreement to provide AusMAT supported the emergency department the AusMAT mechanism and coordinated well-demonstrated in the deployment to trained clinical staff ensures a highly in providing routine care whilst Solomon by the NCCTRC, or deployed directly by Tacloban City in the wake of Typhoon skilled, heat acclimatised workforce Islands colleagues ran a dengue clinic. the NCCTRC. These two models offer a Haiyan, when each and every jurisdiction for deployment on behalf of the Several of the key local clinicians had been substantial degree of flexibility and tailored had the opportunity to send clinical staff. Commonwealth. trained in Darwin during AusMAT courses response to health emergency events. The diversification of this capability underscoring the importance of pre- The funding period was bookended by beyond sudden onset disasters As we look toward the next funding cycle existing relationships in disaster response. Operation Pakistan Assist II in 2010 and commenced in late 2014 during the Ebola the future for the NCCTRC is full of Operation Pacific Assist in 2015. The former virus epidemic and the NCCTRC now has opportunities. In reading this report I ask Finally the NCCTRC contributed medical was a successful demonstration of civil- infectious disease epidemic response as a that you also consider the final chapter and logistical support to the NT Centres for military collaboration in Humanitarian strategic objective for the coming years. which is the first publication of the Disease Control (CDC) in the treatment of and Disaster Response, during which over Underpinning our deployable human NCCTRC strategic plan for 2015 – 2019. indigenous Australians in the East Arnhem 11000 patients were treated by a combined resources is a state of the art trauma field The development of this plan is consistent community of Maningrida. The training of team of clinicians from AusMAT and the hospital. Since 2010 the hospital has been with the ethos of the NCCTRC and was AusMAT members in remote and austere Australian Defence Force. refined and now comprises a 100 bed widely consultative, involved all of our medicine offered an ideal resource for this inpatient facility, 2 operating tables, and staff members, engaged all state health critical health program in a context where The response to Cyclone Pam in March full resuscitation and outpatient capability. jurisdictions through their Chief Health workforce shortages often compromise 2015 was equally unique, this time for The leasing of a climate controlled Officers, and our partners in service delivery. In addition a number the deployment of an AusMAT rapid warehouse has enabled our activation Commonwealth agencies. The product is a of AusMAT members from the southern assessment team with the first Whole of times to be substantially reduced. The clear statement of direction that will states experienced first-hand the realities Government contingent arriving in country. hospital has been viewed by a number of preserve and develop this vital national of remote community life. The partnerships This allowed accurate health intelligence high level delegations and is considered a asset into the future. with the local community and CDC are a and early support to the Vanuatu Ministry unique regional asset. In late 2011 during model for future collaboration in public of Health which led to the team directly health response. assisting in the coordination of Foreign

5 6 Final Report July 2010 to June 2015 Final Report July 2010 to June 2015

Section 2 Section 3 Field Hospital Development and Exercising Royal Darwin Hospital (RDH) and the Trauma Service

Highlights To support the field facility and its water Highlights and Anaesthesia has been vital to the requirements, a new desalination plant successful partnership between RDH » Development of fully equipped and » Accreditation by the Royal Australian was commissioned purifying 10,000L of and the NCCTRC. deployable Type 1 and Type 2 Field College of Surgeons (RACS) as a Level 2 salt water or 40,000L/day of fresh water. In Hospitals in accordance with the World trauma service conjunction with a senior water-sanitation The NCCTRC also directly funds and Health Organisation “Foreign Medical adviser from the International committee » Incorporation of allied health services manages the Royal Darwin Hospital Team” (FMT) system of the Red Cross, Mr Robert Handby, our into the trauma care model at Royal trauma service, a stand-alone unit » Leasing a warehouse facility housing logisticians have substantially developed Darwin Hospital as part of the direct providing door to discharge holistic the national AusMAT equipment and their WATSAN skills. This ensures that the funding and management of the RDH care to trauma patients in the Top End. infrastructure, allowing the NCCTRC hospital can be fully functional in meeting trauma service by the NCCTRC During the funding period the team was to improve response timeliness and the high demands of up to 150 litres of granted Level 2 accreditation by the Royal » Partnerships with the Australian efficiency potable water per patient per day. Australian College of Surgeons. Pending Trauma Registry and Australian Quality the recruitment of a neurosurgeon, we » Establishment of a national capability Improvement Program to compile the The human resource requirements of are likely to achieve Level 1 accreditation, for rapid response to Ebola virus disease first National Trauma Registry Report AusMAT have been supported by the equivalent to a large tertiary receiving to assist regional governments in the 2014 roll-out and use of the AusMAT database hospital. The accreditation team observed event of a suspected Ebola case or other across most jurisdictions. The NCCTRC » Deployment of AusMAT teams in their 2013 report that the trauma infectious disease outbreaks has managed and supported the roll-out, comprising up to 60% of NT based service had changed the model of care » Ongoing use of local and regional major and used the platform as a deployment clinical staff at RDH, decreasing length of stay, events as unique opportunities to train record for the deployments to the Solomon decreasing rehabilitation time and the » Development and implementation of a AusMAT team members and test the Islands, the Philippines and Vanuatu. The need for rehabilitation. trauma care model leading to reduced NCCTRC capability database provides real time access to length of stay and improved patient critical information regarding deployees, The Trauma Service has developed a key outcomes hrough the efforts of the former their credentials and clinical specialty. liaison function engaging with a variety Director of Disaster Preparedness, Dr of stakeholders including Careflight and ver the decade of its existence the Ian Norton the NCCTRC had a leading Maintaining staff and equipment readiness St John Ambulance to improve patient T NCCTRC has been both partner and role in the development of the WHO Foreign is a consistent challenge. To meet this outcomes. Given the NT context of very investor in the Royal Darwin Hospital Medical Team Guidelines and Classification challenge, the NCCTRC identifies major O long distances and travel time, we foster supporting the development of enhanced system, published in 2013. This represents community events where medical, logistical close working relationships with the NT trauma services and infrastructure. a seminal point in International medical and physical challenges must be overcome pre-hospital providers to ensure optimal This funding period has seen a more emergency response and allows host to provide the highest levels of patient retrieval processes. modest investment of 40% of operating governments to assess incoming teams care. While a number of the exercises have funds into the Royal Darwin and Top End against international standards. During this taken place, amongst the most notable are Using the data generated from the Health Services, commensurate with a reporting period the NCCTRC has ensured the annual support of the Tour de Timor trauma registry, the RDH Trauma Service shifting focus toward building overseas that our national medical response asset bike race since 2011. A nation-building continues to actively engage in targeted deployment capability and growth in is compliant with these guidelines and event for Timor Leste, the Tour is a unique community events and on boards. As an NCCTRC core business activities. has constantly worked with our partners environment to test deployment capability example, we aim for a reduction of car in the Commonwealth, most particularly while building our clinical relationship with accident related trauma through our Nonetheless investment remains the Australian Defence Force, to reduce the Timorese Ministry of Health. At a local involvement in the Northern Territory substantial and has at its core two activation times and enable timely and level the NCCTRC is a familiar part of many Football League (NTFL) ‘Always wear your elements. Firstly, a cohort of 38 FTE efficient deployment. NT-based major events including the V8 Increase in trauma cases: seatbelt’ campaign, or on the board of clinical, allied, paramedical and support supercars where our teams are on standby KidSafe NT. Injury and burns prevention staff that enable RDH to be a trauma The AusMAT field hospital now has two to provide high level trauma care. remain a key community engagement and receiving hospital are funded by the operating tables, full resuscitative and At the close of the reporting period, research focus for the team. NCCTRC. These professions include trauma capability, as well as a hospital the NCCTRC has reached a new era in Finally the NCCTRC provides a key maxillo-facial and orthopaedic surgeons, facility capable of managing 100 inpatients. deployment capability and readiness. The emergency management function and radiography and laboratory staff and Whilst the field hospital is able to be used rental of a dedicated warehouse allows the employs the Territory’s main health nursing positions. These staff work within in a variety of emergencies, it is primarily NCCTRC to appropriately store, manage disaster manager as well as the clinical units, and many of them have been a trauma and surgical facility. Following and deploy our field hospitals and various emergency management officer at the AusMAT trained and have deployed on the Ebola virus outbreak in West Africa, the logistic pods. The new warehouse has Royal Darwin Hospital. Throughout the behalf of NT Health. They also contribute NCCTRC tested the capability of the field also become a training facility during the past five years these two key positions to day-to-day activities of the NCCTRC hospital to be configured as a temporary, AusMAT trainings, our primary display and have integrated the NCCTRC, RDH as clinical educators and advisors. In rapidly deployed Ebola Treatment Facility. presentation space, and a R&D laboratory and Territory-wide emergency plans particular, the relationship between the Subsequent to three successful exercises for our logistic capability. 660 611 609 762 838 and ensured preparedness for one of Department of Surgery, Critical Care in late 2014 and early 2015 a stand-alone Australia’s most disaster-prone regions. in in in in in capability now exists to deploy an AusMAT 2010 2011 2012 2013 2014 to an infectious diseases emergency of international significance.

7 8 Final Report July 2010 to June 2015 Final Report July 2010 to June 2015

Section 4 Section 5 Collaborative Relationships - Domestic Engagement Collaborative Relationships – International Engagement

Highlights model. It was the forerunner for the WHO Highlights part funded by the NCCTRC. Our collabora- standards and classification guidelines tion with the NZMAT program has enabled » Development of a bilateral agreement for Foreign Medical Teams and set » Devising, funding and leading the devel- our partners in NZ Health to develop an with Queensland Health to provide the framework for the deployment to opment of the World Health Organisation additional and valuable standing medical reciprocal medical assistance during Operation Philippines Assist. The lessons Standards and Classification for Foreign capability for the region. During the funding a disaster and build our core education learned from that deployment led to the Medical Teams published in 2013 period the NCCTRC has annually support- programs re-convening of the national AusMAT ed the NZMAT training program, engaged » Developing and implementing a multi- » Providing the newly deployed US Marine Working Group under the auspices in multiple co-deployments including the year strategy to introduce Major Incident Corps contingent with medical and heat of the National Health Emergency New Zealand-led deployment to the Solo- Medical Management and Support acclimatisation training relevant to the Management Subcommittee (NHEMS) mon Islands floods in 2013, and seconded (MIMMS) training with key Pacific part- Top End and the AHPPC. The NCCTRC has been the NZ Health Director of Emergency Man- ner nations a coordination focal point for the future agement to back-fill the Executive Director » Finalising the national AusMAT manual strategic development of AusMAT, and the » Partnership with the Australian Gov- role in June/July 2014. in collaboration with jurisdictional and representation by the NCCTRC on these ernment for the successful hosting of Commonwealth stakeholders key national bodies creates the interface the East Asian Summit Rapid Disaster Training activities throughout the region » Development of a Masters in Disaster between the operational and strategic Response Workshop in Darwin have been a significant means of engage- Healthcare in collaboration with aspects of health emergency response ment with national health systems through » Advising and collaborating with New Flinders University School of Nursing and the development of the national asset. to local clinics. Through the NCCTRC and Zealand Health to develop New Zealand drawing on our partners across Australia, » Secondment of senior NCCTRC staff Medical Assistance Team Training The two other key government the NCCTRC provides training in MIMMS, to the NT Government during the relationships are with Emergency » Visit of Susilo Bambang Yudhoyono an internationally recognised medical responses to Cyclone Lam and Cyclone Management Australia and the and Prime Minister Julia Gillard to the emergency management framework. Key Nathan February and March 2015 Department of Foreign Affairs and Trade. NCCTRC in July 2012 international engagement is found in deliv- These departments, along with the ering the MIMMS training to regional part- elationships have been at the heart Department of Health, form the backbone The benefits of a robust international ners. The three year program, co-funded of the NCCTRC’s model of business of Whole of Government response and engagement strategy: by the Department of Foreign Affairs and since its inception. The inestimable R work together in the deployment of Trade, aims to transition the core training value of knowing individuals and agencies » To enhance the reputation of Austra- AusMAT. The NCCTRC has established elements to be independently managed by in the field and during a disaster has been lia in the field of response medicine; strong ties with key officials across national health systems with as needed proven time and time again. Whether government through regular engagement » To enhance the ability of the support from NCCTRC. The same funding through training our colleagues at RSUP and participation in training events NCCTRC to deploy internationally stream has also allowed key clinicians Sanglah Hospital who responded to the as well as domestic and international through networks and linkages; from Pacific nations to join AusMAT deploy- Denpasar Lion Air crash, or meeting forums and think tanks in the health ees in Darwin-based training programs. United States marine colleagues on the » To enhance the ability of partners to emergency response. Over the funding period 50 colleagues from tarmac of Tacloban City airport, there is cope with disaster better; the Western Pacific have been trained. A no better way to efficiently and effectively The NCCTRC recognises the importance » To establish international guidelines further 36 New Zealand, 8 Indonesian and respond to disaster than by having a direct of collaboration in the civil-military and norms in disaster response; and 9 colleagues from a total of 7 countries relationship with other responders. space in Humanitarian and Disaster have joined us for specialist skills training. » To work closely with like-minded Response. During the funding period At a national level the successful organisations as partners, not NCCTRC delivered specific medical The NCCTRC has been an active participant transition was made of our previous competitors. contingent training for the USMC in improving understanding of disaster relationship with the Princess Alexandra Shock Trauma Platoon and Forward response frameworks within the region Hospital in Brisbane to a bilateral Resuscitative Surgical Suite, conducted through the Australia-Indonesia Rapid agreement between the NCCTRC and he period represented a period of a field site visit to Bradshaw Field Disaster Response Initiative and the East Queensland Health. This agreement now significant international engagement Training Area and viewed USMC Field Asia Summit. Driven by Emergency Man- defines a new level of cooperation in for the NCCTRC as a key partner and Medical capabilities and opportunities T agement Australia and partner agencies medical disaster response and has been in its own right. Of particular note during for interoperability. This work has in the region, activities included a rapid leveraged in the secondment of high level the funding period was the development continued to support the exercises disaster workshop in Darwin in September officers to the NCCTRC, the deployment of and publication of the WHO Standards undertaken between the ADF and the 2013 during which a high level delegation senior clinical staff to AusMAT exercises, and Classification guidelines for foreign USMC. High level meetings and ongoing including the head of Indonesia’s National and the support of education programs medical teams. Led by Dr Ian Norton and interaction between the NCCTRC and Disaster Management Authority, the BNPB such as MIMMS. Dr Peter Aitken, and with funding support the Commanding Officers of 1 Brigade, (Indonesian National Board for Disaster from the Department of Foreign Affairs and Northern Command and the US Marine Management (Indonesian: Badan Nasion- The publication of the national AusMAT Trade, the group of international experts Corps have facilitated al Penanggulangan Bencana), visited the manual was the culmination of years produced this seminal document which is the relationship. NCCTRC Warehouse and viewed the field of work moving away from the state- now the basis for a global medical disaster hospital on full display. based disaster medical assistance team response framework and has been used in several sudden onset disasters. Dr Norton’s secondment to the WHO has been

9 10 Final Report July 2010 to June 2015 Final Report July 2010 to June 2015

Section 6 Section 7 Education and Training Research

Highlights rapidly deployed Ebola Treatment Facility. Highlights guidelines have been developed to promote The success of this course led to further adaptation in the home environment prior » Delivery of an average 118 training » Influencing policy and protocols for heat funding being made available to train 120 to deployment, and a subjective well-be- days per year to 1,073 participants, stress in emergency response personnel AusMAT members to respond to infectious ing tool has been developed to monitor exceeding its expected KPIs of 81 through translational research disease epidemics. deployees during activations. Both were training days and 695 participants by » Presentation of research data at major utilised during 2014 Tour de Timor de- around 50%. The NCCTRC has also focussed on the national events including Bushfires and ployment. These initiatives are in addition » Creation of an AusMAT Advanced Team training of local health personnel in the Natural Hazards Cooperative Research to hydration monitoring and field cooling Leader group and accompanying course Northern Territory to respond to mass Centre CRC and the Australasian Fire strategies based upon our research. The to develop a cohort of AusMAT taskforce casualty incidents and the high number of and Emergency Service Authorities product of such research is an evidence leaders remote multi-trauma events affecting NT Council AFAC Conference based system for maximising the health, communities. These courses are designed safety and performance of AusMAT mem- » Development of a training package » Mentoring researchers from the Univer- to be taken on the road and delivered bers on deployment. In addition to these for Infectious Disease Emergencies of sity of Tennessee and the subsequent throughout the Northern Territory. Remote ground-breaking results the research International Significance development of a deployee well-being Area Trauma Education (RATE) and platform has enabled collaboration with a monitoring tool for use during AusMAT RPHTDC (Remote Pre-hospital Trauma number of key partners detailed in Table 1. ver the past five years the NCCTRC training and responses Disaster Course) are specifically run in In many instances these partnerships have has enhanced its course packages remote health centres while Advanced Life » Finalisation and presentation of a com- made real differences to the policies of with the objective of training health O Support (ALS) and Australian Trauma Team prehensive research project analysing a emergency response agencies, most nota- professionals to manage and coordinate Training (ATTT) are delivered in regional decade of trauma-registry data from the bly in national fire and rescue services. trauma, mass casualty and disaster centres. Our training is appreciated by Northern Territory incidents. The AusMAT suite of courses health professionals as they can update The second major area of research interest and Remote Prehospital Trauma and » Delivery of thirteen oral presentations at their clinical skills and knowledge in their is trauma and injury. The NCCTRC has Disaster Care (RPHTDC) are the flagship the 2015 World Congress of Disaster and own environments. In the funding period invested in staff dedicated to the man- offerings. Both represent the Centres Emergency Medicine more than 200 rural and remote clinical agement of the Top End Trauma Registry. overall mandate being to prepare staff for staff completed our training packages. During the funding period the findings of an overseas deployment and to enhance s the NCCTRC has developed its op- a project examining ten years of data have the capacity of clinicians in the Territory to erational capability opportunity has Education Team Report 2010 - 2014: been released. These have shown the Top manage local emergencies. The NCCTRC arisen to be performing research in A End suffers the highest incidence of trau- supports AusMAT courses across all juris- Number of accredited courses 2010 - 2014 two major domains of our interest. matic injury in the nation at 181 people per dictions through either directly managing 100,000. The outcomes of the project have or providing technical assistance to local The well-being of emergency responders provoked further research into paediatric coordinators. This model has allowed in tropical conditions where heat stress is a trauma, assaults, and the role of geogra- jurisdictions choice and flexibility and real and present threat has been the focus phy and seasonal effects of trauma. As well enhanced course development through of Dr Matt Brearley’s work over the past as having important policy implications the ability to trial new techniques. At the three years. The research has identified at community and government level this conclusion of the funding period over 600 that non heat acclimatised emergency research allows us to improve and finesse personnel have completed the AusMAT responders slow their work rate to limit the our data collection tools for field-based re- Team Members course Australia-wide. development of heat stress, thus support- search during AusMAT deployments. It also The AusMAT model is unique in that it is ing the deployment of heat acclimatised 74 88 132 108 115 allows us to make inferences regarding an opportunity to test deployment capabil- responders. the success of our trauma service clinical ity as well as educate new team members in in in in in activity which can be directly translated to in a simulated field environment. 2010 2011 2012 2013 2014 For AusMAT members that are not our management of trauma in the field. chronically heat acclimatised, individual A number of new specialist courses were Number of trained participants 2010 - 2014 introduced. The advanced team leader course, which provides specialist skills in Table 1. NCCTRC research collaborators leading AusMAT teams, brought together a cohort of senior health planners and QLD Fire and Emergency Services NT Fire and Rescue Services operational staff including from the Aus- tralian Defence Force. ACT Fire and Rescue Services NT Police Tactical Response Group NT Police Disaster Victim Identification Unit NT Emergency Service The Infectious Disease Emergencies of International Significance course, Menzies School of Health Research The George Institute developed by the NCCTRC during the Charles Darwin University, Northern Institute Charles Darwin University, School of Health height of the Ebola virus epidemic in West 780 792 1188 1030 1001 Africa, demonstrated that the NCCTRC Flinders University, School of Nursing and in in in in in field hospital could be configured as a Midwifery 2010 2011 2012 2013 2014

11 12 Final Report July 2010 to June 2015 Final Report July 2010 to June 2015

Section 8 NCCTRC Strategic Plan July 2015 – June 2019 Annex A-B

Our Vision: EXCEED and engage Continuous Quality BUILD a highly skilled and culturally Annex A – Published Articles Improvement practices for internal and sensitive workforce. Equipped, Prepared and Ready external systems and processes. » Strategically recruit, develop and retain Our Mission: » Develop, document and review a culturally safe and highly skilled Annex B – Performance against Key internal and external Centre clinical workforce. Performance Indicators (KPIs) Innovate, collaborate and coordinate to and corporate governance reporting » Implement annual learning programs deliver Australia’s health emergency and mechanisms, systems and processes to create a team and leadership culture medical response capability. on a six-monthly basis. across the centre. » Undertake rigorous CQI practices for » Build relationships, rapport, share Strategic Goals and all activities and exercises to ensure knowledge and limit silos through best practice and achievement of key Key Actions: interactive communication practices objectives. and processes. DEPLOY for sudden onset disaster and » Strengthen accountability in clinical medical emergency responses in austere and corporate governance through SAFEGUARD ongoing future viability. and resource poor settings. adherence to delegations and Centre » Constantly explore and examine » Diversify capability and capacity to reporting mechanisms. national and international models deploy to a range of health emergencies of practice for disaster and medical including public health emergencies. DRIVE and lead professional standards. emergency response capabilities to » Continually strengthen and support the » Engage in the promotion, remain “cutting-edge” and relevant. reduction of activation times. implementation and training of » Maximise sustainability through standards for disaster medical efficient use of resources and sourcing BUILD Northern Australia’s surge team deployment in regional and new innovative revenue streams. capacity for trauma and disaster events international forums. of significance. » Deliver operational, tactical and » Drive the development of a robust, strategic advice on capability and Territory-wide Trauma system. professional standards to Australian Government for all aspects of Foreign » Provide clinical / ancillary staff and Medical Team deployments. infrastructure to RDH to facilitate surge response and readiness. LEVERAGE relationships locally, nationally » Build capability within the health and internationally to enhance medical system to enhance clinical service disaster and health emergency response delivery relevant to trauma and capabilities. disaster care. » Develop, foster and maintain collaborative and strategic partnerships CREATE opportunities arising from unique underpinned by appropriate formal training, research methodologies and agreements. content expertise. » Build, test and improve relationships » Develop, protect and promote our with key partners in deployment and unique training methodologies, IT trauma care using joint training technologies, databases and content exercises. expertise. » Provide national focal point for » Create a Centre for Operational AusMAT and strengthen working Research that implements innovative relationships with Australian findings to enhance the capacity to Government, State and Territory deliver patient care and staff wellbeing agencies involved in deployment. in the field. » Profile, publish and promote Centre deployment, development, training and research capacity to boost relevance nationally and internationally.

13 14 Final Report July 2010 to June 2015 Final Report July 2010 to June 2015

Annex A Annex B Performance Indicator 1 Performance Indicator 3 » Read D, Holian A, Moller CC, Poutawera » Brearley M, Norton I, Kingsbury D, Achieved Achieved Published V (2015). Surgical Workload of an Maas S (2014). Responses of Superbike Performance Australian Foreign Medical Team after Riders to Racing in Tropical Conditions. NCCTRC is ready to respond to a major The number of NCCTRC suitably trained Typhoon Haiyan. Australian and New International Journal of Sports incident in the region – regional and operational personnel with appropriate Articles Zealand Journal of Surgery. In press. Physiology and Performance. 9(5): against Key Royal Darwin Hospital (RDH) emergency experience, emergency medicine and 887-890 management plans, business continuity trauma skills is equal to or greater than in » Brearley M, Norton I, Hutton M, Rush plans and the NCCTRC Notification and 2008/09. D, Smith S, Fuentes H (2015). Urban » Walker A, Driller M, Brearley M, Performance Activation Protocols are maintained and Search and Rescue Operations in Argus C, Rattray B (2014). Cold water Over the 2012-2015 period, the NCCTRC reviewed annually. Tropical Climates. In Rumsewicz immersion and iced slush ingestion has delivered an average of 118 training M (Ed),’Research forum 2014: are effective at cooling firefighters Indicators The NCCTRC leads or contributes to the days per year to 1,073 participants, Proceedings of the research forum at following a simulated search in a hot following plans: exceeding its expected KPIs of 81 training the Bushfire and Natural Hazards CRC environment. Applied Physiology, days and 695 participants by around 50%. » NCCTRC Activation Protocol and AFAC conference’, 2 September Nutrition and Metabolism. 39(10): 1159- (KPIs) 2014. Wellington, New Zealand. 1166 » Greater Darwin Region Medical Group Plan » Oppermann E, Spencer M, Brearley » Elgendi M, Norton I, Brearley M, Performance Indicator 4 M (2015). Emotional Athletes, Abbott D, Schuurmans D (2013). » Executive Leadership Team Achieved Brainy Workers and other Hot Systolic peak detection in acceleration Business Continuity Plan At least one NCCTRC response exercise is New Developments: Multiple (re) photoplethysmogram measured from » Royal Darwin Hospital External conducted annually. problematizations of Heat Stress as emergency responders in tropical Emergency (Code Brown) Plan – an object of governance in northern conditions. PLoS One 22 8(10): e76585 In addition to deployments, the NCCTRC Mass Casualties Australia. International Journal of employs a living exercise regime that » Brearley MB, Heaney MF, Norton IN Learning in Social Contexts. 15: 32-39 » Royal Darwin Hospital External incorporates structured drills and also (2013). Physiological responses of Emergency (Code Brown) Plan – maximises the learning potential of live » Gowing CJ, McDermott KM, Ward LM, medical team members to a simulated Tropical Cyclone activities. Martin BL (2015). Ten years of trauma in emergency in tropical field conditions. the ‘Top End’ of the Northern Territory, Prehospital and Disaster Medicine » Emergency Incident Management » Tour de Timor- (2012 / 2013 / 2014) Australia: A retrospective analysis: 28(2): 139-44 System EIMS provision of lead medical support and International Emergency Nursing. utilised as a training opportunity to test » Brearley M (2012). Crushed Ice » NT Health Ebolavirus Preparedness L3(1): 17-21 International logistic capabilities Ingestion – A Practical Strategy for Guideline » Coatsworth N (2014) The Australian Lowering Core Body Temperature. » Princess Alexandra Hospital Activation medical response to Typhoon Haiyan. Journal of Military and Veterans Health Exercise Medical Journal of Australia 201(11): 20(2): 25-30 Performance Indicator 2 » Medical Support to the V8 Supercars 632-634 Achieved Event Darwin Completion of annual assessment of » Tactical level desktop exercises NCCTRC current and future human of the Greater Darwin Region and resources and critical infrastructure surge Royal Darwin Hospital disaster and capacity. emergency management plans The NCCTRC monitors human resource » Maningrida Trachoma Program requirements on 3 levels: April 2012 » Internal – NCCTRC FTE requirements » AusMAT Surgical and Anaesthetic and allocations within the Centre are Course (18th Aug 2014) – full set-up of determined as per strategic plan AusMAT surgical suite and training of surgeons and anaesthetists in austere » External (NT Health) – NCCTRC funds medical practice $5.7 million, equivalent to 38 FTE, within Royal Darwin Hospital as surge » AusMAT Ebolavirus Simulation capacity for disaster and mass casualty Exercise (14th Nov 2014) - full set-up of events AusMAT field hospital as an Ebolavirus Treatment Unit » AusMAT – NCCTRC governs the AusMAT database and holds the Deputy Chair » Tactical Response Group Training and of the AusMAT Working Group that Simulation (1st Dec 2014) – exercise of determines AusMAT Human Resource TRG medic capability subsequent to a Priorities field medic training exercise supported by the NCCTRC »

15 16 Final Report July 2010 to June 2015 Final Report July 2010 to June 2015

Annex B

Performance Indicator 5 Performance Indicator 6 » GDRMG Greater Darwin Region Achieved Achieved Medical Group Collaborative relationships with local, NCCTRC provides input into the » AusTQUIP Steering Committee member national and relevant health organisations development and review of national (including response counterparts) are response protocols. » RACS Vice Chair of Military section established and maintained to enhance » RACS Disaster Preparedness the NCCTRC’s role as the northern As part of core business activities Sub-Committee member Australian hub of disaster response. The the NCCTRC maintains membership Department of Health is informed and, of committees/working groups that » RACS Trauma Committee NT where appropriate, involved in work with may attribute to the review of national Regional Chair other Australian Government agencies response protocols and contribute to » RACS Senior EMST Instructor and international organisations or relevant policy development. & Director countries. In addition the NCCTRC conducts research activities that upon publication » RACS Senior EMST Coordinator The NCCTRC is engaged and partnering can influence or better inform national » RACS Trauma Verification with a series of key health organisations response protocols decision making Sub-Committee and stakeholders: processes. » RACS Member Trauma Verification » NZ Health Department of Working Groups: Site team Emergency Management » AusMAT working group and » RACS EMST ADF Board member » World Health Organisation Global subcommittees Emergency Management Team » RACS Trauma Verification sub-committee » ASEAN Military Medicine Group Committee membership: » Queensland Health Counter » AHPPC (Australian Health Protection Disaster Unit Principal Committee) – Member » 1 Brigade Australian Army » NHEMS (National Health Emergency Performance Indicator 7 Management Standing Committee) Achieved » Northern Command, Australian Defence Force » AusMAT Working Group – Deputy Chair As a member, participate with the Australian Government Department of » US Marine Corps » MIMMS (Major Incident Medical Health and other jurisdictions on the Management and Support) - Member » Australian Trauma Quality Improvement Australian Health Protection Principal and Secretariat Program (AusTQUIP) Committee and that National Health » DSTC (Definitive Surgical Trauma Emergency Management Sub-committee » Sanglah Hospital, Bali Course) Instructor & Sub-Committee to ensure a consistent, strategic and » Ministry of Health, Timor L’este effective response to national health » CENA (College of Emergency Nursing emergencies. » Flinders University School of Nursing Australasia) Senior Trauma Nursing Program Coordinator » World Association of Disaster and The NCCTRC has a 100% attendance and Emergency Medicine » AusTQUIP Trauma Quality Systems participation at both AHPPC and NHEMS. Working Group member » Pasifika Medical Association » SJA (Saint Johns Ambulance) NT » State and Territory AusMAT Quality & Clinical Governance jurisdictional focal points Committee member

Overall project budget (in $ 000)

2010-11 2011-12 2012-13 2013 -14 2014-15 TOTAL

14 212 14 481 14 756 15 007 15 307 73 763

17 18