Introduction by Croakey: As we face a future of intensifying disasters and public health emergencies, the capacity and work of the Australian Medical Assistance Team (AUSMAT) will become ever more important.
Below, experienced AUSMAT personnel share some insider perspectives on their work, following presentations at the recent Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) conference.
The annual conference for radiographers, sonographers, radiation therapists, nuclear medicine practitioners and the wider medical radiation sciences community was held from 9-12 May on Larrakia Country in the Northern Territory. Marie McInerney reports for the Croakey Conference News Service.
Marie McInerney writes:
For radiographer Tom Randell, deployment to the Philippines in 2013 to assist with the shocking toll of Typhoon Haiyan felt like his many years of working in the Royal Darwin Hospital Trauma Service “got condensed into two weeks”.
“Suddenly you see more injuries than you’ve ever seen,” he told the recent 2024 ASMIRT conference, in a keynote speech titled, ‘From typhoons to measles – an AUSMAT radiographer’s experience’.
Randell has served five overseas missions with the Australian Medical Assistance Team (AUSMAT). Known as “the SAS of the medical world”, it’s Australia’s multidisciplinary healthcare team which is deployed in response to national or international disasters and emergencies. It is based within the National Critical Care and Trauma Response Centre (NCCTRC) in Darwin.
Since being set up in 2010, in the wake of the 2002 Bali bombings and the 2004 Boxing Day Tsunami, AUSMAT’s teams have undertaken 36 deployments, including 26 during the COVID-19 pandemic.
Disaster threats
Randell’s colleague, Abigail Trewin, NCCTRC Director of Education and Academic Partnerships, also spoke to the opening plenary of #ASMIRT2024, which brought together medical radiation science practitioners from across the country to Darwin, on Larrakia Country, for three days.
Trewin quoted former Indonesian President Susilo Bambang Yudhoyono as saying the Asia Pacific represented “the supermarket of disaster”.
“If you can imagine it, it can happen in our region and the population and the density and the challenges that presents is extraordinary,” she told delegates ahead of a site visit to the NCCTRC, which highlighted the role of radiography in national and regional disaster and emergency work.
The demand is not subsiding. Asia and the Pacific suffer from more natural disasters than other developing regions and nowhere on the planet is the escalating threat of climate change-induced disasters greater than in the Asia Pacific, according to the UN’s Economic and Social Commission for Asia and the Pacific.
Climate change also heightens the risk of infectious diseases like COVID-19, with the pandemic prompting a huge surge in AUSMAT’s missions nationally and regionally, with deployments “to the trickiest or most wicked COVID problems”.
AUSMAT’s teams were marshalled in the earliest and riskiest days of the pandemic to make multiple flights to China to repatriate Australians from Wuhan, the epicentre of the virus, and managed the deadly and highly political outbreak on the MV Artania cruise ship off the coast of Western Australia in 2020.
AUSMAT also set up and ran the Howard Springs COVID-19 quarantine facility in Darwin. Its teams were deployed to Melbourne’s aged care homes as COVID-19 took a serious early toll in Victoria, and to Fiji, Papua New Guinea and Timor Leste when local services were under pressure.
The pandemic cumulatively served as “the biggest example of why you have an asset like this…so you can do the things that other health systems perhaps aren’t able to do right now,” Trewin said.
Other public health emergency missions have ranged from a 2013 outbreak of trachoma in Maningrida in Arnhem Land to the 2019 major measles outbreak in Samoa, which resulted in 83 deaths.
“There’s the assumption that we’re just here to do disasters with traumas,” Trewin later told Croakey.
“We’re not. When we do a response, it has to be an integrated [one] so we really look at everything from the local population we are serving, to the health facilities we are supporting, right through to waste [generated], and ensuring we report back appropriately to the Ministry of Health that’s impacted so they can make meaningful decisions about what to do next,” she said.
Public health “is incredibly important to us,” she said, foreshadowing a major announcement in the coming months about building public health capacity across the Asia Pacific. “Watch this space,” she said.
See this interview with Trewin at the NCCTRC.
Some history
Outlining the origins of AUSMAT and the NCCTRC, Trewin said Australia sent medical support to the devastating 2004 Boxing Day tsunami, putting together civilian teams that “scrabbled together equipment, supplies, whatever they could find from their local hospitals”.
Many lessons from that experience framed the direction Australia later took, as did the Bali bombings in 2002 when the Royal Darwin Hospital did “extraordinary work”, treating 77 survivors with critical injuries, 55 of them with major burns, she said. It was a “miraculous” response, considering the size of the hospital and the infrastructure available.
But the fact that it took 20-plus hours to retrieve patients, when Bali is less than three hours away by plane, prompted then Prime Minister John Howard to order a national capability “to do this better”, which ultimately evolved into AUSMAT and the establishment of the NCCTRC, she said.
Beginning with just one shipping container worth of resources, AUSMAT now can set up field hospitals with paediatric, adult and surgical wards and, a six-bed intensive care unit, mainly for respiratory care.
AUSMAT teams may also play an advisory role to a host nation or another emergency management team, with much work also invested in upskilling local staff in regional countries, recognising that the impact of disasters continues beyond emergency responses.
NCCTRC is federally funded under an agreement between the Northern Territory and Federal governments. Last night’s Budget allocated $55 million over three years, to “allow the NCCTRC to maintain the staff, equipment and resources needed for 24/7 peak preparedness”.
In an earlier announcement of the funding, Butler noted that the NCCTRC is a specialist trauma medicine hub for northern Australia. It provides an injury prevention program in the Northern Territory, trauma and disaster research, and education for clinicians across Australia, South East Asia and Pacific countries.
About 70 percent of the NCCTRC’s funding invests in AUSMAT capability, Trewin said. “We train large numbers of Australians within the health system to be ready to go. We innovate and develop new equipment to ensure what we do is appropriate and fit for purpose,” she said.
That innovation has seen AUSTMAT build its own water filtration systems to standards sufficient to be able to use in surgery if needed and the capability to “make our own oxygen in the field”.
Sign up
Trewin invited allied health professions to sign up to AUSMAT’S database — but with caveats, as she described the organisation’s exacting, military-like recruitment processes, particularly a psychological personality test looking for team spirit.
“It’s not a reflection on whether you’re great at your job,” she said, “it’s a reflection on whether you will play well in this team and whether you are suitable to work in the environment we’re sending you into because we have mental health as a key factor to think about, and resilience is a really important element of these types of responses.”
All applicants, from surgeons down, get tested for their willingness to wash floors, empty the waste, build field hospitals, and multiple skillsets are highly valued. This weeds out both “princesses” and “one trick ponies”, she said. Logistics personnel are rated as among its most important team members and, despite some of the physical challenges, maturity is preferred.
“Forty is good, 40-plus is even better,” she said. “We want five years postgraduate experience, preferably, which means we’re all older, maybe a little crankier. But it brings a wealth of experience to the table. It also brings, we find, a calmness — most people have had of enough life experience to know when to react and when not to.
“It makes a big difference to the team and the team morale. Teams are not just about the skills you bring. It’s about your personality,” Trewin said.
“You could be the best surgeon but, if you’re a rubbish team player, AUSMAT is not for you.”
Training matters
The military approach also applies to training: “We train as we mean to deploy,” says Trewin.
That can see trainees ‘ambushed’ by Tactical Response Group officers, “because we know from Chechnya and other UN events that people not exposed to the reality of what they may face will have terrible mental health outcomes, so we show our people how bad it could get and then put in the systems to protect them as best we can.”
The point is it allows would-be team members to ask themselves: “Do I want to do this? Am I up for sleeping in the dirt, crappy showers, terrorising events, huge stress levels, ridiculous heat?” And if they say yes? “AUSMAT is for them,” she said.
For Tom Randell, who had specialised in trauma and emergency radiography, it was a resounding yes. “A challenging work environment is great. That’s when you can do your best work, I feel.”
He told the conference about his first deployment to the Philippines, where a fishing village had been washed away and 15,000 people made homeless overnight. Many had “really traumatic injuries” caused by flying debris, compounded by lower nutrition levels that meant reduced bone density.
Another harrowing deployment was the measles outbreak in Samoa, where, in the pouring rain, the AUSMAT team built a neonatal ICU in the carpark of a hospital.
With a total population of just over 200,000 people, the country suffered 5,707 measles cases and 83 measles-related deaths — 87 per cent of them reported as children younger than five years. It was, he said, “really tough and draining on your emotions” to see so many very sick children, with measles attacking the immune system and making infected people susceptible to many infections.
Randell’s most recent role was supporting a national tuberculosis (TB) surveillance prevalence study in Timor Leste in 2023, led jointly by the Menzies School of Health Research with the Timor Leste Ministry of Health.
Timorese members of the Menzies team, Jorgelino Guetteres, Deonizio Gusamo, and Goncalo Pinto, alongside Australian colleagues Dr Chris Lowbridge and Dr Joshua Francis, presented the work at the conference, telling delegates that Timor Leste has one of the highest burdens of TB in the world, but that uncertainty around data affects planning capacity.
“Having a good grasp of the epidemiology of TB is really important,” Lowbridge said.
The small team visited 5,000 households in 50 villages, screening more than 15,000 people. It was a huge logistical exercise with some mountainous villages only accessible by foot and having no electricity. “We became very fit!” Pinto commented.
Randell’s role was to support Timorese health staff to use the equipment, including “incredible” solar-powered backpack X-ray machines that contrasted with the units he first used a decade ago at AUSMAT that were so big “they wouldn’t go in most commercial airlines”.
Watch this interview with Tom Randell
Ambitious goal
TB, the world’s deadliest infectious disease, remains a “massive problem” globally, with around 10 million new cases every year, and high numbers of death, said Francis, a paediatrician and infectious diseases specialist at Royal Darwin Hospital and Associate Professor at Menzies School of Health Research, who provided a global and local overview of the disease to open the session on ‘TB across the Timor Sea’.
Notably incidence of TB in Australia is “incredibly low, very different to much of the region around us,” he said. But not for everyone, with Aboriginal and Torres Strait Islander people particularly at risk. Incidence in Australia is around five per 100,000 people per year, while in the Northern Territory the rate is more than 10 per 100,000 with even higher rates in some remote communities, he said.
Francis is concerned that this alarming prevalence is not fully recognised in Australia, saying ongoing transmission in Aboriginal and Torres Strait Islander communities needs “really careful attention” and stronger partnerships between health services and communities to end the TB epidemic in these places.
Unlike COVID, Francis said, TB does not spread rapidly, more as a “slower grumble”, which has continued to transmit, mostly via households, “over generations and generations”. It starts in the lungs, but can spread to the lymph nodes, to bone, or to the central nervous system, and present with a myriad of different symptoms.
That means it can be difficult to detect clinically and diagnosis relies on having accurate tests — chest x-rays and the work of radiographers are critical, he said.
The World Health Organization’s (WHO) latest Results Report, showcasing key public health milestones, said 2023 saw the highest number of with TB to get treatment since monitoring began almost 30 years ago, after the first-ever all-oral treatment regimens for multidrug-resistant tuberculosis made available in 2022.
But it’s complex work, Francis said, given that TB is a slow replicating bacteria that requires a long course of treatment, usually at least for six months and up to four different medications.
The global aim to reduce TB incidence by 90 percent by 2030 is “incredibly ambitious”, he said.
“We have tools that can work, but it’s about investing in and using them as we can,” he said.
Francis also presented to the conference on the use of handheld echocardiography devices for the early detection of rheumatic heart disease (RHD), which Aboriginal and Torres Strait Islander people in the Northern Territory are at least 125 times more likely to develop than non-Indigenous Australians.
Here’s a Twitter thread of the #ASMIRT2024 opening plenary.
Read more on TB here.
Watch this interview with Abigail Trewin
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