Major Incidents, Mass Casualty Incidents, Operations

Providers Respond to Tropical Cyclone Yasi

Issue 5 and Volume 36.

In early 2011, Australia witnessed some of the worst flooding in the country’s history in the southeast corner of Queensland, leaving thousands homeless and many missing or dead. In the small town of Toowoomba, people, vehicles, animals and houses were washed away by an “inland tsunami,” caused by heavy rains in the Lockyer valley. A short while later, the beautiful river city of Brisbane was devastated by the worst flooding since 1974 (see Figure 1, p. 56).

Heavy flooding soon followed in central Queensland, leaving the main highway between Brisbane and northern Queensland closed, cutting off supplies to all towns north of Rockhampton.

Just as providers began to gain control of rescue and recovery efforts, Tropical Cyclone Yasi, the largest cyclone in the history of Australia, struck the region. While Australians were recovering from the aftermath of these events, a devastating earthquake hit nearby Christchurch, N.Z.

The Bureau of Meteorology (BOM) had been monitoring Yasi in the Pacific Islands region and predicted it could develop from a tropical low into a tropical cyclone before heading southeast toward New Zealand. In the coming days, the predictions were proved correct; however, the concern then became that the storm was getting bigger and the winds were getting faster.

A question begs to be answered: How does EMS plan for events of this magnitude? Does EMS have the infrastructure and global resources to manage these incidents?

Preparing for the Worst
Disaster management plans were initiated, and the people of Queensland began to prepare. The news from the BOM grew worse. Now, not only was Yasi heading straight for Cairns, but it was predicted to rapidly gain pace and become a Category 5 storm by the time it crossed the Cairns coast (see Figure 2, JEMS May 2011 pg. 57).

A buzz of activity followed. Local and district disaster management committees initiated their disaster management plans, reporting back to the state disaster management committee in Brisbane. People seemingly appeared out of nowhere with specific roles and responsibilities; it was clear that Australians had experience dealing with these types of disasters.

The media also kept the public informed of the coming weather events, providing advice on how to prepare, where to get help and where to evacuate to, if necessary. The decision was made to evacuate local hospitals and to have empty hospitals ready in the event of mass casualties. This decision wasn’t taken lightly because the logistics and planning for such an evacuation can be costly and challenging.

Evacuation Begins
The senior management team of the Queensland Ambulance Service had the task of evacuating hospitals, retirement homes and frail care centers in the surrounding regions, and ensuring that all ambulance stations were cyclone ready. Managers and supervisors were soon busy launching disaster plans, which included arranging for additional staff and resources. Plans were made to use off-duty staff from the region and later have them relieved by paramedics from other states.

They needed to ensure that each station had a functional generator, ration packs, battery-operated lighting and additional water. The availability of fuel was also a concern, so arrangements were made with fuel stations to give priority to EMS.

The Special Operations, Mass Casualty & Planning Unit deployed its tactical support unit from Brisbane (complete with tactical medical center and supplies), and specialist response teams of paramedics were activated and deployed.

The State Operations Coordination Centre (SOCC) was activated at the Kedron Park Emergency Services Complex in Brisbane. The SOCC was still operational from the flooding in Brisbane, where the city and surrounding areas remained in the recovery phase. The SOCC made resources available to the tactical support unit so it could effectively manage the disaster.

The Queensland Ambulance Service EMS crew arrived at Cairns Base Hospital mid-morning on Feb. 1 and was sent to the Emergency Operations Center to meet with hospital management and Queensland Health (QHealth) district executives. And so began one of the largest medical evacuations in Australia’s history.

Aircraft Assistance
There was much to consider in preparation for the aircraft arrival: How many patients needed to be moved? How many could walk, and how many were stretcher bound? How many were intensive care unit (ICU) patients? How many were ventilated? How many had specific infusions? Further, were there any patients infected wtih methicillin-resistant Staphylococcus aureus (MRSA) or other infection? Did any mental health patients require police assistance?

The number and types of patients were quickly mapped out and relayed to senior managers, who communicated directly with Brisbane. EMS coordinated with additional staff and resources to assist with this evacuation as well as manage evacuations from surrounding centers and ensure patients would be received in Brisbane, all the while making sure normal day-to-day operational demands were met.

The ventilated ICU patients were pre­dominantly managed by the Royal Flying Doctor Service aircraft and were flown directly to hospitals outside the predicted cyclone path. This service employs medically configured aircraft that perform these types of transfers daily, and they were staffed by doctors and nurses. Queensland EMS ambulances transported patients from the hospital to the airport and vice versa.

The mental health patients were evac­uated by Queensland Police Service air­craft with specialist mental health nursing staff and police officers on board to detain the more dangerous patients.

Less than 24 hours were left to transport the remaining 150 patients, who were in facilities in Cairns. The distance from Cairns to Brisbane, where the majority of the state’s hospitals are located, is 994 miles, hence the need for aeromedical evacuation. Of those patients, four were ventilated ICU patients. The distance and time it would take to transport them by road would be excessive.

The Australian Defense Force (ADF) and Royal Australian Air Force (RAAF) were tasked to assist, and within a few hours, two Hercules C-17s and two Hercules C-130 aircraft were scheduled to arrive at the Cairns International Airport, staffed by military medical providers to evacuate the remaining patients. They needed specific patient requirements, so loadmasters could stock the aircraft to cater to patients’ needs and ensure the correct number of medical personnel—doctors, nurses and paramedics—were on board.

A staging area was set up at the International Arrivals Hall near the airport for patients to be held, where they were sheltered and provided with adequate facilities. The airport fire and rescue staff worked alongside volunteers from the State Emergency Service (SES) to ferry patients from the Arrivals Hall to the aircraft.

The driveway outside the staging area was wide and long enough to accommodate two lanes of traffic going back for more than three km. Ambulances lined up, dropped off patients and belongings, then returned to hospitals to collect more. The team effort from the staff at Cairns Base Hospital, the crew of more than 50 paramedics, 20 firefighters, 30 SES volunteers, 30 QHealth staff, eight airport staff, and the commanders and medical personnel from the ADF and RAAF is what made the preparation for the aircraft evacuation a success.

Four aircraft arrived to assist at around 9:30 p.m. Of the two smaller C-130s, one was configured with more than 100 seats to accommodate the walking patients that were transported by a chartered bus to this aircraft, and it was loaded in no time.

The second C-130 was configured to take a mix of walking and stretcher-bound patients. The stretchers were stacked close together, but the crews did the best they could with the time and space constraints. The larger C-17 aircraft was reserved for stretcher patients only. Ventilated ICU patients were loaded first and had special docking bays to accommodate their monitors. The military assigned a doctor and nurse to each patient, and there was no shortage of equipment, oxygen and monitors.

The loadmasters of the aircraft loaded each patient with military precision and care. Everything was tied down and had its specific place. They were responsible for safety and ensured that all operations in and around the aircraft were conducted within safety guidelines.

By 4 a.m. the hospitals were empty, and the evacuation was complete. Without the team effort of all the agencies, many of these patients would most likely not have survived.

On Feb. 2, EMS crews tried to get some rest; however, it was impossible to sleep knowing the largest tropical cyclone in the history of Australia was coming. The skies had clouded over, and although there was only a light breeze, it was obvious a rough ride was coming. Fuel stations had cars backed up for miles trying to get fuel to evacuate or diesel to fuel their generators.

The Cyclone Hits
By 7 p.m. the same day, all EMS response operations were stopped. The cyclone was due to cross the coast at 11 p.m. By this stage, strong winds were blowing, and it was clear this wasn’t a normal storm. The cyclone was 500 km wide with an eye 100 km in diameter, and expected wind speeds were up to 320 km/h. Ambulances were moved to a holding area on higher ground in Cairns, where staff and their vehicles would be safer. Providers were deployed to evacuation centers all over Cairns. By now, the wind was too strong to safely drive an ambulance without it blowing over. The warnings from the media were clear and sobering: “The time for evacuation has passed.”

As predicted, Tropical Cyclone Yasi crossed the coast at approximately 11 p.m. Crews in the direct path, 180 kilometers south of Cairns, reported hearing a noise like roaring jet engines for more than two hours before dead silence as the eye of the cyclone passed over, and then the deafening roar began again.

Queensland Ambulance Service para­medics were lucky their new Tully ambu­lance station was built to be cyclone ready. The rest of Tully, however, wasn’t so lucky. The town was completely devastated, with houses blown over, roofs blown off and power lines scattered all over the place. Large trees were uprooted and strewn about the streets. Along the coast, boats were thrown, along with floating jetties, into a heap on one side of the Port Hitchinbrook harbor and up into houses. Large luxury yachts perched in people’s front yards.

The Aftermath
It’s amazing that during the cyclone and its aftermath, not one person lost their life as a direct result, especially considering it was bigger, wider and more devastating to property and infrastructure than Hurricane Katrina. This was due to the preparedness of EMS and the Australian people, who had sufficient warning to either evacuate or bunker down. It’s difficult to imagine what the death toll would have been otherwise.

The next phase of the disaster management plan was now put into effect. In the coming days, paramedics from throughout Australia were flown in to take over the roles of Queensland paramedics, so they could go home and rest—and salvage what was left of their houses. Generators were put in place to restore power to stations; damaged vehicles were repaired and put back into service.

The military helped open roads, and cleanup crews were brought in to ensure that essential services were restored as soon as possible. Life and EMS response had to continue as it had before. Although much had changed, one thing remained the same: the commitment of Australian EMS to those who needed care and compassion. JEMS

The 411 on Cyclones
Cyclones are graded into five categories depending on wind speed and subsequent risk of damaging effects. Australian tropical cyclone categories are based on the following Australian Bureau of Meteorology data:
>> Category 1 storms have wind gusts measured at less than 125 km/h. Usually, they cause minimal house damage, but they may cause damage to some crops, trees and trailers, and watercraft may drag their moorings.
>> Category 2 storms have wind gusts measured at 125–170 km/h. They may cause minor house damage and significant damage to signs, trees and heavy damage to some crops. There may be risk of power failure, and small boats may break moorings.
>> Category 3 storms have wind gusts measured at 170–225 km/h. They may cause roof and structural damage, destroy trailers and cause power failures.
>> Category 4 storms have wind gusts measured at 225–280 km/h, which may cause significant roofing loss and structural damage, dangerous airborne debris and widespread power failures.
>> Category 5 storms have wind gusts at more than 280 km/h. These are extremely dangerous and cause widespread destruction.

This article originally appeared in May 2011 JEMS as “A Whirlwind Response: Tropical Cyclone Yasi a success story for Australian EMS.”