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

2. MedSTAR Emergency Medical Retrieval Overview >Multi versus Mass Casualty Events Definitions Issues >Mass Casualty Management Needs Current Capability Recent Disasters and responses Issues >Future Directions

3. MedSTAR Emergency Medical Retrieval 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. MedSTAR Emergency Medical Retrieval Asia Pacific Region

5. MedSTAR Emergency Medical Retrieval The Problem?

6. MedSTAR Emergency Medical Retrieval

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. MedSTAR Emergency Medical Retrieval 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. MedSTAR Emergency Medical Retrieval 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. MedSTAR Emergency Medical Retrieval 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. MedSTAR Emergency Medical Retrieval 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. MedSTAR Emergency Medical Retrieval 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. MedSTAR Emergency Medical Retrieval Air Medical Capabilities >Regional vs International >Rotary Wing vs Fixed Wing >Civilian vs Military

17. MedSTAR Emergency Medical Retrieval Rotary Wing Military Rotary Wing Fixed Wing Lear Jet Military Medium Transport Military Heavy Transport Speed (kph) 230300450775625800 Range (km) 7608003300481551004500 Alt (ft)10,00020,00030,00045,00030,00045,000 Stretcher Patients 212217690 ExampleBell 412NH90Pilatus PC12 36AC130 Hercules Boeing C17 Globmaster

18. MedSTAR Emergency Medical Retrieval Rotary Wing BK 117

19. MedSTAR Emergency Medical Retrieval Black Hawk

20. MedSTAR Emergency Medical Retrieval Black Hawk

21. MedSTAR Emergency Medical Retrieval NH90

22. MedSTAR Emergency Medical Retrieval NH90

23. MedSTAR Emergency Medical Retrieval Fixed Wing Pilatus PC12

24. MedSTAR Emergency Medical Retrieval Pilatus PC12

25. MedSTAR Emergency Medical Retrieval C130J Hercules

26. MedSTAR Emergency Medical Retrieval C130J Hercules

27. MedSTAR Emergency Medical Retrieval C17 Globemaster

28. MedSTAR Emergency Medical Retrieval C17 Globemaster

29. MedSTAR Emergency Medical Retrieval C17 Globemaster

30. MedSTAR Emergency Medical Retrieval Transport to the Airfield?

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

32. MedSTAR Emergency Medical Retrieval Recent Disasters and the Air Medical Responses >QLD floods – 10 th January 2011 18 dead Australia USAR >Cyclone Yasi, Queensland, Australia – 2 nd 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 – 22 nd 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 – 13 th March 2011 28,000 dead, 2800 injured USAR – US, China, South Korea, Australia, NZ

33. MedSTAR Emergency Medical Retrieval Japanese urban search and rescue team in Christchurch, 24 February 2011

34. MedSTAR Emergency Medical Retrieval

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. MedSTAR Emergency Medical Retrieval 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. MedSTAR Emergency Medical Retrieval What do we Need? International Rescue?

39. MedSTAR Emergency Medical Retrieval

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

41. MedSTAR Emergency Medical Retrieval ?

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 www.health.wa.gov.au/hpg >INSARAG – USAR Directory. http://vosocc.uncha.org/USAR_Directory Cited 6th May 2011 http://vosocc.uncha.org/USAR_Directory >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_strat egy/position_paper_civilmilitary_coordination/en/index.html. Cited 6 th May 2011 http://www.who.int/hac/global_health_cluster/about/policy_strat egy/position_paper_civilmilitary_coordination/en/index.html

43. MedSTAR Emergency Medical Retrieval