Paper cups for spacers, oxygen from dive shops

Dr Jacqui Brown (left) and St Johns Ambulance staff in Merimbula.
Dr Jacqui Brown (left) and St Johns Ambulance staff in Merimbula.

Story courtesy of the Royal Australian College of GPs

New Year's Eve mega fires near Mallacoota, Victoria, forced thousands of holidaymakers and locals onto the beach as a last refuge.

The intensity and speed of the fires was staggering - far worse than predicted - and they soon surged north, towards popular tourist towns in New South Wales.

People in Eden sheltered on the wharf as the town's chip mill caught fire.

In Merimbula, local GP Dr Jacqui Brown and her colleagues prepared for the worst.

"We were lucky - we got two days' warning. We had a little window to do something," she said. But do what? As the conditions worsened, the hoped-for help from St Johns Ambulance did not eventuate.

Attempts to land more medical personnel by air failed. That left the doctors and nurses of Merimbula on their own. And the number of patients was growing. More than 1400 people sought refuge in the town after it was designated an evacuation point.

At first, Dr Brown - who is an RACGP medical educator - dashed to the local emergency department to help. But patients were too scared to drive, with an 85km firefront moving towards them.

As the GPs ran out of asthma spacers, they made do with paper cups.

Though the fire never reached the town, the smoke and ash turned day into an eerie evening. There had to be something else Dr Brown could do. So she set up a WhatsApp group for the town's medical staff: 10 GPs, seven nurses and three pharmacists, as well as interns and a psych nurse.

"That was the best thing I did. It meant we could coordinate everyone," Dr Brown said.

Evacuees flooded into Club Sapphire. Two more sites had to be found as people just kept coming. That meant Merimbula's GPs and nurses had to find a way to cover the three sites.

The town's medical staff deliberated through their group chat and decided the bowls club was the best location for their main makeshift clinic. They would deploy nurses at the other sites to triage patients. They could then use the club's courtesy bus to pick up patients and bring them to the main clinic if needed.

The GPs pooled their supplies and brought down boxes to the club. Oxygen, asthma spacers, resuscitation drugs. They then set up their main clinic, guided by an emergency department nurse. But the sheer number of evacuees soon overwhelmed their resources. It was time to think creatively.

As the GPs ran out of asthma spacers, they made do with paper cups. When the oxygen ran out, they sourced more at the town's dive shop. Dr Brown's brother, a gas plumber, also offered oxygen. When diabetes medication ran low, they used the loudspeaker to ask if anyone had some spare.

"We had to be resourceful," Dr Brown said. The GPs and nurses worked tirelessly for four days. Ambulances would come if needed, but the wait could be significant. They treated asthma and respiratory conditions, chest pain, fractured arms and strokes, and consoled people grieving the loss of their homes.

Many came seeking relief from the ash and debris stuck in their eyes. But the most common issue - by far - was anxiety. People were spooked. No one knew what was happening, or whether they would be safe.

"People were having panic attacks. It was smoky and awful, so people were distressed," Dr Brown said.

The club's TVs were tuned to live broadcasts of the fires. The doors of the club were automatic, meaning they would open hundreds of times a day, letting in new drafts of smoke.

"I said, let's turn the TVs off and just have one in the corner down low," Dr Brown said.

"We sat people in front of a pedestal fan to give them fresh air and ice to chew.

"We were calling it infectious calm - we were trying to calm people down. GPs are good at this. A lot of these people we knew, so having a familiar face was helpful."

The days and nights passed in a blur. A new challenge presented itself two days in. Several people who were regular users of alcohol or other drugs showed signs of agitation without access to their drug of choice.

"We had to get the police to come and be a presence, with people getting a bit rowdy. That was so helpful," Dr Brown said.

The shire's mayor decided to move the people living in two outlying aged care homes to a third in a safer location. Those who could not fit had to be housed at the bowls club. The medical team laid out mattresses on the floor behind the makeshift clinic, which a nurse staffed full-time.

People were having panic attacks. It was smoky and awful, so people were distressed

Dr Jacqui Brown

The medical team rotated every four hours in an effort to reduce the possibility of burnout or error, allowing everyone the chance to head home to help their own families.

"We were going hard and conditions were pretty terrible, so the four-hour shifts were a good idea. It was pretty taxing," Dr Brown said.

On January 6, conditions improved enough to let St Johns Ambulance access the town at last, allowing the medical team a break and bringing in fresh supplies. The next day, with the fire weather temporarily easing, most of the evacuees left, heading back to the relative safety of Sydney or Canberra.

That meant the evacuation centre could be closed.

"Evacuating all tourists was a really good decision, because it freed up local holiday accommodation. That meant people who have been displaced or lost their houses have places to go," Dr Brown said.

Owners of holiday houses and motels have opened their doors to those who have lost everything.

"The town has been fantastic," Dr Brown said.

But this year's unprecedented rolling fire season means Merimbula's GPs cannot relax yet. The evacuation centre reopened in recent days ahead of more danger.

"It's expected to pick up [Friday], so the centre will be on standby," Dr Brown said.

This time around, Dr Brown and her colleagues will make a few changes based on what they learned from their first experience of such a disaster. "When registering patients, we forgot to ask their regular doctors," Dr Brown said.

"The next time, we'll take down their regular doctor and make a photocopy of the notes to give to the patient as well."

The Merimbula team is also planning to buy satellite phones in case they lose mobile coverage, as has happened in other fire-stricken towns.

For GPs in other towns that may be affected, Dr Brown recommends setting up a group chat as a way to quickly coordinate action.

"Using the app worked really well to facilitate communication. Other towns could be prepared for this by setting up a group ahead of time," she said. The experience is something Dr Brown will always remember.

"This is the first time I've seen anything like this. It's an unprecedented fire event," she said.