The smell of smoke in the ED: reflections on bushfire season
As we swelter through another summer, YourED reflects on the impact bushfires can have on the entire community, and the medical professionals working in emergency departments across Australia and Aotearoa New Zealand.
When this personal account from the YourED archives was first published in 2020, it was a time before the impact of the COVID-19 pandemic, when Australia was just beginning to recover from its most recent bushfire crisis – a months-long event that killed 33 people, destroyed thousands of homes and caused an estimated three billion native animals to perish or be displaced.
FACEM Dr Michael Hall remembers
Dr Hall is a Senior ED Specialist and DPET at Canberra Health Services. He has a keen interest in clinical leadership, toxicology and searching out the grey among the black and white.
Dr Hall spoke to YourED about his experience in the Australian Capital Territory during the bushfires across the summer of 2019 –2020. This is his firsthand account.:
November 2019
Emergency Department (ED) life is normal. That is, it’s a cluster of unwellness and undifferentiated problems, cloaked in the wrapping of National Emergency Access Targets (NEAT), Australasian Triage Scale (ATS) performance, did-not-wait (DNW) rates, access block and admission processes. It’s hard to sort what matters to us, to the patients, and to the hospital. So … normal.
December 2019
The east coast is on fire. Fires in Queensland, fires in New South Wales. I find myself fascinated and horrified all at once. The scale of the flames, the tireless efforts of the firefighters, the disruption to communities. But it’s abstract, distant. Normal life in Canberra ED is unchanged. The ground is brown and dry, the garden is parched, and the creeks are empty, but life is normal. Patients everywhere, flow challenges, teaching sessions, Christmas parties. Most people seem unaffected by the flames around Braidwood on the distant horizon. We sympathise with our registrar who has a property there and sends us pictures from his deck. We listen as the firefighters work to save Bawley Point. For some of us, there’s this little niggle. A feeling that maybe this summer is different. A tipping point.
The smoke has come. The mountains have vanished. The sunsets are beautiful, but everything is covered in a mild haze. The hot north-westerly wind will blow it away, but the normally restorative sea breeze brings it back every afternoon. We think it’s bad, but we don’t know what the next month will bring. There’s discussion about air purifiers and the safety of exercise, but most people shrug and continue.
“‘The hospital should be a refuge, a place of sanctuary, but although there is no direct threat, nothing in Canberra feels like that anymore.’”
We travel to Tasmania. It’s green and beautiful, and the air is so clean. We sleep deeply and imagine we live in a time when smoke and fire weren’t part of summertime life. We see the forecast of multiple 40 degree-plus days in Canberra, and wonder whether our clean, beautiful city can manage this. We get home to baking heat, relatively immune to the smoke haze due to the winds. Canberra’s hottest day, twice in a row, and the fires creep closer, and time passes.
It’s Christmas Day. We go for a picnic at Honeysuckle Creek in Namadgi National Park. It was closed for the heatwave, but it’s cooler now, although still surrounded daily by dense smoke blown from the coast. All campgrounds are closed but we sit in the picnic area as the only visitors that day wondering again, if something’s changed. This place housed the telescope that beamed the pictures of the moon landings, but now it’s all about the curing levels of the grasslands, the prevailing winds and the air quality. We get used to barely being able to see the local hills, but life continues, still unchanged. The hospital is quiet, with Canberrans escaping to the coast, or to the mountains.
It’s New Year’s Eve. The warnings are off the scale. There are catastrophic fire warnings for the coast, and the mountains, and in a lot of places. There are no fires near Canberra, but people start to prepare. Queues at the petrol station, bottled water being sold by the pallet. And it starts. Reports from Bateman’s Bay, Mallacoota and the Snowy Mountains. A cacophony of noise, with traditional media lagging way behind social media sites. It’s impossible to take your mind off it. We hear, read and watch, as peaceful, relaxing communities become chaotic places battling for survival. We wonder and worry for our rural colleagues, and find ourselves looking for something we can do, while struggling to do the often mundane daily things we must do.
In Canberra, it’s extreme heat, but a relatively clear sky. New Year’s Eve fireworks are cancelled, like much of the east coast, and people are staying in a bit more. There is a cool change forecast, with warnings that the smoke may be stronger. A bit thicker. The change comes. The clouds of thick smoke roll across the city like dust storms in the desert. For five minutes, there is a cool breeze with a towering wall behind it, then it sweeps across. It is thick and acrid, and smells of ancient forest and climate calamity. Eyes water, throat burns, and driving home is like the thickest winter fog, punctuated by eerily silhouetted kangaroos desperately trying to find green grass. In the morning, the city is uniformly grey, and almost silent, except for the queues of people trying to visit a shop for the long sold out air purifiers that most people didn’t think they could ever need.
“‘Everyone seems to have a story; a need to tell, to share and just be there with each other.’”
The hospital smells. There is smoke everywhere, even in resus. This is NOT normal. The hospital should be a refuge, a place of sanctuary, but although there is no direct threat, nothing in Canberra feels like that anymore. There is confusion. Some staff wear masks, patients request them, the public present to triage asking for them, or taking them from the bench and leaving. The calls start to come. Transfers, advice, a slight sense of desperation. Knowing that there is a much bigger story than ISBAR (clinical handover tool) can hope to convey.
Structured handover somehow doesn’t seem enough anymore. You feel as though you must open the conversation to enable them to share the experience. Logistics of moving patients through fire zones and closed roads means long waits and incredible work done by rural communities. One of our consultants needs a police escort to get his coastal ED to work. We put together emergency burn and dressing supplies for a rural hospital that’s run out.
The world calms. Smoke, closed roads, local stories of crisis and drama, without specific challenges. Life becomes a cycle of smoky days and tracking air quality measures. Everyone seems to have a story; a need to tell, to share and just be there with each other. Normal patient care happens, but other things seem somehow less important. The pub is busy, the walking trails almost deserted. It’s a warm afternoon, but not crazy. I sit in an office on Level 10, the mountains sunburnt but beautiful on the horizon. It’s clear for a rare change.
The world changes. A puff of smoke, frail initially, then bigger. Within two hours, there’s a billowing column filling part of the sky. The wind picks up. The inferno that will destroy the natural wonders of the ACT cannot be stopped. We pause, with an inner gasp, and a sense of foreboding. The fire has come to us. For some, the weeks of smoke and fire smells has slowly built to a sense of overwhelming anxiety. For some, this has happened before.
January 2003
A younger version of myself drives over a hill. In the distance, you can see the billowing smoke in the mountains. A huge fire front about 30km long sits in the distance. It’s been there for days. The city watches and barely notices as day-to-day things happen. This is scary, but it cannot affect us. The wind howls. It feels wrong, but we don’t yet know what the day will bring.
My family and I go to the movies. When we leave, the world is different. It’s pitch black at 2pm. There are flames on top of the local hill, in the middle of the city. There is a gasp from the crowd, no one seems to know what to do. I ring the hospital to see if they need help. No, it’s fine they say. I head home, constantly scanning the darkening sky. The air is full of sparks and ash. There is no power to our suburb and a mere trickle of water from the taps and hoses.
We grab our most precious possessions (and argue about whether the extended edition of Lord of the Rings and new DVD player can really count) and leave for the only place of safety we can think of, the hospital. The traffic lights are out. There are fires in the suburb, but we escape to the same Level 10 office that I will sit in 17 years later, watching the world explode again. The code brown goes off — external disaster — and I head down to the ED to help. It’s chaos, yet amazingly calm.
The sickest patients arrive in the first five minutes by private car, and then we just have what seems to be suburbs full of people with sore eyes, breathing problems and minor fall injuries. I call Sydney to try and organise a transport out for a patient with paracetamol toxicity and established hepatic failure. The Sydney call centre states, perhaps ironically, ‘You do know that Canberra is on fire, right?’
“‘There is the feeling that this can, and will, happen again, and that we have to consider our place and our practices in this changing world. I think it has drawn the ED community, the hospital and the city closer together.’”
The 2003 fire was sudden, dramatic and entirely unexpected … but it was quick, and it came and left. The 2019/2020 fires just festered, and grew, and inexorably expanded until lives were filled, resilience sapped, and normality was rewritten. 2003 was more dramatic for Canberra itself, but somehow, for the hospital at least, infinitely more manageable.
January 2020
The Orroral fires have only been burning for hours. We sit on the ridge behind our house, watching towering columns of smoke. The darkening sky reveals the extent of the flames on the local hills. So close, yet just out of reach. We watch the tiny firefighting aerial team, seemingly powerless against the monster. For days, we see the ebb and flow of the smoke and the flames, as it expands, and crawls along the ridge, seemingly in all directions at once. Could it reach into the city again? Are we more prepared than last time? The inattention of 2003 has been replaced with an obsession with detail; fire updates and endless management briefings. We have plans, and subplans, and master plans, but who knows. A simple look at the horizon tells us the power of this thing. If it comes into the city, is a plan going to stop anything?
Late February 2020
The Orroral fire is declared out! Such a simple word, but so powerful. For now, the fire has gone. But more than 50 per cent of Namadgi National Park is destroyed and it will be months before it reopens. The majority of the historical and tourist sites have been protected, but the bush itself, the animals, and the water catchments, are damaged to a degree that would never have been thought possible.
This event has been unprecedented for us. As a city, and a department, we have survived pretty much entirely unscathed. While thousands around the country have lost homes, and countless families have lost loved ones, we have sat in our modern city, with power, air conditioning and running water. But we have also lost, and we are changed. The feeling is tiredness, exhaustion and perhaps resentment at a summer stolen. There is the feeling that this can, and will, happen again, and that we have to consider our place and our practices in this changing world. I think it has drawn the ED community, the hospital and the city closer together. This is not just a place of work, but a place of safety, fellowship and sanctuary for us, and for the people and patients from the surrounding region. It has shown again that emergency medicine is more than KPIs; it is a collection of stories. Our stories, our patients’ stories and our families’ stories.
March 2020
ED is again a cluster of unwellness and undifferentiated problems, cloaked in the wrapping of NEAT targets, ATS performance, DNW rates, access block and admission processes. So … normal?!?
