key: cord-0050804-gxhawggh
authors: Tin, Derrick; Hertelendy, Attila J.; Ciottone, Gregory R.
title: What we learned from the 2019–2020 Australian Bushfire disaster: Making counter-terrorism medicine a strategic preparedness priority
date: 2020-09-29
journal: Am J Emerg Med
DOI: 10.1016/j.ajem.2020.09.069
sha: 4fdb71da56fb7bc43304a2ed83100aa43dc3ae38
doc_id: 50804
cord_uid: gxhawggh

nan

With over 46 million acres burnt, 5900 buildings destroyed, and over $100 billion in damage and economic costs, the Australian bushfire season of 2019-2020, also dubbed the "Black Summer", is estimated to be the costliest natural disaster in the country to date, and put an unprecedented strain on response systems. [1] In light of the strain caused by the concurrent global COVID-19 pandemic, the uniquely vulnerable Australian healthcare system is highly susceptible to strategic, asymmetrical terrorist attack, which has been threatened by some radical extremist organizations. [2] The Australian bushfires stretched the surge capacity of our fire and emergency services almost to the breaking point, and exposed weaknesses in the national healthcare system. [3] The bushfires demonstrated the significant health impacts of climate change-related disasters, that in this case included short term rises in cardiac and respiratory emergency department visits and hospital admissions. [4, 5] The longer-term morbidity and mortality impact resulting from fine particulate matter and environmental pollutant exposure is still being examined, with the subsequent societal

repercussions not yet well understood. Additionally, there are concerns that Australia does not have a national health and climate change strategy or plan. The 2019 bushfires further exposed the lack of a coordinated multidisciplinary health services approach to disaster management. The exclusion of primary care health services in the various phases of the disaster cycle, and in particular in disaster response is a significant shortcoming. [2] It is well established that natural disasters have resulted in long term mental health consequences in affected communities. It was estimated that 80% of Australians were immense strain not only on Australia's health care sector, but that of the international community. [6] As of August 2020, over 2500 Australian healthcare workers in the state of Victoria alone have tested positive for Covid-19. [7] 2020 has been an extraordinary year in Australia, as it has been around the world, not just because of COVID-19, but due to the myriad of overlapping events that have strained our response capacity. This experience has demonstrated that to function effectively, healthcare systems must balance the response to cyclical natural disasters and seasonal viral outbreaks, while also managing the daily acute and chronic traumatic and medical conditions. This leaves little room to surge in the event of a large-scale manmade disasters such as a terrorist attacks, which could be timed to exploit healthcare systems and emergency services under duress.

Terrorist attacks in Australia are relatively rare, with 37 documented attacks (over 70% were incendiary attacks targeting buildings and vehicles) in the decade between 2009-2019, however, the ongoing Covid-19 pandemic is presenting new opportunities for terrorists.

The recent call to arms by the Islamic State (ISIS) encouraging their followers to engage in bushfire terrorism is a major concern. [2] Leveraging climate change and other natural events to inflict a complex manmade disaster in a cost effective, hard to detect, and difficult to prevent way would be ideal as a terrorist methodology. A well-timed, coordinated "attack" could be unmanageable from a firefighting and emergency services perspective, and could result in significant long-term psychosocial, health and financial impacts to our society.

One of the main objectives of counter-terrorism medicine as a disaster medicine subspecialty is to consolidate the healthcare response to terrorism and be forward looking in anticipating novel methodologies that could lead to significant healthcare impacts.

[9]

The current Covid-19 pandemic and the recent bushfires have taught us valuable lessons in multi-agency coordination and disaster response, requiring us to be pro-active in anticipating future events. For terrorist events in particular, the potential cost of a reactiveonly disaster response is unacceptably high and may be at the expense of preventable deaths.

References:

Jihad by fire

Bushfires expose weaknesses in Australia's health system

Health impacts of bushfire smoke exposure in Australia

Lessons Learned from the Australian Bushfires: Climate Change, Air Pollution, and Public Health

Summer of Crisis |

Climate Council

newsGP -Why are so many Victorian healthcare workers contracting COVID-19?

COVID-19 and Terrorism. Perspect Terror