ISRE Report

Planning for pandemics – prehospital preparedness decades in the making

Decades of planning have informed the Queensland Ambulance Service’s robust and measured response to COVID-19, ensuring the safety of paramedics, their families and patients. Insight caught up with Information Support, Research and Evaluation (ISRE) Unit Director Dr Emma Bosley PhD to discuss the scope of work done behind the frontline.

Dr Bosley said it was no accident the QAS’s response to this unprecedented public health event has been so thorough.

“Since the mid-1990s, Queensland has endured many extreme events, from devasting bushfire seasons to the destruction caused by the 2010-11 and 2019 floods, and Tropical Cyclones Larry and Yasi - which saw the complete evacuation of the Cairns Base Hospital,’’ Dr Bosley said.

“Throughout, our expertise and professionalism in responding to major events has been honed and our service has developed a proud reputation in the eyes of the community as being highly dependable.”

Dr Bosley said, ‘with respect to this pandemic, every arm of the service has come together to seamlessly enact our contingency planning’. “From a research perspective, we’ve contributed by reviewing and preparing summaries of literature and previously completed research, including the 2008 joint publication authored by the Australian Centre for Prehospital Research (then comprising the University of Queensland and QAS) and Monash University, The Australian Prehospital pandemic risk perception study and an examination of new public health roles for ambulance services in pandemic response,” she said.

“This seminal work laid the foundations for understanding the potential operational impact during a pandemic - focusing on the characteristics, attitudes and perceptions of the prehospital workforce, and their families.

“Our early investment in that research — some 12 years ago now — helped to inform our 2020 response, tailored to understanding their perspectives and concerns, which were collated via a national survey and focus groups.

“Doing the hard yards back then with such targeted quantitative and qualitative research methods has allowed us to meet — and exceed — our responsibilities today when it comes to ensuring the safety of our personnel, and in turn, their loved ones.”

Dr Bosley said the challenge of COVID-19 tested the service’s planning and contingency strategies like no other incident in modern history.

“We have to remember, unlike a major multi-casualty incident where there’s no risk of harm to friends and family after clocking off — a novel virus such as COVID-19, particularly in its initial stages, can create anxiety for staff and community members, even with

the most stringent PPE and hygiene measures,” she said.

“That’s why our preparedness was so important to ensure the resilience of our workforce during pandemic conditions.

“In addition to being an early contributor to research in this space, over the years we’ve routinely undertaken close surveillance of emergent epidemic trends overseas, including Middle East respiratory syndrome coronavirus (also known as Mers CoV) and prepared modelling advice focusing on transmission dynamics from other biological threats including Ebola and Influenza to inform service planning.

“While COVID-19 has changed the face of daily life for our society, it’s encouraging to see such a seamless implementation of the contingencies we’ve planned and practised for, and while Australia is not out of the woods yet, it’s very reassuring to know as a service we’re well placed to continue to safeguard our staff, family members and friends, and the community as this event evolves.”

Mapping the potential impact of COVID-19 to inform prehospital demand

At the outset, the ISRE Unit simulated the epidemic trajectory of COVID-19 across Queensland, drawing on the expertise of its Cardiac Outcomes Program Research Fellow Dr Tan Doan PhD.

Dr Doan has extensive experience in mapping and modelling the impacts of infectious diseases such as Tuberculosis in some of the world’s most resource-limited countries, and hospital-acquired infections in developed nations.

“Before the declaration of the pandemic, we set about reviewing the emergence of similar scale public health crises internationally and potential operational impacts. Alternative response models were also explored and assessed taking into account Queensland’s decentralised population, age structure and health issues,” Dr Doan said.

“From there, we began tailoring our approach through the lens of the SEIR (Susceptible-Exposed-InfectiousRecovered) model — factoring in the condition’s respiratory aetiology.

“We accounted for the impact of our operational mitigation strategies and kept a keen eye on the information coming out of Australia and overseas, as well as the changing pace of the definitive care response in our state.”

Dr Doan said with coronaviruses known for their unpredictability, it was vital to consider various scenarios to cater for a range of potential impacts.

“Our models simulated a range of epidemic profiles to inform service planning — thankfully, due to the hard work of the community, we’ve been spared the impact other countries have endured,” he said.

“It’s my hope our — and my infant son’s generation — don’t have to live through another pandemic…though if we do, I have every confidence in our response model and our ability to not only thrive but prosper in its aftermath.”

Exercise Cumpston 06, a major pandemic influenza exercise was held in 2006 to test health responses set out in the Australian Health Management Plan for Pandemic Influenza. The national exercise involved all states and territories; however, Queensland (particularly Brisbane), was the focus for the operational component of the exercise. The exercise received wide national and international coverage and the lessons learned are guiding pandemic planning.