New Zealand’s landscape is without doubt a powerful thing. Five months ago it lured my wife Jen and I to work in the South Island as rural GPs for a year. At that time, having recently completed our MRCGP and worked in practices around South London, we could not have imagined how to apply our skills in a disaster such as the earthquake in Canterbury.
Working in a small community in Central Otago, surrounded by spectacular but rugged mountain scenery, you soon get a sense of their survival spirit. The nearest emergency department is three hours drive away and volunteer paramedics can live twenty minutes from the ambulance station.
The core ethos of our new practice is to provide quality emergency care in this environment. The practice manager is a trained paramedic and his wife, who is lead clinician, is an ex-emergency department medic. There are signs throughout the practice that a range of emergency scenarios have been accounted for, including a fully equipped resuscitation bay and stores of emergency lighting, food and water.
Brent Hollow (practice manager), Dr Peter Young and Dr Rob Visser, in Latimer Square, Christchurch
In our first week, days after the explosion at the Pike River coalmine in the North West of the Island, we were invited to the Macraes Gold Mine to hone our skills at a Pre-Hospital Emergency Care course (PHEC). There we were joined by a range of first-aiders including members of the mine rescue squad and local voluntary fire-fighters.
The focus on pre-hospital skills was in complete contrast to a recent role I had in the UK which was to develop the non-emergency skills of a paramedic on the paramedic practitioner course. It was clear from two days of moulage, where we learned how to recover patients with anything from burns to hypothermia, from mineshafts and mountainsides, that as doctors we would be looked towards for leadership in an emergency situation, even in circumstances far beyond our usual expertise.
It was only a few months later, on the afternoon of Tuesday 22 March, after hearing reports of a catastrophic earthquake, that our practice assembled an emergency response team to travel to Christchurch.
Our practice manager and a senior practitioner at the practice, who had worked for several years with the Australian Flying Doctors, led the team that included Jen, two ambulance officers and myself. We equipped an ambulance, a 4WD rescue vehicle and a response car, taking with us protective clothing, food and medical supplies. We travelled in convoy taking every opportunity to refuel, using two-way radios to communicate. After five hours driving in torrential rain we reached the city at 1am on Wednesday.
Christchurch Street near Latimer Square
We passed through army cordons, into streets littered with rubble and liquefaction, to set up camp on Latimer Square. Overnight the growing number of brightly coloured tents signified the arrival of several national and international rescue teams.
When morning came we were directed by civil defence to army medical tents just yards from the burning Canterbury TV (CTV) building. As we waited in hope that pockets of survivors would be found Jen found her first and an unenviable task of certifying bodies recovered from the wreckage. I was left to provide basic medical care and advice to ambulatory patients gravitating towards the square, some of whom were drug seeking.
In the afternoon we were redeployed to support St John Ambulance teams at the Pyne Gould Corporation (PGC) building where there was a confirmed survivor sandwiched between the second and third floors.
The Pyne Gould Guinness (PGC) building, Christchurch
We relieved a medical team that had worked through the night transferring the injured to hospital including one patient whose legs had to be amputated to free him from the debris. We spoke with families whose loved ones remained in the building as the media and even the Prime Minister gathered at the prospect of a further rescue.
Following hours of careful manoeuvring, and unsettling aftershocks, the Urban Search and Rescue (USAR) team recovered a woman, hidden beneath her desk, from a small portal in the corner of the building.
She was taken out on spine board and delivered to us so that we could assess her in a makeshift medical centre. Finding that she had no life threatening injuries we escorted her and her husband to hospital by ambulance. The USAR team searched the rest of the building but their thermal scanners and sniffer dogs signs of life. Back at the camp we were given food prepared by dedicated volunteers before getting some rest in a campervan that had been donated to us by a passer-by.
The following day on Bealey Avenue we located a large 24-hour primary care facility that needed clinical support. With a pharmacy and radiology services it was ideal to provide immediate care to the rest of the city.
We consulted with patients presenting with fractures and infections that had been untreated for two days, acute stress responses, as well as everyday general practice problems. Patients with chronic health problems, some whose regular practice was in the CTV building, needed replacement medications.
Meanwhile, the rest of the team visited welfare centres distributed at the outskirts of the city to help orchestrate medical services there. At the end of the day, feeling that we had made a valuable contribution, we began our journey home. As we travelled we were able to assist by transporting an elderly lady from a district hospital stroke unit with no running water to a rehabilitation bed in Otago.
Back in our day jobs, where we often see patients, including the lady from the PGC building and the patient recovering from the stroke, who have been exiled from Christchurch, we have been able to reflect on the unique role a general practice team can play in a disaster situation.
Being part of an emergency response team was far beyond what we could have anticipated during our time in New Zealand. On our return to the UK, although we are unlikely to encounter a disaster of this nature, this experience has highlighted the importance of preparedness. As practitioners we should give thought to how we would support our community if our existing networks, fuel supplies and telecommunications were shattered.