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Responding to Crisis
Sydney hailstorms: the health role in the recovery process
Lynette A Lee and Anne Collings
We highlight the involvement of community health, public health and
mental health staff in the recovery period after a natural disaster
(hailstorm and ensuing wind and rain over three weeks) which, despite
causing relatively few deaths or severe injuries, affected 20 000
families and caused damage estimated at $1.5 billion. Many families
were given information and advice, and 383 individuals were referred
for health assessment and management by doctors and other healthcare
workers over an eight-month recovery period.
MJA 2000; 173: 579-582
The response -
The hailstorm natural disaster -
General response -
Initial impact on emergency departments -
Impact on health service buildings, property and staff -
Recovery organisation -
Health role in recovery -
Lessons for the future -
References -
Authors' details
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Few residents of the east coast of New South Wales for 50 km north and
south of Sydney will ever forget the massive hailstorm on April 14,
1999, and its aftermath. The storm and the rain that ensued over the
next two weeks brought damage to roofs, windows, walls and
electricity lines, and flooded the homes and devastated the living
conditions of nearly 20 000 families. There were 61 000 insurance
claims for damage to cars, the total damage to public buildings
(including buildings owned by the Department of Health) was
estimated at $45 million, and 60 marine craft were damaged. Although
this disaster was not significant internationally in terms of lives
lost or total destruction of homes, it was the costliest disaster (in
financial terms) in Australian history, with the total bill likely to
exceed $1.5 billion.1
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In this emergency, the "all hazards" approach was used. This is a
legislated set of humanitarian tasks and management arrangements
for the civilian population for responding to and recovering from
natural and hostile disasters.2 Health services played
their part in the "all agencies integrated" response to the
event,2 being involved in the four
elements of disaster management: prevention/mitigation,
preparedness, response, and recovery. South Eastern Sydney Area
Health Service (SESAHS) undertook a key role in administering the
health response from the earliest stage, and its community health
services continued to be involved until November 1999. The
Department of Community Services, the lead agency in the recovery
effort, closed its special Disaster Recovery Centre at the end of
January 2000. In April 2000 the media reported that approximately 100
houses were still awaiting roof repairs.3
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In the afternoon of Wednesday, 14 April 1999, a storm cell formed about
150 km south of Sydney, and travelled northward along the coastline,
mostly over the sea (Box 1). Two severe hailstorms, accompanied by
strong winds and rain, hit the southern and eastern suburbs of Sydney,
the first at about 8 pm and the second about two hours later. Hailstones
up to 9 cm in diameter and weighing over 100 g caused significant damage
to property. This storm's occurrence in autumn, rather than late
spring or summer, was exceptional. In the 200 years since
meteorological records have been compiled (Bureau of Meteorology),
only five hailstorms have occurred in Sydney in April; hailstones
over 8 cm diameter were last reported in 1947.
The hail, which lasted only four hours, left homes devastated and
exposed. The State Emergency Service estimated that nearly 20 000
roofs were affected. Many tarpaulins applied to roofs as a temporary
measure blew off in high winds in the following weeks,
re-establishing the exposure, which was compounded by continuing
rain and very cold weather.
The hailstorm was considered an emergency (defined in the State
Emergency and Rescue Management Act 1989 [NSW] as "an occurrence
which endangers or threatens to endanger, the safety or health of
persons in the State . . . which requires a significant and
co-ordinated response"), and the NSW State Disaster Response Plan
(DISPLAN) was activated.
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Emergency Services | |
The emergency response was conducted within the Emergency
Management arrangements, as a combat agency managed operation, with
the State Emergency Service (SES), the NSW Police Service, the NSW
Ambulance Service, NSW Fire Brigades and Rural Fire Brigades being
mobilised immediately and over ensuing weeks as more rain fell. As the
extent of the damage became more evident, units from all over Sydney
and outside moved in to assist in the response and clean-up. Support
was also provided by the Army.
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Department of Community Services | |
In accordance with DISPLAN, the Department of Community Services
established and staffed a Disaster Recovery Centre at Randwick
racecourse, where Health staff joined with Department of Community
Services officers and volunteers from Anglicare, the Red Cross, the
Salvation Army and other agencies for briefings, debriefings and
planning of activities.
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In the first 24 hours after the storm, the emergency departments at St
Vincent's and Prince of Wales hospitals (serving the inner-city and
eastern suburbs of Sydney) registered a 50% increase in
presentations compared with the same period in 1998 and a 10% increase
over the following weekend, requiring extra staff.
There were two waves of injuries. The first included lacerations,
fractures and soft tissue injuries related to the hailstones and the
rain; the second involved injuries to people trying to repair their
properties. Three people died (one in a boat at sea, one who had a
cerebrovascular accident while in a barricaded house and one who fell
from a roof), and one person had a C6 spinal cord injury. In the first
week the hospital emergency departments gave priority to SES
workers, and treated an average of two per day. The Sydney Children's
Hospital reported one child with a soft tissue neck injury
attributable to the storm.
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Damage to health service buildings across the city amounted to
approximately $5 million. In particular, damage to St Vincent's
Hospital's roof led to the day-surgery area being closed and patients
in one ward being moved. The War Memorial Hospital at Waverley
experienced roof damage in the day centre area, resulting in
attendees being relocated to another part of the hospital for a number
of weeks.
Royal South Sydney Community Health Complex closed three-quarters
of its buildings; most have still not reopened. Many community
development and public health staff worked from home for many months;
some have now returned to their previous office space, while many have
been relocated to offices in other parts of the Area Health Service.
Darlinghurst Community Health Centre incurred roof destruction and
water damage.
One-third of the Northern Sector Community Health car fleet was
damaged. However, the fleet was reduced in size for only a few days, as
priority was given to emergency replacement of the fleet's
windscreens and windows.
Damage to the homes and cars of a number of South Eastern Sydney Area
Health Service staff compounded the stressful conditions under
which they worked in the next few weeks as workplaces were relocated
and damaged equipment was repaired. Many found themselves balancing
their work commitments to affected residents of south-eastern
Sydney against the needs of their own families for a prolonged period.
The debriefings and peer-support meetings organised at many of our
facilities were noted by staff to have been helpful. In addition,
workloads were redefined and prioritised. Some staff members were
relieved of some responsibilities and were assisted by temporary
transfers of staff from other parts of the Area Health Service. It was
noted that more "backfilling" of workers may have eased some of the
tension.
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In keeping with the recovery systems delineated in DISPLAN, in the
first week community health staff in both Sutherland and the eastern
suburbs were asked, by recovery staff (from Department of Community
Services), to see three people needing urgent nursing home
placement. By the end of that week, more referrals for healthcare
assessments, particularly of older people living alone, were
trickling in. In addition to visiting their regular clients,
community health staff saw over 300 new referrals over the next few
months.
The Health Service Functional Area Co-ordinator was asked to become
involved in the briefings at the Recovery Centre; many of the health
activities were initiated from these meetings. South East Health
staff (nurses and medical officers) attended the Recovery Centre for
prolonged periods over the next three weeks, specifically for daily
briefings and debriefings on progress in notifying residents of
available relief assistance, and for receiving referrals for health
assessments for individuals found by the Department of Community
Services' Disaster Recovery Officers during door knocking.
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Coordination |
The Health response was co-ordinated by the South Eastern Sydney Area
Health Service (SESAHS), with four-hourly discussions with the
State Health Functional Area Co-ordinator in the first few days,
reducing to daily and then weekly reports. Staff from aged care teams
in other parts of South East Health were recruited to assist in routine
activities, thus freeing up staff familiar with local resources
available in the eastern suburbs to work on special referrals
resulting from the disaster recovery.
Some of those affected by the storm lived in the area of the Central
Sydney Area Health Service (CSAHS). Liaison officers from Mental
Health and Aged Care services in CSAHS attended the four meetings held
by the SESAHS Functional Area Co-ordinator at the SESAHS Disaster
Control Centre, and they co-ordinated care for victims from their own
areas affected by the storms.
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Public Health |
SESAHS Public Health Unit medical and environmental health officers
with expertise in environmental health, food safety and infectious
diseases attended the Recovery Centre daily during the acute period.
They visited many affected homes and other premises to investigate
and advise on potential public health risks. Public Health Unit staff
prepared a fact sheet and other information for the general public,
distributed by letterbox drops, advising on simple health
precautions such as managing perishable food, wearing rubber gloves
during clean-up, ensuring tetanus vaccination status and
disinfecting areas affected by sewage overflows.
Advice was also given on environmental health issues such as checking
electrical safety, and on precautions to be taken when dealing with
broken asbestos sheet roofing and damp areas. The importance of lead
in ceiling dust and furnishings and the potential for lead exposure
among young children and pregnant women was highlighted,
particularly as carpets could not be rapidly or easily
decontaminated.
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Mental Health |
Mental Health staff (State and Area) also prepared information
sheets for the general public, volunteer staff and general
practitioners on coping personally with the hailstorms: on normal
reactions to a disaster, on positive ways of coping and when to ask for
extra help. Principles of the State health disaster response plan
(HEALTHPLAN) were followed, in that compassionate support was
provided by welfare agencies such as Anglicare and the Red Cross,
while disaster counselling was a professional responsibility which
rested with specifically trained Mental Health staff. Mental Health
staff attended the recovery centre debriefings for approximately
two weeks.
Twenty patients were formally referred to mental health services
during the first three weeks; none became long term patients.
A specific request for assistance came from the Department of
Education, which had sustained $9 million damage to 48 government
schools. School-wide training and information about coping with
loss was provided for students, families and staff in the Bondi
district in both primary and secondary schools, coordinated by the
South Eastern Sydney Area Child and Adolescent Mental Health Team.
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Community Health | |
Community Health staff visited 240 existing clients affected by the
storms in the first few weeks, particularly on weekends and after
hours, times for which they are normally not rostered.
In addition, they established a small taskforce to prioritise
"hailstorm referrals". Staff were allocated to the team, and other
aged care staff from other parts of the Area Health Service were
seconded to the roles normally performed by recovery team members. An
undamaged area of Royal South Sydney Community Health Complex was set
aside as a co-ordination centre with a dedicated phone line and
computer database. Over the ensuing months, community health staff
saw another 383 people for assessments and management of their health
needs. The last "hailstorm referral" -- a woman returning to her home
after living with relatives since the beginning of the disaster -- was
received as late as November 1999.
The Community Health staff response to each referral was no more than
the usual response to a person with health and social needs. Those
referred were assessed to determine the most appropriate way for
those needs to be met (eg, medication management, nutrition,
accommodation, personal support, consultation with general
practitioners).
The significance for the Department of Community Services, the
Department of Housing and others in the recovery process was that
health staff were available, visible and quickly accessible.
Answers to the problems the other services uncovered did not lie in
taking "patients" to the local emergency department, or even in
asking a general practitioner to visit. They lay in referral to staff
who had the primary resources to assist these people in distress and
the networks to know how to gain assistance over and above the
financial response being coordinated by the Department of Community
Services.
Usually, in April and May, community health staff call all their
clients to advise them to seek influenza vaccinations to sustain them
through the winter. Notably, more "hailstorm referrals" than
regular clients were not able to be contacted at their April 1999
address -- some are now living with relatives, some are in nursing
homes and some have since died. This group will be the subject of
further research into the impact of the hailstorm disaster on their
coping skills.
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The story told here outlines the responsibilities assumed in this
disaster and reports the scope of activity required for a prolonged
period after such an event. In particular, it highlights the value of
community health and mental health services and defines a role which
has to date been undervalued.
Specific lessons learned by this Area Health Service
included:
- Daily information sharing in the early
stages was valued by staff;
- The roles of public health and mental health staff were reinforced in
this response to a disaster;
- Community Health staff are important members of disaster
management planning teams;
- Other agencies find that involving health staff in recovery
activities is useful for victims, and reassuring for staff members as
individuals;
- Recovery may be a prolonged process, dedicated space may be required
on a semipermanent basis for central coordination and regular relief
from "special" duties needs to be provided; and
- Maintenance disaster training should incorporate the importance
of briefing and debriefing skills.
These lessons are also documented in reports of other notable
Australian disasters4,5 and are used in training
for disaster management. Lessons learned from the hailstorm
disaster were used to actively involve Community Health staff in
planning the care of housebound patients during road closures for
special events, to learn from Public Health staff about planning for
infectious disease surveillance, and to reinforce the
communication partnerships required in the event of mass casualties
or a disastrous community incident.
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- Henri C. The Sydney hailstorm: the insurance perspective. Aust
J Emerg Manage 2000; 14: 16-18.
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Emergency Management Australia. Commonwealth counter disaster
concepts and principles. Australian counter disaster handbook.
Volume 1. 2nd ed. Canberra: National Capital Printing, 1993.
-
Hailstorm rooves still leaking. Sun-Herald April 9 2000:
31.
-
Wilkinson S. Port Arthur Disaster. Aust N Z J Surg 1999; 69:
569-570.
-
Hodge J. Responding to mass casualty incidents in the rural
setting: a case study. Aust J Emerg Manage 2000: 14 (4): 29-32.
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South Eastern Sydney Area Health Service, Sydney, NSW.
Lynette A Lee, FRACMA, FAFRM, MSc, Director, Clinical
Services, and Conjoint Senior Lecturer, University of New South
Wales;
Anne Collings, BA(Hons), CertNeuroscienceNursing
(Canada), Program Manager, Aged Care and Rehabilitation, Northern
Community Health
Reprints will not be available from the authors.
Correspondence: Dr L
A Lee, South Eastern Sydney Area Health Service, PO Box 430, Kogarah,
NSW 1485. leelATsesahs.nsw.gov.au
©MJA 2000
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| Progress of the hailstorm |
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| Sydney radar images showing
the progress of the storm on Wednesday, 14 April 1999. Areas of heaviest
rain or hail are shown in red. Images courtesy of the Bureau of Meteorology |
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