Lessons from Cyclone Gabrielle
The night of the cyclone
A year ago, Severe Tropical Cyclone Gabrielle hit Aotearoa New Zealand, triggering a national state of emergency. I was working in Tairāwhiti Gisborne the night the cyclone hit. I left the hospital at around midnight, driving home in some of the worst rain I’ve ever seen in my life. As I was driving, all the lights in the entire city went out, an ominous sign. Surprisingly, the sun was shining the next morning and, although there was a lot of debris washed up on the beach, there was no visible damage near my home. Little did I know then the true impact.
We soon realised, though, that all services were down – there was no phone, no internet, no water, and no power. While the hospital had done some prior preparation, including cancelling planned care, none of us could have really anticipated the extent of the major systems failures that we experienced.
“The failure of technology was shocking. I think all of us realise we rely on technology, but the extent of our reliance was not clear until technology was utterly gone.”
Emergency care without technology
The failure of technology was shocking. I think all of us realise we rely on technology, but the
extent of our reliance was not clear until technology was utterly gone. While we normally practise in a low information environment here, it was made even more challenging without phones, power, water, the internet – the entire region of Gisborne didn’t have any internet for twelve days!
Having no phones meant that patients couldn’t call 111 for an ambulance. Hato Hone St John stepped in to just drive around neighbourhoods, looking for people who were out in the street flagging down ambulances to bring patients to hospital.
With phones down, people couldn’t call 111 so Hato Hone St John drove around neighbourhoods, looking for people who needed an ambulance.
The hospital also couldn’t contact staff and we had no ability to access our electronic roster. Fortunately, one of our Senior Medical Officers (SMOs) still had the webpage with the roster loaded on her phone, so we took a photo of that and hand-wrote the roster. We then had another SMO’s partner hand-delivering copies of the roster to everyone’s houses, so that people knew when they were working. Many of our bridges were at risk and vehicle traffic was limited, so the roster delivery happened in part by bicycle!
Another challenge was not knowing where everyone lived. With HR and other non-essential staff not working, in some instances we had to go door-to-door and say, “I think so-and-so lives on this road” to make sure we got them the roster. One lesson is to have printed copies of rosters and contact information at the ready.
We did have a satellite phone, so we were able to use that to arrange patient transfers to Waikato Hospital. However, a satellite phone only works outside. When you are in a critical resuscitation and you’re trying to call to get the patient transferred, the SAT phone doesn’t work, so we had somebody running out to the helipad to make those phone calls.
We had no access to electronic medical records, and we couldn’t get access to check patient’s medications. Patients often don’t know what medications they take, so that was a huge challenge. People from Wairoa who couldn’t access care in Hawke’s Bay were also coming to us, and of course we had no records of them either.
The pathology laboratory was a significant issue because with no water available, or very limited water, they had to ‘batch labs’ which led to major delays in getting test results for patients.
Some critical infrastructure issues had been identified beforehand, but unfortunately hadn’t yet been addressed. For instance, the MRI wasn’t on the back-up generator, but if the magnet is not cooled, then the equipment fails. It was critical that this was dealt with immediately, to avoid wasting over a hundred thousand dollars on a failed magnet.
“The takeaway here is that you have to assume all systems are going to fail and plan ahead. ”
Vulnerable populations
To be honest, in the first few days after the cyclone, we didn’t have huge numbers of patients in ED, and it was quite a bit slower than usual. We saw greater impact in the weeks and even months after – presentations were still up by over 100 visits a week in May which was a significant jump for us.
Vulnerable populations presented a big challenge. A lot of people have home oxygen therapy and there was a limited supply of oxygen in Gisborne. As people ran out at home, they had to come to the hospital and ended up being admitted just because they needed oxygen. Dialysis patients who were no longer able to dialyse at home were presenting with major electrolyte problems and needed to be admitted or transferred elsewhere for dialysis.
The takeaway here is that you have to assume all systems are going to fail and plan ahead. This is particularly true for ED because in a crisis, the solution is often for people to go to the emergency department. We really are the safety net for our communities.
It is important to think about how to practice in an austere environment by identifying vulnerable populations beforehand, anticipating that they may not have access to what they need for a week, and either evacuating them or providing them with access to appropriate resources before there is a critical infrastructure failure.
Many homes were destroyed by the cyclone.
Getting people home
In addition to getting people to hospital and taking care of them, there were also challenges in getting people home.
Tairāwhiti is an isolated area here in Aotearoa with a high Māori population. There are basically three ways in: you can drive around the north part of the east cape, you can drive through the Waioeka Gorge from Bay of Plenty, or you can come up from Napier. All those roads were compromised during the cyclone, so we were physically cut off.
Some of the bridges in the city, all the bridges north of Gisborne up near Tokomaru Bay and the northeast cape, and all the bridges south were destroyed or impassable.
I remember a child who was discharged from hospital after coming into ED who we couldn’t get home. We tried to arrange a flight for him to go back up the coast, but he was too scared to get in the helicopter. His journey home eventually involved a car ride, followed by a motorbike, and then a dinghy to get him back to his farm.
Some people discharged from hospital didn’t have housing to go back to, so they had to rely on whānau, or we had to find other ways to get people housing because there was no place for them to stay. There was also no ATM access, so there was no ability to get kai, or food, or what limited amount of fuel was available because people couldn’t pay for it.
“Caring for staff is important – they needed to be able to get good kai to nourish themselves while they were taking care of other people and get enough fuel to get to and from work and take care of their whānau.”
The impact on staff wellbeing
The amount of stress staff were under had a huge impact on their mental health. I found being at the hospital for 16 hours a day, working most of the time and then coming home to cold food and a dark house quite stressful. A lot of our staff had challenges with childcare and not having access to money.
Caring for staff is important – they needed to be able to get good kai to nourish themselves while they were taking care of other people and get enough fuel to get to and from work and take care of their whānau. Anticipating those things ahead of time, particularly for our workforce, is important because of the extra awhi that we are providing for our community.
When old-school works
When phones, internet and other crucial services were down, “old-school” radio played a huge role in communication.
Health professionals are very innovative, and people really step up when they are under the pump. One of the great things that happened was “rounding” by some of the other specialists. The orthopaedic consultant came by three times a day and checked in to see if we had any cases for him or any referrals, and the surgeons did the same. The pager system eventually got set up the day after the cyclone, with some limited success, but the paediatric SMOs, for instance, took the pagers from the registrars and took extra calls to ensure we could get hold of somebody if we had a critical paediatric case. Pressure was also relieved by free prescriptions and the pharmacy’s willingness to provide two weeks of refills.
The radio was one of the few things that was reliable. While there is a lot of internet radio in Gisborne, one broadcast radio station was still working so we had runners going down to the radio station every day with handwritten notes so they could give information to patients and whanau about what was going on and available resources. We also used this to communicate with the rest of the world that we were okay.
What really helped was people just showing up. It warmed my heart to see other consultants and staff appear and ask, “What do you need?”
I saw people turn up and want to do the work, whether it was running around to aid communication, going from ED to the lab to get results, or anything else that needed doing.
In the end, we proved that old-school still works – but my recommendation is to buy a Starlink anyway.
