In January and February 2019, Townsville, a city of approximately 180,000 people in northeastern Queensland, Australia, faced the worst flooding the region had ever seen. The result was chaos—AUD$1,243 billion (nearly $1 billion USD) worth of property damage and five tragic deaths.

Townsville Hospital Health Service (THHS) continued to serve as the public health system for the region throughout the flood crisis, providing the full spectrum of care for 250,000 people living in both urban and isolated rural areas. What enabled them to continue operations was a combination of staff-influenced disaster response plans and effective partnerships with external, non-health care organizations.

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Due to the high frequency of cyclones in northeastern Queensland, THHS had previous experience responding to climate disasters. We recently sat down with Debbie Maclean, a Nursing Director and the Emergency Preparedness and Continuity Coordinator for THHS at the time, to learn about THHS's robust disaster preparation and what could be replicated at other health care institutions at risk of facing climate emergencies and other disasters. 

Their disaster response team launched in 2011 when a group of staff proactively designed THHS's foundational disaster response plan. This plan included:

• Setting up a command-and-control hierarchy
• Establishing emergency operating procedures
• Building a dedicated disaster management center
• Creating a centralized reporting and communications structure
• Fostering partnerships with local public and private services both locally and at the state level

THHS also coordinated with local private providers to share staff, patients, and resources across sites to prevent any part of the health system from becoming overwhelmed. The willingness of disparate entities to come to the table around a shared problem, even if it meant they had to make concessions for the good of the collective, is a powerful notion. And because this is a rarity in the health care sector, this is a model that health systems around the globe can learn from.

But even with these disaster preparedness elements in place, THHS and its partners had to ensure staff in the health system—and beyond—understood their roles when the time came to act.

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Staff directly involved in responding to disasters should drive solutions and improvements

To prepare staff within the organization, THHS uses the Emergo Train System, a gamified educational emergency simulation program. The virtual program places staff in hypothetical disasters like bombings or floods. Staff are then tasked to make decisions on how to prepare and respond to such an event, such as how to protect equipment or manage an influx of patients with limited capacity. And all of these simulations are timed as if there was an impending disaster.  

The exercise exposes staff to how much time different tasks can actually take. For instance, moving a patient from one ward to another may require 20 minutes that are not available during a time of need. Staff can contextualize which operations need to be prioritized given their limited time and resources and apply this knowledge in a real disaster.

Staff are also invited to a reflection meeting after a disaster event. Here, they are asked to complete a survey and provide suggestions to improve THHS' disaster response for future disasters and highlight the systems and processes that worked well. Staff on the frontline can raise concerns around processes that were inefficient or missing during the disaster.

Inevitably, these changes are often tightly linked to what staff care about the most and what they have control over. For example, this exercise highlighted that the phone list was not updated, or laptops allocated to disaster response were missing or not running the latest software. Inefficiencies can be small, but they can make a big difference in an emergency. Understanding the small details allows stakeholders to work together to find solutions before a real disaster exposes them to devastating consequences.

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By incorporating this feedback, THHS effectively crowdsources innovation to improve upon operational needs that can be applied to all emergency events, including natural disasters and pandemics. And it's because of this self-improvement process that the system was able to mount a cohesive response to the floods and why THHS's disaster-trained staff now help other disaster-prone health systems around the world—from Bali to Fiji—create their own response plans.

Often-neglected partnerships should be prioritized when planning for disasters

Every other year, the disaster response team runs a multi-agency community exercise to simulate a disaster (e.g., a plane crash or a terrorist attack.) THHS and local organizations, such as ambulance and police services, the army, and non-profit groups, run a full response exercise in the field. The multi-agency effort aligns with state, district, and local disaster coordination plans, with all services acting as they would in a real disaster. This not only allows organizations to understand and refine their roles in an emergency, but it also strengthens vital partnerships between organizations who would otherwise operate disparately.

This translates to other emergencies—organizations that were able to rapidly respond to the emergency of Covid-19 did so in part because of their ability to interact with different local players, from public health to local transport companies.

THHS's response to the 2019 floods highlights how valuable it is for health systems to recognize the importance of collaborating with community stakeholders to create a holistic and robust disaster response and learn from their experiences. And when it comes to climate disasters, when the proverbial flood comes for other systems, they need to be ready for it.