When it rains, it pours....Are you ready?

It is not that long ago that the central west regions of Queensland and New South Wales were in the grips of Australia's longest ever drought and whilst bushfires are always a threat the likelihood of them impacting on the town based aged care facilities is usually quite low. Two to three years ago the Pacific's El Nino cycle withered and was replaced by the La Nina cycle that generally brings higher rainfall to the east coast of Australia. More rain is beneficial, but rainfall experiences like 24 inches of rain in 2-3 days is another thing altogether and floods are inevitable. This Christmas holiday season brought a special surprise for the river systems that stretch from the central part of south Queensland to the central parts of northern NSW and it just so happens that QPS Benchmarking had several facilities in the flood zone. The first to experience floodwater was the QLD Health Waroona Multipurpose Centre in Charleville, the next was Fairview Aged Care in Moree followed by The Whiddon Group facilities in Wee Waa and Narrabri. Their experiences were reported on local and national news.

In this article, QPS Benchmarking talks to the managers and staff to learn about how they prepare for flood disasters, their experiences in January and most importantly the lessons that can be used to enhance the quality cycle for their disaster management plans.

Waroona MPHS at Charleville

Charleville hit the national TV headlines several days in a row as the flood waters threatened to burst through the levee banks and decimate the town and it was this threat that governed the response of the emergency services and the aged care facility.

The important plus for Charleville was that the evacuation plans for the aged care facility were totally reviewed just before Christmas and this was in part due to close supervision of the long range weather forecasting for the area. "We are very good at reviewing the plans annually but when the forecasts suggested the possibility of flood it seemed like a very good time to focus on our evacuation plans", said Jeanelle Everitt, Nursing Unit Manager.

The evacuation was ordered as the threat of a levee bank breach might mean a disruption to essential services. The process began early and orderly with the first 16 residents leaving via plane before the flood waters threatened the town. This left 26 resident's still in the facility and due to the rapidly rising water an order was given at 1.45am to evacuate the remaining residents to the racecourse to await an airlift to Brisbane. Had it not been for the training exercises the evacuation could have posed serious problems. Staff and many of the residents knew what to expect. Overnight bags and disaster boxes with essential supplies were ready to go. By 5.00am the residents were on a plane and on their way to Brisbane.

Staff observed that the evacuation appeared to have a greater impact on the relatives than the residents. Whilst many of the residents considered the evacuation an "adventure" some relatives were quite concerned. It was considered that there is an opportunity to engage the relatives more in the disaster planning to ensure that they are aware of what will happen and the need for a standard approach to evacuations.

The Whiddon Group - Wee Waa and Narrabri

Like Waroona, the management at TWG appeared to have a sixth sense about the impending floods and had just completed a review of this part of the disaster plan. The SWOT analysis and review of previous disasters indicated a need to improve the identification system for transferred residents and so an identification band had been added to the evacuation kits.

The unique feature of this flood was the speed that the water was flowing down from Queensland and this cut short the time frame for making a decision to evacuate. The plan involved transferring the residents in the 18 seater bus on roads that are not that great and so being 'ahead of time' in rural and remote communities is always a good thing. Decisions were made on time and the evacuation process occurred smoothly for the first set of residents. Of the 16 residents transferred 8 were sent to the TWG facility in Narrabri and 8 to another non TWG facility.

The speed of the water rise at Wee Waa was so fast that the bus that took the residents to Narrabri could not get back to Wee Waa. So despite an order to evacuate all residents, Wee Waa still had to keep 8 residents. One of the problems was that staff members were isolated at home on their properties and two staff had to be flown into work by helicopter.

Whilst the aged care facilities in Narrabri remained high and dry, Narrabri itself was not immune to the flood waters and just like at Wee Waa the water came down with unprecedented speed. This resulted in low lying parts of the town being inundated and numerous businesses were unable to move their stock in time. Whilst no direct threat was posed to the safety of the residents it did mean that some staff members were isolated from work and that contingencies for supplies had to be kept in mind. Some staff members were isolated at the facility. They had to sleep over, along with the Director of Care Services who slept on the sofa bed in her office. As Maree Taylor (DCS) explains, "rather than being a time of tense anticipation, these events create a spirit of 'comraderie' and staff and residents find quite a bit of time to chat and have a laugh about the situation. The older generation is one that was brought up on the old saying of 'smiling in the face of adversity'".

The transferred residents from Wee Waa were far from distressed and many looked on the event as a holiday.

There were many things that worked well including access to electronic patient notes, the ID badges, support services from Corporate Office and the Hunter New England Area Health Service.

Fairview Aged Care - Moree

Fairview Aged Care in Moree did not have to put in place an evacuation but as the photos show Fairview did achieve for a few days absolute water front property status. "We were about 1 metre away from being inundated and the threat of evacuation was imminent", says Chief Executive Officer, Brett Arthur.

Flood planning for Fairview is about two main issues. The first is maintaining good supply levels. It cannot be guaranteed that supplies will get to us. In this flood Fairview were well prepared, but daily fresh supplies such as milk, bread and fresh fruit and vegetables always pose issues. The second is that the facility is cut off from all directions so it is inevitable that 70% of staff cannot get to work or home from work. The facility did however maintain access to some parts of the town to the south.

It is comforting to have the local hospital next door. This helps to maintain medical support. Some of the doctors can be isolated but the SES always has ways of coping with this. The biggest problems occur when a staff member caught at work during the rain event may need to get home to his or her family, or the staff at the facility need to be replaced and we need to fly someone in from an isolated property. This happened a few times due to the sudden and widespread nature of this flood. Management discovered that it is really helpful if you have GPS coordinates for the staffs' home address. As a result of previous flood events the SES and council are busy re-numbering street addresses on rural properties to measure distances from the town PO and will collect, and put on record, the GPS coordinates for their home.

For this flood, Fairview was able to maintain a daily supply of fresh bread from a bakery on the same side of town. The baker was not the regular supplier but he stepped up to the plate for the emergency. Milk supplies were maintained via a helicopter lift into town. "However we had to make do without fresh fruit and vegetables", explained CEO Brett Arthur.

An emerging threat in the January flood was the potential to lose electricity and sewerage services. At first council was confident that services could be maintained but as the flood waters continued to rise and rise quickly there was some fear that some of the sewerage plant would have to be shut down to avoid a major equipment failure. Achieving a better understanding of this threat will be an important part of the debriefing and future evacuation plans.

The flood event was not confined to just when the waters were high in and around the town. After the first 3 to 4 days, many of the workers at the facility were exhausted and this is when fresh staff were brought by helicopter into the facility. The facility will be looking at how they might minimise the impact on staff by varying the rosters during an emergency. It was necessary to put 8 staff up in the local motels adjacent to the facility and this does of course add considerable operational costs.

The residents remained reasonably unaffected. Some of them were oblivious to the situation but others enjoyed sitting on the verandah and watching the flood waters come down the river and creep up and over the banks. There was some reminiscing of past events going on but there was no panic, just mild curiosity.

Moree had a minor flood in November, just three months earlier and so the facility had just completed a debrief and review of its flood management procedures just eight weeks before the big floods in January. Consequently, everyone was prepared.

Risk management is sometimes assisted by reviewing the circumstances of others and learning from their experiences both positive and negative. The following checklist has been prepared based on the combined stories of Wee Waa, Narrabri, Charleville and Moree.

These issues and opportunities may well be relevant for other QPS clients and worthy of consideration in future reviews of your flood and evacuation plans. It is not an exhaustive list and each locality will have its own unique issues to add.

1. Are practical ID badges included in the evacuation kit to identify residents?
2. Does your facility monitor long range weather forecasts as a prompt for reviews of the disaster plans?
3. Are transistor radios with batteries in the evacuation kits? Useful for listening to flood updates.
4. Has the disaster plan identified someone to deal with relative concerns or when they turn up the facility?
5. Do the disaster kits contain sufficient supplies for staff to care for the residents? Are the supplies quantified in terms of 'days' so that contingency plans for a longer period can be made?
6. If you plan to evacuate residents do they have kit bags packed and ready to go?
7. Is everything in the kit bag labelled with the facility and or appropriate resident's name?
8. Have you assessed the amount of space the kits and any additional equipment will take up on the transport vehicle? Too much might compromise your ability to take all residents.
9. What equipment will be available in the receiving facilities to avoid duplication or shortages?
10. Is there a clear understanding from utility suppliers e.g. Councils about the circumstances when electricity, gas and or sewerage services might be interrupted? This is critical in terms of planning the need or otherwise to evacuate the residents.
11. Has there been any change to the size of levee banks since the last flood plan was devised? This can change the trigger points for evacuation and or disruption to vital services
12. Do you maintain GPS coordinates for staff residences? Some helicopters involved in retrieving staff from their homes wanted GPS coordinates to locate the staff.
13. Do you periodically involve the residents in discussion on what will happen in the event of an evacuation to ensure that they are prepared for what might happen?
14. Have you discussed with or provided the relatives with information of what might happen in the event of an evacuation? It was noted that concerned, confused and or well intending relatives can add to tension at critical moments, particularly with 'special' requests.
15. Have you worked out contingency rosters and work routines for when you might have a limited number of staff available during the floods?
16. If you intend to house staff in the facility during the emergency do you have sufficient space, beds and places to shower and have a downtime?
17. Do you have a good and efficient system in place to communicate with corporate headquarters and to maintain a log of events for use in the debriefing process?
18. When evacuating residents have you arranged for the right supplies and equipment to be transferred? It might be the case that you transfer too little or even much. Liaison with the designated receiving facilities is critical.
19. Do you have a system for transferring comprehensive information on the resident?
20. Have you provided your emergency plans to local disaster controllers, councils, area health services for review and attended local meetings to ensure that the transfer of information has taken place?