As 2020 rolls to a close, Australians are faced with our annual bushfire season. The 2019/2020 season brought catastrophic fires, unprecedented in their extent and intensity – tragically 33 lives were lost and more than 3000 homes destroyed.
A recent report has highlighted the health impacts – both physical and mental – of those fires. The findings provide timely reminders to ensure that we don’t just take proactive measures to protect our property – but also our health and our patients’ health.
GPs play a pivotal role in ensuring patients with respiratory and other chronic conditions are equipped to deal with the challenges of the bushfire season. They also provide long-term support to recovering communities affected by bushfire – especially mental health support.
Here are 7 ways general practice can help patients prepare for the bushfire season.
1. Encourage patients to activate my Health Record
Encouraging patients to activate my Health Record and give healthcare professionals access to their data reduces medication errors and reduces time to gather information.
my Health Record facilitates patient data to be accessible during emergency situations such as bushfires and floods, or atypical situations such as lockdowns or travelling, when patients may not be able to access their regular healthcare providers or documentation.
During last season’s bushfires on the South Coast of NSW, many displaced locals and travellers were stranded without access to their prescriptions and regular medicines. Having access to the patients’ my Health Records, local pharmacies were able to ensure continuity of care when GP surgeries and roads were closed.
2. Review Asthma Action Plans
Written Asthma Action Plans should be reviewed regularly. In addition to the effects of poor air quality from bushfire smoke, stress and heightened emotions due to being in a high risk bushfire zone can be potent triggers of asthma.
Encouraging correct use of preventer medicines reduces risk of flare-ups, and discourages over-reliance on relievers. See the latest Australian Asthma Handbook recommendations.
3. Encourage air quality awareness
Smoke and dust may travel hundreds of kilometres from a bushfire, triggering asthma symptoms and worsening COPD. Patients can subscribe to SMS or email air quality alerts and updates. Some are updated hourly. For example, NSW has moved to a 5-category air quality system, colour-coded for ease of understanding, with an activity guide to safe activities for each level.
In the 2019/2020 bushfires, Canberra had the worst recorded air quality in the world on some days, with hourly fine particulate matter (PM2.5) concentrations reaching 2396 micrograms/cubic metre (around 100 times the level considered safe).
The effects of smoke were also felt indoors in Canberra – as unhealthy air quality, damage to sterile medical equipment and temporary failure of MRI equipment.
4. Raise awareness of thunderstorm asthma
Grass pollen season typically runs from October to December in Australia’s south-eastern states. A wet spring has set the scene for a problematic thunderstorm season in 2020. As was well documented in 2016, thunderstorm asthma events can cause catastrophic health impacts and may affect those without a previous diagnosis of asthma.
Encourage patients with asthma, allergies and hay fever to follow pollen forecasts, stay indoors on high risk days, use preventer medicines as directed, and have an up-to-date Asthma Action Plan, where appropriate.
5. Advise patients with chronic health conditions
Bushfire smoke has been shown to invoke a stronger inflammatory response than urban smoke, drawing comparisons to tobacco smoke. It affects some populations more than others – outdoor workers, the homeless, the elderly, young children, and pregnant women.
In Sydney on days with high bushfire pollution, overall mortality rates have been shown to increase. The effect is amplified on days with high temperatures.
Exposure to bushfire smoke may worsen cardiovascular disease and increase symptoms.
In pregnancy it’s associated with reduced birthweight in babies and increased risk of gestational diabetes mellitus.
Vulnerable groups such as those above and those with complex health needs who are at greater risk from bushfire smoke should be advised to follow local air quality advice and guidelines. They should also be advised to activate their my Health Record, and include scripts, medication lists and medicines in their emergency bushfire survival plan, if they live in a bushfire prone area.
6. Ensure scripts are filled, but don’t stockpile medicines
Sales of over-the-counter and prescription inhalers increased substantially during bushfire activity peaks last season. In Canberra, inhaler sales in pharmacy increased by nearly 200 per cent in late December/January during peak fire activity.
Stock of salbutamol asthma inhalers was adequate for the increased demand throughout Australia and medicine deliveries continued mostly as normal, however, some areas were impacted by road closures.
Patients with chronic health conditions, such as diabetes and asthma, should be advised to have adequate supplies of medicines, and that their medicine prescriptions and medicine lists travel with them during the holiday period, and are included in any bushfire survival plan.
7. Provide mental health support
For those who suffered through the 2019/2020 bushfires, the new bushfire season brings triggers, anxiety and hypervigilance to many.
Additional MBS subsidised mental health items were introduced in January 2020 for Australians adversely affected by bushfire. Eligible GPs can provide these services.
There is no requirement for a prior diagnosed mental health condition, treatment plan or referral, to access the services.
Roughly two-thirds of the services have been face-to-face consultations, with one-third delivered by telehealth.
SANE has produced a new digital health resource for patients – Life After Bushfires to support recovery.