Terror - Auckland's weak link

By ANGELA GREGORY

A terrorist strike in Auckland on the scale of the Bali attack would strain hospital facilities so badly that some of the worst injured would be left to die.

Auckland intensive care specialists say the system would not cope if a bomb exploded in a crowded venue and badly injured dozens of people.

Some who might have survived with treatment would die because the demand would over-stretch medical services.

Some seriously injured patients would have to be sent to Australia for treatment.

This was the blunt assessment from several of the region's trauma experts after the Herald yesterday asked them how New Zealand's biggest urban area could cope with the casualties of a terror strike.

An intensive care specialist at Auckland Hospital, Dr Tony Smith, said hospitals were already working to capacity.

A sudden load of badly injured patients would push them close to collapse.

Decisions about who would be treated would be made on the spot by experienced triage staff.

"There would be the strictest order on who would benefit the most ... some patients would be put aside to die."

Middlemore Hospital's clinical director of acute care, Dr David Gellar, said a Bali-type disaster would put a huge strain on his service.

In 1997, the arrival of five bad burn victims had "virtually destroyed" the intensive care service's ability to cope. The costs of long term care for the badly injured would also be a burden on the hospital system.

"A Bali-type situation would be a real bloody struggle."

Dr Gellar said the hospital had a disaster plan, but it had never been tested effectively. "We have had exercises but nothing that would compare to the real thing."

Auckland hospital's director of trauma services, Dr Ian Civil, said New Zealanders would be surprised at how little extra capacity their health system had.

Dr Civil said Australian trauma surgeons, whose services were under less stress than here, had noted that after Bali they were only marginally able to provide the level of care expected.

Dr Smith, who also is the clinical medical adviser for St John Ambulance, said emergency departments would not be able to cope with a stream of patients arriving at hospitals for urgent treatment.

The limiting factor would not be the abilities of the fire service, police or ambulances, but hospitals with virtually no spare capacity. "We are already 96 to 99 per cent full."

Dr Smith said the city's only trauma units, at Middlemore, Starship and Auckland hospitals, would struggle to handle six badly injured car crash patients.

They were limited in emergency blood supplies, operating theatre space, and staffing.

"Turn that into 60 patients ... the first six we will cope with reasonably well, the next 54 we won't."

But Dr Smith said existing disaster plans were as good as could be expected, considering the limitations facing emergency medical services, including their lack of real experience dealing with disasters.

The disaster plans set out actions for handling multi-casualty incidents such as major fires, building collapses or toxic spills.

"Although a terrorist incident is slightly different, the underlying protocols are exactly the same."

Dr Smith said some seriously wounded people would probably be flown to Whangarei, Hamilton or further afield including to Australia if necessary for specialised burns treatment.

Counties Manukau Health's emergency response planner, Mick Hubbard, said it would be wrong to publicly detail the hospital's disaster plans which were integrated with other hospitals and services.

"The less we advertise what we'd do, the less likely we are to be compromised."

North Shore Hospital emergency care manager Jay Behrouz-Pirnia said the hospital had a disaster plan, but in such a situation it would work with the other Auckland hospitals.

"It would stretch us to the maximum," he said.

"But we have the facilities as a city to deal with it."

Herald feature: Defence