Without enough critical-care drugs and training procedures, rural communities are at even greater risk should COVID-19 take hold, a leading professional body says.
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The Rural Doctors Association (RDAA) president, Dr John Hall said his colleagues were not convinced that preparedness for a spread of COVID-19 was playing out evenly across the whole of rural Australia.
"We've got pockets where this is being done really well, but we are also getting reports that it's not been done properly in many of the smaller rural sites, where they could find themselves dealing with complex COVID-19 patients in the coming weeks," Dr Hall said.
"We are concerned that support and training is not being adequately facilitated by the state health departments that govern these hospitals."
Dr Hall said there was evidence of some complacency among senior managers in the health departments and while their focus on preparing the large regional and metropolitan centres was important and welcome, there was a pressing need to address the situation in the bush.
"I think some people have their heads in the sand thinking that COVID-19 is not going to need to be managed in smaller rural sites, or that it won't penetrate deep enough into rural Australia to be a problem," he said.
"We don't agree with that thinking. We have already seen remote areas like Broken Hill affected by the spread of the virus, so we think it's just a matter of time before some of these people become critically unwell."
I think some people have their heads in the sand thinking that COVID-19 is not going to need to be managed in smaller rural sites, or that it won't penetrate deep enough into rural Australia to be a problem.
- Dr John Hall
Dr Hall believes moving people with COVID-19 could be a major problem in rural areas.
"It will not be easy to move people in a COVID-19 world. Normally our retrieval services are stretched at best. If you have a situation where patients have to be moved from 10 sites at once and you have two aircraft... do the maths, and you work out that some of these patients will be waiting in rural hospitals for some time."
The situation within remote Indigenous communities is also problematic.
"Many in these communities are already at risk because of pre-existing high rates of chronic disease, lower life expectancy and limited health services. The retrieval issues here could be a major problem," Dr Hall said.
Dr Hall is concerned bush hospitals might run out of drugs quickly if they have to deal with a number of cases in a day.
"We have been told the drugs are lacking in some of our sites," he said.
"Training, drugs, equipment and protection are the four things we are calling for to make sure our rural hospitals are prepared, and our communities are not put at risk."
Both the RDAA and the Australian College of Rural and Remote Medicine (ACRRM) believe that good preparation will save lives.
ACRRM president Dr Ewen McPhee, said that current training of staff was essential to being able to provide quality care.
"Practice makes perfect. We need to keep running through simulations and ensure that all staff are fully across all the systems and processes from emergency to inpatient care of a COVID-19 patient," Dr McPhee said.
"There are many great Rural Generalist Anaesthetists working in our communities, along with other Rural Generalists with excellent emergency skills," he said.
"It is also essential that small rural hospitals have equitable access to critical care medications and equipment."
"Some states and districts are doing really well in regards to their ordering, preparation and simulation activities, but in other areas the preparedness of small hospitals has been very concerning.
"The problems in North-West Tasmania serve as a strong reminder that if you are not prepared how quickly you can lose control of the situation."
