Bushfire sun

January 2020

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It’s summer in Australia and the country is on fire. My news feed is ablaze – tragic photos of charred houses, desperate wildlife and families sheltering on the beach. The air in Sydney is smoky and thick, transforming the sun into an iridescent crimson disc.  On Saturday, the temperature reached forty-five degrees. So hot that it hurts to breathe.

While the scale of the current fires is unprecedented, bushfires are a regular occurrence around here. Most Australians have been touched by fire. When we see the pink ‘bushfire sun’ we know what it means. For me, the smell of bushfire smoke triggers complex memories.

I was in the closing moments of my intern year when bushfires ravaged Canberra in January 2003. Fires had been circling for about ten days before they struck with a vengeance – entering the suburbs and eventually destroying nearly five hundred homes. About seventy per cent of uninhabited land in the Australian Capital Territory was burned. Four hundred and ninety people were injured and four people died. The city was forever changed.

I remember sitting outside, eating lunch with my friend Helen. She had been evacuated from her share house in the northern suburbs and had come to my apartment, just over the road from the hospital. The sky was purple and we could see flames outlining the crest of a hill in the next suburb. It felt surreal.

My phone rang – it was the ED consultant. Could I come in? And was I prepared to stay for a while?

There are no photos of the emergency department that day. Smartphones were yet to be invented and no-one thought to bring a camera. Luckily, the images are clear in my memory.

There were people everywhere. Lying on the floor or sitting with their backs against walls and columns. Heads resting on the shoulders and laps of their family and friends. The waiting room overflowed into the forecourt and driveway. I was reminded of the famous scene from Gone With The Wind – Civil War casualties filling the streets of Atlanta. Hair was singed and faces were sooty. The fashion was distinctively Australian – flannel shirts, denim and thongs. Some patients had splints fashioned from beer cartons.

The casemix was surprising. Major burns caused the deaths but were otherwise rare. There were minor burns, but they were easy to manage with first aid and dressings. Eye injuries were very common – with embers, dust and ash swirling in the air. And there were lots of fractures and lacerations – sustained while up a ladder or on the roof, defending homes in the dark. All of the severely injured patients arrived by private car – we had no time to prepare.

The majority of patients had medical problems. We quickly learned how to assess smoke inhalation by measuring carboxy-haemoglobin, a test I have rarely used since. Respiratory illness was exacerbated for two reasons – particles in the air, and interruption of home oxygen supply due to evacuation and widespread power outages. Heat-related illness struck the physiologically vulnerable. There were complications from medication lost or left behind. Consumption of contaminated water and unrefrigerated food sparked an epic outbreak of gastro.

There were patients with mental health problems. Conditions were profoundly upsetting in those first few days, triggering anxiety and mood disturbance, but most mental health care was required during the recovery period. And there was the everyday ED business too – chest pain, car accidents, dizziness, headaches and kids with fever.

I can’t remember exactly who else worked during that time. It was a strange mix. Many of the usual ED staff were out of town – Canberrans migrate to the south coast during the summer holidays. Others were busy defending their homes. One of the registrars had his arm in a cast but was there anyway.

We worked in six-hour shifts, moving through different areas of ED and taking breaks to eat and rest. I started in cubes, managing corneal abrasions, lacerations and fractures. I moved to the outpatient clinics, which we had commandeered to assess patients with chronic illness whose care needs exceeded the capacity of the community evacuation centres – requiring oxygen, CPAP, peritoneal dialysis, insulin or help managing their medications. We improvised, accommodating patients who had brought their own respiratory support devices in chairs next to almost every power point in the ambulatory care area.

Inside the ED, we lost track of time. We listened to the ABC radio emergency broadcast and eagerly asked paramedics for updates as they came and went. We kept tabs on how the fire was spreading and which suburbs were at risk based on the addresses of the patients we were treating. Some clinicians continued to work while their homes burned down.

Wikipedia tells me that the Canberra fires raged for four days. I don’t remember exactly how much time I spent in ED, but I will always remember how it felt. The sounds, the smells and the faces. The heavy, acrid smoke that shrouded the city for days after the acute firestorm passed. The vibe.

Despite the tragic circumstances, working during the Canberra fires was one of the most positive experiences of my career. Everyone was friendly and forgiving – patients and clinicians. In the face of unprecedented clinical demand, teams formed, systems developed, and tribes came together.

It was an absolute privilege to be involved. Just being there was thanks enough, but I plan to keep the thank you letter I received from the ED Director forever.

I didn’t realise at the time how formative this experience would be. It is many years since I worked in Canberra, but the ED team there still feels like family. Bonds formed during the bushfires hold very tight. And it was during this time that a seed was sown that eventually grew into my decision to train, and later lead, in Emergency Medicine.

I would like to thank my colleagues from The Canberra Hospital for inspiring, encouraging and supporting my career.

I would also like to acknowledge and thank all of the clinicians working hard to look after their patients and communities in difficult circumstances as bushfires continue to rage across Australia in 2020.