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Lum on 2002 Bali Bombings

DRLA Executive Director Ky Luu interviews Dr. Gary Lum, Assistant Secretary for the Health Emergency Management Branch in the Office of Health Protection in the Australian Government's Department of Health and Ageing. Dr. Gary Lum discusses Australia's immediate response to the 2002 Bali bombings and the formation of the Australian Health Protection Committee.


Ky Luu:  Going back a little bit in time here, in 2002 you were the Acting General Manager at the Royal Darwin Hospital, which is the premier hospital of the Northern Territory. And you oversaw the response to the 2002 Bali bombings. What approach did you take to get your hospital, the staff, and the patients through this crisis?

Gary Lum: Ky, I suppose the most important thing to mention here is that it wasn’t just me who led.  I had a very close friend, and colleague, and mentor, and I mentioned his name before Dr. Len Notaras.  He was the medical superintendant at the time, and he and I basically made up a management and leadership team for the hospital. What we did is we assembled all of the key players very early on the Sunday afternoon—that was nearly twelve to eighteen hours after the explosions had happened in Bali.  Time 2002 Bali BombingsAnd what we did is we brought the people together, and we worked out a plan very quickly. So we effectively decanted patients from two surgical wards, we emptied our intensive care unit, and we co-located those patients to a private hospital, or to other wards, or to home.  Remarkably, we had patients who said, “I’m sick, but I can probably go home Doc, you need to spend more on others.” So we swept through the entire hospital, and spoke with as many staff as possible about what they should expect.  Most importantly, for this particular activation or this particular operation we had local defense reserve officers, a surgeon, and an anesthetist—or I think you might call him an anesthesiologist—there was a captain and a major in our reserve army, and they were taken to Bali. And they provided us with incredibly valuable and accurate health information from the site. And that came to us directly without any filtering or interference. And it was with that information that we could also better prepare the hospital so that when the patients arrived, we were in a position where we could resuscitate them. I think what’s important is to understand that throughout this process, we maintained access to politicians, bureaucrats, other government officials, the media, and our own staff to ensure effective and widespread communication to keep everybody in the information loop. So Dr. Notaras and I coordinated the information sharing through various networks to ensure a consistent and accurate information feed was always available to as many people as was appropriate.  While we were aware of fatigue issues, we always ensured that our staff was rested, and most importantly, Len and I made it very clear to everybody, particularly our senior people that we knew them, we had confidence in them, they had our confidence in them, they had our trust, and that they knew that we understood that they would always act appropriately. And everybody worked through everybody else. It was very collegiate. One of the amazing things that I saw was surgeons working as technical people, looking after their patients, allowing physicians—that’s internal medicine specialists—come in and look after their patients in a metabolic sense and there was never an issue. There were no turf wars, there were no battles that occurred within the hospital.  People worked seamlessly. They did their specialty job, they did it well, and all the patients that came to us did very well.  And over 36 hours, they were resuscitated. Those that needed expert burns treatment in other jurisdictions were airlifted to those jurisdictions, those patients that had trauma and relatively minor injuries stayed with us in Darwin. And over a period of weeks and months, we looked after those patients, and the patients that we shared with other hospitals around the country, we continued to receive feedback from those hospitals about those patients, so that our staff were getting the feedback information, so that they knew that their job had been done. And that was also something that was really important, knowing that while the acute phase of this was incredibly busy, incredibly stressful, getting feedback on all the patients, no matter where they were, so that everybody understood what was happening, was really important.

Ky Luu:  Australia’s response to the Bali bombing has been described as a whole of government response, with government, state, and territory actors participating. Can you describe the coordination strategy that was implemented, and were there lessons learned from this operation that you are currently utilizing?

Gary Lum: Yes Ky, I mean from a coordination perspective, I think that episode, and nearly all of the others that I’ve worked in—and I’m sure our listeners will understand if they’re working in emergency management—that coordination is multi-layered. We knew, that is I knew, what was going on at a Northern Territory government level. I also had a good idea of what was going on at an Australian government level as well.  But, there were others in the other jurisdictions who were going to be on the receiving end, who also needed to understand. There were people at an operational level who knew what was happening at their level, but didn’t know what was going on at high levels, so that was part of the role was trying to share that information as appropriate, so that nobody felt like they were missing out. Much of the coordination in Darwin was basically done on the fly, but it had been practiced in various guises through our annual preparation for tropical cyclones. And as I said before, because of the greater awareness of terrorism, because of the eleventh of September, and then with the baccilus anthracis letters, we were more attuned to making sure that our response was appropriate. So as a result, after the acute events, Australian government established a variety of committees to bring state territory and commonwealth government agencies together.  And so out of that was born the Australian Health Protection Committee.  There had been a similar committee to that established around 2001, but the AHPC came into existence in 2006, bringing states, territories, and the commonwealth government together, as well as some of the Australian government agencies, like the Australian Defense Force, and Emergency Management Australia. So this committee, this Australian Health Protection Committee, meets formally about three times a year, but we also meet by teleconference as much as we need to, particularly around the health emergencies. So in the last twelve months, we’ve met for the Mumbai terrorist situation, we’ve met for the Victorian bushfires, or what I think you guys call wildfires, we’ve met because of an explosion on a boat in our international waters associated with illegal asylum seekers. We’ve met many, many times over pandemic influenza, there were bombings in Jakarta a couple of months ago, where we prepared to send a team, but fortunately didn’t have to, and more recently, with the earthquake and tsunami in Samoa and Tonga, and also the earthquake in Sumatra, we prepared medical assistance teams. Fortunately, we didn’t have to send teams to Sumatra, but we sent two medical assistance teams to Samoa to assist with the earthquake and tsunami relief there.  So the Australian Health Protection Committee is basically born out of those initial Bali bombings, and has become part of the overall national response, and I suppose that is also part of the reason why I felt like it was time to make a move from Darwin to Canberra, to be part of that bigger picture as well.

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