Vol. 8 Issue 3. 2018

Winter 2018 Vol 8
ESTA’S
TRIPLE
ZERO
HEROES
WINTER
IS HERE
Your
Weather
Update
COMPASSION FATIGUE
Is it a myth ?

CONTENTS
Editor’s Note
2
Latest Events
• Emergency Services Blood
Challenge
• ESTA’s Triple Zero Heroes
• 2018 Search & Rescue Awards
Winter is coming - weather
update
Blaze Aid - Volunteer group
Lessons of resilience - Hobart
floods
The effect of a home model in
elderly care
Accountability within the
Australian Intelligence
Community
Hospital environmental footprint
Globalisation & Infectious Disease
The myth of compassion fatigue
3
4
7
8
13
14
18
21
24
28
32
View from Mt Hotham in Winter
DISCLAIMER
The Australian Emergency Services Magazine is a community
educational resource and does not promote itself as a charity or
fund raising institution, nor solicit on behalf of charities and is no
way financially supported by or associated with any government or
similar institution. Distributions of the publication is Quarterly and
are circulated via a database of interested parties, including business,
subscribers, advertisers, volunteer emergency organistations,
and council libraries. A digital eMag is distributed to a targeted
database in each State & Territory. All information published in
the Australian Emergency Services Magazine is in good faith and
whilst every effort is made to ensure that the publication is free of
error and omission, no responsibility or liability will be accepted by
Boothbook Pty Ltd.
Published by Boothbook Media
ABN:72 605 987 031
www.aesj.com.au
MAGAZINE CONTACTS
1300 851 710
press@aesj.com.au
Suite 112, Locked Bag 1
Robina TC, QLD 4230

EDITORS NOTE
Welcome to the Winter edition of
the Australian Emergency Services
Magazine. There is certainly never
a shortage of things happening and
this edition is as usual full of some
interesting and relevant articles.
We are definitely feeling the cold
blast that recently blustered its way
through the southern states with
snow falling in unusual places yet
again this year. Climate change
can certainly be seen through the
changing of the seasons. Either
the lateness of Summer storms and
cyclone season and the unseasonable
early frosts or hot winter days.
Those keen weather watchers and
our farmers know what Im talking
about. Regardless of this latest
cold blast it seems we are in for a
mild winter this year, according to
weather experts at the Bureau of
Meteorology.
This winter brings another round
of the Emergency Services Blood
Challenge held annually. Get behind
this great cause and support those
you know in the services with an
extra cup of tea and a biscuit!
ESTA’s Triple Zero Heroes were also
announced in the last two months.
There are some amazing stories
of some very brave young people
looking out for others and having
the confidence and quick thinking to
call 000. You can read about them in
this issue.
To help your children feel confident
if faced with such a circumstance a
great resource is a game called the
kids triple zero challenge. You can
download this from the App store or
Google play.
Kids will learn about getting help by
playing games and solving mysteries.
They’ll learn about safety messages
and hear what happens when you
call Triple Zero. Along the way
they will meet the “Zeros” as they
are guided step by step through the
game. For more information on this
visit:
www.kids.triplezero.gov.au
Stay warm and look after each other.
Happy reading,
Emma Parker
Editor

LATEST NEWS
JUNE 1ST - 31ST AUGUST
www.donateblood.com.au/emergency-services-challenge
This winter, Police, Fire, Ambulance
and the SES are again competing
by service and state to give the
most blood donations during
the Emergency Services Blood
Challenge 2018.
Last year, they made an amazing
9,422 donations altogether. Since
each donation saves up to three lives,
that’s up to 28,266 lives saved.
Congratulations to Victoria Police
who made the most donations last
year.
Who will take the title in 2018?
Join the challenge and help your
crew beat the other states and
services.
HOW TO GET INVOLVED
Simply join the Red Cross Blood
Service’s group donation program,
Red25, and donate during the
challenge.
Register for the self-service system,
a secure convenient place where
you can manage your details, group
memberships and appointments.
ONCE REGISTERED
To join or change your Red25 group:
select the ‘Red25 group’ tab, search
for the group you wish to join, select
the group and click to submit.
To make an appointment: select
the ‘Appointment’ tab and follow
the prompts through to making a
donation appointment for between 1
June–31 August.
Give blood to have your donation
automatically added to your group’s
tally.
Track your group’s results online
during the challenge, visit the
challenge page.
Encourage your peers to get involved
too! You can download posters,
email templates, social media images
and more, to help you get the word
out.
To arrange a group donation
appointment call 1300 886 524.

LATEST NEWS
ESTA’s Triple Zero Heroes with ESTA’s CEO Marty Smyth, Victorian Minister for Emergency Services, James Merlino, Victorian Minister for
Health, Jill Hennessy, Brownlow Medallist and Channel 9 presenter Shane Crawford.
ESTA’S TRIPLE ZERO HEROES
A total of 31 young Victorians aged
between four and 13 were named Junior
Triple Zero Heroes by the Emergency
Services Telecommunications Authority
(ESTA), for calling triple zero.
The young heroes are nominated by
the ESTA operators who took their
call. The awards, which are in their
fourteenth year, recognise young people
for their bravery and clear thinking in
emergencies.
This year’s heroes include:
Four-year-old Charlotte who called
triple zero when her mum fell and was
unable to move. She explained what was
happening to our operator and cared for
her mother until paramedics arrived
13-year-old Trinity who was out on a
drive with her mum when they ended
up on the edge of a collapsing road.
Trinity escaped and called triple zero
as the car fell 30 metres off a cliff with
her mum still inside. Trinity remained
calm and provided vital details to our
operator until help arrived
Five-year-old Aoife who called triple
zero when her mum collapsed and then
stopped breathing. Aoife performed
CPR on her mum and did a great job of
caring for her mum and younger sibling
until help arrived.
The Minister for Emergency Services,
James Merlino, said: “ESTA’s triple zero
operators work under pressure to help
Victorians in need, responding to nearly
7000 calls a day.
“Victoria’s brave Junior Triple Zero
Heroes remained remarkably cool, calm
and collected and are shining examples
of how preparing children for an
emergency can save lives.”

LATEST NEWS
2018 ESTA JUNIOR TRIPLE
ZERO HEROES
Adam Kennedy. 11-year-old Adam,
from Shepparton, called triple zero
when his mum started to have diabetes
complications.
Aahana Chapade. Seven-year-old
Aahana, from Roxburgh Park, called
triple zero for her mum who was having
a stroke in the carpark while waiting
to pick her up from school. She stayed
calm and handled the call very well.
Charlotte Perry. Charlotte, from
Upwey, is our youngest hero at just four
years old. She called triple zero when
her mum fell, injured her hip and was
unable to move. She explained what was
happening to our operator and cared for
her mother until paramedics arrived.
Cooper Decker. 12-year-old Cooper,
from Werribee, called triple zero for his
mum who was having trouble breathing.
Emily Abuseaf. 13-year-old Emily, from
Narre Warren South, called triple zero
for her mum who was having chest pain.
Victorian Minister for Emergency Services, James Merlino with Victorian Minister for Health, Jill
Hennessy and Brownlow Medallist Shane Crawford presenting awards to Kiera Hardege and Kushi Patel
“Teaching your children how and when to call triple zero, including
knowing your home address, really can save lives. We tell parents and
carers that the life a child might save could be yours”.
ESTA’s CEO Marty Smyth
Ethan Duggan. Eight-year-old Ethan,
from Wyndham Vale, called triple zero
for his mum who had a stroke.
Aoife Forsyth. Five-year-old Aoife, from
Berwick, called triple zero when her
mum collapsed and stopped breathing.
She performed CPR on her mum and
did a great job of caring for her younger
brother until help arrived.
Grace Wells. 10-year-old Grace, from
Spring Gully, called triple zero for her
mum who was having a stroke.
Jake Ruzicka. 10-year-old Jake, from
Lower Templestowe, called triple zero
for his mum who had a numb face and
thought she was having a stroke.
Jenna Holland.13-year-old Jenna, from
Shepparton, called triple zero when she
witnessed a multiple car collision.
Jordana Tsouras. 11-year-old Jordana,
Victorian Minister for Emergency Services, James Merlino with Victorian Minister for Health, Jill
Hennessy and Brownlow Medallist Shane Crawford presenting an award to Ryobi Hindle

LATEST NEWS
from Hadfield, called triple zero when
her mum started to feel unwell.
Lachlan Grundy. 11-year-old Lachlan,
from Port Melbourne, called triple zero
when he found a man unconscious in a
skate park as he had crashed his bicycle
into a power pole.
Lawrence Brennock. Eight-year-old
Lawrence, from Rosedale in Gippsland,
called triple zero when he saw someone
who was choking on a hamburger and
couldn’t breathe. He explained what was
happening to our operator to get the
right help
Lilly Perry. 13-year-old Lilly, from
Narre Warren South, called triple zero
when her mum passed out.
Mateusz Sztormowski. Nine-year-old
Mateusz or Mati, from Reservoir, called
triple zero when his dad had chest pain.
Michelle and Jade Woang. 12-year-old
Michelle and 11-year-old Jade, from
Blackburn South, called triple zero when
their grandfather had an infection.
Nadia Alsaadi . Nine-year-old Nadia,
from Kings Park, called triple zero when
mum was unwell.
Hayley Warner. 10-year-old Haley
called triple zero when her grandmother
had a seizure.
Jaxon. 12-year-old Jaxon, from
Mornington, called triple zero when his
dad had complications from diabetes.
Tyler Wilde. Nine-year-old Tyler, from
Ararat, called triple zero when his
grandmother fell over.
Peta-Grace Bahrami. Nine-year-old
Peta Grace, from Bentleigh East, called
triple zero for her mum who collapsed.
Ryobi Hindle. 12-year-old Ryobi, from
Redan near Ballarat, called triple zero
when his mum had an asthma attack.
Sam Clift. 10-year-old Sam, from
Traralgon, called triple zero when his
mum hit her head and was knocked
unconscious.
Sashini Kandamulla. 12-year-old
Sashini, from Cranbourne West, called
triple zero when her mum had kidney
problems.
Sharon Zhang. 11-year-old Sharon,
from Mernda, called triple zero when
her brother started having a febrile
convulsion.
Trinity Bennett. 13-year-old Trinity,
from Bundoora, was on a drive with her
mum when they did a U-turn on the
side of the road (soft shoulder) which
started to collapse. Trinity managed
to escape and call triple zero as the car
fell 30 metres off a cliff with her mum
still inside. She remained calm and was
able to provide excellent details to our
operator until help arrived.
Kiera Hardege and Kushi Patel.
11-year-old Kushi and 12 year-old Kiera
called triple zero when they were out
walking their dog and heard a smoke
alarm sounding at a nearby house and
saw smoke.
Michael Moore. 13-year-old Michael,
from Attwood, was riding his bike with
a friend when they discovered a dead
body and phoned triple zero.

LATEST NEWS
SAR AWARDS
2018 AUSTRALIAN SEARCH & RESCUE AWARDS
The National Search and Rescue
(NATSAR) Council is welcoming
nominations for the 2018 Australian
Search and Rescue Award.
This prestigious award is in recognition
of ‘outstanding contribution to search
and rescue within the Australian region’.
The successful nominee(s) will have
made a significant contribution to
Australia’s search and rescue ability or to
the saving of a human life.
The award is open to any individual,
group or organisation and may relate
to a particular event or a sustained
contribution over a period of time.
Nominations close 1 July 2018.
Last year Port Phillip Bay fisherman
Wayne Kelly won the non-professional
Search and Rescue Award for saving the
lives of three kayakers upturned in the
bay, without lifejackets.
Wayne found an unmanned kayak
floating about 4 kilometres off
Mordialloc just before midday on 17
November 2016. Without hesitation, he
contacted emergency services and began
a search on his own for possible missing
persons. Sea conditions were rough,
with winds reaching 30 knots.
Within minutes of starting his search,
Wayne located two men without
lifejackets treading water not far from
the abandoned kayak. They had spent
an hour in the water attempting to swim
the 4 kilometres to shore, and their
efforts had left them severely fatigued
and struggling to keep their heads above
water.
The men alerted Wayne to a third
person who was with them in the kayak
before it capsized. After Wayne pulled
them from the water into the safety of
his boat, he resumed his search. Less
than 30 minutes later, he located the
third missing man also treading water
without a lifejacket.
If it wasn’t for Wayne’s quick thinking
and actions, these three men might have
drowned.
Download the nomination form at:
www.natsar.amsa.gov.au/award.asp

WINTER IS COMING
AND IT’S LOOKING QUITE MILD
Jonathan Pollock & Andrew B Watkins
Australian Bureau of Meteorology
After an exceptionally warm and dry
autumn, it’s time to look ahead to see
what’s in store for winter.
The Bureau of Meteorology’s climate
outlooks for winter, issued today,
shows above-average temperatures and
below-average rainfall are likely across
southern Australia. While some of us
will relish the prospect of a mild winter,
the dry isn’t necessarily good news for
everyone.
Summer-like conditions continued into
early autumn for much of southern
Australia, including an exceptional
heatwave in early April. Temperatures
in autumn were warmer than average
across much of the continent.
New South Wales, South Australia,
Western Australia and Victoria all
experienced one of their warmest
autumns since at least 1900. Overnight
temperatures have also been warmer
than average in most parts.
For many southern areas autumn wasn’t
just warm, it was also extremely dry.
New South Wales, Victoria, southwest
Western Australia and South Australia
all had one of their driest autumns on
record.
Many farmers in southern Australia
look to the autumn break – the first

Autumn maximum temperature map. Bureau of Meterology Very dry autumn for the southern mainland
significant rain event (25mm or more)
after summer – to kick off the crop
and pasture growing season. The
autumn break arrived by mid-May
across southern Victoria, eastern New
South Wales and southwest coastal
Western Australia. However, farmers in
northwest Victoria, inland New South
Wales, eastern South Australia and
much of inland Western Australia didn’t
receive an autumn break this year.
One of reasons for the warm and
dry autumn in the south was higher
than average pressure over southern
Australia. The high pressure meant rain
bearing cold fronts from the Southern
Ocean couldn’t push up into southern
Australia.
So, will this pattern of warm and dry
continue? Two of the major drivers
of Australia’s climate, the El Niño–
Southern Oscillation (ENSO) in the
Pacific Ocean, and its equivalent in the
Indian Ocean, the Indian Ocean Dipole
(IOD), were neutral during autumn,
and are likely to remain so throughout
winter.
Of the eight international climate
models surveyed by the Bureau of
Meteorology, seven predict winter
will see ENSO-neutral sea surface
temperatures in the central Pacific, with
only one model forecasting a warming
to El Niño levels by August.
Models also suggest the Indian
Ocean Dipole (IOD) will remain
neutral through winter. But there
is quite a range of scenarios from
the international modelling centres
the Bureau assesses. One model is
predicting a positive IOD over winter,
one model predicting a negative IOD in
spring, and the other four are neutral.
Typically, when the ENSO and IOD are
both neutral there is no strong shift in
the outlook towards widespread wetter
or drier conditions across most of
Australia.
Most international model outlooks for
the ENSO sea surface temperature index
in the central Pacific Ocean (NINO3.4)
remain neutral in August. Model
outlooks provided by: BoM (Bureau
of Meteorology), CanSIPS (Canadian
Seasonal to Interannual Prediction
System), ECMWF (European Centre
for Medium-Range Weather Forecasts),
JMA (Japan Meteorological Agency),
Météo France, NASA (National
Aeronautics
Autumn rainfall map. Bureau of Meterology No strong influence from Pacific or Indian Ocean this winter
Most international model outlooks
for the IOD sea surface temperature
index remain neutral in August. Model
outlooks provided by: BoM (Bureau

of Meteorology), CanSIPS (Canadian
Seasonal to Interannual Prediction
System), ECMWF (European Centre
for Medium-Range Weather Forecasts),
Météo France, NASA (National
Aeronautics and Space Administration),
and the
However, when these major drivers
are neutral, other factors can have
a greater influence on Australian
rainfall and temperature patterns. For
instance, forecast warmer-than-usual
temperatures in the Tasman Sea and
the associated lower-than-normal
air pressure this winter is likely to
contribute to a weakening of westerly
winds over southern Australia that
would normally draw cold fronts up
from the Southern Ocean.
So, what’s the outlook for winter?
As a result of the weakened westerly
winds, below-average winter rainfall
is likely for western parts of Western
Australia, and for most of New South
Wales extending across the border into
southern Queensland and northern
Victoria. For most other parts, the
outlook is neutral, meaning roughly
equal chances of above- or belowaverage
rainfall.
above-normal likelihood of winter
“mildwaves” – periods of very mild
weather – along Australia’s southeast
coast.
So, what does this all mean? For farmers
and those working in the agricultural
sectors, the warmer temperatures mean
soils will stay warm longer. This is likely
to keep the crop and pasture growing
window open a little longer before the
cold of winter. Dry conditions are likely
to mean a slow and possibly late start to
the growing season, potentially pushing
the crop harvest later into the warmer
months of 2018, when heatwaves can
become a problem.
What does this mean for the snow
season?
For skiers, a later start to the season
becomes more likely with a warm and
dry June expected. On the other hand,
neutral ENSO conditions typically bring
snow cover that’s a little deeper than
average by mid-season.
This is a contrast to strong El Niño or
La Niña phases, which both typically
mean less snow than usual, but for
different reasons. El Niño phases mean
less rainfall and warmer days during the
snow season. La Niña years usually have
more rain, but temperatures can be too
high for snow to form.
This has happened more often in recent
decades because of climate change.
Historically, neutral years have had
more consistent good snow depths than
either El Niño or La Niña years, so late
winter should be a good time to hit the
slopes.
The outlook for June is looking
particularly dry across most of the
southern mainland.
The likely reduction in cold fronts,
and clearer skies over much of the
continent means warmer-than-average
temperatures are favoured across
southern Australia, with the strongest
likelihood (about 80%) in the southeast.
The model suggests there is also an

BLAZE AID
Helping Communities Rebuild After Natural Disasters
Blaze Aid is a volunteer
based organisation that
was born out the ashes
of Black Saturday 2009.
A community that was
devastated and fences that were in need
of rebuilding brought family and friends
together to assist in a way that was
practical and very much in need.
Kilmore East farmers, Kevin and
Rhonda Butler, were among those
whose fences were burnt. Needing to
quickly secure their 1,500 sheep, they
sought assistance from family, friends
and local volunteers to help rebuild their
fences.
Within a week, the fences were
completed – a task that would have
taken them months to do on their own.
Grateful for the assistance they received,
Rhonda and Kevin decided to try to
help a few others with their fencing.
Thus, BlazeAid was born.
Since the devastation of the Black
Saturday bushfires on 8th February
2009, thousands of long- and shortterm
BlazeAid volunteers have come
to help rebuild fences for the bush
fire survivors. Volunteers have come
from all parts of Australia, as well as
New Zealand, Switzerland, England,
Afghanistan, Canada, Germany, Austria,
America and France.
Working tirelessly but cheerfully
alongside the bushfire survivors,
Blaze Aid volunteers have rebuilt over
400 km of fences in areas including
Kilmore East, Kinglake, Kinglake
West, Pheasant Creek, St Andrews,
Strathewen, Flowerdale, Wandong,
Mt Disappointment, Glenburn,
Murrundindi and Clonbinane. In
addition, they have helped to remove
hundreds of kilometres of damaged
fencing, removed fallen trees from
fence-lines, helped with gardening
projects, and even built the odd chook
shed or two.
By lending a hand in true Aussie style,
BlazeAid volunteers not only built
fences, but helped to restore the spirits
of fire survivors who lost family and
friends, pets, stock, homes and property
to the inferno. The survivors assisted are
extremely grateful for the work, support
and friendship of BlazeAid’s volunteers.
BlazeAid’s work over these many
months could not have been achieved
without the generosity of the many
donors, sponsors, volunteer groups,
individuals and businesses who have
assisted us with tools and equipment,
food, accommodation and billeting,
transport and hands-on support in the
fire zones.
You can find information on how to
volunteer, latest camps, what is needed
for immediate assistance and ways to
donate at their website:
www.blazeaid.com.au
Blaze Aid also has a social media
presence on Facebook and is listed
on the govolunteer website for those
looking to help in their communities.
If you have been affected by a natural
disaster there is information on their
page on how to seek help and assistance.
Blaze Aid has been recognised Australia
wide for the incredible contribution the
volunteers have made to peoples lives
and livelihoods.

Lessons in Resilience
Hobart’s flooding disaster a lesson for city planners

Hobart is a city
known for its risk of
catastrophic fire, such
as the devastating
wildfires of 1897-98
and 1967. As the second-driest city
in Australia, until last week it was
easy to forget that Hobart is also
vulnerable to serious flooding. Like
many cities, Hobart’s closeness to
nature can be a double-edged sword
– the hilly terrain affords spectacular
views of the mountain and the river,
but makes the city especially prone to
wildfire and flash-flooding.
Hobart’s lack of preparedness for the
scale and intensity of the May 2018
flood is also partly attributable to the
city’s postwar planning. So how can
Hobart and cities like it become more
resilient to increasingly frequent
natural disasters?
A history of vulnerability and risk
Like it or not, disasters are part
of the urban landscape. So too is
social inequality. And the two can
be mutually reinforcing – socially
isolated and disadvantaged residents
are often less able to cope when
disaster strikes. They may, for
example, lack insurance or be less
mobile.
Social cohesion is a key element in
community disaster recovery, helping
cities “bounce back” after an event.
But good land use planning is also
important to avoid creating future
problems.
Planning (non)-responses
Like the rest of Australia, historically
city planning in Hobart was
characterised by disconnection
from nature. Creeks and streams
were filled in, built over or walled
off (taming nature), creating risks of
catastrophic failure in unexpected
conditions. This approach also
overlooked the important ecological
functions of watercourses.
The recent storm event was not the
worst on record. In the 1960s, the
city experienced very severe flooding.
There were also several bad floods in

the 1930s. But Hobart has changed since
then.
The city has grown significantly. As
houses, roads and buildings increase the
paved area, Hobart has lost some of its
green cover, which acts like a sponge.
And in recent times the city has had an
influx of residents who lack experience
with the city’s natural hazards.
Over the decades, the record of flood
events has been partly translated into
planning knowledge. For instance,
Hobart’s interim town planning
scheme has overlay maps indicating
places prone to flooding, landslide and
wildfire.
Planners now also apply watersensitive
urban design principles. These
include protecting floodplains from
development, limiting the development
of very steep land, and restricting
land uses on flood-prone sites (e.g. to
recreation areas).
Unfortunately for Hobart’s residents,
many of these principles were devised
after much of the city was already
built. Planning is less effective at
retrospectively requiring that buildings
are upgraded or even relocated.
Given Australia’s system of property
rights, planners can seldom relocate
entire communities out of harm’s way –
the response to the Grantham floods in
Queensland has been an exception. The
default approach has been to leave it to
the insurance system to manage risk and
recovery.
Whose responsibility?
One of the drivers for the lack of
policy on minimising disaster risks in
Tasmania is the state government’s aim
to reduce government involvement in
risk management and shift responsibility
onto households and businesses. This is
placing a greater emphasis on disaster
“self-help” through insurance and risk
reduction – such as clearing firebreaks,
cleaning gutters and so on.
We assume that if a flood or fire affects
residents, then insurance will allow
them to get back on their feet. However,
half of residents may be underinsured,
according to Victorian government
estimates. The reasons include being
Hobart Rivulet in flood Circa 1936 - Tasmanian Archives & Heritage Office
unable to afford insurance or deciding
they have more pressing financial
priorities.
Insurance can also be inadequate
because it is hard to estimate
replacement costs. These costs may soar
after a disaster. The Hobart repair bill
has already climbed above A$20 million,
and residents may discover their policy
is inadequate.
What can planners learn from this?
Even though Hobart avoided loss of life
in the recent floods, we might not be
so lucky next time. Governments have
a key role to play in getting the balance
right between regional and large-scale
infrastructure planning and self-help
at the household level. Focusing on
self-help at the expense of planning and
broader-scale mitigation can increase a
city’s vulnerability.
We need to learn from other places. Key
actions should follow the principle of
safe failure and may include:
• better communication of hazard
mapping and using town planning
scheme overlays to enforce
development restrictions
• devising state policies for
watershed, coastal and bushland
management to reduce risks at
regional and watershed scales,
which includes protecting green
space and restoring floodplains
• identifying opportunities for
“multifunctionality” – for example,
a cricket ground is also a flood
retention basin
• strengthening social cohesion and

educing inequality, so communities can bounce
back faster
• identifying properties in harm’s way and using new
building codes, compulsory acquisition or even
managed relocation to reduce hazard exposure
• siting critical infrastructure, such as hospitals and
electricity substations, away from floodplains and
building in redundancy – backup infrastructure,
for example.
Not all these solutions can be implemented
immediately. Paradoxically, some actions – planting
trees, for instance – could increase other risks, such as
bushfires.
In cities like Hobart, by learning from past mistakes and
experimenting with alternative solutions, good planning
can avoid putting people in harm’s way in the future.
Authors:
Jason Byrne
Emma Pharo
Dave Kendal
Kate Isabel Booth
University of Tasmania
www.bullfrogs.com
FURNITURE STATUES OTHER DECOR
Stunning modern &
classic Balinese
furniture
Various types of
statues from the
popular to the rare
Be inspired by our
broad collection of
Balinese home decor
“Bring the Resort Look at Home”
Balinese Decor and Furniture Mornington Peninsula
03 5973 6308 0400 025 828
Visit our showroom at:
Factory 3 1 Watt Road
MORNINGTON VIC
simon.kennedy3@bigpond.com

The impact of home on
the care of our elderly
Suzanne Dyer & Stephanie Harrison
Flinders University
A new study out today has found
residents with dementia in aged-care
facilities that provide a home-like model
of care have a better quality of life and
fewer hospitalisations than those living
in more standard facilities. We also
found the benefits of a home-like model
were provided without an increase in
running costs.
Our study compared home-like models
(which have up to 15 residents per unit
and free access to outdoor areas) to
more standard residential care, where
a large number of people are housed in
one building. In 2011, around half of
all facilities in Australia had places for
more than 60 residents, and the average
size is growing.
The World Health Organisation has
stated smaller home-like residential care
settings “hold promise for older people,
family members and volunteers who
provide care and support”. But Australia

is lagging behind other countries in
offering alternative models of residential
aged care.
What is a home-like model of care?
Most older people with dementia
want to stay at home as long as they
can. When this is no longer possible,
they move into residential aged-care
facilities, which become their homes.
These residential facilities, or nursing
homes, frequently adopt a model of
care that emphasises individuality. This
is known as person-centred care. But
delivering this model may require more
staff or a different mix of staff, which
may be difficult to deliver with current
funding.
So standard aged-care facilities in
Australia often have some similarities
to health facilities, with designated staff
areas and centralised kitchens.
Access to outdoor areas, particularly for
people with dementia, may depend on
the availability of staff. Despite adhering
to philosophies such as person-centred
care, the scheduling of this care and of
meals often lacks flexibility.
The problems are compounded when
residential care is used for multiple
purposes ranging from palliative care to
providing care for people with dementia.
The needs of these two groups are quite
different and the lack of focus makes
delivering quality care a challenge.
Evidence shows the physical design of
the residential aged-care environment
may play an important role in the wellbeing
of residents, particularly those
living with dementia. Internationally,
there is a move towards providing care
in facilities that feel more like a home
and promote independence.
Such models of residential aged care
generally have:
• flexibility in daily routines – for
example, the time people get
dressed and eat
• opportunity for residents to

participate in domestic activities
such as meal preparation
• access to outdoor spaces
• clusters of smaller living units (up
to, say, 15 residents in each)
• care staff assigned to living units for
continuity of care and development
of relationships between staff and
residents.
Our study was specifically designed to
include people with dementia and their
family members. People with dementia
are not often included in research
studies.
It included 541 participants from 17
not-for-profit residential aged-care
facilities in four different states in
Australia. They had been residents for a
year or longer.
These facilities were all considered high
quality. This means they had lower
hospitalisation rates for potentially
avoidable conditions than the national
performance target. And more than
80% of residents in the standard care
facilities indicated they felt as safe as
they wanted and that their environment
was as clean and comfortable as they
wanted.
Around one-quarter of people in the
study lived in a facility with a home-like
model of care. All of them were living
with dementia.
The study found residents in home-like
models of care had a better quality of
life, as rated by the residents themselves
or their family members. They also had
a 68% lower rate of being admitted to
hospital and 73% lower rate of having an
emergency department presentation.
We have previously shown residents
who lived in a home-like model
were 52% less likely to be exposed to
potentially inappropriate medications.
These are medications where the
potential harms may outweigh the
benefit, such as antipsychotics or
relaxants, but are still often prescribed
to older people in residential care.
The benefits for residents were provided
with similar running costs for the
home-like and the standard models
of care. However, the costs excluded
differences in the build of the facilities.
Initial establishment costs are likely to
be higher, due to the requirement for
more space per resident.
Rethinking models of care
Funding arrangements don’t incentivise
Australian aged-care providers to
offer variety in terms of models of
care. Government funding is provided
based on the assessed care needs of
the residents, rather than the preferred
model of care or resident outcomes.
Funding supplements are available
to care providers for reasons such as
residents’ financial hardship or risk
of homelessness and to small, rural
aged-care service providers, but none
are available for offering an alternative
model of care.
The Australian government plans to
improve the aged-care system to offer
“choice and flexibility”. This is crucial,
but we also need to improve choice and
variety in residential aged-care models.

ACCOUNTABILITY
IN OUR
INTEL
INDUSTRY
Daniel Baldino
University of Notre Dame Australia

Intelligence doesn’t have to be,
and rarely is, James Bond-esque.
Indeed, 007 is the world’s worst
spy: everyone knows who he is,
meaning he is compromised,
exposed and susceptible to blackmail
before he even arrives to save the day.
But the September 11, 2001, terror
attacks, and the all-encompassing “war
on terror” that followed, did have a
major transformative impact on the
handling of secrecy and surveillance
activities in government programs.
One impact has been the growth of
executive authority in national security.
This has exacerbated demonstrable
tensions between civil liberties, trust
and secrecy. As noted by former ASIO
chief David Irvine, the public will always
have some degree of suspicion regarding
the secret function of intelligence
agencies.
There is much to be gained by having
an electorate better educated in the
work of the Australian Intelligence
Community (AIC). An informed public
is better placed to question or accept
the need for Australia’s intelligence
agencies. This extends to the merits of
expanding budgets, powers, oversight
and responsibilities.
In the botched hunt for Iraq’s alleged
weapons of mass destruction (WMD)
stockpiles in 2003, the “slam dunk”
assessments used to build a preemptive
war rationale corroded public
confidence in political leadership and
the intelligence industry.
The WMD fiasco was accompanied by
an inexhaustible antagonism around
the world about the role of spies and
intelligence agencies.
It is now widely accepted that Iraq has
been a strategic disaster. Yet many core
public debate points remain conflicted
and uncertain. To what extent should
an intelligence “failure” be traced back
to failings in domestic leadership,
a selective approach to intelligence
estimates and a culture of political spin
that seeks external scapegoats?
Cynicism about the credibility of the
intelligence sector has not abated. US
President Donald Trump, a conspiracy
theorist who famously questioned
former President Barack Obama’s
citizenship, has maintained his theories
into the Oval Office. Trump has both
embraced and distorted the term “Deep
State”. This emotive term is based
on the idea that security elites and
institutions are deliberately attempting
to undermine (or potentially overthrow)
the government. Trump has even
claimed that America’s spies are acting
like Nazis.
His imagery of a corrupt, rogue and
monolithic intelligence bogeyman
out to topple him is downright bogus.
But its rhetorical simplicity plays into
the public’s pre-existing fears about a
shadowy political world.
At the same time, push-back against
Trump’s political tactics and selfserving
showmanship doesn’t mean
the intelligence community should
be immune from criticism and
accountability.
The CIA, for instance, has a lengthy
history of pushing or breaking moral
and legal boundaries in locations such
as Latin America. Ditto the Iran-Contra
affair. US intelligence has also been
accused of monitoring human rights
workers and harassing civil society
groups and social dissenters engaged in
legitimate political activities.
Likewise, in Australia in 1977, the Hope
Royal Commission on Intelligence
and Security unearthed deep-seated
problems with principles of propriety,
including legality, within ASIO.
The end result of inquiries into the
actions of the intelligence community
often raises more questions than
answers, which feeds public mistrust
and anxiety about intelligence and the
function of government.
As we have matured, successive
Australian governments have extended
and deepened the responsibilities of the
intelligence community. It is imperative
that future boundaries set for our
intelligence agencies are not crossed. For
example, we should ensure that the AIC
collects information as needed, not just
because it can.
Unnecessary snooping is just one area
that speaks to the broader importance
of oversight, accountability, and an
educated and understanding electorate.
The overall mandate of the AIC is to

provide the government with “information” to better enable it
to understand the issues confronting it. This, in turn, is meant
to facilitate coherent policymaking.
However, good intelligence will not automatically guarantee
good policy. Intelligence, after all, is an imperfect science and
just one of the tools available to policymakers.
The task of intelligence agencies is not an easy one. Indeed,
large budgets, hardworking staff and all the expertise in the
world cannot ensure that a threat, or opportunity, will be
recognised or acted upon in a timely fashion. Connecting the
dots will rarely result in an end-product of absolute certainty.
At the same time, the demands of policymakers should not
distort or corrupt intelligence – intelligence must inform
policy (not visa versa). Intelligence agencies must “speak truth
to power”. Integrity and candour, rather than ideological or
personal loyalty, remain core prerequisites in dealing with
political leaders.
Yet, the appearance of accountability does not necessarily depoliticise
national security. Nor does it prevent overt political
pressure, or the manipulation of intelligence operations to
justify preordained political conclusions.
In June 2017, Malcolm Turnbull’s government rolled out
the largest and most significant changes to the AIC since its
creation.
Checks and balances on government error and excess should
remain a vital trademark of a healthy democracy. In this sense,
a number of the proposed reforms should be applauded.
This includes boosting the role and resources of both the
Parliamentary Joint Committee on Intelligence and Security,
as well as Office of the Inspector-General of Intelligence and
Security.
We specialise in all hydrodipping of automotive
professional equipment and instruments
Plastics Metals Fibreglass Wood
Spray Painting and Repair
0468 535 993
canberrahydrographics@gmail.com
76 Hoskins Street Mitchell ACT 2911
These changes also attempt to resolve questions about whether
the boundaries and operational principles between agencies
can be more clearly drawn. There are hopes the establishment
of a new Office of National Intelligence (in place of the Office
of National Assessments) will assist in greater co-ordination
and complementary cross-agency efforts.
Of course, much of the devil remains in the detail. And a
number of oversight gaps remain, including how to best
protect whistle-blowers who expose unethical or illegal
behaviour. We are also yet to see the implementation,
execution and performance outcomes stemming from
this major reform exercise. Further, the simultaneous
announcement of new Home Affairs arrangements will
demand equal critical scrutiny.
It’s been mooted that intelligence successes are often
overlooked, while intelligence failures are widely broadcast.
Popular misconceptions, polarisation and arguably excessive
secrecy arrangements mean that the AIC will continue to
operate in, and need to be responsive to, a backdrop of public
misgivings, political point-scoring and conspiracy theories.
Located in the heart of the business area of its
community, Woorabinda Aboriginal Shire Council
supports the needs of community and the
development of employment and
business opportunities
www.woorabinda.qld.gov.au
07 4925 9800
ea@woorabinda.qld.gov.au
112 Munns Drive, Woorabinda QLD 4713

ENVIR
FO
REDUCING
Picture the environmental life cycle of many disposable
surgical instruments. Iron ore from Western Australia is
shipped to China and smelted, fashioned into stainless
steel surgical instruments in Pakistan and exported as
single-use instruments. In Australia, clinicians use these
instruments once, then discard them.
So much that comes into patient contact is routinely
used only once. This includes gowns, surgical drapes and
covers for patients, anaesthetic breathing equipment, face
masks and bed mats.
On top of this, energy is wasted in hospitals because
heating, cooling and devices are left on when not in use.
It’s not surprising then to learn that health care produces
7% of Australia’s carbon emissions; hospitals produce
about half of this.
Here are five ways Australian hospitals can reduce their
environmental footprint and improve their financial
bottom line.
1. Employ a sustainability officer and get staff involved
A hospital sustainability officer examines ways to reduce
energy use and waste, and encourages staff to participate
actively in environmental projects. Although an “upfront
cost”, in the absence of a sustainability officer activities
known to save money and reduce our environmental
footprint won’t occur.
At Melbourne’s Western Health, installing LED lights
saved around 1,200 megawatt hours (Mwh) per year. This
is similar to disconnecting around 165 Victorian houses

OUR HOSPITAL’S
ONMENTAL
OTPRINT
from the electricity grid. The installation cost was paid back
within two years.
Other sustainable activities included alternatively turning off
one of the three hospital gas boilers during lull periods and
installing large-scale (300kW) solar panels. These produce
around 440 Mwh per year.
Since 2007, institutions that have similar daily energy
requirements to 3,000 Australian homes or more have been
required to annually report their energy use and greenhouse
gas emissions to the federal government’s Clean Energy
Regulator. Many medium to large hospitals fall into this
range.
There aren’t any mandated requirements to reduce energy
use or greenhouse gas emissions, but the reporting allows
hospitals to gauge changes over time and strive to improve. In
the absence of a hospital sustainability officer, hospitals hire
expensive contractors to ensure the reporting requirements
are met.
Although some hospital staff are interested in workplace
sustainability and want to make a difference, there are many
barriers to doing so – both physical and psychological. Local
sustainability action plans can be put in place to help staff
work together to improve hospital sustainability. Activities
can include staff in operating rooms being involved in
lighting “switch-offs”, recycling different items and sending
unused, out-of-date equipment to less advantaged countries.
2. Reuse surgical equipment where possible
Single-use medical equipment often costs more money than
reusable equipment. Studies conducted at Western Health and
Yale-New Haven Medical Center in the US found reusable
anaesthetic equipment in operating theatres saved around
A$5,000 a year per operating theatre.
The environmental footprint will vary according to the
source of electricity. In the above studies, cleaning reusable
anaesthetic equipment in Australia resulted in a slightly
higher carbon footprint. This is because sterilisers and
washers use a lot of electricity, which is derived mainly
from coal in Australia. In the US, electricity is sourced from
a less carbon-polluting energy mix (more natural gas in
particular).
Research in Australia and Germany has shown reusing the
standard breathing circuits used by anaesthetists to deliver
oxygen and gases to anaesthetised patients does not increase
the risk of microbiological contamination. Also, reusing
these yearly for a six-theatre operating suite saved around
A$5,500 and the equivalent electricity and water savings of
one entire Australian household.
3. Recycle better
It is feasible to increase the amount of total recyclable
hospital waste from very little to 35%, which saves money
even in operating theatres. The most obvious first step to
increase recycling rates begins with cardboard and paper
products, which surprisingly even now may not be recycled.
It is also important to separate expensive hospital infectious
waste from other less expensive, non-infectious waste.
Plastic from IV bags and oxygen tubes could be recycled.
from shutterstock.com
Several plastic types from hospitals can be recycled relatively

easily, including PVC plastic. Some manufacturers in
Melbourne are working with hospitals to convert PVC plastic
from IV bags, face masks and oxygen tubes into agricultural
pipes and children’s play equipment. More than 130 hospitals
in Australia and New Zealand are involved.
All recycling efforts require collaboration between clinical
staff, infection prevention, environmental services and
recyclers.
4. Avoid potent anaesthetic greenhouse gases
Anaesthetic gases are hundreds to thousands of times more
potent greenhouse gases than CO₂. Desflurane and nitrous
oxide are the most problematic, but can be substituted
without altering patient care.
These gases do have more rapid anaesthetic onset and offset
durations, but other, less environmentally harmful gases can
be used just as effectively. Due to familiarity and perhaps
drug marketing, desflurane and nitrous oxide remain in
common use by anaesthetists.
Several Australian hospitals have saved A$30,000 and
hundreds of tonnes of CO₂ annually by substituting
desflurane with other anaesthetic gases. Victoria’s health
system alone could save hundreds of thousands of dollars a
year by such substitution.
5. Advocate and collaborate towards a low-carbon, low-waste
system
It’s important to minimise patients’ need for care in a
hospital as much as possible. This will involve increasing the
role of general practitioners, public health care and disease
prevention. We should also avoid unnecessary and potentially
harmful tests, such as performing a variety of common blood
tests on all pre-operative patients (even those who don’t need
them).
The health-care system can’t become low carbon and low waste
without leadership, incentives and direction. In 2008 the UK
Climate Change Act legislated for an 80% reduction in CO₂
emissions by 2050 and formed the Sustainable Development
Unit – a national body charged with reducing health care’s
CO₂ emissions. By 2017 there was an 18% increase in UK
health-care activity, yet an 11% reduction in CO₂ emissions.
Nothing like this exists in Australia.
Australia’s current ad hoc, piecemeal approach by engaged
clinicians to improve hospital sustainability and translate
this to all hospitals is not working. The federal government,
which funds around half of all health care, could promote
environmental sustainability by:
• making environmental standards a mandatory
component of quality as part of the remit of the Australian
Commission on Safety and Quality in Health Care – the
accrediting body for Australian hospitals
• creating a health unit modelled on the UK’s Sustainable
Development Unit.
It’s time for more sustainable use of health care’s financial,
environmental and social resources. Our health depends on it.
Forbes McGain
University of Sydney

BUSHFIRE EMERGENCY EVENT PLANNING
INTEGRATED SOLUTIONS TO ENHANCE THE ENVIRONMENT AND PROTECT
PEOPLE FROM BUSHFIRES.
Our clients come from both the private and public sectors, across Victoria and interstate. They range
from individuals needing bushfire assessments for their properties, to private land developers and
government agencies such as local governments and environmental agencies requiring strategic planning
solutions.
Some well known Music Festival
events and other community
icons such as Royal Botanic
Gardens have taken advantage
of our expertise in bushfire and
emergency management over the
years.
Ecotide have the capability
and experience to undertake
event bushfire and emergency
plans for music festivals and
events throughout Victoria. Our
Event Bushfire & Emergency
Management Plans (EMP)
optimises the chance that your
bushfire risk is reduced, and the
appropriate event emergency plan
procedures are in place.
Event Emergency Plans - Bushfire
Emergency Management Plans
Events may include:
Music festivals
Sporting events
Cultural festivals
Jamborees
The EMP will:
• Incorporate a risk management
approach in accordance with
AS31000:2009
• Detailed treatments to mitigate or
minimise the risks
• A prioritised works plan for
treatment implementation
• Simple to follow triggers and
responses in a bushfire emergency
Ecotide’s previous work has included
Lorne’s Falls Festival, Meredith and
Golden Plains Music festivals, all
of which required robust bushfire
emergency management planning to
assure event overseers that it
could safely be operated, and to
ensure that patrons of festival
would be kept safer in a bushfire
emergency.
The Meredith Music Festival,
one of Victoria’s iconic music
festivals, depended upon an
Ecotide Emergency Management
Plan to prepare and organise the
emergency management and
operations of the event. The plan
has helped to reduce risks and
maximise safety for the patrons
of the event, which is critical for
a festival held during December
within the Fire Danger Period.

Globalisation
and
Infectious
Disease
Professor Allen Cheng
Monash University
These days we can get from most remote villages
anywhere to home in 36 hours. And migrating
humans can certainly carry microbial “passengers”.
This means the increasing globalisation of our world
can give infectious diseases a good opportunity to
spread.

In the age of exploration, introduced
infections played a major role in
shaping human history. Although
the origins of the 1918 Spanish Flu
pandemic are hotly debated, the timing
of its onset in Europe coincided with
mass troop movements towards the
end of the first world war. It probably
came with American troops from Camp
Funston in Kansas.
More recently, it’s thought HIV/AIDS
emerged early in the 20th century, but
only in the 1960s did it spread along
transport routes in Africa.
Developed countries, particularly those
like Australia that are geographically
isolated, often feel relatively protected
from epidemics. But travellers have
introduced cases of Ebola to the US
and Europe, brought SARS from Asia
to Canada, and MERS coronavirus
from Saudi Arabia to South Korea.
Recent studies have highlighted the risk
of importation of antibiotic-resistant
bacteria from countries where resistance
is more common.
The impact of globalisation is much
more complex than simply travel,
however. A World Health Organisation
report nominated several factors that
can worsen the spread of infectious
diseases. These include changes to the
environment, demography, economy
and technology.
Environmental impacts on infectious
diseases
The impact of humans on the
environment can change the risks of
infectious diseases in several ways.
Climate change can affect the prevalence
of disease-transmitting insect vectors
(such as mosquitoes, which often
thrive in warmer temperatures) and
sea surface temperatures, which have
been associated with disease outbreaks
such as cholera as warmer oceans allow
germs to thrive.
The encroachment of humans into
animal habitats can result in the
exposure of humans to new diseases,
known as “zoonoses”. This is thought to
be how HIV crossed over from being
a disease of primates to infect humans.
Other diseases that have originated
from contact with animals and their
environments include SARS (from
bats via civet cats in southern China),
Hendra virus (via bats to humans and
horses) and Nipah virus (again bats to
humans and pigs).
Population change and infectious
diseases
In addition to the increase in population
mobility, other diseases can spread as
a result of demographic changes. This
includes increasing urbanisation. It has
resulted in an increase in dengue (as
the mosquito vector is most common
in cities), but a possible decrease in
malaria (partly because of the lack
of freshwater breeding sites for the
malaria-transmitting mosquito).
And conflict can disrupt public health
infrastructure, including clean water,
sanitation and immununisation
programs. This can result in disease
outbreaks among refugees and internally
displaced persons. Crowded conditions
are also associated with more intense
transmission of infections such as
tuberculosis.
The economy and infectious diseases
Economic changes have mixed effects
on infectious diseases. Increasing
national wealth is generally associated
with a shift from infectious diseases to
non-communicable diseases (such as
diabetes and heart disease).
This complex phenomenon is known as
the “epidemiological transition” where
better sanitation and medical care lead
to longer life and thus more diseases of
ageing and injuries.
Lengthening supply chains of food
products can result in international
outbreaks, such as hepatitis A related to
frozen berries from China.
Some antibiotic resistance is related to
antibiotic use in animals. This is often
required because of the industrialisation
of food production.
“Medical tourists” – travellers from
developed countries who take advantage
of cheap, high-standard medical care
in middle-income countries – may be
at risk of antibiotic-resistant infections.
This concept was unheard of even 30-40
years ago.

Global supply chains in pharmaceuticals
have enabled cheaper access to many
drugs, including antibiotics. But
this has led to global shortages of
some antibiotics. Recent damage to
manufacturing facilities in Puerto Rico
resulted in drug shortages in the United
States.
Poor-quality drugs and poor prescribing
practices where drug regulation
standards are lax can mean bacteria
are exposed to low concentrations of
antibiotics.
This means some bacteria don’t die and
thus learn how to evade the drugs.
Additionally, counterfeit
pharmaceuticals are sometimes
spiked with just sufficient amounts of
antibiotics to pass detection assays.
Technological change and infectious
diseases
Technological change has also had
mixed impacts on the prevalence of
diseases and how they spread. Although
the speed of air travel poses many risks,
we now have many better tools for
disease surveillance and analysis.
Examples include the monitoring
of infectious disease outbreaks by
independent organisations such as the
International Society for Infectious

Diseases, which operates the “rumour
desk” website Promed-Mail. And
organisations such as the ECDC
regularly publish risk assessments of
emerging infections.
Improvements in gene analysis and
computer hardware allow us to
pinpoint the origins of many pathogens,
including Ebola, influenza, measles,
food-borne infections and antibioticresistant
bacteria. More importantly,
genomic analyses can enable rapid
recognition and control of outbreaks.
The potential now exists to augment
traditional disease surveillance with new
sources.
In theory, compliance with quarantine
could be verified on social media, or
the source of legionella outbreaks could
be narrowed using mobile phone geolocations.
But similar to the debate over
surveillance technologies for national
security, we need to explore the ethical
implications of these new technologies
first.
North Australian Aboriginal Family Legal Service
www.naafls.com.au
Legal Advice & Assistance
Information, Support & Referral Services
Community Legal Education and Family Violence Prevention Initiatives
Law Reform Activities
E: admin@naafls.com.au
Darwin: 08 8923 8200
Katherine: 08 8972 3200
PO Box 43104
Casuarina NT 0811

The Myt
Compassion

A
71-year-old man with
advanced dementia is
being wheeled into his
residential care home
by two paramedics
after a scheduled
MRI. They notice him smile as he feels
the warmth of the morning sun on his
usually forlorn face. They decide to stop
and let him soak up the rays for a few
more minutes, knowing this may be one
of his last opportunities to do so.
What is the impact of this
compassionate act on this patient? What
is the cost for the health-care providers?
The story we are told is that compassion,
which is increasingly demanded within
health care, is finite. Health-care
providers are finding it increasingly
difficult to provide it — in the midst of
growing patient workloads, paperwork,
institutional demands and workplace
stress. Like cars, when health-care
providers use this fuel in their work,
they run the risk of depleting their
compassion “gas tanks” in the process.
The result: compassion fatigue.
h of
Fatigue
But what if compassion fatigue is a
myth? As an associate professor in the
Faculty of Nursing at the University of
Calgary, my research has focused on
finding ways to improve compassionate
care within health care. Members of my
compassion research lab and colleagues
across Canada have examined the
concept of compassion fatigue within
health-care research.
We found no evidence that there
is anything especially tiring about
compassion. We discovered that the
very idea of compassion fatigue causes
health-care providers to mistakenly
guard this precious commodity. It also
distracts from the very real challenges of
occupational stress.
Cost of caring?
Our research revealed that compassion
fatigue was originally conceptualized
as the “cost of caring.” The argument is
this: the more that health-care providers
are exposed to traumatic patient
situations, the more their compassion
is eroded. In other words, loss of
compassion is an inevitable outcome of
caring.

Over time, a second, more pervasive,
understanding emerged. This views
compassion itself as the cause of fatigue,
rather than a symptom of occupational
stress. Seen this way, expressions of
compassion, in and of themselves, cause
compassion fatigue.
As a result, health-care providers
become susceptible to suffering from
the very thing that their patients need.
Ironically, this leaves us in a quandary,
a vicious cycle, a supply-demand glut
that itself perpetuates the problem —
namely, as the demand for compassion
by patients increases, health-care
providers are required to expend this
apparent finite resource.
Many health-care providers wish
for the institutional support to offer
more compassion in their work.
(Shutterstock)
This also implies that there is something
unique about compassion that makes it
much less “fuel efficient” and potentially
more harmful to health-care providers
than standard forms of care or even
expressions of apathy.
This has consequences for health-care
delivery. It encourages an approach in
which health-care providers mistakenly
guard this precious commodity. They
face a dilemma— to provide patients
with the compassion they want (and
jeopardize themselves in the process) or
leave patients’ needs unmet.
Much like protectionist governments
who try to protect their internal
resources and economies out of fear that
they will be disadvantaged if they extend
them beyond their borders, compassion
fatigue implies that expending too
much compassion to others will be
detrimental to health-care providers’
own wellbeing.
Traumatizing care-giving?
In our review of the literature, we
also discovered the term “compassion
fatigue” originated in the field of crisis
counselling. It was first used to describe
secondary traumatic stress experienced
by counsellors working with trauma
victims. It was adopted into mainstream
health care to provide a more
sympathetic, less stigmatizing, term for
burnout and secondary traumatic stress.
The result is that all care-giving is
potentially traumatic. And health care
is given a special status in comparison
to other occupations, where stress and
burnout are attributed to factors such
as poor work-life balance, increased
workload and lack of support.
Transplanting compassion fatigue
from the field of secondary traumatic
stress and applying it broadly to health
care not only equates all care-giving
as potentially traumatic, but gives
occupational stress among health-care
providers special status in comparison
to other occupations.
How exactly this occurs is not
clear either. Patients have defined
compassion as “a virtuous response
that seeks to address the suffering and
needs of a person through relational
understanding and action.” But it is not
clear which of these key ingredients of
compassion cause compassion fatigue
or are more vulnerable to compassion
fatigue. As a result, research measures,
indicators and interventions for
compassion fatigue rest on a somewhat
fragile foundation.
A stimulus for health-care renewal?
The idea of compassion fatigue has
negative consequences. For healthcare
providers, it distracts from the
very serious, multifaceted issues of
occupational stress that they face on
a daily basis. It also implicates them
unfairly as the problem in the process.
And it suggests that there is something
inherently lacking within health-care
providers themselves.
What’s more, if there was a link between
compassion fatigue and provision
of compassion, then health-care
providers should be some of the least
compassionate individuals in society.
This conclusion is not supported by
research or by patients. In over 13 years
of clinical experience the vast majority
of health-care providers I have had the
privilege of working with would warmly
welcome greater opportunities to
provide compassionate care.
Instead, the focus should be on
developing compassionate health-care
systems to support these individual
health-care providers.
Compassion should be reconceptualized
as a health-care
stimulus — renewing our health-care
systems from the inside-out, sustaining
health-care providers and meeting an
important patient need in the process.
Shane Sinclair
Faculty of Nursing
University of Calgary

Triple Zero (000) 112 From Mobiles
BUREAU OF METEOROLOGY
www.triplezero.gov.au
State Emergency Service (SES) 132 500
General Warnings 1900 969 922 www.bom.gov.au
Cyclone Warnings 1300 659 212 www.bom.gov.au/cyclone
Coastal Marine Warnings 1300 360 427 www.bom.gov.au/marine
Tsunami Threat Information 1300TSUNAMI www.bom.gov.au/tsunami
RADIO
EMERGENCY CONTACT INFORMATION
POLICE FIRE AMBULANCE
ABC Local Radio
ABC Local Radio Frequency Finder
Commercial Radio Australia
www.abc.net.au/local
www.abv.net.au/radionational/frequency/
www.commercialradio.com.au
GOVERNMENT/HEALTH/ROADS
Standard Emergency Warning Signal
www.emergencyalert.gov.au
Health & Hospitals 13HEALTH www.health.gov.au
Road Closures 13 19 40 seek local/state road closure info
ELECTRICITY
Energex 13 19 62 www.energex.com.au
Ergon 13 16 70 www.ergon.com.au
PHONE
Telstra 132 203 www.telstra.com.au
Optus 13 13 44 www.optus.com.au
ANIMALS & WILDLIFE
Wildlife Hotline 1300 130 372
RSPCA 1300 852 188
Disease Watch Hotline 1800 675 888
Lost/Missing Animals
Local RSPCA website
CALL 000 IN AN EMERGENCY

APPS TO HELP
YOU IN AN
EMERGENCY
TECHNOLOGY IS FOREVER CHANGING AND IN MOST CASES TRYING
TO IMPROVE OUR ACCESS TO INFORMATION. WE HAVE PUT
TOGETHER THE TOP APPS IN AUSTRALIA THAT ARE FOCUSED ON
KEEPING YOU SAFE AND INFORMED
Fires Near Me App - Developed by the NSW Rural Fire Service it will
provide information about bushfires from participating fire agencies across
Australia. The app finds your location using a map and will give relevant information
around you. It also allows you to choose a location. The app also
provides information on total fire bans.
The Emergency+ app is a free app developed by Australia’s emergency
services and their Government and industry partners.
The app uses GPS functionality built into smart phones to help a Triple Zero
(000) caller provide critical location details required to mobilise emergency
services
Emergency AUS App - delivers warning and incident information issued
by official agencies across Australia. Providing you with real-time access to
official warnings, incident reports and public Sensory Observations to aid
in better decision making during emergencies and disasters. By bringing
together emergency information from over 25 emergency service agencies
and accessing observations submitted by the public
Triple Zero Kids Challenge App - Start playing and learn about what happens
when you call Triple 000. The online game is designed for children of
kindergarten and primary school age and consists of a number of safety scenarios.
The game is available in seven languages including English, Arabic,
Vietnamese, Chinese, Thai, Hindi and Dinka.

A gift for living
If you’re aged 50-74 you’ll be sent a free bowel cancer screening kit. The kit is simple to use and
can detect bowel cancer before any symptoms appear. Around 80 Australians die of bowel cancer
every week, but if detected early, up to 90% of cases can be successfully treated. So be sure to
complete and return your kit. It’s a gift that could save your life. If you’re over 74 talk to your GP.
By 2020 people aged 50-74 will receive a kit every two years.
australia.gov.au/bowelscreening
1800 11 88 68
Authorised by the Australian Government, Capital Hill, Canberra.

When you make your body move, your heart beats faster. Your senses feel alive and you think
more clearly. You can join a team or find your own thing, but whatever you do, make your move.
Get started at www.girlsmove.gov.au