Medical Services in New Zealand and The Pacific
X: Medical Arrangements for Civil Emergency
X: Medical Arrangements for Civil Emergency
In 1938, when the international situation became unsettled, the Government, on the recommendation of the Organisation for National Security, decided to take such action as would secure the development of effective emergency precautions organisations throughout New Zealand, and the responsibility for preparing a general scheme was placed upon the Department of Internal Affairs. That department, after consultation with the principal local authorities, issued in 1939 two handbooks under the title 'Emergency Precautions Scheme', one for urban and the other for rural localities. The scheme made provision for the setting up of sub-committees under a central committee to handle the following activities, each under the direction of a controller: Supply, Transport, Medical, Law and Order, Communications, Works, Fire, Accommodation and Evacuation, Finance, and Publicity. The scheme was designed to provide an organisation to meet emergency conditions arising from enemy attack, epidemic, earthquake, or other natural disaster, and was commended for adoption by local authorities.
When the Government decided that the scheme should be part of the precautions for home defence, its administration was transferred to the National Service Department, and this was confirmed by the gazetting of the Emergency Precautions Regulations in August page 409 1940. Power was given for the setting up of a scheme by any local authority, and the Minister of National Service was authorised to direct any local authority to exercise this power if he thought fit. In the earlier phase the membership of the organisations was on a voluntary basis.
Compulsory enrolment in the Emergency Reserve Corps of all male British subjects aged 18 to 65 years who were not already serving in the armed forces or the Home Guard was directed by an enrolment order of 22 January 1942. In the larger and more vulnerable centres personnel were posted to six first-line units – Wardens, Fire, Medical, Works, Law and Order, and Communications. To the medical units 20 per cent of the strength was allocated.
Government Emergency Precautions Services
In regard to certain Government undertakings and public utility services, it was necessary to establish certain Government emergency services for the co-ordination of national activities with the local authority services. Among the emergency precautions services so established were Hospitals, Medical, Public Health, Oil Industry, Railways, National Road Transport, Broadcasting, Communications and Electricity Supply.
On 3 June 1941 a conference was called by the Director of National Service to discuss EPS medical arrangements. At the conference were the members of the National Medical Committee and the Medical Superintendent of Wellington Hospital. Consideration was given to the general policy of the EPS (Medical Section) and its relation to the Army and Health Departments.
It was decided that the Medical Section of the EPS should be separate from the hospital services, and that it should organise first-aid posts and be responsible for the evacuation of casualties to the 'hospital door', where the care of the wounded would be taken over by the Health Department. It was considered that the medical superintendents of hospitals could not be responsible for the control of medical sections of the EPS, as they would be fully occupied in running their own hospitals.
A recommendation was made that there should be co-ordination between the Army Department and the EPS medical organisations in the various centres, so that civilian casualties occurring near an army dressing station might receive treatment there and be evacuated by the Army or vice versa. This arrangement was officially made effective in March 1942.page 410
The conference decided that equipment for the first-aid posts would be supplied as required by the nearest public hospital, and it was suggested that motor ambulance cars be obtained from the Transport Section of the EPS and be placed under the control of the Medical Controller of the EPS. As regards trained staff for the first-aid posts, nurses were to be supplied by the Joint Council of the Order of St. John and the Red Cross Society.
The position as regards doctors to man the first-aid posts (and also the advanced dressing stations or surgical centres which also were to become part of the organisation of the EPS medical section) was rather difficult. In the event of a general Territorial mobilisation as well as an active EPS, emergency demands for all medical practitioners would be at a premium. The EPS organisations in the various centres were asked to select and submit the names of medical men required for medical duties with the EPS. They were asked to select, as far as possible, men with no Territorial or hospital obligations. Arrangements were made for the names to be submitted to the National Medical Committee for approval. This committee then considered them in conjunction with lists of essential hospital staffs and doctors required for Territorial mobilisation.
The chairman of the Medical Council, Sir Donald McGavin, was appointed to act in an advisory capacity to the National Service Department on medical arrangements in the Emergency Precautions Scheme throughout the country, thus co-ordinating the work and ensuring uniformity of action. A memorandum of a general nature on the subject was issued by Sir Donald McGavin on 9 July 1941 to local bodies.
Later, further details were worked out in connection with the separate responsibilities of the EPS Medical Section and the Army Medical Service in the event of military operations. The EPS medical organisation could not work in areas covered by military operations, the Army Medical Service being responsible for the treatment and evacuation of casualties in these areas. In the majority of cases the army units would evacuate casualties direct to the nearest hospital. If army transport facilities were limited it might be necessary to transfer casualties to EPS transport at the first-aid post, thus freeing army transport for return to units. If a military unit was not provided with a medical officer, or if, owing to the number of casualties and diffusion of the unit, the medical officer could not give any or sufficient immediate treatment, casualties were to be evacuated to the nearest EPS medical post by the unit's transport. Such cases would be treated there and further evacuation carried out under EPS arrangements.page 411
It was clear that local EPS medical arrangements in the event of military operations could be made only in close consultation with the Army Medical Service.
Hospitals Emergency Precautions Service
The paper of 31 July 1939 prepared by the Medical Committee on emergency hospital organisation (see Section VII) was the basis for the development of the Hospitals Emergency Precautions Service in 1941 and 1942, to some extent supplementary to the arrangements then in force for treating sick from mobilisation camps and sick and wounded invalided back from overseas. In a circular memorandum to hospital boards and medical superintendents of hospitals issued by the Director-General of Health on 17 January 1941, the duties of hospitals in emergencies were set out, and these were later embodied in local and group organisations.
After the gazetting of the Emergency Precautions Regulations in August 1940 a Medical Section of the EPS was organised in 1941 but, as already stated, it was decided that this would be separate from the hospital services; or, more correctly, that its responsibility for casualties would cease when they were delivered to the 'hospital door'.
With the entry of Japan into the war on 7 December 1941, preparations for emergency became more intensive. It was decided that all hospitals, including emergency hospitals, would remain outside the ordinary Emergency Precautions Services. Under Regulation 14 of the Emergency Reserve Corps Regulations 1941, the Minister of National Service on 9 December constituted the Hospitals Emergency Precautions Service as a Government service in the Emergency Reserve Corps. A Dominion organisation was set up, with the Director-General of Health as Dominion Controller and with a headquarters staff controlling local organisations of hospital board emergency committees, each of which had a Local Controller. The local organisations were to establish emergency hospitals to meet any possible contingency arising from the war. Sufficient stocks of supplies and equipment were to be established and adequate staffing arrangements made. Staffs were enrolled on special forms in terms of the regulations.
A reserve of 20,000 beds was established by hospital boards for emergency purposes, but liaison with the DGMS (Army and Air) and ADsMS of mobilised divisions of the Army in New Zealand does not appear to have been very well developed. In the middle of 1942 liaison officers were appointed after discussion between the Health and Army Departments, but they were to act only in the page 412 event of hostilities. Had an emergency actually risen it seems that the apparent lack of co-ordination could easily have created difficulties.
In outline, the organisation of the Emergency Hospital Service comprised:
Dominion Controller (Director-General of Health)
Deputy Dominion Controller (Deputy Director-General of Health)
Six Assistant Controllers (Officers of the Department of Health)
Director of Nursing Services (Director, Division of Nursing)
Regional Nursing Officers (Nurse Inspectors)
Local Organisations, each consisting of:
Hospital Board Emergency Committee
The forty-two hospital boards were grouped into ten groups, each consisting of two to eight contiguous hospital districts. Each group was placed under a Group Officer, who was usually a senior officer of the largest board included in the group. These groups were again aggregated into four areas, two in the North Island and two in the South Island. In each area a 'Hospital Officer' was appointed in charge.
The duties of the hospital and group officers were to serve as liaison officers between the Dominion Controller and the local controllers, and to co-ordinate hospital board activities. In the page 413 preparatory stages they had to satisfy themselves that all hospital boards had made adequate provision as regards buildings, staff, equipment and supplies to deal with any possible emergency that might arise, bring to the notice of the Dominion Controller any instances where there appeared to be insufficient preparation, and generally to advise hospital boards on their emergency schemes. Should an emergency have actually developed, their duties would have been to give whatever help was within their power and generally to mobilise whatever help was required by any particular hospital from outside its own district. It was visualised that should any part of New Zealand become isolated the Dominion Controller would delegate all or part of his powers to the Hospital Officer, or even down to the Group Officers.
The Director of Nursing Services within the scheme was given the responsibility of ensuring that adequate facilities for the training of auxiliary nursing staff had been provided and were being fully availed of, and also that there was effective co-ordination of nursing services throughout the Dominion. The Director of Nursing Services was assisted by seven Regional Nursing Officers, whose main responsibility was to allot nursing personnel to meet any exceptional demand during an emergency.
Within each hospital district the hospital board concerned set up a Hospital Board Emergency Committee. This committee was made responsible to the Dominion Controller for the provision in an emergency of all necessary emergency hospital facilities within its area. The more important of the duties involved included the ear-marking of suitable buildings for use as emergency hospitals, the preliminary adaptation of such buildings, the enrolment and instruction of hospital staff (including auxiliary staff) as members of the hospitals EPS, and the augmenting of reserve stocks of furniture, equipment, medical and other supplies for emergency hospital purposes.
The chief executive officer of each hospital board emergency committee was appointed the local controller for the scheme. Invariably he was the Medical Superintendent of the board's main hospital. His duties in an emergency were to organise and generally manage the reception and treatment of patients in all of the institutions placed under his control, to maintain the necessary contacts between the hospitals EPS and the local EPS organisations within his district (particularly the medical unit of the local EPS) and, should circumstances warrant it, to obtain through the Group Officer any additional assistance he might need to cope with an emergency.
Public Health Emergency Precautions Service
Until the entry of Japan into the war in December 1941, the normal peacetime organisation of the Department of Health and its powers as defined in the Health Act 1920 were considered to be sufficient to meet any emergency that was likely to arise. Japan's entry into the war completely altered the situation. To meet these changed circumstances the Director-General of Health instructed two of his senior officers to survey the situation and submit recommendations as to the action which would be required to ensure that in an emergency essential public health services would be maintained.
The most important points established by the survey were:
The Department must be able to carry out its statutory functions in an emergency and must be able to resist any possible interference by any local EPS organisation.
The Medical Officer of Health's responsibility covered the whole of his health district, and was not limited to the locality in which his headquarters was established.
Departmental officers might be immobilised in an emergency unless they were duly accredited members of an emergency precautions service.
Departmental officers acting in emergency would be covered by insurance only if they were duly accredited members of an EPS service.
For these reasons an approach was made to the National Service Department, and on 11 February 1942 the Minister of National Service signed a warrant establishing a Public Health Emergency Precautions Service, which was given the functions of controlling and regulating during a period of national emergency all matters relating to the maintenance and purity of public water supplies and of milk and other food supplies, the maintenance of sanitation, the control of infectious diseases and the other functions of the Department of Health as defined in the Public Health Act 1920.
The organisation set up paralleled that of the Department itself. The Director-General of Health was appointed Dominion Controller of the Public Health EPS, the Director, Division of Public Hygiene, was appointed Deputy Controller, and each Medical Officer of Health was appointed a Local Controller for his health district. As local controller the Medical Officer of Health was responsible to the Dominion Controller for the maintenance in an emergency of all public health services in his district. This EPS organisation was linked up on one side to the hospitals EPS and on the other page 415 to the local EPS. Arrangements were also made to staff the organisation from the staff of the Department of Health, and while maintaining the necessary liaison with the hospitals and the local EPS, the activities of Medical Officers of Health were channelled into matters relating solely to the public health emergency precautions scheme.
In the provision of medical services in an emergency affecting civilians the Emergency Precautions Service (Medical Section) and the Emergency Hospital Service corresponded respectively to field ambulances and general hospitals in the Army. In some cases, perhaps in all, the arrangements were very complete. Such was the case in Christchurch, where some of the leading doctors had a wealth of First World War experience in the Army. Co-ordination there seems to have been very complete as well, the Controller of the Medical Section of the EPS being also the liaison officer of the Emergency Hospital Service and the BMA. A comprehensive booklet of instructions for both divisions of the medical services for emergency was issued on 24 December 1941. Its information is complete and testifies to the coverage and detail of its arrangements. There is every indication that the scheme would have functioned smoothly and satisfactorily in an emergency. A list of the sections covered in the instructions indicates their detailed nature.
For the EPS (Medical Section) the sections were: administration; aid posts and dressing stations; medical personnel; nursing and other personnel; equipment; Government department aid posts; local body organisation; blood transfusion service; transport; liaison with Emergency Hospital Service; liaison with Army Medical Service; fatal casualties; preparation of schools; disposition of supplies; liaison with Plunket Society; liaison with other sections of EPS; summary; instructions to personnel.
For the Emergency Hospital Service the sections in the instructions were: administration; medical staffing; nursing; domestic, cooking and laundry staff; porters and orderlies; carpenters, plumbers, artisans, etc.; messengers; available beds, hospital board organisation; available beds, private hospitals; review; transport; evacuation of patients; records; admission of patients; mortuary arrangements; fire-fighting services; supplies; equipment; summary; liaison with EPS organisation; notification of state of emergency; traffic control.