What those deaths have taught me

Hospitals changed — and saved lives. The council can act too, says Kristine Barnden

THIS evening, Hobart City Council will be debating whether to join 22 councils around Australia, and 598 jurisdictions around the world, in declaring a climate and biodiversity emergency.

I support this motion, not just because of the way climate disruption is unfolding before our eyes, and the short time we have to head off tipping points that may result in irreversible heating of the atmosphere, but also because I have been reflecting on the way the approach to emergencies in hospitals has evolved over the last 25 years, which has shown that the best way to deal with potential emergency is to call it early and respond decisively.

Twenty-five years ago, when I started working as a junior doctor, hospitals would have an “arrest team” that responded to an emergency call when a patient stopped breathing or their heart stopped beating. For all other patients whose condition was worsening, it was left to the discretion of the nursing staff to call a doctor to assess the patient and decide on management. The doctor was almost invariably the most junior member of the team.

One night, when I was an intern, I was called to review an elderly woman whose blood pressure was low. Alone in the room, I became so focused on the tricky task of taking blood from the small artery in her wrist, that it was some time before I realised I was no longer able to feel her pulse because she had died.

All doctors my age or older have similar stories. People have died because signs their condition was deteriorating weren’t recognised, because inexperienced doctors were out of their depth, because someone had a fixed (false) idea about what the problem was, or even because an experienced surgeon refused to believe a straightforward operation could result in complications. By the time a person has a cardiac or respiratory arrest, it may be too late to save them. Now, a patient’s vital signs are written on a colour-coded chart, and once they reach a level which indicates the possibility of an emergency, a medical emergency response call is initiated. A team arrives — experienced doctors and nurses, with specific roles — and the patient becomes their sole focus until the cause of deterioration is understood and management commenced. Doctors and nurses attend courses that teach the evidence base for managing emergencies, and practise drills in teams.

People, hospitals, cities, planet Earth — all in their way are complex organic systems of interrelated components. A threat to one component will eventually affect the whole organism. A cancer or a slowly bleeding artery may start off localised and asymptomatic, but go on to have devastating consequences if left untreated. In medicine we rightly screen for these things and once suspected, we initiate a rapid, comprehensive, team-based, evidence-based response.

For most of us in Hobart, biodiversity loss and climate change have little effect on daily life, but they are threats that stand to affect our health, way of life and economy. The factors that stand in the way of mitigation and adaptation are built into the fabric of our society, and declaration of an emergency is intended to give us the tools to prioritise action.

When the system of emergency response was introduced, many doctors were dubious. Didn’t we know best how to look after our patients? Did we need a bunch of strangers crashing into the room and causing relatives to panic, just because a patient’s blood pressure was a little low? Many times I have reluctantly initiated an emergency call, thinking it over-reaction. Never have I regretted the fresh eyes, expertise and extra hands. I know this system can save lives.

Declaring a climate emergency is likewise about reassurance, not panic. Many already feel panic and despair, less because of climate change and collapsing ecosystems, than failure of society to respond, despite necessary measures being understood. It is often said what is lacking is not the means to respond to crises, but political will. A declaration of a climate and biodiversity emergency by Hobart City Council is not just an effective strategy to deal with a threat. It is a strong statement of political will.