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After the catastrophic earthquake in Christchurch, New Zealand, on 22 February 2011, the Rhise Group (researching the health implications of seismic events) was formed by Professor Michael Ardagh.The main objective of the group was to facilitate understanding of the health impacts of the Christchurch earthquakes and, specifically, to enable collaboration and sharing of resources where appropriate. This has been achieved through the occasional forum and a shared website, able to be accessed by the 219 members of the group. In addition, the group encouraged a dedicated funding round for earthquake research from the Health Research Council of New Zealand and the Canterbury Medical Research Foundation.This symposium is the most significant event hosted by the Rhise Group to date and allows the recipients of that funding round, and other researchers from within the Rhise Group, to present the current state of their research. Thanks go to the Emergency Care Foundation, Lane Neave Lawyers, University of Otago, Christchurch, Canterbury District Health Board, Canterbury Medical Research Foundation, and Emergency Care Co-ordinations Teams for sponsoring the symposium.Within the wider, loose collaborative of researchers making up the Rhise Group is a small ‘working group' based in the Emergency Department of Christchurch Hospital, and the University of Otago, Christchurch. The working group coordinates the activities of the Rhise Group and includes Professor Ardagh, Dr Joanne Deely, Ms Alieke Dierckx, Dr Sandra Richardson and Dr Martin Than.Particular thanks go to Dr Deely and Ms Dierckx for putting this symposium together and Dr Deely and Professor Ardagh for editing the proceedings. How did the earthquakes change health service utilisation in Canterbury?David MeatesChief Executive Officer, Canterbury and West Coast District Health BoardsThe earthquakes of 2010 and 2011 have changed the way the Canterbury health system is organised and services are provided. While many changes and much of the infrastructure and relationships had been developed prior to the earthquakes, the February quake resulted in further innovation resulting in new initiatives (e.g. eSCRV, CREST, medication management). These have further emphasised the role of keeping people well in their own homes and communities.The combination of earthquakes, system changes and new approaches has significantly changed health service utilisation in Canterbury. The initial reduction in people accessing all services has been replaced by decreasing growth in the rate of acute admission as more people are looked after in the community. Decreases in acute care growth are strongest among the over 65-age group, where the population has increased. While these changes are not attributable to the earthquakes, these seismic events have acted as a catalyst to drive the system changes. David Meates is Chief Executive of the Canterbury and West Coast District Health Boards (DHBs)– responsible for the health services for over 550,000 New Zealanders, and the leadership of over 9,500 direct employees and thousands more non-governmental organisation health sector workers contracted by the DHB. He is a big picture thinker and has particular skills in leading change, and motivating and mobilising others to be part of the transformation. David is passionate about health and what's possible when people grasp the vision and work collectively for the greater good. The achievements of the Canterbury Health System are testimony to his leadership. Originally from Canterbury, David has worked in both the private and public sectors, in NZ and the UK. He has also led and been involved on a number of national groups ranging from workforce negotiations to CEO alliances. Recent experiences in Canterbury have shown David is adept at managing large teams through a crisis and developing and implementing robust recovery plans. The initial health system response to the Christchurch earthquakeMichael Ardagh1, Sandra Richardson2, Viki Robinson3, Martin Than3, Paul Gee3, Seton Henderson4, Laura Khodaverdi4, John McKie5, Gregory Robertson6, Philip Schroeder7, Joanne Deely81. Department of Surgery, University of Otago, Christchurch2. Centre for Postgraduate Nursing, University of Otago, Christchurch3. Emergency Department, Christchurch Hospital4. Intensive Care Unit, Christchurch Hospital5. Department of Orthopaedic Surgery, Christchurch Hospital6. Resident Medical Officers Unit, Canterbury District Health Board7. Rolleston Medical Centre, Christchurch8. Independent Contractor, Canterbury District Health BoardA total of 182 people died and 6659 were treated for injuries during the first day following a violent earthquake that struck Christchurch city at 12.51 on 22 February 2011. A combination of huge peak ground accelerations, time of the day, and collapse of major buildings contributed to the numbers of people injured. We report on the injury burden of the Christchurch earthquake and the initial health system response.175 of those killed died before arriving at hospital. Of the 6659 people injured, 2032 (31%) were male and 4627 (69%) female, and 2752 (41%) were between the ages of 40 and 59 years. Eighty-seven (1%) were children under the age of 10 and 950 (14%) adults over the age of 70 years. 142 people were admitted to hospital including 18 to the Intensive Care Unit. Fourteen people were treated for crush injury syndrome, six of whom required renal replacement therapy and a small number of people required amputations.Experiences suggest that hospitals should prepare for: patients arriving on mass by extraordinary means, patients arriving with no pre-hospital care, loss of electronic registration and tracking of patients, patient unwillingness to come into hospital buildings, loss of all electricity, many unexpected willing helpers, loss of communication, media intrusion, and maintaining teamwork with explicit leadership.Follow up research is concentrating on understanding the demographic distributions and causes of the injuries. (See abstracts by Johnston et. al. and Standing et al. in these proceedings.)Reference: Lancet 2012;379:2109–15. Michael Ardagh is a fellow of the Australasian College for Emergency Medicine and has a PhD in Bioethics. He is Professor of Emergency Medicine at the University of Otago, Christchurch, and Specialist in Emergency Medicine at Christchurch Hospital. He is National Clinical Director of Emergency Department Services (a position also known as ‘Target Champion'), to assist with implementation of the ‘Shorter Stays in the Emergency Department' health target. He is Chair of the Rhise Group (Researching the health implications of seismic events) which was formed to encourage collaborative research regarding the Christchurch earthquakes of 2010 and 2011. Michael was made an Officer of New Zealand Order of Merit (ONZM) for services to medicine in 2012. The 2010/2011 Canterbury earthquakes: context and cause of injuryDavid Johnston1, Sarah Standring2, Kevin Ronan3, Michael Lindell4, Thomas Wilson5, Jim Cousins6, Emma Aldridge2, Michael Ardagh7, Joanne Deely8, Steven Jensen9, Thomas Kirsch10, Richard Bissell111. Joint Centre for Disaster Research, GNS Science/Massey University2. School of Medicine, University of Auckland,3. School of Human, Health and Social Sciences, Central Queensland University4. Hazard Reduction & Recovery Center, Texas A&M University5. Department of Geological Sciences, University of Canterbury6. Geohazards Monitoring, GNS Science7. Department of Surgery, University of Otago, Christchurch8. Independent Contractor, Canterbury District Health Board9. Preparedness, Health and Safety Services, California State University10. Center for Refugee and Disaster Response, Johns Hopkins University11. Emergency Health Services, University of MarylandLittle is known about the relationship between human behaviour and risk of injury during earthquakes. We aimed to fill this gap by analysing the New Zealand Accident Compensation Corporation database for causes and context of injury during the Canterbury earthquakes. The total injury burden was analysed for demography, context of injury, causes of injury, and injury type.Three times as many people were injured in the Christchurch earthquake (22 February 2011) as in the Darfield earthquake (4 September 2010; 7171 vs 2256). Primary shaking caused approximately two-thirds of the injuries from both quakes. Actions during the main shaking and aftershocks led to many injuries.Many people were injured after shaking stopped in both events. Most of these people were injured during clean-up. In both earthquakes: more females than males (1453 vs 803 Darfield; 4646 vs 2525 Christchurch) were injured; trip/fall was the most common cause of injury; and soft tissue injuries was the most common type of injury. The findings of this study suggest that where people were and their behaviour during and after earthquakes influenced their risk of injury. David Johnston is a senior scientist at GNS Science and Director of the Joint Centre for Disaster Research at Massey University. His research focuses on human responses to disasters, crisis decision-making, public education, and building community resilience and recovery. David is Chair of the international Integrated Research and Disaster Risk Scientific Committee. He is also on New Zealand's Royal Society Social Science Advisory Panel, and the editor of the Australasian Journals of Disaster and Trauma Studies, and founding editor of the Journal of Applied Volcanology. Spatial variations in stress-related health compared to earthquake exposure: preliminary results and future directionsSimon Kingham1, Daniel Hogg1, Kim Reed1, ThomasWilson2, Michael Ardagh31. Department of Geography, University of Canterbury2. Department of Geological Sciences, University of Canterbury3. Department of Surgery, University of Otago, ChristchurchFourth September 2010 saw the start of a series of destructive earthquakes around the city of Christchurch, New Zealand (pop 350,000). These left the region with widespread damage to the city and its infrastructure including: major liquefaction (the process by which the ground turns to liquid); 70% of the central city needing to be rebuilt; 20,000 homes needing to be pulled down; and 100,000 homes needing repairing.The aftershocks are ongoing with over 13,000. It is hypothesised that all this will have an ongoing impact on those living in and around the city. The aims of this study were to identify whether adverse stress-related health outcomes were greater among people who have experienced greater physical damage to their communities than those who have experienced less damage, but who also live in the region. Exposure to earthquake damage through amount & extent of liquefaction and land 'colour' (land colour coded according to whether it can be used in the future) was estimated.Emergency department data was collated for chest pain and anxiety for a period of 6 months before and 18 months after the start of the earthquakes. Exposure was related to health. For the period from 1May 2010 to 30 April 2012, there were 9,807 chest pain and 524 anxiety hospital attendances. Those people living in areas of greater earthquake related damage and those living closer to more damaged areas had greater levels of stress-related ill health.It is concluded that there is preliminary evidence that those living in and nearer to areas of greater earthquake impact have greater levels of stress-related ill-health. Further research funded by the Cooperative Research Centre for Spatial Information (CRCSI) is developing more indicators of earthquake impact such as: extent of home damage; infrastructure service closures and restriction, community disruption e.g. school & shop closure; extent of home damage; and magnitude of shaking. In addition population mobility is being included in this analysis. Simon Kingham is Professor of Geography and Director of the GeoHealth Laboratory at the University of Canterbury, in Christchurch, New Zealand. He has carried out research in health and environment issues for over 20 years, specifically looking at environmental exposure. He is a Director of the GeoHealth Laboratory which is funded by the Ministry of Health to undertake applied research in the areas of health geography, spatial epidemiology and Geographical Information Systems. He has published his research widely and has a BA (Hons) and a PhD in Geography from Lancaster University, UK. The role of Public Health in building resilience: from pandemics to earthquakesAlistair HumphreyMedical Officer of Health for CanterburyFollowing the enactment of the 2002 New Zealand Civil Defence and Emergency Management Act in 2002, the Ministry for Civil Defence and Emergency Management (MCDEM) led local agencies in developing strategies for building resilience among Canterbury communities. With the looming spectre of “bird flu” (classification – H5N1), primary care led a multiagency approach to preparing for a pandemic.Representatives from health, government agencies, non-government agencies and private business including media met monthly from August 2005 onwards to develop a strategic approach towards building resilience. One example was the development of the Pandemic Roadshow by MCDEM, Canterbury District Health Board and Science Alive museum.The 2008 MCDEM national survey demonstrated that Cantabrians were more aware of the pandemic threat and generally better prepared for all hazards than other parts of New Zealand. Consequently, Canterbury performed well in response to the 2009 H1N1 pandemic. When struck by the earthquakes a year later, the issues promoted during pandemic preparedness were equally pertinent: hand-washing, availability of sanitiser, water and food supplies and knowing your neighbours. Community briefings reinforced these messages, but were also promulgated using other media.Water and sanitary health services were severely compromised after the 22 February aftershock; hand-washing, a boil water notice and provision of portaloos were key operational and communication issues for many weeks. However, community surveys showed that nearly 90% of Christchurch residents adhered to boiling water more than six weeks after the earthquake, which bought valuable time for the authorities to chlorinate the city water supply and prevent water borne disease. A heightened surveillance system revealed no increase in enteric disease after the earthquake.Promotion of personal hygiene, emergency preparedness and social capital for an anticipated pandemic brought direct benefits to the Christchurch community following the earthquake. Broad interagency collaboration and sophisticated communication strategies facilitated this, and need to be maintained to sustain community resilience. Alistair Humphrey is a Public Health Physician and GP in Christchurch. As Medical Officer of Health for Canterbury, he is designated by and responsible to the Director General of the Ministry of Health. Alistair is on the national pandemic preparedness group for New Zealand and the national group looking at the health effects of climate change (HAIFA). In 2011/2012, Alistair addressed the United Nations International Strategy for Disaster Reduction (UNISDR) global platform, the Towards a Safer World (TASW) group and the Global Risk Forum One Health Summit and other international meetings. He assisted the WHO Emergency Risk Management group in the development of their Safe Hospital Initiative and was an evaluator for the WHO's Emergency Risk Framework exercise. Alistair holds a senior lectureship post at the University of Otago Medical School. He is a Fellow of the Australasian Faculty of Public Health Medicine, Royal Australian College of General Practitioners, Australian College of Rural Medicine, and a member of the UK Faculty of Public Health. Earthquake stress and broken heartsCameron LaceyMāori Health, University of Otago, ChristchurchStress cardiomyopathy has been associated with stress and a large increase in the number of people presenting with this condition was seen following the earthquakes. The cause of this condition remains unknown, but psychiatric illnesses have been proposed as risk factors. We systematically assessed for antecedent psychiatric risk factors in two groups of cases (people who developed sporadic and earthquake-related broken heart syndrome) and compared them to a control group of healthy volunteers. We found that often psychiatric risk factors examined, only ‘neuroticism' significantly differed between participants with broken heart syndrome and healthy volunteers. This suggests that the clinical assessment of psychiatric risk factors is unlikely to assist identification of patients at increased risk of broken heart syndrome. This presentation will also provide an overview of our efforts to identify a genetic risk for this condition. Cameron Lacey is a consultation-liaison psychiatrist with a strong research interest in identification and treatment of psychiatric and cultural factors in medical illness. He is the principle investigator of a team of University of Otago Christchurch researchers including Prof R Mulder, Prof M Kennedy, Prof V Cameron, J Zarifeh and Dr P Bridgman. This group has been investigating factors that contribute to the risk of developing stress cardiomyopathy. ‘It's a thing you've got to sort of learn to live with really': the findings from the Shaken Up study of older adults aged over 75 years following the seismic events in Christchurch, New Zealand, 2011Kathy PeriSchool of Nursing, Auckland UniversityThis project aims to explore the ongoing impact of the Christchurch earthquakes on older peoples' health in primary health care one year post Christchurch earthquakes. The participants were part of the BRIGHT (Brief Risk Identification Geriatric Health Tool) Trial which had been underway since 2007 and in total 1095 older adults aged 79 and over (31 are Maori aged 69 years and over) were enrolled.The Shaken Up study proposed to re-interview these 1095 older adults to investigate their health status in the recovery phase 12 months after their 36 month BRIGHT trial interview, (up to 2 years after the earthquakes), meaning a total of 4 years follow up will be available. Pre-existing status and factors related to earthquake exposure will be examined as predictors of follow up status to identify predictors of poor outcome after earthquake.The main outcomes measured health-related quality of life, NEADL (Nottingham Extended Activities of Daily living), depression, standard of living, family and social support and life satisfaction before, between, and post-earthquakes. Relationship with trajectories of health status (improved, maintained or declined) over the same and subsequent period will be explored.Understanding population-level health of older people with primary care utilisation through the disaster period and 12 months subsequent will enable identification of particularly vulnerable groups of older age. This is internationally relevant as detailed health data before, during and after the disaster is seldom available. It is nationally relevant to enable appropriate planning for ongoing support for older people in Christchurch and other areas, should more disasters occur. Kathy Peri is a registered nurse, senior lecturer and research Fellow at the School of Nursing, University of Auckland, and works two days a week at the Counties Manuka District Health Board as the Clinical Nurse Director for Health of Older People, New Zealand. Her research interests are centred on improving health outcomes for vulnerable older people and she is currently involved in a number of research projects including health robotics, non-pharmacological dementia interventions. Kathy was the Director of Nursing at the Princess Margaret Hospital in Christchurch during the earthquakes and has over the past two and half years been awarded three research grants to explore the impact of the Canterbury earthquakes on the quality of life in community dwelling older people over the age of 75 years. Kathy will present the results of the Health Research Council funded research project today. Learning from Canterbury communities: factors that help and hinder community resilienceLouise Thornley1, Emma Rawson21. Quigley and Watts Ltd2. Community and Public Health, Canterbury District Health BoardIncreasing community resilience is vital – disaster experts, central and local government, non-government organisations, and communities themselves all agree on this point. We know that building stronger communities is important, but how should this be done? This presentation will discuss findings from qualitative research with Canterbury communities after the 2010 and 2011 earthquakes. It will focus on the key role of pre-existing community infrastructure (e.g. local leaders, networks, and marae) in helping communities to adapt post-disaster and to build resilience to future crises.Almost a third of participants in our research were Māori, mostly Ngāi Tahu. Our work highlighted marae as key hubs for emergency support and hosting people in need. Māori participants emphasised that iwi and marae infrastructure helped marae to respond quickly and effectively. Building stronger communities needs to be an everyday activity not an optional extra. Connected communities with good local infrastructure are healthier, recover faster from disasters, and are better prepared for future crises. Louise Thornley is a social researcher specialising in public health. She contracts part-time to Quigley and Watts Ltd, an independent Wellington-based research company, and has recently started as Family Planning's Research and Policy Advisor. Louise's previous work experience is in government, university and community sectors. Before joining Quigley and Watts Ltd in 2006, she was a Senior Policy Analyst for the National Health Committee, and Research Fellow for Otago University, Wellington. Her background is in youth work and community development. She worked in Christchurch's community sector for five years.Emma Rawson, Ngati Ranginui, Ngai te Rangi, Raukawa, is a Māori Health Promoter based at the Canterbury District Health Board in Christchurch. Emma's passions are Māori workforce development and Te Reo Māori as an important leadership tool for change, enhancing identity and wellbeing. She is a recent graduate of Leadership Training for Māori in Public Health, holds a B.A. Maori, University of Canterbury, Post Graduate Certificate in Public Health, University of Otago and is working on gaining a Masters in Health Science. Emma is currently working on projects in Christchurch that support wellbeing and resilience in Māori communities and building sustainable community infrastructure in vulnerable communities. Occupational health of front line workers in ChristchurchDavid McBride1, Kirsten Lovelock1, Daniel Shepherd2, Rex Billington21. Department of Preventive and Social Medicine, University of Otago, Dunedin2. Department of Psychology, Auckland University of TechnologyFront-line disaster workers are exposed to potentially disturbing events and hazardous exposures, and are potentially at risk of physical and emotional harm. As members of the community they also have to contend with ‘dual jeopardy', death or injury in their own family and damage to their personal property. This was a cross sectional study measuring the health status of responders and ‘significant others' using the World Health Organisation (WHO) Health Related Quality of Life (HRQOL) questionnaire with additional instruments to identify (for example) post-traumatic stress symptoms, burnout and fatigue. Eligible participants were Christchurch residents living there on the 4 September 2010.The survey was self-administered, facilitated through the various unions representing these occupational groups or CEOs for non-unionised workplaces. Power considerations indicated that 1,100 responses would allow adequate power. Our response rate was less than the 1,100 that we had aimed for: a total of 370 participants, 200 workers, 130 controls and 40 ‘significant others'.Workers experienced, and reported dual jeopardy; reduced physical exercise; sleep deprivation; increased alcohol consumption and imbalance between job demands and decisional latitude, the latter leading to stress. Ambulance workers and fire-fighters reported sensitisation, mediated physiologically (elevated heart rate and blood pressure) and associated with increased anxiety, when responding to ‘everyday' emergencies following the February earthquake.Our research also provides further evidence that social support from family, peers, colleagues and wider social networks are central to maintaining resilience and reducing vulnerability. Significantly, existing and pre-existing employment relations are central to the nature of how front line workers initially respond to a natural disaster; cope in the aftermath of the disaster and try to remain healthy. David McBride is an occupational physician who did his initial training with the British Coal Corporation as a Medical Officer. His responsibilities were collieries in the Staffordshire and Lancashire coal fields, the Mines Rescue Station at Boothstown and an experimental coal liquefaction plant in North Wales. He did his academic training at the University of Birmingham, and then was appointed Clinical Lecturer in 1991. He was appointed Senior Lecturer in Occupational Health at the University of Otago in 1995 and Associate Professor in 2011. He has been in the army as a reservist since 1973 and has some knowledge of ‘conflict medicine', having served with the New Zealand Defence Force (NZDF) in Timor Leste and Afghanistan. On volunteering for another engagement with the NZDF serendipity must have been a factor in his posting as a Medical Officer to Burnham Camp over the period November 2010–December 2011. He then found himself on another ‘tour' of Afghanistan in January 2012. Facing the unexpected – health care workers and the emergency department response to 22 February earthquakeSandra RichardsonCentre for Post Graduate Nursing Study, University of Otago, ChristchurchThis study identifies the experiences and impact of the 22 February 2011earthquake on those staff who contributed to the Emergency Department response. While there are individual reports from various natural disaster settings identifying personal reactions and perceptions, there is very little reported about the experience of health care providers who are both responders to and part of a disaster event.The focus on health care responders is typically centred on the provision of care and ability to maintain normal services, with little exploring what it means to be part of a disaster situation, coping with competing personal, professional and family commitments.This study commenced in the week following the February event, and involved one on one qualitative interviews with over 90 individuals who were involved in the emergency department response at this time. Given the presence of so many staff and volunteers from a wide range of backgrounds, it was intended to include a multidisciplinary perspective. As a result, interviews were undertaken with staff from medical, nursing, social work, blood bank, orderlies, Maori health and radiology, amongst others. Interviews were reviewed and core themes identified, which allow a clearer understanding of the experience of individuals, and the implications for professional groups and health care planners. A summary of issues and recommendations is presented resulting from this process. Sandra Richardson is a Senior Lecturer with the Centre for Post Graduate Nursing Study at the University of Otago, Christchurch and Nurse Researcher in the Emergency Department, Canterbury District Health Board. Sandra's research interests include Emergency Department crowding, advanced nursing practice and the impact and experience of the Canterbury Earth quake events. Shaky times – the Canterbury earthquakes and all that has followedCaroline BellDepartment of Psychological Medicine, University of Otago, ChristchurchSince 4 September 2010 there have been three major earthquakes and over 13,000 aftershocks in Christchurch inflicting substantial damage to the city. Widespread economic and practical consequences, particularly with insurance companies and the Earthquakes Commission (EQC), have created significant secondary stressors further compounding the difficulties of many. This has resulted in people presenting with a broad spectrum of psychological responses. A specialist team was set up by the Canterbury District Health Board to treat people with significant post-traumatic stress and anxiety and this team is continuing to see new presentations.This paper will discuss the ongoing research of people presenting with post-traumatic stress disorder (PTSD) and those identifying as resilient. Two broad lines of research will be presented that aim at understanding the treatment and neurobiology of people with PTSD and those self-identifying as resilient. Caroline Bell is a consultant psychiatrist and senior lecturer at the University of Otago in Christchurch with an expertise in anxiety. She has had a role in managing the psychosocial responses to the Canterbury earthquakes across the community and is the clinical lead of a treatment team for people with severe Post Traumatic Stress Disorder from the earthquakes. The impact of Christchurch Earthquake on availability of diagnostic-test resultsKevin Taylor1, Peter George1, Joanne Deely21. Canterbury Health Laboratories, Canterbury District Health Board2. Independent Contractor, Canterbury District Health BoardBetween 60–70% of medical decisions are based on laboratory test results. With both community laboratories (MedLab South and Southern Community Laboratories) destroyed in the Christchurch earthquake, the performance of Canterbury Health Laboratories was integral to how the health system delivered care to Canterbury after the disaster.This study assessed the effects of the Christc

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After the catastrophic earthquake in Christchurch, New Zealand, on 22 February 2011, the Rhise Group (researching the health implications of seismic events) was formed by Professor Michael Ardagh.The main objective of the group was to facilitate understanding of the health impacts of the Christchurch earthquakes and, specifically, to enable collaboration and sharing of resources where appropriate. This has been achieved through the occasional forum and a shared website, able to be accessed by the 219 members of the group. In addition, the group encouraged a dedicated funding round for earthquake research from the Health Research Council of New Zealand and the Canterbury Medical Research Foundation.This symposium is the most significant event hosted by the Rhise Group to date and allows the recipients of that funding round, and other researchers from within the Rhise Group, to present the current state of their research. Thanks go to the Emergency Care Foundation, Lane Neave Lawyers, University of Otago, Christchurch, Canterbury District Health Board, Canterbury Medical Research Foundation, and Emergency Care Co-ordinations Teams for sponsoring the symposium.Within the wider, loose collaborative of researchers making up the Rhise Group is a small ‘working group' based in the Emergency Department of Christchurch Hospital, and the University of Otago, Christchurch. The working group coordinates the activities of the Rhise Group and includes Professor Ardagh, Dr Joanne Deely, Ms Alieke Dierckx, Dr Sandra Richardson and Dr Martin Than.Particular thanks go to Dr Deely and Ms Dierckx for putting this symposium together and Dr Deely and Professor Ardagh for editing the proceedings. How did the earthquakes change health service utilisation in Canterbury?David MeatesChief Executive Officer, Canterbury and West Coast District Health BoardsThe earthquakes of 2010 and 2011 have changed the way the Canterbury health system is organised and services are provided. While many changes and much of the infrastructure and relationships had been developed prior to the earthquakes, the February quake resulted in further innovation resulting in new initiatives (e.g. eSCRV, CREST, medication management). These have further emphasised the role of keeping people well in their own homes and communities.The combination of earthquakes, system changes and new approaches has significantly changed health service utilisation in Canterbury. The initial reduction in people accessing all services has been replaced by decreasing growth in the rate of acute admission as more people are looked after in the community. Decreases in acute care growth are strongest among the over 65-age group, where the population has increased. While these changes are not attributable to the earthquakes, these seismic events have acted as a catalyst to drive the system changes. David Meates is Chief Executive of the Canterbury and West Coast District Health Boards (DHBs)– responsible for the health services for over 550,000 New Zealanders, and the leadership of over 9,500 direct employees and thousands more non-governmental organisation health sector workers contracted by the DHB. He is a big picture thinker and has particular skills in leading change, and motivating and mobilising others to be part of the transformation. David is passionate about health and what's possible when people grasp the vision and work collectively for the greater good. The achievements of the Canterbury Health System are testimony to his leadership. Originally from Canterbury, David has worked in both the private and public sectors, in NZ and the UK. He has also led and been involved on a number of national groups ranging from workforce negotiations to CEO alliances. Recent experiences in Canterbury have shown David is adept at managing large teams through a crisis and developing and implementing robust recovery plans. The initial health system response to the Christchurch earthquakeMichael Ardagh1, Sandra Richardson2, Viki Robinson3, Martin Than3, Paul Gee3, Seton Henderson4, Laura Khodaverdi4, John McKie5, Gregory Robertson6, Philip Schroeder7, Joanne Deely81. Department of Surgery, University of Otago, Christchurch2. Centre for Postgraduate Nursing, University of Otago, Christchurch3. Emergency Department, Christchurch Hospital4. Intensive Care Unit, Christchurch Hospital5. Department of Orthopaedic Surgery, Christchurch Hospital6. Resident Medical Officers Unit, Canterbury District Health Board7. Rolleston Medical Centre, Christchurch8. Independent Contractor, Canterbury District Health BoardA total of 182 people died and 6659 were treated for injuries during the first day following a violent earthquake that struck Christchurch city at 12.51 on 22 February 2011. A combination of huge peak ground accelerations, time of the day, and collapse of major buildings contributed to the numbers of people injured. We report on the injury burden of the Christchurch earthquake and the initial health system response.175 of those killed died before arriving at hospital. Of the 6659 people injured, 2032 (31%) were male and 4627 (69%) female, and 2752 (41%) were between the ages of 40 and 59 years. Eighty-seven (1%) were children under the age of 10 and 950 (14%) adults over the age of 70 years. 142 people were admitted to hospital including 18 to the Intensive Care Unit. Fourteen people were treated for crush injury syndrome, six of whom required renal replacement therapy and a small number of people required amputations.Experiences suggest that hospitals should prepare for: patients arriving on mass by extraordinary means, patients arriving with no pre-hospital care, loss of electronic registration and tracking of patients, patient unwillingness to come into hospital buildings, loss of all electricity, many unexpected willing helpers, loss of communication, media intrusion, and maintaining teamwork with explicit leadership.Follow up research is concentrating on understanding the demographic distributions and causes of the injuries. (See abstracts by Johnston et. al. and Standing et al. in these proceedings.)Reference: Lancet 2012;379:2109–15. Michael Ardagh is a fellow of the Australasian College for Emergency Medicine and has a PhD in Bioethics. He is Professor of Emergency Medicine at the University of Otago, Christchurch, and Specialist in Emergency Medicine at Christchurch Hospital. He is National Clinical Director of Emergency Department Services (a position also known as ‘Target Champion'), to assist with implementation of the ‘Shorter Stays in the Emergency Department' health target. He is Chair of the Rhise Group (Researching the health implications of seismic events) which was formed to encourage collaborative research regarding the Christchurch earthquakes of 2010 and 2011. Michael was made an Officer of New Zealand Order of Merit (ONZM) for services to medicine in 2012. The 2010/2011 Canterbury earthquakes: context and cause of injuryDavid Johnston1, Sarah Standring2, Kevin Ronan3, Michael Lindell4, Thomas Wilson5, Jim Cousins6, Emma Aldridge2, Michael Ardagh7, Joanne Deely8, Steven Jensen9, Thomas Kirsch10, Richard Bissell111. Joint Centre for Disaster Research, GNS Science/Massey University2. School of Medicine, University of Auckland,3. School of Human, Health and Social Sciences, Central Queensland University4. Hazard Reduction & Recovery Center, Texas A&M University5. Department of Geological Sciences, University of Canterbury6. Geohazards Monitoring, GNS Science7. Department of Surgery, University of Otago, Christchurch8. Independent Contractor, Canterbury District Health Board9. Preparedness, Health and Safety Services, California State University10. Center for Refugee and Disaster Response, Johns Hopkins University11. Emergency Health Services, University of MarylandLittle is known about the relationship between human behaviour and risk of injury during earthquakes. We aimed to fill this gap by analysing the New Zealand Accident Compensation Corporation database for causes and context of injury during the Canterbury earthquakes. The total injury burden was analysed for demography, context of injury, causes of injury, and injury type.Three times as many people were injured in the Christchurch earthquake (22 February 2011) as in the Darfield earthquake (4 September 2010; 7171 vs 2256). Primary shaking caused approximately two-thirds of the injuries from both quakes. Actions during the main shaking and aftershocks led to many injuries.Many people were injured after shaking stopped in both events. Most of these people were injured during clean-up. In both earthquakes: more females than males (1453 vs 803 Darfield; 4646 vs 2525 Christchurch) were injured; trip/fall was the most common cause of injury; and soft tissue injuries was the most common type of injury. The findings of this study suggest that where people were and their behaviour during and after earthquakes influenced their risk of injury. David Johnston is a senior scientist at GNS Science and Director of the Joint Centre for Disaster Research at Massey University. His research focuses on human responses to disasters, crisis decision-making, public education, and building community resilience and recovery. David is Chair of the international Integrated Research and Disaster Risk Scientific Committee. He is also on New Zealand's Royal Society Social Science Advisory Panel, and the editor of the Australasian Journals of Disaster and Trauma Studies, and founding editor of the Journal of Applied Volcanology. Spatial variations in stress-related health compared to earthquake exposure: preliminary results and future directionsSimon Kingham1, Daniel Hogg1, Kim Reed1, ThomasWilson2, Michael Ardagh31. Department of Geography, University of Canterbury2. Department of Geological Sciences, University of Canterbury3. Department of Surgery, University of Otago, ChristchurchFourth September 2010 saw the start of a series of destructive earthquakes around the city of Christchurch, New Zealand (pop 350,000). These left the region with widespread damage to the city and its infrastructure including: major liquefaction (the process by which the ground turns to liquid); 70% of the central city needing to be rebuilt; 20,000 homes needing to be pulled down; and 100,000 homes needing repairing.The aftershocks are ongoing with over 13,000. It is hypothesised that all this will have an ongoing impact on those living in and around the city. The aims of this study were to identify whether adverse stress-related health outcomes were greater among people who have experienced greater physical damage to their communities than those who have experienced less damage, but who also live in the region. Exposure to earthquake damage through amount & extent of liquefaction and land 'colour' (land colour coded according to whether it can be used in the future) was estimated.Emergency department data was collated for chest pain and anxiety for a period of 6 months before and 18 months after the start of the earthquakes. Exposure was related to health. For the period from 1May 2010 to 30 April 2012, there were 9,807 chest pain and 524 anxiety hospital attendances. Those people living in areas of greater earthquake related damage and those living closer to more damaged areas had greater levels of stress-related ill health.It is concluded that there is preliminary evidence that those living in and nearer to areas of greater earthquake impact have greater levels of stress-related ill-health. Further research funded by the Cooperative Research Centre for Spatial Information (CRCSI) is developing more indicators of earthquake impact such as: extent of home damage; infrastructure service closures and restriction, community disruption e.g. school & shop closure; extent of home damage; and magnitude of shaking. In addition population mobility is being included in this analysis. Simon Kingham is Professor of Geography and Director of the GeoHealth Laboratory at the University of Canterbury, in Christchurch, New Zealand. He has carried out research in health and environment issues for over 20 years, specifically looking at environmental exposure. He is a Director of the GeoHealth Laboratory which is funded by the Ministry of Health to undertake applied research in the areas of health geography, spatial epidemiology and Geographical Information Systems. He has published his research widely and has a BA (Hons) and a PhD in Geography from Lancaster University, UK. The role of Public Health in building resilience: from pandemics to earthquakesAlistair HumphreyMedical Officer of Health for CanterburyFollowing the enactment of the 2002 New Zealand Civil Defence and Emergency Management Act in 2002, the Ministry for Civil Defence and Emergency Management (MCDEM) led local agencies in developing strategies for building resilience among Canterbury communities. With the looming spectre of “bird flu” (classification – H5N1), primary care led a multiagency approach to preparing for a pandemic.Representatives from health, government agencies, non-government agencies and private business including media met monthly from August 2005 onwards to develop a strategic approach towards building resilience. One example was the development of the Pandemic Roadshow by MCDEM, Canterbury District Health Board and Science Alive museum.The 2008 MCDEM national survey demonstrated that Cantabrians were more aware of the pandemic threat and generally better prepared for all hazards than other parts of New Zealand. Consequently, Canterbury performed well in response to the 2009 H1N1 pandemic. When struck by the earthquakes a year later, the issues promoted during pandemic preparedness were equally pertinent: hand-washing, availability of sanitiser, water and food supplies and knowing your neighbours. Community briefings reinforced these messages, but were also promulgated using other media.Water and sanitary health services were severely compromised after the 22 February aftershock; hand-washing, a boil water notice and provision of portaloos were key operational and communication issues for many weeks. However, community surveys showed that nearly 90% of Christchurch residents adhered to boiling water more than six weeks after the earthquake, which bought valuable time for the authorities to chlorinate the city water supply and prevent water borne disease. A heightened surveillance system revealed no increase in enteric disease after the earthquake.Promotion of personal hygiene, emergency preparedness and social capital for an anticipated pandemic brought direct benefits to the Christchurch community following the earthquake. Broad interagency collaboration and sophisticated communication strategies facilitated this, and need to be maintained to sustain community resilience. Alistair Humphrey is a Public Health Physician and GP in Christchurch. As Medical Officer of Health for Canterbury, he is designated by and responsible to the Director General of the Ministry of Health. Alistair is on the national pandemic preparedness group for New Zealand and the national group looking at the health effects of climate change (HAIFA). In 2011/2012, Alistair addressed the United Nations International Strategy for Disaster Reduction (UNISDR) global platform, the Towards a Safer World (TASW) group and the Global Risk Forum One Health Summit and other international meetings. He assisted the WHO Emergency Risk Management group in the development of their Safe Hospital Initiative and was an evaluator for the WHO's Emergency Risk Framework exercise. Alistair holds a senior lectureship post at the University of Otago Medical School. He is a Fellow of the Australasian Faculty of Public Health Medicine, Royal Australian College of General Practitioners, Australian College of Rural Medicine, and a member of the UK Faculty of Public Health. Earthquake stress and broken heartsCameron LaceyMāori Health, University of Otago, ChristchurchStress cardiomyopathy has been associated with stress and a large increase in the number of people presenting with this condition was seen following the earthquakes. The cause of this condition remains unknown, but psychiatric illnesses have been proposed as risk factors. We systematically assessed for antecedent psychiatric risk factors in two groups of cases (people who developed sporadic and earthquake-related broken heart syndrome) and compared them to a control group of healthy volunteers. We found that often psychiatric risk factors examined, only ‘neuroticism' significantly differed between participants with broken heart syndrome and healthy volunteers. This suggests that the clinical assessment of psychiatric risk factors is unlikely to assist identification of patients at increased risk of broken heart syndrome. This presentation will also provide an overview of our efforts to identify a genetic risk for this condition. Cameron Lacey is a consultation-liaison psychiatrist with a strong research interest in identification and treatment of psychiatric and cultural factors in medical illness. He is the principle investigator of a team of University of Otago Christchurch researchers including Prof R Mulder, Prof M Kennedy, Prof V Cameron, J Zarifeh and Dr P Bridgman. This group has been investigating factors that contribute to the risk of developing stress cardiomyopathy. ‘It's a thing you've got to sort of learn to live with really': the findings from the Shaken Up study of older adults aged over 75 years following the seismic events in Christchurch, New Zealand, 2011Kathy PeriSchool of Nursing, Auckland UniversityThis project aims to explore the ongoing impact of the Christchurch earthquakes on older peoples' health in primary health care one year post Christchurch earthquakes. The participants were part of the BRIGHT (Brief Risk Identification Geriatric Health Tool) Trial which had been underway since 2007 and in total 1095 older adults aged 79 and over (31 are Maori aged 69 years and over) were enrolled.The Shaken Up study proposed to re-interview these 1095 older adults to investigate their health status in the recovery phase 12 months after their 36 month BRIGHT trial interview, (up to 2 years after the earthquakes), meaning a total of 4 years follow up will be available. Pre-existing status and factors related to earthquake exposure will be examined as predictors of follow up status to identify predictors of poor outcome after earthquake.The main outcomes measured health-related quality of life, NEADL (Nottingham Extended Activities of Daily living), depression, standard of living, family and social support and life satisfaction before, between, and post-earthquakes. Relationship with trajectories of health status (improved, maintained or declined) over the same and subsequent period will be explored.Understanding population-level health of older people with primary care utilisation through the disaster period and 12 months subsequent will enable identification of particularly vulnerable groups of older age. This is internationally relevant as detailed health data before, during and after the disaster is seldom available. It is nationally relevant to enable appropriate planning for ongoing support for older people in Christchurch and other areas, should more disasters occur. Kathy Peri is a registered nurse, senior lecturer and research Fellow at the School of Nursing, University of Auckland, and works two days a week at the Counties Manuka District Health Board as the Clinical Nurse Director for Health of Older People, New Zealand. Her research interests are centred on improving health outcomes for vulnerable older people and she is currently involved in a number of research projects including health robotics, non-pharmacological dementia interventions. Kathy was the Director of Nursing at the Princess Margaret Hospital in Christchurch during the earthquakes and has over the past two and half years been awarded three research grants to explore the impact of the Canterbury earthquakes on the quality of life in community dwelling older people over the age of 75 years. Kathy will present the results of the Health Research Council funded research project today. Learning from Canterbury communities: factors that help and hinder community resilienceLouise Thornley1, Emma Rawson21. Quigley and Watts Ltd2. Community and Public Health, Canterbury District Health BoardIncreasing community resilience is vital – disaster experts, central and local government, non-government organisations, and communities themselves all agree on this point. We know that building stronger communities is important, but how should this be done? This presentation will discuss findings from qualitative research with Canterbury communities after the 2010 and 2011 earthquakes. It will focus on the key role of pre-existing community infrastructure (e.g. local leaders, networks, and marae) in helping communities to adapt post-disaster and to build resilience to future crises.Almost a third of participants in our research were Māori, mostly Ngāi Tahu. Our work highlighted marae as key hubs for emergency support and hosting people in need. Māori participants emphasised that iwi and marae infrastructure helped marae to respond quickly and effectively. Building stronger communities needs to be an everyday activity not an optional extra. Connected communities with good local infrastructure are healthier, recover faster from disasters, and are better prepared for future crises. Louise Thornley is a social researcher specialising in public health. She contracts part-time to Quigley and Watts Ltd, an independent Wellington-based research company, and has recently started as Family Planning's Research and Policy Advisor. Louise's previous work experience is in government, university and community sectors. Before joining Quigley and Watts Ltd in 2006, she was a Senior Policy Analyst for the National Health Committee, and Research Fellow for Otago University, Wellington. Her background is in youth work and community development. She worked in Christchurch's community sector for five years.Emma Rawson, Ngati Ranginui, Ngai te Rangi, Raukawa, is a Māori Health Promoter based at the Canterbury District Health Board in Christchurch. Emma's passions are Māori workforce development and Te Reo Māori as an important leadership tool for change, enhancing identity and wellbeing. She is a recent graduate of Leadership Training for Māori in Public Health, holds a B.A. Maori, University of Canterbury, Post Graduate Certificate in Public Health, University of Otago and is working on gaining a Masters in Health Science. Emma is currently working on projects in Christchurch that support wellbeing and resilience in Māori communities and building sustainable community infrastructure in vulnerable communities. Occupational health of front line workers in ChristchurchDavid McBride1, Kirsten Lovelock1, Daniel Shepherd2, Rex Billington21. Department of Preventive and Social Medicine, University of Otago, Dunedin2. Department of Psychology, Auckland University of TechnologyFront-line disaster workers are exposed to potentially disturbing events and hazardous exposures, and are potentially at risk of physical and emotional harm. As members of the community they also have to contend with ‘dual jeopardy', death or injury in their own family and damage to their personal property. This was a cross sectional study measuring the health status of responders and ‘significant others' using the World Health Organisation (WHO) Health Related Quality of Life (HRQOL) questionnaire with additional instruments to identify (for example) post-traumatic stress symptoms, burnout and fatigue. Eligible participants were Christchurch residents living there on the 4 September 2010.The survey was self-administered, facilitated through the various unions representing these occupational groups or CEOs for non-unionised workplaces. Power considerations indicated that 1,100 responses would allow adequate power. Our response rate was less than the 1,100 that we had aimed for: a total of 370 participants, 200 workers, 130 controls and 40 ‘significant others'.Workers experienced, and reported dual jeopardy; reduced physical exercise; sleep deprivation; increased alcohol consumption and imbalance between job demands and decisional latitude, the latter leading to stress. Ambulance workers and fire-fighters reported sensitisation, mediated physiologically (elevated heart rate and blood pressure) and associated with increased anxiety, when responding to ‘everyday' emergencies following the February earthquake.Our research also provides further evidence that social support from family, peers, colleagues and wider social networks are central to maintaining resilience and reducing vulnerability. Significantly, existing and pre-existing employment relations are central to the nature of how front line workers initially respond to a natural disaster; cope in the aftermath of the disaster and try to remain healthy. David McBride is an occupational physician who did his initial training with the British Coal Corporation as a Medical Officer. His responsibilities were collieries in the Staffordshire and Lancashire coal fields, the Mines Rescue Station at Boothstown and an experimental coal liquefaction plant in North Wales. He did his academic training at the University of Birmingham, and then was appointed Clinical Lecturer in 1991. He was appointed Senior Lecturer in Occupational Health at the University of Otago in 1995 and Associate Professor in 2011. He has been in the army as a reservist since 1973 and has some knowledge of ‘conflict medicine', having served with the New Zealand Defence Force (NZDF) in Timor Leste and Afghanistan. On volunteering for another engagement with the NZDF serendipity must have been a factor in his posting as a Medical Officer to Burnham Camp over the period November 2010–December 2011. He then found himself on another ‘tour' of Afghanistan in January 2012. Facing the unexpected – health care workers and the emergency department response to 22 February earthquakeSandra RichardsonCentre for Post Graduate Nursing Study, University of Otago, ChristchurchThis study identifies the experiences and impact of the 22 February 2011earthquake on those staff who contributed to the Emergency Department response. While there are individual reports from various natural disaster settings identifying personal reactions and perceptions, there is very little reported about the experience of health care providers who are both responders to and part of a disaster event.The focus on health care responders is typically centred on the provision of care and ability to maintain normal services, with little exploring what it means to be part of a disaster situation, coping with competing personal, professional and family commitments.This study commenced in the week following the February event, and involved one on one qualitative interviews with over 90 individuals who were involved in the emergency department response at this time. Given the presence of so many staff and volunteers from a wide range of backgrounds, it was intended to include a multidisciplinary perspective. As a result, interviews were undertaken with staff from medical, nursing, social work, blood bank, orderlies, Maori health and radiology, amongst others. Interviews were reviewed and core themes identified, which allow a clearer understanding of the experience of individuals, and the implications for professional groups and health care planners. A summary of issues and recommendations is presented resulting from this process. Sandra Richardson is a Senior Lecturer with the Centre for Post Graduate Nursing Study at the University of Otago, Christchurch and Nurse Researcher in the Emergency Department, Canterbury District Health Board. Sandra's research interests include Emergency Department crowding, advanced nursing practice and the impact and experience of the Canterbury Earth quake events. Shaky times – the Canterbury earthquakes and all that has followedCaroline BellDepartment of Psychological Medicine, University of Otago, ChristchurchSince 4 September 2010 there have been three major earthquakes and over 13,000 aftershocks in Christchurch inflicting substantial damage to the city. Widespread economic and practical consequences, particularly with insurance companies and the Earthquakes Commission (EQC), have created significant secondary stressors further compounding the difficulties of many. This has resulted in people presenting with a broad spectrum of psychological responses. A specialist team was set up by the Canterbury District Health Board to treat people with significant post-traumatic stress and anxiety and this team is continuing to see new presentations.This paper will discuss the ongoing research of people presenting with post-traumatic stress disorder (PTSD) and those identifying as resilient. Two broad lines of research will be presented that aim at understanding the treatment and neurobiology of people with PTSD and those self-identifying as resilient. Caroline Bell is a consultant psychiatrist and senior lecturer at the University of Otago in Christchurch with an expertise in anxiety. She has had a role in managing the psychosocial responses to the Canterbury earthquakes across the community and is the clinical lead of a treatment team for people with severe Post Traumatic Stress Disorder from the earthquakes. The impact of Christchurch Earthquake on availability of diagnostic-test resultsKevin Taylor1, Peter George1, Joanne Deely21. Canterbury Health Laboratories, Canterbury District Health Board2. Independent Contractor, Canterbury District Health BoardBetween 60–70% of medical decisions are based on laboratory test results. With both community laboratories (MedLab South and Southern Community Laboratories) destroyed in the Christchurch earthquake, the performance of Canterbury Health Laboratories was integral to how the health system delivered care to Canterbury after the disaster.This study assessed the effects of the Christc

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After the catastrophic earthquake in Christchurch, New Zealand, on 22 February 2011, the Rhise Group (researching the health implications of seismic events) was formed by Professor Michael Ardagh.The main objective of the group was to facilitate understanding of the health impacts of the Christchurch earthquakes and, specifically, to enable collaboration and sharing of resources where appropriate. This has been achieved through the occasional forum and a shared website, able to be accessed by the 219 members of the group. In addition, the group encouraged a dedicated funding round for earthquake research from the Health Research Council of New Zealand and the Canterbury Medical Research Foundation.This symposium is the most significant event hosted by the Rhise Group to date and allows the recipients of that funding round, and other researchers from within the Rhise Group, to present the current state of their research. Thanks go to the Emergency Care Foundation, Lane Neave Lawyers, University of Otago, Christchurch, Canterbury District Health Board, Canterbury Medical Research Foundation, and Emergency Care Co-ordinations Teams for sponsoring the symposium.Within the wider, loose collaborative of researchers making up the Rhise Group is a small ‘working group' based in the Emergency Department of Christchurch Hospital, and the University of Otago, Christchurch. The working group coordinates the activities of the Rhise Group and includes Professor Ardagh, Dr Joanne Deely, Ms Alieke Dierckx, Dr Sandra Richardson and Dr Martin Than.Particular thanks go to Dr Deely and Ms Dierckx for putting this symposium together and Dr Deely and Professor Ardagh for editing the proceedings. How did the earthquakes change health service utilisation in Canterbury?David MeatesChief Executive Officer, Canterbury and West Coast District Health BoardsThe earthquakes of 2010 and 2011 have changed the way the Canterbury health system is organised and services are provided. While many changes and much of the infrastructure and relationships had been developed prior to the earthquakes, the February quake resulted in further innovation resulting in new initiatives (e.g. eSCRV, CREST, medication management). These have further emphasised the role of keeping people well in their own homes and communities.The combination of earthquakes, system changes and new approaches has significantly changed health service utilisation in Canterbury. The initial reduction in people accessing all services has been replaced by decreasing growth in the rate of acute admission as more people are looked after in the community. Decreases in acute care growth are strongest among the over 65-age group, where the population has increased. While these changes are not attributable to the earthquakes, these seismic events have acted as a catalyst to drive the system changes. David Meates is Chief Executive of the Canterbury and West Coast District Health Boards (DHBs)– responsible for the health services for over 550,000 New Zealanders, and the leadership of over 9,500 direct employees and thousands more non-governmental organisation health sector workers contracted by the DHB. He is a big picture thinker and has particular skills in leading change, and motivating and mobilising others to be part of the transformation. David is passionate about health and what's possible when people grasp the vision and work collectively for the greater good. The achievements of the Canterbury Health System are testimony to his leadership. Originally from Canterbury, David has worked in both the private and public sectors, in NZ and the UK. He has also led and been involved on a number of national groups ranging from workforce negotiations to CEO alliances. Recent experiences in Canterbury have shown David is adept at managing large teams through a crisis and developing and implementing robust recovery plans. The initial health system response to the Christchurch earthquakeMichael Ardagh1, Sandra Richardson2, Viki Robinson3, Martin Than3, Paul Gee3, Seton Henderson4, Laura Khodaverdi4, John McKie5, Gregory Robertson6, Philip Schroeder7, Joanne Deely81. Department of Surgery, University of Otago, Christchurch2. Centre for Postgraduate Nursing, University of Otago, Christchurch3. Emergency Department, Christchurch Hospital4. Intensive Care Unit, Christchurch Hospital5. Department of Orthopaedic Surgery, Christchurch Hospital6. Resident Medical Officers Unit, Canterbury District Health Board7. Rolleston Medical Centre, Christchurch8. Independent Contractor, Canterbury District Health BoardA total of 182 people died and 6659 were treated for injuries during the first day following a violent earthquake that struck Christchurch city at 12.51 on 22 February 2011. A combination of huge peak ground accelerations, time of the day, and collapse of major buildings contributed to the numbers of people injured. We report on the injury burden of the Christchurch earthquake and the initial health system response.175 of those killed died before arriving at hospital. Of the 6659 people injured, 2032 (31%) were male and 4627 (69%) female, and 2752 (41%) were between the ages of 40 and 59 years. Eighty-seven (1%) were children under the age of 10 and 950 (14%) adults over the age of 70 years. 142 people were admitted to hospital including 18 to the Intensive Care Unit. Fourteen people were treated for crush injury syndrome, six of whom required renal replacement therapy and a small number of people required amputations.Experiences suggest that hospitals should prepare for: patients arriving on mass by extraordinary means, patients arriving with no pre-hospital care, loss of electronic registration and tracking of patients, patient unwillingness to come into hospital buildings, loss of all electricity, many unexpected willing helpers, loss of communication, media intrusion, and maintaining teamwork with explicit leadership.Follow up research is concentrating on understanding the demographic distributions and causes of the injuries. (See abstracts by Johnston et. al. and Standing et al. in these proceedings.)Reference: Lancet 2012;379:2109–15. Michael Ardagh is a fellow of the Australasian College for Emergency Medicine and has a PhD in Bioethics. He is Professor of Emergency Medicine at the University of Otago, Christchurch, and Specialist in Emergency Medicine at Christchurch Hospital. He is National Clinical Director of Emergency Department Services (a position also known as ‘Target Champion'), to assist with implementation of the ‘Shorter Stays in the Emergency Department' health target. He is Chair of the Rhise Group (Researching the health implications of seismic events) which was formed to encourage collaborative research regarding the Christchurch earthquakes of 2010 and 2011. Michael was made an Officer of New Zealand Order of Merit (ONZM) for services to medicine in 2012. The 2010/2011 Canterbury earthquakes: context and cause of injuryDavid Johnston1, Sarah Standring2, Kevin Ronan3, Michael Lindell4, Thomas Wilson5, Jim Cousins6, Emma Aldridge2, Michael Ardagh7, Joanne Deely8, Steven Jensen9, Thomas Kirsch10, Richard Bissell111. Joint Centre for Disaster Research, GNS Science/Massey University2. School of Medicine, University of Auckland,3. School of Human, Health and Social Sciences, Central Queensland University4. Hazard Reduction & Recovery Center, Texas A&M University5. Department of Geological Sciences, University of Canterbury6. Geohazards Monitoring, GNS Science7. Department of Surgery, University of Otago, Christchurch8. Independent Contractor, Canterbury District Health Board9. Preparedness, Health and Safety Services, California State University10. Center for Refugee and Disaster Response, Johns Hopkins University11. Emergency Health Services, University of MarylandLittle is known about the relationship between human behaviour and risk of injury during earthquakes. We aimed to fill this gap by analysing the New Zealand Accident Compensation Corporation database for causes and context of injury during the Canterbury earthquakes. The total injury burden was analysed for demography, context of injury, causes of injury, and injury type.Three times as many people were injured in the Christchurch earthquake (22 February 2011) as in the Darfield earthquake (4 September 2010; 7171 vs 2256). Primary shaking caused approximately two-thirds of the injuries from both quakes. Actions during the main shaking and aftershocks led to many injuries.Many people were injured after shaking stopped in both events. Most of these people were injured during clean-up. In both earthquakes: more females than males (1453 vs 803 Darfield; 4646 vs 2525 Christchurch) were injured; trip/fall was the most common cause of injury; and soft tissue injuries was the most common type of injury. The findings of this study suggest that where people were and their behaviour during and after earthquakes influenced their risk of injury. David Johnston is a senior scientist at GNS Science and Director of the Joint Centre for Disaster Research at Massey University. His research focuses on human responses to disasters, crisis decision-making, public education, and building community resilience and recovery. David is Chair of the international Integrated Research and Disaster Risk Scientific Committee. He is also on New Zealand's Royal Society Social Science Advisory Panel, and the editor of the Australasian Journals of Disaster and Trauma Studies, and founding editor of the Journal of Applied Volcanology. Spatial variations in stress-related health compared to earthquake exposure: preliminary results and future directionsSimon Kingham1, Daniel Hogg1, Kim Reed1, ThomasWilson2, Michael Ardagh31. Department of Geography, University of Canterbury2. Department of Geological Sciences, University of Canterbury3. Department of Surgery, University of Otago, ChristchurchFourth September 2010 saw the start of a series of destructive earthquakes around the city of Christchurch, New Zealand (pop 350,000). These left the region with widespread damage to the city and its infrastructure including: major liquefaction (the process by which the ground turns to liquid); 70% of the central city needing to be rebuilt; 20,000 homes needing to be pulled down; and 100,000 homes needing repairing.The aftershocks are ongoing with over 13,000. It is hypothesised that all this will have an ongoing impact on those living in and around the city. The aims of this study were to identify whether adverse stress-related health outcomes were greater among people who have experienced greater physical damage to their communities than those who have experienced less damage, but who also live in the region. Exposure to earthquake damage through amount & extent of liquefaction and land 'colour' (land colour coded according to whether it can be used in the future) was estimated.Emergency department data was collated for chest pain and anxiety for a period of 6 months before and 18 months after the start of the earthquakes. Exposure was related to health. For the period from 1May 2010 to 30 April 2012, there were 9,807 chest pain and 524 anxiety hospital attendances. Those people living in areas of greater earthquake related damage and those living closer to more damaged areas had greater levels of stress-related ill health.It is concluded that there is preliminary evidence that those living in and nearer to areas of greater earthquake impact have greater levels of stress-related ill-health. Further research funded by the Cooperative Research Centre for Spatial Information (CRCSI) is developing more indicators of earthquake impact such as: extent of home damage; infrastructure service closures and restriction, community disruption e.g. school & shop closure; extent of home damage; and magnitude of shaking. In addition population mobility is being included in this analysis. Simon Kingham is Professor of Geography and Director of the GeoHealth Laboratory at the University of Canterbury, in Christchurch, New Zealand. He has carried out research in health and environment issues for over 20 years, specifically looking at environmental exposure. He is a Director of the GeoHealth Laboratory which is funded by the Ministry of Health to undertake applied research in the areas of health geography, spatial epidemiology and Geographical Information Systems. He has published his research widely and has a BA (Hons) and a PhD in Geography from Lancaster University, UK. The role of Public Health in building resilience: from pandemics to earthquakesAlistair HumphreyMedical Officer of Health for CanterburyFollowing the enactment of the 2002 New Zealand Civil Defence and Emergency Management Act in 2002, the Ministry for Civil Defence and Emergency Management (MCDEM) led local agencies in developing strategies for building resilience among Canterbury communities. With the looming spectre of “bird flu” (classification – H5N1), primary care led a multiagency approach to preparing for a pandemic.Representatives from health, government agencies, non-government agencies and private business including media met monthly from August 2005 onwards to develop a strategic approach towards building resilience. One example was the development of the Pandemic Roadshow by MCDEM, Canterbury District Health Board and Science Alive museum.The 2008 MCDEM national survey demonstrated that Cantabrians were more aware of the pandemic threat and generally better prepared for all hazards than other parts of New Zealand. Consequently, Canterbury performed well in response to the 2009 H1N1 pandemic. When struck by the earthquakes a year later, the issues promoted during pandemic preparedness were equally pertinent: hand-washing, availability of sanitiser, water and food supplies and knowing your neighbours. Community briefings reinforced these messages, but were also promulgated using other media.Water and sanitary health services were severely compromised after the 22 February aftershock; hand-washing, a boil water notice and provision of portaloos were key operational and communication issues for many weeks. However, community surveys showed that nearly 90% of Christchurch residents adhered to boiling water more than six weeks after the earthquake, which bought valuable time for the authorities to chlorinate the city water supply and prevent water borne disease. A heightened surveillance system revealed no increase in enteric disease after the earthquake.Promotion of personal hygiene, emergency preparedness and social capital for an anticipated pandemic brought direct benefits to the Christchurch community following the earthquake. Broad interagency collaboration and sophisticated communication strategies facilitated this, and need to be maintained to sustain community resilience. Alistair Humphrey is a Public Health Physician and GP in Christchurch. As Medical Officer of Health for Canterbury, he is designated by and responsible to the Director General of the Ministry of Health. Alistair is on the national pandemic preparedness group for New Zealand and the national group looking at the health effects of climate change (HAIFA). In 2011/2012, Alistair addressed the United Nations International Strategy for Disaster Reduction (UNISDR) global platform, the Towards a Safer World (TASW) group and the Global Risk Forum One Health Summit and other international meetings. He assisted the WHO Emergency Risk Management group in the development of their Safe Hospital Initiative and was an evaluator for the WHO's Emergency Risk Framework exercise. Alistair holds a senior lectureship post at the University of Otago Medical School. He is a Fellow of the Australasian Faculty of Public Health Medicine, Royal Australian College of General Practitioners, Australian College of Rural Medicine, and a member of the UK Faculty of Public Health. Earthquake stress and broken heartsCameron LaceyMāori Health, University of Otago, ChristchurchStress cardiomyopathy has been associated with stress and a large increase in the number of people presenting with this condition was seen following the earthquakes. The cause of this condition remains unknown, but psychiatric illnesses have been proposed as risk factors. We systematically assessed for antecedent psychiatric risk factors in two groups of cases (people who developed sporadic and earthquake-related broken heart syndrome) and compared them to a control group of healthy volunteers. We found that often psychiatric risk factors examined, only ‘neuroticism' significantly differed between participants with broken heart syndrome and healthy volunteers. This suggests that the clinical assessment of psychiatric risk factors is unlikely to assist identification of patients at increased risk of broken heart syndrome. This presentation will also provide an overview of our efforts to identify a genetic risk for this condition. Cameron Lacey is a consultation-liaison psychiatrist with a strong research interest in identification and treatment of psychiatric and cultural factors in medical illness. He is the principle investigator of a team of University of Otago Christchurch researchers including Prof R Mulder, Prof M Kennedy, Prof V Cameron, J Zarifeh and Dr P Bridgman. This group has been investigating factors that contribute to the risk of developing stress cardiomyopathy. ‘It's a thing you've got to sort of learn to live with really': the findings from the Shaken Up study of older adults aged over 75 years following the seismic events in Christchurch, New Zealand, 2011Kathy PeriSchool of Nursing, Auckland UniversityThis project aims to explore the ongoing impact of the Christchurch earthquakes on older peoples' health in primary health care one year post Christchurch earthquakes. The participants were part of the BRIGHT (Brief Risk Identification Geriatric Health Tool) Trial which had been underway since 2007 and in total 1095 older adults aged 79 and over (31 are Maori aged 69 years and over) were enrolled.The Shaken Up study proposed to re-interview these 1095 older adults to investigate their health status in the recovery phase 12 months after their 36 month BRIGHT trial interview, (up to 2 years after the earthquakes), meaning a total of 4 years follow up will be available. Pre-existing status and factors related to earthquake exposure will be examined as predictors of follow up status to identify predictors of poor outcome after earthquake.The main outcomes measured health-related quality of life, NEADL (Nottingham Extended Activities of Daily living), depression, standard of living, family and social support and life satisfaction before, between, and post-earthquakes. Relationship with trajectories of health status (improved, maintained or declined) over the same and subsequent period will be explored.Understanding population-level health of older people with primary care utilisation through the disaster period and 12 months subsequent will enable identification of particularly vulnerable groups of older age. This is internationally relevant as detailed health data before, during and after the disaster is seldom available. It is nationally relevant to enable appropriate planning for ongoing support for older people in Christchurch and other areas, should more disasters occur. Kathy Peri is a registered nurse, senior lecturer and research Fellow at the School of Nursing, University of Auckland, and works two days a week at the Counties Manuka District Health Board as the Clinical Nurse Director for Health of Older People, New Zealand. Her research interests are centred on improving health outcomes for vulnerable older people and she is currently involved in a number of research projects including health robotics, non-pharmacological dementia interventions. Kathy was the Director of Nursing at the Princess Margaret Hospital in Christchurch during the earthquakes and has over the past two and half years been awarded three research grants to explore the impact of the Canterbury earthquakes on the quality of life in community dwelling older people over the age of 75 years. Kathy will present the results of the Health Research Council funded research project today. Learning from Canterbury communities: factors that help and hinder community resilienceLouise Thornley1, Emma Rawson21. Quigley and Watts Ltd2. Community and Public Health, Canterbury District Health BoardIncreasing community resilience is vital – disaster experts, central and local government, non-government organisations, and communities themselves all agree on this point. We know that building stronger communities is important, but how should this be done? This presentation will discuss findings from qualitative research with Canterbury communities after the 2010 and 2011 earthquakes. It will focus on the key role of pre-existing community infrastructure (e.g. local leaders, networks, and marae) in helping communities to adapt post-disaster and to build resilience to future crises.Almost a third of participants in our research were Māori, mostly Ngāi Tahu. Our work highlighted marae as key hubs for emergency support and hosting people in need. Māori participants emphasised that iwi and marae infrastructure helped marae to respond quickly and effectively. Building stronger communities needs to be an everyday activity not an optional extra. Connected communities with good local infrastructure are healthier, recover faster from disasters, and are better prepared for future crises. Louise Thornley is a social researcher specialising in public health. She contracts part-time to Quigley and Watts Ltd, an independent Wellington-based research company, and has recently started as Family Planning's Research and Policy Advisor. Louise's previous work experience is in government, university and community sectors. Before joining Quigley and Watts Ltd in 2006, she was a Senior Policy Analyst for the National Health Committee, and Research Fellow for Otago University, Wellington. Her background is in youth work and community development. She worked in Christchurch's community sector for five years.Emma Rawson, Ngati Ranginui, Ngai te Rangi, Raukawa, is a Māori Health Promoter based at the Canterbury District Health Board in Christchurch. Emma's passions are Māori workforce development and Te Reo Māori as an important leadership tool for change, enhancing identity and wellbeing. She is a recent graduate of Leadership Training for Māori in Public Health, holds a B.A. Maori, University of Canterbury, Post Graduate Certificate in Public Health, University of Otago and is working on gaining a Masters in Health Science. Emma is currently working on projects in Christchurch that support wellbeing and resilience in Māori communities and building sustainable community infrastructure in vulnerable communities. Occupational health of front line workers in ChristchurchDavid McBride1, Kirsten Lovelock1, Daniel Shepherd2, Rex Billington21. Department of Preventive and Social Medicine, University of Otago, Dunedin2. Department of Psychology, Auckland University of TechnologyFront-line disaster workers are exposed to potentially disturbing events and hazardous exposures, and are potentially at risk of physical and emotional harm. As members of the community they also have to contend with ‘dual jeopardy', death or injury in their own family and damage to their personal property. This was a cross sectional study measuring the health status of responders and ‘significant others' using the World Health Organisation (WHO) Health Related Quality of Life (HRQOL) questionnaire with additional instruments to identify (for example) post-traumatic stress symptoms, burnout and fatigue. Eligible participants were Christchurch residents living there on the 4 September 2010.The survey was self-administered, facilitated through the various unions representing these occupational groups or CEOs for non-unionised workplaces. Power considerations indicated that 1,100 responses would allow adequate power. Our response rate was less than the 1,100 that we had aimed for: a total of 370 participants, 200 workers, 130 controls and 40 ‘significant others'.Workers experienced, and reported dual jeopardy; reduced physical exercise; sleep deprivation; increased alcohol consumption and imbalance between job demands and decisional latitude, the latter leading to stress. Ambulance workers and fire-fighters reported sensitisation, mediated physiologically (elevated heart rate and blood pressure) and associated with increased anxiety, when responding to ‘everyday' emergencies following the February earthquake.Our research also provides further evidence that social support from family, peers, colleagues and wider social networks are central to maintaining resilience and reducing vulnerability. Significantly, existing and pre-existing employment relations are central to the nature of how front line workers initially respond to a natural disaster; cope in the aftermath of the disaster and try to remain healthy. David McBride is an occupational physician who did his initial training with the British Coal Corporation as a Medical Officer. His responsibilities were collieries in the Staffordshire and Lancashire coal fields, the Mines Rescue Station at Boothstown and an experimental coal liquefaction plant in North Wales. He did his academic training at the University of Birmingham, and then was appointed Clinical Lecturer in 1991. He was appointed Senior Lecturer in Occupational Health at the University of Otago in 1995 and Associate Professor in 2011. He has been in the army as a reservist since 1973 and has some knowledge of ‘conflict medicine', having served with the New Zealand Defence Force (NZDF) in Timor Leste and Afghanistan. On volunteering for another engagement with the NZDF serendipity must have been a factor in his posting as a Medical Officer to Burnham Camp over the period November 2010–December 2011. He then found himself on another ‘tour' of Afghanistan in January 2012. Facing the unexpected – health care workers and the emergency department response to 22 February earthquakeSandra RichardsonCentre for Post Graduate Nursing Study, University of Otago, ChristchurchThis study identifies the experiences and impact of the 22 February 2011earthquake on those staff who contributed to the Emergency Department response. While there are individual reports from various natural disaster settings identifying personal reactions and perceptions, there is very little reported about the experience of health care providers who are both responders to and part of a disaster event.The focus on health care responders is typically centred on the provision of care and ability to maintain normal services, with little exploring what it means to be part of a disaster situation, coping with competing personal, professional and family commitments.This study commenced in the week following the February event, and involved one on one qualitative interviews with over 90 individuals who were involved in the emergency department response at this time. Given the presence of so many staff and volunteers from a wide range of backgrounds, it was intended to include a multidisciplinary perspective. As a result, interviews were undertaken with staff from medical, nursing, social work, blood bank, orderlies, Maori health and radiology, amongst others. Interviews were reviewed and core themes identified, which allow a clearer understanding of the experience of individuals, and the implications for professional groups and health care planners. A summary of issues and recommendations is presented resulting from this process. Sandra Richardson is a Senior Lecturer with the Centre for Post Graduate Nursing Study at the University of Otago, Christchurch and Nurse Researcher in the Emergency Department, Canterbury District Health Board. Sandra's research interests include Emergency Department crowding, advanced nursing practice and the impact and experience of the Canterbury Earth quake events. Shaky times – the Canterbury earthquakes and all that has followedCaroline BellDepartment of Psychological Medicine, University of Otago, ChristchurchSince 4 September 2010 there have been three major earthquakes and over 13,000 aftershocks in Christchurch inflicting substantial damage to the city. Widespread economic and practical consequences, particularly with insurance companies and the Earthquakes Commission (EQC), have created significant secondary stressors further compounding the difficulties of many. This has resulted in people presenting with a broad spectrum of psychological responses. A specialist team was set up by the Canterbury District Health Board to treat people with significant post-traumatic stress and anxiety and this team is continuing to see new presentations.This paper will discuss the ongoing research of people presenting with post-traumatic stress disorder (PTSD) and those identifying as resilient. Two broad lines of research will be presented that aim at understanding the treatment and neurobiology of people with PTSD and those self-identifying as resilient. Caroline Bell is a consultant psychiatrist and senior lecturer at the University of Otago in Christchurch with an expertise in anxiety. She has had a role in managing the psychosocial responses to the Canterbury earthquakes across the community and is the clinical lead of a treatment team for people with severe Post Traumatic Stress Disorder from the earthquakes. The impact of Christchurch Earthquake on availability of diagnostic-test resultsKevin Taylor1, Peter George1, Joanne Deely21. Canterbury Health Laboratories, Canterbury District Health Board2. Independent Contractor, Canterbury District Health BoardBetween 60–70% of medical decisions are based on laboratory test results. With both community laboratories (MedLab South and Southern Community Laboratories) destroyed in the Christchurch earthquake, the performance of Canterbury Health Laboratories was integral to how the health system delivered care to Canterbury after the disaster.This study assessed the effects of the Christc

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