Dr Len Notaras: Industry Q & A

Dr Len Notaras has recently been appointed the Chief Executive Officer for the Northern Territory Department of Health. His new position has overarching responsibility for the National Critical Care and Trauma Response Centre (NCCTRC) of which he was recently Executive Director.

Australian Hospital and Healthcare Bulletin asked Dr Notaras about the NCCTRC and its key position in the Australian Government’s disaster and emergency medical response capabilities.
Can you tell us about the National Critical Care and Trauma Response Centre? What is its purpose and who does it serve? 
The primary objective of the NCCTRC is to continue the development of the Northern Territory’s regional disaster response capability - as a northern hub of evidence based medical care, research and education, which is readily available to respond to major national health incidents.
The NCCTRC is funded by the Australian Government and is an initiative supported by the Northern Territory Government. Investment in preparedness, planning, education, training, and related research, remains critical to the Centre’s development. The NCCTRC was established in 2005 following the 2002 response to the Bali bombing. The NCCTRC provides leadership, as well as timely surge and response capacity through a range of disasters.
The NCCTRC continues to develop strong links in the Asian region particularly with Indonesia and Timor-Leste.
The NCCTRC is highly regarded internationally for its trauma response service. Can you tell us about its model of care and how it has become so recognised?

The NCCTRC emerged as the product of a number of successful responses most notably the 2002 Bali tragedy. 
In the first instance this was contributed to by the real notion of isolation and proximity. Acknowledging that Darwin is placed at the very base of the Pacific ‘ring of fire’, there has for many years been an imperative to recognise the very real need for both preparedness and practice in response. Darwin responded in 1942 to the World War 2 bombings, and again in 1974 to the devastation of Cyclone Tracy, and from this platform built resilience over many years which culminated not only in the Bali Responses but also the PNG tsunami and the Indian Ocean tsunami and a range of other more local disaster responses. The concept of a preparedness, based on well trained and practiced people, evolved very much as a “local product”, and that initiative became the template for the NCCTRC. The Centre is well founded on the premise of response and retrieval, leading following rescue and resuscitation, to repatriation, not only locally, but also nationally and internationally. The very underpinning of the Centre is reliant upon a solid response template, supported by teaching training, partnerships and research.
Dr Len Notaras has recently been appointed the Chief Executive Officer for the Northern Territory Department of Health. His new position has overarching responsibility for the National Critical Care and Trauma Response Centre (NCCTRC) of which he was recently Executive Director.
In regard to disaster management, how does the NCCTRC prepare and equip to respond to disasters? 
Lessons identified from previous state based responses have been assimilated into the planning and professionalism of the NCCTRC rapid response team. No comparable response capacity exists in any other state or territory through the Australian Medical Response Team system (AUSMAT).
[pullQuote] “The very underpinning of the Centre is reliant upon a solid response template, supported by teaching training, partnerships and research..” [/pullQuote]
The NCCTRC is federally resourced, and is ideally placed to remain the operational centre for any medical team responses to Northern Australia and overseas, as directed by the federal government The NCCTRC has a cache of medical and logistics equipment ready for deployment with minimum notice. Training and education are key priorities for the NCCTRC, with significant investment to ensure trauma and disaster training for all clinicians across the NT and Australia. It strives to enhance preparedness through teaching, training and practice, while providing ready response teams equipped to rescue and resuscitate victims of disaster events, and then as appropriate repatriate them to other centres across Australia.
What has been the most recent disaster management project? 
The NCCTRC was tasked by the Australian Government to deploy Australian Medical Assistance Teams (AUSMAT) in the aftermath of Typhoon Haiyan which devastated central Philippines in November 2013. Two teams of 37 members were deployed for 14 days each. Equipment included a 50-bed deployable hospital, x-ray facility, two operating theatres, medical supplies to treat up to 4000 people and perform 200 operations, 5 triage outpatient tents, and food and water purification equipment to ensure the team is self-sufficient. The teams were based in the devastated city of Tacloban.
How does the NCCTRC use those experiences for research and future management? 
The NCCTRC is developing a reputation for disaster research that is operationally relevant, and applicable to Northern region responses, and to tropical neighbours. This includes heat illness prevention in those wearing protective fire or chemical suits in tropical environments. This has applicability to emergency services and the ADF and has been well received nationally.
Research has also been completed in safer deployment of medical team wearing light weight uniforms.
The NCCTRC has led the development of a national bar-code triage scanning device that allows mass casualty tracking of multiple victims. This system also has application in evacuation of health facilities and nursing homes, and in use of cyclone shelters or mass transport aircraft, and in disaster victim identification.
The NCCTRC facilitated a national move to a single triage card for mass casualty response, rather than individual cards per state, through its research into the area. It continues with a strong program of relevant and real world research with application to civilian and ADF disaster response.
How many people are employed and from what scopes of healthcare practice?
The NCCTRC employs a core staff of 37 FTE. This includes a clinical led disaster preparedness and response team, a trauma team and an education and training unit. In addition the NCCTRC funds additional staff within the Royal Darwin Hospital who include doctors, nurses, allied health staff.
How did you come to be so passionate about working in critical care and trauma response?
In 1989 I was working at John Hunter Hospital which the earthquake struck the region. That was my first disaster response and later when I moved to Royal Darwin Hospital to take up the position of Medical Director, there was the East Timor crisis of 1999, the 2002 Bali bombings, the 2005 Bali bombing, in 2006 the Indian Ocean tsunami and again and again it appears.
With degrees in Medicine, Law and Arts, Commerce, History and Hospital Management, you are obviously committed to working towards an efficient healthcare system? How do you feel Australia is fairing in healthcare efficiency?
There is a lot of work to be done when ensuring the we maintain efficiencies in healthcare particularly as the population ages. Healthcare providers and our Government are very aware of this but there is a great body of work to do to address these issues.
You obviously have the support of the Australian Government. Do they have a long-term commitment to provide clinical and academic leadership in disaster and trauma care?
[pullQuote]“The NCCTRC has led the development of a national bar-code triage scanning device that allows mass casualty tracking of multiple victims. This system also has application in evacuation of health facilities and nursing homes, and in use of cyclone shelters or mass transport aircraft, and in disaster victim identification.” [/pullQuote]
Former Prime Minister John Howard recognised the importance of ensuring that Australia has leadership in disaster and trauma care from both a clinical and academic perspective. The positioning of Darwin makes this very relevant particularly with Australia looking very much towards Asia in particular Indonesia and China. We are very fortunate that Australian Government, whether it be Labor or Liberal has recognised this with ongoing support for the NCCTRC.
Internationally, Australia is now being recognised as world leader’s in disaster response. The President of the Philippines said in November last year when he visited the AUSMAT in Tacloban that we are the “shining light in disaster and trauma care”. Similarly, His Excellency Dr Susilo Bambang Yudhoyono of Indonesia and the Governor of Bali IMP have also staunchly supported the centre.
What do you think will be the major issues we face in healthcare operations and management in the next 10 years?
The ability to ensure adequate preparedness and meeting demands with growing budgetary constraints while addressing efficiency is an issue for all healthcare institutions.