An absence of emergent healthcare in the Pacific Islands is impeding development. Geographical remoteness, small land masses, and proportionately large populations create unique challenges across Pacific Island Countries (PICs). The region, infamous for environmental and climatic disasters, as well as a vulnerability to communicable diseases, now faces a rising epidemic of non-communicable diseases. The growing need for emergency care (EC) cannot be met with current systems. This is in stark contrast to Australia, where most citizens enjoy universal health coverage, inclusive of high-quality EC systems.
Every individual is likely to require EC to avoid deterioration, disability, or death within their lifetime. Despite this, EC systems in PICs are profoundly underdeveloped. Pre-hospital care is particularly dire; no PIC demonstrates an adequate level of care and only 36% reported having trained pre-hospital providers within their country. The aforementioned challenges faced in PICs are further compounded by health inequities, particularly with regards to access, resources, and the healthcare workforce. Evidence is increasingly demonstrating the efficacy of EC systems in low resource settings to reduce preventable morbidity and mortality. It is estimated that with effective EC 54% of deaths in developing countries could be averted, in addition to one million disability-adjusted life years annually (a metric used to assess years of healthy life lost). Realisation of these figures would see PICs make significant progress towards global health priorities such as the Sustainable Development Goals and universal health coverage.
Governments across PICs have recognised the need for enhanced EC systems, but lack the expertise required to develop capacity and function. By virtue of their civilian and military training, ADF health professionals are highly skilled and possess the ability to work in low-resource environments. Moreover, their ability to develop and govern trauma systems, as well as provide EC to a high standard, is evidenced by the recent accreditation of the Australian Army’s Role 2 (Enhanced) as a Level 3 Trauma System. However, in the absence of combat injuries and global health engagement opportunities, skill degradation is a serious concern. Thus, the opportunity for a mutually effective partnership is evident.
The Australian Government recently published the 2020 Defence Strategic Update. This update provided a new strategic framework with a specific focus on the Indo-Pacific region. Amongst the outlined objectives, partnership was a recurring theme and support of the Department of Foreign Affairs and Trade’s ‘Pacific Step-Up’ program was emphasised. Captain Tony Chen recently published an editorial in The Cove, eloquently highlighting how current doctrinal constraints limit global health engagement in the ADF and hinder the ability of military healthcare to meaningfully contribute to the acquisition of this national objective. If such constraints were to be overcome, the ADF is well positioned to assist PICs to develop EC systems.
Development efforts of EC systems are underway in PICs. Pacific Islands Society for Emergency Care (PISEC) is a clinical group still in its infancy, led by PIC EC clinicians and supported by civilian Australian EC physicians. The group aims to improve EC systems across the Pacific through research, collaboration, and leadership. Such efforts are demonstrative of local ownership, necessity, and accountability – principles integral to successful development. It is imperative the ADF engagement is a tool to implement and augment initiatives led by the PICs in order to sustainably build local capacity.
Members of PISEC have identified numerous priorities for EC system development, many of which the ADF could expediate. Development of standard operating procedures, cohesive triage interventions and basic emergency response, such as the training of lay responders, are just a few examples. Leveraging existing resources and implementing low resource methods are largely cost-effective interventions. Each death that is averted by first-responder training is estimated to cost US$170 (AUD$240), but training is traditionally costly and geographically constrained for these developing countries. Utilising ADF personnel to train first responders provides a solution that is accessible (via small training teams deployed regionally), cost-effective, and mutually beneficial. Given the potential to halve mortality in a population that is comparatively small in number, there is a significant cost-benefit to Australia, which invested AUD$372.5 billion dollars in the Pacific regional development program last financial year.
The Australian medical community is increasingly recognising the responsibility Australian entities have in assisting the development of PIC EC systems. The ADF is amongst these. With a cohort of highly skilled, logistically capable health professionals at their disposal, the ADF should deploy their assets to assist PICs with this objective if they wish to actually “step up” in the Pacific.