In the midst of a global pandemic it's easy to forget another international disaster - a volcano eruption - that just a few months ago pulled some of Australia's top medical experts into action.

Normal text size Larger text size Very large text size It was all hands on deck. Two days after White Island Volcano erupted in New Zealand, patients began arriving in Australia. The eruption on December 9 injured 27 people and eventually claimed 20 lives. Thirteen Australians were medivaced from New Zealand to hospitals in Sydney and Melbourne. Six of those, with burns to between 7 and 70 per cent of their bodies, were sent to Royal North Shore Hospital’s burns unit where its head, Dr Robert Gates, was waiting. “We didn’t quite know what we were going to receive,” he said. Nurses Tracey Hurley, left, and Kate Walsh in one of the treatment rooms on the ward. Credit:Janie Barrett He noticed some of their wounds looked as though they had been received from the theatre of battle. “Some of them had these areas where it would appear that something like a hot rock had hit them and gone into them, a bit like I imagined shrapnel from a war injury,” he said.


The first priority was removing the burnt skin as quickly as possible because the burn itself is “quite toxic”. “All those bad byproducts of tissue breaking down are absorbed into your system, and they affect your immunity and your heart function and your lung function," Dr Gates said. While the surgeons started removing the toxic skin and replaced it with grafts or donor skin, at the same time, other members of the team were also getting to work. Part of the team at Royal North Shore Hospital's burns unit, from left: Clinical nurse consultant Kate Walsh, senior occupational therapist Akane Katsu, senior social worker Julia Kwiet, network manager of the statewide burn injury service Anne Darton, head of burns Dr Robert Gates, acting nurse unit manager Tracey Hurley and senior physiotherapist Julie Bricknell. Credit:Janie Barrett On their first day in the burns unit, every patient is seen by a diverse team of specialist nursing staff, physiotherapists, occupational therapists and social workers, who plotted their recovery. The nurses do their best to minimise their pain and trauma, especially during regular dressing changes. “We give them a lot of pain relief so they're sedated," acting nurse unit manager Tracey Hurley said.


The changes, which happen about three times a week for each patient, are one of the nurses' largest jobs. The process of removing old dressings, cleaning the wounds and redressing them can take a team of nurses up to three hours, Ms Hurley said. The marathon task is made more difficult in the heated rooms needed to keep the patients warm. No one inside can leave once they’ve started in order to control infection. “We need some people to just help hold limbs, we need some people to help apply the dressings and with some of the patients, we just need someone to talk them through it," Ms Hurley said. Julie Bricknell with a patient in the Royal North Shore Hospital Burns Unit. Credit:Janie Barrett Senior physiotherapist Julie Bricknell started them on movement therapy as soon as possible, even if the patients were not conscious. “When you get a burn your body is essentially trying to make that wound smaller, so what happens is that skin starts to contract,” she said. “If we were to hold off until they were completely healed … they'd have perfectly healed skin and absolutely no function, they would potentially have a lot of disfigurement, but they would also have limitations to their movement."


Burns are also psychologically traumatic, and senior social worker Julia Kwiet's job at the beginning is to help them regain a sense of safety. “It was so out of the ordinary,” she said. “So the trauma there is all of a sudden this happens, so what else is going to happen? Is my world safe again?” All her patients, including those caught in the White Island eruption, face huge adjustment and can be at risk of developing Post Traumatic Stress Disorder. “Treatment adds to the trauma because it's painful, it's incredibly confronting,” she said. "Patients are still in trauma because every time they move or do anything, it hurts." Julia Kwiet with a patient in the Royal North Shore Hospital Burns Unit. Credit:Janie Barrett Ms Bricknell said the work can be challenging. “We're human beings, and we appreciate that people are in pain,” she said.


“I'm honest with people. I say 'look, I appreciate it, it really stretches, and it's really sore. But if you don't do this, you're not going to be able to move'. “I think I see that light bulb moment for people where they go, ‘oh, hang on, she's actually not the bad guy. She's actually trying to help me get back into my life’.” Ms Kwiet is also trying to help patients get back into their lives, but in a different way. Much of her work involves helping people adjust to their new appearance. “I prepare people when they first look at their wounds and then debrief after with them about that,” she said. Examples of compression garments on display at the burns unit. These are made to fit each patient. Credit:Janie Barrett She also takes people out of the ward, to get them used to leaving the safety of the burns unit bubble. “For some patients that's very confronting about then how people are going to look at them if they're disfigured or in their bandages, so I try and keep it kind of casual,” Ms Kwiet said.

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