AKT – Disaster Health

Steven Langley, aged 42, presents to your rural general practice after being rescued from a major bushfire incident 12 hours earlier. He was trapped in a smoke-filled area for over an hour and has since developed a worsening headache and mild confusion. His respiratory rate is 22, oxygen saturation is 97% on room air, heart rate is 95 bpm, and BP is 135/82 mmHg. He appears flushed and is disoriented to time but not person or place.

There is no significant past medical history. He is a non-smoker. He has no visible burns but had soot around his nostrils earlier, now mostly cleaned away.

What is the most appropriate next step in his management?

Mei Lin, aged 34, presents during a flood response effort with vomiting, diarrhoea and myalgia. She has been helping clean up contaminated floodwaters in a regional town for the past 3 days. Her temperature is 38.4°C, BP is 105/70 mmHg, HR 92 bpm, and she is mildly jaundiced. On examination she has mild conjunctival suffusion but no abdominal tenderness.

No significant past history. She is not vaccinated for hepatitis A.

Which of the following is the most likely diagnosis?

Sophie Kennedy, aged 29, presents with dizziness and fatigue 24 hours after being found in a collapsed building following an earthquake. She was rescued after being trapped for 5 hours. She has swelling and tenderness of her left thigh. Her urine is dark brown. Observations: HR 108 bpm, BP 102/68 mmHg, RR 20, afebrile. UEC reveals elevated creatinine and potassium.

No past medical history. Not on any medications.

What is the most important initial treatment?

Aliyah Hassan, aged 7, is brought in by her uncle to the evacuation centre clinic 48 hours after a cyclone. She has a high fever, irritability and is limping on her right leg. The area around her right knee is erythematous and tender. She has multiple mosquito bites and a few superficial scratches. Temperature is 39.2°C, HR 120 bpm, RR 22. No heart murmur or rash noted.

No past history. Immunisations are up to date.

What is the most likely cause of her symptoms?

Jared Nankervis, aged 61, presents to a makeshift GP tent in the aftermath of a severe bushfire event. He has a 2-day history of increasing shortness of breath and wheezing. He is an ex-smoker with a history of asthma but has been well controlled for years. On examination: RR 24, HR 105, O2 sat 92% on room air, diffuse expiratory wheeze. He has no chest pain or fever.

He lost his medication and inhalers during evacuation. What is the most appropriate initial treatment?

Karl Jensen, aged 52, presents to a regional general practice 3 days after a major flood. He has a painful, swollen left lower leg with multiple small lacerations that occurred while wading through muddy water. He now reports worsening pain, erythema and a feeling of heaviness in the leg. On examination, the area is red, warm, and tender with early blistering and crepitus. He is febrile at 38.9°C and hypotensive at 90/60 mmHg.

What is the most appropriate immediate management?

Lina Pham, aged 26, is volunteering at a disaster evacuation centre after a cyclone. She presents to the clinic with severe fatigue, muscle cramps, and nausea. She has been assisting for over 14 hours in humid conditions with minimal fluid intake. On examination, she is alert but dizzy when standing, BP 100/64 supine and 84/58 standing, HR 110 bpm, afebrile.

What is the most likely diagnosis?

Fatima Noor, aged 70, is a known insulin-dependent diabetic who presents to the evacuation clinic after a bushfire destroyed her home. She has not had access to her insulin for the last 48 hours. She now reports nausea, abdominal pain, and increasing fatigue. On examination: HR 110, RR 24, BP 98/65, capillary glucose is 25.6 mmol/L, and ketones are strongly positive on urine dipstick.

What is the most appropriate immediate management?

Thomas Gorry, aged 38, a local farmer, presents after assisting with post-storm cleanup. He reports fever, cough and breathlessness worsening over the past 48 hours. He mentions exposure to large volumes of mould and decaying hay. On examination, his temperature is 38.2°C, O2 saturation 95%, RR 20, and bilateral fine crackles are audible on auscultation.

What is the most likely diagnosis?

Abdul Rahman, aged 33, presents to the mobile clinic after assisting in the recovery of bodies from floodwaters. He now has a fever, dry cough, and conjunctival injection. On questioning, he also reports photophobia and generalised myalgia. His vital signs are stable. There are no localising chest signs and his oxygen saturation is 98% on room air.

What is the most appropriate investigation to confirm the diagnosis?

Sasha Vukovic, aged 45, is brought in after a building collapse due to an earthquake. She was trapped for several hours and has visible abrasions and bruises but is alert. Her main complaint is severe bilateral leg pain and numbness. She is unable to move her legs. Peripheral pulses are diminished. Her BP is 110/70, HR 102 bpm, and RR 20.

What is the most likely diagnosis?

Harry Olson, aged 58, is a volunteer firefighter who presents 24 hours after a bushfire with a persistent cough, mild chest tightness and watery eyes. He reports being directly exposed to heavy smoke without respiratory protection for several hours. O2 saturation is 98%, HR 86, RR 18, and chest auscultation is clear.

What is the most appropriate next step in his management?

Maria Torres, aged 36, presents 3 days after volunteering in a flood-affected community. She reports increasing abdominal pain, bloating, and profuse watery diarrhoea. Her temperature is 37.6°C, BP 115/74 mmHg, HR 84. She is otherwise well. You suspect Giardia infection.

What is the most appropriate initial management?

Liam Reynolds, aged 5, presents to a temporary medical post set up after a cyclone. His parents report he has been increasingly irritable and has not urinated for nearly 12 hours. He has a low-grade fever, dry lips, sunken eyes, and capillary refill of 3 seconds. He weighs 18 kg.

What is the most appropriate management?

Benita Armstrong, aged 81, is brought to a clinic in the aftermath of a heatwave. She lives alone and was found disoriented in her home by a neighbour. Her temperature is 39.5°C, HR 110, BP 90/60, and she is confused. She takes perindopril and furosemide for hypertension. Blood glucose is normal.

What is the most appropriate initial treatment?

Yusef Abdallah, aged 40, presents to your temporary rural GP post set up following a cyclone. He has developed a low-grade fever, malaise, dry cough and a diffuse maculopapular rash over his torso and limbs. He reports having spent the last week in crowded shelters. He is unsure of his vaccination history. On examination, he has bilateral conjunctivitis and Koplik spots.

What is the most likely diagnosis?

Pauline Barker, aged 60, presents 5 days after returning to her rural home post-evacuation for bushfires. She has noticed a persistent dry cough, shortness of breath on exertion, and hoarseness. She has a long history of well-controlled asthma and normally uses a budesonide-formoterol inhaler. She reports her symptoms began after returning to a smoke-damaged home with residual ash and odour.

What is the most appropriate next step?

Ella Nguyen, aged 32, is working as a nurse in a disaster evacuation centre after a flood. She presents with new onset of fever, generalised lymphadenopathy and a sore throat. She reports several needlestick injuries over the past week. Examination shows pharyngeal erythema and enlarged cervical nodes. HIV and hepatitis B status are unknown.

What is the most appropriate immediate investigation?

Hamish MacGregor, aged 4, is brought to your emergency outreach clinic after bushfire evacuation. His parents report increasing cough and wheezing for 2 days. He has had two ED presentations in the past year for asthma. Today, his RR is 34, HR 132, O2 sat 94% on room air. Expiratory wheeze is audible bilaterally.

What is the most appropriate next step in management?

Richard Forster, aged 74, presents with mild confusion, headache and fatigue after volunteering during a regional heatwave. He has been drinking large quantities of water and reports frequent urination. On exam: BP 118/72, HR 88, Temp 37.1°C. He is alert but slow to respond. Serum sodium returns at 122 mmol/L.

What is the most likely cause of his symptoms?

Aleksander Novak, aged 36, presents 48 hours after assisting in bushfire recovery. He developed sudden onset fever, dry cough, and retro-orbital pain. He recalls multiple mosquito bites. Examination reveals flushed face, mild conjunctival injection and petechiae on his arms. Vital signs are stable. Platelet count is 105 × 10⁹/L.

What is the most likely diagnosis?

Isobel Green, aged 50, presents with a 1-day history of severe left calf pain and swelling after clearing flood debris. She had a minor abrasion to the area several days ago. She is febrile at 38.7°C, HR 104, and her leg is warm and erythematous with induration. There is no crepitus or blistering. DVT is excluded by ultrasound.

What is the most appropriate next step?

Nadine Jacobs, aged 27, presents with an itchy, serpiginous rash on her foot 4 days after assisting barefoot in flood clean-up. She has no systemic symptoms. The rash is localised to the sole and appears raised and linear. No vesicles are present.

What is the most likely diagnosis?

George Talbot, aged 67, is staying in a crowded shelter after a cyclone. He presents with sudden onset fever, dry cough, and pleuritic chest pain. He is mildly tachypnoeic (RR 24), with an oxygen saturation of 94% and crepitations heard over the right lower lobe.

What is the most likely cause of his symptoms?

Trevor Singh, aged 39, is a council worker assisting with waste disposal after a flood. He reports a new rash, fever, and malaise. On examination, he has a papulopustular rash on his hands and forearms with surrounding erythema. He also reports nausea. He was not wearing gloves during clean-up.

What is the most likely diagnosis?

Emily Radic, aged 24, presents to your mobile clinic after a major flood. She is 12 weeks pregnant and concerned after noticing mild fever, nausea and tender posterior cervical lymph nodes. She had contact with contaminated water while helping at a community centre. She is otherwise well. No rash is present.

Which of the following is the most important investigation?

Oscar Minh, aged 10, presents 3 days after being in floodwaters with right ear pain and hearing loss. On examination, his ear canal is swollen with purulent discharge and tragal tenderness. Tympanic membrane is not visible.

What is the most appropriate initial management?

Angela Rees, aged 63, presents to a temporary GP clinic in a flood-affected town with 2-day history of fever, myalgia, headache and mild cough. She reports multiple mosquito bites while sleeping without a net. On exam, she is febrile at 38.5°C and appears flushed. No rash is present. Dengue is suspected.

What is the most appropriate next step in management?

Stephen Hall, aged 47, presents to your evacuation clinic after experiencing nightmares, hypervigilance and intrusive thoughts since escaping a major cyclone. He reports sleeping poorly and feeling emotionally numb. These symptoms have persisted for over a month. He denies suicidal ideation or hallucinations.

What is the most likely diagnosis?

Natalie Tana, aged 29, presents with sudden swelling and pain in her right hand after cleaning flood debris. She had a small puncture wound two days earlier. On examination, the hand is swollen, erythematous, and exquisitely tender with reduced range of motion and intense pain with passive stretch of fingers.

What is the most appropriate next step?

Gregory Shaw, aged 62, presents to your clinic 4 days after a bushfire evacuation with worsening shortness of breath. He has a history of COPD and ran out of his medications during the evacuation. He has an O2 saturation of 91% on room air, RR 24, and diffuse wheezing on auscultation.

What is the most appropriate initial treatment?

Helen Black, aged 33, is 10 weeks pregnant and presents after assisting in cyclone cleanup. She reports a rash, joint pain and low-grade fever. The rash is maculopapular and involves her trunk and limbs. She mentions recent mosquito exposure. No significant past medical history.

What is the most appropriate test to confirm diagnosis?

Isaac Horne, aged 7, is brought to your temporary flood clinic with fever, vomiting, and abdominal pain. His mother reports they had no access to clean water for 2 days. On exam, he is febrile at 38.6°C, has mild hepatomegaly and diffuse abdominal tenderness. There is no rash.

What is the most appropriate next investigation?

Carolyn Teague, aged 71, presents to your clinic following a heatwave. She reports new confusion and dizziness. Her daughter says she has been drinking excessively but eating very little. Vitals: HR 88, BP 100/60, Na 119 mmol/L. She takes hydrochlorothiazide for hypertension.

What is the most likely cause of her symptoms?

Jeremy West, aged 41, was involved in flood rescue operations. He presents with persistent cough and low-grade fever. He mentions multiple exposures to stagnant floodwater. CXR shows patchy right lower lobe infiltrates. You suspect melioidosis.

What is the most appropriate antibiotic regimen?

Susan Fenwick, aged 59, presents to your pop-up GP clinic in a remote community affected by bushfires. She has been short of breath for 2 days, with increasing fatigue. She is on home oxygen for chronic lung disease, which she lost during the evacuation. Her O2 saturation is now 85% on room air, RR 26, and she is using accessory muscles.

What is the most appropriate next step?

Alvin Yong, aged 39, presents 1 week after assisting cyclone clean-up. He reports fever, night sweats, and painful axillary lymph nodes. He handled several dead rodents without gloves. On examination, he is febrile at 39.1°C, with tender, enlarged nodes and malaise.

What is the most likely diagnosis?

Monica Silva, aged 34, presents to your evacuation centre clinic with high fever, headache, and rash. She is 15 weeks pregnant and recently returned from cleaning her flooded property in northern Queensland. Examination reveals a maculopapular rash and cervical lymphadenopathy. You suspect rubella.

What is the most important next step?

Imran Ali, aged 12, presents with fever, photophobia, neck stiffness, and vomiting. He has been living in a temporary shelter following a flood disaster. On examination, he is febrile at 39.4°C, and has a positive Kernig’s sign. There is no rash or focal neurology.

What is the most appropriate next step?

Rosa Carmichael, aged 82, presents with fatigue and mild confusion following a week of extreme heat. Her family report reduced fluid intake. She has a history of heart failure and is on frusemide. Vitals: BP 92/60, HR 90, temp 36.4°C. Bloods show Na 126, K 3.2, Cr 140 (baseline 90).

What is the most appropriate next step?

Daniel Webb, aged 44, presents to a pop-up clinic 3 days after volunteering in a post-flood cleanup. He complains of high fever, chills, cough, and pleuritic chest pain. He reports moving animal carcasses without PPE. CXR reveals right lower lobe consolidation. You suspect Q fever.

What is the most appropriate treatment?

Lani Tuvale, aged 2, is brought to a remote cyclone-affected clinic with poor feeding, lethargy and low-grade fever. She has had watery diarrhoea for 3 days. On examination: sunken eyes, delayed capillary refill, dry mucous membranes, weight 11 kg.

What is the most appropriate management?

Ben Hollings, aged 30, presents to your clinic 5 days after cyclone recovery efforts. He reports fever, headache, dry cough and has developed mild haemoptysis. He had exposure to wet soil and compost. CXR shows bilateral infiltrates. You suspect melioidosis.

What is the most appropriate next step?

Katherine Yu, aged 27, presents with a pustular lesion on her hand 4 days after helping clean up livestock pens post-flood. She reports fever and malaise. Examination shows an ulcer with black eschar and surrounding oedema. She is otherwise stable.

What is the most likely diagnosis?

Jacob Eyles, aged 21, presents with acute eye redness, pain and photophobia 2 days after exposure to smoke and ash during bushfire relief. There is no visual loss. Examination reveals conjunctival injection and a small corneal epithelial defect on fluorescein staining.

What is the most appropriate management?

Jasmina Novak, aged 35, presents 1 week after volunteering in flood-affected areas with fatigue, cough, and persistent low-grade fever. She mentions helping clean animal waste and exposure to aerosolised dust in barns. CXR shows patchy bilateral infiltrates. You suspect zoonotic pneumonia.

Which organism is the most likely cause?

Tommy Rankin, aged 58, presents to your rural clinic 2 days after bushfire exposure. He reports increasing hoarseness, throat discomfort and dry cough. He has no difficulty breathing, no fever, and oxygen saturation is 98% on room air. Examination reveals pharyngeal erythema.

What is the most likely cause of his symptoms?

Nina Barlow, aged 46, presents with watery diarrhoea and bloating 4 days after returning from a flooded community. She drank local tap water and reports that others in her group are also unwell. She is afebrile with no blood in stool. Stool microscopy reveals cysts consistent with Giardia.

What is the most appropriate treatment?

Erin Doyle, aged 61, with a history of type 2 diabetes presents to your evacuation centre clinic with a foot ulcer after walking barefoot during cyclone cleanup. The ulcer is red, tender, with surrounding cellulitis. She is febrile at 38.3°C. Her BSL is 17.4 mmol/L.

What is the most appropriate next step?

Amina Yusuf, aged 29, presents to a temporary clinic following a cyclone. She reports insomnia, anxiety, and difficulty concentrating since the event. She feels constantly on edge and avoids reminders of the cyclone. These symptoms have persisted for 3 weeks.

What is the most appropriate diagnosis?