Provision of health information

The community looked to Dr Lester to provide information and advice about the public health risks associated with exposure to smoke and ash from the fire. Information provided by Dr Lester and the Department of Health was communicated in a variety of ways, including through the Department of Health’s website, media interviews and community information sheets.¹⁵

This section focuses on the content and adequacy of the public health message. Details about the method and timing of communications by Dr Lester and the Department of Health are discussed further in Part Five Communications.

PUBLIC HEALTH MESSAGES

The public health messages provided by the Department of Health, and in particular Dr Lester, evolved over the duration of the fire. The health advice provided to the community over time can be described as follows:

• 13 February 2014–the message was conveyed that everyone, particularly those in ‘at risk’ groups (people over 65, preschool aged children and those with pre-existing heart or lung conditions) should avoid prolonged or heavy physical activity outdoors.
• 14 February 2014–the message was conveyed that during extended periods of very smoky conditions, people in ‘at risk’ groups should consider temporarily staying with a friend or relative living outside the smoke-affected area.
• 17 February 2014–pregnant women were added to the ‘at risk’ category.
• 25 February 2014–those in ‘at risk’ groups were advised to consider temporarily staying outside the smoke-affected area, and the community at large was advised to consider a break away from the smoke, and to avoid outdoor physical activity.
• 28 February 2014–those in ‘at-risk’ groups living or working in the southern part of Morwell were advised to temporarily relocate.¹⁶

Dr Lester told the Board that in addition to the above messages, she repeatedly communicated to the community that ‘smoke is bad for your health, smoke has health effects, and avoid the smoke as much as possible; stay out of the smoke, ideally take breaks away from the smoke.’¹⁷

Members of the community told the Board that they were concerned with the advice provided by the Chief Health Officer because it did not match their experiences. Ms Annette Wheatland, Gippsland Regional Manager at Southern Cross Care Victoria, who works in Morwell, stated: ‘…I found it really difficult to make a decision to know what to do because the advice was pretty much that everything’s okay, but I knew it wasn’t.’¹⁸

Some members of the community expressed frustration with what they perceived to be inconsistent advice provided by Dr Lester over the course of the mine fire. As described by local resident Ms Brenda Maguire in her submission to the Board: ‘advice given to the public by Dr Rosemary Lester slowly and subtly changed over the period of the fire, tending towards admitting the smoke was a health risk – yet the town was never evacuated.’¹⁹

COMMUNITY INFORMATION SHEETS

During the Hazelwood mine fire, Dr Lester published a number of alerts, advisories and community information sheets about the potential adverse health impacts of smoke and ash. This information was in addition to the bushfire smoke advisories issued by the Environment Protection Authority (EPA), which included basic health advice from Dr Lester.

Dr Lester told the Board that the health alerts were primarily directed at health practitioners, whereas the community information sheets were primarily directed at the community.²⁰

Community information sheets were developed by the Department of Health in response to community questions and concerns about smoke from the Hazelwood mine fire.²¹ The community information sheets were available from the Department of Health website, as well as in hard copy from respite and health centres established during the fire, and from the community engagement bus.

Community information sheets were published on or around 24 February 2014. Figure 4.46 provides a summary of the key messages detailed in these information sheets.22 Figure 4.47 summarises key messages in community information sheets distributed on 12 March 2014.

Figure 4.46 Key messages from community information sheets distributed by the Department of Health on 24 February 2014

Community information sheet	Key messages
Smoke and your health	How smoke affects your health depends on your age, pre-existing medical conditions such as asthma or heart disease, and the length of time you are exposed to the smoke. Signs of smoke irritation include itchy eyes, sore throat, runny nose and coughing. Children, the elderly, pregnant women, smokers and people with pre-existing illnesses such as heart or lung conditions (including asthma) are more sensitive to the effects of breathing in fine particles. During extended smoky conditions, sensitive individuals should consider temporarily staying with a friend or relative living outside the smoke-affected area. Others should consider a break away from the smoky conditions. Avoid physical activity outdoors. People with a heart or lung condition should follow their treatment plan advised by their doctor. When at home, stay indoors with all windows and doors closed.
Rainwater tanks	If you live in a smoke-affected area you should be aware that your water tank could become contaminated from ash. If your water tastes, looks or smells unusual do not drink it. Water testing is not necessary as contamination is usually obvious. The most effective way to prevent contamination of your water tank is to ensure that your tank is properly sealed and that you disconnect the down pipes while your house is affected by smoke and ash.
Face masks questions and answers	It is better to stay indoors, however if you have to go outdoors and choose to wear a face mask it’s important to understand their benefits and limitations. There are many different types of face masks. Ordinary paper dust masks, handkerchiefs or bandannas do not filter out fine particles or gases contained in the smoke such as carbon monoxide. Fitted properly a P2 face mask can filter out some of the fine particles of the smoke. P2 masks will not provide complete protection. They do not remove or protect against gases contained in the smoke such as carbon monoxide. P2 masks can be very hot and uncomfortable and can make it harder to breathe normally. Anyone with pre-existing heart or lung condition should seek medical advice before using a face mask.
Cleaning up a smoke and ash affected home	The ash deposited by the Latrobe Valley coal mine fires is relatively non-toxic and is similar to the ash that might be found in your fire place. Ash particles have the potential to act as mild skin, eyes, nose or throat irritants but are too large to be breathed deeply into the lungs. Ash on household surfaces is unlikely to cause short or long term health effects. To reduce ingestion of ash or nuisance to the skin, eyes, nose or throat, wear gloves, long sleeved shirts to avoid skin irritation, well fitted dust masks, practice good hygiene. It is not recommended that babies or young children play in ash or dusty conditions.

Additional community information sheets were published on 12 March 2014.23

Figure 4.47 Key messages from community information sheets distributed by the Department of Health on 12 March 2014

Community information sheets	Key messages
Carbon monoxide	Carbon monoxide is a colourless, odourless gas. It is found in smoke and is formed from the incomplete combustion of coal. Carbon monoxide levels in the Morwell Township and around the perimeter of the mine are being monitored. To date, the levels of carbon monoxide in the air are not a health concern for the general community. When breathed in, carbon monoxide displaces oxygen in the blood and deprives the heart, brain and other vital organs of oxygen. Carbon monoxide may cause “flu-like” symptoms such as headache and tiredness, progressing to dizziness, confusion, nausea or fainting. Very high amounts of carbon monoxide in the body may result in oxygen deprivation, leading to loss of consciousness and death. The effects of carbon monoxide exposure are reversible in most cases.
Ash fall out	The primary health concern for ash fallout is settling on surfaces, skin contact or nuisance to the eyes. Ash particles can irritate the eyes, nose and throat but are too large to be breathed deeply into the lungs. If you experienced irritation to your eyes, nose or throat, these effects should resolve quickly once the fires are controlled and the ash fall out has ceased. To reduce ingestion of ash or nuisance to the eyes: practice good hygiene. It is not recommended that babies and young children play in ash or dusty conditions. For fine particles in smoke, sensitive individuals should consider temporarily staying with a friend or relative living outside the smoke affected area. Others should also consider a break away from the smoky conditions.

Despite the above community information sheets, many community members told the Board that they felt uninformed about the potential adverse health risks of the mine fire. At community consultations, the Board was told that there was a lack of information about what was in the smoke and ash that had settled in water tanks, wall and roof cavities.²⁴ Community concern was also expressed in relation to inconsistent advice received about the most appropriate way to clean ash. Members of the community told the Board, that the level of information provided about air and water quality and how individuals should manage pollution levels, was inadequate.²⁵

BUSHFIRE SMOKE PROTOCOL

During the Hazelwood mine fire, the Department of Health, in conjunction with the EPA, issued a number of bushfire smoke advisories pursuant to the Bushfire Smoke, Air Quality and Health Protocol (Bushfire Smoke Protocol).

The Bushfire Smoke Protocol was first developed during the 2006/2007 summer fire season.²⁶ Dr Lester and Mr Chris Webb, Director of Environment Regulation at the EPA, formally endorsed the Bushfire Smoke Protocol on 13 February 2014 (notwithstanding that the protocol was already operating prior to this date).²⁷ Dr Lester told the Board that the Bushfire Smoke Protocol was developed by the Department of Health with the EPA to define agreed actions and health messages prior to a fire season so that the agencies did not have to develop decision-making processes while an incident was occurring.²⁸

The Bushfire Smoke Protocol provides triggers for the EPA to issue a low level or high level smoke advisory (via a media release) based on defined air quality indicators, including PM10 and visibility. The protocol does not refer to PM2.5. A ‘low level advisory’ is issued when the smoke level is unhealthy for sensitive groups and a ‘high level advisory’ is issued when the level of smoke is unhealthy for the whole community.²⁹ Media releases that outlined air quality were issued over the course of the mine fire. They included pre-determined quotes from Dr Lester with general advice about actions to reduce health impacts caused by smoke.³⁰

A high level smoke advisory has three different air quality categories (see Figures 4.48 and 4.49). Dr Lester told the Board that the air quality categories were for internal use only and that there was no need for three different smoke alerts for each category, as the actions that the community needs to take to protect themselves from the smoke are the same.³¹ For example, the advice contained in the high level smoke advisory was the same no matter whether the level ‘high’ referred to ‘unhealthy for all’, ‘very unhealthy’ or ‘hazardous’.

Figure 4.48 Bushfire advisory categories based on PM10 monitoring and visibility³²

Bushfire smoke advisory level		Air Quality (AQ) Categories	PM10 (24 hour) µg/m3	PM10 (1 hour) µg/m3	Visibility (determined by observers)
	Not applicable	Good	Less than 50	Less than 80	> 20km
	LOW	Unhealthy sensitive	51 to 65	81 to 175	< 20km & > 10km
	HIGH	Unhealthy – all	66 to 155	176 to 300	< 10km & > 5km
	HIGH	Very unhealthy – all	156 to 310	301 to 500	< 5km & > 1km
	HIGH	Hazardous	>310	>500	< 1km

Figure 4.49 Bushfire cautionary advice and actions³³

Bushfire smoke advisory level		Air Quality (AQ) Categories	Visibility	Landmark visible from home	Potential health effects	Cautionary health advice
	No media release	Good	> 20km	20km or more	Meets the relevant air quality standard	None
	LOW	Unhealthy – sensitive	< 20km & > 10km	10km	People with lung or heart conditions, elderly, children	People with heart or lung conditions, children and older adults should reduce prolonged or heavy physical activityNo specific message for everyone else other than sensitive groups
	HIGH	Unhealthy – all	< 10km & > 5km	5km	Increased likelihood of effects for people with lung or heart conditions, elderly or childrenGeneral population respiratory symptoms	People with heart or lung conditions, children and older adults should avoid prolonged or heavy physical activityEveryone else should reduce prolonged or heavy physical activity
	HIGH	Very unhealthy	< 5km & > 1km	1km	Increased likelihood of effects for people with lung or heart conditions, elderly or childrenGeneral population respiratory symptoms	People with heart or lung conditions, children and older adults should avoid all physical activity outdoorsEveryone else should avoid prolonged or heavy physical activity
	HIGH	Hazardous	< 1km	Less than 1km	Increased likelihood of effects for people with lung or heart conditions, elderly or childrenGeneral population respiratory symptoms	People with heart or lung conditions, children and older adults should remain indoors and keep activity levels as low as possibleEveryone should avoid all physical activity outdoors

Mr John Merritt, the former Chief Executive Officer of the EPA, advised the Board that:

During the Hazelwood mine fire, the EPA issued 58 advisories pursuant to the Bushfire Smoke Protocol.³⁵ These consisted of 32 ‘low level’ smoke advisories and 26 ‘high level’ smoke advisories.

NURSE-ON-CALL

Nurse-On-Call is the Department of Health’s telephone health advice line. It is a free, 24-hour telephone advice line, funded by the Department of Health and staffed by nurses.³⁶ Nurse-On-Call was actively promoted to the community during the Hazelwood mine fire as a source of health information.³⁷

Dr Lester told the Board that Nurse-On-Call, rather than a generic hotline, was promoted to the community as it enables an individual to convey information and seek advice about a specific health problem. She informed the Board that Nurse-On-Call provides ‘constant health advice for people who ring and it’s authoritative, its content is known and trusted’.³⁸ Nurse-On-Call staff were provided with all of the Department of Health’s information to ensure consistent information was provided to callers.³⁹

The Victorian Government submitted to the Board that general health queries were answered quickly via social media and more serious medical concerns were addressed by health professionals through various channels including Nurse-On-Call.⁴⁰

Ms Lisa Wilson, Gippsland Homeless Network Coordinator at Quantum, utilised the Nurse-On-Call service. She told the Board that she was disappointed the Nurse-On-Call service did not have information about what might be happening due to the smoke. She also described feeling let down by the approach the service took to her call: ‘we were being questioned about who we were and what we were doing, more so than us trying to get information from them.’⁴¹