Code brown emergency forces exhausted hospital staff back to work

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Tuesday’s Victorian government announcement of a statewide code brown for the next four to six weeks, and the intent to recall healthcare staff from leave, has sent shockwaves through much of the Victorian healthcare sector.

Code browns are usually temporary emergency declarations designed to improve staff and resource availability in times of acute, typically short-lived, emergency circumstances such as mass trauma incidents, or larger-scale crises such as bushfires, floods or thunderstorm asthma.

Deputy Premier and acting Health Minister James Merlino announces the Code Brown.Credit:Jason South

There is no doubt that the Victorian healthcare system is now facing such a time of crisis.

The number of COVID-19 positive results in the community, and the consequent number of presentations to hospitals, GPs or emergency calls for ambulances are steadily mounting daily.

At the same time, the number of staff available to care for those seeking help is shrinking by the day as healthcare workers experience the very same sickness and furloughing as the community they serve (many times contracted in their workplace as they aim to support others).

It’s simple math. Presentation numbers are up, staff numbers are down. There is no cavalry to come to the rescue; there are no benched players waiting to be tapped onto the court.

All Victorians know the result: longer wait times and a decline in the quality of care deliverable as fewer staff are stretched between more patients. The equivalent of about three large public hospitals is now dedicated to the support of one illness.

We understand why this equation drove the Victorian government to make its announcement.

As part of their announcement of the code brown, the government announced that hospitals would, consistent with applicable terms and conditions in industrial agreements, be able to recall their staff back from leave. This is a drastic option that we have previously recommended against.

Nevertheless, it makes sense that a provision to cancel leave exists for responses to a mass trauma event.

What is a code brown?

• Code brown is a measure to relieve pressure on hospitals.
• The measure is typically reserved for sudden, short-term emergencies, such as a train crash or bushfire (for example, a code brown was called during the 2016 thunderstorm asthma event).
• During a code brown, hospitals can cancel their staff’s leave to ensure an adequate workforce is on hand.
• They can also defer less urgent services.
• This code brown starts at noon on Wednesday. It’s expected to last for between four and six weeks.
• It will apply to all metropolitan public hospitals. In regional Victoria, Geelong’s Barwon Health and the Grampians, Bendigo, Goulburn Valley, Albury Wodonga and Latrobe Regional health groups are also included. Private hospitals have the option of calling their own code brown.

It’s logical that the government looks at this provision, designed to deal with one- or two-day spikes in acuity and/or presentation numbers, and seeks to apply it to the current Omicron COVID-19 crisis.

The difference here, however, is that this isn’t just an ordinary day. Furthermore, this has not been an ordinary week, month, or two years. The entire health sector has battled through staffing shortages, face ulcers from masks, sweat loss and fainting from PPE, and the omnipresent thought: “When will a mass outbreak occur?”

To say it plainly, the sector is bone tired. We are going into injury time breathless and hungry. And for many, leave has been the light at the end of the tunnel that has been sustaining them through the current darkness.

Everyone in Victoria has made sacrifices in the face of the pandemic. We have all missed experiences, forgone holidays away, cancelled important family events, and we all miss our friends and family from afar. Healthcare workers are no exception to that and were looking forward to such activities on their planned and approved leave.

For many healthcare workers in the current climate though, leave offered something else: a sense of normality. A time to recharge their empty batteries, to gather their thoughts and steel themselves for how much work is left to do. A way to cope with what we have experienced, and what we will experience in the times to come.

Needless to say, those that are on leave, or had leave arranged in the coming weeks, have been left despondent in the face of their life raft potentially being pulled from their grasp in wake of the announcement. We have impressed upon the government that this code brown declaration only occur in a manner consistent with legally binding industrial agreements, and only when no other alternative is available.

Healthcare workers are united by their desire to help. We have no doubt that the fraternity will rise to answer this call, as we have every call that preceded it, and we will get through it together.

We do, however, worry for those of our peers who were just getting by waiting for their earned time on a beach, in a forest, catching up on sleep or spending quality time with their families. Our thoughts are also with GPs who have borne an equally heavy burden throughout the pandemic and feel unable to take leave in the present circumstances.

We hope that all can hang on a little longer, and that true normality is not far away. And that we can all get the earned rest we need soon.

Dr Roderick McRae is president of the Australian Medical Association (Victoria). Dr Gavin Wayne is chair of the Australian Medical Association (Victoria), Doctors in Training Subdivision.

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