tag:theconversation.com,2011:/africa/topics/health-and-bushfires-4526/articlesHealth and bushfires – The Conversation2019-11-22T02:17:37Ztag:theconversation.com,2011:article/1275162019-11-22T02:17:37Z2019-11-22T02:17:37ZHow to manage your essential medicines in a bushfire or other emergency<figure><img src="https://images.theconversation.com/files/303054/original/file-20191121-112975-14msbiq.jpg?ixlib=rb-1.1.0&rect=2%2C4%2C994%2C652&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In an emergency, like a bushfire, making sure you have enough of your regular medication can mean the difference between life and death. But there are many ways to prepare.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/australian-bushfires-2018-nsw-1314222035?src=e0689ffc-a914-4f72-9942-0725c91c91c9-1-4&studio=1">from www.shutterstock.com</a></span></figcaption></figure><p>Some people find managing their medication difficult at the best of times. But in an emergency, like a bushfire or cyclone, this can be harder still. </p>
<p>As catastrophic bushfires burn across Australia, here’s what to think about as part of your emergency planning to make sure you have access to the medicines you need.</p>
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Read more:
<a href="https://theconversation.com/what-you-can-do-about-the-health-impact-of-bushfire-smoke-19333">What you can do about the health impact of bushfire smoke</a>
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<p>As part of your emergency plan, list your medications and where you keep them, along with contact details for your doctor and pharmacist and any other relevant emergency services. </p>
<p>If you have advanced warning of emergency conditions, check both your supply of tablets and any prescriptions you may need. Your prescription label will tell you how many repeats you have left. Try and keep at least one week’s medication on hand.</p>
<h2>I need to evacuate. Now what?</h2>
<p>If you need to evacuate, know how best to store and transport your medication. Most medications for conditions such as blood pressure or cholesterol need to be stored below 25-30°C. These medications will be OK if temperatures are higher than this for short periods of time, while you transport them.</p>
<p>Medicines sensitive to temperature will need to be stored or transported with cold packs in an insulated container of some sort, such as an esky. Putting them in a ziplock bag will help protect them from moisture.</p>
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Read more:
<a href="https://theconversation.com/evacuating-with-a-baby-heres-what-to-put-in-your-emergency-kit-127026">Evacuating with a baby? Here's what to put in your emergency kit</a>
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<p>Insulin is one common medication you need to <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetes-and-insulin">store cold</a>. Your current insulin pen can be stored at room temperature. But store unused pens with a cold pack in an esky until you find refrigeration.</p>
<p>This also applies to <a href="https://www.nps.org.au/medicine-finder/eutroxsig-tablets">thyroxine</a> tablets. Fourteen days supply (usually one strip of tablets) is OK if stored at room temperature. But keep the rest with a cold pack. If you don’t think it will be possible to keep the rest below 25°C for a long time, also keep these with the cold pack.</p>
<p>Many antibiotic syrups, such as <a href="https://www.healthdirect.gov.au/cephalexin">cefalexin</a>, also need to be kept cold. But check the dispensing label or speak to your pharmacist if you are not sure.</p>
<h2>What if I run out of medicine?</h2>
<p>If you are caught without essential medication, doctors and pharmacists can help in a number of ways.</p>
<p>This is easier if you have a regular GP and pharmacist who will both have a complete record of your medication. Your pharmacist can call your GP and <a href="https://www.legislation.nsw.gov.au/#/view/regulation/2008/392/part3/div4/subDiv2/sec44">obtain verbal approval</a> to supply your medication. Your GP will then need to fax or email the prescription to your pharmacist as soon as possible and mail the original script within seven days.</p>
<p>Pharmacists can also dispense emergency supplies of cholesterol medicines and oral contraceptives, so long as you already take them. Under so-called <a href="https://www.humanservices.gov.au/organisations/health-professionals/services/medicare/pbs-pharmacists/initiatives/continued-dispensing">continued dispensing arrangements</a>, pharmacists can dispense a single pack of these medicines once every 12 months.</p>
<p>If you cannot get in touch with your GP, in an emergency, most states allow a pharmacist to dispense a <a href="https://www.legislation.nsw.gov.au/#/view/regulation/2008/392/part3/div4/subDiv2/sec45">three-day supply</a> of your medication. But this is only if the pharmacist has enough information to make that judgement.</p>
<p>Some medicines, such as strong pain medications and sleeping tablets, are not covered by these provisions.</p>
<h2>Medicines for people with lung conditions, like asthma</h2>
<p>People with existing lung conditions (such as asthma, chronic obstructive pulmonary disease or bronchitis), older people, young children and pregnant women are most likely to be vulnerable to the effect of <a href="https://www.nationalasthma.org.au/news/2019/record-pollen-fires-wind-and-storms-a-dangerous-mix-for-asthma">bushfire smoke</a>. They can also have symptoms long after a bushfire if fine particulate matter is still in the air.</p>
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Read more:
<a href="https://theconversation.com/how-does-poor-air-quality-from-bushfire-smoke-affect-our-health-126835">How does poor air quality from bushfire smoke affect our health?</a>
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<p>If you have a respiratory condition, follow the <a href="https://www.nationalasthma.org.au/living-with-asthma/asthma-action-plans">action plan</a> you will have already discussed with your doctor, which outlines what to do in an emergency. </p>
<p>This plan includes instructions on what you should do if your asthma gets worse, such as taking extra doses or additional medication. It also tells you when you should contact your doctor or go to the emergency department.</p>
<p>If you have a respiratory condition, such as asthma, and live in a bush fire prone zone, this action plan needs to be part of your fire safety survival plan.</p>
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Read more:
<a href="https://theconversation.com/thunderstorm-asthma-whos-at-risk-and-how-to-manage-it-86397">Thunderstorm asthma: who's at risk and how to manage it</a>
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<p>You also need to make sure you have enough <a href="https://www.nationalasthma.org.au/understanding-asthma/treatment-and-medicines">preventer and reliever medications</a>, for asthma for example, to hand just in case there is an emergency.</p>
<p>If you don’t have an action plan, taking four separate puffs of your reliever medication may relieve acute symptoms. This applies for adults and children.</p>
<h2>In a nutshell</h2>
<p>Being prepared for an emergency, like a bushfire, goes a long way to keeping you and your family safe. That applies to thinking about your supply of medicines well in advance, if possible. </p>
<p>But if conditions change rapidly and you need to evacuate, an esky containing medicines for a few days, and contact numbers for your GP and pharmacist, could save your life.</p><img src="https://counter.theconversation.com/content/127516/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Bartlett is a member of the Australian College of Pharmacy</span></em></p><p class="fine-print"><em><span>Bandana Saini receives funds from the NHMRC, Australian Department of Health (via Community Pharmacy Agreements) and Asthma Australia.</span></em></p>During bushfire season, managing medication as well as respiratory conditions should be part of any emergency plan.Andrew Bartlett, Associate Lecturer Pharmacy Practice, University of SydneyBandana Saini, Associate Professor, Pharmacy Practice, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/217922014-01-21T19:04:00Z2014-01-21T19:04:00ZBushfire planning leaves behind people with disabilities<figure><img src="https://images.theconversation.com/files/38552/original/tqxqh4th-1389055055.jpg?ixlib=rb-1.1.0&rect=0%2C100%2C945%2C675&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Too few Australian bushfire preparedness plans consider people with disabilities.</span> <span class="attribution"><span class="source">Giant Gingko/Flickr</span></span></figcaption></figure><p>When bushfires start, no one should be more worried than people with disabilities. Recent <a href="http://www.unisdr.org/archive/35032">research</a> shows people with disabilities are <a href="http://www.dinf.ne.jp/doc/english/resource/JDF/appendix1.html">twice as likely</a> to die or be injured than the general population during a disaster. They are also less likely to receive aid and less likely to recover in the long-term.</p>
<p>Jo Ragen, a senior research associate at the University of Sydney, describes her experience of a bushfire evacuation in the <a href="http://en.wikipedia.org/wiki/1994_Eastern_seaboard_fires">1994 fires along Australia’s eastern seaboard</a>:</p>
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<p>We had over 100 young people with physical disabilities at a recreational camp, and I told the [State Emergency Service] we can’t be leaving on trucks. Even though they thought we had enough time to get out, in the end, that’s what happened: young people were loaded onto the back of trucks and utes and we left behind what was really essential equipment for those being evacuated – wheelchairs, ventilators. </p>
<p>It taught me that people with disabilities need to be involved right from the planning stage. Thinking that someone is going to turn up and ‘rescue’ a person with a disability means someone is going to be forgotten and a catastrophic outcome is real.</p>
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<p>As Australian authorities urge the general community to prepare and plan for bushfires, the early warning systems and public awareness campaigns are often failing to consider the needs of persons with disabilities.</p>
<p>Advice on the ground specifically for people with disabilities is pretty slim, and for bushfires is centred on the message of “leave early”. But recent research by the <a href="http://www.bushfirecrc.com/">Bushfire Collaborative Research Centre</a> finds many people instead choose the “wait and see” option. In fact, less than 1% would leave their house on days of extreme or catastrophic fire danger. </p>
<p>This may be compounded for a person with a disability, as leaving early can be difficult as it means leaving behind essential equipment at home that is needed for daily living.</p>
<h2>How we could be better prepared</h2>
<p>For people with disabilities, significant gaps exist in current approaches to bushfire risk reduction. </p>
<p>Communications about bushfire preparedness are often not in accessible formats. There are assumptions that people with disabilities are living in households dependent on others, when many are either living independently or are heads of households.</p>
<p>As Jo Ragen says:</p>
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<p>Plans that lump all people with disabilities together are like plans that say ‘all people with blond hair must do this in a bushfire’. In my experience, when you wait for others to plan, or think someone else will evacuate you, you’ll either get evacuated in a way that is not safe or appropriate, or you’ll get left behind.</p>
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<p>There are various measures being done to improve this situation in Australia. </p>
<p>For example, a recent report on <a href="http://deafsocietynsw.org.au/news/entry/resilience_natural_hazards">“Increasing the Resilience of the Deaf Community in NSW to natural hazards”</a> found that while none of the natural hazard preparedness programs or tools cater specifically to deaf people, there were communication tools that could be considered “deaf-friendly” or required only small alterations. </p>
<p>A recent <a href="http://www.unisdr.org/files/35032_20131004infographicoverview.pdf">United Nations survey</a> consulted nearly 6,000 people with disabilities in 126 countries, and found a high proportion of people with disabilities die or suffer injuries during disasters because they are rarely consulted about their needs and governments lack adequate measures to address them. </p>
<p>In cases where they need to evacuate - such as during floods or earthquakes - only 20% of respondents said they could evacuate immediately without difficulty, 6% said they would not be able to evacuate at all, and the remainder said they would be able to evacuate with a degree of difficulty.</p>
<p>So where does that leave Australians during what is proving to be <a href="http://www.abc.net.au/news/topic/bushfire">another dangerous bushfire season</a>? </p>
<p>The only way we will ensure that no one is left behind is if people with disabilities are actively included in the consultation, planning and preparedness stages of thinking about disasters. Specific input and ideas from people with disabilities is essential for identifying risks and increasing the chance of survival if disaster does strike.</p><img src="https://counter.theconversation.com/content/21792/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarina Kilham is a research fellow on a project funded by Australian Aid on "Promoting the Inclusion of People with Disability in Disaster Management in Indonesia".</span></em></p>When bushfires start, no one should be more worried than people with disabilities. Recent research shows people with disabilities are twice as likely to die or be injured than the general population during…Sarina Kilham, Research Fellow, Centre for Disability Research and Policy, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/115732013-01-13T19:38:34Z2013-01-13T19:38:34ZNatural disasters have unexpected impacts on mental health<figure><img src="https://images.theconversation.com/files/19165/original/mndrmzrx-1357883608.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bushfire affected property at Sommers Bay in Tasmania, Thursday, Jan. 10, 2013. Residents of the worst-hit town Dunalley in the Tasmanian bushfires returned on Friday to see the full extent of the devastation.</span> <span class="attribution"><span class="source">AAP/David Beniuk</span></span></figcaption></figure><p>Radical circumstances (bushfires and natural disasters) flush out the mental illness in society. Whenever there’s a disaster, there’s a rush on hospital admissions for psychiatric problems. But on the whole, the illness is already there.</p>
<p>Emergencies naturally make fodder for delusions and the emergency efforts, for mania. Obviously, there are direct mental health consequences – a small rise in post-traumatic stress disorder inevitably follows disaster. This correlates with the severity of the consequences of the disaster (loss of family, friends, animals and property).</p>
<p>And there’s usually a big rethink, with about a third of those affected leaving the area permanently. But, for the most part, this isn’t driven by mental health issues, it results from the very real fears about whether living in a fire (or other disaster) zone is worth it.</p>
<h2>Resilience and weakness</h2>
<p>In terms of mental health, the real effect of disasters is surprising. When handled well (as they have been in the recent efforts), disasters are an opportunity for communities and people who are directly involved to galvanise, and this appears to inoculate against mental illness by strengthening social bonds, and feeding a sense of purpose and meaning.</p>
<p>Another surprise is the flipside – an inexplicable rise in the mental illnesses that affect the elderly. Those who are frail and can’t get involved may feel they are ultimately only a burden. Such people suffer terribly from mental illness as a result of disasters. The big rise in mental health admissions after a bushfire happens in this group – its first presentations of dementia and senile degeneration is many times higher than with any other mental illness.</p>
<p>The complexity of social, environmental and psychological dynamics during an emergency cannot be underestimated. With normalcy going with the first evacuees, the strength of “all that is good” becomes the new foundation. As the <a href="http://www.em.gov.au/Documents/1National%20Strategy%20for%20Disaster%20Resilience%20-%20pdf.PDF">National Strategy for Disaster Resilience</a> points out, the power of the community (people you never met before come out of the woodwork to help), and the abiding dedication of the emergency services can be truly inspiring. And this is just the thing for building physical and mental resilience.</p>
<p>A useful way to understand this effect is through a theory called salutogenics. The theory rests on a relative sense of coherence that’s built by fostering three things – manageability, comprehensibility and meaning. Conversely, the sense of coherence is depleted by anything that rattles your ability to cope – not only a lack of resources required to manage; a lack of knowledge needed to comprehend circumstances, or a lack of meaning in life, but more general forces like the entropy of age and time.</p>
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<span class="caption">A man walks through waist deep water to a small community cut off by flooded roads from the rest of Gulfport, Miss., after the arrival of Hurricane Katrina on Monday 29 August 2005.</span>
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<p>While emergencies inevitably attack the ability to manage, they allow for meaning by providing clear answers to life’s big question – what are you here for? Getting involved in an emergency effort gives the answer – I’m not a parasite, I’m here to save people. I’m a contributor.</p>
<p>The formation of beliefs like these has been shown to assist in the widest gamut of health outcomes, not only in mental health. <a href="http://usyd.academia.edu/JanGolembiewski">Recent research</a> has also identified the effect of improved meaning and comprehensibility in conditions as diverse as heart disease and cancers. Surprising as it is, disasters can actually improve health if people find a way to get meaningfully involved in the disaster response effort.</p>
<h2>Perceiving is believing</h2>
<p>Reading this, you might think a bushfire is a wonderful thing. But there’s a big caveat – in emergencies, the perceptions of those involved are critical. Good interpersonal connections create meaning, but the lack of structure within emergency situations also provides opportunities for selfishness and even criminality. And these inevitably lend themselves to atrocious outcomes (consider Hurricane Katrina).</p>
<p>Good information improves comprehensibility, but in an emergency, information may be hard to come by and is frequently manipulated. What’s more, people might not have the heart to be honest when it matters most.</p>
<p>An under-promise allows <a href="http://www.em.gov.au/Publications/Australianjournalofemergencymanagement/Pastissues/Pages/AJEM27TWO/Moving-from-theory-to-praxis-on-the-fly-introducing-a-salutogenic-method-to-expedite-mental-health-care-provision-in-disas.aspx">low expectations to be exceeded</a>, and this allows for a powerful message of hope and the belief that everything ultimately works out well. On the other hand, disappointment is easily taken as betrayal.</p>
<p>Disaster victims should be expected to make unreasonable demands. Victims may, for instance, extract promises that are difficult or impossible to keep. Who, after all, wants to deny someone who is desperate and might have his life in danger? Who wouldn’t prefer to lie and say, “don’t worry. Everything will be fine”?</p>
<p>But a hastily made guess that “someone will be there to help in a couple of hours” can start doing damage at 120 minutes and one second. The reason is because the promise suddenly becomes questionable, and at this point, comprehensibility collapses and meaning starts to erode. What could be more destructive mentally?</p><img src="https://counter.theconversation.com/content/11573/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jan Golembiewski does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Radical circumstances (bushfires and natural disasters) flush out the mental illness in society. Whenever there’s a disaster, there’s a rush on hospital admissions for psychiatric problems. But on the…Jan Golembiewski, Researcher in Environmental Determinants of Mental Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/114932013-01-09T19:19:52Z2013-01-09T19:19:52ZSmoke from bushfires poses a health hazard for all of us<figure><img src="https://images.theconversation.com/files/19060/original/pm8g8knn-1357700123.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A bushfire smoke plume visible from Park Beach in Forcett, south-east of Hobart.</span> <span class="attribution"><span class="source">AAP</span></span></figcaption></figure><p>The bushfires currently raging across south-eastern Australia have, once again, focused national attention on the risks they pose for the community. </p>
<p>The immediate concerns, naturally, are the direct impacts on life, property and infrastructure, including the threat to life from the intense radiation around even relatively small fire fronts. But even people living far from bushfires can be affected by the smoke they create. </p>
<p>Hobart, for example, is currently under a pall of smoke from large fires on the Tasman Peninsula to the east, in the southwest forest and in the urban interface to the north. This constitutes a major pollution event affecting a large fraction of Tasmania’s population.</p>
<p>Smoke from bushfires and fires prescribed for fuel reduction, silviculture (tree farming) and biodiversity management are the largest source of air pollutants in Australia. The major pollutants in smoke are carbon dioxide (CO₂), carbon monoxide (CO), methane (CH₄), fine particulate matter, other volatile organic compounds and oxides of nitrogen. </p>
<p>From extensive occupational health, toxicological and epidemiological studies, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/18829114">major causes acute health impacts</a> from bushfire smoke have been identified as fine particulate matter, CO and a small group of respiratory irritants and carcinogens within the thousands of compounds comprising volatile organic compounds – principally, formaldehyde, acetaldehyde and acrolein, benzene, toluene and some polyaromatic hydrocarbons.</p>
<p>The degree to which each of these poses a health risk depends on their local concentration. Concentrations of CO and fine particulate matter in fire zones commonly exceed the short-term occupational health standards and can be between 100 and 1000-fold higher than ambient air quality standards. Indeed, CO concentrations exceeding 300 parts per million and fine particulate matter concentrations of 100 micrograms per cubic metre (µg/m³) are common around bushfires. </p>
<p>Carbon monoxide is particularly insidious because we can’t smell it, and its effects are cumulative. But extensive monitoring of firefighters has found few cases of exposure exceeding occupational health standards. </p>
<p>In fact, we found that firefighters on the ground tended to avoid direct exposure to smoke, and where exposure was unavoidable, irritants in the smoke ensured that firefighters minimised exposure duration. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20956017">We concluded that</a> exposure to smoke for those fighting fires is a manageable issue.</p>
<p>The smoke exposure of the population in the region of a bushfire, however, <a href="http://www.sciencedirect.com/science/article/pii/S1352231011004493">appears to be a greater problem</a>. Our measurements of ambient concentrations during and following the 2006/7 alpine fires in Victoria showed that fine particulate matter is the main hazard for the general population. </p>
<p>Fine particulate matter produced by bushfires comprises particles smaller than 2.5μm ( micrometres, 1μm is 10⁻⁶metres), which can penetrate and lodge deep within the lungs. Once there, their impact can be severe. Such morbidity impacts, including asthma, are difficult to quantify statistically, but <a href="http://www.biomedcentral.com/1471-2458/7/240/">there’s accumulating evidence</a> that they can be substantial, and ongoing studies are addressing the question.</p>
<p><a href="http://www.noaca.org/pmhealtheffects.pdf">What we do know</a> and currently accept is that average population death rate (mortality) goes up by 1% for every 10μg/m³ increase in daily average concentration of fine particulate matter. For health-impaired or susceptible groups in the population, this increase can be up to 4%.</p>
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<span class="caption">A blanket of smoke from nearby bushfires approaches Melbourne on Friday December 8, 2006.</span>
<span class="attribution"><span class="source">AAP</span></span>
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<p>During the 2006/7 fires, for instance, the CSIRO air quality station at Aspendale recorded that smoke affected Melbourne for eight days with concentrations of fine particulate matter reaching approximately 100 μg/m³. If the whole of the population of Melbourne had been directly exposed to this concentration, the daily death rate in the city over the period of exposure could have increased by about 10%. </p>
<p>Rigorously quantifying the number of people affected is major challenge and probably impossible. It’s clear that the extent of smoke dispersion affects the relative impact of smoke on the regional population, which could be significant.</p>
<p>And the health effects of smoke are not just direct, smoke also impacts on other air-quality measures. Secondary chemical processes, particularly photochemistry, result in products such as ozone and ultrafine secondary organic aerosol, both of which potentially pose health risks. </p>
<p>Ozone concentrations <a href="http://www.sciencedirect.com/science/article/pii/S1352231011004493">well above the air quality limit</a> were frequently recorded during the 2006/7 Victorian fires – this is rare at other times.</p>
<p>The impact of smoke on people remote from the fires may, on occasion, substantially exceed the direct injury to people within the fire zone. But we currently lack the operational tools to understand the extent of these impacts or to manage them. </p>
<p>The non-lethal impacts of fine particulate matter haven’t been quantified, and although available models are reasonably reliable, the framework required to bring together all the components for forecasting smoke dispersion hasn’t yet been developed for Australia. Both are essential for managing the diffuse impacts of severe fires, and fortunately, both are now in development. </p><img src="https://counter.theconversation.com/content/11493/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mick Meyer receives funding from both state and federal governments.</span></em></p>The bushfires currently raging across south-eastern Australia have, once again, focused national attention on the risks they pose for the community. The immediate concerns, naturally, are the direct impacts…Mick Meyer, Senior Research Scientist at Centre for Australian Weather & Climate Research, CSIROLicensed as Creative Commons – attribution, no derivatives.