Leading international clinical deployments to crisis zones

Tsunamis, earthquakes or Dengue fever outbreaks. When disaster strikes, Waikato anaesthetist, Dr Alan Goodey, is one of the first to respond. As the Clinical Director of the New Zealand Medical Assistance Team (NZMAT), he helps coordinate and lead our government’s multidisciplinary team, ready to deploy at a moment’s notice to support local health services in the event of a major emergency within the South-West Pacific.

For the WFSA’s World Anaesthesia Day 2025 theme, Anaesthesiology in Health Emergencies, Dr Goodey answers our questions about how anaesthesia and emergency medicine intersect, and what it takes to stay prepared for the unexpected.

How did you become involved with NZMAT as its Clinical Director?

It’s been an extraordinary journey. When I look back at my younger self, it all seems rather improbable; it still surprises me to this day.

I’ve had both the privilege and the responsibility of representing New Zealand on seven international clinical deployments. Experiences that have allowed me to interact with other international medical teams and respond to a range of health events not directly related to anaesthesia or surgery.

My journey into emergency medical teams began with the Pacific Tsunami in 2009, which tragically claimed 189 lives across Samoa, American Samoa and Tonga.

I’d just returned from my first surgical mission with Interplast, spending two weeks in Samoa providing anaesthesia for plastic and reconstructive surgery. I was somewhat familiar with the country, having also completed my medical school elective in Samoa. When news of the tsunami reached us, my wife was adamant that I should go to help, but I knew I couldn’t just turn up. As it transpired, Waikato Hospital responded to a call from the New Zealand government for volunteers. They proposed a complete team, and given my recent experience in the Samoan health system, I took on the role of Clinical Lead.

I naively expected the role to be relatively simple. In reality, it was a steep learning curve into the complexities of medical logistics, working alongside government representatives and the expectations of being a government representative myself. As well as providing clinical advice across a much broader sphere than my usual operating theatre expertise.

After returning from Samoa, there was a clear interest in learning from that mission and potentially building an official team. Several years later, I was contacted by Judy Fairgray, the Project Manager for the newly formed NZMAT and invited to attend a training week. I initially had reservations about further international disaster work and nearly declined. However, I felt my experience in Samoa could be helpful for the new team.

What is NZMAT?

NZMAT is an internationally accredited Emergency Medical Team, administered by the New Zealand Ministry of Health and co-funded by both the health budget and the foreign affairs humanitarian budget. A deployed team typically comprises a Mission Lead (usually representing the Ministry of Health), Urban Search and Rescue logisticians, and civilian volunteer clinicians from across Aotearoa.

The formation of NZMAT followed our experiences in Samoa and the Christchurch earthquake. Its development coincided with the World Health Organization’s movement to address concerns towards the activities of certain foreign medical teams in disaster zones. In particular, the 2010 Haiti earthquake, where the uncoordinated arrival of volunteer medical teams—many of whom were unprepared—and who helped but also created significant bottlenecks and hindered the effective response required.

The WHO’s Emergency Medical Teams (EMTs) initiative now provides a globally agreed framework and standards for such teams. These standards establish a classification system and emphasise the need for self-sufficiency during deployment. For example, the ability to produce potable water, provide meals and accommodation, and ensure team welfare, so as not to burden already limited resources in a disaster setting.

Teams undergo a five-yearly accreditation process to demonstrate compliance with the relevant standards. For NZMAT, we are accredited as both a Type 1 Mobile Team and a Type 1 Fixed Team. We can provide general outpatient emergency care and refer patients who require inpatient stays. The standards help us plan the number of patients we expect to treat daily and the supplies we need to bring on deployment.

The international standards only cover surgical provision within fully functioning field hospitals. However, NZMAT can deploy a surgical team into existing facilities as a specialised care team. Our current accreditation and New Zealand’s close relationships with many Pacific countries provide us with a pathway to deploy surgical teams if required.

What does your role as Clinical Director involve?

The first Clinical Director of NZMAT was Dr Emma Lawrey an emergency physician based in Auckland. She was instrumental in developing the clinical guidelines and the manifests of clinical equipment we carry. Under her leadership NZMAT achieved its first verification as an internationally accredited Emergency Medical team.

Now that NZMAT is well into its second decade, I view my role as guiding the organisation as it transitions from start-up to becoming a long term sustainable clinical organisation that New Zealand can be proud of. The team responsible for running the day-to-day maintenance of our operational capability is very small therefore the knowledge to deploy effective clinical teams in a timely manner is vulnerable to staff turnover.

My role is something like a Chief Medical Officer in terms of my responsibility to ensure the overall quality of care provided by NZMAT is appropriate for the environments we deploy to. I am involved in debriefs and reviews of deployments.

A significant amount of our work involves occupational health focus and team welfare on deployment. Reviewing our extensive vaccination policy, being responsible for advice around Malaria prophylaxis and updating guidelines on managing heat stress are some of the things I’ve become much more aware of working in this role.

The international system and standards of Verified EMTs continues to grow in complexity. The emphasis of EMTs deploying in field hospitals in sudden onset disasters is shifting to more broadly focused teams responding to infectious disease outbreaks or other types of emergencies. I have influence in how we develop NZMATs capability for these types of events where we can adjust NZMATs ongoing capability.

I also keep in mind how valuable NZMATs resources and knowledge could be for any major disaster we have at home, such as a severe earthquake.

What is NZMAT’s role in a major disaster within New Zealand?

The estimated risk of the Trans Alpine Fault rupturing is greater than 50% in the next 50 years, and an estimated 25% risk for the Hikurangi Fault off the southeastern coast of the North Island. Either could cause major issues for our nation.

Our health system would potentially be overwhelmed, and its capacity could be severely reduced by issues affecting infrastructure, workforce and our supply chains. While NZMAT does not have the capability or capacity to make a direct impact, I think it’s real value for the Government is in understanding how international EMT’s function, their strengths and weaknesses, and how we might integrate visiting teams to support our health system through the early stages of large-scale sudden onset disaster.

NZMAT has a close working relationship with the Australian Medical Assistance team. We share training opportunities and recently AUSMAT doctors deployed within the NZMAT deployment to Samoa. Increasing our collaboration with other International EMT’s will only improve our resilience when disaster strikes.

Currently, the New Zealand Defence Force has its own capacity issues and would have very limited ability to deploy and staff a field hospital on its own. The NZMAT type 1 Fixed Field Camp could provide a tented healthcare facility with the capability to provide potable water and an environment for providing basic healthcare. Staffing could be provided by NZMAT volunteers, local clinicians from the affected area, or an international team – depending on the size and scale of the event. All New Zealand based clinicians are likely to be busy in their own health locations which would make staffing NZMAT using local volunteers difficult. The training and experience that we give our volunteers has the potential to improve local responses.