Abstract

Key Words

Introduction

The term triage originates from a French word originally coined to describe a wool sorting process. It was first used in the realm of “combat” by Napolean’s surgeon, Baron Larrey. Combat triage rests on the premise that the greatest good must be accomplished for the greatest number under the varying conditions of warfare (Groff and Jones 2003).

More recently the term ‘environmental triage’ has been used to describe a prioritisation process which seeks to assist policy makers and planners determine legitimate investment targets and approaches to dealing with resource allocation in the battleground of natural resource management and environmental protection. In this context it is the health of ecosystems that is the sphere of intervention. Rather than human life in the balance it is biodiversity and ecosystem process that which we seek to rehabilitate.

The smash hit movie M.A.S.H. and subsequent television series brought the role of combat triage into the popular imagination. “The Swamp” in MASH was the surgeons’ accommodation tent and the location where many bright ideas to respond to difficult situations were hatched – and distilled. Similarly many NRM responses are devised within the “swamp” as outlined by Schon (1987) when he stated “On the high ground, manageable problems lend themselves to solution through the application of research-based theory and techniques. In the swampy lowland, messy, confusing problems defy technical solution. The irony of this situation is that the problems of the high ground tend to be relatively unimportant to individuals or society at large, however great the technical interest may be, while in the swamp lie the problems of greatest human concern.”

In this paper options are explored on how to deal with the sometimes confounding problems encountered in community based natural resource management. In particular the M.A.S.H. program is used as an analogy, to frame a brief overview analysis of the current investment in extension by Regional NRM Groups in Queensland. Data to inform this overview was gathered by a survey responded to by several bodies and the personal experience of the writer.

What are the core aspects of Combat Triage relevant to NRM?

The opening scenes of M.A.S.H. vividly illustrate the process of triage when the wounded are being transported to the unit. So what are some of the aspects of this process which may be analogous to a useful program logic within regional NRM. Table 1, attempts to construct a logical comparison between these two processes. This data is based partly based on a brief workshop process at the APEN NRM Extension Toowomba symposium. The intent of this comparison is to provide a lens through which to question the relevancy and appropriateness of existing extension and prioritisation strategies within NRM groups and agencies more broadly. One key question is whether current NRM regional planning and implementation processes are structured toward a more highly resourced comprehensive “base hospital” approach. Such approaches attempt to deal with all the problems presented to it. Alternately, have they adopted a more strategic, integrated “M.A.S.H. unit” approach which acknowledges the need for rapid responses, based on the use of existing skills and knowledge to prioritise effort and to inform the necessary innovation required by limited resource availability.

Table 1: Comparison of M.A.S.H. Combat Triage and Environmental Triage

Combat Triage in MASH	Environmental Triage in NRM Groups
Incoming wounded are in various conditions, from minor wounds to critically injured.	NRM Groups deal with ecosystems ranging from those that have degraded past several critical ecological thresholds to those who have had only minor disturbance.
Patients come to the M.A.S.H. unit by varying processes quickly by helicopter, slower by ambulance and perhaps slower by truck or even walking. Frequently, the time taken to present to triage can mean they arrive in a more critical condition than when the problem first arose.	Like a M.A.S.H. unit NRM groups are dealing with social and biophysical problems of various gestation periods. Generally the slower, more insidious processes which take longer to become visible in the landscape, or discussable within a local culture, are the more difficult to rehabilitate.
When patients present themselves it is “all hands on deck”. The whole MASH unit, from administration staff to surgeons to the Colonel, are involved. They all have a clear understanding of their roles and respond flexibly to emerging situations.	A key to responding to many NRM issues is to ensure transdisciplinary approaches are adopted within a whole system context. It is important that roles are clear and that the focus is on the outcomes not on defending professional territory eg. community v government, researcher v extension practitioners etc)
The Colonel and administration staff rapidly assess the scale of emergency response required and quickly advise the General of the need to alter programming and seek additional resources to meet demand. Decisions are made on the run, but within an agreed protocol to maximize life saving, rather than risk minimisation..	Adopting triage principles may be useful framework to request programme modification and additional resources through processes such as reviews of Regional Investment Strategies, Management Action Targets and the like. Similarly over-specification and excessive bureaucracy and risk adverse behaviours within environmental triage may result in loss of key assets in the long-term.
The Surgeons are the ones who are doing the triage assessment process not the other troops. At the coal face the sorting and prioritising is therefore conducted by those with content knowledge not positional power and definitely not the Generals.	It needs to be recognized that specialist environmental & social science, as well as NRM and extension knowledge and training is required to undertake environmental triage assessments.
Under the principles of triage sometimes the most severely wounded patients that require complicated and resource intensive responses are left (potentially to die) so more can be saved. Sometimes problems which are presently minor are operated on first, as if not dealt with, they will be much harder to fix at a later time.	In NRM terms prioritizing effort to get the maximum biodiversity or ecosystem benefit for the investment is a principle which requires greater attention. For example, the “Titanic Theory” promoted by Land And Water Australia’s river restoration program provides a framework which promotes protection of significant conservation areas before attempting to remediate severely degraded areas.
Innovation is necessary as the M.A.S.H. unit needs to work with the modest equipment at their disposal. In many instances transferring the patient to the ‘base hospital’ is not an option nor is waiting until the right equipment can be shipped in.	Similarly Regional NRM Groups are faced with the reality that resources will never extend to provide all the known and available technology and expertise. There is a need to realise that urgent action needs to be taken and that innovation with available resources is important.
In the M.A.S.H. unit the clients can be the protagonists - from their own side, but also the enemy, they can be the innocent collateral damage and this may include the need to operate on children and the unborn.	Similarly successful NRM extension will involve Regional Groups involving all client groups not just those who are “on side”. Awareness and involvement strategies may target the perceived “enemy” and all actions need to consider the needs and rights of the innocent to a future.

Why is Triage Relevant as an organising concept for NRM extension

While debate still rages, many scientists are coming to a higher degree of certainty regarding the potential global changes that confront us, as our knowledge of the impact of insidious problems such as global climate change and resource degradation is enhanced. NRM Extension and coordination professionals generally have expert knowledge of potential ecological and social futures states resulting from these pressures. With this knowledge comes a quandary which confronts many of us. How can we make a difference, in a world where resources are allocated in a manner which vastly underestimates the economic value of our life support systems and reinforces the continuance of systems driving potentially catastrophic ecosystem change. Further, how do we allocate the limited resources we have to the greatest advantage within this paradigm.

In many ways we are faced with a similar paradigm to that presented by a soldier in the Korean battlefield as expressed in the M.A.S.H. theme song:

“Through early morning fog I see, visions of things to be, the pains that are withheld from me, I realize and I can see; that suicide is painless, it brings on many changes, and I can take or leave it if I please”

While those in the NRM extension field have clearly chosen not to accept the environmental suicide option, it is important to explore what the best alternative options are within the sphere of influence in which we operate. We have privileged knowledge that allows us to predict future states from current trends but burdened by the understanding it gives us of the magnitude of the problems we are dealing with. So what are some of the key insights from communities who have adopted ‘hope’ as a driver for action? Bernard and Young (1997) describe stories of communities of people throughout the USA realising their inter-connectedness with each other and their surroundings and striving to live their lives according to this realisation. They identified eight characteristics that appear common to these communities:

• a good working knowledge of the ecosystem;
• a commitment to ecosystem health;
• a commitment to learning;
• respect for all parts;
• a sense of place,
• acceptance of change,
• a long-term investment horizon; and
• the ability to set limits.

In the M.A.S.H. series “Radar” could intuitively predict future events and have arrangements in place by the time they eventuated. Similarly for environmental triage concepts to be successful they need to be targeting a clear and shared long term vision and understanding of where current trends may take us. Cork (2004) has suggested that currently our approaches tend to be more “like driving a car through unfamiliar territory on a moonless night to an unknown destination that you know you have to reach without delay. If you only rely on what you can see in your headlights then your progress will be slow (or dangerous if you try to hurry) and you will be continuously reacting to things that loom out of the darkness.” Progress he suggests will be faster and safer if you do some thinking ahead of time about what might come out of the dark and prepare yourself to deal with a range of possibilities adding that ‘nothing connects communities with land and with one another like a common vision of the future and some plans to achieve their vision.’(Cork 2004).

The Attributes of a Successful M.A.S.H. Unit

Those who study literature suggest that many classics that stand the test of time are based on quintessential storey lines expressed through archetypal characters. These works of fiction succeed because they are expressed in a framework that we understand and can relate to as having meaning to our own lives over time. The series M.A.S.H. is still popular 30 years after it was first screened and it could be argued that it is because it possesses the qualities discussed above. The M.A.S.H. unit provides a setting for the development of a range of characters which are typical of teams working in complex, stressful and difficult situations where the desire to make a difference is juxtaposed with a suite of resourcing and bureaucratic constraints that make this task more difficult. It highlights the need for innovation, strong interpersonal relationships and good humour to be effective within these environments. In this light the role of humour in successful NR&M groups is perhaps worthy of more research.

Table 2 outlines the perceived positive and negative attributes of the central characters in M.A.S.H. and attempts to identify the “archetype” that these characters may represent (at least in part). This data is based partly on a brief workshop process at the APEN NRM Extension Toowomba Symposium. It potentially provides some insights into some of the characteristics which should be fostered in environmental triage teams and others which may be less desirable. The challenge is to strengthen those systems and processes within the existing Regional Arrangements which facilitate the former and review and amend those which incite the latter. Further, it may provide a lens through which to look at the various characters within NRM extension to build on the potential positive roles the various character types can play within diverse teams. Some would argue for example, that the transition from Integrated Catchment Management and Landcare to the current ‘Regional Arrangements’ has resulted in an over representation of ‘Technocrats’ within the system.

Overview of Regional Body NRM Extensions Viewed Through a Triage Lens

Post Plan Triage

A number of Regional NRM bodies have and are undertaking post Regional NRM Plan prioritisation to guide the allocation of resources and extension effort. These processes could broadly be described as components of ‘environmental triage’.

For example, Natural Resource Management South East Queensland (NRMSEQ) have undertaken a multi layered Geographic Information Systems sieve mapping process to produce a “Confluence of Issues” map for the region. A similar process has been developed and implemented by the Murray Darling Basin Catchments group. In NRMSEQ Key Investment Areas have been identified where mapping and validation by on-ground groups determines that areas of high asset value and high threat exists. The strength of this process include: strong linkages to government resources and partnerships to access best available knowledge and data layers; ‘ground truthing’ GIS results with community, industry and council round tables; and using results to guide on-ground investment which has respects both social capital within the community and priority investment targets.

The South-West NRM Regional Body has a two pronged prioritisation process which meets some of the criteria of an environmental triage approach. Investment through the FUTURESCAPES program is allocated through a selection process that incorporates geographic prioritisation and property and catchment-scale planning. Priority is also given to on-ground works that involve groups of landholders developing strategic actions for the wider landscape. PLANSCAPES on the other hand targets land manager groups in priority landscapes through a system of research, mapping and data analysis.

Table 2. Analysis of M.A.S.H. Character Types and Attributes within Team Environment

Character & archetype	Positive attributes	Negative attributes
FRANK ‘The Technocrat’	Strong institutional supporter Doesn’t take many risks Saves Lives	Stickler for rules and regulations even when they have perverse outcomes Creates bureaucratic dramas by over reporting of transgressions Seeks to cover up lapses in competence
HOT LIPS HOOLAHAN ‘The Linker” & potentially ‘The Carer Matriarch’	Communicates to both sides Offers strong support in crisis situations Loyal team player who can mediate and create links between individuals	Can let emotions override her generally sensible approach
HAWKEYE “The Larrakin Innovator”	Excellent Clinician and Practitioner Great innovator to achieve good results Inspires camaraderie Irreverent sense of humour, which enhances moral in stressful situations	Can be inconsiderate of others weaknesses or needs Can expose others to unnecessary risk Can go overboard
The COLONEL “The Supportive Leader’	Sponsors different ways of doing things Mediates disputes Flexible Encourages diversity & self determination in resolving problems	Could be more assertive in some situations Can be distracted from the main game ( ie not golf)
TRAPPER ‘The co-conspirator or partner in the dynamic duo”	Shares similar views and values to Hawkeye Is more reflective and more sensitive than Hawkeye and hence can curb some of his excesses	Easily led astray Can be a ‘partner in crime’
FATHER MUCAHY ‘ The Pastor’	Connects individuals to the spiritual purpose of their efforts Provides meaning and deeper understanding Respects the individual and supports their growth Is not evangelical	Can be vague Not a lot of help in triage situations His attempts to resolve conflict by appealing to the protagonists higher natures often doesn’t work His main purpose in the operating theatre is to ‘read the last rights’
RADAR “The Intuit”	Senses future problems and crisis Has solution prepared for when they arrive Pre-empts and acts before official orders Wants to help and organise the supplies which make the unit run.	None- criticising people like this in your organization is sacrosanct
KLINGER ‘The Fool’	Thinks outside the square to achieve objectives Despite his challenging off-the-wall appearance is a good nurse/ practitioner	Goes over the top trying to be different Repeated failure doesn’t result in him reviewing his strategies Looks terrible in pink.

Setting Up M.A.S.H. Units

A number of Regional Bodies are setting up local area and subcatchment scale projects that are analogous to the role of field based MASH Units in a combat arena. A number of labels and nuances exist in these processes variably called area-wide management, integrated area wide management, Neighbourhood Catchments and the like. They share a common theme in being ’place-based’ rather than program driven, promote the development of local solutions to local problems, and seek to reduce the need for centralised command and control regulation and policy intervention through demonstration of informed responses to issues as they arise. Generally they involve growers, industry organisations, scientists and extension officers from government agencies, natural resource management groups and community groups working cooperatively on a sub-catchment basis to develop and implement NRM practices within sustainable production systems and/or to facilitate monitoring of the impact of these practices to inform adaptive management processes. Examples include:

• Integrated Area Wide Management linked to the Agricultural State Investment Project in Condamine Alliance, Qld Murray Darling Commission and Fitzroy Basin.
• Fitzroy Basin Association’s ‘Neighbourhood Catchments’ program; and
• NRMSEQ’s Sustainable Production Partnerships project.

Individual Patient Care

In comparison some of the more remote regions have the ability to offer a level of extension support analogous to individual patient care. The Southern Gulf Region for example is the size of Victoria with a population of only 30 000 people. Through an Australian Government capacity building pilot project the group undertook one-on-one engagement, community consultation and listening to the concerns and aspirations of the community. Through this process the group has developed trust with their stakeholders and enhanced understanding of natural resource management objectives and responses.

The Original Father Mulcahy’s

A significant effort has been undertaken to include indigenous communities, enterprises and individuals within the extension framework of Regional NRM bodies. Reconnecting landscape management with traditional owners and managers in this context is important not only in understanding the higher ‘spiritual’ aspects that drive many within the NRM arena, but also to capture traditional knowledge to inform contemporary management actions and to enhance the capacity of indigenous land managers. Some examples include:

• The Desert Channels NRM Body have held 2 regional Indigenous Forums to foster participation in NRM
• The Far South West Aboriginal NRM Group was formed in 2004, as the Traditional Owner advisory group for natural resource management in the South West NRM region.
• Burnett Mary Regional Group (BMRG) obtained Capacity Building State Investment Program funds to build relationships with indigenous land managers. This included active extension involving DPI&F to Indigenous Properties that featured agricultural enterprises eg. Scrub Hill. This project has resulted in the sharing of Sustainable production knowledge between indigenous communities in the region.

Reemploying Old Surgeons

M.A.S.H. units are not effective without surgeons who have the capacity to handle all the common problems that present to them. In a landscape context a range of specialist technical and extension skills are needed for successful management and rehabilitation. Some regional bodies have acknowledged the gap left by historical government divestment in some programs eg. Soil Conservation and Treecare programs previously run by Department of Natural Resources. South East Queensland Western Catchment Group (SEQWCG), for example, have employed their own Soil Conservation Officer and specialist in Vegetation Management officer to bridge these gaps.

Common Operating Equipment

Dealing with low budgets and difficult supply lines MASH Units across a war front achieve economies of scale by using common operating equipment. Similar conditions within regional NRM groups has seen the emergence of a range of extension tools which are commonly used across various regions to achieve similar purposes. These tools frequently involve ‘packages’ which have built the findings of research and development into a training and extension framework to maximize uptake of sustainable and economically viable management practices. For example:

• Condamine Alliance, BMRG, NRMSEQ SEQWCG are working with Qld Dairyfarmers Organisation to deliver the Dairying Better n Better Program and associated incentives.
• Others eg. SEQWCG are working with Growcom’s Water for Profit program to deliver rural water use efficiency extension and incentives.
• Many Regional Bodies are working with the Meat and Livestock Australia-DPI&F Grazing Land Management Package & funding regional customisation. This package consists of a series of interactive sessions, conducted over 3 days in a workshop format, where participating graziers begin to develop a plan, based on ecological principles, for managing their grazing lands
• Requiring Property Management Plans to be developed prior to receiving incentives is also common.

An ongoing issue with these programs is the need for the post operative repatriation, or in NRM terms, the follow-up extension to enhance uptake of recommended practices. Follow-up extension processes vary across regions and is the current topic of discussions between providers. Dairying Better and Better, for example uses farmer advocates to promote initial involvement and have a role in follow up processes subsequent to field days.

Conclusion

The concept of ‘triage’ provides a useful construct through which to plan and evaluate extension within the resource constraints that typify the community-based natural resource management arena. The M.A.S.H. analogy, while light hearted in nature, does help to analyse some of the underlying program logic and desirable and undesirable operating styles relevant to ‘front line’ NRM delivery. An overview of extension processes currently conducted by Regional NRM bodies has identified some successful approaches which fit within a broad ‘triage’ context and reflect successful elements of overseas practices.

References

Bernard, T. and Young, J. 1997. The Ecology of Hope – Community Collaboration for Sustainability. New Society Publishers. British Columbia.

Cork S (2004) Connecting communities with the future. Rip Rap, River and Riparian Lands Management Newsletter, Land and Water Australia 26, 23-24.

Groff TR, Jones TP (2003) 'Introduction to Knowledge Management: KM in Business.' (Butterworth - Heinemann: Burlington)

Schon, D. (1987) Educating the reflection practitioner: Towards a new design for teaching and learning in the profession. San Francisco, CA: Josey-Bass Publishers.