A fifth person has died due to Monday's extraordinary "thunderstorm asthma" crisis and six people remain in intensive care units, four of whom are critically ill, the health department says.
The latest victim, believed to be a woman, died at the Northern Hospital in Epping on Friday night. A statement from the hospital confirmed the death was "a result of thunderstorm asthma which led to other medical complications".
![About 8500 people went to hospitals during the thunderstorm asthma crisis.](/web/20161126145207im_/http://www.theage.com.au/content/dam/images/g/l/v/u/t/q/image.related.articleLeadwide.620x349.gsy7wa.png/1480148267997.jpg)
"During this difficult time, our thoughts are with the patient's family and friends. It would be inappropriate to make any further comment," said a hospital spokesman.
The health department said another 20 people are still in hospitals being treated for sickness stemming from Monday night when unusual weather conditions caused pollen to explode, triggering breathing problems for thousands of people.
The news comes as Fairfax Media can reveal that most Melbourne hospitals did not follow the state's health emergency plan during the unprecedented outbreak last week, despite Health Minister Jill Hennessy likening its impact to 150 bombs going off across Melbourne.
A leading emergency physician has called for hospitals to review their response to the emergency, following reports of potentially fatal ambulance delays, Ventolin shortages, and a queue of 18 ambulances at Sunshine Hospital during the disaster.
Victoria chair of the Australasian College of Emergency Medicine, Dr Shyaman Menon, said it was unclear whether the Department of Health ordered hospitals to enact "Code Brown" plans, which are designed to create space and resources in a mass casualty emergency, and allow ambulances to offload patients quickly so they can return to the road.
Dr Menon said while emergency department staff across Geelong and Melbourne seemed to do "fantastically well" at treating scores of patients on the night, some did not call Code Browns. In some cases, he said these hospitals seemed to do things consistent with a Code Brown, such as call in extra staff, and that it was unclear why they didn't formally call the code.
"It will be interesting to know why they didn't call a Code Brown… Their response may not have been co-ordinated or adequate for what they had," he said.
While the Department of Health says it activated the State Health Emergency Response Plan on Monday about 8pm, and that "all hospitals quickly activated their emergency response systems", only three hospitals told Fairfax Media that they called a Code Brown consistent with the plan on Monday night.
These hospitals were Geelong, which called one at 7pm, the Austin which called one at 10:10pm and St Vincent's which called one at 11:36pm. The Northern Hospital in Epping called one on Tuesday about 7:30am.
The State Health Emergency Response Plan says: "When hospitals and health services respond to an external emergency, they will activate their Code Brown plan… Code Brown plans provide the additional capacity that hospitals need to receive an influx of patients."
The plan also says: "Once notified of an incident, hospital Code Brown response plans will be activated as the whole health service prepares to manage an influx of patients."
Dr Menon said he believed all hospital chief executives were notified about high demand on Monday night, and that it was left up to them as to whether they called Code Browns or not. He said Code Browns were important because many emergency departments worked at capacity during average weeks, so they have limited resources to be ready for a sudden surge of patients.
He said this phenomenon, known as "access block", occurred when there were no beds in hospitals for emergency department patients to be moved to.
"Access block needs to be addressed on an ongoing basis to ensure that our emergency departments maintain the capacity to respond to the emergency medical demands of our community," he said.
Spokespeople for the Department of Health and Ms Hennessy have declined to explain what hospitals were expected to do on Monday night and if they were told to enact Code Browns or not.
On Friday, Victoria's Emergency Management Commissioner Craig Lapsley said Alison McMillan, the Department of Health's Director of Emergency Resilience, was in charge of co-ordinating the hospital response.
Ms Hennessy has asked the Inspector-General of Emergency Management to review how well the crisis was handled by April 2017. Opposition health spokeswoman Mary Wooldridge said the review should be expedited to ensure the community could trust the state's emergency management plans.