Bali bombings: Medical advancements in Australia 20 years on

Twenty years after the Bali bombings sent shock waves through Australia, Darwin nurse Ronnie Taylor still remembers the most common request from survivors in hospital.

"Can you ring my mum? Can you ring my dad?" she said.

"You could see the relief. It's like they'd been on high alert for a couple of days and suddenly, they just let go."

Just after 11pm on 12 October, 2002, terrorists detonated three suicide bombs in Bali: two in night venues along Kuta's popular nightclub strip, and one outside the US consulate.

The deadly attacks claimed the lives of 202 people - including 88 Australians and three New Zealanders - and put Australia's top medical experts to the test.

"We knew that if people were to have a chance in surviving, to get to Australia, Darwin was the best place to stop," Taylor said.

Heroic efforts of doctors and nurses

As news of the bombings spread across Australia, health staff at the Northern Territory's Royal Darwin Hospital began preparing for an influx of patients.

Located a two and a half hour flight from Bali, the hospital had room for just 15 intensive care unit beds at the time.

They were preparing for the arrival of more than 70 bombing victims, many with life-threatening injuries.

Dr Brian Spain, who helped coordinate the arrival of the patients in Darwin over three days, said "I've absolutely never seen anything like it".

"For a brief moment, it was overwhelming," he said.

"But then, realising I had a great team... we knew we could do it, one person at a time."

Dr Spain said the hospital had 26 hours to prepare for the first load of patients, from when the bombs exploded.

"We brought a burns surgeon and one of his trainees up from Adelaide, so we had a really good team up here to both do the procedures and advise on the best treatment," he said.

"While everyone felt deeply affected by the tragedy of the injuries to all the people, there was a deep sense of pride among the staff [that they were able to help], which remains to this day ... that they were part of an amazing response [not only] for the hospital but on behalf of the nation to look after those victims."

The Royal Australian Air Force delivered a stream of patients to the hospital, while health staff raced to stabilise the wounded and repatriate them back to their home states for further treatment.

"I can still remember walking up the ramp of that Hercules [aircraft] and just seeing it stacked with the first couple of bays of really severely injured people," Dr Spain said.

"The other burns victims were literally [stacked] three high on the military stretchers."

Opening Australia's eyes to burns injuries

Dozens of patients who survived the Bali bombings were left with horrific third-degree burns that extended through every layer of their skin, destroying nerve endings and threatening vital organs.

Renowned burns specialist Dr Fiona Wood, together with her team at Royal Perth Hospital, treated 28 patients using her innovative technique known as "spray-on skin".

The world-first technology, which allows healthy skin cells to be cultured and sprayed onto wounds, greatly reduced permanent scarring in burns victims.

"It was a time when the window to our world [of burns treatment] was opened," Dr Wood said.

"People understood the severity and the shocking nature of burn injury, so that started a program where people supported us."

Dr Wood was named Australian of the Year in 2005 for the assistance she gave people injured in the bombings, and her life-saving medical innovations that continue to help burns victims.

"We're on a journey trying to understand the power of tissue engineering, and how we can use that to heal burn wounds," she said.

Even with extensive experience in managing burns injuries, Dr Wood said she was shocked by the extent of the blast wounds.

"Seeing the complexity of the patients' injuries from Bali was quite eye-opening," Dr Wood said.

"The Bali bombing was a shock to Australia, because it brought terrorism right home to our front door."

From disaster came development

Dr Len Notaras, who was Royal Darwin Hospital general manager at the time, said his team was dealing with horrendous injuries in challenging conditions, but all rose to the occasion.

"[There were] impalements, traumatic amputations, all sorts of horrendous things that are the products of war ... but the response and the success of that particular response is one that each of the individuals involved on the day should be very proud of," he said.

The challenge of coordinating an urgent, highly skilled medical response to the bombings prompted the establishment of a world-leading National Critical Care and Trauma Response Centre (NCCTRC).

"Prior to Bali [bombings], there were a lot of very talented resources throughout the country, but bringing it all together under one umbrella - and being able to respond under one umbrella - was critical," Dr Notaras said.

Since its establishment in 2004, the centre has formed a key part of the Australian government's response to humanitarian disasters, onshore and overseas.

From the Black Summer bushfires and earthquakes, to disease outbreaks, cyclones and oil spills in the Asia-Pacific, the centre's medical assistance teams have saved thousands of lives.

"For the Indo-Pacific and indeed, for the world, the arrival of our blue shirts and beige pants has garnered significant respect," Dr Notaras said.

Taylor, now strategic projects manager at the NCCTRC, said the centre had come a long way since the horrors of the Bali bombings.

"I think it's really important to remember how it happened, and where we came from," she said.

"I'm so proud of the response over those three days. It was unbelievable."

-ABC