The Evolving Role of Rehabilitation Professionals in Disaster

Management

Peter Skelton, BSc, MSc

Technical Advisor, Handicap International and the UK Emergency Medical Team

Top Priority: Preparedness

• We know where disasters are likely to strike!

• Rehabilitation must be integrated into disaster management plans – including mapping of services, referral mechanisms, use of human resources.

• Professionals in high risk countries must be trained in trauma management

• Service providers should consider stockpiling of essential rehabilitation equipment

A Positive Example: Nepal 2015

• EU Project combining government, UN and non governmental actors.

• Mapping of governmental and non-governmental stakeholders

• Rehabilitation integrated into national trauma management guidance and training

• Involvement of professional associations (e.g NEPTA)

• Equipment stockpiled • Injury and Rehabilitation Sub-

cluster then established early to coordinate the response and ensure “Build Back Better” principle applied.

New Guidance…

Emergency Medical Teams

• WHO initiative post Haiti

• Minimum Standards launched in 2013, including basic rehabilitation requirements

• Teams are verified by WHO and requested by the affected country

• Already having an impact – Philippines, Nepal, Ecuador…

Type 1

Type 2

Type 3

Specialty teams

requiring support within

an FMT level 2 or 3 care

facility or local

secondary or tertiary

hospital

How

• Highly consultative inter-disciplinary process

• Literature review

• Working group includes PT, P&O, Rehab Medicine, OT and Nursing

• Contributing organisations include MSF, CBM, ICRC, Handicap International, WHO

• Reviewed by WHO, EMT leaders and global professional bodies (ISPRM, WFOT, WCPT, ISCOS)

Key Standard: Staff

• At least one rehabilitation professional per

20 beds

• Outpatient facilities should be able to

provide basic rehabilitation care or refer

patients to an appropriate EMT or existing

local facility.

Key Standard: Layout and Accessibility

For deployments exceeding 3 weeks, allocation of a purpose-specific rehabilitation space of at least 12 m2;

Recommendations regarding latrines and accessibility.

Key Standard: Equipment

Deployment of EMTs with at least the essential rehabilitation equipment and consumables

• Pragmatic approach taken considering likely logistical constraints

• Self sufficient for first 2 weeks

• 6 wheelchairs and 30 pairs of crutches per 20 beds.

Key Standard: Reporting

Reporting of patients with notifiable injuries (spinal cord injury, lower limb amputation and complex fracture) to the ministry of health of the host country/coordination cell at stipulated intervals.

Key Standard: Discharge/Referral

• To ensure that referrals for rehabilitation are managed effectively, the patient and the referring EMT should both keep a copy of the referral, which should contain the following information, at a minimum:

–– required assistive devices provided;

–– functional status, including mobility and precautions; and –– requirements for follow-up with the referral team (e.g. for surgical review, removal of an external fixator or follow-up X-ray).

• EMTs should keep an updated list of all patients who

require rehabilitation follow-up after discharge or after the departure of the EMT and communicate the list to the host ministry of health/coordinating cell as requested.

Specialised Cell: Rehabilitation

• Embedded into an EMT or a local facility

• Length of stay minimum of 1 month or matches the team deployed into.

• Must either bring equipment or demonstrate an agreement for its provision.

• Must align their services with local practice and consider service provision after their departure.

Step Down Facilities

“An inpatient unit with a mandate to provide interim care for medically stable patients while preparing them for discharge into the community.”

• EMT transforms to step down at request of MoH

• Includes nursing and rehabilitation

• Minimum stay 3 months

Coordination

It is essential that EMTs do not duplicate existing rehabilitation services but rather integrate with and establish referral pathways to local service providers, where they exist.

Implications

• All Emergency Medical Teams should now offer early Rehabilitation

• They should also be better linked to local rehabilitation providers

• There should be better data on the number of injuries and rehabilitation needs earlier in the response

• Those wishing to travel as a rehabilitation provider must either work for a registered EMT or register as a specialised cell – and meet all the standards – training, equipment, length of stay…

Training

Clinical skills attained through accredited education, training,

practice and licensure

Accredited competency based

and culturally sensitive education

and training in adapting and

adjusting skills in a resource poor

setting

Accredited education and training in

humanitarian core competencies

Humanitarian Health Professional

Ecuador