A147 the emerging and rapidly evolving role of rehabilitation professionals in disaster management

1. TheEvolving Role ofRehabilitation
Professionals in Disaster
Management
Peter Skelton, BSc, MSc
Technical Advisor, Handicap International and
the UK Emergency Medical Team

7. 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

8. 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.

9. New Guidance…

13. 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…

14. 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

16. 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)

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

22. 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.

23. 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

24. 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.

25. 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…

26. 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

32. Ecuador