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NHV model in disaster
rehabilitation Jianan LI, MD
Nanjing Medical UniversityNational team leader for disaster rehab, China
Honorary Chair of ISPRM-CRDR
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Lesson learnt from Sichuan earthquake
• Date: May 12, 2008
• Deaths/missing persons: 86,000
• Injured: 374,640;
• Severely injured: 11,000
• Direct economic loss: 100 billion US$
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Difficulties Massive damages
Blocked roads Lack of resources
Finance Rehab persons Facilities and
equipment Lack of coordination
Government Hospitals NGOs
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Severe complications
Poor wound management Poor operations High incidence of pressure sore Lack of knowledge in Crush
Syndrome Lack of systematic early rehab
intervention
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2008.5.12 Sichuan Earthquake Massive transfer and return
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2 month later post earthquake 10,000 injured victims return Sichuan Majority of them were dependent:
Internal fixation with fracture Imitated mobility Bed rest for SCI and TBI
Local rehab strength < 100 rehab physicians < 200 rehab therapists No rehab persons in the community
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Lesson: on site training course? 3 to 5 days training courses were
conducted more 40 times No person may practice after training It is not lack of guidelines, but
manpower in medical rehabilitation Local medical persons are also
victims
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Sichuan Model of disaster rehab What we need:
to establish a comprehensive rehab facility on-site of disaster zone: project with high efficiency, efficacy and sustainability.
How to organize: Non-government organizations: to
provide financial support Health department and hospital at
disaster zone: to provide basic facilities and some medical support
Volunteers in rehab: to provide manpower.
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VolunteersHealth departmentsNGOs
Financing Governance Health workforce
Chinese Association of Rehabilitation Medicine: Local Health Bureau/ Local Disabled Persons Federation
Rehabilitation Services
Capacity building Capacity building
Rehabilitation Medicine
Physical/Occupational therapy
Institutional based rehabilitation
Comm
unity based rehabilitation
Rehabilitation Psychology
Health: home visits, community adaption…
Livelihood
Social and empowerment
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VolunteersHealth departments
NGOs
Financing Governance Health workforce
Chinese Association of Rehabilitation Medicine, Local Health Bureau/ Local
Disabled Persons Federation
Rehabilitation Services
Capacity building Capacity building
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Rehabilitation Services
Rehabilitation Medicine
Physical/Occupational
therapy
Institutional based rehabilitation
Comm
unity based rehabilitation
Rehabilitation Psychology
Health
Livelihood
Social and empowerment
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NGO(CFCF)
LocalHospital
Health Bureau
DisabledPerson’sFederation
IBRCBR
HandicapInternational
PhysiatricianPT/NurseRehabequipment
Earthquake Survivors with SCI
NHV rehabilitation services programs
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Role of physiatrist
Organizer, coordinator, diagnosis, clinical management, planning,,,,,,
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3 year follow up in 2011 Outcome: 3324 severely injured
victims completed institutional rehab and return to community with high satisfaction.
Achievement: Department of rehab medicine established in the local hospitals and community based rehab service is gradually spread out.
Sustainability: Emphasis is shifting from medical rehab to social rehab.
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Method
Quality of Life
Demography
ASIA
Ability of Daily Living
Depression
Complication
Pain
On-site Survey
Walking Ability
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Demography Method
Quality of Life
ASIA
Ability of Daily Living
Depression
Complication
Pain
Walking Ability
WHO Quality of Life Assessment Instrument-Bref (WHOQOL-BREF) The most appropriate scale
for QOL of SCI patient
• Individual’s overall perception of QOL & health
• Domain: Physical Health/ Psychological/Social Relationship/ Environment
*Hill MR, Noonan VK, Sakakibara BM, Miller WC. Quality of life instruments and definitions in individualswith spinal cord injury: a systematic review. Spinal Cord. 2009
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Method
Quality of Life
ASIA
Ability of Daily Living
Depression
Complication
Pain
Walking Ability
Pressure Sore/ UTI / Cystolith / Neurogenic Bladder/ RectumImpairment of Renal Function …
Demography
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Method
Quality of Life
ASIA
Ability of Daily Living
Depression
Complication
Pain
Walking Ability
Visual Analogue Scale (VAS)
Demography
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Method
Quality of Life
ASIA
Ability of Daily Living
Depression
Complication
Pain
Walking AbilityModified Barthel Index (MBI)
Demography
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Method
Quality of Life
ASIA
Ability of Daily Living
Depression
Complication
Pain
Walking Ability
Walking Index for Spinal Cord Injury II
Demography
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Method
Quality of Life
ASIA
Ability of Daily Living
Depression
Complication
Pain
Walking AbilityPatient Health Questionnaire Depression Module (PHQ-9)
Demography
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AIS Above C7
C8-T6 T7-L2 L3-S2 BelowS2
Total Percentage
A 1 5 6 23.1%
B 2 2 7.60%
C 7 7 26.9%
D 3 5 1 2 11 42.3%
Total 3 1 19 1 2 26
Result Result
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Above C7 C8-T6 T7-L2 L3-S2
BelowS2 Total Percentage
Pain 3 1 19 1 2 26 100%New pressure
sore 1 10 1 12 46.2%
Neurogenic bladder 1 12 1 14 53.8%
Cystolith 2 2 7.69%Neurogenic
Rectum 1 8 2 11 42.3%
Heterotopic ossification 1 1 3.85%
Above C7 C8-T6 T7-L2 L3-S2
BelowS2 Total Percentage
Pain 3 1 19 1 2 26 100%New pressure
sore 1 10 1 12 46.2%
Neurogenic bladder 1 12 1 14 53.8%
Cystolith 2 2 7.69%Neurogenic
Bowel 1 8 2 11 42.3%
Heterotopic ossification 1 1 3.85%
Result
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4 year follow up in 2012
Outcome: few disabled people (1%). Depression and pain remain the major
complains Achievement:
Local rehab system built up (rehab capacity tripled) and rehab professionals increased 5 times more.
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HNV model Implementation: Lushan Earthquake in 2013 Time: 8 am, April 20, 2013 Immediate reaction post the
earthquake: 1 min: internet news 6 min: government announcement 18 min: on-site rescue started 28 min: army team arrived at
earthquake zone 120 min: provincial government leaders
arrived at the center zone of the earthquake
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Medical rescue and rehab 60 min: 5 national medical teams (180
people) 120 min: National medical consultant organized.
2nd Day: 183 medical teams (1427 people) arrived and medical rehab early intervention started. The ministry of health documents on principle of early rehab intervention and transferring standard.
3rd day: Medical rehabilitation wards established and local rehab resources are sufficient to deal with post earthquake rehab.
NHV model implemented in the earthquake zone.
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Outcome
Few disabled persons from disaster Local rehab service built up Community rehab service running
well NGO support efficiently
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Future trend? Role of international society? Role of rehab professionals? Volunteer team? Language? Culture and religion? Finance? Diplomatic issue? Safety?