riwc_para_a147 the emerging and rapidly evolving role of rehabilitation professionals in disaster...
TRANSCRIPT
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