Management of Traumatic Brain Injury in Disaster Situations

Original Editor - Naomi O'Reilly

Top Contributors - Naomi O'Reilly, Kim Jackson, Tony Lowe, Rachael Lowe, Jess Bell and Admin  

Introduction

Disaster, as defined by the United Nations, is a serious disruption of the functioning of a community or society, which involve widespread human, material, economic or environmental impacts that exceed the ability of the affected community or society to cope using its own resources. According to the International Federation of Red Cross & Red Crescent Societies a disaster occurs when a hazard impacts on vulnerable people. The combination of hazards, vulnerability and inability to reduce the potential negative consequences of risk results in the disaster.  While disasters can be caused by nature, the human influence on disasters have been widespread throughout the centuries, particularly in relation to conflict situations. Natural disasters and armed conflict are two of the main types of disasters and have marked human existence throughout history resulting in peaks in mortality and morbidity. Find out more about the different types of disasters and disaster management.

A wide variety of mild, moderate, and severe traumatic brain injury occur secondary to overpressure, penetrating wounds, and crush injuries following the huge kinetic energy released by rapid-onset natural disasters. Disaster preparedness planners and emergency medical personnel face a major challenge in preventing and managing neurotrauma within this context.

Immediate Emergency Care

Rehabilitation

The World Health Organization (WHO) has developed Emergency Response Frameworks (Standards and Guidelines), which through the Emergency Medical Team Rehabilitation Group have identified the following minimum technical standards and recommendations for rehabilitation following a traumatic brain injury in disasters;

• Cognitive and Neurological changes should be monitored and regularly assessed
• Early referral to a step-down facility using local rehabilitation providers and support networks, as required
• Appropriate mobility aids prescribed for long-term mobility deficits using local service provider
• Patients with long term or permanent nerve injury considered for orthotic device, sought from a local provider
• Referral pathways identified for microsurgery for appropriate patients

Physiotherapy Rehabilitation Interventions	General Applicability of Recommendations in Disaster Settings
	Weak	Moderate	Strong
Patient Education			Traumatic Brain Injury Education Management of Traumatic Brain Injury Simple Rehabilitation Interventions  Social Support Services Prognosis Short-Term Outcomes Long-Term Outcomes
Gait, Balance and Mobility	Treadmill Training With Body Weight Support Without Body Weight Support Computer-based Interventions	Task-Specific Training Repetitive Training	Conventional Overground Training  Mobility aids
Spasticity and Muscle Tone	Special Seating Special Positioning Devices Botulinum Toxin Injection Therapeutic Nerve Block Motor Point Block Functional Electrical Stimulation Intrathecal Baclofen Surgery	Oral Anti-Spasticity Medications	Education and Therapy Active Control Force Production Functional Muscle Training Simple Splints  Casts Simple Orthoses
Sleep Disturbance Management			Sleep Education Physical Activity Relaxation Therapy Modifications Sleep Environment Psychological Interventions Dietary Modification
Cognitive Rehabilitation	Assistive Technology  Structured Experiments Game Formats Computer-based Treatment	Behavioral Interventions  Internal Strategies Memory Training Attention Strategy Training  Meta-Cognitive Strategies  Visuospatial Skills Training	Basic Compensatory Memory Strategies Direct Feedback External Aids Learning Techniques Group Therapy Psychology Interventions
Behavioural and Emotional Disorders	Social Skills Training Peer Mentoring Program	Comprehensive Neurobehavioural Program Contingency Management Positive Behavioral Program	Physiotherapy Functional Skills Training Sleep Education Cognitive Behavioral Therapy Individual Education Family therapy Group Therapy
Activities of Daily Living	Home Assessment and Modifications Environmental Assessment and Modifications	Constraint Induced Movement Therapy Adaptive Equipment	Guided Practice in ADLs Equipment Training Caregiver Training
Post-Traumatic Headache Management	Biofeedback  Acupuncture		Physical Activity Relaxation Therapy Sleep Education Dietary Modification Psychological Interventions
Service Delivery	Social Skills Training	Behavioral Intervention  Peer Mentoring Program  Telemedicine	Inpatient Rehabilitation Program  Home / Community Based Rehabilitation Family and Carers Support

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Disaster Management Guidelines

Responding Internationally to Disasters: Do’s and Don’ts

When disasters strike, there is always a huge amount of goodwill from rehabilitation professionals around the world who wish to use their skills to support those affected. This brief guidance informs those who are considering responding internationally to a disaster either as individuals or as part of a team. It highlights key questions to consider before departing, whilst working in the disaster area, and on returning home. Responses to these questions considered are presented as “Do’s and Don’ts” which are exempli ed by recommended practices and those to avoid in the real case studies below. The guidance note is not intended to be a step-by-step or technical guide, nor is it exhaustive, and does not supersede any specific guidance provided by your own global professional body.

Minimum Technical Standards and Recommendations for Rehabilitation: Emergency Medical Teams

This document is the result of collaboration between a working group of rehabilitation experts convened by the World Health Organization and external consultations. It is thus based on a collective experience in rehabilitation during responses to recent large-scale emergencies and also on published data. In time, the minimum standards for rehabilitation in emergencies will be part of a broader series of publications based on the Classification and Minimum Standards for Foreign Medical Teams in Sudden Onset Disaster. The purpose of this document is to extend these standards for physical rehabilitation and provide guidance to Emergency Medical Teams (EMTs) on building or strengthening their capacity for and work in rehabilitation within defined coordination mechanisms.

Health Care in Danger: Responsibilities of Health-Care Personnel Working in Armed Conflicts & Other Emergencies

A Guidance Document in simple language for health personnel, setting out their rights and responsibilities in conflict and other situations of violence. It explains how responsibilities and rights for health personnel can be derived from international humanitarian law, human rights law and medical ethics.The document gives practical guidance on: the Protection of Health Personnel, the Sick and the Wounded, Standards of Practice, the Health Needs of Particularly Vulnerable People, Health records and transmission of medical records, Imported Health Care including Military Health Care, Data Gathering and Health Personnel as witnesses to violations of International Law and Working with the Media

Rehabilitation in Sudden Onset Disasters

The role of rehabilitation professionals in responding to sudden onset disasters, such as earthquakes or tsunamis, is evolving rapidly, and they increasingly find themselves at the forefront of emergency response teams. This manual is designed for Physiotherapists and Occupational Therapists who provide rehabilitation in the immediate aftermath of a sudden onset disaster. It was developed to support volunteers on the UK International Emergency Trauma Register, but with the aim of being relevant to all rehabilitation professionals interested in rapid deployment to austere environments.

Communicable Disease Control in Emergencies - A Field Manual

This manual is intended to help health professionals and public health coordinators working in emergency situations prevent, detect and control the major communicable diseases encountered by affected populations.

Resources

International Society of Physical and Rehabilitation Medicine: Disaster Rehabilitation Committee - Role and future agenda Sept 2018

Centers for Disease Control and Prevention, Brain Injuries and Disaster Events Information for Clinicians - List of useful organisations and links

Lee SY, Amatya B, Judson R, Truesdale M, Reinhardt JD, Uddin T, Xiong XH, Khan F. Applicability of traumatic brain injury rehabilitation interventions in natural disaster settings. Brain injury. 2019 Aug 24;33(10):1293-8.

"Many recommendations for TBI care are challenging to implement in disaster settings due to complexities related to the environment, resources, service provision, workforce, and other reasons"

Amatya B, Vasudevan V, Zhang N, Chopra S, Astrakhantseva I, Khan F. Minimum technical standards and recommendations for traumatic brain injury rehabilitation teams in sudden-onset disasters. The Journal of the International Society of Physical and Rehabilitation Medicine. 2018 Apr 1;1(2):72.

"Specialized rehabilitation teams in any disasters are deployed based on the response to meet specific needs required at the request of the host health authorities. These teams should be multidisciplinary and need to be integrated into a disaster response and management plan and their skills need to be shared with local rehabilitation and health-care providers through mentoring and educating/training."

Vasudevan V, Amatya B, Chopra S, Zhang N, Astrakhantseva I, Khan F. Minimum technical standards and recommendations for traumatic brain injury specialist rehabilitation teams in sudden-onset disasters (for Disaster Rehabilitation Committee special session). Annals of Physical and Rehabilitation Medicine. 2018 Jul 1;61:e120.

Regens JL, Mould N. Prevention and treatment of traumatic brain injury due to rapid-onset natural disasters. Frontiers in public health. 2014 Apr 14;2:28

Battlefield and Disaster Nursing Pocket Guide, Ed. by Elizabeth Bridges. Jones & Bartlett, 2009 - guidelines for managing mild through to severe TBI injuries

Veenema TG, editor. Disaster nursing and emergency preparedness. Springer Publishing Company; 2018 Jul 28.

Military Acute Concussion Evaluation 2 (MACE 2)

3 question DVBIC TBI screening tool

Joint Trauma System Clinical Practice Guideline: Neurosurgery and Severe Head Injury (CPG ID:30), Mar 2017

References

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