Role of Rehabilitation Professionals in Early Rehabilitation in Disasters and Conflicts

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Introduction

What exactly is the role of rehabilitation professionals within disasters and conflicts and where do they fit in with the disaster management cycle? The International Federation of Red Cross & Red Crescent Societies defines disaster management, a continuum of four phases: preparedness, response, recovery and mitigation, as the organisation and management of resources and responsibilities for dealing with all the humanitarian aspects of emergencies, in order to lessen the impact of disasters. Although in practice each of the four phases often blends into the next, with no clear beginning or end.

 

Disaster Prevention

"The outright avoidance of adverse impacts of hazards and related disasters " 

UNISDR views Disaster Prevention as the concept of engaging in activities which intend to prevent or avoid potential adverse impacts through action taken in advance, activities designed to provide protection from the occurrence of disasters . WCPT similarly highlight that while not all disasters can be prevented, good risk management, evacuation plans, environmental planning and design standards can reduce risk of loss of life and injury mitigation. The HYOGO Framework was one such Global Plan for natural Disaster Risk Reduction, which was adopted in 2005 as a 10 year Global Plan, signed by agreement with 168 Governments which offered guiding principles, priorities for action and practical means for achieving disaster resilience for vulnerable communities .

Disaster Preparedness

"The knowledge and capacities developed by governments, professional response and recovery organizations, communities and individuals to effectively anticipate, respond to, and recover from, the impacts of likely, imminent or current hazard events or conditions" .

According to ICRC, Disaster Preparedness refers to measures taken to prepare for and reduce the effects of disasters, be they natural or man-made. This is achieved through research and planning in order to try to predict areas or regions that may be at risk of disaster and where possible prevent these from occurring and/or reduce the impact those disasters on the vulnerable populations that may be affected so they can effectively cope. Disaster preparedness activities embedded with risk reduction measures can prevent disaster situations and also result in saving maximum lives and livelihoods during any disaster situation, enabling the affected population to get back to normalcy within a short time period .

Minimisation of loss of life and damage to property through facilitation of effective disaster response and rehabilitation services when required. Preparedness is the main way of reducing the impact of disasters. Community-based preparedness and management should be a high priority in physical therapy practice management .

Rehabilitation professionals can make significant contributions to disaster management preparedness by being aware of any specific hazards and the vulnerability of their country/region, and the likely consequences of disasters that could occur. This should include consideration of likely specific disease or injury types, as well as response capacity and possible impact on existing healthcare services. Early rehabilitation should then be incorporated into the healthcare disaster management plan, ensuring an integrated response with clear roles for rehabilitation professionals from the outset and definitive referral pathways for patients.

Preparedness planning should take place on the level of the individual (personal), their place of work (organisational) and their locality (both regional and national). Mapping of human and institutional resources from across the rehabilitation sector is critical and aids a coordinated disaster response; it informs training needs and the prepositioning of equipment. One way to consider preparedness for early rehabilitation in emergencies incorporating each level is to consider it in terms of four domains: Staff, Stuff, Systems and Space:

Staff	Stuff	Systems	Space
Developed Personal Preparedness Plans Aware of Work Based Emergency Plans including evacuation Rapid Mobilisation in Emergency Trained to Manage Major Trauma as part of Team Know and Understand Role and the Roles of the Team	Stockpile of Equipment to manage immediate surges Wheelchairs Cruches Rollators Splints Dressing etc. Equipment and space available to create; Overflow Capacity Step Down Space	Local and National Health Emergency Management Plans include Rehabilitation Rehabilitation Services, Capacity and Providers Mapped Clinical Protocols in Place for Interdisciplinary Teams Agreed Data Management System for Measurement of Injury/Illness Type and Severity and not just Mortality Agreed Emergency Referral Pathways for Specific Conditions; Amputations Spinal Cord Injury Acquired Brain Injury Burns Agreed Methods for Rapid Needs and Capacity Assessment	Existing Rehabilitation Space would continue to function during identified hazards Overflow Identified Step down for stable patients to decompress acute wards Cohorting of certain patients

Disaster Response / Relief

"The provision of emergency services and public assistance during or immediately after a disaster in order to save lives, reduce health impacts, ensure public safety and meet the basic subsistence needs of the people affected" .

Focused predominantly on immediate and short-term needs, the division between this response/relief stage and the subsequent recovery stage is not clear-cut and can last from a few days to several months, and much longer in many conflicts.. Some response actions, such as the supply of temporary housing and water supplies, may extend well into the recovery stage. Rescue from immediate danger and stabilization of the physical and emotional condition of survivors is the primary aims of disaster response/relief, which go hand in hand with the recovery of the dead and the restoration of essential services such as water and power . 

Coordinated multi-agency response is vital to this stage of Disaster Management in order to reduce the impact of a disaster and its long-term results with relief activities including :

• Rescue
• Relocation
• Provision Food and Water
• Provision Emergency Health Care
• Prevention of Disease and Disability
• Repairing Vital Services e.g. Telecommunications, Transport
• Provision Temporary Shelter

The role of rehabilitation professionals in this phase will be dependent on the nature and scale of emergency, the experience and training of individuals, as well as local health and rehabilitation infrastructure. A good example of this is that Physical and occupational therapists were involved in the response to the Nepalese Earthquake of 2015 from the initial few hours as a result of rehabilitation being appropriately embedded into trauma emergency plans.

Rehabilitation Professional Responsibilities in the initial response may include:

• Early rehabilitation for those with injuries or illness
• Assessing, advising, fitting and providing assistive devices, as well as providing training on their use and maintenance
• Rapidly discharging existing patients to free up bed space for incoming acute patients
• Providing guidance and education to patients, carers and other healthcare professionals
• Coordinating discharge, onward referrals and follow-up of patients once they leave healthcare facilities
• Assessing environments and environmental adaptations needed to ensure accessibility

Additional responsibilities are context specific, and specific to the skills and experience of individuals and can include:

• Conducting rehabilitation needs assessments in the disaster context, mapping available resources and gaps and coordinating an integrated rehabilitation response at either local or national level
• Triage
• Providing basic psychosocial support, such as psychological first aid, or onward referral to appropriate services
• Identifying and assessing people with specific vulnerabilities (such as age, gender or disability) who may find it harder to access services or receive support
• Rapid on-the-job training of rehabilitation colleagues in more specialised areas (such as spinal cord injuries)
• Rapid training of community workers, or other professionals or organisations, to identify people with a disability and others in need of rehabilitation
• In the absence of rehabilitation assistants – training healthcare workers to perform tasks traditionally carried out by rehabilitation assistants
• Advocating for quality rehabilitation provision and basic needs for those injured, at organisation, local and national levels – including use of injury-specific data
• Ensuring inclusion of injured people and people with disabilities in the emergency response and recovery phases (specifically considering long-term service provision, education, livelihood, shelter and accessibility)

Disaster Recovery

Vulnerability of communities often continues for long after the initial crisis is over. Disaster Recovery refers to those programmes which go beyond the provision of immediate relief to assist those who have suffered the full impact of a disaster and include the following activities  :

• Rebuilding Infrastructure e.g. Homes, Schools, Hospitals, Roads
• Health Care and Rehabilitation
• Development Activities e.g. building human resources for health
• Development Policies and Practices to avoid or mitigate similar situations in future

• Disaster Management - How Individual Physical Therapists Can Contribute 

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 Dont's” which are exemplified 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.
	'Health Care in Danger: The Responsibilities of Health-Care Personnel Working in Armed Conflicts and 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.
	Minimum Technical Standards and Recommendations for Rehabilitation: This document is the result of collaboration between a working group of rehabilitation experts convened by WHO and external consultations. It is thus based on collective experience in rehabilitation during responses to recent large-scale emergencies and also on published data. 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. The standards and recommendations given in this document will ensure that EMTs, both national and international, will better prevent patient complications and ensuing impairment and ensure a continuum of care beyond their departure from the affected area.
	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.
	Management of Limb Injuries in Disaster and Conflict - A Field Manual The consensus-based Field Guide, Management of Limb Injuries during disasters and conflicts and the complementary open-access online resources gathered here are aimed at providing that guidance. It draws on the expertise of the International Committee of the Red Cross, which has a long history of delivering care to patients and protecting them in conflict. This field guide will be regularly updated as new controversies are raised and evidence grows.

Resources

The WCPT provide a comprehensive set of resources relating to disaster management, the role of the physiotherapy profession, advice for volunteering and the existing organisations involved:

• WCPT Disaster Management Resources

References