Emergency Medical Teams in Disasters and Conflicts

Original Editors -  Naomi O'Reilly

Top Contributors - Naomi O'Reilly, Kim Jackson, Tarina van der Stockt and Rishika Babburu      

Introduction[edit | edit source]

Emergency Medical Teams (EMT), now considered a vital aspect of the global health workforce, are teams of health professionals (doctors, nurses, physiotherapists, occupational therapists, psychologists, paramedics, etc.) that provide direct clinical care to people affected by disasters and conflicts and support local health systems. Any team of health professionals now coming from another country to practice health care in disaster or conflict settings needs to arrive as part of a team, which must be qualified, trained, and bring equipment and supplies to deliver an effective response rather than imposing a burden on the national system. EMTs must strive for self-sufficiency, providing a quality of care that is appropriate for the context, with credentials that meet a minimum acceptable standard. Traditionally, these teams have been focused on the management of trauma and surgical care, but the response to the Ebola outbreak demonstrated the value in other contexts, such as epidemics and complex emergencies.[1]

EMT response can be both National and International from Governments (civil protection and military), Non-governmental Organizations (NGOs), International Humanitarian Networks (International Red Cross and Red Crescent Movement, Médecins sans Frontières), United Nations Contracted teams, and Private-for-Profit Sector.[2]

EMT Initiative[edit | edit source]

Significant lessons were learned about Foreign Medical Teams / Field Hospitals in the aftermath of Sudden-Onset Disasters following the catastrophic Haiti Earthquake in 2010, promoting the collaboration of experts convened by the Pan American Health Organisation (PAHO) to initiate the development of principles, criteria, and standards for foreign medical teams. This work formed the basis for the Classification and Minimum Standards for Foreign Medical Teams in Sudden Onset Disasters [3] launched in May 2013, that was first used successfully to mobilise and coordinate the deployment of 151 medical teams by the Philippines Department of Health following Typhoon Haiyan in the Central Philippines Archipelago in November 2013. This further led to the development of the EMT Initiative [4], in alignment with the International Health Regulations (2005), which requires the Member States to develop certain minimum public health capacities to “detect, assess, notify and report events” and to “respond promptly and effectively to public health risks and public health emergencies of international concern”.[2] This was further strengthened with the development of the establishment of the Emergency Medical Teams Strategic Advisory Group (SAG) following the EMT Global Meeting in Panama in December 2015. [5]

Figure.1 Emergency Medical Team Initiative Timeline


Implemented through the World Health Organisation Global Secretariat and its Regional Secretariats for Africa, Americas, South-East Asia, Europe, Eastern Mediterranean and Western Pacific, a key focus of the EMT Initiative is the development of national teams, that can be deployed in the shortest time possible, with the utilisation of international teams key role to supplement and support local teams. The purpose of the EMT initiative is to improve the timeliness and quality of health services provided by national and international Emergency Medical Teams and enhance the capacity of national health systems in leading the activation and coordination of this response in the immediate aftermath of a disaster, outbreak and/or other emergencies, with public health expertise and logistics support either included in the team or separately as specific public health or logistics rapid response teams. [4]

The EMT Initiative also requires that all teams and their members are:

  • licensed to practice in their home country;
  • specialists in their field and have suitable malpractice insurance; and
  • registered (and obtain licensing) with national authority and lead international agency.

EMT Classification and Standards[edit | edit source]

Launched in 2016 the EMT Global Classification Process, outlined in the World Health Organisation Classification and Minimum Standards for Emergency Medical Teams is an external peer review evaluation mechanism that assesses EMT compliance against internationally agreed to guide principles and core and technical standards, to improve the quality of care and professionalism during EMT deployments. This benefits the populations served by ensuring EMTs arrive promptly, are well trained, and most importantly integrated within local health systems. With national health systems increasingly adopting the EMT Minimum Standards and Principles, Governments can be assured of a predictable and timely response by self-sufficient teams with well-trained health personnel.[2]   

The process involves submission of an expression of interest by EMTs to join the World Health Organisation Global EMT List, followed by a mentor-supported external peer-review process to support the team towards meeting the international minimum standards and achieving quality assurance. To date, 26 teams have been classified with over 70 teams now working towards classification, with five different team structures.

Table.1 Types of Emergency Medical Teams[6]
Type Description Capacity Minimum Length of Stay
Type 1 Mobile Mobile Outpatient Units

Teams to access the smallest communities in remote areas

>50 patients per day 2 Weeks
Type 1 Fixed Outpatient facilities with or without tented structure >100 patients per day 2 Weeks
Type 2 Inpatient Facilities with Surgery > 100 outpatients

20 inpatients

7 major operations or

15 minor operations a day

3 Weeks
Type 3 Referral Leave Care

Inpatient Facilities

High Dependency

Surgery

> 100 outpatients

40 inpatients, including;

4–6 intensive care beds

15 major operations per day

30 minor operations per day

4 - 6 Weeks
Specialised Care Team Teams that can join local facilities or EMTs to provide supplementary specialist care Variable Variable

EMT Minimal Technical Standards and Recommendations for Rehabilitation[edit | edit source]

The Minimum Technical Standards and Recommendations for Rehabilitation: Emergency Medical Teams were developed to further outline and extend the scope of the minimum standards for rehabilitation in emergencies proposed in the original Classification and Minimum Standards for Foreign Medical Teams in Sudden Onset Disasters document. These standards and recommendations are for use in the context of significant, acute traumatic injury and a surge of related health needs following sudden-onset disasters, such as earthquakes, tsunamis, and cyclones, but also applicable to complex or conflict emergency response, although the patterns of injury, disease, and rehabilitation needs in these situations may be very different.[2]

The priority of EMTs are to save lives and prevent impairment and associated disability, which is reflected in the Technical Standards, which acknowledge the importance of continuing sustainable care for patient outcomes and most importantly referral to and strengthening of local services, that ensure appropriate and efficient patient flow.[1]

The minimal technical standards and recommendations for rehabilitation in EMTs are outlined below;

Minimum Technical Standards[edit | edit source]

Table.2 Minimum Technical Standards for Rehabilitation in Emergency Medical Teams
Type 1 Type 2 Type 3 Specialised Team
Team Configuration
  • At least basic outpatient rehabilitation is recommended for fixed and mobile type 1 EMTs.
  • At least one rehabilitation professional per 20 beds.
  • Number should be increased in accordance with need.
  • At least three rehabilitation professionals.
  • Multidisciplinary
  • Include at least one physiotherapist as well as at another rehabilitation discipline(s) (e.g. occupational therapy, physiatry, and/or rehabilitation nursing).
Qualifications and Experience
  • At least a bachelor’s degree or equivalent in their respective discipline
  • At least three years experience in trauma injury rehabilitation.
  • At least one team member should have experience in emergency response
  • All team members should have undergone training in working in austere environments.
Equipment and Consumables Deploy with the list of recommended rehabilitation equipment for Type 1 EMTs
  • Deploy with at least the minimum rehabilitation equipment and consumables listed
  • Quantity sufficient to be self-sufficient for at least two weeks.
  • Should have the capability to rapidly provide rehabilitation equipment such as
Rehabilitation Space Not Applicable Allocation of rehabilitation space is recommended, especially for Type 2 teams intending to remain for three weeks or longer.
  • Should allocate space for rehabilitation of at least 12 sq m within their facility.
Length of Stay 2 Weeks 3 Weeks 4 -6 Weeks
  • A specialist team that embeds into an EMT should stay for the minimum length of stay of that EMT.
  • A specialist team that embeds into a local facility should plan to stay for at least one month.
Rehabilitation Research
  • If research is being undertaken during deployment, the EMT should maintain all professional, institutional and national ethical standards for research with human participants.

Recommendations for Optimal Care[edit | edit source]

Rehabilitation Workforce[edit | edit source]

Table.2 Rehabilitation Workforce - Recommendations for Optimal Care
Recommendations for Optimal Patient Care
Skill Requirements Rehabilitation Professionals should;
  • Be experienced in trauma and medical rehabilitation.
  • Comply with requirements in the home country
  • Work within their Scope of Practice
  • Early rehabilitation professionals deployed in the initial 2 weeks of response should have at minimum 2 years clinical experience or more if working in a specialist team
  • Minimum stay of 3 weeks recommended ensuring continuity of care and efficient handover
  • Consistency in treatment approaches through the use of guidelines, protocols and common pre-deployment training.
Team Configuration
  • Type 1 EMTs should consider including rehabilitation personnel
  • Type 2 & 3 EMTs should strengthen rehabilitation capacity by deploying additional rehabilitation professionals or recruiting local personnel.
  • Rehabilitation nursing with trauma experience should be used to augment the rehabilitation capability of EMTs.
Multidisciplinary Practice
  • Multidisciplinary practice and patient-centred care should be incorporated and emphasised in all pre-deployment and ongoing training
  • EMTs should utilise a multidisciplinary team approach with rehabilitation professionals involved in daily ward rounds and consultations.
  • Rehabilitation professionals should be involved in the referral and discharge planning of any patient with significant functional limitations.

Resources[edit | edit source]

World Health Organisation Emergency Medical Teams Initiative

Classification and Minimum Standards for Foreign Medical Teams in Sudden Onset Disasters, World Health Organisation

Minimum Technical Standards and Recommendations for Rehabilitation: Emergency Medical Teams, World Health Organisation

A Guidance Document for Medical Teams Responding to Health Emergencies in Armed Conflicts and Other Insecure Environments, World Health Organisation

References [edit | edit source]

  1. 1.0 1.1 World Health Organization (WHO). Minimum Technical Standards and Recommendations for Rehabilitation–Emergency Medical Teams. 2016. Available from: https://resources.relabhs.org/resource/minimum-technical-standards-and-recommendations-for-rehabilitation-in-emergency-medical-teams/ [Accessed 26th February 2022]
  2. 2.0 2.1 2.2 2.3 World Health Organization (WHO). Classification and Minimum Standards for Emergency Medical Teams. 2021 Available from: https://apps.who.int/iris/handle/10665/341857 [Accessed 25th February 2022]
  3. World Health Organization (WHO). Classification and Minimum Standards for Foreign Medical Teams in Sudden Onset Disasters. 2013. Available from: https://www.who.int/publications/i/item/classification-and-minimum-standards-for-foreign-medical-teams-in-sudden-onset-of-disasters [Accessed on 25th February 2022]
  4. 4.0 4.1 World Health Organisation (WHO). Emergency Medical Teams Initiative. Available from: https://extranet.who.int/emt/ [Accessed 28 February 2022]
  5. World Health Organisation (WHO). Strategic Advisory Group. Available from: https://extranet.who.int/emt/Global_Structures/32 [Accessed on 24th February 2022]
  6. Lathia C, Skelton P, Clift Z. Early rehabilitation in conflicts and disasters. Handicap International: London, UK. 2020.