Management of Traumatic Brain Injury in Disaster Situations

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Original Editor - Naomi O'Reilly

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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 here. (Link to Types of Disaster Management on https://physio-pedia.com/Disaster_Management)

Not surprisingly, given the kinetic energy released by rapid- onset natural disasters, such events typically cause a variety of traumatic injuries due to overpressure, penetrating wounds, and crushing including mild, moderate, and severe traumatic brain injury (TBI) to individuals in the spatial domain impacted by a natural disaster. In fact, neurotrauma comprises a major risk factor for mortality and morbidity outcomes that are directly attributable to rapid-onset natural disasters.

The prevention and treatment of traumatic brain injury (TBI) attributable to rapid-onset natural disasters is a major challenge confronting disaster preparedness planners and emer- gency medical personnel responding to those incidents. The kinetic energy released by rapid-onset natural disasters such as earthquakes, hurricanes or typhoons, and tornadoes can cause mild, moderate, or severe TBIs. As a result, neurotrauma is a major risk factor for mortality and morbidity outcomes within the spatial domain impacted by a rapid-onset natural disaster.

Immediate Emergency Care

Considerations for Rehabilitation after Traumatic Brain Injury in Disasters

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 after 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

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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 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. 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.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.

'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
• 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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