Management of Traumatic Brain Injury in Disaster Situations: Difference between revisions
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== Introduction == | == Introduction == | ||
Disaster, as defined by the [http://www.unisdr.org/we/inform/terminology 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.<ref | Disaster, as defined by the [http://www.unisdr.org/we/inform/terminology 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.<ref>United Nations Office for Disaster Risk Reduction. Terminology. http://www.unisdr.org/we/inform/terminology#letter-p [Accessed 29 Sep 2019]</ref> According to the [http://www.ifrc.org/en/what-we-do/disaster-management/about-disasters/what-is-a-disaster/ 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. <ref name="p2">International Federation of Red Cross and Red Crescent Societies. What is a Disaster. http://www.ifrc.org/en/what-we-do/disaster-management/about-disasters/what-is-a-disaster/. [Accessed: 9 Jan 2017]</ref> 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. <ref>Leaning J, Guha-Sapir D. [http://www.nejm.org/doi/full/10.1056/nejmra1109877#t=article Natural Disasters, Armed Conflict, and Public Health]. New England Journal of Medicine. 2013 Nov 7;369(19):1836-42</ref> Find out more about the different [https://www.physio-pedia.com/Disaster_Management#Types_of_Disaster types of disasters] and [[Disaster Management|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. | 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. | ||
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== Rehabilitation == | == 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; | 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; <ref name=":0">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.</ref> | ||
* Cognitive and Neurological changes should be monitored and regularly assessed | * 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 | * Early referral to a step-down facility using local rehabilitation providers and support networks, as required | ||
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* Patients with long term or permanent nerve injury considered for orthotic device, sought from a local 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 | * Referral pathways identified for microsurgery for appropriate patients | ||
< | Rehabilitation is a vital element of the treatment and management process post traumatic brain injury in a disaster setting and should prepare individuals with long-term impairment, their care providers and local rehabilitation personnel to manage their ongoing needs over a longer term. Rehabilitation aims to improve functional outcomes, minimize complications, and educate patient / caregivers and should be started early following any disaster. <ref name=":0" /> | ||
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== Disaster Management Guidelines == | |||
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[http://www.wfot.org/Portals/0/PDF/2016/Dos%20and%20Donts%20in%20Disasters%20April%202016.pdf '''Responding Internationally to Disasters: Do’s and Don’ts'''] | [http://www.wfot.org/Portals/0/PDF/2016/Dos%20and%20Donts%20in%20Disasters%20April%202016.pdf '''Responding Internationally to Disasters: Do’s and Don’ts'''] | ||
[[File:Dos_and_Donts_in_Disasters_April_2016.jpg|left|198x198px]]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. | [[File:Dos_and_Donts_in_Disasters_April_2016.jpg|left|198x198px]]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. |
Revision as of 01:34, 3 October 2019
Original Editor - Naomi O'Reilly
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Introduction[edit | edit source]
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.[1] 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. [2] 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. [3] 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[edit | edit source]
Rehabilitation[edit | edit source]
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; [4]
- 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
Rehabilitation is a vital element of the treatment and management process post traumatic brain injury in a disaster setting and should prepare individuals with long-term impairment, their care providers and local rehabilitation personnel to manage their ongoing needs over a longer term. Rehabilitation aims to improve functional outcomes, minimize complications, and educate patient / caregivers and should be started early following any disaster. [4]
Sub Heading 2[edit | edit source]
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Disaster Management Guidelines[edit | edit source]
Rehabilitation Interventions | General Applicability of Recommendations in Disaster Settings | ||
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Weak | Moderate | Strong | |
Patient Education |
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Gait, Balance and Mobility |
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Task-Specific Training
Repetitive Training |
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Spasticity and Muscle Tone |
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Sleep Disturbance Management |
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Cognitive Rehabilitation |
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Behavioural and Emotional Disorders |
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Comprehensive Neurobehavioural Program
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Activities of Daily Living |
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Post-Traumatic Headache Management |
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Service Delivery |
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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.
Rehabilitation in Sudden Onset Disasters
Communicable Disease Control in Emergencies - A Field Manual
Resources[edit | edit source]
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[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ United Nations Office for Disaster Risk Reduction. Terminology. http://www.unisdr.org/we/inform/terminology#letter-p [Accessed 29 Sep 2019]
- ↑ International Federation of Red Cross and Red Crescent Societies. What is a Disaster. http://www.ifrc.org/en/what-we-do/disaster-management/about-disasters/what-is-a-disaster/. [Accessed: 9 Jan 2017]
- ↑ Leaning J, Guha-Sapir D. Natural Disasters, Armed Conflict, and Public Health. New England Journal of Medicine. 2013 Nov 7;369(19):1836-42
- ↑ 4.0 4.1 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.