FOCUS ON – Rehabilitation in emergencies, a clear priority | April 20, 2016

Disasters are an increasing global problem, affecting more and more people, but the world is also getting better at preparing for and responding to them. As part of this improvement, national and international medical responses are getting better – they are reaching people faster, providing better care and are better coordinated. A need to scale […]

Disasters are an increasing global problem, affecting more and more people, but the world is also getting better at preparing for and responding to them. As part of this improvement, national and international medical responses are getting better – they are reaching people faster, providing better care and are better coordinated.

A need to scale up rehabilitation in disaster response

As a result of this of this improved response, we might logically expect to see less injuries requiring rehabilitation, but it seems likely we will first see a period of time where the opposite is true – a better medical response will actually mean more people surviving disasters with life changing injuries. To date though, rehabilitation services in many disaster-prone countries remain poorly developed and under-resourced.

© Lucas Veuve/Handicap International
© Lucas Veuve/Handicap International

With the exception of work by international organisations such as Handicap International, emergency medical responses in disasters are rarely accompanied by a rapid scale up of a rehabilitation response.

Imagine you have been injured in an earthquake – perhaps you have lost a limb, been paralysed, or find yourself unable to walk or use your arm. You might also have lost your home, your livelihood or even your family. Emergency medical care might have saved your life, but your immediate thoughts are likely to be around what happens next – How are you going to care for yourself? Will you walk again? Will you be able to work or study? How will you work to support your family? If you are a child, will you be able to go back to school?

The importance of providing rehabilitation in disasters has long been clear to those either providing or receiving it, but many health care providers often don’t see it as a priority. It can sometimes be treated as an afterthought by those planning or coordinating emergency responses. Thankfully though, this is now changing, and there is growing international consensus that rehabilitation should be included as a central part of humanitarian responses.

Global Guidance on Rehabilitation in Emergencies

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There is more and more guidance available to support rehabilitation professionals interested in responding to disasters at home or abroad.

The World Confederation of Physical Therapists recently published a guide on the role of physical therapists in disaster management, the World Federation of Occupational Therapists also has guidance available for occupational therapists, and the International Society of Physical and Rehabilitation Medicine have a resource page.

Finally, a Do’s and Don’ts in emergencies guide, endorsed by all of the global professional rehabilitation societies is being launched this week. The guide is available here.

Rehabilitation professionals are also finally being integrated into international emergency medical teams. For the past 3 years, Handicap International has been training rehabilitation professionals to work as part of the UK Emergency Medical Team, ensuring that early rehabilitation is available to people injured in disasters. As part of this process they have worked with a range of different organisations to develop accompanying clinical training manual aimed at rehabilitation professionals.

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The Inclusion of Rehabilitation in Core Humanitarian Guidance

The Sphere Handbook, the core text for humanitarian responders, says that early rehabilitation can greatly increase survival and enhance the quality of life for injured survivors.

The World Health Organisation has published a Classification and Minimum Standards for Emergency Medical Teams. This states that “Rehabilitation is one of the core functions of trauma care systems in regular healthcare, and [Emergency Medical Teams] should have specific plans for the provision of rehabilitation services to their patients post sudden onset disaster.”

The Humanitarian Action Summit report on best practice in surgical responses in disasters includes rehabilitation as an essential part of the spectrum of care for those injured.

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Handicap International’s recommendations

It is clear that there is more and more guidance available that supports the inclusion of rehabilitation in disaster responses. This now needs to result in practical action:

  • To be most effective, the inclusion of rehabilitation professionals in disaster management must begin on a national level before a disaster strikes, with the integration of rehabilitation and follow up care into hospital, regional and national planning.
  • Steps need to be taken to ensure that rehabilitation professionals in disaster prone countries have the skills, equipment and support they need to be able to work effectively as part of a national response when a disaster occurs.
  • Emergency Medical Teams that will be providing inpatient care need to include rehabilitation professionals and essential equipment as part of their teams.
  • Disaster management plans should not just focus on those people with injuries – people with disability are also placed at increased risk when a disaster strikes, and need special attention to make sure they aren’t further disadvantaged by its impact.

Written by Peter Skelton, Physiotherapist and Rehabilitation Project Manager, in Handicap International.

 


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