Role of PRM doctors and therapists interacting with NGO's in disaster relief and challenging settings : Handicap International perspective. Presenter : Susanne Nielsen, PT Authors : Jacquemin Geraldine, MD, FRCPC, MPH Eric Weerts, Technical Referent Handicap International 1 Rehab Disaster Relief Symposium: Where is rehabilitation disaster relief going? 19 th June 2013

Why is this topic of interest?  An increase of involvement of rehabilitation professionals in the aftermath of disasters  Need for specialised human resources on the field  Address the complexities  Better scientific documentation 2

Unique needs for PRM 3  Interdisciplinary approach in emergency context must start early as possible  Coordination of care activities  Local health and rehabilitation staff needs training in PRM concepts  Anticipation of long term needs of severely injured survivors

Handicap International’s work in disaster context 4

Disaster Relief: Where do HI intervene 5

 Sudden onset of natural phenomenon such as tropical storms, tsunamis, earthquakes, etc  Armed conflicts with high number of injured victims  General population affected indirectly by man- made conflicts  Disaster / conflict setting that can not cope with the needs to care for the victims 6

Field conditions: Starting up a rehabilitation program in an emergency context 7

Field conditions  Logistics and security frame work  Set up of local partnership ASAP to operate in the best legal conditions possible  Transport and access to trauma care units with a clear mandate and visibility prepared by the organization  Formulated terms of reference that describe the task required for the PRM 8

Basic Roles for PRM Ensure global and long term approach Act as a link between surgical/acute and rehab teams Assess in-depth the medical aspects of rehabilitation medicine Provide direct technical assistance in constituting adapted protocols that allow physical rehabilitation programs to function optimally within the context 9

Role of PRM in the transfer of knowledge 10

11 Participate in training of rehab team and non rehab staff Direct assistance in care techniques not known by the mainstream trauma team Management of complex trauma cases Assist team in diagnosis of complicated cases

Needed profile and skills of PRM 12

Skills and knowledge +/- PRM with practical record in the field of severe trauma : amputations, neuro trauma, poly trauma Senior provider of knowledge and insight in rehabilitation medicine Team management skills Understanding and skills of project / activity management Ability to connect the missing links in the clinical information that is available to them at the moment of intervention and within the context Ability to enhance and predict as early as possible the needed rehabilitation pathway for the patient and patient groups. 13

Skills and knowledge – cont.+/- For the continuum of care the PRM needs the ability to be the key provider of information, background information and supervision of this key process. Personal skills and attitudes that take into account and respect the customs and local culture the PRM is working in. Accepting that PRM skills and roles may not always be well understood and seen as a primary need in the rehabilitation process of that specific cultural, social and clinical setting. 14

Personal Skills A mindset and attitude resilient towards insecure working environment Need for prioritizing personal security Respect for operational and logistical procedures. Ability to cope with varying workloads Flexibility in the team approach 15

Challenges encountered (1) Experience and local board accreditation in management of:  PRM should be able to work with plaster casts and wound debridement  Check ‘’ hands on ‘’quality of neurogenic bladder management (water column cysto, bladder pharmacopeia)  Functions in ICU setting ( suction, wound care follow-up, small surgery procedures ). 16  This might be not well accepted according to the inter-professional standards.

Challenges encountered (2) To provide direct technical assistance in constituting adapted protocols that allow physical rehabilitation programs to function optimally: pain protocol, anti biotherapy, infection prevention, continence management for neurogenic conditions, comprehensive wound care … 17  Common professional standards dictate that some of these skills are to be performed by other specialists but nevertheless needed in emergencies

Challenges encountered (3)  There is a need to define what skills and procedures PRM can perform in these exceptional circumstances  Personal responsibility and liability in this case might be engaged  Handicap International recognizes this ‘’grey zone ‘’ and would welcome positioning from ISPRM in this field 18

Team approach in physical rehabilitation 19

Ideally the PRM should be team leader of the most common profiles Handicap International is working with : -Physiotherapists -Occupational therapists -Social workers -Psychologists Although these profiles are not present at once in the timeline of projects ( 5 – 8 months ), the PRM needs to ‘’ bridge ‘’ their absence by increasing of task sharing and coaching of the team 20

Examples of PRM assignements within Handicap International projects 21

Assessment of needs mission in Emergency context (Haiti ) Acting team leader of rehabilitation program in Trauma hospital (Syria) Trainer of special rehabilitation skills to doctors, surgeon, nurses, PT, OT (Vietnam) Adviser on training curriculum for Therapist’s specialities (Haiti, Cambodia) Monitoring and evaluation of activity outcomes with complex trauma : SCI, burn wounds, multiple trauma (Congo RDC) Drafting field protocols for disaster preparedness (Nepal) 22

Conclusion PRM specialists are a key human resource in disaster setting. Their specific skills and know-how should be placed within the available rehabilitation teams made up of physical therapists, occupational therapists, psychologists and nurses during an emergency. Special efforts should be done to identify the needed skills of a PRM and allow these skills to be used on the field and the team setting beyond the pure medical standard of operations. 23 ss

24 Thank you Contact: Eric Weerts Technical Referent Emergency and Rehabilitation