Jianan LI, MD Nanjing Medical University National team leader for disaster rehab, China Honorary Chair of ISPRM-CRDR

Date: May 12, 2008 Deaths/missing persons: 86,000 Injured: 374,640; Severely injured: 11,000 Direct economic loss: 100 billion US$

 Massive damages  Blocked roads  Lack of resources  Finance  Rehab persons  Facilities and equipment  Lack of coordination  Government  Hospitals  NGOs

 Poor wound management  Poor operations  High incidence of pressure sore  Lack of knowledge in Crush Syndrome  Lack of systematic early rehab intervention

 Sichuan Earthquake  Massive transfer and return

 10,000 injured victims return Sichuan  Majority of them were dependent:  Internal fixation with fracture  Imitated mobility  Bed rest for SCI and TBI  Local rehab strength  < 100 rehab physicians  < 200 rehab therapists  No rehab persons in the community

 3 to 5 days training courses were conducted more 40 times  No person may practice after training  It is not lack of guidelines, but manpower in medical rehabilitation  Local medical persons are also victims

 What we need:  to establish a comprehensive rehab facility on- site of disaster zone: project with high efficiency, efficacy and sustainability.  How to organize:  Non-government organizations: to provide financial support  Health department and hospital at disaster zone: to provide basic facilities and some medical support  Volunteers in rehab: to provide manpower.

VolunteersHealth departments NGOs FinancingGovernance Health workforce Chinese Association of Rehabilitation Medicine: Local Health Bureau/ Local Disabled Persons Federation Rehabilitation Services Capacity building Rehabilitation Medicine Physical/Occupational therapy Institutional based rehabilitation Community based rehabilitation Rehabilitation Psychology Health: home visits, community adaption… Livelihood Social and empowerment

VolunteersHealth departments NGOs FinancingGovernance Health workforce Chinese Association of Rehabilitation Medicine, Local Health Bureau/ Local Disabled Persons Federation Rehabilitation Services Capacity building

Rehabilitation Services Rehabilitation Medicine Physical/Occu pational therapy Institutional based rehabilitation Community based rehabilitation Rehabilitation Psychology Health Livelihood Social and empowerment

NGO(CFCF) Local Hospital Health Bureau Disabled Person’s Federation IBR CBR Handicap International Physiatrician PT/Nurse Rehab equipment Earthquake Survivors with SCI NHV rehabilitation services programs

Role of physiatrist Organizer, coordinator, diagnosis, clinical management, planning,,,,,,

 Outcome: 3324 severely injured victims completed institutional rehab and return to community with high satisfaction.  Achievement: Department of rehab medicine established in the local hospitals and community based rehab service is gradually spread out.  Sustainability: Emphasis is shifting from medical rehab to social rehab.

Method Quality of Life Demography ASIA Ability of Daily Living Depression Complication Pain On-site Survey Walking Ability

Demography Method Quality of Life ASIA Ability of Daily Living Depression Complication Pain Walking Ability WHO Quality of Life Assessment Instrument-Bref (WHOQOL-BREF) The most appropriate scale for QOL of SCI patient Individual’s overall perception of QOL & health Domain: Physical Health/ Psychological/Social Relationship/ Environment *Hill MR, Noonan VK, Sakakibara BM, Miller WC. Quality of life instruments and definitions in individualswith spinal cord injury: a systematic review. Spinal Cord. 2009

Method Quality of Life ASIA Ability of Daily Living Depression Complication Pain Walking Ability Pressure Sore/ UTI / Cystolith / Neurogenic Bladder/ Rectum Impairment of Renal Function … Demography

Method Quality of Life ASIA Ability of Daily Living Depression Complication Pain Walking Ability Visual Analogue Scale (VAS) Demography

Method Quality of Life ASIA Ability of Daily Living Depression Complication Pain Walking Ability Modified Barthel Index (MBI) Demography

Method Quality of Life ASIA Ability of Daily Living Depression Complication Pain Walking Ability Walking Index for Spinal Cord Injury II Demography

Method Quality of Life ASIA Ability of Daily Living Depression Complication Pain Walking Ability Patient Health Questionnaire Depression Module (PHQ-9) Demography

AIS Abov e C7 C8-T6T7-L2L3-S2 Below S2 Total Percentage A % B % C % D % Total Result

Above C7 C8-T6T7-L2L3-S2 Below S2 Total Percentage Pain % New pressure sore % Neurogenic bladder % Cystolith % Neurogenic Rectum % Heterotopic ossification % Above C7 C8-T6T7-L2L3-S2 Below S2 Total Percentage Pain % New pressure sore % Neurogenic bladder % Cystolith % Neurogenic Bowel % Heterotopic ossification % Result

 Outcome:  few disabled people (1%).  Depression and pain remain the major complains  Achievement:  Local rehab system built up (rehab capacity tripled) and rehab professionals increased 5 times more.

 Time: 8 am, April 20, 2013  Immediate reaction post the earthquake:  1 min: internet news  6 min: government announcement  18 min: on-site rescue started  28 min: army team arrived at earthquake zone  120 min: provincial government leaders arrived at the center zone of the earthquake

 60 min: 5 national medical teams (180 people) 120 min: National medical consultant organized.  2 nd Day: 183 medical teams (1427 people) arrived and medical rehab early intervention started. The ministry of health documents on principle of early rehab intervention and transferring standard.  3 rd day: Medical rehabilitation wards established and local rehab resources are sufficient to deal with post earthquake rehab.  NHV model implemented in the earthquake zone.

 Few disabled persons from disaster  Local rehab service built up  Community rehab service running well  NGO support efficiently

 Role of international society?  Role of rehab professionals?  Volunteer team?  Language?  Culture and religion?  Finance?  Diplomatic issue?  Safety?