Presenter : Susanne Nielsen , PT Authors : Jacquemin Geraldine , MD, FRCPC, MPH

1. 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 Rehab Disaster Relief Symposium: Where is rehabilitation disaster relief going? 19th June 2013

2. 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

3. Unique needs for PRM • 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

4. Handicap International’s work in disaster context

5. Disaster Relief: Where do HI intervene

6. 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

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

8. 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

9. 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

10. Role of PRM in the transfer of knowledge

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

12. Needed profile and skills of PRM

15. 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

16. 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 ).  This might be not well accepted according to the inter-professional standards .

17. 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 …  Common professional standards dictate that some of these skills are to be performed by other specialists but nevertheless needed in emergencies

18. 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

19. Team approach in physical rehabilitation

20. Ideally the PRM shouldbe team leader of the mostcommon profiles Handicap International isworkingwith : • Physiotherapists • Occupationaltherapists • Social workers • Psychologists Althoughthese profiles are not presentat 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

21. Examples of PRM assignements within Handicap International projects

22. 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)

23. Conclusion PRM specialists are a key human resourcein 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. ss

24. Thank you Contact: Eric Weerts Technical Referent Emergency and Rehabilitation Email: eric.weerts@handicap.be