WHO Releases New Rehabilitation Guidelines for Emergency Medical Teams

Mike_Landry_Presenting_Guidelines

DGHI affiliate Michel Landry was among the presenters at the May 8 launch of the WHO's new guidelines for rehabilitation capacity on emergency medical teams.

Published May 30, 2017

“Saving lives is not always the most challenging aspect of disaster response,” said Michel Landry, chief of the Duke Doctor of Physical Therapy division and Duke Global Health Institute (DGHI) affiliate. “Often the biggest challenge is addressing what will happen with patients once emergency medical teams [EMTs] leave. It’s rarely a smooth transition for survivors of a disaster.”

The transition from short-term to long-term rehabilitation care for injured disaster survivors is just one of the complex issues the World Health Organization (WHO) aims to address in a new set of guidelines. These standards, released in Geneva on May 8, outline standards for post-disaster rehabilitation care and provide guidance on strengthening the capacity of EMTs.

Landry, who has participated in many post-disaster emergency responses over the last 20 years, is helping to disseminate and promote these recommendations among EMTs. “Advocacy is important in the transition to the adoption phase,” Landry said, “because despite WHO’s acceptance of the guidelines, some EMTs are still struggling to see the relevance of physical therapy in the early phases of disaster.” 

Putting the Need for Long-Term Rehabilitation into Context

Advances in emergency responses to disasters have enabled us to increase the number of lives saved. But with this success comes an increase in survivors who have complex medical conditions that require long-term—sometimes life-long—medical and rehabilitative care. 

“Rehabilitation needs can persist far beyond the departure of EMTs; therefore, close, supportive collaboration must be established with local services,” the Foreword reads. “… This document emphasizes the importance of aligning practices to the local context and maximizing opportunities for training and mentorship.” A central goal of the guidelines is to facilitate faster patient access to rehabilitation services and equipment, as well as a better transition from EMTs to local health facilities.

Guidelines Touch on Full Range of Considerations

The standards provide guidance on rehabilitation personnel, space, equipment, patient management and capacity building among local health care providers. Highlights include:

  • At least one rehabilitation professional per 20 beds at the time of initial deployment, to be increased as needed
  • Allocation of a designated rehabilitation space for Type 2 EMTs, with at least 12 square meters for Type 3 EMTs
  • Deployment of EMTs with specific essential rehabilitation equipment and consumables (e.g., wheelchairs, crutches, cervical collars, bandages and slings) with enough of each to last at least two weeks
  • Planning for patient discharge from the early stages of care and systematic communication with the host country’s ministry of health and health care facilities
  • Mentoring or training of patients and health care providers in the affected communities—preferably in partnership with local service providers—to ensure sustainable high-quality care

A working group has been established to further develop specific technical standards for addressing conditions such as spinal cord injuries, burns and orthoplastics. Landry, a member of the group, will take the lead on drafting the standards based on the group’s input.

Landry Reflects on the New Standards

Landry sees physical therapy and rehabilitation services in the aftermath of disasters as a human right and social justice issue, and thinks the new guidelines reflect a recognition of this perspective. “Rehabilitation services should be at the forefront of any disaster response,” he notes. “Having a disability doesn’t make you less worthy than anyone else to receive aid in a disaster. Dignity for people with disabilities cannot wait for better times.”

He also believes the guidelines help validate an interdisciplinary approach to care—which he views as essential. “To be effective providers, we need multidisciplinary teams, whether we’re providing care at Duke Hospital or in a disaster zone,” he said. “This approach deconstructs the medical model, recognizes that everybody has a role to play, and ultimately generates better patient outcomes.” 

Read the full document, “Minimum Technical Standards and Recommendations for Rehabilitation: Emergency Medical Teams.”

To be effective providers, we need multidisciplinary teams, whether we’re providing care at Duke Hospital or in a disaster zone.

Michel Landry, DGHI affiliate