The need for guidelines for  common disabling conditions in natural disasters:  ISPRM’s Rehabilitation Disaster Relief Sub...
Background <ul><li>Natural disasters come without warning </li></ul><ul><li>M ay cause disabling traumatic injuries in a c...
Physiatrists’ role in disasters Gosney JE Jr. Physical medicine and rehabilitation: critical role in disaster response. Di...
The scope of the problem <ul><li>Patients in rehabilitation   services :  59,578 in 20 clinics throughout Haiti   Gorry C....
ISPRM-RDRC <ul><li>Rehabilitation Disaster Relief  (Sub-) Committee (RDRC) of the International Society of Physical and Re...
The action plan  <ul><li>Phase 1 </li></ul><ul><li>S earching for already available guidelines </li></ul><ul><li>D ecision...
The action plan  <ul><li>Phase 2  </li></ul><ul><li>T he review of existing  guidelines </li></ul><ul><li>I dentification ...
 
The health conditions for which specific guidelines should be prepared by the Disaster Relief Subcommittee <ul><li>G uidel...
Earthquake Related Injuries Mohebbi  HA, Mehrvarz S, Saghafinia M, Rezaei Y, Towliat Kashani SM, Moussavi Naeeni SM, Motam...
Earthquake Related Injuries The  7.0-magnitude earthquake  in  Haiti  o n January 12, 2010,  The most common injury-relate...
Earthquake Related Injuries Dong ZH, Yang ZG, Chu ZG, Chen TW, Bai HL, Shao H, Tang SS, Denor JC. Earthquake-related injur...
Hurricane Related PM&R Conditions Chiou-Tan FY, Bloodworth DM, Kass JS, Li X, Gavagan TF, Mattox K, Rintala DH. Physical m...
Any rehabilitation guidelines for disaster response? <ul><li>No specific guidelines (those specifically   prepared for fie...
Action <ul><li>S earch ing  the internet for appropriate guidelines, which have already been written and disseminated whic...
LIST OF AVAILABLE GUIDELINES  <ul><li>SCI </li></ul><ul><li>Guidelines for the Management of Acute Cervical Spine and Spin...
LIST OF AVAILABLE GUIDELINES  <ul><li>TBI </li></ul><ul><li>Guidelines for Prehospital Management of Traumatic Brain Injur...
LIST OF AVAILABLE GUIDELINES  <ul><li>AMPUTATION </li></ul><ul><li>VA/DoD Clinical practice guideline for rehabilitation o...
LIST OF AVAILABLE GUIDELINES  <ul><li>WOUNDS </li></ul><ul><li>All you need to know about wound care. WOUND HEALING ASSOCI...
LIST OF AVAILABLE GUIDELINES  <ul><li>BURN INJURY </li></ul><ul><li>Management of Burns. World Health Organization </li></...
LIST OF AVAILABLE GUIDELINES  <ul><li>POLYTRAUMA and FRACTURES </li></ul><ul><li>Practice management guideline for pulmona...
LIST OF AVAILABLE GUIDELINES  <ul><li>PAIN </li></ul><ul><li>Clinical Guidelines for the Use of Chronic Opioid Therapy in ...
Next step <ul><li>The next step will be the reviewing process of available standard guidelines by a group of experts on ea...
  Experts suggested for the preparation of Guidelines on Specific Health Conditions Health Conditions Suggested experts SC...
Other suggestions <ul><li>General </li></ul><ul><li>Because field responder level guidelines seem underrepresented, it is ...
Other suggestions <ul><li>Format of the guidelines </li></ul><ul><li>Guidelines for different conditions should in the sam...
Vulnerable populations <ul><li>Children </li></ul><ul><li>National Commission on Children and Disasters. 2010 Report to th...
Obstacles <ul><li>Lack of guidance or training for physicians  on how to function in disasters </li></ul><ul><li>Not a cle...
Conclusion <ul><li>There is a clear need for rehabilitation guidelines for specific health  conditions encountered in natu...
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Oral the need for guidelines for common disabling conditions in natural disasters. isprm’s crdr approach for guidelines crdr.session.isprm11

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Oral the need for guidelines for common disabling conditions in natural disasters. isprm’s crdr approach for guidelines crdr.session.isprm11

  1. 1. The need for guidelines for common disabling conditions in natural disasters: ISPRM’s Rehabilitation Disaster Relief Subcommittee approach for guideline preparation Aydan Oral, MD Istanbul University , Istanbul Faculty of Medicine Department of Physical Medicine and Rehabilitation Istanbul, TURKEY
  2. 2. Background <ul><li>Natural disasters come without warning </li></ul><ul><li>M ay cause disabling traumatic injuries in a considerable number of affected populations </li></ul><ul><li>T here are scarce medical resources </li></ul><ul><li>T he ability of health professionals to adhere to conventional standards of care could be greatly comprimised </li></ul>Huntington MK, Gavagan TF. Disaster medicine training in family medicine: a review of the evidence. Fam Med. 2011;43(1):13-20. Types of natural disasters Meteorological Hurricane Blizzard Heat/cold wave Geological Earthquake Volcanic eruption Flood Other Fire Explosion Disease outbreak
  3. 3. Physiatrists’ role in disasters Gosney JE Jr. Physical medicine and rehabilitation: critical role in disaster response. Disaster Med Public Health Prep. 2010;4(2):110-2.
  4. 4. The scope of the problem <ul><li>Patients in rehabilitation services : 59,578 in 20 clinics throughout Haiti Gorry C. Once the earth stood still (part I): Cuban rehabilitation services in Haiti. MEDICC Rev. 2010;12(2):44-7 . </li></ul><ul><li>6000 to 8000 people had lost limbs or digits in Haiti Kelly JD. Haitian amputees--lessons learned from Sierra Leone. N Engl J Med. 2010;362(11):e42 </li></ul>
  5. 5. ISPRM-RDRC <ul><li>Rehabilitation Disaster Relief (Sub-) Committee (RDRC) of the International Society of Physical and Rehabilitation Medicine (ISPRM) aimed to provide guidelines for rehabilitation following disasters for common disabling conditions as one of its strategic goals </li></ul>
  6. 6. The action plan <ul><li>Phase 1 </li></ul><ul><li>S earching for already available guidelines </li></ul><ul><li>D ecision making on which guidelines to prepare, adapt, or adopt </li></ul><ul><li>Deciding on the experts who will be reviewing/preparing specific guidelines </li></ul>
  7. 7. The action plan <ul><li>Phase 2 </li></ul><ul><li>T he review of existing guidelines </li></ul><ul><li>I dentification of needs to change from normal standards to disaster standards </li></ul><ul><li>P roducing required guidelines for specific health conditions if no standard guidelines are available </li></ul>
  8. 9. The health conditions for which specific guidelines should be prepared by the Disaster Relief Subcommittee <ul><li>G uidelines should be prepared for SCI, TBI, and Amputees (unanimous agreement) </li></ul><ul><li>G uidelines for fracture/polytrauma and burn injuries </li></ul><ul><li>Pediatric trauma and pain management </li></ul><ul><li>R ehabilitation needs of displaced persons who have a pre-disaster disability </li></ul>
  9. 10. Earthquake Related Injuries Mohebbi HA, Mehrvarz S, Saghafinia M, Rezaei Y, Towliat Kashani SM, Moussavi Naeeni SM, Motamedi MHK, Hoseini SH, Moharamzad Y: Earthquake related injuries: Assessment of 854 victims of the 2003 Bam disaster transported to tertiary referral hospitals. Prehospital Disast Med 2008;23(6):510–515 . Injured Body Regions % Lower extremity Fracture Soft tissue injury 36.2 68.9 31.1 Head and neck Fracture Soft tissue injury 13.6 34.0 66.0 Spinal column and cord Fracture Soft tissue injury 12.0 67.3 32.7 Upper extremity Fracture Soft tissue injury 11.3 59.0 41.0 Face Fracture Soft tissue injury 10.3 90.0 10.0 Surgical interventions % Extremity amputation 10.8 Neurosurgical 6.5
  10. 11. Earthquake Related Injuries The 7.0-magnitude earthquake in Haiti o n January 12, 2010, The most common injury-related surgical procedures were wound debridement/skin grafting, treatment for orthopedic trauma, and surgical amputation Centers for Disease Control and Prevention (CDC). Post-earthquake injuries treated at a field hospital- Haiti, 2010.MMWR Morb Mortal Wkly Rep. 2011;59(51):1673-7. Diagnoses for injured patients % Fracture/Dislocation 54.3 Wound infections/Abscess 37.0 Crush injury 25.3 Head/Face/Brain injury 9.3 Burn 1.9 Other 42.6
  11. 12. Earthquake Related Injuries Dong ZH, Yang ZG, Chu ZG, Chen TW, Bai HL, Shao H, Tang SS, Denor JC. Earthquake-related injuries: Evaluation with multidetector computed tomography and digital radiography of 1491 patients. J Crit Care. 2011 Apr 20. doi:10.1016/j.jcrc.2011.03.007 The 8.0 magnitude Sichuan earthquake in China, at 2:28 pm Beijing time on May 12, 2008 Injuries % Extremity fractures 61.15 Thoracic injury 29.57 Spinal injury 24.98 Pelvic fractures 17.04 Head injury 7.60 Facial fractures 3.43 Abdominal injury 2.51
  12. 13. Hurricane Related PM&R Conditions Chiou-Tan FY, Bloodworth DM, Kass JS, Li X, Gavagan TF, Mattox K, Rintala DH. Physical medicine and rehabilitation conditions in the Astrodome clinic after hurricane Katrina. Am J Phys Med Rehabil. 2007;86(9):762-9 . PM&R conditions % Swollen feet or legs 26.36 Leg pain and cramps 20.92 Headache 15.06 Neck and back pain 12.55 Skin ulcer 6.28 Fracture 5.86 Musculoskeletal arm problem 5.44 Neuropathic 5.02 Musculoskeletal leg problem 4.18 Stroke 2.51 Bursitis 2.09 SCI 1.67 Amputee 1.26
  13. 14. Any rehabilitation guidelines for disaster response? <ul><li>No specific guidelines (those specifically prepared for field response in disasters) are reported to be available </li></ul>
  14. 15. Action <ul><li>S earch ing the internet for appropriate guidelines, which have already been written and disseminated which may be adopted or adapted </li></ul>
  15. 16. LIST OF AVAILABLE GUIDELINES <ul><li>SCI </li></ul><ul><li>Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries. Association of Neurological Surgeons (AANS) / Congress of Neurological Surgeons (CNS) </li></ul><ul><li>Early acute management in adults with spinal cord injury: a clinical practice guideline for health-care professionals. 2008 May. NGC:007157. Consortium for Spinal Cord Medicine; Paralyzed Veterans of America </li></ul><ul><li>Preservation of upper limb function following spinal cord injury: a clinical practice guideline for health-care professionals. 2005 Apr. NGC:004300. Consortium for Spinal Cord Medicine </li></ul><ul><li>Pressure ulcer prevention and treatment following spinal cord injury. 2000 Aug (reviewed 2005). NGC:001815. Consortium for Spinal Cord Medicine; Paralyzed Veterans of America </li></ul>
  16. 17. LIST OF AVAILABLE GUIDELINES <ul><li>TBI </li></ul><ul><li>Guidelines for Prehospital Management of Traumatic Brain Injury 2007. Brain Trauma Foundation </li></ul><ul><li>Traumatic brain injury: diagnosis, acute management and rehabilitation. 2006 Jul. NGC:005397. New Zealand Guidelines Group </li></ul><ul><li>VA/DoD clinical practice guideline for management of concussion/mild traumatic brain injury. 2009 Apr. NGC:007713 Department of Defense - Federal Government Agency [U.S.]; Department of Veterans Affairs - Federal Government Agency [U.S.]; Veterans Health Administration </li></ul><ul><li>Guidelines for Acute Medical Management of Severe Traumatic Brain Injury in Infants, Children, and Adolescents A Supplement to Pediatric Critical Care Medicine: Brain Trauma Foundation </li></ul><ul><li>Guidelines for the field management of combat-related head trauma. Triage and transport decisions. 2005. NGC:005790. Brain Trauma Foundation </li></ul><ul><li>Head injury. Triage, assessment, investigation and early management of head injury in infants, children and adults. 2007 Sept. NGC:005953. National Collaborating Centre for Acute Care </li></ul><ul><li>Guidelines for the field management of combat-related head trauma. Treatment: pain management and the use of analgesics for sedation. 2005. NGC:005788 . Brain Trauma Foundation </li></ul>
  17. 18. LIST OF AVAILABLE GUIDELINES <ul><li>AMPUTATION </li></ul><ul><li>VA/DoD Clinical practice guideline for rehabilitation of lower limb amputation </li></ul><ul><li>Evidence Based Clinical Guidelines for the Physiotherapy Management of Adults with Lower Limb Prostheses. British Association of Chartered Physiotherapists in Amputation Rehabilitation, 2003 </li></ul><ul><li>Amputation - Medical Disability Guidelines </li></ul>
  18. 19. LIST OF AVAILABLE GUIDELINES <ul><li>WOUNDS </li></ul><ul><li>All you need to know about wound care. WOUND HEALING ASSOCIATION OF SOUTHERN AFRICA </li></ul>
  19. 20. LIST OF AVAILABLE GUIDELINES <ul><li>BURN INJURY </li></ul><ul><li>Management of Burns. World Health Organization </li></ul><ul><li>ABA White Paper: Surgical Management of the Burn Wound and Use of Skin Substitutes </li></ul><ul><li>2001 Practice Guidelines for Burn Care. American Burn Association (ABA) </li></ul>
  20. 21. LIST OF AVAILABLE GUIDELINES <ul><li>POLYTRAUMA and FRACTURES </li></ul><ul><li>Practice management guideline for pulmonary contusion - flail chest. 2006 Jun. NGC:005352 </li></ul><ul><li>Eastern Association for the Surgery of Trauma </li></ul><ul><li>ACR Appropriateness Criteria® suspected lower urinary tract trauma. 1996 (revised 2009). NGC:007808. American College of Radiology </li></ul><ul><li>Renal trauma. In: Guidelines on urological trauma. 2009 Mar. NGC:007328. European Association of Urology </li></ul><ul><li>ACR Appropriateness Criteria® rib fractures. 1995 (revised 2008). NGC:007014.American College of Radiology </li></ul><ul><li>Evaluating infants and young children with multiple fractures. 2006 Sep. NGC:005253. American Academy of Pediatrics </li></ul>
  21. 22. LIST OF AVAILABLE GUIDELINES <ul><li>PAIN </li></ul><ul><li>Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain. The Journal of Pain, Vol 10, No 2 (February), 2009: pp 113-130. </li></ul>
  22. 23. Next step <ul><li>The next step will be the reviewing process of available standard guidelines by a group of experts on each disabling health condition, which will eventualy lead to ISPRM guidelines for rehabilitation following natural disasters </li></ul>
  23. 24. Experts suggested for the preparation of Guidelines on Specific Health Conditions Health Conditions Suggested experts SCI Anthony Chiodo (USA), Stieve Stiens (USA), Jianan Li (China), Farooq Rathore (Pakistan), Colleen O’Connell (Canada), James Guest (neurosurgeon) (USA), Peter Wing (Orthopedic Surgeon)( member of the ISCoS group)(Canada), Michael Baumberger ( Switzerland), Apichana Kovhinda (Thailand), Dirk van Kuppevelt (the Netherlands), Kazadi Kalangu (Zimbabwe) TBI Faye Tan (USA), Steven Flanagan (USA), Nathan Zasler (USA), Kazadi Kalangu, A Chingono, James January (Zimbabwe), Polytrauma and Fractures Mary Catherine Spires (USA) Amputees Alberto Esquenazi (USA), Jim Gosney (USA), Anthony Redmond (UK), Colleen O’Connell ( Canada), Al Ingersoll (prosthetist)(USA), Jan Geertzen (the Netherlands), Carolina Schiappacasse (Argentina) Burn injuries Peter Esselman (USA), Steven Fisher (USA) Nerve injuries Jacquelline Wertsch (USA), Andrew Haig (USA) Pediatric trauma Deborah Gaebler Spira (USA)
  24. 25. Other suggestions <ul><li>General </li></ul><ul><li>Because field responder level guidelines seem underrepresented, it is advised that individual PRM national societies should also be surveyed for guidelines which are focused primarily on field response. </li></ul><ul><li>To solicit national society input, this issue could be raised at the NEWS & VIEWS of the ISPRM. </li></ul><ul><li>We should work closely with the Global Initiative for Emergency and Essential Surgical Care (GIEESC) at WHO regarding guidelines. </li></ul><ul><li>The guideline panel should include experts from different disciplines to enhance the value of guidelines </li></ul><ul><li>A consensus should be reached before hand on where these guidelines will be submitted for publication </li></ul>
  25. 26. Other suggestions <ul><li>Format of the guidelines </li></ul><ul><li>Guidelines for different conditions should in the same format to ensure consistency among guidelines. </li></ul><ul><li>Guidelines should be with illustrations for being easily understood by others whose native language is not English </li></ul>
  26. 27. Vulnerable populations <ul><li>Children </li></ul><ul><li>National Commission on Children and Disasters. 2010 Report to the President and Congress. AHRQ Publication No. 10-M037. Rockville, MD: Agency for Healthcare. Research and Quality. October 2010. </li></ul><ul><li>The elderly </li></ul><ul><li>Persons with disabilities </li></ul>
  27. 28. Obstacles <ul><li>Lack of guidance or training for physicians on how to function in disasters </li></ul><ul><li>Not a clear definition of which actions are ethically justified during a crisis </li></ul><ul><li>I nadequate liability protections for health professionals who may have to place some patients' needs ahead of others in crisis situations </li></ul>IOM Report. Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations. September 24, 2009. http://www.iom.edu/Reports/2009/DisasterCareStandards.aspx
  28. 29. Conclusion <ul><li>There is a clear need for rehabilitation guidelines for specific health conditions encountered in natural disasters </li></ul><ul><li>ISPRM RDRC will be doing a very important work that would meet the needs of injuried persons in natural disasters </li></ul>
  29. 30. Thank you for your attention

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