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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
Background ,[object Object],[object Object],[object Object],[object Object],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
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.
The scope of the problem ,[object Object],[object Object]
ISPRM-RDRC ,[object Object]
The action plan  ,[object Object],[object Object],[object Object],[object Object]
The action plan  ,[object Object],[object Object],[object Object],[object Object]
 
The health conditions for which specific guidelines should be prepared by the Disaster Relief Subcommittee ,[object Object],[object Object],[object Object],[object Object]
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
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
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
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
Any rehabilitation guidelines for disaster response? ,[object Object]
Action ,[object Object]
LIST OF AVAILABLE GUIDELINES  ,[object Object],[object Object],[object Object],[object Object],[object Object]
LIST OF AVAILABLE GUIDELINES  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LIST OF AVAILABLE GUIDELINES  ,[object Object],[object Object],[object Object],[object Object]
LIST OF AVAILABLE GUIDELINES  ,[object Object],[object Object]
LIST OF AVAILABLE GUIDELINES  ,[object Object],[object Object],[object Object],[object Object]
LIST OF AVAILABLE GUIDELINES  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LIST OF AVAILABLE GUIDELINES  ,[object Object],[object Object]
Next step ,[object Object]
  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)
Other suggestions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Other suggestions ,[object Object],[object Object],[object Object]
Vulnerable populations ,[object Object],[object Object],[object Object],[object Object]
Obstacles ,[object Object],[object Object],[object Object],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
Conclusion ,[object Object],[object Object]
Thank you for your attention

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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. 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
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  • 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.
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  • 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
  • 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
  • 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
  • 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
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  • 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)
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  • 30. Thank you for your attention