Physiatrists and rehabilitation teams provided critical medical care following several natural disasters between 2005-2010. They treated injuries and conditions like fractures, amputations, spinal cord injuries, and burns. Teams also provided wound care, nutrition, education and counseling. Following disasters, temporary rehabilitation facilities were set up and foreign teams integrated into the response. Models for collaborative and low-cost rehabilitation care were also developed. Experience from these disasters highlighted the important role of physiatrists and rehabilitation in emergency response, and informed better inclusion of people with disabilities in future disaster planning.

1. Introduction/Methods/Results Results (cont) Results (cont) Conclusions Introduction Members of the International Rehabilitation Forum’ s (IRF) Emergency Rehabilitation Work Group (ERWG) with physical rehabilitation response experience from the Kashmir, Sichuan and Haiti earthquakes as well as Hurricane Katrina and Cyclone Sidr desired to share their collective experience with the international physical medicine and rehabilitation disaster response community. Selected Natural Disasters (2005-10) Hurricane Katrina (2005) 1 Kashmir Earthquake (2005) 3 Cyclone Sidr (2007) 4 Sichuan Earthquake (2008) 5 Haiti Earthquake (2010) 2 Methods -Work group members provided accounts of their respective disaster response experiences and noteworthy others related to their disaster of interest. -Accounts were collated and thematically organized. -Common, highly relevant themes were further organized into conclusions. Results Kashmir Earthquake (2005) 3 -Although physiatrists did not have a significant role in the national disaster response strategy prior to the earthquake, Kashmir demonstrated their critical role in providing medical rehabilitative care as well as ancillary care. Physiatrists provided skin care, nutritional therapy, patient/family education and bereavement counseling, for example, due to the lack of rehabilitation nurses, nutritionists and psychologists. -Few rehabilitation facilities existed for the emergent and acute care of the significant numbers of victims with severe disabling injures including complex long bone fractures, amputation, SCI, and TBI. Temporary local facilities were quickly established and foreign field hospitals and providers were highly integrated into the emergency disaster response. Sichuan Earthquake (2008) 5 -Due to the lack of adequate, affordable rehabilitation services for rural victims, a collaborative rehabilitation model featuring no-fee rehabilitative care and medical equipment was developed several months after the earthquake. The 'Mianzhu model' showed statistically positive medical, social and economic benefits and was subsequently applied in other townships. -Emergency foreign medical team and INGO response can be limited by a delay in response time, host government requirements and the language barrier among other factors. Foreign assistance to include specialized medical expertise as well as local training and programming support can benefit the acute and long-term response periods as well. Haiti Earthquake (2010) 2 -Prior to the earthquake Haiti had effectively no local SCI medical or nursing rehabilitation expertise. Rapid training of local staff by foreign teams using a multimodal curriculum improved outcomes for the survivors of SCI and also facilitated development of SCI rehabilitation centers. -Exaggerated media reports of the incidence of traumatic amputations resulted in organizations without adequate expertise desiring to provide prosthetic and orthotic services. Pre-earthquake service providers coordinated with other rehabilitation INGOs providers within the UN/PAHO ‘disability subcluster’ and host MoH framework to regulate P&O service provision. Hurricane Katrina (2005) 1 -Physiatrists expertly treated acute dermatological and musculoskeletal complaints at large general population evacuation shelters on the US Gulf Coast following the hurricane. Chronic rehabilitation conditions including wound care, mobility deficits, subacute stroke, chronic SCIs and neuropathies were also managed in these temporary care settings. -The identified demand for durable medical equipment, consumable medical supplies and specific medications at large regional shelters led to distribution of these materials at smaller shelters. This usage data informed forecasting of medical material needs for similar, future disasters and also indicated the need for additional dedicated ‘special needs’ shelters and greater inclusion of evacuation and transportation protocols for persons with pre-existing disabilities in disaster planning. Cyclone Sidr (2007) 4 -The Bangladesh Association of PMR immediately consulted with the ISPRM on an emergency rehabilitation response and formed several multidisciplinary teams comprised of a physiatrist, nurse, PT, OT and a social worker. Teams primarily provided musculoskeletal and wound care, referring complex wounds and paraplegic cases. Experience from this response prompted a task force for acute medical rehabilitation response in disaster which addressed team factors as well as required coordination and logistical support elements. -The densely populated and disaster response resource-poor coastal regions of Bangladesh are especially vulnerable to natural disasters including cyclones. Proposed models for training first responders in disaster rehabilitation include employing 'imam' and 'muezzin' due to their high prevalence and elevated position of respect and authority in the largely muslim community. Physiatrists and physiatrist-led rehabilitation teams can effectively perform a range of rehabilitation interventions and other medical management functions across different types of natural disaster, over the duration of the disaster response and in a variety of care settings. Physiatrists perform a critical role during the emergency phase of a natural disaster response which includes medical management of traumatic disabling injuries and training of other local and foreign responders in rehabilitation interventions. INGOs providing rehabilitative care as well as national rehabilitation societies and international professional rehabilitation organizations can have a significant positive impact during the emergency response and beyond. Physical rehabilitation responses in recent natural disasters James Gosney (USA) 1 , Colleen O’Connell (CANADA) 2 , Farooq A. Rathore (PAKISTAN) 3 , M. Taslim Uddin (BANGLADESH) 4 , Xia Zhang (CHINA) 5 ISPRM Symposium on Rehabilitation Disaster Relief at the 6 th ISPRM World Conference in Puerto Rico 2011 13 June 2011 San Juan Puerto Rico