Leadership in Disaster
Management: Nepal Earthquake
Professor Fary Khan
Department of Medicine, Royal Melbourne Hospital &
The University of Melbourne
Lead Task force for The Committee on Rehabilitation Disaster Relief (CRDR),
ISPRM WHO Liaison Committee Policy Advisory Group international Society of Physical and
Rehabilitation Medicine (ISPRM)
1. The Problem
Inter-Agency Standing Committee’s (IASC) Cluster System -global authority
for crisis coordination & accountability - WHO - the Health Cluster
Demand for better coordination and control after major international
disaster/crisis.
• poor clinical competence of providers
• unacceptable clinical & management practices
• limited scope of guidelines for foreign medical teams (FMTs)
[Global Health Cluster: coordination and registration of FMTs in Humantarian disasters. Strategy position paper. Geneva 2011]
ELRHA: Enhancing Learning &
Research for Humanitarian Assistance
I:
Registration, coordination &
internal quality improvement
of FMTs
II: Professionalize training & certification
of humanitarian health care
providers & accreditation of their
academic training centers & trainers
2. Foreign Medical Team Requirements
• Professional & ethical standards
• Accelerate deployments
• Match services with supply &
demand
• Create register of FMT provider
organizations
• Team composition by specialty,
experience & bed capacity
• Standardized data collection &
reporting
• Procedures performed by
accredited staff
• FMT staff- experience in
humanitarian settings
• Process to supervise less
experienced
[GHC Concept paper 2011]
Rehabilitation Competencies -HHI
Humanitarian response- needs both trauma surgery & Rehab
Early rehabilitation restores function, improves survival & QoL
Rehabilitation for disabling injuries: wounds/ trauma, amps, SCI, TBI, burns
Prevent complications in pw disabilities & disabling injuries, assistive devices
Partnerships with community services & CBR for post-operative care & Rehab
Identify need for psychological services
[Sphere Minimum Standards, IASC Global Health Cluster FMT-WG Health Services Checklist]
Why is this needed?
Specialised field HR DM - comprehensive med rehab Ax
Interdisciplinary approach - acute, com & care coordination
Needs’ ax- patient complexity & follow-up
Local & rehabilitation staff training in PM&R
Ensure global & a longer-term approach
3.Nepal Earthquake 2015
4. Rehab FMTs- composition, specific focus, selffunded, independent, partnerships
Team Leader Response
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FMT registration with WHO- liaise with rehab sub-cluster
Daily surveillance reports & Exit reports for MoHP
Support desks at the airport- triage critical patients, basic initial symptomatic
management, referral- public hospitals or FMT
Medicine/Equipment Custom Release Help Desk - speedy release of drugs &
medical equipment brought in
Management of dead bodies - National Emergency Operation Center (NEOC),
MoHP– if required
Post Earthquake Hospital Based Disease Surveillance Trauma, ARI, watery
diarrhoea, bloody diarrhoea, fever, total OPD patients, total IPD patients & total
surgical cases (minor/major)
Post-Earthquake Disease Outbreak Surveillance- community
Logistics support- medicines, tents, water, transport, supplies etc.
Considerations
• Logistic cluster- no rehab physicians, few nurses, AH- be flexible/adapt as
needed
• Contact for Medivac, FMT-CC, Exit strategy
• National CBR plan- physical, assistive devices, psychosocial, shelter,
transport etc- work with partners, other stakeholders
• Gender issues
• Safety /security situation
• Environmental issues- H2O, sanitation, landslides
• Coordination & reporting
• Road access
• IDP situation
Leadership
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FMT recruitment, coordination, training etc
Team capacity building - local +FMT
Rehabilitation processes & organisation- liaise local team
Triage & prognosis (based on ASIA scores)
General ward set-up for operational ease
Models of care- CBR + partnerships
Systems of management of referrals, acute & CBR
Medical documentation & record keeping
Need for evidence-based practice
Field Conditions
• Logistics & security frame work
• Set up of local partnerships to operate in the best legal
conditions possible
• Transport & access to trauma care units with a clear mandate
& visibility prepared by the organization
• Formulated terms of reference that describe the task
required for the PRM team
Personal skills
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Good organizational skills
A resilient mindset & attitude - working environments
Prioritize personal security
Operational & logistical procedures
Flexibility to cope with varying workloads & requirements
Cultural sensitivity
Ideally- speak the local language
Activity Plan- outcomes
Discussion with local team re FMT expectations
Local unit priority- patient triage tool developed
Gaps identified
– Lack of rehabilitation processes, documentation, treatment
approaches & systems of care
– Integration with acute hospital (minimal documentation with
patient transfers)
– Limited resources/staff/IT
Specific request for teaching on rehab management
Clinical issues (SCI n=101)
Traumatic SCI
• Fracture management/bracing/ASIA scores
Disability management
• General medical stabilization, CCs
• Spinal shock, resp compromise, AD, paralytic ileus, neurogenic
bladder/bowel, HO etc
• Pain & spasticity care
• Mobilisation program/precautions
• Contractures & complications of immobility
• Closed head injury (concurrent if relevant)
• Diet, falls, pressure care etc
Gaps
Rehabilitation Medicine capacity, limited imaging & pathology
Lack of
• access to timely neurosurgical advice following spinal surgery
• electricity , beds (patients in corridors, even prior to 13th May EQ)
• procedural training for volunteers
• emergency packs in case of evacuation
• Glucometers, urine dipsticks, packaged saline for washing wounds
• Hand hygiene- disinfectant for staff/patients/visitors
Orthotics - more tools needed; no prefabricated devices
More supplies: gloves, dressings, tweezers, staple removers, torches
Appropriate wheelchairs & seating, pillows & pressure mattresses
Lessons Learnt
ISPRM -WHO Min Standards & Recommendations for Rehab in Emergencies:
Guidance Document for FMTs
Requirements for:
• FMT staffing configuration
• Standards for rehabilitation in outbreak response
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Disability inclusive response & accessibility
Deployment
Patient assessment & data collection
Referral & coordination mechanisms
Rehabilitation equipment & resource requirements
Research & development
Thank You
fary.khan@mh.org.au
Ackowledgements
Jim Gosney
Frederick Burkle III
DoHP Nepal
WHO rehab sub-cluster
Host - Amatya Family