Role of PRM doctors and therapists
interacting with NGO's in disaster
relief and challenging settings :
Handicap International perspective.
Rehab Disaster Relief Symposium:
Where is rehabilitation disaster relief going?
19th June 2013
Presenter : Susanne Nielsen , PT
Authors : Jacquemin Geraldine , MD, FRCPC, MPH
Eric Weerts, Technical Referent Handicap International1
Why is this topic of interest?
 An increase of involvement of rehabilitation
professionals in the aftermath of disasters
 Need for specialised human resources on the
field
 Address the complexities
 Better scientific documentation
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Unique needs for PRM
Interdisciplinary approach in emergency
context must start early as possible
Coordination of care activities
Local health and rehabilitation staff
needs training in PRM concepts
Anticipation of long term needs of
severely injured survivors
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Handicap International’s
work in disaster context
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Disaster Relief: Where do HI intervene
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Sudden onset of natural phenomenon such as
tropical storms , tsunamis , earthquakes, etc
Armed conflicts with high number of injured
victims
General population affected indirectly by manmade conflicts
Disaster / conflict setting that can not cope
with the needs to care for the victims
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Field conditions:
Starting up a rehabilitation
program in an emergency
context
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Field conditions
Logistics and security frame work
Set up of local partnership ASAP to operate in
the best legal conditions possible
Transport and access to trauma care units
with a clear mandate and visibility prepared
by the organization
Formulated terms of reference that describe
the task required for the PRM
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Basic Roles for PRM
• Ensure global and long term approach
• Act as a link between surgical/acute and rehab
teams
• Assess in-depth the medical aspects of
rehabilitation medicine
• Provide direct technical assistance in
constituting adapted protocols that allow
physical rehabilitation programs to function
optimally within the context
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Role of PRM in the transfer of
knowledge
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• Participate in training of rehab team and non rehab staff
• Direct assistance in care techniques not known by the
mainstream trauma team
• Management of complex trauma cases
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• Assist team in diagnosis of complicated cases
Needed profile and skills of PRM
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Skills and knowledge
PRM with practical record in the field of severe
trauma : amputations , neuro trauma , poly trauma
Senior provider of knowledge and insight in
rehabilitation medicine
Team management skills
Understanding and skills of project / activity
management
Ability to connect the missing links in the clinical
information that is available to them at the
moment of intervention and within the context
Ability to enhance and predict as early as possible
the needed rehabilitation pathway for the patient
and patient groups.
+/-
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Skills and knowledge – cont.
+/For the continuum of care the PRM needs the
ability to be the key provider of information,
background information and supervision of this key
process.
Personal skills and attitudes that take into account
and respect the customs and local culture the PRM
is working in.
Accepting that PRM skills and roles may not always
be well understood and seen as a primary need in
the rehabilitation process of that specific cultural,
social and clinical setting .
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Personal Skills
• A mindset and attitude resilient towards
insecure working environment
• Need for prioritizing personal security
• Respect for operational and logistical
procedures .
• Ability to cope with varying workloads
• Flexibility in the team approach
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Challenges encountered (1)
Experience and local board accreditation in
management of:
PRM should be able to work with plaster casts and
wound debridement
Check ‘’ hands on ‘’quality of neurogenic bladder
management (water column cysto , bladder
pharmacopeia)
Functions in ICU setting ( suction , wound care
follow-up , small surgery procedures ).
 This might be not well accepted according to
the inter-professional standards .
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Challenges encountered (2)
• To provide direct technical assistance in constituting
adapted protocols that allow physical rehabilitation
programs to function optimally: pain protocol, anti
biotherapy, infection prevention, continence
management for neurogenic conditions,
comprehensive wound care …
 Common professional standards dictate that
some of these skills are to be performed by
other specialists but nevertheless needed in
emergencies
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Challenges encountered (3)
There is a need to define what skills and
procedures PRM can perform in these
exceptional circumstances
Personal responsibility and liability in this case
might be engaged
Handicap International recognizes this ‘’grey
zone ‘’ and would welcome positioning from
ISPRM in this field
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Team approach in physical
rehabilitation
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• Ideally the PRM should be team leader of the most common
profiles Handicap International is working with :
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Physiotherapists
Occupational therapists
Social workers
Psychologists
Although these profiles are not present at once in the timeline
of projects ( 5 – 8 months ) , the PRM needs to ‘’ bridge ‘’ their
absence by increasing of task sharing and coaching of the team
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Examples of PRM assignements
within Handicap International
projects
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• Assessment of needs mission in Emergency context (Haiti )
• Acting team leader of rehabilitation program in Trauma
hospital (Syria)
• Trainer of special rehabilitation skills to doctors , surgeon ,
nurses, PT, OT (Vietnam)
• Adviser on training curriculum for Therapist’s specialities
(Haiti, Cambodia)
• Monitoring and evaluation of activity outcomes with
complex trauma : SCI , burn wounds, multiple trauma
(Congo RDC)
• Drafting field protocols for disaster preparedness (Nepal)
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Conclusion
PRM specialists are a key human resource in
disaster setting.
Their specific skills and know-how should be placed
within the available rehabilitation teams made up
of physical therapists , occupational therapists,
psychologists and nurses during an emergency.
Special efforts should be done to identify the
needed skills of a PRM and allow these skills to be
used on the field and the team setting beyond the
pure medical standard of operations.
ss
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Thank you
Contact:
Eric Weerts
Technical Referent Emergency
and Rehabilitation
Email: eric.weerts@handicap.be
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