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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 5-10

Preparedness among medical rehabilitation professionals for deployment to future disaster settings


1 Department of Rehabilitation Medicine, Royal Melbourne Hospital; Department of Medicine, Royal Melbourne Hospital, The University of Melbourne; Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia
2 Department of Rehabilitation Medicine, Royal Melbourne Hospital; Department of Medicine, Royal Melbourne Hospital, The University of Melbourne; Australian Rehabilitation Research Centre, Royal Melbourne Hospital; School of Public Health and Preventive Medicine, Monash University, Parkville, Victoria, Australia

Date of Submission10-Jan-2020
Date of Decision28-Jan-2020
Date of Acceptance10-Feb-2020
Date of Web Publication08-May-2020

Correspondence Address:
Dr. Su Yi Lee
Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Road, Parkville, Victoria 3052
Australia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jisprm.jisprm_2_20

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  Abstract 


Objective: To assess the preparedness among medical rehabilitation professionals for deployment to disaster settings and to establish a rehabilitation professional database for disaster training and deployment under the auspices of the International Society of Physical and Rehabilitation Medicine (ISPRM). Methods: A survey tool for preparedness for deployment to disaster settings was developed by the authors following approval from the Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ) and ISPRM. The link to the online survey was distributed by email to members through the RMSANZ and Central Office of ISPRM. Participants were registered rehabilitation professionals who were members of the RMSANZ and/or ISPRM. The survey was voluntary. Results: Of the 76 respondents, the majority (94%) were rehabilitation physicians, 72% had >10 years of experience in rehabilitation medicine, 63% expressed an interest in future deployment, and only 24% had some disaster management training in the past. Almost all who expressed an interest in deployment wanted to receive any relevant disaster management training and education before deployment; others were interested in potential opportunities and expectations in disaster management, mitigation, communication, team structure, and telemedicine utilization. Conclusion: Surveying a larger cohort of rehabilitation professionals and documentation of context-specific rehabilitation skills relevant to disaster settings are needed. Establishment of a database of rehabilitation professionals, willing to be deployed, should be considered to assist with the integration of the rehabilitation workforce within the World Health Organization Emergency Medical Team Initiative.

Keywords: Deployment, disaster, rehabilitation professionals, training


How to cite this article:
Lee SY, Amatya B, Galea MP, Khan F. Preparedness among medical rehabilitation professionals for deployment to future disaster settings. J Int Soc Phys Rehabil Med 2020;3:5-10

How to cite this URL:
Lee SY, Amatya B, Galea MP, Khan F. Preparedness among medical rehabilitation professionals for deployment to future disaster settings. J Int Soc Phys Rehabil Med [serial online] 2020 [cited 2020 Jul 9];3:5-10. Available from: http://www.jisprm.org/text.asp?2020/3/1/5/283936




  Introduction Top


A disaster is “a serious disruption of functioning of a community or a society causing widespread human, material, economic or environmental losses, which exceeds its ability to cope using its own resources,” as defined by the United Nations Office for Disaster Risk Reduction.[1] Natural and/or man-made disasters contribute to escalation in worldwide prevalence of disability.[2],[3] Globally, based on the 2010 global population estimates, approximately one billion people have disabilities.[3] Of these, 110–190 million people have significant difficulties, such as inability to ambulate, perform personal care, communicate, and/or participate in social activities or employment.[3] The annual human death toll from natural disasters is an estimated 100,000 deaths, whereas annual economic losses have increased 10-fold in the past four decades, to more than $100 billion. As expected, most disasters occur in developing nations with long-term negative consequences on their economy and development.[4]

Disasters commonly result in long-term physical disability secondary to traumatic brain injury, spinal cord injury, limb amputation, peripheral nerve injury/crush injury, or musculoskeletal injury. [1,5-7] Psychological problems such as posttraumatic stress disorder may affect an individual's functional capacity and interfere with quality of life or societal participation.[8],[9] With increasing frequency of disasters worldwide, there is a greater emphasis and need for rehabilitation medicine in disaster management.[4] The World Health Organization (WHO) defines rehabilitation as “a set of interventions designed to optimise functioning and reduce disability in individuals with health conditions (disease-acute or chronic, disorder, injury or trauma) in interaction with their environment.”[10] The WHO has undertaken different initiatives, including emergency response frameworks, coordination mechanisms, emergency medical team (EMT) accreditation process, and integrating medical rehabilitation professionals into EMTs. It acknowledges the importance of rehabilitation-inclusive disaster management plans from the acute phase to long-term care in the community and collaboration with local health services for a sustainable and comprehensive continuum of care.[11],[12] Health research literature on disaster management addresses the traditional disaster cycle (preparedness, response, recovery, and mitigation phases) and emphasizes the importance of rehabilitation in each step of this cycle.[5],[13]

Considering that local health services can be overwhelmed in large-scale disasters, it is not surprising that limited workforce capacity, particularly the availability of medical rehabilitation professionals can compromise disaster management. The role of a rehabilitation professional is crucial in any disaster setting and needs to be integrated within disaster management. It is a complex role and responsibility and requires a multi-faceted mix of skills and training.[4] The skills and competencies of rehabilitation professionals are pivotal to the effective delivery of care and the empowerment of consumers within the community.[14] Unfortunately, rehabilitation services are not considered a high priority compared with acute medical services in disaster events. This is true not only in developing countries, where rehabilitation services are underdeveloped, but also in developed countries such as Australia, despite a strong medical rehabilitation workforce.[4]

Although there is recognition of limited rehabilitation skilled workforce in disaster settings, to date, there has been no assessment of preparedness and/or willingness of medical rehabilitation professionals for deployment to future disasters. Further, to our knowledge, there is no registry or database of qualified medical rehabilitation professionals, capable and/or willing to be deployed or trained in rehabilitation aspects of disaster medicine. In previous disasters, many EMTs did not include rehabilitation personnel (in particular rehabilitation physicians), and the rehabilitation specialized teams/cells that were deployed, worked individually and/or in “silos.”[7] Specific data are needed to assess the skill base of the rehabilitation workforce, and its capacity to deliver effective rehabilitation care in disaster settings to ensure services and skills meet demand. Besides, documentation of context-specific rehabilitation skills and capacity would assist in estimating the unmet need for service provision for disaster survivors, as well as for planning, setting priorities for education and training, mobilizing resources and advocacy to government.

The objective of this project was to pilot a survey tool to gain insight from rehabilitation professionals who are members of the Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ) and International Society of Physical and Rehabilitation Medicine (ISPRM). The information obtained can help establish an ISPRM database of rehabilitation professionals who are willing and prepared for deployment to disaster settings. This process could run parallel to the WHO-EMT initiative, so that if requested, the ISPRM could assist WHO in suggesting regional trained personnel for deployment.


  Methods Top


Design

An exploratory pilot study using an online survey.

Participants and settings

This study was conducted under the auspices of the RMSANZ and ISPRM. Written approvals were obtained from the Presidential Cabinets of the RMSANZ and ISPRM before the commencement. A letter of endorsement was obtained from the Human Research Ethics Committee of Melbourne Health. The surveys were distributed by RMSANZ and ISPRM through E-mail, using the Survey Monkey Tool online survey software (surveymonkey.com). Participants were registered medical rehabilitation professionals and other health-care professionals who were members of either one or both societies. All participant demographics and other information were already registered in RMSANZ and ISPRM databases. The completion of this survey was voluntary. Hence, completing and returning the survey implied consent.

Data collection

As no previous survey instruments were available to obtain the required information, a situational analysis survey tool specific for rehabilitation [Appendix 1] was developed by the authors, with input from members of the Disaster Rehabilitation Special Interest Group (DR-SIG) of the RMSANZ and the Disaster Rehabilitation Committee (DRC) of the ISPRM (all authors are members of the DR-SIG and DRC). This pilot survey tool was designed to provide a cross-sectional assessment of preparedness and willingness among medical rehabilitation professionals for deployment to future disaster settings and to assess their needs for training and education for the deployment to disaster settings (if needed). The content of this survey included questions about identity, demographics, contact details, geographic regions, professional groups (e.g. medical rehabilitation specialist or other health-care professionals), years of training in rehabilitation, past experience and interest in deployment to future disaster settings, and presence of medical condition or disability that requires special consideration. An open-ended section of the questionnaire provided respondents with an opportunity to supply information in regard to the preferred type of training and/or education before deployment. Participants were also asked if they are willing to share their data with the RMSANZ and ISPRM in future.

Data analysis

All participants identification and information remained confidential. The original and identifiable data were owned by the RMSANZ-DR SIG and ISPRM-DRC. Deidentified data were used by authors for the purpose of this publication. The data were secured and filed in the Department of Rehabilitation Medicine at Royal Melbourne Hospital, Australia, and opened only at the time of data entry into a special password-protected study database (by an independent data entry officer). A primary database was created, which included information obtained from participants. Only the authors had access to this database.

All data were collated using the content analytical technique. Three authors (Su Yi Lee, Bhasker Amatya, and Fary Khan) scrutinized each response and coded the information using a line-by-line process. The deidentified data were entered twice to avoid errors on data entry. Microsoft Excel was used for data entry and analyses. Descriptive analyses were used to make comparisons by geographic regions, professional groups (e.g. rehabilitation physician, or other health-care professionals), years of training in rehabilitation, past experience, and interest in deployment to future disaster settings.


  Results Top


Of the 5309 members of the RMSANZ and ISPRM approached for the study, only a total of 76 participants completed the survey (1.4%). The majority of participants were from Australia (n = 44; 57.9%). Other participants were from New Zealand (n = 5; 6.6%), United States of America (n = 5; 6.6%), Belgium (n = 2; 2.6%), Malaysia (n = 2; 2.6%), and other countries as listed in [Figure 1]. The majority of respondents were rehabilitation physicians (n = 71; 94%), while other participants included allied health professionals, e.g. physiotherapist (n = 4; 5%) and others, e.g. researcher (n = 1; 1%). Most participants (72%) worked in government-funded public health institutions, 15% in the private sector, 5% in both public and private sectors, and 8% in other institutions such as community organizations.
Figure 1: Number of participants from different countries (n = 76) (n = number; % = percentage)

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Qualifications and experience

In regard to experience, 72% of survey participants had ≥10 years of experience in their rehabilitation specialty. Level of education varied, with 54% completing a degree in their respective profession, 24% master's degree, and 22% doctorate.

Deployment to disaster settings

Experience and interest

Three-quarters (75%) of the participants had previously been deployed to a disaster setting, and 63% expressed interest in future deployment to disaster settings. For “readiness” notice before deployment, 53% of participants required ≥7 days' notice, 24% needed 4–7 days, and 23% required 0–3 days' notice before deployment.

Disaster management training

Training and education are important before deployment to disaster settings. Less than a quarter (24%) of survey participants had received disaster management training in the past. Types of training included emergency medicine, disaster preparedness and response, advanced life support skills, trauma management skills, etc. The majority of participants preferred to receive training and education before deployment. Most felt that any relevant training related to disaster management would be useful. [Box 1] shows the types of training and education requested by participants.



Special requirements and medical needs

Sixty-four (86%) respondents reported no need for special requirements (e.g. physical limitations, vaccination) or personal medical needs (e.g. medications) during deployment to disaster settings. Fourteen percent of respondents had special needs, which were related to physical impairments, health-related limitations (e.g. poor endurance, cardiovascular limitations), and special dietary requirements.


  Discussion Top


This pilot study used a structured survey tool to gain insight from rehabilitation professionals, mainly rehabilitation physicians, regarding their preparedness and willingness for future deployment to disaster settings. Although there was a very low response rate, the survey provided valuable information on the years of experience of rehabilitation professionals in their respective profession, level of education, experience and interest in deployment to disaster settings, required readiness notice, previous disaster management training, preferred types of training and education before deployment, and special requirements/medical needs, including vaccination status. The tool also serves as an efficient way of assessing training and education needs among rehabilitation professionals in the delivery of rehabilitation care in disaster settings. Despite the distribution of the surveys to all members of RMSANZ and ISPRM, it was voluntary, and the low response rate of only 1.4% may be due to the lack of interest in disaster management or future deployment to disaster settings among rehabilitation professionals. Most of the survey participants were from Australia (57.9%), which is located in a region known for natural disasters. While 63% of participants expressed interest in future deployment to disaster settings, only 24% had already received some form of disaster management training in the past. Understanding the participants' preferred training and education before deployment is important for future disaster preparedness planning.

It is recognized that strengthening and building rehabilitation capacity through education and training are important in expanding a skilled rehabilitation workforce, for service provision, governance, and awareness of rehabilitation.[15] In response to sudden-onset disasters, the ISPRM-DRC can play a crucial role in organizing, managing, and coordinating both national and international rehabilitation teams (EMTs or specialized rehabilitation cells), in liaison with the WHO, to ensure a rapid, professional, and coordinated response.[16] Information obtained from this study could form the core of a database of rehabilitation professionals who are willing and prepared to undergo training and deployment if requested by the WHO and could be either embedded in acute EMTs or deploy as independent specialized cells on request. However, it is important to consider that visa regulations might differ for health-care professionals from different countries; therefore, it might present as a barrier during disaster response with difficulty obtaining visa approval in such short notice. Hence, this signifies the leadership role of the ISPRM and DRC in future disasters for the management of logistics of the EMT.[16]

In addition, the database may assist the ISPRM (in coordination with WHO EMT) to ensure that all rehabilitation physicians registered in the database comply with the accreditation process and requirements before deployment.[16] The ISPRM-DRC could facilitate and coordinate regional disaster management training and trauma simulation programs, host workshops, symposia, online education modules, and special sessions in national and international scientific meetings. In addition, the committee could develop evidence-based clinical practice guidelines for disaster-related injuries, as well as standardized measurement tools for data collection in disaster settings.[16] Recent capacity building in health-related rehabilitation services for health emergency responses reinforced strengthening rehabilitation capacity in health systems, with competencies and contributions to primary care, as priorities.[17]

Study limitations

The total number of participants (n = 76) in this study represents only a small proportion of rehabilitation professionals across the world. However, it provides an indication of the level of interest in disaster rehabilitation worldwide and provides a baseline for strategies to promote this field within the profession so that it can be integrated within EMTs. The survey was designed by the authors and was not validated before use. However, the authors are experienced rehabilitation professionals and members of the DR-SIG of the RMSANZ and DRC of the ISPRM. The responses to the survey may be used as a basis for refining the tool before its being used again in future. No specific hypotheses were tested, as the purpose was to obtain information. Finally, most participants were from Australia, this is not surprising since the Asia-Pacific region remains the hotspot for disasters. The uneven geographical distribution of rehabilitation respondents may have resulted in missed views, which may also limit the generalizability and validity of findings. A purposeful random sampling method would have been ideal to minimize selection bias; however, this was beyond the authors' authority and the scope of this pilot study. Further research should include a larger cohort of rehabilitation professionals from a wide range of geographical locations using random or other sampling methods that can represent the general views of rehabilitation professionals globally.


  Conclusion Top


This study uses a survey to gather information on the preparedness and willingness of medical rehabilitation professionals for deployment to future disasters. It assessed the capacity for training and education needs of rehabilitation professionals for mobilizing resources in disaster settings, planning appropriate care delivery, and advocacy. The establishment of an ISPRM database of trained deployable rehabilitation professionals could assist in the integration of rehabilitation workforce within the WHO-EMT initiative. Further studies, with larger cohort of rehabilitation professionals, documentation of context-specific rehabilitation skills/capacity for estimating unmet needs disasters should be a priority.

Acknowledgment

We thank the Disaster Rehabilitation Committee of the International Society of Physical and Rehabilitation Medicine and the Disaster Rehabilitation Special Interest Group of the Rehabilitation Medicine Society of Australia and New Zealand for their support. The views expressed in this article are solely those of the authors and not of the above-mentioned committees.

Financial support and sponsorship

This study was conducted by the Department of Rehabilitation Medicine, Royal Melbourne Hospital, Australia.

Conflicts of interest

There are no conflicts of interest.

Appendix1: (Authors' information removed)



Preparedness for Rehabilitation Staff Deployment Questionnaire

Contacts: Su Yi Lee, Bhasker Amatya, Mary Galea, Fary Khan

Royal Melbourne Hospital, Parkville, Victoria, Australia.

Tel.: 03 83872146, E.mail: SuYi.Lee@mh.org.au

Dear Colleague,

Thank you for participating in this survey. The aim of this survey is to understand your willingness and preparedness for deployment to future disasters to assist and provide rehabilitation needs of disaster victims.

Your input and suggestions will help us to create a database of rehabilitation personnel for deployment, and capacity for training/

education of rehabilitation workforce in disaster and austere settings.

Thank you for your time and contribution.

Preparedness for Rehabilitation Staff Deployment Questionnaire



Signature: ___________________________ Date: DD/MM/YYYY

Please e-mail, fax or post to:

Dr. Su Yi Lee

Bld-21 Royal Park Campus, Royal Melbourne Hospital, 34-54 Poplar road,

Parkville, Victoria 3052, Australia.

Tel. +61 (03) 83872146; Fax.: +61 (03) 83872222 E-mail: SuYi.Lee@mh.org.au

Thank you for taking your time in completing this survey



 
  References Top

1.
United Nations International Strategy for Disaster Reduction. 2009 UNISDR Terminology on Disaster Risk Reduction; 2009. Available from: https://www.unisdr.org/files/7817_UNISDRTerminologyEnglish.pdf. [Last accessed on 2019 May 19].  Back to cited text no. 1
    
2.
World Health Organization. Bulletin of the World Health Organization; 2017. Available from: https://www.who.int/bulletin/volumes/95/2/15-157024/en/. [Last accessed on 2019 May 19].  Back to cited text no. 2
    
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World Health Organization and World Bank. World Report on Disability; 2011. Available from: https://www.who.int/disabilities/world_report/2011/report.pdf. [Last accessed on 2019 May 19].  Back to cited text no. 3
    
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Khan F, Amatya B. Rehabilitation Medicine Critical to Disaster Relief; 2016. Available from: https://www.doctorportal.com.au/mjainsight/2016/33/rehabilitation-medicine-critical-to-disaster-relief/. [Last accessed on 2019 May 19].  Back to cited text no. 4
    
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Khan F, Amatya B, Rathore F, Galea M. Medical rehabilitation in natural disasters in the Asia-Pacific region: The way forward. Int J Nat Disaster Health Secur 2015;2:6-12.  Back to cited text no. 5
    
6.
Reinhardt JD, Li J, Gosney J, Rathore FA, Haig AJ, Marx M, et al. Disability and health-related rehabilitation in international disaster relief. Glob Health Action 2011;4:7191.  Back to cited text no. 6
    
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Amatya B, Galea M, Li J, Khan F. Medical rehabilitation in disaster relief: Towards a new perspective. J Rehabil Med 2017;49:620-8.  Back to cited text no. 7
    
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Xu J, Wu Z. One-year follow-up analysis of cognitive and psychological consequences among survivors of the Wenchuan earthquake. Int J Psychol 2011;46:144-52.  Back to cited text no. 8
    
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Dai W, Wang J, Kaminga AC, Chen L, Tan H, Lai Z, et al. Predictors of recovery from post-traumatic stress disorder after the dongting lake flood in China: A 13-14 year follow-up study. BMC Psychiatry 2016;16:382.  Back to cited text no. 9
    
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World Health Organization. Rehabilitation in Health Systems; 2017. Available from: https://apps.who.int/iris/bitstream/handle/10665/254506/9789241549974-eng.pdf?sequence=8. [Last accessed on 2019 May 19].  Back to cited text no. 10
    
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World Health Organization. Emergency Medical Teams: Minimum Technical Standards and Recommendations for Rehabilitation; 2016. Available from: https://extranet.who.int/emt/sites/default/files/MINIMUM%20TECHNICAL%20STANDARDS.pdf. [Last accessed on 2019 May 19].  Back to cited text no. 11
    
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World Health Organization. WHO's Six Year Strategic Plan to Minimize the Health Impact of Emergencies and Disasters; 2015. Available from: https://www.who.int/hac/ercm_strategic_plan_web.pdf?ua=1. [Last accessed on 2019 May 19].  Back to cited text no. 12
    
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Rathore FA, Gosney JE, Reinhardt JD, Haig AJ, Li J, DeLisa JA. Medical rehabilitation after natural disasters: Why, when, and how? Arch Phys Med Rehabil 2012;93:1875-81.  Back to cited text no. 13
    
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Disability and Rehabilitation Research Unit. Competencies for Community Rehabilitation in Queensland. Meadowbrook, Queensland; 2006.  Back to cited text no. 14
    
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Gutenbrunner C. ISPRM-WHO-Liaison Committee (ISPRM-WHO-LC). ISPRM-WHO-Liaison Committee (ISPRM-WHO-LC); 2019. Available from: http://www.isprm.org/collaborate/who-isprm/. [Last accessed on 2019 May 19].  Back to cited text no. 15
    
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Amatya B, Lee SY, Galea M, Khan F. Disaster rehabilitation response plan: now or never. Am J Phys Med Rehabil 2020;99:170-7.  Back to cited text no. 16
    
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Llewellyn G. World Health Organization Collaborating Centre (WHOCC) for Strengthening Rehabilitation Capacity in Health Systems. Available from: https://sydney.edu.au/medicine-health/our- research/research-centres/who-collaborating-centre-for-strengthening- rehabilitation-capacity-in-health-systems.html. [Last accessed on 2019 Jul 08].  Back to cited text no. 17
    


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