Disability and health-related rehabilitation in international disaster relief

Abstract

BackgroundNatural disasters result in significant numbers of disabling impairments. Paradoxically, however, the traditional health system response to natural disasters largely neglects health-related rehabilitation as a strategic intervention.ObjectivesTo examine the role of health-related rehabilitation in natural disaster relief along three lines of inquiry: (1) epidemiology of injury and disability, (2) impact on health and rehabilitation systems, and (3) the assessment and measurement of disability.DesignQualitative literature review and secondary data analysis.ResultsAbsolute numbers of injuries as well as injury to death ratios in natural disasters have increased significantly over the last 40 years. Major impairments requiring health-related rehabilitation include amputations, traumatic brain injuries, spinal cord injuries (SCI), and long bone fractures. Studies show that persons with pre-existing disabilities are more likely to die in a natural disaster. Lack of health-related rehabilitation in natural disaster relief may result in additional burdening of the health system capacity, exacerbating baseline weak rehabilitation and health system infrastructure. Little scientific evidence on the effectiveness of health-related rehabilitation interventions following natural disaster exists, however. Although systematic assessment and measurement of disability after a natural disaster is currently lacking, new approaches have been suggested.ConclusionHealth-related rehabilitation potentially results in decreased morbidity due to disabling injuries sustained during a natural disaster and is, therefore, an essential component of the medical response by the host and international communities. Significant systematic challenges to effective delivery of rehabilitation interventions during disaster include a lack of trained responders as well as a lack of medical recordkeeping, data collection, and established outcome measures. Additional development of health-related rehabilitation following natural disaster is urgently required.

Medical Rehabilitation in Natural Disasters in the Asia-Pacific Region: The Way Forward

“…Due to advances in response, rescue and field management, emergency/surgical and medical care (including infection control) in many disasters, there has been authoritative transition worldwide from high mortality to a significant increase in morbidity rates [13]. The disaster victims are surviving at relatively higher rates, however, many have a range of long-term severe physical and psychological injuries which impact their quality of life.…”

“…Primary goals of medical rehabilitation include management of acute injury, optimization of functional capabilities (including physical, cognitive, neuropsychological function) and social re-integration [14]. Rehabilitation in disaster setting includes: assessment of injury patterns, needs and resource requirements (including long-term); establishment of patient triage, discharge, referral, and tracking systems; collaboration with other healthcare service providers; coordination with emergency response systems, host health system and government managers; and data collection, management and analysis [13,14]. Long-term rehabilitation planning is critical for community recovery where services should be accessible, and include general health maintenance [2,14].…”

“…Despite significant improvements in the coordination and organization of acute care services in emergency responses worldwide, this has not extended to include rehabilitation services [13]. Acute medical response in disaster settings focuses on saving lives and acute injuries get much of the attention, while rehabilitative needs are often neglected [2,14,22].…”

“…Improving or restoring physical and psychosocial abilities is a key issue in rehabilitation of disaster victims, and rehabilitation approaches should include a spectrum of treatments and interventions [13,14]. The role of the PRM physician is critical in disaster settings to coordinate the post-disaster rehabilitation needs and management of victims [13].…”

“…The role of the PRM physician is critical in disaster settings to coordinate the post-disaster rehabilitation needs and management of victims [13]. Earlier experiences in disaster zones have raised awareness and need for inclusion of rehabilitation in response and planning for humanitarian catastrophes [18,25].…”