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Akbaş E, Akbaş A, Usgu S, Bayramlar K. Analysis of amputations occurring in the earthquakes centered in Kahramanmaraş: Adıyaman experience. INTERNATIONAL ORTHOPAEDICS 2024; 48:2513-2518. [PMID: 39164517 DOI: 10.1007/s00264-024-06280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/14/2024] [Indexed: 08/22/2024]
Abstract
PURPOSE Amputations are a common surgical procedure resulting from trauma during earthquakes, leading to severe disability. This study aims to investigate surgical outcomes specific to amputations that occurred in Adıyaman after the Kahramanmaraş earthquakes. METHODS This descriptive study included amputees who presented to Adıyaman University Training and Research Hospital. Between March 6, 2024 and March 29, 2024, amputees were contacted by phone and asked the questions in the form. Data analyzed included demographic information, number and level of amputated extremities, phantom limb pain, stump infection, extrication time, time to initiation of rehabilitation, number of revision, and whether a prosthesis was fitted. RESULTS The study reached 75 amputees. The mean age was 37.9 ± 19.2, and the most frequently amputated age group was adults. Stump infection was observed in 40 amputees (53.3%), phantom limb pain in 47 (62.6%), and revision in 29 (38.7%). The median extrication time was 36 h and initiation of rehabilitation time was 45 days. It was noted that 35 amputees (62.5%) used prostheses. A statistically significant relationship was found between fasciotomy and stump infection (p = .000). Infection was detected in 65% of those who underwent fasciotomy. CONCLUSION Earthquake-related amputations most frequently affected the adult age group and primarily involved lower extremity amputations, such as transfemoral and transtibial amputations. Phantom limb pain, need for revision, and infection are common in earthquake-induced amputations. Delayed fasciotomy increases the risk of stump infection. The data obtained in this study will help plan local health services to coordinate amputation care in disasters.
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Affiliation(s)
- Esin Akbaş
- Adıyaman University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Adıyaman, Turkey.
| | - Abuzer Akbaş
- Adıyaman Training and Research Hospital, Physical therapy unit, Adıyaman, Turkey
| | - Serkan Usgu
- Hasan Kalyoncu University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gaziantep, Turkey
| | - Kezban Bayramlar
- Hasan Kalyoncu University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gaziantep, Turkey
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Ata AM, Borman P, Bilir EE, Alemdaroğlu E, Tezen Ö, Söyler O, Yaşar E. The effect of medium-tension bandage and stump stocking on residual limb maturation in earthquake survivors. Prosthet Orthot Int 2024:00006479-990000000-00252. [PMID: 38775756 DOI: 10.1097/pxr.0000000000000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 03/14/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Residual limb maturation is a crucial stage in postamputation care. OBJECTIVE It was aimed to examine the effect of medium tension bandages and stump stockings on postamputation stump maturation in patients who underwent lower extremity amputations. STUDY DESIGN In this prospective observational study, patients who were earthquake survivors and had undergone emergency amputation of their lower extremities were included. METHODS Medium-tension elastic bandage or personalized stump stockings were used for stump maturation. Residual limb volume was measured once a week for 3 weeks. RESULTS The study included 23 patients and 29 amputated limbs. Because of the larger stump volume of transfemoral amputations and the higher number of these patients in the stocking group ( p < 0.001), the stump volume differed across groups before and during the follow-up ( p < 0.001). There was no difference in mean volumetric measurement between the bandage and stocking groups over time ( p = 0.272). Although the group interaction was significant (p < 0.001), the group × time interaction was not ( p = 0.306). CONCLUSION Medium-tension bandages and stump stockings had a similar effect on postamputation stump maturation in patients with lower extremity amputations. So, depending on the patient's and physician's preferences, both procedures can be used for stump maturation.
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Affiliation(s)
- Ayşe Merve Ata
- Ankara Bilkent City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Pınar Borman
- Ankara Bilkent City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Emine Esra Bilir
- Ankara Bilkent City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Ebru Alemdaroğlu
- Ankara Bilkent City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Özge Tezen
- Ankara Bilkent City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
| | - Osman Söyler
- European University of Lefke, Northern Cyprus, Mersin, Turkey
| | - Evren Yaşar
- Ankara Bilkent City Hospital, Physical Therapy and Rehabilitation Hospital, Ankara, Turkey
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Whittaker G, Wood GA, Oggero G, Kett M, Lange K. Meeting AT needs in humanitarian crises: The current state of provision. Assist Technol 2021; 33:3-16. [PMID: 34951828 DOI: 10.1080/10400435.2021.1934612] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Humanitarian coordination systems increasingly recognize and aim to respond to the needs of people with disabilities within populations affected by crises, spurred on by the UN Convention on the Rights of Persons with Disabilities (CRPD) which was adopted in 2006. Many agencies state their aim to meet the requirements of the CRPD using a "twin track" approach: ensuring the inclusion of people with disabilities in mainstream provision, alongside targeted support for their needs, which may include the need for Assistive Technology (AT). However, there is very little evidence of AT provision in humanitarian settings, which is a specific and urgent need for many people including the elderly and people with disabilities, and an implicit requirement of Article 11 of the CRPD and World Health Assembly resolution on improving access to assistive technology. There is also little evidence of effective mechanisms for AT provision in humanitarian settings. This is despite high and growing levels of unmet AT need in crises, and despite the legally binding requirement in the CRPD to provide AT for those who need it. AT provision faces unique challenges in humanitarian settings. This paper discusses the evidence available in the literature for the scale and quality of AT provision interventions in crises, and what is known about the challenges and facilitators of provision. We conducted a search of the academic literature and retained literature that reported on any form of AT provision following crisis, where international humanitarian response was in place, published in English between January 2010 and June 2020. We found very few examples in that academic literature of systematic and coordinated AT provision at the acute stage of crisis, and even less in the preparedness and post-acute stages. However, it is difficult to assess whether this is the result of insufficient academic attention or reflects a lack of provision. The small body of academic literature that describes AT provision in humanitarian settings paints a picture of small-scale provision, specialized to single types of impairments, and delivered by predominantly by NGOs. We also conducted a search of the gray literature, using the same inclusion criteria, in two countries: Afghanistan and South Sudan (case studies forthcoming). This gray literature provided supplementary evidence of the types of AT providers and AT provision available in those protracted crises. There are very few examples of how AT services can be scaled up (from a very low baseline) and maintained sustainably within a strengthened health system. The literature also describes more examples of provision of assistive products for mobility over assistive products for other impairments. If the paucity of literature on AT provision in humanitarian settings is a reflection of the scale of provision, this implies a deficiency in humanitarian response when it comes to providing people with AT needs with the essential products and services to which they have a right, and which will enable their access to basic, life-saving assistance. We conclude by providing recommendations for urgent actions that the AT and humanitarian community must take to fill this critical gap in the provision of essential products and services for a potentially marginalized and excluded group.
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Affiliation(s)
- Golnaz Whittaker
- Humanitarian Section, UNICEF Office of Research Innocenti, Florence, Italy
| | - Gavin Adam Wood
- Humanitarian Section, UNICEF Office of Research Innocenti, Florence, Italy
| | - Giulia Oggero
- Access to Assistive Technology and Medical Devices Unit, WHO, Geneva, Switzerland
| | - Maria Kett
- Institute of Epidemiology and Healthcare, UCL, London; and Global Disability Innovation Hub, London, UK
| | - Kirstin Lange
- Disability Section, Programme Division, UNICEF, New York, USA
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[Expert consensus on on-site medical rescue and transfer of children in an earthquake]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:391-395. [PMID: 32434630 PMCID: PMC7389387 DOI: 10.7499/j.issn.1008-8830.2003104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/10/2020] [Indexed: 06/11/2023]
Abstract
Children, as a special vulnerable group, are more susceptible to severe physical injury and psychological trauma in an earthquake. The Pediatric Disaster Branch of Chinese Pediatric Society of Chinese Medical Association and the Pediatric Branch of Chinese People's Liberation Army formulated the expert consensus on on-site medical rescue and transfer of children in an earthquake. The consensus introduces the treatment principles and precautions of on-site treatment and subsequent transfer for children in an earthquake, in order to better serve children in this emergency.
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Mousavi G, Khorasani-Zavareh D, Ardalan A, Khankeh H, Ostadtaghizadeh A, Kamali M, Raissi G. Continuous post-disaster physical rehabilitation: a qualitative study on barriers and opportunities in Iran. J Inj Violence Res 2019; 11:35-44. [PMID: 30635998 PMCID: PMC6420917 DOI: 10.5249/jivr.v11i1.1036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 11/03/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Internationally, inclusion of physical rehabilitation services during early disaster response is relatively new. The aim of the study was to gain an understanding of disaster relief physical rehabilitation in Iran. METHODS A qualitative study design was employed and sixteen semi-structured interviews were conducted for data collection. Content analysis was used for data analysis. The participants in this study were purposively selected among people who experienced the Bam (2003) and Varzaghan (2012) earthquakes. RESULTS Three main themes were explored including: indispensable intervention, barriers to continuous intervention and opportunities for intervention. Almost all participants reiterated the importance of effective physical rehabilitation services during disasters. Some participants mentioned significant barriers for delivering such services in the context of Iran. The lack of an effective responsible body, weak disaster-related competencies and under-prioritization by government were among other barriers. On a more positive note, some interviewees talked about national programs that could facilitate service delivery. CONCLUSIONS Providing disaster relief physical rehabilitation has faced many barriers in Iran. However, there are some facilitators in the country that could help provide these services. Finally, the feasibility of post-disaster physical rehabilitation services delivery completely depends on the current national rehabilitation system.
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Affiliation(s)
| | | | - Ali Ardalan
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. .
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Mills JA, Gosney J, Stephenson F, Skelton P, Norton I, Scherrer V, Jacquemin G, Rau B. Development and Implementation of the World Health Organization Emergency Medical Teams: Minimum Technical Standards and Recommendations for Rehabilitation. PLOS CURRENTS 2018; 10:ecurrents.dis.76fd9ebfd8689469452cc8c0c0d7cdce. [PMID: 30050723 PMCID: PMC6050053 DOI: 10.1371/currents.dis.76fd9ebfd8689469452cc8c0c0d7cdce] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Emergency medical teams provide urgent medical and surgical care in emergencies characterized by a surge in trauma or disease. Rehabilitation has historically not been included in the acute phase of care, as teams have either not perceived it as their responsibility or have relied on external providers, including local services and international organizations, to provide services. Low- and middle-income countries, which often have limited rehabilitation capacity within their health system, are particularly vulnerable to disaster and are usually ill-equipped to address the increased burden of rehabilitation needs that arise. The resulting unmet needs for rehabilitation culminate in unnecessary complications for patients, delayed recovery, reduced functional outcomes, and often impede return to daily activities and life roles. Recognizing the systemic neglect of rehabilitation in global emergency medical response, the World Health Organization, in collaboration with key operational partners and experts, developed technical standards and recommendations for rehabilitation which are integrated into the WHO verification process for EMTs. This protocol report presents: 1) the rationale for the development of the standards and accompanying recommendations; 2) the methodology of the development process; 3) the minimum standards and other significant content included in the document; 4) challenges encountered during development and implementation; and 5) current and next steps to continue strengthening the inclusion of rehabilitation in emergency medical response.
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Affiliation(s)
- Jody-Anne Mills
- Rehabilitation Team, Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - James Gosney
- Eastern Virginia Medical School, Norfolk, United States of America
| | - Fiona Stephenson
- Service Manager, Livability Spinal Injury Centre, United Kingdom
| | - Peter Skelton
- Rehabilitation Project Manager, Handicap International United Kingdom, London
| | - Ian Norton
- Emergency Operations and Partnerships, Emergency Operations, World Health Organization, Geneva, Switzerland
| | | | - Geraldine Jacquemin
- Université de Montréal, Institut de Réadaptation Gingras-Lindsay de Montréal, Quebec, CanadaInstitut de Readaptation Gingras-Lindsay de Montreal
| | - Barbara Rau
- Technical Coordinator- Physiotherapy, International Committee of the Red Cross, Geneva, Switzerland
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Mills JA, Durham J, Packirisamy V. Rehabilitation services in disaster response. Bull World Health Organ 2017; 95:162-164. [PMID: 28250521 PMCID: PMC5327930 DOI: 10.2471/blt.15.157024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 03/08/2016] [Accepted: 03/12/2016] [Indexed: 12/05/2022] Open
Affiliation(s)
- Jody-Anne Mills
- School of Public Health, Herston Road, University of Queensland, Herston, Brisbane, Queensland, 4006, Australia
| | - Jo Durham
- School of Public Health, Herston Road, University of Queensland, Herston, Brisbane, Queensland, 4006, Australia
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Abstract
Introduction Earthquake-related trauma results in crush injuries and bony- and soft-tissue trauma. There are no systematic reviews analyzing the typical injury patterns and treatments in "Mega-Mass-Casualty" earthquakes. The characterization of an injury pattern specific to disaster type, be it natural or manmade, is imperative to build an effective disaster preparedness and response system. METHODS The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search strategy was developed to identify all publications relating to earthquakes and the orthopedic treatment in adult patients. The following databases were searched: PubMed (Medline; US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA), Ovid (Ovid Technologies; New York, New York USA), Web of Science (Thomson Reuters; New York, New York USA), and The Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom). RESULTS The searches identified 4,704 articles: 4,445 after duplicates were removed. The papers were screened for title and abstract and 65 out of those were selected for full-text analysis. The quality of data does not permit a standard-of-care (SOC) to be defined. Scarcity and poor quality of the data collected also may suggest a low level of accountability of the activity of the international hospital teams. Qualitatively, it is possible to define that there are more open fractures during daytime hours than at night. Excluding data about open and closed fractures, for all types of injuries, the results underline that the higher the impact of the earthquake, as measured by Richter Magnitude Scale (RMS), the higher is the number of injuries. Discussion Regarding orthopedic injuries during earthquakes, special attention must be paid to the management of the lower limbs most frequently injured. Spinal cord involvement following spine fractures is an important issue: this underlines how a neurosurgeon on a disaster team could be an important asset during the response. Conservative treatment for fractures, when possible, should be encouraged in a disaster setting. Regarding amputation, it is important to underline how the response and the quality of health care delivered is different from one team to another. This study shows how important it is to improve, and to require, the accountability of international disaster teams in terms of type and quality of health care delivered, and to standardize the data collection. Bortolin M , Morelli I , Voskanyan A , Joyce NR , Ciottone GR . Earthquake-related orthopedic injuries in adult population: a systematic review. Prehosp Disaster Med. 2017;32(2):201-208.
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Back DA, Waldmann K, Hauer T, Huschitt N, Bowyer MW, Wesemann U, Lieber A, Willy C. Concept and evaluation of the German War Surgery Course - Einsatzchirurgie-Kurs der Bundeswehr. J ROY ARMY MED CORPS 2016; 163:206-210. [PMID: 27909067 DOI: 10.1136/jramc-2016-000706] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/18/2016] [Accepted: 10/21/2016] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Military surgeons must be prepared to care for severe and complex life-threatening injuries rarely seen in the civilian setting. Typical civilian training and practice do not provide adequate exposure to the broad set of surgical skills required. The German Bundeswehr Medical Service has developed and refined the War Surgery Course (WSC) to meet this training gap. This article describes the recent experience with this readiness curriculum. METHODS Run annually since 1998, WSC consists nowadays of 5 days with 20 theoretical modules. Four sessions with standardised practical skills training use a live tissue porcine model, and the recently added cadaver-based Advanced Surgical Skills for Exposure in Trauma course. Sixteen military surgeons who participated in the WSC in January 2016 completed a survey of their self-rated readiness for 114 predefined emergency skills before and after completion, and provided an overall evaluation of the course. RESULTS Self-assessed readiness improved significantly over baseline for all areas covered in both the practical skills and theoretical knowledge portions of the WSC curriculum. Additionally, all participants rated the course as important and universally recommended it to other military surgeons preparing for missions. CONCLUSIONS The WSC course format was well received and perceived by learners as a valuable readiness platform. Ongoing evaluation of this course will enable data-driven evolution to ensure a maximum learning benefit for participants. With the increasing multinational nature of modern military missions, surgeons' training should follow international standards. Continuing evolution of military surgical training courses should further encourage the sharing and adoption of best educational practices.
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Affiliation(s)
- David A Back
- Department of General, Visceral and Thoracic Surgery, Bundeswehr Hospital Berlin, Berlin, Germany.,Dieter Scheffner Center for Medical Education and Educational Research, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Waldmann
- Department of General, Visceral and Thoracic Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
| | - T Hauer
- Department of General, Visceral and Thoracic Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
| | - N Huschitt
- Department of General, Visceral and Thoracic Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
| | - M W Bowyer
- Division of Trauma and Combat Surgery, Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - U Wesemann
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Bundeswehr Hospital Berlin, Berlin, Germany
| | - A Lieber
- Department of General, Visceral and Thoracic Surgery, Bundeswehr Hospital Berlin, Berlin, Germany.,Department of Traumatology and Orthopaedics, Septic and Reconstructive Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
| | - C Willy
- Department of Traumatology and Orthopaedics, Septic and Reconstructive Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
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Pope S, Vickerstaff AL, Wareham AP. Lessons learned from early rehabilitation of complex trauma at the Royal Centre for Defence Medicine. J ROY ARMY MED CORPS 2016; 163:124-131. [PMID: 27412360 DOI: 10.1136/jramc-2016-000648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/10/2016] [Accepted: 06/14/2016] [Indexed: 02/03/2023]
Abstract
During the recent conflicts in Iraq and Afghanistan, substantial numbers of service personnel survived devastating injuries, presenting significant challenges for early rehabilitation at Queen Elizabeth Hospital Birmingham. Royal Centre for Defence Medicine personnel augmented NHS therapy provision, gaining significant experience in rehabilitating complex trauma. Multidisciplinary working was key to delivering this service, with a unique rehabilitation coordinating officer position established to manage the rehabilitation pathway. A military exercise rehabilitation instructor provided daily gym-based rehabilitation, developing exercise tolerance. Emphasis was placed on early independence, reducing pain, eliminating complications and optimising function. Innovative solutions and non-standard combinations of rehabilitation were required, with therapy working practices redesigned that, we believe, exceed provision elsewhere, including novel applications such as unique patient transfers, specialist seating, additional equipment, problem-solving teaching and early upper limb prosthetic provision. Active pain management allowed engagement in rehabilitation. With limited evidence available, therapeutic modalities attempting to alleviate phantom limb pain centred on patients' ability to engage in treatment. Finally, the requirement to measure change in early trauma rehabilitation was identified, leading to the development of the preprosthetic functional outcome measure. This article aims to document advances made, lessons learned, encourage debate and identify priorities for future research for military complex trauma rehabilitation.
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Affiliation(s)
- Sue Pope
- Directorate of Defence Rehabilitation, DMRC Headley Court, Epsom, UK
| | - A L Vickerstaff
- Defence Primary Healthcare, Wales and West Midlands, Donnington, UK
| | - A P Wareham
- PCRF Leuchars, Leuchars Station Medical Centre, St Andrews, Fife, UK
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Bar-On E, Blumberg N, Joshi A, Gam A, Peyser A, Lee E, Kashichawa SK, Morose A, Schein O, Lehavi A, Kreiss Y, Bader T. Orthopedic Activity in Field Hospitals Following Earthquakes in Nepal and Haiti. World J Surg 2016; 40:2117-22. [DOI: 10.1007/s00268-016-3581-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Trudeau MO, Rothstein DH. Injuries and surgical needs of children in conflict and disaster: From Boston to Haiti and beyond. Semin Pediatr Surg 2016; 25:23-31. [PMID: 26831135 DOI: 10.1053/j.sempedsurg.2015.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Comprehensive care of patients in conflict and disaster requires coordination of medical, social, and public health agencies. Pediatric patients in these settings comprise a particularly vulnerable group subject to disruption of social networks and separation from family, inadequate surgical care due to lack of surgeon, anesthetist, and nursing specialization, and a general lack of advocacy within the global public health agenda. In the recent upswell of attention to the global surgical burden of disease and deficiencies in necessary infrastructure, the needs of pediatric surgical patients remain underappreciated and underemphasized amid calls for improvement in global surgical health. Experience in recent natural and man-made disasters has demonstrated that pediatric patients makeup a significant proportion of those injured, and has perhaps refocused our need to better characterize the surgical needs of children in conflict and disaster. In addition to treat such patients, we recognize the unmet challenges of improving pediatric emergency and surgical infrastructures in the low- and middle-income country settings where conflict and disaster occur most often, and continuing to advocate for vulnerable children worldwide and keep them out of harm's way.
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Affiliation(s)
- Maeve O Trudeau
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David H Rothstein
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, State University of New York, 219 Bryant St, Buffalo, New York 14222; Department of Surgery, State University of New York, School of Medicine and Bioscience, Buffalo, New York.
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McDermott FD, Kelly ME, Warwick A, Arulampalam T, Brooks AJ, Gaarder T, Cotton BA, Winter DC. Problems and solutions in delivering global surgery in the 21st century. Br J Surg 2015; 103:165-9. [PMID: 26663000 DOI: 10.1002/bjs.9961] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/13/2015] [Accepted: 09/04/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Surgery has had low priority in global health planning, so the delivery of surgical care in low- and middle-income countries is often poorly resourced. A recent Lancet Commission on Global Surgery has highlighted the need for change. METHODS A consensus view of the problems and solutions was identified by individual surgeons from high-income countries, familiar with surgical care in remote and poorer environments, based on recent publications related to global surgery. RESULTS The major issues identified were: the perceived unimportance of surgery, shortage of personnel, lack of appropriate training and failure to establish surgical standards, failure to appreciate local needs and poor coordination of service delivery. CONCLUSION Surgery deserves a higher priority in global health resource allocation. Lessons learned from participation in humanitarian crises should be considered in surgical developments.
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Affiliation(s)
- F D McDermott
- Colorectal Department, Royal Devon and Exeter Hospital, Exeter, UK
| | - M E Kelly
- St Vincent's University Hospital, Dublin, Ireland
| | - A Warwick
- Colorectal Department, Royal Devon and Exeter Hospital, Exeter, UK
| | - T Arulampalam
- Surgical Division, Colchester University Hospital, Colchester, UK
| | - A J Brooks
- East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospital, Nottingham, UK
| | - T Gaarder
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - B A Cotton
- Division of Acute Care Surgery, University of Texas Health Science Center, Houston, Texas, USA
| | - D C Winter
- St Vincent's University Hospital, Dublin, Ireland
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Orthopedic Injuries and Their Treatment in Children During Earthquakes: A Systematic Review. Prehosp Disaster Med 2015; 30:478-85. [DOI: 10.1017/s1049023x15004951] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractOrthopedic injuries commonly affect children during earthquakes, but reports about them are rare. This setting may lead to different standards of care, but guidelines are still missing in this field. A systematic review was performed to: (1) assess type and body distribution of pediatric earthquake-related injuries, treatment performed, length of stay, and complications; and (2) identify starting points to define standards of care.PubMed database was researched for papers (1999-2014 period) in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Inclusion criteria were: English, French, Spanish, or Italian language and data reported about orthopedic lesions in children (≤18 years old). Reviews, letters, commentaries, editorials, and single case reports were excluded. Two independent reviewers selected articles after abstract and full-text reading.Traumatic injuries caused child hospital admissions ranging from 46.9% to 100.0%; 16% to 53% suffered fractures. Lower limbs mostly were involved. Soft-tissue injuries affected 55% of patients. Debridement and external fixation (EF) were the most frequent surgical treatments. Amputation rates varied from 5% to 11%.This study revealed that field hospitals should be prepared to: (1) treat mainly lower extremities fractures in children; and (2) use especially EF techniques. The presence of orthopedic surgeons familiar with pediatric traumatology should be considered.MorelliI, SabbadiniMG, BortolinM. Orthopedic injuries and their treatment in children during earthquakes: a systematic review. Prehosp Disaster Med. 2015;30(5):478–485.
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Aït-Mohammed F, Waroux S, Lefort H. [The nursing role in field amputation]. REVUE DE L'INFIRMIÈRE 2015; 209:19-21. [PMID: 26145129 DOI: 10.1016/j.revinf.2014.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Field amputation is a surgical procedure which consists in removing one or several limbs of a victim to extricate them from rubble and evacuate them to a hospital. A last resort, it is a rarely-performed procedure, carried out primarily in disaster medicine. A team which worked in Haiti after the 2010 earthquake reports on one such clinical situation.
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Affiliation(s)
- Farid Aït-Mohammed
- Antenne médicale de l'Ilot Saint Germain, 14, rue Saint Dominique, 75700 Paris, France.
| | - Stanislas Waroux
- Service d'accueil des urgences, SMUR, centre hospitalier Jean Marcel, bd Joseph-Monnier, 83175 Brignoles, France
| | - Hugues Lefort
- Service médical d'unité, Brigade de sapeurs-pompiers de Paris, 3, rue Darmesteter, 75013, Paris, France
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Wong EG, Razek T, Elsharkawi H, Wren SM, Kushner AL, Giannou C, Khwaja KA, Beckett A, Deckelbaum DL. Promoting quality of care in disaster response: A survey of core surgical competencies. Surgery 2015; 158:78-84. [PMID: 25843337 DOI: 10.1016/j.surg.2015.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/10/2015] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Recent humanitarian crises have led to a call for professionalization of the humanitarian field, but core competencies for the delivery of surgical care have yet to be established. The objective of this study was to survey surgeons with experience in disaster response to identify surgical competencies required to be effective in these settings. METHODS An online survey elucidating demographic information, scope of practice, and previous experience in global health and disaster response was transmitted to surgeons from a variety of surgical societies and nongovernmental organizations. Participants were provided with a list of 111 operative procedures and were asked to identify those deemed essential to the toolset of a frontline surgeon in disaster response via a Likert scale. Responses from personnel with experience in disaster response were contrasted with those from nonexperienced participants. RESULTS A total of 147 surgeons completed the survey. Participants held citizenship in 22 countries, were licensed in 30 countries, and practiced in >20 countries. Most respondents (56%) had previous experience in humanitarian response. The majority agreed or strongly agreed that formal training (54%), past humanitarian response (94%), and past global health experiences (80%) provided adequate preparation. The most commonly deemed important procedures included control of intraabdominal hemorrhage (99%), abdominal packing for trauma (99%), and wound debridement (99%). Procedures deemed important by experienced personnel spanned multiple specialties. CONCLUSION This study addressed specifically surgical competencies in disaster response. We provide a list of operative procedures that should set the stage for further structured education programs.
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Affiliation(s)
- Evan G Wong
- Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Surgeons OverSeas (SOS), New York, NY.
| | - Tarek Razek
- Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Hossam Elsharkawi
- Emergencies and Recovery, International Operations, Canadian Red Cross, Ottawa, Ontario, Canada
| | - Sherry M Wren
- Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Adam L Kushner
- Surgeons OverSeas (SOS), New York, NY; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Surgery, Columbia University, New York, NY
| | - Christos Giannou
- International Trauma Surgery, Queen Mary & Barts School of Medicine and Dentistry, University of London, London, UK
| | - Kosar A Khwaja
- Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrew Beckett
- Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dan L Deckelbaum
- Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Gerdin M, Clarke M, Allen C, Kayabu B, Summerskill W, Devane D, MacLachlan M, Spiegel P, Ghosh A, Zachariah R, Gupta S, Barbour V, Murray V, von Schreeb J. Optimal evidence in difficult settings: improving health interventions and decision making in disasters. PLoS Med 2014; 11:e1001632. [PMID: 24755530 PMCID: PMC3995669 DOI: 10.1371/journal.pmed.1001632] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Martin Gerdin and colleagues argue that disaster health interventions and decision-making can benefit from an evidence-based approach Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Martin Gerdin
- Centre for Research on Health Care in Disasters, Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Mike Clarke
- All-Ireland Hub for Trials Methodology Research, Centre for Public Health, Institute of Clinical Sciences, Queens University Belfast, Royal Hospitals, Belfast, United Kingdom
- Evidence Aid, Oxford, United Kingdom
| | | | - Bonnix Kayabu
- Evidence Aid, Centre for Global Health & School of Psychology, Trinity College Dublin, Dublin, Ireland
| | | | - Declan Devane
- National University of Ireland Galway & West Northwest Hospitals Group, Ireland
| | - Malcolm MacLachlan
- Centre for Global Health & School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Paul Spiegel
- United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Anjan Ghosh
- Extreme Events and Health Protection, Public Health England, London, United Kingdom
| | - Rony Zachariah
- Operational Research, Médecins Sans Frontières- Brussels Operational Centre, Gasperich, Luxembourg
| | - Saurabh Gupta
- Department of Immunisation, Hepatitis and Blood Safety, Public Health England, London, United Kingdom
| | | | - Virginia Murray
- Extreme Events and Health Protection, Public Health England, London, United Kingdom
| | - Johan von Schreeb
- Centre for Research on Health Care in Disasters, Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Abstract
AbstractDocumentation of the patient encounter is a traditional component of health care practice, a requirement of various regulatory agencies and hospital oversight committees, and a necessity for reimbursement. A disaster may create unexpected challenges to documentation. If patient volume and acuity overwhelm health care providers, what is the acceptable appropriate documentation? If alterations in scope of practice and environmental or resource limitations occur, to what degree should this be documented? The conflicts arising from allocation of limited resources create unfamiliar situations in which patient competition becomes a component of the medical decision making; should that be documented, and, if so, how?In addition to these challenges, ever-present liability worries are compounded by controversies over the standards to which health care providers will be held. Little guidance is available on how or what to document. We conducted a search of the literature and found no appropriate references for disaster documentation, and no guidelines from professional organizations. We review here the challenges affecting documentation during disasters and provide a rationale for specific patient care documentation that avoids regulatory and legal pitfalls. (Disaster Med Public Health Preparedness. 2013;0:1–7)
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Delauche MC, Blackwell N, Le Perff H, Khallaf N, Müller J, Callens S, Allafort Duverger T. A Prospective Study of the Outcome of Patients with Limb Trauma following the Haitian Earthquake in 2010 at One- and Two- Year (The SuTra2 Study). PLOS CURRENTS 2013; 5. [PMID: 24818064 PMCID: PMC4011624 DOI: 10.1371/currents.dis.931c4ba8e64a95907f16173603abb52f] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Severe limb trauma is common in earthquake survivors. Overall medium
term outcomes and patient-perceived outcomes are poorly documented. Methods and
Findings The prospective study SuTra2 assessed the functional and socio-economic
status of a cohort of patients undergoing surgery for limb injury resulting in
amputation (A) or limb preservation (LP) one year and two years after the 2010
Haiti earthquake. 305 patients [A: n=199 (65%), LP: n=106 (35%)] were evaluated.
Their characteristics were: 57% female; mean age 31 years; 74% of principal
injuries involved the lower limb; 46% of patients had an additional severe
injury; 60% had fractures, of which two-thirds were compound or associated with
severe soft tissue damage; 15% of amputations were traumatic. At 2 years, 51% of
patients were satisfied with the functional outcome (A: 52%, LP: 49%, ns).
Comparison with the 1-year status indicates a worsening of the perceived
functional status, significantly more pronounced in amputees, and an increase in
pain complaints, mainly in amputees (62% and 80% of pain in overall population
at 1- and 2-year respectively). Twenty eight percent (28%) of LP and 66% of A
considered themselves as “cured”. 100% of LP and 79% of A would have chosen a
conservative approach if an amputation was medically avoidable. Two years after
the earthquake, 23·5 % of patients were still living in a tent, 30% were
working, and 25·5% needed ongoing surgical management. Conclusions Only half the
patients with severe limb injuries, whether managed with amputation or limb
preservation, deemed their functional status satisfactory at 2 years. The
patients’ perspective, clearly favors limb conservative management whenever
possible. Prolonged care and rehabilitation are needed to optimize the outcome
for earthquake survivors with limb injuries. Humanitarian respondents to
catastrophes have professional and ethical obligations to provide optimal
immediate care and ensure scrupulous attention to long-term management. Keywords
Haiti earthquake, limb injury, two-year outcome, patients’ perspective,
amputation, limb salvage
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Affiliation(s)
| | | | - Hervé Le Perff
- The Alliance for International Medical Action ALIMA, Fann Résidence, BP15530The Alliance for International Medical Action (ALIMA)
| | | | - Joël Müller
- Université Lille Nord de France - Université d'Artois
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21
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Applying Research Evidence to Prehospital and Disaster Medicine. Prehosp Disaster Med 2013; 28:85-6. [DOI: 10.1017/s1049023x12001860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Zhang X, Reinhardt JD, Gosney JE, Li J. The NHV rehabilitation services program improves long-term physical functioning in survivors of the 2008 Sichuan earthquake: a longitudinal quasi experiment. PLoS One 2013; 8:e53995. [PMID: 23308293 PMCID: PMC3538750 DOI: 10.1371/journal.pone.0053995] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 12/07/2012] [Indexed: 11/19/2022] Open
Abstract
Background Long-term disability following natural disasters significantly burdens survivors and the impacted society. Nevertheless, medical rehabilitation programming has been historically neglected in disaster relief planning. ‘NHV’ is a rehabilitation services program comprised of non–governmental organizations (NGOs) (N), local health departments (H), and professional rehabilitation volunteers (V) which aims to improve long-term physical functioning in survivors of the 2008 Sichuan earthquake. We aimed to evaluate the effectiveness of the NHV program. Methods/Findings 510 of 591 enrolled earthquake survivors participated in this longitudinal quasi-experimental study (86.3%). The early intervention group (NHV–E) consisted of 298 survivors who received institutional-based rehabilitation (IBR) followed by community-based rehabilitation (CBR); the late intervention group (NHV–L) was comprised of 101 survivors who began rehabilitation one year later. The control group of 111 earthquake survivors did not receive IBR/CBR. Physical functioning was assessed using the Barthel Index (BI). Data were analyzed with a mixed-effects Tobit regression model. Physical functioning was significantly increased in the NHV–E and NHV–L groups at follow-up but not in the control group after adjustment for gender, age, type of injury, and time to measurement. We found significant effects of both NHV (11.14, 95% CI 9.0–13.3) and sponaneaous recovery (5.03; 95% CI 1.73–8.34). The effect of NHV-E (11.3, 95% CI 9.0–13.7) was marginally greater than that of NHV-L (10.7, 95% CI 7.9–13.6). It could, however, not be determined whether specific IBR or CBR program components were effective since individual component exposures were not evaluated. Conclusion Our analysis shows that the NHV improved the long-term physical functioning of Sichuan earthquake survivors with disabling injuries. The comprehensive rehabilitation program benefitted the individual and society, rehabilitation services in China, and international rehabilitation disaster relief planning. Similar IBR/CBR programs should therefore be considered for future large-scale rehabilitation disaster relief efforts.
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Affiliation(s)
- Xia Zhang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
- World Health Organization Liaison Sub–Committee on Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine, Geneva, Switzerland
| | - Jan D. Reinhardt
- World Health Organization Liaison Sub–Committee on Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine, Geneva, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - James E. Gosney
- World Health Organization Liaison Sub–Committee on Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine, Geneva, Switzerland
| | - Jianan Li
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
- World Health Organization Liaison Sub–Committee on Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine, Geneva, Switzerland
- * E-mail:
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Emergency Surgery Data and Documentation Reporting Forms for Sudden-Onset Humanitarian Crises, Natural Disasters and the Existing Burden of Surgical Disease. Prehosp Disaster Med 2012; 27:577-82. [DOI: 10.1017/s1049023x12001306] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractFollowing large-scale disasters and major complex emergencies, especially in resource-poor settings, emergency surgery is practiced by Foreign Medical Teams (FMTs) sent by governmental and non-governmental organizations (NGOs). These surgical experiences have not yielded an appropriate standardized collection of data and reporting to meet standards required by national authorities, the World Health Organization, and the Inter-Agency Standing Committee's Global Health Cluster. Utilizing the 2011 International Data Collection guidelines for surgery initiated by Médecins Sans Frontières, the authors of this paper developed an individual patient-centric form and an International Standard Reporting Template for Surgical Care to record data for victims of a disaster as well as the co-existing burden of surgical disease within the affected community. The data includes surgical patient outcomes and perioperative mortality, along with referrals for rehabilitation, mental health and psychosocial care. The purpose of the standard data format is fourfold: (1) to ensure that all surgical providers, especially from indigenous first responder teams and others performing emergency surgery, from national and international (Foreign) medical teams, contribute relevant and purposeful reporting; (2) to provide universally acceptable forms that meet the minimal needs of both national authorities and the Health Cluster; (3) to increase transparency and accountability, contributing to improved humanitarian coordination; and (4) to facilitate a comprehensive review of services provided to those affected by the crisis.BurkleFMJr, NickersonJW, von SchreebJ, RedmondAD, McQueenKA, NortonI, RoyN. Emergency surgery data and documentation reporting forms for sudden-onset humanitarian crises, natural disasters and the existing burden of surgical disease. Prehosp Disaster Med.2012;27(6):1-6.
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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. [PMID: 22676904 DOI: 10.1016/j.apmr.2012.05.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 05/23/2012] [Accepted: 05/24/2012] [Indexed: 10/28/2022]
Abstract
Natural disasters can cause significant numbers of severe, disabling injuries, resulting in a public health emergency and requiring foreign assistance. However, since medical rehabilitation services are often poorly developed in disaster-affected regions and not highly prioritized by responding teams, physical and rehabilitation medicine (PRM) has historically been underemphasized in global disaster planning and response. Recent development of the specialties of "disaster medicine" and "disaster rehabilitation" has raised awareness of the critical importance of rehabilitation intervention during the immediate postdisaster emergency response. The World Health Organization Liaison Sub-Committee on Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine has authored this report to assess the role of emergency rehabilitation intervention after natural disasters based on current scientific evidence and subject matter expert accounts. Major disabling injury types are identified, and spinal cord injury, limb amputation, and traumatic brain injury are used as case studies to exemplify the challenges to effective management of disabling injuries after disasters. Evidence on the effectiveness of disaster rehabilitation interventions is presented. The authors then summarize the current state of disaster-related research, as well as lessons learned from PRM emergency rehabilitation response in recent disasters. Resulting recommendations for greater integration of PRM services into the immediate emergency disaster response are provided. This report aims to stimulate development of research and practice in the emerging discipline of disaster rehabilitation within organizations that provide medical rehabilitation services during the postdisaster emergency response.
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Affiliation(s)
- Farooq A Rathore
- International Society of Physical and Rehabilitation Medicine, Rehabilitation Disaster Relief Committee, Geneva, Switzerland.
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Post-amputation rehabilitation in an emergency crisis: from preoperative to the community. INTERNATIONAL ORTHOPAEDICS 2012; 36:2003-5. [PMID: 22555949 DOI: 10.1007/s00264-012-1553-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Losing a limb (or a part of a limb) usually leads to loss of functionality and subsequent disability. This paper aims at pointing out the importance of comprehensive and multidisciplinary care that includes early, direct or indirect, involvement of rehabilitation service providers even in an emergency context. METHODS We underline the links between amputation and disability as well as the milestones and main purposes of the rehabilitation process following amputation. We then emphasise the influence that the level of amputation has on functional outcomes. RESULTS In order for functional outcomes to balance purely medical factors when identifying the best site for amputation in emergency settings where preoperative involvement of a rehabilitation professional is difficult due to limited resources, we enunciate five general rules to be used as guidelines by the medical team in the absence of a rehabilitation service provider. These five rules, remaining general enough to apply to most contexts and patients, still need to be balanced against contextual and personal factors that can only be identified at the time of the amputation. CONCLUSIONS The main expectations of people who undergo surgery are, usually, to remain actors in the society and regain functional abilities. Therefore, surgical outcomes are closely related to functional outcomes. In order for the functional and personal factors to be taken into account, we recommend, even in an emergency context, preoperative involvement of rehabilitation care providers.
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