Minimum Technical Standards and Recommendations for Traumatic Brain Injury Rehabilitation Teams in Sudden-Onset Disasters

Abstract

Current advances in disaster response and management have improved survival rates of disaster victims, resulting in overwhelming number of survivors with injuries relative to mortality. These include complex and long-term disabling injuries, such as traumatic brain injury (TBI), spinal cord injury, peripheral nerve injury, musculoskeletal injuries and others. Despite lack of accurate data on TBI in sudden-onset disasters (SODs), it remains a common neurological consequence of armed conflict worldwide. TBI is complex and survivors often have long-term physical, cognitive and behavioural disabilities, residual neurological deficits, medical complications and lifestyle consequences. These necessitate comprehensive interdisciplinary management, including medical, surgical and rehabilitation. The goal of rehabilitation in disaster settings is to improve functional independence and successful reintegration into the community, with an emphasis on patient education and self-management. Rehabilitation of TBI survivors should commence from early-response phase during disasters to minimise disability, prevent secondary injury and should be continued long-term in the community. Specialized rehabilitation teams in any SODs are deployed based on the skill-base and response required to meet specific local needs at the request of host health authorities. These interdisciplinary teams (specialized cells) need to be integrated into emergency disaster response and management plans. This report extends the previously published guidelines for WHO Emergency Medical Teams (EMTs) to establishe minimum standards for development and deployment of TBI specialized rehabilitation team in SODs. Overview of rehabilitation input for TBI survivors by EMT type, and specific recommendations and considerations for the management of the TBI victims for EMTs are provided. These include: deployment decision-making process; elements of making rapid assessment of existing TBI care capacity; leadership & operational support; outreach services; medical and surgical input; human resources, skill mix, team competencies and team configuration; equipment including consumables and pharmacological supplies; discharge & referral; data collection, management and health care records; and exit strategy.