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1.
Arch Phys Med Rehabil ; 93(10): 1875-81, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22676904

RESUMO

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.


Assuntos
Medicina de Desastres , Planejamento em Desastres , Desastres , Medicina Física e Reabilitação , Medicina Baseada em Evidências , Humanos , Internacionalidade , Sociedades Médicas
2.
Prehosp Disaster Med ; 26(6): 438-48, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22559308

RESUMO

Limb amputations are frequently performed as a result of trauma inflicted during conflict or disasters. As demonstrated during the 2010 earthquake in Haiti, coordinating care of these patients in austere settings is complex. During the 2011 Humanitarian Action Summit, consensus statements were developed for international organizations providing care to limb amputation patients during disasters or humanitarian emergencies. Expanded planning is needed for a multidisciplinary surgical care team, inclusive of surgeons, anesthesiologists, rehabilitation specialists and mental health professionals. Surgical providers should approach amputation using an operative technique that optimizes limb length and prosthetic fitting. Appropriate anesthesia care involves both peri-operative and long-term pain control. Rehabilitation specialists must be involved early in treatment, ideally before amputation, and should educate the surgical team in prosthetic considerations. Mental health specialists must be included to help the patient with community reintegration. A key step in developing local health systems the establishment of surgical outcomes monitoring. Such monitoring can optimizepatient follow-up and foster professional accountability for the treatment of amputation patients in disaster settings and humanitarian emergencies.


Assuntos
Amputação Traumática , Desastres , Congressos como Assunto , Planejamento em Desastres , Extremidades/lesões , Humanos , Consentimento Livre e Esclarecido , Salvamento de Membro , Prontuários Médicos/normas , Equipe de Assistência ao Paciente , Alta do Paciente , Violência
3.
Prehosp Disaster Med ; 26(6): 429-37, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22475370

RESUMO

The provision of surgery within humanitarian crises is complex, requiring coordination and cooperation among all stakeholders. During the 2011 Humanitarian Action Summit best practice guidelines were proposed to provide greater accountability and standardization in surgical humanitarian relief efforts. Surgical humanitarian relief planning should occur early and include team selection and preparation, appropriate disaster-specific anticipatory planning, needs assessment, and an awareness of local resources and limitations of cross-cultural project management. Accurate medical record keeping and timely follow-up is important for a transient surgical population. Integration with local health systems is essential and will help facilitate longer term surgical health system strengthening.


Assuntos
Desastres , Serviços Médicos de Emergência/normas , Cirurgia Geral/normas , Altruísmo , Benchmarking , Congressos como Assunto , Serviços Médicos de Emergência/organização & administração , Cirurgia Geral/organização & administração , Humanos , Consentimento Livre e Esclarecido , Alta do Paciente
4.
Disabil Rehabil ; 43(5): 718-725, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-31136216

RESUMO

PURPOSE: This report describes the general impact and direct health effects including death and traumatic injuries on populations impacted by the 2017 landslides in the affected hilly and coastal districts in southeastern Bangladesh. The medical response including emergency treatment and rehabilitation provided at pre-hospital and hospital care sites is also described. MATERIALS AND METHODS: An electronic literature search of appropriate databases was performed to identify relevant articles on landslides in Bangladesh, Southeast Asia, and other developing countries from 1990-2017. Summary landslide impact data was extracted from official government and non-government reports and injury data from selected district and tertiary level hospitals was reviewed. RESULTS AND CONCLUSIONS: Most fatalities in the 2017 Bangladesh landslides were due to suffocation and asphyxiation from burial. In Rangamati District, 6343 persons with minor injuries were treated in 22 emergency shelters. One hundred fifty-four injuries were treated at Rangamati General Hospital and 12 of the most severely injured persons were referred to regional tertiary Chittagong Medical College Hospital for specialized injury and rehabilitation management. Physical rehabilitation capacity and services in future landslides may be increased by providing rehabilitation technical skills training to responders and augmenting the emergency response with individual rehabilitation specialists and/or teams of rehabilitation professionals.Implications for rehabilitationLandslides may result in significant direct health effects including death and rehabilitation conditions such as severe traumatic physical injuries and less severe musculoskeletal conditions.Pre-hospital and hospital emergency medical response systems may lack capacity to adequately manage the surge of rehabilitation conditions in landslides.Physical rehabilitation treatment capacity in future landslides may be increased by providing rehabilitation technical skills training to responders and augmenting the emergency response structure with individual rehabilitation specialists and/or teams of rehabilitation professionals.Rehabilitation, disability, emergency management, and other stakeholders are advised to employ such training and workforce strategies to reduce rehabilitation-related health effects in Bangladesh and other South-East Asian countries which are heavily impacted by landslides due to seasonal monsoons.


Assuntos
Tempestades Ciclônicas , Pessoas com Deficiência , Desastres , Deslizamentos de Terra , Bangladesh , Humanos
5.
Disaster Med Public Health Prep ; 15(3): 389-397, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-32456743

RESUMO

OBJECTIVE: A systematic literature review (SLR) was performed to elucidate the current triage and treatment of an entrapped or mangled extremity in resource scarce environments (RSEs). METHODS: A lead researcher followed the search strategy following inclusion and exclusion criteria. A first reviewer (FR) was randomly assigned sources. One of the 2 lead researchers was the second reviewer (SR). Each determined the level of evidence (LOE) and quality of evidence (QE) from each source. Any differing opinions between the FR and SR were discussed between them, and if differing opinions remained, then a third reviewer (the other lead researcher) discussed the article until a consensus was reached. The final opinion of each article was entered for analysis. RESULTS: Fifty-eight (58) articles were entered into the final study. There was 1 study determined to be LOE 1, 29 LOE 2, and 28 LOE 3, with 15 determined to achieve QE 1, 37 QE 2, and 6 QE 3. CONCLUSION: This SLR showed that there is a lack of studies producing strong evidence to support the triage and treatment of the mangled extremity in RSE. Therefore, a Delphi process is suggested to adapt and modify current civilian and military triage and treatment guidelines to the RSE.


Assuntos
Incidentes com Feridos em Massa , Militares , Consenso , Extremidades , Humanos , Triagem
7.
Confl Health ; 11: 13, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28781608

RESUMO

Major challenges and crises in global health will not be solved by health alone; requiring rather a multidisciplinary, evidence-based analytical approach to prevention, preparedness and response. One such potential crisis is the continued spread of nuclear weapons to more nations concurrent with the increased volatility of international relations that has significantly escalated the risk of a major nuclear weapon exchange. This study argues for the development of a multidisciplinary global health response agenda based on the reality of the current political analysis of nuclear risk, research evidence suggesting higher-than-expected survivability risk, and the potential for improved health outcomes based on medical advances. To date, the medical consequences of such an exchange are not credibly addressed by any nation at this time, despite recent advances. While no one country could mount such a response, an international body of responders organized in the same fashion as the current World Health Organization's global health workforce initiative for large-scale natural and public health emergencies could enlist and train for just such an emergency. A Nuclear Global Health Workforce is described for addressing the unprecedented medical and public health needs to be expected in the event of a nuclear conflict or catastrophic accident. The example of addressing mass casualty nuclear thermal burns outlines the potential triage and clinical response management of survivors enabled by this global approach.

8.
PLoS One ; 8(1): e53995, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23308293

RESUMO

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.


Assuntos
Pessoas com Deficiência/reabilitação , Desastres , Terremotos , Fraturas Ósseas/reabilitação , Traumatismos da Medula Espinal/reabilitação , Sobreviventes/psicologia , Adaptação Psicológica , Adulto , Idoso , China , Pessoas com Deficiência/psicologia , Planejamento em Desastres/organização & administração , Feminino , Fraturas Ósseas/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida/psicologia , Análise de Regressão , Traumatismos da Medula Espinal/psicologia , Sobreviventes/estatística & dados numéricos
9.
J Rehabil Med ; 44(3): 200-5, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22367060

RESUMO

OBJECTIVE: This study compares functional status, quality of life and community integration in 2008 Sichuan earthquake survivors with spinal cord injury at hospital discharge and at 1-year follow-up in the community. METHODS: Twenty-six subjects with spinal cord injury completed demographic and medical questionnaires and underwent medical examination at discharge from a hospital rehabilitation department and after 1 year in the community. Functional status, quality of life and community integration were assessed by appropriate instruments over this period. RESULTS: Functional status measures showed significantly increased (p < 0.05) scores for the Modified Barthel Index and Walking Index for Spinal Cord Injury II; depression and pain scores were reduced with no statistical significance. After discharge, nearly half of patients developed a new pressure sore and most patients had urinary complications. Self-reported quality of life, overall health, and satisfaction with social relationships increased significantly (p < 0.05), while the environment domain was reduced (p < 0.05). Social participation (i.e. community integration) results showed an improvement in physical independence and mobility (p < 0.05), but a decline in cognitive independence (p < 0.05). Only 15% of the population returned to work. CONCLUSION: Special attention should be paid to cognitive and emotional function, occupational training and social integration during rehabilitation measures after earthquakes.


Assuntos
Atividades Cotidianas , Terremotos , Qualidade de Vida , Características de Residência , Participação Social , Traumatismos da Medula Espinal/reabilitação , Sobrevida , Adulto , Idoso , China , Cognição , Depressão/etiologia , Meio Ambiente , Feminino , Seguimentos , Nível de Saúde , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Dor/etiologia , Alta do Paciente , Úlcera por Pressão/etiologia , Retorno ao Trabalho , Autorrelato , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/psicologia , Inquéritos e Questionários , Doenças Urológicas/etiologia , Caminhada
10.
J Rehabil Med ; 44(3): 206-9, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22367105

RESUMO

OBJECTIVE: To evaluate functional outcomes, health-related quality of life and life satisfaction in fracture victims 27 months after the 2008 Sichuan earthquake. METHODS: A total of 390 earthquake survivors from 3 earthquake areas who sustained fractures were divided into early intervention, late intervention and control groups. Functional outcomes assessed included activities of daily living using the Modified Barthel Index and pain level with a visual analogue scale. Health-related quality of life was evaluated with the Medical Outcomes Study Short-Form 36 and life satisfaction using the Life Satisfaction Questionnaire. RESULTS: Activities of daily living and life satisfaction in the intervention groups were significantly improved compared with the control group. Health-related quality of life was higher in early intervention subjects compared with controls. Group differences in pain level were not significant. In addition, the early and late intervention groups did not differ significantly in any of the measured outcomes. Good performance of activities of daily living and widowed marital status predicted high health-related quality of life, while pain level was associated with worsened outcomes. Rehabilitation therapy, remunerative employment and female gender were predictors of improved life satisfaction. CONCLUSION: Clinical effectiveness of physical rehabilitation intervention was demonstrated in fracture earthquake victims.


Assuntos
Atividades Cotidianas , Terremotos , Fraturas Ósseas/reabilitação , Saúde , Qualidade de Vida , Adulto , Idoso , China , Emprego , Feminino , Seguimentos , Fraturas Ósseas/complicações , Humanos , Masculino , Estado Civil , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Satisfação Pessoal , Fatores Sexuais , Inquéritos e Questionários
11.
J Rehabil Med ; 44(7): 534-40, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22674233

RESUMO

OBJECTIVES: To characterize a spinal cord injury (SCI) population from the 2008 Sichuan earthquake in China; to evaluate functional outcomes of physical rehabilitation interventions; to assess potential determinants of rehabilitation effectiveness; and to assess medical complications and management outcomes. METHODS: A total of 51 earthquake victims with SCI were enrolled and underwent rehabilitation programming. Functional rehabilitation outcomes included ambulation ability, wheelchair mobility and activities of daily living (ADL) assessed with the Modified Barthel Index at the beginning and end of rehabilitation. Effectiveness of rehabilitation and the effect of other predictors were evaluated by mixed effects regression. Outcomes of medical complication management were determined by comparison of the incidence of respective complications at the beginning and end of rehabilitation. RESULTS: Ambulation, wheelchair mobility and ADL were significantly improved with rehabilitation programming. Both earlier rescue and earlier onset of rehabilitation were significant positive predictors of rehabilitation effectiveness, whereas delayed onset of rehabilitation combined with prolonged time to rescue resulted in a lesser positive effect. Medical complications were managed effectively in 63% (pressure ulcers) to 85% (deep vein thrombosis) of patients during rehabilitation. CONCLUSION: Earthquake victims with SCI may achieve significantly improved functional rehabilitation functional outcomes on a formal, institutional-based physical rehabilitation programme.


Assuntos
Terremotos , Socorro em Desastres , Traumatismos da Medula Espinal/reabilitação , Resultado do Tratamento , Atividades Cotidianas , Adolescente , Adulto , Idoso , Criança , Intervalos de Confiança , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Traumatismos da Medula Espinal/complicações , Adulto Jovem
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