NHV model in disaster

rehabilitation Jianan LI, MD

Nanjing Medical UniversityNational team leader for disaster rehab, China

Honorary Chair of ISPRM-CRDR

Lesson learnt from Sichuan earthquake

• Date: May 12, 2008

• Deaths/missing persons: 86,000

• Injured: 374,640;

• Severely injured: 11,000

• Direct economic loss: 100 billion US$

Difficulties Massive damages

Blocked roads Lack of resources

Finance Rehab persons Facilities and

equipment Lack of coordination

Government Hospitals NGOs

Severe complications

Poor wound management Poor operations High incidence of pressure sore Lack of knowledge in Crush

Syndrome Lack of systematic early rehab

intervention

2008.5.12 Sichuan Earthquake Massive transfer and return

2 month later post earthquake 10,000 injured victims return Sichuan Majority of them were dependent:

Internal fixation with fracture Imitated mobility Bed rest for SCI and TBI

Local rehab strength < 100 rehab physicians < 200 rehab therapists No rehab persons in the community

Lesson: on site training course? 3 to 5 days training courses were

conducted more 40 times No person may practice after training It is not lack of guidelines, but

manpower in medical rehabilitation Local medical persons are also

victims

Sichuan Model of disaster rehab What we need:

to establish a comprehensive rehab facility on-site of disaster zone: project with high efficiency, efficacy and sustainability.

How to organize: Non-government organizations: to

provide financial support Health department and hospital at

disaster zone: to provide basic facilities and some medical support

Volunteers in rehab: to provide manpower.

VolunteersHealth departmentsNGOs

Financing Governance Health workforce

Chinese Association of Rehabilitation Medicine: Local Health Bureau/ Local Disabled Persons Federation

Rehabilitation Services

Capacity building Capacity building

Rehabilitation Medicine

Physical/Occupational therapy

Institutional based rehabilitation

Comm

unity based rehabilitation

Rehabilitation Psychology

Health: home visits, community adaption…

Livelihood

Social and empowerment

VolunteersHealth departments

NGOs

Financing Governance Health workforce

Chinese Association of Rehabilitation Medicine, Local Health Bureau/ Local

Disabled Persons Federation

Rehabilitation Services

Capacity building Capacity building

Rehabilitation Services

Rehabilitation Medicine

Physical/Occupational

therapy

Institutional based rehabilitation

Comm

unity based rehabilitation

Rehabilitation Psychology

Health

Livelihood

Social and empowerment

NGO(CFCF)

LocalHospital

Health Bureau

DisabledPerson’sFederation

IBRCBR

HandicapInternational

PhysiatricianPT/NurseRehabequipment

Earthquake Survivors with SCI

NHV rehabilitation services programs

Role of physiatrist

Organizer, coordinator, diagnosis, clinical management, planning,,,,,,

3 year follow up in 2011 Outcome: 3324 severely injured

victims completed institutional rehab and return to community with high satisfaction.

Achievement: Department of rehab medicine established in the local hospitals and community based rehab service is gradually spread out.

Sustainability: Emphasis is shifting from medical rehab to social rehab.

Method

Quality of Life

Demography

ASIA

Ability of Daily Living

Depression

Complication

Pain

On-site Survey

Walking Ability

Demography Method

Quality of Life

ASIA

Ability of Daily Living

Depression

Complication

Pain

Walking Ability

WHO Quality of Life Assessment Instrument-Bref (WHOQOL-BREF) The most appropriate scale

for QOL of SCI patient

• Individual’s overall perception of QOL & health

• Domain: Physical Health/ Psychological/Social Relationship/ Environment

*Hill MR, Noonan VK, Sakakibara BM, Miller WC. Quality of life instruments and definitions in individualswith spinal cord injury: a systematic review. Spinal Cord. 2009

Method

Quality of Life

ASIA

Ability of Daily Living

Depression

Complication

Pain

Walking Ability

Pressure Sore/ UTI / Cystolith / Neurogenic Bladder/ RectumImpairment of Renal Function …

Demography

Method

Quality of Life

ASIA

Ability of Daily Living

Depression

Complication

Pain

Walking Ability

Visual Analogue Scale (VAS)

Demography

Method

Quality of Life

ASIA

Ability of Daily Living

Depression

Complication

Pain

Walking AbilityModified Barthel Index (MBI)

Demography

Method

Quality of Life

ASIA

Ability of Daily Living

Depression

Complication

Pain

Walking Ability

Walking Index for Spinal Cord Injury II

Demography

Method

Quality of Life

ASIA

Ability of Daily Living

Depression

Complication

Pain

Walking AbilityPatient Health Questionnaire Depression Module (PHQ-9)

Demography

AIS Above C7

C8-T6 T7-L2 L3-S2 BelowS2

Total Percentage

A   1 5     6 23.1%

B     2     2 7.60%

C     7     7 26.9%

D 3   5  1 2 11 42.3%

Total 3 1 19 1 2 26  

Result Result

Above C7 C8-T6 T7-L2 L3-S2

BelowS2 Total Percentage

Pain  3 1 19  1  2 26 100%New pressure

sore   1 10  1 12 46.2%

Neurogenic bladder   1  12    1 14 53.8%

Cystolith 2 2 7.69%Neurogenic

Rectum 1 8 2 11 42.3%

Heterotopic ossification 1 1 3.85%

Above C7 C8-T6 T7-L2 L3-S2

BelowS2 Total Percentage

Pain  3 1 19  1  2 26 100%New pressure

sore   1 10  1 12 46.2%

Neurogenic bladder   1  12    1 14 53.8%

Cystolith 2 2 7.69%Neurogenic

Bowel 1 8 2 11 42.3%

Heterotopic ossification 1 1 3.85%

Result

4 year follow up in 2012

Outcome: few disabled people (1%). Depression and pain remain the major

complains Achievement:

Local rehab system built up (rehab capacity tripled) and rehab professionals increased 5 times more.

HNV model Implementation: Lushan Earthquake in 2013 Time: 8 am, April 20, 2013 Immediate reaction post the

earthquake: 1 min: internet news 6 min: government announcement 18 min: on-site rescue started 28 min: army team arrived at

earthquake zone 120 min: provincial government leaders

arrived at the center zone of the earthquake

Medical rescue and rehab 60 min: 5 national medical teams (180

people) 120 min: National medical consultant organized.

2nd Day: 183 medical teams (1427 people) arrived and medical rehab early intervention started. The ministry of health documents on principle of early rehab intervention and transferring standard.

3rd day: Medical rehabilitation wards established and local rehab resources are sufficient to deal with post earthquake rehab.

NHV model implemented in the earthquake zone.

Outcome

Few disabled persons from disaster Local rehab service built up Community rehab service running

well NGO support efficiently

Future trend? Role of international society? Role of rehab professionals? Volunteer team? Language? Culture and religion? Finance? Diplomatic issue? Safety?