Rehabilitation

EMTs provide rehabilitation according to their typology to improve outcomes for patients and reduce length of stay. This includes the provision of appropriate assistive devices such as crutches and wheelchairs.

Rehabilitation is an essential part of health-care provision, contributing to better functional outcomes, reduced length of stay and improved quality of life. It is one of the core functions of trauma care systems and has an increasingly recognised role in some outbreak responses. As such, EMTs should have specific plans for the provision of rehabilitation services to their patients. As national rehabilitation services are often severely impacted by emergencies and rehabilitation needs persist beyond the minimum stay of many EMTs, it may be necessary for some EMT providers to increase and extend their rehabilitation capacity to bridge a gap while longer term services are established.

1. Ensure the onward referral of patients requiring ongoing rehabilitation
2. Establish physical accessibility to people with injuries and disabilities

Type 1

• • Provide basic rehabilitation care or identify patients requiring rehabilitation and refer them to an appropriate EMT or existing local facility.

Type 2 and 3

• • Provide outpatient and inpatient (acute) rehabilitation services.
  • Have at least one rehabilitation professional per 20 beds.
  • Allocate a rehabilitation space of at least 12m² if staying for more than 3 weeks
  • Deploy with essential rehabilitation equipment.

• Refer to “Minimum technical standards and recommendations for rehabilitation in emergency medical teams.”
• Rehabilitation professionals should be experienced in trauma and acute medical rehabilitation with experience and/or training to work in austere environments.
• Essential rehabilitation skills include basic splinting; assistive device prescription, fitting and training; positioning and early mobilization, education and re-training of patients and care providers in daily activities, as well as basic respiratory interventions.
• As part of providing accessible and ethical care, teams must provide meaningful access to services for people with disability and injuries.
• Ensure physical access inside the facility including accessible washrooms and latrines (with at least one where a caregiver can also access) and flat or ramped patient walkways.
• Plan for discharge and referral from the early stages of care in order to identify service gaps. Promptly communicate any gaps to the coordinating authorities.
• Maximize opportunities to exchange rehabilitation knowledge and competencies with local personnel of various disciplines.

Step-down facilities and rehabilitation

• A step down unit provides interim inpatient care for medically stable patients while preparing them for discharge into the community.
• Consider converting field hospitals into step-down facilities after an emergency, when demand for acute surgical and medical services directly related to the event decreases over time.
• Include medical and nursing support as well as an increased allocation of space and workforce for rehabilitation.
• Place emphasis on preparing patients with long-term impairments, their care providers, and local rehabilitation personnel to safely manage ongoing needs beyond the departure of the EMT.
• Links with local rehabilitation and social care providers, where present, are vital.