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Rehabilitation Needs Assessment in Persons Following Spinal Cord Injury in Disaster Settings: Lessons Learnt in 2015 Nepal Earthquakes

Fary Khan, Bhasker Amatya, Raju Dhakal, Geoff Abbott, Mark Graf, Santos Ramirez, Kathryn Lowenthal and Mary P Galea

Objective: To report on the use of a ‘triage’ clinical tool for rehabilitation decision-making process and outcomes in an acute disaster setting- the Nepal earthquake (EQ); and the lessons learnt.

Participants and Setting: Consecutive EQ victims with a spinal cord injury (SCI) (n=101) admitted to a Nepalese sub-acute medical facility.

Intervention: An accredited WHO Foreign Medical Team (FMT) from the Royal Melbourne Hospital was deployed to assist with priorities identified by the host institution: develop triage processes for clinical outcomes, identify barriers and train local healthcare professionals.

Results: The triage tool was clinically useful in identifying patients requiring immediate and urgent rehabilitation intervention for a range of disabilities. Mean age was 34.4 ± 15.1 years and female (53.5%) admitted 2-10 days following injury. Over two-thirds had SCI (78%) with common clinical issues: pain (74%), bladder (73%) and bowel dysfunction (58%), and pressure ulcers (33.3%). Participants reported symptoms consistent with post-traumatic stress. The ‘triaging’ and disability management plans were well received by staff, as patients were stream-lined for step-down facilities; during this process barriers were identified for future action.

Conclusion: A collaborative interdisciplinary approach using the triage tool improved clinical outcomes in the disaster-setting. Long-term planning should include early rehabilitation, community-based programs, accreditation, partnerships, and inclusion of persons with disability.