Emergency Medical Teams Initiative
Surge capacity in health care during emergenciesDr Ian NortonJune 2018
Updates on the WHO EMT Initiative
• Built on lessons from the Haiti response, where teams in some cases did not comply with expected standards, the EMT initiative was formed; In clinical care and health response “good intentions”are not enough
• Principles, standards and quality matter, even in “mega-disasters” and complex emergencies
• Operations support and logistics are as important as technical skill
• National leadership and coordination is key but may need our support.
• A global governance system was required
• The terminology is of “Emergency” not “foreign” medical teams highlighting the value of national capacity
“EMT’s are any groups of health professionals
providing direct clinical care to populations
affected by disasters or outbreaks and emergencies
as surge capacity to support the local health system
4
EMT ClassificationType Description Capacity
1 Mobile Mobile outpatient teams Remote
area access teams for the
smallest communities
>50 outpatients a day
1 Fixed Outpatient facilities +/- tented
structure
>100 outpatients a day
2 Inpatient facilities with surgery >100 outpatients and 20 inpatients
7 major or 15 minor surgeries daily
3 Referral level care, inpatient
facilities, surgery and high
dependency
>100 outpatients and 40 inpatients
Including 4-6 intensive care beds
15 major of 30 minor surgeries daily
Specialist Cell
(eg rehab, surgical,
paediatric, infectious
disease etc)
Teams that can join national
facilities or EMTs to provide
supplementary specialist care
services
Any direct patient care related service can
be termed a specialist cell EMT when given
in emergency response by international
providers/clinicians
Type1 Mobile or Fixed- Outpatient
Emergency Care
Type 2- Inpatient Surgical Emergency Care
Type 3- Inpatient Referral Care
Additional Specialist Care EMT (e.g.
Cholera, Ebola, Rehabilitation etc)
Objectives of the EMT Initiative
Global/ Regional
commitment & partnerships
Clinical, technical & operational
minimum standards & best
practices
EMT capacity strengthening, preparedness &
training
Quality Assurance & Classification
Efficient and timely
activation and coordination of EMT response
The Numbers▫118 countries with awareness of EMT initiative
▫32 countries directly supported by WHO to create their own national EMTs.
▫Over 90 countries have national EMT programmes
▫84 teams in process of quality assurance, 16 classified (total 100)
▫All 6 WHO regions with active EMT programs
Thailand MERT
– 68 national:2 aiming for international
Japanese DMAT/JDR
– 10,000 national repsonders:1,000 trained for international response
Chinese DMAT system
– 37 national teams:3 internationally classified
Philippines
– 17 Type 1 and 2 Type 2 teams: 1 international
Lessons from Asian EMTs:National : International capacity
Combined clinical and public health approach
Health system impact
• Early Response concentrating on “saving life and limb” or stopping the outbreak
• National response will be critical in the first hours (days and weeks in an outbreak)
• Resilient health infrastructure and systems vital for early response
• Transition to non trauma cases happens in days, teams must be ready for this
• Business continuity (i.e. normal patient care requires support)
Key benefits of the initiativePeople affected by emergencies, disasters and outbreaks• Can be sure teams that treat them are professional and properly equipped• They arrive in a timely manner and are well trained, and integrated with the
health system that normally treats their families
Member states• Can call on teams from neighbours within the region, that often have
shared language, shared context and will arrive quickly• Teams will only come when asked, and will work within the coordination
mechanism of the Ministry of Health• They will report daily their activities and contribute to a coordinated overall
response
EMTs• Will be more likely to be requested by an affected country if they have
demonstrated their quality and been “classified” by WHO
Summary
National EMTs and pre-established national coordination systems are the basis for the WHO EMT system, supplemented by regional quality assured teams
EMTs and rapid public health response teams are a vital part of health security and international health regulations
EMT coordination is a sub-function under the health operations section of the national Health EOC
Emergency Medical Teams Initiative
Surge capacity in health care during emergenciesDr Ian NortonJune 2018
Objectives of the EMT Initiative
Global/ Regional
commitment & partnerships
Clinical, technical & operational
minimum standards & best
practices
EMT capacity strengthening, preparedness &
training
Quality Assurance & Classification
Efficient and timely
activation and coordination of EMT response
Capacity Building of EMTs
• National EMT awareness
workshops
• National EMT coordination
workshops
• National EMT trainings (Train
the trainer)
• EMT Coordination Cell (EMT-
CC) training
• National and regional
simulation exercises
National Impact assessments, National coordination
Type 1
Type 2
Type 3
National authorities are best placed and need support to call on the right teams on a “no regrets” basis. We do
not need to wait for “international experts” to
make this call
Burden of disease in disaster (EQ example) “Time matters”
Comparison of recent disasters and time to Field Hospital arrival
NEPAL 2015Rapid, heavy deployment by regional Government teams (often Type 2 and 3) matched trauma wave
Note trauma wave in shaded area behind graph
Self Sufficiency
Working groups and best practice
Clinical
– Rehabilitation
– Surgical– Limb injury
– Burns MCI
– Highly infectious disease care
– Maternal and Child Health
Coming in 2018
– NCD care and Mental health relevant to EMTs
Operations
– Minimum data sets
– Mentor and verification
– Logistics
– Training
Knowledge hub and online access to resources and materials
4 W’s
Operations
Early
warning
system
PH
info
Daily reporting form;
• Operational coordination
• Situational awareness• Capacity and gaps
• Disease Early warning
• Public Health and humanitarian issues
Links to existing treaties, initiatives and methods of coordination
Member state sovereignty and domestic medical licensing laws
International Disaster Response Law (IDRL) and the right for countries to decline inappropriate or poor quality assistance
International Health Regulations and member state preparedness for health emergencies and outbreaks
Regional commitments on EMT standards (UNASUR, EU, WHO regional and global resolutions)
Regional and geo-political alliances and response agreements
– Increase in bilateral responses
– Eg EU, AU, ASEAN/EAS, LAC, BRIC, FRANZ agreement (Pacific)
– Concepts of Regional and global “Medical Corps” eg African or European initiatives
Co-ordination systems: how to “localize” good multi-lateral ideas?
– UNDAC and OSOCC methodology: how to interact with national EOCs
– Cluster system (noting Health sector is complex, and HC may not be activated by the majority of countries)
– The new concept of EMT-CC (CICOM) in MoHs aligned to Health-EOCs
Coordination & Leadership for ALL EMT’s
4 options for EMT coordination;
– Host Government has mechanism for EMT coordination at their (H)EOC
– Host Government supported to create RDC and EMT-CC by WHO in acute phase
– EMT-CC with WHO support in MoH with cluster activated for other functions
– EMTs coordinated in a sub-cluster in exceptional situations
Case Study 1Philippines Nov 2013
Case Study 2: EBOLA OUTBREAK, West Africa 2014-16,
EMTs have had a primarily trauma and
surgical focus, however, the recent West Africa
Ebola outbreak has demonstrated their value in complex and high risk health emergencies such
as outbreak response.
Ebola outbreak represents a
newparadigm for
EMTs
Case Study 3: Nepal
Case Study 4:Island nations; Cyclone etc
Use of national and regional EMTs in Island nations
Small teams on main island deployed to outer islands for clinical or public health response
Use of national systems for coordination (NDMO, H-EOC etc)
Regional treaties
Mentor Program Consultative Site Visit
Mentor team support development of organization & their preparation of minimum standards evidence package
Verification peer review team conduct site visit and examine ability of organization to meet global standard
Organization is declared “classified” by WHO and require reclassification in 5 years as well as conduct QA and exercises or deploy at least 2 yearly
Step 1
Step 2
Step 3
Step 4Steps
Future global needs for International EMTsNational capacityEvery country requires rapid response capacity for domestic emergencies, (but concentrate on Type 1 and 2)
International capacity
Some countries may offer bilateral support to neighbours or contribute to regional response, adding value with Type 2 and 3
Type 1
Type 2
Type 3
Over 75 Health Partners – National and International in Cox Bazaar, Bangladesh
Thank you!Any questions?
http://extranet.who.int/emt/
[email protected] or [email protected]
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