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/

nortoni@who.int or EMTeams@who.int

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