FMT classification and minimum standards

Registration and coordination of
Foreign Medical Teams
responding to
sudden onset
disasters
Dr. Ian Norton
World Health Organization
Emergency Risk Management and Humanitarian Response
April 2014
Background
• Lessons from recent disasters :
• Asia 2004, Pakistan 2005, Haiti 2010, Philippines 2013/4
• FMT Response Issues
• Varying Capacities
• Lack of coordination
• Lack of national capacity to receive and manage FMTs
• Gaps
• International standards – Foreign Field Hospitals and Sphere
minimum standards insufficient
• Registration and/or authorisation on arrival
• Monitoring, reporting, quality assurance
Burden of disease in disaster
% of total
injured
and killed
100%
100%
50%
50%
29%
0%
Expected effects of Natural disaster
(PAHO. Natural Disaster: Protecting the public’s health. Washington, DC:PAHO,2000)
“Need” for FMT's in relation to country income and SOD severity: A conceptual model
Haiti EQ
Low
Income
Pakistan
EQ
Middle Income
Indonesia
Tsunami
Chile EQ
Affected country income
New
Zealand EQ
High Income
USA
Katrina
Minor
Severity of SOD impact on health service
Moderate
Severe
Comparison of recent SODs and time to FFH arrival
FMT Definition
• “Refers to groups of health professionals and supporting staff
outside their country of origin, aiming to provide health care
specifically to disaster affected populations. They include
governmental (both civilian and military) and nongovernmental teams.”
Note:
• The definition seeks to apply to everyone from the very small groups
of medical personnel arriving with a back pack after watching CNN to
the large professional teams from IFRC, MSF and some Governments.
• It can apply to teams with or without Field Hospitals, an important
change from previous PAHO guidelines. It describes the services and
people more than the facilities that they may or may not bring.
Definition
Outpatient initial
emergency care
of injuries and
other significant
health care needs


Inpatient acute
care, general and
obstetric surgery
for trauma and
other major
conditions

Additional
Specialised Care
FMT
3. Inpatient Referral
Care
2. Inpatient Surgical
Emergency Care
FMT Type
1.Outpatient
Emergency
Care
Classification of and standards for Foreign Medical Teams
Services
Key Characteristics
Triage, assessment, first aid
Stabilisation + referral of severe trauma and nontrauma emergencies
Definitive care for minor trauma and non-trauma
emergencies


Surgical triage, assessment and advanced life
support
Definitive wound and basic fracture management
Damage control surgery
Emergency general and obstetric surgery
Inpatient care for non-trauma emergencies
Basic anaesthesia, X-ray, blood transfusion, lab
and rehab services
Acceptance and referral services
Capacity to provide type 2 services
Complex reconstructive wound and orthopaedic
care
Enhanced X-ray, blood transfusion, lab and rehab
services
High level paediatric and adult anaesthesia
Intensive care beds with 24h monitoring and
ability to ventilate
Acceptance and referral services

Context specific specialist care supplementary to
type 2+3 FMT services or local hospital
Specialised services may include: Burn care, Dialysis

Light, portable and adaptable
Care adapted to context and
scale
Staffed & equipped for
emergency care for all ages
Minimal Benchmark
Indicators
100 patients/day
Opening
Hours
Day time
services


Type1Outpatient Emergency
Care and Referral






Use existing or deployable facility
structures
Clean operating theatre
environment
Care appropriate to context and
changing burden of disease
Multidisciplinary team
experienced to work in resource
scarce settings
Use existing or deployable facility
structures
Sterile operating theatre
environment
Enhanced multidisciplinary teams
providing advanced care
Care appropriate to support
referrals from FMT1+2 and
national health system

1 operating
theatre with 1
operating room:
20 inpatient beds
7 major or 15
minor
operations/day
Day and
night
services

Type 2- Inpatient Surgical
Emergency Care
Complex
inpatient referral
surgical care
including
intensive care
capacity







Additional
specialised care
cells within type
2, 3 or a hospital





Type 3- Inpatient Referral Care


Responds to an expressed need
for specialised services
Embedded in and operates from
FMT 2 or 3, national hospital or
health system
May for some services be self
contained

1 operating
theatre with at
least 2 operating
rooms: 40
inpatient beds
 15 major or 30
minor operations
per day
 4-6 intensive care
beds
Depending on capacity
Additional Specialist Care FMT (e.g. Paediatric
Surgery etc)
and care for crush syndrome, Maxillo-facial surgery,
Orthoplastic surgery, Intensive rehabilitation, Maternal
health*, Neonatal and Paediatric Transport and
Retrieval*
*= Units that may be self contained not embedded
Day and
night
services
On
request
FMT Core Standards
• Agree to register with the relevant national authority or lead international agency on arrival and
•
collaborate with inter-agency response coordination mechanisms at global, national and sub-national levels, as well as with other FMTs and health systems.
Will undertake to report on arrival what type, capacity and services they can offer based on the international FMT classification system
report at regular
•
Will undertake to
intervals during response, and prior to departure, to the national authorities and the cluster, using national
reporting formats, or if not available, the agreed international reporting format.
•
Will undertake to keep
•
confidential records of interventions, clinical monitoring and possible complications.
Will undertake for the individual patient, to have record of treatment performed and referral for follow-up planned as needed.
•
Will undertake to be part of the wider health referral system, and depending on type, offer to accept or refer or both accept and refer patients to other FMTs, the
national health system or, if approved, other countries.
•
FMTs will adhere to professional guidelines: all their staff must be
•
registered to practice in home country and have licence for the
work they are assigned to by the agency
FMTs will ensure that all their staff are specialists in their field ,appropriately trained in either war or sudden onset disaster surgical injury
management. The majority should be experienced in global health, disaster medicine and providing care in austere environments. Acknowledging the need to train
and provide experience to new staff, there may be scope for junior and inexperienced staff in the later phase of a disaster response and working under direct
supervision of experienced colleagues.
•
pharmaceutical products and equipment they bring complies with
international quality standards and drug donation guidelines.
FMTs will ensure that all
http://www.who.int/medicines/publications/med_donationsguide2011/en/index.html
•
•
•
•
self sufficient and not put demand on logistic support from the affected country, unless agreed otherwise before deployment.
FMT comply with minimum hygiene and sanitation standards, including adequate management of medical waste.
FMTs are
FMTs must ensure the team and individuals are covered by adequate malpractice insurance, and have a mechanism to deal with complaints and allegations of
malpractice.
FMTs must have arrangements in place for the care of their team members health and safety.
Type 3
(1)
Type 2
(3-5)
Type 1
(15-30)
Specialty teams requiring
support within an FMT level
2 or 3 care facility or local
secondary or tertiary
hospital
Government Interest
Typhoon Haiyan-FMT
perspective
• Classification clear and easily understood by DoH
and FMTs
• Formal policy from DoH announcing need to
register on arrival (using FMT registration form)
• DoH appeared to struggle to task such volume of
FMTs. Some confusion between command at
national or local level.
• Not all FMTs were equal. Not all FMTs
represented their Government (many NGOs)
• >80 FMTs registered and up to 150 deployed
Minimum Standardscompliance in thePhilippines?
• Core standards
• Self sufficiency (what does this really mean)
• Technical Standards for Type of team
• Surgical- Performance of surgery in nonsurgical facilities……….
• Anaesthetic- safe anaesthesia and pain
relief…………….
• Logistics- Team and field facility
Surgical Standards (and
partnerships)
Next steps
• Registration of FMTs
• Enhanced Knowledge of Classification, Capability
and Coordination Mechanisms
• Ministry of Health and NDMO
• WHO, UNDAC, OSOCC managers
• FMT’s themselves
• Use of existing National coordination
mechanisms
• Enhancement of national team response
• Use of FMTs to support the health system during
surge and early recovery
Deliverables
• Regional engagement
• Geo-political agreement- MAY 2014
• Priority country roll out- LATE 2014
• Registration and validation of teams- JUNE 2014
• Surge team, OSOCC, UNDAC training- MID 2014
• FMT training and competencies- LATE 2014
• Documents and advocacy- JUNE 2014
•
•
•
•
•
Government endorsement document
Case studies linking IDRL and FMTs (IFRC project)
SOPs at country level
New UNDAC handbook, OSOCC Guidelines etc.
Practical training and equipment lists etc.
Thank you
[email protected]
Thank you
[email protected]
http://www.who.int/hac/global_health_clus
ter/fmt/en/index.html

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