Experiences of Canadian Physiotherapists on the Canadian Red Cross Emergency Response Unit (ERU) Register Part II: World Health Organization Emergency Medical Team Rehabilitation Network & Community of Practice

By: Marie Gedeon, Canadian Red Cross (CRC) Physiotherapy Delegate, CRC Focal Point for the WHO
Emergency Medical Team (EMT) Rehabilitation Community of Practice
October 2022

Nowadays, the world is more and more aware of climate change impacts on health, the COVID-19
pandemic issues and planetary boundaries. Due to climate change, sudden onset disasters have the
propensity to occur more frequently and with a greater level of intensity, without advance notice or
warning, often resulting in extensive injuries to people, damage to health facilities, and infrastructure,
and even whole health care systems. In addition, instances of conflicts with non-state actors result in
large numbers of civilian casualties and trauma patients, while health care facilities are being attacked
with disconcerting frequency (Humanity & Inclusion, 2020).

As mentioned in Part I of this blog series, the Canadian Red Cross (CRC) is one of several National
Societies that operates Emergency Response Units (ERUs). These ERUs are deployed on very short
notice, at the request of an affected host country, with the request being coordinated by the
International Federation of Red Cross and Red Crescent Societies (IFRC). The CRC operates a health ERU,
which takes the form of a field hospital or field clinic, depending on the needs in the affected
communities. As part of maintaining this capacity, the CRC ensures that all of the operational
components of the ERU are in place and ready to be deployed, are aligned with international emergency
response systems and standards, and comply with professional competencies and ethics. The CRC is able
to maintain this capacity with support from the Government of Canada.

The World Health Organization (WHO) EMT initiative, commonly referred to as the “Blue Book” (WHO,
2021; updated version), was launched in 2016, and it emerged from a WHO working group that was
revising the terminology from ‘foreign trained assisting medical teams’ to simply ‘emergency medical
teams.’ EMTs are defined as “groups of health professionals providing direct clinical care to populations
affected by disasters or outbreaks and emergencies as a surge capacity to support the local health
system” (WHO, 2016, p. 33). EMTs are part of national and international organizations that are working
towards improving the timeliness and quality of health care services after catastrophic events. The aim
of the WHO EMT initiative is to support Member States, non-governmental, and international
organizations by setting minimum standards, identifying best practices, and establishing logistical and
operational field coordination standard operating procedures.
The WHO EMT initiative has, in recent years, provided significant leadership in strengthening
rehabilitation in emergencies, through not only the publication of the Blue Book but also the publication
of the Minimum Technical Standards and Recommendations for Rehabilitation (WHO, 2016), and the
WHO’s involvement in the development of the handbook on Early Rehabilitation in Conflict and
Disasters (Humanity & Inclusion, 2020). As a result, a growing number of EMTs are engaged in developing their capacity to provide rehabilitation care in emergencies, according to the current
minimum technical standards.

In 2017, the WHO launched the Rehabilitation 2030 initiative, which stresses the importance of
integrating rehabilitation into all health system components (Gimigliano & Negrini, 2017). The
Rehabilitation 2030 initiative was coupled with the creation of a rehabilitation in emergencies role
within the WHO. The unique opportunity to fully integrate rehabilitation into organizations with EMTs, is
currently being propelled by the momentum created by the newly formed WHO EMT Rehabilitation
Network and Community of Practice (COP), led by Peter Skelton. Peter Skelton is known to some
members of the Canadian Physiotherapy Association from a past discussion event held by the Global
Health Division. Precisely at the time of the COVID-19 outbreaks throughout Canada in 2020, he, along
with Phil Sheppard, Mike Landry, and Bronwen Connolly, reflected on the priorities of EMT initiatives to
support national building capacities (Physiotherapy Canada, 2020).

The WHO EMT Rehabilitation Network and COP’s aim is to strengthen links between rehabilitation focal
points in EMTs in order to support the development of quality EMT rehabilitation services. The members
of the WHO EMT Rehabilitation Network and COP learn from each other through sharing of good
practices and information to improve the standardisation of tools. This in turn reduces duplication of
efforts, and thereby strengthens collaboration and support between EMT organisations. To date, the
CRC is the only organization in the Americas Region to appoint an EMT Rehabilitation focal point as part
of this initiative. As mentioned earlier, the WHO also supports the development of the WHO EMT
Rehabilitation COP. Needless to say, in health care systems, physiotherapists (PTs) play an essential core
role. Worldwide, 2.41 billion people benefit from rehabilitation services and it is reported that physical
rehabilitation needs per capita grew 17% worldwide in the last two decades (Jesus & Landry, 2021). As
you may expect, the need for rehabilitation is largely unmet.

Classified EMT organizations may obtain a certification for a 5-year period, after which time the
organization must undergo the certification process again. The certification process is an important
mechanism for providing quality assurance for EMTs that are deployed internationally to support
countries in need, however I strongly feel that EMT training should also prepare the workforce to meet
societal needs as well.

In addition to being a PT delegate with the CRC ERU, I am also the WHO EMT Rehabilitation Focal Point .
In this role, I represent the CRC, along with the other PTs on the ERU register, at the level of the WHO
EMT Rehabilitation Network and COP. The inaugural meeting of the WHO EMT Rehabilitation Network
was held online in October of 2021. The WHO EMT Rehabilitation Network meets twice per year and
COP meetings occur every two months.

One recent WHO EMT Rehabilitation Network and COP meeting took place virtually in November 2022.
The agenda included training strategies developed across EMTs. The CRC has a comprehensive training
programme for ERU delegates, which was detailed in Part I of this blog series. The training program
enables delegates to fulfil their roles within the team safely and effectively, and screens them for
physical and mental fitness prior to deployment.

As PTs, many of us have embraced being polyvalent through working in different settings. It has been
recognized that many PTs are adding to their professional trajectories or career paths, through gaining
education and working in other fields of expertise, some of which are tied to the physiotherapy
profession, others of which are not. With regards to those paths that are linked to physiotherapy, some PTs have veered towards research, education or business, for instance, through taking a Master’s of
Business Administration. Many PTs have completed or are completing additional degrees such as
Master’s degrees in Global Health, International Public Health, Community Health, or Disaster
Management. Historically the physiotherapy profession was propelled by a conflict-embroiled world
war environment through the need for rehabilitation of injured soldiers. In those times, the
physiotherapy discipline in Canada and the United Kingdom, combined physiotherapy and massage
therapy skills into one profession. Over the years, physiotherapy developed into a distinct profession
(Physiotherapy Canada, 2020).

From work in fields of capacity building, to fields of international development, PTs have adhered to
fundamental humanitarian principles and values in their work. They are recognizing the need to pay
attention to principles of equity, diversity, gendered work, social inclusion, and vulnerabilities, as well as
to consider the social determinants of health, Sustainable Development Goals, and to pay respect to
issues of Indigenous cultural securitization (National Collaborating Center for Indigenous Health, 2021),
and to decolonize health (Khan et al., 2021). The physiotherapy profession is evolving; it is going through
fantastic transformations in many ways, not only by integrating rehabilitation professionals at the
curative level in different settings, but also turning to prevention, health promotion, an interdisciplinary
approach, and even a transdisciplinary approach for physical and social protection in emergencies.
In a presentation given at an IFRC health conference in September 2022 in Portugal, Red Cross and Red
Crescent National Societies’ health managers were asked to describe in two words how to integrate
rehabilitation needs into an EMT. In the anonymized Mentimeter data collected, some of the two words
used were interpreted as meaning (with the mindset of): patient safety, seamless care, early recovery,
patient-focused, quality care, future independence, holistically standardized, need-based, mental
health support; and togetherness with MHPSS (Mental Health and Psychosocial Support). Interestingly
enough, no words such as “urgently now” were used. Of course, maybe those two words were not used,
primarily because the question was not when but how? There is a window of opportunity always; the
sooner we adopt measures to better integrate rehabilitation into EMTs, the faster we will be focusing on
team-based care.

For more information about the WHO EMT Rehabilitation Network and COP, click here.

References

Gimigliano, F., & Negrini, S. (2017). The world health organization “Rehabilitation 2030: a call for
action”. European Journal of Physical and Rehabilitation Medicine, 53(2).
https://doi.org/10.23736/S1973-9087.17.04746-3
Humanity & Inclusion. (2020). Early rehabilitation in conflicts and disasters.
https://www.who.int/activities/strengthening-rehabilitation-in-emergencies/early-rehabilitation-in-
conflict-and-disasters
Jesus, T. S., & Landry, M. D. (2021). Global need: including rehabilitation in health system
strengthening. The Lancet, 397(10275), 665–666.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00207-5/fulltext

Khan, M., Abimbola, S., Aloudat, T., Capobianco, E., Hawkes, S., & Rahman-Shepherd, A. (2021).
Decolonising global health in 2021: a roadmap to move from rhetoric to reform. Bmj Global Health, 6(3).
https://doi.org/10.1136/bmjgh-2021-005604
National Collaborating Center for Indigenous Health (NCCIH). (2021). Visioning the future: First Nations,
Inuit, & Métis population and Public Health. NCCIH – National Collaborating Centre for Indigenous Health
> Home > NCCIH PUBLICATIONS
Physiotherapy Canada. (2020). Cross Canada Checkup – Session 5 – Emergency Preparedness & Response
Principles for Physiotherapists. https://www.youtube.com/watch?v=E7obydOaYWM
World Health Organization. (‎2021)‎. Classification and minimum standards for emergency medical
teams. World Health Organization. https://apps.who.int/iris/handle/10665/341857
World Health Organization. (‎2016)‎. Minimum technical standards and recommendations for
rehabilitation. World Health Organization.  https://www.who.int/publications/i/item/emergency-
medical-teams
World Health Organization. (2022). WHO emergency medical teams initiative. EMT | (who.int)

Biography:
Marie Gedeon is a seasoned physiotherapist clinician and a lifelong learner who is passionate about
humanitarian assistance and international relations. Given her background in physiotherapy, combined
with her Master’s degree in International Public Health, she seeks to contribute to leadership in health
system strengthening and is driven by collaborative work environments where deep social learning is
encouraged. She was deployed with the Canadian Red Cross (CRC) during the domestic COVID-19
pandemic response in Quebec as a Public Health Team Leader. The rapid response experience she
gained during that period made her even more connected with humanity and engaged in risk
communication. She is currently nearing the end of a higher education degree in Disaster, Risk
Reduction and Resilience Management, and will start an internship in risk and emergency management
in civil protection. In addition to being a Focal Point within the WHO EMT Rehabilitation Network on
behalf of the CRC, as a volunteer, she leads the CRC PT delegate register working group and the IFRC
Rehabilitation Technical Working Group. She still maintains her clinical physiotherapy licenses and she’s
grateful to be residing on the Mohawk Nation seated Territory. She is a member of the Canadian
Association for Global Health and the Consortium of Universities for Global Health.