Emergencies: Emergency medical teams

• EMTs are groups of health professionals (doctors, nurses, paramedics etc.) that treat patients affected by an emergency or disaster. They come from governments, charities (NGOs), militaries and international organizations such as the International Red Cross/Red Crescent movement. They work to comply with the classification and minimum standards set by WHO and its partners, and come trained and self-sufficient so as not to burden the national system.
• Emergency medical teams have a long history of respondinig to sudden onset disasters (SOD) such as the Haiti earthquake, the Indian Ocean Tsunami and the floods in Pakistan.
• EMTs historically have had a trauma and surgical focus, but Ebola has shown us their value in outbreak response and other forms of emergency.
• The Ebola response was the largest deployment of EMTs for an outbreak (58 teams), which pales in comparison to the 151 teams deployed to respond to Typhoon Haiyan in November 2013 and the nearly 300 teams deployed to Haiti following the earthquake.
• Requirements for emergency health response are broader than those required for sudden onset disasters and trauma. They must include the ability to care for diseases such as cholera, Shigella and Ebola, as well as teams to support populations affected by flood, conflict and protracted crises such as famine.

EMTs work under the guidelines of the WHO Classification and Minimum Standards for Foreign Medical Teams in sudden onset disasters guidance. These guidelines discuss the principles and core standards of how registered EMTs must function and declare their operational capabilities. The electronic version of these guidelines can be found from the link below.

Classification and minimum standards for Emergency Medical Teams in sudden onset disasters

• Classification and minimum standards were published in mid-2013.
• These standards were used for the first time successfully in November 2013, following typhoon Haiyan. The Department of Health Philippines coordinated the deployment of 151 EMTs and found the new classification system fit for purpose.
• A new EMT unit was set up in the department of Emergency Risk Management & Humanitarian Response, WHO, Geneva, in February 2014.Their work has included:
• Building a new global registration system that will allow EMTs to register their capacity and be classified.
• Progression of EMT coordination in Southeast Asia, the Americas, Caribbean, Europe and the Pacific.
• Closer collaboration with UN OCHA, INSARAG (International Search and Rescue Advisory Group), UNDAC (UN Disaster Assessment and Coordination) teams and use by FMTs of the UN OSOCC (onsite operations and coordination centre) mechanisms.
• Regional exercises in the Americas with Urban Search and Rescue and EMTs co-deployed.

Next steps for 2015 include:

• Working with countries to develop their national medical response team capacity
• Training national ministries of health, in countries likely to suffer natural disasters, to be aware of the capacities of FMTs, and establish arrangements for the reception and coordination of teams on arrival.
• Development of best practice guidance and standards for FMTs to respond to the care of children, pregnant women, patients with disabilities, older people, and those with pre-existing health issues who have lost access to their medication during the disaster etc.

WHO has developed a global registration system where emergency medical teams can be verified and classified ready to be deployed to health emergencies. A global registry of all EMTs that meet the WHO EMT minimum standards for deployment in sudden onset emergencies from all-hazards provides time-limited surge clinical capacity to the affected populations. It serves as a deployment and coordination mechanism for all partners who aim to provide clinical care in emergencies such as tsunami, earthquake, flood, and more recently, in large outbreaks, such as the West Africa Ebola outbreak, which require a surge in clinical care capacity. It allows a country affected by a disaster or other emergency to call on teams that have been pre-registered and quality assured.

• Improve the quality of care provided
• Improve coordination between clinical care teams
• Provide a predictable and timely response to affected governments and populations
• Serve as a quality improvement forum, with working groups developing minimum standards, best practice guidance, and sharing best practice between partners
• Provide a forum for interaction between EMT providers and potential recipient countries, including allow countries to inform EMTs of the specific standard operating procedures (SOPs) and requirements for access to their country in the event of an emergency. (e.g. rules on importation of pain relief, registration as a doctor, etc.)

• It enables countries to improve their own national capacity, which they are then able to use to assist other countries in emergencies.
• It enables affected countries to accept and use EMTs in a timely, coordinated manner.
• Host governments and affected populations can depend on FMTs from the registry to arrive trained, equipped and capable of providing the intervention promised. Victims and their families can expect the clinical teams treating them to be of a safe minimum standard.
• Each team has unique individuals with various skill sets. Identifying these differences and placing them into the field requires coordination and communication to ensure the correct gaps are filled. EMT staff help facilitate and coordinate this placement.
• Offers of EMT assistance are more likely to be accepted if teams have pre-registered and have demonstrated their quality. Pre-registration will expedite arrival and tasking procedures in-country. Registered teams will be working within the national and international response effort rather than apart.
• Donors will have surety that the EMTs registered will have reached a minimum standard and would be able to offer a preferred list of accredited medical organisations that could be supported financially and through other means.
• The global community is now able to build around a predictable and described clinical surge capacity and can use this registry to examine capabilities and gaps for local response to various emergencies.

• Traditionally, EMTs were used for sudden onset disasters like earthquakes and typhoons, with a trauma and surgical focus. Ebola care during this multi-country outbreak has necessitated unique medical knowledge and equipment, and has carried unique risks for health care workers. The progress made against Ebola is part thanks to the response by the national and international teams that run the 72 Ebola Treatment Centres (ETCs) across three countries.
• WHO and the world have learned important lessons from the Ebola response that have a wider application to the agency and the global health response community. These lessons have been used to improve coordination, quality and predictability of clinical response teams deploying with surge capacity as EMTs.
• Over 40 organizations, including international NGOs, military, faith-based organizations and governments have deployed EMTs throughout the current Ebola Response.
• Countries that have sent EMTs to West Africa include Australia, China, Cuba, Democratic Republic of the Congo, Denmark, Ethiopia, France, Germany,Kenya, Korea, New Zealand, Nigeria, Norway, Russia, South Africa, Sweden, Uganda, United Kingdom and United States of America.