Operation Functional Recovery: The International Rehabilitation Community Unites to Help Survivors of  Worlwide Disaster

By: Mark A. Young MD, MBA, FACP, Chair, International Exchange Committee, ISPRM - markyoung123@gmail.com

    Throughout the world natural and manmade disaster looms. Within the USA, this was dramatically  witnessed by Americans in 2005 in the face of  Hurricane Katrina. Katrina brought death and destruction to the residents of New Orleans, Mississippi and the Gulf Region. The world had barely been recovering from earlier natural disasters such as the Tsunami in South Asia and East Africa as well as the cataclysmic earthquakes in Turkey and Pakistan when Hurricane Katrina vengefully hit American shores.  

As a first hand observer of Hurricane Katrina who has been asked by my government to play a leadership role in the rehabilitation recovery effort, I would like to share my reflections and observations with fellow members of ISPRM, since I believe that there are many important lessons to be learned about rehabilitation’s potential vital role in international disasters and our unique opportunity as a specialty to “make a difference” through global team work and collaboration. 

Hurricane Katrina & Operation Functional Recovery: Background & Timeline

Within days of the Hurricane, I was personally contacted by my government to lead a national humanitarian effort to set up a unified rehabilitation response to address the medical and therapeutic needs of Katrina's survivors. Persons with disability and citizens in wheelchairs and folks in chronic care facilities and nursing homes were in dire jeopardy and rehabilitation’ powerful input was sorely needed... Working together closely with Professor Mathew Lee, Chair of Rehabilitation at the Rusk Institute, New York University in New York, Mr. Louis Levine, Dr. Stanley Kornhauser and Howard Rusk Jr. of the New York College of Podiatric Medicine other institutions and professional organizations, we labored fast and furiously to assemble a group of  rehabilitation focused disaster response teams composed of concerned and skilled interdisciplinary rehabilitation professionals.  With the encouragement of Dr. Margaret Gianinni, Director of the Office of Disability for United States Health and Human Services Department and the US Surgeon Generals Office, we were able to successfully rally the help and support and active participation of the rehabilitation community.  Named, “Operation Functional Recovery”, our humanitarian efforts centered on addressing the unique rehabilitation needs that Hurricane survivors faced in the aftermath of the destruction.

 Rehabilitation volunteers sought were dedicated groups of men and women who pledged a willingness to serve both locally in the Hurricane torn Gulf Region performing clinical relief tasks as well in their home towns assisting with administrative and logistical details. Recognizing the vast reach of our specialty, I decided to organize this gargantuan team building effort around 6 fundamental “core competencies”  and to assign volunteers to one or more of these groups based on their declared interest and proven aptitude:

Operation Functional Recovery Volunteer Groups:

Ø       Skin and Wound Management

Ø       Neurological  Rehab

Ø       Geriatric Rehab

Ø       Pediatric Rehab

Ø       Pain Management

Ø       Psychological Rehabilitation

Our initial “call to action” was disseminated in the “Advance for Directors in Rehabilitation” Journal in September:

http://rehabilitation-director.advanceweb.com/common/Editorial/Editorial.aspx?CC=59070

 “Operation Functional Recovery”:  A Retrospective Review

Since the inauguration and implementation of Operation Functional Recovery, over 915 volunteers from across the rehabilitation spectrum including physiatrists, PT’s, OT’s, SLP’s, Nurses, Orthotics and Prosthetics, Nutritionists and Psychologists  and others have enlisted with Operation Functional Recovery (OFR) to meet the emerging functional and rehabilitation needs of Katrina survivors. These people have also expressed their willingness to serve in other natural international disaasters Generous offers to volunteer have not been limited to the United States but have come from come from far and wide, and locations abroad including Holland, Canada, Israel, Cuba, Portugal and Turkey.

Pre-Deployment Rehabilitation Planning and Ground Work

In preparation for the humanitarian ground efforts, OFR has held multiple planning and tactical meetings to assure a true “team response”. The inaugural meeting took place on Friday, September 15th, 2005 chaired by Dr. Mark Young. Participants in the teleconference included ranking representatives of major rehabilitation organizational leadership including AAPM&R. APTA, AOTA, ASLPA, APMA and NIEI.

A follow up regional planning meeting was held in Harlem, New York on Sunday, September 18th at the New York College of Podiatric Medicine, chaired by ISPRM members Dr. Mark Young, Dr. Bryan O’Young and David Cassius MD in which deployment plans and a blueprint for cross disciplinary rehabilitation collaboration was drawn. Also present at this crucial planning meeting were a multi-specialty constellation including Dr Stanley Kornhauser, (NIEI), Sue Eisenberg (RN), Harriet Duffy (OT), Lisa Anderson (PT), and Jessica Gross (OT). Alice Quaid (OT), an OT from Metairie, Louisiana was available via teleconference and provided her personal account of the hurricane’s devastating blow and its impact on rehabilitation and people with disabilities.

Many other Operation Functional Recovery activities have taken place, in the weeks since Katrina. Individual pre-conference briefings were held with regional pain management authorities including Dr. Andrew Fischer and Dr David Siegel (Both ISPRM members) on the issue of optimizing Pain Management Humanitarian Services for Katrina Survivors and with physical therapy academic leaders. Discussions about establishment of a Rehabilitation & Psychology Crisis Telephone Hotlines for Katrina survivors were held with academic leaders in the psychology and disaster management trades.  The feasibility of creating an online functional deficit and disability data registry was discussed with Rehabilitation informatics specialists. A centralized e-mail portal has been created and is operational. An OFR web site is currently being constructed and volunteer help is being sought.

Offers of endorsement and moral support have been widely forthcoming for Operation Functional Recovery from all across the rehabilitation continuum. The NYU Medical Center and the Rusk Institute pledged to allocate 5 beds for Katrina survivors. Many other CARF facilities have done so. Additionally, PM&R resident training programs at NYU RUSK as well as other leading programs have explored special provisions for “displaced” Tulane and LSU physicians and rehabilitationists in training. Offers of endorsement from the Healthy Living Forum and Rusk Without Walls, two non-profit organizations have been received. One Tulane medical student  benefited from a one month international rotation arranged by the ISPRM Exchange Committee.

Operation Functional Recovery:  The November Deployment:

A deployment of volunteers took place in November 2005 when several of our dedicated interdisciplinary volunteers conducted an on-site needs assessment and a fact finding mission. The advice and recommendations of several of our international colleagues was sought in order to plan an effective mission, since it had been only a few months earlier that some of our ISPRM colleagues had gained first hand experience with the Tsunami and other natural disasters. Despite the difficulty in locating areas of greatest need and obtaining rehabilitation access and clearance within New Orleans and the surrounding “Hurricane Belt”, our information gathering and fact finding mission was successfully conducted in a variety of venues including clinics, hospitals, Shelters and assistive living facilities that had been hard hit by Hurricane Katrina in New Orleans, Mississippi and the Gulf Region. The needs assessment initiative conducted during the November deployment involved the input of several ISPRM members: Dr. Bryan O’Young, Dr. David Cassius, Dr. Mark Young, and Dr. David Siegel. In addition many interdisciplinary rehabilitation team members took part including Dr. Charles Ross DPM, Lisa Schuler PT and Dr. Chantal Lorio DPM. Physical destruction of Katrina was evident where ever we went.  See Photos: (link)

Operation Functional Recovery November Mission: Observations & Lessons Learned

1)   Although many traditional “medical patients” were evacuated from New Orleans and the Gulf region in the early days after the Hurricane, there are still many persons with disabilities who continue to remain in the area.

2)   Due to the hardship and difficulty associated with evacuation procedure for people with functional deficits associated with their disability (mobility impairments, visual impairments, communication disorders) a significant number of people elected to stay close to home, rather than relocate.

4    Rehabilitation patients with diabetes, peripheral neuropathies, pain and peripheral vascular disease who suffer from chronic wounds have been hard hit by the Hurricane due to a variety of exacerbating factors including loss of glucometer monitoring devices and suboptimal environmental conditions.

5    Many diabetic patients needed to flee their homes without their protective diabetic footwear and many have no shoes to protect their feet. Diabetic glucometers were destroyed by the flooding.

6    In some circumstances mobility deficits have become exacerbated in patients with lower extremity wounds. People have suffered not only physical but also psychological set backs from the Hurricane. Chronic painful conditions have become magnified.

7    People with traditional neurological conditions (stroke, spinal cord injury, MS) continue to face challenges after the Hurricane.

8    Establishment of disability specific evacuation procedures and guidelines (for future disasters) remains a big priority to be addressed by the international rehabilitation community.

9    Rehabilitation’s team orientation and philosophy of “sharing and caring” can make a difference in this disaster and other international calamities. The need for Physical Medicine & Rehabilitation team intervention in the aftermath of the hurricane continues to exist.

10 Continued collaboration among members of the international rehabilitation community during times of crisis will touch the lives of the patient’s we serve.

Persons interested in assisting Operation Functional Recovery may contact Dr. Mark A. Young, Chair of the ISPRM Exchange Committee and Founder and President of Operation Functional Recovery at  markyoung123@gmail.com