The United Kingdom International Emergency Trauma Register: preparing doctors for humanitarian relief work
Authors: Paul Sutton, Anthony Redmond
Publication date: 31 May 2013
Paul Sutton and Anthony Redmond explain the role of the United Kingdom International Emergency Trauma Register in preparing UK clinicians for volunteering in resource poor environments.
Many opportunities exist for health professionals of all grades and specialties to help in resource poor environments, normally through private enterprise, non-governmental organisations, or the armed forces. Settings can range from established centres of care in stable areas to emergency relief services after sudden disasters. Each of these situations carries its own challenges and rewards for clinicians.
The United Kingdom International Emergency Trauma Register (UKIETR) supports health professionals wanting to assist in overseas emergencies. The idea for the register followed the 2010 Haiti earthquake and a review of humanitarian emergency responses by the Department for International Development (DFID).
WHO noted that the international response to the earthquake showed unacceptable practices in the delivery of emergency medical assistance. Areas of concern included accountability, quality control, coordination, and reporting. Specific concerns were also raised about clinical competency, record keeping, and follow-up. In response, WHO hosted a working group to promote registration of emergency medical aid teams and to secure accountability by seeking authorisation to practise from national authorities. The uncoordinated arrival of uninvited help only adds to the burdens of countries affected by disaster; registration allows these countries to see what is on offer and recruit the help they need.
Following its review, DFID allocated funds to support a coordinated medical response from the United Kingdom in the event of a rapid onset disaster. This led to the establishment of the UKIETR in 2011. The register ensures that staff have the necessary skills, training, and experience to provide safe, effective, and appropriate treatment. Teams with an appropriate skill mix are “on call” for deployment on a rotational basis. DFID and the Department of Health have developed an agreement to facilitate release of clinicians from their scheduled activities.
Those joining the register have opportunities for training and development. Successful working in this type of environment ultimately begins with competence in one’s own clinical role. Beyond this resourcefulness, leadership, team working, and adaptability are key. The UKIETR is managed by the medical charity UK-Med, and the charity runs weekend training courses for register members several times a year. Before the course, participants are required to complete the online United Nations course on basic security in the field. The pre-deployment course itself covers tropical medicine, surgery, and obstetrics and gynaecology—all aimed at the non-specialist. The main thrust is toward planning the response to a disaster, casualty management, triage, security, safety, welfare, use of vital equipment, and risk assessment. There is also a practical exercise covering skills in navigation, radio procedure, and use of a global positioning system.
UKIETR also offers other training opportunities. For those who have never worked in a resource poor environment, there are opportunities to spend a short period overseas. Further “under canvas” training—where prospective teams will deploy in a real life scenario, setting up a field hospital, and treating simulated casualties—is currently being developed. A five day course in the technical skills needed for surgery in austere environments is being put together in conjunction with the Royal College of Surgeons of England.
Several matters need to be addressed before deployment. These include a health check, provision of anti-malarial prophylaxis, and access to post-exposure prophylaxis for HIV. In conjunction with the Liverpool School of Tropical Medicine, UKIETR members are screened for any health conditions that might render them vulnerable on deployment, and full immunisation is ensured. They are also screened after deployment. Assistance is given to obtain visas, and all members have full insurance while deployed, including medical indemnity secured through UK-Med. Authorisation to practise medicine in another country is secured by UKIETR through liaison with the host ministry of health and the United Nations.
Humanitarian work provides an opportunity for clinicians to practise their skills in a new, dynamic, and challenging setting. The risks of such a commitment should not be overlooked, but, with adequate training and administrative support, they can be reduced to an acceptable level.
Competing interests: We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: PS has contributed to humanitarian relief efforts overseas; AR is the director of UKIETR.
Paul Sutton specialty registrar in general surgery
Mersey Deanery, Liverpool, UK
Anthony Redmond professor of international emergency medicine University of Manchester, Manchester, UK