Disasters, whether natural or human-made, cause extensive damage and upheaval, impacting numerous individuals and communities in the short and long run. In the aftermath of a disaster, prioritizing holistic well-being, encompassing physical health, emotional stability, and social support for affected populations is crucial.
In emergency and disaster scenarios, occupational therapists possess specialized skills essential for providing therapeutic support across all stages of coping: preparation, initial response, and long-term recovery. Their expertise is pivotal in effectively managing interventions during these critical phases.
This position paper was written from October to November 2023, during the Israel–Hamas "Iron Swords" War. The document draws upon occupational therapists' clinical insights and professional experiences both prewar and during wartime. It integrates research theories and evidence gathered from global disaster contexts. Moreover, it incorporates firsthand learnings from responding to the ongoing disaster, emphasizing the pivotal role in immediate acute care and orchestrating long-term rehabilitation efforts for several affected groups: those directly affected by the disaster, evacuated individuals, and those facing emergencies on the domestic front. This encompassing approach considers people with disabilities and special needs within these groups.
Additionally, beyond their role as part of the multidisciplinary treatment-rehabilitation team during emergencies, occupational therapists represent a segment of the general population during such crises. Consequently, they are also susceptible to experiencing primary and secondary trauma.
Goals
The goals of the position paper are to:
- Highlight the distinctive role of occupational therapy within a diverse therapeutic-rehabilitation-educational team. This role involves serving individuals, families, primary caregivers, communities, health care professionals, policymakers, and society at large amid emergencies and disasters.
- Establish effective interventions derived from occupational therapy experiences, theories, and research across various phases of disaster management: preparation, initial response, treatment, rehabilitation, and long-term recovery. The aim is to sustain national well-being and health during crises.
- Address the essential role of occupational therapy in shaping and advocating for preparedness and response policies concerning future emergency and disaster scenarios and emphasizing the commitment to promoting evidence-based practices in these critical circumstances.
A. Definition of Occupational Therapy
Occupational therapy is a client-centered health profession dedicated to enabling individuals and communities to engage in meaningful activities; it fosters health, well-being, and an improved quality of life. Clients range from individuals across the lifespan to groups, communities, populations, and organizations. The foundation of an occupational therapist's work lies in extensive professional knowledge, offering a comprehensive perspective on the components of function, participation, and health. Five key areas of knowledge pertinent to emergencies and disasters include:
- understanding the structure and function of the human body, health conditions, and their impacts on engaging in activities and occupations;
- embracing the emotional and social dimensions of disability;
- analyzing occupations, activities, and tasks to facilitate effective interventions;
- assessing the various contexts in which individuals operate and their suitability for the individual’s functioning; the assessment considers human, physical, sensory, and technological factors and integrates assistive devices and aids; and
- knowing in depth the health and rehabilitation systems within broader health frameworks.
These knowledge domains, combined with expertise in collaborating within multidisciplinary teams, ongoing training, and adaptability to diverse populations and evolving environments, define the unique approach of occupational therapy.
B. The Distinct Roles of Occupational Therapy in Emergency and Disasters
The roles of the occupational therapy profession in addressing emergencies and disaster response involve adhering to fundamental principles tailored for such contexts:
- Evaluating tasks and activities (task analysis) based on the person’s capabilities and environmental factors to enhance engagement in meaningful occupations; prioritizing meaningful activities and routines to sustain roles and habits within emergency settings
- Maintaining and restoring function and minimizing dependency on others, fostering self-confidence and resilience as needed
- Delivering interventions in any setting where the client is present while adjusting the environment to meet specific needs and objectives; upholding client privacy and preferences during this process
- Proactively addressing and diminishing risk factors immediately after the onset of injury and consistently throughout the rehabilitation and recovery phases
- Acknowledging the importance of preventing secondary trauma among caregivers in disaster and emergency scenarios and prioritizing their mental and emotional health to ensure sustained support
These principles form the core foundation guiding occupational therapists’ response to emergencies. They emphasize adaptability, personalized care, and holistic support for clients and caregivers alike.
1. Emergency Preparedness
1a. Providing Knowledge, Education, and Training
Occupational therapists can provide education, guidance, and training to individuals, families, communities, and organizations, individually or in groups, to enhance skills that foster preparedness and resilience in managing disasters. This provision includes aiding in the formulation and rehearsal of emergency plans, comprehending safety protocols and responses, and ensuring these are accessible to the general population and particularly to those with disabilities.
1b. Needs Assessment and Adapted Response to Vulnerable Populations
Occupational therapists identify needs and create specialized solutions for vulnerable groups in everyday situations. This skill extends to emergencies and disasters, where they incorporate a person-centered lens to assess the needs of individuals or populations, mission requirements, and environmental factors, all centered around the individual's perspective.
This assessment process facilitates the creation of customized preparation plans, incorporating adjusted practices and ensuring information accessibility. For instance, it might involve ensuring entry accessibility for individuals with mobility impairments, pre-organizing medical equipment for those with complex medical needs, or simplifying language for cognitive ease in following instructions. These adaptations cater to unique needs, ensuring a more responsive and inclusive emergency plan.
2. Disaster Response
2a. Immediate Relief Efforts
Immediate relief efforts entail offering first aid as part of a multiprofessional team, including mental and physical first aid.
2a(1). Mental First Aid
- Enhancing time and space awareness: helping individuals grasp their current time and place
- Validating experiences and providing insight: acknowledging challenging circumstances, explaining physiological processes, and highlighting connections between emotions, thoughts, behaviors, and feelings
- Alleviating physical symptoms: implementing calming and regulating techniques to address and alleviate distress-related physical symptoms
- Empowerment through engagement in activities: using tasks, activities, and occupations to instill a sense of control, reducing emotional distress and feelings of helplessness
- Fostering regulation and coping strategies: promoting strategies to regulate emotions and cope effectively to alleviate anxiety and promote emotional well-being
2a(2). Physical First Aid
- Immediate injury treatment: swift and immediate intervention to minimize physical, orthopedic, and neurological injuries and mitigate their immediate consequences
- Timely physical injury intervention: immediate treatments targeting physical injuries to prevent their deterioration, facilitating improved rehabilitation outcomes; these include rehabilitative physical therapy for upper limb injuries, splint adjustments, burn and scar treatment, and pressure dressing management
- Urgent needs assessment: evaluating immediate requirements and adapting essential assistive devices for mobility and self-care in rehabilitation
- Sustaining routine treatments: implementing flexibility and adaptability to ensure an optimal response to evolving needs and conditions
2b. Treatment, Rehabilitation, and Recovery
Occupational therapists can develop personalized treatment and rehabilitation programs tailored to individuals' goals, desires, and capabilities. They facilitate a return to functional independence and meaningful engagement in occupations, restoring motor, cognitive, sensory, emotional, and social skills.
- Creating adapted routines and organizational strategies: These routines and strategies, vital for coping and recovery, include structuring daily schedules encompassing health management, self-care, caregiving, meals, rest, social engagement, productivity, and leisure activities while maintaining occupational balance. The objective is to restore the ability to perform routine tasks and maintain functionality, utilizing available resources despite ongoing uncertainty and crises.
- Adapting environments for individuals who have undergone traumatic events or experienced displacement: This essential adaptation involves establishing safe spaces equipped with orientation aids, even in temporary settings, and fostering supportive community environments.
- Ensuring accessibility and safety in environments tailored to individuals with disabilities and special needs: This includes measures to maximize functionality, minimize dependency, and prevent deterioration.
- Collaborating with community entities to create inclusive environments that cater to the needs of all individuals: This collaboration aims to ensure accessibility, inclusivity, and integration within the community for all.
2c. Interprofessional Collaboration for Trauma-Informed Care
- Occupational therapists have an essential role within a diverse, interprofessional team dedicated to frontline disaster and trauma care.
- They leverage established intervention methods from extensive knowledge gathered over years of analyzing traumatic experiences. This knowledge encompasses understanding the repercussions of trauma across diverse populations, including those with disabilities and special needs, and shaping future-focused policies and procedures to address such situations.
- Interprofessional collaboration involves coordination among health care providers on multiprofessional teams, such as emergency and disaster first responders, volunteers, and trauma specialists. This collective effort aims to cater to the varied needs of trauma-affected populations. The goal of this trauma-informed response is to cultivate an environment fostering safety, trustworthy communication, empowerment, collaborative engagement, and culturally aligned social support, all while minimizing instances of prolonged, recurrent, or secondary trauma.
2d. Preventing Secondary Trauma for Therapists
Implementing strategies to prevent secondary trauma involves specific precautions when caregivers are consistently exposed to intense trauma situations during primary or secondary care. These precautions include acknowledging shared traumatic reality within an overall emergency context. Examples of preventive measures are providing tutorials and supportive training sessions that offer knowledge and strategies, facilitating support groups, and advocating for self-care routines.
3. Fostering Recovery and Long-Term Resilience
3a. Occupational Adaptation and Skill Development
Strengthening the human spirit by fostering inner resilience involves nurturing beliefs, values, self-identity, competence, hope, motivation, and mental strength. Supporting personal recovery journeys involves aiding individuals in navigating hardships, adapting to new situations, reclaiming everyday roles and lost abilities, and cultivating resilience to confront future challenges while preserving an occupational balance of daily activities.
3b. Community Involvement and Empowerment
Facilitating community-driven initiatives, recognizing strengths, and empowering affected populations post disaster cultivates a sense of belonging, resilience, and empowerment within communities.
3c. Environmental Adaptations and Accessibility
- Rebuilding diverse, inclusive, and accessible physical and cognitive environments enhances overall functioning and engagement across the population, including people affected by emergencies or disasters. This entails adapting physical, social, virtual, and cultural surroundings to meet varied needs.
- Environmental adaptation includes adapting equipment and assistive technology previously utilized or now required due to injuries (such as computer or tablet accessibility, communication devices, splints, etc.).
- Consider telehealth solutions to ensure accessibility and sustain therapeutic continuity in services.
4. Advocacy for Occupational Therapy’s Ongoing Role in Policy Promotion, Occupational Justice, and Evidence-Based Practice
4a. Refinement and Expansion of Emergency and Disaster Response Protocols
- Collaborative efforts: refining and expanding procedures, position papers, and protocols for addressing emergencies and disasters and interprofessional collaboration among various government ministries and policymakers
- Advocating occupational justice: taking proactive measures to advocate for occupational justice and upholding the rights of individuals affected by emergency situations
- Integrating therapists in disaster planning: advocating for and publicizing the integration of therapists in local, national, and international disaster preparedness and response plans. This inclusion spans diverse sectors, focusing on physical and mental well-being within the health care realms.
4b. Promoting Evidence-Based Practices
This initiative aims to enhance clinical approaches and foster additional research endeavors by leveraging research and evidence-based practices that highlight the pivotal role of occupational therapists in emergency response scenarios.
Summary
Occupational therapists are a necessary part of emergency and disaster management system. They have unique knowledge and skills to respond to preparation efforts, response, and treatment, and rehabilitation and recovery processes after a disaster. Occupational therapists have a holistic view of the needs of individuals and communities, allowing them to integrate different intervention approaches for coping and to develop resilience through active participation in meaningful occupations while maintaining an occupational balance uniquely adapted to every person. Recognizing and promoting the involvement of occupational therapists during emergencies and disasters will contribute to the effectiveness of our communities' resilience system in times of distress.
Occupational therapists form an indispensable component of the emergency and disaster management system. Their distinct expertise spans preparation, response, treatment, and the holistic recovery process post disaster. With a comprehensive understanding of individual and community needs, they adeptly blend diverse intervention strategies to foster resilience through active engagement in meaningful occupations, ensuring a balanced approach tailored to each person's unique circumstances. Recognizing and advocating for the involvement of occupational therapists during crises will significantly enhance the resilience and recovery of our communities during times of adversity.
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Contributing authors: Orly Boni, Ariela Tzur, Etti Amar, Dana Alush, Dana Weissbrem Padan, Vered Speier Keisar, Chen Cohen, Jasmin Bar Yosef, Ifat Velder Shukrun, Yael Shidlovsky Peres, Liora Peleg, Liat Gafni-Lachter, Limor Rosenberg, Lena Lipskaya-Velikovsky, Moran Shaham Levy, Michal Orpaz Tsipris, Miri Tal Saban, Merav Gelis, Nava Ratzon, Sivan Regev, Adi Stern, Anat Golos, Ofra Bareket, Tzlil Cohen Ben Moshe, Revital Gal, Ruti Sagiv, Shelly Zimmerman, Shimona Lev-On, Sarit Yacobi Cuznir, Tamir Gabai.
Acknowledgment: We thank Dr. Liat Gafni-Lachter for translating the position paper from Hebrew and Donna Magnani for thoughtful copy editing.
This position paper was approved by the members of the Supreme Professional Council, the Israeli Society of Occupational Therapy, and the Association for Professional Advancement of Occupational Therapists.
Central References
Abiodun, O. Y., Odunayo, A. C., Ayub, S., & Kumari, M. (2021). Disaster management and working with displaced persons (methodological paper). Open Journal of Therapy and Rehabilitation, 9, 29–41. https://doi.org/10.4236/ojtr.2021.92003
Parente, M., Tofani, M., De Santis, R., Esposito, G., Santilli, V., & Galeoto, G. (2017). The role of the occupational therapist in disaster areas: Systematic review. Occupational Therapy International, 2017, Article 6474761. https://doi.org/10.1155/2017/6474761
Rushford, N., & Thomas, K. (Eds.). (2015). Disaster and development: An occupational perspective. Elsevier Health Sciences.
Scaffa, M. E., Reitz, S. M., Smith, T. M., & DeLany, J. V. (2011). The role of occupational therapy in disaster preparedness, response, and recovery. American Journal of Occupational Therapy, 65(6), S11–S11.https://doi.org/10.5014/ajot.2011.65S11
World Federation of Occupational Therapists. (n.d.). Resources on disaster preparedness and management. https://wfot.org/resources/disaster-management-for-occupational-therapists
World Federation of Occupational Therapists. (2019a). Guide for occupational therapy first responders to disaster and trauma. https://wfot.org/resources/wfot-guide-for-occupational-therapy-first-responders-to-disasters-and-trauma
World Federation of Occupational Therapists. (2019b). Resource manual: Occupational therapy for displaced persons. https://wfot.org/resources/wfot-resource-manual-occupational-therapy-for-displaced-persons
World Federation of Occupational Therapists. (2022). Disaster preparedness and risk reduction manual. https://wfot.org/resources/wfot-disaster-preparedness-and-risk-reduction-manual
https://doi.org/10.55134/oSDThY04
