Megan Mitchell, PT, DPT, MPH and the National Disaster Management Perspective

Background: Megan is an Associate Faculty, University of Colorado Physical Therapy Program and a clinician in the Emergency Department of Saint Joseph's Medical Center in Denver. Prior to this she worked for 14 years in various Emergency Departments within Denver Health Medical Center.

She's an Emergency Operations Specialist with the National Disaster Management System (NDMS), an on demand Emergency Response PT for Humanity and Inclusion (HI) and teaches emergency response and care for the athlete (American Academy of Sports PT). Her "role within U.S. domestic disaster response is in as many capacities as possible since the United States does not currently include use of PT or PTA in federal disaster response."

Megan is trained in MCI (mass casualty incident) and CBRNE (chemical, biological, radiological, nuclear & explosives) awareness and response operations. She is part of her hospital's emergency response team including the policy and procedure review team. According to Megan: "the facility level is the most readily available access point for therapists to engage in disaster response. Without presence in front of Emergency Managers with an active voice, we will never be included in response operations or requested as a resource during a mass casualty event."

Why is it important that physical therapists be included in domestic disaster responses?  

"Recognition and management of acute injuries and mobilizing people with injuries without causing additional injury is a part of the physical therapist and assistant training. Given the training and skills of PT, we are ideally suited to provide care and management to the walking-wounded during initial and early stage response. This also frees up traditional providers (RN, MD and paramedic) to provide the higher level intervention skills for those considered yellow tagged and red tagged."

What skills do they contribute to the team that would otherwise be absent?

"It isn’t about addressing the absence of skills but adding value from the training and lens of a PT. We are specialists in movement and function that isn’t taught or understood by our MD, RN or paramedic colleagues."

"While each of these professions receives education in body systems and medical and/or surgical interventions but not every patient needs this. PT offers intervention that other providers don’t. We can also improve access and care for those with disabilities and functional access needs."

Megan's most recent deployment was for the Presidential Inauguration in Washington DC on January 20, 2025 where her role was in the "development and implementation of operational tasks for medical teams stationed at the Mall, ensuring health and safety of NDMS personnel including personally taking a responder to the ER for an on-the-job injury, managing personnel concerns and resource requests, and liaising between agency reps in the field."

When activated, members of the NDMS are considered members of the uniformed services. As such, it was important to Megan that she was a part of an effort to "protect people in (not of) this country and swearing an allegiance to protecting the Constitution, not an administration."

For those interested in becoming involved in national disaster management, Megan shares: "the process is messy and convoluted.

There are ways to engage both in the clinical and non-clinical capacity currently but you have to start by understanding the Incident Command System and language. Every company, agency, and facility that accepts CMS funding has an emergency response regulatory requirement. Engaging with the Emergency Manager is the fastest way to change practices."

"Free training is available with the Emergency Management Institute and the Center for Domestic Preparedness. All PTs working in the emergency room needs to take at least CBRNE awareness education training."

Contact Megan Mitchell for more info about her work. See list of resources below.

April Gamble, PT, DPT, CLT and the International Humanitarian Crisis Perspective

Background: Originally from Michigan, April Gamble has been living and working full time in the Kurdistan Region of Iraq since 2017 while staying connected to the rehabilitation profession in the USA and globally. 

Currently, April is Senior Health Advisor for Rehabilitation for UK-MED’s humanitarian emergency response team, integrating rehabilitation and non-specialized mental health into emergency and disaster responses around the world. They lead the implementation of culturally responsive rehabilitation services in the most globally deployed Emergency Medical Team (EMT) and the only WHO-Verified Rehabilitation Specialized Care Emergency Medical Team.

April's role is to advocate and lead the integration of rehabilitation services into UK-MED's emergency responses which occur when a national government invites the organization to provide support as their healthcare system is overwhelmed from natural disaster or conflicts. Recent responses include Lebanon, Gaza, Bangladesh, Ukraine, and Armenia.

What is the focus of your work?

"The overall aim of rehabilitation activities is to support people with life-changing injuries to access rehabilitation services that maximize people's and communities functional abilities to participate in meaningful life activities."

"We strive to achieve this by mobilizing under the national leadership to offer a variety of activities including the delivery of clinical services, implementation of clinical care pathways and protocols, capacity building, advocacy for mobilization of national rehabilitation actors and resources, collaboration with national leaders, and research."

"For example, in Gaza, since January 2024, the UK-MED Rehab team has provided 3806 rehabilitation sessions for 805 patients."

Where did you serve in-country most recently?

"I served in Lebanon from mid-December 2024 to late January 2025."

What was your clinical work like in Lebanon?

"In Lebanon for our Rehabilitation Specialized Care Team, we were embedded into a DOH (Department of Health) national hospital and collaborated with (local) actors to establish it as the first national burn hospital in the country. We provided inpatient and outpatient burn rehabilitation services, alongside surgical and nursing services, to survivors of the war."

"I enjoy working within Burn Rehabilitation because of the intimacy and vulnerability that is fostered with burn survivors and their families. For example, one man that I worked with (see above photo), had severe burns on bilateral upper extremities due to an air strike. He received acute care in another hospital and then was referred to our services 2 months after the initial injury. He presented with significant contractures and hypertrophic scarring, limiting the functional use of his arms and hands."

"When providing burn rehabilitation interventions, like joint mobilizations, scar massage, and therapeutic exercise, it is essential to develop a secure therapeutic relationship, rooted in trauma-informed care principles."

"For example, when providing the interventions, I ensure that I maintain attention and focus on the person, noticing the reactions in their eyes, breathing, and body, to ensure that the intensity of the activity is within the effective range of pain, fear, and challenge. This man's wife and young sons would often accompany him to the 2 hour rehabilitation sessions - I value the intimate relationships that were created with him and his family, and find meaning and joy in witnessing his progress. He has a long road of recovery ahead of him which will involve ongoing rehabilitation, compression garment therapy, and surgical interventions."

"To support the burn survivors, like him, in Lebanon, we also worked alongside the hospital leadership, Ministry of Health and the Lebanese Order of Physiotherapists, to build capacity and resources nationally to ensure ongoing burn rehabilitation after our Emergency Medical Team exits."

Contact April Gamble for more info about her work. See list of resources below.

The Global Health SIG held its annual business meeting on Friday, February 14, 2025 at the APTA Combined Sections Meeting in Houston, Texas. With more than 35 attendees in person or online, The Global Health SIG Chair Kai Kennedy reviewed the SIG’s accomplishments from the prior year, including the launches of Global Health Town Hall, the Global Health SIG newsletter, The Compass, Posters in a Podcast, and the Global Health Research Spotlight. Attendees were encouraged to visit the Academy of Leadership and Innovation’s ALI-Fest where the Global Health SIG, together with the PT Proud SIG and Population Health SIG, hosted the ALI Poster Session highlighting projects aimed to improve health outcomes for communities locally and abroad.

The latter portion of the meeting was dedicated to discussion around recent changes to healthcare initiatives, domestically and abroad. The discussion was led by a panel of Global Health SIG members and colleagues, including PTs and providers on the front lines of healthcare initiatives in Africa and in the Middle East, and an organization that pairs healthcare volunteers with projects around the world. Attendees were able to hear how PTs, PTAs, and organizations are navigating recent changes to funding, research, and educational policy. The panelists and attendees were able to exchange strategies for safeguarding healthcare access for vulnerable communities, including those served by physical therapists and physical therapist assistants.

The ALI Fest Poster Presentation showcased 15 diverse topics on global health and population health, presented by students, faculty, and professionals from the field. Among the highlights were the top 3 social responsibility poster winners, selected from over 1,460 submissions at the CSM, who also attended the event.

For two hours, attendees had the opportunity to engage directly with the presenters, exploring their posters, areas of expertise, and key takeaways. The event was a lively mix of learning and interaction, offering both educational value and an enjoyable atmosphere.

If you missed the ALI Fest, don't worry! The presenters will have a chance to share their work in the Global Health SIG's Posters in a Podcast series, recorded regularly. Stay tuned for upcoming episodes!