Identifying deficiencies in national and foreign medical team responses through expert opinion surveys: implications for education and training

Challenges Faced by Medical Rescue Teams During Disaster Response: A Systematic Review Study

This study was conducted to identify the challenges faced by medical rescue teams during the response phase of sudden-onset disasters and provide a comprehensive understanding of these challenges. Peer-reviewed, English-language articles published until January 2023 that described the challenges faced by medical rescue teams during disaster response were searched in the Web of Science, Scopus, Cochrane, PubMed, and Science Direct databases. The articles were assessed using the Mixed Methods Appraisal Tool (MMAT) version 2018, a quality evaluation tool, and a qualitative thematic synthesis approach was adopted. A total of 353 publications were identified, and 18 of these met the inclusion criteria. Of the 18 included studies, 8 were review articles, 4 were special reports, 3 were cross-sectional studies, 1 was a mixed methods study, 1 was a qualitative study, and 1 was a short communication. Through qualitative analysis, the challenges faced by medical rescue teams during disaster response were categorized into 6 factors: organizational, individual, environmental and health, logistical, communication and information, and other factors. These factors are significant in terms of issues such as delayed access to disaster victims, disruptions in response processes, and an increase in morbidity and mortality rates. Therefore, the findings in our study shed light on future research in the field of disasters and offer opportunities to develop a roadmap for improving the conditions of medical rescue teams.

Enhancing disaster response of emergency medical teams through "TEAMS 3.0" training package-Does the multidisciplinary intervention make a difference?

Background

In the aftermath of disasters, Emergency Medical Teams (EMTs) are dispatched to help local rescue efforts. Although EMTs are recognized to be a critical component of the global health workforce, concerns have emerged over their functioning and effectiveness. For example, lack of cooperation and coordination between different EMTs has been a longstanding issue, resulting in fragmented disaster management.

Methods

To enhance the provision of EMT's field teamwork, the Training for Emergency Medical Teams and European Medical Corps (TEAMS) project was established, and later further updated with novel scenarios and exercises (i.e., adapting EMT operations to a sudden disaster; becoming a modular team; reflecting on ethical dilemmas) in the complementary "TEAMS 3.0" project where a more comprehensive training package was developed. The aim of this study was to assess the effectiveness and quality of the TEAMS 3.0 training package in four training programs in Portugal, Germany, Norway, and Turkey. Participants completed a set of questionnaires designed to assess self-efficacy, teamwork, and quality of training.

Results

The results from all the trainings suggest an improvement for both teams' self-efficacy and teamwork. The mean score among all the participants (N = 100) for both the self-efficacy scale and teamwork scale was 3.217 (±0.223) prior to training and 3.484 (±0.217) following the training, and 2.512 (±1.313) prior to training and 3.281 (±0.864), respectfully, with statistically significant differences according to Wilcoxon paired samples test (p < 0.05). The quality of training is regarded as high and deemed as an appropriate tool package for addressing the objectives of the project and the perceived needs of EMT disaster deployment.

Conclusion

Thus far, the TEAMS 3.0 project has demonstrated to be effective in promoting EMT teamwork capacities.

[Simulation-based training for a hospital incident command group]

BACKGROUND

We report on immersive simulation scenarios with video-enhanced debriefing as part of a full day education program for members of a newly implemented hospital incident command group. The hospital incident command group has a key function in the initial phase of a hospital crisis. Simulation exercises were used to provide practical experience for the participants in a yet unknown task area and to support the acquisition of professional and personal competencies.

OBJECTIVES

Are immersive simulation scenarios with video-enhanced debriefing a suitable method as part of an education program to change the perceptions of participants about their tasks and enhance their motivation to assume leadership positions?

MATERIALS AND METHODS

Participants of a 1‑day educational workshop completed immersive simulation scenarios during which they took on roles and responsibilities of a hospital incident command group. A final questionnaire with a 5-point Likert scale was used to capture changes in specific knowledge and perceptions as a result of the simulation experience.

RESULTS AND CONCLUSION

The vast majority of participants assessed the immersive simulation scenarios as effective in changing their perceptions and to motivate them to become part of a hospital incident command group. Simulation with video-enhanced debriefing is a suitable method for providing professional and personal competencies to members of a hospital incident command group.

Self-perceived preparedness and training needs of healthcare personnel on humanitarian mission: a pre- and post-deployment survey

Background

Humanitarian healthcare workers are indispensable for treating weapon-wounded patients in armed conflict, and the international humanitarian community should ensure adequate preparedness for this task. This study aims to assess deployed humanitarian healthcare workers’ self-perceived preparedness, training requirements and mental support needs.

Methods

Medical professionals deployed with the International Committee of the Red Cross (ICRC) between October 2018 and June 2020 were invited to participate in this longitudinal questionnaire. Two separate questionnaires were conducted pre- and post-deployment to assess respondents’ self-perceived preparedness, preparation efforts, deployment experiences and deployment influence on personal and professional development.

Results

Response rates for the pre- and post-deployment questionnaires were 52.5% (114/217) and 26.7% (58/217), respectively. Eighty-five respondents (85/114; 74.6%) reported feeling sufficiently prepared to treat adult trauma patients, reflected by predeployment ratings of 3 or higher on a scale from 1 (low) to 5 (high). Significantly lower ratings were found among nurses compared to physicians. Work experience in a high-volume trauma centre before deployment was associated with a greater feeling of preparedness (mean rank 46.98 vs. 36.89; p = 0.045). Topics most frequently requested to be included in future training were neurosurgery, maxillofacial surgery, reconstructive surgery, ultrasound, tropical diseases, triage, burns and newborn noncommunicable disease management. Moreover, 51.7% (30/58) of the respondents regarded the availability of a mental health professional during deployment as helpful to deal with stress.

Conclusion

Overall, deployed ICRC medical personnel felt sufficiently prepared for their missions, although nurses reported lower preparedness levels than physicians. Recommendations were made concerning topics to be covered in future training and additional preparation strategies to gain relevant clinical experience. Future preparatory efforts should focus on all medical professions, and their training needs should be continuously monitored to ensure the alignment of preparation strategies with preparation needs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13017-022-00417-z.

A Call for the Application of Patient Safety Culture in Medical Humanitarian Action: A Literature Review

OBJECTIVES

The aims of the study were to assess lessons learned on patient safety in Organization for Economic Cooperation and Development (OECD) countries and to assess whether they are applied or can be applied to the humanitarian medicine.

METHODS

This is (a) a 2013-2018 rapid literature review of reviews and systematic reviews articles (PubMed database) on "patient safety" and "medical error" to look for lessons learned regarding patient safety in OECD countries and (b) a rapid literature review (PubMed and Embase databases) on "humanitarian medicine" and "patient safety," from their creation to 2018, to find any articles related to patient safety in humanitarian medicine. In both reviews were excluded articles specifically related to one device, disease, or medical act. These reviews were complemented by a Google search.

RESULTS

Of the 245 references retrieved, 104 met the inclusion criteria. Of 308 references, 39 respected the inclusion criteria. In OECD countries, patient safety comprises correlated measures taken at three levels. The micro level focuses on individual staff involved in healthcare provision or management; the meso level focuses on medical institutions; the macro level focuses on national healthcare systems. Only one reference mentioned the implementation of a medical error reporting and analysis system in medical humanitarian organization.

CONCLUSIONS

The adoption of strategies and a culture of safety will need to be adapted to address the variety of intervention contexts and to respond first to the fears and expectations of humanitarian staff. Medical humanitarian organizations, in the absence of an overarching authority for the sector, have a major responsibility in the development of a general patient safety policy applicable in all their operations.

Knowledge, attitudes, and Expectations of Medical Staff Toward Medical Error Management Policies in Humanitarian Medicine: A Qualitative Study

BACKGROUND

Patient safety, a major component of quality of care, is now an attribute of health care systems in developed countries at least. Although there is ever more research on this subject in developed countries, humanitarian medicine, mainly implemented in resource-poor countries, has yet to structure its own set of policies and strategies on patient safety and the management of medical errors.

OBJECTIVES

We assessed the knowledge, attitudes, and expectations of medical humanitarian staff regarding the development of policies and strategies related to patient safety and medical error management in medical humanitarian action.

METHODS

We conducted 36 semistructured interviews with international medical and paramedical staff active in 6 medical humanitarian organizations after having interviewed the medical directors or the person in charge of quality of care and the legal advisors. Interviews were transcribed verbatim and subjected to a thematic analysis.

RESULTS

The interviews confirmed the current absence of clear investments in dealing with safety risks in the selected medical humanitarian organizations. The difficulties experienced by medical staff in reporting medical errors such as blame culture, lack of training, and absence of leadership committed on patient safety are nonspecific. Other arguments are related to the specific conditions of humanitarian settings: coexistence of different medical culture, absence of international or local regulations or external pressures, and great diversity of activities and contexts.

CONCLUSIONS

Interviewed staff expressed high expectations of receiving guidance from their organizations and support to adopt clear patient safety and medical error management policies adapted to their complex operational and clinical realities.

Training Package for Emergency Medical Teams Deployed to Disaster Stricken Areas: Has 'TEAMS' Achieved its Goals?

In spite of their good intentions, Emergency Medical Teams (EMTs) were relatively disorganized for many years. To enhance the efficient provision of EMT's field team work, the Training for Emergency Medical Teams and European Medical Corps (TEAMS) project was established. The purpose of this study was to assess the effectiveness and quality of the TEAMS training package in 2 pilot training programs in Germany and Turkey. A total of 19 German and 29 Turkish participants completed the TEAMS training package. Participants were asked to complete a set of questionnaires designed to assess self-efficacy, team work, and quality of training. The results suggest an improvement for both teams' self-efficacy and team work. The self-efficacy scale improved from 3.912 (± 0.655 SD) prior to training to 4.580 (± 0.369 SD) after training (out of 5). Team work improved from 3.085 (± 0.591 SD) to 3.556 (± 0.339 SD) (out of 4). The overall mean score of the quality of the training scale was 4.443 (± 0.671 SD) (out of 5). In conclusion, The TEAMS Training Package for Emergency Medical Teams has been demonstrated to be effective in promoting EMT team work capacities, and it is considered by its users to be a useful and appropriate tool for addressing their perceived needs.

Surgery with Limited Resources in Natural Disasters: What Is the Minimum Standard of Care?

Purpose of Review

In a challenging scenario, such as in the aftermath of a natural disaster, minimum standards of care must be in place from the moment surgical care activities are launched.

Recent Findings

Natural disasters cause destruction and human suffering, especially in low- and middle-income countries, which suffer the most when exposed to their consequences. Health systems can quickly get overwhelmed and can collapse under the burden of injured patients during this event, while qualified surgical care remains crucial. Medécins Sans Frontières (MSF) has a vast experience providing surgical care after natural disasters, and quality is assured through the Donabedian model. Minimum structure standards are put in place from the beginning of an emergency response, together with standard operating procedures providing guidance to professionals working in challenging conditions.

Summary

MSF believes that it is always possible to deliver surgical care, ensuring the best possible quality guaranteeing adequate levels of structure and process. The "do no harm" principle must always be respected as adherence to medical ethics is a must in any context, even a challenging one.

What do They Know? Guidelines and Knowledge Translation for Foreign Health Sector Workers Following Natural Disasters

Introduction The incidence of natural disasters is increasing worldwide, with countries the least well-equipped to mitigate or manage them suffering the greatest losses. Following natural disasters, ill-prepared foreign responders may become a burden to the affected population, or cause harm to those needing help. Problem The study was performed to determine if international guidelines for foreign workers in the health sector exist, and evidence of their implementation.

METHODS

A structured literature search was used to identify guidelines for foreign health workers (FHWs) responding to natural disasters. Analysis of semi-structured interviews of health sector responders to the 2015 Nepal earthquake was then performed, looking at preparation and field activities.

RESULTS

No guidelines were identified to address the appropriate qualifications of, and preparations for, international individuals participating in disaster response in the health sector. Interviews indicated individuals choosing to work with experienced organizations received training prior to disaster deployment and described activities in the field consistent with general humanitarian principles. Participants in an ad hoc team (AHT) did not.

CONCLUSIONS

In spite of need, there is a lack of published guidelines for potential international health sector responders to natural disasters. Learning about disaster response may occur only after joining a team. Dunin-Bell O . What do they know? Guidelines and knowledge translation for foreign health sector workers following natural disasters. Prehosp Disaster Med. 2018;33(2):139-146.

Disaster Preparedness among Health Professionals and Support Staff: What is Effective? An Integrative Literature Review

Introduction It is important that health professionals and support staff are prepared for disasters to safeguard themselves and the community during disasters. There has been a significantly heightened focus on disasters since the terrorist attacks of September 11, 2001 in New York (USA); however, despite this, it is evident that health professionals and support staff may not be adequately prepared for disasters. Report An integrative literature review was performed based on a keyword search of the major health databases for primary research evaluating preparedness of health professionals and support staff. The literature was quality appraised using a mixed-methods appraisal tool (MMAT), and a thematic analysis was completed to identify current knowledge and gaps. Discussion The main themes identified were: health professionals and support staff may not be fully prepared for disasters; the most effective content and methods for disaster preparedness is unknown; and the willingness of health professionals and support staff to attend work and perform during disasters needs further evaluation. Gaps were identified to guide further research and the creation of new knowledge to best prepare for disasters. These included the need for: high-quality research to evaluate the best content and methods of disaster preparedness; inclusion of the multi-disciplinary health care team as participants; preparation for internal disasters; the development of validated competencies for preparedness; validated tools for measurement; and the importance of performance in actual disasters to evaluate preparation.

CONCLUSION

The literature identified that all types of disaster preparedness activities lead to improvements in knowledge, skills, or attitude preparedness for disasters. Most studies focused on external disasters and the preparedness of medical, nursing, public health, or paramedic professionals. There needs to be a greater focus on the whole health care team, including allied health professionals and support staff, for both internal and external disasters. Evaluation during real disasters and the use of validated competencies and tools to deliver and evaluate disaster preparedness will enhance knowledge of best practice preparedness. However, of the 36 research articles included in this review, only five were rated at 100% using the MMAT. Due to methodological weakness of the research reviewed, the findings cannot be generalized, nor can the most effective method be determined. Gowing JR , Walker KN , Elmer SL , Cummings EA . Disaster preparedness among health professionals and support staff: what is effective? An integrative literature review. Prehosp Disaster Med. 2017;32(3):321-328.

Characteristics of Medical Teams in Disaster

Disasters present unique challenges for teams providing medical assistance to those populations impacted by the event. This scoping review focused on the characteristics of medical teams in disaster and how these characteristics are developed. The scoping review methods of Arksey and O’Malley were followed. An inductive thematic analysis of selected articles was used to identify recurrent themes. A total of 6,521 articles were reviewed from eight databases, yielding 33 articles. Four recurrent theme groups were identified: (1) adaptability, flexibility, and improvisation; (2) creativity and innovation; (3) experience and training; and (4) leadership and command structure. The study highlighted key characteristics identified by responders for effective team functioning and interdependence between the characteristics. It also identified the paucity of literature on the subject. Results from the study can help to guide future research and training development for medical teams in disaster.

OldenburgerD,BaumannA,BanfieldL.Characteristics of medical teams in disaster.Prehosp Disaster Med.2017;32(2):195–200.

Foreign Medical Teams in support of the Ebola outbreak: a UK military model of pre-deployment training and assurance

We discuss the training methodology developed and utilised to prepare UK military medical teams to establish an Ebola Treatment Centre in Sierra Leone. We highlight the process of identifying and mitigating nosocomial risk in the Pre-Deployment Training process, encompassing the challenges of developing, training and assuring a capability at pace, which deployed to deliver high quality clinical care to patients with Ebola Virus Disease.

Evaluation of a new community-based curriculum in disaster medicine for undergraduates

BACKGROUND

Nowadays, many medical schools include training in disaster medicine in undergraduate studies. This study evaluated the efficacy of a disaster medicine curriculum recently designed for Saudi Arabian medical students.

METHODS

Participants were 15 male and 14 female students in their fourth, fifth or sixth year at Jazan University Medical School, Saudi Arabia. The course was held at the Research Center in Emergency and Disaster Medicine and Computer Sciences Applied to the Medical Practice in Novara, Italy.

RESULTS

The overall mean score on a test given before the course was 41.0 % and it increased to 67.7 % on the post-test (Wilcoxon test for paired samples: z = 4.71, p < 0.0001). There were no significant differences between the mean scores of males and females, or between students in their fourth, fifth or sixth year of medical school.

CONCLUSIONS

These results show that this curriculum is effective for teaching disaster medicine to undergraduate medical students. Adoption of this course would help to increase the human resources available for dealing with disaster situations.

Assessment of disaster preparedness among emergency departments in Italian hospitals: a cautious warning for disaster risk reduction and management capacity

STUDY HYPOTHESIS

Since the 1990s, Italian hospitals are required to comply with emergency disaster plans known as Emergency Plan for Massive Influx of Casualties. While various studies reveal that hospitals overall suffer from an insufficient preparedness level, the aim of this study was to better determine the preparedness level of Emergency Departments of Italian hospitals by assessing the knowledge-base of emergency physicians regarding basic disaster planning and procedures.

METHODS

A prospective observational study utilized a convenience sample of Italian Emergency Departments identified from the Italian Ministry of Health website. Anonymous telephone interviews were conducted of medical consultants in charge at the time in the respective Emergency Departments, and were structured in 3 parts: (1) general data and demographics, (2) the current disaster plan and (3) protocols and actions of the disaster plan.

RESULTS

Eighty-five Emergency Departments met inclusion criteria, and 69 (81 %) agreed to undergo the interview. Only 45 % of participants declared to know what an Emergency Plan for Massive Influx of Casualties is, 41 % believed to know who has the authority to activate the plan, 38 % knew who is in charge of intra-hospital operations. In Part 3 physicians revealed a worrisome inconsistency in critical content knowledge of their answers.

CONCLUSIONS

Results demonstrate a poor knowledge-base of basic hospital disaster planning concepts by Italian Emergency Department physicians-on-duty. These findings should alert authorities to enhance staff disaster preparedness education, training and follow-up to ensure that these plans are known to all who have responsibility for disaster risk reduction and management capacity.

Development and validation of the Humanitarian Aid Difficulty Scale for Japanese healthcare workers

Few studies have investigated deployment-related experiences of healthcare workers dispatched for medical humanitarian aid or attempted to assess their difficult living and working environments. This is the first study to develop and validate a scale to measure these kinds of difficulties, in 264 Japanese healthcare workers. The Humanitarian Aid Difficulty Scale was developed in three stages. First, an item pool was generated based on literature and expert reviews. The scale was then tested in a pilot study. Reliability and validity were identified through exploratory and confirmatory factor analysis and Cronbach's alpha. The scale consisted of 23 items across five factors based on exploratory factor analysis (cooperation, health status, infrastructure, culture and customs, and supplies and equipment). The total variance explained was 60.7%. Reliability of the five factors was acceptable and validity was supported by confirmatory factor analysis. Cronbach's alpha for the scale was 0.87. The scale may enable evaluation of the level of difficulty of the living and working environments of Japanese healthcare workers in medical humanitarian aid who are at a greater risk of distress.

What Kinds of Skills Are Necessary for Physicians Involved in International Disaster Response?

Introduction Physicians are key disaster responders in foreign medical teams (FMTs) that provide medical relief to affected people. However, few studies have examined the skills required for physicians in real, international, disaster-response situations. Problem The objectives of this study were to survey the primary skills required for physicians from a Japanese FMT and to examine whether there were differences in the frequencies of performed skills according to demographic characteristics, previous experience, and dispatch situations to guide future training and certification programs.

METHODS

This cross-sectional survey used a self-administered questionnaire given to 64 physicians with international disaster-response site experience. The questionnaire assessed demographic characteristics (sex, age, years of experience as a physician, affiliation, and specialty), previous experience (domestic disaster-relief experience, international disaster-relief experience, or disaster medicine training experience), and dispatch situation (length of dispatch, post-disaster phase, disaster type, and place of dispatch). In addition, the frequencies of 42 performed skills were assessed via a five-point Likert scale. Descriptive statistics were used to assess the participants' characteristics and total scores as the frequencies of performed skills. Mean scores for surgical skills, health care-related skills, public health skills, and management and coordination skills were compared according to the demographic characteristics, previous experience, and dispatch situations.

RESULTS

Fifty-two valid questionnaires (81.3% response rate) were collected. There was a trend toward higher skill scores among those who had more previous international disaster-relief experience (P=.03). The more disaster medicine training experience the participants had, the higher their skill score was (P<.001). Physicians reported involvement in 23 disaster-relief response skills, nine of which were performed frequently. There was a trend toward higher scores for surgical skills, health care-related skills, and management and coordination skills related to more disaster medicine training experience.

CONCLUSION

This study's findings can be used as evidence to boost the frequency of physicians' performed skills by promoting previous experience with international disaster relief and disaster medicine training. Additionally, these results may contribute to enhancing the quality of medical practice in the international disaster relief and disaster training curricula. Noguchi N , Inoue S , Shimanoe C , Shibayama K , Matsunaga H , Tanaka S , Ishibashi A , Shinchi K . What kinds of skills are necessary for physicians involved in international disaster response? Prehosp Disaster Med. 2016;31(4):397-406.

Impact of conflict on medical education: a cross-sectional survey of students and institutions in Iraq

OBJECTIVE

This study surveyed all Iraqi medical schools and a cross-section of Iraqi medical students regarding their institutional and student experiences of medical education amidst ongoing conflict. The objective was to better understand the current resources and challenges facing medical schools, and the impacts of conflict on the training landscape and student experience, to provide evidence for further research and policy development.

SETTING

Deans of all Iraqi medical schools registered in the World Directory of Medical Schools were invited to participate in a survey electronically. Medical students from three Iraqi medical schools were invited to participate in a survey electronically.

OUTCOMES

Primary: Student enrolment and graduation statistics; human resources of medical schools; dean perspectives on impact of conflict. Secondary: Medical student perspectives on quality of teaching, welfare and future career intentions.

FINDINGS

Of 24 medical schools listed in the World Directory of Medical Schools, 15 replied to an initial email sent to confirm their contact details, and 8 medical schools responded to our survey, giving a response rate from contactable medical schools of 53% and overall of 33%. Five (63%) medical schools reported medical student educational attainment being impaired or significantly impaired; 4 (50%) felt the quality of training medical schools could offer had been impaired or significantly impaired due to conflict. A total of 197 medical students responded, 62% of whom felt their safety had been threatened due to violent insecurity. The majority (56%) of medical students intended to leave Iraq after graduating.

CONCLUSIONS

Medical schools are facing challenges in staff recruitment and adequate resource provision; the majority believe quality of training has suffered as a result. Medical students are experiencing added psychological stress and lower quality of teaching; the majority intend to leave Iraq after graduation.

Postgraduate Education in Disaster Health and Medicine

Introduction

Education is key to effective disaster management. This study reviews several postgraduate educational programs in disaster medicine.

Methods

This cross-sectional study was conducted in two stages between October 2011 and February 2012. An online search was completed, followed by a web-based survey to collect information on key aspects of the identified programs.

Results

Thirty-four programs were identified worldwide. Public health was the main focus in 84% of these. E-learning was the preferred mode of instruction in 25% of cases. Most programs were accredited either nationally or internationally. Tuitions fees were the main source of funding.

Conclusion

There is a dearth of postgraduate training programs in disaster health and medicine. This applies especially to Asia, which is also the most vulnerable area. Educational provision must be strengthened in Asia and in low- and middle-income countries to enhance capacity building in the health management of disasters.

The Professionalization of International Disaster Response: It Is Time for Midwives to Get Ready

Disasters and humanitarian emergencies due to natural or human origins result in severe and often prolonged suffering of the affected population. Midwives have a role to play in providing assistance because women and their infants experiencing such crises have unique vulnerabilities and needs. This article introduces midwives and other women's health care practitioners to international humanitarian emergency response efforts and describes preparation and training activities they can undertake to get ready to volunteer with an international health aid agency. Various clinical realities and challenges are discussed, including recommended priorities for providing reproductive health care in disaster zones. Common ethical dilemmas in crisis health care settings are also reviewed. By arriving in the field well prepared to participate and collaborate, midwives can make substantial contributions to the safety, health, and comfort of women and their families who have experienced a natural disaster, armed conflict, or disease epidemic.

Disaster medicine curricula in Saudi Arabian medical schools

Background:Disaster medicine training in medical school is a key element of disaster preparedness, and several international educational authorities have called for an increase in this specific type of training. The objective of this study was to assess the current state of disaster medicine education in the Kingdom of Saudi Arabia.Methods:All 30 medical schools in Saudi Arabia were invited to participate in the study, and a 25-item online survey was sent to those that consented.Results:The response rate was 67%. Only three of the responding 20 universities currently have disaster medicine programs, and they spend an average of three hours per year on the subject. Respondents without disaster medicine curricula indicated that a mandatory, accredited course in the final three years of the six-year program was their preferred method for implementation, and most favored a blended approach.Conclusions:The study found that there is a paucity of disaster medicine programs in Saudi Arabia. Most schools indicated a willingness to implement such training in their undergraduate programs but cited lack of an adequate number of relevant professionals as a major impediment.

Art of disaster preparedness in European union: a survey on the health systems

Introduction: Naturally occurring and man-made disasters have been increasing in the world, including Europe, over the past several decades. Health systems are a key part of any community disaster management system. The success of preparedness and prevention depends on the success of activities such as disaster planning, organization and training. The aim of this study is to evaluate health system preparedness for disasters in the 27 European Union member countries. Method: A cross-sectional analysis study was completed between June-September 2012. The checklist used for this survey was a modified from the World Health Organization toolkit for assessing health-system capacity for crisis management. Three specialists from each of the 27 European Union countries were included in the survey. Responses to each survey question were scored and the range of preparedness level was defined as 0-100%, categorized in three levels as follows: Acceptable; Transitional; or Insufficient. Results: Response rate was 79.1%. The average level of disaster management preparedness in the health systems of 27 European Union member states was 68% (Acceptable). The highest level of preparedness was seen in the United Kingdom, Luxemburg, and Lithuania. Considering the elements of disaster management system, the highest level of preparedness score was at health information elements (86%), and the lowest level was for hospitals, and educational elements (54%). Conclusion: This survey study suggests that preparedness level of European Union countries in 2012 is at an acceptable level but could be improved. Elements such as hospitals and education and training suffer from insufficient levels of preparedness. The European Union health systems need a collective strategic plan, as well as enough resources, to establish a comprehensive and standardized disaster management strategy plan. A competency based training curriculum for managers and first responders is basic to accomplishing this goal. Keywords: Disaster medicine; Disaster preparedness; Disaster epidemiology; Health systems; European Union

Identifying deficiencies in national and foreign medical team responses through expert opinion surveys: implications for education and training

INTRODUCTION

Unacceptable practices in the delivery of international medical assistance are reported after every major international disaster; this raises concerns about the clinical competence and practice of some foreign medical teams (FMTs). The aim of this study is to explore and analyze the opinions of disaster management experts about potential deficiencies in the art and science of national and FMTs during disasters and the impact these opinions might have on competency-based education and training.

METHOD

This qualitative study was performed in 2013. A questionnaire-based evaluation of experts' opinions and experiences in responding to disasters was conducted. The selection of the experts was done using the purposeful sampling method, and the sample size was considered by data saturation. Content analysis was used to explore the implications of the data.

RESULTS

This study shows that there is a lack of competency-based training for disaster responders. Developing and performing standardized training courses is influenced by shortcomings in budget, expertise, and standards. There is a lack of both coordination and integration among teams and their activities during disasters. The participants of this study emphasized problems concerning access to relevant resources during disasters.

CONCLUSION

The major findings of this study suggest that teams often are not competent during the response phase because of education and training deficiencies. Foreign medical teams and medically related nongovernmental organizations (NGOs) do not always provide expected capabilities and services. Failures in leadership and in coordination among teams are also a problem. All deficiencies need to be applied to competency-based curricula.