Preparing health professions students for terrorism, disaster, and public health emergencies: core competencies

Can hotels be used as alternative care sites in disasters and public health emergencies-A narrative review

Managing disasters and public health emergencies poses a complex challenge, particularly in maintaining the crucial elements of surge capacity, often referred to as the 4S: staff, stuff, space, and system. While discussions surrounding the management of these emergencies typically emphasize their impact on emergency healthcare services, resources, and capabilities, it is essential to recognize the inherent limitations of these resources. Therefore, integrating non-medical resources such as community staff, supplies, and spaces into the response chain is equally important. Among community facilities, hotels are particularly intriguing due to their organizational and structural capabilities to serve as alternative care sites for lightly injured or non-injured emergency victims. This narrative review explored the potential use of hotels as alternative care sites and the legal implications associated with such utilization. The results confirmed a high potential for using hotels as alternate care sites. However, data concerning its practical and legal implications are insufficient. This paper suggests further research to investigate the criteria for utilizing hotels in this capacity, including admission guidelines for disaster victims and relevant ethical and legal considerations.

Readiness and Response: The Practitioner's Role

The threat of foreign animal diseases is steadily increasing. Veterinary practitioners play a vital role in a community's preparedness for, response to, and recovery from a foreign animal disease outbreak. This article examines the steps a practitioner needs to take to become ready to have a role in disaster readiness and response. Resources exist to provide the practitioner with tools needed to transition their normal daily activities to a larger integrated response. The knowledge and skills used by practitioners in disaster management lead to a more effective and efficient response to a foreign animal disease.

Responsibility of education in improving medical college students' ability to prevent and respond to public health emergencies in China - A systematic review

Background

The outbreak of coronavirus disease 2019 (COVID-19) has highlighted the critical importance of sufficient preparedness for public health emergencies. This places higher requirements on the ability of medical staff to deal with such emergencies. Nonetheless, education courses on public health emergencies in China are usually aimed at public health students, and not at all medical college students. Importantly, these medical students will become medical workers who are generally the first-contact personnel and play an irreplaceable role in responding to most public health emergencies. Therefore, it is urgent to strengthen educational courses to enable these students to adequately prevent and respond to public health emergencies.

Objectives

The purpose of this systematic review was to reveal the current unsatisfactory status of Chinese medical college students' knowledge and skills in dealing with public health emergencies and their training needs.

Methods

We searched EMBASE, PubMed, Google Scholar, Web of Science, CNKI, Wan Fang, and VIP Information Network for all associated original studies written in English and Chinese from the inception of these databases until March 12, 2022.

Results

This systematic review screened out 15 eligible studies that met the inclusion criteria. These studies demonstrated that Chinese medical college students generally have a low ability to deal with public health emergencies. Most students believe it is essential to master coping with public health emergencies and desire to acquire this knowledge. But the participation rate is low, and only a few students actively seek relevant knowledge.

Conclusion

The findings of this review illustrate the importance of improving medical college students' education to prevent and deal with public health emergencies. It is necessary to improve medical college students' education in responding to public health emergencies.Systematic Review Registration: PROSPERO, Identifier [CRD42023467374].

The influence of professional identity, job satisfaction, burnout on turnover intention among village public health service providers in China in the context of COVID-19: A cross-sectional study

Background

In China, COVID-19 has undoubtedly posed a huge challenge to the capacity of rural public health services. Village public health service providers are responsible for reporting and dealing with infectious diseases and public health emergencies. However, the turnover of village public health service providers is gravely threatening the stability of rural primary health system step by step. This study systematically evaluated the effects of professional identity, job satisfaction, burnout on turnover intention of village public health service providers, and further measured the mediating effect of job satisfaction and burnout between professional identity and turnover intention.

Methods

From May to June 2019, 1,244 village public health service providers in Shandong Province were selected as the research objects. Sociodemographic characteristics, professional identity, job satisfaction, burnout and turnover intention were quantitated by self-completed questionnaire and measured by Likert 5-7 scale. Person correlation analysis, One-way ANOVA, and Structural Equation Modeling (SEM) were used for statistical analysis and mediating effect evaluation.

Results

Five hundred and sixty-four (45.3%) village public health providers had high turnover intension. Professional identity had a direct positive effect on job satisfaction (β = 0.146, p < 0.001), job satisfaction had a direct negative effect on burnout (β = 0.263, p < 0.001), and turnover intension (β = -0.453, p < 0.001), while burnout had a direct positive effect on turnover intension (β = 0.242, p < 0.001). Between professional identity and turnover intention, job satisfaction 95%CI: (-0.289)-(-0.11) had significant mediating effects. Job satisfaction 95%CI: (-0.216)-(-0.077) also had significant mediating effects between professional identity and burnout, and burnout had significant mediating effects between job satisfaction and turnover intension, 95%CI: (-0.116)-(-0.052). These results strongly confirm that professional identity, job satisfaction, and burnout are early and powerful predicators of turnover intention.

Conclusion

According to the results, medical administration and management departments should pay attention to improve the professional attraction of public health services by improving the public's understanding of the profession, reducing work intensity, timely granting of subsidy funds, improving old-age security, ensuring the income level, increasing the new force and so on, so as to reduce turnover intension and ensure the health equity of village residents.

Crisis leadership: An evolutionary concept analysis

AIM

The purpose of this study was to define crisis leadership in the nursing context.

BACKGROUND

Leadership during critical situations is perhaps the most crucial element for crisis resolution.

METHODS

Rodgers' evolutionary approach was used to conduct a concept analysis on crisis leadership and find its critical attributes, antecedents, and consequences. The researchers examined articles published in English and Korean from six databases. Articles from 2000 to 2016-with the key terms of crisis leadership, crisis management, crisis intervention, crisis, and disaster-were considered for analysis. Eleven studies were included in the final review.

RESULTS

The core attributes of crisis leadership from a nursing perspective consisted of six attributes: clear, fast, frank communication; a high degree of collaboration; sharing of information; decision-making and fair prioritization; building trust; competency.

CONCLUSIONS

Based on this review, crisis leadership should be revised to focus on competency, nursing interventions, measurement tools, and training protocol development.

The Effectiveness of Functional Exercises for Teaching Method Disaster Medicine to Medical Students

Introduction

Functional exercises are effective for testing disaster management training. Previously, we found that functional exercises promote student engagement and improve the perception of learning after exercise.

Objective

The study objective is to investigate whether functional exercise is effective for teaching disaster medicine.

Methods

Students who partook in a two-day course of disaster medicine were recruited. The course consisted of lectures and workshops followed by a half-day functional exercise and was designed based on four core competency domains which included major disaster medicine concepts. After the lectures and workshops, participants completed a test to assess their knowledge of the core competency domains and a questionnaire to evaluate their willingness to pursue further training and participate in a disaster medical assistance team (DMAT) and their interest in disaster exercises. The functional exercise involved the scenario of an earthquake and mass-casualty incident and participants acted as DMAT members in the exercise. A post-exercise debrief was conducted by the evaluators to discuss performance and evaluate the results of the exercise. Participants then completed the same tests and questionnaires as before the exercise.

Results

Ninety-seven students were recruited, 72 of which were medical students. Pre- and post-exercise tests and questionnaires were completed by 48. We found disaster scene safety knowledge to be significantly improved after the functional exercise. Students’ willingness for further training and participation in a DMAT as well as their interest in disaster training was high before and after the exercise.

Conclusion

Disaster scene safety is a vital element of disaster medicine training but it is difficult to teach. Functional exercises represent a good tool for this purpose and can maintain enthusiasm for learning and participating in disaster medicine-related activities.

Disaster Preparedness in Selected Hospitals of Western Ethiopia and Risk Perceptions of Their Authorities

Purpose

Despite the fact that hospitals are always at a high risk of disasters, the preparedness status in many of the Ethiopian hospitals is not well recognized. It is with this research gap in mind that this study motivated the authors to assess disaster preparedness level in selected hospitals of the western part of Ethiopia and their authorities’ risk perceptions.

Methods

This was a facility-based study conducted by using mixed qualitative and quantitative research designs among selected hospitals of western Ethiopia. While disaster and emergency readiness was evaluated using a modified World Health Organization observation check list. The key informant interview method was used to assess the disaster risk perception of the hospitals’ authorities in the study area.

Results

The overall level of emergency and disaster preparedness in the selected hospitals was weak with an average calculated preparedness score of 45.6%. The score of readiness in terms of disaster response and recovery planning was 33.3%. Moreover, we have not got a documented disaster plan in all of the hospitals and the hazard-specific response sub plans were also not consistently in place. Of prime concerns, this study has revealed that there was no patient evacuation plan in all of the selected hospitals. The human resource preparations of the hospitals were relatively better with an average readiness score of 60%. The study has found that no committee was responsible for emergency readiness at all of the sampled hospitals. The hospital authorities’ disaster risk perception was found to vary according to the type of calamities and this was from moderate to high level.

Conclusion

This study concludes that although their authorities’ risk perception of disasters was high, the selected hospitals were ill-prepared for the potential disaster strikes in this study area.

Iranian's healthcare system challenges during natural disasters: the qualitative case study of Kermanshah earthquake

Background

In order to the significance of lessons learned from the natural disasters for health care systems particularly in developing and under-developed countries, the main purpose of this study was to identify challenges and limitations in light of the earthquake experience in Kermanshah Province.

Methods

The present study was conducted in 2019 as a qualitative research using content analysis method. In this regard, 19 key informants were selected using snowball sampling. To enhance the accuracy of the study, the four validation criteria for qualitative studies in data coding developed by Guba and Lincoln including credibility, transferability, dependability and confirmability were used. Data was analyzed applying Graneheim and Lundman (2004) approach for analyzing the qualitative content of an interview text.

Results

Analysis of the data led to the identification of 2 main themes, 5 sub- themes and 17 main categories. The first main theme was health system oriented challenges containing challenges of medication supply and preparation, structural challenges, challenges in crisis-scene management and challenges of service delivery and the second main theme was non-health system oriented challenges including social and psychosocial challenges.

Conclusion

According to the results, along with health system oriented challenges with the inter-sectoral or intra-sectoral nature, the non-health system oriented challenges the same as social, cultural and psychological factors can be considered as the major challenges of Iran’s healthcare system in the face of crises. This complicated context can shed the light to policy makers that not only attention to the medicine and medical equipment supply chain, manpower preparation and service delivery system can be considered as an emergency, but also careful attention to the structural challenges and crisis-scene management should be planned and considered as a priority. Besides, the policy makers and the local managers should try to plan and act in a contingent situation according to the social and cultural characteristics of the region and the psychological condition and the mental needs of the people.

Global Research on Public Health Emergency Preparedness From 1997 to 2019: A Bibliometric Analysis

OBJECTIVES

To access the trends and focuses of publications on public health emergency preparedness in the timeframe 1997-2019.

METHODS

Publications related to public health emergency preparedness (PHEP) were retrieved from the Web of Science Core Collection database. Bibliometric analyses including output statistics, co-authorship analysis, citation analysis, co-citation analysis, and co-occurrence analysis were performed and mapped using VOSviewer.

RESULTS

A total of 1058 publications on PHEP were included in this study. There was an increasing trend of publication output and citations since 2002. A total of 4605 authors from 1587 institutes and 92 countries contributed to the publications, and the United States lead the field. Disaster Medicine and Public Health Preparedness was the most active and co-cited journal among 243 journals. The knowledge foundation mainly focused on the professionals' capacity, education, and conceptions of PHEP. Epidemics, natural disasters, terrorism, education, and communication were the principle topics; while "vulnerable populations," "disaster medicine," and "hurricane" were the recent hotspots in this field.

CONCLUSIONS

Significant progresses had been achieved worldwide in the past 2 decades, however, improvement of research activity and international collaboration is still a need for most countries.

Core Competencies of Truck Drivers Responding to Emergencies during Transportation of Hazardous Materials

BACKGROUND

Hazardous material (HAZMAT) transportation drivers are responsible for safe delivery of consignments and face multiple challenges carrying out their duties. Drivers are also the first to respond to emergencies and accidents.

OBJECTIVES

The purpose of the present study was to identify the essential competencies needed by HAZMAT transportation drivers to deal with emergencies.

METHODS

Three rounds of focus groups were conducted using expert panels comprised of HAZMAT specialists, health, safety and emergency representatives, security experts and transportation advisors from June to July 2019. The panel discussed competencies, gathered from a literature review, for emergency responders.

RESULTS

The panel identified six (6) core and 23 sub-competencies of HAZMAT drivers. This is the first study in low- and middle-income countries (LMIC) to identify core competencies of HAZMAT truck drivers.

CONCLUSIONS

The integration of these competencies into a development and training program for drivers will better enable drivers to handle emergencies in an efficient and effective manner.

PARTICIPANT CONSENT

Obtained.

ETHICS APPROVAL

The Graduate Advisory Committee of Comsats University approved study protocols.

PARTICIPANT CONSENT

Obtained.

COMPETING INTERESTS

The authors declare no competing financial interests.

Top Training Needs of the Governmental Public Health Workforce

Context:

Workforce development in governmental public health has historically focused on discipline-specific skills. However, as the field of public health has evolved, crosscutting skills have become critical. The 2017 fielding of the Public Health Workforce Interests and Needs Survey (PH WINS) provides a national benchmark for gaps in crosscutting skills in state and local health departments.

Objective:

The purpose of this article is to identify top areas of training needs in the governmental public health workforce using data from PH WINS 2017.

Design:

PH WINS participants in state and local health departments were surveyed in fall 2017 using a Web-based platform. Balanced repeated replication weights were used to account for complex sample design.

Setting:

Forty-seven state health agencies, 26 large city health departments, and a nationally representative sample of mid-to-large local health departments.

Participants:

Permanently employed governmental public health staff.

Main Outcome Measures:

Training needs were determined by combining self-reported skill importance and proficiency. Skills reported to be of high importance, and low levels of proficiency were coded as training needs. Focus area gaps were defined as having a training need in at least one skill in the focus area.

Results:

The largest area of training need, regardless of supervisory status, was in budgeting and financial management (55%; 95% confidence interval [CI], 53-56), with a large gap also identified in systems and strategic thinking (49%; 95% CI, 47-50). There was some variation by supervisory status, with training needs for nonsupervisors in change management and in developing a vision for a healthy community for management.

Conclusions:

The PH WINS training needs assessment provides the first nationally representative data on training needs for the state and local health department workforce. Across state and local health departments, there are common critical training needs essential for the current and future practice of public health.

Assessing Disaster Preparedness and Educational Needs of Private Veterinary Practitioners in Mississippi

The veterinary medical education system faces increasing challenges in educating students in the most current technologies while responding to changing community needs and expectations. Communities expect veterinarians to be involved in disaster management at some level. The purpose of this study was to describe the level of disaster preparedness and educational needs of veterinary practitioners in Mississippi. A survey was mailed to 706 practitioners to assess disaster plans, disaster training, and familiarity with disaster-related organizations. Forty-three percent of veterinarians had a clinic disaster plan. Veterinary practitioners who had experienced a disaster were more likely to have a personal plan (odds ratio [OR] = 4.55, 95% confidence interval [CI] = 2.47-8.37) and a clinic plan (OR = 4.11, 95% CI = 2.28-7.44) than those who had not. Veterinarians residing in Mississippi Gulf Coast counties were more likely to have a personal plan (OR = 3.62, 95% CI = 1.54-8.72) and a clinic plan (OR = 3.09, 95% CI = 1.35-7.21) than were those residing in other areas. Only 17% of veterinarians had assistance agreements with other practices, and few veterinarians indicated having disaster education materials available for their clients. Twenty percent of respondents indicated having obtained formal disaster training, and more than two-thirds of respondents were interested in receiving disaster training, mostly in the form of online delivery. Results suggest that private veterinary practitioners have the desire and need to obtain disaster education. Providing opportunities for both veterinarians and veterinary students to obtain education in disaster management will result in better overall community disaster preparedness.

Creating a Novel Disaster Medicine Virtual Reality Training Environment

INTRODUCTION

Disasters are high-acuity, low-frequency events which require medical providers to respond in often chaotic settings. Due to this infrequency, skills can atrophy, so providers must train and drill to maintain them. Historically, drilling for disaster response has been costly, and thus infrequent. Virtual Reality Environments (VREs) have been demonstrated to be acceptable to trainees, and useful for training Disaster Medicine skills. The improved cost of virtual reality training can allow for increased frequency of simulation and training.

PROBLEM

The problem addressed was to create a novel Disaster Medicine VRE for training and drilling.

METHODS

A VRE was created using SecondLife (Linden Lab; San Francisco, California USA) and adapted for use in Disaster Medicine training and drilling. It is easily accessible for the end-users (trainees), and is adaptable for multiple scenario types due to the presence of varying architecture and objects. Victim models were created which can be role played by educators, or can be virtual dummies, and can be adapted for wide ranging scenarios. Finally, a unique physiologic simulator was created which allows for dummies to mimic disease processes, wounds, and treatment outcomes.

RESULTS

The VRE was created and has been used extensively in an academic setting to train medical students, as well as to train and drill disaster responders.

CONCLUSIONS

This manuscript presents a new VRE for the training and drilling of Disaster Medicine scenarios in an immersive, interactive experience for trainees.

Simulation and Modeling Applications in Global Health Security

Global health security (GHS) is dependent upon having an adequate and prepared health security workforce. There are currently numerous challenges in establishing and maintaining a health security workforce. The frequency and magnitude of disasters have increased significantly over the past 30 years. Current and future GHS threats, both manmade and natural, require a prepared and flexible healthcare provider workforce ready to respond to current or emerging GHS threats. Developing and maintaining GHS -specific skills in the healthcare workforce is a tremendous logistical challenge. Innovative education technologies, including simulation and digital learning, can be leveraged to achieve preparedness for GHS threats.

This chapter focuses on the application of modeling and simulation to support Global Health Security planning, preparedness and operations.

The Emergency Medical System (EMS) response to Iraqi pilgrims' bus crash in Iran: a case report

BACKGROUND

In Iran, Road Traffic Injuries (RTIs) with mass casualties occur repeatedly. Since Road Traffic Accidents (RTAs) occur far from health facilities, EMSs play an important role in reducing the disability and mortality resulting from RTIs. Thus, the study aimed to report Iraqi pilgrims' bus which rolled over in the Malayer town.

CASE PRESENTATION

A mass casualty event occurred on 7 September 2017 when a bus full of Iraqi pilgrims rolled over on a road 4-km outside of Malayer, Iran. A large team of responders were dispatched including 5 ambulances with 10 EMTs along with 6 police officers serving in the area. The accident resulted in 35 injured patients (21 female and 14 male) as well as 11 deaths ranging in age from 2 to 65 years. Twenty-one of the injured were transported to the hospital and 14 patients refused transport and 12 patients sustained multiple trauma. The case has been described four phases of dispatch, on-scene, hospital and post-mission. Frequent calls made by laypeople were considered as the main challenge of dispatch phase. The response on scene was hampered by large numbers of lay bystanders. The over-crowding around the emergency units disrupted the medical care procedures in hospital phase.

CONCLUSION

This case highlights over-crowding and laypeople interference at the scene disrupts the relief and rescue. To solve these challenges, the public education and police monitoring and control is recommended. Establishing a unified command post at the scene can facilitate effective coordination among relief and rescue organizations.

Disaster Preparedness Medical School Elective: Bridging the Gap Between Volunteer Eagerness and Readiness

OBJECTIVE

Eager medical students may not be prepared for unanticipated complexities of disaster response. This study aimed to answer 2 questions: does an online disaster preparedness curriculum create a convenient method to educate medical students and motivate them to be better prepared to volunteer?

METHODS

An online disaster preparedness elective was created for medical students. Four modules were created using Softchalk and hosted on the Blackboard Learning Management System. Students completed embedded pre-elective, post-lesson, and post-elective surveys.

RESULTS

Fifty-five students completed the elective. When posed with the statement, "I feel prepared for an emergency at the University or the immediate area," 70% stated that they disagreed or strongly disagreed before the elective. Subsequently, only 11% claimed to disagree after the elective. At the conclusion of the elective, 13% of students had prepared a personal emergency kit and 28% had prepared a family communication plan for reunification. Students were surveyed on the statement "I would like to be involved in a community disaster response while continuing my medical training." Ninety-four percent claimed to agree or strongly agree before the elective, and 93% stated the same after elective completion.

CONCLUSIONS

This disaster preparedness elective was envisioned to be a resource for students. Advantages of online availability are ease of student access and minimal demand on faculty resources. A voluntary, self-paced online elective in disaster preparedness has shown to create a stronger interest in disaster participation in medical students. Student readiness to volunteer improved; however, willingness remained stagnant.

Knowledge, Experiences and Training Needs of Health Professionals about Disaster Preparedness and Response in Southwest Ethiopia: a cross sectional study

Background

Over the past decade, the magnitude and intensity of disasters have been vividly rising globally due to the forces of nature or man. This study aimed at assessing the perceived knowledge, experiences and training needs of health professionals regarding disasters, their prevention and management in Jimma Zone, Southwest Ethiopia.

Methods

An institution based cross-sectional survey was conducted on 377 health professionals taken from 9 randomly selected districts out of 18. All health professionals working at health offices, hospitals and health centers were included. Data were collected using a structured questionnaire which was developed by the investigators after reviewing the relevant literature in the field. Data were coded and entered into SPSS 20 software for cleaning and analysis. Descriptive and logistic regression analyses were done.

Results

The majority (85.1%) of the participants were able to define the concept of disaster from various perspectives; 9.7% did not know about it at all and 5.2% could describe the concept partially or misconceived it. The majority (84.3%) agreed that disaster has direct public health consequences on humans. The main public health consequence of disaster the participants mentioned was environmental pollution (65.8%). Malaria, measles and diarrhoeal diseases accounted for 35.5%, 33.1% and 10.5% of the epidemics, respectively. Only 20.6% of the respondents were trained on disaster related topics in the last two years.

The majority felt that they had poor knowledge on early warning indicators of drought (48.0%) and flood (48.0%). Simialry, 50.8%, 47.7%, 51.1% and 42.6% of the participants had poor knowledge on preparedness to drought, preparedness to flood, response to drought, response to flood. On composite scale, they generally perceived to have adequate (29.4%), moderate (32.4%) and poor (38.2%) knowledge about early warning information bout, preparedness for and response to common disasters. A vast majority (92.8%) reported that they need training on disaster preparedness, management and response.

Conclusion

A considerable number of professionals had limited understanding about the concept of disaster and response to certain specific disasters. They also had limited opportunities for training, despite their felt needs. Therefore, training should be provided focusing on the specific gaps identified.

Developing the Fourth Evaluation Dimension: A Protocol for Evaluation of Video From the Patient's Perspective During Major Incident Exercises

OBJECTIVE

Presently used evaluation techniques rely on 3 traditional dimensions: reports from observers, registration system data, and observational cameras. Some of these techniques are observer-dependent and are not reproducible for a second review. This proof-of-concept study aimed to test the feasibility of extending evaluation to a fourth dimension, the patient's perspective.

METHODS

Footage was obtained during a large, full-scale hospital trauma drill. Two mock victims were equipped with point-of-view cameras filming from the patient's head. Based on the Major Incident Hospital's first experience during the drill, a protocol was developed for a prospective, standardized method to evaluate a hospital's major incident response from the patient's perspective. The protocol was then tested in a second drill for its feasibility.

RESULTS

New insights were gained after review of the footage. The traditional observer missed some of the evaluation points, which were seen on the point-of-view cameras. The information gained from the patient's perspective proved to be implementable into the designed protocol.

CONCLUSION

Use of point-of-view camera recordings from a mock patient's perspective is a valuable addition to traditional evaluation of trauma drills and trauma care. Protocols should be designed to optimize and objectify judgement of such footage. (Disaster Med Public Health Preparedness. 2017;11:594-599).

Mass casualty education for undergraduate nursing students in Australia

With the increasing risk of mass casualty incidents from extreme climate events, global terrorism, pandemics and nuclear incidents, it's important to prepare nurses with skills and knowledge necessary to manage such incidents. There are very few documented accounts of the inclusion of mass casualty education within undergraduate nursing programs. This paper is the first to describe undergraduate mass casualty nursing education in Australia. A final year Bachelor of Nursing undergraduate subject was developed. The subject focused on initial treatment and stabilisation of casualties predominantly within pre-hospital environments, and included a capstone inter-professional mass casualty simulation. Students experience of the subject was evaluated using the Satisfaction with Simulation Experience Scale (Levett-Jones et al., 2011) and a subject evaluation survey. Student satisfaction and evaluations were extremely positive. As a tool for developing clinical skills, 93% (n = 43) agreed that the simulation developed their clinical reasoning and decision making skills. In particular, the simulation enabled students to apply what they had learned (77%, n = 35, strongly agree). Due to the frequency of mass casualty events worldwide, there is a need for educational exposure in undergraduate nursing curricula. We believe that this mass casualty education could be used as a template for development in nursing curricula.

Implementing a Disaster Preparedness Curriculum for Medical Students

OBJECTIVES

Training in disaster medicine and preparedness is minimal or absent in the curricula of many medical schools in the United States. Despite a 2003 joint recommendation by the Association of American Medical Colleges and the Centers for Disease Control and Prevention, few medical schools require disaster training for medical students. The challenges of including disaster training in an already rigorous medical school curriculum are significant. We evaluated medical students' experiences with mandatory disaster training during a 2-year period in a medical university setting.

METHODS

Disaster training has been mandatory at Thomas Jefferson University since 2002 and requires all first-year medical students to attend lectures, undergo practical skills simulation training, and participate in the hospital's interdisciplinary disaster exercise. Medical students were encouraged to complete a survey after each component of the required training. Twenty-three survey questions focused on assessing students' experiences and opinions of the training, including evaluation of the disaster exercise. Students provided ratings on a 5-point Likert scale (5 = strongly agree, 1 = strongly disagree).

RESULTS

A total of 503 medical students participated in the disaster preparedness curriculum during the course of 2 years. Survey response rates were high for each portion of the training: lectures (91%), skills sessions (84%), and disaster exercise (100%). Students believed that disaster preparedness should remain part of the medical school curriculum (rating 4.58/5). The disaster lectures were considered valuable (rating 4.26/5) and practical skills sessions should continue to be part of the first-year curriculum (4.97/5). Students also believed that participation in the disaster exercise allowed them to better understand the difficulties faced in a real disaster situation (4.2/5).

CONCLUSIONS

Our mandatory disaster preparedness training course was successfully integrated into the first-year curriculum >10 years ago and has been well received by students without compromising the existing university curriculum. Integrating interdisciplinary teams and course components important to other education stakeholders may help other schools overcome obstacles to implementing disaster medicine training. Future education research should focus on developing interdisciplinary education to help disseminate disaster medicine topics across all 4 years of medical school.

Call to Action: The Case for Advancing Disaster Nursing Education in the United States

PURPOSE

Climate change, human conflict, and emerging infectious diseases are inexorable actors in our rapidly evolving healthcare landscape that are triggering an ever-increasing number of disaster events. A global nursing workforce is needed that possesses the knowledge, skills, and abilities to respond to any disaster or large-scale public health emergency in a timely and appropriate manner. The purpose of this article is to articulate a compelling mandate for the advancement of disaster nursing education within the United States with clear action steps in order to contribute to the achievement of this vision.

DESIGN AND METHODS

A national panel of invited disaster nursing experts was convened through a series of monthly semistructured conference calls to work collectively towards the achievement of a national agenda for the future of disaster nursing education.

FINDINGS

National nursing education experts have developed consensus recommendations for the advancement of disaster nursing education in the United States. This article proposes next steps and action items to achieve the desired vision of national nurse readiness.

CONCLUSIONS

Novel action steps for expanding disaster educational opportunities across the continuum of nursing are proposed in response to the current compelling need to prepare for, respond to, and mitigate the impact of disasters on human health. U.S. educational institutions and health and human service organizations that employ nurses must commit to increasing access to a variety of quality disaster-related educational programs for nurses and nurse leaders.

CLINICAL RELEVANCE

Opportunities exist to strengthen disaster readiness and enhance national health security by expanding educational programming and training for nurses.

How Do Doctors and Nurses in Emergency Departments in Hong Kong View Their Disaster Preparedness? A Cross-Sectional Territory-Wide Online Survey

Objectives

To assess the level of all-hazards disaster preparedness and training needs of emergency department (ED) doctors and nurses in Hong Kong from their perspective, and identify factors associated with high perceived personal preparedness.

Design

This study was a cross-sectional territory-wide online survey conducted from 9 September to 26 October, 2015.

Participants

The participants were doctors from the Hong Kong College of Emergency Medicine and nurses from the Hong Kong College of Emergency Nursing.

Methods

We assessed various components of all-hazards preparedness using a 25-item questionnaire. Backward logistic regression was used to identify factors associated with perceived preparedness.

Results

A total of 107 responses were analyzed. Respondents lacked training in disaster management, emergency communication, psychological first aid, public health interventions, disaster law and ethics, media handling, and humanitarian response in an overseas setting. High perceived workplace preparedness, length of practice, and willingness to respond were associated with high perceived personal preparedness.

Conclusions

Given the current gaps in and needs for increased disaster preparedness training, ED doctors and nurses in Hong Kong may benefit from the development of core-competency-based training targeting the under-trained areas, measures to improve staff confidence in their workplaces, and efforts to remove barriers to staff willingness to respond. (Disaster Med Public Health Preparedness. 2018; 12: 329–336)

Self-Perception of Medical Students' Knowledge and Interest in Disaster Medicine: Nine Years After the Approval of the Curriculum in German Universities

BACKGROUND

Following the recommendations of the World Association for Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) to develop standards for training the undergraduates in disaster-relevant fields (2004), a German curriculum was approved in 2006. This paper aims to describe the level of training and interest of medical students nine years later. Problem The aim of this study was to assess the self-perception of medical students' knowledge and interest in disaster medicine nine years after the implementation of a standardized disaster medicine curriculum in German medical schools.

METHODS

This prospective, cross-sectional, observational study was conducted with medical students in Germany using a web-based, purpose-designed questionnaire consisting of 27 mandatory and 11 optional questions.

RESULTS

Nine hundred ninety-two students from 36 of 37 medical schools in Germany participated. More than one-half of medical students were aware of the field of disaster medicine. One hundred twenty-one students undertook training internally within their university and 307 undertook training externally at other institutions. Only a small content of the curriculum was taught. A difference in self-perception of knowledge between trained and untrained participants was found, despite the level of training being low in both groups. Participants were generally highly motivated to learn disaster medicine in a variety of institutions.

CONCLUSION

German students are still largely not well educated regarding disaster medicine, despite their high motivation. The curriculum of 2006 was not implemented as originally planned and the number of trained students still remains low as the self-perception of knowledge. Currently, there is no clear and standardized training concept in place. A renewal in the agreement of implementation of the curriculum at medical schools should be targeted in order to follow the recommendation of WADEM. Wunderlich R Ragazzoni L Ingrassia PL Della Corte F Grundgeiger J Bickelmayer JW Domres B . Self-perception of medical students' knowledge and interest in disaster medicine: nine years after the approval of the curriculum in German universities. Prehosp Disaster Med. 2017;32(4):374-381.

Educational Attainment of the Public Health Workforce and Its Implications for Workforce Development

This study ascertains the levels of educational attainment among state health agency employees as well as the correlates of attainment.

Educational attainment is a critical issue in public health workforce development. However, relatively little is known about the actual attainment of staff in state health agencies (SHAs).

The Public Health Workforce Interests and Needs Survey: The First National Survey of State Health Agency Employees

This article describes a nationally representative survey of central office employees at state health agencies to characterize key components of the public health workforce.

Public health practitioners, policy makers, and researchers alike have called for more data on individual worker's perceptions about workplace environment, job satisfaction, and training needs for a quarter of a century. The Public Health Workforce Interests and Needs Survey (PH WINS) was created to answer that call.

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.

What are the most common domains of the core competencies of disaster nursing? A scoping review

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A total of 12 articles were included.

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The number of domains varied across all of the selected studies.

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This scoping review indicates that communication and ICS are essential domains.

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Disaster planning is one of the most important core competencies for nurses.

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Another of the important domains are decontamination and ethics.

Aim

Scoping review was conducted to identify the most common domains of the core competencies of disaster nursing.

Background

Nurses play an essential role in all phases of disaster management. For nurses to respond competently, they must be equipped with the skills to provide comprehensive and holistic care to the populations affected by or at risk of disasters.

Methods

A scoping review was conducted using the Joanna Briggs Institute methodology. The review used information from six databases: the Cumulative Index to Nursing and Allied Health Literature, Ovid MEDLINE, ScienceDirect, ProQuest, Scopus and the Education Resources Information Center. Keywords and inclusion and exclusion criteria were identified as strategies to use in this review.

Results

Twelve studies were eligible for result extraction, as they listed domains of the core competencies. These domains varied among studies. However, the most common domains were related to communication, planning, decontamination and safety, the Incident Command System and ethics.

Conclusion

Knowledge of the domains of the core competencies, such as understanding the content and location of the disaster plan, communication during disaster and ethical issues is fundamental for nurses. Including these domains in the planning and provision of training for nurses, such as disaster drills, will strengthen their preparedness to respond competently to disaster cases. Nurses must be involved in future research in this area to explore and describe their fundamental competencies in each domain.

Thinking beyond the silos: emerging priorities in workforce development for state and local government public health agencies

CONTEXT

Discipline-specific workforce development initiatives have been a focus in recent years. This is due, in part, to competency-based training standards and funding sources that reinforce programmatic silos within state and local health departments.

OBJECTIVE

National leadership groups representing the specific disciplines within public health were asked to look beyond their discipline-specific priorities and collectively assess the priorities, needs, and characteristics of the governmental public health workforce.

DESIGN

The challenges and opportunities facing the public health workforce and crosscutting priority training needs of the public health workforce as a whole were evaluated. Key informant interviews were conducted with 31 representatives from public health member organizations and federal agencies. Interviews were coded and analyzed for major themes. Next, 10 content briefs were created on the basis of priority areas within workforce development. Finally, an in-person priority setting meeting was held to identify top workforce development needs and priorities across all disciplines within public health.

PARTICIPANTS

Representatives from 31 of 37 invited public health organizations participated, including representatives from discipline-specific member organizations, from national organizations and from federal agencies.

RESULTS

Systems thinking, communicating persuasively, change management, information and analytics, problem solving, and working with diverse populations were the major crosscutting areas prioritized.

CONCLUSIONS

Decades of categorical funding created a highly specialized and knowledgeable workforce that lacks many of the foundational skills now most in demand. The balance between core and specialty training should be reconsidered.

A Survey of Disaster Medical Education in Osteopathic Medical School Curricula

Parrillo SJ , Christensen D , Teitelbaum HS , Glassman ES . A survey of disaster medical education in osteopathic medical school curricula. Prehosp Disaster Med. 2016;31(6):581-582.

Dutch senior medical students and disaster medicine: a national survey

Background

Medical students have been deployed in victim care of several disasters throughout history. They are corner stones in first-line care in recent pandemic planning. Furthermore, every physician and senior medical student is expected to assist in case of disaster situations, but are they educated to do so? Being one of Europe’s densest populated countries with multiple nuclear installations, a large petrochemical industry and also at risk for terrorist attacks, The Netherlands bear some risks for incidents. We evaluated the knowledge on Disaster Medicine in the Dutch medical curriculum. Our hypothesis is that Dutch senior medical students are not prepared at all.

Methods

Senior Dutch medical students were invited through their faculty to complete an online survey on Disaster Medicine, training and knowledge. This reported knowledge was tested by a mixed set of 10 theoretical and practical questions.

Results

With a mean age of 25.5 years and 60 % females, 999 participants completed the survey. Of the participants, 51 % considered that Disaster Medicine should absolutely be taught in the regular medical curriculum and only 2 % felt it as useless; 13 % stated to have some knowledge on disaster medicine. Self-estimated capability to deal with various disaster situations varied from 1.47/10 in nuclear incidents to 3.92/10 in influenza pandemics. Self-estimated knowledge on these incidents is in the same line (1.71/10 for nuclear incidents and 4.27/10 in pandemics). Despite this limited knowledge and confidence, there is a high willingness to respond (ranging from 4.31/10 in Ebola outbreak over 5.21/10 in nuclear incidents to 7.54/10 in pandemics). The case/theoretical mix gave a mean score of 3.71/10 and raised some food for thought. Although a positive attitude, 48 % will place contaminated walking wounded in a waiting room and 53 % would use iodine tablets as first step in nuclear decontamination. Of the participants, 52 % even believes that these tablets protect against external radiation, 41 % thinks that these tablets limit radiation effects more than shielding and 57 % believes that decontamination of chemical victims consists of a specific antidote spray in military cabins.

Conclusions

Despite a high willingness to respond, our students are not educated for disaster situations.

Electronic supplementary material

The online version of this article (doi:10.1186/s12245-015-0077-0) contains supplementary material, which is available to authorized users.

Bioterrorism: Law Enforcement, Public Health & Role of Oral and Maxillofacial Surgeon in Emergency Preparedness

INTRODUCTION

The contrived and deliberate use of pathogenic strains of micro-organisms such as bacteria, viruses or their toxins to spread life-threatening diseases on a mass scale with the aim to devastate the population of an area is referred to as 'bioterrorism'.

RISK ASSESSMENT

The threat of bioterrorism is higher than ever. It is now a well established fact that the capability to create immense panic and unimaginable fear has allured the terrorists for the despicable use of biological agents for causing terror attacks. Moreover to add to the grievance, this era of biotechnology and nanotechnology has created an easy accessibility to more sophisticated biologic agents apart from the conventional bacteria, viruses and toxins. These biologic weapons can cause large-scale mortality and morbidity in large population and create civil disruption in the shortest possible time.

PREPAREDNESS AND MITIGATION

Fight against bioterrorism is a global concern and necessitates that the issue should be criminalized internationally with the assistance of international co-operation and laws in favor of global public health. National public health agencies must also fortify their ability to be able to detect and respond to such biological attacks with better research and training facilities to health professionals, enhanced surveillance and improved diagnostic facilities by evolving an empowered public health system. Public health education and awareness are imperative; people should be made aware of reporting early to health institutions on arousal of signs and symptoms related to suspicious bioterrorist attack.

CONCLUSION

Effective bioterrorism planning, prevention and response requires cooperation and collaboration between law enforcement and public health; Oral and maxillofacial surgeons can be successfully integrated into the emergency medical response system. With their education, training, skills and amenities in form of equipments they can augment medical and surgical personnel in early identification and subsequent control of a bioterrorist attack.

Combating terror: a new paradigm in student trauma education

BACKGROUND

Other than the Advanced Trauma Life Support course, usually run for postgraduate trainees, there are few trauma courses available for medical students. It has been shown that trauma teaching for medical students is sadly lacking within the undergraduate curriculum. We stated that students following formal teaching, even just theory and some practice in basic skills significantly improved their management of trauma patients.

METHODS

Hadassah-Hebrew University in Israel runs an annual 2-week trauma course for final-year medical students. The focus is on hands-on practice in resuscitation, diagnosis, procedures, and decision making. After engaging a combination of instructional and interactive teaching methods including practice on simulated injuries that students must assess and treat through the 2 weeks, the course culminates in a disaster drill where students work alongside the emergency services to rescue, assess, treat, and transfer patients. The course is evaluated with a written precourse and postcourse test, an Objective Structured Clinical Examination and detailed feedback from the drill.

RESULTS

We analyzed student feedback at the end of each course during a 6-year period from 2007 to 2012. Correct answers for the posttest results were higher each year with good reliability as assessed by Chronbach's α and with significant variation from pretest scores assessed using paired-samples t tests. Best scores were achieved in knowledge acquisition and practical skills gained. Students were also asked whether the course contributed to self-preparedness in treating trauma patients, and this consistently achieved high scores.

CONCLUSION

We believe that students benefit substantially from the course and gain lasting skills and confidence in trauma management, decision making, and organizational skills. The course provides students with the opportunity to learn and ingrain trauma principles along Advanced Trauma Life Support guidelines and prepares them for practice as safe doctors. We advocate the global implementation of a student trauma training course as a mandatory educational initiative and propose our course format as a model for similar courses.

Core Competencies in Disaster Management and Humanitarian Assistance: A Systematic Review

Disaster response demands a large workforce covering diverse professional sectors. Throughout this article, we illustrate the results of a systematic review of peer-reviewed studies to identify existing competency sets for disaster management and humanitarian assistance that would serve as guidance for the development of a common disaster curriculum. A systematic review of English-language articles was performed on PubMed, Google Scholar, Scopus, ERIC, and Cochrane Library. Studies were included if reporting competency domains, abilities, knowledge, skills, or attitudes for professionals involved disaster relief or humanitarian assistance. Exclusion criteria included abstracts, citations, case studies, and studies not dealing with disasters or humanitarian assistance. Thirty-eight papers were analyzed. Target audience was defined in all articles. Five references (13%) reported cross-sectorial competencies. Most of the articles (81.6%) were specific to health care. Eighteen (47%) papers included competencies for at least 2 different disciplines and 18 (47%) for different professional groups. Nursing was the most widely represented cadre. Eighteen papers (47%) defined competency domains and 36 (94%) reported list of competencies. Nineteen articles (50%) adopted consensus-building to define competencies, and 12 (31%) included competencies adapted to different professional responsibility levels. This systematic review revealed that the largest number of papers were mainly focused on the health care sector and presented a lack of agreement on the terminology used for competency-based definition. (Disaster Med Public Health Preparedness. 2015;9:430–439)

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.

Building health care system capacity: training health care professionals in disaster preparedness health care coalitions

INTRODUCTION

This study aimed to learn from the experiences of well-established, disaster preparedness-focused health care coalition (HCC) leaders for the purpose of identifying opportunities for improved delivery of disaster-health principles to health professionals involved in HCCs. This report describes current HCC education and training needs, challenges, and promising practices.

METHODS

A semi-structured interview was conducted with a sample of leaders of nine preparedness-focused HCCs identified through a 3-stage purposive strategy. Transcripts were analyzed qualitatively.

RESULTS

Training needs included: stakeholder engagement; economic sustainability; communication; coroner and mortuary services; chemical, biological, radiological, nuclear, and explosives (CBRNE); mass-casualty incidents; and exercise design. Of these identified training needs, stakeholder engagement, economic sustainability, and exercise design were relevant to leaders within HCCs, as opposed to general HCC membership. Challenges to education and training included a lack of time, little-to-no staff devoted to training, and difficulty getting coalition members to prioritize training. Promising practices to these challenges are also presented.

CONCLUSIONS

The success of mature coalitions in improving situational awareness, promoting planning, and enabling staff- and resource-sharing suggest the strengths and opportunities that are inherent within these organizations. However, offering effective education and training opportunities is a challenge in the absence of ubiquitous support, incentives, or requirements among health care professions. Notably, an online resource repository would help reduce the burden on individual coalitions by eliminating the need to continually develop learning opportunities.

Community collaboration as a disaster mental health competency: a systematic literature review

Disasters impact the mental health of entire communities through destruction and physical displacement. There is growing recognition of the need for disaster mental health competencies. Professional organizations such as the AAFP and the ASPH recommend engaging with communities in equal partnership for their recovery. This systematic study was undertaken for the purpose of reviewing published disaster medicine competencies to determine if core competencies included community cooperation and collaboration. A search of Internet databases was conducted using major keywords "disaster" and "competencies". Articles eligible contained laundry lists of basic core competency curriculum beyond emergency response. Data were qualitatively analyzed to identify types of competencies, and the degree of community cooperation. A total of 12 studies were reviewed. Only one study listed competencies specifying community cooperation, although others refer indirectly to it. Findings suggest competency-based education programs could do more to educate future disaster health professionals about the importance of community collaboration.

Self-reported preparedness of New Zealand acute care providers to mass emergencies before the Canterbury Earthquakes: a national survey

INTRODUCTION

Disasters occur more frequently. Acute care providers are the first to respond to mass emergencies from the healthcare sector. The preparedness of acute care providers in New Zealand to respond to mass emergencies has not been previously studied.

OBJECTIVE

To assess the self-reported training and experience of New Zealand acute care providers to respond to mass emergencies and the factors associated with strong preparedness.

METHODS

A cross-sectional national survey of 1500 acute care providers in New Zealand carried out between 2009 and 2010. The survey assessed experience, training and self-reported preparedness. It also determined the factors associated with strong perceived preparedness.

RESULTS

The response rate to this survey was 60.7%. Nurses had a higher response rate than doctors or paramedics. Only 29.2% of acute care providers reported responding to a previous mass emergency event. There were 53.5% of acute care providers who reported having formal training in how to deal with mass emergencies, whereas 58.1% of participants reported that they were aware of their role during a healthcare mass emergency response. The factors associated with self-reported strong preparedness to deal with mass emergencies included: being a paramedic, previous training, participation in a drill, willingness to report to work during an infection or man-made emergency, ability to triage and general awareness of the role during a mass emergency.

CONCLUSION

Almost half of New Zealand acute healthcare providers have no training in dealing with mass emergency events. Training and general awareness of the role during a mass emergency response were the main factors associated with strong self-reported preparedness of acute care providers. The apparent efficacy of training allied to lack of availability means that it should be a national priority.

PRIORITIZATION OF PEDIATRIC CBRNE DISASTER PREPAREDNESS EDUCATION AND TRAINING NEEDS

Children are the members of our population who are most vulnerable to the effects of a chemical, biological, radiological, nuclear or explosive (CBRNE) attack. It has been over 12 years since 9/11 and the majority of clinicians who would be providing care to children in the event of another attack still lack the requisite disaster preparedness training. The purpose of this report is to provide an overview of the recent developments that will enable the affordable creation of key CBRNE educational and just in time material. In 2011, the National Center for Disaster Medicine and Public Health (NCDMPH) convened a pediatric disaster preparedness conference. Much of the initial groundwork for development of a pediatric disaster preparedness curriculum, including the identification of target audiences and requisite role specific CBRNE curriculum content, was the product of this conference. Much of the needed pediatric education and training content for the diagnosis and treatment of the injurious effects of CBRNE has recently been both developed and well vetted. Bringing together these efforts in an educational program will result in a workforce that is better trained and prepared to address the needs of children impacted by these types of disasters.

Terror medicine as part of the medical school curriculum

Terror medicine, a field related to emergency and disaster medicine, focuses on medical issues ranging from preparedness to psychological manifestations specifically associated with terrorist attacks. Calls to teach aspects of the subject in American medical schools surged after the 2001 jetliner and anthrax attacks. Although the threat of terrorism persists, terror medicine is still addressed erratically if at all in most medical schools. This paper suggests a template for incorporating the subject throughout a 4-year medical curriculum. The instructional framework culminates in a short course for fourth year students, such as one recently introduced at Rutgers New Jersey Medical School, Newark, NJ, USA. The proposed 4-year Rutgers curriculum serves as a model that could assist other medical schools contemplating the inclusion of terror medicine in pre-clerkship and clerkship training.

Nationwide Program of Education for Undergraduates in the Field of Disaster Medicine: Development of a Core Curriculum Centered on Blended Learning and Simulation Tools

In recent years, effective models of disaster medicine curricula for medical schools have been established. However, only a small percentage of medical schools worldwide have considered at least basic disaster medicine teaching in their study program. In Italy, disaster medicine has not yet been included in the medical school curriculum. Perceiving the lack of a specific course on disaster medicine, the Segretariato Italiano Studenti in Medicina (SISM) contacted the Centro di Ricerca Interdipartimentale in Medicina di Emergenza e dei Disastri ed Informatica applicata alla didattica e alla pratica Medica (CRIMEDIM) with a proposal for a nationwide program in this field. Seven modules (introduction to disaster medicine, prehospital disaster management, definition of triage, characteristics of hospital disaster plans, treatment of the health consequences of different disasters, psychosocial care, and presentation of past disasters) were developed using an e-learning platform and a 12-hour classroom session which involved problem-based learning (PBL) activities, table-top exercises, and a computerized simulation (Table 1). The modules were designed as a framework for a disaster medicine curriculum for undergraduates and covered the three main disciplines (clinical and psychosocial, public health, and emergency and risk management) of the core of “Disaster Health” according to the World Association for Disaster and Emergency Medicine (WADEM) international guidelines for disaster medicine education. From January 2011 through May 2013, 21 editions of the course were delivered to 21 different medical schools, and 524 students attended the course. The blended approach and the use of simulation tools were appreciated by all participants and successfully increased participants’ knowledge of disaster medicine and basic competencies in performing mass-casualty triage. This manuscript reports on the designing process and the initial outcomes with respect to learners' achievements and satisfaction of a 1-month educational course on the fundamentals of disaster medicine. This experience might represent a valid and innovative solution for a disaster medicine curriculum for medical students that is easily delivered by medical schools.Table 1

IngrassiaPL, RagazzoniL, TengattiniM, CarenzoL, Della CorteF. Nationwide program of education for undergraduates in the field of disaster medicine: development of a core curriculum centered on blended learning and simulation tools. Prehosp Disaster Med. 2014;29(5):1-8.

Enhancing crisis leadership in public health emergencies

Reviews of public health emergency responses have identified a need for crisis leadership skills in health leaders, but these skills are not routinely taught in public health curricula. To develop criteria for crisis leadership in public health, published sources were reviewed to identify attributes of successful crisis leadership in aviation, public safety, military operations, and mining. These sources were abstracted to identify crisis leadership attributes associated with those disciplines and compare those attributes with crisis leadership challenges in public health. Based on this review, the following attributes are proposed for crisis leadership in public health: competence in public health science; decisiveness with flexibility; ability to maintain situational awareness and provide situational assessment; ability to coordinate diverse participants across very different disciplines; communication skills; and the ability to inspire trust. Of these attributes, only competence in public health science is currently a goal of public health education. Strategies to teach the other proposed attributes of crisis leadership will better prepare public health leaders to meet the challenges of public health crises.

Nonclinical core competencies and effects of interprofessional teamwork in disaster and emergency response training and practice: a pilot study

OBJECTIVE

To define and delineate the nontechnical core competencies required for disaster response, Disaster Medical Assistance Team (DMAT) members were interviewed regarding their perspectives and experiences in disaster management. Also explored was the relationship between nontechnical competencies and interprofessional collaboration.

METHODS

In-depth interviews were conducted with 10 Canadian DMAT members to explore how they viewed nontechnical core competencies and how their experiences influenced their perceptions toward interprofessonalism in disaster response. Data were examined using thematic analysis.

RESULTS

Nontechnical core competencies were categorized under austere skills, interpersonal skills, and cognitive skills. Research participants defined interprofessionalism and discussed the importance of specific nontechnical core competencies to interprofessional collaboration.

CONCLUSIONS

The findings of this study established a connection between nontechnical core competencies and interprofessional collaboration in DMAT activities. It also provided preliminary insights into the importance of context in developing an evidence base for competency training in disaster response and management. (Disaster Med Public Health Preparedness. 2013;0:1-8).

A sustainable training strategy for improving health care following a catastrophic radiological or nuclear incident

The detonation of a nuclear device in a US city would be catastrophic. Enormous loss of life and injuries would characterize an incident with profound human, political, social, and economic implications. Nevertheless, most responders have not received sufficient training about ionizing radiation, principles of radiation safety, or managing, diagnosing, and treating radiation-related injuries and illnesses. Members throughout the health care delivery system, including medical first responders, hospital first receivers, and health care institution support personnel such as janitors, hospital administrators, and security personnel, lack radiation-related training. This lack of knowledge can lead to failure of these groups to respond appropriately after a nuclear detonation or other major radiation incident and limit the effectiveness of the medical response and recovery effort. Efficacy of the response can be improved by getting each group the information it needs to do its job. This paper proposes a sustainable training strategy for spreading curricula throughout the necessary communities. It classifies the members of the health care delivery system into four tiers and identifies tasks for each tier and the radiation-relevant knowledge needed to perform these tasks. By providing education through additional modules to existing training structures, connecting radioactive contamination control to daily professional practices, and augmenting these systems with just-in-time training, the strategy creates a sustainable mechanism for giving members of the health care community improved ability to respond during a radiological or nuclear crisis, reducing fatalities, mitigating injuries, and improving the resiliency of the community.

Enhancing the Translation of Disaster Health Competencies Into Practice

Objectives

Disaster health workers currently have no common standard based on a shared set of competencies, learning objectives, and performance metrics with which to develop courses or training materials relevant to their learning audience. We examined how existing competency sets correlate within the 2012 pyramidal learning framework of competency sets in disaster medicine and public health criteria and describe how this exercise can guide curriculum developers.

Methods

We independently categorized 35 disaster health-related competency sets according to the 4 levels and criteria of the pyramidal learning framework of competency sets in disaster medicine and public health.

Results

Using the hierarchical learning framework of competency sets in disaster medicine and public health criteria as guidance, we classified with consistency only 10 of the 35 competency sets.

Conclusions

The proposed series of minor modifications to the framework should allow for consistent classification of competency sets. Improved education and training of all health professionals is a necessary step to ensuring that health system responders are appropriately and adequately primed for their role in disasters. Revising the organizing framework should assist disaster health educators in selecting competencies appropriate to their learning audience and identify gaps in current education and training. (Disaster Med Public Health Preparedness.2014;8:70-78)

Improving emergency preparedness system readiness through simulation and interprofessional education

We applied emerging evidence in simulation science to create a curriculum in emergency response for health science students and professionals. Our research project was designed to (1) test the effectiveness of specific immersive simulations, (2) create reliable assessment tools for emergency response and team communication skills, and (3) assess participants' retention and transfer of skills over time. We collected both quantitative and qualitative data about individual and team knowledge, skills, and attitudes. Content experts designed and pilot-tested scaled quantitative tools. Qualitative evaluations administered immediately after simulations and longitudinal surveys administered 6-12 months later measured student participants' individual perceptions of their confidence, readiness for emergency response, and transfer of skills to their day-to-day experience. Results from 312 participants enrolled in nine workshops during a 24-month period indicated that the 10-hour curriculum is efficient (compared with larger-scale or longer training programs) and effective in improving skills. The curriculum may be useful for public health practitioners interested in addressing public health emergency preparedness competencies and Institute of Medicine research priority areas.