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CONCEPTS
in Disaster Medicine
Enhancing the Translation of Disaster Health
Competencies Into Practice
Lauren Walsh, MPH; Brian A. Altman, PhD; Richard V. King, PhD;
Kandra Strauss-Riggs, MPH
ABSTRACT
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)
Key Words: disaster health, competency, workforce training, disasters
In 2007, Homeland Security Presidential Directive
21 (HSPD-21) established a national strategy
for public health and medical preparedness. This
directive included a call for action to the nation
to ‘‘support and facilitate the establishment of a
discipline of disaster health’’ to provide a ‘‘foundation
for doctrine, education, training, and research.’’
1
The
need for disaster health to become a formal discipline
has long been recognized by leaders in the field, and
considerable progress has been made toward its
advancement. However, the disaster health community
has not reached consensus on the complete body of
knowledge needed by its professionals, a certification
body, nor a process for credentialing. Consequently,
disaster health workers are not held to a common
standard based on a shared set of competencies, learning
objectives, and performance metrics.
While most of the health-related disciplines that are
part of the disaster health workforce are competency
based, no standards regarding the disaster health-
related competencies have been incorporated into the
curricula of each discipline. Furthermore, the majority
of responders in a local disaster will be health
professionals not necessarily trained as response
workers, so continuing education and training must
also aim to augment their competence.
To better establish an objective basis for workforce
competency development, a number of authors have
described consensus-based recommendations regarding
the areas of competence needed for specific subsets of
potential disaster responders.
2–12
Their work has con-
tributed to the literature a wealth of disaster health
competencies for a variety of audiences and settings.
Disaster-related competencies are available for particular
health professions and primary specialties; for those
who want to include disaster health as a secondary
specialty; and for professions within a particular organi-
zation or agency. Competencies related to specific
subject areas such as weapons of mass destruction,
mental and behavioral health, and pediatrics also
exist. Navigating through these competency sets,
however, can be challenging for disaster health
educators wishing to develop courses or training
materials. A clear understanding of how existing
competency sets relate to one another and to the
discipline is essential to ensure commonality of
Disaster Medicine and Public Health Preparedness70 VOL. 8/NO. 1
Copyright &2014 Society for Disaster Medicine and Public Health, Inc. DOI: 10.1017/dmp.2014.7
knowledge, procedures, and terminology across the many
professions within the health sector.
In 2010, an interdisciplinary group of professionals worked
together to examine available competency sets and draw from
them a consensus set of core competencies that represent the
baseline knowledge applicable to all responders in the health
professions, regardless of their experience and background or
previous roles in a disaster.
11
A key outcome of this effort was
the conceptualization of a hierarchical learning framework in
the form of a pyramid model that summarizes and integrates the
various existing disaster medicine and public health competency
sets that were developed for different target audiences within the
disaster workforce.
11
The pyramid summarizes the different
target audiences and subject areas encompassed in the discipline
of disaster health and thus provides an integrated view of
competency requirements in the disaster workforce. Individuals,
regardless of profession or years of experience, could use this
model to guide their own learning, e.g., by focusing on relevant
competencies at the pyramid’s base before integrating compe-
tencies from the three progressively higher levels. From there,
the competencies each person might choose to develop would
be influenced by several factors, including their particular role in
a disaster, profession, specialization, and interests.
The progression in specialization of competencies seen as
one ascends the pyramid should not be interpreted to
represent a hierarchy of individuals, levels of leadership, or
years of experience. Instead, the levels represent increasingly
specialized competencies intended for different and distinct
target audiences. Consequently, the pyramid can help in
efforts to reduce redundancies, gaps, and inconsistencies
in competency-based learning in disaster health. To our
knowledge, however, this model has not been tested in
practice. The present report attempts to move along the
continuum from concept to practice by (1) examining
whether, and how well, existing competency sets can be
placed within the pyramidal framework and (2) illustrating
how this exercise can guide curriculum developers in
choosing competencies relevant to their learning audiences
from among the numerous sets of available competencies in
disaster health. It is our hope to continue to engage in a
collaborative discussion surrounding disaster health education
and training and to assist this emerging discipline in moving
toward a more robust infrastructure for learning.
METHODS
A total of 35 competency sets were identified by a literature
search in PubMed, the National Library of Medicine’s
Disaster Information Management Research Center database,
and Google Scholar. These databases were searched for
the key words ‘‘disaster competency,’’ ‘‘disaster education,’’
‘‘disaster health competencies,’’ ‘‘preparedness education,’’
and ‘‘preparedness competencies.’’ In addition, a Google
search was performed to identify competency sets that may
not have been published in the peer-reviewed literature.
Cited sources in articles from both searches were also
investigated. To be included for classification in this exercise,
the document had to have enumerated specific competencies
for learning in disaster health, be directed toward a health or
health-related profession, and be written in English.
The authors independently categorized the 35 disaster health-
related competency sets according to the 4 levels and criteria of
the pyramid framework published by Walsh et al (Table 1).
11
Then we met to discuss any discrepancies among them and any
challenges that were encountered. All of us were involved in
drafting the criteria of the framework, and were therefore
familiar with the intent behind the pyramid structure and its
potential use in practice. Furthermore, we all have been
actively involved in using the core competencies and the
published pyramid as a guide to develop education and training
opportunities in disaster health. Two of us (R.V.K. and B.A.A.)
also have expertise in adult learning and educational theory
and practice.
RESULTS
Using the pyramid’s criteria as guidance, we classified with
consistency only 10 of the 35 competency sets (Table 2).
Competency sets categorized to level 1 were unanimously
agreed on, but ambiguity in the definitions of the remaining
3 levels made it difficult for us to use the framework
consistently and reach consensus on most of the remaining
sets. In conducting this exercise, 3 main obstacles in using the
pyramid as a classification scheme were identified.
TABLE 1
Criteria for Classifying Competency Sets According to a Hierarchical Learning Framework of Competency Sets in
Disaster Medicine and Public Health
11
Level 1 (base) ‘‘serve as the foundation for the more specific competencies developed by other entities involved in DMPH’’
Level 2 ‘‘those required by the institutions, organizations, and agencies in which health professionals work, although the
foundational competency education should always relate to the provider role’’
Level 3 ‘‘apply to some, but not all, members of the health disciplines and professions that require more specialized knowledge
and skills in disaster-related medicine and public health’’
Level 4 (top) ‘‘the very specific competencies expected of health personnel who compose various disaster response teams, both
foreign and domestic, that must be highly integrated in their performances and actions’’
Translating Disaster Health Competencies
Disaster Medicine and Public Health Preparedness 71
TABLE 2
Author Categorization of Competency Sets According to Pyramid Framework
a
Reference
5–11,13–40
Year Title A1 A2 A3 A4
American College of Emergency Physicians,
NBC Taskforce
2001 Recommendations for WMD training and sustainment 3 3 3 3
Gebbie and Qureshi 2002 Emergency and disaster preparedness: core competencies for
nurses
32/32/32
Centers for Disease Control and Prevention
(CDC), Columbia University
2002 Bioterrorism and emergency readiness: competencies for all public
health workers
22/32 2
Gebbie and Merrill 2002 Public health worker competencies for emergency response 3 2/3 2/3 2/3
Nursing Emergency Preparedness Education
Coalition
2003 Educational competencies for registered nurses responding to mass
casualty incidents
32/32/32
CDC, Columbia University 2003 Emergency preparedness and response competencies for hospital
workers
2222
More et al 2004 Predoctoral dental school curriculum for catastrophe preparedness 3 2/3 2 2/3
Iowa Department of Public Health Mental
Health Competencies Task Force
2004 Mental health competencies for healthcare providers for terrorism
and emergency preparedness and response
22/32 2
Florida Department of Health 2004 State of Florida recommended core competencies and planning/
mitigation strategies for hospital personnel
2222
Markenson et al 2005 Preparing health professions students for terrorism, disaster, and
public health emergencies: core competencies
2 2/3 2/3 2/3
Tachibanai et al 2005 Competencies necessary for Japanese public health center directors
in responding to public health emergencies
4222
World Health Organization 2006 The contribution of nursing and midwifery in emergencies 3 2/3 2 2
Hsu et al 2006 Healthcare worker competencies for disaster training 2 2 2 2
Minnesota Department of Health Office of
Emergency Preparedness
2006 Bioterrorism hospital preparedness program healthcare personnel
emergency preparedness (HPEP) competencies
2?32
College of Nursing Art and Science
University of Hyogo
2006 Core competencies require d for disaster nursing 3 3 3 3
Wenzel and Wright 2007 Veterinary accreditation and some new imperatives for national
preparedness
32/32 2
National Panel for APRN Emergency
Preparedness for All Hazards Response
and Education
2007 APRN education for emergency preparedness and all hazards
response: resources and suggested content
32/32/33
Barbera et al 2007 VHA-EMA certification program, healthcare emergency
management, professional certification program
332/32/3
Office of the Surgeon General 2007 Medical Reserve Corps core competencies matrix 2 4 4 4
Subbarao et al 2008 A consensus-based educational framework and competency set for
the discipline of disaster medicine and public health preparedness
1111
American College of Occupational and
Environmental Medicine
2008 American College of Occupational and Environmental Medicine
competencies
3 2/3 2 2/3
US Public Health Service 2008 Pharmacist readiness training program: pharmacist readiness roles
and competencies
32/32 3
Public Health Risk Management Association 2008 Public Risk Management Association core competencies 3 2/3 2 3
Kuntz et al 2008 Disaster preparedness white paper for community/public health
nursing educators
3333
Polivka et al 2008 Public health nursing competencies for public health surge events 3 2/3 2/3 2/3
Everly et al 2008 On academics: training for disaster response personnel: the
development of proposed core competencies in disaster mental
health
22/33 3
World Health Organization, International
Council of Nurses (ICN)
2009 ICN framework of disaster nursing competencies ? 2/3 ? 3
Jorgensen 2010 Emergency preparedness and disaster response core competency
set for perinatal and neonatal nurses
32/32 2
Association of Schools of Public Health 2010 Public health preparedness and response core competency model 2 2/3 2 2
Walker and Russ 2010 Humanitarian core competencies: professionalizing the
humanitarian sector: a scoping study
2444
Consortium of British Humanitarian
Agencies
2010 Establishing common competencies and leadership frameworks 2 4 4 4
Walsh et al 2012 Core competencies for disaster medicine and public health 1 1 1 1
Schultz and Koenig 2012 Development of national standardized all-hazard disaster core
competencies for acute care physicians, nurses, and EMS
professionals
3333
European Master in Disaster Medicine 2012 European Master in Disaster Medicine XI edition 2 3 3 3
American Red Cross 2011 Disaster Services Human Resource training courses 4 4 4 4
Abbreviations: APRN, Advanced Practice Registered Nurse; EMS, emergency medical services; VHA-EMA, Veterans Health Administration-Emergency Management Academy.
a
Competency sets are listed by publication year. Question mark indicates the authors (A1-A4) could not agree on the classification of a competency set. Slash mark indicates
the author thought the competency set could fit in either of 2 categories.
Translating Disaster Health Competencies
Disaster Medicine and Public Health Preparedness72 VOL. 8/NO. 1
First, level 2 contains 2 distinct types of competency sets,
which caused confusion when classifying sets that met just
1 of the criteria. According to the original framework, second-
level competency sets are for ‘‘institutions, organizations, and
agencies in which health professionals work,’’ but which
‘‘always relate to the provider role.’’ Often, a given competency
set would fit just 1 of the criteria rather than both. For example,
More et al’s ‘‘predoctoral dental school curriculum for
catastrophe preparedness’’ is meant for students of a specific
health profession (dentistry). Because dentistry is a provider
role, it would appear that this set would fit level 2; however,
because the competencies are intended for all dentistry students,
and are not ‘‘required by the institutions, organizations, and
agencies in which health professionals [dentists] work’’ [italics
added],it does not clearly fit the description for that level.
In contrast, some competency sets that clearly pertain to
employees of a specific organization or agency, for example the
‘‘VHA-EMA [Veterans Health Administration-Emergency
Management Academy] emergency response and recovery
competencies’’ for all employees in the Veterans Health
Administration system, do not include competencies specific
to each professional role within that system. Thus, some
competency sets are written by virtue of profession, whereas
others are written by one’s place of employment. Currently,
both sets are categorized as level 2, which could mislead
educators to believe they should choose one set or the other,
while both may be relevant to the learner.
Second, the definition of professionals that may ‘‘require
more specialized knowledge and skills in disaster-related
medicine and public health’’ is very subjective. In attempting
to classify each competency set, it has become apparent that a
difference exists between competencies that are (1) general-
ized for a health profession that may not traditionally
specialize in disaster or emergency health, but which may,
by virtue of its education or training, be reasonably expected
to play a role in disaster response, and (2) intended for those
specializing in disaster-related medicine, nursing, public
health, and the like. It could be argued that both sets
‘‘require more specialized knowledge and skills’’; however,
they are distinctly different groups requiring distinctly
different levels of competence. The former refers to an
augmentation of one’s acquired professional skills and chosen
specialization, whereas the latter refers to individuals who
desire specifically to become disaster health specialists.
Finally, certain competency sets are defined for a specific
scenario or event, or for a specific topic area, rather than
characterizing a comprehensive all-hazards approach. Good
examples of these are the ‘‘educational competencies for
registered nurses responding to mass casualty incidents’’ from
the Nursing Emergency Preparedness Education Coalition
and ‘‘mental health competencies for healthcare providers for
terrorism and emergency preparedness response’’ from the Iowa
Department of Public Health. Under the current framework,
it is not readily apparent whether these would be placed in
level 2 or level 3.
DISCUSSION
Proposed Modifications to the 2012 Hierarchical
Learning Framework
Recognizing and appreciating the collaborative work that
came before the present exercise, we present for discussion
potential additions to the previous framework. Based on the
inconsistencies identified here and to improve practical
application of the pyramidal framework to educators and
learners, we suggest the following modifications to the
existing hierarchical learning framework (Table 1):
1. Separate level 2 into 2 distinct levels. The lower level
would contain profession-specific competency sets, and
the higher level would include organization, agency, or
institution-specific competency sets. This split would allow
competencies that are specific to an agency or organization
and that apply to multiple professions within that agency
(eg, VHA system) to clearly build on the competencies for
unique professions within that agency, which would still
build on the core competencies.
2. Clearly differentiate between competency sets that should be
integrated into the basic training of health professions that
do not specifically specialize in disaster or emergency and
those that are intended for individuals who wish to specialize
in disaster health or a closely related discipline.
3. Create a classification method for competency sets meant
to cover only a specific topic or focal area (ie, mental
health, pediatrics, or chemical, biological, radiological and
nuclear defense) within each level of the pyramid.
A Revised Hierarchical Learning Framework
The modifications proposed would result in a slightly more
detailed figure, but one with more practical utility as a
framework for disaster health learning. The revised pyramid
(Figure) would be analogous to a library of existing
and future competency sets, where each shelf comprises
a broad learning audience and contains different ‘‘books’’ of
competencies relevant to a more specific subset of that
learning audience. Similar to the 2012 pyramid, the modified
hierarchical framework does not represent individuals and
their progression upward through the pyramid, but instead
represents a framework of competency sets that are meant for
different target audiences at each level of the structure.
Included in the revised competency pyramid are all professions
that could reasonably be expected to play a health-related role
in a disaster (or, even more broadly, any health professional
with an interest in education or training in disaster health).
Each of the 5 levels of the pyramid includes all competency
sets targeted at a particular learning audience.
The core level at the base includes only competency sets
targeted for all disaster health professionals. The profession
Translating Disaster Health Competencies
Disaster Medicine and Public Health Preparedness 73
level contains disaster health competency sets specifically
intended for any of the health professions that contribute to
the diverse disaster health workforce (eg, epidemiologists,
nurses, emergency physicians, pharmacists, primary care
practitioners, veterinarians). The organizational level com-
petency sets are for disaster health professionals linked by a
multiprofessional organization such as a hospital, health care
coalition, or nonprofit organization; rather than being
targeted at professions, these competencies are relevant to
the context in which the professions work. Specialist level
competency sets are targeted to individuals seeking advanced
specialization in disaster health rather than looking to
augment previous training with basic disaster health skills
and concepts. Competency sets in the deployment level are
highly specialized and meant for regularly deployed disaster
health responders.
The competency sets included within each level of the
pyramid can be either general (encompassing the full range of
topic areas relevant to the target audience) or specific
(covering just 1 subject area of particular interest to the
learning audience). The specific focal areas are represented
above each main level because they would ideally build on
the general breadth of competencies written for that target
learning audience. Focal areas may include competencies in
discrete topics such as pediatric preparedness, veterinary
medicine, ethics, or triage and could be taught to any of the
identified target learning audiences in the pyramid. These
competencies may be targeted to disaster health professionals
without direct specialization in that focal area but who
may work closely with the population of interest or other-
wise want additional training in the subject. Therefore, the
5 main levels of the pyramid contain comprehensive
competency sets covering the broad range of disaster health
competencies needed for a particular audience, and the
corresponding focal areas contain competency sets that are
targeted to that audience but focused on particular areas
within disaster health.
FIGURE
Revised Framework for the Articulation of Competency Sets for Disaster Health Professionals.
Core level: includes only competency sets targeted for all disaster health professionals.
Profession level: includes disaster health competency sets specifically intended for any of the health professions that contribute to the disaster
health workforce.
Organizational level: includes competency sets for disaster health professionals linked by a multiprofessional organization such as a hospital,
health care coalition, or nonprofit organization.
Specialist level: includes competency sets targeted to individuals seeking advanced specialization in disaster health rather than looking to
augment previous training with basic disaster health skills and concepts.
Deployment level: highly specialized competency sets meant for regularly deployed disaster health responders.
Focal areas: competency sets that are relevant to the learner described in each level, but which cover only a specific subject area within the
cadre of topics that a learner may need to know.
Translating Disaster Health Competencies
Disaster Medicine and Public Health Preparedness74 VOL. 8/NO. 1
TABLE 3
Categorization of Existing Competency Sets by Targeted Learning Audience According to the Revised Framework
Level Breadth Target Audience Reference Year Publication Title
Core General All disaster health workers Subbarao et al 2008 A consensus-based educational framework and competency set for the discipline of disaster
medicine and public health preparedness
Walsh et al 2012 Core competencies for disaster medicine and public health
Core Focal Area Specific All disaster health workers None
Professional General Professions or groups of professions More et al 2004 Predoctoral dental school curriculum for catastrophe preparedness
Wenzel and Wright 2007 Veterinary accreditation and some new imperatives for national preparedness
Tachibanai et al 2007 Competencies necessary for Japanese public health center directors in responding to public
health emergencies
American College of Occupational and
Environmental Medicine
2008 American College of Occupational and Environmental Medicine competencies
US Public Health Service 2008 Pharmacist readiness training program: pharmacist readiness roles and competencies
World Health Organization,
International Council of Nurses (ICN)
2009 ICN Framework of Disaster Nursing Competencies
College of Nursing Art and Science
University of Hyogo
2006 Core competencies required for disaster nursing
National Panel for APRN Emergency
Preparedness for All Hazards
Response and Education
2007 APRN education for emergency preparedness and all hazards response: resources and
suggested content
World Health Organization 2006 The contribution of nursing and midwifery in emergencies
Public Health Risk Management
Association
2008 Public Risk Management Association core competencies
Nursing Emergency Preparedness
Education Coalition
2003 Educational competencies for registered nurses responding to mass casualty incidents
Kuntz et al 2008 Disaster preparedness white paper for community/public health nursing educators
Polivka et al 2008 Public health nursing competencies for public health surge events
Gebbie and Qureshi 2002 Emergency and disaster preparedness: core competencies for nurses
Gebbie and Merrill 2002 Public Health Worker Competencies for Disaster Training
Jorgensen 2010 Emergency preparedness and disaster response core competency set for perinatal and neonatal
nurses
Markenson et al 2005 Preparing health professions students for terrorism, disaster, and public health emergencies: core
competencies
Schultz et al 2012 Development of national standardized all-hazard disaster core competencies for acute care
physicians, nurses, and EMS professionals
Association of Schools of Public Health 2010 Public health preparedness and response core competency model
Professional
Focal Area
Specific Professions or groups of professions Iowa Department of Public Health
Mental Health Competencies Task
Force
2004 Mental health competencies for healthcare providers for terrorism and emergency preparedness
and response
Everly 2008 On academics: training for disaster response personnel: the development of proposed core
competencies in disaster mental health
Centers for Disease Control and
Prevention (CDC), Columbia
University
2003 Bioterrorism and Emergency Readiness: Competencies for All Public Health Workers
American College of Emergency
Physicians – NBC Taskforce
2001 Recommendations for WMD training and sustainment
Organizational General Organizations, agencies Hsu et al 2006 Healthcare worker competencies for disaster training
CDC, Columbia University 2002 Emergency preparedness and response competencies for hospital workers
Florida Department of Health 2004 State of Florida recommended core competencies and planning/mitigation strategies for hospital
personnel
Translating Disaster Health Competencies
Disaster Medicine and Public Health Preparedness 75
Classification of Competency Sets According to the
Revised Hierarchical Framework
As shown in Table 3, published competency sets can be
categorized in the revised framework according to both their
target audience and the breadth (or specificity) of subject.
Target audiences that have yet to be addressed are made more
obvious, as are opportunities for improvement in the education
and training of the disaster health workforce. Because
specialization of the competencies increases with movement
up the pyramid, it is not surprising that more competency sets
exist at the professional and organizational levels than at the
specialist and deployment levels. The lower levels of the
pyramid focus predominantly on increased domestic resilience
and integrating emergency preparedness principles into the
general academic or professional training of health professions,
whereas the specialist and deployment levels examine highly
specialized domestic response, humanitarian assistance, and
foreign medical teams. Thus, a greater number of individuals
across a greater number of professions will require basic
education and training in disaster health than will need
specialty expertise in deployed disaster response.
CONCLUSIONS
The goal of this organizing framework is to better understand
and categorize the many published competency sets within
the discipline of disaster health to identify opportunities for
education and training and assist disaster health educators
in selecting competencies appropriate to their learning
audience. This framework is not intended to generate an
additional competency set or represent an exhaustive list of
all competencies for all people within the discipline.
The strength of this revised pyramid lies in its ability to clearly
illustrate the different target audiences within the disaster health
workforce and the breadth of subject matter taught within
the discipline, thus eliminating ambiguity from the original
framework and highlighting areas for additional competency
development. This revision allows for a more useful comparison
of the competency sets within each tier. It also helps educators
visualize a layered approach to competency-based education and
training, which begins with core competencies and then adds
disaster health competencies relevant to one’s profession. These
levels are next followed by disaster health competencies related
to one’s organization or agency, before adding increasingly
specialized competencies, with the transition from a general
health care workforce to a specifically trained disaster health
specialist or for response deployment. The revised framework
can also help guide the necessary integration of competencies
into a curriculum by allowing educators to select relevant
competencies and use them to craft learning experiences suited
to their target audience.
41
We believe that most, if not all, existing competency sets
can be categorized according to this revised framework.
However, within each level and within each competency set
Table 3. Continued
Level Breadth Target Audience Reference Year Publication Title
Minnesota Department of Health Office
of Emergency Preparedness
2006 Bioterrorism hospital preparedness program healthcare personnel emergency preparedness
(HPEP) competencies
Barbera et al 2007 VHA-EMA certification program, healthcare emergency management, professional certification
program
Organizational
Focal Area
Specific Organizations, agencies None
Specialist General Disaster health specialists Office of the Surgeon General 2007 Medical Reserve Corps Core competencies matrix
European Master in Disaster Medicine 2012 European Master in Disaster Medicine XI edition
Specialist Focal Area Specific Disaster health specialists None
Deployment General Highly specialized response workers American Red Cross - Disaster Services Human Resource Training Courses
Walker and Russ 2010 Humanitarian core competencies: professionalizing the humanitarian sector: a scoping study
Consortium of British Humanitarian
Agencies
2010 Establishing common competencies and leadership frameworks
Deployment Focal Area Specific Highly specialized response workers None
Abbreviations: APRN, Advanced Practice Registered Nurse; EMS, emergency medical services; VHA-EMA, Veterans Health Administration-Emergency Management Academy.
Translating Disaster Health Competencies
Disaster Medicine and Public Health Preparedness76 VOL. 8/NO. 1
are opportunities for flexibility in the intensity and scope of
training. Much discussion, for example, has centered on the
competencies needed for humanitarian response profes-
sionals,
35,42–47
which has also used a pyramidal concept to show
the need for increasing competence within their field.
35
The
present pyramid framework does not imply static training and
education requirements within each level; for example,
humanitarian response professionals do not require the same
competencies as national disaster medical system response teams,
although they would be categorized alongside them. Rather, the
humanitarian assistance initiative toward professionalization is a
necessary and important step to further define education and
training requirements for a very specific subset of professionals
within the broader and more inclusive disaster health workforce.
The revised pyramid framework will allow curriculum
developers and educators to select competencies relevant to
the (1) core knowledge of the field or a particular focal area
within it, (2) one’s particular profession, (3) one’s relation-
ship to an organization, (4) a specialization and career focus
in disaster health, and (5) deployed response. Competency
sets can be adapted to meet the needs of the novice,
intermediate, or advanced professional within each target
audience. Furthermore, they can be selected to increase
requirements for those who desire leadership or teaching
positions and need a greater understanding and command
of knowledge and skill. The framework is not intended to
encompass competency-based education and training nor-
mally required of one’s profession but to demonstrate
increased mastery of that profession by integrating concepts
of preparedness, response, recovery, and mitigation relevant
to one’s role. Although the organization can be modified, and
is likely subject to change, the value of this design lies in
depicting the relationship of existing sets to each other and to
their respective disaster health audiences.
Improved education and training of all health professionals
helps ensure our workforce is appropriately and adequately
primed for its role in disasters. Under this framework, current
and future competency sets can be catalogued and sorted based
on one’s interest or target audience. Such an approach allows
improved understanding of the integration of all health-related
roles in the disaster management system, and simplifies the task
of selecting competencies relevant and necessary for any subset
of the disaster health workforce. In this way, a progressive
competency-based curriculum could be developed. Building all
competencies from a common foundation and lexicon creates
consistencies in their application, construction, and relevance
in the framework, offering flexibility in education and training
of the disaster health workforce, and ensuring a common
foundation across all members of the workforce.
The competency sets shown in the tables represent a subset of
those currently published in the peer-reviewed and gray
literature. They are intended to initiate the use of the
pyramid concept as a way of cataloguing the myriad disaster
health competency sets that now exist. The placement of
existing competency sets in Table 2 reflects our interpretation
and not necessarily that of the researchers who published
them. Because these authors were involved in the drafting of
the original pyramid framework, their interpretations of the
criteria for the classification of competency sets would differ
from those of novice users. Future research in the application
of the pyramid could include its use by trainers and educators.
We hope that the organizational framework presented here
will continue the movement toward the formation of the
discipline and aid those who identify, teach, and perform the
multifaceted competencies of disaster health.
About the Authors
Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc;
National Center for Disaster Medicine and Public Health, Rockville, Maryland
(Dr Altman and Mss Walsh and Strauss-Riggs); and the University of Texas
Southwestern Medical Center, Dallas, Texas (Dr King).
Address correspondence and reprint requests to Lauren Walsh, MPH,
Henry M. Jackson, Foundation for the Advancement of Military Medicine, Inc,
National Center for Disaster Medicine and Public Health, 11300 Rockville Pike,
Suite 1000, Rockville, MD 20815 (email: lauren.walsh.ctr@usuhs.edu).
Funding and Support
The Henry M. Jackson Foundation for the Advancement of
Military Medicine, Inc supports the National Center for
Disaster Medicine and Public Health through a grant
sponsored by the Uniformed Services University of the
Health Sciences. The views expressed here are those of the
authors and do not reflect the official policy or position of
the Uniformed Services University of the Health Sciences,
the US Department of Defense, or the US Government.
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