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Objective The objective of this study is to characterize US-based disaster training courses available to disaster response and disaster health professionals. Its purpose is to better inform policies and decision-making regarding workforce and professional development to improve performance. Methods Courses were identified from 4 inventories of courses: (1) National Library of Medicine Disaster Lit database; (2) TRAIN National Learning Network; (3) Federal Emergency Management Agency (FEMA) National Preparedness Course Catalog; and (4) Preparedness and Emergency Response Learning Centers. An online search used 30 disaster-related key words. Data included the course title, description, target audience, and delivery modality. Levels of learning, target capability, and function were categorized by 3 expert reviewers. Descriptive statistics were used. Results There were 3662 trainings: 2380 (65%) for professionals (53% for public health); 83% of the courses were distance learning, with 16% via classroom. Half of all trainings focused on 3 of 37 disaster capabilities and 38% of them were related to chemical, biological, radiological, nuclear, and explosives (CBRNE). The educational approach was knowledge-based for all courses and 99.6% imparted only lower levels of learning. Conclusion Despite thousands of courses available, there remain significant gaps in target audience, subject matter content, educational approaches, and delivery modalities, particularly for health and public health professionals.
Content may be subject to copyright.
Characterizing the Current State of Training Courses
Available to US Disaster Professionals
Thomas Kirsch, MD; Mark Keim, MD; Kandra Strauss-Riggs, MPH
ABSTRACT
Objective: The objective of this study is to characterize US-based disaster training courses available to dis-
aster response and disaster health professionals. Its purpose is to better inform policies and decision-
making regarding workforce and professional development to improve performance.
Methods: Courses were identified from 4 inventories of courses: (1) National Library of Medicine Disaster Lit
database; (2) TRAIN National Learning Network; (3) Federal Emergency Management Agency (FEMA)
National Preparedness Course Catalog; and (4) Preparedness and Emergency Response Learning
Centers. An online search used 30 disaster-related key words. Data included the course title, description,
target audience, and delivery modality. Levels of learning, target capability, and function were categorized
by 3 expert reviewers. Descriptive statistics were used.
Results: There were 3662 trainings: 2380 (65%) for professionals (53% for public health); 83% of the
courses were distance learning, with 16% via classroom. Half of all trainings focused on 3 of 37 disaster
capabilities and 38% of them were related to chemical, biological, radiological, nuclear, and explosives
(CBRNE). The educational approach was knowledge-based for all courses and 99.6% imparted only
lower levels of learning.
Conclusion: Despite thousands of courses available, there remain significant gaps in target audience, sub-
ject matter content, educational approaches, and delivery modalities, particularly for health and public
health professionals.
Key Words: disaster medicine, disasters, education, government, health education, public health professional
Improving the operational performance of disaster
responders is a national priority. The importance
of training for disaster preparedness and response
professionals regardless of the professional discipline
has been discussed for more than 20 years.14
However, reports of gaps in training and preparedness
persist, particularly for public health and medical
professionals.5,6The current programs are not well-
aligned and do not meet all national capabilities
described in Federal preparedness and response plans.
Domestically and globally, multiple governmental
agencies, organizations, and universities have developed
disaster-related education and training programs, 7,8and
the Federal Emergency Management Agency (FEMA)
leads a national education program specifically for emer-
gency management professionals. However, questions
have been raised about the quality and completeness
of these courses in relation to education and training
design and content, including those for medical and
public health professionals.9
The objective of this study is to characterize US-based
online disaster training courses currently available to
disaster medicine and public health professionals. Its
purpose is to better inform policies and decision-mak-
ing regarding workforce and professional development.
METHODS
Courses were identified from the 4 largest US-based
inventories of publicly-available training courses avail-
able to disaster professionals in 2017, as follows:
1. Disaster Lit: resource guide for disaster medicine and
public health; a National Library of Medicine
(NLM) guide to disaster and public health prepared-
ness literature and related information freely avail-
able on the Internet
2. TRAIN National Learning Network Course
Catalog: a Public Health Foundation learning man-
agement system of public health learning products
3. FEMA National Preparedness Course Catalog: The
Emergency Management Institute (EMI), serving
as the national focal point for the development
and delivery of emergency management training
4. Centers for Disease Control and Prevention (CDC)
funded academic partnerships, the Preparedness and
Emergency Response Learning Centers (PERLCs),
online course catalog
ORIGINAL RESEARCH
Disaster Medicine and Public Health Preparedness 1
Copyright © 2019 Society for Disaster Medicine and Public Health, Inc. DOI: 10.1017/dmp.2019.15
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An online search was performed for each of the 4 databases
using 30 key words from 5 domains as criteria for inclusion
in the study sample (Table 1).
Inclusion criteria included entries that contained at least 1 of
the 30 key words AND: identifiable as an online education
offering; or identifiable as a live training course; or unsure.
For exclusion criteria, courses were excluded from analysis if
they were not available to the general public, not related to
disaster or emergency situations, or applicable toward an
accredited academic degree. Assignments of criteria for data
inclusion/exclusion and discipline were then validated by 3
individual reviewers using the same algorithmn.
The results of these 30 key word searches were aggregated into
a spreadsheet database. Duplicate courses were identified and
excluded. Those data collected included the course title,
course description, host institution, sponsoring insitutions,
target audience, and modality for delivery. Simple calcula-
tions of descriptive statistics were performed using MS
Excelsoftware. Assignments of level of learning, target
capability, and function were performed by 2 expert
reviewers. Discrepancies were then reviewed and adjudicated
by a third reviewer (MK) using the same reference criteria
(Appendix A).
The levels of learning categories were based on Blooms revised
taxonomy.10 This taxonomy is a hierarchical model that clas-
sifies educational learning objects into increasingly complex
and specific cognitive levels. They describe the level of learn-
ing that participants would be expected to achieve based upon
the course description and learning objectives (Table 2).
Target capability and function category were categorized
according to a standard set of criteria from a predesignated list
of 37 widely-accepted emergency management capabilities
and functions (Appendix A). These capabilities and functions
were derived from capabilities created by FEMA, 11 the US
Veterans Administration (VA),12 and the CDC13 to guide
US Government preparedness and response activities. Items
were considered to be related to a given capability if the item
description contained mention of that capability or 1 or more
functions associated with that capability.
RESULTS
The searches identified a total of 4870 courses: 2252 (46.2%)
from the NLM Disaster Lit database; 1759 (36.1%) from the
TRAIN learning system; 707 (14.5%) from the FEMA
National Preparedness Course Catalog; and 152 (3.1%) from
the PERLC course catalog. After the deletion of 1208 dupli-
cates, a total of 3662 unique online training courses were iden-
tified as meeting criteria for inclusion.
Modality
Of the 3662 courses identified, 3049 (83.2%) were available
via web-based or other distance learning modalities (eg,
CD-ROM and webinar); 604 (16.5%) courses were available
by classroom only; 4 (0.1%) courses were available as mixed
online and classroom; and 2 (0.05%) courses were reportedly
available during meetings or conferences. Most modalities for
content delivery involved didactic presentations. Some cour-
sework also involved limited live group interactions, largely in
the form of classes involving discussions or exercises.
Target Audience
The target audiences for the courses were generally divided
into either disaster professionals (2380 courses, 65.0%) or
the general public (732 courses, 20.0%), with 659 (18.0%)
courses targeting both and 12.3% that did not specify a target
audience, leaving 3039 courses for the professionals audience
(Figure 1). Of the courses that targeted the professionals
TABLE 1
Key Words Used in Online Searches, According to
Disaster-Related Domain
Domain Key Words
General disaster, emergency
Emergency management preparedness, emergency
preparedness, response,
recovery, mitigation
Terrorism hazards bioterrorism, terrorism
CBRNE hazards CBRNE (chemical, biological,
radiological, nuclear, and
explosives)
Natural hazards hurricane, cyclone, typhoon, flood,
storms, tornados, earthquake,
landslide, ice storm, heat wave,
drought, outbreak, infectious
disease
Technological hazards power failure, cyber attack
TABLE 2
Criteria for Assigning Levels of Learning According to
Blooms Revised Taxonomy
# Category Description of Ability Course Characteristics
1 Remember Able to recall facts and
basic concepts
Learners memorize
content.
2 Understand Able to explain ideas or
concepts
Learners interact with
content.
3 Apply Able to use information in
new situations
Learners exercise or
apply lessons.
4 Analyze Able to draw connections
among ideas
Learners contrast and
compare concepts.
5 Evaluate Able to justify a stand or
decision
Learners evaluate a
decision or position.
6 Create Able to produce new or
original work
Learners create original
work.
Disaster Training Courses for Disaster Professionals
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audience, 1868 (61.5%) were intended for public health
professionals and 220 (7.2%) were intended specifically for
health care professionals, leaving 842 (27.7%) targeted toward
emergency management/preparedness professionals.
Content
Course subject matter was categorized according to 37 target
learning capabilities detailed in Appendix A. Figure 2 depicts
the number of training courses identified for each target
capability.
The number of courses ranged from 5 (0.1%) for 3 capabilities
(medical material management and distribution; management
and organization) to 733 courses (20.0%) related to emergency
management. The mean number of courses per capability was
99 with a median of 37 courses. Half of the courses (53.1%)
focused on only 3 of the capabilities: emergency management,
733 courses (20.0%); hazard-specific disaster knowledge, 662
courses (18.1%); and health care, 551 courses (15.0%).
Associated functions were categorized for all 37 capabilities.
Functions associated with these 3 most common capabilities
are reported here.
Emergency management accounted for one-fifth of all courses.
Most content (62.2%) focused on preparedness and response,
whereas only 14% were associated with mitigation (8.7%),
recovery (4.2%), and prevention (1.1%). Other courses in this
category included emergency operations centers (13.3%),
incident command systems (12.8%), and emergency manage-
ment (8.5%).
In total, courses associated with chemical, biological, radio-
logical, nuclear, and explosives (CBRNE) comprised 76.3%
of all available courses involving hazard-specific knowledge:
general CBRNE, 37.8%; biological, 35.1%; chemical, 3.4%.
Course content related to biological hazards related mostly
to Ebola and Zika viruses. Other hazard-specific topics
included natural hazards (11.8%), climate change (5.4%),
man-made hazards (3.9%), public health emergencies
(0.9%), case study (0.9%), and active shooter (0.6%).
Of the 551 courses related to health care, 71.7% focused on 4
functions: mental health (32.8%), infectious disease (20.1%),
CBRNE (9.9%), and mass casualty management (9.0%).
Others included pediatrics (6.6%), health care systems
(5.6%), hospital emergencies (3.2%), emergency medical
services (2.9%), toxicology (2.9%), primary health care
(1.4%), health care preparedness (1.3%), health physics
(2.0%), mass care (0.9%), non-communicable diseases
(0.5%), reproductive health (0.5%), and geriatrics (0.2%).
Level of Learning
The levels of learning were assessed by applying Blooms tax-
onomy of learning to course descriptions. Essentially, all
courses (99.4%) delivered learning at a level consistent with
the lowest 3 levels of learning: Remembering, 221 (6.0%);
Understanding, 2866 (78.2%); and Applying, 557 (15.2%).
Twelve courses (0.3%) were found to include learning objec-
tives and descriptions consistent with Blooms level 4
(Analysis). There were no courses identified that related to
FIGURE 1
Target Audience Among US-based Disaster Training Courses.
Disaster Training Courses for Disaster Professionals
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Blooms level 5 (Evaluation) and only 4 courses (0.1%) related
to Blooms level 6 (Creation).
DISCUSSION
Training and education are critical steps for preparing the pro-
fessional disaster workforce. The importance of professionaliz-
ing the disaster workforce has been increasingly discussed in
the professional and academic literature.1,1416 This study
has revealed a very large number of publicly available courses
for disaster-related training for health and public health
professionals in the United States, but the question is, Do
they meet the criteria for improving professionalism and
national preparedness?
This study raises a number of concerns about the existing avail-
able training in all apects of the courses studied: target audi-
ence, content, training approach, and levels of learning.
The first and most practical difficulty is the sheer number of
courses available and the relative paucity of descriptive course
information available online. The lack of information makes it
difficult for those seeking training to identify the appropriate,
high-quality training to meet their education needs. The lack
of guidance is compounded by course overload.In many sub-
ject areas, the number of courses available appears to be exces-
sive given that the training specifically targets 6 professions
only. For example, there were 1318 courses targeted for public
health professionals.
Despite the large number of courses, most of the content is
duplicative while simultaneously limited to a narrow range
of topics. When comparing course content to 37 recognized
national disaster capabilities (Appendix A), over half of all
courses focused on only 3 capabilities, and 38% of all haz-
ard-specific courses had content related to CBRNE, despite
the rare nature of these potential events (as compared with
FIGURE 2
Number of US Disaster-Related Training Courses, According to Target Capability.
Disaster Training Courses for Disaster Professionals
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12% related to natural disasters the most common). This
results in large gaps in training related to target capabilities
and the disaster hazards themselves.
Although it was not possible to make a detailed assessment of
the quality of each course without taking each of them, there
were indications of general issues with quality. The majority of
training courses studied were not only teaching the same sub-
jects, but also nearly all were designed to impart only a lower
level of learning on Blooms taxonomy. These lower levels are
similar to introductory or overview courses in high school or
college and do not develop professional competency beyond
a level of general understanding and have very limited oppor-
tunities for application of knowledge.
The target audience of the courses also appeared uncoordi-
nated and was unequally distributed among professions, with
public health accounting for more than half of all courses, leav-
ing the health care workforce with only 6% of the total courses.
An internationally accepted framework was developed to
define disaster education target audiences on the basis of their
level of responsibility strategic, tactical, and operational17
but we were unable to determine the operational level of the
courses from the information available on the websites.
Overall, despite the availability of literally thousands of
courses, nowhere is there a clear path to the stepwise develop-
ment of professional competency for health and public health
professionals. Effective performance is limited by the absence
of these standards. There are no measures of content complete-
ness or certifications of professional competency. There is a
need for further clarification and vetting of the disaster-related
roles and responsibilities of public health, emergency manage-
ment, and medical professionals. Task analyses should be used
to guide development and updating of tasks, competencies,
and associated learning objectives according to professional
role and target audience.
All trainings appear to use a relatively narrow knowledge-
based approach. Students expectedly gather knowledge in
absence of also developing the closely associated skills and
abilities that are known to ensure a successful performance.
Most models of performance and quality management recog-
nize that, in addition to knowledge, other qualities (eg, skills
and abilities) are also required for effective performance. All
three of these elements are necessary for any employee to per-
form their job effectively. Other than real-time, on-the-job
experience, disaster professionals have few opportunities to
gain, not only a deeper understanding, but also to learn, prac-
tice, and perfect more complex skills, abilities, and behaviors
consistent with the demands of the profession.
Experiential and analytical knowledge is important for disaster
managers, but the courses described in this study are unlikely a
suitable resource for upper levels of knowledge. Opportunities
for students to perform complex analysis, evaluation, and
creation of original content were limited because most courses
were only available as online fixed lectures without discussion
groups. There were very few descriptions of the types of activ-
ities that are necessary for higher level of learning (eg, case
study, problem solving, assessments, critiques, planning, team-
work, and projects). These are more efficiently delivered
through more complex interpersonal group interactions, struc-
tured facilitation, and iteration in collective venues such as
workshops, projects, and programs. Each training modality
(lecture, case study, simulations, and so on) should be aligned
with the level of taxonomy most appropriate for that individ-
uals role and responsibility in the disaster workplace.
More research is needed to study the effectiveness of disaster-
related training courses and education. A recent review article
on health-related disaster training found only 36 scientific
studies in the prior 35 years that assess the methods and quality
of disaster education courses.18
Possible Solutions
There is a need to create a comprehensive strategy and stand-
ardize the educational approach across many levels. To start, a
standard curriculum content focused on (evidence-based) core
competencies should be developed. From that standard con-
tent allows for targeting learning according to actual task
analysis and helps prioritize the scarce time resources for the
busy professional who will benefit most from these courses.
There is also a need to define tiered levels of learning for cur-
riculum content that includes progressively higher levels of
learning for some managerial and technical components of
the curriculum content. Blooms taxonomy can be useful to
define measurable stages of competencies that can then be
achieved through step-wise training. Use of a standard tax-
onomy to define measurable stages of competencies will allow
for a measurable progression through step-wise learning. Each
modality (lecture, case study, simulations, and so on) may be
then aligned with the stage most appropriate for that individ-
ual. The need for higher levels of disaster-related training, such
as experiential and simulation-based, has been well described
in the education and even disaster literature.1921
Competency-based models have become the norm in design-
ing education and training strategies and courses. Such com-
petency models have been developed for disaster managers
by FEMA22,23 and disaster health and public health profession-
als.24 Using these models ensures that educational strategies
map back to disaster preparedness and response priorities
and help standardize training to improve the professionaliza-
tion of the discipline. Authors have also suggested strategies
to facilitate their alignment to practice.25,26
FEMA has attempted to organize their disaster management
training courses by competencies and target audiences,
and has worked with universities to develop appropriate
Disaster Training Courses for Disaster Professionals
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curriculum for higher level learning (FEMA National
Preparedness, https://training.fema.gov/). FEMA offers courses
through 3 mechanisms and sites: The Center for Domestic
Preparedness in Anniston, Alabama, that offers on-site
simulation and classroom training; the EMI online training
site for state, local, and tribal emergency managers; and the
National Training and Education Division, which focuses
on first responders. The online course catalog (https://www.
firstrespondertraining.gov/frt/npccatalog) lists over 700
courses and provides the most complete descriptions to allow
learners to more easily identify appropriate training.
Similar to FEMAs efforts for disaster managers, there is a need
for a structured information and knowledge management
system to manage training for US disaster health and public
health professionals. Effective management of a functional
curriculum in the future would be dependent upon not only
standards being defined, but also measured and subsequent
interventions applied to improve quality. A structured
approach to information and knowledge management for
the community of practice should include the following
components:
1. Information Management
Archiving: hosting and organizing training content
Enterprise portals: aggregating sources of training in 1
access point
Course accreditation: according to standard criteria
Content management: hosting of libraries; subsidizing
access
2. Knowledge Management
Interactive platforms: threaded discussions, file-sharing,
mixed media
Curriculum monitoring and evaluation
Participant evaluation, certification, and credentialing
Data derived from the structured, internal management of this
system would also logically inform long-term monitoring and
evaluation to include efficiency and effectiveness of the train-
ing, as well as identifying training needs and resources.
Limitations
This review was limited to publicly available online trainings
cataloged in 4 databases as available during the fall of 2017.
There may be additional disaster trainings that were missed
in this review, but these 4 national inventories specifically
exist to capture US-based courses and identified nearly 5000
courses, so that this sample may be considered representative
of the current state of US disaster training.
University and college-based courses and degrees were not
included in this study. These more structured, detailed, and
lengthy courses may better meet the higher cognitive levels
of Blooms taxonomy, but they are more difficult to access,
costlier, and thus have a much smaller audience.
There is also potential for selection bias during categorization
and assignment of learning levels, capabilities, and functions.
To mimimize this, we used a battery of 3 separate reviewers but
the limitations of the available course descriptions and learn-
ing objectives sometimes made identifying categories difficult.
Because disaster health trainings are not typically built upon
standardized capabilities or competencies, the authors used
the most widely recognized capabilities as a best practice com-
parison for subject matter content of the training topics.
CONCLUSIONS
There are a very large number of public available courses for
training disaster professionals in the United States.
Although competencies, curriculum, and content have been
described for disaster management, this is not true for health
and public health professionals seeking disaster training and
education. There are issues identified with access, content, tar-
get audience, and quality. These gaps may limit the effective-
ness of the trainings to impart an appropriate level of
knowledge, skills, and abilities that is requisite for competency
among US disaster professionals. Adapting FEMAs knowl-
edge-management model to health and public health could
be a solution for many of these issues.
About the Authors
National Center for Disaster Medicine and Public Health, Uniformed Services
University, Rockville, Maryland (Dr Kirsch, Dr Keim, Ms Strauss-Riggs);
Henry M. Jackson Foundation for the Advancement of Military Medicine,
Bethesda, Maryland (Ms. Strauss-Riggs).
Correspondence and reprint requests to Thomas Kirsch, National Center for Disaster
Medicine and Public Health, Uniformed Services University, 11300 Rockville Pike,
Suite 1000, Rockville, MD (e-mail: thomas.kirsch@usuhs.edu)
Supplementary material
To view supplementary material for this article, please visit
https://doi.org/10.1017/dmp.2019.15.
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models. Disaster Med Public Health Prep. 2013;7(1):812.
Disaster Training Courses for Disaster Professionals
Disaster Medicine and Public Health Preparedness 7
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The number of people employed in international humanitarian care is growing at a yearly rate of 6%. The demand for better coordination, accountability, and training has led to a need for standardized humanitarian training programs for providers. Training should be based on comprehensive core competencies that providers must demonstrate in addition to their skill-specific competencies. This report explores the competencies specific to humanitarian training that are practice- and application-oriented, teachable, and measurable. Competency-based, standardized programs will be used to select humanitarian workers deployed in future crises and to guide the professionalization of this discipline.
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To standardize the key building blocks of disaster health competency models (content, structure, and process), we recommend a reinterpretation of the research, development, test, and evaluation construct (RDT&E) as a novel organizing framework for creating and presenting disaster health competency models. This approach seeks to foster national alignment of disaster health competencies. For scope and completeness, model developers should consider the need and identify appropriate content in at least 4 broad areas: disaster-type domain, systems domain, clinical domain, and public health domain. The whole disaster health competency model should reflect the challenges of the disaster setting to acknowledge the realities of disaster health practice and to shape the education and workforce development flowing from the model. Additional issues for consideration are whether competency models should address response and recovery just-in-time learning and whether the concept of “daily routine doctrine” can contribute to disaster health competency models. The recommendations seek to establish a strategic reference point for disaster competency model alignment within the health workforce.(Disaster Med Public Health Preparedness. 2013;7:8-12)
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This paper discusses the possible future role of standards in assuring the quality and content of programmes for educating and training people in the fields of emergency planning and management. Principles for the establishment of standards are presented. Existing standards in the civil protection and emergency preparedness fields are reviewed. The requisites for a training standard are described. Finally, a prototype standard is presented. The paper also addresses the question of whether standards are appropriate instruments and concludes that they would help ensure comparability, quality assurance and international compatibility of training.