Article

Development of National Standardized All-Hazard Disaster Core Competencies for Acute Care Physicians, Nurses, and EMS Professionals

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Abstract

The training of medical personnel to provide care for disaster victims is a priority for the physician community, the federal government, and society as a whole. Course development for such training guided by well-accepted standardized core competencies is lacking, however. This project identified a set of core competencies and performance objectives based on the knowledge, skills, and attitudes required by the specific target audience (emergency department nurses, emergency physicians, and out-of-hospital emergency medical services personnel) to ensure they can treat the injuries and illnesses experienced by victims of disasters regardless of cause. The core competencies provide a blueprint for the development or refinement of disaster training courses. This expert consensus project, supported by a grant from the Robert Wood Johnson Foundation, incorporated an all-hazard, comprehensive emergency management approach addressing every type of disaster to minimize the effect on the public's health. An instructional systems design process was used to guide the development of audience-appropriate competencies and performance objectives. Participants, representing multiple academic and provider organizations, used a modified Delphi approach to achieve consensus on recommendations. A framework of 19 content categories (domains), 19 core competencies, and more than 90 performance objectives was developed for acute medical care personnel to address the requirements of effective all-hazards disaster response. Creating disaster curricula and training based on the core competencies and performance objectives identified in this article will ensure that acute medical care personnel are prepared to treat patients and address associated ramifications/consequences during any catastrophic event.

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... The Population, Concept, and Context (PCC) for scoping reviews was followed (26,27). The population was the health community; the concept was two or more elements of the disaster health education framework according to international standards and local context identified by five experts (1,11,23,(28)(29)(30)(31)(32); and the context included healthcare facilities, organizations, and schools of medicine, health sciences, and emergency medical services (EMS) in Saudi Arabia. ...
... A disaster health education framework for short and intermediate training in Saudi Arabia was proposed by five disaster medicine experts (1,11,23,(28)(29)(30)(31)(32). The framework was based on international disaster health education frameworks and the roles of health personnel during disaster preparedness including response (either primary roles as frontline healthcare responders or secondary roles as healthcare providers and undergraduate medical students), education level, professional type, and organization roles. ...
... For the intermediate level (professional level) the competency set has more extensive knowledge and advanced skills and is cross-referenced for each professional group (paramedics, nurses, physicians in intensive care units and operating rooms and emergency departments). At the organization-level the competency set is highly specialized and integrated (1,11,23,(28)(29)(30)(31)(32). ...
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Saudi Arabia has made extensive efforts to manage disasters using unique national approaches; however, challenges and obstacles concerning disaster health handling persist. The nation has a reactive strategy to disaster management with a need for increased involvement of health professionals in disaster management and improvement of healthcare facilities emergency preparedness including competency-based education training. Objective: A comprehensive and consistent approach of disaster education programs for short and intermediate training of health professionals involved in disaster responses in Saudi Arabia is still not evident. Therefore, it is vital to explore and map the current state of the disaster education framework in Saudi Arabia. Methods: The Joanna Briggs Institute approach for scoping reviews was used to assess research articles and preprints between January 2000 and September 2021 from Saudi Digital Library; PubMed, CINAHL, and Google Scholar. Five experts identified key aspects of the disaster education approach and eligibility criteria to facilitate identification of relevant articles. Results: Only five articles met the specified criteria and described two short and three intermediate courses on disaster health management in Saudi Arabia. All courses involved competency-specific training aimed at basic or foundational level and involved a range of activities and learning types. None had refresher courses within 12 months. Conclusion: The review highlights the obvious scarcity of short and intermediate term evidence-based disaster health programs in Saudi Arabia. Adoption of the education framework proposed by the authors based on international frameworks could improve the quality and consistency of the disaster education curriculum in Saudi Arabia.
... 14,15 Fortunately, more efforts are being taken by the Saudi Arabian authorities to improve the country's disaster preparedness. 16 In principle, all healthcare providers must be ready and well prepared in many aspects, from ensuring in-clinic provision of essential medical care that is distinct from the events of a disaster, 17 to other non-clinical tasks, such as coordination, communication, and categorizing and prioritizing cases according the availability of resources. [17][18][19] Third, formal and informal education in disaster nursing in Saudi Arabia are still not fully developed, and this might be related to the lack of educators and experts. ...
... 16 In principle, all healthcare providers must be ready and well prepared in many aspects, from ensuring in-clinic provision of essential medical care that is distinct from the events of a disaster, 17 to other non-clinical tasks, such as coordination, communication, and categorizing and prioritizing cases according the availability of resources. [17][18][19] Third, formal and informal education in disaster nursing in Saudi Arabia are still not fully developed, and this might be related to the lack of educators and experts. 1,2,[20][21][22] Fourth, disaster nursing in Saudi Arabia lacks research and valid and reliable tools and scales. ...
... Additionally, the people who are responsible for creating disaster plans and related educational courses ignore ethical considerations. 17 Therefore, it is recommended that courses be designed to teach nurses how to apply their ethical code during different disaster scenarios, especially triage, and that a national guideline be established to help nurses make appropriate decisions. This is crucial for nurses in Saudi Arabia, as it will enhance their ability to make appropriate decisions during emergency situations and add disaster-related ethical and legal content to nursing curricula. ...
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Introduction: Nurses in Saudi Arabia face several challenges in all phases of disaster nursing, such as the infancy of the specialty and a lack of education, preparedness, research, and expertise in both the clinical field and in academics. Overcoming these challenges will help both nurses and the development of the specialty itself in aspects such as policies and procedures, education, and research. Thus, the aim of this study was to explore strategies for improving disaster nursing in Saudi Arabia. Methods: A cross-sectional study with a principal component analysis (PCA) was conducted to identify the factors affecting disaster nursing in Saudi Arabia. The sample of the study was Saudi Arabian nurses, as they are first-line responders in disasters and pandemics. Results: From 800 distributed questionnaires, 569 completed questionnaires were returned, for a response rate of 71%. The findings of the PCA revealed two components that can be extracted from the data. The first is preparedness, which involves 13 items related to the actions that must be taken before a disaster occurs, with a loading range of 0.82 to 0.70. The second factor is the action taken after a disaster occurs, and there are seven items with a loading range of 0.83 to 0.73. Conclusion: For improved disaster nursing, it is essential to develop evaluation tools, create specific nursing legislation for disaster situations, provide personal protective equipment to nurses to minimize the risk of infection, and encourage nurses by appreciating their efforts to minimize their stress level during a disaster. It is also important to make sufficient supplies and equipment available to nurses during a disaster and provide them with psychological support while acknowledging the importance of contact with their families and friends.
... To ensure that healthcare providers are ready for any type of crisis (including pandemics such as COVID-19), increased effort must be made by hospital managers, disaster coordinators, decision makers, researchers, and educators to ensure that responses (including decontamination) are effective. [28][29][30] The first factor identified in this study was related to the core competencies of healthcare providers and their ability to decontaminate infected or contaminated victims with confidence. Decision makers internationally have recognized that ensuring all healthcare providers have the necessary skills is a major concern. ...
... Therefore, identifying areas for improvement is necessary in addition to helping healthcare providers understand the correct use and appropriateness of PPE. 30 There are five types of decontamination: chemical, radiation, and biological decontamination, decontamination triage, and decontaminating hazardous substances. However, some important Second, the concept of preparedness focuses on taking actions to ensure hospital and healthcare providers are ready for disasters. ...
... As summarized in the literature, some important topics in this training might include the following: removing the different types of harmful substance that might put patients and staff at risk of contamination; identifying the possible risks and harm from each substance or case; understanding the team and each person's role; knowing the supplies and equipment required for each decontamination method; and the ability to activate the plan for decontamination in addition to triaging contaminated patients when necessary. 5,8,16,19,21,28,30,31 Finally, healthcare providers also acknowledged they faced barriers to their practice, the most important being insufficient tools and checklists. This issue has been reported by nurses in previous studies in Saudi Arabia. ...
Article
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Introduction: Hospitals face various types of disasters that require either decontamination or disinfection interventions. These contaminants can be chemical, biological, radioactive, or infectious, such as COVID-19. Further, there are few studies in the literature on factors affecting decontamination in hospitals in Saudi Arabia. Methods: Approximately 157 healthcare providers (doctors, nurses, and other specialists) participated in this study. Principle component analysis was used to explore three factors in Saudi Arabia that affect the ability of healthcare providers to decontaminate appropriately. Results: Three factors were extracted: (1) having adequate skills to perform decontamination, (2) being adequately prepared for decontamination before a disaster occurs, and (3) organizational barriers to decontamination. There was a positive correlation between the skills and preparedness and a negative correlation between barriers and both skills and preparedness. Discussion: It is essential to prepare for decontamination during disasters more effectively and to ensure that all healthcare providers have the requisite skills. Moreover, barriers to decontamination must be investigated thoroughly to improve implementation.
... 10 The essential role of first responders and managerial professionals during disasters underlines the need for standardized all-hazard disaster educational programs. 11,12 As such, there have been both international and national attempts to develop educational curricula and materials for these professionals, with respect to disaster management. [11][12][13][14][15] However, while the number of disaster management educational programs continues to grow, there are no common standards upon which these programs are based. ...
... 11,12 As such, there have been both international and national attempts to develop educational curricula and materials for these professionals, with respect to disaster management. [11][12][13][14][15] However, while the number of disaster management educational programs continues to grow, there are no common standards upon which these programs are based. 4 Disaster Training Curriculum (DITAC) is a research project funded by the European Commission under the 7th Framework Program. ...
... 4 ''Management'' and leadership, as well as ''hazard and vulnerability analysis,'' are included as major components in the content of training curricula suggested by different studies. 9,12,15,29 This study confirms these findings. However, it is worrisome that ''mental health'' was at a very low level of consideration in current ETI content in the EU. ...
Article
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Introduction: Education and training are key elements of disaster management. Despite national and international educational programs in disaster management, there is no standardized curriculum available to guide the European Union (EU) member states. European-based Disaster Training Curriculum (DITAC), a multiple university-based project financially supported by the EU, is charged with developing a holistic and highly-structured curriculum and courses for responders and crisis managers at a strategic and tactical level. The purpose of this study is to qualitatively assess the prevailing preferences and characteristics of disaster management educational and training initiatives (ETIs) at a postgraduate level that currently exist in the EU countries. Methods: An Internet-based qualitative search was conducted in 2012 to identify and analyze the current training programs in disaster management. The course characteristics were evaluated for curriculum, teaching methods, modality of delivery, target groups, and funding. Results: The literature search identified 140 ETIs, the majority (78%) located in United Kingdom, France, and Germany. Master level degrees were the primary certificates granted to graduates. Face-to-face education was the most common teaching method (84%). Approximately 80% of the training initiatives offered multi-and cross-disciplinary disaster management content. A competency-based approach to curriculum content was present in 61% of the programs. Emergency responders at the tactical level were the main target group. Almost all programs were self-funded. Conclusion: Although ETIs currently exist, they are not broadly available in all 27 EU countries. Also, the curricula do not cover all key elements of disaster management in a standardized and competency-based structure. This study has identified the need to Prehospital and Disaster Medicine ORIGINAL RESEARCH https://www.cambridge.org/core/terms. https://doi.org/10.1017/S1049023X14000235 Downloaded from https://www.cambridge.org/core. Gothenburg University Library, on 09 Nov 2020 at 09:22:23, subject to the Cambridge Core terms of use, available at develop a standardized competency-based educational and training program for all European countries that will ensure the practice and policies that meet both the standards of care and the broader expectations for professionalization of the disaster and crisis workforce. Education and training initiatives for crisis management in the European Union: a web-based analysis of available programs. Prehosp Disaster Med. 2014;29(2):115-126. Introduction Both the frequency of disasters and the population affected have increased during the last century, though the number of people killed because of disasters has decreased. 1,2 In Europe, disasters have killed more than 120,000 people and have affected 33 million during the last three decades. 3 To meet the multiple health needs of populations affected by disasters a well-prepared response system is necessary. 4 Education and training are key elements of disaster preparedness. 4,5 Knowledge of response, coordination, and integration of resources with other authorities are essential for each and every organization. 6 Therefore, all professionals in different settings (eg, search and rescue, Emergency Medical Services, hospitals, fire brigades, etc) must be trained to contribute to disaster management activities and to practice standards of care with competency-based specialized knowledge and skills in critical situations. 7-9 The Hyogo Framework, a worldwide strategy in disaster risk reduction, emphasizes the transfer of knowledge and expertise to strengthen disaster preparedness for an effective response to disasters at all levels. 10 The essential role of first responders and managerial professionals during disasters underlines the need for standardized all-hazard disaster educational programs. 11,12 As such, there have been both international and national attempts to develop educational curricula and materials for these professionals , with respect to disaster management. 11-15 However, while the number of disaster management educational programs continues to grow, there are no common standards upon which these programs are based. 4 Disaster Training Curriculum (DITAC) is a research project funded by the European Commission under the 7th Framework Program. 16 Its goal is to develop a holistic and standardized training curriculum for first responders and strategic/tactical crisis managers in the 27 European Union (EU) member states. In order to best inform first responders, crisis managers, and policy makers, DITAC identified that it must begin with a comprehensive review of existing disaster medicine and management education and training assets at the postgraduate level within the EU. This paper represents the initial phase of the process to meet professional competency within all EU countries required by DITAC.
... It may be recommended that calls for volunteers, such as nursing interns and students who are willing and have experience working in a clinical setting, would be beneficial. However, nurses must have clear plans to man- age and supervise volunteers when identifying their roles and the tasks that must be accomplished [5,20]. Moreover, it might be useful to bring on board nursing experts with the ability to deal with emergencies and disastrous situations, outline the possible risks from this pandemic, and create a short-or long-term plan to modify these risks. ...
... Updating nurses with current information about COVID-19 and ensuring the availability of PPE might help reduce their fear and worries [25]. Some important suggestions highlighted in the literature that might support nurses' disaster crisis training involve identifying the causes of stress and anxiety, including other external factors such as the behaviors of people which might induce stress in nurses or other healthcare providers, identifying the short-and long-term impact of stress on nurses' lives and health, and ensuring that nurses can obtain access to psychologists and first aid [20]. ...
... Other important resources that are lacking and might place healthcare providers in a critical situation are a lack of PPE and beds in critical care [18,26]. Thus, for better strategies to improve bed capacity and space for COV-ID-19 patients and to receive as much intensive care with ventilators as possible, the medical literature recommends making good decisions during triage, deciding which patients can be moved from critical care units to make space for critical care patients and, if possible, thinking critically and creating a field hospital for the pandemic and ensure ethical issues [20,26,27]. However, the Swiss Academy of Medical Sciences [28] provides important steps for triaging patients for critical care that depend on the availability of beds and the need for admission to critical care units based on some specific criteria. ...
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COVID-19 has affected the life and health of more than 1 million people across the world. This overwhelms many countries’ healthcare systems, and, of course, affects healthcare providers such as nurses fighting on the frontlines to safeguard the lives of everyone affected. Exploring the issues that nurses face during their battle will help support them and develop protocols and plans to improve their preparedness. Thus, this integrative review will explore the issues facing nurses during their response to the COVID-19 crisis. The major issues facing nurses in this situation are the critical shortage of nurses, beds, and medical supplies, including personal protective equipment and, as reviews indicate, psychological changes and fears of infection among nursing staff. The implications of these findings might help to provide support and identify the needs of nurses in all affected countries to ensure that they can work and respond to this crisis with more confidence. Moreover, this will help enhance preparedness for pandemics and consider issues when drawing up crisis plans. The recommendation is to support the nurses, since they are a critical line of defense. Indeed, more research must be conducted in the field of pandemics regarding nursing.
... Educational needs were established on the basis of an expert opinion survey (9),round tables with CRIMEDIM and MSF eld experts, and a literature review of published competency sets for humanitarian workers (10).Since our training program targeted health workers but was meant to be extendable in the future to other sectors operating under the umbrella of humanitarian aid, four papers were selected on the basis of their cross-sectorial approach(6) and de nition of discipline-speci c competencies relevant to our audience (11)(12)(13).These competency sets served as a foundational basis for the course curriculum and were translated into 10 cross-sectorial and 1 profession-speci c competency domain for each specialty [ Table 1]. Learning objectives were phrased according to Bloom's Taxonomy. ...
... Demonstrate ability to make rm decisions during a critical event: e.g priority of transport for severely injured patients in an hostile environment. 11.Clinical considerations in the speci c eld of Anaesthesia, Pediatrics and Emergency Medicine in Low Resource Settings · Understand and apply the principles of safe anaesthesia, emergency medicine or pediatrics in low-resource settings acording to the needs and resource available. ...
... Some challenges commonly encountered in the eld (e.g., communication barriers and shortage of resources) can be easily reproduced through simulation, giving students the chance to become acquainted with similar situations, receive feedback and improve their performance with no risks to patients. At the same time, simulated scenarios allow for the evaluation of performance objectives, re ecting how students would use in the eld the competencies acquired through training (11).In their review entitled "Transfer of learning and patient outcome in simulated crisis resource management", Boet et al found that CRM simulations improve not only learners behavior in the workplace but also, and more importantly, patient outcomes (26). ...
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Background Well-prepared humanitarian workers are now more necessary than ever. Essential to the preparation process are:clearly defined learning objectives, curricula tailored to the nuances of humanitarian settings, simulation-based training, and evaluation.This paper describes a training program designed to prepare medical residents for their first field deployment with Médecins Sans Frontières and presents the results of a pilot assessment of its effectiveness. Methods The training was jointly developed by the Research Center in Emergency and Disaster Medicine-CRIMEDIM of the Università del Piemonte Orientale, Novara, Italy, and the humanitarian aid organization Médecins Sans Frontières- Italy (MSF-Italy); the following topics were covered: disaster medicine, public health, safety and security, infectious diseases, psychological support, communication, humanitarian law, leadership, and job-specific skills. It used a blended-learning approach consisting of a 3-month distance learning module; 1-week instructor-led coaching; and a field placement with MSF. We assessed its effectiveness using the first three levels of Kirkpatrick’s training evaluation model. Results Eight residents took part in the evaluation. Four were residents in emergency medicine, 3 in anesthesia, and 1 in pediatrics; 3 of them were female and the median age was 31 years. Two residents were deployed in Pakistan, 1 in Afghanistan, 1 in the Democratic Republic of Congo, 1 in Iraq, 2 in Haiti and 1 on board of the MSF Mediterranean search & rescue ship. Mean deployment time was 3 months. The average median score for the overall course was 5 (excellent). There was a significant improvement in post-test multiple choice scores (p = 0.001) and in residents’ overall performance scores (P = 0.000001). Conclusion Residents were highly satisfied with the training program and their knowledge and skills improved as a result of participation. Trial registration: This study was approved by the Institutional Ethics Committee (date 24-02-2016, study code UPO.2015.4.10)
... The importance of developing a good awareness of a situation represents a common theme of many studies. Prehospital emergency situations, which can change very fast and at any moment, frequently require the development of situation awareness, both rapidly and on-the-spot [53], while synthesizing information about one's surroundings into a big picture/model of the situation [34,43,44,47,50,54]. Reay et al. [47] highlights constructing a malleable/flexible model, determined to be continuously revised and adapted to a changing situation [59]. ...
... These decisions are primarily about medical treatment and management [40,41,44,47], using various medical equipment, devices, and drugs, and occurring mostly with high density during the on-scene treatment phase of an emergency call [41]. Moreover, there are decisions made about the management of labor and delivery [41], nursing care and support [39,40,48,53,57,58], deterioration prevention [48], extrication and transport [41,44,47], and safetyrelated decisions focused on preventing and mitigating risks of all persons involved [33,40,47,48,50,57]. ...
... Standards represent official structured methods of responding to emergency situations. They can be national, regional, and local guidelines, protocols and policies [42,57], such as diagnostic guidelines [36,48], treatment guidelines [40], advance directives [45], specific safety policies [33,44], but also ethical principles and law [33,42,50,55,57]. These standards can guide situation awareness and decisionmaking processes. ...
Article
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Background: Situation awareness and decision making, listed in non-technical skills taxonomies, are critical for effective and safe performance in high-risk professions. These cognitive skills and their behavioral markers have been studied less in emergency medical services (EMS) crew members. This paper aims to review the existing literature and identify important aspects and behavioral markers of situation awareness and decision making in EMS crew members – those who work in the role of prehospital emergency care providers – and to synthesize findings as a basis for developing a rating and training tool. Method: The search for relevant articles was conducted using electronic databases, reference lists of relevant reviews and included articles and personal collection of articles. The selection process based on the PRISMA statement yielded a total of 30 articles that met the eligibility criteria. Their findings were qualitatively synthesized using the structured approach, informed by the already known structure: situation awareness and its elements (gathering information, interpreting information, anticipating future states), decision making and its elements (generating and considering options, selecting and implementing an option, reviewing outcome/decision). Moreover, the element of maintaining standards also emerged as highly relevant for cognitive skills. Results: This review found an increased research interest in the non-technical cognitive skills of EMS crew members. The majority of included articles’ research designs were qualitative, then mixed, Delphi, and quantitative. It revealed several specifics of cognitive skills, such as EMS crew members need to holistically assess a wide range of cues and information, to make various health- and safety-related decisions and take EMS standards into account. However, there was only a limited number of observable markers of cognitive skills, such as acts and verbalizations, that could be considered as examples of good behavior. In addition, findings indicate a lack of articles focused on mass-casualty incidents and the interconnection of cognitive skills with other non-technical and medical skills. Conclusion: Further research is needed to get a more comprehensive view of behavioral markers of cognitive skills and to develop a rating and training tool to improve EMS crew members’ cognitive performance.
... The most common disaster core competencies include detection of and response to an incident, triage, understanding the use of an incident command system, isolation, surveillance and epidemiology, decontamination, communication, psychological support, care of special populations, ethics, access to resources, and documentation. [13][14][15] These competencies are essential domains for HCPs during disaster planning, preparedness, response, and recovery. [13][14][15] While great attention has been afforded to disaster core competency research, 2,9,[13][14][15][16] little is known about the evidence regarding HCPs' core competencies in man-made disasters, particularly those working in hospitals in the context of major armed conflict. ...
... [13][14][15] These competencies are essential domains for HCPs during disaster planning, preparedness, response, and recovery. [13][14][15] While great attention has been afforded to disaster core competency research, 2,9,[13][14][15][16] little is known about the evidence regarding HCPs' core competencies in man-made disasters, particularly those working in hospitals in the context of major armed conflict. This is despite the acknowledgement that competence of HCPs in this setting is of critical importance. ...
... [13][14][15] These competencies are essential domains for HCPs during disaster planning, preparedness, response, and recovery. [13][14][15] While great attention has been afforded to disaster core competency research, 2,9,[13][14][15][16] little is known about the evidence regarding HCPs' core competencies in man-made disasters, particularly those working in hospitals in the context of major armed conflict. This is despite the acknowledgement that competence of HCPs in this setting is of critical importance. ...
Article
Introduction High rates of mortality and morbidity result from disasters of all types, including armed conflicts. Overwhelming numbers of casualties with a myriad of illnesses and patterns of injuries are common in armed conflicts, leading to unpredictable workloads for hospital health care providers (HCPs). Identifying domains of hospital HCPs’ core competency for armed conflicts is essential to inform standards of care, educational requirements, and to facilitate the translation of knowledge into safe and quality care. Objective The objective of this study is to identify the common domains of core competencies among HCPs working in hospitals in armed conflict areas. Methods A scoping review was conducted using the Joanna Briggs Institute framework. The review considered primary research and peer-reviewed literature from the following databases: Ovid Medline, Ovid EmCare, Embase, and CINAHL, as well as the reference lists of articles identified for full-text review. Eligibility criteria were outlined a priori to guide the literature selection. Results Four articles met the inclusion criteria. The studies were conducted in different countries and were published from 2011 through 2017. The methods included three surveys and one Delphi study. Conclusion This review maps the scope of knowledge, skills, and attitudes required by HCPs who are practicing in hospitals in areas of major armed conflict. Incorporation of identified core competency domains can improve the future planning, education, and training, and may enhance the HCPs’ response in armed conflicts.
... Healthcare providers have significant roles in disaster management, including during the planning phase. Knowing the locations, how to activate a disaster plan within the appropriate response time, and t developments in the hospital's disaster plan will assist healthcare providers to respond rapidly and effectively to any type of disaster [11]. All healthcare providers must have adequate knowledge and skills concerning the disaster plan components [12][13][14]. ...
... All healthcare providers must have adequate knowledge and skills concerning the disaster plan components [12][13][14]. For an enhanced response, healthcare providers should understand the purpose and content of the disaster plan and be able to support it [11]. For example, the list of core competencies that healthcare providers must have to provide an effective response may include: (1) understanding the disaster plan components; (2) knowing how to respond, communicate, and formulate a new plan if the situation suddenly changes; (3) recognizing one's role in the workplace at the time of a disaster; and (4) participating in the planning to meet healthcare needs that arise during a disaster [11,15]. ...
... For an enhanced response, healthcare providers should understand the purpose and content of the disaster plan and be able to support it [11]. For example, the list of core competencies that healthcare providers must have to provide an effective response may include: (1) understanding the disaster plan components; (2) knowing how to respond, communicate, and formulate a new plan if the situation suddenly changes; (3) recognizing one's role in the workplace at the time of a disaster; and (4) participating in the planning to meet healthcare needs that arise during a disaster [11,15]. ...
Article
This study aimed to identify the necessary or essential components for inclusion in hospital disaster plans in Saudi Arabia, components that can be applied in education, planning, preparedness, and further research. The study involved a cross-sectional survey with questionnaires developed using a six-point Likert scale (1 = strongly disagree; 6 = strongly agree). Eight governmental hospitals from two cities were selected as the study's settings, and 850 questionnaires were distributed to doctors and nurses. Principal Component Analysis (PCA), using Varimax rotation with a loading of more than 0.40 for items, was used to extract the factors from the data; redundant items loaded on two or more factors were deleted. In total, 492 healthcare providers responded to the study (58% response rate). Both genders participated: 76% females and 20% males. Of the sample population, approximately 73% were nurses and 25% were physicians. After interpretation, five key factors (with a total variation of 63%) in hospital disaster plans emerged: (1) surge capacity, (2) decontamination, (3) communication, (4) safety and security, and (5) survivor support. The extracted components will inform hospital disaster preparedness and response; however, more research is needed to elaborate the needs, barriers, and enablers associated with these components.
... Besides, the role of Trauma Nurse Practitioners (TNPs) was incorporated into the general function of all Acute Care Nurse Practitioners (ACNP), so they were also required to master theoretical Knowledge and practical skills related to emergency nursing and disaster nursing (37, 38). However, compared with the core competence of emergency nurses (39-41) and disaster nurses (42)(43)(44)(45), the core competence of trauma nurses is more specialized, specializing in the service of patients with trauma and focusing on the whole process of trauma treatment (pre-hospitalin-hospital-post-discharge rehabilitation) (6,7). The core competence requirements of emergency nurses are relatively extensive, mainly serving outpatients (41). ...
... As we all know, the condition of trauma patients, especially those with severe trauma, was complex and dynamic, and nurses' decision-making which was based on the patient's dynamic condition changes, that is, critical thinking decisions, could improve the safety of trauma patients (47). Critical thinking was a very important dimension in Professor Vu's research on the core competence of Trauma nurses in Vietnam (8), and this competence was at a high level in both emergency nurses (40) and disaster nurses (44). Second, the items "Understand the learning needs of the trainee and give the standard guidance" and "Actively participate in making department plans" had higher factor loadings, which represented "Teaching-coaching ability" and "leadership", respectively. ...
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Background Trauma, especially severe trauma, has become a significant public health problem worldwide. This postulates higher requirements on the core competence of trauma nurses. However, limited scales exist to assess it validly and reliably. This study aims to develop and evaluate the psychometric properties of the Trauma Nurse Core Competency Scale (TNCCS). Methods This study included three stages. First, scale development was based on a broad literature review and two rounds of Delphi expert consultation. Then, a pre-investigation was conducted with 106 trauma nurses, and a formal scale was formed. Finally, scale evaluation of reliability and validity, based on a cross-sectional study, was tested with 1,107 trauma nurses. Content validity and structure validity were used to evaluate the validity of TNCCS. The Cronbach's α coefficient and the split-half reliability coefficient were used to evaluate the reliability of TNCCS. Results The final scale contained 46 items under three dimensions, which were Knowledge and skills (21 items), Comprehensive literacy (20 items), and Professionalism & physical and mental health (5 items). The Content Validity Index (CVI) of the total scale was 0.980. The goodness-of-fit indices (χ ² /df = 3.547, RMSEA = 0.065, GFI = 0.929, CFI = 0.912, NFI = 0.904, IFI = 0.929) signified a good fit for this model. The Construct Reliability (CR) ranged from 0.89 to 0.98, and the Average Variance Extracted (AVE) ranged from 0.62 to 0.69. The Cronbach's α coefficient of the scale was 0.99, ranging from 0.90 to 0.98 for the subscales. The split-half reliability coefficient was 0.84. Conclusions The TNCCS demonstrated good validity and reliability, and it could be used to assess the core competency of trauma nurses. The present study has valuable implications for nursing managers to take corresponding measures to train and improve the core competence of trauma nurses.
... The core competencies set for CBRN threats, including mass chemical exposure education, were identified after a comprehensive literature review. Four domains were determined according to participants' roles and tasks and six levels of proficiency (Bloom's Education Taxonomy) were used to establish the core competencies and sub-competencies for the foundation level in major chemical incidents (see Table A1 in Additional Materials file 1) [27,[38][39][40][41]. ...
... This is likely due to the fact that the course was set at a foundation level (basic knowledge and skills for all healthcare providers in different professions) for healthcare providers, based on World Association for Disaster and Emergency Medicine (WADEM) and other international education frameworks. However, the literature confirms that the quality of care and assistance delivered during a disaster improves with inter-professional education [14,27,32,35,38,42,43]. ...
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Background Mass chemical exposure emergencies are infrequent but can cause injury, illness, or loss of life for large numbers of victims. These emergencies can stretch and challenge the available resources of healthcare systems within the community. Political unrest in the Middle East, including chemical terrorist attacks against civilians in Syria and increasing chemical industry accidents, have highlighted the lack of hospital preparedness for chemical incidents in the region. This study aimed to evaluate the effectiveness of a course designed to empower frontline healthcare providers involved in mass casualty incidents with the basic knowledge and essential operational skills for mass chemical exposure incidents in Saudi Arabia. Methods A mixed-methods approach was used to develop a blended learning, simulation enhanced, competency-based course for major chemical incidents for front line healthcare providers. The course was designed by experts from different disciplines (disaster medicine, poisoning / toxicology, and Hazard Material Threat - HAZMAT team) in four stages. The course was piloted over five days at the Officers Club of the Ministry of Interior (Riyadh, Saudi Arabia). The 41 participants were from different government health discipline sectors in the country. Pre- and post-tests were used to assess learner knowledge while debriefing sessions after the decontamination triage session and simulation-enhanced exercises were used for team performance assessment. Results The overall knowledge scores were significantly higher in the post-test (69.47%) than the pre-test (46.3%). All four knowledge domains also had significant differences between pre- and post-test results. There were no differences in the pre and post-test scores for healthcare providers from the different health disciplines. A one-year post-event survey demonstrated that participants were satisfied with their knowledge retention. Interestingly, 38.3% had the opportunity to put this knowledge into practice in relation to mass chemical exposure incidents. Conclusion Delivering a foundation level competency-based blended learning course with enhanced simulation training in major chemical incidents for front line healthcare providers may improve their knowledge and skills in response to such incidents. This in turn can improve the level of national preparedness and staff availability and make a crucial difference in reducing the health impacts among victims.
... Therefore, education and training are key to enhancing nurses' planning, preparedness, response, and recovery when disasters strike. Despite the fact that disaster nursing is a new specialty around the world, educational trends are visible in many countries, as there have been increasing efforts to develop core competencies related to disaster nursing, to develop the content of formal education curricula, and to identify additional education and training needs (1)(2)(3)(4)(5). ...
... Additionally, the International Council of Nurses (ICN) has emphasized how vital it is that nurses be educated, prepared, and competent in dealing with disasters in order to assist individuals, communities, and families (2). Further, nurses must be competent in clinical work, managing surge capacity, following an activation plan, managing volunteers, decontaminating patients, and performing evacuations (4,5). These competencies have been identi ed by scholars as gaps in the current knowledge and skill of nurses; as such, the related learning outcomes and curricula must be improved, with speci c objectives for each of these core competencies added (4). ...
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Background: : An important aspect of disaster preparedness for nurses is that they be ready to respond with a high level of competence. This scoping review aimed to identify current issues related to the education and training of disaster nurses in Saudi Arabia. Methods: This scoping review was conducted using the Joanna Briggs Institute (JBI) methodology. The search involved several different databases in the Saudi Digital Library (SDL), including CINAHL, Science Direct, Scopus, Wiley, and the Education Resources Information Center (ERIC). The search keywords were “disaster,” “nursing,” “education,” “training,” “knowledge,” and “preparedness.” In addition, specific inclusion and exclusion criteria were applied to narrow down the search to only relevant articles. Results: Several gaps in the education of disaster nurses were found in the review, which can be summarized in five different domains: insufficient simulations and drills, inadequate education programs, a lack of formal education, difficulty following guidelines, and difficulty accessing up-to-date educational resources. Conclusion: It is imperative that the highlighted issues related to disaster nursing education in Saudi Arabia be addressed to further develop the educational system in this regard. Future research should aim to determine how to address these issues to enhance the performance of nurses during disaster situations.
... However, this study identified that the nurses were responsible for updating their knowledge to manage patients with COVID-19. During crises, updating their knowledge is essential because it enhances clinical detection, adapting treatment, and discussing implications with patients, especially children, pregnant women, and chronically ill patients (33)(34)(35) . However, this results of this study indicated that there was no unified source for emergency nurses to acquire updated information. ...
... Thus, nurses must be kept up to date with the knowledge needed to enhance their competencies according to approved protocols. If protocols and guidelines are lacking, nurses must use critical thinking and develop plans according to the needs of their patients (35)(36)(37) . ...
Article
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Emergency nurses are in the frontline in managing COVID-19 crises. Directly encountering and dealing with infected patients put nurses at high risk. To date, evidence about emergency nurses’ experiences of COVID-19, particularly those in the frontline, are limited. Understanding the experience and impact of the COVID-19 crisis on emergency nurses could contribute to improving nursing and disaster practices. This study aimed to explore the experiences of emergency nurses during their responses to the COVID-19 crisis. Thus, A cross-sectional design was used. For the data collection, a questionnaire was constructed and its validity and reliability was rigorously evaluated by principle component analysis (PCA), exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). The data were collected in two phases, in which 111 and 128 emergency nurses were recruited from different hospitals in Saudi Arabia. The primary purpose of PCA; EFA and CFA to delete weak loading and extract and confirm factors. The findings of using factor analysis, of the 22 items, 11 items were retained with strong factor loadings (0.88 to 0.54) to three factors. The three factors were worry (4 items), compliance (4 items), and cautiousness (3 items). The reliability of the three factors was 0.84, 0.86, and 0.73, respectively, indicating that the scale had good reliability. The 11 scale items had robust psychometric properties, which implies that they could be used to evaluate emergency nurses’ experience in encountering and dealing with the COVID-19 crisis. Although nurses in the frontline showed compliance with infection control prevention measures, they were likely to experience certain degrees of fear and worry, which could lead to burnout. Hence, it is highly recommended to help nurses overcome such crises by providing consistent support and reassurance. Keywords: mmergency nursing; COVID-19; crisis; nursing care and experiences
... Educational needs were established on the basis of an expert opinion survey [9], round tables with CRIMEDIM and MSF field experts, and a literature review of published competency sets for humanitarian workers [10]. Since our training program targeted health workers but was meant to be extendable in the future to other sectors operating under the umbrella of humanitarian aid, four manuscripts were selected on the basis of their cross-sectorial approach [6] and definition of disciplinespecific competencies relevant to our audience [11][12][13]. These competency sets served as a foundational basis for the course curriculum and were translated into 10 cross-sectorial and 1 profession-specific competency domain for each specialty [ Table 1]. ...
... Some challenges commonly encountered in the field (e.g., communication barriers and shortage of resources) can be easily reproduced through simulation, giving students the chance to become acquainted with similar situations, receive feedback and improve their performance with no risks to patients. At the same time, simulated scenarios allow for the evaluation of performance objectives, reflecting how students would use in the field the competencies acquired through training [11]. In their review entitled "Transfer of learning and patient outcome in simulated crisis resource management", Boet et al. found that CRM simulations improve not only learners behavior in the workplace but also, and more importantly, patient outcomes [26]. ...
Article
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Background: Well-prepared humanitarian workers are now more necessary than ever. Essential to the preparation process are: clearly defined learning objectives, curricula tailored to the nuances of humanitarian settings, simulation-based training, and evaluation. This manuscript describes a training program designed to prepare medical residents for their first field deployment with Médecins Sans Frontières and presents the results of a pilot assessment of its effectiveness. Methods: The training was jointly developed by the Research Center in Emergency and Disaster Medicine- CRIMEDIM of the Università del Piemonte Orientale, Novara, Italy, and the humanitarian aid organization Médecins Sans Frontières- Italy (MSF-Italy); the following topics were covered: disaster medicine, public health, safety and security, infectious diseases, psychological support, communication, humanitarian law, leadership, and job-specific skills. It used a blended-learning approach consisting of a 3-month distance learning module; 1-week instructor-led coaching; and a field placement with MSF. We assessed its effectiveness using the first three levels of Kirkpatrick's training evaluation model. Results: Eight residents took part in the evaluation. Four were residents in emergency medicine, 3 in anesthesia, and 1 in pediatrics; 3 of them were female and the median age was 31 years. Two residents were deployed in Pakistan, 1 in Afghanistan, 1 in the Democratic Republic of Congo, 1 in Iraq, 2 in Haiti and 1 on board of the MSF Mediterranean search & rescue ship. Mean deployment time was 3 months. The average median score for the overall course was 5 (excellent). There was a significant improvement in post-test multiple choice scores (p = 0.001) and in residents' overall performance scores (P = 0.000001). Conclusion: Residents were highly satisfied with the training program and their knowledge and skills improved as a result of participation. Trial registration: This study was approved by the Institutional Ethics Committee (date 24-02-2016, study code UPO.2015.4.10).
... triage, burn treatment, and management of noncommunicable diseases in newborns), but their needs also lie in the field of interprofessional skills (e.g. communication, resource management or public health interventions) [22,36,41,42]. Examples of promising training programmes for humanitarian health workers have been presented and can be built upon to develop future disaster preparedness curricula [43][44][45][46]. ...
Article
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Background Humanitarian healthcare workers are indispensable for treating weapon-wounded patients in armed conflict, and the international humanitarian community should ensure adequate preparedness for this task. This study aims to assess deployed humanitarian healthcare workers’ self-perceived preparedness, training requirements and mental support needs. Methods Medical professionals deployed with the International Committee of the Red Cross (ICRC) between October 2018 and June 2020 were invited to participate in this longitudinal questionnaire. Two separate questionnaires were conducted pre- and post-deployment to assess respondents’ self-perceived preparedness, preparation efforts, deployment experiences and deployment influence on personal and professional development. Results Response rates for the pre- and post-deployment questionnaires were 52.5% (114/217) and 26.7% (58/217), respectively. Eighty-five respondents (85/114; 74.6%) reported feeling sufficiently prepared to treat adult trauma patients, reflected by predeployment ratings of 3 or higher on a scale from 1 (low) to 5 (high). Significantly lower ratings were found among nurses compared to physicians. Work experience in a high-volume trauma centre before deployment was associated with a greater feeling of preparedness (mean rank 46.98 vs. 36.89; p = 0.045). Topics most frequently requested to be included in future training were neurosurgery, maxillofacial surgery, reconstructive surgery, ultrasound, tropical diseases, triage, burns and newborn noncommunicable disease management. Moreover, 51.7% (30/58) of the respondents regarded the availability of a mental health professional during deployment as helpful to deal with stress. Conclusion Overall, deployed ICRC medical personnel felt sufficiently prepared for their missions, although nurses reported lower preparedness levels than physicians. Recommendations were made concerning topics to be covered in future training and additional preparation strategies to gain relevant clinical experience. Future preparatory efforts should focus on all medical professions, and their training needs should be continuously monitored to ensure the alignment of preparation strategies with preparation needs.
... Many studies have been done in this field internationally. These studies have been done in different places and by groups of acute care medical professionals, such as emergency department (ED) nurses, emergency physicians, out-of-hospital emergency medical service (EMS) personnel, medical residents and nursing, medical and EMS students (Brinjee et al., 2021;Mani et al., 2020;Schultz et al., 2012). Also, a recent scoping review investigated the challenges for nurses in disaster management. ...
Article
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Aim: With the rise in frequency and severity of disasters in recent decades, it is essentially important that nurses must be adequately prepared to handle them. This study was aimed to evaluate the levels of disaster core competencies and preparedness of nurses in the emergency department. Design: A cross-sectional survey design was used. Methods: This cross-sectional research was conducted from August 2020 to December 2020 among 271 nurses in the emergency departments of six hospitals in Qazvin, Iran. The participants completed the "Nurses Perceptions of Disaster Core Competencies Scale" (NPDCC) (45 items) and the disaster preparedness (a single-item visual scale). Data were analysed by one-way analysis of variance, independent t-tests and multiple linear regression analysis. Results: The mean scores of disaster preparedness and core competencies of nurses were 6.75 out of 10 (SD = 1.63) and 2.88 out of 5 (SD = 0.80), respectively. "Technical skills" (mean = 3.24, SD = 0.91) were the highest and "communication skills" (mean = 2.57, SD = 0.95) were the lowest across the subscales of the scale. A significant association was found between disaster core competencies and preparedness of nurses (p < .001). Regression analysis results indicated that nursing disaster core competencies were perceived betted by older nurses (B = -0.405) who had experience in the disaster stage (B = 0.228) and nurses with disaster response experience (B = 0.223) and lower professional experience (B = 0.309). Nurses with a postdiploma degree (B = -0.480) and bachelor's degree (B = -0.416) were perceived to have lower disaster core competency than nurses with a master's or PhD degree. Conclusion: There are still gaps in disaster preparedness and core competencies for emergency nurses that need to be addressed. Nursing managers must support an improvement in nursing disaster core competencies. This may be done by conducting sessions for routine disaster scenarios and providing formal disaster preparedness training.
... Understanding the disaster core competencies will enable nurses to work more efficiently during these catastrophic events. 14 The World Health Organization (WHO) in 2005 advised all health sectors to improve medical professionals' disaster response knowledge and skills to reduce risks and enhance emergency preparedness and response. It also prioritized the development of combined emergency preparedness plans and prospective planning under the current coordination mechanism, with regular updating of methodologies and planning for training and simulations. ...
Article
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Introduction: Nursing is considered the healthcare profession with the most members. Emergency nurses constitute the first line of treatment in healthcare facilities when catastrophic events bring disaster victims in need of medical attention. Therefore, these nurses must be well educated and trained efficiently to be able to deal with disastrous situations properly. This study aimed to distinguish the most important elements of education and training for preparing emergency nurses to face disasters in the Kingdom of Saudi Arabia (KSA), specifically, the city of Taif. Methods: This study employed a tool to measure nurses' most important training and education needs that was created by the authors based on a literature review and was approved by an expert panel in disaster nursing. Questionnaires were distributed to emergency nurses in four hospitals run by the Ministry of Health in Taif city. Survey responses were received from 210 participants, and the data were analyzed using a principal component analysis (PCA). A one-way ANOVA was used to determine the differences between groups according to their experiences. Results: The following three factors were extracted from the data after redundant items were loaded and excluded: incident management systems (IMSs), disaster triage, and disaster drills. Nurses with less than three years of experience have a significant need to learn about these elements in order to be able to cope with disasters. Conclusion: Understanding different types of disasters and how to deal with these catastrophic events is crucial. Significant differences existed between ED nurses in their understanding of the basic elements of disaster management based on their level of experience in an ED. Therefore, disaster education must be included in nursing curricula, and more training courses, mock drills, and simulations must be conducted in hospitals for nurses, especially nurses with less experience, so they can learn to manage their responsibilities during disasters.
... 14). Nurses who work, or have worked, in emergency rooms interact with prehospital emergency medical services providers, with whom they have a degree of familiarity (Schultz, Koenig, Whiteside, & Murray, 2012). According to Coyle and Harrison (2015), improving "population health" is essential to prehospital EMS systems and to "local policymakers" (p. 1). ...
Experiment Findings
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The study’s overarching research question is: how do the attitudes of EMS stakeholders in Barbados align with the attributes of the EMS Agenda for the Future? There were eight specific research questions, seven of which focused on quantitative data collection and one qualitative question.
... Meeting nurses training needs and developing strategic guidelines in the realm of spiritual care becomes urgent in light of disasters and emergencies being on the rise worldwide (Chapman & Arbon, 2008;International Federation of Red Cross & Red Crescent Societies, 2018). International institutes urge governments to strengthen strategies for disaster reduction with concrete management plans (ISDR, 2007;WHO, 2019), which include disaster preparedness training of all healthcare professionals (Achora & Kamanyire, 2016;Schultz et al., 2012). Nurses represent an indispensable workforce during disasters (Magnaye et al., 2011), and preparedness for adequate response is crucial (International Council of Nurses & World Health Organization, 2011). ...
Article
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Spiritual support is a key element of holistic care, and better healthcare professionals training and stronger strategic guidelines become urgent in light of health disasters and emergencies, such as the COVID-19 pandemic. To this end, the aim of this study was to explore spiritual support provision within mass and social media and the websites of spiritual leaders, institutions and NHS chaplaincy units during COVID-19 in England, between March and May 2020. A scoping review design informed by Levac and colleagues’ five-staged framework was adopted, and adapted with a multi-strategy search to scope the different domains of online sources. Results revealed that spiritual support for dying patients, their families, health care staff, spiritual leaders and chaplains, had to be drastically reduced, both in quality and quantity, as well as being provided via different technological devices or domestic symbolic actions. No mention was found of a central strategy for the provision of spiritual support. This study points to the importance of developing centralized strategies to prepare healthcare systems and professionals in relation to spiritual support provision, both routinely and during health disasters and emergencies. Further research will have to explore innovative practices, in particular the role of digital technologies, in spiritual support provision.
... Many education and training programs have been developed by a wide range of institutions and organizations to prepare nurses to respond to disasters, however, the competencies were neither consistent nor evidenced-based until 2009 [8], when the International Council of Nurses' established its Framework of Disaster Nursing Competencies [2]. This framework was followed by the development of national standardized "all-hazard" disaster core competencies for all other healthcare workers in the United States [9]. ...
... 21 In addition, as emphasized by Alpert et al, 18 nurses might face ethical challenges when they have a large influx of patients during a disaster response and limited resources. Some performance objectives for healthcare providers, including nurses, which were identified by Schultz et al, 32 include listing ethical principles related to the emergency or disaster, being familiar with approaches for allocating resources during a disaster response, and being able to deal with an ethical dilemma. It is recommended that ethical issues be included in the disaster education priorities at the undergraduate and master's degree levels. ...
Article
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To reduce the impact of disasters, healthcare providers, especially nurses, need to be prepared to respond immediately. However, nurses face several challenges in all phases of disaster management. The findings of a literature review based on scoping approaches, which utilized the Joanna Briggs Institute methodology, indicated that the major barriers facing nurses include the following: (1) disaster nursing is a new specialty; (2) inadequate level of preparedness; (3) poor formal education; (4) lack of research; (5) ethical and legal issues; and (6) issues related to nurses' roles in disasters. Educators, researchers, and stakeholders need to make efforts to tackle these issues and improve disaster nursing.
... There is a need for more and improved disaster management training for healthcare professionals (12). Globally, gaps (13) and barriers (14) in the provision of disaster training for healthcare professionals exist and in Cambodia, little is known about the current challenges faced by healthcare professionals when working during floods or the gaps and barriers that exist in providing flood management training. ...
Article
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Introduction Floods are the most common type of natural disaster worldwide and are projected to become more frequent and more extreme. Cambodia is prone to annual, seasonal flooding. Floods impact health in many ways and can disrupt the health system through destruction of infrastructure and loss or diversion of human, economic and physical resources. Through knowledge acquisition and skills development, training of healthcare professionals can lead to a more effective flood response. Globally, there is a need for more and improved disaster management training for healthcare professionals. Little is known about the current challenges faced by healthcare professionals when working during floods or the gaps and barriers that exist in providing flood management training in Cambodia. This pilot study sought to describe the challenges faced by healthcare professionals and increase understanding of flood management from the perspectives of key training stakeholders in Cambodia. Methods Two qualitative methods were used; rapid assessment methodologies during a national workshop attended by 44 health professionals and semi-structured interviews with six key training stakeholders. Data from the workshop was analysed descriptively and thematic content analysis was used for the interviews. Results The challenges when working during a flood include a lack of physical and human resources. Challenges are mainly operational, relating to planning, preparation and resource use, and communication between healthcare professionals. Gaps in current flood management training include teaching non-technical skills and providing sustainable training. Barriers include a lack of resources and competing interests from external funders and stakeholders. Conclusions The findings of this study offer better understanding into flood management and may help to inform future disaster management curriculums inside and outside of Cambodia. Recommendations for future flood management training in Cambodia include increasing the number and capacity of trainers, harmonizing the involvement of all those involved in training provision and recognising the potential implications of external funders. Recommendations for further research include understanding how informal knowledge sharing processes can contribute to flood management training, particularly in a resource stretched setting, and how best to incorporate essential non-technical skills into training.
... Because of their numbers and distribution, nurses are the largest group in the healthcare domain who face MIDs, and their knowledge and level of preparedness play a crucial role in the pre-, peri-, and post-MID periods [5]. In previous studies, about 80% of Philippine nurses were found to be neither fully prepared nor knowledgeable about disaster preparedness and response, and they lacked an awareness of existing management protocols [6]. ...
Article
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This study aims to assess the readiness of emergency nurses in Southern part of Saudi Arabia in management of public health emergencies, major incidents and disasters, and their need in further educational initiatives, by using quantitative research through a self-reporting validated questionnaire. Although most of the nurses in this study reported knowledge and familiarity with all questionnaire’s elements, it should be kept in mind that disasters are still rare and the opportunity of being actively involved in a real event is limited for a single healthcare worker. Consequently, there may be a few occasions when healthcare staff can really evaluate their knowledge, skills and abilities. Simulation exercises may not only offer a chance to examine these abilities, but also enable healthcare professionals to practice their knowledge and skills in an environment with no harm or concern to patients
... The competencies in the context of preparedness are constantly being developed in higher education fields (e.g. see Markenson et al., 2006, Schultz et al., 2012, Smith et al., 2013 in public health professions; King et al., 2015 in psychiatry;Ng, 2012, Maripe & Sinkamaba, 2014Kaslow, 2004 in psychology;Uhernik, 1998 in counseling). This is understandable because most of these professions serve as the forefronts in disasters, emergencies, and diseases. ...
Article
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The Coronavirus Disease 2019 (COVID-19) has caused an extraordinary crisis that affects educational systems. This editorial letter calls for the development of preparedness competencies as part of the basic education science curriculum. It discusses the background from which the current call is hinged, contemporary place of preparedness competencies in the basic education science curriculum, and possible actions for curriculum development. This call hopes to open windows of opportunity for the consideration of preparedness competencies as part of the basic education science curriculum.
... This piece is often overlooked, but is essential. 24 The Federal Emergency Management Agency and other organizations provide resources for hospitals and communities to navigate this unfamiliar territory. 25 Keys to recovery planning include many of the same principles used in planning for the actual disaster. ...
Article
Disasters, including infectious disease outbreaks, are inevitable. Hospitals need to plan in advance to ensure that their systems can adapt to a rapidly changing environment if necessary. This review provides an overview of ten general principles that hospitals and healthcare systems should consider when developing disaster plans. The principles are consistent with an “all-hazards” approach to disaster mitigation. This approach is adapted to planning for a multiplicity of threats, but emphasizes highly relevant scenarios, such as the COVID-19 pandemic. We also describe specific ways these principles helped prepare our hospital for this pandemic. Key points include acting quickly, identifying and engaging key stakeholders early, providing accurate information, prioritizing employee safety and mental health, promoting a fully integrated clinical response, developing surge plans, preparing for ethical dilemmas, and having a cogent exit strategy for post disaster recovery.
... Without this proactive planning, resource management will be chaotic and inequitable as we have seen with There are a variety of recommendations for specific topics available, such as disaster training for healthcare professionals [3] and allocation of critical care resources [2,4]. These documents are realistic and frank about the change in level and type of care provided due to disaster limitations. ...
Article
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Objective To locate and analyze U.S. State Crisis Standards of Care (CSC) documents to determine their prevalence and quality. Methods Following PRISMA guidelines, Google search for “allocation of scarce resources” and “crisis standards of care (CSC)” for each state. We analyzed the plans based on the 2009 Institute of Medicine (IOM) Report which provided guidance for establishing CSC for use in disaster situations, as well as the 2014 CHEST consensus statement’s 11 core topic areas. Results The search yielded 42 state documents and we excluded 11 that were not CSC plans. Of the 31 included plans, 13 plans were written for an “All Hazards” approach, while 18 were pandemic influenza specific. 18 had strong ethical grounding. 21 plans had integrated and ongoing community and provider engagement, education, and communication. 22 had assurances regarding legal authority and environment. 16 plans had clear indicators, triggers, and lines of responsibility. Finally, 28 had evidence-based clinical processes and operations. Conclusion Five plans contained all 5 IOM elements: Arizona, Colorado, Minnesota, Nevada, and Vermont. Colorado and Minnesota have “All Hazards” documents and processes for both Adult and Pediatric populations and could be considered exemplars for other states.
... The most recent comprehensive competency set applicable specifically to medical professionals was developed in 2012 by the Emergency Medicine Foundation and funded by the Robert Wood Johnson Foundation (Schultz, Koenig, Whiteside, & Murray, 2012 Crisis standards of care are defined as a marked deviation for the normal operations of a healthcare facility during a disaster aimed at maximizing the number of lives saved and conservation of limited resources (Hick, Hanfling, & Cantrill, 2012). During a crisis, healthcare providers may practice outside their scope of practice, use clinical judgement rather than laboratory/radiologic data to guide diagnosis, and utilize abbreviated documentation (Koenig, Lim, & Tsai, 2011). ...
Thesis
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Emergency preparedness among rural healthcare providers
... Therefore, nurses hold the key in disaster response where the resource balance has been disrupted (Schultz et al., 2012;Seyedin, Abbasi Dolatabadi, & Rajabifard, 2015;Yin et al., 2011). There are programs developed focusing on disaster response, but most of the programs target audiences that are dispatched to go into the field or the disaster site. ...
Article
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Aim: To develop a multimodality simulation program for hospital nurses to enhance their disaster competency and evaluate the effect of the program. Methods: The program implementation started in October 2016 and ended in December 2016. It was developed using the ADDIE model (analysis, design, development, implementation, and evaluation). Evaluation consisted of formative assessment and summative assessment. Formative assessment was performed during triage, crisis management, and problem-solving simulation programs through direct feedback and debriefing from the teacher. Summative assessment was performed using the Kirkpatrick curriculum evaluation framework. Results: Needs assessment using the modified Delphi survey resulted in these competencies for hospital disaster nursing: triage, incident command, surge capacity, life-saving procedures, and special situations. Each competency was matched with the appropriate simulation modalities. A total of 40 emergency nurses participated in the study program. The evaluation of the program resulted in improvement in perception, crisis management, problem solving, and technical skills in disaster nursing. Conclusion: Multimodality simulation training program was developed to enhance the competency of hospital nurses in disaster response. All participants improved their disaster response competencies significantly. The program that was developed in this study could be used as a fundamental tool in future research in disaster curriculum development.
... Research suggests that healthcare managers need to integrate training programs into disaster management to improve the knowledge and practice of nurses (7). Several studies have shown that most nurses lack the knowledge required for preparedness in disasters, and only a few can adequately respond to these events (8). The present study was therefore conducted to evaluate the level of knowledge, attitude and performance associated with preparedness for disasters in Iranian nurses. ...
Article
Context: Nurses are the largest group of health service providers with a vital role in assisting victims during disasters. They must be therefore appropriately prepared to respond to health requirements in these situations. Evidence acquisition: Three articles were ultimately extracted from a comprehensive search conducted in the present systematic review and meta-analysis in Google Scholar, SID, Magiran, Scopus, PubMed and Web of Science using English keywords and their Persian equivalents. The I2 index was used to evaluate the heterogeneity between the studies, and the analyses were performed in STATA 14. Results: This review was conducted on 586 nurses working in hospitals. The final meta-analysis included three articles. The matched mean scores of knowledge, attitude and performance concerning disaster preparedness were respectively found to be 43.49 (95% CI: 37.67-49.31, P=0.581, I2=0.0%), 68.81 (95% CI: 63.04-70.58, p=0.913, I2=0.0%) and 56.19 (95% CI: 53.95-58.42, P=0.001, I2=86.2%). Conclusion: The present findings suggested moderate levels of knowledge and performance and good attitudes associated with preparedness in disasters in the Iranian nurses. These parameters can be therefore improved to desirable levels and the overall preparedness for coping with disasters boosted in nurses by training nurses and performing hospital drills.
... 19 Costeffectiveness is a critical factor for widespread dissemination of PDT training, especially considering previous efforts to establish a national paediatric disaster curriculum have had limited success. 20 Little is known about the costeffectiveness of the educational video game setting versus live simulations. [21][22][23] We developed a video game for disaster triage training, 60 s to Survival (60S). ...
Article
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Introduction Disaster triage training for emergency medical service (EMS) providers is unstandardised. We hypothesised that disaster triage training with the paediatric disaster triage (PDT) video game ‘60 s to Survival’ would be a cost-effective alternative to live simulation-based PDT training. Methods We synthesised data for a cost-effectiveness analysis from two previous studies. The video game data were from the intervention arm of a randomised controlled trial that compared triage accuracy in a live simulation scenario of exposed vs unexposed groups to the video game. The live simulation and feedback data were from a prospective cohort study evaluating live simulation and feedback for improving disaster triage skills. Postintervention scores of triage accuracy were measured for participants via live simulations and compared between both groups. Cost-effectiveness between the live simulation and video game groups was assessed using (1) A net benefit regression model at various willingness-to-pay (WTP) values. (2) A cost-effectiveness acceptability curve (CEAC). Results The total cost for the live simulation and feedback training programme was $81 313.50 and the cost for the video game was $67 822. Incremental net benefit values at various WTP values revealed positive incremental net benefit values, indicating that the video game is more cost-effective compared with live simulation and feedback. Moreover, the CEAC revealed a high probability (>0.6) at various WTP values that the video game is more cost-effective. Conclusions A video game-based simulation disaster triage training programme was more cost-effective than a live simulation and feedback-based programme. Video game-based training could be a simple, scalable and sustainable solution to training EMS providers.
... Research suggests that healthcare managers need to integrate training programs into disaster management to improve the knowledge and practice of nurses (7). Several studies have shown that most nurses lack the knowledge required for preparedness in disasters, and only a few can adequately respond to these events (8). The present study was therefore conducted to evaluate the level of knowledge, attitude and performance associated with preparedness for disasters in Iranian nurses. ...
... In a study published in 2012, a consensus document addressed the need for basic educational competencies in DM across all fields, and produced a list of core competencies for medical personnel. 4 Despite this growing political and educational interest in DM, there is no indication that these educational goals are currently being met in the field of EM. ...
Article
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Objectives Disaster Medicine (DM) education for Emergency Medicine (EM) residents is highly variable due to time constraints, competing priorities, and program expertise. The investigators’ aim was to define and prioritize DM core competencies for EM residency programs through consensus opinion of experts and EM professional organization representatives. Methods Investigators utilized a modified Delphi methodology to generate a recommended, prioritized core curriculum of 40 DM educational topics for EM residencies. Results The DM topics recommended and outlined for inclusion in EM residency training included: patient triage in disasters, surge capacity, introduction to disaster nomenclature, blast injuries, hospital disaster mitigation, preparedness, planning and response, hospital response to chemical mass-casualty incident (MCI), decontamination indications and issues, trauma MCI, disaster exercises and training, biological agents, personal protective equipment, and hospital response to radiation MCI. Conclusions This expert-consensus-driven, prioritized ranking of DM topics may serve as the core curriculum for US EM residency programs.
Chapter
As societies become more complex and interconnected, the global risk for catastrophic disasters is increasing. Demand for expertise to mitigate the human suffering and damage these events cause is also high. A new field of disaster medicine is emerging, offering innovative approaches to optimize disaster management. Much of the information needed to create the foundation for this growing specialty is not objectively described or is scattered among multiple different sources. This definitive work brings together a coherent and comprehensive collection of scientific observations and evidence-based recommendations with expert contributors from around the globe. This book identifies essential subject matter, clarifies nomenclature, and outlines necessary areas of proficiency for healthcare professionals handling mass casualty crises. It also describes in-depth strategies for the rapid diagnosis and treatment of victims suffering from blast injuries or exposure to chemical, biological, and radiological agents.
Article
Background In Taiwan, 50 % of the chemical disasters in the last decade were industrial accidents. The leakage of industrial toxic chemical substances may cause significant environmental pollution and harms. Taiwan's chemical disaster education and training mainly rely on simulation, which is labor-intensive, time-consuming, and costly. Tabletop drills are often used to as a substitute for simulations. However, tabletop drills lack a realistic presence. The 360° virtual reality (VR) transforms knowledge of disaster preparedness into audio-visual and other sensory experiences and allows participants to be physically immersed in an environment. Purpose This study examined effectiveness of a “360° VR chemical disaster training program” on disaster preparedness and self-efficacy in ER nurses. Method This study used convenience sampling and quasi-experimental design with two-group repeated measures. Seventy-seven ER nurses were recruited with the experimental group (n = 32) receiving chemical disaster training through 360° VR and the control group (n = 35) receiving training through tabletop drills. Data were collected before, one week after and three weeks after the intervention. Result Participants in the experimental group were significantly younger and less experienced in disaster management than those in the control group. There were no between-group differences in the participants' self-assessment of chemical disaster preparedness and self-efficacy before the intervention. The intervention group showed significantly higher self-assessment chemical disaster preparedness scores than the comparison group (p < .05) one week after the intervention. However, no significant differences were found three weeks after the intervention. Conclusion This study found that both 360° VR and tabletop drills improved preparedness and self-efficacy in chemical disasters among ER nurses. VR could be used for disaster preparedness training for nurses without prior disaster response experiences/ drills, whereas tabletop drills were more suitable for nurses with prior experiences. Both methods may effectively promote nurses' learning effectiveness and self-efficacy in chemical disaster preparedness.
Article
Background We report the development, implementation and results of a sustainable region-wide mass-casualty management pre-hospital training program implemented by the Regione Lombardia emergency medical services (EMS) agency AREU in Italy. Methods The educational program learning objectives are: 1) Command and control, communications and resource management. 2) Mass casualty triage and the START triage protocol. 3) On-scene management 4) Regione Lombardia and AREU Mass Casualty standard operating procedures 5) Inter-agency communications and relations. For each course edition data on participants summative assessment, participants feedback and costs were collected. Results Between June 26th,2013 and December 31 st ,2020 a total of 84 editions of the provider training event were delivered, training an overall 1329 prehospital providers. 1239 (93%) passed the summative assessment and were qualified as being operationally “ready”. Regarding participants’ feedback, the overall program was rated 4.4±0.7out of 5. The overall cost of running the provider program during the study period was € 321,510 (circa US$ 382,000). The average cost per edition was € 3,828 and € 242 per participant. Conclusions We have described a simple yet interactive simulation and blended-learning approach, which has yielded good pass rates, good participant satisfaction and contained costs to systematically train emergency medical service personnel.
Article
The importance of MCI organization and training was highlighted by the events of September 11, 2001. Training focuses on the management of physical injuries caused by a single traumatic event over a well-defined, relatively short timeframe. MCI management is integrated into surgical and trauma training, with disaster management training involving the emergency services, law enforcement, and state infrastructure agencies. The COVID-19 pandemic revealed gaps in the preparedness of nation states and global partners in disaster management. The questions that arose include ‘has training really prepared us for an actual emergency,’ ‘what changes need to be made to training to make it more effective,’ and ‘who else should training be extended to?’ This article focuses on the importance of involving multiple sectors in mass casualty training and asks whether greater involvement of non-medical agencies and the public, in operational drills might improve preparedness for global events such as the COVID-19 pandemic.
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Objective: Educated midwives have a range of abilities to use their skills in normal situations. Given that working under normal situations is different from critical conditions, the recognition of skills and competencies required for midwifery practice is important. The purpose of this study was to explore specific professional competencies that midwives need to have for the provision of reproductive health services during disasters. Methods: This was a qualitative study using a content analysis method. Subjects were 19 midwives with the work experience of practice in disaster situations. Data were collected using semi-structured interviews and analysis was based on the approach suggested by Graneheim and Lundman. Results: Six major categories developed in this study were "safe pregnancy," "safe childbirth," "women's health care," "contraception," "violence and sexually transmitted infections," and "infant care." Conclusions: Midwives can play a very important role in the provision of reproductive health services. Therefore, they must have special capabilities and capacities. Policies and curriculum development are recommended in accordance with the needs of reproductive health in disaster-affected communities.
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Background The evaluation of the present state of disaster preparedness among nurses in developing countries is not very well elucidated. Therefore, it is crucial to identify the adequacy of disaster preparedness among nurses in such countries and to examine the factors that influence the preparedness of nurses with regard to disaster management. Methods A cross-sectional methodological design was used. A convenient sampling method was used to recruit 370 registered nurses from two hospitals in Saudi Arabia. Data were collected using valid and reliable self-reported questionnaires, including the Disaster Preparedness Evaluation Tool, Practice Environment Scale-Nursing Work Index, and Self-Regulation Scale. Results The final model, with good fit indices, revealed that the disaster preparedness of nurses was significantly influenced by nurses’ skills, knowledge, leadership ability and support, self-regulation, nursing quality of care, disaster training, disaster experience, and workplace participation. Altogether, these factors explained 68% of the total variance. Conclusion The factors influencing the preparedness of nurses for disaster are more complex than previously understood. Our model, created and tested using structural equation modelling, merits further research to extend our understanding of how nurses’ perception of disaster management is influenced by organizational characteristics in the hospital work environment.
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Background: The increasing frequency and magnitude of disasters call for enhancing the preparation of nurses with advanced knowledge and skills in disaster management. Objectives: With the release in December 2019 of the updated version 2.0 of the ICN's Core Competencies in Disaster Nursing (ICN CCDN V2.0), the aims of this study were to examine the extent to which the selected disaster nursing postgraduate program curriculum and the dissertation projects address the updated core competencies and to determine whether the syllabus requires revision. Methods: A data mapping analysis approach was used to review the syllabus of the studied program for coverage of the ICN V2.0 core competencies for general professional (Level I) and advanced/specialized nurses (Level II). The dissertation projects of the students were also included in the mapping analysis. Results: It found that 83% of the core competencies were addressed at Level I for general professional nurses and 69% at Level II for advanced/specialized nurses in the curriculum. Out of the 35 core competencies at Level I under the eight domains, six items (17.1%) were not covered under the domains of Intervention and Recovery. Out of the 32 core competencies at Level II, ten items (31.3%) were not covered under the domains of Communication, Incident Management, Safety and Security, Assessment, Intervention, and Law and Ethics. Students' dissertations could complement some of the competencies not covered in the syllabus. Conclusions: The studied curriculum covered the majority of the core competencies proposed by ICN CCDN V2.0, but subjects were required to be revised to address the competencies missing from the syllabus. Moreover, it is critically important for educators to review their curriculum to prepare nurses for disasters, to ensure that they are equipped with the competencies required to meet the demands arising from the increasingly frequent occurrences of global disaster.
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Background Despite the development in disaster nursing and the increasing research and related publications, little efforts have been directed to map the global development and trends of disaster nursing literature, identify gaps and guide future research directions in the field. Objectives To generate a comprehensive picture of publications in disaster nursing over the past three decades and provide a discussion on the gaps and directions for future developments in disaster nursing-related research. Methods A bibliometric analysis was used. The Scopus database was utilized to retrieve disaster nursing publications for the period from 1990 to 2019. Findings A total of 1075 publications on disaster nursing were retrieved. The analysis indicated a rapid growth in publications from 2001 to 2014, followed by a plateau. Disaster nursing publications were geographically polarized within the Anglo-Saxon, European Union and Asian countries, with the United States, Australia, and the United Kingdom being the top three most productive countries. Both the number of publications by year and countries were significantly correlated with the number of total damages caused by disasters (r=0.42, p<0.05 and r=0.41, p<0.001 respectively). The analysis also highlighted that most of the impactful cooperation among different authors was found within the same countries only. The main keyword-based themes of the publications included disaster, nurses/emergency nurses/military nurses, preparedness, communication, and knowledge. The disaster phase of response received the most attention in disaster nursing followed by preparedness, while very few publications addressed disaster mitigation and recovery. Conclusions This study provides nursing leaders, educators, researchers, and practitioners a comprehensive map of the development of disaster nursing literature in the past three decades. However, the field of disaster nursing is still far from being mature. More empirical and theoretical research, especially in the full spectrum of disaster management, should be investigated to meet the global challenge of disasters. International collaboration should be a significant way in improving the quality of the related research.
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Introduction Indonesia, being a part of the Pacific “ring of fire,” is prone to disasters. Several disasters occurred from 2004 to 2019, which resulted in the loss of many lives. These disasters impacted the physical, psychological, psychosocial, and spiritual conditions of survivors. Nurses are the frontline care providers who need adequate competencies to respond to disasters. Objective This study aimed to explore the nurses’ perception of disaster, roles, barriers, and Islamic-based nurses’ competencies in managing psychological, psychosocial, and spiritual problems due to disasters in hospital settings. Methods This is a qualitative study conducted in three large referral hospitals in Banda Aceh, Indonesia. Focus group discussion was conducted on 24 nurses from three hospitals using the discussion guide consisting of five open-ended questions. The data was analyzed through inductive content analysis. Results The study found four themes of Islamic nurses’ competencies in disaster response: 1) perception about the disaster is influenced by religiosity, belief, and values, 2) communication skills, 3) nurses’ roles in disaster response consisted of disaster competencies (the use of Islamic values in managing patients’ conditions, and family engagement, 4) competency barriers consisted of inadequate training, insufficient Islamic-based services, and inadequate involvement of policymakers. This study explored Islamic nurses’ competencies in disaster response related perceptions about the disaster, nurses’ roles, and barriers. The limitation and future of the study were also discussed. Conclusion Perceptions, roles, and barriers in disaster response might influence the development of the Islamic-based nurses’ competencies in care delivery.
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Background. Field hospitals have been established as part of the COVID-19 pandemic response in a range of countries including the Kingdom of Saudi Arabia. Assess input, monitor activities and track output can be used to identify whether field hospitals are meeting their intended targets. Method. Based on a case study approach, the reported results include field hospital construction project performance outcomes, a description of the design process and the development and application of key performance indicators to assess field hospital efficacy. Result. Each of the logic model component (i.e. input, activities and output) has tailored indicators that address different aspects of field hospital; from the infrastructure work to the wider impacts on services. Conclusion. The logic model components and related KPIs can be extremely important in terms of providing insights into how to achieve the field hospital’s objectives.
Preprint
en This study examines how rural medical centers in Northwest Missouri achieve emergency planning compliance with the current Centers for Medicare and Medicaid Services (CMS) emergency preparedness rule. This 2017 study focused on rural hospitals, critical access hospitals, and long‐term care facilities. An exploratory qualitative research study with an interpretive phenomenological approach was applied. Data were gathered from 11 face‐to‐face interviews with medical centers’ emergency and disaster planners in Northwest Missouri. Several categories and subcategories were identified in the data and developed into themes. Thematic analysis indicated significant barriers, including a CMS unfunded mandate, preparedness conducted by a single individual with other duties, lack of a whole community approach, and a lack of financial planning by medical center administration, hinder compliance with the CMS rule, necessary to mitigate nationwide emergencies. All participants agreed to the development of the emergency operations plan, which is essential for compliance. The findings from this study support the need for additional planning staff, time, and training to understand the elements of preparedness. Compliance with the CMS emergency preparedness rule cannot be achieved unless identified barriers are addressed. 摘要 zh 本文分析了密苏里州西北部农村医疗中心如何实现遵从当前联邦医疗保险和医疗补助中心 (CMS) 应急预备规则的应急规划。本研究于2017年开展, 聚焦农村医院、偏远地区医院和长期护理设施。应用了一项包含诠释性现象学方法的探究式定性研究。通过与密苏里州西北部医疗中心的应急和灾害规划者进行11次面对面访谈得出数据。从数据中识别了几组类别和子类别, 这些 (子) 类别被分为不同主题。主题分析指出了一系列显著障碍, 包括一项无经费的CMS授权、由身兼其他职责的个人进行应急预备、缺乏整体的社区方法、缺乏由医疗中心管理部门制定的财政规划, 这些障碍阻碍了对缓解全国应急情况所必需的 CMS 规则遵从。参与者一致认为, 发展应急操作计划 (EOP) 对规则遵从而言至关重要。本研究得出的结果认为, 需要额外的应急规划员工、时间及培训, 以期理解应急预备的各要素。只有在解决上述识别的障碍后才能实现CMS应急预备规则遵从。 RESUMEN es Este estudio examina cómo los centros médicos rurales en el noroeste de Missouri logran el cumplimiento de la planificación de emergencias con la regla actual de preparación para emergencias de los CMS. Este estudio de 2017 se centró en hospitales rurales, hospitales de acceso crítico e instalaciones de atención a largo plazo. Se aplicó un estudio exploratorio de investigación cualitativa con enfoque fenomenológico interpretativo. Los datos se obtuvieron de 11 entrevistas cara a cara con los planificadores de emergencias y desastres de los centros médicos en el noroeste de Missouri. Se identificaron varias categorías y subcategorías en los datos y se desarrollaron en temas. El análisis temático indicó barreras significativas, incluido un mandato sin fondos de CMS, la preparación realizada por una sola persona con otras tareas, la falta de un enfoque comunitario completo y la falta de planificación financiera por parte de la administración del centro médico, obstaculizan el cumplimiento de la regla de CMS, necesaria para mitigar emergencias a nivel nacional. Todos los participantes estuvieron de acuerdo en que el desarrollo del plan de operaciones de emergencia (EOP) es esencial para el cumplimiento. Los hallazgos de este estudio respaldan la necesidad de personal de planificación adicional, tiempo y capacitación para comprender los elementos de la preparación. El cumplimiento de la regla de preparación para emergencias de CMS no se puede lograr a menos que se aborden las barreras identificadas.
Article
Objective The purpose of this study was to investigate differences in the perception of disaster issues between disaster directors and general health care providers in Gyeonggi Province, South Korea. Methods The Gyeonggi provincial committee distributed a survey to acute care facility personnel. Survey topics included awareness of general disaster issues, hospital preparedness, and training priorities. The questionnaire comprised multiple choices and items scored on a 10-point Likert scale. We analyzed the discrepancies and characteristics of the responses. Results Completed surveys were returned from 43 (67%) of 64 directors and 145 (55.6%) of 261 health care providers. In the field of general awareness, the topic of how to triage in disaster response showed the greatest discrepancies. In the domain of hospital level disaster preparedness, individual opinions varied most within the topics of incident command, manual preparation. The responses to “accept additional patients in disaster situation” showed the biggest differences (> 21 versus 6~10). Conclusions In this study, there were disaster topics with discrepancies and concordances in perception between disaster directors and general health care providers. The analysis would present baseline information for the development of better training programs for region-specific core competencies, knowledge, and skills required for the effective response.
Article
Objective The aim of this study was to evaluate the readiness of a tertiary medical cityʼs response to a disaster by assessing the hospital resources and knowledge, attitudes, practices, and familiarity of health care providers toward disaster and emergency preparedness. Methods All KFMC (King Fahad Medical City) staff with > 1 year of clinical experience were eligible to participate in a cross-sectional study. Participants responded to the Emergency Preparedness Information Questionnaire (EPIQ), knowledge and practice questionnaires, and a disaster planning attitude checklist. Data about resources were collected using the hospital disaster preparedness self-assessment tool. Results The overall mean knowledge score for disaster and emergency preparedness was 4.4 ± 1.1, and the mean overall familiarity score was 3.43 ± 0.97. Most participants knew that disaster drills (90.2%) and training (74.6%) are ongoing. Sixty-six (21.0%) agreed that KFMC is unlikely to experience a disaster. The highest and lowest EPIQ familiarity scores were for decontamination (83.0%) and accessing critical resources and reporting (64.3%), respectively. Most participants (99.4%) have access to work computers; however, only 53.0% used the Internet to access information on bioterrorism and/or emergency preparedness. The hospital is ready to respond in case of a disaster according to the used tool. Conclusions The participants’ levels of knowledge, practices, and overall familiarity toward emergency and disaster preparedness were satisfactory; however, participant attitudes and familiarity with where and how to access critical resources in the event of an emergency or disaster situations require reinforcement.
Article
s Objectives The purpose of this study was to define and delineate specific nontechnical competencies for first-line public health responders in Chemical, Biological, Radiological and Nuclear (CBRN) emergencies in China. Study design A qualitative study was conducted in China involving interviews with key informants in the field of health response to CBRN disasters. Methods One-on-one in-depth interviews were carried out with 20 participants, including expert members of National Medical Response Teams for CBRN Disasters, officials at emergency management authorities, and scholars of academic institutions related to CBRN emergency. Interviews were recorded with audio equipment, transcribed and coded into codable passages according to grounded theory with NVivo software. Themes were identified within the transcriptions by using thematic analysis. Results 159 codable passages were produced. Eight domains of nontechnical core competencies were identified: (1) situation awareness, (2) communication skills, (3) collaboration, (4) resource management, (5) task management, (6) cultural competency, (7) austere environment skills, and (8) physical stamina. Conclusions The study identified a variety of competencies for on-scene public health responders in CBRN emergencies. The findings of this study could specifically benefit development of strategy and improvement of content of education and training. Further research that involves input from the disaster response community at large are needed for the validation of these competencies.
Article
Objectives To summarize characteristics and commonalities of non-technical competency frameworks for health professionals in emergency and disaster. Methods An electronic literature search was conducted in PubMed, MEDLINE, ERIC, Scopus, Cochrane database, and Google Scholar to identify original English-language articles related to development, evaluation or application of the nontechnical competency frameworks. Reviewers assessed identified articles for exclusion/inclusion criteria and abstracted data on study design, framework characteristics, and reliability/validity evidence. Results Of the 9627 abstracts screened, 65 frameworks were identified from 94 studies that were eligible for result extraction. Sixty (63.8%) studies concentrated on clinical settings. Common scenarios of the studies were acute critical events in hospitals (44;46.8%) and nonspecified disasters (39;41.5%). Most of the participants (76; 80.9%) were clinical practitioners, and participants in 36 (38.3%) studies were multispecialty. Thirty-three (50.8%) and 42 (64.6%) frameworks had not reported evidence on reliability and validity, respectively. Fourteen of the most commonly involved domains were identified from the frameworks. Conclusions Nontechnical competency frameworks applied to multidisciplinary emergency health professionals are heterogeneous in construct and application. A fundamental framework with standardized terminology for the articulation of competency should be developed and validated so as to be accepted and adapted universally by health professionals in all-hazard emergency environment.
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Background Political unrest in the Middle East heightens the possibility of catastrophe due to violent conflict and/or terrorist attacks. However, the disaster risk reduction strategy in the Saudi health care system appears to be a reactive approach focused more on flood hazards than other threats. Given the current unstable political situation in its neighboring countries and Saudi Arabia’s key role in providing humanitarian assistance and disaster relief to those affected by internal conflicts and wars, it is essential to develop a framework for training standards related to complex humanitarian disasters to provide the requisite skills and knowledge in a gradual manner, according to local context and international standards. This framework could also support the World Health Organization’s (WHO; Geneva, Switzerland) initiative for establishing a national disaster assistance team in Saudi Arabia. Problem The main aim of this study is to provide Saudi health care providers with a competencies-based course in Basic Principles of Complex Humanitarian Emergency. Methods The interactive, competencies-based course in Basic Principles of Complex Humanitarian Emergency was designed by five experts in disaster medicine and humanitarian relief in three stages, accordance to international standards and the local context. The course was piloted over five days at the Officers Club of the Ministry of Interior (MOI; Riyadh, Saudi Arabia). The 33 participants were from different health disciplines of the government sectors in-country. The participants completed the pre- and post-tests and attended three pilot workshops for disaster community awareness. Results The overall knowledge scores were significantly higher in the post-test (62.9%) than the pre-test (44.2%). There were no significant differences in the pre- and post-knowledge scores for health care providers from the different government health disciplines. A 10-month, post-event survey demonstrated that participants were satisfied with their knowledge retention. Importantly, three of them (16.6%) had the opportunity to put this knowledge into practice in relation to humanitarian aid response. Conclusion Delivering a competencies-based course in Basic Principles of Complex Humanitarian Emergency for health care providers can help improve their knowledge and skills for humanitarian assistance and disaster relief, which is crucial for disaster preparedness augmentation in Saudi Arabia.
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Various organizations and universities have developed competencies for health professionals and other emergency responders. Little effort has been devoted to the integration of these competencies across health specialties and professions. The American Medical Association Center for Public Health Preparedness and Disaster Response convened an expert working group (EWG) to review extant competencies and achieve consensus on an educational framework and competency set from which educators could devise learning objectives and curricula tailored to fit the needs of all health professionals in a disaster. The EWG conducted a systematic review of peer-reviewed and non-peer reviewed published literature. In addition, after-action reports from Hurricane Katrina and relevant publications recommended by EWG members and other subject matter experts were reviewed for congruencies and gaps. Consensus was ensured through a 3-stage Delphi process. The EWG process developed a new educational framework for disaster medicine and public health preparedness based on consensus identification of 7 core learning domains, 19 core competencies, and 73 specific competencies targeted at 3 broad health personnel categories. The competencies can be applied to a wide range of health professionals who are expected to perform at different levels (informed worker/student, practitioner, leader) according to experience, professional role, level of education, or job function. Although these competencies strongly reflect lessons learned following the health system response to Hurricane Katrina, it must be understood that preparedness is a process, and that these competencies must be reviewed continually and refined over time.
Article
This paper represents a review of the second edition of Distance Education: A Systems View by Michael Moore and Greg Kearsley (Thomas/Wadsworth, 2005). This second edition reflects a view of current applications of distance education, based on the vantage of instructional systems design. The strengths of the book are reflected in the uniqueness of its consideration of online courses, in particular from the point of view of systematic development and management.
Article
Phlegmasia cerulea dolens (PCD) is a rare venous disorder that continues to be a major therapeutic challenge. We reviewed 16 cases of PCD treated during the past 15 years; 11 of the patients were male, and the average age of all the patients was 59 years. Malignant disease was the most common underlying condition (seven patients). Venous gangrene (VG) was present in seven extremities. Three treatment methods were used alone or in combination--intravenous heparin, venous thrombectomy, and thrombolytic therapy. Heparin was used initially in 13 patients; it yielded a successful result in seven (53%) patients, none of whom had VG. Venous thrombectomy was done in six patients; in three it was the primary procedure, in two it followed failure of heparin, and in one it followed failure of both heparin and thrombolytic therapy. Venous thrombectomy was successful in three (50%) patients, one of whom had early VG. Thrombolytic therapy was used on one occasion in conjunction with both heparin and venous thrombectomy, without benefit. Five patients died, all with VG, three after heparin only, one after heparin and venous thrombectomy, and one after all three treatment methods. Review of the 38 cases reported in the recent literature shows comparable results. These data suggest that nongangrenous forms of PCD respond well to systemic anticoagulation. Combination therapy using venous thrombectomy and heparin is indicated for severe ischemia, early VG, or failure of PCD to improve after six to 12 hours of heparin therapy. Phlegmasia cerulea dolens with VG is the lethal form of the entity and responds poorly to established therapy. Future therapeutic trials need to consider aggressive use of thrombolysis with or without thrombectomy.
Article
Phlegmasia cerulea dolens (PCD) is an uncommon, severe form of lower extremity deep venous thrombosis characterized by extremity swelling, cyanosis, and pain. Progression of the thrombotic process may result in extremity gangrene, amputation, and death. The relative value of specific therapeutic regimens in the treatment of this disease remains uncertain. Twelve patients, 9 females and 3 males, with PCD were treated during a 10-year period. Eighteen lower extremities were involved. Pre-existing conditions included malignancy (eight), postoperative state (four), diabetes (three), previous deep venous thrombosis (three), and hypercoagulation (two). Venous gangrene was present in four patients. All patients were treated initially with bedrest, fluid resuscitation, extremity elevation, and systemic high-dose heparin therapy. Five patients had complete resolution with this regimen alone. One patient required cessation of heparin therapy due to heparin-induced thrombocytopenia and developed gangrenous toes. Two patients whose condition failed to respond to heparin therapy underwent catheter-based delivery of urokinase with marked clinical improvement. Four patients, two with venous gangrene, died, three of whom had disseminated malignant disease. A significant percentage of patients with PCD will respond to extremity elevation, fluid resuscitation, and aggressive systemic anticoagulation therapy. Thrombolytic therapy selectively administered is beneficial in patients whose disease fails to respond promptly. Venous thrombectomy should be reserved for patients with contraindications to thrombolysis.
Article
The task force assessed the needs, demands, feasibility, and content of training for US civilian emergency medical responders (paramedics, nurses, and physicians) for nuclear/biological/chemical (NBC) terrorism. A task force representing key professional organizations, stakeholders, and disciplines involved in emergency medical response conducted an iterated instructional-design analysis on the feasibility and content of such training with input from educational professionals. We then analyzed 6 previously developed training courses for their congruence with our recommendations. The task force produced descriptions of learning groups, content and learning objectives, and barriers and challenges to NBC education. Access to training and sustainment of learning (retention of knowledge) represent the significant barriers. The courses analyzed by the task force did not meet all objectives and challenges addressed. The task force recommends training programs and materials need to be developed to overcome the identified barriers and challenges to learning for these audiences. Furthermore, the task force recommends incorporating NBC training into standard training programs for emergency medical professionals.
Article
Recent terrorist events, changes in Joint Commission on Accreditation of Healthcare Organizations requirements, and availability of grant funding have focused health care facility attention on emergency preparedness. Health care facilities have historically been underprepared for contaminated patients presenting to their facilities. These incidents must be properly managed to reduce the health risks to the victims, providers, and facility. A properly equipped and well-trained health care facility team is a prerequisite for rapid and effective decontamination response. This article reviews Occupational Safety and Health Administration (OSHA) training requirements for personnel involved with decontamination responses, as well as issues of team selection and training. Sample OSHA operations-level training curricula tailored to the health care environment are outlined. Initial and ongoing didactic and practical training can be implemented by the health care facility to ensure effective response when contaminated patients arrive seeking emergency medical care.
MD (American College of Emergency Physicians Board Liaison) American College of Surgeons
  • Acs
  • J Leonard
  • Weireter
Members, National Standardized All-Hazard Disaster Core Competencies Task Force. American Academy of Pediatrics (AAP) Craig Huang, MD American College of Emergency Physicians Carl H. Schultz, MD (Task Force Chair) Ramon W. Johnson, MD (American College of Emergency Physicians Board Liaison) American College of Surgeons (ACS) Leonard J. Weireter, MD Content Consultant Kris Powell, RN Department of Homeland Security/Office of Health Affairs Kathryn H. Brinsfield, MD, MPH Emergency Nurses Association (ENA) Andrew Galvin, ACNP, MSN, CEN National Association of EMS Educators (NAEMSE) Robert Waddell, BS, BA National Association of EMS Physicians (NAEMSP) Jullette Saussy, MD Kathy J. Rinnert, MD, MPH National Association of Emergency Medical Technicians (NAEMT) Connie Meyer, RN, Paramedic National Association of State EMS Officials (NASEMSO) Maxie Bishop, RN, LP
Instructional Design Theory
  • M D Merrill
Merrill MD. Instructional Design Theory. Englewood Cliffs, NJ: Educational Technology Publications; 1994.