Attributes of effective disaster responders: focus group discussions with key emergency response leaders

Post-quake call for action: developing core competencies matrix for Syrian health workers in emergency time

BACKGROUND

The recent earthquake in Syria has caused widespread devastation, leading to extensive damage and loss of life. Considering the diverse range of disasters and conflicts that have affected Syrian society, health workers must possess essential competencies to effectively manage various types of disasters, including earthquakes. Therefore, this study was undertaken to identify the specific competencies required by Syrian health workers to respond efficiently and effectively to earthquakes.

METHODS

An exploratory qualitative study was conducted at the Medical Education Program MEP of the Syrian Virtual University SVU. Nine members of the research team of the MEP, who represent various health specializations in medicine, dentistry, nursing, and pharmacy, accepted to take part in this study. Among these, three members have been actively involved in providing health care in hospitals and the field during the Syrian earthquake on 6 February 2023. The Delphi process was adopted to identify competencies. Health workers involved in earthquake response were categorized into nine groups including medical doctors, dentists, pharmacists, nurses, psychological support professionals, medical students, allied healthcare professionals, on-site disaster teams, and managers. The final list was accepted if it achieved more than 80% agreement among the participants in the first, second, and final rounds.

RESULTS

The study identified 74 competencies (12 knowledge items, 35 skills, and 27 attitudes) essential for health workers to respond effectively to earthquakes. They are categorized into five domains: "Preparing the team for the rescue process during and, after earthquakes, Implementation of the rescue process, Education and psychological support, Research, and development".

CONCLUSION

A list of earthquake competencies was identified for health workers. It is hoped that this list will enhance a country's resilience and will enable decision-makers to support health workers in acquiring these competencies within a very strained health system in Syria and other countries.

Domestic application of lessons learned by Canadian health care professionals working in international disaster settings: a qualitative research study

BACKGROUND

Individuals with prior experience in international disaster response represent an essential source of expertise to support disaster response in their home countries. Our objective was to explore the experiences of personnel involved in international emergency health response regarding their perceptions of essential disaster response attributes and capacities and determine how these competencies apply to the Canadian context.

METHODS

For this qualitative study, we conducted semistructured interviews with key informants in person or over the telephone from May to December 2018. Participants were delegates deployed as part of the Canadian Red Cross medical response team in a clinical or technical, or administrative role within the last 5 years. Interviews were audio-recorded and transcribed. Conventional content analysis was performed on the transcripts, and themes were developed.

RESULTS

Eighteen key informants from 4 Canadian provinces provided perspectives on individual attributes acquired during international deployments, such as agility and stress management, and team capacities developed, including collaboration and conflict management. Key informants, including administrators (n = 5), technicians (n = 4), nurses (n = 4), physicians (n = 3) and psychosocial support workers (n = 2), described these experiences as highly relevant to the Canadian domestic context.

INTERPRETATION

Canadian physicians and health care workers involved with international disaster response have already acquired essential capacities, and this experience can be vital to building efficient disaster response teams in Canada. These findings complement the Canadian Medical Education Directives for Specialists (CanMEDS) roles and can inform course design, competency and curriculum development for physician and professional training programs related to disaster response and preparedness.

Developing Public Health Emergency Response Leaders in Incident Management: A Scoping Review of Educational Interventions

During emergency responses, public health leaders frequently serve in incident management roles that differ from their routine job functions. Leaders' familiarity with incident management principles and functions can influence response outcomes. Therefore, training and exercises in incident management are often required for public health leaders. To describe existing methods of incident management training and exercises in the literature, we queried 6 English language databases and found 786 relevant articles. Five themes emerged: (1) experiential learning as an established approach to foster engaging and interactive learning environments and optimize training design; (2) technology-aided decision support tools are increasingly common for crisis decision-making; (3) integration of leadership training in the education continuum is needed for developing public health response leaders; (4) equal emphasis on competency and character is needed for developing capable and adaptable leaders; and (5) consistent evaluation methodologies and metrics are needed to assess the effectiveness of educational interventions.These findings offer important strategic and practical considerations for improving the design and delivery of educational interventions to develop public health emergency response leaders. This review and ongoing real-world events could facilitate further exploration of current practices, emerging trends, and challenges for continuous improvements in developing public health emergency response leaders.

The importance of pre-training gap analyses and the identification of competencies and skill requirements of medical personnel for mass casualty incidents and disaster training

Background

Effective preparedness to respond to mass casualty incidents and disasters requires a well-planned and integrated effort by all involved professionals, particularly those who are working in healthcare, who are equipped with unique knowledge and skills for emergencies. This study aims to investigate and evaluate the level of knowledge and skills related to mass casualty and disaster management in a cohort of healthcare professionals.

Methods

A cross-sectional brief study was conducted using a validated and anonymous questionnaire, with a sample of 134 employees at a clinical hospital in Lublin, Poland.

Results

The findings of this study may indicate a need for standardization of training for hospitals employees. It also suggests a knowledge gap between different professional groups, which calls for adjusting such general training, to at least, the weakest group, while special tasks and mission can be given to other groups within the training occasion.

Conclusion

Pre-Training gap analyses and identification of participants’ competencies and skills should be conducted prior to training in mass casualty incidents and disasters. Such analyses provides an opportunity to develop training curriculum at various skill and knowledge levels from basic to advance. All training in mass casualty incidents and disasters should be subject to ongoing, not just periodic, evaluation, in order to assess continued competency.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10165-5.

Cognitive skills of emergency medical services crew members: a literature review

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.

Exploring the non-technical competencies for on-scene public health responders in chemical, biological, radiological, and nuclear emergencies: a qualitative study

Objectives

The purpose of this study was to define and delineate specific non-technical 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 using audio equipment, transcribed, and coded into codable passages as per grounded theory using NVivo software. Themes were identified within the transcriptions by using thematic analysis.

Results

A total of 159 codable passages were produced. Eight domains of non-technical 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 is needed for the validation of these competencies.

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Non-technical competencies affect performance of health response to Chemical, Biological, Radiological, and Nuclear (CBRN) disasters.

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Austere environment skills and physical stamina are priority non-technical competencies for on-site public health responders in CBRN events.

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Effective CBRN health emergency training should integrate and synchronize courses based on non-technical/technical competency.

A Literature Review on Psychosocial Support for Disaster Responders: Qualitative Synthesis with Recommended Actions for Protecting and Promoting the Mental Health of Responders

Little scientific evidence exists on ways to decrease the psychological stress experienced by disaster responders, or how to maintain and improve their mental health. In an effort to grasp the current state of research, we examined research papers, agency reports, the manuals of aid organisations, and educational materials, in both English and Japanese. Using MEDLINE, Ichushi-Web (Japanese search engine), Google Scholar, websites of the United Nations agencies, and the database of the Grants System for Japan’s Ministry of Health, Labour, and Welfare, 71 pertinent materials were identified, 49 of which were analysed. As a result, 55 actions were extracted that could potentially protect and improve the mental health of disaster responders, leading to specific recommendations. These include (1) during the pre-activity phase, enabling responders to anticipate stressful situations at a disaster site and preparing them to monitor their stress level; (2) during the activity phase, engaging in preventive measures against on-site stress; (3) using external professional support when the level of stress is excessive; and (4) after the disaster response, getting back to routines, sharing of experiences, and long-term follow-up. Our results highlighted the need to offer psychological support to disaster responders throughout the various phases of their duties.

An Island-Wide Disaster Drill to Train the Next Generation of Anesthesiologists: The SIAARTI Academy Experience

OBJECTIVE

Anesthesiologists play a pivotal role in mass-casualty incidents management. Disaster medicine is part of the anesthesiologist's core skills; however, dedicated training is still scarce and, often, it does not follow a standardized program.

METHODS

We designed and delivered a crash course in disaster medicine for Italian anesthesiology residents participating in the nationwide program, Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) Academy Critical Emergency Medicine 2019. Residents totaling 145, from 39 programs, participated in a 75-minute workstation on the principles of disaster management. Following this, each participant was involved in a full-scale mass-casualty drill. A plenary debriefing followed to present simulation data, maximize feedback, and highlight all situations needing improvement.

RESULTS

Overall, participant performance was good: Triage accuracy was 85% prehospital and 84% in-hospital. Evacuation flow respected triage priority. During the debriefing, residents were very open to share and reflect on their experiences. A narrative qualitative analysis of the debriefing highlights that many participants felt overwhelmed by events during the exercise. Participants in coordination positions shared how they appreciated the need to switch from a clinical mindset to a managerial role.

CONCLUSION

This was an invaluable experience for anesthesiology trainees, providing them with the skill set to understand the fundamental principles of a mass-casualty response.

Nontechnical Competency Framework for Health Professionals in All-Hazard Emergency Environment: A Systematic Review

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.

The Development and Validation of the Perceived Competence Scale for Disaster Mental Health Workforce

OBJECTIVE

This study was conducted to validate a Perceived Competence Scale for Disaster Mental Health Workforce (PCS-DMHW) designed to measure the core competences of mental health workers in disaster response situations at individual and organizational levels. core competences essentially required in disaster response situations were defined on the basis of literature review, focus-group interview with disaster response professionals, and expert judgment.

METHODS

The preliminary items of the PCS-DMHW thus generated were administered to 509 participants consisted of mental health professionals and semi-professionals. The data retrieved from questionnaires were equally divided by two halves. The final items were determined through the exploratory factor analysis of the half data (n=255), and the construct validity was tested by performing the confirmatory factor analysis and criterion-related validity test of the remaining half data (n=254).

RESULTS

Three factors were derived from the individual competences scale; 1) perceived competence of knowledge and skill, 2) ethic, and 3) qualification. And three factors were derived from the organizational competence scale; 1) teamwork, 2) network, and 3) followship.

CONCLUSION

The PCS-DMHW demonstrated fairly high reliability and validity. Finally, the necessity of continuous validation study and the application modalities of this scale in education and training settings were discussed.

Key Attributes of a Medical Learning Community Mentor at One Medical School

PURPOSE

The purpose of this study was to discover the elements required for a successful learning community (LC) faculty member educator of medical students.

METHOD

The authors in this qualitative study evaluated six 90-min focus groups of faculty members. The groups included 31 experienced and 19 inexperienced LC faculty members at the University of Texas Southwestern Medical School. After achieving excellent interrater reliability, transcriptions of the discussions were subjected to thematic analysis using ATLAS.ti software.

RESULTS

Five major themes emerged: (1) LC faculty characteristics/competency, (2) suggested faculty development methods, (3) factors outside the LC environment influencing student relationships, (4) student attributes influencing teaching techniques, and (5) measuring and improving history and physical skills. Faculty characteristics/competency subthemes included role-modeling, mentoring, and teaching competence. Suggested faculty development methods subthemes included assessing and giving feedback to faculty, peer development, and learning from experts. Experienced LC faculty focused more attention on teaching competence and mentoring competence than inexperienced LC faculty.

DISCUSSION

The themes with the most extensive discussion among the experienced LC faculty groups may represent qualities to be sought in future mentor recruitment and faculty development. Future studies could build on this study by similarly investigating student perceptions.

Coping With a Mass Casualty: Insights into a Hospital's Emergency Response and Adaptations After the Formosa Fun Coast Dust Explosion

OBJECTIVE

The study provides a comprehensive insight into how an initial receiving hospital without adequate capacity adapted to coping with a mass casualty incident after the Formosa Fun Coast Dust Explosion (FFCDE).

METHODS

Data collection was via in-depth interviews with 11 key participants. This was combined with information from medical records of FFCDE patients and admission logs from the emergency department (ED) to build a detailed timeline of patients flow and ED workload changes. Process tracing analysis focused on how the ED and other units adapted to coping with the difficulties created by the patient surge.

RESULTS

The hospital treated 30 victims with 36.3% average total body surface area burn for over 5 hours alongside 35 non-FFCDE patients. Overwhelming demand resulted in the saturation of ED space and intensive care unit beds, exhaustion of critical materials, and near-saturation of clinicians. The hospital reconfigured human and physical resources differently from conventional drills. Graphical timelines illustrate anticipatory or reactive adaptations. The hospital's ability to adapt was based on anticipation during uncertainty and coordination across roles and units to keep pace with varying demands.

CONCLUSION

Adapting to beyond-surge capacity incident is essential to effective disaster response. Building organizational support for effective adaptation is critical for disaster planning.

Ensuring a competent public health responder workforce: The CDC experience

INTRODUCTION

From 2009 to 2016, the Centers for Disease Control and Prevention (CDC) activated its Incident Management System for a public health emergency 91 percent of the time. The CDC must ensure its workforce is prepared for the evolving nature of emergencies.

OBJECTIVES

The purpose of this assessment was to identify perceived preparedness and response training needs for the CDC responder workforce.

METHODS

Between November 2012 and January 2013, focus groups and in-depth interviews were conducted with CDC responders, including senior leaders. The evaluation questions were: (1) How well does the current training system prepare CDC staff to respond to emergency events? (2) What gaps exist in the current training system? and (3) What trainings are essential and should be included in the training system?

RESULTS

Eight focus groups were conducted with 51 responders and 18 interviews with response leaders. Themes were identified for each main outcome measure and translated to training improvements.

CONCLUSIONS

The CDC workforce received foundational training. Recommendations are provided to better prepare responders during an emergency. Periodic assessments are necessary to expand training and remain responsive to the complexities of emerging threats.

Ranking the Attributes of Effective Disaster Responders and Leaders

OBJECTIVE

To investigate the relative importance of 10 attributes identified in prior studies as essential for effective disaster medical responders and leaders.

METHODS

Emergency and disaster medical response personnel (N=220) ranked 10 categories of disaster worker attributes in order of their importance in contributing to the effectiveness of disaster responders and leaders.

RESULTS

Attributes of disaster medical leaders and responders were rank ordered, and the rankings differed for leaders and responders. For leaders, problem-solving/decision-making and communication skills were the highest ranked, whereas teamwork/interpersonal skills and calm/cool were the highest ranked for responders.

CONCLUSIONS

The 10 previously identified attributes of effective disaster medical responders and leaders include personal characteristics and general skills in addition to knowledge of incident command and disaster medicine. The differences in rank orders of attributes for leaders and responders suggest that when applying these attributes in personnel recruitment, selection, and training, the proper emphasis and priority given to each attribute may vary by role. (Disaster Med Public Health Preparedness. 2019;13:700-703).

Characteristics of Medical Teams in Disaster

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

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

Characteristics of Effective Disaster Responders and Leaders: A Survey of Disaster Medical Practitioners

Objective

To identify key attributes of effective disaster/mass casualty first responders and leaders, thereby informing the ongoing development of a capable disaster health workforce.

Methods

We surveyed emergency response practitioners attending a conference session, the EMS State of the Science: A Gathering of Eagles. We used open-ended questions to ask participants to describe key characteristics of successful disaster/mass casualty first responders and leaders.

Results

Of the 140 session attendees, 132 (94%) participated in the survey. All responses were categorized by using a previously developed framework. The most frequently mentioned characteristics were related to incident command/disaster knowledge, teamwork/interpersonal skills, performing one’s role, and cognitive abilities. Other identified characteristics were related to communication skills, adaptability/flexibility, problem solving/decision-making, staying calm and cool under stress, personal character, and overall knowledge.

Conclusions

The survey findings support our prior focus group conclusion that important characteristics of disaster responders and leaders are not limited to the knowledge and skills typically included in disaster training. Further research should examine the extent to which these characteristics are consistently associated with actual effective performance of disaster response personnel and determine how best to incorporate these attributes into competency models, processes, and tools for the development of an effective disaster response workforce. (Disaster Med Public Health Preparedness. 2016;page 1 of 4)

A focus group study of the impact of trauma exposure in the 9/11 terrorist attacks

PURPOSE

Much of the mental health research that has emerged from the September 11 (9/11) attacks has been focused on posttraumatic stress disorder and its symptoms. To better understand the broader experience of individuals following a disaster, focus groups were conducted with individuals from affected companies both at Ground Zero and elsewhere in New York City.

METHODS

Twenty-one focus groups with a total of 140 participants were conducted in the second post-9/11 year. Areas of identified concern were coded into the following themes: Disaster Experience, Emotional Responses, Workplace Issues, Coping, and Issues of Public Concern.

RESULTS

Discussions of focus groups included material represented in all five themes in companies both at Ground Zero and elsewhere. The emphasis and the content within these themes varied between the Ground Zero and other companies. Content suggesting symptoms of PTSD represented only a minority of the material, especially in the company groups not at Ground Zero.

CONCLUSIONS

This study's findings revealed an array of psychosocial concerns following the 9/11 attacks among employees of companies in New York City that extended far beyond PTSD. This study's results provide further evidence that trauma exposure is central to individuals' post-disaster experience and focus, and to individuals' adjustment and experience after disaster.

Competencies for disaster mental health

Competencies for disaster mental health are essential to domestic and international disaster response capabilities. Numerous consensus-based competency sets for disaster health workers exist, but no prior study identifies and discusses competency sets pertaining specifically to disaster mental health. Relevant competency sets were identified via MEDLINE, PsycINFO, EBSCO, and Google Scholar searches. Sixteen competency sets are discussed, some providing core competencies for all disaster responders and others for specific responder groups within particular professions or specialties. Competency sets specifically for disaster mental health professionals are lacking, with the exception of one set that focused only on cultural competence. The identified competency sets provide guidance for educators in developing disaster mental health curricula and for disaster health workers seeking education and training in disaster mental health. Valid, criterion-based competencies are required to guide selection and training of mental health professionals for the disaster mental health workforce. In developing these competencies, consideration should be given to the requirements of both domestic and international disaster response efforts.

Literature Review on Medical Incident Command

Introduction

It is not known what constitutes the optimal emergency management system, nor is there a consensus on how effectiveness and efficiency in emergency response should be measured or evaluated. Literature on the role and tasks of commanders in the prehospital emergency services in the setting of mass-casualty incidents has not been summarized and published.

Problem

This comprehensive literature review addresses some of the needs for future research in emergency management through three research questions: (1) What are the basic assumptions underlying incident command systems (ICSs)? (2) What are the tasks of ambulance and medical commanders in the field? And (3) How can field commanders’ performances be measured and assessed?

Methods

A systematic literature search in MEDLINE, PubMed, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, Cochrane Library, ISI Web of Science, Scopus, International Security & Counter Terrorism Reference Center, Current Controlled Trials, and PROSPERO covering January 1, 1990 through March 1, 2014 was conducted. Reference lists of included literature were hand searched. Included papers were analyzed using Framework synthesis.

Results

The literature search identified 6,049 unique records, of which, 76 articles and books where included in qualitative synthesis. Most ICSs are described commonly as hierarchical, bureaucratic, and based on military principles. These assumptions are contested strongly, as is the applicability of such systems. Linking of the chains of command in cooperating agencies is a basic difficulty. Incident command systems are flexible in the sense that the organization may be expanded as needed. Commanders may command by direction, by planning, or by influence. Commanders’ tasks may be summarized as: conducting scene assessment, developing an action plan, distributing resources, monitoring operations, and making decisions. There is considerable variation between authors in nomenclature and what tasks are included or highlighted. There are no widely acknowledged measurement tools of commanders’ performances, though several performance indicators have been suggested.

Conclusion

The competence and experience of the commanders, upon which an efficient ICS has to rely, cannot be compensated significantly by plans and procedures, or even by guidance from superior organizational elements such as coordination centers. This study finds that neither a certain system or structure, or a specific set of plans, are better than others, nor can it conclude what system prerequisites are necessary or sufficient for efficient incident management. Commanders need to be sure about their authority, responsibility, and the functional demands posed upon them.

RimstadR, BrautGS. Literature review on medical incident command. Prehosp Disaster Med. 2015;30(2):1-11.

Implementation of a medical command and control team in Switzerland

In case of a major incident or disaster, the advance medical rescue command needs to manage several essential tasks simultaneously. These include the rapid deployment of ambulance, police, fire and evacuation services, and their coordinated activity, as well as triage and emergency medical care on site. The structure of such a medical rescue command is crucial for the successful outcome of medical evacuation at major incidents. However, little data has been published on the nature and structure of the command itself. This study presents a flexible approach to command structure, with two command heads: one emergency physician and one experienced paramedic. This approach is especially suitable for Switzerland, whose federal system allows for different structures in each canton. This article examines the development of these structures and their efficiency, adaptability and limitations with respect to major incident response in the French-speaking part of the country.

Enhancing the Translation of Disaster Health Competencies Into Practice

Objectives

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

Methods

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

Results

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

Conclusions

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

Proposals for Aligning Disaster Health Competency Models

To standardize the key building blocks of disaster health competency models (content, structure, and process), we recommend a reinterpretation of the research, development, test, and evaluation construct (RDT&E) as a novel organizing framework for creating and presenting disaster health competency models. This approach seeks to foster national alignment of disaster health competencies. For scope and completeness, model developers should consider the need and identify appropriate content in at least 4 broad areas: disaster-type domain, systems domain, clinical domain, and public health domain. The whole disaster health competency model should reflect the challenges of the disaster setting to acknowledge the realities of disaster health practice and to shape the education and workforce development flowing from the model. Additional issues for consideration are whether competency models should address response and recovery just-in-time learning and whether the concept of “daily routine doctrine” can contribute to disaster health competency models. The recommendations seek to establish a strategic reference point for disaster competency model alignment within the health workforce.(Disaster Med Public Health Preparedness. 2013;7:8-12)