Introduction
This report summarizes findings from the nine papers presented at the World Congress on Disaster and Emergency Medicine (Session: BO-17).
Issues Raised
The main issues discussed in the session could be divided broadly into four themes: studies on (1) competency; (2) competence; (3) other factors relating to competence/competency; and (4) educational program evaluation.
Theme 1: Competency
Competency is a knowledge, skill, or attitude that enables the person to perform up to a required standard. 1 In this session, three studies examined the concept of competency. One study conducted an integrative review on the use of the term on disaster preparedness in global settings,Reference Birnbaum and Daily 2 whereas the other two adopted the International Council of Nurses (ICN; Geneva, Switzerland) framework of disaster nursing competenciesReference Bell, Hutton, Wybrecht, Mckenzie and Veneema 3 to examine nurses’ educational needs in disaster relief training 4 and to identify hospital nurses’ competencies in disaster situations.Reference Wu, Wang, Yeh, Chang, Tsai and Kung 5
Theme 2: Competence
As competence is the state of being competent or adequately qualified with the acquisition of a set of competencies, 1 two studies focused on how competent health care workers are in educational and clinical settings: one analyzed the ability of the Prehospital Trauma Life Support (PHTLS) and Advanced Trauma Life Support (ATLS) providers to use the mnemonic “ABCDE” to perform triage in a simulated mass-casualty incident,Reference Marin and Witt 6 while the other study compared the precision and accuracy of sonographic optic nerve sheath diameter (ONSD) measurements among ultrasound fellowship-trained and resident emergency medicine physicians by means of inter-rater reliability in an emergency department.Reference Lampi 7
Theme 3: Other Factors Relating to Competence/Competency
The scope of discussion on competence or competency was extended to two other factors. The development of a training program targeting inter-cultural competency for civil protection providersReference Oberfoell, Murphy, French, Trent and Richards 8 was presented, while another study examined nurses’ perception of the disaster environment on their responses.Reference Hannig, Kietzmann, Schonefeld, Kehl, Knuth and Schmidt 9
Theme 4: Educational Program Evaluation
Two educational programs with different training modes (a 6-month online course in disaster and medical humanitarian response,Reference Ruskie 10 and a five half-day community first-aid training programReference Liu, Lee and Chan 11 ) were evaluated.
Principal Findings
Theme 1: Competency
No global consensus was achieved for defining competency pertaining to disasters, and the use of non-standardized definitions and competencies in disaster research was common.Reference Birnbaum and Daily 2 A similar conclusion was drawn from a recent systematic reviewReference Lin and Kwoh 12 of more than a thousand references: there is no agreement for defining core competencies in disaster management and humanitarian assistance. With reference to the ICN disaster competency framework, Taiwanese nurses considered themselves competent in disaster nursing, 4 whereas Brazilian nurses mapped out 17 competencies that are required specifically in disaster situations.Reference Wu, Wang, Yeh, Chang, Tsai and Kung 5
Theme 2: Competence
Using mnemonics as an educational tool to enhance competence among PHLTS and ATLS providers in a simulated environment, no statistical significance during pre-test and post-test assessment was noted.Reference Marin and Witt 6 Physicians trained in ultrasound fellowship were found to be more precise than the resident emergency medicine colleagues in measuring sonographic ONSD with resident emergency medicine physicians lacking both precision and accuracy.Reference Lampi 7
Theme 3: Other Factors Relating to Competence/Competency
Preliminary qualitative results indicated that nurses with prior disaster deployment experience are not prepared for the austere environmental conditions of disasters, which may have altered their performance in that setting.Reference Hannig, Kietzmann, Schonefeld, Kehl, Knuth and Schmidt 9 Environmental stress also was observed with abrupt transitions of environment.Reference Hannig, Kietzmann, Schonefeld, Kehl, Knuth and Schmidt 9 With regards to cultural aspect, a pilot modular cultural competence training program, including intercultural stress in emergency responses, illustrated that the training provided was acceptable to migrant participants who were affected previously by emergencies.Reference Oberfoell, Murphy, French, Trent and Richards 8 Qualitative data indicated that more specific, practical applications should be included.Reference Oberfoell, Murphy, French, Trent and Richards 8
Theme 4: Educational Program Evaluation
Positive preliminary results were found in the pilot community first-aid educational program.Reference Liu, Lee and Chan 11 Hands-on first-aid skills including Basic Life Support and fracture stabilization were included, and the interest in acquiring these first-aid skills was high.Reference Liu, Lee and Chan 11 The completion rate for the online disaster and medical humanitarian response training course among the first cohort of 1,075 participants was approximately 20% with more than 80% of the course participants indicating fulfillment of their learning expectations.Reference Ruskie 10
Implications for Best Practices
Broader Sense of Competency
Despite the lack of a universally agreed upon definition of competency in disasters,Reference Birnbaum and Daily 2 culturalReference Oberfoell, Murphy, French, Trent and Richards 8 and environmentalReference Hannig, Kietzmann, Schonefeld, Kehl, Knuth and Schmidt 9 perspectives are important aspects to consider in the consensus of the definition, and subsequent development of educational and training programs, especially in terms of cultural competenceReference Oberfoell, Murphy, French, Trent and Richards 8 and environmental stress among nurses.Reference Hannig, Kietzmann, Schonefeld, Kehl, Knuth and Schmidt 9
Disaster Competency-based Training
Since adequately qualified and competent health care workers are essential in disaster and emergency responses, tailored design of training curriculumReference Marin and Witt 6 and specialized training programsReference Lampi 7 may be useful in building relevant competencies. In addition, future disaster-related education and training needs to be competency-based and targeted on understanding the relationship between the cultural and environmental factors and the corresponding core competencies.Reference Ripoll Gallardo, Djalali and Foletti 13
Mode of Training
As for educational and training program evaluation, a community program on first aid for high-school and college-level citizens,Reference Liu, Lee and Chan 11 as well as an online educational program on disaster and medical humanitarian responses,Reference Ruskie 10 were feasible, financially viable, and have demonstrated potential for further development. Disaster education and training can no longer be confined to classroom settings. However, longer-term and in-depth research is required, as most of the positive findings presented in this session were pilot 4 , Reference Oberfoell, Murphy, French, Trent and Richards 8 , Reference Hannig, Kietzmann, Schonefeld, Kehl, Knuth and Schmidt 9 , Reference Liu, Lee and Chan 11 studies or with relatively smaller sample sizes.
