Which organization offers training in disaster management to all levels of healthcare professionals?

Q: Why training for disasters and healthcare emergencies is important for healthcare professionals?

Although there is no consensus regarding the most effective methods of training healthcare workers in disaster preparedness,1,7–9 disaster training has been shown to improve preparedness knowledge8,10,11 and increase the ability and willingness of healthcare workers to report to work during disasters.

Q: What is disaster management in healthcare?

Disaster healthcare management is a systematic process, administrative, organizational, and operational decision-making skills and capacities, that deals with the challenges of planning in order to improve and reduce the healthcare consequences of natural disasters (13).

Q: What is the role of healthcare professionals in a disaster?

The role of public health providers is to promote, protect, and improve the health of individuals and communities. After a major disaster, public health workers are often called upon to participate in a coordinated response to save lives and prevent unfavorable outcomes to vulnerable populations.

Q: Which federal organization is primarily responsible for natural disaster planning and recovery?

When a disaster is declared, the Federal government, led by the Federal Emergency Management Agency (FEMA), responds at the request of, and in support of, States, Tribes, Territories, and Insular Areas and local jurisdictions impacted by a disaster.

Inhaltsverzeichnis Show

Topic Collection: Training and Workforce Development
Must Reads
Capabilities, Competencies, and Certifications
Sample Curricula/Guidance/Development Process Resources
Training Methods and Models
Training Methods and Models: Group Activity
Training Methods and Models: Simulation
Training Methods and Models: Virtual
Willingness to Work and Other Workforce Considerations
Agencies and Organizations
Why training for disasters and healthcare emergencies is important for healthcare professionals?
What is disaster management in healthcare?
What is the role of healthcare professionals in a disaster?
Which federal organization is primarily responsible for natural disaster planning and recovery?

Training and Workforce Development
Topic Collection
October 28, 2021

Topic Collection: Training and Workforce Development

Technical Resources
Emergency Management
Training and Workforce Development

An educated workforce is a foundational component of a prepared workforce, and a prepared workforce is critical to successful disaster response. The resources in this Topic Collection include those that discuss competencies for disaster medicine; experiences with different methods and models for health professional training and workforce development; selected general training resources to support all-hazards preparedness; tools to support training and workforce development; and considerations related to U.S. workforce development, including research on training’s effects on willingness to work during a disaster. Access the Exercise Program Collection for discussion- and operation-based exercises. The rest of ASPR TRACIE's Topic Collections have hazard-specific training information listed under the “Education and Training” category (for example, core training in incident command systems/the National Incident Management System can be found in the Incident Management Topic Collection).

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

Must Reads

The authors provide a brief review of the literature related to adequate disaster staffing, and share the methodology and results of their study that assessed the ability and willingness of healthcare personnel to report to work during a disaster. They note that healthcare personnel experience multiple barriers affecting ability and willingness to report to work during a disaster (responsibility for children being the most significant), and offer strategies for addressing these barriers. Differences between clinical and non-clinical staff responses were observed.

The authors present recommendations for ensuring a trained workforce, even when faced with resource constraints, by focusing training on learning required to improve performance, and ensuring multiple paths to learning. They note the value of informal learning opportunities outside of the classroom setting, and how such learning is less resource intensive than formal learning sessions.

This document from ASPR TRACIE describes a project to develop healthcare emergency preparedness information modules for nurses (EPIMN; modules updated in 2022) and a framework to assess the impacts and outcomes associated with implementing such modules. It includes a summary and background of the project, links to EPIMN, a case study describing the development and impact of EPIMN, an economic framework based on EPIMN, and a calculator based on the economic framework.

Johns Hopkins Hospital staff were sent an anonymous online survey to assess their willingness to respond to work after the release of a radiological dispersal device (i.e., “dirty bomb”). Of the 3,426 respondents: 39% were not willing to respond to a RDD scenario if asked but not required to do so; those who perceived their peers as likely to report to work were 17 times more likely to respond during a RDD event if asked; 27.9% with a perception of low efficacy declared willingness to respond to a severe RDD event; and perception of threat had little impact on willingness to respond.

This issue brief discusses how recent disasters have highlighted gaps, lack of training, and resource constraints related to disaster preparedness for nurses. The author notes that nurses want, and need, access to more training, and acknowledges the challenges to preparedness presented by declining funding and lack of regular engagement of nurses in exercises and training.

The authors surveyed 1,234 healthcare workers from the 2 hospitals affected by the Joplin Tornado in 2011 to assess number reporting to work, willingness to work, personal disaster preparedness, and childcare responsibilities following the disaster. The vast majority of respondents reported to work the week after the tornado, and most indicated they would have used childcare at their hospital if it was provided.

The authors randomized nursing students into 1 of 2 groups: one group received online disaster training only, and the other participated in online training, as well as a virtual reality simulation. The authors concluded that virtual reality simulation “is an instructional method that reinforces learning and improves learning retention.”

This article describes “the phased development of, and delivery strategies for, a CBRNE curriculum to enhance emergency preparedness among nursing professionals” that was developed by the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) and the National Center for Disaster Preparedness at Columbia University's Earth Institute. The curriculum, which may be customized by individual healthcare facilities, included six modules, a just‐in‐time training, and an online annual refresher course that addressed gaps identified in surveys and focus groups conducted at 20 NYC hospitals.

This webpage provides information and related publications about a project that assesses whether state laws influence the public health workforce's willingness to respond in emergencies. The project's aims include identifying and classifying variations in emergency response laws in the 50 U.S. states, and assessing the association between specific state emergency preparedness laws and willingness to respond during emergencies among the public health workforce.

This article reviews the lessons learned from Texas A & M’s “Disaster Day” training for health professional students across seven disciplines, started in 2008 by the College of Nursing. The authors note the value of the interprofessional educational opportunity this event provides, and discuss how it has “enhanced student knowledge of roles and responsibilities and appears to increase collaborative efforts with other disciplines.”

The authors conducted a literature review to “determine key components of a resilience-oriented workforce, with a focus on organizational structures, training and education, and leadership models.” They note that additional research is needed to develop strategies to support workforce resilience across disciplines.

This report describes selected aspects of the health professions workforce at the federal, state, and local levels who would respond to a catastrophic domestic natural disaster (a theoretical earthquake scenario was used). It includes recommendations regarding double counting of responders; volunteer failure to respond; an aging medical workforce; human capital development (e.g., cross-training among professionals); supporting professionals so they may respond; and readiness.

This course consists of 11 online training modules covering a variety of disaster health topics. The module on Core Competency 9 discusses ethical principles.

National Center for Disaster Medicine and Public Health. (n.d.). Resources for Competencies. (Accessed 2/12/2020.)

This webpage contains an annotated bibliography of white papers, grey literature, and publications related to disaster health competencies, categorized as per Walsh et al., 2014. Resources chosen for inclusion define specific competencies for learning in disaster health; are directed toward a health or health-related profession; and are written in English.

This article describes simulation training for donning and doffing personal protective equipment (PPE) using ‘VIOLET’ (Visualizing Infection with Optimized Light for Education and Training), a healthcare mannequin that delivers on demand, simulated bodily fluids (i.e., vomit, cough secretions, diarrhea, and sweat) containing UV-fluorescent tracers. During the simulation, healthcare staff wear PPE to assess and examine a ‘patient’ with a high-consequence infectious disease, and contamination of PPE with these simulated bodily fluids is visualized and body-mapped under UV light before and after removal.

This presentation discusses research conducted to identify influences of perceived threat and efficacy on willingness to respond in public health emergencies. Emergency-specific patterns of response willingness are reviewed, and recommendation for improving response willingness are provided.

The authors reviewed over 100 reports, articles, documents, and analyses related to whether or not responders would be willing to report to work during a disaster. They summarize the research, and present conclusions pertaining to role conflict, role strain and role abandonment, emphasizing worker safety, family support and safety, and communicating expectations and a culture of responsibility in the workplace.

The authors reviewed published literature on healthcare workers’ willingness to work during a disaster or public health emergency to identify related motivation factors. One key finding from their review was that healthcare workers are more likely to come to work if they understand their anticipated response role, and feel prepared to carry it out. The authors recommend frequent training of health care workers in disaster response, as well as the integration of such information into health professional educational curricula.

Capabilities, Competencies, and Certifications

American Board of Emergency Medicine. (n.d.). EMS –Overview. (Accessed 1/8/2020.)

This subspecialty, with biannual opportunities for qualified Emergency Medical Services (EMS) physicians to take the certification exam, subsumes disaster management and mass gathering medicine, as well as daily clinical operations of EMS agencies, content from the national incident management system (NIMS), clinical EMS, concepts in pediatric, bariatric and geriatric prehospital care, and EMS administration.

This model provides the core knowledge, skills, and abilities necessary for a student to demonstrate upon completing a master’s degree or graduate certificate in public health preparedness and response. Version 1.1 includes five domains and 22 competencies and is recommended for use by graduate-level faculty at ASPH-member Schools of Public Health, and other accredited public health programs, however these same domains and competencies are extremely relevant to ensuring prepared public health officials.

The authors developed a set of competencies under 10 domains to define the skills and knowledge necessary to respond to chemical, biological, radiological and nuclear (CBRN) emergencies. They created a training program based upon these competencies, and note that a blended training approach may allow clinicians the opportunity to participate in the same trainings, even in different time zones and locations.

This 73-page report defines core competencies for hospital personnel at the awareness level, mid-level, and advanced level, and provides guidance for determining which staff members should be in each level. Applying these competencies will assist hospitals in the development, implementation, coordination, and evaluation of disaster preparedness and response training programs.

The authors discuss peer-reviewed studies to “identify existing competency sets for disaster management and humanitarian assistance that would serve as guidance for the development of a common disaster curriculum” and conclude that variability in terminology, focus, and priorities effectively preclude common competencies at present.

The authors surveyed participants at an Emergency Medical Services conference and asked them to describe key characteristics of successful disaster/mass casualty first responders and leaders. They advocate further research into how well these characteristics correlate with successful disaster response, and recommend that they be incorporated into competency sets and trainings to support workforce development.

The authors surveyed medical, nursing, and dental students to evaluate knowledge, comfort, perceived competency, and motivation related to disaster response. Results showed that respondents’ knowledge was greater than their perceived competency, and that they were motivated to undergo additional training and respond to disasters. The authors contend that health professional students can get most of their disaster education through the existing (and slightly modified) curricula, and the addition of a few focused subjects delivered through “novel educational approaches.”

These competencies are based on the Competencies for Disaster Medicine and Public Health and are organized into four learning paths: volunteer preparedness, volunteer response, volunteer leadership, and volunteer support for community resilience.

* National Center for Disaster Medicine and Public Health. (n.d.). Resources for Competencies. (Accessed 2/12/2020.)

This 70-page document describes the four capabilities that healthcare coalitions and individual healthcare facilities need to prepare for, respond to, and recover from emergencies. The capabilities are: foundation for healthcare and medical readiness; healthcare and medical response coordination; continuity of healthcare service delivery; and medical surge. For example, Capability 1, Objective 4 covers training and preparing the healthcare and medical workforce (Objective 4, Activities 3-5 also contain specific information about exercises within the HPP program) and Capability 3, Objective 7 is focused on coordinating healthcare delivery system recovery.

The authors surveyed 10 Canadian Disaster Medical Assistance Team (DMAT) Members to define the nontechnical core competencies for disaster response, which were categorized under austere skills, interpersonal skills, and cognitive skills. The importance of specific nontechnical core competencies to interprofessional collaboration is also discussed.

Tactical emergency medical support (TEMS) is a critical component of pre-hospital mass casualty care in high-threat environments (e.g., mass shootings and terrorist attacks). This article discusses refinements of previously developed core competencies for TEMS, with the goal of national standardization of training based on these competencies, and their broader use in all hazards planning.

This document lists the core competencies under eight domains and three staff-related tier levels. Also included are links to resources and tools.

The authors provide suggestions for standardizing and aligning the building blocks of disaster health competency models. They encourage competency developers to consider content in at least 4 key areas: disaster-type domain, systems domain, clinical domain, and public health domain.

The authors identify a set of core competencies and performance objectives based on the knowledge, skills, and attitudes required by disaster medical professionals to ensure they can treat disaster survivors.

The authors review nursing and interprofessional disaster competencies and development of a new interprofessional disaster certification, and provide an overview of a standardized, competency-based interprofessional curriculum for disaster education.

The authors propose modifications to the 2012 learning framework put forth in the article, Core Competencies for Disaster Medicine and Public Health, to address discrepancies identified when they tried to fit 35 existing competency sets into the framework. The article includes a list of the 35 competency sets reviewed.

This article describes training standards (11 competencies and 36 sub-competencies) to ensure workforce competency in disaster medicine and public health. These standards were developed by an expert working group convened in 2010 by the American Medical Association Center for Public Health Preparedness and Disaster Response to review and begin to integrate previous work on core competencies.

Research

The authors studied lessons from aviation and discuss how they can be applied to emergency physicians and overall patient safety.

The authors reviewed nearly 300 articles published between 2008 and 2018 to determine evidence-based team intervention practices. They grouped interventions into four categories: training, tools, organizational (re)design, and programs. Overall, they found “principle-based training” (e.g., TeamSTEPPS) and simulation-based training provided the “greatest opportunities for reaching the improvement goals in team functioning.”

The authors compared learning outcomes (i.e., knowledge gained; confidence with evacuation; and performance in a live exercise) among newborn intensive care unit (NICU) workers who underwent virtual reality simulation (VRS) emergency evacuation training versus those who received web-based clinical updates (CU). Those in the VRS cohort performed significantly better than those in the CU cohort.

The authors tested “chunked” crew resource management (CRM) training into 15-minute sessions with medical students who had experience treating patients. Results indicated that training in these “chunks” was promising; for example, “a traditional lecture was outperformed by an instructional video demonstrating a practical example.”

This resource discusses a survey of 313 nurses and nursing students from across the United States that assessed ability and willingness to report to work during a disaster. Results indicated that: respondents were least likely to report following a radiological/nuclear event; the majority do not have personal preparedness plans; and feeling prepared to respond and supported by their workplace (e.g., safe environment; adequate staffing overall) positively impacted willingness to work.

This report summarizes presentations and discussions from a workshop held to explore technologies that bridge the gap between education and clinical practice, and their potential for improving education and practice.

The Veterans Health Administration National Center for Patient Safety established Clinical Team Training (CTT), based on Crew Resource Management training principles. A questionnaire that was used before and after the training found statistically significant differences in areas such as communication, teamwork, and patient safety.

The authors conducted a workforce assessment of 398 patient care providers in South and North Carolina to determine their emergency preparedness training needs and preferences. They found that providers felt better prepared than 10 years prior, but still desired additional training. Primary obstacles to training were found to be time and financial constraints, and that most employers do not require it. Survey responses suggest that developing short (<1 day) courses that combine performance assessments with a scenario-based environment could be valuable for increasing preparedness.

This article discusses a new statistical model for analyzing data from a validated survey to assess healthcare workers’ willingness to respond after an earthquake, and how results compare to those determined by the more traditional model. The results of the analyses are also presented: females under the age of forty, and nurses were found to be the least likely to respond in earthquake events; and professional commitment to care and perception of efficacy were the most powerful predictors associated with willingness to respond.

This five-year initiative explored the premise that “national preparedness and emergency response is not solely the responsibility of government.” The vast majority of participants in these summits (n=36 summits over five years) gave the summit high marks, and nearly 80% reported using meta-leadership concepts or principles six months post-summit.

The authors conducted focus groups with 46 local health department stuff to explore factors related to willingness to work during an infectious disease outbreak. They present “a proposal for how a web of ethical commitments likely influences willingness to respond.”

Sample Curricula/Guidance/Development Process Resources

Agency for Healthcare Research and Quality. (n.d.). TeamSTEPPS. (Accessed 2/11/2020.) U.S. Department of Health and Human Services.

This set of teamwork tools can help healthcare professionals optimize patient outcomes. The webpage includes links to curriculum materials, a master trainer course, webinars, and research and evidence-based articles.

This document outlines a disaster medicine curriculum for emergency medicine residents. Topics covered include: Common Challenges in Response to Disaster; Management of Medical Response in Disaster; Key Operational Capabilities; Special Populations; and Critical Medical Knowledge (by hazard type). The curriculum also includes an hour-long tabletop exercise.

This book covers the following concepts as they relate to patient safety and crisis resource management in acute care medicine: attention and awareness; decision making; verbal communication; task management; leadership and followership skills; and teamwork.

This presentation discusses best practices for leadership during a crisis, including characteristics of effective leaders, obstacles to effective leadership, and tools to support leadership.

This interactive 6-hour course was created as part of the National Nurse Emergency Preparedness Initiative to provide emergency preparedness training for nurses working in various setting. It uses scenario-based learning to demonstrate the application of theory, and practice.

This poster describes the development and implementation of an interprofessional education disaster preparedness curriculum for health profession students. Students that complete the mandatory and elective components of the training are Hospital Emergency Response Team (HERT) certified, and become part of the hospital’s disaster response and decontamination team.

This article describes the concept of meta-leadership and how it has been applied in disasters. The authors provide an overview of the three dimensions of meta-leadership (the person, the situation, and connectivity) and how the framework can be used to manage employees and supervisors.

This classic article describes the concept of meta-leadership and how this model that emphasizes critical thinking and cross-organizational collaboration can benefit national emergency preparedness.

The Minnesota Department of Health trains staff in sheltering, relocation, and evacuation by grouping them into one of three categories (all staff, operations, and command staff). This matrix highlights training competencies by group.

This webpage provides links to course materials to train individuals responsible for leading responses to emergencies or disasters with public health implications. Course content includes: the importance of leadership skills; critical interpersonal communication skills; how to build a reliable team; and how to manage an Incident Management Team.

National Preparedness Leadership Initiative. (n.d.). Meta-Leadership. (Accessed 2/11/2020.) Harvard T.H. Chan School of Public Health.

This webpage includes information on the meta-leadership framework. The curriculum includes a framework and tools for mastering three dimensions: the person, the situation, and connectivity. There are links to training information, podcasts, and articles.

This article describes a curriculum for community health workers developed to train them to support disaster response and recovery in their communities. Lessons learned from the series of trainings held from 2013-2016 and how they were translated into curriculum modifications over time, are discussed.

This paper discusses an international project to survey “the current provision of disaster medicine education, the design considerations for a Disaster E-Health (DEH) program for health professionals, the key curriculum topics, and the optimal delivery mode.” The authors define DEH as “the application of eHealth technologies to assist the prognosis and treatment of the sick and injured in a disaster and to support appropriate care in the post-disaster situation.”

This webpage provides an overview of the TRAIN Learning Network, which is comprised of three primary components: TRAIN Affiliates (agencies that work together on the TRAIN LMS platform); TRAIN Course Providers (e.g., government agencies, academic institutions, professional associations) who post content on TRAIN that is then reviewed for inclusion in a catalog); and TRAIN Learners (which includes public health, healthcare, and preparedness professionals from the U.S. and 177 other countries).

The authors created a core curriculum of 40 disaster medicine educational topics for emergency medicine residencies. This included the following topics: patient triage, surge capacity, introduction to disaster nomenclature, blast injuries, mitigation, hospital response to chemical mass-casualty incident (MCI), decontamination, trauma MCI, disaster exercises and training, biological agents, personal protective equipment, and hospital response to radiation MCI.

Stanley, S. and Wolanski, T. (2015). Designing and Integrating a Disaster Preparedness Curriculum: Preparing Nurses for the Worst. (E-book available for purchase.)

This book provides recommendations and best practices for incorporating disaster preparedness into nursing curricula, and includes information on leadership and interprofessional education. The recommended strategies may be applicable to training programs for other health professional disciplines.

This crosswalk was created by (YNHHS-CEPDR), in collaboration with a number of national subject matter experts. Emergency and disaster related program, policy, communication, training and exercise elements of regulatory and accreditation standards were mapped to the CMS Emergency Preparedness Conditions of Participation. Every effort was made to ensure that the mapped regulations and accreditation standards matched as closely as possible. However, this document should be used only as a resource for reviewing and updating healthcare emergency preparedness plans and does not replace existing federal, local, or association guidance.

Training Methods and Models

The authors describe findings from a survey of prehospital healthcare providers to determine mass casualty event (MCE) training knowledge retention, self-assessed levels of preparedness for MCEs, and preferred educational formats. Nearly a quarter of those surveyed reported no training in the past year and respondents felt least prepared for a radiological/nuclear event. Drills and lectures were the most used and preferred formats for disaster training.

Paramedics and emergency medical technicians at four training sites showed sustained improvement in primary triage decisions in three different simulations: a school shooting scenario, a multiple family house fire, and a school bus rollover. Participants completed a first simulation with debriefing, and then returned to perform a second simulation two weeks later, showing 10% improvement in triage accuracy. The improvement was sustained six months after the initial training, as demonstrated by completing a third simulation.

Nurses participated in a combination of online and onsite training, followed by an exercise, as part of an interprofessional disaster training program. Pre-and post-training test results, as well as exercise evaluation, showed a significant increase in knowledge measured in the areas of triage, re-triage, surge response, and sheltering.

The authors conducted a literature review to identify training opportunities for healthcare providers in the United States, and found that most were focused on emergency management, and not clinical care delivery. They state a need for a course for non-disaster trained emergency medicine physicians and trainees that is available online and incorporates a mix of educational modalities to prepare providers for acute disaster response.

This article describes a 5-hour emergency preparedness training targeted to interprofessional teams of first receivers that incorporated didactic and small group trainings, followed by practice in a large patient simulator designed to recreate “environmentally challenging (i.e., flood evacuation), multi-patient scenarios using a novel technique developed to utilize trainees as actors.” The training was evaluated by trained observers, and participants completed pre-tests, post-tests, and self-assessments of comfort level with disaster preparedness. Results showed significant improvement in knowledge and comfort level among all participants.

The authors discuss “current challenges and opportunities for the expansion of evidence-based education and training opportunities for health care workforce disaster readiness.” Challenges include the lack of evidence-based training programs for health professionals.

This course consists of 11 online training modules covering a variety of disaster health topics. The module on Core Competency 9 discusses ethical principles.

This article identifies five key characteristics of an effective, interprofessional team in a high-risk, high-pressure situation: training persistence, a wide range of clinical expertise, joint problem solving and creativity, a commitment to learning, and courage.

A semi-structured interview was conducted with a sample of leaders of 9 well-established preparedness-focused health care coalitions (HCCs) to determine education and training needs, challenges, and promising practices. Training topics identified as priorities included chemical, biological, radiological, nuclear, and explosives (CBRNE), and mass-casualty incidents. The authors note that “an online resource repository would help reduce the burden on individual coalitions by eliminating the need to continually develop learning opportunities.”

Training Methods and Models: Group Activity

The authors developed a novel training model for using mass-casualty incident (MCI) scenarios that trained hospital and prehospital staff together during a 1-day training that included pre- and post-tests, 2 hour-long functional exercises, and 4 distinct, hour-long didactic instructional periods. Improvements were observed in post-test scores for all disciplines, and the authors advocate that disaster training be provided “with all disciplines represented to eliminate training ‘silos,’ to allow for discussion of overlapping jurisdictional or organizational responsibilities, and to facilitate team building.”

The authors discuss how they used 6 specific exercises as part of a ‘Disaster Olympix’ to train staff to respond to pediatric disaster victims.

The authors discuss the development of a program developed by an academic-practice partnership. Senior leadership and frontline clinicians were trained via simulation, workshop, and online modules.

The authors describe their experience with a pilot study that leveraged medical students’ participation in a local disaster exercise and mass gathering event to enhance the emergency preparedness training that was provided through lectures, simulations, and asynchronous learning materials.

Medical students participated in a 90-minute didactic training scenario and 2, 40-minute training exercises (a hazardous material scene and a surprise mass casualty incident (MCI) scenario with 100 life-sized mannequins) added to an existing medical school curriculum. Pre- and post-tests were administered to assess student perceptions and disaster medicine knowledge. Post-test scores improved by 54%; students participating in the MCI drill correctly tagged 94% of the victims in approximately 10 minutes; and participants rated the course very favorably.

The authors provide a detailed description of an 8-hour interprofessional emergency preparedness training that incorporated an online pre-test, two post-tests, course assessment, didactic and small group content, and a 6-minute clinical casualty scenario using high-fidelity and low-fidelity simulators and live actors. Knowledge, comfort level, and emergency preparedness skills increased for both experienced providers, and medical students that participated in this multi-modality course.

Training Methods and Models: Simulation

This article describes the development and results of a simulation-based training program for healthcare workers in Saudi Arabia that was focused on donning of personal protective equipment (PPE) to care for a person under investigation with Ebola. The curriculum consisted of a needs assessment, Train-the-Trainer session, 10 PPE courses, and a post-intervention drill. Significant improvement in the skills of the participants was noted through comparison of pre-test and post-test scores.

This document “underscores the helpful role simulation can serve in response to the Ebola virus disease, other emergent epidemic challenges, provider and patient safety, and quality of care in general.” Simulation's essential features and benefits, approaches and uses, the concept of mastery learning, and some selected lessons learned that still represent a challenge are also discussed.

Pediatric emergency medicine physicians, and critical care and pediatric surgery residents, participated in a simulation-based workshop to increase their knowledge and confidence to respond to a disaster involving children. Program evaluations indicated an increase in physicians’ perceived preparedness for pediatric disaster response; this confidence persisted 6 months post-training.

This article describes a multipatient simulation exercise that requires hospital medical providers to rapidly classify and disposition mass casualty incident (MCI) patients, using a format that allows two teams to participate in identical simulations coupled with active audience observation, followed by facilitated group discussion. All of the participants reported good/excellent ability to accomplish MCI initial triage and patient disposition after the exercise.

Pediatric residents received a didactic training in preparation for participation in a series of simulation exercises using actors and low- and high-fidelity patient simulators as part of a multi-victim school shooting scenario. A group structured debriefing followed the first simulation, and new 10-victim simulation exercises were presented 1 week later, and again 5 months later. Participants demonstrated significant improvement of triage skills during the second simulation, and retained that improvement during the third simulation.

Physicians, residents, medical students, clerks, and paramedics participated in a study that compared high-fidelity simulators and use of trained actors to test their responses during 8 different scenarios. Participants’ performance was similar for both simulation methods, and all indicated that “the simulators closely mimicked real-life scenarios, accurately represented disease states, and heightened the realism of patient assessment and treatment options during the drill.”

Nursing students in three levels of their undergraduate program received didactic preparation in disaster preparedness and were assigned to five different simulation response teams. The course was determined to be effective at increasing disaster medicine knowledge: 5 of the 8 nursing students assigned to the disaster site correctly triaged 81.2% of the victims; all 8 nursing students assigned to the emergency department correctly reassessed the victims.

To address errors observed in the emergency department during disasters, this mixed method pilot project was initiated to evaluate the effect of in situ simulation on providers’ knowledge of how to perform during a disaster, and competency in skills related to those actions, as well as on communication during a disaster. The authors contend that results demonstrate that in situ simulation can improve knowledge and communication during a disaster situation.

An interprofessional curriculum employing simulation as a core teaching strategy was used to train experienced clinicians in preparation for operating a freestanding emergency department. Disaster preparedness training included didactic and scenario-based learning, as well as high-fidelity simulation mannequins and moulaged actors. Two days of onsite simulations at the end of the 10-week training period “revealed latent safety threats, lapses in communication, issues of intake procedure and patient flow, and the persistence of inapt or inapplicable mental models in responding to clinical emergencies.”

The authors developed and tested a 10-hour simulation-focused interprofessional curriculum for health professions students to “(1) test the effectiveness of specific immersive simulations, (2) create reliable assessment tools for emergency response and team communication skills, and (3) assess participants' retention and transfer of skills over time.” They include details of the curriculum and evaluation methodology, as well as results of knowledge tests and qualitative evaluations, conducted immediately after the course, and again 6-12 months post-course.

This article describes a comprehensive, multi-modality approach focused on simulation to teach disaster medicine to emergency medicine residents in a 3-year curriculum that included classroom lectures, tabletop exercises, virtual reality simulation, high-fidelity simulation, hospital disaster drills, and journal club discussion. Participants felt better prepared to respond to disasters after completing this training program.

This article explains the planning process and achieved outcomes for an interprofessional training for nursing students and first responders using a bus crash simulation to practice mass casualty incident protocols.

Internal medicine residents participated in a disaster medicine curriculum that included didactic lectures, supplemental readings, and training with high-fidelity human simulators. Compared with residents who did not receive any training, participants’ knowledge increase was significant, as was their subjective sense of preparedness. However, knowledge gain was not maintained at the 1-year follow-up point, which the authors note suggests the need for ongoing reinforcement of learning.

Pediatric residents participated in a tabletop simulation that included 3 pediatric earthquake victims. Confidence in treating earthquake victims improved significantly post-simulation. The authors conclude that tabletop simulations are effective at improving residents’ comfort with responding to rare events.

Training Methods and Models: Virtual

The authors conducted a study to “determine if a fully immersive virtual reality disaster drill is as effective as a comparable live disaster drill using standardized patients in teaching and assessing START triage knowledge and skills for EM residents.” Pre-test results and triage accuracy among the two groups were similar, and results from the post-test, conducted 2 weeks post-training, showed greater knowledge retention among participants in the group that used standardized patients/mannequins. The authors concluded that the 2 training methods were equally effective, and that virtual reality is more cost-effective, and allows for flexibility in disaster scenarios used for training.

The authors describe an online, workplace-based, interprofessional course in surge capacity building in which 72 health and allied staff from five acute care and community health care organizations participated. Surveys were used to assess self-reported improvements in learners' perceptions of their competency, their interprofessional skills, and satisfaction with the different course delivery options (online only; online plus a tabletop exercise; online plus a tabletop exercise and e-simulation). The authors contend that results demonstrate the effectiveness of online learning, particularly with the addition of a tabletop exercise.

This article describes two pilot simulations utilizing a Virtual Laboratory and Imaging system designed to increase the realism of full-scale mass casualty incident (MCI) simulations by dynamically managing the speed and load of virtual departments while collecting data on usage and load. Such data may be used to identify potential bottlenecks in MCI response plans.

This study demonstrated that playing a web-based simulation (video game) is associated with improvements in pediatric and adult primary triage decisions. The study population included paramedics and EMTs, and prehospital healthcare students.

The authors tested the feasibility and reliability of assessing technical and non-technical disaster medicine skills across 3 multi-agency scenarios (1 pre-hospital and 2 in-hospital) within a virtual environment. The authors conclude that the results indicate that virtual technologies may be used to improve major incident response training.

This paper describes how a cognitive task analysis, supported by a live demonstration with a think-aloud protocol, was used to collect the rich psychomotor, procedural, and cognitive data necessary for the design of a serious game for donning personal protective equipment to handle patients with a potential highly infectious disease (e.g., Ebola). The paper also presents a process to translate the collected data into meaningful content to support rapid prototyping of the serious game.

The authors conducted a literature review of the published evidence from 2005-2012 related to the use of virtual reality for disaster training of healthcare workers. They concluded that too few studies had been done, and that future studies must measure long-term retention of knowledge; ability to respond to different types of disasters; and performance in different tasks, such as triage, decontamination, and transport.

The authors translate research findings related to the use of virtual reality simulation in disaster training into education practice. They discuss practice guidelines, implementation recommendations, and integration to practice and evaluation.

This article describes a small pilot program of training delivered to emergency department staff to prepare for patient surge using a multi-user virtual environment (MUVE). Participants all reported an increase in disaster preparedness knowledge, and improved team communication, planning, team decision making, and the ability to visualize and reflect on their performance.

Twenty-two experienced physicians and nurses practiced caring for patients exposed to either a nerve toxin or a dirty bomb within a virtual emergency department. Confidence to respond to chemical, biological, radiological, or nuclear/explosive mass casualty incidents increased from 18% pre-training to 86% post-training, and 59% of respondents felt that this was due to the virtual learning platform.

The authors review several applications of virtual reality-based training in the United States, and discuss advantages, and potential drawbacks and challenges associated with virtual reality as a learning platform.

The authors compared accuracy and efficiency of triage by fourth-year medical students using the START method with virtual reality or live simulation of a mass casualty incident. They found no difference in accuracy or speed of triage between the two tools.

The authors studied the feasibility and effectiveness of an interactive, computer-assisted training course designed to build resilience to the stresses of working during a pandemic. They measured confidence in support and training; pandemic-related self-efficacy; coping style; and interpersonal problems, before and after training, and found that the course was associated with improvement in each variable, with the “medium” duration course providing the greatest benefit. The course is free and may be accessed at https://www.msh-healthyminds.com/sv/.

The authors discuss the design and validation of an online hospital that allowed multiple clinicians to respond simultaneously to care for virtual mass casualty patients within limits of the hospital’s available resources. The authors conclude that the “customizability, reproducibility, and recordability combined with the low cost of implementation suggest that this potentially represents a powerful adjunct to existing training methods.”

The authors tested the use of a policy management game in which participants act as incident commanders with the goal of teaching them how to quickly evacuate an emergency site, to minimize the number of fatalities at the incident site, and to decrease patients’ waiting time for treatment. Participants rated the game favorably, and improvement in their skills was observed, although there were differences in performance across the different groups (students, practitioners, and researchers).

Willingness to Work and Other Workforce Considerations

The authors reviewed literature through to 2013 that discussed healthcare workers’ willingness to work during an influenza pandemic, and found that willingness to work ranged from 23.1% to 95.8%, depending on the context. Male gender, physicians and nurses, full-time employment, perceived personal safety, awareness of pandemic risk and clinical knowledge of influenza pandemics, role-specific knowledge, pandemic response training, and confidence in personal skills were statistically significantly associated with increased willingness. Childcare obligations were significantly associated with decreased willingness.

The authors discuss findings of a nationally representative survey of Emergency Medical Services (EMS) providers that indicated that hazard-specific education; an understanding of one’s response role; and confidence in occupational safety positively influence respondents’ willingness to respond during a pandemic. However, the authors note that EMS workers indicated they were less likely to respond if they felt their family was in danger, particularly if risk of disease transmission to family members was high.

The author conducted a literature review (25 quantitative and 2 qualitative studies) on willingness to work and found pet care needs and the lack of personal protective equipment were top barriers.

The authors surveyed 1,822 hospital employees (clinical and non-clinical) to determine willingness to work during an earthquake versus a pandemic. They found that willingness to work may be increased by considering care for dependent family members, and by providing greater worker protection, cross training, and job importance education for staff.

The authors surveyed clinical and non-clinical support staff at the Children’s Hospital in Denver in 2007. Willingness to respond was associated with higher levels of professionalism, and non-clinical support staff were found to be significantly less likely to report during a pandemic, suggesting the need for additional training for these staff members to help them understand the value of their roles

The authors surveyed physicians, nurses, and pharmacists in Florida in 2009 to assess their ability and willingness to respond to bioterrorist attacks. Only 32% were determined to be competent and willing to respond, with the lowest competency seen in the ability to identify cases and the ability to communicate risk to others. Previous training and drill participation were found to be significant predictors of preparedness.

The author evaluated 32 peer-reviewed, quantitative articles published from January 2001-June 2010 to determine willingness to work during an influenza public health emergency. He found that “factors associated with a willingness to work during an influenza public health emergency include: being male, being a doctor or nurse, working in a clinical or emergency department, working full-time, prior influenza education and training, prior experience working during an influenza emergency, the perception of value in response, the belief in duty, the availability of personal protective equipment (PPE), and confidence in one's employer.” Preferential treatment of healthcare workers and their families for the receipt of vaccines and antivirals were noted as the interventions that most positively influenced willingness to work.

The authors surveyed hospital and public health workers to assess their willingness to respond to a pandemic influenza emergency scenario and a radiological 'dirty' bomb scenario. They found that respondents that felt psychologically prepared were more willing to respond, and self-reported willingness to respond was influenced by perceived self-efficacy and perceived family preparedness.

The authors conducted a national survey of pediatric nurse practitioners to learn about their personal preparedness plans, disaster training, prior disaster experience, and likelihood of responding in the event of a disaster. They found that those who were male, had prior military experience and disaster training, and had a defined role in response plans were most likely to respond during a disaster.

A web-based survey of anesthesiologists was conducted to assess self-reported perceptions of knowledge and skills, as well as attitudes and beliefs regarding education and training, employee development, professional obligation, safety, psychological readiness, efficacy, personal preparedness, and willingness to respond during a natural disaster, pandemic flu, and a radiological event. Few respondents indicated that they think they receive sufficient education for disaster response, and most think that their hospitals should provide this training to them. The authors recommend that additional training be provided, and support for staff to meet family obligations be put in place to encourage providers to come to work during disasters.

The authors discuss disaster response requirements for Family Medicine residents, and note that there is little outcomes-based evidence to support them in the literature.

The authors conducted a review of scientific articles conducted from 2006 to 2016 on nurses’ preparedness for disasters, and found that nurses are insufficiently prepared and do not feel confident responding effectively to disasters. Previous disaster response experience and disaster-related training were found to increase preparedness. The authors note that more, realistic disaster exercises are needed to further prepare nurses.

Physicians and physician assistants from 21 specialties were surveyed to examine their perceptions related to roles and responsibilities of clinicians in a disaster; barriers to participation; implementation of chemical, biological, radiological, nuclear, and explosive training; and training preferences. Respondents indicated that concerns about risk and malpractice, the cost of training, the time involved in training, and the cost for the time in training were all barriers to training. There were no clear preferences for training strategies.

The authors administered a survey to emergency department staff to determine if household preparedness correlates with likelihood of reporting to work during a disaster. Household preparedness did not have an effect on self-reported likelihood of reporting during a disaster. Having dependents in the home; female gender; past disaster relief experience; having a spouse or domestic partner; and not owning pets were factors found to be associated with predicted absenteeism, though this varied based on disaster type.

Conference attendees from government and nongovernmental organizations, academia, and the private sector discussed the current status of medical and public health preparedness for a nuclear incident, examined how increasing concerns about the use of nuclear warfare could lead to potential changes in these assumptions, and discussed capacity building opportunities and challenges in the current threat environment. Chapter 8 discusses considerations for workforce capacity and willingness to respond.

This study explored willingness to work among medical, nursing, and pharmacy students. Medical students indicated they were most willing to work, and greater willingness to work was associated with prior disaster training. The authors cite the “remarkable underemphasis on disaster preparedness in health care curricula,” and note how important it is to prepare health professional students, who will become the healthcare workforce.

Medical students were asked to participate in an online disaster training consisting of 4 modules to determine if the training helped them feel more prepared to respond during a disaster, and if it would affect their willingness to volunteer during an emergency. Pre- and post-survey results showed a significant increase in perceptions of preparedness among participants, though the course did not affect the initially high level of willingness to volunteer.

A survey of more than 6,400 healthcare workers (HCW) in New York City revealed that “in terms of willingness, HCWs were most willing to report during a snow storm (80%), MCI (86%), and environmental disaster (84%) and least willing during a SARS outbreak (48%), radiological event (57%), smallpox epidemic (61%), and chemical event (68%).” Barriers included childcare, elder care, and pet care, but the authors noted that many barriers were also open to interventions.

The authors surveyed bioterrorism coordinators and emergency managers for 31 hospitals in a suburban area to determine which staff members were considered “essential” for disaster response, and if essential staff had been trained on their emergency response roles. Emergency physicians, nurses, and support staff were the 3 categories of staff most often cited, and some hospitals noted that these staff members had not been trained in their roles.

Researchers conducted a national poll among 1,603 practicing physicians in a range of specialties in hospital and nonhospital settings to assess their preparedness and training for emergency response (among other things). Results indicated that there were significant gaps among physicians’ preparedness for public health emergencies, and their participation in trainings and other institutional preparedness activities. The authors recommend collaboration between hospitals and public health agencies to develop useful educational tools, and incorporate online resources into training.

The authors discuss the future of nursing in disaster preparedness and response, and provide recommendations for nursing practice, education, policy, and research to enhance preparedness among nurses. Current barriers and opportunities to advance professional disaster nursing are also included.

The authors surveyed hospital-based pediatric staff in 2009 to characterize their perceptions of, and willingness to respond during, public health emergencies, with the goal of developing a methodology for an institution-specific training package to improve response willingness. The vast majority of respondents indicated a need for more training to respond to the survey scenarios (pandemic influenza and radiological dispersal device), and the authors found six “distinct perceived attitudes/beliefs that had an institution-specific high impact on response willingness: colleague response, skill mastery, safety getting to work, safety at work, ability to perform duties, and individual response efficacy.”

Agencies and Organizations

Why training for disasters and healthcare emergencies is important for healthcare professionals?

Although there is no consensus regarding the most effective methods of training healthcare workers in disaster preparedness,¹^,⁷^–⁹ disaster training has been shown to improve preparedness knowledge⁸^,¹⁰^,¹¹ and increase the ability and willingness of healthcare workers to report to work during disasters.

What is disaster management in healthcare?

Disaster healthcare management is a systematic process, administrative, organizational, and operational decision-making skills and capacities, that deals with the challenges of planning in order to improve and reduce the healthcare consequences of natural disasters (13).

What is the role of healthcare professionals in a disaster?

The role of public health providers is to promote, protect, and improve the health of individuals and communities. After a major disaster, public health workers are often called upon to participate in a coordinated response to save lives and prevent unfavorable outcomes to vulnerable populations.

Which federal organization is primarily responsible for natural disaster planning and recovery?

When a disaster is declared, the Federal government, led by the Federal Emergency Management Agency (FEMA), responds at the request of, and in support of, States, Tribes, Territories, and Insular Areas and local jurisdictions impacted by a disaster.