Southeast Asia is the second biggest region in the world in terms of the total number of natural disasters since 1900. Therefore, the Association of Southeast Asian Nations (ASEAN) initiated regional challenges toward strengthening regional collaboration for disaster prevention and response since the earthquake of Sumatra in Indonesia occurred in 2004. Moreover, ASEAN Leaders signed “the ASEAN Declaration on One ASEAN, One Response” in 2016. Under these circumstances, ASEAN decided to implement the Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project).

The objective of the ARCH Project is to strengthen coordination on disaster health management (DHM) for rapid and effective response to disasters occurring in the ASEAN region and to enhance the capacity of each ASEAN Member State (AMS) on DHM. This article aims to overview the outline and its strategy, and review the progress of the project.

ARCH Project is an ASEAN official project supported by Japan’s official development assistance. Five outputs were launched for: (1) coordination platform on DHM; (2) framework of regional collaboration practices; (3) tools for effective regional collaboration; (4) enhancement of academic network on DHM; and (5) capacity development activities for each AMS. The Project was reviewed in terms of accomplishment and evaluation criteria.

Regional Coordination Committee on DHM was established as a coordination platform to: Oversee the implementation of the ARCH Project for the Output 1; Regional Collaboration Drill was developed and conducted for the Output 2; The standard operating procedure for coordination of emergency medical teams (EMTs) in ASEAN was developed for the Output 3; Various presentations on ARCH were made in academic conferences for the Output 4; and Several training programs and educational curricula were developed for the Output 5. The Project has accomplished its Project Purpose and satisfied all the indicators set. ARCH Project has high Relevance, Impact, Sustainability, and Effectiveness, while some improvements in Efficiency are needed.

ARCH Project is the first-ever successful regional cooperation mechanism and standardization of DHM in ASEAN, one of the most disaster-prone regions. It also contributes to the capacity building of AMS. The ARCH Project has a remarkable impact on the resilience and flexible medical response to disasters, although continuous efforts of stakeholders to make this initiative sustainable are necessary.

Emerging evidence is guiding changes in prehospital management of potential spinal injuries. The majority of settings related to current recommendations are in resource-rich environments (RREs), whereas there is a lack of guidance on the provision of spinal motion restriction (SMR) in resource-scarce environments (RSEs), such as: mass-casualty incidents (MCIs); low-middle income countries; complex humanitarian emergencies; conflict zones; and prolonged transport times. The application of Translational Science (TS) in the Disaster Medicine (DM) context was used to develop this study, leading to statements that can be used in the creation of evidence-based clinical guidelines (CGs).

What is appropriate SMR in RSEs?

The first round of this modified Delphi (mD) study was a structured focus group conducted at the World Association for Disaster and Emergency Medicine (WADEM) Congress in Brisbane Australia on May 9, 2019. The result of the focus group discussion of open-ended questions produced ten statements that were added to ten statements derived from Fischer (2018) to create the second mD round questionnaire.

Academic researchers and educators, operational first responders, or first receivers of patients with suspected spinal injuries were identified to be mD experts. Experts rated their agreement with each statement on a seven-point linear numeric scale. Consensus amongst experts was defined as a standard deviation ≤1.0. Statements that were in agreement reaching consensus were included in the final report; those that were not in agreement but reached consensus were removed from further consideration. Those not reaching consensus advanced to the third mD round.

For subsequent rounds, experts were shown the mean response and their own response for each of the remaining statements and asked to reconsider their rating. As above, those that did not reach consensus advanced to the next round until consensus was reached for each statement.

Twenty-two experts agreed to participate with 19 completing the second mD round and 16 completing the third mD round. Eleven statements reached consensus. Nine statements did not reach consensus.

Experts reached consensus offering 11 statements to be incorporated into the creation of SMR CGs in RSEs. The nine statements that did not reach consensus can be further studied and potentially modified to determine if these can be considered in SMR CGs in RSEs.

The Comprehensive Framework for Disaster Evaluation Typologies, developed in 2017 (CFDET 2017), aims to unify and facilitate agreement regarding the identification, structure, and relationships between various evaluation typologies found in the disaster setting. A peer-reviewed validation process sought input from international experts in the fields of disaster medicine, disaster/emergency management, humanitarian/development, and evaluation. This paper discusses the validation process, its results, and outcomes.

Previous frameworks, identified in the literature, lack validation and consistent terminology. To gain credibility and utility, this unique framework needed to be validated by international experts in the disaster setting.

A mixed methods approach was designed to validate the framework. An initial iterative process informed an online survey which used a combination of a five-point Likert scale and open-ended questions. Pre-determined consensus thresholds, informed by a targeted literature review, provided the validation criteria.

A sample of 33 experts from 11 countries responded to the validation process. Quantitative measures largely supported the elements and relationships of the framework, and strongly supported its value and usefulness for supporting, promoting, and undertaking evaluations, as well as its usefulness for teaching evaluation in the disaster setting. Qualitative input suggested opportunities to strengthen and enhance the framework. There were limited responses to better understand the barriers and enablers of undertaking disaster evaluations. A potential for self-selection bias of respondents may be a limitation of this study. The attainment of high consensus thresholds, however, provides confidence in the validity of the results.

For the first time, a framework of this nature has undergone a rigorous validation process by experts in three related disciplines at an international level. The modified framework, CFDET 2018, provides a unifying framework within which existing evaluation typologies can be structured. It gives evaluators confidence to choose an appropriate strategy for their particular evaluation in the disaster setting and facilitates consistency in reporting across the different phases of a disaster to better understand the process, outcomes, and impacts of the efficacy and efficiency of interventions. Future research could create a series of toolkits to support improved disaster evaluation processes and to evaluate the utility of the framework in the real-world setting.

Paramedics are tasked with providing 24/7 prehospital emergency care to the community. As part of this role, they are also responsible for providing emergency care in the event of a major incident or disaster. They play a major role in the response stage of such events, both domestic and international. Despite this, specific standardized training in disaster management appears to be variable and inconsistent throughout the profession. A suggested method of building disaster response capacities is through competency-based education (CBE). Core competencies can provide the fundamental basis of collective learning and help ensure consistent application and translation of knowledge into practice. These competencies are often organized into domains, or categories of learning outcomes, as defined by Blooms taxonomy of learning domains. It is these domains of competency, as they relate to paramedic disaster response, that are the subject of this review.

The methodology for this paper to identify existing paramedic disaster response competency domains was adapted from the guidance for the development of systematic scoping reviews, using a methodology developed by members of the Joanna Briggs Institute (JBI; Adelaide, South Australia) and members of five Joanna Briggs Collaborating Centres.

The literature search identified six articles for review that reported on paramedic disaster response competency domains. The results were divided into two groups: (1) General Core Competency Domains, which are suitable for all paramedics (both Advanced Life Support [ALS] and Basic Life Support [BLS]) who respond to any disaster or major incident; and (2) Specialist Core Competencies, which are deemed necessary competencies to enable a response to certain types of disaster. Further review then showed that three separate and discrete types of competency domains exits in the literature: (1) Core Competencies, (2) Technical/Clinical Competencies, and (3) Specialist Technical/Clinical Competencies.

The most common domains of core competencies for paramedic first responders to manage major incidents and disasters described in the literature were identified. If it’s accepted that training paramedics in disaster response is an essential part of preparedness within the disaster management cycle, then by including these competency domains into the curriculum development of localized disaster training programs, it will better prepare the paramedic workforce’s competence and ability to effectively respond to disasters and major incidents.

In addition to the traditional logistics role, pharmacists are undertaking important new roles in disasters. Despite this, little is known about the level of acceptance of these activities by other providers.

The aim of this study was to determine the international opinion of disaster and health professionals regarding the emerging roles of pharmacists in disasters.

Delegates at the World Association for Disaster and Emergency Medicine’s (WADEM; Madison, Wisconsin USA) 20th Congress in Toronto, Canada (April 2017) were invited to complete an anonymous survey posing eight questions regarding attitudes towards pharmacists’ roles in disasters. Quantitative data were analyzed using IBM (IBM Corp.; Armonk, New York USA) SPSS statistical software version 23, and qualitative data were manually coded.

Of the 222 surveys handed out, 126 surveys were completed yielding a 56.8% response rate. Of the respondents, 96.8% (122/126) believed pharmacists had a role in disasters additional to logistics. Out of 11 potential roles pharmacists could perform in a disaster, provided on a 5-point Likert scale, eight roles were given a rating of “Agree” or “Strongly Agree” by 72.4% or more of the participants. Lack of understanding of a pharmacist’s roles and capabilities was the highest described barrier to pharmacists’ roles in disaster management.

This multi-disciplinary disaster health “community” agreed pharmacists have roles in disasters in addition to the established role in supply chain logistics. Participants accepted that pharmacists could possibly undertake numerous clinical roles in a disaster. Several barriers were identified that may be preventing pharmacists from being further included in disaster health management planning and response.

WatsonKE, TippettV, SingletonJA, NissenLM. Disaster Health Management: Do Pharmacists Fit in the Team?Prehosp Disaster Med. 2019;34(1):30–37.

Unacceptable practices of health care providers during disasters have been observed because they work outside the scope of their daily practices and have inadequate training. A greater need for the involvement of health professionals in disaster management has been noted in Saudi Arabia. This study evaluates the efficacy of a training course in prehospital major incident management for health care providers in Saudi Arabia.

An interactive course for general principles in prehospital major incident management was developed with domains and core competencies. The course was designed according to the local context and was based on international standards. It was piloted over four days at the Officers Club of the Ministry of Interior (Riyadh, Saudi Arabia) and was sponsored by Mohammed Bin Naif Medical Center, King Fahd Security College in Riyadh, Saudi Arabia. The participants (n=29) were from different disciplines from main government health facilities in Riyadh. They completed a pre-test and a post-test.

The overall score was 55.1% on the pre-test and 68.4% on the post-test (Wilcoxon test for paired samples, P <.05). Three out of the four domains had significant difference between pre- and post-test results, as well as the overall total knowledge.

Conducting inter-disciplinary and competency-based disaster medicine courses for health care providers can augment appropriate disaster preparedness for major incidents in Saudi Arabia.

BajowNA, AlAssafWI, CluntunAA. Course in Prehospital Major Incidents Management for Health Care Providers in Saudi Arabia. Prehosp Disaster Med. 2018;33(6):587–595.

Following the recommendations of the World Association for Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) to develop standards for training the undergraduates in disaster-relevant fields (2004), a German curriculum was approved in 2006. This paper aims to describe the level of training and interest of medical students nine years later.

The aim of this study was to assess the self-perception of medical students’ knowledge and interest in disaster medicine nine years after the implementation of a standardized disaster medicine curriculum in German medical schools.

This prospective, cross-sectional, observational study was conducted with medical students in Germany using a web-based, purpose-designed questionnaire consisting of 27 mandatory and 11 optional questions.

Nine hundred ninety-two students from 36 of 37 medical schools in Germany participated. More than one-half of medical students were aware of the field of disaster medicine. One hundred twenty-one students undertook training internally within their university and 307 undertook training externally at other institutions. Only a small content of the curriculum was taught. A difference in self-perception of knowledge between trained and untrained participants was found, despite the level of training being low in both groups. Participants were generally highly motivated to learn disaster medicine in a variety of institutions.

German students are still largely not well educated regarding disaster medicine, despite their high motivation. The curriculum of 2006 was not implemented as originally planned and the number of trained students still remains low as the self-perception of knowledge. Currently, there is no clear and standardized training concept in place. A renewal in the agreement of implementation of the curriculum at medical schools should be targeted in order to follow the recommendation of WADEM.

WunderlichRRagazzoniLIngrassiaPLDella CorteFGrundgeigerJBickelmayerJWDomresB. Self-Perception of Medical Students’ Knowledge and Interest in Disaster Medicine: Nine Years After the Approval of the Curriculum in German Universities. Prehosp Disaster Med. 2017;32(4):374–381.

Internationally there is an increasing amount of peer-reviewed literature pertaining to disaster nursing. The literature includes personal anecdotes, reflections, and accounts of single case studies. Furthermore, issues such as the willingness of nurses to assist in disasters, the role of nurses in disasters, leadership, competencies, and educational preparedness for nurses have been the focus of the literature.

The aim of this research was to determine the international research priorities for disaster nursing.

This research used a three-round Delphi technique. The first round used a face-to-face workshop to generate research statements with nursing members of the World Association for Disaster and Emergency Medicine (WADEM). The second and third rounds included the ranking of statements on a 5-point Likert scale with nursing members of WADEM and the World Society of Disaster Nursing (WSDN). Statements that achieved a mean of four or greater were considered a priority and progressed.

Participants were from multiple countries. Research statements were generated in the areas of: education, training, and curriculum; psychosocial; strategy, relationship, and networking; and clinical practice. Psychosocial aspects of disaster nursing ranked the highest, with five statements appearing in the top ten research areas, followed by statements relating to: education, training, and curriculum; clinical practice; and finally, strategy, relationship, and networking.

Future disaster nursing research should focus on the area of psychosocial aspects of disaster nursing, in particular, both the psychosocial needs of a disaster-affected community and the psychosocial wellbeing of nurses who assist in disaster health activities.

RanseJ, HuttonA, JeeawodyB, WilsonR. What Are the Research Needs for the Field of Disaster Nursing? An International Delphi Study. Prehosp Disaster Med. 2014;29(5):1-7.

Education and training are key elements of disaster management. Despite national and international educational programs in disaster management, there is no standardized curriculum available to guide the European Union (EU) member states. European- based Disaster Training Curriculum (DITAC), a multiple university-based project financially supported by the EU, is charged with developing a holistic and highly-structured curriculum and courses for responders and crisis managers at a strategic and tactical level. The purpose of this study is to qualitatively assess the prevailing preferences and characteristics of disaster management educational and training initiatives (ETIs) at a postgraduate level that currently exist in the EU countries.

An Internet-based qualitative search was conducted in 2012 to identify and analyze the current training programs in disaster management. The course characteristics were evaluated for curriculum, teaching methods, modality of delivery, target groups, and funding.

The literature search identified 140 ETIs, the majority (78%) located in United Kingdom, France, and Germany. Master level degrees were the primary certificates granted to graduates. Face-to-face education was the most common teaching method (84%). Approximately 80% of the training initiatives offered multi- and cross-disciplinary disaster management content. A competency-based approach to curriculum content was present in 61% of the programs. Emergency responders at the tactical level were the main target group. Almost all programs were self-funded.

Although ETIs currently exist, they are not broadly available in all 27 EU countries. Also, the curricula do not cover all key elements of disaster management in a standardized and competency-based structure. This study has identified the need to develop a standardized competency-based educational and training program for all European countries that will ensure the practice and policies that meet both the standards of care and the broader expectations for professionalization of the disaster and crisis workforce.

IngrassiaPL , FolettiM , DjalaliA , ScaroneP , RagazzoniL , DellaCorte F , KaptanK , LupescuO , ArculeoC , von ArnimG , FriedlT , AshkenaziM , HeselmannD , HreckovskiB , Khorrram-ManeshA , KomadinaR , LechnerK , PatruC , BurkleFMJr. , FisherP . Education and Training Initiatives for Crisis Management in the European Union: A Web-based Analysis of Available Programs. Prehosp Disaster Med. 2014;29(2):1-12.