CONCEPTS - Cambridge University Press...to July 2007 using the terms disaster, public health emer-gency, mass casualty, training, education, course, competen-cies, public health, emergency

A Consensus-based Educational Framework andCompetency Set for the Discipline of DisasterMedicine and Public Health Preparedness

Italo Subbarao, DO, MBA, James M. Lyznicki, MS, MPH, Edbert B. Hsu, MD, MPH,Kristine M. Gebbie, DrPH, RN, David Markenson, MD, FAAP, EMT-P,Barbara Barzansky, PhD, John H. Armstrong, MD, FACS, FCCP,Emmanuel G. Cassimatis, MD, Philip L. Coule, MD, Cham E. Dallas, PhD,Richard V. King, PhD, Lewis Rubinson, MD, PhD, Richard Sattin, MD,Raymond E. Swienton, MD, FACEP, Scott Lillibridge, MD,Frederick M. Burkle, MD, MPH, Richard B. Schwartz, MD, andJames J. James, MD, DrPH, MHA

ABSTRACTBackground: Various organizations and universities have developed competencies for health profession-

als and other emergency responders. Little effort has been devoted to the integration of thesecompetencies across health specialties and professions. The American Medical Association Center forPublic Health Preparedness and Disaster Response convened an expert working group (EWG) toreview extant competencies and achieve consensus on an educational framework and competency setfrom which educators could devise learning objectives and curricula tailored to fit the needs of allhealth professionals in a disaster.

Methods: The EWG conducted a systematic review of peer-reviewed and non–peer reviewed publishedliterature. In addition, after-action reports from Hurricane Katrina and relevant publications recom-mended by EWG members and other subject matter experts were reviewed for congruencies and gaps.Consensus was ensured through a 3-stage Delphi process.

Results: The EWG process developed a new educational framework for disaster medicine and publichealth preparedness based on consensus identification of 7 core learning domains, 19 core compe-tencies, and 73 specific competencies targeted at 3 broad health personnel categories.

Conclusions: The competencies can be applied to a wide range of health professionals who are expectedto perform at different levels (informed worker/student, practitioner, leader) according to experience,professional role, level of education, or job function. Although these competencies strongly reflectlessons learned following the health system response to Hurricane Katrina, it must be understood thatpreparedness is a process, and that these competencies must be reviewed continually and refined overtime. (Disaster Med Public Health Preparedness. 2008;2:57–68)

The frequency and magnitude of disasters haveincreased significantly over the last 30 years, atrend that is expected to continue.1 Factors

such as overpopulation and increased urbanization,2

climate change,3 the spread of communicable infec-tious disease with increased travel and commerce,4

and the ongoing threat of terrorism5 magnify thesusceptibility to and effects of disaster situations. Al-though such issues provide strong impetus to federal,state, and local governments to prioritize and im-prove health system preparedness and response capac-ities, lessons learned from recent disasters demon-strate persistent gaps in education, training, andleadership at all levels.6–12 Recognizing the need to

further enhance health system capability to respondto disasters, in October 2007 President Bush signedHomeland Security Presidential Directive-21.13 Withthis directive, the president calls on the nation topromote the establishment of a discipline that recog-nizes the unique principles in disaster-related medi-cine and public health; provides a foundation for thedevelopment and dissemination of doctrine, educa-tion, training, and research in this field; and betterintegrates private and public disaster health systems.

The emerging discipline of disaster medicine andpublic health preparedness is inclusive and com-prises all health care and public health professionswhose expertise supports the capability of health

CONCEPTSin Disaster Medicine

Disaster Medicine and Public Health Preparedness 57

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systems to prepare for, respond to, and recover from disas-ters and other public health emergencies. Those educatedand trained in this discipline provide care, leadership, andcommunity guidance in all phases of a disaster. They arealso critical agents who interface with public safety andemergency management personnel, government agency of-ficials, legislators, and policymakers, as well as help coor-dinate civilian and military disaster response assets. Be-cause of the immense variation in the nature andmagnitude of specific disaster events, the boundaries of thediscipline are imprecise at best. As a guiding framework,the list of 37 target capabilities established by the USDepartment of Homeland Security provides a useful con-text for health system response entities.14

To prepare health professionals to respond appropriately,and to assist professional schools and continuing educationproviders to meet this challenge, various organizations anduniversities have developed competencies for health pro-fessionals and other emergency responders. To date, theseefforts have been limited primarily to individual specialtiesor targeted professionals such as physicians,15–18 nurs-es,15,19 emergency medical technicians,15 public healthworkers,20 –25 hospital-based health care workers,26 –29 prac-ticing clinicians,30 volunteer health professionals,31–33 andstudents in health professions.34 –36 As yet, little effort hasbeen devoted to the integration of these competenciesacross health specialties and professions that have a stakein disaster medicine and public health preparedness. Thishas resulted in a lack of definitional uniformity acrossprofessions with respect to education, training, and bestpractices, thus limiting the establishment of this disciplineat an operational level. To address these gaps, the Amer-ican Medical Association convened an expert panel todevelop a consensus-based educational framework andcompetency set from which educators could devise learn-ing objectives and curricula tailored to the needs of allhealth professionals.

METHODSA systematic review was conducted to identify competen-cies and other educational and training guidance for pro-fessionals in the disaster health system. PubMed, GoogleScholar, FirstSearch, and Excerpta Medica were searchedfor English-language articles published from January 2004to July 2007 using the terms disaster, public health emer-gency, mass casualty, training, education, course, competen-cies, public health, emergency medical services, and health-care. In addition, an Internet search using the termsdisaster, public health emergency, and mass casualty wasmerged with training, course, competencies, public health,emergency medical services, and healthcare to compile pub-lished competencies outside the peer-reviewed literature.Additional citations were identified via the “related arti-cles” link provided on the PubMed and Google Scholarsites. Information also was derived from manual review of

references cited in relevant journal articles, reports, andtextbooks; examination of Web sites of federal agenciesand relevant stakeholder organizations; and direct commu-nication with recognized experts in this field. The searchwas designed to augment a recent comprehensive litera-ture review funded by the Agency for Healthcare Researchand Quality to identify educational competencies forhealth care workers in disasters.26

Retrieved articles and reports that met the search criteriawere submitted for structured review and analysis by anAmerican Medical Association 18-person expert workinggroup (EWG). Publications were scored (from 0 for no rele-vance to 3 for fully relevant) according to the extent towhich they included disaster training competencies relevantto health professionals (item 1), and whether such compe-tencies were supported by identifiable training objectives(item 2). Articles with a score of 3 on item 1 and a score of2 or more on item 2 were chosen for further review andanalysis. The EWG reviewed selected publications for rele-vance to all health professionals in a disaster and identifiedpotential learning gaps.

The EWG developed competencies based on adaptation ofBloom’s cognitive taxonomy.37 In accordance with this tax-onomy, a new conceptual educational framework was derivedaccording to 6 levels of learning (knowledge, comprehension,application, analysis, synthesis, and evaluation) to enablehealth professionals to achieve the highest appropriate levelof proficiency within each competency. The framework wascreated to accommodate the development of courses andcurricula to meet the diverse education, training, and jobrequirements of all target professions.

The resultant draft educational framework and competencieswere submitted to the following stakeholder organizations forreview:

• American Academy of Family Physicians• American Academy of Pediatrics• American College of Physicians• American College of Emergency Physicians• American College of Surgeons• American Hospital Association• American Nurses Association• American Osteopathic Association• American Psychiatric Association• Emergency Nurses Association• Medical Reserve Corps• National Association of County and City Health Offi-

cials• National Association of Emergency Medical Services

Physicians• Uniformed Services University of the Health Sciences

After stakeholder review, the draft educational frameworkand competencies were revised to incorporate feedback, andthen reviewed further by the National Disaster Life Support

Concepts in Disaster Medicine

58 Disaster Medicine and Public Health Preparedness VOL. 2/NO. 1





Education Consortium (NDLSEC). The NDLSEC comprisesprofessionals from 75 public and private organizations withan interest in disaster preparedness, professional education,and curriculum development. Consensus was ensuredthrough a 3-stage Delphi process with the EWG (after theinitial expert panel review, after the selected stakeholderreview, and after the NDLSEC review). The work was fundedthrough the Health Resources and Services Administrationbioterrorism training program, which is now under the aus-pices of the Office of the Assistant Secretary for Preparednessand Response.

RESULTSThe literature search revealed 71 articles in the peer-re-viewed literature and 20 publications without peer review(eg, after-action and government reports) published afterJanuary 2004 for initial review. After 2 levels of structuredanalysis, 4 peer-reviewed articles23,24,26,34 and 4 publicationsnot peer reviewed27,28,31,35 were selected by the EWG forfurther consideration. To en-sure a comprehensive and thor-ough review, other publishedclinical and public health com-petency sets were included forcomparative assessment.14–

22,25,29,30,32,33,36 In addition, theEWG reviewed several after-ac-tion reports from hurricanes Kat-rina and Rita to identify poten-tial learning gaps for healthsystem responders that are notaddressed in existing educationalcompetency sets.7–9,38–43

During the review process, 2 major issues were identified.First, existing published competencies are limited primarilyto the workplace, a specific discipline, or a practice setting.They lack information needed to address a coordinatedhealth system response to a disaster. Second, existing com-petency sets lack the interdisciplinary rigor that would makethem relevant to all health professionals regardless of theirexperience and background, or prior roles in a disaster. Inparticular, defined competencies for health system leaders ina disaster are lacking.

Competency Design and DevelopmentThe EWG determined that existing competency sets need tobe expanded to include issues such as public health law,ethics, risk communication, cultural competence, mass fatal-ity management, forensics, contingency planning and re-sponse, the civilian–military relationship, and crisis leader-ship. The EWG also determined that the competencies mustbe comprehensive and appropriately address vulnerable indi-viduals and populations (eg, children, pregnant women, frailolder adults, people with disabilities) who may be subject toincreased adverse health effects during a disaster.

Development of Competency DomainsAs a first step, the EWG sought to identify and define thebroad overarching competency domains relevant to all healthprofessionals in a disaster using the literature review of ex-isting competencies as background. After final review, 7competency domains were identified, which encompass all ofthe target audiences of those responsible for a coordinatedhealth system response. These domains are

• Preparation and Planning• Detection and Communication• Incident Management and Support Systems• Safety and Security• Clinical/Public Health Assessment and Intervention• Contingency, Continuity, and Recovery• Public Health Law and Ethics

Delineation of Core Competencies in AccordanceWith Bloom’s Taxonomy

The next step was to mergethe cognitive domains de-rived from Bloom’s taxonomywith an educational modelthat allows health profession-als to demonstrate compe-tency according to their ex-pected role and level ofinvolvement in a disaster.The EWG defined 19 corecompetencies that are rele-vant to all health profession-als (Table 1).

Delineation of Health Personnel CategoriesThe EWG identified 3 broad, yet distinct, personnel catego-ries that encompass all health professionals: informed work-ers/students, practitioners, and leaders. Personnel would beexpected to perform at different levels of proficiency depend-ing on their experience, professional role, level of education,or job function across the core competencies. This frameworkallows for all of the health professions to be represented ineach category, and recognizes the diversity of expected jobfunctions and educational requirements for each health pro-fession involved in disaster planning and response.

The health personnel categories establish increasing stan-dards for each core competency. Health professionals can dem-onstrate proficiency in each category at the following levelsbased on their educational needs, experience, professional role,and job function in disaster planning, mitigation, response, andrecovery:

• Informed Worker/Student: These are health professionalsand students who require awareness and understanding ofparticular aspects of disaster planning, mitigation, re-sponse, or recovery. These people should be able todescribe core concepts or skills but may have limitedability or need to apply this knowledge.

...this educational frameworkwill contribute to any potential

basis for the credentialing orcertification of volunteer health

professionals, such as theMedical Reserve Corps







• Practitioner: These are health professionals who are re-quired to apply clinical or public health knowledge,skills, and values in disaster planning, mitigation, re-sponse, and recovery. Within this category, distinct ed-ucational tracks could be defined and developed to meetrecommended or required proficiency standards (eg, ba-sic, intermediate, advanced).

• Leader: These are senior executives (CEO, COO, CFO),directors, managers, and department heads with admin-istrative decision-making responsibilities, leadershipfunctions, and policymaking roles in disaster planning,mitigation, response, or recovery. Within this category,distinct educational tracks could be defined and devel-oped to meet various leadership roles and functions in adisaster (eg, incident command leaders, health execu-tives, government leaders).

Delineation of Category-specific Competencies inAccordance With Bloom’s TaxonomyThe EWG defined specific competencies within each corecompetency that describe the highest level of proficiencyappropriate for each personnel category (Table 2).

Proposed Learning Matrix for All Health SystemRespondersThe EWG recognized that health professionals vary intheir expected roles and level of involvement in a disaster.Therefore, it developed a learning matrix that can becustomized for any target audience to define proficiencyrequirements within each competency (Table 3). Withthis matrix, disaster health education and training pro-grams can be created or modified to incorporate the com-petencies at the desired proficiency levels.

TABLE 1Core Competencies for All Health Professionals in a Disaster

Competency Domain Core Competencies

1.0 Preparation and Planning 1.1 Demonstrate proficiency in the use of an all-hazards framework for disaster planning and mitigation.1.2 Demonstrate proficiency in addressing the health-related needs, values, and perspectives of all ages

and populations in regional, community, and institutional disaster plans.

2.0 Detection and Communication 2.1 Demonstrate proficiency in the detection of and immediate response to a disaster or public healthemergency.

2.2 Demonstrate proficiency in the use of information and communication systems in a disaster or publichealth emergency.

2.3 Demonstrate proficiency in addressing cultural, ethnic, religious, linguistic, socioeconomic, andspecial health-related needs of all ages and populations in regional, community, and institutionalemergency communication systems.

3.0 Incident Management and SupportSystems

3.1 Demonstrate proficiency in the initiation, deployment, and coordination of national, regional, state,local, and institutional incident command and emergency operations systems.

3.2 Demonstrate proficiency in the mobilization and coordination of disaster support services.3.3 Demonstrate proficiency in the provision of health system surge capacity for the management of

mass casualties in a disaster or public health emergency.

4.0 Safety and Security 4.1 Demonstrate proficiency in the prevention and mitigation of health, safety, and security risks toyourself and others in a disaster or public health emergency.

4.2 Demonstrate proficiency in the selection and use of personal protective equipment at a disasterscene or receiving facility.

4.3 Demonstrate proficiency in victim decontamination at a disaster scene or receiving facility.

5.0 Clinical/Public Health Assessmentand Intervention

5.1 Demonstrate proficiency in the use of triage systems in a disaster or public health emergency.

5.2 Demonstrate proficiency in the clinical assessment and management of injuries, illnesses, andmental health conditions manifested by all ages and populations in a disaster or public healthemergency.

5.3 Demonstrate proficiency in the management of mass fatalities in a disaster or public healthemergency.

5.4 Demonstrate proficiency in public health interventions to protect the health of all ages, populations,and communities affected by a disaster or public health emergency.

6.0 Contingency, Continuity, andRecovery

6.1 Demonstrate proficiency in the application of contingency interventions for all ages, populations,institutions, and communities affected by a disaster or public health emergency.

6.2 Demonstrate proficiency in the application of recovery solutions for all ages, populations, institutions,and communities affected by a disaster or public health emergency.

7.0 Public Health Law and Ethics 7.1 Demonstrate proficiency in the application of moral and ethical principles and policies for ensuringaccess to and availability of health services for all ages, populations, and communities affected by adisaster or public health emergency.

7.2 Demonstrate proficiency in the application of laws and regulations to protect the health and safety ofall ages, populations, and communities affected by a disaster or public health emergency.







TABL

E2

Prop

osed

Core

and

Grou

p-sp

ecifi

cCo

mpe

tenc

ies

for

Hea

lthPr

ofes

sion

als

ina

Disa

ster

Com

pete

ncy

Dom

ains

Core

Com

pete

ncie

s

Cate

gory

-spe

cific

Com

pete

ncie

s

Info

rmed

Wor

ker/

Stud

ent

Prac

titio

ner

Lead

er

1.0

Pre

para

tion

and

Pla

nnin

g1.

1D

emon

stra

tepr

ofic

ienc

yin

the

use

ofan

all-h

azar

dsfra

mew

ork

for

disa

ster

plan

ning

and

miti

gatio

n.

1.1.

1D

escr

ibe

the

all-h

azar

dsfra

mew

ork

for

disa

ster

plan

ning

and

miti

gatio

n.1.

1.2

Expl

ain

key

com

pone

nts

ofre

gion

al,c

omm

unity

,ins

titut

iona

l,an

dpe

rson

al/fa

mily

disa

ster

plan

s.

1.1.

3Su

mm

ariz

eyo

urre

gion

al,c

omm

unity

,offi

ce,

inst

itutio

nal,

and

pers

onal

/fam

ilydi

sast

erpl

ans.

1.1.

4Ex

plai

nth

epu

rpos

eof

disa

ster

exer

cise

san

ddr

ills

inre

gion

al,c

omm

unity

,and

inst

itutio

nal

disa

ster

prep

arat

ion

and

plan

ning

.1.

1.5

Con

duct

haza

rdvu

lner

abili

tyas

sess

men

tsfo

ryo

urof

fice

prac

tice,

com

mun

ity,o

rin

stitu

tion.

1.1.

6P

artic

ipat

ein

the

desi

gn,

impl

emen

tatio

n,an

dev

alua

tion

ofre

gion

al,c

omm

unity

,and

inst

itutio

nald

isas

ter

plan

s.

1.2

Dem

onst

rate

prof

icie

ncy

inad

dres

sing

the

heal

th-r

elat

edne

eds,

valu

es,a

ndpe

rspe

ctiv

esof

alla

ges

and

popu

latio

nsin

regi

onal

,com

mun

ity,a

ndin

stitu

tiona

ldis

aste

rpl

ans.

1.2.

1Id

entif

yin

divi

dual

s(o

fall

ages

)an

dpo

pula

tions

with

spec

ialn

eeds

who

may

bem

ore

vuln

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leto

adve

rse

heal

thef

fect

sin

adi

sast

er.

1.2.

2D

elin

eate

heal

thca

rean

dpu

blic

heal

this

sues

that

need

tobe

addr

esse

din

regi

onal

,co

mm

unity

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inst

itutio

nald

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ter

plan

sto

acco

mm

odat

eth

ene

eds,

valu

es,a

ndpe

rspe

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esof

alla

ges

and

popu

latio

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1.2.

3Id

entif

yps

ycho

logi

calr

eact

ions

that

may

beex

hibi

ted

byvi

ctim

sof

alla

ges,

thei

rfa

mili

es,

and

resp

onde

rsin

adi

sast

eror

publ

iche

alth

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genc

y.

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4C

reat

e,ev

alua

te,a

ndre

vise

polic

ies

and

proc

edur

esfo

rm

eetin

gth

ehe

alth

-rel

ated

need

sof

alla

ges

and

popu

latio

nsin

regi

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mm

unity

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2.0

Det

ectio

nan

dC

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unic

atio

n2.

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stra

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dete

ctio

nof

and

imm

edia

tere

spon

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iche

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genc

y.

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1R

ecog

nize

gene

rali

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san

dep

idem

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lclu

esof

adi

sast

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publ

iche

alth

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genc

y(in

clud

ing

natu

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unin

tent

iona

l,an

dte

rror

ist

even

ts).

2.1.

2D

escr

ibe

imm

edia

teac

tions

and

prec

autio

nsto

prot

ect

your

self

and

othe

rsfro

mha

rmin

adi

sast

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publ

iche

alth

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genc

y.

2.1.

3C

hara

cter

ize

sign

san

dsy

mpt

oms,

asw

ella

sdi

seas

ean

din

jury

patte

rns,

likel

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soci

ated

with

expo

sure

tona

tura

ldis

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toco

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land

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ear

expl

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esan

d/or

rele

ase

ofbi

olog

ical

,che

mic

al,a

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diol

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ents

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1.4

Expl

ain

the

purp

ose

and

role

ofsu

rvei

llanc

esy

stem

sth

atca

nbe

used

tode

tect

and

mon

itor

adi

sast

eror

publ

iche

alth

emer

genc

y.

2.1.

5Ev

alua

tean

dm

odify

polic

ies

and

proc

edur

esfo

rth

ede

tect

ion

and

imm

edia

tere

spon

seto

natu

rald

isas

ters

,in

dust

rial-

ortra

nspo

rtatio

n-re

late

dca

tast

roph

es(e

g,ha

zard

ous

mat

eria

lspi

ll,ex

plos

ion)

,epi

dem

ics,

and

acts

ofte

rror

ism

(eg,

invo

lvin

gco

nven

tiona

land

nucl

ear

expl

osiv

esan

d/or

rele

ase

ofbi

olog

ical

,che

mic

al,a

ndra

diol

ogic

alag

ents

).2.

2D

emon

stra

tepr

ofic

ienc

yin

the

use

ofin

form

atio

nan

dco

mm

unic

atio

nsy

stem

sin

adi

sast

eror

publ

iche

alth

emer

genc

y.

2.2.

1D

escr

ibe

emer

genc

yco

mm

unic

atio

nan

dre

porti

ngsy

stem

san

dpr

oced

ures

for

cont

actin

gfa

mily

mem

bers

,re

lativ

es,c

owor

kers

,and

loca

lau

thor

ities

ina

disa

ster

orpu

blic

heal

them

erge

ncy.

2.2.

2D

escr

ibe

info

rmat

iona

lre

sour

ces

that

are

avai

labl

efo

rhe

alth

prof

essi

onal

san

dth

epu

blic

topr

epar

efo

r,re

spon

dto

,an

dre

cove

rfro

mdi

sast

ers.

2.2.

3U

seem

erge

ncy

com

mun

icat

ions

syst

ems

tore

port

criti

calh

ealth

info

rmat

ion

toap

prop

riate

auth

oriti

esin

adi

sast

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publ

iche

alth

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genc

y.2.

2.4

Acc

ess

timel

yan

dcr

edib

lehe

alth

and

safe

tyin

form

atio

nfo

ral

lage

san

dpo

pula

tions

affe

cted

byna

tura

ldis

aste

rs,i

ndus

trial

-or

trans

porta

tion-

rela

ted

cata

stro

phes

(eg,

haza

rdou

sm

ater

ial

spill

,exp

losi

on),

epid

emic

s,an

dac

tsof

terr

oris

m(e

g,in

volv

ing

conv

entio

nala

ndnu

clea

rex

plos

ives

and/

orre

leas

eof

biol

ogic

al,c

hem

ical

,an

dra

diol

ogic

alag

ents

).

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5Ev

alua

tean

dm

odify

risk

com

mun

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ion

and

emer

genc

yre

porti

ngsy

stem

sto

ensu

reth

athe

alth

,saf

ety,

and

secu

rity

war

ning

s,as

wel

las

actio

nsta

ken,

are

artic

ulat

edcl

early

and

appr

opria

tely

ina

disa

ster

orpu

blic

heal

them

erge

ncy.

2.3

Dem

onst

rate

prof

icie

ncy

inad

dres

sing

cultu

ral,

ethn

ic,

relig

ious

,lin

guis

tic,

soci

oeco

nom

ic,a

ndsp

ecia

lhe

alth

-rel

ated

need

sof

alla

ges

and

popu

latio

nsin

regi

onal

,co

mm

unity

,and

inst

itutio

nal

emer

genc

yco

mm

unic

atio

nsy

stem

s.

2.3.

1D

escr

ibe

stra

tegi

esfo

ran

dba

rrie

rsto

com

mun

icat

ing

and

diss

emin

atin

ghe

alth

info

rmat

ion

toal

lage

san

dpo

pula

tions

affe

cted

bya

disa

ster

orpu

blic

heal

them

erge

ncy.

2.3.

2D

elin

eate

cultu

ral,

ethn

ic,r

elig

ious

,lin

guis

tic,

and

heal

th-r

elat

edis

sues

that

need

tobe

addr

esse

din

regi

onal

,com

mun

ity,a

ndin

stitu

tiona

lem

erge

ncy

com

mun

icat

ion

syst

ems

for

alla

ges

and

popu

latio

nsaf

fect

edby

adi

sast

eror

publ

iche

alth

emer

genc

y.

2.3.

3C

reat

e,ev

alua

te,a

ndre

vise

polic

ies

and

proc

edur

esfo

rm

eetin

gth

ene

eds

ofal

lage

san

dpo

pula

tions

inre

gion

al,

com

mun

ity,a

ndin

stitu

tiona

lem

erge

ncy

com

mun

icat

ion

syst

ems.

(Con

tinue

d)







TABL

E2

Prop

osed

Core

and

Grou

p-sp

ecifi

cCo

mpe

tenc

ies

for

Hea

lthPr

ofes

sion

als

ina

Disa

ster

Com

pete

ncy

Dom

ains

Core

Com

pete

ncie

s

Cate

gory

-spe

cific

Com

pete

ncie

s

Info

rmed

Wor

ker/

Stud

ent

Prac

titio

ner

Lead

er

3.0

Inci

dent

Man

agem

enta

ndSu

ppor

tSys

tem

s

3.1

Dem

onst

rate

prof

icie

ncy

inth

ein

itiat

ion,

depl

oym

ent,

and

coor

dina

tion

ofna

tiona

l,re

gion

al,s

tate

,loc

al,a

ndin

stitu

tiona

linc

iden

tcom

man

dan

dem

erge

ncy

oper

atio

nssy

stem

s.

3.1.

1D

escr

ibe

the

purp

ose

and

rele

vanc

eof

the

Nat

iona

lR

espo

nse

Pla

n,N

atio

nalI

ncid

ent

Man

agem

entS

yste

m,a

ndH

ospi

talI

ncid

entC

omm

and

Syst

emto

regi

onal

,com

mun

ity,

and

inst

itutio

nald

isas

ter

resp

onse

.

3.1.

2D

elin

eate

your

func

tion

and

desc

ribe

othe

rjo

bfu

nctio

nsin

inst

itutio

nal,

com

mun

ity,a

ndre

gion

aldi

sast

erre

spon

sesy

stem

sto

ensu

reun

ified

com

man

dan

dsc

alab

lere

spon

seto

adi

sast

eror

publ

iche

alth

emer

genc

y.3.

1.3

Per

form

your

expe

cted

role

ina

disa

ster

(eg,

thro

ugh

parti

cipa

tion

inex

erci

ses

and

drill

s)w

ithin

the

inci

dent

orem

erge

ncy

man

agem

ents

yste

mes

tabl

ishe

dby

the

com

mun

ity,

orga

niza

tion,

orin

stitu

tion.

3.1.

4D

evis

e,ev

alua

te,a

ndm

odify

inst

itutio

nal,

com

mun

ity,a

ndre

gion

alin

cide

ntco

mm

and,

emer

genc

yop

erat

ions

,and

emer

genc

yre

spon

sesy

stem

s(e

g,ba

sed

onaf

ter-

actio

nre

ports

from

actu

alev

ents

,dis

aste

rex

erci

ses,

and

drill

s)to

ensu

reun

ified

com

man

dan

dsc

alab

lere

spon

seto

adi

sast

eror

publ

iche

alth

emer

genc

y.

3.2

Dem

onst

rate

prof

icie

ncy

inth

em

obili

zatio

nan

dco

ordi

natio

nof

disa

ster

supp

orts

ervi

ces.

3.2.

1D

escr

ibe

glob

al,f

eder

al,

regi

onal

,sta

te,l

ocal

,ins

titut

iona

l,or

gani

zatio

nal,

and

priv

ate

indu

stry

disa

ster

supp

orts

ervi

ces,

incl

udin

gth

era

tiona

lefo

rth

ein

tegr

atio

nan

dco

ordi

natio

nof

thes

esy

stem

s.

3.2.

2D

emon

stra

teth

eab

ility

toco

llabo

rate

with

rele

vant

publ

ican

dpr

ivat

ese

ctor

stak

ehol

ders

toen

sure

effic

ient

coor

dina

tion

ofci

vilia

n,m

ilita

ry,a

ndot

her

disa

ster

resp

onse

asse

ts.

3.2.

3D

evel

op,e

valu

ate,

and

revi

sepo

licie

san

dpr

oced

ures

for

mob

ilizi

ngan

din

tegr

atin

ggl

obal

,fed

eral

,reg

iona

l,st

ate,

loca

l,in

stitu

tiona

l,or

gani

zatio

nal,

and

priv

ate

indu

stry

disa

ster

supp

ort

serv

ices

.Thi

sin

clud

eskn

owle

dge

ofle

gals

tatu

tes

and

mut

uala

idag

reem

ents

for

the

mob

iliza

tion

and

depl

oym

ento

fciv

ilian

,mili

tary

,and

othe

rre

spon

sepe

rson

nela

ndas

sets

.3.

3D

emon

stra

tepr

ofic

ienc

yin

the

prov

isio

nof

heal

thsy

stem

surg

eca

paci

tyfo

rth

em

anag

emen

tofm

ass

casu

altie

sin

adi

sast

eror

publ

iche

alth

emer

genc

y.

3.3.

1D

escr

ibe

the

pote

ntia

lim

pact

ofm

ass

casu

altie

son

acce

ssto

and

avai

labi

lity

ofcl

inic

alan

dpu

blic

heal

thre

sour

ces

ina

disa

ster

.

3.3.

2C

hara

cter

ize

inst

itutio

nal,

com

mun

ity,a

ndre

gion

alsu

rge

capa

city

asse

tsin

the

publ

ican

dpr

ivat

ehe

alth

resp

onse

sect

ors,

and

the

exte

ntof

thei

rpo

tent

iala

ssis

tanc

ein

adi

sast

eror

publ

iche

alth

emer

genc

y.

3.3.

3D

evel

opan

dev

alua

tepo

licie

s,pl

ans,

and

stra

tegi

esfo

rpr

edic

ting

and

prov

idin

gsu

rge

capa

city

ofin

stitu

tiona

l,co

mm

unity

,and

regi

onal

heal

thsy

stem

sfo

rth

em

anag

emen

tofm

ass

casu

altie

sin

adi

sast

eror

publ

iche

alth

emer

genc

y.

4.0

Safe

tyan

dSe

curit

y

4.1

Dem

onst

rate

prof

icie

ncy

inth

epr

even

tion

and

miti

gatio

nof

heal

th,s

afet

y,an

dse

curit

yris

ksto

your

self

and

othe

rsin

adi

sast

er.

4.1.

1U

sing

anal

l-haz

ards

fram

ewor

k,ex

plai

nge

nera

lhea

lth,

safe

ty,a

ndse

curit

yris

ksas

soci

ated

with

disa

ster

s.4.

1.2

Des

crib

ein

fect

ion

cont

rol

prec

autio

nsto

prot

ecth

ealth

care

wor

kers

,oth

erre

spon

ders

,and

the

publ

icfro

mex

posu

reto

com

mun

icab

ledi

seas

es,s

uch

aspa

ndem

icin

fluen

za.

4.1.

2C

hara

cter

ize

uniq

uehe

alth

,saf

ety,

and

secu

rity

risks

asso

ciat

edw

ithna

tura

ldis

aste

rs,i

ndus

trial

-or

trans

porta

tion-

rela

ted

cata

stro

phes

(eg,

haza

rdou

sm

ater

ials

pill,

expl

osio

n),

epid

emic

s,an

dac

tsof

terr

oris

m(e

g,in

volv

ing

conv

entio

nala

ndnu

clea

rex

plos

ives

and/

orre

leas

eof

biol

ogic

al,

chem

ical

,and

radi

olog

ical

agen

ts).

4.1.

3U

sefe

dera

land

inst

itutio

nal

guid

elin

esan

dpr

otoc

ols

topr

even

tthe

trans

mis

sion

ofin

fect

ious

agen

tsin

heal

thca

rean

dco

mm

unity

setti

ngs.

4.1.

3D

evel

op,e

valu

ate,

and

revi

seco

mm

unity

,ins

titut

iona

l,an

dre

gion

alpo

licie

san

dpr

oced

ures

topr

otec

tthe

heal

th,s

afet

y,an

dse

curit

yof

alla

ges

and

popu

latio

nsaf

fect

edby

adi

sast

eror

publ

iche

alth

emer

genc

y.

4.2

Dem

onst

rate

prof

icie

ncy

inth

ese

lect

ion

and

use

ofpe

rson

alpr

otec

tive

equi

pmen

tat

adi

sast

ersc

ene

orre

ceiv

ing

faci

lity.

4.2.

1D

escr

ibe

the

ratio

nale

,fu

nctio

n,an

dlim

itatio

nsof

pers

onal

prot

ectiv

eeq

uipm

ent

that

may

beus

edin

adi

sast

eror

publ

iche

alth

emer

genc

y.

4.2.

2D

emon

stra

teth

eab

ility

tose

lect

,lo

cate

,don

,and

wor

kin

pers

onal

prot

ectiv

eeq

uipm

enta

ccor

ding

toth

ede

gree

and

type

ofpr

otec

tion

requ

ired

for

vario

usty

pes

ofex

posu

res.

4.2.

3D

evel

op,e

valu

ate,

and

revi

sepo

licie

s,pr

otoc

ols,

and

proc

edur

esfo

rth

eus

eof

alll

evel

sof

pers

onal

prot

ectiv

eeq

uipm

entt

hatm

aybe

used

ata

disa

ster

scen

eor

rece

ivin

gfa

cilit

y.







TABL

E2

Prop

osed

Core

and

Grou

p-sp

ecifi

cCo

mpe

tenc

ies

for

Hea

lthPr

ofes

sion

als

ina

Disa

ster

Com

pete

ncy

Dom

ains

Core

Com

pete

ncie

s

Cate

gory

-spe

cific

Com

pete

ncie

s

Info

rmed

Wor

ker/

Stud

ent

Prac

titio

ner

Lead

er

4.3

Dem

onst

rate

prof

icie

ncy

invi

ctim

deco

ntam

inat

ion

ata

disa

ster

scen

eor

rece

ivin

gfa

cilit

y.

4.3.

1Ex

plai

nth

epu

rpos

eof

vict

imde

cont

amin

atio

nin

adi

sast

er.

4.3.

2D

econ

tam

inat

evi

ctim

sat

adi

sast

ersc

ene

orre

ceiv

ing

faci

lity.

4.3.

3D

evel

op,e

valu

ate,

and

revi

sede

cont

amin

atio

npo

licie

s,pr

otoc

ols,

and

proc

edur

esth

atm

aybe

impl

emen

ted

ata

disa

ster

scen

eor

rece

ivin

gfa

cilit

y.

5.0

Clin

ical

/Pub

licH

ealth

Ass

essm

ent

and

Inte

rven

tion

5.1

Dem

onst

rate

prof

icie

ncy

inth

eus

eof

triag

esy

stem

sin

adi

sast

eror

publ

iche

alth

emer

genc

y.

5.1.

1Ex

plai

nth

ero

leof

triag

eas

aba

sis

for

prio

ritiz

ing

orra

tioni

nghe

alth

care

serv

ices

for

vict

ims

and

com

mun

ities

affe

cted

bya

disa

ster

orpu

blic

heal

them

erge

ncy.

5.1.

2Ex

plai

nth

est

reng

ths

and

limita

tions

ofva

rious

triag

esy

stem

sth

atha

vebe

ende

velo

ped

for

the

man

agem

ento

fmas

sca

sual

ties

ata

disa

ster

scen

eor

rece

ivin

gfa

cilit

y.5.

1.3

Per

form

mas

sca

sual

tytri

age

ata

disa

ster

scen

eor

rece

ivin

gfa

cilit

y.

5.1.

5D

evel

op,e

valu

ate,

and

revi

sem

ass

casu

alty

and

popu

latio

n-ba

sed

triag

epo

licie

s,pr

otoc

ols,

and

proc

edur

esth

atm

aybe

impl

emen

ted

ina

disa

ster

orpu

blic

heal

them

erge

ncy.

5.2

Dem

onst

rate

prof

icie

ncy

inth

ecl

inic

alas

sess

men

tand

man

agem

ento

finj

urie

s,ill

ness

es,a

ndm

enta

lhe

alth

cond

ition

sm

anife

sted

byal

lage

san

dpo

pula

tions

ina

disa

ster

orpu

blic

heal

them

erge

ncy.

5.2.

1D

escr

ibe

poss

ible

med

ical

and

men

talh

ealth

cons

eque

nces

for

alla

ges

and

popu

latio

nsaf

fect

edby

adi

sast

eror

publ

iche

alth

emer

genc

y.5.

2.2

Expl

ain

basi

clif

esa

ving

and

supp

ortp

rinci

ples

and

proc

edur

esth

atca

nbe

used

ata

disa

ster

scen

e.

5.2.

3D

emon

stra

teth

eab

ility

toap

ply

and

adap

tcl

inic

alkn

owle

dge

and

skill

sfo

rth

eas

sess

men

tan

dm

anag

emen

tofi

njur

ies

and

illne

sses

invi

ctim

sof

alla

ges

unde

rva

rious

expo

sure

scen

ario

s(e

g,na

tura

ldis

aste

rs;i

ndus

trial

-or

trans

porta

tion-

rela

ted

cata

stro

phes

;epi

dem

ics;

and

acts

ofte

rror

ism

invo

lvin

gco

nven

tiona

land

nucl

ear

expl

osiv

esan

d/or

rele

ase

ofbi

olog

ical

,ch

emic

al,a

ndra

diol

ogic

alag

ents

),in

acco

rdan

cew

ithpr

ofes

sion

alsc

ope

ofpr

actic

e.5.

2.4

Iden

tify

stra

tegi

esto

man

age

fear

,pan

ic,

stre

ss,a

ndot

her

psyc

holo

gica

lres

pons

esth

atm

aybe

disp

laye

dby

vict

ims,

fam

ilies

,and

resp

onde

rsin

adi

sast

eror

publ

iche

alth

emer

genc

y.

5.2.

5D

evel

op,e

valu

ate,

and

revi

sepo

licie

s,pr

otoc

ols,

and

proc

edur

esfo

rth

ecl

inic

alca

reof

alla

ges

and

popu

latio

nsun

der

cris

isco

nditi

ons,

with

limite

dsi

tuat

iona

law

aren

ess

and

reso

urce

s.

5.3

Dem

onst

rate

prof

icie

ncy

inth

em

anag

emen

tofm

ass

fata

litie

sin

adi

sast

eror

publ

iche

alth

emer

genc

y.

5.3.

1D

escr

ibe

psyc

holo

gica

l,em

otio

nal,

cultu

ral,

relig

ious

,an

dfo

rens

icco

nsid

erat

ions

for

the

man

agem

ento

fmas

sfa

talit

ies

ina

disa

ster

orpu

blic

heal

them

erge

ncy.

5.3.

2Ex

plai

nth

eim

plic

atio

nsan

dsp

ecia

lized

supp

orts

ervi

ces

requ

ired

for

the

man

agem

ento

fm

ass

fata

litie

sfro

mna

tura

ldis

aste

rs,e

pide

mic

s,an

dac

tsof

terr

oris

m(e

g,in

volv

ing

conv

entio

nal

and

nucl

ear

expl

osiv

esan

d/or

rele

ase

ofbi

olog

ical

,che

mic

al,a

ndra

diol

ogic

alag

ents

).5.

3.3

Expl

ain

the

sign

ifica

nce

of(a

ndth

ene

edto

colle

ctan

dpr

eser

ve)

fore

nsic

evid

ence

from

livin

gan

dde

ceas

edhu

man

san

dan

imal

sat

adi

sast

ersc

ene

orre

ceiv

ing

faci

lity.

5.3.

4D

evel

op,e

valu

ate,

and

revi

sepo

licie

s,pr

otoc

ols,

and

proc

edur

esfo

rth

em

anag

emen

tofh

uman

and

anim

alre

mai

nsat

adi

sast

ersc

ene

orre

ceiv

ing

faci

lity.

5.4

Dem

onst

rate

prof

icie

ncy

inpu

blic

heal

thin

terv

entio

nsto

prot

ectt

hehe

alth

ofal

lag

es,p

opul

atio

ns,a

ndco

mm

uniti

esaf

fect

edby

adi

sast

eror

publ

iche

alth

emer

genc

y.

5.4.

1D

escr

ibe

shor

t-an

dlo

ng-

term

publ

iche

alth

inte

rven

tions

appr

opria

tefo

ral

lage

s,po

pula

tions

,and

com

mun

ities

affe

cted

bya

disa

ster

orpu

blic

heal

them

erge

ncy.

5.4.

2A

pply

know

ledg

ean

dsk

ills

for

the

publ

iche

alth

man

agem

ento

fall

ages

,pop

ulat

ions

,and

com

mun

ities

affe

cted

byna

tura

ldis

aste

rs,

indu

stria

l-or

trans

porta

tion-

rela

ted

cata

stro

phes

,ep

idem

ics,

and

acts

ofte

rror

ism

,in

acco

rdan

cew

ithpr

ofes

sion

alsc

ope

ofpr

actic

e.Th

isin

clud

esac

tive/

pass

ive

surv

eilla

nce,

mov

emen

tres

trict

ion,

vect

orco

ntro

l,m

ass

imm

uniz

atio

nan

dpr

ophy

laxi

s,ra

pid

need

sas

sess

men

t,en

viro

nmen

talm

onito

ring,

safe

tyof

food

and

wat

er,a

ndsa

nita

tion.

5.4.

3D

evel

op,e

valu

ate,

and

revi

sepu

blic

heal

thpo

licie

s,pr

otoc

ols,

and

proc

edur

esfo

rth

em

anag

emen

tofa

llag

es,

popu

latio

ns,a

ndco

mm

uniti

esaf

fect

edby

natu

rald

isas

ters

,in

dust

rial-

ortra

nspo

rtatio

n-re

late

dca

tast

roph

es,

epid

emic

s,an

dac

tsof

terr

oris

m.

(Con

tinue

d)







TABL

E2

Prop

osed

Core

and

Grou

p-sp

ecifi

cCo

mpe

tenc

ies

for

Hea

lthPr

ofes

sion

als

ina

Disa

ster

Com

pete

ncy

Dom

ains

Core

Com

pete

ncie

s

Cate

gory

-spe

cific

Com

pete

ncie

s

Info

rmed

Wor

ker/

Stud

ent

Prac

titio

ner

Lead

er

6.0

Con

tinge

ncy,

Con

tinui

ty,a

ndR

ecov

ery

6.1

Dem

onst

rate

prof

icie

ncy

inth

eap

plic

atio

nof

cont

inge

ncy

inte

rven

tions

for

alla

ges,

popu

latio

ns,

inst

itutio

ns,a

ndco

mm

uniti

esaf

fect

edby

adi

sast

eror

publ

iche

alth

emer

genc

y.

6.1.

1D

escr

ibe

solu

tions

for

ensu

ring

the

cont

inui

tyof

supp

lies

and

serv

ices

tom

eett

hem

edic

alan

dm

enta

lhea

lthne

eds

ofyo

urse

lf,yo

urfa

mily

,of

fice

prac

tice,

inst

itutio

n,an

dco

mm

unity

ina

disa

ster

,in

vario

usco

ntin

genc

ysi

tuat

ions

(eg,

mas

sev

acua

tion,

mas

ssh

elte

ring,

prol

onge

dsh

elte

rin

plac

e).

6.1.

2D

emon

stra

tecr

eativ

ean

dfle

xibl

ede

cisi

onm

akin

gin

vario

usco

ntin

genc

ysi

tuat

ions

and

risk

scen

ario

s,un

der

cris

isco

nditi

ons

and

with

limite

dsi

tuat

iona

law

aren

ess.

6.1.

3D

escr

ibe

com

mun

ityan

din

stitu

tiona

lpr

otoc

ols

and

proc

edur

esfo

rth

eev

acua

tion

and

trans

port

ofin

divi

dual

san

dpo

pula

tions

(ofa

llag

es)

affe

cted

bya

disa

ster

orpu

blic

heal

them

erge

ncy.

6.1.

4D

evel

op,e

valu

ate,

and

revi

seco

ntin

genc

yan

dco

ntin

uity

polic

ies

and

plan

sfo

rhe

alth

care

prof

essi

onal

s,in

stitu

tions

,and

com

mun

ityhe

alth

syst

ems

tom

aint

ain

the

high

estp

ossi

ble

stan

dard

sof

care

unde

rva

rious

risk

scen

ario

s.

6.2

Dem

onst

rate

prof

icie

ncy

inth

eap

plic

atio

nof

reco

very

solu

tions

for

alla

ges,

popu

latio

ns,i

nstit

utio

ns,

and

com

mun

ities

affe

cted

bya

disa

ster

orpu

blic

heal

them

erge

ncy.

6.2.

1D

escr

ibe

shor

t-an

dlo

ng-te

rmm

edic

alan

dm

enta

lhea

lthco

nsid

erat

ions

for

the

reco

very

ofal

lage

s,po

pula

tions

,and

com

mun

ities

affe

cted

bya

disa

ster

orpu

blic

heal

them

erge

ncy.

6.2.

2D

escr

ibe

solu

tions

for

ensu

ring

the

reco

very

ofcl

inic

alre

cord

s,su

pplie

s,an

dse

rvic

esto

mee

tthe

phys

ical

and

men

tal

heal

thne

eds

ofyo

urse

lf,yo

urfa

mily

,in

stitu

tion,

and

com

mun

ityin

adi

sast

eror

publ

iche

alth

emer

genc

y.6.

2.3

Expl

ain

mec

hani

sms

for

prov

idin

gpo

stev

entf

eedb

ack

and

less

ons

lear

ned

toap

prop

riate

auth

oriti

es(e

g,th

roug

haf

ter-

actio

nre

ports

)to

impr

ove

regi

onal

,co

mm

unity

,and

inst

itutio

nald

isas

ter

resp

onse

syst

ems.

6.2.

4D

evel

op,e

valu

ate,

and

revi

sepo

licie

s,pl

ans,

and

proc

edur

esfo

rth

eco

ntin

uous

eval

uatio

nof

regi

onal

,co

mm

unity

,and

inst

itutio

nal

disa

ster

resp

onse

and

reco

very

effo

rts,a

ndim

plem

entn

eces

sary

actio

nsto

enha

nce

heal

thsy

stem

prep

ared

ness

,res

pons

e,an

dre

cove

ryfo

rfu

ture

even

ts.

7.0

Pub

licH

ealth

Law

and

Ethi

cs

7.1

Dem

onst

rate

prof

icie

ncy

inth

eap

plic

atio

nof

mor

alan

det

hica

lprin

cipl

esan

dpo

licie

sfo

ren

surin

gac

cess

toan

dav

aila

bilit

yof

heal

thse

rvic

esfo

ral

lag

es,p

opul

atio

ns,a

ndco

mm

uniti

esaf

fect

edby

adi

sast

eror

publ

iche

alth

emer

genc

y.

7.1.

1D

escr

ibe

mor

alan

det

hica

liss

ues

rele

vant

toth

em

anag

emen

tof

indi

vidu

als

ofal

lage

s,po

pula

tions

,and

com

mun

ities

affe

cted

bya

disa

ster

orpu

blic

heal

them

erge

ncy.

7.1.

2A

pply

mor

alan

det

hica

lprin

cipl

esan

dpo

licie

sto

addr

ess

indi

vidu

alan

dco

mm

unity

heal

thne

eds

ina

disa

ster

.Th

isin

clud

esun

ders

tand

ing

ofpr

ofes

sion

alob

ligat

ion

totre

at,t

herig

htto

prot

ectp

erso

nals

afet

yin

adi

sast

er,

and

resp

onsi

bilit

ies

and

right

sof

heal

thpr

ofes

sion

als

ina

disa

ster

orpu

blic

heal

them

erge

ncy.

7.1.

3D

evel

op,e

valu

ate,

and

revi

seet

hica

lprin

cipl

es,

polic

ies,

and

code

sto

addr

ess

indi

vidu

alan

dco

mm

unity

heal

thne

eds

inal

lpha

ses

ofa

disa

ster

.

7.2

Dem

onst

rate

prof

icie

ncy

inth

eap

plic

atio

nof

law

san

dre

gula

tions

topr

otec

tthe

heal

than

dsa

fety

ofal

lag

es,p

opul

atio

ns,a

ndco

mm

uniti

esaf

fect

edby

adi

sast

eror

publ

iche

alth

emer

genc

y.

7.2.

1D

escr

ibe

lega

land

regu

lato

ryis

sues

rele

vant

todi

sast

ers

and

publ

iche

alth

emer

genc

ies,

incl

udin

gth

eba

sic

lega

lfra

mew

ork

for

publ

iche

alth

.

7.2.

2A

pply

lega

lprin

cipl

es,p

olic

ies,

and

prac

tices

toad

dres

sin

divi

dual

and

com

mun

ityhe

alth

need

sin

adi

sast

er.

This

incl

udes

unde

rsta

ndin

gof

liabi

lity,

wor

ker

prot

ectio

nan

dco

mpe

nsat

ion,

licen

sure

,priv

acy,

quar

antin

ela

ws,

and

othe

rle

gali

ssue

sto

enab

lean

den

cour

age

heal

thpr

ofes

sion

als

topa

rtici

pate

indi

sast

erre

spon

sean

dm

aint

ain

the

high

estp

ossi

ble

stan

dard

sof

care

unde

rex

trem

eco

nditi

ons.

7.2.

3D

evel

op,e

valu

ate,

and

revi

sele

galp

rinci

ples

,pol

icie

s,pr

actic

es,a

ndco

des

toad

dres

sin

divi

dual

and

com

mun

ityhe

alth

need

sin

all

phas

esof

adi

sast

er.







DISCUSSIONThe EWG process developed a new educational frameworkfor disaster medicine and public health preparedness based onconsensus identification of core learning domains and cross-competencies. The competencies can be applied to a wide

range of health professionals who are expected to perform atdifferent levels according to experience, professional role,level of education, or job function. This approach will lead toa common lexicon and improved standardization of trainingprograms. Within this framework, health professionals will be

TABLE 3Example Learning Matrix: Hospital Administrator*

Core Competencies

Expected Level of Proficiency

Informed Worker/Student Practitioner Leader

1.1 Demonstrate proficiency in the use of an all-hazards framework fordisaster planning and mitigation.

X

1.2 Demonstrate proficiency in addressing the health-related needs, values,and perspectives of all ages and populations in regional, community, andinstitutional disaster plans.

X

2.1 Demonstrate proficiency in the detection of and immediate response to adisaster or public health emergency.

X

2.2 Demonstrate proficiency in the use of information and communicationsystems in a disaster or public health emergency.

X

2.3 Demonstrate proficiency in addressing cultural, ethnic, religious,linguistic, socioeconomic, and special health-related needs of all ages andpopulations in regional, community, and institutional emergencycommunication systems.

X

3.1 Demonstrate proficiency in the initiation, deployment, and coordinationof national, regional, state, local, and institutional incident command andemergency operations systems.

X

3.2 Demonstrate proficiency in the mobilization and coordination of disastersupport services.

X

3.3 Demonstrate proficiency in the provision of health system surge capacityfor the management of mass casualties in a disaster or public healthemergency.

X

4.1 Demonstrate proficiency in the prevention and mitigation of health,safety, and security risks to yourself and others in a disaster or publichealth emergency.

X

4.2 Demonstrate proficiency in the selection and use of personal protectiveequipment at a disaster scene or receiving facility.

X

4.3 Demonstrate proficiency in victim decontamination at a disaster scene orreceiving facility.

X

5.1 Demonstrate proficiency in the use of triage systems in a disaster orpublic health emergency.

X

5.2 Demonstrate proficiency in the assessment and management of injuries,illnesses, and mental health conditions manifested by all ages andpopulations in a disaster or public health emergency.

X

5.3 Demonstrate proficiency in the management of mass fatalities in adisaster or public health emergency.

X

5.4 Demonstrate proficiency in public health interventions to protect thehealth of all ages, populations, and communities affected by a disaster orpublic health emergency.

X

6.1 Demonstrate proficiency in the application of contingency interventionsfor all ages, populations, institutions, and communities affected by adisaster or public health emergency.

X

6.2 Demonstrate proficiency in the application of recovery solutions for allages, populations, institutions, and communities affected by a disaster orpublic health emergency.

X

7.1 Demonstrate proficiency in the application of moral and ethical principlesand policies for ensuring access to and availability of health services for allages, populations, and communities affected by a disaster or public healthemergency.

X

7.2 Demonstrate proficiency in the application of laws and regulations toprotect the health and safety of all ages, populations, and communitiesaffected by a disaster or public health emergency.

X

*This example is intended solely to demonstrate how the proposed competency framework could be applied to a particular target group. It should not beinterpreted as defining expected competencies for hospital administrators.







better able to identify limits to their knowledge, skills, andauthority in a disaster, as well as identify key system resourcesfor referring problems or matters that exceed these limits.

This educational framework strongly supports the recommen-dations of Homeland Security Presidential Directive-21, andpermits application within this rubric. This model allows forthe identification and incorporation of the unique body ofknowledge of disaster medicine and public health prepared-ness and provides for the broad dissemination of this knowl-edge base to various target professions. It also provides apractical and flexible framework for the education, training,and evaluation of all health professionals according to theirexpected role and level of involvement in a disaster. Theframework defines consensus-based floor (informed worker/student) and ceiling (leader) levels of proficiency for allhealth professionals in disaster medicine and public healthpreparedness. It allows for theaccumulation of knowledgeand proficiency in any compe-tency and personnel category,and progression between cat-egories, as well. This corre-lates with the progression ofapplications in tactics, opera-tions, and strategy.

Within personnel categories,distinct educational trackscan be further defined and de-veloped to meet more special-ized learning objectives, train-ing requirements, and jobneeds. Within the practitio-ner category, for example, dis-tinct learning tracks could bedeveloped to meet specified job expectations in a disaster (eg,to meet basic, intermediate, or advanced levels of profi-ciency). In the leader category, separate tracks could bedeveloped for incident command leaders, health executives,and government leaders to meet their various leadership rolesand functions in a disaster. Although it is recommended thatthe core competencies for the informed worker/student beachieved by all potential health system responders beforeachieving the practitioner or leader proficiency levels, thisdecision will ultimately rest with credentialing and certifica-tion entities, as well as curriculum developers.

In accordance with the Pandemic and All-Hazards Prepared-ness Act,44 this educational framework will contribute to anypotential basis for the credentialing or certification of vol-unteer health professionals, such as the Medical ReserveCorps. Conceptually, potential health system volunteerswould be preregistered with documentation of their currentproficiency status in disaster medicine and public healthpreparedness. This could promote the further evolution ofthe Emergency Services Advanced Registry for Volunteer

Health Professionals and similar databases to facilitate themobilization and deployment of well-prepared and well-trained health professionals for all disasters.

Next StepsAn important next step is the development of learning ob-jectives and performance metrics for each category-specificcompetency. Presently, the educational framework and com-petencies are being vetted with the NDLSEC for incorpora-tion into the National Disaster Life Support training pro-gram. Learning objectives and evaluation tools also are beingdeveloped through the NDLSEC for integration into futureiterations of the National Disaster Life Support courses.

The educational framework and competencies still requirevalidation, which will be accomplished by NDLSEC mem-bers and through incorporation into the National Disaster

Life Support program. Al-though these competenciesstrongly reflect lessons learnedfollowing the health system re-sponse to Hurricane Katrinaand can enhance preparednessfor future disasters, prepared-ness is a process rather than anendpoint, and these competen-cies must be reviewed continu-ally and refined over time.

About the AuthorsDr Subbarao is Director, Public HealthReadiness Office, American Medical As-sociation; Mr Lyznicki is Senior Scientist,Center for Public Health Preparednessand Disaster Response, American MedicalAssociation; Dr Hsu is Director of Train-ing, Johns Hopkins Office of Critical

Event Preparedness and Response; Dr Gebbie is Director, Center for HealthPolicy, Columbia University School of Nursing; Dr Markenson is Director,Center for Disaster Medicine, New York Medical College; Dr Barzansky isDirector, Division of Undergraduate Medical Education, American Medical As-sociation; Dr Armstrong is with the Division of Acute Care Surgery, University ofFlorida Health Science Center; Dr Cassimatis is Vice President, Affiliations andInternational Affairs and Associate Dean for Clinical Affairs, Uniformed ServicesUniversity of the Health Sciences; Dr Coule is Director, Center for OperationalMedicine, Medical College of Georgia; Dr Dallas is Director, Institute for HealthManagement in Mass Destruction Defense, University of Georgia and MedicalCollege of Georgia; Dr King is Director, Education and Research, University ofTexas Southwestern Medical Center; Dr Rubinson is Senior Medical Advisor forHealthcare Preparedness and Response, Interagency Policy Agreement, Division ofHealthcare Quality and Promotion, Centers for Disease Control and Prevention;Dr Sattin is Professor, Emergency Medicine and Internal Medicine, MedicalCollege of Georgia; Dr Swienton is Co-Director of Emergency Medical Services,Disaster Medicine and Homeland Security Section, University of Texas South-western Medical Center; Dr Lillibridge is Assistant Dean and Director, GlobalHealth and Security Program, Center for Biosecurity and Public Health Prepared-ness, Texas A&M Health Science Center; Dr Burkle is Senior Fellow, HarvardHumanitarian Initiative, Harvard School of Public Health; Dr Schwartz is Chair,Department of Emergency Medicine, Medical College of Georgia; and Dr Jamesis Director, Center for Public Health Preparedness and Disaster Response, Amer-ican Medical Association.

...existing publishedcompetencies are limited

primarily to the workplace, aspecific discipline, or a practicesetting. They lack information

needed to address a coordinatedhealth system response to a

disaster.







Supported by Medical College of Georgia subaward 07-20312-7 under HealthResources and Services Administration (HRSA) grant T01 HP06415.

The findings and conclusions in this article are those of the authors and do notnecessarily represent the views of HRSA, the Centers for Disease Control andPrevention, or the Agency for Toxic Substances and Disease Registry.

Received for publication December 13, 2007; accepted December 17, 2007.

Authors’ DisclosuresThe authors report no conflicts of interest.

AcknowledgmentsWe appreciate the time and effort of Sandra R. Shefris, MLIS, and YolandaDavis for conducting the literature search and compiling articles for theexpert working group. We also wish to acknowledge the following individ-uals who provided critical review and feedback on this article: Sherri-LynneAlmeida, RN, DrPH, MSN, MEd; Jill A. Antoine, MD; Bruce S. Auerbach,MD; Richard T. Boland; Mona R. Bomgaars, MD, MPH; Arthur Cooper,MD, MS; Robert G. Darling, MD; Steven Diaz, MD; Gerald E. Harmon,MD; Jack Herrmann, MPH; Jack Horner; Heather Kaiser; E. Brooke Lerner,PhD; Mary Anne McCaffree, MD; Marsha Meyer; John A. Mitas II, MD;Glenn W. Mitchell, MD, MPH; Paul E. Pepe, MD, MPH; Cheryl Peterson,MSN, RN; Maurice A. Ramirez, DO; Charles L. Rice, MD; Roslyne D.W.Schulman; and Ruth Steinbrecher, MPH.

ISSN: 1935-7893 © 2008 by the American Medical Association and Lip-pincott Williams & Wilkins.

DOI: 10.1097/DMP.0b013e31816564af

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