IFMSA preGA March Meeting, Malta 2016

Concept note

INTERNATIONAL TRAINING ON DISASTER MEDICINE

For medical students. By medical students.

”One of the easiest disaster risk reduction measures we can take is to

empower children and youth and ensure they are actively involved in disaster risk reduction

and contribute to making their cities and communities resilient to disasters. Denying them

their right would be denying them

from influencing their own future. The earth needs youth´s support to survive the threats

of climate change and growing intensity and frequency of disasters.”

Margareta Wahlström

Special Representative of the UN Secretary-General for Disaster Risk Reduction

Introduction

Over the last century, the number of disasters has remarkably increased, indicating that future generations of physicians will be called upon to provide mass-casualty treatment to an even greater extent than before. A number of studies point to the lack of adequate training in the medical management of disaster response – a deficiency that has become dramatically apparent in the recent past. In every major emergency there are still significant numbers of aid personnel who lack some of essential skills, ss a consequence, many governments and scientific institutions agree that disaster medicine education should be included in the standard medical curriculum. The importance of enhancing education and training in disaster medicine has widely been perceived by medical students emphasizing that are willing to respond to public health emergencies and disasters. However, recent studies have been shown that only a small percentage of medical schools worldwide have included disaster medicine education in their study program. Therefore, training medical students to obtain competencies for becoming humanitarian health professionals is essential. As the Sendai Framework for Disaster Risk Reduction says there’s an urgent need to ‘’enhance the resilience of national health systems, including by integrating disaster risk management into primary, secondary and tertiary health care, especially at the local level’’1. The stress is being put on developing the capacity building of health workers in understanding disaster risk and applying and implementing disaster risk reduction approaches in health work. Additionally, it has been recognized that promoting and enhancing the training capacities in the field of disaster medicine as well as supporting and training community health groups in disaster risk reduction approaches in health programmes is crucial for strengthening health systems and making them resilient in front of disasters. At the same time

there is a need for stronger collaboration within and among different sectors, as well as in the implementation of the International Health Regulations (2005) of the World Health Organization’’.1 Moreover, the topic is poorly represented in medical curriculum, especially in countries that are stricken by disasters, whether that be natural, biological, technological or man made and we as future health care professionals have to take the lead and advocate for better disaster preparedness within the health system. Hospital safety as well as health professionals endangerment while in response teams in the frontlines is just starting to be an issue after the events in Afganistan2 and there is still much work to be done in the awareness and implementation of International Humanitarian Law. During the period of 2013 - 2015, IFMSA has enhanced its members engagement in the field of disaster medicine and humanitarian health. Through this engagement, a series of trainings have been provided to members of IFMSA in international, regional, national, and local level: Global Health Camp, Egypt 2013; PreMM, Tunisia 2014; preEuRegMe, Poland 2014; preAM2014, Taiwan 2014; preMM2015, Turkey 2015 to name a few. The trainings provided a platform for continuous learning and enabled production of the first ever International Training of Disaster Medicine Trainers in summer 2015 in Novara, Italy.3 This training is build on best practice on previous program content and will serve as a guide for future disaster medicine three days trainings.

Vision

Medical students have basic knowledge on disaster medicine and humanitarian health and respect towards the sanctuary of health services, with a holistic humanitarian approach of health in the larger setting of disaster management.

Objectives

The objectives of this 3-day workshop is in line with the work done in previous years through IFMSA on topics of Disaster Medicine, Medical Ethics in disasters and Humanitarian Actions.

It aims to:

1) Provide medical students with basic knowledge and introduction to the speciality of Disaster Medicine and create understanding of the disaster management system;

2) Provide a platform for students from different socioeconomic, cultural, national, religious backgrounds to discuss their perceptions of disaster

medicine’s general and specific needs, especially in humanitarian issues, and use the opportunity to analyse medical ethical dilemmas in disaster settings;

3) Provide a platform for participants of IFMSA - CRIMEDIM Training for Disaster Medicine Training (TdmT) held in Novara, Italy to train medical students using peer-to-peer methodology by sharing knowledge and skills learned during the TdmT;

4) Create a momentum of medical students that are equipped to advocate for the need of training on disaster medicine and stressed actions on ethical dilemmas in disasters;

5) Inspire medical students to use the knowledge acquainted to continue learning more about the Disaster Medicine through platform of IFMSA Program on Emergency, Disaster Risk management and Humanitarian Actions and online platform of TdmT;

6) Empower medical students to do actions on disaster medicine and humanitarian actions in their communities through IFMSA Program on Emergency, Disaster Risk management and Humanitarian Actions

Target Group

Medical students from different cultural, religious, socioeconomic, national backgrounds. There is no need of previous knowledge in disaster medicine or previous engagement on the topic. Selection will be done based on the motivation and opportunity of participants to use the knowledge and skills in their communities and their NMO. Expected number of participants is 25 - 30.

Methodology Lectures Oral presentation using pictures, videos and other type of visual presentations intended to deliver core information, facts and principles about the topics and serve as an introduction in further development of knowledge and ideas through other methods.

Workshops/Role-plays Interactive methodology where participants discuss and or work in breakouts groups. This method offers active engagement of participants and will enable them to develop deeper understanding of knowledge provided or / and develop action plans for further engagement in national or local level. The diversity of background of participants will ultimately serve the purpose to challenge all participants’ beliefs, ideas, historic and other background aiming to create new ideas and concepts. Simulation/Games

Simulation is innovative educational method which actively involves participants in a hypothetical situation that is based on a simplified “real world”. Participants are provided with opportunities to apply their theoretical knowledge in a safe and realistic setting, develop team working and critical thinking skills, and a systematic approach to problem solving. Simulations necessitate extensive debriefing and in-depth analysis of the experience of the participants following the completion of every activity.

Field visit Field trip is an educational trip to sites where students have the opportunity to observe their chosen subject outside of a classroom setting. This will add variety to the regular instructional program and helps students understand integration of subjects, from theory to practice. Through field trips students will be able to see real-life application of the concepts they learn. This can be a real size simulation, study visit to a disaster setting or response setting.

Movie / Documentary Storytelling is important part of learning experience and offers insight in the real word experiences. During the training participants will have opportunity to see several movies/documentaries that will allow them to get the stories from the professionals from the field or question their perception of the world.

Presentation by participants This is used for increasing participation, attention and motivation of participants and to ensure best usage of multinational representations. The national perspectives and content of the presentations helps them recap and deepen what they have learnt.

Training Outline

The training aims to use a variety of interactive methodologies to enhance medical students knowledge on disaster medicine and provide a basic introduction for further training or engagement. All methods described above will be used throughout all the sections of the preGA.

The program and material has been developed by IFMSA members with support from CRIMEDIM. The first day is delivered by graduates of the seven month course Training Disaster Medicine Trainers (TdmT), which is facilitated by CRIMEDIM and IFMSA. The graduates are supported with experienced supervisors during their trainings.

The three day training contains six sections with its separate modules. Each of these sections and modules are described in details below. Each module has its pre-made presentation and will be supported with additional materials during the

module such are case studies, movies, leaflets, prospects etc. Each day will start with 1 hour introduction into the sections that will be covered that day and half an hour briefing in the end of each day.

Training curriculum

DAY 1

Section 1 - Basic Course in Disaster Medicine Module 1.1 Introduction (1,5 h; Interactive Workshop) Module 1.2 Health Care in Disaster (1,5 h; Lecture) Module 1.3 Mass Casualty Management (3h; Lecture and Simulation) Module 1.4 International Coordination and Cluster system (1,5h)

DAY 2

Section 2 - Health in disasters Module 2.1 Mental Health (0,5 h; Lecture & Workshop) Module 2.2 Chemical, Biological, Radiological, Nuclear (0,5 h; Lecture & Workshop) Module 1.3 Current Disaster (0,5 h; Lecture & Workshop)

Section 3 - Risk Assessment & Awareness Module 3.1 Introduction to risk assessment and awareness (1,5; Lecture & Simulation) Module 3.2 Community Awareness (1 h; Workshop)

Section 4 - Study Visit Module 4.1 Real Size Simulation

DAY 3

Section 5 - Disaster Risk Management Frameworks & Policy Module 5.1 International Humanitarian Law (1 h; Lecture & Workshop) Module 5.2 Disaster Bioethic (1,5 h; Lecture, Movie and Workshop) Module 5.3 Disaster Risk Reduction Strategy (1,5 h; Lecture & Presentation Participants) Module 5.4 Youth in Policy Design & Implementation (1,5 h; Lecture, Workshop & Simulation)

Section 6 - Medical Students in Disaster Medicine Module 6.1 Medical students’ engagement in disaster medicine (2 h)

AGENDA

DAY 1

TIME PROGRAM FACILITATOR

08:00 - 09:00

Introduction to the Disaster Medicine Training - Whom are the participants? - What do you participations expect? - What will you learn during the coming three days?

Training Co-ordinator

09:00 - 10:30

Introduction to Disaster Medicine - Definition of disaster and classification of disasters - Epidemiology of disasters - Disaster cycle and disaster risk management - Hazard analysis

TdmT Graduate

10:30 - 11:00 Coffee Break

11:00 - 12:30

Section 2 - Health Care in Disasters - Disaster Risk Management for Health - Disaster Medicine - Professionalization of disaster and humanitarian health

workers - Role of public health - Role of Emergency Medical Services (EMS)

TdmT Graduate

12:30 - 14:00 Lunch Break

14:00 - 15:30 Prehospital Disaster Management - Triage

- Mass Casualty Triage - Simulation: Mass Casualty Triage

TdmT Graduate

15:30 - 17:00

Prehospital and Hospital Disaster Management

- Prehospital disaster response - Hospital disaster preparedness and response - Simulation: Disaster response

Luca Ragazzoni, MD Research Center in Emergency and Disaster Medicine (CRIMEDIM)

17:00 - 17:30 Coffee Break

17:30 - 18:30 International Coordination and Cluster system TdmT Graduate

18:30 - 19:00

Wrap up of the day - What have you learned today? - What was good / bad and what can be improved? - Briefing of Day 2

TdmT Graduate

DAY 2

TIME PROGRAM FACILITATOR

08:30 - 09:00

Introduction of the day - Warm up of the day - Evaluation & Feedback of Day 1 - Overview of the Day 2

Training Co-ordinator

09:00 - 09:30 Mental Health

- Mental health in disaster settings - Role play: Mental health support in disaster setting

Training Co-ordinator

09:30 - 10:00

Biological Disasters - Health effects by biological disasters - Prevention and preparedness for biological disasters - Case studies: Biological disaster outbreaks

Training Co-ordinator

10:00 - 10:30 Current Disasters

- Overview of current disasters - Case study: Current disaster

Training Co-ordinator

10:30 - 11:00 Coffee Break

11:00 - 12:30

Risk Assessment and Awareness - What is Risk Assessment - Methodologies and Responsibilities of Risk Assessment - Online game: Risk Assessment

Training Co-ordinator

10:30 - 11:00 Coffee Break

11:00 - 12:30

Community Awareness

- What does the community need to know? - How can community contribute? - How do you educate the community? (Best practice)

Training Co-ordinator

12:30 - 14:00 Lunch Break

14:00 - 19:00

Study Visit Real Size Simulation

Michael Spiteri, MD Malta Disaster Management Committee

DAY 3

TIME PROGRAM FACILITATOR

08:30 - 09:00

Introduction of the day - Warm up of the day - Evaluation & Feedback of Day 2 - Overview of the Day 3

Training Co-ordinator

09:00 - 10:30

International Humanitarian Law - Movie: Health Care in Danger - Medical Ethics - International Law and Frameworks in Disasters - Case studies: Ethical Dilemmas

Training Co-ordinator

10:30 - 11:00 Coffee Break

11:00 - 12:30

Disaster Risk Reduction Strategy

- Sendai Framework for Action 2015-2030 - Regional & National Disaster Risk Reduction Strategies - Health Care Facility Strategy - Safe Hospital - PreGA Participants’ presentations: Local Hospital Disaster

Risk Management Strategies

Training Co-ordinator / PreGA participants

12:30 - 14:00 Lunch Break

14:00 - 15:30

Youth in Policy Design & Implementation

- Youth Participation in design, implementation, monitor

and review of Disaster Risk Reduction Strategies

- Simulation: Negotiation

Training Co-ordinator

15:30 - 16:00 Coffee Break

16:00 - 18:00 Medical Students in Disaster Medicine

- Next Step: How do you engage? How do you learn more? - Create your Action Plan

Training Co-ordinator

18:00 - 19:00

Celebration & Evaluation of Disaster Medicine 3 Days Training

Training Co-ordinator / PreGA participants

Follow Up Plan

1. Follow up email to the participants maximum 2 weeks after the end of the training. The mail will contain:

- Evaluation and suggested deadline is 1 week after the email is send; - Facebook photo album, with photos from the training; - Invitation for students to apply for next TdmT; - Invitation for students to get engaged locally and nationally with activities

affiliated with IFMSA Program Emergencies, Disaster Risk and Humanitarian Actions

2. Analyse the evaluation results 4 weeks after the training. Make the result into graphics and share it with the participants and all contributors to the training. Make any needed and relevant suggestions of changes to the Disaster Medicine 3 Days Training. 3. Ensure that the TdmT students presenting are evaluated properly by TdmT coordinators. 4. Link students and their activities with coordinator of the IFMSA Program Emergencies, Disaster Risk and Humanitarian Actions. 5. Create focal points in NMOs that would promote disaster medicine activities and link them with the IFMSA Program Emergencies, Disaster Risk and Humanitarian Actions while supporting future projects on emergency and disaster medicine. 6. Present the results of the training at thematic relevant conferences to exchange experiences with other Disaster Medicine training programs and promote the TDMT concept. 7. Create a generic workshop that can be adapted and reused for the next General Assemblies in order to ensure a sustainable training program within IFMSA.

Externals & Facilitators

The delivery of the program is supported by the graduates of the Training Disaster

Medicine Trainers (TdmT) using peer-to-peer methodology, experienced members

of IFMSA and external experts.

Peer-to-peer sessions will be facilitated by Training disaster medicine Trainers

(TdmT) and this preGA co-ordinators. All preGA co-coordinators are experienced in

the topic, have already conducted numerous similar trainings and workshops and/or

have undertook work in relevant disaster medicine related projects either

professionally or voluntarily. To get insight into the atmosphere and learning

experience of first International Training of Disaster Medicine Trainers (TdmT)

check the video here.

Sections that will be supported by external experts are the training on the

computer-based and real-size disaster simulations. Those are experts from the field

of disaster medicine and humanitarian response that have worked on national and

international projects as well as with relevant organizations.

The external experts that will support the workshops are:

Luca Ragazzoni, MD Dr Luca Ragazzoni is a specialist in Anesthesiology and Critical Care. He is conducting research and teaching activities with the Research Center in Emergency and Disaster Medicine (CRIMEDIM), Università del Piemonte Orientale, Novara, Italy. His extensive background in emergency and disaster medicine comes from work with UNDP in Sri Lanka and Burkina Faso, work with MSF Italy as well as Save the Children UK with whom he designed and conducted a training of health professionals during the Ebola outbreak in Sierra Leone. To see the work of Dr Luca Ragazzoni and CRIMEDIM visit links here or here. Dr Michael Spiteri, MD MRCSEd DipIMC RCSEd Dr Michael Spiteri is a Maltese national and an Accident and Emergency Consultant with the Malta Disaster Management Committee. Additionally, he is a Clinical Lead with the Major Incident Preparedness and works as a clinician at Mater Dei Hospital Malta. Find out about the work of Dr Michael Spiteri here. Red Cross Malta The Malta Red Cross was established on the 24th October 1991. By Act of Parliament it was recognised as an autonomous voluntary Relief Society auxiliary to the Public Authorities and allowed to carry out its activities in the Maltese islands in accordance with the rules and principles of the International Red Cross movement. Find out about Malta Red Cross here.

Budget & Resources

The cost of the training will be kept to minimum and thereby be feasible to be delivered without additional resources. The expense of the computer-based disaster simulation will be covered by the Research Center in Emergency and Disaster Medicine (CRIMEDIM). The expense of the real-life disaster simulation will be supported by the Malta Disaster Management Committee and Red Cross Malta with volunteers. We are working on arranging the simulation in walking distance of the venue. Equipment needed: Projector, approximately 40 flipcharts, markers (4 sets of 4 different colors), tape, thicker tape for game playing, camera (will be provided by one of the co-ordinators).

Coordinators Karin Geffert - bvmd-Germany; Mail: karin.geffert@gmail.com Marian Sedlak - SCORP General Assistant / SloMSA Slovak Republic; Mail: ga.scorp.nmo@gmail.com Mehrnoosh Samaei - IFMSA-Iran (IMSA); Mail: mehr.samaie@gmail.com Marjon Feenstra - IFMSA Program Coordinator Emergencies, Disaster Risk and Humanitarian Actions; Mail: humanitarianactions@ifmsa.org Karim M. Abdeltawab - IFMSA Liaison Officer on Human Rights and Peace Issues 2015-2016; Mail: lrp@ifmsa.org Alice Claeson - IFMSA-Sweden; Mail: aliceclaeson@gmail.com Supervisors Moa Herrgård - IFMSA Liaison Officer on Human Rights and Peace Issues 2014-2015; Mail: moa.m.herrgard@gmail.com Ljiljana Lukić, MD - IFMSA Project Support Division Director 2014 - 2015; Mail: lukic.ljilja@gmail.com References 1 Sendai Framework for Disaster Risk Resilience 2015 - 2030. (UNISDR) Available online here: http://www.unisdr.org/files/43291_sendaiframeworkfordrren.pdf 2 Kuduz Hospital airstrike. 2015 (MSF) Available online at: http://www.msf.org/topics/kunduz-hospital-airstrike 3 Learning about Disaster Medicine through IFMSA: The outcomes of the First International Summer Course in Disaster Medicine. Available online at: http://ifmsa.org/2015/11/08/learning-about-disaster-medicine-through-ifmsa/