The literature search revealed relatively few articles describing educational competencies for training of healthcare workers in disaster preparedness and response. Several described the development process and competencies for health professions students, public health workers and, nurses in emergency response [11, 16–24]. However, no articles were identified that outlined disaster training competencies with specific measurable objectives. Outside of the peer-reviewed literature, the structured review of existing courses and competencies identified six sets of published competencies pertaining to the disaster training among different types of healthcare professionals, including public health workers, medical students, first receivers and registered nurses [25–30]. In spite of their importance, none included specific measurable objectives in addressing the broader spectrum of healthcare workers.
Following review and synthesis of the core concepts from the published competencies described above, seven new draft competencies were evaluated by the expert panel. No additional competency areas were suggested by the expert panel. Expert panel opinion in the form of comments and scores ranging from one (strongly agree) to five (strongly disagree) were compiled. For clarity, each of the proposed competencies averaged a score of 2.8 or less (range 1.4 – 2.8). Regarding the relevance for the defined target audience, each of the proposed competencies scored 2.1 or less (range 1.4 – 2). In terms of importance, each of the proposed competencies scored 2.5 or less (range 1.0 – 2.5). For clarity, each of the proposed terminal objectives averaged a score of 2.5 or less (range 1.2 – 2.5). The scores for relevance of the proposed terminal objectives ranged from 1.1 – 3.6.
Through this process, a total of seven cross-cutting competencies and twenty-one terminal objectives for critical event training of all healthcare workers were developed. Since disaster training must integrate multi-disciplinary training with different levels of training, a cross-cutting competency approach can serve as a valuable starting point. Cross-cutting competencies can form the basis for standardized training and unify the disciplines and skill levels involved.
Competency 1
Recognize a potential critical event and implement initial actions
The term, critical event, denotes any situation which threatens to disrupt the ability of an organization to maintain continuity of operations. Critical events include, but are not limited to disasters and emerging infectious diseases. An essential component of appropriate disaster response is the ability for the healthcare worker to recognize a critical event and know what to do – specifically who should be notified and how a disaster plan is activated. It is vital to provide early event recognition and early response mobilization in order to minimize the damage of the critical event. In addition, they should recognize triggers that precipitate reporting to the appropriate personnel.
TO1.1 – (Recognition)
Given scenarios that may be encountered in the course of normal professional duties, the participant should be able to identify all potential critical events and their event type. To be successful, the participant must correctly identify all potential critical events among a list of scenarios.
TO1.2 – (Notification)
Given a potential critical event scenario, the participant should be able to identify the appropriate authorities to be notified, recognize the appropriate notification steps and identify the key information to be reported. To be successful, the participant must correctly identify the appropriate notification steps, information to be reported and correct reporting authority.
TO1.3 – (Protection)
Given a description of a specific potential critical event, the participant should be able to list the immediate actions needed to protect personal, environmental and public safety. To be successful, the participant must correctly identify standard safety precautions as well as additional precautions that may be needed for potential chemical, biological and radiological events.
T O1.4 – (Mobilization)
Given a specific critical event scenario, the participant should be able to make recommendations for emergency response needs prior to disaster plan activation (mobilization). To be successful, the participant must identify the specialized personnel and equipment that may be needed for the type of event and the preparation steps required for mobilization.
TO1.5 – (Synthesis)
Given a simulated workplace scenario, the participant will apply knowledge of potential critical event recognition and immediate response needs to perform the appropriate notification, safety and mitigation actions for that event. To be successful, the participant must correctly identify the type of potential critical event, identify the appropriate safety precautions for that event type and perform the appropriate simulated notification and mobilization actions.
Competency 2
Apply the principles of critical event management
In order for a facility to successfully manage all critical events, healthcare workers should understand the essential elements of an effective preparation and response including the appropriate actions to be performed.
TO2.1 – (Management)
Given a list of disaster terms and management activities, the participant will be able to identify the phases of critical event management and match the activities to the appropriate phase. To be successful, the participant must be able to correctly recognize the phases from among a list of disaster terms and match the activities to the correct phase.
TO2.2 – (Preparedness)
Given a critical event scenario, the participant will be able to apply their knowledge of disaster preparedness to identify the key components of preparedness and recognize appropriate preparedness activities. To be successful, the participant must be able to correctly identify the components of disaster preparedness, and select the appropriate preparedness activities for each preparedness component.
TO2.3 – (Response)
Given a critical event scenario, the participant will be able to apply their knowledge of disaster response to identify the key components of response and recognize appropriate response activities. To be successful, the participant must be able to correctly recognize the components of disaster response and select the appropriate activities for each response component.
TO2.4 – (Recovery)
Given a critical event scenario, the participant will be able to apply their knowledge of disaster recovery to identify the key components of recovery and recognize appropriate recovery activities. To be successful, the participant must be able to correctly recognize the components of disaster recovery and select the appropriate activities for each recovery component.
Competency 3
Demonstrate critical event safety principles
A critical response component for healthcare workers is the ability to protect themselves during a disaster event who in turn will protect the facility and its resources. This encompasses elements of self and scene safety, security issues related to potentially large numbers of victims and contamination, as well as other risks or imminent threats.
TO3.1 – (Safety)
Given a critical event scenario, the participant should be able to demonstrate knowledge of critical safety principles by identifying safety threats and appropriate actions. To be successful the participant must be able to correctly identify appropriate responses to safety threats.
TO3.2 – (Security)
Given a critical event scenario, the participant should be able to demonstrate knowledge of security principles by identifying security threats and appropriate actions. To be successful the participant must be able to correctly identify appropriate responses to security threats.
Competency 4
Understand the institutional emergency operations plan
Familiarity with the institutional emergency operations plan is essential for individuals working within the institution to support and implement an effective, coordinated course of action during any critical event.
TO4.1 – (Purpose)
The participant should be able to identify the purpose and components of an EOP in critical event response. To be successful, the participant must be able to correctly identify the purposes of the EOP and its components.
TO4.2 – (Components)
Given an institutional scenario, the participant will be able to apply knowledge of critical event planning to outline an institutional EOP. To be successful, the participant must be able to identify the necessary EOP components and functions for the scenario presented.
Competency 5
Demonstrate effective critical event communications
Communication is a vital element to a successful critical event response. Healthcare workers need to recognize how poor communication can undermine response effectiveness and learn effective critical event communication skills.
TO 5.1 – (Communication Overview)
Given a critical event scenario, the participant should be able to apply knowledge of communications to fulfill basic communication needs including identification of appropriate timing, content, recipients, and modalities. To be successful, the participant must correctly identify the appropriate communication steps, information to be reported, correct reporting authority, and alternative modalities.
TO5.2 – (Communication Implementation)
Given an institutional scenario, the participant should be able apply knowledge of communications to outline a communications plan. To be successful, the participant must outline the complex communication needs for a critical event.
Competency 6
Understand the incident command system and your role in it
Effective critical event response requires successful integration of internal and external (local, state, and federal) participants. A recognizable and unified command and control structure is essential to achieve this.
TO6.1 – (ICS Overview)
Given a critical event scenario, the participant will be able to recognize their role in the incident command system and identify the corresponding responsibilities and limits of their authority. To be successful, the participant should be able to identify ICS defined individual tasks and scope of responsibility.
TO6.2 – (ICS Implementation)
Given a simulated incident command scenario, the participant should be able to apply knowledge of the incident command system to outline a command structure and interpret incoming information to make appropriate command decisions. To be successful, the participant should be able to correctly identify lines of authority, recognize data needs and select appropriate command decisions.
Competency 7
Demonstrate the knowledge and skills needed to fulfill your role during a critical event
Healthcare workers responding to a critical event require specific knowledge and skills. These encompass triage, personal protection, decontamination, and treatment. Injury pattern recognition and syndrome recognition that suggests the use of particular agents is essential to correct response.
TO7.1 – (Triage Skills)
Given an institutional scenario and descriptions of mock victims, the participant will be able to apply knowledge and skills concerning disaster triage systems to rapidly assign victims to appropriate triage categories. To be successful, the participant must recognize the appropriate triage system and correctly assign triage levels to all victims within a given timeframe.
TO7.2 – (PPE Skills)
Given a critical event scenario and descriptions of mock victims in a simulation, the participant will be able apply knowledge and skills concerning personal protective equipment (PPE) to successfully select, don, and monitor the appropriate level of PPE. To be successful, the participant must recognize levels of PPE as well as correctly choose and simulate utilization of the appropriate level of protection.
TO7.3 – (Decontamination Skills)
Given a critical event scenario, the participant will be able to apply knowledge and skills regarding decontamination to select, demonstrate, and monitor the correct method(s) of decontamination. To be successful, the participant must correctly identify the decontamination level as well as select and demonstrate appropriate decontamination techniques.
TO7.4 – (Diagnosis/Treatment)
Given a description of a patient presentation in a critical event scenario, the participant will be able to apply knowledge and skills regarding critical event diagnosis and treatment to identify critical event related syndromes and causative agents and select the appropriate treatment(s). To be successful, the participant must correctly diagnose the presented clinical syndrome, identify the causative agent and select the appropriate treatment(s).