Disaster Medicine Core Competencies for Emergency Physicians, Nurses and EMTs

Blog Post by Carl H. Schultz, MD, Professor of Emergency Medicine

The specialty of disaster medicine continues to grow and mature.  Journals dedicated to this field of study as well as textbooks now exist.  In fact, ACEP has recently endorsed a new reference text published by Cambridge University Press entitled Koenig and Schultz’s Disaster Medicine:  Comprehensive Principles and Practices.  Ideally, this body of scientific data would lead to development of a standard set of clinical competencies for those involved in the initial evaluation and treatment of disaster victims.  This is needed to ensure that effective emergency medical response can be provided efficiently during all types of disaster events.  Creation of broadly-recognized standard core competencies to support development of disaster response education and training for specific healthcare professionals will help to ensure that medical personnel are truly prepared to care for victims of mass casualties.  Nonetheless, a widely supported standardized set of core competencies for emergency physicians, nurses, and pre-hospital EMS personnel is currently lacking. 

This recognized deficit is about to change, however.  In 2009, ACEP received a grant from the Robert Wood Johnson Foundation to develop standardized all-hazard disaster core competencies for emergency physicians, nurses, and EMTs.  The goal of the grant was to derive a list of clinical competencies representing well-established disaster domains that would apply across the specialties of emergency medicine, emergency nursing, and the pre-hospital arena.   The process involved a modified Delphi technique.  Recognized disaster content experts were involved in both meetings and conference calls over several months to develop these competencies.  Representatives from the following organizations participated:  Society for Academic Emergency Medicine (SAEM), American College of Emergency Physicians (ACEP), American Academy of Pediatrics (AAP), American College of Surgeons (ACS), Emergency Nurses Association (ENA), National Association of EMS Educators (NAEMSE), National Association of EMS Physicians (NAEMSP), National Association of Emergency Medical Technicians (NAEMT), and National Association of State EMS Officials (NASEMSO).  Representatives from the following federal organizations were also invited:  Centers for Disease Control and Prevention/Division of Injury Response (CDC), Department of Health and Human Services/Preparedness and Emergency Operations (HHS.gov), Department of Homeland Security/Office of Health Affairs (DHS), and National Highway Traffic Safety Administration Office of EMS (NHTSA).  An expert on educational development was intimately involved throughout the process.

The final outcome was a list of 19 disaster domains supported by corresponding competencies and 93 associated performance objectives.  These competencies are designed for professionals engaged in their respective daily practice activities.  They do not apply to those who have special interests in disaster medicine.  For this later group, more rigorous competencies would apply.  Table 1 lists the 19 disaster domains (performance objectives have been omitted due to length).

The Board of Directors for the American College of Emergency Physicians has formally endorsed these domains and their associated competencies.  This work product has been submitted to the Robert Wood Johnson Foundation for their final approval and this is expected shortly.  In addition, these recommendations have been or will be forwarded to the respective organizations whose representatives helped create them.  A request will be made that these groups review this material and also formally endorse and distribute these competencies.  Finally, an article will be written and submitted to a peer reviewed journal for publication. 

This process represents just one important step forward in further refining the specialty of disaster medicine.  More such efforts should follow to create competencies for professionals in other fields of medicine.  Eventually, the adoption of clinical competencies for disaster medicine fellowship training will support formal recognition of this new field.

For more information see Koenig and Schultz’s Disaster Medicine:  Comprehensive Principles and Practices , edited by Carl H. Schultz and Kristi L. Koenig and published by Cambridge University Press

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