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Training and Workforce Development
Topic Collection
August 21, 2019

Topic Collection: Training and Workforce Development

An educated workforce is a foundational component of a prepared workforce, and a prepared workforce is critical to all-hazards disaster response. The resources in this Topic Collection include those that discuss competencies for disaster medicine; experiences with different methods and models for health professional training and workforce development; selected general training resources to support all-hazards preparedness; tools to support training and workforce development; and considerations related to U.S. workforce development, including research on training’s effects on willingness to work during a disaster. Please access the rest of ASPR TRACIE’s Topic Collections for more hazard-specific training information listed under the “Education and Training” category.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category. 

Must Reads


The authors provide a brief review of the literature related to adequate disaster staffing, and share the methodology and results of their study that assessed the ability and willingness of healthcare personnel to report to work during a disaster. They note that healthcare personnel experience multiple barriers affecting ability and willingness to report to work during a disaster (responsibility for children being the most significant), and offer strategies for addressing these barriers. Differences between clinical and non-clinical staff responses were observed.
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Altman, B., Strauss-Riggs, K. and Schor, K. (2012). Capturing the Range of Learning: Implications for Disaster Health in a Resource Constrained Future. National Center for Disaster Medicine and Public Health.
The authors present recommendations for ensuring a trained workforce, even when faced with resource constraints, by focusing training on learning required to improve performance, and ensuring multiple paths to learning. They note the value of informal learning opportunities outside of the classroom setting, and how such learning is less resource intensive than formal learning sessions.
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Association of Schools and Programs of Public Health. (2011). Master’s Preparedness & Response Model.
This model provides the core knowledge, skills, and abilities necessary for a student to demonstrate upon completing a master’s degree or graduate certificate in public health preparedness and response. Version 1.1 includes five domains and 22 competencies and is recommended for use by graduate-level faculty at ASPH-member Schools of Public Health, and other accredited public health programs.
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Brand, R. (2016). When Disaster Strikes: Nurse Leadership, Nursing Care, and Teamwork Save Lives. Charting Nursing’s Future, a Robert Wood Johnson Foundation Collection.
This issue brief discusses how recent disasters have highlighted gaps, lack of training, and resource constraints related to disaster preparedness for nurses. The author notes that nurses want, and need, access to more training, and acknowledges the challenges to preparedness presented by declining funding and lack of regular engagement of nurses in exercises and training.
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Charney, R., Rebmann, T., and Flood, R. (2014). Working After a Tornado: A Survey of Hospital Personnel in Joplin, Missouri. (Abstract only.) Biosecurity and Bioterrorism. 12(4):190-200.
The authors surveyed 1,234 healthcare workers from the 2 hospitals affected by the Joplin Tornado in 2011 to assess number reporting to work, willingness to work, personal disaster preparedness, and childcare responsibilities following the disaster. The vast majority of respondents reported to work the week after the tornado, and most indicated they would have used childcare at their hospital if it was provided.
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Christian, M., Kissoon, N., Rubinson, L., et al. (2015). Emergency Preparedness for Clinicians - From Guidelines to the Front Line.
This hour-long webinar includes discussion of the management of multiple critically ill patients during a disaster or pandemic, and the importance of collaboration among front-line clinicians, hospital administrators, professional societies, and public health or government officials. Key lessons learned for improving emergency preparedness from the recent Ebola outbreak are presented.
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Farra, S., Miller, E., Timm, N., and Schafer, J. (2013). Improved Training for Disasters Using 3-D Virtual Reality Simulation. (Available through ResearchGate.) Western Journal of Nursing Research. 35(5):655-71.
The authors randomized nursing students into 1 of 2 groups: one group received online disaster training only, and the other participated in online training, as well as a virtual reality simulation. The authors concluded that virtual reality simulation “is an instructional method that reinforces learning and improves learning retention.”
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George Washington University Institute for Crisis, Disaster, and Risk Management. (n.d.). Healthcare Emergency Management Competencies, Curriculum, and Certification Recommendations. (Accessed 7/10/2019.)
The George Washington University Institute for Crisis, Disaster, and Risk Management supported this on-line Emergency Management Academy for the Veterans Health Administration (VHA) from 2004-2010. This webpage includes links to multiple products developed for use by the VHA and other healthcare organizations seeking to improve or expand their emergency management program.
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Livingston, L., West, C., Livingston, J., et al. (2016). Simulated Disaster Day: Benefit From Lessons Learned Through Years of Transformation From Silos to Interprofessional Education. Simulation in Healthcare. 11(4):293-8.
This article reviews the lessons learned from Texas A & M’s “Disaster Day” training for health professional students across seven disciplines, started in 2008 by the College of Nursing. The authors note the value of the interprofessional educational opportunity this event provides, and discuss how it has “enhanced student knowledge of roles and responsibilities and appears to increase collaborative efforts with other disciplines.”
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Moriarity, T., Chow, L., Hovor, C., et al. (2011). Report on the Domestic Natural Disaster Health Workforce. National Center for Disaster Medicine and Public Health.
This report describes selected aspects of the health professions workforce at the federal, state, and local levels who would respond to a catastrophic domestic natural disaster (a theoretical earthquake scenario was used). It includes recommendations regarding double counting of responders; volunteer failure to respond; an aging medical workforce; human capital development (e.g., cross-training among professionals); supporting professionals so they may respond; and readiness.
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National Center for Disaster Medicine and Public Health. (n.d.). Competency Connector. (Accessed 10/23/2017.)
This webpage contains an annotated bibliography of white papers, grey literature, and publications related to disaster health competencies, categorized as per Walsh et al., 2014. Resources chosen for inclusion define specific competencies for learning in disaster health; are directed toward a health or health-related profession; and are written in English.
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National Center for Disaster Medicine and Public Health. (n.d.). Resources for Core Competencies in Disaster Health. (Accessed 8/6/2019.)
This webpage includes a list of the 11 core competencies for disaster health, along with links to resources to support each of the competencies.
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Office of the Assistant Secretary for Preparedness and Response. (2016). 2017-2022 Health Care Preparedness and Response Capabilities. U.S. Department of Health and Human Services.
This 70-page document describes the four capabilities that healthcare coalitions and individual healthcare facilities need to prepare for, respond to, and recover from emergencies. The capabilities are: foundation for healthcare and medical readiness; healthcare and medical response coordination; continuity of healthcare service delivery; and medical surge. For example, Capability 1, Objective 4 covers training and preparing the healthcare and medical workforce, Capability 3, Objective 2 is focused on Continuity of Operations for healthcare facilities, and Capability 3, Objective 7 is focused on coordinating healthcare delivery system recovery. These four capabilities can help the healthcare delivery system better understand their roles in preparing for and responding to emergencies that impact the public’s health and adjust their EMP and EOP accordingly.
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Rowel, R. and Barnett, D. (2013). Disaster Preparedness: Public Health Infrastructure and Perspectives on Community Resilience. Johns Hopkins University, Bloomberg School of Public Health, MidAtlantic Public Health Training Center.
This presentation discusses research conducted to identify influences of perceived threat and efficacy on willingness to respond in public health emergencies. Emergency-specific patterns of response willingness are reviewed, and recommendation for improving response willingness are provided.
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Stanley, S. and Wolanski, T. (2015). Designing and Integrating a Disaster Preparedness Curriculum: Preparing Nurses for the Worst. (E-book available for purchase.)
This book provides recommendations and best practices for incorporating disaster preparedness into nursing curricula, and includes information on leadership and interprofessional education. The recommended strategies may be applicable to training programs for other health professional disciplines.
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The authors reviewed over 100 reports, articles, documents, and analyses related to whether or not responders would be willing to report to work during a disaster. They summarize the research, and present conclusions pertaining to role conflict, role strain and role abandonment, emphasizing worker safety, family support and safety, and communicating expectations and a culture of responsibility in the workplace.
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U.S. Department of Health and Human Services, National Library of Medicine, Disaster Information Management Research Center. (2017). Disaster-Related Competencies for Healthcare Providers.
This webpage lists resources for disaster-related competencies for healthcare providers, public health professionals, and disaster volunteers.
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Valdez, C. and Nichols, T. (2013). Motivating Healthcare Workers to Work During a Crisis: A Literature Review. Journal of Management Policy and Practice. 14(4):43-51.
The authors reviewed published literature on healthcare workers’ willingness to work during a disaster or public health emergency to identify related motivation factors. One key finding from their review was that healthcare workers are more likely to come to work if they understand their anticipated response role, and feel prepared to carry it out. The authors recommend frequent training of health care workers in disaster response, as well as the integration of such information into health professional educational curricula.
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Capabilities, Competencies, and Certifications


American Board of Emergency Medicine. (n.d.). EMS –Overview. (Accessed 10/18/2017.)
This subspecialty, with biannual opportunities for qualified Emergency Medical Services (EMS) physicians to take the certification exam, subsumes disaster management and mass gathering medicine, as well as daily clinical operations of EMS agencies, content from the national incident management system (NIMS), clinical EMS, concepts in pediatric, bariatric and geriatric prehospital care, and EMS administration. The final opportunity to take the exam without completing an accredited fellowship will be in 2019.
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Association of Schools and Programs of Public Health. (2011). Master’s Preparedness & Response Model.
This model provides the core knowledge, skills, and abilities necessary for a student to demonstrate upon completing a master’s degree or graduate certificate in public health preparedness and response. Version 1.1 includes five domains and 22 competencies and is recommended for use by graduate-level faculty at ASPH-member Schools of Public Health, and other accredited public health programs.
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Djalali, A., Della Corte, F., Segond, F., et al. (2016). TIER Competency-Based Training Course for the First Receivers of CBRN Casualties: A European Perspective. (Free registration required.) European Journal of Emergency Medicine. 24(5):371-376.
The authors developed a set of competencies under 10 domains to define the skills and knowledge necessary to respond to chemical, biological, radiological and nuclear (CBRN) emergencies. They created a training program based upon these competencies, and note that a blended training approach may allow clinicians the opportunity to participate in the same trainings, even in different time zones and locations.
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Emergency Management Assistant Compact. (2017). Mission Ready Packages.
This webpage includes links to package models and templates that can help teams prepare for and respond to a variety of hazards.
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Federal Emergency Management Agency. (2018). IS-100.C: Introduction to the Incident Command System, ICS 100.
After completing this online course, students will be familiar with the principles and features of the Incident Command System, including organizational elements, positions and responsibilities, facilities and functions, and planning.
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Florida Department of Health. (2011). Florida’s Recommended Disaster Core Competencies for Hospital Personnel. Iroquois Healthcare Association.
This 73-page report defines core competencies for hospital personnel at the awareness level, mid-level, and advanced level, and provides guidance for determining which staff members should be in each level. Applying these competencies will assist hospitals in the development, implementation, coordination, and evaluation of disaster preparedness and response training programs.
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Gallardo, A., Djalali, A., Foletti, M., and Ragazzoni, L. (2015). Core Competencies in Disaster Management and Humanitarian Assistance: A Systematic Review. (Abstract only.) Disaster Medicine and Public Health Preparedness. 9(4):430-439.
The authors discuss peer-reviewed studies to “identify existing competency sets for disaster management and humanitarian assistance that would serve as guidance for the development of a common disaster curriculum.”
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* George Washington University Institute for Crisis, Disaster, and Risk Management. (n.d.). Healthcare Emergency Management Competencies, Curriculum, and Certification Recommendations. (Accessed 7/10/2019.)
The George Washington University Institute for Crisis, Disaster, and Risk Management supported this on-line Emergency Management Academy for the Veterans Health Administration (VHA) from 2004-2010. This webpage includes links to multiple products developed for use by the VHA and other healthcare organizations seeking to improve or expand their emergency management program.
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International Board for Certification of Safety Managers. (2017). CHEP (Certified Healthcare Emergency Professional) Certification.
The Board establishes certification and re-certification requirements for the CHEP, and this webpage includes links to information on the various certifications offered, fees, scheduling, and frequently asked questions.
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King, R., Larkin, G., Fowler, R., et al. (2016). Characteristics of Effective Disaster Responders and Leaders: A Survey of Disaster Medical Practitioners. (Abstract only.) Disaster Medicine and Public Health Preparedness. 10(5): 720-723.
The authors surveyed participants at an Emergency Medical Services conference and asked them to describe key characteristics of successful disaster/mass casualty first responders and leaders. They advocate further research into how well these characteristics correlate with successful disaster response, and recommend that they be incorporated into competency sets and trainings to support workforce development.
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Markenson, D., Woolf, S., Redlener, I., and Reilly, M. (2013). Disaster Medicine and Public Health Preparedness of Health Professions Students: A Multidisciplinary Assessment of Knowledge, Confidence, and Attitudes. Disaster Medicine and Public Health Preparedness. 7(9):499-506.
The authors surveyed medical, nursing, and dental students to evaluate knowledge, comfort, perceived competency, and motivation related to disaster response. Results showed that respondents’ knowledge was greater than their perceived competency, and that they were motivated to undergo additional training and respond to disasters. The authors contend that health professional students can get most of their disaster education through the existing (and slightly modified) curricula, and the addition of a few focused subjects delivered through “novel educational approaches.”
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Medical Reserve Corps. (2015). MRC Volunteer Core Competencies.
These competencies are based on the Competencies for Disaster Medicine and Public Health and are organized into four learning paths: volunteer preparedness, volunteer response, volunteer leadership, and volunteer support for community resilience.
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* National Center for Disaster Medicine and Public Health. (n.d.). Competency Connector. (Accessed 10/23/2017.)
This webpage contains an annotated bibliography of white papers, grey literature, and publications related to disaster health competencies, categorized as per Walsh et al., 2014. Resources chosen for inclusion define specific competencies for learning in disaster health; are directed toward a health or health-related profession; and are written in English.
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* National Center for Disaster Medicine and Public Health. (n.d.). Resources for Core Competencies in Disaster Health. (Accessed 8/6/2019.)
This webpage includes a list of the 11 core competencies for disaster health, along with links to resources to support each of the competencies.
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Office of the Assistant Secretary for Preparedness and Response. (2016). 2017-2022 Health Care Preparedness and Response Capabilities. U.S. Department of Health and Human Services.
This 70-page document describes the four capabilities that healthcare coalitions and individual healthcare facilities need to prepare for, respond to, and recover from emergencies. The capabilities are: foundation for healthcare and medical readiness; healthcare and medical response coordination; continuity of healthcare service delivery; and medical surge. For example, Capability 1, Objective 4 covers training and preparing the healthcare and medical workforce, Capability 3, Objective 2 is focused on Continuity of Operations for healthcare facilities, and Capability 3, Objective 7 is focused on coordinating healthcare delivery system recovery. These four capabilities can help the healthcare delivery system better understand their roles in preparing for and responding to emergencies that impact the public’s health and adjust their EMP and EOP accordingly.
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Peller, J., Schwartz, B., and Kitto, S. (2013). Nonclinical Core Competencies and Effects of Interprofessional Teamwork in Disaster and Emergency Response Training and Practice: A Pilot Study. Disaster Medicine and Public Health Preparedness. 7(4):395-402.
The authors surveyed 10 Canadian Disaster Medical Assistance Team (DMAT) Members to define the nontechnical core competencies for disaster response, which were categorized under austere skills, interpersonal skills, and cognitive skills. The importance of specific nontechnical core competencies to interprofessional collaboration is also discussed.
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Pennardt, A., Callaway, D., Kamin, R. et al. (2016). Integration of Tactical Emergency Casualty Care Into the National Tactical Emergency Medical Support Competency Domains. Journal of Special Operations Medicine. 16(2): 62-66.
Tactical emergency medical support (TEMS) is a critical component of pre-hospital mass casualty care in high-threat environments (e.g., mass shootings and terrorist attacks). This article discusses refinements of previously developed core competencies for TEMS, with the goal of national standardization of training based on these competencies, and their broader use in all hazards planning.
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This document lists the core competencies under eight domains and three staff-related tier levels. Also included are links to resources and tools.
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Rose, D., Murthy, S., Brooks, J., and Bryant, J. (2017). The Evolution of Public Health Emergency Management as a Field of Practice. American Journal of Public Health.
The authors explain how the field of public health emergency management has changed in recent years to adapt to infectious disease outbreaks, natural disasters, industrial and environmental catastrophes, and conflict.
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Schor, K.W. and Altman, B.A. (2013). Proposals for Aligning Disaster Health Competency Models. Disaster Medicine and Public Health Preparedness. 7(1):8-12.
The authors provide suggestions for standardizing and aligning the building blocks of disaster health competency models. They encourage competency developers to consider content in at least 4 key areas: disaster-type domain, systems domain, clinical domain, and public health domain.
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Schultz, C., Koenig, K., Whiteside, M., et al. (2012). Development of National Standardized All-Hazard Disaster Core Competencies for Acute Care Physicians, Nurses, and EMS Professionals. (Abstract only.) Annals of Emergency Medicine, 59(3):196-208.
The authors identify a set of core competencies and performance objectives based on the knowledge, skills, and attitudes required by disaster medical professionals to ensure they can treat disaster survivors.
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The authors review nursing and interprofessional disaster competencies and development of a new interprofessional disaster certification, and provide an overview of a standardized, competency-based interprofessional curriculum for disaster education.
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U.S. Department of Health and Human Services, National Library of Medicine, Disaster Information Management Research Center. (2017). Disaster-Related Competencies for Healthcare Providers.
This webpage lists resources for disaster-related competencies for healthcare providers, public health professionals, and disaster volunteers.
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Walsh, L., Altman, B.A., King, R.V., and Strauss-Riggs, K. (2012). Enhancing the Translation of Disaster Health Competencies into Practice. (Abstract only.) Disaster Medicine and Public Health Preparedness. 8(1):70-8.
The authors propose modifications to the 2012 learning framework put forth in the article, Core Competencies for Disaster Medicine and Public Health, to address discrepancies identified when they tried to fit 35 existing competency sets into the framework. The article includes a list of the 35 competency sets reviewed.
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Walsh, L., Subbarao, I., Gebbie, K., et al. (2012). Core Competencies for Disaster Medicine and Public Health. Disaster Medicine and Public Health Preparedness. 6(1):44-52.
This article describes training standards (11 competencies and 36 sub-competencies) to ensure workforce competency in disaster medicine and public health. These standards were developed by an expert working group convened in 2010 by the American Medical Association Center for Public Health Preparedness and Disaster Response to review and begin to integrate previous work on core competencies.
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World Health Organization and International Council of Nurses. (2009). ICN Framework of Disaster Nursing Competencies.
This document provides the background and rationale for the development of the International Council of Nurses Disaster Nursing Competencies, and describes the framework for these competencies, which consists of 10 domains.
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This is the final report from a study consisting of a 6-workshop series conducted to clarify the federal disaster medicine and public health education and training products that existed at the time the study was conducted; identify needs and explore strategies to fill education and training gaps; and synthesize long-term expectations of competencies.
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Sample Curricula/Development Process Resources


American College of Emergency Physicians. (n.d.). Disaster Medicine Curriculum for Emergency Medicine Residents. (Accessed 10/5/17.)
This document outlines a disaster medicine curriculum for emergency medicine residents. Topics covered include: Common Challenges in Response to Disaster; Management of Medical Response in Disaster; Key Operational Capabilities; Special Populations; and Critical Medical Knowledge (by hazard type). The curriculum also includes an hour-long tabletop exercise.
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This document from ASPR TRACIE describes a project to develop healthcare emergency preparedness information modules for nurses (EPIMN) and a framework to assess the impacts and outcomes associated with implementing such modules. It includes a summary and background of the project, links to EPIMN, a case study describing the development and impact of EPIMN, an economic framework based on EPIMN, and a calculator based on the economic framework.
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Christian, M., Kissoon, N., Rubinson, L., et al. (2015). Emergency Preparedness for Clinicians - From Guidelines to the Front Line.
This hour-long webinar includes discussion of the management of multiple critically ill patients during a disaster or pandemic, and the importance of collaboration among front-line clinicians, hospital administrators, professional societies, and public health or government officials. Key lessons learned for improving emergency preparedness from the recent Ebola outbreak are presented.
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DeAtley, C. (2010). Effective Leadership During a Crisis. Creighton University and University of Nebraska, Center for Preparedness Education.
This presentation discusses best practices for leadership during a crisis, including characteristics of effective leaders, obstacles to effective leadership, and tools to support leadership.
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Disaster Resistant Communities Group. (2017). Just In Time Disaster Training – Library.
This webpage offers training videos on a variety of topics related to preparedness. Content is searchable by disaster cycle phase and topic area/setting.
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Florida Department of Health and Florida Hospital Association. (2010). Hospital Disaster Preparedness Awareness Training Part 1.
This document provides information to support an all-hazards training for clinical and non-clinical hospital staff.
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* George Washington University Institute for Crisis, Disaster, and Risk Management. (n.d.). Healthcare Emergency Management Competencies, Curriculum, and Certification Recommendations. (Accessed 7/10/2019.)
The George Washington University Institute for Crisis, Disaster, and Risk Management supported this on-line Emergency Management Academy for the Veterans Health Administration (VHA) from 2004-2010. This webpage includes links to multiple products developed for use by the VHA and other healthcare organizations seeking to improve or expand their emergency management program.
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George Washington University, School of Nursing. (2007). Nurses on the Front Line: Preparing for Emergencies and Disasters. (Registration required.)
This interactive 6-hour course was created as part of the National Nurse Emergency Preparedness Initiative to provide emergency preparedness training for nurses working in various setting. It uses scenario-based learning to demonstrate the application of theory, and practice.
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Grove, D., Cicero, M., Timm, N., et al. (2017). Improving Disaster Preparedness for Children and Families: A National Curriculum for Pediatric Emergency Medicine Fellows. (Abstract only.) Prehospital and Disaster Medicine. 32(S1):S155-S156.
The authors describe the process behind the development of the curriculum. They also include the “King County Pediatric Critical Care Triage Algorithm” and a related worksheet, all developed based on a Centers for Disease Control modeling tool that estimates pediatric critical care needs during a pandemic.
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Hansen, S. (2013). Psychology of Decision Making for First Responders in Disaster Response. (Registration required.) South Central Preparedness and Emergency Response Learning Center (SCPERLC).
This course discusses the psychological factors involved with first responder decision making during emergency response situations. It includes practice-based scenarios to illustrate the key factors that contribute to the ability to make good decisions on scene.
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Minnesota Department of Health. (2015). Public Health Incident Leadership Training.
This webpage provides links to course materials to train individuals responsible for leading responses to emergies or disaster with public health implications. Course content includes: the importance of leadership skills; critical interpersonal communication skills; how to build a reliable team; and how to manage an Incident Management Team.
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Public Health Foundation. (2017). What is TRAIN?
This webpage provides an overview of the TRAIN Learning Network, which is comprised of three primary components: TRAIN Affiliates (agencies that work together on the TRAIN LMS platform); TRAIN Course Providers (e.g., government agencies, academic institutions, professional associations) who post content on TRAIN that is then reviewed for inclusion in a catalog); and TRAIN Learners (which includes public health, healthcare, and preparedness professionals from the U.S. and 177 other countries).
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Stanley, S. and Wolanski, T. (2015). Designing and Integrating a Disaster Preparedness Curriculum: Preparing Nurses for the Worst. (E-book available for purchase.)
This book provides recommendations and best practices for incorporating disaster preparedness into nursing curricula, and includes information on leadership and interprofessional education. The recommended strategies may be applicable to training programs for other health professional disciplines.
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University of Washington, Northwest Center for Public Health Practice. (2008). Workforce Resiliency. (Registration required.)
Each 45-minute module in this 3-part series of trainings discusses individual and organizational resiliency in the face of stress, emergencies, and disasters.
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Yale New Haven Health System, Center for Emergency Preparedness and Disaster Response. (2017). CMS Emergency Preparedness Final Rule Crosswalk.
This crosswalk was created by (YNHHS-CEPDR), in collaboration with a number of national subject matter experts. Emergency and disaster related program, policy, communication, training and exercise elements of regulatory and accreditation standards were mapped to the CMS Emergency Preparedness Conditions of Participation. Every effort was made to ensure that the mapped regulations and accreditation standards matched as closely as possible. However, this document should be used only as a resource for reviewing and updating healthcare emergency preparedness plans and does not replace existing federal, local, or association guidance.
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Training Methods and Models


Altman, B., Strauss-Riggs, K. and Schor, K. (2012). Capturing the Range of Learning: Implications for Disaster Health in a Resource Constrained Future. National Center for Disaster Medicine and Public Health.
The authors present recommendations for ensuring a trained workforce, even when faced with resource constraints, by focusing training on learning required to improve performance, and ensuring multiple paths to learning. They note the value of informal learning opportunities outside of the classroom setting, and how such learning is less resource intensive than formal learning sessions.
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Chaput, C.J., Deluhery, M.R., Stake, C.E., et al. (2009). Disaster Training for Prehospital Providers. (Abstract only.) Prehospital Emergency Care. 11(4):458-465.
The authors describe findings from a survey of prehospital healthcare providers to determine mass casualty event (MCE) training knowledge retention, self-assessed levels of preparedness for MCEs, and preferred educational formats. Nearly a quarter of those surveyed reported no training in the past year and respondents felt least prepared for a radiological/nuclear event.
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Cicero, M., Blake, E., Gallant, N., et al. (2009). Impact of an Educational Intervention on Residents’ Knowledge of Pediatric Disaster Medicine. Pediatric Emergency Care. 25(7):447-51.
The authors used a strictly didactic format to train pediatric and emergency medicine residents in pediatric disaster medicine, and measured knowledge gained and retained by comparing pre-test results to results from an immediate course post-test, and a post-test given 2 months after the training occurred. Participants showed improvement in from baseline in both post-test scores, and the majority indicated a preference for experiential learning, such as drills and other operations-based exercises, instead of further classroom training.
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Cicero, M.X., Whitfill, T., Overly, F., et al. (2016). Pediatric Disaster Triage: A Multiple Simulation Curriculum Improves Prehospital Care Providers’ Assessment Skills. (Abstract only.) Prehospital Emergency Care. 21(2)201-208.
Paramedics and emergency medical technicians at four training sites showed sustained improvement in primary triage decisions in three different simulations: a school shooting scenario, a multiple family house fire, and a school bus rollover. Participants completed a first simulation with debriefing, and then returned to perform a second simulation two weeks later, showing 10% improvement in triage accuracy. The improvement was sustained six months after the initial training, as demonstrated by completing a third simulation.
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Farra, S., Smith, S. and Bashaw, M. (2016). Learning Outcome Measurement in Nurse Participants After Disaster Training. (Abstract only.) Disaster Medicine and Public Health Preparedness. 10(5): 728-733.
Nurses participated in a combination of online and onsite training, followed by an exercise, as part of an interprofessional disaster training program. Pre-and post-training test results, as well as exercise evaluation, showed a significant increase in knowledge measured in the areas of triage, re-triage, surge response, and sheltering.
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Hansoti, B., Kellogg, D., Aberle S., et al. (2016). Preparing Emergency Physicians for Acute Disaster Response: A Review of Current Training Opportunities in the US. (Abstract only.) Prehospital and Disaster Medicine. 31(6): 643-647.
The authors conducted a literature review to identify training opportunities for healthcare providers in the United States, and found that most were focused on emergency management, and not clinical care delivery. They state a need for a course for non-disaster trained emergency medicine physicians and trainees that is available online and incorporates a mix of educational modalities to prepare providers for acute disaster response.
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Jones, J., Staub, J., Seymore, A., and Scott, L. (2014). Securing the Second Front: Achieving First Receiver Safety and Security Through Competency-Based Tools. (Abstract only.) Prehospital and Disaster Medicine. 29(6):643-7.
This article describes a 5-hour emergency preparedness training targeted to interprofessional teams of first receivers that incorporated didactic and small group trainings, followed by practice in a large patient simulator designed to recreate “environmentally challenging (i.e., flood evacuation), multi-patient scenarios using a novel technique developed to utilize trainees as actors.” The training was evaluated by trained observers, and participants completed pre-tests, post-tests, and self-assessments of comfort level with disaster preparedness. Results showed significant improvement in knowledge and comfort level among all participants.
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Kennedy, B., Carson, D., and Garr, D. (2009). South Carolina Area Health Education Consortium Disaster Preparedness and Response Training Network: An Emerging Partner in Preparedness Training. (Abstract only.) Journal of Public Health Management and Practice. 15(2 Suppl):S13-9.
The authors describe a project to design, and then test the effectiveness and acceptability of disaster preparedness training curricula with thought leaders from across 4 states. From this experience, they recommend that “preparedness training for community-based practitioners needs to be concise and professionally relevant,” and “integrated into existing healthcare professions education programs and continuing education offerings.”
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Langan, J., Kavin, R., Wolgast, K. and Veenema, T.G. (2017). Education for Developing and Sustaining a Health Care Workforce for Disaster Readiness. (Abstract only.) Nursing Administration Quarterly. 41(2): 118-127.
The authors discuss “current challenges and opportunities for the expansion of evidence-based education and training opportunities for health care workforce disaster readiness.” Challenges include the lack of evidence-based training programs for health professionals.
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Moriarity, T., Chow, L., Hovor, C., et al. (2011). Report on the Domestic Natural Disaster Health Workforce. National Center for Disaster Medicine and Public Health.
This report describes selected aspects of the health professions workforce at the federal, state, and local levels who would respond to a catastrophic domestic natural disaster (a theoretical earthquake scenario was used). It includes recommendations regarding double counting of responders; volunteer failure to respond; an aging medical workforce; human capital development (e.g., cross-training among professionals); supporting professionals so they may respond; and readiness.
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Schwedhelm, M., Beam, E., Morris, R., et al. (2015). Reflections on Interprofessional Team-Based Clinical Care in the Ebola Epidemic: The Nebraska Medicine Experience. (Abstract only.) Nursing Outlook. 63(1):27-29.
This article identifies five key characteristics of an effective, interprofessional team in a high-risk, high-pressure situation: training persistence, a wide range of clinical expertise, joint problem solving and creativity, a commitment to learning, and courage.
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Scott, L., Crumpler, J., Tolley, J. et al. (2012). Disaster Care Provider Workforce Assessment. Journal of the South Carolina Medical Association. 108(3):80-83.
The authors conducted a workforce assessment of 398 patient care providers in South and North Carolina to determine their emergency preparedness training needs and preferences. They found that providers felt better prepared than 10 years prior, but still desired additional training. Primary obstacles to training were found to be time and financial constraints, and that most employers do not require it. Survey responses suggest that developing short (<1 day) courses that combine performance assessments with a scenario-based environment could be valuable for increasing preparedness.
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Sobelson, R. and Young, A. (2013). Evaluation of a Federally Funded Workforce Development Program: The Centers for Public Health Preparedness. (Abstract only.) Evaluation and Program Planning. 37:50-7.
The evaluation of the Centers for Public Health Preparedness Program found positive growth in development of new training products, training members of the public health workforce, and expansion of partnerships between accredited schools of public health and state and local public health departments.
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Walsh, L., Craddock, H., Gulley, K., et al. (2015). Building Health Care System Capacity: Training Health Care Professionals in Disaster Preparedness Health Care Coalitions. (First page only.) Prehospital and Disaster Medicine. 30(2):123-30.
A semi-structured interview was conducted with a sample of leaders of 9 well-established preparedness-focused health care coalitions (HCCs) to determine education and training needs, challenges, and promising practices. Training topics identified as priorities included chemical, biological, radiological, nuclear, and explosives (CBRNE), and mass-casualty incidents. The authors note that “an online resource repository would help reduce the burden on individual coalitions by eliminating the need to continually develop learning opportunities.”
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Training Methods and Models: Group Activity


Glow, S., Colucci, V., Allington, D., et al. (2013). Managing Multiple-Casualty Incidents: A Rural Medical Preparedness Training Assessment. Prehospital and Disaster Medicine. 28(4):334-41.
The authors developed a novel training model for using mass-casualty incident (MCI) scenarios that trained hospital and prehospital staff together during a 1-day training that included pre- and post-tests, 2 hour-long functional exercises, and 4 distinct, hour-long didactic instructional periods. Improvements were observed in post-test scores for all disciplines, and the authors advocate that disaster training be provided “with all disciplines represented to eliminate training ‘silos,’ to allow for discussion of overlapping jurisdictional or organizational responsibilities, and to facilitate team building.”
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Goodhue, C., Burke, R., Chambers, S., et al. (2010). Disaster Olympix: A Unique Nursing Emergency Preparedness Exercise. (Abstract only.) Journal of Trauma Nursing. 17(1):5-10.
The authors discuss how they used 6 specific exercises as part of a ‘Disaster Olympix’ to train staff to respond to pediatric disaster victims.
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Hoying, C., Farra, S., Mainous, R. Baute, B., and Gneuhs, M. (2017). Collaboration Between Academia and Practice: Interprofessional Crises Leadership & Disaster Management. (Abstract only.) Journal of Nursing Administration 47(2)123-128.
The authors discuss the development of a program developed by an academic-practice partnership. Senior leadership and frontline clinicians were trained via simulation, workshop, and online modules.
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Pollard, K., Bachmann, D., Greer, M., et al. (2015). Development of a Disaster Preparedness Curriculum for Medical Students: A Pilot Study of Incorporating Local Events into Training Opportunities. (Abstract only.) American Journal of Disaster Medicine. 10(1):51-9.
The authors describe their experience with a pilot study that leveraged medical students’ participation in a local disaster exercise and mass gathering event to enhance the emergency preparedness training that were provided through lectures, simulations, and asynchronous learning materials.
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Scott, L., Carson, D., Greenwell, I.B. (2010). Disaster 101: A Novel Approach to Disaster Medicine Training for Health Professionals. (Abstract only.) The Journal of Emergency Medicine. 39(2). 220–226.
Medical students participated in a 90-minute didactic training scenario and 2, 40-minute training exercises (a hazardous material scene and a surprise mass casualty incident (MCI) scenario with 100 life-sized mannequins) added to an existing medical school curriculum. Pre- and post-tests were administered to assess student perceptions and disaster medicine knowledge. Post-test scores improved by 54%; students participating in the MCI drill correctly tagged 94% of the victims in approximately 10 minutes; and participants rated the course very favorably.
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Scott, L., Swartzentruber, D., Davis, C., et al. (2014). Competency in Chaos: Lifesaving Performance of Care Providers Utilizing a Competency-Based, Multi-Actor Emergency Preparedness Training Curriculum. Prehospital and Disaster Medicine. 28(4):322-33.
The authors provide a detailed description of an 8-hour interprofessional emergency preparedness training that incorporated an online pre-test, two post-tests, course assessment, didactic and small group content, and a 6-minute clinical casualty scenario using high-fidelity and low-fidelity simulators and live actors. Knowledge, comfort level, and emergency preparedness skills increased for both experienced providers, and medical students that participated in this multi-modality course.
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Training Methods and Models: Simulation


Bank, I. and Khalil, E. (2016). Are Pediatric Emergency Physicians More Knowledgeable and Confident to Respond to a Pediatric Disaster After an Experiential Learning Experience? (Abstract only.) Prehospital and Disaster Medicine. 31(5):551-556.
Pediatric emergency medicine physicians, and critical care and pediatric surgery residents, participated in a simulation-based workshop to increase their knowledge and confidence to respond to a disaster involving children. Program evaluations indicated an increase in physicians’ perceived preparedness for pediatric disaster response; this confidence persisted 6 months post-training.
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Cicero, M., Auerbach, M., Zigmont, J., et al. (2012). Simulation Training with Structured Debriefing Improves Residents’ Pediatric Disaster Triage Performance. Prehospital and Disaster Medicine. 27(3):239-44.
Pediatric residents received a didactic training in preparation for participation in a series of simulation exercises using actors and low- and high-fidelity patient simulators as part of a multi-victim school shooting scenario. A group structured debriefing followed the first simulation, and new 10-victim simulation exercises were presented 1 week later, and again 5 months later. Participants demonstrated significant improvement of triage skills during the second simulation, and retained that improvement during the third simulation.
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Eason, M. (2013). Sarin Exposure: A Simulation Case Scenario. (Abstract only.) Southern Medical Journal. 106(1):55-62. .
The author describes the successful use of simulation training to prepare healthcare workers to respond to a Sarin exposure incident. Details on the scenario, which reviews the presentation of nerve agent exposure and its management, and includes “a recipe for performing this simulation in a training exercise,” are included.
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Gillett, B., Peckler, B., Sinert, R., et al. (2008). Simulation in a Disaster Drill: Comparison of High-fidelity Simulators versus Trained Actors. Academic Emergency Medicine. 15(11): 1144–1151.
Physicians, residents, medical students, clerks, and paramedics participated in a study that compared high-fidelity simulators and use of trained actors to test their responses during 8 different scenarios. Participants’ performance was similar for both simulation methods, and all indicated that “the simulators closely mimicked real-life scenarios, accurately represented disease states, and heightened the realism of patient assessment and treatment options during the drill.”
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Herrgard, M., Jaravata Rabe, A.P., Lo, S., et al. (2014). Building Resilience by Professionalisation of Healthcare Workers Through Technological Innovations. (Updated in 2016.) United Nations.
The authors discuss “how online disaster simulation exercises and courses, based upon a unified curriculum, can leverage increased global access to available technologies to be powerful training tools for health professionals to engage in disaster medicine.” They advocate for unified global training standards, and the professionalization of the disaster medicine specialty.
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Hutchinson, S., Haynes, S., Parker, P., et al. (2011). Implementing a Multidisciplinary Disaster Simulation for Undergraduate Nursing Students. Nursing Education Perspectives. 32(4):240-3.
Nursing students in three levels of their undergraduate program received didactic preparation in disaster preparedness and were assigned to five different simulation response teams. The course was determined to be effective at increasing disaster medicine knowledge: 5 of the 8 nursing students assigned to the disaster site correctly triaged 81.2% of the victims; all 8 nursing students assigned to the emergency department correctly reassessed the victims.
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Idrose, A., Adnan, W., Villa, G., and Abdullah, A. (2007). The Use of Classroom Training and Simulation in the Training of Medical Responders for Airport Disaster. Emergency Medicine Journal. 24(1): 7–11.
This articles describes the use of enhanced classroom training that included didactic lectures, simulation using a model of the airport, and video of a prior exercise to train clinicians, paramedics, assistant paramedics, and health attendants and drivers to respond to an airport disaster in a cost-effective and efficient way. The authors note that all groups achieved knowledge gain through the multi-modality, interprofessional training, with the non-medical participants improving the most from pre-test to post-test.
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Jung, D., Carman, M., Aga, R., and Burnett, A. (2016). Disaster Preparedness in the Emergency Department Using In Situ Simulation. (Abstract only.) Advanced Emergency Nursing Journal. 38(1):56-68.
To address errors observed in the emergency department during disasters, this mixed method pilot project was initiated to evaluate the effect of in situ simulation on providers’ knowledge of how to perform during a disaster, and competency in skills related to those actions, as well as on communication during a disaster. The authors contend that results demonstrate that in situ simulation can improve knowledge and communication during a disaster situation.
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Kerner, R., Gallo, K., Cassara, M., et al. (2016). Simulation for Operational Readiness in a New Freestanding Emergency Department: Strategies and Tactics. Simulation in Healthcare. 11(5): 345–356.
An interprofessional curriculum employing simulation as a core teaching strategy was used to train experienced clinicians in preparation for operating a freestanding emergency department. Disaaster preparedness training included didactic and scenario-based learning, as well as high-fidelity simulation mannequins and moulaged actors. Two days of onsite simulations at the end of the 10-week training period “revealed latent safety threats, lapses in communication, issues of intake procedure and patient flow, and the persistence of inapt or inapplicable mental models in responding to clinical emergencies.”
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Livingston, L., West, C., Livingston, J., et al. (2016). Simulated Disaster Day: Benefit From Lessons Learned Through Years of Transformation From Silos to Interprofessional Education. Simulation in Healthcare. 11(4):293-8.
This article reviews the lessons learned from Texas A & M’s “Disaster Day” training for health professional students across seven disciplines, started in 2008 by the College of Nursing. The authors note the value of the interprofessional educational opportunity this event provides, and discuss how it has “enhanced student knowledge of roles and responsibilities and appears to increase collaborative efforts with other disciplines.”
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Miller, J., Rambeck, J. and Snyder, A. (2014). Improving Emergency Preparedness System Readiness through Simulation and Interprofessional Education. Public Health Reports. 129(Suppl 4): 129–135.
The authors developed and tested a 10-hour simulation-focused interprofessional curriculum for health professions students to “(1) test the effectiveness of specific immersive simulations, (2) create reliable assessment tools for emergency response and team communication skills, and (3) assess participants' retention and transfer of skills over time.” They include details of the curriculum and evaluation methodology, as well as results of knowledge tests and qualitative evaluations, conducted immediately after the course, and again 6-12 months post-course.
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Ngo, J., Schertzer, K., Harter, P. and Smith-Coggins, R. (2016). Disaster Medicine: A Multi-Modality Curriculum Designed and Implemented for Emergency Medicine Residents. (Abstract only.) Disaster Medicine and Public Health Preparedness. 10(4):611-4.
This article describes a comprehensive, multi-modality approach focused on simulation to teach disaster medicine to emergency medicine residents in a 3-year curriculum that included classroom lectures, tabletop exercises, virtual reality simulation, high-fidelity simulation, hospital disaster drills, and journal club discussion. Participants felt better prepared to respond to disasters after completing this training program.
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Summerhill, E., Mathew, M., Stipho, S., et al. (2008). A Simulation-Based Biodefense and Disaster Preparedness Curriculum for Internal Medicine Residents. Medical Teacher. 30(6):e145-51.
Internal medicine residents participated in a disaster medicine curriculum that included didactic lectures, supplemental readings, and training with high-fidelity human simulators. Compared with residents who did not receive any training, participants’ knowledge increase was significant, as was their subjective sense of preparedness. However, knowledge gain was not maintained at the 1-year follow-up point, which the authors note suggests the need for ongoing reinforcement of learning.
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Weston, B., Simpson, N., Hart, D., et al. (2015). Multiple Casualty Scenario from a Bomb/Blast Injury. (Abstract only.) MedEdPORTAL Publications. 2015;11:10065.
This article describes in detail the simulation plan for a blast-related mass casualty incident exercise.
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Whitney, R., Burke, R., Lehman-Huskamp, K., et al. (2016). On Shaky Ground: Learner Response and Confidence After Tabletop Earthquake Simulation. (Abstract only.) Pediatric Emergency Care. 32(8):520-4.
Pediatric residents participated in a tabletop simulation that included 3 pediatric earthquake victims. Confidence in treating earthquake vicitms improved significantly post-simulation. The authors conclude that tabletop simulations are effective at improving residents’ comfort with responding to rare events.
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Training Methods and Models: Virtual


Andreatta, P., Maslowski, E., Petty, S., et al. (2010). Virtual Reality Triage Training Provides a Viable Solution for Disaster-Preparedness. Academic Emergency Medicine. 17(8):870-876.
The authors conducted a study to “determine if a fully immersive virtual reality disaster drill is as effective as a comparable live disaster drill using standardized patients in teaching and assessing START triage knowledge and skills for EM residents.” Pre-test results and triage accuracy among the two groups were similar, and results from the post-test, conducted 2 weeks post-training, showed greater knowledge retention among participants in the group that used standardized patients/mannequins. The authors concluded that the 2 training methods were equally effective, and that virtual reality is more cost-effective, and allows for flexibility in disaster scenarios used for training.
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Atack, L., Bull, E., Dryden, T., et al. (2012). An Evaluation of Learner Perception of Competency and Satisfaction with Three Models of an Interdisciplinary Surge Capacity Course. (First page only.) Journal of Allied Health. 41(3):106-12.
The authors describe an online, workplace-based, interprofessional course in surge capacity building in which 72 health and allied staff from five acute care and community health care organizations participated. Surveys were used to assess self-reported improvements in learners' perceptions of their competency, their interprofessional skills, and satisfaction with the different course delivery options (online only; online plus a tabletop exercise; online plus a tabletop exercise and e-simulation). The authors contend that results demonstrate the effectiveness of online learning, particularly with the addition of a tabletop exercise.
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Cicero, M., Whitfill, T., Munjal, K., et al. (2017). 60 Seconds to Survival: A Pilot Study of a Disaster Triage Video Game for Paramedics. (Article in press; hyperlink to be added.) American Journal of Disaster Medicine.
The authors demonstrate that playing a web-based screen based simulation (video game) is associated with improvements in pediatric and adult primary triage decisions. The study population included paramedics and EMTs, and prehospital healthcare students.
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The authors tested the feasibility and reliability of assessing technical and non-technical disaster medicine skills across 3 multi-agency scenarios (1 pre-hospital and 2 in-hospital) within a virtual environment. The authors conclude that the results indicate that virtual technologies may be used to improve major incident response training.
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Dass, S., Cid, V., Barnieau, J., & Cummings, P. (2016). A Cognitive Task Analysis for an Emergency Management Serious Game. Proceedings from the Interservice/Industry Training, Simulation, and Education Conference (I/ITSEC).
This paper describes how a cognitive task analysis, supported by a live demonstration with a think-aloud protocol, was used to collect the rich psychomotor, procedural, and cognitive data necessary for the design of a serious game for donning personal protective equipment to handle patients with a potential highly infectious disease (e.g., Ebola). The paper also presents a process to translate the collected data into meaningful content to support rapid prototyping of the serious game.
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Farra, S. and Miller, E. T. (2013). Integrative Review: Virtual Disaster Training. Journal of Nursing Education and Practice. 3(3):93-101.
The authors conducted a literature review of the published evidence from 2005-2012 related to the use of virtual reality for disaster training of healthcare workers. They concluded that too few studies had been done, and that future studies must measure long-term retention of knowledge; ability to respond to different types of disasters; and performance in different tasks, such as triage, decontamination, and transport.
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Farra, S., Miller, E., and Hodgson, E. (2015). Virtual Reality Disaster Training: Translation to Practice. (Abstract only.) Nursing Education in Practice. 15(1):53-7.
The authors translate research findings related to the use of virtual reality simulation in disaster training into education practice. They discuss practice guidelines, implementation recommendations, and integration to practice and evaluation.
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Farra, S., Miller, E., Timm, N., and Schafer, J. (2013). Improved Training for Disasters Using 3-D Virtual Reality Simulation. (Available through ResearchGate.) Western Journal of Nursing Research. 35(5):655-71.
The authors randomized nursing students into 1 of 2 groups: one group received online disaster training only, and the other participated in online training, as well as a virtual reality simulation. The authors concluded that virtual reality simulation “is an instructional method that reinforces learning and improves learning retention.”
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Greci, L., Ramloll, R., Hurst, S., et al. (2013). vTrain: A Novel Curriculum for Patient Surge Training in a Multi-User Virtual Environment (MUVE). (Abstract only.) Prehospital and Disaster Medicine. 28(3):215-22.
This article describes a small pilot program of training delivered to emergency department staff to prepare for patient surge using a multi-user virtual environment (MUVE). Participants all reported an increase in disaster preparedness knowledge, and improved team communication, planning, team decision making, and the ability to visualize and reflect on their performance.
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Heinrichs, W., Youngblood, P., Harter, P., et al. (2010). Training Healthcare Personnel for Mass-Casualty Incidents in a Virtual Emergency Department: VED II.. Prehospital and Disaster Medicine. 25(5):424-32.
Twenty-two experienced physicians and nurses practiced caring for patients exposed to either a nerve toxin or a dirty bomb within a virtual emergency department. Confidence to respond to chemical, biological, radiological, or nuclear/explosive mass casualty incidents increased from 18% pre-training to 86% post-training, and 59% of respondents felt that this was due to the virtual learning platform.
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Hsu, E., Li, Y., Bayram, J., et al. (2013). State of Virtual Reality Based Disaster Preparedness and Response Training. PLOS Currents. April 24.
The authors review several applications of virtual reality-based training in the United States, and discuss advantages, and potential drawbacks and challenges associated with virtual reality as a learning platform.
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Ingrassia, P., Ragazzoni, L., Carenzo, L., et al. (2015). Virtual Reality and Live Simulation: A Comparison Between Two Simulation Tools for Assessing Mass Casualty Triage Skills. European Journal of Emergency Medicine. 22(2): 121-127.
The authors compared accuracy and efficiency of triage by fourth-year medical students using the START method with virtual reality or live simulation of a mass casualty incident. They found no difference in accuracy or speed of triage between the two tools.
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The authors studied the feasibility and effectiveness of an interactive, computer-assisted training course designed to build resilience to the stresses of working during a pandemic. They measured confidence in support and training; pandemic-related self-efficacy; coping style; and interpersonal problems, before and after training, and found that the course was associated with improvement in each variable, with the “medium” duration course providing the greatest benefit. The course is free and may be accessed at https://www.msh-healthyminds.com/sv/.
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Pucher, P., Batrick, N., Taylor, D., et al. (2014). Virtual-World Hospital Simulation for Real-World Disaster Response: Design and Validation of a Virtual Reality Simulator for Mass Casualty Incident Management. (Abstract only.) Journal of Trauma and Acute Care Surgery. 77(2):315–321.
The authors discuss the design and validation of an online hospital that allowed multiple clinicians to respond simultaneously to care for virtual mass casualty patients within limits of the hospital’s available resources. The authors conclude that the “customizability, reproducibility, and recordability combined with the low cost of implementation suggest that this potentially represents a powerful adjunct to existing training methods.”
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Rauner, M., Niessner, H., Leopold-Wildburger, U., et al. (2016). A Policy Management Game for Mass Casualty Incidents: An Experimental Study. (Abstract only.) Flexible Services and Manufacturing Journal. 28(1-2):336–365.
The authors tested the use of a policy management game in which participants act as incident commanders with the goal of teaching them how to quickly evacuate an emergency site, to minimize the number of fatalities at the incident site, and to decrease patients’ waiting time for treatment. Participants rated the game favorably, and improvement in their skills was observed, although there were differences in performance across the different groups (students, practitioners, and researchers).
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Willingness to Work and Other Workforce Considerations


The authors provide a brief review of the literature related to adequate disaster staffing, and share the methodology and results of their study that assessed the ability and willingness of healthcare personnel to report to work during a disaster. They note that healthcare personnel experience multiple barriers affecting ability and willingness to report to work during a disaster (responsibility for children being the most significant), and offer strategies for addressing these barriers. Differences between clinical and non-clinical staff responses were observed.
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Aoyagi, Y., Beck, C., Dingwall R., and Nguyen-Van-Tam, J. (2015). Healthcare Workers' Willingness to Work During an Influenza Pandemic: A Systematic Review and Meta-analysis. Influenza and Other Respiratory Viruses. 9(3):120-130.
The authors reviewed literature through to 2013 that discussed healthcare workers’ willingness to work during an influenza pandemic, and found that willingness to work ranged from 23.1% to 95.8%, depending on the context. Male gender, physicians and nurses, full-time employment, perceived personal safety, awareness of pandemic risk and clinical knowledge of influenza pandemics, role-specific knowledge, pandemic response training, and confidence in personal skills were statistically significantly associated with increased willingness. Childcare obligations were significantly associated with decreased willingness.
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The authors discuss findings of a nationally representative survey of Emergency Medical Services (EMS) providers that indicated that hazard-specific education; an understanding of one’s response role; and confidence in occupational safety positively influence respondents’ willingness to respond during a pandemic. However, the authors note that EMS workers indicated they were less likely to respond if they felt their family was in danger, particularly if risk of disease transmission to family members was high.
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Brand, R. (2016). When Disaster Strikes: Nurse Leadership, Nursing Care, and Teamwork Save Lives. Charting Nursing’s Future, a Robert Wood Johnson Foundation Collection.
This issue brief discusses how recent disasters have highlighted gaps, lack of training, and resource constraints related to disaster preparedness for nurses. The author notes that nurses want, and need, access to more training, and acknowledges the challenges to preparedness presented by declining funding and lack of regular engagement of nurses in exercises and training.
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Chaffee, M. (2009). Willingness of Health Care Personnel to Work in a Disaster: An Integrative Review of the Literature. (Abstract only.) Disaster Medicine Public Health Preparedness. 3(1):42–56.
The author conducted a literature review (25 quantitative and 2 qualitative studies) on willingness to work and found pet care needs and the lack of personal protective equipment were top barriers.
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Charney, R., Rebmann, T. and Flood, R. (2015). Hospital Employee Willingness to Work during Earthquakes Versus Pandemics. (Abstract only.) The Journal of Emergency Medicine. 49(5):665-74.
The authors surveyed 1,822 hospital employees (clinical and non-clinical) to determine willingness to work during an earthquake versus a pandemic. They found that willingness to work may be increased by considering care for dependent family members, and by providing greater worker protection, cross training, and job importance education for staff.
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Charney, R., Rebmann, T., and Flood, R. (2014). Working After a Tornado: A Survey of Hospital Personnel in Joplin, Missouri. (Abstract only.) Biosecurity and Bioterrorism. 12(4):190-200.
The authors surveyed 1,234 healthcare workers from the 2 hospitals affected by the Joplin Tornado in 2011 to assess number reporting to work, willingness to work, personal disaster preparedness, and childcare responsibilities following the disaster. The vast majority of respondents reported to work the week after the tornado, and most indicated they would have used childcare at their hospital if it was provided.
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Chokshi, N., Behar, S., Nager, A., et al. (2008). Disaster Management Among Pediatric Surgeons: Preparedness, Training and Involvement. (Abstract only.) American Journal of Disaster Medicine. 3(1):5-14.
The authors surveyed pediatric surgeons to determine their baseline experience, preparedness, willingness, and availability to act as first receivers during a disaster. They found that 74% of respondents felt they needed more training; those with prior disaster experience felt most prepared to respond; and those with defined leadership roles in the disaster response plan felt prepared, and were 5 times more likely to respond than those without defined leadership roles.
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Cowden, J., Crane, L., Lezotte, D., et al. (2010). Pre-Pandemic Planning Survey of Healthcare Workers at a Tertiary Care Children's Hospital: Ethical and Workforce Issues. Influenza and Other Respiratory Viruses. 4(4):213-22.
The authors surveyed clinical and non-clinical support staff at the Children’s Hospital in Denver in 2007. Willingness to respond was associated with higher levels of professionalism, and non-clinical support staff were found to be significantly less likely to report during a pandemic, suggesting the need for additional training for these staff members to help them understand the value of their roles
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Crane, J., McCluskey, J., Johnson, G., and Harbison, R. (2010). Assessment of Community Healthcare Providers Ability and Willingness to Respond to Emergencies Resulting From Bioterrorist Attacks. Journal of Emergencies, Trauma, and Shock. 3(1):13-20.
The authors surveyed physicians, nurses, and pharmacists in Florida in 2009 to assess their ability and willingness to respond to bioterrorist attacks. Only 32% were determined to be competent and willing to respond, with the lowest competency seen in the ability to identify cases and the ability to communicate risk to others. Previous training and drill participation were found to be significant predictors of preparedness.
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The author evaluated 32 peer-reviewed, quantitative articles published from January 2001-June 2010 to determine willingness to work during an influenza public health emergency. He found that “factors associated with a willingness to work during an influenza public health emergency include: being male, being a doctor or nurse, working in a clinical or emergency department, working full-time, prior influenza education and training, prior experience working during an influenza emergency, the perception of value in response, the belief in duty, the availability of personal protective equipment (PPE), and confidence in one's employer.” Preferential treatment of healthcare workers and their families for the receipt of vaccines and antivirals were noted as the interventions that most positively influenced willingness to work.
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Errett, N., Barnett, D., Thompson, C., et al. (2012). Assessment of Psychological Preparedness and Emergency Response Willingness of Local Public Health Department and Hospital Workers. (Abstract only.) International Journal of Emergency Mental Health. 14(2):125-33.
The authors surveyed hospital and public health workers to assess their willingness to respond to a pandemic influenza emergency scenario and a radiological 'dirty' bomb scenario. They found that respondents that felt psychologically prepared were more willing to respond, and self-reported willingness to respond was influenced by perceived self-efficacy and perceived family preparedness.
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Goodhue, C., Burke, R., Ferrer, R., et al. (2012). Willingness to Respond in a Disaster: A Pediatric Nurse Practitioner National Survey. (Abstract only.) Journal of Pediatric Health Care. 26(4):e7-20.
The authors conducted a national survey of pediatric nurse practitioners to learn about their personal preparedness plans, disaster training, prior disaster experience, and likelihood of responding in the event of a disaster. They found that those who were male, had prior military experience and disaster training, and had a defined role in response plans were most likely to respond during a disaster.
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Hayanga, H., Barnett, D., Shallow, N., et al. (2017). Anesthesiologists and Disaster Medicine: A Needs Assessment for Education and Training and Reported Willingness to Respond. (Abstract only.) Anesthesia and Analgesia. 124(5):1662-1669.
A web-based survey of anesthesiologists was conducted to assess self-reported perceptions of knowledge and skills, as well as attitudes and beliefs regarding education and training, employee development, professional obligation, safety, psychological readiness, efficacy, personal preparedness, and willingness to respond during a natural disaster, pandemic flu, and a radiological event. Few respondents indicated that they think they receive sufficient education for disaster response, and most think that their hospitals should provide this training to them. The authors recommend that additional training be provided, and support for staff to meet family obligations be put in place to encourage providers to come to work during disasters.
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Huntington, M. and Gavagan, T. (2011). Disaster Medicine Training in Family Medicine: A Review of the Evidence. Family Medicine. Family Medicine. 43(1):13-20.
The authors discuss disaster response requirements for Family Medicine residents, and note that there is little outcomes-based evidence to support them in the literature.
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Irvin, C., Cindrich, L., Patterson, W., Southall, A. (2008). Survey of Hospital Healthcare Personnel Response During a Potential Avian Influenza Pandemic: Will They Come to Work? Prehospital and Disaster Medicine. 23(4):328-35.
Doctors, nurses, and nonclinical hospital staff were surveyed to determine how likely they would be to report to work during an influenza pandemic. Doctors were found to be most likely to come to work, as were male respondents. For those unsure about reporting for work, their personal safety was the most significant concern, and the authors note the importance of ensuring workers’ confidence in adequate personal protections.
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Labrague, L., Hammad, K., Gloe, D., et al. (2017). Disaster Preparedness Among Nurses: A Systematic Review of Literature. (Abstract only.) International Nursing Review. March 14.
The authors conducted a review of scientific articles conducted from 2006 to 2016 on nurses’ preparedness for disasters, and found that nurses are insufficiently prepared and do not feel confident responding effectively to disasters. Previous disaster response experience and disaster-related training were found to increase preparedness. The authors note that more, realistic disaster exercises are needed to further prepare nurses.
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Physicians and physician assistants from 21 specialties were surveyed to examine their perceptions related to roles and responsibilities of clinicians in a disaster; barriers to participation; implementation of chemical, biological, radiological, nuclear, and explosive training; and training preferences. Respondents indicated that concerns about risk and malpractice, the cost of training, the time involved in training, and the cost for the time in training were all barriers to training. There were no clear preferences for training strategies.
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Mercer, M., Ancock, B., Levis, J., and Reyes, V. (2014). Ready or Not: Does Household Preparedness Prevent Absenteeism Among Emergency Department Staff During a Disaster? (Abstract only.) American Journal of Disaster Medicine. 9(3):221-32.
The authors administered a survey to emergency department staff to determine if household preparedness correlates with likelihood of reporting to work during a disaster. Household preparedness did not have an effect on self-reported likelihood of reporting during a disaster. Having dependents in the home; female gender; past disaster relief experience; having a spouse or domestic partner; and not owning pets were factors found to be associated with predicted absenteeism, though this varied based on disaster type.
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Patel, R., Wattamwar, K., Kanduri, J. and Nahass, M. (2017). Health Care Student Knowledge and Willingness to Work in Infectious Disease Outbreaks. (Abstract only.) Disaster Medicine and Public Health Preparedness. June 19:1-7.
This study explored willingness to work among medical, nursing, and pharmacy students. Medical students indicated they were most willing to work, and greater willingness to work was associated with prior disaster training. The authors cite the “remarkable underemphasis on disaster preparedness in health care curricula,” and note how important it is to prepare health professional students, who will become the healthcare workforce.
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Patel, V. and Dahl-Grove, D. (2016). Disaster Preparedness Medical School Elective: Bridging the Gap Between Volunteer Eagerness and Readiness. Pediatric Emergency Care. July 23.
Medical students were asked to participate in an online disaster training consisting of 4 modules to determine if the training helped them feel more prepared to respond during a disaster, and if it would affect their willingness to volunteer during an emergency. Pre- and post-survey results showed a significant increase in perceptions of preparedness among participants, though the course did not affect the initially high level of willingness to volunteer.
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Qureshi, K., Gerson, R., Sherman, M., et al. (2005). Health Care Workers’ Ability and Willingness to Report to Duty During Catastrophic Disasters. (Abstract only.) Health Care Workers’ Ability and Willingness to Report to Duty During Catastrophic Disasters. (Abstract only.) Journal of Urban Health. 82(3): 378–388.
A survey of more than 6,400 healthcare workers (HCW) in New York City revealed that “in terms of willingness, HCWs were most willing to report during a snow storm (80%), MCI (86%), and environmental disaster (84%) and least willing during a SARS outbreak (48%), radiological event (57%), smallpox epidemic (61%), and chemical event (68%).” Barriers included childcare, elder care, and pet care, but the authors noted that many barriers were also open to interventions.
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Reilly, M. and Markenson, D. (2009). Education and Training of Hospital Workers: Who Are Essential Personnel during a Disaster? (Abstract only.) Prehospital and Disaster Medicine. 24(3):239–245.
The authors surveyed bioterrorism coordinators and emergency managers for 31 hospitals in a suburban area to determine which staff members were considered “essential” for disaster response, and if essential staff had been trained on their emergency response roles. Emergency physicians, nurses, and support staff were the 3 categories of staff most often cited, and some hospitals noted that these staff members had not been trained in their roles.
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Rowel, R. and Barnett, D. (2013). Disaster Preparedness: Public Health Infrastructure and Perspectives on Community Resilience. Johns Hopkins University, Bloomberg School of Public Health, MidAtlantic Public Health Training Center.
This presentation discusses research conducted to identify influences of perceived threat and efficacy on willingness to respond in public health emergencies. Emergency-specific patterns of response willingness are reviewed, and recommendation for improving response willingness are provided.
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Siddle, J., Tolleson-Rinehart, S., and Brice, J. (2016). Survey of Emergency Department Staff on Disaster Preparedness and Training for Ebola Virus Disease. (Abstract only.) American Journal of Disaster Medicine. 11(1):5-18.
The authors evaluated the effects of targeted training on Emergency Department staff members’ Ebola-related perceptions and attitudes. Post-training survey responses across all disciplines demonstrated that participants felt better able to care for an Ebola patient and understood team roles better, and that the hospital was better prepared for Ebola response.
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SteelFisher, G., Blendon, R., Brulé, A., et al. (2015). Physician Emergency Preparedness: A National Poll of Physicians. (Abstract only.) Disaster Medicine and Public Health Preparedness. 9(6):666-80.
Researchers conducted a national poll among 1,603 practicing physicians in a range of specialties in hospital and nonhospital settings to assess their preparedness and training for emergency response (among other things). Results indicated that there were significant gaps among physicians’ preparedness for public health emergencies, and their participation in trainings and other institutional preparedness activities. The authors recommend collaboration between hospitals and public health agencies to develop useful educational tools, and incorporate online resources into training.
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The authors reviewed over 100 reports, articles, documents, and analyses related to whether or not responders would be willing to report to work during a disaster. They summarize the research, and present conclusions pertaining to role conflict, role strain and role abandonment, emphasizing worker safety, family support and safety, and communicating expectations and a culture of responsibility in the workplace.
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Valdez, C. and Nichols, T. (2013). Motivating Healthcare Workers to Work During a Crisis: A Literature Review. Journal of Management Policy and Practice. 14(4):43-51.
The authors reviewed published literature on healthcare workers’ willingness to work during a disaster or public health emergency to identify related motivation factors. One key finding from their review was that healthcare workers are more likely to come to work if they understand their anticipated response role, and feel prepared to carry it out. The authors recommend frequent training of health care workers in disaster response, as well as the integration of such information into health professional educational curricula.
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Veenema, T.G., Griffin, A., Gable, A.R. (2016). Nurses as Leaders in Disaster Preparedness and Response—A Call to Action. Journal of Nursing Scholarship. 48(2):187–200.
The authors discuss the future of nursing in disaster preparedness and response, and provide recommendations for nursing practice, education, policy, and research to enhance preparedness among nurses. Current barriers and opportunities to advance professional disaster nursing are also included.
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More than 1,500 (non-healthcare) employees in a major German city participated in an online survey that measured variables such as risk perception, role competence, self-efficacy, role importance, sense of duty, and willingness to report to work in the case of a pandemic. Results incidated that nearly 20% would not be willing to report in the event of a pandemic, primarily because of perceived risk of infection and risk of infecting loved ones.
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Watson, C., Barnett, D., Thompson, C., et al. (2011). Characterizing Public Health Emergency Perceptions and Influential Modifiers of Willingness to Respond Among Pediatric Healthcare Staff. American Journal of Disaster Medicine. 6(5):299-308.
The authors surveyed hospital-based pediatric staff in 2009 to characterize their perceptions of, and willingness to respond during, public health emergencies, with the goal of developing a methodology for an institution-specific training package to improve response willingness. The vast majority of respondents indicated a need for more training to respond to the survey scenarios (pandemic influenza and radiological dispersal device), and the authors found 6 six “distinct perceived attitudes/beliefs that had an institution-specific high impact on response willingness: colleague response, skill mastery, safety getting to work, safety at work, ability to perform duties, and individual response efficacy.”
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Agencies and Organizations


American Nurses Credentialing Center. National Healthcare Disaster Certification.
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Federal Emergency Management Agency. Emergency Management Institute.
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Federal Emergency Management Agency, National Training and Exercise Division. Course Catalog.
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* National Center for Disaster Medicine and Public Health. Competency Connector. (Accessed 10/23/2017.)
This webpage contains an annotated bibliography of white papers, grey literature, and publications related to disaster health competencies, categorized as per Walsh et al., 2014. Resources chosen for inclusion define specific competencies for learning in disaster health; are directed toward a health or health-related profession; and are written in English.
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* National Center for Disaster Medicine and Public Health. Resources for Core Competencies in Disaster Health. (Accessed 8/6/2019.)
This webpage includes a list of the 11 core competencies for disaster health, along with links to resources to support each of the competencies.
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Oak Ridge Institute for Science and Education. Radiation Emergency Assistance Center/Training Site.
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Public Health Foundation. TRAIN Learning Network.
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Society for Academic Emergency Medicine. Fellowship Directory.
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