Healthcare professionals working in a disaster face destroyed physical infrastructures, scarce supplies, and a limited-in-training peer group. During a mass casualty event, disaster victims are triaged to the “expectant” category of care because either their injuries are not survivable or the resources needed to care for them are not available.

To examine the challenges that disaster responders face in caring for dying patients in the field, and advocate for basic palliative care training prior to deploying to a disaster.

The world’s literature was reviewed to identify challenges for disaster teams in providing compassionate end-of-life care and to find training exercises for pre-deployment competency building.

Training Topics in Palliative Care Prior to Disaster Deployment include the following:

1. 1.Symptom Management Protocols:
   • Pain
   • Anxiety
   • Respiratory distress
   • Delirium
   • Nausea and Vomiting
2. 2.Spiritual Management
   • Grief
   • Identify meaning
3. 3.Cultural Training specific to the location of the disaster
   • The meaning of death in the culture
   • Who are the decision makers in the family
4. 4.Training for difficult conversations
   • Delivering Bad News
   • Managing a grieving family
5. 5.Self-Care Training
   • Develop a system for debriefing
   • Develop a buddy system
   • Self-care exercises: deep breathing, prayer, meditation, yoga

Challenges to the care of the dying during a disaster include a loss of medical infrastructure and scarce medical or physical resources. Palliative care training for non-palliative care specialists can be instructive for the development of palliative care training for medical care responders after disasters. Applying standards, identifying goals of care for the expectant patient, communication to the patient and family members, if available, can help reduce suffering of this group of devastatingly vulnerable patients. In addition, peer support, on-site discussions and debriefing, and problem-solving when resources are limited will help alleviate moral distress among the providers.

Gender-based violence is endemic across the world. The current evidence suggests that gender-based violence increases after natural disasters. Factors leading to this increase following natural disasters include physical displacement, loss of community supports and protections, economic hardship, and gendered differences in coping. Multiple agencies are mobilized in response to natural disasters, however, personnel are often not adequately trained to recognize or address gender-based violence.

To identify challenges faced by disaster responders in recognizing and responding to gender-based violence in disaster settings, and to advocate for gender-sensitive training prior to deployment by responding personnel.

The world’s literature was reviewed to identify challenges for disaster teams in recognizing and responding to gender-based violence, and to identify principles of training which may be applicable for pre-deployment competency building by disaster response personnel

Disaster response programs should ensure:

• Collection of data to identify vulnerable populations
• Establishment of procedures for monitoring and reporting
• Inclusion of female staff at all levels of planning and response
• Implementation of holistic services including physical and psychosocial care and legal response
• Safety in designing accommodations and distribution centers

Pre-Deployment training should include:

• Gender-sensitive approach, knowledge of prevalence and impact of gender-based violence
• Familiarity with behaviors and conditions associated with gender-based violence
• Non-judgmental, supportive, and validating approach to inquiry and response
• Familiarity with risk assessment tools
• Mobilization of social supports
• Knowledge of resources, including medical and legal services

Natural disasters are destabilizing events which expose vulnerable populations, particularly women, to increased violence. Disaster response teams should be adequately trained on the prevalence and impact of gender-based violence to ensure gender-sensitive interventions. Standard training of response personnel can ensure adequate identification of victims of gender-based violence and referral to appropriate services.