The development of the [US] National Disaster Life Support (NDLS) programs (Advanced, Basic, and Core Disaster Life Support) began prior to 11 September 2001, but in its aftermath, the NDLS programs have become a leading all-hazards disaster medicine training program in the US. The NDLS programs are taught through a training center model. The curriculum is revised via the National Disaster Life Support Education Consortium (NDLSEC), a multi-disciplinary, multi-specialty consortium.

The National Disaster Life Support Foundation (NDLSF) is a not-for-profit organization developed by the academic medical centers and partners that developed the NDLS programs. The founding institutions are the Medical College of Georgia, die University of Georgia, the University of Texas Southwestern, the University of Texas-Houston, and the American Medical Association. The NDLSF has die responsibility to oversee, certify, and monitor a network of training centers. The NDLSEC consist of individual members and 75 representative stakeholder organizations.

The training center network overseen by the NDLSF consists of 70 training centers in the US and 10 developing international training centers. The NDLSEC has >150 members with representatives from virtually every medical discipline and specialty. More than 70,000 individuals have been trained.

The NDLS programs have employed a training center network model to deploy standardized, all-hazards disaster educational programs. The NDLS programs have been successful in bridging die gap in disaster medicine education programs in the US and may represent a useful model for other countries to provide disaster medicine education.

A recent national assessment of emergency planning in Canada suggests that healthcare professionals are not properly prepared for disasters. In response to this gap, an interprofessional course in disaster management was developed, implemented, and evaluated in Toronto from 2007 to 2008. Undergraduate students in nursing, medicine, paramedicine, police, media, and health administration programs from Centennial College, the Michener Institute for Applied Health Sciences, George Brown College, Ryerson University, and the University of Toronto, took the eight-week online course. Curriculum developers set interprofessional competency as a major course outcome right from the start, and this concept guided content and activity development. The course was highly interactive and included video, a discussion forum, an online board game, and the opportunity to participate in a mock disaster simulation with professional staff.

A research study, funded by Health Canada, was conducted using quantitative and qualitative methods to examine the impact of the course on students' disaster management competencies and interprofessional attitudes.

Results indicate that the online course and simulation exercise provided an excellent opportunity for undergraduate students to learn and practice inter-professional collaboration, develop disaster management skills, and develop empathy for victims.

Results underscore the necessity of extensive inter-institutional collaboration regarding simulation planning, curriculum development, and faculty training. The session should be of interest to emergency and disaster educators, heakhcare professionals, policy-makers, and researchers.

Disaster medicine is an increasingly important part of medicine. Training in the practical aspects of disaster medicine often is impossible, and simulation may offer an educational opportunity superior to traditional didactic methods.

Twenty-two medical students at the Università degli studi del Piemonte Orientale were block-randomized into two groups of 11 students stratified by year of education. All participants received an eight-hour course of lectures and problem-based learning in disaster medicine. The intervention group received additional disaster medicine training on the disastermed.ca patient simulator, while the control group spent equal time on the simulator in a non-disaster setting. The ability of the two groups to manage a simulated disaster was compared.

Students in the intervention group were able to triage their patients more quickly than the control group (mean difference = 43 seconds, 95% CI 0.34–1.09 minutes, p <0.0003). Patients in the intervention group also were assessed more quickly (mean difference = 6.3 minutes, 95% CI = 0.4–12.1 minutes, p <0.04). Scores of performance indicators on a standardized scale was significantly higher in the intervention group (18/18) compared to the control group (8/18; p <0.0004). All students stated that they preferred the simulation-based curriculum to a lecture-based curriculum. When asked to rate the exercise overall, the median score was 8 on a 10-point modified Likert scale with no difference between the control and intervention groups.

Simulation of a mass-casualty incident increased the speed at which medical students were able to triage and assess simulated patients. Exposure to the disaster simulation also increased the scores on a structured command-and-control performance indicator instrument. Overall student satisfaction with the simulation-based curriculum was high, and all students felt that the simulation was a valuable learning experience.

Disaster and emergency personnel must master a variety of medical skills and must be able to perform under various stressful circumstances. In general, medical personnel are highly educated and are expected to be self-critical individuals even under extreme circumstances. However, self-critical abilities seldom are trained or evaluated within these circumstances. The combination of training for critical tasks and coping with stress can be trained in a personalized way by using serious gaming techniques. Immersion in the real-life stressful context, by means of a game, is a strong trigger for the intrinsic motivation to learn. Serious gaming could be useful, but it is unclear in what way games should include self-critical learning and coping with stress.

Several studies on the possibilities of serious gaming for medical personnel were performed: (1) an investigation on self-directed learning in ambulance workers; (2) an adventure based learning experiment with military physician; and (3) a literature review on games and stress.

The more subjects are capable of self-critical learning, the more they benefit from a game. Subjects can actively take control on what, how, and when they want to learn, which has an effect on self-efficacy and coping. Moreover, self-critical learning can be enhanced in a game, using feedback directed at the effects of stress on the critical performance of (medical) tasks.

The ways serious games can enhance self-critical learning and coping with stress will be elaborated upon.

The World Association for Disaster and Emergency Medicine (WADEM) Education Committee recommends that all health professionals be exposed to a core program in disaster health. This paper describes the framework, implementation, and evaluation of a Graduate Certificate in Emergency Preparedness and Disaster Health designed for health professionals.

Based on the WADEM Education Committee's framework for disaster health and the structure of the World Health Organization (WHO) Health Action in Crises Unit, a four-unit Graduate Certificate in Emergency Preparedness and Disaster Heath was developed, implemented and evaluated.

This Graduate Certificate evolved over diree years and includes four units: (1) an introduction to emergency preparedness and disaster health; (2) emergency preparedness; (3) response and major incident management, and (4) disaster recovery. Each unit has national and international perspectives.

Appropriate conceptual models provided the content and process of the course, although these have been difficult to locate. Delivery is largely on-campus with pre-reading and post-course assignments. A faculty of national and international leaders enriches delivery. Assessment largely has been assignment-based, with participation in one “Emergotrain” exercise required. Students may take the full Graduate Certificate or individual units only, either for credit or not-for-credit professional development.

Student feedback has been positive, with the introductory unit being rated as amongst the top 10% of units conducted in the faculty for two years in a row. The content, process, and assessments have been well supported with only few suggestions made for future modifications. An online option will now be offered in 2009, and a Graduate Diploma and Masters also will be available in 2009.

This Graduate Certificate has been evaluated positively by participants. The conceptual modeling has been validated and the model may be of interest to other WADEM members.

Mock Code Training is an exercise designed to develop competency in emergency responsiveness. The objectives for this educational intervention were: (1) demonstrate basic airway maneuvers (2) demonstrate basic life support-cardiopulmonary resuscitation (BLS-CPR); (3) demonstrate when and how to call a Code; (4) recognize life-threatening cardiac arrhythmias; (5) initiate relevant cardiac monitoring; and (6) initiate relevant resuscitation based on algorithms.

Drills were conducted monthly on various inpa-tient and outpatient nursing units at the University of Wisconsin Hospital and Clinics. The following data was collected: (1) chime sounded; (2) basic patient assessment; (3) universal precautions; (4) compressions; (5) automated external defibrillator (AED) arrival; (6) unit emergency cart arrival; (7) oxygen administration; (8) code team arrival; (9) Advanced Cardiac Life Support (ACLS) Guidelines; (10) presence of recorder; (11) monitor initiation; (12) advanced airway; (13) intravenous (IV) access; (14) medications; (15) and time resuscitation ended.

The mean results were: (1) action for delivery of compressions = 1 minute, 10 seconds; (2) unit emergency cart arrival = 2 minutes, 15 seconds; (3) oxygen-bag valve mask = 3 minutes, 10 seconds; (4) defibrillation = 7 minutes; (5) code team arrival = 3 minutes, 33 seconds; (6) ACLS Guidelines Initiated = 6 minutes, 13 seconds; (7) monitor initiation = 5 minutes, 33 seconds; (8) advanced airway = 6 minutes; (9) IV access = 3 minutes, 15 seconds; and (10) medication administration = 6 minutes, 30 seconds.

Universities have fallen victim to many disasters over the years, ranging from those caused by natural hazards to campus violence. Most institutions have disaster plans in place and attempt to update those plans on a regular basis. Yet historically, universities do a poor job in testing those emergency operation plans as part of their routine preparation and mitigation practices. In July 2008, Philadelphia University participated in a full-scale, multi-agency exercise in order to test their disaster plan. The purpose of this study was to examine the lessons learned from the drill, analyze the benefits of the drill, and determine if the drill brought value to the university.

Interviews were conducted with 21 of the 25 university personnel who participated in the exercise. The interviews were taped and analyzed with the use of qualitative methods and content analysis techniques.

The emerging themes from the study included the benefits and values of the drill, the lessons learned, how perceptions were changed after the drill, views about the current level of disaster preparedness, and recommendations for improving disaster management practices.

The results demonstrated that the disaster drill was a valuable learning experience for the participants. The university benefited from the drill in multiple ways, learned many lessons, and discovered ways to begin improving their disaster management practices.

Physicians practicing internationally provide comprehensive health care and often prepare with global health courses. These can be limited by timing and do not provide primary care training to sub-specialists. It is hypothesized that Oregon physicians are interested in global health education and want an accessible course that reviews skills used in international medicine.

A survey-based needs assessment was conducted of licensed Oregon physicians that determined the level of interest in global health training. A total of 6,099 surveys were mailed to physicians in June 2007. The surveys included questions regarding demographics (age, gender, years of clinical practice, and practice specialty), international background (volunteer work, disaster relief), global health education interest (obtaining training, specialties desired), and course specifics (length, format, and cost).

A total of 624 surveys were returned for a 10.6% response rate. Of that group, 88.1% expressed interest in global health and 75.8% in a training course. Data analysis of this group showed that it consisted largely of physicians practicing for 15–34 years (mean = 23.8) and 45–64 years of age (mean = 55.8). Answers to course-specific questions indicated physician concerns about course time and educational interests based on differing clinical background.

Oregon physicians are interested in international healthcare education. To meet this need, a global health course has been developed at the Oregon Health and Science University (OHSU).

Emergency medicine continues to grow as an international specialty. With >30 countries developing emergency medicine training, supporting international physician education is imperative. The proposed Emergency Medicine International (EMI) observational fellowship is a systematic model for the academic and experiential training of future leaders.

This program is a result of interest in academic emergency medicine and the responsibility of the educational institution. A literature review on the international development of emergency medicine was performed and the weaknesses were assessed. Based on this review, the goals for EMI are providing: (1) leadership; (2) exposure to education training models; and (3) research instruction. The EMI structure consists of four blocks: (1) emergency medicine clinical rotations; (2) emergency medical services (EMS) experience; (3) medical toxicology exposure; and (4) emergency medicine operations/administration. All blocks are tailored to the training background and interests of participants such as focusing on education methodology (conference organization, simulation) or departmental operations (quality improvement, faculty development). Overlapping all blocks is crucial to education in research methodology and evidence-based practice of medicine.

Assessment of the program includes pre-/post-survey completion by participants and yearly post-fellowship contact tracking the development of emergency medicine in their country.

While different types of organizations can assist in other ways, only academic emergency medicine can help grow and mentor faculty to expand the specialty worldwide.

Following the response to the devastating 2004 tsunami, Medical Teams International's (MTI) Emergency Medical Services (EMS) program has worked directly with the Government of Sri Lanka to develop a comprehensive EMS system. In September and October 2008, a delegation of eight Sri Lankan EMS instructors visited Oregon and Washington for advanced instructor training in EMS skills and observation of local and governmental EMS agencies. The delegation participated in > 1,300 hours of combined classroom education and direct provider observation experiences. Following the visit, the delegation was given a 10-question post-event survey to measure their perception of the effectiveness of this type educational exchange.

A Web-based survey tool was utilized to elicit responses from the participants. Questions consisted of open-ended and ranked questions. The survey period was 30 days and there was a 60% response rate.

The participants felt this opportunity was useful and beneficial to the ongoing development of the EMS system in Sri Lanka. Additionally, participants indicated that the classroom experience was the most important aspect of the visit. An unanticipated response was that the participants were impressed with the concept of collaborative teamwork and unity that exists within US fire departments and EMS agencies.

Future exchange programs should focus more on classroom experiences and less on ride-along type experiences. Additionally smaller groups may allow for greater one-on-one peer education opportunities. This exchange provided participants with opportunities that are not currently available in Sri Lanka. The participants in this exchange will utilize the knowledge from this exchange for many years to come.

Education of graduate students in international disaster relief (IDR) is important. The authors introduced this practical education in Saga University in Japan.

The authors performed a mass casualty disaster exercise involving the simulated IDR from 06 October to 08 December 2008 (every Monday, for two hours/week, for a total of 12 hours). The exercise was designed to simulate the medical relief operation of the Indian Ocean tsunami that occurred in December 2004. Logistical functions also were involved. Thirteen students participated the exercise, and they were assigned to one of two groups. Each group included one Indonesian doctor who was a PhD candidate, while die remaining students were achieving a Masters in nursing. The official language used during the exercise was English. This study reports on the experience and evaluation of the students.

More than 90% of the students answered that this exercise was very instructive and interesting. They rated the simulation exercise very favorably and believed that the knowledge gained through the exercise would be beneficial in the near future.

This kind of practical education is valuable in disaster medicine and disaster nursing training for graduate students in Japan.

Predisaster Drill Activities (PDAs) may act as predictors of preparedness, but have been studied inadequately. To address this gap, a descriptive study of PDAswas conducted at two large hospitals.

A longitudinal study was conducted at two large academic hospitals (A: a tertiary care university hospital, and B: an urban, municipal, Level-1 Trauma Center) in Brooklyn, New York. Both were equipped with disaster plans. Over a period of five weeks preceding a full-scale drill of a simulated pandemic influenza outbreak, eight sequential public health alerts were issued. Hospital responses to pre-identified components were recorded: (1) training; (2) equipment; (3) communications; (4) incident command centers; (5) supplies; (6) staffing; (7) infection control measures; and (8) miscellaneous. A descriptive statistical analysis was performed.

The overall response rate to all die alerts for Hospital A was 67%, while that for Hospital B was 40% (p <0.009).The median delay in responding to alerts for Hospital A was six days (range = 0–19 days), and B was seven days (range = 0–21 days). Training was die most frequendy cited component (n = 20), however the median delays (days) were two (range = 0–13), and nine (range = 4–21) for hospitals A and B, respectively. Responses to communications, supplies and incident command center components were delayed or inadequate. Some additional unexpected responses such as supplemental meetings (n = 4) and additional infection control measures (n = 3) were elicited at both hospitals.

There were disparate responses to identical triggers at similar sites. Pre-disaster Drill Activities may help identify emergency response preparedness gaps and augment available resources for optimal utilization.