The selection and training of medical specialists for field activities in emergencies requires a set of methods for providing professional capacities. The complex psycho-physiological approach allows a new system for the selection and preparedness on the psychological and professional level to be applied.

The objective of this study was to mobilize psycho-physiological instruments for the staff selection procedure, and to follow an approach of psycho-physologically based methods for staff mental preparedness.

The battery of quantitative evaluation methods for study and practice for use in laboratory and field conditions is proposed. The methods are underlined by complicated, bilateral, sensorial reactions in modeled conditions of ipsi- and contra-lateral visual deprivation and conditioned environments on the computer screen. In processing experimental conditions, the mechanisms of integrative factors regulating the characteristics of hemisphere asymmetry have been evaluated and managed as a result of the influence of specific procedures. The conditions of selection and ultimate correction, if necessary, are determined as a result of preliminary professional preparedness and initial mental status. The methods are completely objective based on the quantitative criteria. The selection procedure does not include any subjective evaluation.

The method battery is registered in the national registry of patents and inventions. The results and conclusions could be included in the training of search-and-rescue teams, medical emergency teams, and other hazard staff.

The Pan-American Trauma Society (PTS) developed a Trauma and Emergency Ultrasound Course (USET) in response to the requirement for trauma ultrasound training for low- and middle-income countries. The objective of this study was to evaluate the efficiency of this course.

Pre- and post-course tests were used. An interval estimation of proportions was calculated at 95% CI. Theoretical and practical pre- and post-course knowledge were assessed with the Wilcoxon Signed Rank test at a 0.05 level of statistical significance.

Between 2005 and 2007, 114 students, including general surgeons, emergency medicine physicians, anesthesiologists, critical care physicians, and residents of these specialties, were trained in seven countries (Uruguay, Peru, Mexico, Venezuela, Aruba, Colombia, and Ecuador). The difference on complete knowledge ranked scores before and after the course was statistically significant (p <0.001). After the course, almost all participants (97.4%) demonstrated complete knowledge in final evaluation.

The USET course is an effective approach for trauma ultrasound training. Specific training programs for trauma care providers that work in low- and middle-income countries are necessary and could be performed with low-cost training programs.

The aim of this project was to develop a Web-based, inter-professional education program on chemical, biological, radiological, or nuclear (CBRN) disasters, focusing on making cooperative, on-site efforts during the initial 15 minutes after the event more effective. The program should secure that intervening personnel from the police, health, medical, and rescue services have knowledge and understanding of the initial tasks and strategies of each respective organization in case of CBRN disasters.

Using tabletop seminars based on five scenarios, the strengths and weaknesses regarding accomplishing tasks in case of the CBRN disaster were identified for each organization. Putting further strain on each scenario, the critical levels for satisfactory accomplishment were crystallized. Based on this vital information, all cooperating authorities have, in consensus, decided on the on-site organization.

The project has promoted the development of a profound national cooperation between the police, rescue, medical, and health services. The Web-based program has made the on-site efforts more efficient, focusing on personal and third-party security, on-site organization, zoning, levels of protection, and life-saving decontamination.

This program provides an increased interprofessional understanding of the responsibilities, authority, and capacities of different sectors. This pedagogical program is cost-efficient, applicable at all levels within organizations, secures that everyone receives the same information, available whenever and wherever it is needed, and adjustable. When a participant passes a level, they attain a certificate, thus providing a secure evaluation system where die employer can appreciate the employee's competence.

This paper reports on an Australian experience with the MicroSim software used for the preparation of undergraduate, inter-professional paramedic nurses. The paramedic nurse course focuses on preparing graduates for practice in rural communities where there are opportunities to enhance the productivity and skill retention of the local emergency health workforce.

The students were introduced to the software during their second year of a four-year, double-degree programs to enhance their ability to conduct primary and secondary surveys and respond in a timely and clinically appropriate manner. Their responses were required to be relevant to the nursing, paramedic, and inter-professional preparation for nursing as reviewed by the course thus far. The students were assessed as individuals and teams and were invited to describe observations of their own responses and those of the broader inter-professional team.

Aggregate results will be reported. The students were highly enthusiastic about their participation and assessment, and the method continued its third year in 2009. Examples of student responses to cardiac and trauma clinical scenarios will be demonstrated as two of the most frequent presentation types to the emergency department calls to the ambulance service.

The combination of the use of interactive software and teamwork in simulations that paramedic nurses may experience in rural Victoria was highly successful in promoting confidence, competence, communication, critique, and team-building in this already high achieving group of students.

In an effort to create uniformity in job-critical knowledge and skill sets among hospital emergency coordinators throughout Georgia, yielding improved emergency preparedness and interagency cooperation, the Georgia Department of Human Resources Division of Public Health and the Medical College of Georgia's Center of Operational Medicine created the Certified Hospital Emergency Coordinator (CHEC) Program.

A focus group of emergency management, public health, and emergency medicine experts was convened. Twenty-seven critical and important tasks, skills, and areas of knowledge imperative to professionals were identified. Based on these, two novel courses were developed. The completion of these and other established courses available through the US government and the National Disaster Life Support Foundation, in addition to job experience, form the basis of the newly created three-level certification program.

Approximately 125 hospital emergency managers from all regions of Georgia have been trained thus far, and another four courses are scheduled for 2009 with an average of 30 students per course expected. Attendance at both the Basic and Level II courses has created valuable interpersonal relationships, professional familiarity, and a common educational baseline amongst the state's hospital emergency coordinators.

Georgia's CHEC program represents a novel approach to training and preparedness at the hospital level. Coordination between public health and academia has allowed for the sharing of knowledge and resources in an unprecedented way. This has created enhanced preparedness throughout the state and has emboldened interpersonal and interagency cooperation within the realm of emergency management.

In 2005, a seven-car commuter express train collided with an apartment building in Japan. The crash left 107 passengers dead and 549 injured. This paper highlights confined space medicine mat was provided for three survivors and introduces the current approach for training Japan Disaster Medical Teams (JDMATs) and/or rescue professionals.

A retrospective analysis of confined space medicine provided after the train crash and a study of training of JDMATs and/or rescue teams.

Three medical teams and search-and-rescue teams rescued three survivors whose bodies were trapped in the tangled wreckage of the first car. The medical teams secured intravenous lines and provided oxygen and approximately 4L of fluid before extrication. A 46-year-old woman was extricated in 14 hours, a 19-year-old man in 16.5 hours, and an 18-year-old man 22 hours after the crash. All three worsened at the final moment of extrication. Their crush syndrome required resuscitation at the scene, and intensive care such as hemodialysis and limb amputation in hospitals. Two patients survived and one patient died on me fifth day due to multiple organ dysfunctions.

Now, the curriculum of the JDMAT training course includes lectures and introductory exercises with rescue teams to learn the importance and difficulties of confined space medicine at the scene.

Confined space medicine was provided successfully after the train crash. Knowledge of confined-space medicine is essential to medical and rescue teams. Further education and training curriculum must be created.

The possibility of natural disasters and public health emergencies, coupled with the possibility of terrorism, support the need to incorporate emergency preparedness into the curricula for every health professional school.

A survey methodology was employed to assess attitudes toward and knowledge of emergency preparedness among health profession students including schools of medicine, nursing, dentistry, and public health. The survey was targeted to graduating students, administered prior to the institution of an emergency preparedness curriculum, and then repeated as an annual survey.

The survey found that 51.8% had been present at a disaster site as non-responders, while only 12.1% ever had been present as a responder. With regard to baseline class room exposure, >50% reported no exposure to such key concepts as incident command, triage, all-hazards planning, surge, and aspects of terrorism. In addition, at the baseline, most students felt they had no competency in emergency preparedness. For example, only 10% of students felt competent with personal protective equipment. While exposure both as a responder and student was low, 82.5% of students felt that emergency preparedness should be a mandatory topic in their education. Lastly, with a minimal curriculum change students showed statistically significant increases on knowledge testing.

While exposure was low for emergency preparedness topics and most did not recognize how information they had been taught might be applicable to emergency preparedness, there was a strong desire for additional training. In addition, simple curricular adjustments can lead to significant improvements in knowledge.

Traditionally, emergency care in Pakistan has not been a priority because of lacking primary care. Resources and trained personnel are scarce. Cultural barriers often supersede the urgency of medical conditions. Despite these challenges, the value of emergency care is gaining significance. The objective of this study is to explore the breadth of emergency medicine training in Pakistan, through an analysis of a teaching hospital with an emergency medicine residency. Aga Khan University Hospital in Karachi is a teaching institution with the only emergency medicine residency program in the region. It was started in 2000, led by US-trained physicians, and laid the foundation for emergency medicine in the country.

A review and analysis of the curriculum and clinical duties will be conducted to illustrate the specific roles and training of emergency medicine physicians. A chart review of patients seen in the emergency department during a two-week period will be conducted to determine if the current training is appropriate for the patient population and diseases seen.

This study will provide a view of a curriculum in development and report on unique aspects of the program in relation to other established emergency medicine programs throughout the world. Furthermore, different roles emergency medicine physicians may play in this particular hospital setting will be identified.

Aga Khan University Hospital is a pioneer in establishing emergency medicine as an official discipline in the region. Through an examination of how a program is developing in Pakistan, an invaluable look of how emergency medical care is gaining significance in developing nations will be provided. This will help other nations that are interested in developing such programs to do so.

“Cultural Competency” is an increasingly important skill required by the humanitarian workforce. Reviews and evaluations of recent major international events criticize tiie lack of cultural competency skills among foreign aid workers. This paper reviews two frameworks in the international literature to propose a model for cultural competency education in the humanitarian workforce.

The framework for disaster health, developed by the World Association for Disaster and Emergency Medicine (WADEM) Education Committee, and the Australian National Health and Medical Research Councils (NHMCR) “Cultural Competency in Health: A Guide for Policy, Partnership and Preparation” (2006) were used as frameworks for this review. A meta-review of the literature was conducted to identify cultural considerations in disaster management.

A definition of cultural competence was adopted from a range of theoretical models. Both the WADEM model, which includes the “Socio political, cultural context”, and the NHMRC model, which describes four dimensions for actions (systemic, organizational, professional, and the individual), identify key principles. Using these principles informed by the literature review, a model is proposed to foster culturally competent behavior incorporating all four dimensions.

The model argues that “everyone” is responsible for culturally appropriate and responsive management. This review makes explicit the importance of cultural competency skills in the humanitarian workforce and provides a model, underpinned by contemporary frameworks, to address this challenge.

The conceptual framework for disaster medicine is weak and unstructured. There is a need to reinforce disaster medicine education and research with appropriate conceptual models. This paper outlines the development and structure of one such model—a “work-in-progress”.

A literature review of contemporary education programs in disaster medicine was performed and used to enhance the outcomes of the evolving framework of the World Association for Disaster and Emergency Medicine (WADEM) Education Committee.

The literature review identified some consistent themes representing “new” thinking on conceptualizing the field of disaster medicine.

Four domains were constructed to develop a new framework for conceptualizing disaster medicine, namely: an expanded disaster health framework developed by the WADEM Education committee, which includes the primary disciplines of public health (the collective), emergency and risk management (the organizational), the clinical and psychosocial (the individual), secondary disciplines, the community, and, the socio-political-cultural context; a contemporary view of the disaster cycle; the disaster epidemiology of the region; and the generic personal attributes expected of the humanitarian professional.

The consequent model demonstrates the relationships between these domains.

As a “work-in-progress”, this model has been used to successfully guide the development of undergraduate and graduate programs in emergency preparedness and disaster health. The model provides a framework for common communication and subsequent modification in the light of further research and discussion.

The World Association for Disater and Emergency Medicine (WADEM) Oceania Regional Chapter is the first WADEM Chapter to be formed. This paper describes the journey experienced in the formation of this Chapter.

This is a descriptive, historical review.

The Chapter had its origins in WADEM's 13th World Congress in Melbourne (2003). In Edinburgh (2005), the WADEM General Assembly approved the establishment of Chapters to promote both the discipline and WADEM activities. WADEM Vice President, Professor Frederick (Skip) Burkle Jr, led the development of guidelines for establishing WADEM Chapters, which were considered by the WADEM Board in Amsterdam (2007) and subsequendy approved by the WADEM Officers in August 2007.

Three “Chapter co-sponsors”, later expanded to a steering group of five to include members from Australia, New Zealand, and the Pacific Island Nations, led the process. Three constituting meetings were conducted by teleconference, the general geography of the Oceania region defined, and draft Chapter Charter and Chapter bylaws were distributed for input from WADEM members in the region. The Chapter was launched in November 2008.

Nominations for the inaugural Chapter Council have been called in advance of an election to be finalized in February 2009. The first Chapter Council will meet before the WADEM World Congress in Victoria, Canada (May, 2009). The Council has a list of activities proposed in the constituting meetings, upon which to base an initial strategy plan for the young Chapter.

The WADEM Chapter guidelines have been most useful and the concept of Chapter co-sponsors has proved essential. Enthusiasm in the region has been promoted by the formation of the Chapter and membership in WADEM increased.

The model and process experienced in the Oceania region may prove useful for other potential WADEM Chapters. Experience to date would suggest that WADEM Chapters are viable, achievable, and useful in promoting WADEM and its members.

A review of humanitarian interventions suggested a reform based on three pillars: appointment of a Humanitarian Coordinator; an emergency fund; and the cluster approach for more predictability, efficiency, and accountability in a specific sector with an appointed leader. The cluster approach started late 2005 with some pilot countries in Africa, was followed by other countries. So far, Africa has been the wider cluster experience area. This paper will present different case studies and to highlight lessons learned.

Seven cases from African countries were studied. Cases were analyzed based on a developed framework that took different factors into account. Data were collected from field visits and from exiting documents.

The cluster approach was adopted using different models based on existing coordination structures, government structures and implications, and the presence of a Health Coordinator or an existing emergency body.

The cluster approach has improved sectoral programming in humanitarian responses in the field. It provided stronger and more predictable leadership across sectors, improved preparedness and surge capacities. However, it lacked clear guidance in implementation as well as resources for effective coordination in the field, which are successes. There was a lack of understanding of the concept which made non-governmental organizations reluctant to adhere to a cluster approach.

The success of implementation of the cluster approach required flexibility for an appropriate model in order to be adopted. A participatory approach and transparency are required to bring all partners on board.

Emergency medical services planners and providers consider the needs of many special populations (infants, elderly, disabled, etc.) during a disaster. However, the critical distinctions in gender-specific care, which are based not only on a woman's physiological makeup, but also within her psychosocial framework should be not overlooked. This research identifies key factors in female-specific care, including: (1) 12 risk factors that affect vulnerability, impact, and exposure; (2) post-traumatic stress disorder and pain; (3) triage and advocacy; and (4) supplies and services.

More than 110 surveys were conducted among post-disaster females in the US and South Africa to obtain critical gender-disaggregated data in health services, aid, resources, and evacuations.

The results support the contention that many gender-sensitive services and supplies were needed in post-disaster care settings, but were inadequate or non-existent.

Research indicates a pattern of gender differentiation in all areas of the disaster process—preparedness, response, impact, risk perception and exposure, recovery, and reconstruction. The research also issues and emphasizes interventions that could significantly reduce pain, suffering, and costs. These research conclusions indicate a dearth of gender-disaggregated data and the need for EMS planners and providers to take a more cognizant and proactive approach to gender-specific care in preparedness, triage, psychosocial needs assessment, aid, and advocacy.