Improving access to emergency health services can reduce morbidity and mortality for patients with acute emergent conditions. The WHO and ICRC developed the Basic Emergency Care course to train frontline providers in a systematic approach to common and treatable life-threatening conditions. This study aims to evaluate the knowledge retention of Rwandan emergency care providers after implementation of this course.

A prospective, quasi-experimental, nonrandomized study was conducted at the University Teaching Hospital of Kigali (CHUK) in Rwanda. A formal survey was conducted to understand the current composition and training of Rwandan emergency care providers. Baseline and post-course assessments of knowledge were collected via an existing 25 multiple choice question survey tool which is an already established part of the BEC curriculum. Forty providers who care for patients with acute emergent illness were included. Data collected included age, gender, preferred language, as well as information about professional background, knowledge and skills. Providers with both baseline and post-test results were included in the analysis (n=40).

Of the 40 Rwandan providers, 47.5% (n=19) male and 52.5% (n=21) female, 26 were nurses, six were doctors, six were prehospital providers, one was both a prehospital provider and nurse, and one was a midwife. The mean age was 36.3. Out of 25, the mean baseline score was 17.8 (SD=3.2) and this significantly increased to a mean posttest score of 21.9 (SD=2.4). 85% (n=34) of providers’ knowledge improved, 2.5% (n=1) of provider’s knowledge stayed the same, and 12.5% (n=5) of providers' knowledge decreased. The difference between the pre and post-test scores was found to be statistically significant, 4.1 (SD=3.4), (P<0.0001).

This study demonstrated that implementing the BEC course has significantly improved the emergency provider knowledge base. Further studies are needed to demonstrate the impact of BEC training on patient care and morbidity/mortality outcomes.

Global Emergency Care Skills (GECS) is a charity which delivers medical training to health care professionals in low and middle income countries. Teaching airway management both didactically and through simulation training is a key component of the GECS Emergencies and Trauma Course. In 2022, a team of doctors delivered an intensive, five-day teaching course with a strong emphasis on airway management and airway emergencies at St. Joseph’s Nyabondo Mission Hospital in rural Kenya. This course was delivered to a group of doctors, nurses and clinical officers. At the conclusion of this course we collected qualitative feedback from course participants. The aim of this study was to assess airway knowledge and skills acquisition, as well as real-world application and potential for ongoing teaching of acquired airway skills.

A questionnaire was distributed to course participants to ascertain their experience of didactic airway teaching, airway skills stations, and airway simulation. Each question offered a binary response. To continue to enhance course content, we invited participants to submit qualitative feedback at the end of the questionnaire.

Questionnaires were returned by 19 of a total 24 participants. 53% were registered nurses, 21% were clinical officers, 5% were medical officers and 21% did not respond to this question. Median post graduate clinical experience was four years (2.75-5.25). 37% indicated that they had not heard of simulation training for medical education before undertaking this course. 58% had no previous airway training although 63% had prior exposure to clinical situations which required emergency airway management. 100% reported feeling more confident in their airway skills and potential for training colleagues following this course.

The results indicate that participants gained knowledge, skills, and confidence when approaching airway emergencies. Furthermore, results showed increased perceived competence by participants at providing airway training to colleagues.

Journalists work in dangerous places. In recent years, the risk of illness and injury while reporting has increased, whether in the setting of conflict, protest, extreme weather, or environmental disaster. Journalists are targeted more than ever before. Working safely in remote and dangerous settings, especially without the protection of a large organization, requires a wide range of skills related to safety and security. For several years, the Dart Center for Journalism and Trauma at Columbia University has offered brief, intensive courses focused on personal safety, self defense, cyber-security and medical skills for freelance journalists working in dangerous settings.

We re-conceptualized the medical first responder portion of the Dart Center's "Reporting from Crisis Zones" course to emphasize basic skills related to acute injury and illness, from trauma resuscitation (e.g, hemorrhage control) to environmental exposure and medical illness. We identified the most common medical concerns that these learners might encounter and incorporated feedback from prior courses to develop a one-day curriculum meant to address the most pressing needs of incidental first responders with minimal medical training, and whose primary mission is not providing medical care to others.

The resulting 8-10 hour curriculum focuses on hemorrhage control, basic airway and respiratory maneuvers and wound care, with additional focus on medical illness, indications for evacuation, and communication and prevention techniques. The re-structured curriculum was first offered in Spring 2022. Feedback from learners was positive.

Basic first responder skills are critical for journalists working in dangerous settings, who represent a unique population of learners with specific needs and objectives. Next steps include developing a better understanding of the medical and traumatic problems truly encountered by this population in the field, assessing the long-term educational impact of the course, and developing ongoing opportunities to reinforce learning via online resources, refresher sessions, and guideline development.

Chemical exposures can cause direct and indirect injuries to responding medical personnel. Therefore, hospital healthcare providers should be provided with disaster response training that includes identification of chemical hazards, establishment of the hazard zone, personal protective equipment use, decontamination, and chemical injury antidote use. This study evaluates the educational effectiveness of the chemical-mass casualty incident response education module (C-MCIREM) for hospital healthcare providers.

This was a retrospective quasi-experimental study. Subjects were hospital providers who enrolled in the C-MCIREM program between May 1, 2021, and July 26, 2022. Subjects were hospital providers from Bucheon, Mokpo, Iksan, Jeonju, and Dae-gu cities in South Korea. Subjects completed pre, post, and three-month knowledge retention and self-assessments of readiness tests, as well as evaluations on tabletop exercises (TTX), and a satisfaction survey (11-point Likert) after the course. The instructors scored teamwork measures via standardized evaluations on TTX throughout the course. The K-paired Sample Friedman test was used to compare samples.

127 respondents were enrolled. The median knowledge score rose from 51/100 (39, 66) to 85.5/100 (73.75, 90) with a median retention score of 74/100 (64, 88) (p<0.001). Participants felt their readiness to respond increased in all facets (all p<0.001) on the post and retention test for the MCI situation. All three hospital teams showed significant increases in teamwork between the median of the 1st and 4th TTX as 27/100 (23.5, 29) and 69/100 (66.75, 69.5) (p<0.05). Participants were overall satisfied (9.1/10 SD 1.13) and would recommend the training to others (9.15/10 SD 1.2).

C-MCIREM participants had high satisfaction with a significant increase and persistence in knowledge, improved teamwork, and self-assessed readiness to respond to a chemical mass casualty incident.

In response to the global upward trend of humanitarian emergencies, the humanitarian health workforce has grown substantially in the last decades. Still, humanitarian education and training programs are limited in availability, geographical locations, and teaching methods, and are too expensive for local respondents. To address these gaps, an e-learning tool for humanitarian public health has been developed and evaluated.

Action research was used to develop the e-Learning tool. Rapid prototyping–a modified analysis, design, development, implementation, and evaluation (ADDIE) model, was used to identify the content and instructional design. This iterative process involved consultations and feedback from public health and disaster medicine instructors and students at different levels and training programs from within and outside CRIMEDIM. Qualitative data were analyzed using thematic analysis. Quantitative data were appropriately summarized. Pre/post-test change in knowledge score was tested with paired t-test.

Although different levels of training are needed, targeting health professionals at the entry-level in the humanitarian field is identified as a priority. Scenario-based e-Simulation covers health needs assessment, essential health services, communicable diseases standards, and the health system was developed and evaluated. Trainees were highly satisfied by the clear objectives, the realism of the simulated scenarios, quizzes, and interactivity. In the 1-7 numerical scale, the median for overall experience satisfaction was 6.3 (IQR=5.3-7, N=35). The mean of the post-test score was 7.71, which was significantly higher than the mean of the pre-test score of 5.88. The large effect size of 1.179 indicates the training effectiveness. Poor internet was identified as a potential barrier to delivering the training.

This participatory study resulted in the development of effective Scenario-based e-Simulation. Offline mode of training will be adapted for trainees with poor internet connection settings. Successful factors in instructional design will be used to inform the development of advanced training in the field.

A Mass Casualty Incident response (MCI) full scale exercise (FSEx) assures MCI first responder competencies. Simulation and serious gaming platforms (Simulation) have been considered to achieve and maintain first responder competencies with the challenge of the FSEx. The translational science (TS) T0 question: How can students achieve similar MCI competencies through the use of simulation MCI exercises as with a FSEx?

Initial TS phase T1: Scoping Review

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review was conducted to develop statements for the TS second phase T2 modified Delphi study. 1320 reference titles and abstracts were reviewed with 215 full articles progressing for full review leading to 97 undergoing data extraction.

Second TS stage T2: modified Delphi study

The database was analyzed and initial draft statements were created. Selected modified Delphi experts were presented with 27 statements with instructions to rank each statement on a seven-point linear numeric scale, where 1 = disagree and 7 = agree. Consensus amongst experts was defined as a standard deviation ≤1.0.

After three modified Delphi rounds 19 statements attained consensus and eight did not attain a consensus.

The modified Delphi experts agreed that the simultaneous integration of individual duty and incident management skills should be incorporated into simulation MCI exercise design to achieve competencies depending on high physical fidelity to develop the individual’s manual abilities, as well as high conceptual fidelity, to develop the individual’s clinical reasoning and problem-solving skills. MCI simulation exercises can be developed to achieve similar competencies as FSExs incorporating the 19 statements that attained consensus through the TS phases of a scoping review (T1) and modified Delphi study (T2). The TS process should continue with development of these exercises in the T3 implementation stage and then evaluated in the T4 stage.

The authors developed an evaluation tool to measure changes in exercise participants' awareness of disaster risk and their disaster preparedness behaviors. To create the tool, a mechanism was modeled to visualize the process of changing people's crisis awareness and behavior and questions were developed for each of the twelve factors and two outcomes within the mechanism. In this study, we conducted a disaster exercise in the pharmacy department of Hospital A, one of the disaster base hospitals, and measured the effectiveness of the exercise using the tool.

In the disaster exercise, participants were asked to perform dispensing tasks on five dummy prescriptions using actual medicines, based on the assumption that the dispensing support system was out of order due to a major earthquake. Participants were paired up and dispensed as much as possible within a time limit of 30 minutes. Pre- and post-education sessions were conducted before and after the exercise. Respondents were asked to score each question on a 5-point scale at three time points: before the pre-education, immediately after the disaster exercise, and after post-education.

59 people, including 16 participants, responded to the questionnaire using the evaluation tool. The analysis of the evaluation results revealed that the disaster exercise increased the participants' crisis awareness. Furthermore, participants improved their scores on the questions on feelings of anxiety about the current situation, assumptions about the impact, sense of ownership, and fear of not acting, but no change was observed among non-participants. However, there was no significant difference in scores between the two groups regarding whether they had taken action for disaster preparedness in the period following the exercise.

The exercise raised the participants' crisis awareness, but did not encourage them to change their behavior. Future research should consider ways to encourage staff members to take action to prepare for disasters.

Mass casualty incident (MCI) management was usually taught by lectures and then tested by exercises. However, the lecture may not be interesting and tabletop exercise (TTx) may not adequately engage participants, especially senior medical students. To solve these two problems, we think that a TTx using 3D models can be a good teaching method of MCI management for medical students.

A TTx of MCI in the emergency room (ER) was designed for senior medical students based on five core capabilities of MCI management: incident management system, event recognition and initiation of response, patient triage, surge capacity and capability, and recovery and demobilization. 3D models containing miniatures of the ER, hospital staff, patients, and other personnel were used in the TTx. No lecture was conducted before or during the exercise. Students needed to discuss how to respond to events in the incident and show their responses using the 3D models, and the instructor facilitated the discussion and gave feedback right after the students’ decision.

Knowledge of each core capability was tested by four multiple-choice questions. The interest in learning disaster medicine and willingness to participate in MCI management were evaluated by questionnaire, along with quantitative feedback to the exercise. The same test and questionnaire were conducted before and after the TTx.

From September 2018 to May 2022, 326 students completed both pre- and post-exercise evaluations. The test scores of all five core capabilities, levels of interest, and willingness increased significantly after the exercise. Students thought the exercise was interesting and a good learning tool. Most students wanted to be notified of further training.

A tabletop exercise using 3D models is an effective way to teach senior medical students MCI management and disaster medicine while increasing their interest in learning and willingness to participate.

An adequate Mass-Casualty Incident (MCI) triage system is essential to provide the best possible health care to the greatest number of affected people and to optimize the management of the available resources in the context of a MCI.

In February 2022, Disaster Medicine Service 118 of Regione Piemonte adopted a new 5-color code-MCI triage system and Emergency Medical System (EMS) personnel was trained through a 3-hours-distance learning course. 515 medical doctors and nurses attended the course and completed the final test (triaging of 50 computer-based simulated patients/cases). Their performance was compared to intended triage designations. We collected the data and conducted a descriptive observational study.

A total of 25.750 evaluations were carried out: 1.030 white cases, 6.180 green cases, 6.180 yellow cases, 9.270 red cases and 3,090 black cases. Overall triage accuracy was 89,63%. The overall errors were 2.671 (10.37%). Concerning the type of error, there were 1.415 cases under-triaged (5.5%) and 1.256 cases over- triaged (4.88%). Based on color-code, the highest rate of error was in green cases (3.48%), while black patients showed the highest accuracy rate (0.32%). Based on type, the most frequent error was under-triage of red patients, while the less frequent was over-triage of black patients.

The results of the final test performed by EMS personnel showed the accuracy rates of triage using new 5-color code-MCI triage systems of Regione Piemonte to be in range with data reported in the literature. A study limitation is the fact that the data analyzed are derived from online testing performed in no-time limited and no-stress conditions. Another potential limitation is the distance learning which doesn’t allow a discussion with the teacher or a request for clarification. For this reason, we would plan a future study defining the efficacy of the didactic methodology in comparison with face-to-face courses.

The purpose of this study is to develop a disaster nursing learning support system and a list of learning contents developed by our team to effectively and efficiently acquire the necessary disaster nursing competencies in the acute phase of disasters.

As the first step, based on the ICN Framework of Disaster Nursing Competencies, we examined the teaching materials using nine competencies extracted through prior literature, interviews with disaster nursing practitioners and reviews of disaster nursing experts. Next, we extracted learning contents that are considered difficult to learn in daily work from textbooks used in disaster relief nurse training. We gained new information on disasters using interviews with experts and internet search review literature.

Educational materials, including links to five open access sites, a summary of basic knowledge and original videos (case reports on dispatching disaster relief nurses, lectures on evacuation center management by experts, triage using the START-method and the PAT-method, psychological first aid, handling medical records and J-SPEED+ apps), were implemented. A test as an entry point for learning, a rubric to check current learning achievement, learning confirmation tests for each competency, a forum as a place for exchanging opinions among the learning community and an automatic certificate issuance system were set up.

Disaster nursing is an extension of daily nursing, and many matters can be learned in daily work. There are few things that general clinical nurses should learn in addition as this study showed. However, it is inferred that it is not easy to select and update the knowledge and information that nurses need from the abundance of data available in the information society.

It is meaningful to have a learning support system that allows nurses at medical institutions that are expected to collaborate in the event of an emergency to learn together during the silent phase.

The Virtual Interprofessional Education program is a multi-institutional consortium collaborative formed between five universities across the United States. As of January 2022, the collaborative includes over 60 universities in 30 countries. The consortium brings healthcare students together for a short-term immersive team experience that mimics the healthcare setting. The VIPE program has hosted over 5,000 students in healthcare training programs. The VIPE program expanded to a VIPE Security model to host students across multiple disciplines outside the field of healthcare to create a transdisciplinary approach to managing complex wicked problems.

Students receive asynchronous materials ahead of a synchronous virtual experience. VIPE uses the Interprofessional Education Competencies (IPEC) competencies (IPEC, 2016) and aligns with The Health Professions Accreditors Collaborative (HPAC) 2019 guidelines. VIPE uses an active teaching strategy, problem or case-based learning (PBL/CBL), which emphasizes creating an environment of psychological safety and its antecedents (Frazier et al., 2017 and Salas, 2019, Wiss, 2020). Following this model, VIPE Security explores whether the VIPE model can be tailored to work across multiple sectors to discuss management of complex wicked problems to include: climate change, disaster, cyber attacks, terrorism, pandemics, conflict, forced migration, food/water insecurity, human/narco trafficking etc. VIPE Security has hosted two events to include professionals in the health and security sectors to work through complex wicked problems to further understand their roles, ethical and responsible information sharing, and policy implications.

VIPE demonstrates statistically significant gains in knowledge towards interprofessional collaborative practice as a result of participation. VIPE Security results are currently being analyzed.

This transdisciplinary approach to IPE allows for an all-hands-on-deck approach to security, fostering early education and communication of students across multiple sectors. The VIPE Security model has future implications to be utilized within multidisciplinary organizations for practitioners, governmental agencies, and the military.

Emergency and disaster situations have a major impact on hospitals, some of which are already overloaded daily. The recent COVID-19 outbreak, attacks in Brussels, floods in Wallonia and influx of Ukrainian refugees show that the risk of facing a disaster and involvement of local hospitals (and stakeholders) is real. However, how hospitals implement their own hospital disaster plan (HDP), the position of the hospital disaster coordinator (HDC) and the real efficacy of these measures remain unclear. Therefore, an evaluation tool with an expert-consensus set of Key Performance Indicators (KPIs) and an evaluation of the HDC position is needed

A semi-quantitative survey, as part of evaluation research, was designed by a research group. This questionnaire was based on the document analysis of the main topics of the national template and accompanying legislation. To establish consensus on the importance of the KPIs concerning the HDP, a three-round email-based modified Delphi study (Policy Delphi) was undertaken.

For a task group, 15 qualified multidisciplinary professionals (in-hospital) agreed to participate, 11 completed all rounds. As a pilot group, a total of 25 ‘experts on the field’, were purposively selected from Belgian hospitals, nine of them completed the questionnaire. The modified Delphi reached the agreed consensus threshold (i.e.75%), resulting in five main themes: demographic characteristics/profile HDC, hospital incident management system (HIMS), pre-incident phase, incident phase, post-incident phase. Collectively including a core set of 289 KPIs (29 indicators to assess progress concerning the HDC position).

This study employed a modified Delphi approach to establish consensus, resulting in the development of an evaluation tool to measure hospital disaster preparedness and to evaluate progress of the HDC position within Belgian hospitals. All indicators were considered relevant and immediately implementable. When the implementation of KPIs is completed, the statement is that a HIMS exists within the hospitals.

Melbourne hosted WCDEM-13 in May 2003 when Congress participants endorsed a Melbourne Statement with five actions. Twenty years on, WCDEM-22 in Ireland provides an opportunity to reflect on the impact of the Melbourne Statement.

A desktop review of Congress and subsequent documents informed by the personal experiences of the co-authors, who contributed to the Local Organizing Committee for the Melbourne Congress and/or subsequently through the WADEM Oceania Chapter.

The WADEM Education Sub-committee, co-chaired by a Melbourne member, followed through with one of the key actions from the Melbourne Statement: “WADEM will promote international professional standards and education programs for persons involved in disaster prevention, preparedness, response, and recovery.” The Education Sub-committee held a series of European meetings, resulting in an international meeting in Brussels in 2004 producing ‘International Guidelines and Standards for Education and Training to Reduce the Consequences of Events that May Threaten the Health Status of a Community’. This was presented to the 2005 WCDEM in Edinburgh, and later published in PDM (2007), thereby meeting a second action from the Melbourne Statement. However, this energetic, collaborative, and productive process subsequently ‘failed to thrive.’ The influence of three further Melbourne Statement actions, were harder to analyze. WADEM members in Australia led other identifiable actions e.g. formation and leadership of the WADEM Oceania Chapter (2008); a National Framework for Disaster Health Education in Australia (2010); and Teaching Emergency and Disaster Management in Australia: Standard’s for Higher Education Providers (2017).

The insightful Melbourne Statement reflected the times and led to identifiable, but limited, WADEM outcomes. Congress participants endorsed an Outcomes Statement at WCDEMs in Edinburgh (2005) and Amsterdam (2007) but not at subsequent WCDEMs. Outcome Statements have become commonplace in professional congresses, and it may be timely to re-introduce Congress Statements as a feature of future WCDEMs.

The World Health Organization (WHO) has developed and supported numerous initiatives to build capacity and awareness about health emergency and disaster risk management (Health EDRM). These include establishing the Health EDRM Research Network (Health EDRM RN) in 2018 and the publication of the Health EDRM Framework in 2019. These initiatives recognize that research is vital to generating the evidence to inform decision making and research that is integral to disaster preparedness, response and recovery will be vital to delivering the aspirations associated with caring, coping and overcoming in an increasingly challenging world.

To strengthen the capacity for conduct and use of research, resources were developed by the WHO Guidance on Research Methods for Health EDRM.

This first WHO textbook on Health EDRM research methods was published in 2021 and updated in 2022 with a chapter on Health EDRM research in the context of COVID-19. The 44 chapters offer practical advice about how to plan, conduct and report on a variety of quantitative and qualitative studies that can inform questions about policies and programs for health-related emergencies and disasters across different settings and level of resources. Case studies of direct relevance to Health EDRM provide real-life examples of research methods and how they have modified policies.

More than 160 authors in 30 countries contributed to the guidance, which is relevant to researchers, would-be researchers, policy makers and practitioners. It should help improve the quality of Health EDRM research; the quality of policy, practice and guidance supported by the evidence generated; and research capacity, collaboration and engagement among researchers, the research community, policy-makers, practitioners and other stakeholders.

The Guidance is being supplemented by additional resources, including audio podcasts, slideshows, video presentations and webinars, and the content as a whole will be discussed in this presentation.

In order to promote useful and usable scientific evidence for health emergency and disaster risk management (Health EDRM), the World Health Organization (WHO) Health EDRM Knowledge Hub has been established as part of the WHO Thematic Platform for Health EDRM research network (Health EDRM RN). The Knowledge Hub aims to extend scientific knowledge; strengthen evidence-based practice in the management of health risks in emergencies and disasters; create and develop a competent network in the Health EDRM community; and integrate research, policy and practice.

To begin with, the Knowledge Hub has five interconnected research themes: (1) health data management; (2) psychosocial support; (3) health needs of sub-populations; (4) health workforce development; and (5) research methods. Systematic literature reviews and expert consultations have assessed current research under each theme and identified potential knowledge gaps. The work of the Knowledge Hub is advised by members of the Health EDRM RN and staff in WHO regional offices.

The WHO Health EDRM Knowledge Hub will be a platform for providing and exchanging up-to-date evidence. This will include information on validated methods for managing health data and identifying health needs in specific subpopulations. The Knowledge Hub will raise awareness of psychosocial support, health workforce development and research before, during and after disasters. It is targeted to policy-makers, researchers, practitioners and the broader community with the aim of accelerating evidence-informed policy and programs. This will support implementation of the Sendai Framework for Disaster Risk Reduction 2015–2030, the WHO Health EDRM Framework, and other related global, regional and national agendas.

This paper introduces this new initiative and describes its objectives, design, and implementation. Additionally, it provides an overview of the Knowledge Hub and invites session participants to provide insights into their current needs and to make recommendations for improvement.

Disaster management and emergency preparedness relies on the collaboration, communication, and expertise of a multidisciplinary team. Skills in preparation, communication, and management of disasters are core competencies of an emergency physician. To learn the principles of disaster management, simulations are critical as mass casualty/rapid surge events seldom occur. The COVID-19 pandemic resulted in the cancellation of in-person events. In response to these restrictions, the University of Toronto, EM Program developed a successful virtual interprofessional mass casualty simulation.

The novel online simulation event was piloted in 2021 and ran for three-hours. The exercise focused on developing soft skills (e.g., communication, team-work, and debriefing) and hard skills (e.g., triage, casualty distribution, and activation of plans). Groups were composed of members of each post-graduate year to facilitate near-peer learning. A total of six groups were formed: Adult, Children, Community Hospitals, EMS, Government, and Media. Each Team used multiple communication tools (i.e., Whatsapp groups, Zoom breakout rooms, Shared Google Documents) to swiftly pivot and manage a mass casualty event. Post-exercise debriefing and anonymous evaluations were gathered.

A total of 28-residents (nine PGY1, ten PGY2, and eight PGY3 learners) and 11-staff observers participated (25-respondents). Nineteen participants rated the simulation exercise as excellent and six as “very good”. Twenty participants rated the workshop as “very useful” and five as “useful”. Positive feedback centered around content applicability, exercise creativity, level of engagement, and learning value. Constructive feedback included the need for more pre-exercise orientation time, increasing disaster management time, and inviting allied-health staff.

There is a clear need for EM residents to learn and develop skills related to disaster management and emergency preparedness. This exercise showed that disaster management and emergency preparedness competencies can be learned in a virtual format. This virtual format has encouraged its continuation and further inspired the curation of a four-year program.

As public health emergency management (PHEM) is a growing field, so is the development of its workforce. Ensuring workforce readiness from graduate-level education and courses can be challenging given the limitations of the traditional classroom environment. This presentation highlights a novel curriculum created and taught by first responders consisting of simulation and application of practical skills developed within a public health graduate certificate program.

The semester-long course reviews foundations of PHEM and students progress through a sequence of increasingly complex discussions and operation-based exercises for both domestic and international disaster preparedness and response. Students progress through case studies, tabletops, functional exercises, and full-scale exercises with practical skills interspersed. This includes creation of SMART objectives and incident action planning, crisis communication and public messaging drills, use of radios, personal protective donning and doffing, and Geiger counter use.

During the COVID-19 pandemic, the curriculum was adapted for asynchronous and live virtual sessions with further offerings including various online trainings that are required for most employments in the field and guest speakers with national recognition for their experiences in public health and healthcare emergency management and subject matter expertise in various fields related to preparedness and response.

Since commencing in 2016, approximately 100 students have completed the course and feedback has been overwhelmingly positive even with limitations of in-person activities during the COVID-19 Pandemic. Student feedback has noted that the majority of students feel that the knowledge and skills from the coursework is applicable to future employment and that their ability to think critically about the subject matter increased as a result of taking the course.

Implementation of this innovative graduate level course can serve as a model to enrich students’ education through practical activities and hands-on simulations.

Global Emergency Care Skills, an Irish-based NGO, provided a five-day intensive training course to 24 local healthcare professionals in Nyabondo, Kenya in November 2022, in advance of the opening of a new major trauma center which will serve the greater Kisumu region. The pre-participation knowledge, experience and skills base was surveyed. Following the completion of didactic, workshop and simulation-based training, the perceived acquired competence and applicability of skills were surveyed. The ability to provide ongoing teaching of skills acquired within local healthcare settings was evident.

Nine emergency medicine and two anesthesia doctors currently working in the Irish healthcare system traveled to Nyabondo in the Kisumu region in Kenya for one week in November 2022. A five-day course based on providing practical training addressing comprehensive trauma and acute deteriorating patient knowledge and skills was provided. This included extensive focus on the primary survey approach. A quantitative survey of 22 questions with binary answering options was used. 19 participants completed the survey, and qualitative data on the applicability of the training provided to the local healthcare resource environment was gathered.

Following surveying participants we found that the majority of participants had no previous experience or knowledge of simulation based learning. Further, a vast majority had no formal skills or educational training post completing their medical qualification.

The overwhelming majority of participants felt that this training improved their confidence and competence in managing trauma and assessment of the critically unwell adult and child. 100% of participants stated they gained new skills and were confident in their ability following this training to deliver local training on an ongoing basis in their own healthcare settings.

In November 2022, a group of eleven Irish doctors traveled to St. Joseph’s Hospital, Nyabondo, Kenya with Global Emergency Care Skills (GECS), an Irish NGO. The group delivered a training course to healthcare staff in the hospital, in advance of the scheduled opening of a regional Major Trauma Center on site. This course incorporated didactic lectures, skills stations and simulated clinical scenarios and covered commonly encountered emergency presentations in low and middle income countries (LMICs).

A qualitative study was conducted using a free text questionnaire with faculty, exploring their experiences of education in a resource-limited environment. Responses were interpreted by performing thematic analysis to identify recurring themes.

All eleven faculty members completed the survey in full. An interrogation of the responses identified commonalities across the majority of faculty members. The main themes encountered were increased recognition of the lack of postgraduate training in LMICs, the challenge of devising material appropriate to a resource-limited setting, a growth in confidence and individual teaching ability, and a reaffirmation of the effectiveness of simulation teaching in medical education.

This survey demonstrates the significant impact of teaching such a course on faculty members. Despite the challenges encountered, faculty members strongly felt that simulation training offered significant benefits. Survey respondents noted that moulage could be adapted to suit the needs of course participants without compromising on educational goals. In the absence of formal postgraduate education in LMICs, external agencies continue to play an important role in the delivery of structured training programs.

Neonatal resuscitations are challenging to any mixed ED with rotating medical staff. Covid-19 decimated nursing numbers and reduced training to a standstill. New doctors and nurses find pediatric resuscitations (simulations and in real cases) challenging as there are complex algorithms/calculations as well as preparing and operating systems such as a Drager ResuscitaireR.

Training rotating or new staff for rare complex resuscitations can be time and resource consuming with little yield.

We describe our experience of applying incremental measures after almost every simulation to improve team performance and knowledge.

This is an ongoing audit of simulations and cases for neonatal / infant resuscitations using our pediatric bay and Drager ResuscitaireR system. Our main aim was to improve:

1. Nursing preparation time / competence for:

- Pediatric / neonatal drug doses

- Drager ResuscitaireR system setup

2. Medical staff competence for:

- Neonatal resuscitation algorithms

- Drager ResuscitaireR usage (PPV/Ventilator setup)

Two ED consultants ran “in-situ” simulations and recorded gaps/errors (including feedback in debrief). Any measures deemed fixable were implemented ASAP. Improvement was made if error was not repeated in subsequent two independent simulations.

Audits of five real cases and fifteen simulations revealed gaps (e.g. dose miscalculations, equipment unfamiliarity) which were corrected by simple measures after each discovery. These include:

1. Neonatal resuscitation checklist with steps to setup the Resuscitaire

2. Weight-based resuscitation cards / pre-made packs of equipment instead of manual calculations

3. Position markers for "ideal" ResuscitaireR ventilator settings

4. Step by step ResuscitaireR numbered markers on machine

We found improvements in knowledge gaps, task accomplishment rates, staff satisfaction, appreciation of deficits and in-situ simulation uptake. More gaps are found and resolved at every simulation.

A Human Factors approach with incremental adjustments and simple improvements with each simulation led to better team task accomplishment in complex preparation and resuscitation.