“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.

Since 2006, the Disaster Mental Health Team of the Egyptian Ministry of Health has provided aid during several crises, including the Red Sea Ferry accident, Sinai terrorist attacks, Delta train accident, and others. The Gaza crisis, which has not been resolved at the time of this report, has described as the worst crisis in the Middle East since the 1967 war.

The author of this report currently is at the Alarish General Hospital in North Sinai, Egypt.

The report elaborates on the actions of the Disaster Mental Health Team of the Egyptian Ministry of Health during the Gaza crisis in late 2008 and early 2009. Currently, the Team is at the Egypt-Gaza border, working side-by-side with an emergency medical team in North Sinai. The report discuss the approaches of the team and summarizes lessons learned from previous activities.

Currently, the roles of the team include working with the injured, family members, and emergency personnel.

An in-depth view of the work done by the Egyptian Disaster Mental Health Team during the crisis will be documented, evaluated, and ways to improve future responses will be presented.

A set of managerial and clinical guidelines for disaster mental health is needed.

Mental health is a low priority in resource-poor settings and among vulnerable populations fighting for survival after disasters. The psychosocial situation in the conflict setting is more complicated than for victims of natural disasters because their baseline mental health status is unknown.

Psychosocial evaluations from Indian disasters during the past 10 years were collated and analyzed for important mental health predictors. Social issues of food security, equity of safe water provision, and about distribution of disaster relief and aid also were evaluated.

Children were the most vulnerable group in India. Post-traumatic stress disorder (PTSD) usually was a transient response to disasters, and lasted for an average of 90 days. Residual sadness was the only persisting PTSD symptom (84%). Underlying depression was the most important predictor for residual PTSD. Interventions facilitated through natural groups (language and ethnic groups) were easier to facilitate and yielded better results. While spiritual healing workshops had a definite role, relief being provided along religious lines was more controversial. Of 98% whose homes had been destroyed, 89% had their homes relocated/rebuilt within 24 months, and 51% had resumed their previous occupation. However, only 30% recovered economically after natural disasters. The healthcare providers, funders, and relief agencies were hesitant in their response in the setting of complex emergencies, as they are unsafe work environments, at the personal and political level. Mental health interventions were more complex and outcomes less predictable in the conflict setting as compared to natural disasters.

Systematic mental health surveillance post-disaster must be included in the general post-disaster assessment. There is a need for supportive education, training of mental health workers, and development of region specific social and psychological questionnaire for validated use in India.

The emotional aspects of traumatic events often are ignored for professionals involved in disaster interventions immediately with victims of emotional trauma. There is a growing body of theoretical and empirical literature that recognizes that engaging in therapeutic work with trauma survivors can and does impact the professionals involved. Compassion fatigue is the latest in an evolving concept that is known in the field of traumatology as secondary traumatic stress. Most often, this phenomenon is associated with caring for others in emotional or physical pain.

In a literature review, Beaton and Murphy (1995) assert that emergency/first responders and crisis workers absorb the traumatic stress of those they help. By doing so, they are at-risk for compassion fatigue. Among the negative consequences that often are not linked to their work, include substance abuse and relationship conflicts. Although the body of literature exploring the prevalence of compassion fatigue continues to grow, the lack of research to support the underlying theory of the concept in relation to measurement is cause for alarm.

This presentation will explore a theoretical model that accounts for and predicts the emergence of compassion stress and compassion fatigue among professionals working with traumatized people as well as explicate the principals associated with accurate diagnosis,assessment, research, treatment, and prevention of compassion fatigue.

Recent studies have documented the adverse impacts of disaster exposure for emergency response personnel. Increasingly, researchers and practitioners are focusing on the role of resiliency in reducing the risk of adverse mental health impacts on first responders. To that end, a novel resiliency-building intervention program was developed and implemented by an external peer-assistance program for a large urban police department. The program includes education and debriefing components and initially was piloted in precincts and now is being implemented at the firing range. A session consists of a team of two peer support officers and a mental health clinician presenting a short psycho-educational program designed to familiarize officers to signs and symptoms of distress and promote effective coping. This is followed by an hour-long small group discussion that gives officers an opportunity to discuss events that have affected them, giving them a better opportunity to mitigate the Stressors associated with those events. To assess the feasibility of this approach, a process evaluation of the program was conducted.

Audio-taped, in-depth, semi-structured individual interviews were conducted with 25 program facilitators (14 peers and 11 clinicians). A thematic analysis of the transcripts followed.

Participants reported that the program was well received by officers of all ranks. An important aspect of this program was the relative privacy afforded by offering it in a more neutral setting of the firing range as opposed to a precinct. The presence and involvement of their fellow officers was seen as significant in fostering openness and normalizing officers' experiences. Participants also reported that this support mechanism likely would help prepare officers for disasters and other critical incidents.

This program is a feasible and relatively inexpensive approach to providing psycho-education to police officers. This model maybe effective for other departments.

The experiences of racially/ethnically diverse residents and communities in the US in the wake of the wildfires in California, Hurricane Katrina, and other disasters have shown the serious if not fatal lack of their effective engagement in response to these events, confusion around access to and provision of emergency care, and failure to adhere to recommended services guidance and requirements. As one of the most diverse states in the country, California's experience with earthquakes and wildfires has heightened related concerns around the capacity of healthcare providers to effectively meet the needs of diverse communities. The objectives of this study were to: (1) identify barriers and challenges to meeting emergency health needs of these communities during disasters; (2) identify programs and policy gaps in the current environment; and (3) develop recommendations as well as guidance for improvement.

Three methods were used in conducting the study. The project team reviewed and synthesized literature from California and other sources; reviewed 148 Websites; and conducted key informant interviews with 17 officials and community representatives identified through state sources/environmental review during summer/fall 2008.

Research identified four major barriers, challenges, and gaps affecting the provision of effective health care during emergencies: (1) significant lack of community engagement and trust among diverse residents, especially among immigrants who feared deportation actions; (2) cultural misunderstanding that led to misinformation and a related lack of training and education resources for emergency personnel; (3) lack of interpreter/translation services; and (4) insufficient coordination at local, regional, and state levels.

Improvement will require four major actions: (1) effective collaboration between these communities; (2) emergency care providers and other key sectors; (3) resources to increase availability and access to interpreters; and (4) coordination of information and resources to minimize gaps and duplication, and greater flexibility in allocation of funds to meet local emergency medicine priorities.

Mass-casualty incidents (MCIs) can cause a surge of psychological casualties and family/friends searching for victim information and reunification. Staff training in psychological first aid and a joint hospital-community psychosocial response plan is essential or hospitals will be overwhelmed, reducing their patient care capacity. The aim of this presentation is to outline the steps needed to develop and evaluate a psychosocial response plan template for an urban center of ≥500,000.

Existing psychological first aid training programs and hospital-community psychosocial response plans for urban populations ≥500,000 will be surveyed. Psychosocial response staff in community and hospital settings across Canada will be surveyed to determine needs and issues. Common threads will be identified and end-users/experts will be invited to review for feasibility and sustainability. This information will be used to collabora-tively build a plan with the Toronto, Ontario psychosocial community and train and evaluate it in two large-scale exercises 29 November 2009 (mass-casualty trauma) and 30 November 2009 (pandemic), in Toronto. Data will be collected to determine the effectiveness of the plan to absorb and mitigate a MCI surge.

Expected Results: Elements needed for a sustainable psychosocial response training plan that integrates and improves daily operational skills, builds relationships and communication between community and hospitals, and develops a community plan capable of absorbing a surge in psychosocial demand in the event of a mass-casualty incident will be identified.

Conference Presentation: The results of the literature review, preliminary survey results, and an initial framework for the joint Toronto hospital-community psychosocial response plan will be presented.

Recently, many reports have shown that women have been the perpetrators of acts or of terrorism are being actively recruited by terrorist organizations. Female-initiated terrorist attacks have occurred in India, Iraq, Sri Lanka, Lebanon, Syria, Palestine, Egypt, Uzbekistan, Turkey, Chechnya, and Jordan. Achieving a better understanding of women who become supporters or perpetrators of terrorist acts can assist in planning, preparing, and deterring terrorist attacks, and minimizing the morbidity and mortality from these events.

A review of scientific, medical, and academic literature pertaining to women and terrorist activities was performed. In addition, government reports and media accounts of terrorist attacks where women were direcdy or centrally involved as perpetrators were collected and reviewed. Common elements, themes, and similarities were analyzed to determine trends in terrorist activities involving women as perpetrators, planners, facilitators, and active supporters of specific terrorist incidents.

A variety of factors that influence women into participating in terrorist activities have been discussed by various authors and researchers. In addition to coordinating and participating in terrorist attacks, there have been several additional areas of involvement of women in support of domestic and international terrorism, as well as specific tactical reasons tliat terrorist organizations seek out vulnerable women to exploit and recruit into roles within their organizations.

A greater understanding of the psychosocial, behavioral, and socio-economic factors that influence women to become active supporters, facilitators and/or perpetrators of terrorist acts across the globe is essential to mitigating these incidents and protecting the health and safety of the public. Further research is needed to explore methods to identify women who may be vulnerable to recruitment by terrorist groups, in order to attempt to prevent the extent of these attacks on nations across the globe.

Mental stress management of medical staff in an international medical cooperation (IMC) is important for effective activities.

The authors examined the mental stress of of IMC medical staff that was experienced throughout three activity periods. The activity periods included: (1) “Period A”, from decision-to-participate to arrival in the field; (2) “Period B”, from arrival in the field to before going back home; and (3) “Period C”, after going back home to three months after going back home. Self-administered questionnaires were used to examine the type of mental care preferred by staff. Participants were 154 medical staff members who worked in a past IMC. The data of 89 medical staff members were analyzed. The period of data collection was between August 2007 and November 2008.

The results clarified that 66 (74.1%) staff felt stress during Period A, 69 (77.5%) during Period B, and 47 (52.8%) during Period C. Main stress factors during Period A included “difficulty of gathering information”, “schedule coordination”, and “rapid environmental changes”; In Period B, “ambiguity of information”, “unexpected circumstances”, and “human relationship”; and in Period C, “lots of works after return to the hospital”, “prepare the activities report”, and “lack of taking vacation after IMC”.

Stress levels and factors gradually changed during activity periods in IMC activities. It is important to establish effective mental stress management systems for the future success of IMCs.