Ethiopian policy and strategy aim to make health care systems capable of dealing with emergencies. However, Ethiopian health care still lacks a comprehensive “all-hazard” approach and a disaster preparedness program. Thus, this study aimed to assess the level of disaster preparedness in selected public hospitals for mass-casualty incidents (MCIs) in Amhara Regional State, Northwest Ethiopia.

A descriptive cross-sectional study was conducted at general and comprehensive specialized hospitals (CSHs) in Amhara Regional State, Ethiopia using a World Health Organization (WHO) hospital emergency response checklist that included a domain on mass-casualty management (MCM) adapted from a literature review.

Seventeen (17) hospitals were evaluated (response rate: 81%). Five (29.4%) were teaching hospitals (tertiary health care) and 12 (70.5%) were non-teaching (secondary health care) hospitals. With an average mean of 97.3 (SD = 33.68; range 31-160), most hospitals under WHO required an Acceptable level of preparedness. Two were at an Unacceptable (0-67) level of preparedness, 12 (70.5%) hospitals were at an Insufficient (68-134) state, while the other three had an Acceptable (135-192) level of preparedness.

The preparedness level of hospitals is Insufficient for potential MCIs in this region and needs prior attention in implementing existing strategic guidelines to develop and activate hospital disaster plans if and when needed.

The study objective was to determine the feasibility of training physicians in the principles of the National Incident Management System (NIMS) and Incident Command System (ICS) as applied to in-hospital rapid responses and to assess physicians’ attitudes regarding rapid responses.

This was an educational pilot study. Resident physicians completed a pre-survey, followed by online training in the principles of NIMS and ICS, a knowledge test, and a post-survey.

The number of residents who participated was 22. In the pre-survey, most (20/22) did not have a working understanding of NIMS/ICS. Participants (21/22) agreed that residents should have more training in resource organization. On the knowledge test, the median score was 9.5/10. In the post-survey, participants felt more comfortable clearing extra resources from the scene (P < 0.001) and that it would be easier to keep track of resources (P < 0.001). Most indicated that they had a working understanding of NIMS/ICS (P < 0.001) and felt more comfortable establishing command using NIMS/ICS (P < 0.001). All agreed that they would consider using an NIMS/ICS-based structure on their next rapid response.

Training physicians in the principles of NIMS/ICS as they pertain to rapid responses is feasible and appears to change residents’ attitudes about rapid responses.

Recent disasters emphasize the need for disaster risk mitigation in the health sector. A lack of standardized tools to assess hospital disaster preparedness hinders the improvement of emergency/disaster preparedness in hospitals. There is very limited research on evaluation of hospital disaster preparedness tools.

This study aimed to determine the presence and availability of hospital preparedness tools across the world, and to identify the important components of those study instruments.

A systematic review was performed using three databases, namely Ovid Medline, Embase, and CINAHL, as well as available grey literature sourced by Google, relevant websites, and also from the reference lists of selected articles. The studies published on hospital disaster preparedness across the world from 2011-2020, written in English language, were selected by two independent reviewers. The global distribution of studies was analyzed according to the World Health Organization’s (WHO) six geographical regions, and also according to the four categories of the United Nations Human Development Index (UNHDI). The preparedness themes were identified and categorized according to the 4S conceptual framework: space, stuff, staff, and systems.

From a total of 1,568 articles, 53 met inclusion criteria and were selected for data extraction and synthesis. Few published studies had used a study instrument to assess hospital disaster preparedness. The Eastern Mediterranean region recorded the highest number of such publications. The countries with a low UNHDI were found to have a smaller number of publications. Developing countries had more focus on preparedness for natural disasters and less focus on chemical, biological, radiological, and nuclear (CBRN) preparedness. Infrastructure, logistics, capacity building, and communication were the priority themes under the space, stuff, staff, and system domains of the 4S framework, respectively. The majority of studies had neglected some crucial aspects of hospital disaster preparedness, such as transport, back-up power, morgue facilities and dead body handling, vaccination, rewards/incentive, and volunteers.

Important preparedness themes were identified under each domain of the 4S framework. The neglected aspects should be properly addressed in order to ensure adequate preparedness of hospitals. The results of this review can be used for planning a comprehensive disaster preparedness tool.

The Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project) developed Regional Collaboration Drills (RCDs) and is proposing an ASEAN Academic Network to strengthen capacity in disaster health management (DHM) in ASEAN Member States (AMS), as well as developing a standard training curriculum in DHM. This study aims to clarify the impacts and sustainability of the ARCH Project.

The four previous RCDs and the enhancement of academic activities were reviewed.

The ARCH Project developed the RCDs with simulation exercises based on possible disaster scenarios in each host country to test and validate the capacity of AMS International Emergency Medical Teams (I-EMTs), the Standard Operating Procedure (SOP) for I-EMT coordination, and regional tools, as well as the relevant domestic SOPs of the host countries for receiving international assistance. Following the RCD in Thailand, three AMS: Viet Nam, Philippines, and Indonesia, all of which are considered disaster-prone, successfully hosted RCDs with significant improvements. The project also established a sub-working group (SWG) to develop a standard curriculum in DHM. Two curricula developments, the Basic Course on DHM and In-Country Course for Coordination on EMTs, are on-going as part of the project activity. The establishment of the ASEAN Academic Network and the ASEAN Institute for DHM (AIDHM) are currently in the endorsement process of the ASEAN health sector.

The RCDs are very effective to test and to validate the SOP and regional tools developed, providing opportunities for AMS I-EMT to familiarize the tools, as well as for host countries to assess their coordination capacity for receiving international assistance and identifying the country’s specific challenges, and verifying ASEAN regional coordination mechanism. The development of the standard curriculum can enhance regional capacity both in supporting disaster-affected countries and in receiving international assistance. A sustainable capacity development mechanism in DHM is envisaged through the establishment of the ASEAN Academic Network and AIDHM toward the goal of One ASEAN One Response.

This team created a manual to train clinics in low- and middle-income countries (LMICs) to effectively respond to disasters. This study is a follow-up to a prior study evaluating disaster response. The team returned to previously trained clinics to evaluate retention and performance in a disaster simulation.

Local clinics are the first stop for patients when disaster strikes LMICs. They are often under-resourced and under-prepared to respond to patient needs. Further effort is required to prepare these crucial institutions to respond effectively using the Incident Command System (ICS) framework.

Two clinics in the North East Region of Haiti were trained through a disaster manual created to help clinics in LMICs respond effectively to disasters. This study measured the clinic staff’s response to a disaster drill using the ICS and compared the results to prior responses.

Using the prior study’s evaluation scale, clinics were evaluated on their ability to set up an ICS. During the mock disaster, staff was evaluated on a three-point scale in 13 different metrics, grading their ability to mitigate, prepare, respond, and recover in a disaster. By this scale, both clinics were effective (36/39; 92%) in responding to a disaster.

The clinics retained much prior training, and after repeat training, the clinics improved their disaster response. Future study will evaluate the clinics’ ability to integrate disaster response with country-wide health resources to enable an effective outcome for patients.

The recent increase in natural disasters and mass shootings highlights the need for medical providers to be prepared to provide care in extreme environments. However, while physicians of all specialties may respond in emergencies, disaster medicine training is minimal or absent from most medical school curricula in the United States. A voluntary Disaster Medicine Certificate Series (DMCS) was piloted to fill this gap in undergraduate medical education.

Beginning in August of 2017, second- and third-year medical students voluntarily enrolled in DMCS. Students earned points toward the certificate through participation in activities and membership in community organizations in a flexible format that caters to variable schedules and interests. Topics covered included active shooter training, decontamination procedures, mass-casualty triage, Incident Command System (ICS) training, and more. At the conclusion of the pilot year, demographic information was collected and a survey was conducted to evaluate student opinions regarding the program.

Sixty-eight second- and third-year medical students participated in the pilot year, with five multi-hour skills trainings and five didactic lectures made available to students. Forty-eight of those 68 enrolled in DMCS completed the retrospective survey. Student responses indicated that community partners serve as effective means for providing lectures (overall mean rating 4.50/5.0) and skills sessions (rating 4.58/5.0), and that the program created avenues for real-world disaster response in their local communities (rating 4.40/5.0).

The DMCS voluntary certificate series model served as an innovative method for providing disaster medicine education to medical students.

Kommor MB, Hodge B, Ciottone G. Development and implementation of a Disaster Medicine Certificate Series (DMCS) for medical students. Prehosp Disaster Med. 2019;34(2):197–202

Unacceptable practices of health care providers during disasters have been observed because they work outside the scope of their daily practices and have inadequate training. A greater need for the involvement of health professionals in disaster management has been noted in Saudi Arabia. This study evaluates the efficacy of a training course in prehospital major incident management for health care providers in Saudi Arabia.

An interactive course for general principles in prehospital major incident management was developed with domains and core competencies. The course was designed according to the local context and was based on international standards. It was piloted over four days at the Officers Club of the Ministry of Interior (Riyadh, Saudi Arabia) and was sponsored by Mohammed Bin Naif Medical Center, King Fahd Security College in Riyadh, Saudi Arabia. The participants (n=29) were from different disciplines from main government health facilities in Riyadh. They completed a pre-test and a post-test.

The overall score was 55.1% on the pre-test and 68.4% on the post-test (Wilcoxon test for paired samples, P <.05). Three out of the four domains had significant difference between pre- and post-test results, as well as the overall total knowledge.

Conducting inter-disciplinary and competency-based disaster medicine courses for health care providers can augment appropriate disaster preparedness for major incidents in Saudi Arabia.

BajowNA, AlAssafWI, CluntunAA. Course in Prehospital Major Incidents Management for Health Care Providers in Saudi Arabia. Prehosp Disaster Med. 2018;33(6):587–595.

This study aimed to review available disaster training options for health care providers, and to provide specific recommendations for developing and delivering a disaster-response-training program for non-disaster-trained emergency physicians, residents, and trainees prior to acute deployment.

A comprehensive review of the peer-reviewed and grey literature of the existing training options for health care providers was conducted to provide specific recommendations.

A comprehensive search of the Pubmed, Embase, Web of Science, Scopus, and Cochrane databases was performed to identify publications related to courses for disaster preparedness and response training for health care professionals. This search revealed 7,681 unique titles, of which 53 articles were included in the full review. A total of 384 courses were found through the grey literature search, and many of these were available online for no charge and could be completed in less than six hours. The majority of courses focused on management and disaster planning; few focused on clinical care and acute response.

There is need for a course that is targeted toward emergency physicians and trainees without formal disaster training. This course should be available online and should utilize a mix of educational modalities, including lectures, scenarios, and virtual simulations. An ideal course should focus on disaster preparedness, and the clinical and non-clinical aspects of response, with a focus on an all-hazards approach, including both terrorism-related and environmental disasters.

HansotiB, KelloggDS, AberleSJ, BroccoliMC, FedenJ, FrenchA, LittleCM, MooreB, SabatoJJr., SheetsT, WeinbergR, ElmesP, KangC. Preparing Emergency Physicians for Acute Disaster Response: A Review of Current Training Opportunities in the US. Prehosp Disaster Med. 2016;31(6):643–647.