Foreign Training Centres In Disaster Medicine

Published Date: 02 Nov 2017

Looking at the geographical distribution of disasters, Asia was the continent most often hit by natural disasters, accounted in 2011 for 86.3% of global disaster victims and suffered 75.4% damages globally.

Going forward, the government of Japan works on a culture of resilience and prevention based on continuous learning. So, most Japanese cities have a government–run experienced based disaster training centre which makes use of technology and simulators to give a real idea of what it feels like to be in an emergency situation.

3.2 The Fukuoka Citizens’ Disaster Prevention Centre.

The Fukuoka Citizens’ Disaster Prevention Centre was chosen to be presented as one of the most progressive curricula for disaster preparation worldwide. Based on extremely high technology and uniquely realistic simulations and innovative methods builds a culture of resilience starting from early ages.

Fukuoka City has a special advanced emergency response unit, which deals with massive disasters and accidents and provides training for a variety of emergencies. The unit exists in 18 major cities in Japan and works internationally, having been dispatched to disaster–stricken areas not only in Japan but in other countries also. The training menu consists of training in fire-fighting, rescue, emergency and prevention techniques. Lectures and practical training along with rescue activities and best survival strategies are also part of the curriculum.

The Fukuoka Citizens’ Disaster Prevention Centre is a facility where visitors learn techniques and develop abilities to take action in relation to disasters as well as being a facility that realistically simulates various disasters in case of emergencies(21). The General Experience Course (Experiential and Observation Zone) lasts one hour and attracts locals, tourists and children who must visit the Centre for training once a year. Training for care givers from retirement homes and hospitals, school teachers, day care staff and baby sitters is possible.

1,400 people, including prefectural and municipal government officials, firefighters, police and locals participated at the Fukuoka’s Prefecture Comprehensive Disaster Drill that was held in Itishima city to further enhance their preparedness for disasters such as earthquakes, tsunamis and nuclear disasters of Fukuoka.

Fukuoka Disaster Training Centre based on the hard–earned culture of preparedness, the progressive facilities and the latest in 3-D effects and computer graphics simulation machines has become a leading model on disaster readiness inspiring many other Training Centres around the world(21).

3.3 The American Red Cross Programme.

Because of its long tradition and experience as the world’s largest emergency response organization, the American Red Cross has played a major role in providing assistance during large scale disasters and therefore its presence in this paper was considered necessary. Believing that it’s through young people’s education that the impact of disasters can be minimized, it develops flexible emergency preparedness programmes for school–aged children across the country through the use of its own educational materials that can be easily integrated into the class curriculum.

The American Red Cross Masters of Disaster curriculum is centered on a series of ready–to-go lesson plans providing important disaster safety and preparedness information to children(22). The specific materials meet national educational standards and are specifically tailored for lower elementary and middle school classes(22).

The curriculum consists of a variety of activities and demonstrations on disaster–related topics along with lessons that can be incorporated into daily or thematic programming of any organization. One of the advantages of the curriculum is its non-sequential character that allows organizers to choose the lesson plans that best fit into their topics of interest(22).

"The education on essential preparedness skills that children receive through that program will carry them through life and help them reduce anxiety about unknown aspects of disasters’ tragic events and deal with life’s unexpected turns"(22).

"The series of topics is of the highest quality and most comprehensive available with almost 200 lesson plans. The curriculum materials cover safety and prevention for injuries and damage from hazards in the United States of America with topics on Disaster preparation and Personal Safety coping with issues like Terrorism, War and Pandemic Flu–Facing Fear, Recovering and Rebuilding from disasters–Aftermath, Home Injuries Prevention–Home Safety, Earthquakes, Fire Prevention-Safety, Floods, Hurricanes, Lightning, Tornadoes and Wild land Fires"(22).

3.4 The Disaster Training Curriculum ("DITAC").

DITAC was selected to be presented in this paper because it proposes to develop a holistic training curriculum, standardized strong as an efficient approach to increase the resilience in facing disasters and crises within the European Union(23). This curriculum will be accessible to pertinent organizations throughout the EU and will, become the first step towards building a European Emergency Response Centre(23).

This Disaster Training Curriculum is funded by the European Commission and deals with the key challenges in the management of disaster incidents by first responders and strategic crisis managers .

"DITAC, which is primarily coordinated by the University Clinic Bonn, brings together scientists from various academic institutions across Europe in order to develop a standardized strong, comprehensive and efficient EU-wide approach to crises and disasters to feature the added value by EU coordinated actions in the field of crisis response. The Curriculum will improve the preparedness and availability of trained personnel by providing a common language, common objectives and common tools, leading to better results in the protection and assistance of people confronted with large-scale crises.

Establishing a curricular training on how to respond to an international crisis and making it accessible to pertinent organizations throughout the EU will be a first step towards building a European Emergency Response Centre"(23).

A series of realistic training simulations is required to effectively prepare the trainees to perform accurately in difficult disastrous situations.

The major incident training systems being used across Europe are: the British Major Incident Medical Management and Support ("MIMMS") system and the European-based and Swedish-led Medical Response to Major Incidents and Disasters ("MRMI") course(23).

MIMMS’ Advanced Life Support Group is a leading course available for all aspects of dealing with a major incident and the whole chain of response: scene, transport, hospitals, coordination and command, including also training in triage and individual patient-management(23). Candidates should be from medical, nursing or paramedical background, officers or team leaders. The course is available as a 3 day face to face course or a 2 day face to face course with a pre-course learning element. Lectures, skill stations and workshops, practical and table top exercises are also included. The certification of the course is valid for 4 years.

Postgraduate course in Medical Response to Major Incidents ("MRMI") is organized in collaboration between the European Society for Trauma & Emergency Surgery ("ESTES"), International Association for Trauma Surgery and Intensive Care ("IATSIC") and Karolinska University Hospital, Stockholm, Sweden. The course is interactive based on an advanced simulation model and starts with one day of preparative training in groups, followed by two full days of simulation exercises with all participants active in their normal positions and with careful evaluation and analysis of the result of the response(23). Doctors and administrative staff, nurses, paramedics and ambulance staff, officers in fire–rescue, police and protection services as well as instructors are the groups of trainees(23).

3.5 Educational Guide and Resource for Medical Student Disaster Medicine Education.

Due to its comprehensive, interdisciplinary nature, instructive design, and flexible structure, this curriculum was selected to also benefit other health-care professional systems by serving as a model curriculum, or facilitating refinement and testing of other existing, and perhaps as yet unpublished models(24).

It’s a fact that the recent large-scale of natural and man-made disasters has increased the focus on disaster medicine. As a consequence, medical schools in many parts of the world have begun to incorporate disaster-related topics into their curricula(24).

Because a fully developed and comprehensive medical school disaster medicine curriculum wasn’t available, the German government commissioned the development of a core medical student disaster medicine curriculum, which could serve as a standardized template(24). The curriculum was finally adapted by nine universities into the 4th-year German medical school program.

The development of a disaster preparedness curriculum for medical students resulted in a course of 14 modules with each unit requiring approximately 2 hours time(24). The concepts of "disaster medicine, response, medical assistance, law, command, coordination, communication, and mass casualty management, are introduced(24). Life-saving emergency and limited individual treatment under disaster conditions are discussed. Specifics of initial management of explosive, war-related, radiological/nuclear, chemical, and biological incidents emphasizing infectious diseases and terrorist attacks are presented. An evacuation exercise is completed, and a mass casualty triage is simulated in collaboration with local disaster response agencies. Decontamination procedures are demonstrated at a nuclear power plant or the local fire department, and personal decontamination practices are exercised. Mannequin resuscitation is practiced while personal protective equipment is utilized. An interactive review of professional ethics, stress disorders, psychosocial interventions, and quality improvement efforts complete the training"(24).

Since the developed course offers a cross-professional design in a really adaptable structure, it also permits flexibility in addressing a multiplicity of disaster situations, including floods, hurricanes, earthquakes and surveillance–related health problems as well as care for vulnerable populations as children and hospitalized patients(24).

For the introduction to the practices of disaster medicine at the students in medical school program, during the pilot implementation, a core curricular team of physicians was assembled and scheduled all tasks(24). "Internal and external professionals with expertise in subject areas were identified and invited to become teaching faculty. After coordination with medical school program planners, facilities for the in-house curriculum units (rooms, equipment) were organized with the lecture support staff. For the external units, collaborations with rescue and disaster response agencies were established to permit common exercises. For exchange and drill of non-physician professionals and students, agencies provided equipment, faculty, and their trainees to serve as mock victims for a mass casualty simulation. Finally, feedback on the curriculum from all participants was utilized to make alterations and improvements as needed"(24).

3.6 The National Disaster Life Support Courses.

"The National Disaster Life Support Foundation, Inc. ("NDLSF") oversees the National Disaster Life Support ("NDLS") courses, a series of education programs to better prepare health care professionals and emergency response personnel for mass casualty events. The NDLS courses are comprehensive, all-hazards, competency-based, standardized, and multi-disciplinary"(25).

The NDLS courses were developed by four academic centers Georgia Health Sciences University, University of Georgia, University of Texas Southwestern Medical Center at Dallas, and Texas A&M School of Public Health.

"The NDLS courses stress a comprehensive all-hazards approach to help physicians and other health professionals deal with catastrophic emergencies from terrorist acts as well as from explosions, fires, natural disasters (such as hurricanes and floods), and infectious diseases"(25).

"Pacific EMPRINTS is approved as a National Disaster Life Support Regional Center-Pacific under the National Life Support Foundation ("NDLSF"). Pacific EMPRINTS and its associated NDLS Faculty are able to offer the following two courses in Hawaii and other locations in the Pacific region. The first course is the Basic Disaster Life Support course which lays out the conceptual framework for the second course, Advanced Disaster Life Support, which uses hands-on exercises and scenarios to train participants"(25).

Basic Disaster Life Support ("BDLS").

BDLS is targeted to multiple disciplines including emergency medical service ("EMS") personnel, hazardous materials personnel, public health personnel, and health care providers. The goal of teaching multiple disciplines simultaneously is to develop a commonality of approach and language in the health care community, improving the care and coordination of response in Weapons of Mass Destruction ("WMD") disasters and public health emergencies. The BDLS course is a review of the "all-hazards" topics including natural and accidental man-made events, traumatic, explosive, nuclear, radiological, biological and chemical events. There is also included information on the health care professionals’ role in the public health and incident management systems, community mental health, and special needs of underserved and vulnerable populations(25). "The recognition and management of the disaster scene and victims are reinforced through a unique approach, introduced in the Core Disaster Life Support Course called the D-I-S-A-S-T-E-R Paradigm, which helps to organize the students' preparation and response to disaster management. The paradigm emphasizes an "all-hazards" approach to mass casualty incident management and facilitates ongoing qualitative and quantitative assessment of an incident"(25).

The target audiences are Physicians, Nurses, Paramedics, Health Professionals, Dentists, Pharmacists, Veterinarians, Health Profession Students, First Responders and Mental Health Professionals. The course length is 8 hours and a recertification is required every three years.

Advanced Disaster Life Support ("ADLS").

"ADLS is an advanced practicum course for those who have successfully completed the BDLS course. It is an intensive, two-day course that allows students to demonstrate competencies in casualty decontamination, specified essential skills, and mass casualty incident information systems/technology applications. Using simulated, all-hazards scenarios and mass causality incidents, ADLS makes use of four interactive sessions in which participants treat simulated patients in various disaster drills and situations. Training is focused on the development of hands-on skills to allow participants to apply the knowledge learned in BDLS"(25).

"ADLS’s interactive scenarios and drills utilize high-fidelity mannequins and volunteer patients to simulate a realistic experience in treating pathologic patient conditions not routinely encountered by the responders and health care providers. Hands-on exercises teach practical skills, such as decontamination and use of protective equipment, and provide instruction in topics that traditionally are not addressed in health care education curricula"(25).

"Day 2 of ADLS is the "hands on" day of training. Four skills stations reinforce the previous day’s learning. These skills stations are as follows:

S.A.L.T. Triage - Simulated disaster victims must be triaged and treated correctly while attempting to manage a chaotic scene and request appropriate resources.

Personal Protective Equipment (PPE) and Decontamination - This station teaches important concepts about the use of personal protective equipment and decontamination techniques.

Disaster Skills - This station teaches vital skills necessary for medical disaster management.

Human Patient Simulator - Recognition of victims of a chemical and biological disaster is paramount. This station is designed to reinforce the detection and proper treatment of conditions that may occur during disasters that we do not normally treat. Treatment of chemical, biological, and traumatic patients is covered. The use of high fidelity human patient simulators allows the student to see, hear, and feel information that would normally be provided by an instructor, creating a more realistic experience than standard mannequins can provide"(25). 

ADLS is targeted to Physicians, Nurses, First Responders, Paramedics, Pharmacists, Health Professionals, and Medical Students.

The length of the course is 16 hours and every three years recertification is required. Participants must attend both days of training to receive the certificate of completion(25).

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Antonine Plague was an ancient pandemic that devastated the Roman Empire from AD 165-180, currently thought to either be smallpox or measles. The second siege of the plague claimed 2,000 lives per day only in Rome.

A Centre for Modern Research and Education in Disaster Medicine in Southeastern Mediterranean

Bearing in mind all disasters that have at times devastated Greece since the beginning of time, we stress hereby the vulnerability of the whole South Eastern Mediterranean area towards disasters [1] . Apart from the disasters themselves, we should also consider that in this area we find large low income populations that would suffer most in case of a catastrophe; these are communities with the least coping capacity towards disasters. In addition, armed conflicts and riots in this region give rise to critical and complex humanitarian issues. This is yet another reason for taking special precautions when structuring a plan against any predictable distress in this part of the world.

Further considering that in this area there exist no entity concentrated on directing research projects and on offering educational curricula on the broader field of disaster medicine covering the whole Southeastern Mediterranean territory, we realize the urgency and the necessity of incorporating such an institution. And especially an institution based in Greece which among its Southeastern Mediterranean neighbors is probably the country most exposed to various disastrous hazards. More to the point, experience of past disastrous incidents may prove valuable in structuring any prevention or contingency planning. In addition, Greece is the crossroad of three continents and may undertake the role of uniting populations and diverse cultures from neighboring countries in a common effort to respond to disasters. Even more, Greece as a member of the European Union has access to funds that may provide the resources to adequately support a research and education centre in the field of disaster medicine.

In particular, this area necessitates a Centre for Research and Education in Disaster Medicine ("the Centre"), the educational and research objectives of which ought to be adjusted to the requirements posed by the multiple disaster risks threatening this geographic region. It is essential to create a Centre of high international caliber able to collaborate with other national or international organizations with the same scope of work. Such a Centre would help the area to better prepare for handling imminent disasters and to learn from analyzing past catastrophic events in order to mitigate any foreseeable adverse disaster effects.

An institution as this should be located in an area with an international imprint, capable to play a geostrategic role in the Southeastern Mediterranean basin. It should have the capacity of accommodating large numbers of visitors with appropriate supporting infrastructure, i.e. airports, ports and hotels. In an area with moderate climate for it to operate all year round; easily accessible from all countries in the region; with local authorities that have demonstrated their commitment to embrace the operation of such a centre; and with the capability of guaranteeing its uninterrupted and safe function through the collaboration with experienced local field professionals such as the police, armed forces, fire-fighters, medics, paramedics, rescuers, and ambulance crews.

A Centre for Research and Education in Disaster Medicine should operate under the auspices of a University institution which specializes in providing education in the broader area of disaster management. This is vital since such a Centre would require substantial experience in deploying educational, training and research projects. As such, it will be requested to certify undergraduate and post graduate studies, to receive medical and other students interested in pertinent to disasters studies; to function as an international pool of teaching and research personnel; to verify its applied experience in introducing educational curricula and research projects; to cooperate with other international teaching and research institutions; as well as to function as a beacon for scientists, researchers, students and scholars from around the world.

Of utmost importance would be the ability of such a Centre to liaise with national and international Institutions and Organizations recognized for their work on the subject-matter of disaster medicine. The functioning of such a Centre as a model - prototype research and education centre, with international and acknowledged impact on the field, would be of essence. The academic spectrum of this Centre would be to train attendees on how to react when multiple disasters strike as well as to cope with all resulting humanitarian issues.

Though a particular study is required to define such a Centre’s funding, we should note here that analogous centres abroad are supported either by the European Union, International Organizations, and charitable institutions or even by taxes and duties imposed on each individual visiting the centre’s location. Other funding sources could be Greeks living abroad, tuition fees, the state itself and competent agencies and ministries.

Lastly, not being within the scope of this paper, a study on all legal issues related to the incorporation and functioning of this Centre should be initiated.

In the following chapters we elaborate the dual character of a Southeastern Mediterranean Centre in Disaster Medicine providing an outline of its syllabus in the fields of research and education.

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