Kenneth Schor

Core Competencies for Disaster Medicine and Public Health

Effective preparedness, response, and recovery from disasters require a well-planned, integrated effort with experienced professionals who can apply specialized knowledge and skills in critical situations. While some professionals are trained for this, others may lack the critical knowledge and experience needed to effectively perform under stressful disaster conditions. A set of clear, concise, and precise training standards that may be used to ensure workforce competency in such situations has been developed. The competency set has been defined by a broad and diverse set of leaders in the field and like-minded professionals through a series of Web-based surveys and expert working group meetings. The results may provide a useful starting point for delineating expected competency levels of health professionals in disaster medicine and public health.

Implementation of evidence-based humanitarian programs in military-led missions: part I. Qualitative gap analysis of current military and international aid programs

BACKGROUND A recent Department of Defense instruction mandates country-specific assessments, identification of interventions, and development of guidance for Department of Defense to plan, train, and prepare for the provision of humanitarian assistance in stability operations. It also directs the use of outcome-based measures of effectiveness and the establishment of processes facilitating transparency of information. Whereas this would align military-led projects closer to the standards of the international aid community, how this process will be developed and implemented within the military has not yet been determined. METHODS To begin developing an evidence-based program for military-led humanitarian aid, we conducted a qualitative gap analysis comparing information from a Web search of Department of Defense medical after-action reports, lessons learned, and expert interviews with the internationally accepted standards in humanitarian assistance impact assessment. RESULTS There is a major gap in the ability of the Department of Defense to assess the impact of humanitarian assistance in stability operations compared with international development standards. Of the 1000 Department of Defense after-action reports and lessons learned reviewed, only 7 (0.7%) reports refer to, but do not discuss, impact assessment or outcome-based measures of effectiveness. CONCLUSIONS This investigation shows that the Department of Defense humanitarian assistance operations are, historically, recorded without documentation using quantifiable health data identifying which aid activities contributed directly to desired outcomes or favorable public opinion, and rarely are analyzed for effectiveness. As humanitarian assistance operations assume an ever greater role in US military strategy, it is imperative that we investigate useful impact assessment models to meet mission directives and, more important, to maximize coordination in a necessarily integrated and cooperative development environment. These findings provide baseline knowledge for the implementation of an evidence-based impact assessment process to validate future Department of Defense humanitarian assistance operations.

Implementation of Evidence-based Humanitarian Programs in Military-led Missions: Part II. The Impact Assessment Model

The Department of Defense does not implement health-sector humanitarian assistance impact assessments to complement those of the international humanitarian aid community. This oversight fails to meet the recent Department of Defense Directive 3000.05 mandate calling for the application of measures of effectiveness. The decision by the Department of Defense to incorporate humanitarian assistance in stability operations should be supported by evidence-based impact assessments. This article proposes implementation of an impact assessment model in Department of Defense humanitarian assistance operations. The use of an impact assessment model will refocus previously identified information gaps from traditional military input-output management toward a greater emphasis on outcomes. This will help answer which humanitarian activities are successful, which are not, and why. Over time, the use of an impact assessment model will ensure that the Department of Defense and its operational units are learning as an organization while applying evidence-based lessons learned to future stability operations. Most important, the use of this model will both provide better understanding of the role that the Department of Defense has in humanitarian activities and help interpret and transfer these activities to the host nation and international aid community in a timely and efficient manner.

Developing a Monitoring and Evaluating Capability for the U.S. Department of Defense Humanitarian Assistance Program

UNLABELLED The Department of Defense spends more than

Building Health Care System Capacity: Training Health Care Professionals in Disaster Preparedness Health Care Coalitions

50 million dollars a year on humanitarian assistance (HA) projects. Although the projects are perceived as beneficial, demonstrating sustainable long-term impact is not possible. METHODS A seven-step monitoring and evaluation (M&E) process was adapted for this study that combined different steps within a logical framework approach. RESULTS A retrospective analysis found that M&E is not part of the HA program (HAP) process from nomination through completion and beyond. To address this M&E deficiency, a comprehensive logframe matrix composed of 5 goals, 14 objectives, 100 activities, and many indicators was created. CONCLUSIONS Incorporating this proposed Department of Defense HAP logframe matrix into existing project nomination and After-Action Report (AAR) processes would enable HAP managers to prioritize limited resources, demonstrate sustainable program impact, and align individual HA projects with the overarching national defense strategy and overall U.S. government foreign policy.

Proposing a Framework for Mobile Applications in Disaster Health Learning.

INTRODUCTION This study aimed to learn from the experiences of well-established, disaster preparedness-focused health care coalition (HCC) leaders for the purpose of identifying opportunities for improved delivery of disaster-health principles to health professionals involved in HCCs. This report describes current HCC education and training needs, challenges, and promising practices. METHODS A semi-structured interview was conducted with a sample of leaders of nine preparedness-focused HCCs identified through a 3-stage purposive strategy. Transcripts were analyzed qualitatively. RESULTS Training needs included: stakeholder engagement; economic sustainability; communication; coroner and mortuary services; chemical, biological, radiological, nuclear, and explosives (CBRNE); mass-casualty incidents; and exercise design. Of these identified training needs, stakeholder engagement, economic sustainability, and exercise design were relevant to leaders within HCCs, as opposed to general HCC membership. Challenges to education and training included a lack of time, little-to-no staff devoted to training, and difficulty getting coalition members to prioritize training. Promising practices to these challenges are also presented. CONCLUSIONS The success of mature coalitions in improving situational awareness, promoting planning, and enabling staff- and resource-sharing suggest the strengths and opportunities that are inherent within these organizations. However, offering effective education and training opportunities is a challenge in the absence of ubiquitous support, incentives, or requirements among health care professions. Notably, an online resource repository would help reduce the burden on individual coalitions by eliminating the need to continually develop learning opportunities.

Operation Canine Lifeline: Recommendations for Enhancing Prehospital Care for Government Working Dogs

Mobile applications, or apps, have gained widespread use with the advent of modern smartphone technologies. Previous research has been conducted in the use of mobile devices for learning. However, there is decidedly less research into the use of mobile apps for health learning (eg, patient self-monitoring, medical student learning). This deficiency in research on using apps in a learning context is especially severe in the disaster health field. The objectives of this article were to provide an overview of the current state of disaster health apps being used for learning, to situate the use of apps in a health learning context, and to adapt a learning framework for the use of mobile apps in the disaster health field. A systematic literature review was conducted by using the PRISMA checklist, and peer-reviewed articles found through the PubMed and CINAHL databases were examined. This resulted in 107 nonduplicative articles, which underwent a 3-phase review, culminating in a final selection of 17 articles. While several learning models were identified, none were sufficient as an app learning framework for the field. Therefore, we propose a learning framework to inform the use of mobile apps in disaster health learning. (Disaster Med Public Health Preparedness. 2017;11:487-495).

Delivering Flexible Education and Training to Health Professionals: Caring for Older Adults in Disasters.

Operation Canine Lifeline was a tabletop exercise developed by students and faculty of Boston University School of Medicines Healthcare Emergency Management masters program. The tabletop exercise led to discussion on current protocols for canines working in the field, what occurs if a canine encounters a toxin in the field, and what to do in situations of national security that require working with civilian agencies. This discussion led to the creation of a set of recommendations around providing prehospital veterinary care to government working dogs. The recommendations include a government-run veterinary toxicology hotline for the sole use of the government, issuing handlers deployment kits and preprogrammed smartphones that contain information on the care practices for dogs, and an increased effort for civilian integration, through local emergency medical services, in the emergency care of government canines. (Disaster Med Public Health Preparedness. 2017;11:15-20).

Disaster Health Competencies and Their Application: Caring for Seniors

The National Center for Disaster Medicine and Public Health (NCDMPH), in collaboration with over 20 subject matter experts, created a competency-based curriculum titled Caring for Older Adults in Disasters: A Curriculum for Health Professionals. Educators and trainers of health professionals are the target audience for this curriculum. The curriculum was designed to provide breadth of content yet flexibility for trainers to tailor lessons, or select particular lessons, for the needs of their learners and organizations. The curriculum covers conditions present in the older adult population that may affect their disaster preparedness, response, and recovery; issues related to specific types of disasters; considerations for the care of older adults throughout the disaster cycle; topics related to specific settings in which older adults receive care; and ethical and legal considerations. An excerpt of the final capstone lesson is included. These capstone activities can be used in conjunction with the curriculum or as part of stand-alone preparedness training. This article describes the development process, elements of each lesson, the content covered, and options for use of the curriculum in education and training for health professionals. The curriculum is freely available online at the NCDMPH website at http://ncdmph.usuhs.edu (Disaster Med Public Health Preparedness. 2016;10:633-637).

Building Health Care System Capacity to Respond to Disasters: Successes and Challenges of Disaster Preparedness Health Care Coalitions

Disaster medicine and public health (disaster health) competencies are presented from a broad and inclusive perspective for all health professions. Concepts presented include the all-hazards approach, key competency audiences (educators and lifelong learners), linkages to national frameworks and goals, a detailed description of current core competencies, contextual proficiency variations, and considerations for access and functional needs populations. The absence of reference to disaster health competencies in existing geriatric competencies is highlighted with concern. A potential strength in the disaster context is the routine biopsychosocial approach inherent in caring for Seniors. To engage the learner, a series of seven questions cross-referenced to the core competencies is offered as a means to assist health professionals and systems in becoming better able to mitigate, prepare for, respond to, and recover from disasters. A more detailed discussion of the questions, with linkages to the geriatric disaster context, is offered.