Prehospital

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Prehospital Disaster Medicine EducationCore
Content for Medical Students and Residents

• Kristi L Koenig, MD, FACEP
• Professor of Emergency Medicine
• Co-Director, EMS and Disaster Medical Sciences
  Fellowship
• Director of Public Health Preparedness
• University of California at Irvine, School of
  Medicine
• Orange, California, USA

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Prehospital Disaster Medicine EducationOverview

• Why should we include it?
• What should we include?
• Core Content
• How should we include it?
• Methods for Medical Student Resident Education

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Why should Disaster Medicine be core content for
medical students and residents?
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Why is this important in todays climate?

• Department of Homeland Security Grants
• awarded more than 300 million to eight
  universities since 9/11
• Degrees
• gt 200 colleges have created homeland-security
  degree and certificate programs since 9/11
• Another 144 have added emergency management with
  a terrorism emphasis
• Jobs
• Governments and corporations are hiring people
  with expertise
• Real World Events

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Real World Global Events
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Getting through Airport Security
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Liaison Committee on Medical EducationAnnual
Medical School Questionnaire 2004-2005

• Compiled by AAMC
• 125 Medical Schools
• Required Elective Courses
• Biological/Chemical Terrorism 104 22
• Disaster Management 49 17
• Global Health Issues 74 58

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What should be included in the core content?

• Disaster Medicine
• New field
• Unique body of knowledge?
• Nomenclature
• What is a disaster?
• How can we teach when not standardized?

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What should be included in the core content?

• Concepts and Philosophy
• Definitions
• All Hazards Approach
• Comprehensive Emergency Management
• Incident Management Systems
• Strategic, Tactical (operational), Clinical

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What should be included in the core content?

• Sample Core Topics
• Disaster Triage
• Surge Capacity
• Ethics
• Scarce resource allocation
• Shift from individual to population health care

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WADEM Position Paper

• CBRN education and training should be included
  with disaster medicine in the basic curriculum of
  medical professional schools
• Core competencies for CBRN education as part of
  disaster management must be defined

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What is the core content?

• Prehospital and Disaster Medicine as unique
  bodies of knowledge
• Transdisciplinary, translational, transformational

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Terminology

• Terminology is the foundation for education and
  training
• Lack of uniformity
• Need standardized definitions prior to developing
  competencies and curriculum

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Developing a Competency Based Curriculum

• Conduct needs assessment
• Identify general and specific competencies
  addressed by a given experience
• Write goals and objectives
• Determine learning methods
• Determine assessment methods
• Accreditation Council for Graduate Medical
  Education (ACGME) Outcome Project 2006

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Education and Training

• Education and Training
• What is the difference?
• Must connect to an organizations operational
  procedures
• Example
• White Powder discovered in hospital at 3 a.m.

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Education and Training ProgramsTerminology

• Competency
• Education
• Training
• Exercise
• Organizational Learning

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Competency

• Specific knowledge element, skill or ability
• Objective and measurable
• Required for effective job performance
• Leads to achieving the objectives of the
  organization
• Example
• Recognize an illness as potentially resulting
  from exposure to a biological terrorism agent

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Education

• Instruction that is structured to achieve
  specific competency-based objectives that
  primarily impart knowledge
• Varying levels of proficiency
• Awareness
• Operations
• Expert

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Training

• Instruction that imparts or maintain skills
  necessary for performance of assigned
  responsibilities under disaster conditions
• Objectives are competency-based
• Specify a level of proficiency
• Awareness
• Operations
• Expert

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Exercise

• Scripted, scenario-based activity designed to
  evaluate ability to achieve both systems and
  individual objectives
• Demonstrates competencies for response and
  recovery
• Identifies potential system improvements

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Exercise

• What effects do an exercise have on regular
  patient care activities?

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Organizational Learning

• Systems-based process for assessing proposed
  changes and incorporating approved proposals
• Alterations to system structures, processes,
  competencies, facilities, supplies and equipment
• Accessible to entire organization
• Consistent with core mission and objectives

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Instructional System Development

• Basic theory that supports education and training
  program development
• Originated by U.S. military
• Five phases

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Instructional System Development

• Training Needs Analysis
• Identification of target audiences
• Requirements for each group
• Program Design and Delivery
• Content Development
• Implementation
• Evaluation and Improvements

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Instructional System DevelopmentFive Phases
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Program Design

• Adult Learning Principles
• Encouraging self-direction
• Reinforcing and building upon prior experiences
• Providing training in small groups
• Offering supportive and challenging environment

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Comparison of Types of Education and Training
Program Designs

• On-Site
• Pros - Hands-On, Interactive, No Distractions,
  Collegiality
• Cons - Expensive, Scheduling, Instructor
  Availability
• Distance Learning
• Pros - Inexpensive, Anywhere and Anytime, Can
  Repeat
• Cons - No Interaction, Lack of Motivation, Boring

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Distance Learning
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On-Site Simulation Training

• Students
• Visualize pharmacology and pharmacodynamics of
  medications
• Observe realistic physiologic parameters of
  diseases
• Bedside interactions with healthcare
  professionals
• Facilitators
• Provide immediate feedback
• Document decision-making processes
• Vary each simulation based on individual need
• Complete assessments without interfering with
  patient care

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Israeli Simulation Center
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Program Design

• For large numbers of students, if focus is
  primarily of imparting knowledge
• Use technology
• Satellite broadcasts, videotapes
• Electronic documents, CD-ROMS and DVDs
• Web-based courses (Distance Learning)

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USAMRIID Satellite Broadcasts Live Interactive
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Cost-EffectivenessDistance Learning Programs
Year Participants Cost
Cost/Student FY97 satellite 5,632 1.16M
206 FY97 tape 2,334 0.04M
17 FY98 satellite 18,167 1.20M
66 FY99 satellite 18,716
0.96M 51 FY00 satellite 9,935 0.55M
55 Total 54,784 3.91M 71
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On-Site Training versus Distance LearningCost
and Time Comparison to Train 54,784 Students

• On-site
• 90 years
• 54 million
• 986 per person
• Satellite Broadcasts and Tapes
• 4 years
• 3.91 million
• 71 per person

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CD-ROM or DVD
Interactive Training
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USAMRIID On-Site Training
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Private Companies

• http//www.logicalimages.com/resourcesBTAgents.htm

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National Disaster Life Support Disaster
Preparedness Training
Comprehensive, standardized family of all
hazard training programs Developed by the NDLS
consortium of academic, state, and federal
centers American Medical Association
endorses http//www.bdls.com
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National Disaster Life SupportEducation and
Training
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Future Directions

• Standardize disaster nomenclature
• Develop competencies as basis for course design
• Enhance use of information technology
• Software to create realistic simulated disasters
• Develop measures of effectiveness
• Does education save lives?