Education and Training of Emergency Medical Teams: Recommendations for a Global Operational Learning Framework
Nieves Amat Camacho, Amy Hughes, Frederick M. Burkle Jr., Pier Luigi Ingrassia, Luca Ragazzoni, Anthony Redmond, Ian Norton, Johan von Schreeb
An increasing number of international emergency medical teams are deployed to assist disaster-affected populations worldwide. Since Haiti earthquake those teams have been criticised for ill adapted care, lack of preparedness in addition to not coordinating with the affected country healthcare system. The Emergency Medical Teams (EMTs) initiative, as part of the Word Health Organization’s Global Health Emergency Workforce program, aims to address these shortcomings by improved EMT coordination, and mechanisms to ensure quality and accountability of national and international EMTs. An essential component to reach this goal is appropriate education and training. Multiple disaster education and training programs are available. However, most are centred on individuals’ professional development rather than on the EMTs operational performance. Moreover, no common overarching or standardised training frameworks exist. In this report, an expert panel review and discuss the current approaches to disaster education and training and propose a three-step operational learning framework that could be used for EMTs globally. The proposed framework includes the following steps: 1) ensure professional competence and license to practice, 2) support adaptation of technical and non-technical professional capacities into the low-resource and emergency context and 3) prepare for an effective team performance in the field. A combination of training methodologies is also recommended, including individual theory based education, immersive simulations and team training. Agreed curriculum and open access training materials for EMTs need to be further developed, ideally through collaborative efforts between WHO, operational EMT organizations, universities, professional bodies and training agencies. Keywords: disasters; education; emergencies; global health; learning
The work of the authors NAC and JvS was funded by grants from SIDA and the Swedish National Board of Health and Welfare. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have declared that no competing interests exist.
Disasters regularly have devastating effects on populations worldwide 1,2. To assist affected countries an increasing number of international emergency medical teams has been deployed 3. Concerns regarding the standard of medical care provided and the lack of preparedness of the teams have been raised. Health practitioners have been observed to work outside their scope of practice and license 4,5, and teams have lacked the basic capacities and means to be fully self-sufficient 2,6. Additional concerns have been highlighted regarding the lack of cultural awareness and coordination with local authorities as well as international agencies 7,8,9. More recently, the response to the West African Ebola epidemic has shown critical gaps in the timeliness, coordination and effectiveness of international emergency medical teams responding to outbreaks 10.
The ‘Foreign Medical Teams’ (FMTs) initiative evolved in 2010 under the umbrella of the World Health Organisation (WHO), the Global Health Cluster and other actors, with the aim to improve the quality and accountability of international emergency medical teams responding to disasters. In 2013, the FMT Working Group published a first edition of the ‘Classification and minimum standards for Foreign Medical Teams in sudden onset disasters’, in which capacities, services and minimum deployment standards for FMTs were defined 11. A global list of quality assured and classified FMT organizations was launched in July 2015. A change of name from FMT to Emergency Medical Teams (EMT) with a pre-fix to differentiate International and National teams (I-EMT and N-EMT) was endorsed at the global meeting held in Panama in December 2015. This was in recognition of the importance of national and international teams working collaboratively to maximise the response to large scale health emergencies (Table 1).
The World Health Assembly 2015 recognised the need for a global health surge capacity and the establishment of the Global Health Emergency Workforce (GHEW), of which the EMT initiative is a part. The GHEW aims to improve coordination, readiness and quality assurance in the deployment of EMTs and individual experts such as those deployed through the Global Outbreak Alert and response Network (GOARN) and other networks and partnerships 12.
To improve the quality and professionalism of deployed teams, a coherent approach to education and training has been identified as a key next step 8. A standardised learning framework is needed to assist EMTs to prepare for response and allow quality assurance mechanisms for the EMT initiative. Organisations wishing to be EMT classified will be required to reveal their training strategies.
Multiple organisations and universities have developed education and training programmes for disaster and emergency response; with a significant variation in scope, curriculum and quality 13,14,15,16. The lack of common standards to guide education and training design and provision have been highlighted 13,17,18. In addition, many of the proposed training models are focused on individuals, rather than multidisciplinary EMTs 19. The so called ‘competency-based models’ have been recommended as the basis for education and training in the disaster field by several authors 20,21,22,23,24,25,26,27,28. Such models are promoted as a way to standardise the training of individuals and contribute to the professionalisation of the discipline, but reviews of available competency models have shown limitations in their practical application 18,29. Although some authors have suggested possible ways to facilitate their alignment to practice 30,31, no competency models have led to a systematic and operationally focused framework to guide EMT organisations through an agreed training pathway for their teams.
The aim of this study is to explore and reflect on current practices related to disaster education and training and suggest key components for an operational EMT learning framework. This targets primarily I- EMTs.