Despite the increasing risks and complexity of disasters, education for Malaysian health care providers in this domain is limited. This study aims to assess scholarly publications by Malaysian scholars on Disaster Medicine (DM)-related topics.

An electronic search of five selected journals from 1991 through 2021 utilizing multiple keywords relevant to DM was conducted for review and analysis.

A total of 154 articles were included for analysis. The mean number of publications per year from 1991 through 2021 was 5.1 publications. Short reports were the most common research type (53.2%), followed by original research (32.4%) and case reports (12.3%). Mean citations among the included articles were 12.4 citations. Most author collaborations were within the same agency or institution, and there was no correlation between the type of collaboration and the number of citations (P = .942). While a few clusters of scholars could build a strong network across institutions, most research currently conducted in DM was within small, isolated clusters.

Disaster Medicine in Malaysia is a growing medical subspecialty with a significant recent surge in research activity, likely due to the SARS-CoV-2/coronavirus disease 2019 (COVID-19) global pandemic. Since most publications in DM have been on infectious diseases, the need to expand DM-related research on other topics is essential.

Disaster Medicine (DM) education for Emergency Medicine (EM) residents is highly variable due to time constraints, competing priorities, and program expertise. The investigators’ aim was to define and prioritize DM core competencies for EM residency programs through consensus opinion of experts and EM professional organization representatives.

Investigators utilized a modified Delphi methodology to generate a recommended, prioritized core curriculum of 40 DM educational topics for EM residencies.

The DM topics recommended and outlined for inclusion in EM residency training included: patient triage in disasters, surge capacity, introduction to disaster nomenclature, blast injuries, hospital disaster mitigation, preparedness, planning and response, hospital response to chemical mass-casualty incident (MCI), decontamination indications and issues, trauma MCI, disaster exercises and training, biological agents, personal protective equipment, and hospital response to radiation MCI.

This expert-consensus-driven, prioritized ranking of DM topics may serve as the core curriculum for US EM residency programs.

The Society of Academic Emergency Medicine Disaster Medicine Interest Group, the Office of the Assistant Secretary for Preparedness and Response – Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) team, and the National Institutes of Health Library searched disaster medicine peer-reviewed and gray literature to identify, review, and disseminate the most important new research in this field for academics and practitioners.

MEDLINE/PubMed and Scopus databases were searched with key words. Additional gray literature and focused hand search were performed. A Level I review of titles and abstracts with inclusion criteria of disaster medicine, health care system, and disaster type concepts was performed. Eight reviewers performed Level II full-text review and formal scoring for overall quality, impact, clarity, and importance, with scoring ranging from 0 to 20. Reviewers summarized and critiqued articles scoring 16.5 and above.

Articles totaling 1176 were identified, and 347 were screened in a Level II review. Of these, 193 (56%) were Original Research, 117 (34%) Case Report or other, and 37 (11%) were Review/Meta-Analysis. The average final score after a Level II review was 11.34. Eighteen articles scored 16.5 or higher. Of the 18 articles, 9 (50%) were Case Report or other, 7 (39%) were Original Research, and 2 (11%) were Review/Meta-Analysis.

This first review highlighted the breadth of disaster medicine, including emerging infectious disease outbreaks, terror attacks, and natural disasters. We hope this review becomes an annual source of actionable, pertinent literature for the emerging field of disaster medicine.

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

A common method of disaster training is needed to improve disaster nursing education and facilitate better communication among interprofessional disaster responders. To inform the development of disaster nursing curricula, a novel disaster nursing education method consistent with Homeland Security Exercise and Evaluation Program (HSEEP) and the International Council of Nurses (ICN) framework was developed to improve disaster nursing competencies in a baccalaureate nursing program.

In total, 89 undergraduate nursing students participated. Perceived disaster nursing knowledge, confidence, and training/response were assessed with 14 items before and after the education.

Exploratory factor analysis showed 3 factors, knowledge, confidence, and training/response, explained 71% of variation in items. Nursing students showed large improvements in perceived disaster nursing knowledge (t=11.95, P<0.001, Cohen’s d=1.76), moderate increases in perceived confidence (t=4.54, P<0.001, d=0.67), and no change in disaster training and response (t=0.94, P=0.351, d=0.13).

Results show preliminary evidence supporting the effectiveness of disaster nursing education informed by HSEEP. This training has the potential to fill current practice gaps in disaster nursing knowledge and build confidence to use those skills in practice. (Disaster Med Public Health Preparedness. 2018;12:703-710)

This study had 2 aims. First, we evaluated the current levels of disaster preparedness among university students in southern China. Second, we assessed students’ demands for future disaster education. In addition, we examined the influence of demographic factors on current disaster preparedness status and demand.

A cross-sectional design was used. The data were collected from 1893 students in 10 universities in the Guangzhou Higher Education Mega (GHEM) center. A self-administered questionnaire developed for this study was administered to assess the current status and demand for disaster education.

The results are based on 1764 valid questionnaires. Among the participants, 77.8% reported having had disaster education experiences before, 85.5% indicated their desire for a systematic disaster course, and 75.4% expressed their willingness to take such a course upon its availability. The total mean score for demand for disaster course content (5-point Likert scale) was 4.17±0.84, with items relating to rescue skills given the highest scores. These results suggested that students had high desires for disaster preparedness knowledge, especially knowledge concerning rescue skills. We observed significant differences in disaster education experiences between male and female students and across programs, school years, and home locations. Furthermore, we observed significant differences in demand for disaster course content between male and female students and across universities, student programs, years of school, and students’ majors.

A systematic disaster course focused on rescue skills is needed by all types of universities. To improve the disaster education system in universities, disaster drills should be performed on a semester basis as a refresher and to enhance disaster preparedness. The government and universities should support building a simulated disaster rescue center and recruit faculty from the emergency department, especially those who have had disaster relief experience. (Disaster Med Public Health Preparedness. 2017;11:310–317)

In resource-constrained environments, appropriately employing triage in disaster situations is crucial. Although both case-based learning (CBL) and simulation exercises (SEs) commonly are utilized in teaching disaster preparedness to adult learners, there is no substantial evidence supporting one as a more efficacious methodology. This randomized controlled trial (RCT) evaluated the effectiveness of CBL versus SEs in addition to standard didactic instruction in knowledge attainment pertaining to disaster triage preparedness.

This RCT was performed during a one-day disaster preparedness course in Lucknow, India during October 2014. Following provision of informed consent, nursing trainees were randomized to knowledge assessment after didactic teaching (control group); didactic plus CBL (Intervention Group 1); or didactic plus SE (Intervention Group 2). The educational curriculum used the topical focus of triage processes during disaster situations. Cases for the educational intervention sessions were scripted, identical between modalities, and employed structured debriefing. Trained live actors were used for SEs. After primary assessment, the groups underwent crossover to take part in the alternative educational modality and were re-assessed. Two standardized multiple-choice question batteries, encompassing key core content, were used for assessments. A sample size of 48 participants was calculated to detect a ≥20% change in mean knowledge score (α=0.05; power=80%). Robustness of randomization was evaluated using X2, anova, and t-tests. Mean knowledge attainment scores were compared using one- and two-sample t-tests for intergroup and intragroup analyses, respectively.

Among 60 enrolled participants, 88.3% completed follow-up. No significant differences in participant characteristics existed between randomization arms. Mean baseline knowledge score in the control group was 43.8% (standard deviation=11.0%). Case-based learning training resulted in a significant increase in relative knowledge scores at 20.8% (P=0.003) and 10.3% (P=.033) in intergroup and intragroup analyses, respectively. As compared to control, SEs did not significantly alter knowledge attainment scores with an average score increase of 6.6% (P=.396). In crossover intra-arm analysis, SEs were found to result in a 26.0% decrement in mean assessment score (P < .001).

Among nursing trainees assessed in this RCT, the CBL modality was superior to SEs in short-term disaster preparedness educational translation. Simulation exercises resulted in no detectable improvement in knowledge attainment in this population, suggesting that CBL may be utilized preferentially for adult learners in similar disaster training settings.

AluisioAR, DanielP, GrockA, FreedmanJ, SinghA, PapanagnouD, ArquillaB. Case-based Learning Outperformed Simulation Exercises in Disaster Preparedness Education Among Nursing Trainees in India: A Randomized Controlled Trial. Prehosp Disaster Med. 2016;31(5):516–523.

The effect on behavioral change of educational programs developed to reduce the community’s disaster informational vulnerability is not known. This study describes the relationship of disaster education, age, sex, and country-specific characteristics with students discussing disasters with friends and family, a measure of proactive behavioral change in disaster preparedness.

Three thousand eight hundred twenty-nine final year high school students were enrolled in an international, multi-center prospective, cross-sectional study using a pre-validated written questionnaire. In order to obtain information from different educational systems, from countries with different risk of exposure to disasters, and from countries with varied economic development status, students from Bahrain, Croatia, Cyprus, Egypt, Greece, Italy, Portugal, Romania, and Timor-Leste were surveyed. Logistic regression analyses examined the relationship between the likelihood of discussing disasters with friends and family (dependent variable) and a series of independent variables (age, gender, participation in school lessons about disasters, existence of a national disaster educational program, ability to list pertinent example of disasters, country's economic group, and disaster risk index) captured by the questionnaire or available as published data.

There was no statistically significant relationship between age, awareness of one’s surroundings, planning for the future, and foreseeing consequences of events with discussions about potential hazards and risks with friends and/or family. The national educational budget did not have a statistically significant influence. Participants who lived in a low disaster risk and high income Organization for Economic Co-operation and Development (OECD) country were more likely to discuss disasters. While either school lessons or a national disaster education program had a unique, significant contribution to the model, neither had a better predictive utility.

The predictors (national disaster program, school lessons, gender, ability to list examples of disasters, country’s disaster risk index, and level of economic development), although significant, were not sufficient in predicting disaster discussions amongst teenagers.

CodreanuTA , CelenzaA , AlabdulkarimAAR . Factors Associated with Discussion of Disasters by Final Year High School Students: An International Cross-sectional Survey. Prehosp Disaster Med. 2015;30(4):1–9.

Community-level disaster readiness is a major component of community health promotion. However, many readiness programs are focused on the response of emergency and health care personnel and not on the preparedness levels of local citizens. This potentially leaves the public unready and unprepared for emergency event response.

A 20-item survey on general states of disaster preparedness was delivered to the residents of a midsized midwestern county. The residents were asked to share their knowledge of local hazards, emergency systems, and personal preparedness.

A convenience sample of 423 residents responded to the survey. Fifty-seven percent (n=241) reported limited personal preparedness. Seventy-six percent (n=321) acknowledged little to no familiarity with residential emergency systems, and 52% (n=220) reported that they did not know how to gain information on public health emergencies, such as pandemic flu and evacuation response.

Local citizens should become educated on the methods to support personal disaster and emergency readiness. Health care and emergency management organizations are encouraged to include these concepts in routine community health promotion activities and to pay special attention to known areas of community vulnerability. Failure to do so creates a population unable to support themselves in the provision of basic health and safety measures. (Disaster Med Public Health Preparedness. 2015;9:239-244)

This study assessed disaster medicine knowledge and competence and perceived self-efficacy and motivation for disaster response among medical, nursing, and dental students.

Survey methodology was used to evaluate knowledge, comfort, perceived competency, and motivation. Also, a nonresponder survey was used to control for responder bias.

A total of 136 responses were received across all 3 schools. A nonresponder survey showed no statistical differences with regard to age, gender, previous presence at a disaster, and previous emergency response training. In spite of good performance on many knowledge items, respondent confidence was low in knowledge and in comfort to perform in disaster situations. Knowledge was strong in areas of infection control, decontamination, and biological and chemical terrorism but weak in areas of general emergency management, role of government agencies, and radiologic events. Variations in knowledge among the different health professions were slight, but overall the students believed that they required additional education. Finally, students were motivated not only to acquire more knowledge but to respond to disaster situations.

Health care students must be adequately educated to assume roles in disasters that are a required part of their professions. This education also is necessary for further disaster medicine education in either postgraduate or occupational education. As students’ performance on knowledge items was better than their perceived knowledge, it appears that a majority of this education can be achieved with the use of existing curricula, with minor modification, and the addition of a few focused subjects, which may be delivered through novel educational approaches. (Disaster Med Public Health Preparedness. 2013;7:499-506)

An understanding of disaster medicine and the health care system during mass-casualty events is vital to a successful disaster response, and has been recommended as an integral part of the medical curriculum by the Association of American Medical Colleges (AAMC). It has been documented that medical students do not believe that they have received adequate training for responding to disasters. The purpose of this pilot study was to determine the inclusion of disaster medicine in the required course work of medical students at AAMC schools in the United States, and to identify the content areas addressed.

An electronic on-line survey was developed based upon published core competencies for health care workers, and distributed via e-mail to the education liaison for each medical school in the United States that was accredited by the AAMC. The survey included questions regarding the inclusion of disaster medicine in the medical school curricula, the type of instruction, and the content of instruction.

Of the 29 (25.2%) medical schools that completed the survey, 31% incorporated disaster medicine into their medical school curricula. Of those schools that included disaster medicine in their curricula, 20.7% offered disaster material as required course work, and 17.2% offered it as elective course work. Disaster medicine topics provided at the highest frequency included pandemic influenza/severe acute respiratory syndrome (SARS, 27.5%), and principles of triage (10.3%). The disaster health competency included most frequently was the ability to recognize a potential critical event and implement actions at eight (27.5%) of the responding schools.

Only a small percentage of US medical schools currently include disaster medicine in their core curriculum, and even fewer medical schools have incorporated or adopted competency-based training within their disaster medicine lecture topics and curricula.

> SmithJ , LevyMJ , HsuEB , LevyJL . Disaster Curricula in Medical Education: Pilot Survey. Prehosp Disaster Med.2012;27(5):1-3.

In order to prepare the healthcare system and healthcare personnel to meet the health needs of populations affected by disasters, educational programs have been developed by numerous academic institutions, hospitals, professional organizations, governments, and non-government organizations. Lacking standards for best practices as a foundation, many organizations and institutions have developed “core competencies” that they consider essential knowledge and skills for disaster healthcare personnel.

The Nursing Section of the World Association for Disaster and Emergency Medicine (WADEM) considered the possibility of endorsing an existing set of competencies that could be used to prepare nurses universally to participate in disaster health activities. This study was undertaken for the purpose of reviewing published disaster health competencies to determine commonalities and universal applicability for disaster preparedness.

In 2007, a review of the electronic literature databases was conducted using the major keywords: disaster response competencies; disaster preparedness competencies; emergency response competencies; disaster planning competencies; emergency planning competencies; public health emergency preparedness competencies; disaster nursing competencies; and disaster nursing education competencies. A manual search of references and selected literature from public and private sources also was conducted. Inclusion criteria included: English language; competencies listed or specifically referred to; competencies relevant to disaster, mass-casualty incident (MCI), or public health emergency; and competencies relevant to healthcare.

Eighty-six articles were identified; 20 articles failed to meet the initial inclusion criteria; 27 articles did not meet the additional criteria, leaving 39 articles for analysis. Twenty-eight articles described competencies targeted to a specific profession/discipline, while 10 articles described competencies targeted to a defined role or function during a disaster. Four of the articles described specific competencies according to skill level, rather than to a specific role or function. One article defined competencies according to specific roles as well as proficiency levels. Two articles categorized disaster nursing competencies according to the phases of the disaster management continuum. Fourteen articles described specified competencies as “core” competencies for various target groups, while one article described “cross-cutting” competencies applicable to all healthcare workers.

Hundreds of competencies for disaster healthcare personnel have been developed and endorsed by governmental and professional organizations and societies. Imprecise and inconsistent terminology and structure are evident throughout the reviewed competency sets. Universal acceptance and application of these competencies are lacking and none have been validated. Further efforts must be directed to developing a framework and standardized terminology for the articulation of competency sets for disaster health professionals that can by accepted and adapted universally.

This paper is a report on an exercise designed to reveal the extent of belief in the common myths about disasters held by members of four groups of students from the University of Massachusetts and three groups of trainee emergency workers from Italy.

A questionnaire was administered in which students and trainees were asked to agree or disagree with 19 statements about disasters. These statements were based on common misconceptions about disasters and are at least statements untenable in statistical terms, if not downright wrong. In each case, a Likert scale was used to assess the strength of the students' and trainees' agreement or disagreement with the statements.

The results suggest that some of the misconceptions (for example, that panic and looting are widespread reactions to disaster) were strongly held, whereas others (for instance, that disasters cannot be managed) were less well-rooted. Despite years of refutation by experts, all groups firmly believed that dead bodies constitute a health hazard if they are not disposed of quickly. Attitudes to the proposition that technology offers a solution to the disaster problem were equivocal.

Though the results of the study by no means were homogeneous, students and emergency workers, on either side of the Atlantic, bring many of the same misconceptions that the mass media continually propagates. These beliefs represent a serious challenge for the instructor who wants to ensure that disasters and emergencies are not misconstrued.