電子期刊 |
ISSN:1684-193X
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Updated
Feb 25, 2003
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Contents:
Volume 1, Nomber 2; Jan, 2003 |
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Effectiveness
of the Standardization of Training and Uniform Certification on
Disaster Medical Assistance Team in Taiwan |
Chien-Chih Chen, MD, Hang Chang, MD, PhD, and Tzong-Luen
Wang, MD, PhD |
From the Department of Emergency Medicine(Chen
CC, Chang H, Wang TL), Shin-Kong Wu Ho-Su Memorial Hospital.
Correspondence to Dr. Tzong-Luen Wang, Department
of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, 95
Wen Chang Road, Taipei, Taiwan. E-mail M002183@ms.skh.org.tw
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Abstract
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The objectives of this study were
tried to evaluate the effectiveness of the standardization of training
and uniform certification by making comparisons among Taiwan Society
of Disaster Medicine (TSDM) and other Societies, to analyze the
composition of the students joined in the examination of certification
and to help further modification of DMAT set-up. We invited ten
specialists of disaster medicine to establish an examination database
for certification. Fifty questions were randomly selected as the
final test of certification within the following four months. Totally
517 students joined in the examination of certification. Of 400
students attending the basic training course of TSDM, 10 students
(2.5%) failed to pass, whereas 12 students (10%) failed (P<0.05
vs. TSDM group) among another 117 students joined in the training
course of other Societies. The mean scores were 74.67 and 69.15
in TSDM and other Societies respectively (P<0.05). The effectiveness
of the standardization of training and uniform certification has
been proven in our study. Further policies may be needed to direct
the standardization of training course, appropriate certifications
and licensure of DMAT members and the engagement of emergency medical
technicians in the DMATs. (Ann Disaster Med. 2003;1:70-77)
Key words: Standardization; Uniform Certification; Disaster Medicine |
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Introduction
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The natural energy contains infinite
lives, however, it sometimes brings calamity as well. In this high-density
society, the centralization of population increases calamity level
to thousand times than past. A scientific research reveals that
the natural calamity is growing by geometric progression in recent
decades. In these few years, wars and terror attacks have been caused
severe damages to human society. Hence, how to take precautions
against natural and man make calamities has become a “Not a moment
is to be lost” matter. Historically the government has relied on
the military as a source of manpower and supplies during disasters. 1
Military personnel are well trained and prepared to establish
and maintain essential services in areas that have had infrastructures
destroyed by warfare. As a result of restructuring and downsizing,
the military does not represent the labor pool that it once did.
This results in a decrease in the military's ability to respond
to disaster relief situations. The new role of the military during
disasters will be to transport supplies, equipment, and volunteer
disaster workers to, and within, a stricken area. 1
In Taiwan, so-called volunteer disaster workers has always conjured
up images of the Tzu Chi Foundation aiding disaster victims. Its
resources to act as providers of food, shelter, and emergency living
areas, rather than providers of expert medical care. This void between
Tzu Chi Foundation involvement and the traditional military role
of providing disaster health care workers is currently filled by
disaster medical assistance teams (DMATs). Staffed by volunteers,
DMATs provide medical care both at the scene of a disaster and at
transfer points and reception sites associated with patient evacuation.
According to the definition from National Disaster Medical Team
(NDMS) in the United States, 2 DMATs
are organized as a division of the federal government through the
NDMS. NDMS is a joint effort of the Department of Health and Human
Services, the Department of Defense, the Department of Veterans
Affairs, the Federal Emergency Management Agency (FEMA), state and
local governments, and private organizations. NDMS was developed
to provide for mutual aid among different parts of the nation in
the event of a catastrophic disaster that overwhelms the health
care resources in the locally affected area. Its main objectives
are to (1) provide direct medical assistance to the disaster area
in the form of DMATs, (2) evacuate patients who cannot be cared
for locally, and (3) provide hospitalization through a nationwide
network of pre-allocated hospital beds.
After Chi-Chi earthquake, our government has been engaged in the
establishment of a good disaster response system including DMATs
since July 2000. 3,4
However, the compositions of our DMATs (either national or local)
individualized, depending upon different policies and different
guidance in each team, so the ability of emergency response and
action are different in each team. The phenomenon elucidated that
our disaster response system is still lacking in uniform policies
and consistent planning. Taiwan Society of Disaster Medicine has
been established in 2001, and engaged in the standardization of
training and uniform certification of local disaster medical assistance
team. The objectives of this study are tried to 1) evaluate the
effectiveness of the standardization of training and uniform certification
by making comparisons between Taiwan Society of Disaster Medicine
and other Societies; 2) analyze the composition of the students
joined in the examination of certification; and 3) help further
modification of DMAT set-up.
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Methods |
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We enrolled the specialists and experts of disaster
medicine and designed the basic training course of local DMAT in January
2002. We conducted eight shows of basic training course in city and
country of Taiwan during one year. Two hundred and twenty eight questions
from ten specialists of disaster medicine were included in the examination
database in August 2002. We picked up 50 questions as final and conducted
five examinations of certification within four months. All of the
persons attending in DMAT training courses were permitted to attend
the examination of certification. Of them, 400 joined in the basic
training course of Taiwan Society of Disaster Medicine, 117 of other
Societies. The certification was based upon the scores above 60 points.
The relationship between the training courses conducted from different
societies and the performance and that among students with different
medical background were also analyzed. |
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Statistic Analysis |
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All the data were processed and
analyzed with Microsoft Excel 2000 for Windows. The techniques applied
to data analysis included descriptive statistics generating and
independent samples t-test and chi-square test. We compared the
percentage of failure between the students from Taiwan Society of
Disaster Medicine and those from other Societies by chi-square test.
The differences in the performance of students were examined by
an independent samples t-test. A P value less than 0.05 was considered
as statistically significant. |
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Results |
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These 228 questions consisted of
the categories such as NDMS, incident command system, public health,
mass evacuation, logistics, and mass casualty. We picked up 50 questions
for final examination. Of all 400 students attending the basic training
course of Taiwan Society of Disaster Medicine, 390 students passed
and 10 failed. Among another 117 students attending the training
course of other Societies, 105 passed and 12 failed. The percentages
of failure were 2.5% and 10% in Taiwan Society of Disaster Medicine
and other Society, respectively (P<0.05) (Table 1 ).
The mean scores were 74.67 and 69.15 in Taiwan Society of Disaster
Medicine and other Society respectively (P<0.05)(Table 3 ).
Table 2
depicts the composition of the students attended in the training
course of Taiwan Society of Disaster Medicine and joined in the
examination of certification. The nurses, doctors, EMTs and volunteers
comprised around 58.25%,12.75%,2.5% and 4.75% respectively. Table
2
depicts the composition of the students attended in the training
course of other Societies and joined in examination of certification.
The nurses, doctor EMTs and volunteers
comprised around 29.06%, 9.4%, 3.42% and 52.14% respectively. The
comparison between Table 2
revealed that the volunteers comprised around 4.75% in Taiwan Society
of Disaster Medicine whereas they consisted 52.14% in other Societies.
Few EMTs joined in the examination of certification in Taiwan Society
of Disaster Medicine and other societies. |
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Table 1. The result of certification and chi-square
test |
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Table 2. The composition of the students attended
in the TSDM and other societies |
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Table 3. The mean score of TSDM and other societies |
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Discussion |
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DMATs deploy to disaster sites
with sufficient supplies and equipment to sustain themselves for
a period of 72 hours while providing medical care at a fixed or
temporary medical care site. 1-2
In mass casualty incidents, their responsibilities include triaging
patients, providing austere medical care, and preparing patients
for evacuation. In other types of situations, DMATs may provide
primary health care and/or may serve to augment overloaded local
health care staffs. Under the rare circumstance that disaster victims
are evacuated to a different locale to receive definitive medical
care, DMATs may be activated to support patient reception and disposition
of patients to hospitals. DMATs are designed to be a rapid-response
element to supplement local medical care until other contract resources
can be mobilized, or the situation is resolved.
There are two national disaster medical assistance teams (NCKU、NTU)
and 12 local disaster medical assistance teams in Taiwan at present.
However, the compositions of our DMATs (either National or local)
varied significantly, depending upon different policies and different
guidance in each team, so the ability of emergency response and
action are different in each team. 5
The phenomenon elucidated that our disaster response system is still
lacking in uniform policies and consistent planning. 5
Taiwan Society of Disaster Medicine has therefore been engaged in
the standardization of training and uniform certification of local
disaster medical assistance team. We found out that the scoring
and success rate of the students attending the training courses
of Taiwan Society of Disaster Medicine were both better than other
students (P<0.05). Therefore, the training course needed to been
standardized and DMAT members are required to maintain appropriate
certifications and licensure within their disciplines.
As mentioned previously, a general DMAT teams normally consist of
approximately 35 members - 4 or 5 physicians, 10 to 12 nurses and
paramedics, 8 to 12 EMTs, with the remainder of the team made up
of support personnel. 1 In Taiwan, however,
EMT accounts for only 6.4% of DMAT members,5 which is different
from the observations in the United States (28.7%). 5-10
In our study, the EMT comprised only 2.5% of all the students attending
examination of certification. It may also explain the fact that
there is a greater need for physically strong persons with the ability
of first aid rather than for highly trained medical specialists
during a disaster. The immediate situation will require more tasks
such as stretcher carrying than technical surgeries or procedures. 1
Besides primary first aid and emergency care, the paramedics and
EMT always have accepted the training of “disaster medicine” and
have some clinical experiences, so the attendance of them should
be a crucial step in setting up a good DMAT. 5
In other words, more EMT should be encouraged to join DMAT.
Another issue is concerning about the role of the volunteers attending
in the DMATs. There are still controversies about the role of volunteers.
In one of our DMATs, there are more than 60% of the members to be
volunteers. 5 The volunteers attended
in training course of other Society joined in the examination of
certification comprised 52.14%. It is different from the DMATs in
the United States (< 5%). 9-12 As
we know, most of the volunteers lack in medical training such as
basic and advanced life support and lack clinical experiences. The
roles of the volunteers in real disaster situations may be limited.
Instead, the paramedics on EMT should play a better role than the
volunteers do.
An important limitation of this study is that the compositions of
two groups were different; the students attending Taiwan Society
of Disaster Medicine have higher percentage of medical education
background that those in other societies. It may explain the better
performance in certification from those in Taiwan Society of Disaster
Medicine. Other limitations include limited students in other societies
attending the certifications, and lack of consistent certification
in all national DMATs and local DMATs.
In conclusion, the effectiveness of the standardization of training
and uniform certification has proven to be good. The uniform policies
need to be direct to the standardization of training course, appropriate
certifications and licensure of DMAT members and encourage the EMTs
to attend the DMAT training.
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References |
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