Tay Joyce, Chou Wei-Kuo, Cheng Ming-Tai, Yang Chih-Wei, Huang Shuo-Kuen, Lin Chien-Hao
National Taiwan University Hospital, Department of Emergency Medicine, Taipei, Taiwan.
National Taiwan University Hospital, Department of Medical Education, Taipei, Taiwan.
West J Emerg Med. 2025 Jun 25;26(4):1095-1104. doi: 10.5811/westjem.24961.
Situated in the western Pacific Ocean, Taiwan has faced a diverse array of natural and man-made disasters. Since 2000, disaster medicine education has been progressively integrated into various medical professions, with a focus on training disaster medical assistance teams, managing chemical and radiological emergencies, and enhancing prehospital and hospital emergency management capabilities. Despite the key roles of emergency physicians (EP) as primary responders and crucial managerial personnel during disasters, a comprehensive assessment of the disaster medicine core competencies (DMCC) required for emergency medicine (EM) residency training might serve as a blueprint for Taiwan's EM residency core curriculum. We sought to survey the most critical DMCCs, prioritize them, and determine their appropriateness for the EM residency training program. We also compare dthe prioritization of DMCCs between Taiwan and the United States.
To accomplish these objectives, we employed a modified Delphi method over three rounds. Initially, three EPs developed a draft of DMCCs for Taiwan. This draft, including 42 DMCCs, was subsequently reviewed by a task force comprising 22 leaders in disaster medicine from EM residency training hospitals across Taiwan. The Delphi method facilitated consensus on the DMCCs through three iterative rounds of polling, with each round evaluating the appropriateness of the proposed competencies. The study also compared the prioritized DMCCs proposed in both Taiwan and the US.
The following 15 DMCCs were rated as highly appropriate with high consensus agreement: personal protective equipment (PPE); decontamination; incident command systems; mass casualty incidents; basic concepts and nomenclature of disaster medicine; medical response to chemical emergencies; triage; identification, notification, activation, and information collection; medical response to radiation emergencies; medical response to bioterrorism and biological emergencies; mental health; disaster exercises; prehospital disaster management; communication and information management; and health consequences of different disasters. A comparison with DMCCs in the US revealed shared prioritization for PPE and decontamination competencies. However, Taiwan placed greater emphasis on prehospital disaster operation management, mental health implications, and health consequences across different disasters, while the US focused more extensively on emergency management within hospitals.
The expert-consensus-driven ranking of DMCCs in the study showed noteworthy agreement with the US. However, the roles of EPs, experience of previous disasters, and government policies may influence specific competencies. This underscores the importance of incorporating local context into disaster medicine training.
台湾位于西太平洋，面临着各种各样的自然和人为灾害。自2000年以来，灾害医学教育已逐步融入各种医学专业，重点是培训灾害医疗援助团队、管理化学和放射突发事件以及增强院前和医院应急管理能力。尽管急诊医师在灾害期间作为主要响应者和关键管理人员发挥着关键作用，但对急诊医学住院医师培训所需的灾害医学核心能力进行全面评估，可能会为台湾的急诊医学住院医师核心课程提供一个蓝图。我们试图调查最关键的灾害医学核心能力，对其进行优先排序，并确定它们是否适合急诊医学住院医师培训项目。我们还比较了台湾和美国在灾害医学核心能力优先排序方面的差异。
为实现这些目标，我们采用了经过改进的三轮德尔菲法。最初，三名急诊医师制定了台湾灾害医学核心能力的草案。该草案包括42项灾害医学核心能力，随后由一个特别工作组进行审查，该工作组由台湾各地急诊医学住院医师培训医院的22名灾害医学领域的领导者组成。德尔菲法通过三轮反复投票促进了对灾害医学核心能力的共识，每一轮都对所提议能力的适当性进行评估。该研究还比较了台湾和美国提出的优先排序的灾害医学核心能力。
以下15项灾害医学核心能力被评为高度适当且达成了高度共识：个人防护装备；去污；事件指挥系统；大规模伤亡事件；灾害医学的基本概念和术语；对化学突发事件的医学应对；分诊；识别、通知、启动和信息收集；对辐射突发事件的医学应对；对生物恐怖主义和生物突发事件的医学应对；心理健康；灾害演练；院前灾害管理；通信和信息管理；以及不同灾害的健康后果。与美国的灾害医学核心能力相比，个人防护装备和去污能力的优先排序相同。然而，台湾更加强调院前灾害行动管理、心理健康影响以及不同灾害的健康后果，而美国则更广泛地关注医院内部的应急管理。
该研究中由专家共识驱动的灾害医学核心能力排名与美国的情况显示出显著的一致性。然而，急诊医师的角色、以往灾害的经验以及政府政策可能会影响具体的能力。这凸显了将当地情况纳入灾害医学培训的重要性。
