Commentaar op artikel over de effectiviteit van rampentraining in de zorg

Subbarao I, Hsu EB, Burkle FM, Jr., Bostick A, James JJ. Building a fundamental framework for disaster education and training. Ann Emerg Med 2009 Jun;53(6):837-8.

The recent article by Williams, Nocera and Casteel sought to determine whether training interventions for health care providers convey the knowledge and skills required for disaster response.1 Due to the lack of sufficient evidence, the study could not conclusively determine whether the training for health care providers is effective. However, the authors did find that the current quality and scope of continuing education for disaster preparedness was largely inconsistent

These conclusions are significant. However, we suggest that they will not, and should not, come as a surprise to the disaster medicine community. The majority of courses available for analysis were rapidly constructed in response to the September 11, 2001 terrorist attacks. In the struggle to meet the demands to provide substantive bioterrorism response, many educational programs were hastily funded, developed, and taught. These were often designed without benefit of an overarching set of core competencies appropriate to the various target audiences within the health care community. The result was a fragmented collection of training programs, often based on discipline-specific competencies that were neither appropriate to a broadly based body of learners, nor conducive to rigorous scientific evaluation.

Williams and colleagues highlight the need to critically evaluate available training programs as a necessary first step towards reaching the goal to train responders well. Unexpected by the disaster community, an October, 2007 Homeland Security Presidential Directive 21 (HSPD-21) was published.2 A document designed to set forth a national strategy for public health and medical preparedness, it also proved to be an opportunity for the disaster community to once again seek the elements essential for a framework for future educational and training programs. A multi-disciplinary expert panel, convened to reconcile federal efforts required under HSPD-21, also catalyzed efforts to better define a set of consensus-based competencies appropriate to the operational and management roles of health responders.3 These core competencies build a framework upon which learning objectives can be designed and existing educational methodologies can be effectively analyzed. Future courses, incorporating consensus-based competencies, should enable researchers to rigorously evaluate the degree to which various instructional modalities convey information that is both useful and actionable to a broad target audience.

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