Basic and Advanced Skills for Disaster Healthcare

My company recently reviewed the existing core competency documents for disaster healthcare in light of the October 18, 2007 Homeland Security Presidential Directive (HSPD-21) which in part calls for:

“...the recognition of the unique principles in disaster-related public health and medicine merit the establishment of their own formal discipline.  Such a discipline will provide a foundation for doctrine, education, training, and research and will integrate preparedness into the public health and medical communities.”

Stakeholders in the development of the discipline described in HSPD-21 have proposed either publicly or privately a body of knowledge and skills core to such a discipline. This essential body of knowledge is codified as Core Competencies. To date the American Association of Physician Specialists (AAPS), the American Medical Association (AMA) and the American Osteopathic Association (AOA) have prepared core competency documents.

In the past, divergent core competency documents within a medical discipline such as emergency medicine or family practice have resulted in decades of division and discord within the profession and specialty. Ultimately, wherever such divergence has existed medical science and evidence based medical practice have resulted in convergence of the core competency documents and near universal agreement on the skills and knowledge that define and are essential to a distinct medical discipline.

Unfortunately, the United States and its citizens cannot afford to wait decades for the medical politicians and special interests to conclude that there is already agreement on the knowledge base and skills core to the discipline and specialty of disaster medicine. HSPD-21 places further impetus on resolving the issue of core competencies so that the disaster medicine discipline called for in HSPD-21 may advance with all alacrity.

The core competency documents from AAPS, AMA and AOA are each developed in differing taxonomy systems. This difference in taxonomy systems combined with differences in batching of skills and knowledge within documents complicated the extraction of commonly agreed upon core points of knowledge and key skills.

The complete review and core competency crosswalk is available for download here:

Download disaster_healthcare_core_competencies_review_crosswalk_25oct07.pdf

We propose a single summary core competency document presented as a “crosswalk reference” with the associated AAPS, AMA and AOA core competency documents. Given that the AOA currently has no core competencies to contribute, the crosswalk would require update when the AOA document becomes available.

It is our that this composite summary and associated “crosswalk reference” along with all three core competency documents form AAPS, AMA and AOA be recognized by the United States Department of Homeland Security (DHS); Department of Health and Human Services (HHS); Department of Defense (DOD); Institutes of Medicine; National Institute of Health (NIH); Centers for Disease Control (CDC) and Department of Education (DoE). This will establish the needed basis for the foundation of a distinct discipline in disaster healthcare as called for by HSPD-21 while bypassing the inherent delay in recognizing that all three systems enumerate the same core knowledge and skills.