The challenges facing the international health organizations in Haiti in 2010 and the subsequent review of the consequences of Sudden-Impact disasters by both the World Health Organization (WHO) and the Pan American Health Organization designed to building a mechanism that would define a broad and comprehensive operating concept for Emergency Medical Teams (EMTs). The review also resulted in the identification of improper care, unnecessary medical and non-medical procedures, and lack of coordination, transparency, accountability, and cultural and language insensitivities. These shortcomings indicated inadequate preparedness and a lack of oversight of deployed health-care workers. ^{Reference Albina, Archer and Boivin1}

With several reports indicating the unsuccessful management of disasters by deployed resources, the groundwork was initiated by WHO to develop principles, criteria, and standards for foreign EMTs. ² As part of this process, first the WHO-EMT had to identify the number of levels of medical teams according to their size, capabilities, and specialties, as the determinant in a certification method. The main purpose of establishing such a mechanism was to improve the operating mechanism of all medical teams that are activated and arrive at disaster areas and to create an integrated system that meets the needs in the field collaboratively, preventing previous situations where medical teams worked on a stand-alone basis.

The conceptual basis of coordination and certification, as well as the criteria and minimum standards, was taken from the coordination system built by the International Search and Rescue Advisory Group (INSARAG) for the Urban Search and Rescue units (USAR). This system, with a history dating back 30 y ago of functionality in disaster areas has provided necessary adjustments and developments of the concept to meet the needs and the concept of international health assistance. ³

The aim was to integrate the EMT mechanism into a large variety of challenging local health systems in disaster areas.

The Right Approach to Achieve the Right Outcome

The idea of using EMTs to improve the coordination of health-care services between the affected countries and deployed medical teams to provide appropriate and needed health-care would certainly be beneficial to the victims of disasters and emergencies. However, it has been shown that an essential component to achieving a better outcome of EMT deployment is to use the current disaster education and training programs to improve the EMTs’ operational performance rather than individuals’ professional development. ^{Reference Amat Camacho, Hughes and Burkle4} Such an improvement, in turn, depends on the existence of standardized training frameworks, which not only increase the collaborative engagement of all participants but also enhances their skills in decision-making at different levels of engagement. An earlier report proposed a three-step operational learning framework that could be used for EMTs globally that emphasized: (1) ensuring professional competence and license to practice, (2) supporting the adaptation of technical and non-technical professional capacities into the low-resource and emergency context, (3) preparing for effective team performance in the field. These requirements can be fulfilled by some of the current simulation training exercises. ^{Reference Khorram-Manesh, Berlin and Carlström5} (4) Additionally, the coronavirus disease 2019 (COVID-19) response and EMT deployments in protracted crises.

The gradual improvement in EMT deployment to diverse disaster areas was observed in the subsequent super-typhoon in the Philippines in 2013, the earthquake in Nepal in 2015, the Ebola epidemic in West Africa, the earthquake in Haiti in 2021, and other emergencies globally. ^{Reference Amat Camacho, Karki and Subedi6,Reference Brolin Ribacke, Saulnier and Eriksson7}

In subsequent years, written and updated criteria were published by WHO-EMT with the assistance of experts in the field. The consultatory books (eg, Red Book, and Blue Book), which include the concept, the method, the minimum standards, the criteria, the classification, and more have, along with the improved process of mentoring and certification system have greatly impacted the quality of medical units that go through the certification process. ⁸

The Ukrainian Experience

While the concept of the EMT system is gaining momentum, it must be constantly examined to identify the gaps and issues that may arise from the field experiences that need to be resolved before the subsequent missions occur. In March 2022, after Russia invaded Ukraine, one of the authors (K.P.) of this study was asked by the WHO-EMT to lead the coordination of the WHO-EMTCCs in Ukraine. On arrival, he observed first-hand the differences between diverse international medical teams already deployed. Some were certified after going through the entire WHO-EMT certification process, while others were not certified, or their certification process was not completed. Consequently, the major question was whether all international medical teams that had arrived in the field should be included in the mutual response and the WHO-EMTCC mechanism to operate optimally, or to exclude medical teams that were not certified or engaged in the process of certification. It was recognized that there were both advantages and disadvantages to the inclusion of all medical teams.