Introduction
In 2024 there were 393 reported global disasters resulting from natural hazards, affecting 167.2 million people and accounting for 16,753 fatalities. These disasters were responsible for US$241.95 billion in economic damage. 1 A disaster can quickly overwhelm the resources of a local community, necessitating assistance from national and international emergency medical teams (EMTs). EMTs originate from governments, non-governmental organizations, humanitarian networks, United Nations contracted teams, and the private sector. Each team consists of different responders from disciplines such as physicians, nurses, and paramedics. 2
Historically, medical response efforts to large-scale disaster events have highlighted significant variability in the capabilities of responding medical providers and EMTs. Analysis of the 2010 Haiti earthquake response as well as the 2004 Indian Ocean tsunami found that a number of medical teams were poorly prepared, inexperienced, or lacked the competencies to provide the level of medical care required, highlighting the need for medical team standards.Reference Arnaouti, Cahill and Baird 3 – 5 The wide variety of capabilities and terminology used by different medical teams made it difficult for receiving countries to determine what help to accept. 2 The World Health Organization (WHO) EMT initiative that followed created minimum team standards for responding EMTs to improve the quality and timeliness of medical services, with the first publication of the Classification and Minimum Standards for Foreign Medical Teams in Sudden Onset Disasters in 2013. 2 However, there remains a lack of globally recognized minimum competency standards at the level of the individual disaster medical responder. To create standardization in individual disaster medical responder capabilities, a set of core competencies must first be identified.
Competency has been defined as “an observable ability of a health professional related to a specific activity that integrates knowledge, skills, values, and attitudes.”Reference Englander, Frank and Carraccio 6 Competencies can be grouped into domains or categories, consistent with Bloom’s Taxonomy of Learning Domains.Reference Bloom, Engelhart and Furst 7 Upon establishment of standardized core competencies for disaster responders, global training and educational curriculum can be developed. Competency-based education has been recognized as a well-established model in medical education for the last several decades and may lead to superior and more efficient medical training.Reference Powell and Carraccio 8 It has been suggested that competency-based education should be the foundation of training for practitioners responding to global crises.Reference Burkle 9 Although a number of studies have been conducted on competencies related to disaster medicine in general, research on competencies for deployable disaster medical response specialists is sparse, and it is this highly specialized group at the tip of the pyramid that is the focus of the current research.
This study examines existing competencies and related topics such as qualifications, education, and disaster experience for physicians, nurses, and paramedics who are members of deployable disaster EMTs.
Methods
Design
This scoping review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).Reference Tricco, Lillie and Zarin 10
Search Strategy
Firstly, comprehensive searches in Ovid MEDLINE, Ovid Embase, CINAHL, Scopus, and Web of Science Core Collection were performed on September 16, 2024. To capture all relevant literature pertaining to the competencies of disaster medicine responders and specialists, relevant keywords and controlled vocabulary were carefully selected (see Appendix A for full search string). All searches were limited to publications from 2010 to current and limited to the English language. The year 2010 was specifically selected as this was the year of the catastrophic Haiti earthquake, the pivotal event that highlighted the need for standard of care in international disaster response. Initial title and abstract screening followed by subsequent full text screening was performed using Covidence, a web-based software tool (www.covidence.org). Each stage of screening was performed by two independent reviewers, with a third reviewer utilized in cases of disagreement. The reference list from each included study was systematically screened.
Secondly, a gray literature search of websites was conducted to identify any existing competency sets or requirements for deployable disaster specialists. Websites were searched to determine if they were from a leading professional organization identified by the author group as most likely to contribute to disaster specialist standards internationally (see Appendix B for a complete list of organizations included in the grey literature search). Vanderbilt University was the only university included, as this was the origin of the Disaster Competencies for Nurses. Note that the Royal College of Nursing is a professional body as opposed to a university, and was included for its collaboration with the International Council of Nurses. Responding humanitarian organizations were excluded from this study. A Google Advanced Search using select keywords was used to identify documents and PDF documents pertaining to each organization, with screening of the first 20 Google results.
Inclusion and Exclusion Criteria
Papers were included if the study included (i) disaster specialists who participate in disaster response, specifically physicians, nurses, paramedics, nurse practitioners, and physician assistants; (ii) competencies and requirements, such as a focus on competencies and competency domains, if they were a literature review of existing competencies or presented novel competencies, or included the requirements for disaster specialists pertaining to credentials, qualifications, educational training, and disaster medicine experience; (iii) were peer-reviewed papers in a journal; and (iv) had a disaster context with primary focus on health care, including disasters from natural hazards, or Chemical, Biological, Radiological, and Nuclear (CBRN) incidents.
Papers were excluded if they had (i) non-disaster specialists, such as studies solely about students, or hospital workers with no particular disaster experience were excluded; (ii) studies that do not focus on competencies and requirements; (iii) incomplete manuscripts, conference abstracts, theses, dissertations, books, book chapters, white papers, reports, commentaries, opinion pieces; (iv) full-text papers are not available; or (v) studies that are not based in a disaster context with primary focus on health care and are not classified as natural disasters or CBRN attacks, such as studies focused solely on epidemics and pandemics were excluded, as these refer to biological outbreaks not CBRN attacks, or studies that were strictly about military medicine.
Data Analysis
Extracted data was entered into a Microsoft Excel sheet (Microsoft Corporation; Redmond, Washington, USA). For each article, the author, study title, year of publication, target professional group (physician, nurse, paramedic, multidisciplinary), country of origin, and competencies or domains were identified. For courses or training programs, the duration, delivery format, and curriculum topics were extracted.
Results
A total of 4626 results were retrieved, and after removing duplicates, 2473 unique results remained for the initial title and abstract screening. Finally, 54 peer-reviewed papers were included in this review (see Figure 1).Reference Acquaviva, Posey and Dawson 11 –Reference Yin and Arbon 64 Additionally, a total of 22 governmental organizations and non-governmental organizations were included from the grey literature search. Of the 54 manuscripts reviewed, nursing has the greatest representation at 51.9% (n = 28), followed by multidisciplinary manuscripts (n = 14, 25.9%), paramedics (n = 7,13.0%), and physicians (n = 5, 10.2%) (Table 1).
PRISMA.
Figure 1. Long description
The flowchart has two main columns. The left column, titled Identification of studies via databases, starts with ‘Papers identified from databases (n = 4626)’. Below, ‘Papers removed before screening (n = 2153): Duplicate records manually removed (n = 10), Duplicate records removed automatically by Covidence (n = 2143)’. An arrow leads to ‘Papers screened (n = 2473)’, then to ‘Papers excluded (n = 2173)’. The next box is ‘Papers sought for retrieval (n = 300)’, followed by ‘Papers not retrieved (n = 0)’. The next box is ‘Papers assessed for eligibility (n = 300)’, then ‘Papers excluded (n = 246): Not physician, nurse, or paramedic focused (n = 121), Not competency / qualification / education focused (n = 61), Other (n = 58)’. The final box is ‘Papers included in review (n = 54), Documents from websites of included studies (n = 3)’. The right column, titled Identification of studies via other methods, starts with ‘Records identified from: Websites (n = 22)’. An arrow leads to ‘Documents sought for retrieval (n = 22)’, then ‘Documents not retrieved (n = 0)’. The next box is ‘Documents assessed for eligibility (n = 22)’, then ‘Documents excluded (n = 19): No identified competencies for disaster specialists (n = 19)’. The process ends with the inclusion of documents from both columns.
Professions
Table 1. Long description
From the top row downward, the table has three columns labeled Profession, Approx. Count, and Examples. The first row lists Nurses with an approximate count of 28 and examples including Acquaviva, Al Thobaity, Aliakbari, Chen, Conlon, Danna, Evio, Farra, Guo, Hamid, Honda, Kimin, Li, Mani, Nekooei, Niu, Prosdocimi Menegat, Rezaei, Sato, Silva, Slepski, Su, Susanti, Yin, and others. The second row lists Paramedics with a count of 7 and examples Al-Wathinani, Caviglia, Cicero, Horrocks, Kouvalainen, Lochmannová, and Mechem. The third row lists Physicians with a count of 5 and examples Hansoti, Kumar, Noguchi, Pierre, and Wexler. The fourth row lists Multidisciplinary with a count of 14 and examples Aluisio, Asgary, Bajow, Broach, Bustamante, Della Corte, Forbes, Gill, Kirsch, Kuhls, Redwood-Campbell, Schultz, Walsh, Westman, and others.
Nurse-Based Studies
The literature was dominated by nursing studies with most manuscripts focusing on nursing competencies, skill domains, or the development/evaluation of nurse-specific training programs. Topics included training evaluations and competency frameworks. There are a number of short courses with varied lengths from hours to days. Delivery formats vary with many using established nurse competencies. Competencies focus on triage, infection control, personal protective measures, Incident Command System (ICS), ethical-legal knowledge, psychological support, and cultural awareness. Some studies highlight specialized skills (n = 6, 21.4%) such as CBRN, forensic evidence, and crush injury (Table 2).
Nursing studies
Table 2. Long description
Beginning at the top row, columns are Author (Year), Country, Duration, Delivery Format, Competency-Based or Outcomes, and Key Competencies/Outcomes. Acquaviva (2012, USA) lists C B R N event recognition, notification, protection, triage, treatment, decontamination, recovery in a 6-hour online course. Al Thobaity (2017, Australia) reviews domains: communication, planning, decontamination and safety, I C S, ethics. Aliakbari (2015, Iran) covers professional ethics and legal adherence via single-day interviews. Chen (2023, China) uses Delphi study for infectious disease knowledge, management, protection, education. Conlon (2011, China) delivers triage, trauma care, infection control, psychosocial support, rehabilitation in 2-day didactics and skill stations. Danna (2015, USA) provides disaster basics, I C S, legal and ethical issues, vulnerable populations, crisis interventions in 12-hour web-based modules. Evio (2017, Philippines) includes nurse roles, triage, mental health, community health, response planning in 3-day lectures and demos. Farra (2016, USA) offers disaster life support, I C S, triage, leadership, legal/ethical, P P E, skill labs in a 1-week hybrid course. Guo (2023, China) reviews communication skills, self-protection, public health, ethics/law, collaboration. Hamid (2023, Indonesia) proposes six pillars: leadership, resources, interventions, cultural/spiritual, motivation, policy. Honda (2022, Japan) surveys risk-communication competencies: trust, distress alleviation, message tailoring, behavior support. Kimin (2021, Indonesia) reviews triage, trauma care, psychological first aid, I C S, critical thinking, local culture. Li (2015, China) interviews on sterilization, trauma, psychological readiness, preparedness, cooperation, duty. Mani (2023, Saudi Arabia) surveys 40-plus competencies: P P E, triage, burn/blast/crush management, decontamination, infection control, I C S, resource allocation, psychological first aid, record-keeping, ethical triage. Mani (2024, Saudi Arabia) interviews on readiness, leadership, communication, advanced triage, cultural awareness. Nekooei (2014, Iran) interviews on triage, crush syndrome, psychological support, I C S, field hospital leadership, safety, trauma interventions. Niu (2023, China) interviews on aseptic technique, infection control, triage, survival, communication, emergency response, adaptability. Niu (2024, China) interviews on critical care operations, trauma rescue, hazard identification, triage, resource management, resilience, calm. Prosdocimi Menegat (2018, Brazil) interviews on leadership, teamwork, health care, community orientation, communication, psychological support, surveillance, education. Rezaei (2020, Iran) interviews on clinical (knowledge, triage, observation), personal (communication, resilience), ethical (commitment). Sato (2019, Japan) interviews on radiation care, patient anxiety, protective measures. Silva (2023, Brazil) reviews planning, leadership, communication, evidence collection, chain of custody, psychosocial support, cultural sensitivity. Slepski (2010, Unknown) reviews I C S, triage, risk communication, preparedness, critical thinking, ethical-legal, vulnerable populations across W H O, I N C M C E. Su (2022, China) reviews triage, first aid, monitoring, psychological support, communication, with disaster-specific variation. Susanti (2023, Indonesia) interviews on trauma care, wound management, psychological first aid, coping, leadership, negotiation. Veenema (2017, USA) summarizes articles establishing disaster competencies. Yin (2011, China) surveys I V insertion, triage, hemorrhage control, debridement, airway, chest drainage, infection control. Yin (2012, China) surveys qualifications: minimum 3 years E D, advanced rescue training, nurse:physician ratio. Abbreviations are defined in the table foot.
USA = United States of America; CBRN = Chemical, Biological, Radiological, and Nuclear; ICS = Incident Command System; rehab = rehabilitation; PPE = Personal Protective Equipment; mgmt = management; PHE = public health emergencies; comms = communications; emerg = emergency; ops = operations; ID = identification; rad = radiation; WHO = World Health Organization; INCMCE = International Nursing Coalition for Mass Casualty Education; PFA = Psychological First Aid; ED = emergency department
Overall, these studies underscore the breadth of disaster nursing competencies: from basic clinical triage and first aid to psychosocial care, team leadership, and legal/ethical readiness in crisis.
Paramedic-Based Studies
Paramedicine studies focus on prehospital disaster care, including triage, hemorrhage control, specialized active-shooter protocols, or advanced hazards (CBRN, radiological/nuclear). Workshops are either single-day or short training modules. Delivery focuses on simulation, either in person, via virtual reality, or hands-on practical components. Competencies focus on triage, especially pediatric or mass-casualty, incident command system awareness, hemorrhage control, radiological/nuclear response, and specialized paramedic roles in high-threat environments. Paramedic training often emphasizes rapid scene assessment, life-saving interventions, and communication under incident command systems (Table 3).
Paramedic studies
Table 3. Long description
Column headers from left to right are Author with year, Country, Duration, Delivery Format, Competency-Based or Outcomes, and Key Competencies or Outcomes. First row: Al-Wathinani 2021, Saudi Arabia, one-time survey, online survey, focus on knowledge gaps and recommended courses, key outcomes are I C S, field triage, A T L S, P H T L S, A C L S, B L S, infection control for mass gatherings. Second row: Caviglia 2022, Sierra Leone, one week train the trainers and one week course, didactics, exercises, discussion, simulation, drills, curriculum topics, key outcomes are M C I response including triage, prehospital and national response, I D concepts and prevention, training planning. Third row: Cicero 2014, U S A, duration not specified, hands-on practical simulation, triage skill refinement, key outcome is pediatric triage evaluating airway, breathing, circulation, mental status in less than one minute. Fourth row: Horrocks 2019, Australia, not applicable, literature review, identifies core competency domains, key outcomes are general I C S, triage, communications, public health, specialist skills for austere environments, advanced airway, self-care, big-picture thinking. Fifth row: Kouvalainen 2024, Finland, one-time reflective essay, reflective-essay approach, multi-authority R N incident competencies, key outcomes are occupational safety, triage, contamination avoidance, I C S hierarchy, communications, scene assessment in radiological or nuclear events. Sixth row: Lochmannová 2022, Czech Republic, approximately one day, virtual reality simulation, exercise objectives and skill performance, key outcomes are active scene management using M E T H A N E, S T A R T triage, basic trauma care, radio communication. Seventh row: Mechem 2015, U S A, single-day workshop, face-to-face didactic and simulation, specific medical interventions for hot zones, key outcomes are hemorrhage control with tourniquets and hemostatics, basic airway, chest seals, needle decompression. Table footnotes define abbreviations such as A T L S for Advanced Trauma Life Support, P H T L S for Prehospital Trauma Life Support, A C L S for Advanced Cardiac Life Support, B L S for Basic Life Support, M C I for Mass Casualty Management, I D for infectious disease, U S A for United States of America, min for minute, mgmt for management, I C S for Incident Command System, R N for Registered Nurse, Rep. for Republic, M E T H A N E for Major Incident Declared, Exact Location, Type of Incident, Hazards, Access and Egress, Number and Severity of Casualties, Emergency Services, and S T A R T for Simple Triage and Rapid Treatment.
ATLS = Advanced Trauma Life Support; PHTLS = Prehospital Trauma Life Support; ACLS = Advanced Cardiac Life Support; BLS = Basic Life Support; MCI = Mass Casualty Management, ID = infectious disease; USA = United States of America; min = minute; mgmt = management; ICS = Incident Command System; RN = Registered Nurse; Rep. = Republic; METHANE = Major Incident Declared, Exact Location, Type of Incident, Hazards, Access and Egress, Number and Severity of Casualties, Emergency Services; START = Simple Triage and Rapid Treatment
Physician-Based Studies
Articles focus on emergency physicians or disaster-deployed physicians, focusing on advanced roles, such as incident command system leadership, specialized procedures, or coordination in austere environments. Duration was not specifically mentioned in the papers. Practical training is mentioned but many manuscripts include literature reviews to define skills. Competencies focus on ICS, CBRN threats, mass-casualty triage, surgical/clinical management in austere settings, and public health aspects. Topics of leadership and coordination skills in incident command systems are a focus combined with specialized or advanced clinical proficiencies for disaster contexts (Table 4).
Physician studies
Table 4. Long description
Column headers from left to right are Author (Year), Country, Duration, Delivery Format, Competency-Based or Outcomes, and Key Competencies or Outcomes. The first row lists Hansoti (2016) from USA, a literature review with core competencies and disaster phases, emphasizing ICS, mass-casualty care, triage, C B R N, terrorism, communications, and response. The second row is Kumar (2013) from USA, recommending FEMA ICS courses, focusing on ICS modules IS-100, IS-200, IS-700, IS-800 for disaster team physicians. The third row is Noguchi (2016) from Japan, a one-time survey identifying skill sets for Japanese F M T M D s, including surgical (debridement, suturing), clinical (mass triage, pediatrics, infection control), public health (vaccination, outbreak screening), and management (liaison with local organizations). The fourth row is Pierre (2018) from Haiti, with unclear duration, training before deployment, curriculum topics for austere anesthesia, including routine anesthesia preparation, airway setup, managing difficult airways, sedation, and pain control in orthopedic settings. The fifth row is Wexler (2023) from USA, a Delphi study among experts, defining core content areas for D M physician training, including principles of D M, emergency management oversight, public health, C B R N, mass gatherings, legal and ethical issues, psychological aspects, and technology. Abbreviations are defined in the table foot: U S A is United States of America, I C S is Incident Command System, C B R N is Chemical, Biological, Radiological, and Nuclear, F E M A is Federal Emergency Management Agency, M D is Doctor of Medicine, D R is Disaster Response, F M T is foreign medical teams, E M is emergency medicine, D M is disaster medicine, mgmt is management.
USA = United States of America; ICS = Incident Command System; CBRN = Chemical, Biological, Radiological, and Nuclear; FEMA = Federal Emergency Management Agency; MD = Doctor of Medicine; DR = Disaster Response; FMT = foreign medical teams; EM = emergency medicine; DM = disaster medicine; mgmt = management
Country
Many studies were conducted in the United States (n = 15, 27.8%), followed by China (n = 9, 16.7%).
Duration of Program
Training duration varied from hours to multi-week formats. Manuscripts that did not include program format focused on Delphi process, surveys or interviews, and lastly literature reviews (Table 5).
Duration of program
Table 5. Long description
The table has three columns: Duration Category, Approximate Number of Articles, and Examples. From top to bottom, the first row is Short (1 day or less), with approximately 9 articles, including Kuhls (8 hour B D L S), Mechem (active shooter), and paramedic workshops such as Cicero pediatric triage. The second row is Multi-day (2 to 7 days), with approximately 6 articles, including Conlon (2 days), Evio (3 days), Bajow (32 hours or 4 days), Bustamante (approximately 2.5 days on-site), and Caviglia (1 week). The third row is Multi-week (8 or more days), with approximately 3 articles, including Asgary (8 weeks in refugee setting), Della Corte (2-week in-class plus e-learning, with a note on a slightly shorter but intense residency), and others mentioning multiple weeks. The fourth row is Not Specified or N/A, with approximately 36 articles, including many literature reviews, scoping reviews, Delphi or single survey studies such as Al Thobaity, Guo, Kirsch, and Westman that do not specify program length. Table footnotes define B D L S as Basic Disaster Life Support, e-learning as electronic learning, and lit as literature.
BDLS = Basic Disaster Life Support; e-learning = electronic learning; lit = literature
Delivery Format
Three main delivery formats were evident in the literature. These were hands-on, practical, simulation/drills, and online. Some studies (n = 21, 38.9%) include multiple formats, such as online and simulation (Table 6).
Delivery format
Table 6. Long description
The first row lists Hands-On Practical including tabletop exercises plus Didactic, with approximately 13 articles. Notes mention Bajow, Aluisio, Asgary, Farra, Caviglia, and others, describing multi-day courses with skill stations, workshops, or in-person labs. The second row is Simulation, live or virtual reality, with approximately 6 articles. Examples include Mechem (active shooter), Lochmannova (virtual reality mass casualty incident), Cicero (pediatric triage), and some overlap with Hands-On. The third row is Online or Hybrid, with approximately 8 articles. Examples are Acquaviva (online Chemical, Biological, Radiological, and Nuclear course), Della Corte (electronic learning plus two weeks in class), and partial modules or train-the-trainer pre-reading. Abbreviations at the bottom clarify VR as Virtual Reality, M C I as mass casualty incident, peds as pediatric, C B R N as Chemical, Biological, Radiological, and Nuclear, and e-learning as electronic learning.
VR = Virtual Reality; MCI = mass casualty incident; peds = pediatric; CBRN = Chemical, Biological, Radiological, and Nuclear; e-learning = electronic learning
Most Commonly Cited Competencies
The most commonly cited competencies are ICS, triage skills, communication, personal protective equipment (PPE), psychological first aid/mental health, ethical legal preparedness, clinical/technical skills, and leadership and teamwork. ICS focuses on the understanding of roles, chain of command, and multi-agency coordination. Triage skills focus on systems such as START/JumpSTART or are more general and discuss mass-casualty triage, pediatric triage, and reverse triage. Communication included crisis and risk communication, interprofessional coordination, and cultural awareness in diverse contexts. PPE included topics such as infection control, radiological/nuclear protection, and scene safety. In the psychological first aid space, topics include supporting survivors, responders, families and managing stress and post-traumatic stress disorder. Ethical and legal preparedness focused on resource allocation, crisis standards of care, liability, confidentiality, and caring for special populations. Clinical technical skills included hemorrhage control, advanced trauma care, sedation or anesthesia in austere settings, decontamination, and specialized triage for CBRN incidents. Lastly leadership and team work include leading health teams, coordinating volunteers, managing limited resources, and ensuring continuity of operations.
Gray Literature Results
Of the 22 organizations researched, 3 organizational websites outline established competencies related to deployable disaster physicians, nurses, or paramedics. The American Medical Association (United States) lists key competencies for physicians as those related to ethical decision-making during crises, with emphasis on crisis standards of care, resource allocation, ethical dilemmas in resource-limited settings, and triage. The International Council of Nurses (Switzerland) offers a robust list of competencies for nurses divided into 8 domains, which include preparation and planning, communication, incident management, safety and security, assessment, intervention, recovery, and law and ethics. The World Medical Association (France) specifies competencies within the categories of triage, patient relations, disaster aftermath, and media relations.
Discussion
The ongoing need for disaster medical specialists is clear. In 2024 alone, 393 natural disasters affected 167.2 million people, caused over 16,000 deaths, and resulted in nearly US$242 billion in economic damage. 1 Climate change is expected to increase the frequency and severity of natural disasters, while geopolitical instability and emerging infectious diseases create additional humanitarian emergencies requiring specialized medical response. 65 The capacity to rapidly deploy competent medical teams represents a critical component of global health security.Reference Hertelendy, Salio and Ciottone 66
The dominance of nursing literature in this review, representing nearly half of all included studies, reflects the substantial investment the nursing profession has made in defining disaster competencies and developing specialized training programs. This may stem from nurses’ historical role as the largest component of health care workforces globally and their presence across all phases of disaster response.Reference Al Thobaity, Plummer and Williams 12 , Reference Guo, Bian and Li 30 , Reference Slepski, Littleton-Kearney, Powers and Daily 56 The relative paucity of physician-focused literature, comprising only 10% of included studies, suggests an opportunity for disaster medicine to more explicitly define the specialized competencies required of disaster-deployed physicians beyond general emergency medicine training.Reference Hansoti, Kellogg and Aberle 32 , Reference Wexler, Schultz and Biddinger 62 The intermediate representation of paramedic literature indicates growing recognition of the unique prehospital disaster medicine capabilities this profession provides, particularly in austere and hazardous environments.Reference Horrocks, Hobbs and Tippett 34 , Reference Mechem, Bossert and Baldini 44
The core competencies identified in this review align substantially with the multidisciplinary competencies proposed by Walsh and colleagues in their 2012 foundational work, which established a pyramidal hierarchy of disaster medicine and public health competencies.Reference Walsh, Subbarao and Gebbie 60 The consistent emphasis on Incident Command System knowledge, triage skills, communication abilities, and ethical decision-making across the reviewed literature validates these as fundamental capabilities for all disaster responders.Reference Al Thobaity, Plummer and Williams 12 , Reference Guo, Bian and Li 30 , Reference Hansoti, Kellogg and Aberle 32 , Reference Horrocks, Hobbs and Tippett 34 However, our review extends Walsh’s framework by examining the apex of the competency pyramid, the highly specialized skills required by regularly deployed disaster response specialists. These include advanced clinical procedures in austere environments,Reference Noguchi, Inoue and Shimanoe 48 specialized hazard response capabilities for chemical, biological, radiological, and nuclear incidents,Reference Acquaviva, Posey and Dawson 11 , Reference Kouvalainen and Nordquist 37 , Reference Horiuchi, Yamada and Kinoshita 67 and enhanced leadership competencies for managing field medical teams.Reference Farokhzadian, Mangolian Shahrbabaki and Farahmandnia 68
The profession-specific competencies identified in this review reflect the distinct roles each discipline assumes during disaster response. Paramedics’ emphasis on prehospital care, hemorrhage control, and tactical medicine in high-threat environments aligns with their traditional scope of practice extended to disaster contexts.Reference Horrocks, Hobbs and Tippett 34 , Reference Mechem, Bossert and Baldini 44 Nurses’ focus on the full disaster management cycle, from preparedness through recovery, and their attention to psychosocial support and vulnerable populations reflects nursing’s holistic care philosophy.Reference Conlon and Wiechula 23 , Reference Danna, Pierce and Schaubhut 24 , Reference Tas and Cakir 69 Physicians’ concentration on Incident Command System leadership roles, advanced clinical decision-making, and management of complex medical interventions demonstrates the expectation that physicians will assume coordination and oversight responsibilities during deployments.Reference Noguchi, Inoue and Shimanoe 48 , Reference Wexler, Schultz and Biddinger 62 Nevertheless, the substantial overlap in core competencies across all three professions supports the value of interprofessional disaster training initiatives that build shared mental models and enhance team functioning during actual deployments.
The wide variation in training program duration, ranging from single-day workshops to multi-week intensive courses, coupled with the diversity of delivery formats employed, underscores the absence of evidence-based standards for disaster medicine education.Reference Wexler, Schultz and Biddinger 62 Short-duration programs may be pragmatic and accessible but risk providing insufficient depth and limited opportunities for skill consolidation.Reference Cicero, Brown and Overly 22 , Reference Mechem, Bossert and Baldini 44 , Reference Voicescu, Lamine and Loșonți 70 Conversely, extended programs may be more comprehensive but face barriers related to cost, time commitment, and participant availability.Reference Baetzner, Wespi and Hill 71 The increasing incorporation of simulation-based training and virtual reality technologies represents a promising trend that may offer high-fidelity learning experiences while minimizing logistical constraints.Reference Tin, Hertelendy and Ciottone 72 , Reference Brown, Margus and Hart 73 However, the lack of comparative effectiveness studies examining different training approaches limits our ability to make evidence-based recommendations regarding optimal training modalities.Reference Way, Panchal and Price 74
The historical context that prompted the development of disaster medicine standards cannot be overlooked. The poorly coordinated responses to the 2004 Indian Ocean tsunami and the 2010 Haiti earthquake revealed significant deficiencies in the capabilities of deployed medical teams, prompting the WHO to establish classification and minimum standards for EMTs. 2 , Reference Arnaouti, Cahill and Baird 3 , 5 , Reference Hertelendy, Salio and Ciottone 66 These team-level standards represented a crucial advancement in disaster response quality, but the absence of corresponding individual-level competency standards has allowed variability in responder capabilities to persist. As Burkle and colleagues have argued, competency-based education should serve as the foundation for training practitioners who respond to global crises.Reference Burkle 9
The findings of this review have important implications for practice, education, and policy. For individual disaster medical specialists and their employers, the identified core competencies provide a framework for self-assessment, professional development planning, and credentialing processes. For educational institutions and professional organizations, these findings support the development of standardized curricula and competency-based training programs that ensure disaster responders possess the minimum capabilities required for safe and effective deployment.Reference Powell and Carraccio 8 For policymakers and emergency medical team coordinators, the delineation of profession-specific and shared competencies can inform team composition decisions and deployment matching processes that align available capabilities with anticipated mission requirements.
This scoping review reveals substantial convergence around core disaster medicine competencies while highlighting the need for profession-specific skill sets and exposing significant gaps in evidence regarding optimal training approaches. The establishment of globally recognized, competency-based standards for individual disaster medical specialists represents an essential next step in the evolution of the EMT framework pioneered by the WHO. 2 Such standards would complement existing team-level classifications, enhance the quality and consistency of disaster medical care, and ultimately improve outcomes for populations affected by disasters worldwide. The path forward requires continued collaboration among health care professions, international organizations, academic institutions, and disaster-affected communities to develop, validate, and implement comprehensive competency frameworks that reflect both the shared foundations and specialized expertise required of those who serve on the front lines of humanitarian response.
Limitations
Several limitations of this scoping review warrant consideration. First, the restriction to English-language publications may have excluded relevant literature from non-English-speaking countries with substantial disaster medicine expertise. Second, the heterogeneity of study designs, target populations, and outcome measures precluded quantitative synthesis and limited our ability to draw definitive conclusions about the effectiveness of specific competencies or training approaches. Third, the exclusion of pandemic and epidemic-focused studies, while justified by the review’s focus on disasters from natural hazards and CBRN incidents, may have omitted relevant competency frameworks applicable to large-scale public health emergencies. Fourthly, the inclusion of literature review papers means that a broader scope was included in this paper; however, this is limited to the secondary analysis of the included literature reviews. Fifthly, this review was limited to physicians, nurses, and paramedics; however, it is recognized that EMTs are multidisciplinary teams that often include additional allied health specialists and support staff such as mental health specialists, pharmacists, social workers, respiratory therapists, and logisticians. Future research should consider competencies for other allied health specialists involved in EMTs. Finally, the rapid evolution of disaster medicine as a field means that some competencies, particularly those related to emerging technologies and novel hazards, may be underrepresented in the literature reviewed.
Conclusion
There is some consensus in the existing literature around a core set of fundamental competencies that should be included for deployable disaster medical specialists associated with an EMT, including Incident Command System knowledge, triage skills, communication abilities, personal protective measures, psychological first aid, and ethical decision-making that transcend professional boundaries and represent the essential foundation for all disaster responders. Importantly, profession-specific competencies that reflect each discipline’s unique scope of practice and role within EMTs should be encouraged to be developed. Despite this convergence on core content, significant variability exists in training program duration, delivery formats, and assessment methods, underscoring the urgent need for evidence-based educational standards. The disaster medicine community must prioritize the development of globally recognized, competency-based standards for individual responders that complement the WHO EMT level classification system. Such standards, informed by robust comparative effectiveness research and validated through rigorous assessment, will enhance the consistency and quality of disaster medical response.
Supplementary material
The supplementary material for this article can be found at http://doi.org/10.1017/dmp.2026.10374.
Acknowledgments
None.
Author contribution
CW, AV, GRC, AJH, and JMF conceived the study. JYK, JR, and AH developed the research methodology. JYK conducted a preliminary literature search. CAW, FSI, RAG, JR, AH, and YI performed a screening of the literature. CAW and RAG conducted a review of the literature and extracted the relevant data. AH, GRC, and AJH verified the data extraction. YI, APH, and BN conducted the grey literature search. AH performed data analysis. CAW, AJH, RAG, AH, JR, and GRC authored the manuscript. AJH and AV were responsible for project administration.
All authors edited the manuscript.
Funding statement
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Competing interests
None to declare.
Ethics approval
No Ethics or IRB approval required.
