Development of an Evaluation Framework Suitable for Assessing Humanitarian Workforce Competencies During Crisis Simulation Exercises

The need to provide a professionalization process for the humanitarian workforce is well established. Current competency-based curricula provided by existing academically affiliated training centers in North America, the United Kingdom, and the European Union provide a route toward certification. Simulation exercises followed by timely evaluation is one way to mimic the field deployment process, test knowledge of core competences, and ensure that a competent workforce can manage the inevitable emergencies and crises they will face. Through a 2011 field-based exercise that simulated a humanitarian crisis, delivered under the auspices of the World Health Organization (WHO), a competency-based framework and evaluation tool is demonstrated as a model for future training and evaluation of humanitarian providers. CranmerH, ChanJ, KaydenS, MusaniA, GasquetP, WalkerP, BurkleF, JohnsonK. Development of an evaluation framework suitable for assessing humanitarian workforce competencies during crisis simulation exercises. Prehosp Disaster Med. 2014;29(1):1-

Emergency care in 59 low- and middle-income countries: a systematic review

Abstract Objective: To conduct a systematic review of emergency care in low- and middle-income countries (LMICs). Methods: We searched PubMed, CINAHL and World Health Organization (WHO) databases for reports describing facility-based emergency care and obtained unpublished data from a network of clinicians and researchers. We screened articles for inclusion based on their titles and abstracts in English or French. We extracted data on patient outcomes and demographics as well as facility and provider characteristics. Analyses were restricted to reports published from 1990 onwards. Findings: We identified 195 reports concerning 192 facilities in 59 countries. Most were academically-affiliated hospitals in urban areas. The median mortality within emergency departments was 1.8% (interquartile range, IQR: 0.2–5.1%). Mortality was relatively high in paediatric facilities (median: 4.8%; IQR: 2.3–8.4%) and in sub-Saharan Africa (median: 3.4%; IQR: 0.5–6.3%). The median number of patients was 30 000 per year (IQR: 10 296–60 000), most of whom were young (median age: 35 years; IQR: 6.9–41.0) and male (median: 55.7%; IQR: 50.0–59.2%). Most facilities were staffed either by physicians-in-training or by physicians whose level of training was unspecified. Very few of these providers had specialist training in emergency care. Conclusion: Available data on emergency care in LMICs indicate high patient loads and mortality, particularly in sub-Saharan Africa, where a substantial proportion of all deaths may occur in emergency departments. The combination of high volume and the urgency of treatment make emergency care an important area of focus for interventions aimed at reducing mortality in these settings

When the powerless lose interest in leading: Generalized sense of power predicts changes in the desire to lead

An immersive field-based simulation was used to examine how feeling powerless may erode one’s desire to lead. We studied current and prospective humanitarian aid professionals during a major field training exercise (a three-day simulated humanitarian crisis). Those with a lower generalized sense of power in their everyday lives (a) had higher levels of the stress hormone cortisol during the first night of the simulated crisis, (b) reported less assertiveness during the simulated crisis, and (c) left the simulated crisis with a relatively diminished desire to lead, despite not being deemed worse leaders by their teammates. In short, for those who felt they lacked power in their everyday lives, merely participating in the simulated crisis was sufficient to further undermine their desire to lead. These results suggest that feelings of power are a key leadership resource, without which one may be vulnerable to self-selection out of leadership.<p/

The generalized sense of power is a psychological resource: Evidence from a disaster response field training exercise

We examined whether the generalized sense of power—the belief that one is able to influence others in one's various social relationships—serves as a psychological resource that enables leadership in high-stakes, unfamiliar group challenges, such as emergencies or crises. We studied current and prospective humanitarian aid professionals (N = 180) during a major field training exercise: a three-day, immersive simulated humanitarian crisis. Individuals who entered the simulated crisis with a greater sense of power in their social relationships experienced lower stress (anxiety), behaved more assertively, and left the simulation with a relatively heightened desire to lead, despite not being deemed better leaders by their teammates. Lacking an initial sense of power was associated with experiences (e.g., feeling timid) that undermined the desire to lead. These results suggest that the psychological sense of power is a key leadership resource, without which one may be at risk of self-selecting out of leadership.</p

Academic Affiliated Training Centers in Humanitarian Health, Part I: Program Characteristics and Professionalization Preferences of Centers in North America

The collaborative London based non-governmental organization network ELRHA (Enhancing Learning and Research for Humanitarian Assistance) supports partnerships between higher education institutions and humanitarian organizations worldwide with the objective to enhance the professionalization of the humanitarian sector. While coordination and control of the humanitarian sector has plagued the response to every major crisis, concerns highlighted by the 2010 Haitian earthquake response further catalyzed and accelerated the need to ensure competency-based professionalization of the humanitarian health care work force. The Harvard Humanitarian Initiative sponsored an independent survey of established academically affiliated training centers in North America that train humanitarian health care workers to determine their individual training center characteristics and preferences in the potential professionalization process. The survey revealed that a common thread of profession-specific skills and core humanitarian competencies were being offered in both residential and online programs with additional programs offering opportunities for field simulation experiences and more advanced degree programs. This study supports the potential for the development of like-minded academic affiliated and competency-based humanitarian health programs to organize themselves under ELRHA's regional "consultation hubs" worldwide that can assist and advocate for improved education and training opportunities in less served developing countries