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Critical Concepts in Disaster Medicine for Saudi Arabian Emergency Residency Programs Bader K Alossaimi, MD1-2; Michael Sean Molloy1,3, MD, EMDM1; Alexander Hart, MD1; Amalia Voskanyan1; Abdullah A Alhadhira, MD1; Ritu Sarin, MD1; Gregory Ciottone, MD, FACEP, FFSEM1 1Fellowship in Disaster Medicine, Beth Israel Deaconess Medical Center, Department of Emergency Medicine 2 Emergency Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia 3 School of Medicine and Medical Science, University College Dublin, Dublin 4, Ireland Abstract: Introduction: Saudi Arabia, the largest country in the Middle East has recently suffered numerous terrorist attacks resulting in multiple mass casualty incidents. It is also the location of the Hajj, one of the world’s largest yearly mass gatherings during the annual Muslim pilgrimage to Mecca. Between 2000 and 2011 flooding accounted for 7 of the 11 most damaging natural disasters in the kingdom’s history. Disasters happen unexpectedly, healthcare providers pre-incident knowledge and understanding of basic Disaster Medicine [DM] concepts is crucial to the healthcare systems. As multiple reviews of disaster responses, including those following Hurricane Katrina, have demonstrated that a lack of basic training in disaster operations has a negative effect on patient outcomes. Thus, it is crucial that providers have this knowledge for the healthcare system to respond in an effective, unified manner. Emergency physicians are front-line specialists treating disaster victims additionally playing key roles in both disaster management and incident response. Introducing healthcare providers to best practices is a stated vision of the Saudi Commission for Health Specialties. Standardizing the curriculum of DM taught to physicians during their residency training can accomplish this worthy goal. Aim: To produce consensus on core disaster medicine topics which should be taught to Emergency Medicine residents during their training in the Kingdom of Saudi Arabia. Methods: A Delphi survey of a panel of Saudi Arabian Emergency Medicine Residency Program Directors and experts in DM was conducted with 3 consecutive iterations of surveys. An initial invitation and consent letter were distributed to 16 participants, 6 EM Residency Program Directors, 6 Disaster Medicine experts and 4 Disaster Medicine experts also holding positions as EM Residency Program Directors. The first iteration was a single question (List up to 15 Disaster Medicine core competencies for EM Physicians). In subsequent rounds, each participant reviewed topics summarized by the investigation team which were contributed in the first round. The participants rated each item on a 5-point Likert Scale to establish priorities, until greater than 80% consensus was reached on the topics rated as 4 or higher at the end of round 3. Results: There was a 100% response rate. Only 22 (33.8%) of 65 initial competencies reached ≥ 80% consensus on completion of round 3. These included Mass casualty triage (Average rating 5/5), Definition of disasters (4.8/5), Decontamination (4.6/5), Mass casualty incidents (4.6/5), Hospital incident command system (4.6/5), Incident command system (4.6/5), Personal protective equipment (4.5/5), Phases of disasters (4.5/5), Mass gathering planning/management (4.4/5), Blast Mass Casualties (4.3/5), Communication between responders (4.2/5), CBRNE (4.2/5), EMS role in disasters (4.1/5), Types of disasters (4.1/5), Disaster preparedness (4.1/5), Hazard vulnerability analysis (4/5), All-Hazards planning approach (4/5), Surge capacity/capability (4/5), Radiation/Nuclear Disasters (4/5), Pandemic Infections (4/5), Situational awareness (4/5), Basic Disaster Life Support course (4/5). Discussion: This Saudi Arabian expert consensus will drive development of a core Disaster Medicine curriculum to be integrated into Emergency Medicine training programs across the Kingdom. Improved training can allow for a higher level of performance in disaster response. This consensus can also serve as a foundation for introducing Disaster Medicine into other medical education programs across the Kingdom in future.

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All rights reserved.