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The Objective:Identify healthcare personnel specific emergency management competencies and how they are utilized during a disaster.Questions:- Describe ways to demonstrate the core competencies described by James et al.
– Describe hazard specific competencies for a hospital emergency manager.Reference to appropriate authoritative resources and official websites. Must be accessible online. Use New Times Roman 12 font with 1” margins and APA style. The answer should be at least 400 words.


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Appendix C – Healthcare Emergency Management Competencies
Appendix C
Healthcare Emergency Management Competencies:
Competency Framework Final Report 1
Joseph A. Barbera, MD, Anthony G. Macintyre, MD, Greg Shaw, DSc,
Valerie Seefried, MPH, Lissa Westerman, RN, Sergio de Cosmo, MS
Institute for Crisis, Disaster, and Risk Management
The George Washington University
October 11, 2007
In December 2004, the Veterans Health Administration (VHA) Emergency Management
Strategic Healthcare Group awarded the Institute for Crisis Disaster & Risk Management
(ICDRM) a contract to participate in establishing innovative training and personal
development curricula for the VHA Emergency Management Academy (VHA-EMA).
The objective of the project was to develop a nationally peer-reviewed, National Incident
Management System (NIMS) compliant, competency-based instructional outline and
curriculum content upon which to base education and training courses. The curriculum is
intended to educate VHA personnel for response and recovery in healthcare emergencies
and disasters, to provide a resource for future VHA training programs, and to be placed in
the public domain for use by other healthcare personnel.
The initial phase of the EMA project consisted of developing a competency framework
(competency definition, structure and format, and critical elements) followed by
development of peer-reviewed emergency response and recovery competencies for VHAselected healthcare system job groups. The competencies describe knowledge, skills, and
abilities essential for adequate job performance during the emergency response and
recovery phases of an incident. Peer review was accomplished through a web-based
survey of the proposed competencies, which was distributed to a select, nationwide
sampling of emergency management personnel who were identified as having extensive
experience or advanced expertise in healthcare emergency response. The survey process
was designed to obtain a balanced expert opinion as to whether the project team’s written
competencies were valid, and to assess the appropriate level of proficiency for each
primary competency (i.e., awareness, operations, or expert). The competencies developed
during this initial phase were then used to guide the development of learning objectives
for the instructional curriculum.
This report was supported by Department of Veterans Affairs, Veterans Health Administration contract
“Emergency Management Academy Development,” CCN20350A. The report is the work of the authors
and does not represent the views of the Department of Veterans Affairs or any of its employees.
Institute for Crisis, Disaster and Risk Management
The George Washington University
Appendix C – Healthcare Emergency Management Competencies
An extensive research effort was conducted to understand the historical use of
competencies, and to establish objective criteria for competency development.
Historical development of competencies
Competency modeling originated in business management research, and has evolved
extensively over the past 25 years as other disciplines began adopting the practice. 2 The
original intent of competency development was to enhance the then common “job
analysis” by relating a position’s requisite knowledge, skills and abilities to the overall
objectives of the organization in which the position existed. This approach aligns the
objectives (i.e., desired outputs) of individual jobs with the overall objectives of the
organization, such that organizational objectives are achieved through effective
individual job performance. While this was the original intent of competencies, their
definition varied widely as time progressed. Competency definitions range from
emphasizing underlying characteristics of an employee (e.g., a motive, trait, skill, aspects
of one’s self-image, social role, or a body of knowledge) that produce effective and/or
superior performance 3 to performance characteristics (i.e., how an employee conducted
their job in relation to the organization’s objectives). 4
The application of competencies across the many organizations that use them has also
varied widely. The private sector has commonly employed competencies to define
“superior performers” 5 and therefore, as a selection tool for hiring, promotion, and/or
salary enhancement. In other organizations, competencies have been used for job-specific
performance feedback and improvement. Still others have used competencies to guide
future program training and development. Because of this variation in definition and
application, it becomes critically important to address these vagaries at the outset of any
competency development project. This concept was well-described by one competency
research team:
“The first step in the implementation of any competency-based management
framework must be the organizational consensus on how to define ‘competency.’
This agreed upon definition will drive the methodology used to identify and
assess the competencies within the organization.” 6
The GWU-ICDRM project team strongly agreed with this concept, and started the project
by defining how the competencies within this initiative would be applied:
Newsome, Shaun, Victor M Catano, and Arla L. Day. Leader Competencies: Proposing a Research
Framework. 2003. available at
Boyatzis, Richard. The Competent Manager: A Model for Effective Performance New York: Wiley, 1982.
US Office of Personnel Management. Executive Core Qualifications (ECQ’s), accessed at
Klein AL. Validity and Reliability for Competency-based Systems: Reducing Litigation Risks.
Compensation Benefits and Review, 28, 31-37, 1996. cited in “Newsome, Shaun, Victor M Catano, and
Arla L. Day. Leader Competencies: Proposing a Research Framework. 2003.
Newsome, Shaun, Victor M Catano, and Arla L. Day. Leader Competencies: Proposing a Research
Framework. 2003. available at
Institute for Crisis, Disaster and Risk Management
The George Washington University
Appendix C – Healthcare Emergency Management Competencies
The project competencies are intended to serve as formative tools to guide
healthcare system personnel in developing knowledge, skills and abilities for
effective performance during emergency response and recovery. These
competencies are also intended to serve as a guide for developing preparedness
education and training, and therefore, to serve as a basis for the healthcare
emergency management curriculum. Finally, the competencies may be employed
as a tool for assessing the performance of individual healthcare personnel
performance during emergency response and recovery operations.
Defining a competency framework
Despite an extensive search of published articles related to competencies, the GWUICDRM project team determined that no single authoritative source presented a
consistent competency definition and competency framework to adequately support the
VHA-EMA project needs. A framework was therefore developed, analyzed through pilot
competency development, refined and completed before establishing the individual
emergency response and recovery competencies for this project. The competency
framework was therefore used to impose a strict methodological consistency when
developing and defining all competencies developed in this program. Central to this
framework is the critical importance of competencies being objective and measurable,
internally and externally consistent, and tightly described within the context of the
organization’s specific objectives.
Within this framework, the project team defined a “competency” as a specific knowledge
element, skill, and/or ability that is objective and measurable (i.e., demonstrable) on the
job. It is required for effective performance within the context of a job’s responsibilities,
and leads to achieving the objectives of the organization. Competencies are ideally
qualified by an accompanying proficiency level. 7
The GWU-ICDRM project team recognized the need to adapt the methods for
competency development, since the usual business approach to establishing competencies
is problematic for emergency management. Business management models establish
competencies by observing performance and relating it to individual and organizational
outputs. Because emergencies are rare events, and therefore emergency response and
recovery outputs occur very infrequently, the related competency framework and
definitions for this project are based less upon observed outputs. Instead, the basis is a
healthcare system’s emergency response and recovery objectives, together with the
NIMS-consistent incident command system 8 structure and processes mandated for use by
all emergency response organizations in the U.S. 9,10
GWU Institute for Crisis, Disaster and Risk Management. Emergency Management Glossary of Terms
(October 2007) available at
Fedral Emergency Management Agency. National Incident Management System (NIMS) (March 1, 2004),
available at:
Bush GW. Homeland Security Presidential Directive (HSPD) -5: Management of Domestic Incidents
(February 28, 2003) accessed at
Institute for Crisis, Disaster and Risk Management
The George Washington University
Appendix C – Healthcare Emergency Management Competencies
Response competencies in systems using the Incident Command System (ICS), therefore,
should be based upon the general incident objectives an organization has during incident
response, and upon the organizational structures, processes, and relationships with other
organizations that are used during response rather than those used during everyday
experience. Emergency competencies are commonly developed without this relationship
to a defined response system, 11 making it difficult to define how scientific or medical
knowledge is to be implemented in an emergency response. In contrast, the GWUICDRM project team specifically incorporated the NIMS mandate to use ICS by
including reference to the NIMS/Incident Command System structure and processes
throughout the project’s emergency response and recovery project competencies.
Because of the anticipated large number of competencies, the project team also
established a “primary versus supporting competency” hierarchy to categorize the
individual competencies as they were developed. Designating “primary” and
“supporting” competencies helps to maintain a priority in the framework when listing a
large number of individual competencies. Supporting competencies are also a means to
more fully define and clarify the primary competencies.
Preparedness versus response and recovery competencies
Published articles describing emergency management competencies commonly do not
differentiate between preparedness and response competencies, and list them in an
intermixed fashion. 12,13 The GWU-ICDRM project team sought to maintain a separation
between these categories.
Preparedness competencies are commonly based upon everyday organizational
objectives, structure, processes, and relationships to other organizations. Preparedness is
unquestionably important, but for it to be accurate, comprehensive and successful in
establishing an effective emergency response capability, a thorough understanding of the
response system must be established first, and preparedness guided by this. It was
therefore reasoned by the project team that specific competencies for emergency response
should be established and validated first, and then used as the “end state” to guide the
development of valid preparedness competencies.
Barbera JA, Macintyre AG, et al. Emergency Management Principles and Practices for Healthcare
Systems, Unit 3, Lesson 3.1.1, accessed at
ATPM (Association of Teachers of Preventive Medicine) in collaboration with Center for Health policy,
Columbia University School of Nursing. Emergency Response Clinician Competencies in Initial
Assessment and Management, 2003, accessed at
INCMCE (International Nursing Coalition for Mass Casualty Education). Educational Competencies for
Registered Nurses Responding to Mass Casualty Incidents, 2003. Available at:
ACEP (American College of Emergency Physicians) and the U.S Department of Health & Human
Services, Office of Emergency Preparedness. Developing Objectives, Content, and Competencies for the
Training of Emergency Medical Technicians, Emergency Physicians, and Emergency Nurses to Care for
Casualties Resulting From Nuclear, Biological, or Chemical (NBC) Incidents, Final Report April 23, 2001.
American College of Emergency Physicians, Irving, Texas.
Institute for Crisis, Disaster and Risk Management
The George Washington University
Appendix C – Healthcare Emergency Management Competencies
Because of these considerations, the initial project focus was response and recovery
competencies. Emergency management program competencies related to mitigation and
preparedness were developed later for the two job groups that are the initial focus of the
certification project.
Establishing appropriate levels of proficiency
Concurring with other authors that “competency” is not an all-or-none phenomenon, the
GWU-ICDRM project team established “proficiency levels” to address this issue in a
graduated fashion. Proficiency levels delineate the “The degree of understanding of the
subject matter and its practical application through training and performance…” 14 In
emergency management, proficiency indicates the level of mastery of knowledge, skills
and abilities (i.e., competencies) that are demonstrable on the job and lead to the
organization achieving its objectives. Levels of proficiency may therefore also be used to
describe the level of mastery that is the objective of and specific training or education
program. The final proficiency levels defined for this project are presented in Table 1.
Table 1. Definition of the Levels of Proficiency
Represents an understanding of the knowledge/skills/abilities
Awareness encompassed by the competency, but not to a level of capability to
adequately perform the competency actions within the organization’s
Represents the knowledge/skills/abilities to safely and effectively
perform the assigned tasks and activities, including equipment use as
Represents operations-level proficiency plus the additional
knowledge/skills/abilities to apply expert judgment to solve problems
and make complex decisions.
As core and job group competencies were developed, the project team qualified each
primary competency with an indicated level of proficiency (awareness, operations,
EMA. Urban Search & Rescue Incident Support Team Training: Student Manual. Module 1, Unit 4,
Page 6: Planning Process Overview. n/a:40. 4/16/2004, accessed at:
Institute for Crisis, Disaster and Risk Management
The George Washington University
Appendix C – Healthcare Emergency Management Competencies
Developing emergency response and recovery competencies
Using the competency framework established in this project, response and recovery
“core” competencies were developed for all personnel within a healthcare system that
may have a role in the emergency response, regardless of their specific emergency
response and recovery function. Additional competencies were then established for three
functionally based job groups within a healthcare. The original designation for these job
groups were (1) healthcare facility leaders, (2) patient care providers, and (3) emergency
management program managers. The titles and definitions evolved with outside input as
the project tasks were accomplished (see Table 2 for final titles and descriptions).
Initial competency identification and development was accomplished through an analysis
of ICS as presented in NIMS, an extensive literature review, and an evaluation of the
VHA system and processes for emergency response. 15 Additionally, the GWU-ICDRM
project team relied upon their extensive emergency management and disaster response
experience, and upon related previous research efforts. 16,17,18
The emergency response and recovery competencies for the initially designated three job
groups were then fully developed, studied through a web-based survey, revised based
upon input and completed. 19
Identification of additional job groups and their associated competencies
Early in the competency development process, it became apparent that there were
additional important healthcare emergency management job groups beyond the three that
were initially described.
These groups have distinct response and recovery
responsibilities (and therefore associated competencies) for the healthcare organization’s
resiliency and medical surge. After extensive research during the latest phase of the
project, the additional groups were identified as: Facilities and Engineering Services
(FES), Police and Security Services (PSS), and Clinical Support Services (CSS). Their
descriptions are presented in Table 2. Using the previously defined methodology
(including web-based peer review), the follow-on project allowed for the development of
emergency response and recovery competencies for these remaining job groups.
Veterans Health Administration. VHA Emergency Management Program Guidebook, 2005, accessed at:
Barbera, Joseph A and Anthony G. Macintyre. Medical and Health Incident Management System: A
Comprehensive Functional Description for Mass Casualty Medical and Health Incident Management.
Institute for Crisis, Disaster & Risk Management. The George Washington University, Washington DC,
October 2002, accessed at
Barbera, Joseph A and Anthony G. Macintyre. Mass Casualty Handbook: Hospital Emergency
Preparedness and Response, First Edition. Jane’s Information Group, 2003.
CNA Corporation. Medical Surge Capacity & Capability: The Management System for Integrating
Medical and Health Resources During large-Scale Emergencies. August 2004, accessed at:
Barbera JA, Macintyre AG, et al. VHA-EMA Emergency Response and Recovery Competencies:
Competency Survey, Analysis, and Report (June 16, 2005), available at
Institute for Crisis, Disaster and Risk Management
The George Washington University
Appendix C – Healthcare Emergency Management Competencies
Development of preparedness and mitigation (program) competencies for
Emergency Management Program Managers and Healthcare System Leaders
The methodology utilized in this project focused first on the development and validation
of response and recovery competencies as an “end state” for healthcare system personnel
in their emergency management activities. The second phase of the project allowed for
the development of program competencies for Emergency Program Managers and
Healthcare System Leaders, which focused upon preparedness and mitigation activities
necessary to reach this “end state.” These two job groups maintain primary responsibility
for the emergency management program within a healthcare system, and thus have
extensive primary competencies that relate to program development and maintenance
required for successful response to emergencies and disasters.
The program competencies were developed using the earlier methods, with identical
criteria that the competencies be objective and measu …
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