MILITARY MEDICINE, 00, 0/0:1, 2019

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Perceived Knowledge, Skills, and Preparedness for Disaster
Management Among Military Health Care Personnel
CAPT Heather C. King, NC, USN; LTJG Natalie Spritzer, NC, USN; LTJG Nahla Al-Azzeh, NC, USN

ABSTRACT Introduction: The Indo-Asia-Pacific region has the highest incidence of natural disasters world-wide.
Since 2000, approximately 1.6 billion people in this region have been affected by earthquakes, volcanos, tsunamis,
typhoons, cyclones, and large-scale floods. The aftermath of disasters can quickly overwhelm available resources,
resulting in loss of basic infrastructure, shelter, health care, food and water, and ultimately, loss of life. Over the last 12
years, US military forces have collaborated with countries throughout the Indo-Asia-Pacific region to enhance disaster
preparedness and management during shipboard global health engagement missions. Military health care personnel are
integral in this effort and have planned subject-matter expert exchanges, multidisciplinary conferences, courses, and
hyper realistic simulated military-to-military training exercises related to disaster preparedness. Military health care
providers are essential not only to providing international education and training, but also to ensuring optimal readiness
to respond to future disasters in the Indo-Asia-Pacific region and worldwide. The ability to effectively respond to disas-
ters and collaborate with other nations promotes international stability. Yet, few studies have examined disaster pre-
paredness among US military health care personnel. This study aimed to assess knowledge, skills, and preparedness
for disaster management among US military health care personnel preparing to deploy on a global health engagement
mission. Materials and Methods: A descriptive, cross-sectional study utilizing the Disaster Preparedness Evaluation
Tool (DPET) examined self-reported perceptions of disaster preparedness among US military health care personnel pre-
paring to deploy on a shipboard global health engagement mission. The DPET assessed perceived knowledge of disas-
ter preparedness, disaster mitigation and response, and disaster recovery. Three hundred Hospital Corpsmen/Medics
and officers in the Nurse Corps, Medical Corps, Medical Service Corps, and Dental Corps were invited to participate.
One hundred fifty-four surveys were completed (response rate, 51%). Nineteen surveys were excluded from the analy-
sis due to incomplete responses. Participants rated responses to 46 Likert items (scale of 1–6) and responded to 23
descriptive items. The study protocol was approved by the Naval Medical Center San Diego Institutional Review
Board, protocol number NMCSD.2017.0061, in compliance with all applicable federal regulations governing the pro-
tection of human subject research. Results: All item mean scores on each of the three DPET subscales resulted in mod-
erate levels of perceived disaster preparedness among military healthcare personnel (disaster preparedness means
ranged from 3.04 to 4.67, disaster response means ranged from 3.76 to 4.29, and disaster recovery means ranged from
3.47 to 4.29). The final regression model had 6 significant variables that predicted DPET scores: previous disaster drills
(p = 0.00), experiencing a real disaster (p = 0.002), bioterrorism training (p = 0.02), education level (p = 0.025), years
in specialty (p = 0.019), and previous global health engagement missions (p = 0.016), with R2 = 0.39, R2adj = 0.36,
F (7, 127) = 12.04. Conclusions: Disaster preparedness among military healthcare personnel could be improved to
function optimally for future global health engagement missions. This study expands current understandings of disaster
preparedness among US military health care providers and identifies ways to improve and enhance training.

INTRODUCTION as the “ring of fire” due to the large number of earthquakes,

The Indo-Asia Pacific region has the highest incidence of nat- volcanos, tsunamis, typhoons, cyclones, and large-scale
ural disasters worldwide, with approximately 1.6 billion peo- floods that occur within and around the basin of the Pacific
ple affected since 2000.1 This region is commonly referred to Ocean. This region, in addition to its geographical disposition
to natural disasters, is not immune to threats of terrorism,
Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego,
weapons of mass destruction, or chemical, nuclear, biologic,
CA 92134. and radiologic warfare. The aftermath of any type of disaster
The views expressed in this article are the result of research conducted can quickly overwhelm available resources, resulting in loss
by the authors and do not necessarily reflect the official policy or position of of basic infrastructure, shelter, health care, food and water,
the Department of the Navy, Department of Defense, or the US Government. and, ultimately, loss of life. Therefore, disaster preparedness
I am a military service member or federal/contracted employee of the
United States government. This work was prepared as part of my official
is a high priority in this region of the world.2,3
duties. Title 17 U.S.C. 105 provides that “copyright protection under this Over the last 10 years, the US military has collaborated
title is not available for any work of the United States Government.” Title with international militaries, non-governmental organizations,
17 U.S.C. 101 defines a US Government work as “work prepared by a mili- and civilians throughout the Indo-Asia Pacific region to
tary service member or employee of the US Government as part of that per- enhance international capacity to prepare and respond to dis-
son’s official duties.”
doi: 10.1093/milmed/usz038
asters. Many of these efforts have occurred during shipboard
© Association of Military Surgeons of the United States 2019. All rights global health engagement missions. Military health care per-
reserved. For permissions, please e-mail: journals.permissions@oup.com. sonnel play integral roles in such missions, including

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 Knowledge, Skills, and Disaster Preparedness

participating in or leading subject matter expert exchanges, Although the DPET has not been used in previous

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formal conferences or courses, and high-fidelity simulated research with US military personnel, it has been used to
military-to-military training exercises. compare perceptions of disaster preparedness between
Military health care providers are central not only to military nurses and civilian nurses in the Middle East
disaster preparedness education and training but also to region.10 In a study conducted in Saudi Arabia, military
ensuring optimal readiness to respond to future disasters in nurses perceived themselves as more prepared than their
the Indo-Asia Pacific region and worldwide. The ability to civilian counterparts.10 Another study conducted in
effectively respond to disasters and collaborate with partner Taiwan also found increased personal preparedness among
nations promotes international stability; a central theme of military nurses.14 The DPET was selected for this study
military global health engagement missions.4,5 To accom- as it has been widely used and has been shown to be a
plish this task, building and sustaining disaster readiness valid and reliable instrument across studies, with reported
among military healthcare personnel is essential. However, Cronbach’s alpha inter-item correlation coefficients rang-
this task is challenging, as military personnel frequently relo- ing from 0.91 to 0.93.6,9
cate, change deployment platforms, and deploy rapidly. The original DPET is a 67-item instrument that measures
Although many educational resources are available to mili- perceptions of knowledge, skills, and preparedness for the
tary health care personnel, including formalized courses, pre-disaster, response, and recovery stages of a disaster. The
shipboard training, simulated shipboard exercises, and online DPET consists of 3 subscales (disaster preparedness = 25
training courses, education and training in disaster prepared- items, response = 15 items, and recovery = 6 items) and 7
ness training varies widely and is not standardized across the categories (disaster knowledge, disaster skills, personal pre-
US Department of the Navy or US Department of Defense. paredness, response knowledge, patient management, recov-
To our knowledge, no study has examined the current ery knowledge, and recovery management). Additionally,
level of disaster preparedness or readiness among US mili- items 47 through 67 are open-ended questions that collect
tary health care personnel. An assessment of the strengths demographic information. Participants rate their responses to
and weaknesses of disaster preparedness knowledge in this the first 46 items using 6-point Likert scales. Responses
population will help identify gaps in knowledge and inform range from 1 (strongly disagree) to 6 (strongly agree).
military leaders and educators of these gaps. Therefore, the Higher scores indicate greater preparedness.
purpose of this study was to examine the current level of For this study, the demographic items were slightly modi-
knowledge, skills, and disaster preparedness among US mili- fied to include physicians, nurses, dentists, hospital corps-
tary health care personnel about to deploy on a ship based men/medics, and Medical Service Corps personnel. The
global health engagement mission. occupational specialty titles “RN” (for registered nurse) and
“Nurse Practitioner” in the original DPET were replaced
with “NC Officer, MC Officer, MSC Officer, DC Officer or
METHODS
Hospital Corpsman” (NC = Nurse Corps, MC = Medical
A descriptive cross-sectional study assessed self-reported
Corps, MSC = Medical Service Corps, and DC = Dental
perceptions of disaster preparedness in a convenience sample
Corps). Our study team also added 2 demographic questions
of military health care personnel preparing to deploy on a
to obtain deployment history information, which we deemed
shipboard global health engagement mission. An anony-
important data that may influence disaster preparedness
mous, de-identified 69-item survey was delivered to active
scores on the DPET (for a total of 69 items). No other modi-
duty health care personnel via an approved web-based survey
fications were made, and permission to use the DPET was
platform (MAX Survey, MAX.gov). The study was approved
granted by the originators of the DPET.
by the Naval Medical Center San Diego Institutional Review
The survey took participants approximately 10 minutes to
Board.
complete.

Measures
The Disaster Preparedness Evaluation Tool (DPET) assessed Sample
disaster preparedness in the sample population. The DPET A convenience sample of 154 male and female active duty
was originally developed in 2007 to assess the level of pre- health care personnel preparing to deploy on a specific ship
paredness in nurse practitioners practicing in the United based global health engagement mission (Pacific Partnership
States.6 Since Tichy and Bond’s initial study in 2009,6 the 2018) participated in this study. Study inclusion criteria spec-
DPET has been used in other populations of nurses around the ified active duty health care personnel (Hospital Corpsmen/
world, including in Bangladesh, Bhutan, Cambodia, China, Medics and officers in the Nurse Corps, Medical Corps,
Laos, Nepal, the Philippines, the Solomon Islands, Japan, Medical Service Corps, and Dental Corps) ages 17 to 60
Jordan, and Saudi Arabia.7–12 Recently, the DPET has been years from any branch of military service. Study exclusion
used to examine health care providers’ disaster preparedness criteria included civilians and active duty personnel with spe-
and has demonstrated excellent psychometric properties.13 cialties not related to health care.

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 Knowledge, Skills, and Disaster Preparedness

Data Collection Procedures (independent variables) and total DPET score (dependent vari-

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Three hundred military health care personnel were invited to able). For this study, participant characteristics of interest
participate in the study, via two methods: (1) an e-mail invi- included age, education level, occupational specialty, years in
tation with a link to complete the survey online and (2) in- occupational specialty, previous participation in disaster drills,
person recruitment with electronic devices offered for survey previous bioterrorism training, previous disaster preparedness
completion. The in-person recruitment was conducted by a training, experience of a real disaster, and number of previous
civilian research team member, to avoid any perception of combat or global health engagement deployments. A model to
coercion of active duty participants. Data collection occurred explain the variance in the dependent variable was created, in
over a 2-month period in January and February 2018, just which tests with a p value less than 0.05 were considered sta-
prior to a ship-based global health engagement deployment. tistically significant. Statistical analyses were conducted using
The study team intentionally scheduled the data collection to Stata (version 13).
take place shortly before deployment, with the goal of most An estimated effect size (ƒ2) of 0.15, statistical power of
accurately reflecting disaster preparedness among military 0.80, 10 predictor variables, and α = 0.05 was used to esti-
health care personnel. mate a necessary sample size of 114 participants for standard
A total of 154 surveys were completed (response rate, multiple regression analyses. During recruitment, the team
51%). Nineteen of these surveys were excluded from the attempted to obtain participants from each specialty (i.e.,
analysis due to incomplete responses, and 135 surveys were Nurse Corps, Medical Corps, Medical Service Corps, Dental
included for analysis. Participant responses were anony- Corps, and Hospital Corpsman/Medic) to adequately repre-
mous, and Secure Sockets Layer (SSL) software was used sent the specialties in a global health engagement mission.
by the MAX Survey platform to encrypt participant data. A To determine the instrument’s internal consistency and
statement about the use, confidentiality, and voluntary nature estimate reliability in a US military health care personnel
of the survey was included for participants’ awareness. sample, we calculated Cronbach’s α coefficients for the total
DPET scale and its subscales.

Data Analysis
RESULTS
Demographic and frequency data were analyzed using descrip-
tive statistics. Measures of central tendency (mean and stan- Demographics
dard deviation) were used to describe individual Likert items, A variety of military health care personnel were represented
DPET subscale means, and the DPET total score. Following in this study, with the majority of the sample consisting of
the original authors of the DPET, we defined item means Hospital Corpsmen/Medics (54%) and Nurse Corps officers
between 1.00 and 2.99 as perceived weak knowledge, means (20%) (Table I). Fifty-six percent of participants were male
between 3.00 and 4.99 as perceived moderate knowledge, and and 44% were female. Mean age was 32.8 ± 9.07 years, and
means between 5.00 and 6.00 as perceived strong knowledge. the majority of participants (79.5%) worked at a military
These values have been used by multiple investigators to eval- treatment facility. Approximately half of the participants had
uate both individual item means and overall subscale means. either a bachelor’s, master’s, or doctoral degree (50.4%),
A backward stepwise regression was used to examine the while half had either some college but no degree, high
degree of association between participant characteristics school education, or other school (49.6%). Mean years of
experience in a specialty was 6.34 ± 6.09. Most participants
TABLE I. Participant Demographic Characteristics had never previously deployed on a previous global health
Demographic Characteristics (N = 135)
engagement mission (72.6%) or combat mission (61.5%).
However, 19.6% of participants had experienced a real disas-
Gender
ter, and 70.4% of participants were aware of a disaster plan
Male (n, %) 76, 56.3%
Female (n, %) 59, 43.7% in their workplace. Sixty-two percent of participants reported
Highest education level completed that disaster drills were conducted regularly in their work-
Some college, no degree (n, %) 43, 31.9% place, and 65.9% found them to be helpful.
Associate’s degree (n, %) 17, 12.6%
Bachelor’s degree (n, %) 24, 17.8%
Master’s degree (n, %) 15, 11.1% Open-Ended Questions
Doctoral degree (n, %) 29, 21.5%
Thirty percent of the military health care providers partici-
Other type of degree (n, %) 7, 5.2%
Military Corps/specialty pating in this study reported having received disaster educa-
Medical Corps officer (n, %) 18, 13.3% tion in an undergraduate program, and 13.3% had received
Dental Corps officer (n, %) 5, 3.7% disaster education in a graduate program. Nearly half (47%)
Medical Service Corps officer (n, %) 11, 8.1% had participated in disaster preparedness continuing educa-
Nurse Corps officer (n, %) 28, 20.7%
tion courses, 51.9% had participated in bioterrorism training,
Hospital Corpsman/Medic (n, %) 73, 54.1%
and 55.6% reported training at facility-based disaster drills.

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 Knowledge, Skills, and Disaster Preparedness

TABLE II. DPET Disaster Preparedness Subscale Items and Means

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Mean and SD
Item (N = 135)
Disaster knowledge
1. I would be interested in educational classes on disaster preparedness that relate specifically to my community situation. 4.60 ± 1.0
2. I am aware of classes about disaster preparedness and management that are offered for example at either my workplace, the 3.76 ± 1.4
university, or community.
3. I find that the research literature on disaster preparedness is understandable. 4.28 ± 1.1
4. I know the limits of my knowledge, skills, and authority as a NC Officer, MC Officer, MSC Officer, DC Officer or Hospital 4.67 ± 1.1
Corpsman to act in disaster situations, and I would know when I exceed them.
5. Finding relevant information about disaster preparedness related to my community needs is an obstacle to my level of 4.00 ± 1.2
preparedness.
6. I am aware of what the potential vulnerabilities in my community are (e.g., earthquake, floods, terror, etc.). 4.66 ± 1.1
7. In case of a disaster situation I think that there is sufficient support from local officials on the county or state level. 4.33 ± 1.1
8. I know where to find relevant research or information related to disaster preparedness and management to fill in gaps in my 4.05 ± 1.2
knowledge.
9. I have a list of contacts in the medical or health community in which I practice. I know referral contacts in case of a disaster 3.79 ± 1.4
situation (health department, etc.).
10. I find that the research literature on disaster preparedness and management is easily accessible. 4.09 ± 1.2
11. I participate in one of the following educational activities on a regular basis: continuing education classes, seminars, or 3.76 ± 1.5
conferences dealing with disaster preparedness.
12. I am familiar with the local emergency response system for disasters. 3.97 ± 1.3
13. I know who to contact (chain of command) in disaster situations in my community. 4.53 ± 1.3
14. I read journal articles related to disaster preparedness. 3.30 ± 1.6
15. I participate/have participated in creating new guidelines, emergency plans, or lobbying for improvements on the local or 3.07 ± 1.6
national level.
16. I have participated in emergency plan drafting and emergency planning for disaster situation in my community. 3.44 ± 1.6
Disaster skills
1. I am familiar with accepted triage principles used in disaster situations. 4.47 ± 1.1
2. I participate in disaster drills or exercises at my workplace (clinic, hospital, etc.) on a regular basis. 4.04 ± 1.5
3. I consider myself prepared for the management of disasters. 3.87 ± 1.3
4. In case of a bioterrorism/biological attack, I know how to use personal protective equipment. 4.44 ± 1.3
5. I would be considered a key leadership figure in my community in a disaster situation. 3.04 ± 1.5
6. In a case of bioterrorism/biological attack, I know how to perform isolation procedures so that I minimize the risks of community 4.08 ± 1.3
exposure.
7. In case of a bioterrorism/biological attack, I know how to execute decontamination procedures. 4.00 ± 1.4
Personal preparedness
1. I have personal/family emergency plans in place for disaster situations. 4.15 ± 1.4
2. I have an agreement with loved ones and family members on how to execute our personal/family emergency plans. 4.17 ± 1.5

DC = Dental Corps; DPET = Disaster Preparedness Evaluation Tool; MC = Medical Corps; MSC = Medical Service Corps; NC = Nurse Corps.

Levels of Preparedness during response (12 items). All item mean scores ranged from
Disaster Preparedness Subscale 3.76 to 4.29 (perceived moderate knowledge), with no mean
The disaster preparedness subscale consists of three catego- scores falling below 3.5 (Table III). The overall subscale mean
ries: disaster knowledge, disaster skills, and family prepared- was 60.0 ± 15.4 for all questions. Inter-item correlation for the
ness. All item mean scores ranged from 3.04 to 4.67 in the disaster response subscale was 0.95.
perceived moderate knowledge range (means of 3.00–4.99)
(Table II). In the disaster knowledge category, 3 items had
Disaster recovery subscale
means lower than 3.50: reading disaster preparedness journal
The disaster recovery subscale consists of two categories: disas-
articles, participating in creating new guidelines, and drafting
ter recovery knowledge (1 item) and disaster recovery manage-
emergency plans. The item with the lowest mean on this sub-
ment (5 items). All item mean scores indicated perceived
scale was about being considered a key leadership figure in
moderate knowledge, with a range of 3.47 to 4.29 and an overall
the community (in the disaster skills category). The overall
subscale mean of 23.3 ± 6.6 (Table IV). Three items were
subscale mean was 100.6 ± 21.4 for all questions. Inter-item
below or close to a mean of 3.5. These items were about partici-
correlation for the disaster preparedness subscale was 0.94.
pating in peer evaluation of skills on disaster preparedness,
familiarity with performing focused health assessment for Post-
Disaster Response Subscale traumatic stress disorder (PTSD), and feeling confident manag-
The disaster response subscale consists of two categories: ing emotional outcomes for acute stress disorder or PTSD. Inter-
disaster response knowledge (3 items) and patient management item correlation for the disaster recovery subscale was 0.89.

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TABLE III. DPET Disaster Response Subscale Items and Means

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Mean and
SD
Item (N = 135)
Knowledge-specific response
1. I am able to describe my role in the response phase of a disaster in the context of my workplace, the general public, media, and 4.27 ± 1.2
personal contacts.
2. I am familiar with the organizational logistics and roles among local, state, and federal agencies in disaster response situations. 3.79 ± 1.4
3. I am familiar with psychological interventions, behavioral therapy, cognitive strategies, support groups, and incident debriefing for 4.01 ± 1.2
patients who experience emotional or physical trauma.
Patient management during response
1. I can manage the common symptoms and reactions of disaster survivors that are of affective, behavioral, cognitive, and physical 4.04 ± 1.2
nature.
2. I would feel confident providing patient education on stress and abnormal functioning related to trauma. 4.16 ± 1.3
3. I can identify possible indicators of mass exposure evidenced by a clustering of patients with similar symptoms. 4.29 ± 1.2
4. As an NC Officer, MC Officer, MSC Officer, DC Officer, or Hospital Corpsman, I would feel confident as a manager or coordinator 4.05 ± 1.4
of a shelter.
5. I feel reasonably confident I can treat patients independently without supervision of a physician in a disaster situation. 3.79 ± 1.5
6. I would feel confident working as a triage provider and setting up temporary clinics in disaster situations. 4.10 ± 1.4
7. As an NC Officer, MC Officer, MSC Officer, DC Officer, or Hospital Corpsman, I would feel confident in my abilities as a direct 4.12 ± 1.4
care provider and first responder in disaster situations.
8. I would feel confident implementing emergency plans, evacuation procedures, and similar functions. 3.87 ± 1.3
9. As an NC Officer, MC Officer, MSC Officer, DC Officer, or Hospital Corpsman, I would feel reasonably confident in my abilities to 4.09 ± 1.4
be a member of a decontamination team.
10. I am familiar with the main groups (A, B, C) of biological weapons (anthrax, plague, botulism, smallpox, etc.), their signs and 3.86 ± 1.4
symptoms, and effective treatments.
11. I feel confident discerning deviations in health assessments indicating potential exposure to biological agents. 3.76 ± 1.4
12. In case of a bioterrorism/biological attack, I know how to perform focused health history and assessment, specific to the bioagents 3.85 ± 1.4
that are used.

DC = Dental Corps; DPET = Disaster Preparedness Evaluation Tool; MC = Medical Corps; MSC = Medical Service Corps; NC = Nurse Corps.

TABLE IV. DPET Disaster Recovery Subscale Items and Means

Mean and SD
(N = 135)
Recovery Knowledge
1. I am familiar with what the scope of my role in a post-disaster situation would be. 4.19 ± 1.2
Recovery management
1. I am able to discern the signs and symptoms of Acute Stress Disorder and Post-Traumatic Stress Disorder. 4.29 ± 1.2
2. I participate in peer evaluation of skills on disaster preparedness and response. 3.47 ± 1.5
3. I would feel confident providing education on coping skills and training for patients who experience traumatic situations so they 4.21 ± 1.2
are able to manage themselves.
4. I am familiar with how to perform focused health assessment for PTSD. 3.60 ± 1.5
5. I feel confident managing (treating, evaluating) emotional outcomes for Acute Stress Disorder or PTSD following disaster or 3.56 ± 1.5
trauma in a multi-disciplinary way such as referrals and follow-ups, and I know what to expect in ensuing months.

Regression Model Results had negative coefficient values, which predicted lower
A backward stepwise regression placed all variables of inter- DPET scores (Table V).
est into the model. The regression model had 6 significant To further analyze the negative coefficient values of years
variables: previous disaster drills (p = 0.00), experiencing a in specialty and education level, three separate regression
real disaster (p = 0.002), bioterrorism training (p = 0.020), models for healthcare specialty (Medical Corps: Dental
education level (p = 0.025), years in specialty (p = 0.019), Corps and Medical Service Corps included with Medical
and previous global health engagement missions (p = Corps), Nurse Corps, and Hospital Corpsman/Medic were
0.016), with R2 = 0.39, R2adj = 0.36, F (7, 127) = 12.04. conducted placing all variables of interest into each model.
The variables that contributed to higher DPET scores In the regression model for both Medical Corps and Nurse
included previous disaster drills, experiencing a real disaster, Corps, previous global health engagement missions was a
bioterrorism training, and previous global health engagement significant predictor of higher DPET scores (p = 0.005, p =
deployments. Both years in specialty and education level 0.001), R2 = 0.49 & 60, R2adj = 0.38 & 0.51, F (4, 18) =

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TABLE V.

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Regression Analysis Results

Variable Coefficient Standard Error t p 95% CI

Previous disaster drill 24.97 5.90 4.23 0.000 13.3 36.7
Experiencing real disaster 23.36 7.45 3.13 0.002 8.6 38.1
Previous GHE deployment 2.17 0.884 2.45 0.016 0.4 −3.9
Years in specialty −1.23 0.516 −2.38 0.019 −2.3 −0.2
Bioterrorism training 13.82 5.86 2.36 0.020 2.2 −25.4

CI = confidence interval; GHE = global health engagement.

4.34 & F (5, 22) = 6.58 (Medical Corps and Nurse Corps Additionally, in this sample of US military health care per-
respectively). For the Hospital Corpsman/Medics regression sonnel, several items’ mean scores were in the moderate cate-
model, experiencing a real disaster (p = 0.046) and previous gory, but approached the lower cut-off of 3.00. These items
drills (p = 0.001) were significant predictors of higher DPET included reading disaster journals, creating new guidelines,
scores, R2 = 0.33, R2adj = 0.28, F (5, 67) = 6.62. drafting disaster plans, considering themselves key leaders in
disasters, being familiar with how to perform a focused
health assessment for PTSD, and knowing how to manage
DISCUSSION emotional outcomes for acute stress disorder/PTSD.
This study is timely, given that close to half of the world’s Given these findings, and the known military training
natural disasters occur in the Indo-Asia-Pacific region, where requirements for operational readiness, opportunities exist to
US military health care providers regularly engage in mis- examine current disaster preparedness training methodolo-
sions focused on enhancing disaster preparedness with inter- gies, increasing exposure of military healthcare personnel to
national partners (Pacific Partnership missions and Rim of simulated disaster exercises, and cultivating a higher value
the Pacific Exercises). US military health care personnel in on disaster preparedness within military systems.
this region need to be able to respond to disasters with seam- The overall regression model revealed 6 variables were
less interoperability, thus disaster preparedness and opera- predictive of DPET scores, four variables predicted higher
tional readiness are paramount. scores (previous disaster drills, experiencing a real disaster,
Given the importance of military health care personnel to bioterrorism training, and previous global health engagement
effectively prepare and respond to disasters worldwide, this deployment), and two variables predicted lower scores (years
study provides valuable information on this sample’s percep- in service and educational level). The most statistically sig-
tions of disaster preparedness. Although nearly half of study nificant variables in the overall regression model were disas-
participants reported that they had participated in continuing ter drills and bioterrorism training. This is an encouraging
education courses (47%), bioterrorism training (51.9%), and finding because it demonstrates the value and investment
training in facility disaster drills (55.6%), their mean DPET military facilities and operational commands have placed on
scores, both total and by subscale, reveal only moderate levels these training efforts.
of perceived disaster preparedness. This finding indicates that Experiencing a real disaster also predicted higher DPET
disaster preparedness could be improved among military scores. After conducting the additional regression models
health care personnel, who will need to function optimally this variable was highly predictive for Hospital Corpsman
when responding to future disaster situations. and Medics. This finding is important, since disaster experi-
Similar results – of moderate levels of disaster prepared- ence and experiential knowledge is not currently considered
ness – have been found among health care providers through- for manning requirements of these missions. Military health
out the Indo-Asia-Pacific region.7,11,12,14 Also similar to care providers who have experienced a real disaster add
previous studies, the military health care providers in this value to global health engagement missions and provide
study reported higher mean scores on the disaster prepared- invaluable experiential knowledge for teaching service mem-
ness, disaster response, and disaster recovery subscales than bers of current and future missions.
have been reported by civilian health care counterparts.10,11 Variables that predicted lower DPET scores included edu-
Military health care personnel around the world may be cational level and years in specialty. Initially, we found these
exposed to increased training requirements compared to civil- results surprising. However, this finding is explained by the
ian healthcare personnel, resulting in increased perception of large number of Hospital Corpsman/Medics included in the
disaster preparedness. However, given the known military study sample. Hospital Corpsman/Medics tend to be younger
training requirements (Chemical, Biologic, Radiologic, Nuclear and may be exposed to higher numbers of disaster drills
Defense Course, Incident Command Systems Course) and the resulting in higher perceptions of disaster preparedness.
required disaster drills in both military facilities and operational Senior military health care personnel tend to have leadership
exercises, it is surprising perceptions of levels of disaster pre- positions and increased levels of responsibilities that may
paredness are not higher. limit the number of drills and trainings that they participate

6 MILITARY MEDICINE, Vol. 00, 0/0 2019

 Knowledge, Skills, and Disaster Preparedness

in; however, the actual amount of disaster preparedness CONCLUSION

Downloaded from https://academic.oup.com/milmed/advance-article-abstract/doi/10.1093/milmed/usz038/5382213 by U. of Florida Health Science Center Library user on 20 March 2019
training reported among this cohort was highly variable. This study is timely, as both the findings of this study and pre-
An interesting finding in this study was that previous vious studies in the Indo-Asia-Pacific region have identified
combat deployments did not predict higher DPET scores. weaknesses in disaster preparedness among health care provi-
This surprised our research team, given the large component ders. Given the combination of a high incidence of natural dis-
of trauma care provided during combat-related deployments, asters in this region and the annual US-sponsored global
and it highlights to the unique skill set in disaster prepared- health engagement missions in the region, a clear opportunity
ness and management. exists to both enhance disaster preparedness among military
Previous global health engagement deployment, in com- health care providers and promote international cooperation
parison, did predict higher DPET scores in the overall final utilizing disaster preparedness as a means to accomplish oper-
regression model and for Medical Corps Officers and Nurse ational readiness and enhanced Indo-Asia-Pacific stability.
Corps Officers. Global health engagement missions focus
not only on trauma care, but also on planning and executing ACKNOWLEDGMENTS
subject matter expert exchanges on disaster preparedness
The authors gratefully acknowledge the participation of US military health
and health care topics, cooperative health engagements, care personnel in their support of this research project
hyper-realistic trauma training exercises with state-of-the art
equipment, and ship-to-shore and ship-to-ship patient move-
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