Earthquakes are among the most common natural disasters worldwide, causing massive destruction and multiple casualties [11, 12]. Therefore, health workers must be able to respond appropriately when an earthquake occurs. On February 6, 2023, the Eastern Mediterranean region suffered multiple quakes and aftershocks that had never been witnessed since 1939. Medical teams worked tirelessly to provide professional health care to the injured [13, 14]. However, more work needs to be undertaken to determine the prerequisite characteristics of various health professionals during earthquakes. This is where the role of competency-based medical education needs to be noted. All health workers who provide medical care and psychological support for the injured, at site locations or in hospitals should have the essential competencies to approach patients affected by the disaster [15]. Therefore, this study was undertaken to identify the required core competencies for health workers based on the Syrian earthquake experience.
To identify competencies effectively, it is necessary to consider factors such as meeting public requirements and expectations, particularly about disaster and emergency situations; addressing existing health issues within the community; understanding the distinct characteristics of the population being served; socioeconomic development; and the unique clinical setting found in Syria [16]. By addressing these factors, specific competencies can be identified for health workers in Syria to respond effectively to disasters and emergencies.
The first investigation was to identify members involved in the healthcare-related earthquake response and then to identify their competencies in the light of their specializations, roles, and responsibilities.
To prevent overlapping responsibilities, ensure optimal allocation of resources, and foster seamless collaboration among health workers, nine distinct roles within the medical team were identified [17]
. Each group has its duties, and integrating these roles delivers the best medical care during earthquakes. The field experience of our team, who had witnessed the actual medical response during this catastrophe, was also considered.
Specialized medical doctors were the first group selected as they provide professional surgical and medical care at hospitals while considering different specializations, various challenges, and diverse cases [18, 19]. They provide emergency medical treatment to people trapped or injured in collapsed buildings [20, 21]. They are responsible for making critical decisions within tight time constraints, striving for a shallow margin of error [22, 23].
The second group comprises nursing staff who are pivotal in responding to the multifactorial challenges caused by disasters. They can support medical doctors and provide physical and psychological care to the injured [24, 25]. These group members also play critical roles in preparing for and responding effectively to disasters in hospitals and communities [26, 27]. However, studies indicate that nursing staff is not adequately prepared to respond to the complex demands of disasters [28–30] due to insufficient integration of national disaster policy frameworks [31].
Mass casualty events related to disasters present numerous challenges that well-trained leaders can only effectively manage [32]. That is why we have designated hospital managers and leaders of rescue teams as a distinct category. These events often result in patient surges that overwhelm hospital resources, space, and staff, necessitating courageous decision-making in the face of scarce resources. Influential leaders must think several steps ahead and assume critical roles in planning, collaborating, communicating, and preparing the rescue process [33–35].
Dentists are essential healthcare team members, yet their role has not been emphasized in disasters. It has primarily been confined to the traditional forensic odontology in identifying victims after disasters [36]. However, subsequent experiences have demonstrated the successful utilization of dentists in the disaster emergency medical response system [24, 37, 38]. The findings of the current study highlight the importance of a specific set of competencies that define dentists as vital contributors to medical surge events during active disaster response. This is due to their continuous learning, competence in evidence-based practice, and ability to implement scientific research findings [39, 40].
Pharmacists contribute significantly to disaster response efforts by effectively collaborating with other healthcare providers. Their responsibilities extend beyond dispensing medications under established protocols. Pharmacists also offer counseling and guidance to patients regarding medication usage, addressing any concerns or queries related to treatment and medications [41, 42].
Medical students can assist in mass casualty situations under proper medical supervision when hospitals are overwhelmed. Well-prepared medical students can contribute effectively to disaster response efforts [43–45].
The on-site disaster team constitutes a multidisciplinary team responsible for providing on-scene care. They serve as the first line of defense in managing the increasing number of patients during such disasters. Ensuring the safety of these responders is a priority, necessitating the use of personal protective equipment, measures to mitigate the risk of injury, and comprehensive training to manage stress effectively [46]. Disaster responders should perform triage, as patients with life-threatening injuries require immediate stabilization and evacuation to more advanced healthcare facilities [47].
Psychological support professionals are critical in offering PFA as a vital intervention in providing early psychological assistance to survivors of natural disasters during the initial response [48]. PFA can be administered by mental health professionals and 'peer responders' such as volunteers, first responders, and even public members [49]. PFA aims to promote safety, stabilize disaster survivors, and connect them with necessary support and resources [50]. Psychological support providers are also responsible for conducting mental health and psychosocial needs assessments, organizing healing activities for children, offering support to staff and volunteers, and providing essential psychological information to the affected population [51].
Allied healthcare professionals and other stakeholders, including volunteers, non-governmental organization staff, and civil defense members, can effectively assist the medical team if they are well-prepared [5, 52].
The classification we have adopted for preparing the team for the rescue process during and after the earthquake can ensure a comprehensive perspective of the rescue process and proper preparation for future disasters. Each category was then subdivided according to the three domains of learning: knowledge (cognitive), skills (psychomotor), and attitudes (affective) [53]. The presence of these abilities together in the health worker will help maintain patients' physical and psychological health during earthquakes.
Furthermore, based on the work of George Miller [25, 53], we evaluated each competency for each role of health workers and adopted a relevant hierarchy as proposed; non-essential, familiar, knowledgeable, and competent. Logically, not all health workers should develop all the competencies identically. For example, in the hospital, doctors must provide skilled professional medical care to the injured. However, dealing with survivor detection equipment is non-essential for them, as it is a critical task of the on-site disaster team.
The literature shows a previous qualitative study [25] conducted in Iran on nurses during the Kermanshah earthquake in 2017 to identify core competencies for nurses during earthquakes. The study concluded that many essential competencies are classified into four groups: clinical competency (cardiopulmonary resuscitation skills and airways management), personal competencies (communication skills, resiliency, and creativity in providing care), ethical competencies (commitment to ethics and professional responsibility), and fundamental caring skills (triage, psychological care, and monitoring skills) [25].
Another study undertaken by a multidisciplinary expert working group representing clinical medicine, nursing, public health, adult education, and emergency management identified 11 core competencies and 36 sub-competencies required for health workers during disasters. These competencies provide a useful starting point for delineating the expected competency levels of health professionals in disaster medicine and public health [6].
The healthcare system in Syria, like all aspects of life, has been severely damaged due to more than a decade of conflict. The most pressing challenge facing the Syrian healthcare system is the lack of medical resources due to long-lasting sanctions [54]. In addition, up to 50% of the health facilities have been destroyed, including Al-Kindy Hospital, the largest hospital in the Middle East, located in northern Syria, which was destroyed during the armed conflict in late 2013 [55]. The scarcity of healthcare professionals is a pressing issue in Syria as many have left the country searching for better opportunities [56, 57], leading to an exodus of almost 70% of medical personnel [55]. Consequently, there is a chronic shortage of healthcare personnel and an increased workload on the remaining medical staff [55]. To address this chronic challenge, serious steps should be undertaken to enhance the healthcare system in Syria and increase the preparedness of medical teams to face disasters.
In this study, the selection of experts, with several perspectives, opinions, and multidisciplinary backgrounds, has enabled us to identify members who should appropriately respond during the earthquake and to provide a comprehensive list of competencies required for providing the best care and medical support to affected people. However, for the sake of completeness, future work should take into consideration involving patients and their families, who experienced earthquakes to further improve understanding of their challenges and needs. This can provide valuable insights into the competencies needed by health workers in such situations.