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Disaster Management Education and Training for Paramedics: A Scoping Review

Published online by Cambridge University Press:  25 July 2025

Mohammed Ali Alqahtani Open the ORCID record for Mohammed Ali Alqahtani [Opens in a new window] ,
Adem Sav  and
Ghasem (Sam) Toloo
Mohammed Ali Alqahtani*
Affiliation:
School of Public Health and Social Work, Faculty of Health, Queensland University of Technology , Brisbane, Australia Department of Emergency Medical Care, College of Applied Medical Sciences, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
Adem Sav
Affiliation:
School of Public Health and Social Work, Faculty of Health, Queensland University of Technology , Brisbane, Australia
Ghasem (Sam) Toloo
Affiliation:
School of Public Health and Social Work, Faculty of Health, Queensland University of Technology , Brisbane, Australia
*
Corresponding author: Mohammed Ali Alqahtani; Email: maa.alqahtani@hdr.qut.edu.au
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Abstract

Objectives

The aim of the present scoping review is to provide a comprehensive description and classification of the published research studies on education and training of paramedics and paramedic students in the context of disaster management with emphasis on educational/training techniques and their efficacy and the recent trends in this evolving field. The review is also designed to identify the main research gaps and to suggest recommendations for future research plans.

Methods

PubMed, Web of Science Core Collection, Scopus, Google Scholar, and ProQuest Dissertations and Theses were searched. Studies were included in the final analysis if they studied any aspect of paramedics or paramedic students’ education or training in the context of disaster management.

Results

Forty-three studies fulfilled the selection criteria. Three themes were identified: 1) Conventional disaster education/training techniques; 2) Smart technology-based disaster education/training techniques; and 3) Development of and/or assessment of disaster education/training courses, programs, packages, or curricula.

Conclusions

While disaster triage training is the focus of many studies, a new trend is emerging that integrates smart technology into educational and training programs. Also, there is increasing international interest in developing disaster training programs and curricula.

Keywords

paramedicsdisasterdisaster educationdisaster training

Information

Type
Systematic Review
Information
Disaster Medicine and Public Health Preparedness , Volume 19 , 2025 , e207
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

The Sendai Framework for Disaster Risk Reduction asserts that minimizing the loss and damage from disasters requires building resilience through an all-of-society engagement and integrated efforts of all stakeholders at international, national, and local levels, including the health sector. 1 This approach emphasizes that disaster risk management must start well before a disaster strikes, and continue during and after the event.Reference Bedi, Vijay and Dhaka 2 However, studies show that medical facilities, health workers, and support staff are insufficiently prepared to handle major emergencies and disasters.Reference Alruwaili, Islam and Usher 3 –Reference Samei, Babaie and Sadegh Tabrizi 7 Factors affecting disaster preparedness may include governmental efficiency, standardized guidelines and plans, sufficient resources, adequate communication systems, and education and training. The latter is the cornerstone of competent emergency services and is a proven approach to enhance disaster preparedness.Reference Beyramijam, Farrokhi and Ebadi 4 , Reference Almukhlifi, Crowfoot and Wilson 5

Paramedics are traditionally involved in the primary assessment of the incident scene, triage, providing essential care and transport of victims.Reference Horrocks, Hobbs and Tippett 8 They are required to enhance their knowledge and skills in disaster risk management process for an optimal performance in such highly demanding conditions.Reference Baetzner, Wespi and Hill 9 However, little is known about specific and standardized disaster training programs for paramedics, and the extant educational and training plans show many variations and inconsistencies.Reference Horrocks, Hobbs and Tippett 8

The objectives of the present review are to provide a comprehensive description and classification of the published research on education and training of paramedics and paramedic students in the context of disaster management with emphasis on educational/training techniques and their efficacy and the recent trends in this evolving field, to identify the main research gaps, and to suggest recommendations for future research plans.

Methods

The present review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.Reference Tricco, Lillie and Zarin 10

Search Strategy

Five databases were searched for relevant studies, including PubMed, Web of Science Core Collection, Scopus, Google Scholar, and ProQuest Dissertations and Theses. Search terms were developed using keywords combinations and Medical Subject Headings (Mesh) terms for the concepts of paramedics, disaster, and education/training. Search concepts and relevant search terms are listed in Table 1.

Table 1.

Search concepts and terms

Search was limited to studies published in English language from January 2010-August 2024. Journal articles, conference papers, and non-peer reviewed theses and dissertations were included. Search strategies used in different databases are shown in Table 2. All obtained results were imported to Endnote and duplicates were identified and removed using automated function and manual screening. Considering the large number of results obtained by Google Scholar, we imported only the first 500 results to the reference manager. Haddaway et al.Reference Haddaway, Collins and Coughlin 11 recommended to focus on the first 200-300 results in Google Scholar search for grey literature.

Table 2.

Search strategies, keywords, and number of results retrieved from each database for the scoping review (2010–2024).

* First 500 results included in identification of new studies via databases.

Inclusion and exclusion criteria

Studies were included in the final analysis if they studied any aspect of paramedics or paramedic students’ education or training in the context of disaster management. In addition, they should be published in English with available full text. Studies were excluded if paramedics were not explicitly stated in the study sample, if they described training or educational interventions not specifically practiced during disaster management, or if they studied general aspects of paramedic education and training not specific for disaster management scenarios.

Data charting, analysis, and synthesis of results

The first author initially developed a preliminary data-charting form that was used to extract data from included studies. The form and the extracted data were then shared with the other 2 authors who independently reviewed the chart and the extracted data. The reviewers’ recommendations were discussed collaboratively until a consensus was reached. Then, both the chart and extracted data were refined and updated. Extracted data included general descriptive data (first author, year of publication, type of publication, country of origin), methodological data (design, scenario/context, sample), and main outcome findings. Data were thematically analyzed to identify themes and subthemes. Finally, results were qualitatively synthesized, summarized, and presented.

Results

Search Results

Search identified 3107 records from all databases which were reduced to 2459 records after electronic and manual removal of duplicates. Application of inclusion and exclusion criteria on titles and abstracts of these records identified 99 records that required further screening of full texts. Forty-three studies were included in the final analysis (Figure 1). The included studies were published as journal articles (90.7 %) and conference papers (9.3 %).

Figure 1.

PRISMA flow diagram illustrating the process of study selection for the scoping review on disaster management education and training for paramedics (2010–2024).

General Characteristics of Included Studies

The studies belonged to 19 countries including the US (41.9 %), Saudi Arabia (11.6 %), Germany (7.0 %), and others. The study design widely varied according to the study purpose and context. Quasi-experimental design using pretest-posttest or within-subjects analysis was used in 37.2 % of studies while mixed methods were used in 32.6 % and randomized design was used in 20.9 %. The study sample in only 37.1 % of studies exclusively included paramedics and/or paramedic students, while in other studies, they were recruited among other professionals.

Identified Themes and Subthemes

Studies were categorized under 3 themes: 1) Conventional disaster education/training techniques; 2) Smart technology-based disaster education/training techniques; and 3) Development of and/or assessment of disaster education/training courses, programs, packages, or curricula.

Theme 1: conventional disaster education/training techniques

This theme included 25 studies investigating the value of various types of education/training techniques on knowledge and performance of participants. The theme was subdivided into 2 subthemes:

Subtheme 1A: disaster triage education/training techniques. Fifteen studies were categorized under this subtheme. The studied techniques included role playing and educational video,Reference Aghababaeian, Sedaghat and Tahery 12 mixed-methods simulations,Reference Cicero, Brown and Overly 13 video game,Reference Cicero, Whitfill and Munjal 14 screen-based simulation,Reference Cicero, Whitfill and Walsh 15 , Reference Cicero, Whitfill and Walsh 16 educational review session and/or aide-memoir,Reference Cuttance, Dansie and Rayner 17 brief lecture,Reference Deluhery, Lerner and Pirrallo 18 visually enhanced mental simulation,Reference Demir, Tunçbilek and Alinier 19 serious gaming and card-sort exercise,Reference Knight, Carley and Tregunna 20 and others. Generally, use of these techniques resulted in improved triage accuracy. However, in comparative studies, the difference between techniques varied. Importantly, Ghazanfar et al.Reference Ghazanfar, Fares and Mubarak 21 highlighted the decline of knowledge retention 60 days after triage training. Dittmar et al.Reference Dittmar, Wolf and Bigalke 22 emphasized the value of yearly refresh training in improving triage accuracy. More details of these studies are shown in Table 3.

Table 3.

Summary of included studies (n = 43)

Abbreviations: ALS: Advanced life support, BLS: Basic life support, EMT: Emergency medicine technician, FAST: Focused Assessment with Sonography in Trauma, MCI: Mass casualty incident, RN: Registered nurse, RTs: Respiratory therapists, SALT: Sort–assess–lifesaving interventions–treatment/transport, START: simple triage and rapid treatment, VR: Virtual reality.

* Conference paper

Subtheme 1B: other types of disaster education/training interventions. Ten types of interventions were discussed in the studies that belonged to this subtheme. They included in situ simulation for Covid-19 pandemic preparedness,Reference Aljahany, Alassaf and Alibrahim 23 multimedia cholinergic crisis management training,Reference Andreatta, Klotz and Madsen 24 drills for pediatric disaster preparedness,Reference Cicero, Golloshi and Gawel 25 stadium patient evacuation simulation,Reference Gangaram, Thomson and Morris 26 hazardous area response team training,Reference Huabbangyang, Nomrabporn and Chiraratchawarich 27 interprofessional disaster training,Reference Innis, Mack and Bull 28 active shooter incidents training,Reference Jones, Kue and Mitchell 29 mass destruction weapons events training,Reference Motola, Burns and Brotons 30 ultrasound simulator for FAST skills training,Reference Paddock, Bailitz and Horowitz 31 and incident command training.Reference Shulman, Jaffe and Perry 32 These interventions resulted in improved knowledge, performance, or collaboration among participants (Table 3).

Theme 2: smart technology-based disaster training techniques

Eleven studies documented various aspects of smart technology applications in disaster training. These applications included virtual reality (VR),Reference Berndt, Wessel and Mentler 33 –Reference Vogt, Boer and de Boer 41 , Reference Asadzadeh, Samad-Soltani and Rezaei-Hachesu 73 smartphone-based training,Reference Bauchwitz, Nguyen and Woods 42 and Google Glass telesimulation.Reference McCoy, Alrabah and Weichmann 43 Authors of these studies generally warned that while use of these technologies proved to be useful, they can’t replace real-world training, and they need further improvement and enhancement (Table 3).

Theme 3: development of and/or assessment of disaster education/training courses, programs, or curricula

The third theme included 7 studies that described the development of detailed disaster education/training courses, programs, or curricula, or assessed the performance and gaps in existing ones. Alnoaimi et al.Reference Alnoaimi, Hart and Issa 44 assessed the expatriate prehospital provider training curricula in Bahrain. They showed that these curricula lacked coverage of many core competencies (e.g., critical thinking and decision-making skills) as compared to national curricula.

Bajow et al.Reference Bajow, AlAssaf and Cluntun 45 described the development of a major incident management course, while Bajow et al.Reference Bajow, Alawad and Aloraifi 46 reported their experience with development of a humanitarian health emergency and relief course. Sultan et al.Reference Sultan, Carlström and Sorensen 47 identified multiple gaps in disaster and emergency medicine curriculum in Saudi Arabia. Bhattacharya et al.Reference Bhattacharya, Singh and Semwal 48 documented details and implementation of a training program for disaster preparedness in India. Caviglia et al.Reference Caviglia, da Silva-Moniz and Venturini 49 described the development of a prehospital disaster training package in Sierra Leone.

Discussion

Studies included in this review were conducted in 19 countries across the globe. However, 41.9% of these studies were conducted in the US. This may be related to the continuously rising threat of some disastrous events in the country, including catastrophic tropical cyclonesReference Lau, Yip and Dulebenets 50 and mass shootings.Reference Schwerin, Thurman and Goldstein 51 The US also provides multiple graduate programs in all aspects of disaster management. 52

Saudi Arabia ranked second after the US, which may be explained by the fact that the Kingdom was one of the most affected countries by Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection.Reference Shapiro, London and Nigri 53 Also, the annual complex and unique challenges of the Hajj enhanced the academic and governmental interest in improving the preparedness against the different health threats related to such mass gathering events.Reference Khan and Noji 54 –Reference Taibah, Arlikatti and Andrew 57 Moreover, it is clear that most studies were performed in high-income 58 countries while only few studies were conducted in developing countries. Unfortunately, this finding is not new. In one study, it was found that less than 1% of disaster-related research was conducted in developing countries even though these countries are the scene of about 85.% of world disasters.Reference Roy, Thakkar and Shah 59

Fifty eight percent of studies are related to Theme 1, with most of them focusing on disaster triage training. This is not surprising considering the vital role of triage accuracy in such situations and the necessity of improving triage skills of first responders.Reference Ghanbari, Ardalan and Zareiyan 60 , Reference Yang and Kim 61 In fact, poor prehospital disaster triage efficiency is associated with unfavorable clinical outcomesReference Cicero, Santillanes and Cross 62 , Reference Yang and Kim 61 and inefficient resource utilization.Reference Killien, Mills and Errett 63 Educational and training activities reported by different studies resulted in positive impact either on the knowledge or the performance of the trainees. However, the study design of many studies listed under this theme was quasi-experimental design using pretest-posttest or within-subjects analysis and fewer studies followed randomized design. While randomized design is considered the optimal design for interventional studies, implementation may be hindered by logistic or ethical obstacles.Reference London, Omotade and Mello 64 The main shortcoming of quasi-experimental designs is the presence of unequivocal comparative groups.Reference Handley, Lyles and McCulloch 65 Following within-subject analysis is arguably related to false or biased conclusions particularly when used in studies based on educational or training interventions.Reference Lambdin and Shaffer 66 –Reference Charness, Gneezy and Kuhn 68 Pretest-posttest design also has multiple inherent flaws.Reference Stratton 69 Unfortunately, these study design issues are frequently encountered in the prehospital care and paramedical research and can affect the quality of evidence that can be derived from these studies. Martin-Gill et al.Reference Martin-Gill, Brown and Cash 70 recognized multiple gaps in the quality of recommendations suggested by many prehospital care guidelines. They highlighted the value of using high-quality research in development of these guidelines. Also, McDonald et al.Reference McDonald, Little and Kriellaars 71 identified the lack of standardization in paramedicine research in terms of variables, methods, quality thresholds, and used terminology.

Many studies included in this review showed the effectiveness of integrating technological innovations in paramedics education and training for disaster management. Reference Magi, Bambi and Iovino72-Reference Wang and Jahng 74 The continuous improvement of VR and augmented reality (AR) technologies is particularly attractive in disaster education and training considering the cost and the demanding logistic requirements of conventional real life training methods.

Notably, 37% of the studies exclusively included paramedics or paramedic students, and in other studies, they were part of multi-professional samples. Considering the important direct role paramedics play in disaster management, further research specifically designed with paramedics’ needs for disaster risk management knowledge and skills may be required. One of the hurdles against development of dedicated paramedicine research is the inflexible adoption of hospital care principles into the prehospital setting without considering its distinctive features.Reference Bigham and Welsford 75 A multidisciplinary approach that involves academic institutions, paramedicine researchers, and industry leaders may provide a platform to build reality-based paramedicine research agendas at the national and international levels.Reference O’Meara, Maguire and Jennings 76 –Reference Schmitt, Moore and Heath 78

Limitations

The findings of the present review may be limited by search strategy restriction to studies published in English. This may lead to missing important data published in other languages. Also, the review focused on paramedical education and training in the field of disaster management, which essentially requires multidisciplinary approach.

Conclusions

The present scoping review highlights the main features of published studies in the evolving field of disaster education and training for paramedics and paramedic students. While traditional disaster triage education and training is the main subject of many studies, there is increasing interest in development of new training tools integrating AR and VR into the educational and training programs. There is a trending international interest in development of national disaster management education and training programs and curricula.

Recommendations

Development of a comprehensive agenda that integrates paramedicine research in multidisciplinary disaster management is highly recommended. Assessment of the efficacy of educational/training interventions through randomized controlled studies is also encouraged. International initiatives are needed to promote paramedicine research in disaster management, particularly in developing countries. More integration of technological advancements, especially VR, is advisable to overcome multiple shortcomings related to conventional training protocols.

Author contribution

All authors contributed to conceptualization, formal analysis, drafting, and final revision of this review.

Competing interests

The author(s) declare none.

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Figure 0

Table 1. Search concepts and terms

Figure 1

Table 2. Search strategies, keywords, and number of results retrieved from each database for the scoping review (2010–2024).

Figure 2

Figure 1. PRISMA flow diagram illustrating the process of study selection for the scoping review on disaster management education and training for paramedics (2010–2024).

Figure 3

Table 3. Summary of included studies (n = 43)