UK Approaches in Disaster Medical Education

Disaster medicine has been practiced for as long as medics have been rising to the challenge of treating patients among the devastation caused by both natural and man-made catastrophes. Now, however, there is increasing awareness of the diverse skills required to intervene effectively during catastrophic events and of the necessity to: (a) formalize and evaluate the training of healthcare professionals in the field; (b) recognize the collection of skills and training necessary to establish the specialty or subspecialty of Disaster Medicine; and (c) ensure the ubiquity of essential disaster-response knowledge and skills among those who will be called upon to provide that response. In other words, disaster response should not be haphazard but, rather, both structured and efficient, with skilled leaders to manage it.

The United Kingdom is often found at the sharp end of such disaster medicine theory and practice – e.g., during the Blitz of World War II, the terrorist attacks of recent years, military commitments in Iraq and Afghanistan, and the London riots earlier this month. In addition, centuries of independent medical tradition and a unique nationalized health system have produced catastrophe planning and response systems that are often both innovative and unusual.

Today, as disaster medicine approaches the formal academic recognition in Britain it already has in the United States, the timing is ripe to explore the similarities and differences – in both thinking and practice – between the two nations. Accordingly, this article presents a summary of some of the United Kingdom’s key paradigms in education for disaster medicine, introduces a new and unique degree-level leadership course, and discusses the value to educators (on both sides of the Atlantic) of exploring overseas models in this way.

The University of London’s New BSc in Leadership in Disaster Medicine Recognition of the importance of teaching disaster medicine in the undergraduate medical curriculum led to development – at St. George’s, University of London, Centre for Trauma, Conflict & Catastrophe – of the intercalated BSc in Leadership in Disaster Medicine. The new BSc course aims to enhance the knowledge, skills, and careers of potential future leaders in the field of disaster medicine.

The foundation module – with teachings on security and survival, clinical casualty management, incident management and mass-casualty planning, tropical medicine, extreme medicine, and public health in disasters – is delivered through a series of lectures, seminars, and topical debates, supported by practical and tabletop exercises.

Most sessions focus on leadership, management, and decision-making in national and international disaster responses. In addition, opportunities will be facilitated for students to undertake attachments and visits to influential players in disaster response – such “players” including but not necessarily limited to international and nongovernmental organizations, and government departments, as well as journals published with a focus on disaster medicine. The University encourages students to undertake relevant research or literature review and helps them get their work related to the course published.

Diploma in the Medical Care of Catastrophes (DMCC) The DMCC was instituted in 1993 by the Faculty of Conflict and Catastrophe Medicine at the Society of Apothecaries, one of London’s livery companies dating from 1617. This postgraduate diploma is aimed at individuals who provide medical, surgical, and public health response to environmental and man-made disasters including conflict, both at home and overseas.

A part-time one-year instructional course prepares doctors, dentists, nurses, and paramedics for the final examination with modules on the epidemiology of disasters, priorities for intervention, the disaster environment, the specialized application of clinical knowledge, and team security. The examination consists of a written article and a series of objective-structured clinical examinations in which candidates are questioned on their detailed knowledge of areas such as medical planning for mass gatherings and triage in the disaster setting.

Major Incident Medical Management and Support (MIMMS) Offered by the Advanced Life Support Group at numerous centers in the United Kingdom and worldwide – and with military adopters, including the North Atlantic Treaty Organization (NATO) – MIMMS is a three-day course teaching a practical approach to on-the-scene response operations by healthcare professionals. MIMMS is centered on an “all hazards” model – i.e., a systematic approach flexible enough to be applied to any major incident.

Here it should be noted that a “major incident” is the preferred term in Britain for an emergency that requires the commitment of extraordinary resources and/or special arrangements from relevant services.

Teaching is delivered through lectures, tabletop exercises, practical workshops, and a field exercise and is supported by an extensive manual, currently going into a third edition. Topics covered include: (a) the organizational structure of relevant health, emergency, and support services; (b) appropriate preparation of personal, medical, and communications equipment; (c) priorities and approaches at the scene; and (d) practical radio skills and clinical procedures.

Attention also is given to the media, hospital response, and psychological aspects of a particular situation. HMIMMS – a two-day version of the course tailored to hospital rather than pre-hospital providers – is also offered, and teaches a similar intra-operable approach. Abbreviated one-day versions of both courses are also available.

The Royal Society of Medicine’s Catastrophes & Conflict Forum The Royal Society of Medicine in London – founded over 200 years ago – is one of the major providers of continuing medical education in the United Kingdom. Members – including doctors, dentists, veterinary surgeons, students of these disciplines, and allied healthcare professionals – are offered numerous educational resources and events by a number of specialty interest groups operating under the Society’s aegis.

One such group is the Catastrophes & Conflict Forum. Recent events offered by the Forum and its partners have covered areas such as: improvised explosive devices and blast injuries; nuclear and radiological threats; and humanitarian opportunities overseas. The Society also occasionally arranges landmark international events with overseas partners, such as the 2007 Conference on Disaster Management, jointly convened with the New York Academy of Medicine.

Learning about the educational models of other nations provides a useful set of reference points for the critical appraisal of domestic approaches. Those interested in disaster medicine education – or domestic preparedness education in general – may wish to consider whether U.S. and UK paradigms in these areas can usefully influence each other. Such cross-fertilization ofeas may of course be limited by differences in national healthcare and government systems, as well as by socioeconomic and cultural factors, but in an age of international humanitarian and military cooperation, at least some degree of harmonization may be considered desirable in this field as well. To take but one example: The variety of triage systems used across the world means that a given triage category can have some rather different meanings to American and British responders. Accordingly, working toward the standardization of such models may be a valuable activity for educators around the world.


For additional information: On The Royal Society of Medicine, visit

On the Advanced Life Support Group, visit

On The Society of Apothecaries

James M. Matheson

Dr. JamesM Matheson, BA (Hons), MBBS, DMCC, is a member of the council of the Catastrophes & Conflict Forum of the Royal Society of Medicine and the Faculty of Conflict and Catastrophe Medicine at the Society of Apothecaries of London. He lectures on the Leadership in Disaster Medicine BSc at St. George’s, University of London, and has jointly edited Making Sense of Disaster Medicine, an undergraduate medical textbook.

Robert Stellman

Dr. Robert Stellman, MA (Hons, Cantab), MB, BS (Dist.), DPMSA, is a member of the governing Council of the Catastrophe & Conflict Forum. Involved in pre-hospital work for several years, he gained his medical degrees at the University of Cambridge and University College London. He received disaster medical training in both the United Kingdom and United States, as well as elsewhere around the world, and has gained ADLS, ADMR, DMEP, and MIMMS-Commander accreditation, among other qualifications. His research on cross-Atlantic approaches in disaster medicine won funding from the Drexler Foundation of the Royal College of Surgeons of England, and other institutions.



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