Enhancing Communication Between Military and Civilian Responders In Large-Scale Disasters

Theoretical Background and research questions/hypothesis:  Emergency response operations represent a strategic imperative for the nation’s health. Numerous reports have cited the communication failures experienced during the civilian and military interface in response operations during times of crisis, as recently evidenced with Hurricane Katrina. Funded by the United States Department of Defense, this research identified training needs to ensure that civilian responders can interface effectively with military operations in the event of a catastrophe.    Research questions:

• 1) What key knowledge, skills, and proficiencies are desired of physicians, nurses, allied health professionals, public health professionals, and emergency responders to ensure effective medical evacuation in a catastrophe requiring military support (typically aeromedical evacuation)? 
• 2) What gaps exist in current training content for the target population?
• 3) What training standards, methods, formats, programs will produce desired improvement in requisite knowledge, skills, and proficiencies among the target population? 

Methods: A triangulated approach was used to identify current critical gaps in training of civilian responders.  A panel of experts included civilian and military practitioners, public health and emergency system administrators, and researchers, who provided their perspectives on critical aspects of communication and service coordination.  Secondly, two focus groups with military medical transport personnel and civilian health professionals were conducted to identify gaps in coordination, required proficiencies, and training needs.  Finally, a web-based survey with civilian medical practitioners and public health professionals  (n=673) from two regions of the US (southeast and mid-west) provided their perceptions of issues and training needs related to civilian-military interface in disaster response.

Results:  Findings were consistent among all three data formats. Both military and civilian respondents identified communication as the primary area of need. Specifically, the experts and focus groups pointed to an abundance of military acronyms, unrealistic expectations, and disparate cultures. Survey data indicated a significant knowledge gap of civilian healthcare providers to effectively communicate with military healthcare providers.  Nearly three-fourths of respondents believed they were not well-trained to work with the military during a disaster response or were unsure whether or not they were well-trained for a disaster response partnership. The survey identified the following key areas for training: (in rank order) communication, chain of command during a disaster, and logistics of working with military personnel.  Desired training formats included interactive role play with simulated conditions.    

Conclusions: Poor communication is the most critical barrier to effective coordinated response between military and civilian responders in federal disaster response. Training formats need to provide experiential learning in communication, shared expectations, and an appreciation of military culture.

Implications for research and/or practice:  Identifying gaps and training needs for civilian medical responders has far-reaching implications in public health’s ability to coordinate medical response as part of Emergency Support Function (ESF)-8.  Results from this study have informed the development of an interactive civilian emergency responder training program that addresses communication (oral and non-verbal), realistic expectations regarding logistics and military culture, and comprehensive chain of command to promote an effective interface between civilian and military operations during a catastrophe.