Strengthening Disaster Preparedness and Response in the Northern Mariana Islands Through First Aid Training

Publication Date: 2023

Translating Research Into Action

This curriculum was developed to teach disaster response first aid skills to Northern Mariana Islands residents in order to save lives during disaster and make communities more resilient. The curriculum consists of 12 modules that can be viewed by clicking the image below.

Basic Disaster First Aid Curriculum

Introduction

Our original Public Health Research Award study—Community First Aid Training: A Tool To Strengthen Community Resilience—was successful in providing Disaster Response Advanced First Aid (DRAFA) instruction to residents of the Commonwealth of the Northern Mariana Islands (CNMI). The initial research demonstrated that participants in the DRAFA course found it worthwhile, rating the quality of the class as 9.85 out of 10. However, the project’s broader public health goal to provide disaster first aid training to a representative group of CNMI residents could not occur because the three-day length of DRAFA course proved to be too long for most community members who are not employed in emergency management or public health fields due to their busy lives. And while there was participation from all three of the most-populated Northern Mariana Islands, very few women participated. In fact, 90% of the DRAFA trainees were males.

This project attempted to address those shortcomings by using curriculum mapping and input from local experts to create a more customized, practical course, which we titled Basic Disaster First Aid. After updating the curriculum, we used a train-the-trainer model to teach local experts how to give the course to community members in the places they live and other nearby locations. Next, we offered two full-length Basic Disaster First Aid courses to the general public, which allowed us to test the curriculum in real time and gave new instructors an opportunity to practice their teaching skills under our supervision and gain confidence. Coaching during these pilot courses was provided by the first author, the original developer and long-time instructor of the DRAFA curriculum.

The recipients of the train-the-trainer course rated its overall quality as a 9.8 out of 10. Community members who participated in the pilot Basic Disaster First Aid courses rated their overall quality as 9.3 out of 10 for the first session and 9.7 out of 10 for the second. The improvement between the first and second sessions demonstrates how the new instructors improved with coaching and practice.

The newly trained instructors came from all three of the most populated Northern Mariana Islands. In addition, as opposed to the initial DRAFA training, nearly 40% of the community members who took the Basic Disaster First Aid pilot courses were women.

Community Partners

Community partners were absolutely essential in the success of our project. Our community partners included the following local organizations:

• Northern Marianas College
• CNMI Fire & Emergency Medical Services
• CNMI Homeland Security and Emergency Management
• Rodgers Educational Consulting
• American Red Cross of the Northern Marianas Chapter

These organizations led the efforts in identifying and recruiting experts to review the curriculum and become instructors. They also provided marketing to attract community participants to the pilot Basic Disaster First Aid classes. Northern Marianas College provided the classroom, photographers and videographers to document the training, and a vehicle for use during the week-long program.

The experts who reviewed the curriculum and took the train-the-trainer class were largely employees of these organizations. These employees were key to both the design and implementation of the project. The organizations allowed these employees to participate and count it as part of their regular workday. In short, the project would have been impossible without their strong contributions.

With the exception of the Red Cross, all organizations were involved in the initial project and were as integral to its success as they were to this present project. The organizations were contacted initially by the Cooperative Research, Extension, and Education Services (CREES) staff at Northern Marianas College. They used their rich network and deep local knowledge to help connect many of the other players.

Project Objectives and Activities

At the outset of our award, we outlined the following objectives and activities:

• Recruitment of Experts: Recruit 6-12 CNMI leaders, particularly those who have previously taken DRAFA, or those intimately familiar with the disaster hazards facing the CNMI, to serve on a review panel.
• Curriculum Mapping: Convene a meeting of DRAFA alumni and CNMI leaders to use curriculum mapping to review the DRAFA curriculum to make it more relevant and practical for use in the CNMI. Participants will rate the experience at least an 8/10 in terms of overall experience value.
• Draft Basic Disaster First Aid Curriculum: Adapt and customize the DRAFA curriculum into a disaster-response first aid class for the Northern Mariana Islands based on the local expert review and the feedback, ensuring that the new curriculum is customized to the local context and shortened so that non-specialist community members and non-medical first responders are able to take it.
• Train the trainers: Work with DRAFA alumni to train at least four new instructors in how to deliver the Basic Disaster First Aid course.
• Pilot the New Course: Teach two sessions of the newly designed, customized disaster-response first aid course to community laypeople and non-medical first responders.
• Train Community Members: Train at least 24 non-specialist community members in Basic Disaster First Aid, significantly increasing their disaster-response first aid knowledge and ensuring that they rate the course’s value and quality as at least an 8/10.
• Document Curriculum Development Process: Describe the curriculum mapping process used to customize the DRAFA curriculum with the goal of developing generic recommendations for other locales.

To realize these objectives, our community partners helped us identify several local disaster and emergency medical services (EMS) experts. We were able recruit seven of these identified local experts to review the original DRAFA curriculum and led them through a process of curriculum mapping. The local experts helped us to identify the most important components of the three-day DRAFA course and shorten it to a six-hour class. They also provided insight in how to customize the content to the CNMI context. In the end, DRAFA was transformed into the Basic Disaster First Aid course.

Next, our local partners recruited ten DRAFA alumni and review experts to participate in the train-the-trainer class to prepare them as instructors and publicized two pilot courses to the community. These two classes were held, one on a weekday and one on a weekend day, March 17 and 18, 2023. Finally, the new instructors and community partners reviewed the process and made recommendations for future classes in the Northern Mariana Islands and beyond.

Results

We assessed our ability to meet our project objectives based on the numbers of experts, instructors, and community members involved and participant feedback forms, which had both qualitative and quantitative questions. Our project produced a number of outputs, allowing us to come close to completely achieving our desired outcomes.

In terms of outputs, we recruited a strong and sufficiently large team of experts to review the curriculum. We convened several meetings to review the curriculum. The curriculum mapping process was not as valuable as we had hoped, but it still was helpful in the process, allowing us to quickly adapt DRAFA into the more focused and shorter Basic Disaster First Aid class. Ten disaster or EMS experts from all three of the most populated islands received the train-the-trainer course, preparing them to teach the revised curriculum. Local partners promoted the two pilot Basic Disaster First Aid classes throughout the community using posters. Their efforts led to the enrollment of 48 community members in the two classes. The Northern Marianas College also developed two marketing recruitment videos that will be used to promote future classes. We have embedded those videos in this webpage for readers to view.

The project resulted in a number of very positive outcomes, in addition to developing the new course, Basic Disaster First Aid. For example, we brought together educational, disaster, and EMS experts from across the Northern Mariana Islands, strengthening community connections and enhancing networks. Moreover, the curriculum development process and the curricular outcome can serve as a model for other communities.

In summary, as one of our community partners put it:

We have been able to enhance our capacity to help elevate the skillsets of our people. We are excited and looking forward to implementing Basic Disaster First Aid in communities across the Northern Mariana Islands starting with the most vulnerable areas.

Reflections and Lessons Learned

In reflection we learned a number of valuable lessons. To begin, we learned that the opportunity provided by a Continuation Award is a deal changer. Without that additional support, the original, but very preliminary, results of our disaster resiliency project would have lacked sustainable implementation.

We learned that the curriculum mapping process offered a helpful model for refining our original work to a more focused and practical course. However, curriculum mapping is largely designed for aligning different curricula, and is therefore not recommended for future efforts to customize disaster first aid curricula to new locales.

We had recognized that the three-day DRAFA class was too expensive and time consuming to be practical for busy non-specialist community members. Thus, we aimed to shorten the course so that it could be conducted during an evening or half day. We didn’t quite meet that goal but did go from a three-day course to a six-hour one.

However, in reviewing feedback from the newly trained instructors who taught the pilot classes and the community members who participated, we learned that even six hours was too short to cover the vital information of a quality disaster first aid class. Instead, we have concluded that the Basic Disaster First Aid curriculum should be revised so that the course is delivered as an eight-hour class, still allowing it to be completed in one day (or over several evenings), while allowing a more relaxed pace, more time for skills practice, and time for scenarios.

We also recognized during the original project that it was too expensive and unsustainable to rely on outside experts to teach the classes. It was clear to us that the answer was to train local disaster or EMS experts to provide this service. In the two pilot classes, this approach proved to be very successful. Based on feedback from community members who took the class, as well as from the lead author, who developed the original curriculum and had taught the class multiple times, the local experts knew their material well, but could improve their delivery. As evidenced by the fact that the evaluations significantly improved between the first- and second-class offerings, they will improve delivery with practice.

In terms of advice to others looking to translate their research into practice, we make the following suggestions:

• One and done does not always work. It may well take several iterations of an intervention before the right fit, length, and delivery are discovered.
• Local community partners are key. They know the ground, the culture(s), the networks.
• Ideal timing of educational interventions is tricky. Too long and community members will not be able to afford to take time out of their busy lives. Too short and quality can suffer. It may take more than one offering of a new curriculum to find the ideal timing.

Basic Disaster First Aid Curriculum

The full Basic Disaster Aid curriculum that we used to train instructors and community members during this project is provided below:

• Module 1: Introduction
• Module 2: First Steps in an Emergency
• Module 3: Spinal Issues and Patient Movement
• Module 4: Head and Mental Status
• Module 5: Wounds and Wound Care
• Module 6: Muscoskeletal Injuries
• Module 7: Circulatory Emergencies
• Module 8: Respiratory Distress and Chest Trauma
• Module 9: Abdominal Issues
• Module 10: Drowning
• Module 11: Environmental Issues
• Module 12: Other Concerns

Further Reading

Curriculum Mapping as a Tool to Facilitate Curriculum Development: A New School of Medicine Experience

Community First Aid Training: A Tool to Strengthen Community Resilience

Adapting the Emergency First Aid Responder Course for Zambia Through Curriculum Mapping and Blueprinting

Acknowledgments. We would like to express our sincere gratitude to all of our partners who played an instrumental role in the successful implementation of this project. Our expert review panel consisted of Leo Mereb, Dinicio Reyes, Melton Atalig, and Juan Diego Tenorio. We would also like to acknowledge the support from our community partners, including Patricia Coleman, Franklin R. Babauta, Gerald J. Deleon Guerrerro, Juan A. Pua, Raymond T. Dela Cruz, Glenn L. Maratita, Ron H. Ogo, Joel O. Hocog, Victorino L. Mendiola, Jr., Clement R. Bermudes, and Juan Diego Tenorio. Without their commitment and active involvement, this would not have been possible.