Emergency Medical Teams response to the Türkiye earthquake: lessons learned workshop report Istanbul, Türkiye 15–16 June 2023
Emergency Medical Teams response to the Türkiye earthquake: lessons learned workshop report Istanbul, Türkiye 15–16 June 2023 Abstract The “Emergency Medical Team (EMT) response to the Türkiye earthquake: lessons learned workshop” was held in Istanbul, Türkiye from 15 to 16 June following the devastating series of earthquakes in Türkiye that began on 6 February 2023. The workshop brought together 82 experts and EMT professionals from 20 countries across 4 WHO regions. Participants reflected on, shared and analysed their experiences from the earthquake with an aim to identify ways to improve interoperability and partnerships, quality service delivery, and information management systems during emergency response. As a result of activities conducted during the workshop, key priorities were identified to support EMT response activities and the EMT community of practice, as well as successful implementation of the EMT methodology at a national level. These priorities include strengthening of national EMT coordination mechanisms, advancing EMT networks and partnerships to support greater intra and interregional collaboration, and improved information management systems to inform operational decision-making. Furthermore, participants highlighted a need for enhanced research and training opportunities through establishment of a capacity-building hub, the Regional European EMT Capabilities Hub, as an invaluable regional resource to support strengthening of knowledge transfer, capacity-building and development of EMTs through a community of practice. Keywords DISASTER MEDICINE; DISASTER PLANNING; CAPACITY BUILDING; EMERGENCY RESPONDERS Document number: WHO/EURO:2024-9935-49707-74484 © World Health Organization 2024 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). 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This publication contains the report of the Emergency Medical Team response to the Türkiye earthquake: lessons learned workshop held on 15–16 June 2023 and does not necessarily represent the decisions or policies of WHO Designer: Viktoriya Arkhipenko Photos: © WHO Contents Abbreviations iv Executive summary v Background 1 Workshop goals, objectives and expected outcomes 2 Presentations 3 Working groups 4 EMT coordination, interoperability and civil–military partnerships 5 EMT delivery of quality healthservices 6 Strengthening interoperability of information systems 6 Interactive surveys 7 Baseline survey 7 Session 1: EMT interoperability and military medical team engagement/inclusive partnerships 7 Session 2: EMT delivery of quality health services and response 8 Session 3: Strengthening information management systems 9 Endline survey and key learnings 10 Key outcomes and recommended actions 11 Next steps 12 Annexes 13 Annex 1: Agenda 13 Annex 2: Glossary/Terminology 15 Annex 3: Guidance and resources 16 iv Abbreviations EMT Emergency medical team EMTCC Emergency Medical Team Coordination Cell KIMEP Knowledge and Information Management Emergency Platform PHHE WHO European Centre for Preparedness for Humanitarian and Health Emergencies REECH Regional European EMT Capabilities Hub UMKE National Medical Rescue Team (UMKE) and EMT of the Turkish Government and the Ministry of Health of Türkiye WHO World Health Organization vExecutive summary The “Emergency Medical Team (EMT) response to the Türkiye earthquake: lessons learned workshop” was held in Istanbul, Türkiye from 15 to 16 June as a follow up to the devastating series of earthquakes in Türkiye that began on 6 February 2023. The event was organized by the Health Emergencies Programme of the WHO Regional Office for Europe and the EMT Initiative. It was supported by the Ministry of Health, Government of Türkiye as co-organizer and host, the WHO Country Office in Türkiye and the Regional European EMT Capabilities Hub (REECH) at the WHO European Centre for Preparedness for Humanitarian and Health Emergencies (PHHE). At the event, 82 experts and EMT professionals from 20 countries came together in person and virtually to reflect on, share and analyse their experiences from the earthquakes. This group represented EMT colleagues from the WHO European, Eastern Mediterranean and Western Pacific regions, as well as the Region of the Americas. Participants took part in detailed discussions to review key areas of the EMT response and coordination for best practices and lessons learned to inform further regionalization and strengthening of the EMT Initiative in the WHO European Region and beyond. The workshop aimed to synthesize the discussions and outcomes of the response to identify the next steps for: • the development of an operational research system for generating evidence on EMTs; • strengthening the communities of EMT practice through identification of needs; • provision of access to EMT knowledge across frontline EMT responders; and • creation of an enabling environment for utilization of the EMT approach by Member States and partners. Through presentations, group work, discussions and live polling, participants shared important lessons learned across interoperability and partnerships, quality service delivery, and information management systems. These included the need for (i) more robust and standardized communication, coordination and information exchange during both the preparedness and response phases, (ii) further improvement of interoperability through strengthening coordination mechanisms, (iii) a significant demand for investment in an EMT knowledge and information management system to ensure the ability to scale up and sustain activities, (iv) development of health workforce capacities, and (v) a strong demand for more sharing of experiences and best practices among the EMT community of practice. As a result of individual and group activities, the following key priorities were identified by the participants: • strengthening of the national EMT coordination mechanism, adapted to the context and agile enough to meet complex operational demands when activated to receive international EMTs; • advancing EMT networks and partnerships through a community of practice to enhance greater interregional collaboration and complementarity of capabilities as part of further regionalization of the EMT Initiative; • a centralized point of reference that offers the opportunity for collaboration on research efforts and transferability in sharing of experiences, and best practices in building a robust portfolio of EMT evidence; • an EMT regional–national surge strategy in place to ensure that training efforts remain relevant to addressing needs and gaps across the Region; and • improving and leveraging information management systems to enhance and inform operational decision-making, sharing of experiences and best practices to contribute towards strengthening evidence-based research, generation and transfer of knowledge on EMTs, enhancement of EMT capacity and professional capabilities, and performance of the EMT workforce to ultimately improve delivery of needs-based services by EMTs. Participants noted that a capacity-building hub would be an invaluable regional resource to support strengthening of knowledge transfer, capacity-building and development of EMTs through a community of practice and address many of the above requests and priorities indicated by EMTs and stakeholders. As a direct outcome of this workshop, REECH will be established to enhance the capacity of an EMT community of practice and other health emergency workforce in Member States throughout the WHO European Region and beyond. This will be achieved by effectively coordinating EMT research and training activities and establishing a conducive environment for successful implementation of the EMT methodology at a national level.
1Background On 6 February 2023, at 1:17 UTC (4:17 local time), two major earthquakes (7.7 and 7.6 in magnitude) struck south-east Türkiye, devastatingly impacting 10 provinces (Adıyaman, Adana, Diyarbakır, Elazığ, Gaziantep, Hatay, Kahramanmaraş, Kilis, , Malatya, Osmaniye, and Şanlıurfa). The epicentre of the first earthquake was northwest of Kahramanmaraş. There was widespread damage with over 107 000 injured and more than 50 000 deaths. The earthquake and its aftershocks are estimated to have caused US$ 103.6 billion in damages, or equivalent to 9% of Türkiye’s forecasted gross domestic product for 2023, making them the fourth-costliest earthquakes on record1. The Turkish Government and the Ministry of Health of Türkiye activated its National Medical Rescue Team (UMKE) Emergency Medical Team (EMT) resources from across the country to respond quickly, assist with search and rescue operations and provide medical care to those injured. The Emergency Medical Team Coordination Cell (EMTCC) mechanism was activated by the Ministry of Health to respond to and enhance the overall coordination and effectiveness of 38 international EMTs that were deployed to the affected areas as per the request issued by the WHO EMT Secretariat at the onset of the disaster. Between 6 February and 24 April 2023, international and national EMTs reporting on activities recorded nearly 97 000 consultations, with 60% of those reported by UMKE. 1 Emergency Medical Team Coordination Cell Sitrep, 27/03/2023–02/04/2023. From 15 to 16 June 2023, the “EMT response to Türkiye earthquake: lessons learned workshop” was held in Istanbul, Türkiye to provide an opportunity for first-line EMT responders to the earthquake to reflect on their experiences during the emergency and deep-dive to review key areas of the EMT response and coordination to identify best practices and lessons learned. The workshop brought together 82 experts and EMT professionals from 20 countries and four WHO Regions to share and analyse their experiences from the earthquakes that struck Türkiye in February 2023. The event was organized by the Health Emergencies Programme of the WHO Regional Office for Europe and the EMT Initiative with support from the Ministry of Health, Government of Türkiye as co-organizer and host. Further support was provided by the WHO Country Office in Türkiye and the Regional European EMT Capabilities Hub (REECH) at the WHO European Centre for Preparedness for Humanitarian and Health Emergencies (PHHE). The outcomes of the Workshop will ultimately inform further regionalization and strengthening of the EMT Initiative in the WHO European Region and beyond, including the establishment of REECH in Istanbul, Türkiye. 2The purpose of the of the “EMT response to the Türkiye earthquake: lessons learned workshop” was to provide an opportunity for first-line EMT responders to the earthquake in Türkiye to have an appreciative inquiry learning environment, review key areas of the EMT response and coordination undertaken for improvement, inform further regionalization and strengthening of the EMT Initiative in the WHO European Region and beyond, including the establishment of a regional EMT knowledge hub in Istanbul, Türkiye. The primary objectives of the workshop were to: • contribute to the development of an operational research system for generating evidence-based knowledge for EMTs through systematic collection of lessons learned during emergencies; • strengthen communities of EMT practice through identification of needs and provision of access to EMT knowledge across frontline EMT responders; and • create an enabling environment for utilization of the EMT approach by Member States and partners. Through presentations, live polling of participants and multiple working groups and breakout sessions, the workshop focused on facilitating in-depth analysis of EMT coordination and interoperability. It also facilitated analysis on information management, technical standards for EMTs, health service delivery and partnerships among EMTs, as well as a comprehensive review of personal observations and lessons learned over the course of EMT deployment and engagement. Expected outcomes included the synthesis of discussions and responses to identify next steps for the development of an operational research system for generating evidence on EMTs, strengthening communities of EMT practice through identification of needs and provision of access to EMT knowledge across frontline EMT responders. Additional expected outcomes were creation of an enabling environment for utilization of the EMT approach by Member States and partners. This includes identification of best practices and areas for continuous improvement. These would enhance EMT strengthening across the Region through fostering of partnerships, and experience- and knowledge-sharing. Workshop goals, objectives and expected outcomes 3The opening remarks were made by Dr Selami Kılıç, Director-General for the European Union (EU) and Foreign Affairs, Ministry of Health of Türkiye; Dr Eray Çınar, Emergency Health Care Services, Ministry of Health of Türkiye; Dr Gerald Rockenschaub, Regional Emergency Director, WHO Regional Office for Europe; Dr Batyr Berdyklychev, WHO Representative to Türkiye. On the topic of national EMT leadership, coordination and response, there were presentations by the Türkiye Ministry of Health on lessons learned from activation of the national emergency health system, and EMTCC mechanism and national EMT capacity, that of UMKE. These learnings were shared by Mr Yusuf Irmak, Head of Department for Relations with International Organizations, Ministry of Health, Türkiye, and Dr Şükrü Yorulmaz, Head of Disaster and Emergency Management, Ministry of Health, Türkiye. Presentations focused on the delivery of quality health services and response by EMTs, and covered lessons learned from operational dynamics of the earthquake response to deliver quality EMT standards. These were shared by Dr Elliot Tenpenny, Samaritan’s Purse EMT, USA and Mr Roberto Arranz, the Spanish Agency for International Development Cooperation (AECID) EMT, Spain. Finally, for the segment on “Strengthening information management systems”, presentations focused on lessons from EMT coordination and on generation, access, and dissemination of information to inform better operational decision-making. These were delivered by Mr Didier Talbot, French National Directorate for Civil Protection Members (ESCRIM) EMT, France and Mr Tasuhiko Kubo, Japan Disaster Relief EMT, Japan. Presentations 4Working groups The discussions and group work focused on identifying EMT needs and priorities across knowledge generation, knowledge transfer and enabling environment to drive forward action across lessons learned from key technical areas such as EMT interoperability and partnerships, quality service delivery, and information management systems. Participants shared important lessons learned across these technical areas, including the need for more robust and standardized communication, coordination and information exchange during both preparedness and response, as well as a strong demand for more sharing of experiences and best practices among the EMT community of practice. Participants referenced known definitions, including generation and transfer of knowledge on EMTs, and community of practice, to ensure consistency of terms and concepts during the group work discussions. Below is a condensed overview of the discussion and primary outcomes from across the various working groups. 5EMT COORDINATION, INTEROPERABILITY AND CIVIL–MILITARY PARTNERSHIPS The working group identified many shared perspectives between EMTs and military medical teams in response to emergencies, such as the necessity for further improvement in interoperability through strengthening coordination mechanisms for deploying surge capacities such as utilizing urban search and rescue, military and EMT mechanisms, and exploring areas of cross-transferability of quality standards, resources and systems. Other areas highlighted during the discussions included better streamlining of information management and standardization of common datasets to better capture a comprehensive overview of the impact of an emergency and EMT response. There was consensus that a community of practice would be beneficial in strengthening interoperability; however, such efforts would need to consider targeting the appropriate form of community to maximize engagement. Knowledge generation: research • real-time EMT–military best practices • adaptation to the operational context • field coordination approaches and mechanisms • cross-transferability of standards, systems and equipment. Knowledge transfer: training • joint scenario-based exercises that harness interregional engagement • information management • interoperability of standards applied between EMTs and military teams • modularization and specialized care teams between EMTs and military teams • EMTCC. Enabling environment • leveraging resources and unique capabilities between EMTs and civil–military teams to strengthen EMT quality and standards; • targeting the right people and identifying different levels of engagement across stakeholders; • growth, adaptation and evolution of EMTs harnessed through collective engagement from an EMT community of practice; and • establishing a shared communication platform (within the CoP) for sharing operational experiences. 6STRENGTHENING INTEROPERABILITY OF INFORMATION SYSTEMS There was a strong consensus by the working group of a lack of capacity and capabilities existing across knowledge and information management systems by the EMT Initiative in supporting a coherent approach during response and coordination operations. Key areas identified that need further investment included the development of knowledge and information management standards, a pool of information management specialists deployable for EMTCC, training of EMTs to ensure effective application of EMT knowledge and information management tools and strengthening of information management systems. Knowledge generation: research • EMT information management, common language and tools for data analysis. • standardization of high- quality level of care (contextualized). Knowledge transfer: training • cultural exchange and interoperability • highly infectious diseases • infection prevention an control (IPC) • interdisciplinary approach. Enabling environment • common vision and common goals among the EMT community of practice • open community, willingness to share information and knowledge. EMT DELIVERY OF QUALITY HEALTHSERVICES The working group discussed the changing humanitarian landscape and adaptability required by EMTs over the coming years to remain relevant in meeting the needs of affected populations. High priorities identified for EMTs included the importance of contextualized quality services, scaling up capacities and skills in specialized areas such as infection prevention and control and highly infectious diseases, as well as sharing lessons learned by the EMT community through a community of practice. Knowledge generation: research • development of standards for knowledge and information management (datasets, forms and data collection, data protection, analysis and storage); • development of an EMT data structure for research; and • dedicated and timely resourcing of information management specialists in the EMTCC (to support real- time research). Knowledge transfer: training • dissemination of lessons learned to the EMT community and utilization of these • interpretation of data • digitalization (web-based, apps, ChatEMT) • data protection and security Enabling environment • a platform for communities of practice to exchange information • information communication • national versus international information management standards. 7Throughout the meeting, participants were encouraged to participate in a series of live, online surveys to support an interactive meeting and evaluation of learning. Over the course of five surveys, attendees were able to respond to prompts and questions regarding knowledge generation, knowledge transfer and community of practice of EMTs, as well as the intersectionality with information systems, delivery of quality health services, and coordination, interoperability and partnerships. Throughout the polls and surveys, participants were also able to submit open text responses to various questions, enabling them to share personal experiences, preferences and identify or self-report gaps and challenges in various areas. BASELINE SURVEY The baseline survey was a brief introductory session that collected general demographic information about the group, including their position, length of time they have been active in emergency response operations and which sector they work in. It also gathered information on the audience’s initial knowledge and understanding of the cross-cutting concepts to be covered over the course of the workshop. These included an understanding of research and generation of knowledge in the context of EMTs, how capacity- building may contribute to interoperability among EMTs, service delivery and response, development of information management systems, understanding of the regionalization of the Global EMT Strategy 20302 and the methodologies of the EMT Initiative. The participants in attendance represented various sectors, with 58% of respondents coming from the government, 26% representing international or national-level nongovernmental organizations and 16% from the military. When asked what their primary motivation was for attending the workshop, participants highlighted a number of areas, including and not limited to: 2 Emergency medical teams 2030 strategy. Geneva: World Health Organization; 2023 (https://iris.who.int/handle/10665/372867, accessed 27 June 2024). License: CC BY-NC-SA 3.0 IGO. • overall experience-sharing and knowledge exchange on the earthquake response; • stronger coordination and collaboration with the EMT community to understand how to improve responses in the future for quicker and more effective responses; and • contribute to a strengthened EMT mechanism. Coordination, cooperation and communication, trust, respect and transparency were key terms included in nearly every submitted definition of an enabling environment. SESSION 1: EMT INTEROPERABILITY AND MILITARY MEDICAL TEAM ENGAGEMENT/INCLUSIVE PARTNERSHIPS To ascertain information on various operational experiences and challenges during their deployment to the earthquake-affected sites in Türkiye, participants were polled on whether they faced any obstacle or challenge regarding interoperability and engagement with teams from other sectors and any additional details they might wish to share. Of the respondents, 38% noted challenges and even proposed solutions, including improved interoperability and coordination between the USAR team and EMTs, a need to identify missing information concerning local national system knowledge, language barriers and bureaucratic challenges. Other challenges were a need for advance communication and identification of focal points, and enhanced communication, coordination and data-/information- sharing on site. It was also recognized that the deployment of EMTs through WHO/United Nations does not align with bilateral agreements. Another important question posed to attendees focused on key areas of capacity-building that Interactive surveys 8could be developed to strengthen and support interoperability. Respondents overwhelmingly noted an interest in joint interdisciplinary training and exercises, stronger coordination and communication between military and EMT groups as well as other EMTs in general, and stronger definitions around interoperability. Responses also included capacity- building on referral systems, logistics and operational capacity, as well as a suggestion for a coordinator on the ground who would be solely attached to EMTs and to local commanders on the ground. As an outcome of this session, 88% of respondents agreed that it would be helpful to develop a network or community of practice to focus on this topic. The other 12% did not disagree, but voted “unsure”, indicating that they possibly needed more information on how a community of practice could strengthen coordination or what it would entail. SESSION 2: EMT DELIVERY OF QUALITY HEALTH SERVICES AND RESPONSE When asked to note one or two areas within quality health services and delivery where they believed their team or EMTs in general would benefit from strengthened capacities, respondents overwhelmingly indicated communication and information management/sharing. Figure 1. Reported areas where further development would be advantageous Additionally, they noted that the primary advantages of a network or community of practice on this topic would be improved communication, to learn from each other and exchange peer experiences, expertise and best practices in an effort to provide the best and most efficient care possible to affected communities and populations, as noted in figure ## above.. Within this topic, participants were again asked if they faced any obstacle or challenge regarding delivery of quality health care. Nearly half the respondents replied “yes” and noted missing specialists and capabilities appropriate to the response, obstacles in follow up on transferred patients and continuity of care, language barriers, and quality of data management and communication between the authorities. 3 Classification and minimum standards for emergency medical teams. Geneva: World Health Organization; 2021 (https://iris. who.int/handle/10665/341857, accessed 5 April 2024). License: CC BY-NC-SA 3.0 IGO. When asked to suggest plausible solutions to the challenges encountered, the following ideas were submitted that emphasized real-time exchange of information and cultural context: • pre-briefings on host community characteristics; • more preparation and simulations before disasters; • having local clients and local translators; • using the Classification and Minimum Standards for Emergency Medical Teams3 (blue book) as a minimum standard but the host nation should impose other standards before deployment; and • a live feed of needed capabilities and distribution of specialists and knowledge about local services. communication Health General medicine conduct Information Management Information sharing Planlama Standards and bespoke training Measurable Quality Managament standard special Istanbul unified prepare Mental health carecovering Health information systemsbetter communication between teams Primary healthcare attention regular Transfer of care possibilities toolsinformation training research Need assessment Planning, action plan, teamteams Distribution 9SESSION 3: STRENGTHENING INFORMATION MANAGEMENT SYSTEMS Most participants noted challenges that focused on communication and context when polled on any major information gap encountered during the overall deployment experience in Türkiye. These gaps included information about other teams, their location and communication with them, information about local services and background on the national health- care system, primary health-care data, and local rules and regulations. When questioned on whether they encountered any obstacle to accessing information, respondents noted a lack of common analysis or harmonization of data and information on real-time capacity of health structures, both national and EMTs, as well as limited sharing of critical information in the early days of the response and a reliance on local relationships to stay informed. Participants emphasized coordination and communication with other teams, locals and formal bodies as crucial when asked to share best practices or successes in this area of work during the earthquake response. The following responses were submitted: • information-sharing with different teams and establishment of an information structure as a priority; • contact with local clients and networks, and continuous building and strengthening of own local networks; • having a direct contact or liaison between the EMT and a local officer, as well as close coordination with the Ministry of Health; and • coordination and open communication among key technical partners, including a joint rapid needs assessment. Furthermore, participants were asked what type of development they would like to see/would request for increasing information management skills, to which they provided the following feedback: • a common secure platform to support information exchange, which could be an Internet-based site or accessible through an application; • the development of a community of practice; a tool where information can be accessed, exchanged and a safe real-time chat function enabled to commu- nicate with other teams and the EMTCC and share case studies and experiences; • platform with real-time data, local rules and information, and location of EMTs and local health facilities; and • more information management capacity at the field level with implementation of training in information management structures and providing support to EMTs. These requests are very much in line with the recently launched the Knowledge and Information Management Emergency Platform, or KIMEP, for EMTs, which currently has an active governance module for EMT regional group elections and will be expanded to include data entry, coordination, sharing and more. 10 ENDLINE SURVEY AND KEY LEARNINGS Following the meeting, a final anonymous survey was circulated to all virtual and in-person attendees, gauging key learnings, evaluating knowledge gained in strategic areas, major points for consideration and feedback on the event itself. Both throughout and after the workshop, participants noted overwhelming support for the development of a more formal community of practice and establishment of a capacity-/capability-building resource. The information on the proposed REECH was received with great interest. The creation and operationalization of REECH is expected to assist Member States in the WHO European Region in addressing strategic operational challenges identified at this Workshop and strengthening country-specific EMT capacities. REECH will be hosted by the WHO PHHE in Istanbul, Türkiye. When asked if participants intend to provide input/ feedback to the REECH concept note, 90% responded “yes” and indicated an interest in learning more. They provided specifics as to how they foresaw their EMT collaboration with the Hub, noting that they anticipated working together on methodology development, training and exercises; information- sharing and lessons identified from other missions and EMTs; learning and communicating with colleagues across the Region and an overall increase in capacity and interoperability, diversity and corporation. To inform further progress of REECH development, attendees were asked to list one or two areas that they considered a priority for capacity-building. Information management was mentioned by nearly all respondents, followed by coordination with other responders/institutions and response networks, as well as interoperability. When asked to select the most interesting/informative sessions from the workshop, the top three choices were consistent with the free- text responses and included: • EMT interoperability and military medical team engagement (28%) • EMT delivery of quality health services and response (21%) • information management systems (17%) Final feedback was provided in terms of workshop structure and content, with responses focused on the importance of information management and knowledge generation for coordination, as well as creation of a space for continued information exchange and lessons learned among EMTs and across activities. This Workshop provided an outlet to collaborate and help EMTs set a vision for improving and moving forward. In the future, it would be important to consider expansion of online engagement and interactivity, making the event more hybrid so more EMTs could participate and facilitate conversations on more specific and critical aspects of the response. 11 As a result of the discussions, presentations, breakout groups and polling, the following key priorities were identified by participants to take forward in the Region under the guidance of or implemented through REECH: Strengthening EMT coordination and response Strengthening the national EMT coordination mechanism, adapted to the context and agile enough to meet complex operational demands when activated to receive international EMTs, through improved information sharing. EMT networks and partnerships Advancing EMT networks and partnerships through a community of practice to enhance greater interregional collaboration and complementarity of capabilities as part of further regionalization of the EMT Initiative. Operational Research Systematized collection of evidence and best practices in emergencies, offering a centralized point of reference to enable collaboration on research efforts and transferability in sharing of experiences, and best practices. Training Evidence-based training opportunities and capacity building to address needs and gaps across the Region and facilitate knowledge transfer. Enabling environment Making efforts to strengthen the enabling environment to be strategic and intentionally directed to leverage time, resources, capacities and capabilities and effectively to support development and expansion and strengthening of the EMT Initiative. Knowledge and information management Improving information management systems and standards to better inform operational decision-making and delivery of EMT needs-based services. Investing in an EMT knowledge and information management system to ensure the ability to scale up, and maintain continuity and sustainability of health workforce capacity . Harnessing information management systems to better offer sharing of experiences and best practices to contribute towards strengthening evidence- based research, generation and transfer of knowledge to enhance EMT capacity and professional capabilities and performance of the EMT workforce. Key outcomes and recommended actions 12 As a result of these discussions, 93% of participants believed that REECH would be an invaluable regional resource to support strengthening of EMT knowledge transfer, capacity-building and development through a community of practice. It would also address many of the above requests and priorities indicated by EMTs and stakeholders. A key strategic priority of the EMT Initiative is to build the capacity of national health workforces to respond to emergencies. This involves establishing a quality assurance system for EMT response grounded in evidence-based standards and enhancing coordination mechanisms and information management systems. The Global Emergency Medical Teams 2030 Strategy4 calls on countries and organizations to take a proactive approach to enhance their EMT and rapid response capabilities, which includes adopting the EMT methodology while adapting it to the local context. Furthermore, it is vital to strengthen the technical and operational skills of the health workforce and document evidence-based strategies and best practices. The primary purpose of REECH will be to enhance the capacity of an EMT community of practice and other health emergency workforce in Member States throughout the WHO European Region and beyond. This will be achieved by effectively coordinating EMT research and training activities and establishing a conducive environment for the successful implementation of the EMT methodology at a national level. Special emphasis will be placed on the core areas of EMT work: governance; quality assurance and mentorship; coordination and leadership in emergency response; and standards setting. The priorities identified, along with the core areas of EMT work, will form the foundation for REECH’s strategic direction. REECH’s approach will revolve around forming partnerships with leading research, training, practice, and donor organizations involved in the spectrum of EMT activities. This collaboration will aim to develop and implement a comprehensive regional agenda for EMT research and training, focusing on identifying and 4 EMT 2030 Strategy prioritizing the most critical topics. The partnerships will encompass EMTs, WHO collaborating centres, other research and academic institutions dedicated to health emergency preparedness and response, as well as other relevant institutions within and beyond the WHO European Region. The target audience of REECH’s research will be the EMT workforce and leadership, as well as decision-makers in Member States and international organizations. The primary objective is to equip them with the latest and most reliable evidence, enabling informed decisions during preparedness and response efforts. In terms of training activities in the field of knowledge transfer, the main audience will be the EMT community of practice, with a special emphasis on supporting new and developing national teams integrated into the health systems of WHO Member States. Additionally, REECH will work towards cultivating an enabling environment by targeting decision-makers in Member States, donors, and other key partners who will contribute to adopting the EMT methodology at the national level through advocacy of the amendments in legislation and maintenance of EMT capacity through sustainable and predictable funding. The goal is to raise awareness of EMTs and advocate for adoption of the EMT methodology and strengthening of preparedness and response capacities at the national level. These identified priorities have also been taken into account with the development and drafting of the EMT Regional Action Plan 2024–2030 to be shared at the 74th Regional Committee for Europe, reflecting an emphasis on enabling environments and Member State support in the development and integration of EMT capacities at the national level. Other priorities are a strengthened regional EMT community of practice aimed at improving interoperability and partnerships across priority areas of work, scaling up EMT information management and digitalizing EMT areas of work, supporting data and evidence-based decision-making, and improving coordination of EMT knowledge generation and knowledge transfer. Next steps 13 Annexes ANNEX 1: AGENDA Emergency Medical Teams (EMTs) response to the Türkiye earthquake: lessons learned workshop Time Topic Speaker/Facilitator Thursday, 15 June 08:30–09:00 Registration Morning coffee Meet and Greet 09:00–09:30 Opening of Lessons Learned Workshop by Türkiye Ministry of Health and WHO Regional Office for Europe Dr Selami Kılıç Director-General for the European Union and Foreign Affairs, Ministry of Health, Türkiye Dr Eray Çınar Emergency Health Care Services Ministry of Health, Türkiye Dr Gerald Rockenschaub Regional Emergency Director, WHO Regional Office for Europe Dr Batyr Berdyklychev WHO Representative to Türkiye 09:30–09:35 Methods of working and introductory survey Kristina Ronsin Co-facilitator, WHO Regional Office for Europe 09:35–09:45 Setting the scene: earthquake response reflective results from Türkiye Catherine Smallwood Manager Programme Area WHO Regional Office for Europe 09:45–10:30 National EMT leadership, coordination and response Experiences from the Ministry of Health, Türkiye Lessons learned from activation of national emergency health system, EMTCC mechanism and national EMT capacity (UMKE) Yusuf Irmak Head of Department for Relations with International Organizations Ministry of Health, Türkiye Dr Şükrü Yorulmaz Head of Disaster and Emergency Management, Ministry of Health, Türkiye 10:30–11:00 Coffee break 11:00–11:30 EMT interoperability and military medical teams engagement 12:00 – 13:00 Experiences from the field Lessons learned from collaborative interoperability between the EMTCC, EMTs, military and other operational partners in supporting operational excellence Dr Jean-Baptise Bruguet German Federal Ministry of Defence Professor Ofer Merin Israel Defence Force 14 11:30–12:00 EMT delivery of quality health services and response Experiences from the field Lessons learned from operational dynamics of earthquake response context to deliver quality EMT standards Dr Elliot Tenpenny Samaritan’s Purse EMT, United States of America Mr Roberto Arranz Spanish Agency for International Development Cooperation (AECID ) EMT, Spain 12:00–12:30 Strengthening information management systems Experiences from the field Lessons from EMT coordination and EMTs on generation, access, and dissemination of information to inform better operational decision-making Mr Didier Talbot French National Directorate for Civil Protection Members (ESCRIM) EMT, France Mr Tasuhiko Kubo Japan Disaster Relief EMT, Japan 12:30–13:30 Lunch 13:30–14:30 Formal ceremony 14:30–15:30 Breakout session 1 – Knowledge generation 15:30–16:00 Coffee break 16:00–17:00 Breakout session 2 – Knowledge transfer 17:00–18:00 Breakout session 3 – Community of practice 18:00–18:15 Wrap up and closing of Day 1 Kristina Ronsin Co-facilitator, WHO WHO Regional Office for Europe Regional Office for Europe 19:30–22:00 Dinner/Social event Friday, 16 June 09:00–09:15 Review of Day 1 and outstanding questions Kristina Ronsin Co-facilitator, WHO WHO Regional Office for Europe Regional Office for Europe 09:15–10:30 Plenary sharing from Group Breakout session work Nuran Higgins Co-facilitator, WHO Regional Office for Europe 10:30–11:00 Coffee break 11:00–12.00 Roadmap: Strategy 2030 and WHO Europe Regional EMT Knowledge and Capacity- building Strategy/Hub Capacity-building workstream of Global EMT 2030 Strategy Dr Flavio Salio EMT Initiative Lead WHO headquarters The way forward – regionalization of EMT Strategy 2030 through the establishment of European Regional EMT Knowledge and Capacity-building Hub Dr Oleg Storozhenko Operational Partnerships Officer, WHO Regional Office for Europe 12:20–13:00 Summary and wrap up of the meeting Nuran Higgins Oleg Storozhenko Kristina Ronsin 12:00–13:00 Lunch 15 ANNEX 2: GLOSSARY Generation of EMT knowledge o Knowledge generation is aimed at supplying EMTs with evidence-based research results to enhance knowledge related to their work, including real-time knowledge management support of an active emergency to support learning, and to inform EMT leadership and governance decisions. o Research is a necessary part of capacity-building of EMTs as it increases individual knowl- edge, skills and competences and, when translated into practice, it improves and enhances professional capabilities, increases the performance of EMTs and, in the end, provides better health outcomes. o Enhancing knowledge and facilitating information management is of the highest im- portance not only in the immediate management of an emergency, but also to inform decision-making as emergencies evolve. Further post-emergency learning is always strengthened by reliable data and intelligent analysis, which should be a key part of capac- ity-building. o Strategic Objective #1 of the Regional EMT Knowledge and Capacity-building Hub is to contribute to generating evidence-based knowledge through advancing research activities on EMTs. Transfer of EMT knowledge o EMT knowledge transfer is provided through access of EMTs to a professional learning envi- ronment tailored to meet the real needs of EMT members in the workplace, and functional- ly linked to practice, research, and innovation in the area of health emergency response. o Learning and development is based on a concept of continuing professional development that suggests a combination of formal training, self-study, workplace practical learning, and a community of practice. The development of EMT learning content will utilize an “all hazards” approach. o The key priority of EMT knowledge transfer is expansion of the global EMT methodology, including guiding principles, core and technical standards, EMT typology, and classification policies to facilitate its adoption by emergency response providers at the level of Member States. o Strategic Objective #2 of the Regional EMT Knowledge and Capacity-building Hub is to strengthen a learning and development environment for EMTs through transfer of knowl- edge and building capacity across Member States, subregional networks of countries, the entire Region and beyond. Community of practice o This constitutes a community of health professionals who provide an emergency response, share the goals of the EMT Initiative, and follow the global EMT methodology. o An EMT enabling environment that considers EMT stakeholders, economic, political, envi- ronmental and social factors that support implementation of the EMT Initiative. o Strategic Objective #3 of the Regional EMT Knowledge and Capacity-building Hub is to cre- ate an enabling environment for knowledge utilization by Member States across the WHO European Region and beyond. 16 This section highlights the questions used to guide discussions within working groups and priority areas considered during the lessons learned workshop in order to develop key outcomes and recommended actions. Knowledge generation — research ☐ What are the critical areas of information that need to be developed through future research to support generation of knowledge for EMTs and military teams? ☐ What practical actions are required to facilitate the fostering of knowledge generation through research to improve the effectiveness and EMT interoperability of civil–military engagement? ☐ What are the main barriers to be considered that could hinder the generation of knowledge through research? And solutions to address them? Knowledge transfer — training ☐ What are the critical areas of learning that need to be developed through future training opportunities to support the acquisition of new skills, competencies and knowledge of EMT members and military teams? ☐ What practical actions are required to facilitate the fostering of learning and development to improve the effectiveness of EMT interoperability and civil–military engagement? ☐ What are the main barriers likely to hinder learning and development opportunities against these actions that need to be considered? And solutions to address them? Enabling environment ☐ What are the critical areas needed to establish a community of practice to strengthen EMT interoperability and civil–military engagement? In essence, what would it look like in practice to function optimally? ☐ What practical actions are required to facilitate the fostering of a community of practice? ☐ What are the main barriers likely to hinder a community of practice against these actions that need to be considered? And solutions to address them? Research ☐ What are the critical areas of information that need to be developed through future research to support generation of knowledge for EMT members, Member States and partners? ☐ What practical actions are required to facilitate the fostering of knowledge generation through research to improve the effectiveness and delivery of quality EMT health services and response? ☐ What are the main barriers likely to hinder the generation of knowledge through research against these actions that need to be considered? And solutions to address them? Training ☐ What are the critical areas of learning that need to be developed through future training opportunities to support the acquisition of new skills, competencies and knowledge of EMT members, Member States and partners? ☐ What practical actions are required to facilitate the fostering of learning and development to improve the effectiveness and delivery of quality EMT health services and response? ☐ What are the main barriers likely to hinder learning and development opportunities against these actions that need to be considered? And solutions to address them? Enabling environment ☐ What are the critical areas needed to establish a community of practice to improve the effectiveness and delivery of quality EMT health services and response? In essence, what would it look like in practice to function optimally? ☐ What practical actions are required to facilitate the fostering of a community of practice? ☐ What are the main barriers likely to hinder a community of practice against these actions that need to be considered? And solutions to address them? ANNEX 3: GUIDANCE AND RESOURCES EMT coordination, interoperability and civil–military partnerships EMT delivery of quality health services 17 Strengthening interoperability of information systems Research ☐ What are the critical areas of information management that need to be developed during EMT coordination operations through future research to support generation of knowledge for EMT members, military teams, Member States, partners? ☐ What practical actions are required to facilitate the fostering of knowledge generation through research to improve the effectiveness of information management during EMT coordination operations? ☐ What are the main barriers likely to hinder the generation of knowledge through research against these actions that need to be considered? And solutions to address them? Training ☐ What are the critical areas of learning that need to be developed through future training opportunities to support the acquisition of new skills, competencies and knowledge of EMT members, military teams, Member States and, partners in information management? ☐ What practical actions are required to facilitate the fostering of learning and development to improve the effectiveness of information management during EMT operations? ☐ What are the main barriers likely to hinder learning and development opportunities against these actions that need to be considered? And solutions to address them? Enabling environment ☐ What critical areas are needed to establish a community of practice to improve the effectiveness of information management during EMT operations? In essence, what would it look like in practice to function optimally? ☐ What practical actions are required to facilitate the fostering of a community of practice? ☐ What are the main barriers likely to hinder a community of practice against these actions that need to be considered? And solutions to address them? 18 19 20 World Health Organization Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel: +45 45 33 70 00 Fax: +45 45 33 70 01 Email: eurocontact@who.int Website: www.who.int/europe The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czechia Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands (Kingdom of the) North Macedonia Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan Türkiye Turkmenistan Ukraine United Kingdom Uzbekistan Document number: WHO/EURO:2024-9935-49707-74484