Provider Skills Assessment and Development Guideline
National Disaster Medical System, Disaster Medical Assistance Team PA-1
Version 1.0 , 1/18/13
Comments to Keith Conover, M.D., FACEP, Team Medical Director kconover@pitt.edu
Download from http://conovers.org/ftp/DMAT-Provider-Skills.pdf and comment (Adobe Reader 9 or X), or as a
Word file (http://conovers.org/ftp/DMAT-Provider-Skills.docx) send to kconover@pitt.edu
Rationale
There is a basic core of cognitive and performance skills that we expect of each practitioner, to
competently perform the duties expected of a DMAT provider. This is separate from training in
DMAT-specific equipment, medications and supplies, which is accomplished at team and
National Disaster Medical System training. It also is separate from disaster-specific training for
WMD (weapons of mass destruction) and the like. It is the skills needed for basic urgent
medical care.
The choice of items for the core skills list depends on:

How frequently it will occur in our practice (mostly in a DMAT tent-ED, sometimes as
backfill in an ED, less commonly other duties). If we get sent into a hospital to do other
tasks, we’ll match skills beyond the core with the jobs as best we can.

How hard it is to acquire and maintain the skill.

How important the skill is – will it save lives? Prevent morbidity?
The skill set should be a subset of emergency medicine, with a few additions from primary care
and other specialties, and slanted to DMAT’s specific needs.
Authority
We have no funding for any of this training.
We also have no authority to require practitioners to meet any standards we set. However, we
still have a volunteer ethos in the team, and we can ask practitioners assess themselves against
this standard, and we will do the best we can to help them towards this level of competence.
Team Support
DMAT PA-1 leadership will do their best to help providers obtain this training with the least
expense possible. Potential means include:

Arranging for local skills training for skills that suffer significant skill decay. An example
might be arranging difficult airway management sessions at simulation centers such as
the STAR center at Western Pennsylvania Hospital or the WISER Center at the University
of Pittsburgh.

Encouraging and tracking the development of internal instructors and course
coordinators for recommended courses, such as PALS, ACLS, or ADLS, so that the team
can offer such courses to team members at reduced or no cost.

Arranging continuing medical education credit for internal team training (accomplished
for physicians and midlevels, free for team members; working on it for RNs and EMS
personnel) so that team members will have more flexibility in CME spending for courses
of benefit to disaster operations.
Guideline
Compliance with this guideline is entirely voluntary.
For all courses, completion suffices; there is no need to maintain certification. Practitioners
who don’t practice a skill regularly should retake course as they think needed.
Those with American Board of Emergency Medicine (ABEM) or American Osteopathic Board of
Emergency Medicine (AOBEM) certification are deemed to comply with topics noted EM.
Those with board certification from the American Board of Internal Medicine (ABIM), American
Board of Anesthesiology (ABA), American Board of Obstetrics and Gynecology (ABOG), or the
American College of Surgeons (ACS), are deemed to comply with topics noted CC.
Similarly, some providers might have experience that actually would be superior to taking such
a course. For instance, a CRNA at a burn center wouldn’t need ACLS or ABLS. This will be up to
the judgment of the provider in consultation with the Team Medical Director in consultation
with the team Commander and Training Officer.
Key to Sources of Training
ABLS: Advanced Burn Life Support (American Burn Association)
ACLS: Advanced Cardiac Life Support (American Heart Association)
ATLS: Advanced Trauma Life Support; Early Management of Severe Trauma (EMST) outside
North America (American College of Surgeons)
Buttaravoli: textbook Minor Emergencies by Philip Buttaravoli, MD, FACEP
DAM: Difficult Airway Management Emergency Medicine – Community (DAM EM COMM)
course of the University of Pittsburgh’s Winter Institute for Simulation Education and Research
(WISER)
EMBC: Emergency Medicine Boot Camp (The Center for Emergency Medicine Education)
FCCS: Fundamental Critical Care Support Course (The Society of Critical Care Medicine)
MedExpress: The “CRASH” course offered by MedExpress to its urgent care center employees,
including such things as X-ray and EKG interpretation, and management of common urgent care
problems. (MedExpress)
PALS: Pediatric Advanced Life Support (American Heart Association) or equivalent APLS:
Advanced Pediatric Life Support (American Academy of Pediatrics, American College of
Emergency Physicians)
Topic
Infectious disease common problems, including Lyme
disease and STARI, viral and bacterial meningitis
Dermatologic problems, acute: contact dermatitis,
arthropod bites, cutaneous larva migrans, diaper
dermatitis, friction blisters, shingles, impetigo,
pediculosis, pityriasis rosea, pyogenic granuloma, scabies,
sea lice, sunburn, tick removal, tinea (capitis, corporis,
cruris, pedis), urticaria
Abscess, cellulitis, erysipelas and ecthyma diagnosis and
management, including incision and drainage
Analgesia (including IV medications)
Bartholin cyst incision and drainage
Bladder Catheterization
Burns: management (comprehensive)
Cardiac defibrillation
Cardiac pacing (external = transthoracic)
Cardiac Resuscitation (including defibrillation and
synchronized cardioversion, ACLS drugs)
Cold-related disorders: hypothermia, chilblain, frostnip,
deep frostbite
Closed reduction of hernia
CPAP and BiPAP management
Critical Care: Recognition and Assessment of the
Seriously Ill Patient, Airway Management,
Cardiopulmonary/Cerebral Resuscitation, Diagnosis and
Management of Acute Respiratory Failure, Mechanical
Ventilation,
Monitoring Blood Flow, Oxygenation, and Acid-Base
Status, Diagnosis and Management of Shock, Neurologic
Support, Basic Trauma and Burn Support, Acute Coronary
Syndromes, Life-Threatening Infections: Diagnosis and
Antimicrobial Therapy Selection, Management of LifeThreatening Electrolyte and Metabolic Disturbances,
Critical Care in Pregnancy, Ethics in Critical Care
Medicine, Critical Care in Infants and Children: The Basics
Cricothyrotomy
Delivery of newborn
Dislocations, diagnosis and closed reduction, including:
nursemaid’s elbow, patellar dislocations, finger and toe
dislocations, shoulder dislocations, elbow and hip
Notes
EM
Where obtained
EMBC
EM
MedExpress,
Buttaravoli
EM
EM, CC
EM
EM, CC
EM
EM, CC
EM, CC
EM, CC
MedExpress,
Buttaravoli, EMBC
EMBC
Buttaravoli, EMBC
EMBC
ABLS, EMBC
ACLS, PALS
ACLS, PALS
ACLS, PALS
EM
Buttaravoli, EMBC
EM
EM, CC
CC
EMBC
FCCS, EMBC
FCCS
EM
EM
EM
ATLS
EMBC
Buttaravoli, EMBC
dislocations
Lacerations and other soft tissue problems, acute: simple EM
and complex (2-layer) laceration management and repair,
contusions, puncture wounds, abrasions, small impaled
objects (fishhooks, splinters and foreign bodies in skin
and under nails), nail avulsions, subungual ecchymosis
and hematomas and nailbed lacerations, paronychia, ring
removal, torn earlobes, and zipper entrapment.
Electrocardiogram interpretation
EM, CC
Buttaravoli, EMBC
Electrolyte and metabolic management
Endotracheal intubation (oral, nasal)
Envenomation and stings and bites, diagnosis and
treatment: marine envenomations, North American
poisonous snakebite, black widow and brown recluse
spider bites, scorpion bites, mammalian and human
bites, bee and wasp stings, fire ant bites/stings
Heat Illness (Dehydration, Heat Exhaustion, Heatstroke)
management
Eye examination: Wood’s light (slit lamp skills helpful but
not essential)
Eye problems, simple, diagnosis and treatment:
conjunctivitis, corneal abrasion, styes, subconjunctival
hemorrhage
ENT problems, simple, diagnosis and treatment: wax
impaction, nosebleed, foreign bodies in ear and nose and
throat, croup, tonsillitis, mononucleosis, nasal fracture,
otitis media (serous and suppurative), perforated TM,
acute rhinosinusitis
Oral and dental problems, simple, diagnosis and
treatment: aphthous ulcers, dental fractures,
subluxation, and luxation, dental pain (abscess, caries,
pericoronitis, dry socket, pulpitis), oral lacerations,
gingivitis, thrush, oral herpes, angular cheilitis, salivary
duct stones, TMJ capsulitis and syndrome, uvulitis
Foreign body removal: corneal/conjunctival
EM, CC
EM, CC
EM
ACLS, MedExpress,
EMBC
FCCS, EMBC
ACLS, DAM
Buttaravoli, EMBC
EM
Buttaravoli, EMBC
EM
Buttaravoli, EMBC
EM
Buttaravoli, EMBC
EM
Buttaravoli, EMBC
EM
MedExpress,
Buttaravoli, EMBC
EM
Foreign body removal: cutaneous
EM
Fracture splinting with plaster and fiberglass material:
thumb spica splint, ulnar gutter splint, volar arm splint,
sugar tongs arm splint, long arm splint, posterior leg
splint, sugar tongs leg splint
EM
MedExpress,
Buttaravoli, EMBC
MedExpress,
Buttaravoli, EMBC
MedExpress,
Buttaravoli, EMBC
Muscular and tendon and related problems, acute,
diagnosis and management: bursitis (subdeltoid,
trochanteric, subacromial), carpal tunnel syndrome,
cervical, thoracic and lumbar strains, torticollis, De
Quervein’s Tenosynovitis, Achilles tendinitis, boutonniere
deformity, mallet finger and splay finger injuries, patellar,
plantaris gastrocnemius and biceps tendon rupture,
rotator cuff injuries, muscle cramps, fibromyalgia,
polymyalgia rheumatica, plantar fasciitis
Joint problems, acute: ganglion cysts, acute inflammatory
arthritis including gout
Fractures, diagnosis and management/closed reduction,
including: boxer’s fracture of hand, clavicle fractures,
fingertip (tuft) and finger and toe fractures, radial head
fracture, scaphoid fractures, wrist fractures, spinal
fractures including coccyx fractures, pelvic fractures
Laboratory study interpretation (iStat common studies)
EM
MedExpress,
Buttaravoli, EMBC
EM
MedExpress,
Buttaravoli, EMBC
MedExpress,
Buttaravoli, ATLS,
EMBC
Local anaesthesia
EM
Lumbar puncture
Nasal cautery and packing
EM, CC
EM
Nasogastric intubation
Nerve blocks: digital, dental, facial
EM, CC
EM
Neurological problems, acute: migraines, seizures, Bell’s
palsy, concussion, vertigo, weakness, stroke
Pulmonary and chest problems, acute, diagnosis and
treatment: asthma, bronchitis, pneumonia, smoke
inhalation, irritant exposure, rib fractures and other chest
wall injuries
Gastrointestinal problems, acute, diagnosis and
management: esophageal foreign body, vomiting, upper
GI bleeding, hiccups, nonsurgical rectal foreign body
removal, hemorrhoids, anal fissures, diarrhea,
constipation
Urologic problems, acute, diagnosis and treatment: blunt
scrotal trauma, testicular torsion, epididymitis, genital
herpes, phimosis, paraphimosis, prostatitis, urethritis,
urinary retention, cystitis and pyelonephritis
Gynecologic problems, acute, diagnosis and treatment:
Bartholin abscess, dysmenorrhea, vaginal foreign body,
EM
EM
EM, CC
EM
MedExpress,
Buttaravoli, EMBC
MedExpress,
Buttaravoli, EMBC
EMBC
MedExpress,
Buttaravoli, EMBC
EMBC
MedExpress,
Buttaravoli, EMBC
MedExpress,
Buttaravoli, EMBC
MedExpress,
Buttaravoli, EMBC
EM
MedExpress,
Buttaravoli, EMBC
EM
MedExpress,
Buttaravoli, EMBC
EM
MedExpress,
Buttaravoli, EMBC
emergency contraception, Pelvic Inflammatory Disease,
vaginal bleeding and vaginitis
Sprains and related injuries, diagnosis and treatment: AC
joint, ankle, midfoot, fingers and toes, knee ligaments
(and meniscus injuries), lateral and medial epicondylitis,
locked knees, gamekeeper’s thumb
Oxygen therapy
Pediatric resuscitation
Pericardiocentesis
Poisoning, treatment of
Prehospital Airways (Combitube, King LT)
Psychiatric evaluation and therapy (initial) and
management of related issues, including: dystonic
reactions, tardive dyskinesia, and serotonin syndrome
Radiographic study interpretation
Respirator management
Sedation, procedural
Sexual Assault examination collection of specimens
Sexually transmitted diseases evaluation and treatment
Spinal immobilization and clearing
Subungual hematoma trephination
Thoracentesis
Thoracostomy tube drainage (chest tube)
Ultrasound: perform basic limited emergency bedside
ultrasound procedures, including the following: FAST
(focused abdominal ultrasound in trauma), urinary
retention, renal for hydronephrosis, gallbladder for
gallstones, abdominal aortic aneurysm, intrauterine
pregnancy, skin: foreign body and abscess;
musculoskeletal: fracture.
Venous access: central lines (subclavian, internal jugular)
Venous access: external jugular IV
Venous access: femoral venipuncture
Venous access: intraosseous access
Venous access: peripheral IV
Wound Debridement and Repair
EM
MedExpress,
Buttaravoli, EMBC
EM, CC
EM, CC
EM, CC
EM, CC
EM, CC
EM
FCCS, ACLS, EMBC
PALS
ACLS
EMBC
ACLS
EMBC
EM, CC
EM, CC
EM, CC
EM
EM
EM
EM
EM, CC
EM, CC
EM
MedExpress, EMBC
FCCS
Buttaravoli, EMBC
EMBC
Buttaravoli, EMBC
ATLS, EMBC
Buttaravoli, EMBC
EMBC
ATLS
plan to set up team
training for this.
EM, CC
EM, CC
EM, CC
EM, CC
EM, CC
EM
ACLS, ATLS
EMBC
EMBC
PALS
EMBC
Buttaravoli, EMBC