Building a Culture of Disaster Readiness in Small Island Developing States (SIDS) Through Education and Training: A Field Report of Rural Trinidad and Tobago.

Summary: Trinidad and Tobago allocates 3. 3% of its Gross Domestic Product (GDP) to health care. The most common hazards are storms and flooding, which have a direct financial impact, accounting for up to 5. 7% of GDP. Nations and health systems can benefit from savings of up to 13 for every 1 invested in mitigation. East Trinidad is vulnerable to climate change, prompting the need for disaster preparedness by the semi-autonomous Eastern Regional Healthcare Authority (ERHA), which is responsible for the region. Engaging the framework of clinical governance, education, and training was the pillar upon which readiness was developed. This need will continue to be exacerbated by climate change. The ERHA collaborated with the Pan American Health Organization, facilitated through the Ministry of Health, to deliver didactic, multi-sectoral courses designed to improve the response skills of healthcare providers in Mass Casualty Management between 2022 and 2024. This included practical sessions, which were assessed by trained local and regional instructors. There were positive outcomes from this standardized education and training program, involving four cohorts of 285 participants, which included both clinical and auxiliary staff from hospital and community-based services. Immediate assessment demonstrated mean pretest to post-test scores improving from 58% to 74%. Feedback included participants’ desire for continuous training and integration of clinical scenarios. The key long-term outcome has been the successful coordination of two drills in 2024 involving multiple facilities. The authors find that this experience demonstrates the importance of cultural paradigm change needed to bridge existing clinical and academic gaps. This can be effectively instituted with strong leadership in the governance of the health care system, which must focus on disaster readiness. Small Island Developing States (SIDS) and other resource-limited countries are encouraged to adopt a similar model of standardized training to establish a foundation for disaster response.