A Textual Mapping Analysis of Mass Trampling Incident Emergency Drill Scripts Based on ICN Core Competencies in Disaster Nursing Version 2.0

To evaluate the alignment of mass trampling incident emergency drill scripts with the International Council of Nurses (ICN) Core Competencies in Disaster Nursing Version 2.0 and to identify areas of higher and lower textual coverage of competency items.

Crowd crush incidents are increasingly frequent worldwide and pose severe risks of mass casualties. Despite the importance of systematic and standardized emergency drills, there is limited evidence on the extent to which existing drill scripts address core disaster nursing competencies, particularly in high-risk mass gathering scenarios.

We mapped 24 provincial-level emergency drill scripts from a mass casualty exercise in China against the ICN Version 2.0 framework. Two researchers independently reviewed each script line by line and deductively coded the content against the eight domains and 33 competency items of the ICN Version 2.0 framework. Coverage rates were calculated and summarized using four descriptive categories: high, moderate, low, and no textual coverage.

Domain-level coverage represents the proportion of competency items appearing in at least one script. It was high for Assessment (100%), Incident Management (100%), Preparation and Planning (80%), and Communication (75%). Law and Ethics (67%), Intervention (50%), and Safety and Security (40%) met the criterion for moderate coverage. No domain fell within the low-coverage category, and no Recovery-domain item was represented in any script (0% domain-level coverage). Several competency items related to post-drill evaluation, education and training, psychological support, isolation, decontamination, and recovery were infrequently represented or absent.

The drill scripts showed relatively strong textual representation in Assessment, Incident Management, Preparation and Planning, and Communication, but less comprehensive representation in Law and Ethics, Intervention, and Safety and Security, while Recovery was not represented. Future drills should strengthen underrepresented competency-related content that can reasonably be demonstrated during immediate response. Competencies involving organizational planning, education and training, post-exercise activities, and recovery-phase activities may require complementary assessment beyond script review to support a more objective and comprehensive evaluation.

This study may help nursing managers understand how disaster nursing core competencies are represented in emergency drill scripts and identify competency areas that warrant further attention. The findings may provide a reference for targeted improvements in disaster preparedness planning, training, drill design, and subsequent competency assessment.