need irrespective of likely outcome. The egalitarian will place some emphasis on equality, and the way that this is achieved might differ. The guiding factor is need rather than the ultimate benefit or utility of the intervention. Approaches based on egalitarian principles are complex guides in disaster settings. In the words of Eyal (2016) "Depending on the exact variant of egalitarianism, the resulting limited priority may go to patients whose contemporaneous prognosis is dire (because their medical prospects are now poor), to patients who have lived with serious disabilities for years (because their lifetime health is worse), to young patients (because dying now would make them short-lived), to socioeconomically disadvantaged patients (because their welfare prospects and resources are lower), or to those who queued up first (because first-come first-served may be thought to express equal concern." Procedural Approach The inherent difficulties in triage may lead practitioners to attempt to minimize active selection or prioritization of patients in face of scarcity of resources, and instead rely upon guidelines which do not take into account medical need or possibility of positive outcomes. In this approach, known as proceduralism, selection or prioritization may be based on patient's inclusion in a particular group (for example, by citizenship, or membership within an organization such as health insurance group). This approach prioritizes simplification of the triage and transparency, although there are significant ethical drawbacks, especially when procedures favor those who are part of socioeconomically advantaged groups (such as those with health insurance). Procedural systems of triage emphasize certain patterns of decision making based on preferred procedures. This can take place in the form of a fair lottery for instance; or establishing transparent criteria for entry into hospitals - based on non discriminatory conditions. This is not outcome driven; it is a process driven activity aimed at providing consistent frameworks upon which to base decisions. These are by no means the only systems upon which decisions are made, but provide a basic framework to evaluate the ethical reasoning behind what are often difficult choices during disaster response and management. Areas of competency Internationally, disaster medicine specialists must demonstrate competency in areas of disaster healthcare and emergency management including but not limited to: Disaster behavioral health Disaster law Disaster planning Disaster preparation Disaster recovery Disaster response Disaster safety Medical consequences of disaster Medical consequences of terrorism Medical contingency planning Medical decontamination Medical implications of disaster Medical implications of