Empowering Airport Emergency Response: Developing a Core Competency Framework for Nursing Staff in Airport Emergency Centers Based on the Onion Model

Introduction : Airports, as critical transportation hubs, present unique medical emergency scenarios characterized by high unpredictability, diverse and complex disease profiles, and a demand for multi-departmental coordination. These conditions impose specialized requirements on the core competencies of nursing staff in airport emergency centers. However, current research has predominantly focused on emergency care skills within hospital settings, resulting in a significant gap in the evaluation system for nursing competencies specifically tailored to international airport emergency contexts. Existing training and assessment programs often lack systematic and tiered competency indicators, leading to insufficiently targeted training content and difficulties in evaluating outcomes. Therefore, this study aims to develop a scientific, systematic, and measurable core competency indicator framework for nursing staff in airport emergency centers based on the Onion Model, to address the absence of standardized assessment tools in this field. Method : Based on a comprehensive literature review, we developed a preliminary set of core competency indicators for airport emergency center nursing according to the Onion Model. Subsequently, 17 experts participated in a two-round Delphi survey between June and December 2025 to refine and finalize the indicators and their respective weights. Data : The study data primarily included: • Quantitative rating data (using a 5-point Likert scale) and qualitative feedback from the two rounds of Delphi expert consultations. • Pairwise comparison matrix data required for the Analytic Hierarchy Process (AHP). • Statistical data for calculating expert engagement rate, authority index, consensus level, and degree of coordination, to validate the reliability of the methodology and the effectiveness of the results. Results : The response rate for the questionnaires was 100% in both Delphi rounds. The expert authority index reached 0.832, and Kendall’s coordination coefficients were 0.509, 0.415, and 0.413 across different levels (P < 0.005). Based on the Onion Model, the finalized core competency indicators for nursing in airport emergency centers comprised 4 first-level indicators, 13 second-level indicators, and 56 third-level indicators. This study established a scientific and reliable competency indicator framework, providing a theoretical reference for training nursing staff in airport emergency centers. Implication : This study innovatively applies the Onion Model to the specific context of emergency nursing, providing a theoretical framework and empirical evidence for understanding and analyzing nursing competency structures in specialized settings. It enriches research on nursing competency models. The developed indicator system can be directly applied to the recruitment, selection, targeted training curriculum design, performance assessment, and career development guidance of nursing staff in airport emergency centers.