In an effort to institutionalize NATO prehospital medical best practice standards, and to reduce preventable morbidity and mortality from Russian conventional weapon systems and irregular and multidomain warfare, the US-based non-governmental humanitarian organization HEAL Corp supported Subject Matter Experts (SMEs) through a working group to establish a fit for purpose curriculum for Ukrainian battlefield medics with the National Academy of the Ministry of Internal Affairs (MoIA) for Ukraine.

The curriculum working group culminated in the delivery of the pilot course in Ukraine. The institutionalization of Modules for training on combat medics may offer a fit for purpose, sustainable and standardized approach for NATO standardization and to rapidly reduce morbidity and mortality for warfighters.

This short report describes the methodology, implementation and evaluation of the Trauma, Resuscitation and Evacuation in Combat Course (“TRECC”) curriculum and course delivery which is a product of the working group and program series with novel approaches and lessons learned for future iterations.

The institutionalization of Modules for training on combat medics may offer a fit for purpose, sustainable and standardized approach for NATO standardization and to rapidly reduce morbidity and mortality for warfighters.

In August 2023, 68% (n=25,900) of the Northwest Territories, Canada, evacuated from wildfires, including the never previously evacuated capital, Yellowknife. Official evacuation orders extended from August 16 to September 6 for this region, impacting health protection services (HPS) in the Territory for remaining residents, and risks on return.

The Office of the Chief Public Health Officer (OCPHO) reviewed and implemented priorities over a three-day period prior to the evacuation order for time critical HPS to continue remotely or transfer to receiving jurisdictions. On return to community, OCPHO implemented processes for reviewing surveillance objectives to assess for impacts to affected populations.

During evacuation, over 15 reports of animal exposures were assessed remotely for rabies prophylaxis. Individuals requiring sexually transmitted infection (STI) follow-up were referred to receiving jurisdictions. One patient with infectious tuberculosis was transferred to another province. Water plant operators were supported with new communication and out-of-Territory testing protocols. On return, enhanced surveillance included: respiratory viruses, STI and blood borne infections, gastrointestinal illness, and toxic drug supplies.

While some HPS continued to mitigate risks, future surveillance will assess the scale of impacts. Updates to continuity of operations plans need to include considerations for remote and local services.

Presentation on what the National Disaster Medical System is and how the program of the system looked internally to modernize to meet challenges.

Describe the National Disaster Medical System.

Define specifically what the NDMS program is.

Discuss challenges that response teams face in a changing landscape of response.

Discuss the changes and modifications of roles and responsibilities to meet response capabilities.

To minimize loss of life, mass casualty response requires swift identification, efficient triage categorization, and rapid hemorrhage control. Current training methods remain suboptimal. Our objective was to train first responders to triage a mass casualty incident using Virtual Reality (VR) simulation and obtain their impressions of the training’s quality and effectiveness.

We trained subjects in SALT Triage then had them respond to a terrorist bombing of a subway station using a fully immersive VR simulation. We gathered learner reactions to their VR experience and post-encounter debriefing with a custom electronic survey.

Nearly 400 subjects experienced the VR encounter and completed evaluation surveys. Most participants (95%) recommended the experience for other first responders and rated the simulation (95%) and virtual patients (91%) as realistic. Ninety-four percent of participants rated the VR simulator as “excellent” or “good.” We observed no differences between those who owned a personal VR system and those who did not.

Our VR simulator (go.osu.edu/firstresponder) is an automated, customizable, fully immersive virtual reality system for training and assessing personnel in the proper response to a mass casualty incident. Participants perceived the encounter as effective for training, regardless of their prior experience with virtual reality.

Augmented reality (AR) is a valuable tool in disaster preparedness training such as tabletop exercises that enhances the exercise by overlaying digital information and virtual objects.

This study intends to develop an application using AR to be used during the exercise.

The data is collected through interviews on the opinions and views of the experts from five main agencies in a disaster response; the National Disaster Management Agency, the Royal Malaysia Police, the Fire and Rescue Department of Malaysia, the Ministry of Health, and the Malaysia Civil Defence Department, discussing their duties during a flood scenario. The consensus achieved after series of interviews with the experts, including document reviews guided by National Security Council Directive 20.

The AR approach is created through ‘marker-based’ which use an image recognition to build up an engaging ‘storyline’ of flood scenario. It includes the updates on the changing plot during the exercise using an ‘inject’ meant to progress the plot and provide fresh data to evaluate and react to.

Integrating virtual objects and entities into the tabletop exercise is made possible by AR, where it revolutionises how disaster responders being trained using an approach that more engaging and effective.

The objective of this research is to assess how New York City Health + Hospitals emergency management professionals (EMPs) perceive climate change-related events, to a.) improve communication for increased receptivity and b.) identify gaps in perceived risks.

The study surveys EMPs from 13 geographically different healthcare facilities in NYC about their perceptions on climate change and its related emergency scenarios, preferred information sources on climate change, and the best modes of communication during climate-related extreme weather events.

The results of this study support a.) the importance of official hospital-system guidance regarding climate risks b.) the use of a diverse array of terminology, including messaging that refrains from the phrase ‘climate change’ and instead refers to the ‘future’ c.) the incorporation of clear actionable deliverables and d.) the inclusion of expert voices into messaging. Overall, recent events and upcoming seasonal hazards appear to affect perception of risk more than objective measures. Knowledge of city and temporal factors that impact perceived risk can be mobilized to harness engagement.

The results of this study inform best practices for climate communications to EMPs, critical in preparing our health systems for future climate disasters.

This article explores the health-related challenges for refugees now residing in the United States and highlights strategies for building resilience in this vulnerable population.

This is a descriptive study identifying six common challenges refugees face when relocating from their country to another country.

Refugees in the United States face many challenges, including language barriers, access to quality education, discrimination based on cultural and religious differences, and inadequate healthcare access. Child refugees, constituting a significant portion of the refugee population, face distinct challenges compared to adults. Many refugees grapple with psychological trauma and access to proper healthcare.

Refugees face many challenges when transitioning to a new country, including losing community, familial support, safety, and cultural norms. To address these challenges in the United States, advocates, and public health advisors must actively engage with refugees to assess their needs and build resilient communities. Proactive outreach tailored to refugees’ vulnerabilities is crucial to ensuring their well-being and successful integration into their new homes.

Chatbots, conversational agents providing access to information and services through interaction in everyday language, can make essential health information and services more accessible, available, and affordable. Kati Collective, together with Meta, worked to identify, outline, and develop some of the most critical tools and processes required to leverage chatbots for social good with a focus on health. The results of this work are compiled in a comprehensive, modular playbook. We propose to share our learnings and guide participants of our session to explore the existing uses, benefits, trade-offs, and challenges of using chatbots in disaster medicine.

There are significant challenges and barriers to scale, impact, and sustainability of their chatbot interventions. In response to these challenges, we used a participatory design process, landscape analysis, desk research and interviews with key stakeholders in the digital for development space to inform which content to include and in what format to best connect information to action.

The Playbook contains key information, tools, exercises, and resources organized into four interrelated modules based on barriers and enablers.

This Playbook is particularly relevant in analysis, planning, strategizing and design phases of the chatbot project lifecycle and is highly extensible to disaster medicine.

This study sought to compare terrorist attacks targeting healthcare in two different geographical areas that are economically and culturally similar: North America and Europe.

The Global Terrorism Database is a database that documents 214,666 worldwide terrorist events from 1970 to 2021. It was searched to identify terrorist attacks against healthcare using keywords. We manually excluded incidents that did not specifically relate to attacks on healthcare. This resulted in 311 and 150 entries in North America and Europe respectively.

The most common method of attack in Europe was bombing (42%) compared to attacks on infrastructure (66%) in North America. The primary target in North America was abortion related (84%). In Europe, the primary target was businesses (37%). In Europe, 18.7% of attacks were assassinations or attempts vs 3% in North America. The total number of fatalities in Europe is 51 vs 3 in North America.

Even though there were significantly more attacks in North America, there were far fewer total fatalities compared to Europe. Attacks in North America appear to be ideological, targeting infrastructure to send a message. Whereas, in Europe, the targets and methods used are more targeted towards the individual and their property.

To investigate the differences between doctor helicopters (DHs) and disaster medical assistance teams (DMATs) based on past examples and the current situation in Shizuoka Prefecture.

First, we examined cases in Shizuoka Prefecture from 2014 to 2023, where incidents involving five or more injured individuals were simultaneously managed using multiple DHs. Next, we investigated the presence of DMATs in Shizuoka Prefecture and assessed their role in disaster responses within the prefecture.

Since 2014, there have been eight incidents in Shizuoka Prefecture where multiple DHs were deployed to respond to mass casualties. In contrast, Shizuoka DMATs were placed on standby three times during the same period, with one active deployment during a disaster caused by a landslide in Atami. The other two cases were managed solely by DHs and ambulance teams.

Localized disasters in Shizuoka Prefecture have seen the effective use of multiple DHs for timely patient transportation, particularly when suitable weather conditions permit. In contrast, DMATs are primarily deployed for extended medical activities lasting more than one day. This differentiation highlights the importance of choosing the appropriate medical response approach based on the nature and scope of the disaster.

To perform a scoping review identifying the criteria for the deployment of the United States National Guard (USNG) to domestic sudden-onset natural disasters to identify the body of literature on which further research and policy decisions may be based.

On January 23, 2023 authors performed a search to identify texts relevant to the involvement of the USNG response to sudden-onset domestic natural disasters. English language texts from any year were considered. Independent reviewers screened titles and abstracts, then full-texts, then extracted data from included texts.

From 886 search results, 34 texts were included. Fifteen criteria for USNG deployment were identified. Lack of security, power failure, and logistical coordination were the most common criteria. Hurricanes were the most common disaster type in the included results.

Disaster response coordinators may use these results to develop policies optimizing the use of the USNG in disaster response.

Artificial intelligence (AI) in emergency medicine has been increasingly studied over the past decade. However, the implementation of AI requires significant buy-in from end-users. This study explored desired clinical applications of AI by emergency physicians.

A 3-round Delphi process was undertaken using STAT59 software. An international expert panel was assembled through purposeful sampling to reflect a diversity in geography, age, time in practice, practice setting, role, and expertise. Items generated in Round 1 were collated by the study team and ranked in Rounds 2 and 3 on a 7-point linear numeric scale of importance. Consensus was defined as a standard deviation of 1.0 or less.

Of 66 invited experts, 29 completed Round 1, 25 completed Round 2, and 23 completed Round 3. Three statements reached consensus in Round 2 and four statements reached consensus in Round 3, including safe prescribing, guiding choice of drug, adjusting drug doses, identifying risk or prognosis, and reporting/interpreting investigation results.

Many desired clinical applications of AI in emergency medicine have not yet been explored. Clinical and technological experts should co-create new applications to ensure buy-in from all stakeholders. Specialty organizations can lead the way by establishing local clinical priorities.

Caregivers are responsible for the in-home care of children with chronic medical conditions (CMCs) and may have care-related questions in order to support the child’s higher quality of life. We propose using a digital health platform, the personal health library (PHL), facilitating collection, organization, utilization, storage, and retrieval of health information, that will allow us to develop an mHealth smartphone app to facilitate patient/caregiver engagement and self-care management of children with CMCs.

Pilot Application of the PHL in the Pediatric Chronic Medical Conditions Population: We will design the PHL to collect and integrate data from health and non-health information, in various formats and modalities, including 1) Parent/caregiver-reported data; 2) Clinical data and; 3) Social determinants of health (SDoH) data; 4) Observations of Daily Living (ODL) data including the PedsQL Parent Questionnaire and the Functional Status Scale. The app will be customized to provide information regarding training in post-acute hospitalization care and deliver information on troubleshooting medical technology care, i.e. tracheostomy care.

We expect that the design of the PHL application will ultimately provide a layer of support for parents and caregivers of children with CMCs for whom home health is not available following hospitalization.

This study analyzes disparities in initial healthcare responses in Turkey and Syria following 2023 earthquakes.

Using Humanitarian Data Exchange, Crude Mortality Rates (CMR) and injury rates in both countries were calculated, and temporal trends of death tolls and injuries in the first month post- catastrophe were compared. WHO Flash Appeal estimated funding requirements, and ratios of humanitarian aid personnel in Urban Search and Rescue (USAR) teams per population from ReliefWeb and MAPACTION data were used to gauge disparities.

56,051,096 individuals were exposed, with Turkey having 44 million vs 12 in Syria. Turkey had higher CMR in affected areas (10.5 vs 5.0/10,000), while Syria had higher CMR in intensely seismic regions (9.2 vs 7.7/1,000). Turkey had higher injury rates (24.6 vs 9.9/10,000). Death and injury rates plateaued in Syria after three days, but steadily rose in Turkey. Syria allocated more funding for all priorities per population except healthcare facilities’ rehabilitation. Turkey had 219 USAR teams compared to Syria’s six, with significantly more humanitarian aid personnel (23 vs 2/100,000).

Significant disparities in initial healthcare response were observed between Turkey and Syria, highlighting need for policymakers to enhance responses in conflict-affected events to reduce impact on affected populations.

Domestic and International Disaster Response requires ongoing preparedness through full-scale exercises and training. The Humanitarian Response Intensive Course (HRIC) includes a 3-day in-person simulation to prepare future humanitarian workers. The Massachusetts General Hospital (MGH) Disaster Medical and Global Disaster Response Teams supported the HRIC through the development of a simulated field hospital for the course participants. Additionally, the MGH teams engaged in an intensive continuing education program for specialized training.

An interdisciplinary team developed and delivered seven discrete educational modules utilizing small group methodologies and combining didactics and simulation for a total of 14 hours of content over the 3-day course. Participants engaged in structured debriefing and completed written evaluations at the end of each day.

18 participants completed the course and simulation weekend. Participants strongly agreed that learning outcomes were met and they noted that they felt more prepared to deploy in the future with comments specifically noting the ability to function as part of a team and increased awareness of personal safety in an alternate care setting.

Structured learning within a large-scale immersive, interdisciplinary simulation resulted in participants reporting increased preparation for real-world events.

Small island developing states in the Eastern Caribbean face a dual burden of climate-related disasters and noncommunicable diseases (NCDs). While the relationship between disasters and health has been demonstrated for acute emergencies, there is limited understanding of the impacts of repeated disaster exposure on NCD management and control. The Eastern Caribbean Health Outcomes Research Network (ECHORN) leverages its robust community-driven network for data sharing and implementation science related to furthering our understanding of the intersection of disaster exposure and NCDs.

The ECHORN cohort study is an ongoing longitudinal cohort study characterizing risk and protective factors for NCDs in the Eastern Caribbean. The cohort (N=2,961) was empaneled between 2013-2018 across four sites. Regional partners identified disaster exposure as a priority for research and coordination moving forward.

ECHORN Wave III includes a disaster exposure survey to analyze the impact of exposure to repeated climate events and natural disasters (COVID19, earthquakes) on NCD management in the Eastern Caribbean. This first-of-its-kind study offers a data-driven approach to sustainable NCD management and climate-resilient policy development.

With the anticipated acceleration of NCDs and disasters across the Caribbean, ECHORN’s work to inform disaster-resilient NCD management and control is imperative and time-sensitive.

Italy frequently experiences major events like earthquakes, floods and migrant shipwrecks. Global concerns include climate change, pandemics and wars. We would assess the role of public health experts and the current state of Italian post-degree Public Health schools towards these challenges.

A cross-sectional online survey was conducted in Italy in June 2023, among all Italian Public Health residents enrolled in SItI. The study investigated the presence of trainings and updates about emergencies. It also explored interest and importance of topic, impact of Covid-19 pandemic and sources of information.

Out of 289 respondents, 86.2% deemed the topic important and 74.4% expressed interest (both p<0.001). 90.1% pointed out the lack of dedicated courses and 93.1% as for specialized master’s programs (both p<0.001). Perceived importance in the topic correlates with the desire to attend dedicated conferences (p<0.001). For COVID-19, 24.6% recognized the importance of topic pre-pandemic, while 50.9% raised awareness during (both p<0.001).

A discussion is needed for enhanced training programs in public health emergency prevention and management across Italy, pledging for uniformity within different training networks. In this way, a more robust response to future emergencies may be ensured.

Nuclear radiological emergencies are classified as low frequency, but high impact events. Radiophobia and fear of deleterious outcomes often evokes hesitancy among responders. This review explored PPE use as a protective mechanism for responders’ safety and identified tools that promote PPE efficacy among first responders during nuclear radiological events.

A systematic literature review was conducted using five scientific databases. More than 5,500 articles were screened to identify literature relating to “PPE use” by first responders during “nuclear radiological events”.

Regulatory agencies such as the IAEA and the NRC assert that PPE, (when worn correctly and consistently) minimizes radiation exposure. Adequate training of first responders emerged as a critical determinant to support appropriate PPE selection and usage during radiological emergencies. This included new employee trainings and refresher courses for existing employees. Pedagogical tools highlighted in the literature included tabletop exercises, safety huddles, trial runs for donning and doffing of new gear (with emphasis on air-fed suits), just-in-time training and virtual reality simulations.

Education on the effective use of PPE is essential to promote self-efficacy among medical staff and other first responders during nuclear radiological events. Comprehensive training will reduce unintended exposures, decrease hesitancy, and maximize employee safety.

Congress directed the Secretary of Defense (DoD) to conduct a Pilot program to increase the National Disaster Medical System’s (NDMS) surge capacity, capabilities, and interoperability to support patient movement during a large-scale overseas contingency operation.

The Pilot conducted a mixed methods exploratory study, the Military-Civilian NDMS Interoperability Study (MCNIS), identifying 55 areas of solutions for NDMS innovation that align with interagency stakeholder interests. Priorities were determined via facilitated discussions, refined and validated by all five Pilot sites.

As the DoD provides essential support for the patient movement component within NDMS, the results highlighted areas for improvement between receiving patients at an airfield and moving them to NDMS definitive care partners during a large medical surge event. This includes patient tracking capabilities, transportation processes and patient placement.

In collaboration with the Departments of Health & Human Services, Homeland Security, Transportation, and Veterans Health Administration, the Pilot is addressing these areas for improvement, by executing site-specific projects that will be validated and identified for export across the system. Leaders across the Pilot site healthcare networks are working to enhance patient movement and tracking. Ultimately, the Pilot will deliver dozens of proven solutions to enhance the NDMS’s patient movement capabilities.

This study explores the feasibility of applying ragdoll physics, a procedural animation, and related game-engine technologies to create real-time simulations for investigating crowd disasters.

We harnessed the power of the Unity Game Engine to develop real-time simulation for the dynamics of a crowd disaster with rendering of scene objects and user interface (UI) elements. Humanoid agents with trigger colliders were linked to color schemes representing impact forces sustained with lethal thresholds ranging from 500 to 550 pounds force for males and 450 to 500 pounds force for females. The simulation enables users to manipulate parameters such as population, crowd density, directional movement and forces applied.

Our simulation showcases an animated real-time depiction of a crowd disaster and enables visualization of casualties, both injured and dead, based upon a quantitative evaluation of the forces sustained.

Utilization of the Unity Game Engine for the development of visually-engaging real-time crowd disaster simulation has promising outcomes. This novel approach for modeling and analysis of crowd dynamics may provide valuable insights with applications in mass gatherings, crowd management, safety, and preparedness.