To determine the incidence and characteristics of hospital-based gun violence from 2000–2019.

A keyword-based search of the Nexis Uni database was conducted to identify hospital based shootings ((“shooting” w/5 “healthcare”) OR (“shooting” w/5 “health care”) OR (“shooting” w/5 “hospital”) OR (“shooting” w/5 “emergency room”) OR (“shooting” w/5 “ER”). Hospital based shootings were defined as any firearms discharge that occurred on hospital grounds in which at least one person was injured. Specialty hospitals and other healthcare facilities were excluded. Demographic, motive, and outcome data from news articles were abstracted by 2 independent reviewers with discrepancies resolved by a third reviewer. Motives were categorized according to a previously published classification schema.

We identified 146 hospital-based shootings. 88 shootings have occurred since 2010. 133 of the shooters were male (91%), with a median age of 46. 77 (53%) shooters were killed, 49 from suicide (34%). Shootings were most frequently motivated by social violence (n=32, 22%).

Hospital-based shootings are not a rare occurrence, with middle-aged male shooters as the most common perpetrators. These events appear to be increasing over time and evidence-based mitigation strategies should be investigated.

Mass casualty incidents (MCIs) come unannounced, mandating the immediate shift from the daily routine to crisis mode through the implementation of an MCI response plan (plan). On August 4, 2020, a massive explosion devastated the Lebanese capital, Beirut, causing 8643 injuries and 200 deaths.1 The private Lebanese American University Medical Center in Beirut has an an estimated 10,000 emergency department (ED) visits per year. The purpose of this study is to analyse the plan of this private hospital in a low resource country in response to a blast MCI.

A retrospective analysis of the expected outcome of the pre-existing plan was performed.

Major flaws were noted. Triage was impossible using the START method and will be done outside the ED dividing patients into walking and non-walking. Identification and registration of patients was impossible. Patients will be assigned a number and be registered later. Colored jackets were created to recognize response team members for better organization.t Radiologic imaging will be ordered only when they change the patients’ disposition.

This analysis showed failure of the plan at different levels and adjustments were made to advance the plan. Periodic exercises and annual review are needed for continuous improvement.

This review aimed to identify health impacts of climate change on persons with disabilities in developing countries as well as factors influencing the vulnerability and resilience of affected individuals to related natural disasters.

PubMed, PsycINFO, Scopus, and Embase databases were searched, 2005 to 2023 inclusive, focusing on the keyword terms “persons with disabilities”, “climate change” and “developing countries”. Identified articles were screened for inclusion and qualifying articles received a full-text review. Of 463 articles identified, following removal of six duplicates, 457 articles were screened; 412 were excluded. Of the remaining 45 full-text articles assessed for eligibility, 15 were selected and included in the review with two additional articles from a manual search.

Findings revealed themes including the impact of climate change on the physical and mental health of persons with disabilities in developing countries. The general theme of resilience to natural disasters and specific coping strategies were also elaborated.

While there is increasing recognition of the psychosocial impacts of climate change-related natural disasters on persons with disabilities, there remain significant gaps in awareness of mental health needs and related service provision. Resolving these gaps is indispensable to achieving equitable climate change-related health outcomes in developing countries.

In mass casualty scenarios, patients with apparent hemodynamic and respiratory stability might have occult life-threatening injuries. These patients could benefit from more accurate triage methods. This study assessed the impact of point-of-care ultrasound (POCUS) on the accuracy of secondary triage conducted at an advanced medical post (AMP) to enhance the detection of patients who, despite their apparent clinically stable condition, could benefit from immediate life-saving interventions or priority earlier transport to definitive care.

A mass casualty simulated event consisting of a bomb blast in a remote area was conducted with 10 simulated casualties classified as YELLOW at the primary triage scene; patients were evaluated by 4 physicians at an AMP. Three patients had, respectively, hemoperitoneum, pneumothorax, and hemothorax. Two of the four physicians were provided the use of POCUS.

All 4 physicians were able to suspect hemoperitoneum, but only physicians utilizing POCUS detected pneumothorax and hemothorax.

This study suggests that POCUS-enhanced secondary MCI triage at an AMP may represent an effective methodology to accurately detect nonapparent injuries that require time-dependent priority transport or life-saving interventions. Further studies with larger samples conducted in varied MCI scenarios are warranted.

Despite the global expansion of electronic medical record (EMR) systems and their increased integration with artificial intelligence (AI), their utilization in disaster settings remains limited, and few studies have evaluated their implementation. We aimed to evaluate Fast Electronic Medical Record (fEMR), a novel, mobile EMR designed for resource-limited settings, based on user feedback.

We examined usage data through October 2022 to categorize the nature of its use for disaster response and determine the number of patients served. We conducted interviews with stakeholders and gathered input from clinicians who had experience using fEMR.

Over eight years, fEMR was employed 60 times in 11 countries across four continents by 14 organizations (universities, non-profits, and disaster response teams). This involved 37,500+ patient encounters in diverse settings including migrant camps at the US-Mexico and Poland-Ukraine borders, mobile health clinics in Kenya and Guatemala, and post-earthquake relief in Haiti. User feedback highlighted adaptability, but suggested hardware and workflow improvements.

EMR systems have the potential to enhance healthcare delivery in humanitarian responses, offer valuable data for planning and preparedness, and support measurement of effectiveness. As a simple, versatile EMR system, fEMR has been deployed to numerous disaster response and low-income settings.

The recent rise of active shootings calls for adequate preparation. Currently, the ‘Run, Hide, Fight’ concept is widely accepted and adopted by many hospitals nationwide. Unfortunately, the appropriateness of this concept in hospitals is uncertain due to lack of data. To understand the ‘Run, Hide, Fight’ concept application in hospital, a review of currently available data is needed.

A systematic review was done focusing on the ‘Run, Hide, Fight’ concept using multiple databases from the last 12 years. The PRISMA flow diagram was used to systematically select the articles based on specific inclusion and exclusion criteria. The measurements were subjective evaluations and survival probabilities post-concept.

One agent-based modeling study suggested a high survival probability in non-medical settings. However, there is a paucity of data supporting its effectiveness and applicability in hospitals. Literature suggests a better suitable concept, the ‘Secure, Preserve, Fight’ concept, as a response protocol to active shootings in hospitals.

The effectiveness of the ‘Run, Hide, Fight’ concept in hospitals is questionable. The ‘Secure, Preserve, Fight’ concept was found to be designed more specifically for hospitals and closes the gaps on the flaws in the ‘Run, Hide, Fight’ concept.

Prompt safety confirmations before and after a disaster are key to reducing risks in disasters among older adults. This study aims to reveal issues in contacting fragile older adults once flood disaster strikes to ensure a sustainable safety net.

Focus group interviews were conducted in three municipalities of Kumamoto, Japan, which experienced a flood disaster in July 2020, with nine care managers, nurses, and center directors of community-based integrated support centers in August 2023.

Communication records of support and lists of older adults requiring support in regular operations were useful, and the safety of those on the lists was first confirmed immediately after the disaster struck. However, confirmation of safety of those who did not rely regularly on public services, those who lived alone, and older couples, was delayed and their safety was determined by their neighbors’ reports.

Prompt safety confirmation system in the event of a disaster is required for, in particular, fragile older adults who do not rely on public services, which lead to early support intervention.

The city was hit by a flood on July 5, 2022. Afterwards, the mayor of Belgrade declared that no one should be blamed because we cannot influence God’s will. Objective is examination of the relationship between such a laissez-faire approach to Disaster Risk Reduction (DRR) from the city government, and some groups from hill areas (historically not flooded), who were flooded and have started to develop DRR approaches to adequately respond to the next possible flood.

Participant observation site work is in progress and includes 32 households in the residential hill area of Belgrade that experienced its first rain floods from 2019 to 2023. DRR is represented through self-installed special devices on the city sewage network. The data collection and analysis included narrative analysis and sociological analysis of photographs. All data was first anonymized as some practices were viewed as legitimate but not always legal.

During the relevant three years, the number of non-flooded homes increased proportionally with increasing self-installation of special devices on their city sewage system

Groups left without official DRR policies can develop resilience through individual actions in communal infrastructure and find ways to resist natural hazards and government laissez-faire DRR.

In a model of military-civilian trauma system integration, coordination of mass casualty incident response by military and civilian entities could be more effective through reduced duplication of services and improved resource utilization. The following study seeks to examine and address the challenges faced in establishing integrated trauma systems.

Through a survey this study comprehensively gathered data on trauma system capabilities and the current degree of military-civilian integration of 73 individual countries. Through a scoring method based on participant responses, countries were classified into three distinct integration types, ranging from minimal (Type I) to robust (Type III). This method allowed analysis of the association of numerous trauma system factors with increased integration status.

A higher integration status is associated with coordinated use of military and civilian resources for aero-medical evacuation (Chi Square p<0.05). With regards to resource utilization, countries with higher integration status exhibited more rapid availability of blood products (Chi Square p<0.05), a critical factor contributing to improved mortality among traumatically injured patients.

By identifying key areas where integration can be strengthened, and by understanding the underlying factors shaping these frameworks, this research seeks to build more collaborative and resource-efficient responses to mass casualty incidents globally.

the line between our physical and digital selves becomes increasingly blurry, sexual, and reproductive data rights must be safeguarded as a key lever of bodily autonomy and gender equality.

Kati Collective will facilitate an engaging workshop on protecting personal sexual reproductive health data rights and bodily autonomy to build a shared understanding of this critical issue and begin to explore pathways for solutions.

Develop co-created policy-level recommendations and pathways to action contributing to improved understanding, alignment and collaboration among key stakeholders, and improved protection, ownership, governance of SRH data.

There is an urgent need for collective action to co-develop policy-level recommendations and pathways to action to protect SRH rights and bodily autonomy.

Defining the role of federal wildland firefighters (WFF) in the context of emergency medical services (EMS) is a gap in the literature. Our work highlights the importance of standardizing and enhancing the EMS capabilities of federal WFF for their own occupational safety and well-being, while emphasizing their potential for responding to all disasters and providing medical safety net in rural communities.

A comprehensive academic literature review on the topic returned one non-peer reviewed manuscript. Study members analyzed National Wildfire Coordinating Group (NWCG) EMS policy to assess current EMS standards within the WFF service.

The study reveals a lack of standardized, comprehensive support for EMS capabilities among federal WFF, despite need for their expertise in wide-ranging emergency situations. There are few incentives for individuals to obtain and maintain EMS certification. Various innovations, such as the Alaska Fire Medic Program and the BLM Operational Medical Support Program, are potential models for improving EMS across the entire NWCG.

To enhance the safety, professionalization, and efficiency of WFF, the NWCG should consider standardizing EMS guidelines, especially in providing consistent support for medical certifications. EMS certified WFF could contribute to nationwide disaster response capabilities if supported by NWCG.

The potential for a radiological disaster from natural environmental causes, human error, aging nuclear power plants, buried radioactive waste, regular ground transport of radioactive materials, a shared international border, and the threat of radiological terrorism make the Western New York region vulnerable for a radiation emergency. A global threat from Russia and intentional uses of nuclear weapons by non-state approved users, such as North Korea, raise public awareness. Limited importance has been given to educating medical providers and emergency planners with radiological knowledge and preparation.

The goal of this study was to understand the relationships of the peerception of risk, emergency self-efficacy and willingness to respond to a radiation emergency among health professionals.

Two hundred sixty-nine (269) medical and health practitioners were selected for a purposive, convenience sample in an eight-county region of Western New York. Participants identified the need for improved knowledge and preparation for the management of a radiation emergency.

Statistical findings using the author created Structural Equation Model (SEM) revealed a goodness of fit for perception of risk as a strong predictor of willingness to respond to a radiation emergency.

The SEM study names the variables that influence training for global nuclear realities.

The release of ChatGPT in November 2022 drastically lowered the barrier to artificial intelligence with an intuitive web-based interface to a large language model. This study addressed the research problem: “Can ChatGPT adequately triage simulated disaster patients using the Simple Triage and Rapid Treatment (START) tool?”

Five trained disaster medicine physicians developed nine prompts. A Python script queried ChatGPT Version 4 with each prompt combined with 391 validated patient vignettes. Ten repetitions of each combination were performed: 35190 simulated triages.

A valid START score was returned In 35102 queries (99.7%). There was considerable variability in the results. Repeatability (use of the same prompt repeatedly) was responsible for 14.0% of overall variation. Reproducibility (use of different prompts) was responsible for 4.1% of overall variation. Accuracy of ChatGPT for START was 61.4% with a 5.0% under-triage rate and a 33.6% over-triage rate. Accuracy varied by prompt between 45.8% and 68.6%.

This study suggests that the current ChatGPT large language model is not sufficient for triage of simulated patients using START due to poor repeatability and accuracy. Medical practitioners should be aware that while ChatGPT can be a valuable tool, it may lack consistency and may provide false information.

This study aims to assess the public healthcare system by implementing a scorecard in Hatay and Kahramanmaras provinces in Türkiye after the Kahmaranmaras earthquake.

The methodology employing in this study, action research, informs the active interaction between participants who have been involved in disaster risk reduction in the variety of capacities, such as affected local government, emergency medicine department, nursing and care association.

The scorecard application was carried out with 18 participants in Maraş and 22 in Hatay. The scorecard application shows that the items with the lowest scores in Hatay were related to the resilience of public health infrastructure and key health facilities, and the fulfilment of society’s role in disasters. In Maraş, on the other hand, coping with patient surge in disaster, fulfilment of society’s role in disasters, and mental health services in the context of disasters.

With the participation in scorecard workshop, communications between these stakeholders for community public healthcare system can discuss the best way to prepare and collaborate to promote further community disaster risk reduction planning during post-disaster recovery phase.

This study aimed to use artificial intelligence (AI) computing techniques to determine if they can validate the findings of a previously published thematic analysis article focusing on disaster medicine experts’ open-ended feedback about Middle East and North African countries (MENA) for chemical, biological, radiological, and nuclear (CBRN) threats.

Automated text analytics techniques were employed to explore and visualize the semantic essence of the experts’ feedback through word vector transformation and Principal Component Analysis (PCA) for dimensionality reduction. The t-distributed Stochastic Neighbor Embedding (t-SNE) is another more advanced dimensionality reduction technique that enhanced the capturing of the determined components.

Two prominent clusters emerged from the full textual data set representing word similarities groups in the original data set, denoting a thematic group of ideas that experts have emphasized in their responses. Upon deep reading the text feedback, the themes linked preparedness with different training types, such as tabletop exercises and policies/legislation. The findings are in line with currently adopted practices.

While AI methods demonstrated their valuable application in disaster medicine and helped validate the experts’ recommendations objectively, they should be approached cautiously, as they can be complex and challenging to comprehend fully.

High-Fidelity training in triage for Mass Casualty Incidents (MCI) is resource intensive and therefore limited in frequency despite knowing that this skill degrades with time. Didactic classroom materials offer a non-resource-intensive introduction to foundational concepts, but the extent to which it can prepare providers for real world scenarios is limited. Virtual reality (VR) is an effective training alternative, but in its infancy of development and accessibility. To bridge the gap between these modalities, we propose a video-enhanced method to didactic training.

During Uniformed Service University’s (USU) annual Operation Bushmaster field exercise we produced video footage of individual casualties along with multiple casualty scenes consisting of several 5-15 second videos capturing various elements of a primary survey.

The videos offer a higher-fidelity alternative to written casualty descriptions allowing the learner to visually process casualty presentation that is more representative of reality. The video segments facilitate thinking through specific points in the decision-making process for triage and life saving interventions.

Video enhanced didactic training offers a bridge between written didactic training and exercise or VR training for MCI triage skills acquisition and sustainment. Assessment and validation of this training methodology with various MCI responders is recommended.

Hemorrhage control, triage efficiency, and triage accuracy are essential skills for optimal outcomes in mass casualty incidents. This study evaluated user application of skills through a Virtual Reality (VR) simulation of a subway bombing.

EMS clinicians and healthcare professionals engaged in a VR simulation of a bomb/blast scenario utilizing VRFirstResponder, a high-fidelity, fully immersive, automated, customizable, and programmable VR simulation platform. Metrics including time to control life-threatening hemorrhage and triage efficacy were analyzed using median and interquartile ranges (IQR).

389 EMS responders engaged in this high-fidelity VR simulation encountering 11 virtual patients with varying injury severity. The median time to triage the scene was 7:38 minutes (SD = 2:27, IQR = 6:13, 8:59). A robust 93% of participants successfully implemented all required hemorrhage control, with a median time of 3:51 minutes for life-threatening hemorrhage control (SD = 1:44, IQR = 2:41, 4:52). Hemorrhage control per patient took a median of 11 seconds (SD = 0:47, IQR = 0:06, 0:20). Participants accurately tagged 73% of patients and 17% effectively utilized the SALT sort commands for optimal patient evaluation.

The VRFirstResponder simulation, currently under validation, aims to enhance realism by incorporating distractors and refining assessment tools.

Asymmetric warfare, conflict and terrorist attacks involving children raise concerns regarding the preparedness to respond to mass casualty incidents involving pediatric patients. The objective of this project was to assess the resources available in the metropolitan Milan area to develop a priority dispatch plan for a mass casualty incident with pediatric patients.

A focused search of the medical literature and clinical guidelines established a minimal standard requirements of care of pediatric patients involved in an MCI to determine the surge capabilities in terms of number of patients and severity of injuries for each study hospital in the metropolitan Milan area.

The hospitals that took part in the study were either adult trauma centers or pediatric hospitals in the metropolitan Milan area. The overall surge capability identified was of 40-44 pediatric patients involved in an MCI involving pediatric patients, distributed based on age and severity and based on the hospital resources and expertise.

The findings from the metropolitan Milan area shows the basis for non-Pediatric Trauma Center adult and pediatric hospitals to work in synergy to develop MCI response plans involving pediatric patients. Simulations exercises will need to be carried out to evaluate and validate the plans.

The Public Health Extreme Events Research (PHEER) Network is a researcher-led network that aims to advance the public health disaster science field by coordinating a community of practice that can rapidly mobilize to conduct time-sensitive research in the aftermath of disasters. This presentation will introduce PHEER to the public health emergency preparedness and response community and allow for input into the evolving public health research framework.

Participants will understand the goals and objectives of the PHEER Network.

Participants will learn about how they can be involved in the PHEER Network.