The COVID-19 crisis and future crises stress the medical system and require leaders to rise to the occasion. Some leaders are very successful while others flounder. This was seen at every level of government and health care. Applying the principles of crisis leadership and communication (and avoiding pitfalls) will increase the collective readiness to respond effectively during stressful times.

Literature review and US Centers for Disease Control and Prevention (CDC) guidelines.

While there is robust literature on the topics of crisis communications and leadership, this training is lacking in healthcare circles. This presentation aims to introduce the subject and advocate for increased training in Crisis Communications. The US CDC has developed a freely downloadable training manual, along with tools for rapidly developing a crisis message. Furthermore, a checklist to help with the presentation and a list of communication pitfalls to avoid are included. These tools allow for both pre-crisis preparation and just-in-time training.

Leaders can use these tools to prepare in advance for crisis communications, avoiding common mistakes that reduce communication effectiveness.

On March 22, 2016, the capital of Europe was hit by two terrorist attacks. As terrorism becomes more and more violent, we must learn and share our experiences to enhance our effectiveness in saving lives. The first attack hit the departure hall of the airport, which, due to its strategic role, relies upon a dedicated emergency plan. However, it focuses on airplane crashes and not on explosions in a crowded terminal. The second attack hit the subway at rush hour. An attack in such a confined environment is particularly challenging for the rescue teams as injuries are worsened, access is hindered, and numerous exits. Eleven medical teams were sent to perform triage and provide vital care. Two disaster response teams organized the medical response. Advanced Medical Posts were set up, and the mass casualty plan of all hospitals was activated. Managing war injuries for civilian teams was challenging. On-site care consisted essentially of prehospital damage control and burn care to ensure rapid evacuations for hemostatic surgery. 313 victims were dispatched to thirty hospitals. Another challenge was safety. Several threats were brought, and explosives were found on both sites. Lessons from Paris prompted a review of our multiple-site emergency plan. One single way of communication was used, and the evacuations were managed centrally. Finally, the key factor that helped limit the number of casualties was the acquaintanceship between emergency workers and non-medical teams built during exercises, allowing them to adapt and blend in as one team. Lessons from previous attacks were crucial to improving our management of the medical response. These should be shared widely, as another attack may always occur anywhere and at any time.

With increasingly frequent disasters, including public health emergencies and mass casualty events, impacting and disrupting usual practice, disaster preparedness and response competency are critical for hospital and prehospital clinicians, support staff, and administrators, most of whom lack formal disaster training. Clinical event debriefing (CED), often referred to as hot wash, cold wash, and after-action reporting by disaster and military professionals, is a valuable quality improvement (QI) tool for improving disaster management. Artificial intelligence (AI) can inform disaster-specific content not only for post-event debriefing, but also to guide and optimize preparedness and response before, during, and after a disaster. Disaster experts and WADEM, as an association, play crucial roles in establishing AI best practices and educating individuals, including those without formal disaster training, on opportunities, challenges, strategies, and effective prompts for using AI to optimize disaster-specific patient management, healthcare system utilization, and provider well-being.

This session will address considerations for the use of AI for:

1. Identifying disaster-specific, clinical setting-specific, and patient-specific topics, including activation, staff, space, stuff, processes and workflows, triage, tracking, decontamination, infection control, evaluation and management of specific patients and groups of patients, disposition, reunification, ethical/legal considerations, roles, and team building across professions and specialties.

2. Creating debriefing scripts before CED and using video capture and analysis of events to identify debriefing considerations and topics for hot and cold debriefs based on actual clinical events.

3. Generating debriefing reports and strategies to convert actionable items into actions. 4. Collecting, analyzing, and using data, including in real-time to dynamically guide disaster clinical decision support and allocation of healthcare system resources, and to create just-in-time educational resources.

As AI continues to evolve and opportunities for use and continues to expand within and beyond healthcare, AI will no doubt optimize management across all phases of disaster.

In line with the importance of being prepared against CBRN threats in the modern world, the impact of customizing training according to professional groups on participants’ knowledge and skill levels was examined. This study aims to evaluate the effectiveness of CBRN (Chemical, Biological, Radiological, and Nuclear) training modules specially designed for different professional groups.

The research was designed as a quasi-experimental study with a pre-test and post-test design. A total of 271 individuals from five different professional groups—physicians, auxiliary health personnel, search and rescue personnel, auxiliary search and rescue personnel, and students—who received training from the SBÜ CBRN Training and Simulation Center participated in the study. Before and after the training, tests consisting of 25-30 multiple-choice questions were administered to measure knowledge and awareness levels regarding CBRN. The tests were evaluated out of 100 points, and those who scored 50 points or above were considered successful.

In evaluations conducted before and after the training, a statistically significant increase was found between the pre-test and post-test scores in all professional groups and genders. A statistical difference was found between professional groups in terms of pre-test scores; particularly, it was determined that the pre-test scores of auxiliary search and rescue personnel were lower than those of other groups, but they showed the highest score increase after the training.

Customizing training according to professional groups enhances its effectiveness and better responds to participants’ professional needs. In the future, optimizing training programs based on participant feedback, more frequent use of advanced technologies (AR and VR), and the integration of psychological resilience training may further increase the success of the training. It is recommended that training programs be updated at regular intervals and that content specific to professional groups be developed.

In response to the Turkey-Syria earthquake of February 2023, the Japan Disaster Relief (JDR) Medical Team was deployed to Gaziantep as a Type-2 Emergency Medical Team from February 10 to March 24, 2023. A total of 1,946 patients visited the disaster relief site. Three deployment batches were dispatched, with the first and second including judo therapists assigned as logisticians. Judo therapists, as a unique medical profession in Japan, provide conservative treatment for acute orthopedic injuries, including fractures, dislocations, and sprains. Due to the high patient volume, these therapists contributed to the rehabilitation department together with physical therapists. This report describes their experiences and explores the potential applications of judo therapy in future disasters.

Data on patients who visited the rehabilitation department were obtained from the Japan International Cooperation Agency. Judo therapists self-reported the number of patients treated. Treatment methodologies were assessed through structured interviews with the therapists. Ethical considerations adhered to the Declaration of Helsinki.

During the first and second batches, 198 patients received care, representing 72.5% of the total rehabilitation department users. Among these, 79 patients were treated by judo therapists, constituting 28.9% of all rehabilitation department users. Operating with limited resources, judo therapists utilized locally available items to create immobilization devices for treating knee ligament injuries.

This experience indicates the importance of integrating traditional treatment into emergency medical responses. The ability to provide care in disaster areas and evacuation centers during large-scale emergencies suggests the potential of traditional medicine, including judo therapy, in disaster situations. This approach can enhance the overall resilience of affected communities and contribute to the well-being of individuals facing the challenges of recovery.

The aim of this study was to describe nurses’ experiences of competence development in home care.

Home care services are increasingly used to support clients’ coping at home. As the number of clients with multiple diseases is growing, continuous competence development is needed.

Qualitative cross-sectional study. Four registered nurses (RNs) and seven licenced practical nurses (LPNs) from one well-being services county in Finland participated in interviews. The data were analysed with thematic analysis.

Three themes were found in the analysis: having adequate competence to work as a nurse in home care, being a competent and developing licenced practical nurse, and being an improving and developing registered nurse. Competence development requires continuous training. Nurses need various practises to update their knowledge and skills. Managers have an important role in supporting, organizing, and timing competence development opportunities.

Homeless encampments present public health threats to individuals and communities alike. Given the significant risks of traumatic injury, disease morbidity, and early mortality, public health mitigation efforts are critical. “Housing First” approaches have recently gained traction for their humane perspective and efficacy, and research supports a positive impact of housing on individual health outcomes. The present study spotlights a public health approach to a direct-to-housing encampment decommissioning initiative started in New Orleans in 2023. We focus on its two pilot sites, which supported encampment residents directly into housing. We use 911 data as our principal indicator, as it simultaneously reflects community wellbeing and burdens on local emergency systems.

To quantify the impacts of encampment decommissioning on emergency service utilization, we analyzed 911 data trends across three incident categories: “Medical,” “Trauma,” and “Severe (with likely or confirmed fatality).” Call volume and types at each pilot site were analyzed for 6 months during active encampment presence, and 6 months after residents were housed and sites closed. Using a one-sided t-test method at alpha = 0.05, we evaluated the statistical significance of any decreases in average monthly call volume following encampment closure across all 3 categories at both sites.

Before encampment decommissioning, both sites experienced relatively high call volumes for a relatively small geographic area. At each, “Medical” and “Severe” call rates were significantly lower across the 6 months following encampment closure (p <0.05). At one site, a drop in “Severe” and “Medical” calls per month approached or exceeded 90%.

Our study offers a broader perspective, framing encampments as public health emergencies and illustrating the community-level impacts of prioritizing direct housing placement and definitive closure. The resulting drop in calls for service not only reflects the health hazards of encampment living but also implies reduced burdens on first responders, ED personnel, and neighborhoods post-closure.

High doses of radiation can cause Acute Radiation Syndrome, with one fatal complication being bacteremia and septicemia due to intestinal bacteria entering the bloodstream after epithelial damage. Over the 130 years since radiation’s discovery, survival has been observed at exposures below 3–4 Gy; patients exposed to over 4–5 Gy with severe gastrointestinal damage have a 0% survival rate, making gastrointestinal health key for survival. This study investigated short-term changes in gut microbiota following radiation exposure to aid in developing diagnostic and therapeutic methods for radiation accidents.

Eight-week-old male C57BL mice were divided into three groups (0, 4, and 8 Gy; n = 4) and exposed to whole-body X-rays. Cecal contents and rectal feces were collected 72 h post-exposure. Gut microbiota was analyzed by sequencing the V3-V4 region of the 16S rRNA gene (2 × 300 bp, MiSeq) and comparing sequences with the EzBioCloud 16S database. Alpha and beta diversity and bacterial composition were analyzed using Qiime2, with regression analysis performed using the R package MaAsLin2. Alpha diversity was calculated with the Shannon Index, and beta diversity with the Weighted Unifrac distance. Statistical analysis was performed using one-way ANOVA.

Significant differences in alpha diversity were observed in cecal flora (CF) between the 4 Gy and non-irradiated groups, with irradiated groups showing higher median values, even when no significant differences were found. Beta diversity differed significantly in both CF and rectal flora between the 4 Gy and 8 Gy groups compared with the non-irradiated group. Genera in the families Muribaculaceae and Lachnospiraceae correlated positively with radiation dose, whereas the genus Kineothrix showed a negative correlation. Ruminococcus and Turicibacter increased only at the high exposure levels. These bacterial genera could serve as dose markers.

Further research will investigate the reproducibility of these findings and whether restoring disrupted microbiota could aid in treatment.

Climate change presents an urgent challenge to global public health, exacerbated by political denial and fragmented global governance. This study examines the impact of climate change on public health and explores the barriers posed by political denial, emphasizing the need for a unified interdisciplinary approach to ensure sustainable solutions.

A comprehensive literature review was conducted, sourcing data from academic databases including PubMed, Web of Science, and Google Scholar. The review focused on studies addressing the intersection of climate change, political influences, and public health, with a thematic analysis used to synthesize findings. Key topics included the impact of extreme weather events on health, the role of political governance in global health strategies, and the effectiveness of existing public health frameworks.

The analysis identified significant direct and indirect effects of climate change on public health, such as the increase in vector-borne diseases and mental health challenges due to extreme weather events. Political denial, particularly in autocratic regimes, was found to hinder international cooperation and the implementation of effective public health

policies. The study also highlighted the need for robust education and simulation activities, as well as the potential of collaborative frameworks like the Command-and-Control Safety Communication Assessment Triage Treatment Transport (CSCATTT) to address these challenges.

To effectively tackle the intertwined challenges of climate change and global health, a unified and interdisciplinary approach is essential. This includes overcoming political denial, enhancing global governance structures, and integrating environmental strategies with public health initiatives. The study advocates for the creation of a new global multidisciplinary entity to coordinate these efforts, ensuring a holistic and sustainable response to future global health crises.

Nurses, as key healthcare providers, play a critical role in disaster response, especially in resource-limited, disaster-prone areas such as the Mamuju district in Indonesia. Psychological preparedness is vital for nurses to manage stress and trauma while delivering psychosocial support during disasters. Despite its importance, research on psychological preparedness tailored for nurses is limited. This study developed an intervention module to enhance emergency nurses’ psychological preparedness, integrating cultural context and professional demands.

A sequential mixed-method action research design was employed. Phase 1 developed a module with three components across seven sessions: disaster preparedness, nurses’ roles, and stress management. Expert reviews validated the module, leading to refinements. Phase 2 tested the module in a pre-post design without a control group, involving 59 emergency nurses across two groups. Participants met the criteria, including at least one year of emergency experience and exposure to the 2021 earthquake. Quantitative data were collected using DASS-21 and the PREPARED tool, and qualitative assessments were conducted during training.

The expert review process indicated that the module adequately addressed key aspects, scoring ≥3 for most components, except Session 7: Stress Management (Physical), general assessment components, and the program introduction. Consequently, adaptations were made to improve these sections. Quantitative analysis (t-tests) in Phase 2 revealed that the first training group demonstrated a greater reduction in depression, anxiety, and stress levels (as measured by DASS-21) compared to the second group. However, the PREPARED tool gain scores showed no significant difference between the two groups. Qualitative findings supported these results, highlighting the diverse sources and impacts of stress, as well as participants’ subjective improvements following physical and breathing exercises.

The disaster preparedness module enhances nurses’ stress management and readiness, demonstrating its potential to improve psychological preparedness in disaster contexts.

Large-Scale Combat Operations (LSCO) pose significant challenges to prehospital medical care, particularly in Damage Control Resuscitation (DCR). The conflict in Ukraine offers critical insights into these challenges, emphasizing the role of blood transfusion and Tactical Combat Casualty Care (TCCC) in modern warfare. This systematic review aims to analyze advancements and challenges in pre-hospital care during LSCO, focusing on the Ukrainian conflict. Key objectives include evaluating blood transfusion practices, limitations of current protocols, and the need for adaptive medical strategies.

This review involves a comprehensive analysis of military medical practices during LSCO. The study examines the implementation of blood transfusion protocols, the use of Low Titre O Whole Blood (LTOWB), and the development of Clinical Practice Guidelines (CPGs) for DCR. Data and observations from various medical personnel and organizations involved in the Ukrainian conflict are utilized.

The analysis highlights the essential role of blood transfusion in improving soldier survivability in modern warfare. It identifies significant limitations in the Walking Donor Program and underscores the importance of LTOWB. Innovative medical strategies adopted in Ukraine, such as the use of portable ultrasound devices and drones for blood delivery, demonstrate the adaptability required in LSCO environments. The study also emphasizes the need for improved training, equipment, standardization, and strategies to enhance medical readiness and combat effectiveness.

The findings underscore the need for a unified approach to blood transfusion protocols and the development of adaptable DCR strategies. Enhanced support and collaboration among NATO and partner states are crucial for expanding access to blood products and improving prehospital care in LSCO scenarios. The experiences from Ukraine offer valuable lessons for modernizing military medical care to reduce preventable morbidity and mortality.

In 2022, Japan revised its Model Core Curriculum for Medical Education and introduced a new component on “Health Crisis Management.” Medical students are required to understand the following aspects of Health Crisis Management: the concept, types, and responses to health crises; risk communication; legal framework; disaster health management, including the role of the Disaster Medical Assistance Team. In response, Okayama University restructured its health crisis management curriculum and launched a new class in 2023. This class, which targets fourth-year students, involves group discussions on optimal medical resource allocation strategies during large-scale natural disasters. Each group is tasked with presenting their proposed allocation strategy and emphasizing its strengths and limitations, followed by a Q&A session where they explain the background and details of their strategy. The experiences of the class revealed that medical students consider factors beyond the severity and urgency of medical conditions when allocating resources, such as whether the patient belongs to the “guild” of medical professionals. Some interesting convictions expressed by medical students will also be included in the congress presentation, such as the idea that medical professionals should receive priority over the general public for treatment, while local government legislators and local worthies should not. The medical students who are expected to become practicing physicians across Japan in the coming years are learning about health crisis management from various perspectives under the new curriculum. This novel course is designed to help students understand that preparedness and accountability are crucial in Health Crisis Management and that there is no absolute right answer to the question of optimal medical resource distribution during a disaster because of the various values, cultures, and philosophies involved.

A 39-year-old male developed chest pain while at work and then collapsed. A bystander applied an AED and performed CPR for 15 minutes. ROSC was achieved by the time paramedics arrived. ECG performed at a rural hospital showed anterior ST elevation, and thrombolysis was administered. A HEMS nurse and paramedic team were dispatched to transport the patient to a hospital with a cath lab and CCU. During the 1-hour and 40-minute flight, the patient did not reperfuse, and persistent ST elevation was noted. Despite maximal medical therapy, the patient had multiple episodes of pulseless ventricular fibrillation, necessitating 25 defibrillations and periods of CPR. Due to the patient’s unstable status, the supervisory HEMS physician updated the receiving hospital. The Shock Team at the receiving hospital was activated, and appropriate resources were readied for the patient’s arrival. Five minutes before

After a brief assessment in the CCU, the patient was transferred to the OR, where ECMO was established under ongoing CPR. The patient was subsequently transferred to the cath lab, where a 100% proximal LAD lesion was identified. A DES was successfully deployed in the LAD. After 3 days, the patient was decanulated from ECMO. He was subsequently extubated and transferred to the ward. Following a 20-day stay in the hospital, the patient was discharged home, ambulatory, neurologically intact, and able to live independently. When the HEMS organization reviewed the case, they recognized the difficulty of delivering prolonged quality CPR in flight and acquired a LUCAS device. This case illustrates the importance of empowering prehospital providers to manage critically ill patients, the value of coordinating with a receiving hospital, and the benefits of clinical audit.

Prior disasters directly inform planning and implementation for subsequent disasters. The Louisiana State University New Orleans Emergency Medicine Residency has planned and implemented a hurricane response protocol, “Code Grey,” for multiple storms. Hurricane Ida made landfall as a Category 4 Hurricane in 2021, followed by Hurricane Francine, a Category 2 Hurricane, in 2024.

Hurricane Ida exposed multiple areas for improvement in the Code Grey protocol. Following Ida, given post-storm discussions and resident feedback, an after-action report was created. These identified areas of improvement include the following: (1) resident Code Grey assignments and scheduling, (2) timing of Code Grey activation, (3) expectations for those who evacuate and coordination for safe return into the city, and (4) communication from program leadership.

The details of Francine’s planning and protocol were a direct response to those identified areas of improvement. Since Ida, protocols at both the hospital and residency levels have been updated to reflect lessons learned. Assignments for the 2024 Hurricane season included updated rules for pregnant residents and those currently on vacation or off service rotations. Direct resident communication began earlier and more frequently, continuing throughout the storm and beyond. This allowed residents to decide whether to evacuate or shelter in place and prepare for their specific assignments/roles during the storm.

Communication included program recommendations on preparation, safety, and expectations, as well as Code Grey timelines and planning. Additionally, a Hurricane Handbook was created for incoming interns and current residents to help familiarize them with personal hurricane preparation, storm safety, and explicit evacuation guidelines. These guidelines include the distance to travel from the city, methods of travel, and expectations of when and how to return. While in turn, Francine exposed further areas of improvement and will inform future responses, lessons learned from Ida improved Code Grey preparation and implementation for current residents.

Mount Merapi erupted again in early 2021, impacting Magelang Regency. The Disaster Agency of Magelang District strengthened its early warning system and evacuation site after the largest eruption of Mount Merapi in 2010. Even though the data showed there were no fatalities in Magelang District, public health issues emerged at the refugee camp. Public health programs should always be available to refugees living in camp settings and settlements. The District Health Office (DHO) Magelang, as the coordinator of the Health Emergency Operation Center (HEOC), needs to prepare a health disaster plan to manage public health services, coordination, collaboration, and communication.

Training and mentoring in preparing the DHO Magelang disaster plan had been carried out for approximately eight months. During the mentoring process, many issues need to be prepared in health disaster planning, and in line with the Contingency Plan for Mount Merapi Eruption, which was arranged by the Disaster Agency of Magelang District.

The Disaster Agency of Magelang District has already arranged a contingency plan for the Merapi Eruption. However, this document does not detail the role of the health sectors, so DHO Magelang needs to prepare an operational planning document (DHO disaster plan). Preparing for health disaster planning is very helpful in mobilizing resources to meet the basic needs of victims in refugee camps. DHO explores strategies that can be implemented to improve the role and function of HEOC. Resource arrangements, coordination, roles and functions, procedures, and strategy planning were urgent to manage and integrate into disaster planning documents.

The urgency of integrating the document contingency plan for the Merapi Eruption and the document DHO disaster plan lies in equalizing the scenarios used, coordinating the operation health cluster and arranging facilities, including evacuation sites, and preparing SOPs.

The role of pharmacists in disasters has been increasingly acknowledged, yet their responsibilities and core competencies for effective disaster management remain insufficiently defined, limiting their engagement. As pharmacists’ roles in clinical care expand, their involvement in disaster situations has similarly evolved. However, conventional pharmacy education in Taiwan currently lacks comprehensive training in disaster management. This study aims to elucidate pharmacists’ roles in disaster management and identify essential competencies, proposing a framework for advancing disaster-related education for pharmacists.

A qualitative study was conducted through semi-structured interviews from July 2024 to November 2024 with senior pharmacists from the Pharmaceutical Society of Taiwan, the Federation of Taiwan Pharmacists Association, and healthcare professionals from five disaster medical assistance teams. Participants were purposively selected, and the interviews explored pharmacists’ roles and required competencies in disaster contexts. Data were transcribed and analyzed via thematic analysis, with a second researcher contributing to enhance reliability. Preliminary findings were reviewed by participants to ensure validity.

Theoretical saturation was achieved after interviewing 15 participants. Nine categories of roles and their respective competencies were identified: understanding of disasters, self management, clinical pharmacy, pharmaceutical management, first-aid skills, psychological support, medical assistance, teamwork, and policy-making. These were consolidated into four key themes: basic disaster knowledge, pharmaceutical care in disasters, healthcare extension, and disaster management. These themes form a progressive structure for pharmacists’ education in disaster management, grounded in their professional expertise. It begins with the application and enhancement of existing knowledge based on an understanding of disasters and extends to other healthcare related services, ultimately progressing to disaster management.

The study identified the professional roles of pharmacists in disaster management, encompassing nine core competencies. This framework provides a basis for defining training objectives and structuring disaster preparedness programs for pharmacists.

To expand wilderness medicine education for medical students, the Advanced Wilderness Life Support elective course at Cooper Medical School of Rowan University was developed and piloted. The course is a one-week introduction to wilderness medicine approaches, treatments, and working with limited resources. This course consisted of a unique format of daily lectures followed by afternoon simulations, hands-on practice, and practical skills. Topics included performing primary and secondary surveys in the backcountry, basic preparedness, and various wilderness emergencies. Students participated in simulations incorporating these topics, culminating in a written exam and a practical skills exam. Passing both exams resulted in Advanced Wilderness Life Support certification.

Ten students participated in the course. Students received a survey pre- and post-course to assess their knowledge of the information taught. The results of the survey showed the median score improved from 65% pretest to 85% post-test. Results indicate an improvement in knowledge following the AWLS course. A second survey was given to gauge the impact of the hands-on sessions with four questions using a scale of 1 to 5 (1 being ‘did not have an impact’, 5 being ‘crucial to learning’). Six students (86%) felt that hands-on skills were important to learning and retaining the content taught in this course (43% rated 4, 43% rated 5). Five students (71%) completely agreed (rated 5) that their confidence in recognizing and appropriately treating wilderness medicine emergencies benefited from the hands-on sessions compared to lectures only. Regarding retention, five students (71%) rated 4, one student rated 3, and one student rated 2 (1=do not feel confident in my skills; 5=feel confident in my skills). Overall, these results indicate that interactive, hands-on sessions enhance the learning experience for students, potentially improve retention, and should be considered integral components of wilderness medicine elective courses.

Simulation Exercises (SimEx) and After Action Reviews (AAR) are crucial tools for strengthening preparedness and response capabilities during emergencies. However, limited research has examined their application in mass gathering (MG) contexts. To address this, the World Health Organization (WHO) developed an MG practical guide for SimEx and AAR to enhance MG preparedness and readiness through structured evaluation.

A scoping literature review and consultations with MG experts identified best practices and challenges in planning and executing SimEx and AAR for MGs. This informed an operational guide to streamline methodologies and support effective SimEx and AAR implementation. By integrating insights from event experts, the guide addresses specific MG challenges such as crowd control, emergency medical response, and multi-agency communication.

The research highlighted significant gaps in current methodologies, including a lack of clear objectives and tailored exercise designs for MG events. The guide addresses this by providing resources, including scenario templates for several health emergencies, such as crowd surges or outbreaks. These tools aim at improving stakeholder coordination, clarifying roles, and strengthening response mechanisms. Findings demonstrate that MG-focused SimEx and AAR resources enhance health security by identifying gaps, refining coordination, and ensuring readiness for real-world scenarios.

The WHO MG practical guide for SimEx and AAR fosters structured learning, documents lessons, and provides mitigation measures to improve health security at MGs. Emphasizing a proactive, risk-based approach, it helps organizers manage public health risks and ensure safety. Emphasizing a proactive, risk-based approach, it enables organizers to manage public health risks, ensure safety, and foster continuous learning and resilience, preparing countries and event organizers to address evolving public health challenges at future mass gatherings.

Greece is one of the 10% of European Union countries that do not have a unique aerial Search and Rescue (SAR) system to cover primary and secondary air transport by specialized personnel. There are innumerable difficulties in terms of search, rescue, and air transportation. Complications are mainly related to the small territorial coverage, but also a disproportionately large range of the sea area of Greece. As a part of a wider empirical qualitative research, this systematic literature review aimed to provide a comprehensive description of existing aerial SAR systems worldwide, offering a framework for further developing new system capabilities that Greece can use to reduce the fatality rates at the accident scene.

A systematic integrative literature review was used according to Whittemore and Knafl’s descriptions. The databases investigated were PubMed, CINAHL, Scopus, Web of Science and EMBASE to find papers addressing the above aim. The electronic search strategy identified 573 potential studies. Following title, abstract and full-text screening, 20 studies met the eligibility criteria for final inclusion.

The review revealed that regular simulation-based training, including fatigue management, emergency procedures, and scene leadership, is crucial for an effective aerial SAR system. Additionally, it is necessary to have an increased number of air bases and fleet modernization, which enables the fast transportation of patients. The use of drones and robust real-time communication between SAW teams can also maximize efficiency and safety.

For the development of a new aerial SAR framework, it is important to prioritize various components. These include communication technology and infrastructure and the development of a training culture for all medical staff by taking into account local mission profiles and the individual needs of the personnel. An effective aerial SAR system is crucial to promptly locate victims and save lives.

Despite often being located near large cities, many Military Treatment Facilities abroad practice day-to-day as small hospitals with limited resources. When a polytrauma patient presented in critical condition to the urgent care of one such Military Treatment Facility, requiring emergent exploratory laparotomy, massive transfusion, and critical care for over 24 hours before medical air evacuation, the flexibility and creativity of providers at all levels were tested. Surgical staff created a makeshift wound vacuum after packing the abdomen, an endoscopy suite was transformed into an intensive care unit room, blood products were acquired from outside resources, and anesthesiology staff flexed into the roles of both intensive care nurses and providers. Checklists based on the Prolonged Field Care Casualty Card were created for hourly care endpoints, and schedules were made for provider-to-provider handoffs to prevent fatigue. This case details the prehospital management, initial emergent care, surgical intervention, damage control resuscitation, and prolonged care of this patient in a low-resourced environment before successful aeromedical evacuation. Lessons learned from this event can be used to assist implementation of a formal trauma protocol, improve medical readiness in the event of a mass casualty, and facilitate navigation of a semi-austere environment during extended care for critically ill patients.