To devise a means of reducing the burden of transportation of medical team members from unaffected areas to the vicinity of disaster-stricken areas in the event of a disaster.

In the 2024 training exercise for medical activities during a major earthquake, we planned to transport the Disaster Medical Assistance Team (DMAT), four teams from Hyogo Prefecture and two from other prefectures, from freight stations in Kobe and Osaka outside the disaster area to Sagami freight station in the assumed disaster area using freight trains. In this case, high-height vehicles, such as ambulances, were placed in open-top containers, while low-height vehicles, such as DMAT cars, were placed in 20-ft general-purpose containers. The team members were to meet at Sagami Freight Station by the Shinkansen bullet train the day after the vehicles were dispatched, to receive them in anticipation of their arrival. After the training, the return trip was also conducted in the same manner.

The vehicles were placed in containers at the departure terminal station and shipped two days before the training. The team members entered the affected area by bullet train the day before the training exercise.

Half of them received their vehicles as scheduled, but the other half had to change the receiving station due to freight train delays. All the vehicles participated in the large-scale earthquake medical operation training on time without any problems. There were no delays or other problems on the return trip.

Emergency vehicle transport by freight train was feasible and showed the potential to help reduce the workload of the crews. Although there were delays on the outbound route, the arrival time was more predictable than self-driving on the expressway, and could be handled by changing the receiving station.

Humanitarian crises, often characterized by mass displacement, armed conflicts, and natural disasters, may increase the risk of infectious disease outbreaks, particularly in low- and middle-income countries (LMICs). These crises exacerbate the vulnerability of already fragile healthcare systems, limiting access to essential resources and further compromising public health. This systematic review aims to evaluate the strategies and interventions implemented in LMICs to prevent and manage infectious diseases during humanitarian crises from 2018 to 2023.

A comprehensive literature search was conducted across databases, including Scopus, PubMed, and Web of Science, following the SPIDER framework to identify relevant studies. The review included studies published between 2018 and 2023 that focused on the prevention and management of infectious diseases in LMICs during humanitarian crises. The quality of the studies was assessed via the Joanna Briggs Institute checklist.

Eleven results were identified from 1,415 unique articles, addressing different interventions for infectious disease control, including vaccination campaigns, epidemiologic surveillance, and integrated health services.

Gang violence in Haiti and Cyclone Kenneth in Mozambique have fueled cholera outbreaks, tackled through surveillance, case management, improved WaSH services, and vaccination. In Thailand, mathematical models optimized cholera vaccination in refugee camps. At Kumbh Mela in India, targeted surveillance prevented disease spread. The Philippines improved disaster response with point-of-care testing. Yemen’s malaria surveillance integration was recommended. Uganda’s multihazard plan supported the Ebola and refugee crises. In South Sudan, integrated immunization increased coverage. Despite conflicts, Nigeria’s measles efforts faced challenges, but SARS-CoV-2 vaccination improved through visual communication.

These interventions highlight the importance of diverse, targeted, and collaborative responses to address complex health crises without relying on unsustainable investments. They emphasize safeguarding the right to health, even in the face of challenging sociopolitical conditions, crises, or natural disasters.

Mentalising skills may be conceptualised as composed by both personal and interpersonal competencies, in turn shaped by early adverse experiences and coping strategies. Although cross-sectional observations described a role for mentalising skills in burnout development, large-scale longitudinal studies on the topic remain limited, especially in relation to psychiatry training.

The primary aim was to investigate protective and risk factors for higher burnout scores across time. Secondary aims included testing whether psychiatry exhibited different burnout scores across time in comparison to other medical residents.

A cohort of 1803 medical residents (1131 psychiatry residents) was assessed for mentalising skills, conceptualised as composed of emotional regulation (Difficulties in Emotion Regulation Scale), interpersonal competencies (Interpersonal Competence Questionnaire), coping strategies (Coping Orientation to Problems Experienced) and burnout dimensions (Maslach Burnout Inventory). One-year follow-up was available for 520 psychiatry residents (73.03% response rate) and 234 other medical residents (35.94% response rate). Longitudinal mixed models and bivariate latent change models were employed.

Across all residents, greater levels of burnout were associated with higher scores in insecure attachment, emotional dysregulation and maladaptive coping, as well as lower scores in interpersonal skills. Attending at least one supervision per month was associated with lower burnout scores across time. According to a bivariate latent change model, emotional regulation improvements through years were associated with lower burnout scores across time. In psychiatry residents, lower burnout scores across time were observed as compared to other medical residents. Psychiatry residents benefited from a higher protective effect of interpersonal competencies (group by moderator by time interaction) and coping strategies against burnout.

Mentalising skills may mitigate burnout development. Training in psychiatry emerged as a potential mitigating factor against burnout increases. Structured supervisions may foster professional development and emotional resilience.

As part of the congressionally mandated NDMS Pilot Project, researchers sought to simulate the capabilities and patient care surge capacities of NDMS-enrolled facilities in the National Capital Region (NCR). This element of the simulation project focuses on accurately characterizing HCF resources, specialty capacities, and surge potential to support simulation-based patient throughput modeling in high-casualty scenarios.

The project team selected 16 acute care facilities enrolled in the NDMS Bethesda-FCC Region for simulation, excluding psychiatric and rehabilitation-only centers. Using NDMS provided data and publicly available sources, the team developed a detailed HCF characterization framework that includes specialty center designations (e.g., trauma and burn centers), bed type capacity, and geospatial data. Unlike traditional models, this characterization also captured specific medical specialties required for combat casualty care, including niche trauma services. To approximate real-world conditions, the simulation used “licensed beds” as a baseline, with an assumed percentage available as surge capacity, representing the portion of beds theoretically available for NDMS cases.

The characterization process resulted in a comprehensive HCF dataset that reflects the nuanced capacity of each facility, including relevant specialties and trauma-related capabilities. This structured HCF data supported realistic patient-to-facility assignments in the simulation, accurately modeling the limits and constraints of each HCF’s ability to manage complex trauma and medical cases from large-scale combat operations.

This in-depth characterization of HCFs provides a foundational tool for understanding and optimizing surge capacity in high-casualty scenarios. By capturing detailed specialty and surge capacity data, the model offers a more precise framework for assessing regional healthcare readiness. Future work can confirm or revise current HCF capabilities and capacities through direct contact with the specific HCFs.

3D printing technology has demonstrated great efficacy in ad hoc manufacturing of surgical supplies such as needle drivers, forceps, and tissue suture materials. 3D printed nylon sutures manufactured using a fused deposition modeling (FDM) 3D printer exhibited multiple advantages over commercial nylon and polybutester suture materials, including higher ultimate tensile strength and ultimate extension. A mouse model study was conducted to evaluate the healing of laceration wounds repaired using 3D printed nylon suture compared to commercial polybutester (Novafil) suture.

The 3D printed sutures were manufactured using Ultimaker S3 FDM printers and nylon filament, then sterilized using ethylene oxide sterilization. Twenty mice were included in the study, each receiving a 2 cm dermal laceration along their back. Ten mice had their lacerations repaired with simple interrupted 3D printed nylon sutures, and ten with simple interrupted polybutester sutures. All mice underwent daily wound assessments for 7 days, followed by euthanasia and harvesting of local tissue around the laceration site for objective measurement of inflammatory response via FlowJo analysis of F4/80+/80+&CD45+ macrophages and cytokine array.

No wound complications, such as dehiscence or infection, were observed in either group. The mean CD45+&F4/80+ macrophage (%) for 3D printed and polybutester sutures was 29.3 and 27.7 (p=0.59, from 2 two sample t-tests), resulting in no statistically significant difference. Additionally, there was no significant difference in tissue inflammation when evaluating cytokine response.

Data from this study suggests no difference in wound healing, infection, or inflammatory response between 3D printed nylon and polybutester sutures. The cost of manufacturing 3D-printed suture materials is significantly lower compared to the per-unit pricing of commercial suture materials. Furthermore, 3D printers provide the agency to produce critical supplies on an ad hoc basis with potential applications in low-resource medical scenarios such as rural/developing regions, war zones, or refugee encampments.

To prevent preventable deaths in mass casualty incidents (MCIs), securing prehospital care at the scene and hospital capacity for patient transport is key. For this purpose, the alert function of EMISHP (Emergency Medical Information System in Hyogo Prefecture) was innovated in 2003, allowing fire departments and hospitals to share information over the Internet. With this alert function, fire departments have been able to apprise hospitals of the MCI in a timely way.

Retrospective analysis of MCIs between 2003 and 2024 in which the alert function of EMISHP was activated. For each number of casualties, the duration from emergency call to activation of alert function (activation time), the duration from emergency call to clearance of alert function (S/R time), and the number of destination hospitals were evaluated. Also evaluated was the number of training exercises between 2003 and 2024.

In the past 21 years, EMISHP’s alert function has been activated for 330 MCIs. Casualty count ranged from 0 to 662 (median value=5). A Japan Railways derailment accident recorded the highest number of casualties. Activation time ranged from 1 to 417 minutes (median value = 15). S/R time ranged from 13 to 2,556 minutes (median value 73). Several destination hospitals ranged from 0 to 54 (median value = 3). In all cases, information was shared between fire departments and hospitals, while Hyogo Emergency Medical Center (the principal hub hospital for disasters in Hyogo) oversaw and coordinated the medical response, e.g., securing hospital capacity, dispatching EMTs to the scene. A total number of training exercises was 416/21 years (average nearly 20/year).

Securing time and medical resources in response to MCIs becomes possible when information is shared between fire departments and hospitals in a timely, organized way. EMISHP’s alert function—its use reinforced through frequent training exercises—has contributed much to this purpose.

Intimate partner violence (IPV) is a violation of human rights that transcends geographical and cultural boundaries. Each country’s approach to this problem is inherently different and fragmented, making it a global public health dilemma. During the COVID-19 pandemic, nearly every country experienced significant increases in cases of IPV and other violent crimes. This highlights the dire need for continued improvements in our policies and procedures regarding victim identification and care.

Learners from the United States (US) and Japan engaged in a weeklong lecture series covering topics of child abuse, IPV, sexual assault, and human trafficking. The objective of this project was to engage in an open dialogue to compare and contrast each country’s judicial and health policies regarding violent crimes. Before and after each lecture session, learners were asked to complete an eight-question self-assessment (1=strongly disagree to 5=strongly agree) evaluating their knowledge of the topics.

A five-day lecture series was presented to 159 learners (68% nurses, 6% social workers, 3% physicians, and 23% others). Survey data demonstrated a consistent post-course improvement in self-assessment of clinical evaluation skills (x̄=3.1-3.7, p=0.0001), case management skills (x̄=2.9-3.4, p=0.0007), awareness of resources (x̄=3.2-3.7, p=0.006), willingness to report suspected cases (x̄=4-4.3, p=0.032), and understanding of a forensic nurses’ role (x̄=3.3-4.1, p=0.0001). A decrease in self-reported overall competency was observed after each lecture session (x̄=4.6-3.7, p=0.0001). A majority (58.7%) of learners indicated the lecture series content would change their future practice.

This project was successful in establishing a knowledge exchange between the US and Japan, highlighting key differences in each country’s judicial and healthcare procedures while identifying areas in need of improvement. The continuation of similar relationship-building and knowledge-exchange efforts is critical to global efforts in combating IPV and violent crimes to improve community wellness.

Research has reported that prehospital time and distance play a crucial role in determining patient outcomes such as mortality or injury severity. This study aimed to investigate the association of prehospital time with traffic injury severity.

This study employed a retrospective analysis of data from January 1, 2016, to December 31, 2022, focusing on 5,022 traffic crash patients admitted to a Level-I trauma center and transported by EMS in Taiwan. The variables included were EMS prehospital time (response, on-scene, and transport times), patient demographics (age and gender), crash time, and injury severity score (ISS). Patients with ISSs ≥ 9 were classified as sustaining killed or serious injuries (KSIs). Chi-square tests identified risk factors, and logistic regression models estimated the adjusted odds ratio for KSI.

The results revealed that an increased minute of prehospital time was associated with an increase in the risk of KSI by 2%. A response time over 4 minutes raised the KSI risk by 80%, while on-scene and transport times of 7 minutes or more increased the risk by 98% and 87%, respectively. Total prehospital time exceeding 21 minutes led to a 97% higher KSI risk. Logistic regression models revealed that crashes between 00:00 and 5:00 had a 70% higher KSI risk, with elderly individuals at midnight facing a fivefold greater risk than other age groups.

Study findings support the notion that enhancing EMS efficiency may provide crucial clues for improving trauma care programs. In addition, strategic deployment of emergency personnel during high-risk early morning hours can be beneficial in dealing with serious traffic accident injuries.

In recent decades, disasters have increasingly impacted populations and public health systems, partly due to climate change, population growth, and infrastructure vulnerabilities. Effective emergency response requires robust preparedness through planning, training, and readiness assessments. The Three-Level Collaboration (3LC) exercise, focusing on local, regional, and national coordination, is a recognized approach to disaster preparedness. However, further empirical evidence is needed to assess the effectiveness of these training methods in strengthening disaster management capabilities. This study aims to evaluate their impact on enhancing these capabilities.

This mixed-method retrospective study analyzed data collected from the training sessions through observation and self-assessment questionnaires. The effectiveness of the Three-Level Collaboration (3LC) and Hybrid Simulation Training was evaluated based on criteria such as coordination among different levels, response time, and overall performance in simulated disaster scenarios.

Participants included 120 medical personnel and staff from disaster response and disaster management organizations, including firefighters, NGOs, municipalities, and communities, participating in training programs (60 participants for the conventional method and 60 for the hybrid one). Participants’ median age was 38 (32,44), 68 of them were women (55.7%), and 79 of them were healthcare professionals (64.8%). Participants in the conventional training group demonstrated improvement in the CSCATTT approach (collaborative measures for disaster management) by 48.5% compared to participants in the hybrid exercise, which showed 75% improvement.

The hybrid training method combining the Three-Level Collaboration and tabletop exercises proved more effective than the conventional method in enhancing participants’ collaborative disaster management skills, as evidenced by the higher improvement rate in the CSCATTT approach. This suggests that hybrid training could be a valuable strategy for strengthening disaster management capabilities.

Nepal faces significant challenges in addressing trauma-related injuries, with falls, road traffic accidents, and burns being the leading causes of injury. A pilot study evaluated emergency care capacity at tertiary hospitals in Kathmandu, Nepal, using the World Health Organization’s (WHO) newly deployed Hospital Emergency Unit Assessment Tool (HEAT). A focused secondary analysis of the HEAT tool results was conducted to assess emergency trauma capacity.

This cross-sectional mixed-method study uses the WHO HEAT Tool to assess resources for trauma care delivery through descriptive statistics and comparative analysis. The tool combines open-ended questions, scaled responses, and discrete answers to evaluate facility signal functions, focusing on “trauma interventions” and signal functions that reflect emergency trauma care capacity.

Across all sites (n=7), an average 6.6 out of 10 trauma interventions were adequately available. All sites had adequate availability of resources for endotracheal intubation, bag-valve-mask ventilation, and oxygen saturation monitoring. Three sites reported adequate availability of mechanical ventilation but only one site had adequate availability of rescue surgical airway procedures. All sites reported adequate availability of needle decompression for tension pneumothorax and placement of tube thoracostomy. Only 1 out of 7 sites had interosseous access, while 4 had central venous access. All sites reported adequate availability of external hemorrhage control, wound packing, and suturing. Five sites reported adequate availability of pelvic binders. None of the sites reported utilizing the WHO Trauma Care checklist.

Integrating trauma care-related questions into the HEAT tool was a feasible methodology for assessing strengths and identifying critical gaps in trauma care delivery in Nepal. Major gaps were identified in care, such as capacity for rescue surgical airway procedures, mechanical ventilation, and utilization of trauma care checklists. Further validation of this tool in application to emergency trauma care can improve trauma care delivery in resource-limited settings like Nepal.

Preparing nursing students for disaster response is increasingly important due to the rising frequency and severity of disasters. Mass casualty exercises expose nursing students to realistic emergency response situations. This presentation describes a complex interprofessional exercise where nursing students practiced disaster response skills during a simulated airplane crash.

The Triennial Airport Disaster Exercise (TADE) was held on October 20, 2023, in Honolulu, Hawaii, USA, and involved multiple federal, state, and local emergency response agencies. Nursing faculty and students from 3 universities participated as emergency responders during the event. To prepare students, the faculty provided them with comprehensive training on disaster management, incident command system, disaster triage, and first aid. Students were placed in various incident roles, including triage team members, field hospital care team members, and disaster management task force leaders. Each role required interprofessional communication and critical thinking skills. A post-exercise survey was conducted to evaluate the TADE as a learning experience, focusing on how the exercise influenced students’ knowledge/skill attainment and interest in additional disaster response training.

Evaluation data showed that the TADE enhanced students’ understanding of nurses’ roles in disaster response and the importance of interprofessional practice. Students were satisfied with their personal performance and the overall exercise. Open-ended feedback described the importance of working in teams to adapt to a chaotic, realistic situation. Areas of improvement included communication and exercise organization.

Few opportunities exist for nursing students to gain exposure to disaster response situations where relevant skills can be practiced. The TADE is an excellent example of an innovative learning experience that offered nursing students invaluable interprofessional disaster response experience and stimulated interest in further disaster response training. By partnering with local response agencies, nursing faculty can develop unique, realistic learning environments for students to practice effective care that can be applied in future disasters.

Injuries involving the pelvic area are common, and pelvic injuries occur in 25% of multiple trauma patients. Stop-the-bleeding, bandage, and temporary fixation over the pelvis are critical for trauma care in the pre-hospital setting. A novel pelvic binder (AP MAX Bandage) was designed and manufactured for this purpose. We conducted a study to compare the pressure created by the SAM pelvic splint, the most popularly applied in Taiwan, and our novel MAX pelvic Bandage by a group of new users on a dummy model.

A group of 30 volunteers was recruited to apply these two pelvic binders, a SAM pelvic splint, and a MAX bandage to a dummy. A design using the IV set, which was used to detect the intra-peritoneal pressure, was reset in the dummy to detect the pressure between the binder and the dummy. Those volunteers had practiced the SAM splint, but all were new to the MAX bandage. All the data about the pressure levels created by two pelvic binders were recorded one by one.

On average, the SAM splint and the MAX bandage created similar pressure on the dummy by different users, and the volunteers applied the MAX bandage faster.

Compared with the SAM pelvic splint, the AP MAX bandage seems to be as good as the SAM pelvic splint and is easier for volunteers as newcomers. AP MAX bandage is 10 centimeters broader than SAM splint and provides more consistent pressure, regardless of whether it is on the middle of the pelvic bandage or the edges. It is also applicable for hip fracture that is contraindication for the SAM pelvic splint. It is important for pre hospital trauma care because, for most of the cases, it is difficult to differentiate the hip fracture from pelvic fracture before arrival a the ER.

Healthcare simulation has evolved to support interprofessional education (IPE) and interprofessional collaborative practice (IPCP) to enhance teamwork and communication. In 2010, the World Health Organization published the Framework for Action on IPE, and the Canadian Interprofessional Health Collaborative established domains for IPE competencies. As part of a comprehensive response to improve emergency preparedness for mass casualty events, Changi General Hospital (CGH) developed a trauma simulation training program built upon these frameworks. The training program has been continually revamped, most significantly in 2017 with the introduction of a new surge protocol for managing smaller-scale emergencies involving fewer than 20 critical casualties.

The IPE-based trauma simulation training aimed to build collaborative competencies across healthcare teams comprising medical and nursing staff from Emergency Medicine, Surgery, Orthopedic Surgery, and Anesthesiology specialties. The Interprofessional Collaborative Competency Attainment Survey (ICCAS, Revised 2018) was used to evaluate the effectiveness of the training. ICCAS is a validated tool that measures improvements across the key domains via a retrospective self-reported pre- and post-course survey design.

The ICCAS results revealed substantial improvements in all of the domains of interprofessional collaboration:

1. • Communication: A 25.1% increase in clarity and role-based communication across healthcare teams.

2. • Collaboration and Team Functioning: A 26.6% improvement in joint decision-making during triage and resource allocation, promoting smoother teamwork and better patient outcomes.

3. • Roles and Responsibilities: A 24.5% enhancement in participants’ understanding of their roles and those of their colleagues, leading to more efficient teamwork.

4. • Conflict Resolution and Patient-Centered Care: A 24.2% improvement in managing conflicts under stress, optimizing team dynamics, and enhancing patient care.

The results of the ICCAS have affirmed the effectiveness of integrating IPE frameworks into trauma simulation training. Continued training and feedback will further sustain these gains and strengthen interprofessional collaborative practice in CGH’s emergency preparedness.

Mass casualty incidents (MCIs), including natural disasters, pandemics, multi-vehicle traffic accidents, and mass shooting events, are rare but are becoming a more routine encounter in emergency medicine. Training emergency medicine physicians for these events can be difficult given the incontinence of involvement during residency. Tools such as SALT (Sort, Assess, Lifesaving-interventions, Treat/Transport) triage have been developed to standardize response to MCIs, but can only be prepared to a degree of preparation. One way to improve training and education is through simulation, which provides a risk-free environment that can improve knowledge, clinical skills, and comfort with rare scenarios.

Surveys were obtained regarding familiarity and comfort with concepts and confidence in MCI management. A pre-survey was obtained before a 2-hour education, followed by a 2-hour disaster simulation with participants running EMS response, critical access hospitals with limited resources, and a tertiary referral center. Post survey data was collected following the education and simulation. Surveys were collected on Qualtrics using the Likert scale (1-5) with pre- and post-survey averages.

All covered areas of training with familiarity and comfort in concepts improved by an average of 1.2 and 1.3 points, with the largest improvement seen on SALT Triaging (1.7, 1.8), Dry Decontamination (1.4, 1.6), and Wet-Decontamination (1.4, 1.6). Confidence metrics improved by an average of 1 point, with the largest improvements in Role Assigning (1.18) and Transfer Decisions (1.11).

Our education and simulation event led to a modest increase in comfort for MCIs. Health systems surge planning, hospital-staging, and SALT triaging had the most improvement in both familiarity and comfort, with averages of 1.4, 1.4, and 1.75 points, respectively. There was also improvement in confidence for resource distribution, role assigning, and transfer decisions. This reinforces that simulation events are an effective way of educating in a risk-free environment, especially for rare health care practices.

At the onset of the COVID-19 pandemic, the Israeli Ministry of Health granted temporary authorization for nursing graduates who had completed their studies but had not yet taken the Governmental Licensing Exam in Nursing (GLEIN) to work in hospital wards with expanded responsibilities typically designated for registered nurses. This study aimed to evaluate whether clinical work experience in hospital settings during the COVID-19 pandemic positively impacted nursing students’ scores on the GLEIN.

A retrospective analysis was conducted at a Nursing School in Israel. The participants comprised nursing students enrolled in the Career Retraining to Nursing Program for Graduates of Other Academic Professions, all registered to take the June 2020 GLEIN.

The analysis included sixty-eight students: 23 who were recruited to work as nurses at the pandemic’s outset and 45 who did not engage in work during this period. No statistically significant differences were found in demographic characteristics or average grades obtained in the preceding academic year between the two groups. However, the group with clinical work experience demonstrated statistically significantly higher average final grades and GLEIN scores compared to their counterparts without work experience. Furthermore, work experience was identified as a predictor of higher scores on the GLEIN.

Clinical work experience plays a crucial role in achieving elevated scores on the GLEIN, extending beyond the impact of academic performance alone. Such experience equips students for practical roles in the field and is anticipated to align the expectations of novice nurses, thereby fostering nurse retention post-graduation and sustaining the essential nursing workforce.

Training in mass casualty incidents (MCI) usually requires complex drills and great logistical effort. For years, different teaching groups have used tabletop simulation exercises in training activities to improve response to mass casualty incidents. It is difficult to find affordable tabletop games that fulfill training requirements.

We used the “Double Diamond” methodology from the innovation field of knowledge. There are four stages: 1) Discovery or identification of needs; 2) Definition, in which we specify the challenges on which we will focus; and 3) Development. Generation of ideas as solutions to the identified challenges and then testing their implementation; and 4) Delivery, in which the designed solution is put into operation.

We identified that there is a need for a tabletop game for MCI to be easy to get. After ten years of using basic and rudimentary tabletop games, we have defined the needs. In a one-year project, we developed the game with the premise of being easily transported and at a reduced production cost. “MassCas” game can simulate many different scenarios (collapse buildings, fires, terrorist attacks, road accidents, rain accidents, mass gatherings, etc), risks (fire, explosion, chemical spills, active shooter, etc), and resources (different types of ambulances, rescue teams, police, etc). We have also developed patients with the possibility to identify life-saving interventions (tourniquet, pneumothorax drainage, and oropharyngeal device).

We have designed a tabletop game that is easy to transport at a reduced cost, adaptable to providers’ needs (emergency teams, primary health care teams, etc.), and able to simulate many different scenarios.

This study has been partially financed by the Foundation for Biosanitary Research and Innovation of the Principality of Asturias (FINBA), the managing entity of the Health Research Institute of the Principality of Asturias (ISPA).

Disaster risk reduction significantly reduced direct disaster-related deaths, but indirect deaths are becoming a significant issue after recent disasters in Japan, an aging society. Some of these deaths were officially certified for condolence grants to bereaved families who applied, which may hinder the accuracy of mortality statistics. This study aimed to investigate the extent to which official medical certificates documenting disaster relevance were included in the municipal documents for indirect disaster-related deaths.

This study conducted a retrospective cross-sectional analysis using anonymized data obtained from municipalities through information disclosure (IRB approval: 2023-1-489). The study assessed 755 certified indirect disaster-related deaths after the 2011 Great East Japan Earthquake in the Miyagi Prefecture, Japan, to determine whether the medical documents in the certification included references to disaster relevance.

Of the 755 cases, 74 (9.8%) death certificates and 145 (19.2%) medical documents mentioned disaster relevance. In 536 (71.0%) cases, the disaster relevance was only mentioned in the self-reported documents submitted by bereaved families. The median [interquartile range] time from the disaster onset to disaster-related death was 21 days [7–52 days]. The deaths occurred 61.1% within 30 days, 34.0% during 31-180 days, and 4.5% after 181 days. The mean age of the deceased was 79.7 years, with no gender difference. The predominant etiologies of these deaths included circulatory (32.7%) and respiratory (27.7%) diseases.

Only 30% of official medical documents mentioned disaster relevance in 755 certified cases as indirect disaster-related deaths, suggesting the lack of systematic registration of disaster relevance. Especially, middle and long-term disaster-related deaths can be marginalized. After establishing social consensus, changing the medical practice and municipal handling of death certification for disaster-affected people is essential for accurate disaster mortality statistics.

Eight years after the Great Hanshin-Awaji Earthquake of 1995, Hyogo Prefecture established the Hyogo Emergency Medical Center(HEMC) with the Hyogo Prefectural Emergency Medical Operations Center, which serves as a leading facility for disaster and emergency medical care. We would like to take a look at the current state of Hyogo Prefecture’s disaster medical care system in 2025, 30 years after the Great Hanshin-Awaji Earthquake.

We will check the official records to confirm the role played by the HEMC, which is the prefecture’s record and core facility.

In Hyogo prefecture, at present, 20 disaster base hospitals have been designated in 10 disaster medical regions. The disaster medical system is operated around two councils: the Hyogo Prefecture Disaster and Emergency Medical System Management Council and the Hyogo Prefecture Disaster Base Hospital Liaison Council. At present, both of these councils have their secretariats at the HEMC, and they are working not only on medical care but also on strengthening cooperation with health, welfare, and other related organizations. In fiscal 2023, they are working to strengthen the exercise system centered on the Exercise Planning and Management Subcommittee established in the Liaison Council of Disaster Base Hospitals, etc., and are working to build a business continuity management system (BCMS). This subcommittee and local health and medical authorities have begun to assess the earthquake resistance of individual hospitals’ inpatient facilities, the risk of power loss and countermeasures, and the status of water use and countermeasures for water outages, and are working to compile a list of these vulnerabilities in normal times.

Starting with the establishment of each disaster base hospital BCP, they are now working towards the development of BCMS at the regional and community level in the fields of health, medical care, and welfare.

As part of its responsibilities for the “Health Mission” in Montérégie (1.5 million inhabitants, 11 000km2), CISSS de la Montérégie-Centre adopted a Code Orange strategy and initiated the REM project in January 2022. In collaboration with regional partners, REM is a continuous improvement project aimed at analyzing major events and their impact on hospitals, as well as identifying performance indicators and optimizing time-dependent patient trajectories during multi-casualty incidents (MCI).

REM project led to the creation of the Regional Committee for the Simulation of Major Events in Montérégie (CRSEM) and the implementation of the NORIA Regional Simulation Program. In the Fall 2023, the CRSEM carried out two simulation exercises: NORIA1 (table-top) and NORIA2 (functional). The NORIA2 activity simulated exchanges between various regional partners (911 call center, police, fire department, ambulance services, regional coordination, hospitals) during a fictitious bus accident and demonstrated the added value of a real-time digital casualty traceability tool.

To ensure optimal use of a digital MCI tool, it is important to train paramedic teams in its use during routine activities. As a result, in partnership with an EMT technology firm, CISSS de la Montérégie-Centre established the TrackMi Montérégie project (2024). An existing mobile tool designed for the rapid exchange of MCI information was modified to also collect routine prehospital data to optimize clinical trajectories and hospital fluidity. The application supports geolocation of patients en route to the hospital and a secure web-based platform for real-time data analysis.

Optimal hospital management depends on its alignment with pre-hospital resources and the timely transfer of validated information. Technology has the potential to improve patient tracking, communications, coordination, and incident management. Simulation exercises foster communication and collaboration among different organizations. Together, the above-mentioned initiatives in the Montérégie area have improved disaster preparedness and, as a result, the resilience of responders and communities.

On October 4th, 2024, the New Taipei City Fire Department received a call about a middle-aged man trapped under a large stone weighing approximately 2 tons following a landslide. The landslide was triggered by heavy rains from Typhoon Krathon, which struck Taiwan. The local fire squad was initially dispatched to free the man, but was unsuccessful. As time passed, firefighters grew increasingly concerned about the man’s medical condition due to prolonged entrapment.

“Special Medical Response unit” was then activated, implementing a new protocol developed by the New Taipei City Fire Department. This protocol involves collaboration between trained medical professionals and firefighters to provide advanced medical support during complex rescues. A key feature is the deployment of a specialized medical team directly to the scene, including surgeons, emergency physicians, nurses, and paramedics. Aside from standard prehospital management, this team can deliver on-site advanced medical care, such as administering blood transfusions and managing pain with controlled medications. In extreme cases, they are also trained to perform field amputations to expedite evacuation. This two-tier response involves dispatching an ambulance to transport the medical team, while a mobile surgical truck collects medications and blood products from a contracted hospital before heading to the site as quickly as possible.

In this particular case, upon arrival, the medical team administered tranexamic acid to control bleeding and managed the patient’s pain with tramadol. They also coordinated with the receiving hospital to prepare the trauma team in advance. The team monitored the patient’s condition throughout the rescue, and once successfully evacuated, he was transported to a level-one trauma center for further treatment. The patient was later diagnosed with crush injuries and rhabdomyolysis. This case highlights the critical role of advanced emergency protocols in enhancing patient outcomes during complex rescue operations.