Resuscitation Simulation-based education plays a vital role in the modern education of medical and nursing students. This systematic review explores the merits of high-fidelity and low-fidelity simulation in medical education, specifically focusing on resuscitation training for nursing and medical students.

The MEDLINE, CINAHL, EMBASE, and Cochrane Library were searched. The last search was updated in June 2023. Studies were screened according to inclusion and exclusion criteria.

For quality evaluation, the Medical Education Research Study Quality Instrument and the Cochrane Collaboration’s Risk of Bias tool were used.

Eleven randomized control trials were ultimately included. The total participants was 796 students (399 High fidelity and 397 Low-fidelity). The majority were medical students. The MERSQI showed a median score of 13 for the included studies; the maximum percentage was 80 %, and the minimum was 67 %. Performance bias exists in all the included studies. On the one hand, six studies (n=374) demonstrated improvement in favour of the HF simulation group. On the other hand, four studies (n=320) failed to show any improvement in skill performance between both groups. One study showed a slight improvement in skill performance at the conclusion. Six RCTs examined knowledge improvement as an outcome, and five (n=332) showed no difference at the report’s conclusion. In three (n=235) out of the four studies that examined the retention of skills, performance, and knowledge over different follow-up periods, the results showed no observed advantage of high-fidelity manikins over low-fidelity manikins.

The results indicate that although high-fidelity simulation may have its benefits in areas of skill performance and confidence, it may only sometimes excel over low-fidelity simulation when it comes to acquiring and retaining knowledge and skills.

Crush syndrome, also known as traumatic rhabdomyolysis, often occurs in disasters like earthquakes, traffic accidents, and building collapses. It results in muscle cell necrosis, leading to symptoms such as hypovolemic shock, hyperkalemia, and acute kidney injury (AKI). The mortality rate of rhabdomyolysis is about 10%. An intelligent auxiliary diagnostic system for rhabdomyolysis based on machine learning is crucial.

This study aimed to develop an intelligent auxiliary diagnostic system, utilizing the MIMIC-III database and electronic medical records from several Chinese hospitals. The system was trained and validated with 70% and 30% of patient data, respectively. A variety of machine learning methods were used to establish injury grading and prognosis assessment models, and statistical methods and feature importance assessment methods were used to analyze and explain the features selected by the model.

The 22 clinical indicators originally included in the modeling were reduced to 11 through feature analysis and feature screening. In internal tests, the auxiliary diagnostic system based on 11 parameters achieved an average accuracy of 0.89. External validation with 360 cases showed an average accuracy of 0.84, with an AKI prediction accuracy of 0.83 and an AUC value of 0.82. Death risk prediction accuracy reached 0.89.

This intelligent auxiliary diagnostic system provides valuable recommendations for the diagnosis and treatment of rhabdomyolysis, improving treatment success rates and optimizing medical resource allocation in disaster situations. By leveraging machine learning, we have established a robust and reliable tool to assist healthcare providers in managing this complex condition.

As temperatures globally continue to rise due to climate change, sporting events such as marathons will take place on warmer days, increasing the risk of exertional heat stroke (EHS). This is especially pertinent to sports that draw a large number of amateur athletes, such as endurance running.

The medical librarian developed and executed comprehensive searches in Ovid MEDLINE, Ovid Embase, CINAHL, SPORTDiscus, Scopus, and Web of Science Core Collection on August 14, 2024. Relevant keywords were carefully selected. The remaining results underwent title, abstract, and full text screening in a web-based tool called Covidence. The included full texts were analyzed for pertinent data.

A total of 3918 results were retrieved, and when all duplicates were removed, 1698 results remained. After title, abstract, and full text screening, 38 articles remained for inclusion. There were 22 case reports, 13 retrospective reviews, and 4 prospective observational studies. The races included half marathons, marathons, and other long distances. In the 22 case reports, only five articles examined more than a single patient encounter, and the mean environmental and patient temperatures were 21.0°C and 40.5°C, respectively. In the retrospective reviews, the mean environmental and patient temperatures were 19.8°C and 40.7°C. Discussion points emphasized that increasing environmental temperatures result in higher incidences of EHS.

With rising global temperatures from climate change, athletes are at higher risk of EHS. This scoping review reveals that younger, male patients are more often at risk, and early ice water immersion is the best treatment for EHS. Earlier race start times and cooling stations may mitigate incidences of EHS; however, data on event medicine preparation for hotter temperatures remains scarce. Future work needs to concentrate on universal reporting of illnesses in mass gathering events, as well as the establishment of heat-related illness prevention and mitigation protocols.

An adequate information system and management are pivotal to support communication and decision-making in the emergency department (ED). The use of a dashboard (visual display of data management), which consists of quality and clinical dashboards, efficiently provides information to manage ED processes and improve the quality of care. This study aims to evaluate the impact of dashboard utilization on ED quality of care and user experiences.

In this systematic review, six databases (i.e., PubMed, MEDLINE OVID, Web of Science, Scopus, CINAHL Plus, and EMBASE) were used to search relevant articles. The final search was conducted on April 22, 2024. Data collection was carried out using a data extraction form. All articles were scanned, read full-text, and analyzed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline.

Fifty-six full-text papers were retrieved, of which 23 were included in the review based on the inclusion and exclusion criteria. The impact of dashboard utilization on quality of care was categorized as timeliness (length of stay, boarding time, waiting time), safety (medication safety), patient-centered care (patient satisfaction and leave without being seen), efficiency (order for radiology, ED bed occupancy, cost, admission, drug prescription), and effectiveness (prognosis). Over the years, most of the studies measured the impact of dashboard utilization on timeliness and efficiency domains. No studies have yet measured the impact of the equity domain. From the user’s perspective, dashboard usability was categorized as average to good. Situation awareness indicated as good where the highest scaled item was concentration support.

ED dashboard utilization affects timeliness, safety, patient-centered care, efficiency, and effectiveness domains. Future research is required to measure the impact of the equity dashboard and optimize artificial intelligence dashboard utilization. This is the first systematic review evaluating the impact of using dashboards on the quality of care in the ED.

First aid is multifaceted, with one scenario involving mass casualty incidents where multiple patients are injured simultaneously. In such situations, triage must first be conducted, followed by the allocation of appropriate medical resources according to the severity of injuries and the available resources. However, emergency care education in Taiwan rarely addresses this topic, often focusing solely on one-on-one scenarios, leading to a disconnect between education and real-world practice. This study surveys perceptions of mass casualty incidents to explore the importance of community people learning to triage, and then provides scientific suggestions on the design of resilience education for Taiwanese people to jointly build a resilient urban and rural area.

According to the medical treatment process of injured and injured patients, it can be divided into three stages: first aid/first response, ambulance transfer, and medical treatment in the hospital. Therefore, this study focuses on “Community people”, “Civilian rescuer”, “Emergency medical practitioners (including fire department)”, and “Hospital medical staff” are the research objects for which questionnaires are distributed. Then use Standard deviation, One-way ANOVA, Scheffe’s method/Tukey’s range test to analyze and obtain key information.

The study found that all four groups agreed that courses on “first aid education under 39 hours” and “disaster preparedness education” should include triage training. Additionally, the study found that hospital-based medical personnel and emergency medical practitioners believe that community members with basic first aid training, volunteers of disaster response teams, and community leaders should learn triage, rather than requiring everyone to learn it.

This study suggests that triage training should be included as an extension/supplementary course in disaster resilience education or as part of continuing/in-service education. Give priority to those who already have first aid knowledge and disaster prevention teaming skills to improve their survival rate and resilience in emergencies.

HuMA supported the obstetrics and gynecology departments of hospitals affected by the Noto Peninsula earthquake by dispatching experts. Keiju General Hospital continued to provide medical care in the temporary ward after the damage to its obstetrics and gynecology ward made it difficult to provide medical care. Pregnant women who could not live safely after the disaster were urged to evacuate to the hospital, and they accepted pregnant women; for example, a pregnant woman with gestational diabetes who survived the tsunami and the collapse of her house, and a pregnant woman who was close to giving birth. The hospital had been collecting information on pregnant women visiting the hospital since before the disaster, and promptly sent messages after the disaster to check their health status, evacuation locations, and whether they had any problems or symptoms. For those who wanted to transfer to another hospital due to evacuation, they wrote referral letters and contacted the transfer destination. Those who were worried about not being able to visit the hospital were consulted by phone. During the Kumamoto earthquake, at the request of the Aso City public health nurse, HuMA and ALSO collected information from local pregnant women and responded according to the risks. Utilizing this experience, the hospital had been communicating with them by phone and social media since before the disaster, and information was collected immediately after the disaster. However, information on pregnant women was insufficient, because they were not able to collect the pregnant women who never visit the hospital. If the information on local pregnant women could be managed by the government during peacetime, it could lead to smoother responses to pregnant women in disasters and save more pregnant women and fetuses.

An earthquake with a magnitude of 5.6 on the Richter scale on November 21, 2022, in Cianjur District, West Java Province, Indonesia, with a depth of 1 km from the surface caused by the Cugenang Fault. Approximately 114.683 people are affected and are IDPs. Of 47 primary health centers in Cianjur, 13 health centers experienced significant damage. The reproductive health subcluster is one of the health cluster subclusters that is greatly needed to ensure the needs of vulnerable populations are met.

This field report was written using an observational descriptive approach, where the authors were part of a joint team sent by Universitas Gadjah Mada. The management team assisted in managing the health cluster coordination post and deployed a type-1 mobile emergency medical team (EMT type-1 mobile) to support the affected population. This was accomplished by partnering with village midwives to provide basic health services to IDPs.

Approximately 535 nEMTs were registered in HEOC to assist in Cianjur. The nEMT was directed to assist village midwives in the affected areas. Fifty-four village midwives were mapped in the Cianjur District Health cluster response map along with their contact numbers. A total of 162 midwives were mobilized to the field to strengthen three reproductive health tents set up in three primary health centers.

The best practice from this response operation was the activation of reproductive health, which was immediately activated on day one, and the appointment of nine components of MISP on the day after. This was also the first major disaster where the reproductive health subcluster officially used the Minimum Initial Service Package (MISP) approach in their report. This experience inspired more NGOs and sub-national health offices to develop reproductive health contingency and preparedness plans using nine components of the MISP approach, and national regulations were adopted to accommodate this effort.

In mass-casualty incidents (MCIs), command centers often rely on oral or written reports, leading to communication gaps, misunderstandings, and inadequate logistics of available resources. In this study, a real-time communication and information system for Triage, Position, and Documentation (TriPoD) has been developed using action research in collaboration with end-users to ensure high usability. TriPoD integrates commercially available technology, utilizing a digital triage tag with a unique ID number that attaches to each injured person. Prehospital providers scan the electronic triage tag via a mobile app, instantly sending data to command centers through a web portal. The developed TriPoD enables a seamless transfer of patient information through the whole emergency care chain, from the scene of the MCI during transport, to and within hospitals. The study aimed to evaluate TriPoD’s effectiveness and usability during a simulated MCI with figurants.

Using a qualitative observational design, nonparticipant observers were stationed at the incident site, at a regional command center, and a hospital command center. Observers systematically compared TriPoD with standard procedures and management.

Results revealed that command centers received real-time updates on the patient count, triage status, and locations faster than traditional methods. Data transmitted through the web portal was updated each time a new patient was scanned, allowing for continuous real-time monitoring and decisions. Both prehospital providers and command center users observed TriPoD’s effectiveness and usability, with minor delays when prehospital emergency care providers did not consistently scan injured individuals.

The study demonstrates that seamless information transfer from MCI scenes enhances reliable communication and management efforts. Although TriPoD shows strong potential for improving MCI response and management, further development and testing with intended users are essential.

Following the 7th of October and the Iron Swords war, over 10,000 displaced people are located in the Dead Sea hotel complex, which is far from settlements and health services, and where emergency services are limited. The lack of health infrastructure and the long evacuation distances to the hospitals require a unique operating model.

For this purpose, an assessment of the area and capabilities was carried out. A preparedness ordinance was written for the activation of the response in an MCI in the Dead Sea area, which includes:

A primary triage site will be operated near the event site with the help of the medical teams stationed in the hotels, and they will undergo a refresher on the principles of trauma care. Placing EMS, including an incident commander, and deploying rescue vehicles to their crews, with civil-military cooperation to evacuate casualties.

The hospitalization complex at the MOH will determine evacuation targets: Urgently injured patients will be transferred to the hospitals by airplane and ICU ambulance. Non-urgent casualties will be held at the site until an additional evacuation force, such as a bus or an ambulance, is assembled.

An exercise was held to test readiness and determine the factors involved in MCI. The Ministry of Health’s hospitalization complex led the exercise, which aimed to create a working language and cooperation between the parties and work on the operational concept according to the order.

Points to save:

1. • Cooperation between all the factors in the field and hotels

Points for improvement:

1. • Due to travel distances, car evacuation is less realistic; therefore, there is a need for air evacuation.

2. • Accuracy of the role of the hospitalization complex /EMS/Home Front Command

3. • Training and equipping the medical and nursing staff on MCI

Crowd crush is a type of disaster that continues to occur around the world, and some of these disasters have a devastating impact on society. Despite the high number of human casualties, there is no single solution, which is why a multidisciplinary approach is required rather than a single solution. Therefore, it is necessary to apply a scientific academic approach to understand crowd crush, but there is confusion on the terms and definitions underlying it. In this study, we aimed to derive appropriate conceptual definitions and terminology for crowd crush through a survey of experts.

Experts were selected by discipline to conduct the expert survey. The experts were selected from the fields of safety and security management, engineering, medicine and health, sociology, and psychology, and a total of 25 experts were selected for in-depth interviews. The experts were selected based on their research, teaching, and consulting activities related to crowd crush, and only those with relevant interests and knowledge were included through preliminary interviews.

In some cases, experts expressed the same concept in different terms, and this was more pronounced when the experts came from different disciplines. This is likely due to applying the terminology used in their academic fields to crowd crush, which can be confusing if different terms are used. While most of the concepts and definitions were consistent, some terms needed to be reorganized to fit the context of crowd crush.

There is some confusion about the concepts and terminology of crowd crush, even among experts. So a committee is needed to further clarify the concepts and terminology in order to develop standards of prevention, preparedness, and response in the crowd crush situation.

This work was supported by the National Research Foundation of Korea(NRF) grant funded by the Korean government (MSIT) (No. NRF-2023R1A2C1002938).

The Nankai megathrust earthquake occurs in the Nankai trough, an oceanic trench that runs along the Pacific coast of Japan and recurs in Japan approximately every 100 to 150 years. The last Nankai megathrust earthquake was in the 1940s. Since then, many industrial plants have been built in Japan. The next Nankai megathrust earthquake will be the first time these plants on the Pacific coast face a colossal earthquake. In the Great East Japan Earthquake of 2011, fires broke out at oil refineries, causing health problems. The Fukushima Daiichi nuclear power plant accident resulted in prolonged evacuations and increased disaster-related deaths. Although technological measures such as anti-seismic reinforcement and seawall construction are being taken against earthquakes, management plans for injuries and physical and mental illnesses associated with industrial accidents may still need to be developed. Disaster risk reduction (DRR) plays a vital role in ensuring the security of disaster victims. This abstract aims to review existing DRR strategies in safety and health management for major plant incidents possibly triggered by the Nankai megathrust earthquake, according to the Sendai Framework. The Sendai Framework provides comprehensive priority themes in DRR.

A literature review was conducted by searching available published literature from online databases. The information used in this review is taken from articles, journals, and government reports regarding the topic from November 2014 to October 2024.

This review revealed that DRR strategies for major plant incidents possibly triggered by the Nankai megathrust earthquake lack areas related to health management compared to safety management in four priorities in the Sendai Framework.

It was suggested that DRR strategies for industrial accidents caused by the Nankai megathrust earthquake focus on engineering aspects. However, these strategies should also include health management for earthquake-triggered industrial accidents.

Effective management of health crises requires coordinated and comprehensive responses. Establishing a health related Emergency Operations Center (HEOC) in Indonesia necessitates unprecedented collaboration due to unique challenges. HEOC Guidelines outline key elements of the pentahelix concept (Government, academics, agencies or business actors, society or community, and the media) for this complex process. Supported by the The Australian Department of Foreign Affairs and Trade (DFAT) thru the Australia Indonesia Health Security Partnership (AIHSP) program, this program aims to strengthen national coordination for responding to health threats, aligning with the Ministry of Health regulations, by ensuring the involvement of Pentahelix components up to the implementation level. Activities include regulatory reviews, development of HEOC guidelines with cross-sectoral representation in selected provinces, public test, tabletop exercise, and field simulation. The involvement of all components of Pentahelix is an important factor in every activity carried out. The initiative, with its Pentahelix approach, has significantly improved engagement, communication, and decision-making among stakeholders. The resulting guidance is the result of cross-stakeholder collaboration in the health sector. It has promoted equal participation and accessibility for all, including marginalized groups. Through collaborative efforts and adherence to regulations, the development of pentahelix-approached HEOC guidelines in Indonesia has enhanced preparedness for health crises, especially at the sub-national level. It fosters coordination among multiple stakeholders while ensuring the inclusion and empowerment of diverse populations.

The actions of medical emergency responders during disasters and crises differ from daily care due to the scale, hectic pace, and the need to cooperate with other emergency services such as the police, fire brigade, and community care. A multitude of choices must be made in a short period to get a grip on the situation. Medical workers generally also have little experience with large-scale crises. This means that skills must be developed and maintained mainly through education, training, and drills. But the time to do that is scarce and is in addition to the requirements to maintain regular medical skills. To develop these skills, training courses have been developed via e-learning in addition to the physical courses. But real-life drills are problematic: they consume a lot of resources in health care organizations, such as ambulance services and emergency departments. Moreover, in the Netherlands, they are not used in working with volunteer Red Cross workers in the day-to-day situation, nor within the disaster organization that the government rolls out. That is why, in addition to physical drills, tabletop applications have been developed, and intensive role plays are used in small group training situations. Serious gaming combined with virtual reality is increasingly used in various places to enhance this package and make it more efficient. This field study investigated what the regions and organizations in the Netherlands are already doing and identified the gaps. A pilot is now a serious game developed, which enables individual care providers to practice working together with other care providers and AI online. This is input for national agreements with the regions to connect the separate initiatives. The aim is to achieve a coherent joint program, which makes the expensive investments possible and keeps the costs for the user low.

The Great East Japan Earthquake (GEJE) of 2011, compounded by the ensuing tsunami and Fukushima nuclear disaster, had profound impacts on the affected populations. While the immediate psychological consequences of the disaster have been well-documented, less is known about the long-term mental health trajectories of survivors. This systematic review aims to synthesize existing longitudinal studies to provide a comprehensive overview of long-term mental health outcomes following the GEJE in Japan.

This review was conducted following PRISMA guidelines. Using predefined inclusion criteria, a comprehensive search across PubMed, Web of Science, and APA PsycINFO was performed to identify studies assessing symptoms of PTSD, depression, and psychological distress among GEJE survivors with multi-wave follow-up data, with at least one time point being one year or longer post-exposure.

A search conducted in July 2024 screened 1183 references and identified 24 longitudinal studies, spanning from seven months before to 140 months after the GEJE. The included studies varied in sample characteristics, measurement tools, cut-off criteria, and follow-up time points, making direct comparisons challenging. Across most studies, PTSD, depression, and distress showed an initial peak in symptoms following the disaster, which gradually declined over time. In some studies, PTSD symptoms appeared to start higher and show a sharper decline compared to depression or distress. Additionally, variations were observed among different subgroups, including junior high school children and long-term evacuees, who tended to exhibit higher or more sustained levels of mental health challenges.

The systematic review highlights that the GEJE has had enduring effects on survivors’ mental health. While PTSD symptoms tend to decline significantly over time, symptoms of psychological distress and depression also decrease, albeit at a slower rate. Long-term mental health care should be provided, especially for vulnerable subgroups, to mitigate the disaster’s lasting psychological impacts.

Once a year, during the Festival of Sun-Moon Lake in Nan-Tou County, Taiwan, a long-distance swimming mass gathering event (LDSMG) takes place. It’s about 3 km from the launch to the landing area. The number of participants was 22,606 in 2024. This study aimed to collect patient data from the medical stations (launching and landing areas) and analyze the differences between them.

In 2024, the number of patients requiring treatment was determined from on-site data. A total of 152 patients presented at on-site medical stations (MSs). The medical utility rate is 0.67%, where 35 patients presented to launching MSs and 91 to landing MSs. The ages ranged from eight to 80 years. Eighty-four patients (55%) were male. Fifty-six patients were treated with medication (2.74 per 1,000 attendees). Four patients were taken to the hospital (0.04 per 1,000 attendees); two were from a landing MS. The injuries included trauma (47.3% vs 20.0%), such as abrasion, laceration, contusion, and hypothermia (8.7% vs 6.6%), eye problems (9.9% vs 0%), etc. The patients got specific problems like hypothermia, abrasions, and eye problems more often in landing MS.

The medical utilization rate was 0.84%, reached a high of 0.88%, then fell to 0.67% in 2024. The patient presentation rate (PPR) was quite the same from the data gathered on-site. The PPR of LDSMG was related to factors including the seating or standing, the outdoors or indoors, the mobility of the crowd, whether the activity was contained within a boundary, attendance figures, and humidity and temperature. It’s especially related to the water temperature, visualization of the lifeguard, the capacity of the space in swimming, and the crowdedness of swimmers. The medical stations, including staff, supplies, and facilities, should be tailored to the medical needs of the swimmers accordingly.

Strategies and systems developed during COVID-19 were crucial in handling the healthcare supply chain during the “Swords of Iron” war, which began on October 7, 2023. During COVID-19, Logi Group played a central role as the Israeli MOH’s supply chain headquarters and developed protocols for handling disruptions in global and domestic supply, providing resilience against logistical challenges. When war erupted, Logi applied its pandemic era methods to address immediate logistical and operational demands. The crises’ similarities, such as healthcare systems operating under fire and supply chain challenges, required quick and coordinated responses.

Systems developed, such as an integrated emergency operation center, facilitated coordination between suppliers, hospitals, the military, the government, and logistics companies. The dynamic supply chain models designed during COVID-19 allowed quick adaptation to market and operational disruptions, a capability crucial during the war. Additionally, the reflecting market challenges and barriers influenced healthcare regulations and policies, enabling swift adaptations during war.

The lessons learned design the required operational approach, “emergency routine” rather than a transition from routine to emergency. The five key principles in the strategy for preparedness and operational continuity to address a variety of national crises are:

1. 1. Manage security inventory within operational layers on-site.

2. 2. Regulation for suppliers’ operational continuity.

3. 3. No Pareto – every component is crucial.

4. 4. Minimize market concentration.

5. 5. Effective Local production strategy.

Embedding emergency mechanisms within routine operations creates a state of “emergency routine.” By doing so, the transition from routine to emergency becomes seamless and efficient, reflecting the reality that such transitions are often immediate and leave no time for setup. The operations during the war underscored the importance of supply chain national strategy, demonstrating that preparedness and multi-sector collaboration in crisis are essential for maintaining continuity and efficiency.

The COVID-19 pandemic and the countermeasures taken threatened population health and well-being. This study, which is part of the Integrated Health Monitor COVID-19, examined the impact of five different restrictive countermeasures (lockdowns, work-from-home advice, mandatory work-from-home rule, school closures, and closures of sports venues) implemented in the Netherlands during the COVID-19 pandemic on general practitioner (GP) contacts for mental health complaints.

GP contacts were examined for anxiety, depression, fatigue, and irritability from electronic patient records. Data were derived from the Nivel Primary Care Database. This database holds records of 400 practices with 1.7 million registered patients and is representative of the Dutch population. Periods with and without measures (we examined the period from 2018 until 2022) were compared using Poisson regression models, correcting for seasonal effects, age, and gender.

Weeks with specific restrictive measures were accompanied by increased GP consultations. The strongest effects are visible for the closure of sports venues and lockdowns. Closure of sports venues was accompanied by increased contact for anxiety and depression among all age groups. GP contacts for depression increased among 5-14 and 15-24 year-olds during lockdowns. The work-from-home advice was accompanied by increases in contacts for fatigue and irritability in the same groups, and an increase in irritability among older age groups. The mandatory work-from-home rule was accompanied by increases in irritability, particularly among 45-74 year-olds. Unexpectedly, during school closures, GP contacts for mental health problems did not change.

The study suggests that adolescents and young adults were most strongly affected by several restrictive measures, especially the closure of sports venues and lockdowns. Caution is appropriate when assigning causality, however. Countermeasures often overlapped in time, as governmental responses during periods of high infection rates typically consisted of a multi-pronged approach. This makes it difficult to discern the individual effects of specific countermeasures.

The Government Flying Service (GFS) plays a crucial role in Hong Kong’s emergency response system as the exclusive aero-support agency. Its responsibilities include medical evacuation, in- and off-shore search and rescue, fire-fighting, underslung load operations, and various other tasks. As a versatile and multi-functional entity, these responsibilities also introduce significant challenges for operational managers and coordinators in planning and resource management during incidents. A survey was designed to investigate the challenges faced and the vital information required during complex emergency operations management.

An anonymous questionnaire was designed and distributed to 16 operation managers and 24 coordinators. They were asked to rate the challenges they faced in managing complicated emergency response operations and the vital information required to support their decision-making and operational coordination. Each listed item was scored on a 10-point Likert scale, with points labeled as “Least challenging” (1) and “Most challenging” (10), as well as “Least important” (1) and “Most important” (10), respectively.

Among the 28 (70%) respondents, 11 are operation managers, and 17 are coordinators. For managers, the most challenging condition is “Discrepancies between reported information from the tasking agency and the real situation” (mean = 7.73); the most important information is “Aircrew availability” (mean = 8.18). For coordinators, the most challenging condition is “Multiple active communications (phone, radio, fax, colleague)” (mean = 8.06); the most important information is “Casualty condition (for Search and Rescue, Medevac)” (mean = 7.71).

By analyzing survey data on the critical issues encountered and essential information needed during complex emergency scenarios, this study seeks to provide valuable insights for enhancing operational efficiency and decision-making processes within multi-functional aero-support agencies. The findings have the potential to drive improvements in operational management practices and inform future training strategies for managers and coordinators in similar contexts.

TAP catheter analgesia offers a viable alternative to epidural for midline laparotomy. By combining data from three trials, we present a comprehensive analysis, underscoring TAP PCA’s effectiveness and safety across diverse clinical contexts, including in emergency.

Data from three studies were pooled to assess TAP catheter analgesia for post-operative pain relief in patients with midline laparotomy: the STAPLE Trial (quasi-experimental in emergency laparotomies), the WIRELESS Trial (RCT on Ropivacaine via TAP PCA (patient-controlled analgesia) vs. epidural PCA), and the TABLET Trial (bilateral thrice daily bupivacaine injection through TAP catheter vs. continuous epidural infusion).

The STAPLE trial showed on-demand bupivacaine infusion through a TAP catheter in emergency midline laparotomy (58 patients) reduced rescue doses (0.17±0.50 vs. 1.89±0.89), lowered VAS scores at 6 hours (3.07 vs. 4.65) and 24 hours (2.81 vs. 4.40), enabled 13-hour earlier mobilization, and decreased pulmonary complications, when compared to 62 historical controls.

The WIRELESS trial (50 patients randomized in each group) found TAP-PCA non-inferior to epidural PCA in pain relief over 72 hours. Epidural had more complications, with 34% requiring discontinuation versus 10% in TAP. While epidural showed lower VAS at 6 hours (2.7 vs. 3.08), this difference was clinically insignificant. TAP had an earlier flatus passage and shorter median hospital stay (5 vs. 6 days).

The TABLET trial randomized 100 midline laparotomy patients (elective and emergency) and demonstrated equivalent pain relief at rest and during exertion up to 72 hours, with fewer complications in the TAP group (0 vs. 4).

The TAP block provides effective analgesia for emergency and elective laparotomies, promoting early mobilization and fewer complications, especially in cases where epidural anesthesia is unsuitable or unavailable, reducing dependency on anesthesiologists and high-dependency units.

In traumatic mass casualty incidents (MCIs), accurate triage is essential for prioritizing care and managing resources effectively. This study assesses the accuracy of the START (Simple Triage and Rapid Treatment) method across different responder variables, including occupation, experience, gender, and unit. Additionally, it compares the accuracy rates for each triage category and the time spent. The study further evaluates the execution rate of critical interventions, such as hemorrhage control and airway opening, which are essential steps within the START method.

This study utilized AI-generated realistic images of injured patients to create a high-fidelity simulation environment. Participants included physicians, nurses, and emergency medical technicians (EMTs) with varying levels of experience (<2 years, 2-5 years, >5 years) and from different units (emergency department, non emergency, and fire stations). During the simulation, evaluators interacted face-to-face with participants, acting as standardized patients (SPs) to support the triage decision-making process. Participants assessed 30 simulated patients within a 30-minute timeframe, making triage color judgments based on START criteria. Bleeding control materials and nasopharyngeal airways were provided for simulated interventions.

On average, participants correctly assessed 28.04 cases, achieving a mean accuracy rate of 93.71%. The average time spent on triage was 845.28 seconds. Triage accuracy by color category was as follows: green (94%), yellow (96%), red (89%), and black (100%). Analysis by occupation and experience indicated that experienced participants and those in emergency-related roles performed more accurately, particularly in the red and black categories.

This study highlights variability in START triage accuracy based on responder occupation and experience. The use of AI-generated injury images facilitated realistic training, suggesting that such simulations could enhance competency in triage skills, especially in hemorrhage and airway management. Enhanced training for responders from non-emergency units or with limited experience may lead to more consistent triage accuracy and improved MCI response.