A full-scale simulation exercise is a comprehensive drill designed to replicate a real-world emergency scenario, thereby identifying the strengths and weaknesses in current practices. The overarching goal is to enhance healthcare system resilience through improved protocols, as highlighted in this systematic review tailored for researchers. The study aims specifically to assess the impact of full-scale simulations on enhancing hospital disaster plans.

Following PRISMA guidelines, this systematic review investigates the impact of full-scale simulation exercises on hospital disaster preparedness. The focus was on hospital staff involved in disaster and emergency preparedness training. The primary intervention was the execution of full-scale simulation exercises, and our research included various study designs, including randomized controlled trials and observational study designs. A comprehensive electronic database search was conducted, spanning PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials, from inception until October 9, 2023. The risk of bias was assessed using NIH tools.

The literature search yielded 2,398 results, with 28 publications finally included in the systematic review. Summarizing a broad range of disaster preparedness simulation exercises with a specific focus on full-scale simulation (FSS), the studies consistently demonstrated a positive impact on participants’ skills, as well as identifying safety issues in hospital settings. Moreover, they revealed that simulations effectively addressed crucial areas for improvement in disaster response, including communication breakdowns, equipment deficiencies, and flaws in emergency plans. The studies utilised a multidimensional approach to evaluation metrics, encompassing non-technical skills, communication, teamwork, decision-making, and operational readiness. The exercises varied in duration from 30 minutes to multi-day simulations, covering a diverse range of disaster scenarios, such as mass casualties, viral epidemics, large aviation accidents, and terrorist attacks.

There is a need for further programs that align simulation exercises with community resources for better preparedness in the face of public health disasters.

Modern warfare, with the use of long-range, high-impact weaponry, has escalated both the number and severity of injuries compared to past conflicts. Additionally, widespread infrastructure destruction, particularly of roads, complicates medical evacuation. Alarmingly, healthcare faces continuous targeted attacks, as verified in Ukraine, indicating a disregard for the Geneva Convention and humanitarian law. All of this combined has resulted in increased morbidity and mortality. To improve safety and efficacy in future medical evacuations (MEDEVAC), it is desirable to examine current emergency medical services (EMS) operations in modern warfare. This study aims to describe challenges faced by ambulance personnel operating in Ukrainian war zones during the evacuation of casualties and to understand the strategies employed to mitigate risks.

The study uses two data sources: a literature search through academic databases, grey literature, and websites with relevant keywords, and interviews with personnel (n = 11) experienced in Ukraine EMS and war zones. The data were thematically analyzed.

Literature descriptions of EMS being targeted for attacks were supported by study participants’ first-hand testimonies. Participants described a constant fear of being attacked while evacuating casualties, as well as adjustments in work methods to enhance safety, such as keeping the vehicle in motion or hidden, and modifying its colors (camouflage), lighting, and interiors to reduce the risk of being targeted.

It may not be obvious to civilian EMS that some protective measures taken when operating in a context of warfare may breach their non-combatant protection under international humanitarian law, in effect rendering them a form of military combatant status, while lacking in military protection and training. This ethical and judicial grey zone dilemma must be addressed by civilian and military actors, while acknowledging that its root cause is unlawful and condemnable military attacks on healthcare services.

Emergency Medical Services (EMS) personnel are regularly exposed to high-stress situations, traumatic events, and life-threatening environments. The constant barrage of intense scenarios and critical incidents, along with chronic stressors of the job, places them at risk for burnout and the development of mental health conditions such as depression and anxiety. The Mental Health Needs Assessment (MHNA) explores issues related to mental health for EMS in New York State (NYS).

The MHNA is based on a representative, statewide web survey and qualitative focus groups. The sampling frame includes first responder occupations across NYS, including EMS. The final EMS survey sample was 2,229. Survey data were evaluated through basic descriptive statistics. Thematic qualitative data analysis was applied to focus group data.

There are multiple sources of stress for EMS. Critical incidents, like traumatic events, and workplace challenges, like toxic work culture, were identified as sources of stress by the majority of EMS. Approximately 4 in 10 EMS cited public perception of the profession, difficulty with colleagues, and shiftwork as stressful elements of their work. EMS reports a range of mental health challenges. Stress was experienced by more than two-thirds of EMS. A majority of EMS reported having experienced symptoms associated with depression and anxiety. Just under half experienced symptoms associated with PTSD. Thoughts of suicide were reported by 20 percent. EMS encounters barriers to seeking mental health care. Approximately eight in ten reported stigma, fear of being seen as unreliable, and lack of culturally competent providers as barriers to seeking care. About three-quarters cited concern about negative career impact and concern about confidentiality as barriers to seeking care.

EMS in NYS, as elsewhere, faces multiple stressors, endures a range of mental health challenges, and confronts barriers to seeking mental health care. MHNA revealed important information and implications for improving interventions among EMS.

Inappropriate medicine donations during health emergencies remain a global challenge, particularly for resource-limited nations. Despite its prevalence, little research has explored this issue from an interdisciplinary or systems perspective. Understanding the motivations, effects, and outcomes of these donations is essential for developing strategies to mitigate negative consequences and build local capacity. A deeper understanding of the complexity and interconnectedness of the problem is necessary before solutions can be proposed.

This study explores the stakeholders involved and the complexity of their relationships regarding medicine donations in response to health emergencies for resource-limited countries. It aims to identify, characterize, and map key stakeholders involved in the donation process—including governments, organizations, charities, pharmaceutical companies, and community organizations—across six countries: Japan, Canada, the United Kingdom, Nigeria, Rwanda, and Uganda.

The study follows a three-step stakeholder analysis framework. First, stakeholders will be identified using a snowball sampling method, leveraging partner organizations to ensure diverse perspectives. Second, an online questionnaire will assess each stakeholder’s influence, attitudes, interests, capacity to contribute, and perceived barriers to participation in the medicine donation process. The questionnaire will also evaluate their desired level of involvement and identify other key players within the donation process. Third, stakeholders’ attributes will be mapped in a matrix, categorizing them by their levels of influence and interest. Stakeholder relationships (i.e., level of collaboration) will be analyzed using social network analysis (SNA).

This analysis will provide insights into the key actors and dynamics in medicine donation, offering a foundation for future studies aiming to investigate and curb inappropriate donations in future health emergencies.

Exercise Kingfisher, conducted in Singapore’s Tan Tock Seng Hospital (TTSH) on September 21, 2024, simulated a hospital-wide response to a mass casualty event involving hazardous materials (HAZMAT) and radiation threats. The exercise aimed to validate the Emergency Department’s (ED) Civil Emergency Plan and assess operational readiness.

A multi-disciplinary team of physicians, nurses, and operations staff participated, ensuring a cohesive response.

Disaster education was integral to the success of Exercise Kingfisher. Over 1,400 hospital staff underwent comprehensive training, including the use of HAZMAT personal protective equipment (PPE), decontamination procedures, field medical team training, and critical care response. Regular email reminders and WhatsApp group updates kept staff informed about evolving workflows, ensuring real-time communication and readiness. Evidence based practices, including decontamination wash timings and care for the pediatric casualty, were integrated. To improve overall situational awareness and provide real-time casualty numbers, we leveraged technology. Virtual reality (VR) was employed for training decontamination staff, which optimized the training of a large number of staff within a short period. Technology integration improved patient tracking, resource allocation, and inter departmental coordination.

Exercise Kingfisher validated the effectiveness of staff training and protocol updates. The hospital managed 204 casualties in four hours, demonstrating a high level of operational readiness. VR technology enabled more staff to be trained, and real-time communication tools improved coordination. The multi-disciplinary approach expedited triage and treatment, reducing response times and increasing patient management efficiency.

Exercise Kingfisher has highlighted the importance of disaster education and protocol revision in preparations for a mass casualty incident. By integrating updated evidence, enhancing staff training, and employing a multi disciplinary approach, TTSH Emergency Department demonstrated a readiness to manage HAZMAT and radiological threats. Future exercises will continue to build on these successes, focusing on refining educational programs and strengthening interdepartmental collaboration.

During heightened alert and wartime, first responder responsibilities expand significantly. Since ambulance services are a limited resource, rescue services take on additional roles, such as transporting patients and injured individuals from structural collapse. A workshop was conducted to produce activity suggestions for adapting the rescue services towards handling the additional tasks during wartime and heightened alert.

The research team’s task was to design and test an evaluation model that allowed for the systematic development of action proposals maturing from evaluations to ensure effective use of resources.

A structured workshop was conducted, engaging numerous stakeholders, to test the model for systematic generation of activity suggestions. The methodology shares characteristics with Engeström’s activity theory, specifically the process of expansive learning and the change laboratory model, but was adapted to fit the time and resource constraints typical of disaster response planning. Our approach retained core aspects of activity theory while enhancing efficiency and scalability for broader participation. The compressed, interactive format enabled robust input from a diverse group of responders and administrators, supporting rapid iteration and feedback.

This model demonstrates a viable, systematic approach to evaluating and enhancing first responder efforts under challenging conditions. By adapting activity theory principles to a condensed timeframe, we created an accessible tool that can streamline planning and preparedness for expanded emergency roles. This evaluation model holds promise for broader applications in civil defense and emergency management, particularly where quick yet thorough participatory assessments are required.

As climate change brings more rapid intensification, severity, and frequency of hurricanes, it is critical to look to lessons learned from the past to increase healthcare resiliency for the future. Twenty years ago, New Orleans lay devastated from Hurricane Katrina. Since the storm, it has rebuilt a healthcare system that is structurally and operationally fortified and has been put to the test multiple times in recent years. This presentation describes changes made to infrastructure, planning, staffing, communications, supplies, logistics, and patient tracking at a vital New Orleans hospital that enable the facility to remain functional and self-sufficient through major hurricanes and their aftermath.

Attacks on hospitals and medical points in conflict zones significantly impact mortality and injury rates. This study applies a Bayesian Ridge Regression model to predict these rates, analyzing variables such as geographic location, type of operation, perpetrator, and demographics.

The dataset, collected by the White Helmets, comprised records of attacks, detailing injuries, fatalities, and contextual variables. Categorical variables (Governorate, Type of Operation, Perpetrator) were encoded, and temporal variables (Year, Month, Day) were extracted. The Bayesian Ridge Regression model was developed, trained, and tested to determine the influence of each factor on mortality and injury rates.

For mortality prediction, the model identified the number of deceased men (β = 1.23), women (β = 0.57), and children (β = 0.40) as the most influential variables. Geographic locations, particularly Homs (β = 1.23), Idleb (β = 0.57), and Hama (β = 0.40) governorates, also had significant impacts. Temporal factors showed minimal influence, with coefficients for the year (β = 4.47e-09), month (β = 4.69e-09), and day (β = 2.50e-08). The model demonstrated high accuracy with an R-squared value of 1.0. For injury rate prediction, the number of injured men (β = 1.64e-10), women (β = -1.23e-10), and children (β = 1.18e-10) were influential. Homs (β = 1.23), Idleb (β = 0.57), and Hama (β = 0.40) also significantly impacted injury rates. Temporal factors had low coefficients, with year (β = 3.24e-10), month (β = 3.17e-10), and day (β = 1.15e-09). The model achieved an R-squared value of 0.98, indicating strong predictive capability for injury rates.

The Bayesian Ridge Regression model provides critical insights into factors affecting mortality and injury rates in attacks on healthcare facilities. These findings can inform clinical guidelines, emphasizing the protection of vulnerable populations, resource allocation in high-risk regions, and implementing targeted interventions based on these results.

The demand for over-the-counter (OTC) drugs, particularly cold remedies, antitussives, and analgesics, has become indispensable in daily life. The easy accessibility of OTC drugs has led to their becoming a significant public health challenge, especially among the younger population. Notably, OTC drug abuse has increased significantly in recent years in Japan, where digital platforms have demonstrated a substantial influence on inappropriate medication use. This study investigates trends in online search behavior related to overdoses in Japan using infodemiological methods.

Monthly search volumes for specific queries were obtained from Yahoo! JAPAN, one of the predominant search engines in Japan. Data were sourced from the Yahoo! Japan DS INSIGHT server. We tracked the search volumes for the term “overdose” from 2020 to the most recent date. Additionally, we conducted analyses of sequential search patterns before and after overdose-related queries.

Search volume data demonstrated annual increases for “overdose” queries were 89,800 in 2020, 158,000 in 2021, 245,000 in 2022, and 448,000 in 2023. Temporal analysis of search patterns in 2023 data, examining queries one week before and after searching for “overdose,” revealed a notable increase in searches related to self-harm and suicide.

The findings demonstrate exponential growth in overdose-related online searches related to overdoses in Japan, particularly in recent years. These findings also indicate a potential link between increased interest in overdoses and concerns about self-harm and suicide. These results underscore the importance of surveillance of digital search behaviors in detecting emerging patterns of substance abuse and mental health issues. Further research is warranted to elucidate the underlying factors driving this increase and to develop evidence-based interventions for overdose prevention and mental health promotion.

Stockpiling antidotes and therapeutics is required in cases of CBRNE terrorism. However, there have been no studies on an appropriate stockpiling system and the cost of stockpiling antidotes. Therefore, the speakers focused on the expiration date of the antidote, estimated the expiration date from the results of the accelerated test of the antidote, and examined the optimization of the running stock.

The accelerated test is a method in which the rate of change is measured in a short period of time under high temperature conditions, and the stability under normal storage conditions is predicted based on the measurement results. In this study, we speculated on the stability of various antidotes if the drug changes only by chemical reactions and the temperature dependence of its rate follows the Arrhenius equation. A gas multiplier [ R ] = 8.3144621 J/(K·mol), temperature [ T ] = 273 K, and activation energy [ E ] = 92466.4 J/mol were used in the calculation.

The subjects were administered atropine sulfate, pralidoxime iodide, diazepam, hydroxocobalamin, dimercaprol, penicillamine, Prussian blue, methylene blue, and fomepizole. Extrapolating the results of the accelerated tests of various antidotes to Arrhenius’ equation, it was estimated that atropine sulfate had a shelf life of 3.1 years, pralidoxime iodide for 3 years, diazepam for 3.5 years, hydroxocobalamin for 3 years, dimercaprol for 12.6 years, penicillamine for 4.5 years, Prussian blue for 3 years, methylene blue for 3 years, and fomepizole for 5 years.

We focused on accelerated testing of various antidotes and predicted the long-term stability of the products. As a result, the titer was estimated to be maintained within three years. Based on these findings, the cost of stockpiling antidotes used in emergencies can be suppressed by adjusting the rolling stock period of various antidotes.

Natural disasters affect mental health negatively. Compared to earthquakes, climate change often affects the people of a region repeatedly, but there is limited data on the impact of repeated disasters on mental health. In 3, 6, 9, and 12 months after the heavy rain, we conducted a web survey on the mental health of victims of the heavy rain disaster in Akita Prefecture, Japan.

To determine the psychological impact of the torrential rains in Akita Prefecture beginning in July 2023, the survey was administered 4 times: three months (October 13, 2023), six months (January 12, 2024), nine months (April 12, 2024), and one year (July 12, 2024) after the disaster. The municipalities where the participants lived were in the Akita Prefecture in Japan. Depression Anxiety Stress Scale (DASS) -21 and Impact of Event Scale Revised (IES-R) were used to evaluate psychological health.

There were significant differences in the scores for depression, anxiety, and stress, as indicated by the DASS-21, at four points: 3, 6, 9, and 12 months after the disaster, as determined by the Kruskal-Wallis tests (depression: p = 0.017; anxiety: p = 0.037; stress: p = 0.005). There were significant differences in the scores for PTSD as indicated by the IES-R between 6,1,2, 9, and 12 months after the disaster, as determined by the Kruskal-Wallis test (6 months and 12 months, p = 0.000; 9 months and 12 months, stress, p = 0.000).

Heavy rain is unlike annual snowfall and low levels of sunshine, was found to have a significant impact on mental health immediately after the disaster. Akita Prefecture has a high suicide rate compared to the rest of Japan. In the event of a disaster in such an area, to provide rapid support is necessary to improve mental health.

Rock in Rio Lisboa, a prominent four-day music festival in Portugal, attracts over 160,000 attendees each weekend across two weekends. To safeguard public health and ensure medical readiness for such a large-scale event, comprehensive strategies were developed. These strategies required close coordination among emergency services, festival organizers, healthcare providers, and public health authorities to address challenges stemming from high-density crowds, extended event hours, fluctuating weather conditions, and the potential for public health hazards.

A multi-tiered healthcare infrastructure was established on-site, which included a fully equipped medical center, advanced life support modules, and strategically positioned mobile response teams to provide immediate care. A strong focus was also placed on mental health support, with professionals trained in psychological first aid available to manage anxiety, stress, and other crowd-induced psychological concerns. Additionally, preventive measures such as hydration stations and effective crowd management were implemented to reduce the risk of serious health incidents.

Public health teams, consisting of public health physicians, regulatory authorities, and environmental health officers, enforced stringent food and water safety measures. Daily water quality assessments were conducted, and strict audits were performed on the 79 food and beverage vendors to ensure compliance with safety regulations, thereby preventing outbreaks of foodborne and waterborne illnesses. Medical teams provided care to 1,644 individuals during the event, addressing issues such as dehydration, minor injuries, and heat-related illnesses, with fewer than 1% of cases requiring transportation to external healthcare facilities.

This report illustrates the efficacy of proactive, multidisciplinary planning in managing health risks at large gatherings. The strategies employed at Rock in Rio demonstrate a scalable model for future events that prioritizes attendee well-being and resilience, showcasing how well-coordinated public health and medical interventions can minimize the impact of health crises in mass gatherings.

On September 17, 2024, a coordinated series of pager and walkie-talkie explosions targeted thousands of members affiliated with a prominent political party across Lebanon. The blasts resulted in 2,800 injuries and 12 fatalities, with nearly two-thirds of the injuries affecting the face, eyes, or hands.

The Lebanese American University Medical Center (LAUMC) treated 38 injured individuals, of whom 36 were admitted as inpatients, and 13 of them required care in the Intensive care unit. Surgical intervention was needed for 33 patients, with 32 suffering finger amputations, 31 presenting with eviscerated eyes, and 17 experiencing combined eye and hand injuries. This intentional mass casualty event overwhelmed healthcare infrastructure, as the unprecedented pattern and severity of injuries created an urgent demand for ophthalmological and orthopedic expertise.

The incident highlights the growing need to understand and prepare for the medical impacts of hybrid warfare, where non-traditional and unconventional tactics, such as technological sabotage, can generate large-scale civilian casualties. It also exposed critical gaps in disaster preparedness, underscoring the need for hospitals to reassess their mass casualty protocols, establish targeted training programs, and conduct regular preparedness drills.

Lessons from this event emphasize the importance of maintaining robust emergency response systems capable of addressing large-scale, unconventional threats and injury patterns.

China is a country where diverse ethnic groups coexist, each with its own unique culture. Therefore, national emergency medical teams(nEMTs) need to have a high level of cultural sensitivity and adaptability when carrying out rescue operations. Despite the proven effectiveness of serious games in enhancing general training outcomes, specialized tools targeting cross-cultural skills remained scarce. Therefore, this study introduced an innovative serious game, EMT-CrossCulture Game(ECCG), designed to augment traditional training methods through immersive cultural simulation.

ECCG created immersive scenarios that simulated various cultural and medical emergencies. A retrospective comparative analysis was conducted between 2023 and 2024 with 56 nEMT junior members. Participants were assigned to an experimental group(using ECCG in addition to standard training) and a control group(receiving standard training without the cross-cultural component). Data collection included pre- and post-training assessments, a comprehensive final test, a survey on cross-cultural adaptability, game usage data, and qualitative feedback through semi-structured interviews. The repeated-measures analysis of variance(ANOVA) was used to compare the scores.

Significant improvements in cross-cultural competence and adaptability were observed in the experimental group compared to the control group(p<0.05). Additionally, participants in the experimental group reported higher levels of engagement, motivation, and satisfaction with the training. Qualitative feedback provided insights into the strengths and areas for improvement of the game.

ECCG training is a potentially effective method for improving the cross-cultural competence and adaptability of NEMT junior members. These findings can provide information for future training programs, and the team is dedicated to developing AR and VR versions to enhance the learning experience and emergency response capabilities.

Singapore is a densely populated nation with a population density of 8207 people/km2. Khoo Teck Puat Hospital (KTPH) is a 795-bed public acute care hospital that sees over 138,000 patients annually, and must be operationally ready to respond to mass casualty incidents (MCI). This study aims to evaluate the effectiveness of a new teaching method using clips from popular Korean medical dramas to enhance interest, realism, and preparedness for staff, most of whom lack prior training or experience for MCI.

A 90-minute training session was developed to teach the specific scenarios where department staff may be involved during an MCI. These are a) deployment to the MCI site as part of a Field Medical Team (FMT), b) Hospital decontamination team for HAZMAT incidents, and c) Hospital management of MCI casualties. Key concepts like onsite triage, field management and safety, decontamination indications and techniques, and department MCI protocols were taught. Clips from Korean-drama series depicting realistic scenes from a) building collapse with management of casualties at onsite first aid post, b) hospital decontamination of casualties with chemical injuries after a factory fire, and c) A&E triage, organization, and management of multiple casualties were played.

Sixty-three health care workers participated and shared their anonymous evaluations. 33% had prior experience in MCI training or drills. On a scale of 0-5, the mean self-rated knowledge on MCI response was 2.4, rising to 3.9 after the session. The mean self-perceived level of preparedness was 2.4, rising to 3.8 after the session. All participants found the session useful and effective in preparing them for MCI response, with a mean overall rating of 4.2 for the session.

This new teaching method is simple and inexpensive to prepare and is shown to be effective in training staff. More research may be performed to determine its long-term effectiveness.

Disaster medicine, which can be viewed as a combination of emergency medicine and public health, covers a broad range of topics including blast/penetrating injuries, CBRNE, operational medicine, disaster psychology, event medicine, and humanitarian medicine. This presentation will highlight:

1. 1. The definition of a disaster and common factors in all disasters.

2. 2. The phases and goals of emergency management.

3. 3. Common areas of focus in healthcare emergency management (e.g., surge capacity, security, decontamination, education/training, drills/exercises).

4. 4. The Hospital Incident Command System (HICS) and Cooper University Health Care’s modified HICS structure.

5. 5. The hazard vulnerability analysis, emergency operations plan, continuity of operations plan, and 96-hour plan.

6. 6. Surge capacity and how it relates to conventional, contingency, and crisis modes of care.

7. 7. Exercise design and drills.

Penicillin allergy reporting is common in U.S. healthcare systems, but true allergies and clinically significant reactions are inaccurately reported. Validated tools like PEN-FAST score allow for structured risk assessment; however, many clinicians remain unfamiliar with how to utilize the score to inform decision-making and prescribing. Integrating the PEN-FAST tool into the electronic health record (EHR) admission workflow may promote awareness and improve clinical utility.

We integrated the PEN-FAST tool into the admission navigator of our hospitals’ electronic health record to be completed by nursing staff. Over a seven-month period, completed PEN-FAST scores across our health system were analyzed to evaluate the overall opportunity for allergy assessment and delabeling. The study population consisted of patients with a documented penicillin class allergy and a completed PEN-FAST score. Patients with incomplete scores or responses marked as unknown for every item were excluded.

A total of 13,121 patients were included in the final evaluation. There were 10,309 (78.6%) patients with low-risk scores (PEN-FAST score of 0–2), indicating they were potential candidates for direct antibiotic challenges. The remaining 2,812 (21.4%) patients were categorized as high-risk (PEN-FAST score of 3+), who were likely not eligible for a challenge without prior skin testing.

A substantial opportunity remains to improve the assessment and documentation of penicillin allergies throughout the healthcare system. Utilizing the electronic health record to prompt frontline staff to use validated risk assessment tools may improve documentation of allergies and support better management of patients with penicillin allergy labels.

Neighborhood socioeconomic status is a key determinant of geographical disparities in life expectancy within countries. These disparities can influence a community’s disaster resilience and are critical factors to consider in disaster management. However, previous studies on this topic have not adequately accounted for spatial spillover effects, where the conditions in one region may impact neighboring areas. This study aimed to examine the association between neighborhood socioeconomic factors and life expectancy in Japanese municipalities, explicitly considering spatial spillover effects. Findings from this study could inform the development of regional indicators of disaster resilience from a socioeconomic perspective.

This cross-sectional ecological study analyzed 1,732 Japanese municipalities, with life expectancy as the outcome variable and ten socioeconomic factors plus two control variables as explanatory variables. Moran’s I was first calculated for the residuals of the linear regression model to examine the presence of spatial dependency. The Spatial Durbin Error Model was then applied to identify both direct effects within a municipality and spillover effects from adjacent areas.

Moran’s I for the linear regression model was statistically significant, indicating the presence of spatial dependency. Unemployment and education levels showed spillover effects in the same direction as their direct effects, suggesting that improved conditions in one area are associated with increased life expectancy in neighboring areas as well. Conversely, taxable income showed a negative spillover effect for females, suggesting that improvements in income level in neighboring areas might contribute to adverse social or psychological impacts.

The study demonstrated the need to consider spatial spillover effects of socioeconomic factors from neighboring regions on health, in addition to direct effects from the region of interest. These findings offer insights for disaster management policymakers and practitioners in developing regional indicators and targeted interventions to strengthen disaster resilience and mitigate vulnerabilities across interconnected areas.

More than one billion people live in mountain areas worldwide. Increasing mountain tourism and decreasing visitor preparedness may increase the risk for major incidents, and climate instability may affect incident mechanisms, frequencies, magnitudes, as well as conditions for medical evacuation. In its guidelines for mountain multi-casualty incidents (MCIs), the International Commission for Alpine Rescue (ICAR) notes that, compared with an urban environment, a lower number of casualties may be considered an MCI because resources are more limited. In Sweden, previous research on mountain rescue medical capacity is lacking.

To describe the incidence of mountain MCIs in Sweden and assess the corresponding perceived capacity of Swedish mountain rescue personnel.

Retrospective analysis of all mission reports in the national Swedish Police Registry on Mountain Rescue 2018– 2022 (n = 1543) was performed to describe frequencies of incidents with ≥2 casualties. 21 participants from the Swedish police governed and volunteer-based organization, Swedish mountain rescuers, from 4 different mountain counties were interviewed to describe self-assessed capacity concerning MCIs. The collected data were analyzed using qualitative content analysis.

216 (14%) of all incidents 2018–2022 involved ≥2 casualties. Of these, 39 involved 3 casualties, 21 involved 4 casualties, and 15 involved 5 casualties. Interviewees indicated the context-dependent number of casualties above which mountain rescue resources may become insufficient as 2-4. Impending factors indicated were organizational (e.g., inter-organizational communication, dependency on other organizations, mobilization time), legislative (trained medical professionals prohibited from administering drugs), and human (e.g., rescuer fatigue).

A notable proportion of mountain incidents in Sweden exceeds the self-assessed maximum capacity of Swedish mountain rescue. The dependency on other organizations for medical evacuation motivates further study into possible international joint rescue ventures, exercises, and information exchange. Current legislation regarding the administration of medication by trained medical professionals warrants further discussion.

As the COVID-19 pandemic and subsequent disasters and geopolitical conflicts have revealed, deficiencies in the capacity of science to integrate data readily and efficiently into crisis preparation, response, and recovery policy and actions significantly limit the capacity of scientists and policymakers to have full information.

UNESCO partnered with the Committee on Data (CODATA) of the International Science Council (ISC) to explore how the principles of open science, as outlined in the 2021 UNESCO Recommendation on Open Science, could guide efficient and effective policies for data sharing in times of crisis, taking into account existing international policies and action frameworks. The UNESCO-CODATA Data Policy for Times of Crisis Facilitated by Open Science (DPTC) project aims at developing guidance and tools for data policy required to address crises within the framework of the UNESCO Open Science Recommendation and to contribute to the UNESCO Open Science Toolkit.

The objectives of the toolkit include:

• Assisting policymakers in formulating data policies that promote open science during crises; Helping stakeholders implement data policies through the toolkit contributions being designed; Promoting collaboration among stakeholders involved in crisis response and research;

• Serving as elements of a communication and advocacy toolkit to raise awareness about the importance of open science and effective data policies during crises;

• and To be adaptable, flexible, and customizable to suit varying contexts and crisis scenarios by providing stakeholders with appropriately tailored tools to address their specific policy-related needs in an open science framework, taking into account local regulations, cultural considerations, and available resources.

Comprising a factsheet, a guidance document, and a checklist for data policies for times of crisis facilitated by open science, these resources are intended to assist in designing the most efficient data policies for times of crisis, not only addressing immediate response needs but also preparedness and long-term recovery.