On February 6, 2023, two major earthquakes occurred with the epicenter in Kahramanmaraş. The earthquakes severely affected eleven provinces in Türkiye and northern Syria, causing the death of tens of thousands of people and the collapse of hundreds of thousands of buildings. This study aimed to identify the problems encountered by search and rescue teams during the Kahramanmaraş earthquake and to develop strategic solutions to these problems.

This exploratory-descriptive qualitative study was conducted with eight participants. The participants were selected through the snowball sampling method and were involved in the search and rescue operations during the disaster. Data were collected through in-depth structured interviews and field observations and analyzed using the thematic analysis approach. During the analysis, researchers cross-checked and discussed disagreements until a consensus was reached.

All participants were male, and the mean age was 44.50±7.58 (min= 29, max= 51). The duration of the participants’ work in the earthquake zone varied between 4-16 days. The study found that the difficulties encountered during search and rescue operations were grouped into seven themes: safety, chaos and confusion, human resources and management, meeting personal needs, communication, transportation, and emotional strain. It was found that these problems were generally serious in the first 24 hours, then partially improved and continued to decrease after 72 hours.

Insufficient number of teams due to the large number of collapsed buildings, communication disruptions, and meeting personal needs are the main difficulties encountered during search and rescue operations. It is considered that the use of the experience and techniques of miners in search and rescue under rubble, the extension of incentive activities to increase the number of volunteer search and rescue teams, and the strengthening of the necessary studies for the accreditation of these teams can contribute to the solution of these problems.

Since 2018, there has been a vast expansion of prehospital blood programs from less than 10 to greater than 150 in 2024. The trauma adage of the “Trauma Triad of Death” involves limiting hypothermia, acidosis, and coagulopathy. Accordingly, the vast majority of prehospital blood programs have some type of warmer in their system to at least partially warm products before administration; however, there is limited evidence behind this practice in the prehospital setting. When New Orleans EMS began their blood program in 2021, the funding was not available for warmers, and the decision was made to embark on a prehospital cold blood program, with cold pRBC ranging in temperature from 2° to 8° C. This study hypothesized that the administration of 2 units of cold pRBC would not result in hypothermia nor have negative effects on the patients.

This retrospective study used data from New Orleans EMS patient records merged with local hospital patient records from the years 2021 to 2024. Out of the 285 patients who received blood transfusions during this period, a total of 104 patients were included in the study. These patients received 2 units of unwarmed pRBC utilizing a LifeFlow® hand-operated rapid infuser, for a variety of indications including trauma and medical hemorrhages.

Patient ages ranged from 15 to 71, with an average of 37 years. 88% were male and 12% were female. 82% of individuals sustained penetrating trauma. The average temperature change was -0.01 °C (95% CI, -0.12 to 0.14) after rapid transfusion of 2 units of unwarmed pRBC.

This study demonstrated that unwarmed blood did not cause a clinically significant change in body temperature. These results suggest that blood warmers may not be necessary for prehospital transfusions of 2 units of pRBC or less.

On February 6th, 2023, a 7.7-magnitude earthquake struck southeast Türkiye. There was widespread damage, with over 107,000 injured and more than 50,000 deaths. Since needs exceeded the country’s capacities, deployment of emergency medical teams (EMTs) and the activation of the Emergency Medical Team Coordination Cell (EMTCC) were coordinated by the Turkish Ministry of Health and the WHO. Despite the scale of the response, there is little research analyzing EMTs’ activities and characteristics. Analysis is critical to understand EMTs’ impact amid the overall response and identify gaps to improve future EMT responses. The objective of this study is to assess EMT response to the Türkiye earthquake.

This mixed-method study includes a review of publicly available information and interviews with key informants who were involved in the EMT response following the earthquake. Data will be gathered from online sources, building on information about EMT deployments published by the WHO. Data on EMT characteristics, services provided, and operational aspects will be collected.

A total of 38 EMTs were deployed in response to the earthquake, comprising 4 national (UMKE) and 34 international EMTs. Among international EMTs, 47% arrived from the European region, and the Eastern Mediterranean and Western Pacific regions contributed 7 EMTs each. Out of the 38 deployed teams, 14 were WHO-classified. Regarding EMT type, 74% of EMTs were governmental, 18% were non-governmental organizations, and 8% were military teams. Regarding capacities, a majority (53%) were Type 2 and Type 1 Fixed (29%). Two Type 3, two Specialized Support Teams, and one Specialized Care Team deployed. Amid consultations (n = 50815), 63% were not related and 27% were indirectly related to the earthquake. Trauma only accounted for 20% of the caseload.

The results of this study will add to existing knowledge from previous disasters, identifying characteristics for effective EMT response and areas for improvement in future responses.

The WHO Emergency Medical Teams (EMT) Initiative necessitates that EMT members receive suitable training to prepare for deployment. The WHO EMT 2030 document aims to establish training curricula to build capacity. This study aims to investigate disaster deployment surgical training to date and map training courses available.

The PCC framework was used, and the eligibility criteria were set. The Royal College of Surgeons of Edinburgh Library Service was used to conduct searches of: Allied and Complementary Medicine; Cochrane; EMBASE; Health Management Information Consortium; Medline; no date or language limits were applied. Search results were imported to Rayyan and then underwent screening by two independent reviewers. Data were then extracted.

A total of 915 references were returned, 74 papers were included, and 48 directly discussed disaster surgery training courses. Overall, 65 courses were mentioned, the most frequently: Advanced Trauma Life Support: 14%, Terror and Disaster Surgical Care: 14%, Definitive Surgical Trauma Care: 12%, Disaster Response Course: 8%, Advanced Surgical Skills Exposure in Trauma: 8%, Major Incident Medical Management and Support: 6%, Surgical Training for Austere Environments: 6%, Advanced Course for Deployment Surgery (Cours Avancé de CHIRurgie en Mission EXtérieure): 5%, the remaining 27% accounted for other courses. These publications originated from only 19 countries; authors had affiliations with the USA in 17 cases, Germany in 11, France in 4, Australia in 3, South Africa in 3, Sweden in 3, Canada in 2, the Netherlands in 2, Switzerland in 2, the UK in 2 cases.

This scoping review highlights a growing but still fragmented landscape of disaster deployment surgical training, with a number of frequently cited courses and a concentration of publications from high-income countries. Despite the WHO EMT 2030 emphasis on standardized, assessable, and globally accessible training frameworks, the current literature reveals variability in course offerings and geographic representation.

During the Noto Peninsula Earthquake in 2024, a health support program took place for approximately four months, providing acupuncture and massage therapies to both relief workers and evacuees. The health support for relief workers was provided at four locations, while the support for evacuees was provided at one location. In the acute phase, the program targeted medical personnel, Self-Defense Forces, and firefighters, focusing on treating physical problems such as back pain and ankle sprain. Approximately one month later, the extension was granted to city hall officials in affected cities who were also earthquake victims, having evacuated their homes. They were suffering from anxiety, insomnia, cold intolerance, and eye strain. After around three months had passed, the number of relief workers in those offices was increased with officials from outside, and they started addressing chronic fatigue issues, including shoulder stiffness, lower back pain, and knee joint pain. Given that the needs of those relief workers evolved in each phase, it is necessary to provide flexible support. Acupuncture and massage therapies can have positive effects broadly, covering “from acute to chronic stages,” “in both physical and mental health,” and “from pediatric to elderly ages.” When a disaster occurs, it is often difficult to find medical records of affected individuals on time. In addition to that, little attention is paid to maintaining the health of those who make efforts to relieve difficulties in affected areas. Under such conditions, acupuncture and massage can contribute to easing relief workers’ health problems and enable comprehensive health support in a disaster. So, it can be encouraged worldwide to consider incorporating these methods into disaster response efforts.

Patients with serious cardiovascular diseases (CVDs) can be treated at a few facilities, and often require long distance transport. However, it requires extensive medical equipment. When alternatives are lacking, clinicians may request the Self-Defense Forces to transport these patients under “disaster relief” protocols. In this study, we compared adult and pediatric CVD cases transported by the Air Medical Evacuation Squadron (AMES).

Eighteen pediatric and 13 adult cases of CVD evacuated by AMES between 2006 and 2023 were reviewed, with the medical records. Each patients’ age, main disease, purpose of transportation, evacuation distance, and use of mechanical ventilators or extracorporeal membrane oxygenation (ECMO) were examined.

The average age was 2.0 ± 3.9 (0–13) years for children and 50.2 ± 17.8 (22–99) years for adults. The most prevalent disease was cardiomyopathy (15 children and four adults (83.3% vs. 30.8%, respectively; p<0.001), followed by heart failure (HF) zero children and seven adults (0% vs. 53.8%, respectively; p<0.001). The reason for transport was placement of a ventricular assist device (VAD) in 16 children and 11 adults (88.9% vs. 84.6%, respectively; p=0.13). The evacuate distance was 447.2 ± 232.0 miles in children and 358.5 ± 201.3 miles in adults (p=0.97), of whom three children and one adult traveled more than 600 miles. Thirteen children and nine adults (72.2% vs. 69.2%, respectively; p=0.15) were fitted with a ventilator, of whom six children and six adults (46.1% vs. 66.7%, respectively; p=0.021) were placed on ECMO.

In cases of severe CVD transported by AMES, the most prevalent CVDs were cardiomyopathy and HF in children and adults, respectively. More adults than children were placed on ECMO. The majority of adults and children with CVD were transported for the installation of VAD.

The October 7, 2023, attack on Israel by Hamas was an unprecedented healthcare crisis. This assault resulted in over one thousand deaths and over 1,900 injuries, with around 360 individuals sustaining critical injuries. The immediate surge in urgent care needs overwhelmed even Israel’s robust, universal health coverage system. This multi-faceted, extreme scenario highlighted the need for adaptive strategies. The Southern Command Medical Corps and the civilian health services encountered complex decision-making challenges, balancing immediate life-saving interventions with long-term healthcare management. This study examines the decision-making processes of senior medical officers, focusing on how they navigated the sudden, extreme demand for health services. The aim is to identify key areas for strengthening health systems to enhance their capacity to respond effectively to large-scale, unexpected crises.

The research employed a qualitative methodology involving a meticulous examination of documentation from military emergency discussion papers and interviews with seven Southern Command medical officers and eleven senior medical personnel who provided field aid. The objective was to gain an in-depth understanding of decision-making processes at both the headquarters and tactical levels.

Five central themes emerged: the medical commanders’ high level of professionalism, the presence of mature and confident leadership, the importance of continuous learning during routine, the provision of complete and explicit support to personnel in the field, and the constant endeavor to obtain comprehensive information about ongoing events.

This study provides a rare and unique insight into the decision-making processes of senior military medical officers. The identified themes suggest the potential for advancing the command capabilities of medical officers and commanders, irrespective of their rank or the nature of their medical assignments. These findings offer valuable lessons for strengthening the resilience and responsiveness of healthcare systems in the face of unanticipated crises, both in military and civilian contexts.

Japan frequently experiences natural disasters such as earthquakes and typhoons, and medical support during disasters has become a critical challenge, particularly in a super-aged society. Previous research has utilized simulations to analyze medical resource allocation and Disaster Medical Assistance Teams (DMAT) activities during the acute phase. However, there has been insufficient focus on medium-term measures, including primary care for chronic illnesses in aging populations. This study aims to develop a simulation model that replicates processes from the occurrence of a disaster to evacuation behavior, the emergence of medical needs, especially for chronic diseases, and activities of medical support team patrols at relief stations and shelters, to efficiently allocate medical resources and develop support plans.

An agent-based simulation model was developed to analyze evacuee behavior, changes in medical needs over time, and the impacts of medical team rotations and supply timing on shelters. The model incorporates various scenarios, such as the timing of aid station establishment and medical supply distribution, while considering geographical and timing of actions. This approach enabled a comprehensive analysis of medical support and resource allocation options during disasters.

The simulation results validated the effectiveness of multiple policy scenarios and identified optimal resource allocation based on medical demand patterns. Geographical conditions and timing were found to significantly influence the placement of aid stations and the assignment of human resources. Statistical analysis and optimization techniques were applied to determine ideal strategies for specific conditions, enabling the sophistication of simulation model parameters.

The disaster medical simulation model developed in this study provides realistic evacuation behaviors and medical demands. It serves as a valuable tool for optimizing resource allocation and intervention timing in disaster scenarios. Additionally, the model demonstrates potential for improving disaster response capabilities through scenario-based training and could contribute to the standardization of disaster medical support plans.

Many rural emergency nurses are nervous caring for pediatric patients; they care for the critically ill pediatric patient infrequently, especially in smaller rural or frontier communities. Over the last few years, the Child Ready program, with the support of an HRSA grant, has partnered with such communities to offer education and support to improve pediatric outcomes. One specific example is a rural facility in Northern New Mexico, using the EMSC pediatric readiness score as a measure, the Child Ready team worked with the facility, offering both in-person and virtual education and support for physicians and nurses. An initial pediatric readiness score of 64 was assessed, and areas of improvement were identified. The education was specifically targeted towards the facility’s needs, utilizing their equipment and virtual mock codes to increase staff confidence in responding to emergencies. In person events facilitated team building with the Child Ready team supporting the relationship between the Child Ready Virtual Pediatric Emergency Department and the rural facility. With this support, the rural facility improved confidence to utilize equipment and respond to pediatric emergencies, policies and procedures were written and implemented, and pediatric-specific equipment was procured. The rural facilities EMSC Pediatric Readiness score jumped from 64 to 94 with the support of the Child Ready program, improving the rural response to pediatric care.

We will discuss how the use of a virtual platform combined with in-person support can improve pediatric readiness and nursing confidence.

Obstetric Early Warning Systems (OEWS) improve maternal morbidity outcomes across various settings by enhancing emergency obstetric care and facilitating early intervention. However, there is limited research analyzing the effectiveness and implementation of OEWS in low-resource, low-complexity care settings, and none to date in humanitarian settings. This study aims to develop and validate a Modified Early Obstetric Warning System (MEOWS) to predict severe maternal outcomes in refugee camp health centers in Cox’s Bazar, Bangladesh.

A retrospective case-control methodology was used, and de-identified obstetrics electronic medical records (EMR) from October 2017 to June 2024 were obtained via the camp’s EMR system, NIROG, at two sites: Kutupalong and Balukhali. Data was split into developmental and validation datasets. Primary predictor variables were systolic blood pressure, diastolic blood pressure, and heart rate; secondary predictors included age, BMI, gravida, gestational age at birth, and elevated fasting blood glucose (FBG). Severe maternal outcomes were the primary outcome variable based on ACOG’s Obstetrics Care Consensus and WHO’s near-miss criteria. A stepwise logistic regression was used to create the model.

Among 446 patients with complete data, 36 experienced SMOs. Controls were randomly selected and included at a 4:1 control-to-case ratio. At a 5% level of significance, only elevated FBG was associated with SMOs. Both the developmental and validation datasets revealed a fourfold higher likelihood of SMOs in patients with elevated FBG at 80% and 90% confidence, respectively. However, 43% of those with elevated FBG did not have a diabetes diagnosis.

These findings suggest that elevated FBG should be included in obstetrics early warning systems for the camp health centers and similar settings, as FBG is not regularly included in standard obstetrics early warning systems. Furthermore, the lack of associated diabetes diagnosis suggests a possible area for patient care improvement within the camp health centers in Cox’s Bazar.

Climate change is associated with increasing frequency and severity of extreme weather events, but little is known about the impact of disaster exposure on people living with dementia (PLWD). PLWD may experience increased confusion, disorientation, anxiety, and paranoia during disasters, potentially leading to the inappropriate use of psychotropic medications as a form of symptom management. This study examined new psychotropic prescription medications or changes to existing prescriptions among US Medicare beneficiaries with a dementia diagnosis following hurricane exposure.

This study used a retrospective cohort design with administrative claims data from Medicare beneficiaries diagnosed with dementia. The study population included 71,401 beneficiaries residing in counties exposed to Hurricanes Harvey, Irma, or Florence between 2017 and 2018. Exposure to major hurricanes (Harvey, Irma, and Florence) was determined based on Federal Emergency Management Agency disaster declarations for affected counties. The primary outcome was the rate of new psychotropic prescriptions or changes to existing prescriptions within 12 months post-hurricane exposure, compared between beneficiaries in exposed versus unexposed counties.

PLWD exposed to hurricanes had a 10% higher rate of starting new antipsychotic prescriptions compared to those in unexposed counties (Incidence Rate Ratio [IRR]: 1.10; 95% CI, 1.04-1.17). Exposure to Hurricane Harvey was associated with a 20% higher rate of new antipsychotic prescriptions (IRR: 1.20; 95% CI, 1.07-1.36), while no significant changes were observed following Hurricanes Irma (IRR: 0.99; 95% CI, 0.90-1.08) or Florence (IRR: 0.92; 95% CI, 0.80-1.05).

Exposure to Hurricane Harvey was associated with increased rates of new antipsychotic prescriptions among PLWD, suggesting that tailored disaster preparedness and response strategies are needed to address the unique needs of this vulnerable population. Understanding patterns in psychotropic medication prescribing among PLWD before, during, and after disasters is essential to improving disaster readiness and reducing inappropriate medication use.

Recent global events, including the COVID-19 pandemic, escalating conflicts, and natural disasters, have highlighted the critical role of nurses in disaster prevention, mitigation, response, and community recovery. Despite this, many nursing education programs lack comprehensive disaster preparedness training. This paper explores the importance of integrating comprehensive disaster preparedness into nursing curricula and the value of international cooperation in developing these educational initiatives.

An international collaboration was initiated at the World Association for Disaster and Emergency Medicine (WADEM) conference in Killarney, Ireland, in 2023. This event provided a platform for establishing partnerships between nursing researchers from Australia, Japan, and Israel. Following the conference, a series of Zoom™ discussions were conducted to examine current disaster nursing education practices and explore opportunities for international collaboration.

Our discussions revealed an almost complete lack of significant disaster preparedness training across nursing programs globally. However, there was a strong consensus among participants on the necessity of enhancing disaster nursing education for students. The international collaboration initiated at WADEM 2023 led to the development of a preliminary framework for integrating disaster response competencies into nursing curricula. This framework emphasizes practical skills, scenario-based learning, and cross-cultural understanding in disaster contexts.

This initiative underscores the importance of international cooperation in advancing disaster nursing education. By leveraging diverse experiences and expertise from multiple countries, we can develop more comprehensive and effective training programs for nursing students. Integrating disaster education into pre-service nursing curricula is crucial for building a globally competent healthcare workforce capable of responding effectively to various disaster scenarios. This approach not only enhances the preparedness of individual nurses but also strengthens the resilience of healthcare systems and communities worldwide in the face of disasters.

A 26-year-old male patient presented to the Emergency Department with chemical burns sustained at his workplace, reportedly from 4% Sodium Hydroxide exposure. Despite wearing full personal protective equipment (PPE), including a body suit, goggles, boots, gloves, and a hood, the patient experienced contact burns on his forehead. Immediately following the exposure, he initiated workplace decontamination procedures, rinsing his suit and irrigating the affected area before seeking medical attention.

He presented with persistent forehead pain without visual symptoms. Initial examination was conducted, there was an erythematous area of 4x2 cm over the central forehead, two smaller sub-centimetre brown spots above his left eyebrow, and the glabella. The eye examination was normal. The patient received continuous irrigation with normal saline until pH normalization, and the burns team was consulted. During treatment, physicians recognized a pattern consistent with prior cases involving similar injuries, which prompted further inquiry. Upon subsequent questioning, it was revealed that the chemical spill incident involved multiple index casualties, who had presented separately to the emergency department throughout the day. Both the patient and his coworker, involved in the chemical spill cleanup, were unaware of additional casualties and had chosen not to disclose specific details, including the company’s name. The link was made through address correlation. All patients were treated conservatively, discharged without complications, and had uneventful follow-ups.

This case underscores the crucial management of early decontamination and burns management. Proper workplace protocols for PPE use are also paramount. The coordination of responses via a safety manager and proper communication through national networks is also key to ensuring a timely response and appropriation of resources. Finally, the critical need for clinicians to maintain a high index of suspicion in potential mass workplace incidents, particularly when patients may withhold details due to confidentiality concerns or limited awareness.

Triage systems such as SALT, SMART, and START were developed for prehospital providers to be able to provide consistent and logical sorting when facing a mass casualty event (MCE). In the field, the most important and resource-limited decision is to determine the priority of transport. By contrast, in a hospital, there is potential for overwhelm of other resources, such as available proceduralists and operating rooms. As such, these protocols are less useful when implemented as secondary triage for patients after transfer from the site of the incident.

Simplified Management and Resource Triage for Mass Casualty Events (SMART-MCE) is a novel method designed for secondary, in-hospital triage, specifically addressing the intricacies of critical resource management in the emergency department.

Description: A triage officer is appointed by the incident commander, with preference for a senior emergency physician. Upon arrival, patients are sorted based on immediate resource needs to address the pathology of circulation (C), airway (A), or breathing (B). Patients who have a problem with C or A+B are triaged to the highest resourced area, zone one. Patients with a single problem with A or B are triaged to the critical area, zone two. Patients with no immediate problems with C, A, or B are triaged to the delayed area, zone three.

SMART-MCE was developed at the Samson Assuta Ashdod University Hospital (AA), a 300-bed regional trauma center in Ashdod, Israel, and implemented for the first time during the October 7th massacre in southern Israel. It performed well for maximal resource utilization in an efficient and consistent manner: eighty-five trauma patients were transported to AA, with zero casualties during the initial treatment phase in the emergency department. Based on these preliminary findings, this method warrants further study to establish its usefulness in other hospitals in Israel and internationally.

While ambulance dispatch guided by artificial intelligence (AI) could be useful, little is known about the accuracy of AI in making patient diagnoses based on the pre-hospital patient care report (PCR). The primary objective of this study was to assess the accuracy of ChatGPT (OpenAI, Inc., San Francisco, CA, USA) to predict a patient’s diagnosis using the PCR by comparing to a reference standard assigned by experienced paramedics. The secondary objective was to classify cases where the AI diagnosis did not agree with the reference standard as paramedic correct, ChatGPT correct, or equally correct.

In this diagnostic accuracy study, a convenience sample of PCRs from paramedic students was analyzed by ChatGPT-4 to determine the most likely diagnosis. A reference standard was provided by an experienced paramedic, reviewing each PCR and giving a differential diagnosis of three items. A trained pre-hospital professional assessed the ChatGPT diagnosis as concordant or non-concordant with one of the three paramedic diagnoses. If non-concordant, two board-certified emergency physicians independently decided if the ChatGPT or the paramedic diagnosis was more likely to be correct.

ChatGPT-4 triaged 78/104 (75.0%) PCRs correctly (95% confidence interval 65.3% to 82.7%). Among the 26 cases of disagreement, judgment by the emergency physicians was that in 6/26 (23.0%) the paramedic diagnosis was more likely to be correct. There was only one case of the 104 (0.96%) where dispatch decisions based on the AI-guided diagnosis would have been potentially dangerous to the patient (under-triage).

In this study, the overall accuracy of ChatGPT to diagnose patients based on their emergency medical services PCR was 75.0%. In cases where the ChatGPT diagnosis was considered less likely than the paramedic diagnosis, most commonly, the AI diagnosis was more critical than the paramedic diagnosis, potentially leading to over-triage. The Under-triage rate was low at less than 1%.

Children are the most affected population by natural and man-made disasters because of their physical and psychosocial vulnerability, high dependency on parents and other caregivers, and limited voice and representation. Pediatric needs should be considered in all disaster plans and response efforts. The far-reaching impact of a major disaster encompasses inadequate search and rescue efforts, transportation issues, insufficient medical personnel, and limited bed capacity. Reaching victims within the first hours may be challenging due to various factors, including health workers themselves being earthquake victims, extensive damage to access roads, and the destruction or damage to hospitals. The increasing need for healthcare professionals could give rise to a need for field hospitals and volunteer health workers. A team of pediatricians, orthopedic surgeons, plastic surgeons, and experienced team leaders is crucial for the medical and surgical management of pediatric mass-casualty events. Medical treatment and hospitalization can vary depending on the time elapsed since the event, the distance to field hospitals or hospitals located in remote, unaffected regions, the average age of the affected population, and the type of disaster. This presentation addresses the challenge of caring for children and the critical factors to be considered in disaster management for earthquakes, based on experiences gained from the 2023 Türkiye earthquake.

The Royal Hospital for Children in Glasgow (RHCG) is the largest pediatric emergency department (ED) in Scotland, with over 76,000 attendances in 2022. Glasgow has a growing population of minority ethnic groups, with a 75% increase in the 2022 census from 2011. Research suggests widening health inequalities, with children from different socioeconomic and ethnic backgrounds more likely to present to the ED. They may experience language barriers and are often unaware of alternative services within the National Health Service (NHS), such as NHS 24 and free prescriptions from pharmacies. The aim is to address these knowledge gaps.

The demographics and presentation mode of out-of-hours “standard” and “non-urgent” cases based on the Manchester Triage System were analyzed in two weeks in winter 2022. A partnership was formed with a charity catering to refugee and asylum-seeking women and girls aged 12 years and over who experience isolation and digital exclusion. Workshops were facilitated at the charity with language assistants, with talks from healthcare professionals covering ED, General Practice, Maternity services, Immunizations, and Mental Health. Awareness was also raised on the right to interpreter services.

Families from a minority ethnic background made up 30% of attendances and only 13% of those called NHS 24 for advice, with the rest self-referring to the ED. In response, multilingual leaflets and posters were created to direct families to RHCG’s website, signposts to services available for common presentations in 242 languages. Written feedback from workshop attendees highlighted the need for this initiative, with many reflecting on the amount of information learnt, particularly on antenatal care, health visiting, and mental health. Several women also decided to vaccinate their children.

Further work needs to be done to bridge the gap in access to health information, and this can be done in partnership with charities.

Taskforce Kiwi is a veteran-led volunteer disaster relief charity that responds to disasters in Aotearoa/New Zealand and internationally. TFK aims to help disaster-affected communities in their recovery, promote veteran psychosocial well-being, and ensure self-sufficiency in first aid (without burdening affected communities). FACET is used when initially defining skill requirements for the deploying team. The tool will be available for use by other organizations.

Each deployment must have an appropriate team composition with relevant first-aid skills for the deployment’s injury risk. Volunteer time is valuable, and the use of skills should be optimized. Medical oversight via telehealth and standing orders for essential medications will be a force multiplier of skills for the less qualified.

FACET requires the following data:

* Likely state of disaster on arrival

* Location

* Duration

* Likely activities to be undertaken

* Effectiveness/Availability of local Emergency Services

* Local Emergency Services ETA if called

Using a series of predefined drop-down boxes, the data is evaluated to determine the required competencies to complete the activities and the severity of possible injuries, and then identifies the first aid competency level needed.

Results:

The FACET identifies the minimum first aid competency required. Namely:

* Basic First Aid

* Disaster (Austere) First Aid (in house curriculum and training)

* Veteran Defence Force Medics

* Registered Health Care Professionals

Thus, relevant potential team members can be quickly identified.

FACET has been verified retrospectively across several domestic and international deployments, aligning with the actual first aid inputs required. FACET is an objective tool (spreadsheet/mobile phone app) to document and inform team composition for disaster recovery deployments of volunteers, ensuring appropriate first aid competencies commensurate with the austerity and hazards of the situation. FACET objectively supports what might otherwise only be a “gut feeling” and provides objective data for ongoing risk and hazard analysis.

Special Enforcement Officers (SEOs) in the Netherlands, employed by municipalities to enforce regulations in public spaces, are frequently exposed to aggression and violence, increasing their risk of psychological issues. The “Psychosocial Support for High-Risk Professions” guidelines provide a basis for assessing SEOs’ psychosocial support needs; however, existing support practices often fall short of addressing the unique demands of their roles. As SEOs’ tasks and responsibilities continue to expand, their specific psychosocial support needs must be better understood and addressed.

A mixed-methods approach was applied, including a document review and semi-structured interviews with SEOs and their supervisors. Document analysis identified existing preventive strategies and evidence-based best practices, creating a preliminary list of psychosocial needs. A total of 17 SEOs and 10 supervisors were interviewed, focusing on SEOs’ support needs, best practices, and policy gaps across different municipalities and geographic regions. Qualitative thematic analysis was used to uncover recurring themes, particularly where formal support policies diverged from SEOs’ practical experiences and perceived needs.

Significant variability was found in perceived support levels, with smaller municipalities frequently offering fewer formal resources. Informal peer support emerged as a primary source of reassurance and solidarity among SEOs, while formal support, when provided, was more effective when supervisors had enforcement experience. A critical issue identified was ambiguity in SEOs’ roles, particularly regarding their overlap with police duties. This role ambiguity fosters confusion and insecurity, amplifying stress and diminishing the impact of other support measures. SEOs consistently emphasized that without a clear role definition, other support needs remain challenging to address effectively.

The findings highlight the need for an enhanced psychosocial support framework that includes clear role definitions, access to structured support systems, and acknowledgment of SEOs’ unique challenges. Addressing the foundational issue of role ambiguity is essential for reducing psychological risks and fostering resilience among SEOs.

News of disasters often prompts individuals, organizations, and countries to seek ways to support affected areas. However, the notion that “any donation is a good donation” can lead to unintended consequences, particularly with inappropriate pharmaceutical donations. The practice of inappropriate donations can burden recipient countries with the need to manage, store, and dispose of unwanted or expired medicines, wasting valuable resources, which leads to adverse effects on the environment, the economy, health, and quality of life. This study aimed to develop a prioritized list of research questions (RQs) to investigate donated medicines, drawing on insights from international interdisciplinary experts.

There were 46 people invited from over 10 countries and 15 disciplines to participate through an asynchronous Delphi study conducted in four rounds using an online questionnaire platform (Qualtrics) from May to September 2024. Round 1, participants suggested RQs; in Round 2, they ranked and commented on draft questions using a 9- point Likert Scale. Consensus was defined as a mean score of ≥ 7, with an interquartile range (IQR) ≤ 3, with no answer ≤ 3. Round 3 involved controlled feedback for participants to re-rank questions that did not achieve consensus on a 4-point Likert Scale; Round 4 sought final approval for the generated list.

Twenty-four experts participated, representing seven countries,14 areas of research expertise, and 10 types of methodology expertise. The panel reached consensus on 21 RQs from an initial list of 29, encompassing seven social science and humanities, six environmental, four health, three economic questions, and one interdisciplinary perspective.

This study successfully identified key research priorities concerning donated medicines, emphasizing the need for a coordinated approach to mitigate harm and enhance the effectiveness of pharmaceutical donations. Future research should focus on addressing these questions to develop best practices that balance humanitarian assistance with responsible resource management, ultimately supporting disaster-affected communities more sustainably.