Indonesia is recognized as the most charitable nation globally, demonstrating a strong commitment to assisting communities, particularly those affected by disasters. The Ministry of Health’s Emergency Medical Team (EMT) Health Reserve Personnel (Tenaga Cadangan Kesehatan/TCK) or TCK-EMT dashboard indicates significant engagement since 2023, with 493 registered EMTs, 252 health teams, and 13,999 individual health volunteers. This remarkable growth challenges the government to educate EMTs on effective health service management. In response, the Center for Health Policy and Management (CHPM) at Universitas Gadjah Mada (UGM) provides essential management training for EMTs across the nation.

This report presents data collected from the EMT management training conducted by CHPM UGM, encompassing terms of reference, educational materials, participant demographics, and pre- and post-training assessments that illustrate implementation methods and knowledge outcomes.

In 2024, two batches of hybrid training were held to enhance EMT competencies. The first day involved an online module covering fundamental management principles, including an overview of the EMT Coordination Cell (EMTCC), the organizational structure, deployment preparation, and rapid health assessment techniques. The second day included face-to-face practical training, where the simulation room was organized to replicate an EMTCC post. Participants actively engaged in various EMT activities, including departure preparations, EMT registration, operational planning, daily reporting, EMTCC daily meetings, and compiling health management data. A total of 68 participants (28 men and 40 women), primarily from hospitals, were involved, including 20 doctors, 15 nurses, and 14 pharmacists. A significant increase in knowledge was recorded, with a p-value of 0.0001.

Upon evaluating the training’s processes and outcomes, CHPM UGM plans to expand this initiative, targeting a broader participant base to strengthen the TCK EMT program and enhance the managerial skills of EMTs alongside their technical capabilities in health services.

Fleadh Cheoil na hÉireann is an annual music festival showcasing Irish culture and artistic expression. Wexford Town (Pop 30,000) hosted the first Wexford Festival from August 4- 11, 2024, with an estimated 650,000 people visiting to enjoy the festivities. Although this mass-gathering event (MGE) presented significant socioeconomic benefits locally, there were concerns about the potential burden additional populations would place on local health care services at Wexford General Hospital (WGH), which was still recovering from fire damage.

A retrospective audit of the WGH emergency department (ED) over three months covering this period was performed to determine what effect (if any) this event had on local healthcare services. Generic attendance data were retrieved from automated daily reports for analysis and compared to periods before, during, and after the event.

14,161 patients presented to WGH ED during July, August, and September 2024. The highest monthly attendance (4957) was presented during the pre-event season in July (35.0%). 4638 (32.7%) patients presented in August during the Fleadh, and 4566 (32.2%) patients presented post-event month. The number of attendances arriving by ambulance to the ED increased by 25.53%, and ambulance presentations increased by 9.96% from July to August.

This MGE did not result in an expected increase in patient attendances to the local ED; however, there was an increased burden on ambulance services due to travel logistics, tourists unaware of the facility’s location, and generic road closures. Because WGH was situated near the Fleadh (3.3km), there were greater traffic restrictions in the area as ambulances were the only permitted form of transfer for patients from the Fleadh medical team to WGH. Traffic restrictions are a necessary safety measure to mitigate risks of road trauma at MGEs, but this could be adapted more efficiently in preparation for the next Fleadh in 2025.

The Louisiana Health Department divides the state into 9 regions. Region 1 includes four parishes: New Orleans Parish, Plaquemines Parish, St Bernard Parish, and Jefferson Parish. Within Region 1, there are 11 ground ambulance agencies, made up of public and private agencies. One might think collaboration between 11 different public and private agencies would be difficult to accomplish; however, in this region, the agencies work exceptionally well together. There are a few key ways collaboration throughout the year increases interagency communication and coordination, and builds capacity during day-to-day operations and mass casualty events. The Metro Ambulance Council (MAC) serves Southeast Louisiana. It is comprised of all Region 1 EMS agencies, as well as the neighboring St. Charles Parish EMS agency. The MAC meets at least once a quarter; during these meetings, agencies report out and support each other’s needs that arise. Agencies work together to create regional plans and protocols. Having the regional protocols and plans results in a single language across the board that all agencies follow, increasing the ease of coordination. In October 2024, regional EMS agencies conducted two mass casualty exercises, including a full-scale exercise with 8 of the 11 agencies participating, involving over 70 volunteer patients. This exercise tested and proved positive interagency communication and incident command structure among the eight responding agencies. The second exercise was a tabletop between regional EMS agencies and 12 regional Hospitals, for EMS, this tabletop tested the Regional Mass Casualty transportation plan. It was found that through good communication and coordination within the regional EMS agencies, they were able to move all 400 simulated patients in a timely manner, as laid out in the regional plan. The high level of coordination between regional EMS agencies has led to a significant increase in pre-hospital EMS capacity.

The use of ultrasound imaging as a bedside diagnostic tool has become widely accepted in emergency departments across the globe. However, the adoption of clinical ultrasound is still fragmented, with this discrepancy being most notable in rural or developing healthcare facilities. This is a feasibility evaluation of a low cost tele-mentoring model to guide non-proficient operators through two-point compression US evaluating bilateral lower extremities for deep venous thrombosis (DVT).

A convenience sample consisting of six first-year medical students was enrolled in the study. Using a two-way zoom video and audio call, the guiding physician (off-site) directed the participant through the DVT exams by providing instructions on patient positioning, probe placement, image optimization, and venous compression. The exams were evaluated by two ultrasound fellowship trained third-party emergency medicine physicians to validate if the archived images were diagnostic (Yes/No); to grade (1-5 score) the image quality using the reporting guidelines established by the American College of Emergency Physicians.

Six participants were enrolled in the study, with all participants reporting that the instructions from the guiding physician were easy to understand, with a mean score of 9.9/10. All participants felt their ultrasound examination had high diagnostic value, and their experience with the tele-mentoring session improved their ultrasound skills, with means of 9/10 and 9.7/10, respectively. External validating physician 1 scored 50% of the exams as diagnostic with a mean image quality rating of 3.5/5. External validating physician 2 scored 83% of the exams as diagnostic with a mean image quality rating of 3.6/5.

The use of a tele-mentoring model facility diagnostic facilities has potential applications in ad-hoc scenarios such as refugee, wilderness, or warfare medicine. Data from this study provided valuable insight into the role of a tele mentoring model for clinical ultrasound in rural or field emergency facilities.

The objective of this research was to assess community pharmacists’ insights, knowledge, attitudes, and willingness to engage in disaster management via an online survey.

Informed by a literature review, the survey was collaboratively developed and pilot-tested among a small group of pharmacists. Recruitment was facilitated through local pharmacists’ organizations. Analysis included descriptive statistics of the Likert scale questions and qualitative methods for open-ended questions.

The survey included 37 questions and received 160 complete and 50 partial responses. Most pharmacists recognized their specific role in emergency response and expressed willingness to fulfill it, showing greater readiness for health-related events. Many pharmacists reported insufficient preparedness and a lack of awareness of potential risks, with few having developed disaster preparedness plans. Pharmacists were significantly better prepared for local disease outbreaks and pandemics than for natural disasters or war. A small minority had undergone formal disaster management training, yet a large majority showed willingness to engage in further training initiatives, preferably through online platforms. The survey is currently being extended to the French-speaking region of Belgium. Additionally, we are exploring opportunities for collaboration in disaster management among pharmacists in various settings, including community, defense, and hospital environments.

In Flanders, Belgium, pharmacists are not adequately equipped for emergencies but recognize their potential role and are open to pursuing additional education to enhance their disaster preparedness. The results should inform the development of training programs across different subdisciplines and could ultimately support the organization of simulation exercises.

To achieve the target: “one ASEAN, one response” of the ARCH project**, the question is whether the existing EMTs within and among ASEAN countries are similar? Therefore, we have conducted the research.

(**): Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management

A prospective, descriptive, cross-sectional study was designed for 5 target ASEAN member states (AMS): Indonesia, Malaysia, Philippines, Thailand, and Vietnam. The data of 8 EMTs in 3 targeted AMS (Indonesia, Philippines, and Vietnam) were collected from 10th September to 30th October 2024, using a data-collecting form developed in consultation with the ARCH project. Subsequently, data collection for 2 AMS, Malaysia and Thailand, is scheduled to be conducted.

There were 4 EMTs at the national level (N-EMTs) and four international EMTs (I-EMTs). These four I-EMTs were waiting for WHO recognition under the classification of the EMT type 1 (fixed). The average number of registered EMT members was 91.13± 69.70 (5-189), of which I-EMTs had a larger number than N-EMTs. I-EMT members also had a more diverse professional structure than N-EMT members. EMTs were provided all seven main groups of medicines, including medicines for pain and palliative care, cardiovascular care, the respiratory tract, gastrointestinal diseases, diuretic effects, nervous system disorders, as well as infection control; however, no EMTs had all 30 medicine groups as recommended by WHO. 5/8 EMTs had cold chain drugs. The average expiry date of medicine ranged from 8.87± 6.41 months to 42±12.21 months. 100% of EMTs had planned for maintenance, periodic operation of medical equipment, and replacement of medication and medical supplies.

There were different workforces and medical materials, as well as medicines of EMTs, among ASEAN countries. It is necessary to develop a standard for EMTs from the ARCH project.

Unmanned aerial vehicles (UAVs), or drones, have rapidly diversified in capabilities and applications due to advancements in technology and increased affordability. While drones positively impacted sectors such as healthcare and consumer delivery, particularly in remote and austere environments, their use has also been exploited by Violent Non-State Actors (VNSAs) for terrorist attacks. This study aimed to analyze the global prevalence of drone-related attacks targeting civilians and critical infrastructure, focusing on enhancing hospital and prehospital care preparedness in response to these emerging threats.

A retrospective review of the Global Terrorism Database from 1970 to 2020 assessed the prevalence of drone-related attacks. Cases were excluded if they had insufficient information regarding drone involvement or if government entities conducted the attacks. Trends in the number of attacks per month, fatalities, and injuries were analyzed using time series and trend analysis.

The database search yielded 253 drone-related incidents, with 173 meeting the inclusion criteria. These incidents resulted in 92 fatalities and 215 injuries, primarily affecting civilian targets (76 events, 43.9%), followed by military targets (46 events, 26.5%). The Middle East was the most affected region (168 events, 97% of total attacks), with the Islamic State of Iraq identified as the most common perpetrator (106 events, 61.2%). Nearly all attacks involved explosive devices attached to drones (172 events, 99.4%). Time series with linear trend analyses indicated an upward trend in drone attacks by VNSAs over the years, leading to increased morbidity and lethality.

There has been a notable increase in drone attacks over time, characterized by higher lethality and morbidity. With injuries outnumbering fatalities, there is an urgent need for improved response strategies. Investment in training for medical personnel, bolstered security measures, and targeted research is essential for effectively managing mass-casualty incidents resulting from drone attacks.

The Denver Health Paramedic Division (DHPD) is the primary 911 emergency medical transportation service in Denver, Colorado. It supports emergency and non-emergency medical response at critical gathering sites, such as Denver International Airport and event venues around the city. Additionally, DHPD runs numerous community-focused special operations, including the High-Risk Infection Transport Team (HITTeam), which focuses on responding to special pathogen events. The HIT Team is closely integrated with hospital partners as part of the Region 8 Emerging Special Pathogen Treatment Center.

DHPD is committed to continuous improvement and exploring ways to improve care and comfort for patients. In 2022, the HITTeam began work on the virtual assessment model (VAM) as an innovative and novel approach to treating low-risk suspect cases in the community. In 2024, DHPD paramedics took this a step further by studying to become endorsed community paramedics (P-CP), enabling them to perform expanded medical interventions in community-integrated healthcare service settings. The HIT Team is leading efforts to attain P-CP endorsements to enhance the quality of special pathogen care delivered by the Division and re-focus response on the community in what is traditionally a hospital-centric subspecialty. Alongside hospital and public health partners, HITTeam P-CPs will incorporate special pathogen case assessment, monitoring, specimen collection, patient and family teaching, and pharmaceutical intervention into a mobile framework, thus reducing reliance on hospital-based resources and response structures for low-risk suspect cases.

DHPD’s collaboration with other public safety and emergency preparedness entities highlights the Division’s commitment to providing high-quality medical and support services to meet community needs. Obtaining P-CP endorsement for members of the HITTeam is another step towards establishing DHPD as an integral part of the social fabric of Denver. It could have far-reaching consequences when it comes to centering paramedicine on the patients and community members who utilize DHPD services.

Mass Casualty Incidents (MCIs) overwhelm health care systems, necessitating effective preparedness. Yoseftal Medical Center is a small community hospital in Eilat, on the southern tip of Israel. The massacre on October 7, 2023, unmasked significant gaps in emergency preparedness protocols, prompting a comprehensive rehaul. Since the beginning of the Iron Swords War, Yoseftal has faced unprecedented challenges in providing medical care to its local population and the waves of evacuees from across Israel. In parallel, it must reckon with new threats of missile attacks and the risk of large-scale MCIs, particularly challenging due to its remote and isolated location. In a matter of weeks, Yoseftal successfully transformed its capabilities to manage a large-scale MCI, thanks to assistance from institutions within the broader healthcare system. This study explores how Yoseftal enhanced its MCI readiness using available resources and innovative approaches.

The methodology included a literature review, a review of procedural data from the Israeli Ministry of Health, an on-site survey, participation in a simulation exercise, and interviews.

Three preparedness stages were observed: 1) Pre-October 7, 2023: The hospital complied with routine emergency drills and inspections suitable for small-scale casualty incidents. 2) October 7, 2023, to February 2024: This capacity-building phase included consultations, coordination with local and national institutions, equipment and personnel reinforcement, infrastructure upgrade, protocol updates, and drills, including guided isolated exercises and full-scale institutional exercises. 3) February 2024-present: This phase is characterized by the ongoing maintenance of standby teams and managers, equipment reinforcement, and drills. Each phase was driven and maintained by solidarity within the local community and the broader health system.

Collaboration, intensive training, and community solidarity are critical for effective MCI preparedness in small community hospitals.

The UNDRR Disaster Resilience Scorecard for Cities is a known tool that was developed for local governments to evaluate their resilience to disasters. In this review, we examine the case where a modified version of the scorecard was used to assess resiliency to nuclear disasters, and the potential for further modification of the scorecard to better assess specific stressors on a healthcare system.

Utilizing a modified Delphi approach with nuclear and radiation experts from the US and Israel, the UNDRR Scorecard was modified to assess resiliency to a nuclear disaster. Once modified, the scorecard was distributed to local government officials, nuclear and radiation specialists, and public health and healthcare personnel utilizing Qualtrics software. A post-scorecard survey was provided for feedback on how the scorecard could further be improved and refined to achieve its stated objective. Small changes were made after consideration of the feedback from the same committee of experts that initially modified the scorecard.

Early results have identified strengths and weaknesses within local governments and health systems that can be used to strengthen the response to a nuclear disaster. Most recently, the scorecard was used at a workshop for nuclear safety in Montgomery, Alabama, and received positive feedback. Modifications continue to be made from post-survey feedback after approval of the expert committee.

The scorecard has been a useful tool in defining the baseline preparedness and estimating the resilience of local governments and health systems to disasters. In Montgomery, Alabama, the scorecard helped identify important action items for the community to focus on to improve their community’s resilience to nuclear disasters. This case in modification of the UNDRR utilizing this approach shows promise that, with a structured approach, the UNDRR disaster resilience scorecard can be modified to further improve a community’s resilience to specific disasters.

On April 10, 2022, a touring car crashed on the highway and rolled over. Two passengers died on the scene. There were five U1 patients, mainly with traumatic amputations, two of them in profound shock. Five were U2 and thirteen were U3, and six were uninjured. The dispatch activated the disaster plan, and within eight minutes, responders were sent out. Although the location wasn’t clear and a traffic jam blocked the highway, the first medical teams arrived on the scene after 17.5 minutes. Within 20 minutes, three medical teams and five ambulances were on scene. Seven medical teams, six “112” ambulances, and nine Red Cross ambulances were deployed. One helicopter from another province was activated due to traffic problems. The Red Cross also activated support teams and a command-communication vehicle. The fire department applied tourniquets and passers-by, saving the lives of amputees. Patients were spread over nine hospitals, and because of severe, life-threatening lesions, the T1 patients were evacuated by the scoop and run system. Prominent was a lack of experience and limited disaster management education. Previous drill participation offered confidence. The victims’ multinationalism caused problems in communication and identification. Several medical teams had extra physicians on board, as the initial alarm was suggestive of many (seriously) injured patients, facilitating the scoop-and-run procedure. The helicopter was used for the patient in the most profound shock, although the estimated time of arrival wasn’t clear. Debriefing revealed the serious impact on the teams, stressing the importance of post-exposure support.

The communication with the bus firm was difficult, so it wasn’t possible to obtain a passenger list. Although a SITREP is important, it was hard to get. The victims’ multinationalism needed communication with the respective embassies without fixed procedures. Return to normal action was fast, but with little chance to relax and cope.

The COVID-19 pandemic disrupted emergency healthcare worldwide, heavily impacting Japan’s emergency services from early 2020. Reflecting on its effects is essential for future pandemic preparedness.

This study analyzed data from the Aichi Medical Association’s annual survey of emergency patients at 26 tertiary emergency hospitals in Aichi Prefecture, Japan. Over the three pandemic years (2020-2022), we examined trends in ambulance transports, hospitalization rates, and severe cases by age group: pediatric (0-14), non-elderly (15- 64), early elderly (65-74), and late elderly (75+).

Across the three years, age distribution remained constant: pediatric 9%, non-elderly 30%, early elderly 15%, and late elderly 46%. In 2020, ambulance transports dropped sharply (2019: 198,607 cases; 2020: 173,329), particularly in pediatric and non-elderly groups, while hospitalization rates rose (40.2%→44.0%). Surprisingly, severe cases declined (63,382→52,782). In 2021, ambulance transports for pediatric and late elderly patients began increasing, with hospitalization rates continuing to rise (44.5%) and moderate (90,444 cases) and severe cases (62,732) increasing in all age groups. By 2022, ambulance transports had returned to pre-pandemic levels (197,539), but children and non-elderly mild cases increased markedly, and hospitalization rates declined slightly (42.0%). The number of severe cases (72,031) also increased.

In 2020, the number of severe cases as well as mild cases likely decreased due to the restricted outings due to fears of infection. In 2021, virulent variants (Alpha, Delta) contributed to more severe cases. By 2022, increased transmissibility, decreased virulence (Omicron), vaccine distribution, and “pandemic fatigue” contributed to a surge in mild cases. Additionally, while restrictions on movement out and the spread of infection prevention measures led to a decrease in severe cases and non-coronavirus epidemic infections, stress and weakened immunity may have contributed to the increase in moderate and severe cases in subsequent years moderate and severe cases in later years.

The Taiwan Superbike Series is a well-known motorcycle racing event, held three times a year, with each event spanning two days. Each event features a 15-minute qualifying session on the first day, followed by a seven-lap sprint race. The second day includes a 10-minute warm-up and a 15-lap main race. This article shares medical rescue experiences and notable pitfalls from a specific event in 2024.

At this event, a total of 156 riders participated, leading to 644 race starts. There were 50 instances where riders were brought to the medical station after falling, resulting in a medical utilization rate of 77.6 cases per 1,000 race starts. Two specific cases are noteworthy:

Case One: A 39-year-old male rider crashed during the qualifying session. Upon arrival at the medical station, he only exhibited an abrasion on his left wrist, and a detailed physical examination revealed no other issues. However, three and a half hours later, he returned with left chest pain. During this secondary evaluation, he exhibited memory loss, having no recollection of his previous visit. Additionally, the left chest contusion was not apparent in the first evaluation.

Case Two: A 31-year-old male rider crashed during the sprint race at the end of the first day, with no signs of discomfort or injury. However, the following day at noon, he returned due to dizziness. Similar to the first case, he also had no memory of visiting the medical station the previous day.

In summary, the medical utilization rate for riders in the Taiwan Superbike Racing is approximately 77.6 cases per 1,000 race starts. Additionally, concussions can sometimes be difficult to diagnose immediately, potentially delaying the recognition and diagnosis of certain injuries. These experiences underscore the importance of careful monitoring in future events to enhance rider safety in motorcycle racing.

The COVID-19 pandemic has had a profound impact on the mental health and well-being of healthcare professionals, including paramedics. This systematic review aims to investigate the specific effects of the pandemic on paramedics’ mental health and identify potential coping strategies. By examining the available literature, this review seeks to contribute to a better understanding of the challenges faced by paramedics during this unprecedented crisis and to inform the development of targeted interventions to support their mental health.

A systematic search was conducted using three electronic databases: MEDLINE, CINAHL Complete, and Scopus. The search terms included “COVID-19,” “coronavirus,” “paramedic,” “emergency medical service,” “mental health,” “stress,” and “anxiety.” Inclusion criteria were limited to peer-reviewed articles published between 2021 and 2023, focusing on studies that investigated the impact of the COVID-19 pandemic on paramedics’ mental health. Exclusion criteria included studies that did not specifically focus on paramedics or did not report on mental health outcomes.

The results of the systematic review revealed a significant negative impact of the COVID-19 pandemic on paramedics’ mental health. Several studies reported increased levels of stress, anxiety, depression, and burnout among paramedics during the pandemic. Work-related stressors such as increased workload, exposure to infectious diseases, and challenging working conditions were identified as key contributors to these mental health issues. Additionally, personal stressors, including fear of infection, financial concerns, and social isolation, exacerbated the negative impact of the pandemic on paramedics’ mental well-being.

The COVID-19 pandemic negatively impacted paramedics’ mental health, leading to increased stress, anxiety, and burnout. To address this, it’s crucial to provide mental health support, promote self-care, and foster supportive work environments. Further research is needed to understand the long-term impact and develop effective interventions.

Appropriate seal of airway management devices is a crucial factor during ventilatory support in critically ill patients. The presence of a leak during ventilation is associated with worse patient outcomes. This study aims to evaluate the level of seal of advanced airway management devices during mechanical ventilation in a manikin model.

Advanced airway management devices, such as an orotracheal tube, a laryngeal mask 1st generation, a laryngeal tube, and an i-Gel, were placed in the manikin simulator Code Blue® III Adult with OMNI® (Gaumard). Ventilatory support was delivered through the Ventway Sparrow mechanical ventilator at predefined ventilatory settings across all devices for ten minutes.

Ten device placements were conducted for each one. The manikin provided feedback on achieving the target volume set during ventilatory support across all evaluated devices. For the analysis, a total of 1200 ventilations in each device were evaluated. Target volume achievement for orotracheal tube was 100%; for laryngeal mask 1st generation was 74% (95% CI: 65-83%); for laryngeal tube was 83% (95% CI: 80-86%); and for i-Gel was 98% (95% CI: 96-100%). The level of leakage is inversely proportional to the level of compliance with the target volume. While the endotracheal tube remains the gold standard for target volume achievement and to avoid leaks, i-Gel seems to be an appropriate option until definitive airway management placement.

Results suggest a wide variability of seal level between different airway management devices. Endotracheal tubes stand out as the gold standard for an appropriate seal against the 1st generation laryngeal mask. However, the manikin study comprises several limitations; further studies are needed to compare the level of seal in real patients and its impact on patient mortality and complications.

The ever-present menace of employing weapons of mass destruction during military conflicts or terrorist attacks requires thorough preparation of the Emergency Medical Services (EMS), medical hubs (MHs), and hospitals for such CBRNE threats. Preparing to respond to the use of CBRNE weapons demonstrates notable gaps in pre-hospital and hospital procedures. The potential influx of casualties from contaminated areas (hot zones) to emergency departments (EDs) or medical hubs (MHs) would require rapid detection and identification of CBRNE agents.

The research aimed to design new procedures for the rapid detection and identification of CBRNE agents directly at the patient’s bedside (CBRNE Point of Care Testing). The study was conducted over three years. Tests of the portable detection devices and simulations of CBRNE incidents were conducted as part of it. In total, twenty-one simulations and seven special tests to assess the new procedures were completed.

The assessment of the capabilities of portable detection equipment, detection and identification methods, as well as AI-supported CBRNE triage protocols, helped to develop new procedures for EMS, MHs, and EDs. These new procedures allow for rapid detection and identification of hazardous materials (biological, chemical, radiation/nuclear) precisely at the place where medical assistance is provided. The AI-supported rapid detection and identification of CBRNE agents on/in the victim’s body helps to determine the scale of contamination (external and internal) and its potential adverse impact on the victim and the medical personnel’s organisms. In turn, the procedures following the CBRNE detection and identification accelerate the application of medical countermeasures and specialist treatment.

The implementation of CBRNE medicine procedures and equipping the EMS/MHs/EDs with portable diagnostic equipment (CBRNE Point of Care Testing instruments) increases the safety of medical staff and the responsiveness of the Medical Rescue System to CBRNE threats.

The Sendai Framework for Disaster Risk Reduction 2015-2030 emphasizes education and training as essential elements for disaster risk reduction. However, recent studies have highlighted significant variability in disaster management (DM) training curricula, methodologies, and evaluation practices. A recognized issue within DM capacity-building programs is the lack of scientifically sound monitoring and evaluation (M&E). The M&E process serves two main functions: an internal function focused on quality assessment and continuous improvement of the course, and an external function related to outcome reporting and performance evaluation. Given the relatively low frequency of disasters, most responders experience real events infrequently, making effective training and M&E crucial to ensure they are prepared to perform optimally when disasters occur. DM training programs encompass a broad range of topics, from clinical medicine to management, and employ various instructional methods, including e-learning, traditional lectures, and simulations. This complexity complicates the M&E process. Additionally, evaluating DM training outcomes during actual disasters is nearly impossible due to the numerous factors that influence response effectiveness. Most educational programs in general medical education and DM training struggle to demonstrate a clear connection between training activities and desired outcomes. Organizers often only report on the number of individuals trained, participant satisfaction, and knowledge gains. This M&E approach is suboptimal because it analyses only limited aspects of the educational process and overlooks the complex, dynamic processes within the programs. Consequently, a high-quality, validated M&E process, deliberately designed to address the complexity of DM training, should incorporate a variety of evaluation methods, including formative assessments and summative assessments, incorporating both qualitative and quantitative data. A comprehensive M&E framework has the potential to improve the course itself, improve its learning outcomes, and ensure all stakeholders of a trustworthy educational process.

Wildfires are an increasing threat, exposing two billion people globally to harmful air quality. Children with higher outdoor exposure, increased air intake relative to body weight, and developing lungs are particularly vulnerable to wildfire smoke. This study examines the impact of socioeconomic status (SES) on severe lung disease exacerbations in critically ill children during wildfires.

This was a retrospective cohort analysis of 2,417 children, aged 0-29 years, admitted to a quaternary Pediatric Intensive Care Unit for acute respiratory disease during wildfires from 2016 to 2023. Data were sourced from Virtual Pediatric Systems, Social Deprivation and Vulnerability Indices, Fire Information for Resource Management System, and Air Quality System, and merged using zip codes.

Wildfire-related pollution exposure was defined as wildfire presence within 100 miles on satellite imagery and PM2.5 levels at least one standard deviation above the annual mean in the 10 days before admission.

SES was categorized using the Area Deprivation Index (ADI), Social Vulnerability Index (SVI), and Child Opportunity Index (COI), with high and low SES defined as the highest and lowest quintiles. Fisher’s exact test and Mann-Whitney U tests compared outcomes between SES groups.

Using COI, patients with low SES had a significantly longer ICU LOS (1.3 days, p < .001) and higher absolute risk of requiring mechanical ventilation (28%, p < .001) during wildfires. The risk of mortality using PIM3, but not PRISM3, was also significantly elevated (0.6%, p < .001) for low SES patients. Age and gender assigned at birth were similar between the low and high SES groups across all indices. These findings were consistent across ADI and SVI.

This study highlights disparities in outcomes for children from low SES backgrounds during wildfires, with low SES linked to more severe respiratory outcomes. Additional research and greater public health awareness can inform targeted interventions and disaster preparedness to protect these vulnerable populations.

Emergency Department Length of Stay (EDLOS) is a critical indicator of overcrowding, which has become a significant public health concern worldwide. Overcrowding reduces the quality of care, increases the risk of medical errors, causes dissatisfaction among patients, and causes burnout in healthcare workers. There is limited literature on implementing and evaluating solutions to prolong EDLOS. This study aims to assess the impact of quality improvement initiatives for reducing the length of stay in the Green Zone of the Emergency Department of a tertiary-level hospital and their effect on patient satisfaction. The objectives were to explore the health-related issues and challenges encountered by patients in green zones, to develop feasible interventions to address these problems, and to assess the effectiveness of quality improvement interventions in reducing EDLOS.

This was an exploratory mixed-method study design with purposive sampling. A multidisciplinary quality improvement (QI) team was formed, and process flow diagrams and fishbone analysis were used to identify factors contributing to prolonged triage waiting time. Orientation sessions empowered staff, and patient experiences were explored through interviews. Change ideas were tested iteratively, focusing on feasible interventions to reduce waiting time. The successes and challenges of each change attempt were documented, focusing on lowering consultation delays as a primary factor contributing to prolonged EDLOS.

There was a significant decrease in median EDLOS from 170 to 149 min (p 0.038) after intervention. The median number of patients who stayed for more than 120 min, 360 min, and 600 min was decreased from 415 (IQR 391- 478) to 362 (IQR 322-374) (p 0.011), 144 (IQR 104-164) to 91(IQR 82-119) (p 0.066), and 65 (IQR 37-67) to 26 (IQR 22-33) (p 0.066), respectively.

This quality improvement study effectively reduced patient stay duration in the ED through targeted interventions, improving workflow and efficiency.

The incidence and severity of acute mountain sickness (AMS) escalate with altitude. If left untreated, AMS can progress to high-altitude pulmonary edema (HAPE) or high-altitude cerebral edema (HACE), both potentially fatal. The most effective treatment involves rapid descent to lower altitudes with increased oxygen availability. Portable hyperbaric bags have traditionally been used to simulate a lower altitude environment; however, their bulk and weight restrict usability. This study aims to evaluate the efficacy of a novel portable hyperbaric mask, which is lighter, compact, and allows simultaneous access to the patient’s vascular system and mobility during use. The primary endpoint is the change in oxygen saturation before, during, and after mask use at high altitude. Secondary endpoints include subjective respiratory distress and AMS symptoms.

This pilot prospective self-controlled, intervention-focused crossover trial, conducted in two phases, will evaluate a novel 3D-printed portable hyperbaric mask in healthy volunteers. Phase 1 will take place at Rifugio Torino in the Italian Alps (3375m). Baseline measures for oxygen saturation, subjective respiratory distress, and AMS symptoms, assessed by the Lake Louise Score, will be recorded for each participant before mask application. These parameters will be reassessed at intervals during mask application and after removal. Phase 2 will replicate the procedure at higher altitudes, first at Aconcagua Base Camp (4200m) and later at the summit (6960m). Data collection is scheduled between December 2024 and February 2025.

We anticipate observing notable variations in oxygen saturation, subjective respiratory distress, and AMS symptoms, correlating with mask use at various altitudes.

This study aims to assess the portable hyperbaric mask’s effectiveness in alleviating AMS symptoms and potentially preventing HAPE and HACE.