The COVID-19 pandemic has significantly strained global health systems, particularly impacting frontline healthcare workers (FLHCWs) who are at increased risk of experiencing mental health issues. These challenges affect the well-being of FLHCWs and have implications for patient care and the sustainability of the healthcare workforce. Despite these critical concerns, there remains a lack of comprehensive understanding regarding the specific factors contributing to psychological distress among FLHCWs in countries like Sri Lanka.

This study employed semi-structured interviews to explore the factors contributing to psychological distress among doctors and nurses in Sri Lanka during the COVID-19 response. Sixteen FLHCWs from various public hospitals were selected using snowball sampling and interviewed until data saturation was achieved. Thematic analysis was conducted to identify and categorize the participants’ major stressors and support needs.

Thematic analysis revealed several significant stressors experienced by FLHCWs during the COVID-19 response in Sri Lanka. These included staff shortages, excessive workloads, low confidence levels, moral dilemmas, social stigma, family impacts, issues with protective equipment, triage complexities, and inadequate rewards, particularly prevalent in smaller hospitals.

Addressing the psychological distress among FLHCWs necessitates strategic interventions such as capacity building, equitable distribution of resources, ensuring safe working environments, and implementing robust support mechanisms. These findings underscore the importance of developing sustainable strategies to enhance mental health resilience among FLHCWs globally, thereby safeguarding their well-being and patient care quality during emergencies and disasters.

Parental presence is a critical element in pediatric care, providing emotional support that can significantly enhance a child’s well-being. However, in cases involving High-Consequence Infectious Diseases (HCIDs), this need must be carefully weighed against infection control imperatives to prevent pathogen transmission. This tabletop exercise, titled “Parental Presence During Pediatric HCID Care,” was developed to simulate and address the complex, real-world decision-making that healthcare providers face when balancing these needs in high-stakes environments.

Designed for a small team consisting of three participants—representing a pediatric healthcare provider, an Infection Control Officer, and a Parent—and three facilitator presenters, this exercise introduces a scenario in which a young child with a suspected HCID is in isolation, and the parent is distressed and requesting bedside access. Through structured discussion and guided role-play, participants explore initial considerations for allowing or restricting parental presence, assess risks, and develop a preliminary action plan that balances infection prevention with family-centered care.

The drill provides an immersive learning experience that highlights the importance of interdisciplinary collaboration and clear communication in HCID care, encouraging participants to examine practical measures (e.g., PPE, restricted visitation, virtual communication) and ethical challenges (e.g., the psychological needs of both child and parents). This phase concludes with a facilitated debrief, allowing participants to reflect on their decisions and insights gained.

Presented as an interactive tabletop, this exercise would offer conference attendees a hands-on opportunity to engage with and refine strategies for family-centered care within infection control constraints, fostering an understanding of best practices that can be adapted across healthcare settings.

The growing threat of terrorism against military entities necessitates a comprehensive understanding of terrorist networks to develop effective counter-terrorism strategies. This study employs advanced network analysis and artificial intelligence (AI) to explore interconnections and influence within these networks. AI tools, including machine learning algorithms and natural language processing, identify critical nodes and propose strategic interventions that enhance public safety and health.

Data from the Global Terrorism Database from 1970 to 2020, focusing on incidents involving military targets, were analyzed using centrality measures and hierarchical clustering to identify influential nodes and vulnerabilities. Specific AI techniques, such as supervised learning models for pattern recognition and natural language processing for threat language detection, were integrated to improve threat detection and automate responses. Ethical considerations regarding data privacy and algorithmic transparency were prioritized throughout the analysis.

The analysis identified key nodes such as the Taliban, ISIL, and Al-Qaeda, with degree centrality scores of 0.80, 0.75, and 0.65, respectively, highlighting their significant influence across the network. Quantitative metrics revealed that regions such as Iraq and Afghanistan serve as operational hubs, with eigenvector centrality scores above 0.85, indicating them as strategic targets for disruption. AI-enhanced threat detection demonstrated a 30% improvement in accuracy, increasing from 70% to 91%, significantly reducing false positives from 20% to 7%, and enabling proactive interventions. Targeting high-centrality nodes within the network’s scale-free structure could reduce operational capacity by 40%, effectively diminishing threats.

The integration of network analysis and AI technologies reveals crucial insights into the structure and dynamics of terrorist networks. Targeting key nodes and vulnerabilities allows policymakers to develop strategies to disrupt terrorist activities and enhance public safety. AI-driven tools significantly improve threat detection and response, offering transformative potential in counter terrorism. Policymakers should address data privacy and algorithmic bias and incorporate these insights into security strategies to enable effective threat responses.

Equity is a critical component of disaster medicine, addressing the disproportionate vulnerabilities experienced by marginalized populations during crises. This study examines frameworks, practices, and innovations designed to integrate equity into disaster response, aiming to improve outcomes and resilience while mitigating disparities.

Key frameworks, including those from the WHO, FEMA, and SPHERE, were analyzed for guiding equitable disaster responses. Strategies such as cultural competence, inclusive communication, and equitable resource allocation were reviewed alongside technological innovations like telemedicine, geospatial mapping, and data tracking systems. Barriers, including financial constraints, systemic inequities, and implicit bias, were explored to identify actionable solutions.

Equitable disaster responses were found to enhance survival rates, recovery speed, and community resilience. Frameworks emphasized reducing health disparities and prioritizing vulnerable populations. Innovations, such as real-time data systems and multilingual communication platforms, effectively targeted underserved areas. Persistent barriers included a lack of training, systemic biases, and challenges in resource allocation, highlighting the need for comprehensive policies and collaborations.

This study underscores the imperative of equity in disaster medicine, advocating for strategies that foster inclusive, effective, and fair disaster response operations. Integrating equity into disaster response necessitates a multifaceted approach, combining robust frameworks, actionable policies, and technological advancements. Addressing implicit bias and improving cultural competency among responders are essential to equitable care delivery. Future efforts should prioritize real-time data use, stakeholder engagement, and legislation to institutionalize equity in disaster planning and response.

Immediate responder groups in disaster response need to self-organize to provide aid before the arrival of the professional response. These groups consist of individuals in proximity to the event and may vary in emergency response expertise from emergency response professionals (ERP) to medical laypeople. While ERP training typically includes some teamwork education, research on ERP expertise on teamwork in immediate responder groups is limited. This study investigates how teamwork processes differ between groups with or without an ERP in a controlled simulated scenario.

Twenty-eight groups (76 participants) participated in a traffic accident scenario. Participants completed the Team Process Survey afterwards, measuring transitional, action, and intrapersonal processes. Transitional processes include goal setting and planning, action processes involve monitoring goal progress, and intrapersonal processes concern maintaining motivation and handling conflicts. The scenario involved two critically injured people and limited resources. An ERP was present in eight groups. The controlled simulation allowed for the standardization of situational and environmental factors.

A significant difference in transitional processes was found between groups with (M=3.2, SD=0.9) and without ERP (M=2.78, SD=0.6), Welch’s t(31.3) = −2.05, p = .05, with a medium effect size, Cohen’s d = −0.55. However, no difference was found in the action, Welch’s t(31.8) = −0.51, p = .61, or intrapersonal, Welch’s t(44.9) = 0.45, p = .65, process dimensions.

The presence of emergency response expertise in immediate responder groups can be expected to support transitional team processes by facilitating shared reflection on the groups’ goals, strategies, and plans in between periods of individuals’ taskwork efforts. However, further training in leadership in line with current best practices in intra-professional teamwork for both ERP and in first aid education for medical laypeople could potentially improve action and intrapersonal team processes in the immediate responder phase of disaster response.

Power outages can be caused by natural disasters, accidents in the surrounding area, or damage from wild animals, but it is difficult to recreate and train for these situations in medical institutions. VR technology is suitable for training because it can reproduce situations that are difficult to experience in real life, such as power outages. In addition, BCPs are important in crises such as power outages, but their recognition is unknown. This study aimed to develop teaching materials that reproduce power outages and stoppages in elevators using VR and to investigate the recognition of BCP.

In the VR training material, the trainees are transporting a patient when the elevator stops suddenly due to a power outage, and they are trapped in the dark for several minutes. The trainees are all staff members from the hospital, including students, and the scene unfolds as the trainees consider the patient’s anxiety, the alarm sound of the infusion pump, how to respond to the emergency button, and how to use the emergency power supply. After the power outage training, a survey was conducted to assess the effectiveness of the training and the level of awareness of the BCP.

From the results of the questionnaire, it can be said that the training was effective, as the trainees felt anxious and scared, and found it difficult to remain calm. The results showed that many of the trainees were unaware of BCP, and through this training, they learned about the importance of BCP.

BCPs are important as a measure to take in the event of an emergency, but their recognition was low. This teaching material is useful as a safety education tool to raise awareness of BCP through power outage training.

During the COVID-19 pandemic, migrants and women were among the most vulnerable groups. By adopting an intersectional lens, it is possible to emphasize how migrant women (MW) faced specific impacts. This study aimed to explore how MW living in Milan, Italy, experienced the COVID-19 pandemic, particularly regarding their social and health needs and access to care.

Two qualitative studies using semi-structured interviews were conducted to investigate the impact of the pandemic on MW regarding a wide range of experiences, by engaging them directly and key informants (KI) working in third sector organizations and public hospitals.

Nineteen MW and twenty-seven KIs were interviewed. The pandemic significantly worsened MW’s economic situation, with service shutdowns hindering their regularization process. Bureaucratic barriers increased reliance on NGOs, which were also MW’s preferred entry point to the national healthcare system before and during the pandemic. KIs reported an increase in gender-based violence, while requests for assistance declined. Despite vaccine skepticism, most MW got vaccinated because of its de facto mandatory nature. A fatalistic view of the pandemic and disasters was prevalent among MW, with many perceiving them as inevitable events and believing that protective measures are futile. Distrust towards the national healthcare system, institutions, and media was common among MW. While KIs noted significant marginalization among MW, the women themselves considered social isolation one of the least significant impacts and did not see themselves as particularly vulnerable.

Establishing trust in advance is essential for effective disaster response. Disaster risk management should adopt an intersectional approach and consider diverse cultural perspectives on preparedness. Although specific barriers faced by MW were identified, their migratory identity seems to outweigh their gender identity. This project was supported by Fondazione Cariplo (ref. 2022-1447) and conducted in the framework of the International PhD in Global Health, Humanitarian Aid, and Disaster Medicine (UPO).

The primary mission of Environmental Justice policy and programs is to ensure that all individuals, regardless of their backgrounds, are treated fairly and included in decision-making processes that affect their health and the environment. It highlights the intersections of environmental policy, social equity, and human rights, advocating for fair treatment and meaningful involvement of all individuals in environmental decision-making processes. Historically, communities of color, low-income populations, and indigenous groups have borne the brunt of pollution, resource depletion, and climate change, often due to systemic inequalities and discriminatory practices.

Core to the implementation and measurement of environmental justice is the identification, collection, and analysis of the drivers of health data that describe the causal relationships between environmental, social, and genomic factors and document the health impacts that result from these relationships.

Very large volumes of publicly available location and time-specific Environmental, Social & Genomic Drivers of Health (ESDoH+G) data already exist for analysis. The World Health Organization (WHO) and national health agencies worldwide have amassed the location and time-specific health impact data (ICD codes) needed to statistically establish the causal relationships.

The total worldwide ESDoH+G data housed in public and private databases as of 2023 is estimated to exceed 300 exabytes (300 million terabytes). Despite interest and attention to ESDoH+G data from governments, researchers, healthcare, NGOs, and private industry, most of this data has never been systematically correlated or subjected to big data analysis and predictive analysis.

An extensive big data analysis using the publicly accessible ESDoH+G data and health impact data would demonstrate correlations and causative relationships between ESDoH+G factors and health outcomes. By leveraging big data, further analyses would inform policies and decisions that can help reduce health inequities.

Comprehensive Emergency Management (CEM) and Hazard Vulnerability Analysis (HVA) are vital topics in disaster management, particularly for hospital emergency preparedness training. Traditionally, these topics are taught through lectures, which rely heavily on the instructor’s ability, potentially limiting effectiveness. This study introduces a serious game approach as an alternative method and compares its effectiveness with lectures in fostering engagement and knowledge gain.

Participants, all hospital staff, were divided into two groups. The Lecture (L) group received a traditional lecture from an expert in hospital emergency management, while the Game (G) group engaged in a board game, “Hospital Hazard,” designed by the researchers to teach CEM and HVA concepts. Participants completed surveys before and after the sessions. The pre-survey assessed interest in learning CEM and HVA and willingness to engage in hospital CEM/HVA activities, using a 5-point Likert scale (1=very low, 5=very high). The post-survey reassessed these metrics and evaluated session enjoyment, willingness to recommend, perceived educational effectiveness, and knowledge gain, also on a 5-point scale (1=very poor, 5=very good).

The L group included 60 participants, and the G group had 109. Both groups showed significant improvement in interest and willingness after the sessions (Interest: L 3.65 → 4.08, G 3.76 → 4.30; p<0.05; Willingness: L 3.67 → 4.07, G 3.83 → 4.30; p<0.05). The G group rated the game significantly higher in terms of enjoyment, willingness to recommend, and effectiveness as a learning tool (G:L = 4.73:4.33, 4.67:4.33, 4.68:4.47, respectively; all p<0.05), with no significant difference in knowledge gain between groups (G:L = 4.46:4.40; p=0.53).

The serious game approach matched expert lectures in boosting interest, willingness, and knowledge gain among hospital staff. It outperformed lectures in enjoyment, recommendation willingness, and perceived effectiveness as a learning tool. Thoughtfully designed serious games are promising tools for teaching CEM and HVA in hospital settings.

Although game-based applications have been used in disaster medicine education, no serious computer games have been designed specifically for training Emergency Medical Team (EMT) members. To address this need, a serious computer game called the IEMT-training game was developed. In this game, players assume the roles of EMT members, assess patient injuries in a virtual environment, and provide suitable treatment options.

The design of this study is a retrospective comparative analysis. Data from 251 EMT members were extracted from an EMT training database for analysis. The data collection process covered the 2019-2020 academic year. To compare the performance between the groups, a generalized estimating equation (GEE) approach was used to analyze the pre-, post-, and final test scores of EMT members, accounting for the potential correlation within the data. Additionally, a survey questionnaire was distributed to trainees to gather insights into teaching methods, and the responses were subsequently analyzed.

Statistically significant differences were observed in the test scores between the lecture and game groups (p < 0.05). Specifically, the serious game group achieved higher knowledge retention scores than those in the lecture group (p < 0.05). The survey results indicated that the game group exhibited higher learning motivation scores and lower cognitive load compared with the lecture group.

The IEMT training game developed by the instructor team is a promising and effective method for training EMT members in disaster rescue. The game equips the trainees with the necessary skills and knowledge to respond effectively to emergencies. It is easy to comprehend, enhances knowledge retention and motivation to learn, and reduces cognitive load.

This qualitative study sought to explore the unique experiences of children receiving hematopoietic stem cell transplant (HCT) and their caregivers, with a primary focus on the multifaceted aspects of adherence following discharge.

Convenience sampling was used to enroll 14 caregivers and 15 children at a large Midwestern children’s hospital. Children had an allogenic HCT for a malignant or nonmalignant disorder and were 1–12 months off immunosuppression. Participants completed a semi-structured interview in the HCT-clinic or via phone about the child’s experience taking medications and adhering to post-transplant guidelines.

Caregivers were primarily female (n = 13, 87%), White (n = 11, 73%), and not Hispanic (n = 15, 100%). Children were primarily male (n = 9, 60%), White (n = 10, 67%; missing: n = 3), and not Hispanic (n = 13, 87%; missing: n = 2). Children’s average age was 13.14 years (SD = 2.88). Two primary themes emerged from the interviews, (1) family navigation and self-management of post-HCT medications and restrictions with 3 subthemes highlighting structured routines, adaptations to life post-HCT, and experiences with daily restrictions and other aspects of care; (2) advice from families on navigating post-HCT care with 2 subthemes highlighting communication and strategies for maneuvering post-HCT treatment. Of note, half of caregivers (n = 7, 50%) reported the child was responsible for taking their medications, and 43% (n = 6) of children were responsible for knowing when to take their medications.

This study contributes a nuanced understanding of adherence in pediatric HCT, emphasizing the need for tailored interventions that transcend traditional medical frameworks and enable clear communication between families and the medical team. Findings underscore the importance of providers adopting a comprehensive and patient-centered approach. Healthcare providers should consider the psychosocial aspects of HCT, implement tailored family-centered strategies to optimize adherence, and prioritize comprehensive communication to improve outcomes.

Natural phenomena may trigger disasters or have man-made causes, but one common factor in disasters of any kind is that they all involve animals. That reason alone necessitates veterinary involvement in disasters, but there are many other compelling reasons why veterinarians should be involved in mitigating these events. First, veterinarians possess unique training and broad experience in multi-species animal health and welfare, veterinary public health, epidemiology, biosecurity, food safety, and systems thinking. This knowledge is explicitly needed in the planning for and response to disasters. Second, veterinarians’ high-profile traditional roles in rescue and emergency treatment of animals are widely recognized. Through decades of disasters, veterinarians have come to be included in the first-responder group of medical professionals, along with physicians, nurses, paramedics, and others. Veterinarians work side-by-side with medical and allied health professionals in humanitarian efforts that help to protect and maintain the human-animal bond. Third, there are lesser-known activities veterinarians perform that make them highly beneficial to the health maintenance of people and animals in crises, including: 1) animal evacuation, 2) disaster assessment and disease surveillance, 3) food and water safety, 4) zoonotic disease, 5) animal disease control, 6) decontamination, 7) euthanasia and depopulation. Appreciative of these contributions, the American Veterinary Medical Association strongly recommends veterinary involvement in emergency management for planning and response operations regarding disasters. The relatively new One Health approach recognizes the interconnectedness of animal, human, and environmental health. It promotes collaboration among public and private entities, physicians, veterinarians, public health professionals, social scientists, and other science, health, and environmentally related disciplines. This team approach must be implemented during disasters to minimize negative impacts. As major contributors to health, veterinarians face challenges, obligations, and opportunities during natural and man-made disasters to support the health resiliency of animals, people, and the ecosystem.

Disasters are increasing globally, in both frequency and severity. Rural and remote areas are disproportionately exposed to disasters, with unequal resources and a significantly reduced health workforce and infrastructure. Nurses play an important role in assisting with and responding to disasters; however, in rural and remote settings, there is limited literature describing nurses’ roles or experiences in these events. This study aimed to uncover what it is like for rural and remote nurses when assisting in disasters using a phenomenological approach.

Sixteen nurses from rural or remote Australia were interviewed about their experiences assisting during a disaster. A phenomenological approach underpinned the study, with descriptive thematic analysis of the data uncovering moments of disaster. These moments provide a shared history across participants, disaster subtypes, and locations.

Eight moments were identified during the nurses’ experience assisting in a disaster. These moments consisted of a Prelude, Being notified, Making a decision, Preparing, Initial evaluation of the scene, Stepping into Action, Stepping down, and Lessons through reflection. Within each of the moments, rural and remote nurses tell us how events occurred, how the moments stood out in their singularity, and how they transitioned into another moment, highlighting the uniqueness of each activity and interaction within each moment.

Rural and remote nurses played a significant role in assisting in disasters either in their community or at their place of work. This study highlighted the nuances of their work’s geographical location and the activities they are engaged in. It also shows the innate knowledge required of rural and remote nurses in disaster situations. This study provides an in-depth insight into what these nurses do and their experiences, which will help increase disaster awareness, particularly in rural and remote contexts.

Transfusion of packed red blood cells (PRBC) or low-titer group O whole blood (LTOWB) has become standard practice in trauma patients with significant blood loss. As blood ages, it undergoes metabolic and structural changes. This study aimed to test the association between the age of PRBC/LTOWB and mortality among adult trauma patients.

This is a retrospective cohort study at an academic level one trauma center. Adult trauma patients who received at least one unit of PRBC or LTOWB within the first hour of arrival to the emergency department (ED) between January 2016 and December 2019 were included. The primary outcome was in-hospital mortality. Multivariable logistic regression models were used to test the associations between the mean age of PRBC and LTOWB units transfused during the initial 24 hours and in-hospital mortality.

Of 388 patients included, 362 received PRBC and 121 received LTOWB. In-hospital mortality occurred in 31% of patients. The median (interquartile range) mean age of transfused PRBC units was 21 (16-26) days, and LTOWB units was 11 (9-12) days. Neither age of PRBC nor LTOWB was found to be associated with in-hospital mortality: PRBC adjusted odds ratio (aOR) = 0.99 (95% CI 0.95 to 1.03) and LTOWB aOR = 1.12 (95% CI 0.88 to 1.41).

The mean age of LTOWB or PRBC units transfused during the first 24 hours after presenting to the ED for a traumatic injury was not found to be associated with in-hospital mortality.

To support the needs of current research applications for healthcare and public health preparedness and response for radiological and nuclear disasters by providing an up-to-date scoping review of current literature in the field.

A systematic literature search using four databases to identify articles on topics such as “radiological emergency preparedness,” “nuclear disaster medicine,” “nuclear terrorism,” “CBRNE,” and “radiological decontamination” produced 293 articles, of which 96 met the extraction criteria. The articles were evaluated, and the findings were summarized into 7 themes addressing medical and healthcare preparedness for nuclear and radiological events.

The scoping review generated evidence supporting and defining various measures healthcare and government entities can take to improve nuclear and radiological disaster readiness and responsiveness in health systems. Strengthening preventive measures and policies, prehospital and hospital mechanisms, training and education, regional collaboration, communication, and infrastructure support were the main gaps identified.

The literature concluded that the inadequacies of modern health care systems’ radiological disaster preparedness were an overarching concern. It identified the major challenges and proposed solutions for public safety to the growing threat of radiologic disasters.

Unplanned re-attendance at the Emergency Department (ED) exacerbates hospital overcrowding, strains resources, and raises healthcare costs. In response to these challenges, an audit of post-ED discharge telehealth services was conducted to evaluate its impact on re-attendance rates at a tertiary hospital in Singapore. This audit analyzed data from the service provided between January 1 and December 31, 2022.

In this initiative, patients were contacted by trained tele-callers within 96 hours of discharge from the ED. Those who answered the call formed the intervention arm while those who did not answer formed the control group. A total of 17,355 ED visits were reviewed, with re-attendance rates within seven and 14 days post-discharge serving as the main outcome. A logistic regression model adjusted for potential confounding variables, including gender, race, age, short-stay unit utilization, ambulance utilization, musculoskeletal conditions, GP referral, abscondment, and previous ED or inpatient admission before the index visit was used.

The re-attendance rate in the intervention group was 74.2 per 1,000 compared to 101.1 per 1,000 in the control group. Patients in the intervention group had significantly lower odds of re-attendance within 3 to 7 days (OR=0.78, 95% CI [0.65, 0.93]) and within three to 14 days (OR=0.84, 95% CI [0.73, 0.98]). Additionally, increased healthcare utilization in the three months before the index visit was associated with higher odds of re-attendance.

The implementation of telehealth follow-up services significantly reduced ED re-attendance rates up to 14 days post-discharge. The findings underscore the vital role of telehealth services in managing hospital capacity by reducing re-attendance, thereby enabling more efficient use of resources. The results from this review support the continued integration as a strategy to optimize healthcare delivery.

WHO adopted the Japanese-Surveillance in Post-Extreme Emergencies and Disasters (J-SPEED) concept under the name EMT Minimum Data Set (MDS) as a data collection tool to be used globally in 2017, and it was first utilized in the 2019 Idai Cyclone in Mozambique. Despite its widespread use, there has been a lack of investigation into the perspectives of EMT members and EMT Coordination Cells (EMTCC) regarding the effectiveness and challenges of the WHO EMT MDS tools during disasters. This study examines the effectiveness and difficulties encountered by EMT members and EMTCC using the WHO EMT MDS data collection tools in disaster contexts.

An exploratory qualitative design was employed. A semi-structured interview was conducted among thirty-three EMT members, and in-depth interviews were carried out among ten EMTCC members overseas via video conferencing. It comprises questions addressing the type of MDS tools used, simplicity, usefulness, timeliness, data quality, and any challenges encountered in data collection and handling during disasters. The data obtained were subjected to analysis through thematic analysis.

Thirty-three EMT members indicated that WHO EMT MDS data collection tools positively impacted data collection efficiency and patient care in disasters. Identified challenges included human resources, technical issues, infrastructure, and items in the MDS tools. The findings from ten EMTCC representatives yielded six themes: accessibility and quality of data collection tools; benefits of MDS data collection tools, provision of training for data entry to new EMT members, challenges faced during coordination; and recommendations to improve the data collection tools.

The outcome of the study will elucidate the strengths and limitations of MDS data collection tools, contributing to evidence for the guidelines and a video for the effective use of WHO EMT MDS tools by EMT members during disasters and medical emergencies for international efforts to improve disaster response outcomes.

A collaborative partnership between Region Östergötland (Sweden) and the Rwanda healthcare system was established to facilitate mutual learning and healthcare capacity building. The partnership aims to build capacity in the healthcare system with the goals of enhancing patient safety, knowledge exchange, and professional development within both healthcare systems. Initiated in 2022, the collaboration has involved two visits by the Swedish team to Rwanda and a reciprocal visit by Rwandan healthcare leaders to Sweden, promoting cross cultural understanding and identifying common challenges in healthcare delivery.

The partnership utilized a participatory approach, with teams engaging in clinical observations, joint workshops, and discussions on healthcare practices. Key activities included structured visits to healthcare facilities in both countries, focusing on areas such as primary healthcare, infection control, and neonatal health. Objectives are outlined for knowledge exchange and capacity building, ensuring a formalized and sustainable approach to the collaboration.

The visits enabled both teams to gain insights into each healthcare system’s unique strengths and limitations. Swedish healthcare professionals observed practices that adapted to limited resources, enhancing their skills in critical situations. Rwandan counterparts learned about patient safety protocols and quality improvement methodologies. Additionally, participants identified specific areas for further training, such as delivery of care, pediatric neurosurgery, and training of healthcare personnel working at health posts and primary healthcare centers.

The partnership between Region Östergötland and Rwanda’s healthcare system highlights the value of international collaborations in healthcare improvement. By facilitating bidirectional knowledge exchange, the partnership not only bolstered clinical expertise but also fostered a deeper understanding of cultural and systemic healthcare differences. Future efforts will aim to build on these outcomes, focusing on long-term capacity building and expanding the scope of joint training programs.

Thousands of individuals sustained injuries or lost their lives in the recent war in Israel. The Israeli Army Military Medical Academy is tasked with providing training for both active-duty and reserve soldiers while concurrently updating guidelines as part of ongoing field education. This study aims to elucidate the process that facilitated the training of thousands of soldiers while concurrently updating and enhancing their knowledge as part of an investigation into actual battlefield events.

A mixed-methods approach was employed. Quantitative content analysis was performed on training materials updated during the conflict to identify modifications in training emphasis and examine real-time content updates. Qualitatively, semi-structured interviews were conducted with 15 paramedics and physicians; 7 were in the reserves, and 8 were in mandatory service. The inclusion criteria were participation in the Gaza conflict directly. The goal was to assess their satisfaction with the relevance of pre-deployment training. Interview data were analyzed using thematic analysis.

Quantitative analysis revealed significant shifts in training focus, with increased emphasis on:

1. 1. Hemorrhage control.

2. 2. Volume restoration for patients in deep shock.

3. 3. Avoiding unnecessary procedures.

4. 4. Proper medical reporting and documentation

The qualitative analysis yielded five key themes:

1. 1. Enhanced self-esteem among trained personnel.

2. 2. Importance of incorporating battlefield examples in training.

3. 3. Trainers’ adaptability to modify programs upon request.

4. 4. Significance of stripping and covering injured to preserve body heat during drills.

5. 5. Necessity of including pain management in practical training.

This study underscores the critical need for real-time modifications in military medical training during active combat to optimize training quality. The operational methods employed within the Israeli army serve as a potential model for implementation in military training units globally. Future research should focus on the long-term outcomes of adaptive training methods and their applicability to other military and civilian emergency response contexts.

In 2023, extended drought conditions in the Mississippi and Ohio River watersheds brought Mississippi River flow to historic lows. In September, local governments and water systems across Orleans, St. Bernard, and Jefferson Parishes (Counties) received a warning that saltwater from the Gulf of Mexico could reach drinking water intakes within weeks. Due to a lack of reverse osmosis/desalination equipment at treatment facilities, regional contingency plans were developed to protect drinking water for approximately 852,762 residents. Increased sodium and chloride concentrations have documented long-term health impacts and present a health risk, particularly to critical populations including infants/young children, residents with chronic health conditions, residents without automotive transport, and residents with limited income. A State of Emergency declaration was approved by President Biden on September 27, 2023, to provide federal support to the State of Louisiana.

Local water distribution plans relied on coordinated logistics efforts between local and regional stockpiles, partner donations, and contracted services. A bottled water distribution plan was modeled on previous COVID-19 mass testing/vaccination plans using high-throughput drive-through and walk-up sites. Home delivery teams and call centers were considered for critical populations unable to independently pick up resources. Engineering alternatives, including upstream freshwater dilution with a temporary pipeline and barging, were pursued by regional and state partners to reduce the likelihood of distribution plan activation.

Due to increased river flow and rapid construction of a sill in the Mississippi River by the US Army Corps of Engineers, increased salinity levels ultimately never reached New Orleans. Nevertheless, this regional planning process serves as a model to rapidly expand capacity for commodity distribution in a major urban city that is experiencing major environmental, health, and infrastructure challenges due to climate change.