Successful decontamination of chemically contaminated casualties requires staff to be well-trained and familiar with complex processes and workflows. The task is made more challenging with space and time constraints, with each drill lasting 4 hours. Virtual reality (VR) has been proposed as a tool in disaster and decontamination training due to the realism and cost advantages over large-scale real-life exercises. This study aims to compare the usefulness of a novel VR training tool against conventional live decontamination training in a single-centre emergency department (ED) in Singapore.

This study was a collaborative effort between Tan Tock Seng Hospital Emergency Department and Singapore Institute of Technology research professors, engineers, and interns. Healthcare workers with no prior experience first underwent mass casualty decontamination training using an innovative VR training tool in a 2-hour session. Knowledge of workflows and processes was then assessed on a 15-point test. This was also administered to other healthcare workers who had undergone conventional training. The primary outcome was the test scores for each group of healthcare workers. Secondary outcomes included scores for technical quality of the software and qualitative feedback provided by VR trainees.

Forty healthcare workers have been scheduled to complete their VR training sessions over the next two months. From the conventional group, 45 healthcare workers had a mean test score of 75.4%. Full results, including analysis of primary and secondary outcomes across both the VR and conventional groups, are expected by January 2025.

The results of this study will be useful in validating the use of VR in decontamination training as an effective training tool. Lessons learned from developing the VR tool can also be applied to other VR applications in the future.

The arts offer opportunities to express grief, share experiences, and rebuild cultural identity, particularly when these are disrupted by natural disasters or crises. The participatory nature of the arts fosters collective problem solving and strengthens social cohesion, which can support community preparedness and resilience. Moreover, the arts can promote awareness of disaster risks and preparedness strategies through engaging and culturally relevant mediums.

Creative arts therapies offer evidence-informed interventions that support emotional recovery, post-traumatic growth, and psychological resilience. They have been integrated into emergency response frameworks to address mental health and psychosocial support for communities. The sensory and embodied nature of the arts can reduce stress, mitigate symptoms of post-traumatic stress, and enhance coping mechanisms, enabling individuals to process traumatic experiences in ways that verbal communication alone may not.

One program integrating the arts and creative arts therapies into disaster recovery efforts is Creative Forces®: NEA Military Healing Arts Network, which has begun to translate its work with military-connected trauma to support for veterans and communities impacted by natural disasters and other emergencies. Following a literature review, needs assessments, and field scans, Creative Forces sent a creative arts therapist to work with the Administration for Strategic Preparedness and Response (ASPR) and the Hawaii Medical Response and Recovery Team after the Maui Wildfires. This work set the foundation for a multi-year pilot project that is exploring how the arts and creative arts therapies can integrate with emergency response teams and local communities in disaster efforts.

Integrating arts-based approaches into disaster management practice policy can enhance the effectiveness of preparedness, response, and recovery efforts. Future efforts should include building trusted networks and resource hubs between community arts organizations, cultural leaders, and emergency response sectors to support integrating arts-based services into disaster efforts.

Foreign body airway obstruction (FBAO) stands as an important contributor to accidental fatalities, yet prompt bystander interventions have been shown to improve survival. This study aimed to evaluate the incidence, interventions, and survival outcomes of patients with out-of-hospital cardiac arrest (OHCA) related to FBAO in comparison to patients with non-FBAO OHCA.

In this population-based cohort study, we included all OHCAs in Denmark from 2016 to 2022. Cases related to FBAO were identified and linked to the patient register. Descriptive and multivariable analyses were performed to evaluate prognostic factors potentially influencing survival.

A total of 30,926 OHCA patients were included. The incidence rate of FBAO-related OHCA was 0.78 per 100,000 person-years. Among FBAO cases, 24% presented with return of spontaneous circulation upon arrival of the emergency medical services. The 30-day survival rate was higher in FBAO patients (30%) compared to non-FBAO patients (14%). Bystander interventions were recorded in 26% of FBAO cases. However, no statistically significant association between bystander interventions or EMS personnel’s use of Magill forceps and survival was shown, aOR 1.47 (95 % CI 0.6-3.6) and aOR 0.88 (95% CI 0.3-2.1).

FBAO-related OHCA was rare but had a higher initial survival rate than non-FBAO-related OHCA, with a considerable proportion of patients achieving return of spontaneous circulation upon arrival of the emergency medical service personnel. No definitive associations were established between survival and specific interventions performed by bystanders or EMS personnel. These findings highlight the need for further research in this area.

When a natural or man-made disaster occurs, emergency medical teams (EMTs) are dispatched to deliver medical surge capacity for injured and sick individuals. Accurate prediction of EMT consultations during disasters can improve dispatch and withdrawal decisions. However, no published studies have yet demonstrated a method for predicting the number of consultations or patients based on EMT activity data. This research explores an innovative yet simple and reliable method to predict the number of consultations required by EMTs during disasters, aiming to enhance the effectiveness and efficiency of medical response.

Data for this study were collected using the Japan-Surveillance in Post-Extreme Emergencies and Disasters (J SPEED) system and the Minimum Data Set (MDS) framework. These datasets encompassed five disasters in Japan and one in Mozambique. For each disaster, the number of consultations was predicted using the K-value and the constant attenuation model, an approach originally developed to forecast the number of COVID-19 patients.

The total number of Emergency Medical Team (EMT) consultations per disaster varied between 684 and 18,468. The predicted curves closely matched the actual K-value data for each disaster, with R2 values ranging from 0.953 to 0.997. However, offset adjustments were required for the Kumamoto earthquake and the Mozambique cyclone, as their R2 values were below 0.985. Across all six disasters, the differences between the predicted cumulative number of consultations, based on K-values, and the observed numbers ranged from ±1.0% to ±4.1%.

The K value and constant attenuation model reliably predicted EMT consultations during six different disasters. This simple model may be useful for the coordination of future responses of EMTs during disasters.

Establishing an effective management system is crucial for preparedness against large-scale disasters. This study aims to assess the preparedness of the Health, Medical Care, and Welfare Coordination Headquarters (HQs) across local governments in Japan.

In 2023, an email-based survey on disaster preparedness was conducted among 157 local governments in Japan, including 47 prefectures and 110 cities (including special wards) with health centers. Logistic regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for government categories. The independent variable in the analyses was prior disaster experience, defined as events requiring the activation of disaster response headquarters after July 2017, when the Ministry of Health, Labour, and Welfare requested local governments to establish HQs.

Responses were received from 149 local governments (95%, including 46 prefectures and 103 cities). All prefectures (100%) and 77% of cities reported being prepared to establish HQs. However, only 54% of prefectures and 32% of cities conducted exercises for establishing or operating HQs. Additionally, 48% of prefectures and 47% of cities had established formats for assessing evacuation centers. The adjusted ORs (95% CIs) for conducting HQ exercises and for deciding assessment formats, with prior disaster experience as the independent variable, were 0.51 (0.24–1.13) and 1.61 (0.75–3.45), respectively.

While most local governments have prepared to establish HQs for large-scale disaster response, the proportion conducting exercises remains low. Governments with prior disaster experience were less likely to conduct exercises, possibly because they were preoccupied with recovery efforts and found it challenging to design exercise programs that could surpass the effectiveness of real disaster experiences. Conversely, these governments were more likely to have predefined assessment formats, possibly due to their use during past disasters.

Effective Hospital Incident Command System (HICS) communication is critical for maintaining situational awareness and ensuring coordinated responses to disasters. Traditional tools, such as radios, phones, email, and, more recently, online platforms like Zoom, often lack the secure, HIPAA-compliant, and streamlined functions needed for complex health care incident management. Microsoft Teams offers a unified platform with document sharing, teleconferencing, real-time messaging, and scheduling capabilities, making it well-suited to support HICS operations. Additionally, given its widespread Health Organization enterprise use, many individuals on health care teams use it on a daily basis for routine care, allowing for a lower threshold for adoption and familiarization.

Two recent scenarios highlighted its novel use and demonstrated its effectiveness. First, in a full-scale hospital exercise that activated the High Consequence Pathogen team, including transport, the Emergency Department, inpatient units, the laboratory, environmental services, and local partners, Microsoft Teams served as a virtual command center. Its use enabled rapid dissemination of information, improved communication across departments, and promoted shared situational awareness.

Second, during the American Airlines crash at Ronald Reagan Washington National Airport (DCA) in January 2025, Microsoft Teams was employed to activate and coordinate the anticipated ICU disaster response. The platform enabled leaders to quickly connect, allocate resources, including staffing, and maintain real-time updates during a high-acuity event, underscoring its value in real-world emergencies.

Key lessons from both experiences include the importance of pre-establishing contact lists, enabling device alerts for timely notifications, and training staff in the use of Microsoft Teams for incident response. Familiarity with the Microsoft platform, combined with its accessibility across desktop and mobile devices, enhances communication efficiency and collaboration. Microsoft Teams proved to be a practical and effective tool for strengthening HICS, with potential for further refinement through health care-specific customization.

The opening ceremony of the Paris Olympic Games (POG) attracted over 500,000 spectators to both banks of the Seine River. Given the scale of the event and the risk of unforeseen emergencies, meticulous planning and exceptional preparation of the emergency medical services (EMS) were paramount. In the case of a disaster, the main difficulties are the crowds, saturated evacuation roads, and the impossibility of crossing the Seine River dividing Paris into 2 zones. This report aims to describe the use of some exceptional equipment to overcome these difficulties.

Two medical teams of motorcyclists, the Medical Moto Units (MMU), were deployed on both sides of the Seine River. Each team consisted of three members, including one medical doctor, and was equipped for Advanced Life Support (ALS). These agile teams were designed to navigate the congested streets and narrow lanes surrounding the ceremony site. Their mobility was essential to reaching victims quickly.

The major innovation in these special emergency resources is the “EVACARe.” It is a collective ALS ambulance with 8 stations that allows patients under life support to be cared for for 12 hours in complete autonomy. Strategically parked close to the event site, the EVACARe was ready to respond to mass casualty incidents.

The POG demonstrated the importance of solid EMS preparation to guarantee the safety of participants. By strategically deploying exceptional response resources such as EVACARe and MMU, combined with highly trained personnel, the organizers effectively mitigated risks and reacted quickly to unforeseen challenges. The successful implementation of these measures serves as a model for future large-scale events.

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.