The objective of the study was to aggregate all media communications from a three-month conflict deployment of Canadian Medical Assistance Teams (CMAT), a small non-governmental EMT Type 1, to Poland and Ukraine, and to examine them for adherence to communications best practices.

A media communications literature search using ProQuest and an organizational social media search were completed. Communications were categorized by date and as one of five media types: print, audio, video, authored by a volunteer, or third-party mention. Public information officer best practices were reviewed in the gray literature, and adherence to these practices was qualitatively assessed using Notebook LM, a publicly available large-language model.

Between March and August 2022, there were 45 media appearances, including 17 with video footage, 10 articles authored by volunteers, 9 audio clips, 7 printed news articles, and two third-party mentions. Media correspondence was distributed among 21 distinct volunteers, with two formally media-trained volunteers responsible for 20 instances (44.4%) of the correspondence and the remainder trained by briefing alone. Overall, no overtly negative or critical events occurred, for example, breaches of ethics or security.

Volunteers generally followed media orientation directions regarding communications and provided accurate information to the media. A dedicated communications specialist is needed to ensure a wide range of media, including traditional methods and social media, is created and managed, and that volunteers receive media training. Lastly, there is a constant security threat associated with divulging operational details to the press, which was addressed and successfully mitigated during our deployment.

The Disaster Medical Assistance Student (DMAS) is the student division of the Japan Association for Disaster Medicine, with eight branches nationwide. Since its inception ten years ago, DMAS has been actively engaged in activities centered around disaster medicine. Regular study sessions are held both in person and online, focusing not only on theoretical aspects but also on practical, hands-on training.

Recently, a survey was conducted among DMAS student members, requesting them to share their insights and experiences gained through DMAS activities. The survey results indicate that students acquire crucial knowledge and skills related to disaster response, which they believe would be difficult to learn in a traditional classroom setting. The hands-on training sessions provide students with the opportunity to experience the realities of disaster medicine, enhancing their ability to respond effectively and adapt under pressure. These opportunity sessions also emphasize the importance of collaboration and coordinated response systems, helping students understand the value of teamwork in high-stress emergencies.

Many students expressed that their involvement in DMAS has not only enriched their knowledge but also deepened their commitment to disaster medicine. Through these activities, they gain a practical understanding of the role of healthcare professionals during disasters. They also prepared them to become valuable members of the medical community. As they look to the future, it is anticipated that DMAS members will continue to grow as disaster medicine practitioners, with the skills and mindset required to support and strengthen Japan’s disaster response framework. DMAS aims to cultivate these students into future health care professionals who will uphold and advance disaster medicine in Japan, ultimately benefiting communities in times of need.

Nepal, prone to significant seismic events, experienced a devastating 7.8 magnitude earthquake on April 25, 2015, resulting in substantial loss of life and injury. Tribhuvan University Teaching Hospital (TUTH) in Kathmandu, as a central emergency facility, played a critical role in managing disaster casualties. This study assesses the effectiveness of TUTH’s emergency triage and treatment response for the 510 earthquake victims admitted on April 25.

To assess the effectiveness of emergency triage and treatment at TUTH during the April 25, 2015, earthquake disaster and identify key healthcare challenges recorded from this disaster. The Department of Emergency and General Practice led the triage efforts, utilizing the Simple Triage and Rapid Treatment (START) protocol to classify patients: “Red” for critical, “Yellow” for delayed, “Green” for walking wounded, and “Black” for deceased. Triage times averaged less than 60 seconds per patient, and critical cases received immediate care from dedicated medical teams. The study also reviews healthcare challenges experienced in rural settings

The review of work at TUTH showed that GP-led support worked well. Of the 510 initial victims, 38 were triaged as “Red,” 136 as “Yellow,” 336 as “Green,” and 71 were deceased. Over the subsequent 17 days, 1,457 earthquake victims were treated, including 205 critical “Red” cases. Surgeons performed 143 major operations, including 101 orthopaedic surgeries, 22 neurosurgeries, and 18 general surgeries.

Despite TUTH’s effective response, post-disaster analyses highlighted broader healthcare challenges in the response and recovery phase across affected regions. The healthcare access was significantly affected, causing major gaps in services due to widespread damage to health facilities, a lack of medical supplies, and difficulties reaching affected areas, leading to increased risks of infectious diseases. Many affected populations faced challenges accessing basic medical care, with the most vulnerable, like children and pregnant women, experiencing severe consequences.

Disaster emergency medicine is uniquely positioned to evolve as the global landscape of risks grows increasingly complex and interconnected. Climate change, biodiversity loss, and environmental degradation are amplifying hazards, transforming them into disasters that transcend traditional boundaries. A Planetary Health framework provides an opportunity to reimagine disaster emergency medicine by connecting its practices with other sectors and addressing the systemic drivers of vulnerability and risk. The Planetary Health Alliance offers a powerful platform for generating insights and fostering interdisciplinary collaboration, emphasizing the links between human health and environmental systems. By leveraging this global network, disaster emergency medicine can adopt innovative approaches, including integrating nature-based solutions, ecological foresight, and cross-sector partnerships into disaster preparedness, response, and recovery. These efforts highlight the importance of aligning health and environmental systems to enhance resilience and mitigate cascading impacts.

Opportunities for innovation include using ecological data to predict disasters, embedding biodiversity preservation into risk management strategies, assigning economic value to nature, and designing recovery efforts that rebuild in harmony with natural systems. By incorporating insights from the Planetary Health Alliance, disaster emergency medicine can expand its reach, align with sustainability goals, and engage with a broader range of stakeholders. This projection highlights the transformative potential of Planetary Health to broaden the field of disaster emergency medicine, fostering new partnerships across sectors such as public health, engineering, and urban planning. It will also challenge practitioners to look beyond immediate disaster response, envisioning a future where prevention, sustainability, and equity are central pillars of their work. As disaster emergency medicine professionals face an uncertain future, this lecture seeks to illuminate a path forward: one that embraces interdisciplinary approaches, addresses root causes of disaster vulnerability, and positions the field as a leader in building a safer, more resilient world.

In the prehospital environment, language barriers can significantly impede communication between Emergency Medical Services (EMS) personnel and patients, which in turn affects the delivery and quality of emergency care. While this issue is widely acknowledged as a critical concern on a global scale, there remains a notable gap in research specifically addressing its implications within Saudi Arabia.

A quantitative cross-sectional study was conducted in Jeddah, Saudi Arabia, involving a sample of 278 EMS personnel from three key institutions: the Saudi Red Crescent Authority (SRCA), the Ministry of Health Hospitals (MOH), and the National Guard Hospital (NGHA). Participants were selected through convenience sampling. Data were gathered via a questionnaire that assessed demographic information, language proficiency, and perceived language barriers using a Six-Point Likert scale. Statistical analyses included means and standard deviations for quantitative variables and frequencies for categorical data.

The study identified several factors contributing to language barriers in paramedic-patient interactions, including family member interference (32.37%), patient stress and distress (30.22%), and language disparities between paramedics and patients (28.06%). Participants reported significant communication challenges, such as potential loss of critical information (mean=4.49) and difficulties in engaging with foreign-speaking families (mean=3.73). Notably, paramedics trained in English and working in Arabic-speaking environments faced heightened language barriers, particularly regarding patients’ comprehension of diagnoses and interventions (p-value=0.04). EMS personnel expressed concerns about patient resistance stemming from language barriers, which could adversely affect patient care outcomes.

These findings underscore the urgent need for targeted interventions to mitigate language barriers in prehospital emergency care, ensuring equitable and high-quality services for all patients.

Excessive fear during the COVID-19 pandemic has been linked to increased mental health issues, including depression and anxiety, the spread of misinformation, social panic, and discrimination. This study is a questionnaire-based analysis on factors related to the fear of COVID-19.

Approximately 20,000 participants from an internet survey panel were selected to reflect Japan’s general population by age, gender, and residence. Surveys were conducted in October 2020 and January, April, July, and October 2021. Fear of COVID-19 was assessed using the Fear of COVID-19 Scale (FCV-19S), along with background information. High fear was defined as an FCV-19S score of 21 or above. After excluding invalid responses, 16,642 participants were included for the analysis. Multivariable logistic regression analysis was conducted with fear of COVID-19 as an outcome.

Female gender, individuals in their 20s and 30s (compared to teens), hypertension, hyperlipidemia, reduced physical activity, recent symptoms of cough, sore throat, or fatigue, and decreased income were significantly associated with higher FCV-19S scores. Conversely, individuals in their 70s (compared to teens) and unmarried individuals (compared to those with spouses) showed a negative correlation. Additionally, a higher amount of savings correlated with lower fear levels.

Identifying individuals prone to heightened fear during crises like pandemics could enable timely interventions to improve mental health and reduce societal disruptions. This approach may also apply to other emergencies, such as earthquakes, tsunamis, or terrorist attacks.

Securing medical supplies is crucial to healthcare system security. On June 11, 2024, Becton Dickinson, a major supplier of blood culture vials, reported supply delays, and health authorities issued guidelines to reduce the use of these vials. To assess resilience to logistics disruptions, this study investigates how this vital shortage affected the implementation of blood culture testing in Japanese medical institutions.

The data source was the DPC (Diagnosis Procedure Combination) database from October 2021 to September 2024, obtained from hospitals participating in the Quality Indicator/ Improvement Project (QIP) of Kyoto University. This dataset includes all records of medical procedures performed in the participating hospitals, including blood culture testing. An Interrupted Time Series Analysis (ITSA) was conducted to assess the effects of the vial shortage and usage reduction recommendations on blood culture testing.

A total of 886,511 blood culture test opportunities from 142 acute care hospitals were included and analyzed. The number of blood culture tests performed reduced to 88.2 % (95% CI: 86.8%-89.6%) after the supply shortage announcement in Japan. The decline was more pronounced in outpatient settings and small hospitals with less than 199 beds (first quartile), with reductions to 77.2 % (74.1 %-80.4 %) and 69.5 % (61.6%-78.5%), respectively. These results are provisional, as data collection is still ongoing.

The supply shortage significantly impacted blood culture testing in Japan, particularly in smaller hospitals, which may be more vulnerable to supply disruptions. Further research is required to understand how this decrease in blood culture testing affects patient outcomes, particularly for those with infectious diseases. Understanding the patterns of practice change could provide valuable insights for mitigating future supply crises.

Disaster Medicine emerged from the modest roots of response and resuscitation. More recently, the focus has expanded to include preparedness, prevention, and recovery, pursued via the mechanisms of risk reduction, capacity building, and research. The scope has broadened from treatment to health, with a significant rise in the role of public health. Recent pandemics, global population growth, human migration and dislocation, urbanization, climate change, warfighting and conflict, and novel disease emergence have forced a convergence of disaster medicine and public health. More than ever, a trans-disciplinary approach to education, training, planning, and practice is indicated. Successful implementation around these complex challenges requires large-scale collaboration, trust, and meaningful engagement. It will also be driven by a renewed perspective, explored via a practical exercise. This is designed to bring together the capability, positions, data, and power that often sit in separate institutional boundaries.

Mass Gathering and Event Medicine

Right-wing (RWX) and left-wing extremists (LWX) constitute ideologically motivated violent extremism (IMVE), a term used to describe what was previously known as “domestic terrorism”. Of most concern has been the rise of RWX.

In 2021, for the first time, the Australian Security Intelligence Organisation (ASIO) declared that RWX constituted fifty percent of its priority caseload. The United Nations Security Council Counter-Terrorism Committee reported a 320 percent increase in RWX globally from 2016 to 2021.

A review of the gray and published literature was undertaken to determine the underlying causes of this rise in RWX.

Across the Anglosphere, in Europe, Asia, and elsewhere, transnational trends are fuelling individual grievances and resentments, funneling people into RWX movements.

There are several reasons why RWE has increased.

Since the 1980s, most countries have experienced rising inequalities in wealth. Globalization and the accompanying rise in inequality are key structural elements driving RWX.

Global inequality also feeds into extreme-right conspiracy theories about a corrupt global cabal that wants to create a ‘New World Order’ – a far-right conspiracy theory which claims that a powerful but secret global elite aims to take over the world and establish a global dictatorship.

Disinformation and misinformation are so rife that specialists had to come up with a new field of study – infodemiology.

Ecofascism. Eco-fascists blame the ‘capitalist class’ and corporate elites for the degradation of the environment.

Perceived threat to identity defined by ethnic, racial, or national status.

Global migration and COVID-19 are amplifiers of RWX

There is no doubt that the world has undergone profound stress and upheaval this century: environmental crisis, a global financial crisis, and a global pandemic. In periods of social, political, and economic uncertainty, extremism can grow, and the disaffected can be recruited into these movements.

Traumatic Mass Casualty Incidents are becoming more common in the United States. Recognizing the impact of mass casualty incidents (MCI), the American College of Surgeons recommends that trauma programs be integrated into hospital disaster plans and develop a plan for surgical response to mass casualty incidents. To date, there are no guidance documents for MCI preparedness and response specific to pediatric surgical teams and pediatric perioperative hospital space. Development of a guide to creating a pediatric surgery-specific MCI response plan would improve preparedness and potentially outcomes for children affected by traumatic MCIs.

Researchers conducted semi-structured focus group discussions with subject matter experts (SME) from eight Pediatric Level I Trauma Centers in the Federal Emergency Management Administration’s Region V. Subject matter expert roles included Trauma Program Director, Trauma Surgeon, Trauma Coordinator, Emergency Manager, Emergency Physician, and Operating Room Leadership from each institution. The interviews were recorded, and verbatim transcripts were created to develop a comprehensive dataset for analysis.

Analysis of the focus group discussions identified four key themes which—in their presence or absence—affect the effective implementation of an MCI/surge plan: (1) departmental collaboration for effective implementation; (2) identification of challenges such as resource management and coordination; (3) use of regular drills and exercises to prepare staff and refine protocols; and (4) a commitment to continuous improvement to the plans.

As pediatric health care institutions, particularly trauma programs, confront the complexities of modern emergency response, it will be essential that they address the four key themes listed above in their MCI response plan. With a framework adapted from these focus groups, the study authors created a guidebook to create and optimize a surgical surge response plan for trauma programs to facilitate MCI preparedness and response.

Local health services can be quickly overwhelmed in the aftermath of a disaster. As a veteran-led disaster relief charity founded in 2022, Taskforce Kiwi identified an ethical imperative to not be a burden on disaster-affected health services while it assists that community in recovering. This requires the volunteers to have the appropriate first aid skills to treat likely injuries within the team. Taskforce Kiwi identified a skill gap between basic first aid and Defense Force/Emergency Services Medic training. With no appropriate courses available, Taskforce Kiwi developed a bespoke peer-led solution that does not require complex or extensive training equipment and can thus be easily implemented by other voluntary organizations in low-resource communities.

The curriculum requirements were researched and are evidence-based, focusing on common injuries encountered by disaster relief volunteers, such as wounds prone to infection and soft tissue injuries. Delivery is a one-day session covering patient assessment, hemorrhage control, wound care, including delayed closure, heat stress, coached rehydration, scripted telehealth consultation, incident roles, and the use of standing orders for medication, including inhaled methoxyflurane analgesia. A public first aid certificate is a prerequisite, and a pre-course webinar enables the peer-led training to be delivered to volunteers in a timely and cost effective manner.

Post-course surveys of the Disaster First Aid course indicate an average 28% increase in perceived confidence across numerous skills. Over three sessions, Disaster First Aider capacity was increased by 24 people. The participant’s most valuable session was wound cleaning, which involved using fresh dead pigskin, soil, simulated blood, steri-strips, and dressings.

The Disaster First Aid course fills the training gap between basic first aid and trained medics, building capacity within Taskforce Kiwi. When funding and equipment are scarce, the course provides an effective solution to disaster volunteer organizations.

Children are often overlooked in disaster planning and response. Children are particularly vulnerable in a disaster, and their outcomes may be quite different from adults. Pediatric disaster research faces significant challenges in methodology and infrastructure, often relying on limited, non-representative, and non-generalizable data. To advance this field, there is a critical need to train future disaster scientists who can develop research-informed solutions that advance the entire spectrum of the disaster cycle. We developed a curriculum that responds to the need to increase the number of professionals trained to perform pediatric disaster science research. This program was developed in collaboration with the HRSA-funded Pediatric Pandemic Network (PPN).

A consensus-driven pediatric disaster medicine research curriculum was developed using expertise from the PPN. Pediatric disaster medicine experts agreed to lead educational sessions in conjunction with program faculty. A diverse group of participants was recruited for the 2024 cohort to spend 10% of their time attending interactive Zoom educational sessions, individual mentoring sessions, developing a capstone project, and attending the PPN annual meeting to meet potential national mentors.

Eighteen applicants were accepted from 15 different states. 1/3rd of applicants were underrepresented in medicine. Accepted scholars represented emergency medicine, critical care medicine, surgery, hospital medicine, and epidemiology. We included a feedback loop in our curriculum that led to the addition of an implementation science session, analysis of an early-stage investigator’s disaster-specific grant proposals, sessions on QI, health services research, and other topics using disaster science research examples.

To our knowledge, this disaster science research training program is the first of its kind in the US. To increase sustainability, we have submitted an NIH application to continue to fund this program from 2026-2031.

Conventionally, DNAR (Do Not Attempt Resuscitation) was not permitted in prehospital care by Japanese EMTs. In recent years, the Ministry of Health, Labor and Welfare has been promoting awareness of the Advanced Care Planning (ACP) policy. Accordingly, fire departments, medical associations, care manager liaison conferences, nursing facilities, etc., have been conducting awareness-raising activities on ACP and DNAR, targeting a range of professions, including the general public. In Kobe City, approximately 70 cases/year were deemed suitable for DNAR.

In the Kobe Medical Control (MC) council, a preparatory working group (PWG) for DNAR protocol was established in 2021 with the participation of representatives of care managers, nursing facilities, and women’s associations, as well as medical and legal experts. The PWG decided that 1) presence or absence of ACP should be actively inquired by EMTs at the scene, 2) the patient’s presumed intention is deemed to be applicable when it is confirmed by a family doctor without an official form as Physician Orders for Life-Sustaining Treatment (POLST), and 3) MC physicians are responsible for whole prehospital activities. The new protocol was launched in April 2023. Together, the Kobe City Medical Association has created a patient consent form for ACP instead of POLST and has actively held multiple educational sessions for citizens and health care professionals.

In the first year since the program began, there were 78 cases of DNAR application, and 41 cases of CPR being discontinued. Of these, 18 cases were transported to the hospital, 15 cases were handed over to the family, and 8 cases were referred to the family doctor.

The introduction of DNAR protocols and the educational activities of ACP across multiple professions have halved the number of patients who received unnecessary CPR against their presumed intention.

This presentation proposes an overarching treatment paradigm for the management of trauma patients with simultaneous chemical, biological, and radiological exposure, which has not been explicitly documented in the literature.

Literature search and expert opinion. (There is a limited body of unclassified work available for reference. Much data is derived from animal studies or inferred from historical events.)

Whether it’s another pandemic, a chemical accident or deliberate attack, or a radiological exposure from a dirty bomb or nuclear detonation, trauma patients are increasingly exposed to CBRN. While military physicians regularly plan for these patients, in civilian medicine, trauma and CBRN casualty management are considered separate problems. Decontamination, isolation, and newer treatments all impact the patient and the physician.

Although there is some experience with COVID-19-exposed patients with trauma, this has primarily been with single or small numbers of casualties. Providers wear appropriate PPE,and patients remain in isolation during care. Future pandemic diseases or bio-warfare agents may require higher levels of PPE than were needed during COVID-19. There have been few chemical casualties with combined traumatic injuries in civilian hospitals. Terrorism or warfare with chemical weapons can potentially create large-scale combined casualties.

Nuclear detonation presents the potential to produce the greatest number of casualties with a mixture of explosive injury, burns, acute radiation syndrome, and radioactive contamination. Neither modern civilian hospitals nor military facilities have experience with this level of casualty production. Although it is difficult to prepare for large-scale casualties, having a well-understood plan of action can help improve the medical response. Particularly important is appropriate triage to ensure the optimum distribution of scarce resources while helping the greatest number of casualties possible.

Using available open-source literature and expert opinion, a new scheme for patient flow and management priorities has been proposed.

Indonesia’s geographical position, situated among multiple tectonic plates, renders it exceptionally vulnerable to megathrust earthquakes. Given this risk, hospitals, as key health care facilities, must develop comprehensive Hospital Disaster Plans (HDPs) to respond to such emergencies effectively. Since 2008, the Center for Health Policy and Management (CHPM) at Universitas Gadjah Mada has conducted a series of HDP training programs. Post-COVID-19 Pandemic, these trainings have transitioned to in-person technical guidance sessions, although some online training activities continue.

In 2024, the training program featured one HDP online seminar and one three-day in-person HDP technical guidance session. The online seminar provided basic and core HDP knowledge, while the in-person session focused on practicing risk analysis and the Hospital Safety Index (HSI) within a megathrust earthquake context. Participants developed detailed job action sheets and standard operating procedures for disaster response.

A total of nine hospitals and 38 individuals engaged in the training activities. However, only three hospitals attended the technical HDP development guidance. Throughout the sessions, participants actively reviewed and discussed their existing HDP documentation. Despite these efforts, evaluating the revised HDP documents proved challenging due to the inability to conduct on-site observation of hospital environments. Participants also supplied limited evidence, particularly concerning data to support their HSI indicators. As an alternative, we recommended that participants utilize contingency plans or disaster risk assessments issued by the National Disaster Management Agency (BNPB) and local Regional Disaster Management Agencies (BPBD).

HDP training is vital in addressing the evolving landscape of disaster risks. Accordingly, updates to HDPs should prioritize enhancing hospital preparedness for effective disaster response, rather than merely meeting institutional accreditation standards.

Timely transfers from emergency departments (EDs) to specialized departments are crucial for ensuring prompt, appropriate care. Delays in these transfers can lead to adverse outcomes, extended hospital stays, and increased healthcare costs. This study aims to evaluate the causes and assess the impact of delayed patient transfers from the ED to specialized departments, to enhance patient care. The primary objective of the study is to record and categorize the root causes of the delayed transfer.

After ethical clearance was obtained from the institutional ethical committee. This single-center, prospective observational study at AIIMS Bhopal included patients aged 18 years and above who remained in the ED for over 24 hours. Over six months, data were collected on delay factors such as patient-related issues (e.g., multiple comorbidities, poor prognosis), physician-related factors (e.g., inter-departmental communication gaps), and resource limitations (e.g., ICU bed availability). Descriptive statistics determined the prevalence of each delay factor, while Pearson’s Chi-square and Spearman’s rank correlation assessed associations between delay durations, patient outcomes, and APACHE II scores. Multiple regression analysis was adjusted for confounders to explore key factors influencing delays.

Delays were primarily attributed to inter-departmental confusion (40%), often in cases involving polytrauma, patients with multiple comorbidities, Additional factors included: lack of ICU bed availability (30%), patients managed completely outside the ED with no active interventions required from specialized departments (20%), and cancer patients with metastatic disease needing palliative care (20%). Miscellaneous reasons accounted for 10% of the delays. Transfer delays were associated with longer hospital stays but did not significantly impact overall mortality.

Identifying and addressing factors that delay patient transfers can improve healthcare efficiency and patient outcomes. Streamlining communication and optimizing resource allocation can reduce Emergency Department (ED) overcrowding and ensure timely transfers to specialized care. Future efforts will focus on implementing these findings to minimize delays at our institution.

Children with medical complexity (CMC) are defined as disabled children who are on a ventilator or require medical care to carry out daily life under Article 56 of the Child Welfare Law in Japan. In Japan, it is estimated that there were about 20,000 children aged 0 to 19 living at home under medical care in 2023. The mortality rate of persons with disabilities in the Great East Japan Earthquake was twice that of healthy persons, and it was reported that the mortality rate was higher among those living at home than among medical facility residents. Responding to disasters for CMC has become an urgent issue.

Primary triage was performed based on information on the normal conditions of CMC aged 1 to 16 who were treated at Tottori University Hospital in 2018. In this study, we triaged 69 children with medical care needs aged 1 to 16 years under normal conditions using Jump START and START methods.

There were 69 affected children (boys: girls 39: 30). The median age was 9.0. The reasons for medical healthcare needs were cardiac disease in 14, congenital anomaly syndrome in 13, perinatal disorders in 12, chromosomal abnormalities in 10, sequelae from trauma in 4, muscle diseases in 3, otolaryngological diseases in 3, metabolic diseases in 3, respiratory diseases in 2, and oncological diseases in 2. The triage results showed that one was in the expectant group, 24 were in the immediate treatment group, 12 were in the delayed treatment group, and 32 were in the minor group. Among the children triaged to Category III, 14 required oxygen administration, including 4 with noninvasive ventilators and 1 with a tracheostomy.

It is difficult to triage CMC appropriately using the START method and Jump START method, and it is necessary to develop a triage method specifically for CMC.

Turbulence accidents in aviation are common and can cause serious injuries, but injury patterns and relevant flight characteristics are often overlooked. This study aimed to analyze aviation accidents, classify turbulence-related injuries, and identify associated flight factors.

This study was a retrospective database and chart review. The National Transportation Safety Board database was searched for air carrier accidents with serious injuries or fatalities from January 2014 to December 2023. Accident charts were hand-searched, and flight details with injury patterns were manually extracted and categorized by axial or extremity location and Anatomic Profile (AP) (Category A = head and spinal cord, Category B = thorax and anterior neck, Category C = remaining serious, Category D = remaining non-serious injuries). Injury types and severity are compared by flight phase and seatbelt status.

A total of 153 air carrier serious accidents resulted in 156 casualties with serious injuries and five deaths. Turbulence was the most common cause (107, 69.9%) and was responsible for 117 (75.0%) casualties with serious injuries and no deaths. Fractures were the most common injuries (112, 72.3%) and were more likely sustained in turbulence-related accidents (OR 4.79, 95% CI 1.63-14.07). Location of fractures was axial in 34 (22.8%) and extremity in 78 (52.3%). AP was Category A in 16 (10.7%), B in 11 (7.4%), and C in 102 (68.5%) injuries. Fractures were less likely during cruising (OR 0.09, 95% CI 0.01-0.80) and more likely during descending (OR 21.95, 95% CI 1.19-403.4) flight phases. There was no significant association between seatbelt sign presence and fractures (OR 2.22, 95% CI 0.09-52.1).

Turbulence was the leading cause of aviation accidents and inflicted serious injuries like head and spine fractures, especially during flight descent. These findings can help airlines prioritize safety measures and healthcare responders prepare for relevant injuries.

On October 7, 2023, Hamas carried out an unprecedented attack on the State of Israel and kidnapped 251 people into captivity in the Gaza Strip. Several months later, as part of a humanitarian exchange deal, 105 hostages were released in five phases and admitted to one of six hospitals throughout the country for treatment. Shamir Medical Center (SMC) was one of these facilities. This study aims to describe the structure, process, and outcomes of establishing a comprehensive, multi-step operational protocol for receiving hostages returning from captivity.

Description of the process of preparing SMC as a receiving center, the establishment of procedures for implementation of the medical protocol, and the assessment of multi-disciplinary team preparedness and implementation, and outcomes in an institutional protocol.

Twenty-four returning hostages were received at SMC. Social workers, dietitians, and translators were used by 100% of the majority group of returning hostages from the same country of origin, and the sole individual from the other country of origin utilized a dietitian, social worker, ENT consultations, and a hearing test. Among the majority group, orthopedic and dermatological consultations were utilized by 17.4%, and 13% received an ENT consultation. Of the administered imaging, 13% received a chest X-ray, 8.7% received a limb X-ray, 17.4% received a head CT scan, and 4.3% received an abdominal CT. In addition, 21.7% were provided with antibiotic therapy. Protocol efficacy was measured by assessing the time to various operational aspects of protocol implementation and medical procedures, such as the mean hours to room assignment, primary physician evaluation, and social worker session. No correlation between age and operational variables was found.

This novel operational protocol was successfully implemented and may serve as a framework for managing similar unpredictable sensitive events in the case of future need.

According to the Indonesia Index Disaster Risk 2023, disaster events occurred in almost all regions of Indonesia. Out of 514 districts/cities, disasters occurred in 451, or 87% of the total. There are many strategies and regulations issued by the Governments, one of which is the Regulation of the Ministry of Health MoH Regulation number 75 of 2019 concerning Health Crisis Management. The Center for Health Policy and Management (CHPM) at the Faculty of Medicine, Public Health and Nursing, University Gadjah Mada (FK-KMK UGM), as a policy center in academic settings, must integrate these policies to develop programs. What support can be provided to develop disaster health management?

A review of all field report activities, webinars, seminars, training, workshops, and mentoring that had been conducted by Division Disaster Health Management, CHPM FK-KMK UGM during 2024.

There are two activities conducted for individual training: the Webinar on Disaster Health Management and the Seminar on Emergency Medical Team. Five activities for organization training that all aim to arrange and assist public health centers, hospitals, and district health offices to prepare a Health Disaster Plan. The total number of participants in individual training was 195, and in organizational training, there were 25 institutions. The evaluation result showed that participants need all this training, and it is very relevant to their work. In addition to increasing their capacity, preparing for health disaster plans is an urgent issue for health sectors to develop an operational planning document for handling disasters.

Academic roles in developing health disaster management extend beyond the curriculum to include policies focused on training and mentoring. In addition, the consultants in the Division of Disaster Health Management, CHPM FK-KMK UGM, are committed to supporting health sectors in developing practical, evidence-based policy and management solutions for health disaster planning.