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.

To review the capacity and standards for Victorian Medical Assistance Teams (VMATs) within the context of national Emergency Medical Team (EMT) benchmarks in Australia and internationally.

The requirement for responsive, timely, agile, well-prepared, and scalable emergency medical responses has been demonstrated in recent years. Given ongoing climate and geopolitical challenges, the threat of civil conflict, and the stress on prehospital and health systems post-COVID, it is imperative that we ensure local EMTs are appropriately trained and prepared. In recent years, a focus for the WHO has been to build strong national disaster medical responses. Early national responses are considered most critical in major disasters and complex emergencies.

The study reviewed a State-based jurisdictional program, the VMATs, and compared it with national and international standards. A cross-sectional survey of key VMAT management personnel and clinical leads was conducted, with follow-up site visits to audit the current state of staffing, cache, training, exercising, and mobilization. In addition, a literature review including Medline search, local and international policies and standards was conducted, with interviews of national and international exemplar EMTs. Ethics approval was obtained from the University of Melbourne.

Local EMTs reported substantial pressures that negatively impact training and exercising, challenges with staff turnover, maintenance of cache, and deployment challenges in the post-pandemic environment. Site visits following the online survey demonstrated improved compliance with training, exercising, and preparedness activities. Visits to other national and international teams demonstrated similar concerns more broadly.

Due to consistently reported post-pandemic pressures, there were significant challenges to EMTs. Surveys followed by site visits seemed to be a catalyst for improved compliance with training, exercising, and preparedness. A state-based EMT working group considered rationalization of VMAT numbers and location of teams in order to facilitate best practice in team management and rapid mobilization of staff and equipment.

An earthquake with a magnitude of 5.6 on the Richter scale on November 21, 2022, in Cianjur District, West Java Province, with a depth of 1 km from the surface, was caused by the Cugenang Fault. Approximately 114.683 people were affected and were IDPs. Of 47 primary health centers in Cianjur, 13 health centers experienced major damage. Medical logistics management is urgently needed at critical times like this to distribute medicines, medical devices, and disposable medical supplies to the affected areas to immediately replace the stock of health centers or village midwives that have been used, as well as to manage aid so that it does not pile up in the health cluster coordination post.

This field report was written using an observational descriptive approach, where the authors were part of a joint team sent by Universitas Gadjah Mada. The team consists of a management team, which is deployed to assist in the management of the health emergency operation and cluster coordination post (HEOC), and one n-EMT type-1 mobile to provide health assistance in the affected population attached to local health providers such as village midwives or primary health center (Puskesmas).

The lesson learnt was that there was no accumulation of medical logistic donations at the Health Cluster Post or the district pharmacy installation (IFK). The head of the Cianjur district office hall was used as a temporary storage place for donated logistics by nEMT and other volunteer and distributed back to nEMT with incomplete drugs for their service activity in IDPs. In one month of response operations, the HEOC was able to mobilize donations to serve 1388 health posts operated by nEMTs, 163 primary health centers, and 32 hospitals. The operationalization of the Cianjur HEOC’s logistics team is supported by adequate pharmaceutical personnel from the Indonesian Pharmacists Association (ATB-IAI).

Basic life support (BLS) is an emergency skill that includes performing appropriate cardiopulmonary resuscitation (CPR). Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide and is rising in Nepal, the country with high vulnerability, 11th and 16th globally to Earthquakes and multi-hazards, respectively. After an OHCA event, a bystander starting CPR quickly has been shown to increase the survival rate. While the Nepali police are generally the first responders to the disasters and emergencies in rural parts, they are not trained in BLS. This program assesses a pilot training of hands-only CPR and choking first aid to the Nepal Police and Nepal Army participants in rural Nepal.

A community-based nonprofit organization, HAPSA-Nepal, coordinated with the local government to pilot this program. The program included pre- and post-tests, lectures, videos, and small group hands-on exercises; facilitators included faculty emergency physicians, residents, and medical officers. Structured pre- and post-test questionnaires, confidence surveys, and skills checklists were conducted. Descriptive analysis examined the respondents’ characteristics, and a paired t-test was used to compare pretest and post-test scores.

A total of 126 participants received the training in this pilot phase. Before this training, 98.4% of the participants had not received any CPR training, and 100% of the participants had not received training on first aid for choking. The average pretest score was 4.4 with 95% CI±1.75, and the average post-test score was 8.06 with 95% CI ±1.73 (out of a total of 11). All participants passed the skills assessment.

Locally adapted BLS training programs that included hands-only CPR and choking first aid showed a significant knowledge gain and skills competence among the frontline participants.

The District Health Office (DHO) of Lumajang has prepared a contingency plan for handling the Semeru Volcano in 2015. The eruption of Mount Semeru that occurred during COVID-19 in 2021, which resulted in casualties, losses, and property damage, proves that disaster health management in the Semeru Disaster Prone Area needs to run more effectively. Considering the many challenges and problems faced at that time, like one-stop information provision, accumulation of logistical assistance, public health programs, and management of the Emergency Medical Team, DHO Lumajang decided to update that contingency plan.

Full day discussion activities with the participants were DHO Lumajang, representatives of the district agency for disaster, the public health center, the hospital, the professional health organization, and the social department. This discussion aims to review and update the Contingency Plan of Mount Semeru Eruption 2015 that was arranged by DHO Lumajang.

Organizational structure, risk analysis, scenario development, capacity analysis, policies and strategies, and SOPs are all important components to updates in a contingency plan document. The organizational structure prepared follows the MoH 2023 Health Crisis Management guidelines. Contingency plans are based on scenarios that analyze risks, and the participants decided to use a multi-disaster scenario that occurs during COVID-19. Capacity analysis involves assessing vulnerabilities and capacities at the regional level based on data Semeru Eruption 2021. SOP updates are adjusted to coordination flows and strategy policy for effective preparedness, response, and recovery operations.

Strategy DHO of involving cross-sectors to review and update contingency plans is a good collaboration. Disaster health management policies and strategies continue to develop following regional needs in dealing with disasters. Experience in dealing with various disasters requires the DHO to build collaboration with cross sectors, especially to organize coordination mechanisms.

Succinylcholine and Rocuronium are the principal neuromuscular blocking (NMB) agents used for rapid sequence intubation (RSI). Previous studies comparing the two agents show controversial results. A Cochrane systematic review revealed that Succinylcholine was more likely to achieve good intubating conditions than Rocuronium. This study aimed to compare Succinylcholine (1.5 mg/kg) versus Rocuronium (1.2 mg/kg) and their association with first-pass success during RSI.

This was a retrospective study at a single academic emergency department. We included patients who underwent RSI with either Succinylcholine or Rocuronium between 2017 to 2021. The primary outcome was first-pass success, whereas the secondary outcome was clinically acceptable intubation conditions. Logistic regression analysis was used to compare both agents.

This sample included a total of 342 patients. Of whom, 201 (58.7%) patients received Succinylcholine and 141 (41.2%) received Rocuronium. Unadjusted comparison between Succinylcholine and Rocuronium revealed no difference in first-pass success rates (84.3% vs. 82.9%; p= 0.23) and had similar clinically acceptable intubation conditions (89.9% vs. 88.3%; p= 0.19). After adjusting for confounding factors, first-pass success rates (p= 0.22) and clinically acceptable intubation conditions (p= 0.19) remained similar between the two agents.

The use of 1.5 mg/kg of Succinylcholine compared with 1.2 mg/kg of Rocuronium revealed statistically similar first pass success rates and clinically acceptable intubation conditions.

Civilian prehospital care in armed conflicts has gained critical importance as modern warfare increasingly affects civilian populations. While prehospital care in conflict zones has traditionally focused on military personnel, the growing number of civilian casualties necessitates tailored approaches. This scoping literature review assesses current knowledge on civilian prehospital care in conflict zones, examining challenges, innovations, and potential directions for improving emergency responses in these high-risk environments.

A systematic scoping review was conducted following the Joanna Briggs Institute guidelines. Research databases, including PubMed and Web of Science, were searched using keywords such as “prehospital,” “armed conflict,” and “civilian.” Studies were screened based on the inclusion criteria: non-military civilian populations, prehospital care, and set in armed conflict zones. Included studies were analyzed to identify common themes, challenges, and best

practices.

Twenty articles met the inclusion criteria. The review highlighted several recurring themes: innovations adapted from military prehospital care, the critical role of Trauma Stabilization Points (TSPs), challenges in resource allocation, logistical barriers, and the psychological toll on patients and responders. Findings suggest that while military strategies like TSPs have shown potential when adapted for civilians, their implementation faces challenges due to limited resources, security risks, and a lack of trained personnel. Community-based first responders and non-governmental organizations (NGOs) play vital roles in providing care where formal medical systems are inadequate.

Civilian prehospital care in conflict zones requires adaptable, resource-efficient strategies to manage logistical and operational constraints. The integration of technology, training of local responders, and community resilience building are essential for future progress. Further studies are urgently needed to assess and improve current practices in medical evacuation and stabilization in low-resource, unsafe environments.

During the recent war in Israel, thousands of soldiers sustained injuries, and hundreds lost their lives. The army was required to maintain precise data on the injured and deceased, detailing the nature and location of injuries, the hospital to which a patient was transported, the vehicle used for transportation, and the time of injury, to support operational decision-making. This study presents the rapid and professional process undertaken by the IDF’s Southern Command to establish the “Golden Watch” system, which compiles and displays all this data.

The study employed a mixed-methods approach. The quantitative analysis involved examining data collected by the system and comparing it with information from hospitals, medical teams, and commanders’ reports. The qualitative component included interviews with six senior officers to assess their satisfaction and perspectives on the system.

The quantitative analysis determined that the system’s reliability is exceptionally high, with data accuracy exceeding 99% across all tested aspects, including the nature of the injury, injury date, injury location, evacuation destination, and evacuation method. The qualitative findings revealed three key themes: the system’s simplicity is a significant advantage, its primary disadvantage is its reliance on manual input, and its unique capability to present a comprehensive overview of broad statistics is essential.

This research demonstrates that adapting to leverage advanced technologies during a mission is possible and necessary. The “Golden Watch” system provides a model that can be readily implemented in hospitals, military forces, and other organizations worldwide. By enhancing the comprehensive situational picture, this system has the potential to significantly improve decision-making and operational effectiveness in crisis response and emergency management contexts beyond the military domain.

During the COVID-19 pandemic, reliable data to inform public health policy-making was needed. Misclassification or bias in crisis needs assessments can lead to inadequate or misdirected resources. This study assessed differences in prevalence and risk factor associations for psychological well-being across two datasets examining the COVID-19 pandemic public health impact, focusing on how these differences relate to the sampling methods used.

Data was obtained from two studies with different sampling Methods: 1) a quarterly cross-sectional panel study (N ~ 5.000 per wave), and 2) a biennial public health monitor with targeted social media sampling (N ~ 70.000 per wave). Both online questionnaires were distributed among Dutch youth (16-25 years) in June 2022, in which psychological well-being was assessed using the Mental Health Inventory 5 (MHI-5). Differences in the prevalence between the two data sets were assessed using Wilcoxon rank sum tests and Welch two-sample t-tests. Risk factors were studied using linear regression. To determine whether there was an inherent effect due to the difference in sampling methods, propensity score matching was conducted on demographics using nearest neighbor matching.

Psychological well-being was found to differ significantly between the two datasets, with the mean difference in MHI-5 score being 4 points lower for data obtained through social media sampling. Regarding risk factors, having trust in the future and experiencing various nonspecific symptoms revealed strong associations in both datasets. Between the datasets, notable associations were found with ongoing suffering from COVID-19-related experienced events in the panel data and with primarily demographic variables in the social media sampling data. The significantly lower MHI-5 score persisted after matching the participants based on demographics.

Findings underscore the importance of taking precautions with interpreting the findings from social media-based sampling methods, as they run an increased risk of producing biased information for public health policy-making.

On the morning of April 3, 2024, at 7:58 AM, a magnitude 7.2 earthquake struck off the coast of Hualien, Taiwan. It caused seismic intensities of 6 on the Richter scale near the epicenter. Several buildings in downtown Hualien were tilted and damaged. The roads within Taroko National Park were severely damaged, resulting in traffic disruptions. Casualties were reported on the roads and at various tourist sites. A hotel was isolated due to road blockages, trapping around 600 people. On the first day, rescue and emergency medical response focused on Hualien City. All four hospitals in the city activated mass casualty protocols. The Urban Search and Rescue Team carried out search and rescue operations at the severely damaged “Uranus Building.” The Hualien County Health Bureau also deployed a disaster medical team’s advanced group to the site to gather information and perform medical tasks. After retrieving the body that had perished in the Uranus Building and confirming that all other buildings had been cleared, the search and rescue operations concluded on the first day.

On the second day, the focus shifted to evacuating the 600 people trapped at the Silks Place Taroko Hotel. The rescue teams set up a base camp at the road’s maintenance public works station, and the National Airborne Service Corps helicopters airlifted the rescue teams near the hotel. After arriving at the hotel, they cooperated with the hotel staff to establish a command post. After evaluating the medical needs and risks, those requiring medical attention and vulnerable groups were prioritized for helicopter evacuation. A total of eight helicopter trips were carried out, evacuating 145 people.

This article will describe the situations and response measures encountered by the medical sector, particularly focusing on the assessment of medical needs and the support methods in isolated areas.

Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) threats are significant concerns in today’s security climate and global instability. It is therefore crucial to be prepared with robust protocols and procedures for effective chemical decontamination. Currently, most hospitals in Singapore use wash timings of up to 15 minutes. However, there has been little evidence to show optimal wash timings for chemical decontamination. If the process is too short, it might not provide sufficient decontamination, or too long, resulting in a waste of resources. This study aims to investigate optimal wash timings during chemical decontamination to ensure efficient yet effective chemical decontamination.

A total of 20 full-sized mannequins on trolleys simulating derobed patients on trolleys were used. Firstly, a colorless, non-scented, non-toxic gel simulating chemical contamination (Glo Germ®) was applied to the mannequins in a standardized manner - across the head, face, bilateral axillae, front and back torso, groin, and bilateral lower limbs. Ten mannequins were washed by staff for eight minutes each, and ten mannequins were washed by staff for five minutes each. After washing, mannequins were examined using ultraviolet light, with any residual Glo Germ® visible under ultraviolet light. Mannequins without residual traces of Glo Germ® were successfully decontaminated. The total number of mannequins successfully decontaminated was recorded for each wash timing.

Both wash timings (eight minutes and five minutes) resulted in successful decontamination, with no trace of Glo Germ® seen on any of the ten mannequins used for each wash timing.

Both wash timings yielded successful decontamination of all ten mannequins. Using a wash timing of five minutes would maintain effective decontamination, yet save time and water resources during chemical decontamination. This study successfully validated the use of a shorter wash timing, as well as the hospital’s chemical decontamination protocols.

Nurses have played a crucial role in the battle against COVID-19. Their roles and responsibilities have evolved significantly, primarily focusing on being liaisons and subject-matter experts to ensure the effective utilization of COVID-19 therapeutics. Nurses engaged with ASPR stakeholders (state/territorial/local health departments, professional organizations, applicable advocacy groups, and private sector partners such as pharmacies).

This presentation aims to outline the key responsibilities and objectives of clinicians during the COVID-19 pandemic response and provides a clear understanding of the roles clinicians play in collaborating with interdisciplinary teams: disseminating accurate information, promoting public health measures, and adapting to evolving guidelines Nurses collaborated with stakeholders and established monoclonal antibody infusion centers. They supported clinical grand rounds and created a collaborative document with FAQs for stakeholders and other federal partners. They created Clinical Implementation Guidelines (CIG), Side by Side (SXS), and Decision Aids (DA).

Their multifaceted roles as liaisons and subject matter experts have not only facilitated the understanding of clinical aspects of COVID-19 therapeutics among healthcare staff but have also fostered collaboration with diverse stakeholders, contributing to a more comprehensive and effective response to COVID-19. One of their primary roles has been that of a liaison, bridging the gap between clinical knowledge and the broader community of stakeholders. They are responsible for disseminating the latest clinical guidelines, sharing best practices, and addressing any emerging challenges in real time.

At the end of this session, participants will be able to:

• Recall three resources nurses created in support of COVID-19.

• State one role nurses had regarding MABs.

• Describe one role nurses had during the ASPR COVID-19 Clinical Rounds.