Nepal is highly susceptible to natural disasters, including earthquakes, floods, and landslides, which have been exacerbated by climate change. General Practitioners (GPs) are often the first point of contact in affected communities, playing a crucial role in managing the health consequences of such calamities. This study explores the role of GPs in disaster management in Nepal, with a particular focus on preparedness, response, and recovery phases.

A review of current literature, policy documents, and field data was conducted to assess GPs’ roles, knowledge of disaster medicine, and the skills required for effective disaster response. Additionally, a gap analysis was performed to evaluate current skills and the specific needs of GPs in disaster situations. The study was undertaken in partnership with Saving Lives International – a UK charity.

The findings highlight that Nepal GPs have been trained in triaging injuries, providing essential primary care, and delivering essential mental health support in post-disaster settings. However, gaps were identified in areas such as quality and outcomes assessments, disaster medicine preparedness training, emergency response coordination, field medicine, pre-hospital trauma care, and impact on mental health. It underscores the importance of integrating GPs into disaster management frameworks in Nepal, emphasizing the collaboration with government agencies, non-governmental organizations (NGOs), and community leaders. Training in disaster medicine and response protocols, as well as fostering community resilience, were identified as key areas of improvement.

Enhancing GPs’ involvement in disaster management through structured training programs and resource allocation can improve healthcare outcomes in vulnerable communities, particularly during the recovery phase. Leveraging the local knowledge and established relationships, GPs can enhance the overall efficacy of disaster response efforts. The study calls for strategic investment in GP disaster preparedness to build a more resilient healthcare system capable of responding to the escalating threat of natural disasters in Nepal.

Coordinated Terror Attacks (CTAs) have evolved significantly with increased complexity and deliberate strategies to maximize casualties and societal impact. These attacks, characterized by multiple incidents across space and time, may target healthcare facilities directly or through secondary attacks. Recent events demonstrate a concerning rise in CTAs that pose a unique threat to the healthcare infrastructure, with complex challenges. This scoping review examines literature on CTAs targeting hospitals and hospital responses to recent major CTAs to identify potential gaps in preparedness and response. Based on these findings, the review offers policy recommendations to enhance hospital readiness, response protocols, and overall resilience.

This scoping review used the Arksey and O’Malley five-step framework. Manuscripts were retrieved from six databases and search engines using keywords relating to coordinated attacks and hospital facilities. Analysis focused on evaluating whether the terror event can be characterized as a CTA, whether it directly targeted or impacted a healthcare facility, and how such a facility responded.

Of 1,616 papers screened, 26 met the inclusion criteria: seven addressed CTA events in which healthcare facilities were confirmed targets, 12 publications examined how non-targeted hospitals responded to CTAs, and six secondary data analyses examined the broader trend of terrorist attacks targeting hospitals. Notable CTA events were referenced as key examples for discussion. Characteristics of the attacks, hospital response, lessons learned, author recommendations, and proposed methods for CTA hospital preparedness were extracted.

The findings highlight a gap in the literature and suggest an opportunity for further research into the threats CTAs pose to healthcare. Increasing evidence of CTAs underscores the need for hospitals to prepare specifically for CTAs. Hospitals must harden operationally and structurally, integrate system-wide communication, and systematically allocate resources in a stepwise fashion to improve the response to waves of casualties and maintain functionality during cascading, multisite, and/or prolonged attacks.

CBRNE disasters cause severe social disruption and require a special medical response. The Center has prepared a CBRNE disaster response manual in advance of the 2019 Rugby World Cup in Kobe. The Center has similarly held several table-top drills in the neighborhood of the city center to simulate a terrorist attack, but the number of participants was about 20-30 people each time. Therefore, an exercise scenario of multiple patients injured by an accident at a nearby chemical plant was proposed. Before the exercise, a series of study sessions were practiced to deepen the staff’s understanding of CBRNE, including an outline of CBRNE, decontamination tent set-up, and so on. A scenario was developed in which multiple walk-in patients, after dermal or inhalation contamination by chemical agents, collapsed at the hospital entrance, and the initial response was made by multi-professional staff, including a reception clerk, ER nurses, and physicians. On the day of the drill, more than 70 people participated. In the post-drill questionnaire, there were many favorable comments on the drill itself. Many of the participants requested that the next training should be based on an explosion, which could occur in a neighbor’s. As for CBRNE disasters, especially chemical disasters, there have been no mass casualties from terrorist attacks in Japan since the two Sarin gas incidents in 1994 and 1995. On the other hand, chemical disasters such as suicides, accidents, and factory disasters while using toxic agents occur routinely; if the number of the injured/contaminated was too large, or the cause was a terrorist attack in the simulation scenario, participants could hardly view it as realistic. In this CBRNE disaster drill, we believe that the use of “highly probable and realistic training scenarios” raises the sense of urgency and attracts more staff.

In Belgium, the Ministry of Health is responsible for the medical-psychosocial disaster care. One of the tasks is registering all those affected, wounded, and not-wounded. The evaluation of the Brussels Bombings (2016) showed that registration, collecting, processing, and disseminating data about those affected was difficult and became almost impossible in complex multi-site incidents.

This was the start of the Belgian Incident Tracking System (BITS) project. This system now collects, processes, and generates data on persons involved in an emergency situation. It traces and identifies those affected throughout both the medical and the psychosocial chain in a simple way.

Each relief worker can, based on their specific profile, complete the pathway and file of those affected step by step, through a mobile or web-based application, online and offline. This applies to the relief workers who are dispatched to the incident, the advanced medical units, the hospitals to which the injured are taken, and all the relief workers in the reception centers.

With BITS, psychosocial workers in a call center or at a reception center can look up missing persons within the relief chain. If the missing person is not found, a thorough registration of the search query is filed. This data can contribute to the identification of unknown persons, those seriously injured/unconscious, or deceased. For those who leave the scene without seeking help. BITS will enable an online “I Am Safe” counter.

Finally, a wide variety of lists, according to European privacy regulations, can be generated and shared with partners within a crisis center or with actors responsible for the aftercare. Whereas BITS is in production and is being used in incidents right now, the developments are still ongoing, including lessons learned after every exercise and/or incident.

Currently, Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is gaining prominence over time as adjunctive management for Non-Compressible Torso Hemorrhage (NCTH). However, in resource-limited situations, such as disasters, there is still relatively little information about this procedure.

This study intended to determine the feasibility of REBOA in NCTH patients, factors related to survival, the following complications, and the feasibility of performing the procedure with limited resources.

23 NCTH patients treated with REBOA without fluoroscopic machine confirmation of the balloon position in the ER at the Trauma Center Khon Kaen University, were retrospectively reviewed from 2012 to 2013. The ascertained survival rate after the procedure and 28 days of mortality are the primary outcomes, while associated factors and complications are secondary outcomes.

Among NCTH patients undergoing REBOA, the survival rate after the procedure was 26.09% (n=6), and 28 days afterward was 21.74% (n=5). There were significant differences in the Glasgow Coma Scale (GCS) scores upon arrival between the survival group (SG) and non-survival group (NSG) after the procedure. The median GCS was 11 for the SG and 3 for the NSG (OR 1.76, p=0.024). At 28 days, the only statistically significant results were found in the GCS range of 10-12, with 3 survivors (75.00%) versus 3 non-survivors (15.79%) (OR 16, p=0.035).

10 patients experienced prehospital CPR (43.48%) but did not survive. 7 patients underwent CPR during REBOA, one of them stayed after the procedure but died 28 days afterward. The complications were bleeding 65.22% (n=15), and acute kidney injury 21.74% (n=5).

Among NCTH trauma patients undergoing REBOA, approximately a quarter had survived after REBOA and primary operative procedure, and slightly lower at 28 days after injury. This procedure can be safely performed by an experienced surgeon under a limited resource situation.

Military-targeted terrorism poses a persistent threat to global security, impacting national defense and international stability. Accurate forecasting of such incidents is crucial for developing effective counter-terrorism strategies. This study leverages advanced time series analysis to predict future trends in military-targeted terrorism incidents, providing insights for policymakers and military strategists.

This study utilizes historical data from the Global Terrorism Database (GTD) from 1970 to 2020 to forecast incidents from 2021 to 2030. Three predictive models, such as ARIMA, Random Forest, and Long Short-Term Memory (LSTM) networks, were employed to capture patterns and predict future incidents. Model performance was evaluated using Mean Absolute Error (MAE), Root Mean Square Error (RMSE), and R-squared (R²) metrics. The LSTM model was further optimized through hyperparameter tuning to enhance prediction accuracy.

The LSTM model demonstrated superior performance compared to ARIMA and Random Forest models. Specifically, the LSTM achieved an MAE of 10.2 and an RMSE of 12.5, with an R² value of 0.82, indicating a strong fit and predictive capability. The ARIMA model recorded an MAE of 12.3 and RMSE of 14.8, while the Random Forest model had an MAE of 15.7 and RMSE of 18.2. The forecasts revealed an increasing trend in military-targeted terrorism incidents over the next decade, with predicted peaks of 65 incidents in 2022 and 71 incidents in 2023.

Integrating LSTM networks with traditional time series models enhances the predictive accuracy of military-targeted terrorism forecasts. These insights enable policymakers to allocate resources effectively, plan strategic interventions, and improve preparedness against potential threats. Future research should incorporate additional data sources, such as social media analytics and geopolitical factors, to refine predictions and enhance situational awareness. This study underscores the importance of leveraging advanced machine learning techniques to address complex security challenges.

Disaster films are a popular form of entertainment. Large-scale pandemics, climate-related disasters, technological and man-made disasters, and comets on intersecting paths with Earth are popular topics in this film genre. But what roles do (or can) disaster films play in an all-of-society approach to disaster risk reduction (DRR)?

Disaster films were chosen through a systematic search on Rotten Tomatoes, IMDb, and ChatGPT. After screening 111 trailers, 32 films were obtained from streaming networks and online purchases. The inclusion criteria for screening the films included a focus on realistic disasters, examples of resilience and vulnerability, and representation of high-risk populations. A team of reviewers screened the trailers and conducted content and thematic analysis for each included film.

Preliminary analysis highlighted how disaster films can support an all-of-society approach to disaster preparedness, response, and recovery through examples of resilience, information to enhance awareness, and modeling attitudes and actions underpinned by social justice. Mis/disinformation, confusing messaging, and industry-specific language are important considerations for population health and accurate risk communication through film.

Disaster films represent unique opportunities for public education to promote resilience and enhance DRR. This presentation will highlight how disaster entertainment can be integrated into an all-of-society approach to support DRR, emphasizing important considerations for disaster risk messaging and inclusive practice.

Traslacion is one of the biggest religious events in the Philippines. It involves a vigil and the procession of the carriage of the Black Nazarene in the streets of Manila, usually starting at the break of dawn and lasting for about 18 to 20 hours. This year, it is estimated that more than 10 million devotees flocked to the area during the event. Various risks and hazards are present. Compression asphyxia, heat exhaustion, and trauma cases are common. Traslacion is manned mainly by different rescue organizations that regularly volunteer to take care of medical services aside from the existing emergency medical services of the national and local government units. Thus, it is important to understand the preparation of medical volunteers and identify challenges and best practices during a mass gathering.

Planning and meetings started six months ahead. It involved multiple government agencies, church officials, and civil society organizations. Online lectures were utilized by the volunteers, and a simulation exercise was done with uniformed personnel for harmonization. An Incident Management Team was organized, and a Multi-Agency Command Center was set up. Advanced medical posts were situated strategically with different rescue and medical volunteers along the whole route of the procession. Strike teams were formed by the volunteers to extract patients from the thick crowd and bring them to different medical stations. There were 1,484 patients reported, and most suffered minor injuries. No major injuries or deaths were seen during Traslacion 2024 despite the number of devotees. Now, the challenge for the organizers is to keep future Traslacion safe. The volunteers have been the backbone of the medical response to this event in providing an early response. Despite the risks and hazards present in this event, early planning and preparation can make a difference in the outcome of this anticipated annual event.

This is a 45-year-old female patient who presented to the emergency department with altered mental status, pinpoint pupils, and tachycardia after intentionally ingesting a large quantity of the antihistamine cyproheptadine and alcohol. The patient was treated with physostigmine, a cholinesterase inhibitor, which improved her clinical condition. This case highlights the importance of recognizing and managing acute anticholinergic intoxication, a potentially life-threatening condition.

Case Presentation:

The patient, a 45-year-old female, was brought to the emergency department due to a poor response and the presence of “sleeping pills” (cyproheptadine 2 mg) and alcohol bottles. On arrival, she presented with confusion, decreased responsiveness, pupils dilated, and tachycardia. Physostigmine was administered for suspected anticholinergic intoxication. After physostigmine, the patient became more conscious, oriented, and alert, though still fatigued. She reported taking over 10 tablets of cyproheptadine and consuming alcohol due to insomnia, denying suicidal intent. Physical examination revealed the patient to be sleepy but oriented, with bilateral dilated pupils. Vital signs were notable for hypertension and tachycardia. Laboratory investigations, including arterial blood gas and electrocardiogram, were unremarkable. Based on the clinical presentation and history, the impression was acute anticholinergic intoxication. The patient was admitted for further management and monitoring.

Anticholinergic intoxication can result from the overdose of various medications, including antihistamines. The administration of physostigmine helped to reverse the patient’s anticholinergic symptoms. Ongoing management in the observation unit was crucial to monitor for potential complications and address any mental health concerns.

Hurricane Maria, a category 4 storm, arrived in Puerto Rico in 2017, knocking out power to the entire island of 3.2 million people. Power remained out in areas for months, taking scores of primary care operations offline, interrupting the pharmacy supply chain, and diverting outpatient care to hospital systems. Initial death tolls were reported as low as 64. Multiple subsequent studies demonstrated deaths downstream of the disaster due to power interruptions in the thousands.

Similarly, Hurricane Dorian, which hit the Bahamas in 2019, stayed over a populated island for more than 24 hours as a category 5 hurricane, causing widespread infrastructure destruction of its primary healthcare system and prolonged power loss. Primary care delivery was further interrupted shortly thereafter by the COVID-19 epidemic, resulting in compounding disaster and increased mortality from chronic conditions, as well as population migration seeking primary health services.

Both hurricanes resulted in large-scale international relief efforts, much of which focused on implementing resilient power infrastructure.

Miami-Dade County sits on the southern tip of the peninsula of subtropical Florida. With a rapidly growing population of 2.7 million people, it is uniquely susceptible to flooding, heat, and hurricanes. Much of the county’s population is served by governmentally subsidized health care. An interruption in care in primary healthcare centers due to closures, particularly for vulnerable populations, including patients reliant on power-supplied durable medical equipment, will be deadly.

The University of Miami, who launched long term responses to both hurricanes, is proposing to add solar energy microgrids and batteries to reduce the post-disaster burden on inpatient healthcare systems, and reduce morbidity from chronic illness, as well as reducing carbon emissions for a cost savings overall to the healthcare system, developing the concept of the “medical resilience hub,” to offset reliance in disaster on tertiary care centers and relief agencies.

The integration of planetary health into medical education is increasingly recognized as essential for training future physicians. However, existing educational efforts primarily target medical students, leaving resident physicians with limited training in addressing the health impacts of environmental stressors. This study aims to evaluate the effectiveness of a simulation-based curriculum in enhancing Emergency Medicine residents’ knowledge and confidence in discussing these health challenges with patients.

A cohort of Emergency Medicine residents at Johns Hopkins Hospital will participate in simulation sessions designed to address planetary health topics. Participants will complete pre- and post-session surveys using Qualtrics to assess changes in their comfort levels when discussing environmental health issues. Data will be analyzed using descriptive statistics, including chi-square and Fisher’s exact tests, to evaluate the primary outcome of increased confidence in discussions with patients. The study will take place from September 2024 to June 2025.

Expected outcomes include a significant increase in the proportion of residents reporting comfort in discussing health challenges driven by environmental stressors post-simulation. Secondary surveys will be conducted six months after the sessions to assess retention of knowledge and confidence.

This study will provide insights into the efficacy of simulation-based education in enhancing resident training in planetary health. By addressing this education gap, we aim to empower residents to adopt a more holistic approach to patient care, integrating environmental factors into their clinical practice. The results could inform future curricular developments in medical training programs nationwide.

Disasters are serious disruptions to a community’s functioning that exceed its capacity to cope using its resources. Natural, man-made, technological hazards, and other factors may cause disasters and influence a community’s exposure and vulnerability.

The objective of the study was to assess the knowledge, practice, and attitude of healthcare workers in Nepal regarding disaster preparedness and management for emergencies.

A retrospective study was conducted among healthcare workers in Nepal registered for the 1st World Academic Council of Emergency Medicine- Table-top Exercise and Communication in Disaster Medicine conference as participants or faculty. Information was collected using total enumeration sampling and a questionnaire developed from a literature review, and the questionnaire was adapted from the Emergency Preparedness Information Questionnaire (EPIQ). Percentages, means, and medians were calculated for socio-demographic data, knowledge, practices, and attitudes toward emergency preparedness. A chi-square test assessed associations between socio demographic characteristics, emergency procedures, and familiarity scores on the preparedness questionnaire.

A total of 118 participants took part in the study, most with over six months of emergency department experience. There was a significant association between work experience and emergency procedure status (χ2 = 6.982, p=0.008), and between education level and familiarity with disaster management (χ2 = 5.507, p=0.019). However, there was a low correlation (r=0.140, p=0.129) between emergency procedure status and disaster management familiarity.

Emergency preparedness is crucial for life-saving in disasters. The availability of emergency services and skills related to emergency preparedness and disaster management is crucial for saving lives in emergency conditions. The hospital should provide emergency preparedness and disaster management training to all healthcare workers. In addition, the hospital authority should perform disaster exercises/tabletop simulation exercises, or drills periodically.

The Sun Herald City to Surf is an annual 14km Fun run that starts from the center of Sydney, Australia, to Bondi Beach. This event attracts a field of 90,000 domestic and international runners. This annual event generates a substantial number of casualties, mainly related to exercise-induced heat exhaustion and poorly prepared entrants. This event’s history has seen runners suffer cardiac arrests in the past. The aim of early health engagement through the deployment of Emergency Medical Teams is to reduce mortality and morbidity from heat-related illness, with the added benefit of reducing presentations to an already burdened health system.

The profile of the event and the risk of incident occurrence ensure that comprehensive multi-agency planning and community engagement go into this event. The Health response to this event is extensive, from primary first aid, massage, and physiotherapy to resuscitation-capable Emergency Medical Teams (EMTS). Selection of the amount of health resources considers event history, which includes the number and type of presentations, time of presentation, and expected weather and risks identified.

Local health Districts are invited to apply to the EOI to supply Emergency Medical teams for this event. The standup of two medical facilities requires significant coverage from EMTs. Planning includes a proactive approach to messaging runners and a comprehensive review of previous events’ casualties and weather conditions. The multiagency identified risks also ensure that health has plans in place, including mobile teams for start-line crushes.

This approach has seen a reduction in critical presentations over the last five years, while also seeing an increase in participant numbers due to the event’s popularity. This successful event reduces the burden on the existing overburdened health system and allows an opportunity to prepare for and exercise in an out-of-hospital event to ensure our teams’ ongoing readiness.

The Israeli health system was responsible for leading the fight against SARS-COV-2 as a medical emergency, making delivering real-time, professional information to the population crucial. The survival of the Israeli healthcare system during disasters is closely linked to the provision of medical services by the four HMOs. Professional and relevant spokespeople must ensure effective information delivery by adhering to the highest standards. This study assesses how professional information is communicated to the Israeli public.

During the COVID-19 pandemic (2020-2022), thirteen influential individuals from the Israeli healthcare system, actively involved in leading the country’s response, were extensively interviewed using a semi-structured approach. The interviews underwent evaluation by a peer review panel. Access to participants was obtained, and the interviews were conducted in person or via Zoom. The participants were provided with the questionnaire format in advance. The data analysis was done with ATLS.TI 22, resulting in the identification of six themes. One of these themes emphasized the importance of delivering professional information to establish public trustworthiness during emergencies. The themes were derived by identifying recurring concepts and categories within the participants’ quotes.

Many instances were uncovered, illustrating the paramount significance of professional information delivery in shaping the trustworthiness of the public during the COVID-19 pandemic. All 13 interviewees unequivocally recognized the impact of professional information dissemination. They supported their viewpoints with concrete illustrations, emphasizing the role of physicians as spokespersons, the need for media interaction through question-and-answer sessions during conferences, and the importance of unified messaging across all media platforms and among all professionals involved.

The study demonstrates the approach adopted by the Israeli healthcare system in managing the pandemic, encompassing an examination of the ramifications of professional information delivery. The abundance of lessons and examples presented may also hold relevance for other countries, offering potential for broader application.

Healthcare needs from mass casualty events in humanitarian crises require trained personnel to manage complex patient care in challenging environments. Healthcare for humanitarian responses in conflict-affected contexts is characterized by staffing and material constraints, public health risks, mental health challenges, damaged infrastructure, the necessity for coordination between Ministries of Health, NGOs, and other international organizations, and risk to the safety and security of healthcare providers. There is a higher probability of conflict related mass casualty events. To improve preparedness, an adapted training resource was developed using the Emergo Train System (ETS) in collaboration with the International Committee of the Red Cross and Region Östergötland. ETS, an adaptable simulation platform, enables teams to practice managing critical patient flow scenarios, enhancing capability and capacity for patient care in mass casualty incidents in conflict settings.

The module was iteratively designed based on ETS’s validated processes and customized for humanitarian settings. It underwent testing with health care personnel working in conflict settings, incorporating feedback from simulation instructors. Testing involved realistic contextualized scenarios that were easy to use, relevant, and supported capacity building.

The Humanitarian set was used in Ukraine, Nigeria, Yemen, and Somalia, where feedback was positive. The module was reported as highly relevant, easy to navigate, and valuable for capacity building. It improved the ability to perform triage of patients and enhanced healthcare workers’ communication and collaboration. Feedback indicated that the simulation supported skill acquisition in decision-making, contributing to a better-prepared healthcare workforce in conflict-affected settings. The set was further improved with roadblocks, military vehicles, religious buildings, and tented structures.

The ETS-based module has proven effective in enhancing the readiness and competency of healthcare providers in humanitarian settings. This collaborative effort showcases the potential of ETS for capacity building, supporting the ICRC’s goals of delivering healthcare in crises.

The study aims to evaluate a personnel traceability tool based on QR codes in a contaminated zone during a nuclear and radiological (RN) event.

A prospective, monocentric study was conducted to assess an IT tool using QR codes linked to individual identities, attached to uniforms and wristbands, utilizing a spreadsheet created with Microsoft® Office Excel. The QR codes were scanned by a reader connected to a computer at the single entrance and exit of the zone. Color codes indicated the duration of presence in the contaminated zone. To evaluate the tool, similar information was recorded manually. A satisfaction questionnaire regarding the speed of registration and tracking in the zone was administered at the end of the exercise. Results are expressed in counts and percentages, as well as mean ± standard deviation, with p < 0.05 considered significant for satisfaction comparisons using a Wilcoxon rank test.

No software malfunctions were reported. Satisfaction among the 25 participants was assessed on a scale of 10, with a score of 9 for the QR codes compared to 7.6 for manual registration and 7.2 for personnel tracking in the zone.

In conclusion, this tool demonstrates its utility and effectiveness in managing a significant number of healthcare providers during an RN event. The interconnected use of this software by various services could reduce delays in the contaminated zone.

While Japan’s current disaster medical support system effectively addresses acute medical needs, sustainable primary care support requires enhancement. Following the Noto Peninsula Earthquake on January 1, 2024, the Japan Primary Care Association (JPCA) initiated specialized primary care support in Wajima City through December 2024. This report describes comprehensive primary care support activities in a region with over 50% of the elderly population that experienced flooding six months post-earthquake.

Support was provided to an outreach-based primary care clinic where a local physician, an Ishikawa Medical Association’s Northern Noto Branch member, served as one of Wajima City’s medical coordinators. The clinic provides home medical care, nursing, and rehabilitation services, and operates an NGO offering a “third place” support program for adolescents.

Between February 5 and July 1, 2024, eighteen physicians were dispatched. The team handled 1,487 outpatient visits and 725 home visits with local primary care physicians. This support enabled the local physician to attend 86 regional healthcare meetings, including the Wajima City Health and Medical Welfare Coordination Headquarters meetings. Additionally, 29 community activities were supported, including health promotion cafes and programs for high-risk pregnant women. Following severe flood damage in September, which caused one-meter flooding and the loss of outpatient functions, physician dispatch resumed. To enhance sustainability, visiting physicians covered weekend home visits, allowing local staff essential rest periods.

The JPCA aimed to develop support focusing on local healthcare sustainability and human resources. Supporting this crucial medical institution, which functions as the local medical association’s disaster coordinator, contributes to maintaining the regional healthcare system’s mid- to long-term sustainability.

In a disaster-prone region, ASEAN has committed to disaster risk reduction through the ASEAN Leaders’ Declaration on Disaster Health Management (ALD-DHM) since 2017. This declaration emphasizes the critical role of Knowledge Management (KM) in DHM and outlines necessary regional and national actions in the adopted Plan of Action (PoA). However, there is a pressing need to transform fragmented experiential knowledge into systematic scientific understanding among healthcare practitioners, policymakers, and academics in DHM. To overcome these challenges, the AJDHM publication program was launched in early 2024, mandated to implement the PoA for disseminating research.

This study aimed to describe the scope, accessibility, and quality of AJDHM. To achieve this, a comprehensive review was conducted to analyze the editorial and operational dimensions of the journal.

ASEAN established the ASEAN Academic Network on DHM (AANDHM) to implement KM activities, supported by a Steering Committee (SC) from each Member State focused on empowering emerging health practitioners. Its scope primarily aligns with the WHO Health Emergency and Disaster Risk Management framework. The AJDHM’s Editorial Board (EB) is composed of designated academics and practitioners related to DHM, recommended by the SC of AANDHM, including academicians from Japan. External reviewers are selected based on the EB’s recommendations. The journal’s digital platform is maintained by the Faculty of Medicine, Universitas Gadjah Mada, using the Open Journal System, and it has acquired an ISSN. AJDHM’s inaugural publication is scheduled for 2025.

In conclusion, AJDHM seeks to bridge scientific, policy, and practical insights within ASEAN contexts, positioning itself as a vital platform for retaining lessons learned and enhancing the capacity of emerging researchers.

Mass-casualty incidents (MCIs) have increased globally over the last two decades, both in number and magnitude. Preventable on-scene mortality in MCIs may result from delays in pre-hospital time (PHT). This study aimed to identify factors contributing to PHT delays and explore pre-hospital care providers’ (PHCPs) suggestions to optimize PHT.

A cross-sectional, global online survey was conducted between May and August 2024. PHCPs with experience in at least one MCI were invited via professional associations and social media. Data was collected via a validated questionnaire, including Likert-scale statements to measure agreement levels, multiple-choice, and open-ended questions. Queen Mary Research Ethics Committee (DSREC_01_v2_F_Alruqi) approved.

There were 225 participants from 54 countries. Of these, 29.78% were from low- and middle-income countries (LMICs), and 70.22% were from high-income countries (HICs). Most participants were paramedics (62.22%), followed by physicians (16.44%), EMTs (7.56%), nurses (5.33%), others (4.89%), and first responders (3.56%). The median number of MCIs experienced was 5 (IQR 3 – 14); HIC: 5 (IQR 3 – 10); LMIC: 10 (IQR 5 – 20). The majority of respondents cited poor communication (84%) and geographical challenges (80%) as primary factors associated with extended PHTs. LMICs reported that equipment inadequacy and hospital distance were also linked to extended times (75% and 63%, respectively). Resource limitations were more of a challenge for LMICs (30.77% vs 18% in HICs), whereas policy and administrative issues affected 20% of HIC participants compared to none from LMICs. Almost all participants suggested that regular training (95%) and past MCI experience (90%) were key factors for optimizing PHTs. HIC respondents emphasized the benefits of effective communication for shorter PHTs, and improved security was prioritized in LMICs.

While geographical location and distance are non-modifiable factors, improving communication in MCI settings may decrease PHTs. Effective communication strategies should be integrated into MCI training and planning.

The Western Regional Alliance for Pediatric Emergency Management (WRAP-EM) has been actively supporting international disaster responses through its Mental Health Virtual Reachback Team model. WRAP-EM employs an evolving consultative collaborative model, drawing from the National Children’s Disaster CONOPS. This involves meeting with the requesting organization to identify critical mental health response and recovery needs, recommending strategic approaches, and providing tactical support and resources to facilitate implementation. The MH Reachback Team offers evidence-based tools and processes via consultation, technical assistance, and training to disaster response governmental and tribal entities, disaster relief NGOs, and independent agencies.

In response to the catastrophic flood disaster in Derna, Libya, WRAP-EM provided consultation and training to establish a mental health response. Over 10,000 children have been triaged using the PsySTART system, and ongoing efforts are underway to build capacity within the community to meet these needs, including training Libyan MH providers in Stepped Trauma-Focused Cognitive Behavioral Therapy appropriate for low-resource environments.

Additionally, WRAP-EM has supported the Gaza Health Initiative, a multinational effort focused on rebuilding Gaza’s healthcare system for children affected by conflict. Medical teams deployed to Gaza received training in trauma-informed pediatric care, as well as the Anticipate-Plan-Cope/PsySTART Responder medical provider resilience-building system. Training has been conducted for providers from multiple countries, including the United States, Canada, the United Kingdom, Jordan, Egypt, and Australia.

This approach for addressing mental health needs of youth following disasters requires a multi-disciplinary team with expertise in Emergency Management, Mental Health Clinicians with knowledge and understanding of the disaster behavioral health literature, experience in disaster response in both high and low resource environments, and a flexible approach that can be adapted to the culture and community. The capacity to engage with impacted communities to inform planning for mental health surge response from a systems and clinical focus is key.