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.

Eilat is the southernmost tourist city in Israel, with a population of about 65,000. The Iron Swords War brought 65,000 displaced people to the town. The local hospital has 67 beds, no trauma unit, three operating rooms, and a few specialist doctors. The referring hospital is about 100 km away, and the nearest airport is 20 minutes away. Given the worsening threat of an MCI in the city and taking into account the hospital’s limitations, the Ministry of Health’s hospitalization desk, in cooperation with the rescue forces and the army, drew up an action plan:

1. • Increasing the number of personnel, including orthopedists, surgeons, pediatric surgeons, anesthesiologists, intensive care specialists, traumatologists, Emergency Physicians, and nurses as a backup team.

2. • Converting the hospital into a triage facility, performing life-saving procedures, delaying treatment, and determining the priority order for secondary evacuation.

3. • Training was conducted for both the hospital and its backup staff. There were many MCI exercises, including sudden drills, cooperating with the army, and the rescue forces.

In the hospital, there was a significant knowledge gap regarding the operation of the RN and familiarity with the RN’s manual. Officials did not know their defined mission, and the hospital headquarters did not demonstrate command and control during the incident. The hospital did not compile a situational picture that allowed decision-making and casualty evacuation as required. The hospital headquarters did not demonstrate command and control during the incident. A lack of trained medical professionals from the trauma profession was observed.

Recommendations:

1. • The hospital permanently placed skilled personnel from the trauma professions throughout the war. Conducting joint training to enhance the skills of hospital personnel in triage.

2. • Daily practice of all staff for MCIs.

On January 1, 2024, the Noto Peninsula earthquake struck, causing significant damage, particularly in the Oku Noto region. The Japanese government, through relevant agencies, deployed medical containers. However, many challenges emerged in the deployment of these medical containers due to the lack of maintenance and systematization. This study aims to clarify the challenges in the maintenance of mobile medical containers during disaster operations and the necessity of systematization.

This study examines the “Report on the Deployment and Operation of Medical Containers During the 2024 Noto Peninsula Earthquake,” along with field surveys and interviews with the maintenance team.

The maintenance team patrolled daily for two months to maintain the scattered containers in the disaster area. However, they faced extreme difficulties, such as road collapses due to the earthquake, snowfall, snow accumulation, low temperatures, and long-distance travel. Additionally, securing personnel was challenging.

There is an urgent need to establish an operational system for mobile medical containers. Maintenance tasks, such as checking fuel levels of generators, monitoring container tilt, inspecting external and internal damage, and assessing snow accumulation at the installation sites, should be measured by sensors. Integrating this data into the operational system and visualizing it is necessary to reduce the burden on the maintenance team.

Central Asia, a region characterized by seismic activity, extreme weather conditions, and diverse cultures, presents complex gender dynamics within disaster response and recovery efforts. Despite longstanding traditions that often relegate women to secondary roles, recent years have seen a shift driven by policy changes and educational initiatives. This study analyzes gender representation in disaster response in Kazakhstan, Kyrgyzstan, Uzbekistan, Tajikistan, and Turkmenistan, focusing on how cultural factors influence these roles. The aim is to provide a data backed comparison of participation rates, leadership presence, and community impact, offering insights into how gender inclusivity affects disaster resilience.

A detailed content analysis was used, examining the various publicly available sources, including government documents, reports from emergency agencies, media coverage, and social media posts published in Kazakh, Kyrgyz, Russian, and English languages. The dataset spanned the past decade, with a particular focus on between 2018 and 2023. Quantitative data on gender participation were extracted and analyzed alongside qualitative information regarding societal attitudes and cultural practices.

In Kazakhstan, women comprised 20% of formal disaster response teams, with urban participation boosted by educational campaigns. Notably, women held leading roles, including department heads at the Ministry for Emergency Situations, and emergency drill participation rose by 35% from 2020 to 2023. In Kyrgyzstan, 40% of first responders were women, though leadership remained male-dominated. Uzbekistan saw moderate gains in women-led awareness programs, while Tajikistan and Turkmenistan had only 10% female participation in formal roles due to patriarchal norms. Social media analysis highlighted traditional views, showing support for inclusive policies but resistance in rural areas.

The study underscores notable progress in women’s disaster response involvement in Central Asia, driven by educational programs and inclusive policies. Yet, deep-rooted cultural norms still hinder leadership roles in more traditional areas. Expanding targeted, culturally adaptive training can enhance regional resilience.

Technology has the potential to improve patient tracking, communications, and management during major events. To ensure optimal use of a digital casualty traceability tool in a “disaster situation,” it is important to train paramedics to use it during routine activities. Hence, in partnership with an EMT technology firm, CISSS de la Montérégie-Centre established the TrackMi Montérégie project.

An existing digital mobile tool designed for rapid exchange of critical information in multi-casualty incidents (MCI) was modified to also collect routine prehospital data to optimize clinical trajectories. The application supports geolocation of patients en route to the hospital and a secure web-based platform for real-time data analysis. As a pilot project (July-December 2024), paramedics in Montérégie voluntarily collected prehospital data into the TrackMi database.

Preliminary TrackMi data analysis revealed that paramedic transport priority (11% urgent, 10% immediate, 79% non-urgent) differed significantly from call center (CCS) ambulance assignments (44% P1-Immediate/Urgent, 42% P3-Immediate). TrackMi distribution for age (20% 85+, 65% 65+, 11% 65-, 3% n/a), gender (57% female, 43% male, 0% other) and Medical Priority Dispatch System (MPDS) complaints (27% 26-Sick person, 16% 17-Falls, 11% 6-Breathing difficulty, 8% 10-Chest pain) matched CCS data. However, TrackMi MPDS assessment by paramedics differed from CCS MPDS data in 37% of cases. In a subgroup analysis (85+), results showed that a majority of patients had a short stay in the emergency room without hospitalization (59%), and TrackMi MPDS better matched the hospital final diagnosis category.

Optimal hospital management depends on its alignment with prehospital resources and the timely transfer of validated information during MCI events and routine operations. As the health system faces many challenges, including aging populations, scarcity of ambulance resources, and lack of personnel and hospital beds, digital tools are increasingly required to assist in the real-time analysis of prehospital data, improve clinical trajectories, and hospital fluidity.

Ensuring hospital functionality during and after disasters is crucial for global communities. The World Health Organization’s (WHO) Hospital Safety Index (HSI) serves as a robust instrument for evaluating hospital safety to disasters in three components: structural, non-structural, and emergency and disaster management. This study leverages HSI scores to assess safety trends in 15 private clinics in Colombia.

A retrospective analysis was conducted on existing Hospital Safety Index (HSI) scores from 15 private Colombian clinics (2015-2023). Data was sourced from the safety index calculator tool of each institution, which reflects the evaluations by a multidisciplinary team (structural engineer, hospital architect, disaster management nurse). Results were contrasted with the evaluation team´s recommendations. Correlation analysis explored the relationship between specific HSI components and overall safety performance.

The primary threats to all clinics were earthquakes and fires. Overall, the structural and non-structural components demonstrated adequate safety levels for both risks. Key areas of concern include insufficient knowledge about post-disaster water and energy autonomy and inadequate restrain of furniture, equipment, and pharmacy/warehouse contents to prevent tipping during an earthquake. The analysis revealed that emergency and disaster management was the weakest component across all clinics, with a prevalence of the “paper plan syndrome”.

The results consistently show that while there are aspects of the structural and non-structural components that are common to all clinics that could be improved, the primary deficiency lies in the lack of a comprehensive emergency and disaster risk management plan. Such a plan should promote a gradual reduction of vulnerabilities, be based on an understanding of the real challenges posed by a disaster, and be developed in a multidisciplinary manner by decision-makers. Moreover, the plan should be disseminated to all employees, contractors, and patients, tailored to their specific roles.

Following natural disasters, specialized health, medical, and welfare teams are deployed to affected areas to support the affected population. It is crucial to manage the health of affected individuals, but also that of the responders. It has been suggested that responders’ performance declines when they experience physical or mental health issues, highlighting the need for comprehensive health management, including environmental factors. This study aimed to examine the association between responders’ activity environments and their performance using the Responders Health Management ver. of the Japan-Surveillance in Post-Extreme Emergencies and Disasters (J-SPEED).

This study targeted health, medical, and welfare responders involved in the response to the Noto Peninsula earthquake on January 1, 2024. Data were collected via the Responders Health Management ver. of J-SPEED from January 6 to March 31, 2024. We analyzed the association between responders’ activity environments and their performance during the acute (January) and subacute (February – March) phases.

Several activity environment factors were significantly associated with lower performance throughout the study period, including “Unclear organization and chain of command”, “Difficulty in ensuring a safe activity environment”, and “Lack of meals and breaks”. During the acute phase, “Activities at headquarters” was a significant factor associated with lower performance, while in the subacute phase, “Lack of infection protection equipment” was a significant factor.

This study found phase-specific factors associated with lower performance in disaster relief responders. These findings suggest the need to consider phase-specific responses when developing future health care strategies for responders.

This presentation will report on medical evacuation challenges involving pediatric specialty hospitals and the capabilities and challenges identified during the October 2022 National Pediatric Disaster Conference Significant Event Readiness Forum (SERF). The event drew pediatric subject matter experts and entities from across the nation to explore opportunities along the disaster response continuum addressing the multi-state and federal capability in the event of a catastrophic earthquake. Over 351 coalition, pediatric, EMS, air-medical state, regional, and national disaster response partners participated in this hybrid event. The purpose of a SERF is to foster information sharing and relationship development with a targeted group of stakeholders who do not always plan together.

The presentation will discuss how a Significant Event Readiness Forum provided a framework for stakeholders to understand command structures and situational awareness on the first responder and private sector level is needed to operationally manage military, and private sector medical transportation staging, triage, and deployment of ground and air transport associated with a no-notice catastrophic event.

In the event of massive infrastructure disruptions, facilities will be faced with decisions to self-evacuate or shelter in place. Prolonged staging will necessitate going “old school,” informed by lessons learned from our colleagues in war and austere settings.

Lessons learned:

1. 1. Facilitated discussions are needed across disciplines and sectors before community planning for pediatrics and other special populations.

2. 2. SERF format results in improved communication and consensus planning across disciplines and private public partnerships.

3. 3. Improvements are needed in developing and testing plans for interoperable interstate communication, coordination, and response.

4. 4. Addressing the “basic” needs of the workforce and community in the first 24 hours for food, water, restrooms, shelter, and emotional support may be one of the most important factors in resilience and recovery.

The Japan DMAT Secretariat’s International Operations Section supports international requests to share Japan’s disaster medical knowledge. Its activities include technical transfer to developing countries, organizing disaster medical symposia, and gathering advanced insights to enhance Japan’s disaster response systems. A review of Japan DMAT Secretariat International Operations Section activities were conducted. The results of the review include:

International Collaboration and Technical Transfer - Japan has provided disaster medical expertise to developing and neighboring countries, drawing on its experience from the Great East Japan Earthquake. Initiatives include technical transfer across Asia and joint symposia with the US and South Korea. Participation in International Conferences and Workshops - Japan DMAT actively shares knowledge at international forums, such as the APCDM and NDMS Summit, presenting Japan’s disaster medical achievements.

Training and Hosting Programs - Japan DMAT provides technical support through training to countries like Moldova, Ukraine, and Taiwan, assisting them in building local disaster medical systems. Field and Operational Training - Collaborative training with organizations like the U.S. ASPR strengthens mutual disaster response capabilities, including tabletop and field exercises for potential large-scale disasters.

Knowledge Exchange and Cooperative Frameworks - Regular exchanges with countries like Israel, Taiwan, and South Korea support disaster medicine knowledge sharing and cooperation.

The International Operations Section is essential in advancing disaster medical knowledge and technologies globally. To further expand these activities, resource and budget support are needed, along with deeper cultural and political understanding tailored to the partner country’s needs. Given Japan’s risk of large-scale earthquakes, the section’s work fosters smooth coordination with international medical teams, leveraging these collaborative relationships.

Violence in health care settings, particularly directed toward healthcare workers, has received increasing attention in the United States. While health care-related violence has taken many forms, shootings have raised special concerns, given the number of potential victims and disruption to a community’s essential health infrastructure. However, there is limited evidence on trends in hospital-based gun violence. To address this gap, we studied characteristics of US hospital-based shootings over two decades.

A search of Nexis Uni was conducted for newspaper articles, newswires, web news articles, or magazines mentioning hospital-based shootings during the period from 2000 and 2019. The search strategy included the terms (“shooting” w/5 “healthcare” OR (“shooting” w/5 “health care”) OR (“shooting” w/5 “hospital”) OR (“shooting” w/5 “emergency room”) OR (“shooting” w/5 “ER”). Articles were screened for relevance, and data were subsequently extracted and categorized by two independent reviewers.

From 2000-2019, we identified 148 hospital-based shootings with 241 victims. Mean number of shootings increased from 3.4/year during 2000-2004 to 8.4/year during 2005-2009 [rate ratio (RR): 2.5, 95% CI: 1.4, 4.3], to 11.2/year during 2010-2014 (RR: 1.3, 95% CI: 0.9, 2.0) but decreased to 6.6/year during 2015-2019 (RR: 0.6, 95% CI: 0.4, 0.9). An overwhelming majority (91%) of shooters were male, with a median age of 46. The most frequent motive was the spillover of social violence (22%). The majority (59%) of events involved a single victim, although 14% had 3 or more victims. Perpetrators were also most likely to be victims (35%), followed by hospital staff (26%).

Hospital-based shootings remain a persistent threat, with the 2010-2014 period representing increased risk. While motives were varied, the spillover of social violence was seen with the greatest frequency. Most hospital shootings involved a single victim, but some events involved three or more victims. These findings can potentially inform prevention and mitigation strategies for hospital-based gun violence.

An estimated one million people traveled to the state of Indiana to view the April 8, 2024, total solar eclipse, with over 125,000 of them coming to the city of Indianapolis. This study seeks to evaluate the impact of this large mass gathering on Fire and Emergency Medical Services call volume and response times, as well as interhospital transfer volume.

Call volumes and response times for the Indianapolis Fire Department (IFD) were analyzed for the following date ranges (all 2024): 3/29-4/4, 4/5-4/11, and 4/12-4/18. Indianapolis Emergency Medical Services (IEMS) call volumes and response times, as well as interhospital transfer (IHT) volume for Indiana University-affiliated hospitals (Indianapolis region) were analyzed for the following date ranges (all 2024): 3/5-4/4, 4/5-4/11, and 4/12-5/10.

IFD total call volume, average daily call volume, and mean response times: for 3/29-4/4: 1074 (153.4), 0:04:16 (urban); 323 (46.1), 0:05:15 (rural.) For 4/5-4/11: 1062 (151.7), 0:04:11 (urban); 334 (47.7), 0:05:31 (rural.) For 4/12-4/18: 1193 (170.4), 0:04:08 (urban); 368 (52.6), 0:04:58 (rural.) IEMS total call volumes, average daily volume, and mean response times: for 3/5-4/4: 11706 (377.6), 0:08:25. For 4/5-4/11: 2763 (394.7), 0:08:38. For 4/12-5/10: 11899 (410.3), 0:08:17. IHT total volume and daily average volume: For 3/5-4/4: 2632 (84.9) For 4/5- 4/11: 567 (81) For 4/12-5/10: 2537 (87.5).

There was minimal variation in response times for either IFD or IEMS during the week of the eclipse compared to the surrounding time frames. There was minimal variation in call volume for IFD, IEMS, and HTV during similar weeks. This could be due to multiple factors, including minimal impact of the mass gathering on emergency medical services or transfers, the large geographic area of the mass gathering, adequate anticipatory preparation, the peaceful nature of the gathering, or other undetermined variables.

The Hualien County Disaster Medical Team, established in 2018, aims to enhance disaster response efficiency. Experiences from several major earthquakes and a train derailment in 2021 revealed that personnel had spent much time locating supplies in complex disaster settings. Applying Lean Management principles, we developed “modular tactical medical belt bags” and “tactical belts” to facilitate the location of supplies, aiming to reduce time and improve operational efficiency by:

1. Regularly checking the inventory and expiration date.

2. Categorizing disaster supplies into modular tactical kits (Triage, Injection, Trauma, Immobilization, and Personal Items Kits). For saving time, tactical kits are fully replaced rather than restocked item-by-item when some items are exhausted.

3. Utilizing tactical belts. The belt, equipped with essentials like a radio and tape, allows responders to keep critical items readily accessible.

Modular kits effectively reduced the time spent retrieving supplies in disaster settings. Tactical belts saved an average of 2 minutes in locating items. Initially, tactical kits were restocked by logistics, taking an average of 5–7 minutes. Later, the process was changed from refilling bags to exchanging used bags for fully stocked ones, giving responders instant access to necessary supplies. This adjustment increased user satisfaction from 82% to 93%.

Every second counts. Applying lean management to DMAT logistics design - “Modular Tactical Medical Waist Bag” and “Tactical Belt” - reduces the time consumed in inventory management, enables faster acquisition of necessary items in unfamiliar environments, and improves the efficiency of disaster medical response.

This case demonstrates the successful use of non-invasive ventilation (NIV) in managing acute pulmonary edema, complicated by altered mentation, severe acidosis, mixed hypercapnic respiratory failure and metabolic acidosis with hyperlactatemia. A 70-year-old female with a history of ischemic cardiomyopathy, diabetes mellitus, hypertension, hyperlipidemia, and previous stroke presented with worsening shortness of breath over two days, which acutely worsened one hour before her Emergency Department visit. Upon arrival, her oxygen saturation was 44% on a non-rebreather mask, and she had an altered mentation (Glasgow Coma Scale E1V1M4). Clinical examination revealed acute pulmonary edema with bilateral lung crepitations and lower limb edema. Arterial blood gas (ABG) showed severe acidosis (pH 6.93), hypercapnia (pCO2 59, pO2 73), low bicarbonate (9), and hyperlactatemia (lactate 12.12).

She was started on biphasic positive airway pressure (BiPAP) with an inspiratory positive airway pressure (IPAP) of 15 cm-H2O, expiratory positive airway pressure (EPAP) of 5 cm-H2O, and FiO2 of 100%. Following 40 minutes of NIV, her oxygen saturation and mentation improved (E4V5M6), with significant ABG improvement (pH 7.28, pCO2 32, pO2 311, bicarbonate 16, lactate 7.35). She was admitted to the high-dependency unit, successfully weaned off NIV within 24 hours, and transferred to the general ward the following day.

While NIV is essential for managing acute heart failure and pulmonary edema, its use is challenging in patients with severe acidosis (pH < 7.2) and altered mentation. Acidosis can indicate respiratory failure, and altered mentation raises concerns about the patient’s ability to tolerate the NIV mask or protect their airway. However, this case demonstrated that despite these contraindications, careful monitoring led to rapid improvements. This underscores the importance of reassessment soon after NIV initiation, as it can still be effective if improvement is seen, avoiding intubation and improving patient outcomes.

Disasters impose significant challenges on global health systems, especially in vulnerable populations with limited resources and disaster preparedness training. The International Federation of Medical Students’ Associations (IFMSA) Emergency, Disaster Risk, and Humanitarian Action (EDHA) program addresses these issues by equipping medical students and communities with essential disaster resilience and preparedness skills.

The EDHA program facilitated 46 targeted activities over three years, including 21 disaster-response training sessions for medical students and healthcare professionals. Nine humanitarian campaigns aided disaster-affected areas, while partnerships with local NGOs and health ministries supported advocacy and policy engagement. Data were collected through reports on activities reached, training outcomes, and policy influence.

The EDHA program reached over 82,000 individuals, comprising 57,000 community members who gained public health information and 25,000 medical students and professionals who enhanced their disaster preparedness skills. Training evaluations showed a 65% increase in knowledge retention and a 70% improvement in disaster response skills. Policy discussions in five countries led to local advancements in disaster preparedness. The humanitarian campaigns delivered critical aid, including medical supplies, to areas affected by crises, ensuring direct community benefit and strengthening local health resilience.

The IFMSA EDHA program builds disaster resilience in vulnerable populations through education, advocacy, and community aid. This program also empowers future healthcare leaders to create effective and responsive health systems in times of crisis.

Disaster triage is an essential competency for paramedics, demanding quick and accurate decision-making in high-pressure environments. Traditional training methods, such as lectures and tabletop exercises (TTx), may not fully replicate the intensity required to build these skills. Virtual reality (VR) presents a novel solution, offering realistic and interactive simulations within a controlled environment.

A randomized study was conducted with paramedic students (n=83) at the Faculty of Medicine, Ramathibodi Hospital, Mahidol University, divided into traditional (lecture + TTx, n=41) and VR-based (lecture + VR-SSST, n=42) training groups. Both groups received identical lectures, followed by their respective practice methods. Knowledge was assessed through pre- and post-tests covering memory, comprehension, application, and analysis domains. Motivation was measured using the ARCS model (Attention, Relevance, Confidence, Satisfaction).

Both groups showed significant post-test knowledge improvement. The VR group outperformed in all ARCS dimensions: attention (4.78 vs. 4.17, p<0.001), relevance (4.79 vs. 4.37, p<0.001), confidence (4.74 vs. 4.24, p<0.001), and satisfaction (4.71 vs. 4.34, p<0.001).

The findings indicate that VR-based disaster triage training enhances motivation more effectively than traditional methods, while both approaches are effective for knowledge acquisition in paramedic students.

A 42-year-old female with no significant past medical history presented to the emergency department (ED) with altered sensorium. Her spouse reported confusion and left-sided hemiparesis. Examination revealed right gaze deviation and left hemiplegia. Brain CT imaging showed an acute intraparenchymal hematoma in the right frontal lobe, with hemorrhage along the right cerebral convexity and a resultant leftward midline shift. Due to the hemorrhage pattern involving multiple arterial regions, a CT brain venogram was performed, revealing multiple cerebral sinus thromboses. She was also found to have diabetic ketoacidosis (DKA). Anticoagulation was initiated, and she was treated for DKA and admitted to the high-dependency unit for monitoring. During her stay, a repeat CT brain scan was performed following a drop in GCS, which showed stable hemorrhage but a new infarct in the right occipital and frontal lobes. She subsequently underwent cerebral venous sinus thrombectomy. Thrombotic and autoimmune screenings were normal. She recovered with residual left-sided hemiparesis and was referred to a rehabilitation hospital and discharged with lifelong anticoagulation.

Managing CVST with venous hemorrhage presents challenges, as anticoagulation may exacerbate the hemorrhage. This patient’s initial plain CT brain hemorrhagic findings were not initially recognized as a possible CVST by the neurosurgeon, and after reviewing the CT images by the ED physician, further discussion with the radiologist was done, and a CT venogram was performed. Although plain CT brain scans are widely used, ED physicians must recognize findings suggestive of CVST. While CVST is treated with anticoagulation, endovascular thrombectomy may be a viable option for selected patients in centers equipped with this capability.