On July 19, 2024, SUNY Downstate Medical Center faced system-wide failures after a faulty CrowdStrike update. Disruptions to EMR, radiology, and lab workflows required immediate response. This presentation explores the impact and response to this global healthcare cybersecurity event.

SUNY Downstate activated its Emergency Operations Center and manual protocols. Communication was maintained through departmental huddles, Sendword Now, and the Telegram app. External partners, including NYCDOH and GNYHA, were notified as IT worked to restore critical systems.

Through effective coordination, SUNY Downstate reduced downed workstations from 3,500 to 1,500 within hours. Critical systems, including EMR and radiology, were restored by the next day, allowing continued care despite manual lab operations and limited access to certain tests.

This incident reinforced the need for robust emergency and cybersecurity protocols in healthcare. SUNY Downstate’s response minimized patient impact and highlighted the importance of preparedness, clear communication, and resilient systems for future incidents.

In undifferentiated cardiac arrest, the “5Hs and 5Ts” approach has been the cornerstone guiding advanced care and management. In recent years, however, more streamlined and targeted approaches have been posited for specific subsets of arrests where a single H or T is likely to be the cause. Specific Hs and Ts — for example, traumatic arrest, drowning (hypoxia), and hypothermia, to name just a few — have each enjoyed tailored approaches and algorithms that inform the sequence and dictate care to focus on high-yield diagnostics and interventions that are context-specific and depart somewhat from standard ACLS algorithms.

This systematic review examines the potential for developing a focused algorithm for recreational toxicologic arrests at music festivals.

The evidence supporting specific interventions (e.g., airway support, antidotes, deviation from standard ACLS medications) is reviewed, and the primary considerations (toxidrome, substances used, presenting rhythm, etc) affecting decision-making are summarized for the tailored management of cardiac arrest related to recreational substance use at music festivals.

Cardiac arrests at music festivals would benefit from a tailored approach to high-yield management, medications, and interventions based on substances ingested, presenting toxidrome, and presenting cardiac rhythm. There is a need for further research on this subject to bolster the evidence for deviation from standard Advanced Cardiac Life Support (ACLS) practices, as a tailored toxicological approach would likely confer significant benefits to patient outcomes.

At the WADEM 2023 Killarney congress, a new presentation format involving a tabletop-style discussion was offered. One abstract accepted for this format described a study comparing the capture of patient hazard exposure information by health and medical responders at six large international natural hazard disasters. The original objective of submitting the abstract was to present the study as an oral presentation, demonstrate the universal lack of patient hazard-exposure assessment, and advocate for urgent change in the recommended emergency minimum patient dataset.

Round table participants joined a facilitated discussion to identify and share similar challenges from their fields of expertise and collectively explore innovative ideas to solve challenges. The examples and network ideas were collated, and agreement was sought to follow up with participants after the session.

Based on feedback from round-table participants, ongoing conference discussions, and post-conference communications with a wider healthcare network, an initiative called ExposureNet was created using resource support of philanthropic actors. Since its launch at the World Congress of Epidemiology in Cape Town in October 2024, hundreds of disaster and emergency workers from across high and low-income country domains have registered their interest in joining the network. The purpose of ExposureNet is to connect and support disaster and emergency practitioners in building the evidence base about patterns of illness/injury from exposure to events and identify interventions, their timeliness, and the quality of care necessary to protect vulnerable people.

WADEM’s importance and leadership in advancing disaster health and medicine policy and practice cannot be underestimated. Without the change in conference format, the ExposureNet initiative would not exist. Now, a worldwide community of disaster health and medicine practitioners is supporting each other to build evidence about the relationship between people’s exposure to crises and disaster events and the patterns of injury and illness they cause.

The COVID-19 pandemic likely increased exposure to potentially traumatic events. A population of special interest is healthcare workers who cared for COVID-19 patients, as they were, especially during the peaks of the pandemic, exposed to groups of severely ill or dying patients under extreme care delivery circumstances. This review and meta-analysis estimate the pooled prevalence of mental health outcomes among healthcare workers exposed to these conditions.

A systematic literature search was conducted using several databases: Embase, PubMed, PsycINFO, and PTSDPubs. Inclusion criteria focused on studies assessing work-related trauma exposure among healthcare workers during the pandemic and those reporting prevalence rates of trauma-related mental health outcomes (PTSD, anxiety, and depression). A multilevel meta-regression was used to calculate pooled prevalence rates and examine the impact of study characteristics on outcomes.

Eleven studies were included that assessed the mental health of healthcare workers who cared for severely ill or dying COVID-19 patients. The mean pooled prevalence of trauma-related mental health outcomes was 26.1%. There was no significant difference in pooled prevalence between outcome types (PTSD, anxiety, or depression). A significant difference was observed between the pooled prevalence from studies conducted in countries with a high Human Development Index (12.9%) compared to studies from countries with a very high Human Development Index (45.8%).

A relatively high proportion of healthcare workers exhibit psychopathology following work-related exposure to the pandemic. This highlights the severe psychological toll of the pandemic on this professional group, who faced sustained exposure to stressful situations during the pandemic in exceedingly difficult circumstances. It is crucial to ensure early access to psychosocial support, such as organized peer support, to healthcare workers during major public health crises, especially during crises when traditional social support systems may be disrupted.

Primary care is the gateway to any healthcare system. Paradoxically, where the need is greatest – particularly in fragile states and conflict-affected communities – so, too, is the shortage. Providers serving in these circumstances face a wide range of clinical problems across various age groups, but with limited resources to draw upon. And there are precious few educators to prepare these practitioners for the daunting tasks they face. Drawing from primary care program development in diverse communities, this session will define primary care needs, identify primary care providers, address problems and challenges in training, examine assumptions that can hinder healthcare system building, and discuss how to implement and monitor sustainable interventions based on primary care principles.

The World Health Organization (WHO) has emphasized the need for the development of resilient health systems to meet current and future disaster readiness needs. The WHO has also emphasized mechanisms that will achieve this goal, including a focus on strengthening the global nursing workforce to achieve the Sustainable Development Goals. However, there is limited synthesized research focusing on the contributions of the nursing workforce in developing and fostering health system resilience globally.

Using Joanna Briggs Institute methodology for scoping reviews, three databases (PubMed, CINAHL, and Scopus) were searched for publications from 2006 until April 2024. English-language research studies and quality or process improvement projects were included. Systematic reviews, as well as studies focused on individual resilience, were excluded. Studies meeting search criteria were exported and screened first by title and abstract, and subsequently underwent a full-text review using Covidence software. Quantitative and qualitative data from studies meeting inclusion criteria were extracted and analyzed according to study objectives to create a narrative synthesis. This study was registered in the Open Science Framework on May 28, 2024.

Eleven articles were included of the 795 total retrieved. Overall, there is limited discussion of the nursing workforce in health system resilience. Eight of the 11 articles (73%) suggest that the nursing workforce is involved in operationalizing resilience during disasters, 10 articles (91%) call for nurses to be leaders in policy and the development of resilient health systems, however, this review found zero reports in the literature of the nursing workforce’s role in the planning, development, and leadership of resilient systems.

Nurses are essential to resilient health systems, however, there is limited research examining the nursing workforce and its contributions to resilient health systems, particularly within disaster contexts. More targeted research on nursing workforce contributions to achieve resilient health systems is needed.

On January 8, 2020, Al Asad Air Base was attacked with more than 12 Theatre Ballistic Missiles from Iran. To date, this is the largest ballistic missile attack on American service members. Soldiers began to report post-concussive symptoms and sleep changes. The goal of this study is to characterize neurobehavioral symptoms among these soldiers.

A survey performed 4-6 weeks after the attack assessed blast exposure, neurobehavioral symptom inventory (NSI), and sleep habits before and after the event. A latent class analysis (LCA) informed by the presence of the most common persistent NSI symptoms was executed. The resultant profiles assessed the soldier’s location, and if on the base distance to the missile strikes and self-reported sleep duration.

In total, 593 service members and contractors completed the survey; 85% were 40 years of age or younger. The LCA identified three distinct classes: ‘Minimally Affected’ (60.5%), ‘Moderately Affected’ (28.8%), and ‘Profoundly Affected’ (10.7%). Overall, the most commonly reported persistent symptoms were ‘difficulty sleeping’ (32.7%), ‘feeling anxious’ (25.7%), and ‘headache’ (22.3%). The Moderately and Profoundly Affected classes had substantially elevated probabilities of persistent neurobehavioral symptoms, significantly reduced sleep duration, and were more likely to be closer or more exposed to the missile strikes than those in the Minimally Affected class.

More than 80% of the soldiers reported some form of blast exposure. Three phenotypic classes characterized by increasing likelihood of persistent neurobehavioral symptoms were identified. Increased proximity to the missile strike was associated with a greater number and/or persistence of mental and physical symptom burden after the attack. Soldiers exposed to theatre ballistic missile attacks should be screened promptly and until symptom resolution.

This presentation aims to illuminate the unique challenges faced by older adults in the context of climate change and its compounding effects on health risks. Older individuals, particularly those with comorbidities, experience increased vulnerability due to environmental factors such as poor air quality, extreme weather events, and displacement from natural disasters. The presentation identifies specific health concerns, including:

1. Neurocognitive Impairments: Exposure to extreme heat exacerbates conditions like dementia and increases the risk of heat-related illnesses, especially in those with pre-existing cognitive impairments.

2. Metabolic Disorders: Climate-induced disruptions in medication access, such as delivery issues, contribute to elevated cortisol levels and exacerbated metabolic conditions.

3. Cardiovascular and Respiratory Issues: Poor air quality resulting from industrial pollution and wildfires leads to oxidative stress, adversely affecting cardiovascular and respiratory health.

4. Renal Health: Dehydration and electrolyte imbalances result from extreme temperatures and disrupted water supply, impacting kidney function.

5. Musculoskeletal Pain: Long-term temperature fluctuations and weather changes can lead to joint pain and mobility issues among older adults.

6. Psychosocial Effects: Disruptions to social networks during disasters increase feelings of isolation and vulnerability among older populations.

7. Immune System Compromise: The proliferation of waterborne pathogens poses a significant risk to older adults’ immune health.

8. Integumentary Concerns: Natural disasters can increase exposure to flesh-eating bacteria and diseases such as Melioidosis.

By addressing these challenges, the presentation underscores the urgent need for targeted interventions and policies to support the health and well-being of older adults in the face of climate change.

Wildfires are an increasing global threat, exposing over 2 billion people annually to hazardous air quality. Children from low socioeconomic status (SES) regions often experience worse respiratory outcomes during wildfires compared to their higher SES peers. However, direct data on wildfire impacts remains limited. This study examines whether wildfires exacerbate respiratory health disparities compared to non-wildfire periods.

A retrospective cohort study of 2,417 patients aged 0-29 years admitted to a quaternary Pediatric Intensive Care Unit for acute respiratory failure from 2016-2023 was conducted. Data were collected from Virtual Pediatric Systems, the Area Deprivation Index (ADI), Fire Information for Resource Management, and the Air Quality System, and merged using zip codes.

The Wildfire cohort included children with a wildfire within 100 miles, confirmed by satellite, and PM2.5 levels in the 10 days before admission exceeding 1 standard deviation above the annual mean. Non-wildfire patients were all other respiratory failure admissions in the same period. SES was defined by ADI quintiles, with low and high SES representing the lowest and highest quintiles. Statistical analyses included Fisher’s exact test, Mann-Whitney U test, and logistic regression.

During wildfires, children from low SES backgrounds had a significantly higher risk of intubation than in non-wildfire times (29% vs. 13%, p = .003), a difference not observed in high SES children (8% vs. 10%, p = 0.49). Logistic regression showed that wildfire exposure and low SES together increased intubation odds (OR = 2.7, p = .04). Higher Pediatric Index of Mortality 3 (PIM3) scores also raised intubation risk (OR = 1.3, p < .001) while other investigated demographic factors did not.

This study underscores the elevated respiratory risks for low-SES children during wildfires. Additional research and greater public health awareness can inform targeted interventions and disaster preparedness to protect these vulnerable populations as wildfire frequency increases.

The Taliban takeover in August 2021 put an end to over 40 years of conflict, albeit it resulted in the departure of several international organizations from the country and the freezing of assets, which unleashed economic and humanitarian crises. Taking advantage of the reopening of previously restricted areas and the longstanding presence of Emergency in the country, this study sought to achieve a thorough understanding of access to care in Afghanistan by exploring trends, barriers, and changes after August 2021.

The project consisted of three phases: analysis of Emergency aggregated surgical, maternal, and pediatric data to explore healthcare utilization over the years; dissemination of a 67-item questionnaire to patients visiting Emergency facilities by trained local staff; and semi-structured interviews with local health professionals.

The result of a collaboration between Emergency and CRIMEDIM.

Facilities’ records from 11 provinces were analyzed, 1807 questionnaires were collected, and 43 interviews were conducted. Data revealed a drop in consultations in August 2021, but rates returned to normal as early as September 2021, with more patients seeking care for civilian trauma rather than war wounds. Although patients feel safer when visiting health facilities, their ability to pay for care has decreased after August 2021. Many health system-related factors impact access to care and make people go straight to larger hospitals, aggravating the congestion of patients in tertiary hospitals.

This study contributes to paving the way to Universal Health Coverage in Afghanistan. Although the country has a unique social, political, and economic context, these results can be generalized to other postcolonial settings.

Full authorship: Martina Valente, Alessandro Lamberti-Castronuovo, Francesca Bocchini, Monica Trentin, Yasir Shafiq, Michela Paschetto, Ghulam Ali Bahdori, Jan Agha Khadem, Mirza Sayed Nadeem, Mohammand Hanif Patmal, Mohammad Tawoos Alizai, Francesco Barone-Adesi, Rossella Miccio, Luca Ragazzoni.

The widespread availability of handheld point-of-care ultrasound systems (HHUS) has rapidly increased the number of preclinical emergency medicine ultrasound examinations in Germany. HHUS used by emergency physicians at the Southside Festival (SSF) in southern Germany was evaluated over several years according to its feasibility and ability to change patients’ disposition and treatment process.

By questionnaire, the doctors performing the examination were asked about the indication, the body region examined, the ultrasound protocol used, if any, the duration of the examination, and any changes in the further procedure. In addition, the subjective assessment of the assessability, the visualization under the existing lighting, and the ultrasound experience of the users were surveyed.

In three years, a total of 29 ultrasound examinations were assessed by the sonographers. The majority of examined regions were the abdomen (55.2%). 27.6% used the (e)FAST protocol; no protocol was used in 41.4%. Indications: 31.0% pain, 20.7% trauma, 27.6% examiner’s interest, 24.1% confirmation of suspected diagnosis, 3.4% as part of CPR. Duration: examination 41.4% <2 min, 41.4% 2-5 min. In 20.7%, the procedure was changed due to the examination. Assessability and visualization were rated 2 (1 very good - 6 poor). Half of the users considered themselves experienced.

Ultrasound examinations under medical service conditions at an MGE were feasible and accessible. The majority of examinations concerned the abdomen. US protocols were only used in half of the cases. The duration of the examination was usually less than 5 minutes, and the procedure was changed further by the examination in 20.6% of cases. Since there is supposed to be a large amount of extremities trauma in festival visitors, this percentage might be even higher when (in fracture and joint ultrasound) trained emergency physicians are in charge. Data collection will continue.

Mortality resulting from incompressible hemorrhage is the primary cause of pre-hospital deaths, highlighting the urgent need for the development of innovative hemostatic materials capable of effectively managing this type of bleeding. Inspired by the long-lasting foams constituted by transition metal ion-protein complexes, an injectable and stable liquid hemostatic foam has been developed, composed of gelatin/silk fibroin and hemostatic transition

metal ions, Ca2+/Fe2+. The foam was rapidly obtained using a simple dual-syringe Tessari method. The dimensional changes of the foam were characterized, and its interaction with blood was observed under an optical microscope. The rheological properties of the foam were investigated using a rheometer. The hemostatic performance of the material was validated using rat liver laceration models, femoral artery bleeding models, and porcine femoral artery injury models.

A liquid hemostatic foam was successfully prepared for rapid hemostasis and short-term protection of non compressible wounds. The prepared foam exhibits excellent stability and mechanical strength, meeting the requirements for addressing incompressible hemorrhage. While achieving rapid hemostasis, the foam can be easily removed from the wound without disrupting the clot or causing secondary bleeding, which aids in pre-hospital rescue and the expedited transportation of casualties. This manuscript aims to further advance rapid prehospital treatment for non-compressible hemorrhage, thereby minimizing mortality from such bleeding incidents as much as possible.

The integration of AI into the field of disaster medicine represents a significant advancement in improving the speed and efficiency of emergency response by facilitating faster decision-making processes, optimizing resource allocation, and enhancing communication systems. Given the effectiveness of AI, it is essential to explore its potential applications within disaster medicine. To investigate this topic, we conducted a scoping review on AI applications aimed at enhancing the efficiency of emergency response and minimizing the time to care.

Following the PRISMA-ScR guidelines, a comprehensive search was conducted across five databases. Peer-reviewed studies published in English between 2019 and 2024 that focused on AI applications in disaster medicine were included. Two reviewers independently screened the titles, abstracts, and full texts. Relevant findings were extracted in a thematic format.

Out of 15,431 studies, 239 were included. The volume of publications increased from 8 in 2019 to 59 in 2021. Research output was predominantly concentrated in Asia (40%), followed by multi-country collaborations (21%), with both Europe and North America contributing (15%) each. The primary focus of the studies was on machine learning (65%), often in combination with deep learning (50%) and decision-support systems (36%). Common applications identified included decision-support tools (86%), AI-assisted triage (63%), early warning systems (52%), and patient monitoring (49%). Notably, most of the studies (84%) concentrated on pandemics, while natural disasters were (16%), and humanitarian crises (3%).

The results of our research indicate that the COVID-19 pandemic has resulted in rapid advancements in innovative applications, primarily focused on enhancing situational awareness and optimizing triage procedures in pandemic-related emergencies. To evaluate the life-saving potential of AI, it is essential to integrate these technologies into a wider range of disaster scenarios, supported by rigorous validation processes. This approach will improve the ability of responders to protect communities during future disasters.

From 2020-2022, this author deployed three times with the US Army. These deployments involved a field hospital in Baghdad, Iraq; a no-notice deployment with a forward resuscitative surgical team before the fall of Kabul, Afghanistan; and a no-notice deployment with a forward resuscitative surgical team to Romania after Russia invaded Ukraine. This presentation:

1. Relives those deployments, as well as the moments leading up to those deployments, from the point of view of an Emergency Medicine Physician.

2. Discusses the unique medical cases seen in those austere environments, such as treatment of COVID-19 and hypoxia in a combat zone with a portable oxygen generator, treatment of a military working dog, diagnosis and management of infectious myositis, and mass casualties from the explosion at Abbey Gate in Kabul.

3. Discusses the NATO roles of care (e.g., Role 1, Role 2, Role 3, and Role 4).

4. Discusses CBRNE preparation in Eastern Europe.

Hyperbaric oxygen treatment (HBOT) is often required in various disaster situations, such as fires, explosions, chemical accidents, and ship sinking rescues. Hyperbaric oxygen chambers (HBOCs) capable of performing such treatment are key resources for responding to disasters. As such, their quantity and placement must be appropriate. In this study, assuming a disaster situation that requires multiple HBOCs to be deployed simultaneously, the author investigated and analyzed the regional deployment status of HBOCs in Korea and their adequacy for toxic gas disasters based on medical institutions with HBOCs, and developed a scoring index to express this.

In the event of a disaster requiring HBOT, all hospitals with HBOCs in Korea could theoretically participate, so hospitals with HBOCs were examined. The distribution of HBOCs by region, type, and population was then analyzed, as well as the ability to perform simultaneous HBOT and HBOT in disasters by region. The results were used to derive the Critical Patient Response Index (CPRI) and Total Patient Response Index (TPRI) for hazardous gases and comparison by region.

In Korea, a survey of HBOCs over the past 15 years found that the first wave of expansion in 2015-2016 and the second wave of expansion since 2019 have resulted in increased deployment in previously underserved areas. However, when analyzed based on population base, concurrent capacity, and treatment performance, the deployment of HBOCs was skewed toward some regions. Expressed as an index, the CPRI ranged from 0.045 to 1.5, and the TPRI ranged from 0.215 to 3.222, allowing for a clear comparison of disaster response capabilities.

The index developed in this study has limitations, as it may not include all actual hospitals and may not reflect differences in human resources or operations. Nevertheless, the index can be used objectively and relatively to represent a region’s ability to respond to disasters requiring HBOT.

In 2023, conflict-related injuries resulted in 172 thousand fatalities. A majority of those killed and injured in armed conflicts are civilians. The most common anatomical site of conflict-related injury for civilians is the extremities. There is a need for increased knowledge on the epidemiology of civilian casualties. This study aims to describe the epidemiology of a population treated for conflict-related extremity injuries at civilian hospitals.

Data were derived from a pragmatic randomized controlled trial performed at two civilian trauma hospitals in Iraq and Jordan with patients injured in Iraq or Syria. Recruited patients were adults (≥18 years) with an acute (<72 h) conflict-related extremity injury not suitable for primary closure.

Median age was 28 (interquartile range [IQR] 21–34) years. 155/165 (94%) patients were male. On admission, the median systolic blood pressure was 120 (IQR 110–130) mmHg, the median heart rate was 96 (IQR 85–110) beats per minute, and the median hemoglobin level was 133 (IQR 113–144) g/L. 93/165 (56%) patients had at least one fracture. The most common mechanism of injury was gunshot (100/165 [61%] patients), followed by blast (63/165 [38%] patients). 43/165 (26%) patients had concomitant injuries. Bleeding requiring blood transfusion affected 56/165 (35%) patients. Only 1 patient received more than 10 units of packed red blood cells. Wound infection was found in 29/165 (18%) patients. The median length of stay was 10 (IQR 5–37) days. After 5 days, 92/165 (56%) patients had obtained wound closure. One (1%) patient died during hospital stay.

Males were highly overrepresented amongst the patients. Compared to previous similar studies, gunshot as a mechanism of injury was unusually frequent. Fractures were common, including open fractures. Bleeding was a common complication, but massive transfusions were rare. The mortality of the patients was low in comparison to non-conflict civilian trauma hospitals.

According to The International Disaster Database, one-third of disasters worldwide are technological. In Japan, chemical, biological, radiological, nuclear, and explosive (CBRNE) disasters are less common than natural disasters. However, every hospital is required to respond, because once a disaster occurs, victims might rush to the nearest hospital regardless of the hospital’s preparedness. The present study aimed to determine the association between the readiness and willingness of regional hospitals to accept victims of CBRNE disasters.

Physicians and nurses of middle rank and above who are currently working in the emergency departments of 685 regional medical care support hospitals were asked to respond to a questionnaire about their past experiences and preparedness with regard to CBRNE disasters and their willingness to respond if victims came to the hospital in the future. A binomial logistic regression analysis was used to confirm this association. The survey was approved by the institutional ethical review boards of the affiliated universities.

105 physicians (15.3%) and 113 nurses (16.5%) responded to the survey. Regarding the respondents, 76.2% (80) of physicians and 69.0% (78) of nurses belonged to disaster-based hospitals. A total of 67.6% (71) of physicians and 54.9% (62) of nurses had previous CBRNE disaster response experience, including pandemics. Willingness to receive victims was significantly associated with the learning experience of the CBRNE disaster (physicians only), working at a disaster-based hospital, and having a history of victim acceptance training for chemical disasters, including terrorism. For nurses, the presence of manuals was associated with their willingness to accept victims of non-terrorist chemical, radiological, and explosive terrorist disasters.

It is hoped that regional hospitals will improve their preparedness for CBRNE disasters. As the effectiveness of manuals and training for responding to victims has been suggested, disaster-based hospitals are expected to support these.

Mass Casualty Incidents (MCI) require complex training and response, and local response in the first hours is essential. In many places worldwide, this initial local response is provided by the primary health care (PHC) network. The training method for MCI is complex and costly, and may not be integrated into the PHC network. Our objective is to measure self-perception and the impact of a brief training action through an MCI tabletop exercise carried out with primary care doctors and nurses using the “MassCas” tabletop game, specifically designed for this project.

Descriptive intervention study of the impact of a two-hour training intervention in the Health Research Institute of the Principality of Asturias with primary care doctors and nurses from the Principality of Asturias. Self-perception using a Likert scale on methodology, knowledge, and skills was analyzed. We also tested knowledge retention with a multiple-choice knowledge test after two months. Strengths and weaknesses of the methodology, as well as attitudes toward mass casualty incidents, were also identified through open questions.

Twenty-seven doctors and nurses participated in the training program. 85% of participants improved their level of knowledge after two months without studying material. Self-perception measured 27 items in 3 dimensions: methodology (Median=9; IQR=2), knowledge (Median=10; IQR=1), and skills (Median=9; IQR=1). All items except one had a median greater than or equal to 9. All items ranked a median 8-10.

Primary care health professionals perceive gamification using the “MassCas” tabletop game for mass casualty incidents as a useful tool in their training in mass casualty incidents and in acquiring specific knowledge and skills in this area.

This study has been partially financed by the Foundation for Biosanitary Research and Innovation of the Principality of Asturias (FINBA), the managing entity of the Health Research Institute of the Principality of Asturias (ISPA).

The 2018 Western Japan floods resulted in numerous fatalities among elderly residents, with many cases of “drowning at home” reported. This study analyzes victim characteristics to explore mitigation strategies for a society experiencing increasing climate-related disasters. We collected cases of home drowning fatalities during the floods in Ehime and Okayama Prefectures through media reports (newspapers and television) and analyzed survival patterns. In Ehime Prefecture, 9 (29.1%) of 32 victims drowned, with 3 (9.7%) drowning at home. All three were over 70 and found on the first floor. In Okayama’s Mabi town, 43 (84.3%) of 51 drowning victims died at home, with 36 (70.6%) being elderly (65+). 42 died on the first floor, one on the second floor. Both prefectures reported cases where surviving elderly residents reached the second floor but failed to convince their spouses to follow, resulting in spouse fatalities. In one case, an elderly couple survived by floating on their bed, which rose with the water level near the ceiling. In Ehime, a family successfully rescued a one-year-old girl and her great-grandmother using a two-seater sofa as flotation. Swimming while clothed is challenging, particularly for elderly individuals with reduced physical strength. Given that most elderly victims drowned on the first floor, the survival probability could increase through flotation strategies. When external evacuation risks are high during indoor flooding, back float and improvised flotation devices (life jackets, coolers, sealed backpacks with clothing) may contribute to survival. This survival technique, internationally known as “Uitemate” (Float and Wait), effectively prevents drowning in various flood disasters and represents a household-level disaster risk reduction strategy.

Airway management, ventilation, and adequate oxygenation are an essential part of prehospital care. The easiest airway can be the most difficult airway for the inexperienced person, especially in disaster situations where more patients will need airway interventions. The combination of Guedel & BVM or perilaryngeal supraglottic airways (LMA) are two airway management techniques that are used in the field. However, effective ventilation with a combination of Guedel & BVM cannot be provided in inexperienced hands due to air leakage. Regarding LMA, there is a decisional dilemma regarding its use by inexperienced providers in prehospital settings. Therefore, new airway equipment providing both airway control & ventilation is needed for prehospital airway control and ventilation. There is new supraglottic airway equipment, guedel-type cuffed oropharyngeal airway (Tulip airway), which can provide both airway control and ventilation support. The study compares Guedel & BVM, LMA, and Tulip airway on prehospital use for airway management.

The study group included military first aid school students. They used Guedel & BVM, Tulip airway, and LMA on the manikin-based simulator. Ventilation adequacy was assessed visually by inflating the balloon that stimulated the lung. Time from insertion to achieved ventilation, instructor intervention, and maneuver requirement were recorded.

The median time from Insertion to achieved ventilation of Tulip airway on manikin was shorter than Guedel & BVM and LMA. Tulip airway requires less instructor intervention and maneuver requirements.

If we grade them from basic to advanced, Tulip airway combines Guedel & BVM and LMA. Although the Tulip airway is simpler than LMA, it is as effective as LMA. As providing ventilation with the simplest airway device is important in disaster situations, Tulip airway, as a guedel-type cuffed oropharyngeal airway, can be evaluated for disaster medical care guidelines.