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.

With the second surge of the COVID-19 pandemic, there was a precipitating need for capacity enhancement of the emergency area in our setting, regarding the number of beds and circulation space. The existing facility for COVID 19 testing of our employees was zeroed in on to be transformed into a fully functional pediatric emergency department.

With a period of 72 hours, the project was undertaken with precise ground-level planning, listing and cohorting of activities, and clear earmarking of roles amongst the team members. The activities were transcribed onto a Gantt chart, assigned timelines to them, and the rate-limiting steps were identified. The civil and electrical works entailed: 1) dismantling of existing structures, 2) putting up of wash basins, 3) RO water system, 4) placement of signages, 5) setting up of a registration area, 6) placement of curtain assembly for each bed, 7) creation of electric-panels at head ends of beds, 8) provision of UPS points, and 8) alternate source of electricity for life saving equipment which were undertaken on a war footing. The IT points were mapped; the telephone line for internal communication and the LAN were extended. The extension of manifold pipeline works from the Trauma ED area to the pediatric emergency department is a rate-limiting step in our timelines, and the execution of it kept us ahead of the planning curve.

The floor area and beds that became available through this transformed new pediatric emergency department were about 279 square meters and 16 beds, almost 3.6 times the floor area and double the bed strength of the old pediatric emergency department.

While it required significant planning on paper and onsite visits by the team members from Hospital Administration, Pediatrics, Engineers, and Manifold, creating a spacious, contemporary pediatric emergency department was made possible within 72 hours.

Mass Casualty Events (MCI) have a direct and persistent impact on the safety and well-being of an emergency department (ED) and its staff. ED physicians may be faced with the prospect of providing ongoing patient care while simultaneously experiencing direct threats to their health or physical safety. In our study, we considered the unique operational challenges encountered and management strategies adopted by the ED staff and its leadership in response to an all-hazard MCI impacting an academic urban emergency department.

We conducted a retrospective, observational study of data from a tertiary academic medical center of patients arriving at the ED during a protracted MCI lasting from May 11th to May 21st, 2021. No arriving patients were excluded from the analysis. Patient demographics, ED resource utilization, throughput, disposition, and other pertinent data were considered. An analysis was done of three distinct patient populations, including the event group, a non-event group, and a control group. Descriptive statistics were used to evaluate observational findings.

We reviewed the records of 8,527 total patients presenting to the Shamir Medical Center ED during the event and control periods. Of those, 283 patients were identified as casualties from the MCI, and 3,563 patients were identified as presenting with complaints not related to the event. Our control group consisted of the 4,681 patients who presented in the two weeks before the MCI.

Findings from our observational qualitative study suggested that, in the absence of larger public health interventions, a manmade MCI, with direct threats to an ED and its staff, could force a department to concurrently address the unique clinical needs of two distinct patient populations while simultaneously needing to take measures to protect hospital staff. Additionally, a higher burden of patient volumes and clinical acuity is likely to be encountered by select specialty consult services.

The military conflict between Russia and Ukraine that emerged in February 2022 transitioned in mid-2023 from an “existential war” into a “war of attrition.” A distinct division within society marks this new phase. On one side are those actively engaged in the war effort, and on the other are individuals who have become passive or indifferent regarding the ongoing war as the new normal.

The longitudinal study assessed the impact of a prolonged conflict on resilience and coping mechanisms, based on two samples (T1 – July 2022 [N = 1001]; T2 – November 2023 [N = 2247]). Data were collected through internet panels’ respondents who completed a structured quantitative questionnaire.

A significant decrease was found in three types of resilience (individual, community, and societal), hope, sense of danger, perceived threats, and PTSD symptoms during the second versus the first measurement. The best predictor of societal resilience was government support. The best predictor of individual resilience was community resilience. The best predictor of PTSD symptoms was perceived threats. The predictors explain 68% (T1) and 60% (T2) of societal resilience, 19% (T1 and T2) of individual resilience, and 58% (T1) and 12% (T2) of PTSD symptoms.

Findings suggest that 'routinization’ of an ongoing emergency is formulated, allowing the population to coexist with the adversity and accept the war as the “new normalcy.” Nonetheless, the future is perceived as uncertain, leading to a decline in hope. Strategies that focus on bolstering resilience during adversities should consist of social support mechanisms that enhance the population’s hope and morale and build the government’s trust and support.

Mass casualty incidents (MCIs) are major emergencies in emergency departments, necessitating effective training for healthcare personnel. Tabletop exercises (TTx) and functional exercises (FE) are two non-disruptive training methods that can simulate MCI responses. However, little research has compared the effectiveness of these two methods. This study aims to evaluate the effectiveness of TTx and FE as training tools for MCI preparedness.

Participants were divided into two groups: the T group (trained via TTx) and the F group (trained via FE). Both exercises simulated a train station explosion, requiring the hospital to manage 26 simulated casualties. TTx involved instructor-facilitated group discussions, while FE required role-playing in a simulated hospital setting. Participants were assessed before the exercise, immediately after, and six months post-exercise. Evaluations included confidence in MCI response, willingness to attend future training, willingness to participate in real MCIs, knowledge of disaster medicine, and familiarity with MCI response plans. Data were analyzed using ANOVA and paired t-tests to assess short- and long-term effects. Additionally, participants provided feedback on the factors that most contributed to their learning.

Both exercises significantly improved confidence in MCI response, with TTx having more sustained effects. FE increased willingness to attend future training and participate in real MCIs, though effects diminished after six months. Neither exercise significantly affected disaster medicine knowledge. Familiarity with MCI response plans improved in both groups but returned to baseline after six months. Participants rated both exercises as valuable learning tools, citing scenario-based learning, greater engagement, interactivity, and real-time feedback as key factors.

TTx and FE are both valuable for hospital disaster preparedness, with each offering unique advantages. Hospitals should select the exercise format that best suits their staff and needs. Regular re-training within six months may be required to sustain preparedness.

Since 2015, at the request of the Ministry of Education and the Interior, all schools have been required to organize an internal “intrusion attack” exercise to test their PPMS. Under the guidance of the Haute-Garonne prefecture, one or two full-scale interdepartmental “attack-intrusion” PPMS drills are organized in parallel each year. Between November 1, 2022, and December 31, 2024, 2644 students aged between 11 and 19 took part in the exercises, along with 207 teachers and 220 non-teaching staff. A few days in advance, parents and school staff are informed of the date of the exercise, which will take place on a closed site. Arrangements for the participation of children with special needs are specified. There is no communication to the general public on this subject. The scenario involves an armed intrusion into a school, resulting in several casualties. The first part of the exercise consists of playing out, in real life, the response and coordination of services (school, law enforcement, and first aid). The second part is a tabletop exercise that tests the coordination of the various psychological support services during this intrusion. If required during the exercise, players can be taken in charge by these services. The 3rd part allows a defusing of the exercise, followed by an exchange between the students and staff of the school and the state services, to present the missions of each and the equipment used during the exercise. The exercises led to improvements in the implementation of the PPMS in the establishments tested. No adverse events have been reported to date.

A Disaster Medical Assistance Team (DMAT) provides rapid-response medical care, supports overwhelmed hospitals, and conducts patient triage and emergency care. In Taiwan, most DMATs are hospital-based, formed of healthcare personnel from the same hospital. But in Eastern Taiwan, due to elongated terrain and fewer medical personnel, regional health center staff are utilized for DMAT. These health center staff typically focus on preventive medicine and chronic care, resulting in less experience with emergency cases. This study aimed to explore the differences in emergency medical responses between health center personnel and hospital staff within disaster medical teams.

On October 15, 2024, a DMAT drill was held in Taitung, simulating a magnitude 7 earthquake. Two teams were formed to treat simulated patients, with an injury distribution of 50% mild, 30% moderate, and 20% severe. Station A comprised a newly established team from health center personnel, while Station B consisted of a five-year-old DMAT with hospital staff. Key assessment items included wound cleaning and dressing, limb stabilization, airway management, and continuous assessments of consciousness and vital signs. Results were analyzed to compare the accuracy of medical interventions.

At Station A, 21 patients were encountered, with two excluded as black triage, resulting in 19 treated patients and a treatment accuracy of 93.4%. Station B treated 24 of 25 patients (excluding one black triage), achieving a 96.2% accuracy. The percentage of completely correct treatments was 73.7% for Station A and 83.3% for Station B. Repeated assessments of consciousness and vital signs were frequently overlooked at both stations.

The findings indicated no statistically significant differences in the performance of health center personnel compared to hospital staff. Thus, health center personnel, with appropriate disaster training, can effectively perform emergency medical tasks in pre-hospital settings.

This study aimed to assess changes in attitudes toward routinely recommended vaccines among Hawaii parents following the COVID-19 pandemic and to identify associated factors influencing these changes.

An online survey was conducted in March 2023 among parents/caregivers of children aged 0-12 years residing in Honolulu, Hawaii. Data collected including sociodemographics and household characteristics, theoretical constructs of the Health Belief Model, emergency preparedness behaviors, risk perception of diseases, and attitudes toward vaccines. Descriptive statistics were used to assess parental vaccine attitudes, logistic regressions were employed to identify factors associated with changes in attitudes regarding routinely recommended vaccines (vaccines other than the COVID-19 vaccine).

Participants (N=278) were mostly female (84.2%), college-educated (68.3%), food-secured (66.5%), and possessed an emergency preparedness kit (50.7%). Attitudes toward routinely recommended vaccines remained unchanged in 65.1% of participants (60.1% positive, 5% negative), while 34.8% reported changed attitudes (21.9% changed to positive; 12.9% changed to negative). Multivariable logistic regression revealed that factors that influenced changes in vaccine attitudes included race/ethnicity, having a family emergency plan, concerns about climate-related health impacts, perceived time barriers, and the belief that vaccines are part of emergency preparedness plans. Specifically, individuals identifying as Japanese or Filipino, those with an emergency plan, and those less concerned about climate change were less likely to change to negative vaccine attitudes. Conversely, perceiving vaccines as unrelated to emergency preparedness and experiencing time barriers were associated with an increased likelihood of changing to negative attitudes.

This study highlights how attitudes toward routinely recommended vaccines shifted among parents after the COVID-19 pandemic, and identifies modifiable factors such as concerns about climate change, time barriers, and the perception that vaccines are unrelated to emergency preparedness. Insight gained from these findings can guide targeted public health interventions aimed at enhancing vaccine acceptance and readiness in advance of future potential pandemics.

Floods rank among the most frequent and destructive natural disasters globally, presenting severe threats to human life, infrastructure, and economic stability. In Poland, existing flood risk management strategies often neglect the complexities of self-evacuation, particularly in areas with a 1% annual flood occurrence. This study seeks to fill this gap by evaluating the effectiveness of self-evacuation via private vehicles in flood-prone regions, aiming to enhance emergency response strategies and mitigate the adverse consequences of flooding.

A comprehensive four-step traffic modelling approach was applied to simulate self-evacuation in flood-prone regions. The model integrated national traffic flow data alongside responses from questionnaire surveys conducted among residents in flood-risk areas across Poland. By utilizing Geographic Information Systems (GIS) and traffic engineering tools, a high-resolution network model was developed, encompassing both main and local roads to provide an accurate assessment of traffic distribution. The analysis considered various scenarios, including pre-flood and during-flood conditions, with or without existing commuter traffic, and evacuation travel time thresholds of eight and 15 minutes to designated shelters.

The analysis showed that evacuating before a flood is more effective than during the flood, as a larger portion of the population can reach safety within the set travel time limits. Evacuation routes were significantly hindered by limited road capacity, bottlenecks, and natural barriers, especially under active flood conditions. The model identified key sections of the road network at risk of congestion during evacuation and offered valuable insights into the efficiency of shelters at different time intervals.

Effective flood risk management in Poland requires integrating self-evacuation strategies with advanced traffic modelling. This study emphasizes proactive evacuation planning and stronger infrastructure resilience to reduce flood impacts. Key recommendations include optimizing evacuation routes and improving communication for timely evacuations.

This research was funded by the National Science Centre, Poland, under the OPUS call in the Weave programme [2023/51/I/HS4/00255].

This presentation elucidates experience from the field in providing mental health education and support to primary care providers of refugees. There are myriad models of care integration of mental health within primary care. Certain models allow for informal occasions to enhance provider well-being in addition to patient care. Collaborative care models (mental health and primary care) during crises provide unique opportunities for not only education but also support of practitioners.

This study reports on the First Regional Support Nurse Training Workshop, held in July 2024. The workshop was designed to enhance the disaster response capabilities of nursing professionals, addressing challenges in regional healthcare during large-scale disasters. The workshop was organized in response to a decline in the number of registered disaster support nurses in Hamamatsu City. To address this issue, the Regional Disaster Preparedness and Human Resources Education Center (R-CEC) collaborated with Hamamatsu City to develop a practical disaster training program aimed at increasing the number of disaster support nurses and improving their preparedness for disaster scenarios. The workshop curriculum was created based on participants’ needs and included lectures, hands-on practical exercises, and group discussions. These sessions focused on improving nursing professionals’ ability to respond quickly and accurately during disaster situations. Fifty-three nursing professionals from the region participated in the workshop, which took place on July 21, 2024. After the workshop, a review session was conducted to gather feedback from participants, allowing for discussions on the workshop’s effectiveness and potential areas for improvement. The workshop successfully provided participants with essential disaster response skills and knowledge. The practical exercises, in particular, were highly rated for their relevance to real-world scenarios. The feedback session revealed that participants felt more confident in their disaster response abilities, and suggestions for further improving the workshop’s content and structure were noted. The First Regional Support Nurse Training Workshop achieved its goal of enhancing disaster preparedness among nursing professionals. This initiative is expected to contribute significantly to the disaster resilience of regional healthcare systems by ensuring that nursing staff are better equipped to handle emergencies. Future workshops will aim to build on this success, further expanding the program and incorporating participant feedback for continuous improvement.

Trauma Stabilization Points (TSPs) represent the initial tier of professional, fully trained medical response equipped to provide trauma care. While the US military has used a similar system for years, the first non-military TSP implementation was in late 2016 as U.S.-backed Iraqi and Kurdish forces advanced on the city of Mosul, Iraq. TSPs formed the foundation of the Mosul trauma response and were instrumental in its success. Although encountering many logistical and funding challenges, TSPs in Iraq provided effective trauma care and served as a blueprint for future applications. In 2018, TSPs were established in Gaza when violence erupted between Palestinian demonstrators and Israeli security forces; these TSPs also had a profound impact on trauma outcomes. In the following years, TSPs were utilized in response to clashes in other areas, notably in 2021 in Jerusalem. Following the attacks of October 7, 2023, and Israel’s subsequent military operation, TSPs were implemented throughout the region. However, they have faced significant logistical and security challenges. In response to the 2022 full-scale invasion of Ukraine, many international organizations and local responders formed ad hoc trauma responses that complemented the established Ukrainian healthcare system, effectively managing the initial civilian trauma response. As the frontlines stabilized, the Armed Forces of Ukraine implemented TSPs, locally known as “STAB” points, throughout areas of active fighting. Ukrainian STAB points are characterized by increased capabilities, such as access to basic surgical interventions, labs, and imaging. They also differ by treating patients days after initial injury, which is uncommon in other settings. TSPs in Iraq, Gaza, and Ukraine have effectively addressed conflict related trauma by providing structured, adaptable medical interventions, whether for immediate stabilization or delayed patient reception. However, more comprehensive outcome data is essential to refine clinical and operational best practices.

Disaster can increase the vulnerability of women and girls to Gender-Based Violence (GBV) and limit their access to reproductive health (RH) services. This implementation research explores the challenges of integrating GBV services within existing RH services in disaster-prone areas.

This study employed a mixed-methods design to examine the challenges associated with integrating GBV services into RH services in two crisis-prone regions of Indonesia. Qualitative data were collected through focus group discussions (FGDs) and in-depth interviews with key stakeholders, including community members, healthcare service providers, and representatives from the Provincial Health Office (Dinas Kesehatan) and the Women’s Empowerment and Child Protection Agency (DP3A) at both district and provincial levels of the study area. These methods were utilized to explore stakeholder perspectives on the integration of GBV services within SRH programming. Quantitative data were gathered via a structured survey to assess community acceptance of the proposed integrated GBV-RH service model. Data analysis was guided by thematic analysis, with theoretical frameworks including the Social Ecological Model to examine multi-level influences on service integration and the WHO’s Six Building Blocks of Health Systems to assess structural and operational dimensions of integration.

The implementation of the GBV and SRH during disasters faces several key challenges, including: a) limited engagement and passive dependency of the local authorities on the issues, b) low participation and advocacy from grassroots organizations and community leaders, c) excessive workload constraints and inadequate communication capacity within the health sector, impeding effective service delivery and stakeholder coordination, c) limited community awareness and preparedness, d) Insufficient policy operationalization, e) Fiscal constraints, including inadequate budgetary allocations to support program scalability and sustainability.

A disaster preparedness program funded by local authorities is necessary to develop to enhance the integration of RH and GBV services for women and children during disasters.

The development of standardized disaster medicine curricula for frontline providers is lacking in the international platform. This report describes the approach utilized by the State University of New York (SUNY) Downstate, an Academic Medical Center in New York. SUNY offers one of the few disaster medicine fellowships in the United States, which also accepts international applicants and non-emergency Medicine (EM) physicians. Previous examples of non-traditional graduates from the program include the Director of the SUNY Pediatric Intensive Care Unit, a Critical Care specialist in India, and an EM physician in Ghana.

Each of the non-traditional graduates completes a “virtual” version of the traditional Disaster Medicine Fellowship. The curriculum includes topic-based modules during which the fellows attend online courses, create and/or update their home institutions’ disaster protocols, create and deliver training to their institution’s staff, conduct disaster drills for their community, produce original research, and participate with local disaster response partners. With each topic-based module, the program’s benefits extend beyond the fellow gaining pertinent knowledge. Intentionally, the curriculum design enables the institution and community where the fellow works to gain staff training, updated disaster protocols, and increased coordination among local response agencies.

The two main goals of the SUNY Global Disaster Medicine fellowship are to increase access to a global disaster medical curriculum and to strengthen the emergency preparedness for communities that have fellows in the program. The next steps for this program are creating a formal annual virtual class of ten participants from an academic medical center in Kuala Lumpur, Malaysia. The proposal has been signed by leaders from both centers and is scheduled to begin in July 2025. Beyond that, future goals are to expand this program to multiple academic centers globally that do not currently have access to a disaster medical fellowship program.

Pediatric reunification is a critical component of hospital disaster planning. Timely reunification has shown improved outcomes for children, yet many hospitals fail to have a plan. The U.S. Administration for Strategic Preparedness and Response funded Region V for Kids, a Pediatric Center of Excellence for standardizing pediatric disaster preparedness. A Reunification Workgroup was formed within this center to determine if an educational series would improve pediatric reunification plans for U.S. hospitals.

This pilot project is a mixed-methods study including nine children’s hospitals from six states. Hospitals were pre-surveyed in May 2023 and post-surveyed after completion of the educational series in July 2024. The series comprises five modules: Patient Tracking, Facility Logistics, Information Sharing, Plan Activation, and Recovery. Modules were developed from deficits revealed via a gap analysis from the presurvey and virtually presented each month from January through May 2024 to emergency managers and physicians. Sessions were also recorded for self-guided learning. The audience was polled live for immediate feedback during each virtual session.

Live polling questions included presentation helpfulness, speaker knowledge, presentation content, and session expectations. The post-survey solicited information on reunification knowledge enhancement, relevancy, and changes to clinical practice, the virtual experience, independent learning opportunities, and ease of the online learning platform. Using a scale from 1 to 5, with 1 being strongly disagree and 5 being strongly agree, all modules averaged above 4, with a range of 3 to 5 in both polling and post-survey questions. Descriptive results indicated that modules were concise, informative, relevant, and practical.

This pilot is the first educational series developed for standardizing and improving pediatric reunification plans in the U.S. The project used knowledge deficits to improve education, strategy, and guidance for reunification planning. Similar educational series should be considered in pediatric reunification development for hospitals globally.

Evidence-based guidelines for psychosocial care support the well-being of workers in high-risk fields like ambulance services, the fire brigade, and the police. Between 2022 and 2024, the Dutch guidelines were fully revised. Part of this revision involved a systematic literature review to examine (1) psychological effects of impactful events on uniformed personnel and factors that influence these risks, and (2) available evidence for effective prevention strategies.

Two comprehensive searches were conducted in Ovid Medline ALL (1949-2022), PsycINFO (Ovid; 1806-2022), and PTSDpubs (National Center for PTSD, US; 1871-2022) between September and November 2022, with an update in summer 2024. Both searches were registered in PROSPERO. A wide range of search terms was used, derived from existing guidelines, expanded with new terms, and peer-reviewed by experts to ensure relevance. Two independent researchers screened the results and extracted key data, with 15-20% double-checked for consistency. Methodological quality of all included studies was assessed.

For study one, 1,413 studies were screened, resulting in 43 included studies. The quality of studies (using AMSTAR criteria) was generally low, and most were cross-sectional. Effects were found in several domains: somatic, psychological, social, work-related, behavioral, and ethical. Risk factors included aspects of the incident, personal history, work pressure, and coping style, while protective factors included work meaningfulness, social support, and training. For study two, 2,334 studies were screened, with 22 RCTs included. Twenty-five prevention interventions were identified, most being selective (48%) or universal (40%) in nature. However, study quality was generally low (according to the Cochrane Risk of Bias tool), with some interventions showing mixed outcomes.

The identified factors and prevention studies are valuable for understanding and addressing mental health challenges in high-risk occupations. However, the review highlights a lack of high-quality empirical knowledge, complicating the development of evidence-based guidelines and urging for expert-based co-creation models.

Mass gatherings (MGs), such as religious pilgrimages, sporting events, and cultural festivals, present significant public health challenges. The large concentration of people in one location can place substantial strain on local healthcare systems. WHO’s Medical Care Planning for Mass Gatherings guidance provides event organizers with a comprehensive framework to mitigate risks, ensure high-quality medical care, and alleviate pressure on local health services.

The development of this guidance was informed by a systematic review of the existing literature on mass gathering medical care and event health services (EHS). Additionally, a WHO Mass Gathering Workshop brought together public health experts, event organizers, and emergency medical teams (EMTs) to identify critical gaps in current planning standards. These insights were used to adapt the WHO EMT methodology specifically for mass gatherings, ensuring relevance to a variety of global contexts.

The guidance outlines ten key domains essential for medical care planning at MGs, including clinical and operational capacity, human resource management, and mass casualty incident response. The team will describe the key concepts underpinning these domains and the areas covered by the guidance. Standards for EHS-EMTs were established to address these needs. The framework also offers practical recommendations on surge capacity, staffing, transport logistics, and patient referral systems, aimed at enhancing preparedness and response capabilities.

The WHO guidance addresses a critical gap in global standards for health services at mass gatherings. It offers practical, adaptable solutions that enable event organizers and host countries to enhance health outcomes, improve safety, and ensure a coordinated medical response. By following this framework, future mass gatherings can be managed with greater efficiency, reducing risks to public health.

Bioaerosols significantly contribute to infection transmission. Nebulization increases the degree of fugitive aerosols and is limited in use during the COVID-19 pandemic. However, nebulized medications may be an important part of treatment and a transmission risk when infectious bioaerosols are present. Allowing for nebulized medication delivery while mitigating environmental contamination permits safe transport and in-hospital treatment without airflow restrictions. Using a novel device, preliminary data assessing the efficacy of nebulized DNA and environmental fugitive aerosols are presented.

A novel device was 3D printed and attached to a simple facemask on a manikin. The vacuum port of the device was attached to the wall suction. Reprogramming a cough assist machine, bioaerosol was pushed/pulled through the pulmonary tree of a manikin while nebulized medical aerosol was ‘inhaled’. Distinct DNA-coated 1 micrometer spheres were nebulized from the manikin’s lungs and face mask medication port at a rate of 8L/min. Sampling sites included air sampling at 50 L/min, the face mask surface, and an inline filter to capture scavenged and lung DNA. Standard cycle threshold detection curves were obtained for each DNA oligo used.

Sampling comparing DNA delivery with and without a mouthpiece demonstrated a 6-fold higher ‘medication DNA’ uptake with a mouthpiece. Similarly, a 16-fold reduction in scavenged ‘medication DNA’ into the vacuum system occurred with a mouthpiece. More than 99% of the nebulized DNA was scavenged with and without a mouthpiece without reaching the environment.

Using a model to simulate the generation of inspiratory and expiratory pressures, this device, in combination with commonly available transport and hospital equipment, was successful in preventing environmental contamination when nebulizing solutions coated with DNA. It is important to add a mouthpiece when concurrently administering nebulized medications to maximize medication availability to the lungs. Future studies should reproduce these results and discuss a generalizable model to test medication delivery and environmental impact.

Efficient patient flow in emergency departments (EDs) is vital for improving outcomes, particularly for critically ill patients. Despite expanding critical care capacity, inefficiencies in processing times, bed allocation, and patient transfers were observed in the Regional Emergency Medical Center (REMC). This study aimed to evaluate the impact of quality improvement (QI) interventions on optimizing decision-to-discharge and discharge-to-exit times while enhancing critical care utilization.

A multi-faceted QI initiative was conducted to streamline patient flow and optimize resource utilization from January to August 2024. The study period was divided into two phases: pre-intervention (January to April) and post-intervention (May to August). Key strategies included educational sessions to enhance staff competencies, the introduction of a “Zone Movement Assessment Tool” to improve patient transfers, and bed allocation based on the Korean Triage and Acuity Scale (KTAS), as well as collaboration with administrative units and local fire departments to expedite admissions. Data on decision-to-discharge and discharge-to-exit times were collected before and after these interventions, alongside metrics on bed utilization rates and financial impact.

The interventions reduced the median decision-to-discharge time from 147 to 130.5 minutes and discharge-to-exit time from 80.25 to 55 minutes. Although not statistically significant (p > 0.05), boxplot analysis showed decreased variability, improving consistency. A strong correlation (r = 0.91) between the two metrics suggested that improvements in one area positively impacted the other. KTAS Level 3 patient allocation increased from 55% to 82%, and bed turnover nearly doubled from 2.9 to 4.8 times per month. Critical care revenue increased by KRW 302,826,630.

The QI initiative improved ED efficiency, enhancing patient flow and resource utilization. While not statistically significant, the gains in consistency, bed use, and revenue highlight practical benefits. Ongoing monitoring, staff training, and iterative improvements are recommended to sustain these outcomes. Further studies with larger samples are needed to validate these results.

The manuals on military field surgery describe in detail the strategy and tactics for treating wounded soldiers in military conflicts. However, when children are provided with assistance during military conflicts and acts of terrorism, the situation reverses. Children become accidental or secondary participants in military operations and are admitted to civilian children’s hospitals, where the staff often has no experience treating such wounds.

During the period from 2014-2024, 156 children with mine-explosive and gunshot wounds were treated at the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (Moscow, Russia), including patients injured in the acts of terrorism in Kerch (2018), Kazan (2021) and military conflict in Ukraine (2014-2024). The ages of the children ranged from 4 to 17 years old. There were 68.6% boys. The main locations of wounds were lower limbs - 134 (46.7%), upper limbs - 47 (16.4%), and head - 50 (17.4%). Thoracoabdominal injuries were detected (found) in 37 (12.9%), and spinal injuries in 19 (6.6%) children. Among all (the children, 25 traumatic limb amputations and 56 open bone fractures were noted.

To improve the quality of treatment, surgical treatment of wounds was applied along with modern methods of physical treatment. Vacuum therapy was used in 72 patients, hydrosurgical treatment in 23, ultrasonic cavitation treatment in 45, and low-temperature argon plasma in 68. Satisfactory results were achieved in all of the observations.

Compliance with the principles of military field surgery in the treatment of wounds during the provision of assistance to children with mine-explosive and gunshot wounds and the using modern technologies allow us to prepare the wound surface for the final stage of plastic closure in a short time, to preserve the rehabilitation potential and to return the child to the social environment.