During initial emergency response for the Noto Peninsula Earthquake occurred on 1 January, 2024, liaison officers from Division of Infectious Disease Prevention and Control, Ministry of Health, Labour and Welfare (MHLW) were deployed to support to Disaster Infection Control Team (DICT) and faced various barriers to implementing pre coordinated national strategy of supply chains, which has not well described pull-type emergency supplies procurement for Infectious Disease Control (IPC), resulted in organizing new supply chains.

A descriptive study was conducted based on the reports about IPC supplies procurement between 5 January 2024, when the first MHLW liaison officer from the division was deployed, and 9 January 2024, listing stakeholders including ordering parties, suppliers, carriers, relevant ministries, storage locations/staging posts, and final destinations. Furthermore, the Delphi method with a two-round questionnaire to stakeholders is planned towards identifying the challenges for the pre-coordinated national strategy of supply chains.

By the ninth day of the disaster, ten routes for procuring supplies related to IPC had been identified. Of these, five routes were coordinated with the prefectural government. The MHLW’s liaison worked horizontally to connect the various divisions of the prefectural government and urged them to determine who would be in charge, and with the cooperation of MHLW’s other liaisons from other divisions. Then, the pull-type route was established on 6 January, followed by DICT’s logistic system on January 9th.

Identifying both public and private health supply chains during initial disaster response had reduced disruption in the affected local government in the early stage of the Noto Peninsula Earthquake. In this study, stakeholders and supply chains were listed, and the barriers as challenges to implementation for the pre-coordinated national strategy of supply chains were described, which would contribute to protecting the health and security of disaster victims in future disasters.

Information management for large-scale disasters is at the heart of logistics. When there is a disaster, the MHLW issues a notification document regarding the measures to be taken by the MHLW and the relevant local governments, depending on the damage situation. However, it takes time to summarize and understand the notification documents. Therefore, we developed a system using Gemini to search for notification documents issued in the event of a disaster.

Gemini is a multimodal AI that can make advanced decisions by combining various types of information and can quickly summarize and search information from Google Drive. Notification documents were stored in Google Drive, and questions were created from keywords such as “dispatch of medical professionals” and “handling of insurance treatment,” and the search results were verified.

As a result of searching for the question, “I want to know about the dispatch of medical personnel when there is a disaster,” three materials were matched. In addition, the search results included a summary of the materials and links to all related materials stored in Google Drive.

The advantages of the notification document retrieval system are as follows: it is possible to check the notifications that are common to multiple disasters at once, anyone can use it free of charge by sharing an account, and it is possible to summarize the contents of the materials as well as extract related materials. Conversely, as an improvement, it was mentioned that since it is not an exact match, documents that are not necessary are extracted, and only a part of the required documents is extracted. Although it is necessary to devise ways to share accounts and update data, a notification document retrieval system using multimodal AI can be expected to manage information in the event of a disaster.

The vastness of the Pacific Ocean stretches out to the east and south of Japan. If a ship crew at high sea suddenly experiences trauma or illness, transporting them to appropriate medical facilities poses significant challenges compared to on-land situations. In these contexts, research and analysis by the Japan Self-Defense Force (SDF) on evacuation activities from the high seas provide useful information to international personnel engaging in sea rescue and research.

Documents published by the Ministry of Defense and Marine Rescue Japan Team were utilized. Cases from 2019 to 2023 were examined in terms of age, gender, nationality, and disease classification.

The Japan Coast Guard (JCG) is responsible for command and control in the area of Japan. Furthermore, as requested by the chief officer of the JCG regional branch, the SDF helps with high-sea evacuations. A total of 55 cases were referred to the SDF by the JCG. Among these, 35 (64%) were evacuated by the Japan Maritime SDF, and 20 (36%) by the Japan Air SDF. In 11 cases, long-distance evacuation was conducted more than 500 miles away from land using new aircraft capable of landing on the sea surface. All cases of Japan Air SDF evacuations used search-and-rescue helicopters. Documents confirm that in 29 cases, most evacuees were male, aged 50–59, followed by ages 30–39 and 40–49. Trauma or neurovascular disease was the most common cause, followed by acute abdominal issues. All 29 cases were attended by civil medical staff.

To complete evacuation missions from the high seas, cooperation between civil medical facilities and JCG or SDF officials is crucial. This system must be essential to maintain maritime security, including evacuations for safety and freedom of the seas.

Mass gathering (MG) events should be an opportunity to strengthen the host city/country’s public health capacity and improve compliance with the International Health Regulations (2005). This legacy should be built into the planning for the event and receive investment; the evidence to support this happening is limited. This lack of evidence on the legacy of MGs was highlighted in the recent literature review undertaken to update the Public Health for Mass Gatherings: Key Considerations (KC2) (2015).

A systematic literature review methodology was used to search for relevant publications and grey literature of a wide range of MGs globally, focusing on evaluations, legacies, and impacts. This also included searches for specific technical areas, e.g., emergency response.

The literature review identified a small number of peer-reviewed publications that explicitly address the health legacy and evaluation from MGs or the host city/country population (11 papers met criteria from 399 identified). This makes the justification of hosting major MGs challenging. There remains a significant barrier to building and sharing the evidence base for the health legacy and benefits of hosting an MG. Linking this to legal instruments such as the IHR (2005), which requires countries to prevent, detect, and respond to public health risks, could help gain host country/city investment, as it is recognized that MGs can increase this risk.

It was hoped that this updated literature review would identify new evidence for viable and sustainable legacies from MGs. However, the findings were limited and did not look at longer-term benefits. Legacy is often neglected due to a lack of funding, capacity, short-term thinking, and being overlooked by the focus on the smooth running of the event. Event organizers and host cities/countries should better incorporate and implement planning to reduce the risk to the event and provide sustainable legacies.

Armed conflict can be described as human development in reverse. Outside of the direct consequences of violence, there are numerous ways that an armed conflict may have indirect effects on people’s health and well being. Studies give varying results, and the health impact seems to differ from context to context. We aimed to determine how conflict intensity is associated with health outcomes, accounting for existing vulnerabilities and functioning of healthcare services in countries going through armed conflict.

The study is based on panel data on conflict intensity, vulnerability, functioning of healthcare services, and health outcomes in 42 conflict-affected countries between 2000 and 2019, using fixed-effects panel regression analysis to determine the association between conflict intensity and health outcomes.

Conflict intensity was positively associated with the health outcomes included in this study. As the conflict intensity increased, the mortality and prevalence due to these outcomes also increased, albeit this was not statistically significant for half the outcomes (8/16). After adjusting for vulnerabilities and functioning of healthcare services, this positive association became significant for all the health outcomes. Vulnerabilities and functioning of healthcare services were stronger predictors of the outcomes. Sub-group analysis showed that conflict intensity was more significantly associated with outcomes in countries with high- and medium vulnerability scores.

Existing vulnerabilities and the condition of healthcare systems are known to impact health outcomes. The association between conflict intensity and health outcomes strengthens when existing vulnerabilities and the state of healthcare services are considered. This underscores the importance of incorporating strategies to address socioeconomic inequities and strengthen healthcare system capacity in interventions for conflict-affected regions. It also raises additional concerns for the long-term negative health effects related to the increasing trend of attacks on health care in contemporary conflicts.

Pandemics, unlike other disasters, extend over prolonged periods, requiring continuous responses from both public and private sectors. The term “dual disaster” describes the occurrence of a pandemic alongside other emergencies. However, little research has explored how COVID-19 impacted non-pandemic emergencies.

This study analyzed emergency data from Taiwan’s Emergency Medical Resources Management System (EMRMS) between 2018 and 2023. EMRMS is a web-based platform where hospitals report details such as date, age, sex, transport mode, triage level, disposition, and diagnosis during emergencies. We examined COVID-19-related policies from 2020 to 2023, categorizing them into four phases: Imported COVID (IC), Regional Epidemic (RE), Regulatory Relaxation (RR), and Extensive Community Transmission (ERT). Pre-pandemic data served as the non-COVID (NC) baseline. To compare emergency trends, annualized emergency rates were calculated for each phase, and casualty data, including triage levels, ICU needs, and mortality, were reviewed.

A total of 734 emergencies involving 6,734 casualties were reported. The annualized emergency incidences were 172.8 (NC), 154.8 (IC), 85.9 (RE), 78.2 (RR), and 105.2 (ERT). Emergencies declined during the pandemic phases, though the proportion of patients transported by EMS remained stable. However, casualty severity increased, with more ICU admissions, surgeries, and deaths observed.

COVID-19 shifted emergency patterns, reducing incidence but increasing severity. Infection control and crowd management lowered emergency numbers, but resource-limited periods heightened the burden on healthcare systems. Preparedness for severe emergencies remains critical in dual disaster scenarios.

The COVID-19 pandemic had a profound global impact, including numerous indirect consequences on healthcare systems. Acute orofacial infections are prevalent across all age groups. While most of these infections are mild and can be managed without hospitalization, they carry the potential to become life-threatening. Infections in the head and neck regions can spread deeper into the orofacial and neck areas, potentially compromising the airways.

This study aimed to assess the impact of pandemic control measures on orofacial and respiratory infections in oral and maxillofacial surgery (OMFS) and ear, nose, and throat (ENT) emergency units.

Records of patients with orofacial or respiratory infections based on patient ICD-10 codes diagnosed at the Oral and Maxillofacial Surgery (OMFS) or ENT Emergency Departments of Helsinki University Hospital (HUS), Helsinki, Finland, from March 1st to October 30th, 2020, were reviewed. Data was compared to corresponding periods in 2018 and 2019.

The study included 7,900 patients. There was a significant mean reduction of 37% in infection cases in 2020 compared to previous years (1,894 vs. 2,929 and 3,077, respectively, p<.001). ENT patients were 51% less likely to be admitted to the ward in 2020 compared to previous years (p=.013), and patients from rural areas were less likely to visit OMFS or ENT emergency departments during the 2020 study period compared to 2019 and 2018 (26.8% vs. 29.0% and 30.3%, p=.031).

There was a notable decline in emergency department visits for orofacial and respiratory infections during the COVID-19 pandemic in 2020. These findings provide valuable insight for decision-making during future health crises.

In Japan, temporary information is issued about disasters to reduce damage. On 8 August 2024, the Japan Meteorological Agency issued the first temporary information bulletin (Caution: Major Earthquake) about the possibility of a large-scale earthquake occurring in the assumed epicentral region of the Nankai Trough Earthquake. Although this kind of temporary information is useful for disaster prevention, we believe that it may have an impact on the mental health of many people, so we will conduct a survey and propose ways to intervene.

A psychological survey was conducted on web monitors before and after the 8 August 2024 Nankai Trough Earthquake Special Information (17 April; 22 August). A psychological survey was conducted on web monitors before and after the 8 August 2024 Nankai Trough Earthquake Special Information (T1: 17 April; T2: 22 August). The number of people surveyed was 300 for T1 and 1,400 for T2. The psychological test forms used were the Depression Anxiety Stress Scales (DASS)-21 and the Impact of Event Scale-Revised (IES-R). The scores are shown as the median (25th percentile - 75th percentile).

The Depression score on the DASS-21 changed from T1 0 (0-1) to T2 2 (0-8), the Anxiety score from T1 2 (0-12) to T2 2 (0-10), and the Stress score from T1 2 (0-16) to T2 2 (0-6). The PTSD score, as indicated by the IES-R, also changed from T1 3 (0-9) to T2 4 (0-17). Mann-Whitney’s U test showed a significant difference in Depression, Stress, and PTSD scores (P < 0.05).

Although this is temporary information for disaster prevention, it may affect the mental health of many people. To maintain the mental health of these many people, our team would like to propose the introduction of smartphone apps such as the me-fullness® app.

Emergency Department (ED) evaluation of suspected Viral Hemorrhagic Fever (VHF) patients can significantly disrupt an institution’s ED operations. Given the significant risk of contamination, best practice is to close off areas where the patient has been present. While designed to protect healthcare workers and other patients, this can have unintended consequences, such as closing off access to critical areas and supplies. A full-scale disaster drill was conducted at a New York City (NYC) designated Ebola Receiving Center. A fictitious patient suspected of VHF was taken to the designated VHF treatment area through EMS and walk-in triage. The impact on normal patient/staff flow and access to critical resources was documented by trained observers.

The following areas were unintentionally blocked due to patient transport to the designated VHF treatment room:

1. 1. Arrival via EMS: a) critical elevators to OR, MICU, SICU, and Labor and Delivery, b) ED Radiology including X-Ray, CT, and ultrasound.

2. 2. Arrival via walk-in: a) waiting room, b) triage area, c) the entirety of the non-critical adult emergency department, approximately 81 patient treatment locations.

This drill highlighted the potential for significant disruptions to ED operations when managing VHF patients, even when using a pre-identified VHF treatment room. By identifying feasible access to appropriate care areas, hospitals can mitigate these challenges and ensure the continuity of daily operations. EDs should consider similar strategies when developing their VHF response plan. The Division of Disaster Preparedness & ED administrators assessed the ED’s architectural blueprint to locate areas of entry/egress and the ED’s treatment/diagnostic areas. Multiple attempts to find a space within the emergency department to care for VHF patients without closing the ED proved difficult. However, after reviewing the blueprint, an ideal area outside the ED treatment areas was identified.

In times of disaster in rural settings, helicopter rescue is crucial. Since the 1990s, helicopters without any medical support have been used to transport patients from remote areas to tertiary care centers. In 2013, private organizations improved pre-hospital care by adding medical teams and equipment, making Helicopter Emergency Medical Services (HEMS) a critical part of emergency care, particularly in remote areas.

This retrospective observational study analyzes patients who were transferred by helicopter to Grande International Hospital (one of the tertiary centers in Kathmandu, Nepal) between May 10, 2018, and May 9, 2024. Patient’s demographics (age, gender, ethnicity), medical conditions/outcomes, and geographic origins were analyzed. Data was analyzed using SPSS version 25.

The 782 helicopter rescues show that 68.8% of the participants were men, with a mean age of 47.21 years. Of them, 90.92% were Nepalese, and the majority of cases (42.23%) were transferred from Province 4 of the country. Pneumonia (211 cases), trauma (107), neurological emergencies (85), cardiovascular emergencies (44), and COVID pneumonia (140) were among the major medical reasons for transfer. The COVID pandemic highlighted the importance of HEMS. 40.4% of cases were self-landed, whereas 59.6% of cases were accompanied by HEMS physicians. Interhospital transfers and a sizable portion of high-altitude operations were part of many rescues. With an average hospital stay of 13.73 days and a 14.3% mortality rate, the majority of patients were admitted to the intensive care unit.

HEMS has significantly saved lives over the years at a particular tertiary hospital. This data allows for advancing HEMS use in a rural setting like Nepal, especially during times of disaster, to provide acute medical and rescue care. It is imperative to address and evaluate HEMS accessibility and its importance regarding infrastructure, cost, geographic diversity, and the country’s vulnerability to disaster.

The Israeli healthcare system was responsible for spearheading the battle against SARS COV-2 as a medical necessity, concurrently confronting the imperative to fully utilize all accessible medical resources, encompassing hospitals and community medicine facilities. The complete and effective management of patients, particularly during emergencies, is of utmost importance for the Israeli nation. This study endeavors to elucidate the essentiality of community medicine during emergencies, exemplified by the COVID-19 pandemic.

A cohort of thirteen influential officials from the Israeli healthcare system, actively leading the nation’s response to COVID-19, underwent in-depth interviews. These interviews were subjected to thorough scrutiny by a panel of peers. The participants were accessed through in-person meetings or virtual interactions via Zoom. The participants were given the questionnaire in advance, enabling them to familiarize themselves with its format. Subsequently, employing ATLS.In TI 22, six themes emerged. Among these themes, one particularly highlighted the significant role of community medicine as an indispensable component of the medical response, particularly in emergencies. These themes were derived by identifying recurrent concepts present within the quotes provided by the participants.

Numerous compelling instances were unveiled, demonstrating the utmost importance of community-level medical care during the COVID-19 pandemic. All thirteen interviewees explicitly emphasized the impact of medical teams operating within community medicine, substantiating their viewpoints with concrete examples. The primary discovery revolved around the Israeli HMO’s capacity to provide hospitalization services at patients’ homes and to effectively reduce the number of individuals seeking emergency room care. In addition, HMOs were seen as significant in fostering public trust.

This study provides a comprehensive understanding of the approach employed by the Israeli healthcare system in tackling the pandemic, accompanied by recommendations about the integration of community medicine. The abundance of lessons presented in this study may also be relevant to other countries, suggesting the potential for broader application.

On 6 February 2023, a 7.8-magnitude earthquake struck the southern region of Türkiye, the most powerful earthquake recorded in the country since 1939. A second earthquake with a magnitude of 7.6 occurred nine hours later, its epicenter approximately 70 km from the first earthquake. On the same day, with the earthquakes having caused widespread destruction of houses and infrastructure in urban centers and rural areas across the country, the Government of Türkiye issued a level four alarm calling for international assistance. As of 5 April 2023, AFAD reported that the death toll has reached 50,3391 and 107,204 People injured. Some three million people have relocated, and more than half a million buildings have sustained damage, of which at least 298,000 buildings have either collapsed or have been severely damaged.

The ALS/MND Association of Turkiye headquarters in Izmir attempted to contact its 98 registered patients in the earthquake zone, where an estimated 550 patients were in need. The Association Chair, who is also an ALS Patient, with support from other volunteers and official institutions, evaluated the first 72-hour needs for the ALS/MND patients to keep them alive.

• Reached patients (first 24 hours): 30

• Reaching out to the Association Call Center: 15

• Number of mobile phones that could not be reached in the earthquake zone: 300,000 adults. Number of visited patients: 30 patients at the location by visit; 15 patients by volunteers, on the fifth day after the event.

• Most needed materials: Generator, O2 concentrator, rechargeable aspirator, air mattresses, medical consumables, diapers, water, fuel, batteries, hygiene products.

In disasters, the survival and rescue of individuals belonging to vulnerable groups is difficult, and the results are limited. Therefore, it is important to make comprehensive plans and keep regular records before a disaster occurs.

Ambulance diversion has emerged as a strategy to address Emergency Department (ED) overcrowding, but the question of when or whether diversion should be triggered is widely debated. Although the positive and adverse impacts of diversion have been primarily studied using quantitative data, little is known about the experience and perceptions of key stakeholders involved in diversions. Our study aims to explore the challenges and impacts of ambulance diversion as experienced by key stakeholders and their suggestions for improving the diversion process.

Semi-structured interviews were conducted with key stakeholders, including physicians, nurses, and paramedics, across two EDs and four fire stations. All interviews were audio-recorded following consent and transcribed verbatim. The transcripts were subjected to thematic analysis to identify key themes and sub-themes.

A total of 33 stakeholders were interviewed. The primary reasons for ambulance diversions were perceived to be resource constraints in EDs, overcrowding and bed block situations. Challenges during diversions included communication breakdowns, operational delays, lack of clarity in diversion criteria and emotional stress for both EMS and hospital staff. Participants felt diversions impacted patient safety, staff morale, system efficiency and could generate inter-institutional conflict. Suggestions on improvements focused on use of alternative care pathways, improving hospital’s flow issues, better information sharing, and optimizing the diversion process through strategizing the timing and duration of diversions. Reworking the hierarchical approach of dissemination of information to ground staff was also suggested.

This study highlights that while diversions may offer temporary relief for overwhelmed hospitals, they also pose challenges and negatively impact receiving hospitals and EMS operations. The findings underscore the need for systemic improvements to address the root causes of ED overcrowding and enhance understanding among stakeholders involved in diversions.

The management of chemically contaminated patients poses a formidable challenge to the emergency department, necessitating a complex approach to patient care. While the standard emergency medicine training predominantly focuses on clinical topics, the emergence of chemically contaminated cases mandates a comprehensive understanding of management aspects such as suspicion in exposure contexts, decontamination procedures, prevention of personnel contamination, and tailored treatment modalities.

In August 2024, a 59-year-old patient was admitted to the Emergency Department (ED) after a workplace accident involving a traumatic impact with a solid object. Upon arrival, the patient was conscious, hemodynamic, and respiratory stable, having as main complaints sudden blindness and pain in the right lower limb, revealing an open fracture of the tibial plateau. A rapid medical history elucidated that the patient had been subjected to exposure from an unidentified container of acid, an incident undisclosed by the pre-hospital team. After a thorough patient history was obtained, the individual was triaged as chemically contaminated, with the contaminant identified as a mix of nitric and hydrofluoric acid. The patient was promptly isolated, decontaminated, intubated, and provided with provisional fracture fixation.

This case aligns with existing literature, as most chemically contaminated patients arriving in EDs are exposed due to occupational or accidental household incidents. However, most hazardous materials (HAZMAT) hospital protocols are designed for mass casualty contamination events, requiring extensive human, material, and structural resources. They are often excessive when handling these single-patient cases. The complexity of these protocols makes them hard to use and not practical in overcrowded EDs. Therefore, developing and implementing user-friendly protocols for managing individual HAZMAT patients in the ED would be beneficial. Additionally, regular training should be provided not only for emergency medicine personnel but also for the connecting specialties dealing with these patients, including anesthesiology, surgery, gastroenterology, or ophthalmology.

Hospital capacity is increasingly constrained by outpatient clinic availability, limits on inpatient volume, operative case loads, and rising demand for emergency care. Chronic surge and emergency department (ED) boarding is the new normal. Innovative strategies must meet increased demand and keep hospital-based care, particularly emergency care, available to patients.

At Stanford Health Care, an academic medical center and level I trauma center, licensed capacity is just over 600 beds, but regularly the census surges above 800 inpatients. In response, a team designed and implemented a capacity level protocol, streamlining operations and prioritizing safe care.

This protocol includes clear thresholds and triggers for escalation, subsequent countermeasures - including an escalation to the emergency surge plan - which maintain continuity and preserve capacity for dynamic patient needs.

Protocol development occurred in partnership between the Office of Emergency Management and the Director of Clinical Inpatient Access and Throughput. There was regular stakeholder engagement with leaders from clinical services, including emergency medicine, inpatient medicine, and the interventional platform. It was implemented in 2024 with endorsement from executive and clinical leadership.

There are four capacity levels, followed by activation of the emergency surge plan. The levels escalate from routine through categories with increasing risks to patient care, requiring specific actions: targeted provider communication; focused resources for inpatient discharges; limiting intake from the transfer center; prioritizing ED boarders for beds; rescheduling planned admissions and surgical cases. At level three, leaders meet to discuss countermeasures and escalations. Once at capacity level four, those same leaders consider whether to activate the emergency surge plan. This assembles the Hospital Incident Command System (HICS) and requires accountability throughout the platform and the executive level. It reserves countermeasures, including emergency waivers for hallway beds.

Since protocol implementation, the emergency surge plan has been activated several times, creating immediate capacity and preserving crucial services.

As global disasters become more frequent1 and healthcare worker (HCW) shortages loom2, the demand for international HCWs increases. These disasters propagate healthcare needs generated freely over geopolitical boundaries, and the global HCW workforce repository desperately needs resuscitation. Civilian and military populations internationally recognize nurses, dentists, pharmacists, and doctors as the majority of global disaster medical response teams in the HCW role. Lack of consistent global identity results in the exclusion of Physician Assistants/Associates(PAs). While the profession offers a unique opportunity to contribute to fulfilling this global HCW need, a globally recognized definition of the PA is urgently needed to augment the inclusion of PAs in responding to these healthcare needs. A loss of title clarity leads to a lack of reference. Since its inception, the PA profession has continued to grow geographically and expand in scope of practice, and its role is a critical component in global HCW response efforts. By obligating the World Health Organization (WHO)3 to officially define and formally recognize the PA title, PAs and PA-like roles functionally assume ownership of a known archetype, solidifying itself to keep pace with international HCW rosters in fulfilling global disaster medical needs.

Systematic Article Review, word search. Keywords: global; Physician Assistant/Associate; clinical officer; healthcare; shortage; occupation; feldsher; title; classification; paramedicine

Actionable items to support and put into use once this PA Title Authorization takes place would be an international exchange program for starter PA programs worldwide. Title formality develops a consistent framework when discussing special interest groups, international relations, and building organizations. It also conveys a common search term; when others are looking into PA-like roles, they are more likely to find PA. Increasing grammatical coherence captures multiple references under the varying terms worldwide.

Require WHO to formally recognize PA title in the ISCO.3

The spread of mis- and disinformation on mobile and messaging apps during the COVID-19 pandemic not only fuelled anxieties and mistrust in health authorities but also undermined the effectiveness of the overall public health response. For context, mobile and messaging apps help users stay informed and connected to their families, friends, colleagues, and communities. However, during the COVID-19 pandemic, these apps were also one of the primary channels where misinformation and disinformation circulated.

Recognizing the importance of including mobile and messaging apps in risk communication and emergency response strategies, the World Health Organization (WHO) and some countries in the WHO Western Pacific Region independently piloted initiatives to reach messaging app users, meet their evolving information needs, and streamline health ministry communication.

The enhanced use of mobile and messaging apps enabled consistent and timely communication, improving coordination during the COVID-19 pandemic. Leveraging their features also helped identify and potentially fill crucial information gaps, mitigating the harms of mis- and disinformation and fostering stronger trust in health authorities.

The findings from the work carried out by WHO and countries in the Western Pacific Region identified some promising innovative communication interventions using mobile and messaging apps. While these interventions should be further explored and evaluated, they have demonstrated that interventions need to be proactive, flexible, and able to adapt to changes in misinformation and disinformation content shared through messaging apps.

Hospital disaster preparation involves creating systems and processes to enhance a hospital’s readiness for emergencies. The first step in crisis management is having a disaster management strategy, mandated by international agreements like the Sendai Framework. The 2015 Nepal earthquake highlighted hospitals’ capacity concerns, leading to the inclusion of hub and satellite hospitals in disaster plans. Later, infectious disease management and lessons from COVID-19 were incorporated. The disaster plans for Nepal’s 25 hub hospitals, collaborating with the Health Emergency Operation Center (HEOC) and the Provincial Health Emergency Center (PHEOC), were updated. Workshops aimed to empower participants to own the hospital plans. The Hospital Disaster Preparedness and Response Plan (HDPRP) addresses preparedness, response, and recovery, including COVID-19 management. Developed through testing, the HDPRP, along with workshops and engagement strategies, bolsters hospitals’ disaster response capabilities.

During times of medical surge, alternative care sites (ACFs) offer additional bed space for expansion of inpatient services. However, traditional ACFs often fail to have adequate infrastructure to support robust clinical operations (lack of adequate wraparound services, such as lab and radiology) and cannot usually provide anything other than subacute services. Hotels are most closely proximate to hospitals in many ways: individual rooms with toilets and showers, space for a kitchen, adequate elevators to accommodate stretchers, PA systems, etc. Medium-sized and convention-sized hotels could be converted to hospital space, offering the potential for wraparound services that allow admission of all patient types, including ICU and general med-surg patients. This research was funded by the US Department of Defense as part of the “Modular/Convertible Capability Pilot Project” to increase medical surge capabilities and capacities to care for our Nation’s combat casualties and to inform nationwide changes to the existing National Disaster Medical System (NDMS).

Since ACFs operate outside of traditional hospital buildings, hotels present a viable option for an ACF. The result of this project was Team Colorado’s Hotel2Hospital Playbook, which provides instructions and guidance for the just in-time conversion (within 2-4 weeks) of any hotel into a hospital. The Playbook includes strategies to select and engage a Partner Hotel; guidelines for using, augmenting, and adding to the existing hotel infrastructure to create a hospital-like care setting; an approach for converting hotel rooms into patient care rooms, clinical equipment, and staffing needs; and how to establish services such as Lab, Pharmacy, and Radiology in a hotel facility. The H2H Playbook includes architectural drawings, engineering plans, checklists, and other resources that hospital emergency management personnel and other emergency preparedness professionals can use.

Global Emergency Care Skills (GECS) is an award-winning Irish non-profit organization founded in 2008 that provides high-quality emergency care training and education to healthcare professionals in low to middle-income countries (LMICs) in Africa, where trauma remains a leading cause of death. This study presents a multimodal analysis of trauma theory and skills training for emergency physicians, nurses, clinical officers, and paramedics in Lusaka. Combining quantitative assessments, qualitative feedback, and observational data to evaluate the effectiveness of different training approaches and the participants’ experience of these approaches.

A mixed-methods approach was employed to analyze the impact of trauma training. Quantitative data were collected through pre- and post-training assessments to measure changes in clinical competence, including technical skills and non-technical skills. Qualitative data were gathered through structured interviews and focus groups with participants and trainers to assess perceptions of the training’s relevance, feasibility, and effectiveness. Additionally, observational data from simulated trauma scenarios were analyzed to identify performance improvements and team dynamics.

The multimodal analysis revealed that this trauma training significantly improved the participant’s confidence and clinical competence. Quantitative findings showed marked improvements in trauma management skills, especially in areas of rapid assessment and management. Qualitative data highlighted the importance of low-cost, adaptable

simulation methods, such as task trainers and role-playing, which allowed for realistic training despite limited resources. Observational data indicated enhanced teamwork and communication in high-stress trauma scenarios. Participants reported increased satisfaction with training that was tailored to local resource conditions and healthcare contexts.

Skills and simulation-based trauma training, when analyzed through a multimodal lens, prove to be an effective and adaptable tool for improving trauma care in LMICs. By integrating quantitative, qualitative, and observational data, this study demonstrates that such training enhanced both technical and non-technical skills among the course’s participants, contributing to improved patient care.