Pericarditis is a relatively uncommon condition in emergency settings but is frequently encountered in cardiology. Viral infections are the most common cause, though it can also result from autoimmune conditions, cancer, and, in this case, trauma.

A 70-year-old male patient attended the emergency department with sudden-onset, sharp, pleuritic, central chest pain. The patient reported having a fishbone stuck in his throat earlier in the day, which he had swallowed with food boluses and was pain-free after. Assessment revealed signs consistent with pericarditis, with diffuse ST segment elevation on electrocardiogram. Blood tests showed elevated inflammatory markers and negative Troponin T. A diagnosis of acute pericarditis was made, and the patient was admitted to cardiology for workup and treatment.

A computed tomography (CT) scan of the thorax, abdomen, and pelvis was performed, given his persistent pain despite analgesia. It showed a foreign body at the mid-lower thoracic oesophagus, perforating through the anterior and posterior walls with surrounding inflammatory changes, with moderate low-density pericardial effusion with features of pericarditis. Emergency esophagogastroscopy was arranged, together with repair of the perforations with surgical clips by General Surgery. The patient recovered uneventfully and was discharged after one week. An interval CT Thorax was done in the outpatient setting six weeks post-discharge, showed no mediastinal collection or pneumomediastinum, and an interval decrease in size of the pericardial effusion.

While viral infections remain the top cause of pericarditis, this case highlights the importance of maintaining a broad differential diagnosis of etiologies when diagnosing pericarditis. This necessitates thorough history taking and a low threshold for CT imaging, especially in older patients without preceding respiratory symptoms, immunosuppression, or known autoimmune conditions, to uncover atypical causes. Early identification and intervention are crucial to prevent complications and ensure favorable patient outcomes.

Preparing medical students for disaster response is a complex challenge that goes beyond theoretical knowledge. To address this, an innovative educational tool in the form of an interactive board game has been created. The game is designed to simulate real-life emergency scenarios, engaging students in critical thinking, teamwork, and effective decision-making under pressure.

The board game utilizes open-source guidelines to simulate realistic emergency scenarios, requiring strategic decision-making. Players assume roles such as Team Leader, Doctor, Medical Support, Logistics Coordinator, and Psychologist, each contributing unique skills. Game mechanics include triage, resource management, and resolving ethical dilemmas, such as prioritizing care with limited supplies or addressing psychological distress. Scenarios progress through timed rounds, emphasizing urgency and collaboration.

The board game was evaluated internally for educational content and design feasibility. The scenarios integrate real-world medical protocols, emphasizing decision-making under pressure. The game’s theoretical framework was validated against established emergency medicine practices, highlighting its potential to foster engagement and collaborative learning among medical students. The evaluation focused solely on aligning the game content with open-source medical standards and ensuring an accurate representation of crisis conditions.

This game introduces a fresh approach to training healthcare students in disaster response. Combining realistic scenarios with a strategic, team-based format creates a stimulating and effective learning environment. The game shows potential as a valuable tool for medical education, providing a risk-free environment for developing critical skills in disaster response and preparing students to handle real-world crises confidently and competently.

The COVID-19 pandemic posed an immense threat to one million Rohingya from Myanmar living in the world’s largest and most densely populated refugee camps in Cox’s Bazar, Bangladesh. In response to the crisis and lack of COVID-19 testing as well as lack of awareness and widespread stigma against the disease, a global nonprofit, HAEFA, implemented “COVID-19-like Symptom Monitoring and Patient Follow-up System for the patients under home quarantine” in Kutupalong and Balukhali refugee camps in Cox’s Bazar. The main objective of the monitoring by nine trained Rohingya volunteers by phone was to ensure prompt identification of severe symptoms (breathlessness and others) and hospitalization. We present here an evaluation of the prevalence of COVID-19-like symptoms, the development of severe disease requiring hospitalization, and mortality.

Deidentified patient data (n = 553) collected from HAEFA’s Symptom Monitoring and Patient Follow-up System between September 1, 2020, to April 30, 2021, were analyzed for a comprehensive analysis of COVID-19-like disease within the camps.

A total of 553 patients with COVID-19-like symptoms were registered at two HAEFA clinics. The mean age of the patients was 19.18 years, three patients were > 65 years old, and 53% (n = 293) of the patients were successfully followed up for 14 days. 95.85% of the followed-up patients stayed under home quarantine during the entire period. 91.2% experienced fever, and 23.7% had at least one risk factor for COVID-19. 12.18% of patients developed shortness of breath who were referred to nearby hospitals. In 21.72% of households, at least one family member developed similar symptoms. There were no reported mortalities.

The home-based, remote symptom monitoring system by trained community volunteers successfully followed up 53% of patients (n = 293) with COVID-19-like symptoms for 14 days. This method helped detect early severe symptoms among 12% of patients under home quarantine and arranged effective referral for hospital-based management without mortality.

Uninterrupted access to medical communications during disasters is necessary to optimize disaster preparedness, response, and patient outcomes. Robust, data-driven approaches to understand telecommunication network performance during and after disasters are necessary. The objective of this pilot study was to identify patterns in network disruption during natural disasters to enable characterization of performance and inform standards.

Network performance data from multiple mobile and fixed cellular network carriers, provided by Ookla For Good, was analyzed to characterize performance during three major disasters: Hurricane Michael, Panama City, Florida (October 10, 2018), Hurricane Ian, Fort Myers, Florida (September 28, 2022) and Puerto Rico earthquakes (December 28, 2019 – January 11, 2020). Time series analysis and geospatial analysis were conducted on the available network performance data for these regions before, during, and after the disasters to identify patterns of change in network latency and download and upload speeds.

Despite substantial gaps in data (missing, uneven, and time-restricted datasets), distinct patterns of impact and recovery of network performance were identified. Panama City experienced the most severe disruptions, with significant declines in download and upload speeds and prolonged latency across both mobile and fixed-line networks. Fort Myers showed a similar trend, with marked drops in network performance following Hurricane Ian, although most providers demonstrated a strong recovery over time. In contrast, Puerto Rico was less affected by the earthquake, exhibiting minimal volatility in network performance.

This analysis identified varying degrees of network resilience across different locations, carriers, and disasters. Additional data could permit the development of an intelligent model that is capable of predicting network performance during disasters. Understanding how hurricanes and earthquakes impact telecommunications infrastructure can inform stakeholders about expected network conditions, guide the development of resilient systems, and be used to set minimum standards that ensure continuity of medical communications during natural disasters.

Increasing patient visits to the emergency department (ED) at Sengkang General Hospital led to overbooking in the orthopedics specialist outpatient clinic. This delayed follow-up care for fractures and dislocations, which in turn impacted timely patient management. A quality improvement project aimed to increase the percentage of ED patients with fractures and dislocations who receive follow-up appointments within two weeks to 80%.

An initial audit revealed that only 20% of patients received follow-up appointments within the target timeframe. Root cause analysis identified several key issues: junior ED doctors, with varying levels of system-based knowledge, often overbooked appointments; communication between doctors and administrative staff was inconsistent; and demand for orthopedic appointments exceeded availability.

Two Plan-Do-Study-Act (PDSA) cycles were implemented. PDSA 1 focused on reducing demand through appropriate referrals and scheduling duration, while PDSA 2 increased clinic availability by adding more appointment slots. Together, these interventions led to a sustained positive change. After PDSA 1, performance initially improved but then declined. PDSA 2 produced a statistically significant, sustained improvement, with performance stabilizing above the targeted 80%.

Regular audits continually track progress, and new doctors are provided guideline briefings. Patient satisfaction feedback is also being reviewed. This PDSA approach could be applied to similar specialist clinic appointment wait times issues.

The role of Point-of-Care Ultrasound (POCUS) continues to expand in the prehospital environment, with more services adopting this technology to facilitate earlier diagnosis and treatment. While this technology has been used in Helicopter EMS for over a decade, it has only recently entered the ground EMS arena. In the United States, fewer than 10% of EMS agencies have POCUS programs, with most use in air EMS services. As portability, durability, and cost have improved, it has allowed this technology to be utilized in several life-saving areas. This, coupled with the increasing literature base demonstrating the ability of paramedics to perform POCUS with accurate interpretation, has opened the possibility of its use in this space. Significant applications in the prehospital environment include identifying life-threatening traumatic injuries such as pneumothorax, cardiac tamponade, and abdominal bleeding, as well as differentiating heart failure from COPD in critically ill patients with respiratory distress. Furthermore, POCUS can be used in early assessment of ROSC in cardiac arrest, as well as determining hemodynamics and volume status to guide resuscitation. This case series will focus on various clinical scenarios from a large urban ground EMS service that has adopted POCUS in its agency. The case series will include differentiating causes of dyspnea, identification of traumatic injuries, and its use during cardiac arrest management. We will highlight how POCUS was utilized in this setting and how care was changed based on the POCUS findings.

On January 1, 2024, a magnitude 7.6 earthquake struck the Noto Peninsula in Ishikawa Prefecture, prompting patient evacuations at several hospitals. We investigated the primary causes of hospital evacuations during the acute phase. From July to September 2024, surveys were conducted at seven of the nine emergency-designated hospitals located in northern and central Noto, as well as at two emergency-designated hospitals in Kanazawa City. These surveys covered damage to infrastructure, buildings, and staff, along with basic hospital information such as patient numbers, bed capacity, and the number of dialysis patients. On-site interviews were also conducted. Based on this information, we analyzed the hospitals that carried out patient evacuations and the causes for these evacuations.

Out of the nine hospitals surveyed, six conducted patient evacuations. An analysis of the causes of patient evacuations within the first 72 hours following the disaster, focusing on the relationship between evacuations and factors such as water supply disruptions, power outages, gas supply interruptions, and building damage, revealed that seven hospitals experienced water supply disruptions. Among these, five hospitals evacuated dialysis patients. Of the two hospitals that did not conduct evacuations, one had no dialysis patients at the time of the disaster. At the same time, the other was able to continue dialysis services due to sufficient water provision from external support, despite the water disruption. After 72 hours following the disaster, evacuations were also conducted due to building damage, and transfers of patients with chronic illnesses were carried out.

During the acute phase of a disaster, the transfer of dialysis patients may become necessary due to disruptions in water and sewage systems, even if there is no risk of building collapse. It is therefore essential to reinforce water and sewage infrastructure, utilize well water, and enhance water supply systems for use during disasters.

During the initial wave of the COVID-19 pandemic, our hospital established a task force to coordinate efforts across the institution in response to the growing health crisis. As the first wave began to subside, the hospital scaled down its response capacity and conducted a survey to assess the experiences of staff members.

The survey aimed to inform measures to strengthen preparedness for subsequent waves. Key topics included levels of stress, concerns about infection, attitudes toward future involvement, and an open-ended section for additional comments. Data collection was conducted online.

A total of 338 responses were received, with nurses comprising 57%, physicians 12%, and other staff 31%. While 45.9% provided favorable feedback regarding the response measures, 65.6% reported experiencing mental stress, 50.5% physical stress, and 79.3% expressed concern about contracting the virus. Approximately half (49.1%) indicated their intention to participate in the response to future waves, though 27.5% expressed reluctance.

The survey revealed diverse suggestions for improvement, primarily related to command structure, information dissemination and sharing, infection control protocols at various stages, and mental health support for staff. Notably, perceptions of the same measures varied significantly, highlighting the need for careful communication. Effective risk communication, which is crucial during public health emergencies, was identified as a key area for improvement. Both management and frontline staff would benefit from enhanced understanding of risk communication strategies.

The unprecedented nature of the pandemic response placed significant mental and physical burdens on healthcare workers, coupled with high levels of concern about infection. The findings underscore the importance of thoughtful communication, particularly in crises, where messages can be perceived differently depending on the recipient’s perspective.

Disasters place considerable stress on systems. The role of laypersons in disasters cannot be overlooked. A course was developed by Disaster Volunteer Corps, Singapore General Hospital, for laypersons, focusing on principles of basic disaster management and interventions. The course included scene safety, triage, emergency communications, and basic lifesaving procedures. Emergency physicians supervised emergency medicine residents and trained medical students who conducted the sessions. This paper focuses on the feedback from the pilot conduct of the course.

The course was delivered over two phases; Phase 1 was delivered online. Phase 2 was delivered in person, culminating in a simulated mass casualty incident. Course feedback was sought through an online form. Descriptive statistics are used to display the quantitative feedback while grouped thematic feedback is presented for free text feedback.

35 laypersons participated, with 24 providing feedback. Prior to the course, 50% rated their own skills and knowledge as “Poor”. Post-course, the majority of them rated themselves as “Good”, with a minimum rating of “Acceptable”. This shows that the course provided basic knowledge and skills for responding to an MCI.

Participants noted that: i) course objectives were clear; ii) audio and visual aids and doctor-medical student pairs facilitated an effective learning experience; iii) facilitators were “knowledgeable” and provided “useful feedback and advice”. The duration of the course was deemed suitable by most participants. Participants also fed back that they would seek opportunities to upskill. The overall rating of the course was high, with all participants receiving either a “Good” or “Excellent” rating. All participants would recommend the course to others.

The positive feedback received and the improvement in the knowledge of participants highlight the success of this pilot program. Given the demand by laypersons keen on applying themselves in basic disaster response, more work needs to be done in refining this course model for future conduct and expansion.

The National Health Institute Ricardo Jorge (INSA), in collaboration with the Local Health Unit of Castelo Branco (ULSCB) and local authorities, implemented comprehensive epidemiological surveillance during the BOOM Festival 2023, held from July 20-27 in Idanha-a-Nova, Portugal. This multidisciplinary psytrance festival, attracting around 40,000 attendees from 169 countries, presented unique public health challenges due to high interpersonal contact, diverse international attendance, and temporary accommodation facilities that increase the risk of infectious disease transmission, injuries, and substance-related incidents.

The primary goal of this collaboration was the early detection and timely response to health risks. Real-time health monitoring was conducted using data collected from the “Boom Medical Service” field hospital, the Kosmicare facility (dedicated to psychological care), and ULSCB (Local Health Unit of Castelo Branco) units, including the Idanha-a-Nova Health Center and Hospital Amato Lusitano. A daily report compiled health data, analyzed trends, and identified emerging risks, which was then shared in briefings with key stakeholders, including civil protection, law enforcement, and festival organizers.

The epidemiological team comprised 17 members, including public health physicians, general practitioners, EUPHEM program microbiologists, and medical students. Key observations included a notable increase in gastrointestinal complaints, prompting further investigation into potential exposures. Surveillance data revealed various health issues, such as wound care (33.1%), altered consciousness (10.7%), musculoskeletal complaints (12.4%), ENT problems (7.7%), and gastrointestinal issues (6.0%).

The festival setting demonstrated the importance of real-time surveillance, integrated health responses, and multidisciplinary collaboration to safeguard public health at mass gatherings. These measures emphasize the need for adaptable strategies and ongoing evaluation to optimize health interventions in similar high-risk environments. This experience also highlights the role of public health in mitigating risks while promoting safer, enjoyable events.

The Hajj pilgrimage, a significant spiritual journey for Muslims, occurs annually in Mecca, Saudi Arabia, attracting millions of participants from diverse backgrounds worldwide. This surge in pilgrims poses substantial challenges for healthcare services, as many face health risks due to physical exertion, dehydration, and exposure to infectious diseases. The unique healthcare demands during Hajj necessitate a thorough understanding of the quality of care provided and the challenges faced by medical convoys.

This observational retrospective cross-sectional study involved 295 patients transferred from Makkah and Madinah hospitals to Arafat via a specialized medical convoy service during the 2023 Hajj season. Data were collected from electronic patient data sheets, documenting demographic characteristics, comorbidities, diagnoses, transfer details, and the Risk Score for Transported Patients (RSTP).

Among the 295 patients, the majority were males with an average age of 63.16 years. The most common nationalities were Asian (48.1%) and African (28.5%). Significant comorbidities included hypertension (34.2%) and diabetes mellitus (33.2%). RSTP indicated that 96.6% of patients had scores below 6. Nearly half were discharged within 72 hours post-transfer, while a small percentage experienced deterioration or mortality. Most patients (58.3%) did not receive any medications or anesthesia, although 31.2% were administered analgesics. Common diagnoses included fractures (15.3%) and heat stroke (10.5%). Univariate logistic regression analysis revealed significant associations between higher RSTP and factors such as older age, presence of arrhythmias, need for respiratory support, lower Glasgow Coma Scale scores, total score, and blood pressure.

This study highlights the diverse demographics and significant comorbidities of patients transferred during Hajj, indicating the need for tailored healthcare strategies. The strong association between higher RSTP scores and factors such as age and arrhythmias underscores the importance of enhanced monitoring during transport. It is crucial to develop protocols that ensure patient safety and optimize outcomes in future healthcare delivery during Hajj.

Mass gatherings present unique challenges and opportunities for public health systems. Effectively managing these events ensures attendees’ safety and well-being and contributes to a lasting public health legacy by strengthening health systems and enhancing global health security. The evolution and activities of Mass Gathering Medicine are examined through the lens of an annual gathering of millions: the Hajj. By effectively addressing the health challenges associated with mass gatherings, host nations can transform these events into opportunities to strengthen health infrastructures, promote international collaboration, and leave an enduring public health legacy.

The increasing frequency and intensity of natural disasters necessitate robust and effective training for emergency responders. Large-scale multi-casualty incident (MCI) simulations offer a platform for participants to experience high-pressure scenarios that mimic real-world challenges. In February 2024, Charlotte’s Vista Forge Large MCI training exercise provided such an opportunity, involving emergency medical services (EMS) personnel, firefighters, the NC National Guard, and the Air Force. This study evaluates how participation in the Vista Forge MCI influenced responders’ performance during the subsequent real-world emergency: Hurricane Helene, which impacted Western North Carolina. By analyzing survey responses from participants, we assess the perceived effectiveness of training in enhancing readiness, coordination, and response efficiency.

This study utilized a mixed-methods approach, collecting survey data from participants who attended the Vista Forge MCI in February 2024. Surveys were distributed to participants following their deployment in response to Hurricane Helene. Quantitative measures focused on self-reported improvements in readiness, response coordination, decision-making, and overall confidence. Qualitative feedback provided deeper insights into the training’s relevance and the real-world applicability of skills gained.

Hurricane Helene occurred in September of 2024. Due to the timeframe, the study and IRB process are currently underway but not completed. Data and full results will be available by March 2025.

Hurricane Helene occurred in September of 2024. Due to the timeframe, the study and IRB process are currently underway but not completed. Data and full results will be available by March 2025.

The October 7, 2023, Hamas attack on Israel resulted in hundreds of fatalities, abductions, and hospitalizations, marking the beginning of the ongoing war. This mass casualty incident (MCI) overwhelmed the medical system and demanded unprecedented civil-military coordination in response to ongoing terrorist assaults. The World Health Organization’s Civil-Military Coordination (CIV-MIL) framework underscores the necessity of collaboration in emergency response, particularly in conflict zones. This study examines sustainable strategies for integrating military and civilian medical capabilities to improve disaster preparedness and response in war-affected areas, using the Israeli experience to inform a model applicable to similar global high-risk scenarios.

The documented files of the medical cooperation plans between the Israel Defense Forces Medical Corps and three hospitals for use in a possible escalation of hostilities, written from 2020 onward, were reviewed. All documents were compared, and points of incompatibility or inaccuracy in coordination between the entities were identified. The results were presented to twelve senior officials in the IDF Medical Corps and the Israeli Health System through semi-structured interviews to obtain their opinions through open interviews regarding the strategy required to enhance disaster preparedness.

Document analysis revealed four critical coordination gaps: hospitals lack awareness of available military medical resources, army medical records remain undigitized, large-scale mass casualty drills are infrequent, and helicopter transport for the injured is improvised on an ad hoc basis. Interviews highlighted three predominant themes: inadequate exercise budgets, independent organizational planning that wastes resources and hinders preparedness, and staff turnover impacting emergency preparedness.

This study is crucial as it highlights one of the most significant aspects of emergency response: the importance of routine long-term coordination and planning. In any context where there is cooperation between military and civilian entities, it is essential to consider the results of this study as the foundation for a work plan.

Background: The Noto Peninsula Earthquake in 2024 and heavy September rains caused extensive damage, highlighting the essential role of volunteer support amid limited resources. For students aiming to become paramedics, participating in disaster-affected areas provides a valuable chance to learn practical disaster medicine and establish fundamental healthcare skills. Objective: This study evaluates the educational impact of disaster volunteer activities and bathing assistance on students. Methods: A survey of 29 students was conducted using a five-point Likert scale, analyzing correlations between interest and understanding of disaster medicine, self-efficacy, learning motivation, teamwork skills, mental stress, and communication with disaster survivors. Results: A strong correlation emerged between interest in disaster medicine and knowledge of disaster conditions (r=0.816, p<0.01). Self-efficacy and accomplishment showed a significant link between accomplishment and self growth (r=0.392, p<0.05), as well as between self-growth and perceived contribution to activities (r=0.458, p<0.05). Learning motivation showed a positive correlation with cooperative skills (r=0.370, p<0.05). Teamwork correlated with supply transport and debris removal (r=0.523, p<0.01), and students who recognized the importance of volunteer work exhibited higher task efficiency (r=0.413, p<0.05). Discussion: These activities enabled students to better understand disaster medical systems and realities, including resource challenges. Bathing assistance for the elderly helped students develop flexible communication by recognizing and addressing their needs. Working with local residents and disaster welfare teams in debris removal emphasized teamwork and leadership, enhancing their learning motivation. Students also reported feelings of accomplishment and self growth through community support. Conclusion: Disaster volunteer activities deepen students’ disaster medicine knowledge and compassion, fostering growth as future paramedics through community support experiences.

Traditional evacuation drills are costly, disrupt hospital routines, and require significant downtime, making it essential that hospital personnel fully understand evacuation concepts, challenges, and routes prior to full-scale drills. This study presents a novel token-based methodology for conducting hospital evacuation tabletop simulations, which serve as a vital preparatory step before large-scale drills.

The methodology was tested in eight tabletop sessions at Fundación Cardioinfantil, a leading hospital in Colombia ranked third in Latin America. Participants included area leaders and key decision-makers responsible for crisis response, ensuring that the exercise closely mirrored the risk of structural collapse during an earthquake.

The simulation begins with a detailed list of patients in the simulated area, including health status information, enabling participants to prioritize evacuations based on medical needs and vulnerabilities. A flow chart guides decision-making, helping participants sequence evacuations to prioritize critical patients while minimizing risks. Architectural plans are also used to identify main and alternative evacuation routes, providing a clear spatial understanding of the hospital’s layout.

Participants used tokens representing patients and available hospital personnel (e.g., doctors, nurses, administrative staff) according to actual staffing levels during specific shifts to perform the feasible evacuations. This token-based approach allows participants to identify constraints and visualize challenges such as resource allocation and staff distribution during an emergency.

Feedback from participants highlighted several benefits, including improved insights into patient prioritization, identification of previously unclear evacuation routes, enhanced occupant distribution through different exits, and a heightened awareness of the availability of neighboring resources, such as additional space or staff. Challenges related to resource allocation were also identified, allowing the hospital to address potential gaps before a live evacuation.

This tabletop methodology provides a robust, scalable approach, ensuring critical decision-makers are well prepared before executing full-scale exercises and improving the safety of evacuations in real emergencies.

Thunderstorm-associated asthma events (TAE) are unique natural phenomena characterized by sudden surges in respiratory emergencies coinciding with severe weather. TAEs have affected multiple countries and significant population cohorts globally. This scoping review examines the extent of literature on TAE through the dual lenses of an emergency management framework and healthcare system burden.

Comprehensive searches in Ovid MEDLINE, Ovid Embase, CINAHL, Scopus, Web of Science Core Collection, and Cochrane Library (via Wiley) were conducted on September 20, 2024. After removing duplicates, 1,710 unique results remained for the initial title and abstract screening in a web-based tool called Covidence. Findings reported according to PRISMA-ScR.

Thirty-three studies were included; ten discussed difficulties in response, and twenty-one provided recommendations for future mitigation. The most frequent response challenges described were lack of medication and insufficient equipment and beds (50% each). Twenty-one studies included mitigation recommendations; the most discussed were early public weather warnings (57%).

Only one article mentioned a mitigation strategy implemented prior to the event. The state of the literature reflects a lack of both response challenges and implementation of mitigation strategies for TAE. This highlights the need for more publications on mitigation and response plans.

Floods are among the most frequent and destructive disasters globally, posing significant threats to human life, infrastructure, cultural and environmental heritage, and economic activities. The impact of floods is expected to grow due to climate change, population growth, and economic factors. Effective flood risk management involves assessing three key components: the hazard, exposure, and vulnerability. While understanding of hazards and exposure has improved, the terminology and methodologies for assessing vulnerability remain in development.

This study focuses on evaluating the flood vulnerability level in municipalities of Mazovia Province, Poland, using a flood vulnerability index and open-access data. Research was conducted in municipalities identified as flood hazard areas (fluvial floods) with a 1% probability of occurrence.

The total flood vulnerability index of municipalities showed that the municipality of Wyszków had the greatest vulnerability, which stems from its highest exposure indicator, its high lack of resilience level, and its low level of susceptibility. The proportion of individuals with non-Polish nationality is relatively low in this area. Additionally, the percentages of people living in hardship, older individuals, and women are moderate compared to other municipalities.

Municipalities, where vulnerability is mainly influenced by exposure, should implement spatial policies that limit land use within flood hazard areas. In areas where susceptibility significantly influences flood vulnerability, it is crucial to educate residents on how to protect themselves from flooding and to inform them about appropriate behaviors during a flood. Municipalities with low resilience should invest in the necessary manpower and equipment for effective rescue operations, facilitate a swift return to normalcy, and increase funding for civil protection efforts. Additionally, they should assess whether the number and availability of emergency services (such as firefighters) align with the population size and distribution.

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

The Flemish-speaking northern part of Belgium has a history of terror attacks. Hospitals are particularly vulnerable due to their accessibility, visibility, and high density of patients, staff, and visitors. Cybercrime and terror are extremely booming, with health institutions as ideal targets. This study aims to assess the extent to which Flemish hospitals are prepared for terrorist attacks and extremism.

All acute hospitals with a specialized Emergency Department (ED) were sent an online survey on demographics, access control, online security, ED security, and security in terror events.

56 out of the 59 (95%) hospitals responded. None use metal detectors, 8% plan security control for weapons in crises. 3% have 24/7 security personnel for entrance control, 59% have none. 55% have no alternative location for an incident in the ED, 37% have any control on radiation, and only 13% 24/7. 61% provide decontamination, in 14% inside the ED! 33% state that personnel are adequately decon-trained. 49% have adequate personnel protective equipment for CBRN situations, and only 42% of the hospitals have trained personnel to use them. Blocked cyberattacks were reported in 33%, in 3.7% the attack caused leaking of patient data, in 5.6% there was unavailability of files, and in 3.7% patient care had to be canceled or seriously delayed. 48% of the hospitals have their own 24/7 service to counter cyberattacks. There had been a real terror threat in 9% of the hospitals, and the overall threat for physical attacks was scored at 3/10. The threat of cyberattacks scored 5.9/10. 66% have no protocol for terror attacks in their region, 45% have no scenario for an incident inside the hospital, and 91% have no scenario for secondary attacks on the hospital.

Counterterrorism defense measures vary across our hospitals but seem frequently inadequate. Cyberattacks are a real threat with serious impacts.