The SENS (Environmental and Neurosensory Simulation) Center was conceived as a cutting-edge facility to train prehospital emergency teams, military personnel, and other crisis responders through high-fidelity simulations. Initial specifications outlined ambitious targets, including 360° immersive video, a temperature range from 0° to 30°C, limited precipitation control, and a basic olfactory spectrum.

Through rigorous benchmarking and international collaboration, the SENS team refined and expanded these capabilities to meet training demands more effectively. Notable advancements include:

1. • Expanded Temperature Range: Enhanced from the planned 0°–30°C to -5°–40°C, plus simulated heat radiation, allowing for scenarios in extreme cold and heat.

2. • Precipitation and Snow: Rain simulation was upgraded from 0–10 mm/h to a substantial 0–30 mm/h, with the added capability to generate snowfall up to 5 cm/h—meeting critical training needs for mountain and cold-weather operations.

3. • Environmental Opacity and Olfactory Simulation: Opacification from smoke and fog now reaches up to 95%, enhancing visibility training under adverse conditions. The range of odors was broadened to include sulfur, rot, blood, and turpentine, providing a sensory depth essential for realistic emergency scenarios. Some limitations arose, primarily due to technical and financial constraints:

4. • Projection Field: Although initially targeting a 360° immersive experience, technical considerations restricted video projection to a 270° arc.

5. • Humidity Control: The initial target of modulating hygrometry from 30% to 100% was postponed due to the complexity of integrating humidity control into the existing system within budgetary limits.

Overall, the SENS facility represents a significant leap forward in environmental simulation for crisis training. Despite certain compromises, it has achieved a level of sensory integration that sets a new standard in the field, providing trainees with an unparalleled immersive experience that enhances their readiness for real-world emergencies.

The International Federation of Medical Students’ Associations (IFMSA) organizes the International Training on Disaster Management (ITDM) workshops to equip medical students and future health professionals with the knowledge and skills necessary to contribute effectively to disaster risk management and humanitarian response. This abstract reviews the outcomes of international training workshops conducted over three years, focusing on disaster risk reduction, international humanitarian law, and the right to health in disaster scenarios.

Three-day international training sessions targeted medical students from various countries. Key outcomes were assessed through attendance records, post-training evaluations, and engagement in global networks and fieldwork opportunities.

Eight international trainings were conducted, engaging over 70 medical students from diverse backgrounds. Post training evaluations indicated a significant increase in participants’ understanding of disaster preparedness, response, and advocacy skills. Participants reported enhanced capabilities to engage in meaningful youth participation and contribute to policy discussions regarding health rights during emergencies. Furthermore, participants successfully joined international networks, leading to collaborative initiatives in disaster management.

The ITDM workshops have equipped future health professionals with the skills and knowledge necessary for disaster response. Through this program, participants are empowered to advocate for ethical standards in health emergencies and strengthen global collaboration among youth in the medical field. Such outcomes demonstrate the urgent need to include education on disaster risks in the training curriculum for medical students worldwide, ultimately contributing to more resilient health systems in the face of disasters.

Military-targeted terrorism is a persistent global threat that affects national security and stability. This study analyzes the global trends, key perpetrators, and characteristics of terrorist attacks targeting military entities over five decades using data from the Global Terrorism Database (GTD).

The GTD was utilized to extract incidents from 1970 to 2020, focusing specifically on attacks targeting military entities. Descriptive statistics were employed to identify trends in attack frequency, casualties, and the most active terrorist groups. The study classified incidents by attack and weapon types and assessed the impact across 102 countries and regions. Geospatial analysis was conducted to visualize the distribution of incidents and identify high-density regions using geographic information systems tools.

From 1970 to 2020, there were 5,534 terrorist incidents targeting military personnel, causing 19,971 fatalities and 23,865 injuries globally. Activity showed significant fluctuations, with a notable rise after 2000. The Middle East & North Africa were the most affected region with 1,915 attacks (34.6%), followed by South Asia with 1,534 attacks (27.72%) and Sub-Saharan Africa with 808 attacks (14.6%). The most affected countries were Iraq (3,989 deaths, 5,132 injuries), Afghanistan (3,738 deaths, 4,470 injuries), and Syria (1,707 deaths, 1,709 injuries). Top terrorist groups, including the Taliban and ISIL, were responsible for many of these attacks. Bombings/explosions were the most common attack type, occurring in 3,138 incidents (56.70%), followed by armed assaults in 1,348 incidents (24.36%). Visual clustering identified potential hotspots, such as Baghdad, Mosul, and Fallujah in Iraq; Kabul in Afghanistan; and Maiduguri in Nigeria, with high fatalities.

This study highlights the ongoing and evolving threat of terrorism targeting military personnel. The findings stress the need for improved counter-terrorism strategies and greater international cooperation. By understanding historical trends and attack characteristics, policymakers and military strategists can develop more effective interventions to safeguard military personnel and assets.

In preparation for the Paris 2024 Summer Games, the French national public health Agency anticipated increased environmental and infectious risks, including heat waves, arboviruses, measles, and foodborne outbreaks, as well as tension on drug stocks. Strengthening the capacity to detect, alert, and adapt preventive actions was essential to ensure a timely response to health emergencies. Since the Games, the Agency is conducting an after-action review to learn from the experience for future mass gatherings.

The Agency put in place a specific health surveillance protocol for the Games from July 8 to September 15, 2024. The Agency provided daily and weekly reports to health authorities, along with risk analysis based on epidemiological criteria, in the event of a health incident. Though relying on existing syndromic and specific surveillance, the Agency seized the opportunity to develop new field surveillance systems in collaboration with first aid responders. This enriches the knowledge on mass gatherings and strengthens the Agency’s line of conduct and responsiveness for future events. The Agency identified key prevention messages for travelers and Games spectators by collaborating with French health authorities, international entities, and the Games organizer. This led the Agency to adjust its internal organization during the Games while continuing to pursue its ongoing missions.

Although there were no major health alerts during the Olympic Games, the sanitary surveillance of this event should leave a useful legacy: knowledge of relevant indicators or systems for early detection of signals during a mass gathering, providing timely reassurance to health authorities to contribute to preventive or control measures, and fluid communication between public and Olympic stakeholders.

This case report highlights the management of a 53-year-old female with acute stridor and respiratory distress, attributed to a large thyroid mass. In the emergency department at AIIMS Bhopal, an awake video laryngoscopy technique was used to secure the airway, positioning the patient in the right lateral decubitus after topical nebulization with 4% lidocaine. This approach allowed for safe, effective visualization of glottic structures, avoiding potential complications linked to traditional intubation.

Significant Findings:

• • Technique Adaptation: The use of video laryngoscopy, especially in an awake state and lateral positioning, demonstrated an innovative airway management approach for difficult airways due to thyroid enlargement.

• • Enhanced Visualization: The video laryngoscope provided clearer glottic visualization, ensuring precise and timely intubation, which is critical in cases of acute respiratory distress.

• • Impact: This case underscores the value of adaptive strategies in emergency airway management, particularly for patients with complex anatomical challenges. The successful outcome emphasizes that, in settings with limited alternatives, awake video laryngoscopy in lateral decubitus is an effective technique to enhance patient safety.

• • Lesson Learned: In managing emergency airways complicated by anatomical abnormalities, particularly in resource-constrained environments, the combination of awake video laryngoscopy and lateral positioning can offer a safer, more controlled approach. This technique may serve as a reliable alternative in situations where standard approaches may fail or carry higher risks.

Emergency Medical Teams (EMTs) must compile daily reports of 91 Minimum Data Set (MDS) items for each operational site during disaster responses. This requirement demands extensive data aggregation into the standardized EMT MDS data format, creating a significant administrative burden in resource-constrained settings. While paper-based medical records remain essential in austere environments, manual compilation consumes critical time and resources. This preliminary research explores the feasibility of an automated approach using image analysis technology.

The exploratory development investigated three technical components: 1) Structured paper form design optimized for MDS parameter extraction through strategic placement of checkboxes and data fields; 2) Experimental implementation of Python-based image processing system with OCR capability and CNN-based checkbox recognition; 3) Data conversion pipeline generating CSV files compliant with EMT MDS eDATA format. Initial testing utilized simulated medical records to assess technical feasibility.

Preliminary testing demonstrated the technical viability of automated data extraction and EMT MDS eDATA format generation. A convolutional neural network (CNN) model, trained with 1,504 data samples for checkbox recognition, achieved high accuracy metrics (accuracy, precision, recall, and F1-score all 0.98) in validation testing. The automated system reduced processing time from 20 to 10 seconds per medical record compared to manual data entry. The prototype system successfully generated standardized CSV outputs while reducing operator fatigue through automated data compilation.

This preliminary investigation demonstrates the successful bridging of paper-based medical documentation and digital reporting requirements in disaster response settings. The achieved 98% accuracy in data extraction and 50% reduction in processing time establishes a proof-of-concept for automated EMT daily reporting. Further development will focus on algorithm optimization for enhanced accuracy and speed, mobile application development for improved field usability, and systematic validation through multi-user testing under simulated operational conditions. This solution provides an efficient pathway for both mobility-focused EMTs and electronic health record backup strategies.

Human resource shortage frequently arises in hospital disaster response. Medical students may fill the gap with additional education on disaster response operational capabilities, having their primary medical knowledge and understanding of operations in hospitals through clinical clerkships. To make them join in the operation, a curriculum based on the hospital disaster response manual is needed.

The tasks in a university hospital’s disaster management manual were extracted and categorized to determine whether they should be included in the curriculum. Then, the necessary tasks were broken down into component skills to be the targets for medical students to acquire in a designed curriculum. The developed curriculum is piloted on volunteer medical students, and they are proposed to participate in the hospital disaster drill.

The four categories were defined to determine the placement of the extracted tasks based on medical students’ capabilities: a) immediately capable, b) capable with basic training, c) capable with advanced training, and d) incapable. The curriculum should include tasks in b) and c); the latter requires additional education. Of the 451 tasks identified, 87 (19%) fell into category a), 182 (40%) into b), 40 (9%) into c), and 142 (31%) into d). The component skills from b) and c) included communication equipment operation, information gathering, and documentation. Consequently, the curriculum focused on information handling and communication procedures, and primary disaster medical skills were added. The preliminary implementation of five sessions in the curriculum made 17 volunteer medical students more interested in the field. Some participated in the hospital disaster response drills, and the hospital staff recognized their capabilities.

A curriculum for medical students to participate in hospital disaster response activities was developed. It was partly piloted for medical students, and further evaluations of its effectiveness were needed.

During the Paris 2024 Olympic Games preparations, disaster medicine simulations were organized. One scenario featured the release of a neurotoxic agent into the bleachers of a stadium during a field hockey game, causing poisoning and a stampede in the audience. To design the situation more realistically, designated participants were assigned as victims and others as witnesses. The aim of this study was to assess the psychological impact of this exercise on these participants.

All 76 participants were volunteers. Thirty-five were designated as involved, 32 as moderately injured, 8 as seriously injured, and one as dead. Psychologists briefed 72% of participants before the exercise. Immediately after the start of the exercise, participants were informed that a neurotoxic agent was released by two terrorists. They were asked to follow a decontamination process in the stadium. This included medical care, with undressing and decontamination with absorbent material, followed by showers. Gender, age, occupation, similar experience, their opinion, and anxiety level (State-Trait Anxiety Inventory - STAI) were collected just before, immediately after, and one week after the exercise.

The response rate was 89%, average age 37 years, sex ratio 0.7, 89% of participants had previous first-aid training, and 39% had previously participated in a similar disaster exercise. Anxiety levels ranged from 2% before exercise to 12% immediately after and 10% one week after exercise. The exercise was considered upsetting for 38% of participants, although this was not associated with a refusal or reluctance to take part in this type of exercise again (22%). Anxiety levels were not related to a previous briefing with psychologists or any similar experience.

Anxiety generated by this type of exercise could be anticipated by carefully avoiding recruiting overly emotional individuals. However, this did not affect participants’ willingness to partake in future events.

Coping strategies are essential for first responders in Nepal as they face disaster-related challenges. This study explores differences in coping mechanisms between professional and community-trained responders, aiming to assess the impact of formal training on their resilience and effectiveness in crises.

This was a cross-sectional survey conducted in Kathmandu, Nepal, from nationwide participants from various districts. Participants included 30 professionals and 30 community first responders. The COPE (Coping Orientation to Problem Experienced) tool, translated into Nepali, measured coping strategies over 15 domains. Data collection methods included paper-based, computer-based, mobile apps, or online surveys.

A total of 60 first responders participated, with a mean age of 34.85 years; most were aged 21-30 (43.3%) and 31- 40 (26.67%). Community responders reported higher levels of religious coping (mean score 13.4), planning (14.4), and instrumental social support (13.3). In contrast, professional responders exhibited greater use of acceptance (11), denial (7.1), and mental disengagement (9.5). Both groups reported similar levels of venting (9.8).

The study reveals distinct coping strategies between professional and community-trained first responders, with professionals favoring acceptance and denial, and community responders preferring religious coping and planning. These findings suggest the need for tailored support, though generalizations should be approached cautiously due to potential bias and limited sample size.

With the increasing availability of longer-range missiles and explosive-carrying unmanned aerial vehicles, the risk to civilian targets, including hospitals, has increased worldwide. Recent events place Israeli cities and hospitals at high risk of such attacks. Following four months of preparations, a large-scale missile attack drill was conducted at Beilinson Tertiary Medical Center. Drill components included missile strikes on hospital buildings, followed by a multi-casualty chemical incident caused by a missile strike on a HAZMAT container.

Descriptive analysis of the drill design, preparatory actions, and after-action reports.

Preparations included: re-training hospital staff on the actions during an imminent missile strike, training of ED and ED staff reinforcements on logistical and medical preparedness for mass casualty chemical incidents. The drill scenario included structural damage to four hospital wards. Injured patients and staff members were evacuated to the ED, and a rapid safety assessment was performed, leading to the decision to evacuate them. In the following stage, over 50 simulated chemical injury patients from a nearby explosion were transported by EMS to the hospital. Insights gained from the second stage highlight the need to improve staff preparedness for mass chemical incidents, communication, and command and control challenges by fully training personnel in decontamination areas. There was a personnel shortage in the decontamination areas operating in the ED ambulance bay, and frequent staff rotations were needed due to fatigue. Staff training on actions during a pre-strike alarm, post missile strike safety assessment, and ward evacuation proved effective.

A hospital missile strike scenario is extremely challenging. It requires enhancing hospital preparedness, focusing on rapid actions during a pre-strike alarm and post-strike care and evacuation of the injured. It also requires immediate assessment of post-attack structural safety and the need for complete evacuation of structurally unsafe hospital areas. Difficulties included assuring patient flow and command and control during decontamination.

Tallinn Emergency Medical Service is the public ambulance service for the densely populated region of 500,000. Treatment protocols for ambulance guide the use of naloxone in opioid overdose with appropriate monitoring. However, the exact number of used doses, time at dispatch, and disposition after treatment is not proven.

The electronic database of Tallinn Emergency Medical Service was analyzed for two periods. 2018-2019 (1st period) and in 2023-2024 (2nd period). In 2028-2019, the main overdose substance was fentanyl. In 2023 -2024, in addition to common street drugs, nitazene was introduced. All ambulance dispatches for “possible overdose” and dispatches for diagnosed opioid overdoses were analyzed. All cases for opioid overdose were analyzed for several naloxone doses, time on dispatch, time onsite, and disposition after treatment.

In general, during the 1st period, all street drug overdose-related visits comprised 0.22-0.43% of all ambulance visits, and opioids constituted 23-28% (51-91 dispatches annually) of all street drug-related visits. During the 2nd period, the corresponding numbers were 0.67-0.75 and 41-44% (221-295 annually). The frequency of hospitalization was 14.7-19.6% during both periods. The mean time onsite was similar during the two periods for patients treated onsite, 21.5-26.2 minutes. The mean on-scene time for patients who needed hospitalization was 52,7-67,2 minutes. The analysis of 2023 data showed that after 40 minutes on-scene, 65.4% of patients were hospitalized, and after 60 minutes, 95%. Hospitalization rate after naloxone doses was similar during both periods. Hospitalization rates were 4.9% after one dose of naloxone, 18.3% after the second dose, 32.5% after the third dose, and 30% after the fourth dose.

The number of ambulance dispatches due to drug overdose has increased significantly during the second period. The use and efficacy of naloxone have not changed during the two periods. Time at the scene for more than 40 minutes translates into a need for hospitalization.

Hualien County, stretching 137.5 kilometers, is characterized by mountainous terrain that complicates external transportation. Medical resources are mainly concentrated in northern Hualien, and disaster relief efforts face huge challenges. To this end, the Hualien Health Bureau established the Hualien Disaster Medical Assistance Team (DMAT) and developed the mobile application system iDMAT. The team collaborates closely with the Fire Department and receives logistical support from the NGO Tzu Chi Foundation to ensure swift and effective rescue operations.

1. Inter-agency Collaboration: Hualien DMAT is composed of medical and administrative staff from eight hospitals and works jointly with the Fire Department. EMTs arrive at the disaster scene first, setting up casualty collection points in cold zones. Hualien DMAT’s advance team then joined them to enhance patient care. Tzu Chi Foundation maintains logistics. 2. DMAT Advance Team: This team consists of one physician, two nurses, and two administrative staff members. They can quickly reach the disaster scene and initiate preliminary rescue actions, meeting the flexible needs of multi-site disasters. 3. iDMAT Development: DMAT members use the iDMAT APP to log disaster assessments and patient information in real-time. By scanning patient wristband QR codes, teams track triage, treatment, and transfer progress. All data is uploaded to the cloud, ensuring information accuracy and continuity.

During the 2021 Taroko train accident, the 2022 Taitung earthquake, and the 2024 Hualien 0403 earthquake, the DMAT advance team swiftly conducted on-site assessments, reporting directly to the Health Bureau via iDMAT. This real-time data sharing enables disaster relief decisions to be made promptly, while hospitals receive patient updates in advance, greatly enhancing treatment efficiency.

Hualien’s integrated model of inter-agency collaboration and iDMAT application reduces response times and ensures continuous patient care, alleviating healthcare provider burdens. This model effectively improves disaster response capability and highlights the value of real-time information management in disaster relief.

Natural disasters pose significant challenges for vulnerable populations worldwide, particularly older persons residing in Latin America and the Caribbean. This region faces disproportionate exposure to natural hazards, including floods, hurricanes, and earthquakes, with older adults representing a rapidly growing segment of the population. Older adults present unique vulnerabilities due to physiological aging, chronic medical conditions, increased mobility, and socio-economic constraints. These factors place them at increased risk of adverse outcomes during and after disasters. Despite recommendations from international organizations, gaps remain in research and policy planning to safeguard this vulnerable demographic.

A scoping review was conducted to synthesize the available literature on the resilience of older persons following natural disasters in Latin America and the Caribbean. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA- ScR) guidelines were followed. Comprehensive searches were conducted in major databases, including MEDLINE, Embase, Scopus, Web of Science, and CINAHL. After deduplication and screening, 11 articles were included for data abstraction. Thematic analysis was performed using Whittemore and Knafl’s integrative framework.

Older persons were found to face compounded vulnerabilities during disasters, with critical disruptions in healthcare access, utility services, and social support networks. Psychological impacts such as depression, anxiety, and PTSD were common, particularly in those with prior dependence or social isolation. Despite these challenges, some older persons showcased high levels of resilience. However, advanced age was generally associated with decreased resilience, especially in economically disadvantaged populations. Policy analysis revealed that while some guidelines exist, consistent national-level implementation in Latin America and the Caribbean remains insufficient.

This review highlights the urgent need for evidence-based disaster preparedness and recovery strategies tailored to older adults in Latin America and the Caribbean. Multi-sectoral collaboration among governments, health agencies, and local communities is essential to completing this process. Strengthening social support systems, integrating older persons’ voices into planning, and prioritizing targeted research can contribute to more resilient, inclusive disaster management in the region.

On October 7, 2023, Hamas executed a surprise attack on Israel, resulting in over a thousand fatalities and more than 1,900 injuries, with around 360 individuals sustaining critical injuries. This assault included acts of abduction, massacre, rape, war crimes, and crimes against humanity. The extensive casualties, affecting both Israelis and foreign nationals, predominantly civilians, were unprecedented. This study aims to investigate the methodologies employed in delivering rapid professional mental health care to soldiers on the battlefield within hours of impact and to assess these interventions’ effectiveness and immediate outcomes.

A comprehensive analysis of 50 case studies involving the deployment of rapid professional mental health response teams was conducted. Cases were selected based on random selection from the military medical record system. Additional Data sources included official reports, operational logs, and after-action reviews. The analysis focused on operational procedures, intervention effectiveness, and immediate outcomes.

The study yielded five key findings: 1. Rapid professional intervention significantly enhanced an individual’s capacity to resume and perform combat missions. 2. It is essential to establish a senior logistical framework that allows safe navigation and access. This requires active participation from senior commanders. 3. Treated soldiers who returned to duty demonstrated operational efficiency comparable to their untreated counterparts. 4. Two-thirds of the patients requested further treatment afterward. 5. The need for immediate psychological assistance was evenly distributed between combat personnel and support staff.

This research presents a novel and substantive framework for analyzing case studies in unprecedented, surprising, and extreme contexts. The resultant findings have the potential to serve as a foundational basis for the development of mental health intervention strategies applicable to military personnel across diverse combat scenarios within Western armed forces globally. Future research should focus on long-term outcomes and the potential application of these rapid response models in non-military crises.

Israel and the IDF are committed to rapid response and advanced care in conflict situations. The evacuation of injured personnel from combat zones via helicopter involves multiple critical factors that influence the success of the operation. Key factors include the selection of the evacuation sector, determining optimal flight paths, and assessing hospital capabilities for trauma care. To enhance operational efficiency, advanced systems have been implemented, providing real-time visibility of the event location, helicopter position, and all relevant data, while maintaining operational security due to the classified nature of the information.

Additional considerations include weather conditions, concurrent events in the operational area, and the helicopter’s landing capabilities. The number of injured personnel being evacuated, the hospital’s current load, and its ability to transfer patients efficiently from the helipad to the treatment facility are crucial in determining the success of the evacuation.

Challenges associated with this role include managing high-pressure decision-making, processing vast amounts of information from various sources, and navigating uncertainty and incomplete data. Maintaining sharpness and alertness, particularly during night operations, is essential to ensure mission success.

Over the past few months, these systems and protocols have demonstrated high effectiveness, with minimal errors and rapid patient transfers to hospitals where quality care is provided. This experience underscores the importance of thorough preparation, precise coordination, and continuous assessment of both operational and medical factors in the successful execution of helicopter evacuations from combat zones in Israel.

In the last 25 years, health systems have had to respond to a large number of pandemic or pandemic-prone respiratory virus outbreaks (i.e., SARS 2002, H5N1 2003, H1N1 2009, MERS 2011, H7N9 2013, COVID-19 2019). These outbreaks have impacted the ability of the health workforce to come to work and the surge capacity of the health system. It is important to measure the pattern of absence in these outbreaks to plan for future pandemics.

A scoping review was conducted according to the Arksey and O’Malley framework and PRISMA-ScR guidelines. The search was limited to publications from 1998 to July 19, 2022. The search strategy included eight databases. Study selection using pre-defined criteria and structured data extraction was conducted by two independent reviewers with final consensus.

Of the 2099 studies identified, 37 were included. There were 26 studies on COVID-19, 10 studies on H1N1 (2009), and 1 study on MERS (2011). The majority were cohort studies (n=24), and self-reported surveys of health care workers (HCWs) (n=12). The majority of the reported absenteeism rates were not standardized, and included the total number of absence days (n=12), number of new absence episodes (n=9), proportion of HCW absent per day (n=6), and excess pandemic absences (n=17), etc. The proportion of HCWs absent per day ranged from 9.1% to 25.1% during COVID-19 (from 3 studies) and 1.45% to 43% during H1N1 (from 3 studies). After standardization, the median was 0.7 new absence episodes per 100 HCW per week (range 0.2 to 29.1) (from 4 studies), and 15.3 days per 100 HCW per week (range 4.7 to 126) (from 10 studies).

Health workforce absenteeism is a significant issue that must be considered in pandemic planning and response. Future research should be reported in a standardized fashion to allow meaningful comparisons between health facilities.

Accurate prehospital stroke identification is critical to ensuring timely treatment and improving patient outcomes. The National Institutes of Health Stroke Scale (NIHSS) is an established tool for assessing stroke severity, but it is not commonly used by paramedics. This project aimed to enhance prehospital stroke care by training paramedics to use NIHSS for early stroke assessment.

A full-day training program was developed, where paramedics were educated on all aspects of the NIHSS. The training was performed in groups of 10-20 paramedics per session. Training included sessions covering the step by-step use of the NIHSS, followed by practical exercises. After completing the training, each paramedic took an online certification exam on the BlueCloud platform. BlueCloud is an online platform that provides certification and training programs, including NIH Stroke Scale (NIHSS) certification. The certification was for the course ‘AA01.1 - NIHSS-English Group A-V5 - 1st Certification.’

Training started in May 2024, when the first groups of paramedics were certified.

A total of 600 paramedics were enrolled in the training program. By the end of 2024, approximately half of the paramedics had been certified, and the remaining paramedics are scheduled to be trained and certified in NIHSS by spring 2025. Three paramedics did not pass certification on the first attempt; two passed on the second, while one abstained from a second attempt.

Certifying paramedics in NIHSS through a structured training and examination program is a feasible approach to improving prehospital stroke assessment. Evaluation is necessary to assess the long-term impact on patient outcomes.

There is a geometric increase in the practice of complementary and alternative medicine in Nigeria, yet there is no adequate regulation that aims at protecting public interest and guiding general practices. Regulatory practices are not being complied with because of poor implementation of these regulations. There is a need to analyze the stakeholders involved in these regulatory practices to identify their interests and influence on the regulatory practices. It is important to identify the challenges encountered and the facilitators to the effective regulation of CAM in Nigeria. These analysis has an impact on health system strengthening.

This work primarily aimed at identifying the stakeholders’ views and perspectives toward the regulatory practices of CAM, identifying the stakeholders’ interest and influence on the regulatory practices of CAM. It further identified the challenges and enablers of these regulatory practices.

This study utilized a qualitative in-depth interview, which involved a purposive sampling method of twelve (12) respondents. A combination of deductive and inductive thematic analysis was utilized to analyze the manual and electronic transcripts from interview tape recordings.

There was an agreement amongst stakeholders that more actions need to be taken for proper and adequate regulatory practices to be put in place. Deductive and inductive thematic analysis was used to identify the regulatory practices involved in registration, labeling, and advertising. Also, interests and influences were identified together with the challenges and facilitators of these regulatory practices. Stakeholders recommended the active participation of the government and practitioners. They also identified the importance of continuing policies that make CAM studies worthy of Public Health interest.

Stakeholders’ interests and influence are an integral part of decision-making towards the regulatory practices of CAM. Regulation of CAM is not an easy task, as there are many challenges encountered.

The Red Cross Red Crescent Health Information System (RCHIS) is an electronic health records and health information management system designed for international disaster response scenarios for medical documentation and reporting in the Red Cross/ Red Crescent equivalent of the Emergency Medical Teams (EMT), which are classified by the World Health Organization (WHO). It incorporates both a cloud-based server and a local server to address temporary internet outages, allowing remote information management and operational support when data-sharing agreements permit.

To enhance its functionality in settings with no internet access, RCHIS was adapted to operate entirely offline, ensuring operational continuity and redundancy. These settings may either be conflict settings without internet access or settings where data storage in the cloud is prohibited by local privacy or health data protection laws. An analysis of its architecture identified components reliant on the cloud-based server, and offline alternatives were developed to maintain full functionality.

Key modifications included the introduction of a second local server to improve redundancy and business continuity. This change enables data recovery from locally stored backups without requiring an internet connection. The system’s account creation process was revised, replacing cloud-based mechanisms with a local process that generates and displays temporary passwords. Additionally, the system now supports offline generation of the WHO EMT Minimum Data Set (MDS) report.

These adaptations required significant architectural changes. While the shift to a fully offline mode sacrifices some cloud-based benefits, such as remote information management and operational support opportunities, RCHIS is now a robust tool for deployment in environments without internet connectivity. Furthermore, the use of a local server supports compliance with data sovereignty regulations, broadening the system’s applicability in diverse operational contexts.