This field report investigates the integration of civil-military collaboration in Poland to strengthen emergency medical response frameworks, with a focus on lessons learned from the COVID-19 pandemic and the ongoing Russo-Ukrainian conflict. These crises have exposed gaps in Poland’s emergency preparedness, particularly in coordination and rapid response capacities. By implementing a unified command structure, interoperable data sharing systems, and technology-driven strategies, such as predictive analytics, drone logistics, and digital health management, this report outlines a collaborative model that enhances Poland’s emergency response efficiency.

Key findings emphasize that civil-military collaboration, reinforced by joint training exercises and simulations, leads to faster mobilization, better resource allocation, and improved operational consistency across sectors. This model encourages a proactive approach by establishing communication protocols for real-time data exchange and optimizing readiness through frequent skill-building programs. Additionally, community engagement initiatives foster public awareness and resilience, providing a more comprehensive approach to disaster preparedness.

The significant impact of this integration model is reflected in enhanced responder competencies, a streamlined response framework, and a scalable, adaptable emergency response system that can be tailored to other contexts. The lessons drawn from these efforts serve as a foundation for building a sustainable, technology-enhanced civil-military collaboration that could inform similar emergency response strategies globally.

The October 7, 2023, massacre in Israel was a large, multi-site asymmetric attack with characteristics of both a very large terrorist attack and a conventional armed invasion, where Israel temporarily lost territorial control. Thus, it is a unique event in a Western democracy. Assuta Ashdod is a Level 2 trauma center located 26km from the Gaza Strip, which received 114 patients on October 7th, during which it activated its Mass Casualty Protocol (MCP). This study aimed to explore the experiences of staff working in this environment to inform hospital preparedness efforts in Israel and globally.

A purposeful sample of 18 key staff, including physicians, nurses, security, and orderlies, underwent semi-structured interviews. These were recorded, transcribed, and processed using thematic analysis methodology.

The participants felt well prepared for this event because of recurring, frequent, and immersive MCP drills that had preceded it. Participants mentioned entering a state of mind where they worked mechanically without reflecting on the event itself. The hospital being structurally protected from rocket attacks allowed participants to concentrate on the work without fear of injury. Assuta Ashdod is a relatively small hospital where staff know each other well, and this was recognized as allowing for flexibility and effective communication. Obstacles included a shortage of secretaries for the correct registration and tracing of patients. While paper-based patient files are used during MCP drills, the lack of familiarity with interacting with these during regular work resulted in suboptimal documentation. Some clinicians mentioned a lack of situational awareness as they worked in isolation in a single part of the system throughout MCP activation.

This study has offered insights from staff with practical experience from MCP activation in a major asymmetric attack and has identified several organizational and resilience-related aspects that may inform preparedness efforts in the future.

In May 2023, the Emilia-Romagna Region experienced two unprecedented rainfall episodes, leading to severe flooding and landslides, especially in the Romagna area, its Southernmost part. This study aimed to assess the health response to the May 2023 floods in this area by identifying the main actions undertaken in response to the floods and by highlighting criticalities and lessons learned.

This study was conducted in the context of a collaboration between CRIMEDIM, the Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, and the Romagna Local Healthcare Authority. To achieve the objective, a retrospective qualitative case study design was chosen, and semi-structured interviews were employed to gather in-depth information on the experiences and perspectives of key informants involved in the flood response.

Interviewees consisted of 25 key informants related to the following fields: authorities and public administration, health management, public health, primary care, social services, hospital and emergency care system, communication, and the third sector. The findings highlight the strain on the local health system, including service and infrastructure disruptions. The response strategies have been analyzed and clustered in phases (alert and activation, coordination, communication, identification of vulnerable individuals, evacuation management, surge capacity, health service delivery, logistics, and the role of volunteers), offering a comprehensive overview of local disaster response strategies. Recommendations include enhancing the interoperability of health information systems for disaster management, improving the coordination of evacuations for at-risk populations, improving the capacity to map fragile and vulnerable populations, and strengthening spontaneous volunteers.

This study highlights the importance of collaborations between local health authorities and academia for ongoing evaluations to enhance disaster response and resilience.

Full authorship: Valente Martina, Del Prete Clara, Facci Giulia, Martino Ardigò, Grilli Roberto Giuseppe, Bravi Francesca, Reno Chiara, Ragazzoni Luca

Virtual patients (VPs) have the potential to support military medicine training. Gamification is at least as effective as traditional educational methods and is often more effective for improving knowledge, skills, and satisfaction in health professions education. In military trauma care, where medics must make both medical and tactical decisions, gamified VPs can offer active learning opportunities to better prepare them for providing medical care in austere environments. Despite the potential of VPs to improve military medical training, studies exploring the integration of gamification into VP design are limited.

This study aimed to understand the reasoning and perceptions of Swedish military medics when interacting with VPs, offering insights and recommendations for designing VPs with game elements to support decision-making.

Fourteen military medics from the Swedish Home Guard-National Security Forces participated in a tactical combat care course, engaging with three VP cases simulating military trauma scenarios. Data were collected through think-aloud sessions and semi-structured interviews. The participants’ reasoning processes and perceptions were analyzed using interaction analysis, along with reflexive thematic analysis. A second round of coding identified game elements that could enhance the VP design.

Our analysis indicated that mistakes in VP decisions, followed by feedback, facilitated the military medics’ reflection. The thematic analysis revealed six themes: motivation (“keep on trying”); agency in interaction with VPs; realistic tactical experience; confidence (“I know that the knowledge I have works”); social influence on motivation; and personalized learning. Game elements such as scoring, badges, progress bars, challenges, avatars, and leaderboards were suggested to make the learning experience more enjoyable and increase medics’ confidence.

Overall, the VPs were positively received. Gamification in VP design appears to be a promising approach for military trauma training, encouraging the inclusion of game elements as well as consequences for wrong decisions to support military medics’ training.

Emergency medical technicians (EMTs) often perform patient-handling tasks in emergency settings, posing a high risk of occupational injury. The prevalence of Work-Related Musculoskeletal Disorders (WRMSD) among EMTs has been underestimated due to the lower reporting rate of WRMSD events in Taiwan. This study employed a nationwide safety manual handling survey by integrating the health belief model (HBM) and the transtheoretical model (TTM) to examine behavioral factors influencing the adoption of safety manual handling skills among EMTs.

A cross-sectional study was conducted among frontline EMTs in Taiwan, including full-time and volunteer EMTs from fire departments in Taiwan. Data on individual characteristics, WRMSD experiences, six factors of measuring attitude toward safety handling, and behavioral change stages to adopting safety handling via a questionnaire were analyzed using descriptive statistics and multinomial logistic regression to determine the impact of each factor on adopting safe handling techniques.

A total of 761 participants completed the questionnaire. The lower back was the most frequent WRMSD body part among participants. The most frequent type of patient handling-related injuries was strain/sprain (88.4%). The patient handling-related injuries occurred within 5.3 years after career initiation in 76.9% of participants. The results also indicated that higher perceived benefits and lower perceived barriers increase the odds of being in all TTM stages. The cue to action level was also a predictor for investigating the likelihood of being in each stage of change compared to the reference category.

Promoting the adoption of safety handling skills is a long-term battle in improving occupational health and safety among EMTs. Perceived benefits, perceived barriers, and cues to action may be the critical factors for designing and implementing the interventions in the future. Future interventions should focus on letting EMTs understand the benefits and barriers of conducting safety manual handling and provide clear, real-world guidance.

One Health plays an important role in public health emergencies and pandemic preparedness. Successful public health interventions of infectious disease spread require cooperation of human health, environmental health, and animal health partners. However, One Health is still a new policy initiative in the United States. Few studies have looked at One Health initiatives across U.S. states, and which agencies are involved or excluded from such policy priorities.

To assess scope, primary data was collected from federal and state agencies, ASTHO, and the NCSL. This data was supplemented with elite interviews of state bureaucrat leaders in emergency management and public health to determine whether One Health was an explicitly mentioned policy priority in public health emergency preparedness across states.

Less than a third of US states have/had a One Health Committee or Task Force, many of which have little authority or power to ensure intragovernmental collaboration and cooperation. One-fourth have a division within an agency dedicated to One Health, or they have One Health listed as an official policy priority. Very few states have passed laws or policies that establish official state One Health programs. One Health is most commonly located within a state department of health or public health. Moreover, relationships between emergency management and public health agencies are variable, with little coordination at the subnational level. Formal One Health initiatives are located in environmental health departments or siloed departments within public health. Informal initiatives are coalitions across academic research institutions, nonprofit actors, community organizations, and individual state bureaucratic “policy entrepreneurs”.

While One Health pushes for a collaborative, multisectoral, and transdisciplinary approach, there is little evidence that such initiatives are occurring in practice across US states and localities. Stronger collaborations between emergency management and public health agencies are needed at both the state and local levels.

The Emergency Medical Team (EMT) initiative enhances rapid response to public health emergencies by mobilizing and coordinating national and international medical teams that provide surge capacity. Since the escalation of hostilities in Gaza in October 2023, the local health system has faced severe challenges, including widespread infrastructure damage, critical shortages of medical supplies, and limited access to healthcare. In response, the World Health Organization, upon request from Gaza health authorities, activated the EMT mechanism and established an EMT Coordination Cell to support international deployment. By the end of 2024, 51 national and international EMTs were deployed across Gaza, addressing urgent healthcare needs in trauma care, surgery, maternal and child health, disease outbreak surveillance, non-communicable diseases, and mental health.

A total of 918 international and 242 national personnel delivered over 2.2 million general medical consultations, nearly 37,000 emergency surgeries, and more than 14,000 referrals. Two national EMTs have resumed activities, significantly strengthening local emergency care and specialized surgical capacity. In 2025, EMTs maintain their presence and impact despite major operational constraints, including insecurity, restricted access, and persistent shortages of essential supplies. Current priorities include reinforcing all levels of healthcare, expanding community and home-based services, strengthening disease surveillance, and increasing psychosocial support for both patients and health workers. Operational agility remains critical to respond to evolving needs, including hospital evacuations, displacement, and surges in casualties.

In the realm of trauma response preparation for prehospital teams, the combination of Augmented Reality (AR) and Virtual Reality (VR) with manikin technologies is growing in importance for creating training scenarios that closely mirror potential real-life situations. The study focused on training in airway management and intubation for trauma incidents, based on a Trauma AR-VR simulator involving reserve paramedics of the National EMS service (Magen David Adom) who had not practiced for up to six years, activated during the Israel-Gaza conflict (October 2023). The trauma simulator merges the physical and virtual realms by utilizing a real manikin and instruments outfitted with sensors. This integration enables a precise one-to-one correspondence between the physical and virtual environments.

A quantitative questionnaire was utilized to gauge the influence of AR-VR training on specific psychological and skill-based metrics, including self-efficacy, resilience, medical knowledge, professional competency, confidence in performing intubations, and the perceived quality of the training experience. The methodology entailed administering a pre-training questionnaire, delivering a targeted 30-minute AR-VR training session on airway management techniques, and collecting post-training data through a parallel questionnaire to measure the training’s impact.

Post-training evaluations indicated a significant uptick in all measured areas, with resilience (3.717±0.611 to 4.008±0.665) and intubation confidence (3.541±0.891 to 3.833±0.608) showing particularly robust gains. The high rating (4.438±0.419 on a scale of 5) of the training quality suggests a positive response to the AR-VR integration for the enhancement of medical training.

The application of AR-VR in the training of reserve paramedics demonstrates potential as a key tool for their swift mobilization and efficiency in crisis response. This is particularly valuable for training when quick deployment of personnel is necessary, training resources are diminished, and ‘all hands on deck’ is necessary.

In a world increasingly challenged by disasters and emergencies, practical disaster medicine training is crucial for saving lives and improving response efforts. The Training Disaster Medicine Trainers (TdmT) educational program, launched in 2015 through a partnership between the International Federation of Medical Students’ Associations (IFMSA) and the Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM), aims to enhance the capacity of medical students worldwide. The program provides theoretical knowledge and practical skills in disaster medicine, addressing the growing need for competent leaders in disaster and emergency management, aligning with the Sendai Framework’s goals for disaster risk reduction. TdmT seeks to train a new generation of medical professionals who can effectively contribute to disaster risk management, becoming peer educators in their universities and beyond. The program empowers graduates to serve as trainers and advocates for disaster medicine practices by focusing on knowledge dissemination.

The program is delivered annually, and includes online and residential phases with theoretical lessons and simulations (table-top, computer-based, and full-scale). Covering topics such as triage during mass casualty incidents, pre-hospital and hospital responses, and Chemical, Biological, Radiological, and Nuclear (CBRN) incidents. To date, TdmT has trained 140 graduates worldwide who have implemented disaster medicine training at local, national, and international levels.

Graduates of the TdmT program have successfully established training sessions, workshops, and simulations, enhancing capacity building in disaster medicine and disaster management within their communities. Feedback indicates improved knowledge and confidence among participants, contributing to more effective emergency management practices.

The TdmT program fosters a culture of preparedness and resilience in health systems worldwide. By equipping future leaders and professionals with essential tools and knowledge, TdmT strengthens individual capabilities and enhances disaster response.

On February 3, 2023, a freight train containing 149 train cars operated by Norfolk Southern Railway derailed in East Palestine, Ohio. Eleven of the derailed cars contained hazardous chemicals, including vinyl chloride, ethylene glycol monobutyl ether acetate, 2-ethylhexyl acrylate, isobutylene, n-butyl acrylate, and benzene residue. The Ohio Regional Poison Control Centers received calls from the community and health care providers affected by this incident. On February 6, railroad officials decided to perform a controlled burn with the train cars carrying 115,580 gallons of vinyl chloride due to the rising temperatures, which posed an explosion hazard.

Retrospective case narrative reviews were performed on the phone calls received from the affected community to the Cincinnati Drug and Poison Information Center (DPIC). The cases started in February 2023 and ended in October 2024. Data included the caller location and clinical effects/symptoms from the initial chemical spill, and the controlled burn was entered into a Geographic Information System (GIS).

179 cases were reviewed, with the most common clinical effects/symptoms. The cases were included based on their distance from the derailment, < 1 mile, 5 miles, 20 miles, and > 20 miles radius.

Understanding the health effects of chemical spills in a technological disaster will inform the creation of emergency and disaster management protocols for hospitals and first responders.

During domestic disasters, emergency medical support by nurses includes various forms of assistance, such as participation in DMAT teams, disaster support nurses dispatched by nursing associations, and independent deployment by NGOs and NPOs. Following the Noto Peninsula Earthquake on January 1, 2024, the Health, Medical, and Welfare Coordination Headquarters of Ishikawa Prefecture organized the dispatch of nurses to support medical institutions, social welfare facilities, and evacuation shelters in the disaster-affected areas.

The aim of this study is to identify challenges in coordinating the dispatch of nurses during the Noto Peninsula Earthquake in 2024.

The coordination of nurse dispatch needs was conducted by personnel from Ishikawa Prefecture, the Japan Nursing Association, and the Ishikawa Nursing Association, in collaboration with DMAT staff experienced in nurse dispatch. Unlike previous disasters, where nurses were primarily dispatched to hospitals and evacuation centers, the Noto Peninsula Earthquake required deployment to temporary shelters outside the affected area and to social welfare facilities in the Noto region, where the aging population exceeded 50%. This led to prolonged coordination efforts for long-term dispatch to hospitals and welfare facilities. Information for assessing dispatch needs came from local personnel, municipalities, and systems such as EMIS, D24H, and J-SPEED.

Although the response to the Noto Peninsula Earthquake was confined to a single prefecture, anticipated disasters like the Nankai Trough Earthquake or a direct hit on a metropolitan area would affect multiple prefectures, complicating coordination efforts. The variability in the number, duration, and locations of nurse dispatch depends on the personnel involved in coordination, underscoring the importance of training to manage nurse dispatch effectively in large-scale disasters.

“Outside the Box”

Nurses who have experienced caring for patients with COVID-19 have the potential to identify local and systemic factors that contributed to what helped support the nurses and their ability to provide care and what did not. The three research questions were: 1) What are the experiences of nurses providing care to patients during COVID-19 in community, hospital, and long-term care settings, and how do these experiences impact their professional and personal well-being? 2) How do nurses perceive the effectiveness of organizational strategies, including crisis standards of care, personal protective equipment (PPE) provision, and support for personal preparedness, in supporting their response and practice during the COVID-19 pandemic? 3) What are nurses’ perceptions of the organizational, local, county, state, and federal policies that either support or hinder their ability to effectively respond to the challenges posed by the COVID-19 pandemic?

A qualitative approach was used to interview registered nurses, who had cared for patients with COVID-19 in one of three health care settings (hospitals, long-term and residential care facilities, and community-based or public health response).

Results indicate that most of the nurses felt supported by their immediate supervisor but abandoned by organizational leadership. They experienced challenges with equipment, staffing, emotional support, changing policies, and grief, and felt supported by work colleagues and family.

Healthcare systems were unprepared to respond to a pandemic. The nursing workforce was affected by the lack of preparedness. Preparations for the next pandemic should be underway to address patient care needs and the health and welfare of nurses on the frontline, including maintaining adequate supplies of personal protective equipment, managing a surge of patients, and providing physical and emotional support to nurses and other healthcare workers.

In September 2023, the City of New Orleans became aware of progressive saltwater intrusion up the Mississippi River, the city’s main water source. Saltwater intrusion, a result of global drought conditions and climate change, has increasingly plagued coastal areas globally, causing ill-effects on population health and infrastructure through pipe corrosion, water contamination, and damage to essential appliances. University Medical Center is the largest quaternary hospital New Orleans, a 446-bed hospital serving as the region’s only level 1 trauma center, burn center, and hub for the local medical community. In preparation for possible saltwater intrusion, UMC identified water supply contingency solutions in order to continue patient care throughout the hospital. Reverse Osmosis machines were procured with production capacity up to 1892 L/minute. In addition to tap water filtration, the RO systems are capable of filtering non-potable water supplies including 750,000 gallons (2.84 million L) on-site and an addition 1.5 million gallons (5.69 million L) stored at an off-site location. Finally, an outside vendor was hired to monitor water quality in the hospital and alert hospital administrators once municipal water became substandard. Special considerations were made for services highly reliant on water, including dialysis, dental, laboratory services, sterile processing, pharmacy, and surgery. To continue dialysis services, UMC planned to share capacity with a private service provider (Davita, Inc.) including CRRT machines and storage space for dialysate fluid. The dental team utilized their own water filtration system. A vendor was hired to distribute bottled water as needed. Ultimately, high salinity water never reached the pipes of New Orleans as a result of increased river flow and construction of a sill. However, this overall process serves as a blueprint for rapid expansion of water contingency planning for a major urban hospital.

During the 2016 Kumamoto earthquake, a grade 1–4 evacuation triage (Simple Triage and Rapid Treatment for Neonates, START-Neo) was used to determine the evacuation order at a tertiary neonatal intensive care unit (NICU). However, most newborns are classified as grade 2 or 3, which makes it difficult to determine the order of evacuation. A five-category, 0–12 scale (Neonatal Extrication Triage, NEXT) was developed to reflect the medical care provided. This retrospective observational study investigated whether the use of (i) a triage system (vs. random orders) and (ii) NEXT (vs. START-Neo) improved NICU evacuation efficiency.

NEXT and START-Neo were assessed over 49 days. Given that the evacuation was performed in either ascending or descending order of patient severity, an efficient triage system was defined as one that precisely reflected patient severity. The severity of newborn patients at the time of triage assignment was determined using a Neonatal Therapeutic Intervention Scoring System (NTISS). The Total Evacuation Score (TES) was defined as the time integral of the NTISS scores of newborns waiting for evacuation and remaining within the NICU from the start to the completion of the evacuation. The TES was compared between (i) no triage, (ii) NEXT, and (iii) START-Neo. A computer-based evacuation simulation was conducted using all possible combinations of evacuation orders (NEXT and START-Neo) or randomly extracted combinations (no triage).

Compared to no-triage, both NEXT and START-Neo led to a reduction in TES throughout the study period. NEXT was superior to START-Neo on 34 of 49 days and showed no difference on 10 days.

Triage systems are crucial for improving NICU evacuation efficiency. NEXT, an improved triage system, appears likely to reduce the overall risk of newborns remaining in a damaged NICU before transportation.

On October 7, 2023, Hamas launched a devastating attack on Israel, resulting in over one thousand deaths and over 1,900 injuries. Physicians, paramedics, and medics were caught in the crossfire, both as victims and first responders. They faced the daunting task of providing care under continuous fire while grappling with the knowledge that their colleagues were among the victims. This study explores the psychological and professional challenges healthcare providers encounter during this extreme scenario, examining their coping mechanisms and ability to deliver critical care in the face of personal risk and loss.

The research employed a qualitative methodology involving in-depth interviews with seven paramedics, five doctors, and six medics who provided continuous medical care during the events of October 7, fully aware that their colleagues had been injured or killed. The goal was to comprehensively understand the difficulties they experienced, their coping strategies, and their ability to function under such extreme circumstances.

In the research, five central themes emerged consistently across all interviews: personal and moral dedication, prior experience in high-stress environments, awareness of their irreplaceability, the necessity to fulfill duties, and the understanding that the deceased medical colleagues would have expected them to continue their work.

This research provides a compelling and unique insight into the experiences of field-level medical personnel who must deliver aid while facing immediate danger, knowing that their colleagues have been injured or killed. The findings offer valuable lessons that can enhance preparedness and resilience for similar events in the future, not only in military and conflict settings but also in the context of other large-scale crises and attacks on healthcare facilities. The study’s insights can inform the development of targeted training, support systems, and organizational strategies to better protect and empower medical personnel in the face of such extraordinary challenges.

Prolonged Casualty Care (PCC) refers to delivering medical care in austere environments where evacuation is delayed. In future conflicts, the United States Department of Defense anticipates delays in medical evacuation due to extensive operational areas and challenges associated with operating in semi- and non-permissive environments. This study investigates the impact of a high-fidelity simulation, Operation Gunpowder, designed to teach PCC skills to US military medical students. The simulation emphasizes hands-on experience and leadership within the context of delayed medical evacuation in a limited resource environment.

A qualitative phenomenological design was employed to explore the experiences of 35 third-year military medical students who participated in Operation Gunpowder. Data were collected through pre- and post-simulation interviews and analyzed for thematic insights, first individually coded and then collectively agreed on emerging themes as a group.

Three main themes emerged: (1) Benefited from Hands-on Learning: Learners highlighted the importance of practical experience in mastering skills essential for PCC, contrasting it with traditional learning methods. (2) Navigated the Operational Environment: Participants discussed how the simulation exposed them to unpredictable, high-stress scenarios, enhancing their ability to improvise and manage patient care under pressure. (3) Developed Leadership Skills and Abilities: Students recognized their growth and potential in leadership roles, emphasizing teamwork and communication as critical for successful operations.

Operation Gunpowder effectively enhanced students’ clinical skills and preparedness for real-world military operations. The simulation fostered hands-on learning, resilience in unpredictable operational environments, and the development of leadership abilities. These findings underscore the necessity for simulation-based training in military medical education, particularly in preparing students for the complexities of PCC in future deployments. Further research will quantify the simulation’s impact on skill performance and explore the integration of telemedicine in austere environments to enhance military medical education.

This study aimed to identify factors related to the survival outcome of out-of-hospital cardiac arrest patients in the emergency department at Det-Udom Crown Prince Hospital.

This retrospective descriptive study collected data of out-of-hospital cardiac arrest patients at the emergency department during January 2022 and December 2023 from the hospital database. The data was analyzed by descriptive statistics and the Chi-square test or Fisher’s exact test.

Among the 168 patients, 72% were male, age average, 55 years. Incidents occurred at home (56.5%), and cause of cardiac arrest by accidents being (31.5%). The sustained return of spontaneous circulation was 25.8%. The survival to hospital admission was 24.1%, and survival with a good neurological outcome (Cerebral Performance Category; CPC) Cat I-II was 2.15%.

The factors significantly associated with out-of-hospital cardiac arrest survival (P-value<0.05) were as follows: The associated factors of failure in resuscitation were diabetes (Odd = 2.676), hypertension (Odd = 2.333), and cardiac arrest due to accidents (Odd = 2.509). During transportation factors associated with improved patient survival; defibrillator use (Odd = 0.430), chest compressions (Odd = 0.417), fluid administration (Odd = 0.430), and adrenaline administration (Odd = 0.467). Additionally, factors related to emergency medical services include response time, on-scene time, chest compression techniques, opening the airway, oxygenation, and type of ventilation.

Enhancing cardiopulmonary resuscitation (CPR) skills, expanding emergency medical response units to cover broader areas, and ensuring rapid access to emergency medical services can significantly increase the survival rate of out-of-hospital cardiac arrest patients.

The long-term mental health impact of disasters is still poorly understood. This multilevel meta-analysis aimed to assess the impact of the number of fatalities while simultaneously controlling for multiple factors. The objective was to verify whether there is an association between the extent of fatal casualties during a disaster and the mental health impact on exposed populations.

Medline, PsycInfo, PTSDpubs, Web of Science, and SocINDEX were searched for studies published from January 1946 to July 2024 (PROSPERO 2020, CRD42020108528). Longitudinal data from 71 studies (76 disaster-exposed samples) were extracted and augmented with fatality data sourced from Wikipedia. Fatality categories (<10, 10-99, 100-999, 1,000-9,999, >10,000), disaster type (natural vs. human-made), category (e.g., earthquakes, floods, terrorist attacks), mental health outcome (e.g., post-traumatic stress disorder, depression, anxiety, grief, suicidality), population age groups, disaster year, measurement month, study quality, and country income were included in the analysis.

The pooled average prevalence of mental health problems was 21.81% (95% CI [10.07-40.98]). From months 1 to 300, the post-disaster mental health burden decreased after an initial peak in the first months, followed by a second peak before declining again (p < 0.001). The prevalence of mental health problems did not differ significantly between mental health outcomes, disaster types or categories, population age groups, disaster year, study quality classification, or country income context. When controlling for these factors, fatality categories (reference: <10) had no significant effect on mental health. The proportion of fatalities differed between income groups. In 67% of disasters in upper-middle-income countries, fatalities exceeded 10,000, while 63% of disasters in high-income countries had fewer than 100 deaths.

Although this controlled multilevel meta-analysis demonstrates that the mental health impact of disaster exposure is profound and long-lasting, it did not confirm that a more excessive number of fatalities was related to increased mental health problems.

The COVID-19 pandemic revealed gaps in preparedness for large-scale health emergencies, highlighting vulnerabilities within communities and systems. Widespread distrust and skepticism towards innovative tools were common. To better manage future crises, it is crucial to integrate these tools, including information technology and AI-driven solutions, while actively engaging civil society organizations, citizens (especially vulnerable and non compliant groups), policy-makers, and health authorities. The PREPSHIELD project aims to foster a holistic, citizen-centered approach to health crisis management by developing policy recommendations and innovative tools.

Launched on September 1, 2024, with 13 partners, the PREPSHIELD project will run for three years. It will begin by identifying challenges and best practices from past epidemics and pandemics, focusing on areas such as healthcare response and communication with non-compliant groups. These insights will inform the development of crisis management tools, including a mobile app and an online platform, as well as policy recommendations. These will be tested through tabletop and online exercises at three pilot sites, each representing different scales and levels of institutional trust: the city of Hamburg, Piedmont Region, and Romania.

PREPSHIELD will deliver several key outcomes, including policy recommendations and tools for more inclusive pandemic management. A mobile application will be developed to provide educational content, information, alerts, and polls, while also allowing citizens to report data such as well-being, mental state, concerns, and alerts. This data will be linked to a platform designed to enhance situational awareness and support multi-actor decision making.

By promoting an inclusive and innovative approach to disaster management, PREPSHIELD will enhance pandemic preparedness but also provide insights for other types of disasters. WADEM provides a key platform to share this project and its preliminary findings with a community of disaster practitioners and scholars.

This project is funded by the European Union.

Indonesia is one of the countries with the highest disaster risk in the world, including the Tasikmalaya District in West Java Province. An information system to support the health office and public health centers (PHC) was developed to monitor preparedness, implement mitigation strategies, and enhance their capacity in the pre disaster phase.

This study employs a research and development (R&D) methodology. It starts with a qualitative approach to data collection through interviews and focus group discussions (FGDs) with stakeholders. These stakeholders provided insights into the problems and user needs for the system design’s foundation. The system design method used is the Framework Application of System Technique (FAST) approach.

The data collection revealed several issues in system implementation in the field, including a lack of human resources, budgeting, infrastructure, and policy procedures. The system’s user needs include disaster event monitoring and mitigation functions, visualization of attractive information such as maps and graphs as a dashboard, and features integrated with the climatology agency for early warnings. The system is also designed to be multi-user and accessible from various locations and platforms. Based on these findings, a web-based information system called HaRMoniS (health risk crisis monitoring information system) was developed, with features and functions aligned with the expectations and needs of the users. Thirty-eight out of forty PHCs used this system to cover almost two million people in the Tasikmalaya District.

With this system, PHC, the health office, as well as the community, can monitor disaster/health crisis risks, vulnerability levels, and capacity achievements in their area within the Tasikmalaya District. This allows the PHC and health offices, as the responsible parties for the health sector, to improve their preparedness, mitigation, and capacity-building efforts in the pre-disaster phase, thereby improving their readiness before a disaster occurs.