In 2017, unprecedented rainfall from Hurricane Harvey resulted in severe flooding in parts of Texas. While the association between the immediate effects of severe weather on mortality is well established, less is known about long-term mortality and how risk may differ across vulnerable populations, especially those reliant on health services. This study examines the association between severe weather exposure from Hurricane Harvey and mortality among vulnerable populations of older adults.

This retrospective cohort study used Medicare administrative claims data from beneficiaries aged 65+ who resided in Texas or Louisiana the year before and after Hurricane Harvey. Historic weather data was used to construct a 4-day measure of ZIP code tabulation area cumulative rainfall and identify locales exposed to high rainfall (above 75mm). Vulnerable older adult populations were identified. Attributable risk and relative risks (RRs) were estimated to quantify the impact of high rain exposure on mortality. Time-to-event analyses estimated associations between exposure to high rain and 12-month mortality.

The study included 1,730,693 beneficiaries; 535,794 (37.5%) were exposed to high rain in Texas, and 264,265 (87.5%) in Louisiana. Beneficiaries with Alzheimer’s disease and related dementias (ADRD) exposed to high rain had a 5% higher risk of mortality in fully adjusted models (HR=1.05, 95% CI: 1.02, 1.07) and 1,192 attributable deaths. High rain resulting from Hurricane Harvey was associated with a 13% higher risk of mortality among beneficiaries with end-stage renal disease (ESRD) in fully adjusted models (HR=1.13, 95% CI: 1.04, 1.23) and 85 attributable deaths.

The risk of mortality from exposure to severe weather differs based on the type of vulnerability. Those with an ADRD or ESRD diagnosis, in particular, had elevated mortality rates. High rain exposure had a significantly larger mortality impact on those of lower socioeconomic status. Emergency planning should pay particular attention to these highly vulnerable groups.

When dealing with radioactively contaminated patients, medical staff often experience anxiety, even though their health is unlikely to be affected by radiation exposure. An application has been developed to simulate the exposure dose to medical personnel by inputting the contamination status of the patient. In addition, it was examined whether the application could be used for radiation exposure medical education to reduce the concerns of medical personnel about radiation.

The application utilizes the Particle and Heavy Ion Transport code System (PHITS), a radiation behavior code, to simulate the geometry of a supine patient and a medical staff member standing alongside. Simulations were conducted assuming contamination of the patient with various radionuclides. Using this data and FileMaker Pro, an iOS application was developed that allows for an intuitive calculation of exposure doses. This application has been incorporated into radiation emergency medical education.

Simulations revealed that even in scenarios involving radionuclide release from a criticality accident, such as significant deposition of radioactive iodine or cesium on the patient’s body surface, medical personnel are unlikely to receive doses exceeding 100 mSv. Furthermore, medical doctors, nurses, and radiological technologists who underwent radiation protection training demonstrated significantly reduced anxiety regarding radiation exposure both before and after the training.

Providing medical personnel with an estimate of their potential exposure doses during the treatment of contaminated patients has proven effective in reducing anxiety. Continued basic research and education on low frequency events like radiation accidents remain crucial.

Public General hospitals in Israel must provide Emergency and Trauma care 24/7 without bias or connection. Hospitals differ in their ability to provide trauma care for different types of injuries, availability, infrastructure, services, and manpower. The MOH established a Trauma Committee to apply trauma care standards according to universal standards; hospitals are classified into three levels of trauma care: a Level One Trauma Center, a Regional Trauma Center, and a Local Trauma Hospital. The criteria include specialist physicians, nurses, nurse coordinators, other supporting medical and paramedical teams, Trauma Unit capacity and capabilities, Trauma Registration as part of the national system, standard medical equipment in the ED’s trauma Unit, Internal guidelines and procedures, Quality Assurance of care for the injured, research, and Trauma Education.

Six of the twenty-eight hospitals assessed by the committee were recognized as Level One Trauma Centers; one medical center was required to complete deficiencies and is in the re-evaluation process. Seven Medical Centers were approved as Regional Trauma Centers. Three medical centers were required to complete deficiencies and participate in the re-evaluation process. Six hospitals are approved as local trauma hospitals, but another six do not meet the requirements, and their recognition has been delayed.

At this point, some hospitals do not meet the required standard due to a lack of motivation to promote their system and blame it on a lack of budgets, the need for preparation, appointment of positions, and commitment. The committee’s hands are tied because it cannot oblige hospitals to fulfill the recommended standards. In the absence of the ability to “punish,” it is possible that some hospitals will not be part of the standard Trauma care in the national trauma system. Moreover, their Trauma Care standard may be inadequate. The committee needs to have the legal authority to enforce its recommendation.

The medical unit of the Japan Disaster Relief (JDR) Urban Search and Rescue (USAR) team comprises five members, including physicians and nurses, who are responsible for providing medical care to rescued victims and managing team members’ health, including rescue dogs'. Unlike other USAR teams, JDR’s distinctive feature is nurse participation; however, the specific contributions of these nurses remain unevaluated. This study aimed to assess nurses’ contributions during USAR activities using V. Henderson’s 14 Basic Needs as an evaluation framework.

Four nurse researchers with Medical Manager qualifications evaluated nursing care involvement across nine USAR team roles (leadership, rescue workers, structural assessors, handlers, rescue dogs, communication staff, coordinators, medical staff, and local staff). The evaluation used Henderson’s 14 Basic Needs, rated on a 5-point Likert scale (1: no attention; 5: very high attention). Statistical analysis employed R software for descriptive statistics and intraclass correlation coefficients (ICC).

The ICC(3,1) demonstrated high agreement at 0.882 (95% CI: 0.849-0.911). Analysis of three domains revealed: “Basic Physiological Functions” averaged 4.95 (SD=0.224) across all roles; “Environmental Adjustment” averaged 4.56 (SD=0.63), with human roles scoring higher (mean 4.75-5.0) than rescue dogs (mean 4.0); “Social Aspects” showed lower scores (mean 3.9, SD=1.11), particularly for rescue dogs (mean 2.8). “Beliefs and values” scored highest for local staff (mean 5.0) compared to other roles (mean 1.0-2.0).

Nurses’ contributions demonstrate a hierarchical priority system emphasizing physiological function management while maintaining environmental adjustment attention. Although social aspects scored lower, this reflects the acute phase of disaster response, with high scores for local staff in “beliefs and values,” highlighting cultural considerations in international operations. The findings demonstrate that nursing practice in USAR activities encompasses fundamental nursing elements while prioritizing life-sustaining care, enhancing overall team performance through physician collaboration.

The war in Ukraine has forced hospitals near the frontlines to overcome a considerable number of complex injuries under challenging conditions. This study presents a comprehensive analysis of 7,758 war-wounded patients admitted to the first traumatological Intensive Care Unit of Mechnikov Hospital in Dnipro, Ukraine, a civilian hospital acting as the main role 4 facility for the eastern and southern zones, between 2022 and 2024.

A retrospective two-tiered study design was employed. The first tier analyzed automated hospital records for all war-wounded patients, focusing on demographics, mechanisms of injury, injury severity, and outcomes. The second tier consisted of a manual review of 41 detailed patient files to provide in-depth clinical insights. Metrics included injury patterns, prehospital interventions, surgical procedures, and ICU mortality rates.

Explosive injuries accounted for the majority of cases across all years (93.2% in 2022, 93.7% in 2023, and 88.5% in 2024), with a rising proportion of gunshot wounds (2.5% in 2022 to 7.5% in 2024). Median patient age was 38 (IQR 30–47), and the median length of hospital stay was three days (IQR 2–5). Limb injuries (87.8%) were the most common, followed by head (58.5%), thoracic (51.2%), and abdominal injuries (26.8%). ICU mortality rates declined over time, from 6.8% in 2022 to 5.4% in 2024. Prehospital interventions were prevalent, notably intubation (82.9%), tourniquet (65.9%), and damage-control surgery (70.7%).

The study highlights the prevalence of blast-induced polytrauma, emphasizing the importance of prehospital interventions and damage-control surgery in reducing mortality, but shows an evolution of the proportion of gunshot wounds over time. While ICU mortality rates compare favorably with other conflict zones, a declining trend over the years seems to follow the adaptation of therapeutic and logistical procedures. Limitations include the exclusion of prehospital fatalities and challenges in data collection due to major resource and environmental constraints.

A mass casualty incident (MCI) is a sudden onset event that can generate many patients with the potential to overwhelm healthcare resources. Many Canadian hospitals plan to use disaster-specific triage tools during an MCI, rather than routine procedures, despite a lack of studies. It is not known whether these alternate triage tools have ever been utilized in actual Canadian MCIs. This study sought to discover what triage strategies have been recorded and their frequency of use.

A scoping review of scientific databases and the grey literature was conducted to find published material regarding the triage strategy employed by the responding hospital(s) during real MCI events in Canada over the last 40 years (i.e., January 1, 1983, to December 31, 2022). A survey of healthcare providers was also administered to elicit further information regarding triage practices.

The database searches identified 279 reports; 32 underwent full manuscript review, and 2 were included in the study. The grey literature search yielded 28 reports; 23 were fully reviewed, and 1 was included. The grey literature search also identified 22 events that triggered MCI alerts at Canadian hospitals, and contacts for 15 of these events were invited to participate in the survey. Survey data were retrieved from 6 events (40% response rate). Nine separate disaster events were reported on in total. Six of these events reported a pre-existing hospital MCI triage plan, with 5 (83%) citing intent to use an alternate triage system. During the actual event, only 1 (12.5%) reported using an alternate triage strategy.

It may be appropriate to disregard alternate disaster triage tools for hospital triage and use routine procedures, saving valuable time and financial resources. The creation of a national repository of disaster responses impacting healthcare delivery in Canada should be strongly considered.

Healthcare organizations used off-the-shelf video conferencing platforms to provide telehealth services during the SARS-CoV-2 pandemic. However, the reliability and resiliency of these platforms for all-hazards disaster response when the telecommunication infrastructure may be damaged or overwhelmed is unknown. Further, industry standards to guide technology and system development for disaster response are lacking. This study characterized the impact of degraded networks on the ability to maintain adequate audio and video quality to support clinical telehealth encounters in simulated austere network conditions.

Network manipulation testing was performed in a cyber-sandbox for HIT on off-the-shelf video-conferencing platforms (Zoom, Microsoft Teams, Webex, Skype, and Google Meet) and two commercial telehealth platforms in development for regional disaster response in the United States. A high-precision network emulator was used to perform controlled network degradation, including network bandwidth, network delay, packet loss, and packet corruption. Delays in establishing synchronous video calls, video resolution, missing video frames, video freezes, delayed video, audio quality, delayed audio, and audio intelligibility were examined, as these issues can compromise the quality of the telehealth encounter.

Decreasing the network quality of service decreased audio and video quality. With all platforms tested, when network bandwidth was <200 KB/s, network delay was >5 seconds, packet loss exceeded 15%, or packet corruption exceeded 20%, communication via audio and video conference failed.

This study identified minimum network performance thresholds required to use video conferencing and telehealth platforms to deliver disaster telehealth services in simulated settings. These results inform system users and technology developers of methods, metrics, and expected performance to prepare for real-world performance degradation expected in disasters. Future studies should examine real-world network performance in a variety of disaster conditions.

Identifying patients with first-episode psychosis (FEP) who are unlikely to achieve early clinical recovery (ECR) is critical for personalised intervention and resource allocation. ECR – defined as the concurrent achievement of symptomatic and functional remission – represents a clinically meaningful outcome that captures both illness control and functional reintegration.

To develop and externally validate prediction models for ECR using clinical, cognitive and genetic data.

We analysed two large, independent Spanish cohorts: the primeros episodios psicóticos cohort (N = 335), for model development and internal validation, and the Programa Asistencial a las Fases Iniciales de Psicosis cohort (N = 668), for external validation. Forty-seven baseline clinical and cognitive variables and 87 polygenic risk scores (PRSs) were examined. Predictors were selected using penalised logistic regression. Logistic regression and three machine learning algorithms were compared for discrimination, calibration and clinical utility.

The best-performing model was a logistic regression using six routinely collected clinical and cognitive predictors (duration of untreated psychosis, days of treated psychosis, baseline functioning, insight, executive function and cognitive reserve), with an optimism-corrected area under the receiver operating characteristic curve of 0.73 in development and 0.63 in external validation. PRS models showed limited external generalisability and did not improve prediction. Machine learning algorithms offered no advantage over regression models.

A simple, interpretable logistic regression model based on routine clinical and cognitive variables can predict early recovery in FEP with acceptable generalisability. These findings support the use of transparent, clinically grounded models in early psychosis care and highlight the current limitations of genetic predictors for individualised treatment.

Adequate health workforce capacity is an essential component of disaster and other health emergency response. During a disaster, healthcare workers (HCWs) may be unwilling or unable to respond due to various factors. This study aims to identify factors that can be modified and solutions that can be formulated to support HCWs.

A scoping review was conducted according to the Arksey and O’Malley framework and PRISMA-ScR guidelines. The search strategy included eight databases, which were searched from 1998 to July 19, 2022. Pandemic or pandemic-prone respiratory virus outbreaks in the last 25 years, defined by the WHO, were included. Two independent reviewers conducted the study selection and data extraction.

37 studies were included. There was heterogeneity in design, population, and included absenteeism causes and measures. 22 studies identified potential predictors. These include individual factors, including demographics, professional cadre, seniority, occupational exposure risk, personality trait, perceived stressors and mental well-being, and concern for personal or family illness, that may predict their likelihood of absenteeism. Ecological factors were also identified that may correlate with the magnitude of absenteeism seen at a workforce level. These included the type of clinical department or hospital, community, and hospital pandemic infection rates, and certain response measures, such as HCW testing rates, availability of personal protective equipment (PPE), staff vaccinations, and public health restrictions on community movement and activities.

Building on the potential absenteeism predictors, factors, and mitigation strategies scoped in this review, further research will be essential to develop valid models for predicting absenteeism rates and to establish effective mitigation strategies, which will allow for preventive and anticipatory actions to safeguard workforce capacity.

There has been an increase in murders and attempted murders of important persons over the past few years. Assault on important persons is a form of terrorism, and it is necessary to minimize damage for the sake of social peace and order. Healthcare providers (HCPs) are required to respond quickly to save lives when an incident occurs. However, no data have shown whether HCPs and medical institutions are adequately prepared. We conducted a survey on the current status of the medical system for responding to assaults on important persons.

A questionnaire survey was conducted among physicians on the largest medical portal site in Japan. The questionnaires are: A. Experience in receiving request to deal with injuries and/or illness of important persons, B. Specific preparation for providing treatment, C. Capability of dealing with injuries of important persons at your medical institutions, D. Treatment experience for injured important persons, and E. Evaluation of the medical system for important persons in Japan. Participants were asked to give anonymous responses.

A total of 1091 physicians participated in this survey. A. Of the 1091 participants, 78 physicians (7.1%) have received the request, B. Of those, 51 physicians (65.4%) had made specific preparations, C. 109 physicians (10.0%) responded that the medical system was in place, D. Only 18 physicians (1.6%) had experience treatment both gunshot and stab wounds, and E. 58 physicians (5.3%) answered that the medical system has been established. It has become clear that there are very few physicians who can provide proper medical care to injured important persons, and the system has not been well established either.

In order to protect society from the threat of terrorism, further efforts to establish a system that can provide appropriate medical care to injured persons are required.

The occurrence of disasters often has a tremendous impact on communities. In large-scale disasters, affected residents often need to rely on self-rescue before emergency response resources arrive. Therefore, enhancing the disaster response capability of community members is increasingly important, especially in light of the current extreme weather conditions.

From 2020 to 2024, the organization conducted 15 training sessions for frontline community responders, with over 1,000 participants in total. The training included classroom lectures, hands-on practice, and scenario-based drills to increase familiarity. A post-training assessment was conducted to ensure that participants understood and were proficient in the skills and knowledge taught in the course.

In the final assessment, all participants passed, achieving a 100% success rate. In the technical skills section, participants were able to independently complete all tasks. During the lecture sessions, instructors engaged with participants in comprehensive drills to confirm their retention of the course content.

Building community resilience is not a short-term endeavor with immediate results. Starting from basic first aid education and gradually expanding to all-hazard response training, the long-term planning and implementation of frontline community responder training can strengthen the community’s comprehensive response capabilities, equipping them to effectively handle both natural and human-made disasters in the future.

External hemorrhage is a leading preventable cause of death in prehospital settings. Despite established protocols and training, the application and outcomes of tourniquet use vary. Region 2 South, an area of four counties in southern Michigan containing 2.5 million people, implemented tourniquet application protocols and training programs. This study aims to analyze the effectiveness and accuracy of tourniquet applications.

Retrospective analysis of tourniquets from October 2019 to December 2023 that included patients presenting to level 1 and level 2 trauma centers with pre-hospital tourniquet placement. Data collected included personnel applying tourniquets, mechanism of injury, appropriateness and correctness of indications, associated interventions, and complications.

473 tourniquets were applied. EMS performed (218, 46.8%), followed by fire/police (196, 42.1%), and the ED (19, 4.1%), and bystander applied in 53 cases (11.3%). The mechanisms of injury were gunshots (185 cases, 39.5%), lacerations (59 cases, 12.6%), and stab wounds (45 cases, 9.6%). 78.3% of tourniquets met appropriate indications, and 89.3% were applied correctly. The odds of applying with appropriate indication were lower when bystanders performed the procedure (OR 0.33, 95% CI 0.18 - 0.60), as were the odds of correct application (OR 0.40, 95% CI 0.19 - 0.87). Data on interventions were missing (54.8%), but when available, it showed blood product administration in 7.8% of patients, suturing in 33.3%, vascular repair in 17.6%, and 27.1% of patients required multiple interventions. Complications related to tourniquets occurred in 2 (0.42%) cases.

EMS and law enforcement are primary applicers of tourniquets, with a significant portion applied correctly and appropriately. There is a lower likelihood of proper application by bystanders. The study indicates tourniquets are generally applied correctly and effectively, with minimal complications. This underscores the importance of continued training and data collection improvements to enhance prehospital care outcomes, as well as the importance of providing continued and further training to the public.

Solar eclipses are often associated with mass gatherings along the path of totality. Understanding the effects of such events on emergency services is crucial for preparedness and resource allocation. This study aims to investigate preparations for and the impact of the April 8, 2024, total solar eclipse in two metropolitan areas: Indianapolis and Bloomington, Indiana, USA.

Organizations involved in emergency management and public safety were sent a questionnaire assessing their preparedness efforts as well as the expected and actual impact that the eclipse had on each organization. Data was collected and managed using REDCap electronic data capture tools hosted at Indiana University School of Medicine.

Twenty-seven organizations were sent the questionnaire. Fifteen responses were obtained. Eight self-identified as hospital/healthcare, one as fire department, one as school/university, zero as federal or state government, one as local government, three as emergency medical services, zero as police, and one as other (emergency management/fire department) The median overall anticipated impact before the eclipse was three on a 1-5 Likert scale, with increased traffic being the most anticipated impact The median perceived impact after the eclipse was two (1-5 Likert scale), with increased population, traffic, and potential for mass casualties being the most impacted. Key themes extrapolated from the qualitative data include: communication and coordination between and within organizations is key to effective preparation and response; exercise planning for real-world events has intrinsic value beyond the actual event; overall impacts to hospitals were less than expected; overall preparedness efforts likely decreased any significant impacts.

Solar eclipses pose unique problems and require multi-agency coordination to prepare for large influxes of visitors. While impacts on emergency services may not be as profound as initially anticipated, active preparation for such events has intrinsic value and may mitigate negative consequences.

Early prehospital identification of stroke and triage to the right level of care may result in more patients receiving acute treatment. Approximately 25% of patients in Denmark receive revascularisation after an acute stroke. Further, 20 % of patients with stroke are not being recognized by paramedics when assessed on scene in a telephone conference with the stroke centre.

Accurate prehospital stroke identification is critical for treatment and 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. In this study, paramedics are using an app to assess the patient, guiding the paramedic through the NIHSS, while each step is documented in a short video, which is transferred to the centralized stroke center.

A stepped wedge randomized trial is performed, with paramedics being the subject which is randomized. First, paramedics are enrolled in October 2024. Data collection is terminated in December 2025. A paramedic in an intervention cluster uses a mobile app for patients with suspected stroke, recording videos of patients. The app analyses the videos, highlighting potential stroke predictors. Recorded videos and NIHSS scores are transmitted to the stroke center for thrombolysis decision-making. In the control group, standard procedures are followed.

The primary outcome measure is for prehospital recognition of patients with acute stroke, defined as the proportion of patients accepted for stroke evaluation and discharged with a final stroke diagnosis. A power calculation yields that no less than 1200 patients will be enrolled in each arm of the trial for 95% power to detect a 5% improvement, with 85% sensitivity assumed in the control group.

The results will show the intervention’s potential to improve stroke recognition rates and its ability to reduce on-scene times.

This study investigated the impact of natural disasters on the incidence of acute rheumatic fever (ARF) among First Nations peoples in Australia, as reported from 2012 through 2021.

Records covering natural disasters in Australia from 2012 to 2021 were compiled from the Emergency Events Database (EM-DAT) and the Australian Disaster Mapper. ARF incidence rates among First Nations peoples in Australia were retrieved from the Australian Institute of Health and Welfare, expressed as an annual incidence rate per 100,000 population. Calculations of ANOVA, simple linear regression, and multiple linear regression were performed to compare the number of natural disasters and the type of natural disasters to the incidence of ARF.

From 2017 to 2021, the annual incidence of ARF was significantly predicted by the number of natural disaster events in all five regions of Australia (p < .05), and even more strongly when excluding New South Wales (p < .01). From 2012 to 2021 using data excluding New South Wales, there was a weaker association between natural disaster events and ARF incidence (p = .07). When the natural disasters were further categorized into meteorological (including storms, floods, and cyclones) and climatological disasters (including fires, droughts, and heatwaves), a significant association was found between the type of disaster and ARF incidence from 2012 to 2021 (p = .02) and from 2017 to 2021 (p = .01). From 2012 to 2021, climatological disasters were a significant predictor with a negative correlation (p < .01). Conversely, from 2017 to 2021, meteorological disasters were the most significant predictor with a positive correlation (p < .01).

The incidence of meteorological disasters is associated with ARF among First Nations people in Australia. These findings introduce ARF as a disease of concern that disproportionately affects vulnerable populations in the wake of natural disasters.

Emergency departments (EDs) play a critical role in healthcare delivery and are contributors to greenhouse gas emissions. As frontline providers of acute care, EDs are uniquely positioned to address the health impact of climate change while also mitigating their environmental impact. Previous research has documented the healthcare sector’s overall response to climate change, but specific strategies employed by EDs remain underexplored. This review seeks to fill that gap by collating and analyzing existing data on ED practices aimed at sustainability to combat climate change and reduce their carbon footprint.

A scoping review was conducted using relevant terms related to emergency departments, climate change, climate resiliency, and mitigation. Papers written in English were included. From PubMed and Embase, 217 studies were found using the key terms. Seven papers made the final data extraction phase. Covidence software was used. A PRISMA model will be included in the final presentation.

Key findings indicate that EDs have started implementing energy-efficient technologies, waste reduction programs, and sustainable transportation initiatives. Some facilities have initiated training programs to educate staff on climate impacts and emergency preparedness in the face of climate-related events. However, the review also identified significant variability in the extent of these initiatives, with many EDs lacking formalized climate action plans. Additionally, there were no nationally unified plans identified for EDs to follow.

The scoping review highlights a growing recognition among EDs of their role in addressing climate change, with promising advancements in sustainability practices. However, the inconsistency in implementation and lack of standardized metrics suggest that more cohesive strategies are needed. To effectively combat climate change, EDs should prioritize developing formal action plans, sharing best practices, and fostering interdisciplinary collaborations that enhance both resilience and sustainability in emergency care.

On October 7, 2023, Israel experienced an unprecedentedly severe terrorist attack, resulting in more than 1,200 fatalities, 1,455 injuries, and 239 hostages. The scale of the attacks on civilians placed an immense strain on hospitals, particularly in the south. This necessitated a significant shift in hospital operations, including the activation of Mass Casualty Event (MCE) protocols. Soroka and Barzilai hospitals were forced to transition to a MEGA MCE mode, dramatically altering the operation of their emergency departments, trauma units, operating rooms, and internal medicine wards. Due to the overwhelming number of casualties and the significant strain on southern hospitals, secondary evacuation operations were conducted for the first time since the Yom Kippur War (1973). Hundreds of casualties were transferred from overwhelmed southern hospitals to those in the central and northern regions of the country.

This massive operation involved the coordinated efforts of the Home Front Command, the Ministry of Health, and hospitals across the nation, all operating in emergency mode. The success of these rapid and effective actions can be attributed to ongoing training, exercises, and cooperation spearheaded by the Hospital Preparedness Branch. This multi-year readiness program, involving 28 hospitals, included comprehensive emergency room training, tabletop drills and simulations for hospital headquarters, and large-scale drills. The annual training program encompassed MEGA, SURPRISE, SAMPLE, and MTE drills, ensuring all hospitals were prepared for large-scale emergencies. This presentation aims to share the lessons learned from both hospital-level and national-level evaluations regarding hospital preparedness for MCES. It will also provide insights derived from the secondary evacuation processes, which involved transferring hundreds of casualties daily, using Magen David Adom ambulances and helicopter evacuation rounds by the Israeli Defense Forces (IDF).

The increasing frequency and severity of natural disasters and humanitarian crises pose considerable problems to healthcare systems, particularly in terms of blood supply management. Effective blood supply chain management is critical for assuring timely access to blood products during crises, when transfusion demand increases due to trauma and mass casualties.

A comprehensive review of literature and case studies from past emergencies was conducted to assess current practices in blood supply chain management. Key strategies were categorized according to the four phases of emergency management. In addition, interactions with stakeholders from blood banks, hospitals, and emergency services were conducted to get insights into effective coordination and resource mobilization.

The results show that improving blood availability during emergencies requires proactive donor engagement initiatives, integrated communication systems, and coordination with emergency management organizations. Operational efficiency is greatly increased by proactive mitigation techniques like keeping stable inventory and readiness measures like interagency communication and catastrophe response plans. 'Walking blood banks’ and drone delivery systems are examples of innovative response-phase solutions that meet urgent transfusion needs. The recovery phase underscores the importance of strategic planning for restoring services and sharing resources among healthcare providers.

A coordinated and proactive approach to blood supply chain management across all phases of emergency management is essential for improving responsiveness during crises. By implementing the identified strategies, healthcare systems can ensure the availability of life-saving blood products when they are needed most, ultimately enhancing patient outcomes in emergencies.

As COVID-19 was declared a pandemic, it has become a significant concern worldwide, related to its high potential to destabilize many countries in the future. During the peak phase of the pandemic (2020-22), Indonesia also suffered a significant number of deaths and a high positive rate. Indonesia, a country with a high risk of natural disasters, faced severe challenges, as it contended with the pandemic in addition to simultaneous natural disasters, including earthquakes in West Sulawesi and East Nusa Tenggara. Muhammadiyah Indonesia, one of the largest philanthropic organizations in Indonesia, established the Muhammadiyah Covid-19 Command Center as a central hub for managing the pandemic. The pandemic did not stop Muhammadiyah’s efforts in handling natural disasters, which included sending emergency medical teams to areas affected by the earthquake in West Sulawesi and flash floods in East Nusa Tenggara. During the team’s assignment, adjustments to assignment procedures were made to prevent the transmission of COVID-19 infection between medical volunteers and the community. Supervision and evaluation of the special procedures were carried out intensively, resulting in an excellent output of fewer than 5% positive cases among medical volunteers. Lessons learned are that emergency medical response for sudden onset disasters (SOD) during the COVID-19 pandemic can be conducted with specific health protocols. Logistics, especially personal protective equipment (PPE) and additional facilities related to the COVID-19 pandemic, played a crucial role during this deployment. It is essential to improve and closely monitor the understanding of health protocols among all personnel during deployment. Assessing the affected area for COVID-19 management, including tracing, testing, treatment, and establishing a referral system, is a must. Additionally, emergency procedures regarding COVID-19 must be prepared as early as possible to ensure an effective response.

The purpose of this presentation is to highlight the challenges refugees and Internally Displaced People (IDP) face when living in tents. These include lack of privacy, safety, and security for families and children; inadequate/insufficient water sources leading to hygiene issues and infectious disease outbreaks; and extremes in temperature exacerbating medical conditions. This presentation will provide an awareness of how these challenges impact Palestinian women, as well as highlight unique challenges they face as it pertains to sanitation, cultural norms, access to care, and obstetric complications. Resiliency strategies to combat these challenges, as well as the lifetime implications, will be shared from the personal lived experiences of Palestinian women.