During the October 7, 2023, massacre in Israel, a large number of communities in multiple locations were attacked simultaneously. Many of these were cut off from help, resulting in delays in the evacuation of patients from the field to higher levels of care. This has highlighted the need for capacity building among first responders in performing life-saving procedures to victims of trauma, as well as managing mass casualty incidents before the arrival of ambulance paramedics. Three types of first responders were identified as providing crucial trauma care in these circumstances: the Army medical corps, local, community-based security teams, and medical staff in peripheral hospitals. To streamline training across a large geographical area, a mobile emergency medical training unit was established to bring expertise and the equipment to first responders nationwide. This is the first mobile simulation unit in Israel run exclusively and voluntarily by Emergency Physicians. Providers benefit from being trained and drilled together as a team on familiar ground through high-fidelity simulations. To date, over 100 workshops have been completed, training more than 3,000 medical personnel. Following the MARCH principles of trauma care, prioritized skills include hemorrhage control and airway management, prevention of hypothermia and expedient evacuation, and the integration of these into the assessment and care of both the individual trauma patient as well as multiple victims in mass casualty events. The workshops are modular and adapted to the professional level and requirements of the participants. To evaluate the efficacy of the workshops, pre- and post-workshop knowledge, proficiency, and confidence levels are continuously assessed at a programmatic level through surveys and qualitative methods. Mobile simulation units run by Emergency Physicians likely offer uniform, high-level emergency trauma care training to a wide spectrum of providers in their native environment.

Traumatic events often result in a large number of casualties, and while numerous disaster triage methods exist, there is a lack of evidence comparing their effectiveness.

Utilizing data from public databases, a retrospective evaluation was conducted on 10,000 patients to assess the value of six disaster triage methods on patient outcomes, specifically mortality. Receiver Operating Characteristic (ROC) curves were employed for the analysis.

The Sacco Score demonstrated the largest area under the ROC curve; however, there was no significant difference in outcomes when compared to methods such as START, CareFlight, etc. (p > 0.05).

Based on the current evidence, the differences in effectiveness among these disaster triage methods are not statistically significant. Therefore, it is recommended that methods that are faster and simpler to implement be selected for use in disaster response.

Healthcare professionals in Emergency Departments (EDs) must be prepared to handle mass casualty incidents (MCIs) that can strain resources and impact care quality. Despite Singapore’s low risk of natural disasters, its vulnerability to incidents like plane crashes and terrorist attacks necessitates comprehensive disaster planning. This includes readiness for CBRNE threats and HAZMAT decontamination. During civil emergencies, public hospitals in Singapore mobilize resources like Field Medical Teams (FMT), civil emergency (CE) personnel, and HAZMAT decontamination stations (HDS). Sengkang General Hospital (SKH) ED employs a two-pronged approach of lectures and simulations for training. About 50 ED healthcare professionals participated in a program organized into three groups: FMT, CE, and HDS. In the lectures, participants gained knowledge about civil emergencies, workflows, and their specific roles during MCI activation. This was complemented by simulations conducted every two weeks. FMT simulation focuses on efficiently deploying support teams from the hospital to incident sites. CE participants utilize building blocks for a tabletop exercise to visualize the department’s layout and processes during MCI activation. HDS participants train to don hazmat suits quickly and set up a decontamination area. SKH ED also conducted a full-dress rehearsal simulating a massive MCI activation involving all participants. The two-pronged approach enhances understanding and interactive learning through safe simulations, thereby boosting emergency preparedness. As a relatively new hospital, SKH ED greatly benefits from these simulations. However, training is limited by time constraints and the specific qualifications required for different roles, such as an Advanced Diploma in Emergency Medicine or HAZMAT certification. There is also a need to enhance training for managing pediatric casualties, as most public hospitals primarily serve adults. While disasters are rare in Singapore, the potential severity of such incidents highlights the importance of well trained staff in the ED. Therefore, prioritizing training for ED staff in emergency and disaster preparedness is essential for effective management.

The world was not prepared when the coronavirus pandemic hit. The Integrated Health Monitor COVID-19 studies the impact of the COVID-19 pandemic on Dutch population health and well-being since 2021. These results should be taken into account when increasing pandemic preparedness.

The Integrated Health Monitor COVID-19 contains four main study arms: (1) systematic literature reviews, (2) quarterly and (3) bi-annual monitoring through questionnaires in different target groups, and (4) Primary Care patient registration data. All effects since September 2021 were pooled and assessed for possible effect mitigation options and lessons learned for future pandemics.

The effects of both COVID-19 infection and containment measures on Dutch population health are still present. Two years after the Omicron lockdown in December 2021, the prevalence of post-COVID-19 syndrome was 3,4% (95% CI: 3,0%-3,8%) among adults (26+ years), and there is hardly any recovery in youth mental health. Some effects can still be mitigated by acknowledging the sorrow from the pandemic and strengthening social networks.

Reflecting upon the acute phase of the pandemic shows the focus of the monitoring and advisory activities in the Netherlands on two tracks: (1) infectious disease control and the acute consequences for mental health, and (2) behavior patterns related to COVID-19 countermeasures. Even though some monitoring included mental health aspects (mostly as a predictor of behavior), the pandemic’s effects on well-being were underexposed and therefore underemphasized in COVID-19 policy-making for a long time.

Mental health and well-being were negatively affected during the COVID-19 pandemic. This is assumed to be an effect of the containment measures. Therefore, part of pandemic preparedness should be to start monitoring population health and well-being simultaneously with monitoring infectious disease and behavior. Thereby, these aspects can be proportionally weighed and taken into account in policy decisions during an infectious disease outbreak.

The concept of ‘perceived threats’ in the context of various emergencies captures how populations experience and interpret actual and potential risks. Understanding public perceptions of diverse threats during and after these crises is critical for numerous reasons, from influencing public health behaviors to enhancing community trust and resilience.

The study assessed the Israeli population’s perceptions of varied threats during three types of adversities – the COVID-19 pandemic, a socio-political crisis triggered by a judicial reform process, and a protracted war. Data were collected through internet panels, targeting a representative sample of the Hebrew-speaking Israeli population. Four main risks were surveyed: health, economic, security, and political threats. The findings were analyzed to identify commonalities and diversities in risk perceptions during the different adversities.

The findings present that political instability was the highest perceived risk throughout the COVID-19 pandemic and the socio-political crisis. Furthermore, the political threat was ranked close to security during the protracted “Iron Swords” war. After 11 months of conflict, the public perceived the political risk as the most severe when ranking the four types of risks.

Misalignments between governmental strategies and the public’s risk perceptions can lead to ineffective emergency management. For example, during the COVID-19 pandemic, while government officials focused on the fear of the virus, the public’s concerns centered on political instability. This misalignment resulted in a lower uptake of repeated vaccinations. The study underscores the necessity of understanding public perceptions to tailor emergency responses that are socially sensitive and practically feasible. Enhanced comprehension of these dynamics is pivotal for current and future public health strategies and the overall endurance and recovery of societies from prolonged emergencies.

During a pandemic, it is essential to have timely and effective responses to rapidly monitor its impact on the healthcare system. The system of data collection, analysis, and feedback was reconstructed for this purpose.

To rapidly measure the COVID-19 impact, a sub-project was launched early in 2020 as part of the Quality Indicator/Improvement Project (QIP), to which over 500 hospitals were voluntarily registered from across the nation. In normal times, the anonymous individual-level data of all the patients of participating hospitals were routinely collected and securely stored in the QIP database securely managed. Under the COVID-19 pandemic, QIP was converted into an emergency mode, which enabled a more rapid assessment of the healthcare system. Statistical methods used included interrupted time-series analysis adjusted for seasonality and time trends.

During the pandemic, inpatient visits were reduced in almost all areas, including stroke, myocardial infarction, heart failure, pneumonia, insufficiency fractures, and even cancer surgeries, except for alcohol-induced diseases. Furthermore, the number of inpatients and outpatients did not recover even after the pandemic was over, which showed an increasingly difficult environment for healthcare management. Hospital reimbursement income dropped dramatically, by as much as 30% in the first half of the year compared to the previous year, particularly in hospitals that treated more COVID-19 inpatients. This alerted an urgent need for subsidies to sustain the healthcare system. Evidence suggested that the quality of care was maintained in medical and surgical fields such as acute myocardial infarction and insufficiency fractures, even under a stressful working environment during the pandemic.

The system developed in this project demonstrated a prototype that could potentially be implemented at the national level to rapidly monitor the impacts of pandemics on healthcare systems, enabling policymakers and healthcare administrators to respond more effectively and timely.

According to the World Health Organization, over 5% of the world’s population –430 million people have hearing loss. It is estimated that by 2050, over 700 million people will have disabling hearing loss. In emergencies and disasters, alerts are predominantly transmitted through sound channels, posing significant challenges for the hearing-loss population. Ensuring accessible alert systems for this population is crucial. The recent “Iron Swords” war prompted the Israel Home Front Command to implement an accessible app that combines sound, vibration, and light alerts alongside traditional auditory warnings.

This study aimed to evaluate the effectiveness of the alert application among individuals with hearing loss and identify factors influencing alert accessibility.

A cross-sectional survey with accessible Hebrew was conducted from October 17 to November 30, 2023 (ten days after the war started) via the Qualtrics platform. The survey targeted individuals with hearing loss, including deaf people, hard-of-hearing individuals, and those with or without cochlear implants or hearing aids.

The study included 167 participants with hearing loss, of whom 52.1% (n = 87) self-identified as deaf persons and 43.7% (n = 73) as hard-of-hearing. Among the participants, 127 reported using cochlear implants and/or hearing aids. During daytime hours, approximately 69.46% of participants received warnings from the alert app (via sound, light, or vibration), compared to only 32.34% during nighttime hours. Notably, almost half of the participants (43.1%) reported not receiving alerts from the app at night. In response, about 47.31% of participants rely on family members as an alternative source of alerts.

This application demonstrates effectiveness in delivering daytime alerts to individuals with varying degrees of hearing loss. However, its efficacy significantly diminishes during nighttime hours, regardless of hearing status. These findings highlight the need for developing more robust solutions for nighttime alert accessibility among populations with hearing loss.

Due to its classification as a medical emergency, the Israeli health system was tasked with spearheading the fight against SARS-COV-2 in Israel. Consequently, politicians were crucial in cultivating public trust, coordinating all facets of the country’s healthcare infrastructure, and managing medical emergencies. In times of disaster, the Israeli healthcare system’s survival relies heavily on delivering medical services by the four HMOs. This study aims to assess the relevance of political tensions to the healthcare system in Israel.

While fighting the COVID-19 pandemic (2020-2022), thirteen high-ranking individuals within the Israeli healthcare system who were directly involved in managing and leading the country’s response to COVID-19 were interviewed in-depth using a semi-structured approach. The interviews were also subject to peer review panel evaluation. Access to participants was obtained by the researchers, and they were interviewed physically or via Zoom. The questionnaire format was provided in advance. Data analyses were done with ATLS.TI 22. The study identified six themes, including one that focused on the impact of political tensions. The themes were generated by identifying recurring concepts and categories within the participants’ quotes.

Numerous instances of the apparent influence of political tensions on the capacity of medical managers and staff were discovered. Among the 13 interviewees, 12 explicitly linked political tensions to a substantial impact, substantiating their perspectives with specific instances. They particularly highlighted the Prime Minister’s decision-making process and collaboration with other ministers and emphasized the treasury’s role in reconciling the politicians’ interests.

The study showcases a thorough understanding of how the Israeli healthcare system tackled the pandemic, addressing the impact of political tensions on it. This understanding presents a unique opportunity to gain insights into how service delivery can be enhanced both within the healthcare system and throughout the country. Numerous lessons and examples provided may be relevant for other countries.

Given the global increase in disasters, the International Council of Nurses calls for every nurse to be a disaster nurse, and the Royal College of Nurses in the UK even considers nursing to be a safety-critical profession. In the DACH countries (Germany, Austria, and Switzerland), however, the role and mandate of nurses in disaster preparedness and response have so far received little attention. This study aimed to investigate this observation from the perspective of experts.

A modified multi-stage Delphi study was conducted. The initial stage involved an in-person roundtable symposium to identify positions and assumptions on nurses’ roles and mandates in disasters in the DACH countries. This was followed by three successive and increasingly standardized online surveys (stages 2-4). Originally consisting of experts from nursing, disaster relief organizations, politics, the armed forces, and the education sector, the group was gradually expanded to include experts from related fields and professions (from n = 28 to n = 74).

Participants considered it highly relevant to clearly define the role and mandate of nurses in disasters. A consensus was reached that nurses in the DACH countries should play a key role in maintaining the health and safety of the population. To enable nurses in German-speaking countries to fulfil their safety-critical mandate before, during, and after disasters, experts with a nursing background called for the inclusion of nurses in decision-making bodies. However, the participants believed the development of competencies in disaster nursing must be improved at all levels.

The modified Delphi study showed that a clarification and an agreement must be reached on the role and mission of nursing in disasters in the DACH region. Realizing the safety-critical potential of nurses before, during, and after disasters requires addressing both policy and educational gaps in the three countries.

Climate change is expected to increase the frequency of infectious disease outbreaks and weather-related disasters. However, agencies are often separated in institutional focus, either on infectious diseases or disaster management, but not both, which limits capacity to respond when they happen together. This project aimed to explore how to prepare for and respond to overlapping infectious disease outbreaks and weather-related disasters in the state of Victoria, Australia.

Qualitative interviews were conducted with 20 stakeholders in infectious diseases and/or emergency management, including researchers, government workers, practitioners, and citizen scientists. Interviews focused on each stakeholder’s imagined worst case, best case, and most likely case for how disasters and infectious disease outbreaks could overlap in the next 5 years. Interviews were thematically analyzed using strategic foresight methods to create future scenarios. Strategic foresight methods seek to give readers a ‘memory of the future’ to act upon in the present. Participatory workshops were held with government agencies to examine the scenarios against existing policies and practices.

Three future scenarios were created, including overlaps in disasters and infectious disease outbreaks that were coincidental (High Pathogen Avian Influenza outbreak and extreme flooding co-occur), cascading (bushfires lead to animal movement and an outbreak of Tularaemia occurs) and compounding (extreme heatwave and Hendra virus outbreak exacerbate each other and become harder to manage). Workshops examined pathways for managing these overlaps, identified barriers and facilitators for organizational change, and highlighted the importance of cross-agency collaboration.

It is imperative to address the complexity of overlapping infectious disease outbreaks and disasters. This study underscores the importance of considering multiple hazards in scenario planning and capacity building and illustrates ways of working with different stakeholder groups to plan for the future. The present findings further highlight the possibility for creative governance among agencies facing uncertainty and complex risks.

The civilian-military collaboration for mega disaster rescue is performed as an operation under civilian control. In Japan, only the JSDF and the US military can offer agile C4ISR systems and 3-D operation by a joint task force. This paper shows the activities of Operation Tomodachi and the Noto Peninsula Earthquake.

Operation Tomodachi at the Mega East Japan Earthquake

In 2011, the political situation in Asia was not dangerous due to the six countries’ meeting format. Nuclear power plants in Fukushima experienced a meltdown due to a tsunami. Rescue teams were required to manage the CBRNE disaster, and CBIRF was dispatched from the US Marines. JSDF FDMA(Fire and Disaster Management Agency) prevented the China syndrome by brave reactor cooling operations from land and air. The US military conducted a 3-D rescue operation using an aircraft carrier and an amphibious assault ship. JSDF sent over 100,000 soldiers for rescue. Airport and main highways were repaired quickly.

Noto Peninsula Earthquake:

In January 2024, the political situation was critical due to the Ukraine war, the Hamas attack, and the Taiwan crisis. Both the JSDF and the US military were on high alert. Fortunately, the earthquake area was limited, and the JSDF base near the Noto Peninsula was not damaged. JSDF, National Police Agency, FDMA, and Japan Coast Guard performed 3-D rescue operations. Innovative devices such as LCAC from an amphibious ship or multi-role drones were activated. JSDF provided eight months of operation for lifelines in the NOTO area. No looting or riots were reported.

Today, the risk of the Nankai Trough Mega Earthquake is increasing, and JSDF and the US military are required for disaster rescue and defense. Available forces depend on international circumstances. The Security Treaty Between the US and Japan has become the backbone for defense, economic activity, and disaster resilience.

Western Australia implemented a swift and extensive response to the COVID-19 pandemic. Broad public health protections included strict international and state border closures, rapid lockdowns, and a widespread vaccination strategy that resulted in 95% of the population receiving two doses of the vaccine before the first community outbreak of the virus. This presentation investigates the longitudinal patterns of post-traumatic stress symptoms (PTSS), depression, and anxiety among healthcare workers in Western Australia, and the risk and protective factors associated with changes in status during the onset of COVID-19 community spread. It outlines data from an explanatory mixed methods study that included a longitudinal assessment of healthcare staff (n = 183) working at tertiary hospitals and major clinics across Perth (before and following the first wave), a follow-up state-wide survey (n = 815), and qualitative data from interviews and focus group discussions (n = 21). The quantitative data revealed moderate levels of mental health difficulties reported at baseline. At follow-up, overall rates of post-traumatic stress symptoms (PTSS), depression, and anxiety remained stable; however, latent growth models revealed that those with lower PTSS, depression, or anxiety symptoms at baseline reported a larger increase in symptoms over time, and those with higher symptoms at baseline had a smaller decline over time, indicating a ‘catch up’ effect. Key risk and protective factors will be presented, and implications for future pandemic preparedness will be outlined. Improvements in systemic workplace factors are needed to support healthcare workers’ mental health during periods of acute stress, even in settings with high levels of emergency preparedness.

The impact of generational trauma on pediatric patients is a cycle that gets passed on from generation to generation. This is particularly true for children who are brought up in war-torn countries, and their parents experienced the implications of war firsthand. The child may have unexpected reactions to harmful and dangerous situations happening around them, from walking alongside a building that had just been bombed without any outward reaction to their body shutting down and not being fazed by their environment. Children take on adult roles, which strips them of their childhood. This detachment is reflected in how they care and provide support to their children. This presentation will discuss ways to break the cycle of trauma and highlight the health implications associated with not doing so.

On April 3, 2024, an earthquake measuring 7.2 on the Richter scale occurred off the coast of Hualien County, Taiwan. This earthquake was the largest earthquake in Taiwan after the September 21 earthquake in 1999. The Taroko National Park, located in the northern part of Hualien City, had serious rockfalls and collapses; many tourists and vehicles were trapped on the trails and tunnels waiting to be rescued. The non-governmental organization, the Taiwan Development Association for Disaster Medical Teams, the disaster preparedness and rescue group, signed a cooperation agreement with the Special Search and Rescue (SSAR) Team and immediately formed an advance team to carry out the rescue mission.

The SSAR team of the National Fire Agency and from neighboring counties and cities were responsible for coordinating rescue missions at the disaster site. Three of these teams have doctors, nurses, and emergency paramedics. Formation of an SSAR medical team to accompany the disaster relief mission. It was anticipated that more people or injuries would be extricated from the Taroko National Park on the second day of the disaster, and initial assessment, medical assistance, and medical evacuation assistance.

The disaster medical advance team was dispatched by the on-site command center to perform medical operations at the scene of Taroko National Park with the SSAR medical team, sharing human resources and medical supplies, and at the same time being responsible for the evacuation of patients from the medical station. 181 people were monitored by the medical station and treated by the doctors for the evacuation. This was the first time that the disaster medical team and the SSAR medical teams cooperated in the rescue of a large-scale earthquake disaster in Taiwan in the past 25 years.

Penetrating injuries from homemade spearguns are common, serious injuries, especially in river basin areas or after flooding. Harpoon injuries are unique and affect surgical treatment planning. This study focuses on managing speargun injury to the torso from pre-hospital to definitive repair.

This case-series study presented five patients injured by a homemade speargun to the torso and attended to the trauma level one center, describing management in the context of the Khon Kaen University experience.

All patients were injured by the fixed-type barbed metal harpoon. Three patients were shot in the chest, and two were shot in the abdomen. All patients were hemodynamically stable. Since each harpoon has a fixed-type barb, it cannot be pulled out retrogradely, so they must be immobilized from a pre-hospital setting, and all patients must undergo surgery. The standard surgical exposure is used to remove the harpoon in an antegrade direction to prevent further tissue injury.

Speargun injuries are challenging and can occur after flooding when there are few facilities available. The harpoon needs to be immobilized from prehospital and surgically removed. To facilitate the operation or investigation, it is sometimes necessary to cut the protruding part of the harpoon using a large bolt clipper with at least two adjustable wrenches to hold the harpoon in place. The recommendation is that the patient should be positioned in the supine position for effective standard surgical management. Since this type of injury can occur after a flooding disaster, it is important to prepare for it.

Located in eastern Taiwan, Hualien County is the largest county by area. This county is vast but elongated, with 93% of its land covered by mountains and rivers. Therefore, when disasters like earthquakes or typhoons strike, roads are often blocked by mudflows, falling rocks, or landslides, isolating affected areas and making it difficult for medical resources to reach them.

To enhance mobility in responding to the urgent medical needs of multi-site or island-like disaster areas, the Hualien County Disaster Medical Assistance Team has formed an Advanced Team. This team includes one logistics officer, one administrative officer, and three medical personnel: one doctor and two nurses. The main goals of the Advanced Team are reconnaissance and emergency medical support. Before establishing medical stations, they provide information on risk conditions and healthcare in the disaster areas.

Upon arrival in the disaster area, the Advanced Team will conduct a rapid assessment of local conditions, safety risks, casualties, medical needs, and public health resources. Based on casualties, temporary medical stations will be set up to provide emergency medical services. Simultaneously, contact points will be established to maintain ongoing communication and information exchange with hospitals, the government, and non-governmental organizations. After the above efforts, the team leader will decide whether to activate the main disaster medical team based on conditions in the area and guide them in the handover of the medical station.

The author, a member of the Hualien County Disaster Medical Team’s operational unit, served as a registered nurse on the Advanced Team during two local earthquake disasters. This report shares insights from disaster site assessments and operational models used in advanced missions, exploring the differences between them. Through this experience, it aims to guide future teams in quickly assessing disaster areas to safeguard residents’ health, safety, and sanitation.

Climate change is a significant threat to human health. It is affecting emergency medicine practice through the increase in climate-related disease patterns and shifts in epidemiology for conditions diagnosed and treated in emergency departments (EDs), especially for vulnerable populations. Singapore is ranked 187/192 on the World. Risk Index based on the 2022 World Risk Report. Singapore has thus far been fortunate to be spared from natural disasters such as earthquakes, typhoons, and volcanic eruptions. There has been occasional flooding during heavy rain, but it is not sustained and does not significantly impact transport systems. The objective is to assess the current state of knowledge and perceptions towards heatwaves of emergency department (ED) healthcare workers in Singapore and investigate potential strategies and solutions to improve the knowledge and readiness.

A qualitative study was conducted in Khoo Teck Puat Hospital in Singapore, using semi structured face-to-face interviews with an open-ended interview guide, on emergency physicians and registered nurses of various lengths of work experience actively working in the ED. The thematic analysis approach was employed, which involves memo-writing, coding, and theme development with constant comparison.

Six themes— (1) Knowledge and understanding of Extreme Weather Events, (2) Knowledge and understanding of Heatwaves, (3) Impressions of vulnerability to heatwaves, (4) Measures or factors to help prevent heat related illness, (5) Perceived impact of heatwave on emergency departments, and (6) Potential strategies and solutions— emerged and were presented in an interactive framework.

There is basic foundational knowledge, with more education and training required, especially targeting the knowledge gaps identified. There is also a need to increase awareness of heatwaves, their impact on health, and to develop comprehensive extreme heat response plans. The findings provide a framework for emergency departments to guide their preparations for inevitable heat waves and their associated health impacts.

Lung Ultrasound (LUS) is a widely utilized point-of-care ultrasound (POCUS) application in emergency and critical care settings for assessing dyspneic patients. It aids clinicians in differentiating among various potential diagnoses, including congestive heart failure, chronic obstructive pulmonary disease, pneumothorax, pleural effusion, and pneumonia, thereby guiding appropriate treatments and interventions. In the prehospital setting, clinical decision-making can be especially challenging due to limited diagnostic resources when distinguishing these common causes of acute dyspnea. POCUS is a tool that has been used in Helicopter Emergency Medical Services (EMS) for over a decade, but has only recently found its way into ground ambulance services. Advances in technology have made ultrasound machines more portable, durable, and affordable, improving both the accessibility and feasibility of using this valuable diagnostic tool in prehospital care. While POCUS has increasingly been integrated into prehospital training protocols for various applications, LUS has not been widely adopted in this context despite its recognized utility in the management of dyspneic patients and its relative ease of training. New Orleans EMS in Louisiana, USA, has begun incorporating LUS education into their POCUS training for providers. Paramedics and advanced EMTs are now employing basic LUS to evaluate dyspneic patients in the field, using ultrasound findings to inform treatment decisions. This case series presents several patient cases from this initiative, demonstrating how LUS contributed to identifying the etiology of dyspnea and highlighting typical pathologic findings observed during LUS examinations. We will further explore how these findings lead to a change in management that would not have been available without the use of POCUS in the prehospital setting.

Sudden cardiac arrest (SCA) is a leading cause of mortality worldwide, with in-hospital survival rates (25.5%) significantly higher than out-of-hospital arrests (10.8%). Effective cardiopulmonary resuscitation (CPR) is crucial for improving survival in hospital settings. Key factors affecting CPR success include compression rate, depth, and minimizing interruptions. Real-time feedback has been shown to enhance CPR performance and patient outcomes. This study aims to evaluate the impact of real-time feedback during CPR training for healthcare providers in Rwanda to improve CPR practices and potentially patient outcomes.

Health care providers received a one-hour CPR simulation course. The course featured hands-on practice with Laerdal manikins equipped with real-time feedback technology. Before and after the course, participants completed a multiple-choice assessment based on the AHA Basic Life Support (BLS) exam. Data on chest compression quality were collected using the Laerdal app and CPR feedback system.

Seventy-two healthcare providers participated in the study. Post-training knowledge scores increased from 52% to 82% (p < 0.001), and confidence levels improved from 2.92 to 3.68 (p < 0.001). These are preliminary results from an ongoing study; more data are being collected and will be analyzed and incorporated as a series.

The training program significantly improved healthcare providers’ knowledge and confidence. While individual CPR metrics did not significantly change, overall CPR quality improved. Follow-up sessions are recommended to assess long-term retention and skill decay.

In the Israeli Defense Forces (IDF), women are increasingly taking on combat roles that previously were reserved only for males. During the ‘’Iron-Swords” war in Israel, female fighters of the IDF took part and fought alongside male soldiers in the Gaza Strip. It was the first time that female combat soldiers of the IDF officially joined the corps across the Israeli borders. This novelty raised a lot of questions about the medical aspects consumption of medical care and medication in this special group.

A 17-question questionnaire was distributed to the female soldiers of the Search and Rescue (S&R) brigade of the Home Front Command in the IDF. The survey contained both multiple-choice and open-ended questions. Questions focused on service characteristics, symptoms during the combat period, and medical care they received.

1. • 135 female soldiers serving as active duty or reserve soldiers answered the questionnaire. 98.5% (133) of soldiers were in combat positions, 71.9% (97) took part in fighting across Israeli borders.

2. • Gastrointestinal complaints, headaches, menstrual pain, and low back pain were the most common symptoms (46.7%, 40.7%, 37%, 30.4%, respectively).

3. • Additional complaints unique to female population were dysuria, vaginal symptoms such as pruritus and inconvenience (17%, 14.8% respectively).

4. • Half of the soldiers reached for medical care. 39.2% felt that the medical crew across borders did not have enough supplies and medications to treat them properly.

5. • Dysuria, vaginal symptoms and menstrual pain led to seek medical treatment in more than 60% of symptomatic soldiers (83%, 67%, 64% respectively).

6. • 39.3% of soldiers use chronic medications of any kind. 25.9% take oral contraceptives and 14.1% use nutritional supplements.

The concept of female medicine is different from our former understanding of frontline medical support. Standard medical cross-border kits do not include solutions to gender-oriented complaints. Personalized medical education and the provision of suitable medications are essential components of cross-border healthcare initiatives.