Mega MCI poses a significant challenge to the health system, particularly in combat zones under fire. Such an event affects the ability of the EMS and health services to evacuate and provide adequate medical care. On 7 October 2023, Hamas forces attacked southern Israel from Gaza. The attacks resulted in over 3,000 casualties (wounded and dead) who were brought to hospitals; some of them were brought to hospitals a long time after their injury due to the difficulty of evacuation under fire, a fact that influenced their condition and their survival. The massive influx of casualties overwhelmed the two hospitals in the nearest war zone, which were located approximately 40 and 20 km from the attacked sites.

Since the attack, the State of Israel has been in a continuous state of war, creating a challenge to the health system, which is faced with the need to provide an adequate response to the war casualties and, at the same time, to continue the routine medical activity to meet the needs of the entire population in the time of “emergency “routine.”

This work presents the Ministry of Health (MoH) Emergency Operation Center (EOC) activity during and since the October attack, the cooperation with the Home Front Command (HFC), and the coordinated patient management, transfers in and between hospitals, and field evacuations by ambulances and military forces. It also discusses the ongoing hospital and EMS functions during the “Emergency Routine.” This presentation will provide an initial analysis of what happened, provide insights from the management level, and share lessons learned.

The Antidote Response Network (ARN) strengthens local preparedness and response to a chemical incident by addressing local antidote availability, placement, mobilization, and rapid delivery from pharmacies to an incident area. The ARN comprises entities with antidotes (e.g., hospital pharmacies) and pushes their real-time inventory to be securely received, stored, and accessible by an honest broker (e.g., poison information center). When a chemical mass casualty incident requiring urgent antidote response occurs, the entity urgently needing an antidote notifies the honest broker, the honest broker alerts all ARN members of the need for antidote, and members mobilize and deploy the requested antidote. The honest broker coordinates antidote pick-up and delivery to the incident area, necessitating the development of technological platforms that can accommodate these requirements.

A secure web-based and smartphone platform was developed to receive and store automated real-time ARN pharmacy antidote inventory uploads that can be accessed by an honest broker and can notify ARN pharmacies of a chemical mass casualty incident requiring urgent antidote response.

Pharmacy-based antidote inventories were successfully interfaced with a secured server, accessible by an honest broker as well as an operationalized smartphone platform that sends alerts to ARN members verified by the honest broker.

The ARN web-based and smartphone platform allows honest brokers rapid access to pharmacy antidote assets and locations, alerts ARN members of a chemical mass casualty incident requiring urgent antidote response as well and coordinates antidote pick up and delivery to the incident area of need.

In Japan, where natural disasters are frequent, disaster medical education is becoming increasingly important in pre-graduate medical school education, but it is difficult to conduct medical training and practice at actual disaster sites. In cooperation with a private company, we have created a VR video that simulates medical care at a disaster site and utilized it for clinical training of medical students. We report on the usefulness of the VR-based education together with a student survey.

The VR video was created based on a scenario in which many people were injured when a train derailed and overturned due to a major earthquake, and a rescue team was dispatched from the university hospital. The video enables the viewer to learn about the activities of the medical team from the perspective of a doctor and to learn about on-site safety management by reproducing the disaster scene in computer graphics. In the clinical training of medical students, lectures were given using the VR video, and practical training for patient examination was conducted using a simulator.

In a student survey, many responded that the VR video was useful for learning about medical treatment at disaster sites.

In Japan, where natural disasters occur frequently, the use of VR video in pre-graduate education for disaster medicine is considered useful.

On October 29, 2022, crowds gathered for a spontaneous Halloween event at the Itaewon area of Seoul, South Korea, resulting in a crowd crush disaster. In this study, the authors investigated the process of patient transportation and dispersal from call to hospital treatment and examined the medical characteristics of crowd disasters.

Researchers analyzed the data of firefighter-paramedic transports of patients due to crowd crush during the Itaewon tragedy in 2022 based on the official input data of transports. Data from 310 patient transports were collected, excluding ambulance requests from hospitals or morgues that were not from the accident scene. The time taken for each stage of transport and transport distance were analyzed. Patients’ initial triage outcomes, initial medical characteristics, and clinical triage outcomes were also analyzed.

High fatalities relative to the number of injuries were found. A sudden increase in transport demand led to a temporary shortage of ambulances. The time for ambulance dispatch and access to patients was the longest. Even when paramedics arrived at the scene, the start time from arrival at the scene to patient care by paramedics was characterized by an increase due to the nature of crowd incidents, where dense crowds make it difficult to access patients. While there may not be many cases of visible trauma on the scene, stampedes are fundamentally a traumatic medical condition, and there may be many traumatic injuries that are not revealed until final diagnosis and autopsy.

Issues of access to patients and high mortality are unique to crowd crush disasters, and further research should continue.

School disaster resilience is crucial for community safety, serving as educational centers and emergency shelters in disaster-prone areas. Resilient schools ensure student safety and educational continuity, while assessment tools are vital for evaluating readiness, identifying vulnerabilities, and guiding mitigation strategies. However, many existing tools lack local relevance and comprehensiveness, limiting their effectiveness. Developing appropriate tools is essential for enhancing school disaster resilience effectively. This review aimed to identify, evaluate, and synthesize existing assessment tools for measuring school disaster resilience.

This review evaluated school disaster resilience assessment tools from 2015 to 2024, focusing on quantitative studies in English. Relevant studies were selected using databases such as PubMed, ScienceDirect, CINAHL, and Google Scholar with keywords “school”, “disaster”, “resilience”, and “education”. Extracted data included tool types, methodologies, key components, and outcomes, with quality appraised using CASP and JBI checklists to ensure methodological rigor.

From the 395 initial search articles, eight were identified that met the inclusion criteria. The findings synthesized two main categories of existing assessment tools. First, school disaster resilience tools generally focus on structural, non-structural, and functional aspects. Second, psychosocial resilience was critical but underrepresented, with only a few tools assessing psychological preparedness and support mechanisms for students and teachers. Despite addressing essential dimensions, the tools often lacked adaptability to regional specifics, limiting their effectiveness in diverse socio-economic and geographic contexts.

Existing assessment tools contribute to school disaster resilience by identifying key vulnerabilities, but lack adaptability to diverse local contexts. Findings highlight the need for robust, context-specific tools that encompass both physical and human resilience in disaster-prone areas. Future tool development should incorporate regional flexibility to enhance school resilience, supporting uninterrupted education and community safety during crises.

Three years after their initial release, the United Nations Office for Disaster Risk Reduction (UNDRR) and the International Science Council (ISC) are undertaking a review of the UNDRR/ISC Hazard Information Profiles (HIPs) ahead of the UNDRR Global Platform for Disaster Risk Reduction that will take place in June 2025.

These HIPs provide an authoritative reference on the scope, name, and definitions of hazards of relevance to the Sendai Framework for Disaster Risk Reduction. The HIPs were hailed as ‘groundbreaking’ in the Report of the Midterm Review of the Sendai Framework in 2023 and continue to provide extensive information to various stakeholders across different sectors, including disaster risk reduction planning, monitoring, training, and research.

They are widely utilized by intergovernmental bodies, national governments, disaster management agencies, statistical offices, private sectors, and academic institutions, fostering a more comprehensive and unified approach to disaster risk monitoring, recording, and planning. For example, the World Health Organization (WHO) and the International Organization for Migration (IOM) have incorporated these profiles in their reference systems and are employing them in some of their trainings globally. Additionally, UNDRR uses these profiles for monitoring disasters, with the HIPs supporting a new hazardous event and disaster losses and damages tracking system developed by UNDRR, UNDP, and WMO in partnership with many. Many other stakeholders use them as foundational tools for disaster planning and response efforts, research, and teaching.

In this review cycle, particular emphasis will be placed on the ‘multi-hazard context’, aiming to enhance understanding of the interplay between different hazards, which can result in cascading, compound, and complex events. This will facilitate the utilization of the profiles for multi-hazard risk assessment and early warning systems. Leveraging the latest advancements in machine learning, efforts have been made to make the HIPs more machine actionable, thereby expanding their usability and applications

In response to the 2014 Ebola outbreak, MedStar Washington Hospital Center established the Biocontainment Unit (BCU) to provide safe treatment of patients infected with special pathogens. Through federal funding for infectious disease preparedness from the Administration for Strategic Preparedness and Response and the Centers for Disease Control and Prevention, the MedStar BCU became one of thirteen Regional Emerging Special Pathogen Treatment Centers in the United States. The Medstar BCU is designed to deliver safe and effective clinical care for patients infected with high-consequence infectious diseases.

Providers, including physicians, advanced practice providers, and registered nurses, underwent quarterly simulation-based training that focused on donning and doffing personal protective equipment (PPE) including a powered air purifying respirator, coverall, isolation gown, two layers of elbow-length gloves, one layer of examination gloves, foam clogs, and boot covers. All post-training surveys included two primary outcomes related to PPE, and the distributions of these responses were summarized.

89% of participants were comfortable, very comfortable, or extremely comfortable with donning and doffing PPE, while 11% of participants were still not comfortable after training. Training proctors monitored for PPE breaches. Of 100 respondents, 4 responded that a PPE breach had occurred during training. 87% of participants were comfortable, very comfortable, or extremely comfortable with caring for patients in full biocontainment PPE, however, 12% of responders were extremely uncomfortable or not comfortable. Distributions in post-training comfort level did not vary significantly between training sessions, suggesting that each session had a relatively consistent impact on these two measures.

Simulation-based medical training can increase provider preparedness in high-level isolation unit settings by improving PPE proficiency and self-efficacy. PPE proficiency and competency are integral to the low-frequency, high-consequence events of providing safe care for patients infected with special pathogens.

Past events have demonstrated that crises and disasters can profoundly impact the mental health of those affected. To date, both practitioners and academics have focused on mitigating short-term adverse outcomes through psychosocial care, while medium- and long-term consequences have been relatively overlooked. Although a growing number of studies point to waves of mental health problems in the post-disaster timeline, little is known about predictors, especially in the early stages. This study aims to identify potential determinants of mental health for individuals at least 12 months after a disaster event.

This literature review searches Medline, PsycInfo, PTSDpubs, Web of Science, and SocINDEX for studies published from January 1946 to July 2024. It includes studies that examine the prevalence of mental health problems, such as post-traumatic stress disorder, among survivors, along with information on predictors at various time points.

A variety of factors were identified, which can be categorized into two dominant groups: vulnerability-related factors (e.g., sociodemographic risk factors such as gender or age, prior health problems, and lack of social support) and exposure-based factors. The latter range from primary exposures (e.g., danger, loss of loved ones or property, time since exposure or loss) to secondary exposures (e.g., loss of income, property damage, and relocation). In most cases, the identified factors were linked to sociodemographic risk factors and measured concurrently with mental health issues. However, several studies provided information on predictors identified at earlier time points (cross-lagged).

The factors identified in this study are valuable for policymakers, practitioners, and scholars seeking to better understand and address the mental health burden at various stages post-disaster, particularly for at-risk populations. Researchers should assess vulnerability and exposure-based factors more systematically in longitudinal monitoring programs to enhance the knowledge base regarding early predictors.

The World Health Organization has identified the development of emergency medicine as a priority. Seven new emergency departments have been opened in major cities of Armenia, but are staffed by non-emergency trained physicians. Thirteen physicians are currently participating in the first emergency medicine training program. Implementation of emergency medicine training programs in other countries has shown a reduction in mortality, and procedural training is central to emergency medicine education.

The Accreditation Council for Graduate Medical Education (ACGME) specifies core competencies for each specialty in the United States. All residents must complete a minimum of fifteen key procedures essential to the practice of emergency medicine for graduation requirements. There are many additional procedures performed by emergency physicians. A curriculum to teach these procedures to residents in Armenia, either through lecture or hands-on practice, was created. All residents were initially asked to identify how many times they had previously performed a list of 69 emergency medicine procedures.

Before the start of the program, most residents had very little procedural experience and relied heavily on consultant support. At this point in the curriculum, residents have had teaching in many procedures, including incision and drainage, laceration repair, intubation, and several point-of-care ultrasounds. Most reported performing these procedures initially in conjunction with consulting services, and now more independently.

Development of procedural expertise is central to emergency medicine education. This is typically done during lectures, in simulation, and on shift. As this residency program is non-clinical, faculty have relied on a combination of lecture and simulation to support resident learning, in addition to scheduled in-person teaching several times during the program. Nearly three-quarters of the way through the curriculum, residents have incorporated procedures into their practice with the support of consulting services as they grow the scope of emergency medicine in Armenia.

Out-of-hospital cardiac arrest (OHCA) is a critical medical emergency that poses significant global public health concerns. The survival rates for OHCA remain alarmingly low, contributing to as high as 10% of the total mortality in developing countries. This study aimed to analyze survival outcomes of OHCA patients in various developing countries, related to the mode of transport to the Emergency Department (ED).

This study was a retrospective analysis of the Pan-Asian Resuscitation Outcomes Study registry (PAROS) data from 2015-2018. PAROS study is a multi-center cohort study providing baseline information on OHCA epidemiology, management, and outcomes. Data was analyzed from Thailand, China, the Philippines, and Vietnam. The primary outcome was return of spontaneous circulation (ROSC), and the secondary outcome was survival to discharge or 30 days post-arrest. Subgroup analysis was performed within each country.

The study included 3,905 patients. 1,945 (49.8%) patients were conveyed by Emergency Medical Services (EMS), 448 (11.5%) by private ambulance, 1,148 (29.4%) by private transport, and 364 (9.32%) by public transport. The public transport group had the lowest ROSC rate at 17.0%, compared to EMS (22.7%), private ambulance (29.0%), and private transport (25.8%). Survival rate was also the lowest for the public transport group at 4.12%, compared to EMS (5.3%), private ambulance (12.5%), and private transport (5.05%). Both ROSC rate and survival outcomes were statistically significant. Subgroup analysis showed a significant relationship between the mode of transport and outcomes for Vietnam and China.

In patients with OHCA in various developing countries, the mode of transport is associated with differing ROSC rates and survivability outcomes. More education of EMS services and other prehospital interventions, such as bystander CPR, can be done in these countries to improve outcomes for OHCA patients. Further research can be done to analyze how other prehospital interventions can affect outcomes for OHCA patients in developing countries.

Junior residents in the SingHealth Emergency Medicine Residency Program receive 16 hours of protected time monthly for formal teaching sessions. consisting of classroom teaching and hands-on sessions in simulation centers. Evaluation of the program indicated gaps in the training (from program evaluation committee, faculty and residents survey, 360 evaluations, clinical competency committee). Specifically, residents reported i) limited leadership opportunities in resuscitation scenarios, ii) lack of formal inter-professional education (IPE), and iii) insufficient exposure to department-specific resuscitation setups and workflows.

To address these gaps, in-situ simulation training was introduced, with the following objectives:

• Help residents develop effective team leadership skills, with a focus on non-technical skills.

• Foster IPE, enhance collaboration, communication, and role clarity within the team.

• Build familiarity with departmental resuscitation setups and workflows by training in actual work environments.

• Session frequency and duration – Three half-day in-situ training sessions during junior residency

• Scenario rotation and leadership opportunities – residents take turns leading a variety of resuscitation scenarios, each focusing on department-specific workflows and system-based practices.

• Hi-fidelity manikins to simulate realistic physiological responses, with technical support from simulation center staff.

• Nursing participation to enhance the realism of scenarios and foster interprofessional interactions.

• Specialist-led debriefings

Post-training feedback was highly positive. Key highlights include i) High satisfaction scores - the mean score for the session was 4.8 out of 5, a score notably higher than most other training sessions, ii) Perceived improvement in critical thinking, clinical decision-making, and confidence in leading resuscitations, iii) Increased familiarity with emergency department workflows and equipment.

Utilization of in-situ training could better equip junior residents with the skills required to lead resuscitation teams as they progress into senior roles. Further methods of assessment (e.g., direct observation of leadership and decision making during scenarios by faculty using structured assessment tools) are planned to assess knowledge gain and behavioral changes.

While statistically uncommon, aircraft-related MCIs pose a wicked challenge for disaster response systems because the sudden surge of numerous critically injured patients can quickly overwhelm local healthcare resources. Aircraft disasters present unique and specific considerations like jet fuel fires, debris, and multi-agency involvement. No study thus far has systematically examined current literature to consolidate best practices for an optimal field medical response to an aircraft-related MCI. This narrative scoping review aims to analyze lessons learned from previous incidents and exercises to guide future preparedness efforts.

Following the PRISMA-ScR guidelines, the authors systematically searched PubMed and Cochrane using MeSH keywords. A total of 29 out of 518 retrieved articles were eventually included in the qualitative synthesis.

This review utilized the CSC-ATT/ETHANE framework advocated by Major Incident Medical Management and Support. Command and control is the most critical element to ensure coordinated responses across various agencies. In the SQ006 crash, the airport fire department was designated as the lead agency but focused solely on fire suppression and failed to establish incident command. Safety concerns include hazards like spilled aviation fuel, toxic gases, live ammunition (e.g. the Pope Air Force Base crash), and environmental factors (hypothermia, lightning, heat exhaustion). Maintaining communications can be challenging due to ambient noise and radio-traffic congestion (e.g. the 2015 TransAsia crash), worse since crash sites typically span large search areas and may have scant cellular reception. Efficient triage, treatment, and transport systems can improve outcomes for survivors, who often suffer from spinal injuries, head trauma, and extremity fractures. Conveyance with spinal immobilization should be considered, as a significant proportion (18% in the TK1951 crash) may sustain spinal injuries.

By analyzing experiences learned from previous incidents, this scoping review provides actionable insights to better optimize the field medical response in the chaotic aftermath of an aircraft MCI.

The COVID-19 pandemic was an unprecedented, catastrophic public health emergency. With an absent executive branch, all fifty states scrambled to respond to a crisis that had broad, far reaching impacts. Fiercely bitter partisanship was often blamed for causing inadequate, variable US pandemic response efforts. But what explains why the United States, despite its wealth of resources and strong institutions, had a slow, fragmented, and highly politicized pandemic response? A lack of policy alignment, or propensity toward misalignment, in the United States contributed to its uniquely disappointing pandemic outcomes.

Using a qualitative approach, they conducted (a) elite interviews of bureaucrats at the state-level in public health agencies, emergency management agencies, and the governor’s office (n=47) and (b) a historical analysis of the development of disaster and pandemic policy in the United States.

Three main variables within a fragmented institutional structure explain alignment and misalignment in the US pandemic response: (1) authority, (2) bureaucratic structures, and (3) capacity. These three variables interact within the greater overlapping fabric of federalism and state-specific contexts that are impacted by prior policy decisions (path dependency), institutional design, and inter- and intra-governmental relations.

These findings have broad implications for future US disaster response and public health emergency response capacities and capabilities. They also help further our understanding of federalism: its impact on disaster response and public health emergencies, the intersection of public health and emergency management, and the importance of governors in a federalist system experiencing a crisis.

The COVID-19 pandemic profoundly impacted healthcare systems worldwide, with India experiencing over 45 million confirmed cases and more than 534 000 deaths (WHO, 2024). This crisis significantly disrupted training programs globally, including the Ronald Reagan Institute for Emergency Medicine at George Washington University institution’s longstanding partnerships with 18 institutions across India focused on delivering education and training for emergency medicine (EM). The scale and duration of the pandemic posed unprecedented challenges to providing essential support to EM trainees, yet also underscored a critical global initiative to enhance resilience during times of crisis. As the pandemic unfolded, traditional in-person training faced severe limitations, prompting a shift to remote education. This transition allowed us to leverage online platforms for real-time didactics, case discussions, tele simulations, and remote procedural workshops, ensuring educational continuity for approximately 150 EM trainees annually. This innovative approach maintained engagement and demonstrated the scalability of distance learning to enhance education while supporting workforce development. Moreover, the pandemic amplified the importance of interprofessional collaboration and mentorship, as virtual platforms enabled connections among trainees and faculty across geographic boundaries, illustrating the resilience of educational networks in times of crisis. This experience underscored the necessity for adaptable curriculum delivery, which has led to hybrid models combining virtual and in-person training in the post-pandemic landscape, including a virtual tabletop exercise on disasters. The lessons learned from the pandemic presented a unique opportunity to innovate EM training at our partner sites in India, equipping the workforce to better respond to future healthcare challenges. By embracing adaptable training models, we can enhance educational experiences and ultimately improve emergency care delivery during times of crisis, fostering sustainable workforce capacity that strengthens healthcare systems overall.

When the Earthquake struck, Masu Memorial Hospital was forced to suspend routine medical service. After the earthquake, there were serious problems with high radiation levels in the residential areas of the Nakadori region of Fukushima Prefecture, where the hospital is located. As a result, children’s outdoor activities were restricted for two years. Witnessing the reality of the children’s situation and feeling helpless, the hospital decided to study disaster medicine and fight for the children’s generation.

In August 2013, the team participated in the Fukushima DMAT training. It was also convinced that there is disaster medical care that can be provided only by those who were in charge of community medical care. After the DMAT training, recognizing the importance of regional disaster response, the hospital is currently researching past disasters in the Adachi region of Fukushima Prefecture, where the hospital is located, and has established a department in charge of this area to examine how to respond to disasters daily. As a result, it was able to conduct external activities for various disasters that occurred outside of Fukushima Prefecture. In particular, in 2019, the team assisted hospitals submerged by the Abukuma River flooding. In recognition of these achievements, a Disaster Emergency Medical Department was organized within our hospital in 2018, and in 2021, the hospital was designated as a Disaster Base Hospital of Fukushima prefecture.

In times of disaster, one must have the courage to calmly and directly face unpredictable events and make appropriate decisions. As medical professionals in Fukushima Prefecture, the goal is to continue efforts to build a disaster medical organization with colleagues that can be passed on to the next generation.

Few studies have reported on the clinical care of hostages released from captivity. This study aims to describe the establishment of a clinical protocol for hostages returning from captivity.

This study describes the process of creating procedures for the implementation of the clinical protocol itself. The study was conducted at Shamir Medical Center (SMC) and assessed the outcomes of 24 returning hostages. Data collected included the clinical protocol for receiving the returning hostages and the returning hostages’ demographics and clinical data.

All returning hostages were foreign workers, and all but one were from the same nationality. The majority group of 23 returning hostages from the same nationality received testing for Q-fever, Hepatitis B, and HIV. Orthopedic, dermatological, and ear, nose, and throat consultation, chest and limb X-ray, head and abdominal CT scans, and antibiotics were also utilized by the majority. The returning hostage from a different nationality of origin utilized consults with an ENT, hearing test, and tests for Q-fever, urine toxicology, Hepatitis B, and HIV. Among the majority group, the mean percentage loss of body weight was 10%±10%. No correlation was found between age and change in weight (rho = -0.227; p=0.350). In addition, 17.4% tested positive for Q fever, 30.4% tested positive for Hepatitis B, and 13% tested positive for a sexually transmitted disease. They spent a mean of 5±1 days hospitalized. The sole hostage lost 15% of his body weight, tested positive for Q fever, and spent three days hospitalized. Consults with social workers and dietitians, translators, and Covid-19 tests were used by all returning hostages.

This novel clinical protocol was successfully utilized in real time and may serve as a framework for the complex and sensitive clinical management of returning hostages, in case of need.

Samson Assuta Ashdod is a 300-bed hospital located in Southern Israel and is the equivalent of a Level 2 trauma center. During the October 7, 2023, massacre, Assuta received a total of 114 patients while under direct threat from the attack. Due to the ongoing threat, a mass casualty event was declared in the hospital, but staff were not called in from home out of concern for their safety. As a result, the response was limited to on-duty personnel and those who arrived voluntarily. Additionally, due to safety reasons, the emergency department could not be evacuated of routine patients, requiring the management of mass casualty patients alongside existing patients. This after-action report presents key findings and lessons learned, focusing on how preparedness influenced the response under these unique conditions. The analysis covers staffing, communication, documentation, command and control, training and preparedness, facilities and equipment, and staff discipline. The findings highlight both strengths and challenges. Staffing limitations emphasized the need to define critical personnel and develop strategies to rapidly adapt roles and responsibilities. Communication issues, especially during simultaneous threats, pointed to the need to adjust modes of communication, including internal and external channels of communication. Inadequacies in documentation significantly affected care continuity of care. The Command-and-Control structure set in place proved itself adaptable to evolving needs. Training was found to be crucial for the response, but revealed gaps in readiness for urgent and conflicting needs. Facility limitations, particularly the inability to clear the emergency department, impacted patient management. Discipline among staff and a common purpose proved vital for maintaining order in the chaotic conditions and MCE. This report provides insights into refining disaster response strategies for hospitals facing MCEs while under threat and underscores the importance of flexible and resilient emergency preparedness

Global health risks from extreme heat are escalating at unprecedented rates. Before the hottest years on record, mortality estimates exceeded 480,000 deaths per year for 20 years. For some countries, attributed mortality is higher than any other natural hazard. The universal emergency medical and health response aims to reduce harm through early warning and self-protection advisories. Unlike other natural hazards, such as SARS-CoV-2, no standardized health protection advisory is recommended by health authorities, nor has existing content been evaluated for efficacy in reducing risk. The primary objective of this study was to analyze, compare, and assess the quality of health advice provided by health authorities in different countries aimed at reducing the risk of extreme heat.

The study applied a qualitative multi-case study methodology using WHO HEPR (2023) guidance and ISO 31000 risk management standard to create domains to compare, analyze, and grade national/state health advisory guidance of 32 countries. Local country heat hazard classification indices and contextual factors were incorporated. Analysis was performed using QSR NVivo12.

Health protection/risk mitigation advice varied across all framework domains. All countries included hazard-threat parameters, vulnerable groups, actions to reduce exposure, improve cooling, and manage fluid intake. Interventions were universally generic, unclear, and often misaligned with the local hazard scale. No country recommended in-situ temperature or wet bulb monitoring, detailed water consumption rates, or signals to confirm dehydration/rehydration, defined triggers to seek medical advice, included actions in the event of power loss or failure to maintain a safe thermal range, or business continuity actions. Quality rankings did not correlate with a higher relative risk of extreme heat events.

Significant review and improvement of existing health advisories are urgently required to reduce the risk from extreme heat. Failing to address current deficits will contribute to the rising catastrophic mortality impacts from extreme heat events.

In Hualien, Taiwan, the mountainous terrain covers 90% of the area, and medical resources are concentrated in urban centers, which makes emergency response in disaster situations challenging. Natural disasters occur frequently, and Hualien County urgently needs to establish and develop a disaster medical rescue team. In 2018, the Hualien County Health Bureau formed a disaster medical team to address local needs. However, accurately estimating logistical supply requirements remains a significant challenge, as insufficient supplies may delay response, while overstocking leads to resource waste.

To improve the accuracy of advanced preparation of logistical supplies, Hualien’s major disaster data in the past ten years were reviewed. A major disaster is an incident involving more than 30 injured people. The two most significant incidents were the 2018 earthquake (293 injuries) and the 2021 train accident (220 injuries), of which over 90% were trauma victims. Based on these data, supply and demand are estimated using the Historical Data Projection method adapted to local conditions. Emergency nurse practitioners experienced in responding to these disasters completed a questionnaire about supply types and quantities.

Through this analysis, the four most in-demand supplies were identified: 4x4 gauze pads (221 packs), cotton swabs (222 packs), 4-inch elastic bandages (43 packs), and 6-inch elastic bandages (28 packs).

This study demonstrates that the high demand for gauze and swabs underscores the critical need for wound cleaning and dressing in trauma-heavy scenarios. Literature suggests that precise pre-arrangement of logistical supplies reduces resource waste and improves cost-effectiveness. The Historical Data Projection aligns with Hualien’s needs, providing reliable guidelines for resource allocation. Ongoing data collection and AI integration will further enhance the accuracy of supply forecasting, ensuring efficient disaster response.

Climate change has caused an increasing frequency and intensity of weather-related disasters that cause devastation by flooding. Local clinics damaged by flooding take time to reopen, and in small rural communities like Asheville, NC, health care disparities increase after disasters. Little published data exists about patient needs during the recovery period, weeks after the initial disaster. Free mobile clinics responding to disasters would benefit from improved understanding of patient needs before entering the disaster zone.

A cross-sectional study was completed based on data collected at a free clinic located in Swannanoa, North Carolina, US, during the recovery period after Hurricane Helene. During five days, 40 patients visited the clinic and completed a simple survey stating the reason for their visit. The qualitative survey was analyzed to collect information to improve preparation for similar small free clinics working in flood response.

Lack of medication for chronic problems, including hypertension and diabetes, was the most common reason patients came to the clinic. Respiratory problems, known to be a frequent concern after flooding, were the second most frequent reason patients sought medical help. Skin complaints were the third most common concern at the clinic.

Preparation is essential for medical clinics responding to disasters to ensure they have the treatments their patients are most likely to need. Chronic health problems, respiratory concerns, and skin issues are the most common ailments these clinics must prepare for.