In the early hours of July 14, 2017, a structural collapse of a viaduct under construction in the east of Singapore resulted in 1 fatality and 10 casualties with serious injuries. All casualties were conveyed to the nearest hospital, Changi General Hospital (CGH). The unexpected wave of patients exposed critical inefficiencies in interdepartmental coordination and resource management, highlighting the need for a protocolled response to a casualty surge.

Singapore has a tiered civil emergency response plan to cater to mass casualty incidents with more than 20 casualties at a single institution. CGH’s experience identified a gap in the management of moderate patient surges, defined as an influx of 5-20 critically injured individuals. Based on findings from internal audits and post-event analysis, a trauma surge protocol was developed, addressing coordination, resource allocation, and team communication.

Key protocol recommendations:

1. 1. Protocol Activation: The trauma surge protocol is activated when patient influx exceeds normal capacity with regard to casualty numbers and acuity level, triggering call tree activation with information cascade. This allows for rapid diversion and redeployment of resources and personnel.

2. 2. Role Clarity: Interdepartmental role clarification enables the distribution of responsibilities among medical, nursing, and operational personnel from Emergency Medicine, General Surgery, Orthopedic Surgery, Anesthesiology, Radiology, and Laboratory Services.

3. 3. Resource Management: Streamlined triage guidance optimizes the allocation of resources such as blood products, advanced imaging, and operating theatre space. This accelerates patient throughput and minimises disruption to in-flight patients.

4. 4. Communication: Protocolization establishes communication channels and clear workflows, facilitating interprofessional collaboration among responders working in a high-pressure environment.

Most recently, in July 2023, the trauma surge protocol enabled CGH to manage five critically injured casualties from a heavy vehicle road traffic accident more efficiently. Further protocol refinements will be supported with post-event evaluation and regular interprofessional simulation training.

Radiological and nuclear emergencies can occur as a result of a nuclear facility accident/attack, due to mishap while working with or transporting nuclear materials, and due to intentional attacks with improvised or military-grade nuclear devices or with radiation dispersal devices, “dirty bomb.” While rare, such incidents present significant challenges to healthcare providers in the pre-hospital and hospital arenas. As part of a collaborative research project, data-driven recommendations regarding the required medical and emergency agency preparedness were sought.

An initial research stage included interviews with three leading Israeli experts on radiation/nuclear risk assessment and preparedness. The two lead Israeli researchers conducted these. The interviews were conducted with predefined open-ended questions and analyzed using qualitative research methods.

The three subject experts included: A former head of the Israeli Atomic agency, a senior advisor to the Israeli Ministry of Health on hospital emergency management and CBRNE, and the Israeli national EMS CBRNE specialist. Major themes identified in these interviews included: differences in risk assessment between the U.S. and Israel, with the Israeli experts focusing on the risk of a radiation dispersal device attack on a stadium,/mall, or a strategic facility. The experts stressed that even a low casualty event of this type might have far-reaching psychological and economic repercussions. Prehospital and hospitals must prepare for a high number of worried-well and public panic. All emphasized the importance of first responder training and radiation identification capacities. Two pointed to the importance of risk and event communications targeting the general public and healthcare personnel.

Experts from three levels: the national level tasked with risk assessments and national preparedness guidelines, the Ministry of Health and hospital preparedness management, and national EMS CBRNE management. Similar themes were identified regarding risk assessment, major challenges, and required interventions.

Children are frequently victims of disasters. However, gaps remain in pediatric disaster preparedness. The New York City Pediatric Disaster Coalition (NYCPDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to prepare NYC for mass casualty events that involve large numbers of children. On May 23, 2024, the NYC PDC conducted a pediatric disaster full-scale exercise testing surge, communications, and secondary transport. Participants included three NYC pediatric hospitals and the NYC Pediatric Intensivist Response Team (PIRT).

The full-scale exercise was prospectively designed with specific goals: to test and improve communications with staff and city agencies; to test and improve hospitals’ pediatric surge capacity plans and response; to identify space, staffing, and equipment needs for pediatric disaster; and for hospitals to identify and triage patients requiring secondary transport to another facility.

In collaboration with the DOHMH, PDC designed a Master Scenario Events List (MSEL) along with other tools to measure strengths and weaknesses to be identified at each institution at a system level. PDC created an exercise evaluation guide to assess: Communications, Emergency Operation Plans, Surge, Patient Tracking, Patient Transfer, Supplies, and Staffing, utilizing a performance rating scale from 1-4 and qualitative reporting.

This information was used to report lessons learned and challenges to the participants and DOHMH in an after-action report. An after-action report was written based on information from evaluation guides, site-specific and group hot-washes, and an after-action meeting.

This presentation will highlight the strengths, challenges, and lessons learned from the exercise. Conducting a multi-hospital pediatric disaster full-scale surge exercise produced lessons learned to address exercise gaps that can improve surge capabilities during future exercises and real-time events.

Emergency departments (EDs) must be prepared for sudden surges of critically ill patients. To maintain readiness, United States (U.S.) hospitals conduct full-scale mass casualty (MCI) exercises, though few studies examine their impact on real-time patient care in active EDs. This study addresses this gap by evaluating the operational impacts of a full-scale exercise (FSE) conducted at a major U.S. level one trauma and tertiary referral center. On a Wednesday morning, 78 moulaged patients tested the ED’s surge capacity with a layered staffing model simulating disaster response demand. This study aims to determine if high-fidelity FSEs can integrate into active EDs without affecting real patient care.

Data from the electronic medical record was collected over two time periods on the exercise day and control days: the exercise (6 hours) and impacted clinician’s shift (14 hours). The primary outcome was the median length of stay (LOS) for real patients. Secondary outcomes included door-to-doctor time, time to disposition, and arrival-to room time. Medians from the exercise day were compared to control dates (four preceding and four following Wednesdays) using the Mann-Whitney U test.

Median LOS during the exercise was 164 minutes, while control days during the same time were 162 minutes. Median LOS for the impacted clinician shift during the exercise was 190 minutes, while control days were 174 minutes. For the exercise period, no statistically significant differences were found for LOS and all secondary outcomes. For the impacted clinician shift, only LOS demonstrated a statistically significant difference (p=0.043).

With strategic planning, FSEs can be integrated into active EDs with minimal impact on patient care and operations. FSE planning should aim to minimize disruptions and include objective tracking metrics to evaluate the success of these efforts. Future studies should assess patient outcomes, return visits, and clinician cognitive load for a more comprehensive evaluation of FSE impacts.

Disaster response often requires complex, multi-agency efforts and brings together responders and leaders from various backgrounds. International response can be complicated by varying clinical practices, lack of coordination, and differing cultures and languages. Tabletop exercises are well-established techniques to improve readiness and coordination in disaster response. In April 2024, an international group of disaster medicine experts from the United States, Canada, and France designed, planned, and facilitated a multi-agency tabletop exercise for the disaster response elements based in Toulouse, France. A structured post-exercise debrief with this team was performed, and distinct themes were extrapolated, including successes, challenges, and lessons learned in designing, planning, and facilitating this tabletop.

Successes in designing and planning the exercise included multidisciplinary collaboration, early coordination with the core planning team, detailed scenario design, the experience of planners, well-timed injects, and good stakeholder participation. Challenges include understanding the capabilities of responding agencies, language barriers, last-minute changes and participation, changing objectives, time zone coordination, and lack of follow up.

Successes in facilitating the tabletop included clarity and design of the exercise, adequate logistics, an appropriate number of participants and facilitators, not deviating from the master scenario events list (MSEL), real-time translation, collaboration from various stakeholders, adaptability and flexibility of facilitators, and a well coordinated emergency operations center. Challenges in facilitating the tabletop included language barriers, facilitators’ lack of familiarity with the host country’s response system, perceived bias that affected communication, lack of communication method between facilitators, lack of pre-exercise introductions, and post exercise debrief role confusion.

International multi-agency tabletop exercises pose unique challenges. The successful completion of these exercises is dependent on early and comprehensive planning, a thorough understanding of the stakeholder capabilities, clear and concrete objectives, adequate translation capabilities, good pre- and post-exercise follow up, and facilitator flexibility and adaptability.

Prolonged Casualty Care (PCC) addresses the need for extended patient care in military and disaster medicine, where resources are limited, and evacuations are delayed. Clinicians without surgical or critical care backgrounds often lack the training to provide prolonged care in such environments. This report presents a preliminary evaluation of an 8-hour PCC course specifically designed to equip non-critical care clinicians with essential skills for prolonged casualty management under austere conditions.

The PCC course is currently in the planning phase, focusing on developing 10 core competencies essential for prolonged casualty care, including patient assessment, documentation, decision-making, and treatment. The curriculum will incorporate skill stations and time-compressed simulation scenarios to provide participants with hands-on practice. Pre and post-course assessments are planned to evaluate participants’ knowledge and skill acquisition once the course is implemented.

Expected outcomes include improved knowledge and skills in prolonged casualty care among participants, particularly in handling patient care under resource constraints. We anticipate that participants will gain confidence and practical skills through the structured training and scenario-based exercises. Feedback will be gathered to refine the curriculum based on participant experiences and suggestions.

Although still in the planning phase, the 8-hour PCC course is designed to fill a critical gap in prolonged casualty care training for non-critical care clinicians. By emphasizing core skills for resource-limited settings, this course aims to improve clinical preparedness for disaster and conflict scenarios. Future research will be conducted to assess the course’s effectiveness upon implementation.

Although LEOs frequently provide medical care to injured individuals, this care is more likely to be perceived by EMS as harmful compared with non-LEO emergency medical responders. Despite the rapid provision of LEO care after OIS, no mortality benefit has been demonstrated. The purpose of this study is to characterize the nature and appropriateness of care rendered by LEOs.

Retrospective analysis of open-source video footage of OIS occurring between January 1, 2023, and December 31, 2023. Only footage containing LEO medical care was included in the final cohort. Care provided, appropriateness of care, presence of cognitive errors, and mortality outcomes were evaluated. The study was deemed exempt by the Mayo Clinic Institutional Review Board.

Of 347 videos, 87 were included in the final cohort. Time to LEO intervention was 170.2 ± 218.6 s; care was rendered in < 120 s in 59.2% of cases and > 300 s in 14.3%. Mortality was 55.3%. Torso trauma occurred in 58.6% of cases, while isolated extremity trauma occurred in 19.5%. Tourniquets were placed in 27/30 casualties and were not indicated in 18. One of three casualties who did not receive a tourniquet may have benefited from one. Chest seals were appropriate in 29 casualties and applied in 18. Hemostatic gauze was applied in 14 casualties; it appeared appropriate in 5 and was incorrectly applied in 6. CPR was performed in 25 casualties; 4 had signs of life and 4 received CPR from a standing position. Difficulty identifying medical supplies appropriate for the injury was noted in 11 videos. Cognitive compromise was noted in 14 videos.

Although care was rapidly rendered in the majority of cases, mortality remained high. Inappropriate or incorrectly applied medical interventions were commonly noted. Multiple opportunities to improve LEO medical care exist.

Recent years have seen an increase in disaster situations worldwide. Emergency physicians (EPs) have a key role in all phases of disaster management. There is no current international description of Disaster Preparedness (DP) among European EPs.

An international survey-based study of DP levels, using a modified KArP model, was conducted between April and June 2024 among post-residency EPs in 9 European countries. Their levels of education, training, and experience in Disaster Medicine were described. Correlations were sought between the participants’ general characteristics and DP-scores.

Results from 813 participants were collected. Mean rP-score was 66,54% (SD 14,99) and mean KArP-score was 71,83% (SD 12,45). Only half of the participants reported a dedicated practical training in Disaster Medicine during specialty training, whereas almost 25% of all participants reported no Disaster Medicine training. Only 57% reported full-scale disaster exercises in the previous 12 months. Significant differences were found from one country to another in levels of education and training in Disaster Medicine, as well as in DP-scores. Several factors were identified that were significantly associated with DP-scores. DP-scores were significantly lower among pediatric EPs.

It is crucial to improve and harmonize individual and collective DP in European EPs. It is particularly critical to improve DP levels in pediatric EPs. Based on the results, simple checklists aimed at optimizing individual and collective DP levels were proposed. This is the first international description of DP among European EPs. Further studies are needed to validate this EP-specific KArP-tool, to continue identifying factors associated with improved DP-scores in EPs, and to study the impact of interventions aimed at optimizing DP, both individually and at department-level.

The Mosul Trauma response was novel for several reasons:

1. WHO’s Role in Coordinating Trauma Care: It was the first time the World Health Organization (WHO) took the lead role in coordinating trauma care in an active conflict setting. Traditionally, the WHO’s role had been more about coordination in natural disasters or health emergencies, not in direct conflict zones.

2. Adaptation of Military Trauma Models for Civilians: The approach was inspired by military trauma systems, adapting concepts like the “golden hour” to provide rapid stabilization and care to civilians. This involved setting up Trauma Stabilization Points (TSPs) close to the frontlines (within 10 minutes) and field hospitals within an hour’s reach, replicating military strategies for quick response and care.

3. Deployment of Humanitarians Near the Frontlines: The effort placed humanitarian medical teams closer to active combat zones than ever before, a significant deviation from traditional humanitarian approaches. This strategy aimed to save lives by reducing the time between injury and treatment, despite the heightened risks.

4. Involvement of a Private, For-Profit Medical Company: WHO contracted Aspen Medical, marking the first time WHO or any similar agency engaged a private, for-profit medical organization to provide trauma care in a conflict zone. This broke new ground by integrating private-sector capabilities into a traditionally NGO-dominated field, showing flexibility in responding to urgent medical needs.

5. Coordination with Military Forces: The trauma system was developed in close coordination with military operations, using military intelligence to help place medical facilities. This integration of military and civilian efforts blurred lines traditionally maintained to preserve humanitarian neutrality, sparking discussions on the balance between effective care and adherence to humanitarian principles.

While disasters directly claim many lives, secondary health effects among disaster-affected populations can be equally lethal. This scoping review aimed to map scientific evidence regarding secondary health effects following natural disasters in Japan.

A systematic search was conducted using five databases: MEDLINE, CINAHL, EMBASE, PsychINFO, and Ichushi Web. Primary screening was performed independently by two blind reviewers who assessed titles and abstracts for inclusion. Descriptive statistical analysis was conducted on papers that passed secondary screening.

The database search yielded 16,870 papers, with 5,900 duplicates removed. Of the 10,970 papers screened, 1,557 met the inclusion criteria. The most frequently studied disasters were the Great East Japan Earthquake (n = 662, 42.5%), COVID-19 pandemic (n = 517, 33.2%), Great Hanshin-Awaji Earthquake (n = 102, 6.6%), Fukushima Daiichi Nuclear Accident (n = 90 papers, 5.8%), and Kumamoto Earthquake (n = 63, 4.0%). Predominant study designs included cross-sectional/observational studies (n = 660, 42.4%), follow-up studies (n = 490, 31.5%), survey research (n = 136, 8.7%), comparative studies (n = 102, 6.6%), and data analysis studies (n = 98, 6.3%). The most commonly investigated health conditions were psychiatric disorders (n = 824, 52.9%), followed by cardiovascular diseases (n = 163, 10.5%), health-related behaviors (n = 117, 7.5%), endocrine/metabolic disorders (n = 92, 5.9%), and respiratory diseases (n = 77, 4.9%).

This scoping review captured a comprehensive overview of health effects following natural disasters in Japan, providing valuable insights into the patterns and distribution of secondary health impacts in disaster-affected populations.

Field hospitals (FHs) play a crucial role in providing medical care during various crises, including natural disasters, pandemics, and conflicts. While the traditional model of FH has been in use for many years and has contributed substantially to medical care delivery, limitations, including resources, manpower, and access to specialized medical expertise, exist in this model. Telemedicine has emerged as a promising solution to this challenge.

The methodology involved collecting data on-site at the Sheba FH in Ukraine through direct observation of patient care. This data was compiled into a database containing patient information, conditions treated, and the type of care provided. To evaluate the suitability of telemedicine in different contexts, a conceptual model was created based on the empirical experience of content experts and a literature review.

Of the 6,161 patients who received care at the FH, 103 consultations were conducted through telemedicine. The majority of these consultations involved the treatment of chronic diseases, with dermatology (22), radiology (20), oncology (8), and neurology (10) being the most common areas. Additionally, there were seven surgical consultations and six pediatric consultations. The conceptual framework developed suggests that in most scenarios, particularly slow-onset disasters and within 72 hours of a sudden-onset disaster, trauma complications tend to decrease significantly. Conversely, there is an increase in non-trauma emergencies, indirectly caused by infectious diseases, and accumulated elective care needs, where the use of telemedicine becomes more relevant and feasible.

The findings demonstrate the promising potential of telemedicine in changing the field of disaster medicine and response. By leveraging technology to provide remote access to specialized medical expertise, telemedicine can help bridge the gap in access to quality care that often exists in disaster scenarios. Moreover, by enabling remote consultations, telemedicine can help optimize the utilization of resources, allowing for more efficient resource allocation and reducing strain.

This study investigates the quality of life among civilians with acute conflict-related extremity injuries sustained in Syria and Iraq, comparing Negative-Pressure Wound Therapy (NPWT) to standard treatment.

Data were derived from a randomized controlled trial. Quality of life was assessed using the Self-Reporting Questionnaire 20 (SRQ-20) (range: 0–20) and the Wound-QoL (range: 4–7) questionnaires, with baseline and follow-up measurements. Statistical analyses compared NPWT to standard treatment, examining total scores as well as improvements. For the SRQ-20 results, the number of patients with a total score above the screening cut-off value was compared. For the Wound-QoL results, individual item responses were analyzed. Student’s t-test was used.

The median number of days between baseline and follow-up was eight (IQR: 4–21) for SRQ-20 and four (IQR: 4–7) for Wound-QoL. No differences were found between standard treatment and NPWT for the SRQ-20 scores at baseline or at follow-up, nor in the number of patients with scores above the screening cut-off value. For Wound QoL, patients receiving NPWT had better total scores at baseline than patients who received standard treatment (means of 10.3 vs. 13.1, 95% CI: 1.45–4.15), but there were no differences at follow-up (means of 7.2 vs. 7.4, 95% CI: -1.08–0.77). When comparing individual items at baseline, patients receiving NPWT had better scores on questions assessing unpleasant smell, poor sleep, and disturbing discharge compared to those receiving standard treatment, with mean differences of 0.45 (95% CI: 0.21–0.69), 0.65 (95% CI: 0.23–1.1), and 0.88 (95% CI: 0.69– 1.1), respectively.

The results indicate that NPWT offers early benefits for symptoms of unpleasant smell, poor sleep, and discharge compared to standard treatment. However, these differences did not persist. The possible short-term gains in quality of life with NPWT should be weighed against the technique’s associated costs, especially in low-resource settings.

The October 7, 2023, terrorist attack in Israel and the 2022 Russian invasion of Ukraine have highlighted the need for lay bystanders to be able to assist victims during mass casualty incidents (MCIs) before the arrival of Emergency Medical Services (EMS). The “First Seven Minutes” (F7M) training has been developed by Israel’s EMS to train lay bystanders to respond medically in this context by teaching a seven-step approach to administering an MCI scene. A programmatic study was conducted to understand if F7M increased the self-assessed ability among participants to respond and whether this varied with the participants’ level of personal resilience.

This was a survey-based before-after intervention study where all F7M participants from 2018-19 were invited to participate. A 5-point Likert scale questionnaire was administered before and after training to investigate self assessed ability to respond medically in conflict-related MCIs. Personal resilience was assessed using a modified Brief Resilience Scale. The Wilcoxon signed-rank test was used to test for significance between mean scores.

The analysis included a total of 128 participants. Following training, self-assessed ability to respond increased significantly (Mean Difference 0.5, p<0.05). Low-resilience participants benefited more than participants with normal or high resilience (MD 1.14, p<0.05 vs MD -0.38, p<0.05, CI: 0.73 – 1.56 vs CI: -0.52 – -0.23).

In contemporary armed conflicts with escalating violence against civilians, F7M may be a useful tool for building capacity in bystanders to assist during MCIs. Further, it may be of benefit in wider preparedness efforts to mitigate civilian loss of life during armed conflicts. The relevance of F7M in this context will be more extensively discussed during an oral or poster presentation.

Bioaerosols significantly contribute to infection transmission. Nebulization increases the degree of fugitive aerosols and is limited in use during the COVID-19 pandemic. However, nebulized medications may be an important part of treatment. A novel scavenger device was developed and attaches to a simple face mask.

Allowing for nebulized medication delivery, it additionally scavenges fugitive aerosol, which can be used for diagnostic evaluation. Preliminary scavenger data for nebulized DNA and the diagnostic yield with an inline filter system are presented.

The novel scavenger device was 3D printed and attached to a simple face mask. The vacuum port of the scavenger device was attached to wall suction with an inline flow meter. The face mask with attached device was then secured to a manikin. DNA-coated 1 micrometer spheres were nebulized from the manikin’s mouth for 15 minutes at a nebulized rate of 6L/min. Sampling sites included left and right air sampling at 50 L/min, the interior face mask surface, and an inline filter to capture scavenged DNA. Standard cycle threshold detection curves were obtained for each DNA oligo used.

Sampling comparing ‘off-vacuum’ nebulization to ‘on vacuum’ nebulization demonstrated no significant environmental contamination identified during 'on vacuum’ nebulization by the airborne samplers. Preliminary data for cycle threshold values found an average log reduction of 2.75 in total copies of nebulized DNA. More than 99% of the nebulized DNA was scavenged with suction on compared to 45% with suction off. Similarly, during 'on vacuum', DNA diagnostic yield collected on the filter paper had an average log DNA copy of 3.834396.

Preliminary data indicate this device, in combination with commonly available transport and hospital equipment, was successful in preventing environmental contamination when nebulizing solutions coated with DNA. It also demonstrated the ability to scavenge enough DNA for diagnostic purposes. Future studies will include medication administration effectiveness and other diagnostic sampling mechanisms.

This study aimed to investigate the early assessment of pediatric trauma patients(PTPs) following earthquakes, identifying key in-hospital mortality factors. Effective early assessments and interventions were crucial for pediatric patients due to their unique physiological and psychological responses. Aligning with the Sendai Framework for Disaster Risk Reduction 2015-2030, this research focused on reducing disaster-related mortality among vulnerable populations like children. Prior research had focused on advanced tools, often found to be infeasible post-earthquake. Furthermore, multicollinearity among factors complicated statistical analysis, thus necessitating the identification of simple, rapid assessment indicators that predicted pediatric mortality.

This study undertook a comprehensive retrospective analysis of 200 PTPs recorded in the Western China Earthquake Patient Database(WCEPD). The study employed Least Absolute Shrinkage and Selection Operator(LASSO) regression to identify independent variables influencing in-hospital mortality. The study collected 20 baseline indicators that could be swiftly obtained upon patient admission. These indicators included demographic information, vital signs, consciousness status, and injury specifics, such as the nature and location of injuries.

The LASSO regression analysis identified 5 independent factors significantly associated with in-hospital mortality among PTPs: Glasgow Coma Scale/Pediatric Glasgow Coma Scale(GCS/PGCS), Systolic Blood Pressure(SBP), Respiratory Rate(RR), Pulse Rate(PR), and crush injury. Based on these factors, a predictive nomogram was constructed to identify PTPs with elevated in-hospital mortality risks.

Through the application of LASSO regression, this study successfully identified and analyzed 5 simple, rapidly assessable factors predictive of pediatric trauma mortality in disaster settings. The development of a predictive nomogram incorporating these factors provided a powerful tool for early identification and timely intervention.

Laypeople acting as immediate responders can save lives in both day-to-day medical emergencies and large-scale disasters, provided that they receive sufficient training in, e.g., first aid. Growing evidence suggests that laypeople can successfully be taught hemorrhage control, yet which training factors that contribute to successful training outcomes are relatively unknown. This systematic review aims to address this gap through a theory-informed analytic approach through the lens of a well-established training effectiveness model used in multiple domains.

A literature search was conducted within five databases: CINAHL, Embase, PubMed, Scopus, and Web of Science. Studies on medical laypeople who had been formally trained in bleeding control or were part of experimental studies where bleeding control was given to the participant were included. A deductive analysis was conducted where each study’s content was analyzed and thematically described according to a predetermined theoretical framework on training effectiveness.

In total, 2962 records were identified after the initial search. 56 studies were included in the review after screening and assessment of the records. Training performance, self-perceived ability, and knowledge acquisition were found to be among the most studied factors. Conversely, trainee expectations, desires, and motivation to attend training, real-world performance, and how patient outcomes are affected by training were among the least studied factors, in addition to rarely being highlighted as important or discussed thoroughly.

The findings suggest that bleeding control training is linked to positive increases in multiple training outcomes, yet the lack of evidence for several important training effectiveness factors could hinder the understanding of how to improve future training programs. These findings could be used by educators and researchers within the field to direct efforts to further bridge the gap between the lack of or existence of scientific evidence and current practices.

During the COVID-19 pandemic, migrants and women were among the most vulnerable groups. By adopting an intersectional lens that considers the challenges arising both from being a migrant and a woman, it is possible to emphasize how migrant women (MW) face specific impacts. While emergency department (ED) datasets are typically used in disaster contexts to analyze utilization patterns and monitor conditions post-emergency, this study employed ED data to assess whether the pandemic exacerbated MW’s barriers to accessing primary healthcare (PHC).

A retrospective observational analysis was conducted using data from the Sacco Hospital ED in Milan, Italy. Ambulatory-care sensitive conditions (ACSC) served as indicators to assess PHC effectiveness. Access-related variables were analyzed using appropriate tests to identify patterns in ED utilization, while time trends revealed visits distribution over time.

ED utilization decreased for all groups, but while Italian patients did not return to pre-pandemic utilization levels, both migrant women and men exceeded their previous visit rates. Although ACSC-related visits declined across all groups, the decrease among MW was not statistically significant, suggesting a more stable reliance on the ED. After the pandemic, ACSC visits among MW slightly increased, indicating a potential decline in their health status, possibly due to postponed PHC during the pandemic. The study also found that MW, like migrant men, are referred to GPs more often than Italians and are triaged with lower urgency codes.

While differences between migrants and Italians are evident, they primarily reflect trends within the broader migrant population rather than specific patterns among MW, particularly concerning ED utilization, urgency of presentation, and assessment outcomes. EDs must collect more detailed information to facilitate a nuanced and intersectional analysis. This project was supported by Fondazione Cariplo (ref. 2022-1447) and conducted in the framework of the International PhD in Global Health, Humanitarian Aid, and Disaster Medicine (UPO).

Simulation tasks teams were conducted with each team consisting of a medical doctor, a nurse, an emergency life saving technician, and an ambulance crew certified for rescuer tasks.

The scenarios were competitive using high-fidelity manikins and standardized actor patients on-site and at stations, called Rallye Medicina.

The current study aimed to evaluate tasks in a Japanese medical rally in 2019 for effectiveness.

Multiple attribute utility technology was used, as the task was intended to achieve multiple goals.

Despite mitigation safety measures, disasters will occasionally impact medical facilities. This report examines the 2023 Wexford General Hospital (WGH) fire’s impact on emergency doctor redistribution and patient safety. Little has been written to date on staff redistribution after a healthcare facility’s temporary closure/reorganization. A change in the standard ED profile was necessary because of extremely limited inpatient & ICU beds for 4 months, with Ambulance diversion, and the Standard Emergency Department (ED) model of care was amended to an injury unit & assessment units for medical, surgical, and pediatric patients. Skeleton staffing remained on site, and nursing/medical/admin staff were redirected to regional receiving facilities.

Data was obtained from the roster coordinator, WGH’s managerial planning committee, and standardized anonymized reports from the electronic patient record system, iPMS.

WGH ED distributed 45% of the medical staff to a neighboring hospital, which geographically would have addressed the majority of patient diversion. The study found that despite WGH ED injury unit functioning with fewer staff, average waiting times across all patient categories decreased by 77%, down from 3 hours and 12 minutes to 44 minutes. This occurred despite the patient load only being down 56% on average.

The redistribution of staff to neighboring facilities helped alleviate the additional workload in those facilities and did not result in a significant increase in waiting time for walk-in and GP-referred patients to the injury and assessment units. Encouragingly, it decreased patient waiting times, highlighting the importance of process flow adaptation during and in the recovery phase of a disaster. Adjusting the ED services to identify and continue to safely manage appropriate patients unlikely to need admission locally was also found to have a positive impact on patient turnover and limited the effect on other regional receiving units for that extended 4-month duration.

Hydrofluoric acid (HF) exposure leads to severe and life-threatening injuries, necessitating prompt and accurate prognosis for effective treatment. Despite advancements, machine learning (ML) in predicting outcomes for HF exposure is underexplored. This study aims to develop a robust AI-driven model to forecast hospitalization and mortality in HF exposure cases.

A comprehensive dataset of 163 patients treated for HF burns was utilized, including demographic data, injury specifics, and initial treatment responses. Data, extracted from case series and reports following PRISMA guidelines (1979-2020), were preprocessed to handle missing values and encode categorical variables. Due to significant class imbalance, under-sampling techniques were applied. Multiple ML algorithms, including Logistic Regression, Random Forest, and Gradient Boosting Machines, were evaluated. Models were trained using stratified k-fold cross-validation and optimized through grid search. Statistical analysis was performed using Python (version 3.8) with libraries like scikit-learn, pandas, and numpy. Initial treatments included topical calcium gluconate application, intravenous calcium gluconate, and Hexafluorine irrigation.

The Random Forest model, after hyperparameter tuning and data balancing, outperformed others, achieving an accuracy of 93.94%, precision of 94%, recall of 100%, F1-score of 97%, sensitivity of 93%, specificity of 90%, and an ROC AUC of 0.9355. Key predictive features included age, total body surface area (TBSA) affected, and initial treatment type. Older age and higher TBSA were linked to worse outcomes, defined as increased mortality and hospitalization. Topical calcium gluconate was the most effective initial treatment, followed by intravenous calcium gluconate and Hexafluorine irrigation. The confusion matrix showed excellent balance, maintaining high recall without sacrificing precision.

The AI-driven model enhances clinical decision-making for HF exposure by providing accurate prognostic information. By addressing class imbalance and leveraging advanced ML techniques, the model improves predictive performance. This tool can help clinicians make informed treatment decisions, optimize resource allocation, and improve patient outcomes.