Emergency department trauma triage can be challenging for injured pediatric patients. For verbal children (and adults), the Glasgow Coma Scale (GCS) is commonly used to assess disability, and a modified GCS assessment tool is used for the pre-verbal age group. A common disability assessment for both verbal and pre-verbal pediatric patients to risk-stratify the need for higher acuity trauma care or mortality would be useful.

The primary aim was to investigate whether using only the motor component of GCS (mGCS) compared to total GCS (tGCS) was associated with intensive care management or mortality in the pediatric population. The strength of association for the composite outcome for verbal (≥ 2 years old) and pre-verbal children (< 2 years old) was also analyzed.

This was a retrospective review of patients <18-years-old, who presented to KK Women’s and Children’s Hospital’s emergency department (ED) with moderate (Injury Severity Score (ISS 9-15) to severe (ISS>15) traumatic injuries from January 2012 to December 2021. The data were prospectively collected from the hospital’s trauma registry.

Among 582 included for analysis, the median age was seven years old (interquartile range 2-12), who were predominantly male (63.4%). 22.4% of patients died or required ICU care. Overall, adjusted relative risks (aRR) for tGCS and mGCS to predict ICU/mortality were 0.86(95%CI: 0.84 to 0.89) and 0.76(95%CI: 0.70 to 0.81), respectively. The aRR to predict for ICU/mortality in children <2-years-old for tGCS was 0.83(95%CI: 0.78 to 0.88), and mGCS was 0.76(95%CI: 0.70 to 0.81). The aRR to predict for ICU/mortality in children ≥ 2 years old for tGCS was 0.88(95%CI: 0.84 to 0.91), and mGCS was 0.76(95%CI: 0.70 to 0.83).

mGCS may be a viable alternative to tGCS for disability assessment to predict the need for ICU care or mortality in moderately to severely injured verbal and pre-verbal children.

Certain medical procedures are rarely performed, confer risk to the health care provider or patient, and are challenging to learn or practice. Attempted tourniquet placement on a non-injured limb, if fully deployed, can be painful or dangerous to the subject. Therefore, simulated tourniquet application would be an ideal way to learn or practice this skill without risking the target limb. We describe a low-fidelity simulation system that a volunteer can wear, allowing for safe tourniquet application to a limb while protecting the subject from any ill effects of the tourniquet.

This is accomplished by shielding the limb with a segment of PVC pipe easily obtained from any home improvement store. A 4.5-inch-long PVC tube with a diameter slightly larger than a subject’s arm can be secured with a strap or rope around a volunteer’s torso to hold the PVC in place over the mid-bicep. A Foley catheter can then be taped parallel to the tube lumen outside the PVC ring so it won’t migrate. Using IV tubing, a refillable bag of IV fluid (+/- red dye) can then be attached to the Foley and allowed to flow out into a catch basin or draining tube. A learner can then practice applying a tourniquet to the arm and safely tighten it enough to occlude the flow of fluid through the Foley, simulating occluding a bleeding vessel. A pressure infusion cuff can be applied to the saline bag coupled with the Foley to generate any “blood pressure” that the testers wish, with the PVC eloquently protecting the wearer.

Low-fidelity simulation is a cost-effective and easy way for educators to ensure that learners can practice rare or dangerous procedures, such as tourniquet application. Such practice can build procedural competency so that it can be performed correctly when required.

Extreme weather events (EWEs) have devastating impacts on populations, ecosystems, and critical infrastructure. While their effects on health have been extensively studied, their impacts on the health system are less understood. This study aims to investigate the impacts of heatwaves, cold spells, floods, landslides, and wildfires on the health system, focusing on changes in system performance, alterations in patient flows, and disruptions to infrastructure.

A systematic review of reviews was conducted using PubMed, Scopus, and Web of Science databases. The search string was developed by combining keywords with Boolean operators. Eligible studies include narrative and systematic reviews (with or without meta-analysis) that address the impacts of selected EWEs on the health system. Only studies published in the last 10 years with full texts available online were included.

Of 2108 retrieved reviews, 668 duplicates were removed, 1286 were excluded after title and abstract screening, and 40 were excluded after full-text assessment, resulting in 114 included reviews. The impacts were categorized by type of event and by the affected health system component–e.g., pre-hospital, hospital (emergency pathway, medical and surgical pathway, outpatient pathway, and day hospital), primary care and elderly care, pharmacies, and public health. The impacts concern infrastructure and equipment, care accessibility, quality, service utilization, surge capacity, and resource availability.

The results of this study provide insights into the expected impacts of EWEs on the health system and suggest actions to enhance preparedness.

Full authorship: Valente Martina, Del Prete Clara, Facci Giulia, Cenati Stefano, Musso Francesco, Calligaro Sara, Ragazzoni Luca, Francesco Barone-Adesi

This study is conducted within the Horizon Europe project MOUNTADAPT, co-funded by the EU. Views and opinions expressed are, however, those of the author(s) only and do not necessarily reflect those of the EU or CINEA. Neither the EU nor the granting authority can be held responsible for them.

The 2026 Milano-Cortina Winter Olympics pose unique challenges for disaster medicine preparedness, particularly in managing bioemergencies within alpine regions. This study describes a comprehensive multiscenario drill designed to evaluate and enhance the command and control capabilities of the Olympic hospital complex in responding to potential infectious disease outbreaks and biothreats, utilizing existing resources.

The drill encompassed three integrated components: 1. Command and Control Role-Playing Exercises: structured role-playing sessions were prepared to simulate decision-making processes during bioemergency scenarios; 2. Virtual Simulation: Advanced virtual reality platforms were employed to create immersive bioemergency scenarios, allowing participants to engage in realistic simulations of outbreak management; 3. Field Exercise: A practical field exercise was conducted within the Olympic hospital complex, simulating a sudden influx of patients presenting with symptoms of a contagious disease. This exercise tested the hospitals’ surge capacity, patient triage procedures, isolation protocols, and the practical application of command-and-control strategies in a real-world setting.

Data collection methods included real-time observations, debriefing sessions, and participant feedback surveys, focusing on response times, decision-making efficacy, and inter-agency coordination. The integrated drill revealed several key findings, including the importance of e-role-playing exercises to enhance command hierarchies and improve inter-agency communication. Virtual simulations and field exercises were used to test the hospitals’ preparedness and response.

This multiscenario drill effectively integrated role-playing, virtual simulation, and practical field exercises to assess and enhance the bioemergency preparedness of the Olympic hospital complex. The findings underscore the importance of comprehensive training approaches that combine theoretical knowledge with practical application, tailored to the unique challenges of mountain healthcare settings. Implementing the lessons learned will strengthen the region’s capacity to respond to bioemergencies during the Milano-Cortina Winter Olympics and serve as a model for similar alpine regions globally.

Mass Gathering Medicine is a relatively new subspecialty. Focusing on improving the health impact and mitigating issues is a newly recognized skill. Given the heterogeneity of MGM, including sporting, festivals, and religious gatherings, standards can be challenging to institute. With vast types of MGM staffing, medical skills can vary. Current literature needs more research and guidance on training standards for event medical staff. This study highlights expert opinion on minimum standards for medical staff to improve public and participant safety.

The study is a three-round Delphi based on the CREDES criteria. Experts were identified at the MGM conferences in Riyadh and NYC in 2023. The study was performed via STAT59. Emails were sent to the experts requesting participation. In round 1, experts generated opinions on medical staff training. The second and third rounds used a 7-point linear scale to rank each statement. The ranking consisted of “not at all important” to “extremely important”. Stat59 anonymized all statements and rankings. The statements were considered to have reached a consensus if the responses had a standard deviation (SD) of less than or equal to 1.0.

137 open-ended statements were generated in round 1, and 73 appropriate statements proceeded to round 2. 28.7% of the statements (21/73) found consensus after round 2. In round 3, 39.6% of the remaining statements reached consensus (21/53). Forty-two statements from the initial 73 (57.5%) met consensus. Certain priority themes were noted. This included venue-specific information, good staff orientation to operations and capabilities, and community coordination. Mass-casualty preparation and triage were secondarily highlighted as a critical focus.

MG events continue to increase in size and frequency. This expert consensus provides a framework for training. Further work is needed to specialize core competency expectations for specific events and venues.

Artificial intelligence (AI) is revolutionizing healthcare. Emergency departments (EDs) are under increasing time pressure, and physicians often rely on patient information leaflets (PILs) to inform/reassure patients with common presentations. International recommendations require PILs to be at an appropriate reading level (that of a 12-year old child), thereby improving comprehension for patients (7, 8). Some PILs are too difficult to read for patients(9, 10), demanding consideration of appropriate lexical complicity (7, 11).

This study assesses whether commercially available large language models (LLMs) can improve the reading comprehension level of PILs. The readability/lexical complexity of 19 PILs currently used in an Irish ED was measured with validated reading level metrics, including the Common European Framework of References for Languages (CEFR) grade, using an online tool against the set standard reading comprehension. Two LLMs were employed with the same instructions to rewrite the PILs, scored using the same metrics, and improvements quantified.

Only three current PILs met the required lexical complexity level (median 63.3%, IQR 7.3). LLM generated PIL overshot the improvement in reading level, simplifying it by a median of 4% (1 CEFR level). The first LLM improved the median reading level to 60.25% (CEFR = C1, IQR 6.41), while the second LLM resulted in a median reading level of 56.92% (CEFR = C1, IQR = 5.6), meeting the target in 12 of 19 PILs.

The findings demonstrate the importance of a critical review of the reading levels used in EDs. LLMs may be employed to facilitate improving readability, but may not be able to reach the instructed reading level at first iteration, and are more useful in simplifying PILs at an initial college reading level. All AI-generated PIL retained the core message. Currently available LLMs may be utilized by healthcare workers to simplify PIL, improving readability to the recommended reading level.

The Do Not Resuscitate (DNR) order aims to prevent futile interventions when the medical prognosis is poor. This study evaluates resource utilization by DNR patients in the Intensive Care Unit (ICU) and compares it with non-DNR patients, addressing a gap in research within Saudi Arabia.

We conducted a retrospective analysis of 7,104 patients admitted to the ICU at King Abdullah Medical City, Makkah, from January 2016 to June 2023. Patients were categorized into DNR and non-DNR groups. Data were extracted from the critical care registry and analyzed descriptively. The chi-square test assessed resource utilization outcomes between the two groups post-DNR decision.

Among the 7,104 patients analyzed, 988 were classified as DNR, while 6,116 were non-DNR. Notably, DNR patients had a mean age of 61.4 years, significantly older than the non-DNR group at 55.9 years (p < 0.001). The mortality rate for DNR patients was markedly higher at 85.1%, compared to just 10.2% for non-DNR patients (p < 0.0001). Furthermore, DNR patients utilized a substantial amount of critical care resources, with 88.9% requiring mechanical ventilation versus 41.4% in the non-DNR group (p < 0.001), and 28.6% receiving Continuous Renal Replacement Therapy (CRRT) compared to 6.7% (p < 0.001). The mean length of ICU stay was also significantly longer for DNR patients at 20.4 days, in contrast to 8.0 days for non-DNR patients (p < 0.001). Additionally, a higher percentage of DNR patients received two or more antibiotics (76.1%) compared to 56.8% of non-DNR patients (p < 0.001).

DNR patients consumed substantial healthcare resources post-DNR decision. Optimizing physician approaches toward DNR patients is essential to balance resource allocation and patient comfort in terminal cases.

Prolonged grief disorder (PGD) is a debilitating condition recently recognized to psychiatric diagnostic manuals. There is a pressing need for valid, reliable, and culturally adapted instruments that align with internationally established diagnostic criteria for the diagnosis of pathological grief, particularly for Latinx populations, who often face limited access to timely mental health services. This study aimed to translate, adapt, and validate the Mexican version of the PG-13-R scale.

We translated and then back-translated the original PG-13-R. The scale was reviewed by experts in psychometrics and cognitively debriefed with a Mexican sample. The study included 397 participants, consisting of: (1) Family members of patients who died from cancer and received supportive care from a patient navigation program at a public hospital in Mexico City (CDMX) and (2) Individuals from the broader community who were contacted via social media (X, Facebook). Participants completed an online survey that included sociodemographic data, the preliminary version of the PG-13-R, an assessment of depression (PHQ-9) and of anxiety (GAD-7). Internal consistency was analyzed using Cronbach’s alpha. A confirmatory factor analysis (CFA) was conducted to examine evidence of validity, along with a Pearson correlation analysis between PG-13-R scores and existing measures assessing related but distinct constructs (i.e., depression and anxiety).

CFA supported a 1-factor structure with good model fit after accounting for error covariance between related items. The Mexican PG-13-R demonstrated good internal consistency (Cronbach’s α = 0.89) and positive significant correlations with measures of depression and anxiety, providing evidence of score reliability and validity.

The adapted PG-13-R offers a culturally appropriate tool for assessing prolonged grief in Mexican Spanish-speaking populations, with potential for use in clinical and research settings. The use of the PG-13-R scale is recommended for clinical research and mental health care in the Mexican population.

Mount Lewotobi Laki-Laki in East Flores District, East Nusa Tenggara Province (NTT), Indonesia, erupted on Monday, November 4, 2024. At least nine people died, dozens more were injured, and several buildings burned due to ‘material rain’ from the eruption. Referring to data from the National Disaster Management Agency (BNPB), the local government has declared a two-month emergency response status from November 4 to December 31, 2024. Earlier this year, the consultant from the Center for Health Policy and Management, University of Gadjah Mada (CHPM UGM), visited NTT Province several times to assist the NTT Provincial Health Office (PHO) in developing a health contingency/preparedness plan. The impact applied in the Eruption of Mount Lewotobi Laki-Laki disaster response operation

This field report was written using an observational descriptive approach. The authors were part of a team of consultants who assisted in building health capacity for disaster management. The best practices and lessons learned are documented as part of academia’s role in assisting the Ministry of Health in building the capacity of NTT PHO, so they are ready with a health contingency plan before a disaster strikes. During the early stage of response operations, the Health Emergency Operation Centre (HEOC) was activated with a solid organizational structure established, rapid health risk assessment (RRA) conducted, and integrally involving the sub-subclusters under the health cluster. Moreover, a response map was developed in the early stage of response, as well as a health cluster coordination meeting. Due to the efficient management of the existing health capacity, an EMT-CC has not yet been established, as no non-EMT personnel are required from outside the province. Furthermore, the NTT Province is an archipelago-type province; the capacity building provided by CHPM-UGM will help them determine where to establish the EMT-CC based on the response map and RRA results.

Surge attendance is an ill-defined, site-dependent concept. Our site is a small rural ED in Ireland with an inpatient bed capacity of 225 beds. It is not unusual now for daily ED attendance to exceed total hospital bed capacity. With an average 20% admission rate, a hospital must achieve a length of stay of less than four days for acute admissions to maintain elective and day care capacity. Careful monitoring of daily, weekly, monthly, and annual attendance trends is required to ensure adequate patient flow through modeling.

Trend analysis of system-generated attendance reports to evaluate 10 years of daily attendance patterns (2014- 2024) and predict potential future bottlenecks. Data examined in Excel.

Daily attendance ranged from a low of 1 to a high of 242 in 2024. Average DAILY attendance increased from 93.12 in 2014 to 169.83 in 2024. First day > 130 was 2014, > 150 was 2017, > 170 was 2019, > 190 was 2021, > 210 was 2022, > 240 was 2024. Daily attendance standard deviation was 14.27 in 2014 and 20.52 in 2024. Minimum daily attendance ranged from 48 in 2014 to 108 in 2024.

Average daily attendance in 2024 is similar to maximum daily attendance in 2019, which occurred only once that year. In 2015, there were 22 days with attendance > 120, which would have been considered surge attendance at the time. In 2024, there have been 304 days above 120. By comparison, there have been 29 days above 210 attendances in 2024 (Average + 2 standard deviations). In predicting future staffing models required one is required to plan for the daily average + 2 standard deviations to ensure that 95% of the time, there will be adequate staffing. Monitoring trends carefully will ensure departments are adequately staffed and avoid excessive workload and burnout among ED staff.

Emergency Medical Services (EMS) play a crucial role in Mass Casualty Incidents (MCIs). To improve tracking and the quality of clinical information during MCIs, several electronic devices have been developed. This study aims to evaluate Italian EMS professionals’ perceptions of a hypothetical wearable device during MCIs, implement its use in MCIs, and improve MCI management and patient outcomes. Using the Technology Acceptance Model (TAM), this study aimed to measure the perceived usefulness, the perceived ease of use, and the behavioral intention to use the device. It features a unique patient identifier, vital sign monitoring, LED-based triage code assignment, geolocation, and real-time wireless data transmission to a server.

A voluntary and anonymous survey was electronically distributed to all 67 EMS dispatch centers across Italy. Following an introduction outlining the device’s functions, the questionnaire comprised questions for demographic data collection and questions to explore TAM constructs. Questions were structured using the seven-point linear numeric scale, ranging from “strongly disagree” (1) to “strongly agree” (7).

Among the 141 respondents, the median age was 45; the majority were male (60%), nurses (67%), and reported five or more years of EMS experience (77%). 52% of them reported previous experience in MCI response. The survey showed excellent internal reliability (Cronbach’s alpha: 0.95). Overall, participants considered the device useful for improving situational awareness, coordination, resource allocation, and patient care. However, regarding the perceived ease of use, no consensus emerged on the integration challenges in MCI workflows and the possible slowdown in rescues. Finally, most participants would use the device and would recommend its comprehensive adoption in future MCI responses.

This study suggests that this hypothetical wearable device might be a promising tool valued by EMS professionals; however, further investigation is warranted to address the lack of consensus regarding its impact on patient care during MCI response.

The risk of Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) incidents has grown in recent years due to multiple factors, including rising terrorism threats, technological advancements, ongoing conflicts, industrial accidents, and emerging infectious diseases. Hospitals are critical response centers during these incidents, yet CBRNE events pose unique challenges to healthcare operations, staff safety, and patient care. Comprehensive training and preparedness are essential for strengthening hospitals’ disaster response capabilities and protecting healthcare workers and patients. This scoping review aims to assess the effectiveness of various CBRNE training methods in developing healthcare providers’ competencies and knowledge within hospital settings.

Collaborating with the research team, the medical librarian developed and executed comprehensive searches in Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, and CINAHL. Relevant keywords were carefully selected to capture all relevant literature pertaining to CBRNE training in hospital settings. Two research team members used Covidence to analyze the results through title, abstract, and full-text screening. Data was analysed to evaluate the effectiveness of various CBRNE training methods.

After screening and meeting the inclusion and exclusion criteria, 23 papers were included in this review. Training effectiveness was thoroughly documented in 91% of the reviewed articles. Nursing personnel emerged as the predominant category of trained healthcare providers within hospital-based programs. The most prevalent training methodology observed was the utilization of tabletop exercises, and biological hazards were the most commonly used threats in scenarios. None of the articles concluded whether any training methods were superior or optimal to others in enhancing effectiveness.

Overall, CBRNE training, when implemented effectively through a combination of didactic education, simulations, drills, and virtual reality exercises, improves the knowledge and competencies of healthcare professionals. It can lead to better preparedness for responding to threats in the hospital environment and ultimately may improve patient outcomes and public safety.

In Japan, education on disaster management began gradually after the Great Hanshin-Awaji Earthquake and has been incorporated into medical education in recent years. However, when I was a student, there was virtually no such education, and even after I became a doctor, I only participated in in-house disaster drills. In recent years, however, earthquakes, heavy rains, and other disasters have become more frequent in Japan, and it has become clear that in-hospital drills are not sufficient to cope with such disasters.

The Japanese Orthopedic Association is conducting triage training to first help people understand the basics of disasters, then to formulate a policy in the event of a disaster, and finally to pick up severely injured patients from among those who are generally considered as inherited orthopedic conditions. The training is conducted as a web based exercise, as it was started in 2020, the year of the coronary pandemic. The training is being conducted in each prefecture and has now been held in each prefecture. In the future, we plan to further strengthen our preparedness for future disasters by preparing review materials for reviewing the content of the training and considering training not on a prefecture-by-prefecture basis but on a wide area basis, and face-to-face training.

Disaster drills, such as Mass Casualty Incident (MCI) are complex events which require many resources in the crowded Emergency Departments (ED). Previous studies were done in paediatric ED’s and did not demonstrate any effect on patient care. In our novel research, we aim to describe, for the first time, the impact of disaster drills on a large referral Adult ED and the different impact of planned and surprise drills was never studied.

A retrospective study, examining electronic medical records of patients over the age of 18, who visited the ED during documented drill sessions between 2017-2023, in comparison to a control group consisting of visits at the same hours, one and two weeks before and following the drill. Variables such as triage levels, time-to-triage, time to-physician, re-admission rates, and mortality were examined, while further differentiating the impact of surprise and planned drills.

The research group consisted of 585 patients, and the control group 2447, with similar characteristics for all patients. Out of eight drills that took place, four were surprise drills and four were planned. Time-to-admission on the planned drills was shorter. Average time-to-triage was significantly longer in the general research group and even longer in the research group in the surprise drill, our subgroup, where the median time was doubled.

It was found that MCI drills do impact patient care, specifically extended triage times. These findings are crucial and should be considered to ensure that real time patient care is not jeopardized.

An article published in JAMA in August 2023 highlighted a list of 15,438 nursing homes analyzed by the Center for Medicare and Medicaid Services (CMS). Of that total list, 5,705 were “never used facilities,” which refers to nursing homes identified in a recent JAMA Network Research Letter * as not having oral antiviral or monoclonal antibody use.

During seven weeks from October 1 to November 17, 2023, a five-member team from HHS Coordination and Operations Response Element (H-CORE) Operations Technical Assistance (OpTA) Division – including three nurses, one science analyst, and one physician assistant – surveyed all 5,705 “never used facilities ”. They gathered information on knowledge of the COVID-19 therapeutics Paxlovid and Lagevrio, accessibility in obtaining Paxlovid and Lagevrio from pharmacies or other entities, and hesitation from residents or providers/clinical staff in the use of Paxlovid and Lagevrio.

Four primary barriers to accessing Paxlovid and Lagevrio were identified: (1) pharmacy distribution issues, (2) staffing issues, (3) corporate control setbacks, and (4) mis/disinformation among residents living in long-term care facilities. Four primary barriers to accessing Paxlovid and Lagevrio were identified: (1) pharmacy distribution issues, (2) staffing issues, (3) corporate control setbacks, and (4) mis/disinformation among residents living in long-term care facilities. Four primary barriers to accessing Paxlovid and Lagevrio were identified: (1) pharmacy distribution issues, (2) staffing issues, (3) corporate control setbacks, and (4) mis/disinformation among residents living in long-term care facilities.

Supporting outreach initiatives by continuing collaboration with local/state health departments to vulnerable populations by disseminating specifically targeted information will help contribute to equitable access to care.

The National Disaster Medical Team of NCKUH, established in 2008, was assigned by the Central Government to provide the medical response during disasters. However, we lack the rescue experience in a high-risk environment, including human-made disasters. So, we tried to develop a training course based on TECC (Tactical Emergency Casualty Care) and hope to provide the trainee in Taiwan with the capability to perform proper rescue and medical care in the under-threat circumstances.

We thoroughly went through the whole TECC class and modified the modules to new ones according to Taiwan’s training and regulations. We reorganized the classes to 1. Introduction, 2. Care under threat with high risk (compress, tie, and go), 3. Care under threat with moderate risk (CABDE), 4. Care under threat with low risk (Vital signs and P.E.), 5. Mass Casualty Triage (CABDE), 6. Summary. Furthermore, we modified the skill stations about 1. Move the casualties 2. Airway, and 3. Stop-the-bleeding to be more friendly to local trainees and encourage them to ask.

The Post-course Satisfaction rate is high. The comparison between pre-test and post-test shows highly educational and helpful for them to learn the concept, “evaluating the risk in the environment first”. The trainee showed a high interest in newly-designed modules, esp. the airway management. It demonstrated that this TUECC course significantly increased their self-confidence in responding the injured patients in a disaster in the future.

Following the concept of TECC, reasonable modification of the templates into a new TUECC course seems to be very positive for the local trainee here in Taiwan. More studies to examine the effectiveness and continuous effects compared with TECC are mandatory in the future.

This report demonstrated the health challenges faced by Taipei Search and Rescue Team members who responded to the 2023 Turkey-Syria earthquake. Sixty members joined the Taiwan Search and Rescue Team from February 7 to 14, 2023. Over the mission period, the team completed over 30 search operations, resulting in two successful rescues and one field amputation. During the mission, team members had 24 documented medical consultations for various health concerns. These included five cases of soft tissue injuries, four frostbites, three headaches, three respiratory tract irritations, two skin rashes, two cases of symptomatic hypertension, two upper respiratory infections, and single cases of stress-related symptoms, diarrhea, and toothache.

General health symptoms affected the majority of the team, with 89.8% reporting sleep issues, 67.8% experiencing skin problems, 45.8% musculoskeletal pain, 40.7% headaches, 40.0% upper respiratory infections, and 30.5% constipation. One month post-mission, health concerns persisted for some team members: 15 continued to experience respiratory symptoms, five reported ongoing sleep problems, four had elevated blood pressure, and one developed a skin infection.

To monitor psychological impact, the PTSD Checklist for DSM-5 (PCL-5) was administered across four sessions— immediately post-mission, at two weeks, at four weeks, and six months. Average PCL-5 scores were initially 7.30 (SD: 9.84) and peaked at 8.69 (SD: 10.30) at two weeks before declining. Five members initially scored above 30, yet their scores decreased over time, with no provisional PTSD cases remaining by the fourth week.

These findings reveal the significant physical and psychological toll faced by responders in disaster scenarios. This report further emphasized the vital role of the medical unit within the search and rescue team, as comprehensive medical support during deployment and post-mission is crucial for improving the well-being of rescue personnel in demanding operations.

As part of the French health system’s response to exceptional events, a regional organization has been set up. The decree of January 18, 2024, appoints the RRHEs and describes their reference missions, capacities, and means of care and diagnosis.

The Toulouse University Hospital has been designated as an RRHE and provides reference missions for CBRN (Chemical, Biological, Radiological, and Nuclear) risks, as well as climatic and medico-psychological risks. It provides a diagnostic and therapeutic care mission for patients in the context of a CBRN event or one causing numerous somatic and psychological injuries.

It has provided expertise and technical assistance to the Regional Health Agency in the development of operational plans and in the creation of adapted care pathways. Through technical expertise, it has supported the region’s health establishments in the preparation and local management of Exceptional Health Situations (EHS).

The RRHE has developed and managed a network of healthcare professionals comprising independent healthcare professionals or those working in healthcare establishments, who are responsible for EHSs as part of the care pathway. Finally, it has organized and coordinated the training of EHS trainers and regional EHS referents, as well as coordinated regional and interregional exercises.

In 2024, 26 RRHEs in France were financed by a specific grant. At Toulouse University Hospital, it financed medical time for each risk, managerial time, pharmacist time, non-medical staff, logisticians, secretariat, and laboratory technicians.

The RRHE Occitanie has established a multidisciplinary team specific to the Occitanie region, which, despite its recent appointment, responds effectively to the missions entrusted to it.

Effective civil-military coordination in medical responses remains an underdeveloped yet increasingly vital area of emergency health planning. Despite existing frameworks, such as the Oslo and MCDA guidelines, gaps persist in addressing operational realities between civilian and military medical teams, particularly during public health emergencies. This study investigates and presents the initial policy findings from a structured Delphi process aimed at developing technical recommendations for medical civil-military coordination (MedCivMil), under the World Health Organization’s Emergency Medical Teams (EMT) initiative.

A Delphi methodology was employed to gather expert consensus from a globally representative Technical Working Group (TWG) of 36 specialists across military, civil, and academic sectors. Participants were organized into three thematic subgroups - coordination, cooperation, and medical standards. Each subgroup evaluated a series of policy statements developed through literature review and expert co-chair collaboration. Consensus was defined as ≥80% agreement and/or a median ≥6 with a standard deviation ≤1.4. The process entailed two rounds of anonymous feedback using structured online surveys.

Consensus was achieved on all 41 statements after the second round. The coordination subgroup prioritized principles, planning, task division, and information sharing, with minimal contention. The cooperation subgroup surfaced more complex debates around authority, risk, and trust, requiring significant revision. The medical standards subgroup highlighted the need for ethical consistency, shared clinical protocols, and training across civilian and military actors.

Findings underscore the need for clear operational guidance that supports mutual respect, ethical alignment, and practical interoperability. Joint training, transparent leadership structures, and participative planning were emphasized as critical enablers of effective MedCivMil. The study contributes foundational policy direction to an evolving framework, facilitating future operational and tactical guidelines for emergency medical coordination across civilian and military domains.

The intensive care unit is a high-resource environment caring for the most critically ill patients that often runs at near or full capacity during regular activity. There is a need to understand how ICU staff navigate the surge in healthcare demand, in a country with a traditionally low disaster preparedness, during a real-time of near-disaster.

Semi-structured interviews were conducted with a strategic sample of eleven ICU staff members from three hospitals in Stockholm, Sweden (anesthesiologists, specialist nurses, nurse assistants) who worked during a state of near disaster in 2020. The interviews were analyzed using qualitative content analysis.

Three main categories were identified: organizational level, team level, and individual level. Challenges of rapid expansion, insufficient supplies, and unfamiliarity with equipment were described. Inconsistencies in staff continuity and training in crisis were identified. Moral distress was described due to the overwhelming situation. The importance of the voluntary nature of an emergency contract was emphasized to maintain staff morale and trust in management. The flow of creativity was described. Hierarchy and prestige within the teams could disappear. Over time, the ICU staff became leaders, delegating and educating in the ICU. Experience with excessive work hours, wearing military gas masks was gained.

Our findings indicate that in situations of near disaster, local leadership should focus on physical presence, clear communication, and staff well-being. Hospitals may consider a balanced approach that integrates hierarchical decision-making with the skills and knowledge of frontline staff. Customized mental health programs should be prepared to be activated, and methods for the fast integration of new ICU staff without prior ICU knowledge need to be developed. When standard health care can no longer be provided, regional leadership should consider activating the disaster mode.