Clinicians play a pivotal role in responding to victims of terror, yet we know little about the typology and the type of trauma inflicted. In the past, organization-sponsored terrorism was perceived as the major threat; however, since 2021, more than 50 per cent of ASIO’s priority caseload is domestic extremism, paralleled by a global surge of 320 per cent from 2016 to 2021. Government sources indicate that the most likely form of terrorism in Australasia will involve attacks by lone actors or a small group using simple attack methodologies and rudimentary weapons targeting crowded places.

This report will provide context and deepen understanding of the terrorism threat posed by all sources, focusing on lone actors (using the Christchurch Mosque massacre as a case study). It will examine methods, targets, and the health implications for emergency physicians to enhance prevention, preparedness, response, and recovery from terrorist events using datasets such as the Global Terrorist Database (GTD), Counterterrorism agency analysis, and a comprehensive literature review.

A terrorist act committed by a lone actor represents a distinctive form of political violence targeting individuals/groups perceived as “others” or “outsiders,” posing a threat to the perpetrator’s sense of nationalism, veiled within an anti-government and anti-democratic context. Targets are mainly religious (31%), private citizens (29%), Government 14% The most common weapons used are incendiary devices or firearms (73%). Chemical use is 1%.

Terror attacks result in greater trauma than that of non-terrorism related trauma, affect more body regions, and cause patients to stay twice as long in the hospital. Victims have a higher ISS and require more surgical interventions.

A perfect storm is emerging globally: climate change, disinformation, conspiracy theories, and inequality. Clinicians have a role in expanding knowledge, advocacy, understanding, response coordination, and expertise in recovery.

NDLSTM 4.0 – Continuously Revised, Continuously Improved Board of Directors*, National Disaster Life Support FoundationTM. The National Disaster Life Support FoundationTM (NDLSFTM) is pleased to provide updates to the World Association of Disaster and Emergency Medicine (WADEM), at its twenty-fourth biennial Congress, on the fourth edition of its internationally acclaimed Basic Disaster Life SupportTM (BDLS®) Course, first introduced to WADEM at its twenty-third biennial Congress. Maintaining its focus on the PRE-DisasterTM Paradigm and DISASTER ParadigmTM, the Course has continuously evolved to expand its accessibility to its increasingly digital worldwide community. It has now been translated into Spanish, Chinese, and Korean. As before, BDLS® 4.0 consists of 4 hours of online prework arranged in 18 topical modules, to be completed before enrollment in a live 4-hour series of 5 instructor-led interactive scenarios, which can be delivered actually or virtually, focused on common problems encountered in disaster healthcare. Comprehensively beta tested by 2,246 students (online component) and 112 students (instructor-led component) at institutions of higher learning within the United States and across the globe, the course has been enthusiastically received. The online component, termed Essentials of Disaster Life SupportTM (EDLS®), is now additionally available. At the same time, select modules of interest have been offered to emergency medical teams on-site in Ukraine and elsewhere. Revisions to both the Certified Healthcare Emergency Coordinator (CHEC) Basic and Advanced Courses, which include concepts of meta leadership and novel regulatory issues, have been completed and will be described in detail at the time of presentation.

*Gerald Beltran, Arthur Cooper (chair), Phillip Coule, Cham Dallas, James James, Ira Nemeth, Paul Pepe, Richard Schwartz (vice chair), Raymond Swienton, John Williams (executive director)

Peace Winds (PW) is an international NGO that provides humanitarian aid to people facing crises worldwide. ARROWS (Airborne Rescue and Relief Operations With Search), a part of PW’s project, supports victims of man made and natural disasters. On January 1, 2024, the Noto Peninsula in Japan suffered a magnitude 7.6 earthquake. During that time, the PW staff and rosters (registered members) were dispatched to the affected area to provide disaster relief.

This study aims to discuss the importance of a standardized handover process during humanitarian aid and identify the potential improvements to enhance effective disaster relief activities from the rosters’ perspective for future catastrophes. During the initial relief efforts, the PW staff and the rosters started gathering accurate information, evaluating the victims’ needs, and planning the next steps. However, due to the ever-changing nature of the situation, they needed to adapt to different tasks, which changed day by day. The rosters working on the next phase recognized the need to establish a standardized handover procedure to delegate responsibilities to later-joining rosters effectively. This structured handover process provided a clear overview of the relief efforts to the rosters involved at different times and for different durations.

While the handover procedure was successfully created during this response, it could have been further optimized if it had been introduced from the onset of the activities. Thus, the handover process should be discussed in advance between the PW staff and the rosters during preparatory training. This approach may also apply to other organizations with similar personnel structures.

An efficient handover process is crucial for disaster management. By discussing responsibility delegation and simulating the handover procedure during preparatory training, cooperation in the actual humanitarian activities could be optimized.

The purpose of this presentation is to highlight the humanitarian risk aid workers face when responding to active war zones/conflict areas. Over the last 10 years, there has been an increase in aid workers killed in active war zones. A decade later, the reports of aid workers targeted, arrested, and/or killed are on the rise. A comparison of 20 countries where ongoing violence and war have greatly impacted aid workers’ ability to respond will be compared to the war in Gaza since October 2023. Graphical evidence will highlight the aid workers killed, healthcare workers arrested, as well as the number of incidents where damage to healthcare facilities and obstruction in providing care occurred.

Mental disorders, including stress, anxiety, and depression, are prevalent among Emergency Medical Services (EMS) workers globally due to their high-stress work environment. Despite the importance of these issues, data on EMS workers’ mental health in Saudi Arabia is scarce. This study assessed the prevalence of these disorders among EMS workers in the Makkah region, providing insights into their well-being.

A cross-sectional study was conducted from January to April 2024 at the Saudi Red Crescent Authority (SRCA), the Ministry of Health (MOH), and the Ministry of National Guard Health Affairs (MNGHA) in the Makkah region. A convenience sample of 352 certified EMS workers, employed for over one year, completed an electronic survey assessing demographic data, lifestyle habits, and mental health using the DASS-21 scale. Descriptive statistics were used, with Chi-square and Mann-Whitney U tests for bivariate analysis, and logistic and linear regressions for multivariate analysis. Results were significant at p < 0.05.

Among the 352 participants, 12.2%, 23.0%, and 17.6% experienced extremely severe stress, anxiety, and depression, respectively. Mann-Whitney U tests showed a significant association between a history of mental illness and severe stress, anxiety, and depression (p < 0.05). However, logistic regression revealed a significant link only to depression. Chi-square tests revealed significant associations between stress, anxiety, and depression levels and several factors. Linear regression indicated that non-communicable disease (NCD) medications increased stress, anxiety, and depression, while more sleep reduced all three. Additionally, years of experience were a significant predictor only for stress, indicating that more experience increased stress levels.

This study underscores the high prevalence of stress, anxiety, and depression among EMS personnel in the Makkah region, highlighting the influence of NCD medications, sleep duration, years of experience, and the history of mental illness. These results emphasize the urgent need for targeted mental health interventions and support systems for EMS workers.

World Youth Day 2023, hosted in Lisbon, Portugal, likely represented one of the largest mass gatherings in the country’s history, with an estimated 1.5 million attendees. The Ministry of Health established a comprehensive task force involving 17 institutions to coordinate public health preparedness and response efforts. Key initiatives included capacity building and scaling up essential services, such as food and water safety measures, legionella and vector surveillance, the issuance of temporary National Health Service (NHS) numbers to facilitate health care access, and the enhancement of IT systems for interoperability. Primary, pre-hospital, and hospital care services were expanded, with resources pre-deployed, including WHO-certified Emergency Medical Teams (EMT) and Primary Medical Aid (PMA) units.

The preparedness phase also faced challenges, including a lack of historical data from previous editions, unpredictable participant numbers, logistical complexities across multiple venues, and environmental concerns such as a potential heatwave. Surveillance was conducted using both indicator-based systems (SINAVE, eVM, SICO-VDM, INEM) and event-based tools (RONDA Bulletin, MediSys, mobile and meteorological data) for real-time situational awareness.

Communication strategies included the use of the SNS24 Helpline, a mobile app with health recommendations, and regular situation room briefings featuring real-time data dashboards. International cooperation with organizations like the ECDC and WHO bolstered these efforts. Key takeaways from the event emphasized the importance of data integration for evidence-based decision-making, a clearly defined organizational structure, thorough training programs, and a solid legal framework to support response activities. The conference underscored the legacy potential of these initiatives, aiming to improve public health emergency responses for future events of similar magnitude.

In planning and implementing humanitarian responses to crises, a crucial set of questions revolves around issues of when and how to close projects. Discussion has primarily focused on exit strategies of organizations. Less attention has been directed to how project closure is experienced and perceived by people living in crisis-affected communities. This study aimed to better understand these perspectives and to develop resources to raise awareness and support dialogue around humanitarian project closure.

An interpretive description qualitative study was carried out in six communities in the Philippines that had experienced typhoons, displacement due to volcanic eruption, or armed conflict. Focus groups and key informant interviews were conducted with community members and local stakeholders. There were 9-31 participants in each setting, totaling 101 participants. Inductive and constant comparative approaches were used to compare within and across settings and identify practices and approaches associated with project closure that were valued by participants. Working closely with an Advisory Board drawn from local civil society organizations, a guidance document and workshop material were co-developed and tested in the six communities.

Elements of project closure that were particularly valued by participants included transparency, collaboration, participation, sustainability, monitoring post-closure, fairness, and preparedness. These findings were used to structure the guidance document and develop workshop materials to increase awareness of considerations related to how humanitarian projects are closed, both for humanitarian organizations and members of communities affected by humanitarian crises.

How humanitarian projects are closed is highly consequential and can be a source of harm or can promote positive impacts that endure after a project has ended. Drawing attention to community perceptions of what is at stake related to project closure can create opportunities for dialogue and generate insights to improve humanitarian closure practices and policy, including empowering communities.

Crush injury is a type of tissue damage caused by external pressure on a part of the body, commonly seen in natural disasters, traffic accidents, and other scenarios. The severity of the injury is closely linked to patient prognosis, making the establishment of appropriate animal models crucial for crush injury research.

Bama miniature pigs were randomly assigned to three groups, subjected to a 10-fold body weight pressure on the hindlimb muscles. The duration of compression was controlled to simulate mild, moderate, and severe crush injuries. Ultrasound imaging assessments were performed before compression and at 0, 4, 24, and 72 hours post-decompression. Blood samples were collected at each time point for biochemical analysis. At the study’s conclusion, muscle tissue from the compressed areas was collected for histopathology.

Ultrasound imaging showed that in the mild group, muscle echogenicity was slightly increased with mild structural disruption; in the moderate group, echogenicity was enhanced, with ground-glass changes; in the severe group, muscle echogenicity was chaotic, with a mesh-like hypoechoic pattern and edema in the fat layer. Biochemical analysis revealed a trend of initial elevation followed by a decline in CK, CK-MB, and potassium (K) levels within groups. Intergroup comparison showed a progressive increase in these markers with the severity of injury, especially in the severe injury group, which exhibited the highest levels. Histopathological analysis showed widespread muscle necrosis, vascular rupture, and inflammatory cell infiltration in the severe injury group, while mild and moderate groups primarily exhibited cellular edema and localized inflammation.

This study successfully established a Bama miniature pig model of crush injury with varying severity, and the model’s validity was confirmed through imaging, biochemical, and histopathological evaluations. These findings provide a valuable experimental foundation for further research into clinical diagnosis, prognostic assessment, and therapeutic strategies for crush injuries.

Space is a crucial hospital resource that is often overwhelmed by patient surges during disasters. Temporary hospital annexes were key infrastructural expansions forced by the COVID-19 pandemic. This scoping review explored construction, workflow features of, and experience setting up annex facilities.

Pubmed, Embase, and CINAHL databases, as well as gray literature, were searched for articles or reports of annexes, shelters, or related structures built or adapted within hospitals for clinical use during the pandemic. Reference lists and citations from included manuscripts were manually searched. Design, physical properties, construction process, workflow, and clinical utilization were extracted using a predefined form and thematically analyzed.

470 articles were screened, and 9 relevant articles were identified. Broad strategies for temporary annex facilities were (1) repurposing non-clinical areas and (2) building de novo structures. Non-clinical areas repurposed were a conference room and a multi-storey car park. De novo structures built were tents, containers, or both in combination. The annexes were often located adjacent to the emergency department (ED) (6, 66.7%), where the surge was greatest, and used for triage, swabbing, and low-acuity management before discharge. Car parks (2, 22.2%) were chosen for their segregation from clinical buildings while still being accessible for diverting stable patients from the ED and referring providers. Most annexes used for low-acuity ED diversion were converted or built in three to six days. One de novo container, a 50-bed isolation ward, required 50 days. Two reports used de novo containers and tents for Computed Tomography and plain radiography, respectively. Reports describe reduced ED length of stay, wait times for investigations, and Personal Protective Equipment usage.

This scoping review identified strategies to increase hospital infrastructure capacity and matched relevant construction and workflow features to function during the COVID-19 pandemic. Hospital stakeholders can contextualize these experiences to improve infrastructure preparedness to disasters.

As healthcare becomes increasingly technology-dependent, cyberattacks are rising in parallel with the growing frequency and severity of natural disasters. Cyber criminals are strategically exploiting system vulnerabilities during disaster response periods, creating a dangerous nexus of simultaneous threats to healthcare organizations. This study investigates the frequency of concurrent cyberattacks and natural disasters targeting healthcare entities, analyzing emerging patterns and common vulnerabilities to inform more resilient security strategies.

In collaboration with the research team, the medical librarian developed and executed comprehensive searches in Ovid MEDLINE, Ovid Embase, CINAHL, Web of Science Core Collection, Cochrane Library (via Wiley), and IEEE Xplore on August 14, 2024. To capture all relevant literature about cyberattacks occurring with natural disasters, relevant keywords and controlled vocabulary were carefully selected. The remaining results underwent title and abstract screening, followed by full-text screening by two research team members in Covidence. The included full texts were then analyzed for pertinent data about the co-occurrence of natural disasters and cyberattacks affecting healthcare facilities.

A total of 2,502 results were retrieved; duplicates were removed, and 2,209 unique results remained. 110 articles were screened based on title and abstract, then the remaining articles underwent full-text screening, and 43 articles were included in the study. These articles included almost exclusively cyberattacks during the COVID-19 pandemic. The majority occurred in the US, UK, and Ireland. Common themes included increasing reliance on technology and remote work increased the risk of cyberattacks, with a multitude of recommendations on how to better protect hospital systems from future attacks.

With the increase in cyberattacks and natural disasters, we will likely see an increasing co-occurrence. Future work needs to concentrate on increasing cybersecurity to diminish threats to healthcare systems, to prevent morbidity and mortality, protect personal information, and prevent financial losses.

The Disaster/Digital Information System for Health and Well-being (D24H), fully operational since April 2024, supports health, medical, and welfare teams in disaster-stricken areas by integrating, analyzing, and providing data collected by various teams. During the 2024 Noto Peninsula Earthquake, the system was used by the coordination headquarters and health centers to assess evacuation shelter conditions. Disaster Medical Assistance Teams (DMAT) and other support teams conducted assessments based on Sphere standards, recording data for approximately 400 shelters, resulting in over 4,500 updates from January to August 2024. The study aims to collect data to analyze changes in the shelter environment and the effects of support interventions, contributing to improved disaster response planning. This study aims to enhance future disaster response planning and support by using the collected data to analyze changes in shelter environments and the effects of support interventions.

Data from the D24H Survey were analyzed as a time series. The collected data were cleaned for correct anomalies and missing values. Time-series analyses visualized changes in resource supply and infrastructure sufficiency, while regression analysis examined the effects of support team visits and resource delivery timing on environmental improvements, identifying effective support indicators.

The study identified temporal trends in shelter resources and infrastructure sufficiency. Comprehensive assessments revealed a relationship between support interventions and shelter conditions. Criteria for high-risk shelters were established, providing evidence for prioritizing support plans.

The study clarified the relationship between shelter conditions and support interventions, providing a framework for prioritizing disaster support. The findings enhance the efficiency of disaster responses, enabling better resource allocation, standardizing support activities, and improving public health and living conditions in shelters.

Cooper University Health Care’s Section of Military, Diplomatic & Field Surgical Affairs (MILDAF), in conjunction with members of Cooper’s Trauma, Surgical, and Emergency Departments as well as the Salem County, New Jersey’s Sheriff’s Office and Office of Emergency Management developed a model for Tactical Trauma Training for all levels of Law Enforcement, EMS, and Fire/Rescue members.

In April 2024, more than 275 law enforcement, EMS providers, firefighters, and rescue personnel from New Jersey, Pennsylvania, Delaware, and New York attended the week-long Mid-Atlantic Severe Situation Exercise (MASSE), which focused on point-of-injury management for emergency responders. This exercise provided high-fidelity training with cadavers within simulated settings of real-world situations.

Events such as MASSE serve to develop and improve life-saving skills for first responders to ensure preparedness in the face of unpredictable, complex, and dangerous real-life crises. Scenarios at the MASSE training event included farm vehicle accidents, man-in-the-machine incidents, domestic violence, hostage situations, and an austere location medical intervention lab. First responders in attendance gained new skills to better equip them to deal with potential real-world situations and save lives.

Participants learned proper tourniquet placement from US Army medical personnel embedded at Cooper. Participants also received hands-on training from surgeons in the cadaver lab. Cadaver lab topics included emergent airway maneuvers, intra-osseous vascular access, needle decompression of tension pneumothorax, and arterial bleeding control techniques in both extremity and junctional wounds. Instructors then challenged participants to use these skills in three unique live-fire scenarios and then provided immediate actionable feedback in a tactical and medical debrief.

By pooling resources and expertise, MASSE serves to improve the skills of local first responders and EMS, thereby enhancing public safety. The MILDAF team and their partners look forward to continually improving and executing high-fidelity hands-on training.

The Ministry of Road Transport and Highways, Govt. of India, on 30th May 2013 approved the “National Ambulance Code (NAC)” as Automotive Industry Standard - 125 (AIS 125) and on 8th September 2016 notified compliance with AIS-125 (Part 1) mandatory for all road ambulances manufactured on and after the 1st April 2018. NAC detailed the constructional and functional requirements of Category M (four wheelers) and L (two & three wheelers) vehicles used for transport and/or emergent care of patients. In this research report, an effort has been made to examine the impact of the ‘National Ambulance Code’ on the quality and availability of ambulances in India over the past decade.

The report was compiled after detailed discussions and semi-structured interviews with industry experts, academicians, ambulance procurement teams, and ambulance manufacturers.

It was strongly felt that the National Ambulance Code has, for the first time, legally enshrined the definition of a road ambulance in India. As the ambulance code also prescribes other vehicle-specific parameters like seating, electrical, fire safety, stretcher loading angle, etc., it simplifies ambulance procurements for healthcare providers, who are often not well-versed in automobile engineering aspects. This has also helped ambulance manufacturers standardise their inventory and models, thereby allowing faster delivery of ambulances. The biggest impact of this was felt during COVID-19, when the average turnaround time for new ambulance deliveries was reduced to days vs. months in the days before the ambulance code.

Standardization of basic ambulance design, specifications, and safety requirements is a work in the right direction, as often the end users are medical professionals who are not very well versed with vehicle engineering aspects. However, a right balance has to be struck between standardization and strangulating innovation. Hence, a periodic review of the Ambulance Code is recommended to ensure any amendments in line with industry and user feedback are incorporated timely.

New Orleans hosts over 130 special events annually, with a few standing out as large-scale and nationally recognized, including two nationally ranked events, which are closely matched in success by the Special Event Assessment Rating (SEAR) system. The Super Bowl is a SEAR 1 event (the highest ranking of special event with national importance), and Mardi Gras is a SEAR 2 event within a week of one another. That is why New Orleans emergency medical services (NOEMS) started planning early. Planning for these events began a year in advance. It included, but was not limited to: regional EMS collaboration and coordination, training and education, event operation plans, and updating multiple inter- and intra-agency plans. Prehospital multi-event medical planning cannot be done in a silo; meetings included mutual aid EMS agencies, health departments, emergency management offices, and regional hospitals, among others. This prehospital coordination group met multiple times, leading up to the events. It worked on updating active shooter plans, Mass Casualty Incident (MCI) plans, MCI transportation plans, mass fatality plans, and family reunification plans. By meeting in the lead-up to these events, personnel can build relationships, allowing for greater ease of communication during the event or any incidents. Ideally, these plans and training will never be needed. For the small percentage of time when such plans need to be implemented, all the pre-event coordination can make a huge difference in response time and response effectiveness.

Emergency departments are expected to be readily available to provide care to the public at any time, but on an average day, the ability to receive patients can be stretched to capacity, attempting to meet the demands for services. Within the United States, the most common cause for older adults to be seen and treated in the ED is due to falls. After experiencing a fall, roughly 35% of older adults were discharged from the ED with unrecognized but modifiable fall-risk factors. Provision of care from rehabilitation services at the right time and place has consistently presented challenges with barriers to access, including referral delays, scheduling delays, transportation, or additional costs. Ongoing staffing and labor pool shortages post-pandemic have further exacerbated the need for boarding of patients within the emergency department, resulting in avoidable complications such as delirium and hospital-acquired deconditioning that have shown worsening clinical outcomes for ill patients. Competing demands by providers and nursing staff in resource-constrained emergency departments make it necessary to task-shift provision of care to other services, including rehabilitation.

Information was obtained by clinical practice and academic literature review via Google Scholar and the use of the University of Colorado library search.

Inclusion of a physical therapist within the emergency department has improved the opportunity for collaboration to reduce wait times for care and improved access to care. Patients and health systems have seen additional benefits with a reduction in costs associated with unnecessary hospital admissions, reduced use of narcotics for pain control, and a reduction in demands for imaging. The addition of regularly staffed PT in the ED allows for appropriate care by the appropriate provider in the emergency setting.

Staffing a PT within the ED is safe, financially feasible, and well-received by physicians and nursing colleagues.

Climate change, geopolitical conflicts, and hybrid threats jeopardize global nutrition security. The objective of this study was to identify and characterize all documented terrorist attacks on water and food supply targets as reported to the Global Terrorism Database (GTD).

All incidents from 1970 through 2020 with ‘food and water’ listed as target type were selected. Temporal factors, location, target type, attack and weapon type, perpetrator type, and number of casualties were collated.

363 incidents across 65 countries were analyzed, resulting in 392 fatal injuries and 302 non-fatal injuries. In this series, 78.2% of incidents targeted water supplies, 21.5% against food supplies, and one targeted both. Most of the targets consisted of food aid programs in conflict areas. Bombings/explosions were the most frequently identified attack type (61.2%), followed by facility/infrastructure attacks (15.7%) and armed assaults (11.0%). There was one case of a radiological threat, and in twelve incidents, chemicals were used.

Food and water supply chains are important targets for terrorism. The water supply chain is targeted far more frequently than the food supply chain. The possible devastating effect is immense on already vulnerable people living in conflict areas and relying on state-led or international food aid programs.

Mass casualty incidents (MCI) stress systems. Research shows the critical role laypersons play in saving lives and reducing morbidity by providing time-sensitive interventions at a disaster scene. While many first-aid and basic life support courses exist, training for laypersons to respond to disasters is few. A course, “Ground Zero,” was developed by Disaster Volunteer Corps, Singapore General Hospital, for laypersons focusing on basic disaster management and simple lifesaving interventions. This review aims to detail the methods of course development and challenges faced in this pilot program. Kern’s 6-step approach was undertaken for curriculum development. Core content for Ground Zero included scene safety, triage, emergency communications, and principles for basic lifesaving procedures. Emergency physicians supervised Emergency Medicine residents and trained students who conducted the sessions. Course feedback was sought through online forms. Pre- and post-session quizzes were undertaken to assess the learning and confidence of the participants. (Key challenges faced)

• Implementation: Phase 1 was delivered online with breakout sessions, due to COVID-19 pandemic restrictions. Phase 2 was delivered in person, with sessions centering around hands-on practice, and culminating with a simulated MCI, with scene safety, assessment and intervention, and evacuation of casualties undertaken by participants.

• Understanding: the course needed to address disaster response from the layperson’s perspective. MCI principles needed to be simplified, and the limitations of life-saving measures in MCIs had to be addressed sensitively. Citizens have differing levels of baseline medical understanding and willingness to intervene. Focus stayed on empowering and not endangering them in their efforts. The importance of alignment with emergency systems was also taught.

Previous studies demonstrate the willingness of laypersons to respond to disaster scenarios. However, there is a lack of training in this area. Education remains a cornerstone in disaster readiness. Further training and research need to be conducted.

The Sudanvirus Disease outbreak in 2022 prompted our High-Risk Infection Team (HITeam) to evaluate and implement novel response strategies. To improve the flexibility and efficiency of special pathogens response, HITeam members developed a Virtual Assessment Model (VAM) for at-home evaluation of individuals suspected of having high-consequence infectious diseases (HCID).

The VAM incorporates aspects of care, normally rendered in a high-level isolation unit (HLIU), into a mobile response framework where special pathogens clinicians are brought into an individual’s home. To address real-life VAM feasibility, a comprehensive residential functional exercise was executed. External evaluators were invited to assess the model.

The VAM allows for thorough assessment of a suspect case in the field and postponement of full HLIU activation until more information is available. Developing, testing, and implementing the VAM required input from an interdisciplinary group of partners, culminating in a functional exercise that demonstrated the ability of nurses, physicians, laboratorians, paramedics, and public health personnel to integrate into one cohesive care team. Even though participants in the exercise followed the model as described, feedback from participants and observers led to an alteration in the timing of the virtual visit to minimize the time of the on-site team inside a suspect case’s residence. Virtually obtaining history and performing preliminary environmental scan while the on-site team is preparing to deploy would optimize the on-site team’s workflow to focus on clinical assessment, sample collection, and delivery of care-package consisting of patient friendly information materials, thermometer, sphygmomanometer, and pulse-oximeter, which was identified as a must-do during the functional exercise.

The VAM has long-term sustainability implications for global special pathogens programs and provides solutions for broader challenges in healthcare by role-modeling cost-effective, patient-centered care within the highly nuanced HCID care. Optimizing the model via exercises is key for its seamless real-life implementation.

The impact of climate change on pediatric and vulnerable populations and the long-term implications that are not as highlighted in research. Though it will take years to deduce the impact on pediatric and vulnerable populations, this presentation will provide an overview of climate change hazards during disasters and discuss considerations for pediatric and vulnerable populations that clinicians can be aware of and consider as they pertain to disaster response.