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.

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.