Blunt and penetrating trauma are common in many disasters, including hurricanes. Injured patients can present to the hospital during the event or up to several days after. Patients often present with lacerations and abrasions, but well-appearing patients still require a thorough physical exam and appropriate imaging with necessary consults. During disasters, patients can overwhelm the hospital and traditional imaging modalities (CTs); therefore, ultrasound can assist in patient triage and diagnoses during these times while accelerating patient care.

This chapter outlines the management of a Clostridium difficile (C. diff) outbreak on a cruise ship, focusing on the early identification and triage of affected passengers, resource allocation, and the coordination of care in a resource-limited setting. The scenario reviews communication strategy within the ship’s command structure, planning for the transportation of severely affected individuals to onshore facilities, contact precautions, and quarantine. It provides a comprehensive approach to handling infectious disease outbreaks in isolated environments.

Ultrasound is the most commonly used medical imaging method in pregnancy. In early pregnancy a scan is performed to confirm the presence of a normally sited pregnancy, establish viability, determine number of embryos, determine gestational age and hopefully to reassure about the absence of complications. Ultrasound used with standard presets for clinical reasons in early pregnancy is safe and the benefits outweigh any theoretical risks.

This case outlines the management of a mass casualty incident (MCI) involving a 24-year-old male who sustained multiple stab wounds during an active shooter situation at a concert. The patient presents with significant injuries, including stab wounds to the back and upper extremities, hypotension, tachycardia, and respiratory distress. Upon arrival, the patient is intubated for airway protection, and procedures are performed to address tension pneumothorax and life-threatening bleeding. The case highlights key emergency principles, such as the importance of rapid trauma assessment, bleeding control, and chest tube placement. The article also discusses the challenges of managing critically ill patients in the context of an MCI, emphasizing the need for mass transfusion protocols, advanced imaging, and coordinated care with trauma surgery. This scenario serves as a training tool for preparing emergency medical teams to handle multiple traumatic injuries under the pressure of an MCI.

This case presents a medical scenario involving a 25-year-old crew member aboard a large commercial fishing vessel who sustains severe trauma after being struck by a swinging metal crate. The patient suffers from a left-sided hemopneumothorax and spleen laceration, resulting in hemodynamic instability. The medical officer, working in an austere environment with limited resources, must rapidly assess and manage the patient using available supplies, such as a chest tube kit, uncrossmatched blood, and basic first aid materials. Key teaching objectives include identifying both visible and hidden injuries, managing critical trauma in resource-limited conditions, and coordinating with shore-based emergency medical services. The scenario emphasizes quick decision-making and life-saving interventions, such as chest tube placement and blood transfusion, without access to advanced imaging or laboratory testing. The exercise challenges responders to stabilize the patient while awaiting additional support, preparing them for trauma care in isolated or resource-scarce environments.

Key teaching points include understanding the pathophysiology of aspiration pneumonia in disaster settings, the impact of inadequate infrastructure and crowded conditions on disease progression, and the management of septic shock and respiratory failure. Critical actions for healthcare providers include prompt airway management, fluid resuscitation, and the initiation of broad-spectrum antibiotics and vasopressors. The case emphasizes the need for rapid intervention and proper resource allocation in disaster-stricken areas to improve patient outcomes. Additionally, it underscores the challenges faced by medical teams in managing complex cases in austere environments following natural disasters like tsunamis.

The scenario begins with the evaluation of multiple patients, including a 6-year-old boy, a 21-year-old marathon runner, and a 70-year-old man, all presenting with symptoms of nausea, vomiting, and diarrhea. As the senior medical officer, the physician must recognize the viral gastroenteritis outbreak and take steps to manage the rapidly spreading illness with limited resources, all while on a ship far from shore. Key teaching points include the differential diagnosis of gastrointestinal symptoms across various age groups, the management of dehydration and electrolyte imbalance, and the implementation of infection control measures. The scenario emphasizes the need for coordinated public health action in a confined, resource-limited setting, while also navigating the captain’s decision not to turn the ship around, as no patients are critically ill.

The scenario aims to teach participants the importance of recognizing heat stroke early, understanding its pathophysiology, and implementing appropriate management strategies. Key actions include obtaining core temperature, initiating aggressive cooling measures, fluid resuscitation, and managing complications such as rhabdomyolysis, hyperkalemia, and neurological symptoms. The simulation also emphasizes the need for advanced airway management and timely admission to intensive care for further treatment. Through this scenario, learners gain hands-on experience in managing a critically ill patient with heat stroke, enhancing their clinical skills and understanding of the complexities involved in treating heat-related emergencies. The article provides a comprehensive framework for educators to facilitate discussions on heat stroke pathophysiology, management strategies, and the role of interdisciplinary collaboration in patient care.

What therapeutic intervention is indicated for treatment-resistant psychiatric/aggressive symptoms in a patient with CTE and a comorbid primary psychotic disorder?

What is a contraindication for naltrexone?

This case involves likely casualties that may present to a facility following a mass gathering stampede incident. Patients within this context may present with blunt polytrauma and subtle signs of impending decompensation that portend catastrophic outcomes if not caught early during the standardized trauma evaluation. The nature of a mass gathering, mass casualty event is such that external factors and players may provide unanticipated barriers to care at critical moments. Rapid identification and mitigation of these confounders and confederates are critical, in order to prevent degradation of high-efficacy trauma care for potentially complex and critical ill patients.

This scenario presents a 54-year-old woman with a history of hypertension who is brought to a rural critical access emergency department after being shot during an active shooter incident at a grocery store. She has multiple penetrating wounds to her neck, groin, and extremities, requiring immediate hemorrhage control, resuscitation, and airway management. The patient is initially hypotensive, tachycardic, and in hemorrhagic shock. Lifesaving interventions such as wound packing, tourniquet application, IV or IO access, and blood transfusions are crucial to stabilize her condition. As her condition worsens, an expanding neck hematoma necessitates securing the airway, with a potential need for a surgical airway. The scenario emphasizes the need for prompt recognition of life-threatening injuries, coordination of care for transfer to a trauma center, and the preparation of the emergency department for the arrival of additional victims from the scene, highlighting key principles in trauma management and disaster preparedness.

This case presents a standardized patient (SP) scenario designed for training healthcare professionals in disaster response, focusing on the management of a patient trapped following a hurricane. The scenario involves a 72-year-old man who has been trapped in his basement for seven days after a category 3 hurricane caused structural damage to his home. Participants, acting as members of a FEMA Search and Rescue task force, are tasked with evaluating the patient’s condition, ensuring scene safety, and coordinating appropriate medical care and transport.

This case presents a detailed scenario following a massive earthquake in California, focusing on the prolonged extrication and medical care of a male trapped beneath debris in a collapsed apartment building. The earthquake caused widespread structural devastation across 10 counties, leaving the victim pinned under a heavy steel girder with severe injuries to his right lower extremity. As search and rescue teams arrive four hours after the collapse, they must navigate unsafe structural conditions while providing medical stabilization, who is suffering from significant pain and potential crush syndrome. The case emphasizes critical aspects of Urban Search And Rescue (USAR) operations, such as ensuring scene safety, using appropriate personal protective equipment (PPE), and maintaining strong team communication. It also outlines the necessary medical interventions, including managing traumatic injuries, preventing crush syndrome, and providing wound care.

Diagnosis and management of NMS and its differentiation from catatonia