This presentation will report on medical evacuation challenges involving pediatric specialty hospitals and the capabilities and challenges identified during the October 2022 National Pediatric Disaster Conference Significant Event Readiness Forum (SERF). The event drew pediatric subject matter experts and entities from across the nation to explore opportunities along the disaster response continuum addressing the multi-state and federal capability in the event of a catastrophic earthquake. Over 351 coalition, pediatric, EMS, air-medical state, regional, and national disaster response partners participated in this hybrid event. The purpose of a SERF is to foster information sharing and relationship development with a targeted group of stakeholders who do not always plan together.

The presentation will discuss how a Significant Event Readiness Forum provided a framework for stakeholders to understand command structures and situational awareness on the first responder and private sector level is needed to operationally manage military, and private sector medical transportation staging, triage, and deployment of ground and air transport associated with a no-notice catastrophic event.

In the event of massive infrastructure disruptions, facilities will be faced with decisions to self-evacuate or shelter in place. Prolonged staging will necessitate going “old school,” informed by lessons learned from our colleagues in war and austere settings.

Lessons learned:

1. 1. Facilitated discussions are needed across disciplines and sectors before community planning for pediatrics and other special populations.

2. 2. SERF format results in improved communication and consensus planning across disciplines and private public partnerships.

3. 3. Improvements are needed in developing and testing plans for interoperable interstate communication, coordination, and response.

4. 4. Addressing the “basic” needs of the workforce and community in the first 24 hours for food, water, restrooms, shelter, and emotional support may be one of the most important factors in resilience and recovery.

The war in Israel, which began on October 7, 2023, posed significant challenges for breastfeeding mothers. Breastfeeding-focused Facebook groups quickly became crucial sources of information and emotional support. Analyzing posts from the first week of the conflict reveals specific concerns and informational needs of breastfeeding mothers in emergencies. This study identifies three central themes, provides insights into their concerns and informational needs, and formulates actionable recommendations for immediate responses during wartime.

This study employs a qualitative research methodology to examine the experiences of breastfeeding mothers within Facebook communities. A reflective thematic analysis was conducted on messages posted on two primary Facebook groups (total of 90.1K members) from the first day of the war (October 7, 2023) throughout the subsequent week.

Three main themes emerged:

Breastfeeding mothers reported severe stress and anxiety, fearing these emotions might affect their infants through breastfeeding. They sought information on anxiety medications and the safety of continuing breastfeeding while on treatment.

Mothers observed a perceived decline in milk production, raising concerns about their infants’ nutrition and noting increased infant restlessness. They sought advice on enhancing milk production, including pumping techniques and galactagogues.

Posts highlighted concerns for infants whose mothers were killed or missing, with offers to donate breast milk and offers to breastfeed infants in need.

During war or disaster, social media becomes a primary source of information. Breastfeeding mothers’ Facebook groups serve as sources of information, comfort, and connection. Concerns about the war’s impact on breastfeeding lead to a need for evidence-based, reliable information that is immediately accessible. Required information includes the effects of maternal psychological state on lactation, medication use, and milk production. Additionally, these groups function as platforms for offering and receiving support among mothers and lactation professionals.

Managing disasters and public health emergencies presents a complex challenge, especially in maintaining the crucial elements of surge capacity, i.e., the 4S: Staff, Stuff, Space, and System. This study focuses on using alternative care sites, focusing on hotels, during disasters and public health emergencies.

This study used a survey approach in two phases. In the first phase, the willingness to participate as an alternative care site was investigated among hotels in Bangkok, Thailand. In the second phase, the requirements for being an alternative care site were discussed with selected managers through a semi-structured interview session, including the legal implications of such utilization.

The results indicated a general willingness among participating hotels to participate as an alternative care site. However, some hotels lacked the requirements for being an alternative care site.

Based on the requirements in this paper, there is a high potential for using hotels as alternative care sites during disasters and public health emergencies. However, there is a need for further research concerning practical admission criteria and legal implications. This study recommends a Delphi study among medical and legal professionals to investigate the criteria for utilizing hotels in this capacity.

The Louisiana Health Department divides the state into 9 regions. Region 1 includes four parishes: New Orleans Parish, Plaquemines Parish, St Bernard Parish, and Jefferson Parish. Within Region 1, there are 11 ground ambulance agencies, made up of public and private agencies. One might think collaboration between 11 different public and private agencies would be difficult to accomplish; however, in this region, the agencies work exceptionally well together. There are a few key ways collaboration throughout the year increases interagency communication and coordination, and builds capacity during day-to-day operations and mass casualty events. The Metro Ambulance Council (MAC) serves Southeast Louisiana. It is comprised of all Region 1 EMS agencies, as well as the neighboring St. Charles Parish EMS agency. The MAC meets at least once a quarter; during these meetings, agencies report out and support each other’s needs that arise. Agencies work together to create regional plans and protocols. Having the regional protocols and plans results in a single language across the board that all agencies follow, increasing the ease of coordination. In October 2024, regional EMS agencies conducted two mass casualty exercises, including a full-scale exercise with 8 of the 11 agencies participating, involving over 70 volunteer patients. This exercise tested and proved positive interagency communication and incident command structure among the eight responding agencies. The second exercise was a tabletop between regional EMS agencies and 12 regional Hospitals, for EMS, this tabletop tested the Regional Mass Casualty transportation plan. It was found that through good communication and coordination within the regional EMS agencies, they were able to move all 400 simulated patients in a timely manner, as laid out in the regional plan. The high level of coordination between regional EMS agencies has led to a significant increase in pre-hospital EMS capacity.

The COVID-19 crisis and future crises stress the medical system and require leaders to rise to the occasion. Some leaders are very successful while others flounder. This was seen at every level of government and health care. Applying the principles of crisis leadership and communication (and avoiding pitfalls) will increase the collective readiness to respond effectively during stressful times.

Literature review and US Centers for Disease Control and Prevention (CDC) guidelines.

While there is robust literature on the topics of crisis communications and leadership, this training is lacking in healthcare circles. This presentation aims to introduce the subject and advocate for increased training in Crisis Communications. The US CDC has developed a freely downloadable training manual, along with tools for rapidly developing a crisis message. Furthermore, a checklist to help with the presentation and a list of communication pitfalls to avoid are included. These tools allow for both pre-crisis preparation and just-in-time training.

Leaders can use these tools to prepare in advance for crisis communications, avoiding common mistakes that reduce communication effectiveness.

3D printing technology has demonstrated great efficacy in ad hoc manufacturing of surgical supplies such as needle drivers, forceps, and tissue suture materials. 3D printed nylon sutures manufactured using a fused deposition modeling (FDM) 3D printer exhibited multiple advantages over commercial nylon and polybutester suture materials, including higher ultimate tensile strength and ultimate extension. A mouse model study was conducted to evaluate the healing of laceration wounds repaired using 3D printed nylon suture compared to commercial polybutester (Novafil) suture.

The 3D printed sutures were manufactured using Ultimaker S3 FDM printers and nylon filament, then sterilized using ethylene oxide sterilization. Twenty mice were included in the study, each receiving a 2 cm dermal laceration along their back. Ten mice had their lacerations repaired with simple interrupted 3D printed nylon sutures, and ten with simple interrupted polybutester sutures. All mice underwent daily wound assessments for 7 days, followed by euthanasia and harvesting of local tissue around the laceration site for objective measurement of inflammatory response via FlowJo analysis of F4/80+/80+&CD45+ macrophages and cytokine array.

No wound complications, such as dehiscence or infection, were observed in either group. The mean CD45+&F4/80+ macrophage (%) for 3D printed and polybutester sutures was 29.3 and 27.7 (p=0.59, from 2 two sample t-tests), resulting in no statistically significant difference. Additionally, there was no significant difference in tissue inflammation when evaluating cytokine response.

Data from this study suggests no difference in wound healing, infection, or inflammatory response between 3D printed nylon and polybutester sutures. The cost of manufacturing 3D-printed suture materials is significantly lower compared to the per-unit pricing of commercial suture materials. Furthermore, 3D printers provide the agency to produce critical supplies on an ad hoc basis with potential applications in low-resource medical scenarios such as rural/developing regions, war zones, or refugee encampments.

Following the 7th of October and the Iron Swords war, over 10,000 displaced people are located in the Dead Sea hotel complex, which is far from settlements and health services, and where emergency services are limited. The lack of health infrastructure and the long evacuation distances to the hospitals require a unique operating model.

For this purpose, an assessment of the area and capabilities was carried out. A preparedness ordinance was written for the activation of the response in an MCI in the Dead Sea area, which includes:

A primary triage site will be operated near the event site with the help of the medical teams stationed in the hotels, and they will undergo a refresher on the principles of trauma care. Placing EMS, including an incident commander, and deploying rescue vehicles to their crews, with civil-military cooperation to evacuate casualties.

The hospitalization complex at the MOH will determine evacuation targets: Urgently injured patients will be transferred to the hospitals by airplane and ICU ambulance. Non-urgent casualties will be held at the site until an additional evacuation force, such as a bus or an ambulance, is assembled.

An exercise was held to test readiness and determine the factors involved in MCI. The Ministry of Health’s hospitalization complex led the exercise, which aimed to create a working language and cooperation between the parties and work on the operational concept according to the order.

Points to save:

1. • Cooperation between all the factors in the field and hotels

Points for improvement:

1. • Due to travel distances, car evacuation is less realistic; therefore, there is a need for air evacuation.

2. • Accuracy of the role of the hospitalization complex /EMS/Home Front Command

3. • Training and equipping the medical and nursing staff on MCI

Ambulance diversion has emerged as a strategy to address Emergency Department (ED) overcrowding, but the question of when or whether diversion should be triggered is widely debated. Although the positive and adverse impacts of diversion have been primarily studied using quantitative data, little is known about the experience and perceptions of key stakeholders involved in diversions. Our study aims to explore the challenges and impacts of ambulance diversion as experienced by key stakeholders and their suggestions for improving the diversion process.

Semi-structured interviews were conducted with key stakeholders, including physicians, nurses, and paramedics, across two EDs and four fire stations. All interviews were audio-recorded following consent and transcribed verbatim. The transcripts were subjected to thematic analysis to identify key themes and sub-themes.

A total of 33 stakeholders were interviewed. The primary reasons for ambulance diversions were perceived to be resource constraints in EDs, overcrowding and bed block situations. Challenges during diversions included communication breakdowns, operational delays, lack of clarity in diversion criteria and emotional stress for both EMS and hospital staff. Participants felt diversions impacted patient safety, staff morale, system efficiency and could generate inter-institutional conflict. Suggestions on improvements focused on use of alternative care pathways, improving hospital’s flow issues, better information sharing, and optimizing the diversion process through strategizing the timing and duration of diversions. Reworking the hierarchical approach of dissemination of information to ground staff was also suggested.

This study highlights that while diversions may offer temporary relief for overwhelmed hospitals, they also pose challenges and negatively impact receiving hospitals and EMS operations. The findings underscore the need for systemic improvements to address the root causes of ED overcrowding and enhance understanding among stakeholders involved in diversions.

There has been an increase in murders and attempted murders of important persons over the past few years. Assault on important persons is a form of terrorism, and it is necessary to minimize damage for the sake of social peace and order. Healthcare providers (HCPs) are required to respond quickly to save lives when an incident occurs. However, no data have shown whether HCPs and medical institutions are adequately prepared. We conducted a survey on the current status of the medical system for responding to assaults on important persons.

A questionnaire survey was conducted among physicians on the largest medical portal site in Japan. The questionnaires are: A. Experience in receiving request to deal with injuries and/or illness of important persons, B. Specific preparation for providing treatment, C. Capability of dealing with injuries of important persons at your medical institutions, D. Treatment experience for injured important persons, and E. Evaluation of the medical system for important persons in Japan. Participants were asked to give anonymous responses.

A total of 1091 physicians participated in this survey. A. Of the 1091 participants, 78 physicians (7.1%) have received the request, B. Of those, 51 physicians (65.4%) had made specific preparations, C. 109 physicians (10.0%) responded that the medical system was in place, D. Only 18 physicians (1.6%) had experience treatment both gunshot and stab wounds, and E. 58 physicians (5.3%) answered that the medical system has been established. It has become clear that there are very few physicians who can provide proper medical care to injured important persons, and the system has not been well established either.

In order to protect society from the threat of terrorism, further efforts to establish a system that can provide appropriate medical care to injured persons are required.

From January 2023 to March 2024, a project supported by the Japan International Cooperation Agency (JICA) aimed to establish a DMAT in Moldova. The Japan DMAT Secretariat designed a comprehensive training program and provided essential materials. Collaboration with Moldova’s National Center for Emergency Prehospital Medical Assistance (CNAMUP) and the National Agency for Public Health (ANSP) was crucial in enhancing Moldova’s disaster medical capabilities. Key activities included training sessions in Japan, site evaluations, and the implementation of a training course for future trainers in July 2024. More than 20 participants from Moldova’s key medical institutions, including the CNAMUP and the Institute of Emergency Medicine, completed the training. A significant achievement was the successful Training of Trainers course, where Moldovan professionals, who had previously received instruction in Japan, led the sessions. This marked a major step toward self-sufficiency in disaster medical response. The project not only improved the knowledge and skills of medical professionals in disaster scenarios but also laid the foundation for Moldova to develop its own disaster medical system tailored to its unique needs. The initiative highlighted the importance of fostering local expertise to create a sustainable and resilient disaster response framework. Future efforts should focus on adapting the training program to Moldova’s specific disaster risks, incorporating lessons learned from actual disaster experiences, while maintaining cooperation with Japan to ensure ongoing support and development. This project exemplifies the value of international collaboration in building strong, locally-driven disaster response systems that can save lives in critical situations.

Hazard scenarios during torrential rain disasters in Japan involve a high proportion of elderly people and accidents indoors. One of the reasons for this is the lack of available workers at welfare facilities for the elderly. The purpose of this study is to examine the factors that affect the attitudes of staff toward onsite attendance at welfare evacuation shelters.

Thirty welfare evacuation shelters were randomly sampled from 89 shelters in a city, and a self-administered, anonymous questionnaire survey was conducted by mail. The levels of disaster preparedness and disaster awareness were measured from responses, and their relationship to attitudes toward onsite attendance during disasters was analyzed.

A total of 113 staff subjects were analyzed. Responses of walking to work in the event of a disaster (p=0.002, x2test), being aware of a disaster manual (p=0.004, x2test), and having defined roles at the facility in the event of a disaster (p=0.034, x2test) were associated with onsite attendance. Disaster preparedness was associated with the ability to visualize disaster situations (p=0.009, Mann-Whitney U test), the ability to sense impending disasters (p=0.019, Mann-Whitney U test), and concern regarding disasters (p=0.001, Mann-Whitney U test). Compared to non-attendees, attendees were more concerned (OR 1.261; 95% CI: 1.025, 1.551) and less anxious (OR: 0.846; 95% CI: 0.719, 0.996) about disasters.

The results suggest that encouraging facility staff to be more familiar with disaster preparedness and make firmer decisions to act in the event of a disaster can improve attitudes toward onsite attendance during disasters.

With the second surge of the COVID-19 pandemic, there was a precipitating need for capacity enhancement of the emergency area in our setting, regarding the number of beds and circulation space. The existing facility for COVID 19 testing of our employees was zeroed in on to be transformed into a fully functional pediatric emergency department.

With a period of 72 hours, the project was undertaken with precise ground-level planning, listing and cohorting of activities, and clear earmarking of roles amongst the team members. The activities were transcribed onto a Gantt chart, assigned timelines to them, and the rate-limiting steps were identified. The civil and electrical works entailed: 1) dismantling of existing structures, 2) putting up of wash basins, 3) RO water system, 4) placement of signages, 5) setting up of a registration area, 6) placement of curtain assembly for each bed, 7) creation of electric-panels at head ends of beds, 8) provision of UPS points, and 8) alternate source of electricity for life saving equipment which were undertaken on a war footing. The IT points were mapped; the telephone line for internal communication and the LAN were extended. The extension of manifold pipeline works from the Trauma ED area to the pediatric emergency department is a rate-limiting step in our timelines, and the execution of it kept us ahead of the planning curve.

The floor area and beds that became available through this transformed new pediatric emergency department were about 279 square meters and 16 beds, almost 3.6 times the floor area and double the bed strength of the old pediatric emergency department.

While it required significant planning on paper and onsite visits by the team members from Hospital Administration, Pediatrics, Engineers, and Manifold, creating a spacious, contemporary pediatric emergency department was made possible within 72 hours.

Mass Casualty Incidents (MCIs) overwhelm health care systems, necessitating effective preparedness. Yoseftal Medical Center is a small community hospital in Eilat, on the southern tip of Israel. The massacre on October 7, 2023, unmasked significant gaps in emergency preparedness protocols, prompting a comprehensive rehaul. Since the beginning of the Iron Swords War, Yoseftal has faced unprecedented challenges in providing medical care to its local population and the waves of evacuees from across Israel. In parallel, it must reckon with new threats of missile attacks and the risk of large-scale MCIs, particularly challenging due to its remote and isolated location. In a matter of weeks, Yoseftal successfully transformed its capabilities to manage a large-scale MCI, thanks to assistance from institutions within the broader healthcare system. This study explores how Yoseftal enhanced its MCI readiness using available resources and innovative approaches.

The methodology included a literature review, a review of procedural data from the Israeli Ministry of Health, an on-site survey, participation in a simulation exercise, and interviews.

Three preparedness stages were observed: 1) Pre-October 7, 2023: The hospital complied with routine emergency drills and inspections suitable for small-scale casualty incidents. 2) October 7, 2023, to February 2024: This capacity-building phase included consultations, coordination with local and national institutions, equipment and personnel reinforcement, infrastructure upgrade, protocol updates, and drills, including guided isolated exercises and full-scale institutional exercises. 3) February 2024-present: This phase is characterized by the ongoing maintenance of standby teams and managers, equipment reinforcement, and drills. Each phase was driven and maintained by solidarity within the local community and the broader health system.

Collaboration, intensive training, and community solidarity are critical for effective MCI preparedness in small community hospitals.

In 2023, extended drought conditions in the Mississippi and Ohio River watersheds brought Mississippi River flow to historic lows. In September, local governments and water systems across Orleans, St. Bernard, and Jefferson Parishes (Counties) received a warning that saltwater from the Gulf of Mexico could reach drinking water intakes within weeks. Due to a lack of reverse osmosis/desalination equipment at treatment facilities, regional contingency plans were developed to protect drinking water for approximately 852,762 residents. Increased sodium and chloride concentrations have documented long-term health impacts and present a health risk, particularly to critical populations including infants/young children, residents with chronic health conditions, residents without automotive transport, and residents with limited income. A State of Emergency declaration was approved by President Biden on September 27, 2023, to provide federal support to the State of Louisiana.

Local water distribution plans relied on coordinated logistics efforts between local and regional stockpiles, partner donations, and contracted services. A bottled water distribution plan was modeled on previous COVID-19 mass testing/vaccination plans using high-throughput drive-through and walk-up sites. Home delivery teams and call centers were considered for critical populations unable to independently pick up resources. Engineering alternatives, including upstream freshwater dilution with a temporary pipeline and barging, were pursued by regional and state partners to reduce the likelihood of distribution plan activation.

Due to increased river flow and rapid construction of a sill in the Mississippi River by the US Army Corps of Engineers, increased salinity levels ultimately never reached New Orleans. Nevertheless, this regional planning process serves as a model to rapidly expand capacity for commodity distribution in a major urban city that is experiencing major environmental, health, and infrastructure challenges due to climate change.

Traumatic Mass Casualty Incidents are becoming more common in the United States. Recognizing the impact of mass casualty incidents (MCI), the American College of Surgeons recommends that trauma programs be integrated into hospital disaster plans and develop a plan for surgical response to mass casualty incidents. To date, there are no guidance documents for MCI preparedness and response specific to pediatric surgical teams and pediatric perioperative hospital space. Development of a guide to creating a pediatric surgery-specific MCI response plan would improve preparedness and potentially outcomes for children affected by traumatic MCIs.

Researchers conducted semi-structured focus group discussions with subject matter experts (SME) from eight Pediatric Level I Trauma Centers in the Federal Emergency Management Administration’s Region V. Subject matter expert roles included Trauma Program Director, Trauma Surgeon, Trauma Coordinator, Emergency Manager, Emergency Physician, and Operating Room Leadership from each institution. The interviews were recorded, and verbatim transcripts were created to develop a comprehensive dataset for analysis.

Analysis of the focus group discussions identified four key themes which—in their presence or absence—affect the effective implementation of an MCI/surge plan: (1) departmental collaboration for effective implementation; (2) identification of challenges such as resource management and coordination; (3) use of regular drills and exercises to prepare staff and refine protocols; and (4) a commitment to continuous improvement to the plans.

As pediatric health care institutions, particularly trauma programs, confront the complexities of modern emergency response, it will be essential that they address the four key themes listed above in their MCI response plan. With a framework adapted from these focus groups, the study authors created a guidebook to create and optimize a surgical surge response plan for trauma programs to facilitate MCI preparedness and response.

The Japan DMAT Secretariat’s International Operations Section supports international requests to share Japan’s disaster medical knowledge. Its activities include technical transfer to developing countries, organizing disaster medical symposia, and gathering advanced insights to enhance Japan’s disaster response systems. A review of Japan DMAT Secretariat International Operations Section activities were conducted. The results of the review include:

International Collaboration and Technical Transfer - Japan has provided disaster medical expertise to developing and neighboring countries, drawing on its experience from the Great East Japan Earthquake. Initiatives include technical transfer across Asia and joint symposia with the US and South Korea. Participation in International Conferences and Workshops - Japan DMAT actively shares knowledge at international forums, such as the APCDM and NDMS Summit, presenting Japan’s disaster medical achievements.

Training and Hosting Programs - Japan DMAT provides technical support through training to countries like Moldova, Ukraine, and Taiwan, assisting them in building local disaster medical systems. Field and Operational Training - Collaborative training with organizations like the U.S. ASPR strengthens mutual disaster response capabilities, including tabletop and field exercises for potential large-scale disasters.

Knowledge Exchange and Cooperative Frameworks - Regular exchanges with countries like Israel, Taiwan, and South Korea support disaster medicine knowledge sharing and cooperation.

The International Operations Section is essential in advancing disaster medical knowledge and technologies globally. To further expand these activities, resource and budget support are needed, along with deeper cultural and political understanding tailored to the partner country’s needs. Given Japan’s risk of large-scale earthquakes, the section’s work fosters smooth coordination with international medical teams, leveraging these collaborative relationships.

As part of the congressionally mandated NDMS Pilot Project, researchers sought to simulate the capabilities and patient care surge capacities of NDMS-enrolled facilities in the National Capital Region (NCR). This element of the simulation project focuses on accurately characterizing HCF resources, specialty capacities, and surge potential to support simulation-based patient throughput modeling in high-casualty scenarios.

The project team selected 16 acute care facilities enrolled in the NDMS Bethesda-FCC Region for simulation, excluding psychiatric and rehabilitation-only centers. Using NDMS provided data and publicly available sources, the team developed a detailed HCF characterization framework that includes specialty center designations (e.g., trauma and burn centers), bed type capacity, and geospatial data. Unlike traditional models, this characterization also captured specific medical specialties required for combat casualty care, including niche trauma services. To approximate real-world conditions, the simulation used “licensed beds” as a baseline, with an assumed percentage available as surge capacity, representing the portion of beds theoretically available for NDMS cases.

The characterization process resulted in a comprehensive HCF dataset that reflects the nuanced capacity of each facility, including relevant specialties and trauma-related capabilities. This structured HCF data supported realistic patient-to-facility assignments in the simulation, accurately modeling the limits and constraints of each HCF’s ability to manage complex trauma and medical cases from large-scale combat operations.

This in-depth characterization of HCFs provides a foundational tool for understanding and optimizing surge capacity in high-casualty scenarios. By capturing detailed specialty and surge capacity data, the model offers a more precise framework for assessing regional healthcare readiness. Future work can confirm or revise current HCF capabilities and capacities through direct contact with the specific HCFs.

Ensuring continuity of service in any business is a priority, but in most cases, it does not impact life and death, except in a health care setting. How do you ensure that staff engage in the development and testing processes to meet their needs, as well as those of the organization, before activating their plan? This question was recently tested when a Local Health District undertook a project to rewrite the business continuity plans(BCP) to promote and increase awareness of the impact on services.

After extensive research, a BCP template was developed to ensure a standardised approach throughout the Local Health District. Key stakeholders were identified and invited to meetings and exercises. To inform the development of BCPs for each facility, simulated exercises of outages were conducted. This provided information for the development of the BCPs. Scenarios covered interruptions to the supply of power, gas, both medical and natural, and water.

The scenario progressed through discussion and directed questions. The exercises were recorded. This provided an opportunity for the development of the BCP to enhance current response assumptions and gain leverage for further engagement and development of robust and relevant plans.

Over 100 people participated in face-to-face sessions, with the majority being disaster portfolio holders, executives, department managers, and clinical managers. A review of notes taken showed that the exercise elicited a greater appreciation by attendees of the impact (if any) on their specific service and the need for development of service-specific plans. This approach to plan development was successful as it led to the development of contemporary plans while considering facility needs and expectations. This exercise provided an opportunity to review the level of understanding of a Business Continuity plan and the impacts such outages can have on the service delivery of individual departments.

Nurses who have experienced caring for patients with COVID-19 have the potential to identify local and systemic factors that contributed to what helped support the nurses and their ability to provide care and what did not. The three research questions were: 1) What are the experiences of nurses providing care to patients during COVID-19 in community, hospital, and long-term care settings, and how do these experiences impact their professional and personal well-being? 2) How do nurses perceive the effectiveness of organizational strategies, including crisis standards of care, personal protective equipment (PPE) provision, and support for personal preparedness, in supporting their response and practice during the COVID-19 pandemic? 3) What are nurses’ perceptions of the organizational, local, county, state, and federal policies that either support or hinder their ability to effectively respond to the challenges posed by the COVID-19 pandemic?

A qualitative approach was used to interview registered nurses, who had cared for patients with COVID-19 in one of three health care settings (hospitals, long-term and residential care facilities, and community-based or public health response).

Results indicate that most of the nurses felt supported by their immediate supervisor but abandoned by organizational leadership. They experienced challenges with equipment, staffing, emotional support, changing policies, and grief, and felt supported by work colleagues and family.

Healthcare systems were unprepared to respond to a pandemic. The nursing workforce was affected by the lack of preparedness. Preparations for the next pandemic should be underway to address patient care needs and the health and welfare of nurses on the frontline, including maintaining adequate supplies of personal protective equipment, managing a surge of patients, and providing physical and emotional support to nurses and other healthcare workers.

Driving Force for Innovation

To tackle the growing health crises, including natural disasters and pandemics, an Open Ecosystem has been created at an academic center to accelerate challenge-driven research and human resource development for health security. Health Security here aims to prevent, prepare for, respond to, mitigate, recover from, and reconstruct to protect and improve people’s health during any crisis, whether of sudden onset or silent progression.

Significant Findings: This ecosystem has three ecological cycles that reciprocally enhance performance for health security

1. Policy, Practice, and Academia

The first is an interconnection of Policy, Practice, and Academia. For example, a memorandum of understanding is in place between the national headquarters of disaster medical assistance teams and academia to advance simultaneously solution-oriented R&D and expertise training for health security. Additional mechanisms are being developed for national/local authorities, as well as relevant organizations, to fuse academia with policy and practice.

2. Research, Education, and Social Contribution

The second is a circulatory interconnection of the three functions of Research and Development, Human Resource Development, and Social Contribution, which encompasses on-site practices, advancing policies and social systems, and strengthening communities.

3. Transdisciplinary, Local/Global Boundary-Crossing Networks

The third consists of three-layer networks: 1) transdisciplinary partnership of medicine, public health, disaster reduction engineering, public policy, law, economics, social psychology and other natural and socio-behavioral sciences; 2) networking with the national organizations of infection diseases, global health, public health, disaster medical assistance team headquarters, governments, universities and organizations; 3) global networks of national and international agencies and academic institutions around the world.

Open Platform for Co-Creation

Based on the above founding philosophies, the Centre for Health Security at Kyoto University was established in April 2024 as an open platform for individuals and organizations worldwide to collaborate and advance local and global health security activities.