The risk of Chemical, Biological, Radiological, Nuclear, and Explosive (CBRNE) incidents is increasing due to terrorism, technological advancements, conflicts, and emerging diseases. Hospitals, as critical response centers, face unique challenges during such events. Comprehensive training is crucial to ensure effective response and protect both patients and staff. This scoping review assesses the effectiveness of CBRNE training in enhancing knowledge, competencies, and preparedness among hospital-based health care providers.

Comprehensive searches were conducted in Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, and CINAHL using targeted keywords. Papers were screened using Covidence. Data were analyzed to evaluate the effectiveness of various training methods used in hospital settings.

A total of 23 papers were included in this review. Training effectiveness was reported in 91% of the reviewed articles. Nurses were the predominant group participating in hospital-based training programs. Tabletop exercises were the most commonly used training method, and biological hazards were the most frequent scenario type. No study identified a single superior method for improving training effectiveness.

CBRNE training incorporating diverse modalities improves health care providers’ knowledge and competencies. Enhanced preparedness supports better responses to disasters, potentially leading to improved patient outcomes and public safety.

This study examined public attitudes and experiences in using the Internet for first aid guidance in real-life medical emergencies.

The study involved: (1) an analysis of YouTube comments (n = 6,786) on first aid videos using latent Dirichlet allocation topic modeling; (2) a survey of completers of an online Basic Life Support course (n = 731).

Topic modeling of social media comments revealed users’ frustration with unskippable advertisements, reflecting a collective perception of online videos as a source of immediate advice on first aid in real-life emergencies. According to the survey data, 14.6% of respondents sought online first-aid instructions during a real-life emergency. An additional 8.9% reported similar experiences among friends or relatives. Of those who searched for advice, 90.7% found and implemented instructions. Most respondents showed readiness to attempt this in future as they believe it could be lifesaving.

The existing public demand for, and continued use of, the Internet as a source of advice on first aid, the risks arising from laypeople’s reliance on information of questionable quality, and the potential usefulness of authoritative digital guidance for instances where other means of assistance are unavailable constitute an intricate public health issue that requires attention and comprehensive solutions.

This study explored the prevalence and attributes of triage errors made by emergency responders during virtual reality simulations of mass casualty incidents.

The study analyzed errors made by 99 emergency responders during their triage and treatment of a mass casualty incident in virtual reality. Responders received training on the Sort, Assess, Life-saving Intervention, Treatment, Transport (SALT) protocol, then responded to a virtual bombed subway station. Responder accuracy, efficiency, and application of treatments were tracked. Error analysis was performed through the lens of human factors. Accordingly, errors were categorized by their nature: either perception, proficiency, or procedure.

Responders correctly triaged 70% of virtual patients, and 78% demonstrated relative efficiency. Interaction times between responders and patients averaged 20 seconds. The time to assess and treat all patients for life-threatening bleeding injuries across the entire scene averaged six minutes. Most errors were related to proficiency (e.g., competence or experience). However, procedural errors (shortcomings of SALT) and perceptual errors (degraded sensory input from programmed environmental chaos, i.e., virtual smoke/debris and louder sound) were also observed. Most errors were related to patients with either respiratory issues or multiple injuries.

Virtual reality (VR) offered a controlled environment for studying errors made by emergency responders in a mass casualty incident, which will lead to improved training and protocols to better prepare them for these events.

To compare and analyze COVID-19 control outcomes, including case severity, vaccination, and excess mortality, across 6 nations (USA, UK, China, Russia, Japan, and South Africa) from January 2020 to December 2022.

This study utilized data from the “Our World in Data” dataset to characterize the epidemiological features of COVID-19 across 6 countries. Generalized linear models (GLMs) were employed to examine the associations between Stringency Index (SI), vaccination coverage, and epidemiological outcomes.

The USA had the highest median cases per million and the UK the highest deaths per million, while China reported the lowest for both. Hospitalization and ICU rates were highest in the UK and the USA, respectively, and lowest in Japan. Vaccination coverage was highest in China and lowest in South Africa. Excess mortality was highest in Russia and lowest in Japan. Generalized linear models indicated a negative association between the SI and cases in China (β = −40, P = 0.015), which became stronger after adjusting for vaccination (β = −311, P < 0.001), but positive associations were observed in the USA, UK, and South Africa. SI was negatively associated with excess mortality in most countries.

Effective pandemic control is highly context-dependent. The relationships among vaccination, variant prevalence, and health care burden were complex, shaped by implementation context, public compliance, and health care capacity.

To explore the experiences of military medical first responders managing mass casualty incidents (MCIs) during the ongoing conflict in Ukraine to identify key challenges and insights.

This qualitative study employed in-depth, semi-structured interviews with medical first responders who managed MCIs in Ukraine. Thematic analysis was leveraged by our research team to identify recurring themes and patterns within the interview data.

Our results revealed crucial takeaways related to the (1) need for preparedness and training, (2) variability of triage, (3) importance of communication and teamwork, and (4) the resulting psychological strain.

These firsthand accounts offer valuable lessons for identifying challenges of first responders, developing areas of future research for MCI response strategies, and enhancing the readiness and well-being of medical first responders in current and future conflicts.

Mass casualty incidents (MCIs) in high-risk environments pose major challenges for coordinated emergency response. Training is often infrequent, resource-intensive, and lacks interagency consistency. This study explores the use of Virtual Reality (VR) simulation to train responders in the RAMP triage model across emergency services.

An observational qualitative design was used. Sixteen participants from various emergency services engaged in a VR-based MCI scenario involving 26 patients and hazardous conditions. The scenario required rapid RAMP triage based on essential cues (radial pulse and the ability to follow commands). Structured interviews followed, and data were analyzed thematically.

Three themes emerged: (1) Deficiencies in current training, including inconsistent MCI protocols, lack of guideline familiarity, and limited interagency practice; (2) VR as an effective, low-resource training method enabling repeatable and safe practice—RAMP triage was found intuitive and efficient, even for non-medical personnel; and (3) prerequisites for VR implementation, such as realistic design, technical infrastructure, and stakeholder involvement to support shared understanding.

VR-based MCI training is a feasible and effective supplement to traditional drills. It enables scalable and flexible skill-building, though it should complement and not replace live exercises.

The study aims to explain the challenges experienced by Emergency Medical Services workers in a massive disaster due to resource scarcity.

In this qualitative study, in-depth interviews were conducted with 14 Emergency Medical Services workers in the region within the first 72 hours of the Kahramanmaraş Earthquakes. Participants were determined by snowball sampling method, and data were collected using a semi-structured interview form. Collected data were evaluated using descriptive and content analysis methods.

When the data were analyzed, the difficulties experienced by the participants were covered in two main themes and eight sub-themes. The main themes were physical and managerial challenges, and the sub-themes were nutrition, shelter and adverse weather conditions, hygiene, safety, sleep shortage and exhaustion, operational, logistics and transportation, communication and coordination.

The findings suggest that challenges in meeting the basic physical needs of Emergency Medical Services workers during massive disasters may reduce the overall effectiveness of response efforts. Ensuring their physical safety, particularly in large-scale earthquakes that cause severe structural damage, emerges as a persistent concern. Disaster preparedness efforts should more carefully consider the fragility and vulnerability of high-risk zones when developing national response plans.

A standardized framework for evaluating Emergency Medical Teams (EMT) deployments is currently lacking. This study aimed to identify evaluation practices and elucidate stakeholder perspectives on evaluating EMT deployments.

Qualitative interviews were conducted with seventeen participants from all World Health Organization regions, including EMT members, researchers, funders, EMT deploying organizations, and host governments. Thematic analysis using Braun and Clarke’s 6-step process was applied to generate data-driven codes and themes.

Participants generally agreed on the importance of evaluating EMT deployments and sharing lessons learned to establish best practices. Participants recommended that evaluations be carried out externally for objectivity, incorporating both qualitative and quantitative data. They highlighted that voices of local stakeholders are essential but often overlooked. Participants identified evaluation areas which could be used to develop a comprehensive evaluation framework, which included leadership, partner coordination, information management and planning, health operations and technical expertise, operations support and logistics, and finance and administration.

Stakeholders generally recognized the value of establishing a standardized evaluation framework for EMT deployments to enable sharing of best practices and learning for improvement. Further research should prioritize identifying evaluation priorities, with next steps being piloting in both training and deployment settings.

Case study has been frequently conducted in disaster-related research, yet the trends and patterns of disaster-related case study are unclear. This large-scale analysis aimed at better understanding their thematic focus and reporting practices.

Based on systematic search strategy, publication metadata from 1901 to 2023 were obtained from Elsevier/Scopus and analyzed. Structural topic modeling was employed to identify the focus areas of the topics. The number of topics was determined based on content and diagnostic metrics such as held-out likelihood and semantic coherence. Hierarchical clustering was used to categorize the identified topics. The contents and reporting styles of the most-cited articles within each topic were further analyzed.

This large-scale analysis included 18,782 publications, showing an increase in number. The number of topics was determined as 12. They grouped into 2 overarching categories: public health and social medicine; and earth science and environmental technology. There were variabilities in reporting.

This study highlighted a growing trend in the publication of disaster-related case studies across diverse thematic areas. As variabilities in reporting exist, there is a need for standardization in reporting to enhance transparency in disaster-related case study.

The aim of this research is to explore the experience of allocating scarce health resources in humanitarian response settings, specifically in relation to decision-making.

This research utilized an exploratory qualitative design. Participants were identified as clinicians with relevant first-hand experiences with scarce health resource allocation in humanitarian response settings. Participants were purposively recruited to include the broadest perspectives possible. Semi-structured interviews were hosted remotely. Transcripts capturing participant narratives were analyzed using inductive thematic analysis to allow themes to emerge.

Seventeen participants were recruited and interviewed as part of the Scarce Health Resource Allocation in Humanitarian Response Settings (SHARE-HRS) project. Inductive thematic analysis related to decision making revealed 5 key themes: devices; priorities; ideals; context-specific decision making; and weight of decision making. These themes informed the development of the SHARE-HRS Decision Making Model.

While health resource allocation decision-making is not unique to humanitarian settings, there are unique situational challenges faced by humanitarian health care workers. The SHARE-HRS Decision Making Model provides a new insight into how these challenges may be addressed or impact decision-making, and thus offers a structure and common nomenclature for future humanitarian health response operations and research.

The growing frequency of global disasters highlighted the need to integrate technology into disaster management. This systematic review describes the global landscape of mobile phone technologies for natural hazard-induced disaster prevention, preparedness, response, and recovery.

A systematic review was conducted by searching databases, including Embase and MEDLINE, for studies published in English between 2000 and March 2024 that examined mobile applications for disaster management.

The review included 26 studies covering 77 mobile apps across 14 countries. Most apps were privately owned (78.26%), supported multiple disaster phases (41.56%), and favored the Android platform (46.67%), with GPS being the most common technology (15.58%). Apps primarily targeted the general public (63.64%) and focused on earthquakes (32.47%) and hurricanes (31.17%). Despite their potential, adoption remains low; only 11.33% (6 apps) exceeded 1 million downloads, while 33.96% failed to surpass 1,000 downloads.

This review highlights significant gaps in the development, adoption, and impact of disaster management apps, especially in high-risk regions. Future efforts must focus on enhancing accessibility, addressing user needs, expanding features, and fostering stakeholder collaboration to improve the effectiveness of mobile technologies in disaster preparedness, response, and recovery.

Exercises are an essential component of preparedness and should be used to enhance capability and contribute to continuous improvement. An exercise can be as simple as a planning group discussing an emergency plan or as complex as a major multi-agency event involving several organizations and participants. This study aims to identify and conceptualize quality indicators (QIs) influencing prehospital disaster exercises across structure, conduct, and outcome.

This research was conducted through a systematic review and searching of the databases of PubMed, Scopus, Web of Science, and Google Scholar. Thematic content analysis was used for data analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for systematic search, and the Critical Appraisal Skills Program (CASP) was used for quality assessment of the final extracted articles.

From an initial set of 3,083 articles, 10 high-quality studies were included for analysis. The quality indicators influencing prehospital disaster exercises were analyzed into 3 themes, 8 categories, and 21 subcategories. The primary themes and related main categories included: Exercise structure QIs (knowledge promotion and cognitive skills, supply of exercise hardware and software requirements and resources desirable management), Exercise conduct QIs (practical proficiency in essential skills and decision-making capacity), and Exercise outcome QIs (evaluation and reporting of exercise, promotion of managerial capabilities and competencies, and development of psychological capabilities).

The findings of this research present a knowledge framework that can help exercise planners in prehospital settings in designing scientifically sound and standardized exercises aimed at enhancing disaster response processes. Furthermore, the implementation and evaluation of both discussion-based and operation-based disaster exercises informed by these identified quality indicators can foster the development of knowledge and promote behavioral change among prehospital staff, and facilitate a standardized response to emergencies and disasters.

Assessing hospital preparedness for nuclear and radiological threats is one of the most effective methods for evaluating the condition of hospitals in relation to such incidents. This study aimed to review the tools used to assess hospital preparedness for nuclear and radiological threats and to analyze the strengths and weaknesses of these instruments.

In this systematic review, the full texts of 98 studies identified through database searches and 7 studies identified through manual searches were reviewed. Data were extracted from studies that addressed the measurement tools for assessing hospital preparedness for nuclear and radiological threats from 2000 to 2024, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The content quality of the tools was evaluated based on the World Health Organization (WHO) preparedness criteria, and the psychometric properties of the tools were examined using the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) study criteria.

Among the studies reviewed, only 21 met the inclusion criteria, within which 9 tools for assessing hospital preparedness were identified. Eight tools directly assessed vulnerability in terms of physical space, related equipment, and hospital personnel, while one tool used a different criterion as an indicator of hospital preparedness for nuclear and radiological threats. The findings showed that most of the tools focused solely on evaluating a hospital’s vulnerability in terms of physical space, equipment, and personnel, with insufficient attention given to other critical aspects such as protocols, triage, and other important issues.

Given the limitations of existing tools in terms of psychometric evaluation, the lack of theoretical models, the reliance on empirical findings for tool design, and considering the critical importance of measuring and assessing hospital preparedness for nuclear and radiological threats, there is a pressing need in the health sector for the development of scientific tools based on the experiences of process owners and hospital specialists. These tools should adhere to rigorous processes of instrument development and validation.

Health care workers (HCWs) are vital in disaster response. This study explores HCWs’ experiences delivering care in the earthquake-affected zone in Türkiye.

A qualitative study with a phenomenological design was conducted. Eighteen HCWs, including physicians, nurses, and National Medical Rescue Team (UMKE) members, were selected through maximum variation sampling. Data were collected through semi-structured interviews and analyzed thematically using Braun and Clarke’s 6-phase approach, following COREQ guidelines.

Three periods (pre-arrival, in the earthquake zone, and post-departure) and 8 themes were identified. In the pre-arrival phase, emotional symptoms and general organization were the main themes. In the earthquake zone, physical symptoms, basic needs, health care organization, health care delivery, and other services were prominent. The post-departure phase focused on emotional symptoms and return to routine work. Overall, emotional difficulties persisted throughout all phases, while organizational problems were concentrated in the pre-arrival and in the earthquake zone periods.

HCWs experienced emotional challenges across all periods and organizational problems in the pre-arrival and in the earthquake zone period. Clear information before arrival, structured orientation upon arrival, balanced staff distribution, and continuous psychological support throughout all phases are essential to protect HCWs’ well-being and sustain health care delivery during disasters.

To prevent power lines from igniting wildfires, utility companies in California are authorized to conduct Public Safety Power Shutoffs (PSPS), de-energizing, or shutting off power to equipment during periods of high wildfire risk. This study assessed the association between PSPS and emergency department visits.

The study quantified the extent to which counties in California experienced PSPS each day between September 15 and November 30, 2019. Linear mixed models were used to estimate the rate of emergency department encounters per 100,000 county residents based on quartiles of PSPS exposure, compared to no PSPS exposure at the county-day level. Analyses examined all emergency department encounters as well as age- and diagnosis-specific visits.

There was an increase of 15 emergency department visits per 100,000 persons aged 65 years and older on days with the highest levels of PSPS exposure compared to days without PSPS. The highest level of PSPS exposure was associated with increased rates of emergency department visits for respiratory, cardiovascular, injury, and mental or behavioral diagnoses.

Despite advanced notification, PSPS events are associated with negative health consequences. Older adults are particularly vulnerable to the unintended adverse health effects of PSPS and should be prioritized in mitigation efforts.