Fukuoka Prefecture, located in northern Kyushu, Japan, is known for its natural beauty and a long history of international exchange. Kitakyushu City, in Fukuoka Prefecture, developed as a significant industrial hub owing to the establishment of steel mills during Japan’s modernization, while also preserving its surrounding natural landscapes. Kitakyushu City Yahata Hospital plays a vital role in disaster response in Kitakyushu’s diverse industrial and rural areas. Our hospital is responsible for information gathering, resource allocation, and interagency collaboration in disaster situations. This report reviews the field mobilizations of hospitals and incidents of multiple injuries in 2023.

We retrospectively analyzed all dispatches and patient admissions between January 1 and December 31, 2023. The review includes cases in which our medical staff provided pre-hospital emergency care on-site and instances of multiple injuries and illnesses.

During 2023, there were 12 dispatch requests, with 10 completed requests and two cancellations. Specific incidents included six traffic accidents, two drownings, one factory accident, one rail-related incident, and two rescue incidents in mountainous areas. Additionally, two major incidents occurred: a river drowning involving schoolchildren and a fire at a demolition plant.

Our findings underscore the necessity for Kitakyushu medical personnel to be proficient in prehospital emergency care, particularly given the city’s varied geography and industrial landscape. Enhanced training in collaboration with fire departments, factory personnel, railway operators, and airport disaster managers is essential for strengthening emergency response capabilities across diverse settings.

D24H - Disaster/Digital Information System for Health and Well-being - was initiated in 2018 to provide information support for health, medical, and welfare activities during disasters and became fully operational in 2024. Integrated with the SIP4D (Shared Information Platform for Disaster Management) disaster information database, D24H customizes and delivers disaster-affected area information tailored for health, medical, and welfare supporters. During the Noto Peninsula Earthquake on January 1, 2024, D24H was deployed to share critical information, including electricity and water supply statuses, road damage, and updates on medical institutions and shelters, thereby supporting the disaster-stricken area.

D24H comprises a database using Geographic Information Systems (GIS), tools for conducting field surveys in disaster-affected areas, and features for file and task sharing, as well as communication among support personnel. The system’s functionalities were designed based on interviews with key stakeholders, including DMAT, DHEAT, DWAT, and the Japanese Red Cross Society, which are involved in health, medical, and welfare support activities during disasters.

Information on disaster-affected areas can now be visualized on maps and summarized in a dashboard using indicators, aiding the Health, Medical, and Welfare Coordination Headquarters in gaining an overview of the affected region. The survey tool implemented a smartphone-based input system, allowing flexible customization of survey targets and items as needed. Interviews revealed high expectations for the implemented file-sharing and communication tools.

D24H, deployed during the Noto Peninsula Earthquake, successfully visualized the situation in the disaster-affected area and contributed to health crisis management activities for disaster victims. However, due to a lack of adequate training and practice opportunities before deployment, not all functionalities were fully utilized. Since the earthquake, many health, medical, and welfare supporters have inquired about training and workshops. By acquiring proficiency in D24H through training and exercises, stakeholders can better prepare for future disasters.

The war in Ukraine and Gaza highlighted challenges to the way aid is delivered, and responders can do their work. These challenges include targeting of aid workers; threats and arrest of aid workers; deliberate obstruction to providing care; and the threatened safety and security of aid workers and death. Aid workers need to change their response and recognize that this includes how aid is delivered to countries in an active war zone. This poster will provide a comparison between the wars in Ukraine since February 2022 and Gaza since October 2023, to aid workers. This will include comparing trends in aid workers killed, attacked, abducted, and injured, as well as challenges in evacuations. Additionally, lessons were learned as it pertained to new trends in conflict zones and the impact on aid workers. The need for additional safety and security measures leads to civilians not having access to care, which increases their morbidity and adds to the mortality rates. Significant findings evaluate the trends and changes aid workers need to implement when responding to other active war zones to ensure the safety of responders.

Continuity of care (COC) and care coordination (CAC) are essential for promotive, preventive, curative, and rehabilitative services within people-centered health systems. However, maintaining COC and CAC is particularly challenging during emergencies and disasters, such as armed conflicts. Armed conflicts result in casualties, population displacement, attacks against healthcare infrastructure and workers, and supply chain disruptions. This systematic review synthesizes evidence on mechanisms and consequences of the impact of armed conflicts on COC and CAC, to provide evidence for future interventions and policies to strengthen healthcare delivery in conflict settings.

This systematic review follows the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and PRISMA guidelines. The search strategy targets two key concepts—armed conflicts and continuity/coordinated care—and the resulting strings were run on PubMed MEDLINE, Scopus, and Web of Science. In addition to peer-reviewed sources, grey literature was manually retrieved from reports, policy documents, and digital resources of relevant international organizations responding to or researching conflict situations. Eligible studies had to: (i) be available in English, French, Italian, or Spanish; (ii) address armed conflicts’ impact on COC and CAC; (iii) focus on conflict-affected populations regardless of demographics; and (iv) be published between 01.01.2010 and 31.07.2024.

The ongoing data extraction process aims to capture the study details, while the specific COC/CAC aspects affected by armed conflicts are being deductively categorized using the World Health Organization’s “Continuity of Care and Coordination of Care frameworks”. Emerging themes will be identified inductively to refine relevant concepts. Data will be synthesized based on the extraction form and thematic analysis.

This systematic review aims to provide evidence-based recommendations on mitigating the destructive impact of armed conflicts on COC and CAC and supporting health service delivery during active wars and military confrontations.

A 2021 drill evaluating a patient under investigation for Ebola Virus Disease (EVD) revealed a significant vulnerability in the Emergency Department (ED) workflow, resulting in a loss of access to critical elevators, ED radiology, and ED treatment areas. This report describes the development and implementation of a new treatment area and process to care for patients with concerns for Viral Hemorrhagic Fevers (VHF). ED Administration and the Division of Disaster Preparedness performed a Gemba walk to evaluate ED Viral Hemorrhagic Fever workflows and assess treatment areas that minimally impact the ER flow. For Walk-ins: The Gemba walk identified an underutilized triage room outside the main ED. This room was converted to a “Hot Triage” room, where high-risk patients are cared for outside the ED. This allows other patients to navigate the entire ED without crossing the VHF patient’s path. For EMS: The Gemba walk identified that EMS patients should not proceed past ambulance triage, otherwise significant closures would occur. Therefore, EMS should transport patients into the decontamination showers directly from outside the building. If patients make it into ambulance triage, the door to that area can be secured, and a team will manage the patient there. A just-in-time training document was created that describes the novel workflows above and delineates the preparation that must be taken before entering the patient’s room. A PPE cart was developed that included pre made kits for VHF patient evaluation. Medical equipment listed in the document and found in the cart included telemonitor, resuscitation supplies, POC blood gas and malaria PCR cards, baby monitor, and critical contact numbers. Identifying appropriate care areas is crucial to a comprehensive VHF response plan. By isolating and evaluating potential VHF patients early and outside the department, EDs can minimize the risk of transmission and maintain hospital operations.

Japan faces a high risk of disasters, and its aging population has led to an increase in vulnerable individuals, such as the elderly and people with disabilities. During disasters, these individuals often fail to receive adequate support, leading to deteriorating health and functional decline. Furthermore, many welfare facilities supporting them are privately operated, making it difficult to sustain services due to facility damage or caregivers’ inability to work. This situation exacerbates the health risks for vulnerable populations who require welfare services but are unable to receive sufficient support. To address these issues, it is crucial to examine policies that ensure efficient and sustainable welfare service provision. This study aimed to develop a simulation model for systematically planning disaster welfare support for vulnerable populations, enhancing the accuracy of policy consideration.

This study developed an agent-based model (ABM) to simulate individualized care plans, coordination among welfare facilities, and collaboration with medical institutions. The model incorporated human resource allocation, shelter operations, and the timing of supply provision across multiple scenarios designed to support vulnerable populations during disasters. Regional characteristics and policy implementation timing were considered to evaluate the scenarios’ effectiveness from multiple perspectives. This approach enabled a comprehensive evaluation of broad support activities, including coordination between welfare facilities and medical institutions, efficient resource allocation, supply provision, and shelter management.

The simulation model evaluated multiple scenarios for human resource allocation and shelter coordination, quantitatively assessing the impact of geographical conditions and policy timing on vulnerable populations. By applying statistical and optimization methods, the study identified optimal parameters for the simulation, enabling the design of effective disaster welfare policies.

The developed simulation model is a valid tool for evaluating the effectiveness and validity of disaster welfare policy considerations. It is also applicable for education and training, offering broad utility in practical settings.

Seizures are a critical medical emergency requiring prompt intervention to improve patient outcomes and prevent complications. Intranasal (IN) midazolam has emerged as a promising treatment due to its ease of administration and rapid onset. However, there is a lack of comprehensive systematic reviews assessing its effectiveness, particularly in prehospital settings, compared to other treatments. This study aims to systematically evaluate and compare the effectiveness of intranasal midazolam in acute seizure management and patient outcomes in prehospital care and emergency departments.

A comprehensive search was conducted using the PICOS framework. This systematic review included clinical trials and observational studies published between August 2014 and August 2024 to review published data on intranasal midazolam used in prehospital and emergency departments. Data were extracted using Covidence and organized into summary tables for analysis.

Three out of 489 studies included 5062 patients, all of them being under 18, and 4957 in prehospital settings. One clinical study trial and two cohort studies. The main indicator of medication success was seizure termination within ten minutes. One study reported that success rate of 88.2%. The second indicator was the reduction of seizure recurrence. Two studies noted the need for redosing with the intranasal route, with a risk difference of 11% and a 95% CI. Despite the higher frequency of redosing, intranasal midazolam showed comparable efficacy to other routes. Adverse effects, including respiratory depression and nasal irritation, were observed. Additionally, one study reported somnolence and vomiting.

The majority of the studies reported that intranasal midazolam might be an effective, safe, and easily applicable treatment for acute seizures in Adolescent and pediatric populations. However, it may require redosing compared to other routes. Additionally, further research is needed to refine its application and to validate and generalize the results.

Climate change significantly impacts health across the Caribbean, increasing the frequency and severity of extreme weather events, including hurricanes, floods, heatwaves, droughts, and wildfires. These climate-related hazards place considerable strain on already limited healthcare systems, disrupt essential services, and disproportionately affect vulnerable populations, including people at extremes of age, individuals with chronic diseases, and low-income communities. This presentation looks at strategies to bolster emergency response, enhance public health preparedness, and facilitate the integration of climate resilience into regional health policy.

A multi-disciplinary approach is required for effective emergency response. This strategy encompasses targeted disaster medicine training for healthcare workers at all levels, streamlined rapid deployment protocols, the integration of early warning systems into healthcare operations, and standardized clinical pathways for managing climate-induced health conditions. Strengthening these components can reduce preventable morbidity and mortality in future climate-related disasters. Investments in resilient health infrastructure are critical for the region. Areas of priority include reinforcing infrastructure and energy systems to withstand hurricanes and sea level rise, and securing potable water supplies. Healthcare worker capacity building through surge response training, intersectoral and regional coordination, and logistical readiness is equally important. Community outreach programs focused on climate hazard education ensure that the affected populations are informed and prepared.

Healthcare governance must incorporate climate change adaptation. National health policies should align with global frameworks such as the WHO’s operational guidance for climate-resilient health systems and the Sendai Framework for Disaster Risk Reduction. Climate-resilient policies should be driven by data-informed vulnerability assessments and allocate resources to priority areas. By implementing these strategies, Caribbean nations can build more resilient and equitable healthcare systems that protect populations and infrastructure amid intensifying climate impacts.

Mild Traumatic Brain Injury (mTBI) affects millions of people worldwide each year and significantly impacts the healthcare system. Clinical criteria and computed tomography (CT) scans are used for diagnosis. The Glial Fibrillary Acidic Protein (GFAP), a protein present in glial cells, and the ubiquitin C-terminal hydrolase L1 (UCH-L1), localized in neurons, are biomarkers that have been approved to help determine the need for CT brain scans after traumatic brain injury.

This study was performed in the emergency department of the Municipal Clinical Hospital of Timisoara, Romania. Inclusion criteria consisted of all patients with mTBI admitted for 3 months with a brain CT, over 18 years of age, and with a Glasgow Coma Scale score between 13 and 15 at admission. Biomarkers were collected within a maximum of 12 hours of trauma.

Of the 145 patients admitted with mTBI, 106 met the inclusion criteria, of whom 56 (52.83%) were men and 50 (47.17%) were women. Demographic characteristics between groups were similar. Males had a median age of 66 years [range 20-89], and female patients had the same 66 [range 19-94] (p = 0.986). The median for UCHL-1 (cut-off was 400 pg/ml) was 495.4 for females and 690.7 for males. For GFAP (cut-off was 35 pg/ml), there was a median of 60.9 for females and 58.3 for males. Higher values of these biomarkers were positively correlated with complications on brain CT (p < 0.001 for both).

Male patients showed significantly higher concentrations of UCHL-1 than females. This study demonstrates that elevated values of the two biomarkers are correlated with specific lesions on CT scans after mTBI and may play an essential role in determining whether or not emergency CT scans should be performed.

Disaster Medicine training can be resource-intensive and difficult to reproduce on a large scale. This study explored the use of an online open-source platform, GatherTown, in Disaster Medicine training for medical students. The maps provided were modified to recreate a disaster zone with multiple casualties and hazardous elements. The hypothesis was that this platform would be an effective teaching method and help in knowledge application.

Medical students from all three medical schools in Singapore were recruited. Those who consented to participate were sent a pre-test questionnaire. Students watched a standardized, prerecorded Introduction to Disaster Medicine video. They then worked together in teams with facilitators to triage and treat 30 casualties in a virtual mass casualty setting. A post-test questionnaire was then sent; this included 10 questions that assessed the students’ knowledge of key elements of disaster management. Pre- and post-test results were matched and analyzed.

A total of 43 medical students participated across 2 sessions in 2024. 17 (39.5%) were Year 1 students, 5 (11.6%) Year 2, 8 (18.6%) Year 3, 12 (27.9%) Year 4, and 1 (2.3%) was a Year 5 student. The average pre- and post-test scores were 52.3% and 66.5%, respectively, with an average increase of 14.2% (0.89-1.94 95% Confidence Interval), p < 0.001. 29 (67%) students improved, while 3 had lower scores and 11 had the same score. Students felt that the scenario-based virtual game helped facilitate learning of Mass Casualty Incident principles (4.88/5), was interactive and informative (4.91/5), and improved their understanding of disaster triage (4.91/5).

The virtual platform Disaster-Town shows promise and may have future applications in training medical students in Disaster Medicine.

Empathy involves communicating and understanding others’ emotion in multisensory contexts, including visual and auditory modalities. Schizophrenia (SCZ) patients have impaired empathy, but whether the impact of visual/auditory context would be altered in SCZ patients and people with high social anhedonia (HSoA) remained unclear.

We administered the modified Chinese version of the Empathic Accuracy Task (EAT) to clinical (50 SCZ patients and 50 healthy controls) and subclinical samples (59 HSoA and 60 low social anhedonia [LSoA] participants). The EAT employed audio-only, audiovisual, and audioavatar visual conditions to assess the impact of multimodal information on empathy during positive and negative emotional events.

In positive-valenced context, SCZ patients performed worse than controls in cognitive and affective empathy. The Modality-by-Group interaction on empathic accuracy was significant, that is, SCZ patients performed worse than controls in both audiovisual and audioavatar visual conditions, but comparable to controls in audio-only condition. In negative-valenced context, SCZ patients performed worse than controls in cognitive empathy. The Modality-by-Group interaction on empathic accuracy was significant, that is, SCZ patients performed worse than controls in audio-only and audiovisual conditions. Moreover, HSoA participants exhibited lower cognitive empathy than controls in positive-valenced context; and lower cognitive empathy and empathic motivation in negative-valenced context. No significant Modality-by-Group interaction was found in the HSoA–LSoA sample.

SCZ patients have generalized impairments of cognitive and affective empathy across positive and negative contexts, particularly in multimodal conditions. HSoA individuals are primarily impaired in cognitive empathy and empathic motivation.

Evacuation shelters are essential temporary accommodations during disasters. However, concerns regarding shelter conditions, including safety and comfort, persist. Currently, the Internet is the most widely used source of information. This study aimed to investigate public interest in evacuation shelters in Japan by analyzing online search trends.

Monthly search volumes for search queries were obtained from Yahoo! JAPAN, one of the most frequently used search engines in Japan. The search volume data were obtained from the Yahoo! Japan DS INSIGHT server. We tracked the search volumes for “evacuation shelters” from 2020 to the most recent date, focusing on trends before and after the Noto Peninsula earthquake in January 2024. In addition, we analyzed search queries that included terms related to shelters to assess changes in interest.

The estimated search volume for “evacuation shelters” was 600 in December 2023, which increased to 13,200 in February 2024. In January 2024, searches for sexual assault countermeasures in shelters showed the most significant increase, rising by 13,750% from December 2023 to 5,500. Similar search terms were “shelter sexual harm examples” and “shelter sexual harm,” with 5,100 and 2,100 searches, respectively.

The study findings suggest that public concern about safety in evacuation shelters has increased rapidly in the wake of the 2024 Noto Peninsula earthquake. Concerns about sexual assault were prominent, strongly suggesting a need for countermeasures. These results highlight the importance of strengthening measures to prevent sexual assault and providing information tailored to the needs of the population in the management of evacuation centers, which will contribute significantly to the realization of safer and more secure evacuation centers.

Following the 2021 military coup in Myanmar, widespread conflict and displacement have severely strained healthcare systems along the Myanmar-Thailand border. This pilot study assessed emergency care capacity in the southern Shan and Karenni States, located in the southeastern region of Myanmar.

Interviews were conducted utilizing a modified WHO hospital unit emergency assessment tool across seven healthcare facilities. Cluster analysis methods were used on the data to identify naturally occurring groups across a set of variables provided to investigate healthcare infrastructure. Upon examination of the dendrogram and utilizing Ward’s algorithm, the data from the four clinics were grouped, while the three secondary hospitals were evaluated individually. Descriptive statistics were examined to understand the similarities and differences between locations.

Four clinics and three hospitals were evaluated, and 162 facility characteristics were obtained. All facilities were found to provide basic emergency care services and have at least one emergent bed available, while only one hospital has a 24-hour emergency care unit. Strengths across facilities studied include management of acute respiratory distress, intravenous fluid administration, and burn management. Critical gaps across facilities include an absence of a dedicated triage area and a lack of formalized protocols, quality improvement measures, and reliable access to water and electricity.

This pilot study reveals strengths and gaps in emergency healthcare infrastructure within the southern Shan and Karenni States. These findings underscore the need for targeted interventions to strengthen emergency care capacity in this conflict-affected region, focusing on infrastructure, protocol development, and resource availability.

The COVID-19 pandemic caused residency programs to rapidly transition to using virtual learning for didactic education. A tabletop game-style simulation of a mass casualty incident (MCI) was planned for the summer of 2020; rather than cancel it, the authors developed a method to run the simulation utilizing an online gaming platform (Roll20) to create an MCI drill. This model of virtual, game-style simulation has implications for education across all levels of training, making large-scale MCI simulations available to groups that otherwise would not have the opportunity or resources to participate in person.

This study utilized a cross-sectional survey of fifteen emergency medicine residents who participated in a virtual MCI simulation. The survey assessed learners’ perceptions of the simulation, focusing on preparedness, knowledge gained, impact on clinical practice, and utility and quality of the virtual tool. Survey items included Likert-scale and open-ended questions.

Seven individuals responded to the survey. 85.7% of respondents felt more prepared to deal with an MCI after the exercise and reported that this exercise was practice-changing. 85.7% reported that the virtual platform was a useful educational tool in disaster management and would be useful for other topics. Most participants (57.2%) felt that the pre-exercise instructions were challenging to understand, but 71.5% felt that, nonetheless, the learning objectives were achieved. Open-ended comments included a sense that this teaching method was “fun, innovative, and engaging,” but required more detailed pre-learning to ensure that all individuals could navigate the platform well.

An online role-playing platform is an effective, engaging method of conducting MCI exercises that improves knowledge and changes practice. Remote learning methods have the potential to increase participation in MCI simulations. This study is limited by the small group that participated. A larger study with wider participation is a promising future avenue for research.

In a mass casualty incident, adult medicine-trained emergency physicians and nurses may need to treat pediatric casualties, as part of Field Medical Teams (FMTs) deployed to pre-hospital First Aid Posts. These healthcare professionals are often unaccustomed to managing pediatric patients, who present relatively infrequently to adult general hospital emergency departments in Singapore. A pediatric pre-hospital trauma module was developed to address this gap in knowledge and skills, potentially improving the survival of pediatric casualties in a disaster scenario.

The pediatric module was embedded in the National Disaster Medical Responders’ Course (DMRC) to ensure all emergency medicine medical and nursing staff would progressively benefit from this training. The learning objectives included: 1) effective clinical management of pediatric trauma in a pre-hospital environment with limited medical resources; 2) efficient management of team dynamics in organizing the FMT’s response to pediatric trauma management in a pre-hospital environment; and 3) accurate prioritization during pediatric trauma triaging and evacuation to hospital in a pediatric-predominant mass casualty incident. The curriculum included the following aspects: triage; initial assessment and primary survey; airway, breathing, circulation, and disability considerations focusing on differences between adult and pediatric patients; and team dynamics. Course content was delivered via pre-recorded lectures (given the ongoing COVID-19 pandemic) and hands-on skill stations in small groups.

From April 2022-August 2024, 50 courses with 1144 participants from public healthcare institutions were conducted. Of the participants, 246/1144 (21.5%) were doctors, 787/1144 (68.8%) were nurses, 65/1144 (5.7%) were allied health, and 46/1144 (4.0%) were administrative staff.

Medical responders in a mass casualty incident need to be prepared for managing pediatric casualties, which are infrequently encountered in daily clinical practice. This module is an important component of Singapore’s disaster medical curriculum and will contribute to disaster preparedness for the vulnerable pediatric population.

Global connectivity increases the risk of infectious disease spread. Frontline healthcare workers’ knowledge and preparedness are crucial. HCIDs pose unique challenges due to high mortality and widespread impact. This study examines the current state of resident physicians’ knowledge on HCIDs as well as their comfort and willingness to provide care before and after specialized training.

The study involved emergency medicine learners using a pre- and post-survey design to assess their knowledge and comfort with HCIDs. Participants attended a 30-minute lecture on HCIDs, followed by a hands-on simulation with high-level PPE. The post-survey measured changes in their understanding and comfort after the interventions.

Most participants were emergency medicine residents. 32% had HCID training, 45% PPE training, 35% treated HCID patients, and 48% participated in a drill. Before education, 25% believed PPE would limit care, 38% knew where to find equipment, and 67% knew where to find HCID resources. After the simulation, these numbers increased to 79%, 58%, and 97%, respectively. Confidence in HCID knowledge rose from 2.3 to 3.6, ability to identify risk factors from 2.8 to 3.8, and preparedness from 2.5-3.0 to 3.8. Comfort in determining PPE for COVID was highest, with a 1.4-1.6 point increase for Ebola and Marburg. Biocontainment PPE tasks were rated moderately difficult.

Education and simulation significantly improved emergency medicine residents’ knowledge and preparedness for handling HCIDs. Post-simulation, there was a notable increase in the belief that PPE would limit patient care, awareness of equipment locations, and access to HCID resources. Confidence in identifying risk factors, symptoms, and preparedness for HCID care also saw substantial gains. Comfort in determining PPE for COVID remained the highest, with marked improvements for Ebola and Marburg. Overall, training effectively enhanced participants’ readiness and confidence in managing HCID scenarios, highlighting the importance of continued education and simulation in emergency medicine.

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.