The 15th Asia Pacific Conference on Disaster Medicine (APCDM) was held in Seoul, South Korea, on November 25–26, 2024, under the theme “Collaboration, Cooperation, Coordination for Disaster Response.” The conference brought together 655 participants from 16 countries to share experiences and strategies in disaster prevention, preparedness, response, and recovery, especially in light of the significant suffering caused by the COVID-19 pandemic.

The Asia-Pacific region, home to 4.7 billion people—60% of the world’s population—and covering 30% of the Earth’s land area, is highly vulnerable to natural and man-made disasters. Urbanization, industrialization, aging populations, and climate change contribute to frequent large-scale disasters, including earthquakes, volcanic eruptions, typhoons, and industrial accidents.

The conference identified multiple common challenges and the need for comprehensive disaster medical responses to a wide range of scenarios, including natural disasters, CBRN (chemical, biological, radiological, and nuclear) incidents, and – importantly- public health emergencies. There is a pressing need for trans-disciplinary integration across historically divergent disciplines, including epidemiology, emergency medical services, acute care, dialysis, and mental health interventions.

The conference arrived at a central message that disaster medicine is not just individual healthcare but a form of public health service targeting society and systems. Effective disaster response requires national and community-level leadership, legal and regulatory frameworks, and strong interdisciplinary collaboration. Cooperation among medical professionals, public health experts, emergency responders, social scientists, and engineers is essential to building resilience.

To enhance disaster resilience, the region—and indeed the world—must emphasize the importance of robust databases, data-driven analyses, surge capacity systems to manage large-scale medical needs, and, above all, cultural excellence that fosters trust and cooperation within communities. The APCDM served as a call to action, reaffirming that comprehensive, cross-sectoral engagement is vital for effective disaster preparedness and response.

Trauma systems are crucial for enhancing survival and quality of life for trauma patients. Understanding trauma triage and patient outcomes is essential for optimizing resource allocation and trauma care. The aim was to explore prehospital trauma triage in Region Zealand, Denmark. Specifically, characteristics for patients who were either primarily admitted or secondarily transferred to Major Trauma Centers were described.

A retrospective descriptive study of severely injured trauma patients was conducted from January 2017 to December 2021.

The study comprised 744 patients, including 55.6% primary and 44.4% secondary patients. Overall, men accounted for 70.2% of patients, and 66.1% were aged 18-65 years. The secondary patients included more women - 34.2% vs. 26.3% and a higher proportion of Injury Severity Score of ≥15 - 59.6% vs. 47.8%, compared to primary patients. 30-day survival was higher for secondary patients - 92.7% vs 87%. Medical dispatchers assessed urgency as Emergency level A for 98.1% of primary patients and 86.3% of secondary patients. Physician-staffed prehospital units attended primary patients first more frequently - 17.1% vs. 3.5%. Response times were similar, but time at the scene was longer for primary patients, whereas time from injury to arrival at a Major Trauma Center was longer for secondary patients.

Secondary trauma patients had higher Injury Severity Scores and better survival rates. They were considered less urgent by medical dispatchers and less frequently assessed by physician-staffed units. Prospective quality data are needed for further investigation of optimal triage and continuous quality improvement in trauma care.

On July 19, 2024, SUNY Downstate Medical Center faced system-wide failures after a faulty CrowdStrike update. Disruptions to EMR, radiology, and lab workflows required immediate response. This presentation explores the impact and response to this global healthcare cybersecurity event.

SUNY Downstate activated its Emergency Operations Center and manual protocols. Communication was maintained through departmental huddles, Sendword Now, and the Telegram app. External partners, including NYCDOH and GNYHA, were notified as IT worked to restore critical systems.

Through effective coordination, SUNY Downstate reduced downed workstations from 3,500 to 1,500 within hours. Critical systems, including EMR and radiology, were restored by the next day, allowing continued care despite manual lab operations and limited access to certain tests.

This incident reinforced the need for robust emergency and cybersecurity protocols in healthcare. SUNY Downstate’s response minimized patient impact and highlighted the importance of preparedness, clear communication, and resilient systems for future incidents.

In undifferentiated cardiac arrest, the “5Hs and 5Ts” approach has been the cornerstone guiding advanced care and management. In recent years, however, more streamlined and targeted approaches have been posited for specific subsets of arrests where a single H or T is likely to be the cause. Specific Hs and Ts — for example, traumatic arrest, drowning (hypoxia), and hypothermia, to name just a few — have each enjoyed tailored approaches and algorithms that inform the sequence and dictate care to focus on high-yield diagnostics and interventions that are context-specific and depart somewhat from standard ACLS algorithms.

This systematic review examines the potential for developing a focused algorithm for recreational toxicologic arrests at music festivals.

The evidence supporting specific interventions (e.g., airway support, antidotes, deviation from standard ACLS medications) is reviewed, and the primary considerations (toxidrome, substances used, presenting rhythm, etc) affecting decision-making are summarized for the tailored management of cardiac arrest related to recreational substance use at music festivals.

Cardiac arrests at music festivals would benefit from a tailored approach to high-yield management, medications, and interventions based on substances ingested, presenting toxidrome, and presenting cardiac rhythm. There is a need for further research on this subject to bolster the evidence for deviation from standard Advanced Cardiac Life Support (ACLS) practices, as a tailored toxicological approach would likely confer significant benefits to patient outcomes.

At the WADEM 2023 Killarney congress, a new presentation format involving a tabletop-style discussion was offered. One abstract accepted for this format described a study comparing the capture of patient hazard exposure information by health and medical responders at six large international natural hazard disasters. The original objective of submitting the abstract was to present the study as an oral presentation, demonstrate the universal lack of patient hazard-exposure assessment, and advocate for urgent change in the recommended emergency minimum patient dataset.

Round table participants joined a facilitated discussion to identify and share similar challenges from their fields of expertise and collectively explore innovative ideas to solve challenges. The examples and network ideas were collated, and agreement was sought to follow up with participants after the session.

Based on feedback from round-table participants, ongoing conference discussions, and post-conference communications with a wider healthcare network, an initiative called ExposureNet was created using resource support of philanthropic actors. Since its launch at the World Congress of Epidemiology in Cape Town in October 2024, hundreds of disaster and emergency workers from across high and low-income country domains have registered their interest in joining the network. The purpose of ExposureNet is to connect and support disaster and emergency practitioners in building the evidence base about patterns of illness/injury from exposure to events and identify interventions, their timeliness, and the quality of care necessary to protect vulnerable people.

WADEM’s importance and leadership in advancing disaster health and medicine policy and practice cannot be underestimated. Without the change in conference format, the ExposureNet initiative would not exist. Now, a worldwide community of disaster health and medicine practitioners is supporting each other to build evidence about the relationship between people’s exposure to crises and disaster events and the patterns of injury and illness they cause.

The COVID-19 pandemic likely increased exposure to potentially traumatic events. A population of special interest is healthcare workers who cared for COVID-19 patients, as they were, especially during the peaks of the pandemic, exposed to groups of severely ill or dying patients under extreme care delivery circumstances. This review and meta-analysis estimate the pooled prevalence of mental health outcomes among healthcare workers exposed to these conditions.

A systematic literature search was conducted using several databases: Embase, PubMed, PsycINFO, and PTSDPubs. Inclusion criteria focused on studies assessing work-related trauma exposure among healthcare workers during the pandemic and those reporting prevalence rates of trauma-related mental health outcomes (PTSD, anxiety, and depression). A multilevel meta-regression was used to calculate pooled prevalence rates and examine the impact of study characteristics on outcomes.

Eleven studies were included that assessed the mental health of healthcare workers who cared for severely ill or dying COVID-19 patients. The mean pooled prevalence of trauma-related mental health outcomes was 26.1%. There was no significant difference in pooled prevalence between outcome types (PTSD, anxiety, or depression). A significant difference was observed between the pooled prevalence from studies conducted in countries with a high Human Development Index (12.9%) compared to studies from countries with a very high Human Development Index (45.8%).

A relatively high proportion of healthcare workers exhibit psychopathology following work-related exposure to the pandemic. This highlights the severe psychological toll of the pandemic on this professional group, who faced sustained exposure to stressful situations during the pandemic in exceedingly difficult circumstances. It is crucial to ensure early access to psychosocial support, such as organized peer support, to healthcare workers during major public health crises, especially during crises when traditional social support systems may be disrupted.

Primary care is the gateway to any healthcare system. Paradoxically, where the need is greatest – particularly in fragile states and conflict-affected communities – so, too, is the shortage. Providers serving in these circumstances face a wide range of clinical problems across various age groups, but with limited resources to draw upon. And there are precious few educators to prepare these practitioners for the daunting tasks they face. Drawing from primary care program development in diverse communities, this session will define primary care needs, identify primary care providers, address problems and challenges in training, examine assumptions that can hinder healthcare system building, and discuss how to implement and monitor sustainable interventions based on primary care principles.

The World Health Organization (WHO) has emphasized the need for the development of resilient health systems to meet current and future disaster readiness needs. The WHO has also emphasized mechanisms that will achieve this goal, including a focus on strengthening the global nursing workforce to achieve the Sustainable Development Goals. However, there is limited synthesized research focusing on the contributions of the nursing workforce in developing and fostering health system resilience globally.

Using Joanna Briggs Institute methodology for scoping reviews, three databases (PubMed, CINAHL, and Scopus) were searched for publications from 2006 until April 2024. English-language research studies and quality or process improvement projects were included. Systematic reviews, as well as studies focused on individual resilience, were excluded. Studies meeting search criteria were exported and screened first by title and abstract, and subsequently underwent a full-text review using Covidence software. Quantitative and qualitative data from studies meeting inclusion criteria were extracted and analyzed according to study objectives to create a narrative synthesis. This study was registered in the Open Science Framework on May 28, 2024.

Eleven articles were included of the 795 total retrieved. Overall, there is limited discussion of the nursing workforce in health system resilience. Eight of the 11 articles (73%) suggest that the nursing workforce is involved in operationalizing resilience during disasters, 10 articles (91%) call for nurses to be leaders in policy and the development of resilient health systems, however, this review found zero reports in the literature of the nursing workforce’s role in the planning, development, and leadership of resilient systems.

Nurses are essential to resilient health systems, however, there is limited research examining the nursing workforce and its contributions to resilient health systems, particularly within disaster contexts. More targeted research on nursing workforce contributions to achieve resilient health systems is needed.

On January 8, 2020, Al Asad Air Base was attacked with more than 12 Theatre Ballistic Missiles from Iran. To date, this is the largest ballistic missile attack on American service members. Soldiers began to report post-concussive symptoms and sleep changes. The goal of this study is to characterize neurobehavioral symptoms among these soldiers.

A survey performed 4-6 weeks after the attack assessed blast exposure, neurobehavioral symptom inventory (NSI), and sleep habits before and after the event. A latent class analysis (LCA) informed by the presence of the most common persistent NSI symptoms was executed. The resultant profiles assessed the soldier’s location, and if on the base distance to the missile strikes and self-reported sleep duration.

In total, 593 service members and contractors completed the survey; 85% were 40 years of age or younger. The LCA identified three distinct classes: ‘Minimally Affected’ (60.5%), ‘Moderately Affected’ (28.8%), and ‘Profoundly Affected’ (10.7%). Overall, the most commonly reported persistent symptoms were ‘difficulty sleeping’ (32.7%), ‘feeling anxious’ (25.7%), and ‘headache’ (22.3%). The Moderately and Profoundly Affected classes had substantially elevated probabilities of persistent neurobehavioral symptoms, significantly reduced sleep duration, and were more likely to be closer or more exposed to the missile strikes than those in the Minimally Affected class.

More than 80% of the soldiers reported some form of blast exposure. Three phenotypic classes characterized by increasing likelihood of persistent neurobehavioral symptoms were identified. Increased proximity to the missile strike was associated with a greater number and/or persistence of mental and physical symptom burden after the attack. Soldiers exposed to theatre ballistic missile attacks should be screened promptly and until symptom resolution.

This presentation aims to illuminate the unique challenges faced by older adults in the context of climate change and its compounding effects on health risks. Older individuals, particularly those with comorbidities, experience increased vulnerability due to environmental factors such as poor air quality, extreme weather events, and displacement from natural disasters. The presentation identifies specific health concerns, including:

1. Neurocognitive Impairments: Exposure to extreme heat exacerbates conditions like dementia and increases the risk of heat-related illnesses, especially in those with pre-existing cognitive impairments.

2. Metabolic Disorders: Climate-induced disruptions in medication access, such as delivery issues, contribute to elevated cortisol levels and exacerbated metabolic conditions.

3. Cardiovascular and Respiratory Issues: Poor air quality resulting from industrial pollution and wildfires leads to oxidative stress, adversely affecting cardiovascular and respiratory health.

4. Renal Health: Dehydration and electrolyte imbalances result from extreme temperatures and disrupted water supply, impacting kidney function.

5. Musculoskeletal Pain: Long-term temperature fluctuations and weather changes can lead to joint pain and mobility issues among older adults.

6. Psychosocial Effects: Disruptions to social networks during disasters increase feelings of isolation and vulnerability among older populations.

7. Immune System Compromise: The proliferation of waterborne pathogens poses a significant risk to older adults’ immune health.

8. Integumentary Concerns: Natural disasters can increase exposure to flesh-eating bacteria and diseases such as Melioidosis.

By addressing these challenges, the presentation underscores the urgent need for targeted interventions and policies to support the health and well-being of older adults in the face of climate change.

Wildfires are an increasing global threat, exposing over 2 billion people annually to hazardous air quality. Children from low socioeconomic status (SES) regions often experience worse respiratory outcomes during wildfires compared to their higher SES peers. However, direct data on wildfire impacts remains limited. This study examines whether wildfires exacerbate respiratory health disparities compared to non-wildfire periods.

A retrospective cohort study of 2,417 patients aged 0-29 years admitted to a quaternary Pediatric Intensive Care Unit for acute respiratory failure from 2016-2023 was conducted. Data were collected from Virtual Pediatric Systems, the Area Deprivation Index (ADI), Fire Information for Resource Management, and the Air Quality System, and merged using zip codes.

The Wildfire cohort included children with a wildfire within 100 miles, confirmed by satellite, and PM2.5 levels in the 10 days before admission exceeding 1 standard deviation above the annual mean. Non-wildfire patients were all other respiratory failure admissions in the same period. SES was defined by ADI quintiles, with low and high SES representing the lowest and highest quintiles. Statistical analyses included Fisher’s exact test, Mann-Whitney U test, and logistic regression.

During wildfires, children from low SES backgrounds had a significantly higher risk of intubation than in non-wildfire times (29% vs. 13%, p = .003), a difference not observed in high SES children (8% vs. 10%, p = 0.49). Logistic regression showed that wildfire exposure and low SES together increased intubation odds (OR = 2.7, p = .04). Higher Pediatric Index of Mortality 3 (PIM3) scores also raised intubation risk (OR = 1.3, p < .001) while other investigated demographic factors did not.

This study underscores the elevated respiratory risks for low-SES children during wildfires. Additional research and greater public health awareness can inform targeted interventions and disaster preparedness to protect these vulnerable populations as wildfire frequency increases.

The Taliban takeover in August 2021 put an end to over 40 years of conflict, albeit it resulted in the departure of several international organizations from the country and the freezing of assets, which unleashed economic and humanitarian crises. Taking advantage of the reopening of previously restricted areas and the longstanding presence of Emergency in the country, this study sought to achieve a thorough understanding of access to care in Afghanistan by exploring trends, barriers, and changes after August 2021.

The project consisted of three phases: analysis of Emergency aggregated surgical, maternal, and pediatric data to explore healthcare utilization over the years; dissemination of a 67-item questionnaire to patients visiting Emergency facilities by trained local staff; and semi-structured interviews with local health professionals.

The result of a collaboration between Emergency and CRIMEDIM.

Facilities’ records from 11 provinces were analyzed, 1807 questionnaires were collected, and 43 interviews were conducted. Data revealed a drop in consultations in August 2021, but rates returned to normal as early as September 2021, with more patients seeking care for civilian trauma rather than war wounds. Although patients feel safer when visiting health facilities, their ability to pay for care has decreased after August 2021. Many health system-related factors impact access to care and make people go straight to larger hospitals, aggravating the congestion of patients in tertiary hospitals.

This study contributes to paving the way to Universal Health Coverage in Afghanistan. Although the country has a unique social, political, and economic context, these results can be generalized to other postcolonial settings.

Full authorship: Martina Valente, Alessandro Lamberti-Castronuovo, Francesca Bocchini, Monica Trentin, Yasir Shafiq, Michela Paschetto, Ghulam Ali Bahdori, Jan Agha Khadem, Mirza Sayed Nadeem, Mohammand Hanif Patmal, Mohammad Tawoos Alizai, Francesco Barone-Adesi, Rossella Miccio, Luca Ragazzoni.

The widespread availability of handheld point-of-care ultrasound systems (HHUS) has rapidly increased the number of preclinical emergency medicine ultrasound examinations in Germany. HHUS used by emergency physicians at the Southside Festival (SSF) in southern Germany was evaluated over several years according to its feasibility and ability to change patients’ disposition and treatment process.

By questionnaire, the doctors performing the examination were asked about the indication, the body region examined, the ultrasound protocol used, if any, the duration of the examination, and any changes in the further procedure. In addition, the subjective assessment of the assessability, the visualization under the existing lighting, and the ultrasound experience of the users were surveyed.

In three years, a total of 29 ultrasound examinations were assessed by the sonographers. The majority of examined regions were the abdomen (55.2%). 27.6% used the (e)FAST protocol; no protocol was used in 41.4%. Indications: 31.0% pain, 20.7% trauma, 27.6% examiner’s interest, 24.1% confirmation of suspected diagnosis, 3.4% as part of CPR. Duration: examination 41.4% <2 min, 41.4% 2-5 min. In 20.7%, the procedure was changed due to the examination. Assessability and visualization were rated 2 (1 very good - 6 poor). Half of the users considered themselves experienced.

Ultrasound examinations under medical service conditions at an MGE were feasible and accessible. The majority of examinations concerned the abdomen. US protocols were only used in half of the cases. The duration of the examination was usually less than 5 minutes, and the procedure was changed further by the examination in 20.6% of cases. Since there is supposed to be a large amount of extremities trauma in festival visitors, this percentage might be even higher when (in fracture and joint ultrasound) trained emergency physicians are in charge. Data collection will continue.

Mortality resulting from incompressible hemorrhage is the primary cause of pre-hospital deaths, highlighting the urgent need for the development of innovative hemostatic materials capable of effectively managing this type of bleeding. Inspired by the long-lasting foams constituted by transition metal ion-protein complexes, an injectable and stable liquid hemostatic foam has been developed, composed of gelatin/silk fibroin and hemostatic transition

metal ions, Ca2+/Fe2+. The foam was rapidly obtained using a simple dual-syringe Tessari method. The dimensional changes of the foam were characterized, and its interaction with blood was observed under an optical microscope. The rheological properties of the foam were investigated using a rheometer. The hemostatic performance of the material was validated using rat liver laceration models, femoral artery bleeding models, and porcine femoral artery injury models.

A liquid hemostatic foam was successfully prepared for rapid hemostasis and short-term protection of non compressible wounds. The prepared foam exhibits excellent stability and mechanical strength, meeting the requirements for addressing incompressible hemorrhage. While achieving rapid hemostasis, the foam can be easily removed from the wound without disrupting the clot or causing secondary bleeding, which aids in pre-hospital rescue and the expedited transportation of casualties. This manuscript aims to further advance rapid prehospital treatment for non-compressible hemorrhage, thereby minimizing mortality from such bleeding incidents as much as possible.

The integration of AI into the field of disaster medicine represents a significant advancement in improving the speed and efficiency of emergency response by facilitating faster decision-making processes, optimizing resource allocation, and enhancing communication systems. Given the effectiveness of AI, it is essential to explore its potential applications within disaster medicine. To investigate this topic, we conducted a scoping review on AI applications aimed at enhancing the efficiency of emergency response and minimizing the time to care.

Following the PRISMA-ScR guidelines, a comprehensive search was conducted across five databases. Peer-reviewed studies published in English between 2019 and 2024 that focused on AI applications in disaster medicine were included. Two reviewers independently screened the titles, abstracts, and full texts. Relevant findings were extracted in a thematic format.

Out of 15,431 studies, 239 were included. The volume of publications increased from 8 in 2019 to 59 in 2021. Research output was predominantly concentrated in Asia (40%), followed by multi-country collaborations (21%), with both Europe and North America contributing (15%) each. The primary focus of the studies was on machine learning (65%), often in combination with deep learning (50%) and decision-support systems (36%). Common applications identified included decision-support tools (86%), AI-assisted triage (63%), early warning systems (52%), and patient monitoring (49%). Notably, most of the studies (84%) concentrated on pandemics, while natural disasters were (16%), and humanitarian crises (3%).

The results of our research indicate that the COVID-19 pandemic has resulted in rapid advancements in innovative applications, primarily focused on enhancing situational awareness and optimizing triage procedures in pandemic-related emergencies. To evaluate the life-saving potential of AI, it is essential to integrate these technologies into a wider range of disaster scenarios, supported by rigorous validation processes. This approach will improve the ability of responders to protect communities during future disasters.

From 2020-2022, this author deployed three times with the US Army. These deployments involved a field hospital in Baghdad, Iraq; a no-notice deployment with a forward resuscitative surgical team before the fall of Kabul, Afghanistan; and a no-notice deployment with a forward resuscitative surgical team to Romania after Russia invaded Ukraine. This presentation:

1. Relives those deployments, as well as the moments leading up to those deployments, from the point of view of an Emergency Medicine Physician.

2. Discusses the unique medical cases seen in those austere environments, such as treatment of COVID-19 and hypoxia in a combat zone with a portable oxygen generator, treatment of a military working dog, diagnosis and management of infectious myositis, and mass casualties from the explosion at Abbey Gate in Kabul.

3. Discusses the NATO roles of care (e.g., Role 1, Role 2, Role 3, and Role 4).

4. Discusses CBRNE preparation in Eastern Europe.