Hyperbaric oxygen treatment (HBOT) is often required in various disaster situations, such as fires, explosions, chemical accidents, and ship sinking rescues. Hyperbaric oxygen chambers (HBOCs) capable of performing such treatment are key resources for responding to disasters. As such, their quantity and placement must be appropriate. In this study, assuming a disaster situation that requires multiple HBOCs to be deployed simultaneously, the author investigated and analyzed the regional deployment status of HBOCs in Korea and their adequacy for toxic gas disasters based on medical institutions with HBOCs, and developed a scoring index to express this.

In the event of a disaster requiring HBOT, all hospitals with HBOCs in Korea could theoretically participate, so hospitals with HBOCs were examined. The distribution of HBOCs by region, type, and population was then analyzed, as well as the ability to perform simultaneous HBOT and HBOT in disasters by region. The results were used to derive the Critical Patient Response Index (CPRI) and Total Patient Response Index (TPRI) for hazardous gases and comparison by region.

In Korea, a survey of HBOCs over the past 15 years found that the first wave of expansion in 2015-2016 and the second wave of expansion since 2019 have resulted in increased deployment in previously underserved areas. However, when analyzed based on population base, concurrent capacity, and treatment performance, the deployment of HBOCs was skewed toward some regions. Expressed as an index, the CPRI ranged from 0.045 to 1.5, and the TPRI ranged from 0.215 to 3.222, allowing for a clear comparison of disaster response capabilities.

The index developed in this study has limitations, as it may not include all actual hospitals and may not reflect differences in human resources or operations. Nevertheless, the index can be used objectively and relatively to represent a region’s ability to respond to disasters requiring HBOT.

In 2023, conflict-related injuries resulted in 172 thousand fatalities. A majority of those killed and injured in armed conflicts are civilians. The most common anatomical site of conflict-related injury for civilians is the extremities. There is a need for increased knowledge on the epidemiology of civilian casualties. This study aims to describe the epidemiology of a population treated for conflict-related extremity injuries at civilian hospitals.

Data were derived from a pragmatic randomized controlled trial performed at two civilian trauma hospitals in Iraq and Jordan with patients injured in Iraq or Syria. Recruited patients were adults (≥18 years) with an acute (<72 h) conflict-related extremity injury not suitable for primary closure.

Median age was 28 (interquartile range [IQR] 21–34) years. 155/165 (94%) patients were male. On admission, the median systolic blood pressure was 120 (IQR 110–130) mmHg, the median heart rate was 96 (IQR 85–110) beats per minute, and the median hemoglobin level was 133 (IQR 113–144) g/L. 93/165 (56%) patients had at least one fracture. The most common mechanism of injury was gunshot (100/165 [61%] patients), followed by blast (63/165 [38%] patients). 43/165 (26%) patients had concomitant injuries. Bleeding requiring blood transfusion affected 56/165 (35%) patients. Only 1 patient received more than 10 units of packed red blood cells. Wound infection was found in 29/165 (18%) patients. The median length of stay was 10 (IQR 5–37) days. After 5 days, 92/165 (56%) patients had obtained wound closure. One (1%) patient died during hospital stay.

Males were highly overrepresented amongst the patients. Compared to previous similar studies, gunshot as a mechanism of injury was unusually frequent. Fractures were common, including open fractures. Bleeding was a common complication, but massive transfusions were rare. The mortality of the patients was low in comparison to non-conflict civilian trauma hospitals.

According to The International Disaster Database, one-third of disasters worldwide are technological. In Japan, chemical, biological, radiological, nuclear, and explosive (CBRNE) disasters are less common than natural disasters. However, every hospital is required to respond, because once a disaster occurs, victims might rush to the nearest hospital regardless of the hospital’s preparedness. The present study aimed to determine the association between the readiness and willingness of regional hospitals to accept victims of CBRNE disasters.

Physicians and nurses of middle rank and above who are currently working in the emergency departments of 685 regional medical care support hospitals were asked to respond to a questionnaire about their past experiences and preparedness with regard to CBRNE disasters and their willingness to respond if victims came to the hospital in the future. A binomial logistic regression analysis was used to confirm this association. The survey was approved by the institutional ethical review boards of the affiliated universities.

105 physicians (15.3%) and 113 nurses (16.5%) responded to the survey. Regarding the respondents, 76.2% (80) of physicians and 69.0% (78) of nurses belonged to disaster-based hospitals. A total of 67.6% (71) of physicians and 54.9% (62) of nurses had previous CBRNE disaster response experience, including pandemics. Willingness to receive victims was significantly associated with the learning experience of the CBRNE disaster (physicians only), working at a disaster-based hospital, and having a history of victim acceptance training for chemical disasters, including terrorism. For nurses, the presence of manuals was associated with their willingness to accept victims of non-terrorist chemical, radiological, and explosive terrorist disasters.

It is hoped that regional hospitals will improve their preparedness for CBRNE disasters. As the effectiveness of manuals and training for responding to victims has been suggested, disaster-based hospitals are expected to support these.

Mass Casualty Incidents (MCI) require complex training and response, and local response in the first hours is essential. In many places worldwide, this initial local response is provided by the primary health care (PHC) network. The training method for MCI is complex and costly, and may not be integrated into the PHC network. Our objective is to measure self-perception and the impact of a brief training action through an MCI tabletop exercise carried out with primary care doctors and nurses using the “MassCas” tabletop game, specifically designed for this project.

Descriptive intervention study of the impact of a two-hour training intervention in the Health Research Institute of the Principality of Asturias with primary care doctors and nurses from the Principality of Asturias. Self-perception using a Likert scale on methodology, knowledge, and skills was analyzed. We also tested knowledge retention with a multiple-choice knowledge test after two months. Strengths and weaknesses of the methodology, as well as attitudes toward mass casualty incidents, were also identified through open questions.

Twenty-seven doctors and nurses participated in the training program. 85% of participants improved their level of knowledge after two months without studying material. Self-perception measured 27 items in 3 dimensions: methodology (Median=9; IQR=2), knowledge (Median=10; IQR=1), and skills (Median=9; IQR=1). All items except one had a median greater than or equal to 9. All items ranked a median 8-10.

Primary care health professionals perceive gamification using the “MassCas” tabletop game for mass casualty incidents as a useful tool in their training in mass casualty incidents and in acquiring specific knowledge and skills in this area.

This study has been partially financed by the Foundation for Biosanitary Research and Innovation of the Principality of Asturias (FINBA), the managing entity of the Health Research Institute of the Principality of Asturias (ISPA).

The 2018 Western Japan floods resulted in numerous fatalities among elderly residents, with many cases of “drowning at home” reported. This study analyzes victim characteristics to explore mitigation strategies for a society experiencing increasing climate-related disasters. We collected cases of home drowning fatalities during the floods in Ehime and Okayama Prefectures through media reports (newspapers and television) and analyzed survival patterns. In Ehime Prefecture, 9 (29.1%) of 32 victims drowned, with 3 (9.7%) drowning at home. All three were over 70 and found on the first floor. In Okayama’s Mabi town, 43 (84.3%) of 51 drowning victims died at home, with 36 (70.6%) being elderly (65+). 42 died on the first floor, one on the second floor. Both prefectures reported cases where surviving elderly residents reached the second floor but failed to convince their spouses to follow, resulting in spouse fatalities. In one case, an elderly couple survived by floating on their bed, which rose with the water level near the ceiling. In Ehime, a family successfully rescued a one-year-old girl and her great-grandmother using a two-seater sofa as flotation. Swimming while clothed is challenging, particularly for elderly individuals with reduced physical strength. Given that most elderly victims drowned on the first floor, the survival probability could increase through flotation strategies. When external evacuation risks are high during indoor flooding, back float and improvised flotation devices (life jackets, coolers, sealed backpacks with clothing) may contribute to survival. This survival technique, internationally known as “Uitemate” (Float and Wait), effectively prevents drowning in various flood disasters and represents a household-level disaster risk reduction strategy.

Airway management, ventilation, and adequate oxygenation are an essential part of prehospital care. The easiest airway can be the most difficult airway for the inexperienced person, especially in disaster situations where more patients will need airway interventions. The combination of Guedel & BVM or perilaryngeal supraglottic airways (LMA) are two airway management techniques that are used in the field. However, effective ventilation with a combination of Guedel & BVM cannot be provided in inexperienced hands due to air leakage. Regarding LMA, there is a decisional dilemma regarding its use by inexperienced providers in prehospital settings. Therefore, new airway equipment providing both airway control & ventilation is needed for prehospital airway control and ventilation. There is new supraglottic airway equipment, guedel-type cuffed oropharyngeal airway (Tulip airway), which can provide both airway control and ventilation support. The study compares Guedel & BVM, LMA, and Tulip airway on prehospital use for airway management.

The study group included military first aid school students. They used Guedel & BVM, Tulip airway, and LMA on the manikin-based simulator. Ventilation adequacy was assessed visually by inflating the balloon that stimulated the lung. Time from insertion to achieved ventilation, instructor intervention, and maneuver requirement were recorded.

The median time from Insertion to achieved ventilation of Tulip airway on manikin was shorter than Guedel & BVM and LMA. Tulip airway requires less instructor intervention and maneuver requirements.

If we grade them from basic to advanced, Tulip airway combines Guedel & BVM and LMA. Although the Tulip airway is simpler than LMA, it is as effective as LMA. As providing ventilation with the simplest airway device is important in disaster situations, Tulip airway, as a guedel-type cuffed oropharyngeal airway, can be evaluated for disaster medical care guidelines.

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 Events (MCI) have a direct and persistent impact on the safety and well-being of an emergency department (ED) and its staff. ED physicians may be faced with the prospect of providing ongoing patient care while simultaneously experiencing direct threats to their health or physical safety. In our study, we considered the unique operational challenges encountered and management strategies adopted by the ED staff and its leadership in response to an all-hazard MCI impacting an academic urban emergency department.

We conducted a retrospective, observational study of data from a tertiary academic medical center of patients arriving at the ED during a protracted MCI lasting from May 11th to May 21st, 2021. No arriving patients were excluded from the analysis. Patient demographics, ED resource utilization, throughput, disposition, and other pertinent data were considered. An analysis was done of three distinct patient populations, including the event group, a non-event group, and a control group. Descriptive statistics were used to evaluate observational findings.

We reviewed the records of 8,527 total patients presenting to the Shamir Medical Center ED during the event and control periods. Of those, 283 patients were identified as casualties from the MCI, and 3,563 patients were identified as presenting with complaints not related to the event. Our control group consisted of the 4,681 patients who presented in the two weeks before the MCI.

Findings from our observational qualitative study suggested that, in the absence of larger public health interventions, a manmade MCI, with direct threats to an ED and its staff, could force a department to concurrently address the unique clinical needs of two distinct patient populations while simultaneously needing to take measures to protect hospital staff. Additionally, a higher burden of patient volumes and clinical acuity is likely to be encountered by select specialty consult services.

The military conflict between Russia and Ukraine that emerged in February 2022 transitioned in mid-2023 from an “existential war” into a “war of attrition.” A distinct division within society marks this new phase. On one side are those actively engaged in the war effort, and on the other are individuals who have become passive or indifferent regarding the ongoing war as the new normal.

The longitudinal study assessed the impact of a prolonged conflict on resilience and coping mechanisms, based on two samples (T1 – July 2022 [N = 1001]; T2 – November 2023 [N = 2247]). Data were collected through internet panels’ respondents who completed a structured quantitative questionnaire.

A significant decrease was found in three types of resilience (individual, community, and societal), hope, sense of danger, perceived threats, and PTSD symptoms during the second versus the first measurement. The best predictor of societal resilience was government support. The best predictor of individual resilience was community resilience. The best predictor of PTSD symptoms was perceived threats. The predictors explain 68% (T1) and 60% (T2) of societal resilience, 19% (T1 and T2) of individual resilience, and 58% (T1) and 12% (T2) of PTSD symptoms.

Findings suggest that 'routinization’ of an ongoing emergency is formulated, allowing the population to coexist with the adversity and accept the war as the “new normalcy.” Nonetheless, the future is perceived as uncertain, leading to a decline in hope. Strategies that focus on bolstering resilience during adversities should consist of social support mechanisms that enhance the population’s hope and morale and build the government’s trust and support.

Mass casualty incidents (MCIs) are major emergencies in emergency departments, necessitating effective training for healthcare personnel. Tabletop exercises (TTx) and functional exercises (FE) are two non-disruptive training methods that can simulate MCI responses. However, little research has compared the effectiveness of these two methods. This study aims to evaluate the effectiveness of TTx and FE as training tools for MCI preparedness.

Participants were divided into two groups: the T group (trained via TTx) and the F group (trained via FE). Both exercises simulated a train station explosion, requiring the hospital to manage 26 simulated casualties. TTx involved instructor-facilitated group discussions, while FE required role-playing in a simulated hospital setting. Participants were assessed before the exercise, immediately after, and six months post-exercise. Evaluations included confidence in MCI response, willingness to attend future training, willingness to participate in real MCIs, knowledge of disaster medicine, and familiarity with MCI response plans. Data were analyzed using ANOVA and paired t-tests to assess short- and long-term effects. Additionally, participants provided feedback on the factors that most contributed to their learning.

Both exercises significantly improved confidence in MCI response, with TTx having more sustained effects. FE increased willingness to attend future training and participate in real MCIs, though effects diminished after six months. Neither exercise significantly affected disaster medicine knowledge. Familiarity with MCI response plans improved in both groups but returned to baseline after six months. Participants rated both exercises as valuable learning tools, citing scenario-based learning, greater engagement, interactivity, and real-time feedback as key factors.

TTx and FE are both valuable for hospital disaster preparedness, with each offering unique advantages. Hospitals should select the exercise format that best suits their staff and needs. Regular re-training within six months may be required to sustain preparedness.

Since 2015, at the request of the Ministry of Education and the Interior, all schools have been required to organize an internal “intrusion attack” exercise to test their PPMS. Under the guidance of the Haute-Garonne prefecture, one or two full-scale interdepartmental “attack-intrusion” PPMS drills are organized in parallel each year. Between November 1, 2022, and December 31, 2024, 2644 students aged between 11 and 19 took part in the exercises, along with 207 teachers and 220 non-teaching staff. A few days in advance, parents and school staff are informed of the date of the exercise, which will take place on a closed site. Arrangements for the participation of children with special needs are specified. There is no communication to the general public on this subject. The scenario involves an armed intrusion into a school, resulting in several casualties. The first part of the exercise consists of playing out, in real life, the response and coordination of services (school, law enforcement, and first aid). The second part is a tabletop exercise that tests the coordination of the various psychological support services during this intrusion. If required during the exercise, players can be taken in charge by these services. The 3rd part allows a defusing of the exercise, followed by an exchange between the students and staff of the school and the state services, to present the missions of each and the equipment used during the exercise. The exercises led to improvements in the implementation of the PPMS in the establishments tested. No adverse events have been reported to date.

A Disaster Medical Assistance Team (DMAT) provides rapid-response medical care, supports overwhelmed hospitals, and conducts patient triage and emergency care. In Taiwan, most DMATs are hospital-based, formed of healthcare personnel from the same hospital. But in Eastern Taiwan, due to elongated terrain and fewer medical personnel, regional health center staff are utilized for DMAT. These health center staff typically focus on preventive medicine and chronic care, resulting in less experience with emergency cases. This study aimed to explore the differences in emergency medical responses between health center personnel and hospital staff within disaster medical teams.

On October 15, 2024, a DMAT drill was held in Taitung, simulating a magnitude 7 earthquake. Two teams were formed to treat simulated patients, with an injury distribution of 50% mild, 30% moderate, and 20% severe. Station A comprised a newly established team from health center personnel, while Station B consisted of a five-year-old DMAT with hospital staff. Key assessment items included wound cleaning and dressing, limb stabilization, airway management, and continuous assessments of consciousness and vital signs. Results were analyzed to compare the accuracy of medical interventions.

At Station A, 21 patients were encountered, with two excluded as black triage, resulting in 19 treated patients and a treatment accuracy of 93.4%. Station B treated 24 of 25 patients (excluding one black triage), achieving a 96.2% accuracy. The percentage of completely correct treatments was 73.7% for Station A and 83.3% for Station B. Repeated assessments of consciousness and vital signs were frequently overlooked at both stations.

The findings indicated no statistically significant differences in the performance of health center personnel compared to hospital staff. Thus, health center personnel, with appropriate disaster training, can effectively perform emergency medical tasks in pre-hospital settings.

This study aimed to assess changes in attitudes toward routinely recommended vaccines among Hawaii parents following the COVID-19 pandemic and to identify associated factors influencing these changes.

An online survey was conducted in March 2023 among parents/caregivers of children aged 0-12 years residing in Honolulu, Hawaii. Data collected including sociodemographics and household characteristics, theoretical constructs of the Health Belief Model, emergency preparedness behaviors, risk perception of diseases, and attitudes toward vaccines. Descriptive statistics were used to assess parental vaccine attitudes, logistic regressions were employed to identify factors associated with changes in attitudes regarding routinely recommended vaccines (vaccines other than the COVID-19 vaccine).

Participants (N=278) were mostly female (84.2%), college-educated (68.3%), food-secured (66.5%), and possessed an emergency preparedness kit (50.7%). Attitudes toward routinely recommended vaccines remained unchanged in 65.1% of participants (60.1% positive, 5% negative), while 34.8% reported changed attitudes (21.9% changed to positive; 12.9% changed to negative). Multivariable logistic regression revealed that factors that influenced changes in vaccine attitudes included race/ethnicity, having a family emergency plan, concerns about climate-related health impacts, perceived time barriers, and the belief that vaccines are part of emergency preparedness plans. Specifically, individuals identifying as Japanese or Filipino, those with an emergency plan, and those less concerned about climate change were less likely to change to negative vaccine attitudes. Conversely, perceiving vaccines as unrelated to emergency preparedness and experiencing time barriers were associated with an increased likelihood of changing to negative attitudes.

This study highlights how attitudes toward routinely recommended vaccines shifted among parents after the COVID-19 pandemic, and identifies modifiable factors such as concerns about climate change, time barriers, and the perception that vaccines are unrelated to emergency preparedness. Insight gained from these findings can guide targeted public health interventions aimed at enhancing vaccine acceptance and readiness in advance of future potential pandemics.

Floods rank among the most frequent and destructive natural disasters globally, presenting severe threats to human life, infrastructure, and economic stability. In Poland, existing flood risk management strategies often neglect the complexities of self-evacuation, particularly in areas with a 1% annual flood occurrence. This study seeks to fill this gap by evaluating the effectiveness of self-evacuation via private vehicles in flood-prone regions, aiming to enhance emergency response strategies and mitigate the adverse consequences of flooding.

A comprehensive four-step traffic modelling approach was applied to simulate self-evacuation in flood-prone regions. The model integrated national traffic flow data alongside responses from questionnaire surveys conducted among residents in flood-risk areas across Poland. By utilizing Geographic Information Systems (GIS) and traffic engineering tools, a high-resolution network model was developed, encompassing both main and local roads to provide an accurate assessment of traffic distribution. The analysis considered various scenarios, including pre-flood and during-flood conditions, with or without existing commuter traffic, and evacuation travel time thresholds of eight and 15 minutes to designated shelters.

The analysis showed that evacuating before a flood is more effective than during the flood, as a larger portion of the population can reach safety within the set travel time limits. Evacuation routes were significantly hindered by limited road capacity, bottlenecks, and natural barriers, especially under active flood conditions. The model identified key sections of the road network at risk of congestion during evacuation and offered valuable insights into the efficiency of shelters at different time intervals.

Effective flood risk management in Poland requires integrating self-evacuation strategies with advanced traffic modelling. This study emphasizes proactive evacuation planning and stronger infrastructure resilience to reduce flood impacts. Key recommendations include optimizing evacuation routes and improving communication for timely evacuations.

This research was funded by the National Science Centre, Poland, under the OPUS call in the Weave programme [2023/51/I/HS4/00255].

This presentation elucidates experience from the field in providing mental health education and support to primary care providers of refugees. There are myriad models of care integration of mental health within primary care. Certain models allow for informal occasions to enhance provider well-being in addition to patient care. Collaborative care models (mental health and primary care) during crises provide unique opportunities for not only education but also support of practitioners.

This study reports on the First Regional Support Nurse Training Workshop, held in July 2024. The workshop was designed to enhance the disaster response capabilities of nursing professionals, addressing challenges in regional healthcare during large-scale disasters. The workshop was organized in response to a decline in the number of registered disaster support nurses in Hamamatsu City. To address this issue, the Regional Disaster Preparedness and Human Resources Education Center (R-CEC) collaborated with Hamamatsu City to develop a practical disaster training program aimed at increasing the number of disaster support nurses and improving their preparedness for disaster scenarios. The workshop curriculum was created based on participants’ needs and included lectures, hands-on practical exercises, and group discussions. These sessions focused on improving nursing professionals’ ability to respond quickly and accurately during disaster situations. Fifty-three nursing professionals from the region participated in the workshop, which took place on July 21, 2024. After the workshop, a review session was conducted to gather feedback from participants, allowing for discussions on the workshop’s effectiveness and potential areas for improvement. The workshop successfully provided participants with essential disaster response skills and knowledge. The practical exercises, in particular, were highly rated for their relevance to real-world scenarios. The feedback session revealed that participants felt more confident in their disaster response abilities, and suggestions for further improving the workshop’s content and structure were noted. The First Regional Support Nurse Training Workshop achieved its goal of enhancing disaster preparedness among nursing professionals. This initiative is expected to contribute significantly to the disaster resilience of regional healthcare systems by ensuring that nursing staff are better equipped to handle emergencies. Future workshops will aim to build on this success, further expanding the program and incorporating participant feedback for continuous improvement.

Trauma Stabilization Points (TSPs) represent the initial tier of professional, fully trained medical response equipped to provide trauma care. While the US military has used a similar system for years, the first non-military TSP implementation was in late 2016 as U.S.-backed Iraqi and Kurdish forces advanced on the city of Mosul, Iraq. TSPs formed the foundation of the Mosul trauma response and were instrumental in its success. Although encountering many logistical and funding challenges, TSPs in Iraq provided effective trauma care and served as a blueprint for future applications. In 2018, TSPs were established in Gaza when violence erupted between Palestinian demonstrators and Israeli security forces; these TSPs also had a profound impact on trauma outcomes. In the following years, TSPs were utilized in response to clashes in other areas, notably in 2021 in Jerusalem. Following the attacks of October 7, 2023, and Israel’s subsequent military operation, TSPs were implemented throughout the region. However, they have faced significant logistical and security challenges. In response to the 2022 full-scale invasion of Ukraine, many international organizations and local responders formed ad hoc trauma responses that complemented the established Ukrainian healthcare system, effectively managing the initial civilian trauma response. As the frontlines stabilized, the Armed Forces of Ukraine implemented TSPs, locally known as “STAB” points, throughout areas of active fighting. Ukrainian STAB points are characterized by increased capabilities, such as access to basic surgical interventions, labs, and imaging. They also differ by treating patients days after initial injury, which is uncommon in other settings. TSPs in Iraq, Gaza, and Ukraine have effectively addressed conflict related trauma by providing structured, adaptable medical interventions, whether for immediate stabilization or delayed patient reception. However, more comprehensive outcome data is essential to refine clinical and operational best practices.