The development of standardized disaster medicine curricula for frontline providers is lacking in the international platform. This report describes the approach utilized by the State University of New York (SUNY) Downstate, an Academic Medical Center in New York. SUNY offers one of the few disaster medicine fellowships in the United States, which also accepts international applicants and non-emergency Medicine (EM) physicians. Previous examples of non-traditional graduates from the program include the Director of the SUNY Pediatric Intensive Care Unit, a Critical Care specialist in India, and an EM physician in Ghana.

Each of the non-traditional graduates completes a “virtual” version of the traditional Disaster Medicine Fellowship. The curriculum includes topic-based modules during which the fellows attend online courses, create and/or update their home institutions’ disaster protocols, create and deliver training to their institution’s staff, conduct disaster drills for their community, produce original research, and participate with local disaster response partners. With each topic-based module, the program’s benefits extend beyond the fellow gaining pertinent knowledge. Intentionally, the curriculum design enables the institution and community where the fellow works to gain staff training, updated disaster protocols, and increased coordination among local response agencies.

The two main goals of the SUNY Global Disaster Medicine fellowship are to increase access to a global disaster medical curriculum and to strengthen the emergency preparedness for communities that have fellows in the program. The next steps for this program are creating a formal annual virtual class of ten participants from an academic medical center in Kuala Lumpur, Malaysia. The proposal has been signed by leaders from both centers and is scheduled to begin in July 2025. Beyond that, future goals are to expand this program to multiple academic centers globally that do not currently have access to a disaster medical fellowship program.

Pediatric reunification is a critical component of hospital disaster planning. Timely reunification has shown improved outcomes for children, yet many hospitals fail to have a plan. The U.S. Administration for Strategic Preparedness and Response funded Region V for Kids, a Pediatric Center of Excellence for standardizing pediatric disaster preparedness. A Reunification Workgroup was formed within this center to determine if an educational series would improve pediatric reunification plans for U.S. hospitals.

This pilot project is a mixed-methods study including nine children’s hospitals from six states. Hospitals were pre-surveyed in May 2023 and post-surveyed after completion of the educational series in July 2024. The series comprises five modules: Patient Tracking, Facility Logistics, Information Sharing, Plan Activation, and Recovery. Modules were developed from deficits revealed via a gap analysis from the presurvey and virtually presented each month from January through May 2024 to emergency managers and physicians. Sessions were also recorded for self-guided learning. The audience was polled live for immediate feedback during each virtual session.

Live polling questions included presentation helpfulness, speaker knowledge, presentation content, and session expectations. The post-survey solicited information on reunification knowledge enhancement, relevancy, and changes to clinical practice, the virtual experience, independent learning opportunities, and ease of the online learning platform. Using a scale from 1 to 5, with 1 being strongly disagree and 5 being strongly agree, all modules averaged above 4, with a range of 3 to 5 in both polling and post-survey questions. Descriptive results indicated that modules were concise, informative, relevant, and practical.

This pilot is the first educational series developed for standardizing and improving pediatric reunification plans in the U.S. The project used knowledge deficits to improve education, strategy, and guidance for reunification planning. Similar educational series should be considered in pediatric reunification development for hospitals globally.

Evidence-based guidelines for psychosocial care support the well-being of workers in high-risk fields like ambulance services, the fire brigade, and the police. Between 2022 and 2024, the Dutch guidelines were fully revised. Part of this revision involved a systematic literature review to examine (1) psychological effects of impactful events on uniformed personnel and factors that influence these risks, and (2) available evidence for effective prevention strategies.

Two comprehensive searches were conducted in Ovid Medline ALL (1949-2022), PsycINFO (Ovid; 1806-2022), and PTSDpubs (National Center for PTSD, US; 1871-2022) between September and November 2022, with an update in summer 2024. Both searches were registered in PROSPERO. A wide range of search terms was used, derived from existing guidelines, expanded with new terms, and peer-reviewed by experts to ensure relevance. Two independent researchers screened the results and extracted key data, with 15-20% double-checked for consistency. Methodological quality of all included studies was assessed.

For study one, 1,413 studies were screened, resulting in 43 included studies. The quality of studies (using AMSTAR criteria) was generally low, and most were cross-sectional. Effects were found in several domains: somatic, psychological, social, work-related, behavioral, and ethical. Risk factors included aspects of the incident, personal history, work pressure, and coping style, while protective factors included work meaningfulness, social support, and training. For study two, 2,334 studies were screened, with 22 RCTs included. Twenty-five prevention interventions were identified, most being selective (48%) or universal (40%) in nature. However, study quality was generally low (according to the Cochrane Risk of Bias tool), with some interventions showing mixed outcomes.

The identified factors and prevention studies are valuable for understanding and addressing mental health challenges in high-risk occupations. However, the review highlights a lack of high-quality empirical knowledge, complicating the development of evidence-based guidelines and urging for expert-based co-creation models.

Mass gatherings (MGs), such as religious pilgrimages, sporting events, and cultural festivals, present significant public health challenges. The large concentration of people in one location can place substantial strain on local healthcare systems. WHO’s Medical Care Planning for Mass Gatherings guidance provides event organizers with a comprehensive framework to mitigate risks, ensure high-quality medical care, and alleviate pressure on local health services.

The development of this guidance was informed by a systematic review of the existing literature on mass gathering medical care and event health services (EHS). Additionally, a WHO Mass Gathering Workshop brought together public health experts, event organizers, and emergency medical teams (EMTs) to identify critical gaps in current planning standards. These insights were used to adapt the WHO EMT methodology specifically for mass gatherings, ensuring relevance to a variety of global contexts.

The guidance outlines ten key domains essential for medical care planning at MGs, including clinical and operational capacity, human resource management, and mass casualty incident response. The team will describe the key concepts underpinning these domains and the areas covered by the guidance. Standards for EHS-EMTs were established to address these needs. The framework also offers practical recommendations on surge capacity, staffing, transport logistics, and patient referral systems, aimed at enhancing preparedness and response capabilities.

The WHO guidance addresses a critical gap in global standards for health services at mass gatherings. It offers practical, adaptable solutions that enable event organizers and host countries to enhance health outcomes, improve safety, and ensure a coordinated medical response. By following this framework, future mass gatherings can be managed with greater efficiency, reducing risks to public health.

Bioaerosols significantly contribute to infection transmission. Nebulization increases the degree of fugitive aerosols and is limited in use during the COVID-19 pandemic. However, nebulized medications may be an important part of treatment and a transmission risk when infectious bioaerosols are present. Allowing for nebulized medication delivery while mitigating environmental contamination permits safe transport and in-hospital treatment without airflow restrictions. Using a novel device, preliminary data assessing the efficacy of nebulized DNA and environmental fugitive aerosols are presented.

A novel device was 3D printed and attached to a simple facemask on a manikin. The vacuum port of the device was attached to the wall suction. Reprogramming a cough assist machine, bioaerosol was pushed/pulled through the pulmonary tree of a manikin while nebulized medical aerosol was ‘inhaled’. Distinct DNA-coated 1 micrometer spheres were nebulized from the manikin’s lungs and face mask medication port at a rate of 8L/min. Sampling sites included air sampling at 50 L/min, the face mask surface, and an inline filter to capture scavenged and lung DNA. Standard cycle threshold detection curves were obtained for each DNA oligo used.

Sampling comparing DNA delivery with and without a mouthpiece demonstrated a 6-fold higher ‘medication DNA’ uptake with a mouthpiece. Similarly, a 16-fold reduction in scavenged ‘medication DNA’ into the vacuum system occurred with a mouthpiece. More than 99% of the nebulized DNA was scavenged with and without a mouthpiece without reaching the environment.

Using a model to simulate the generation of inspiratory and expiratory pressures, this device, in combination with commonly available transport and hospital equipment, was successful in preventing environmental contamination when nebulizing solutions coated with DNA. It is important to add a mouthpiece when concurrently administering nebulized medications to maximize medication availability to the lungs. Future studies should reproduce these results and discuss a generalizable model to test medication delivery and environmental impact.

Efficient patient flow in emergency departments (EDs) is vital for improving outcomes, particularly for critically ill patients. Despite expanding critical care capacity, inefficiencies in processing times, bed allocation, and patient transfers were observed in the Regional Emergency Medical Center (REMC). This study aimed to evaluate the impact of quality improvement (QI) interventions on optimizing decision-to-discharge and discharge-to-exit times while enhancing critical care utilization.

A multi-faceted QI initiative was conducted to streamline patient flow and optimize resource utilization from January to August 2024. The study period was divided into two phases: pre-intervention (January to April) and post-intervention (May to August). Key strategies included educational sessions to enhance staff competencies, the introduction of a “Zone Movement Assessment Tool” to improve patient transfers, and bed allocation based on the Korean Triage and Acuity Scale (KTAS), as well as collaboration with administrative units and local fire departments to expedite admissions. Data on decision-to-discharge and discharge-to-exit times were collected before and after these interventions, alongside metrics on bed utilization rates and financial impact.

The interventions reduced the median decision-to-discharge time from 147 to 130.5 minutes and discharge-to-exit time from 80.25 to 55 minutes. Although not statistically significant (p > 0.05), boxplot analysis showed decreased variability, improving consistency. A strong correlation (r = 0.91) between the two metrics suggested that improvements in one area positively impacted the other. KTAS Level 3 patient allocation increased from 55% to 82%, and bed turnover nearly doubled from 2.9 to 4.8 times per month. Critical care revenue increased by KRW 302,826,630.

The QI initiative improved ED efficiency, enhancing patient flow and resource utilization. While not statistically significant, the gains in consistency, bed use, and revenue highlight practical benefits. Ongoing monitoring, staff training, and iterative improvements are recommended to sustain these outcomes. Further studies with larger samples are needed to validate these results.

The manuals on military field surgery describe in detail the strategy and tactics for treating wounded soldiers in military conflicts. However, when children are provided with assistance during military conflicts and acts of terrorism, the situation reverses. Children become accidental or secondary participants in military operations and are admitted to civilian children’s hospitals, where the staff often has no experience treating such wounds.

During the period from 2014-2024, 156 children with mine-explosive and gunshot wounds were treated at the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (Moscow, Russia), including patients injured in the acts of terrorism in Kerch (2018), Kazan (2021) and military conflict in Ukraine (2014-2024). The ages of the children ranged from 4 to 17 years old. There were 68.6% boys. The main locations of wounds were lower limbs - 134 (46.7%), upper limbs - 47 (16.4%), and head - 50 (17.4%). Thoracoabdominal injuries were detected (found) in 37 (12.9%), and spinal injuries in 19 (6.6%) children. Among all (the children, 25 traumatic limb amputations and 56 open bone fractures were noted.

To improve the quality of treatment, surgical treatment of wounds was applied along with modern methods of physical treatment. Vacuum therapy was used in 72 patients, hydrosurgical treatment in 23, ultrasonic cavitation treatment in 45, and low-temperature argon plasma in 68. Satisfactory results were achieved in all of the observations.

Compliance with the principles of military field surgery in the treatment of wounds during the provision of assistance to children with mine-explosive and gunshot wounds and the using modern technologies allow us to prepare the wound surface for the final stage of plastic closure in a short time, to preserve the rehabilitation potential and to return the child to the social environment.

The WHO estimates that 16% of the world population (1.3 billion) has a significant disability. As the global population of people with disabilities (PWD) increases and ages, the percentage of this vulnerable population will increase. During disaster preparedness planning, the special needs of PWD must be considered. The key aim of this project was to identify barriers to access to healthcare for PWD in Region IX of the US (AZ, CA, Guam, HI, & NV). A subset of the project examined barriers to COVID-19 healthcare access for PWD during the pandemic.

A mixed methods approach included both key informant interviews and focus groups (N = 60) of healthcare workers (HCW) and PWD to inform the development of survey instruments, which asked about access to healthcare in general and also during the COVID pandemic. Survey results for healthcare services during the COVID-19 pandemic are reported here (N = 688).

For HCW (N = 359), nearly one-fourth (23.9%) reported inability to make modifications to help PWD receive the COVID-19 vaccine; 21.1% reported barriers to making modifications so PWD could receive COVI-19 care during the pandemic; about one-half (49.3%) of HCWs used telehealth to care for PWD, and of these, 43.2% experienced difficulties with telehealth processes and technology. PWD (N = 329) also reported severe challenges. One-quarter (24.9%) reported needing modifications to receive the COVID-19 vaccine, and of these, 34.1% encountered barriers to receiving a COVID-19 vaccination. During the pandemic, more than half (55.5%) of PWD used telehealth services, and 22.7% reported problems with using the telehealth technology. Overall challenges for healthcare access included inadequate facility accessibility, lack of adaptive exam equipment and furniture, short encounter time, communication technology problems, lack of transportation, and low HCW knowledge about caring for PWD.

Understanding these needs and barriers can inform future planning to ensure PWDs have equitable healthcare access during all disaster events.

During Hurricane Helene, misinformation spread rapidly across media platforms, complicating public understanding and response efforts. As the storm neared, false information fueled confusion and anxiety, particularly among vulnerable populations, undermining the effectiveness of official, fact-based communication. Much of this misinformation originated on social media, where users shared unverified and often sensationalized updates about the hurricane’s impact. This phenomenon highlighted the dangers of “weaponized health communication.”

Traditional and non-traditional media played significant roles in spreading misinformation. In the rush to deliver updates, news outlets reported on speculative scenarios, sometimes based on unnamed sources, which blurred the lines between fact and fiction. This resulted in conflicting messages, leaving the public uncertain about which actions to take and which guidance to trust.

A public health, disaster management, and medicine literature review examined how misinformation (MDM) spreads during crises. Case studies from domestic and international contexts revealed key themes about state-sponsored information operations, the role of social media, and the challenges posed by public distrust. These insights informed potential countermeasures to mitigate MDM in future crises.

Various organizations, including governments, militaries, and non-governmental institutions, have developed strategies to counter MDM in public health and disaster contexts. However, widespread distrust in government and the effectiveness of MDM campaigns on social media complicate these efforts. Countermeasures like Inoculation Theory, which has been used to combat climate science denial and anti-vaccine misinformation, show promise in mitigating malicious MDM. By using targeted messaging to “inoculate” the public against false narratives, these methods could help protect vulnerable populations during critical events.

Prehospital emergency care, a subspecialty of Emergency Medicine, is primarily provided by the Ambulance Command of the Fire Service Department in Hong Kong. The Government Flying Service also provides emergency care in Hong Kong’s airspace and a significant portion of the South China Sea. As part of the Hospital Authority Accident & Emergency Department response, Medical Control Officers (MCOs) and Emergency Medical Team (EMT) are dispatched to disaster scenes to provide on-site triage, emergency stabilization treatment, and advice on orderly diversions to hospitals.

The objectives of this analysis were:

• To examine the nature of EMT activations

• To analyze the characteristics and outcomes of EMT patients

• To analyze the location of accident blackspots in the Tuen Mun District

Data were collected retrospectively from the Pre-Hospital Emergency Care database in the Accident and Emergency Department from January 1st, 2011, to December 31st, 2021. All clinical records were reviewed.

During the study period, there were 20 episodes of EMT dispatch. Notably, there were no EMT activations in 2012, 2017, and 2018. Most EMT patients were male (90% male, 10% female).

The nature of EMT activations was categorized as follows:

A. Prolonged rescue with patients entrapped for over 30 minutes: Motor vehicle crashes (45%), Severe industrial accidents (30%), Building collapses (5%).

B. No EMT activations were dispatched for Mass Casualty Incidents (MCI).

C. Other activations were escorting critically ill cross-border cases (20%).

In terms of discharge destination, 70% of patients were admitted to the hospital, while 30% unfortunately resulted in death.

Maintaining vigilance and continuous training for the Emergency Medical Team (EMT) is essential, especially considering the small and uneven yearly numbers. Regarding the clinical training of EMTs, multiple government departments implemented preventive measures for black spots in motor vehicle collisions (MVCs), e.g., improving road infrastructure.

Disaster medicine education is of paramount importance, and it is essential to train medical personnel who can effectively participate in disaster response. This paper presents a 20-year history (2005-2024) of disaster medicine education at Saga University.

The education of disaster medicine at Saga University in Japan, including the SINCHI educational model and practical exercises was reviewed. This study was reviewed and approved by the Faculty of Medicine, Saga University (Saga, Japan: IRB approved no. 28-14).

The history of disaster medicine education between 2005 and 2024 was examined, along with civil-military cooperation, multi-professional cooperation, and the practical education model. During the 20 years, the education model consisting of six elements was gradually established. The SINCHI education model includes simulation exercises, group work, international nursing knowledge, general nursing and medical skills and knowledge, promotion of communication skills, humanity education, and infection prevention and control. The model aims to provide a comprehensive approach to medical education. It covers topics such as creating a list of medical staff members, conducting information-gathering simulations, creating a list of medical instruments, and developing a plan for risk management and operations.

The article discusses the 20-year history of disaster medicine education at Saga University, including the SINCHI education model. Hands-on simulation training is highly instructive and effective, as evidenced by the positive evaluations of participating students.

Mis/disinformation has long predated the rise of social media, but today’s social platforms serve as powerful amplifiers, presenting critical challenges for disaster management. Effective disaster response and mass vaccination campaigns, for instance, depend on public trust—a foundation that is easily undermined by misleading or harmful narratives amplified on social media.

This presentation examines specific instances in which social media has impacted disaster response, highlighting the challenges of ensuring accurate, unbiased messaging. While social media can play a valuable role in crisis communication, it must be carefully managed to remain free from political bias and readily understandable to all audiences. Without proper oversight and an emphasis on factual information, the rapid spread of mis/disinformation during disasters poses heightened risks, especially to marginalized communities.

Emergency Department (ED) attendances have been growing worldwide for decades, the rationale for this is societal, cultural, and geographically dependent, but has not been described in detail. Increased access to primary care has been postulated as a solution; however, as the number of General Practitioners (GPs) and GP training posts has increased over the last decade in Ireland, so too has the rise in ED attendances. Detailed analysis is required on an ongoing basis to predict the Staff, staff, and space required to appropriately manage the growing cohort of attendances.

Trend analysis of system-generated attendance reports to evaluate 10 years of attendance patterns (2014-2024) and predict potential future pinch points. Data examined in Excel.

Monthly attendances ranged from a low of 540 to a high of 5028. Average monthly attendance increased from 2657 in 2014 to 4744 in 2024. First month > 3,000 was June 2015, first month > 4,000 June 2021, and first > 5,000 attendances was May 2024.

COVID lockdowns in 2020 and 2021 negatively affected attendance, as did a fire resulting in a hospital evacuation in March 2023. Determining trends in presentations and future predictions is important to ensure that staffing levels match predicted attendances and thus avoid “black escalation” and offload delay. The first time attendances exceeded 3000/month was June 2015, th years later in 2018, every month exceeded 3,000 attendances, and have done so almost every month since, apart from COVID lockdowns, and during fire restricted attendance months in 2023. First month > 4,000 attendances June 2021, and since August 2023, 2 years later, every month has exceeded 4,000 attendances. In May 2024, the first month,> 5,000 attendances occurred. IF predictive models hold in 22 months, every month will be > 5,000 attendances with implications for admissions, bed capacity, ambulance turnover, and more importantly, ED staffing.

Motor vehicle collisions (MVCs) are a major public health concern worldwide and have significant implications for disaster medicine.

A retrospective epidemiological analysis of MVC-related data was conducted using a database of the Israeli Central Bureau of Statistics. The study population included all children involved in MVCs in Israel between January 1, 2013, and December 31, 2022.

A total of 94,412 children aged 0-14 years were involved in MVC in Israel over the study period. Of these, 18,995 (20.1%) required hospitalization and treatment. The highest number of casualties occurred among individuals aged 10-14 years (44%), followed by 5-9 years (38%), 2-4 years (14%), and 0-1 years (4%). Pre-hospital and field treatment and evacuation were provided by Basic Life Support ambulances in 6,030 (31.7%) of the cases, mobile intensive care unit (MICU) treatment and evacuation was used in 2,766 (14.5%) of cases, and air transport to a trauma center was utilized in 109 cases (0.6%), military transport occurred in 22 cases (0.1%) of cases. Overall, 13,566 pediatric casualties had an Injury Severity Score (ISS) of 1-8 (71.3%), 3381 had an ISS of 9-15 (17.7%), and 1148 had an ISS of 16-24 (6%). Six hundred and ninety children had ISS OF 25-49 (3.6%), and 75 had ISS of 50-75 (0.4%). A total of 586 deaths occurred on the scene, and 2143 children were admitted to intensive care units.

MVCs resulted in a relatively high number of casualties and deaths during the 10-year study period. Efforts should be made to reduce the burden of MVCs on the Israeli childhood population.

Resilience is “the capacity to function (during) and recover successfully from adversities; ‘bounce back’ or even ‘bounce forward’.” Resilience is vital for coping with emergencies, as it was identified as a protective factor against distress and enhances compliance with guidelines issued by authorities.

A longitudinal study was conducted, measuring resilience (individual, community, and societal), positive (hope, morale, and social cohesion), and negative (sense of danger, distress) coping mechanisms periodically, five times during the protracted war between Israel and Gaza. Data were collected using structured, quantitative, validated scales. Resilience and coping mechanisms were compared across the five measurements and between evacuated versus non-evacuated populations.

Individual resilience was higher in the fifth compared to the first measurement, while community and societal resilience decreased consistently throughout the war. Morale rose while hope and social cohesion significantly decreased between measurements. The evacuated population reported significantly lower levels of resilience, social cohesion, hope, and morale, and higher levels of distress and sense of danger compared to the average scores of the overall population. Hope was the best predictor of societal resilience among the overall population, while the level of ‘support for the government’ was found to be the best predictor among the evacuated population.

Individual resilience was higher in the fifth compared to the first measurement, while community and societal resilience decreased consistently throughout the war. Morale rose while hope and social cohesion significantly decreased between measurements. The evacuated population reported significantly lower levels of resilience, social cohesion, hope, and morale, as well as higher levels of distress and sense of danger compared to the average scores of the overall population. Hope was found to be the best predictor of societal resilience among the overall population, while the level of ‘support for the government’ was found to be the best predictor among the evacuated population.

PDV (Ongoing Deadly Violence) refers to incidents where one or more attackers subject the public to life-threatening violence, often using simple means. These events are typically brief but result in many serious injuries. Saving lives and preserving health during ongoing deadly violence in a hospital environment requires effective, coordinated efforts based on a unified approach. It requires mental preparedness, and the involved parties have jointly planned, trained, and drilled their staff.

Södersjukhuset is one of Sweden’s largest hospitals for acute care. A PDV exercise was conducted at the hospital on October 2, 2024. The goal was to prepare hospital staff to handle a violent incident within a healthcare setting. The exercise involved personnel from the information desk, pediatric emergency department, and hospital security, working in collaboration with police special squad teams and local officers. Before the exercise, each department developed specific action lists to prepare its staff.

The exercise began with a realistic scenario: a couple who had lost their child acted violently in the pediatric department, using a knife and handgun, which created a simulated casualty scene with injured role players from knife and gunshot wounds. Staff responded according to the PDV plan, locked themselves in, and alerted the police and security guards. Within 14 minutes, the police had neutralized the perpetrators, and hospital staff initiated acute medical interventions. All injured role players were triaged and treated.

After the exercise, a joint evaluation was held with all participants. The police deemed the exercise highly successful, and hospital staff felt strengthened in their professional roles and their ability to handle a PDV event. In addition, psychological debriefing sessions were arranged to process emotions and reflections. To conclude, the hospital’s readiness and coordination abilities are reinforced; however, the training of staff and updating of action plans for PDV events continue.

Emergency medical care systems are essential for mass gathering events held in large stadiums. In May 2022, Nippon Sport Science University agreed with the Japan Professional Football League’s Yokohama F. Marinos to provide first aid for spectators at soccer stadiums. This first-aid system was developed mainly by paramedics, with the participation of paramedic students. In this study, we analyzed the occurrence of injuries and weather conditions across 51 games from May 2022 to September 2024. We specifically examined the patient presentation rate (PPR) and the transport to hospital rate (TTHR). We also explored the correlation between temperature, WBGT (Wet Bulb Globe Temperature), and PPR. The average annual attendance was 26,903 (±12,220). The PPR was 0.15 (±0.20), and the TTHR was 0.02 (±0.04). There were 4.69 (±5.75) injuries per game, with 88.4% of cases not requiring medical attention. However, injuries were significantly more frequent during the summer months. The incidence of patients in soccer stadiums showed a weak positive correlation with the number of attendees (r = 0.430) and a stronger positive correlation with higher temperatures (r = 0.537) and WBGT (r = 0.517). Similar trends have been reported in other countries regarding the association between PPR and temperature, and this study confirmed the same pattern. Although no cases of cardiac arrest occurred, the early intervention rescue system effectively prevented patients from becoming seriously ill. Further research is needed to develop prevention strategies, especially for heat stroke during the summer season.

Children face unique vulnerabilities during crises, necessitating specialized care. This study aims to assess the adequacy of pediatric-specific pre-deployment training provided by non-governmental organizations (NGOs) operating in crisis zones.

To identify NGOs active in disaster response, a list of those that responded to the 2023 Turkey-Syria earthquake was selected from Charity Watch’s top-rated NGOs in the International Relief & Development category. A comprehensive analysis of their public websites was performed, and NGOs were contacted for information on pediatric-specific training. Response rates and the content of training offered were analyzed to evaluate the current state of pre-deployment training.

Twelve of the twenty-three (52.1%) NGOs examined responded to inquiries. Among the responding NGOs, only one (12.5% of respondents) offered any pediatric-specific training. The sole NGO that provided such training sets a baseline minimum requirement for clinical staff to hold both pediatric and neonatal life support certificates (or equivalent). Furthermore, staff receive mandatory training on child safeguarding, as well as Integrated Management of Neonatal and Childhood Illness training. Other non-pediatric-specific courses, such as Personal Safety and Security, Psychological First Aid, and Hostile Environment Awareness Training, are also offered by this specific NGO.

This study underscores the critical need for standardized and comprehensive pre-deployment training for healthcare personnel in disaster zones, with a particular focus on pediatric care. NGO responses and practices revealed inconsistencies in training content, strategies, and programs, emphasizing the need for greater transparency. Establishing best practices and collaboration between NGOs, healthcare experts, and authorities is vital to ensure the effective care of pediatric patients in disaster zones.

The increasing frequency and intensity of disasters demand a shift in disaster medicine from reactive response to proactive prevention. As we start to think beyond the Sendai Framework for Disaster Risk Reduction, the principles of Planetary Health offer an opportunity to expand the role of disaster emergency medicine. This submission highlights the work of the Johns Hopkins Institute for Planetary Health in integrating environmental sustainability and resilience into disaster medicine through innovative, preventative strategies.

Key initiatives at the Institute include embedding biodiversity conservation into disaster planning and incorporating nature-based solutions to mitigate risks and protect vulnerable populations. Additionally, the Institute’s recovery strategies emphasize rebuilding in ways that align with environmental sustainability and long-term resilience.

These initiatives underscore the role of Planetary Health in addressing the root causes of disaster vulnerability, such as unsustainable development and environmental degradation. This approach not only enhances the capacity of disaster medicine programs but also aligns them with global sustainability and equity goals.

This case study from the Johns Hopkins Institute for Planetary Health provides a replicable model for other institutions seeking to strengthen their disaster medicine programs through transdisciplinary synergy. By shifting the focus from reaction to prevention and integrating environmental determinants of health, disaster medicine can become a leading force in building resilient, sustainable systems that safeguard communities against future crises.