Shifting environmental, social, and political climates demonstrate the need to systematically identify, prioritize, and scale local strategies for strengthening public health system resilience. The UNDRR Scorecard approach can address this challenge. Specifically, the Public Health Scorecard (Scorecard), launched in April 2020, has been used in diverse settings and translated into 15 languages. This has expanded to food security, education, and rehabilitation services. When coupled with the Delphi process, this approach achieves consensus on implementable grassroots strategies.

The Scorecard has been applied by co-authors in 20 locations across nine countries. This included pre-disaster, post-disaster, and a conflict setting covering five thematic areas, public health (n = 15), food security (n = 4), education (n = 4), and rehabilitation services (n = 1). This method requires workshop participants to discuss and then individually complete the Scorecard questions, organized around the Ten Essentials for Making Cities Resilient. Upon consensus, participants develop and prioritize actions. The Delphi process was used for 13 workshops conducted as part of a project funded by the WHO Kobe Center. This method allowed further synthesis of recommendations based on impact and feasibility.

The WHO Kobe Centre funded project promulgated further application of the Scorecard method to help guide the recovery of public health systems after the Türkiye earthquakes of 2023. This also led to the expansion of this approach into other sectors such as education and food security. Also, almost two years after the application of the Scorecard in Waco, Texas, United States, the local health district was awarded the best in Texas. The Scorecard approach can also be modified towards assessing emerging issues, which was demonstrated by application in Lviv, Ukraine, to identify and prioritize strategies for strengthening rehabilitation services.

The Scorecard approach is now a feasible methodology for identifying and prioritizing strategies for strengthening public health system resilience in conflict, disaster, and other crisis settings.

This practical report aims to introduce a Disaster Nursing Program for Nursing Students (DNPNS) at the Tachikawa Faculty of Nursing, Tokyo Healthcare University. The DNPNS is a four-year program. As a first step in the DNPNS, students learn basic disaster nursing and medicine, such as the history of disasters in Japan, how to handle corpses, and triage methods. In the second step, students acquire knowledge of the laws related to disasters and the various phases of disaster management. They deepen their understanding of disasters from meteorological and architectural perspectives. Experts in these fields are invited as lecturers for each class.

In Step 3, lectures and exercises are conducted on community disaster prevention, evacuation center management, and responses to special disasters. For community disaster prevention, students can research disaster prevention plans from various local governments and gain insight into the reality of community-based disaster prevention by presenting unique prevention strategies. They have also conducted a simulation of shelter management using cards, addressing issues that Japanese evacuation centers may face, including potential health problems during an influx of disaster victims. Additionally, students receive practical instructions from Disaster Medical Assistance Team(DMAT) members on secondary triage at first-aid stations and practice these skills. Through these exercises, the students can apply the knowledge acquired in Steps 1 and 2 to solve practical problems.

Finally, in the fourth step, a five-day practical training program is conducted. The program includes five key components: tabletop exercises for handling numerous disaster victims as hospital nurses, mass casualty incident triage simulation, shelter setup and management simulation, initial response training for disaster situations, and participation in a Disaster Base Hospital drill, where they act as either victims or nursing staff. Through these programs, focus has been devoted to developing practical disaster-nursing skills.

Social media platforms have become crucial tools for crisis communication, especially among deaf and hard-of-hearing populations. Given the global prevalence of hearing loss (over 430 million affected), effective communication strategies for this population during emergencies are vital.

This study examined four WhatsApp groups catering to the deaf and hard-of-hearing community during the 2023 Israel-Hamas war. These groups served distinct purposes: government updates, emotional support, news updates, and mutual assistance. Data science tools, including Natural Language Processing (NLP) models and sentiment analysis, were employed to analyze message frequency, content, and emotional tone.

Emergency and disaster events significantly increased daily message frequency, peaking in the early evening, especially following large-scale rocket attacks. Word frequency analysis revealed recurring themes of “hearing,” “welfare,” “problem,” “transcription,” “payment,” and “accessibility.” Sentiment analysis predominantly showed negative emotions, reflecting the community’s distress and helplessness. Government updates group saw the highest activity, particularly in the initial days, indicating a strong need for official information. However, frequent updates also led some members to leave the group due to fear. The emotional support and news update groups highlighted significant challenges in accessing information, with discussions focusing on the lack of sign language interpreters for news broadcasts and the need for better transcription services. Financial concerns regarding the cost of accessibility services were prominent. The mutual assistance group facilitated the exchange of experiences, coping strategies, and technological solutions like vibrating alarms in alerting apps. However, discussions revealed ongoing issues with real-time alert systems.

Social media has the potential to bridge communication gaps for this population during crises while highlighting persistent accessibility challenges. Our findings highlight a critical need for improved services, including accessible information dissemination and targeted alert systems, these insights can inform more effective crisis communication strategies, enhancing emergency preparedness for the deaf and hard-of-hearing community.

This presentation provides an overview and context of the medical response to the Great Tokyo Earthquake (a.k.a., The Great Kantô Earthquake) and fire that destroyed much of Tokyo and Yokohama 101 years ago. At 11:58 am on September 1, 1923, a magnitude 7.9 quake 23km beneath Sagami Bay impacted Tokyo and the surrounding six prefectures. Although tsunamis hit coastal areas over 100km away, the main cause of mortality was fires in urban centers. These fires quickly spread throughout the wooden environment and eventually combined into firestorms. Of the estimated total 105,000 deaths, 92,000 are believed to be fire-related; over 85% of Tokyo’s 60,198 fatalities have been attributed to fire. The brunt of these was east of the Sumida River around modern-day Sumida Ward, where approximately 1/6 of the population died. At one site near the present-day Edo Tokyo Museum, a cyclone of flame engulfed several thousand evacuees gathered at an abandoned riverside military supply depot.

Medical infrastructure was also heavily impacted by the loss of two thousand hospital beds and the main Japan Red Cross (JRC) warehouse. However, within one week, telegraphic communications were used to contact regional offices within the country, and in the Korean and Manchurian colonies. In addition, the US Ambassador requested aid from military units in the Philippines. Supplies and personnel soon arrived for temporary facilities; around fifty JRC centers were eventually established and continued operation into the following spring.

This presentation outlines the early post-disaster medical and public health responses and explains how they have been evaluated over time. For example, while motorized ambulances represent innovations, dependency on foreign intervention has been criticized from a security standpoint. Meticulous data management practices of the JRC, municipal government, and the Metropolitan Police Department were also a feature and resulted in published detailed reports of the responses.

Increase in temperature and natural disasters may have impacts on individual behavior and cause social destabilization; however, there is no clear evidence regarding the impact of flash flooding. The study sought to evaluate the impact of flash floods on rates of violent trauma in Texas.

Data from the Texas EMS Registry between 2018-2022 following 16 flash floods was used. Violent trauma totals were calculated within the county of the flash flood incidence. The baseline rate was established two weeks prior to the flash flood, and the post period extended two weeks post flood. Multivariable linear regression was performed to compare changes in violent trauma rates and county level covariables. Analyses were adjusted for county median income, county population, county social vulnerability index (SVI), total cost of damaged property, and the county baseline rate.

The baseline and post-flood median rate of violent trauma per county was 14.5 and 13.5 cases per week, respectively. Baseline violent trauma rates were positively correlated with county population (r=0.76), and increased SVI (r=0.53), and negatively correlated with increased income (r=-0.30). Testing showed no significant difference in the rates of violent trauma in the post-flash flood group compared to baseline (z=0.547, p=0.5843). Further analysis showed that for every $10,000 decrease in median income, there was an increase in weekly violent trauma by 2.67 cases (95% CI -0.87, 6.21; p=0.12) post flash flood.

The findings demonstrate a positive correlation between the social vulnerability index and baseline rates, and a negative correlation between county median income and baseline rates. The findings also show a potential reduction in violent trauma in counties with higher income, indicating potential disparities in community resilience. Research with a larger population of flash floods is needed to further evaluate the impacts of flash floods and the potential protective factors against fluctuations in violence rates.

Based on much public demand, emergencies are extensively covered on televised news. As most individuals acquire knowledge about large-scale events through the media, these outlets play a crucial role by delivering vital information and safety guidelines to the public. However, they also simultaneously provide viewers with vivid, unsettling, and distressing details about casualties, impending dangers, and dire predictions, which could potentially be traumatizing and deter individuals from taking the necessary proactive protective behavior concerning each threat. This study aims to assess the impact of continuous 24/7 news broadcasting on the mental well-being of Jewish Israelis during the ‘Iron Swords’ War and compare it to findings from the 2014 Conflict.

An internet-based cross-sectional panel survey was conducted on 11–12 October 2023, during the ‘Iron Swords’ War. The study focused on Israel’s adult Jewish population, enabling comparisons with a previous 2014 study.

Participants reported news consumption changes, attitudes towards newscasts (burdensome, relaxing, stressful, addictive, Fear Of Missing Out [FOMO], avoidance), opinions on 24/7 news, and anxiety symptoms. Among 802 adult Jewish participants in Israel, 83.8% increased news consumption. While more than 70% of respondents found the newscast stressful at least a medium level, more than 40% said they do not try to avoid them at all. Nearly 24% found it very addictive. Women and younger individuals reported more FOMO, stress, and addiction. More than 70% reported experiencing at least one anxiety symptom, and 21% of all four. Linear regression explained 42.9% of the variance of reported anxiety, with gender, age, news stress, addiction, and FOMO as predictors.

The results show an increase in all measurements compared to a separate study conducted using the same tools in 2014. Jewish Israelis struggled with news consumption during the recent war, harming their mental health. Heightened anxiety was observed, compared to 2014, and affected all demographics.

In the post-pandemic era, nurses are frontline workers directly involved in patient treatment and care. They may encounter serious psychological and mental problems, which can lead to emotional exhaustion. Yet, researchers have investigated the relationship between psychological capital and emotional exhaustion using total scores. Network analysis studies on psychological capital and emotional exhaustion in nurses during the post-epidemic period are lacking, which can deeply reveal the complex relationship between variables and provide a more comprehensive and accurate perspective for us to understand the interaction mechanism between these two variables.

A cross-sectional survey was conducted from December 2022 to January 2023 on 1185 frontline clinical nurses from 5 hospitals in Xi’an, China. The clinical nurses were selected using the convenience sample approach through online platforms upon the notice of hospital administrators. Psychological capital and emotional exhaustion were assessed using the Psychological Capital Questionnaire and the Chinese Maslach Burnout Inventory (CMBI). Network analyses were used for the statistical analysis.

From a network analysis perspective, “I feel exhausted” (Q3) and “I am optimistic about the future of my job” (X22) have the highest expected influence, suggesting their most significance in the network. In the community of emotional exhaustion, the statement “I feel very tired” (Q1) has the highest bridge expected influence, while in the community of psychological capital, the statement “When I have a setback at work, I have a hard time recovering from it ” (X13) has the highest bridge expected influence, indicating they have the strongest connections with the other community.

Complex patterns of relationships emerged between psychological capital and emotional exhaustion. These results have significant implications for clinical practice in the post-epidemic era. Stress management workshops with relaxation techniques and training on building psychological capital, including cultivating optimism and providing resilience training, could be implemented.

Hospital readiness is fundamental in major incidents or disasters for community preparedness. The Thai hospital’s self-assessment tool for mass casualty incidents and disasters has been developed using a systematic review process. However, to determine levels of hospital preparedness, a scoring assessment tool needs to be developed for hospital evaluation.

The scoring assessment tool, based on the Thai hospital’s assessment tool for mass casualties and disasters, was developed by 3 experts in emergency and disaster management, using the modified Delphi method and brainstorming techniques.

All key elements of the Thai hospital’s assessment tool for mass casualties and disasters were categorized according to the World Health Organization’s Six Building Blocks Plus health system framework. A Likert scale ranging from zero to five (0-5), with five representing the highest score, for ease and to standardize continuous assessment, planning, and preparedness, was applied in each element. The sum of all achieved points will represent the level of hospital preparedness: low or minimum, in need of great improvement (0-59), average or in need of some improvement (60-79), and good or in need of less improvement (79-100).

The scoring for the Thai hospital’s assessment tool for mass casualties and disasters, based on the WHO Six Building Blocks Plus health system framework, was developed. This tool can be used to determine the level of hospital preparedness and the quality assurance process.

One of the primary objectives of on-site medical services at mass gathering events is to minimize the impact on the local healthcare infrastructure. Although many case reports attempt to quantify this positive effect by expressing patient encounter volume in terms of ambulance or hospital avoidance metrics, there is no accepted definition for what constitutes an on-site medical visit that results in the prevention of formal community health services. This research aims to develop a working definition for operational use and data collection at events.

A mixed-methods research project was undertaken, utilizing an initial literature review and a set of qualitative interviews based on a questionnaire comprising 25 standardized, distinct clinical vignettes commonly found in the literature for mass gathering events. Interviews were conducted with 10 event medical doctors and 10 emergency doctors who do not do event medicine. These were transcribed and coded using standard qualitative methods, and the themes were explored until saturation was reached. The degree of agreement on hospital avoidance between interviewees and event vs. emergency doctors was recorded for each vignette.

Results are in process. Participants generally agreed on the cases’ on-site management, with some positively contributing to and others having no effect on hospital avoidance. Themes emerging from the qualitative interviews relevant to defining what constitutes avoidance included the degree of training (and hence the ability to treat and release), equipment considerations, acuity considerations, and on-site diagnostic capabilities.

A working definition of hospital avoidance by on-site medical event care is proposed. This definition can be used to quantify the positive effects of treatment on events in a standardized and reportable manner.

Mass gatherings, which can be defined as events exceeding 1,000 participants in a specific location for a defined purpose and duration, pose heightened public health risks. These risks stem from high participant density, increased interpersonal contact, and the presence of attendees from diverse regions. Temporary accommodations and food services contribute to the risk of disease transmission, while alcohol and other drug consumption can lead to risk behaviors. Given Portugal’s suitability for such events due to climate, tourism, and cultural factors, establishing a technical norm is crucial to ensure safety and preparedness.

The draft technical norm emphasizes the need for a formal registration, mandating the designation of a health focal point by event organizers. Events can be classified into risk levels (low, medium, high, extreme) based on type, participant numbers, duration, and proximity to medical facilities. The classification determines the required health resources and response measures. For low-risk events, basic life support teams and defibrillators are necessary, while high- and extreme-risk events require advanced life support and medical centers, with pre approval timelines ranging from 15 to 120 days.

Key health provisions should include pre-event planning, epidemiological surveillance, health promotion, and harm reduction strategies. Contingency plans should address food and water safety, environmental concerns, emergency exits, crowd control, and crisis scenarios. Surveillance systems must ensure data collection and daily reporting to health authorities, facilitating coordinated responses. Special considerations include managing high risk factors, such as rival groups or substance use, and providing health services (including access to water and sun protection, for instance) during long wait times or setup phases.

This norm proposal integrates health system readiness with real-time monitoring and cross-agency collaboration, underscoring the importance of comprehensive planning to mitigate health risks while supporting the success and safety of mass gatherings.

World Health Organization data suggests the Western population is aging and living longer with multiple medical co-morbidities. Octogenarians and nonagenarians have been shown to have longer patient experience times (PET) and longer boarding times in Emergency Departments (ED) than younger patients.

Automatic system-generated monthly and annual reports were examined from 2014 to 2024 to determine the frequency of attendance of patients in age groups greater than 80 years on a year-by-year basis. Data was examined using Microsoft Excel to determine trends.

ED attendances overall grew from 29,239 in 2014 to 49,560 in 2024 year to date. This represents a 41% rise in overall attendance. 2014 Raw data reveals a total of 2,194 attendances in the over 80 years of age cohort, or 7.50% of overall attendances. This increased to a full year maximum of 4,705 attendances in 2022, comprising 9.78% of all attendances. Year to date, 2024 looks to exceed that figure with 4,610 attendances to November 5th, comprising 9.30% of all attendances. Growth in attendance by over-80-year-old attendees was 52.41%. Over 90- year-old presentations increased from 365 (1.25%) in 2014 to 895 (1.81%) year to date 2024.

ED attendances in general rose over the 11 years examined (41.00%); however, the rise in over-80s attendances greatly exceeded this (52.41%). This cohort of patients is more likely to require additional services such as frailty team, occupational therapy, semi-urgent primary care follow up and transport away from the ED when discharged. A larger proportion of this cohort will also require admission, indicating a growing trend in admissions, also of a cohort likely to have a longer length of stay, with implications for acute bed capacity at a time when capacity overall is constrained.

Emergency departments (EDs) face the critical challenge of quickly and accurately triaging patients, a process essential for prioritizing care and allocating resources effectively. Current triage systems, while functional, often fall short in rapidly identifying critically ill patients, potentially delaying necessary interventions. This study aims to address these shortcomings by developing a more precise predictive model using machine learning algorithms, thus enhancing the efficiency and safety of triage operations.

The study employed an exploratory, retrospective observational design to analyze 560,336 emergency triage records from the Fourth Military Medical University’s First Affiliated Hospital, collected between 2014 and 2023. The dataset included a mix of structured and unstructured data elements, including demographic information, vital signs, chief complaints, and triage levels. Our methodology encompassed data preprocessing, feature engineering, and text embedding using the Ernie-Health-Zh, a Chinese knowledge-enhanced pre-trained language model. We divided the data into a training set (70%) and a test set (30%) and developed models using Logistic Regression, Random Forest, and XGBoost algorithms.

The XGBoost algorithm emerged as the most effective, achieving a sensitivity of 0.9555 and an AUC value of 0.9956. It showed remarkably high classification accuracy across different severity levels of emergency conditions, with AUC values of 0.9900 for Level I, 0.9680 for Level II, 0.9839 for Level III, and 0.9993 for Level IV.

The predictive model developed in this study significantly improves the accuracy of triage assessments in EDs, ensuring more effective and safer patient management. By enabling faster, more accurate identification of critically ill patients, the model optimizes the use of emergency resources and enhances overall patient outcomes. This advancement holds substantial potential to transform triage practices in emergency medicine, setting a new standard for emergency care efficiency.

This study aims to investigate whether healthcare professionals from distinct occupational backgrounds demonstrate increased interest in disaster response post-training.

An anonymous online survey (via Google Forms) was administered immediately following the training sessions. The survey collected data on participants’ years of experience, professional categories (physicians, nurses, EMTs, administrative personnel, other healthcare professionals), and self-assessed interest in disaster response both pre- and post-training. Data from 278 participants involved in practical drills and tabletop simulations were analyzed, assessing shifts in interest levels by occupational group. Interest was rated using a 10-point scale, where 1 indicated minimal interest and 10 represented maximum interest.

Nurses comprised the majority of the sample (59.92%). On average, the interest level across all participants increased by approximately 1.1 points. Physicians, EMTs, and nurses initially reported higher interest levels (mean scores of 7.87,7.73, and 7.7, respectively), each averaging about 1 point higher than administrative and other healthcare professionals. Notably, administrative and other healthcare professionals initially recorded lower interest (mean scores of 6.61 and 5.83) but demonstrated a post-training increase of approximately 2 points, surpassing the overall average improvement.

The disaster medical training program was effective in enhancing interest in disaster response across all professional groups, with the most substantial gains observed among administrative and other healthcare professionals. These groups, often attending involuntarily, likely developed a heightened appreciation for disaster preparedness through practical training, which bolstered their confidence and engagement. Such multidisciplinary training initiatives are pivotal in advancing healthcare teams’ disaster response capabilities, ultimately strengthening community resilience.

During wartime, Israeli hospitals face significant security challenges, requiring rapid shifts from routine operations to various states of emergency. Even in peacetime, hospitals maintain high levels of preparedness, regularly practicing their response to extreme events. However, since the outbreak of the Iron Swords War, hospitals have been on heightened alert, employing comprehensive strategies to address emerging threats. Those situated within conflict zones are crucial in delivering immediate medical care to the injured while managing risks such as missile attacks, bombings, and other security threats.

As a hospital outside the front-line zone, this presentation outlines our preparation and response strategies to address war-related threats such as rocket attacks and UAV incursions, support front-line hospitals by admitting transferred patients, and mitigate potential damages while saving lives. These efforts are carried out alongside continuous preparedness for and management of mass-casualty incidents (MCIs).

The preparation plan involves a multi-dimensional response strategy, including:

1. 1. Maximizing protected areas within the hospital

2. 2. Increasing stocks of equipment and essential medications

3. 3. Ensuring operational continuity in case of national system failures

4. 4. Addressing human resource challenges by training staff and maintaining resilience

5. 5. Sustaining a constant state of readiness and alert

6. 6. Collaborating with external rescue authorities and supporting hospitals in conflict zones Balancing emergency response with the need to maintain routine operations over an extended period of high alert

A robust contingency plan and preparedness for wartime scenarios are essential to ensure resilience, operational continuity, and an effective response to emerging needs. These efforts are critical to saving lives and supporting both routine and emergency medical operations.

Peace Winds Japan (PW), a Japanese NGO, is working on the Mutual Learning Project for Emergency Medical Support in Disaster-Prone Countries to enhance international cooperation in disaster medicine and improve disaster response capabilities between Taiwan, the Philippines, and Japan. As part of this initiative, PW has conducted joint training with medical teams from each country. Building on these efforts, PW collaborated with a Taiwanese civilian medical team during the Noto Peninsula Earthquake in January 2024 to support affected areas. This presentation reflects on its outcomes and challenges.

On the day of the earthquake, PW dispatched a response team and immediately initiated contact with the Taiwanese team, joining in the field on the second day after the disaster. Over a week, the Taiwanese team provided support not only in healthcare but also in other areas. Specifically, they assisted PW’s medical team with patient consultations, vital sign measurements, organizing shelters, improving sanitary conditions, and distributing supplies.

During the acute phase, when human resources were limited, the Taiwanese team’s support was essential and offered encouragement to those affected. The past training simulations proved effective, enabling smooth procedures, logistics, and communication. However, challenges remained, such as activity restrictions due to the lack of local medical license approval.

This experience reinforced the importance of mutual understanding and relationship-building during non-emergency times. Moving forward, PW intends to address these challenges and further strengthen the acceptance system for international support. It is hoped that this initiative will extend beyond Taiwan and the Philippines, spreading to neighboring countries and having a broader impact across the region.

Austere environment disaster response poses situations and challenges, many child-specific, that differ from disaster response in routine and well-resourced practice settings. Pragmatic and ethical considerations limit feasibility of including children in live disaster drills, especially in an austere environment. As part of the Beth Israel Deaconess Medical Center (BIDMC) Disaster Medicine Fellowship’s (DMF) annual 4-day immersive austere environment Pre-Deployment Course a large-scale simulation drill with pediatrics was conducted.

The Pre-Deployment Course was conducted on private undeveloped property and on the adjacent State Reservation. The 4-day course focused on preparation for and response to a catastrophic flood in a rural agricultural area of a developing country with poor infrastructure. Participants stayed in tents and ate mostly MREs. The hybrid adult live actor, pediatric low fidelity manikin simulation required our multidisciplinary group of fellows to set up their pop-up field clinic; triage 40 pediatric victims; and fully evaluate and manage 6 pediatric victims. Hot wash was conducted immediately after the simulation and cold debrief 1 month after to identify strengths, gaps, and patient care and personal challenges of austere environment disaster response.

The simulation engaged 9 fellows and 3 guest trainees; 7 faculty ran the simulation, 8 faculty acted as adolescent patients and/or caregivers. The simulation scheduled for 2 hours was terminated at 96 minutes when predesignated endpoints were met. Hotwash and 1-month cold debrief identified austere environment pediatric disaster response considerations and challenges including: vulnerabilities; medical, psychosocial impacts; evaluation; management; logistics; and patient, caregiver, and responder ethical and moral hazards. All trainees supported inclusion of pediatric simulation in future courses.

The experience provided team building, technical performance training, psychosocial stress preparation and management training for disaster response in the austere environment. The simulation planning, design, scenarios, and debriefs provide a toolkit for including pediatrics in other austere environment disaster training.

Prehospital care is a health service provided on scene and during the transfer of the patient to a definitive center. It provides life-saving support as soon as possible to enhance survival. The most common modes of transportation include Helicopter Emergency Medical Service (HEMS), Ground Emergency Medical Service (GEMS), jet planes, and fixed-wing aircraft. The General practitioners (GPs) must be competent with multiple skills to provide high-quality prehospital care, and their role starts from the first inquiry call and continues even after the safe transfer of patients to the definitive center.

A retrospective analysis of prehospital services provided by the Grande International Hospital emergency team over the last two and a half years (October 2021 to December 2023).

In total, 421 HEMS cases landed in the Grande International Hospital from October 2021 to December 2023. Among these 228 HEMS cases, a medical team led by General Practitioners (GPs) was present.

General practitioners (GPs) play a vital role as team leaders in providing high-quality pre-hospital/intra-hospital care in the majority of emergency medical service cases in Nepal. Ongoing efforts to improve and expand these services contribute to saving lives and improving healthcare accessibility in Nepal.

Although there have been many case reports of earthquake disasters describing each prevalence rate (PR) of Post-Traumatic Stress Reaction (PTSR) in the disaster-stricken area, few meta-analytic studies have tried to integrate them for preparing for the next tragic disaster. As part of a study titled “Research on Strengthening DPAT Functions and Preparing for the Nankai Trough Earthquake,” we reviewed and analyzed literature on PTSR following earthquake disasters worldwide. The study aims to evaluate the impacts of general earthquake disasters on the occurrence of PTSR and to estimate spatiotemporal PRs of PTSR in the affected area.

A systematic review is conducted by using four search engines, including Ichushi Web, PubMed, CiNii, and CINAHLin by the PRISMA guideline. We searched papers from 1970 to the present with the keywords “earthquake” OR “tsunami” AND “mental health” OR “psychiatry” OR “post-traumatic stress disorder” OR “depression” OR “psychological” OR “stress.” This yielded a total of 2,930 articles. Including criteria is a research study written in English or Japanese reporting PR of PTSD or PTSR in the disaster-affected area.

After excluding duplicates and studies that did not meet our criteria, we focused on 265 articles. Our review covers studies from various regions, with 109 from China, 50 from Japan, 18 from Italy, 16 from Indonesia, 15 from Turkey, and so on. Weighted averages of PRs integrated by periods after earthquakes were 29.0% in 3 months, 19.2% in one year, 18.8% in 3 years, and 20.2% in 10 years. The highest PR integrated by country or affected population was 60.9% in Turkey, and was 80% in the bereaved family for each. However, there were also significant research biases in some of these studies.

This study highlights the substantial psychological impact of earthquake disasters and supports the need for enhanced mental health response strategies.

Ultrasound has become a critical diagnostic tool for emergency medicine physicians, especially in low- and middle-income countries (LMICs) where access to advanced imaging technologies is limited. Despite its potential, training emergency physicians in ultrasound techniques in resource-constrained environments presents unique challenges. This study aims to explore the experiences of emergency medicine physicians undergoing ultrasound training in LMICs, focusing on the barriers faced, the benefits realized, and the impact on clinical practice.

A qualitative, thematic analysis was conducted to examine the experiences of emergency medicine physicians who completed an ultrasound training program in a low-resource setting. Semi-structured interviews were held with participants, and data were analyzed to identify recurring themes related to the training process, challenges encountered, and its effects on patient care. Thematic analysis was used to categorize and interpret the data to provide a comprehensive understanding of the training experience.

The analysis identified three primary themes: adaptability and resourcefulness, learning through practical experience, and the impact of training on patient care. Participants reported challenges related to limited access to high-quality ultrasound equipment, insufficient training materials, and inconsistent mentorship. Despite these challenges, participants noted significant improvements in their diagnostic abilities, particularly in emergency and trauma care. Physicians demonstrated innovative strategies, such as using low-cost portable devices, to overcome resource limitations. Hands-on practice was identified as crucial to skill development, with many participants highlighting the value of real-time feedback and peer collaboration.

Ultrasound training for emergency medicine physicians in LMICs presents both challenges and opportunities. The study underscores the importance of hands-on learning and adaptability in overcoming resource limitations. It also highlights the need for sustained mentorship and support to maximize the impact of training programs. Tailored ultrasound education, along with continued access to affordable and portable equipment, is essential for improving diagnostic capacity and patient care in resource-limited settings.