As global disasters become more frequent1 and healthcare worker (HCW) shortages loom2, the demand for international HCWs increases. These disasters propagate healthcare needs generated freely over geopolitical boundaries, and the global HCW workforce repository desperately needs resuscitation. Civilian and military populations internationally recognize nurses, dentists, pharmacists, and doctors as the majority of global disaster medical response teams in the HCW role. Lack of consistent global identity results in the exclusion of Physician Assistants/Associates(PAs). While the profession offers a unique opportunity to contribute to fulfilling this global HCW need, a globally recognized definition of the PA is urgently needed to augment the inclusion of PAs in responding to these healthcare needs. A loss of title clarity leads to a lack of reference. Since its inception, the PA profession has continued to grow geographically and expand in scope of practice, and its role is a critical component in global HCW response efforts. By obligating the World Health Organization (WHO)3 to officially define and formally recognize the PA title, PAs and PA-like roles functionally assume ownership of a known archetype, solidifying itself to keep pace with international HCW rosters in fulfilling global disaster medical needs.

Systematic Article Review, word search. Keywords: global; Physician Assistant/Associate; clinical officer; healthcare; shortage; occupation; feldsher; title; classification; paramedicine

Actionable items to support and put into use once this PA Title Authorization takes place would be an international exchange program for starter PA programs worldwide. Title formality develops a consistent framework when discussing special interest groups, international relations, and building organizations. It also conveys a common search term; when others are looking into PA-like roles, they are more likely to find PA. Increasing grammatical coherence captures multiple references under the varying terms worldwide.

Require WHO to formally recognize PA title in the ISCO.3

The spread of mis- and disinformation on mobile and messaging apps during the COVID-19 pandemic not only fuelled anxieties and mistrust in health authorities but also undermined the effectiveness of the overall public health response. For context, mobile and messaging apps help users stay informed and connected to their families, friends, colleagues, and communities. However, during the COVID-19 pandemic, these apps were also one of the primary channels where misinformation and disinformation circulated.

Recognizing the importance of including mobile and messaging apps in risk communication and emergency response strategies, the World Health Organization (WHO) and some countries in the WHO Western Pacific Region independently piloted initiatives to reach messaging app users, meet their evolving information needs, and streamline health ministry communication.

The enhanced use of mobile and messaging apps enabled consistent and timely communication, improving coordination during the COVID-19 pandemic. Leveraging their features also helped identify and potentially fill crucial information gaps, mitigating the harms of mis- and disinformation and fostering stronger trust in health authorities.

The findings from the work carried out by WHO and countries in the Western Pacific Region identified some promising innovative communication interventions using mobile and messaging apps. While these interventions should be further explored and evaluated, they have demonstrated that interventions need to be proactive, flexible, and able to adapt to changes in misinformation and disinformation content shared through messaging apps.

Hospital disaster preparation involves creating systems and processes to enhance a hospital’s readiness for emergencies. The first step in crisis management is having a disaster management strategy, mandated by international agreements like the Sendai Framework. The 2015 Nepal earthquake highlighted hospitals’ capacity concerns, leading to the inclusion of hub and satellite hospitals in disaster plans. Later, infectious disease management and lessons from COVID-19 were incorporated. The disaster plans for Nepal’s 25 hub hospitals, collaborating with the Health Emergency Operation Center (HEOC) and the Provincial Health Emergency Center (PHEOC), were updated. Workshops aimed to empower participants to own the hospital plans. The Hospital Disaster Preparedness and Response Plan (HDPRP) addresses preparedness, response, and recovery, including COVID-19 management. Developed through testing, the HDPRP, along with workshops and engagement strategies, bolsters hospitals’ disaster response capabilities.

During times of medical surge, alternative care sites (ACFs) offer additional bed space for expansion of inpatient services. However, traditional ACFs often fail to have adequate infrastructure to support robust clinical operations (lack of adequate wraparound services, such as lab and radiology) and cannot usually provide anything other than subacute services. Hotels are most closely proximate to hospitals in many ways: individual rooms with toilets and showers, space for a kitchen, adequate elevators to accommodate stretchers, PA systems, etc. Medium-sized and convention-sized hotels could be converted to hospital space, offering the potential for wraparound services that allow admission of all patient types, including ICU and general med-surg patients. This research was funded by the US Department of Defense as part of the “Modular/Convertible Capability Pilot Project” to increase medical surge capabilities and capacities to care for our Nation’s combat casualties and to inform nationwide changes to the existing National Disaster Medical System (NDMS).

Since ACFs operate outside of traditional hospital buildings, hotels present a viable option for an ACF. The result of this project was Team Colorado’s Hotel2Hospital Playbook, which provides instructions and guidance for the just in-time conversion (within 2-4 weeks) of any hotel into a hospital. The Playbook includes strategies to select and engage a Partner Hotel; guidelines for using, augmenting, and adding to the existing hotel infrastructure to create a hospital-like care setting; an approach for converting hotel rooms into patient care rooms, clinical equipment, and staffing needs; and how to establish services such as Lab, Pharmacy, and Radiology in a hotel facility. The H2H Playbook includes architectural drawings, engineering plans, checklists, and other resources that hospital emergency management personnel and other emergency preparedness professionals can use.

Global Emergency Care Skills (GECS) is an award-winning Irish non-profit organization founded in 2008 that provides high-quality emergency care training and education to healthcare professionals in low to middle-income countries (LMICs) in Africa, where trauma remains a leading cause of death. This study presents a multimodal analysis of trauma theory and skills training for emergency physicians, nurses, clinical officers, and paramedics in Lusaka. Combining quantitative assessments, qualitative feedback, and observational data to evaluate the effectiveness of different training approaches and the participants’ experience of these approaches.

A mixed-methods approach was employed to analyze the impact of trauma training. Quantitative data were collected through pre- and post-training assessments to measure changes in clinical competence, including technical skills and non-technical skills. Qualitative data were gathered through structured interviews and focus groups with participants and trainers to assess perceptions of the training’s relevance, feasibility, and effectiveness. Additionally, observational data from simulated trauma scenarios were analyzed to identify performance improvements and team dynamics.

The multimodal analysis revealed that this trauma training significantly improved the participant’s confidence and clinical competence. Quantitative findings showed marked improvements in trauma management skills, especially in areas of rapid assessment and management. Qualitative data highlighted the importance of low-cost, adaptable

simulation methods, such as task trainers and role-playing, which allowed for realistic training despite limited resources. Observational data indicated enhanced teamwork and communication in high-stress trauma scenarios. Participants reported increased satisfaction with training that was tailored to local resource conditions and healthcare contexts.

Skills and simulation-based trauma training, when analyzed through a multimodal lens, prove to be an effective and adaptable tool for improving trauma care in LMICs. By integrating quantitative, qualitative, and observational data, this study demonstrates that such training enhanced both technical and non-technical skills among the course’s participants, contributing to improved patient care.

Pericarditis is a relatively uncommon condition in emergency settings but is frequently encountered in cardiology. Viral infections are the most common cause, though it can also result from autoimmune conditions, cancer, and, in this case, trauma.

A 70-year-old male patient attended the emergency department with sudden-onset, sharp, pleuritic, central chest pain. The patient reported having a fishbone stuck in his throat earlier in the day, which he had swallowed with food boluses and was pain-free after. Assessment revealed signs consistent with pericarditis, with diffuse ST segment elevation on electrocardiogram. Blood tests showed elevated inflammatory markers and negative Troponin T. A diagnosis of acute pericarditis was made, and the patient was admitted to cardiology for workup and treatment.

A computed tomography (CT) scan of the thorax, abdomen, and pelvis was performed, given his persistent pain despite analgesia. It showed a foreign body at the mid-lower thoracic oesophagus, perforating through the anterior and posterior walls with surrounding inflammatory changes, with moderate low-density pericardial effusion with features of pericarditis. Emergency esophagogastroscopy was arranged, together with repair of the perforations with surgical clips by General Surgery. The patient recovered uneventfully and was discharged after one week. An interval CT Thorax was done in the outpatient setting six weeks post-discharge, showed no mediastinal collection or pneumomediastinum, and an interval decrease in size of the pericardial effusion.

While viral infections remain the top cause of pericarditis, this case highlights the importance of maintaining a broad differential diagnosis of etiologies when diagnosing pericarditis. This necessitates thorough history taking and a low threshold for CT imaging, especially in older patients without preceding respiratory symptoms, immunosuppression, or known autoimmune conditions, to uncover atypical causes. Early identification and intervention are crucial to prevent complications and ensure favorable patient outcomes.

Preparing medical students for disaster response is a complex challenge that goes beyond theoretical knowledge. To address this, an innovative educational tool in the form of an interactive board game has been created. The game is designed to simulate real-life emergency scenarios, engaging students in critical thinking, teamwork, and effective decision-making under pressure.

The board game utilizes open-source guidelines to simulate realistic emergency scenarios, requiring strategic decision-making. Players assume roles such as Team Leader, Doctor, Medical Support, Logistics Coordinator, and Psychologist, each contributing unique skills. Game mechanics include triage, resource management, and resolving ethical dilemmas, such as prioritizing care with limited supplies or addressing psychological distress. Scenarios progress through timed rounds, emphasizing urgency and collaboration.

The board game was evaluated internally for educational content and design feasibility. The scenarios integrate real-world medical protocols, emphasizing decision-making under pressure. The game’s theoretical framework was validated against established emergency medicine practices, highlighting its potential to foster engagement and collaborative learning among medical students. The evaluation focused solely on aligning the game content with open-source medical standards and ensuring an accurate representation of crisis conditions.

This game introduces a fresh approach to training healthcare students in disaster response. Combining realistic scenarios with a strategic, team-based format creates a stimulating and effective learning environment. The game shows potential as a valuable tool for medical education, providing a risk-free environment for developing critical skills in disaster response and preparing students to handle real-world crises confidently and competently.

The COVID-19 pandemic posed an immense threat to one million Rohingya from Myanmar living in the world’s largest and most densely populated refugee camps in Cox’s Bazar, Bangladesh. In response to the crisis and lack of COVID-19 testing as well as lack of awareness and widespread stigma against the disease, a global nonprofit, HAEFA, implemented “COVID-19-like Symptom Monitoring and Patient Follow-up System for the patients under home quarantine” in Kutupalong and Balukhali refugee camps in Cox’s Bazar. The main objective of the monitoring by nine trained Rohingya volunteers by phone was to ensure prompt identification of severe symptoms (breathlessness and others) and hospitalization. We present here an evaluation of the prevalence of COVID-19-like symptoms, the development of severe disease requiring hospitalization, and mortality.

Deidentified patient data (n = 553) collected from HAEFA’s Symptom Monitoring and Patient Follow-up System between September 1, 2020, to April 30, 2021, were analyzed for a comprehensive analysis of COVID-19-like disease within the camps.

A total of 553 patients with COVID-19-like symptoms were registered at two HAEFA clinics. The mean age of the patients was 19.18 years, three patients were > 65 years old, and 53% (n = 293) of the patients were successfully followed up for 14 days. 95.85% of the followed-up patients stayed under home quarantine during the entire period. 91.2% experienced fever, and 23.7% had at least one risk factor for COVID-19. 12.18% of patients developed shortness of breath who were referred to nearby hospitals. In 21.72% of households, at least one family member developed similar symptoms. There were no reported mortalities.

The home-based, remote symptom monitoring system by trained community volunteers successfully followed up 53% of patients (n = 293) with COVID-19-like symptoms for 14 days. This method helped detect early severe symptoms among 12% of patients under home quarantine and arranged effective referral for hospital-based management without mortality.

Uninterrupted access to medical communications during disasters is necessary to optimize disaster preparedness, response, and patient outcomes. Robust, data-driven approaches to understand telecommunication network performance during and after disasters are necessary. The objective of this pilot study was to identify patterns in network disruption during natural disasters to enable characterization of performance and inform standards.

Network performance data from multiple mobile and fixed cellular network carriers, provided by Ookla For Good, was analyzed to characterize performance during three major disasters: Hurricane Michael, Panama City, Florida (October 10, 2018), Hurricane Ian, Fort Myers, Florida (September 28, 2022) and Puerto Rico earthquakes (December 28, 2019 – January 11, 2020). Time series analysis and geospatial analysis were conducted on the available network performance data for these regions before, during, and after the disasters to identify patterns of change in network latency and download and upload speeds.

Despite substantial gaps in data (missing, uneven, and time-restricted datasets), distinct patterns of impact and recovery of network performance were identified. Panama City experienced the most severe disruptions, with significant declines in download and upload speeds and prolonged latency across both mobile and fixed-line networks. Fort Myers showed a similar trend, with marked drops in network performance following Hurricane Ian, although most providers demonstrated a strong recovery over time. In contrast, Puerto Rico was less affected by the earthquake, exhibiting minimal volatility in network performance.

This analysis identified varying degrees of network resilience across different locations, carriers, and disasters. Additional data could permit the development of an intelligent model that is capable of predicting network performance during disasters. Understanding how hurricanes and earthquakes impact telecommunications infrastructure can inform stakeholders about expected network conditions, guide the development of resilient systems, and be used to set minimum standards that ensure continuity of medical communications during natural disasters.

Increasing patient visits to the emergency department (ED) at Sengkang General Hospital led to overbooking in the orthopedics specialist outpatient clinic. This delayed follow-up care for fractures and dislocations, which in turn impacted timely patient management. A quality improvement project aimed to increase the percentage of ED patients with fractures and dislocations who receive follow-up appointments within two weeks to 80%.

An initial audit revealed that only 20% of patients received follow-up appointments within the target timeframe. Root cause analysis identified several key issues: junior ED doctors, with varying levels of system-based knowledge, often overbooked appointments; communication between doctors and administrative staff was inconsistent; and demand for orthopedic appointments exceeded availability.

Two Plan-Do-Study-Act (PDSA) cycles were implemented. PDSA 1 focused on reducing demand through appropriate referrals and scheduling duration, while PDSA 2 increased clinic availability by adding more appointment slots. Together, these interventions led to a sustained positive change. After PDSA 1, performance initially improved but then declined. PDSA 2 produced a statistically significant, sustained improvement, with performance stabilizing above the targeted 80%.

Regular audits continually track progress, and new doctors are provided guideline briefings. Patient satisfaction feedback is also being reviewed. This PDSA approach could be applied to similar specialist clinic appointment wait times issues.

The role of Point-of-Care Ultrasound (POCUS) continues to expand in the prehospital environment, with more services adopting this technology to facilitate earlier diagnosis and treatment. While this technology has been used in Helicopter EMS for over a decade, it has only recently entered the ground EMS arena. In the United States, fewer than 10% of EMS agencies have POCUS programs, with most use in air EMS services. As portability, durability, and cost have improved, it has allowed this technology to be utilized in several life-saving areas. This, coupled with the increasing literature base demonstrating the ability of paramedics to perform POCUS with accurate interpretation, has opened the possibility of its use in this space. Significant applications in the prehospital environment include identifying life-threatening traumatic injuries such as pneumothorax, cardiac tamponade, and abdominal bleeding, as well as differentiating heart failure from COPD in critically ill patients with respiratory distress. Furthermore, POCUS can be used in early assessment of ROSC in cardiac arrest, as well as determining hemodynamics and volume status to guide resuscitation. This case series will focus on various clinical scenarios from a large urban ground EMS service that has adopted POCUS in its agency. The case series will include differentiating causes of dyspnea, identification of traumatic injuries, and its use during cardiac arrest management. We will highlight how POCUS was utilized in this setting and how care was changed based on the POCUS findings.

On January 1, 2024, a magnitude 7.6 earthquake struck the Noto Peninsula in Ishikawa Prefecture, prompting patient evacuations at several hospitals. We investigated the primary causes of hospital evacuations during the acute phase. From July to September 2024, surveys were conducted at seven of the nine emergency-designated hospitals located in northern and central Noto, as well as at two emergency-designated hospitals in Kanazawa City. These surveys covered damage to infrastructure, buildings, and staff, along with basic hospital information such as patient numbers, bed capacity, and the number of dialysis patients. On-site interviews were also conducted. Based on this information, we analyzed the hospitals that carried out patient evacuations and the causes for these evacuations.

Out of the nine hospitals surveyed, six conducted patient evacuations. An analysis of the causes of patient evacuations within the first 72 hours following the disaster, focusing on the relationship between evacuations and factors such as water supply disruptions, power outages, gas supply interruptions, and building damage, revealed that seven hospitals experienced water supply disruptions. Among these, five hospitals evacuated dialysis patients. Of the two hospitals that did not conduct evacuations, one had no dialysis patients at the time of the disaster. At the same time, the other was able to continue dialysis services due to sufficient water provision from external support, despite the water disruption. After 72 hours following the disaster, evacuations were also conducted due to building damage, and transfers of patients with chronic illnesses were carried out.

During the acute phase of a disaster, the transfer of dialysis patients may become necessary due to disruptions in water and sewage systems, even if there is no risk of building collapse. It is therefore essential to reinforce water and sewage infrastructure, utilize well water, and enhance water supply systems for use during disasters.

During the initial wave of the COVID-19 pandemic, our hospital established a task force to coordinate efforts across the institution in response to the growing health crisis. As the first wave began to subside, the hospital scaled down its response capacity and conducted a survey to assess the experiences of staff members.

The survey aimed to inform measures to strengthen preparedness for subsequent waves. Key topics included levels of stress, concerns about infection, attitudes toward future involvement, and an open-ended section for additional comments. Data collection was conducted online.

A total of 338 responses were received, with nurses comprising 57%, physicians 12%, and other staff 31%. While 45.9% provided favorable feedback regarding the response measures, 65.6% reported experiencing mental stress, 50.5% physical stress, and 79.3% expressed concern about contracting the virus. Approximately half (49.1%) indicated their intention to participate in the response to future waves, though 27.5% expressed reluctance.

The survey revealed diverse suggestions for improvement, primarily related to command structure, information dissemination and sharing, infection control protocols at various stages, and mental health support for staff. Notably, perceptions of the same measures varied significantly, highlighting the need for careful communication. Effective risk communication, which is crucial during public health emergencies, was identified as a key area for improvement. Both management and frontline staff would benefit from enhanced understanding of risk communication strategies.

The unprecedented nature of the pandemic response placed significant mental and physical burdens on healthcare workers, coupled with high levels of concern about infection. The findings underscore the importance of thoughtful communication, particularly in crises, where messages can be perceived differently depending on the recipient’s perspective.

Disasters place considerable stress on systems. The role of laypersons in disasters cannot be overlooked. A course was developed by Disaster Volunteer Corps, Singapore General Hospital, for laypersons, focusing on principles of basic disaster management and interventions. The course included scene safety, triage, emergency communications, and basic lifesaving procedures. Emergency physicians supervised emergency medicine residents and trained medical students who conducted the sessions. This paper focuses on the feedback from the pilot conduct of the course.

The course was delivered over two phases; Phase 1 was delivered online. Phase 2 was delivered in person, culminating in a simulated mass casualty incident. Course feedback was sought through an online form. Descriptive statistics are used to display the quantitative feedback while grouped thematic feedback is presented for free text feedback.

35 laypersons participated, with 24 providing feedback. Prior to the course, 50% rated their own skills and knowledge as “Poor”. Post-course, the majority of them rated themselves as “Good”, with a minimum rating of “Acceptable”. This shows that the course provided basic knowledge and skills for responding to an MCI.

Participants noted that: i) course objectives were clear; ii) audio and visual aids and doctor-medical student pairs facilitated an effective learning experience; iii) facilitators were “knowledgeable” and provided “useful feedback and advice”. The duration of the course was deemed suitable by most participants. Participants also fed back that they would seek opportunities to upskill. The overall rating of the course was high, with all participants receiving either a “Good” or “Excellent” rating. All participants would recommend the course to others.

The positive feedback received and the improvement in the knowledge of participants highlight the success of this pilot program. Given the demand by laypersons keen on applying themselves in basic disaster response, more work needs to be done in refining this course model for future conduct and expansion.

The National Health Institute Ricardo Jorge (INSA), in collaboration with the Local Health Unit of Castelo Branco (ULSCB) and local authorities, implemented comprehensive epidemiological surveillance during the BOOM Festival 2023, held from July 20-27 in Idanha-a-Nova, Portugal. This multidisciplinary psytrance festival, attracting around 40,000 attendees from 169 countries, presented unique public health challenges due to high interpersonal contact, diverse international attendance, and temporary accommodation facilities that increase the risk of infectious disease transmission, injuries, and substance-related incidents.

The primary goal of this collaboration was the early detection and timely response to health risks. Real-time health monitoring was conducted using data collected from the “Boom Medical Service” field hospital, the Kosmicare facility (dedicated to psychological care), and ULSCB (Local Health Unit of Castelo Branco) units, including the Idanha-a-Nova Health Center and Hospital Amato Lusitano. A daily report compiled health data, analyzed trends, and identified emerging risks, which was then shared in briefings with key stakeholders, including civil protection, law enforcement, and festival organizers.

The epidemiological team comprised 17 members, including public health physicians, general practitioners, EUPHEM program microbiologists, and medical students. Key observations included a notable increase in gastrointestinal complaints, prompting further investigation into potential exposures. Surveillance data revealed various health issues, such as wound care (33.1%), altered consciousness (10.7%), musculoskeletal complaints (12.4%), ENT problems (7.7%), and gastrointestinal issues (6.0%).

The festival setting demonstrated the importance of real-time surveillance, integrated health responses, and multidisciplinary collaboration to safeguard public health at mass gatherings. These measures emphasize the need for adaptable strategies and ongoing evaluation to optimize health interventions in similar high-risk environments. This experience also highlights the role of public health in mitigating risks while promoting safer, enjoyable events.

The Hajj pilgrimage, a significant spiritual journey for Muslims, occurs annually in Mecca, Saudi Arabia, attracting millions of participants from diverse backgrounds worldwide. This surge in pilgrims poses substantial challenges for healthcare services, as many face health risks due to physical exertion, dehydration, and exposure to infectious diseases. The unique healthcare demands during Hajj necessitate a thorough understanding of the quality of care provided and the challenges faced by medical convoys.

This observational retrospective cross-sectional study involved 295 patients transferred from Makkah and Madinah hospitals to Arafat via a specialized medical convoy service during the 2023 Hajj season. Data were collected from electronic patient data sheets, documenting demographic characteristics, comorbidities, diagnoses, transfer details, and the Risk Score for Transported Patients (RSTP).

Among the 295 patients, the majority were males with an average age of 63.16 years. The most common nationalities were Asian (48.1%) and African (28.5%). Significant comorbidities included hypertension (34.2%) and diabetes mellitus (33.2%). RSTP indicated that 96.6% of patients had scores below 6. Nearly half were discharged within 72 hours post-transfer, while a small percentage experienced deterioration or mortality. Most patients (58.3%) did not receive any medications or anesthesia, although 31.2% were administered analgesics. Common diagnoses included fractures (15.3%) and heat stroke (10.5%). Univariate logistic regression analysis revealed significant associations between higher RSTP and factors such as older age, presence of arrhythmias, need for respiratory support, lower Glasgow Coma Scale scores, total score, and blood pressure.

This study highlights the diverse demographics and significant comorbidities of patients transferred during Hajj, indicating the need for tailored healthcare strategies. The strong association between higher RSTP scores and factors such as age and arrhythmias underscores the importance of enhanced monitoring during transport. It is crucial to develop protocols that ensure patient safety and optimize outcomes in future healthcare delivery during Hajj.

Mass gatherings present unique challenges and opportunities for public health systems. Effectively managing these events ensures attendees’ safety and well-being and contributes to a lasting public health legacy by strengthening health systems and enhancing global health security. The evolution and activities of Mass Gathering Medicine are examined through the lens of an annual gathering of millions: the Hajj. By effectively addressing the health challenges associated with mass gatherings, host nations can transform these events into opportunities to strengthen health infrastructures, promote international collaboration, and leave an enduring public health legacy.