The congressionally directed NDMS Pilot Project evaluates civilian medical system readiness to manage 1,000 repatriated casualties daily over 100 days from a conventional near-peer conflict. This component simulated patient throughput in NDMS-enrolled healthcare facilities within the National Capital Region (NCR) to assess capacity and identify constraints. Researchers developed projected combat casualty cases to accurately predict healthcare resource needs, treatment phases, and patient throughput under high-volume conditions.

Emergency Medicine physicians conducted a literature search and analysis incorporating recent US military experience and peer-reviewed medical literature to project likely injury patterns. Researchers analyzed 1,817 de identified trauma cases from GWU Hospital (2018-2022) and 989,989 cases from the National Trauma Data Bank (2016-2021) to capture similar injury profiles. A prospectively developed Combat Casualty Case Data Tool tracked demographics, ICD-10 codes, medical specialty requirements, bed types, and timelines for sequential treatment phases. Formatted in Excel, the tool enables simulation operators to adjust casualty types and prevalence, examining impacts on resource availability and patient flow. Each case includes an “Arrival Severity Designation” for triage priority, while patient journey maps outline “Optimal Patient Journey Time” and resource needs.

This approach produced 204 casualty cases, representing a distribution of anticipated injury types and resource demands. This case collection promotes realistic modeling to assess NDMS capacity, with structured data supporting precise tracking through patient care phases from airfield arrival and case distribution, care throughput, recovery, and indicated rehabilitation until NDMS discharge.

The detailed casualty cases are essential for understanding and planning the NDMS surge capacity that respects clinical standards. By capturing phase-by-phase patient care needs that are matched to healthcare facility capabilities, this model supports accurate healthcare resource assessment and guides future NDMS projects on patient throughput and resource allocation. Future versions could incorporate more detailed rehabilitation and residential care needs for more accurate end-to-end healthcare throughput projections.

The SENS (Environmental and Neurosensory Simulation) Center was conceived as a cutting-edge facility to train prehospital emergency teams, military personnel, and other crisis responders through high-fidelity simulations. Initial specifications outlined ambitious targets, including 360° immersive video, a temperature range from 0° to 30°C, limited precipitation control, and a basic olfactory spectrum.

Through rigorous benchmarking and international collaboration, the SENS team refined and expanded these capabilities to meet training demands more effectively. Notable advancements include:

1. • Expanded Temperature Range: Enhanced from the planned 0°–30°C to -5°–40°C, plus simulated heat radiation, allowing for scenarios in extreme cold and heat.

2. • Precipitation and Snow: Rain simulation was upgraded from 0–10 mm/h to a substantial 0–30 mm/h, with the added capability to generate snowfall up to 5 cm/h—meeting critical training needs for mountain and cold-weather operations.

3. • Environmental Opacity and Olfactory Simulation: Opacification from smoke and fog now reaches up to 95%, enhancing visibility training under adverse conditions. The range of odors was broadened to include sulfur, rot, blood, and turpentine, providing a sensory depth essential for realistic emergency scenarios. Some limitations arose, primarily due to technical and financial constraints:

4. • Projection Field: Although initially targeting a 360° immersive experience, technical considerations restricted video projection to a 270° arc.

5. • Humidity Control: The initial target of modulating hygrometry from 30% to 100% was postponed due to the complexity of integrating humidity control into the existing system within budgetary limits.

Overall, the SENS facility represents a significant leap forward in environmental simulation for crisis training. Despite certain compromises, it has achieved a level of sensory integration that sets a new standard in the field, providing trainees with an unparalleled immersive experience that enhances their readiness for real-world emergencies.

The International Federation of Medical Students’ Associations (IFMSA) organizes the International Training on Disaster Management (ITDM) workshops to equip medical students and future health professionals with the knowledge and skills necessary to contribute effectively to disaster risk management and humanitarian response. This abstract reviews the outcomes of international training workshops conducted over three years, focusing on disaster risk reduction, international humanitarian law, and the right to health in disaster scenarios.

Three-day international training sessions targeted medical students from various countries. Key outcomes were assessed through attendance records, post-training evaluations, and engagement in global networks and fieldwork opportunities.

Eight international trainings were conducted, engaging over 70 medical students from diverse backgrounds. Post training evaluations indicated a significant increase in participants’ understanding of disaster preparedness, response, and advocacy skills. Participants reported enhanced capabilities to engage in meaningful youth participation and contribute to policy discussions regarding health rights during emergencies. Furthermore, participants successfully joined international networks, leading to collaborative initiatives in disaster management.

The ITDM workshops have equipped future health professionals with the skills and knowledge necessary for disaster response. Through this program, participants are empowered to advocate for ethical standards in health emergencies and strengthen global collaboration among youth in the medical field. Such outcomes demonstrate the urgent need to include education on disaster risks in the training curriculum for medical students worldwide, ultimately contributing to more resilient health systems in the face of disasters.

Military-targeted terrorism is a persistent global threat that affects national security and stability. This study analyzes the global trends, key perpetrators, and characteristics of terrorist attacks targeting military entities over five decades using data from the Global Terrorism Database (GTD).

The GTD was utilized to extract incidents from 1970 to 2020, focusing specifically on attacks targeting military entities. Descriptive statistics were employed to identify trends in attack frequency, casualties, and the most active terrorist groups. The study classified incidents by attack and weapon types and assessed the impact across 102 countries and regions. Geospatial analysis was conducted to visualize the distribution of incidents and identify high-density regions using geographic information systems tools.

From 1970 to 2020, there were 5,534 terrorist incidents targeting military personnel, causing 19,971 fatalities and 23,865 injuries globally. Activity showed significant fluctuations, with a notable rise after 2000. The Middle East & North Africa were the most affected region with 1,915 attacks (34.6%), followed by South Asia with 1,534 attacks (27.72%) and Sub-Saharan Africa with 808 attacks (14.6%). The most affected countries were Iraq (3,989 deaths, 5,132 injuries), Afghanistan (3,738 deaths, 4,470 injuries), and Syria (1,707 deaths, 1,709 injuries). Top terrorist groups, including the Taliban and ISIL, were responsible for many of these attacks. Bombings/explosions were the most common attack type, occurring in 3,138 incidents (56.70%), followed by armed assaults in 1,348 incidents (24.36%). Visual clustering identified potential hotspots, such as Baghdad, Mosul, and Fallujah in Iraq; Kabul in Afghanistan; and Maiduguri in Nigeria, with high fatalities.

This study highlights the ongoing and evolving threat of terrorism targeting military personnel. The findings stress the need for improved counter-terrorism strategies and greater international cooperation. By understanding historical trends and attack characteristics, policymakers and military strategists can develop more effective interventions to safeguard military personnel and assets.

In preparation for the Paris 2024 Summer Games, the French national public health Agency anticipated increased environmental and infectious risks, including heat waves, arboviruses, measles, and foodborne outbreaks, as well as tension on drug stocks. Strengthening the capacity to detect, alert, and adapt preventive actions was essential to ensure a timely response to health emergencies. Since the Games, the Agency is conducting an after-action review to learn from the experience for future mass gatherings.

The Agency put in place a specific health surveillance protocol for the Games from July 8 to September 15, 2024. The Agency provided daily and weekly reports to health authorities, along with risk analysis based on epidemiological criteria, in the event of a health incident. Though relying on existing syndromic and specific surveillance, the Agency seized the opportunity to develop new field surveillance systems in collaboration with first aid responders. This enriches the knowledge on mass gatherings and strengthens the Agency’s line of conduct and responsiveness for future events. The Agency identified key prevention messages for travelers and Games spectators by collaborating with French health authorities, international entities, and the Games organizer. This led the Agency to adjust its internal organization during the Games while continuing to pursue its ongoing missions.

Although there were no major health alerts during the Olympic Games, the sanitary surveillance of this event should leave a useful legacy: knowledge of relevant indicators or systems for early detection of signals during a mass gathering, providing timely reassurance to health authorities to contribute to preventive or control measures, and fluid communication between public and Olympic stakeholders.

This case report highlights the management of a 53-year-old female with acute stridor and respiratory distress, attributed to a large thyroid mass. In the emergency department at AIIMS Bhopal, an awake video laryngoscopy technique was used to secure the airway, positioning the patient in the right lateral decubitus after topical nebulization with 4% lidocaine. This approach allowed for safe, effective visualization of glottic structures, avoiding potential complications linked to traditional intubation.

Significant Findings:

• • Technique Adaptation: The use of video laryngoscopy, especially in an awake state and lateral positioning, demonstrated an innovative airway management approach for difficult airways due to thyroid enlargement.

• • Enhanced Visualization: The video laryngoscope provided clearer glottic visualization, ensuring precise and timely intubation, which is critical in cases of acute respiratory distress.

• • Impact: This case underscores the value of adaptive strategies in emergency airway management, particularly for patients with complex anatomical challenges. The successful outcome emphasizes that, in settings with limited alternatives, awake video laryngoscopy in lateral decubitus is an effective technique to enhance patient safety.

• • Lesson Learned: In managing emergency airways complicated by anatomical abnormalities, particularly in resource-constrained environments, the combination of awake video laryngoscopy and lateral positioning can offer a safer, more controlled approach. This technique may serve as a reliable alternative in situations where standard approaches may fail or carry higher risks.

Emergency Medical Teams (EMTs) must compile daily reports of 91 Minimum Data Set (MDS) items for each operational site during disaster responses. This requirement demands extensive data aggregation into the standardized EMT MDS data format, creating a significant administrative burden in resource-constrained settings. While paper-based medical records remain essential in austere environments, manual compilation consumes critical time and resources. This preliminary research explores the feasibility of an automated approach using image analysis technology.

The exploratory development investigated three technical components: 1) Structured paper form design optimized for MDS parameter extraction through strategic placement of checkboxes and data fields; 2) Experimental implementation of Python-based image processing system with OCR capability and CNN-based checkbox recognition; 3) Data conversion pipeline generating CSV files compliant with EMT MDS eDATA format. Initial testing utilized simulated medical records to assess technical feasibility.

Preliminary testing demonstrated the technical viability of automated data extraction and EMT MDS eDATA format generation. A convolutional neural network (CNN) model, trained with 1,504 data samples for checkbox recognition, achieved high accuracy metrics (accuracy, precision, recall, and F1-score all 0.98) in validation testing. The automated system reduced processing time from 20 to 10 seconds per medical record compared to manual data entry. The prototype system successfully generated standardized CSV outputs while reducing operator fatigue through automated data compilation.

This preliminary investigation demonstrates the successful bridging of paper-based medical documentation and digital reporting requirements in disaster response settings. The achieved 98% accuracy in data extraction and 50% reduction in processing time establishes a proof-of-concept for automated EMT daily reporting. Further development will focus on algorithm optimization for enhanced accuracy and speed, mobile application development for improved field usability, and systematic validation through multi-user testing under simulated operational conditions. This solution provides an efficient pathway for both mobility-focused EMTs and electronic health record backup strategies.

Human resource shortage frequently arises in hospital disaster response. Medical students may fill the gap with additional education on disaster response operational capabilities, having their primary medical knowledge and understanding of operations in hospitals through clinical clerkships. To make them join in the operation, a curriculum based on the hospital disaster response manual is needed.

The tasks in a university hospital’s disaster management manual were extracted and categorized to determine whether they should be included in the curriculum. Then, the necessary tasks were broken down into component skills to be the targets for medical students to acquire in a designed curriculum. The developed curriculum is piloted on volunteer medical students, and they are proposed to participate in the hospital disaster drill.

The four categories were defined to determine the placement of the extracted tasks based on medical students’ capabilities: a) immediately capable, b) capable with basic training, c) capable with advanced training, and d) incapable. The curriculum should include tasks in b) and c); the latter requires additional education. Of the 451 tasks identified, 87 (19%) fell into category a), 182 (40%) into b), 40 (9%) into c), and 142 (31%) into d). The component skills from b) and c) included communication equipment operation, information gathering, and documentation. Consequently, the curriculum focused on information handling and communication procedures, and primary disaster medical skills were added. The preliminary implementation of five sessions in the curriculum made 17 volunteer medical students more interested in the field. Some participated in the hospital disaster response drills, and the hospital staff recognized their capabilities.

A curriculum for medical students to participate in hospital disaster response activities was developed. It was partly piloted for medical students, and further evaluations of its effectiveness were needed.

During the Paris 2024 Olympic Games preparations, disaster medicine simulations were organized. One scenario featured the release of a neurotoxic agent into the bleachers of a stadium during a field hockey game, causing poisoning and a stampede in the audience. To design the situation more realistically, designated participants were assigned as victims and others as witnesses. The aim of this study was to assess the psychological impact of this exercise on these participants.

All 76 participants were volunteers. Thirty-five were designated as involved, 32 as moderately injured, 8 as seriously injured, and one as dead. Psychologists briefed 72% of participants before the exercise. Immediately after the start of the exercise, participants were informed that a neurotoxic agent was released by two terrorists. They were asked to follow a decontamination process in the stadium. This included medical care, with undressing and decontamination with absorbent material, followed by showers. Gender, age, occupation, similar experience, their opinion, and anxiety level (State-Trait Anxiety Inventory - STAI) were collected just before, immediately after, and one week after the exercise.

The response rate was 89%, average age 37 years, sex ratio 0.7, 89% of participants had previous first-aid training, and 39% had previously participated in a similar disaster exercise. Anxiety levels ranged from 2% before exercise to 12% immediately after and 10% one week after exercise. The exercise was considered upsetting for 38% of participants, although this was not associated with a refusal or reluctance to take part in this type of exercise again (22%). Anxiety levels were not related to a previous briefing with psychologists or any similar experience.

Anxiety generated by this type of exercise could be anticipated by carefully avoiding recruiting overly emotional individuals. However, this did not affect participants’ willingness to partake in future events.

The network theory of mental disorders posits that associations between symptoms activate other symptoms to maintain a disorder over time. Network analytic approaches therefore may inform treatment targets. In the present study, we compared baseline OCD symptom networks among treatment responders to non-responders and examined how network structure and connectivity changed from before to after exposure and response prevention (ERP) treatment.

Community adults with OCD (n = 712) who underwent intensive outpatient treatment were assessed using the Yale-Brown Obsessive Compulsive Scale (YBOCS) at admission and discharge. Network comparison tests were used to (a) examine differences in baseline symptom network structures between treatment responders versus non-responders and (b) examine changes in network structures from pre- to post-treatment.

Pre-treatment network structures and global connectivity did not differ significantly between treatment responders and non-responders. However, post-treatment networks exhibited greater global strength (i.e., stronger associations between OCD symptoms) and significantly different network structure (i.e., different patterns of associations between OCD symptoms) relative to the pre-treatment network.

Findings showed that network structure and connectivity in OCD may be more informative as a marker of therapeutic change than in discriminating treatment responders from nonresponders using baseline symptoms. After ERP treatment, associations between obsessions and compulsions demonstrated significantly greater global network strength and altered network structure, thus underscoring the potential for network approaches to identify mechanisms of change throughout OCD treatment. Future studies incorporating session-by-session data may clarify when and how these network shifts occur over the course of therapy to help identify treatment targets.

Coping strategies are essential for first responders in Nepal as they face disaster-related challenges. This study explores differences in coping mechanisms between professional and community-trained responders, aiming to assess the impact of formal training on their resilience and effectiveness in crises.

This was a cross-sectional survey conducted in Kathmandu, Nepal, from nationwide participants from various districts. Participants included 30 professionals and 30 community first responders. The COPE (Coping Orientation to Problem Experienced) tool, translated into Nepali, measured coping strategies over 15 domains. Data collection methods included paper-based, computer-based, mobile apps, or online surveys.

A total of 60 first responders participated, with a mean age of 34.85 years; most were aged 21-30 (43.3%) and 31- 40 (26.67%). Community responders reported higher levels of religious coping (mean score 13.4), planning (14.4), and instrumental social support (13.3). In contrast, professional responders exhibited greater use of acceptance (11), denial (7.1), and mental disengagement (9.5). Both groups reported similar levels of venting (9.8).

The study reveals distinct coping strategies between professional and community-trained first responders, with professionals favoring acceptance and denial, and community responders preferring religious coping and planning. These findings suggest the need for tailored support, though generalizations should be approached cautiously due to potential bias and limited sample size.

With the increasing availability of longer-range missiles and explosive-carrying unmanned aerial vehicles, the risk to civilian targets, including hospitals, has increased worldwide. Recent events place Israeli cities and hospitals at high risk of such attacks. Following four months of preparations, a large-scale missile attack drill was conducted at Beilinson Tertiary Medical Center. Drill components included missile strikes on hospital buildings, followed by a multi-casualty chemical incident caused by a missile strike on a HAZMAT container.

Descriptive analysis of the drill design, preparatory actions, and after-action reports.

Preparations included: re-training hospital staff on the actions during an imminent missile strike, training of ED and ED staff reinforcements on logistical and medical preparedness for mass casualty chemical incidents. The drill scenario included structural damage to four hospital wards. Injured patients and staff members were evacuated to the ED, and a rapid safety assessment was performed, leading to the decision to evacuate them. In the following stage, over 50 simulated chemical injury patients from a nearby explosion were transported by EMS to the hospital. Insights gained from the second stage highlight the need to improve staff preparedness for mass chemical incidents, communication, and command and control challenges by fully training personnel in decontamination areas. There was a personnel shortage in the decontamination areas operating in the ED ambulance bay, and frequent staff rotations were needed due to fatigue. Staff training on actions during a pre-strike alarm, post missile strike safety assessment, and ward evacuation proved effective.

A hospital missile strike scenario is extremely challenging. It requires enhancing hospital preparedness, focusing on rapid actions during a pre-strike alarm and post-strike care and evacuation of the injured. It also requires immediate assessment of post-attack structural safety and the need for complete evacuation of structurally unsafe hospital areas. Difficulties included assuring patient flow and command and control during decontamination.