Natural disasters pose significant challenges for vulnerable populations worldwide, particularly older persons residing in Latin America and the Caribbean. This region faces disproportionate exposure to natural hazards, including floods, hurricanes, and earthquakes, with older adults representing a rapidly growing segment of the population. Older adults present unique vulnerabilities due to physiological aging, chronic medical conditions, increased mobility, and socio-economic constraints. These factors place them at increased risk of adverse outcomes during and after disasters. Despite recommendations from international organizations, gaps remain in research and policy planning to safeguard this vulnerable demographic.

A scoping review was conducted to synthesize the available literature on the resilience of older persons following natural disasters in Latin America and the Caribbean. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA- ScR) guidelines were followed. Comprehensive searches were conducted in major databases, including MEDLINE, Embase, Scopus, Web of Science, and CINAHL. After deduplication and screening, 11 articles were included for data abstraction. Thematic analysis was performed using Whittemore and Knafl’s integrative framework.

Older persons were found to face compounded vulnerabilities during disasters, with critical disruptions in healthcare access, utility services, and social support networks. Psychological impacts such as depression, anxiety, and PTSD were common, particularly in those with prior dependence or social isolation. Despite these challenges, some older persons showcased high levels of resilience. However, advanced age was generally associated with decreased resilience, especially in economically disadvantaged populations. Policy analysis revealed that while some guidelines exist, consistent national-level implementation in Latin America and the Caribbean remains insufficient.

This review highlights the urgent need for evidence-based disaster preparedness and recovery strategies tailored to older adults in Latin America and the Caribbean. Multi-sectoral collaboration among governments, health agencies, and local communities is essential to completing this process. Strengthening social support systems, integrating older persons’ voices into planning, and prioritizing targeted research can contribute to more resilient, inclusive disaster management in the region.

On October 7, 2023, Hamas executed a surprise attack on Israel, resulting in over a thousand fatalities and more than 1,900 injuries, with around 360 individuals sustaining critical injuries. This assault included acts of abduction, massacre, rape, war crimes, and crimes against humanity. The extensive casualties, affecting both Israelis and foreign nationals, predominantly civilians, were unprecedented. This study aims to investigate the methodologies employed in delivering rapid professional mental health care to soldiers on the battlefield within hours of impact and to assess these interventions’ effectiveness and immediate outcomes.

A comprehensive analysis of 50 case studies involving the deployment of rapid professional mental health response teams was conducted. Cases were selected based on random selection from the military medical record system. Additional Data sources included official reports, operational logs, and after-action reviews. The analysis focused on operational procedures, intervention effectiveness, and immediate outcomes.

The study yielded five key findings: 1. Rapid professional intervention significantly enhanced an individual’s capacity to resume and perform combat missions. 2. It is essential to establish a senior logistical framework that allows safe navigation and access. This requires active participation from senior commanders. 3. Treated soldiers who returned to duty demonstrated operational efficiency comparable to their untreated counterparts. 4. Two-thirds of the patients requested further treatment afterward. 5. The need for immediate psychological assistance was evenly distributed between combat personnel and support staff.

This research presents a novel and substantive framework for analyzing case studies in unprecedented, surprising, and extreme contexts. The resultant findings have the potential to serve as a foundational basis for the development of mental health intervention strategies applicable to military personnel across diverse combat scenarios within Western armed forces globally. Future research should focus on long-term outcomes and the potential application of these rapid response models in non-military crises.

Israel and the IDF are committed to rapid response and advanced care in conflict situations. The evacuation of injured personnel from combat zones via helicopter involves multiple critical factors that influence the success of the operation. Key factors include the selection of the evacuation sector, determining optimal flight paths, and assessing hospital capabilities for trauma care. To enhance operational efficiency, advanced systems have been implemented, providing real-time visibility of the event location, helicopter position, and all relevant data, while maintaining operational security due to the classified nature of the information.

Additional considerations include weather conditions, concurrent events in the operational area, and the helicopter’s landing capabilities. The number of injured personnel being evacuated, the hospital’s current load, and its ability to transfer patients efficiently from the helipad to the treatment facility are crucial in determining the success of the evacuation.

Challenges associated with this role include managing high-pressure decision-making, processing vast amounts of information from various sources, and navigating uncertainty and incomplete data. Maintaining sharpness and alertness, particularly during night operations, is essential to ensure mission success.

Over the past few months, these systems and protocols have demonstrated high effectiveness, with minimal errors and rapid patient transfers to hospitals where quality care is provided. This experience underscores the importance of thorough preparation, precise coordination, and continuous assessment of both operational and medical factors in the successful execution of helicopter evacuations from combat zones in Israel.

In the last 25 years, health systems have had to respond to a large number of pandemic or pandemic-prone respiratory virus outbreaks (i.e., SARS 2002, H5N1 2003, H1N1 2009, MERS 2011, H7N9 2013, COVID-19 2019). These outbreaks have impacted the ability of the health workforce to come to work and the surge capacity of the health system. It is important to measure the pattern of absence in these outbreaks to plan for future pandemics.

A scoping review was conducted according to the Arksey and O’Malley framework and PRISMA-ScR guidelines. The search was limited to publications from 1998 to July 19, 2022. The search strategy included eight databases. Study selection using pre-defined criteria and structured data extraction was conducted by two independent reviewers with final consensus.

Of the 2099 studies identified, 37 were included. There were 26 studies on COVID-19, 10 studies on H1N1 (2009), and 1 study on MERS (2011). The majority were cohort studies (n=24), and self-reported surveys of health care workers (HCWs) (n=12). The majority of the reported absenteeism rates were not standardized, and included the total number of absence days (n=12), number of new absence episodes (n=9), proportion of HCW absent per day (n=6), and excess pandemic absences (n=17), etc. The proportion of HCWs absent per day ranged from 9.1% to 25.1% during COVID-19 (from 3 studies) and 1.45% to 43% during H1N1 (from 3 studies). After standardization, the median was 0.7 new absence episodes per 100 HCW per week (range 0.2 to 29.1) (from 4 studies), and 15.3 days per 100 HCW per week (range 4.7 to 126) (from 10 studies).

Health workforce absenteeism is a significant issue that must be considered in pandemic planning and response. Future research should be reported in a standardized fashion to allow meaningful comparisons between health facilities.

Accurate prehospital stroke identification is critical to ensuring timely treatment and improving patient outcomes. The National Institutes of Health Stroke Scale (NIHSS) is an established tool for assessing stroke severity, but it is not commonly used by paramedics. This project aimed to enhance prehospital stroke care by training paramedics to use NIHSS for early stroke assessment.

A full-day training program was developed, where paramedics were educated on all aspects of the NIHSS. The training was performed in groups of 10-20 paramedics per session. Training included sessions covering the step by-step use of the NIHSS, followed by practical exercises. After completing the training, each paramedic took an online certification exam on the BlueCloud platform. BlueCloud is an online platform that provides certification and training programs, including NIH Stroke Scale (NIHSS) certification. The certification was for the course ‘AA01.1 - NIHSS-English Group A-V5 - 1st Certification.’

Training started in May 2024, when the first groups of paramedics were certified.

A total of 600 paramedics were enrolled in the training program. By the end of 2024, approximately half of the paramedics had been certified, and the remaining paramedics are scheduled to be trained and certified in NIHSS by spring 2025. Three paramedics did not pass certification on the first attempt; two passed on the second, while one abstained from a second attempt.

Certifying paramedics in NIHSS through a structured training and examination program is a feasible approach to improving prehospital stroke assessment. Evaluation is necessary to assess the long-term impact on patient outcomes.

There is a geometric increase in the practice of complementary and alternative medicine in Nigeria, yet there is no adequate regulation that aims at protecting public interest and guiding general practices. Regulatory practices are not being complied with because of poor implementation of these regulations. There is a need to analyze the stakeholders involved in these regulatory practices to identify their interests and influence on the regulatory practices. It is important to identify the challenges encountered and the facilitators to the effective regulation of CAM in Nigeria. These analysis has an impact on health system strengthening.

This work primarily aimed at identifying the stakeholders’ views and perspectives toward the regulatory practices of CAM, identifying the stakeholders’ interest and influence on the regulatory practices of CAM. It further identified the challenges and enablers of these regulatory practices.

This study utilized a qualitative in-depth interview, which involved a purposive sampling method of twelve (12) respondents. A combination of deductive and inductive thematic analysis was utilized to analyze the manual and electronic transcripts from interview tape recordings.

There was an agreement amongst stakeholders that more actions need to be taken for proper and adequate regulatory practices to be put in place. Deductive and inductive thematic analysis was used to identify the regulatory practices involved in registration, labeling, and advertising. Also, interests and influences were identified together with the challenges and facilitators of these regulatory practices. Stakeholders recommended the active participation of the government and practitioners. They also identified the importance of continuing policies that make CAM studies worthy of Public Health interest.

Stakeholders’ interests and influence are an integral part of decision-making towards the regulatory practices of CAM. Regulation of CAM is not an easy task, as there are many challenges encountered.

The Red Cross Red Crescent Health Information System (RCHIS) is an electronic health records and health information management system designed for international disaster response scenarios for medical documentation and reporting in the Red Cross/ Red Crescent equivalent of the Emergency Medical Teams (EMT), which are classified by the World Health Organization (WHO). It incorporates both a cloud-based server and a local server to address temporary internet outages, allowing remote information management and operational support when data-sharing agreements permit.

To enhance its functionality in settings with no internet access, RCHIS was adapted to operate entirely offline, ensuring operational continuity and redundancy. These settings may either be conflict settings without internet access or settings where data storage in the cloud is prohibited by local privacy or health data protection laws. An analysis of its architecture identified components reliant on the cloud-based server, and offline alternatives were developed to maintain full functionality.

Key modifications included the introduction of a second local server to improve redundancy and business continuity. This change enables data recovery from locally stored backups without requiring an internet connection. The system’s account creation process was revised, replacing cloud-based mechanisms with a local process that generates and displays temporary passwords. Additionally, the system now supports offline generation of the WHO EMT Minimum Data Set (MDS) report.

These adaptations required significant architectural changes. While the shift to a fully offline mode sacrifices some cloud-based benefits, such as remote information management and operational support opportunities, RCHIS is now a robust tool for deployment in environments without internet connectivity. Furthermore, the use of a local server supports compliance with data sovereignty regulations, broadening the system’s applicability in diverse operational contexts.

The protracted conflict in Syria has led to a fragmented health system, resulting in two distinct syndromic surveillance systems: Early Warning and Response Network (EWARN) and Early Warning and Response System (EWARS). Given this unique epidemiological context in Syria, there is a need for continuous evaluation of these Early Warning Systems (EWS) to improve their effectiveness in detecting and responding to public health threats.

A retrospective analysis of EWARN and EWARS surveillance data assessed functional characteristics. WHO alert thresholds for measles, acute bloody diarrhea (ABD), acute jaundice syndrome (AJS), and severe acute respiratory infections (SARI) were tested using three methods. Sensitivity, specificity, and Youden’s index determined threshold suitability for each syndrome.

The annual average number of reported cases was 1,140,717 for EWARS and 10,189,415 for EWARN. The study found that the optimal alert thresholds varied among the different diseases. The percentile method showed promising results, demonstrating good sensitivity and specificity. For measles, the 85th percentile (P85) threshold had the best results (Youden’s index = .443), whereas for ABD it was the P75 (Y= .532), and for SARI it was P90 (Y= .653).

The study supports the use of adaptable disease-specific alert thresholds, such as the percentile approach. Further research is needed to develop statistical methods that can be applied across various EWS in conflict contexts.

Effective triage at mass gatherings is essential for optimal resource allocation and timely medical care. Unlike disaster or hospital settings, mass gatherings present unique challenges. The primary objectives of triage at such events are to identify and prioritize life-threatening conditions, recognize cases exceeding available care levels, and minimize disruptions for both patients and the event itself. This study introduces a novel decision-support tool for triaging patients at mass gatherings, directing them to either a “Medical Zone” or a “First Aid Zone” based on non-vital sign criteria. The tool employs four straightforward questions to facilitate rapid triage. The inter-rater consistency was assessed to determine the tool’s reliability.

Thirty-one responders with experience in event-based care assessed 46 written patient vignettes, assigning each patient to either the Medical Zone or First Aid Zone based on four binary questions: 1) Is the patient unable to walk calmly and independently? 2) Is the patient communicating in a distressed manner? 3) Does the patient have cardiac or respiratory complaints? 4) Does the patient give a worrying impression? Responders included event first responders, emergency medical technicians, nurses, and physicians, all of whom received standardized instructions on the tool’s usage.

The overall inter-rater agreement for triage decisions, measured by Fleiss’ Kappa (0.64, P < 0.001), demonstrated substantial consistency among responders. This suggests that the tool can consistently guide responders in assigning patients to the appropriate care zones, thereby supporting efficient resource allocation in the field.

This four-question triage tool demonstrates substantial inter-rater reliability, showing promise as a reliable and efficient method for triaging patients at mass gatherings. Future studies should evaluate its effectiveness in live field conditions to validate its practical impact on the triage process during large-scale events.

Every year, Mie University Hospital carries out disaster preparedness drills simulating earthquakes. As a part of the drills, a survey is performed to assess disaster awareness of the hospital staff. The aim of this study was to investigate the change in disaster awareness before and after the Noto Peninsula earthquake in January 2024 and to predict the number of hospital staff who can come to work in the event of a disaster.

A survey was conducted using Google Forms and ask the hospital staffs questions regarding (1) job category, (2) ability to get to work, (3) time required to get to work, (4) disaster response plans in family, and (5) environment and preparedness for “Simulation whether employees can come to work in the event of disaster.”

Of 2,276 hospital staff, 1,027 (45.1%) responded to the survey. Compare to 2023, there was a significant increase in the percentages of respondents who had established meeting places and communication methods at the time of a disaster (2023 vs 2024; 41.3% vs 53.1%, p < 0.0001) and who had discussed evacuation plans with their families (40.4% vs 54.8%, p < 0.0001). The “Simulation whether employees can come to work in the event of disaster” showed that 46.7% (321/688) of staff who responded that to would be able to come to work in the survey were expected to come to work. The reasons for being unable to come to work were “having children” and “lack of transportation.”

The Noto Peninsula earthquake raised disaster preparedness awareness among staffs and their families. However, the actual number of staff who can come to work at the time of a disaster is considered limited. To improve the issue, addressing family care needs such as childcare and securing transportation are essential.

The Haute-Garonne Emergency Medical-Psychological Unit (CUMP 31), comprised of five health care professionals (two nurses, two psychologists, and one psychiatrist), provides urgent medical-psychological support for traumatic incidents.

In January 2024, CUMP 31 intervened following the homicide of a 16-year-old girl by her stepfather and the attempted murder of her 17-year-old brother, Marcel, who was a direct witness to the event. At the initial intervention, Marcel exhibited acute stress symptoms, including limb tremors, dissociative signs marked by an immediate lack of emotional responsiveness, and disrupted thought processes. Marcel benefited from a 48-hour phone follow-up, followed by three nursing consultations over several weeks. He was then transferred to another CUMP unit due to relocation.

This case exemplifies the CUMP 31’s approach supporting direct witnesses of severe family trauma, highlighting the continuity of care from initial intervention to network-based reorientation. Over the past three years, CUMP 31 has conducted 46 immediate interventions (0-48 hours), 61 post-immediate interventions (48-72 hours), and facilitated 1,172 consultations within six months after the traumatic event, averaging three sessions per individual to treat acute stress and prevent post-traumatic stress disorder (PTSD).

Through Marcel’s story, this case underscores CUMP’s utility in managing urgent medical-psychological cases and the critical role of network coordination for the sustained support of victims and witnesses of severe traumatic events. Moreover, the increasing demand for CUMP 31’s services in cases of intrafamilial homicide may reflect a rise in family-related violence or enhanced visibility of the CUMP system, leading to heightened utilization.

Magen David Adom (MDA), Israel’s national Emergency Medical Service (EMS), is responsible for responding to crises, including military conflicts, natural disasters, and cyber threats. Under the Magen David Adom Law 5710- 1950, MDA supports the Israeli Defense Forces (IDF) Medical Corps and ensures peacetime readiness.

MDA’s All-Hazards approach creates adaptable emergency response plans for diverse crises, incorporating sheltering, mass casualty management, and communication continuity. Close collaboration with the National Emergency Management Authority (NEMA) and the Ministry of Health ensures that preparedness for military conflict strengthens readiness for natural disasters.

Following the October 7, 2023, Hamas attack, MDA rapidly updated its preparedness to address prolonged, multi-front warfare. Key goals included plans for extended power outages and managing multiple simultaneous incidents. Enhancements included autonomous regional hub operations, strengthened satellite communications, and mobile medical patrols. MDA’s resilience in non-traditional emergencies was demonstrated during the July 2024 CrowdStrike cybersecurity incident, where rapid manual operations and alternative communication methods ensured uninterrupted emergency response.

MDA’s generic emergency plans, adaptable across various crises, provide a robust response model. This flexible approach, reinforced by interagency cooperation, strengthens MDA’s emergency preparedness and offers insights for EMS organizations worldwide.

In environments impacted by extreme disasters, the prevalence of human-made disasters and high-risk situations has been increasing. It has become an important issue to enhance situational awareness and strengthen response capabilities for medical professionals, building upon their existing expertise, from the perspective of NGOs. From 2022 to 2024, the organization held over eight training sessions with more than 150 participants, lasting from 2 to 5 days each. All participants were healthcare professionals. The training included situational awareness, basic battlefield injury management, and advanced damage-control resuscitation, combined with highly realistic, scenario-based exercises to enhance situational awareness and response capabilities.

In post-training interviews, all participants reported that the training helped them develop new logical thinking and perspectives. The scenario-based exercises enhanced their response speed and adaptability. The skills acquired were applicable not only in high-risk environments but also in their daily work settings. High-risk environments are not limited to humanitarian conflicts; they can also occur in everyday settings. Given the current global instability, similar training courses conducted by NGOs can effectively improve the situational awareness and response abilities of healthcare professionals.

While armed assailant attacks in a healthcare setting are rare, they pose a potential risk to healthcare staff, patients, visitors, and the infrastructure. They can disrupt health care services and deprive people of life-saving treatment.

Many hospitals have well-developed disaster plans to respond to a mass casualty incident (MCI) occurring outside the hospital. Hospital staff receive emergency preparedness training to respond to MCI as part of their job scope, either through online modules or participation in disaster drills.

A lack of an armed assailant incident response plan can significantly reduce the hospital’s ability to appropriately respond to such an incident. The random, short-lasting but violent nature of an armed assailant incident makes healthcare response extremely challenging. Along with the response to the incident, the other challenges also include the management of the assailant as well as the safety and management of the patients, public, and healthcare staff during the incident.

The primary objectives of the response plan should be:

• threat assessment and pre-incident planning

• initiating immediate response during an incident to minimize the assailant’s access to potential victims

• damage and post-incident recovery and support plans

During the attack, based on the best available evidence, adopting the model of “Run, Hide, Fight” or “Secure, Preserve, Tell” are recommended. Care provision to the injured during this event should be remembered by the acronym THREAT.

• T- Threat Suppression

• H- Hemorrhage Control

• RE - Rapid Extrication to safety

• A - Assessment by medical providers

• T- Transport to definitive care

Once the attack has ended, there must be an assessment of the department/hospital’s ability to continue routine operations.

Various stakeholders of the health care facility should work together to develop an armed assailant incident response plan that best suits their needs and capacity. This will be of immense benefit for keeping healthcare facilities safe.

On July 31, 2024, a deadly landslide in Wayanad, Kerala, India, occurred following continuous rainfall. Wayanad is situated in the Western Ghats, with lush green hills, dense forests, beautiful landscapes, and scenic waterfalls. Choormala and Mundakkai villages in the Wayanad District were hit by a landslide, which devastated the villages. Debris traveled 8 km along the local river, altering its course, causing a break in the bank, and destroying buildings and homes along the riverbanks and in villages.

The landslide caused 420 deaths, 397 injuries, and 118 people are still missing. The Wayanad Landslide was triggered by heavy rainfall and seismic activity. This sets the stage for disaster, as significant deforestation of tea plantations causes them to have a slope of 20 degrees. This increased the risk of flash floods during the rainy season. The leading causes of this are deforestation, seismic sensitivity, poor building construction, increasing population, urbanization, industrialization, increased traffic, and increased global warming. A massive landslide after torrential rain caused flash floods, a breach, and a massive landslide, bringing in mass devastation. Local villages, the Army, and the National Disaster Response Force all contributed to the rescue efforts and continue to assist in the rehabilitation.

The primary cause of the Wayanad Landslide was heavy rainfall, deforestation, and unstable soil. Major triggering factors include monocropping, illegal construction, global warming, climate change, increased greenhouse gases, and the use of fossil fuels. A decrease in global warming, deforestation, overconstruction, and help with research for climate change will help avoid this in the future. Active research is being done in India via the Kerala Disaster Management Authority, under the NDMA. Cochin University is also researching the causes of landslides and how to prevent them in the future.

The war in Israel, which began on October 7, 2023, posed significant challenges for breastfeeding mothers. Breastfeeding-focused Facebook groups quickly became crucial sources of information and emotional support. Analyzing posts from the first week of the conflict reveals specific concerns and informational needs of breastfeeding mothers in emergencies. This study identifies three central themes, provides insights into their concerns and informational needs, and formulates actionable recommendations for immediate responses during wartime.

This study employs a qualitative research methodology to examine the experiences of breastfeeding mothers within Facebook communities. A reflective thematic analysis was conducted on messages posted on two primary Facebook groups (total of 90.1K members) from the first day of the war (October 7, 2023) throughout the subsequent week.

Three main themes emerged:

Breastfeeding mothers reported severe stress and anxiety, fearing these emotions might affect their infants through breastfeeding. They sought information on anxiety medications and the safety of continuing breastfeeding while on treatment.

Mothers observed a perceived decline in milk production, raising concerns about their infants’ nutrition and noting increased infant restlessness. They sought advice on enhancing milk production, including pumping techniques and galactagogues.

Posts highlighted concerns for infants whose mothers were killed or missing, with offers to donate breast milk and offers to breastfeed infants in need.

During war or disaster, social media becomes a primary source of information. Breastfeeding mothers’ Facebook groups serve as sources of information, comfort, and connection. Concerns about the war’s impact on breastfeeding lead to a need for evidence-based, reliable information that is immediately accessible. Required information includes the effects of maternal psychological state on lactation, medication use, and milk production. Additionally, these groups function as platforms for offering and receiving support among mothers and lactation professionals.

Major public health emergencies generate a surge in non-standard medical records, which challenge efficient patient care and data management. Handwritten or incomplete records, along with simplified Hospital Information Systems (HIS), struggle to manage the surge in patient data, leading to incomplete, unstructured, and difficult-to trace records. This study explores the use of AI and NLP to standardize and manage these records during disasters.

A deep learning-based system using pre-trained NLP models such as BERT and T5 is being developed. The system extracts and standardizes patient information, symptoms, and treatment details. Training will occur within the world’s only non-military, WHO-certified Type 3 International Emergency Medical Team (EMT), utilizing a large dataset from high-risk natural disaster areas in Southwest China (sourced from publicly available or open-source databases). The evaluation will focus on handling diverse and unstructured data and employing metrics such as precision, recall, and F1 score.

Initial testing shows promising outcomes, with the system demonstrating its potential to extract and standardize key medical information. Further validation is needed to ensure real-world reliability.

AI and NLP present a promising solution for managing non-standard medical records in disaster medical rescue. Automating record standardization can enhance emergency response efficiency and improve patient outcomes. Future work will aim to enhance real-time data collection, integrate the system into daily prehospital and emergency care, and collaborate with experts to refine the system.