Nursing homes regularly call emergency medical services (EMS) for residents with life-threatening emergencies. Most of them are transferred to an emergency room (ER). In many cases, these are end-of-life situations as the patient’s death seems imminent, and transfer to the ER is likely to be uncomfortable and unnecessary.

This study aimed to identify, among NH residents, risk factors of short-term death (48 hours) at the time of the EMS call.

This study included all incoming calls for NH residents to an EMS between May 9, 2022, and May 8, 2023. Age, gender, dependency level, vital signs, destination (left on scene or hospitalized), and vital status at 48 hours were collected. Comparisons were made using Chi-2 tests and analyses of variance. Multivariate analyses were performed using top-down stepwise logistic regression.

One thousand eight hundred and twenty-two patients were included. The average age was 87.6 years. Sixty-six percent were very dependent. Three-quarters of calls resulted in hospitalization. Patients left on scene were significantly older (89 years) and more dependent (73%) than those hospitalized (respectively 87 years and 59% – p < 10-3). At 48 hours, 20% of patients were left on scene, and 16% of hospitalized patients had died. Five risk factors of short-term death were identified: initial oxygen saturation ≤ 90%, initial blood pressure < 70 mmHg, respiratory distress as the main chief complaint, being very dependent, and age ≥ 90 years.

Identifying risk factors of short-term death in NH residents could enable EMS to more often consider keeping the patients on scene with appropriate palliative care. This could be achieved with the help of a clinical prediction tool, yet to be validated by other surveys.

On February 6, 2023, two major earthquakes, measuring 7.7 and 7.6, struck Kahramanmaraş, Turkey, triggering widespread devastation across 11 provinces and affecting approximately 14.1 million people, including 4.8 million children. With over 50,000 fatalities and 100,000 severe injuries reported, this disaster underscored the critical need for tailored emergency response protocols for vulnerable populations, particularly children.

Under the direction of the Turkish Ministry of Health, a specialized pediatric emergency team, comprising pediatric emergency fellows, specialists, and a pediatric intensivist, was deployed to the earthquake zone. Despite challenging conditions, the team quickly established a triage system, managed a high volume of severely injured children, and addressed life-threatening conditions such as crush syndrome and hyperkalemia. Manual tracking of patients and strategic transfer coordination enabled effective patient flow despite limited resources and adverse weather conditions.

Initial interventions prioritized resuscitation, intubation, and dialysis for patients suffering from crush syndrome and associated hyperkalemia-induced arrhythmias. Due to ICU damage, patients were monitored in makeshift spaces, including corridors. Over the course of three days, the team performed intensive fasciotomies, initiated alkali fluid treatments, and facilitated the transfer of approximately 20 patients per day. The response highlighted critical material shortages, fatigue among healthcare personnel, and the necessity of streamlined transfer systems and real-time communication with supporting organizations.

This field report highlights the importance of pre-established disaster response teams, including pediatric emergency specialists, nursing support, and essential medical equipment, in addressing pediatric-specific needs during disasters. Effective disaster response for children requires continuous advocacy, specialized training, and coordination with regional authorities to ensure comprehensive care. Lessons from this deployment advocate for scalable, organized, and well-resourced pediatric emergency response systems in disaster-prone regions.

Dual disorder, comprising of substance use and mental health disorders, requires a comprehensive treatment approach. The most effective is integrated dual disorder treatment, which involves addressing both conditions concurrently by the same specialists and in the same setting. This study examines characteristics of integrated dual disorder care offered by treatment services across European countries.

In 2022, representatives of 14 integrated care for dual disorder providers in 10 European countries were asked to respond to a survey about their treatment process, outcomes, barriers and facilitators when implementing dual disorder treatment in respective countries. Thematic qualitative analysis was used to explore closed- and open-ended responses, focusing on commonalities and differences between surveyed services.

Integrated care services varied in treatment settings and structure, but all offered comprehensive support for dual disorder. Among 14 services, half addressed tobacco addiction or provided suicide prevention, three treated cannabis use, and none accepted patients in opioid agonist therapy. Few services reported evaluating treatment outcomes in standardised way. Services supported patients with social security, employment, housing and education, but also noted difficulties in coordinating post-treatment care due to divergent views on dual disorder among specialists from different services.

Integrated care services provide comprehensive and tailored support for people with dual disorder but remain distinct within the healthcare options available to this patient group across Europe. Existing and future integrated care services would benefit from addressing tobacco and cannabis use, measuring treatment outcomes and improving continuity of care.

On a stormy September evening in 2021, the remnants of Hurricane Ida arrived in New York City, resulting in record rainfall, widespread flooding, and 13 deaths. Eleven of those deaths occurred in basement-level homes of residents of Asian descent in low-income Asian immigrant communities. As a result of this experience, members of an Asian immigrant community organization requested disaster preparedness education for their members.

The Household Emergency Preparedness Instrument (HEPI) was translated into Korean, field-tested, and pilot tested. The K-HEPI was then used in a controlled before-and-after study to measure the preparedness level of an at-risk population before and after receiving a group-based educational intervention. The experimental group received two classes covering evacuation planning, community resources, and disaster kits. The experimental group’s K-HEPI scores were compared to the control group’s scores at baseline and at one-month follow-up.

The K-HEPI generated the intended factor structure, providing evidence for construct validity of the translated instrument. Participants in the experimental arm (n = 200) realized greater pre-post gains in disaster preparedness compared to those in the control arm (n = 199) (Preparedness Actions and Planning Subscale β=1.29, SE=0.103, p < 0.001; Disaster Supplies & Resources Subscale β=1.07, SE=0.110, p < 0.001).

The community organization continues to offer the disaster preparedness intervention to its members, demonstrating the program’s sustainability. The K-HEPI should be used to assess disaster preparedness among Korean-speaking populations and to evaluate the effectiveness of preparedness interventions. Further testing of the K-HEPI and the intervention in longitudinal studies is recommended to explore potential associations between disaster preparedness and outcomes such as survival without rescue, prevention of injury, or acute exacerbations of chronic illnesses. Replicating the intervention across different immigrant populations is essential, and data from these studies can inform policy development to better address the needs of immigrant communities before, during, and after disasters.

More than four years after the start of the COVID-19 pandemic, many states in the United States have not approved a framework for the ethical allocation of scarce medical resources and/or the invocation of Crisis Standards of Care (CSC) in their state emergency operations plans.

This report discusses a pragmatic approach to socialization of and education about such a guidance document, through structured tabletop exercises for leaders of regional Healthcare Coalitions (HCCs) in the State of Michigan. In Michigan, the State Disaster Medical Advisory Committee revised previous state guidance on the ethical allocation of scarce medical resources during the pandemic. Revisions included a more nuanced use of scoring systems predictive of mortality (some of which have been deemed potentially disadvantageous to certain racial groups), consideration of the perspectives of the disability community, and a greater emphasis on the ethical duty to plan so that CSCs need not be invoked.

Detailed presentations to Regional HCCs were conducted throughout the state, immediately followed by a structured tabletop exercise (TTX) that allowed HCC members to work through a scenario (a critical blood product shortage) using ethical guidance alongside practical aspects of emergency management and health system operations. Identical conferences occurred for both urban and rural HCCs.

This state-endorsed ethical and legal framework was presented by the legal expert (co-author LG), followed by practical applications by a hospital executive preparedness expert (co-author ML). HCC’s emergency management and medical leaders practiced how the critical shortage would impact their region using the framework’s principles within the construct of their emergency operation plans. This method of amplifying state guidance with concomitant TTX could provide a superior educational tool for those tasked with responding to critical scarcity events.

The importance of considering disaster medicine from a legal perspective has long been recognized. This presentation discusses recent international human rights law/international humanitarian law themes in disaster medicine in Japan and overseas, as well as the possibility of collaboration with related academic societies.

1. Cases of support for foreigners in disaster-affected areas.

J-MIND is the disaster medical interpretation network for the support of foreigners in disaster-affected areas in Japan. It requires a combination of theological backgrounds and a practical foundation in international human rights law to ensure no one is left behind, even in disaster situations.

2. In the process of preparing the Hospital ERU (Emergency Response Unit)

The Japanese Red Cross Society is preparing a Hospital ERU, where we must assume several situations related to international human rights law/international humanitarian law. This process would have many things to do with other GOs and NGOs with similar plans to open emergency hospitals abroad. As disaster medicine in Japan becomes more globalized, coordination in many areas, including international law, will be necessary.

Japan frequently experiences natural disasters, and there is concern about a major earthquake in the Tokyo area, where more than three million people live. The University of Tokyo Hospital is one of the disaster base hospitals in Tokyo, and strengthening disaster response capacity is important. This study aimed to identify the factors associated with staff behavior towards disaster response.

Two different surveys were conducted, a paper-based questionnaire for the departments of the University of Tokyo Hospital (UTH) and an online-based questionnaire for individuals. Eighteen departments in UTH were selected for the paper-based questionnaire because they were considered important in determining hospital functions during a disaster. For the online-based questionnaire, hospital staff were recruited for voluntary participation. Each questionnaire was developed based on the previously reported survey conducted earlier.

Out of 18 departments, 17 departments responded to the survey. There was no significant relationship between the preparedness for disaster and the work content of the section. 338 staff responded to the individual survey. Strong trends were observed in many items related to behavior and knowledge of local conditions and disaster response in hospitals. Some background factors, such as age and profession, were significantly associated with respondents’ behavior and knowledge. Some barriers were observed consistently across sections and individuals. The three main barriers were: lack of leadership, lack of employee engagement, and heavy workload.

This study identified some factors, both in departments and individuals, that may influence behavior towards disaster response in the hospital. Based on these findings, three actions are considered necessary: vision and mission with effective leadership, commitment through education and training, operational efficiency and human resource management.

Further improvement of disaster preparedness in UTH is necessary at the organizational level.

Clarifying the return on investment in disaster management is vitally important for quantifying its value, attracting funding, policy deployment, and eventually promoting this field. The study aimed to consolidate evidence of social return on investment in natural disaster management and to incorporate insights from health perspectives to figure out future directions.

A scoping review was conducted following the PRISMA guidelines, using databases including PubMed and Web of Science. The search strategy employed keywords related to disaster management and cost-benefit analysis. The exclusion criteria encompassed non-English language publications, man-made disasters, and studies in which costs and benefits were not quantified in monetary value.

A literature search was conducted on August 15, 2024, and resulted in identifying 972 documents, of which 46 were selected for further analysis. Additionally, 56 grey literatures were identified, with 14 adopted. A total of 220 disaster management interventions were found, addressing various disasters such as floods, typhoons, and earthquakes. The interventions included hard infrastructure measures, warning systems, and green infrastructure development, encompassing pond maintenance and afforestation. The benefits primarily consisted of the estimated damage that could be avoided. The benefit-cost ratios distributed from approximately zero to over 2000, with a median of 2.30 and quartiles of 1.07 and 5.00. Approximately half of the literature assessed the value of human life by converting the number of deaths into monetary values. The impact on health as a benefit is infrequently taken into account.

The benefit-cost ratios of disaster management are generally high and sometimes very high, with three-quarters exceeding 1 and one-quarter exceeding 5. Furthermore, these benefits are likely underestimated, as the impacts on health are rarely measured. When assessing social return on investment in disaster management, it is considered mandatory to take health into account.

Indonesia’s three research reactors (RSG-GAS in Serpong, TRIGA2000 in Bandung, and the Kartini reactor in Yogyakarta) play a critical role in advancing nuclear research but also pose significant risks, including the release of radioactive materials due to accidents or natural disasters. Despite these risks, preparedness and response mechanisms for nuclear emergencies, particularly in healthcare settings, remain underexplored compared to the country’s established natural disaster management systems.

This field report evaluates the multidisciplinary approach to nuclear disaster preparedness in Indonesia, focusing on the implementation of radiation accident simulation. The Indonesian Ministry of Health coordinated the radiation emergency simulation. It involved key stakeholders, including three National Nuclear Disaster Referral Hospitals (RSUP Fatmawati, RSUP Hasan Sadikin, and RSUP Dr. Sardjito), the Indonesian Nuclear Regulatory Agency (BAPETEN), the National Research and Innovation Agency (BRIN), Public Safety Center 119, and professional organizations. The simulation integrated theoretical and practical components, effectively enhancing participants’ understanding of nuclear emergency management and response. Simulations included pre-hospital treatment at accident sites, ambulance transportation, decontamination procedures, and the preparation of hospital emergency departments. The expert observers evaluated the simulations, but standardized evaluation tools need to be developed. The limited availability of radiation detection devices and personal protective equipment (PPE) was identified as a gap in the infrastructure. There is a need to include BNPB in the simulation, as it is the government agency designated for coordinating disaster management activities in Indonesia.

Multidisciplinary radiation emergency simulations are essential for effectively responding to nuclear emergencies, particularly in medical emergency preparedness and response. While the drills improved knowledge and operational coordination, developing standardized evaluation tools and addressing infrastructure gaps and resource allocation are critical next steps for optimizing preparedness.

This field report investigates the integration of civil-military collaboration in Poland to strengthen emergency medical response frameworks, with a focus on lessons learned from the COVID-19 pandemic and the ongoing Russo-Ukrainian conflict. These crises have exposed gaps in Poland’s emergency preparedness, particularly in coordination and rapid response capacities. By implementing a unified command structure, interoperable data sharing systems, and technology-driven strategies, such as predictive analytics, drone logistics, and digital health management, this report outlines a collaborative model that enhances Poland’s emergency response efficiency.

Key findings emphasize that civil-military collaboration, reinforced by joint training exercises and simulations, leads to faster mobilization, better resource allocation, and improved operational consistency across sectors. This model encourages a proactive approach by establishing communication protocols for real-time data exchange and optimizing readiness through frequent skill-building programs. Additionally, community engagement initiatives foster public awareness and resilience, providing a more comprehensive approach to disaster preparedness.

The significant impact of this integration model is reflected in enhanced responder competencies, a streamlined response framework, and a scalable, adaptable emergency response system that can be tailored to other contexts. The lessons drawn from these efforts serve as a foundation for building a sustainable, technology-enhanced civil-military collaboration that could inform similar emergency response strategies globally.

The October 7, 2023, massacre in Israel was a large, multi-site asymmetric attack with characteristics of both a very large terrorist attack and a conventional armed invasion, where Israel temporarily lost territorial control. Thus, it is a unique event in a Western democracy. Assuta Ashdod is a Level 2 trauma center located 26km from the Gaza Strip, which received 114 patients on October 7th, during which it activated its Mass Casualty Protocol (MCP). This study aimed to explore the experiences of staff working in this environment to inform hospital preparedness efforts in Israel and globally.

A purposeful sample of 18 key staff, including physicians, nurses, security, and orderlies, underwent semi-structured interviews. These were recorded, transcribed, and processed using thematic analysis methodology.

The participants felt well prepared for this event because of recurring, frequent, and immersive MCP drills that had preceded it. Participants mentioned entering a state of mind where they worked mechanically without reflecting on the event itself. The hospital being structurally protected from rocket attacks allowed participants to concentrate on the work without fear of injury. Assuta Ashdod is a relatively small hospital where staff know each other well, and this was recognized as allowing for flexibility and effective communication. Obstacles included a shortage of secretaries for the correct registration and tracing of patients. While paper-based patient files are used during MCP drills, the lack of familiarity with interacting with these during regular work resulted in suboptimal documentation. Some clinicians mentioned a lack of situational awareness as they worked in isolation in a single part of the system throughout MCP activation.

This study has offered insights from staff with practical experience from MCP activation in a major asymmetric attack and has identified several organizational and resilience-related aspects that may inform preparedness efforts in the future.

In May 2023, the Emilia-Romagna Region experienced two unprecedented rainfall episodes, leading to severe flooding and landslides, especially in the Romagna area, its Southernmost part. This study aimed to assess the health response to the May 2023 floods in this area by identifying the main actions undertaken in response to the floods and by highlighting criticalities and lessons learned.

This study was conducted in the context of a collaboration between CRIMEDIM, the Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, and the Romagna Local Healthcare Authority. To achieve the objective, a retrospective qualitative case study design was chosen, and semi-structured interviews were employed to gather in-depth information on the experiences and perspectives of key informants involved in the flood response.

Interviewees consisted of 25 key informants related to the following fields: authorities and public administration, health management, public health, primary care, social services, hospital and emergency care system, communication, and the third sector. The findings highlight the strain on the local health system, including service and infrastructure disruptions. The response strategies have been analyzed and clustered in phases (alert and activation, coordination, communication, identification of vulnerable individuals, evacuation management, surge capacity, health service delivery, logistics, and the role of volunteers), offering a comprehensive overview of local disaster response strategies. Recommendations include enhancing the interoperability of health information systems for disaster management, improving the coordination of evacuations for at-risk populations, improving the capacity to map fragile and vulnerable populations, and strengthening spontaneous volunteers.

This study highlights the importance of collaborations between local health authorities and academia for ongoing evaluations to enhance disaster response and resilience.

Full authorship: Valente Martina, Del Prete Clara, Facci Giulia, Martino Ardigò, Grilli Roberto Giuseppe, Bravi Francesca, Reno Chiara, Ragazzoni Luca

Virtual patients (VPs) have the potential to support military medicine training. Gamification is at least as effective as traditional educational methods and is often more effective for improving knowledge, skills, and satisfaction in health professions education. In military trauma care, where medics must make both medical and tactical decisions, gamified VPs can offer active learning opportunities to better prepare them for providing medical care in austere environments. Despite the potential of VPs to improve military medical training, studies exploring the integration of gamification into VP design are limited.

This study aimed to understand the reasoning and perceptions of Swedish military medics when interacting with VPs, offering insights and recommendations for designing VPs with game elements to support decision-making.

Fourteen military medics from the Swedish Home Guard-National Security Forces participated in a tactical combat care course, engaging with three VP cases simulating military trauma scenarios. Data were collected through think-aloud sessions and semi-structured interviews. The participants’ reasoning processes and perceptions were analyzed using interaction analysis, along with reflexive thematic analysis. A second round of coding identified game elements that could enhance the VP design.

Our analysis indicated that mistakes in VP decisions, followed by feedback, facilitated the military medics’ reflection. The thematic analysis revealed six themes: motivation (“keep on trying”); agency in interaction with VPs; realistic tactical experience; confidence (“I know that the knowledge I have works”); social influence on motivation; and personalized learning. Game elements such as scoring, badges, progress bars, challenges, avatars, and leaderboards were suggested to make the learning experience more enjoyable and increase medics’ confidence.

Overall, the VPs were positively received. Gamification in VP design appears to be a promising approach for military trauma training, encouraging the inclusion of game elements as well as consequences for wrong decisions to support military medics’ training.

Emergency medical technicians (EMTs) often perform patient-handling tasks in emergency settings, posing a high risk of occupational injury. The prevalence of Work-Related Musculoskeletal Disorders (WRMSD) among EMTs has been underestimated due to the lower reporting rate of WRMSD events in Taiwan. This study employed a nationwide safety manual handling survey by integrating the health belief model (HBM) and the transtheoretical model (TTM) to examine behavioral factors influencing the adoption of safety manual handling skills among EMTs.

A cross-sectional study was conducted among frontline EMTs in Taiwan, including full-time and volunteer EMTs from fire departments in Taiwan. Data on individual characteristics, WRMSD experiences, six factors of measuring attitude toward safety handling, and behavioral change stages to adopting safety handling via a questionnaire were analyzed using descriptive statistics and multinomial logistic regression to determine the impact of each factor on adopting safe handling techniques.

A total of 761 participants completed the questionnaire. The lower back was the most frequent WRMSD body part among participants. The most frequent type of patient handling-related injuries was strain/sprain (88.4%). The patient handling-related injuries occurred within 5.3 years after career initiation in 76.9% of participants. The results also indicated that higher perceived benefits and lower perceived barriers increase the odds of being in all TTM stages. The cue to action level was also a predictor for investigating the likelihood of being in each stage of change compared to the reference category.

Promoting the adoption of safety handling skills is a long-term battle in improving occupational health and safety among EMTs. Perceived benefits, perceived barriers, and cues to action may be the critical factors for designing and implementing the interventions in the future. Future interventions should focus on letting EMTs understand the benefits and barriers of conducting safety manual handling and provide clear, real-world guidance.

One Health plays an important role in public health emergencies and pandemic preparedness. Successful public health interventions of infectious disease spread require cooperation of human health, environmental health, and animal health partners. However, One Health is still a new policy initiative in the United States. Few studies have looked at One Health initiatives across U.S. states, and which agencies are involved or excluded from such policy priorities.

To assess scope, primary data was collected from federal and state agencies, ASTHO, and the NCSL. This data was supplemented with elite interviews of state bureaucrat leaders in emergency management and public health to determine whether One Health was an explicitly mentioned policy priority in public health emergency preparedness across states.

Less than a third of US states have/had a One Health Committee or Task Force, many of which have little authority or power to ensure intragovernmental collaboration and cooperation. One-fourth have a division within an agency dedicated to One Health, or they have One Health listed as an official policy priority. Very few states have passed laws or policies that establish official state One Health programs. One Health is most commonly located within a state department of health or public health. Moreover, relationships between emergency management and public health agencies are variable, with little coordination at the subnational level. Formal One Health initiatives are located in environmental health departments or siloed departments within public health. Informal initiatives are coalitions across academic research institutions, nonprofit actors, community organizations, and individual state bureaucratic “policy entrepreneurs”.

While One Health pushes for a collaborative, multisectoral, and transdisciplinary approach, there is little evidence that such initiatives are occurring in practice across US states and localities. Stronger collaborations between emergency management and public health agencies are needed at both the state and local levels.

The Emergency Medical Team (EMT) initiative enhances rapid response to public health emergencies by mobilizing and coordinating national and international medical teams that provide surge capacity. Since the escalation of hostilities in Gaza in October 2023, the local health system has faced severe challenges, including widespread infrastructure damage, critical shortages of medical supplies, and limited access to healthcare. In response, the World Health Organization, upon request from Gaza health authorities, activated the EMT mechanism and established an EMT Coordination Cell to support international deployment. By the end of 2024, 51 national and international EMTs were deployed across Gaza, addressing urgent healthcare needs in trauma care, surgery, maternal and child health, disease outbreak surveillance, non-communicable diseases, and mental health.

A total of 918 international and 242 national personnel delivered over 2.2 million general medical consultations, nearly 37,000 emergency surgeries, and more than 14,000 referrals. Two national EMTs have resumed activities, significantly strengthening local emergency care and specialized surgical capacity. In 2025, EMTs maintain their presence and impact despite major operational constraints, including insecurity, restricted access, and persistent shortages of essential supplies. Current priorities include reinforcing all levels of healthcare, expanding community and home-based services, strengthening disease surveillance, and increasing psychosocial support for both patients and health workers. Operational agility remains critical to respond to evolving needs, including hospital evacuations, displacement, and surges in casualties.

In the realm of trauma response preparation for prehospital teams, the combination of Augmented Reality (AR) and Virtual Reality (VR) with manikin technologies is growing in importance for creating training scenarios that closely mirror potential real-life situations. The study focused on training in airway management and intubation for trauma incidents, based on a Trauma AR-VR simulator involving reserve paramedics of the National EMS service (Magen David Adom) who had not practiced for up to six years, activated during the Israel-Gaza conflict (October 2023). The trauma simulator merges the physical and virtual realms by utilizing a real manikin and instruments outfitted with sensors. This integration enables a precise one-to-one correspondence between the physical and virtual environments.

A quantitative questionnaire was utilized to gauge the influence of AR-VR training on specific psychological and skill-based metrics, including self-efficacy, resilience, medical knowledge, professional competency, confidence in performing intubations, and the perceived quality of the training experience. The methodology entailed administering a pre-training questionnaire, delivering a targeted 30-minute AR-VR training session on airway management techniques, and collecting post-training data through a parallel questionnaire to measure the training’s impact.

Post-training evaluations indicated a significant uptick in all measured areas, with resilience (3.717±0.611 to 4.008±0.665) and intubation confidence (3.541±0.891 to 3.833±0.608) showing particularly robust gains. The high rating (4.438±0.419 on a scale of 5) of the training quality suggests a positive response to the AR-VR integration for the enhancement of medical training.

The application of AR-VR in the training of reserve paramedics demonstrates potential as a key tool for their swift mobilization and efficiency in crisis response. This is particularly valuable for training when quick deployment of personnel is necessary, training resources are diminished, and ‘all hands on deck’ is necessary.

In a world increasingly challenged by disasters and emergencies, practical disaster medicine training is crucial for saving lives and improving response efforts. The Training Disaster Medicine Trainers (TdmT) educational program, launched in 2015 through a partnership between the International Federation of Medical Students’ Associations (IFMSA) and the Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM), aims to enhance the capacity of medical students worldwide. The program provides theoretical knowledge and practical skills in disaster medicine, addressing the growing need for competent leaders in disaster and emergency management, aligning with the Sendai Framework’s goals for disaster risk reduction. TdmT seeks to train a new generation of medical professionals who can effectively contribute to disaster risk management, becoming peer educators in their universities and beyond. The program empowers graduates to serve as trainers and advocates for disaster medicine practices by focusing on knowledge dissemination.

The program is delivered annually, and includes online and residential phases with theoretical lessons and simulations (table-top, computer-based, and full-scale). Covering topics such as triage during mass casualty incidents, pre-hospital and hospital responses, and Chemical, Biological, Radiological, and Nuclear (CBRN) incidents. To date, TdmT has trained 140 graduates worldwide who have implemented disaster medicine training at local, national, and international levels.

Graduates of the TdmT program have successfully established training sessions, workshops, and simulations, enhancing capacity building in disaster medicine and disaster management within their communities. Feedback indicates improved knowledge and confidence among participants, contributing to more effective emergency management practices.

The TdmT program fosters a culture of preparedness and resilience in health systems worldwide. By equipping future leaders and professionals with essential tools and knowledge, TdmT strengthens individual capabilities and enhances disaster response.

On February 3, 2023, a freight train containing 149 train cars operated by Norfolk Southern Railway derailed in East Palestine, Ohio. Eleven of the derailed cars contained hazardous chemicals, including vinyl chloride, ethylene glycol monobutyl ether acetate, 2-ethylhexyl acrylate, isobutylene, n-butyl acrylate, and benzene residue. The Ohio Regional Poison Control Centers received calls from the community and health care providers affected by this incident. On February 6, railroad officials decided to perform a controlled burn with the train cars carrying 115,580 gallons of vinyl chloride due to the rising temperatures, which posed an explosion hazard.

Retrospective case narrative reviews were performed on the phone calls received from the affected community to the Cincinnati Drug and Poison Information Center (DPIC). The cases started in February 2023 and ended in October 2024. Data included the caller location and clinical effects/symptoms from the initial chemical spill, and the controlled burn was entered into a Geographic Information System (GIS).

179 cases were reviewed, with the most common clinical effects/symptoms. The cases were included based on their distance from the derailment, < 1 mile, 5 miles, 20 miles, and > 20 miles radius.

Understanding the health effects of chemical spills in a technological disaster will inform the creation of emergency and disaster management protocols for hospitals and first responders.