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.

During domestic disasters, emergency medical support by nurses includes various forms of assistance, such as participation in DMAT teams, disaster support nurses dispatched by nursing associations, and independent deployment by NGOs and NPOs. Following the Noto Peninsula Earthquake on January 1, 2024, the Health, Medical, and Welfare Coordination Headquarters of Ishikawa Prefecture organized the dispatch of nurses to support medical institutions, social welfare facilities, and evacuation shelters in the disaster-affected areas.

The aim of this study is to identify challenges in coordinating the dispatch of nurses during the Noto Peninsula Earthquake in 2024.

The coordination of nurse dispatch needs was conducted by personnel from Ishikawa Prefecture, the Japan Nursing Association, and the Ishikawa Nursing Association, in collaboration with DMAT staff experienced in nurse dispatch. Unlike previous disasters, where nurses were primarily dispatched to hospitals and evacuation centers, the Noto Peninsula Earthquake required deployment to temporary shelters outside the affected area and to social welfare facilities in the Noto region, where the aging population exceeded 50%. This led to prolonged coordination efforts for long-term dispatch to hospitals and welfare facilities. Information for assessing dispatch needs came from local personnel, municipalities, and systems such as EMIS, D24H, and J-SPEED.

Although the response to the Noto Peninsula Earthquake was confined to a single prefecture, anticipated disasters like the Nankai Trough Earthquake or a direct hit on a metropolitan area would affect multiple prefectures, complicating coordination efforts. The variability in the number, duration, and locations of nurse dispatch depends on the personnel involved in coordination, underscoring the importance of training to manage nurse dispatch effectively in large-scale disasters.

“Outside the Box”

Nurses who have experienced caring for patients with COVID-19 have the potential to identify local and systemic factors that contributed to what helped support the nurses and their ability to provide care and what did not. The three research questions were: 1) What are the experiences of nurses providing care to patients during COVID-19 in community, hospital, and long-term care settings, and how do these experiences impact their professional and personal well-being? 2) How do nurses perceive the effectiveness of organizational strategies, including crisis standards of care, personal protective equipment (PPE) provision, and support for personal preparedness, in supporting their response and practice during the COVID-19 pandemic? 3) What are nurses’ perceptions of the organizational, local, county, state, and federal policies that either support or hinder their ability to effectively respond to the challenges posed by the COVID-19 pandemic?

A qualitative approach was used to interview registered nurses, who had cared for patients with COVID-19 in one of three health care settings (hospitals, long-term and residential care facilities, and community-based or public health response).

Results indicate that most of the nurses felt supported by their immediate supervisor but abandoned by organizational leadership. They experienced challenges with equipment, staffing, emotional support, changing policies, and grief, and felt supported by work colleagues and family.

Healthcare systems were unprepared to respond to a pandemic. The nursing workforce was affected by the lack of preparedness. Preparations for the next pandemic should be underway to address patient care needs and the health and welfare of nurses on the frontline, including maintaining adequate supplies of personal protective equipment, managing a surge of patients, and providing physical and emotional support to nurses and other healthcare workers.

In September 2023, the City of New Orleans became aware of progressive saltwater intrusion up the Mississippi River, the city’s main water source. Saltwater intrusion, a result of global drought conditions and climate change, has increasingly plagued coastal areas globally, causing ill-effects on population health and infrastructure through pipe corrosion, water contamination, and damage to essential appliances. University Medical Center is the largest quaternary hospital New Orleans, a 446-bed hospital serving as the region’s only level 1 trauma center, burn center, and hub for the local medical community. In preparation for possible saltwater intrusion, UMC identified water supply contingency solutions in order to continue patient care throughout the hospital. Reverse Osmosis machines were procured with production capacity up to 1892 L/minute. In addition to tap water filtration, the RO systems are capable of filtering non-potable water supplies including 750,000 gallons (2.84 million L) on-site and an addition 1.5 million gallons (5.69 million L) stored at an off-site location. Finally, an outside vendor was hired to monitor water quality in the hospital and alert hospital administrators once municipal water became substandard. Special considerations were made for services highly reliant on water, including dialysis, dental, laboratory services, sterile processing, pharmacy, and surgery. To continue dialysis services, UMC planned to share capacity with a private service provider (Davita, Inc.) including CRRT machines and storage space for dialysate fluid. The dental team utilized their own water filtration system. A vendor was hired to distribute bottled water as needed. Ultimately, high salinity water never reached the pipes of New Orleans as a result of increased river flow and construction of a sill. However, this overall process serves as a blueprint for rapid expansion of water contingency planning for a major urban hospital.

During the 2016 Kumamoto earthquake, a grade 1–4 evacuation triage (Simple Triage and Rapid Treatment for Neonates, START-Neo) was used to determine the evacuation order at a tertiary neonatal intensive care unit (NICU). However, most newborns are classified as grade 2 or 3, which makes it difficult to determine the order of evacuation. A five-category, 0–12 scale (Neonatal Extrication Triage, NEXT) was developed to reflect the medical care provided. This retrospective observational study investigated whether the use of (i) a triage system (vs. random orders) and (ii) NEXT (vs. START-Neo) improved NICU evacuation efficiency.

NEXT and START-Neo were assessed over 49 days. Given that the evacuation was performed in either ascending or descending order of patient severity, an efficient triage system was defined as one that precisely reflected patient severity. The severity of newborn patients at the time of triage assignment was determined using a Neonatal Therapeutic Intervention Scoring System (NTISS). The Total Evacuation Score (TES) was defined as the time integral of the NTISS scores of newborns waiting for evacuation and remaining within the NICU from the start to the completion of the evacuation. The TES was compared between (i) no triage, (ii) NEXT, and (iii) START-Neo. A computer-based evacuation simulation was conducted using all possible combinations of evacuation orders (NEXT and START-Neo) or randomly extracted combinations (no triage).

Compared to no-triage, both NEXT and START-Neo led to a reduction in TES throughout the study period. NEXT was superior to START-Neo on 34 of 49 days and showed no difference on 10 days.

Triage systems are crucial for improving NICU evacuation efficiency. NEXT, an improved triage system, appears likely to reduce the overall risk of newborns remaining in a damaged NICU before transportation.

On October 7, 2023, Hamas launched a devastating attack on Israel, resulting in over one thousand deaths and over 1,900 injuries. Physicians, paramedics, and medics were caught in the crossfire, both as victims and first responders. They faced the daunting task of providing care under continuous fire while grappling with the knowledge that their colleagues were among the victims. This study explores the psychological and professional challenges healthcare providers encounter during this extreme scenario, examining their coping mechanisms and ability to deliver critical care in the face of personal risk and loss.

The research employed a qualitative methodology involving in-depth interviews with seven paramedics, five doctors, and six medics who provided continuous medical care during the events of October 7, fully aware that their colleagues had been injured or killed. The goal was to comprehensively understand the difficulties they experienced, their coping strategies, and their ability to function under such extreme circumstances.

In the research, five central themes emerged consistently across all interviews: personal and moral dedication, prior experience in high-stress environments, awareness of their irreplaceability, the necessity to fulfill duties, and the understanding that the deceased medical colleagues would have expected them to continue their work.

This research provides a compelling and unique insight into the experiences of field-level medical personnel who must deliver aid while facing immediate danger, knowing that their colleagues have been injured or killed. The findings offer valuable lessons that can enhance preparedness and resilience for similar events in the future, not only in military and conflict settings but also in the context of other large-scale crises and attacks on healthcare facilities. The study’s insights can inform the development of targeted training, support systems, and organizational strategies to better protect and empower medical personnel in the face of such extraordinary challenges.

Prolonged Casualty Care (PCC) refers to delivering medical care in austere environments where evacuation is delayed. In future conflicts, the United States Department of Defense anticipates delays in medical evacuation due to extensive operational areas and challenges associated with operating in semi- and non-permissive environments. This study investigates the impact of a high-fidelity simulation, Operation Gunpowder, designed to teach PCC skills to US military medical students. The simulation emphasizes hands-on experience and leadership within the context of delayed medical evacuation in a limited resource environment.

A qualitative phenomenological design was employed to explore the experiences of 35 third-year military medical students who participated in Operation Gunpowder. Data were collected through pre- and post-simulation interviews and analyzed for thematic insights, first individually coded and then collectively agreed on emerging themes as a group.

Three main themes emerged: (1) Benefited from Hands-on Learning: Learners highlighted the importance of practical experience in mastering skills essential for PCC, contrasting it with traditional learning methods. (2) Navigated the Operational Environment: Participants discussed how the simulation exposed them to unpredictable, high-stress scenarios, enhancing their ability to improvise and manage patient care under pressure. (3) Developed Leadership Skills and Abilities: Students recognized their growth and potential in leadership roles, emphasizing teamwork and communication as critical for successful operations.

Operation Gunpowder effectively enhanced students’ clinical skills and preparedness for real-world military operations. The simulation fostered hands-on learning, resilience in unpredictable operational environments, and the development of leadership abilities. These findings underscore the necessity for simulation-based training in military medical education, particularly in preparing students for the complexities of PCC in future deployments. Further research will quantify the simulation’s impact on skill performance and explore the integration of telemedicine in austere environments to enhance military medical education.

This study aimed to identify factors related to the survival outcome of out-of-hospital cardiac arrest patients in the emergency department at Det-Udom Crown Prince Hospital.

This retrospective descriptive study collected data of out-of-hospital cardiac arrest patients at the emergency department during January 2022 and December 2023 from the hospital database. The data was analyzed by descriptive statistics and the Chi-square test or Fisher’s exact test.

Among the 168 patients, 72% were male, age average, 55 years. Incidents occurred at home (56.5%), and cause of cardiac arrest by accidents being (31.5%). The sustained return of spontaneous circulation was 25.8%. The survival to hospital admission was 24.1%, and survival with a good neurological outcome (Cerebral Performance Category; CPC) Cat I-II was 2.15%.

The factors significantly associated with out-of-hospital cardiac arrest survival (P-value<0.05) were as follows: The associated factors of failure in resuscitation were diabetes (Odd = 2.676), hypertension (Odd = 2.333), and cardiac arrest due to accidents (Odd = 2.509). During transportation factors associated with improved patient survival; defibrillator use (Odd = 0.430), chest compressions (Odd = 0.417), fluid administration (Odd = 0.430), and adrenaline administration (Odd = 0.467). Additionally, factors related to emergency medical services include response time, on-scene time, chest compression techniques, opening the airway, oxygenation, and type of ventilation.

Enhancing cardiopulmonary resuscitation (CPR) skills, expanding emergency medical response units to cover broader areas, and ensuring rapid access to emergency medical services can significantly increase the survival rate of out-of-hospital cardiac arrest patients.

The long-term mental health impact of disasters is still poorly understood. This multilevel meta-analysis aimed to assess the impact of the number of fatalities while simultaneously controlling for multiple factors. The objective was to verify whether there is an association between the extent of fatal casualties during a disaster and the mental health impact on exposed populations.

Medline, PsycInfo, PTSDpubs, Web of Science, and SocINDEX were searched for studies published from January 1946 to July 2024 (PROSPERO 2020, CRD42020108528). Longitudinal data from 71 studies (76 disaster-exposed samples) were extracted and augmented with fatality data sourced from Wikipedia. Fatality categories (<10, 10-99, 100-999, 1,000-9,999, >10,000), disaster type (natural vs. human-made), category (e.g., earthquakes, floods, terrorist attacks), mental health outcome (e.g., post-traumatic stress disorder, depression, anxiety, grief, suicidality), population age groups, disaster year, measurement month, study quality, and country income were included in the analysis.

The pooled average prevalence of mental health problems was 21.81% (95% CI [10.07-40.98]). From months 1 to 300, the post-disaster mental health burden decreased after an initial peak in the first months, followed by a second peak before declining again (p < 0.001). The prevalence of mental health problems did not differ significantly between mental health outcomes, disaster types or categories, population age groups, disaster year, study quality classification, or country income context. When controlling for these factors, fatality categories (reference: <10) had no significant effect on mental health. The proportion of fatalities differed between income groups. In 67% of disasters in upper-middle-income countries, fatalities exceeded 10,000, while 63% of disasters in high-income countries had fewer than 100 deaths.

Although this controlled multilevel meta-analysis demonstrates that the mental health impact of disaster exposure is profound and long-lasting, it did not confirm that a more excessive number of fatalities was related to increased mental health problems.

The COVID-19 pandemic revealed gaps in preparedness for large-scale health emergencies, highlighting vulnerabilities within communities and systems. Widespread distrust and skepticism towards innovative tools were common. To better manage future crises, it is crucial to integrate these tools, including information technology and AI-driven solutions, while actively engaging civil society organizations, citizens (especially vulnerable and non compliant groups), policy-makers, and health authorities. The PREPSHIELD project aims to foster a holistic, citizen-centered approach to health crisis management by developing policy recommendations and innovative tools.

Launched on September 1, 2024, with 13 partners, the PREPSHIELD project will run for three years. It will begin by identifying challenges and best practices from past epidemics and pandemics, focusing on areas such as healthcare response and communication with non-compliant groups. These insights will inform the development of crisis management tools, including a mobile app and an online platform, as well as policy recommendations. These will be tested through tabletop and online exercises at three pilot sites, each representing different scales and levels of institutional trust: the city of Hamburg, Piedmont Region, and Romania.

PREPSHIELD will deliver several key outcomes, including policy recommendations and tools for more inclusive pandemic management. A mobile application will be developed to provide educational content, information, alerts, and polls, while also allowing citizens to report data such as well-being, mental state, concerns, and alerts. This data will be linked to a platform designed to enhance situational awareness and support multi-actor decision making.

By promoting an inclusive and innovative approach to disaster management, PREPSHIELD will enhance pandemic preparedness but also provide insights for other types of disasters. WADEM provides a key platform to share this project and its preliminary findings with a community of disaster practitioners and scholars.

This project is funded by the European Union.

Indonesia is one of the countries with the highest disaster risk in the world, including the Tasikmalaya District in West Java Province. An information system to support the health office and public health centers (PHC) was developed to monitor preparedness, implement mitigation strategies, and enhance their capacity in the pre disaster phase.

This study employs a research and development (R&D) methodology. It starts with a qualitative approach to data collection through interviews and focus group discussions (FGDs) with stakeholders. These stakeholders provided insights into the problems and user needs for the system design’s foundation. The system design method used is the Framework Application of System Technique (FAST) approach.

The data collection revealed several issues in system implementation in the field, including a lack of human resources, budgeting, infrastructure, and policy procedures. The system’s user needs include disaster event monitoring and mitigation functions, visualization of attractive information such as maps and graphs as a dashboard, and features integrated with the climatology agency for early warnings. The system is also designed to be multi-user and accessible from various locations and platforms. Based on these findings, a web-based information system called HaRMoniS (health risk crisis monitoring information system) was developed, with features and functions aligned with the expectations and needs of the users. Thirty-eight out of forty PHCs used this system to cover almost two million people in the Tasikmalaya District.

With this system, PHC, the health office, as well as the community, can monitor disaster/health crisis risks, vulnerability levels, and capacity achievements in their area within the Tasikmalaya District. This allows the PHC and health offices, as the responsible parties for the health sector, to improve their preparedness, mitigation, and capacity-building efforts in the pre-disaster phase, thereby improving their readiness before a disaster occurs.

In 2017, unprecedented rainfall from Hurricane Harvey resulted in severe flooding in parts of Texas. While the association between the immediate effects of severe weather on mortality is well established, less is known about long-term mortality and how risk may differ across vulnerable populations, especially those reliant on health services. This study examines the association between severe weather exposure from Hurricane Harvey and mortality among vulnerable populations of older adults.

This retrospective cohort study used Medicare administrative claims data from beneficiaries aged 65+ who resided in Texas or Louisiana the year before and after Hurricane Harvey. Historic weather data was used to construct a 4-day measure of ZIP code tabulation area cumulative rainfall and identify locales exposed to high rainfall (above 75mm). Vulnerable older adult populations were identified. Attributable risk and relative risks (RRs) were estimated to quantify the impact of high rain exposure on mortality. Time-to-event analyses estimated associations between exposure to high rain and 12-month mortality.

The study included 1,730,693 beneficiaries; 535,794 (37.5%) were exposed to high rain in Texas, and 264,265 (87.5%) in Louisiana. Beneficiaries with Alzheimer’s disease and related dementias (ADRD) exposed to high rain had a 5% higher risk of mortality in fully adjusted models (HR=1.05, 95% CI: 1.02, 1.07) and 1,192 attributable deaths. High rain resulting from Hurricane Harvey was associated with a 13% higher risk of mortality among beneficiaries with end-stage renal disease (ESRD) in fully adjusted models (HR=1.13, 95% CI: 1.04, 1.23) and 85 attributable deaths.

The risk of mortality from exposure to severe weather differs based on the type of vulnerability. Those with an ADRD or ESRD diagnosis, in particular, had elevated mortality rates. High rain exposure had a significantly larger mortality impact on those of lower socioeconomic status. Emergency planning should pay particular attention to these highly vulnerable groups.

When dealing with radioactively contaminated patients, medical staff often experience anxiety, even though their health is unlikely to be affected by radiation exposure. An application has been developed to simulate the exposure dose to medical personnel by inputting the contamination status of the patient. In addition, it was examined whether the application could be used for radiation exposure medical education to reduce the concerns of medical personnel about radiation.

The application utilizes the Particle and Heavy Ion Transport code System (PHITS), a radiation behavior code, to simulate the geometry of a supine patient and a medical staff member standing alongside. Simulations were conducted assuming contamination of the patient with various radionuclides. Using this data and FileMaker Pro, an iOS application was developed that allows for an intuitive calculation of exposure doses. This application has been incorporated into radiation emergency medical education.

Simulations revealed that even in scenarios involving radionuclide release from a criticality accident, such as significant deposition of radioactive iodine or cesium on the patient’s body surface, medical personnel are unlikely to receive doses exceeding 100 mSv. Furthermore, medical doctors, nurses, and radiological technologists who underwent radiation protection training demonstrated significantly reduced anxiety regarding radiation exposure both before and after the training.

Providing medical personnel with an estimate of their potential exposure doses during the treatment of contaminated patients has proven effective in reducing anxiety. Continued basic research and education on low frequency events like radiation accidents remain crucial.

Public General hospitals in Israel must provide Emergency and Trauma care 24/7 without bias or connection. Hospitals differ in their ability to provide trauma care for different types of injuries, availability, infrastructure, services, and manpower. The MOH established a Trauma Committee to apply trauma care standards according to universal standards; hospitals are classified into three levels of trauma care: a Level One Trauma Center, a Regional Trauma Center, and a Local Trauma Hospital. The criteria include specialist physicians, nurses, nurse coordinators, other supporting medical and paramedical teams, Trauma Unit capacity and capabilities, Trauma Registration as part of the national system, standard medical equipment in the ED’s trauma Unit, Internal guidelines and procedures, Quality Assurance of care for the injured, research, and Trauma Education.

Six of the twenty-eight hospitals assessed by the committee were recognized as Level One Trauma Centers; one medical center was required to complete deficiencies and is in the re-evaluation process. Seven Medical Centers were approved as Regional Trauma Centers. Three medical centers were required to complete deficiencies and participate in the re-evaluation process. Six hospitals are approved as local trauma hospitals, but another six do not meet the requirements, and their recognition has been delayed.

At this point, some hospitals do not meet the required standard due to a lack of motivation to promote their system and blame it on a lack of budgets, the need for preparation, appointment of positions, and commitment. The committee’s hands are tied because it cannot oblige hospitals to fulfill the recommended standards. In the absence of the ability to “punish,” it is possible that some hospitals will not be part of the standard Trauma care in the national trauma system. Moreover, their Trauma Care standard may be inadequate. The committee needs to have the legal authority to enforce its recommendation.

The medical unit of the Japan Disaster Relief (JDR) Urban Search and Rescue (USAR) team comprises five members, including physicians and nurses, who are responsible for providing medical care to rescued victims and managing team members’ health, including rescue dogs'. Unlike other USAR teams, JDR’s distinctive feature is nurse participation; however, the specific contributions of these nurses remain unevaluated. This study aimed to assess nurses’ contributions during USAR activities using V. Henderson’s 14 Basic Needs as an evaluation framework.

Four nurse researchers with Medical Manager qualifications evaluated nursing care involvement across nine USAR team roles (leadership, rescue workers, structural assessors, handlers, rescue dogs, communication staff, coordinators, medical staff, and local staff). The evaluation used Henderson’s 14 Basic Needs, rated on a 5-point Likert scale (1: no attention; 5: very high attention). Statistical analysis employed R software for descriptive statistics and intraclass correlation coefficients (ICC).

The ICC(3,1) demonstrated high agreement at 0.882 (95% CI: 0.849-0.911). Analysis of three domains revealed: “Basic Physiological Functions” averaged 4.95 (SD=0.224) across all roles; “Environmental Adjustment” averaged 4.56 (SD=0.63), with human roles scoring higher (mean 4.75-5.0) than rescue dogs (mean 4.0); “Social Aspects” showed lower scores (mean 3.9, SD=1.11), particularly for rescue dogs (mean 2.8). “Beliefs and values” scored highest for local staff (mean 5.0) compared to other roles (mean 1.0-2.0).

Nurses’ contributions demonstrate a hierarchical priority system emphasizing physiological function management while maintaining environmental adjustment attention. Although social aspects scored lower, this reflects the acute phase of disaster response, with high scores for local staff in “beliefs and values,” highlighting cultural considerations in international operations. The findings demonstrate that nursing practice in USAR activities encompasses fundamental nursing elements while prioritizing life-sustaining care, enhancing overall team performance through physician collaboration.

The war in Ukraine has forced hospitals near the frontlines to overcome a considerable number of complex injuries under challenging conditions. This study presents a comprehensive analysis of 7,758 war-wounded patients admitted to the first traumatological Intensive Care Unit of Mechnikov Hospital in Dnipro, Ukraine, a civilian hospital acting as the main role 4 facility for the eastern and southern zones, between 2022 and 2024.

A retrospective two-tiered study design was employed. The first tier analyzed automated hospital records for all war-wounded patients, focusing on demographics, mechanisms of injury, injury severity, and outcomes. The second tier consisted of a manual review of 41 detailed patient files to provide in-depth clinical insights. Metrics included injury patterns, prehospital interventions, surgical procedures, and ICU mortality rates.

Explosive injuries accounted for the majority of cases across all years (93.2% in 2022, 93.7% in 2023, and 88.5% in 2024), with a rising proportion of gunshot wounds (2.5% in 2022 to 7.5% in 2024). Median patient age was 38 (IQR 30–47), and the median length of hospital stay was three days (IQR 2–5). Limb injuries (87.8%) were the most common, followed by head (58.5%), thoracic (51.2%), and abdominal injuries (26.8%). ICU mortality rates declined over time, from 6.8% in 2022 to 5.4% in 2024. Prehospital interventions were prevalent, notably intubation (82.9%), tourniquet (65.9%), and damage-control surgery (70.7%).

The study highlights the prevalence of blast-induced polytrauma, emphasizing the importance of prehospital interventions and damage-control surgery in reducing mortality, but shows an evolution of the proportion of gunshot wounds over time. While ICU mortality rates compare favorably with other conflict zones, a declining trend over the years seems to follow the adaptation of therapeutic and logistical procedures. Limitations include the exclusion of prehospital fatalities and challenges in data collection due to major resource and environmental constraints.

A mass casualty incident (MCI) is a sudden onset event that can generate many patients with the potential to overwhelm healthcare resources. Many Canadian hospitals plan to use disaster-specific triage tools during an MCI, rather than routine procedures, despite a lack of studies. It is not known whether these alternate triage tools have ever been utilized in actual Canadian MCIs. This study sought to discover what triage strategies have been recorded and their frequency of use.

A scoping review of scientific databases and the grey literature was conducted to find published material regarding the triage strategy employed by the responding hospital(s) during real MCI events in Canada over the last 40 years (i.e., January 1, 1983, to December 31, 2022). A survey of healthcare providers was also administered to elicit further information regarding triage practices.

The database searches identified 279 reports; 32 underwent full manuscript review, and 2 were included in the study. The grey literature search yielded 28 reports; 23 were fully reviewed, and 1 was included. The grey literature search also identified 22 events that triggered MCI alerts at Canadian hospitals, and contacts for 15 of these events were invited to participate in the survey. Survey data were retrieved from 6 events (40% response rate). Nine separate disaster events were reported on in total. Six of these events reported a pre-existing hospital MCI triage plan, with 5 (83%) citing intent to use an alternate triage system. During the actual event, only 1 (12.5%) reported using an alternate triage strategy.

It may be appropriate to disregard alternate disaster triage tools for hospital triage and use routine procedures, saving valuable time and financial resources. The creation of a national repository of disaster responses impacting healthcare delivery in Canada should be strongly considered.

Healthcare organizations used off-the-shelf video conferencing platforms to provide telehealth services during the SARS-CoV-2 pandemic. However, the reliability and resiliency of these platforms for all-hazards disaster response when the telecommunication infrastructure may be damaged or overwhelmed is unknown. Further, industry standards to guide technology and system development for disaster response are lacking. This study characterized the impact of degraded networks on the ability to maintain adequate audio and video quality to support clinical telehealth encounters in simulated austere network conditions.

Network manipulation testing was performed in a cyber-sandbox for HIT on off-the-shelf video-conferencing platforms (Zoom, Microsoft Teams, Webex, Skype, and Google Meet) and two commercial telehealth platforms in development for regional disaster response in the United States. A high-precision network emulator was used to perform controlled network degradation, including network bandwidth, network delay, packet loss, and packet corruption. Delays in establishing synchronous video calls, video resolution, missing video frames, video freezes, delayed video, audio quality, delayed audio, and audio intelligibility were examined, as these issues can compromise the quality of the telehealth encounter.

Decreasing the network quality of service decreased audio and video quality. With all platforms tested, when network bandwidth was <200 KB/s, network delay was >5 seconds, packet loss exceeded 15%, or packet corruption exceeded 20%, communication via audio and video conference failed.

This study identified minimum network performance thresholds required to use video conferencing and telehealth platforms to deliver disaster telehealth services in simulated settings. These results inform system users and technology developers of methods, metrics, and expected performance to prepare for real-world performance degradation expected in disasters. Future studies should examine real-world network performance in a variety of disaster conditions.

Identifying patients with first-episode psychosis (FEP) who are unlikely to achieve early clinical recovery (ECR) is critical for personalised intervention and resource allocation. ECR – defined as the concurrent achievement of symptomatic and functional remission – represents a clinically meaningful outcome that captures both illness control and functional reintegration.

To develop and externally validate prediction models for ECR using clinical, cognitive and genetic data.

We analysed two large, independent Spanish cohorts: the primeros episodios psicóticos cohort (N = 335), for model development and internal validation, and the Programa Asistencial a las Fases Iniciales de Psicosis cohort (N = 668), for external validation. Forty-seven baseline clinical and cognitive variables and 87 polygenic risk scores (PRSs) were examined. Predictors were selected using penalised logistic regression. Logistic regression and three machine learning algorithms were compared for discrimination, calibration and clinical utility.

The best-performing model was a logistic regression using six routinely collected clinical and cognitive predictors (duration of untreated psychosis, days of treated psychosis, baseline functioning, insight, executive function and cognitive reserve), with an optimism-corrected area under the receiver operating characteristic curve of 0.73 in development and 0.63 in external validation. PRS models showed limited external generalisability and did not improve prediction. Machine learning algorithms offered no advantage over regression models.

A simple, interpretable logistic regression model based on routine clinical and cognitive variables can predict early recovery in FEP with acceptable generalisability. These findings support the use of transparent, clinically grounded models in early psychosis care and highlight the current limitations of genetic predictors for individualised treatment.