There has been an increase in murders and attempted murders of important persons over the past few years. Assault on important persons is a form of terrorism, and it is necessary to minimize damage for the sake of social peace and order. Healthcare providers (HCPs) are required to respond quickly to save lives when an incident occurs. However, no data have shown whether HCPs and medical institutions are adequately prepared. We conducted a survey on the current status of the medical system for responding to assaults on important persons.

A questionnaire survey was conducted among physicians on the largest medical portal site in Japan. The questionnaires are: A. Experience in receiving request to deal with injuries and/or illness of important persons, B. Specific preparation for providing treatment, C. Capability of dealing with injuries of important persons at your medical institutions, D. Treatment experience for injured important persons, and E. Evaluation of the medical system for important persons in Japan. Participants were asked to give anonymous responses.

A total of 1091 physicians participated in this survey. A. Of the 1091 participants, 78 physicians (7.1%) have received the request, B. Of those, 51 physicians (65.4%) had made specific preparations, C. 109 physicians (10.0%) responded that the medical system was in place, D. Only 18 physicians (1.6%) had experience treatment both gunshot and stab wounds, and E. 58 physicians (5.3%) answered that the medical system has been established. It has become clear that there are very few physicians who can provide proper medical care to injured important persons, and the system has not been well established either.

In order to protect society from the threat of terrorism, further efforts to establish a system that can provide appropriate medical care to injured persons are required.

The occurrence of disasters often has a tremendous impact on communities. In large-scale disasters, affected residents often need to rely on self-rescue before emergency response resources arrive. Therefore, enhancing the disaster response capability of community members is increasingly important, especially in light of the current extreme weather conditions.

From 2020 to 2024, the organization conducted 15 training sessions for frontline community responders, with over 1,000 participants in total. The training included classroom lectures, hands-on practice, and scenario-based drills to increase familiarity. A post-training assessment was conducted to ensure that participants understood and were proficient in the skills and knowledge taught in the course.

In the final assessment, all participants passed, achieving a 100% success rate. In the technical skills section, participants were able to independently complete all tasks. During the lecture sessions, instructors engaged with participants in comprehensive drills to confirm their retention of the course content.

Building community resilience is not a short-term endeavor with immediate results. Starting from basic first aid education and gradually expanding to all-hazard response training, the long-term planning and implementation of frontline community responder training can strengthen the community’s comprehensive response capabilities, equipping them to effectively handle both natural and human-made disasters in the future.

External hemorrhage is a leading preventable cause of death in prehospital settings. Despite established protocols and training, the application and outcomes of tourniquet use vary. Region 2 South, an area of four counties in southern Michigan containing 2.5 million people, implemented tourniquet application protocols and training programs. This study aims to analyze the effectiveness and accuracy of tourniquet applications.

Retrospective analysis of tourniquets from October 2019 to December 2023 that included patients presenting to level 1 and level 2 trauma centers with pre-hospital tourniquet placement. Data collected included personnel applying tourniquets, mechanism of injury, appropriateness and correctness of indications, associated interventions, and complications.

473 tourniquets were applied. EMS performed (218, 46.8%), followed by fire/police (196, 42.1%), and the ED (19, 4.1%), and bystander applied in 53 cases (11.3%). The mechanisms of injury were gunshots (185 cases, 39.5%), lacerations (59 cases, 12.6%), and stab wounds (45 cases, 9.6%). 78.3% of tourniquets met appropriate indications, and 89.3% were applied correctly. The odds of applying with appropriate indication were lower when bystanders performed the procedure (OR 0.33, 95% CI 0.18 - 0.60), as were the odds of correct application (OR 0.40, 95% CI 0.19 - 0.87). Data on interventions were missing (54.8%), but when available, it showed blood product administration in 7.8% of patients, suturing in 33.3%, vascular repair in 17.6%, and 27.1% of patients required multiple interventions. Complications related to tourniquets occurred in 2 (0.42%) cases.

EMS and law enforcement are primary applicers of tourniquets, with a significant portion applied correctly and appropriately. There is a lower likelihood of proper application by bystanders. The study indicates tourniquets are generally applied correctly and effectively, with minimal complications. This underscores the importance of continued training and data collection improvements to enhance prehospital care outcomes, as well as the importance of providing continued and further training to the public.

Solar eclipses are often associated with mass gatherings along the path of totality. Understanding the effects of such events on emergency services is crucial for preparedness and resource allocation. This study aims to investigate preparations for and the impact of the April 8, 2024, total solar eclipse in two metropolitan areas: Indianapolis and Bloomington, Indiana, USA.

Organizations involved in emergency management and public safety were sent a questionnaire assessing their preparedness efforts as well as the expected and actual impact that the eclipse had on each organization. Data was collected and managed using REDCap electronic data capture tools hosted at Indiana University School of Medicine.

Twenty-seven organizations were sent the questionnaire. Fifteen responses were obtained. Eight self-identified as hospital/healthcare, one as fire department, one as school/university, zero as federal or state government, one as local government, three as emergency medical services, zero as police, and one as other (emergency management/fire department) The median overall anticipated impact before the eclipse was three on a 1-5 Likert scale, with increased traffic being the most anticipated impact The median perceived impact after the eclipse was two (1-5 Likert scale), with increased population, traffic, and potential for mass casualties being the most impacted. Key themes extrapolated from the qualitative data include: communication and coordination between and within organizations is key to effective preparation and response; exercise planning for real-world events has intrinsic value beyond the actual event; overall impacts to hospitals were less than expected; overall preparedness efforts likely decreased any significant impacts.

Solar eclipses pose unique problems and require multi-agency coordination to prepare for large influxes of visitors. While impacts on emergency services may not be as profound as initially anticipated, active preparation for such events has intrinsic value and may mitigate negative consequences.

Early prehospital identification of stroke and triage to the right level of care may result in more patients receiving acute treatment. Approximately 25% of patients in Denmark receive revascularisation after an acute stroke. Further, 20 % of patients with stroke are not being recognized by paramedics when assessed on scene in a telephone conference with the stroke centre.

Accurate prehospital stroke identification is critical for treatment and 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. In this study, paramedics are using an app to assess the patient, guiding the paramedic through the NIHSS, while each step is documented in a short video, which is transferred to the centralized stroke center.

A stepped wedge randomized trial is performed, with paramedics being the subject which is randomized. First, paramedics are enrolled in October 2024. Data collection is terminated in December 2025. A paramedic in an intervention cluster uses a mobile app for patients with suspected stroke, recording videos of patients. The app analyses the videos, highlighting potential stroke predictors. Recorded videos and NIHSS scores are transmitted to the stroke center for thrombolysis decision-making. In the control group, standard procedures are followed.

The primary outcome measure is for prehospital recognition of patients with acute stroke, defined as the proportion of patients accepted for stroke evaluation and discharged with a final stroke diagnosis. A power calculation yields that no less than 1200 patients will be enrolled in each arm of the trial for 95% power to detect a 5% improvement, with 85% sensitivity assumed in the control group.

The results will show the intervention’s potential to improve stroke recognition rates and its ability to reduce on-scene times.

This study investigated the impact of natural disasters on the incidence of acute rheumatic fever (ARF) among First Nations peoples in Australia, as reported from 2012 through 2021.

Records covering natural disasters in Australia from 2012 to 2021 were compiled from the Emergency Events Database (EM-DAT) and the Australian Disaster Mapper. ARF incidence rates among First Nations peoples in Australia were retrieved from the Australian Institute of Health and Welfare, expressed as an annual incidence rate per 100,000 population. Calculations of ANOVA, simple linear regression, and multiple linear regression were performed to compare the number of natural disasters and the type of natural disasters to the incidence of ARF.

From 2017 to 2021, the annual incidence of ARF was significantly predicted by the number of natural disaster events in all five regions of Australia (p < .05), and even more strongly when excluding New South Wales (p < .01). From 2012 to 2021 using data excluding New South Wales, there was a weaker association between natural disaster events and ARF incidence (p = .07). When the natural disasters were further categorized into meteorological (including storms, floods, and cyclones) and climatological disasters (including fires, droughts, and heatwaves), a significant association was found between the type of disaster and ARF incidence from 2012 to 2021 (p = .02) and from 2017 to 2021 (p = .01). From 2012 to 2021, climatological disasters were a significant predictor with a negative correlation (p < .01). Conversely, from 2017 to 2021, meteorological disasters were the most significant predictor with a positive correlation (p < .01).

The incidence of meteorological disasters is associated with ARF among First Nations people in Australia. These findings introduce ARF as a disease of concern that disproportionately affects vulnerable populations in the wake of natural disasters.

Emergency departments (EDs) play a critical role in healthcare delivery and are contributors to greenhouse gas emissions. As frontline providers of acute care, EDs are uniquely positioned to address the health impact of climate change while also mitigating their environmental impact. Previous research has documented the healthcare sector’s overall response to climate change, but specific strategies employed by EDs remain underexplored. This review seeks to fill that gap by collating and analyzing existing data on ED practices aimed at sustainability to combat climate change and reduce their carbon footprint.

A scoping review was conducted using relevant terms related to emergency departments, climate change, climate resiliency, and mitigation. Papers written in English were included. From PubMed and Embase, 217 studies were found using the key terms. Seven papers made the final data extraction phase. Covidence software was used. A PRISMA model will be included in the final presentation.

Key findings indicate that EDs have started implementing energy-efficient technologies, waste reduction programs, and sustainable transportation initiatives. Some facilities have initiated training programs to educate staff on climate impacts and emergency preparedness in the face of climate-related events. However, the review also identified significant variability in the extent of these initiatives, with many EDs lacking formalized climate action plans. Additionally, there were no nationally unified plans identified for EDs to follow.

The scoping review highlights a growing recognition among EDs of their role in addressing climate change, with promising advancements in sustainability practices. However, the inconsistency in implementation and lack of standardized metrics suggest that more cohesive strategies are needed. To effectively combat climate change, EDs should prioritize developing formal action plans, sharing best practices, and fostering interdisciplinary collaborations that enhance both resilience and sustainability in emergency care.

On October 7, 2023, Israel experienced an unprecedentedly severe terrorist attack, resulting in more than 1,200 fatalities, 1,455 injuries, and 239 hostages. The scale of the attacks on civilians placed an immense strain on hospitals, particularly in the south. This necessitated a significant shift in hospital operations, including the activation of Mass Casualty Event (MCE) protocols. Soroka and Barzilai hospitals were forced to transition to a MEGA MCE mode, dramatically altering the operation of their emergency departments, trauma units, operating rooms, and internal medicine wards. Due to the overwhelming number of casualties and the significant strain on southern hospitals, secondary evacuation operations were conducted for the first time since the Yom Kippur War (1973). Hundreds of casualties were transferred from overwhelmed southern hospitals to those in the central and northern regions of the country.

This massive operation involved the coordinated efforts of the Home Front Command, the Ministry of Health, and hospitals across the nation, all operating in emergency mode. The success of these rapid and effective actions can be attributed to ongoing training, exercises, and cooperation spearheaded by the Hospital Preparedness Branch. This multi-year readiness program, involving 28 hospitals, included comprehensive emergency room training, tabletop drills and simulations for hospital headquarters, and large-scale drills. The annual training program encompassed MEGA, SURPRISE, SAMPLE, and MTE drills, ensuring all hospitals were prepared for large-scale emergencies. This presentation aims to share the lessons learned from both hospital-level and national-level evaluations regarding hospital preparedness for MCES. It will also provide insights derived from the secondary evacuation processes, which involved transferring hundreds of casualties daily, using Magen David Adom ambulances and helicopter evacuation rounds by the Israeli Defense Forces (IDF).

The increasing frequency and severity of natural disasters and humanitarian crises pose considerable problems to healthcare systems, particularly in terms of blood supply management. Effective blood supply chain management is critical for assuring timely access to blood products during crises, when transfusion demand increases due to trauma and mass casualties.

A comprehensive review of literature and case studies from past emergencies was conducted to assess current practices in blood supply chain management. Key strategies were categorized according to the four phases of emergency management. In addition, interactions with stakeholders from blood banks, hospitals, and emergency services were conducted to get insights into effective coordination and resource mobilization.

The results show that improving blood availability during emergencies requires proactive donor engagement initiatives, integrated communication systems, and coordination with emergency management organizations. Operational efficiency is greatly increased by proactive mitigation techniques like keeping stable inventory and readiness measures like interagency communication and catastrophe response plans. 'Walking blood banks’ and drone delivery systems are examples of innovative response-phase solutions that meet urgent transfusion needs. The recovery phase underscores the importance of strategic planning for restoring services and sharing resources among healthcare providers.

A coordinated and proactive approach to blood supply chain management across all phases of emergency management is essential for improving responsiveness during crises. By implementing the identified strategies, healthcare systems can ensure the availability of life-saving blood products when they are needed most, ultimately enhancing patient outcomes in emergencies.

As COVID-19 was declared a pandemic, it has become a significant concern worldwide, related to its high potential to destabilize many countries in the future. During the peak phase of the pandemic (2020-22), Indonesia also suffered a significant number of deaths and a high positive rate. Indonesia, a country with a high risk of natural disasters, faced severe challenges, as it contended with the pandemic in addition to simultaneous natural disasters, including earthquakes in West Sulawesi and East Nusa Tenggara. Muhammadiyah Indonesia, one of the largest philanthropic organizations in Indonesia, established the Muhammadiyah Covid-19 Command Center as a central hub for managing the pandemic. The pandemic did not stop Muhammadiyah’s efforts in handling natural disasters, which included sending emergency medical teams to areas affected by the earthquake in West Sulawesi and flash floods in East Nusa Tenggara. During the team’s assignment, adjustments to assignment procedures were made to prevent the transmission of COVID-19 infection between medical volunteers and the community. Supervision and evaluation of the special procedures were carried out intensively, resulting in an excellent output of fewer than 5% positive cases among medical volunteers. Lessons learned are that emergency medical response for sudden onset disasters (SOD) during the COVID-19 pandemic can be conducted with specific health protocols. Logistics, especially personal protective equipment (PPE) and additional facilities related to the COVID-19 pandemic, played a crucial role during this deployment. It is essential to improve and closely monitor the understanding of health protocols among all personnel during deployment. Assessing the affected area for COVID-19 management, including tracing, testing, treatment, and establishing a referral system, is a must. Additionally, emergency procedures regarding COVID-19 must be prepared as early as possible to ensure an effective response.

The purpose of this presentation is to highlight the challenges refugees and Internally Displaced People (IDP) face when living in tents. These include lack of privacy, safety, and security for families and children; inadequate/insufficient water sources leading to hygiene issues and infectious disease outbreaks; and extremes in temperature exacerbating medical conditions. This presentation will provide an awareness of how these challenges impact Palestinian women, as well as highlight unique challenges they face as it pertains to sanitation, cultural norms, access to care, and obstetric complications. Resiliency strategies to combat these challenges, as well as the lifetime implications, will be shared from the personal lived experiences of Palestinian women.

The COVID-19 pandemic has caused significant psychological distress, especially among healthcare workers. While Psychological First Aid (PFA) and Stress First Aid (SFA) were commonly utilized in disaster settings, a few institutions had adapted them in the pandemic to provide psychological support for their healthcare workers. This systematic review aims to explore the application of PFA and SFA in addressing the psychological challenges faced by healthcare workers during the COVID-19 pandemic.

Searches were conducted in PubMed, CINAHL, and the Cochrane Library in August 2024. Studies were included if they utilized PFA or SFA as the primary intervention or employed frameworks based on either approach.

Seven studies were included in the review, with six conducted in the United States. Three studies focused on PFA-related interventions. One study reported that up to 20% of staff utilized the service. Another study highlighted a high satisfaction rate with the sessions, significant reductions in anxiety and emotional distress, and improved coping abilities. Four studies explored the implementation of PFA and SFA training for healthcare workers. Benefits of this training include increased awareness of available psychological resources, enhanced resilience, improved communication skills, greater proficiency in peer support, and better overall mental well-being.

Current literature provided encouraging evidence for the effectiveness of PFA and SFA in supporting healthcare workers during the COVID-19 pandemic. However, further research is needed to evaluate the impact of scaling up these programs and to determine their long-term effectiveness in preserving the mental health, well-being, and resilience among healthcare workers.

Because messages are broadcast on social media timelessly and efficiently, it is a critical disaster management survey tool. Taiwan’s Regional Emergency Medical Operation Center (REMOC) has responded to nationwide disaster messages in real time since 2005. To construct an early warning system to reduce the delay between the outbreak of accidents and messages received by REMOC.

Timely data, often from first responders and social media, is critical. A system was developed to collect disaster related posts from social media platforms, focusing on keywords like typhoon, flooding, and traffic accidents. Given the mix of topics, informal language, and frequent errors, text analytics and the SVM-based tool LibShortText were used to classify relevant messages. REMOC’s system identified 3,022 disaster-related messages out of 66,588 total posts. We calculated event frequency in 2019, response speed, and engagement rate (ER) to assess the responsiveness of traditional media and individual users.

Most messages collected were related to earthquakes (23%), followed by traffic accidents (17%), fires (12%), and floods (3%). Of 702 earthquake-related messages (142 episodes), social media users shared 35 messages about 18 earthquakes, while traditional media posted 667 messages about 124 earthquakes. Social media consistently posted 100% of earthquake messages faster than traditional media (“early dissemination efficacy”: 124/124). For 251 fires (367 messages), social media shared 122 messages on 82 fires, with an early dissemination efficacy of 0.57 hours. For 32 flood events (117 messages), social media posted 55 messages on 16 floods, achieving an early dissemination efficacy of 0.65 hours.

Results show that social media users responded faster than traditional media to disaster news, especially for earthquakes, fires, and floods. Earthquakes and floods had the highest response rates from social media. Integrating REMOCs and social media information systems can greatly enhance preparedness and response, particularly for earthquakes and floods.

Emergency nursing in Gaza’s war zone presents innumerable challenges when caring for female patients in a depleted health care system. Negative health outcomes specifically impact women of all ages due to a lack of access to menstrual care products, prenatal and primary care, private bathrooms, medication, essential nutrition, and clean water. The massive destruction of infrastructure and consequent internal displacement of millions have led to a rise in infectious diseases. The few remaining functional hospitals depend heavily on foreign medical delegations for supplies, which results in a lack of standardized treatment for women’s health complaints. Emergency departments must also navigate overcrowding, lack of basic supplies and specialists, and prioritization of daily mass casualty incidents from nearby explosions. These obstacles make treatment, discharge teaching, and follow-up care for women’s health difficult to implement. Despite these arduous circumstances, Gazan health care professionals find innovative solutions to improve outcomes and reduce harm while honoring the cultural and religious preferences of their female patients.

The terror attacks on October 7th, 2023, and the war that followed, have had a profound impact on the mental health of the Israeli population. The presentation will provide a comprehensive analysis of mental health outcomes following the war, incorporating data from multiple data sources.

The research focuses on the prevalence and correlates of post-traumatic stress disorder (PTSD), emotional distress, and substance use, utilizing a combination of traditional epidemiological methods, including medical records analysis and surveys with innovative data collection techniques. PTSD, anxiety, and depression, as well as quality of life, were measured in different populations and correlated with other data sources, including Google Trends™ of Spotify™ music application data regarding Israel.

31.4% of participants screened positive for PTSD approximately one month after the attacks, and significant increases in the use of tobacco, alcohol, tranquilizers, and sleep medications were reported. Younger age, female gender, and higher levels of exposure to the attacks were associated with increased PTSD and emotional distress. Google Trends identified an increase in searches related to depression, anxiety, and PTSD, and Spotify music preferences in Israel detected a decrease in songs’ valence, as defined by Spotify’s algorithm.

This study highlights the critical need for targeted mental health interventions and support mechanisms to address the widespread psychological impact of the October 7th war and to monitor its effects in various populations. These findings provide valuable insights for mental health professionals and policymakers in Israel and globally.

The Japan Disaster Relief(JDR) Medical Team was classified as an Emergency Medical Team (EMT) Type 2 in 2016 and reclassified in 2023. A working group has been set up to prepare the system for actual operations regularly, and the Type 2 outpatient care and Type 1 Fixed and Type 1 mobile are led by the Clinical Care 1 Working Group C1. The C1 is made up of members from multiple professions and is mainly focused on the functions required for outpatient care, and is not restricted to any particular profession, but is conducting a cross-sectional study.

A SWOT analysis of the C1 activity structure and studies will be conducted to identify proactive and improvement strategies.

Internal ‘strengths’ included the multidisciplinary nature of the C1 and the fact that the team members have experience in responding to disasters at home and abroad. Weaknesses included the fact that the manuals prepared were not fully utilized due to the large number of pages and the burden of reading for the team members. External factors such as limited training and drills, were cited as ‘opportunities. ‘Threats’ included improved response capabilities of other teams.

It is important to develop an ambulatory care system with members comprising multiple professions, as in C1, so that the construction of a system in each department can be examined in a cross-sectional and practical manner. On the other hand, for the JDR medical team, which has limited opportunities for dispatch, it is necessary to prepare manuals and study their operation in line with normal conditions and actual activities to ensure smooth activities at the time of dispatch.

Over the past 20 years, there has been a global increase in health and humanitarian crises, conflicts, catastrophic events, and disasters, caused by multiple risk factors and increasing vulnerabilities, which are making our planet vulnerable, hence the need to widely inform and share the culture of risk reduction on these issues, using web information and communication technologies and strategies.

Planet emergency disaster med net was created as the first Italian web site platform for national and international sharing information on Disaster Medicine, Catastrophes, Conflicts and Humanitarian Crises to increase the knowledge of professionals and those who want to approach these issues from a perspective of “disaster risk reduction” and to foster an integrated view of the current crises of the planet and possible solutions. The guiding principles will be based on the concepts of Global Health and One Health.

The goal of this project is to provide real-time information on planetary emergencies, disasters, conflicts, and humanitarian crises. The platform’s inspiring principles are based on the concept of One Health, an integrated and unifying holistic approach that aims to sustainably balance and optimize human, animal, and ecosystem health, recognizing that the health of humans, animals (both domestic and wild), and ecosystems is inextricably linked, interdependent, and interconnected. Expected results will be to promote an integrated view of current crises on the Planet and possible solutions from a health and information perspective, following a global health approach, to improve resilience and promote disaster risk reduction.

Using communication, information technology, and new technologies, including artificial intelligence, as tools to increase capacity and skills in disaster risk reduction, to improve disaster resilience, and also encouraging new ways of strong cooperation and interaction through the promotion of a transnational collaborative network in disaster medicine.

The ability to estimate healthcare utilization during mass gathering events can tremendously impact local healthcare resources and the cost of organizing such events. Various prediction models have been proposed in the literature to assist event organizers in forecasting medical service demands. This study will examine the extent and type of evidence regarding prediction modules and variables for healthcare utilization at various mass gatherings (MG) events.

The study included a search of four electronic databases (MEDLINE, EMBASE, Cochrane Library, and SCOPUS). Limits include the literature published on or after January 1, 2003. All retrieved citations looked at prediction models and variables of medical usage at all types of mass gathering events across all demographics, planned or spontaneous, that reported patient presentation rate (PPR) and/or transport to hospital rate (TTHR) at the event. All literature review articles were excluded.

This scoping review analyzed 25 studies. Thirteen studies focused on prediction models for medical usage rates in MG, and 12 studies explored predictive variables for PPR in MG.

The Arbon model (used in nine studies) was the most frequently examined. The Hartman classification model appeared in seven studies. Plan Risk Manifestations (PRIMA), a Belgian tool, was used in three studies. The Zeitz method and the South Africa Mass Gathering Model (SA-MGM) are featured in two studies.

Positively correlated variables with PPR included temperature (most cited, six times), event type (five times), heat index (four times), and crowd size (three times). Other less frequently cited variables (once each) included humidity, venue accessibility, festival format, and age class. Overall, temperature and event type were the most frequently used predictors across studies.

Healthcare utilization prediction tools vary widely. Healthcare organizations can help improve and optimize scarce resources during mass gathering events by understanding the variety and nature of these prediction tools.