Research was conducted to identify needs for policy and legislation changes aimed at creating enabling environment for the implementation of the Emergency Medical Teams (EMT) Regional Action Plan 2024-2030 (RAP) to be facilitated by the WHO Regional European EMT Capability Hub (REECH).

• Establishing commonalities and differences in EMT-related policy and legislation in countries representing different subregions of the WHO/Europe.

• Informing the RAP policy and legislation framework development.

An analysis of the legal and normative frameworks governing EMTs in the selected countries – Spain, the UK, Georgia, Kyrgyzstan. The study involves reviewing legislative documents, policy frameworks, and operational guidelines that regulate EMTs’ integration into national health systems and emergency response coordination mechanisms.

Common characteristics of national legislation and policy frameworks include clear legal mandates, integration with national health systems, and alignment with national health policies. Differences identified: EMT governance and subordination (e.g., health sector in Georgia and UK, civil protection domain in Spain and Kyrgyzstan); patterns of international collaboration (e.g., stronger engagement with EUCPM for Spain, WHO guidance and support for Kyrgyzstan and Georgia).

The WHO European region’s diversity informs different approaches to policies and legislation aimed at supporting RAP. Enablers include clear EMT mandates and their integration with national health systems and international mechanisms. However, routes to these enablers vary due to differences in policies, health system design, and legislation adoption procedures. Future research will include more countries and a detailed list of research questions to identify patterns in legislation and policy enablers for achievement of the Global EMT goals.

The EMT-ATG achieved a significant milestone with its inaugural deployment during the SIDS4 Conference in Antigua. The EMT2030 strategy and Global Health Emergency Corps (GHEC) approach underscore the importance of collaborative leadership and joint efforts among all the networks to provide a comprehensive response.

The primary objective of the deployment was to ensure the health and safety of SIDS4 conference attendees through a coordinated and effective emergency medical response. It also aimed to demonstrate the capability of small island countries to establish and deploy fully operational and self-sufficient EMTs in coordination with other rapid response capacities, fostering a model of collaborative leadership.

Training programs, conducted in collaboration with PAHO, focused on disaster response, triage, and mass casualty management. PAHO capacity building included the procurement of medical equipment, establishment of mobile medical units, and enhancement of communication systems for seamless coordination.

In preparation for deployment, ATG-EMT conducted simulation exercises and drills which involved various stakeholders, including local health authorities, security agencies, prehospital EMS, public health rapid response teams, and community volunteers.

The successful deployment of ATG-EMT during the SIDS4 Conference demonstrated the team’s capability to provide high-quality medical care and support at a high-profile international event. This contributed to the health and safety of over 4,500 delegates.

The deployment highlights the importance of continuous training, robust capacity building, meticulous preparation in developing an effective emergency medical response system and serves as a model for small island countries aiming to enhance their disaster response capabilities.

On February 6th, 2023, a 7.8 magnitude earthquake struck Türkiye and Syria causing hundreds of thousands of casualties and almost 57,000 fatalities. The two main hospitals of Antakya (capital of the Hatay province, 1,686,043 inhabitants) were strongly damaged and not operational from the day of disaster. The EMT2-ITA Regione Piemonte (EMT2-ITA) deployed its field hospital in Antakya and became operative on February 2023, the 17th.

The objective of this study is to perform a descriptive analysis of the EMT2-ITA mission in Türkiye, to better prepare the teams for future missions.

Starting from the paper patient records and the surgical procedures logbook, a chart review was conducted: the anonymous data of the patient records were manually entered into an electronic data collection form by healthcare staff (nurses supervised by doctors). Descriptive statistics were used to analyze the database.

A total of 5,459 triage admissions were recorded during the 29 days of activity: almost all the admissions (4,952; 90.7%) were not critical patients (white or green codes), with only few cases (507; 9,3%) needing urgent or immediate care (yellow and red codes).

The EMT2-ITA performed a total of 51 surgical operations (orthopedic, gynecological, general, and maxillofacial surgery). The mother-child emergency was important too, with 31 births and 23% (1281) of pediatric patients.

The data collected show that the main activity of EMT2-ITA in Türkiye was the full commitment to support and maintain the ordinary health care capacity of the affected country.

The PT EMT plays a crucial role in emergency assistance during disasters, outbreaks, and mass gatherings, alleviating pressure on hospital emergency departments and supporting local health systems. The EMT Initiative ensures that health services provided in emergencies are safe, timely, equitable, and efficient. This initiative supports the deployment of teams and the development of structures necessary to deliver quality health services in host countries.

Benchmarking for EMT development and deployment to ensure consistent and quality clinical governance and preparedness.

Analysis of clinical management and supply chain practices based on PT EMT’s experience.

To enhance clinical performance, the Portuguese team supplemented WHO’s Minimum Standards by developing 25 clinical guides. These guides help in precise assessment of clinical consumables, ensuring the module’s self-reliance and reducing material wastage. They also facilitate the preparation of cargo manifests and optimize the packaging and transport of clinical supplies, adhering to safety standards.

Using WHO’s Essential Medicines List and considering potential deployments in Portuguese-speaking countries, the PT EMT established a robust inventory of essential clinical consumables. This inventory ensures authorized entry into host countries and continuity of care post-deployment. The organization of clinical supplies into three kits allows for autonomous care for up to 15 days, supporting 100 patients daily. This preparedness was recognized and integrated into WHO’s revised Bluebook in 2021.

Since 2019, this approach has been tested and refined at major events like Fatima’s mass gathering and World Youth Day 2023, demonstrating increased operational efficiency and sustained emergency response capabilities for the PT EMT.

There is a need for high-quality disaster training in lower income communities that bear an increasing burden of MCIs. Tabletop exercises (TTX) are low-fidelity, low-cost training methods consisting of facilitator-moderated, discussion-based activities. Simulation education (SIM) is a high-fidelity modality mimicking psychological stress, muscle memory and cognitive load of an MCI. These represent economical training strategies which are standardizable across different regions, developing disaster management skills for first responders.

This study compares the effectiveness of TTX and SIM in building knowledge for Emergency Physicians (EPs) involved in MCIs and increasing comfort in managing disaster scenarios.

64 EPs were randomly assigned to a 1-hour session of TTX or SIM on MCIs and completed assessments testing knowledge and self-perceived comfort levels. Simulation and Disaster Medicine faculty members subsequently moderated debriefing sessions.

TTX participants (N=38) had median knowledge scores of 71% compared to 57% in SIM participants (N=25). TTX participants’ comfort level in dealing with MCIs after the education sessions showed a median comfort level of 5/5 compared to 3/5 in SIM participants. TTX showed an average change in comfort level of 2.13 (SD 1.53) pre- and post-education sessions compared to 1.68 (SD 1.38) in the SIM group, with no statistically significant difference between the groups.

Both modalities increased comfort level in managing MCIs, although participants in TTX performed better on the post-exercise assessment. This data suggests TTX may be an efficacious cost-effective strategy to increase knowledge and comfort in preparing staff for MCIs.

The military offensive on Gaza since October 2023 caused mass displacement, killing over 39,480 Palestinians and injuring 91,128 (to 1 August 2024). Gaza’s hospitals cannot cope with large numbers of trauma patients due to successive mass casualty incidents. Restricted humanitarian access into Gaza, ongoing attacks on hospitals and healthcare workers, and limited medical supplies hinder operations.

MAP provided quality treatment of trauma cases in the south and middle areas of Gaza through the deployment of specialized care teams from December 2023 - August 2024.

MAP’s specialist multidisciplinary EMTs initially deployed through Rafah and then through Jordan, operated and treated patients alongside the depleted local workforce. The careful selection of clinical skills in each EMT to best complement existing teams ensured maximum efficiency in trauma treatment.

Despite the severe challenges, MAP’s eight EMTs conducted 1,718 consultations and 551 surgeries, with 71% of surgeries being conflict-related and 21% were for children, over 97 days of treatment provision.

Factors contributing to effective deployment of EMTs and successful treatment of trauma and other cases included: 1. Availability of a local team able to support EMTs throughout their deployment inside Gaza; 2. Well-established relationships with the local hospitals prior to October 2023, allowing for effective liaison and adaptability to the rapidly changing and hostile environment; 3. Previous investment and expansion of our network of clinical specialist volunteers enabling rapid scale up of our EMT operations; and, 4. Flexibility of MAP volunteer specialists in undertaking new roles in the emergency room and operating theatres based on need.