To determine the incidence and characteristics of hospital-based gun violence from 2000–2019.

A keyword-based search of the Nexis Uni database was conducted to identify hospital based shootings ((“shooting” w/5 “healthcare”) OR (“shooting” w/5 “health care”) OR (“shooting” w/5 “hospital”) OR (“shooting” w/5 “emergency room”) OR (“shooting” w/5 “ER”). Hospital based shootings were defined as any firearms discharge that occurred on hospital grounds in which at least one person was injured. Specialty hospitals and other healthcare facilities were excluded. Demographic, motive, and outcome data from news articles were abstracted by 2 independent reviewers with discrepancies resolved by a third reviewer. Motives were categorized according to a previously published classification schema.

We identified 146 hospital-based shootings. 88 shootings have occurred since 2010. 133 of the shooters were male (91%), with a median age of 46. 77 (53%) shooters were killed, 49 from suicide (34%). Shootings were most frequently motivated by social violence (n=32, 22%).

Hospital-based shootings are not a rare occurrence, with middle-aged male shooters as the most common perpetrators. These events appear to be increasing over time and evidence-based mitigation strategies should be investigated.

In mass casualty scenarios, patients with apparent hemodynamic and respiratory stability might have occult life-threatening injuries. These patients could benefit from more accurate triage methods. This study assessed the impact of point-of-care ultrasound (POCUS) on the accuracy of secondary triage conducted at an advanced medical post (AMP) to enhance the detection of patients who, despite their apparent clinically stable condition, could benefit from immediate life-saving interventions or priority earlier transport to definitive care.

A mass casualty simulated event consisting of a bomb blast in a remote area was conducted with 10 simulated casualties classified as YELLOW at the primary triage scene; patients were evaluated by 4 physicians at an AMP. Three patients had, respectively, hemoperitoneum, pneumothorax, and hemothorax. Two of the four physicians were provided the use of POCUS.

All 4 physicians were able to suspect hemoperitoneum, but only physicians utilizing POCUS detected pneumothorax and hemothorax.

This study suggests that POCUS-enhanced secondary MCI triage at an AMP may represent an effective methodology to accurately detect nonapparent injuries that require time-dependent priority transport or life-saving interventions. Further studies with larger samples conducted in varied MCI scenarios are warranted.

Italy frequently experiences major events like earthquakes, floods and migrant shipwrecks. Global concerns include climate change, pandemics and wars. We would assess the role of public health experts and the current state of Italian post-degree Public Health schools towards these challenges.

A cross-sectional online survey was conducted in Italy in June 2023, among all Italian Public Health residents enrolled in SItI. The study investigated the presence of trainings and updates about emergencies. It also explored interest and importance of topic, impact of Covid-19 pandemic and sources of information.

Out of 289 respondents, 86.2% deemed the topic important and 74.4% expressed interest (both p<0.001). 90.1% pointed out the lack of dedicated courses and 93.1% as for specialized master’s programs (both p<0.001). Perceived importance in the topic correlates with the desire to attend dedicated conferences (p<0.001). For COVID-19, 24.6% recognized the importance of topic pre-pandemic, while 50.9% raised awareness during (both p<0.001).

A discussion is needed for enhanced training programs in public health emergency prevention and management across Italy, pledging for uniformity within different training networks. In this way, a more robust response to future emergencies may be ensured.

The recent rise of active shootings calls for adequate preparation. Currently, the ‘Run, Hide, Fight’ concept is widely accepted and adopted by many hospitals nationwide. Unfortunately, the appropriateness of this concept in hospitals is uncertain due to lack of data. To understand the ‘Run, Hide, Fight’ concept application in hospital, a review of currently available data is needed.

A systematic review was done focusing on the ‘Run, Hide, Fight’ concept using multiple databases from the last 12 years. The PRISMA flow diagram was used to systematically select the articles based on specific inclusion and exclusion criteria. The measurements were subjective evaluations and survival probabilities post-concept.

One agent-based modeling study suggested a high survival probability in non-medical settings. However, there is a paucity of data supporting its effectiveness and applicability in hospitals. Literature suggests a better suitable concept, the ‘Secure, Preserve, Fight’ concept, as a response protocol to active shootings in hospitals.

The effectiveness of the ‘Run, Hide, Fight’ concept in hospitals is questionable. The ‘Secure, Preserve, Fight’ concept was found to be designed more specifically for hospitals and closes the gaps on the flaws in the ‘Run, Hide, Fight’ concept.

A mass casualty incident (MCI) is unpredictable and involves many casualties at the same time and place. This brief report will present the results from an evaluation a full-scale MCI exercise, aiming to increase preparedness for such events, from the perspectives of future health-care professionals, as well as personnel in various emergency teams taking part in MCI response.

All participants in a 2-day, full-scale MCI exercise (N = 206) were invited to participate in an investigator-developed survey.

In total, 124 participants (60.2%) responded to the questionnaire. Most of the respondents were satisfied with the information and frames of the full-scale MCI exercise. Based on their experiences, over half of the respondents perceived that the county ambulance, police, and fire departments were well prepared in case of an MCI in the future. Reported areas of improvement were specifically related to communication lines and triage.

Weakness in communication lines and triage were assumed a threat to effective handling of MCIs. However, further studies are needed to decide the content needed in MCI exercises to effectively increase regional preparedness for such events.

This study explores the feasibility of applying ragdoll physics, a procedural animation, and related game-engine technologies to create real-time simulations for investigating crowd disasters.

We harnessed the power of the Unity Game Engine to develop real-time simulation for the dynamics of a crowd disaster with rendering of scene objects and user interface (UI) elements. Humanoid agents with trigger colliders were linked to color schemes representing impact forces sustained with lethal thresholds ranging from 500 to 550 pounds force for males and 450 to 500 pounds force for females. The simulation enables users to manipulate parameters such as population, crowd density, directional movement and forces applied.

Our simulation showcases an animated real-time depiction of a crowd disaster and enables visualization of casualties, both injured and dead, based upon a quantitative evaluation of the forces sustained.

Utilization of the Unity Game Engine for the development of visually-engaging real-time crowd disaster simulation has promising outcomes. This novel approach for modeling and analysis of crowd dynamics may provide valuable insights with applications in mass gatherings, crowd management, safety, and preparedness.

Nuclear radiological emergencies are classified as low frequency, but high impact events. Radiophobia and fear of deleterious outcomes often evokes hesitancy among responders. This review explored PPE use as a protective mechanism for responders’ safety and identified tools that promote PPE efficacy among first responders during nuclear radiological events.

A systematic literature review was conducted using five scientific databases. More than 5,500 articles were screened to identify literature relating to “PPE use” by first responders during “nuclear radiological events”.

Regulatory agencies such as the IAEA and the NRC assert that PPE, (when worn correctly and consistently) minimizes radiation exposure. Adequate training of first responders emerged as a critical determinant to support appropriate PPE selection and usage during radiological emergencies. This included new employee trainings and refresher courses for existing employees. Pedagogical tools highlighted in the literature included tabletop exercises, safety huddles, trial runs for donning and doffing of new gear (with emphasis on air-fed suits), just-in-time training and virtual reality simulations.

Education on the effective use of PPE is essential to promote self-efficacy among medical staff and other first responders during nuclear radiological events. Comprehensive training will reduce unintended exposures, decrease hesitancy, and maximize employee safety.