Natural disasters are becoming more frequent. The crises that follow are becoming more impactful along with diverse emergency-prone hazards and security contexts. EMTs play a crucial role in emergency and disaster response offering timely medical assistance, stabilizing patients, and ensuring safe transport to medical facilities. EMTs must have public health competencies to evaluate, prioritize, and resource all types of medical and public health emergencies.

Define the essential competencies for leading/coordinating actions between public health and disaster medicine to reliably prepare EMTs for lasting success.

We hosted an international colloquium targeted at EMT capacity building and training.

EMTs work in environments with limited resources, including medical supplies, equipment, personnel, which impacts their ability to provide care. EMTs provide care to individuals and communities during recovery and provide medical assistance for displaced individuals, addressing acute health concerns and chronic conditions. They empower individuals and communities to take active roles in their recovery fostering empowerment, preparedness, and cohesion. EMTs ensure continuity of care and effectively address emerging health concerns.

Continued investment is needed in public health training, resources, and support systems to enhance the effectiveness of EMTs in disaster management: 1) training equips EMTs with critical team competencies, 2) adequate resources, including medical supplies, equipment/transportation, are essential for EMTs, 3) investment in mental health support systems to address the psychological impacts of disaster response and recovery, 4) funding research initiatives and embracing technological advancements helps identify best practices and develop evidence-based protocols, 5) establish (international) regulatory framework, registration, and individual competency certification to professionalize EMT cadre.

The 2022 Russian invasion of Ukraine exacts a heavy death toll throughout Ukraine. Morbidity and mortality of warfighters and vulnerable civilian communities are inversely proportional to quality access to a viable medical evacuation chain. The military inspector is one option to fill the gap in prehospital medicine to reduce morbidity and mortality by providing damage control resuscitation/surgery (DCR/DCS).

Qualitative and quantitative methodologies are applied. Qualitatively describing the medical evacuation of Shane, providing death estimates of the point of injury to receipt of DCR/DCS. Provide interoperable care across the military-civilian and humanitarian sectors. Describe the standardized and consistent evacuation chains across the entire battlefront from the point of injury to the Role 1/Role 2 echelons of care.

The medical evacuation chain for this current iteration of Russian violence is currently inadequate, not standardized, not well integrated at the military-civilian interface. Preventable morbidity and mortality from conventional Russian weapon systems have increased.

Armed Forces of Ukraine to engage with NATO and EU colleagues to acquire the methodology and practical applications to reduce preventable morbidity and mortality. Standardized approaches to the concept of damage control resuscitation and damage control surgery to the paradigm of tactical combat casualty care can help reduce morbidity and mortality. The Ukraine crisis and Russian war is killing people in Ukraine, prehospital medicine must address and focus on reducing preventable causes of morbidity and mortality.

Russia invaded Ukraine in February 2022, leading to significant preventable death across Defense forces and communities. When appropriate and adequate training has been provided, the use of point of injury (POI) care guidelines as exhibited by tactical combat casualty care (TCCC) and the implementation of damage control resuscitation (DCR) and damage control surgery (DCS) can reduce preventable morbidity and mortality in the far foreword environment.

Background: Russia invaded Ukraine in 2014 exacting a heavy increase in preventable morbidity and mortality on the battlefield. Multiple global health engagement strategies by allied forces and health partners have focused on prehospital medicine. The most recent iteration of violence has seen a comprehensive invasion with the use of multi-domain battle and conventional weapons systems across nearly every state in Ukraine. These conventional weapon systems deployed by Russian forces exact a heavy lethality on all communities.

This report uses anecdotal data from undisclosed locations in Eastern Ukraine from the tactical evacuation care, Role 1, Role 2 to the Role 3 echelons of care as reported.

Appropriate application of combat application tourniquets (CATs), pressure dressings, access to tranexamic acid (TXA), antibiotics, basics of TCCC care and DCR/DCS, including access to blood as early as possible, save lives.

Rapid access to tactical evacuation care and initiation of DCR/DCS from Role 1 to Role 2 has good effect. The Ukrainian armed forces have pushed damage control Resuscitation and Surgery as far forward as Role 1, which may require a paradigm shift within the NATO military medical standards and preparations for a peer conflict.

Adequate TCCC, DCR and DCS training in the form of global health engagement have anecdotal success in the reduction of morbidity and mortality and in providing force health and medical readiness across NATO nations and partner forces such as Ukraine.

The world is facing the devastating impact a biological event can have on human health, economies, and political stability. COVID-19 has revealed that national governments and the international community are woefully unprepared to respond to pandemics—underscoring our shared vulnerability to future catastrophic biological threats that could meet or exceed the severe consequences of the current pandemic. This study examines potential threats related to deliberate Russian military use and misuse of the tools of modern biology or an accident caused by a CBRN event evolving rapidly in the highly volatile political environment in and around Ukraine and other conflicts.

A participatory foresight, co-creative, future and transformation-oriented methodology was used to structure a transformative model for a disciplined exploration of scenarios to confront complex challenges and facilitate improved outcomes. Foresight helps to evaluate current policy priorities and potential new policy directions; see how the impact of possible policy decisions may combine with other developments; inform, support and link policy-making in and across a range of sectors; identify future directions, emerging technologies, new societal demands and challenges; and anticipate future developments, disruptive events, risks and opportunities.

The study found that the “mitigation scenarios” are based on the “Confront, Regulate, Overcome” metamodel combined with the “Security, Rescue, Care” response modalities. These require the cooperation/coordination of law enforcement forces along with military forces, fire departments and civil security resources, hospital and first-line responder teams, in order to appropriately address populations, assets and territories issues elicited by the identified threat, which drives key decision makers’ tasks at the strategic level.

The participatory foresight exercise demonstrated gaps in national and international biosecurity and pandemic preparedness architectures highlighted by the challenges of the Ukraine war—exploring opportunities for better cooperation to improve prevention and response capabilities for high-consequence biological events, and generate actionable recommendations for the international community.

Training in disaster medicine can be partly theoretical but it must include a large practical part. If part of it can be developed through exercises in virtual reality or on a computer, the realization of life-size disaster exercises bringing together all the disciplines is of great help in this learning. Exercises of such magnitude are difficult to carry out in civilian life for reasons of resources and cost. We therefore wanted to develop this disaster medicine course with the three French-speaking civil universities but also with the Royal Military School for the practical part.

Collaboration agreements were established between three civilian universities (ULB, UCLouvain, ULiège) and the Royal Military School. The army thus provides the infrastructures of the Belgian military units to organize the exercises, personnel, means of make-up, vehicles, and security, all free of cost. Coordination meetings before exercises are also organized during the year by the army.

The exercises are organized in complete safety conditions on military fields, isolated from the civilian environment without disturbing the daily functioning of civilians. Access is authorized and organized for the various disciplines (firefighters, police, red cross and other participants). Nearly 100 people (victims, firemen, policemen,...) and 50 vehicles per exercise make the scenario completely believable. Different scenarios are repeated six times to complete the training of 80 students.

The collaboration between civilians and military has made it possible to set up quality training integrating a large part of life-size exercises at no cost and in complete safety. This ends the course by integrating in practice all the knowledge learned during the theoretical part and the virtual exercises.

Antidepressants have limited efficacy in older adults with depression and cognitive impairment, and psychosocial interventions for this population have been inadequately investigated. Problem Adaptation Therapy (PATH) is a psychosocial intervention for older adults with major depression, cognitive impairment, and disability.

This study tests the efficacy of PATH versus Supportive Therapy for Cognitively Impaired Older Adults (ST-CI) in reducing depression (Montgamery Asberg Depression Rating Scale [MADRS]) and disability (World Health Organization Disability Assessments Schedule-II [WHODAS-II]) and improving cognitive outcomes (Mini Mental State Examination [MMSE]) over 24 weeks (12 weeks of treatment and 12-week post-treatment follow-up).

Participants were recruited through collaborating community agencies of Weill Cornell Institute of Geriatric Psychiatry. Both interventions and all research assessments were conducted at home.

Thirty-five older adults (age ≥ 65 years) with major depression and cognitive impairment no dementia (CIND).

PATH aims to increase emotion regulation by incorporating a problem-solving approach, teaching compensatory strategies, and inviting caregiver participation. Supportive Therapy aims to facilitate the expression of affect, as well as promote empathy.

Depression was measured using the MADRS, disability using the WHODAS-II, and cognition using the MMSE.

PATH participants showed significantly greater reduction in MADRS total score (7.04 points at 24 weeks, treatment group by time interaction: F[1,24.4] = 7.61, p = 0.0108), greater improvement in MMSE total score (2.30 points at 24 weeks, treatment group by time interaction: F[1,39.8] = 13.31, p = 0.0008), and greater improvement in WHODAS-II total score (2.95 points at 24 weeks, treatment group by time interaction: F[1,89] = 4.93, p = 0.0290) than ST-CI participants over the 24-week period.

PATH participants had better depression, cognitive, and disability outcomes than ST-CI participants over 6 months. PATH may provide relief to depressed older adults with CIND who currently have limited treatment options.

Few studies have examined the challenges faced by emergency medicine (EM) physicians in conducting goals of care discussions. This study is the first to describe the perceived barriers and facilitators to these discussions as reported by Canadian EM physicians and residents.

A team of EM, palliative care, and internal medicine physicians developed a survey comprising multiple choice, Likert-scale and open-ended questions to explore four domains of goals-of-care discussions: training; communication; environment; and patient beliefs.

Surveys were sent to 273 EM staff and residents in six sites, and 130 (48%) responded. Staff physicians conducted goals-of-care discussions several times per month or more, 74.1% (80/108) of the time versus 35% (8/23) of residents. Most agreed that goals-of-care discussions are within their scope of practice (92%), they felt comfortable having these discussions (96%), and they are adequately trained (73%). However, 66% reported difficulty initiating goals-of-care discussions, and 54% believed that admitting services should conduct them. Main barriers were time (46%), lack of a relationship with the patient (25%), patient expectations (23%), no prior discussions (21%), and the inability to reach substitute decision-makers (17%). Fifty-four percent of respondents indicated that the availability of 24-hour palliative care consults would facilitate discussions in the emergency department (ED).

Important barriers to discussing goals of care in the ED were identified by respondents, including acuity and lack of prior relationship, highlighting the need for system and environmental interventions, including improved availability of palliative care services in the ED.

We undertook a non-targeted lipidomics analysis of post-mortem cerebrospinal fluid (CSF), frontal cortex grey matter, and subjacent white matter to define potential biomarkers that distinguish cognitively intact subjects from those with incipient or established dementia. Our objective was to increase our understanding of the role of brain lipids in pathophysiology of aging and age-related cognitive impairment.

Levels of 650 individual lipids, across 26 lipid subclasses, were measured utilising a high-resolution mass spectrometric analysis platform.

Monoacylglycerols (MAG), diacylglycerols (DAG), and the very-long-chain fatty acid 26:0 were elevated in the grey matter of the mild cognitive impairment (MCI) and old dementia (OD) cohorts. Ethanolamine plasmalogens (PlsEtn) were decreased in the grey matter of the young dementia (YD) and OD cohorts while and phosphatidylethanolamines (PtdEth) were lower in the MCI, YD and OD cohorts. In the white matter, decrements in sulphatide levels were detected in the YD group, DAG levels were elevated in the MCI group, and MAG levels were increased in the YD and OD groups.

The parallel changes in grey matter MAGs and DAGs in the MCI and OD groups suggest that these two cohorts may have a similar underlying pathophysiology; consistent with this, MCI subjects were more similar in age to OD than to YD subjects. While PlsEtn and phosphatidylethanolamine were decreased in the YD and OD groups they were unaltered in the MCI group indicating that alterations in plasmalogen synthesis are unlikely to represent an initiating event in the transition from MCI to dementia.