This study aimed to understand the current landscape of USA-based disaster medicine (DM) programs through the lens of alumni and program directors (PDs). The data obtained from this study will provide valuable information to future learners as they ponder careers in disaster medicine and allow PDs to refine curricular offerings.

Two separate surveys were sent to USA-based DM program directors and alumni. The surveys gathered information regarding current training characteristics, career trajectories, and the outlook of DM training.

The study had a 57% response rate among PDs, and 42% response rate from alumni. Most programs are 1-year and accept 1-2 fellows per class. More than 60% of the programs offer additional advanced degrees. Half of the respondents accept international medical graduates (IMGs). Only 25% accept non-MD/DO/MBBs trained applicants. Most of the alumni hold academic and governmental positions post-training. Furthermore, many alumni report that fellowship training offered an advantage in the job market and allowed them to expand their clinical practice.

The field of disaster medicine is continuously evolving owing to the increased recognition of the important roles DM specialists play in healthcare. The fellowship training programs are experiencing a similar evolution with an increasing trend toward standardization. Furthermore, graduates from these programs see their training as a worthwhile investment in career opportunities.

This study analyzes disparities in initial health care responses in Turkey and Syria following the 2023 earthquakes.

Using Humanitarian Data Exchange, Crude Mortality Rates (CMR) and injury rates in both countries were calculated, and temporal trends of death tolls and injuries in the first month post- catastrophe were compared. World Health Organization (WHO) Flash Appeal estimated funding requirements, and ratios of humanitarian aid personnel in Urban Search and Rescue (USAR) teams per population from ReliefWeb and MAPACTION data were used to gauge disparities.

56 051 096 individuals were exposed, with Turkey having 44 million vs 12 million in Syria. Turkey had higher CMR in affected areas (10.5 vs. 5.0 per 10,000), while Syria had higher CMR in intensely seismic regions (9.3 vs. 7.7 per 1,000). Turkey had higher injury rates (24.6 vs. 9.9 per 10 000). Death and injury rates plateaued in Syria after 3 days, but steadily rose in Turkey. Syria allocated more funding for all priorities per population except health care facilities’ rehabilitation. Turkey had 219 USAR teams compared to Syria’s 6, with significantly more humanitarian aid personnel (23 vs. 2/100,000).

Significant disparities in the initial health care response were observed between Turkey and Syria, highlighting the need for policymakers to enhance response capabilities in conflict-affected events to reduce the impact on affected populations.

The 2023 Turkish-Syrian earthquakes, the most devastating in the region since 1939, heightened challenges in Syria’s health care system amid ongoing conflict, disrupting Gaziantep’s humanitarian aid supply route. The initial health care responses post-earthquakes in Turkey and Syria were analyzed through a descriptive study, where Crude Mortality Rates (CMR) and injury rates during the first week were calculated. The World Health Organization’s funding priorities and the ratio of humanitarian aid personnel in Urban Search and Rescue teams per population were assessed. Turkey had 4-fold higher earthquake exposure and experienced higher CMR and injuries per population, while Syria had higher CMR in intensely seismic regions. Temporal trends showed plateaued death and injury rates in Syria within 3 days, while Turkey’s continued to increase. Syria required more funding across nearly all priorities while Turkey had more humanitarian aid personnel per population. Significant health care response disparities were observed, emphasizing the imperative for policymakers to enhance initial responses in conflict-affected events.

This study analyzes disparities in initial healthcare responses in Turkey and Syria following 2023 earthquakes.

Using Humanitarian Data Exchange, Crude Mortality Rates (CMR) and injury rates in both countries were calculated, and temporal trends of death tolls and injuries in the first month post- catastrophe were compared. WHO Flash Appeal estimated funding requirements, and ratios of humanitarian aid personnel in Urban Search and Rescue (USAR) teams per population from ReliefWeb and MAPACTION data were used to gauge disparities.

56,051,096 individuals were exposed, with Turkey having 44 million vs 12 in Syria. Turkey had higher CMR in affected areas (10.5 vs 5.0/10,000), while Syria had higher CMR in intensely seismic regions (9.2 vs 7.7/1,000). Turkey had higher injury rates (24.6 vs 9.9/10,000). Death and injury rates plateaued in Syria after three days, but steadily rose in Turkey. Syria allocated more funding for all priorities per population except healthcare facilities’ rehabilitation. Turkey had 219 USAR teams compared to Syria’s six, with significantly more humanitarian aid personnel (23 vs 2/100,000).

Significant disparities in initial healthcare response were observed between Turkey and Syria, highlighting need for policymakers to enhance responses in conflict-affected events to reduce impact on affected populations.

Disease surveillance is an integral part of public health. These systems monitor disease trends and detect outbreaks, whereas they should be evaluated for efficacy. The United States Centres for Disease Control and Prevention publish Guidelines for Evaluating Surveillance Systems to encourage efficient and effective use of public health surveillance that are accepted worldwide.

This study reviews syndromic surveillance during natural and man-made disasters internationally. It aims to (1) review the performance of syndromic surveillance via pre-specified attributes during disaster and to (2) understand its strengths and limitations.

PubMed was systematically searched for the articles assessing syndromic surveillance during a disaster. A narrative review was carried out based on those articles. Updated Guidelines for Evaluating Public Health Surveillance Systems were used to review performance of systems.

5,059 studies from PubMed were evaluated, and 16 met inclusion criteria. The majority of these studies considered the implementation of syndromic surveillance useable during disaster events. Studies described systems giving relevant and timely information. Simplicity and timeliness were the most highlighted attributes.

Syndromic surveillance is simple, flexible, useful and usable during a disaster. Timely data can be obtained, but the quality of this type of data is sensitive to incomplete and erroneous reporting; because of this, a standardized approach is necessary to optimize these systems.

International humanitarian aid is crucial in disasters but must be needs-driven and coordinated with requests from local authorities. We identify disaster and population factors associated with international aid appeal during disasters and hence guide preparation by international humanitarian aid providers.

In this retrospective database analysis, we searched the Emergency Events Database for all disasters from 1995 to 2015. Disasters with and without international aid appeals were compared by location, duration, type of disaster, deaths, number of people affected, and total estimated damage. Logistic regression was used to examine the association of each factor with international aid appeal.

Of 13,961 disasters recorded from 1995 to 2015, 168 (1.2%) involved international aid appeals. Aid appeals were more likely to be triggered by disasters which killed more people (OR 1.29 [95% confidence interval (CI) 1.02-1.64] log10 persons), affected more people (OR 1.85 [95%CI 1.57-2.18] / log10 persons), and occurred in Africa (OR 1.67 [95%CI 1.06-2.62). Earthquakes (OR 4.07 [95%CI 2.16-7.67]), volcanic activity (OR 6.23 [95%CI 2.50-15.53]), and insect infestations (OR 12.14 [95%CI 3.05-48.35]) were more likely to trigger international aid appeals. International aid appeals were less likely to be triggered by disasters which occurred in Asia (OR 0.46 [95%CI 0.29-0.73]) and which were transport accidents (OR 0.12 [95%CI 0.02-0.89]).

International aid appeal during disasters was associated with greater magnitude of damage, disasters in Africa, and specific types of disasters such as earthquakes, volcanic activity, and insect infestations. Humanitarian aid providers can focus preparation on these identified factors.

Children are often disproportionately impacted by disasters, and yet pediatric specific considerations are not properly emphasized during disaster planning and training, resulting in the desperate needs of children falling through the cracks during disasters. Children differ from adults developmentally, physiologically, and psychologically, and are more vulnerable to negative long-term medical, social, and behavioral outcomes. Additionally, children lack autonomy and rely on adults to gain access to the healthcare system and other resources. Despite the distinctions between adults and children, time and curricula for pediatric disaster training is insufficient, and workforce capacity and competency to plan for and respond to the disaster related needs of children are inadequate; this is especially true for both physicians and other healthcare responders who do not complete a specific pediatric residency. Our study seeks to determine the key core competencies of pediatric disaster medicine that should be included in the training of responders.

A systematic gray literature review of existing pediatric disaster medicine curricula was performed, from which a list of the most commonly present key core competencies was created.

Data collection and analysis is expected to be completed by April 2023 and will yield a ranked list of core competencies.

There is a need for improved pediatric disaster training that addresses the specific considerations of children; this is especially true for non-pediatricians who may be treating children following a disaster. The gray literature review will identify key components of pediatric disaster medicine, which should be applied to all such training curricula to ensure that the care of children who suffer during and after disasters is equitable across the globe.

The current war in Ukraine and the subsequent deployment of Non-Governmental Organizations (NGOs) from around the world has highlighted the many potential dangers faced by humanitarian aid workers operating in conflict zones. Humanitarian aid workers may face both direct and indirect threats and aggression whilst on deployment, and given the rising number of global conflicts, the authors postulate a need to incorporate threat awareness training as part of pre-deployment training.

A list of the top 22 rated NGOs providing international aid was obtained from CharityWatch. All 22 were contacted via their public email addresses or website contact pages to find out if they provide any form of security, tactical, or threat awareness training.

Seven of the 13 NGOs that responded did not deploy staff into recent conflict zones or surroundings. All six NGOs who deployed staff into Ukraine or surrounding border countries, provided either security, tactical, or threat awareness training to their staff.

With the rising number of conflicts and disasters around the world, humanitarian aid workers are increasingly exposed to hostile environments and there is a compelling need for NGOs to ensure staff are adequately trained and prepared to handle any dangers and threats they may face.

Children differ from adults, developmentally, physiologically, and psychologically. Additionally, children lack legal agency, and thus rely on adults to gain access to the healthcare system and other resources. Though children are often the face of disaster relief, the desparate needs of children can fall through the cracks during disaster response. Many training programs for disaster responders do not give pediatric concerns and issues the appropriate attention they deserve. Pediatric disaster medicine is often minimally addressed in emergency medicine residencies and prehospital provider training. Furthermore, pediatric disaster supplies and protocols are often lacking and insufficient to meet the needs of children during and after disasters.

This is a modified Delphi study. An initial set of pediatric disaster medicine competencies from a systematic review of PubMed, EMBase and the gray literature will be presented to an initial group of Subject Matter Experts (SMEs) comment, additions, and edits. This modified set of competencies will then be distributed to a large group of providers with experience in the field. Through a series of surveys, each competency in the curriculum will be rated. Those competencies which achieve a high overall rating will be reported.

Data collection and analysis expected to be completed by April 2023.

This modified Delphi study will establish and prioritize a set of core competencies for pediatric disaster response based on expert recommendations. The use of such gold standard core competencies to develop discipline-role-specific pediatric disaster training can increase pediatric disaster workforce capacity and competency critically needed to improve pediatric disaster response.

In 2022, the Harvard/Beth Israel Deaconess Disaster Medicine Fellowship conducted a full-scale exercise (FSX) with the dual mission of 1) training Disaster Medicine Fellows (DMFs) in exercise design, planning, and execution, and 2) expanding local first responder experience with pediatric casualties in a mixed-method terrorist attack.

Project PUNCH (Preparedness for Uncertain and Novel Chemical Hazards) was planned in two stages. A tabletop exercise in the form of a facilitated discussion was conducted in March 2022 with stakeholders from Fire, Emergency Medical Services (EMS), and the Massachusetts HazMat Team. A FSX simulating a combined blast and chemical attack on a family gathering was held in June 2022 at Anna Maria College in Paxton, MA.

Fire, EMS, HazMat, LifeFlight, local Police, MA State Police, a local Medical Reserve Corps, and over 40 volunteer victims including 16 pediatric volunteers participated in the FSX. The FSX was a two-hour exercise with a simulated explosion and a secondary drone-deployed dummy-opioid aerosol release. This was the first FSX for the Paxton Region since the coronavirus pandemic began. Planning was conducted by the DMFs between January and June 2022 with the aid of Fellowship faculty and local stakeholders following Homeland Security Exercise and Evaluation Program guidelines. Local and Fellowship leadership with Pediatric expertise were engaged to plan pediatric specific considerations, precautions and safety measures. COVID precaution guidelines were followed. These efforts are detailed in the forthcoming field report. Educational guides for toxidromes and triage and resuscitation of pediatric victims were distributed to first responders.

The end outcome was a FSX that trained DMFs in exercise design, planning, and execution, and increased experience of local first responders with the concepts of asymmetric terrorist attacks and comfort with pediatric disaster victims. Multi-agency disaster drills remain an important training tool for preparedness and response to mass casualty events.

The complexity of disaster management is rising because of rapidly advancing technological changes and the challenges associated with coordinating responses among multi-organizational contexts. One of the common problems with multi-organizational disaster management is the need for an interoperability language. Therefore, by maintaining effective communication, risk can be reduced, and lives can be saved in times of crisis. The United States SCIPs represent one of the solutions used to achieve a culture of better interoperability. In 2019, The National Council of Statewide Interoperability Coordinators (NCSWIC) and CISA collaborated to create a tool that identified 25 Interoperability Markers. This tool is integrated with SCIPs to increase interoperability and serves as a national framework to describe interoperability maturity at the state levels.

This is a descriptive study documenting each state's 25 interoperability markers and analyzing common gaps and successes. Two methods were used for collecting data. First, an online search for each state's SCIP. Then, an email was sent to all state's Statewide Interoperability Coordinators (SWIC) to request the most recent update of that state’s SCIP. Data were collected from October 1-31, 2022 and exported into an Excel spreadsheet (Microsoft Corp; Redmond, Washington, USA) for descriptive statistics and analysis.

The level of interoperability maturity across the United States is 66%. The governance level in the interoperability continuum scored the highest across states with 76.4%. While the other levels of the interoperability continuum like technology, training and exercise, and interstate emergency communication scored 63.5%, 64%, and 60% respectively.

This study identifies a high level of interoperability maturity across the United States at the governance level. It is essential to continue to improve interstate interoperability through compatible technological solutions and multi-agency training. Finally, further research on interoperability markers is needed to enhance multi-agency emergency response.

Emergency Medical Services (EMS) is a critical part of Disaster Medicine and has the ability to limit morbidity and mortality in a disaster event with sufficient training and experience. Emergency systems in Armenia are in an early stage of development and there is no Emergency Medicine residency training in the country. As a result, EMS physicians are trained in a variety of specialties.

Armenia is also a country prone to disasters, and recently, the Armenian EMS system was challenged by two concurrent disasters when the 2020 Nagorno-Karabakh War broke out in the midst of the SARS-CoV-2/coronavirus disease 2019 (COVID-19) pandemic.

This study aims to assess the current state of disaster preparedness of the Armenian EMS system and the effects of the simultaneous pandemic and war on EMS providers.

This was a cross-sectional study conducted by anonymous survey distributed to physicians still working in the Yerevan EMS system who provided care to war casualties and COVID-19 patients.

Survey response rate was 70.6%. Most participants had been a physician (52.1%) or EMS physician (66.7%) for three or less years. The majority were still in residency (64.6%). Experience in battlefield medicine was limited prior to the war, with the majority reporting no experience in treating mass casualties (52.1%), wounds from explosives (52.1%), or performing surgical procedures (52.1%), and many reporting minimal to no experience in treating gunshot wounds (62.5%), severe burns (64.6%), and severe orthopedic injuries (64.6%). Participants had moderate experience in humanitarian medicine prior to war. Greater experience in battlefield medicine was found in participants with more than three years of experience as a physician (z-score −3.26; P value <.01) or as an EMS physician (z-score −2.76; P value <.01) as well as being at least 30 years old (z-score −2.11; P value = .03). Most participants felt they were personally in danger during the war at least sometimes (89.6%).

Prior to the COVID-19 pandemic and simultaneous 2020 Nagorno-Karabakh War, EMS physicians in Armenia had limited training and experience in Disaster Medicine. This system, and the frontline physicians on whom it relies, was strained by the dual disaster, highlighting the need for Disaster Medicine training in all prehospital medical providers.

Disaster responders operate in situations that are cognitively, emotionally, and morally distressing. The prevalence of mental health sequelae amongst disaster responders is well-documented. The World Health Organization (WHO) has published minimum standards for Emergency Medical Teams (EMTs), which requires them to assess the mental health and psychosocial support needs of their patients and staff, provide first aid, and ensure referral pathways for follow-up care are available. Specific to EMT staff and volunteers, the standards require that support services are always accessible. However, there is no requirement for EMTs to have their own mental health specialists, nor is having a mental health specialist assigned to each team and mission necessarily practical.

This study will assess the existing mental health resources of WHO EMTs and their use of telemedicine in mental health care.

A survey will be distributed to the leadership of all WHO EMTs that are currently credentialed to capture descriptive statistics.

Data expected to be collected and analyzed by October 1, 2022.

The absence of a mental health specialist significantly limits the availability of support services for EMT personnel. Given that the use of telemedicine in both disaster response and mental health services has been well-documented, telemedicine could be a low-resource method to link WHO EMT staff and volunteers with mental health specialists throughout the deployment cycle.

Emergency Medical Services (EMS) is a critical part of Disaster Medicine (DM) and can limit morbidity and mortality with sufficient training and experience. Emergency systems in Armenia are in an early stage of development and there is no Emergency Medicine residency training available to EMS physicians. The Armenian EMS system was challenged by two concurrent disasters when the 2020 Nagorno-Karabakh War arose during the SARS-CoV-2 (COVID-19) pandemic.

This study assessed the state of disaster preparedness of the Armenian EMS system and effects of the simultaneous pandemic and war on EMS providers.

This was a cross-sectional study by anonymous survey of Yerevan EMS physicians who provided care to war casualties and COVID-19 patients.

Most participants had been a physician for ≤three years (52.1%). Many were in residency (64.6%).

Battlefield medicine experience was limited prior to the war. The majority reported no experience treating mass casualties (52.1%), explosives wounds (52.1%), or performing surgical procedures (52.1%). Greater battlefield medicine experience was found with ≥three years of experience as a physician (z-score -3.26; P value <.01) or EMS physician (z-score -2.76; P value <.01), and being ≥30 years old (z-score -2.11; P value = .03). Most participants felt in danger during the war at least sometimes (89.6%).

EMS physicians in Armenia had limited training and experience in DM prior to the 2020 Nagorno-Karabakh War, but practiced in a setting requiring extensive DM knowledge as evidenced by the simultaneous response to the COVID-19 pandemic and war. There is a strong need for DM training within the Armenian EMS system.

WHO EMTs play an important role in providing assistance and health care services to countries hit by an emergency or a natural disaster. Therefore, EMTs are subjected to vastly different cultures from various countries, meaning they require training to cultural awareness, an understanding and acceptance of the languages, beliefs, cultures, and morals of those receiving care. The World Health Organization (WHO) has published minimum standards for Emergency Medical Teams (EMTs), which briefly mention that the senior EMT team member must have some knowledge of cultural awareness. However, there is no requirement for cultural awareness training for EMTs prior to responding to disasters.

The goal of this study is to determine the presence of cultural awareness training, and if present, what are the competencies covered by the training for the WHO EMTs.

A survey will be distributed to Accredited WHO EMTs to capture the presence for cultural awareness training and the core competencies of the existing training.

Data expected to be collected and analyzed by October 1, 2022.

Cultural awareness training is a crucial and beneficial skill for EMTs while deploying internationally. For WHO EMTs, it is essential to respond internationally in an accepted and ethical manner; cultural awareness training should be a requirement for all teams deploying to a foreign country. A cultural awareness curriculum will create more efficient EMTs that provide effective aid to countries in need.

Road traffic collisions (RTC) result in a significant number of preventable deaths worldwide. In 2010, the United Nations General Assembly launched, “The Decade of Action for Road Safety (2011–2020)” with the stated goal to “reduce road traffic deaths and injuries by 50% by 2020.” This study aims to analyze trends in RTC numbers and subsequent deaths with respect to road safety laws in Nigeria and to suggest suitable interventions.

Annual reports for the period 2007–2017 were obtained from the Federal Road Safety Corps of Nigeria. These reports were analyzed for trends in RTC, including reported causes, fatalities, injuries, and casualties.

Overall total injuries, casualties, and fatalities increased by 74.7%, 61.2%, and 9.6%, respectively. Analysis showed that the 3 main causes of RTC were speed violation, loss of control, and dangerous driving.

Although current trends do not suggest that Nigeria will accomplish its initial goal of decreasing fatalities by 50% by 2020, there has been a reduction in the number of crashes resulting from dangerous driving. Further interventions such as implementing automated speed monitoring, collaboration, and data sharing between federal and regional agencies, and improving the state of road networks should be implemented to decrease fatalities further.

The goal of this study is to determine the impact of the Holy Month of Ramadan on emergency department (ED) and hospital resource utilization in comparison to the time of Hajj and the rest of the year, so as to better define future resource needs of hospitals responding to events of this large size and duration.

A retrospective chart review was conducted of electronic medical records, ED visits, and hospital admissions during Ramadan, Hajj, and all other months over a three-year period on the Hijra calendar (1438-1440) or Gregorian (2016-2019). Primary outcomes were the change in the number of ED visits, hospital admissions, and intensive care unit (ICU) admissions during Ramadan in comparison to during Hajj and other months. Secondary outcomes included mortality; number of surgeries by specialty; and admissions to cardiac, respiratory, orthopedic, and neurosurgery wards.

During the three years, ED visits increased during Ramadan by 83.0%, 74.8%, and 40.3%, respectively, when compared to non-Hajj, non-Ramadan months. Hospital admissions rose by 21.05%, 50.96% and 48.22%. Combined ED and in-hospital mortality rose by 15.21%, 21.47%, and 1.39%. While there was a large increase in ICU admissions during Ramadan of 1440 (May 2019), this was not a trend seen in other years. Despite there only being two years of data for comparison, there was a trend towards increased admissions to all specialty wards. There was an average 46.69% increase in admissions to the general surgery ward during Ramadan months compared to other months, a 31.06% increase in admissions to the orthopedic surgery ward, and a 44.05% increase in admissions to the cardiac care unit.

Ramadan is associated with a significant increase in the population of Makkah (Mecca), Saudi Arabia. Despite this study only focusing on a three-year period, and some variables with only two years of data available, it demonstrates a significant increase in ED visits, hospital admissions, and mortality during Ramadan compared to non-Hajj/non-Ramadan months. During mass gatherings of this size, it would benefit local and regional hospital systems to devote increased resources to patient care, especially to the ED, to prevent morbidity and mortality.

Since 2001, a burgeoning interest by health care professionals in the growing asymmetrical terrorist threat and its impact on health care preparation and response has seen significantly increased academic output around this nebulous subject. Despite this, there has failed to be a consolidation of this sub-specialty.

This editorial argues for the consolidation of the body of experience gathered since 2001 into an initiative called Counter-Terrorism Medicine (CTM). It proposes that previously discrete sub-specialty areas can be consolidated, with improvements in collective understanding, and can build on previous work to provide a non-political health care focused definition of terrorist events, based on the triad of Violence, Intent, and Heath Care Impact. It notes the importance this defining triad has in health care planning and response considerations. Finally, it defines the parameters of CTM within the larger specialty of Disaster Medicine (DM).

There is a growing body of academic work on the health care implications of terrorism. The time is right to coalesce these into an initiative referred to as CTM and to consider this as a discrete part of DM.