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.

Chemical, biological, radiological, and nuclear (CBRN) incidents require meticulous preparedness, particularly in the Middle East and North Africa (MENA) region. This study evaluated CBRN response operational flowcharts, tabletop training scenarios methods, and a health sector preparedness assessment tool specific to the MENA region.

An online Delphi survey engaging international disaster medicine experts was conducted. Content validity indices (CVIs) were used to validate the items. Consensus metrics, including interquartile ranges (IQRs) and Kendall’s W coefficient, were utilized to assess the panelists’ agreement levels. Advanced artificial intelligence computing methods, including sentiment analysis and machine-learning methods (t-distributed stochastic neighbor embedding [t-SNE] and k-means), were used to cluster the consensus data.

Forty experts participated in this study. The item-level CVIs for the CBRN response flowcharts, preparedness assessment tool, and tabletop scenarios were 0.96, 0.85, and 0.84, respectively, indicating strong content validity. Consensus analysis demonstrated an IQR of 0 for most items and a strong Kendall’s W coefficient, indicating a high level of agreement among the panelists. The t-SNE and k-means identified four clusters with greater European response engagement.

This study validated essential CBRN preparedness and response tools using broad expert consensus, demonstrating their applicability across different geographic areas.

The threat of chemical, biological, radiologic, nuclear, and explosive (CBRNe) terrorist attacks has increased over time. The need for rapid and effective responses to such attacks is paramount. Effective medical counter-measures to CBRNe events are critical and training for such may effectively occur early in physician training. While some medical specialties are more involved than others, counter-terrorism medicine (CTM) spans all medical specialties.

All United States allopathic medical schools were examined via online curriculums and queries for academic content related to CBRNe and terrorist medical counter-measures.

Analysis of 153 United States allopathic medical schools demonstrated that 15 (9.8%) medical schools offered educational content related to CBRNe and terrorist counter-measures. This is in contrast to legislation following the September 11, 2001 attacks that called for high priority for such education.

Effective CBRNe medical counter-measures are currently in place; however, there is room for improvement in education that may begin during medical school. While certain medical specialties such as emergency medicine, primary care, and dermatology may have specific niches in such events, physicians of all medical specialties have something to offer, and even a basic education in medical school can help best prepare the nation for future attacks.

The mass gathering event (MGE) industry is growing globally, including in countries such as Canada. MGEs have been associated with a greater prevalence of injury and illness when compared with daily life events, despite most participants having few comorbidities. As such, adequate health, safety, and emergency medical planning is required. However, there is no single entity regulating these concerns for MGEs, resulting in the responsibility for health planning lying with event organizers. This study aims to compare the legislative requirements for MGE medical response systems in the 13 provinces and territories of Canada.

This study is a cross-sectional descriptive analysis of Canadian legislation. Lists of publicly available legislative requirements were obtained by means of the emergency medical services directors and Health Ministries. Descriptive statistics were performed to compare legislation.

Of the 13 provinces and territories, 10 responded. For the missing 3, a law library review confirmed the absence of specific legislation. Most (n = 6; 60%) provinces and territories referred to provisions in their Public Health laws. Four confirmed that MGE medical response was a municipal or local concern to be addressed by the event organizers.

No provinces could list specific legislation guiding safety, health, and medical response for an MGE.

The aim of this work was to determine the impact of Moral Distress (MD) in emergency physicians, nurses, and emergency medical service staff at the Rand Memorial Hospital (RMH) in the Bahamas, and the impact of Hurricane Dorian and the COVID-19 pandemic on Moral Distress.

A cross-sectional study utilizing a 3-part survey, which collected sociodemographic information, Hurricane Dorian and COVID-19 experiences, as well as responses to a validated modified Moral Distress Scale (MDS).

Participants with 2 negatively impactful experiences from COVID-19 had statistically significantly increased MD compared to participants with only 1 negatively impactful experience (40.4 vs. 23.6, P = 0.014). Losing a loved one due to COVID-19 was associated with significantly decreased MD (B = - 0.42, 95% CI -19.70 to -0.88, P = 0.03). Losing a loved one due to Hurricane Dorian had a non-statistically significant trend towards higher MD scores (B = 0.34, 95% CI -1.23 to 28.75, P = 0.07).

The emergency medical staff at the RMH reported having mild - moderate MD. This is one of the first studies to look at the impact of concurrent disasters on MD in emergency medical providers in the Bahamas.

This study interprets data from NG situation reports (SITREPS) given to the National Guard Bureau (NGB) by each state national guard headquarters regarding their COVID-19 relief efforts from April to June 2020. This is the first published study about NG disaster relief utilizing quantitative data provided by the United States (US) military.

The SITREPS of all 50 states, the District of Columbia, Guam, Puerto Rico, and the US Virgin Islands for the dates of April 10, May 6, May 16, and June 3, 2020 were examined by two authors, to analyze the state NG activities.

During the COVID-19 pandemic, the NG primarily provided security, performed COVID-19 testing, ran COVID-19 shelters, provided food assistance, transported supplies, aided mortuaries, supported warehouses, and deployed medical personnel to hospitals. Numerical data about the services provided, such as quantity, was rare, but is included as available.

The United States National Guard provided assistance to their local citizens in multiple essential areas. This elucidation of the uses of the National Guard should be considered during future governmental disaster preparedness planning efforts and can be extrapolated to international military disaster relief.

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.

Disaster Medicine (DM) is the clinical specialty whose expertise includes the care and management of patients and populations outside conventional care protocols. While traditional standards of care assume the availability of adequate resources, DM practitioners operate in situations where resources are not adequate, necessitating a modification in practice. While prior academic efforts have succeeded in developing a list of core disaster competencies for emergency medicine residency programs, international fellowships, and affiliated health care providers, no official standardized curriculum or consensus has yet been published to date for DM fellowship programs based in the United States.

The objective of this work is to define the core curriculum for DM physician fellowships in the United States, drawing consensus among existing DM fellowship directors.

A panel of DM experts was created from the members of the Council of Disaster Medicine Fellowship Directors. This council is an independent group of DM fellowship directors in the United States that have met annually at the American College of Emergency Physicians (ACEP)’s Scientific Assembly for the last eight years with meeting support from the Disaster Preparedness and Response Committee. Using a modified Delphi technique, the panel members revised and expanded on the existing Society of Academic Emergency Medicine (SAEM) DM fellowship curriculum, with the final draft being ratified by an anonymous vote. Multiple publications were reviewed during the process to ensure all potential topics were identified.

The results of this effort produced the foundational curriculum, the 2023 Model Core Content of Disaster Medicine.

Members from the Council of Disaster Medicine Fellowship Directors have developed the 2023 Model Core Content for Disaster Medicine in the United States. This living document defines the foundational curriculum for DM fellowships, providing the basis of a standardized experience, contributing to the development of a board-certified subspecialty, and informing fellowship directors and DM practitioners of content and topics that may appear on future certification examinations.

Since 1902, disasters in the Northern Triangle of Central America, which consists of the countries Guatemala, Honduras, and El Salvador, have caused over one-hundred-thousand deaths, affected millions of people, and caused tens of billions of dollars in damages. Understanding the nature and frequency of these events will allow stakeholders to decrease both the acute damages and the long-term deleterious consequences of disasters.

This study provides a descriptive analysis of all disasters recorded in the Emergency Events Database (EM-DAT) affecting Guatemala, Honduras, and El Salvador from 1902-2022.

Data were collected and analyzed from the EM-DAT, which categorizes disasters by frequency, severity, financial cost, distribution by country, burden of death, number of people affected, financial cost by country, and type of disasters most prevalent in each country. Results are presented as absolute numbers and as a percentage of the overall disaster burden. These trends are then graphed over the time period of the database.

The EM-DAT recorded 359 disasters in the Northern Triangle from 1902 through 2022. Meteorologic events (floods and storms) were the most common types of disaster (44%), followed by transport accidents (13%). Meteorologic events and earthquakes were the most severe, as measured by deaths (62%), people affected (60%), and financial cost (86%). Guatemala had the greatest number of disasters (45%), deaths (68%), and affected people (52%). The financial costs of the disasters were evenly distributed between the three countries.

Meteorologic disasters are the most common and most severe type of disaster in the Northern Triangle. Earthquakes and transport accidents are also common. As climate change causes more severe storms in the region, disasters are likely to increase in severity as well. Governments and aid organizations should develop disaster preparedness and mitigation strategies to lessen the catastrophic effects of future disasters. Missing data limit the conclusions of this study to general trends.

Health care provision depends on reliable critical infrastructure (CI) to power equipment and to provide water for medication and sanitation. Attacks on CI limiting such functions can have a profound and prolonged influence on delivery of care.

A retrospective analysis of the Global Terrorism Database (GTD) was performed of all attacks occurring from 1970-2020. Data were filtered using the internal database search function for all events where the primary target was “Utilities,” “Food or Water Supply,” and “Telecommunications.” For the purposes of this study, the subtype “Food Supply” was excluded. Events were collated based on year, country, region, and numbers killed and wounded.

The GTD listed 7,813 attacks on CI, with 6,280 of those attacks targeting utilities, leading to 1,917 persons directly killed and 1,377 persons wounded. In total, there were 1,265 attacks targeting telecommunications causing 205 direct deaths and 510 wounded. Lastly, 268 attacks targeted the water supply with 318 directly killed and 261 wounded. Regionally, South America had the most attacks with 2,236, followed by Central America and the Caribbean with 1,390. Based on infrastructure type, the most attacks on utilities occurred in El Salvador (1,061), and the most attacks on telecommunications were in India (140). Peru (46) had the most attacks on its water supply.

The regions with the highest number of total attacks targeting CI have historically been in South America, with more attacks against power and utilities than other infrastructure. Although the numbers of persons directly killed and wounded in these attacks were lower than with other target types, the true impacts on lack of health care delivery are not accounted for in these numbers. By understanding the pattern and scope of these attacks, Counter-Terrorism Medicine (CTM) initiatives can be created to target-harden health care-related infrastructure.

Russia’s annexation of Crimea in 2014, and the recent Russo-Ukrainian war that started in 2022, were triggers that radically changed the perception of security in the Nordic and Baltic countries. The on-going Russian hybrid war has resulted in a renewed global interest in the safety and security of many countries (eg, the Nordic-Baltic Eight). The prospective North Atlantic Treaty Organization (NATO) membership of Finland and Sweden may drastically change the regional military and political landscape.

The objective of this study was to identify and characterize all documented terrorist attacks in this region as reported to the Global Terrorism Database (GTD) from 1970 through 2020.

The GTD was searched using the internal database functions for all terrorism incidents in the Nordic-Baltic states: Denmark, Estonia, Finland, Iceland, Latvia, Lithuania, Norway, and Sweden.

Temporal factors, location, target type, attack and weapon type, perpetrator type, number of casualties, and property value loss were collated. Results were exported into an Excel spreadsheet for analysis.

There were 298 terrorism-related incidents from 1970 through 2020. Most attacks occurred in Sweden, followed by Norway and Finland. No entries were recorded for the Baltic states prior to their independency in 1991. The 298 incidents resulted in a total of 113 fatalities and 277 injuries.

Facility/infrastructure attacks were the most frequently identified attack type (35.0%), followed by bombings and explosions (30.9%). Armed assaults were responsible for 80 fatalities and 105 injuries, followed by bombings/explosions with 15 fatalities and 72 injuries. The predominant target types were immigrants and refugee shelters (64/298 incidents). In only 33.6% of the incidents, perpetrators were known. Right-wing assailants represented the largest group, accounting for 27 incidents.

From 1970 through 2020, there were 298 terrorist attacks in the Nordic-Baltic Eight. Sweden accounted for 50% of incidents.

The profile of terrorist attacks was very diverse, as were the perpetrators and targets. Every country had its own incident characteristics. The surge of right-wing extremism must be closely monitored.

Industrial disasters can have a myriad of repercussions ranging from deaths, injuries, and long-term adverse health impacts on nearby populations, to political fallout and environmental damage. This is a descriptive epidemiological analysis of industrial disasters occurring between 1995 and 2021 which may provide useful insight for health-care systems and disaster medicine specialists to better prevent and mitigate the effects of future industrial disasters.

Data were collected using a retrospective database search of the Emergency Events Database (EM-DATS) for all industrial disasters occurring between January 1, 1995, and December 31, 2021.

A total of 1054 industrial disasters were recorded from 1995 to 2021. Most of these disasters occurred in Asia (720; 68.3%), with 131 (12.4%) in Africa, 107 (10.2%) in Europe, 94 (8.9%) in the Americas, and 2 (0.2%) in Oceania. Half of these disasters were explosions (533; 50.6%), 147 (13.9%) were collapses, 143 (13.6%) were fires, 46 (4.4%) were chemical spills, 41 (3.9%) were gas leaks, and 34 (3.2%) were poisonings. There were 6 (0.6%) oil spills and 3 (0.3%) radiation events.

A total of 29,708 deaths and 57,605 injuries were recorded as a result of industrial disasters, and they remain a significant contributor to the health-care risks of both workers and regional communities. The need for specialized emergency response training, the potential devastation of an industrial accident, and the vulnerability of critical infrastructure as terror targets highlight the need to better understand the potential immediate and long-term consequences of such events and to improve health-care responses in the future.

Compared to trauma-based injuries, chemical injuries can inflict widespread and persistent injuries to exposed victims. Emergency medical services (EMS) personnel are vulnerable to chemical injuries. Specialized training is required, including zone setup, personal protective equipment (PPE), decontamination, and antidote use, beyond simple advanced trauma life support. The purpose of this study is to evaluate the educational effectiveness of the online chemical-mass casualty incident response education module (C-MCIREM) for EMS personnel.

This study is a retrospective pre-and post-test comparison. Subjects were EMS personnel who enrolled in the C-MCIREM program at the EMS Korea online conference between August 27, 2021 and September 5, 2021. Subjects provided demographic data and completed pre-course and post-course knowledge tests and self-assessments of readiness, as well as a satisfaction survey after the course. For readiness and satisfaction surveys, an 11-point Likert scale was used. The Wilcoxon Rank Sum test was used to compare the two samples.

A total of 322 respondents were enrolled. Two-hundred (62.1%) responded that they were most motivated to take the course because of curiosity about the subject. The median pre-course knowledge score was 57/100 (47, 66) and the post-knowledge score was 80/100 (66, 91) (p<0.001). Participants stated they felt their readiness to provide triage, treatment, transport, decontamination, to select correct antidotes, and to use correct PPE (all p<0.001) increased. 90.4% stated they were satisfied with the course. Participants were overall satisfied with the use of the online format (7.71/10 SD 2.05), and were willing to recommend the training to other EMS providers (7.63/10 SD 2.1).

The online C-MCIREM program showed high satisfaction with a significant increase in knowledge and self-assessed readiness to respond to a chemical mass casualty incident.