The aim of this study was to identify and prioritize strategies for strengthening public health system resilience for pandemics, disasters, and other emergencies using a scorecard approach.

The United Nations Public Health System Resilience Scorecard (Scorecard) was applied across 5 workshops in Slovenia, Turkey, and the United States of America. The workshops focused on participants reviewing and discussing 23 questions/indicators. A Likert type scale was used for scoring with zero being the lowest and 5 the highest. The workshop scores were analyzed and discussed by participants to prioritize areas of need and develop resilience strategies. Data from all workshops were aggregated, analyzed, and interpreted to develop priorities representative of participating locations.

Eight themes emerged representing the need for better integration of public health and disaster management systems. These include: assessing community disease burden; embedding long-term recovery groups in emergency systems; exploring mental health care needs; examining ecosystem risks; evaluating reserve funds; identifying what crisis communication strategies worked well; providing non-medical services; and reviewing resilience of existing facilities, alternate care sites, and institutions.

The Scorecard is an effective tool for establishing baseline resilience and prioritizing actions. The strategies identified reflect areas in most need for investment to improve public health system resilience.

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.

Reusing PPE is not recommended but was common during COVID-19 pandemic. Limited guidance on proper PPE use and its reuse heightened the hazards to health care worker (HCW) safety. Emerging data on PPE use suggests that most HCWs were contaminated by donning and doffing of PPE while adhering to standards of care.

A prospective observational study was conducted to understand HCW behaviors in donning, doffing, and reusing PPE. Emergency Department physicians and nurses were video-recorded donning, doffing, and reusing PPE within a simulated acute care environment. Participants performed five donning and doffing PPE procedures. PPE kit included gown, face shields, and N95 respirator masks. Participants had access to disposable gloves and hand sanitizer. Recordings were reviewed and coded independently by two trained coders based on checklist of key behaviors. Agreement between coders was high (81.9%). All participants reported completing PPE training.

28 videos of participants capturing 278 procedures were reviewed. None of the participants followed the CDC’s order for donning across five scenarios. Majority of participants failed to perform hand hygiene before donning or re-donning PPE or when doffing PPE. For contaminant spread risk, 92.85% (n=26) touched patient-facing side of PPE during re-donning and/or doffing PPE (M= 3.75, SD= 2.37, Median = 4; 0-9 times). The most common area of self-contamination was hands (n= 111 across all participants in 5 donning/doffing sequences). Touching patient-facing side of PPE was more likely to occur during donning than doffing (70.5% vs. 20.1% of sequences).

The study found wide variation in PPE donning/doffing practices among HCW in violation of CDC guidance. This first study to review PPE reuse through a human factors lens, identifyied deviant behaviors that contribute to HCW self-contamination. Efforts are needed to redesign PPE and develop effective ways to train staff using PPE equipment safely.

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.

Disaster research is primarily posthoc analysis, locally focused or within response organizations, overlooking the wellness and safety of first and second responders or the broad multi- and interdisciplinary activities necessary to foster and sustain recovery. A broad framework to span locality, institutional, and professional boundaries supports the development of a true learning community–a health EDRM sector that supports society in recognizing lessons, refining findings, and free and fluid global sharing.

Several organizations joined to create a robust disaster health learning community: CREDO, GloHSA, ICDM, and ECDM, a multi-national, multi-disciplinary collaborative network of patients, universities, societies, regulators, publishing, healthcare, and technology partners designed to foster expert level education and training with shared educational design concepts, milestones, and core curricula that embrace the strength of a standardized base upon which to link unique pillars of excellence of separate functions, institutions, nations, and regions.

The Emergency Disaster Global Health Sciences (EDGHS) model developed by University of Texas Southwestern Medical Center is interactive, open, and responsive. EDGHS addresses critical gaps in applied research by convening leaders across the healthcare and public health continuum to map the way forward, designing and implementing high-quality, evidence-based practical and policy research.

This defines essential public health functions for national contexts, including a focus on emergency preparedness and response, strengthening competency-based education on essential public health functions, and mapping and measurement of occupations delivering EDRM functions, offering an exportable model of global relevance.

Putting disaster prevention into recovery processes is a strategic opportunity to improve the well-being of future generations. The survivability and well-being needs of present and future generations are contingent on knowledge-based, lived experiences of recoverable disaster loss and damage, and the capacity to thrive sustainably. This presentation serves as an invitation to join the growing momentum of creating a learning health EDRM community.

The aim of this study was to examine safety-related contamination threats and risks to health-care workers (HCWs) due to the reuse of personal protective equipment (PPE) among emergency department (ED) personnel.

We used a Participatory Design (PD) approach to conduct task analysis (TA) of PPE use and reuse. TA identified the steps, risks, and protective behaviors involved in PPE reuse. We used the Centers for Disease Control and Prevention (CDC) guidance for PPE donning and doffing specifying the recommended task order. Then, we convened subject matter experts (SMEs) with relevant backgrounds in Patient Safety, Human Factors and Emergency Medicine to iteratively identify and map the tasks, risks, and protective behaviors involved in the PPE use and reuse.

Two emerging threats were associated with behaviors in donning, doffing, and re-using PPE: (i) direct exposure to contaminant, and (ii) transmission/spread of contaminant. Protective behaviors included: hand hygiene, not touching the patient-facing surface of PPE, and ensuring a proper fit and closure of all PPE ties and materials.

TA was helpful revealed that the procedure for donning and doffing of re-used PPE does not protect ED personnel from contaminant spread and risk of exposure, even with protective behaviors present (e.g., hand hygiene, respirator use, etc.). Future work should make more apparent the underlying risks associated with PPE use and reuse.