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Burn mass casualty incident (BMCI) preparedness is lacking across Canada. A focused exploration of the current policies, protocols and practices in Alberta that address the response to a BMCI was conducted. In this case study, data were gathered from documents outlining the health system response to a mass casualty incident and health care professionals directly involved. Interviews were conducted online, recorded and transcribed. Qualitative description was used to code common themes across documents and transcripts. Fifteen documents and nine participant interviews were included in this study. Overall, the current policies, protocols and practices in place were limited to all-hazards mass casualty incident planning and did not address the specialized needs of burn patients. Deficiencies included no burn-specific plan at each of the two burn centres, a lack of provincial-level recognition of the unique challenges associated with a BMCI and no established Canadian burn disaster communication plan. Suggestions of strategies for a burn plan included forward triage, patient movement, use of telemedicine, partnering skilled and non-skilled staff, and procuring additional supplies. For best patient outcomes the provincial health authority needs to provide dedicated time for burn care experts to develop BMCI response plans to better address this unique hazard. • All hazards mass casualty (MC) plans do not work for multiple burn injured patients. • Participant communication and decision-making practices deviated from the MC plan. • Participants expressed concerns about the overall ability to respond to a burn MC. • Creating burn capacity includes strategies for space, staffing, and supplies needed. [ABSTRACT FROM AUTHOR]

Mass shootings (incidents with four or more people shot in a single event, not including the shooter) are becoming more frequent in the United States, posing a significant threat to public health and safety in the country. In the current study, we intended to analyze the impact of state-level prevalence of gun ownership on mass shootings—both the frequency and severity of these events. We applied the negative binomial generalized linear mixed model to investigate the association between gun ownership rate, as measured by a proxy (i.e., the proportion of suicides committed with firearms to total suicides), and population-adjusted rates of mass shooting incidents and fatalities at the state level from 2013 to 2022. Gun ownership was found to be significantly associated with the rate of mass shooting fatalities. Specifically, our model indicated that for every 1-SD increase—that is, for every 12.5% increase—in gun ownership, the rate of mass shooting fatalities increased by 34% (p value < 0.001). However, no significant association was found between gun ownership and rate of mass shooting incidents. These findings suggest that restricting gun ownership (and therefore reducing availability to guns) may not decrease the number of mass shooting events, but it may save lives when these events occur. [ABSTRACT FROM AUTHOR]

Since 2019, the war in Ethiopia between the Federal Government and the Tigrean People's Liberation Front (TPLF) has severely impacted civilians, including children. Although children have been affected in many of the war-torn regions of the country, the study targeted two specific locations, Maikadra and Chenna, in Amhara National Regional State, where civilians were massacred because of their ethnicity. The focus of the study was to understand the acute and complex child abuse that occurred in the midst of the war. A qualitative method with a descriptive case study design was employed to collect and analyze data. Twenty-four individuals were purposely selected and participated in the interviews. From Maikadra, the participants included seven children, two parents, two school principals, one eyewitness woman in the community, and one Kebele administrator. Similarly, from Chenna, five children, three parents, two school principals, and one Kebele administrator participated in the interviews. We applied in-depth interviews and systematic observation to gather primary data. Using social ecology as a theoretical framework, the result revealed that at the micro level, community members (particularly children) experienced witnessing killings, experience rape and verbal abuse, intimidation, and the destruction of the family unit. At the mezzo level, the study documented communities' experiences related to displacement and the destruction of schools and community networks. Further, at the exo level, the study revealed experiences of hunger, starvation, and the emergence of child-headed families. Finally, at the macro community level, the study revealed loss of future aspirations and the development of negative attitudes toward cultural values. All these forms of child abuse, as reported by study participants, are crimes deliberately committed by the TPLF rebel groups. This study suggests multiple interventions at all levels are required. Highlights: This qualitative case study, conducted in war-torn areas of Ethiopia, sheds light on the various contexts in which children were subjected to abuse. The war resulted in child abuse that can be explained at micro, mezzo, exo, and macro system levels. Children were directly targeted and witnessed ethnic-based atrocities. They lost their parents, took on family responsibilities, became orphaned, saw their schools turned into burial sites and were no longer attending school. Their future aspirations have been compromised. War actors from the TPLF perpetuated negative attitudes towards the Amhara cultural values. [ABSTRACT FROM AUTHOR]

Purpose: To investigate prehospital preparedness work for Mass Casualty Incidents (MCI) and Major Incidents (MI) in Norway. Method: A national cross-sectional descriptive study of Norway's prehospital MI preparedness through a web-based survey. A representative selection of Rescue and Emergency Services were included, excluding Non-Governmental Organisations and military. The survey consisted of 59 questions focused on organisation, planning, education/training, exercises and evaluation. Results: Totally, 151/157 (96%) respondents answered the survey. The results showed variance regarding contingency planning for MCI/MI, revisions of the plans, use of national triage guidelines, knowledge requirements, as well as haemostatic and tactical first aid skills training. Participation in interdisciplinary on-going life-threatening violence (PLIVO) exercises was high among Ambulance, Police and Fire/Rescue Emergency Services. Simulations of terrorist attacks or disasters with multiple injured the last five years were reported by 21/151 (14%) on a regional level and 74/151 (48%) on a local level. Evaluation routines after MCI/MI events were reported by half of the respondents (75/151) and 70/149 (47%) described a dedicated function to perform such evaluation. Conclusion: The study indicates considerable variance and gaps among Prehospital Rescue and Emergency Services in Norway regarding MCI/MI preparedness work, calling for national benchmarks, minimum requirements, follow-up routines of the organisations and future reassessments. Implementation of mandatory PLIVO exercises seems to have contributed to interdisciplinary exercises between Fire/Rescue, Police and Ambulance Emergency Service. Repeated standardised surveys can be a useful tool to assess and follow-up the MI preparedness work among Prehospital Rescue and Emergency Services at a national, regional and local level. [ABSTRACT FROM AUTHOR]

There have been a large number of masscasualty incidents in recent years, including climate change-related disasters, mass shootings, terrorist attacks, transportation accidents and a global pandemic. Communities, families and friends have suffered grief and loss, while nations continue to bear the scars of trauma. Disasters caused by acts with criminality, although necessarily managed by the police for the investigative aspect, must be planned for, and responded to with victim-centred practices by the police, local government and other relevant community stakeholders for the duration of the response and recovery. Inconsistency and confusion over terminology and language in emergency management can lead to a lack of understanding about which stakeholders or agencies should be engaged in, and responsible for different aspects of the planning, preparedness, mitigation and response to a community disaster — regardless of what type of disaster it is, and irrespective of the disaster being caused by a person or persons with ill-intent. This paper discusses how a wholeof- community and victim-centred approach to criminal act disaster response should be applied to support those persons most adversely affected by the incident. It also promotes the application of victim-centred practices to ensure that the needs of victims are regarded ethically, and with compassion following any disaster caused by an act of criminality. The term 'mass victimisation incident' will be introduced and applied through a case study. [ABSTRACT FROM AUTHOR]

This paper examines Phil Klay's story collection, Redeployment (2015), with particular reference to victimhood in war and the culpability of war casualties. The victimhood argument is essential to wars because it emphasizes the innocence of one party at the expense of the other, providing a pretext and justification for violent retaliation. It serves the pro-war narrative and validates action on the ground against the second party. The argument in this paper is made in two constructs: 'American Victims,' which addresses the representation of American soldiers as victims of war and their accountability for violence, and 'Local Victims,' which examines the presence of Iraqis as victims of war and their responsibility for the status quo in Iraq. Both Americans and Iraqis, soldiers who participate in the war as well as civilians, are made victims of war in Klay's stories. The suffering of locals is presented but as part of the larger victimization of American soldiers, who are the most visible victims of war. [ABSTRACT FROM AUTHOR]

The effects of navigating the aftermath of tragedies involving children or other major incidents can spill over into nurses’ personal lives, but there is no ‘right’ way to process such distressing events, according to experts. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles within the issue including military-civilian partnership to help maintain competencies by military nurses, mass shooting in an acute care setting, and best practices for caring for patients with injuries from violence.

Abstract Background Road traffic accidents (RTAs) are predicted to become the world’s seventh leading cause of death by 2030. Given the significant impact of RTAs on public health, effective hospital preparedness plays a pivotal role in managing and mitigating associated health and life-threatening issues. This study aims to meticulously evaluate the preparedness of selected hospitals in western Iran to handle road traffic accidents with mass casualties (RTAs-MC). Methods The study employed a descriptive-analytical approach, utilizing a reliable and valid questionnaire to measure hospitals’ preparedness levels. Descriptive statistics (frequency distribution and mean) were utilized to provide an overview of the data, followed by analytical statistics (Spearman correlation test) to examine the relationship between hospital preparedness and its dimensions with the hospital profile. Data analysis, performed using SPSS software, categorized preparedness levels as weak, moderate, or high. Results The study found that hospitals in Kurdistan province had a favorable preparedness level (70.30) to respond to RTAs-MC. The cooperation and coordination domain had the highest preparedness level (98.75), while the human resource management (59.44) and training and exercise (54.00) domains had the lowest preparedness levels. The analysis revealed a significant relationship between hospital preparedness and hospital profile, including factors such as hospital specialty, number of beds, ambulances, staff, and specialized personnel, such as emergency medicine specialists. Conclusion Enhancing preparedness for RTAs-MC necessitates developing response plans to improve hospital profile, considering the region’s geographic and topographic features, utilizing past experiences and lessons learned, implementing of Hospital Incident Command System (HICS), providing medical infrastructure and equipment, establishing communication channels, promoting cooperation and coordination, and creating training and exercise programs.

Objective: Given the frequency of disasters worldwide, there is growing demand for efficient and effective emergency responses. One challenge is to design suitable retrospective charts to enable knowledge to be gained from disasters. This study provides comprehensive understanding of published retrospective chart review templates for designing and updating retrospective research. Methods: We conducted a systematic review and text analysis of peer-reviewed articles and grey literature on retrospective chart review templates for reporting, analysing, and evaluating emergency responses. The search was performed on PubMed, Cochrane, and Web of Science and pre-identified government and non-government organizational and professional association websites to find papers published before July 1, 2022. Items and categories were grouped and organised using visual text analysis. The study is registered in PROSPERO (374,928). Results: Four index groups, 12 guidelines, and 14 report formats (or data collection templates) from 21 peer-reviewed articles and 9 grey literature papers were eligible. Retrospective tools were generally designed based on group consensus. One guideline and one report format were designed for the entire health system, 23 studies focused on emergency systems, while the others focused on hospitals. Five papers focused specific incident types, including chemical, biological, radiological, nuclear, mass burning, and mass paediatric casualties. Ten papers stated the location where the tools were used. The text analysis included 123 categories and 1210 specific items; large heterogeneity was observed. Conclusion: Existing retrospective chart review templates for emergency response are heterogeneous, varying in type, hierarchy, and theoretical basis. The design of comprehensive, standard, and practicable retrospective charts requires an emergency response paradigm, baseline for outcomes, robust information acquisition, and among-region cooperation. [ABSTRACT FROM AUTHOR]

The impact of disasters is changing, with disaster events becoming more complex and often affecting multiple countries simultaneously. Despite this, quality management systems have not yet been established in the field of disaster medicine. The German research project QUARZ-SAND, developed a national disaster medicine quality management system and an online registry. This theoretical study ascertains the current state of quality management in disaster medicine and compares existing initiatives to QUARZ-SAND and highlights advantages and synergies in the pooling of incident data, in view of improving resilience to national and transboundary disaster events. A systematic literature research was conducted on December 18, 2020 in the databases PubMed and LIVIVO. Existing disaster medicine quality management tools were identified and compared with QUARZ-SAND. It was determined that a lot of effort is still needed to get to an internationally accepted common standard and a tool such as a registry for evaluating medical disaster responses. A first step toward the establishment of a registry is the development of a standardized data set. [ABSTRACT FROM AUTHOR]

Objective: We offered a workshop at the 2023 annual meeting of the Society for Academic Emergency Medicine to teach the Sort–Assess–Lifesaving Interventions–Treatment/Transport (SALT) triage protocol for responding to mass casualty incidents (MCIs) using an immersive virtual reality (VR) simulator. Here, we report workshop outcomes. Methods: After a 1‐h didactic on the basics of triage protocols, workshop participants rotated through three skill stations at which learners learned how to use the VR headset and controllers, practiced applying SALT triage skills through a tabletop exercise, and then finally used our VR simulator for training responses to MCIs. During their encounter with VR, participants applied their new knowledge to triaging and treating the victims of an explosion in a virtual subway station. After a brief orientation, participants entered the scene to treat and triage virtual patients who had various life‐threatening (e.g., acute arterial bleed, penetrating injury, pneumothorax, amputations) and non–life‐threatening injuries (lacerations, sprains, hysteria, confusion). The simulator generated a performance report for each workshop attendee to be used for debriefing by a skilled facilitator. Results: Participants were mostly trainees (residents), all of whom properly initiated their encounter with global sort commands (walk and wave) to identify the most critically injured. On average, participants correctly treated 92% of 18 injuries, with all bleeding injuries being properly controlled (tourniquets or wound packing). On average, participants correctly tagged 87.7% of 11 patients, but only took the pulse of 67% of the 11 patients. Learners had difficulty with cases involving embedded shrapnel and properly tagging patients who were stable after treatments. Conclusions: Our VR simulator provided a practical, portable, reproducible training and assessment system for preparing future emergency medical systems (EMS) medical directors to teach their EMS professionals the triage and lifesaving intervention treatment skills needed to save lives. [ABSTRACT FROM AUTHOR]

Anticipating and planning for the urgent response to large-scale disasters is critical to increase the probability of survival at these events. These incidents present various challenges that complicate the response, such as unfavorable weather conditions, difficulties in accessing affected areas, and the geographical spread of the victims. Furthermore, local socioeconomic factors, such as inadequate prevention education, limited disaster resources, and insufficient coordination between public and private emergency services, can complicate these situations. In large-scale emergencies, multiple demand points (DPs) are generally observed, which requires efforts to coordinate the strategic allocation of human and material resources in different geographical areas. Therefore, the precise management of these resources based on the specific needs of each area becomes fundamental. To address these complexities, this paper proposes a methodology that models these scenarios as a multi-objective optimization problem, focusing on the location-allocation problem of resources in Mass Casualty Incidents (MCIs). The proposed case study is Mexico City in a earthquake post-disaster scenario, using voluntary geographic information, open government data, and historical data from the 19 September 2017 earthquake. It is assumed that the resources that require optimal location and allocation are ambulances, which focus on medical issues that affect the survival of victims. The designed solution involves the use of a metaheuristic optimization technique, along with a parameter tuning technique, to find configurations that perform at different instances of the problem, i.e., different hypothetical scenarios that can be used as a reference for future possible situations. Finally, the objective is to present the different solutions graphically, accompanied by relevant information to facilitate the decision-making process of the authorities responsible for the practical implementation of these solutions. [ABSTRACT FROM AUTHOR]

Copyright of Community & Physician / Toplum ve Hekim is the property of Turk Tabipleri Birligi / Turkish Medical Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

During the Second World War there were large-scale fatalities when air raid shelters were hit by bombs. The greatest loss of life in a shelter was at Bethnal Green in the East End of London on 3 March 1943, where 173 people died in a crush on the stairs at the shelter entrance. The causes of this incident have been distorted by post-war press claims that the reasons why it happened were covered up, and panic was the main cause of so many deaths. A recent publication has insinuated that the Government manipulated the inquiry for political reasons. This article evaluates these claims against the available evidence, to demonstrate that such a catastrophic loss of life was far more complicated than suggested. The victims of this disaster deserve to be remembered as unfortunate casualties of war, rather than as being trampled to death by a terrified crowd. [ABSTRACT FROM AUTHOR]

Tourniquets are a mainstay of life-saving hemorrhage control. The US military has documented the safety and effectiveness of tourniquet use in combat settings. In civilian settings, events such as the Boston Marathon bombing and mass shootings show that tourniquets are necessary and life-saving entities that must be used correctly and whenever indicated. Much less research has been done on tourniquet use in civilian settings compared to military settings. The purpose of this study is to describe the prehospital use of tourniquets in a regional EMS system served by a single trauma center. All documented cases of prehospital tourniquet use from 2015 to 2020 were identified via a search of EMS, emergency department, and inpatient records, and reviewed by the lead investigator. The primary outcomes were duration of tourniquet placement, success of hemorrhage control, and complications; secondary outcomes included time of day (by EMS arrival time), transport interval, extremity involved, who placed/removed the tourniquet, and mechanism of injury. Of 182 patients with 185 tourniquets applied, duration of application was available for 52, with a median (IQR) of 43 (56) minutes. Hemorrhage control was achieved in all but two cases (96%). Three cases (5.8%) required more than one tourniquet. Complications included five cases of temporary paresthesia, one case of ecchymosis, two cases of fasciotomy, and two cases of compression nerve injury. The serious complication rate was 7.7% (4/52). Time of day was daytime (08:01-16:00) = 15 (31.9%), evening (16:01-00:00) = 27 (57.4%), and night (00:01- 08:00) = 5 (10.6%). The median transport interval was 22 (IQR 5] minutes. The limbs most often injured were the left and right upper extremities (15 each). EMS clinicians and police officers were most often the tourniquet placers. Common mechanisms of injury included gunshot wounds, motorcycle accidents, and glass injuries. Tourniquets used in the prehospital setting have a high rate of hemorrhage control and a low rate of complications. [ABSTRACT FROM AUTHOR]

Background: Road traffic accidents (RTAs) are predicted to become the world's seventh leading cause of death by 2030. Given the significant impact of RTAs on public health, effective hospital preparedness plays a pivotal role in managing and mitigating associated health and life-threatening issues. This study aims to meticulously evaluate the preparedness of selected hospitals in western Iran to handle road traffic accidents with mass casualties (RTAs-MC). Methods: The study employed a descriptive-analytical approach, utilizing a reliable and valid questionnaire to measure hospitals' preparedness levels. Descriptive statistics (frequency distribution and mean) were utilized to provide an overview of the data, followed by analytical statistics (Spearman correlation test) to examine the relationship between hospital preparedness and its dimensions with the hospital profile. Data analysis, performed using SPSS software, categorized preparedness levels as weak, moderate, or high. Results: The study found that hospitals in Kurdistan province had a favorable preparedness level (70.30) to respond to RTAs-MC. The cooperation and coordination domain had the highest preparedness level (98.75), while the human resource management (59.44) and training and exercise (54.00) domains had the lowest preparedness levels. The analysis revealed a significant relationship between hospital preparedness and hospital profile, including factors such as hospital specialty, number of beds, ambulances, staff, and specialized personnel, such as emergency medicine specialists. Conclusion: Enhancing preparedness for RTAs-MC necessitates developing response plans to improve hospital profile, considering the region's geographic and topographic features, utilizing past experiences and lessons learned, implementing of Hospital Incident Command System (HICS), providing medical infrastructure and equipment, establishing communication channels, promoting cooperation and coordination, and creating training and exercise programs. [ABSTRACT FROM AUTHOR]

We currently have multiple blood components that meet the highest quality and safety standards. However, we still have unmet needs, especially in operation areas, prehospital care situations and in disasters with mass casualties. Blood and its derivatives continue to be a scarce commodity, which in our environment depends on the altruistic donation of citizens and has limitations for its conservation, transportation and expiration. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Gun violence in the United States is a public health crisis. In 2019, gun injury became the leading cause of death among children aged birth to 19 years. Moreover, the United States has had 57 times as many school shootings as all other major industrialized nations combined. The purpose of this study was to understand the frequency of school-related gun violence across a quarter century, considering both school shootings and school mass shootings. METHODS: We drew on 2 publicly available datasets whose data allowed us to tabulate the fre- quency of school shootings and school mass shootings. The databases contain complementary data that provide a longitudinal, comprehensive view of school-related gun violence over the past quarter century. RESULTS: Across the 1997--1998 to 2021--2022 school years, there were 1453 school shootings. The most recent 5 school years reflected a substantially higher number of school shootings than the prior 20 years. In contrast, US school mass shootings have not increased, although school mass shootings have become more deadly. CONCLUSIONS: School shootings have risen in frequency in the recent 25 years and are now at their highest recorded levels. School mass shootings, although not necessarily increasing in frequency, have become more deadly. This leads to detrimental outcomes for all the nation's youth, not just those who experience school-related gun violence firsthand. School-based interventions can be used to address this public health crisis, and effective approaches such as Multi-Tiered Systems of Supports and services should be used in support of students' mental health and academic and behavioral needs. [ABSTRACT FROM AUTHOR]

Introduction: Tetanus is a rather rare disease in the Western countries thanks to widespread vaccination programs and the availability of prophylactics for patients with tetanus-prone injuries. The few cases that do occur are promptly managed in intensive care units (ICUs). However, tetanus is not so rare in developing countries, where access to a suitable level of care is limited. An unstable political situation can be a significant factor influencing patient outcomes. Case report: A ten-year-old boy presented at the EMERGENCY hospital in Lashkar-Gah (southern Afghanistan) with generalized tetanus after falling off his bicycle. In response to his rapidly deteriorating general conditions -- respiratory failure and hemodynamic instability -- the patient was urgently transferred by ambulance to the ICU at the EMERGENCY hospital in Kabul (northern Afghanistan). The patient was placed on mechanical ventilation while receiving intravenous sedation and pharmacologic paralysis for almost four weeks. A prolonged infusion of a high dose of magnesium sulphate and labetalol was also given to counteract autonomic dysfunction. Multiple complications related to the long stay in the ICU were observed and promptly addressed. During this period, several mass casualties took place in Kabul, which stretched the hospital's surge capacity. The patient was discharged and accompanied back to Lashkar-Gah three months after his admission to the hospital. Conclusions: This case report shows some of the many difficulties that arise when managing a patient with severe tetanus in a war zone where resources are limited. [ABSTRACT FROM AUTHOR]

Anger is a well-recognised but little understood emotion in postdisaster contexts. For service providers working in recovery environments, it is critical to understand anger to ensure effective supports and interventions are mobilised. This article describes findings from a study conducted four years after the 2009 Victorian Black Saturday bushfires. Thirty-eight community and service-provider participants were interviewed as individuals, dyads, or within focus groups about their own and others' experiences of anger. Postdisaster anger was described as more immediate, intense, and frequent than predisaster, and seen by participants as destructive, productive, and justified. Experiences and understandings differed by gender, and related to aggression, violence, and family violence. Service provision was a key trigger for anger, with leadership styles, community expectations, and community members' level of control over decision making being factors that shaped experience. Based on these findings, five proposed principles for anger-sensitive practice in disaster contexts, along with wider considerations for understanding anger, are provided. IMPLICATIONS This article provides unique understandings of the experience of anger following disaster, which are useful for social workers, community members and leaders, and other service providers. Research findings about anger experiences and outcomes postdisaster are synthesised into proposed principles for practice with disaster-impacted communities (that can potentially build capability prior to disasters). [ABSTRACT FROM AUTHOR]

Background: Before the arrival of patients at medical facilities, emergency medical teams often encounter numerous challenges in dealing with mass casualties resulting from road traffic accidents. This study examines the challenges that pre-hospital emergency medical services face during mass casualty incidents caused by road traffic accidents. Materials and Methods: This... [ABSTRACT FROM AUTHOR]

Across a range of recent terrorist attacks in the United Kingdom, the question of how crowds behave in confined public space is an important concern. Classical theoretical assumptions are that human behaviour in such contexts is relatively uniform, self‐interested and pathological. We contest these assumptions by reporting on a study of public response to a marauding knife attack that occurred on London's underground rail network in 2015. The analysis draws primarily upon footage from 27 CCTV cameras positioned across the station footprint supplemented by social media, news footage, radio logs and incident reports. Using an innovative methodology, we topographically and chronologically mapped behaviours during the incident. The analysis demonstrates that while rapid egressions occurred as the threat escalated, at every phase of the incident members of the public intervened spontaneously with coordinated, purposeful, socially oriented actions. This behavioural pattern contrasts with classical assumptions of a chaotic and apathetic crowd in emergencies. We highlight eight complementary categories of actions in the public response that appeared functional for the collective safety of the crowd during the short period before the police arrived. The policy implications for emergency planning, and the methodological innovations involving the use of video data are discussed. [ABSTRACT FROM AUTHOR]

Background: Mass casualty incident (MCI) triage simulation is an increasingly useful tool for teaching triage systems to medical students, trainees, and hospital staff. MCI simulation in the prehospital setting has not yet been studied in this population. Objectives/Aims: We aimed to assess the effectiveness of a prehospital MCI simulation in medical students, residents, and fellows. Our primary outcome was knowledge of the components of the triage algorithms used in MCI response. Our secondary outcome was each participant's confidence level if required to assist with or lead a MCI response. Methods: This was an observational study with pre–post surveys. We recruited 30 medical students, 14 emergency medicine (EM) residents, and four pediatric EM fellows to fill out a survey before and after a 3‐h simulation session practicing the START and JumpSTART algorithms on two prehospital MCI scenarios. Results: Overall, all groups demonstrated significant improvement in knowledge of triage colors, information needed to assign a triage color, pediatric airway management during a MCI, and indications for breaths‐first CPR. They also demonstrated significant increase in confidence both in assisting with and in leading a MCI response. Conclusions: Simulated practice triaging patients in prehospital MCI scenarios improves knowledge of triage algorithms and increases confidence in assisting with or leading a MCI response in medical trainees. [ABSTRACT FROM AUTHOR]

We analyze a range of future scenarios for Russia related to the Ukraine War. Although regime change is a publicly-stated objective for several leaders of NATO countries, we find very little prospect for it. The Russian economy has largely evaded the effects of the sanctions. Despite enormous casualties and incompetence in the management of the war, both Putin and the war remain popular with the Russian public. Contrary to most analysis to date, the Wagner Group mutiny of June 2023 is not an indication of Putin’s weakness, but his strength. The coercive mechanisms of the Russian state remain intact. Indeed, they have grown stronger. Finally, there is little to no prospect for the emergence of a significant antiwar movement. Regardless of the outcome of the war in Ukraine, Putin is likely to remain in power. Western leaders should begin to grapple with this unpleasant reality and its policy implications. [ABSTRACT FROM AUTHOR]

Goal: To seek and describe current scientific knowledge on the preparedness of medical personnel for an active shooter attack, with the identification of an optimal preparation strategy concerning prevention and potential management of this emergency on the premises of a medical facility. Methods: A scoping study with five phases of methodological steps was applied on the basis of the identified research question. According to the PCC (population, concept, context) format, the research question was divided into individual keywords in selected languages used for the search. Primary studies published between 2000 and December 2023 were included in the selection process. The sources were searched in December 2023 and freely available. Licensed databases EBSCOhost, Cinahl Plus with Full text, Medline, Medline Complete, and Google were used to find relevant studies. We used the "find similar articles" function in many databases. Selected English language keywords were searched using Boolean operators and placeholders. Results: The final analysis included nine studies. As precautions, the authors recommended the development of guidelines and establishment of a system, not only at the national level, but also within individual facilities interconnected with the police, regular training of employees with practical simulation, orientation signs in buildings, communication links for quick information and, last but not least, knowledge of warning behaviour. Conclusion: Healthcare providers should be systematically prepared for an active shooter emergency. [ABSTRACT FROM AUTHOR]

Copyright of Military Science Review / Hadtudományi Szemle is the property of National University of Public Service and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

On 7 October 2023, Israel faced an unexpected attack by Hamas, causing over 1,200 deaths and injuring more than 9,000 individuals. This report delves into the rapid medical response spearheaded by Israel's civilian Emergency Medical Service, Magen David Adom (MDA), during this crisis. Utilizing data from MDA's electronic database, 4,097 dispatch records from the day were analyzed. Of these, 39.3% were directly related to the attack. EMS teams faced multiple challenges, including handling an overwhelming number of casualties and navigating active combat zones, which impeded safe access to victims, posed significant risks to teams' safety, and constrained patient evacuation strategies. This incident underscores the importance of reinforcing healthcare resilience, particularly emphasizing the need for centralizing various aspects of response efforts. These include streamlined communication, national coordination of pre-hospital resources, and systemic management of patient evacuations. Moreover, providing substantial support for EMS personnel, who operated in highly challenging conditions, is imperative. [ABSTRACT FROM AUTHOR]

Mass shootings have caused many to feel anxious and afraid of this seemingly common event. Therefore, the objective of this study was to develop and evaluate the properties of the Mass Shootings Anxiety Scale (MSAS), which is a five-item scale that was based on 759 adults. The MSAS demonstrated solid reliability (α and ω of 0.93), factorial validity (PCA and CFA support), and convergent validity (e.g., correlations with functional impairment and drug/alcohol coping). The MSAS also measures anxiety equivalently across gender, political orientation, and gun violence exposure groups. The MSAS not only discriminates well between persons with and without dysfunctional anxiety, using a cut score of ≥10 (92% sensitivity and 89% specificity), but also demonstrates incremental validity by explaining 5% to 16% additional variance in important outcomes beyond sociodemographics and posttraumatic stress. These preliminary results support the MSAS as a valid screening tool for clinical practice and scholarly inquiry. [ABSTRACT FROM AUTHOR]

As an extension to a previous study, a linear calibration curve covering doses from 0 to 10 Gy was constructed and evaluated in the present study using calyculin A-induced premature chromosome condensation (PCC) by scoring excess PCC objects. The main aim of this study was to assess the applicability of this PCC assay for doses below 2 Gy that are critical for triage categorization. Two separate blind tests involving a total of 6 doses were carried out; 4 out of 6 dose estimates were within the 95% confidence limits (95% CL) with the other 2 just outside. In addition, blood samples from five cancer patients undergoing external beam radiotherapy (RT) were also analyzed, and the results showed whole-body dose estimates statistically comparable to the dicentric chromosome assay (DCA) results. This is the first time that calyculin A-induced PCC was used to analyze clinical samples by scoring excess objects. Although dose estimates for the pre-RT patient samples were found to be significantly higher than the mean value for the healthy donors and were also significantly higher than those obtained using DCA, all these pre-treatment patients fell into the same category as those who may have received a low dose (<1 Gy) and do not require immediate medical care during emergency triage. Additionally, for radiological accidents with unknown exposure scenario, PCC objects and rings can be scored in parallel for the assessment of both low- and high-dose exposures. In conclusion, scoring excess objects using calyculin A-induced PCC is confirmed to be another potential biodosimetry tool in radiological emergency particularly in mass casualty scenarios, even though the data need to be interpreted with caution when cancer patients are among the casualties. [ABSTRACT FROM AUTHOR]

Dealing with a mass casualty incident presents many challenges in the clinical and preclinical situation. There are various systems and structures to address this problem. In the present work, the management of the train accident near Garmisch-Partenkirchen on 3 June 2022 is evaluated with the aid of the recommendations of the Federal Office for Civil Protection and Disaster Relief for hospital alarm and deployment planning as well as the recommendations from the terror and disaster surgical care training of the German Academy of Trauma Surgery and the findings are presented from the perspective of a regional trauma center. It also discusses which key factors in the present case have proved to be successful and in which areas there is still a need for improvement. [ABSTRACT FROM AUTHOR]

Introduction During exercises or operations, there may be times when U.S. medical capabilities are not available and the next best or only option may be to use partner nation (PN) or host nation capabilities. Joint Publication 4-02 Joint Health Services states that "medical planners should always consider the quality, suitability, and availability of multinational and host-nation support." It is normal practice for medical planners to survey PN medical capabilities as part of the pre-deployment planning process. Currently, medical capability surveys are not conducted in a consistent and systematic manner across the DoD global health engagement enterprise. The lack of a systematic approach undermines medical operations planners' ability to conduct efficient and adequate pre-deployment surveys. Materials and Methods The article presents the results of a descriptive analysis of 62 unclassified medical capability surveys of PN or host nation facilities from the U.S. Africa Command (USAFRICOM) area of responsibility that were conducted by U.S. DoD personnel. The team characterized the content and formats of surveys with respect to what medical capabilities were described, how the capabilities were described, and how the information was presented. These analyses focused on determining if a surveyor obtained information about a capability, not whether or not the facility had a capability. Results Approximately 75-80% of surveys included information describing the presence or absence of five key capabilities: Emergency department/trauma care, surgical services, intensive care unit, laboratory, and imaging. Conversely, 30-50% of surveys did not include any information describing the presence or absence of five other key capabilities: Pharmacy, blood bank, mass casualty plans, land evacuation, or air evacuation. Information on key capabilities and administrative information was not consistently reported across the sample of surveys. There was substantial variation in how capabilities were characterized, including number of staff, staff training, and available equipment. Additionally, the order in which information was presented in surveys varied within and across components. Conclusions There are significant inconsistencies in the types of capabilities and services documented and how the quality of the capabilities and services is characterized. These inconsistencies can be attributed, in part, to the absence of information that explicitly confirmed whether or not the facility had a capability. Such variation results in obscured or incomplete depictions of facility capabilities, thereby undermining the ability of medical planners to coordinate effective medical readiness for engagements, exercises, or real-life operations. Guidance and survey templates could support better-informed decision-making by including information about survey methods and documenting the lack of confirmatory information. The DoD enterprise should consider how guidance and a standard survey template could improve the relevance, accuracy, and efficiency of data collection and reporting. [ABSTRACT FROM AUTHOR]

Introduction The leadership of Vista Forge 2022 requested evaluation of the handoff process between military assets and civilian emergency medical services (EMS) providers by the Beth Israel Deaconess Fellowship in Disaster Medicine (BIDMF). Vista Forge was a multi-agency military–civilian full-scale disaster exercise coordinated by the U.S. Military. The exercise, held in Atlanta, Georgia, simulated response to a nuclear bomb in an urban setting by military and civilian disaster teams. Materials and Methods BIDMF had several two-person teams who monitored handoff procedures between military assets after decontamination and civilian emergency medical services providers during the exercise evaluation. Results A verbal handoff between military and civilian entities was usually not done. Triage tags placed on mannequins before decontamination remained attached to the bodies and were sent with them to civilian hospitals. Triage tags were generic military forms without specific radiation or chemical exposure information. Not all decontamination groups had the same medical capabilities, and in a disaster it is unclear how these teams would manage medical emergencies. Conclusions Future studies should develop a standardized handoff procedure to be used in mass casualty situations, and trial it in future multi-agency disaster exercises. Radiation specific triage tags should be considered. [ABSTRACT FROM AUTHOR]

The conflict in Gaza and Israel that ignited on October 7, 2023 signals a catastrophic breakdown in the possibility of ethical dialogue in the region. The actions on both sides have revealed a dissolution of ethical restraints, with unimaginably cruel attacks on civilians, murder of children, destruction of health facilities, and denial of basic needs such as water, food, and shelter. There is a need both to understand the nature of the ethical singularity represented by this conflict and what, if any, options are available to allow the reconstruction of communication between the warring parties. This article seeks to address these tasks by analysing the conflict as inherently an ethical one, in the sense that it exposes a rupture in the fabric of communicative relationships that has evolved systematically out of the deep cultural structures from which all protagonists have emerged. Drawing on the work of Levinas, Habermas, Arendt, and others, and referring to the specific circumstances in the region, it examines the ethical sources of the crisis and tries to identify conditions for its resolution. The possibility of reconciliation—that is, of refiguring relationships to open up a space for dialogue to create pathways to heal the ruptures—is examined. The dark legacy of the Holocaust is identified as an abiding cultural vulnerability for both societies. It is concluded, however, that the rich history of partnerships and collaborations between Jews and Palestinians provides a robust infrastructure on the basis of which a sustainable peace might be built, providing a much-needed source of hope. [ABSTRACT FROM AUTHOR]

Policy PointsPromoting healthy public policies is a national priority, but state policy adoption is driven by a complex set of internal and external factors.This study employs new social network methods to identify underlying connections among states and to predict the likelihood of new firearm‐related policy adoption given changes to this interstate network.This approach could be used to assess the likelihood that a given state will adopt a specific new firearm‐related law and to identify points of influence that could either inhibit or promote wider diffusion of specific laws. Context: US states are largely responsible for the regulation of firearms within their borders. Each state has developed a different legal environment with regard to firearms based on different values and beliefs of citizens, legislators, governors, and other stakeholders. Predicting the types of firearm laws that states may adopt is therefore challenging. Methods: We propose a parsimonious model for this complex process and provide credible predictions of state firearm laws by estimating the likelihood they will be passed in the future. We employ a temporal exponential‐family random graph model to capture the bipartite state law–state network data over time, allowing for complex interdependencies and their temporal evolution. Using data on all state firearm laws over the period 1979–2020, we estimate these models' parameters while controlling for factors associated with firearm law adoption, including internal and external state characteristics. Predictions of future firearm law passage are then calculated based on a number of scenarios to assess the effects of a given type of firearm law being passed in the future by a given state. Findings: Results show that a set of internal state factors are important predictors of firearm law adoption, but the actions of neighboring states may be just as important. Analysis of scenarios provide insights into the mechanics of how adoption of laws by specific states (or groups of states) may perturb the rest of the network structure and alter the likelihood that new laws would become more (or less) likely to continue to diffuse to other states. Conclusions: The methods used here outperform standard approaches for policy diffusion studies and afford predictions that are superior to those of an ensemble of machine learning tools. The proposed framework could have applications for the study of policy diffusion in other domains. [ABSTRACT FROM AUTHOR]

In a mass fatality incident (MFI), effective preservation of tissue samples is the cornerstone for downstream DNA-based identification of victims. This is commonly achieved through freezing of tissue samples excised from bodies/fragmented remains which may be buried or stored in refrigerated containers. This may, however, not be possible depending on the nature of the MFI; in particular, during armed conflict/war where extended periods of electrical outages would be expected. The present study compared the effectiveness of long-term tissue preservation at ambient temperatures using two commercial products (non-iodized kitchen salt and a 40% alcoholic beverage) against a chemical preservative (Allprotect™ Tissue Reagent (Qiagen, Germantown, MD, USA)) and freezing at −20 °C. Bovine muscle tissue, used as a proxy for human tissue, was treated with the four preservation methods and sampled at six different time-points over a 24-month period. All four methods were able to preserve the bovine tissue, generally yielding STR-PCR (Short Tandem Repeat-Polymerase Chain Reaction) amplicons > 200 bp in size even at the end of 24 months. Gel electrophoresis, however, indicated that salt was more effective in preserving DNA integrity with high-molecular-weight DNA clearly visible as compared to the low-molecular-weight DNA smears observed in the other methods. This study also proposes a simple process for the rapid and low-cost preservation of tissue samples for long-term storage at ambient temperatures in support of post-incident victim identification efforts. [ABSTRACT FROM AUTHOR]

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This study analyses the relationship between vessel groups (small, medium and large) and casualty or loss type of UK fishing vehicles based on a summary of information concerning casualties and losses that occurred on fishing vessels in the UK from 2013 to 2020. The study establishes loss of control as the main cause of casualty occurrences for all fishing vessels. Further, flooding/foundering is the main contributor to the loss of fishing vessels smaller than 24 m in length, and grounding/stranding is the main contributor to the loss of fishing vessels 24 m or longer. Fishing vessels below 15 m in length comprise the majority of casualties and losses, while medium-size vessels (15 m or longer, but less than 24 m) make the highest average contribution per vessel to casualties. [ABSTRACT FROM AUTHOR]

Mass shootings are a public health crisis and have become more frequent on U.S. university campuses over the past decade, with the number doubling since 2000. Due to this alarming trend, many institutions have developed response strategies for active shooting events. Yet, the extent to which these response strategies address the needs and minimize harm for students, faculty, and staff has not been evaluated critically after a campus mass shooting. Michigan State University (MSU) experienced a mass shooting on February 13, 2023. Before, during, and 6 months following this tragedy, the university employed an estimated 18 strategies to inform, support, and protect its students, faculty, and staff. While MSU continues to address concerns and roll out programs related to this event, here we aimed to (1) create a timeline of resources and communication provided by MSU from the event to 6 months post-event; (2) critically evaluate the extent to which these resources met the needs of students, faculty, and staff through a survey among persons involved in public health research; and (3) identify potential areas for improvement in the university's responses. We used an online survey where participants (n = 10) rated the university responses and provided additional comments. From our survey, we recommend that, in the event of a campus shooting, other universities are attentive to re-engaging with the community within which the university is situated, holding communal events on campus, offering pauses in classes, and enhancing mental health services. These responses were seen as crucial to re-establish campus life and learning. [ABSTRACT FROM AUTHOR]

The article examines the challenges faced by emergency medical services (EMS) during mass casualty incidents (MCI). Topics include the difficulties in clinical management due to overwhelmed resources and unstable situations, highlighting the importance of effective triage systems. Additionally, it discusses the identification of critically injured patients, particularly those with uncontrolled bleeding, where early recognition and rapid transport to surgical facilities are key.

The article offers information on healthcare simulation in disaster medicine, focusing on its benefits for emergency response teams, particularly in teaching non-clinical skills and disaster coordination. Topics include the use of simulation to improve learning in disaster medicine, the challenges of communication and mass casualty incident (MCI) triage, and different simulation modalities for disaster response training.

The article offers information on disaster management, focusing on the increasing frequency of disasters and the need for improved disaster response expertise. Topics include the evolving landscape of complex humanitarian emergencies, the role of Australasian ED teams in disaster preparedness and response, and the challenges faced by ED clinicians in transitioning from normal operations to disaster leadership.

A deep neural network-based artificial intelligence (AI) model was assessed for its utility in predicting vital signs of hemorrhage patients and optimizing the management of fluid resuscitation in mass casualties. With the use of a cardio-respiratory computational model to generate synthetic data of hemorrhage casualties, an application was created where a limited data stream (the initial 10 min of vital-sign monitoring) could be used to predict the outcomes of different fluid resuscitation allocations 60 min into the future. The predicted outcomes were then used to select the optimal resuscitation allocation for various simulated mass-casualty scenarios. This allowed the assessment of the potential benefits of using an allocation method based on personalized predictions of future vital signs versus a static population-based method that only uses currently available vital-sign information. The theoretical benefits of this approach included up to 46% additional casualties restored to healthy vital signs and a 119% increase in fluid-utilization efficiency. Although the study is not immune from limitations associated with synthetic data under specific assumptions, the work demonstrated the potential for incorporating neural network-based AI technologies in hemorrhage detection and treatment. The simulated injury and treatment scenarios used delineated possible benefits and opportunities available for using AI in pre-hospital trauma care. The greatest benefit of this technology lies in its ability to provide personalized interventions that optimize clinical outcomes under resource-limited conditions, such as in civilian or military mass-casualty events, involving moderate and severe hemorrhage. [ABSTRACT FROM AUTHOR]

Purpose: Assessing the diagnostic performance and supplementary value of whole-body computed tomography scout view (SV) images in the detection of thoracolumbar spine injuries in early resuscitation phase and identifying frequent image quality confounders. Methods: In this retrospective database analysis at a tertiary emergency center, three blinded senior experts independently assessed SV to detect thoracolumbar spine injuries. The findings were categorized according to the AO Spine classification system. Confounders impacting SV image quality were identified. The suspected injury level and severity, along with the confidence level, were indicated. Diagnostic performance was estimated using the caret package in R programming language. Results: We assessed images of 199 patients, encompassing 1592 vertebrae (T10–L5), and identified 56 spinal injuries (3.5%). Among the 199 cases, 39 (19.6%) exhibited at least one injury in the thoracolumbar spine, with 12 (6.0%) of them displaying multiple spinal injuries. The pooled sensitivity, specificity, and accuracy were 47%, 99%, and 97%, respectively. All experts correctly identified the most severe injury of AO type C. The most common image confounders were medical equipment (44.6%), hand position (37.6%), and bowel gas (37.5%). Conclusion: SV examination holds potential as a valuable supplementary tool for thoracolumbar spinal injury detection when CT reconstructions are not yet available. Our data show high specificity and accuracy but moderate sensitivity. While not sufficient for standalone screening, reviewing SV images expedites spinal screening in mass casualty incidents. Addressing modifiable factors like medical equipment or hand positioning can enhance SV image quality and assessment. [ABSTRACT FROM AUTHOR]

Objective To understand the characteristics and hospital management procedures of mass casualty incidents in Jinshan District and to provide clinical suggestions for standardizing the management of mass casualty incidents. Methods A retrospective analysis of mass casualty incidents handled by the Affiliated Jinshan Hospital of Fudan University from January 1, 2010 to December 31, 2021 was conducted, and the characteristics and hospital treatment procedures of mass casualty incidents were analyzed. Results The hospital handled 197 mass casualty incidents in 12 years, with a total of 1 430 injured persons. The primary cause of injury was traffic accidents, accounting for 100 cases (50.9%), followed by chemical injuries, accounting for 25 cases (12.7% ). The most common age distribution of the injured population was between 21 and 50 years old, with 995 people (69.5%); 964 (67.4%) were male and 466 (32.6%) were female; 23 (1.6%) were dead on arrival; 73 (5.1%) were admitted to the ICU, and 106 (7.4%) were hospitalized. The frequency of mass casualty incidents was similar in March to May (spring) with 60 cases (30.5%), June to August (summer) with 52 cases (26.4%), and September to November (autumn) with 54 cases (27.4%), while the frequency decreased in December to next February (winter) with 31 cases (15.7%). The highest frequency of occurrence was from 8:00 to 16:00, with 186 cases (94.4%), followed by 16:00 to 24:00, with 11 cases (5.6%), and no mass casualty incidents occurred from 0:00 to 8:00. After the new treatment procedure was implemented in 2016, the forewarning rate increased significantly (P < 0.05), the forewarning content increased (P < 0.01), and the allocation time of treatment materials was significantly shortened (P < 0.01); the accuracy rate of secondary injury assessment increased (P < 0.01), and the retention time was significantly reduced (P < 0.01). Conclusions In Jinshan District of Shanghai, the primary cause of mass casualty incidents was traffic accidents, followed by chemical injuries. The age group with the most mass casualties was between 20 and 50 years old, with males significantly outnumbering females. The key points of mass casualty incident treatment include forewarning, timely initiation of treatment procedures, zone and hierarchical treatment, secondary damage control, timely diversion, experienced commanders, summary, and drills. [ABSTRACT FROM AUTHOR]

This study analyses the dynamics of banditry in northwest Nigeria through qualitative and quantitative research methodology. To populate their cells, bandits apply economic incentives and coercion. They also leverage existing social relationship with members of the communities. Banditry manifests through the deployment of large-scale violence, but it is strongly undergirded by a criminal economy. The organizational structures of bandits have developed over time by accident and by design depending on the evolution of each cell and the contexts in which they operate. The paper concludes that efforts to eliminate, neutralise and disrupt (END) banditry in northwest Nigeria must embrace three strategies – the peacebuilding approach, security sector reform, and development. [ABSTRACT FROM AUTHOR]

Background: Following the Beirut explosion, our university hospital received at least 350 casualties. Subsequently, infection control standard practices were compromised. Concerns for Multi-Drug Resistant Organisms (MDROs) infections in injured patients and a resulting hospital outbreak were raised. The objectives of the study were to compare the rate of hospital growing MDROs 6 months before and 6 months after the Beirut explosion, to identify emerging microorganisms and to evaluate the change in surgical infection prevention practices. Methods: This is a retrospective chart review of patients with hospital acquired infections (HAI) admitted to the hospital before and after the Beirut explosion. The study was conducted between February 4, 2020 and January 4, 2021. Excluded patients were those transferred from other hospitals and those with community acquired infections. The primary outcome was to identify the rate of growing MDROs post explosion. The secondary outcomes were identifying antibiotics used for surgical prophylaxis in patients requiring surgeries and patients diagnosed with a HAI. Therefore, patients were divided in three groups. Control group included patients admitted with explosion-related injuries on that same day. Patients admitted and between February 4 and August 4 and diagnosed with HAI were compared to those admitted post August 4 with explosion-related HAI and to patients diagnosed with non-explosion-related HAI between August 4 and January 4, 2021. An estimated rate of 18-22% MDRO was needed to achieve a statistical significance with 80% power and 0.05 α. Pearson Chi square test was used to analyze the primary outcome. Results: A total of 82 patients with 150 cultures were included in this study. Data showed an increase in the rate of MDRO after the explosion with 37.1% of the cultures taken before the explosion and 53.1% after the explosion (p = 0.05). When comparing the types of HAI in both groups, culture sites were significantly different between pre- and post-explosion patients (p = 0.013). However, both groups had similar types of microbes (p = 0.996) with an increase in candida related infections. Conclusion: These findings confirmed that the Beirut explosion impact on antimicrobial resistance was similar to combat zone incidence, where an increase in MDROs rate such as Escherichia coli (E.Coli) and Stenotrophomonas maltophilia, in addition to the increase in candida related infections. [ABSTRACT FROM AUTHOR]