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Introduction: Chemical mass casualty incidents (MCIs) pose a substantial threat to public health and safety, with the capacity to overwhelm healthcare infrastructure and create societal disorder. Computer simulation systems are becoming an established mechanism to validate these plans due to their versatility, cost-effectiveness and lower susceptibility to ethical problems. Methods: We created a computer simulation model of an urban subway sarin attack analogous to the 1995 Tokyo sarin incident. We created and combined evacuation, dispersion and victim models with the SIMEDIS computer simulator. We analyzed the effect of several possible approaches such as evacuation policy ('Scoop and Run' vs. 'Stay and Play'), three strategies (on-site decontamination and stabilization, off-site decontamination and stabilization, and on-site stabilization with off-site decontamination), preliminary triage, victim distribution methods, transport supervision skill level, and the effect of search and rescue capacity. Results: Only evacuation policy, strategy and preliminary triage show significant effects on mortality. The total average mortality ranges from 14.7 deaths in the combination of off-site decontamination and Scoop and Run policy with pretriage, to 24 in the combination of onsite decontamination with the Stay and Play and no pretriage. Conclusion: Our findings suggest that in a simulated urban chemical MCI, a Stay and Play approach with on-site decontamination will lead to worse outcomes than a Scoop and Run approach with hospital-based decontamination. Quick transport of victims in combination with on-site antidote administration has the potential to save the most lives, due to faster hospital arrival for definitive care. [ABSTRACT FROM AUTHOR]

Postmortem fingerprinting is the fastest and most reliable way to scientifically identify unknown decedents from mass fatality incidents. In disaster victim identification (DVI), fingerprints, DNA, and dental examinations are the three primary methods of identification. Additional secondary identifiers such as comparative medical radiography, scars, marks, and tattoos can also be used if viable antemortem information can be located. As DNA technology continues to evolve, RAPID DNA may now identify a profile within 90 min if the remains are not degraded or comingled. When there are true unknowns, however, there is usually no DNA, dental, or medical records to retrieve for a comparison without a tentative identity. It is imperative to understand how to properly collect postmortem prints following various postmortem changes, which databases are available to search against, and what additional resources are available prior to any such event occurring. With advances in technology, automated fingerprint searching is faster than ever before. Mobile devices can now search all the major databases within a matter of minutes from a cell phone or tablet utilizing a peripheral fingerprint scanner. Preliminary research into the application of WD‐40® when utilizing optical‐capacitive scanners has shown to greatly increase the efficacy of capturing usable fingerprints. This additional step allows for the digital capture of fingerprints in even complicated settings, both in daily cases and DVI incidents. This article outlines all the available ways to obtain postmortem fingerprints in complex cases, and how they can be applied to efficiently and effectively used in the DVI process. [ABSTRACT FROM AUTHOR]

This paper reviews MFI's from a historical perspective commencing with DVI in the late 20th century. For this paper, this era, 1970–90s is designated as the early modern period. As DVI by DNA analysis is introduced into the process, in the beginning of the mid‐1990s, or late modern period, a shift in ID modality usage is noted. A statistical analysis of the primary identification (ID) methods established that dental identification was the majority identifier, or gold standard, in the early modern era. Although primarily viewed from a United States (US) perspective, referenced international incidents parallel the incidents investigated by US authorities. The introduction of DNA demarcated the early from the late modern era. Through research, development, and application this highly discriminating ID method would effectively, surpass dental ID as the gold standard into the late modern era. DNA ID would eventually overcome early criticism regarding cost and time consumption. In the MFI's discussed, the discriminating accuracy of DNA, when referenced against the dental identifications, validated the reliability of dental ID. Errors will be significantly minimized through confirmatory reconciliation by more than one ID method. In conclusion despite increased usage of DNA, dental ID has not been eliminated and remains a major contributor to DVI. Dental ID continues to develop through increased application of advanced imaging technology. Despite DNA's rapid advancement and application to DVI, the multidisciplinary approach to scientific identification should remain in the near future. Therefore, comparative dental ID will remain an important and reliable contributor to DVI. [ABSTRACT FROM AUTHOR]

Forensic archaeology and anthropology have developed significantly over past decades and now provide considerable assistance to the investigation process of disaster victim recovery and identification. In what are often chaotic death and crime scenes, the formal process of utilizing archaeological methods can bring control, order, and ensure systematic search. Procedures assist in defining scene extent, locating victims and evidence, rule out areas for consideration, and provide standardized recording and quality assurance through dedicated use of standardized forms (pro formas). Combined archaeological and anthropological search methods maximize opportunities to recovery the missing through identifying remains, mapping distributions, and providing accounting of victims at the scene. Anthropological assistance in examinations contributes to individual assessment, resolving commingling and fragmentation issues, and utilizing DNA sampling methods and matching data to reassociate and account for the missing. Utilization of archaeology, anthropology, and DNA matching data provides scope to review crime scene recovery and determine requirements and potential for further survey and retrieval. Adopting the most suitable methods for a particular context can maximize recovery, efficiency, and resource use. Case studies demonstrate the utility of archaeological methods in a range of scenarios. They exemplify the success of multidisciplinary analysis in providing evidence of the sequence of events, the timing of events, the impact of taphonomic processes, the location and accounting of victims, and the demonstration of systematic scene search. The considerations provided in this article, utilizing archaeology and anthropology processes, may assist investigators in planning and implementing responses to mass fatalities. [ABSTRACT FROM AUTHOR]

Military trauma provides a unique pattern of injuries due to the high velocity, high kinetic energy ammunition utilized, and the high prevalence of blast injury. To further complicate this, military trauma often occurs in austere environments with limited logistical support. Therefore, military medical providers are forced to learn nonstandard techniques and when necessary, practice a level of improvisation not commonly seen in other medical fields. The case presented in this manuscript is a prime example of these challenges. At the onset of fighting both the medic's rucksack, carrying with it the primary source of medical gear and the precious supply of cold-stored blood products are lost. The scenario was further complicated by rough mountainous terrain and a prolonged evacuation time. The medical provider was forced to utilize nonstandard devices such as an improvised junctional tourniquet which used a rock to focus the devices pressure. They also adapted their basic understanding of surgical procedures to conduct a vascular cutdown procedure for wound exposure and effectively pack an otherwise non-compressible wound to a major artery. Despite a significant loss of equipment, the medic and their team were able to successfully care for a number of patients in this mass casualty scenario. [ABSTRACT FROM AUTHOR]

Doctors and nurses suffer different mental health conditions following traumatic incidents. We systematically synthesized existing evidence on the prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) and their associated risk factors among doctors and nurses following mass casualty incidents (MCIs). Systematic review. Seven databases were searched (2010–2022) with peer-reviewed articles in English using the predefined keywords. Two reviewers screened the titles, abstracts, and full texts using the eligibility criteria and extracted data independently. We used the National Institutes of Health Quality Assessment Tools (NIH-QAT) and the Critical Appraisal Skills Programme checklist (CASP) to measure the quality appraisal of the included studies. A total of 5170 articles were retrieved, and 2512 articles were assessed by title and abstract (53 were eligible for full-text review). Finally, we included 19 studies. Most were assessed as of fair quality with a considerable risk of bias. PTSD was the highest-reported mental health condition. Nurses reported higher mental conditions, particularly PTSD. Two sets of risk factors (personal and workplace) are associated with anxiety, depression, and PTSD were found. MCIs have a significant impact on the mental health outcomes of emergency health workers. Preventive measures should be designed considering the high-risk group, personal, and organizational risk factors of mental health outcomes. [ABSTRACT FROM AUTHOR]

In today's world, terrorist attacks pose a constant threat, whether through bombings like those in Sarafovo 2012, Ankara 2015, Madrid 2005, mass shootings as seen in Moscow 2024 and the USA, or vehiclerelated incidents like Barcelona and Cambrils 2016. Terrorists aim to inflict maximum harm, making prompt and effective response from medical teams crucial in stabilizing and reducing disability among casualties. Beyond medical expertise, strong organization and cohesion among emergency teams are imperative to prevent chaos when handling multiple casualties. This article delves into the preparedness and awareness of medical professionals in the Burgas region for managing mass disasters, accidents, and terrorist acts. A survey of 157 doctors and nurses across three medical institutions revealed that 70.70% work in surgical departments and 29.29% in therapeutic departments. Alarmingly, 66.24% of respondents lacked awareness of specific action plans for their professional duties and their roles in a mass casualty situation, leading to potential organizational crises and delays in life-saving interventions. However, there's a positive outlook as 78.98% of medics expressed willingness to take initiative and 85.98% were ready to provide medical care regardless of their working hours. Analysis of these findings underscores the need for comprehensive action plans at all administrative levels, including ward managers, head nurses, doctors, nurses, and orderlies. Additional training and documentation of duties and competencies will ensure efficient organization during emergencies. [ABSTRACT FROM AUTHOR]

The term 'zero responder' was initially devised in 2010 to describe those passing by or unharmed in a mass casualty incident, who provide life-saving care for injured persons before qualified professionals arrive. This review aims to determine how the literature defines the role of the zero responder and to explore how they can be better integrated into the emergency response. Current definitions of the zero responder in a medical setting were found through a literature search of several databases and online libraries using defined search terms. Additionally, a manual search of citations in included articles was performed to yield more results. In total, 16 papers defining the zero responder were included. These definitions were evaluated, and a revised definition was suggested to clarify the role in a medical setting relating to mass casualty incidents. The role of the zero responder can be facilitated through authority recognition and adequate equipment provision. Familiarisation with the term and role of zero responders among ambulance services is essential for effective collaboration. Further research and clarity on the integration of these two groups is necessary to facilitate effective and safe working between them. [ABSTRACT FROM AUTHOR]

In a chemical mass casualty incident requiring skin decontamination, dry removal using absorbent materials may be beneficial to enable immediate decontamination. The efficacy of absorbent materials has therefore been evaluated, alone or procedures including both dry and wet decontamination, following skin exposure to two low volatile toxic chemicals using an in vitro human skin penetration model. Additionally, removal using active carbon wipes was evaluated with or without the Dahlgren Decon solution. All dry decontamination procedures resulted in a significantly decreased skin penetration rate of the industrial chemical 2‐butoxyethanol compared to the control without decontamination. Wet decontamination following dry absorption significantly improved the efficacy compared to dry removal alone. Dry decontamination post‐exposure to the chemical warfare nerve agent VX showed no decontamination efficacy. However, dry and wet decontamination resulted in a decreased agent skin penetration rate during the last hour of the experiment. At −15°C, significantly reduced VX skin penetration rates were demonstrated for both dry decontamination alone and the dry and wet decontamination procedure. The Dahlgren Decon solution significantly reduced the amount of VX penetrating the skin, but the active carbon wipe alone did not impact the skin penetration rate. In conclusion, absorbent materials are beneficial for the removal of low‐volatile chemicals from the skin, but the degree of efficacy varies between chemicals. Despite the variability, immediate dry decontamination using available absorbent materials prior to wet decontamination is recommended as a general procedure for skin decontamination. The procedure should also be prioritized in cold‐weather conditions to prevent patient hypothermia. Skin decontamination is important in a chemical mass casualty incident, including toxic, low‐volatile chemicals. In vitro human skin studies displayed the beneficial impact of dry decontamination prior to wet decontamination, however, the degree of efficacy varies post‐exposure to the industrial chemical 2‐butoxyethanol and the nerve agent VX. In cold air temperatures, dry removal was efficient post‐exposure to VX. Immediate dry removal using available absorbent materials prior to wet decontamination is therefore recommended as a general procedure for skin decontamination. [ABSTRACT FROM AUTHOR]

Hospitals, patients, and health-care workers are legally protected by international humanitarian law and the Geneva Convention. However, since Oct 7, 2023, the health-care system in the Gaza Strip, occupied Palestinian territory, has been under unprecedented direct military attacks by Israel, with support for patients proving to be challenging for the remaining health-care workers. Peer-to-peer telemedicine holds promise for assisting surgeons in high-risk, low-resource environments, but might be of reduced utility in extremely austere settings. We present a patient case series of traumatic injuries shared in an international telemedicine group by the surgical team at Nasser Medical Complex, also known as Nasser Hospital, the largest remaining partially functioning hospital in Gaza. WhatsApp (Meta; Menlo Park, CA, USA), a widely available and user-friendly end-to-end encrypted smartphone application, was used to facilitate consultations for weapon-inflicted injuries. All the presented patient cases were shared after obtaining verbal consent from the patients and discussed through a multidisciplinary team approach. The group was developed into a community with more than 15 specialty and injury-oriented subgroups and over 1000 members who joined through non-targeted social media outreach followed by snowball recruitment. Prospective registration and formal ethics approval in Gaza was impossible because the Ministry of Health, including the local Helsinki Committee, had suspended all operations. In June, 2024, we obtained ethics approval from the local Helsinki committee in Gaza. We present 12 select patient case studies from a pool of hundreds of patients admitted to Nasser Hospital between Jan 28 and Feb 12, 2024. Four (33%) of the 12 patients were female and eight (67%) were male, with four patients (33%) being children (younger than 18 years). The age range was between 3 years and 70 years, with a median age of 25 years. Most patients presented with penetrating injuries (11 [92%] of 12), with six patients presenting with wounds secondary to fragment injury, and five patients presenting with wounds due to gunshots. One patient presented with a direct blast injury. The site of reported injuries included head and neck areas (four [33%] of 12), abdomen (four [33%] of 12), chest (three [25%] of 12), pelvis (two [17%] of 12), and limbs (one [8%] of 12). Most patients were lost to follow-up (11 [92%] of 12) and were affected by the invasion of the hospital by the Israeli Defense Forces, which subsequently rendered the hospital non-functional. One patient died following their injury. The health-care team at the now non-functioning Nasser Hospital in southern Gaza adapted their allocation and distribution of extremely low resources and relied on smartphones for specialised telemedicine outreach purposes. This enhanced the capability of the medical teams in management of mass casualties of military assaults that few are trained to work in. Nonetheless, the options available to a health-care system that is under-staffed, under-served, and under siege, are extremely constrained, regardless of such telemedicine initiatives. None. [ABSTRACT FROM AUTHOR]

Rift Valley fever (RVF) is a neglected vector-borne disease which is endemic in many countries across Africa and has seen recent geographical expansions into the Arabian Peninsula. RVF can cause severe infections in both animals and humans. RVF infections in livestock can lead to mass fatalities. In humans, the symptoms are nonspecific and can often lead to misdiagnosis. However, a small proportion progresses to haemorrhagic infection with a significantly higher mortality rate. The culmination of this can cause severe socioeconomic impacts. This review aims to identify the main socioeconomic impacts caused by RVF outbreaks as well as existing knowledge gaps. Ninety-three academic and grey papers were selected, covering 19 countries and 10 methodological approaches. A variety of socioeconomic impacts were found across all levels of society: Livestock trade disruptions consequently impacted local food security, local and national economies. Most livestock farmers in endemic countries are subsistence farmers and so rely on their livestock for sustenance and income. RVF outbreaks resulted in a variety of socioeconomic impacts, e.g., the inability to pay for school fees. Main barriers to vaccine uptake in communities were lack of access, funds, interest along with other social aspects. The occupational risks for women (and pregnant women) are largely unknown. To our knowledge, this is the first review on RVF to highlight the clear knowledge gap surrounding the potential gender differences on risks of RVF exposure, as well as differences on occupational health risk in pastoral communities. Further work is required to fill the gaps identified in this review and inform control policies. Author summary: Rift Valley fever (RVF) outbreaks have affected many regions globally with varying severity. The number of reported cases in animals and humans is patchy at best, with some countries not recording animal events. This review focuses on 3 main themes: Health Burden; Economic Impacts; and Prevention and Surveillance. The review explores socioeconomic impacts across local, regional, and national levels. We found women have varying degrees of risk to exposure of RVF; however, more research is required to better understand gender differences. RVF outbreaks tend to begin in livestock and spillover into humans. The complex disease dynamics are poorly understood because of the interactions between animals, humans, and the environment. This cross-boundary dynamics fall outside of the public health remit and into veterinary health. This allows for outbreaks to spread uncontrollably for some time. More research using a One Health Lens is required which explores these complex dynamics with the combination of different social aspects. This review highlights the wider impacts experienced at different levels of society and where there are major gaps in our knowledge. Further analysis into these gaps is required to and will aid policy makers in developing new control measures around RVF. [ABSTRACT FROM AUTHOR]

Introduction: Mass casualty incidents (MCI) are unforeseeable and complex events that occur worldwide, therefore enhancing the training that medical first responders (MFRs) receive is fundamental to strengthening disaster preparedness and response. In recent years, extended reality (XR) technology has been introduced as a new approach and promising teaching technique for disaster medicine education. Objective: To assess the effectiveness of XR simulation as a tool to train MFRs in MCIs, and to explore the perception and experience of participants to these new forms of training. Design: Systematic review. Methods: This systematic review was conducted in accordance with the "Preferred reporting items for systematic reviews and meta-analyses" (PRISMA) statement. Four databases were searched (MEDLINE, EMBASE, CINAHL and LILACs) using a comprehensive search strategy to identify relevant articles, and MetaQAT was used as a study quality assessment tool. Data from included studies was not pooled for meta-analysis due to heterogeneity. Extracted data was synthesised in a narrative, semi-quantitative manner. Results: A total of 18 studies were included from 8 different countries. Studies encompassed a variety of participants (e.g., nurses, paramedics, physicians), interventions (virtual, mixed and augmented reality), comparators (comparison between two groups and single groups with pre-post evaluation), and outcomes (effectiveness and MFR perception). The synthesis of data indicated that XR was an effective tool for prehospital MCI training by means of improved triage accuracy, triage time, treatment accuracy, performance correctness and/or knowledge acquired. These XR systems were well perceived by MFRs, who expressed their interest and satisfaction towards this learning experience and emphasized its usefulness and relevance. Conclusion: This research supports the usefulness and significance of XR technology that allows users to enhance their skills and confidence when facing forthcoming disasters. The findings summarize recommendations and suggestions for the implementation, upgrade and/or assessment of this novel and valuable teaching method. [ABSTRACT FROM AUTHOR]

In recent years, the landscape of disasters, conflicts and terror events has become more frequent and complex. Climate change, armed conflicts, terrorism, disinformation, cyber‐attacks, inequality and pandemics now present significant challenges to humanity. Emergency physicians today are likely to encounter ideologically motivated violent extremism or terrorist actions by radicalised lone actors. Terror medicine, distinct from disaster medicine, addresses the unique and severe injuries caused by terrorist incidents, including explosions, gunshots and chemical agents. The chaotic aftermath of such attacks demands rapid triage, prioritisation and strict adherence to scene safety protocols. Moreover, terrorist events have profound psychological impacts on victims and responders alike. Understanding the broader public health implications of these attacks is crucial for emergency physicians to enhance community safety and resilience. Terror medicine also brings unique ethical and legal challenges, such as patient confidentiality, mandatory reporting and mass casualty management. Effective responses to terror incidents necessitate close collaboration between healthcare providers and law enforcement. Familiarity with terror medicine principles fosters better communication and coordination, ultimately improving response efficiency and patient outcomes. This review offers a comprehensive approach to understanding terror medicine, defining the concept of ‘terror’, its significance for emergency physicians, and the known health impacts on patients, healthcare workers and responders. By delving into these aspects, the review aims to equip medical professionals with the knowledge and skills needed to navigate the complexities of terror‐related emergencies effectively. [ABSTRACT FROM AUTHOR]

Vicarious trauma (VT) is an occupational challenge incurred through hearing about traumatic experiences of others such as child maltreatment, mass casualties, and others while serving in helping professions. Without sufficient resources and support, long‐term exposure can lead to symptoms such as intrusion, avoidance, arousal, emotional numbing, anxiety, and decline in one's ability to work. Organisations can mitigate VT's impact by addressing the needs of staff through 5 evidence‐informed areas of occupational health. This project explored the impact of VT‐informed practices on organisational responses to the COVID‐19 pandemic. We compared responses from 50 organisations on strengths and weaknesses in core areas of being VT‐informed to how those organisations responded to the COVID‐19 pandemic. Subscales of the VT Organizational Readiness Guide (VT‐ORG) were utilized as the exposure variables and 4 new COVID‐19 questions served as the outcome. We ran a series of multilevel linear regression models with clustering controlled for at the organisational level. Staff ratings on 4 of the 5 pillars of the VT‐ORG were positively associated with the organisation's responsiveness to the pandemic. Various demographic factors of the employees were negatively associated with organisations’ responsiveness to the pandemic. While this study contributes to the growing research on VT, it also provides justification for helping organisations to become VT‐informed; it provides evidence that being prepared for VT can also be useful to support workers and their communities during emergencies such as the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Disaster nursing plays a vital role in addressing the health needs of vulnerable populations affected by large scale emergencies. However, disaster nursing faces numerous challenges, including preparedness, logistics, education, ethics, recovery and legalities. To enhance healthcare system effectiveness during crises, it is essential to overcome these issues. This umbrella review, conducted using the Joanna Briggs Institute (JBI) methodology, synthesizes data from 24 studies to identify key strategies for improving disaster nursing. The review highlights nine key themes: Education and Training, Research and Development, Policy and Organizational Support, Technological Advancements, Psychological Preparedness and Support, Assessment and Evaluation, Role-Specific Preparedness, Interprofessional Collaboration and Cultural Competence, and Ethics and Decision-Making. The review emphasizes the importance of education, technological advancements, psychological support, and interprofessional collaboration in bolstering disaster nursing preparedness and response efforts. These elements are crucial for enhancing patient outcomes during emergencies and contributing to a more resilient healthcare system. This comprehensive analysis provides valuable insights into the various aspects essential for enhancing disaster nursing. By implementing evidence-based strategies within these nine themes, the nursing profession can enhance its capacity to effectively manage and respond to the complex needs of disaster-affected populations, ultimately improving patient care and outcomes during emergencies. [ABSTRACT FROM AUTHOR]

Gun violence in the United States is a serious problem. Addressing the problem will require not only strong leadership but also a unique approach. One such approach was utilized by U.S. President Abraham Lincoln, who assembled a "Team of Rivals" with positions different than his own that provided helpful perspective in finding solutions to the problems of the time. This article applies the team of rivals approach to the problem of gun violence. [ABSTRACT FROM AUTHOR]

Yellow fever virus (YFV) infections can cause severe diseases in humans, resulting in mass casualties in Africa and the Americas each year. Secretory NS1 (sNS1) is thought to be used as a diagnostic marker of flavivirus infections, playing an essential role in the flavivirus life cycle, but little is known about the composition and structure of YFV sNS1. Here, we present that the recombinant YFV sNS1 exists in a heterogeneous mixture of oligomerizations, predominantly in the tetrameric form. The cryoEM structures show that the YFV tetramer of sNS1 is stacked by the hydrophobic interaction between β-roll domains and greasy fingers. According to the 3D variability analysis, the tetramer is in a semi-stable state that may contain multiple conformations with dynamic changes. We believe that our study provides critical insights into the oligomerization of NS1 and will aid the development of NS1-based diagnoses and therapies. [ABSTRACT FROM AUTHOR]

Background: The risk of terrorist attacks in the Federal Republic of Germany is present and is currently increasing. Publicly funded acute care hospitals and their owners are involved in disaster control as part of their remit and are responsible for taking comprehensive precautions to ensure their operational capability in the event of disasters. This mandate must also be ensured in the event of terrorist attacks and amok incidents. For this purpose, an optimal cooperation between preclinical and clinical care is indispensable. Aim: Recommended actions for collaboration between nonclinical and clinical planning to manage a mass casualty incident in terrorist life-threatening response situations are presented. Material and methods: The Inter-Hospital Security Conference Baden-Württemberg (IHSC BW) is an association of representatives of acute hospitals in Baden-Württemberg, the Ministry of the Interior, Digitalization and Migration Baden-Württemberg, the Ministry of Social Affairs and Integration Baden-Württemberg, the State Police Headquarters Baden-Württemberg and the Baden-Württemberg Hospital Association. From 2018 to 2020, the IHSC BW developed recommendations for action on cooperation between police, hospitals and non-police emergency response. The recommendations for action were agreed by the group members in 6 working sessions and initialled in two subsequent video conferences. A recommendation was considered adopted when the IHSC BW plenary assembly finally gave its approval with an absolute majority. Results and discussion: Competence-based interface solutions for a smooth cooperation between prehospital and hospital management in the care of patients who have become victims of a terrorist attack are to be demanded. For preliminary planning, the establishment of a local safety conference at the county disaster control authority level with the following participants is recommended: disaster control authority, fire department, regional police headquarters, chief emergency physician, rescue services and disaster control officers of affected clinics. It is recommended to set up a joint command and situation center (CSC), where management personnel from the police, rescue service, fire department and disaster control can meet to organize the handling of the incident jointly, competently and without loss of time. From this CSC, a liaison officer should then provide the clinics with information at regular intervals. Exercises should take place regularly. Cross-organizational exercises are particularly important, and this is one of the tasks of the local safety conference. [ABSTRACT FROM AUTHOR]

In the summer of 1904, the passenger ship General Slocum caught fire on New York City's East River, resulting in the deaths of approximately 1,021 people. This article examines the city's formal response to these deaths, specifically investigating the technologies deployed by city officials and employees to help overcome the natural limits of the corpse to increase the likelihood for identification. I argue that these technologies of preservation – corporeal, visual, and written – were motivated not only by the desire to assist the victim's families but also by a new culture of urban bureaucracy that tasked municipalities with containing urban chaos. As such, this event foreshadowed an emerging modern disaster victim identification paradigm as a state-managed, bureaucratic process that both aided and alienated victims' families. [ABSTRACT FROM AUTHOR]

Background: Emergency medical services preparedness in mass casualty incidents is one of the most important concerns in emergency systems. A mass casualty incident is a sudden event with several injured individuals that overwhelms the local health care system. This study aimed to identify and validate the components of emergency medical services readiness in mass casualty incidents which ultimately led to designing a conceptual model. Methods: This research was an explanatory mixed-method study conducted in five consecutive stages in Iran between November 2021 and September 2023. First, a systematic review was carried out to extract the components of emergency medical services preparedness in mass casualty incidents based on the PRISMA guideline. Second, a qualitative study was designed to explore the preparedness components through in-depth semi-structured interviews and analyzed using the content analysis approach. Third, the integration of the components extracted from the two stages of the systematic review and qualitative study was done by an expert panel. Fourth, the obtained components were validated using the Delphi technique. Two rounds were done in the Delphi phase. Finally, the conceptual model of emergency medical services preparedness in mass casualty incidents was designed by a panel of experts. Results: 10 articles were included in the systematic review stage and sixteen main components were extracted and classified into four categories. In the second stage, thirteen components were extracted from the qualitative study and classified into five categories. Then, the components of the previous two phases were integrated into the panel of experts and 23 components were identified. After validation with the Delphi technique, 22 components were extracted. Lastly, the final components were examined by the panel of experts, and the conceptual schematic of the model was drawn. Conclusions: It is necessary to have an integrated framework and model of emergency medical service readiness in the planning and management of mass casualty incidents. The components and the final model of this research were obtained after the systematic scientific steps, which can be used as a scheme to improve emergency medical service preparedness in response to mass casualty incidents. [ABSTRACT FROM AUTHOR]

On October 7, 2023, Hamas terrorists attacked people in their homes, fields, and at a music festival in Israeli communities near the border with Gaza. More than 1,145 men, women, and children were killed, about 1,800 wounded were evacuated to hospitals in the country, and 253 infants, children, women, elderly, and men were abducted. This mass casualty incident (MCI) was the start of a war that is still ongoing. The Israeli medical system, which faced an overwhelming first 24 h, continues to take care of casualties, including those who are injured by missiles that target Israeli residential areas. Israel has a well-established trauma system, and as a result of the experience gained in this war, the system merited review. This was the topic of a meeting of leaders of the Israeli healthcare system, and it forms the basis of this report. The meeting and report provide a platform for presenting the trauma system management during the war, highlighting the strengths of the system as well as its challenges and lessons learned. The participants also brainstormed and discussed possibilities for future improvements. [ABSTRACT FROM AUTHOR]

Mass violence incidents (MVIs) involving firearms, commonly referred to as "mass shootings" have become increasingly frequent in the United States. These shootings often result in immediate casualties and have far-reaching psychological impacts on survivors, witnesses, and the broader community. This study aimed to assess the prevalence and risk factors of depression within affected communities. Population-based cross-sectional study. Data were collected from six communities affected by MVIs involving firearms that occurred between 2015 and 2020. Participants were randomly selected through address-based sampling, and depression was assessed using Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) diagnostic-level major depressive episode (MDE). Overall, the MDE prevalence was 17·2% since the MVI, 15·4% in the past year, and 8·2% in the past month. Significant risk factors for MDE since MVIs include high exposure to the incident (adjusted relative risk [aRR] = 1·32, 95% confidence interval [CI]: 19–1·60), being aged 18–29 years (aRR = 2·52, 95% CI: 1·61–3·95), being a woman (aRR = 1·58, 95% CI: 1·27–1·96), having low social support (aRR = 1·80, 95% CI: 1·46–2·22), and experiencing past sexual or physical trauma (aRR = 2·20, 1·52–3·19). Our study reveals a high burden of depression within communities affected by MVIs involving firearm use. Persons with high exposure to the MVIs and certain demographic groups had greater risks for MDE. These findings highlight the long-term mental health burden in communities affected by MVIs and underscore the necessity of providing mental health services in its aftermath. [ABSTRACT FROM AUTHOR]

Aim: To identify the number of incidents, over a 1-year period in a single UK Ambulance Service Trust, where patients attended by Hazardous Area Response Team (HART) paramedics where eligible to receive Pre-hospital Blood Products (PHBP) but did not due to the unavailability of a suitably trained clinician. Methods: This was a Service Evaluation using a three-stage method of filtering data to reduce bias and improve accuracy when identifying eligible cases. These stages consisted of an initial data request, a peer review filtering stage and then finally an Expert Consensus Panel review of cases to determine whether PHBP should have been administered. Results: The consensus group considered 14 cases that would have 'Likely' or 'Certainly' have received PHBP if a suitably trained clinician was available on scene. Twelve cases involved a traumatic cause whilst the remaining two were medical. Similarly, 12 cases involved patients with spontaneous circulation whilst two patients had no pulse. South Western Ambulance Service Foundation Trust (SWASFT) Bristol HART attended eight and Exeter HART six of these cases. Conclusion: This study reveals that across the South West of England, there were a number of patients, being attended by HART, who may potentially benefit from PHBP but are not receiving this intervention due to the unavailability of a suitably trained clinician. This could be far more in the event of a multi or mass-casualty event. HART paramedic access to PHBPs would enable more patients to access a potentially lifesaving treatment and contribute to narrowing the care gap identified in the Manchester Arena Inquiry. The authors recommend that a local pilot trial is undertaken to explore whether a HART PHBP service is feasible, sustainable, cost-effective, appropriate, and safe. [ABSTRACT FROM AUTHOR]

In the developing economy of Bangladesh, local factory owners in the garment industry have felt great pressure to improve factory safety, but the costs for those improvements are not shared by the global apparel firms that wield immense influence over them. Consequently, we examine whether multi-stakeholder initiatives (MSIs), as vehicles of corporate social responsibility (CSR), offer platforms for democratic oversight or merely serve as new arenas to exercise corporate power. Given their role in connecting global and local contexts and their history of safety incidents, local factory owners possess a unique perspective on the impact and contested nature of CSR in global supply chains. This article presents a qualitative study of MSIs in the Bangladesh garment industry, particularly after the Rana Plaza collapse. Through interviews with local factory owners and executive managers, we explore the reasons behind their opposition to CSR as exercised by global apparel firms, and the contestation of those practices by their local business association. Our findings lead us to conclude that garment industry MSIs are unlikely to be effective without labor procurement practices that harmonize global and local interests to mitigate the competitive pressures on local factory owners. [ABSTRACT FROM AUTHOR]

Treatment Planning for Mass Casualty Incidents The existing emergency response guidelines emphasize prioritizing the treatment of victims with initially critical health conditions, but tend to overlook the potential deterioration of less critical victims. Such deterioration can result in prolonged treatment times and irreversible health damages. In "Treatment Planning of Victims with Heterogeneous Time Sensitivities in Mass Casualty Incidents," Shi, Liu, and Wan draw insights from a unique data set containing timestamps of surgeries conducted in a field hospital established in response to a large-scale earthquake. They develop scheduling models to enhance treatment planning for mass casualty incidents. They identify conditions under which victims with less critical initial conditions may have higher or lower priority than their counterparts in an optimal schedule, aiming to do the greatest good for the greatest number. Through a counterfactual analysis utilizing their data set, the authors demonstrate that implementing their model could significantly reduce surgical makespan, overdue cases, and victim deterioration compared with the previously employed treatment plan. The current emergency response guidelines suggest giving priority of treatment to those victims whose initial health conditions are more critical. Although this makes intuitive sense, it does not consider potential deterioration of less critical victims. Deterioration may lead to longer treatment time and irrecoverable health damage, but could be avoided if these victims were to receive care in time. Informed by a unique timestamps data set of surgeries carried out in a field hospital set up in response to a large-scale earthquake, we develop scheduling models to aid treatment planning for mass casualty incidents (MCIs). A distinguishing feature of our modeling framework is to simultaneously consider victim health deterioration and wait-dependent service times in making decisions. We identify conditions under which victims with a less critical initial condition have higher or lower priority than their counterparts in an optimal schedule—the priority order depends on victim deterioration trajectories and the resource (i.e., treatment time) availability. A counterfactual analysis based on our data shows that adopting our model would significantly reduce the surgical makespan and the total numbers of overdue and deteriorated victims compared with using the then-implemented treatment plan; dynamic adjustment of treatment plans (if a second batch of victims arrive) and care coordination among surgical teams could further improve operational efficiency and health outcomes. By demonstrating the value of adopting data-driven approaches in MCI response, our research holds strong potentials to improve emergency response and to inform its policy making. Funding: G. Wan's work was supported in part by the National Natural Science Foundation of China [Grant 71931008]. Supplemental Material: The e-companion is available at https://doi.org/10.1287/opre.2021.0310. [ABSTRACT FROM AUTHOR]

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.

Introduction: The preparedness of the healthcare system to address emergency situations is contingent on the inclination of healthcare personnel. Nursing students can serve as valuable resources to supplement the workforce during major incidents and disasters. This study investigated the facilitators and barriers of nursing students' willingness to respond to disasters at the Alborz University of Medical Sciences in 2022. Methods: In this cross-sectional descriptive study, 234 nursing students were recruited using convenience sampling. A deductive-inductive questionnaire was developed and distributed through an online self-administered survey comprising demographic information and questions on barriers, facilitators, various disaster scenarios, preferred activities, and reasons for pursuing a nursing career. Results: The mean willingness scores of nursing students in response to various disasters were as follows: 3.15 for natural disasters, 2.60 for man-made disasters, 2.94 for pandemics, and 3.32 overall. Among the disaster scenarios, the earthquake response obtained the highest willingness score, while infectious disease epidemics received the lowest score. The most and least willingness to perform activities during disaster response were related to bedside care and participation in patients' personal hygiene, respectively. Key determinants of participation included the possibility of immunization and concerns for family safety. Conclusion: The findings indicated that nursing students are generally willing to assist as members of the healthcare team during disasters. However, the willingness to respond to infectious disease epidemics and man-made disasters was below the norm. Concerns about family health and the risk of disease transmission were identified as primary barriers. Addressing these concerns is crucial to enhance nursing students' participation in disaster response. [ABSTRACT FROM AUTHOR]

Introduction: Medical First Responders (MFRs) in the emergency department SUMMA 112 are tasked with handling the initial management of Mass Casualty Incidents (MCI) and building response capabilities. Training plays a crucial role in preparing these responders for effective disaster management. Yet, evaluating the impact of such training poses challenges since true competency can only be proven amid a major event. As a substitute gauge for training effectiveness, self-efficacy has been suggested. Objective: The purpose of this study is to employ a pre- and post-test assessment of changes in perceived self-efficacy among MFRs following an intervention focused on the initial management of MCI. It also aimed to evaluate a self-efficacy instrument for its validity and reliability in this type of training. Method: In this study, we used a pretest (time 1 = T1) – post-test (time 2 = T2) design to evaluate how self-efficacy changed after a training intervention with 201 MFRs in initial MCI management. ANOVA within-subjects and between subjects analyses were used. Results: The findings reveal a noteworthy change in self-efficacy before and after training among the 201 participants. This suggests that the training intervention positively affected participants' perceived capabilities to handle complex situations like MCI. Conclusion: The results allow us to recommend a training program with theory components together with practical workshops and live, large-scale simulation exercises for the training of medical first responders in MCI, as it significantly increases their perception of the level of self-efficacy for developing competencies associated with disaster response. [ABSTRACT FROM AUTHOR]

Once a fire breaks out in an electric bus, it can easily lead to mass casualties and severe injuries, resulting in significant property damage and social impact. The high-temperature smoke and toxic gases in an electric bus fire are key factors that cause a large number of casualties, both of which are closely related to ventilation conditions. In view of this, this study utilized the Fire Dynamics Simulator (FDS 6) software to establish a three-dimensional experimental model of an electric bus. Numerical simulations of the fire combustion process in the electric bus under different ventilation conditions were conducted. Multiple fire scenes were established based on varying ventilation areas, different wind speeds, and diverse window opening positions. This study specifically analyzed the temperature and CO concentration variations under different fire scenes. By comparing the simulation results under different ventilation conditions, it can be concluded that when an electric bus catches fire, opening 100% of the windows, the wind speed is 8 m/s, and opening the rear window of the electric bus first can minimize the fire risk. Through the numerical simulation of electric bus fires under various conditions, this study analyzed the impact of different ventilation conditions on electric bus fires, providing a theoretical basis for firefighting and rescue efforts as well as personnel evacuation in electric bus fire incidents, with the ultimate goal of maximizing public safety. [ABSTRACT FROM AUTHOR]

The study establishes the degree to which terrorist organisations are successful in achieving their stated goals and objectives. The analysis is undertaken within the framework of the strategic actor theory, which argues that terrorist organisations are rational actors that undertake a series of calculated actions towards the achievement of predetermined goals. The Key Performance Indicator (KPI) methodology, borrowed from the discipline of Management, was used as the analytical framework to measure the performance of the Islamic State. The study notes that the Islamic State's ideology and brand continue to attract sympathisers, but the organisation has lost significant territory, financial resources, and the ability to carry out terrorist attacks that produce mass casualties. This has undermined the attainment of its key goals of spreading radical Islam worldwide and establishing a caliphate in the Levant. [ABSTRACT FROM AUTHOR]

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]

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]

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]

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]

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]

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]

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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]

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]