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European historiography on wars has embarked on a study of a matter of crucial significance: the involvement of ordinary individuals as perpetrators of mass casualties. This article aims to provide insights and hypotheses concerning the underlying motives behind such actions, focusing on the unique context of the Spanish Civil War. The data utilized for this study are drawn from a sample of 112 oral interviews conducted with former combatants of the Spanish Civil War, all born between 1905 and 1920. During these interviews, 112 men participated a semi structured discussion. Individual perceptions and variables of interest relevant to acts of violence were subjected to qualitative analysis. Our analysis suggests that instances of aggression often arise because of emotional triggers, alignment with fascist ideological convictions, societal pressures and a sense of duty-driven obedience. Our results refute the notion that ideological factors alone suffice as explanations. [ABSTRACT FROM AUTHOR]

We collected data from two sources – social media and online questionnaires – to investigate the emotional consequences of social sharing during the COVID‐19 pandemic. Study 1 tracked and analysed sentiment of tweets posted over the course of a month in the crisis period and found that users who tweeted more frequently about COVID‐19 expressed decreasing negative sentiment and increasing positive sentiment over time. Granger causality tests confirmed that this association was better interpreted in the forward direction (sharing levels predicting sentiment) than in the reverse direction (sentiment predicting sharing levels). Study 2 focused on immediate emotional consequences of sharing COVID‐19‐related events and found that participants reported improved overall affect about an event after sharing it, especially when that event was a personal experience rather than a news story. Reported positive feelings about both kinds of events were also significantly higher after sharing. Taken together, both studies suggested that social sharing is linked with emotional relief and may therefore help people to deal with their negative experiences during a persistent collective crisis. [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]

Posttraumatic stress disorder (PTSD) often occurs following mass casualty events, yet the connection between the number of individuals injured in an event and PTSD risk in smaller‐scale events (i.e., involving one or several injured persons) remains unclear. We conducted a registries‐based study cross‐referencing three databases across the continuum of care for military trauma patients hospitalized for traumatic injuries. The study population was categorized into three groups based on the number of injured individuals involved (i.e., single injured person, two to four [2–4] injured people, and five or more [≥ 5] injured people), and PTSD prevalence was assessed using long‐term disability claim diagnoses. Overall, 4,030 military personnel were included (age at injury: Mdn = 20 years), and 18.3% were subsequently diagnosed with PTSD, with the highest prevalence in events involving ≥ 5 injured individuals (35.8%). Regression analyses adjusted for potential confounders revealed that being injured in an event with 2–4 injured persons, OR = 1.68, 95% CI [1.31, 2.15], or ≥ 5 injured persons, OR = 2.36, 95% CI [1.79, 3.13], was associated with increased odds of developing PTSD compared to being the sole injured person. The findings suggest a direct association between the number of injured individuals in an event and PTSD prevalence among traumatic injury survivors. The results underscore the importance of early diagnosis and interventions to prevent PTSD in individuals injured in multicasualty and mass casualty events. [ABSTRACT FROM AUTHOR]

The prevalence of conflict is a well-known contributor to the emergence of humanitarian crises that lead to both direct and indirect public health challenges. In Ethiopia, the past three years have been marked by an armed conflict that has produced numerous public health difficulties in the country. The recent Northern Ethiopia war resulted in hundreds of thousands of fatalities and the displacement of millions of people. A few months after the end of the Northern Ethiopia war, another conflict erupted in Amhara region in April 2023, which has since spread throughout the region. This commentary is intended to examine the public health implications of the armed conflict in the Amhara region, which has not received sufficient attention from the global community. Since the outbreak of a new-armed conflict in Amhara, the area has experienced with both direct and indirect consequences. Marked by multiple civilian attacks and extrajudicial killings, the military action in the region has caused displacement of millions of Amhara people with limited access to humanitarian assistance. Those who still reside in conflict-affected areas of the region face high burden of Malnutrition and Food Insecurity with a compromised access to essential public services such as clean water, hospitals, roads, and financial institutions such as banks. This conflict has disrupted the region's WASH facilities and hindered access to early identification and treatment leading to an increased in the incidence of communicable diseases such as Cholera, Malaria and Measles. The surveillance system of the region has also been severely impacted coupled with a collapsing health system that is unable to adapt amid the crisis. Despite the looming humanitarian and public health catastrophe, there has been minimal support from the government of Ethiopia and the global community to mitigate the implications of the war and assist the Amhara people. Therefore, it is imperative that the international community pay appropriate attention to the ongoing public health crisis and ensure that the people of Amhara receive the necessary basic and life-saving support. [ABSTRACT FROM AUTHOR]

A discontinuity exists between the hazardous environment that created HRO and the structured business and healthcare environment. Discontinuity emerges when order security drives people to create order through design. The HRO develops order through emergent properties. Disasters self-organize, confounding our efforts to predict and plan a response. The HRO uses feedback from the environment to maintain homeostasis and achieve allostatic growth. Energy entering the organization creates forces to which the individual must respond. The effect on the individual illuminates the functional benefit of stress-impaired cognition. Self-organization brings order to disorder and is used by individuals to communicate, supported by mirror neurons. The combination of subjectivity and objectivity enables us to give meaning to experience. Full Spectrum Analysis considers contextual information and influences the interpretation of information, which is vital in a fluctuating environment. [ABSTRACT FROM AUTHOR]

Objectives: The prehospital emergency triage rapid algorithm (PETRA) method was designed to overcome the deficiencies of the earlier described simple triage and rapid treatment (START) method. This study has compared the START and PETRA triage methods regarding the appropriateness of triaging victims following a simulated mass casualty incident in terms of accuracy and time efficiency. The two triage systems were compared. Methods: This was a prospective study using a convenience sample of randomly distributed paramedic students between September 2022 and December 2022 at the Civil Defense College in Amman. Sample 102 students of the paramedic diploma program at the College. Total time of prehospital triage, accuracy of prehospital triage, level of under triage, and level of over triage were measured for both study groups. Results: Independent t-test revealed that there was no significant difference between the PETRA and START methods in terms of the prehospital triage accuracy, time spent in prehospital triage, and level of over triage. However, the level of under triage in the PETRA group was lower compared to the START group. Conclusion: The study proposes that the paramedic should adopt the PETRA method as an improved alternative to the START method during a massive causality incident. In the same way, this research encourages the incorporation of the PETRA method in the curricula of paramedics and nurses. More research is required to support the existing findings. [ABSTRACT FROM AUTHOR]

Active shooter drills are widely used in schools throughout the United States, with more than 92% of public schools having an active shooter plan. These drills can increase student stress and anxiety and can have a variety of negative effects, such as somatic complaints, anxiety, poor self-regulation of emotions and behaviors, risk for depression, and prevalence of obesity and eating disorders. This article describes the efficacy of physical activity breaks, mindful breathing techniques, and emotional regulation strategies to reduce stress reactivity and enhance recovery in elementary-age students following active shooter safety drills. A list of example activities is provided for each of the three stress management categories. Each of the activities can be adapted to various developmental levels (i.e., K-12), settings (i.e., classroom, hallway, outdoors), and time availability (i.e., one minute to 10 minutes). The strategies may also be utilized following other emergency drills or during other times of high student and classroom stress. [ABSTRACT FROM AUTHOR]

While the uses of generative artificial intelligence (AI) are vast, one capability it lacks is true creativity. This requires originality and surprise, neither of which is possible without the human process. Yet students and others increasingly rely on AI, so it seems likely to shape public discourse as well as everyday life. Social-media groupthink and insular academic communities have already narrowed the range of intellectual discourse. AI stands to exacerbate the trend, filtering out unconventional prose and content in languages and dialects that are not widely spoken. Yet AI companies have limited motivation to enlighten consumers about its shortcomings. As with other sweeping technological innovations, complacency and overreliance on AI appears inevitable absent intervention. Without proper guidelines, AI could distil writing and idea formulation into a few predicted outcomes and extinguish true creative thought. [ABSTRACT FROM AUTHOR]

At the 39th meeting of the International Society of Traumatic Stress Studies, three leading researchers and clinicians in technology‐enabled traumatic stress support were invited to reflect on their careers and contributions to the field. Dr. Brian P. Marx has led the development of large‐scale technologies to screen, assess, and treat traumatic stress pathology across diverse etiologies and needs. Dr. Barbara O. Rothbaum, a pioneer in the development of virtual reality for exposure therapy, has demonstrated the efficacy and scalability of digital treatment for traumatic stress. Retired Col. Dr. Eric Vermetten has worked extensively on the intersection of basic mechanisms, novel psychological and biological treatment, and technology for scalable assessment and treatment, primarily in military and mass casualty contexts. The panelists were asked to reflect on their initial ambitions, concerns, unexpected challenges, and the influence of their work on new research trajectories. Their insights provide valuable lessons about the process and content of their work, and their pioneering efforts have significantly advanced the field of technology‐enabled traumatic stress support. [ABSTRACT FROM AUTHOR]

Advances in fire safety and building construction have made fires in modern health care facilities uncommon and easily contained. Therefore, emergent hospital evacuations resulting from an internal fire are rare. On January 4, 2017, a fire occurred at the John Sealy Hospital, part of the University of Texas Medical Branch at Galveston, resulting in emergent evacuation of the hospital building and an adjacent office and patient care building. The internal emergency response system was quickly activated, and more than 100 patients and 200 staff members were evacuated within 27 minutes with no fire- or smoke-related injuries. Obstacles encountered during the evacuation process included difficulties with communication and confirming patient count in a timely manner. This article describes the emergent hospital evacuation during the fire, summarizes the subsequent reflections of a multiagency after-action review, and issues a call to action for further research and publication on emergency patient evacuation. [ABSTRACT FROM AUTHOR]

Background: Burn mass casualty incidents can overwhelm local resources, challenging effective communication, triage, and provision of care. International responders can help by providing education and direct patient care. Local Problem: On November 5, 2021, a fuel tanker truck exploded in Freetown, Sierra Leone, killing or injuring hundreds of people. The needs of the severely burned survivors overwhelmed local resources, requiring an international response. Burn specialist teams from several countries, including the United States, were deployed to provide assistance. Methods: Members of the US burn care team educated local health care practitioners about wound care, physical therapy, and fluid and pain management. Educational content was delivered through lecture and discussion, case studies, clinical application, and bedside teaching. Demonstration of cultural competence and humility, as well as attentiveness to nuances of local communication, helped avoid ethnocentrism and other barriers to collaboration. Public congratulations and formal completion certificates were used to provide meaningful recognition of successful class participation. Results: Before the lecture and discussion intervention, 57 students participating in a pretest assessment had an average score of 53.9% (high, 80%; low, 27.5%). After the intervention, 38 students participating in a posttest assessment had an average score of 79.3% (high, 95%; low, 55%), and local health care providers delivered care with more attention to patient comfort and shared new knowledge with colleagues. Conclusions: Providing optimal burn care and education under austere conditions requires cultural humility and a spirit of inquiry. Attentiveness to communication and cultural nuances promotes collaboration, improves educational effectiveness, and builds local burn care capacity. [ABSTRACT FROM AUTHOR]

Operation Allies Refuge started in July 2021 with implications for critical care nurses, both military and civilian, serving at the US Army's Landstuhl Regional Medical Center in Landstuhl, Germany. Cultural and logistical concerns and complications were at the forefront of care provided to Afghan evacuees during the operation and were exacerbated by a mass casualty event on August 26, 2021, when a suicide bomber attacked the Abbey Gate of Hamid Karzai International Airport in Kabul, Afghanistan. This article discusses the issues that affected care, including language barriers, supply shortages, cultural differences, mass evacuation during a pandemic, and management of the mass casualty event by the critical care team. The information is compiled into a summary of lessons learned to assist in future management of emergency evacuee care within our military and civilian health care systems. [ABSTRACT FROM AUTHOR]

Background: From 2018 to 2022, mass shooting incidents in the United States increased by 67.7%. Health care–associated shootings also increased. The role of acute and critical care nurses during shootings is not well defined in the literature. Objective: To identify roles of acute and critical care nurses during mass shooting incidents and provide best-practice recommendations for shooting incidents within a hospital. Methods: The methods of Whittemore, Knafl, and Torraco informed this integrative review. Ovid MEDLINE, CINAHL, and Scopus databases were searched for publications related to acute and critical care nurses, mass shooting incidents, and hospital setting. Results: Of 13 589 articles retrieved, 27 were included; 63% were narrative reviews. The highest level of evidence was an expert consensus panel; next highest was a quasi-experimental study that simulated experiences to test mass casualty incident response. Third highest was a qualitative study that analyzed nurses' experiences during a mass casualty experience. Discussion: The evidence revealed 3 themes: prevention and preparedness, response to incident, and recovery phase. Education and training for acute and critical care nurses about mass shooting incidents are central to defining nurses' roles and best practices for these incidents. Nurses must know Stop the Bleed techniques and run-hide-fight protocols. Additionally, acute and critical care nurses need representation on hospital committees to develop and implement policies and procedures. Conclusions: Hospitals are not immune to mass shooting incidents. Acute and critical care nurses require education including simulations and drills on mass shooting incidents to ensure safety of nurses and patients. [ABSTRACT FROM AUTHOR]

Background/Objectives: Emergency Medical Response Systems (EMRSs) play a vital role in delivering medical aid during natural and man-made disasters. This quantitative research delves into the analysis of risk and effectiveness within Serbia's Emergency Medical Services (EMS), with a special emphasis on how work organization, resource distribution, and preparedness for mass casualty events contribute to overall disaster preparedness. Methods: The study was conducted using a questionnaire consisting of 7 sections and a total of 88 variables, distributed to and collected from 172 healthcare institutions (Public Health Centers and Hospitals). Statistical methods, including Pearson's correlation, multivariate regression analysis, and chi-square tests, were rigorously applied to analyze and interpret the data. Results: The results from the multivariate regression analysis revealed that the organization of working hours (β = 0.035) and shift work (β = 0.042) were significant predictors of EMS organization, explaining 1.9% of the variance (R2 = 0.019). Furthermore, shift work (β = −0.045) and working hours (β = −0.037) accounted for 2.0% of the variance in the number of EMS points performed (R2 = 0.020). Also, the availability of ambulance vehicles (β = 0.075) and financial resources (β = 0.033) explained 4.1% of the variance in mass casualty preparedness (R2 = 0.041). When it comes to service area coverage, the regression results suggest that none of the predictors were statistically significant. Based on Pearson's correlation results, there is a statistically significant correlation between the EMS organization and several key variables such as the number of EMS doctors (p = 0.000), emergency medicine specialists (p = 0.000), etc. Moreover, the Chi-square test results reveal statistically significant correlations between EMS organization and how EMS activities are conducted (p = 0.001), the number of activity locations (p = 0.005), and the structure of working hours (p = 0.001). Conclusions: Additionally, the results underscore the necessity for increased financial support, standardized protocols, and enhanced intersectoral collaboration to strengthen Serbia's EMRS and improve overall disaster response effectiveness. Based on these findings, a clear roadmap is provided for policymakers, healthcare administrators, and EMS personnel to prioritize strategic interventions and build a robust emergency medical response system. [ABSTRACT FROM AUTHOR]

Introduction: Emergencies are increasingly prevalent, necessitating specialized management to address significant social disruption. Effective management of health emergencies requires resilience from governments and health institutions, as these emergencies are becoming more common and have wide-ranging consequences on health, society, and the economy. Due to the interconnected nature of our global society, events in one location can have international or even global impacts, as demonstrated by the COVID-19 pandemic. Objective: This study aims to assess disaster management preparedness among nurses and physicians during pandemics. Methods: This study used an online survey conducted in late 2022 to collect primary data through a purposive sampling method, involving both government and private hospitals in Palestine. The participants included 512 nurses and 241 physicians from various hospital units. Results: The findings indicate varying levels of knowledge among participants, with a significant portion (67%) reporting no prior experience with real disaster situations. Additionally, 63% lacked prior disaster response experience. Regarding training courses, 17.8% of nurses and physicians prioritized emergency preparedness, trauma mass casualty response, and triage disaster management systems. Despite some understanding of disaster management, the study emphasizes the importance of hospital managers implementing national standards, engaging healthcare professionals in continuous education, and addressing gaps in perceived competence. Conclusion: While participants demonstrated some knowledge of disaster management, the study suggests the importance of hospital managers adopting national standards, engaging healthcare professionals in continuous learning activities, and addressing perceived competence gaps. [ABSTRACT FROM AUTHOR]

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]

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]

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]

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]

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]

Purpose: On 22 March 2016, the burn unit (BU) of Queen Astrid Military Hospital assessed a surge in severely injured victims from terror attacks at the national airport and Maalbeek subway station according to the damage control resuscitation (DCR) and damage control surgery (DCS) principles. This study delves into its approach to identify a suitable triage scoring system and to determine if a BU can serve as buffer capacity for mass casualty incidents (MCIs). Methods: The study reviewed retrospectively the origin of explosion, demographic data, sustained injuries, performed surgery, and length of stay of all admitted patients. Trauma scores (Injury Severity Score (ISS) and New Injury Severity Score (NISS)) and triage scores (Revised Trauma Score (RTS), New Trauma Score (NTS), and Trauma Score Injury Severity Score (TRISS)), were compared to burn mortality scores (Osler updated Baux Score and Tobiasen's Abbreviated Burn Severity Index (ABSI)). Results: Of the 23 casualties admitted to the BU, the scores calculated on average 3.5 indications for a level 1 trauma center (ISS 4, NISS 6, RTS 0, T-NTS 4). Nevertheless, no deaths occurred during admission or the 1-year follow-up. Conclusion: MCIs create chaos and a high demand for care. Avoiding bottlenecks and adhering to the DCR/DCS principles are necessary to deliver the best care to the largest number of people. This study indicates that a BU can serve as buffer capacity for MCIs. Nevertheless, its integration into the medical resilience plan depends on accurate scoring, comprehensive care availability, and understanding of the DCR/DCS concept. NTS for triage seems the best fit for scoring polytrauma referrals to a BU during MCIs. [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]

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]

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]

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]

Research on the effects of collective trauma tends to take a psychocentric approach, focusing on the impact of being geographically near the traumatic event (physical proximity) or personally knowing a victim (social proximity). We theorize that this approach falls short in describing the effect of collective trauma among interdependent cultural groups, such as Indigenous Peoples, for whom the self and one's group are inextricably tied. Using a concurrent embedded mixed-methods design (N = 545), the current study explores the influence of cultural proximity (having a shared cultural connection to victims) in the wake of a fatal school shooting involving students from both a Native American tribe and a predominantly White city. After controlling for physical and social proximity, student distress behaviors and staff support behaviors, but not staff members' own psychological distress, were significantly higher in schools with higher Native student populations, where a larger proportion of students shared cultural connections with the victims. We discuss implications regarding the importance of providing adequate support for Indigenous Peoples, and interdependent cultural groups in general, following collective trauma. [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]