The NIGHTINGALE PROJECT aims at transforming the landscape of Mass Casualty Incident (MCI) response by seamlessly incorporating cutting-edge technologies. At its core, this initiative leverages advanced solutions, including wearable wristbands and unmanned aerial vehicles (drones), to enhance the operational efficiency and effectiveness of MCI response teams. These technologies are designed to provide real-time data collection, communication, and coordination capabilities, offering invaluable support for first responders in chaotic and resource-constrained MCI scenarios. The successful integration of such innovative technologies within the complex operational context of MCI handling poses a series of challenges that hold the potential to reshape the existing paradigms. Therefore, NIGHTINGALE users have performed a thorough analysis of the widely operated protocols and discussed common denominators of MCI prehospital response in light of these new technological solutions, with the objective of translating recommendations into practice.

Gain a comprehensive understanding of the cutting-edge technologies (such as wearables and drones) that can potentially be integrated in prehospital MCI response.

Learn how these technologies operate and their potential benefit in enhancing MCI response.

Understand challenges and implications of technology integration into the complex operational context of MCI handling.

This study aimed to use artificial intelligence (AI) computing techniques to determine if they can validate the findings of a previously published thematic analysis article focusing on disaster medicine experts’ open-ended feedback about Middle East and North African countries (MENA) for chemical, biological, radiological, and nuclear (CBRN) threats.

Automated text analytics techniques were employed to explore and visualize the semantic essence of the experts’ feedback through word vector transformation and Principal Component Analysis (PCA) for dimensionality reduction. The t-distributed Stochastic Neighbor Embedding (t-SNE) is another more advanced dimensionality reduction technique that enhanced the capturing of the determined components.

Two prominent clusters emerged from the full textual data set representing word similarities groups in the original data set, denoting a thematic group of ideas that experts have emphasized in their responses. Upon deep reading the text feedback, the themes linked preparedness with different training types, such as tabletop exercises and policies/legislation. The findings are in line with currently adopted practices.

While AI methods demonstrated their valuable application in disaster medicine and helped validate the experts’ recommendations objectively, they should be approached cautiously, as they can be complex and challenging to comprehend fully.

Climate change has impacts that contribute to increased disasters and chronic stressors. Subsequently we are faced with the great resignation of employees in the first responder and healthcare workforces.

These industries are crucial to community recovery and there is an urgent need to understand risk and protective factors toward burnout and mental health.

We hypothesize that disaster experiences and community disruptions contribute to burnout and mental health problems among the healthcare and emergency personnel workforces. Mixed methodology was used to identify services that would support retention.

As symptoms of burnout increased, mental health problems also increased. Increased burnout was associated with increased work hours per week, more hours than usual, and more traditional first responder roles. Social isolation and other trauma, such as disaster, were associated with mental health problems. Protective factors included wellbeing, connectedness, and self-care.

Findings support the need for services aimed at reducing negative mental health and loneliness while improving coping skills. This presentation explores the utility of artificial intelligence, such as wearable technology, to screen, triage, and provide mental health services. By leveraging technologies, we offer a plan for addressing burnout, increased retention and the future of disaster mental health.

The confluence of extreme weather conditions and crowded forests are contributing to larger and more severe forest fires. The progressive migration of the US population into the wildland-urban-interface is placing more people in the path of wildfire, while the emissions from wildland fire are reversing historical improvements in national air quality and placing the health of people remote from the wildfire at risk. The presentation will describe the historical pattern of wildfire in the U.S., factors contributing to a significant increase recently, and projections for wildfire behavior into the future. The human health effects of wildfire will be addressed within the context of mental health issues emerging among survivors of wildfire, and health effects to exposure to emissions of firefighters, and populations at a distance. Clinical and public health recommendations for individuals and communities to protect themselves from smoke exposure will be presented.

Describe the factors that are increasing the size and severity of wildfire.

Describe actions individuals and communities can take to reduce exposure to wildfire smoke.

Describe key unanswered questions requiring new research to inform policy and decision-making by professionals charged with managing forests and environmental quality, prescribed fire, public health and healthcare.

Prompt safety confirmations before and after a disaster are key to reducing risks in disasters among older adults. This study aims to reveal issues in contacting fragile older adults once flood disaster strikes to ensure a sustainable safety net.

Focus group interviews were conducted in three municipalities of Kumamoto, Japan, which experienced a flood disaster in July 2020, with nine care managers, nurses, and center directors of community-based integrated support centers in August 2023.

Communication records of support and lists of older adults requiring support in regular operations were useful, and the safety of those on the lists was first confirmed immediately after the disaster struck. However, confirmation of safety of those who did not rely regularly on public services, those who lived alone, and older couples, was delayed and their safety was determined by their neighbors’ reports.

Prompt safety confirmation system in the event of a disaster is required for, in particular, fragile older adults who do not rely on public services, which lead to early support intervention.

The COVID-19 pandemic created a public health crisis worldwide. Healthcare workers became sick at a time when hospitals were overwhelmed with patients, leaving critical staffing shortages. International governments instructed their military assets to fill gaps in care and to initiate projects to promote public health efforts. The COVID-19 pandemic created a unique international military response to a biologic disaster.

This literature review highlights the non-conflict assets allocated, abilities utilized, projects completed, overall effectiveness, and lessons learned by the military community worldwide to support their local populace. This collated information is then compared using three interoperability frameworks to assess government responses. This data is then extrapolated to give recommendations for future civil-military actions occurring after climate change related disruption of healthcare delivery systems.

Medline (PubMed), SCOPUS, and CINAHL were searched for English language articles from 2020 with terms focused on the military, COVID-19, and collaboration. After data collection, the Joint Emergency Services Interoperability Program, Operational Interoperability Maturity Model, and Homeland Security Interoperability Continuum frameworks were utilized to evaluate collaboration and coordination between governments and military in response to the disaster.

Data collection has been completed. Analysis and conclusion planned for completion by November 2023.

This review aimed to identify health impacts of climate change on persons with disabilities in developing countries as well as factors influencing the vulnerability and resilience of affected individuals to related natural disasters.

PubMed, PsycINFO, Scopus, and Embase databases were searched, 2005 to 2023 inclusive, focusing on the keyword terms “persons with disabilities”, “climate change” and “developing countries”. Identified articles were screened for inclusion and qualifying articles received a full-text review. Of 463 articles identified, following removal of six duplicates, 457 articles were screened; 412 were excluded. Of the remaining 45 full-text articles assessed for eligibility, 15 were selected and included in the review with two additional articles from a manual search.

Findings revealed themes including the impact of climate change on the physical and mental health of persons with disabilities in developing countries. The general theme of resilience to natural disasters and specific coping strategies were also elaborated.

While there is increasing recognition of the psychosocial impacts of climate change-related natural disasters on persons with disabilities, there remain significant gaps in awareness of mental health needs and related service provision. Resolving these gaps is indispensable to achieving equitable climate change-related health outcomes in developing countries.

High-Fidelity training in triage for Mass Casualty Incidents (MCI) is resource intensive and therefore limited in frequency despite knowing that this skill degrades with time. Didactic classroom materials offer a non-resource-intensive introduction to foundational concepts, but the extent to which it can prepare providers for real world scenarios is limited. Virtual reality (VR) is an effective training alternative, but in its infancy of development and accessibility. To bridge the gap between these modalities, we propose a video-enhanced method to didactic training.

During Uniformed Service University’s (USU) annual Operation Bushmaster field exercise we produced video footage of individual casualties along with multiple casualty scenes consisting of several 5-15 second videos capturing various elements of a primary survey.

The videos offer a higher-fidelity alternative to written casualty descriptions allowing the learner to visually process casualty presentation that is more representative of reality. The video segments facilitate thinking through specific points in the decision-making process for triage and life saving interventions.

Video enhanced didactic training offers a bridge between written didactic training and exercise or VR training for MCI triage skills acquisition and sustainment. Assessment and validation of this training methodology with various MCI responders is recommended.

This study analyzes disparities in initial healthcare responses in Turkey and Syria following 2023 earthquakes.

Using Humanitarian Data Exchange, Crude Mortality Rates (CMR) and injury rates in both countries were calculated, and temporal trends of death tolls and injuries in the first month post- catastrophe were compared. WHO Flash Appeal estimated funding requirements, and ratios of humanitarian aid personnel in Urban Search and Rescue (USAR) teams per population from ReliefWeb and MAPACTION data were used to gauge disparities.

56,051,096 individuals were exposed, with Turkey having 44 million vs 12 in Syria. Turkey had higher CMR in affected areas (10.5 vs 5.0/10,000), while Syria had higher CMR in intensely seismic regions (9.2 vs 7.7/1,000). Turkey had higher injury rates (24.6 vs 9.9/10,000). Death and injury rates plateaued in Syria after three days, but steadily rose in Turkey. Syria allocated more funding for all priorities per population except healthcare facilities’ rehabilitation. Turkey had 219 USAR teams compared to Syria’s six, with significantly more humanitarian aid personnel (23 vs 2/100,000).

Significant disparities in initial healthcare response were observed between Turkey and Syria, highlighting need for policymakers to enhance responses in conflict-affected events to reduce impact on affected populations.

Defining the role of federal wildland firefighters (WFF) in the context of emergency medical services (EMS) is a gap in the literature. Our work highlights the importance of standardizing and enhancing the EMS capabilities of federal WFF for their own occupational safety and well-being, while emphasizing their potential for responding to all disasters and providing medical safety net in rural communities.

A comprehensive academic literature review on the topic returned one non-peer reviewed manuscript. Study members analyzed National Wildfire Coordinating Group (NWCG) EMS policy to assess current EMS standards within the WFF service.

The study reveals a lack of standardized, comprehensive support for EMS capabilities among federal WFF, despite need for their expertise in wide-ranging emergency situations. There are few incentives for individuals to obtain and maintain EMS certification. Various innovations, such as the Alaska Fire Medic Program and the BLM Operational Medical Support Program, are potential models for improving EMS across the entire NWCG.

To enhance the safety, professionalization, and efficiency of WFF, the NWCG should consider standardizing EMS guidelines, especially in providing consistent support for medical certifications. EMS certified WFF could contribute to nationwide disaster response capabilities if supported by NWCG.

Rapid deforestation, urbanization, and biodiversity loss over the last century has changed landscapes and disorientated the climate. This has magnified temperature, wind speed, air quality, and other meteorological variables. For example, the urban heat island effect has resulted in city areas being hotter than nearby rural areas and expanding physical landscapes combined with shifting precipitation patterns has increased flood risks in new locations. The result has been unexpected disruption to healthcare, supply chains, and changes in vector, water, and foodborne disease patterns. To find solutions to this challenge, a transdisciplinary approach is needed to assess and anticipate the impact of floods and other emerging risks on public health systems. The United Nations Public Health System Resilience Scorecard (Scorecard) could provide the process needed for this to occur. This is a reliable, scalable, and versatile tool that has been applied and tested in multiple communities and countries. Attendees to this session will learn about the Scorecard methodology and how it can be applied in different settings, used to build consensus, and employed to inform future resilience actions. Ultimately, providing a framework for maximizing the resilience of public health systems during a time of rapidly shifting environmental, social, and fiscal climates.

Identify the impact floods and other disasters can have on public health systems in non-traditional at-risk areas.

Explore the United Nations Public Health System Resilience Scorecard (Scorecard) and its alignment with the 2030 United Nations agenda.

Understand why a transdisciplinary approach is needed to assess the impact of floods and other emerging risks on public health systems.

Demonstrate how the Scorecard can be applied in multiple communities and countries to identify, rank, and prioritize resilience actions for public health systems.

Asymmetric warfare, conflict and terrorist attacks involving children raise concerns regarding the preparedness to respond to mass casualty incidents involving pediatric patients. The objective of this project was to assess the resources available in the metropolitan Milan area to develop a priority dispatch plan for a mass casualty incident with pediatric patients.

A focused search of the medical literature and clinical guidelines established a minimal standard requirements of care of pediatric patients involved in an MCI to determine the surge capabilities in terms of number of patients and severity of injuries for each study hospital in the metropolitan Milan area.

The hospitals that took part in the study were either adult trauma centers or pediatric hospitals in the metropolitan Milan area. The overall surge capability identified was of 40-44 pediatric patients involved in an MCI involving pediatric patients, distributed based on age and severity and based on the hospital resources and expertise.

The findings from the metropolitan Milan area shows the basis for non-Pediatric Trauma Center adult and pediatric hospitals to work in synergy to develop MCI response plans involving pediatric patients. Simulations exercises will need to be carried out to evaluate and validate the plans.

The city was hit by a flood on July 5, 2022. Afterwards, the mayor of Belgrade declared that no one should be blamed because we cannot influence God’s will. Objective is examination of the relationship between such a laissez-faire approach to Disaster Risk Reduction (DRR) from the city government, and some groups from hill areas (historically not flooded), who were flooded and have started to develop DRR approaches to adequately respond to the next possible flood.

Participant observation site work is in progress and includes 32 households in the residential hill area of Belgrade that experienced its first rain floods from 2019 to 2023. DRR is represented through self-installed special devices on the city sewage network. The data collection and analysis included narrative analysis and sociological analysis of photographs. All data was first anonymized as some practices were viewed as legitimate but not always legal.

During the relevant three years, the number of non-flooded homes increased proportionally with increasing self-installation of special devices on their city sewage system

Groups left without official DRR policies can develop resilience through individual actions in communal infrastructure and find ways to resist natural hazards and government laissez-faire DRR.

Chatbots, conversational agents providing access to information and services through interaction in everyday language, can make essential health information and services more accessible, available, and affordable. Kati Collective, together with Meta, worked to identify, outline, and develop some of the most critical tools and processes required to leverage chatbots for social good with a focus on health. The results of this work are compiled in a comprehensive, modular playbook. We propose to share our learnings and guide participants of our session to explore the existing uses, benefits, trade-offs, and challenges of using chatbots in disaster medicine.

There are significant challenges and barriers to scale, impact, and sustainability of their chatbot interventions. In response to these challenges, we used a participatory design process, landscape analysis, desk research and interviews with key stakeholders in the digital for development space to inform which content to include and in what format to best connect information to action.

The Playbook contains key information, tools, exercises, and resources organized into four interrelated modules based on barriers and enablers.

This Playbook is particularly relevant in analysis, planning, strategizing and design phases of the chatbot project lifecycle and is highly extensible to disaster medicine.

The potential for a radiological disaster from natural environmental causes, human error, aging nuclear power plants, buried radioactive waste, regular ground transport of radioactive materials, a shared international border, and the threat of radiological terrorism make the Western New York region vulnerable for a radiation emergency. A global threat from Russia and intentional uses of nuclear weapons by non-state approved users, such as North Korea, raise public awareness. Limited importance has been given to educating medical providers and emergency planners with radiological knowledge and preparation.

The goal of this study was to understand the relationships of the peerception of risk, emergency self-efficacy and willingness to respond to a radiation emergency among health professionals.

Two hundred sixty-nine (269) medical and health practitioners were selected for a purposive, convenience sample in an eight-county region of Western New York. Participants identified the need for improved knowledge and preparation for the management of a radiation emergency.

Statistical findings using the author created Structural Equation Model (SEM) revealed a goodness of fit for perception of risk as a strong predictor of willingness to respond to a radiation emergency.

The SEM study names the variables that influence training for global nuclear realities.

Telehealth, or the use of digital health technology to support clinical care, education, and health administration over a distance, has increased dramatically in the 21st century. The frequency and severity of disasters that cause damage, disruption, loss of life, and health service deterioration have also increased over the same period. Advances in telecommunication networks and mobile technology have made telehealth systems more accessible and affordable, and rising acceptance has engaged hesitant users. Yet, telehealth remains underutilized particularly for cross-jurisdictional disaster response in the United States. In this presentation, we will discuss progress in the development and implementation of new regional disaster telehealth systems funded by the U.S. Administration for Strategic Preparedness and Response. We will review administrative and legal barriers to implementation in the context of real-world examples to understand how they impact domestic disaster response capabilities. We will also discuss innovative new global partnerships that have successfully leveraged digital tools to provide access to health resources for international humanitarian disaster response. Finally, we will consider next steps in the path to fully actualizing the potential for telehealth to transform disaster response.

Discuss current federally funded efforts to develop and implement regional telehealth systems designed to support cross-jurisdictional disaster medical response in the United States.

Examine administrative and legal barriers to adoption and implementation that can impact timely mobilization, deployment, and use of disaster telehealth services.

Review examples of successful and failed implementation to guide future research, development, and implementation efforts for system developers, sponsors, and governmental and non-governmental disaster response entities.

In this interactive session which combines instruction with live-streaming, participants will learn about the use of ChatGPT in disaster medicine.

Create an OpenAI account, write an effective prompt, and manage a conversation with ChatGPT.

List errors common to ChatGPT and understand why they occur.

Review how ChatGPT can interface with internet connected devices and other apps.

Discuss the ethical, legal, and social implications of generative AI.

Italy frequently experiences major events like earthquakes, floods and migrant shipwrecks. Global concerns include climate change, pandemics and wars. We would assess the role of public health experts and the current state of Italian post-degree Public Health schools towards these challenges.

A cross-sectional online survey was conducted in Italy in June 2023, among all Italian Public Health residents enrolled in SItI. The study investigated the presence of trainings and updates about emergencies. It also explored interest and importance of topic, impact of Covid-19 pandemic and sources of information.

Out of 289 respondents, 86.2% deemed the topic important and 74.4% expressed interest (both p<0.001). 90.1% pointed out the lack of dedicated courses and 93.1% as for specialized master’s programs (both p<0.001). Perceived importance in the topic correlates with the desire to attend dedicated conferences (p<0.001). For COVID-19, 24.6% recognized the importance of topic pre-pandemic, while 50.9% raised awareness during (both p<0.001).

A discussion is needed for enhanced training programs in public health emergency prevention and management across Italy, pledging for uniformity within different training networks. In this way, a more robust response to future emergencies may be ensured.