The international and national response team faces many challenges during a complex humanitarian emergency. These include difficult organization, an unprepared national disaster plan, and a disrupted political system. Previous studies showed a reactive approach in earlier disasters in Saudi Arabia and the need for greater involvement of health professionals in disaster management. As a result, several medical education and training institutes began to introduce courses which were mainly about Major Incidents Response, but with less attention to Humanitarian Assistance and Disaster Relief.

The course provides Basic Principles in Complex Humanitarian Emergency for healthcare providers in the kingdom and is focused on the aspect of community awareness for disaster and humanitarian relief.

The interactive competencies-based course in Basic Principles of Complex Humanitarian Emergency was implemented. The course was designed by 5 experts in disaster medicine and humanitarian relief and was piloted over five days at officers club of Minister of Interior in Riyadh, sponsored by King Fahd Security College. The participants (n=30) were from different health disciplines. They completed the pre- and post-tests and presented three pilot workshops for disaster community awareness.

The overall scores were 44.19% for the pre-test and 62.85% for the post-test (Wilcoxon test for paired sample: z = 3.729, p<0.001). There were no significant statistical differences among professions of healthcare providers for both pre- and post-tests.

Delivering competencies-based course in Basic Principles of Complex Humanitarian Emergency for health care providers can help in the improvement of knowledge and skills for humanitarian assistance and disaster relief in Saudi Arabia, which is important for disaster preparedness augmentation in the kingdom. The next course for the same group may be recommended for achieving the level that will train them to participate in the National Disaster Assistance team.

Behavioral health needs of attendees at mass gathering events who require emergency department (ED) evaluation are poorly understood. Appropriate resource allocation of mental health staff and other behavioral interventions necessary to support this patient population are also unclear.

To describe behavioral characteristics and psychiatric resource utilization of patients presenting to a tertiary academic medical center emergency department from mass gathering events.

Single-center retrospective study evaluating attendees at mass gathering events who presented to a Chicago ED. Electronic medical records for patients presenting between October 13, 2013, and December 31, 2015, were reviewed and descriptive analyses performed.

209 distinct records were reviewed. Most patients presented from large outdoor concerts (n = 186, 89%). Forty-two (20.1%) reported a mental health complaint at presentation, including concerns related to pre-existing psychiatric disturbances or onset of new symptoms. Twenty-seven of the total cohort (12.9%) endorsed a prior psychiatric history. Thirty-five (16.7%) reported use of prescribed psychotropic medications, including antidepressants, stimulants, mood stabilizers, and others. Diagnostic testing among the total sample included serum ethanol measurement (31.1%), urinary toxicology (25.4%), acetaminophen (6.2%), aspirin (5.3%), and creatine kinase measurements (11%). Computed brain tomography was ordered for 20 patients (9.6%). Twelve patients (5.7%) received an anxiolytic (lorazepam) and 113 (54.1%) received intravenous fluids. An antipsychotic (olanzapine) was administered to one patient (0.5%). There were no reports of suicidal ideation, but physical restraints for agitation were employed in 13 patients (6.2%). Police consultation occurred in 10 cases (4.8%). No formal psychiatric consultations were requested by ED providers.

Patients presenting to the emergency department from mass gathering events frequently endorse behavioral complaints requiring directed use of diagnostic and other emergency department resources for their ailments. The need for physical restraints and limited use of anxiolytics and antipsychotics in our sample suggest that psychiatric consultation is underutilized.

This study aimed to document the growth and challenges encountered in the decade since inception of the National Ambulance Service (NAS) in Ghana, West Africa. By doing so, potentially instructive examples for other low- and middle-income countries (LMICs) planning a formal prehospital care system or attempting to identify ways to improve existing emergency services could be identified.

Data routinely collected by the Ghana NAS from 2004–2014 were described, including: patient demographics, reason for the call, response location, target destination, and types of service. Additionally, the organizational structure and challenges encountered during the development and maturation of the NAS were reported.

In 2004, the NAS piloted operations with 69 newly trained emergency medical technicians (EMTs), nine ambulances, and seven stations. The NAS expanded service delivery with 199 ambulances at 128 stations operated by 1,651 EMTs and 47 administrative and maintenance staff in 2014. In 2004, nine percent of the country was covered by NAS services; in 2014, 81% of Ghana was covered. Health care transfers and roadside responses comprised the majority of services (43%–80% and 10%–57% by year, respectively). Increased mean response time, stable case holding time, and shorter vehicle engaged time reflect greater response ranges due to increased service uptake and improved efficiency of ambulance usage. Specific internal and external challenges with regard to NAS operations also were described.

The steady growth of the NAS is evidence of the need for Emergency Medical Services and the effects of sound planning and timely responses to changes in program indicators. The way forward includes further capacity building to increase the number of scene responses, strengthening ties with local health facilities to ensure timely emergency medical care and appropriateness of transfers, assuring a more stable funding stream, and improving public awareness of NAS services.

Blockchain is a distributed ledger technology for storing and transmitting information (value) that is secure, verifiable, and auditable. Two specific use-case opportunities exist, identity management and payment systems.

A secure and auditable solution for disaster refugee support.

Gap analysis, literature search, and synthesis using existing technologies.

Strategy foundation: A blockchain identity management system that utilizes the Hyperledger Fabric framework; identification on a large scale, in a distributed model that provides immutable record capabilities to prevent fraud, with the ability to incorporate biometrics and DNA; deploy applications that will provide supply-chain capabilities; cryptocurrency for recipients and other relief functions for refugees/disaster victims; components such as consensus, membership services, and Smart Contracts; cloud-based, with redundancies in multiple vendors and additional complex government cloud requirements/certifications, leveraging NIST 800–53 by utilizing a hybrid public permissions architecture.

There are an estimated 68 million refugees worldwide at any time. Valid identification is needed by most refugees to qualify for government or international donor relief. That identification is crucial in getting refugees and victims access to the aid supply chain. Blockchain stores data on a large number of computer nodes connected over the Internet. Each node contains an identical copy that is time-stamped and protected by a cryptographic technique called hashing, and control is decentralized. This blockchain strategy will revolutionize the way the government manages the $30 billion in foreign aid to refugees. It will build upon the identities established to deploy applications that will provide supply-chain capabilities, cryptocurrency for recipients, and other relief functions for refugees/disaster victims. Stakeholders beyond government will also benefit tremendously. The distributed nature of our application will provide visibility to NGOs, nonprofits, host nation stakeholders, and other relief organizations. A single system that provides information to everyone involved will almost instantaneously change the face of relief.

The elderly have the highest rates of morbidity/mortality in a disaster and are therefore the most vulnerable. 50% of deaths in Hurricane Katrina were ≥75 years old. In the California wildfires, most deaths were people in their 70s and 80s living in areas with unreliable communication services (without cell phone service, etc.), and were uninformed of the disaster or unable and/or unwilling to evacuate. Issues include social isolation and limited technology skills (may not receive messages).

A review of the literature and after action reports from multiple disasters.

Augmented services are needed for persons with decreased mobility (impaired access to transportation and shelters); impaired senses; dependence on devices/technology, comorbidities requiring medications/equipment/oxygen, special feedings, sanitary/hygiene needs increased susceptibility to environmental extremes (heat, cold), inability to do ADLs (need for caregivers), increased susceptibility and increased morbidity/mortality with infections, illnesses, trauma; exacerbation of underlying conditions/illnesses when in crowded transportation vehicles and shelters. Additional stress may precipitate or exacerbate coping skills especially in those with dementia, delirium, or mental health illnesses.

Recommendations include the following:

1. 1. Communications: messages in various forms: closed captioning, TTY deaf phones, use of family, friends, neighbors, officials for notification in addition to mass communication notices, house-to-house notification.

2. 2. Medical: Medical/Special Needs Shelters to provide medical care (dialysis, etc.), cache of common medications (diabetic and BP medications) and devices (BP monitoring, glucometers), oxygen, wound care supplies, potable and non-potable water, special diets/formulas, feeding tubes, catheter care, diapers and other hygiene supplies.

3. 3. Independence: Health care professionals to assist with medical and psychiatric needs. Caregivers to assist with ADLs.

   4. Supervision: Those with dementia, delirium, mental health conditions may need supervision.

   5. Transportation: Need for ambulances, wheelchair vans, specially equipped buses/vans in addition to “usual” school buses/vans with access to water, food, and sanitation if traveling long distances.

Those residing in supervised facilities including nursing homes, mental health facilities, group homes, and penal institutions for health, legal, or security reasons present unique challenges in a disaster.

A review of the literature and after action reports on supervised and institutionalized populations in disasters.

Recommendations for supervised, institutionalized populations in a disaster include: (1.) preplanned agreements for specialized transportation if needed; (2.) reciprocal agreements between similar facilities (nursing home with another nursing home, prison with other prison, dialysis centers, etc.) for resource sharing; (3.) arrangements for sharing and emergency privileging of personnel in institutions that are not their primary workplace; (4.) just-in-time training for appropriate volunteers; and (5.) accommodations for family members if personnel are to be available during a disaster.

Individuals in some institutions need a personalized disaster plan with pertinent data: next of kin with contact information, medical records, care providers and care plan to accompany a mobilized individual. Long-term care and housing may be needed if the institution is nonfunctional. Dealing with medical and behavioral issues is secondary to the disaster. Chronic issues must be considered as well.

Discussion: Caring for specialized, institutional individuals is complex and difficult. Comprehensive pre-disaster planning can mitigate the effects of the disaster.

Public health (PH) and nursing students are an underutilized demographic in disaster response. Knowledge of the disaster response phase may enhance student understanding of preparedness, and provide response capabilities.

A single four-hour simulation-based training session, with toxicologists as instructors, can effectively improve PH and nursing student knowledge and skills in chemical and radiation response, despite minimal prior experience.

A convenience sample was used to test PH and nursing students in a response training program. An introductory lecture and simulation training reviewed: mass casualty care, triage, personal protective equipment, decontamination, and chemical and radiation exposure toxidromes. An examination was administered pre-training, and then post-training, to evaluate relevant training, knowledge, risk perception, and comfort in response capabilities to chemical and radiation incidents.

Forty-two students attended the course; 39 were included in the study. Seventy-two percent (n=28) of participants had no prior disaster training. Overall, there were significant differences between the pre-test and post-test scores for all students [95% CI: 5.4 (4.7-6.1); p<0.0001, paired t-test]; maximum score 15/15. Comparing scores of nursing and PH students, despite statistical difference in pre-test scores (median, IQR: 9.0 (7.5-10±2.0); 7.0 (5.7-9.0) respectively; p=0.048, Mann Whitney U-test), there were no statistical differences in post-test scores (median, IQR: 14.0 (13.0-14.0); 13.0 (12.0-14.0), respectively, Mann Whitney U-test). All students recognized nerve agent toxidrome and performed SALT triage after the training (p <0.0001, McNemar test). Subjectively, participant comfort level in responding to a chemical or radiological incident improved (p <0.0001, McNemar test). Individual risk perception for chemical or radiological disasters did not improve after training.

Improvement of knowledge and comfort was demonstrated, irrespective of previous experience. Simulation-based training of chemical and radiation disaster preparedness, led by medical toxicologists, is an effective means of educating PH and nursing students, with minimal prior fluency.

There are many database sets and websites which provide chemical information, but they do not perform an adequate role for emergency medical support in a chemical disaster.

To make the basis of a chemical emergency medical information system.

We reviewed the database sets, mobile applications and websites in the world which provide chemical database and emergency medical response information from a chemical accident or disaster site to hospitals. Also, we examined chemical accident cases which developed during disasters. A chemical database set for emergency medical response was proposed and the algorithm for elicitation of chemicals suitable for emergency medical response and information providing. We performed a survey about chemical emergency medical information system to related personnel.

By four steps of elicitation of chemicals, the number of chemicals more than 100,000 was decreased to less than 1,000. The standard of steps includes accident preparedness, toxicity and circulating amount and expert consultation. Algorithm for elicitation of chemicals was made and 82% of related personnel supported the chemical emergency response algorithm. The emergency medical real-time consultation system for chemical disaster was placed under control of the call center.

When mass exposure by toxic chemicals occurs, the chemical emergency medical information system will be helpful for acute identification of chemicals, protection of related personnel and emergency medical response. Also, it can be possible to guide citizens immediately in case of a chemical disaster.

Muhammadiyah, the Indonesia non-governmental organization (NGO), has more than 300 hospitals. It is one of the forerunners of the Safe Hospital Initiative in Indonesia beginning in 2008. Muhammadiyah realized that hospital strengthening must be done in collaboration with community strengthening. From 2016 to 2018, Muhammadiyah ran a program named Hospital Preparedness and Community Readiness for Emergency and Disaster (HPCRED) that was carried out through strengthening two hospitals and their surrounding communities in Palangka Raya, Central Kalimantan, and Bima, West Nusa Tenggara (NTB). This program was funded by the Australian Government and is in line with the Safe Hospital Comprehensive Framework of the World Health Organization (WHO).

To strengthen hospitals and the surrounding communities to prepare for emergencies and disasters.

HPCRED completed 92 activities in two areas consisting of the following: 10 training, 26 workshops, 12 exercises, four monitoring and evaluation meetings, and seven technical sessions/seminars. The exercises consisted of tabletop exercises, skill drills, command post exercise, and full-scale exercise.

There were positive changes in the hospitals and communities particularly on disaster management, policy, procedures, staff and community skills, knowledge, and behavior. The integration and collaboration between the hospital surrounding communities were established and can be examined by documents, agreements, and activities done together between the hospital and community during and after the program.

Before the program, hospitals were not ready to face disasters. PKU Bima Hospital collapsed during a flash flood in December 2016. The community, to save housing from water, hollowed the hospital wall out causing water entrance into the hospital. It meant there were no communication and coordination between the hospital and its community. HPCRED not only made them communicate and coordinate but also collaborate and cooperate to reduce risks and response disasters such as responding Lombok Earthquake in July 2018.

Electronic Dance Music events (EDMs) are complex mass gatherings and given published rates of illnesses, injuries, and hospitalizations, these events can place an additional burden on local health care services. Accordingly, during the planning process for EDMs many stakeholders are involved; however, local hospitals, a key part of the medical safety plan, are often excluded. In this case report, it is posited that the involvement of local hospital(s) and the resulting integration of on-site and acute-care service provision during an event, ultimately reduces the burden placed on local hospitals.

Case report; synthesis of published literature.

A 25,000 person per day, two-day mass gathering EDM event trialed a model of collaborative planning with a local community hospital. Planning included the identification of a hospital liaison, pre-event teleconferences between event staff, contracted and public medical response teams, emergency management teams, harm reduction practitioners, public health, and hospital personnel. Throughout the collaborative planning process, vital information was shared in order to optimize patient continuity of care and streamline the transition of care from site medical response to an acute care setting. Outcomes included the prevention of unnecessary transfers to the hospital; however, those patients who required transfer had their initial treatment started prior to leaving the venue. Further, collaborative planning also contributed to improved bidirectional data sharing to better understand the impact on the local hospital of the event, including transfers from the onsite medical team as well as transports from the community and self-presentations for care.

The collaboration of onsite medical and hospital teams improved the delivery of essential medical care to the patrons of the event and added a layer to the safety planning process essential to mass gathering events.

Currently, there are no universally accepted personal protective equipment (PPE) training guidelines for Emergency Medicine physicians, though many hospitals offer training through a brief didactic presentation. Physicians’ response to hazmat events requires PPE utilization to ensure the safety of victims, facilities, and providers; providing effective and accessible training is crucial. In the event of a real disaster, time constraints may not allow a brief in-person presentation and an accessible video training may be the only resource available.

To assess the effectiveness of video versus in-person training of 20 Emergency Medicine Residents in Level C PPE donning and doffing (chemical-resistant coverall, butyl gloves, boots, and an air-purifying respirator).

A prospective observational study was performed with 20 Emergency Medicine residents as part of Emergency Preparedness training. Residents were divided into two groups, with Group A viewing a demonstration video developed by the emergency preparedness team, and Group B receiving in-person training by a Hazmat Team Member. Evaluators assessed critical tasks of donning and doffing PPE utilizing a prepared evaluation tool. At the drill’s conclusion, all participants completed a self-evaluation to determine their confidence in their respective trainings.

Both video and in-person training modalities showed significant improvement in participants’ confidence in doffing and donning a PPE suit (p>0.05). However, no statistically significant difference was seen between training modalities in the performance of donning or doffing (p>0.05).

Video and in-person training are equally effective in preparing residents for donning and doffing Level C PPE, with similar error rates in both modalities. Future trainings should focus on decreasing the overall rate of breaches across all training modalities.

Compared with traditional START Triage Method, the Sacco Triage Method is a new way to access death risk in disaster scenes. However, due to the difficulties in disaster medical research, there is still no evidence to prove which one is more effective.

To assess and compare the value of START Triage Method and Sacco Triage Method in the death risk assessment of transport and the one-month death risk assessment of the earthquake mass trauma patients.

A retrospective analysis was conducted on 1,612 patients who were transferred to the West China Hospital by assigning to different triage levels by Sacco Triage Method and START Triage Method respectively. Both of the triage methods were evaluated based on death cases on either during transport or in the emergency department, using the area under the receiver-operator curve.

For death during the transport and in the emergency department, the receiver-operator curve of two groups reflected as 0.721 and 0.649. For death in a consequence, the receiver-operator curve of the two groups was revealed as 0.667 and 0.519.

As an accurate triage method, the Sacco Triage Method may be used in a mass casualty incident. It is a more effective way than the START Triage Method for the evaluation of death risk assessment of the mass trauma patients.

Traumatic brain injury (TBI) is an important public health concern because of the high mortality rate of young people and a high proportion among the trauma. According to studies, patients visiting the emergency department (ED) with TBI comprise 1.4% of all ED patients.

The authors think that the characteristics of patients with TBI will vary according to the age group. Therefore, the purpose of this study is to investigate the clinical and social characteristics of patients with TBI visiting the ED by age group.

Trauma patients who conducted brain CT at the ED of Korean University Hospital (three hospitals) for 3 years from March 2013 to February 2016 were enrolled. Medical records were investigated retrospectively. The GCS scores were estimated at initial ED arrival. The primary outcome was to determine the characteristics of each age groups with gender, severity (by GSC score), trauma mechanism, and admission rate.

A total of 15,567 TBI patients received brain CT evaluation during the investigation period. Based on age, patients in their 50s were the most common (16.5%). Regarding the severity, the ratio of mild was higher in under patients under 9 (99.3%); the ratio of severe was higher for patients in their 20s (4.6%). In almost every age group, the male ratio of TBI was higher, except for females aged 70 or older. Under 19 years of age, the ambulance utilization rate was lower than any other age group. The most common injury mechanism was a collision, the next was a traffic accident, and in under 9, a fall was the most common. 70.1% of patients returned home after treatments.

Identifying the characteristics of patients with TBI visiting ED is fundamental. Therefore, it is necessary to continuously collect basic data on TBI among patients visiting the ED.

Personal protective equipment (PPE) is a necessary item in the period of unknown and high-risk emerging infectious disease. It is not only the necessary requirement of strict isolation, but also the last line of defense to protect medical staff.

Compare the differences between contaminated frequency and sites under two types of PPE doffing.

Recruited 56 health care workers (HCWs) who worked in clinical to follow the different PPE removal guidelines issued by the Chinese Center for Disease Control (CDC) and the World Health Organization (WHO) final resolution for preventing Ebola virus. Eight batches of HCWs were divided to conduct simulations of contaminated PPE removal using fluorescent lotion (Glitter Bug Potion, On Solution Pty Lt). Then we recorded the frequency and sites of contamination of personnel after removal of contaminated PPE by the method of visual observation.

According to China’s CDC process, the parts that are easily contaminated during PPE removal are: left hand and wrist (7 times), left calf (7 times), front chest center and left and right chest (6 times each) and left abdomen (5 times). Contaminated parts of the PPE process in accordance with the WHO process from high to low were: right hand and wrist (13 times), left hand and wrist (12 times), middle of the abdomen (10 times), left chest (9 times), and left abdomen (6 Times). There was no statistical difference between the two kinds of PPE piercing and removal (Z=1.177, P > 0. 05).

Under the guidance of the two processes recommended by China CDC and WHO, there was no significant difference in the frequency of pollution after removing PPE. It is speculated that the PPE recommendation processes issued by WHO and China CDC are effective for personal protection against fulminating infectious diseases.

Trauma bypass has been introduced successfully worldwide with sustained reductions in mortality/morbidity. Analyzing structure, process, and outcome individually and collectively in systems has been found to focus improvement efforts in the audit cycle. The second Irish report on Major Trauma Audit (MTA) was published in December 2017. The median age of trauma patients in Ireland was 59, indicating an aging trauma population. 28% of patients required secondary transfer to complete their care. The mortality rate for 2016 was only 4%.

To determine the ability of a road-based EMS system to bring patients from areas of Wexford County to proposed receiving centers within 60-90 minutes.

Analysis took population centers in Wexford County, used Google Maps to estimate travel times at 3pm on a weekday, and proposed new trauma units and centers in Dublin, Cork, and Waterford.

In Wexford County urban centers, >95% of patients will not reach a trauma unit in less than 60 minutes with current prehospital medical service capabilities. This even excludes response/on-scene time by prehospital practitioners in land-based EMS vehicles.

The proposed introduction of trauma bypass systems in Ireland should not disenfranchise patients with respect to the standards they are currently receiving. Gap analysis suggests considerable work is required within the ambulance service to increase critical skill levels of paramedics to support critical patients in the golden hour of their transfer. An increase in vehicles/resources will be required to ensure adequate staffing to meet Health Information and Quality Authority (HIQA) targets of 8 and 19 minutes for response acuity, and for longer durations of transport allied to dynamic resource deployment model as used by National Emergency Operations Centre (NEOC). Unintended consequences of system changes will need to be monitored carefully to avoid further adversely impacting recruitment of staff to bypassed Model 3 hospitals.

Disasters are unique in that they impact all socioeconomic, class, and social divides. They are complex, hard to conceptualize and operationally define, and occur sporadically without warning. However, regardless of each disasters innate unpredictability, there is one common need that directly impacts patient morbidity and mortality: effective triage.

Currently the United States has no uniform triage mandate. The purpose of this study is to gather descriptive data on the type of mass-casualty triage currently being utilized by first responders (Emergency Medical Services/Fire/Nurses) and improve our understanding regarding the prevalence of mass casualty triage.

A descriptive mixed methods survey is being distributed to first responders/nurses in the Appalachian region. This survey collects respondents demographics, profession, and MCI triage data. Data will be analyzed and descriptive statistics will be generated. GIS will be utilized to graph findings and visualize local and national trends.

Results of this study are pending.

Organizations have addressed the need for a standard triage protocol, even going so far as to create uniform criteria which each triage system should meet. However, the literature does not describe how individual professions train their members in disaster triage, or what triage is currently being utilized in each profession. Nurses and first-responders serve as linchpins in many communities. They remain in a community, both before, during, and after a mass casualty event, but they do not perform in a vacuum. During an MCI (mass-casualty incident) their scope of practice may vary, but they have common foci: the affected community. A better understanding of the type of MCI triage that each profession is using is vital in understanding how triage is being applied, and vital in identifying gaps in application that may impact the effectiveness of field triage, and affect local and national policy, practice, and future research.

Unpredictable events, such as disasters, can change the organizational configuration of health facilities. In a situation of multiple victims, this scenario modifies the flow of care to adapt to the reality that is there. In addition, emergency and emergency units provide immediate care to maintain and preserve the lives of these victims, making it a challenge for all health professionals.

To construct an Operational Protocol for nursing care with multiple victims and disasters in a Hospital Emergency and Emergency Service.

We used a descriptive study with a qualitative approach using the Focal Group technique (GF). The participants included nursing staff and residents who work in the emergency and emergency unit in a hospital in the south of Brazil. The topics from the GF discussion were analyzed by the scientific content of Minayo (2013).

The operational assistance protocol for multiple victims and disasters was planned with a redistribution of materials, equipment, human resources of the service, and physical restructuring of the service and other units with the construction of a flow chart to meet the proposed demand.

In the study, we observed the importance of discussing and planning proposals for care with multiple victims. In addition, the interest of the participants was fundamental to the success of this protocol. This protocol serves as an incentive for nursing professionals and academics for future research that evaluates the effectiveness of using nursing competencies to assist multiple victims in emergency and disaster situations.

Disasters disturb the balance of medical supply and demand. Because normal supply chains break down in the wake of disasters, it is difficult to deliver daily necessities to affected areas. In addition, without a reliable supply of medical equipment and medicines, the number of sick and injured patients increases.

We propose that emergency medical teams should bring medical equipment and daily necessities when responding to disasters.

The Social Emergency Management Alliance (SEMA) was established in 2017. SEMA is a cooperative system between NGOs and the private sector for disaster relief in Japan. Humanitarian Medical Assistance (HuMA) utilized this system to provide emergency medical assistance during the Western Japan Floods in 2018.

After the flooding, increased amounts of dust caused many cases of conjunctivitis. There were also numerous cases of heat stroke and dehydration, especially in the elderly. We requested SEMA to bring eye drops to wash out dust and isotonic drinks to prevent dehydration and heat stroke to Mabi Town, Okayama. SEMA coordinated with the private sector to provide eye drops and isotonic drinks via a forwarding agent, and we were able to distribute them to affected people and prevent worsening disease.

NGOs working within affected areas can assess the exact needs of affected people in order to avoid waste. Such collaboration through SEMA will allow for more effective disaster relief in the future. It is our hope that more private companies join SEMA to reduce the suffering of disaster victims.

Information systems (IS) have facilitated workflow in the health care system for years. However, the utilization of IS in disaster medical assistance teams (DMATs) has been less studied.

In Taiwan, we started a program in 2008 to build up an information system, MEDical Assistance and Information Dashboard (MED-AID), to improve the capability and increase the efficiency of our national DMAT.

Method: The mission of our national DMAT was to provide acute trauma care and subacute outpatient care in the field after an emergency event (e.g., earthquakes). We built the IS through a user-oriented process to fit the need of the DMAT. We first analyzed the response work in the DMAT missions and reviewed the current paperwork. We evaluated the eligibility and effectiveness of the core functions of DMATs by experts in Taiwan and then developed the IS. The IS was then tested and revised each year in two table-top exercises and one regional full-scale exercise by the DMAT staffs who came from different hospitals in Taiwan.

During the past 10 years, we identified several core concepts of IS of DMAT: patient tracking, medical record, continuity of care, integration of referral resources, disease surveillance, patient information reporting, and medical resources management. The application of the IS facilitate the DMAT in providing safe patient care with continuous recording and integrate patient referral resources based on geographic information. The IS also help the planning in real-time disease surveillance and logistic function in the medical resources monitoring.

Information systems could facilitate patient care and relieve the workload on information analysis and resources management for DMATs.

The literature on mass gatherings has expanded over the last decade. However, no readily accessible curriculum exists to prepare and support event medical leaders. Such a curriculum has the potential to align event medical professionals on improving event safety, standardizing emergency response, and reducing community impacts.

We organized collaborative expert focus groups on the proposed “core curriculum” and “electives.”

Key features of a mass gathering medical curriculum include operations-focused, evidence-informed, best-known practices offered via low barrier, modular, flexible formats with interactive options, and a multi-national focus.

Core content proposed:

• Background (Definitions, Context, Risk, Legalities)

• Event Medical Planning - “The Seven Steps” - (1.) Assessment and Environmental Scan - Event Emergency Action Plan, (2.) Human Resources, (3.) Equipment/Supplies, (4.) Infrastructure/Logistics, (5.) Transportation (To, On, From), (6.)

  Communication (Pre, During, Post), and (7.) Administration/Medical Direction

• Event After-Action Reporting

• Case-based Activities

Electives mirror Core outline and serve as expanded case-studies of specific event categories. Initially proposed electives include:

• Concerts/Music Festivals

• Running Events

• Cycling Events

• Multi-Sport Events

• Obstacle Adventure Courses

• Staged Wilderness Courses

• Amateur Games

• Political Gatherings & Orations

• Religious Gatherings & Pilgrimages

• Community Gatherings (e.g., Parades, Fireworks, etc.)

Complex team learning to standardize real-world approaches has been accomplished in other medical domains (e.g., ACLS, AHLS, ATLS, PALS, etc.). A course for event medicine should not re-teach medical content (i.e. first aid, paramedicine, nursing, medicine); it should make available a commonly understood, systematic approach to planning, execution, and post-event evaluation vis a vis health services at events. A ‘train the trainer’ model will be required, with business operations support for sustainable course delivery. The author team seeks community feedback at WCDEM 2019 in creating ‘the ACLS’ of Event Medicine.