There has been a dramatic increase in the number of mass shootings (loosely defined as an incident with four or more indiscriminate victims) in the United States (1). Additionally, the use of high-caliber, military-style weapons, has become more common in civilian shootings. These trends should influence how emergency departments prepare for disasters, including an inventory of what critical care medical materials (supplies) are readily available in the event of a disaster.

To demonstrate the need for the adoption of medical materials planning for disasters to account for new injury patterns from mass shootings.

A review of injury patterns from recent mass shootings was conducted using available literature (2). The average number of victims presenting to the emergency department in these events was reviewed. Estimation of critical care specific medical materials in the emergency department required for the management of an “average” number of victims with the typical injury pattern of these events was conducted.

Some critical care specific medical materials: intubation equipment, chest tubes, and central venous catheters may be in short supply during a mass shooting event.

Emergency physicians must anticipate and prepare for new disaster trends such as mass shootings and high caliber weapons injuries. This includes having specialty medical supplies readily available in sufficient amount. Normal stocking of critical care specific medical materials may be inadequate in a mass shooting event based on the available literature.

Saudi Arabia, the largest country in the Middle East, has suffered numerous terrorist attacks and is the location of Hajj, one of the world’s largest annual mass gatherings. Healthcare providers’ pre-incident knowledge and understanding of basic disaster medicine (DM) concepts are crucial for a unified and effective health-system response. Introducing healthcare providers to best practices is a stated vision of the Saudi Commission for Health Specialties. Standardizing DM curriculum taught to physicians during their residency training will assist this goal.

To produce expert consensus on the most critical DM topics for the residency curriculum in emergency medicine (EM) in the Kingdom of Saudi Arabia.

Utilizing a Delphi approach, a panel of Saudi Arabian experts in DM and EM residency directors were surveyed regarding potential DM topics for EM residency curricula. The first round comprised of open-ended questions seeking lists of suggested DM curriculum topics. In subsequent rounds, each participant received a questionnaire asking them to review the items contributed in the first round, summarized by the investigation team. The participants rated each item on a five-point Likert Scale to establish preliminary priorities and added their comments. In further rounds, participants reviewed and prioritized subjects until they reached a consensus of >=80%.

The study is ongoing and full data will be available in the new year.

This expert consensus from major stakeholders can be used to improve the foundation of the DM curriculum. The Delphi Method gives an evidence-based approach to identification and prioritization of subjects, which should be integrated within the Saudi Arabian Emergency Medicine Residency Curriculum. It also can be used as a cornerstone for implementation in other medical education programs across the Kingdom in the future.

Providing culturally sensitive disaster nursing is essential to enhance survivors’ resilience, especially in Pacific Rim island countries, which are home to 80% of the disaster victims of the world. Until now, most studies have focused on immigrant culture or language, and few have explored the idea of disaster nursing adjusted to the affected area’s culture.

The study explores public health nurses’ (PHNs) tacit knowledge regarding culturally sensitive disaster nursing focusing on the Pacific Rim island countries. This first report is the result of the study that clarified how Japanese PHNs, as relief nurses, considered the local culture to provide care to survivors in Japan.

Study participants were nine PHNs from seven prefectures, who provided care to survivors of natural disasters that occurred in 2011–2017 in Japan. Semi-structured interviews were conducted with questions such as, “Which culture did you consider while providing care to survivors in each disaster phase?” Data were analyzed qualitatively and inductively and were sorted according to the four disaster phases. The study was approved by the ethical committee at the National Institution of Public Health.

In the acute phase, PHNs utilized close relationships between local residents and health care providers to collect information. They balanced local habits and the prevention of secondary health damage in the subacute phase; for example, balancing sanitation habits and prevention of contaminations. Additionally, they, as strangers to the community, played a role in alleviating tensions between residents under stress. During the recovery phase, they strengthened survivors’ attachment to the area.

PHNs dispatched from the outside of the affected areas must be culturally malleable to adjust their practice to the local context. Being strangers in an affected area can be advantageous if they utilize their position effectively.

There was no common medical record used in disasters in Japan. At the 2011 Great East Japan Earthquake, medical teams used their own medical records instead of a unified format and operational rules. As a result, confusion occurred at the clinical practice site. The Joint Committee on Medical Records proposed a standard format of disaster medical records in February 2015. The Ministry of Health, Labor, and Welfare has issued the notification of states’ use of a standardized medical record for disaster in 2017. It was confirmed that standardized disaster medical records were used by each organization in the 2018 Western Japan torrential rain disaster and the Hokkaido Iburi Eastern Earthquake, but the actual condition of those records was not clarified.

We sent a questionnaire to the local governments where the medical team worked in 2018 Western Japan torrential rain disaster and the Hokkaido Iburi Eastern Earthquake. In the questionnaire, we asked about the operation and management of standardized disaster medical records at the time of the disaster and also questioned future management methods.

There was no use of other medical records. Standardized medical records were used in all records. All records were managed and operated by the disaster medical headquarters responsible for health care and welfare. Standardized disaster medical records were recorded on paper. Evacuees included patients who moved from shelter to shelter or to temporary housing to get better living conditions. That created difficulties transferring records since it was recorded on paper and stored in medical headquarters. Some returning patients were checked by several medical teams, resulting in the creation of several medical records of the same patient’s condition. Future improvements and management of the recording process and record-keeping are required.

In September 2017, Hurricane Maria devastated Puerto Rico’s health care infrastructure. To meet the demands of ongoing primary care and medical emergencies, Federal Medical Shelters (FMS) were set up to serve local communities for the weeks after the hurricane. A team of health professionals from New York assisted federal authorities in the provision of healthcare in the FMS.

To describe the population of patients requesting medical care in the aftermath of Hurricane Maria at FMS Manati and to categorize the range of problems faced by patients after the hurricane, and examine how this changed longitudinally over the course of the operation.

Researchers collected basic data of patients at presentation to the FMS. Descriptive analyses were performed of the patient population and nature of presenting illnesses. Chi-squared analysis was performed to compare the change over time of presenting complaints. Ethics approval was granted by Columbia University.

Data was collected for a two-week period approximately three weeks after the hurricane made landfall. The FMS saw 2,154 patients over a 14-day period. The population of patients (median age = 43 years [IQR 39 years]) assessed was bimodal in distribution, with one peak in children at 1 year. A second peak occurred at age 53 years. 60.2% of presenting complaints were infection- or chronic disease-related. Musculoskeletal complaints were the third most common. Chi-squared tests revealed no statistically significant change in the frequency of specific types of complaints between the start and end of data collection.

In the weeks after Hurricane Maria, infants and elderly were seen to predominantly seek medical care. Likely related to the collapse of the healthcare infrastructure, there was a high prevalence of infection-related and chronic medical conditions. The data support the need to focus resources to treat vulnerable populations, infectious issues, and chronic medical conditions.

The effort of medical and health services distribution requires data. However, the data and information were ignored in an emergency situation. For improving the distribution of data and information, the Center of Health Policy and Management, Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada (UGM) developed forms based on Health Crisis Response Guideline by Ministry of Health 2016 and the World Health Organization (WHO).

Describing the implementation and development of forms based on Lombok and Central Sulawesi earthquake in 2018 for health cluster.

The form contains (1) a volunteer registration form; (2) a monitoring potential outbreak disease form; (3) health problem in health cluster daily report form; (4) a chronological situation form. This will be implemented in health policymaking by the Sulawesi district health office (DHO) and will be regularly analyzed in every week.

North Lombok DHO, Central Sulawesi health office, and volunteers accepted these forms well. Periodically volunteers had reported their activity to DHO. All these reports contain many health indicators including environmental health. Reproductive health and health promotion. Implementation of this form in the other type of disaster in Indonesia is suggested.

First, these forms are important to attach to the guideline of health crisis response in order to be accessed by all DHO. Second, all forms are printed documents. It needs to develop into data input and analysis applications.

Vehicles stranded in rising water account for the majority of swiftwater rescues (SWR) during urban and small stream flash flooding. Multiple simultaneous SWR incidents are commonplace during severe storms. Historically, SWR teams have pursued a “reach, throw, row, go” strategy. However, reach and throw attempts are usually futile. Boat operations and/or in-water rescue attempts can be technically complicated, time-consuming, and a drain on rescuer resources.

To design an ideal SWR modality for use during urban and small stream roadway flooding.

SWR objectives, strategy, and tactics were mapped against various transportation modalities to develop the safest solution for urban and small stream flood response.

High water vehicles (HWV), such as the “deuce and a half” 6 × 6 military truck, represent a new standard for SWR practicality and safety as they can reduce rescuer time in-water. HWVs are heavy and high enough to be stable on roadways in most flash flooding conditions. A properly designed emergency response package includes a fording kit, multi-directional floodlights for nighttime operations, public safety radios, and a siren that doubles as a public address system to coach victims as a rescue is initiated. Deployable ladders enable rescuer egress from and victim access to a covered lighted cargo bed that holds PPE, throw bags, and rescue rings; a deployable “boat in a bag” for victims who require ferrying; and a heated seating area where medical evaluation can be conducted while staying dry.

SWRs are dangerous resource-intensive incidents which account for more rescuer morbidity/mortality than all other technical rescue sub-types combined. These incidents will increase in frequency and severity worldwide due to climate change and overdevelopment. If rescue conditions are still tenable, HWVs are the most efficient and effective platform for conducting SWR from flooded roadways while decreasing safety risks to first responders and victims.

In the Netherlands, we started in 2016 with a new procedure for large scale medical assistance during a crisis. The normal daily assistance in the Netherlands is organized on a regional level, and we have 25 regions. These regions are far too small to handle big incidents, and cooperation is needed on a higher level to generate enough capacity. However, the Aim is that most emergency workers continue to do their own work in standard procedures, we also need more coordination, information management, transition of “stay and play” to “scoop and run” and deploying volunteers and citizens.

We developed the model practice-based, however, we have little big incidents. We feel the urgency to compare this practice to international knowledge.

The goal is twofold: validation of the starting points of our model, but also further improvement: speeding up the transport and treatment of patients, improvement of capacity, safety of the ambulance staff – especially with terrorist attacks or contamination, civil participation. We held the first survey on scientific literature in English, related to items in our prehospital assistance model. (the article is not yet published).

The conclusion was, that scientific articles are rare, however, a lot of information is given about the practical course of incidents. Scientific research to explore these experiences is rare, partly due to a missing universal terminology on disaster medicine.

We want to contribute to enlarging the scientific knowledge on large scale prehospital assistance. We expect that a lot of practical experience can be unlocked by bringing together experts in this field. We want to present the Dutch model, with a focus and invitation to compare this with the models in other countries, to compare experiences, to deepen them and to stimulate international research. We want to commit ourselves to facilitate this.

Risk assessment for mass gatherings (MGs) is undertaken to enable public health authorities to systematically identify and assess the generic characteristics of an MG, which introduce or enhance particular threats and develop measures to reduce or mitigate these threats. The World Health Organization Collaborating Centres on Mass Gatherings and Global Health Security (WHO CCs) produced a comprehensive guide to MGs called “Public Health for Mass Gatherings: Key Considerations” (KC2). This is being converted into an eLearning resource. A public health risk assessment toolkit is being developed by the WHO CCs to complement and guide organizers in their planning process for the health risks associated with an MG event. Preparations for the Birmingham 2022 Commonwealth Games (BCG) are underway and it is important to involve a public health element in the planning for the BCG.

To develop a public health risk assessment toolkit for MGs and pilot it as part of the planning process for the BCG.

Based on KC2 principles, methods included developing and finalizing a public health risk assessment toolkit for MGs. This study also piloted the toolkit for the BCG.

A toolkit will be developed. Key learning will be documented on how the toolkit can be improved. The pilot will identify the key public health risks for the BCG, and assess how to mitigate them.

The development of this toolkit will be an innovative contribution to the resources available for those organizing MGs. It will support organizers to conduct risk assessments and thus maximize the potential for health from the event. Piloting the toolkit for the BCG is an opportunity for validating it, and provides valuable learning for its use in future events. It will support the risk assessment process for the BCG and share learning regarding the key risks for this event.

Disaster Medicine (DM) is a discipline arising from the marriage of emergency medicine and disaster management. The importance of DM has recently increased, with current wildfire situations throughout the world being examples of mass scale disasters with significant human morbidity and mortality. DM deals with preparedness, mitigation, response, recovery, and prevention of disasters (1).

To develop an educational strategy and reusable format for delivering undergraduate DM courses online. Man-made, weather-related, humanitarian, and technological disasters occur all around the globe annually, yet the majority of medical schools do not have an undergraduate DM program. This project developed an online course structure accessible to medical schools and students throughout the world.

Learning theories and models of learning were used to construct a course layout that encouraged students to be active learners, developed long-term retention strategies, and facilitated assessment for and of learning. This was accomplished through innovative educational modalities, including novel apps and external online resources. The course focuses heavily on outcome-based education with an emphasis on the development of applicable skills. Each lecture is divided into a series of learning objectives to allow students to master concepts sequentially, followed by questions to make use of the “testing effect” (2).

Focused review of current medical education literature reveals that students learn best when given short, outcome-focused “mini-lectures” followed by low-stakes assessment and feedback.

Medical schools without trained DM staff now have access to expert online material developed by educationalists with a focus on skills and knowledge retention.

The underground mining industry has one of the most hazardous industrial occupations, and requires an increased level of preparedness for injury incidents. The most important outcome for seriously injured victims is the reduction in morbidity and mortality. Receiving effective and timely care may mean the difference between life and death. However, mines are usually located in a rural area and the incident site may be deep underground which makes it an extraordinary challenge for the rescue services. A successful rescue response in an extraordinary milieu demands a high level of inter-organizational cooperation skills at the incident site.

To analyze statements of collaborate activities during a major incident exercise in the underground mine industry, essentially for patient outcome.

A Delphi technique was performed, asking opinions from experts in iterative rounds to generate, understand, and form consensus on group opinion around this complex issue. The experts were personnel from disaster medicine (n=3), emergency and prehospital medicine (n=10), rescue service (n=16), and mine industry (n=9), all with operative command positions.

Three iterative rounds were performed. The first round was conducted as a workshop to collect opinions about the most important inter-organization cooperation activities to optimize patient outcome from an injury incident in an underground mine. This resulted in 63 statements. The statements included information about: early alarm routines, collaborative support and efforts of early life-saving interventions, relevant resources and equipment, command and control room, and functions. In round two participants shared and communicated decisions about safety, situation awareness, and guidelines for response. All statements reached consensus among the experts in round three.

These inter-organizational statements are considered important by experts, and could be used to evaluate collaboration in major incident exercises. Hence, the statements can also be quality indicators for reporting results from major incident management.

In 2006, Japan DMORT was established by physicians, nurses, forensic pathologists, social workers, and a journalist (inspired by a major train crash in the previous year) to provide mental support to disaster victims’ families who had not received care. However, disaster victims’ identification and care of the families were monopolized by police in Japan. Also, our ‘study group’ status confused people who were affected by disasters.

To describe the development and future challenges of our association.

We developed our policy to focus on mental support through various activities such as the 11 closed seminars with disaster victims’ families, 21 training courses for disaster responders, and several workshops in medical or nursing conferences. In the Christchurch Earthquake, NZ (2011), with young Japanese casualties in a collapsed building, our core member reported the needs of families’ mental support, which showed the validity of our policy.

In the Great East Japan Earthquake (2011), we distributed mental health care manuals for disaster responders. In the landslides in Izu Oshima Island (2013), 3 members supported victims’ families through the town office. In the Kumamoto Earthquake (2016), two members made grief work on families of 17 victims at the prefectural police academy. These activities convinced the police of the need for medical/mental support and ourselves of the necessity for legal status. In 2017, we reorganized our association into an incorporated society. We also became official members of crime/disaster victims support liaison councils of two prefectures among 47 in Japan. In 2018, official agreements were made with the Hyogo prefectural police. But in the Heavy Rains and Flooding of July and in the Hokkaido Eastern Iburi Earthquake of September, the local police did not agree to accept us.

Official collaboration with police is essential nationwide in Japan. Further relief activities are expected.

South Korea experienced Middle East Respiratory Syndrome (MERS) outbreak in 2015. To mitigate the threat posed by MERS, the Ministry of Health and Center for Disease Control designated hospitals to be responsible for managing any suspected or confirmed infectious patient. These hospitals receive mandatory training in managing infectious patients, but many of the trainings lack practical skills practice and pandemic preparedness exercise.

To develop and evaluate a training course designed to train healthcare providers from designated hospitals to enhance their competencies in managing emerging infectious diseases and potential outbreaks.

A two-day course was developed by the Center for Disaster Relief, Training, and Research in collaboration with the Korea Health Promotion Institute using Kern’s 6-step approach. The course consisted of didactic lectures, technical skills training, tabletop simulation, and scenario-based simulation. Table-top simulation exercises consisted of cases involving a single infectious patient detected in the outpatient clinic and outbreak in the emergency department. Scenario-based simulation exercises involved managing a critically ill infectious patient in an isolated ward. A post-survey questionnaire was used to evaluate the course and assess the perception changes of the participants. All pre-to-post differences within subjects were analyzed with paired t-tests.

A total of 121 healthcare providers participated in three separate courses. The competencies for pandemic preparedness knowledge, skills, and attitude improved from pre- to post-course. The differences were all statistically significant (p<0.05). Overall course satisfaction in average for expectation, time, delivery method, and contents were 9.5, 9.2, 9.4, and 9.2, respectively.

There needs to be tests and exercises to recognize gaps of systems in place for pandemic preparedness. Simulation exercises are ideal tools for this purpose. Although this was only a two-day intensive course, this increased familiarity with workflows, tested the coordination of workflows between different disciplines and allowed the identification of gaps.

Assessing disaster preparedness in a given region is a complex problem. Current methods are often resource-intensive and may lack generalizability beyond a specific scenario. Computer-based stochastic simulations may be an additional method but would require systems that are valid, flexible, and easy to use. Emergo Train System (ETS) is an analog simulation system used for disaster preparedness assessments.

To digitalize the ETS model and develop stochastic simulation software for improved disaster preparedness assessments.

A simulation software was developed in C#. The simulation model was based on ETS. Preliminary verification and validation (V&V) tests were performed, including unit and integration testing, trace validation, and a comparison to a prior analog ETS disaster preparedness assessment exercise.

The software contains medically validated patients from ETS and is capable of automatically running disaster scenarios with stochastic variations in the injury panorama, available resources, geographical location, and other variables. It consists of two main programs: an editor where scenarios can be constructed and a simulation system to evaluate the outcome. Initial V&V testing showed that the software is reliable and internally consistent. The comparison to the analog exercise showed a general high agreement in terms of patient outcome. The analog exercise featured a train derailment with 397 injured, of which 45 patients suffered preventable death. In comparison, the computer simulation ran 100 iterations of the same scenario and indicated that a median of 41 patients (IQR 31 to 44) would suffer a preventable death.

Stochastic simulation methods can be a powerful complement to traditional capability assessments methods. The developed simulation software can be used for both assessing emergency preparedness with some validity and as a complement to analog capability assessment exercises, both as input and to validate results. Future work includes comparing the simulation to real disaster outcomes.

By prioritizing emergency patients, triage facilitates the timely provision of care to the largest possible number of patients arriving at an emergency room (ER). Previous triage methods include the Canadian and Japan Triage and Acuity Scales. Since these methods sort patients into five categories, multiple patients are often categorized into the same category. Furthermore, since these scales adopt original complex algorithms to determine the triage category, triage personnel need to be very familiar with the algorithm. Hence, a simple triage method is needed to prioritize ER patients.

To develop a new triage method to prioritize patients arriving at the ER.

Patients aged ≥13 years who arrived at the ER of Yodogawa Christian Hospital without being transported by ambulance between January 2016 and October 2018 were assessed. We analyzed correlations between the items included in the triage sheet and admission. We calculated risk ratios (RRs) of the items that were significantly related to admission. The RR of an item was considered its score, and the triage score was calculated by summing the individual RR scores for each patient. We performed receiver operating characteristic (ROC) analysis of admission and triage scores.

Among 20992 patients, 2030 patients (9.7%) were admitted to the hospital. The triage scores of all the patients ranged from 26.5 to 62.3. According to the ROC analysis, the area under the curve was 0.791 and the optimal cutoff value for the triage score was 32.7 (sensitivity: 0.74, specificity: 0.70).

Since this research was based on data from a Japanese secondary level emergency hospital in an urban area, our triage method can be adapted to the many ERs in Japan that share a similar background. The method used to develop this triage method can also be used to develop triage methods for ERs with different backgrounds.

Disasters are situations of complexity and unpredictability that require the performance of teams from various instances with preparation and qualification to assist the victims, recover the environment, and restore living conditions. Health services are essential in the response to a disaster, and nurses all over the world play a significant role in these disasters.

To develop a valid and reliable scale to identify nursing competencies in disasters.

Competencies were selected from those related to the framework developed by the International Council of Nurses. A methodological study was developed in two stages: I) validity of content and appearance verification and II) verification of applicability and reliability with test-retest. The participants of stage I were eight specialists in emergencies and disasters in Brazil. In stage II, 326 nurses from the Emergency Mobile Assistance Service in Southern Brazil participated. Data analysis utilized the Content Validity Index and Interest Reliability Index. Psychometric properties of the instrument were measured with Cronbach’s alpha coefficient; applicability and test-retest reliability with the use of the t-test and intraclass correlation coefficient and factorial validity.

Forty-one competencies of 51 were organized in three domains according to Factor Analysis. Cronbach’s alpha values showed good internal consistency. There was no significant difference between the test and retest scores. The intraclass correlation coefficient values were adequate. The instrument showed reproducibility and adequate applicability.

This tool will assess nurses’ competencies for disaster response and provide evidence for the development of educational policies in disasters, creating a reliable and prepared workforce to respond more effectively during a disaster.

Major earthquakes with a magnitude of 8-9 are anticipated to occur in the next 30 years at a 60 percent chance on the southern coast of Japan. Since the most part of our Prefecture is likely to be damaged by tsunami and landslides, residents are expected to take a self-reliant approach on the initial several days after the earthquakes and tsunami.

To improve the resilience of the local communities we have developed and applied an educational program of disaster response.

An active learning program was designed on roles of rescuers and sufferers, and conducted two-hour sessions for high school students using a scenario in which they encountered an earthquake during a field trip. Half of the participants were assigned to play students on a field trip and asked to discuss options as a small group to survive and secure their safety in an isolated situation after an earthquake. They exchanged ideas to stay alive, cooperate with local residents and request disaster assistance using very short radio messages to the appropriate counterpart. The other half of the participants were assigned to be school administrations and asked to estimate the situation of sufferers. Their task as a small group was to organize assistance based on the best assumption from the limited information of the isolated students and local villagers.

After the sessions, the participants expressed their discovery in the discrepancy of situational recognition between the two groups and they learned about assumption-based planning as well as good information sharing.

Through this program, the participants experienced simulated situations and learned perspectives from both sides; providing relief as rescuers and receiving aid as sufferers. The participants were motivated to share and utilize their knowledge and skills to make their community resilient to disasters.

The continuous development of the knowledge and skill of the emergency medical technicians (EMTs) in Ghana is important for the success of the pre-hospital system. Due to distance and time constraints, an online e-learning platform is a good way to educate the Emergency Medicine Technicians in Ghana.

The study looked at the feasibility of developing a distant learning module for the training and continuous medical education of EMTs.

EMTs in the Ashanti Region were randomly selected to be part of the study. They received online lectures and notes that were accessible by their mobile phones. They all received a test at the end of each model. The study measured their willingness to participate, average attendance for each model, and the scores for each model test. The study also measured the overall feasibility of the distant learning program.

The study developed a training course comprised of 7 modules: trauma and surgical emergencies, obstetric emergencies, pediatric emergencies, disaster management, medical emergencies, basic ultrasound, and medical research. Tests and quizzes were electronically sent to EMTs over the course of the research period, with an average test score of 70.14% (low: 35%, high: 95%) for the cohort. Feedback from participants showed gains in knowledge and skill delivery. The average attendance for all model was 56.6% ranging from 47.37%-63.16% for the models. Challenges for attendance included internet access, heavy duties, and other personal reasons. The post-training interview showed 100% willingness to participate in future online programs with the most common reasons stated as low cost, ease of attendance for models, and reduced expense.

The study concluded that online, distant learning models can be used in Ghana for training and continuous medical education for EMTs. It is an easy and cost-effective model compared to a face-to-face model.

The project was provided under the auspice and support of the Israel Agency for International Development Cooperation (MASHAV) at the Ministry of Foreign Affairs (MFA). Togo, one of the smallest and least developed countries in West Africa, has a population of ~7.9 million. About 65% of its population lives in rural areas. Due to the lack of medical resources, Togo suffers from health problems including those related to trauma and mass events. In May 2017, a trauma and disaster team came to Togo to train the medical team in the new trauma unit, donated and built by the MFA. The unit was built in the Atakpame Regional Hospital (ARH), located 160km north of the capital, Lomé. ARH serves one million inhabitants, mostly from rural areas.

The training included lectures, simulations, drills, case studies, bedside teaching, and operation of medical technologies.

Following the training, it was recommended to continue the program and to move forward with advanced training. Following the team’s recommendations, MASHAV decided to expand the program and to provide a multilateral project to Togo and ten other West African countries within five months after the first training ended. Twenty participants (mostly senior doctors) were chosen from ten Western African countries and brought to Lomé. The participants joined a two-day Trauma and Disaster Preparedness seminar. Following the seminar, they were moved to Atakpame to join the local team and the facilitators, to visit the trauma unit, and to learn about it as a model for trauma care that can be modified to the capabilities of the local facility.

Lessons learned and recommendations from those two projects were brought to the MFA that will try to develop more training and cooperation models to help and establish better trauma care and disaster response, supported by the Israeli team.

To evaluate the value of ultrasonic measurement of the respiratory variability of inferior vena cava (IVC) in the preoperative volume-response evaluation of elderly hip fracture patients.

Volume-loading tests were carried out in elderly patients with hip fractures requiring surgical treatment from August 2017 to February 2018. The maximum diameter (IVCe) and minimum diameter (IVCi) of the IVC were measured by ultrasound, and the variation of IVC (IVC-CI) was calculated before surgery. SV was monitored by a FloTrac/Vigileo system, and positive volume responsiveness was defined as ΔSV increasing by more than 15%. The sensitivity and specificity of IVC-CI to volume responsiveness evaluation was analyzed by ROC, and the correlation between IVC-CI and ΔSV was analyzed by Spearman correlation analysis.

Ultrasound measurements and volume-loading tests were successfully performed in 39 of the 44 patients. Among them 21 cases were volume responsiveness positive (group R) and 18 cases were volume responsiveness negative (group N). Before the volume-loading test, IVCi in group R was significantly smaller than group N and IVC-CI was significantly larger than group N (P<0.05), while the difference between IVCe and group N was not statistically significant (P>0.05). After the volume-loading test, the differences between IVCe, IVCi, IVC-CI, and group N were not statistically significant (P>0.05). Area under curve (AUC) of IVC-CI to assess volume responsiveness in geriatric hip fracture patients was 0.80±0.08 (0.65-0.95, P=0.001), with a 20.69% cut off value, 77.78% sensitivity, and 76.19% specificity. Through the Pearson correlation analysis, IVC-CI and Δ SV were positively correlated with the coefficient r = 0.367 (P<0.05).

As a rapid and noninvasive monitoring method, ultrasonic measurement of the respiratory variability of inferior vena cava in assessing the volume responsiveness of geriatric hip fracture patients can provide guidance for perioperative fluid management.