The basis of International Humanitarian Law (IHL) is the Theory of Natural Law, which states that the laws of morality and the ability to use reason in the determination of inalienable human rights, are innate to humans, and cannot be taken away by any states or laws. IHL is an agreement among nation-states that applies to situations of conflict to protect civilians and guides conduct in time of war. IHL extends protection to civilian medical personnel. The recent escalation in chemical weapons use by states has violated IHL and the 1997 Chemical Weapons Convention (CWC) treaty, with little repercussion from the international community.

We review the increase in chemical weapons use, international chemical weapon treaty violations, and violations of IHL against medical personnel.

A review was conducted of existing medical and grey literature for sources discussing chemical agents, their history, and violations of laws prohibiting their production, stockpiling, or use. The following publications were reviewed: PubMed, EBSCHost, and Google Scholar.

The use of sarin, chlorine, and mustard gas against civilians has been confirmed multiple times in Syria by the United Nations since 2011. Physicians for Human Rights mapped 537 attacks, both violent and chemical, against 348 different medical facilities in Syria from March 2011 to July 2018. Since March 2011, at least 847 civilian medical personnel have reportedly been killed. Many were killed by government forces as part of a war strategy creating further incapacitation. Most recently, Medecins Sans Frontiers concluded its Yemen mission due to repeated attacks, including two in one week in October 2018.

There must be recognition and emphasis on the health severity of such attacks and the violations of IHL and the CWC. Physicians must use their unique positions for advocacy and call for action in upholding international treaties.

The community-based integrated management of newborn and childhood illness (CBIMNCI) training package has been widely used throughout Nepal. Adding a component of disaster response and management to this program would greatly impact the community, and could improve the knowledge and skills of community workers for the management of children during a disaster.

Describe the development and implementation of a community-based training for children in disasters.

Using expertise from emergency and pediatric emergency physicians, pediatricians, and psychiatrists, we developed a two-day training and facilitator manual covering topics such as trauma, resuscitation, burn, drowning, disaster, nutrition, and care of the newborn. The information and manuals were presented to the Nepal Division of Child Health for approval. Four pilot trainings were conducted in Bardia and Bardibas in Nepal in September 2017, including knowledge and skill-based sessions. Knowledge was tested pre- and post-training using multiple choice questions (MCQ) and self-reflections. Skills were evaluated by direct observation and marked using a Likert scale. Confidence was assessed using a confidence matrix before and after the course. Overall feedback was taken at the end of the session.

Of 82 participants, 74 participants from four trainings were included for analysis. Post-test Cronbach’s alpha for MCQ was 0.82 and the confidence matrix was 0.86. Mean score for the pre-test MCQ was 6.12 (SD 2.22) compared to the post-test mean of 10.97 (SD 2.97), which was a statistically significant improvement (p<0.05). Trainees reported that the trauma teaching was helpful. They felt that it improved confidence regarding trauma and disasters.

Adding this training to current CBIMNCI can be an effective tool to reach out to primary health care workers, and provide further knowledge and skills on care of children during a disaster or humanitarian crisis.

The Rohingya refugee crisis in Bangladesh continues to overburden humanitarian resources and undermine the health and security of over 900,000 people. Spatial, sector-specific information is required to better understand the needs of vulnerable populations, such as women and girls, and to target interventions with improved efficiency and effectiveness.

The aim of this study was to create a gender-based vulnerability index and explore the geospatial and thematic variations in the gender-based vulnerability of Rohingya refugees residing in Bangladesh by utilizing pre-existing, open-source data.

Data sources included remotely-sensed REACH data on humanitarian infrastructure, UN Population Fund resource availability data, and the Needs and Population Monitoring Survey conducted by the International Organization for Migration in October 2017. Gaps in data were addressed through probabilistic interpolation. A vulnerability index was designed through a process of literature review, variable selection and thematic grouping, normalization, and scorecard creation. Pareto ranking was employed to rank sites based on vulnerability scoring. Spatial autocorrelation of vulnerability was analyzed with the Global and Anselin Local Moran’s I applied to both combined vulnerability index rank and disaggregated thematic ranking.

Twenty-four percent of settlements were ranked as most vulnerable, with 30 highly vulnerable clusters identified predominantly in the Upazila of Sadar. Five settlements in Dhokkin, Somitipara, and Pahartoli were categorized as less vulnerable outliers amongst highly vulnerable neighboring sites. Security- and health-related variables appear to be the largest drivers of gender-specific vulnerability in Cox’s Bazar. Clusters of low security and education vulnerability measures are shown near the refugee ingress point near Gundum.

The humanitarian space produces tremendous amounts of data that can be analyzed with spatial statistics to better target research and programmatic intervention. The critical utilization of these data and validation of vulnerability indexes is required to improve the international response to the global refugee crisis.

The need to use evidence in humanitarian settings is recognized, yet utilizing that evidence to make decisions about humanitarian response remains a challenge.

To identify how, when, and why decision makers in humanitarian response use scientific, peer-reviewed evidence to make decisions.

An online cross-sectional survey of fifteen open- and closed-ended questions on demographics, experience, and role in humanitarian response was developed by Evidence Aid (EA) and Karolinska Institutet (KI). The online survey was available on the EA website from August 2015 to October 2018. Participants were self-selected, recruited through social media channels and mailing lists of EA and KI. All respondents and responses were anonymized. Responses were analyzed with descriptive statistics and content analysis.

47 people responded, primarily working in Europe or North America with roles of humanitarian response director/manager, independent consultant, or policymaker. Personal assessment of the quality of information, trust in the source, and information that was contextually relevant or based on field experience were factors for deciding whether information should be considered evidence. Reasons for using evidence when making decisions included adhering to good practice to maximize impact and effectiveness of aid, reassurance that the right decisions were being made, personal or organizational values, and using evidence as a tool to protect beneficiaries and organizations from poor quality decisions and program content.

Using evidence for decision making was common practice during the process of designing implementing and evaluating humanitarian response content, yet reasons for use varied. The importance of evidence developed and validated from field experience and trust in the source reported by this sample suggests that strengthening collaborative efforts between decisionmakers and evidence generators could be one approach to improve evidence and evidence use in humanitarian response.

All Fire and Emergency Services (FES) personnel must balance FES work with their other responsibilities. Given that women tend to take on a greater responsibility for management of household/domestic activities than men, the on-call component of their FES work may be associated with very different challenges. Despite this, women have rarely been the focus of on-call research.

To explore women’s on-call experiences in the FES by examining coping styles and strategies, with the goal of helping to innovate the way women are supported in FES roles.

Relevant findings from two studies are included. The first study involved FES personnel from two agencies in Australia (n=24) who participated in a semi-structured interview. The second study was an anonymous online survey to determine work characteristics, sleep, stress, and coping in on-call workers more broadly, with workers from all industries across Australia (n=228) invited to participate.

Interview data identified two major themes in terms of coping with on-call work. Support (from family, social, and work), planning, and preparation were identified as important in helping women cope in the context of on-call unpredictability. Results from the survey (43% women) showed that on-call workers were an engaged group in terms of their coping, with 67% classified as having a positive coping style and 58% of women indicating that they agreed/strongly agreed with the statement, “I cope well with on-call work.”

Taken together, these data highlight engagement with positive coping by women who do on-call work, including in the FES. Importantly, positive coping strategies, such as talking about emotions, problem-solving, and seeking support have been linked to increased shift work tolerance in other populations. Coping style and strategies represent modifiable variables which could be specifically applied to assist women to manage the unique challenges associated with on-call work in the FES.

Pressure in the workplace has been studied in a number of settings. Many studies have examined pressure from physiological and psychological perspectives, mainly through studies on stress. Performing under pressure is a fundamentally important workplace issue, not least for complex, volatile, and emergency situations.

This research aims to better understand performance under pressure as experienced by health and emergency staff in the workplace.

Three basic questions underpin the work: (1) how do health and emergency workers experience and make sense of the ‘pressures’ entailed in their jobs? (2) What impacts do these pressures have on their working lives and work performance, both positively and negatively? (3) Can we develop a useful explanatory model for ‘working under pressure’ in complex, volatile, and emergency situations?

The present paper addresses the first question regarding the nature of pressure; a subsequent paper will address the question of its impact on performance. Using detailed interviews with workers in a range of roles and from diverse settings across Ecuador, this study set out to better understand the genesis of pressure, how people respond to it, and to gain insights into managing it more effectively, especially with a view to reducing workplace errors and staff burnout. Rather than imposing preformulated definitions of either ‘pressure’ or ‘performance,’ we took an emic approach to gain a fresh understanding of how workers themselves experience, describe and make sense of workplace pressure.

This paper catalogs a wide range of pressures as experienced by our participants and maps relationships between them.

We argue that while individuals are often held responsible for workplace errors, both ‘pressure’ and ‘performance’ are multifactorial, involving individuals, teams, case complexity, expertise, and organizational systems, and these must be taken into account in order to gain better understandings of performing under pressure.

Behavioral health needs of first responders often receive less attention than those of survivors. Fire, police, medical, and other personnel frequently witness direct loss of life, assaultive violence, and other stressors during disasters. Evidence indicates a greater incidence of psychiatric sequelae among disaster workers. What role do emergency management authorities have in addressing the needs of such personnel?

To evaluate integration of first responder behavioral health needs among a metropolitan healthcare coalition, the Chicago Healthcare System Coalition for Preparedness and Response (CHSCPR).

CHSCPR developed a Behavioral Health Annex providing uniform guidance on behavioral health integration into emergency operations with attention to first responders. An electronic Behavioral Health Capability Survey of coalition members was performed in March 2017 to assess implementation of these recommendations. Qualitative and quantitative responses were recorded.

Fifteen of thirty-five institutions responded, including academic and private community hospitals. Many reported no services. Where services existed, most facilities endorsed use of employee assistance programs or external vendors for staff support. 4/15 (26.7%) reported proactive strategies to mitigate stress such as information sheets on healthy coping. Measures for family support of affected emergency personnel were varied and typically outsourced to online resources, or reported as “in development.”

Findings suggest that recognition of emergency personnel behavioral health needs is lacking in city-wide disaster planning with greater emphasis on post-disaster needs than preventative efforts. Increased awareness of risk for psychological decompensation among first responders, and inclusive efforts to mitigate this risk, are warranted in future disaster planning.

In Brazil, poverty-stricken population groups were the most affected by Zika virus (ZIKV). Women and children are fragile links that need focused attention, especially in relation to health care.

To investigate vulnerable, at-risk women in relation to their awareness of the ZIKV infection knowledge about the disease.

With evidence-based risk communication literature and consequences of ZIKV infection, a data collection instrument with open-ended questions was developed. Women from a small municipality in west-central Brazil, most from a rural setting, were interviewed at primary health care centers in April 2018. Interviews were recorded and transcribed. A preliminary analysis ensued.

Forty women were interviewed. The average age was 42.3 (21-74 yrs) and 39 women had at least one child. The average number of people living in the same home was 3.8 (1-18) and 24 homes (60%) had one to four children. Fourteen women (54%) were beneficiaries of income supplementation programs. Two interviewees mentioned they had never heard of Zika and eight (20%) had no actual knowledge to convey. Other groups had some knowledge about ZIKV. Fifteen (37.5%) associated ZIKV with mosquito bites and another 15 with pregnancy or birth defects. Ten women (25%) mentioned dengue or chikungunya, but only 7 (17.5%) were aware of symptoms. Only eleven women (27.5%) declared public health workers as information sources.

Positive aspects of awareness and knowledge were the tentative relationship some women made between pregnancy risk and exposure to mosquitoes, and with dengue or chikungunya. However, given ample media coverage and the severity of the epidemic, it is noteworthy to point out that all aspects were mentioned by fewer than half of the women. Health workers were not represented as relevant sources of information. Future in-depth content analysis of interviews may reveal important issues for risk communication strategies for this population.

The Zika virus (ZIKV) infection outbreak in Brazil surged in late 2014, peaking in 2015. The most affected region was the northeast, but Rio de Janeiro was especially affected in poor, vulnerable, low-income communities with inadequate sanitation and water. Most cases of the ZIKV-related neurologic syndrome, microcephaly, were detected among newborns coming from this environment.

To identify risk perception and consequences of ZIKV infection for pregnant women in a vulnerable community in Rio de Janeiro.

Forty women who frequented a primary health care center (PHC) in a ZIKV-prone area of Rio de Janeiro were interviewed based on an open-ended questionnaire on ZIKV infection and risk. No censorship regarding age or other demographic characteristics was applied. Interviews were transcribed and analyzed according to analytical categories stemming from the literature and prior work. Preliminary analysis focused on risks for pregnant women and other groups.

Absolute number of responses reflect density of issues within all responses. Age range was 15-60 years. Several women identified microcephaly as a consequence of ZIKV infection for newborns, but many respondents did not cite any health problem associated with ZIKA in pregnancy. Although some cited pregnant women and children as most vulnerable, people living in or near insalubrious environments, such as the elderly, and those with low immunity were more cited. Information was mostly obtained from health professionals and television. Many confused origin and symptoms of ZIKV infection with other arbovirus infections.

This vulnerable group of women, who continuously attend a PHC in the area, have had community experience with the disease and its consequences, showed surprisingly little knowledge as to the risks of ZIKV infection for pregnant women. Results may indicate that the health system has still not achieved adequate risk communication for at-risk women for ZIKV infection in Rio de Janeiro.

With the increase in the number and intensity of disasters, integrated risk management has been a subject of discussion in Brazilian health system, in which the local level plays an important role. Competency Mapping of Managers working at a Municipal Health Office from a Metropolitan Area of Curitiba, Southern Brazil was developed.

To describe gaps in core competencies identified for Surveillance and Control of Risks and Threats.

The Public Health Core Competencies contained in the booklet: A Regional Framework for the Americas, of the Pan American Health Organization, originated a semi-structured self-assessment questionnaire. A Likert scale with levels of proficiency (from one to five) was aggregated to the 56 specific core competencies. It was applied to a sample of 78 managers between the months of October 2017 and January 2018. The data obtained were submitted to quantitative analysis. Gaps (Training Priority Degree) were defined according to the grade of importance and expression by means of a arithmetic mean and standard deviation.

Gaps were identified for the competencies: Design disaster risk management plans for natural, technological and biological threats so as to mitigate their impact on health (2.82 ± 1.16); Design investment projects for reducing the health risks of disasters (2.8 ±1.07); Provide an immediate response to threats, risks and damage from disasters based on the risk assessment, in order to protect health (2.89 ± 1.13); Plan and execute post-disaster reconstruction, based on the damage identified for the immediate restoration and protection of the population’s health (2.81 ± 1.11).

The degree of expression for these competencies indicate the need of preparing public health managers for surveillance, by monitoring the exposure of people or population groups to environmental agents, or their effects with an integrated approach to injuries and the etiology of emergencies and disasters.

Mass gatherings are growing in frequency. Religious, or in this case, “mass” mass gatherings are also growing in complexity, requiring considerable effort from nations hosting a Papal Mass. Ireland hosted a papal mass in 1979 when the prospect of terrorism at such events was significantly lower. Large high-profile events such as a Papal Mass offer a platform via the media and social media to gain widespread coverage of adverse events. In 2018, a predicted 500,000 guests were scheduled to attend a Papal Mass gathering in Phoenix Park, Dublin, a bounded 1,700-hectare park in the center of Dublin.

To develop a medical plan estimating numbers of people requiring medical attention at a Papal Mass held in Ireland late August 2018, and compare same with actual numbers treated post-event. This study aims to reduce the medical impact of such an event on local receiving hospitals through plans that effectively manage medical- and trauma-related presentations on site.

A literature review of medical reports regarding medical care at Papal Mass gatherings worldwide found a range of predicted medical attendance from 21-61 per 10,000 attendees. On that basis we had prepared on-site facilities, facilities on travel routes and access point system for medical care for a crowd of 500,000 were selected.

One of 6 receiving hospitals in Dublin had an increase in average presentations on the day. Attendance was reduced significantly due to weather. 261 patients were treated on site, falling in line with lower rate predicted of 31 patients treated in hospital on site and 17 transports off-site.

A predictable number of patients presented for medical care. On-site medical services reduced transports to hospital. Reduced attendance ensured facilities were sufficient, but could have been under the pressure of the predicted attendance of 500,000.

Human Stampedes (HS) occur at religious mass gatherings. Religious events have a higher rate of morbidity and mortality than other events that experience HS. This study is a subset analysis of religious event HS data regarding the physics principles involved in HS, and the associated event morbidity and mortality.

To analyze reports of religious HS to determine the initiating physics principles and associated morbidity and mortality.

Thirty-four reports of religious HS were analyzed to find shared variables. Thirty-three (97.1%) were written media reports with photographic, drawn, or video documentation. 29 (85.3%) cited footage/photographs and 1 (2.9%) was not associated with visual evidence. Descriptive phrases associated with physics principles contributing to the onset of HS and morbidity data were extracted and analyzed to evaluate frequency before, during, and after events.

34 (39.1%) reports of HS found in the literature review were associated with religious HS. Of these, 83% were found to take place in an open space, and 82.3% were associated with population density changes. 82.3% of events were associated with architectural nozzles (small streets, alleys, etc). 100% were found to have loss of XY-axis motion and 89% reached an average velocity of zero. 100% had loss of proxemics and 91% had associated Z-axis displacement (falls). Minimum reported attendance for a religious HS was 3000. 100% of religious HS had reported mortality at the event and 56% with further associated morbidity.

HS are deadly events at religious mass gatherings. Religious events are often recurring, planned gatherings in specific geographic locations. They are frequently associated with an increase in population density, loss of proxemics and velocity, followed by Z-axis displacements, leading to injury and death. This is frequently due to architectural nozzles, which those organizing religious mass gatherings can predict and utilize to mitigate future events.

Research on events and mass gatherings is hampered by a lack of standardized and central reporting of event data and metrics. While there is work currently being done on report standardization, this will require a plan for recording, storing, and safeguarding a repository of event data. A global event data registry would further the work of standardized reporting by allowing for the collection and comparison of events on a larger scale.

To characterize the considerations, challenges, and potential solutions to the implementation of a global event data registry.

A review of the academic and grey literature on the current understanding and practical considerations in the creation of data registries, with a specific focus on an application to mass gathering events.

Findings were grouped under the following domains: (1) stakeholder identification and consultation, (2) research goals and clinical objectives, (3) technological requirements (ie hosting, format, maintenance), (4) funding (budget, affiliations, sponsorships), (5) ethics (privacy, protection, jurisdictions), (5) contribution facilitation (advertising, support), and (6) data stewardship and registry access for researchers.

This work outlines key considerations for undertaking and implementing an event data registry in the mass gathering space, and compliments ongoing work on the standardization of data collected at mass gathering events. If practical and ethical considerations are appropriately identified and managed, the creation of an event data registry has the potential to make a major impact on our understanding of events and mass gatherings.

Community-based strategies designed to minimize the impact on local emergency services during mass gathering events (MGEs) require evaluation to provide evidence to inform best practice.

This study aimed to describe characteristics and outcomes for people aged 16-18 years requiring emergency care before, during, and after a planned youth MGE “Schoolies week” on the Gold Coast, Australia.

A retrospective observational study was undertaken. Presentations from all young adults to the emergency department (ED) or In-Event Health Service (IEHS) over a 21-day period in 2014 were included. Descriptive and inferential analyses were performed to compare across time and to describe characteristics of and outcomes for young adults requiring healthcare.

A total of 1029 presentations were made by youth aged 16 – 18 to the ED and IEHS over the study period (ED: 139 pre, 275 during, and 195 post; IEHS: 420 during). Patient characteristics and outcomes to the ED that varied significantly between pre, during, and post Schoolies periods included patient’s age (higher proportion of 17-year-olds), residing outside the Gold Coast region, and not waiting for treatment. All were higher during Schoolies week. Of the 24,375 MGE attendees, 420 (1.72% [95% CI, 1.57 – 1.89], 17.2/1,000) presented to the IEHS. The majority were toxicology related (n=169, 44.9%). Transportation to hospital rate was low (0.03% [95% CI, 0.01 – 0.06], 0.3/1,000) for the 24,375 MGE attendees.

Findings from this study support previous research indicating that MGEs can impact local emergency healthcare services. The provision of the IEHS may have limited this impact. The recipients of care delivery, predominantly males with trauma- or toxicology-related problems, warrants further investigation. Research describing the structures and processes of the IEHC could further inform health care delivery in and out of hospital settings.

Music festivals are globally attended events that bring together performers and fans for a defined period of time. These festivals often have onsite medical care to help reduce the impact on local healthcare systems. Historically, the literature suggests that patient transfers offsite are frequently related to complications of substance use. However, there is a gap in understanding as to why patients are transferred to a hospital when an onsite medical team, providing a higher level of care (HLC), is present.

To better understand the causes that necessitate patient transportation to the hospital during festivals that have onsite physician-led coverage.

De-identified patient data from a convenience sample of four, large-scale Canadian festivals (over two years) were extracted. Patient encounters that resulted in transfers to hospital, by ambulance, non-emergency transport vehicle (NETV), or self-transportation were analyzed for this study.

Each festival had an onsite medical team that included physicians, nurses, and paramedics. During 34 event days, there were 10,406 patient encounters, resulting in 156 patients requiring transfer to a hospital. A patient presentation rate of 16.5/1,000 was observed. The ambulance transfer rate was 0.12/1,000 of attendees. The most common reason for transport was musculoskeletal injuries (54%) that required imaging.

The presence of onsite teams capable of treating and releasing patients impacted the case mix of patients transferred to a hospital, and may reduce the number of transfers for intoxication. Confounding preconceptions, patients in the present study were transferred largely for injuries that required imaging. Results suggest that a better understanding of the specific effects onsite medical teams have on avoiding off-site transfers will aid in improving planning for music festivals. Findings also identify areas for further improvement in care, such as onsite radiology, which could potentially further reduce the impact of music festivals on local health services.

Mass gatherings attended by large crowds are an increasingly common feature of society. In parallel, an increased number of studies have been conducted to identify those variables that are associated with increased medical usage rates.

To identify studies that developed and/or validated a statistical regression model predicting patient presentation rate (PPR) or transfer to hospital rate (TTHR) at mass gatherings.

Prediction modeling studies from 6 databases were retained following systematic searching. Predictors for PPR and/or TTHR that were included in a multivariate regression model were selected for analysis. The GRADE methodology (Grades of Recommendation, Assessment, Development, and Evaluation) was used to assess the quality of evidence.

We identified 11 prediction modeling studies with a combined audience of >32 million people in >1500 mass gatherings. Eight cross-sectional studies developed a prediction model in a mixed audience of (spectator) sports events, music concerts, and public exhibitions. Statistically significant variables (p<0.05) to predict PPR and/or TTHR were as follows: accommodation (seated, boundaries, indoor/outdoor, maximum capacity, venue access), type of event, weather conditions (humidity, dew point, heat index), crowd size, day vs night, demographic variables (age/gender), sports event distance, level of competition, free water availability, and specific TTHR-predictive factors (injury status: number of patient presentations, type of injury). The quality of the evidence was considered as low. Three studies externally validated their model against existing models. Two validation studies showed a large underestimation of the predicted patients presentations or transports to hospital (67-81%) whereas one study overestimated these outcomes by 10-28%.

This systematic review identified a comprehensive list of relevant predictors which should be measured to develop and validate future models to predict medical usage at mass gatherings. This will further scientifically underpin more effective pre-event planning and resource provision.

There is currently no standardized approach to collecting mass gathering health data, which makes comparisons across or between events challenging. From 2013 onward, an international team of researchers from Australia and Canada collaborated to develop a Minimum Data Set (MDS) for Mass Gathering Health (MGH).

The process of developing the MDS has been reported on previously at the 2015 and 2017 World Congresses on Disaster and Emergency Medicine, and this presentation will present a final MDS on MGH.

This study drew from literature, including the 2015 Public Health for Mass Gatherings key considerations, previous event/patient registry development, expert input, and the results of the team’s work. The authors developed an MDS framework with the aim to create an online MGH data repository. The framework was populated with an initial list of data elements using a modified Delphi technique.

The MDS includes the 41 data elements in the following domains: community characteristics, event characteristics, venue characteristics, crowd characteristics, event safety considerations, public health considerations, and health services. Also included are definitions and preliminary metadata.

The development of an MGH-MDS can grow the science underpinning this emerging field. Future input from the international community is essential to ensure that the proposed MDS is fit-for-purpose, i.e., systematic, comprehensive, and rigorous, while remaining fluid and relevant for various users and contexts.

The Sydney City-2-Surf is the world’s largest annual run entered by around 80,000 people. First aid planning at mass participation running events such as the City-2-Surf is an area in the medical literature that has received little attention. Consequently, first aid planning for these events is based on experience rather than evidence. The models for predicting casualties that currently exist in the literature are either dated or not statistically significant.

The aim of this study was to characterize patterns of injuries linked to geographic location across the course of the City-2-Surf, and to explore relationships of injury types with location and meteorological conditions.

Records for formally treated casualties and meteorological conditions were obtained for the race years 2010-2016 and statistically analyzed to find associations between meteorological conditions, geographic conditions, casualty types, and location.

The most common casualties encountered were heat exhaustion or hyperthermia (39.2%), musculoskeletal (25.4%), and physical exhaustion (10.2%). Associations were found between gradient and the location. Type of casualty incidence with the individual distribution trends of casualty types were quite clear. Clusters of musculoskeletal casualties emerged in the parts of the course with the steepest negative gradients, while a cluster of cardiovascular events was found to occur at the top of the ‘heartbreak hill,’ the longest climb of the race. Regression analysis highlighted the linear relationship between the number of heat and physical exhaustion casualties and the apparent temperature (AT) at 12pm (R²= 0.59, P=0.044). This linear equation was used to formulate a model to predict these casualties.

The findings of this study demonstrate the relationship between meteorological conditions, geographic conditions, and casualties. This will assist planners of other similar events to determine optimum allocation of resources to anticipated injury and illness burden.

Obstacle Course Races (OCR) are mass participation sporting events, challenging participants to complete physical and mental tasks over a variety of distances and terrains. The case series studied, Spartan Race, has races occurring in urban, rural, and wilderness venues, ranging from 5 to 42 kilometers, while incorporating 20 to 60 obstacles.

To understand the injury rates, injury and illness patterns, and transport considerations within OCRs.

A secondary data analysis of de-identified medical charts from 56 Spartan Race events occurring in Eastern Canada from 2014 to 2018 was performed. The scope of practice was first aid from 2014 to 2017, with the addition of advanced life support onsite in 2018.

Over 5 years, 2,387 injuries occurred among 127,481 participants, creating a patient presentation rate of 18.7/1000. Although the majority of injuries (92%; n=2,204) were treated onsite, a transport to hospital rate of 1.2/1000 (n=154) occurred along with an ambulance transport rate of 0.23/1000 (n=29). Lacerations (55%) and musculoskeletal (36%) injuries were the most frequent clinical presentations observed, whereas life-threatening emergencies (affecting airway, breathing, and circulation) were infrequent (n=10). Transport to the closest local tertiary care center was on average 49.8 kilometers (25.3 kilometers) and 40.5 minutes (17.9 minutes) away from the venue.

These results suggest that there may be an upper limit to the injury rates within Spartan Races. The majority of patient presentations were able to be treated onsite, supporting the need for a qualified onsite medical team to mitigate the strain on local healthcare systems. Although life-threatening emergencies were uncommon, they do occur, and medical teams must be appropriately prepared. Further research is needed to understand the staffing and equipment requirements of medical teams, the demographic information of the injured, and the examination of the impact OCR events have on the local health care systems.

Roof-harvested rainwater held in domestic tanks is used for a variety of purposes in Australia, including drinking and irrigation. There is limited evidence about the quality of rainwater after bushfires. Current health guidelines can be interpreted that landholders need to drain their rainwater tanks to avoid the risk of contamination. Anecdotal reports indicate that following such advice caused additional distress to landowners affected by bushfires in South Australia. Sustainable water management is important for future resilience and more evidence on water quality following bushfires is needed.

This project investigated whether there is contamination of roof-harvested rainwater after bushfires, and if so, whether such water was safe for various purposes.

In 2017 we tested artificially contaminated water spiked with chemicals associated with bushfires (chromated copper arsenate-treated ash and firefighting foam) and conducted a pilot field study using two purposely built roofs during a pre-fire season burn off. A field validation is planned for the summer of 2018/19 (December 2018 - March 2019), i.e., we plan to obtain 200 samples from 50 households affected by bushfire – two samples immediately after the fire event and another two after the first rain.

The artificially created contaminated water fell within guidelines for non-potable uses such as irrigation and stock watering, but was found unsuitable for drinking even after being filtered through two commercially available water filtration systems. We also plan to present results from our field study of 50 households.

Contaminant concentrations, even in artificially spiked water samples, are low and acceptable for non-potable uses. Bottled water should be used for drinking. Landholders should be encouraged to use their water for recovery purposes. Such advice may assist with decreasing the stress experienced by affected landholders and help with recovery efforts through the availability of a greater body of water.