Chemical terrorist attacks using nerve gas require patients with immediate administration of antidote, or otherwise they will experience abnormal neurological activity, respiratory arrest, and death. When it occurs in large stadiums at mass gatherings such as the Olympics, under normal medical care systems, preventable deaths occur due to insufficient deployment of on-site auto-injectors and stockpiled antidotes in hospitals. In Japan, the government has stockpiled antidotes in confidential warehouses and deployed auto-injectors around possible terrorist sites. When a chemical attack occurs, a stockpile of antidotes go to hospitals, auto-injectors go to the site, and firefighters and police are allowed to administer auto-injectors to patients. However, few studies are conducted on pre-deployment of auto-injectors and antidotes in chemical terrorisms. Therefore, the number of pre-deployment was examined.

A single chemical attack with 750 patients was assumed. Response was divided into five steps: (1) transportation of stockpiles to hospitals, (2) transportation of auto-injectors to the site, (3) on-site use of auto-injectors, (4) transportation of patients to hospitals, and (5) patient care in hospitals. Computer estimation was used for the time required for transportation for (1), (2), and (4). Desktop exercises were conducted for on-site response time, outpatient response time, and the number of beds available at hospitals for (3) and (5). The values obtained from computer estimation and desktop exercises were imported into the simulation model to measure the number of paramedics, auto-injectors required to be deployed in advance, and the amount of stockpiles required to be delivered to hospitals.

A minimum of 80 auto-injectors and ten paramedics were required to be pre-positioned at the scene. A minimum of 100 ampules of antidote was required immediately at the nearest hospitals.

The pre-deployment of auto-injectors and personnel are essential to reduce the number of deaths in the event of chemical terrorisms.

Asia is one of the regions most affected by natural disasters such as major typhoons. In Japan, recovery from natural disasters is said to take more than 10 years, and local government officials are primarily responsible for this recovery. In this study, we investigated the effectiveness of the me-fullness® smartphone application in maintaining the well-being of local government employees involved in recovery efforts.

We conducted a survey of 35 employees of the town of Shichigahama, one of the areas affected by the 2011 Great East Japan Earthquake. The Chalder Fatigue Scale (CFS), Athens Insomnia Scale (AIS), and Depression, Anxiety and Stress Scale–21 Items (DASS-21) were used as survey instruments. 22 of the 35 employees used the me-fullness application on their smartphones for one month. During the month the application was in use, there was a heavy rain warning and an election for the House of Counselors, which the Shichigahama town employees had to cope with in parallel with the recovery from the Great East Japan Earthquake.

The percentage of insomnia indicated by an AIS score of four or higher was 53.5% (7/13) before and 30.8% (4/13) after the use of the me-fullness application. The percentage of stress was 38.5% (5/13) before and 7.7% (1/13) after the use of the me-fullness application.

This study showed that the me-fullness® application could improve the sleep and stress of local government employees and maintain their well-being for a long time during the recovery efforts.

As Ireland's population increases and chronic disease becomes more prevalent, demand for limited general practice services will increase. Nursing roles within a general practice are now considered to be standard, yet alternative non-medical professional roles are under-explored within an Irish context. Non-medical personnel such as Advanced Paramedics (APs) may have the capability to provide support to general practice.

A sequential explanatory mixed methodology was adopted. A questionnaire was designed and distributed to a purposeful sample of GPs attending a rural conference followed by semi-structured interviews. Data was recorded and transcribed verbatim and thematically analyzed.

In total n=27 GPs responded to the survey and n=13 GPs were interviewed. The majority of GPs were familiar with APs and were receptive to the concept of closely collaborating with APs within a variety of settings including out-of-hours services, home visits, nursing homes, and even roles within the general practice surgery.

GP and AP clinical practice dovetail within many facets of primary care and emergency care. GPs believe that current models for providing rural general practice care are unsustainable, and they realize the potential of integrating APs into the general practice team to help support services into the future. These interviews provide a detailed insight into the opinions of rural general practitioners in Ireland on healthcare provision and the clear necessity for support and change.

Children are often disproportionately impacted by disasters, and yet pediatric specific considerations are not properly emphasized during disaster planning and training, resulting in the desperate needs of children falling through the cracks during disasters. Children differ from adults developmentally, physiologically, and psychologically, and are more vulnerable to negative long-term medical, social, and behavioral outcomes. Additionally, children lack autonomy and rely on adults to gain access to the healthcare system and other resources. Despite the distinctions between adults and children, time and curricula for pediatric disaster training is insufficient, and workforce capacity and competency to plan for and respond to the disaster related needs of children are inadequate; this is especially true for both physicians and other healthcare responders who do not complete a specific pediatric residency. Our study seeks to determine the key core competencies of pediatric disaster medicine that should be included in the training of responders.

A systematic gray literature review of existing pediatric disaster medicine curricula was performed, from which a list of the most commonly present key core competencies was created.

Data collection and analysis is expected to be completed by April 2023 and will yield a ranked list of core competencies.

There is a need for improved pediatric disaster training that addresses the specific considerations of children; this is especially true for non-pediatricians who may be treating children following a disaster. The gray literature review will identify key components of pediatric disaster medicine, which should be applied to all such training curricula to ensure that the care of children who suffer during and after disasters is equitable across the globe.

Ambulance times are internationally recognized Key Performance Indicators (KPI) for prehospital care. International benchmarking by comparing ambulance times between countries is a valuable method to help to identify strengths and weaknesses across healthcare systems. However, ambulance times are not standardized across or sometimes even within countries. Thus, this benchmarking study aims to compare terminology and definitions of ambulance times from the ambulance services of a range of countries to facilitate international benchmarking.

A 23-point questionnaire was developed and pilot-tested on members of international emergency care organizations. The final questionnaire was administered to domestic and international Ambulance Services, who use the Advanced Medical Priority Dispatch System, asking for the terminology and definitions for times from “call received” to “arrival at hospital”. This included “clock start” and “clock stop” times. We asked for the ambulance terms and related variable names in the computer aided dispatch/reporting system. We engaged with clinical stakeholders and Patient and Public Involvement Contributors throughout the process.

We gathered information from 10 international ambulance services, representing nine countries, and three continents. Some services in the United Kingdom have standardized ambulance times terminology and definitions. However, in the majority of cases terminology differed greatly between countries, and at times within countries and between reports. Definitions of ambulance times varied between countries and regions, with some having different clock start and stop times and others not collecting data on the same time periods.

The current level of variation in international ambulance times terminology and definitions poses a challenge for international benchmarking and research. International consensus or harmonization of language and definitions would result in more efficient and accurate global comparison. On a smaller scale, defining terms in publications and reports would begin facilitating this process.

Variations in the incidence and patterns of injuries exist between genders which may impact treatments and outcomes. The study aimed to describe the epidemiology, treatments, and outcomes based on the gender of persons presenting with injuries to an Emergency Department (ED) in Kigali, Rwanda.

This was a secondary analysis of a prospective cross-sectional study conducted in January-June 2021 at the Centre Hospitalier Universitaire de Kigali ED. Descriptive statistics were performed and variable comparisons based on binary gender self-designation (male or female) were conducted.

A total of 601 patients were included in the analysis of whom 25.6% were female and 74.4% were male. Gender differences were found in the mechanism of injury with females more likely to be injured via falls (43.5% versus 23.0%, p=0.001), while males were more likely to be in a road traffic accident (52.6% versus 39.6%, p=0.006), have stab and/or laceration (9.0% versus 2.0%, p=0.004) or have been assaulted (6.9% versus 2.6%, p=0.047). Injury severity was not significantly different between genders based on the median Kampala Trauma Score and presence of triage hypotension. For treatments females were more likely to have been transported by prehospital services (87.7% versus 72.9%, p=0.001), but were less likely to received acute ED treatments of intubation, wound care, tourniquets, blood products, thoracostomy and point-of-care ultrasound during the first six hours of care (67.5% versus. 78.1%, p=0.009). Hospital admission was significantly greater among females as compared to males, (31.2% versus 41.8%, p=0.019) but no difference in mortality was observed (2.0% versus 1.3%, p=0.568).

This study provides data on differences in epidemiologic and care characteristics between males and females presenting for emergency injury care in Rwanda. These findings can inform future research and help the development of gender-centered healthcare delivery in Rwanda and other similar contexts.

Crisis collaboration exercises are perceived as developing and testing cross-sectoral team integration, preparedness efforts, and response. However, the general problem is that crisis collaboration exercises may tend to produce results with limited usefulness in actual crisis work. The purpose of this quantitative, non-experimental, survey-based study was to examine to what extent there was a statistically significant relationship between participation in Norwegian maritime crisis collaboration exercises and the perceived levels of learning and usefulness in an actual crisis. The scope was limited to relevant public, military, and non-governmental exercise participants.

Surveys were electronically distributed among participants in three 2016 Norwegian maritime crisis collaboration exercises. The data collection instrument was the Collaboration, Learning, and Utility scale (Berlin & Carlström, 2015). The CLU-Scale is specially designed to measure collaboration exercise participants' perceived levels of learning and utility. The scope was limited to relevant public and non-governmental exercise participants including health, law enforcement, and military stakeholders.

The effects of collaboration, learning, and usefulness were tested in two bivariate regression analyses, where the first tested the relationship between collaboration and learning, and the second tested the relationship between learning and usefulness. To measure the linear dependence between the variables, Pearson’s r was calculated. The coefficients of determination (r2) were calculated to determine what proportions of the variance in the dependent variables could be considered predictable from the independent variables.

The joint collaborative characteristics predicted 27% (r2 = 0.27) of the learning variance, which meant that the remaining 73% of the predicted variance was unaccounted for. The perceived learning items predicted 34% (r2 = 0.34) of the usefulness variance.

This study found a moderately strong statistically significant relationship between participation in Norwegian maritime crisis collaboration exercises and perceived levels of learning and usefulness. More focus on collaboration learning techniques in exercise planning and evaluation is recommended.

Hemipelvectomy occurs seldom, yet it is a serious injury. Hemipelvectomy following trauma is associated with high incidence of morbidity and mortality. Successful management requires early recognition with a multi-speciality approach and meticulous surgical technique.

Retrospective data from hospital records of the Level-1 Trauma Center, between December 2011 through September 2022 was obtained. Clinical details including mechanism of injury, trauma scoring, associated injuries, hemodynamic status, surgical procedures, wound complications, ICU stays, hospital stay, prosthesis application, and their outcome were analyzed. Patients were followed up physically in OPD or telephonically.

Total footfall 615,274 patients with 16,786 admissions in trauma surgery, 1,299 amputations and 13 hemipelvectomy patients during the study period of ten years. Seven were in shock on presentation, of which, four were non responders and three responded to initial resuscitation. Seven patients had associated Genitourinary injuries, four had anorectal involvement, five had vascular injuries and six had associated extremity injuries. Six patients underwent hemipelvectomy in the primary surgery and seven ended up in hemipelvectomy on consecutive surgeries. Multiple surgeries were required for all the patients both for control of local sepsis and adequate soft tissue cover. Eight of thirteen patients developed wound infections, and related sepsis, one survived a covid infection and three had MODS. Four out of thirteen patients died and of the nine survivors, prosthesis is being used by three patients, two returned to work without prosthesis and two lost to follow up.

With a multidisciplinary and dedicated team approach, we can expect favorable outcomes in post-trauma hemipelvectomy patients.

New Zealand is widely known across the globe as an adventure tourism destination. On December 9, 2019, the natural wonders of the country became a major disaster that impacted the lives of many and stretched the resources of the New Zealand healthcare system.

Whakaari/White Island is an uninhabited, privately owned island 50 km off the North Island of New Zealand. It contains two strato-volcanoes, which were and remain a popular tourist destination. While an international tourist group were enjoying their guided tour of the crater, one of the volcanoes erupted, sending superheated debris and gas into the air. Of the 47 individuals on the island at the time, 39 were rescued. Overall, 25 people survived. The mortality of this event was significantly lower than historic volcanic eruptions involving ballistic and pyroclastic injuries. We are fortunate to present information specifically on the chemical and physiological changes noted from exposure to volcanic ash.

Located in New Zealand’s largest city is Middlemore Hospital, home of the National Burns Center. This center is supported by three regional burn centers throughout the country. Prior to Whakaari, mass-casualty plans were in place, however, system-wide adaptations were required on many levels to ensure delivery of healthcare. This included changes in pre-hospital triage, support for regional burns centers and repatriation to home countries.

This poster presentation takes you on the journey of adaptation experienced within the National Burns Service, focusing on operating theater, intensive care and acute burns management.

Case Study

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Compared to trauma-based injuries, chemical injuries can inflict widespread and persistent injuries to exposed victims. Emergency medical services (EMS) personnel are vulnerable to chemical injuries. Specialized training is required, including zone setup, personal protective equipment (PPE), decontamination, and antidote use, beyond simple advanced trauma life support. The purpose of this study is to evaluate the educational effectiveness of the online chemical-mass casualty incident response education module (C-MCIREM) for EMS personnel.

This study is a retrospective pre-and post-test comparison. Subjects were EMS personnel who enrolled in the C-MCIREM program at the EMS Korea online conference between August 27, 2021 and September 5, 2021. Subjects provided demographic data and completed pre-course and post-course knowledge tests and self-assessments of readiness, as well as a satisfaction survey after the course. For readiness and satisfaction surveys, an 11-point Likert scale was used. The Wilcoxon Rank Sum test was used to compare the two samples.

A total of 322 respondents were enrolled. Two-hundred (62.1%) responded that they were most motivated to take the course because of curiosity about the subject. The median pre-course knowledge score was 57/100 (47, 66) and the post-knowledge score was 80/100 (66, 91) (p<0.001). Participants stated they felt their readiness to provide triage, treatment, transport, decontamination, to select correct antidotes, and to use correct PPE (all p<0.001) increased. 90.4% stated they were satisfied with the course. Participants were overall satisfied with the use of the online format (7.71/10 SD 2.05), and were willing to recommend the training to other EMS providers (7.63/10 SD 2.1).

The online C-MCIREM program showed high satisfaction with a significant increase in knowledge and self-assessed readiness to respond to a chemical mass casualty incident.

The Thai government has established public health policies to cope with COVID-19 and reduce the spread of disease by promulgating the Emergency Decree since March 26th 2019 in concept “stay at home, stop the spread of the virus for the sake of nation.” Those measures had been affected to people in all social levels whether it be urban or rural. The objective of this qualitative study was aimed to study the mechanisms and experiences of village health volunteers who work to control COVID-19 at the community level.

Forty village health volunteers in the 8th health region were included in the study. Data collection by using focus group discussion combined with audio recordings and the data were analyzed by content analysis.

The community’s context in the upper northeastern region of Thailand live in kinship. This is a factor supporting the operation of village health volunteers (VHVs) in the surveillance, prevention, and control of disease in the community. The mechanisms for disease prevention and control in the community are a virtual "Spider web" that connects people in the community, VHVs, Community Leaders, Public Health Officers, and Sub-district Administrative Organization (SAO) officers that operate together. While people in the community, especially "women", act in surveillance in the form of "watchdogs" that report abnormalities of community member movements to the VHV for coordination in surveillance, prevention, and control of disease in their community. The VHV and partners use management guidelines as prescribed by the Ministry of Public Health and adapted to the social and cultural context.

The community's COVID-19 surveillance mechanism that mediates kinship begins with fear and panic from a lack of knowledge in the early stages of the outbreak. The kinship of people in the community is one of the strengths and factors of success in preventing and controlling the disease.

On February 24, 2021, a large explosion and fire occurred in an industrial estate in Singapore. Eight casualties with major burns were conveyed to the emergency department (ED) at Singapore General Hospital, the designated regional Burns Centre. This article details the events and recommendations arising from this multiple casualty incident.

An After-Action Review (AAR) was conducted to examine the prehospital notification process, casualty triage & tagging, medical management, manpower and resource allocation, and command-and-control structure.

All eight casualties were conveyed by the national Emergency Medical Services (EMS) and arrived within a 46-minute window. The first three suffered 90% full-thickness burns and inhalational injuries and were intubated. The remaining five suffered between 37% to 64% burns, with three requiring intubations as well.

Four major areas were identified for improvement:

Firstly, there was scant information from EMS regarding total casualty count. There was also inadequate knowledge of mass burns triage protocols in the ED. Thus, resources were heavily utilized for the first three casualties - all of whom were later deemed unsalvageable, given palliative care and demised.

Secondly, casualty identities were initially unknown. They were tagged with similar-looking ten-digit serial numbers, resulting in a near-miss event involving mislabelled blood tubes.

Thirdly, there was unfamiliarity with the incident response plan for a multiple casualty incident of this scale. This contributed to lack of situational oversight and inconsistent leadership direction from various stakeholders with resulting conflicting instructions.

Fourthly, routine trauma computed tomography pan-scans for all casualties caused delayed reporting by Radiology and created a bottleneck in casualty disposition.

A multi-disciplinary workgroup comprising Emergency, Trauma, Burns and Intensive Care departments outlined several recommendations based on the AAR findings. Drills were strongly recommended to resume following a hiatus due to COVID-19.

AARs help provide invaluable insights. Response plans should be refined together with relevant stakeholders.

The constraints of performing prehospital decontamination in mass casualty incidents involving the release of chemical agents at disaster sites in modern cities are notable. Compounding this are highly built-up urban areas with significantly high population density and traffic congestion. This places the burden of performing such decontamination on nearby healthcare facilities. Based on this need, public hospitals in Singapore have been equipped with decontamination facilities. We present a review of the utilization of this facility at our institution.

A retrospective review of the utilization of the hospital decontamination station (HDS) was carried out, noting its frequency, purpose, and outcomes.

Since its construction, the HDS has been deployed successfully many times a year for both routine training and disaster preparedness exercises. Despite the lockdown measures due to Covid-19, with concomitant reduction in social and economic activity, the HDS was activated five times for decontamination of chemical contaminated casualties. It is fortunate that, although HDS training activities were curtailed during this period, emergency department (ED) staff were still able to function effectively using prior experience, donning chemical protective suits, and performing decontamination. The semi-automated HDS facilitated rapid deployment which contributed to ease of use of this resource for timely decontamination of casualties with good outcomes.

Chemical incidents resulting in contaminated casualties are uncommon events. Nonetheless hospitals must be prepared to deal with this situation in a timely manner. The rapidly deployable HDS has become an important resource and an operationally ready solution for dealing with chemical contaminated casualties presenting at short notice to the ED. Regular training and deployment exercises utilizing the HDS provide staff familiarity critical to overall readiness for chemical incidents. This strategy provides a reliable countermeasure in an all-hazards approach to disaster preparedness at the hospital.

Mass gatherings are becoming increasingly more common and require adequate preparedness in order to ensure the safety of participants. Standardized planning tools for optimal resource utilization during these events are lacking. We analyzed prehospital data from a high census US theme park to determine whether heat index and wet bulb index are predictive of patient presentation and transport rates.

This was a retrospective analysis of prehospital data from a high census US theme park. Daily EMS data including call and transport volume as well as corresponding local weather information were gathered between May 2021 to September 2022. The relationship between patient presentation rate and transport rate and weather information was analyzed using Analysis of Variance Testing. Patient presentation rates were calculated based on average daily attendance according to unofficial attendance tracking sources. Seasonal attendance variation was accounted for by comparing variations in patient presentation and transports to the average call and transportations rates for that respective month.

A total of 515 days of data were included. We found that higher wet bulb temperature readings correlated with both higher patient presentation rates per 10,000 attendees (>80F 4.09, 70-79F 3.39, <69F 2.84 patients; P<0.05) and increased hospital transport rates per 10,000 attendees (>80F 1.38, 70-79F 1.29, <69F 1.09 patients; P<0.05). Adjusted for seasonal variation of attendance, higher wet bulb temperatures were likewise correlated with increased presentation (>80F 102%, 70-79F 98%, <69F 93% of average patients per day; P<0.05) and transports (>80F 101%, 70-79F 100%, <69F 93% of average transports per day; P<0.05). Additional analysis noted similarly increased patient presentation and transport rates on days with higher maximum heat indices.

In the setting of a high census US theme park, higher wet bulb and heat indices were strongly associated with increased patient presentation rates and patient transport rates.

During the Covid-19 Pandemic, the Department of Emergency Medicine is the one of most busy in Nepal. Challenges and complexities of providing emergency medical service during the waves of the Covid-19 pandemic in Nepal were analyzed.

Three years (2020 – 2022) of data was analyzed from Covid patients registered in Tribhuvan University Teaching Hospital (TUTH), Institute of Medicine for reference with National Data of Ministry of Health and Population, Government of Nepal.

On November 15, 2022, there were 5,969,338 Covid PCR tests and 1,452,639 Covid Antigen tests in Nepal with 1,000,826 (16.8%) PCR, 152,197 (10.5%) being positive. The cure rate was 98.7% (988,316 cases). There were 12,019 mortalities with 1.2% case fatality. In TUTH 2020 – 2022 records; 3,794 total severe Covid-19 patients were admitted; In the first year, only two patients (1M:1F); In the second year 2,056 patients 1.8M:1F and in the third year 1,736 with 1.1M:1F. The age groups with the first wave vs the second wave were 6.42% vs 5.47% of 0-20 years; 24.22% vs 26.84% of 21-40 years; 30.57% vs 30.87 of 41-60 years and 38.57% vs 36.87% of above 60 years. The hospital mortality rate was 751 (19.8%). Challenges were due to resource limitation, limited PPE, scarcity of oxygen, medication, and ventilators. In TUTH, all levels of emergency management and various definite care were provided 24/7 hours in the pandemic period. There are a lot of challenges in Pre-Hospital Emergency Care Service due to a limited number of designated Advance Ambulances during transportation of severe Covid patients. With these challenges and complexities, there were six deaths of their own hospital staff due to severe Covid-19.

The challenges and complexities of providing emergency medical services during the Covid-19 pandemic in Nepal have been overcome with teamwork and activation of the emergency care system in Nepal.

Japan is the only country to have experienced the atomic bombings and still has many nuclear power plants. In 2011, a nuclear power plant accident occurred during a major magnitude 9.0 earthquake, and there was a great deal of concern about radiation exposure medicine for the public. It is necessary to provide appropriate radiation exposure medicine.

The facility is located within the IAEA's UPZ, and in the event of an emergency, it is necessary to provide medical care for a large number of people exposed to radiation, so an advanced radiation exposure medical facility was built in 2015 (the surrounding population is approximately 300,000).

The basics of radiation exposure medicine are: 1) medical priority, 2) prevention of the spread of radioactive materials, and 3) protection of our responders from radiation exposure. Everything from whole body assessments, contamination examinations due to exposure, medical procedures (including advanced medical procedures), and decontamination were able to be performed. The facility is also equipped with WBC (whole body counter) that can assess internal exposure. A support system for other medical facilities was being developed in the region by forming a team that can respond to radiation exposure.

With the current system, not only radiation exposure medicine will be handled, but also CBRNE and other such services in the future. For this reason, repeated training and human resource development are very important.

Infection countermeasures that consider patient characteristics are needed at psychiatric hospitals.

Based on the experience of implementing countermeasures against infection by COVID-19, which has become a pandemic disaster over the past few years. This report is on the current situation and issues of infection countermeasures in psychiatric hospitals.

Reasons for why it is difficult to take COVID-19 countermeasures in psychiatric hospitals included the following: for patient predispositions–it is difficult to promote understanding and practice of infection countermeasures such as proper wearing of masks, hand hygiene enforcement, zoning, etc. For environmental predispositions–it is difficult to ventilate because windows and doors cannot be opened, and it is difficult to isolate infected individuals as there are few private rooms. Countermeasures included the following: recreation should be limited to that which does not involve speaking and having everybody face the same direction, ensuring sufficient space between people during meals, installing ventilation equipment in hospital wards, handle care in private rooms until the hospitalized patient is judged to be not infectious, and conducting zoning and isolation on a hospital ward level. Results showed that although COVID-19 outbreaks occasionally occurred in hospital wards, this did not result in spread throughout the hospital.

Future challenges include improving the quality of infection countermeasures in hospitals through thoroughly educating hospital personnel who are unaccustomed to taking infection countermeasures.

In March 2022, Team Rubicon deployed an EMT Type 1 mobile team to provide medical care for internally displaced people in Ukraine. Regional medical facilities and universities identified a need for training programs to prepare for the expected increase in wartime casualties.

Deployed medical teams researched and compiled initial course content. Presentations were prepared and conducted with the assistance of Ukrainian translators. The curriculum was expanded to include whole blood transfusion and point of care ultrasound. After the prioritization of needs by the MOH, Team Rubicon deployed a seven-member team to conduct training in 16 cities over two months. They provided instruction in whole blood transfusion, hemorrhage control, blast injuries, prehospital triage, shock management, point of care ultrasound, and treatment of chemical exposures. Surveys were conducted pre- and post-training to assess the usefulness of the training provided.

In two months, a total of 1549 unique individuals were trained. The participants included 769 physicians, 244 nurses, 299 paramedics, 83 hospital administrators, and 154 additional professionals. They included 614 males and 935 females. The number of participants in each course included: 477 for hemorrhage control, 564 for treatment of chemical exposures, 483 for blast injury and field trauma, 412 for pre-hospital and triage training, 135 for point-of-care ultrasound, and 154 for whole blood transfusion.

With the assistance of the Ukrainian Ministry of Health, an NGO was able to conduct 64 sessions training 1549 individuals. This experience demonstrates the ability to create a robust educational platform to fulfill the medical needs of a community affected by warfare.

Existing studies have identified the national rate of PVT for severely injured patients to be 9-16%, our ED has displayed a PVT incidence of 35.4%, suggesting a substantial difference in ED arrival. This study aims to explore descriptive demographics and injury characteristics of patients who arrived by PVT to our ED.

A prospective, single-center observational study conducted in Detroit, Michigan. Included patients aged 15 ≥ years who arrived at the ED by PVT for blunt or penetrating trauma. The sample population consisted of 128 patients from August 2019-April 2021. Each subject completed a survey regarding their injury and prehospital care. A retrospective chart review was conducted to acquire information on their injuries.

The mean age was 44.3 ± 20.3 years old, range 15-93. 51/128 female, 77/128 male. Patients comprised 93/128 African American, 19/128 Caucasian, 4/128 Asian, 4/128 Hispanic/Latino, and 8/128 other. The most common insurance was Medicaid, comprising 63/128 patients, 25/128 of patients had Medicare and 38/128 had private coverage. Utilizing ESI indices to evaluate severity levels, 73/128 arrived at the ED with an ESI level of 3, 47/128 level of 2, 5/128 level of 4, and 3/128 level of 1, the most severe. Majority of patients 36/128, presented with trauma-related injuries due to a fall. 25/128 presented with a laceration, and 22/128 presented after a motor vehicle crash. The upper extremities were the most common location of trauma 38/128 followed by the lower extremities 23/128. The mean ED length of stay was 11.18 hours.

Overall, the findings from this study allowed us to characterize our population of PVT trauma patients through their demographics and injury characteristics. We were able to establish some descriptive characteristics that delineate the population of patients at our ED in Detroit, which is the first step in identifying why trauma patients choose varying modes of transportation.

In Japan, natural disasters such as earthquakes and typhoons are extremely frequent. It is predicted that Tokyo Inland earthquakes will occur within the next 30 years. Disuse syndrome and Disaster-related deaths have increased in disasters. It has been reported that Disuse syndrome and Disaster-related deaths are particularly prevalent among those who require special care. Therefore, it is necessary to consider support for them in the future disaster. Telemedicine has become increasingly popular in recent years. Previous researches using telemedicine have reported that it is useful for rehabilitation and management of chronic diseases. This study aimed telemedicine would be useful to prevent Disuse syndrome and Disaster-related deaths.

The subjects were physicians, nurses, physical therapists, occupational therapists, and speech therapists. Semi-structured interviews were conducted with the subjects on how telemedicine could be used to assist them. The data were analyzed using Krippendorff's content analysis.

The research interviewed medical staff including physical therapists and occupational therapists with knowledge about disaster medicine. Thirteen categories of problems with telemedicine were identified, including problems with infrastructure and operation by the elderly. Eight categories of support that could be provided were generated that were common to all rehabilitation professionals, two categories for physical therapists, two categories for occupational therapists, and five categories for speech therapists.

This study examined what kind of support can be provided using telemedicine to prevent Disuse syndrome and Disaster-related deaths. Common support by rehabilitation professionals included instruction in exercises and prevention of economy class syndrome. It was suggested that speech therapists could provide oral swallowing exercises and support for those with dysphagia. However, the handling of communication devices by the elderly, and the interaction of medical personnel were cited as problems. In response to these issues, there was a possibility to support the victims by collaborating with remote and local medical professionals.