In March of 2022, the Washington Post reported that the: “Deadliest war isn’t in Ukraine, it’s in Ethiopia.” Current death toll estimates are around 600,000: 50,000-100,000 (warfare); 150,000-200,000 (starvation), and 100,000 (lack of medical treatment). Due to increasing civil unrest, a mixed-methods study began at the University of Gondar Hospital in Gondar, Ethiopia. Between 2018-2022, the estimated (daily average) of patients was reported to have quadrupled, from 100 to 400. The global research team implemented 12 new systemic revisions in overcrowding, triage nursing praxes, and resuscitations. Patient data from 521 hospital records was evaluated, as well as resource allocation(s) in staffing, equipment, and training.

The study’s inclusion criteria for A&E data included all patients who sought emergency care at UoG Teaching Hospital’s Emergency Department between May 13, 2018, and June 29, 2018, primarily during the normal daytime working hours between 9am and 2pm, as nighttime security and road travel were deemed less secure for data collectors.

After the 12-benchmark implementation, there was an approximate 15%-25% decrease in direct-from-triage ‘Red’ patient admission; congestion dropped 50%-70%; and the occurrences of successful resuscitations increased. The study revealed that over 75% of patients presented with symptoms indicative of illness(es), and 24.4% presented with trauma (remaining psychiatric). Of the trauma cases, approximately 28.3% were ‘intentional’ injuries. The patients’ mean TEWS triage score was 3.294, with a standard deviation from the mean of 1.9938.

The overall prevalence of patients necessitating surgical evaluation, the elevated use of triage discriminators due to space, equipment, and staff concerns, and the predominant use of ‘Yellow Zone’ services–all pointed to the vital need for resource re-allocation(s), stricter ECCN adherences to TEWS triage indices, as well as future Mass Casualty Planning, Triage, and Response, and Mass Casualty Medical Operations training.

Since 1902, disasters in the Northern Triangle of Central America, which consists of the countries Guatemala, Honduras, and El Salvador, have caused over one-hundred-thousand deaths, affected millions of people, and caused tens of billions of dollars in damages. Understanding the nature and frequency of these events will allow stakeholders to decrease both the acute damages and the long-term deleterious consequences of disasters.

This study provides a descriptive analysis of all disasters recorded in the Emergency Events Database (EM-DAT) affecting Guatemala, Honduras, and El Salvador from 1902-2022.

Data were collected and analyzed from the EM-DAT, which categorizes disasters by frequency, severity, financial cost, distribution by country, burden of death, number of people affected, financial cost by country, and type of disasters most prevalent in each country. Results are presented as absolute numbers and as a percentage of the overall disaster burden. These trends are then graphed over the time period of the database.

The EM-DAT recorded 359 disasters in the Northern Triangle from 1902 through 2022. Meteorologic events (floods and storms) were the most common types of disaster (44%), followed by transport accidents (13%). Meteorologic events and earthquakes were the most severe, as measured by deaths (62%), people affected (60%), and financial cost (86%). Guatemala had the greatest number of disasters (45%), deaths (68%), and affected people (52%). The financial costs of the disasters were evenly distributed between the three countries.

Meteorologic disasters are the most common and most severe type of disaster in the Northern Triangle. Earthquakes and transport accidents are also common. As climate change causes more severe storms in the region, disasters are likely to increase in severity as well. Governments and aid organizations should develop disaster preparedness and mitigation strategies to lessen the catastrophic effects of future disasters. Missing data limit the conclusions of this study to general trends.

The use of chemical, biological, radiation, and nuclear (CBRN) weapons is not new, and though rare, it is an issue of concern around the world due to their ability to cause large-scale mass-casualty events and their potential threat to global stability. The purpose of this study is to explore the use of CBRN weapons by non-state actors through analysis of the Violent Non-State Actor (VNSA) CBRN Event database, and aims to better inform health care systems of the potential risks and consequences of such events.

Data collection was performed using a retrospective database search through the VNSA CBRN Event database.

A total of 565 events were recorded. Five hundred and five (505) events (89.4%) involved single agents while 60 events (10.6%) involved multiple agents. Fatalities numbered 965 for chemical agents, 19 for biological agents, and none for radiological and nuclear events. Injuries numbered 7,540 for chemical agents, 59 for biological agents, 50 for radiological events, and none for nuclear attacks. Fatality and injury per attack was 2.22 and 17.37, respectively, for chemical event agents and 0.15 and 0.48, respectively, for biological event agents.

Violent Non-State Actors were responsible for 565 unique events around the world involving the use of CBRN weapons from 1990-2020. The United States (118), Russia (49), and Iraq (43) accounted for the top three countries where these events occurred. While CBRN events remain relatively rare, technological advances have the potential to facilitate the use of such weapons as part of a hybrid warfare strategy with significant repercussions for civilian health and health care systems.

While the pressure points technique for proximal hemorrhage control is long known, it is not recommended in standard prehospital guidelines based on a study showing the inability to maintain occlusion for over two minutes.

This report details a gunshot wound to the left axillary area with complete transection of the axillary artery, leading to profuse junctional hemorrhage and profound hemorrhagic shock.

Proximal pressure of the subclavian artery was applied against the first rib (the pressure points technique) and maintained for 28 minutes.

Cessation of apparent bleeding and excellent, enduring physiologic response to blood transfusion were observed.

The pressure points technique can be life-saving in junctional arterial hemorrhage and should be reconsidered in prehospital guidelines.

Currently, many airplanes and helicopters are used as air ambulances to transport high-acuity patients. Unfortunately, civilian air medical transport in the United States has experienced a significant number of serious and fatal accidents. At the moment, additional research is needed to identify what factors affect air medical safety.

Accident reports from the National Transportation Safety Board (NTSB) were queried. Accident reports were analyzed if the accident occurred from 2000 through 2020, involved a helicopter or airplane on an air medical flight (as identified by the NTSB), and had at least one fatality. The date of the accident, the model of aircraft involved, and NTSB-determined probable causes of the accident were examined.

Eighty-seven (87) accidents and 239 fatalities took place from January 2000 through December 2020. Nearly three-fourths (72.4%) of fatalities occurred on helicopters, while just 27.6% occurred on airplanes. Interpreting the NTSB findings, various human factors probably contributed to 87.4% of fatalities. These include pilot disorientation, pilot errors, maintenance errors, impairment, fatigue, or weather misestimation. Nighttime-related factors probably contributed to 38.9% of fatalities, followed by weather-related factors (35.6%), and various mechanical failures (17.2%).

These data show that the probable causes of fatal air medical accidents are primarily human factors and are, therefore, likely preventable. Developing a safety-first culture with a focus on human factors training has been shown to improve outcomes across a wide range of medical specialties (eg, anesthesia, surgery, and resuscitation). While there have been fewer fatal accidents in recent years, a continued emphasis on various training modalities seems warranted.

Russia’s annexation of Crimea in 2014, and the recent Russo-Ukrainian war that started in 2022, were triggers that radically changed the perception of security in the Nordic and Baltic countries. The on-going Russian hybrid war has resulted in a renewed global interest in the safety and security of many countries (eg, the Nordic-Baltic Eight). The prospective North Atlantic Treaty Organization (NATO) membership of Finland and Sweden may drastically change the regional military and political landscape.

The objective of this study was to identify and characterize all documented terrorist attacks in this region as reported to the Global Terrorism Database (GTD) from 1970 through 2020.

The GTD was searched using the internal database functions for all terrorism incidents in the Nordic-Baltic states: Denmark, Estonia, Finland, Iceland, Latvia, Lithuania, Norway, and Sweden.

Temporal factors, location, target type, attack and weapon type, perpetrator type, number of casualties, and property value loss were collated. Results were exported into an Excel spreadsheet for analysis.

There were 298 terrorism-related incidents from 1970 through 2020. Most attacks occurred in Sweden, followed by Norway and Finland. No entries were recorded for the Baltic states prior to their independency in 1991. The 298 incidents resulted in a total of 113 fatalities and 277 injuries.

Facility/infrastructure attacks were the most frequently identified attack type (35.0%), followed by bombings and explosions (30.9%). Armed assaults were responsible for 80 fatalities and 105 injuries, followed by bombings/explosions with 15 fatalities and 72 injuries. The predominant target types were immigrants and refugee shelters (64/298 incidents). In only 33.6% of the incidents, perpetrators were known. Right-wing assailants represented the largest group, accounting for 27 incidents.

From 1970 through 2020, there were 298 terrorist attacks in the Nordic-Baltic Eight. Sweden accounted for 50% of incidents.

The profile of terrorist attacks was very diverse, as were the perpetrators and targets. Every country had its own incident characteristics. The surge of right-wing extremism must be closely monitored.

Russia invaded Ukraine in February 2022, leading to significant preventable death across Defense forces and communities. When appropriate and adequate training has been provided, the use of point of injury (POI) care guidelines as exhibited by tactical combat casualty care (TCCC) and the implementation of damage control resuscitation (DCR) and damage control surgery (DCS) can reduce preventable morbidity and mortality in the far foreword environment.

Background: Russia invaded Ukraine in 2014 exacting a heavy increase in preventable morbidity and mortality on the battlefield. Multiple global health engagement strategies by allied forces and health partners have focused on prehospital medicine. The most recent iteration of violence has seen a comprehensive invasion with the use of multi-domain battle and conventional weapons systems across nearly every state in Ukraine. These conventional weapon systems deployed by Russian forces exact a heavy lethality on all communities.

This report uses anecdotal data from undisclosed locations in Eastern Ukraine from the tactical evacuation care, Role 1, Role 2 to the Role 3 echelons of care as reported.

Appropriate application of combat application tourniquets (CATs), pressure dressings, access to tranexamic acid (TXA), antibiotics, basics of TCCC care and DCR/DCS, including access to blood as early as possible, save lives.

Rapid access to tactical evacuation care and initiation of DCR/DCS from Role 1 to Role 2 has good effect. The Ukrainian armed forces have pushed damage control Resuscitation and Surgery as far forward as Role 1, which may require a paradigm shift within the NATO military medical standards and preparations for a peer conflict.

Adequate TCCC, DCR and DCS training in the form of global health engagement have anecdotal success in the reduction of morbidity and mortality and in providing force health and medical readiness across NATO nations and partner forces such as Ukraine.

Terrorist attacks against hospitals and health care providers have disproportionally increased during the last decades. A significant proportion of these attacks targeted abortion clinics and abortion providers. In the light of the overturning of Roe v. Wade in 2022, an increase of anti-abortion terrorist attacks is anticipated. Therefore, it becomes imperative to gain further insight into the risk and characteristics of past terrorist attacks. This study aimed to review terrorist attacks against health care targets providing abortion services from 1970 through 2020.

Data collection was performed using a retrospective database search through the Global Terrorism Database (GTD). The GTD was searched using the internal database functions for all terrorist attacks against abortion health care providers from January 1, 1970 - December 31, 2020. Temporal factors, location, attack and weapon type, and number of casualties or hostages were analyzed using descriptive statistics.

In total, 262 terrorist attacks were identified in five different countries. The majority (96.6%) occurred in the United States, with the highest counts during the last 20 years of the 20th century. Facility and infrastructure attacks were the most common attack types, followed by bombings and explosions. The attacks resulted in 34 injuries and nine fatalities. Kidnapping took place in three incidents. Of all successful attacks, 96.9% resulted in property damage.

Abortion-related health care facilities and providers have repeatedly been the target of terrorists over the past decades. Nearly all of these attacks took place in the United States, with the highest counts during the last 20 years of the 20th century.

A scoping review of the literature available on landmines in Egypt and their resultant disaster impact (human losses, material losses, economic losses and environmental losses) on the Bedouin communities inhabiting contaminated regions and on Egypt is presented. A narrative approach is taken to map the data extracted from the available literature to: the domains of losses; evidence of external assistance; and progress, revealing the widespread impacts of the hazard of landmine contamination.

The review question was mapped based on the JBI and the Arksey and O’Malley Frameworks with reference to Aromataris and Munn (2020), and Peters (2022). The research question was identified starting with the search strategy, and is broken down using PCC as recommended for Scoping Reviews (Peters, 2022).

Searches of scientific literature were conducted using multiple databases, further searches of search engines, social media and of grey literature were conducted. The search results were then screened over two stages to determine their relevance. Data was then extracted using the PRISMA-ScR checklist before being tabulated and charted.

The data collated evidently shows human losses manifest as mortality, physical disability, psychological trauma, financial instability and social impacts; while material losses include blocks to considerable areas of the country’s landmass suitable for urban housing, agricultural and touristic potential, as well as mineral, and oil and gas reserves; economic losses include impedance to development, lost revenues and deterrence from investment; environmental losses comprise extensive contamination of Egypt’s land.

Evidence of external assistance being sought and provided is ample, signifying the overwhelm of Egypt’s coping capacity; rather, positive steps to de-mine the land and provide mine risk education and survivor assistance are beneficial in risk reduction. While landmine contamination is not classically considered to carry a disaster risk, this study proposes it does.

The aim of this study was to establish the frequency and profile of disasters and to analyze trends in disasters and their impact on Spanish public health.

Retrospective observational study of disasters that occurred in Spain from 1950 through 2020 was conducted. The variables studied for each episode were number of people affected, number of injured/sick, and number of deaths. Absolute and relative frequencies, population rates, mean, median, standard error of the mean (SEM), and 95% confidence intervals (CI) were used, and trend analysis was performed using exponential smoothing and linear regression.

A total of 491 disasters were identified in Spain. Of these, 255 (51.9%) were natural disasters, 224 (45.7%) technological disasters, and 12 (2.4%) man-made disasters. The average number of disasters per year was 7.01 (95% CI, 5.99-9.34). These disasters affected a total of 820,489 people, with an average of 3,491 people (SEM = 2.18) per episode. There was a significant increase (P <.001) in the total frequency of disasters in Spain during the period studied.

Spain has a disaster profile of mixed type, combining natural with technological disasters. From 1950 through 2020, there was a significant increase in the number of disasters, with an overall profile similar to that of Europe, with climatological disasters being the most frequent type.