Volcanoes cause a wide range of hazardous phenomena. Close to volcanic vents, hazards can be highly dangerous and destructive and include pyroclastic flows and surges, ballistic projectiles, lava flows, lahars, thick ashfalls, and gas and aerosol emissions. Direct health impacts include trauma, burns, and exacerbation of respiratory diseases. Far-reaching volcanic hazards include volcanic ashfalls, gas and aerosol dispersion, and lahars. Within Oceania, the island arc countries of Papua New Guinea (PNG), the Solomon Islands, Vanuatu, Tonga, and New Zealand are the most at-risk from volcanic activity. Since 1500ad, approximately 10,000 lives have been lost due to volcanic activity across Oceania, with 39 lives lost since 2000. While volcano monitoring and surveillance save lives, residual risks remain from small, sudden, unheralded eruptions, such as the December 9, 2019 eruption of Whakaari/White Island volcano, New Zealand which has a death toll of 21 at the time of writing. Widespread volcanic ashfalls can affect the habitability of downwind communities by contaminating water supplies, damaging crops and buildings, and degrading indoor and outdoor air quality, as well as disrupting transport and communication networks and access to health services. While the fatality rate due to volcanic eruptions may be low, far greater numbers of people may be affected by volcanic activity with approximately 100,000 people in PNG and Vanuatu displaced since 2000. It is challenging to manage health impacts for displaced people, particularly in low-income countries where events such as eruptions occur against a background of low, variable vaccination rates, high prevalence of infectious diseases, poor sanitation infrastructure, and poor nutritional status. As a case study, the 2017-2018 eruption of Ambae volcano, Vanuatu caused no casualties but triggered two separate mandatory off-island evacuations of the entire population of approximately 11,700 people. On the neighboring island of Santo, a health disaster response was coordinated by local government and provided acute care when evacuees arrived. Involving primary care clinicians in this setting enhanced local capacity for health care provision and allowed for an improved understanding of the impact of displacement on evacuee communities.

Hypoxemic patients often desaturate further with movement and transport. While inhaled epoprostenol does not improve mortality, improving oxygenation allows for transport of severely hypoxemic patients to tertiary care centers with a related improvement in mortality rates. Extracorporeal membrane oxygenation (ECMO) use is increasing in frequency for patients with refractory hypoxemia, and with increasing regionalization of care, safe transport of hypoxemic patients only becomes more important. In this series, four cases are presented of young patients with severe hypoxemic respiratory failure from Legionnaires’ disease transported on inhaled epoprostenol to ECMO centers for consideration of cannulation. With continued climate changes, Legionella and other pathogens are likely to be a continued threat. As such, optimizing oxygenation to allow for transport should continue to be a priority for critical care transport (CCT) services.

This report describes the main adaptive and transformative changes adopted by the brand-new National Emergency Medical Service (NEMS) to face the novel coronavirus disease 2019 (COVID-19) in Sierra Leone, including ambulance re-distribution, improvements in communication flow, implementation of ad-hoc procedures and trainings, and budget re-allocation. In a time-span of four months, 1,170 COVID-19 cases have been handled by the NEMS through a parallel referral system, while efforts have been made to manage the routine emergencies of the country, causing a substantial intensification of daily activities.

Disaster in Washington State (USA) is inevitable. It is incumbent on health care providers to understand the practice environment as it will be affected by disasters. This means understanding the basic concepts of emergency management, local to national emergency response structure, and the risks and vulnerabilities of the region where one works. This understanding will help health care providers anticipate and prepare for disaster response and recovery. Washington State has many unique features with regard to climate and geography, population, public health, and general infrastructure that create significant vulnerabilities to disaster and strengths with regard to potential response and recovery. This report attempts to define and contextualize emergency management and to condense the extensive research and planning that has been conducted in Washington State surrounding disaster assessment, planning, mitigation, and response from a health care providerʼs prospective. The aim is to increase awareness of and preparation for disaster-related topics among health care providers by creating informed responders.

External aortic compression (EAC) has long been used to control exsanguinating post-partum hemorrhage, but it has only recently been described in the prehospital trauma setting. This paper reports four cases where manual EAC was used during transport to manage life-threatening bleeding, twice from stab wounds, once from ruptured ectopic pregnancy, and once from severe lower-limb trauma. It showed that EAC has life-saving potential in the prehospital setting, but that safety and efficacy during transport requires the use of a hands-free compression device, such as an aortic tourniquet.

Standardization of operating guidelines for veterinary care in evacuation and emergency animal shelters is imperative for an organized response and to facilitate treatment and prevention of medical conditions stemming from the effects of a disaster and the associated outcomes of sheltering. Safeguarding animal welfare through creating guidelines should expedite care, assure consistency, and provide appropriate safety measures for animals and veterinary medical providers. Veterinary integration into an incident command system (ICS) and response training allows for proper allocation of roles and responsibilities, as well as coordination of veterinary supplies and personnel. Central components of the operational model include guidelines for animal identification, triage, medical records, medical treatments, and discharge instructions. An outline for communication with disaster response agencies, as well as animal owners, is aimed to inform appropriate conduct. Improving the animal component of disaster response is integral in meeting societal needs and improving animal welfare in the face of a disaster.

Pain management for patients with chest trauma in aeromedical prehospital and retrieval medicine is important in order to maintain respiratory function. However, it can be challenging to achieve with opioids alone due to side effects including sedation, respiratory depression, and nausea.

Reported are two trauma patients with uncontrolled pain despite multiple doses of opioids managed with a single-injection erector spinae plane block (ESB).

The sono-anatomy and performance of the block, indications, and possible complications associated with the ESB are described.

An ultrasound-guided ESB is useful for multimodal pain therapy following chest trauma in aeromedical retrieval medicine.

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a form of an infectious respiratory disease, discovered in November 2012 in Saudi Arabia. According to the World Health Organization (WHO; Geneva, Switzerland) reports, a total of 2,519 laboratory-confirmed cases and 866 MERS-CoV-related deaths were recorded as of March 5, 2016.1 The majority of reported cases originated from Saudi Arabia (2,121 cases). Also, MERS-CoV is believed to be of zoonotic origin and has been linked to camels in the Arabian area.1,2 In this report, the authors discuss the lessons learned from the MERS-CoV outbreak at King Abdul-Aziz Medical City-Riyadh (KAMC-R) from August through September 2015 from the Emergency Medical Services (EMS) perspective. The discussion includes the changes in policies and paramedic’s practice, the training and education in infection control procedures, and the process of transportation of these cases. The authors hope to share their experience in this unique situation and highlight the preparedness and response efforts that took place by the division of EMS during the outbreak.

Flood is the most common natural hazard in Iran, which annually affects the environment and human lives. On March 25, 2019 in Shiraz-Iran, following a heavy rainfall, the occurrence of a flash flood caused an extensive number of deaths, injuries, and vehicle demolitions in a short time. Evidence suggests that man-made causes of the incident, including unsustainable urban development and lack of early warning services, have played a more influential role compared with its natural causes. This study has attempted to substantiate that understanding disaster risks, as the first priority of Sendai Framework for Disaster Risk Reduction (SFDRR) 2015-2030, directly impacts the decisions and actions of policymakers, local authorities, and the public. To provide more safety, mitigation, and disaster risk reduction, attention should primarily be paid on making a cultural paradigm shift through providing sufficient training in developing appropriate disaster risk perception in the community at large.