Domestic and International Disaster Response requires ongoing preparedness through full-scale exercises and training. The Humanitarian Response Intensive Course (HRIC) includes a 3-day in-person simulation to prepare future humanitarian workers. The Massachusetts General Hospital (MGH) Disaster Medical and Global Disaster Response Teams supported the HRIC through the development of a simulated field hospital for the course participants. Additionally, the MGH teams engaged in an intensive continuing education program for specialized training.

An interdisciplinary team developed and delivered seven discrete educational modules utilizing small group methodologies and combining didactics and simulation for a total of 14 hours of content over the 3-day course. Participants engaged in structured debriefing and completed written evaluations at the end of each day.

18 participants completed the course and simulation weekend. Participants strongly agreed that learning outcomes were met and they noted that they felt more prepared to deploy in the future with comments specifically noting the ability to function as part of a team and increased awareness of personal safety in an alternate care setting.

Structured learning within a large-scale immersive, interdisciplinary simulation resulted in participants reporting increased preparation for real-world events.

Point-of-care ultrasound is a proven life-saving diagnostic tool that can be easily utilized in remote and austere settings with ever-improving portability. The utility of point-of-care ultrasound in prehospital care as a feasible and valuable tool to assist in prioritizing patients for damage control resuscitation and transport from the field will be highlighted with a focus on resource-limited environments and conflict settings. The session will conclude with a discussion around the successes, challenges, and lessons-learned after the implementation of a point-of-care ultrasound for trauma training program that was deployed to Ukraine in the fall of 2022.

Understand the role that point-of-care ultrasound can play in prehospital patient management.

Identify the benefits and pitfalls of point-of-care ultrasound utilization in the prehospital and resource-scarce environment.

Outline successful strategies and identify potential challenges for implementing a point-of-care ultrasound for trauma training program in complex environments.

In mass casualty scenarios, patients with apparent hemodynamic and respiratory stability might have occult life-threatening injuries. These patients could benefit from more accurate triage methods. This study assessed the impact of point-of-care ultrasound (POCUS) on the accuracy of secondary triage conducted at an advanced medical post (AMP) to enhance the detection of patients who, despite their apparent clinically stable condition, could benefit from immediate life-saving interventions or priority earlier transport to definitive care.

A mass casualty simulated event consisting of a bomb blast in a remote area was conducted with 10 simulated casualties classified as YELLOW at the primary triage scene; patients were evaluated by 4 physicians at an AMP. Three patients had, respectively, hemoperitoneum, pneumothorax, and hemothorax. Two of the four physicians were provided the use of POCUS.

All 4 physicians were able to suspect hemoperitoneum, but only physicians utilizing POCUS detected pneumothorax and hemothorax.

This study suggests that POCUS-enhanced secondary MCI triage at an AMP may represent an effective methodology to accurately detect nonapparent injuries that require time-dependent priority transport or life-saving interventions. Further studies with larger samples conducted in varied MCI scenarios are warranted.

Despite the global expansion of electronic medical record (EMR) systems and their increased integration with artificial intelligence (AI), their utilization in disaster settings remains limited, and few studies have evaluated their implementation. We aimed to evaluate Fast Electronic Medical Record (fEMR), a novel, mobile EMR designed for resource-limited settings, based on user feedback.

We examined usage data through October 2022 to categorize the nature of its use for disaster response and determine the number of patients served. We conducted interviews with stakeholders and gathered input from clinicians who had experience using fEMR.

Over eight years, fEMR was employed 60 times in 11 countries across four continents by 14 organizations (universities, non-profits, and disaster response teams). This involved 37,500+ patient encounters in diverse settings including migrant camps at the US-Mexico and Poland-Ukraine borders, mobile health clinics in Kenya and Guatemala, and post-earthquake relief in Haiti. User feedback highlighted adaptability, but suggested hardware and workflow improvements.

EMR systems have the potential to enhance healthcare delivery in humanitarian responses, offer valuable data for planning and preparedness, and support measurement of effectiveness. As a simple, versatile EMR system, fEMR has been deployed to numerous disaster response and low-income settings.

The release of ChatGPT in November 2022 drastically lowered the barrier to artificial intelligence with an intuitive web-based interface to a large language model. This study addressed the research problem: “Can ChatGPT adequately triage simulated disaster patients using the Simple Triage and Rapid Treatment (START) tool?”

Five trained disaster medicine physicians developed nine prompts. A Python script queried ChatGPT Version 4 with each prompt combined with 391 validated patient vignettes. Ten repetitions of each combination were performed: 35190 simulated triages.

A valid START score was returned In 35102 queries (99.7%). There was considerable variability in the results. Repeatability (use of the same prompt repeatedly) was responsible for 14.0% of overall variation. Reproducibility (use of different prompts) was responsible for 4.1% of overall variation. Accuracy of ChatGPT for START was 61.4% with a 5.0% under-triage rate and a 33.6% over-triage rate. Accuracy varied by prompt between 45.8% and 68.6%.

This study suggests that the current ChatGPT large language model is not sufficient for triage of simulated patients using START due to poor repeatability and accuracy. Medical practitioners should be aware that while ChatGPT can be a valuable tool, it may lack consistency and may provide false information.

This study sought to compare terrorist attacks targeting healthcare in two different geographical areas that are economically and culturally similar: North America and Europe.

The Global Terrorism Database is a database that documents 214,666 worldwide terrorist events from 1970 to 2021. It was searched to identify terrorist attacks against healthcare using keywords. We manually excluded incidents that did not specifically relate to attacks on healthcare. This resulted in 311 and 150 entries in North America and Europe respectively.

The most common method of attack in Europe was bombing (42%) compared to attacks on infrastructure (66%) in North America. The primary target in North America was abortion related (84%). In Europe, the primary target was businesses (37%). In Europe, 18.7% of attacks were assassinations or attempts vs 3% in North America. The total number of fatalities in Europe is 51 vs 3 in North America.

Even though there were significantly more attacks in North America, there were far fewer total fatalities compared to Europe. Attacks in North America appear to be ideological, targeting infrastructure to send a message. Whereas, in Europe, the targets and methods used are more targeted towards the individual and their property.

Congress directed the Secretary of Defense (DoD) to conduct a Pilot program to increase the National Disaster Medical System’s (NDMS) surge capacity, capabilities, and interoperability to support patient movement during a large-scale overseas contingency operation.

The Pilot conducted a mixed methods exploratory study, the Military-Civilian NDMS Interoperability Study (MCNIS), identifying 55 areas of solutions for NDMS innovation that align with interagency stakeholder interests. Priorities were determined via facilitated discussions, refined and validated by all five Pilot sites.

As the DoD provides essential support for the patient movement component within NDMS, the results highlighted areas for improvement between receiving patients at an airfield and moving them to NDMS definitive care partners during a large medical surge event. This includes patient tracking capabilities, transportation processes and patient placement.

In collaboration with the Departments of Health & Human Services, Homeland Security, Transportation, and Veterans Health Administration, the Pilot is addressing these areas for improvement, by executing site-specific projects that will be validated and identified for export across the system. Leaders across the Pilot site healthcare networks are working to enhance patient movement and tracking. Ultimately, the Pilot will deliver dozens of proven solutions to enhance the NDMS’s patient movement capabilities.

To investigate the differences between doctor helicopters (DHs) and disaster medical assistance teams (DMATs) based on past examples and the current situation in Shizuoka Prefecture.

First, we examined cases in Shizuoka Prefecture from 2014 to 2023, where incidents involving five or more injured individuals were simultaneously managed using multiple DHs. Next, we investigated the presence of DMATs in Shizuoka Prefecture and assessed their role in disaster responses within the prefecture.

Since 2014, there have been eight incidents in Shizuoka Prefecture where multiple DHs were deployed to respond to mass casualties. In contrast, Shizuoka DMATs were placed on standby three times during the same period, with one active deployment during a disaster caused by a landslide in Atami. The other two cases were managed solely by DHs and ambulance teams.

Localized disasters in Shizuoka Prefecture have seen the effective use of multiple DHs for timely patient transportation, particularly when suitable weather conditions permit. In contrast, DMATs are primarily deployed for extended medical activities lasting more than one day. This differentiation highlights the importance of choosing the appropriate medical response approach based on the nature and scope of the disaster.

To perform a scoping review identifying the criteria for the deployment of the United States National Guard (USNG) to domestic sudden-onset natural disasters to identify the body of literature on which further research and policy decisions may be based.

On January 23, 2023 authors performed a search to identify texts relevant to the involvement of the USNG response to sudden-onset domestic natural disasters. English language texts from any year were considered. Independent reviewers screened titles and abstracts, then full-texts, then extracted data from included texts.

From 886 search results, 34 texts were included. Fifteen criteria for USNG deployment were identified. Lack of security, power failure, and logistical coordination were the most common criteria. Hurricanes were the most common disaster type in the included results.

Disaster response coordinators may use these results to develop policies optimizing the use of the USNG in disaster response.

the line between our physical and digital selves becomes increasingly blurry, sexual, and reproductive data rights must be safeguarded as a key lever of bodily autonomy and gender equality.

Kati Collective will facilitate an engaging workshop on protecting personal sexual reproductive health data rights and bodily autonomy to build a shared understanding of this critical issue and begin to explore pathways for solutions.

Develop co-created policy-level recommendations and pathways to action contributing to improved understanding, alignment and collaboration among key stakeholders, and improved protection, ownership, governance of SRH data.

There is an urgent need for collective action to co-develop policy-level recommendations and pathways to action to protect SRH rights and bodily autonomy.

The recent rise of active shootings calls for adequate preparation. Currently, the ‘Run, Hide, Fight’ concept is widely accepted and adopted by many hospitals nationwide. Unfortunately, the appropriateness of this concept in hospitals is uncertain due to lack of data. To understand the ‘Run, Hide, Fight’ concept application in hospital, a review of currently available data is needed.

A systematic review was done focusing on the ‘Run, Hide, Fight’ concept using multiple databases from the last 12 years. The PRISMA flow diagram was used to systematically select the articles based on specific inclusion and exclusion criteria. The measurements were subjective evaluations and survival probabilities post-concept.

One agent-based modeling study suggested a high survival probability in non-medical settings. However, there is a paucity of data supporting its effectiveness and applicability in hospitals. Literature suggests a better suitable concept, the ‘Secure, Preserve, Fight’ concept, as a response protocol to active shootings in hospitals.

The effectiveness of the ‘Run, Hide, Fight’ concept in hospitals is questionable. The ‘Secure, Preserve, Fight’ concept was found to be designed more specifically for hospitals and closes the gaps on the flaws in the ‘Run, Hide, Fight’ concept.

INSPIRE: Readiness is a dynamic innovation platform where innovative approaches, advanced methods, state-of-the-art tools, and modern resources are aggregated and contextualized and where information is shared can be turned into action.

ASTHO conducted an environmental scan to assess initiatives across the organization. Disciplinary groups convened to reflect on experiences during the COVID-19 response, identify tools, model practices from the workforce, data systems management, and training utilized/adapted during the pandemic. ASTHO also completed a literature review to track and highlight areas of congruity and help identify gaps in information previously collected.

In the evolving landscape of the post-COVID-19 era, a stagnant document would not adequately illustrate the challenges, lessons learned, and innovative resources used by health agencies. From this assessment, INSPIRE: Readiness was designed as an ever-evolving discovery hub where the ASTHO community can learn from their peers about successful strategies for overcoming similar gaps and challenges and apply those insights to their health agency needs.

By facilitating a way for professionals to learn from each other’s experiences, be inspired by success stories, discover new methods, act, and inspire others, we can contribute significantly to enhancing public health preparedness and response.

Mass casualty incidents (MCIs) come unannounced, mandating the immediate shift from the daily routine to crisis mode through the implementation of an MCI response plan (plan). On August 4, 2020, a massive explosion devastated the Lebanese capital, Beirut, causing 8643 injuries and 200 deaths.1 The private Lebanese American University Medical Center in Beirut has an an estimated 10,000 emergency department (ED) visits per year. The purpose of this study is to analyse the plan of this private hospital in a low resource country in response to a blast MCI.

A retrospective analysis of the expected outcome of the pre-existing plan was performed.

Major flaws were noted. Triage was impossible using the START method and will be done outside the ED dividing patients into walking and non-walking. Identification and registration of patients was impossible. Patients will be assigned a number and be registered later. Colored jackets were created to recognize response team members for better organization.t Radiologic imaging will be ordered only when they change the patients’ disposition.

This analysis showed failure of the plan at different levels and adjustments were made to advance the plan. Periodic exercises and annual review are needed for continuous improvement.

This study explores the feasibility of applying ragdoll physics, a procedural animation, and related game-engine technologies to create real-time simulations for investigating crowd disasters.

We harnessed the power of the Unity Game Engine to develop real-time simulation for the dynamics of a crowd disaster with rendering of scene objects and user interface (UI) elements. Humanoid agents with trigger colliders were linked to color schemes representing impact forces sustained with lethal thresholds ranging from 500 to 550 pounds force for males and 450 to 500 pounds force for females. The simulation enables users to manipulate parameters such as population, crowd density, directional movement and forces applied.

Our simulation showcases an animated real-time depiction of a crowd disaster and enables visualization of casualties, both injured and dead, based upon a quantitative evaluation of the forces sustained.

Utilization of the Unity Game Engine for the development of visually-engaging real-time crowd disaster simulation has promising outcomes. This novel approach for modeling and analysis of crowd dynamics may provide valuable insights with applications in mass gatherings, crowd management, safety, and preparedness.

Since 2006, the Maricopa County Department of Public Health (MCDPH) has conducted routine surveillance of heat-associated deaths in the county. During that time, the number of deaths each year has been on the rise with 2022 numbers showing a 25% increase over 2021. Risk factors such as homelessness and alcohol and drug use have been shown to increase the risk of heat-associated death. During the summer of 2023, record-breaking heat in the metro-Phoenix area was widely reported. The MCDPH heat-associated death surveillance data was widely reported and used by policy makers to address extreme heat as a regional disaster. In this presentation participants will learn how heat-associated death surveillance has evolved over time to inform public health leaders and policy makers to the risk factors associated with poor outcomes from extreme heat. Participants will also understand how the data is shared at the local, national and international levels to inform extreme heat response activities.

Participants will learn how heat-associated death surveillance has evolved over time to inform public health leaders and policy makers of the risk factors associated with poor outcomes from extreme heat.

Participants will also understand how the data is shared at the local, national and international levels to inform extreme heat response activities.

Hemorrhage control, triage efficiency, and triage accuracy are essential skills for optimal outcomes in mass casualty incidents. This study evaluated user application of skills through a Virtual Reality (VR) simulation of a subway bombing.

EMS clinicians and healthcare professionals engaged in a VR simulation of a bomb/blast scenario utilizing VRFirstResponder, a high-fidelity, fully immersive, automated, customizable, and programmable VR simulation platform. Metrics including time to control life-threatening hemorrhage and triage efficacy were analyzed using median and interquartile ranges (IQR).

389 EMS responders engaged in this high-fidelity VR simulation encountering 11 virtual patients with varying injury severity. The median time to triage the scene was 7:38 minutes (SD = 2:27, IQR = 6:13, 8:59). A robust 93% of participants successfully implemented all required hemorrhage control, with a median time of 3:51 minutes for life-threatening hemorrhage control (SD = 1:44, IQR = 2:41, 4:52). Hemorrhage control per patient took a median of 11 seconds (SD = 0:47, IQR = 0:06, 0:20). Participants accurately tagged 73% of patients and 17% effectively utilized the SALT sort commands for optimal patient evaluation.

The VRFirstResponder simulation, currently under validation, aims to enhance realism by incorporating distractors and refining assessment tools.

To determine the incidence and characteristics of hospital-based gun violence from 2000–2019.

A keyword-based search of the Nexis Uni database was conducted to identify hospital based shootings ((“shooting” w/5 “healthcare”) OR (“shooting” w/5 “health care”) OR (“shooting” w/5 “hospital”) OR (“shooting” w/5 “emergency room”) OR (“shooting” w/5 “ER”). Hospital based shootings were defined as any firearms discharge that occurred on hospital grounds in which at least one person was injured. Specialty hospitals and other healthcare facilities were excluded. Demographic, motive, and outcome data from news articles were abstracted by 2 independent reviewers with discrepancies resolved by a third reviewer. Motives were categorized according to a previously published classification schema.

We identified 146 hospital-based shootings. 88 shootings have occurred since 2010. 133 of the shooters were male (91%), with a median age of 46. 77 (53%) shooters were killed, 49 from suicide (34%). Shootings were most frequently motivated by social violence (n=32, 22%).

Hospital-based shootings are not a rare occurrence, with middle-aged male shooters as the most common perpetrators. These events appear to be increasing over time and evidence-based mitigation strategies should be investigated.

Disasters are the consequences of natural or technological hazards that affect a vulnerable society.1 Technological disasters are divided into three groups: industrial, transport, and miscellaneous.2,3 It is possible to determine the risks of technological disasters, to determine priorities, and to plan services by knowing this epidemiology.4 In this study, we aimed to define the distribution and characteristics of the subtypes of technological disasters in the world according to regions and years.

Our study was conducted using the international dataset at www.emdat.be/. The technological disasters between 1970 and 2020, the years they occurred, their locations (region and continent), the types of disasters, and the numbers of dead and affected were recorded.

We found that the greatest number of disasters occurred between 2001 and 2010. The most common type of disaster was transportation accidents. While the continent with the most frequent disasters was Asia (3 879 [45.6%]), it was followed by Africa (2 220 [26.1%]) and South and North America (1 359 [16%]).

Transport accidents are the most common cause of technological disasters, and road accidents are the most common type of transport accident.

Integration of head-mounted virtual reality (VR) devices has been revolutionary in health professions education. In disaster preparedness training, VR simulation-based learning exposes health care professionals to the unique challenges of diverse scenarios, enhancing their adaptability. The aim of the study was to evaluate the effectiveness of a head-mounted VR tool for teaching basic radiation emergency medicine skills to medical students.

The participants were 64 medical students (5th-year) who underwent a 3-hour training session in radiation emergency medicine that was conducted via head-mounted VR devices. Students scored their perceived emotion, performance, and self-efficacy at various time points in a self-reported online questionnaire.

Comparison of survey responses before and after the session showed significant differences in terms of neutral emotion (P = 0.011), negative activating emotions (P < 0.001), and negative deactivating emotions (P = 0.004). The post-hoc test revealed statistically significant differences in negative activating emotions between before and during (P < 0.05), and between before and after (P < 0.05) the VR simulation. In addition, negative deactivation and neutral emotions changed significantly after the simulation.

The use of head-mounted VR devices was effective in modulating medical students’ emotions and contributed to improving their perceived performance in radiation emergency medicine.