On February 13, 2021, Winter Storm Uri hit the United States beginning in the Pacific Northwest, heading across the central US, and eventually exiting on the East coast. By February 16, roughly 73% of the continental United States had snow coverage leading to ten million households without power. To understand the disaster-related causes and circumstances of death for Winter Storm Uri, we activated media mortality surveillance to help inform preparedness and response efforts.

We searched the internet for key terms related to the winter storm, including storm name and type (e.g., winter storm), location-specific terms (e.g., state, county, city), mortality-related terms (e.g., death, mortality), cause of death (e.g., exposure, motor vehicle collision, carbon monoxide), along with other information learned from previous days (e.g., name of individual). We compiled and coded data into a standardized media mortality surveillance database and conducted descriptive statistics.

Between February 13 and March 2, 2021, the media reported 136 storm-related deaths from nine states. The winter storm had the largest impact in Texas (n=91). Of decedents with sex data available (n=91), the majority (58%) were male. For decedents with age data available (n=93), the majority (91%) were adults. Exposure to extreme temperatures (47%) was the most common cause of death, followed by blunt force trauma (15%), CO poisoning (7%), and fire (7%). Roughly one-third of deaths (34%) were indirectly related to the winter storm with motor vehicle collision (13%) representing the top indirect circumstance. Twenty-six deaths (19%) have an unknown circumstance and cause of death.

This was the first time we activated media mortality surveillance for a winter storm providing timely data for public health action. Media mortality surveillance continues to be a useful tool in assessing the impact of a disaster and guiding response efforts.

Hazardous materials (HazMat) training is not a requirement for accreditation of US Emergency Medicine (EM) residencies, nor for EM board certification by the American Board of Emergency Medicine (ABEM). However, the US Occupational Safety and Health Administration (OSHA) requires hospitals train all personnel expected to deal with contaminated patients. This QI project aimed to develop an EM physician-specific HazMat course and evaluate the physician comfort level with HazMat personal protective equipment (PPE) donning and doffing, triage, procedural skills, and decontamination.

A four-hour “HazMat for Docs” course was designed at a large urban academic trauma center and offered to second-year EM residents. Additionally, we performed a quantitative survey of a cohort of 72 current and recently graduated EM residents (classes 2019-2024), some of whom had taken the course in person. Our primary outcome was to measure improvement in comfort level with essential HazMat tasks after completing the course. Our secondary outcome was to evaluate the current or recently graduated EM physician's overall comfort levels with managing a HazMat incident, as well as HazMat skills and knowledge retention.

A total of 53 responses (73.6%) were obtained. 45.3% of the respondents were male and 54.7% female. 37.8% of the respondents were recent EM graduates, with 20.8% PGY-4, 13.2% PGY-3, 15.1% PGY-2, 13.2% PGY-1. 16/53 (30.2%) had prior EMS experience. EM Physicians were most comfortable with donning and doffing PPE (4.92 on a 7-point scale) and least comfortable with decontamination procedures (2.98/7). After completing the HazMat course, EM physicians increased their comfort level with HazMat decontamination procedures by 8.6% and with organizing a multi-disciplinary ED HazMat response by 10.5%.

EM Physician comfort levels with HazMat procedures are low. Increased training aimed at improving physician knowledge, preparedness, and comfort level for such events is necessary and can be accomplished through a short course.

The COVID-19 pandemic has underlined the international priority to systemically operationalise resilience in the face of increasing prevalence of complex and cascading hazards. This concept paper identifies the components of a resilient society, establishing the usefulness and usability of the application of ‘resilience’, and proposes the characteristics used by a resilient system.

Through the review of case-based examples and previously published concept papers, this paper underwent a concept analysis to understand and qualify the characteristics of a resilient community. Through extensive research and critical analysis of disaster risk responses both effective and not, the authors condensed the literature to identify the key components of a resilient society.

To respond to this evolving landscape of disaster risk, community and governmental responses should be collaborative in order to be successful and sustainable to increase resilience across communities, societies and networks. To unpick the complexity of how communities and governments might promote resilience effectively, we explore whether community and social capital are useful resources to create and sustain resilient approaches to disaster risk reduction and management. We consider that by exploring how social capital links, bridges and bonds actors within a system are qualitative key facets of a resilient community. A resilient system is the product of trust and collaboration between asset-based networks of bonded and bridged communities and risk and support-based networks of bonded and bridged organizations.

By evaluating the usefulness and usability of the concept, we consider that a resilient system is an iterative learning process, asset based, trusting across power and resource gradients and is best built before or even if essential during a crisis. Noting that resilience is a dynamic process which requires integrated collaboration and continual adjustment to develop a sustainable framework, we consider that social characteristics of a resilient system are useful, useable and should be used.

A mass hospital evacuation occurred in Taiwan in 2021 due to the clustered COVID-19 infection in Hospitals. To maintain essential services with limited manpower, 74 patients are triaged and evacuated to 12 hospitals in 6 cities in 16 hrs for further treatment.

All patients were evaluated by physicians for discharge. The patients who still needed hospitalization were classified into three groups according to the risk of infection1. The high-risk group of patients were cared for by infected staff directly; the moderate-risk group were patients admitted to the same ward but didn’t receive care from infected staff. The low-risk group were patients avoiding infection outbreak. Only the low-risk group patients were transferred, excluding patients with unstable vital signs, hospice, and prison. Command Center of HICS of TGH set up a transfer execution team to handle this task.

There were 74 patients transferred, including 56 from internal medicine and 18 from the surgery ward. Most of the transfers are concentrated within 16 hours. These patients were transferred to 12 emergency hospitals in 6 cities. The average transport time was 1.5 hours and the longest was about 3 hours due to the distance and traffic.The 17 private ambulances and 11 Fire Department ambulances were dispatched and transferred 60 patients. In addition, there were 14 patients evacuated by small buses. No mortality or COVID-19 infection had been reported within 3 days after this mass evacuation, only one patient had been intubated after one hour of arrival to hospital due to condition deterioration.

A hospital evacuation is a complicated process, especially during a pandemic. All infection control measures create difficulties in the patient transfer process. Well-prepared evacuation plans, regular drills, well-trained personnel, an organized command system, and regional cooperation are the keys to mass evacuation in a disaster.

Hospitals are subject to internal and external threats which could necessitate an evacuation. Such evacuation needs deliberate surge and collaboration, particularly collaborative use of community capacities to handle affected patients, personnel, devices, and hospital structures using consensus systems. Therefore, it is crucial to identify hospital evacuation procedures’ flaws and assess the possibility of implementing measures using community resources. This study aimed to explore Thai hospitals’ current evacuation readiness and preparation regarding surge capacity and collaboration according to the Flexible Surge Capacity concept.

The previously used hospital evacuation questionnaire was adopted. It contained relevant questions about hospital evacuations’ responses and preparedness encompassing surge capacity and collaborative elements and an open-ended question to collect possible perspectives/comments.

The findings indicate glitches in evacuation protocols and triage systems and inadequacies in surge planning and multi-agency collaboration. Additionally, it was evident that hospitals had limited information about communities' capabilities and limited collaboration with other public and private organizations.

Although implementing the measures for concept integration to hospital evacuation is challenging, pragmatic research exploring planning for community engagement according to the flexible surge capacity to build a concrete hospital evacuation plan would enhance hospital readiness and its generalizations. The latter needs to be tested in simulation exercises.

Mass casualty incidents result in mass casualties at short notice and stress healthcare systems. Research shows the critical potential role laypersons have by providing time critical intervention, on-scene, while awaiting arrival of emergency services, thus reducing mortality.

This study aims to demonstrate the attitudes of laypersons to responding to mass casualty incidents in Singapore.

Laypersons were invited to participate in a pilot course aimed at training laypersons principles and interventions for mass casualty incidents. This was developed by the Disaster Volunteer Corps of Singapore General Hospital Department of Emergency Medicine. Respondents were invited to answer a questionnaire which aimed to explore knowledge and prior experiences, willingness, attitudes, and readiness. Descriptive statistics were analyzed, and free-text responses were categorized into various headings by theme.

A total of 29/30 course enrollees responded to the questionnaire. Twenty (69%) participants were female. The median age was 50 years old (IQR 35-56.5). Most of the participants were employed (82.7%) and were Singapore Citizens (89.7%).

65.5% had no previous experience with first aid, and none had experience with MCIs. Understanding of mass casualty incidents was poorly understood, 1.42/5 (±0.56).

Respondents were most willing to assist in conventional disasters as compared to other types. Competency in voluntary role and altruism were the most important motivators as compared to compensation which was the least.

Overall, there is a high understanding that Singapore is at risk of disasters but most respondents do not have emergency plans in place for disaster situations.

This study shows that while laypersons are willing, most do not have the knowledge or experience to respond to mass casualty incidents. This mirrors previous studies in Singapore relating to attitudes and knowledge of laypersons to CPR and AED.

More research and intervention is needed into the attitudes and willingness of members of public and mass casualty incidents.

Health service capacity has been an issue in Ireland since the 1980s swinging cuts. Government reports from 2003 have consistently identified a requirement for 3,000-5,000 extra beds on top of the current approximately 10,500 capacity. Acute hospital bed capacity issues have escalated, the formal system of recording “over capacity” patients or “patients on trolleys” has developed. A “Trolleygar” reports issues from the Health Service Executive (HSE) three times daily. This count is an underestimate as patients temporarily housed in day care units, surgical, or medical assessment units, discharge lounges and other clinical areas which have a bed space are not counted in this overcapacity measure. This study's aim is to calculate the annual number of days on which no patients were lodged on trolleys in Wexford General Hospital.

Descriptive study using anonymized freely available data from the national HSE Trolley GAR reports on trolley patients in Wexford General Hospital from January 2019 until September 2022. A Golden Zero trolley day was stated as a day on which there were no reported trolley-patients at the three time points, Silver Zero trolley day when two of the time periods recorded no trolleys and a Bronze Zero Trolley day when one period recorded a zero trolley count.

Data was collected on 1,369 days, with 90 days excluded due to missing data sets. There were 162 Golden days recorded (12.67% of total days). The year 2020 recorded the highest number of Golden days at 28.69% (105 days), followed by 2021 with 11.23% (41 days). During 2019 there were 3.84% (14 days) Golden days and 2022 had the lowest number (January-September) with 0.73% (2 days).

Despite a zero-tolerance policy, Golden days are disappearing rapidly, capacity is urgently required with post-pandemic ED attendance surges worldwide. True recording of overcapacity patients is required for appropriate capacity modeling.

The local, national, and global disasters have increased the demand for Emergency Management professionals. Institutions of higher education can play a key role to support and respond to this demand. One institution of higher education responding to this demand is Anna Maria College (AMC). AMC is a four-year, independent, Catholic institution accredited by the New England Commission of Higher Education, which was formerly known as the New England Association of Schools and Colleges. Established in 1946 by the Sisters of Saint Anne, the College was founded to increase access to quality education, educational innovation, and respect for service to others through development of the total human being. AMC offers exceptional professional programs at all degree levels, especially in community-oriented professions, propelling students to lives of civic, spiritual, and personal consequence. Based on the number of public safety majors and their networks, an area of interest has become how the college could contribute and respond to the demand for emergency managers.

These search resources were used: Chronicle, HigherEd jobs, Indeed, GoogleScholar Emergency Management majors curriculum, with searches from 2012 onward. Keywords used included emergency management jobs, higher education emergency management curriculum, public safety and community networking, disaster, and emergency preparedness, and filling the emergency management pipeline.

Data collection and analysis planned for completion by February 2023.

Higher education can support the pipeline to narrow the gap and respond to the demands for trained and educated community members in disaster and emergency preparedness. Higher education responses include strategies such as, creative emergency management curriculum and community networking.

The docimology or "science of examinations" is a scientific discipline devoted to the study of the examination in all its dimensions. The main objective is the development of standards guaranteeing valid, reliable and objective tests. It was adopted within a Medical School in 2007.

Our aim was to analyze results of docimological survey results of written acute medicine examinations through a global approach, by discipline and by item.

This was a retrospective study analyzing the notes of acute medicine examinations (January and May sessions) of Second Cycle Medical Studies 3). We have calculated docimological parameters allowing three levels of assessment: global, by discipline, and items analysis.

We analyzed 407 scripts, 99 questions and 6,919 pieces of data. The overall success rate was 97.6%. Highest success rates were found in Medical resuscitation (87%). The lowest rate was found in emergency medicine (53%). The difficulty index for the January session was 0.53 and 0.61 for the May session. For the January session: 24% of questions were easy, 14% of questions were difficult and 61% were of acceptable difficulty. For the May session: 40% of questions were easy, 6% of questions were difficult and 54% were of acceptable difficulty. The discrimination index was 0.27 for the January session and 0.24 for the May session. Discrimination was very good in 18% of items and good in 25%. Useless and bad discrimination items were about 35% for both sessions. Average Cronbach’s Alpha was 0.84, showing good internal-consistency.

Overall, acute medical examinations have joined docimological recommendations and had an acceptable internal consistency and a good level of difficulty and discrimination. However, some weaknesses had been revealed specially for the discipline with low weighting. A reflection on the integration of questions would make up for these weaknesses. This would ensure better assessment and training.

In this era of increasingly fragile hospital systems, major emergency preparation is firmly being placed under the spotlight. The response to major emergencies requires the mobiliZation of numerous resources to ensure an effective, coordinated response. Yet, studies confirm a global deficit in the knowledge and skills of staff responding to these events in Ireland. Non-consultant hospital doctors (NCHDs) provide a useful and necessary surge response during these events, but currently there are no training programs specifically focused on their major emergency training requirements. The aim of this research was to define the essential elements of a focused curriculum for non-consultant hospital doctors responding to a major emergency (ME).

A two-step process was employed. Initially, a comprehensive ME competency set was compiled from relevant literature, consulting field-specific experts and from current ME training programs. A sample of experts was paneled from several acute hospitals in Ireland using purposive and snowball recruitment. A modified Delphi process, using on-line surveys, was utilized to identify the competencies deemed essential for NCHDs responding to an ME event.

Three Delphi rounds were required to complete this study. Of the 116 initial survey items, 68 competencies were confirmed as essential NCHD competencies, a total reduction of 40%. A 70% consensus rate was applied to 71 survey items in the final round, resulting in an agreement in 68 competencies (96%). A preponderance of the rejected competencies were specific to managerial and administrative tasks, whilst many retained competencies related to direct clinical care.

This study has defined the essential elements of a curriculum for NCHD doctors responding to a major emergency in Ireland, using the Delphi methodology. This derived competency set should be useful to national bodies, regional organizations, and hospital stakeholders to allow the creation of bespoke NCHD major emergency training programs.

Ultrasound is the standard imaging technique for diagnosing lower limb deep venous thrombosis (DVT). The National Institute for Health and Care Excellence (NICE) guidance 158 recommendation 1.1.3 states that all patients with sufficient pretest probability for DVT should be offered a proximal leg vein ultrasound within four hours. However, due to high patient volumes, formal radiology department ultrasound wait times often exceed one week. Point-of-care ultrasound (POCUS) is used to bridge diagnostic delay in our emergency department (ED) .

This study aimed to quantify numbers offered POCUS for suspected proximal lower DVT in our ED and accuracy of such studies.

A retrospective review of electronic records was conducted for patients who underwent formal lower-limb ultrasound for suspected DVT at our hospital over a three-month period (August 1, 2022-October 12, 2022). Patient charts for all ED presentations were assessed to determine whether POCUS was offered and whether DVT was diagnosed.

Statistical analysis was conducted using PRISM v9.

80 formal ultrasound scans were performed at our hospital for lower limb DVT. 58 were requested for patients presenting to ED, of which 42 had complete records available meeting selection criteria.

POCUS was offered to 24 patients in ED (57.1%). Sensitivity was 66% (95% CI 12%- 98%), and specificity was 94.1% (95% CI 75%-99%). Overall accuracy was 90%, with only one false negative study identified at formal follow-up ultrasound.

Although sample size was small, our results suggest that POCUS is an accurate but underused tool to diagnose lower limb DVT. Developing a standardized protocol for performing and reporting POCUS DVT scans in ED should allow for earlier diagnosis and initiation of appropriate treatment where necessary.

Business continuity planning (BCP) ensures that critical healthcare operations are not interrupted and are recovered quickly, in the event of a disaster. BCP has an important role in avoiding adverse health impacts, particularly in long-term care settings. The purpose of this study is to conduct a literature review and comparison of the U.S. and Japanese BCP in long-term care to identify and compare challenges and desirable approaches in each country to support older adults.

We systematically searched PubMed, CINAHL, Japan Medical Abstracts Society and EMBASE databases, gray literature, and conducted a hand search of high-impact journals for studies published between 2000 and 2022 that assessed BCP in the United States and Japan.

From the literature, a challenge identified in the U.S. is the limited coordination within and across regions and between healthcare institutions and long-term care settings. The advantages are that an established structure of planning, training and evaluation is in place, with evidence from recent disasters showing net positive effects. In Japan, a significant challenge is that, despite an emphasis on continuity in the provision of medical care and welfare to individuals, cooperation between BCP at healthcare institutions and BCP at long-term care facilities is underdeveloped. The advantage is that BCP at medical institutions is incorporated into the national healthcare plan in Japan, making it easy to design BCP protocols and plans according to local needs.

Future research should focus on two points. 1) In the U.S., there is a need for evaluation of BCP cooperation and coordination among healthcare networks, especially in long-term care settings. 2) In Japan, it is necessary to promote BCP in healthcare sectors and accumulate training and evaluation across the fields of medical institutions and long-term care facilities.

Urolithiasis prevalence is approximately 15-20%, the third most common urological presentation to emergency departments (ED). In the ED, renal stones are usually diagnosed by clinical presentation, but imaging modalities play a role in confirmation and exclusion of hydronephrosis. 85% of stones are calcium oxalate/calcium phosphate, which are radio opaque, and 15% are radiolucent uric acid or cysteine stones. Non-contrast CT scans have 95% and 97% sensitivity and specificity rates, while x-rays have 57% and 76% respectively. In Wexford General Hospital, radiology prefers plain film x-rays prior to CT scans in assessing kidney stones.

The aim of this study was to assess the sensitivity of x-rays in patients undergoing low dose non-contrast CT for kidney stones and to apply this information to clinical practice. A retrospective audit was conducted using NIMIS/PACS from December 1, 2021-March 31,2022. All patients who underwent CT KUBS for evaluation of renal stones were included, and CT KUB findings were compared with initial x-ray findings.

A CT KUB was performed on 56 patients to assess renal stones, and 29 patients had renal stones. Among 29 patients, 21 had x-rays and CT scans performed, and 12 had x-ray findings that indicated renal stones, indicating 57% sensitivity. The study found 36 patients had x-rays for renal stones, but no CT scan was scheduled for 15 patients who might have undiagnosed radiolucent stones.

Radiological imaging plays a central role in the management of suspected renal stones. CT KUB is a useful tool for evaluating patients with radio-opaque kidney stones as well as detecting radiolucent stones and renal pathologies that can be missed with plain radiographs. Low-dose CT KUB is recommended as a first-line investigation for renal stone patients to reduce radiation risks and unnecessary abdominal x-rays while assisting clinicians in accurately diagnosing patients and excluding other possible causes.

Front loading tests reduce Patient Experience Time (PET) in Emergency Departments (ED). “Blanket” or “scattergun” approach to test requests results in prolonged PET, increase in laboratory workload with wastage of resources. Coagulation studies are one of the most commonly ordered investigations. Previous to the 2020 audit, it was suggested that 70% of ED coagulation requests were unnecessary not changing management. By establishing local guidelines, we worked to reduce coagulation test requests.

The aim of this study was to assess reduction in coagulation tests following implementation of local guidelines in ED. The coagulation indicator checklist was introduced to ED areas storing coagulation bottles. Presentations, small group education, reminders about clinical indications for appropriate coagulation requests were given to nurses, doctors, and advising about audits of practice. From February 1-14, 2022, nurses and doctors were instructed to send coagulation samples after filling out audit forms for the laboratory indicating the purpose of the request.

Prospective data in February demonstrates a 20% decline in coagulation requests. Only 47% of requests had accompanying coagulation forms filled and the remaining 53%was not filled. In 57% of cases, coagulation samples were requested appropriately, and in 43% there were no indications.

Through microsystem interventions and awareness campaigns, unnecessary coagulation requests can be reduced. By introducing local guidelines, regular training of new doctors and nurses at induction and intervals, clinical practice changes can be embedded. Consideration should be given to specific coagulation request forms stating the indication for the request. The cost of each sample is 2.87 euro. Obtaining 90% compliance with coagulation requests can save approximately 100,000 euros annually.

According to the Climate Change Advisory Council, Ireland is woefully unprepared for future extreme weather events such as heatwaves, flooding, and coastal surges, which are going to be more extreme and frequent in the future. Met Éireann issued numerous red weather warnings since the inception of the severe weather forecasting system. Storms Ophelia (Ex. Hurricane) and Emma (Snow Storm) proved to be extremely challenging weather events for the Health Service across Ireland.

A comprehensive review of debriefs and lessons identified processes completed across the health system was conducted, in connection with lived experiences of emergency management staff, following Storm Ophelia and Storm Emma.

As part of the emergency management life cycle and an attempt to enhance severe weather preparations, this study lists over 50 actions (development of specific HR policies, creating 4X4 capacity, severe weather preparations sessions, development of service-specific red weather event action cards, development of severe weather care plans for community palliative care and renal dialysis patients, sharing critical health care facilities with Local Authorities for road salting and gritting etc.) that were taken across the Health Service Executive South (Cork and Kerry) to enhance the preparations for severe weather events,

The frequency and intensity of severe weather events will increase in Ireland over the coming years, as a result, it is essential that healthcare facilities and services have learned from previous severe weather events to ensure that the necessary plans and procedures are in place for future events, ensuring the delivery of safe and effective patient care and staff safety.

There is no universal agreement on what competence in disaster medicine is, nor what competences and personal attributes that add value in a medical disaster situation. Some studies suggest that not only technical skills are needed, but also non-technical skills. However, little is known about the actual demands and skills needed to manage a medical disaster situation. Therefore, this scoping review aimed to identify core competencies required for the disaster medicine response.

A scoping review using the Arksey & O´Malley framework (1) was used. Structured searchers in the databases PuBMed, CINAHL full plus, Web of Science, PsychInfo and Scopus was conducted. Thereafter, data was structured and analyzed. Inclusion criteria were (1) original papers published in English during the last ten years, (2) covering any aspect of competence or skills needed to respond to a disaster situation. (3) Both qualitative and quantitative studies were included. Exclusion criteria were (1) reviews, editorial texts or similar, (2) papers focusing on the care of single patients.

(1) Arksey H, O’Malley L. Scoping Studies: Towards a methodological framework. Int. J. Social Research Methodology. 2005;8(1):19-32.

To be presented at the congress.

To be presented at the congress.

A collaborative project between Sweden and Kosovo with the aim to develop treatment guidelines for the ambulance services was undertaken. Firstly, relevant guidelines were identified, then translated, and processed to fit with the Kosovan ambulance service system. The next step was to train instructors in becoming proficient in training colleagues to use the guidelines. A train the trainer approach was chosen as it can be seen as grounded in Kolb's experiential learning theory and Crossan et al. organizational learning theory. Those theories describe how individuals learn and how organizations develop.

This implementation project supported training of local instructors to become proficient in training colleagues in 13 selected treatment guidelines for the ambulance services using scenario training. Initially, Kosovar instructors received directions from Swedish instructors then they observed the Swedish instructors. After this, they took more responsibility for the training. Seven Swedish instructors instructed eight Kosovar instructors for a week where about 100 Kosovan doctors and nurses were trained in patient assessment and treatment guidelines. The trainees were divided into four parallel groups of 4-5 participants with one Kosovar instructor supported by a Swedish instructor.

After the training week, eight instructors from two different ambulance service centers achieved proficiency in training colleagues in using treatment guidelines. Each Kosovar instructor was involved in 30 training occasions.

The training resulted in the involved Kosovar ambulance service centers being able to train new colleagues in providing standardized patient assessment and treatment using treatment guidelines. In addition, the trained Kosovar instructors will be able to contribute to the development of new guidelines and revision of established guidelines.

Applying a train the trainer approach, theoretically grounded in learning theories, provides a sound basis to achieve systematic change for improving patient safety. Here, the knowledge distribution among practitioners is improved in an inexpensive manner.

The Tokyo 2020 Games were held without spectators in the fifth wave of the COVID-19 pandemic after one-year postponement. From all over the world, approximately 11,000 Olympians and 4,400 Paralympians participated in the games. As one of the designated medical institutions, Tokyo Medical and Dental University Hospital provided emergency medical care for the personnel referred by medical staff at the venues or the Olympic Village clinics. On the other hand, it played a central role in treatment and care for COVID-19 patients in the Tokyo metropolitan area. The aim of this study was to review the emergency medical care system of the hospital as a designated hospital for the Tokyo 2020 Games and discuss the measures for future large-scale international events.

A retrospective analysis of persons involved in the Games who visited our emergency department by request was conducted. COVID-19 patients who were admitted were also analyzed. The study period was from July 13 to August 11 for the Olympics and from August 17 to September 11 for the Paralympics, respectively in 2021. The data was derived from electronic health records from the hospital.

The total number of ED visits was 38 during the period. One patient was hospitalized, and another patient was transferred. Twenty-one (55%) were athletes, seven (18%) were staff members, and ten (26%) were others. The reason for the visit was medical disease in 23 (61%) and surgical disease in 15 (39%). There was one COVID-19 positive patient. The number of COVID-19 inpatients was 124.

Emergency medical care was provided for the persons involved in the Tokyo 2020 Games in cooperation with all the staff at the hospital. The COVID-19 pandemic ‘disaster’ may have had some impact on our hospital’s role as the designated medical institution.

The Battle of Mosul (2016-2017) involved asymmetric warfare and excess civilian causalities. Emergency Management Centre (EMC) was a designated trauma center for the battle, located 80 km from Mosul. Exploratory laparotomy outcomes in local hospitals are poorly studied compared to military hospitals. Improving response to complex emergencies requires better contextual understanding.

Prehospital and hospital data were collected from all patients undergoing exploratory laparotomy at EMC during the battle. Data were collected and validated by EMC’s chief surgeon. New Injury Severity Scores (NISS) were calculated from operative data.

Seventy-three patients were included. 22 (30.1%) were children; 40 (54.8%) were non-combatant adults. 51 (69%) were male. Bullets caused 74.0% of injuries. Children had prolonged time from injury to first laparotomy compared to adults (600 vs 208 minutes, p<0.05). Median hospital length of stay (LOS) was six days (IQR 4-10; children 16.4 days vs adults 8.6 days, p=0.05). Median NISS was 18 (IQR 12-27). NISS were significantly higher for women (28.5 vs 19.8), children (28.8 vs 20), and re-laparotomy (32.0 vs 19.0) compared to men, adults, and primary laparotomy, respectively. In univariate and multivariate analysis, NISS was associated with hospital, but not ICU, LOS (p<0.01). Twelve patients were re-laparotomies after surgery elsewhere: ten (83.3%) were for failed repairs or missed injuries. Median time to re-operation was 5.5 days (IQR 1-8). Re-operations had longer ICU (4.5 vs 2.9, p<0.01) and hospital stays (20.7 vs 7.6, p<0.01). Three (4%) patients died; two of which were re-laparotomies.

During the battle, civilians and combatants had similar injury mechanisms and outcomes. Children had a long time to present and LOS. Low mortality likely reflects high prehospital mortality. Prolonged times to admission suggest the need for improved hospital transport. Re-operation was associated with increased complications and LOS. NISS demonstrated predictive value for hospitals, but not ICU, or LOS.

Nepal is a country with geographical difficulties in tackling day-to-day emergency healthcare and disaster preparedness. The aim is to develop community preparedness by training for day-to-day emergency and disaster response in Nepal to generate preventive and first aid awareness of consequences and complications of simple to severe emergency conditions during day-to-day emergencies and disasters.

It is an analysis of five years of advanced first-aid training at the Nepal Disaster and Emergency Medicine Center from July 2015 to March 2020. In April 2015, the earthquake affected 15 districts of Nepal.

During July 2015 to March 2020, NADEM has been training 3,995 Community First Aiders for Male Leaders and Active Community people: 1,315 special mothers’ group–Adolescent Maternity & Child Health First Aiders; 794 Ambulance Drivers–Advanced First Aid Trained of remote districts of Mountain and hilly region’s ambulance’s Drivers and Assistants ; 637 ToT First Aiders for Community School Teachers (Training of Trainers); Total AFAT Trained by NADEM = 6,741 (Province 1 to 5); Total Population AFAT Trained = 52,610 (Province 1 to 5); Total Population Benefit by AFAT = 902,100 and its ongoing. NADEM Study Reports of Nepali community with ‘Incident Rate of First Aid Required’ is 9% per day with First Aid Services for 87.4% minor causes, 5.4% major causes, 0.5% gynecological causes, 1.7% AMCH causes, 4.5% trauma causes, 0.5% Prehospital Cardiac Arrest. With NADEM advanced first-aid training, now we are preventing 70% of deaths in remote parts of those districts before reaching the health care centers.

It is a great challenge to train community laypersons to be Community First Aiders who can tackle day-to-day emergencies and disasters in their community with knowledge, skills practice, and attitude to prepare and prevent the increased tendencies of disability, deformity, morbidity, and mortality in Nepal.