When hydrological disasters occur in local rural communities, the demand for health services increases, especially in primary healthcare.1 Health services are essential in the response to a disaster where nurses all over the world play a significant role.

To identify nurses’ competencies when responding to disasters caused by floods in the rural area.

A descriptive, exploratory, and qualitative study was developed. The Critical Incidents Technique was adopted. Twenty public health nurses who worked during the flood season in the years of 2014 and 2015 in a rural area in Southern Brazil were interviewed. Critical incidents and requirements identified in the empirical data gave rise to the development of the competencies.

Thirty competencies were identified and classified in the following domains: leadership and management, teamwork, health care, community-oriented, communication, psychological support, health surveillance, and education.

Although the competencies could be related to the established international competencies for the nurse in disasters, some were described only in this study. They can contribute to the education and practice of nurses in primary health care, strengthening its capacity to face disaster situations by flood in the rural area.

Clinicians working in emergency departments (ED) play a vital role in the healthcare response to chemical, biological, radiological, nuclear, and explosive (CBRNe) events. However, ED clinicians’ individual and workplace preparedness for CBRNe events is largely unknown.

The aim of this research was to explore Australian ED nurses and doctors’ perceptions of individual and workplace preparedness related to CBRNe events.

The study populations were Australian nurses and doctors who work in EDs. Data was collected via a survey with 43 questions requiring binary responses or a rating on a Likert scale. The survey consisted of questions relating to the participant’s previous disaster training, perceived likelihood of a CBRNe event impacting their ED, perceived level of knowledge, perceived personal preparedness, perception of ED preparedness, and willingness to attend their workplace. Data were analyzed using descriptive and inferential statistics.

There were 244 complete responses, 92 (37.7%) doctors and 152 (62.3%) nurses. When comparing doctors and nurses, there was a statistical difference between gender (p = < 0.001), length of employment (p = < 0.001), and role in the ED (p = < 0.001). Doctors and nurses had a similar level of previous training except for practical training in mask fitting (p = 0.033). CBRNe events were considered separately. Perceived level of knowledge, perceived personal preparedness, and perception of ED preparedness were significant predictors of willingness to work in all CBRNe event. Perceived likelihood of a CBRNe event impacting their ED was not a predictor of willingness.

This research contributes to an overview of the current status of Australian ED clinicians’ preparedness for CBRNe response. To increase the willingness of ED doctors and nurses attending their workplace for a CBRNe event, strategies should focus on enhancing individuals perceived level of knowledge, perceived personal preparedness, and perception of ED preparedness.

This paper aims to clarify how the Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project) strengthened regional collaboration mechanisms on disaster health management (DHM) in ASEAN.

The political process and the relevant documents of the ARCH Project were reviewed.

The ARCH Project established the Regional Coordination Committee as a coordination platform for providing strategic direction to the project and strengthening the regional coordination of DHM. Also, the Project Working Groups and Sub-Working Groups were set up as implementation bodies for the project activities with representatives of ASEAN Member States (AMS). With support from DHM experts of Japan and Thailand, a series of discussions were conducted for the development of a Standard Operating Procedure (SOP) for the Coordination of International Emergency Medical Teams (I-EMTs), regional tools, and collective measures supporting AMS to overcome challenges, and thereby meeting the minimum requirements set by the WHO EMT Initiative. The progress and outputs of the ARCH Project are subsequently elevated to the ASEAN Health Sector for endorsement, the updates are further shared to the Joint Task Force to Promote Synergy with Other Relevant ASEAN Bodies on Humanitarian Assistance and Disaster Relief (JTF-HADR) for the implementation of the ASEAN Declaration on One ASEAN One Response. The initiation of the ARCH Project in July 2016 has resulted in the development of the ASEAN regional collaboration framework, including the establishment of the Regional Coordination Committee on Disaster Health Management (RCCDHM), the SOP for ASEAN I-EMT coordination, and regional tools, such as forms for Medical Record for Emergency and Disaster and Health Needs Assessment. Moreover, further discussions on ASEAN Collective Measures that aim to support AMS to meet the WHO EMT minimum standards and strengthening I-EMT coordination capacity were also conducted. As adopted by the ASEAN Health Ministers Meeting (AHMM) in 2019, the RCCDHM was established as one of the mechanisms to operationalize the Plan of Action to implement the ASEAN Leaders’ Declaration on DHM.

The contribution of the ARCH Project to strengthen the ASEAN regional capacity in DHM has enhanced the regional coordination platform, with a formalization of RCCDHM as ASEAN’s official regional mechanism, and of the on-going integration process of the SOP for EMT coordination into the ASEAN SASOP.

Ambulance patients who are unable to be quickly transferred to an emergency department (ED) bed represent a key contributing factor to ambulance offload delay (AOD). Emergency department crowding and associated AOD are exacerbated by multiple factors, including infectious disease outbreaks such as the coronavirus disease 2019 (COVID-19) pandemic. Initiatives to address AOD present an opportunity to streamline ambulance offload procedures while improving patient outcomes.

The goal of this study was to evaluate the initial outcomes and impact of a novel Emergency Medical Service (EMS)-based Hospital Liaison Program (HLP) on ambulance offload times (AOTs).

Ambulance offload times associated with EMS patients transported to a community hospital six months before and after HLP implementation were retrospectively analyzed using proportional significance tests, t-tests, and multiple regression analysis.

A proportional increase in incidents in the zero to <30 minutes time category after program implementation (+2.96%; P <.01) and a commensurate decrease in the proportion of incidents in the 30 to <60 minutes category (−2.65%; P <.01) were seen. The fully adjusted regression model showed AOT was 16.31% lower (P <.001) after HLP program implementation, holding all other variables constant.

The HLP is an innovative initiative that constitutes a novel pathway for EMS and hospital systems to synergistically enhance ambulance offload procedures. The greatest effect was demonstrated in patients exhibiting potentially life-threatening symptoms, with a reduction of approximately three minutes. While small, this outcome was a statistically significant decrease from the pre-intervention period. Ultimately, the HLP represents an additional strategy to complement existing approaches to mitigate AOD.

Increasing numbers of marathon running events are taking place around the world. The difficulty encountered in the management of mass gatherings, especially running in marathons, is how emergency services can deliver treatment in a timely manner. Therefore, for this kind of situation, preparation is the key to success in terms of patient management.

The aim of this study was to describe the presentation of cases at a start-finish medical post in an international marathon race set in a rural area.

All medical record forms were collected from the start-finish medical post of the Khon Kaen International Marathon (KKIM) 2020. The race took place on January 26, 2020. The data were coded by two authors, and in the case of different codes, the final codes were determined by discussion.

The total number of participants in this event was 16,489. Participants who used the start-finish medical post numbered 74 (44.8 people per 10,000). More than one-half of patients were male (41; 56.9%), while 31 (34.0%) were female. The age range of the casualties was from 17 to 88 years old. The rate of incidence for those who used this post was 44.8 per 10,000 participants. The greatest density of users was at 3.40 hours after the marathon had started. The common symptoms which were found consisted of 17 soft tissue injuries (23.0%), 15 instances of cramps (20.3%), and 11 musculoskeletal (MSK) injuries (14.9%). Almost all patients were discharged, and only two of the cases were actually admitted to the hospital. No statistical significance between males and females was found (OR = 0.81; 95% CI, 0.51-1.3). However, marathon and half-marathon runners had a higher risk of being casualties (OR = 3.49; 95% CI, 1.71-7.15 and OR = 3.51; 95% CI, 1.79-6.88).

The injuries of most of the patients who used the medical post at a start-finish point were mild. Distances which are longer than 20km increase the risk for getting injured. However, a prospective study and multi-session interpretation is recommended.

The threat of chemical, biological, radiologic, nuclear, and explosive (CBRNe) terrorist attacks has increased over time. The need for rapid and effective responses to such attacks is paramount. Effective medical counter-measures to CBRNe events are critical and training for such may effectively occur early in physician training. While some medical specialties are more involved than others, counter-terrorism medicine (CTM) spans all medical specialties.

All United States allopathic medical schools were examined via online curriculums and queries for academic content related to CBRNe and terrorist medical counter-measures.

Analysis of 153 United States allopathic medical schools demonstrated that 15 (9.8%) medical schools offered educational content related to CBRNe and terrorist counter-measures. This is in contrast to legislation following the September 11, 2001 attacks that called for high priority for such education.

Effective CBRNe medical counter-measures are currently in place; however, there is room for improvement in education that may begin during medical school. While certain medical specialties such as emergency medicine, primary care, and dermatology may have specific niches in such events, physicians of all medical specialties have something to offer, and even a basic education in medical school can help best prepare the nation for future attacks.

Triage is an important aspect of the management of mass-casualty incidents (MCIs). This study evaluates triage after the Turkish Airlines aircraft crash near Amsterdam in 2009. What were the results of triage? What were the injuries of priority 3, and of “walking” casualties? Did the mechanism of trauma have a factor in this mass-casualty triage? How does this affect spinal immobilization rate during transport?

A retrospective analysis of investigational reports, ambulance forms, and medical charts of survivors of the crash was performed. Outcomes included triage classification, type of injury, Abbreviated Injury Scale (AIS) score, Injury Severity Scale (ISS) score, need for emergency intervention according to the “Baxt criteria”, and spinal immobilization during transport.

There was minimal documentation of prehospital triage. According to the in-hospital triage, 28% of patients were priority 1, 10% had an ISS score ≥ 16, and 3% met the Baxt criteria for emergency intervention. Forty percent were priority 3, 72% had an ISS score ≤ 8, and 63% were discharged from the emergency department. Approximately 83% were over-triaged, and the critical mortality rate was 0%. Nine percent of priority 3 casualties. and 17% of “walking” casualties had serious injuries. Twenty-five percent of all casualties were transported with spinal immobilization; 22% of patients with diagnosed spinal injury were not transported with spinal immobilization.

After the Turkish Airlines crash, documentation of triage was minimal. According to the Baxt criteria, there was a great amount of over-triage. Possible injuries sustained by plane crash survivors that seem minimally harmed (P3) must not be underestimated. Considering spinal immobilization, Not insufficient consideration given the high-energy trauma mechanism.

Smallpox has been eradicated, but advances in synthetic biology have increased the risk of its re-emergence. Residual immunity in individuals who were previously vaccinated may mitigate the impact of an outbreak, but there is a high degree of uncertainty regarding the duration and degree of residual immunity.

A systematic literature review using the PRISMA criteria was conducted to quantify the duration and extent of residual immunity to smallpox after vaccination. 29 papers related to quantifying residual immunity to smallpox after vaccination were identified.

Duration of protection of >20 years was consistently shown in the 16 retrospective cross-sectional studies, while the lowest estimated duration of protection was 11.7 years among the modeling studies. Childhood vaccination conferred longer duration of protection than vaccination in adulthood. Multiple vaccinations did not appear to improve immunity. Most studies suggest a longer duration of residual immunity (at least 20 years) than assumed in smallpox guidelines. Estimates from modeling studies were less but still greater than the 3-10 years suggested by the WHO Committee on International Quarantine or US CDC guidelines. These recommendations were probably based on observations and studies conducted while smallpox was endemic. The cut-off values for pre-existing antibody levels of >1:20 and >1:32 reported during the period of endemic smallpox circulation may not be relevant to the contemporary population but have been used as a threshold for identifying people with residual immunity in post-eradication era studies.

Of the total antibodies produced in response to smallpox vaccination, neutralizing antibodies have shown to contribute significantly to immunological memory. Although the mechanism of immunological memory and boosting is unclear, revaccination is likely to result in a more robust response. There is a need to improve the evidence base for estimates on residual immunity to better inform planning and preparedness for re-emergent smallpox.

To determine if lockdown measures related to the COVID-19 pandemic changed the frequency and epidemiology of geriatric patient emergency medical service (EMS) facilitated visits to the emergency department (ED) in Hamilton, Ontario, Canada.

A retrospective chart review was conducted comparing ED presentations of patients over 65 years of age presenting to two academic hospitals in Hamilton, Ontario via EMS between March 17, 2020, and July 15, 2020 (the first wave of the COVID-19 pandemic) to March 17, 2019, and July 15, 2019 (pre-pandemic).

Total EMS facilitated geriatric ED number of visits decreased by 17.3% during the first wave of COVID-19 in 2020, relative to the same seasonal time frame in 2019 (March 17- July 15). Visits were more dramatically decreased in the first 8 weeks after the pandemic was declared but then recovered to pre-pandemic levels thereafter. More geriatric patients visiting the ED via EMS were admitted during the initial stages of the COVID-19 pandemic, relative to 2019. However, the acuity and epidemiology of visits remained the same during the first wave of the COVID-19 pandemic, relative to 2019.

Lockdown measures during the first wave of the COVID-19 pandemic coincided with decreased geriatric EMS ED visits in the initial two months after the pandemic was declared. Visit numbers recovered as the first wave ended. The epidemiology, as well as the overall acuity, did not change.