Populations that participated in this project represented > 46% of the total H1N1 patients hospitalized and 34% of deaths in the state of Oregon.

A committee was convened by the Oregon Health Authority to increase access to vulnerable populations. The committee determined the project must be supported by: (1) a local advocacy group; (2) a local Health Department; and (3) an emergency medical services (EMS) provider agency to provide immunization. This project involved outreach to a vulnerable population that may not be able to utilize mass vaccination clinics and may have limited access to medical services. Outreach was accomplished using three models: (1) volunteers delivering meals; (2) mailings to those receiving in-home meals; and (3) a community organization that conducted a flu clinic frequented by people with disabilities. Three models were developed for receiving calls and scheduling appointments. All projects followed the same procedure for vaccine administration.

Seventy home-bound individuals met the criteria for vaccination. Post-survey results indicated: 55.2% lived alone and were homebound. Over 70% had previously received their vaccinations from their healthcare provider and 38.9% were not previously vaccinated due to vaccine availability. Fifty-eight individuals were vaccinated. Partner organizations were surveyed after their efforts were completed. Findings indicated that relationships between the EMS agencies and providers were greatly enhanced.

Outreach using nontraditional partners was an effective method to reach a vulnerable population. The project demonstrated that qualified vaccinators can be mobilized quickly. However, because this resource-intensive effort is more costly than providing mass vaccination, similar projects should only be utilized when less costly means are not effective, or when the risk level of the vulnerable population being served warrants it.

Electronic waste (e-waste) is increasing worldwide and is often shipped from developed to developing countries. Many of these products contain toxic levels of metals, organics, etc. When unsafe recycling approaches or methods are used (e.g., burning wire to reclaim copper), the resulting occupational exposures can adversely affect the health of e-waste recyclers.

To identify which polybrominated and which polychlorinated dibenzo-p-dioxins/furans are higher in electronic waste recyclers when compared to non-recyclers.

This study focused on female e-waste recyclers and non-recyclers that live in rural northern Vietnam. Whole blood, urine, and serum of forty e-waste recyclers and twenty Vietnamese comparisons and were evaluated for metals, organics, and dioxin-like exposure by the Center for Disease Control. This paper will be reporting on serum organohalogens. The Vietnamese cohorts were compared to the U.S. general population, using the National Health And Nutrition Examination Survey. TEQ’s were calculated and statistical significance was determined using Wilcoxon Rank Sum Test. The IRB of the University of Texas Health Science Center Houston and the Ethics Board of the Hanoi School of Public Health oversee this study.

12378-PeCDF, 123678-HxCDD, 123678-HxCDF, and 1234678-HpCDF were significantly different between recyclers and Vietnamese comparisons. Total dioxin TEQ was higher in e-waste recyclers than comparisons. Of the polybrominated dioxins and furans, 12378-PeBDD and 2378-TeBDF were significantly different between recyclers and comparisons.

This is the only study with data on polybrominated dibenzo-p-dioxins/furans in female electronic waste recyclers from rural Northern Vietnam, and the first to describe serum levels of both polychlorinated and polybrominated dibenzo-p-dioxins/furans in Vietnamese female e-waste recyclers. Improved occupational protocols may reduce potential adverse health effects such as cancer, endocrine, reproductive, developmental, and other disorders.

As the largest body of health professionals, nurses are looked upon during a disaster for leadership, clinical assistance, and support during these events. Nurses are at the forefront of managing disasters in their communities, yet their complex role as advanced nurse practitioners, clinicians, managers, and leaders is not always fully understood and/or recognized. The aim of this paper is to explore the level of Advanced Nursing Practice (ANP) in Australia that takes place in a disaster

This scoping review was guided by Arksey and O’Malley’s framework. The review searched five relevant databases. A scoping review design was chosen as the authors expected that evidence in the field would be produced using a wide variety of methodologies.

Nurses work long hours during a disaster with hospitals and nurses becoming the center of events and the "go to" place during a disaster. During disasters nurses often have little sleep, have limited time to meet their individual/personal needs, and frequently put others needs before themselves. Nurses mentioned in these studies were reported to have worked while they were worried for themselves and their families. These nurses reported feeling capable and reported that all their experience and skills came to the fore during these challenging situations.

During disasters, most nurses are found to be flexible and adaptable, with many taking on a variety of roles. Nurses are quick to find solutions with problem-solving keys and their ability to respond to disasters "just what you do." The nurses in these studies demonstrated fundamental expertise and had the agility to pivot when the occasion demanded. As a result of this study, it is evident, and not surprising, that these Australian nurses work beyond conventional limits during a disaster.

Effects of a disaster on a community’s mental health can persist after the physical effects of the event have passed. The pediatric population is often overrepresented in disasters and prone to serious mental health disorders based on their age and parental/community response. Pediatric primary healthcare providers require the psychosocial skills necessary to work in disaster zones and to care for children in disasters.

Pediatric Disaster Mental Health Intervention (PDMHI) was initially developed in response to Superstorm Sandy’s impact on children and their families in New York City. The objective was to develop training for primary care providers in pediatric disaster mental healthcare and to study its impact on the trainees.

A faculty of experts in pediatric mental health, psychiatry, psychology, and disaster preparedness was convened to develop curriculum. The faculty developed a four-hour intervention to equip healthcare providers with the skills and knowledge necessary to care for pediatric patients with mental health problems stemming from a disaster via evaluation, triage, intervention, and referral.

Three PDMHI training sessions were held. A total of 67 providers were trained. Of these, there were 31 pediatricians, 18 nurses, 8 social workers, 4 psychologists, 2 psychiatrists, and 4 others. Pre- and post-tests measured knowledge before and impact 3 months post-intervention. 62.5% of responding primary care providers made changes to their practice. 92% felt better equipped to identify, treat, and refer patients. 81% would be willing to work in a disaster zone and felt prepared to treat patients with disaster mental health issues.

PDMHI covers psychosocial responses to disasters from normal to mental health disorders. Participants gained tools for managing pediatric mental health issues in primary care. Study data showed an increase in the participants perceived knowledge and skills about pediatric disaster mental health, and willingness to participate in future disasters.

The Illinois EMSC Pediatric Facility Recognition Program was implemented in 1998. The objective was to identify the capability of a hospital to provide optimal pediatric emergency and critical care. Beginning in 2004, steps were taken to integrate pediatric disaster preparedness into the facility recognition process.

The goal of this study was to identify the impact of the EMSC Pediatric Preparedness Checklist across time in Chicago hospitals undergoing Pediatric Facility Recognition.

Chicago hospitals were evaluated during the 2012 and 2016 Pediatric Facility Recognition Program. The following components were surveyed as they relate to pediatrics: Overall Emergency Operations Plan (EOP), Surge Capacity, Decontamination, Reunification/Patient Tracking, Security, Evacuation, Mass Casualty Triage/JumpSTART, Children with Special Health Care Needs/Children with Functional Access Needs, Pharmaceutical Preparedness, Recovery, Exercise/Drills/Trainings. Data from 2012 and 2014 checklist categories were compared and p-values were computed utilizing Fisher’s Exact Test. A p-value <0.05 was considered statistically significant.

Stockpiling of staging areas or having ready access to resuscitation supplies increased 46% (p < 0.05), testing of pediatric surge capacity in previous 24 months decreased 43% (p < 0.05), maintaining warmed water source for decontamination decreased 43% (p < 0.05), and having familiarity of evacuation procedures in ED, pediatric, and nursery personnel decreased 42% (p < 0.05). Although not statistically significant, the training of pediatric staff with JumpSTART triage increased 59%, EOP containing a pediatric reunification process increased by 36%, the presence of specific staff plans to allow care of dependents increased for children (29%), elderly (32%) and pets (35%), integration of a pediatric component into hospital EOP increased by 29%, and identification of an alternate treatment site for children decreased by 25%.

Integrating the EMSC Pediatric Preparedness Checklist surveys into the facility recognition process impacts pediatric disaster preparedness and planning, and identifies areas of improvement in hospitals.

Airway management is a cornerstone in the prehospital care of critically ill or injured patients. Surgical cricothyrotomy offers a rapid and effective solution when oxygenation and ventilation fail using less-invasive techniques. However, the exact indications, incidence, and success of prehospital surgical cricothyrotomy are unknown, with variable rates reported in the literature. This study aimed to examine prehospital indications and success rates for surgical cricothyrotomy within a large, suburban, ground-based Emergency Medical Services (EMS) system.

This is a retrospective analysis of 31 patients who underwent paramedic performed surgical cricothyrotomy from 2012 through 2022. Key demographic parameters were analyzed, including the incidence of cardiac arrest, call type (trauma versus medical), initial airway management attempts, number of endotracheal intubation (ETI) attempts before surgical airway, and average time to the establishment of a surgical airway in relation to the number of ETI attempts. Surgical cricothyrotomy success was defined as the acquisition of four-phase end-tidal capnography reading. The primary data sources were the EMS electronic medical records, and descriptive statistics were calculated.

A total of 31 patients were included in the final analysis. Of those who received a surgical cricothyrotomy, 42% (13/31) occurred in the trauma setting, while 58% (18/31) were medical calls. In all patients who underwent surgical cricothyrotomy, the median (IQR) time to the procedure was 17 minutes (IQR = 11-24). In trauma patients, the median time to surgical cricothyrotomy was 12 minutes (IQR = 9-19) versus 19 minutes (IQR = 14-33) in medical patients. End-tidal carbon dioxide (ETCO2) detection and placement success was confirmed in 94% (29/31) of patients. Endotracheal intubation was attempted in 55% (17/31) before subsequent surgical cricothyrotomy, with 29% (9/31) receiving more than one ETI attempt. The median time to surgical cricothyrotomy when multiple prior intubation attempts occurred was 33 minutes (IQR = 23-36) compared to 14.5 minutes (IQR = 6-19) in patients without a preceding intubation attempt.

Prehospital surgical airway can be performed by paramedics with a high degree of success. Identification of the need for surgical cricothyrotomy should be determined as soon as possible to allow for rapid securement of the airway and to ensure adequate oxygenation and ventilation.

During the COVID-19 pandemic, it became difficult to conduct face-to-face training and practice for disaster medial education. As an alternative to this, it was proposed to build a metaverse world using virtual and augmented reality(XR) technology and implement disaster training education within it. Therefore, the authors investigated the process and effects.

The authors conducted training of healthcare workers through software implementing a metaverse called MediBase and NurseBase, which was created for doctors and nurses in hospitals to respond to disasters such as COVID-19. The trainees were given a practical orientation after basic theoretical education, attached a VR headset, and performed a medical response to a virtual disaster according to their judgment, and the records and debriefing were organized and analyzed.

The satisfaction of trainees with education reached a maximum of 88%. Even in the part where the correct choice was made in the theoretical evaluation, the time was delayed or the wrong choice or behavior appeared in the metaverse practical education and training.

In disaster situations that cannot be implemented identically to reality and most disaster education and training that cannot target actual patients, metaverse-based disaster medical education and training is expected to become a more effective alternative in the future.

Out-of-hospital cardiac arrest (OHCA) is a significant global cause of mortality, and Emergency Medical Services (EMS) response interval is critical for survival and a neurologically-favorable outcome. Currently, it is unclear whether EMS response interval, neurologically-intact survival, and overall survival differ between snowy and non-snowy periods at heavy snowfall areas.

A nation-wide population-based cohort of OHCA patients, registered from 2017 through 2019 in the All-Japan Utstein Registry, was divided into four groups according to areas (heavy snowfall area or other area) and seasons (winter or non-winter): heavy snowfall-winter, heavy snowfall-non-winter, other area-winter, and other area-non-winter. The first coprimary outcome was EMS response interval, and the secondary coprimary outcome was one-month survival and a neurologically-favorable outcome at one month.

A total of 337,781 OHCA patients were divided into four groups: heavy snowfall-winter (N = 15,627), heavy snowfall-non-winter (N = 97,441), other area-winter (N = 32,955), and other area-non-winter (N = 191,758). Longer EMS response intervals (>13 minutes) were most likely in the heavy snowfall-winter group (OR = 1.86; 95% CI, 1.76 to 1.97), and also more likely in heavy snowfall areas in non-winter (OR = 1.44; 95% CI, 1.38 to 1.50). One-month survival in winter was worse not only in the heavy snowfall area (OR = 0.86; 95% CI, 0.78 to 0.94) but also in other areas (OR = 0.91; 95% CI, 0.87 to 0.94). One-month neurologically-favorable outcomes were also comparable between heavy snowfall-winter and other area-non-winter groups.

This study showed OHCA in heavy snowfall areas in winter resulted in longer EMS response intervals. However, heavy snowfall had little effect on one-month survival or neurologically-favorable outcome at one month.

Trauma care is one of the key components of disaster medicine. However, it is difficult in Japan to gain extensive experience in trauma surgery, especially penetrating trauma. The Advanced Trauma Operative Management (ATOM) course was developed as a model for teaching operative trauma techniques to surgical residents, fellows, and attending surgeons as the number of these cases decreases in the US. In 2008, a new ATOM training site was established at Jichi Medical University in Japan, and as of December, 2010, five courses have been offered.

The ATOM course consists of lectures and a porcine operative experience. Comprehensive evaluation of ATOM was designed to assess participant learning in the cognitive, affective, and psychomotor domains. Data on the first 36 participants was retrospectively collected and analyzed.

Participants included: 20 expert trauma surgeons, and 16 general surgeons. All groups showed improvement in knowledge (pre-test score: 61.9 ± 16.4 (mean ± standard deviation), post-test score: 70.6 ± 16.5, p-value < 0.001) with results in the expert and fellow groups reaching statistical significance. Self-confidence also improved (pre-evaluation score: 65.4 ± 17.6, post-evaluation score: 82.0 ± 9.4, p-value < 0.001), with all groups reaching statistical significance.

This course creates real operative situations in a standardized fashion that improves knowledge and operative confidence for trauma operations, which may be of great benefit in disaster medicine training.

The use of recreational substances is a contributor to the risk of morbidity and mortality at music festivals. One of the aims of onsite medical services is to mitigate substance-related harms. It is known that attendees’ perceptions of risk can shape their planned substance use; however, it is unclear how attendees perceive the presence of onsite medical services in evaluating the risk associated with substance use at music festivals.

A questionnaire was administered to a random sample of attendees entering a multi-day electronic dance music festival.

There were 630 attendees approached and 587 attendees completed the 19 item questionnaire. Many confirmed their intent to use alcohol (48%, n=280), cannabis (78%, n=453), and recreational substances other than alcohol and cannabis (93%, n=541) while attending the festival. The majority (60%, n=343) stated they would still have attended the event if there were no onsite medical services available. Some attendees agreed that the absence of medical services would have reduced their intended use of alcohol (30%, n=174) and recreational substances other than alcohol and cannabis (46%, n=266).

In the context of a music festival, plans for recreational substance use appear to be substantially altered by attendees’ knowledge about the presence or absence of onsite medical services. This contradicts our initial hypothesis that medical services are independent of planned substance use and serve solely to reduce any associated harms. Additional exploration and characterization of this phenomenon at various events would further clarify the understanding of perceived risks surrounding substance use and the presence of onsite medical services.