The European Union Horizon 2020 research and innovation funding program awarded the NIGHTINGALE grant to develop a toolkit to support first responders engaged in prehospital (PH) mass casualty incident (MCI) response. To reach the projects’ objectives, the NIGHTINGALE consortium adapted the Translational Science (TS) process. The aim of this study is to perform the first TS (T1) phase PRISMA scoping review to extract data that will be used to guide the creation of the initial evidence-based second TS phase (T2) modified Delphi statements for a subsequent study.

The consortium was divided into three work groups (WGs) MCI triage, Prehospital Life Support and Damage Control (PHLSDC) and Prehospital Processes (PHP). Each WG conducted simultaneous literature searches following the PRISMA extension for scoping review with a common research strategy sharing MCI related search terms and then terms specific for each WG. Final included articles went through data extraction based on identified themes and sub-themes from PH MCI response literature to be used to create the future statements.

The initial search yielded 925 total references to be considered for a title and abstract review (PH Triage 311, PHLSDC 329, PHP 285), then 483 articles for a full reference review (MCI Triage 111, PHLSDC 216, PHP 156) and 155 articles for the database extraction process (MCI Triage 27, PHLSDC 38, PHP 90).

The progression of the study of prehospital MCI response enabled NIGHTINGALE partners to methodically obtain information that will contribute to each WG’s creation of initial T2 modified Delphi statements.

The mental health challenges encountered by paramedics have received much attention in recent years. This attention has particularly focused on high rates of stress, depression, anxiety, and post-traumatic stress disorder. This heightened awareness of the high incidence of mental illness, which has at times tragically resulted in the suicide of serving and former paramedics, is stimulating the address of mental health within the paramedic profession. It is now time to call on paramedic educators to prepare student paramedics for the mental health challenges associated with a career in the emergency medical services.

To explore the preparedness of student paramedics for the mental health challenges of the paramedic profession and identify the coping strategies used by veteran paramedics to successfully meet these challenges.

Twenty semi-structured interviews with veteran paramedics from Australia and New Zealand were conducted.

Advice from veteran paramedics was comprised of three key themes: support, health, and the profession.

The findings of the study indicate that the preparation of student paramedics for the mental health challenges of the paramedic profession throughout the undergraduate curriculum could be advantageous. The advice offered by veteran paramedics can be included within undergraduate paramedic curricula and delivered by sharing the personal experiences of the veteran paramedics. These experiences are highly credible and sharing them offers an opportunity for veterans to contribute positively to the future of paramedicine. Guidelines for their inclusion in the undergraduate paramedic curriculum should be prepared to facilitate knowledge translation and to encourage the development of conscious coping strategies by student paramedics during their learning phase. Further research is needed to raise awareness in this area, with a specific focus on preparing paramedic students to cope with mental health challenges related to undergraduate degree programs, and how they feel about commencing their career as a paramedic.

Training Agricultural Emergency Responders by Paula L. Cowen, D.V.M., Director, Professional Development Staff, Veterinary Services, Animal Plant Health Inspection Service, United States Department of Agriculture

Background Emergency Response is a critical component of our Animal Agriculture infrastructure. The ability to deploy trained personnel to handle any kind of emergency is key to quickly containing any disaster and mitigating the effects. This training is provided by a number of federal agencies, universities as well as at the state and local level.

Several training strategies are employed by a number of different entities. Training is available on-line, in the classroom, with wet labs using live animals, through exercises and case studies. An overview of training and education of Agricultural Emergency Response personnel across the United States will be covered with a more in depth look at the training provided by the Animal Plant Health Inspection Service.

The Professional Development Staff provides technical training in disease identification and control, emergency response, import/export, and other topics as needed. Protecting and promoting American Animal Agriculture is our core mission. Veterinary Services provides leadership at the intersection of Animal and Public Health concerns.

The treatment of open lower limb fractures represents a major challenge for any trauma surgeon, and this even more so in resource-limited areas. The aim of the study is to describe the intervention, report the treatment plan, and observe the effectiveness of the Norwegian Open Fracture Management System in saving lower limbs in rural settings.

A retrospective and prospective interventional study was carried out in the period 2011 through 2017 in six rural hospitals in Cambodia. The fractures were managed with locally produced external fixators and orthosis developed in 2007. Based on skills and living locations, two local surgeons and one paramedic without reconstructive surgery experience were selected to reach the top of the reconstructive ladder and perform limb salvage surgeries. This study evaluated 56 fractures using the Ganga Hospital Open Injury Score (GHOIS) for Gustilo-Anderson Type IIIA and Type IIIB open fracture classification groups.

The primary success rate in open tibia fractures was 64.3% (95% CI, 50.3 - 76.3). The average treatment time to complete healing for all of the patients was 39.6 weeks (95% CI, 34.8 - 44.4). A percentage of 23.2% (95% CI, 13.4 - 36.7) experienced a deep infection. Fifteen of the patients had to undergo soft tissue reconstruction and 22 flaps were performed. Due to non-union, a total of 15 bone grafts were performed. All of the 56 patients in the study gained limb salvage and went back to work.

The given fracture management program proves that low-resource countries are able to produce essential surgical tools at high quality and low price. Treatment with external fixation and functional bracing, combined with high-level training of local surgeons, demonstrates that a skilled surgical team can perform advanced limb salvage surgery in low-resource settings.

To validate the Belgian Plan Risk Manifestations (PRIMA) model, actual patient presentation rates (PPRs) from Belgium’s largest football stadium were compared with predictions provided by existing models and the Belgian PRIMA model.

Actual patient presentations gathered from 41 football games (2010-2019) played at the King Baudouin Stadium (Brussels, Belgium) were compared with predictions by existing models and the PRIMA model. All attendees who sought medical help from in-event health services (IEHS) in the stadium or called 1-1-2 within the closed perimeter around the stadium were included. Data were analyzed by ANOVA, Pearson correlation tests, and Wilcoxon singed-rank test.

A total of 1,630,549 people attended the matches, with 626 people needing first aid. Both the PRIMA and the Hartman model over-estimated the number of patient encounters for each occasion. The Arbon model under-estimated patient encounters for 9.75% (95% CI, 0.49-19.01) of the events. When comparing deviations in predictions between the PRIMA model to the other models, there was a significant difference in the mean deviation (Arbon: Z = −5.566, P <.001, r = −.61; Hartman: Z = −4.245, P <.001, r = .47).

When comparing the predicted patient encounters, only the Arbon model under-predicted patient presentations, but the Hartman and the PRIMA models consistently over-predicted. Because of continuous over-prediction, the PRIMA model showed significant differences in mean deviation of predicted PPR. The results of this study suggest that the PRIMA model can be used during planning for domestic and international football matches played at the King Baudouin Stadium, but more data and further research are needed.

The rise of the COVID-19 pandemic caused significant concerns due to the risk of transmission in such mass gatherings. Too many variables for such a critical challenge made it more of a complex situation, with an enormous negative impact on either decision. In this paper, we aimed to summarize the experience of Saudi Arabia in hosting and managing Hajj throughout the pandemic for three seasons, the public health strategies to control the COVID-19 transmission during Hajj, and the policies and regulations that were implemented for the safe return of Hajj.

This is a summary of our experience in managing Hajj seasons throughout the COVID-19 pandemic for the period 2020, 2021, and 2022. A description of the factors, models, and tools used to assess the situation for each year, and the bundles of measures followed to mitigate the events aiming to hold a "Safe Hajj".

2020 was a unique year, with the pandemic at its height with no vaccination available. So, the decision was to hold a symbolic strict Hajj of only 1,000 pilgrims residing within Saudi Arabia. In 2021, as the World was easing restrictions and distributing vaccines, around 60,000 internal pilgrims got to perform Hajj, and 2022 hosted one million international pilgrims. That is still 40% of 2019 Hajj with 2.5 million due to considerations to avoid usual overcrowding and mandating COVID-19 full vaccination status.

Our experience with the COVID-19 pandemic over the past three years has informed us that huge MGs can be conducted safely during the pandemic if adequate measures were implemented. That would include an accurate and reliable risk assessment to inform policymakers about the most effective strategies.

In the United States, tornadoes are the third leading cause of fatalities from natural disasters1. To aid prevention and mitigation of tornado-related morbidity and mortality, improvement in standardizing tornado specific threat analysis terminology was assessed. The largest number of tornado-related fatalities has occurred in the state of Texas for over a hundred years. The occurrence of tornadic clusters or “outbreaks” has not been formally standardized. The concept of “tornado outbreaks” is better defined and its role in fatality mitigation is addressed in this Institutional Review Board (IRB) approved study.

To understand the role of “tornado outbreaks” related clusters in Texas in relationship to morbidity and mortality.

This IRB approved (IRB2017- 0507) research study utilized GIS tools and statistical analysis of historical data to examine the relationship between tornado severity (based on the Fujita Scale), the number of tornadoes, and the trends in morbidity and mortality. This study was funded in part from The National Science Foundation grant (NSF Grant #1560106) in support of the CyberHealthGIS Research Experience for Undergraduates (REU).

A statistically significant difference was demonstrated between the severity of a tornado and related morbidity and mortality during “tornado outbreaks” in Texas during a defined 30-year period.

Understanding the role and discerning the impacts of “tornado outbreaks” as related to tornado severity has critical implications to disaster preparedness. Applications of this conclusion may improve shelter planning/preparation, timely warning, and educating the at-risk public. Subsequently, examining the likelihood and improved descriptions of “tornado outbreaks” may aid in reducing the number of tornado-related injuries and fatalities nationally.

Interest in nuclear power as a cleaner and alternative energy source is increasing in many countries. Despite the relative safety of nuclear power, large-scale disasters such as the Fukushima Daiichi (Japan) and Chernobyl (Ukraine) meltdowns are a reminder that emergency preparedness and safety should be a priority. In an emergency situation, there is a need to balance the tension between a rapid response, preventing harm, protecting communities, and safeguarding workers and responders. The first line of defense for workers and responders is personal protective equipment (PPE), but the needs vary by situation and location. Better understanding this is vital to inform PPE needs for workers and responders during nuclear and radiological power plant accidents and emergencies.

The aim of this study was to identify and describe the PPE used by different categories of workers and responders during nuclear and radiological power plant accidents and emergencies.

A systematic literature review format following the PRISMA 2020 guidelines was utilized. Databases SCOPUS, PubMed, EMBASE, INSPEC, and Web of Science were used to retrieve articles that examined the PPE recommended or utilized by responders to nuclear radiological disasters at nuclear power plants (NPPs).

The search terms yielded 6,682 publications. After removal of duplicates, 5,587 sources continued through the systematic review process. This yielded 23 total articles for review, and five articles were added manually for a total of 28 articles reviewed in this study. Plant workers, decontamination or decommissioning workers, paramedics, Emergency Medical Services (EMS), emergency medical technicians, military, and support staff were the categories of responders identified for this type of disaster. Literature revealed that protective suits were the most common item of PPE required or recommended, followed by respirators and gloves (among others). However, adherence issues, human errors, and physiological factors frequently emerged as hinderances to the efficacy of these equipment in preventing contamination or efficiency of these responders.

If worn correctly and consistently, PPE will reduce exposure to ionizing radiation during a nuclear and radiological accident or disaster. For the best results, standardization of equipment recommendations, clear guidelines, and adequate training in its use is paramount. As fields related to nuclear power and nuclear medicine expand, responder safety should be at the forefront of emergency preparedness and response planning.

The Yale New Haven Center for Emergency Preparedness and Disaster Response (YNH-CEPDR) has worked in the United States with state and local health and medical organizations to evaluate critical decision making activities and to develop decision making tools and protocols to enhance decision making in a time sensitive environment. YNH-CEPDR has also worked with international organizations and US federal agencies to support situational awareness activities in simulated and real world events.

During this session YNH-CEPDR will share the best practices from recent events such as the H1N1 response and the Haiti Earthquake. Participants will be engaged in discussions regarding overall framework for successful information collection, analysis and dissemination to support decision making based on these experiences. This session will also incorporate concepts provided by the US National Incident Management System (NIMS) and the Incident Command System (ICS), specifically through the development of Situational Reports (SitReps), Incident Action Plans (IAP) and Job Action Sheets as methods to implement the framework and concepts discussed. Participants will be led through a series of scenario-based discussions to allow application of critical decision making factors to their organization. At the conclusion of the session, participants will be able to identify next steps for enhancing the synchronization of critical decision making and information analysis within their organizations.