Despite a large number of nurses involved in disaster situations in different ways, there are few theories or models that define and describe the goal and content of disaster nursing.

This study aimed to present a model for disaster nursing, based on a literature review of the concept and content of disaster nursing.

A systematic literature review of 15 original qualitative or quantitative articles was conducted. A thematic synthesis was used to analyze the data.

The main theme of Disaster Nursing: Crossing Borders, included three dimensions (personal borders, professional borders and environmental borders) and four themes describing the process of disaster nursing (being hit by reality; adapting to the conditions; providing aid, relief, and caring; recovering, remembering, and growing). Based on these results the HOPE model was developed. ‘HOPE’ stands for ‘Holistic health assessment and promotion; Organization and management of immediate response; Professional adaptation; Endurance and recovery.

The HOPE model for disaster nursing describes the core element and essence of nursing in the disaster response phase and can serve as guidance both for nurses deployed in disasters and in disaster nursing training.

Healthcare facilities frequently use disaster codes as a way to communicate with employees that an emergency or incident is occurring. As increasing numbers of providers work at multiple facilities, and healthcare systems continue to build disaster response teams and protocols covering multiple facilities, standardization of disaster code terminology is critical. A lack of consistency in terminology can potentially have a devastating impact on the understanding and response of visiting or relief staff.

To evaluate the level of standardization in terminology of disaster codes in healthcare facilities.

A convenience sample was taken from a private Facebook™ group consisting of emergency department nurses from a wide range of facilities. The Facebook™ group was asked to share their hospital disaster codes. Of the 40,179 total members, 78 commented, including 55 photos of quick reference badges, and the rest were descriptions/lists of codes. One badge was excluded due to a blurry photograph. Results were collated and analyzed for trends and standardization.

The most common codes were, “Code Red” for fire (72.7%), “Code Blue” for cardiac arrest (44.9%), “Code Silver” for active shooter/weapons event (37.7%) and “Code Orange” for hazardous materials (33.8%). There were 168 instances of a code term being associated with a particular event by five or fewer facilities. Two facilities used numeric systems, with 11 using plain language descriptions.

Disaster code language is inconsistent. Few of the codes were consistently assigned to the same meaning, and none were universal. Color coding was the most common method, but there was little consistency even within color code systems. Additionally, some facilities used a combination of colors, numbers, terms, and plain language. Healthcare facilities should embrace standard terminology and create a consistent language for disaster codes to enhance response capabilities and medical security.

Antibiotic resistance is when bacteria change and adapt in response to antibiotics, becoming able to defeat these drugs when used to treat infections. A direct consequence of this adaptation is an increased difficulty in treating multiple diseases. Because of increased antibiotic resistance, the World Health Organization has declared it a significant threat to public health.

One frequent consequence of natural disasters is infections, as seen in the December 2004 Indian Ocean tsunami. Survivors sustained a variety of wound infections that ranged from common pathogens to rarely seen organisms including fungi.

This research analyzes the microbiology observed in wound infections associated with exposure to freshwater, seawater, soil, fecal, and other contamination after Hurricane Harvey in 2017 and Hurricane Florence in 2018.

Therapies for infections will also be discussed in addition to how the utilization of rapid detection technology for antimicrobial resistance and correct treatments require antimicrobial susceptibility knowledge to improve health outcomes, lower economic costs, prevent further spread of multi-drug resistant outbreaks and assist with antimicrobial stewardship.

More than one million runners have joined the marathon games since 2007 in Taiwan. There were over 150 marathon games held in Taiwan in 2018. The increase rate was 21% as compared to that of 2014. The medical encounter rate was 1.33% in 2015 and increased to 1.41% in 2017. The most common type of injury was muscle spasm. The second most common was abrasion due to falls. The treatment for muscle spasm was RICE only. Cardiac arrest of marathon runners was reported occasionally and time is critical for rescue.

To shorten the rescue time of the runners in an emergency. Base on the prodromal research, BLE communication technology is further used to improve the rescue positioning communication technology in the marathon.

After rescue notification devices have been set up in each 0.5 km on the runway of the marathon, the runner can send a rescue signal through the rescue notification devices in case of emergency. The rescue signal, periodically advertisement SN# with rescue mark, of the runner can be precisely located and the rescue can be started very soon.

In the simulation, the rescue signal can be located in 7.5 minutes, fastest in 3 seconds. The precision rate of timing is ±160ms/6σ that under IAAF accuracy requirement. The location error is less than 20 meters, and the rescue time can be shortened to one half as before.

The rescue time of runner is correlated with the quality of marathon EMS. It is critical to the runner, especially in cardiac arrest. By using BLE communication devices, the runner can be located faster and more precisely. As rescue time shortened, CPR & AED can be given sooner. The quality of marathon EMS will be improved substantially.

The human disaster is a permanent challenge for the Brazilian government because the difficulties faced are related to the lack of interface between public policies, resulting in fragile analyses of risk and non-prevention, being that annually several Brazilian lives are lost in disasters that continue to happen.

The article is the result of research and presents the analyses of health policy, actions, and programs developed to anticipate the fire victims of the Nightclub Kiss concert hall that took place in 2013 (Santa Maria, Brazil). The objective was to investigate and analyze the disasters and human disasters, especially the fire of Nightclub Kiss when 242 young people died. Causes and determinants were analyzed in order to subsidize public policies, in particular, the health policy.

A qualitative case study supported by the critical dialectic method with semi-structured interviews, focus group, documentary analysis, and bibliographic review.

The experiences accumulated throughout history show that disaster situations require public policies to be able to act readily, resolve, and pay attention to the needs of the population involved. Disasters are increasingly recurrent episodes and generate deep social consequences that mark human life. Managing a human disaster remains a challenge for the health policy in Brazil. The difficulties faced are related to the lack of interface with other public policies. The urgency to incorporate intervention/action strategies into health plans is important. Implementation of prevention and training programs, and adopting strategies and protocols for the whole network of attention is critical.

It is important to emphasize the importance of broadening the theoretical definitions by overcoming the divergences of the concepts adopted between the theoretical and operational field, by elaborating a review of the Brazilian legislation in order to broaden and contemplate the needs of different people.

This research starts from the assumption that work accidents, in addition to fortuitous or individual phenomena, imply social and organizational factors, and highlights the social character of the production of the accident at work. For this reason, this study investigates the living conditions and the ways of workers in the oil and gas industry in Brazil.

To analyze the human factors in the relationship with work accidents on oil platforms from the social dimensions.

It is qualitative research and it has as instruments of collection the focal group and individual interviews with workers and managers of the platforms, participant observation, and documentary analysis.

The research is still being carried out, but some reflections are possible so far: accidents at work depend on the direct or indirect relationship of workers with the work process itself, the modalities of production of work, and management of work. Possible causes underlying the accident are the quality of life and the conceptions of health and safety. Associated with it are social constructs and the multifactorial causes of occupational accidents including the relations between acts and unsafe conditions.

The increase in outsourcing and the decrease in training quality, as well as the prioritization of production, targets the detriment of meeting safety criteria. There is a need to reassess labor management, safety policies, and outsourcing processes. Lack of awareness of the proper use of safety equipment and the organization of the work environment are major causes of work-related accidents. The human factor focuses on the individual, group, organizational, and social dimensions in complex interactions. The identification of social processes between working groups in empirical reality, the influence of elements of culture, organizational management, and their impacts on relations and on safe work performance allows an understanding of social risks.

The use of rail transport is increasing in Sweden, as well as within Europe, and train speeds are escalating. These factors contribute to an increasing frequency of train crashes and major crashes so severe that they can be classified as disasters. There is a lack of knowledge concerning factors of importance related to the rescue operation that can influence survival rate at train crashes, especially in cold environments.

The aim was to identify preventable death and severe complications among passengers in a train crash in rural and cold environments using a simulation-based model.

A train crash scenario was developed based on scientific research, crash reports, and lessons observed in incidents. The scenario was set to a train with seven carriages consisting of 150 passengers that derailed in a curve in 160km/h, 10km from the hospital. In Umeå in the north of Sweden, 12 participants from seven emergency/disaster organizations joined in two preparing workshops and a real-time simulation-based train crash. The Emergo Train System (ETS) was chosen as a simulation tool. Data collection such as rescue capacities, response time, and patient surge were collected and transferred into the ETS.

The results show 17 preventable death and 9 preventable severe complications since the actions were not implemented in the recommended time.

The results show that an extended rescue operation can have devastating consequences especially in cold environments. Further experimental simulations are needed with defined interventions to find out how preventable deaths and severe complications can be reduced.

It is a requirement for a World Health Organization verified Emergency Medical Team (EMT) that all members be immunized against common diseases in the deploying region. Most jurisdictions use private suppliers such as travel doctors for immunization services. When a deployment is announced, members are nominated by their jurisdiction under the condition they are fully immunized. It is up to the individual to monitor their immunization status.

To determine how many members nominated for deployment were fully immunized.

Nominated members sent their completed vaccination record to a central location for assessment of their immunization status. The following data were recorded: vaccination status, last-minute booster doses required, and the number of emails sent by the assessor in processing the records. The number of phone calls made and received were not recorded.

To complete the skills matrix for a field hospital containing an emergency department and operating theater (an EMT type 2), 61 members were nominated. At the time of assessment, 32 (52%) were fully immunized, requiring no further booster doses (vaccinations or serology tests). Three members were removed from the deployment as they were not fully immunized. Last-minute booster doses were required by 27 (44%) members, with a total of 74 booster doses administered (range 0-5). 19 of the booster doses administered were immunizations required to work in any health facility in Australia. The most common vaccines requiring booster doses were rabies (n=21) and typhoid (n=15). 58 emails were sent over a period of 5 days to 24 members to clarify vaccination status.

This deployment highlighted a gap in members’ perception of their immunization status, leading to delays in deployment readiness for the team. A new electronic system where vaccine status tracking occurs in real time should address this issue.

As of May 2018, a new European privacy law called the General Data Protection Regulation (GDPR) is in order. With this law, every organization operating in the European Union (EU), needs to adhere to a strict set of rules concerning collection and processing of personal data.

To explore the consequences of the GDPR for data collection at mass gatherings in the European Union.

Since the law was published on April 27, 2016, a thorough reading of the law was conducted by 4 persons with a background in mass gathering health. The GDPR consists of 99 articles organized into 11 chapters. There are also 173 recitals to further explain certain ambiguities. Key articles and recitals relating to healthcare and scientific research were identified. Possible pitfalls and opportunities for data collection and processing at mass gatherings were noted.

Under article 4, key definitions are noted. There is a clear definition of “data concerning health”. According to the GDPR, health data is a special category of personal data which should not be processed according to article 9(1). However, there is an exception for scientific research (article 9(2)(j)). There are a few safeguards in place, as laid out in article 89. One interesting point is that according to article 89(2), certain derogations can take place if the law interferes with scientific research. The GDPR has major consequences for data collection and processing in the EU. However, with the use of certain safeguards (e.g., pseudonymization) there are still ample opportunities for scientific research. It is important to review one’s method of data collection to make sure it complies with the GDPR.

A common language is needed to compare the impacts of incidents, crises, and disasters among health care coalition members, such as emergency medical services, general practitioners, and hospitals. A generic impact scale was developed, based on the Crisis Standards of Care, and was put to the test during the 2017 and 2018 winter/flu-seasons.

To define an impact scale for the quantitative assessment of the hospital response to incidents, crises, and disasters.

An impact scale has to be generally applicable to be useful in the context of a health care coalition. It should be applicable to all hazards and all parties in proactive and reactive, real-time settings. In addition, the scale should be easy to understand and score and should be independent of the various information systems in use. The Crisis Standards of Care were chosen as basis and were operationalized in a seven-point Likert-scale for expert-based scoring: “No impact,” “Buffer capacity needed,” “Buffer capacity sufficient,” “Unusual adaptations to care needed,” “Unusual adaptations sufficient,” “Disturbance of continuity of care inevitable without external assistance,” and “Disturbance of continuity of care inevitable.”

During the 2017 and 2018 winter/flu-seasons, crisis managers of ten hospitals scored the scale almost daily for three months. This served as a regional monitor and created the possibility to distribute patients and resources more evenly over the hospitals and with the care sector.

The impact scale improved communication and mutual understanding between hospitals and with other health care organizations, and is expected to have helped in maintaining the continuity of care during the 2017 and 2018 winter/flu-seasons. More research is needed on the reliability of the response. Nevertheless, the scale has since become an integral part of the regional contingency planning.

If there is consensus about how to handle a patient with a specific condition, from the ambulance service point of view, it matters less for the patient which ambulance arrives to take care of the patient. Guidelines are a way of standardizing treatment or management of the patient for a given patient condition. Clear and implemented guidelines that promote the handling of the patients is done from best practice and are evidence-based according to the best ability of the organization.

The aim of the current study was to implement guidelines into an organization that was not currently using guidelines. The study was conducted as a collaborative effort between a Swedish pre-hospital training organization and the local ambulance service organization in Kosovo.

An iterative process of implementing the guidelines was applied:

1. 1. Identify guidelines appropriate for the local organization. For each iteration, five guidelines are chosen.

2. 2. Have the five guidelines translated into Albanian.

3. 3. The guidelines are adapted to local conditions and context.

4. 4. The five guidelines are approved by an expert group.

5. 5. The five guidelines are implemented in the organization.

The initial iteration included was carried out in the form of a workshop where 22 persons (doctors and nurses) from the local ambulance service in Kosovo participated. During the workshop, the first three implementation steps were taken, while remaining steps were carried out by the local organization.

With the local management and ambulance personnel involved throughout the process, the implementation of guidelines were delivered in a more feasible way as well as more easily accepted and adhered to. Supporting a standardized treatment or management of the patient will benefit future patients. These standards should be based in evidence-based practice adopted to local conditions.

Children with Special Health Care Needs (CSHCNs) are at an increased risk for physical, developmental, or emotional conditions, and require special services beyond what is typically required by children. Improving emergency preparedness amongst families with CSHCNs has been advocated by the Centers for Disease Control (CDC), Federal Emergency Management Agency (FEMA), and The American Academy of Pediatrics (AAP).

We evaluated the preparedness of children and family members, who are infected, or affected, by HIV illness and require daily medications.

A convenience sample was used to enroll patients and their parents at a pediatric infectious disease clinic. Surveys were used to assess baseline emergency preparedness. Patients were then given an educational intervention on improving personal preparedness. Participants were provided with emergency go-kit and educational materials. Follow up was completed in 30 days to re-assess preparedness by re-administering the initial survey with additional questions.

Thirty-eight patients were enrolled and 10 were lost to follow up. Data from a total of 28 patients were used for study results analyses. Chi-squared testing was used for non-parametric variable analyses for an N < 30. Participants who designated an emergency meeting place outside of their home, post-intervention, were statistically significant-X2 (1) = 29.20, p-value <0.0001. Participants who completed an emergency information form, post-intervention, were statistically significant-X2 (1) = 13.69, p-value <0.0002. Participants who obtained an emergency kit of supplies for 3 days, post-intervention, were statistically significant-X2(1) = 8.92, p-value <0.0028. Participants who obtained a home first aid kit, post-intervention, were statistically significant-X2(1) = 12.16, p-value <0.0005. Five families obtained an emergency supply of medications, post-intervention-X2 (1) = 1.99, p-value = 0.1582. This result was not statistically significant.

This study demonstrates that brief educational intervention has potential to improve the preparedness of CSHCNs, including those living with HIV illness.

On February 6, 2018, a magnitude 6.2 earthquake struck Hualien, Taiwan. Over 150 patients crammed into the emergency department of nearby hospitals within two hours. Mass casualty incident (MCI) management was activated. During the recovery phase, little attention was paid to the mental health of hospital staff.

To analyze the prevalence of post-traumatic stress disorder (PTSD) among healthcare providers (HCPs) and explore the possible risk factors.

63 HCPs in the emergency department of the single tertiary hospital near the epicenter were included. The Chinese version of the Davidson Trauma Scale (DTS-C) was used to evaluate the prevalence of PTSD. Questionnaires were sent to explore the possible contributing factors.

The average age of the HCPs was 32.7 years (30.3 years for nurses; 40.4 years for physicians). The prevalence of PTSD was 3.2% eight months after the incident. The mean DTS-C score was 8.9/136. Nurses had a higher score than physicians (10.8 and 4.7). HCPs with 6-10 years working experience had the highest score (14.2), while those with less than 3 years experience had the lowest (4.8).

We found HCPs had a lower prevalence of PTSD compared with earthquake survivors (Chou 2007), and physicians had longer working years and lower DTS-C scores. The professional training may help HCPs going through psychological impacts during the disaster. HCPs with 6-10 years of experience in the emergency department were found to have a higher risk of developing PTSD. Most of them were taking the responsibility of a team leader during the MCI, which may cause significant stress to these staff. Adequate training regarding MCI management could help to relieve tension and frustration, hoping to prevent the development of PTSD. Based on our study, PTSD among HCPs is an ignored issue, and we should follow-up HCPs’ psychological condition in the future.

The Dallas Convention Center received over 3800 evacuees because of the unprecedented flooding caused by Hurricane Harvey. A multidisciplinary medical clinic was established onsite to address evacuee needs for medical evaluations, emergency care, chronic disease management, pharmaceuticals, durable medical equipment, and local health services integration. To operate efficiently, the Dallas Mega-Shelter Emergency Operations Center (EOC) worked with the Mega-Shelter Medical Clinic (MMC) under a fluid incident command (IC) structure that was National Incident Management System (NIMS) compliant. Iterations of MMC IC demonstrated maturations in organizational structure while supporting MMC operations that varied from rigid NIMS doctrine.

To explore the use of a fluid IC structure at a large evacuation medical shelter after Hurricane Harvey.

We observed evolutions of IC organizational charts and operational impacts.

Modifications through just-in-time iterations of the IC organizational chart were posted and reviewed with MMC IC and EOC sector chiefs. Changes in the organizational chart were noted to improve identification of logistical needs, supply delivery, coordinate with other agencies, and to make decisions for resource typing and personnel utilization. Adaptations also improved communication, which led to timely situational awareness and reporting accuracy.

MMC medical services were improved by allowing modifications and adaptations to NIMS compliant MMC IC organizational roles and duty assignments. The fluidity of IC structure with ability for just-in-time modifications directly impacted the provision of disaster medical services. Unique situational awareness, coordination of care pathways within the local innate health infrastructure, compliance with health service regulations, and personnel resource typing all contributed to and benefitted from these IC modifications. MMC and EOC IC collaboration facilitated effective communication and maintained an appropriate span of control and efficient activity reporting.

Influenza vaccine is recommended for high-risk populations in Australia (including those aged over 65 years) but is less effective in the elderly due to a progressive and predictable age-related decline in immune function, referred to as immunosenescence. Aged care facilities (ACF) are known to be at high risk of explosive outbreaks of influenza (even in highly vaccinated populations) and may reflect a higher intensity of transmission within the closed setting of ACF, as well as lower immunity and immunosenescence in the frail elderly.

To measure the impact of influenza in aged-care staff (ACS) and residents as well as vaccine effectiveness, a prospective observational epidemiological study was conducted in collaboration with an aged-care provider with multiple sites from March to October 2018. Weekly active surveillance on influenza-like symptoms and questionnaires were used to collect data on two groups: ACS and residents. A range of variables was examined against their 2018 influenza vaccination status in statistical analysis.

Vaccination rates were high in residents and consistent with other studies. Vaccine rates in aged-care staff were lower and consistent with other studies.

Residents and relatives are unlikely to change their minds about vaccination from year to year unless there is targeted effort to persuade them to so, and negative perception of the vaccine is likely to persist. Workplace influenza vaccination programs targeted at staff could be an effective method of raising vaccine uptake.

The global health threat posed by the ongoing deterioration in natural ecosystems and damage to our physical environment is growing at a rapid pace. Less recognized is the threat from natural hazard disasters, which concentrate contaminants from the damaged environment and expose large vulnerable populations to life-threatening medical conditions and disease. Currently neither international nor any national health and medical emergency response protocols or programs have prepared health responses to protect the health of communities in such events.

This study performed a retrospective health risk assessment on two recent events where such impacts unfolded, namely the 2015 southeast Equatorial Asia smoke haze disaster and the 2016 Melbourne thunderstorm asthma epidemic. The primary objective was to test if the characterization of health risk could have been identified earlier and catastrophic levels of mortality and morbidity reduced.

The study employed a two-staged retrospective health risk characterization assessment. The first step applied the UNISDR (2017) framework for health risk disaster assessment combing a thematic and targeted word literature review to identify the level of health and medical risk knowledge prior to each event. The second stage applied a risk characterization matrix developed using ISO and Australian Health Department semi-quantitative health assessment standards.

The 2015 southeast Equatorial Asia smoke haze disaster risk assessment was characterized as an extreme health risk and the 2016 Melbourne thunderstorm asthma epidemic characterized as a high health risk.

Innovative medical response approaches are urgently needed to mitigate the growing health risk to whole populations from natural hazard disasters compounded by deteriorating natural ecosystems and the physical environment. This requires emergency medical and health teams to recognize the two-tailed human health risk from natural disaster hazards, along with investment in advanced planning, environmental risk surveillance, specialist training, technical guidance, and multi-sector coordination.

Mexico has suffered multiple social and natural events that tested its response capacity. Hospital units of the third level of care are an axis of response and a central reference. Guaranteeing their integral and organized response promotes risk prevention and mitigation strategy in emergencies and disasters.

To analyze the national and international regulations and the existing documents about emergency and disasters related to a hospital with the identification of the critical actors in the response.

This research consists of a cross-sectional and descriptive study with a mixed methodology (qualitative and quantitative), that generates a protocol for response in a third level care hospital. Quantitative analysis was carried out using central tendency measurements based on a surveys (training, knowledge) performed in the hospital services that provide a critical response with the ED in emergencies or disasters (ED, ICU, Supplies, Nursing, Operating Room, Security, Hospital Admission, Crisis Committee). In the quantitative analysis, the staff were interviewed about their experience in responding to previous events (to the same critical services), recognizing importance and points of improvement with a discourse analysis methodology.

With the information collected and based on the protocols of Safe Hospital program (PAHO/WHO) we generated a protocol organized by the ED that involves massive victims.

Regulations oblige hospital units to have protocols of action in critical situations linked to Safe Hospital program, so it is a great tool for planning. All the surveyed personnel consider that it is important to have a plan that allows for immediate steps to ensure quality and timely patient care, considering it an ethical and social obligation. Analysis suggests that continuous training and the contribution of an operational plan per service provide security and better prognosis to the victims. The protocol includes all critical response services with a clinical practice guide.

The Tetra digital radio network enables a secure and encrypted environment for verbal and minimal data (SDS, Unit Alert) communication. In Finland (population 5.6 million), the technology has been in use since 2002, and the network currently has close to 40,000 end-users representing several authorities including emergency medical services and health care, police, fire and rescue services, Border Guard, Customs, and defense forces. The national dispatch authority uses the network to dispatch and communicate with EMS, police, and rescue services, and inter-authority talk groups have been designed to enable direct communication between each or all actors as needed. On a daily basis, the network transmits more than 7.5 million messages and 150,000 verbal contacts. The system has proved to be extremely stable during mass casualty incidents needing simultaneous actions by hundreds of individuals representing several authorities. Finland, Sweden, and Norway have common borders in the north, which EMS units routinely cross on a daily basis responding to urgent missions. Both Sweden and Norway have nationally implemented the Tetra communication network, but are using different operators.

The need to facilitate communication between Tetra end-users in the Nordic countries using each other’s networks resulted in an inter-system-interface (ISI) solution enabling network roaming. Between Finland and Norway, the mechanism was launched late in 2017 and is being implemented between Finland and Sweden in 2018.

Pending configuration of necessary talk groups, the system will be functional and in use in 2019.

Based on agreements on cross-border emergency assistance between Nordic countries in mass-casualty and other major incidents, the countries have developed national capacities to deploy response teams to neighbor countries for on-scene assistance and medical evacuation. Planning of necessary talk groups is in progress, and practical testing will be performed during the Barents rescue exercise hosted by Sweden in 2019.

The use of tourniquets by the civilian population has been deemed a critical aspect of the initial response during an active shooter situation. Tourniquet deployment in public-access must be accompanied by education. Studies indicate that the act itself is not an intuitive process and enclosed instructions may be inadequate. However, civilians for diverse reasons may not avail themselves of accepted training programs.

To develop an alternative means of “Just-In-Time” education to enable a naïve responder to apply a commercial tourniquet efficaciously.

A video (~40 seconds long) was created highlighting the actual application of a C-A-T® (Combat Application Tourniquet) on a human model. It was uploaded to YouTube on a public channel. A QR® code was generated using https://www.qr-code-generator.com, embedding the link for the YouTube® video. An appropriately-sized QR® code was printed and applied with packaging tape (Scotch®) to the exterior wrapping of a C-A-T® device. The C-A-T® with code was then accessed with the iPhone®.

With the iPhone® camera app activated and focused on the C-A-T’s QR® code, a request popped-up to open “YouTube.com” in Safari. When pressed, the full-screen video appeared immediately with audio of excellent quality.

The use of a QR® code and its video link is a feasible option to provide “Just-In-Time” training to a naïve civilian population who are responding to an active shooter situation. This offers the naïve responder two options of immediate education: the enclosed instructions and the QR® code. Redundancy in communications is essential in any emergency response. An important limitation of this innovation is the inability to obtain Internet® access and therefore, the availability of the enclosed instructions is still critical. Research to prove that this innovation will allow the application of a tourniquet to proceed expeditiously with few errors is currently underway.

The Japanese Association for Disaster Medicine (JADM) Disaster Medical Coordination Support Team (DMCST) was formed in 2016 when Japan experienced Kumamoto earthquake to support other disaster medical assistance teams in terms of headquarter operation logistics.

Introducing medical association-based disaster medical support team.

JADM DMCST was formed by an association member who had experience in disaster medical headquarter operation and logistic support. Disaster medical headquarter tends to have a gap between acute phase and sub-acute phase due to an alternation of disaster medical assistance team. To keep disaster medical management at medical management headquarter, experienced manpower requires. JADM DMCST provided assistance to fill those gaps.

For 2016 Kumamoto Earthquake, 107 members responded as a JADM DMCST, 78 members responded for 2018 West Japan Torrential Rain Disaster. Most of the members responded to the medical headquarter of affected prefecture’s, city’s, and medical region’s headquarters. Members provided logistic support in headquarter operation, gathered medical needs information, helped medical team dispatch coordination, gathered evacuation shelter information, provided heat stroke support for evacuees, assisted deep vein thrombosis management, provided AED delivery operation, and helped statistical information analysis based on WHO standards.

JAMD DMCST could provide medical management support at each headquarters without time span restrictions which the most of disaster medical assistance team has. Since all members were experienced in disaster medical management, they could connect and keep providing medical assistance to the affected people. At the time of disaster, disaster medical management headquarter is always short handed due to a large amount of incoming information. All this information was managed by the support team. Although JADM DMCST contributed to support headquarter management, each member had to pay for his/her transportation, hotel, food and any devices required for headquarter operations. Therefore, improving member’s responding condition is next problem to solve.