The world is facing the devastating impact a biological event can have on human health, economies, and political stability. COVID-19 has revealed that national governments and the international community are woefully unprepared to respond to pandemics—underscoring our shared vulnerability to future catastrophic biological threats that could meet or exceed the severe consequences of the current pandemic. This study examines potential threats related to deliberate Russian military use and misuse of the tools of modern biology or an accident caused by a CBRN event evolving rapidly in the highly volatile political environment in and around Ukraine and other conflicts.

A participatory foresight, co-creative, future and transformation-oriented methodology was used to structure a transformative model for a disciplined exploration of scenarios to confront complex challenges and facilitate improved outcomes. Foresight helps to evaluate current policy priorities and potential new policy directions; see how the impact of possible policy decisions may combine with other developments; inform, support and link policy-making in and across a range of sectors; identify future directions, emerging technologies, new societal demands and challenges; and anticipate future developments, disruptive events, risks and opportunities.

The study found that the “mitigation scenarios” are based on the “Confront, Regulate, Overcome” metamodel combined with the “Security, Rescue, Care” response modalities. These require the cooperation/coordination of law enforcement forces along with military forces, fire departments and civil security resources, hospital and first-line responder teams, in order to appropriately address populations, assets and territories issues elicited by the identified threat, which drives key decision makers’ tasks at the strategic level.

The participatory foresight exercise demonstrated gaps in national and international biosecurity and pandemic preparedness architectures highlighted by the challenges of the Ukraine war—exploring opportunities for better cooperation to improve prevention and response capabilities for high-consequence biological events, and generate actionable recommendations for the international community.

Due to climate change, many countries are exploring nuclear power as a clean, sustainable, and alternative energy source. However, radiophobia stemming from a history of major accidents at nuclear power plants (most recently Fukushima Daiichi) inhibits the expansion of this industry. In an unlikely event of a large-scale accident, the risks posed to humans are minimal when mitigation measures are followed. This includes appropriate Personal Protective Equipment (PPE) for first responders, and medical professionals responding to these emergencies. An examination of the PPE recommendations for these scenarios will highlight best practices for minimizing exposures, and the effects of radiation.

A systematic literature review will provide a historical baseline of the PPE worn during previous nuclear power plant events. Additionally, current recommendations for PPE levels in response to these emergencies will be explored. Five databases will be utilized for this study, including PubMed, Web of Science, and SCOPUS.

Many studies examine different types of nuclear radiological exposures, but few focus on nuclear power plant scenarios. More than 5,000 articles emerged from a preliminary survey of the five databases. However, less than 1% of them satisfied the extraction criteria, and reviewed PPE for nuclear power plant accidents. Medical responders caring for “exposed” individuals who present at Emergency Departments have minimal exposure once they’re decontaminated, and everyday PPE is maintained. However, data on PPE recommendations for on-site response remains unexplored. Airtight suits and full-face respirators emerged as industry gold standard for protection, but a closer examination of these types of suits, and responders' self-efficacy utilizing the gear would clarify their actual protective qualities.

While nuclear power plant accidents do not occur often, many remain fearful of their impact. Maintaining proper PPE (including respiratory habiliment) for event responders is one way to minimize the adverse health effects of these nuclear radiological exposures.

An exhausted, isolated, increasingly desperate Russia, still in possession of over 4,400 nuclear warheads, puts the world at risk. Since the outbreak of war in Ukraine, Russian rhetoric and military doctrine have evinced an increasing nonchalance toward the employment of tactical nuclear weapons as stockpiles of conventional weapons are depleted. Poor targeting control (or outright perfidy), demonstrated by recent events in Poland possibly violating NATO’s collective defense clause, have only incensed an imminently combustible situation. Given this threat, it behooves medical professionals to gain thorough acquaintance with Acute Radiation Sickness (ARS), including an assessment of sources of exposure, presentation, prognostic indicators, immediate treatments, long-term concerns, and sources of consultant support.

Through thorough review of military and civilian sources, training courses, historical cases, injury mechanisms, first-responder concerns, hospitalization parameters, and laboratory indicators, the ARS spectrum will be explored. Surgical, anesthetic, and intensive care implications will be discussed, as will infection and nutritional concerns. Emerging practices, specialized therapy, and long-term medical sequelae will be covered.

A thorough discussion of potential sources (civil and military), clinical recognition, and presentation of ARS will focus on best clinical guidance, providing the most up-to-date treatment strategies, and will give clear guidance regarding how best to prepare, treat, and obtain specialist consultation.

It is the earnest hope of the presenter (a senior naval physician with nuclear power experience, anesthesiology consultant/board examiner, and intensivist, who studied radiation safety and injury for much of his career and wrote a Diploma in the Medical Care of Catastrophes dissertation on radiologic injury management) that the audience will never face the horror of a single radiologic casualty. However, the likelihood of such wishful thinking seems as remote as ever. Attendees will not only learn guidance for treatment and prognostication, but will know how to obtain support and expert consultation.

Non-conventional terrorism (NCT) is laced with uncertainty that can foster fear and lead to unwanted public behavior. One such example is the masses of worried-well overcrowding hospitals. The purpose of this study was to explore public behavioral intentions during NCT and the effect of risk messaging in attenuating unwanted behavior.

An online intervention-based study was conducted among 1,802 adult Israeli participants. Threat perception and behavioral intent before and after exposure to hypothetical NCT scenarios were assessed stratified to the media type, exposure to rumors and fake news, and risk messaging.

Participants perceived the CBRN terrorism threat as low-medium in likelihood, and threat intrusiveness and perceived incident severity were estimated at a medium level. Nearly half (45%) of participants indicated it is highly likely that they would seek medical attention following an NCT incident. Exposure to fake news significantly increased the intention to seek medical attention (p=0.001). However, the odds of participants exposed to risk messaging reporting this intention were 0.470 (95% CI: 0.359, 0.615) times that of participants not exposed to risk messaging (χ2=30.366, p<0.001).

This study shows that overcrowding hospitals by worried-well following a non-conventional terror incident can be attenuated by risk messaging. In particular, this study suggests that simple, timely, and clear risk messaging is capable of overcoming fake news that otherwise can increase unwanted behavior. Rumors and fake news have limited power to alter threat perception, but they can significantly change behavioral intent and cause unwanted behavior that could jeopardize crisis management. Rational behavior by the public during NCT can be considered an outcome of rational decision-making by crisis managers, especially risk communicators.

Disasters occur globally and can impact emergency department (ED) services. Chemical, biological, radiological, and nuclear (CBRN) events have different characteristics in terms of onset and duration when compared to other disasters, such as wildfires, floods, and hurricanes. It is important to have an understanding of the impact of CBRN events on EDs to inform disaster preparedness. The purpose of this paper is to identify peer-reviewed published literature that describes the impact on EDs from CBRN events.

An integrative literature methodology was used, guided by the Preferred Reporting Items of Systematic reviews and Meta-Analysis (PRISMA) Guidelines. MEDLINE, PsycINFO, CINAHL, Pubmed, and Scopus were searched using terms relating to CBRN events and EDs. Papers were included if they focused on the impact of real-world CBRN event(s). Information from each included paper was extracted into a table, including author(s), CBRN event characteristics, ED response characteristics, patient presentation characteristics, and outcome characteristics.

Of the 15,982 studies that were identified from the database searches, 4,012 were duplicates and 11,696 were irrelevant at the title and abstract screening stage. Therefore, 274 were screened at the full-text stage resulting in 44 studies for inclusion. Included papers were mostly from the United States of America (n=22/44, 50%), followed by Turkey (n=4/44, 9.1%). Most of the events were chemical (n=36/44, 81.9%), with Chlorine (n=9/36, 25%) being the most frequently reported chemical agent. Between 1 and 5,500 people [M=54, IQR: 22-253] presented to EDs because of CBRN events.

Emergency departments assess and manage patients who present following CBRN events. Of these patients, the majority do not require hospital admission, suggesting that the ED is integral in the health response to CBRN events. As such, EDs should be adequately prepared, from a resource and process perspective to assess, manage and discharge large numbers of CBRN-related patients.

Future strategic pressures in the Indo-Pacific region will present major policy and strategic challenges driven by rapidly increasing populations, resource depletion and contests, and forced adaptation to a changing climate. While regional countries remain likely to continue on a high growth trajectory, there is growing concern that nations will face difficulty to sustain economic gains in the face of strategic resource depletion and availability, population growth, and increasingly frequent extreme weather events. This mismatch could result in strategic miscalculation and reformulation, driving CBRN proliferation choices that fall outside of historical norms or standards. Such societal stressors are already occurring in the region and themselves may suddenly impact on health and social systems in unpredictable and complex ways.

Three tabletop exercises called the Boxwood Scenarios were conducted utilizing the Avalanche TTX system, including participants from key intelligence, military, and academic experts. Participants were invited to a Delphi study examining positive and negative drivers, shaping factors, motivators, and consequences of CBRNE proliferation in the Indo-Pacific region. Two rounds of result review were conducted by the group. These results underwent a systematic mixed methods analysis (quantitative and qualitative methods) and interpretation.

Climate change, demographic and geopolitical pressures were highlighted as key to future potential CBRN proliferation risks, with this nexus resulting in major proliferation concerns as early as 2040. Proliferation decisions driven by, and occurring in parallel to, climate and demographic pressures were identified as of major concern. Such decisions would have profound multi-layered social, health and broader implications for Indo-Pacific countries with declining determinants of national power.

Climate change and demographic and geopolitical pressures could drive future Indo-Pacific CBRN proliferation. The consequences to human populations, the viability of ongoing international disaster risk reduction and capacity-building efforts, and the increased future risk of major CBRN events cannot be overstated.

Considerations for patient and staff safety are critical during an encounter with an individual who is potentially contaminated by hazardous materials in the hospital setting. Decontamination training for all team members may be ideal, however, there are significant barriers precluding implementation including time-spent, associated costs, and staffing limitations. Studies demonstrate that immediate recognition of potential contaminants and removal of clothing mitigates risks with a best-estimated 85% hazard reduction. Initial risk-reducing best practices like focused training and resources, allow for more adequate decontamination response and improve team training gaps with potential first receivers throughout the hospital setting.

A two-step process was implemented to address a training disparity including a deployment of high-impact resources and the installment of these resources at high-risk locations. First, a slide deck with focused education to both clinical and non-clinical staff was developed from the established decontamination team training program. The focus of this training was to introduce the concept of RAIN (Recognition, Avoidance, Isolation, and Notification). This education highlights how to safely remove potentially contaminated clothing and contain the materials. RAIN kits were created with the items necessary to safely accomplish this while prioritizing patient privacy and safety to patient and staff. The kits included instructions, privacy kits, thermal blankets, and trauma shears. Next, the RAIN kits were deployed at pre-identified locations where potentially contaminated patients may present.

Qualitative improvement in staff satisfaction was noted after the implementation of the abridged, high-impact RAIN kits. The pre-deployed kits at critical high-likelihood locations throughout the hospital created a more accessible model with improved ease of use and effectiveness, reducing current gaps in training. Limitations should be considered when implementing a high-acuity, low-frequency program to clinical and non-clinical staff with support from leadership.

Focused education and pre-deployed kits empower staff to respond in hospital settings for potentially contaminated patients.

Healthcare provision depends on reliable infrastructure to power equipment, and provide water for medication and sanitation. Attacks on infrastructure limiting such functions can have a profound and prolonged influence on the delivery of care.

A retrospective analysis of the Global Terrorism Database (GTD) was performed of all attacks occurring between 1970-2020. Data was filtered using the internal database search function for all events where the primary target was “Utilities”, “Food or Water Supply” and “Telecommunications.” For the purposes of this study the subtype “Food Supply” was excluded. Events were collated based on year, country, region, numbers killed and wounded.

The GTD listed 7,813 attacks on infrastructure with 6,280 attacks targeting utilities leading to 1,917 persons directly killed and 1,377 wounded. In total there were 1,265 attacks targeting telecommunications causing 205 direct deaths and 510 wounded. Lastly, 268 attacks targeted the water supply with 318 directly killed and 261 wounded. Regionally, South America had the most attacks with 2,236, followed by Central America and the Caribbean with 1,390. Based on infrastructure type, the most attacks on utilities occurred in El Salvador (1,061), the most attacks on telecommunications were in India (140) and Peru (46) had the most attacks on its water supply.

The regions with the highest number of total attacks targeting infrastructure have historically been in South America, with more attacks against power and utilities than other infrastructure. The numbers of persons directly killed and wounded in these attacks were lower than those with other target types. However, the true impacts these attacks have on lack of health care delivery are not accounted for in these numbers. By understanding the pattern and scope of these attacks, Counter-Terrorism Medicine initiatives can be created to target harden healthcare-related infrastructure.

This study aims to analyze and describe terrorism-related attacks in East Asia from 1970 to 2020. This descriptive analysis of terrorist attacks in East Asia will help first responders, emergency medical services (EMS), hospital-based medical providers, and policymakers establish a more refined hazard vulnerability assessment framework and develop a counter-terrorism medicine (CTM) mitigation, preparedness, response, and recovery plan.

This descriptive observational study draws data from the Global Terrorism Database (GTD) from January 1, 1970, to December 31, 2020. Epidemiology outcomes included primary weapon type, primary target type, the country where the incident occurred, and the number of total deaths and injuries collected. Data from 2021 was not yet available at the time of this study. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis.

There were 779 terrorism-related events in East Asia from 1970 to 2020. In total, the attacks resulted in 1,123 deaths and 9,061 persons injured. The greatest number of attacks (371; 47.63%) occurred in Japan and the second most occurred in China (268; 34.4%). Explosives were the most used primary weapon type (308; 39.54%) in the region, followed by incendiary devices (260; 33.38%). Terrorist attacks drastically diminished from their peak of 92 in 1990, but there were additional peaks of 88 in 1996, 18 in 2000, 20 in 2008, and 36 attacks in 2014.

A total of 779 terrorist attacks occurred from 1970 to 2020 in East Asia, resulting in 1,123 deaths and 9,061 injuries. Of those, 82.03% of attacks occurred in Japan and China. Terrorist attacks drastically diminished since their peak in 1996, but there is an overall uptrend in attacks since 1999.

Despite Spanish experience in counterterrorism, jihadism means new modus operandi, based on active mass casualty incidents, involving new injury patterns as mass bleeding ones. Therefore, the environment is completely different to first responders' structure. This change forced the revision of the tactical response model, led by the Spanish Association for Emergency Medicine's Tactical Care Secretary, who provides a discussion forum to its members, reaching a joint framework document, IBERO, adapted to Spanish tactical emergency capabilities.

Methodology was based on three parameters:

1. 1) Literature revision, selecting three sources: Books and academic papers, TCCC and TECC guidelines, and Hartford Consensus, and AARs from the main active incidents with similarities to jihadist ones.

2. 2) Formation of discussion groups: Threat definition, tactile response, and prehospital care, triage and evacuation systems.

3. 3) A final group formed by representatives of each discussion group wrote the final document.

The protocol defines a staged plan of action, adapted to Spanish legislation and institutions, following the acronym IBERO:

1. 1) Information: threat intelligence and information transmitted to responders from the incident location and dispatchers.

2. 2) Block the threat by perimeter, zonification and suppression of the threat.

3. 3) Escalation of resources. Definition of areas of action according to direct threat, indirect threat and safe areas of action.

4. 4) Response and Rescue. Extrication to safe areas, including different stages of triage and protection against secondary attacks.

5. 5) Order and evacuation. Access to other emergency services, and psychological first aid.

The document proves the need for a coordinating framework of the Spanish emergency system to be fully adapted to these new threats. The discussion groups have identified the need for regular training on threat identification, zonification setting, mass bleeding control, extrication, and evacuation techniques during hostile situations. To achieve this goal, realistic training is mandatory.

Targeted Automobile Ramming Mass Casualty attacks (TARMAC) have occurred worldwide since 2010. The dramatic increase in incidence warrants special attention to the unique pattern of injury associated with such attacks as they are unlike any other type of intentional trauma. This study characterizes the resulting injuries from the 2017 Charlottesville, Virginia TARMAC attack.

Patient records of victims were identified and analyzed for injuries, demographics, and surgical needs. The data were evaluated for patterns.

Nineteen TARMAC victims were treated in the UVAHS Emergency Department. Most were female (68%). Average age was 29.4 years (range 13 – 72 years). Data showed seven ICU admissions, four standard admissions, and seven discharges. There was one fatality and the specific injury data was unavailable. Most injuries were orthopedic: lower extremity fractures (n=7) [2 open], upper extremity fractures (n=7), axial skeleton fractures (n=6), and a facial fracture (n=1). Arterial injuries required interventional radiology (n=1) or observation (n=2). Organ injuries included a Grade 1 spleen laceration (n=1) and pneumomediastinum (n=1). six victims required one or more operative interventions during admission: emergent procedures (n=6) and delayed procedures (n=4). In the Emergency Department, two bony reductions were performed, five lacerations were repaired, and one thoracotomy was performed. Injury Severity Scores were calculated (mean=11.5; median 6; range 1-75).

Due to the mechanism of injury, TARMAC attacks inflict a unique wounding pattern. Intentional mass blunt trauma is previously unknown to emergency medicine. Vehicle variables including weight, speed, and bumper height affect the injury location and severity. This vehicle, a low-height sports car, inflicted primarily lower extremity injuries. Mortality rates have been higher in attacks involving taller, heavier vehicles, as seen in France, Germany, and Sweden. Analysis of victim data from TARMAC attacks will help emergency medicine physicians, surgeons, and disaster medicine specialists to prepare, train, and mitigate against this increasingly frequent tactic.

The COVID-19 pandemic inspired social changes that promote outdoor activities including eating at restaurants, which may linger in a world hyperfocused on disease transmission prevention, increasing the vulnerabilities to vehicle-based terrorism. Vehicle ramming attacks started to transition from a relatively rare method of attack to one of the most lethal forms of terrorism prior to the emergence of COVID-19.

This study aims to provide a historical analysis of the terrorism-based attacks using vehicles between 1970 and 2019 by retrospectively searching the Global Terrorism Database for terror events that used a vehicle as a means of attack–a methodology suggested by Tin et al.

257 recorded terror attacks involved some type of vehicle between 1970 and 2019. The attacks resulted in 808 fatalities and 1715 injuries when excluding the September 11 attacks. 76 events occurred in the West Bank and Gaza Strip, 25 in the USA, 16 in Israel, and 14 in the UK. Of the 257 terror incidents, 71% (183) occurred within the last 6-year span of inquiry.

By 2016, vehicle attacks were the most lethal form of attack comprising just over half of all terrorism-related deaths in that year. Large gatherings such as festivals, sporting events, and now outdoor seating at restaurants, leave a number of people highly vulnerable to vehicle ramming attacks depending on established countermeasures. The increased prevalence of outdoor activities and gatherings in a post-COVID-19 world will further expose large numbers of people to the potential vulnerabilities of vehicle-based terrorism. The scale of the casualties from a vehicle-based terror attack can overwhelm traditional resources and strain the abilities of the healthcare sector. Counterterrorism and disaster medicine specialists are crucial players in educating first responders and emergency medicine providers, allowing them to adequately prepare for an evolving threat in a world devastated by COVID-19.

Sub-Saharan Africa (SSA) has become a hotspot for global terrorism, with nearly 50% of global terror-related deaths occurring in SSA in 2021. To address growing terrorism-related health implications the field of counter-terrorism medicine (CTM) seeks to study the impacts of terrorism and implement healthcare initiatives. This study is a semi-quantitative analysis of terrorist-related activity in SSA from 1970-2020.

A retrospective analysis of the Global Terrorism Database (GTD) was performed for the region of SSA between 1970-2020. The number of attacks, deaths, and injuries, as well as primary weapons types, country where attacks occurred, and primary target types, were collated into a Microsoft Excel™ spreadsheet (Microsoft, Redmond Washington, USA) and analyzed.

A total of 19,320 attacks were recorded, resulting in 77,565 deaths and 52,986 injuries. Nigeria had the greatest number of attacks. Firearms were the most frequent weapons used, followed by explosives, unknown, and incendiary, with all others making up the remainder. Private citizens and property were the most frequently targeted entities, followed by general government facilities, police, business, military, diplomatic government facilities, and religious figures/institutions, with all other targets making up the remainder.

The majority of deaths from terrorism in SSA are the result of firearm attacks. Nigeria had the largest number of attacks and the highest number of killed and wounded. Private citizens and property are the most frequently targeted. Terrorism poses unique challenges to governments, populations, healthcare systems, and aid organizations. By understanding the impact and scope of terrorist activity in SSA, Counter-Terrorism Medicine (CTM) initiatives can be employed to improve healthcare outcomes.

The United Nations High Commissioner of Refugees (UNHCR) estimates that there were over 100 million displaced people as of May, 2022, which has left many people without adequate healthcare and strained local healthcare systems. While there is concern about violence that may be brought as a result of these large influxes of people, few are focused on attacks that are perpetrated on these displaced peoples. This study is a semi-quantitative analysis of terrorist attacks on refugees, refugee camps, internally-displaced peoples, and asylum seekers.

A retrospective search of the Global Terrorism Database (GTD) was performed for all terrorist-related events from 1970 to 2020 that targeted refugees, refugee camps, internally displaced peoples (IDPs), and asylum seekers. The number of attacks, country of attacks, weapon types, numbers wounded, and numbers killed were collated into a Microsoft Excel™ spreadsheet (Microsoft, Redmond Washington, USA) and analyzed.

There were a total of 683 attacks which resulted in a total of 3148 deaths and 4374 injuries from 1970-2020. These occurred in 56 countries, with Sudan having the largest number of attacks at 113, followed by Germany (71), Iraq (61), Nigeria (51), and Sweden (43). The most frequent weapons used were explosives (213), followed by firearms (210), incendiary (140), unknown (74), melee (45), and chemical (1).

Terrorist attacks against refugees/IDPs/asylum seekers resulted in 3148 deaths and 4374 injuries in 683 attacks. Sudan had the highest number of terrorist attacks, and the most frequent weapon used was explosives. Attacks against refugees pose unique challenges to government, NGO’s, and other stakeholders due to the lack of healthcare access and transient nature of this population. By understanding the scope and impact of terrorist-related attacks against this vulnerable population counter-terrorism medicine initiatives can be employed to improve healthcare access and outcomes.

Early in the Russian-Ukrainian conflict, the Ukrainian Ministry of Health (MoH) implemented policy reform to allow for pre-hospital whole blood transfusion (pWBT). Team Rubicon (TR) worked with a multinational group of experts to disseminate training that accelerated the implementation of pWBT across the country.

TR utilized an assess, align, and act (A3) approach to drive the pWBT implementation. TR established relationships with Ukrainian providers to understand current needs, restrictions, and protocols for pWBT. TR aligned pWBT advocacy efforts, working with the disaster medicine program at Ivano-Frankivsk Medical National University to create a local lead advocate. Existing and novel coordination mechanisms were used to unite and inform MoH, World Health Organization, Non-Governmental Organizations, and local health systems. Finally, TR coordinated a multispecialty, multi-national team of healthcare providers who developed and delivered a training package in alignment with national guidelines utilizing a combination of didactics, videos, and demonstrations. From August to October of 2022, TR conducted pWBT trainings across Ukraine. Pre- and post-surveys were utilized to determine comfort with pWBT and usefulness of the training.

TR emerged as the point of reference for pWBT in Ukraine. 109 individuals from over 14 organizations were trained. Participants included 69 physicians, 23 paramedics, 7 nurses, and 10 other professionals. 95% of those surveyed had not received prior pWBT training. Participants reported increased comfort levels, with average pre- and post-course comfort scores of 1.7 and 3.2 (4=very comfortable), respectively. The majority of participants found the training useful (average score of 3.8, 4=very useful). Feedback demonstrated high satisfaction ratings and an increased awareness of the regulatory changes.

TR utilized the A3 model to drive a coalition that supported policy reform and trauma system improvements in Ukraine. TR’s ability to leverage international medical expertise, work collaboratively with MoH, and provide material resources supported local implementation of pWBT.

As of October 2022, the civilian casualty count of the invasion of Ukraine is reported to be 16,295, with actual figures believed to be considerably higher. As explosive trauma continues to terrorize populations, frontline medical personnel are faced with escalating resource constraints including transport, imaging modalities, and electricity. Point of care ultrasound (POCUS) is considered the gold standard in acute trauma evaluation, but very few hospitals or pre-hospital medics have access to or training in POCUS.

In collaboration with the Ukrainian Ministry of Health, the World Health Organization, and the Global Health Program at Butterfly Network, Team Rubicon developed and conducted 64 practical trauma trainings and donated 50 Butterfly iQ+ portable ultrasound devices in Ukraine between August and October, 2022. Of these trainings, 19 specifically focused on the use of POCUS for trauma. Pre- and post-surveys were deployed to determine demographics, comfort level with POCUS for trauma care, and usefulness of the course.

In total, 149 individuals were trained in POCUS for trauma. Of these, 130 were physicians, 15 were paramedics, three were RNs, and one was a pharmacist. Only 14.8% of these clinicians self-reported any previous POCUS training. All participants reported an increase in comfort level, with an average pre- and post-course comfort scores of 1.9 and 3.3 (4=very comfortable), respectively. General satisfaction with the training was high (average score of 9.8/10). Qualitative feedback commended the quality and novelty of this training, requested further examples of pathology, and endorsed more POCUS trainings, generally. The most critical lesson learned was the need to re-orient training around the foundations of POCUS given low levels of experience and training.

Access and training in POCUS for trauma is critical for resource-constrained medical personnel operating in conflict-affected communities. A one-day POCUS practicum-oriented course is feasible to support awareness and proficiency.

Emergency nurses’ views on their roles, challenges, and preparedness in the context of armed conflict are necessary to capture in-depth insights into healthcare needs. They can identify the required education and training for emergency nurses and provide evidence of the situations of care in the context of armed conflicts. Unfortunately, the evidence about these factors in the context of armed conflict is scant.

A semi-structured interview with 23 participants was conducted using qualitative content analysis. The study was conducted in Saudi border hospitals that are shared with Yemen. The COREQ guideline for reporting qualitative research was followed.

The emergency nurses’ roles in hospitals in the context of armed conflict discussed clinical nurses’ and head nurses’ roles. The main challenges that emergency nurses faced include poor orientation, access blocks, and communication barriers. Various perspectives about the preparation, including education, training, and strategies for preparing emergency nurses, were identified. The most striking findings in these settings were the diversity of armed conflict injuries, clinical profile, triage of mass causality, trauma care, surge capacity, orientation, communication, and strategies for preparing nurses.

This study provided an estimate of the scope of ED nurses' roles, and how they were prepared across a range of hospitals in the armed conflict areas and therefore a snapshot of their experiences significant to be an informative resource for these settings. This study has provided essential implications for preparedness and planning. Given the large number of preparational courses being undertaken by ED nurses in these settings, the choice of the required education and training must be planned accordingly considering the clinical profile of patients in armed conflict areas, trauma care, triage of mass causality, surge capacity, safety and security, communication, policies, and law.

In March of 2022, the Washington Post reported that the: “Deadliest war isn’t in Ukraine, it’s in Ethiopia.” Current death toll estimates are around 600,000: 50,000-100,000 (warfare); 150,000-200,000 (starvation), and 100,000 (lack of medical treatment). Due to increasing civil unrest, a mixed-methods study began at the University of Gondar Hospital in Gondar, Ethiopia. Between 2018-2022, the estimated (daily average) of patients was reported to have quadrupled, from 100 to 400. The global research team implemented 12 new systemic revisions in overcrowding, triage nursing praxes, and resuscitations. Patient data from 521 hospital records was evaluated, as well as resource allocation(s) in staffing, equipment, and training.

The study’s inclusion criteria for A&E data included all patients who sought emergency care at UoG Teaching Hospital’s Emergency Department between May 13, 2018, and June 29, 2018, primarily during the normal daytime working hours between 9am and 2pm, as nighttime security and road travel were deemed less secure for data collectors.

After the 12-benchmark implementation, there was an approximate 15%-25% decrease in direct-from-triage ‘Red’ patient admission; congestion dropped 50%-70%; and the occurrences of successful resuscitations increased. The study revealed that over 75% of patients presented with symptoms indicative of illness(es), and 24.4% presented with trauma (remaining psychiatric). Of the trauma cases, approximately 28.3% were ‘intentional’ injuries. The patients’ mean TEWS triage score was 3.294, with a standard deviation from the mean of 1.9938.

The overall prevalence of patients necessitating surgical evaluation, the elevated use of triage discriminators due to space, equipment, and staff concerns, and the predominant use of ‘Yellow Zone’ services–all pointed to the vital need for resource re-allocation(s), stricter ECCN adherences to TEWS triage indices, as well as future Mass Casualty Planning, Triage, and Response, and Mass Casualty Medical Operations training.

Russia invaded Ukraine in February 2022, leading to significant preventable death across Defense forces and communities. When appropriate and adequate training has been provided, the use of point of injury (POI) care guidelines as exhibited by tactical combat casualty care (TCCC) and the implementation of damage control resuscitation (DCR) and damage control surgery (DCS) can reduce preventable morbidity and mortality in the far foreword environment.

Background: Russia invaded Ukraine in 2014 exacting a heavy increase in preventable morbidity and mortality on the battlefield. Multiple global health engagement strategies by allied forces and health partners have focused on prehospital medicine. The most recent iteration of violence has seen a comprehensive invasion with the use of multi-domain battle and conventional weapons systems across nearly every state in Ukraine. These conventional weapon systems deployed by Russian forces exact a heavy lethality on all communities.

This report uses anecdotal data from undisclosed locations in Eastern Ukraine from the tactical evacuation care, Role 1, Role 2 to the Role 3 echelons of care as reported.

Appropriate application of combat application tourniquets (CATs), pressure dressings, access to tranexamic acid (TXA), antibiotics, basics of TCCC care and DCR/DCS, including access to blood as early as possible, save lives.

Rapid access to tactical evacuation care and initiation of DCR/DCS from Role 1 to Role 2 has good effect. The Ukrainian armed forces have pushed damage control Resuscitation and Surgery as far forward as Role 1, which may require a paradigm shift within the NATO military medical standards and preparations for a peer conflict.

Adequate TCCC, DCR and DCS training in the form of global health engagement have anecdotal success in the reduction of morbidity and mortality and in providing force health and medical readiness across NATO nations and partner forces such as Ukraine.

A scoping review of the literature available on landmines in Egypt and their resultant disaster impact (human losses, material losses, economic losses and environmental losses) on the Bedouin communities inhabiting contaminated regions and on Egypt is presented. A narrative approach is taken to map the data extracted from the available literature to: the domains of losses; evidence of external assistance; and progress, revealing the widespread impacts of the hazard of landmine contamination.

The review question was mapped based on the JBI and the Arksey and O’Malley Frameworks with reference to Aromataris and Munn (2020), and Peters (2022). The research question was identified starting with the search strategy, and is broken down using PCC as recommended for Scoping Reviews (Peters, 2022).

Searches of scientific literature were conducted using multiple databases, further searches of search engines, social media and of grey literature were conducted. The search results were then screened over two stages to determine their relevance. Data was then extracted using the PRISMA-ScR checklist before being tabulated and charted.

The data collated evidently shows human losses manifest as mortality, physical disability, psychological trauma, financial instability and social impacts; while material losses include blocks to considerable areas of the country’s landmass suitable for urban housing, agricultural and touristic potential, as well as mineral, and oil and gas reserves; economic losses include impedance to development, lost revenues and deterrence from investment; environmental losses comprise extensive contamination of Egypt’s land.

Evidence of external assistance being sought and provided is ample, signifying the overwhelm of Egypt’s coping capacity; rather, positive steps to de-mine the land and provide mine risk education and survivor assistance are beneficial in risk reduction. While landmine contamination is not classically considered to carry a disaster risk, this study proposes it does.