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Nepal is a country with geographical difficulties in tackling day-to-day emergency healthcare and disaster preparedness. The aim is to develop community preparedness by training for day-to-day emergency and disaster response in Nepal to generate preventive and first aid awareness of consequences and complications of simple to severe emergency conditions during day-to-day emergencies and disasters.
Method:
It is an analysis of five years of advanced first-aid training at the Nepal Disaster and Emergency Medicine Center from July 2015 to March 2020. In April 2015, the earthquake affected 15 districts of Nepal.
Results:
During July 2015 to March 2020, NADEM has been training 3,995 Community First Aiders for Male Leaders and Active Community people: 1,315 special mothers’ group–Adolescent Maternity & Child Health First Aiders; 794 Ambulance Drivers–Advanced First Aid Trained of remote districts of Mountain and hilly region’s ambulance’s Drivers and Assistants ; 637 ToT First Aiders for Community School Teachers (Training of Trainers); Total AFAT Trained by NADEM = 6,741 (Province 1 to 5); Total Population AFAT Trained = 52,610 (Province 1 to 5); Total Population Benefit by AFAT = 902,100 and its ongoing. NADEM Study Reports of Nepali community with ‘Incident Rate of First Aid Required’ is 9% per day with First Aid Services for 87.4% minor causes, 5.4% major causes, 0.5% gynecological causes, 1.7% AMCH causes, 4.5% trauma causes, 0.5% Prehospital Cardiac Arrest. With NADEM advanced first-aid training, now we are preventing 70% of deaths in remote parts of those districts before reaching the health care centers.
Conclusion:
It is a great challenge to train community laypersons to be Community First Aiders who can tackle day-to-day emergencies and disasters in their community with knowledge, skills practice, and attitude to prepare and prevent the increased tendencies of disability, deformity, morbidity, and mortality in Nepal.
On March 11, 2011, the Great East Japan Earthquake with a 9.0 magnitude struck the northeastern coast of Japan. The death toll reached 15,892 and 2,576 people were reported missing. Tohoku University and Fukushima Medical University, both of which are located in the affected prefectures, responded massively to the disaster.
Method:
To deal with the next disaster, both universities established the “Conductor type Human Resources Development” (CHRD) program for Disaster Medicine and Health Care in 2019, not only for doctors, but also other medical professionals (such as dentists, nurses, pharmacists, etc.) supported by the Japanese government. The main course of CHRD program, “Disaster Management course,” which is also a certification program at Tohoku University, comprises 14 practical educational contents (seven practical trainings and seven lectures) based on the work experience of both universities in collaboration with various organizations.
Results:
To date, 59 students have enrolled in the Disaster Management course, two students are enrolled in the board-certified physician in public health and social medicine acquisition course, three students are enrolled in the master's course, a Tohoku University Graduate School of Medicine course, and two students are enrolled in the doctoral course. Until October 2022, a total of 17 people were certified to have completed the "Disaster Management course," and one person completed the board-certified physician in public health and social medicine acquisition course. A total of 68 practical trainings and lectures were held until 2021, the total number of times this program was attended by students until 2021 was 916. Average comprehension rate and satisfaction rate with practical trainings and lectures by students are 97.2% and 98.3%, respectively.
Conclusion:
All the students who complete the CHRD program are believed to acquire comprehensive skills related to disaster health and medical care and will be able to respond effectively in all phases.
The number of backcountry skiers and snowboarder surged in the last years, especially during the COVID-19 pandemic, as ski resorts shut down. Inevitably, this led to an increase in avalanche-related injuries and death. As avalanche rescue device, avalanche airbags are increasingly becoming part of the standard winter mountaineering equipment.
Method:
This study provides a review of available data and an updated perspective on avalanche airbags, discussing their function and efficacy to reduce mortality and their limitations.
Results:
Causes of death in individuals caught by avalanches are multiple. Airbags seem to reduce mortality by decreasing chances of critical burial, the most determining risk factor. However, there is scarcity of reliable scientific research on the topic, and the way in which airbags reduce mortality and to what extent is still debated. Several elements seem to influence airbags efficacy, and their use still yields several limitations linked to manufacturing, proper use, users education, and risk compensation.
Conclusion:
Avalanche airbags seem to be an important tool in reducing mortality in backcountry expeditions. However, more research and standardized data collection is needed to fill the knowledge gap, mountain communities should promote adequate education of winter-recreationists on how to prevent and react to an avalanche, and on the correct use of airbags in combination with already available tools such as transceivers, probes and shovels, and manufacturing companies should ensure higher efficacy of the survival avalanche equipment for better prevention of burial, asphyxia, and trauma.
The Medical-Psychological Emergency Cells (CUMP) are integrated in France into the pre-hospital Medical Emergency Services (SAMU). The objective of this study aims to show an integrated course of care and the major interest of the inclusion of the Psychological Cells in the structures of the SAMU.
Method:
The CUMP of the Toulouse Area is made up of Psychologists, Nurses, Psychiatrists, professionals or volunteers sent or put on alert. Interventions take place immediately under the aegis of the prehospital medical care department or in a deferred manner within the first 48 hours. All subjects having at the time signs of acute stress, peritraumatic dissociation, behavioral disorders, are invited to follow-up consultations within 48 to 72 hours. The objective of this work is to show the continuity of care and the pathway of patients coordinated from an emergency call to several months beyond.
Results:
During 2021, 222 situations were handled, either individually or collectively. 94 were assaults (physical, psychological, or sexual), 55 were accidents (traffic accident, fire, explosion, etc.), 50 were confrontations with death (attending a suicide, death, etc.), 13 were traumatic bereavements, and 10 a context of a health disaster. Overall, 1,109 patients were seen immediately on site, 192 post-immediate in less than 48 hours and 197 had repeated individual consultations.
Conclusion:
1) The participation of the same professionals in immediate and post-immediate care makes the prevention of chronic post-traumatic stress more effective.
2) The articulation with the care structures for lasting psycho-trauma establishes consistency in the course of care: sensitivity to signs of distress, dissociation or stupefaction.
3) The links with the pre-hospital emergency medical aid service make emergency specialists aware of the psychological component of traumatic events.
Accidental hypothermia remains an important contributory factor to the mortality of trauma patients in both civilian and military environments. As a component of the ‘lethal triad’ it poses a significant problem in patients at risk of hemorrhage from traumatic injuries. Systems used to mitigate hypothermia in the prehospital environment must strike a balance between weight: size ratio and optimal performance.
Method:
This study compared three hypothermia mitigation systems; two leading products and the novel Xtract™SR Heatsaver, over a three-day trial period. Seven subjects were placed in a closed system, held at around 0°C, to promote the onset of mild hypothermia. Individuals with a tympanic temperature recording of < or = 35°C were placed into one of the three systems. Recordings of aural temperature and a numerical perceived comfort score were made every 15-20 minutes to assess rate of rewarming and subject’s perceptions of the process. An additional study was carried out by an experienced consultant in military and civilian emergency medicine, on day three of the trial, to determine the ease of clinical assessment of individuals placed inside the Xtract™SR Heatsaver prototype.
Results:
On all three days, subjects placed in the Xtract™SR Heatsaver recovered from their hypothermic state faster than those placed in the other systems. Clinical assessment could easily be performed on a patient placed in the Xtract™SR Heatsaver system.
Conclusion:
Results demonstrate that the new Xtract™SR Heatsaver system is superior with regards to reducing heat loss, increasing patient comfort and allowing for clinical assessment. The study also highlights the importance of the use of adjuncts such as heat cell blankets and insulation matts alongside hypothermia mitigation systems deployed in the prehospital environment. Furthermore, data gathered provides scope for future research into nuances surrounding the effects and onset of hypothermia.
Nepal’s reported risk to Climate Change adaptation reported by Notre Dame Global Adaptation Initiative Index (ND-GAIN Index) 2020 is 5.2 and ranked 71% high in country vulnerability, 126th of the total 180 countries. According to the report of the Ministry of Forest and Environment in 2018, flood is one of the principal climatic hazards in Nepal. According to the Department of Health Services Nepal, 3,500 children die each year due to water-borne diseases (WBD). The objective of this study is to analyze the climate change impact focusing on floods and WBD for the past two decades.
Method:
A secondary data analysis method was used to analyze the impact of floods and WBD attributed to climate change. Data was obtained from Nepal Risk Reduction Portal (http://drrportal.gov.np), Nepal Annual Health Reports (2000-2021), Nepal Government Vulnerability and Risk Assessment reports, and reputable journals.
Results:
Climate-related disasters have increased by six-fold in 2021, as compared to 2000 in Nepal. Among the people affected by disasters 71% of them are due to floods. Flood events during the last 21 years have a fluctuating trend with highest and lowest events observed in 2017(388) and 2015(15) respectively. Heavy and unusual rainfall patterns as a major indicator of climate change is likely to cause riverine floods and flash flooding by melting the glaciers. The incidence of diarrhea disease rose by 4.39% for 1°C increase in ambient temperature in data analysis collected on temperature and diarrhea from July 2002-June 2014.
Conclusion:
The findings suggested that increased temperatures in Nepal might have induced a change in flood events and the incidence of WBD (such as diarrhea), thus emphasizing the importance of climate change adaptation plans, flood risk management, and WBD surveillance to be prioritized and put in place to mitigate the effects of climate change.
Internationally, Disaster Victim Identification (DVI) activities are conducted under the International Criminal Police Organization system for handling a large number of bodies during disasters. However, the police have taken the initiative and commissioned clinicians and dentists to estimate the cause of death and identify the deceased, under a unique system in Japan. In this presentation, we examine the problems in the current DVI activities in Japan through DVI training.
Method:
We held DVI training sessions three times in preparation for the occurrence of a large-scale disaster in Chiba Prefecture with Chiba Prefectural Police, Chiba Medical Association, Chiba Dental Association, local government staff in Chiba, and forensic staff in other institutions. We conducted desktop trainings using paper dolls, under a simulation of an aircraft disaster, and a natural disaster such as flooding and landslides caused by typhoon damage in the third session. After the training, participants reflected on their activities through a questionnaire.
Results:
In accordance with the conventional method, the police officers numbered the bodies, photographed and checked their personal belongings, followed by the estimation of the cause of death with a doctor, the preparation of documents. Subsequently, dentists collected postmortem findings and matched with antemortem data. On the other hand, police officers and local government staff interviewed the bereaved family members under simulations. In the post-survey, participants were generally satisfied with the training, but some said that it was difficult to understand the activities of other professions.
Conclusion:
In Japan, where there are no DVI teams, this training was a good opportunity for all the job categories involved in DVI activities to meet each other. While the activities conducted by each profession helped to improve skills, the collaboration among professions was poor. We would like to improve the quality of DVI activities by introducing a team system for collaboration among multiple professions.
Japan is one of the most disaster-prone countries in the world. The government has traditionally taken the lead during disaster responses, but now NGOs have begun to play an active role in disaster response. Peace Winds Japan (PWJ), is the first Japanese NGOs to utilize medical teams, search-and-rescue dogs, and disaster response in conjunction with one another. The presentation will be focused on operations and lessons learned.
Method:
Initially, the NGO only supported disaster-affected areas, both domestic and abroad, by providing relief supplies. However, in 2010 they began training rescue dogs to perform life-saving search-and-rescue operations immediately after sudden onset disasters. In 2014 NGO dispatched rescue dogs and a disaster response team for the first time at the Hiroshima landslide disaster. A medical team was added in 2018, and since then has sent out teams to ten other disaster sites, including West Japan Flood in 2018 and Ukraine Crisis as an international EMT in 2022.
Results:
One of the strengths of the organization is the ability to respond quickly by using aviation and maritime transport. They operate two helicopters and one vessel and can promptly and effectively transport patients and resources. Eight critical patients were transported from the hospital by helicopter during the West Japan Flood.
Conclusion:
Furthermore, joint rescue drills were conducted with both public and private organizations, and continue to seek ways for collaboration and cooperation in disaster settings.
In this study, assuming a toxic gas-generating disaster situation requiring multiple hyperbaric oxygen chambers at the same time in Korea, the regional arrangement of hyperbaric oxygen chambers and its adequacy for toxic gas-generating disasters were investigated and analyzed based on medical institutions equipped with hyperbaric oxygen chambers.
Method:
It is assumed that all hospitals with hyperbaric oxygen chambers should be included theoretically if a large number of patients require hyperbaric oxygen treatment in the event of a toxic gas disaster. First, we received data from the manufacturer that provided the hyperbaric oxygen chambers, interviewed the persons in charge, and then contacted the relevant hospitals to check the placement in the second step. Afterwards, the deployment of hyperbaric oxygen chambers and population-based deployment status, the simultaneous capacity of hyperbaric oxygen treatment, and the ability to perform hyperbaric oxygen treatment in response to toxic gas disasters based on region were analyzed.
Results:
The annual number of hyperbaric oxygen chambers showed the first increase period in 2015 and the second increase period after 2019. Even when analyzed based on population-based, simultaneous capacity, and treatment performance, the distribution of hyperbaric oxygen therapy chambers was uneven especially in special areas.
Conclusion:
In preparation for future disasters, a regional arrangement plan for hyperbaric oxygen chambers should be established and implemented. The national monitoring system and the long-distance transport system should be established until proper distribution.
The COVID-19 pandemic challenged healthcare systems globally disrupting access to high quality essential health services. The pandemic may be viewed as a disaster impacting on patients and staff alike. There is a paucity of research describing how large health services have maintained, scaled and innovated care during the pandemic. The study was conducted to provide insights to inform hospital disaster management responses, specifically to identify organizational learnings from the COVID-19 response, capture instances of innovation, understand the impact of COVID-19 on models of care and to identify organizational priorities to prepare for a potential future disaster or terror event.
Method:
Survey research was conducted using a qualitative research strategy. The study was conducted at a 550-bed university-affiliated tertiary hospital located in the southeast corner of Australia in the State of Victoria. The survey was purpose designed, included open-ended questions requiring text responses, and was completed in an online survey form. A thematic analysis of the data was completed.
Results:
A total of 258 staff completed the survey, with staff representing doctors, nurses, allied health, and support personnel. There were four overarching domains of learning identified; People and Care, Staff Support, Implementation of Care, and Organizational Factors. These domains were supported by 14 topic areas which highlighted specific areas of learning and opportunity in preparing for or responding to a potential future disaster or terror event
Conclusion:
There was a need during the pandemic to pivot rapidly to reorganize services and workforce to operate and deliver care in a safe manner. Attention to and action in the domains of People and Care, Staff Support, Implementation of Care, and Organizational Factors can be considered by organizations when planning health service delivery in response to and during the COVID-19 pandemic, or more generally to a potential future disaster or terror event.
Emergency Medical Team Coordination Cell (EMTCC) was established in WHO Moldova Country Office to coordinate responding International EMTs in March 2022. Japan International Cooperation Agency (JICA) sent an EMTCC assistance team to support the WHO-approved minimum data collection for emergency medical teams, Minimum Data Set (MDS), operations and other coordination activities. Introducing activities of the JICA EMTCC assistance team at the Moldova EMTCC will suggest future use.
Method:
EMTCC assistance team activities were reviewed.
Results:
There was a wide range of high-level administrative functions in EMTCC, such as planning, logistics, assurance and governance, and human resources. One of the significant functions was introducing MDS to the medical team and extracting the data summaries for reporting to the Moldova Ministry of Health. All these tasks require considerable time to manage and must be completed promptly for effective EMTCC operations.
Conclusion:
The EMTCC coordinator should function as a decision-maker to control the coordination of EMTs communicating with WHO and implementing the EMT initiative. In a disaster, especially in the acute phase of EMTCC activities, more high-level administrative functions will be required with immediate processing. Therefore, it is considered that the EMTCC assistance team should work with the coordinator as early as possible. In addition, all these EMTCC assistance team activities should be standardized and specified in the EMTCC handbook for future operation reference.
Compared to trauma-based injuries, chemical injuries can inflict widespread and persistent injuries to exposed victims. Emergency medical services (EMS) personnel are vulnerable to chemical injuries. Specialized training is required, including zone setup, personal protective equipment (PPE), decontamination, and antidote use, beyond simple advanced trauma life support. The purpose of this study is to evaluate the educational effectiveness of the online chemical-mass casualty incident response education module (C-MCIREM) for EMS personnel.
Method:
This study is a retrospective pre-and post-test comparison. Subjects were EMS personnel who enrolled in the C-MCIREM program at the EMS Korea online conference between August 27, 2021 and September 5, 2021. Subjects provided demographic data and completed pre-course and post-course knowledge tests and self-assessments of readiness, as well as a satisfaction survey after the course. For readiness and satisfaction surveys, an 11-point Likert scale was used. The Wilcoxon Rank Sum test was used to compare the two samples.
Results:
A total of 322 respondents were enrolled. Two-hundred (62.1%) responded that they were most motivated to take the course because of curiosity about the subject. The median pre-course knowledge score was 57/100 (47, 66) and the post-knowledge score was 80/100 (66, 91) (p<0.001). Participants stated they felt their readiness to provide triage, treatment, transport, decontamination, to select correct antidotes, and to use correct PPE (all p<0.001) increased. 90.4% stated they were satisfied with the course. Participants were overall satisfied with the use of the online format (7.71/10 SD 2.05), and were willing to recommend the training to other EMS providers (7.63/10 SD 2.1).
Conclusion:
The online C-MCIREM program showed high satisfaction with a significant increase in knowledge and self-assessed readiness to respond to a chemical mass casualty incident.
The initial medical certificate (CMI) is a medico-legal document of great importance. Writing CMIs is a frequent act in emergency medicine. In 2011, the Haute Authority of Medicine (HAS) published good practice recommendations concerning the writing and content of these certificates. Nevertheless, this practice faces a difficult reality in the emergency services. The aim of this study was to analyze the writing quality of CMIs in terms of compliance of all the criteria collected with respect to HAS recommendations.
Method:
This was a retrospective study, evaluating professional practices over a period of two years in Ben Arous ED. We analyzed CMIs written by EPs. The certificates were subjected to a critical reading to begin a comparative study of the quality of writing of these certificates with the HAS recommendations using a criteria grid relating to the theoretical content of the certificates.
Results:
207 CMIs were analyzed (Acts of violence 88%, work accidents 12% and AVP less than 1%). The medical writers were mainly represented by general practitioners (98%). Not all of the CMIs complied with writing recommendations. The identity of the physician, the identity of the patient, the date of the examination and of the facts, the nature of the lesions, the handwritten signature of the doctor and the stamp were mentioned in more than 95% of the CMIs. The presence of CNOM registration number, the profession, the address and the number of the national identity of the patient, the place of the facts, the medical history and the previous condition of the patient were absent in more than 95% of the CMIs. The duration of the ITT was written in full in 36% of the cases.
Conclusion:
The study revealed insufficiencies in the quality of CMI drafting written by EP. Specific training is underway to improve certificate redactions.
Policymakers, practitioners and the public all have a role in health emergency and disaster risk management (Health EDRM). They need to access, understand and use evidence from research to take actions to reduce health risks and harm. They need the best available evidence to maximize their ability to save lives and reduce suffering. Evidence Aid seeks to meet this need through collections of specially prepared plain-language summaries of systematic reviews, freely available online in multiple languages (www.EvidenceAid.org). The summaries and webpages can be linked to reference management software and embedded in other websites.
Method:
Evidence Aid has added a substantial number of summaries to its collections since 2020, for example, adding a collection for reviews of relevance to the COVID-19 pandemic and its associated measures. From 2021, Evidence Aid built on its partnership with the Pan American Health Organization (PAHO/WHO) to identify and summarize reviews relevant to building resilience into health systems. This included enhancements enriching the content of each summary with the authors’ implications for practice and research, equity considerations and funding sources.
Results:
In November 2022, the Resilient Health Systems collection contained more than 200 summaries relevant to ensuring that health systems are resilient to emergencies, disasters and related challenges. There were also 600 summaries relevant to the COVID-19 pandemic, 150 on the health of refugees and asylum seekers, more than 100 on physical and mental health impacts of disasters and 110 on preventing and treating acute malnutrition.
Conclusion:
Evidence Aid’s 1000+ summaries of systematic reviews relevant to Health EDRM provide a unique gateway into this evidence base for policymakers, practitioners and the public wishing to ensure that disaster preparedness, response, recovery and rehabilitation are effective and efficient. It should be a key component in helping people and organizations to care, cope and overcome in an increasingly challenging world.
The Novel Integrated Toolkit for Enhanced Pre-Hospital Life Support and Triage in Challenging and Large Emergencies (NIGHTINGALE) project was awarded to a consortium to design an innovative toolkit featuring different technological solutions for prehospital mass casualty incident (MCI) response. Translational science (T) methodology was undertaken to develop evidence-based guidelines for MCI response.
Method:
The consortium was divided into three work groups (WGs) MCI Triage, Prehospital Life Support and Damage Control and Prehospital Processes. Each WG previously collected data through the project T1 scoping review stage to provide the foundation for the initial T2 modified Delphi draft statements to present to WG internal focus groups for content and NIGHTINGALE study objectives. Their refined statements proceeded to WG specific external focus groups for further editing to be clear and concise for the following modified Delphi consensus rounds. Final WG statements were presented to modified Delphi experts for their consensus using the STAT59 platform with instruction to rank each statement on a seven-point linear numeric scale, where 1 = disagree and 7 = agree. Consensus amongst experts was defined as a standard deviation ≤1.0.
Results:
After three modified Delphi rounds, 18 of 24 statements attained consensus by the MCI Triage experts, eight of 25 by the Prehospital and Life Support and Damage Control experts, and 23 of 28 by the Prehospital Processes experts.
Conclusion:
The three work groups will utilize consensus statements during the NIGHTINGALE project T3 phase to create evidence-based MCI response guidelines.
The COVID-19 pandemic created a public health crisis worldwide. Healthcare workers also became ill at a time when hospitals were overwhelmed with patients, leaving critical staffing shortages. Mass vaccination efforts were initiated in some cases without adequate civilian manpower. The governments of many nations utilized their military assets to fill gaps in care, and to initiate projects promoting public health efforts. The COVID-19 pandemic created a never-before-seen international military response to an infectious disease disaster. This literature review highlights the non-conflict assets allocated, abilities utilized, projects completed, overall effectiveness, and lessons learned by the military community worldwide to support their local populace. By collating this information into a single document, the collective global experience can be better analyzed and this information utilized to develop a framework for future disaster preparedness and mitigation planning efforts.
Method:
Medline (PubMed), GoogleScholar and the JSTOR Security Studies collection were searched for English language articles from January 1, 2020 and onwards. Keywords used included civil-military coordination, hospital, deployment, COVID-19, vaccination, and healthcare. Titles were initially screened for relevance and the abstracts were then reviewed for a decision on inclusion. Article inclusion was determined by author consensus based on relevance to the objectives. Key papers were also hand searched for additional unidentified references.
Results:
Data collection and analysis planned for completion by January 2023.
Conclusion:
The COVID-19 pandemic created a huge need for manpower which was backfilled by militaries around the world. This literature search demonstrates how military resources were able to contribute to the pandemic response, including successes and opportunities for future improvement.
The lack of planning and coordination by the mass gathering event organizers involving other stakeholders, especially from the health sector, caused mass casualty incidents which could not be managed in a timely manner and resulted in many victims. This was worsened by the fact that the nearest health facilities to the mass gathering event did not have a disaster management plan such as a hospital disaster preparedness plan which, if any, was not operational. No firm regulation forced, monitored, and evaluated the necessity of high-risk mass gathering events to have such a preparedness plan yet in Indonesia.
Method:
Using a case study qualitative research method by conducting media observations and listening to webinars on experiences with health workers involved in handling the social disaster of the Kanjuruhan tragedy. Supported by analysis of policy reviews and in-depth interviews with the involved stakeholders on the field.
Results:
This is ongoing research, the results have not been finalized. However, from the information that has been obtained so far, it can be concluded that there is no synergy between the plans prepared by the football match organizing committee, police, local government, and nearest referral health facilities. This was identified by the absence of a medical director at the referral health facility, the absence of in and out access for the medical team to the mass gathering event location, and the absence of crowd management at the site of the incident resulted in 720 injured and 135 of them dead. This made the incident the second worst football stampede incident in history.
Conclusion:
Specific mass gathering regulation specific to football matches is required as Indonesia has a risk of hooliganism in some areas. This will be mandatory for the organizing committee to comply with and involve relevant stakeholders, especially the local health sector.
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.
Method:
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.
Results:
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).
Conclusion:
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.
In addition to national nuclear disaster training, local training is conducted once a year to identify issues with training.
Method:
The facility is located in the urgent protective action planning zone (UPZ), an exposure medical facility was built in 2015 and has conducted four trainings so far. The fifth training was conducted this time to develop human resources (training), manage equipment and materials, receive medical teams, collaborate with the Advanced Radiation Medical Support Center, review manuals, and inform local residents.
Results:
There are currently eleven nurses registered as nuclear disaster response nurses at the facility, and two nurses participate in the national nuclear disaster training program each year. On the other hand, unlike physicians and other professionals, the number of nurses enrolled for reasons such as relocation has not increased. The facility also functions as a core hospital in the event of a disaster, and currently has about 30 nurses who are willing to be dispatched in the event of a disaster. It was found that even in core facilities for nuclear disaster response, awareness of nuclear disasters within the facilities is low and few personnel are willing to work there. Previous studies have shown that they are anxious about radiation, the possibility of late effects from low-dose exposure, and concerns about the genetic effects of exposure and its effects on themselves in nursing.
Conclusion:
As a core facility for nuclear disasters, issues were reported on and identified through training, such as human resource development, management of materials and equipment, and review of manuals.