In the first months of 2018, there was an increase in the number of cases of fever possibly related to toxoplasmosis in the city of Santa Maria, Brazil, reaching significant values. Toxoplasmosis is an autoimmune acute infection usually asymptomatic in 80-90% of immunocompetent adults. In this outbreak, the intensity of the symptoms presented warrants attention.

To report cases of the toxoplasmosis outbreak in the city of Santa Maria, Brazil.

This is a cross-sectional study using data on the outbreak of toxoplasmosis in Santa Maria published in bulletins by the Municipal Health Department of Santa Maria, Rio Grande do Sul, Brazil.

The outbreak of toxoplasmosis in Santa Maria was confirmed on April 19, 2018. Until June 14, 2018, 510 cases were confirmed. According to the most recent bulletin released by the State Health Department on June 8, 2018, 441 occurrences are people residing in Santa Maria. Five are residents of the districts and seven cases are patients residing in neighboring counties. In a bulletin published on May 25, 2018, 1,116 cases were reported to state epidemiological surveillance by the end of May. Of these, 766 cases were still suspected (fever, headache and/or myalgia accompanied by lymphadenopathy, weakness, arthralgia, or change in vision. In the other 460 cases, there was laboratory confirmation of acute toxoplasmosis, of which 35 were pregnant, with two fetal deaths (36 and 28 weeks), and two abortions. There are also 212 cases still pending laboratory confirmation.

The results of this research show that the current outbreak of toxoplasmosis in the city of Santa Maria, Brazil, is the largest reported in Brazil and appears to be the largest in the world. The notification to authorities by physicians was very important for the identification of this outbreak.

On Friday, September 28, 2018, the 7.4 Richter Scale earthquake hit Central Sulawesi and was followed by a tsunami. Within a month after the unpredictable earthquake and tsunami, a 773 aftershock earthquake was noted. These events took a major toll on the population in the affected areas. 2,086 people died and more than four thousand people were injured. 1.373 people went missing and 206.494 were evacuated. Surveillance data from November 4, 2018, to October 24, 2018, showed that an increased number of illnesses such as diarrhea was the second leading reported cases. Data showed that the number of diarrhea cases was 3.350 with two peaks of epidemic curves on October 10 and 22, 2018.

To verify the diarrhea outbreak after the tsunami in Palu, Donggala, and Sigi District.

Verification of medical records at six selected primary healthcare institutions with the highest number of cases of diarrhea.

A pseudo-epidemic of diarrhea occurred. A high number of diarrhea cases occurred due to double reporting and misdiagnosed cases. Investigation reports showed that liquid defecation was considered diarrhea even though it occurred less than three times a day. The follow-up activity was contacting data entry managers to revise data, disseminate findings during the daily meeting of the health-related officers, and broadcasting findings through a WhatsApp group of provincial and district surveillance officers. Post-investigation, the number of diarrhea incidences was lower and the peak was not shown on the epidemic curve. It can be interpreted that a diarrhea outbreak did not occur in the tsunami-affected area in the Palu, Donggala, and Sigi districts.

During a time of disaster, a chaotic situation led to improper data collection. Data verification should be conducted to assure the validity of reported data.

Over the last two decades, Frequency Modulation (FM) radio has been established as the only form of sound broadcasting in Ghana. Radio is the most accessible of mass media. There are more than 40 operational radio stations in the Ashanti region of Ghana. Most stations are commercial, broadcasting in the local language (Asante-Twi). Many urban radio health slots discuss various diseases and their treatments mainly for the benefit of patients. Complementary and Alternative Medicine (CAM) practitioners who are able to pay for airtime dominate as ‘experts’ in most of these shows.

We identified an IEC gap regarding policies governing healthcare delivery, healthcare financing, training, ethics and research, and environmental issues. In June 2015, orthodox medical practitioners collaborated with a private, local, English-speaking radio station to produce and host a weekly health show whose content was aimed at holistically discussing health from the viewpoint of practitioners, clients, policy makers, administrators, and financiers in a simplified language for the general public, including healthcare trainees.

The show dubbed “Staying Alive” first aired on Tuesday, July 7, 2015, at 20:00 GMT and continues to air to date, appealing to a wide range of active listeners. “Staying Alive” to the best of our knowledge remains the only show with a holistic approach to health. Over the last 23 months, we have experienced challenges in sustaining sponsorship to fund the cost of production and airtime for the show, and the cost of effectively assessing the public health impact of the show. Orthodox medical practitioners can employ mass radio as an effective tool for advocacy, information dissemination, and education of clients or health trainees in low or middle-income urban settings through effective collaboration with media stations.

Hospitals are required to maintain emergency preparedness 24/7. In order to maintain readiness, Israeli hospitals operate Emergency Committees comprised of medical, nursing, and administrative professionals who are responsible for capacity building including the development of plans, infrastructure, equipment, training, crisis management, and learning lessons. The Ministry of Health (MOH) and Home Front Command (HFC) conduct a comprehensive, structured evaluation of emergency preparedness in every hospital every two to three years.

To assess the impact of a periodical evaluation on levels of emergency preparedness over time in a level one trauma center.

Evaluation of emergency preparedness is conducted by approximately 12 evaluators from the MOH and HFC, encompassing mass casualty incidents (MCIs), mass toxicological/chemical incidents (MTEs), radiological and biological events, earthquakes and conflicts. Evaluations are based on objective parameters, relayed to hospitals prior to the evaluation. The hospital’s level of emergency preparedness is graded and improvements that must be implemented are delineated. The grades of four evaluations conducted from 2011 to 2018 were compared to identify trends in preparedness.

Mean levels of emergency preparedness in the 2018 versus 2011 evaluations presented an increase concerning all threats, including MCIs (92 vs. 90), MTEs (99 vs. 77, respectively), biological events (96 vs. 73, respectively), radiological events (91 vs. 79), earthquakes (87 vs. 60, respectively), and conflicts (95 vs. 74). The relative change in levels of preparedness was more noted concerning biological events and earthquakes.

A periodical evaluation by governing authorities seems to motivate the hospital’s administrations to invest efforts in building and maintain a high level of emergency preparedness. Systematic evaluations conducted bi-annually contributed to improved readiness for diverse emergency scenarios, including for threats that less frequently materialize.

Indicators are used as a benchmark for the quality of disaster response. Desirable attributes of indicators include precision, clear definition, improvement opportunity, unbiased, flexibility, and validity. Due to a lack of universally acceptable, objective indicators, it is currently difficult to gauge improvements in mass casualty preparedness within a hospital.

To describe existing indicators relevant to hospital disaster response, and to explore the use of two new indicators (decanting and chain of command).

A structured literature search in indexed databases was used to identify articles related to the measurement of hospital performance in mass casualties using a matrix technique and snowballing. Relevant websites of disaster management organizations were also reviewed and local disaster management experts were interviewed. Proposed indicators were compared against attributes and some (triage time by category, notification time, time to adequate staff response, preventable deaths, decanting times and chain of command for intensive care unit, and emergency department) were tested and measured in two exercises involving more than 90 staff each, held at two Southeast Queensland hospitals in 2017 and 2018.

Over 50 proposed indicators, including indicators within large sets, were identified. Measurement of some indicators was found to be highly subjective. The decanting and chain-of-command indicators emerged as most useful. Intensive Care Unit required 40 mins to decant beds by 50%, while ED required 25 mins to decant beds by 80%. With regards to the chain of command, ED and triage staff performed best, with 66.7% correctly identifying their immediate supervisor. Overall, staff members were able to correctly identify immediate supervisor better compared to team leaders (59.3% and 40% respectively).

There is a need to narrow down, simplify, and objectify indicators for mass casualty performance. Baseline measurements from actual disasters will provide important comparative data.

Societies invest substantial amounts of resources on disaster preparedness of hospitals. However, the concept is not clearly defined or operationalized in the international literature.

This study seeks to contribute to the alignment of knowledge of disaster preparedness in hospitals based on a systematic review and analysis of definitions and operationalizations.

A systematic search was conducted in five databases: Scopus, Pubmed, Web of Science, Disaster Information Management Research Centre, and Safetylit. Peer-reviewed articles containing definitions and operationalizations of disaster preparedness in hospitals were included. Articles published in languages other than English, or without available full-text were excluded, as were articles on pre-hospital care.

Of the 39 included publications, 14 defined disaster preparedness in hospitals and 26 operationalized the concept. Although the definitions differed, they also reflected similar elements. Based on an analysis of the operationalizations, 12 different components could be identified that generally were not studied in relation to each other. Moreover, where publications primarily focused on structure and process aspects of disaster preparedness, 4 articles described the preferred outcome.

This review points at an absence of consensus on the definition and operationalization of disaster preparedness in hospitals. By combining the elements of the definitions and the components operationalized disaster preparedness could be conceptualized in a more comprehensive and complete way. A framework was developed that can guide future disaster preparedness research.

Between 2015 and 2018, a number of influential disaster-related International Consensus Frameworks evolved.

To locate these Frameworks and identify commonalities, potential interactions, and possible implications for WADEM.

A targeted literature review and thematic analysis.

The review identified the following Frameworks: Sendai Framework for Disaster Risk Reduction 2015–2030; Sustainable Development Goals 2030 Agenda; Paris Climate Change Conference; WADEM Position Statement on Climate Change; World Humanitarian Summit; Core Humanitarian Standards; Sphere Handbook, Humanitarian Charter and Minimum Standards in Humanitarian Response; Habitat111 - the new Urban Agenda; Sphere Guidelines for Urban Disasters; Rockefeller Foundation’s 100 Resilient Cities Project; New York Declaration for Refugees and Migrants; Dhaka Declaration on Disability and Disaster Risk Management; WHO Emergency Medical Teams and Accreditation; WADEM’s Disaster Research and Evaluation Frameworks; ALNAP’s Evaluation of Humanitarian Action Guide; and Evidence Aid’s Use of Evidence in the Humanitarian Sector: A Practice Guide.

All Frameworks used substantial theoretical and/or evidence-based underpinnings, and evolved from structured processes. One subset had major political and government influences while others reflected applied, professional influences. A number of the Frameworks further evolved during 2017-18, providing indicators, international reporting, and interpretative guidelines. Common themes included a desire to improve the quantum and quality of science, evidence-based and accountability, use of Resilience as a conceptual framework, commonalities, and interactions between the new generation humanitarian, development concepts, and traditional disaster concepts, particularly in the global influence of climate change and greater urbanization. Other themes included new paradigms (e.g. international influence of Rockefeller’s Acute Shocks), Chronic Stressors concept, and the anchoring theme of the Sustainable Development Goals and capacity building. The ALNAP, Rockefeller, Sphere, and WADEM Evidence Aid Frameworks provide useful guidelines on how the objectives of these International Consensus Frameworks may be achieved and measured. All Frameworks have implications for the future direction of WADEM.

Located on the Pacific Ring of Fire, Indonesia has to cope with the constant risk of many disasters. Hospitals in Indonesia are very vulnerable. Around 1,300 hospitals suffered damage since the Aceh tsunami (2006), with losses reaching 3 billion USD. Muhammadiyah is an Indonesian non-governmental organization (NGO) that has more than 300 hospitals. It is one of the forerunners in the Safe Hospital Initiative in Indonesia and has implemented a program named Hospital Preparedness and Community Readiness for Emergency and Disaster (HPCRED), which strengthened PKU Muhammadiyah hospitals in Bima (West Nusa Tenggara), the only hospital in Bima City, and in Palangkaraya (Central Borneo), funded by the Australian government.

HPCRED improved the hospital through implementing two trainings (Hospital Disaster Management and Disaster Medical Officer), three workshops (Disaster Risk Management Policy, Hospital Emergency Response Plan, and Forming Hospital Disaster Management Committee and Disaster Medical Team), four exercises (Medical Skill Drill, Table Top, Command Post, and Full Scale). The improvement was evaluated through Muhammadiyah Safe Hospital Standard and Assessment Tool, which assessed four standards based on WHO Comprehensive Safe Hospital Framework (2015): (1) Management, (2) Human Resource, (3) Structure and Infrastructure, and (4) Integration and Cooperation.

After two years of program, both hospitals improved significantly. The PKU Muhammadiyah Palangkaraya index improved from 53 to 331 while the PKU Muhammadiyah Bima Hospital index improved from 83 to 374.

Before the program, hospitals were not ready to face disasters. The PKU Muhammadiyah Bima Hospital collapsed during a flash flood in December 2016. PKU Muhammadiyah Palangkaraya was overwhelmed during a haze disaster that occurred in April 2016. After the program, the hospitals were safe and ready to face similar disasters. They also already had the ability to respond to disasters on other islands, such as the earthquake in Lombok and Palu (2018).

More and more hospitals are using the Hospital Incident Command System (HICS) for organizational management under emergency conditions. HICS is an incident management system based on principles of the Incident Command System (ICS), which assists hospitals and healthcare organizations in improving their emergency management planning, response, and recovery capabilities for unplanned and planned events. This study aims to explore how Chinese hospitals manage their organizations with HICS in Mass Casualty Incidents (MCI).

To explore the feasibility of HICS in Chinese hospitals under MCI.

A combination of literature analysis and empirical research was used in this study. Through case studies and experience summarization, the necessity and feasibility of the incident command system (ICS) and the emergency medical response system (EMRS) was demonstrated in the early stage of MCI. Based on this, a new "1 SECTION-5 GROUPS-10 TEAMS " model was proposed, and its value of practical application was discussed in MCI.

Multiple resources must be mobilized In MCI, and it is necessary to establish an ICS and an EMRS as soon as possible in the early stages of MCI. The earlier ICS is set up, the more initiative can be taken. The "1 SECTION-5 GROUPS-10 TEAMS" model proposed in this study has a good effect on the practice of drills and rescues, indicating that this model has a certain promotion effect in the hospital's response to MCI.

The "1 SECTION-5 GROUPS-10 TEAMS" model has high feasibility and can be further verified in the subsequent rescue practice.

One lesson learned from the 2015 Nepal earthquake was the need for a more coordinated effort between hospitals to improve disaster response. To improve the coordination, the concept of a hub and satellite system was introduced.

Describe the implementation of a hub and satellite system in the disaster management plan to improve coordination and communication between hospitals and the health system during a disaster.

A standard hospital disaster management plan was developed and validated with governmental and non-governmental agencies. Twenty-five hub hospitals within Nepal were identified. Smaller hospitals surrounding hub hospitals were identified as satellite hospitals. A plan was made to address communication and coordination between hub-satellite hospitals and ministry of health involving resource sharing, capacity analysis, and development of deployment teams in each hub. An output-based workshop was planned. Each hospital’s existing plans were evaluated before the workshop with a checklist containing essential components of disaster management. Each hospital was oriented and allowed to fill up a standardized template of a disaster management plan, after which their disaster management plan was reevaluated. The newly developed plan was then tested with a tabletop exercise function. The trainings were conducted from September 2017 to October 2018.

Disaster management plans were made in 110 hospitals, including nine hub hospitals and 101 satellite hospitals in three of seven provinces in Nepal. Evaluation of a pre-workshop score for the existing disaster plan was 18/32, and the score of the disaster plan post-workshop was 30/32 on average. The average score for hospitals for the tabletop exercise was 68.2% (53.8% to 84.6%).

A hub-satellite system-based disaster management plan has been developed and implemented in more than 100 hospitals in Nepal. Workshops for these hub and satellite hospitals improved their communication, coordination, and planning to improve disaster preparedness and future response.

Sendai Framework for Disaster Risk Reduction 2015-2030, for the first time, describes how disaster affects the health of people. Japan is prone to natural hazards, but at the same time, Japan has achieved one of the highest life expectancies (LE) in the world. After experiencing many disasters, Japan seems to have achieved resilience against disasters. Thus, we tested a hypothesis that high LE correlates with low disaster risk.

We compared LE from the World Health Organization's (WHO) Global Health Observatory and the Index for Risk Management’s (INFORM) disaster risk index, or World Risk Index (WRI), of each country using JMP software. INFORM risk index varies from 0-10, while WRI varies from 0-1, where a higher value means higher disaster risk in both systems. INFORM risk index considers hazard and exposure, vulnerability, lack of coping capacity, and lack of reliability. WRI considers exposure, susceptibility, lack of coping capacity, and lack of adaptive capacity, including logarithmized LE as a part of adaptive capacity.

The overall INFORM risk index was negatively correlated with LE (p<0:0001). Although natural hazard did not correlate with LE (p=0.7), the human hazard, vulnerability, and lack of coping capacity negatively correlated with LE (p<0.0001, respectively). Health-related indicators, which confirm the vulnerability and lack of coping capacity, were negatively correlated with LE. Cluster analysis of LE and INFORM risk of six categories resulted in four clusters of countries, suggesting that health development and disaster risk reduction are independent determinants. WRI also correlated with LE, but there are many outliers compared to the INFORM risk index.

High LE can be a good complementary indicator of low disaster risk. Strategies to achieve better health that contribute to high LE are also effective and important strategies for disaster risk reduction.

Mass casualty incidents, specifically incidents with chemical, biological, radiological, and nuclear agents (CBRN) or terrorist attacks, challenge medical coordination, rescue, and ambulance care. Recently in the Netherlands, a new model for emergency preparedness for large-scale mass casualties and a specific approach dealing with terrorist attacks was introduced (2016).

To provide insight into the first experiences with this approach in order to identify strengths and pitfalls.

The study had a qualitative design and was performed between January 2017 and June 2018. A semi-structured interview included topics that were selected based on available literature. All interviews were typed out verbatim and were analyzed using a structured approach of labeling and clustering of the response.

The main issues raised by the respondents included the following:

• The interpretation of definitions introduced in the new model for the mass casualty preparedness model and the terrorist attack approach differed among respondents.

• All respondents supported the six points of departure in the CRBN and terrorist attack approach.

• Awareness of optimal personal safety (‘safety first principle’) specific for CBRN and terrorism is lacking.

• Respondents reported that several rescue workers did not feel competent to perform specific newly introduced tasks, such as the command and control of the first ambulance arriving at the scene and the coordination task of emergency transport by the dispatch nurse.

• Current regional differences in preparedness may complicate interregional collaboration.

As the approach is new and experience is primarily based on the outcome of exercises, the systematic planning and evaluation of exercises, and sharing of opinions and knowledge, as a result, is important to ensure an unambiguous approach in a real situation.

Hospitals and the healthcare sector suffer from chronic work overload and personnel shortages in many nations. This poses strong incentives to rationalize all activities not directly related to care, such as the preparations for disasters and other hazards. One such rationalization is to turn from a rule-based to a risk-based approach. However, the risk landscape of hospitals and the relationship to the risk landscape of public authorities are ill-defined. Health Care Coalitions (HCCs) are in a good position to fill this gap and serve as an intermediary. We developed a scheme for defining the risk landscape of HCCs and its members and performed a prioritization process.

Objectives were to develop a knowledge platform of hospitals on risk assessment, promote integrated risk management by the HCC and its members, and determine the limiting (response) state for all relevant hazards.

We put maximum effort in limiting the time consumption for hospitals and align with the regular practices in hospitals for business continuity management. Strong points included the cooperation with the public authorities for safety and for health, a stepwise development of risk awareness and stepwise guidance for the assessment by hospitals, and formalization of the scenario-selection and choice of priorities by the HCC board.

A gross list of (>230) safety hazards was produced along with a netlist of (>80) hazards relevant to health care. In addition, an impact-scale for the continuity of care serving as a measurement stick for all health care sectors was developed. Risk diagrams were developed to present the results in a simple and clear format.

The HCC risk landscape served its purpose in improving the mutual understanding with the public authorities. The formal assessment provides a solid basis for operational planning, education, training, and future investments.

Hospitals are fundamental infrastructure, and when well-designed can provide a trusted place of refuge and a central point for health and wellbeing services in the aftermath of disasters. The ability of hospitals to continue functioning is dependent on location, the resilience of buildings, critical systems, equipment, supplies, and resources as well as people. Working towards ensuring that the local hospital is resilient is essential in any disaster management system and the level of hospital resilience can be used as an indicator in measuring community resilience. The most popular measure of hospital resilience is the World Health Organisation’s Hospital Safety Index (HSI) used in over 100 countries to assess and guide improvements to achieve structurally and functionally disaster resilient hospitals. Its purpose is to promote safe hospitals where services “remain accessible and functioning at maximum capacity, and with the same infrastructure, before, during and immediately after the impact of emergencies and disasters.” It identifies likely high impact hazards, vulnerabilities, and mitigation/improvement actions.

The HSI can be a valuable tool as part of the 2015-2030 Sendai Framework for Disaster Risk Reduction. However, to date, it has been used infrequently in developed countries. This project pilots the application of the HSI across seven facilities in a North Queensland health service (an area prone to cyclones and flooding), centered on a tertiary referral center, each providing 24-hour emergency health services.

Key indicators of resilience and the result of the audit will be discussed within geographical and cultural contexts, including the benefits of the HSI in augmenting existing hospital assessment and accreditation processes to identify vulnerabilities and mitigation strategies.

The research outcomes are to be used by the health service to improve infrastructure and provide anticipated community benefits, especially through the continuation of health services post disasters.

With the move into Gold Coast University Hospital, a new disaster plan was developed in 2017. To assess preparedness for the Commonwealth Games (April 2018), a number of mass casualty exercises were conducted, including a large multi-agency exercise with Queensland Police and Ambulance Services. During this preparation phase, senior clinicians from the perioperative area clarified their sub-plans and developed a novel model of periop response.

This study assesses this model of response and evaluates it within the context of periop disaster exercises.

The periop response model evolved through multi-disciplinary key stakeholder engagement into a defined model of surgical, anesthetic, and periop nursing responses with dedicated roles and parallel communication streams from ED to OR by the respective specialties. Throughout different disaster exercises, this model of response was tested, refined, and evaluated by formal post-exercise debriefs and group meetings.

Since May 2017, seven different mass casualty exercises with periop response were performed; firstly, a table-top (EmergoTrainSystem) format was used, which revealed communication and logistical deficiencies. After model refinement, further exercises were accomplished, all within the clinical environment, including movements of mock patients from ED to OR. These exercises generated improvements in communication, coordination, and logistics. Every exercise was also used to test more detailed information, communication, and organizational tasks of the various involved craft groups, such as notification, call-in lists, whiteboard structure, transport facilitation, and many more. Overall, our newly developed periop response model proved to be robust and successful, even with rotating personnel through different roles.

Apart from the success of the periop response model, other hospital areas (ICU, bed and ward management) became involved. With growing interest and staff turn-over a regular periop disaster response exercise program has now been established. This model of periop response has potential for use in other health systems.

World events continue to compel hospitals to have agile and scalable response arrangements for managing natural and instigated disasters. While many hospitals have disaster plans, few exercise these plans or test their staff under realistic scenarios.

This study explores changes in perceived preparedness of multidisciplinary hospital-wide teams to manage mass casualty incidents.

Two Emergo Train System (ETS) mass casualty exercises involving 80 and 86 “victims,” respectively, were run at two southeast Queensland hospitals: one large teaching hospital and one smaller regional hospital. Pre- and post-exercise surveys were administered, capturing participants’ confidence, skills, and process knowledge anonymously on 5-point Likert scales. A waiver of ethics review was obtained. Changes in individuals’ pre- and post-scores were analyzed using paired t-tests. Open-ended questions and a “hot debrief” occurring immediately post-exercise allowed for capture of improvement ideas.

Nearly 200 unique healthcare staff (n=193) participated in one exercise. At least one survey was returned by 159 staff (82.4%). Pre- and post- surveys were available for 89 staff; two-thirds (n=59) were nurses or doctors, and 46% overall were emergency department clinicians. Ninety-seven percent reported the exercise was valuable, also recommending additional simulations. Analysis of the 89 matched-pairs showed significant (p<.001) increases in self-confidence, skills, and knowledge (point increases on a five-point Likert scale (95% confidence intervals): 0.8 (0.6-0.9) for confidence and 0.4 (0.2-0.5) for both skills and knowledge. The exercise was critically appraised and a summary of operational learnings was developed. The most common criticism of ETS was its lack of real patients.

Involvement in simulated exercises (e.g. ETS) can increase confidence, knowledge, and skills of staff to manage disasters, with the biggest improvement in confidence. Whilst validating and testing plans, simulations can also uncover opportunities to improve processes and systems.

Emergency physicians play a frontline role in hospital disaster responses and require appropriate training.

The aim of the current study was to pilot and compare the effectiveness of two emergency preparedness teaching interventions: the first employing traditional lecture-based instruction (LEC) and the second utilizing interactive simulation/game-based teaching (SIM).

A two-group randomized pre- and post-test design was implemented into the didactic curriculum of the Emergency Medicine (EM) Residency Training Program at the San Lucas Episcopal Hospital in Ponce, Puerto Rico. Residents (n=23) completed either a LEC (control) or SIM teaching module (single day, one to two hours) focusing on emergency preparedness concepts, disaster-related clinical decision-making, and physician responsibilities during hospital disaster protocols. Knowledge-based multiple-choice exams and scenario-based competency exams were administered at three different time points: one-week pre-intervention, immediately post-training, and two-weeks post-training. Test scores were compared between groups at each time point using the Mann-Whitney U test.

Following the teaching interventions, no significant differences were found between the LEC group versus the SIM group in knowledge-based exam performance (LEC 81.1%[9.4] vs. SIM 74.9%[12.1]; U=42.50, p=0.15) and scenario-based exam performance (LEC 80.0%[9.7] vs. SIM 80.2%[9.2]; U=62.00, p=0.83), suggesting both teaching methods were similarly effective. Indeed, knowledge-based exam scores improved two-fold and scenario-based exam scores improved by over 50% immediately following training relative to baseline exam scores. Two-weeks post-training, a significant decrease in scenario-based exam performance was found in the LEC group relative to the SIM group (LEC 63.1%[11.6] vs. SIM 75.4%[11.5]; U=91.50, p=0.036), suggesting residents who train with simulations show greater retention of scenario-based concepts compared to those who train with lecture-based training alone.

The current study highlights the potential dual value of incorporating simulation training in EM emergency preparedness curriculums in improving both knowledge and concept retention of physician disaster responsibilities.

Disaster medicine has been identified as a fundamental discipline for health professionals. In Italy, the role of physicians during disaster response is officially recognized by the Italian Code of Medical Ethics and by the Ministry of Education. Nevertheless, few Italian medical schools include this discipline in their curricula.

With the aim of teaching basic knowledge of disaster medicine to Italian medical students, Research Center in Emergency and Disaster Medicine (CRIMEDIM) and Italian Medical Students’ Association (SISM) developed DisasterSISM, a nationwide training project in disaster medicine.

DisasterSISM consists of three courses: Basic, Advanced, and Train-of-Trainers (ToT). The Basic courses are managed by medical students who are trained during the one-week intense ToT. All courses are delivered using innovative training methodologies, such as e-learning, peer education, table-top exercises, and virtual reality simulations.

From 2012 to 2018, a total of 122 courses (111 Basic, 5 Advanced, and 6 ToT) have been delivered. DisasterSISM reached 37 out of 45 Italian medical schools, training more than 2,500 students. A survey conducted after the end of each course showed that participants considered the knowledge in Disaster Medicine essential for their future profession, regardless of the specialty chosen. Students also expressed their appreciation about the blended-learning approach, with a predilection for virtual reality simulations. The comparison between the entrance and the final exam scores showed a significant increase in knowledge.

In six years, DisasterSISM reached the majority of Italian medical schools, providing disaster medicine knowledge to hundreds of undergraduates. Considering the fast growth and diffusion of the project, the significant increase of knowledge, and the positive feedback received from participants, we suggest that the DisasterSISM model be implemented in other countries to widely disseminate information about prevention and disaster preparedness among medical students and health professionals.

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

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

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

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

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

Civil emergencies occurring with little warning can quickly produce mass casualties. To develop an Emergency Department’s surge capacity, medical student involvement in the disaster response has been advocated. Duke-NUS Medical School in Singapore is located in proximity to Singapore General Hospital (SGH) and represents an untapped manpower resource. With appropriate training, medical students can be leveraged upon as ready and reasonably qualified manpower.

This review provides a snapshot of the conceptualization and setting up of the Disaster Volunteer Corps (DVC) program. We discuss the overall strategy and benefits to stakeholders, emphasizing the close symbiotic relationship between academia and healthcare services.

Duke-NUS medical students will be recruited to receive training from SGH emergency physicians. The frequency of training will be four times yearly, with ad hoc participation in disaster simulation exercises. A call-tree will be employed for DVC activation. The DVC curriculum includes disaster response principles, HAZMAT, crowd control, marshaling, logistics, psychological support, and basic first aid. Teaching methods include didactic lectures, case discussions, involvement in event medical cover, and participation in disaster simulation exercises and response planning.

To date, there are 10 medical students and four emergency physician faculty volunteers involved in the program. Support is provided by adjunct instructors from nursing, nuclear medicine, social work, and security, for training in decontamination, radiological disasters, psychological first aid, and crowd control measures respectively. Assessment by faculty will be conducted to ensure the quality of training and competency of skills.

The DVC provides a unique way of teaching medical students disaster medicine principles in a hands-on experiential format, while simultaneously enhancing the operational readiness of the hospital in times of disaster. This model of close collaboration between university educational and healthcare services provides a feasible model of structured volunteerism that could be replicated in other similar settings.