The mass gathering event (MGE) industry is growing globally, including in countries such as Canada. MGEs have been associated with a greater prevalence of injury and illness when compared with daily life events, despite most participants having few comorbidities. As such, adequate health, safety, and emergency medical planning is required. However, there is no single entity regulating these concerns for MGEs, resulting in the responsibility for health planning lying with event organizers. This study aims to compare the legislative requirements for MGE medical response systems in the 13 provinces and territories of Canada.

This study is a cross-sectional descriptive analysis of Canadian legislation. Lists of publicly available legislative requirements were obtained by means of the emergency medical services directors and Health Ministries. Descriptive statistics were performed to compare legislation.

Of the 13 provinces and territories, 10 responded. For the missing 3, a law library review confirmed the absence of specific legislation. Most (n = 6; 60%) provinces and territories referred to provisions in their Public Health laws. Four confirmed that MGE medical response was a municipal or local concern to be addressed by the event organizers.

No provinces could list specific legislation guiding safety, health, and medical response for an MGE.

The aim of this work was to determine the impact of Moral Distress (MD) in emergency physicians, nurses, and emergency medical service staff at the Rand Memorial Hospital (RMH) in the Bahamas, and the impact of Hurricane Dorian and the COVID-19 pandemic on Moral Distress.

A cross-sectional study utilizing a 3-part survey, which collected sociodemographic information, Hurricane Dorian and COVID-19 experiences, as well as responses to a validated modified Moral Distress Scale (MDS).

Participants with 2 negatively impactful experiences from COVID-19 had statistically significantly increased MD compared to participants with only 1 negatively impactful experience (40.4 vs. 23.6, P = 0.014). Losing a loved one due to COVID-19 was associated with significantly decreased MD (B = - 0.42, 95% CI -19.70 to -0.88, P = 0.03). Losing a loved one due to Hurricane Dorian had a non-statistically significant trend towards higher MD scores (B = 0.34, 95% CI -1.23 to 28.75, P = 0.07).

The emergency medical staff at the RMH reported having mild - moderate MD. This is one of the first studies to look at the impact of concurrent disasters on MD in emergency medical providers in the Bahamas.

We developed the Shell Game Task (SGT) as a novel Performance Validity Test (PVT). While most PVTs use a forced-choice paradigm with “memory” as the primary domain being assessed, the SGT is a face-valid measure of attention and working memory. We explored the accuracy of the SGT to detect noncredible performance using a simulatordesign study.

Ninety-four university students were randomly assigned to either best effort (CON) (n=49) or simulating traumatic brain injury (TBI) (SIM) (n=45) conditions. Participants completed a full battery of neuropsychological tests to simulate an actual evaluation, including the Test of Memory Malingering (TOMM) and the SGT. The SGT involves three cups and a red ball shown on the screen. Participants watch as the ball is placed under one of the three cups. Cups are then shuffled. Participants are asked to track the cup that contains the ball and correctly identify its location. We created two difficulty levels (easy vs hard, 20 trials each) by changing the number of times the cups were shuffled. Participants were given feedback (correct vs incorrect) after each trial. At the conclusion of the study, participants were asked about adherence to study directions they were given.

Participants with missing data (CON=1; SIM=2) or who reported non-adherence to study directions (CON=2; SIM=1) were removed from analyses. Twenty-five percent in SIM and 0% in CON failed TOMM

Trial 2 (<45) suggesting adequate manipulation of groups. Groups were not different in age, gender, ethnicity, or education (all p’s>.05). There were 9 participants in each group with concussion/TBI history. TBI history was not significantly related to performance on the SGT in either group, although participants with TBI history tended to do better. Average performances on TOMM Trial 1 (36.62 vs 47.91, p<.001) and TOMM Trial 2 (37.50 vs 49.71, p<.001) were significantly lower in the SIM group. Performance on SGT was also significantly lower in the SIM group across SGT Total Correct (20.17 vs 24.65 of 40, p=.008), SGT Easy (10.60 vs 13.52 of 20, p=.002), and SGT Hard (9.57 vs 11.13 of 20, p=.068). Mixed ANOVA showed a trend towards significant group by SGT difficulty interaction (F(1,86)=3.41, p=.052, np2=.043). There was steeper decline in performance on SGT Hard compared to SGT Easy for CON. ROC analyses suggested adequate but not ideal sensitivity/specificity: scores <8 on SGT Easy (sensitivity=26%; false positive=11%), <7 on SGT Hard (sensitivity=26%; false positive=7%), and <15 on SGT Total (sensitivity=24%; false positive=9%).

These preliminary data indicate the SGT may be able to detect malingered TBI. However, additional development of this measure is necessary. Further refinement of difficulty level may improve sensitivity/specificity (e.g., CON mean performance for SGT Easy trails was 13.52, suggesting the items may be too difficult). This study was limited to an online administration due to COVID, which could have affected results; future studies should test inperson administration of the SGT. In addition, performance in clinical control groups (larger samples of individuals with mild TBI, ADHD) should be tested to better determine specificity for these preliminary cutoffs.

This study interprets data from NG situation reports (SITREPS) given to the National Guard Bureau (NGB) by each state national guard headquarters regarding their COVID-19 relief efforts from April to June 2020. This is the first published study about NG disaster relief utilizing quantitative data provided by the United States (US) military.

The SITREPS of all 50 states, the District of Columbia, Guam, Puerto Rico, and the US Virgin Islands for the dates of April 10, May 6, May 16, and June 3, 2020 were examined by two authors, to analyze the state NG activities.

During the COVID-19 pandemic, the NG primarily provided security, performed COVID-19 testing, ran COVID-19 shelters, provided food assistance, transported supplies, aided mortuaries, supported warehouses, and deployed medical personnel to hospitals. Numerical data about the services provided, such as quantity, was rare, but is included as available.

The United States National Guard provided assistance to their local citizens in multiple essential areas. This elucidation of the uses of the National Guard should be considered during future governmental disaster preparedness planning efforts and can be extrapolated to international military disaster relief.

Disease surveillance is an integral part of public health. These systems monitor disease trends and detect outbreaks, whereas they should be evaluated for efficacy. The United States Centres for Disease Control and Prevention publish Guidelines for Evaluating Surveillance Systems to encourage efficient and effective use of public health surveillance that are accepted worldwide.

This study reviews syndromic surveillance during natural and man-made disasters internationally. It aims to (1) review the performance of syndromic surveillance via pre-specified attributes during disaster and to (2) understand its strengths and limitations.

PubMed was systematically searched for the articles assessing syndromic surveillance during a disaster. A narrative review was carried out based on those articles. Updated Guidelines for Evaluating Public Health Surveillance Systems were used to review performance of systems.

5,059 studies from PubMed were evaluated, and 16 met inclusion criteria. The majority of these studies considered the implementation of syndromic surveillance useable during disaster events. Studies described systems giving relevant and timely information. Simplicity and timeliness were the most highlighted attributes.

Syndromic surveillance is simple, flexible, useful and usable during a disaster. Timely data can be obtained, but the quality of this type of data is sensitive to incomplete and erroneous reporting; because of this, a standardized approach is necessary to optimize these systems.

Since 1902, disasters in the Northern Triangle of Central America, which consists of the countries Guatemala, Honduras, and El Salvador, have caused over one-hundred-thousand deaths, affected millions of people, and caused tens of billions of dollars in damages. Understanding the nature and frequency of these events will allow stakeholders to decrease both the acute damages and the long-term deleterious consequences of disasters.

This study provides a descriptive analysis of all disasters recorded in the Emergency Events Database (EM-DAT) affecting Guatemala, Honduras, and El Salvador from 1902-2022.

Data were collected and analyzed from the EM-DAT, which categorizes disasters by frequency, severity, financial cost, distribution by country, burden of death, number of people affected, financial cost by country, and type of disasters most prevalent in each country. Results are presented as absolute numbers and as a percentage of the overall disaster burden. These trends are then graphed over the time period of the database.

The EM-DAT recorded 359 disasters in the Northern Triangle from 1902 through 2022. Meteorologic events (floods and storms) were the most common types of disaster (44%), followed by transport accidents (13%). Meteorologic events and earthquakes were the most severe, as measured by deaths (62%), people affected (60%), and financial cost (86%). Guatemala had the greatest number of disasters (45%), deaths (68%), and affected people (52%). The financial costs of the disasters were evenly distributed between the three countries.

Meteorologic disasters are the most common and most severe type of disaster in the Northern Triangle. Earthquakes and transport accidents are also common. As climate change causes more severe storms in the region, disasters are likely to increase in severity as well. Governments and aid organizations should develop disaster preparedness and mitigation strategies to lessen the catastrophic effects of future disasters. Missing data limit the conclusions of this study to general trends.

Health care provision depends on reliable critical infrastructure (CI) to power equipment and to provide water for medication and sanitation. Attacks on CI limiting such functions can have a profound and prolonged influence on delivery of care.

A retrospective analysis of the Global Terrorism Database (GTD) was performed of all attacks occurring from 1970-2020. Data were 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, and numbers killed and wounded.

The GTD listed 7,813 attacks on CI, with 6,280 of those attacks targeting utilities, leading to 1,917 persons directly killed and 1,377 persons 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), and the most attacks on telecommunications were in India (140). Peru (46) had the most attacks on its water supply.

The regions with the highest number of total attacks targeting CI have historically been in South America, with more attacks against power and utilities than other infrastructure. Although the numbers of persons directly killed and wounded in these attacks were lower than with other target types, the true impacts 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 (CTM) initiatives can be created to target-harden health care-related infrastructure.

Industrial disasters can have a myriad of repercussions ranging from deaths, injuries, and long-term adverse health impacts on nearby populations, to political fallout and environmental damage. This is a descriptive epidemiological analysis of industrial disasters occurring between 1995 and 2021 which may provide useful insight for health-care systems and disaster medicine specialists to better prevent and mitigate the effects of future industrial disasters.

Data were collected using a retrospective database search of the Emergency Events Database (EM-DATS) for all industrial disasters occurring between January 1, 1995, and December 31, 2021.

A total of 1054 industrial disasters were recorded from 1995 to 2021. Most of these disasters occurred in Asia (720; 68.3%), with 131 (12.4%) in Africa, 107 (10.2%) in Europe, 94 (8.9%) in the Americas, and 2 (0.2%) in Oceania. Half of these disasters were explosions (533; 50.6%), 147 (13.9%) were collapses, 143 (13.6%) were fires, 46 (4.4%) were chemical spills, 41 (3.9%) were gas leaks, and 34 (3.2%) were poisonings. There were 6 (0.6%) oil spills and 3 (0.3%) radiation events.

A total of 29,708 deaths and 57,605 injuries were recorded as a result of industrial disasters, and they remain a significant contributor to the health-care risks of both workers and regional communities. The need for specialized emergency response training, the potential devastation of an industrial accident, and the vulnerability of critical infrastructure as terror targets highlight the need to better understand the potential immediate and long-term consequences of such events and to improve health-care responses in the future.

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.

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.

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).

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 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.

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.

Data collection and analysis planned for completion by January 2023.

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 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.

The COVID-19 pandemic provided a unique opportunity for the United States National Guard (NG) to assist in an infectious disease disaster. This study aims to interpret data from NG situation reports (SITREPS) given to the National Guard Bureau (NGB) by each state national guard headquarters regarding their relief efforts from April to June 2020. This is the first published study about NG disaster relief utilizing quantitative data provided by the US military.

The SITREPS of all 50 states, the District of Columbia, Guam, Puerto Rico, and the US Virgin Islands are available for the dates of April 10, May 6, May 16, and June 3, 2020 through a NG website that requires government level access. These were examined to evaluate and analyze the activities directed by each state NG headquarters as part of COVID-19 response efforts. No other dates were available for analysis.

During the COVID-19 pandemic, the NG primarily provided security, tested for COVID-19, ran COVID-19 shelters, assisted foodbanks, delivered meals, provided transportation services, aided mortuaries, supported protective equipment warehouses, and deployed medical personnel to cover hospital shortages. They provided services to children, homeless persons, residents of skilled nursing facilities, and Native Americans living on tribal lands. Service members (SM) sewed masks, provided translation services, and cooked in prison kitchens. All state NGs participated in COVID-19 relief to varying degrees. Numerical data about the services provided such as quantity was rare but is included as available.

The United States National Guard provided a wide variety of services through activation of its service men and women that impacted COVID-19 response throughout all states and territories. This elucidation of the uses of the National Guard should be considered during future governmental disaster preparedness planning efforts, and can be extrapolated to international military disaster relief.

The COVID-19 pandemic created a public health crisis worldwide. Mass vaccination efforts in some cases were initiated without adequate civilian manpower due to critical medical staffing shortages. The governments of many nations deployed their military assets to fill gaps in care and to initiate projects to promote vaccinations. The COVID-19 pandemic created a unique international military vaccination response to an infectious disease disaster.

This literature review highlights creative solutions, abilities utilized, projects completed, overall effectiveness, and lessons learned by the military community worldwide to support their vaccination efforts within their countries. 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.

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, military, COVID-19, vaccination, vaccine. Titles were initially screened for relevance. 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.

Data collection and analysis planned for completion by January 2023.

The COVID-19 pandemic created a public health need for mass vaccination distribution that was assisted by militaries throughout the world. This literature search demonstrates the ways in which military resources contributed to COVID-19 vaccination efforts, including creative techniques, successes and opportunities for future improvement.

Mass gatherings have become more frequent since the beginning of the 21st century. In Canada alone, music festival and sporting event industries will each represent yearly revenues over one billion USD by 2025. Such events require adequate medical planning, as they are associated with a greater prevalence of injuries and incidents than daily life, despite most participants having few comorbidities. Most often, the responsibility of medical planning lies with event producers. This study aims to compare the existing legislative requirements for mass gathering medical response in the ten provinces and three territories of Canada.

This study is a cross-sectional descriptive study of legislation. Lists of legislative requirements were obtained by contacting via email or phone the emergency medical services (EMS) directors and Health Ministries of all the provinces and territories of Canada, and asking about any legislation or provision within existing laws regarding mass gatherings. Simple statistics were performed to compare legislation across provinces and territories.

Data collection and analysis are planned to be completed by December 31, 2022. Initial data collection and analysis revealed that none of the seven provinces who answered our emails have provincial legislations. Two referred to specific provisions in the Public Health laws of their province, though nothing specifically refers to mass gatherings. One confirmed that mass gathering medical response was a municipal/local concern to be addressed by the event producers and the locality where the event takes place, and one referred to guidelines published in 2014.

Although some provinces and territories referred to provisions contained in public health legislation, none of the provinces reached to date could list specific legislation on mass gathering medical response. If this trend continues through full data analysis, it will highlight once more the need to provide more standardized guidance to organizers and municipalities in planning medical response.

Chemical exposures can cause direct and indirect injuries to responding medical personnel. Therefore, hospital healthcare providers should be provided with disaster response training that includes identification of chemical hazards, establishment of the hazard zone, personal protective equipment use, decontamination, and chemical injury antidote use. This study evaluates the educational effectiveness of the chemical-mass casualty incident response education module (C-MCIREM) for hospital healthcare providers.

This was a retrospective quasi-experimental study. Subjects were hospital providers who enrolled in the C-MCIREM program between May 1, 2021, and July 26, 2022. Subjects were hospital providers from Bucheon, Mokpo, Iksan, Jeonju, and Dae-gu cities in South Korea. Subjects completed pre, post, and three-month knowledge retention and self-assessments of readiness tests, as well as evaluations on tabletop exercises (TTX), and a satisfaction survey (11-point Likert) after the course. The instructors scored teamwork measures via standardized evaluations on TTX throughout the course. The K-paired Sample Friedman test was used to compare samples.

127 respondents were enrolled. The median knowledge score rose from 51/100 (39, 66) to 85.5/100 (73.75, 90) with a median retention score of 74/100 (64, 88) (p<0.001). Participants felt their readiness to respond increased in all facets (all p<0.001) on the post and retention test for the MCI situation. All three hospital teams showed significant increases in teamwork between the median of the 1st and 4th TTX as 27/100 (23.5, 29) and 69/100 (66.75, 69.5) (p<0.05). Participants were overall satisfied (9.1/10 SD 1.13) and would recommend the training to others (9.15/10 SD 1.2).

C-MCIREM participants had high satisfaction with a significant increase and persistence in knowledge, improved teamwork, and self-assessed readiness to respond to a chemical mass casualty incident.

Industrial disasters can have a myriad of repercussions ranging from acute deaths, injuries, and long-term adverse health impacts on nearby populations to political fallout and environmental damage. This is a descriptive epidemiological analysis of industrial disasters occurring between 1995 and 2021 which may provide useful insight for health care systems and disaster medicine specialists to better prevent and mitigate the effects of future industrial disasters.

Data was collected using a retrospective database search of the Emergency Events Database (EM-DATS) for all industrial disasters occurring between January 1, 1995, and December 31, 2021.

1,054 industrial disasters were recorded from 1995 to 2021. The majority of these disasters occurred in Asia (720, 68.3%), with 131 (12.4%) in Africa, 107 (10.2%) in Europe, 94 (8.9%) in the Americas, and 2 (0.2%) in Oceania. Half of these disasters were explosions (533, 50.6%), 147 (13.9%) were collapses, 143 (13.6%) were fires, 46 (4.4%) were chemical spills, 41 (3.9%) were gas leaks, and 34 (3.2%) were poisonings. There were 6 (0.6%) oil spills and 3 (0.3%) radiation events.

A total of 29,708 deaths and 57,605 injuries were recorded as a result of industrial disasters and they remain a significant contributor to the healthcare risks of both workers and regional communities. The need for specialized emergency response training, the potential devastation of an industrial accident, and the vulnerability of critical infrastructure as terror targets highlight the need to better understand the potential immediate and long-term consequences of such events and to improve healthcare responses in the future.

Global disasters have increased over the last century, with growing numbers of people affected. In the Middle East and North Africa, natural disasters have tripled since the 1980s. Education and training for disaster preparedness for healthcare providers can help reduce vulnerability to disasters by improving their knowledge and response effectiveness. Physicians working in the emergency department are integral members of the response to those incidents. Currently, no studies describe how much training or experience in disaster preparedness exists for physicians working in the emergency departments in Kuwait. However, comparable studies in different regions have illustrated the importance of researching this field. This paper aims to assess the disaster preparedness levels of emergency department physicians in Kuwait.

An online survey will be sent to the physicians working in the emergency departments of the seven general hospitals in Kuwait. This survey consists of four domains:

1. 1) Demographics: personal and professional characteristics of participants.

2. 2) Education and training: exploring the involvement of participants in prior formal training courses or exercises in disaster preparedness.

3. 3) Experience: assessing the involvement of participants in the mitigation or response to previous disasters.

4. 4) Knowledge and perception: participant awareness of local hospital plans and systems as well as their attitudes and opinions about disaster preparedness.

Data collection and analysis are planned for completion by March 31, 2023.

The needs assessment is essential to developing educational curriculums for any discipline. In disaster medicine, tailoring the training curriculum is especially important because learners might not have experience in the field due to the high acuity and low frequency of disasters. The results can be used to develop a roadmap for Emergency Physician training in disaster preparedness in Kuwait. In addition, the approach adopted in this paper can be used to assess further disciplines for disaster preparedness.

International humanitarian aid is crucial in disasters but must be needs-driven and coordinated with requests from local authorities. We identify disaster and population factors associated with international aid appeal during disasters and hence guide preparation by international humanitarian aid providers.

In this retrospective database analysis, we searched the Emergency Events Database for all disasters from 1995 to 2015. Disasters with and without international aid appeals were compared by location, duration, type of disaster, deaths, number of people affected, and total estimated damage. Logistic regression was used to examine the association of each factor with international aid appeal.

Of 13,961 disasters recorded from 1995 to 2015, 168 (1.2%) involved international aid appeals. Aid appeals were more likely to be triggered by disasters which killed more people (OR 1.29 [95% confidence interval (CI) 1.02-1.64] log10 persons), affected more people (OR 1.85 [95%CI 1.57-2.18] / log10 persons), and occurred in Africa (OR 1.67 [95%CI 1.06-2.62). Earthquakes (OR 4.07 [95%CI 2.16-7.67]), volcanic activity (OR 6.23 [95%CI 2.50-15.53]), and insect infestations (OR 12.14 [95%CI 3.05-48.35]) were more likely to trigger international aid appeals. International aid appeals were less likely to be triggered by disasters which occurred in Asia (OR 0.46 [95%CI 0.29-0.73]) and which were transport accidents (OR 0.12 [95%CI 0.02-0.89]).

International aid appeal during disasters was associated with greater magnitude of damage, disasters in Africa, and specific types of disasters such as earthquakes, volcanic activity, and insect infestations. Humanitarian aid providers can focus preparation on these identified factors.

Since 1900, disasters in the Northern Triangle of Central America—Guatemala, Honduras, and El Salvador—have caused over one-hundred-thousand deaths, affected millions of people, and caused billions of dollars of damages. As climate change causes increasingly frequent severe weather events, the catastrophic effects of disasters are likely to contribute to poverty and political and economic instability in the region leading to greater levels of migration out of the Northern Triangle.

This study provides a descriptive analysis of all disasters recorded in the EM-DAT database affecting Guatemala, Honduras, and El Salvador between 1900-2022. Disasters are analyzed by frequency, severity, financial cost, distribution by country, burden of death, affected and financial cost by country, and type of disasters most prevalent in each country. These trends are then graphed over the time period of the database.

EM-DAT records 359 disasters in the Northern Triangle between 1900 and 2022. Meteorologic events (floods and storms) were the most common types of disaster (44%), followed by transport accidents (13%). Meteorologic events and earthquakes were the most severe, as measured by deaths (62% of total deaths caused by disasters), people affected (60%), and financial cost (86%). Guatemala had the greatest number of disasters (45%), deaths (68%), and affected people (52%). The financial costs of the disasters were evenly distributed between the three countries.

Meteorologic disasters are the most common and most severe type of disaster in the Northern Triangle. Earthquakes and transport accidents are also common. As climate change causes more severe storms in the region, disasters are likely to increase in severity as well. Governments and aid organizations should develop disaster preparedness and mitigation strategies to lessen the catastrophic effects of these coming disasters. Missing data in the EM-DAT dataset limits the conclusions of this study to general trends