During armed conflicts and other situations of violence, EMTs are deployed to respond to the needs of the affected population. It is when fighting breaks out that healthcare services are most needed, but it is also when they are most exposed to violence and insecurity. Current evidence indicates that health personnel, health infrastructure and patients have been the target of different types of attacks.

A new report published on 24 of May 2022 by the Safeguarding Health in Conflict Coalition identified there were 1,335 incidents of violence or obstruction against health care perpetrated in 2021: 161 health workers killed; 320 injured; 170 kidnapped; 713 arrested. Health facilities were destroyed or damaged in 188 incidents, 111 health transports destroyed or damaged and 64 health transports stolen or hijacked.

In a nutshell, health facilities and health workers were subjected to devastating and widespread violence and obstruction of care in 49 conflict-affected countries in 2021.

This presentation analyzes the current challenges, describes the method used consisting of a scoping review of the available evidence in addition to semi-structured feedback from key stakeholders working in unsecured environments, and supports the identification of skills and competencies that EMT members need before deployment. This presentation will also propose the definition of skills and competencies for EMT members needed before deployment to unsecured environments.

Recommendations for future action focus on International norms and standards, a competencies framework, evidence and data, and state-of-the-art competencies to address safety and security during deployment needed for a capability-building framework.

How to optimize EMTs' response in unsecured environments requires designing training and learning pathways that improve skills and knowledge on safety and security for EMT members before their deployment to prevent and mitigate violence against health care during deployment in unsecured environments.

Educational initiatives such as Stop the Bleed continue to educate medical laypeople in first aid for massive bleedings. The effect of including realistic blood early in Stop the Bleed-type training remains unknown. The aim of this study was to investigate the effects of including realistic blood early in a Stop the Bleed-type training on medical laypeople's intent to provide future aid and self-perceived ability to provide aid.

In total, 46 medical laypeople participated in this study. Two bleeding control tasks, wound packing and tourniquet application, were performed in a simulated scenario on a manikin with a wound. Participants received brief Stop the Bleed-type training and were divided into two groups: with (Blood) or without (Control) blood present during the tasks. After the experiment, two surveys were administered, one on confidence in their ability to perform each task, and a previously established survey on their intent to aid a bleeding victim in real-life situations.

The post-trial survey showed that the participants in the Blood group had lower confidence than the Control group in their wound packing ability (MBlood = 2.09, SDBlood = 0.85; MControl = 3.04, SDControl = 0.86), t(43) = 3.725, p < .001, but not regarding their tourniquet application ability, t(43) = 0.019, p = 0.985. Further, there was no difference between the groups in their intent to aid in future real accidents (MBlood = 91.00, SDBlood = 6.10: MControl = 90.39, SDControl = 8.30), t(43) = 0.282, p = .782.

This study shows that introducing realistic blood early in Stop the bleed-type training of laypeople results in decreased confidence in their wound packing ability. However, it does not decrease their intent to aid in future emergencies. Future studies should investigate when and how complicating factors such as blood should be introduced in laypeople hemorrhage control training.

Located in a disaster-prone country, more than 3000 hospitals in Indonesia must have a Hospital Disaster Plan (HDP). Instead of pursuing only the hospital accreditation requirements, HDP should be beyond that. Since 2008, CHPM UGM has been providing various HDP training. However, during the COVID-19 pandemic, there was a change in offline assistance that shifts to online. This study reports the learning activities, output, and challenges.

There were three batches of HDP-paid online courses in 2021. Each batch consists of three series courses. The first series was a basic HDP seminar. The second series was for intensive HDP mentoring for two months. In the second series, the participants focused on analyzing risk and hospital safety index (HSI), detailing job action sheets, and detailing disaster standard operating procedures. Moreover, the third series in the fourth month was an online tabletop exercise (TTX).

25 hospitals and 112 people participated. However, only five hospitals that committed finalized the HDP document. The learning process challenges were the participant’s unstable network and their focus on who was on duty while attending the courses. Although the TTX online was a new trial, it worked to asses hospital preparedness for disaster management through well preparation, detailed scenario and proper evaluation instrument. However, it was still difficult to assist participants in completing the HDP documents online, because observation of the hospital environment cannot be carried out while the evidence provided by participants were limited, for example supporting evidence for the HSI indicators.

The online series of HDP is feasible because it saves accommodation and transportation costs. However, the intensive online mentoring should be carried out longer to allow participants to do assignments and collect evidence of indicators that must be shown to the facilitators.

Cold exposure generally has a negative effect on tasks that rely on finger dexterity. It is not known if cold exposure will affect medical laypeople’s ability to perform first aid for life-threatening bleedings, specifically tourniquet application. This study investigates the effect of cold exposure on medical laypeople’s tourniquet application ability.

Twenty-nine adult medical laypersons received brief tourniquet application training and then completed a tourniquet application test in a baseline condition and three partial cold immersion conditions where their hands were immersed in nearly 0°C water. The three cold immersion conditions were 16°C, 12°C, and 8°C hand-skin temperature. Tourniquet application quality was measured using a procedural checklist. Time until bleeding control was also measured.

The results show that cold exposure significantly increases the time to bleeding control, F(3, 84) = 5.42, p < .01, η2 = .05. Planned contrasts revealed a significant increase in time between baseline and 8°C hand-skin temperature (M baseline = 65.5s, SD = 17.0; M 8°C = 76.9s, SD = 19.6), t(28) = 3.77, p < .01, r = 0.38. No effect was found on the procedural application quality, F(3, 84) = 2.21, p = .09.

Cold exposure can decrease the chance of survival for the injured person when a medical layperson provides first aid for life-threatening bleedings due to increased application time. The results can also be used when educating medical laypeople in first aid for life-threatening bleedings as it provides evidence of specific effects from a stressor that is common in regions with cold climate. Future research should be aimed at exploring possible mitigation strategies such as tourniquet design or rewarming procedures and investigating if a similar effect exists for prehospital professionals.

Knowledge management on Disaster Health Management (DHM) is one of the priority areas in the Plan of Action to implement the ASEAN Leaders’ Declaration on DHM (POA/ ALD DHM) (2019-2025). The Japan International Cooperation Agency (JICA) has been implementing the Project for Strengthening the ASEAN Regional Capacity on Disaster Health Management (ARCH Project) since 2016 to assist the ASEAN region in strengthening coordination capacity on DHM. A regional training course on DHM for ASEAN member states (AMS) in Japan was proposed to be implemented in 2022 as a JICA’s Knowledge Co-creation Program (KCCP).

The training curriculum of the KCCP included emergency and disaster medicine in Japan, international trends on DHM, and underwent reviews by AMS representatives of the ARCH Project. Prior to the training, participants were required to prepare country reports (CRs) outlining information on legislation, system and structure related to emergency and disaster medicine, as well as systems to receive international emergency medical teams (I-EMTs).

The four-week KCCP course contained a trial implementation of a four-day training program for receiving I-EMTs and coordination among stakeholders in ASEAN disaster response, based on the regional standard curriculum developed by the ARCH Project, and invited experts in DHM not only from Japan but also from AMS as instructors. Participants analyzed and identified challenges on DHM in their countries, and developed draft action plans (APs) to improve the situation through the knowledge obtained from the program.

The draft APs, the training deliverables, will be shared with the ARCH Project, and used to build a support mechanism to achieve national level targets of the POA/ ALD DHM, and the progress will be reflected in the CR in the subsequent year. The KCCP on DHM is expected to facilitate knowledge sharing in AMS and Japan, and contribute to fostering the culture of mutual learning.

The occurrence of disasters and mass casualty incidents (MCIs) is on the rise, thus training and rehearsal for disaster response remain paramount. Virtual reality (VR) platforms have previously been shown to be well-received, engaging, and immersive for disaster training. The primary objective of this study was to ascertain if a human actor-based VR MCI scenario could elicit a sympathetic response, as measured by heart rate variability (HRV), in medical doctors and trainees compared to a baseline state.

A simulation was filmed with students, residents, and surgeons on a GoPro 360 camera. Subjects (n=35) were recruited to sufficiently power (1-b=0.8) a Wilcoxon matched-pairs test and Welch’s t-test. Subjects watched the simulation on an Oculus Quest headset while having HRV recorded. Multivariate logistic regression was performed to identify factors associated with increased odds of significant sympathetic activation. Statistical significance was established at p<0.05.

Thirty-five subjects were enrolled and included three trauma surgeons, three emergency medicine (EM) attendings, eight EM residents, six surgery residents, and 15 medical students. A significant decrease in HRV was observed across all groups in the MCI (median 20 ms IQR 16.2, 31.4 ms) compared to baseline (33.2 ms IQR 27.2, 44.1 ms; p<0.0001). Sympathetic activation was most pronounced in students, then attendings, then residents. There was no significant difference in the fold-difference of sympathetic activation of EM physicians (-48.5% +/- 32.1%) versus surgeons (-49.5% +/- 25.2%; p=0.57). In all groups, SNS activation occurred independently of heart rate, age, sex, number of years in practice, first responder experience, or prior MCI response.

Live-actor VR MCI simulation elicited a strong sympathetic response from students, residents, and attending physicians. By recruiting and disinhibiting essential neural pathways via controlled SNS activation, VR MCI training has the potential to enhance the encoding and consolidation of disaster training in a low-cost and reproducible manner.

In Tohoku, the northeastern part of the main island of Japan, students entered medical school following the Great East Japan earthquake that occurred on March 11, 2011. Such students wished to volunteer at the time of disaster, however, the undergraduate medical curriculum was inadequate to enable the practice of disaster medicine. Thus, the Tohoku Disaster Medical Assistance Student (DMAS) holds workshops for undergraduate students to acquire disaster medicine knowledge.

Tohoku DMAS offers Peer Learning Education. In the DMAS course, students learned disaster medicine through lectures and simulations under the supervision of disaster medicine experts. The workshops vary in length between 3–8 hours. Tohoku DMAS’s goal is to support disaster management headquarters and shelters. Students are expected to provide logistical support that includes recounting the chronology of events at disaster management headquarters and helping with managing evacuation shelters.

According to the activity reports and roster of the course, there were only three students initially when the course was formed in 2018, however, the group continued to grow, and 165 students currently belong to the Tohoku DMAS. Those students include medical students, nursing students, and paramedics students at various universities and colleges. The DMAS has held 30 training sessions since 2018. The total number of training participants was 1,308. The DMAS has held tabletop simulation exercises and lectures on various topics such as shelter management, disaster triage, and nuclear disasters. Furthermore, some members have participated in emergency drills for each prefecture. The current challenge of the program was obtaining adequate insurance coverage for students and financial support during the activity at the disaster scene.

The DMAS plays a role in disaster medicine education for undergraduate medical students in the Tohoku region. The program continues to grow and faces opportunities and challenges.

As disasters increase globally in both frequency and intensity, the vulnerability of children during disasters has become obvious. Pediatricians are often left to manage the resulting physical and mental repercussions. With minimal to no disaster medicine training offered at most U.S. pediatric residencies, the need for an easily accessible pediatric disaster medicine curriculum has been exacerbated. While this need has been highlighted in the literature, material to include or methods to sustainably incorporate disaster medicine into training programs has not been established.

From a thorough literature review, 19 topics were selected as potentially necessary to include in a disaster medicine curriculum for pediatric residents. Utilizing the Delphi method, subject matter experts were asked to rank these topics with an option to add others. Two independent surveys separated by time were administered with the goal of identifying ten critical core concepts for pediatric resident disaster medicine education. A virtual roundtable discussion then took place to finalize the ten core concepts, discuss objectives, and consider realistic methods of incorporating the curriculum into the residency timeline.

The ten core concepts identified were 1) introduction to disaster medicine, 2) patient triage, 3) surge capability, 4) mental health effects of a disaster, 5) preparedness for children with special healthcare needs, 6) communicating personal/family disaster preparedness, 7) hospital disaster mitigation, 8) reunification, 9) drills and training, and 10) disaster ethics and crisis standards of care.

Experts agreed upon a longitudinal multi-modal approach with inclusion of short didactics, case scenarios, questions/answers, games, and links to further educational activities and opportunities focused on individualized needs.

The Delphi method was a successful approach to gathering expert consensus to establish core concepts for a pediatric resident disaster medicine curriculum.

Road traffic injuries (RTIs) are the largest individual contributor to the global burden of injury and were among the five leading causes of global disability-adjusted life years (DALYs) in 2016. In regions with limited emergency medical services, training lay first responders (LFRs) has been shown to increase availability of prehospital care for RTIs, but sustainable mechanisms to scale these programs remain unstudied.

Using a training of trainers (TOT) model, a six-hour LFR training program was launched in Lagos, Nigeria. The course was taught in a hybrid fashion with primary didactics over Zoom and practical in-person breakout sessions. Thirty TOTs proceeded to train 350 transportation providers as LFRs over one month. A previously validated, 23 question, pre-/post- assessment was administered digitally to assess knowledge acquisition. Participants responded to five-point Likert survey assessing instruction quality and post-course confidence.

TOTs scored a median of 56.5% (IQR: 43.5%, 71.7%) and 91.3% (IQR: 88.0%, 95.7%) on the pre- and post-assessments, respectively, with bleeding control scores increasing most (+69.4%). Course trainees scored a median of 34.8% (IQR: 26.0%, 43.5%) and 73.9% (IQR: 65.2%, 82.6%) on the pre- and post-assessments, respectively, with airway and breathing increasing most (+48.6%). All score increases were statistically significant with p<0.001 and did not differ by trainer. Participants rated confidence 5/5 (IQR: 5,5) in first aid skills and 5/5 (IQR: 4,5) in emergency transportation, increasing from pre-course confidences of 3/5 (IQR: 3,4) and 4/5 (IQR: 3,5), respectively (p<0.001). Participants rated the quality of education content and TOT instructors to be 5/5 (IQR:5,5).

This is the first time the efficacy of digital instruction for first responder trainers in LMICs has been investigated and demonstrates knowledge acquisition equivalent to that of prior in-person courses. Future work will examine the cost-effectiveness of the training of LFRs and the effect of LFRs on trauma outcomes.

The use of simulation games in education has been rising in recent years. Triage is not only a major content among the EMS (emergency medical services) but also a necessary skill for students to improve their first-aid ability. This study aims to investigate a game for education called MASS (movement, assessment, sort, and sending), which attempts to enhance students’ capability of disaster response.

A randomized controlled trial was conducted among students who took the course: “Understanding Disaster and Surviving Risk” during the term and volunteered to participate in teaching research from different faculties in Sichuan University. Participants were trained by using the simulation game or the online course before class. The simulation game is MASS, which uses virtual reality techniques to create a realistic 3D tanker explosion scene, and the online course is a Massive Open Online Course created by the teaching team. In the class, questionnaires with subjective and objective multiple choices were carried out after a discussion. With SPSS version 27.0, statistical significance among groups was determined by Mann-Whitney U-test for rank variables, Fisher’s exact test for binary variables.

73 students were included in this study, including 45 in the online course group and 28 in the simulation game group. The qualitative experience survey showed the two groups were significantly different in experience of disaster scene challenges, application scenes, and method of triage (P=0.031, 0.007, 0.031, respectively). Students in the simulation game group showed significantly better performance in knowledge acquisition including application scene of triage, key of the expectant’s assessment, and rescue condition for thoracentesis than in the Online game group (P=0.048, 0.020, 0.010, respectively).

Simulation games can improve students’ experience and performance in triage training. Due to the unrepeatability of disaster, the study suggests that games can be used to conduct simulation education for disaster medicine.

Blended learning has been proven to support the teaching of various concepts across disciplines. This study aims to investigate the impact of the traditional blended teaching mode (self-study online and face-to-face consultation) on the undergraduate’s learning of disaster skills, and compared with face-to-face consultation, explore the influence of new mode (tutoring manipulation online) on the acquisition and forgetting of knowledge in disaster medicine based on the blended learning.

A prospective cohort study method was used. The two semesters in a school year adopted different blended teaching models for 8 weeks. In the first term, students conducted disaster theoretical knowledge before class through an Online Course created by our team. In class, teachers guided training about response and preparedness (face-to-face consultation). Due to the outbreak of Covid-19, a new training model was adopted (tutoring manipulation online) in the second term. Three knowledge tests were conducted before class, after class, and six months after the end of the term. An accuracy rate difference was defined between the second and first as correct improvement rate (CIR), and the difference between the second and third as forgetting rate (FR).

Seventy-five students were included in the traditional group, and 64 students were included in the new group. The three results in traditional group were (0.38±0.11) %, (0.65±0.11) %, (0.56±0.13) %,and (0.49±0.15) %, (0.71±0.13) %, (0.60±0.12) % in new group. The mean scores after 6 months on both groups were lower than at the end of the term (Ptraditional <0.001, Pnew =0.010). The new group had a higher accuracy rate on all tests than the traditional group (P <0.01).

Traditional blended learning models can improve students’ performance in disaster training and deepen knowledge memory. The new blended model may replace the traditional model for disaster training during the Covid-19 pandemic.

The New South Wales (NSW) Biocontainment Centre (NBC) is the first high-level isolation unit in Australia. This state-wide referral facility, located at Westmead Hospital, Sydney, will provide care for patients with high-consequence infectious diseases (HCIDs), including viral hemorrhagic fevers (VHF). In preparation, a tabletop exercise with key stakeholders was held to introduce and socialize the NBC’s capacity to support NSW’s preparedness for the management of a patient with HCID.

Invitations were provided to key stakeholders within Westmead Hospital (facility executive, emergency and ICU services, security, switchboard); NSW Preparedness and Response Branch; retrieval services; peripheral hospitals; pediatric hospital network; and NSW Public health units (state and district).

The scenario presented was an unwell patient with suspected VHF arriving at a peripheral hospital emergency department.

Discussion during the four-hour long exercise was facilitated with directed questions and injects, and was recorded. Recommendations and key learnings from the exercise and debrief provided opportunities to enhance current response assumptions.

Forty-five people participated both face-to-face and virtually. Participant discussion showed increasing appreciation of patient presentations to any part of the NSW health system and available assistance. Recommendations included: enhanced access to NBC support with a direct “1-800 number”, coordination for communication, treatment, and transport, and if required, deployment of an NBC team to peripheral sites. Areas for future collaborative work were identified.

This exercise successfully achieved collaboration of key stakeholders to develop an updated, comprehensive and robust plan for management of HCID patients within NSW, regardless of their presentation site. It has created an opportunity to brainstorm and optimize how the NBC can interact with other agencies to maximize the NSW HCID response.

Australian Standard 4080-2010 Planning for Emergencies in Health Care Facilities outlines the requirements for all health care facilities to have procedures in place to respond to internal and external emergencies. These procedures must include mechanisms to activate emergency response systems, and staff should be trained and familiar with these procedures.

To guide staff, Emergency Procedures Flip Charts have been developed and strategically placed throughout facilities. These Flip Charts address immediate actions for staff to follow, including notification and escalation via an internal emergency number.

Specific training has been developed for identified key staff, such as Fire Wardens, but for the general staff the training in Emergency Codes is generic and does not provide scope for staff to contextualize response actions in relation to their department and its nuances.

A survey of staff across all disciplines was conducted which identified knowledge gaps in the immediate response requirements for the different Emergency Codes. To address this knowledge gap, and to ensure staff have an increased understanding of the response expectations relevant to their department, the Six Minute Intensive Training (SMIT) Tools have been developed. These tools can be delivered by any staff member in any forum, such as safety huddles, handover, in-services and toolbox talks.

A survey was conducted three months after their implementation which identified an increased understanding of response requirements. This result, combined with After Action Reviews from actual responses, highlighted an increased knowledge of the Emergency Codes and response actions. It also identified areas to improve delivery using localized examples.

The introduction of the SMITs is a successful first step for increasing staff knowledge and responses to Emergency Codes. The opportunity for staff to deliver these SMITs within their own departments provided an avenue to contextualize responses to local practices and nuances.