Both prevention and preparedness are essential to avoid casualties and deaths in mass gathering disasters (MGDs). What countermeasures should be taken?

Retrospective analysis of a MGD at Akashi City Fireworks Festival in 2001; discussion of countermeasures at Kobe Luminarie, an annual light festival to commemorate the Great Hanshin Earthquake. Retrospective analysis of mass casualty incidents (MCIs) between 2003 and 2022 in which the alert function of EMISHP (Emergency Medical Information System in Hyogo Prefecture) was activated. Duration from emergency call to activation of alert function (activation time), number of casualties, and number of destination hospitals were evaluated.

More than 200 persons were injured and eleven people died in the Akashi Fireworks crowd crush. The main cause of this MGD was lack of gateway control and one-way flow control of visitors. With such measures in place, no MGD has occurred at Kobe Luminarie. In the past nineteen years in Hyogo, the alert function has been activated for 288 MCIs, such as vehicle accidents and fires. Activation time ranged from 1 to 73 minutes (median value=12). The casualty count ranged from 0 to 662 (median value=5). The number of destination hospitals ranged from 0 to 54 (median value=2). In all cases, emergency medical coordinators at Hyogo Emergency Medical Center, a principal hub hospital for disasters, directly or indirectly contributed to the medical response, e.g. securing hospital capacity, dispatching doctor-attending cars/helicopters and other medical teams to the scene, sharing information on the MCI between fire departments and hospitals.

Prevention of MGDs requires taking proactive measures, such as gateway restriction and one-way flow control without bottlenecks. Preparedness is made possible by the alert function of EMISHP; it enables smoother patient transport to hospitals and contributes much in securing sufficient time and resources for medical response in MCIs, including MDGs.

Mass gathering events (MGE), organized or unplanned, can attract sufficient attendees to strain the planning and response resources of the host community, state, or nation, thereby delaying the response to emergencies. MGEs also have the potential to cause a mass casualty incident. But MGE can also lead to improvements in the organization of local emergency medical services or public health that form the legacy of that MGE. Emergency medical teams (EMTs) could be deployed to ensure health security as a surge in MGE. But these EMTs should be built on guiding principles and core standards. However, to the best of our knowledge, there are no standards on medical planning and response during any type of MGE (e.g., sports, religious, or festivals).

A systematic review was performed in accordance with current guidelines, using six databases, namely Medline (via the PubMed interface), Scopus, Embase, Cochrane Library, ScienceDirect, and CINAHL, as well as literature sourced by Google Scholar and The Journal of Prehospital and Disaster Medicine. Studies published on minimum standards or medical planning and response during MGE from 2002-2022, written in English, were selected and assessed for eligibility by two reviewers.

From a total of 20,159 articles, 138 were screened, and 32 were assessed for eligibility. Two were only abstracts, and the others did not contain any description of minimal standards available for medical planning or response in different types of MGE.

No studies were found that describe any form of standards for medical planning and the response of emergency medical teams in different types of mass gathering events (e.g., sports, religious, festivals). There is a need for minimum standards for emergency medical teams deploying as a surge in mass gathering events.

This presentation is a continuation of a WADEM presentation from 2013 entitled: Fires in Social Settings: An Examination of Prevention Strategies.

Nightclubs should be a place of fun and frivolity, but sometimes they become a place of death and destruction. The fire at the Cocoanut Grove in Boston Massachusetts, USA, in November, 1942 was the deadliest nightclub fire worldwide with a death toll of 492 and over 130 injured. Since that tragedy, regulations that could prevent or mitigate lethal incidents at nightclubs continue to be unenforced globally. This presentation will describe not only elements leading up to the Cocoanut Grove fire, but the resulting advances that have improved the lives and safety of the public.

The discussion begins by examining the general environment within the U.S. in fall of 1942. Appointed and elected officials tasked with protecting the public to reduce occurrences for such disasters failed in their performance of their respective roles. Groundbreaking medical advances used to treat the victims include the use of penicillin, methods of treating cutaneous burns, the use of electrolyte balance to aid in determining the ongoing treatment of burn victims, as well as other medical advances improved directly as a result of the fire. Additionally, the first systematic study of grief and survivors’ guilt and the recognition of what is now called Post Traumatic Stress Disorder commenced.

Finally the divergent theories of the sources of the fires, how fire codes have changed in the aftermath as well as how the parties that were directly or indirectly responsible for the fire were disciplined by the judicial system will be reviewed.

Stadiums are an important part of the entertainment and sporting cultures of communities around the world, but the combination of outdated infrastructure with poor safety planning, large numbers of people gathering within a confined space, and the high frequency of such events have led to a number of significant disasters in the past.

This is a descriptive analysis of stadium disasters occurring between 1901-2021 which may provide useful insight for event safety personnel and disaster medicine specialists to better prevent and mitigate the effects of potential future stadium disasters.

Data was collected using a retrospective database search of the Emergency Events Database (EM-DATS) for all stadium-related accidental disasters occurring between January 1, 1901-July 30, 2022. A disaster is defined by CRED in its glossary as “technological accidents of an industrial nature, or involving industrial buildings”. All categories and definitions are predetermined by the EM-DATS as per their glossary.

The May 24, 1964 Estadio Nacional disaster in Lima, Peru was the worst (in terms of deaths) to date with 350 deaths. This is followed by the 1982 Luzhniki Stadium disaster in Moscow, Russia (340 deaths), the 2001 Accra Sport Stadium disaster in Ghana (123 deaths), and the 1985 Hillsborough Stadium disaster in Sheffield, England (96 deaths) as well as 14 of the 40 stadium disasters occurred in Africa, 11 in Europe, 10 in the Americas, and five in Asia.

A total of 40 stadium disasters were included, leading to 2,025 deaths and 6,640 injuries. This equated to an average of 50.6 deaths and 166.0 injuries per disaster. Given the potential risk of mass casualty events, stadiums should incorporate disaster medicine education, training, and expertise in their emergency medical plans.

There are known higher rates of drug and alcohol consumption in music festival attendees. Patterns of MDMA use had been changing over a number of years however the festival season (Sept 2018 - May 2019) in NSW saw a dramatic rise in drug related mortality and morbidity which had not been seen in other states in Australia although similar instances had been noted overseas.

With over 70 music festivals in NSW in this period, five deaths in four months and 29 severely unwell patrons transported to NSW hospitals, the impact was significant.To support both the festival site and NSW hospitals a Health Response Team (HRT) deployment model was implemented

The planning and intervention strategies included provision of onsite specialist critical care teams to complement existing event management and paid healthcare providers. Disaster management principles, although documented, had not previously been used in the music festival setting. To deploy such a team, guidance on equipment, pharmaceutical and physical requirements were scarce. Our team developed processes and protocols for all aspects of this unique deployment.

Operational procedures included specific equipment, medications, documentation processes, and clinical protocols were developed and reviewed and refined after each festival.

The effectiveness of the teams was evidenced through the early recognition and management of severe drug toxicity seen at the five festivals to which WSLHD deployed HRTs. This management resulted in good outcomes with minimal morbidity and no deaths of the 29 festival patrons treated by the HRT noting 25 required intensive care admission.

Innovative processes and collaborative arrangements enabled effective deployment to NSW music festivals. Expert HRTs were key in preventing drug related morbidity and mortality through early recognition and management of complications. Team members gained unique and invaluable experience as a result of their deployments and patients transported to hospital were managed more effectively.

Leaving a viable public health legacy and sustainable improvements in health infrastructure and capacity should be key for mass gatherings (MGs). Legacy includes improvements in health systems, health behaviors and delivering future MGs. Legacy planning and evaluation should be considered early in planning however, they are often neglected due to lack of funding to support, embed learning and maintain a sustainable legacy, and often favored over the event running smoothly.

Building on the Public Health for Mass Gatherings: Key Considerations (KC2) (2015), an updated literature review will identify new evidence for evaluating MGs and their legacy. This review will inform the development of updated resources to reflect the changing global health landscape and learning from MGs hosted during COVID-19, which can inform ways of better embedding legacy and evaluation in planning and post-event.

A systematic literature review methodology will be used. Electronic databases will be searched for relevant publications and grey literature of a wide range of MGs globally, focusing on evaluations, MG legacies, and impacts. Searches for specific technical areas e.g., surveillance, will also take place.

The literature review undertaken to develop the KC2 chapter identified limited publications. The increased interest in this field, should lead to an improved evidence base while recognizing evidence for long-term evaluation and legacy impact may still be more restricted due to the challenges of undertaking these studies. Recent literature will likely reflect work undertaken to deliver MGs during COVID-19, which will be included to identify good practice and transferable learning.

Key findings of the review will be published, and the evidence base will be used to update the evaluation and legacy chapter of the KC2. There are also plans to develop a MG evaluation and legacy tool that will be applicable beyond the major high-profile funded events.

A large urban jurisdiction identified a lack of experience and knowledge in use of the established regional patient tracking system among frontline emergency department employees. Lack of nursing retention, shifted departmental priorities throughout the pandemic response, and decreased opportunities for exercising were notable causes of this identified knowledge gap. Effective patient tracking has a significant impact during response to any event with the capacity to strain the hospital and healthcare system. Mass casualty incidents pose a global threat to all jurisdictions. Recognition of this threat magnifies the importance of establishing a patient tracking system and empowering frontline staff, through education and training, to immediately implement the exercised patient tracking platform.

Bolstering hospital readiness through site visits and first-receiver clinician engagement during special event planning improved effective use of a citywide patient tracking system during planned events. “Just-in-time” training tools were developed and distributed during site visits. Notably, identification of key clinical staff at each institution was an important step in meaningful clinician engagement. Utilization of these systems during special events is an opportunity to exercise a high stakes procedure during a low stakes incident.

Site visits and training material distribution effectively enhanced first-receiver participation in patient tracking during a special event in comparison to previous special events. Users required less prompting throughout the response, and the post-intervention survey indicated an increase in user confidence levels. Increased utilization of the system improved visibility into the hospital's lived experience while engaged in the response.

Targeted site visits and educational material tailored to first-receiver clinicians during special events improved patient tracking efforts throughout a large urban healthcare system. During real and planned events, person and patient tracking allows for patient load balancing across the healthcare system, assists with patient and family reunification, and directs future planning, funding, and first responder and receiver education.

The absence of clinical information in the aftermath of disasters in resource-constrained environments costs lives. fEMR– fast Electronic Medical Records–is a medical records system designed for mobile clinics and has proven useful in post-disaster settings. While the original version of the system was developed for areas without access to the Internet, a new version of this system was developed in 2019 to accommodate regions with connectivity.

We reviewed the design, implementation, and usage of fEMR from June 2014 to October 2022. We used logged data of the number of users, patient encounters, and the circumstances of each deployment. We compared usage between the original fEMR system and fEMR-on-chain.

The original fEMR system was created in an iterative process by students in Computer Science classes at three different American universities. The system creates a closed intranet signal to which clinicians connect their own device to access the software. The hardware is transported to the medical team in a carry-on suitcase prior to deployment. All data are stored on a laptop that acts as a server. The online version, fEMR On-Chain, was developed under a grant, but is sustained in development through academic partnerships. Both versions are designed so that the provider can complete an encounter with as few clicks as possible and with as little input as necessary to identify patients.The original fEMR system has been deployed to mobile clinics worldwide since 2014. The system has about 14,181 patients and 16,021 clinical encounters from 12 different countries. fEMR On-Chain has been deployed to refugee and migrant settings since 2019, containing about 18,000 patients and 22,000 encounters in two different countries.

Successive versions of the fEMR system have been used in a variety of conditions and settings, with usage accelerating since 2019 in refugee and migrant health centers.

In the USA, traumatic injuries are the leading cause of death before age 45 and have significantly lower mortality if treated in a verified trauma center. Burn injuries are included in trauma statistics and represent 1.1 million injured people annually seeking medical assistance. Routing of burn injuries to ABA-recognized burn centers has yet to be assessed as it has in trauma injury. Our goal was to examine the impact of prehospital routing of burn injuries on hospital length of stay, mortality, and potential costs-of-care through a statewide care coordination center.

Our study is a retrospective statewide analysis of burn injuries from 01/01/2017 thru 12/31/2019 using the Louisiana Hospital Inpatient Discharge Database. Routing of burn patients was implemented in 2018 using the ABA burn referral criteria. Data included: total admissions with primary burn diagnosis, region, discharge status, length of stay, and raw mortality by region and state. Descriptive and comparative statistics were performed to assess the impact of routing burn-injured patients. Cost analysis was performed using Louisiana Medicaid per diem rates from 2021 at $1,907.92/day.

1,288 patients were treated in Louisiana during the study period, with 855 post-routing and 433 pre-routing. The mean length of stay was reduced from 11.84 days in 2017 to 8.82 days in 2018 (p value=0.0988), with a potential savings of 761 inpatient care days or $2.17 million. Overall mortality across the state was unchanged except in the highest volume region, where it dropped from 7.9% in 2017 to 3.6% in 2019 (54%).

Burn injuries are a time-sensitive trauma. This study marks the first analysis pre and post-implementation of routing for burn injuries by a statewide care coordination center. Our study demonstrates improvement in length of stay and mortality but a continued need to examine other contributing factors, such as injury severity and concomitant trauma.

In Japan, there is an 80% probability that the Nankai Trough Mega Earthquake will occur within 30 years, and a tsunami of more than 30 meters is expected to hit the Pacific coast, killing more than 320,000 people and devastating many towns. This study clarifies the necessity and feasibility of a high-performance medical container developed by Showa to fill the gap in medical care during a large-scale disaster, especially after the sub-acute stage.

1) Simulation of the damage to disaster center hospitals in the event of the Nankai Trough Mega Earthquake.

2) To clarify the feasibility of immediate response, a demonstration experiment was conducted by combining and installing ten units of medical containers.

1) Of the prefectures where the death toll from Nankai Trough Mega Earthquake is estimated to be 5,000 or more, 119 disaster center hospitals located in cities and towns with coastlines were examined to determine if they were in the tsunami inundation zone. The results showed that 44 hospitals, or about 37%, were inundated and their medical functions were likely to be paralyzed.

2) Ten containers of medical treatment rooms, ICUs, CTs, power supplies, and oxygen could be assembled in seven days. This is by far the shortest time compared to the more than two months it takes for a temporary hospital.

It is clear that medical containers can fill the void of medical care in the event of Nankai Trough Mega Earthquake.

During the COVID-19 pandemic, it became difficult to conduct face-to-face training and practice for disaster medial education. As an alternative to this, it was proposed to build a metaverse world using virtual and augmented reality(XR) technology and implement disaster training education within it. Therefore, the authors investigated the process and effects.

The authors conducted training of healthcare workers through software implementing a metaverse called MediBase and NurseBase, which was created for doctors and nurses in hospitals to respond to disasters such as COVID-19. The trainees were given a practical orientation after basic theoretical education, attached a VR headset, and performed a medical response to a virtual disaster according to their judgment, and the records and debriefing were organized and analyzed.

The satisfaction of trainees with education reached a maximum of 88%. Even in the part where the correct choice was made in the theoretical evaluation, the time was delayed or the wrong choice or behavior appeared in the metaverse practical education and training.

In disaster situations that cannot be implemented identically to reality and most disaster education and training that cannot target actual patients, metaverse-based disaster medical education and training is expected to become a more effective alternative in the future.

Natural disasters and catastrophes are challenges faced by emergency services. These are dangerous environments in which there are life-threatening victims as in other CBRN incidents, which can add great risks for nearby populations and the environment. The main objective of this project is the development and testing of new technologies that increase the safety and efficiency of the work of first responders in disasters.

The SnR consortium, with 28 partners, has designed, implemented, and tested new technologies, with an advanced communication and monitoring system for professionals, victims, and other first responders, with innovative positioning and assistance ICT that facilitate the exploration and evaluation of disaster areas.

These technological advances are validated and evaluated with performance, efficiency, and usability indicators, in laboratories and in real working conditions, through a total of seven case studies, in seven different countries, covering a wide range of representative disaster scenarios.

The development of a new communication and monitoring system for professionals and victims, coordinated on the Concorde platform, together with chemical alert sensors, synchronized with smartwatches, smart uniforms, and pediatric immobilizers, are some of the tools tested. The pilots carried out to confirm the usefulness of the 26 technological tools designed and tested in the field, which have helped to reduce the damage and casualties that can occur in S&R operations.

In conclusion, the H2020 European Search and Rescue project (S&R), through the development of new technologies, offers a holistic approach to the effective response to emergencies and provides increased capabilities and resources to first responders in the field, increasing their effectiveness and safety. This project has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement (No. 882897).

Belize has no formal prehospital emergency medical system, leaving the majority of acutely sick and injured persons overwhelmingly dependent on private transport. To address this issue, a collaboration of public and non-profit partners worked with the Belize National Fire Service to implement the country's first formal prehospital emergency medical service using novel communications technologies. With new resources and vehicles already donated to the fire service, the collaboration focused specifically on the communications component of the response system, specifically to improve the handling of incoming requests for emergency assistance from the public, as well as to improve the process of dispatching prehospital personnel using readily-available mobile technologies.

Working with the Belize National Fire Service, program partners implemented the country's first emergency communications center, trained new dispatchers, field-tested the dispatch technology through intensive training sessions, and launched the system in the capital district of Cayo.

Launched in June 2022, the program has thus far achieved the following outcomes:

• Active Dispatchers: 26

• Active Responders: 104

• Emergencies Dispatched: 156

• Average Scene Response Time: 7m45s

Over the past year, partner NGOs Trek Medics and Empact Northwest have worked collaboratively to implement a first-ever centralized emergency dispatch system for the Belize National Fire Service, using a novel cloud-based dispatch software running on readily-available mobile phones and mobile. In addition to drastic improvements in response performance, satisfaction among system managers and response personnel is high, with plans currently underway to scale the program nationally.

In recent years, Japan has been hit by a number of natural disasters including the Great East Japan Earthquake, the Kumamoto Earthquake, the heavy rains in western Japan, and the heavy rains in Kumamoto to name a few. In each of these events, a number of hospitals located within the disaster areas were damaged and ceased to function, leading to difficulties in providing regional medical care. This presentation examines the effectiveness of mobile medical containers in handling such situations in the future.

This study organizes lessons learned from past disasters as well as the merits of and challenges facing current mobile medical containers while looking into the future.

When the Great East Japan Earthquake occurred, assembly-and-installation type temporary health clinics were constructed, but due to the numerous Japanese laws and regulations, it took almost three months for these to be delivered. On the other hand, current mobile medical containers are already in use in countries such as Tonga and Senegal and have the following advantages: (1) High mobility and easy installation, (2) Expandability as necessary, and (3) Durability for long-term use.

Despite challenges such as clarification of legal handling, electricity, water supply and drainage, we consider mobile medical containers to be effective alternative medical facilities in the event of disasters.

Health information technology, especially electronic health records (EHRs) pose difficult design problems due to the data and workflow complexity, high-stakes stressful nature of healthcare work, variability of information and collaboration needs and stakeholders. Emergency response poses further requirements. We propose a different, novel approach in which flexible ‘building block’ platforms composable by nonprogrammers could address rapid implementation and sharing of new functionality as needed at the point of care. In order to truly meet unpredicted emergency needs a philosophy of maximal flexibility and data comprehensiveness is required.

Existing technologies were used in new ways to permit prototype design of composable health IT platforms, intended to be added to existing health information systems, allowing nonprogrammers (including clinician end users) to assemble any desired data, visualization, and new logic to permit rapid tool deployment in emergencies. An example is the rapid composition of Covid-19 screening and treatment tools (in minutes) for fast implementation of new screening and care guidelines (as happens in a new epidemic), with usable visualization and decision tools.

Prototype systems were successfully built and configured for rapid tool creation for pandemic-specific needs including setup of automated screening and decision tools using EHR data plus point of care data gathering. These will be demonstrated. A modular, composable approach is usable by nonprogrammer clinicians, permitting those most familiar with rapidly changing clinical needs and guidelines to implement new health IT functionality directly instead of incurring delays typical when IT staff must do ad hoc programming. At this time new initiatives and mandates for health IT interoperability make this more easily doable than previously.

Disaster response may be facilitated by a different approach to health IT design and use, with advantages for rapid response, streamlining clinician work, and ease of use.

Rapid developments in healthcare technology can significantly improve the quality, availability, and immediacy of care in health emergency events; however, without a cohesive framework to conceptualize the interplay between emerging technologies, we risk creating silos, ignoring applications, and reducing interoperability between innovations.

This framework was developed after reviewing the current literature regarding new technologies in healthcare assessment and delivery, discussing relevant innovations with experts, and analyzing global market trends in emerging health technology capabilities.

Innovative health technologies deployed in disaster settings can be grouped by their relevance to (1) Disease and Injury Surveillance and Detection, (2) Population Protection, (3) Responder Protection, and (4) Disease and Injury Management. The first category encompasses technologies that help characterize the severity and scope of an event at its onset, utilizing a network of wearable devices, sensors, remote infectious disease sampling, and other tools. Once an incident occurs, technologies aimed at Population Protection are necessary to preserve the well-being of unaffected citizens. Scaled-up on-demand manufacturing for prophylactic medical countermeasures and needle-free delivery mechanisms for pre-treatments against CBRN threats will be paramount. Healthcare and emergency responders require additional support before and during incident response, especially just-in-time training through virtual and augmented reality, biometric monitoring, next-generation personal protective equipment, and enhanced communications capabilities. Finally, delivering care to patients in healthcare emergencies will require optimized allocation of scarce resources based upon acuity and survivability. Effective healthcare service delivery can be bolstered using Telehealth, autonomous patient transport, drone delivery, robotic and haptically guided care delivery, and decision support tools.

To effectively manage the successful adoption and implementation of innovative tools applicable to health emergencies, areas of impact and utility should be comprehensively categorized. This framework guides emergency managers, policymakers, and innovators alike to understand how individual developments coalesce in the larger context of disaster prevention, response, and recovery.

To quickly operate a temporary hospital using disaster medical containers in the event of a large-scale disaster, dozens of large trailers must be quickly brought to the disaster site. This study aims to establish a logistic system for transporting and installing containers using drones and GIS.

By linking drones and GIS, a theoretical model was created to quickly determine routes and installation sites for large trailers transporting medical containers from candidate routes simulated in advance by taking into account hazard maps and road conditions.

Using this system, it is possible to

(1) Establish whether the roads planned to be passed through are passable.

By narrowing down candidate routes through preliminary simulations that overlay hazard maps and roads that are passable for large trailers, it is possible to narrow down the routes that need to be confirmed. Immediately after a disaster, a drone can be used to confirm road damage, flooding, landslides, etc., and map them on the GIS to determine the extent to which they are passable.

(2) Identify locations that take into account demand and safety.

Locations that are close to the disaster area, safe, and in demand for medical care can be determined and identified based on the population mesh and the damage situation.

GIS and drones have a high affinity and are used in various ways. However, there is still no linkage between GIS and drones adapted to medical care and logistics at disaster sites in Japan. This system is indispensable to comprehensively determine the safety and demand of roads and installation sites.

Although hyperbaric oxygen therapy is required in disasters or emergency situations, barotrauma, which is the most common complication, continues to occur. If barotrauma occurs during hyperbaric oxygen treatment, treatment is stopped, and there is no proper preventive method for this. Therefore, the authors evaluated the degree of barotrauma prevention by applying a tympanometry-based anti-barotrauma device (ABT).

The candidates of the clinical trial are adults between the ages of 18 and 65 who correspond to academic indications for hyperbaric oxygen therapy. In a prospective parallel design, the candidates were placed in the test group and control group. Simple randomization and one-sided blinding were applied. The medical staff directly observed the severity of middle ear barotrauma through a video otoscope. The number of treatment interruptions and completions along with findings from the otoscope observation (Grade 0~5) such as level of ear pain (pain scale value) were collected at three university hospitals.

When ABT was applied, it was possible to prevent barotrauma earlier than the traditional medical observation. However, since the application of ABT requires the patient's voluntary cooperation, it is difficult to prevent barotrauma if a patient has reduced consciousness or is unable to follow the instructions of the medical staff.

Applying ABT is an appropriate method for early detection of barotrauma. However, in order to be applicable to patients with reduced consciousness or difficulty in cooperation, an automatic intrinsic pressure reduction system should be developed.

The coronavirus disease (COVID-19) poses an urgent threat to global public health and is characterized by rapid disease progression even in mild cases. In this study, we investigated whether machine learning can be used to predict which patients will have a deteriorated condition and require oxygenation in asymptomatic or mild cases of COVID-19.

This single-center, retrospective, observational study included COVID-19 patients admitted to the hospital from February 1, 2020, to May 31, 2020, and who were either asymptomatic or presented with mild symptoms and did not require oxygen support on admission. Data on patient characteristics and vital signs were collected upon admission. We used seven machine learning algorithms, assessed their capability to predict exacerbation, and analyzed important influencing features using the best algorithm.

In total, 210 patients were included in the study. Among them, 43 (19%) required oxygen therapy. Of all the models, the logistic regression model had the highest accuracy and precision. Logistic regression analysis showed that the model had an accuracy of 0.900, precision of 0.893, and recall of 0.605. The most important parameter for predictive capability was SpO2, followed by age, respiratory rate, and systolic blood pressure.

In this study, we developed a machine learning model that can be used as a triage tool by clinicians to detect high-risk patients and disease progression earlier. Prospective validation studies are needed to verify the application of the tool in clinical practice.

In order to deal with disastrous situations needing massive healthcare support, a new tool, financed by FEDER European funds (Interreg POCTEFA program) has been designed: the multipurpose mobile hospital Europe Occitanie (UMPEO). It is a projectable, foldable, versatile and autonomous truck with an interchangeable function from advanced medical post to operational command center, for acute events involving mass gathering or during multiple victims disasters. This study aims to show the usefulness of this structure during the COVID-19 health crisis.

The UMPEO is a shelter deployable in an emergency ward or intensive care unit, mobilizable in one hour, projectable by truck and autonomous for the first two hours. A descriptive, transversal, European study was carried out to describe its use in the cross-border countries of the Pyrenees (France, Spain and Andorra). When applicable, demographic data were gathered and/or a satisfaction questionnaire was given to the caregivers involved.

Between September 8, 2020 andFebruary 25, 2021, UMPEO was mobilized as a COVID-19 testing center, emergency department, vaccination center or as a command center at a political summit. Thus, 1322 screening tests were carried out over the screening three weeks deployment and 91% of the volunteers considered the screening operation useful. Used as a hospitalization ward, UMPEO was able to accommodate 266 patients over a period of four weeks. Eight hundred people were able to benefit from two doses of vaccines during the six weeks of the mobile vaccination campaign.

This tool, initially designed to be used in the event of a catastrophic event of an accidental or terrorist type or as a help station during mass gathering, has been diverted without any modification of its structure to meet the challenges of the global health crisis and provide a solution adapted to the population of countries bordering the Pyrenees.