With an aging population and patients on end-of-life care (EOL) pathways, emergency departments (ED) are seeing an increase in patients requiring EOL care. There is paucity of data of attitudes and knowledge of physicians providing EOL care in the ED both internationally and in Ireland. The aim of this project was to assess the attitudes and knowledge of ED physicians towards EOL care.

This was a cross-sectional electronic survey of ED physicians working in Irish Eds, facilitated through the Irish Trainee Emergency Research Network (ITERN) over six weeks from September 27, 2021, to November 8, 2021. The questionnaire covered the following domains: Demographic data, Awareness of EOL Care, Views, and attitudes towards EOL care.

A total of 311 completed questionnaires across 23 participant sites were analyzed, with a response rate of 45%. The majority of the respondents were under the age of 35 (62%), were male (58%) and at SHO level (36%). In terms of awareness 32% (98) of respondents were not aware of palliative care services in their hospitals while only 29% (91) were aware of national EOL guidance. Fifty-five percent (172) reported commencing EOL care in the ED, however 75.5% (234) respondents reported their knowledge of EOL care to be limited or non-existent. Few (30.2%) respondents felt comfortable commencing EOL care in the ED without speciality team input. There appears to be a lack of clarity on the roles and responsibilities of ED nurses and doctors in the care of the dying patients in ED with only 31.2% (95) being clear on this role. Significant differences were observed with regards to clinical experience and physician grade.

This study has highlighted a lack of awareness and knowledge of EOL care, particularly among less experienced ED physicians. However, there was a willingness to commence EOL care in the ED.

In August 2021, Hurricane Ida struck Louisiana as a near-category five storm, bringing massive devastation to the region’s healthcare infrastructure. In its aftermath, extreme heat coincided with record COVID-19 hospitalizations in the state, leaving minimal healthcare surge capacity remaining and medically vulnerable populations unprotected. Meanwhile, sparse pre-storm evacuations exposed prominent gaps in existing medical response plans designed to serve high-risk groups. Subsequently, Louisiana rapidly established a 250-bed alternative care site (ACS) within hard-hit New Orleans. This presentation highlights key considerations in the operation of the site and discusses which patient populations are most in need of medical support following tropical weather events.

The findings of this discussion are the result of after-action reviews, brief literature reviews, and the experiences of responders during Hurricane Ida. The presentation also draws on retrospective patient chart reviews from Louisiana’s prior alternative care sites.

Following Hurricane Ida, a post-storm alternative care site was rapidly established in New Orleans in partnership with a US Disaster Medical Assistance Team (DMAT). Operationalized in less than 72-hours, this site provided inpatient care to displaced persons with major chronic medical needs (e.g. home ventilators, hemodialysis, respiratory therapies), significant mobility impairment, wound care, and psychiatric illnesses. Incorporating Louisiana’s experience with a COVID-19 alternative care site, this facility far-exceeded the typical scope of medical shelters, simultaneously lessening medical surge on already-overburdened hospitals and meeting post-storm needs in the region.

Following extreme weather events in metropolitan areas, traumatic injuries and acute illness comprise a small proportion of the medical needs after the event. Accordingly, disaster medical responses must prepare to treat large numbers of chronic illness exacerbations that result from a loss of access to primary care, home health support, and auxiliary services. This approach efficiently leverages resources into lifesaving interventions and protects healthcare systems during times of high stress.

The Russian invasion of Ukraine began on February 24, 2022. UNHCR reported, as of April 6th, more than 4.3 million refugees have fled Ukraine, with 401,704 refugees arriving in the Republic of Moldova, around 100,000 of whom have remained in the country. JICA investigated whether Moldova's healthcare needs were burdened by accepting a large number of Ukrainian refugees, and examined the way to support them.

JICA dispatched the 3rd team as a survey team. The 2nd team consisted of two medical doctors, one nurse/midwife, one clinical engineer (CE), one Japan DMAT logistician, and two JICA staff. The dispatch period was three weeks when five major hospitals were visited in the capital, evaluating the current situation and the need for support for the future.

As of April 6, 2022, 3,853 people were staying in refugee accommodation centers, while the rest lived in ordinary Moldovan families. Evacuees, like Moldovan citizens, were covered by health insurance, and evacuees had access to medical care. Medical institutions were not overwhelmed by medical needs due to the Ukraine crisis. There was no epidemic of infectious diseases even at evacuation centers. However, since there was no system to share emergency information between hospitals, we held a disaster medical seminar to introduce the current situation of disaster support in Japan and supporting EMTCC.

As a survey team, not only doctors but also nurses, midwives, and CEs surveyed, making it easier to understand the specific medical needs at medical facilities. Most of the evacuees stayed in ordinary Moldovan homes, and it is possible that avoiding a crowded environment at the evacuation shelters prevented the epidemic of infectious diseases.

919,000 Rohingya refugees live in overcrowded camps in Cox’s Bazar, Bangladesh after fleeing violence in Myanmar. The Médecins Sans Frontières (MSF) Goyalmara Hospital offers the highest level of pediatric and neonatal care serving the Rohingya refugees and palliative care is gradually being integrated due to high mortality and medical complexity of patients. The purpose of this study was to understand the moral experiences of staff involved in providing palliative care to inform program implementation at Goyalmara Hospital and in other humanitarian contexts.

This focused ethnography was conducted between March-August 2021 at Goyalmara Hospital. Data collection involved participant-observation, individual interviews (22), focus group discussions (5), and analysis of protocols and other documents. Interviews and focus groups were audio-recorded, translated, and transcribed. A coding scheme was developed, and data coded using NVivo 11.

A key finding of this study was the important yet contested role of clinical guidelines and policies in palliative care related decision-making which was shaped by the authority and impermanent presence of international staff in the project. Staff saw clinical guidelines as a valuable resource that supported a consistent approach to care over time, and some locally hired staff used clinical guidelines as a tool to support their point of view during care planning discussions with international staff. Others felt that palliative care guidelines and other policies were inappropriately or rigidly applied, particularly surrounding decisions to refer (or not refer) patients to a higher level of care, or to discontinue certain medical treatments at end of life.

MSF staff experienced tension between the need for clarity and consistency, and the need to tailor guidelines to the context, patient, and family. Open discussion of staff concerns may alleviate moral distress and alert teams to areas where advocacy, staff psycho-social support, training, or clinical mentoring are needed.

Japan is an island nation surrounded by the ocean. Seventy percent of the country is mountainous, and there is no abundance of habitable flat land. Japan is a disaster-prone country, with an average of 25 typhoons per year occurring near Japan and 20% of the world's earthquakes of magnitude six or greater occurring in Japan. The Great East Japan Earthquake (2011) destroyed many medical facilities in coastal areas. The government is seeking ways to continue medical services using ships in preparation for future Nankai Trough Earthquakes. This study introduces the current status of studies for installing hospital ships in Japan.

Based on materials on hospital ships published by the Cabinet Office and reports on training exercises conducted by various organizations, this report summarizes the current status of studies on introducing hospital ships in Japan.

In 1991, a committee was established to gather domestic experts to study a multi-purpose ship, and various studies have been conducted intermittently. The current policy focuses on utilizing existing resources such as Self-Defense Force cargo ships, civilian car ferries, etc. The demonstration training for a hospital ship with the Self-Defense Force's field surgery system and the Red Cross Emergency Response Unit has been conducted. Other studies are underway to provide medical support to remote islands by ocean tugboats. Future issues for utilizing existing ships include 1) maintaining medical personnel and medical equipment and materials in times of disaster, 2) utilizing and maintaining ships during peacetime, and 3) establishing access to ships that are unable to dock at a port.

Hospital ships in Japan are considered to utilize existing vessels rather than building new ones. However, there are unresolved issues, such as how to operate the ships during disasters, the cost of maintenance, and transporting patients from land.

The Sydney North Health Network (SNHN) covers an area of 350 square miles in Eastern Australia. It is one of 31 Primary Health Networks (PHNs) across Australia. The purpose of PHNs is to improve access to primary healthcare particularly those at risk of poor health outcomes. During disasters these vulnerable groups may be even more disadvantaged. As part of SNHN's role in enhancing the wellbeing, resilience, and preparedness of communities and primary healthcare providers during disasters, SNHN is focusing on recovery and resilience initiatives that build on local strengths, while addressing challenges.

The aim of this community engagement research was to determine the impact of recent extreme weather events on the community, and identify strategies to improve wellbeing, resilience and preparedness. The research was approached through a co-design process to explore assets, strengths and vulnerabilities within vulnerable community members during disasters, and to ascertain their perspective on their needs during disasters. SNHN funded a well-established local community organization to conduct surveys and focus groups with the SNHN community to inform future community-led programs to support individuals and communities in disasters.

Participants considered impacts on mental and physical health, children, the environment, and property as key challenges. Equally, they acknowledged they didn't start as a "blank slate", but came to the disaster with considerable individual and community strengths and assets, that enabled their resilience, including numerous resources to support social capital. Person-centered, community-inclusive planning, preparedness, and connectedness was seen as key solution.

In order to promote and enhance the wellbeing, resilience, and preparedness of communities and primary healthcare providers, successful recovery and resilience initiatives should build on local strengths, while addressing challenges. Individuals and communities should be integral in designing programs to build their local resilience and wellbeing, as they know their attributes and strengths, and their needs.

Urban communities are under constant threat of numerous potential disasters, including cyanide exposure events. Exposure can occur in settings such as structure fires, industrial accidents, or even intentional acts of terrorism. The typical treatment modality for cyanide toxicity employs the antidote, hydroxocobalamin. While studies regarding antidote availability have been conducted in Korea and Hong Kong, a literature search did not reveal any such studies in any part of New York City.

The borough of Brooklyn has a population of 2.57 million people. In the setting of a mass casualty incident (MCI) involving cyanide toxicity, such as a large structural fire or a chemical attack, it is uncertain of the region's capability to provide hydroxocobalamin. The objective of this study is to assess the stockpile of hydroxocobalamin across acute care hospitals in Brooklyn.

The amount of hydroxocobalamin required to treat a cyanide-related MCI was based on recommendations from the 2018 US Expert Consensus Guidelines for Stockpiling Antidotes. Ten grams of hydroxocobalamin are needed for each 100-kg patient. Theoretically, a minimum of 50 grams of hydroxocobalamin would be required for a mass casualty incident (5 patients).

Fifteen acute care hospitals within Brooklyn were identified as potential treatment sites for cyanide exposure. Each site’s emergency manager was sent a survey identifying hydroxocobalamin availability in both their pharmacy and their emergency department.

All 15 hospitals responded to the survey. Two of the 15 hospitals had at least 50g of hydroxocobalamin in their inventory, however, no hospital had 50g stored in their emergency department. The median amount of hydroxocobalamin stored was 20g or two doses.

Should a mass casualty incident involving cyanide exposure occur, only two hospitals in the borough of Brooklyn would be prepared to treat five or more patients presenting to their hospital.

Pharmacists have been recognized as essential healthcare professionals during the COVID-19 pandemic. However, evidence of the challenges that were faced by the profession and the way pharmacists adapted their roles throughout the pandemic are largely unknown. This study aimed to describe the impact of COVID-19 on pharmacy practice around the world.

A cross-sectional online questionnaire with pharmacists who provided direct patient care during the pandemic. Pharmacists were recruited through social media with assistance from national/international pharmacy organizations. The questionnaire was divided into three sections; 1) demographics, 2) pharmacists’ roles/services during the pandemic, and 3) practice challenges. The questionnaire was adapted from the established, piloted, and published INSPIRE Canadian Survey. The data were analyzed using SPSS 28. Descriptive statistics were used to report frequencies and percentages.

A total of 505 pharmacists practicing in 25 countries consented and completed the questionnaire. Only 26.4% (132/500) of participants were engaged with local disaster and public health agencies during the pandemic to coordinate pandemic response. The most common role that pharmacists undertook was responding to drug information requests (89.4%, 448/501), followed by allaying patients' fears/anxieties about COVID-19 (82.7%, 413/499), educating the public on reducing the spread of COVID-19 (81.3%, 409/503), and addressing misinformation on COVID-19 treatments/vaccinations (79.1%, 397/502). The most common services provided by pharmacists were performing medication reviews (78.5%, 391/498) and managing and/or monitoring patients’ chronic diseases (72.3%, 362/501). Almost half of the participants reported administering COVID-19 vaccines (44.9%, 225/501). The most common challenge that pharmacists encountered was increased stress level (82.2%, 415/505), followed by medication shortages (72.3%, 360/505).

Despite the unprecedented nature of the COVID-19 pandemic and the various challenges associated with it, pharmacists around the world adapted their roles and services to continue to meet the needs of their patients and be their safe-haven for ongoing care.

This research aims to review the impact of drug addiction, domestic violence and suicide in Australia through the lens of disaster risk reduction. This study explores whether drug addiction, domestic violence and suicide can be considered as disasters according to established thresholds and definitions; and whether contemporary health emergency and disaster risk management (HEDRM) practice can be adapted to support action to reduce the impact of these events and inform disaster risk reduction.

A literature review was conducted to explore drug addiction, domestic violence and suicide as societal disruptions causing disasters. Key Australian government reports describing deaths associated with suicide, domestic violence and drug addiction were identified, following which a constrained snowball sampling was applied to the bibliography of each document to gather further key articles and inform the evolution of the impact of these themes in Australia over the period 2000-2018. The search strategy included both peer reviewed and grey literature. We used the search terms ‘social disruption’, 'non-traditional', ‘drug addiction’, ‘domestic violence, ‘suicide’ and 'societal disruption' as key words and included articles if they demonstrated an analysis of the theme related to health impact related to disaster settings.

Utilizing the Australian Disaster Resilience Knowledge Hub and the international CRED criteria for a disaster, the impact on human health of drug addiction, domestic violence, and suicide upon the Australian population each meet the criteria of a disaster.

Public health practice through the lens of the determinants of social disruption combined with activities that consider hazards, vulnerability, and exposure, can institute prevention, preparedness, response, and recovery programs to reduce the impact of drug addiction, domestic violence, and suicide.

With the Covid-19 pandemic impacting the world at such a quick rate and with many unknown variables and dangers, there was an immediate need for ethical guidance to ensure those in many different healthcare settings such as researchers and other professionals could perform ethically in this new and complex situation. This study aims to take existing research on those ethical guidance documents in the UK/Ireland and compare them with those from the United States.

This study used a qualitative systematic review methodology with thematic synthesis to analyze the included ethics-related guidance documents, as defined in this review, published in the UK and Ireland between March 2020 and March 2022. The search included a general search in Google Scholar and a targeted search on the websites of the relevant professional bodies and public health authorities in the three countries. The ethical principles in these documents were analyzed using the constant comparative method (CCM).

In the UK and ROI review, 44 guidance documents met the inclusion and exclusion criteria, and 11 main ethical principles were identified, which were then categorized under two main themes: respect and duty. The 11 main ethical principles were: fairness, honesty, minimizing harm, proportionality, responsibility, autonomy, respect, informed decision-making, community, the duty of care and reciprocity.

In the US review, 270 documents were found from searching several public health United States government bodies. Of these documents, 50 were deemed to be Covid-19 ethical guidance, each ethical principle was tallied from every document and compared with the results from the UK/Ireland study.

There were remarkable similarities in some ethical principles prioritized in the Covid-19 pandemic ethical guidelines across the Atlantic Ocean. However, there were differences in the interpretations and frequencies in which these principles were used across different regions.

In a climate where natural disasters are becoming progressively more frequent and severe, there is a greater need for healthcare resilience. Hospital pharmacists are important healthcare responders during disasters, but little is known about how prepared pharmacists are to fill roles in disasters or how prepared pharmacy departments are to support their response. The aim of this study was to determine the disaster preparedness of pharmacists and pharmacy departments in a Metropolitan Health Service in Australia and investigate any relationship between the two.

This research utilized two surveys to determine the individual preparedness of registered pharmacists within the eligible hospitals and the preparedness of pharmacy departments (this information was obtained through the Directors of Pharmacy).

In total, 68 individual pharmacists participated in the study. It was found that individuals were moderately prepared (preparedness score 19.98). Interventions, such as education, improved individual preparedness scores, though these had poor uptake, where only 17.4% (n=12/68) of participants had received disaster education or training. Individual preparedness was unaffected by facility preparedness and provision of comprehensive resources.

The preparedness of hospital pharmacy departments was generally low, where two hospitals were rated as ‘somewhat prepared’, due to the presence of a mostly comprehensive plan and a moderate engagement in activities that contributed to preparedness. The third hospital was ‘poorly prepared’, as it did not have a disaster plan and had low engagement in preparedness activities.

This study shows that a substantial improvement in pharmacy preparedness is required to achieve healthcare resilience and quality patient outcomes in disaster aftermath–further reinforcing the need for national and pharmacy-specific guidance, complemented by standardized preparedness interventions such as education and training. There is also a glaring disconnect between the preparedness of pharmacy facilities and their workforce, which demonstrates a culture of disaster preparedness.

General Practitioners (GPs) manage the majority of usual healthcare needs in a community. These healthcare needs do not cease in disasters; they increase and expand. However, inclusion of GPs in disaster healthcare systems is only just beginning. Systematic review of the health effects of disasters over days, months, and years, shows the major burden of healthcare needs associated with disasters is within the realm of usual general practice. In Australia, Primary Health Networks (PHNs) represent local GPs in each region. They offer the best option for systematic linkage of GPs to the broader DHM system.

A systematic review of the literature on the health effects of disasters and three qualitative studies reviewing the current experiences, barriers and facilitators to GP involvement in DHM systems were undertaken through a PhD at the Australian National University in 2022. A knowledge to action framework was developed and utilized to provide a systematic strategy to guide efforts to diffuse, disseminate, and implement the research as it emerged, with a focus on sustaining those changes through integration of PHNs into Australian DHM systems.

Integration of GPs, through PHNs, is evolving, through systematic inclusion in planning and policy in local health districts. Over time, evidence-based knowledge of disaster healthcare needs has been incorporated into GP disaster planning and preparedness, and resource development, and utilized by GPs during the recent 2019 Black Summer Bushfires, and East coast Floods.

As our knowledge of the healthcare needs of disasters continues to reflect our increasingly challenging and complex world, the proven benefit of active involvement in holistic, comprehensive continuity of healthcare through General Practice in DHM systems through PHN linkage becomes more urgent.

People with hearing disabilities (PwHDs) face many challenges in their everyday lives, as their environments were not designed to accommodate their needs. They may have a communication disability as well as a hearing disability. To cope, PwHDs rely on the assistance of others, their communities, technology, and personal resources. In emergency situations challenges become greater and resources scarcer.

This study was conducted from November 2018 through July 2020. A mixed-methods approach consisting of in-depth interviews and online quantitative surveys with PwHDs in Israel was used. The qualitative part enquired about the resources they used to cope during emergencies and the obstacles they faced. Grounded theory was used for the analysis of the findings. The quantitative part focused on their perceptions of self-efficacy, methods of communication, and accessibility of services in emergency situations. The participants were deaf or hard of hearing individuals, and those who used hearing aids and/or had a cochlear implant, as well as individuals who chose not to use them. The study excluded people over 60, because we focused on those who didn’t suffer from hearing loss caused by age. The survey was accessible in Israeli sign language using Qualtrics survey platform. The statistical analysis was conducted using SPSS ver.23.

PwHDs’ resources for coping with emergencies were identified and classified under four categories.

1. Characteristics of the PwHD: type, methods of communication (sign language, read lips, speech) and accessibility of services.

2. Personal resources: Independent communication and self-efficacy.

3. Time of event: Daytime or nighttime.

4. Characteristics of the emergency: Personal vs. collective.

The study identified the resources PwHDs used to cope with emergencies. Results can help develop standards of accessibility for places providing services during both day and night that will allow PwHDs to communicate independently.

Pharmacists’ pivotal role during the COVID-19 pandemic has been widely recognized, as they adapted to continue to provide an even higher level of care to their patients. We sought to gain deeper understanding of frontline pharmacists’ lived experiences of the COVID-19 pandemic and its impact on their roles and professional identity (what they do and what it means to them).

Photovoice was used, a visual research method that uses participant-generated photographs to articulate their experiences, and semi-structured interviews. This approach allowed us to explore the subjectivity of professional identity from the pharmacists’ lived experiences. Participants were asked to provide 3-5 photos that reflected on how they see themselves as a pharmacist and/or represents what they do as a pharmacist. The semi-structured interview guide asked open-ended questions about their photos, included a photo-elicitation exercise, and additional questions based on a recent scoping review. We recruited frontline community pharmacists who provided direct patient care during the COVID-19 pandemic in Alberta, Canada through social media and relevant pharmacy organizations. Data analysis incorporated content, thematic and visual analysis and was facilitated using NVivo software. Ethics approval was obtained from the University of Alberta ethics board.

Five primary themes emerged from the photographs and interviews: (1) autonomy, (2) clinical courage, (3) leadership, (4) safety, and (5) value and support. The photographs identified symbols participants associated with their lived experiences (e.g., worn shoes illustrate the relentless pace of pharmacists, a messy bed representing work-life balance out of control).

This study identified that pharmacists’ felt the pandemic made them visible to the public and made them feel valued as a trusted resource and a safe-haven for ongoing healthcare. Additionally, it was highlighted how participants demonstrated clinical courage and led their communities by adapting their roles and using their autonomy to fulfil community needs.

In 2019, the World Health Organization published the Health Emergency and Disaster Risk Management (H-EDRM) framework, detailing how all actors in the health system can contribute to reducing negative health outcomes of emergencies and disasters, including mass casualty incidents (MCI). The H-EDRM framework’s whole-of-health-system approach stresses the need for each level of healthcare systems to be involved in all phases of the disaster cycle, particularly preparedness and response. This approach highlights the critical role that lower levels of care, including primary healthcare, can play during MCI, demonstrating the need to integrate these into countries’ disaster plans. Nevertheless, countries’ disaster management plans have historically focused on hospitals and few recommendations exist for how to practically proceed with such an integration. This study explores what has been published on the topic of reverse triage (RT), namely the process used by healthcare workers (HCWs) to determine which patients can safely be discharged to lower levels of care, resulting in increased surge capacity at hospitals. The objective of this work is to collect evidence around existing criteria, tools or referral pathways used by HCWs during MCI, ultimately integrating lower levels of care in MCI management.

A systematic literature review was performed and a total of 12 studies were analyzed.

Literature focusing on RT towards lower levels of care during MCI is scant and limited to few case studies. There is no standardized tool or guidelines for how to perform RT and existing referral pathways are described in only isolated case studies.

Published evidence on RT criteria is limited. The results of the current review can serve as groundwork upon which to design further research studies. It can be used to help devise strategies and policies for the integration of lower levels of care during MCI.

The COVID-19 Pandemic negatively impacted the mental wellbeing of healthcare workers worldwide. Many organizations responded reactively to their staff needs. The novel, evidence-informed Social Support, Tracking Distress, Education and Discussion Community (STEADY) program was implemented, with senior leadership support across a large hospital. STEADY is a multi-pronged program developed to mitigate occupational stress injury in healthcare workers and first responders. This project examined the feasibility of implementing STEADY across hospital units during a pandemic.

STEADY was implemented in five acute care units and across the rehab site of a large hospital. Data was collected on the five program components (drop-in peer support groups and critical incident debriefs, psychoeducation workshops, wellness assessments, peer partnering, community-building initiatives). Most peer support groups were facilitated by the program manager trained in peer support and one of six clinical staff.

The program was iteratively adapted to meet the needs of target units/groups. More than 300 sessions were run in ~one year, for an average of ~1.15 sessions per unit per week. With flexible adaptation to the mode of facilitation, ~75% of planned workshops and ~85% of peer support sessions were run. Three critical incident stress debriefs were held. The formal partnering program was offered via e-mail with minimal uptake. Ninety-five wellness assessments were completed by target end-users, with 36 personalized responses sent. Gratitude trees were posted in each unit for community-building. Eight target unit staff completed formal peer support facilitation training. Twenty additional groups across the organization requested STEADY programming support and ten requested gratitude trees.

Results indicate that most components of the STEADY program were feasible to implement in hospital units during the pandemic. On-site, interactive programming was most engaging for end-users. Leadership support and flexible, continuous adaption by program leaders were identified as facilitators to program implementation and uptake.

Emergency service workers are confronted with serious risks for their health, well-being and functioning. In order to prevent consequences to them and their families, emergency organizations should provide optimal support after an intensive period of employment. In many countries, the military pays special attention to the transition of their personnel from deployment to home via post-deployment adaptation programs (PDAPs). The objective of this presentation is to provide a structured analysis of the military approach to post-deployment adaptation and to identify potential lessons for emergency services.

A systematic literature search was performed to find original peer-reviewed studies on PDAP in six databases (MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, PTSDPubs, and OpenGrey). The overall risk of bias of the articles was assessed using GRADE guidelines. The literature was analyzed guided by a program evaluation framework entailing different domains.

The search resulted in 1535 unique records that were screened for eligibility; 16 articles were included, of which only three showed low risk of bias. Most articles describe some form of third location decompression (N = 10) and also some agreement exists on how to adapt skills and cognitions after deployment (Battlemind; N = 4). The results suggest positive mental health effects and satisfaction of these elements.

Empirical, high-quality evidence for PDAP is scarce. In addition, the existing literature reveals a lack of systematic method in describing the goals of PDAP and the ways of achieving these. Nevertheless, this study reveals promising elements that are in line with international guidelines, such as minimizing the level of exposure, intervention delivery and adjustment issues. We discuss how future research should incorporate these elements using a systematic approach.

Veterinarians have been identified as a professional group at elevated risk for behavioral health issues associated with an emergency response. Prior studies demonstrate the significant and long-lasting mental health effects experienced by veterinary responders. To examine the scale and scope of behavioral health issues exhibited by veterinary responders, an online anonymous survey was conducted.

A Qualtrics® survey was conducted to identify the scope and scale of behavioral health issues of veterinarians responding to disasters. Informed consent language and the survey included stress warnings for participants to stop the survey and seek support if needed. A link to the survey was sent to veterinarians from contact lists and the survey link was coded for reuse so it could be forwarded to others. Sending emails announcing the survey were sent and the survey was open for one month following the second notice. The results were tabulated and analyzed by the authors.

Fifty-one percent of respondents reported experiencing at least one behavioral health symptom during the disaster response and 34% reported at least one behavioral health symptom six months after the event. Milder symptoms such as loss of sleep and anxiety decreased significantly after six months, however more severe symptoms such as mood swings (24/22), depression (21/21), nightmares (18/20), and suicidal thoughts (5/5) did not significantly decrease. Sixteen percent reported support during the event and 13% reported support after.

Survey analysis indicated that the scale and scope of veterinary responders’ behavioral health issues are significant, and the findings indicate that further study and action to improve health outcomes is warranted. Recommendations include developing standards and guidelines, incorporating behavioral health training into response activities, developing assessment and reporting protocols, collaborating with other professions to determine best practices, and providing funding for further research on behavioral health.

Internationally, COVID-19 has impacted populations because of both infections and measures to prevent the spread of the virus. The pandemic's long-term social and psychological effects on the Dutch population were studied.

The GOR-COVID-19 health monitor1 includes quarterly measurements among youth (12- to 24-year-olds) and adult (25 and older) panels. The measurements of June and September 2022 included the open-ended question, ‘In your life at this moment, do you still feel the effects of the corona pandemic from the last 2.5 years?’ The first author qualitatively analyzed the responses (7.171 in total) through descriptive coding. A team member did a co-coder reliability check.

In the questionnaire, various people name positive effects of the pandemic, such as being able to spend time alone or feeling more confident. However, many respondents describe how the pandemic negatively affected their social life, mental health, personal development, financial situation, and perception of society. People who experienced life transitions show vulnerability to social isolation while working and learning online because they missed the opportunity to establish a new social network. Among them are young people who started secondary school, university, or their first job during the pandemic. The youth also often describe having difficulty with social interaction, feeling they have ‘unlearned’ to be in large groups or interact with strangers. Older generations, in contrast, comment on their own continued cautiousness.

After years of pandemic, fear of contamination and social distancing measures have impacted society and individuals. The findings raise the question, ‘How will the experience of a pandemic continue to shape society and, in particular, what will be the lasting effects on the social networks and mental health of generation Z?’

1 See Integrated GOR-COVID-19 health monitor and The Dutch GOR-Covid-19 health monitor, both in the European Journal of Public Health (2022) 32:3.

Women in coastal Bangladesh face greater challenges while staying at evacuation centers during cyclone emergencies. This study explores the lived experience of women and their well-being as evacuees.

The research undertook a phenomenological approach to conduct in-depth interviews of nineteen women from three extremely vulnerable districts of coastal Bangladesh.

The interviews revealed that women experienced obstacles to maintaining hygiene, using the toilets and accessing privacy, and suffered distress as pregnant women, lactating mothers, and through menstruation, which affected them physically and hampered their mental health. Coming from a male-dominated socio-cultural background, female evacuees unaccompanied by male guardians experienced fear and uncertainty. Some participants recollected facing social pressure and overwhelming emotions as carers of children and elderlies, whereas some reconciled traumatizing incidents such as witnessing death. Such experiences led to anxiety, stress, and depression with either temporary or permanent trauma. Participants frequently mentioned panic attacks and stress-related physical issues such as heart palpitations, dizziness and light-headedness. However, spiritual beliefs and social bonds within the community enabled peace and optimism among the women. Findings highlight that certain factors determined women evacuees' experience of wellbeing. Social context of the women imposed burdens of responsibility and caused inaccessibility of resources to restore physical-mental wellbeing. The settings, infrastructures and environment of the evacuation centers were not women-friendly, which resulted in many negative experiences among the evacuees, greatly affecting their sense of wellness. However, participants could channel positive mindsets through prayers and spiritual faith. Women were able to access some resources and use these for their well-being through social bonding and connecting with the women within the shelters.

Unconditional trust in a deity and sisterhood within communities have been two quintessential features of women, which played major roles in women’s experiences and molded their understandings of well-being in the cyclone shelters.