Over the past years, the Outaouais region (Quebec, Canada) and their residents have had to endure no less than five natural disasters (floods, tornadoes). These disasters are likely to have a variety of consequences on the physical and mental health of adolescents, as well as on their personal, family, school and social lives. The experiences of teenagers are also likely to vary depending on whether they live in rural or urban areas.

Data were collected via a self-administered questionnaire in February 2022. A total of 1307 teenagers from two high schools participated in the study by completing an online survey. The questionnaire measured various aspects of the youth's mental health using validated tests, such as manifestations of post-traumatic stress, anxiety and depression, as well as the presence of suicidal thoughts and self-harm. Other aspects of the youth's experience were measured, including their level of social support, school engagement, alcohol and drug use, and coping strategies.

One third of young students (n=1307) were experiencing depressive symptoms and suicidal thoughts, as well as significant daily stress. More than 25% of the students had moderate or severe anxiety and thoughts of self-harm. These problems were significantly more prevalent among youths with prior exposure to a natural disaster. The study data also revealed that youths living in rural areas had a more worrying profile than those living in urban areas.

Similar to other studies (Ran et al., 2015; Stratta et al., 2014), our research data revealed that youths living in rural areas presented a more concerning profile than those residing in urban areas. It therefore seems important, in future studies and services, to focus more specifically on these teenagers to better understand their needs and to develop adapted services more likely to meet them.

The Japan Disaster Medical Assistance Team (DMAT) was established in 2005. Although it had become possible to gather medical teams at an early stage in the fields of health and welfare, there had still been a lack of personnel. In 2017, the Japanese government decided to establish the Health and Medical Coordination Headquarters when we had major disasters. Not only the medical team, but also the public health nurse and the welfare team gathered at this headquarter, and activities that integrated health, medical care, and welfare started from an early stage. On the other hand, WHO indicates to establish EMTCC within the Ministry of Health, in order to manage and coordinate EMT activities and aggregate data.

The Japanese Headquarters and the EMTCC were compared in terms of their functions and issues.

In Japanese headquarters, the director of the local public health center will be the director, and the secretariat for the headquarters will be run by supporters. Participants in the headquarter meeting include leaders of public institutions involved in health risk management. Furthermore, leaders of unions such as medical, dentist, pharmacists and nurses on the side of supporters, leaders of medical, healthcare, and welfare will participate. To establish EMTCC, WHO dispatches a coordinator, information manager, and data analyst.

EMTCC collects medical information by using Minimum Data Set (MDS), which is similar to Japanese Surveillance in post extreme emergencies and disasters (J-SPEED). The most significant difference is that EMTCC does not deal with health and welfare issues.

Regarding medical care, information is summarized in a similar way at headquarters. These facts indicate the Japanese headquarters management experience is applicable to EMTCC.

There is a consensus that there lacks a standard for primary triage during mass casualty incidents. This is further compounded by a dearth of high quality research on the topic. Some studies suggest the superiority of SALT triage versus other triage systems, however, findings have not widely transitioned to clinical practice. We believe that despite specialized training including that in emergency medicine or emergency medical services (EMS), there will be significant variability amongst triage determination and use of triage methods. This study intends to analyze various provider skill levels and their accuracy of triage determination.

In a disaster exercise, a group of providers trained to use START triage were expected to triage, treat and determine transport order of the patients from a scenario of a simulated intentional radiological dispersal device (RDD) detonation with multiple casualties. Another group of providers trained to use SALT triage were expected to triage, treat, and determine transport order of patients from a scenario of a building collapse after a hurricane to assess SALT triage with the participating officers. Additional cohorts of EMS clinicians will be given the same case scenarios and asked to triage, treat when necessary, and determine transport order of the patients.

The initial data from the RDD exercise includes 102 patient case scenarios with 27 minimal (green), 40 delayed (yellow), and 35 immediate (red) patients. The providers involved in the exercise are trained at minimum to NREMT EMT level. Results showed an under-triage rate of 7.8%, an over-triage rate of 20.6% and overall accuracy of 71.6% when using START triage.

The undertriage rate with START is 7.8% is higher than the generally acceptable rate of less than 5%. Our research is ongoing and we anticipate completion in 2023. We hope that our research provides future direction to improve triage in disaster scenarios.

The European Union Horizon 2020 research and innovation funding program awarded the NIGHTINGALE grant to develop a toolkit to support first responders engaged in prehospital (PH) mass casualty incident (MCI) response. To reach the projects’ objectives, the NIGHTINGALE consortium adapted the Translational Science (TS) process. The aim of this study is to perform the first TS (T1) phase PRISMA scoping review to extract data that will be used to guide the creation of the initial evidence-based second TS phase (T2) modified Delphi statements for a subsequent study.

The consortium was divided into three work groups (WGs) MCI triage, Prehospital Life Support and Damage Control (PHLSDC) and Prehospital Processes (PHP). Each WG conducted simultaneous literature searches following the PRISMA extension for scoping review with a common research strategy sharing MCI related search terms and then terms specific for each WG. Final included articles went through data extraction based on identified themes and sub-themes from PH MCI response literature to be used to create the future statements.

The initial search yielded 925 total references to be considered for a title and abstract review (PH Triage 311, PHLSDC 329, PHP 285), then 483 articles for a full reference review (MCI Triage 111, PHLSDC 216, PHP 156) and 155 articles for the database extraction process (MCI Triage 27, PHLSDC 38, PHP 90).

The progression of the study of prehospital MCI response enabled NIGHTINGALE partners to methodically obtain information that will contribute to each WG’s creation of initial T2 modified Delphi statements.

Hospitals around the world need to be safe and prepared to face disasters, being these man-made or caused by natural hazards. The Hospital Safety Index (HSI) is a tool developed by the World Health Organization (WHO) that allows access to the level of preparedness of hospitals; it is the most widely used instrument of its kind. Although the HSI is frequently used by hospitals and healthcare facilities around the world, scientific literature on its application in real life is scarce and qualitative studies are absent. By adopting a qualitative methodology, this study aims to investigate the use of the HSI to assess disaster preparedness in hospitals and healthcare facilities, identify challenges and facilitators of the HSI use, and devise recommendations for future adaptations of the tool.

A retrospective qualitative study employing semi-structured online interviews was conducted to gather opinions and perspectives of professionals using the HSI to assess disaster preparedness. Participants were recruited by contacting via email the authors of scientific publications on the use of the HSI.

In total, nine people from three different countries (Serbia, Sri Lanka, and Indonesia) and having different professional backgrounds agreed to participate in this study. They shared the reasons for their choice of using the HSI, against other tools, as well as the steps taken before and during data collection. Strengths and weaknesses of the HSI were identified and authors reported the challenges they encountered in the preparatory phase and during data collection. Modifications of the tool and recommendations for the future were proposed targeting both researchers and hospital managers.

As far as the authors know, this is the first qualitative study examining the methodological implications of using the HSI and providing practical recommendations that can advance the HSI tool and foster its use for disaster preparedness assessments worldwide.

Gallstone ileus is a rare cause of intestinal obstruction. It commonly affects older patients with significant medical conditions. This disease has a high mortality rate (12-17%), hence should be an important diagnosis to consider, especially as the geriatric population grows worldwide.

Method: Case Report:

84-year old gentleman, with diabetes and ischemic heart disease, presented with diarrhea, vomiting and fever for one day. He was febrile, tachycardic and hypotensive. There was lower abdominal tenderness with guarding. Labs done revealed metabolic acidosis with a raised lactate along with raised inflammatory markers. Impression was intra-abdominal sepsis, with a need to rule out mesenteric ischemia. He underwent CTAP which revealed gallstone ileus. The gallbladder was collapsed and pneumobilia was present in keeping with fistulation. Dilated small bowel loops were present with a transition point at the distal jejunum or proximal ileum, where there are two gallstones. Patient underwent exploratory laparotomy. There was an obstructing large gallstone 100cm from the DJ flexure. After removal of gallstone and decompression, the bowel was pink with areas of bruising. Patient was hypotensive intra-operatively likely contributed by septic shower, requiring dual vasopressors. He was transferred to the ICU post-operatively and developed cardiogenic shock with type 2 respiratory failure precipitated by sepsis. He demised on Day 2 post-operatively.

Gallstone ileus is caused by intestinal impaction of a gallstone that has migrated through a cholecystoenteric fistula. The classic radiologic sign of gallstone ileus is Rigler's triad. This is only picked up 15% of the time on plain abdominal x-rays. Early CT scans can reveal Rigler triad up to 80% of the time. Surgical management remains the cornerstone of treatment.

Gallstone ileus remains a diagnostic challenge as patients present with non-specific signs and symptoms. It is prudent for emergency physicians to consider this disease in elderly patients who present with small bowel obstruction.

Incarcerated individuals represent a particularly vulnerable sector of society, with a disproportionate burden of drug use, mental health problems, and chronic illness. The purpose of this study was to perform a descriptive analysis of EMS response to detention facilities.

Retrospective review of EMS calls to detention facilities between 1/1/2002 and 12/31/2021 within our EMS system. Data were analyzed using descriptive statistics and Student’s t-test. This study was deemed exempt by the Institutional Review Board.

3,126 requests for service occurred during the study period. Average patient age was 40.2 ± 13.3 years, compared with 54.0 ± 25.9 years for non-detention center calls (p < 0.001). The majority (80.8%) of patients were male. Mean scene time was 14:13 ± 7:49 minutes, compared with 12:04 ± 12:27 minutes (p < 0.01) for non-detention center calls. The most common complaints were chest pain (15.6%), trauma (13.6%), seizure (11.7%), behavioral (9.2%), and overdose (4.7%); OB requests accounted for 5.8% of calls for female patients. Most calls (86.0%) to detention centers involved incarcerated individuals. Four percent of patients refused treatment; 27.8% of these patients were still transported. One hundred and eight patients were identified by EMS as not needing transport. Consent for treatment/transport by the patient was documented in 5.2% of charts.

Within our 911 service area, calls to detention facilities are not uncommon, predominantly involve incarcerated individuals, and are primarily due to chest pain, trauma, or seizures. Consent for treatment/transport was not documented in most EMS encounters. Further study is needed to better understand the health care needs of these patients, including ability to consent and access to chronic medications.

Mass-casualty incidents (MCI) featuring a large number of injured persons caused by human-made or by natural disasters are increasing globally. During these incidents, medical first responders (MFR) need to take appropriate action that saves lives. In this context, the adage “practice makes perfect” is befitting to MCI training. However, providing large-scale MCI training is often difficult due to the significant effort required to create these types of exercises. Drawbacks include a large number of actors needed to portray victims, availability of infrastructure, and realistic treatments. Virtual Reality (VR) has been demonstrated in several domains to be a serious alternative, and in some areas also a significant improvement to conventional training. As an advanced alternative to VR, Mixed Reality (MR) have the potential to provide a dynamic simulation of an VR environment and hands-on practice on injured victims.

The aim is: 1) to present insights of a newly developed MR training system for increasing MCI preparedness and 2) discuss pedagogical aspects e.g. how the intended learning outcomes are perceived in MR training, how the participants experience the learning in MR training, and what impact MR training will have in their future work practice.

An MR training system, designed for teams of up to four MFRs to perform training in real-time, will be pilot-tested at the beginning of 2023. The system features a fully functional touch-enabled human manikin design for practicing skills in emergency situations. The pilot tests will be carried out within the Med1stMR project (https://www.med1stmr.eu/) where approximately four teams of MFR will be evaluated based on the intended learning outcome.

Preliminary results from the pilot tests will be available at the conference.

Research is needed to strengthen the knowledge and impact of MR training as a pedagogical method to better support MCI training and preparedness.

Young people in Sub-Saharan Africa, especially males, have been insufficiently engaged in HIV Testing Services (HTS). In Kenya, these persons are often treated in emergency departments (EDs) for injuries, a healthcare interaction where HTS including HIV self-testing (HIVST) could be leveraged. There is, however, limited data from stakeholders on ED-HTS which impedes programmatic advancement.

A qualitative study was completed to understand facilitators and challenges for ED-HTS and HIVST delivery in Kenya (12/2021-03/2022). Data were collected via 28 in-depth patient interviews (14 males and 14 females) who had been treated in the Kenyatta National Hospital (KNH) ED and through seven focus-group discussions conducted with 49 ED healthcare personnel (nurses, doctors, HIV testing counselors, and administrators). Transcripts were double-coded and thematically analyzed with Dedoose™ software using a parallel inductive and deductive approach to capture both a priori and emergent themes.

Patients and providers viewed ED-HTS as a beneficial provision that was facilitated by engaged staff, education, perceived high HIV risk, and confidentiality. However, ED-HTS was limited by burdens on staff time and material resources, lacking systems integration, and patient illness severity. Facilitators of ED-HIVST delivery were perceived to have greater autonomy and confidentiality as well as lower health resource utilization. Challenges for ED-HIVST identified included patients’ concerns about HIVST accuracy and psychological stress, as well as providers’ concerns for loss to follow up and inability to complete confirmatory testing.

ED stakeholders are receptive to HTS and HIVST provisions. This data provides insight into the patient, provider, and systems aspects that can be leveraged in ED-based HTS to enhance program impacts via intervention functions in the forms of education, care integration, resource scaling, and solidified post-self-testing follow-up mechanisms.

The Mountain Plains Regional Disaster Health Response System (Mountain Plains RDHRS) works to build disaster capacity across US Federal Region VIII, a rural western six-state region. It conducts an annual rehearsal of concepts and exercises to identify gaps and inform policy development. In 2022, a multi-state exercise was conducted involving responders from individual hospitals coordinating with Healthcare Coalitions and State Public Health. These responses rolled up to a multi-state emergency operations center overseen by the Mountain Plains RDHRS.

A fictitious mass multi-state botulism incident generated a pediatric surge across the region. Individual patient cards with demographic information were given to a set of hospitals in participating states. The communication pathways within states were identified. Communication between local and regional pediatric transfer centers were assessed. Overall situational awareness was tracked.

The exercise format was incident occurrence and notifications by normal channels and a Zoom conference call held on day one. Situational awareness and patient movement occurred in multiple Zoom rooms on day two. An after-exercise review occurred by Zoom on day three including all participants from the exercise.

There was generally good information flow within states, but minimal information exchange across states There was poor regional situational awareness with a lack of complete patient lists and transfers. The Mountain Plains RDHRS planned to exceed the hospital’s patient capacities with a large number of pediatric patients to practice patient movement across state lines. Instead the hospitals showed a surprising willingness to keep and manage critical pediatric patients instead of transferring to tertiary care pediatric centers. This was identified as a consequence of the COVID-19 experience.

Web-based exercises vertically spanning responses from individual hospitals to multi-state regional entities are feasible. This exercise demonstrated multiple gaps in regional disaster response.

Three years into the COVID-19 pandemic, experience and studies have shown that public behavior significantly contributes to the disease spread increase or reduction. As the pandemic becomes a chronic threat, maintaining public trust to comply with health regulations proves challenging as people develop pandemic fatigue. This study aims to analyze the long-term trends in public attitudes toward the COVID-19 pandemic and compliance with health regulations.

A longitudinal cohort study was performed from February 2020 until January 2022, collecting data from nationally representative samples (N=2,568) of the adult population in Israel. Data Collection was timed with the first five morbidity waves of the COVID-19 pandemic. We examined public trust in Israeli health regulations, public panic, worry, and compliance with health regulations, particularly self-quarantine.

The data shows that public trust in health regulations in January 2022 is at an all-time low (25%) compared to the maximum value measured in March 2020 (~75%). The perceived worry from COVID-19 is steadily declining, whereas the perception of public panic is increasing as the pandemic progresses into a chronic threat. While public compliance with self-quarantine was reported to be close to 100% in the early stages of the pandemic, it has dropped to 38% in early 2022, mainly when compensation for lost wages is not offered. Regression analysis suggests that trust is a significant predictor of compliance with health regulations.

The findings, spanning more than two years of the pandemic, highlight the importance of maintaining public trust as a significant driver of public compliance with health regulations. The "fifth wave" of the pandemic resulted in an all-time low in public trust. The Israeli public, usually highly compliant, shows signs of crumbling conformity. Decision-makers ought to consider means to foster public trust.

In 2018 Sierra Leone, a country highly prone to disasters, launched its first National Emergency Medical Service (NEMS) aiming to strengthen the provision of essential health services to the population with the long-term goal of creating a resilient health system able to effectively respond to and recover from emergencies. The Center for Research and Training in Disaster Medicine, Humanitarian Aid, and Global Health (CRIMEDIM), together with the Italian NGO Doctors with Africa (CUAMM), under the supervision of the Ministry of Health and Sanitation (MoHS), developed a prehospital Disaster Training Package (DTP) delivered to all NEMS personnel to boost the prehospital management of mass-casualty incidents (MCIs) and outbreaks.

The DTP was designed following the six-step approach to curriculum and training development with the ultimate goal of creating a workforce comprising qualified emergency responders with specific professional competencies to respond to outbreaks and MCIs. The DTP included a first phase in which NEMS local trainers underwent a training-of-trainers (ToT) course, enabling them to deliver cascade trainings to 16 district ambulance supervisors, 441 paramedics, 441 ambulance drivers, and 36 operators working in the NEMS operation center.

Starting on July 19, 2021, the ToT course was delivered to the seven national trainers. All trainers successfully passed the final examination and achieved high scores in the practical sessions, demonstrating active participation, commitment to the project, and good awareness. Following the ToT course, the series of cascade trainings started on August 2, 2021, delivered by the just-trained national trainers under the direct supervision of the two training managers.

The NEMS’ DTP is the very first Disaster Medicine training course delivered to prehospital healthcare providers in Sierra Leone. The authors believe that the provision of the DTP to all NEMS personnel has the potential to improve Disaster Medicine culture among health professionals in the Country.

Recurring outbreaks of cholera coupled with lack of laboratory diagnostic capacity in low resource settings fuels clinicians’ reliance on clinical case definitions and highlights the importance of accurate diagnostic guidelines. While “rice-water” stool color is the hallmark predictor of cholera, few have examined the diagnostic accuracy of this assessment. This study assesses the sensitivity, specificity and positive and negative predictive value (PPV; NPV) of classifying stool color as “rice”, “clear” (i.e. watery) or “rice or clear” stool by either the patient or nurse for diagnosing cholera.

From March 2019-2020, a random sample of patients presenting to the International Centre for Diarrhoeal Diseases Research, Bangladesh with acute diarrhea who had a stool sample obtained were included in this analysis (N=2135).

Of the 1198 (56.1%) of patients that had culture growth, 641 (53.5%) were positive for Vibrio cholerae. “Rice” stool was reported by 518 (23.8%) patients and 640 (29.5%) nurses, while “clear” stool was reported by 1081 (49.8%) patients and 353 (16.3%) nurses. When observed by nurses, both “rice” (76%) and “clear” (85%) stool were reasonably specific but not very sensitive for cholera (44% and 20%, respectively). The combined “rice or clear” colored stool had the best balance of sensitivity (65%) and specificity (61%) with a PPV of 42% and NPV of 80%. When reported by patients, “rice” stool had high specificity for cholera (76%) but low sensitivity (25%), while “clear” stool had both poor sensitivity (54%) and specificity (51%).

Current international guidance that recommends classifying watery (clear) stool as cholera in outbreaks may still miss many patients with culture confirmed cholera even when the stool color is observed by trained health professionals and is likely not useful at all self-reported by patients. The combination of “rice or clear” diarrhea may provide somewhat more accurate assessments.

Globally, nurses play pivotal roles in epidemic and emergency response. Nurses’ actions include supporting and informing surveillance and detection, dispensing live-saving medical countermeasures, implementing prevention and response interventions, providing direct care for patients, educating patients and the public, providing health systems leadership, and counseling community members. Despite these roles, there exist gaps in how countries train and prepare their nursing workforce for these health threats.

To help address this gap, the Johns Hopkins Center for Health Security has developed an International Resource Center for Pandemic and Disaster Nursing. We have established an international working group to provide input on the goals and mission of the center, website development and functionality, and advocacy efforts. This working group has met four times over the course of the last year. We have also met with several organizations involved in nursing and epidemic and disaster preparedness and response, including the World Health Organization and the International Council of Nurses (ICN), to identify ways to align our work with other ongoing efforts.

Presently, we have developed a static website that provides access to evidence-based, open-source trainings and educational resources applicable to pandemic and disaster nursing. The website also provides listings of upcoming webinars, guest blog posts, trainings, and conferences relevant to disaster and pandemic nursing. The website will be launched in early 2023.

The long-term vision for this center is to expand beyond a static website and create a vibrant and fully staffed virtual center. This center would be the first of its kind dedicated to developing the resources, technical assistance, partnerships, and advocacy efforts needed to build and support a global nursing workforce that is prepared for outbreaks and disasters. It would build on the existing wealth of expertise within the working group and forge lasting connections between disaster nurse experts across the globe.

Understanding how to best prepare hospital staff for disasters or emergencies is critical, as there is increasing frequency and scope of these events. Considerations include: identifying key staff, their roles, strategies to support continuity of care, delivery mode of education, and resource allocation.

Participants experienced in disasters and major emergencies or preparation at three tertiary referral teaching hospitals were purposively selected during 2016 and 2019. An interpretive paradigm and case study design enabled the exploration of perspectives concerning effective and preferred methods for preparedness. Fifty-five allied health professionals, medical practitioners, and nurses participated in semi-structured interviews; and support staff participated in focus groups.

Key findings: 1. Recognition that allied health professionals and support staff are essential and must be included in disaster or major emergency preparation and plans. 2. Factors that increase the likelihood of staff deciding to be absent from work include: perception of danger, insufficient understanding of responsibilities, and hospital preparation is perceived inadequate. Staff understanding their role has a positive influence for attendance and coping during disasters. 3. Preferred and most effective method of disaster preparedness is practical learning, combined with other preparation methods. Online learning as the major mode was unpopular. 4. Challenges of inadequate resources limits managers’ ability to facilitate staff preparation and care delivery during disasters. Resources affect method, duration and multidisciplinary inclusion in disaster preparation.

This research found disaster preparedness in hospitals is critical. Site and occupation specific differences need to be addressed. To mitigate impacts of disasters or major emergencies, preparation must include identification of required resources. Disaster preparedness and management must be inclusive of multidisciplinary staff, including allied health and support staff. Facilitation of role understanding to promote continuity of care during disasters or major emergencies is imperative to promote staff participation and effectiveness in response to disasters.

On January 19, 2020, Washington State reported the first confirmed case of COVID-19. Two years later, the Centers for Disease Control and Prevention (CDC) reported over 90 million cases across every U.S. state and territory causing more than 1 million deaths, with numbers continuing to grow. As part of the overall pandemic response, CDC, in coordination with America’s Poison Centers, conducted enhanced surveillance of National Poison Data System (NPDS) data to detect potentially harmful, non-traditional behaviors taken to prevent, treat, or cure COVID-19 to provide situational awareness and ensure CDC continues to develop effective, evidence-based health communication messages and materials.

Data from the fifty-five U.S. poison centers (PCs) are uploaded in near real-time to NPDS. CDC monitored several categories including cleaners and disinfectants, medications/vitamins, and behaviors such as suicide and drug use. We characterized exposures by daily call volume, age group, management site, route of exposure, and medical outcome compared to previous years. We also conducted follow-up detailed review for certain anomalies, spikes, or extreme adverse events.

We reported PC data to several task forces within the CDC Emergency Operations Center. The daily number of exposures increased sharply beginning in March 2020 for exposures to cleaners and disinfectants. For example, bleach exposure calls saw a 62.1% increase compared to 2019. Several medications saw spikes in calls in coordination with media coverage of certain treatments (e.g., hydroxychloroquine) throughout the pandemic.

This data helped ensure a coordinated public health response to COVID-19 and maximized the unique role of PCs in addressing public and medical provider concerns and questions. Results led to several actions including notifications to state health departments, targeted messaging, and tailored response efforts. PCs are a valuable resource for providing guidance and advice about exposures to hazardous substances and can help reduce the burden on the healthcare system.

Some incidents require early deployment of emergency department personnel not designated as disaster medical assistance team (DMAT). Although not as trained as DMAT members, they should be aware of basic disaster response concepts and knowledge. Educating disaster readiness to every healthcare staff in emergency departments would be ideal but it is very costly in both time and expense. To overcome this problem, we tried to evaluate the effectiveness of teaching basic concept and knowledge to non-designated personnel in a short-session and measure the effect.

This study is a before-and-after comparison study. From July 2020 to July 2022, a two-hour education was given to volunteers among doctors, nurses, paramedics and administrative staff working in emergency departments across four hospitals in Korea. Educational sessions consisted of basic disaster concept, pre-deployment DMAT preparations, initial actions required on incident site, key elements of incident response (command, control, safety, communication), and triage. Attendees were given a pretest before the session and another test after the session. Chi-square test and Wilcoxon rank test were used to compare the results.

Total of 105 volunteers participated in the study. Participants were mostly nurses (62.9%) followed by paramedics (23.8%). Overall knowledge level reported to be increased, including knowledge regarding DMAT deployment (29.5% to 93.3%, p<0.001), DMAT personnel (26.7% to 94.3%, p<0.001), DMAT-designated equipment (23.8% to 60.0%, p<0.001), initial response (27.6% to 69.5%, p<0.001) and patient transport priority (74.3% to 94.3%, p<0.001). Questions testing triage and rate of participants answering every question showed improvement with post-test median score of 67% and rate of 1.0% to post-test median score of 100% and rate of 35.2%, respectively (both p<0.001).

Educating non-DMAT personnel in emergency departments with a short session showed significant improvement in basic knowledge of disaster response. It may help institutions with limited resources.

Low/middle-income countries (LMIC) in Africa face unique, systemic challenges in medical education. Africa faces a shortage of medical schools; only one school serves 24 countries. 11 countries have no medical school. Residency programs are few. The effect of this shortage is far-reaching. Africa has 3.5% of the world’s health workforce and 1.7% of the world’s physicians, yet 27% of the global disease burden. COVID-19 created further resource constraints, especially in emergency medicine (EM). Non-clinical physician functions such as student and resident education suffered. In Rwanda, we implemented a pre-recorded, remote teaching model to substitute in-person instruction. This study evaluates whether remote teaching is received positively by EM learners and whether it is a viable alternative during times of limited in-person availability.

28 lectures were recorded by American EM faculty. The recordings were presented to Rwandan EM residents within their standard didactic curriculum. Lecturers were available in real time via Zoom. Topics were chosen by Rwandan faculty based on curricular needs. Program evaluation followed the Kirkpatrick framework. Attendees completed a post-lecture Likert-scale survey assessing the first Kirkpatrick level related to satisfaction, lecture and learning method quality, and suitability. Qualitative and free-response data was also collected.

Responses were analyzed with descriptive statistics using means and standard deviations. The mean response range across questions was 3.6-4.3 (1 = worst, 5 = best); the standard deviation range was 0.4-1.6, indicating an overall positive result. Qualitative feedback, which reached saturation, did not indicate significant dissatisfaction with the quality or suitability. Points for improvement included lecturer accents and rate of speech.

When in-person lecturers are unavailable, pre-recorded and remote instructional methods may be a suitable substitute. Future directions may include piloting the project with a multinational cohort or in LMICs with greater technological or resource limitations, and assessing higher Kirkpatrick framework objectives.

WHO Thematic Platform for Health Emergency and Disaster Risk Management Research Network (Health EDRM RN) is a global expert network, launched in 2018, aiming to strengthen the scientific evidence for managing health risks associated with all types of emergencies and disasters, and to foster global collaboration among academia, government officials and other stakeholders. The Health EDRM RN’s activities are in line with WHO Health EDRM Framework, which support Sendai Framework for Disaster Risk Reduction 2015-2030.

Health EDRM RN’s strategic direction is discussed and advised by its Core Group that consists of focal points of WHO HQ responsible unit, all six Regional Offices, WHO Center for Health Development (Secretariat), RN co-chairs, and key external stakeholders. Based on the strategic direction, the Secretariat facilitates global, regional, and local collaborative activities with the RN participants and partners. As of 2022, over 250 global experts participate in the network.

Following the results of the Core Group Meeting in 2019, 2020 and 2021, multiple activities and results were generated including the identification of five Health EDRM key research areas. WHO Guidance on Research Methods for Health EDRM developed in collaboration with over 150 global experts, initiation of the project to establish WHO Health EDRM Knowledge Hub for developing WHO Health EDRM Research Agenda and aligning with UNDRR research agenda on thematic areas including developing a special supplement on mid-term review of Sendai Framework implementation in health. The 2022 Core Group Meeting, held on October 27, 2022, agreed to promote knowledge dissemination and implementation research for better outputs for regions and countries.

WHO Health EDRM RN will continue its unique function as the platform of global experts and stakeholders to produce, disseminate, and apply knowledge. Participation and engagement by more and broader experts are expected.

International health partnerships have often been characterized by wealthier countries or organizations pushing resources and money into projects in countries with different needs. This can be new technologies, building facilities, and/or training personnel. Often this has been assessed in the amount of money spent. In recent years more focus has been put on synergy effects in involved organizations. Hence the change from aid to partnerships. A previous study focused on the subjective perception of the workforce regarding clinical skills, management skills, communication & teamwork, etc. (Jones et al., 2013). This paper focuses on defining learning goals and using a model by Patzauer (2022) as a complement to traditional partnership evaluation measures.

Seven team members from a health partnership participated in a project for implementing ambulance service treatment guidelines through training of the partner's ambulance personnel and instructors. The training took place during one week in the partnership country. All Swedish participants were nurses actively working as ambulance personnel or had previously worked in ambulances. Before the training week the participants answered a questionnaire with open questions about their personal learning goals and expectations for the training week. At the end of the week, after having trained ambulance personnel, they answered another questionnaire with open questions addressing what they had learned.

Analysis of the responses showed that the participants expected to acquire both personal and clinical skills. Afterwards, they had improved language skills, self-efficacy, and becoming better instructors.

The model of using learning goals as an integral part of evaluating health care partnerships provides knowledge that is useful both in terms of assessing the project, and also as input to participants' managers showing clinical and organizational benefits. Including personal learning goals as a part of partnership projects' evaluation, provide useful knowledge about benefits and experiences that improves the organizations.