Teaching and becoming culturally competent are concepts that have and continue to evolve partly due to the language being used such as culturally competent, culturally sensitive, and cultural humility. With such an influx of ethnically diverse populations, nurses need to become competent in the care of patients from many cultural backgrounds. Faculty must first be culturally competent to provide this pedagogy for nursing students. This paper explores and analyzes the cultural competence of Baccalaureate Nursing Faculty in the United States.

This study was conducted using a quantitative, descriptive approach among baccalaureate nursing faculty. The Multicultural Awareness, Knowledge, and Skills Survey (MAKSS) tool was used for this study. The survey was sent to 70 randomly selected baccalaureate nursing program Deans and/or Associate Deans listed on a public web site. The sample was purposely chosen to represent at least one program from each of the 50 states across the United States.

Ninety-four responses were received. Of the 94 responses, 37 surveys were incomplete, leaving a sample size of 57. An analysis was completed on the 57 completed surveys. Limitations include the length of the survey (60 questions) as the authors found that some participants did not answer all the questions. Although faculty rated themselves high regarding being able to identify cultural biases, faculty highlighted the need for more education on culture.

Faculty appear to be culturally aware and recognize the need for more education to achieve a culturally competent skill set. With the increase in the influx of immigrants from all over the world, the population of the United States is changing. Cultural competence needs to be included in curricula to ensure that patients are advocated for and respected.

In Germany, more than 3.3 million people in need of long-term care are receiving home care. Although not all of them use professional home care providers, their services are essential especially to those who need skilled nursing care and medical-technical assistance in addition to everyday support–such as approximately 30,000 people who receive home mechanical ventilation. Little is known about the disaster resilience of home care infrastructures and ways to strengthen them. A research consortium called AUPIK, funded by the German Federal Ministry of Education and Research from 2020-2023, sought to close this gap.

A participatory process was initiated as part of the AUPIK project based on results of a multi-perspective empirical baseline analysis which resulted in a first draft text about measures to promote disaster resilience in home care. 37 representatives of home nursing care providers and community health-care services, professional boards, scientific and education institutions participated in a web-based survey on the draft text, followed by two digital group discussions. Finally, the gradually revised, condensed and consented starting points were published and distributed.

Eight starting points were defined. Among others, there is an urgent need to strengthen risk awareness and resource management among home care providers, to promote individual disaster competence and preparedness among all parties involved and, not least, to strengthen community-based networking initiatives between home care providers, emergency and disaster organizations and local authorities. Institutions or persons who should take responsibility for implementation at different levels are addressed directly.

The final version of the starting points represents a consensus on urgently needed initiatives to promote disaster resilience in home nursing care in Germany. The participatory development process should support commitment on the part of all stakeholders and thus promote effective implementation of disaster resilience initiatives in home nursing care.

Road tunnel systems are becoming increasingly complex. Regardless of incident, the confined nature of the road tunnel impairs responding emergency services accessibility, with a risk for delay in treatment of time-sensitive injuries such as pneumothorax or internal hemorrhage. Consequently, the need for rapid decision-making by the emergency services commanders is increased. However, in Sweden ambulance commanders lack experience and training in managing road tunnel incidents. This may further delay the medical response.

The aim is to investigate if the ambulance commander decision-making in simulated road tunnel incidents may be improved by a specific road tunnel incident e-learning course.

A web-based intervention study was performed with 20 participants; 10 participants in the intervention and control group, respectively. The control group received a pre-recorded general lecture on incident management. The intervention group received a specific road tunnel incident e-learning course, consisting of five interactive modules with learning materials (e.g. road tunnel structures, collaboration and safety). All participants participated in web-based simulations of major road tunnel incidents at one and six months post-intervention. In these simulations, participants acted as ambulance commanders and decided on the best course of action in 15 dissimilar and multiple choice-based management decisions. For each decision, time and choice of decision were recorded as outcome measurements.

Preliminary analysis from the one-month follow up simulation indicates that none of the participants decided to enter the road tunnel system at the early stage of the incident. The motivation for the participants decision-making was not clear.

The cautiousness to enter the road tunnel system will impair the emergency medical services response, including delaying vital medical care. Further research into the reasoning behind this decision is needed and identified causes may be further addressed in updated educational materials and collaborative discussions.

In Singapore, disaster training and preparation are taken seriously. Many exercises and training sessions have been planned and run yearly with the hope of being able to respond effectively to an emergent disaster. This presentation aims to evaluate the effectiveness of our training programs to determine if the learner participants are equipped to manage disasters when they happen based on their learning objectives.

The disaster training programs that Singapore General Hospital participates in, both nationally and internally, were analyzed based on Bloom’s taxonomy for educational objectives. At the lowest level, the learner demonstrates the ability to remember the facts that he learned, followed by understanding the concepts, applying the information, analyzing the learning undertaken, evaluating his performance, and creating new methods to learn or train to improve his performance.

Based on the analysis of the various exercises and training sessions, most learning objectives are pegged to the remembering to application levels (90%) while very few participants, especially the instructors and evaluators (<10%) may achieve learning objectives of being able to analyze and evaluate the training sessions. As disaster training involves multiple interprofessional teams there is also a risk of rapidly diminishing retention of knowledge and skills over time because of the high turnover of manpower especially from residents and medical officers who are attached to the departments for a few months.

There is room for more targeted disaster training aimed at more participants and with learning objectives determined at the higher level of Bloom’s taxonomy, at least to achieve the ability to analyze and evaluate one’s performance for improvement. Creating opportunities for more participants to be able to do that would be a challenge.

The Health Information and Quality Authority (HIQA) Tallaght Report of 2012 found care of lodged admitted patients on ED trolleys was undermined in terms of quality and safety. HIQA advised the practice of lodging in ED adjacent hospital corridors should be discontinued entirely. This message was reiterated during the pandemic. Some lodged patients may spend the total duration of their admission on an ED trolley. ED has 15 Adult rooms, seven pediatric rooms, two minor injury rooms, one procedure room and two resus bays. The aim was to calculate the annual number of days when no admitted patients were lodged on trolleys in ED.

A descriptive study using data available from nationally issued reports on patients allocated to trolleys to the ED of Wexford General Hospital from January 2019-September 2022. Data was collected from national HSE daily SBAR reports. “Lodged patients” were those present in ED admitted but for whom no ward bed existed at 0745 daily.

Data was collected for 1,369 days, 90 days were excluded due to missing data sets, and data were included for 1,279 days. 290 days were recorded in 2019 with no lodged patients, 126 in 2020, 55 in 2021, and only 11 days in 2022 with no lodged patients. In 2022 the average number of lodged patients was six (Range 0-19). A total of 47 days had a lodged count of ten or greater.

Despite a strong recommendation from HIQA to terminate the practice of ED patient lodging, this has not been implemented. During the COVID-19 pandemic, there had been a reduction in the overall number of patients visiting the ED. This contributed to the reduction in trolley-lodged patients however post-COVID pandemic there has been a surge in attendance with a clear deficit in bed capacity.

As the population in the Republic of Ireland increases, the number of Emergency Department (ED) attendances and admission rates increase, placing significant pressure on the health care system, the limited staff and hospital resources.

The aim of this study is to assess the admission rates in an Irish Public Hospital Emergency Department between 2014 and 2022.

This retrospective study was done using information provided by the Health Service Executive Integrated Patient Management System. Data for the period between February 2014 to September 2022 were collected. From the data, the admission rate can be calculated and trends observed.

Emergency department attendance rates have increased from 29,236 to 42,637 between 2014 and 2019, with a decline noticed in 2020 to 37,751 and a drastic increase in 2021 at 43,182. Currently up until September 2022 there has been 35,503 attendances and 8,570 admissions, with an admission rate of 24.14%. The number of admissions has ranged from 9,056 in 2014 to the highest being 12,175 in 2019. This means the admission rate is averaging between 24% to 31% per annum, with the highest being 31,04% in 2015, and the lowest in 2017 at 24,99%.

This study showed a steady increase in attendances per annum, which correlates to an increase in the total admissions from 2014 to 2022, with approximately one third of all ED attendances resulting in admission. The increase in attendances and admission rate could be related to the population growth from 4.6 to 5.1 million from 2014 to 2022. The decrease in attendances during 2020 could be attributed to the Covid-19 pandemic restrictions being implemented, and lifted in 2021 which showed a drastic increase in ED numbers. Ultimately, the increase in admissions will place a burden on the Public Hospitals in Ireland.

Electronic dance music festivals (EDMF) are a unique subset of music mass gatherings. Besides the already more significant burden on in-event health services (IEHS) that comes with these festivals, EDMF are also known for their illicit drug use, with their attendees at high risk for illegal drug use.

Encounter data from all patients seen and treated by IEHS at an annual outdoor multi-day EDMF (focused on hardstyle dance music) in August 2019 were analyzed. Based on the chief complaint, and medical and nursing notes, a list was consolidated into 31 reasons for the consultation of IEHS. The most common reasons for consulting IEHS were analyzed.

This outdoor hardstyle dance event had 30,000 attendees, of which 580 visited IEHS. This resulted in a patient presentation rate of 19.3/1,000 attendees. Four were transported to the hospital (transport to hospital rate: 0.13/1,000 attendees). The most prevalent reason to consult IEHS were lacerations and abrasions (9.66%), sprains (9.48%), and headaches (7.59%). Only 4.83% of all patients (n = 12) presented with adverse effects of illicit drug use. Of interest is that twelve patients with intoxications (42.86% of all intoxicated patients) were initially triaged as life-threatening, mainly due to obstructed airways. Only one of these twelve needed endotracheal intubation and was transported to the hospital. All other intoxicated patients returned to the event. No direct relationship between gender and the chief complaint was found.

Besides typical patient presentations, illicit drug use with its adverse effects can seriously impact IEHS. These results confirm the need for highly trained (Advanced life support level) IEHS at EDMF. Competent IEHS can mitigate the burden of these events on regular EMS.

Saudi Arabia has experienced special challenges calling for effective teamwork in the management of disasters and emergencies, such as wars, earthquakes, and major accidents linked to the Hajj pilgrimage over the years. In 2015, 769 pilgrims died in a crowd stampede during Hajj. The outcome of the incident could have been different if the rescuers had the necessary multiagency and collaborative disaster education. This study aims to determine the development of Saudi HCWs’ teamwork during collaboration exercises.

This study employed two methods to gather data: (observational) during three-level-collaboration (3LC) tabletop-exercises and semi-structured interviews, by employing two theoretical models (team development models). The number of participants was (100) HCWs.

The results of these exercises had a positive impact on the functionality of HCWs and helped them prepare for disaster management and mitigation inside and outside of a medical facility. Based on the theoretical framework of the integration of team members, the participants reported that the trans-professional team developed because they understood the scenarios. In addition, the participants underscored they developed their skills and knowledge of disaster management because of the attempts made in scenario one. Furthermore, on the theoretical framework of team maturity, several participants indicated that immaturity in scenario one is because of the team members not having the same knowledge and skills. While in scenario two, they are mature because of training and challenges resulting in individual development.

This study focused on determining the development of healthcare teamwork during collaborative exercises. HCWs were exposed to two scenarios. The tabletop training enabled HCWs to gain the maturity in team building and disaster management. Immature and overripe HCWs cannot easily embrace teamwork. In addition, the public should be made aware of disasters that may come their way. Continuous training of HCWs and creating public awareness are essential parts of disaster management.

The COVID-19 pandemic also raged in Fukushima Prefecture, Japan. Moreover, it forced a response to the medical crisis just as much as the disaster. After the Great East Japan Earthquake, disaster response system development progressed in Fukushima Prefecture. The relationship between the DMAT and the Prefectural Medical Health and Welfare Department was becoming more assertive.

However, as the disaster response members became fixed, there was an urgent need to develop new young human resources.

Meanwhile, flood damage caused by Typhoon No. 24 occurred in September 2018. It was the first time since the Great East Japan Earthquake that a disaster countermeasures headquarters was set up within the prefectural office. In that response, we discovered young talents. Furthermore, they nurtured in response to the medical crisis caused by the COVID-19 pandemic.

In recent years, the main elements of disaster response required support for continuing medical care and securing public health. Unfortunately, however, these things are insufficient both as medical education and as postgraduate education. Therefore, few human resources are interested in disaster medicine and taking action. In addition, it is also a fact that, like surgical operations, if disasters are not responded to, they will not come to fruition. The response to this pandemic is genuinely an opportunity for human resource development. Taking advantage of this crisis to develop new human resources can be a blessing.

Nepal’s reported risk to Climate Change adaptation reported by Notre Dame Global Adaptation Initiative Index (ND-GAIN Index) 2020 is 5.2 and ranked 71% high in country vulnerability, 126th of the total 180 countries. According to the report of the Ministry of Forest and Environment in 2018, flood is one of the principal climatic hazards in Nepal. According to the Department of Health Services Nepal, 3,500 children die each year due to water-borne diseases (WBD). The objective of this study is to analyze the climate change impact focusing on floods and WBD for the past two decades.

A secondary data analysis method was used to analyze the impact of floods and WBD attributed to climate change. Data was obtained from Nepal Risk Reduction Portal (http://drrportal.gov.np), Nepal Annual Health Reports (2000-2021), Nepal Government Vulnerability and Risk Assessment reports, and reputable journals.

Climate-related disasters have increased by six-fold in 2021, as compared to 2000 in Nepal. Among the people affected by disasters 71% of them are due to floods. Flood events during the last 21 years have a fluctuating trend with highest and lowest events observed in 2017(388) and 2015(15) respectively. Heavy and unusual rainfall patterns as a major indicator of climate change is likely to cause riverine floods and flash flooding by melting the glaciers. The incidence of diarrhea disease rose by 4.39% for 1°C increase in ambient temperature in data analysis collected on temperature and diarrhea from July 2002-June 2014.

The findings suggested that increased temperatures in Nepal might have induced a change in flood events and the incidence of WBD (such as diarrhea), thus emphasizing the importance of climate change adaptation plans, flood risk management, and WBD surveillance to be prioritized and put in place to mitigate the effects of climate change.

The Medical-Psychological Emergency Cells (CUMP) are integrated in France into the pre-hospital Medical Emergency Services (SAMU). The objective of this study aims to show an integrated course of care and the major interest of the inclusion of the Psychological Cells in the structures of the SAMU.

The CUMP of the Toulouse Area is made up of Psychologists, Nurses, Psychiatrists, professionals or volunteers sent or put on alert. Interventions take place immediately under the aegis of the prehospital medical care department or in a deferred manner within the first 48 hours. All subjects having at the time signs of acute stress, peritraumatic dissociation, behavioral disorders, are invited to follow-up consultations within 48 to 72 hours. The objective of this work is to show the continuity of care and the pathway of patients coordinated from an emergency call to several months beyond.

During 2021, 222 situations were handled, either individually or collectively. 94 were assaults (physical, psychological, or sexual), 55 were accidents (traffic accident, fire, explosion, etc.), 50 were confrontations with death (attending a suicide, death, etc.), 13 were traumatic bereavements, and 10 a context of a health disaster. Overall, 1,109 patients were seen immediately on site, 192 post-immediate in less than 48 hours and 197 had repeated individual consultations.

1) The participation of the same professionals in immediate and post-immediate care makes the prevention of chronic post-traumatic stress more effective.

2) The articulation with the care structures for lasting psycho-trauma establishes consistency in the course of care: sensitivity to signs of distress, dissociation or stupefaction.

3) The links with the pre-hospital emergency medical aid service make emergency specialists aware of the psychological component of traumatic events.

Proper packing technique is crucial to minimize blood loss and successfully stop fatal junctional (axilla, groin, and neck) bleedings. Several medical simulators and mannequins are used to teach techniques for manual pressure and wound packing. Live tissue training (LTT) using animal models represents a high-fidelity simulator, but the number of times massive hemorrhage can be practiced is limited due to cumulative blood loss of the animal. Moreover, the animal’s potent coagulation limits the reuse of injuries. The study aimed at creating and validating a reproducible and repeatable exsanguination simulator to be used for high-volume training.

This study was approved by the regional animal ethics committee (Dnr 17953-2020). All animals were fully anesthetized throughout the duration of experiments. A repeatable exsanguination simulator using live tissue (RESULT) was created using commonly available materials to add reproducible junctional bleedings in an LTT context. A canister of porcine or bovine blood is connected to a standard gravity infusion set with roll clamp and pump chamber removed and added to a 100 cm 3-way stopcock connected to a 60 ml syringe. The free end of tubing is surgically inserted into the hind leg of a pig and placed inside a 5 cm long and 5 cm deep wound cavity. The simulator was evaluated with instructors controlling the rate of bleeding using the syringe while training participants packed the wound.

According to the instructors, participants benefited from the additional training made possible by using RESULT. Instructors received direct feedback on applied manual pressure and packing through the resistance of the syringe plunger. Moreover, participants found the increased number of repetitions beneficial to their training. The animals had no change in status from the multiple bleeding interventions.

Both participants and instructors found the novel bleeding model useful for high-volume training in stopping massive junctional bleeding.

ASEAN Leaders’ Declaration on Disaster Health Management (ALD on DHM) (2019-2025) was adopted by the ASEAN Summit in November 2017 to strengthen the DHM system at national and regional levels, and the Plan of Action (POA) to implement the ALD on DHM was endorsed by the ASEAN Health Ministers Meeting in August 2019. Knowledge Management (KM) is one of the five priority areas in the POA with the relevant targets including the regional academic network establishment, organization of regional academic conferences, publication of the ASEAN academic journal on DHM, and so forth. The ARCH Project Phase2 (ARCH2), which started in January 2022, focuses on aiming to support implementation of this POA.

The ARCH2 will support the establishment of the ASEAN Academic Network on DHM (AAN-DHM) and the ASEAN Institute for DHM (AIDHM). In addition, the ARCH2 will support the promotion of academic activities on DHM which shall be conducted under the AAN-DHM in collaboration with the AAN member institutes and AIDHM.

Terms of Reference (TOR) of AAN-DHM was endorsed by the 15th ASEAN Health Ministers Meeting in May 2022. Afterward, the National Focal Point (NFP) institutes for the AAN were nominated among all ASEAN Member States (AMS). The first meeting of representatives of the NFP was held in September 2022 to discuss several areas such as governance of the AAN-DHM, the organization plan for the ASEAN Academic Conference (AAC), and the publication plan of the ASEAN Journal. Simultaneously, the TOR of the AIDHM was prepared for further discussion of its establishment.

The AAN has already been established to initiate the preparation of its academic activities. The AAC on DHM is scheduled to be held in November 2023 in Indonesia as the first regional event for accelerating academic activities toward enhancing KM on DHM in the region under the AAN-DHM.

The Novel Integrated Toolkit for Enhanced Pre-Hospital Life Support and Triage in Challenging and Large Emergencies (NIGHTINGALE) project was awarded to a consortium to design an innovative toolkit featuring different technological solutions for prehospital mass casualty incident (MCI) response. Translational science (T) methodology was undertaken to develop evidence-based guidelines for MCI response.

The consortium was divided into three work groups (WGs) MCI Triage, Prehospital Life Support and Damage Control and Prehospital Processes. Each WG previously collected data through the project T1 scoping review stage to provide the foundation for the initial T2 modified Delphi draft statements to present to WG internal focus groups for content and NIGHTINGALE study objectives. Their refined statements proceeded to WG specific external focus groups for further editing to be clear and concise for the following modified Delphi consensus rounds. Final WG statements were presented to modified Delphi experts for their consensus using the STAT59 platform with instruction to rank each statement on a seven-point linear numeric scale, where 1 = disagree and 7 = agree. Consensus amongst experts was defined as a standard deviation ≤1.0.

After three modified Delphi rounds, 18 of 24 statements attained consensus by the MCI Triage experts, eight of 25 by the Prehospital and Life Support and Damage Control experts, and 23 of 28 by the Prehospital Processes experts.

The three work groups will utilize consensus statements during the NIGHTINGALE project T3 phase to create evidence-based MCI response guidelines.

Postgraduate education is important in preparing and enhancing health professionals for the practice of disaster and terror medicine. The World Association for Disaster and Emergency Medicine (WADEM) has formulated a standardized international perspective for education and training in disaster medicine and health. Notwithstanding, there continues to be a reported gap in competency-based training in disaster and terror medicine internationally, particularly across Asia Pacific, which is a known vulnerable region. We report on a new Graduate Diploma in Disaster and Terror Medicine, to be expanded to Master level in 2024. The course is delivered mainly online to a multidisciplinary international audience. This paper summarizes the development of the course and outlines the key influences that have contributed to the design of the course.

A survey of the critical care workforce conducted by the Department of Critical Care at the University of Melbourne in early 2020 identified the need to develop education in disaster and terror medicine. A market and competitor analysis identified there was a gap in clinician focused courses offered in Australia and internationally. Based upon these results, a new course was developed to meet these needs.

Based on the results of the survey and feedback from expert stakeholders, the new postgraduate courses in disaster and terror medicine were developed. They offer both core and elective subjects, utilizing a modular approach with supervised simulation and practical training. The courses incorporate problem-based learning, the principles and practices of online education and advances in simulation-based learning, providing both a public health and clinical lens.

The nested suite of postgraduate disaster and terror medicine courses at the University of Melbourne is at the forefront of learning within this field and meets the contemporary needs of health professionals who practice disaster and terror medicine

Midway through the ‘Sendai Framework for Disaster Risk Reduction 2015-2030’, many nations are spending time, money and effort to enhance their level of preparedness when facing disasters, on the other hand communities, countries and even continents are being left behind. This study was conducted aiming at evaluating the level of disaster preparedness and response of Tunisian University Hospitals.

This is a cross-sectional nationwide study conducted in Tunisia, from November 2020 to April 2021. Including nine Tunisian University Hospitals and using the Hospital Safety Index. The data were analyzed using the 'Module and safety index calculator'.

This study showed that seven out of the nine University Hospitals were assigned the ‘B’ category of safety with overall safety indexes that ranged between 0.37 and 0.62. Also, four out of nine University Hospitals had safety scores less than 0.20 regarding their emergency and disaster management.

This is the first study to evaluate disaster preparedness and response of university hospitals in Tunisia and in north Africa. It showed that the lack of knowledge, resources and willingness, are the most important issues that need to be addressed in order to enhance the preparedness of Tunisian hospitals.

Exposure to toxic fumes from an industrial chemical fire may not only lead to airway burns and inhalational injury but also toxic exposure via the transdermal route.

A 45-year-old gentleman presented with dyspnea two hours after a ten-minute exposure to toxic fumes while fighting an industrial chemical fire without personal protective equipment. He reported voice hoarseness and chest tightness. Nasoendoscopy demonstrated paranasal sinus soot and significant upper airway edema. Awake fiber-optic intubation was performed for prophylactic airway protection in the Burns ICU but bronchoscopy did not reveal any inhalational burns.

However, the patient developed worsening lactic acidosis (serum lactate 2.8mmol/L to 8.1mmol/L with pH 7.28) within 12 hours post-exposure. Carboxyhemoglobin was 0.9%. Toxicology was consulted for suspicions of transdermal HAZMAT contamination, in particular cyanide given the profound lactic acidosis. The patient was given two doses of hydroxocobalamin and brought to the Hospital Decontamination Unit for de-gowning and thorough wash-down. The chemical scan meter showed high levels (352IU) of an unknown chemical on his skin pre-decontamination, which could not be detected post-decontamination. Lactate improved to 5.0mmol/L within two hours post-decontamination while acidosis resolved at eight hours post-decontamination. The patient was extubated and discharged without sequelae.

To our knowledge, no other human cases of transdermal cyanide poisoning have been reported. Cyanide interferes with mitochondrial oxidative phosphorylation pathways to cause toxicity and death if untreated. However, its effects via transdermal exposure are often delayed compared to exposure via more conventional inhalational routes. This makes recognition difficult and compounds the challenge of long turnaround time for blood cyanide tests. Increased transdermal absorption is possible through intact skin if moistened by sweat.

The potential for transdermal HAZMAT absorption from exposure to toxic fumes is underrecognized. It is crucial to maintain vigilance given the challenges in diagnosing transdermal cyanide toxicity and importance of initiating treatment early.

Triage in a disaster scenario centers around doing the greatest good for the greatest number of people. There are a variety of triage systems, and to this date there is no US national endorsement of one system because triage is a dynamic procedure and there is no fixed rule for it. The Simple Triage and Rapid Treatment (START); Sort, Assess, Life-saving interventions, Treatment/Transport (SALT); Sacco; CareFlight; JumpSTART; and Pediatric Triage Tape (PTT) triage systems are discussed with emphasis on how they perform.

There are approximately 20 adult and two pediatric triage systems that exist for primary disaster triage. The focus is on six primary triage systems. A literature search was performed using textbooks and original research.

A basic assignment to immediate, delayed, minimal, or expectant can sort a large group of casualties in a matter of minutes, but improper category assignment can lead to under-triage or over-triage.

When assessed by a trained paramedic arriving at a Level 1 pediatric trauma center, SALT was found to be the most accurate triage system at 59% compared to JumpSTART, CareFlight, and TriageSieve. All triage systems exhibited under-triage rates of at least 33% and SALT had the highest over-triage rate at 6%. In another study, the START triage system was found to be 85% sensitive and 86% specific in predicting critical injury in designated trauma patients.

Mass casualty incidents are unfortunately becoming more common as the increasing numbers of violent attacks produce an overwhelming number of victims. One triage process may not work in all disasters, but first responders should be trained to evaluate for the most critical patients in a sea of evolving patient presentations. Furthermore, randomized, controlled trials in real-world conditions are nearly impossible to perform given the specific circumstances of disasters.

Children differ from adults, developmentally, physiologically, and psychologically. Additionally, children lack legal agency, and thus rely on adults to gain access to the healthcare system and other resources. Though children are often the face of disaster relief, the desparate needs of children can fall through the cracks during disaster response. Many training programs for disaster responders do not give pediatric concerns and issues the appropriate attention they deserve. Pediatric disaster medicine is often minimally addressed in emergency medicine residencies and prehospital provider training. Furthermore, pediatric disaster supplies and protocols are often lacking and insufficient to meet the needs of children during and after disasters.

This is a modified Delphi study. An initial set of pediatric disaster medicine competencies from a systematic review of PubMed, EMBase and the gray literature will be presented to an initial group of Subject Matter Experts (SMEs) comment, additions, and edits. This modified set of competencies will then be distributed to a large group of providers with experience in the field. Through a series of surveys, each competency in the curriculum will be rated. Those competencies which achieve a high overall rating will be reported.

Data collection and analysis expected to be completed by April 2023.

This modified Delphi study will establish and prioritize a set of core competencies for pediatric disaster response based on expert recommendations. The use of such gold standard core competencies to develop discipline-role-specific pediatric disaster training can increase pediatric disaster workforce capacity and competency critically needed to improve pediatric disaster response.

Casualties need to be triaged, stabilized and treated before they can be evacuated to the hospital. However, when Field Medical Teams (FMTs) arrive at the First Aid Post (FAP), the staff has to perform outside of their usual settings. There are also differences in the conception of medical operations, organization of the FAP, availability of medical equipment and supply, as well as means of communication, command, and control which can affect their performance and eventually the optimal survival of casualties during a mass casualty incident.

Guided by Kern’s model for curriculum development, Disaster Medical Responder's Course (DMRC) was developed. The curriculum focused on disaster response operations and processes; roles and responsibilities; command, control and communication; as well as supplies and resources. The content was taught through interactive lectures and skill stations. Course evaluation was based on the Kirkpatrick Model. A feedback form evaluated the reaction of the participants as to whether the course was relevant, if they learnt new knowledge and skills, and if they could apply these to their roles as FMTs. A tabletop exercise evaluated learning with participants working collaboratively.

DMRC has been sustainable since 2013 with six to eight courses per year. There had been numerous revisions of the content and delivery to keep up-to-date with the latest concept of operations, best practices from the literature, as well as educational methodologies. The last update was in 2020 in response to the COVID-19 pandemic where course schedule and mode of delivery were adjusted to comply with the safe management measures.

FMTs will require training so they can function to their maximum capacity and capability. In Singapore, DMRC is the course for this unique and important training of FMTs. DMRC plays a pivotal role in ensuring the preparedness and operational readiness of FMTs for mass casualty incidents.