Explosive hazards like landmines are known to contaminate over sixty countries and continue to threaten the health of affected communities across generations. The current study is the first to consider the impact of landmines and explosive remnants of war by drawing on global casualty data to determine mortality patterns.

This study is a retrospective analysis of secondary multi-source data on over 100,000 explosive hazard casualties from 17 low and middle income conflict-affected countries. This data was collected from mine action centers, international non-governmental organizations, and international bodies (e.g., United Nations), and include surveillance data, retrospective and prospective survey, and data collected through organizational operations.

The global case fatality rate was 38.8 deaths per 100 casualties. Males represented 87.4% (n = 34,642) of those killed, however females had higher odds of death when involved in an explosive incident (OR = 1.29, 95% CI: 1.24 – 1.34, p < 0.01). Adults experienced higher odds of death compared to children (OR = 1.60 95% CI: 1.55 – 1.64, p < 0.01). Case fatality ranged between countries with Lao PDR, Angola and Ukraine the countries with the highest proportion of deaths. Improvised explosive devices (IEDs) and ERW had higher odds of death compared to antipersonnel landmines (OR = 1.78, 95% CI: 1.67 – 1.91, p < 0.01; OR = 1.55, 95% CI: 1.50 – 1.60, p < 0.01).

Mortality from landmines and other explosive hazards remains a public health issue in conflict impacted countries. This study addresses the lacunae of global data for explosive hazard casualties and provides an understanding of how fatal injury is endured. Adult males represent the most deaths globally, however case fatality ranges across conflicts. ERW and IED had the highest risk of death. These findings underscore the need for a global health response and strengthen advocacy measures for conflict affected communities as well as weapons prohibition campaigns.

Sri Lanka has been divided into 26 districts. These 26 districts are Colombo, Gampaha, Kalutara, Galle, Matara, Hambanthota, Trincomalee, Batticaloa, Ampara, Jaffna, Mullaitivu, Kilinochchi, Mannar, Vavuniya, Kandy, Matale, Nuwara Eliya, Anuradhapura, Polonnaruwa, Rathnapura, Kegalle, Badulla, Monaragala, Puttalam and Kurunegala. Ten key natural disasters have been identified in Sri Lanka as important to develop response capacity. These natural disasters are coastal erosion, cyclones, droughts, earthquakes, epidemics, floods, forest fires, landslides, lightning and tsunamis. Five battalions of the Sri Lanka Army Medical Corps (SLAMC) have been established in various parts of Sri Lanka. These battalions are named 1 SLAMC, 2(V) SLAMC, 3 SLAMC, 4 SLAMC and 5 SLAMC. The Army Hospital, Army Base Hospitals (ABH), and Medical Reception Stations have been located in various parts of Sri Lanka

Each battalion and hospital have Emergency Medical Teams (EMTs) for response to disasters. An EMT consists of: one medical officer, two nurses, two nursing assistants and one ambulance with a driver. There are two EMTs in each battalion and each ABH. The Army hospital has three EMTs.

1 SLAMC is responsible for responding to disasters in Colombo, Gampaha, Kalutara, Galle, Matara, Rathnapura, Kegalle, Kurunegala and Puttalam. 2(V) SLAMC is responsible for responding to disasters in Hambanthota, Kandy, Matale, Nuwara Eliya, Badulla and Monaragala. 3 SLAMC will respond to disasters in Anuradhapura, Vavuniya, Mannar and Mullaitivu. 4 SLAMC will respond to disasters in Jaffna and Kilinochchi dis. 5 SLAMC is responsible for disasters arising in Polonnaruwa, Trincomalee, Batticaloa and Ampara. When disasters happen in adjacent districts, hospitals will respond to those disasters.

EMTs will be deployed to the disaster site as soon as possible and do treatments for casualties by staying seven days. The number of EMTs depends on the magnitude of the disaster.

The challenges that the health systems face in the last years increased exponentially. No matter if we are talking about the impact of the COVID-19 pandemic or the Russian military action in Ukraine, the European health ecosystem is facing new problems. In the light of these uncertainties, we assessed which could be the next trends that can impact the healthcare systems, in order to better prepare and adapt to the new contexts.

Using two foresights exercises (FSE), one in 2018 and the second one in 2022, we identified the most important trends in the political, economic, social, technological, security, environmental and medical sectors that could have an impact on health.

53 people participated in the first FSE and 40 in the second one. The respondents identified cyber security, an increased reliance on digital technologies for communications, CBRNE management of the patients, centrally coordinated attacks, demographic aging, reduced economic resources, violence against emergency medical staff and the increased need and demand for psychosocial support as the most important trends. Moreover, they considered that wars, hybrid threats, the fake news, pandemics and the influence of artificial intelligence could impact the healthcare systems.

Many of the trends identified in 2018 as having a possible impact on the health system proved to be relevant four years later. Therefore, we consider the FSE a relevant tool in foreseeing the main areas that could have an impact on health and its results could guide the preparedness for the future.

The Network Of practitioners For Emergency medicAl systems and cRitical care project (NO-FEAR) was funded through an innovative call from the European Commission contained in the Horizon 2020 2016-2017 work program dedicated to Safe Societies - Protecting the freedom and security of Europe and its citizens.

The call assumed that professionals from many different sectors, including medical emergency teams, had little means and time to monitor innovation and research that could be useful to them. Moreover they have little opportunity to interact with academia or industry on these issues.

The project, funded in 2018 under a Coordination and Support Action Call, brings together practitioners, academia, policymakers and the industry involved in the response to medical emergencies, crises and health threats.

Since the very beginning, NO-FEAR has mobilized the vast network created during the project, to share real-time knowledge, experiences, lessons observed and challenges.

Qualitative methodology

This article intends to present the stages of the project during its journey where the creation of a network of practitioners dedicated to medical emergency services according to the three pillars methodology set in the project and which took place during the Covid 19 pandemic constituted a space to test innovative approaches in the relationship between end user and industry, in the identification of gaps and needs in the field and in responding to them, often going beyond the mandate of the project, creating a community capable of acting at the intersection of policymaker, companies and citizens.

The case of NOFEAR demonstrates how, thanks to a European project, created a network of individuals and businesses that interact and or collaborate with each other can accelerate knowledge driven and sustainable growth of multidisciplinary ecosystems able to mitigate the fragmentation of the emergency medical systems.

Disasters have the potential to cause a surge of patients, some of which may require admission to an intensive care unit (ICU). Due to the high resource requirements of ICUs, normal standards of care may need to be altered to treat more people with limited resources, a care model referred to as crisis standards of care (CSC). The pragmatic implementation of CSC in ICUs due to patient surges from disasters has not been well explored in the literature.

This scoping review guided by the Joanna Briggs institute methodology for scoping reviews searched medical databases including CINHAL, PubMed, ProQuest and SCOPUS. Articles were included if they reflected on the actual implementation of CSC delivered in ICU as a result of a patient surge from a disaster. Quantitative data was extracted into tables and qualitative content was thematically analyzed.

A total of 17 papers were included in the review. The disaster event that dominated the results was COVID-19. Most papers relayed subjective accounts of how care models were impacted by patient surges. Common themes included the repurposing of other clinical areas to accommodate ICU patients, resource shortages (particularly ventilators) and staff shortages. Moral strain was felt when processes such as palliation and treatment modality were altered due to resource restrictions.

This review highlights the dearth of high-quality research in implementing CSC in ICUs. Understanding the pragmatic experiences of CSC shows not only the logistical insufficiencies that have been experienced, but the moral and clinical repercussions that these insufficiencies have caused. Inadequate preparation for future disasters, particularly short notice disasters, may lead to further implementation of CSC resulting in poorer outcomes for patients and detrimental impacts on healthcare workers. More research into the practical application of CSC in ICU may help mitigate the impact of patient surges from disasters.

In the context of COVID-19 outcomes, global data has deduced a gender bias towards severe disease among males. The aim of this study is to compare morbidity and mortality during two years of the COVID-19 pandemic in female and male patients with COVID-19, as well as to assess length of stay, health seeking behavior time after positive diagnosis, and vaccination differences.

A retrospective-archive study was conducted in Israel from March 1st (patient zero cases) to March 1st, 2022 (two consecutive years). Data were obtained from the Israeli Ministry of Health's (MOH) open COVID-19 database.

The findings indicate female infections are 1.12 times more likely, across almost all age groups, apart from the youngest (0-19) age groups. Despite this, the relative risk of severe illness, intubation and mortality is higher among men. In addition, our findings indicate that the mean number of days taken by unvaccinated men from positive diagnosis to hospital admission was greater than among unvaccinated women among the deceased population.

Targeted approaches including risk communication which take into consideration sex and gender and the intersecting factors are necessary to engage in the fight against COVID-19 for ensuring the most effective and equitable pandemic response.

This study evaluates the perceptions of preparedness and willingness to work during disasters and public health emergencies among 213 healthcare workers from 10 ministries of health hospitals in the southern region of Saudi Arabia, which is exposed to the risk of disasters such as flash floods in wadis, fires, sandstorms, armed conflicts at the border and ongoing waves of COVID-19 pandemic.

This study employed a quantitative research design by using a survey (Fight or Flight).

The results showed that participants' willingness to work unconditionally during disasters and emergencies varied based on the type of condition: natural disasters (61.97%), seasonal influenza pandemic (52.58%), smallpox pandemic (47.89%), SARS/COVID-19 pandemic (43.56%), special flu pandemic (36.15%), mass shooting (37.56%), chemical incident and bombing threats (31.92%), biological events (28.17%), Ebola outbreaks (27.7%), and nuclear incident (24.88%).

Among several factors that determine healthcare workers’ willingness to work during disasters and public health emergencies, appropriate knowledge and skills to confidently manage an incident and the assurance of their families’ safety are two decisive factors. Although we could only find a significant correlation between education and willingness to work during emergencies, previous reports have confirmed a significant correlation between education, age, and years of experience and the perception of hazards and fear and consequently willingness to work under threatening circumstances. While unsuccessful management of disasters and emergencies may be the result of organizational shortcomings and resource scarcity, healthcare workers’ lack of knowledge, skills, and confidence and emotional distractions due to uncertainty about their own safety and that of their families may also play a significant role. Besides educational initiatives, which increase staff members’ confidence through knowledge acquisition and skill improvement, other measures, which guarantee their families’ safety and well-being during an emergency, should be established and implemented.

People with hearing disabilities (PwHDs) often do not receive the warnings sent out to the general community during emergencies. Our goal was to identify the obstacles preventing PwHDs from accessing vital information in routine circumstances and during general emergencies.

This study was conducted from November 2018 through July 2020. We used a mixed-methods approach. The qualitative portion consisted of a standardized, open-ended interview with 19 PwHDs from various socio-economic backgrounds, religions, areas of residence and levels of hearing disability about coping with emergency situations in Israel. Grounded theory was used for analysis of the findings. The quantitative portion consisted of a cross-sectional survey of 288 PwHDs focused on perceptions of their self-efficacy in dealing with emergencies, methods of communication and accessibility of services. Using the Qualtrics survey platform with Israel sign language videoclips that included subtitles in straightforward Hebrew increased the participation. The statistical analysis was conducted using SPSS ver.23.

Most respondents explained that their responses differed depending on whether the emergency is collective or personal.

1. Collective emergencies: Events such as earthquakes or wars that affect everyone. Most solutions provided to the general population are not accessible to or suitable for PwHDs.

2. Private emergencies: PwHDs often encounter personal emergencies such as difficulty asking for help on the street, the inability to contact call centers or the difficulty in obtaining accessible information from organizations.

The distinction between types of emergencies requires the development of different resources for dealing with routine issues and public emergencies. The latter affect PwHDs less than private emergencies. Standards of accessibility must be established for places providing services both during the day and at night, such as emergency rooms, telephone service centers, clinics, etc. These standards are the basis that which will allow for PWHDs to communicate independently.

Effectively responding to an incident across jurisdictions and coordinating with regional and jurisdictional partners is extremely challenging. The COVID-19 pandemic exemplified the need to develop an operational structure which would serve as a regional medical operations hub. Although there has been guidance for using a Medical Operations Coordination Cell (MOCC), the concept can be difficult to apply and develop for the specific needs of varying regions and jurisdictional entities.

The Mountain Plains Regional Disaster Health Response System (MPRDHRS) has developed a Medical Emergency Operations Center (MEOC) to address gaps in response coordination efforts across the six state Region VIII within the United States. This MEOC has been developed to synchronize and integrate existing systems and processes to manage the medical components of a response. This center is similar to other MOCC concepts. However, in a novel approach, the MPRDHRS organized a response framework that focuses on functional roles based on the specific needs of our region with response coordination and personnel availability. This organization is similar to the use of emergency support functions in a jurisdictional EOC.

While developing the MEOC, a local Lean team collaborated with the MPRDHRS on continuous improvement initiatives. Drills, workshops, and exercises were used to test the MEOC and offer just in time training to MPRDHRS members to staff different positions within the MEOC. The MEOC was activated for an incident response within the MPRDHRS region with many lessons learned.

The MEOC is a new, developing system augmented to meet the needs of regional partners. The system was developed using feedback and ideas from partners, process improvement experts, and internal team members. Additionally, lessons learned from incidents and applications of drills, workshops, and exercises will be shared to leverage within any organization.

The Merriam-Webster Dictionary describes culture as “the customary beliefs, social forms, and material traits of a racial, religious, or social group.” Also noted are: “the characteristic features of everyday existence (such as diversions or a way of life) shared by people in a place or time.” Much has been written about the impact of culture on disaster risk and response. However, the issues are complex and multifactorial.

The author/presenter extensively reviewed current qualitative and quantitative literature regarding the impact of culture on disaster phases of mitigation, preparedness, response, and recovery.

There are over a thousand publications on the issue of culture and disaster. While it is clear culture plays a role in the phases of disaster management, there continues to be debate as to the weight which should be placed on culture, or whether it can be seen as separate from other elements which significantly impact phases of disaster, including political, economic, technologic, geophysical, etc.

With subject matter expertise based on lived and academic experience, the presenter plans to utilize a tabletop format to engage small groups in discussion of the above concepts as well as their experiences relating to catastrophes and cultures. The hope is that this format will spur further translational research interest.

The number of backcountry skiers and snowboarder surged in the last years, especially during the COVID-19 pandemic, as ski resorts shut down. Inevitably, this led to an increase in avalanche-related injuries and death. As avalanche rescue device, avalanche airbags are increasingly becoming part of the standard winter mountaineering equipment.

This study provides a review of available data and an updated perspective on avalanche airbags, discussing their function and efficacy to reduce mortality and their limitations.

Causes of death in individuals caught by avalanches are multiple. Airbags seem to reduce mortality by decreasing chances of critical burial, the most determining risk factor. However, there is scarcity of reliable scientific research on the topic, and the way in which airbags reduce mortality and to what extent is still debated. Several elements seem to influence airbags efficacy, and their use still yields several limitations linked to manufacturing, proper use, users education, and risk compensation.

Avalanche airbags seem to be an important tool in reducing mortality in backcountry expeditions. However, more research and standardized data collection is needed to fill the knowledge gap, mountain communities should promote adequate education of winter-recreationists on how to prevent and react to an avalanche, and on the correct use of airbags in combination with already available tools such as transceivers, probes and shovels, and manufacturing companies should ensure higher efficacy of the survival avalanche equipment for better prevention of burial, asphyxia, and trauma.

The use of ketamine in the prehospital setting has increased with EMS providers. Adverse effects of prehospital ketamine administration have not been well-established in the trauma population. The objective of this study was to evaluate the effects of pre-hospital ketamine on trauma patients presenting to a Level 1 trauma center. This study hypothesized that respiratory depression or oversedation from ketamine would increase the number of ED (Emergency Department) intubations.

A retrospective chart review of adult trauma patients receiving prehospital ketamine from 2016-2021 was performed. Patients with severe traumatic brain injuries were excluded. A 1:1 propensity match was performed of patients with similar demographics, injury severity, and mechanism of injury who did not receive prehospital ketamine. Univariate analyses were used to compare the groups. The primary outcome was the incidence of intubation in the Emergency Department.

Seventy-four trauma patients who received prehospital ketamine were identified. The average ketamine dose was 39 mg IV and 226.4 mg IM. 35.1% of patients received ketamine for pain while 29.7% received it for agitation. The ED intubation rate was higher in the prehospital ketamine group with 17.6% (n=13/74) requiring intubation as compared with 4.8% (n=3/63) who did not receive ketamine (p=0.03). Patients who required intubation in the ED had higher average doses of both IV/IO (37.7 +/- 4.8 mg vs. 55.0 +/- 24.2 mg) and IM ketamine (196.4 +/- 41.7 mg vs 290.0 +/- 41.3 mg).

ED intubation rate was higher in the ketamine group. Patients that were intubated had received higher ketamine doses on average. Further studies are needed to understand and refine prehospital dosing and indication protocols to allow for more efficacious utilization of pre-hospital ketamine in trauma patients. A multicenter trial is ongoing.

The Irish Paramedicine Education and Research Network (IPERN) is dedicated to collaboratively building research culture and research capacity for out-of-hospital care in Ireland and internationally. IPERN is led by an inter-professional team of paramedics, nurses, doctors, allied health professionals and scientists. IPERN supports clinicians to bridge the theory-practice gap through involvement in research training, knowledge generation, knowledge translation, evidence implementation, policy setting, research partnerships, co-production and research leadership. The aim of this study is to quantitatively describe the activity of IPERN in the first two years of it’s foundation (2021-2022).

This is an observational study and data was collected prospectively throughout 2021 and 2022. Data on event attendance was collated via the Event management software EventBrite and supplemented with minutes from IPERN Committee meetings. Data analysis was performed in Microsoft Excel and comprised descriptive statistics.

The IPERN Team comprises 14 inter-professional members of whom nine (64%) are paramedics. To date IPERN has launched seven special interest groups; Medical, Trauma, Pediatrics, Mental Health, Human Factors, Medical Logistics and Equality Diversity & Inclusion. The network hosted 14 CPD events from March 2021 to November 2022. In terms of research capacity building, the work of IPERN has been presented at six international conferences and the IPERN Team has successfully secured four grants since the foundation of the network.

Due to the complex and multidisciplinary nature of out-of-hospital care a strategic and collaborative approach to research capacity-building is essential. Underpinning evidence-based practice is a strong research culture and it is imperative that all clinicians involved in out-of-hospital care have the opportunity to develop knowledge and expertise. IPERN takes a participatory approach to research and our events provide an open and friendly platform for members to engage in research, building a vibrant research community both in Ireland and internationally.

The pandemic caused by the SARS-CoV-2 virus, which has been rapidly developing globally since the beginning of 2020, has forced individual states to take many restrictive decisions aimed at stopping the pandemic and controlling the crisis situation. In Poland, the strategy of fighting the pandemic in the initial phase covered the entire country and was based primarily on preventive mechanisms to identify and quell the pandemic.

A retrospective analysis was conducted incorporating media and a literature review. This retrospective analysis was performed using legal acts and press resources and other media reports to investigate every province of Poland.

This research describes one element of the state security system tasks, that of securing an appropriate number of hospital beds for COVID-19 patients. The process focused first on establishing both the purpose and tasks of dedicated hospitals followed by discussions of the potential problems related to the functioning of these specialized facilities for patients infected with SARS-COV-2 virus. Primary attention was given to ensuring both the security of the crisis situation and the diligent monitoring of the current epidemic

In order to effectively use human and infrastructural resources, it was crucial to implement objective, unified methods of organization and management, as well as ongoing evaluation of the results of the conducted activity.

The steady increase in the number of natural and man-made disasters causes the need for urgent ambulance aircraft evacuation of seriously injured to the specialized federal medical institutions with appropriate equipment, advanced technologies and highly qualified personnel to provide specialized high-tech assistance to victims. The medical institutions can be located at a considerable distance from the place of emergency.

EMERCOM of Russia, staffed by highly qualified medical personnel, equipped with resuscitating medical modules in airplanes and helicopters (MMA and MMH), has been successfully carrying out medical evacuation of seriously injured in emergency situations to specialized medical institutions for many years (since 2008).

Based on the results of the use of the medical modules, it was proved that their use in mass ambulance aircraft evacuation is fully justified. During the flights, sparing transportation of the injured is provided, complete monitoring and compliance with the continuity of the treatment process. With the use of MMA and MMH, the quality of mass ambulance aircraft evacuation of seriously injured has significantly improved and the delivery time from the lesion to specialized hospitals has been reduced, as well as the lethality of victims.

The analysis of the effectiveness of the use of medical modules showed that the use of modules during the ambulance aircraft evacuation of seriously injured reduces mortality at the pre-hospital stage by 3.3 times, at the hospital stage–by two times (p<0.05).

EMERCOM of Russia introduced into the practice of aviation medical evacuation the medical technology using extracorporeal membrane oxygenation (ECMO) for the rescue of seriously injured.

On the basis of NRCERM, a simulation center has been founded and equipped for the training of aviation medical teams, a training program has been developed for the medical personnel of EMERCOM of Russia participating in ambulance aircraft evacuation of victims in emergency situations.

Tropical cyclones are common weather phenomena occurring during the summer and fall months, primarily impacting coastal areas of the eastern shore of North America and the eastern and southeastern coast of Asia. The injuries often reported in the aftermath of these storms include near drowning, orthopedic injuries, and stress-induced cardiovascular emergencies. However, in the aftermath of Hurricane Ida (August 2021), we saw (and will discuss) an unusual trend of burn injuries.

Anonymized patient data from the regional burn center was reviewed for storm-related injuries in the 30 days post-Hurricane Ida landfall. This retrospective analysis included demographics of the patient population, size of injury (reported in total body surface area [TBSA]), mechanism of injury, and length of stay.

Inclusion criteria (burn injury as a chief complaint during the 30 days following the hurricane) identified 41 patients. Of the 41 patients, (32/41 [78.0%]) were admitted for their injuries. The leading nature of the injuries included flame (25/41 [60.1%) and scald (9/41 [22.0%]). The leading cause of burn injury included generator operations (refueling, gasoline, propane, contact with hot surfaces, etc., (14/41 [34.1%]), debris management (7/41 [17.1%]), and open flame for cooking or lighting (11/41 [26.8%]). Patient ages; median of 43.0 years [0.5 to 79]) with sexual (identity being recorded as) male (32/41 [78.0%]) and (9/41 [22.0%]) female.

Climate change is contributing to the increased frequency and intensity of tropical cyclones. Consequently, strategies such as generator use and reliance on alternative fuel sources for lighting, heating, and cooking, have become more widespread to cope with the temporary interruption of public utilities following a natural disaster. However, these temporary solutions have led to an increased frequency of burn and inhalation injuries. Solutions include campaigns to increase public awareness and an increased clinical readiness to receive and manage more patients with burn and inhalation injuries.

Gunshots and bomb blasts are important causes of injury within conflict zones and extremities are frequently affected. There is a paucity of research on the characteristics and outcomes among civilians with conflict-related extremity injuries.

We performed a prospective cohort analysis utilizing data collected during a randomized trial at two civilian hospitals in Jordan and Iraq between 2015 and 2019. Adult patients who presented within 72 hours of sustaining an extremity injury requiring surgical care were included. We used mechanism of injury (gunshot versus bomb blast) as the exposure and wound closure by day five as the primary outcome measure.

The population was predominantly young men (n=163, 94% male, median age 29 years), injured by gunshots (61%) or bomb blasts (39%). Compared to the gunshot group, participants in the bomb blast group had more concomitant injuries (32/63 [51%] vs 11/100 [11%]; p<0.001), larger wounds (median area 100 cm2 [IQR 50–145] vs 53 cm2 [IQR 25–78]; p<0.001) and more frequent infections (16/63 [25%] vs 13/100 [13%]; p=0.04). Wound closure by day five was achieved in 25% (n=16/63) of the bomb blast group and 74% (n=74/100) of the gunshot group (p<0.001). This difference remained after controlling for confounding factors (OR 4.7; 95% CI 1.6–13.7).

In this first prospective cohort analysis of civilians with acute conflict-associated injuries, those with extremity wounds caused by bomb blasts had worse outcomes than those with gunshot wounds. Our findings may prove useful to inform treatment protocols for civilians in armed conflict settings.

The COVID-19 crisis stressed the medical system and required leaders to rise to the occasion. Some institutions were very successful while others floundered. We saw this at every level of government as well as in healthcare. Applying the principles of crisis leadership and communication (and avoiding pitfalls) will increase our readiness to respond effectively during stressful times.

Literature review and US Centers for Disease Control and Prevention guidelines.

While there is robust literature on the topics of crisis communications and leadership this training is lacking in healthcare circles. This poster aims to introduce the subject and advocate for increased training in Crisis Communications.

The US CDC has developed a freely downloadable training manual, along with tools for rapidly developing a crisis message. Furthermore, a checklist to help with the presentation and a list of communication pitfalls to avoid are included.

Leaders can use these tools to prepare in advance for crisis communications, avoiding common mistakes that reduce communication effectiveness.

Interventions that mitigate hazard exposures offer the most efficient means of reducing disaster mortality. However, such interventions require an evidence base that describes the relationship between hazard exposure dynamics and health risk. Medical practitioners have long used patient specific hazard exposure assessments to determine acute and chronic disease risk and align medical treatment and care. This study compared patient-specific hazard exposure data collected from people seeking healthcare during seven different natural hazard disaster events and compared the minimum patient data set standards recommended at the time.

Patient data collection forms used by primary and secondary health care providers during emergency health and medical responses to seven natural hazard disasters were reviewed. Data fields relating to potential exposure characteristics were recorded and compared to patient data fields used by health services prior to the disaster event. A literature review of definitions of disaster ‘exposure’ adopted by UN disaster management agencies were compared with the health and medical sector.

Only the SARS-CoV-2 disaster consistently assessed and recorded details about patient exposure characteristics. Patient hazard exposure data was typically limited to the time of onset of symptoms and duration relative to hazard impact. Little qualitative or quantitative assessment of the magnitude of exposure to any hazard was included, or patient-environmental data. While variables of hazard and vulnerability were extensively studied, and discussed in scholarly and industry literature, the concept of exposure received comparably little attention.

Building an evidence base to correlate hazard and environmental exposure characteristics with patient health effects must be prioritized, especially for cohorts vulnerable from physiological or co-morbid factors. Such advances can be made through simple inclusions in minimum patient dataset recommendations. Understanding hazard-exposure dynamics are vital for advancing emergency health responses toward early intervention and health protection from future hazards that threaten functioning of whole health systems.

The Dutch Multidisciplinary Guideline for Psychosocial support during Disasters and Crises (2014) contains general principles and recommendations for mental health and psychosocial support (MHPSS) to those affected by disasters, crises or other potentially traumatic events. Changes in the field of MHPSS, ‘new’ types of crises (such as social unrest and long-term crises) as well as new (scientific) knowledge have been identified. A revision of the guideline is therefore necessary to ensure that the document is in line with the current scientific evidence and practice.

The aim of the revision is to regain national consensus on the updated recommendations for providing optimal MHPSS in the event of disasters and crises. Needs and challenges identified in the national field formed the basis for the revision, together with the existing recommendations from 2014. The setup of the revised guideline is in accordance with the Dutch EBRO method [Evidence Based Guideline Development]. The knowledge input was twofold: first, a systematic literature search was conducted in PsycINFO, Ovid Medline, Embase en PTSDpubs. Further, a multidisciplinary working group was formed with representatives from the domains of practice, policy and research. A consensus process was followed to test and revise the guideline.

The literature search yielded 3,845 unique articles and 180 met the inclusion criteria. Based on the scoping review, supplemented with literature and expert knowledge, the recommendations have been updated and revised. The majority of the recommendations are still valid. They have been adapted based on current literature. Knowledge of the two new themes: ‘long-term and creeping crises’ and ‘social media’ is translated into recommendations in the field of MHPSS.

The revision will lead to a more complete starting point for additional guidelines, perspective for action and protocols for specific users and applications.