Industrial disasters can have a myriad of repercussions ranging from deaths, injuries, and long-term adverse health impacts on nearby populations, to political fallout and environmental damage. This is a descriptive epidemiological analysis of industrial disasters occurring between 1995 and 2021 which may provide useful insight for health-care systems and disaster medicine specialists to better prevent and mitigate the effects of future industrial disasters.

Data were collected using a retrospective database search of the Emergency Events Database (EM-DATS) for all industrial disasters occurring between January 1, 1995, and December 31, 2021.

A total of 1054 industrial disasters were recorded from 1995 to 2021. Most of these disasters occurred in Asia (720; 68.3%), with 131 (12.4%) in Africa, 107 (10.2%) in Europe, 94 (8.9%) in the Americas, and 2 (0.2%) in Oceania. Half of these disasters were explosions (533; 50.6%), 147 (13.9%) were collapses, 143 (13.6%) were fires, 46 (4.4%) were chemical spills, 41 (3.9%) were gas leaks, and 34 (3.2%) were poisonings. There were 6 (0.6%) oil spills and 3 (0.3%) radiation events.

A total of 29,708 deaths and 57,605 injuries were recorded as a result of industrial disasters, and they remain a significant contributor to the health-care risks of both workers and regional communities. The need for specialized emergency response training, the potential devastation of an industrial accident, and the vulnerability of critical infrastructure as terror targets highlight the need to better understand the potential immediate and long-term consequences of such events and to improve health-care responses in the future.

This study aimed to design, implement, and evaluate a training program on nursing students’ disaster response self-efficacy.

This study was conducted using a pre-test, post-test, and follow up design. A total of 92 nursing students participated in the study. The developed program was implemented both theoretically (online) and practically (in person). Nursing students’ disaster response self-efficacy was measured using the Disaster Response Self-Efficacy Scale that was filled out 1 week before the intervention, and 2 months after the intervention by the students. The students’ satisfaction with the program and their views on the program were also surveyed.

Overall score and all items score had significant improvement in short-, and long-term except in 1 item (item 22). The highest increase in score was related to practical items and referral for psychiatric treatment (items 7, 8, 10, and 18) and the lowest increase was related to communication and ethical skill items (items 20, 21, and 22). It is possible that the students had a higher perception of communication and ethical skills even before the training. Most of the students were satisfied with the program.

A training intervention that can provide theoretical materials online, as well as face-to-face practical programs, can increase nursing students’ disaster response self-efficacy.

The use of chemical, biological, radiation, and nuclear (CBRN) weapons is not new, and though rare, it is an issue of concern around the world due to their ability to cause large-scale mass-casualty events and their potential threat to global stability. The purpose of this study is to explore the use of CBRN weapons by non-state actors through analysis of the Violent Non-State Actor (VNSA) CBRN Event database, and aims to better inform health care systems of the potential risks and consequences of such events.

Data collection was performed using a retrospective database search through the VNSA CBRN Event database.

A total of 565 events were recorded. Five hundred and five (505) events (89.4%) involved single agents while 60 events (10.6%) involved multiple agents. Fatalities numbered 965 for chemical agents, 19 for biological agents, and none for radiological and nuclear events. Injuries numbered 7,540 for chemical agents, 59 for biological agents, 50 for radiological events, and none for nuclear attacks. Fatality and injury per attack was 2.22 and 17.37, respectively, for chemical event agents and 0.15 and 0.48, respectively, for biological event agents.

Violent Non-State Actors were responsible for 565 unique events around the world involving the use of CBRN weapons from 1990-2020. The United States (118), Russia (49), and Iraq (43) accounted for the top three countries where these events occurred. While CBRN events remain relatively rare, technological advances have the potential to facilitate the use of such weapons as part of a hybrid warfare strategy with significant repercussions for civilian health and health care systems.

Disaster Medicine (DM) requires skills, knowledge, and prior experience that are rarely put to test by health care providers. Pediatric DM presents unique challenges in terms of both knowledge and practice.

An anonymous survey consisting of demographic and five-point Likert scale questions was administered to physicians, nurses, and other medical personnel from Israel’s major medical emergency teams who were deployed to respond to the refugee crisis in Ukraine. This included teams from the Hadassah and Tel Aviv Sourasky Medical Centers and the Israel Ministry of Health.

Of the 171 members of the medical teams deployed on the Ukraine border, a total of 105 responses were obtained (61.4%) from 61 physicians, 50 nurses, and 12 other health care providers. The teams were composed of pediatricians (31.6%), internal medicine physicians (21.6%), Emergency Medicine and intensive care physicians (18.0%), and 31.0% other specialties.

For 60% of the participants, this was their first deployment, and 78% had received no training in DM. Members rated the need for DM training at 4/5 (IQR 3-5). Forty-nine (49) members (46.6%) were not briefed on situational awareness and 97 members (89.5%) were not trained in the recognition of acute stress reactions. The responders also rated their concerns about providing medical aid to children at 2/5 (IQR 1-3). A medical clown was part of the teams 42.8% of the time; the presence of clowns was rated at a median of 4/5 (IQR 4-5). The team members underscored the need for more targeted training in DM at 5/5 (IQR 3-5).

The findings highlight the need for the formulation of a disaster education model that includes pediatric DM.

Disaster Medicine (DM) is defined by Koenig and Shultz as the “disciplines and organizations involved with governmental public health, public and private medical delivery including Emergency Medical Services (EMS), and governmental emergency management.” The Accreditation Council for Graduate Medical Education (ACGME) sets curriculum requirements and standards for Emergency Medicine (EM) residencies and EMS fellowships, which include a limited portion of the DM curriculum topics recommended by the Society of Academic Emergency Medicine (SAEM). The ACGME does not currently approve DM fellowships, as DM is not recognized as a subspecialty by the American Board of Medical Specialties (ABMS). This lack of nationally standardized guidelines for DM training leads to variability in disaster-related knowledge and skills, even among physicians trained by ACGME-accredited programs.

The objective of this study is to analyze the DM components covered in EM residency and EMS fellowship in the United States and compare those to SAEM DM fellowship curriculum guidelines.

The DM curriculum components of EM residencies and EMS fellowships were evaluated, using the SAEM DM curriculum as a control. Overlapping topics, as well as gaps between the programs, were analyzed using descriptive statistics.

Of the DM curriculum components developed by SAEM, EMS fellowship covered 15 of 19 (79%) major curriculum components and 38 of 99 (38%) subtopics, while EM residency covered seven of 19 major curriculum components (37%) and 16 of 99 (16%) subtopics. Together, EM residency and EMS fellowship cover 16 of 19 (84%) major curriculum components and 40 of 99 (40%) subtopics.

While EMS fellowship covers a large portion of the DM major curriculum components recommended by SAEM, there are several important DM subtopics that are not covered either in EM residency or EMS fellowship. Furthermore, there is no standardization for the depth and manner that DM topics are addressed in either curriculum. Time constraints in EM residency and EMS fellowship may also prevent extensive review of important DM topics. Disaster Medicine covers a distinct body of knowledge, represented in the curriculum subtopics, that are not covered in either EM residency or EMS fellowship. The development of an ACGME-accredited DM fellowship and recognition of DM as a distinct subspecialty could allow for more effective DM graduate medical education.

Sports venues foster community and support local economies. Due to their capacity to host hundreds to thousands of spectators, sports venues are vulnerable to becoming targets of terrorism. Types of venues targeted, regional trends, and methods of attack employed world-wide have not been well-described.

A search of the Global Terrorism Database (GTD) was conducted from 1970 through the end of 2019. Pre-coded variables for target type “business” and target subtype “entertainment/cultural/stadium/casino” were used to identify attacks involving venues where sports events might be viewed by spectators as part of an audience. Sports venues were specifically identified using the search terms “sport,” “stadium,” ”arena,” and “ring,” as well as mention of any specific sport. Two authors then manually reviewed each entry for specific information to confirm appropriateness for inclusion, selecting preferentially for attacks against venues where watching a sports event was the primary focus for the majority of the attendees. Descriptive statistics were performed using R (3.6.1).

Seventy-four (74) terrorist attacks targeting sports venues were identified from January 1, 1970 through December 31, 2019. Thirty-three (33) attacks, or 44.6% of attacks, involved soccer stadiums or soccer venues, while 33.8% of attacks (25 attacks) involved unspecified sports venues. A bombing or explosion was the most frequent method of attack employed, comprising 87.8% of attacks. The highest number of attacks occurred in the Middle East & North Africa. In total, 213 persons died and 699 more were wounded in attacks against sports venues.

Although terrorist attacks against sports venues are uncommon, they carry the risk of mass casualties, especially when explosives are used. A greater understanding of the threat posed by terrorist attacks against sports venues can aid emergency preparedness planning and future medical responses.

Sub-Saharan Africa (SSA) has become a hotspot for global terrorism, with nearly 50% of global terror-related deaths occurring in SSA in 2021. With a large population and complex geopolitical and social climate, terrorist activity further burdens an already strained medical system. This study provides a retrospective descriptive analysis of terrorist-related activity in SSA from 1970-2020.

A retrospective analysis of the Global Terrorism Database (GTD) was performed for the region of SSA from 1970-2020. Data were filtered using the internal database search function for all events in the following countries: Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Comoros, the Democratic Republic of the Congo, Djibouti, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Namibia, Niger, Nigeria, People’s Republic of the Congo, Republic of the Congo, Rhodesia, Rwanda, Senegal, Seychelles, Sierra Leone, Somalia, South Africa, South Sudan, Sudan, Swaziland, Tanzania, Togo, Uganda, Zaire, Zambia, and Zimbabwe. Number of attacks, deaths, and injuries, as well as primary weapons types, country where attacks occurred, and primary target types, were collated and analyzed.

A total 19,320 attacks were recorded, resulting in 77,565 deaths and 52,986 injuries. Firearms were the most frequent weapons used (8,745), followed by explosives (6,031), unknown (2,615), and incendiary (1,246), with all others making up the remainder (683.) Private citizens and property were the most frequently targeted entities (8,031), followed by general government facilities (2,582), police (1,854), business (1,446), military (805), diplomatic government facilities (741), and religious figures/institution (678), with all other targets making up the remainder (3,183).

The majority of deaths from terrorism in SSA are the result of firearm attacks and explosions. Nigeria, Somalia, South Africa, The Democratic Republic of the Congo, and Sudan have had the largest number of attacks since 1970, and Nigeria has the largest number of people killed and injured. The health implications of terrorist attacks are often compounded by violence and pose unique challenges to governments, populations, and aid organizations. By understanding the impact and scope of terrorist activity in SSA, Counter-Terrorism Medicine (CTM) initiatives can be employed to improve health care outcomes.

This study aims to analyze and describe terrorism-related attacks in East Asia from 1970 through 2020.

East Asia consists of South Korea, North Korea, Singapore, Hong Kong, China, Japan, Taiwan, and Macao. According to the Global Terrorism Index (GTI) 2022, the impact of terrorism in East Asia is very low. However, the assassination of former Japanese Prime Minister Shinzo Abe on July 8, 2022 demonstrates that East Asia is not safe from terrorist attacks. This descriptive analysis of terrorist attacks in East Asia will help first responders, Emergency Medical Services (EMS), hospital-based medical providers, and policymakers establish a more refined hazard vulnerability assessment (HVA) framework and develop a Counter-Terrorism Medicine (CTM) mitigation, preparedness, response, and recovery plan.

This is a descriptive observational study drawing data from the Global Terrorism Database (GTD) from January 1, 1970 through December 31, 2020. Epidemiology outcomes included primary weapon type, primary target type, the country where the incident occurred, and the number of total deaths and injured collected. Data from 2021 were not yet available at the time of this study. Results were exported into an Excel spreadsheet (Microsoft Corp.; Redmond, Washington USA) for analysis.

There were 779 terrorism-related events in East Asia from 1970 through 2020. In total, the attacks resulted in 1,123 deaths and 9,061 persons injured. The greatest number of attacks (371; 47.63%) occurred in Japan and the second most occurred in China (268; 34.4%). Explosives were the most used primary weapon type (308; 39.54%) in the region, followed by incendiary devices (260; 33.38%). Terrorist attacks drastically diminished from their peak of 92 in 1990, but there were additional peaks of 88 in 1996, 18 in 2000, 20 in 2008, and 36 attacks in 2014.

A total of 779 terrorist attacks occurred from 1970 through 2020 in East Asia, resulting in 1,123 deaths and 9,061 injuries. Of those, 82.03% attacks occurred in Japan and China. Terrorist attacks drastically diminished since their peak in 1996, but there is an overall uptrend in attacks since 1999.

Previous studies have demonstrated the use of virtual reality (VR) in mass-casualty incident (MCI) simulation; however, it is uncertain if VR simulations can be a substitute for in-person disaster training. Demonstrating that VR MCI scenarios can elicit the same desired stress response achieved in live-action exercises is a first step in showing non-inferiority. The primary objective of this study was to measure changes in sympathetic nervous system (SNS) response via a decrease in heart rate variability (HRV) in subjects participating in a VR MCI scenario.

An MCI simulation was filmed with a 360º camera and shown to participants on a VR headset while simultaneously recording electrocardiography (EKG) and HRV activity. Baseline HRV was measured during a calm VR scenario immediately prior to exposure to the MCI scenarios, and SNS activation was captured as a decrease in HRV compared to baseline. Cognitive stress was measured using a validated questionnaire. Wilcoxon matched pairs signed rank analysis, Welch’s t-test, and multivariate logistic regression were performed with statistical significance established at P <.05.

Thirty-five subjects were enrolled: eight attending physicians (two surgeons, six Emergency Medicine [EM] specialists); 13 residents (five Surgery, eight EM); and 14 medical students (six pre-clinical, eight clinical-year students). Sympathetic nervous system activation was observed in all groups during the MCI compared to baseline (P <.0001) and occurred independent of age, sex, years of experience, or prior MCI response experience. Overall, 23/35 subjects (65.7%) reported increased cognitive stress in the MCI (11/14 medical students, 9/13 residents, and 3/8 attendings). Resident and attending physicians had higher odds of discordance between SNS activation and cognitive stress compared to medical students (OR = 8.297; 95% CI, 1.408-64.60; P = .030).

Live-actor VR MCI simulation elicited a strong sympathetic response across all groups. Thus, VR MCI training has the potential to guide acquisition of confidence in disaster response.

Emergency medical (EM) response systems require extensive coordination, particularly during mass casualty incidents (MCIs). The recognition of preparedness gaps and contextual priorities to MCI response capacity in low- and middle-income countries (LMICs) can be better understood through the components of EM reponse systems. This study aims to delineate essential components and provide a framework for effective emergency medical response to MCIs.

A scoping review was conducted using 4 databases. Title and abstract screening was followed by full-text review. Thematic analysis was conducted to identify themes pertaining to the essential components and integration of EM response systems.

Of 20,456 screened citations, 181 articles were included in the analysis. Seven major and 40 sub-themes emerged from the content analysis as the essential components and supportive elements of MCI medical response. The essential components of MCI response were integrated into a framework demonstrating interrelated connections between essential and supportive elements.

Definitions of essential components of EM response to MCIs vary considerably. Most literature pertaining to MCI response originates from high income countries with far fewer reports from LMICs. Integration of essential components is needed in different geopolitical and economic contexts to ensure an effective MCI emergency medical response.

The threat that New York faced in 2020, as the COVID-19 pandemic unfolded, prompted an unprecedented response. The US military deployed active-duty medical professionals and equipment to NYC in a first of its kind response to a “medical” domestic disaster. Transitions of care for patients surfaced as a key challenge. Uniformed Services University and the Icahn School of Medicine at Mount Sinai hosted a consensus conference of civilian and military healthcare professionals to identify care transition best practices for future military-civilian responses.

We performed individual interviews followed by a modified Delphi technique during a two-day virtual conference. Patient transitions of care emerged as a key theme from pre-conference interviews. Twelve participants attended the two-day virtual conference and generated best practice recommendations from an iterative process.

Participants identified 19 recommendations in 10 “sub-themes” related to patient transitions of care: needs assessment and capability analysis; unified command; equipment; patient handoffs; role of in-person facilitation; dynamic updates; patient selection; patient tracking; daily operations; and resource typing.

The COVID-19 pandemic resulted in an unprecedented military response. This study created 19 consensus recommendations for care transitions between military and civilian healthcare assets that may be useful in future military-civilian medical engagements.

Despite the increasing risks and complexity of disasters, education for Malaysian health care providers in this domain is limited. This study aims to assess scholarly publications by Malaysian scholars on Disaster Medicine (DM)-related topics.

An electronic search of five selected journals from 1991 through 2021 utilizing multiple keywords relevant to DM was conducted for review and analysis.

A total of 154 articles were included for analysis. The mean number of publications per year from 1991 through 2021 was 5.1 publications. Short reports were the most common research type (53.2%), followed by original research (32.4%) and case reports (12.3%). Mean citations among the included articles were 12.4 citations. Most author collaborations were within the same agency or institution, and there was no correlation between the type of collaboration and the number of citations (P = .942). While a few clusters of scholars could build a strong network across institutions, most research currently conducted in DM was within small, isolated clusters.

Disaster Medicine in Malaysia is a growing medical subspecialty with a significant recent surge in research activity, likely due to the SARS-CoV-2/coronavirus disease 2019 (COVID-19) global pandemic. Since most publications in DM have been on infectious diseases, the need to expand DM-related research on other topics is essential.

Emergency Medical Services (EMS) is a critical part of Disaster Medicine and has the ability to limit morbidity and mortality in a disaster event with sufficient training and experience. Emergency systems in Armenia are in an early stage of development and there is no Emergency Medicine residency training in the country. As a result, EMS physicians are trained in a variety of specialties.

Armenia is also a country prone to disasters, and recently, the Armenian EMS system was challenged by two concurrent disasters when the 2020 Nagorno-Karabakh War broke out in the midst of the SARS-CoV-2/coronavirus disease 2019 (COVID-19) pandemic.

This study aims to assess the current state of disaster preparedness of the Armenian EMS system and the effects of the simultaneous pandemic and war on EMS providers.

This was a cross-sectional study conducted by anonymous survey distributed to physicians still working in the Yerevan EMS system who provided care to war casualties and COVID-19 patients.

Survey response rate was 70.6%. Most participants had been a physician (52.1%) or EMS physician (66.7%) for three or less years. The majority were still in residency (64.6%). Experience in battlefield medicine was limited prior to the war, with the majority reporting no experience in treating mass casualties (52.1%), wounds from explosives (52.1%), or performing surgical procedures (52.1%), and many reporting minimal to no experience in treating gunshot wounds (62.5%), severe burns (64.6%), and severe orthopedic injuries (64.6%). Participants had moderate experience in humanitarian medicine prior to war. Greater experience in battlefield medicine was found in participants with more than three years of experience as a physician (z-score −3.26; P value <.01) or as an EMS physician (z-score −2.76; P value <.01) as well as being at least 30 years old (z-score −2.11; P value = .03). Most participants felt they were personally in danger during the war at least sometimes (89.6%).

Prior to the COVID-19 pandemic and simultaneous 2020 Nagorno-Karabakh War, EMS physicians in Armenia had limited training and experience in Disaster Medicine. This system, and the frontline physicians on whom it relies, was strained by the dual disaster, highlighting the need for Disaster Medicine training in all prehospital medical providers.

This study aimed to evaluate a risk of flooding and landslides among home-care patients, to reveal an extent to which patients require support for evacuation, and to determine whether risk was accurately perceived among the patients.

This is a cross-sectional study targeting the patients who were actively treated at the home-care clinic in Fukui Prefecture, Japan. We collected data on the patients’ sociodemographic and clinical characteristics. Additionally, we collected data on their risk of flooding and landslides through hazard maps and distributed a questionnaire to these patients regarding their risk awareness of flooding and landslides.

Of the 199 eligible home-care patients, 84.9% (169 of 199) were at risk of flooding and/or landslides, and 58.6% (99 of 169) of them needs support during evacuation. Furthermore, of those who were at risk of flooding and/or landslides, 46.0% (45 of 99) had accurate risk assessments. Factors that resulted in inadequate risk awareness of flooding and landslides included: not placing importance on evacuation, not using medical equipment, and living on the first floor.

There was limited risk awareness of flooding and/or landslides among the home-care patients. The information of the risk factors regarding inadequate risk awareness of flooding and landslides should be used to sophisticate flooding and landslides evacuation strategy.