This review aimed to map the main ethical tensions experienced by health workers in low- and middle-income countries during infectious disease outbreaks.

We conducted a critical interpretive review of qualitative research studies. After searching 3 databases, 4445 articles were exported to Rayyan, deduplicated, and screened for eligibility. Of the 98 articles retained for full review, 25 met the inclusion criteria. Data were extracted to an Excel spreadsheet and key ethical tensions were identified using a descriptive content and thematic analysis approach.

Twenty-three of the studies focused on the COVID-19 pandemic, and two addressed Ebola epidemics. Three major ethical tensions were experienced by health workers, which involved conflicts between their professional duty to patients, colleagues, and communities, as against their concerns for personal safety, the well-being of their families, and facing stigma and discrimination. Secondary tensions arose when health workers seeking to manage these primary ethical tensions experienced further uncertainty about whether to disclose information about their professional roles with family members or community.

Ethical tensions are unavoidable during contagions, and may be amplified due to structural features. Authorities must take steps to support health workers as they navigate ethical tensions during localized epidemics or global pandemics.

Rural and urban environments are exposed to the same types of climate-induced disasters, but rural populations are considered particularly vulnerable to the adverse health effects associated with these disasters. This study compares individual-level public health preparedness for climate-induced disasters in rural versus urban environments and examines the impact of rurality on variables that influence preparedness attitudes and behaviors.

A national, online survey was conducted from April to June 2024. Chi-squared tests and multiple logistic regression models with interaction terms were used to compare the preparedness attitudes and behaviors reported by rural and urban populations.

Rural and urban populations generally shared preparedness attitudes and behaviors, but several significant differences were observed. Regression analysis suggested that rurality interacted with age and income to play a significant role in modifying the odds of having an evacuation plan and reporting concern about the severity of future climate-induced disasters.

Rurality appears to influence certain attitudes and behaviors related to preparedness for climate-induced disasters. Should climate-induced behaviors become more frequent and severe in the future, dedicated efforts should be taken to ensure that these events do not exacerbate health disparities between rural and urban environments.

Preparation for mass casualty incidents (MCIs) requires knowledge of the number of victims to be treated on site and transferred to hospitals. The objective was to collect this information for MCIs with hospital admissions in Europe over the last 30 years.

This was a scoping review of MCIs with hospital admissions in Europe between 1991 and 2023. The study was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines with PubMed, the Web of Science, Industrial and Transport Accident Reports, and two global databases on terrorism and disasters. Events with ten victims transferred to hospitals were included.

In total, 2,498 documents were identified, and 82 documents covering 62 MCIs were selected. In Europe, there was a median of 73 MCI: 9 victims died on site (12%), 48 were transferred to hospitals (66%), and 13 with serious casualties (17%). MCI is divided into 7 categories: explosion, ballistic, fire, road, ram raid, railway, and industrial accident.

By improving our knowledge of past MCIs and their casualty figures, we can now train more realistically and be better prepared to respond to future MCIs.

This study aimed to develop a disaster triage training program designed to enhance knowledge, skills, and resilience for disasters among nurses.

A randomized controlled trial was conducted at two government hospitals in Indonesia. One hundred and eight nurses were randomly assigned in equal numbers to the experimental and control groups. The experimental group received a 4-hour triage training focused on mass casualty incidents. Disaster triage knowledge, skills, and resilience were assessed at three time points: before, immediately after, and 1 month following the intervention. Generalized Estimating Equations were used to evaluate the effectiveness of the training program.

The results of this study revealed that nurses in the experimental group showed significantly greater improvements in disaster triage knowledge, skills, and resilience compared to those in the control group at 2 post-test time points. In addition, feedback from trained nurses emphasized its relevance to local disaster scenarios, such as earthquakes and floods, and highlighted the value of hands-on practice and easily accessible learning materials.

The study demonstrates that disaster triage training can effectively enhance nurses’ preparedness for disasters. It is recommended that health care institutions integrate disaster-related content into regular on-the-job training programs for nurses and assess its effectiveness.

This brief report explores rehabilitation in the 2023 Armenia emergency response following a fuel depot explosion, injuring over 300 people and overwhelming the national healthcare system.

It is based on a grey literature review, lessons observed, and secondary analysis of publicly available data shared with the Emergency Medical Team Coordination Cell, regional reports and guidelines, and the authors’ observations and reflections.

The World Health Organization emphasizes rehabilitation in burn care emergencies. Challenges included a shortage of skilled rehabilitation providers, limited guidance to support continuity of care, and inadequate burn care equipment. The United Kingdom’s Emergency Medical Team and Samaritan’s Purse were the only EMTs offering rehabilitation, delivering over 386 interventions. These 2 EMTs and WHO Armenia, with the request of the Ministry of Health of Armenia, delivered just-in-time training, equipping multidisciplinary health care providers with burn rehabilitation skills.

The lessons observed emphasize the importance of ensuring rehabilitation providers, clinical protocols, and equipment are integrated into acute care facilities, national emergency plans, and EMT deployments. Also, just-in-time training should be prioritized and aligned with workforce mobilization, adopting a competency-based approach to strengthen health systems for future emergencies.

This study investigated coping mechanisms among neurosurgeons responding to earthquake-related stress following the February 6, 2023, Kahramanmaraş earthquake in Turkey. Given the extreme challenges faced by neurosurgical teams, the study aimed to illuminate their stress-coping strategies under crisis conditions.

A cross-sectional study was conducted in 2023 with 64 neurosurgeons engaged in earthquake relief efforts. The Coping with Earthquake Stress Questionnaire (CESQ), covering Religious Coping, Positive Reappraisal, and Seeking Social Support dimensions, was administered. Convenience sampling was used. Data analysis employed IBM SPSS 25.0, applying descriptive statistics, Chi-square, t-tests, ANOVA with Bonferroni correction, and Pearson correlation (α = 0.05). Power analysis confirmed sufficient sample size.

Neurosurgeons showed notable psychological resilience despite personal and material losses. Positive reappraisal was the most common coping strategy, consistent across experience levels. Although not statistically significant, less experienced neurosurgeons (1-5 years) showed a higher tendency toward seeking social support. A positive correlation was observed between Religious Coping and Positive Reappraisal.

Positive reappraisal emerged as a key coping mechanism, underlining neurosurgeons’ resilience. Mental health support, especially for early-career professionals, remains vital. Broader CESQ applications and cross-cultural studies are encouraged to guide future psychological preparedness efforts in neurosurgery.

To evaluate the hospital-level impact of the COVID-19 pandemic on U.S. academic medical centers (AMCs) and assess regional variation in care delivery to inform public health emergency preparedness strategies.

We retrospectively analyzed adult inpatient discharges from 106 AMCs using Vizient® Clinical Data Base from October 2019 to December 2023. The study period was divided into pre-COVID (Oct 2019-Mar 2020), early-COVID (Apr 2020-Dec 2020), late-COVD (Jan 2021-May 2023), and post-COVID (Jun-Dec 2023). Outcomes included hospital encounters, length of stay (LOS), ICU admissions, ICU LOS, mortality, and case mix index (CMI). Mixed models assessed temporal and regional variation.

Among 13.5 million discharges, monthly encounters declined during early COVID and rebounded post-COVID (P < 0.0001). Observed LOS increased from 6.2 to 6.7 days during the pandemic and remained elevated post-COVID (P < 0.0001). ICU LOS rose during early and late COVID (P < 0.0001), while ICU admission rates declined slightly over time (P = 0.0112). Mortality peaked at 3.4% during early COVID and returned to 2.8% post-COVID (P < 0.0001).

The COVID-19 pandemic significantly disrupted inpatient operations at U.S. AMCs, with increased LOS, ICU burden, and case complexity. By segmenting the pandemic into phases, we identified patterns in hospital performance that reflect evolving public health challenges.

CBRN events can occur randomly or intentionally. Rapid and appropriate response to CBRN events can significantly mitigate the adverse effects on physical health and reduce mortality rates. The effectiveness of these responses largely depends on the preparedness of hospital emergency Clinical staff.

This study was a mixed-methods research aiming to develop and validate a psychometric research instrument in 2025. Based on the review of the literature regarding CBRN events, the items were extracted, rewritten, and validated. In the quantitative phase, the validity of the questionnaire was evaluated in terms of face, content, and construct validity, and its reliability was evaluated based on internal consistency and stability (Cronbach’s alpha and Interclass Correlation Coefficient [ICC]).

The designed questionnaire included 6 dimensions and 65 items. The dimensions included (1) programs and guidelines, treatment of the injured; (2) exercise; (3) decontamination and waste management; (4) education and human resources; (5) prevention, coordination, and security; and (6) PPE. The content and face validity of the questionnaire were approved by the specialists and experts of hospital emergency and health in disasters and emergencies. The content validity ratio was >0.6 for all items. The content validity index was also approved for all items. The Cronbach’s alpha coefficient and ICC were respectively 0.977 and 0.972 for the total questionnaire.

Hospital Emergency Clinical Staff play a vital role in responding to CBRN events; therefore, policies, programs, coordination efforts, budgets, and other necessary measures are strongly recommended to increase ED clinical staff preparedness against CBRN events.

Earthquakes cause significant mortality and morbidity, particularly through crush injuries and their complications. This study aimed to evaluate whether systemic immune inflammation index (SII) and Pan-immune inflammatory values (PIV) obtained from complete blood count parameters can predict intensive care needs, dialysis requirements, and mortality in patients with crush injuries following earthquake.

We retrospectively analyzed data from 76 patients with crush injuries admitted to a university hospital following the earthquake. Blood samples were collected upon admission. SII and PIV were calculated and compared with conventional laboratory markers for their ability to predict clinical outcomes.

Intensive care unit (ICU) admission was required in 40.8% of patients, and 21.1% required dialysis. In ROC analysis, an SII value above 1372 predicted ICU admission with 67.7% sensitivity and 66.7% specificity (P < .001), while an SII value above 1735 predicted dialysis requirement with 75.0% sensitivity and 73.3% specificity (P < .001). Similarly, a PIV value above 1345 predicted ICU admission with 74.2% sensitivity and 73.3% specificity (P < .001), and a value above 1906 predicted dialysis requirement with 81.3% sensitivity and 78.3% specificity (P < .001).

Complete blood count-derived inflammatory markers may serve as accessible, early indicators to complement clinical assessment for resource allocation following earthquake-related crush injuries, particularly in resource-limited disaster settings. These tools may aid in patient triage and care planning when comprehensive laboratory testing is limited.

This study examines the impact of a disaster awareness education program on general disaster preparedness beliefs in Türkiye, utilizing the Health Belief Model as a theoretical framework.

A quasi-experimental, single-group design with pre-test, post-test, and follow-up measurements was employed. Participants were enrolled in a Disaster Awareness Education course at a Public Education Center. Data were gathered using a demographic questionnaire and the General Disaster Preparedness Belief (GDPB) Scale. Repeated measures ANOVA was conducted to assess changes over time.

Significant improvements were observed in perceived susceptibility, perceived severity, perceived barriers, cues to action, and self-efficacy following the intervention. While male participants showed no significant changes, female and middle-income participants experienced substantial improvements. Perceived susceptibility initially increased but reverted to baseline at follow-up. Perceived severity decreased and remained low, whereas perceived barriers declined post-education but were not sustained. Cues to action showed a steady increase, suggesting ongoing motivation. Self-efficacy improved significantly and was maintained over time.

Disaster education has a positive impact on general disaster preparedness beliefs. Tailored interventions may be especially beneficial for specific demographic groups such as males and lower-income individuals. It is recommended that future studies investigate the mechanisms underlying demographic disparities in educational impact, particularly among male and low-income participants.

To compare the effectiveness of tabletop exercises (TTX) and high-fidelity in-person simulations (IPS) in improving knowledge, confidence, and perceived preparedness in disaster medicine among emergency medicine residents.

A prospective, randomized educational intervention was conducted across 2 urban emergency medicine residency programs. Sixty-three residents were randomized to TTX or IPS groups. Each group completed a preintervention knowledge and confidence assessment, participated in their assigned exercise based on a simulated mass casualty incident (MCI), and underwent a structured debrief. Postintervention surveys assessed change in knowledge and self-reported comfort levels. A paired 2-tailed Student’s t-test was utilized to compare results. Statistical significance was defined as P < 0.01.

Both groups demonstrated increased self-reported confidence and knowledge regarding management of MCIs. TTX participants showed higher median post-test scores (77.4%, N = 38) compared to IPS participants (67.4%, N = 25). Results were not statistically significant (P = 0.079).

TTX is an effective modality for disaster medicine education, with outcomes comparable to IPS. While TTX may better align with knowledge-based assessments, IPS remains essential for practicing real-time decision-making under stress. Combining these 2 modalities may provide both the knowledge base and psychological duress required for robust disaster scenario training.

To determine the prevalence and severity of anxiety and depression among health care professionals in Khyber Pakhtunkhwa and the impact of gender and professional roles on mental health outcomes.

A cross-sectional study was conducted between March and November 2023 using stratified random sampling among health care professionals, including doctors, nurses, paramedics, and emergency staff, across multiple hospitals. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to assess anxiety and depression. Data were analyzed using R/RStudio, employing descriptive statistics, chi-square tests, independent t-tests, Mann-Whitney U tests, and Pearson’s correlation coefficient.

Among 651 participants, 65% were male. Anxiety prevalence was significant, with 42% experiencing minimal anxiety, 35% mild, 16% moderate, and 7.7% severe. Depression prevalence included 10% with no depression with 7.8% moderately severe and 5.9% severe depression. Nurses (40%) and doctors (34%) had the highest depression rates. Females exhibited significantly higher anxiety and depression scores. Anxiety prevalence varied across hospitals (P = 0.024). A strong positive correlation was observed between GAD-7 and PHQ-9 scores.

Mental health challenges among frontline health care workers in Khyber Pakhtunkhwa are substantial, with anxiety and depression particularly prevalent among nurses and doctors. Female workers experience greater psychological distress. We recommend implementation of hospital-based mental health support systems, prioritizing interventions for female staff and high-burden departments. Policies ensuring regular psychological screening and peer support mechanisms are urgently needed.

Exertional heat stroke (EHS) occurs when core body temperature exceeds 40°C (104°F) with central nervous system dysfunction and has been identified as a leading cause of morbidity and mortality among endurance athletes. With rapid identification and treatment, survival approaches 100%. This study describes the clinical presentation and course of seven patients transported by emergency medical services from a half marathon with EHS.

The 2022 Cambridge Half Marathon occurred during unusually warm weather, with a did not finish rate of 2%. Retrospective review was performed of seven patients transported during the race to an urban, level I trauma center with EHS.

Seven patients transported to the study site were included for analysis. All patients treated with cold water immersion at scene were discharged from the emergency department. Three patients without treatment on scene required admission to the intensive care unit. Descriptions of all patients are provided.

Lessons learned from this event include the importance of rapid cooling, the role of event-day communications, the varied impacts on emergency department operations, and the increasing need to anticipate such events outside of traditional warm weather seasons.

Our study examined the association between willingness-to-respond (WTR) and behavioral factors, demographics, and work-related characteristics among emergency department healthcare workers (HCWs) toward a radiological dispersal device (RDD) (“dirty bomb”) blast scenario in Pakistan.

A cross-sectional survey was conducted in August to September 2022 among emergency department HCWs from 2 hospitals in Karachi, Pakistan. Nonprobability purposive sampling was used to recruit participants. Multivariate logistic regression analyses were performed to examine the association between WTR and key attitudes/beliefs, including perceived norms, preparedness, and safety, as well as the EPPM variables.

Among behavioral factors, perceived likelihood that colleagues will report to work duty, perceived importance of one’s role, and psychological preparedness showed particularly significant associations with WTR; 53.6% of participants indicated low perceived threat, while 46.43% showed high perceived threat, toward an RDD disaster scenario.

Our findings point to the need to improve WTR toward an RDD event by shifting behavioral factors among HCWs through efficacy-focused training; enhancing WTR through such training strategies is imperative beyond mere delivery of information. Changing norms around response, along with institutional support, may further boost WTR during RDD emergencies.