Mass Gathering Medicine focuses on mitigating issues at Mass Gathering Events. Medical skills can vary substantially among staff, and the literature provides no specific guidance on staff training. This study highlights expert opinions on minimum training for medical staff to formalize preparation for a mass gathering.

This is a 3-round Delphi study. Experts were enlisted at Mass Gathering conferences, and researchers emailed participation requests through Stat59 software. Consent was obtained verbally and on Stat59 software. All responses were anonymous. Experts generated opinions. The second and third rounds used a 7-point linear ranking scale. Statements reached a consensus if the responses had a standard deviation (SD) of less than or equal to 1.0.

Round 1 generated 137 open-ended statements. Seventy-three statements proceeded to round 2. 28.7% (21/73) found consensus. In round 3, 40.3% of the remaining statements reached consensus (21/52). Priority themes included venue-specific information, staff orientation to operations and capabilities, and community coordination. Mass casualty preparation and triage were also highlighted as a critical focus.

This expert consensus framework emphasizes core training areas, including venue-specific operations, mass casualty response, triage, and life-saving skills. The heterogeneity of Mass Gatherings makes instituting universal standards challenging. The conclusions highlight recurrent themes of priority among multiple experts.

Stable iodine intake is an essential preventive strategy against thyroid cancer following a nuclear disaster. However, the rate of stable iodine intake during pregnancy and thyroid outcomes among their children have remaifned unclear.

This observational study used data from a thyroid screening program at Research Institute of Radiation Safety for Disaster Recovery Support in Fukushima, Japan. The participants were children from Miharu Town, which implemented stable iodine intake during the Fukushima Nuclear Disaster, born between March 15, 2011 and March 31, 2012. Thyroid ultrasound results were stratified according to stable iodine intake.

This study included 86 children born after the disaster. A total of 34.9% (30 of 86) of their mothers reported taking stable iodine during pregnancy. As for thyroid screening outcomes, none of the children required detailed thyroid examination.

The intake rate of stable iodine during pregnancy was about 1/3 within the traceable municipality after the Fukushima Nuclear Disaster, which was lower than the previously reported number of 63.5% among children. Awareness-raising and effective communication toward pregnant women would be important for nuclear disaster preparedness. There were no participants who required further thyroid examination in this study.

Dentists possess critical skills that can support disaster response efforts. However, in disaster-prone countries like Iran, the integration of dentists into emergency preparedness remains underdeveloped. This study aimed to assess the knowledge, attitudes, and self-reported practices of senior dental students in Tehran regarding disaster management and their potential role in it.

A cross-sectional survey was conducted among 240 senior dental students from three major dental schools in Tehran. An online questionnaire evaluated participants’ demographics, knowledge (9 items), attitudes (8 items), and self-reported practices (3 items) related to disaster preparedness. Data were analyzed using t-tests and Pearson correlation coefficients, with significance set at P<0.05.

Students demonstrated moderate knowledge (mean score: 7.1 out of 18), favorable attitudes (13.1 out of 16), but low levels of self-reported practice (1.9 out of 6). Most respondents lacked awareness of national disaster management policies, although 92.5% acknowledged the need for disaster-related training. Only 37.9% had received any training in CPR or disaster response. Female students scored significantly higher in attitude but not in knowledge or practice. Prior disaster experience did not significantly influence preparedness scores. Positive correlations were found between knowledge and both attitude (r = 0.27) and practice (r = 0.33).

Despite a strong interest in disaster preparedness, Iranian dental students lack sufficient training and practical experience. Incorporating disaster management education into the dental curriculum is essential to empower future dentists for roles in national emergency response frameworks.

Widespread disasters can obstruct all external supports and isolate hospitals. This report aimed to extract key preparedness measures from 1 such hospital in Australia, which was flood-affected and cut off from surrounding supports.

Nine interviews with key personnel behind a flood-affected hospital’s evacuation and field hospital setup were conducted, and a narrative analysis of interview transcripts, meeting notes, and published accounts of hospital evacuation was conducted to highlight important preparedness measures for other hospitals.

Findings indicate hospitals should compile a comprehensive list of resources needed to set up a field hospital. The analysis highlighted the importance of effective patient communication and in-transit tracking for safe evacuation, and revealed that staff can be better prepared if trained to expect disruptions and initiate pre-evacuation discharges.

Increase in climate change-driven extreme weather events requires a proportional increase in hospitals’ abilities to respond and adapt. This report points to key measures that can prepare hospitals to move their patients to improvised makeshift field facilities, if no external support is available.

When unexploded ordnance (UXO) is embedded in the body, the effect of explosive weapons used in conflict is amplified. Though relatively rare, such events present potentially devastating consequences for the patient and medical providers as routine diagnostic and therapeutic procedures hold potential to initiate detonation of the embedded UXO (eUXO). The objective is to identify and synthesize available literature relating to the management of eUXO in low resource settings.

A scoping review was conducted using PRISMA-ScR methodology to evaluate literature in all languages from all date ranges until January 31, 2024, discussing the management of casualties with eUXO, including types of ordnance, injury patterns, diagnostics, resource utilization, surgical interventions, and outcomes.

Search strings identified 3,425 records. After title and abstract screening 3,397 were excluded yielding 18 for full text screening of which 5 were excluded. Therefore 13 reports were included in analysis. Data variable reporting was heterogeneous but themes and subthemes regarding safety, planning and communication emerged.

A scoping review was conducted to identify gaps in existing literature on the management of eUXO in low resource settings. Coordinated engagement from personnel representing a variety of clinical and non-clinical specialties is required to safely manage eUXO.

Disasters disproportionately affect vulnerable populations, necessitating specialized support through welfare shelters, which offer tailored care for those with special needs. Despite their importance, comprehensive reporting on welfare shelter operations during disasters remains limited. This study aimed to analyze the establishment and operation of a welfare shelter in Wajima City, Japan, following the 2024 Noto Peninsula Earthquake, providing insights into operational processes.

The research presents a first-hand narrative account of a welfare shelter’s operation over a 3-month period. The authors, directly involved in key roles, structured the narrative around 3 phases: Initial (January 1-7, 2024), Operational (January 8-March 31, 2024), and Withdrawal (March-April 2024).

Key findings include challenges in personnel management and resource procurement during the initial phase, implementation of continuous care systems and health management in the operational phase, and difficulties in securing relocation sites for evacuees during the withdrawal phase. Challenges in maintaining nutritional balance and managing infectious diseases were observed throughout the shelter’s operation. Implementing flexible staffing strategies may serve as a practical means to support sustained welfare shelter management.

This case study highlights the importance of pre-disaster planning, broad regional collaboration, and adaptability and continuity in welfare shelter management. The study offers valuable lessons for improving welfare shelter operations and emphasizes the need for comprehensive disaster preparedness strategies including long-term care and relocation planning for vulnerable populations.

A train derailment in East Palestine, Ohio, near the Ohio-Pennsylvania border on February 3, 2023, resulted in the release of hazardous substances and chemical exposures among residents and Pennsylvania first responders. We aimed to analyze data collected from an Assessment of Chemical Exposure (ACE) survey to better understand unique exposures and health symptoms among Pennsylvania first responders and identify additional safety measures to protect responders in future hazardous materials spill events.

Descriptive statistics for ACE survey results from 114 Pennsylvania first responders were produced and relationships between exposures, health symptoms, and occupation type were examined using logistical regression models.

First responder occupation title and job duties were determinants of chemical exposure types, and specific chemical exposure types were associated with unique health outcomes. Firefighters and those with a job duty to suppress the fire were more likely to report contact with vapor/gas compared to all other roles and those with a duty of environmental monitoring. Contact with vapor/gas was associated with increased likelihood of reporting 2 or more health symptoms.

This analysis highlights the necessity of tailoring emergency response action plans and personal protective equipment considering first responder occupation title and to the specific duties conducted within their role.

This study aims to investigate the relationship between post-traumatic stress disorder (PTSD) and job-related stress among nurses working in both central and district areas of Adıyaman following the earthquake. Additionally, we assess potential risk factors influencing both PTSD and job-related stress.

This cross-sectional study involved 332 nurses. The study considered several independent variables, including age, gender, marital status, place of residence, experience of family loss due to the earthquake, and workplace location. The dependent variables for the study were identified as post-traumatic stress disorder and job stress.

Of the nurses surveyed, 69% showed symptoms of post-traumatic stress disorder.

Notably, higher job stress scale scores were identified among women (P = 0.028), married individuals (P = 0.005), those with children (P < 0.001), those who were in Adıyaman during the earthquake (P < 0.001), and those who experienced family loss due to the earthquake (P < 0.001). Furthermore, a significant positive correlation was observed between PTSD scores and job stress scores (r = 0.599; P < 0.001).

Given the bidirectional impact of PTSD and job stress, prompt and comprehensive interventions are essential for safeguarding nurses’ mental health and professional capacity following major events. These interventions should also consider other risk factors, such as female gender or experiencing a family loss.

The impact of the COVID-19 pandemic on psycho-social, economic, and biological factors on depression trajectories are poorly understood. The aim of this study was to determine the association of pandemic-related social and economic risk factors with depression. This baseline survey provides a foundation for the longitudinal panel study to assess the trajectory of psychopathologies and mental health resilience as the societal recovery from this pandemic occurs.

We telephonically surveyed 2000 randomly selected participants 18 years-and-older, stratified by 2 cosmopolitan cities in the high middle-income former-Soviet country of Kazakhstan. Survey-adjusted Poisson regression analyses produced probable depression (CESD-16) prevalence ratios (PRs) for COVID-19 death and disease, economic duress, and other socio-psychological factors.

Household suspected having-or-diagnosed with COVID-19 with prevalence ratio (PR) = 1.48 (95% CI 1.09-2.02; P = 0·013), friends/coworkers diagnosed with COVD-19 with PR = 1.43 (1.04-1.95; P = 0.026), lost employment PR = 1.80 (1.04-3.11; P = 0.037), and insufficient income for food PR = 1.54 (1.15-2.06; P = 0.004) were independently associated with depression. Having COVID-19 deaths among family/friends or acquaintances/coworkers were not associated with depression, but family stress had a dose-response association, with PR = 13.42 (7.11-25.32; P < 0.001) for very high stress.

The study findings can inform future effective interventions and policies for protecting population mental health during and after extended periods of the pandemics.

Breastfeeding assumes critical importance in the aftermath of disasters such as earthquakes, as it provides all the essential nutrients required by infants, enhances their immune systems, and mitigates the risks associated with using contaminated water for formula preparation. This study investigates the experiences of breastfeeding mothers living in temporary shelters within the earthquake-affected region.

A qualitative approach was employed to identify the challenges faced by breastfeeding mothers. The study’s sample included 14 mothers who met the inclusion criteria. Data were collected through a semi-structured interview form and analyzed using MAXQDA qualitative data analysis software, following Colaizzi’s 7-step method.

The mothers in the study ranged in age from 31-37 years, with their infants ranging from 10 days-6 months old. Based on the data gathered from the interviews, 4 main themes were identified: basic life needs (with sub-themes of housing, warmth, nutrition, hygiene/sanitation, sleep, and clothing), emotional difficulties (with sub-themes of shock, fear, crying, and stress), care difficulties (with sub-themes of challenges in accessing medication, constipation, diarrhea, reduced comfort, and decreased urine output), and breastfeeding difficulties (with sub-themes of breast rejection, breast engorgement, baby feeding issues, reduced milk production or interruption, and privacy concerns).

From the onset of the earthquake, mothers encountered significant challenges in breastfeeding their infants. In emergency and disaster situations, it is imperative that experienced health care personnel offer essential information and support to assist these mothers in navigating the difficulties they face.

As the global incidence of heat-related illnesses escalates in the wake of climate change-induced heat waves, the critical necessity for reliable diagnostic tools becomes apparent. This scoping review aimed to summarize the existing body of published evidence on biomarkers that could potentially be utilized for the diagnosis of heat-related illness in the clinical setting.

We conducted a thorough search of 3 databases, including Embase, MEDLINE, on Ovid, and The Cochrane Library (Wiley) databases from October 11, 2022 up until January 15, 2024. We also manually included studies by searching the reference lists of the included articles. Studies that performed statistical validation were summarized in detail.

2877 citations were identified and screened, with 228 studies reviewed as full text. 56% of these studies were conducted within China or North America. The studies identified 113 biomarkers. Most common biomarkers studied were troponin I, IL-6, platelets, and ALT. The studies exhibited considerable variation, reflecting the diverse range of investigated biomarkers and the absence of standardized statistical validation for the biomarkers.

Numerous biomarkers have been evaluated in the literature, but none have been studied to impact clinical practice. There is significant variation in the methodology and statistical validation. There is a need for further research to identify clinically relevant biomarkers for heat related illnesses.

About 13% of pregnant women with substance use disorder (SUD) receive treatment and many may encounter challenges in accessing perinatal care, making it critical for this population to receive uninterrupted care during a global pandemic.

From October 2021-January 2022, we conducted an online survey of pregnant and postpartum women and interviews with clinicians who provide care to this population. The survey was administered to pregnant and postpartum women who used substances or received SUD treatment during the COVID-19 pandemic.

Two hundred and ten respondents completed the survey. All respondents experienced pandemic-related barriers to routine health care services, including delays in prenatal care and SUD treatment. Disruptions in treatment were due to patient factors (38.2% canceled an appointment) and clinic factors (25.5% had a clinic cancel their appointment). Respondents were generally satisfied with telehealth (M = 3.97, SD = 0.82), though half preferred a combination of in-person and telehealth visits. Clinicians reported telehealth improved health care access for patients, however barriers were still observed.

Although strategies were employed to mitigate barriers in care during COVID-19, pregnant and postpartum women who used substances still experienced barriers in receiving consistent care. Telehealth may be a useful adjunct to enhance care access for pregnant and postpartum women during public health crises.

In Turkey, a region prone to seismic activity, the 2023 Kahramanmaraş earthquakes exemplified the critical need for effective disaster nursing competencies, highlighting the challenges health care professionals face in large-scale emergencies. This study aims to evaluate disaster nursing competencies, particularly in the context of the 2023 Kahramanmaraş earthquakes.

This study involved a total of 352 nurses, 73 of whom played an active role in the earthquake response. Employing the Turkish version of the Disaster Nursing Preparedness – Response Competency (DNPRC) Scale, this study compared the competencies of nurses based on their demographic and professional characteristics, and whether they were actively involved in the earthquake response.

Nurses who received disaster training, especially those with combined theoretical and practical training, and those who participated in drills, scored significantly higher on the DNPRC Scale. Intriguingly, nurses actively involved in the earthquake response scored lower, indicating a discrepancy between perceived and actual competencies.

The study highlights the complexity of disaster nursing competencies and the gap between self-assessed competency and real-world challenges. It underscores the need for re-evaluating current training programs and implementing more scenario-based approaches to adequately prepare nurses for the realities of disaster response.

To describe the process of the development of evidence-based guidelines on the assessment and clinical management of internal contamination with transuranic actinides (specifically plutonium, americium, and curium) in incidents where workers, emergency responders, and the public might uptake these radionuclides internally through inhalation, ingestion, or wound contamination.

The World Health Organization (WHO) set up a guidelines development group (GDG) that follows the protocol required for producing evidence-based recommendations as described elsewhere. The GRADE® approach was applied throughout the process, including developing research questions formulation, prioritization and rating the importance for the outcomes, assessing the certainty of the evidence, considering contextual factors, and making recommendations.

Through 3 working group meetings held 2023-2024, the GDG defined and rated patient-important health outcomes, and evidence gathered through systematic reviews and its certainty rating, working towards formulating the recommendations using an evidence-to-recommendation (EtR) framework.

The WHO protocol for developing health care management guidelines uses a transparent and robust evidence-based GRADE® approach. Once published, these guidelines will provide the first evidence-based recommendations for assessment and clinical management of internal contamination with transuranic actinides.

The objective is to determine if a practical face-to-face emergency disaster incident response training program delivered in the clinical setting will improve self-reported confidence and assessed knowledge of emergency department (ED) nurses to respond to disasters.

A single site prospective pre-test and post-test randomized controlled trial was adopted for this study. The intervention was a practical face-to-face training program, while the control group completed the required annual mandatory hospital online training.

There was a large difference in post-test median self-reported confidence between groups. There was also a large difference in the proportion of subjects who reached satisfactory levels of self-reported confidence post-test. Regarding assessed knowledge, there was a moderate difference in post-test median knowledge between groups. There was also a moderate difference in the proportion who reached satisfactory levels of knowledge post-test.

This study has shown that ED nurses who undertake a practical face-to-face disaster preparedness education program in the clinical setting, are better prepared to respond to emergency disaster incidents. Organizations should consider the use of a practical structured face-to-face emergency disaster incident response education program to complement and enhance any online emergency and disaster training.

To identify changes in emergency department (ED) use in Houston, TX during the mid-summer Hurricane Beryl-induced power outage to inform future targeted public health interventions.

Syndromic surveillance system ED visit daily counts for total visits, heat-related illness, carbon monoxide poisoning, acute cardiac condition, stroke, dialysis, and medication refills post-hurricane were statistically compared to the 2 weeks prior and plotted alongside the percentage of the population with power outage.

Daily ED visits post-storm were statistically higher (P< 0.05) than the 2 weeks prior for total visits and acute cardiac events (Day 1, 2); heat-related illness (Day 1-3); dialysis (Day 0-3); and carbon monoxide poisoning and medication refill (Day 1-9).

While 50% of the city experienced power outages from high winds, total ED visits, acute cardiac events, and heat-related illness were statistically higher in the first 3 days after Beryl than expected. Houston developed targeted messaging to mitigate these events in future disasters.

Nurses play a critical role in preventing health care-acquired infections (HAIs) by applying infection control practices during hospitalization, in health care settings, and after patient discharge. Our aim was to evaluate the effect of an HAIs educational workshop on the knowledge, attitude, and practice of pediatric nurses at Al-Mezan Hospitals in Palestine.

A quasi-experimental study was conducted in 2022 among 44 pediatric nurses working in the PICU, NICU, pediatric ward, and nursery departments. Data were collected using demographic, knowledge, attitude, and practice questionnaires before and after the intervention. The educational workshop consisted of 4 sessions, each lasting 45 minutes. Data were analyzed using SPSS version 23, including descriptive statistics and paired t tests, with a significance level set at P < 0.05.

Post-intervention scores showed significant improvements: knowledge increased from 52.9 ± 3.3 to 61.9 ± 4.1, attitude from 44.1 ± 4.1 to 52.6 ± 3.4, and practice from 42.1 ± 5.7 to 53.3 ± 3.3. All changes were statistically significant (P ≤ 0.001), indicating the effectiveness of the workshop.

The HAIs educational workshop significantly enhanced the knowledge, attitudes, and practices of pediatric nurses regarding infection control. These findings highlight the importance of continuous education and training programs to improve health care quality and patient safety.

CBRN incidents require specialized hazmat decontamination protocols to prevent secondary contamination and systemic toxicity. While wet decontamination is standard, it can present challenges in cold weather or when resources are limited. Dry decontamination offers an alternative and supportive approach, though its effectiveness across different contaminants remains unclear. This scoping review evaluates the effectiveness, advantages, and limitations of dry decontamination in hazmat incidents.

A scoping review was conducted using MEDLINE, CINAHL, and other databases. Following the PRISMA-ScR approach, 9 studies were selected from 234 identified articles. The review assessed decontamination techniques, materials, and effectiveness across different contaminants.

Dry decontamination is rapid, resource-efficient, and suitable for immediate use in pre-hospital and hospital settings, especially during mass casualty incidents (MCIs). Dry decontamination is highly effective for liquid contaminants, with blue roll and sterile trauma dressings removing over 80% of contaminants within minutes. However, dry decontamination is less effective for hair and particulate contaminants. Blotting and rubbing techniques significantly enhance decontamination efficiency.

Dry decontamination can be an effective alternative for wet decontamination, particularly for liquid contaminants, as a first-line approach for scenarios where wet decontamination is not a practical solution for logistical and environmental reasons. However, dry decontamination is less effective than wet decontamination for hair and particulate contaminants. Combining dry and wet decontamination is shown to be more effective. Identifying the need for including dry decontamination as an integral part of the CBRN response plan improves the efficacy of decontamination.