The study objective was to compile and rate expert-informed recommendations to enhance US Military Health System (MHS) pandemic preparedness, with implications for large civilian health systems and national preparedness.

A Modified Delphi process was used to assess the importance and feasibility of pandemic preparedness recommendations from Department of Defense (DoD) after-action reports and inspector general reviews. The process consisted of a pre-work phase and 4 rounds of panelist engagement. Panelists rated each recommendation on both importance and feasibility using a Likert scale.

Thirty panelists participated in the interview round, 21 completed the first round of asynchronous rating, 15 participated in the second round of consensus rating, and 14 attended the final consensus conference. The Delphi process began with 102 recommendations; at completion, 25 recommendations were rated high importance and high feasibility. Recommendations addressed key domains including support to civil authorities, public health emergency management, personnel, and policy.

The 25 highest-rated recommendations highlight key areas for enhancing MHS planning for future pandemic preparedness, such as civilian-military coordination, telehealth expansion, and supply chain resilience. While tailored to the MHS, the findings highlight critical areas relevant to civilian health systems and national preparedness, including public health measures, interagency coordination, and resource management.

A nuclear detonation resulting in radiation exposure to a large population can cause acute radiation syndrome (ARS). Bone marrow colony stimulating factors (CSF), also known as cytokines, are FDA approved to treat hematopoietic-acute radiation syndrome (H-ARS). This review characterizes the use of CSFs (filgrastim, pegfilgrastim, romiplostim, and sargramostim) and stem cell therapies for H-ARS.

Using identified keywords, the literature search was conducted on biomedical databases from January 1996-July 2022 and returned 7452 articles. However, after review based on PICO and exclusion criteria, a total of 39 animal studies were included in this systematic review.

Data synthesis using vote counting demonstrated that 34 of 39 studies reported benefit with CSFs or stem cell therapies based on an increase in percent survival or physiological improvement in the experimental group when compared to the control (87% [95% CI 71.77%-95.18%], P = <0.001).

While studies looking at efficacy of CSFs given after 24 hours were limited, 2 studies included in this review showed that delayed administration of CSFs up to 120 hours may be beneficial compared to no treatment. Lack of standardization in experimental study design (e.g. radiation doses, animal species, interventions) between studies prevented direct comparisons using meta-analytic statistical approach.

Health systems have finite capacity. During crises, policymakers may explicitly reallocate health system resources, or capacity limitations may necessitate implicit resource reallocation. This study modelled timing and intensity of pre-vaccination health system resource reallocation policies to predict excess mortality during the COVID-19 pandemic.

This longitudinal panel analysis included 85 countries (752 country-months, January 2020-January 2021). The predictor was resource reallocation scope, scale (summarized as intensity, 0-100), and timing. The outcome was all-cause excess mortality (percentage deaths greater than historical average/month). Covariates included COVID-19 incidence and health system parameters.

Simultaneous health system resource reallocation was associated with increased mortality in multivariate models (b = 0.80, 95%CI 0.42-1.18). However, preemptive (previous month’s) resource reallocation was protective against excess mortality (b = −0.58, 95%CI −0.93–0.23: e.g., 42,010 fewer deaths per unit increased resource reallocation, March 2020, all study countries). Effects were magnified in older populations. Health system capacity and preparedness were associated with lower mortality.

In the pre-vaccination COVID-19 pandemic, preemptive health system resource reallocation was associated with lower mortality, whereas simultaneous resource reallocation was associated with greater mortality. This longitudinal multinational study indicates that readiness, capacity building, and proactive resource reallocation improve crisis response.

There is limited data describing statewide pediatric surge response during times of capacity strain.

Characterize the burden and response to a surge in pediatric respiratory admissions in Oregon in 2022.

This analysis utilized data from the Oregon Capacity System (OCS) and the state discharge database to describe patient characteristics, census changes, and admission pattern shifts during an RSV epidemic in 2022.

Statewide pediatric census, weekly pediatric admissions, weekly admissions from non-children’s hospital emergency departments (EDs) to non-children’s hospitals.

The median census in Oregon’s pediatric inpatient hospitals increased by 19% during the surge period (306 vs 364, P < 0.001), while the median pediatric intensive care unit census increased by 50% (24 vs 36, P < 0.001). Weekly elective pediatric admissions to children’s hospitals decreased by 33% (30 vs 20, P = 0.03). ED admissions to non-children’s hospitals increased by 160% (15 vs 39 per week, P = 0.02).

As the statewide pediatric inpatient census increased, targeted reductions in elective admissions and increased utilization of non-children’s hospitals increased capacity during a respiratory surge. This analysis underscores the importance of real-time situational awareness and coordinated surge response between hospitals.

This study analyzes the scientific literature on disaster medicine and medical rescue between 1992 and 2024 using bibliometric methods, focusing on productivity, collaboration networks, and thematic trends.

Original articles were retrieved from the Web of Science Core Collection using the TS field with the terms: (“disaster medicine”) AND (“emergency medical services” OR “public health”) for disaster medicine, and (“disaster medicine”) AND (“emergency medical services” OR “public health”) AND (“medical rescue” OR “medical triage” OR “medical transport”) for medical rescue. A total of 727 articles were analyzed (654 disaster medicine, 73 medical rescue). Bibliometric analyses were performed with RStudio 4.4.2, applying Bradford’s and Lotka’s laws.

Disaster medicine publications received an average of 12.9 citations and emergency medical rescue publications 11.6 citations per year. The international co-authorship rate was 25.1% in disaster medicine and 30.1% in emergency medical rescue. The core journals are Disaster Medicine and Public Health Preparedness and Prehospital and Disaster Medicine in disaster medicine, and Prehospital and Disaster Medicine in emergency medical rescue on both measures. In the last decade, the themes of “preparedness resilience-public health” in disaster medicine and “management-simulation-triage” in emergency medical rescue have increased.

Disaster medicine publications have increased steadily, particularly in themes such as preparedness, resilience, and public health. In contrast, medical rescue research remains smaller in volume and focuses more on operational themes such as management, simulation, and triage.

The aim of this study was to determine the health problems of individuals who survived the 2023 Kahramanmaraş earthquake according to the Omaha System.

This descriptive cross-sectional study was conducted in Adıyaman, Türkiye, and included 297 earthquake survivors. Data were collected using the Problem Classification Scheme of the Omaha System.

The majority of individuals who survived the earthquake were women and had at least one chronic disease. Of the 42 problems listed in the Omaha Problem Classification Scheme, 38 were identified. Most of the identified problems were actual and individual-level issues. Income, Sanitation, Residence, Living/workplace safety, Communication with community resources, Communicable/infectious condition, and Nutrition problems were identified in all earthquake survivors.

The Omaha System provides nurses with pertinent data to organize health services and prioritize interventions in the post-disaster period. The problems identified highlight the urgent need to improve health and living conditions in temporary shelters.

On September 17, 2024, a coordinated detonation of approximately 5,000 pager devices in Lebanon produced a large mass-casualty incident. Devices contained pentaerythritol tetranitrate (PETN). We report 5 pediatric patients transferred to a tertiary referral center for management of complex multisystem injuries.

We performed a brief report of 5 children (<12 years) referred to Baqiyatallah Hospital, Tehran. Demographics, injury pattern, surgical interventions, and short-term outcomes (up to 3 months) were abstracted from medical records. All patients received multidisciplinary care (ophthalmology, plastic surgery, orthopedics, otolaryngology, pediatrics, infectious disease).

Mean age was 9.2 years (range 5–11). All 5 children sustained ocular, facial, and hand injuries. Three eyes were auto-eviscerated, and 4 children underwent partial hand amputations. Multiple operative procedures were required per patient (ocular surgery, facial reconstruction, orthopedic fixation). Early outcomes were poor for vision and hand function in the majority; reconstructive planning and prosthetic rehabilitation were anticipated for longer-term care.

Close-range exposure to small PETN-containing devices produced a distinctive pediatric injury pattern dominated by severe ocular and upper-extremity trauma. These findings emphasize the need for pediatric-focused acute care algorithms and sustained rehabilitation resources after blast incidents.

This study examined the relationship between food safety, food access, and nutritional status among earthquake victims in Kahramanmaraş and Hatay, Türkiye.

This descriptive, cross-sectional study was conducted face-to-face with 209 earthquake victims in 2023.

The median age was 42 years, and 52.6% were female. Among women, the perception of unhealthy food, inadequate mass feeding services, and dissatisfaction with meals increased the risk of food safety concerns. In men, those with an associate degree or higher were 20.7 times more likely to perceive food safety as inadequate, while the perception of unhealthy food raised this risk by 12.4 times. Lack of access to sufficient drinking water increased the risk of food inaccessibility by 2.6 times among women. In men, employment and dissatisfaction with meals increased this risk by 2.7 and 2.8 times, respectively. Both genders exhibited inadequate intake of water, energy, protein, polyunsaturated fats, fiber, folate, potassium, calcium, magnesium, iron, zinc, and several vitamins (P <0.05), while phosphorus and sodium levels were elevated (P <0.01).

Food safety and access issues were critical among earthquake victims, significantly impacting nutritional status. Findings emphasize the need for improved emergency food aid and distribution systems to mitigate post-disaster nutritional risks.

In March 2019, flooding of the Missouri River and its tributaries destroyed infrastructure and farmland and affected communities, including those in the state of Nebraska. The objective of this study was to assess emergency preparedness and satisfaction with flood response, recovery, and relief efforts 5 years following the 2019 floods in rural eastern Nebraska.

Using stratified simple random sampling, this study surveyed 13 Nebraska communities to assess emergency preparedness and satisfaction with flood response, recovery, and relief efforts 5 years following the 2019 Missouri River Flood. Descriptive statistics are reported.

Households impacted by the 2019 Nebraska flood reported worsening physical and mental health symptoms and identified major gaps in communication, long-term mental health support, and infrastructure resilience. Self-reported preparedness improved post-flood. Inadequate early warnings and poor information dissemination eroded trust.

There are persistent mental and physical health impacts resulting from exposure to the 2019 Missouri River floods that can impact communities’ ability to respond and recover from subsequent hazards. Evaluating the impacts of previous disasters is a critical component of increasing community resiliency and local public health and emergency preparedness capacity to serve these populations.

Operational Canines are highly trained and valuable animals that support emergency and disaster response efforts, such as Search and Rescue, scene security, and recovery operations. While working, Operational Canines often encounter dangerous operational and environmental situations.

To maintain their health and operational readiness, it is critical that Operational Canines receive regular wellness care before entering the field and emergency treatment when necessary in the field.

Nevertheless, the most common first responders to Operational Canine field emergencies—Canine Handlers, Law Enforcement Officers, and Emergency Medical Service personnel—often have limited species-specific medical training, and there are no nationally standardized training programs.

This article proposes a nationally standardized program to train first responders, specifically Canine Handlers, Law Enforcement Officers, and Emergency Medical Service personnel on Operational Canine wellness management and emergency medical care at a level tailored to participants’ knowledge and skill sets. Finally, this article discusses recent legal trends relating to OpK9 emergency medical care, which highlight the pressing need for a nationally standardized training program.

This study aims to elucidate the ethical dilemmas faced by pre-hospital emergency medical service personnel during disaster triage, with a specific focus on the Kahramanmaraş Earthquakes, and to document their experiences.

This phenomenological study employed semi-structured interviews with 29 pre-hospital emergency medical service workers who served during the first 72 hours of the Kahramanmaraş Earthquakes to gather qualitative data. Purposeful sampling was used for face-to-face interviews, and MAXQDA20 was utilized for content analysis.

The main themes encompassed problems related to disaster management organization, environmental factors, and individual factors. Environmental factors, such as coordination deficiencies at the scene, jurisdictional confusion, security concerns, and seasonal conditions, as well as personal factors including education and experience, were pivotal in the occurrence of ethical dilemmas in disaster triage.

Pre-hospital emergency medical services personnel affected by the disaster faced more ethical dilemmas. The presence of many affected children had a profound emotional impact on participants, leading to more frequent ethical dilemmas, particularly in the application of black code protocols.

This research explores the legal and jurisdictional frameworks governing the deployment of Australian WHO-classified Emergency Medical Teams (EMTs) in Asia-Pacific disaster responses, focusing on how these factors influence authorization, timeliness, scope of practice, and legal risks.

A scoping review was conducted using thematic document analysis, comparative legal analysis, and case studies anchored in specific jurisdictions. Sixty-one publicly available sources were reviewed, including legal instruments, national disaster laws, bilateral agreements, and reports from recent EMT missions.

EMTs face fragmented legal environments. Host-country sovereignty primarily determines authorization, but the mechanisms for expedited licensure, customs clearance, and legal protection are often lacking. WHO classification provides no overarching legal standing during international deployments. Other barriers include immigration rules, drug regulations, and inconsistent data protection laws. Case studies highlight gaps in bilateral agreements and inconsistent credential recognition.

Despite improved technical standards, legal uncertainty hampers EMT effectiveness, including legal risk exposure. Countries should establish bilateral frameworks, regional licensing systems, embedded legal support, and standardized data governance. These steps are critical for ensuring timely, safe, and lawful EMT operations during international disasters.