While tabletop exercises (TTX) are frequently used for disaster preparedness, their value for strengthening hospital pharmacies’ (HPs) business continuity plans (BCPs) remains uncertain. This study aimed to assess the impact of a TTX on the quality of HPs’ BCPs and on links between BCPs and crisis response training.

Swiss HPs’ BCPs were evaluated with a grid scoring 48 items (5-point Likert scale; 1 = “not at all sufficient” to 5 = “excellent”; 3 = minimal satisfactory expectation). Baseline BCP assessments were followed by a TTX simulating a blackout. A hot debriefing immediately after the TTX, followed by a written report from investigators, highlighted areas of improvement in business continuity management. Nine months later, follow-up BCP assessments were followed by a full-scale exercise (FSX) simulating cyberattacks and observed by four assessors. Participants reported satisfaction using questionnaires. The primary outcome was the difference between pre- and post-TTX BCP scores; the secondary outcome was the correlation between follow-up BCP scores and overall FSX responses.

Mean percentage of expected key items included in five HPs’ BCPs rose from 47.9% to 54.2% (P < 0.05). Mean overall BCP score increased by 8.6%, from 1.74 ± 0.15 to 1.89 ± 0.16 (P < 0.05). Aspects relating to risk reduction or response improved more than those involving risk readiness or recovery. HPs with better BCP scores responded better to the FSX (R2 = 0.78). Participants greatly appreciated both exercises.

HPs’ BCPs slightly improved, with a correlation between BCP quality and HPs’ ability to deal with crisis. The study highlighted the benefits of strengthening HPs’ business continuity preparedness and the usefulness of disaster simulations, including TTX.

This study aims to determine the agility level of the prehospital emergency medical services (EMS) organization and to examine the impact of organizational agility (OA) on prehospital emergency health care professionals’ perception of disaster preparedness using a structural equation model (SEM).

This study employed a quantitative correlational research design and was carried out with 468 health care professionals serving in various roles within the 112 Ambulance Service, a public prehospital emergency health care institution operating in Istanbul, in the Marmara region of Türkiye.

Among personnel working in prehospital EMS, the average OA score was 3.65 ± 0.83 and the average disaster preparedness perception score was 4.00 ± 0.71, indicating a high level. According to the results of the SEM analysis, it was determined that OA (competence, flexibility, responsiveness, and speed) has a significant and positive effect on the perceptions of disaster preparedness among personnel working in prehospital EMS, and that the explained variance (R2) is 0.582.

The study offers a set of recommendations intended to enrich the existing literature and to enhance OA and disaster preparedness within prehospital emergency health care institutions.

Cardiovascular diseases are the leading global cause of mortality but remain underaddressed in complex emergencies where health responses focus on infectious diseases and acute care. This scoping review mapped public health interventions addressing cardiovascular disease in complex emergencies and identified intervention types, epidemiological findings, and research gaps.

We conducted a scoping review of studies published between 2014 and April 2024, identified through PubMed, the Directory of Open Access Journals, ReliefWeb, and Google Scholar. Eligible studies examined cardiovascular prevention, management, or outcomes in crisis-affected populations.

Thirty-one studies were included, most published in the past 5 years. Evidence primarily focused on hypertension, with interventions targeting primary prevention, including risk factor control, workforce training, and health system constraints, as well as secondary prevention, such as screening, early diagnosis, treatment, and continuity of care. Evidence on coronary artery disease and tertiary prevention, including cardiovascular rehabilitation, was limited. Common barriers included disrupted continuity of care, population displacement, attacks on health services, undertrained staff, medication interruptions, and inadequate funding during complex emergencies. The WHO Noncommunicable Diseases Kit showed mixed effectiveness depending on contextual adaptation and health system capacity.

Addressing cardiovascular disease in complex emergencies requires strengthened primary care platforms and health care access.

Hospitals play a crucial role in responding to respiratory pandemics, yet the degree of their readiness varies widely across health systems. Identifying and prioritizing the most critical indicators of hospital preparedness can guide policymakers in resource allocation and strategic planning. This study aimed to determine and rank the key indicators influencing hospital readiness for respiratory pandemics in referral hospitals in Kerman Province, Iran.

A mixed-method, multicriteria decision-making (MCDM) approach was applied. Initially, a semi-structured Delphi process involving hospital managers and experts was used to identify essential readiness indicators based on the WHO checklist and local conditions. The finalized indicators were then prioritized using the Analytic Hierarchy Process (AHP) and the Best-Worst Method (BWM).

Eight indicators were recognized as crucial for hospital preparedness. Among them, “Appropriate Management Team and Planning” ranked highest, followed by “Provision of Human Resources” and “Provision of Medicine and Equipment.” “Waste Management and Disinfection of the Environment” was identified as the least significant indicator. The consistency ratios for both methods were within acceptable limits, confirming the reliability of expert judgments.

Effective management and proactive planning are the most influential determinants of hospital readiness during respiratory pandemics. Strengthening management structures, optimizing human resources, and ensuring essential supplies are critical steps toward enhancing health care system resilience.

After natural hazards, Emergency Medical Teams (EMTs) provide critical care when national systems are overwhelmed. While their short-term effectiveness is established, their contribution to long-term health system recovery remains underexplored.

From the perspective of deployed members, this study explored the barriers and facilitators influencing the long-term effectiveness and sustainability of EMT interventions post-disaster.

This qualitative study used in-depth interviews with nine purposively sampled EMT members who had deployed to natural hazards. Using thematic analysis, we identified three core themes: barriers to sustaining impact, mechanisms promoting long-term effectiveness, and challenges in measuring impact.

Poor coordination with national staff, limited knowledge transfer, logistical and cultural barriers, and the absence of structured monitoring and evaluation strategies constrained the long-term effectiveness of EMT interventions. Strategies such as local capacity building and Risk Communication and Community Engagement (RCCE) have been identified as two mechanisms through which sustainable health care programming can be implemented.

The findings highlight a persistent tension between acute response priorities and the goal of long-term health system strengthening. This study suggests that addressing this gap requires integrating structured approaches, such as MEAL and RCCE, to better support sustainable health development post-disaster.

Individuals who experience psychological distress during acute emergencies require timely and effective psychosocial support. This study explores operational and systemic hurdles faced by mental health and psychosocial (MHPSS) practitioners worldwide to inform sustainable, contextually appropriate responses, policy development, and intersectoral collaboration.

This study utilized a mixed-method survey. Participants (N = 45) were MHPSS staff and delegates covering four continents. Quantitative data were gathered through the ranking of operational, health-system, and government-level barriers, while qualitative data from open-ended questions were analyzed using reflexive thematic analysis.

Top-ranked barriers were low awareness of the benefits of MHPSS, lack of prioritization within the health system, and absence of relevant policies for local authorities. Qualitative analyses identified themes including systemic under-prioritization, workforce quality-capacity gaps, and operational access constraints. MHPSS is frequently viewed as non-essential (a “nice-to-have” rather than lifesaving), resulting in delayed funding and fragmented coordination.

The findings aim to inform policy development and intersectoral collaboration. Recognizing MHPSS as a fundamental, lifesaving element of humanitarian efforts is essential to improve response effectiveness and foster long-term resilience. Strengthening understanding and collaboration across sectors can ensure that MHPSS is prioritized alongside physical health, ultimately promoting recovery during emergencies.

To evaluate the viability and impact of South Korea’s inaugural Military-Civilian Partnership (MCP) pilot program in overcoming peacetime volume deficits and enhancing military clinical readiness.

Over a 1-year period (September 2024-August 2025), an active-duty military surgeon maintained regular duties at a military facility, completing 65 shifts, while performing 41 intermittent 24-hour shifts at a civilian regional trauma center (RTC). The patient demographics, injury severity, and procedural/surgical volumes of the surgeon’s cases were retrospectively analyzed.

The surgeon managed 103 and 193 patients at the military facility and civilian RTC, respectively. The civilian RTC presented a significantly higher burden of severe trauma, with more patients presenting with Injury Severity Score (ISS) >9 (49% vs 35%, P = 0.023) and ISS >15 (35% vs 23%, P = 0.035). While the civilian RTC provided a higher volume of invasive procedures (142 vs 23) and complex visceral repairs, the military facility uniquely exposed the surgeon to military-specific mechanisms (gunshots, blasts) and preserved baseline dexterity through unrestricted general surgery access.

These results suggest that a tailored, intermittent MCP model effectively sustains military clinical readiness by blending high-density civilian trauma exposure with military-specific trauma care.

The 2022 floods in Pakistan marked one of the country’s most severe natural disasters, displacing approximately 33 million people, causing significant loss of life, and devastating infrastructure. While initial relief efforts focused on immediate food, shelter, and medical support, the transition to long-term rehabilitation has proven complex and prolonged, often overshadowed by emerging crises.

A mixed-methods study was conducted between September 2022 and September 2024 in flood-affected districts of Sindh province, Pakistan. Semi-structured interviews were conducted with 6 community leaders from 4 severely affected districts (Naushehro Feroze, Sukkur, Tando Allahyar, and Dadu). Operational records from the Humanity Initiative (HI), a student-led NGO, were also reviewed to document relief activities, geographic reach, volunteer deployment, and patient outcomes.

HI deployed over 150 medical students and health care professionals across 6 districts, establishing emergency medical camps that served more than 12,000 individuals. Thematic analysis of community leader interviews identified 5 key domains of persistent need: access to clean water, housing, food security, mental health, and educational continuity.

Student-led organizations play a vital complementary role in disaster recovery, particularly in remote and underserved areas. Sustained, integrated rehabilitation addressing mental health, economic recovery, and education is essential. Collaborative frameworks between student-led NGOs, larger organizations, and policymakers are needed to ensure long-term resilience.

Radiation and nuclear (R/N) incidents disproportionately threaten children due to biological sensitivity and psychosocial vulnerability. No standardized tool exists for systematic evaluation of pediatric response during post-incident Recovery. This paper introduces a specialized Pediatric After-Action Report (PAAR) template to address this gap.

The Pediatric After-Action Report (PAAR) template was developed by synthesizing disaster cycle principles, pediatric disaster medicine literature, and documented operational gaps from R/N incidents. Core functional domains were identified and structured into analytical and corrective action frameworks tailored to R/N-specific pediatric challenges.

The PAAR provides a comprehensive instrument for evaluating pediatric response across radiation-specific triage, age-appropriate medical countermeasures, prolonged sheltering, mental health interventions, family reunification, and risk communication. Each domain includes targeted questions linked to a corrective action framework assigning responsibilities and timelines to translate findings into improved preparedness. This PAAR addresses a critical omission in CBRN disaster management.

By enabling rigorous pediatric-focused after-action review, it ensures children’s unique needs are systematically assessed and continuously improved. Its integration into exercise cycles and real-incident recovery is essential to closing the disaster cycle for the most vulnerable population.

This study aimed to examine the barriers and facilitators influencing voluntary participation in health care crises.

This qualitative and exploratory study was conducted in 2025 at governmental health care centers in eastern Iran. Data were collected through a series of unstructured interviews. Stratified, purposeful, and snowball sampling were employed. Data analysis was performed using the qualitative thematic analysis approach as outlined by Braun and Clarke.

Data saturation was achieved after conducting interviews with 14 participants. Barriers to voluntary participation among health care personnel were organized into four primary themes: Physical, Psychological, and Emotional Challenges; Organizational Issues; Financial and Material Constraints; and Family, Social, and Cultural Concerns. Conversely, facilitators promoting voluntary participation were classified into 5 main themes: Intrinsic Motivation, Values, and Personal Characteristics; Cultural, Social, and Family Support; Organizational Support and Leadership; Experience and Skills; and Material and Financial Incentives.

Barriers and facilitators varied across clinical and paramedical professions, with differences also noted between physicians and nurses. The negative impact of closed, autocratic, and non-transparent organizations highlighted the importance of an open, accountable, and equitable environment in promoting voluntary engagement.

This systematic review and meta-analysis aimed to identify and synthesize evidence on risk factors for COVID-19 in incarcerated populations.

A systematic search of PubMed, Scopus, and Google Scholar was conducted for English articles until October 2025. Study quality was assessed using the PRISMA checklist and NOS tool. Meta-analysis was performed in Stata 17 using a random-effects model, with odds ratios as the primary effect measure and statistical significance set at P < 0.05. Heterogeneity was evaluated via I2 statistics.

Twelve articles were ultimately included in the study. For the meta-analysis, only 5 articles were considered, which evaluated sex, age, and vaccination status as the risk factors of COVID-19. The total sample size was 176169, consisting of 169117 males and 7,726 females. In most studies, the average age was reported to be around 40 years. Fully vaccinated prisoners were less likely to contract COVID-19 than unvaccinated ones (OR: 0.38; 95% CI: 0.22, 0.67; P = 0.001), while no significant relationships were found regarding sex and age.

Our findings confirm that full vaccination significantly protects against COVID-19 in prisons. Prioritizing vaccination campaigns, along with measures like mask use and hand hygiene, is essential to protect incarcerated individuals and the wider community.

Early warning systems compress evacuation windows, creating secondary domestic hazards. This study analyzes the community epidemiology and behavioral dynamics of evacuation falls during Israel’s 2026 missile crisis.

A retrospective study analyzed 2,941 emergency department visits. Daily alert volumes were integrated with municipal warning times (15-90 seconds) to calculate exposure-adjusted risk and map socioeconomic and architectural vulnerabilities.

Evacuation falls comprised 36.9% of crisis presentations. Per-alert relative risk multiplied more than eightfold over time, revealing a “complacency-panic mismatch.” Women comprised 66.7% of casualties aged 46+, indicating a caregiving (“kin-keeping”) burden. This was supported by strict gender parity among injured infants (0-4), signaling passive trauma via burdened caregivers. Risk patterns depended on warning times: 0-30s zones shifted risk to younger adults (acute flight response), whereas 90s windows affected frail populations (43.7% aged 66+). Concurrently, 51.4% of injuries occurred in high-socioeconomic municipalities due to internal architectural hazards.

Evacuation injuries represent a critical public health crisis. Mitigating this burden requires time-tailored protocols addressing caregiver biomechanics and household hazards, while prioritizing in-room protection for mobility-impaired individuals during acute scenarios.

The increasing frequency and severity of climate-related disasters pose major threats to public health, particularly when they intersect with other crises like pandemics. Puerto Rico has faced multiple large-scale disasters in recent years, yet research on their cumulative health effects remains limited. This study examines associations between disaster exposure—Hurricane María and the COVID-19 pandemic—and self-reported physical, mental, and behavioral health among Puerto Rican adults using Behavioral Risk Factor Surveillance System data (2015-2021).

We used multivariable linear and log-binomial models, adjusting for key sociodemographic factors.

Among 35,517 respondents, post-disaster periods were mostly linked to worse health outcomes, including more days of poor mental health, increased substance use, and more negative health perceptions. The early post-hurricane period showed the greatest harm, with participants reporting 2.47 more poor mental health days (P < 0.002), lower likelihood of exercise (PR = 0.65), and higher likelihood of smoking (PR = 1.20). Conversely, early and late pandemic periods showed apparent health improvements, though these findings require cautious interpretation.

Our results underscore the need for disaster-responsive mental health care, resilient infrastructure, and policies addressing financial inequities that heighten vulnerability. Strengthening community networks and ensuring equitable preparedness and relief efforts are essential to reducing the health impacts of future disasters.