The widespread use of explosive weapons in populated areas (EWIPA) has become a defining feature of modern conflict with devastating consequences for civilians. Practical guidance on sheltering during explosive attacks remains limited, inconsistent, and unevenly integrated with existing scientific and technical evidence. This study explored the landscape of shelter guidance through the perspectives of international humanitarian practitioners working in EWIPA contexts.

Semi-structured interviews were conducted with 10 practitioners from international humanitarian NGOs, Red Cross societies, and UN agencies engaged in risk education, emergency response, and conflict monitoring. Participants were purposively selected for operational experience in EWIPA-affected regions. Interviews explored 4 domains: guidance content, information sources, dissemination channels, and implementation challenges. Data were analyzed using a hybrid inductive-deductive approach.

Practitioners described various sheltering messages, from general cues like “find cover” to specific techniques including low-profile positioning. Most guidance drew on field experience rather than empirical research. Dissemination strategies varied by context. Challenges included message distortion, difficulty engaging high-risk groups, and absence of standardized recommendations.

Shelter guidance in EWIPA contexts is fragmented and only partially connected to the existing technical and scientific evidence base. Findings highlight the need for coordinated, context-specific, and evidence-informed approaches to strengthen civilian protection.

Attacks on health care are war crimes. This study aims to investigate the types, scales, and patterns.

The secondary analysis explores public data from WHO’s “Surveillance System for Attacks on Health Care (SSA)” from January 2018 to December 2024.

The analysis shows that the attacks on health care and number of affected countries increased strongly. A total of 8,012 attacks on health care were recorded across 22 countries. Just over half of the attacks impacted health care personnel, and almost a quarter affected patients. Attacks can vary widely in type, complexity, and impact, which have regional specificities. The occupied Palestinian territory and Ukraine have suffered the most attacks on health care worldwide. Country-specific attack strategies are identified. Furthermore, the combination of violence with individual and heavy weapons in an attack accumulated the probability of injuries or deaths. Improvements were observed in a few countries. A 2-step cluster analysis reveals that the heterogeneous attacks can be well clustered into approximately 2 halves. It identifies patterns across countries. The most important predictor for clustering of the attacks on health care is violence with heavy weapons, which is frequently observed, for example, in Ukraine.

The global trend has worsened dramatically. Prevention and protection are needed.

This study qualitatively examines community experiences related to housing following natural disasters, focusing on damage to home infrastructure, barriers to completing repairs, and the resources needed for recovery and rebuilding.

Participants included members from 3 historically underserved Houston communities (Kashmere Gardens, Fifth Ward, and Third Ward) with Social Vulnerability Index (SVI) rankings in the 80th percentile. Town hall–style conversations were held within each community; small focus groups were completed within the town halls. Reflexive thematic analysis was used to identify themes, supported by researcher triangulation, reflexivity, and member checking to establish trustworthiness.

Analysis identified 7 key themes :1) Successive Disasters Exacerbate Problems Driven by Gentrification, 2)Insufficient and Unequal Post-Disaster Resources Drive Dependence on Community Support Networks, 3) Systemic Delays in Relief Services to Underserved Communities Underscore The Need for Government Accountability, 4) Growing Distrust in Local Government to Address Evolving Post-Disaster Needs, 5) Navigating Complex Insurance Policies While Being Drained by a Disaster, 6) Trickle-Down Unpreparedness Starts at a City Level, and 7) Steps to Prepare for Future Disasters.

Systemic inequities in disaster preparedness and response affecting low-income Black and Hispanic communities are evident. Addressing these disparities requires prioritizing resource distribution, infrastructure investments, and community-driven planning and resilience building.

Researchers have revealed that the incidence of aspiration pneumonia (AP) increases following a disaster, not only due to the disaster itself but also due to environmental factors, which will propose dysphagia rehabilitation targets. We aimed to delineate the current status of dysphagia rehabilitation in disasters.

English literature was searched via scientific databases, representative journal homepages, trial registries, and gray literature.

A total of 242 articles were reviewed in full text, and 31 were included in this review. Most hazards were earthquakes (19/31), and most reports originated from Japan (19/31). The reported issues were summarized according to the International Classification of Functioning, Disability, and Health (ICF) codes. Twenty-seven codes related to areas such as Swallowing, Caring for teeth, and Food were the most frequently reported. In addition, three additional items not formally listed in the ICF were considered: nutrition, oral hygiene, and denture.

The mechanisms of emergency lifestyle-related aspiration pneumonia were identified, and approaches to prevent AP were proposed. We further discuss how to promote dysphagia rehabilitation in disasters. Nevertheless, multidisciplinary coordination is important, and more involvement of rehabilitation specialists is required.

Disaster risk assessment is essential in territories increasingly affected by climate-related hazards. This study applies a sequential methodology for quantifying and assessing disaster risk using open-source information, focusing on Coquimbo, Chile, a coastal city with high exposure.

A 7-step model was developed, integrating sectorization by Neighborhood Units, hazard identification, recurrence analysis (2000-2024), and the evaluation of vulnerabilities, capacities, and exposure. Hazards included earthquakes, tsunamis, droughts, wildfires, and landslides. Resilience was calculated through weighted vulnerability and capacity variables, while exposure was estimated using infrastructure values. Disaster risk was computed as the product of hazard, resilience, and exposure.

Coquimbo shows heterogeneity. UV06 Sindempart, UV10 El Llano, and UV15 La Herradura demonstrated capacities, while UV12 El Culebrón and UV17–UV18 Tierras Blancas showed the highest vulnerabilities. Coastal UVs such as UV05 Baquedano and UV13 Guayacán concentrate exposure due to infrastructure and population density. Earthquakes and tsunamis were identified as the most recurrent hazards. The methodology generated 150 risk estimates across 30 Neighborhood Units.

The methodology enables a structured, replicable evaluation of disaster risk, even with limited data. Its application in Coquimbo highlights territorial disparities that can guide prioritization of resilience strategies, early-warning systems, and evidence-based planning.

Natural disasters may worsen cancer outcomes through treatment delays, screening interruptions, or fragmented health care delivery. We investigated whether climate-related natural disasters were associated with changes in county-level prostate-specific antigen (PSA) screening.

We modeled county-level screening estimates from the Behavioral Risk Factor Surveillance System (BRFSS) from 2004 to 2012 using Census-derived demographic weights. The Federal Emergency Management Agency (FEMA)’s Disaster Declarations Summaries database was used to include counties that experienced a single climate-related natural disaster. The year of disaster was considered the index date, with 2-year pre- and post-disaster periods used to model counterfactual screening prevalence with vs without a natural disaster. Primary outcome was county-level PSA screening prevalence. We applied log-linear regression to estimate prevalence ratios for the association between natural disaster and two-year county-level PSA screening.

In 37 states, 365 counties experienced a single natural disaster, including a total population of 7,584,059 men aged 40-79. Compared to baseline county-level screening prevalence, PSA screening in the 2-year post-disaster period was 8% lower (rate ratio [RR]:0.92, 95% CI: 0.90-0.94, P <0.001]).

We observed significantly lower county-level PSA screening prevalence following a climate-related natural disaster. These results underscore the potential impacts of climate-related natural disasters on cancer screening services.

Violence against health workers and health care facilities in conflict settings is a major public health concern, disrupting service delivery and undermining humanitarian response. While attacks on health care have been widely documented, standardized multicountry comparisons using consistent surveillance metrics remain limited.

A retrospective, descriptive observational analysis was conducted using incident-level, open-source records curated on the United Nations Humanitarian Data Exchange (HDX) from 2016 to 2024, covering 20 conflict-affected settings. Incidents involving harm to aid and health workers and attacks on health care facilities were summarized descriptively and standardized per capita to enable cross-setting comparison.

Across the 20 settings, reported harm to health systems increased after 2021. PSE exhibited the highest per-capita burden, with 407 aid and health-worker fatalities and 420 reported attacks on health care facilities, while Ukraine recorded the highest absolute number of facility attacks (1,060). Myanmar demonstrated a distinct pattern characterized by large-scale arrests of health care workers following the 2021 military coup. Other settings demonstrated variable burdens and harm modalities, including personnel-lethal, infrastructure-destructive, and coercive patterns.

Reported attacks on health care in conflict settings are widespread and heterogeneous. This descriptive, per-capita comparison highlights variability in harm modalities across settings and identifies high-burden contexts that may warrant prioritization for surveillance strengthening, preparedness planning, and protection-focused operational coordination. Further research is needed to examine drivers, impacts on service delivery, and prevention strategies using attribution-aware, mixed-methods approaches.

Mass gathering events represent complex operational environments that challenge emergency preparedness and prehospital medical response systems. Milano Pride, Italy’s largest LGBTQIA+ event, attracts over 300,000 attendees annually and combines a dynamic parade with a high-density static concert. This study reports a 3-year experience (2022-2024) of prehospital organization, operational deployment, and patient presentation patterns during the event.

A retrospective observational study was conducted using data from medical action plans, mission reports, and patient records collected during the final day of Milano Pride from 2022 to 2024. The integrated response system included 6 Basic Life Support ambulances, one Advanced Life Support unit, foot and bicycle rescue teams, a field hospital, and a centralized command center.

A total of 165 missions were recorded across the 3 editions. Most cases were minor and managed on site; 8-20% required field hospital care and ≤7% hospital transport. Substance- and alcohol-related presentations accounted for approximately one quarter of cases annually. Trauma-related cases decreased over time. The mean patient age was 32 years, and the medical incident rate (0.17-0.20 per 1,000 participants) was lower than rates reported for comparable international events.

A structured, multidisciplinary prehospital system ensured effective on-site care while minimizing hospital impact, highlighting the importance of proactive planning and coordinated response in large urban mass gatherings.

Broad predictions about disaster health care needs are insufficiently granular to estimate system impacts. Historical utilization data could refine predictions, but disaster patients differ systematically from usual health care. This study matches civilian health care utilization data to predicted disaster patient characteristics and validates the method, using the theoretical example of mass military patient transfer to civilian hospitals.

An ICD-10 code sorting algorithm was developed, categorizing each ICD-10 code into one of 13 broad stakeholder-predicted categories. Blinded clinicians validated each categorization. Healthcare Cost and Utilization Project (HCUP) and civilian hospital billing data were used to match category/ICD-10 code pairs to Diagnosis-Related Groups (DRG) to understand utilization for each disaster injury category.

Agreement was excellent (Cohen’s ĸ = 0.86; 99.2% agreement among ≥2/3 clinicians). The resulting ICD-10 codes—disaster injury category crosswalk was applied to 1,945,272 HCUP inpatient encounters. Most disaster injury categories corresponded exactly to one DRG; some DRGs, e.g., multi-system trauma, corresponded to multiple disaster injury categories. Length of stay and payer varied by disaster injury category and HCUP vs hospital billing data.

This method refines broad predictions about disaster epidemiology using linkage to granular civilian health care data; it can improve readiness by accurately modeling disaster care and reimbursement.

The purpose of this study was to assess senior nursing students’ performance and perceived readiness following a fully immersive VR mass disaster triage simulation and evaluate the effectiveness of VR as an educational modality for emergency preparedness training.

A retrospective observational study assessed BSN students who participated in a VR simulation incorporating START triage and TeamSTEPPS™ principles. Sixty-four students completed the post-experience survey using validated PACT instruments and custom measures.

Students demonstrated successful application of START triage methods and TeamSTEPPS domains during the simulation. Students reported significant increases in perceived knowledge of emergency response (M = 64.3%, SD = 27.5), attitude toward mass disaster training importance (M = 76.8%, SD = 24.5), and ability to respond (M = 66.9%, SD = 26.2). Wilcoxon signed-rank tests revealed significant improvements in understanding of all TeamSTEPPS concepts (P <.05).

VR simulation effectively enhanced nursing students’ perceived readiness for mass disaster response and demonstrated successful application of emergency skills, supporting its integration into nursing curricula for Generation Z learners.

As the 2024 Paris Olympic Games approach, it seemed relevant to analyze 25 past years of medical workload at the Stade de France to better predict future needs by identifying the determinants of workload levels.

Site: Stade de France, the largest French stadium, in the Greater Paris area.

Inclusion: Events from 1998 to 2022.

Parameters: Nature of event; level of event; competition finals; number of spectators, weather, and medical workload.

End-points: Number of patient presentations.

459 events were studied: 167 (36%) football matches, 142 (31%) rugby matches, 111 (24%) artistic performances, 26 (6%) athletics competitions, 11 (2%) motor sports competitions, and 2 (0.5%) other types of events. Median attending spectators: 72,057 [56,825-78,500]. Median patient presentations: 29 (15-59) or 5 (2-9) per 10,000 spectators. Median transports to hospital: 2 (1-3) per event, or 0.3 [0.1-0.5] per 10,000 spectators. Median medicalized transports to hospital: 0 [0-0] per event. The nature of the event, rugby (OR = 7.97 [1.65-46.80]), international event (0.18 [0.04-0.76]), and temperature (OR = 0.86 [0.77-0.96]) were associated with a greater frequency of high medical workload in multivariate analysis.

Rugby matches, level of event, and outdoor temperature were independent determinants of medical workload. Number of spectators and duration of the event had no influence.

As natural disasters become more frequent and severe, examining their impact on health care access is increasingly important. This study was a community-level assessment of the effects of flooding and COVID-19 on access to health care services.

This study utilized a self-administered survey in flood-prone Houston communities. Bivariable associations of having experienced flooding damage, as well as having a history of COVID-19 diagnoses, were examined by demographics and health care access using chi-square analyses, t-tests, and both unadjusted and adjusted logistic and Poisson regression models.

Among 206 surveys, 20.39% reported homes or vehicles lost to flooding, and 33.5% had been diagnosed with COVID-19. Those who experienced flooding were 3 times more likely to report their closest hospital closed, their doctor’s office closed, delays filling prescriptions, not getting needed medical care, and delayed medical care access. Experiencing both COVID-19 and flooding was even more strongly associated with the frequency of health care services lost.

These findings highlight the need for expanded health care access and support services that accommodate localized damages in communities susceptible to adverse events. Future planning for disasters should include plans for expanded access to health care resources for those with comorbidities and low-socioeconomic groups.