Hazardous materials (HazMat) incidents pose significant risks to public health, safety, and the environment. This study aimed to characterize the temporal trends, geographic distribution, operational settings, and incident types of HazMat events reported in Oman.

This retrospective descriptive study analyzed data from the national HazMat incident records maintained by the Civil Defence and Ambulance Authority (CDAA). All reported chemical, biological, or radiological incidents between June 1, 2019, and November 30, 2024, were included.

A total of 55 HazMat incidents were recorded during the study period. Reported incidents increased over time, with the highest annual counts observed in 2023 (14 incidents) and 2024 (17 incidents). Muscat Governorate accounted for 39 incidents (71%). Residential neighborhoods were the most common operational setting (26/55, 47%), followed by other public areas (9/55, 16%), while airports, educational institutions, industrial areas, and transportation corridors each accounted for 5 incidents (9%). Gas leaks were the most frequently reported incident type, involved in 28 incidents (51%).

HazMat incidents in Oman increased over the study period and were concentrated in Muscat Governorate. Incidents occurred across diverse operational settings, particularly residential and public environments, while gas leaks represented the most frequently reported incident type.

The establishment of rapid response teams (RRTs) has gained increasing prominence due to the growing threats of emerging infectious diseases, natural disasters, and other public health emergencies. As a center for Hajj and a regional hub for commerce and travel, the Kingdom of Saudi Arabia (KSA) faces distinct challenges. This study explores the Ministry of Health’s main reasons and challenges in establishing RRTs.

We employed a cross-sectional qualitative design, utilizing in-depth interviews with key stakeholders and document analysis to explore the historical process of establishing RRTs in KSA and the challenges encountered.

Specialists’ insights revealed that the concept of RRTs was formally introduced and applied following the initiation of the Field Epidemiology Training Program (FETP) in KSA in 1989. However, its primary implementation began after the Middle East respiratory syndrome (MERS) outbreak in 2014. Identified challenges included a lack of trained personnel and resource availability due to unclear governance. There is a need for real-time data collection and technological solutions, improved inter-agency collaboration and information sharing, and governance.

The establishment of RRTs in KSA is estimated to have started with the initiation of the FETP. The challenges encountered provide valuable lessons for future emergency responses.

This study examined the behavioral characteristics of psychiatric inpatients following disasters.

Data were collected from 2 psychiatric hospitals in Japan, 1 affected by the Northern Osaka Earthquake (magnitude 6.1, seismic intensity 6) on June 18, 2018, and the other impacted by torrential rainstorms (total rainfall reaching 1800 mm; 224 fatalities, 8 missing) between June 28 and July 8, 2018. Focus group interviews were conducted with 24 nursing staff members from each hospital, divided into 8 groups.

A total of 158 inpatient behaviors were identified and organized into 19 themes. To delineate behavioral patterns, these behaviors were interpreted as adaptive (53.1%), maladaptive (22.2%), or unclassifiable (24.7%). Among maladaptive behaviors requiring prioritized care, 56.8% were associated with psychiatric disorders, while 43.2% reflected general disaster-related reactions.

Psychiatric inpatients demonstrated adaptive responses alongside typical disaster-related behaviors, with some behaviors attributable to underlying psychiatric conditions. Post-disaster care for psychiatric inpatients should emphasize strategies that support adaptability and protection. Additionally, targeted care for maladaptive behaviors specific to psychiatric conditions and vigilant observation of patients who do not display overtly agitated behaviors are critical.

Floods are increasing with climate change, and evacuating medically vulnerable people receiving home healthcare remains challenging. Patients dependent on medical devices and long-term care face complex challenges throughout the evacuation process. However, key factors influencing successful evacuation and effective support strategies remain underexamined. This study aimed to identify such factors and essential support measures across evacuation phases.

Semi-structured interviews were conducted with 13 participants—family caregivers, healthcare providers, and municipal officials—from July 2022 to March 2023 in 3 Japanese regions. Snowball sampling was used via medical administrative institutions. Thematic analysis followed COREQ guidelines, focusing on three phases: preparation, evacuation, and post-evacuation. Ethics approval was obtained (MG2022-01).

Preparation showed heterogeneous readiness: some services had hazard maps and manuals/BCPs, whereas household engagement was limited and operationalization was constrained by resources. During evacuation, participants described transport and staffing limitations, difficulty in moving medical equipment, and uncertainty about feasible options, with occasional consideration of vertical evacuation. Post-evacuation challenges centered on shelter sanitation and supplies, continuity of medical support, and coordination of support systems.

A three-phase, multi-stakeholder perspective clarifies how constraints accumulate and informs coordinated planning among municipalities, home-care teams, and families. Limitations include a small, region-specific sample and no direct patient interviews.

In September 2024, Lebanon experienced an unprecedented mass casualty incident involving the simultaneous detonation of thousands of weaponized pager devices. This systematic review characterizes the resulting injury patterns, surgical burden, and disaster-response lessons to help inform future preparedness and response strategies.

PubMed, Embase, Scopus, and Web of Science were searched for studies on casualties from the pager explosions. A random-effects meta-analysis estimated pooled prevalence of injuries by body region.

Sixteen articles met inclusion criteria overall, comprising seven studies in the clinical synthesis and nine articles in the qualitative disaster-response synthesis. A consistent injury pattern predominantly affected the hands, face, and eyes. Specialty-specific cohorts demonstrated severe ocular destruction, frequent hand amputation, and a substantial operative burden. In the two comparable hospital-based cohorts eligible for meta-analysis, upper extremity injuries were most common (pooled prevalence 84%; 95% CI: 73–91%; I2 = 0%). The incident exposed critical weaknesses in triage, communication, and specialty surge capacity.

The 2024 pager explosions produced a novel injury signature distinct from conventional blast trauma. These findings, while based on limited case series, underscore the urgent need for health care systems to develop flexible, adaptive disaster plans that can respond to the unique threats of unconventional warfare.

Yemen’s health care system has been critically disrupted by ongoing conflict, resulting in severe deficiencies in toxicology services. Toxicological emergencies, including poisonings, chemical exposures, and drug overdoses, represent a significant and underreported public health burden, compounded by systemic resource and training gaps.

To evaluate the availability, functionality, and safety of toxicology services in Yemen and identify key challenges faced by health care providers.

A cross-sectional, mixed-methods study was conducted using online surveys, key informant interviews, and facility audits. Quantitative data from 158 health care workers were analyzed using SPSS version 23, while qualitative data were thematically analyzed to provide contextual insights.

Toxicology services were unavailable in 72.4% of facilities, with 78.8% lacking dedicated toxicology units. Pesticide poisoning (73.1%), chemical exposure (58.3%), and drug overdose (49.1%) were the most frequently encountered emergencies. Significant barriers included a lack of antidotes (80.8%), diagnostic tools (85.4%), and adequately trained personnel (81.5%), with only 20% of health care workers receiving formal toxicology training. Furthermore, 70.1% of respondents reported no access to poison control centers, and 57.7% indicated the absence of referral laboratories.

Yemen’s toxicology services face critical gaps in resources, training, and diagnostics. Practical steps such as basic toxicology training, improved antidote access, and mobile health support can enhance emergency care in this resource-limited setting.

To examine systemic challenges to health system resilience in Puerto Rico following Hurricane Maria, focusing on resource, management, and policy domains.

Semi-structured interviews (n = 62) were conducted from January to April 2023 with health care professionals, patients, community leaders, nonprofits, and government stakeholders using purposive sampling. Interviews were conducted in Spanish, transcribed, translated, and thematically analyzed.

Resource failures centered on prolonged power outages (mean 62.7 days; up to 300 days), which cascaded into water, transport, and communication breakdowns. These disruptions endangered patients through interrupted surgeries, inoperable imaging, oxygen shortages, and infection control failures. Management challenges included depleted stockpiles, staff burnout, and workforce migration, which extended wait times to 6-8 months. Coordination was inconsistent, with duplication of aid in some areas and neglect in others, while top-down governance slowed response. Policy constraints compounded vulnerabilities: health insurance pre-authorizations delayed urgent care, capped Medicaid funds, and lack of federal parity, limited preparedness, and centralized aid distribution left rural communities underserved.

Puerto Rico’s health system resilience was undermined by interdependent failures across infrastructure, management, and policy. Building resilience will require investment in decentralized power, reforms to emergency insurance protocols, stronger inter-agency coordination, and equitable federal financing to ensure preparedness for future climate-related disasters.

This pilot study describes the design and field evaluation of web-based pre-deployment medical screening and health monitoring by the Urban Search and Rescue (US&R) branch of the Federal Emergency Management Agency (FEMA).

A review of US&R medical officers’ (MOFR) and task force physicians’ workflow identified web-based solutions. A Microsoft Forms tool (Microsoft Corporation, Redmond, Washington, USA) was utilized for pre-deployment medical screening. A web-based dashboard was developed for reporting task force daily Injury and Illness Logs, submission tracking, and syndromic surveillance.

The pre-deployment medical screening tool was completed by 100% of Incident Support Team (IST) members and took less than 4 minutes to complete. A post-deployment survey revealed that the new process was more efficient for the IST members and for the MOFRs in comparison to an in-person screen. Task force daily compliance with web-based Injury and Illness Log reporting was 84%. Successful syndromic surveillance was demonstrated and assisted in maintaining operational readiness. All tools were noted to be intuitive to use and were more efficient compared to prior workflows despite no advanced training in their use.

Web-based medical screening, reporting, and surveillance tools can be successfully implemented with high reporting adherence and improved workflow efficiency without prior training.

This brief report examines physical and mental health symptom profiles among older adults approximately 5 months after Hurricane Helene–related flooding in Southern Appalachia.

Survey data were collected from 233 older adults and assessed physical health symptoms, posttraumatic stress disorder, depressive symptoms, flood event exposure, environmental contaminant exposure, and post-flood stressors. Cluster analysis was conducted to identify post-disaster physical and mental health symptom profiles, and analysis of variance and chi-square tests were conducted to examine differences in disaster exposure, post-flood stressors, and sociodemographic characteristics across profiles.

Three distinct post-disaster health symptom profiles were identified: a lower symptom profile, an elevated mental health symptom profile, and a combined elevated physical and mental health symptom profile. Disaster exposure, contaminant exposure, and post-flood stressors increased in a graded manner across profiles, indicating a dose–response framework of disaster-related health impacts. Higher symptom burden profiles were disproportionately represented among older adults with disabilities/chronic illness and among older age groups.

Findings highlight heterogeneity in post-disaster health experiences among older adults and underscore the value of identifying high-risk subgroups and implementing recovery strategies that address co-occurring physical and mental health needs among older adults following flood events.

In recent years, a significant number of Farsi-speaking refugees and asylum seekers have sought asylum in Germany. This group often suffers from emotional distress, which can significantly impact their mental health. The present study aimed to assess the general mental health status and emotional distress among Farsi-speaking refugees, while also exploring the relationship between resilience, psychological flexibility, perceived social support, and meaning in life with posttraumatic growth.

The study involved 230 Farsi-speaking refugees living in refugee camps in Berlin and Brandenburg, Germany. Participants completed several questionnaires, including the RHS-15 screening questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), the Acceptance and Action Questionnaire (AAQ-2), the Multidimensional Scale of Perceived Social Support (MSPSS), the Meaning in Life Questionnaire (MLQ), and the Posttraumatic Growth Inventory (PTGI). Data collection took place from August to November 2022. Data analysis was conducted using descriptive methods and linear regression.

The study revealed high levels of emotional distress among Farsi-speaking refugees. More than two-thirds of refugees (n = 159, 69.13%) were at high risk for depression, anxiety, and PTSD symptoms. In addition, there were potential factors that were strongly linked to posttraumatic growth.

The findings emphasize the importance of providing psychosocial care in refugee camps after resettlement and, at the same time, focusing on posttraumatic growth by clinicians.

Mass casualty incidents (MCIs) continue to pose significant operational challenges for health care facilities, particularly when compounded by electronic health record (EHR) downtime or cyberattacks. Despite advancements in technology, providers may consider using simple, paper-based patient triage and tracking methods during an MCI. This study describes the implementation of a paper-based triage and patient tracking tool, integrated into a broader MCI Toolkit, to support operational continuity.

Developed by NYU Langone Hospital—Brooklyn Emergency Department in collaboration with Emergency Management, the tool was deployed in 6 full-scale exercises (2021–2025) and 2 real-world MCIs across trauma and non-trauma ED settings. The tool follows a 3-step process: rapid triage using Simple Triage and Rapid Treatment (START), documentation of acuity and location, and post-triage identity reconciliation. The MCI Toolkit includes operational resources such as contact lists, patient placement maps, and job action sheets. After each event, feedback was gathered from clinical staff and senior leadership.

In the feedback sessions, the tool was noted to be intuitive and required minimal training. It enabled rapid triage, patient placement, and real-time situational awareness for Incident Command. During a downtime simulation, it supported a seamless transition from electronic to manual processes. Across incidents, it improved patient throughput, ensured appropriate team assignment, and supported role flexibility when leadership was unavailable.

Our experience using the paper-based Triage Tracker showed it reliably maintained patient tracking without electronic systems. Its ease of use and integrated resources supported coordination, patient flow, and operational continuity during MCIs and EHR disruptions.

Recent years have seen an increase in disaster situations worldwide. There is no current international description of disaster preparedness (DP) among European EPs.

To make a transversal, international description of the self-reported DP levels among European EPs, using a KArP (Knowledge-Attitude-readiness-to-Practice) analysis.

An international survey-based observational study of DP, using a KArP-model, was conducted between April and June 2024 among post-residency EPs in 9 European countries. The respondents’ levels of education, training, and experience in disaster medicine (DM) were described. Correlations were sought between the participants’ characteristics and DP scores.

Results from 813 participants were collected. Mean rP-score was 66,54% (SD 14,99) and mean KArP-score was 71,83% (SD 12,45). Only half of the participants reported a dedicated practical DM training during specialty training, whereas almost 25% reported no DM training. Only 57% reported full-scale disaster drills in the previous year. Significant differences were found from one country to another in education and training in DM and in DP scores. DP scores were lower among pediatric EPs.

Improving and harmonizing individual and collective DP in European EPs is crucial. Simple checklists aimed at optimizing individual and collective DP were proposed.

Identification, a cognitive process by which individuals think of themselves as similar to another person, may be associated with distress during traumatic events. This study examined the association of identification with psychological responses among disaster workers not directly exposed to an airline crash.

Participants were 421 workers (aged 18-60 [M (SD) = 36.2 (9.9)], 86.4% male, 98.3% White, 71.8% married). Surveys at 2 months (Time 1; T1) and 7 (T2) months post-disaster assessed identification (i.e., extent to which participants identified victims as similar to themselves, a friend, and/or family member), previous disaster exposure, and acute stress and anger/hostility. Linear and logistic regression analyses examined the relationship of identification to psychological responses over time.

Approximately 15% of participants reported that they had high levels of acute stress within a week of the airplane crash when assessed 2 months later. Among those with high identification, 30.2% had high acute stress. In multivariable models, adjusting for covariates, greater identification was associated with acute stress and anger/hostility at T1, but not anger/hostility at T2.

Identification is associated with high levels of acute stress and anger/hostility in non-exposed individuals. Those with greater identification, regardless of exposure, could be at increased risk of distress and may benefit from early interventions.

This convergent parallel mixed-methods cross-sectional national survey informs us of current disaster trainings and perceived preparedness of school nurses and their anticipated roles.

Disasters are increasing while training to handle the emergency care is not prioritized. School nurse education is outdated, consisting of one quality program focusing on triage in disasters.

A convergent parallel mixed-methods survey, with closed- and open-ended questions, was distributed online to elementary, middle school, and high school nurses.

Quantitative results identified cardiopulmonary resuscitation, active shooter, and fire training as the most prevalent training with floods and earthquakes lacking training. Thematic analysis provided views on past disaster experience, previous nursing experience, first aid and triage, desire to be included on safety committees, need for mandatory scheduled disaster training, and benefits of debriefing.

School nurse disaster management is essential to protect our children. School administrators need to appreciate this multi-faceted resource and provide up-to-date comprehensive mandatory training.