Children with medical complexity (CMC) are highly vulnerable during disasters, yet few Japanese welfare evacuation shelters accept them, leading to hospital-dependent planning. We aimed to assess the key issues hindering the establishment of welfare evacuation shelters for CMC.

In Tottori Prefecture (2020-2024), the government, municipalities, a university hospital, and device partners used facility assessments, staff education, and tabletop/field simulations (weekday earthquake with power outage and ventilator-dependent 5-year-old model) to identify gaps and iteratively revise manuals.

Key issues included space underestimation, difficult mobility, power insecurity, unreliable verbal information, unclear deterioration pathways, and undefined public health nurse (PHN) roles. Revisions established PHN-led reception/triage, standardized information collection, specified power sourcing, and set escalation/transport flows. A section on “Persons Requiring Medical Care” was added to prefectural policies, and the disaster medical guidance was updated, shifting preparedness from hospital-centered to shelter-based welfare.

This simulation-driven intersectoral model appears scalable; however, it was performed in a single prefecture with limited follow-up, impairing generalizability.

Rapid-onset hazards such as flash floods and tornadoes often provide limited warning lead time. When these events occur overnight, residents may be asleep and less likely to receive warnings, increasing injury and mortality risk. This study examined confidence in receiving overnight flash flood and tornado warnings and factors associated with warning reception confidence.

A cross-sectional survey of 1,008 adults across 12 southeastern U.S. states assessed confidence in receiving overnight flash flood and tornado warnings (12:00-6:00 AM) and factors associated with warning reception confidence.

Approximately half of respondents reported confidence in their ability to receive overnight flash flood (47.8%) and tornado (51.5%) warnings. Greater confidence was associated with greater warning source reliance, having a nighttime household emergency plan, higher nocturnal hazard risk perception, and greater trust in weather information. Mobile home residents reported lower confidence in receiving overnight tornado warnings than respondents residing in other housing types.

Many respondents remained uncertain about their ability to receive overnight warnings. Efforts to increase access to multiple warning sources capable of awakening residents, strengthen nighttime household preparedness planning, and improve awareness of nocturnal hazard risks may help improve overnight warning reception and support protective action.

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.

Pediatric patients present distinct developmental, psychosocial, and clinical challenges during high-consequence infectious disease (HCID) transport. Despite these differences, national biocontainment transport systems have historically been designed around adult patients, resulting in limited pediatric-specific guidance and operational experience.

The aim of this study was to describe pediatric-specific observations from the inaugural deployment of the US Department of Health and Human Services’ (HHS) Portable Biocontainment Unit (PBCU) during a national full-scale exercise and to identify considerations relevant to pediatric-inclusive HCID transport.

A qualitative, observational evaluation was conducted during the 2025 Tranquil Passport Full-Scale Exercise. Data sources included structured interviews with pediatric actors and caregivers, evaluator observations, and facilitated multi-disciplinary debriefings. Pediatric participants simulated biocontainment transport scenarios within the PBCU across multiple sites and phases of care.

Pediatric transport within the PBCU required advance planning to address developmental, psychosocial, and physiologic needs distinct from adult care. Pediatric participants frequently described confusion or anxiety related to noise, vibration, movement, and the appearance of personnel in personal protective equipment (PPE). Communication challenges associated with masked voices were reported. Caregiver separation due to infection-control requirements was consistently described as stressful. Clinical teams identified benefits of pediatric-specific medication dosing guides and essential medication sets within the confined biocontainment environment.

This inaugural deployment of the PBCU with pediatric participants identified key operational and psychosocial considerations relevant to pediatric-inclusive HCID transport. Findings supported the need for deliberate integration of pediatric-specific planning, communication strategies, and resources within biocontainment transport systems. These observations may also inform pediatric HCID transport planning in international settings where similar challenges are encountered.

Community pharmacies fulfill a pivotal function in maintaining the uninterrupted delivery of health care services and safeguarding the medication supply chain during disaster situations. However, the extant evidence regarding the disaster preparedness levels of pharmacies is limited, particularly in regions with high seismic risk.

The objective of this study was to assess the disaster preparedness levels of community pharmacies in Istanbul and to examine factors associated with their preparedness status.

In this descriptive cross-sectional study, conducted between December 2024 and April 2025, researchers collected data from 360 pharmacies. These pharmacies were selected using a systematic sampling method. The researchers developed a structured questionnaire to collect the data.

The investigation revealed that only 32.8% of pharmacies had a disaster plan, 91.7% had not conducted drills, 85.6% lacked smoke detectors, and 71.4% lacked fire alarms. Conversely, 87.5% of pharmacies reported collaborating with neighboring pharmacies or regional representatives during disaster situations. The findings of the study indicated that pharmacies that had undergone disaster training exhibited significantly higher levels of safety equipment, planning, and material stockpiles (P < 0.05).

The findings indicate that pharmacies in Istanbul demonstrate proficiency in collaboration and fundamental supply procurement. However, deficiencies are observed in drills, fire safety measures, data backup protocols, and strategic planning. In order to enhance the disaster resilience of pharmacies, it is imperative that training programs be expanded, drills be made mandatory, and institutional governance be strengthened.

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.

This study examines factors influencing the development of disaster meal provision manuals in food service facilities in earthquake-prone regions of Japan. Given the increasing frequency of natural disasters, ensuring meal service facilities’ preparedness is crucial to safeguarding vulnerable populations, including infants, pregnant women, the elderly, and individuals with chronic conditions.

A survey of 866 meal service facilities in Mie Prefecture, Japan, was conducted to assess disaster preparedness measures. Key factors analyzed included the presence of registered dietitians, disaster preparedness drills, and stockpiling of balanced emergency food supplies. Logistic regression analysis was used to identify predictors of manual development.

The presence of registered dietitians (OR = 2.82, 95% CI: 1.95-4.08), disaster preparedness training (OR = 3.15, 95% CI: 2.18-4.57), and balanced emergency food stockpiles (OR = 2.52, 95% CI: 1.66-3.83) were significant predictors of disaster meal provision manual development.

Findings underscore the essential role of dietitians in disaster nutrition planning and highlight the need for proactive preparedness strategies to enhance food security and facility resilience. These insights can inform policy recommendations in Japan and other disaster-prone regions facing similar challenges.

This study examined the relationship between climate change awareness and belief in disaster preparedness among university students and explored the mediating role of social media use purposes.

A cross-sectional survey was conducted with 418 university students. Data were collected using validated scales measuring climate change awareness, disaster preparedness belief, and social media use purposes. Pearson correlation, multiple linear regression, and bootstrap-based mediation analysis (PROCESS Macro Model 4) were performed.

Climate change awareness was positively associated with both social media use purposes (r = .322, P < 0.001) and disaster preparedness belief (r = .307, P < 0.001). Regression analysis showed that climate change awareness (B = 0.185, P < 0.001) and social media use purposes (B = 0.243, P < 0.001) significantly predicted disaster preparedness belief. Mediation analysis indicated that social media use purposes partially mediated the relationship between climate change awareness and preparedness belief.

Higher climate change awareness was associated with stronger disaster preparedness beliefs among university students. Social media use purposes partially mediate this relationship and function as a complementary digital mechanism linking climate awareness to preparedness beliefs

To identify stakeholders’ perceptions of the role of the nurse educator in Hospital Disaster Management (HDM), determine the core competencies required for their effective participation, and establish training areas to enhance their participation during disasters.

A qualitative hermeneutic-phenomenological design was adopted with 38 stakeholders comprising doctors, clinical nurses, nurse administrators, and nurse educators in tertiary hospitals and nursing colleges in Kerala, India. The responses were collected through in-depth interviews with 15 respondents and focus group discussions with 4 different groups in December 2023.

Themes identified included preparedness gaps, underuse of secondary stakeholders, training and coordination capabilities, training needs, fear of clinical competence and safety, role confusion, elitism, and social responsibility, totaling 7 themes. Participants identified roles, preparedness, variable clinical exposure, and the necessity of planned competency development as unsatisfactory. The nurse educators were able to contribute to training, supervision, documentation, and psychosocial support, provided they are well prepared.

Nurse educators can be of great help to HDM, but are not being used to their full potential due to unclear role expectations and limited readiness. Their competencies can be enhanced and incorporated into institutional disaster plans to build surge capacity and improve coordination in hospital disaster responses.

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.

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.

This study explores the relationship between sustainable earthquake awareness and earthquake stress coping strategies among university students following the February 6, 2023, earthquake.

A descriptive, cross-sectional study was conducted between March and April 2024, involving 239 university students. Following the STROBE checklist, data were collected using the Personal Information Form, Earthquake Stress Coping Scale (ESCS), and Sustainable Earthquake Awareness Scale (SEAS). Ethics approval was obtained, and data were gathered through face-to-face surveys.

The average participant age was 21 years; 67.8% were women, and 20% had direct earthquake experience. Among participants, 67.4% reported negative academic impacts due to the earthquake. Higher SEAS scores were associated with higher income, prior earthquake experiences, having an emergency kit, securing belongings, and participation in earthquake training and drills. Higher ESCS social support-seeking scores correlated with higher income, earthquake preparedness training, drill participation, awareness of emergency meeting areas, and enrollment in the child development department.

The findings highlight gaps in earthquake preparedness among university students while emphasizing the role of personal earthquake experiences in fostering awareness and adaptive coping strategies. Enhancing earthquake preparedness training could improve resilience among students in earthquake-prone regions.

To assess interagency emergency response capabilities for radiological threats through a tabletop exercise (TTX) simulating a nuclear power plant accident, with focus on communication protocols, patient referral pathways, and public information management in Ukraine’s current security context.

A structured 3-day TTX was conducted in September 2024 by the WHO Ukraine Country Office, simulating a cooling system failure at a fictional North-West Nuclear Power Plant. Twelve organizations participated, including regional health authorities, emergency services, and international partners. The exercise employed a progressive scenario that injects testing accident notification, media management, medical response, and evacuation procedures. Performance was evaluated using structured criteria (Achieved, Partially Achieved, Not Achieved) across predefined indicators.

The exercise identified critical preparedness gaps including the absence of regular radiological-nuclear emergency drills in regions without nuclear facilities, challenges in potassium iodide procurement and distribution, staff hesitancy due to inadequate insurance coverage, and lack of standardized decontamination procedures. Communication protocols functioned effectively, though coordination delays were noted. Patient referral pathways required strengthening, particularly for contaminated casualties.

While Ukraine demonstrates functional emergency response frameworks, specific radiological preparedness requires enhancement. Regular multiagency drills, improved staff protection policies, standardized decontamination protocols, and robust public information systems are essential for effective radiological emergency response.