OBJECTIVE:Terrorist attacks targeting American fast-food restaurants remain an underexplored threat, given their high volume of civilians, predictable operating hours, and limited security. However, there remains limited data available on the extent and characteristics of these attacks. DESIGN:A retrospective search and descriptive analysis of the Global Terrorism Database was performed, querying attacks targeting American fast-food restaurants between 1970 and 2020. Keywords were used to identify attacks involving the top 15 American fast-food franchises by annual revenue. Attacks were analyzed by geography, modality, weapon type, and perpetrating group. RESULTS:There were 72 reported attacks on American fast-food restaurants, leading to 112 injuries and 26 deaths. McDonalds (45.8 percent) and Kentucky Fried Chicken (26.4 percent) were the most frequently targeted establishments. Most attacks took place in the United States (US) (19.4 percent). A disproportionate share of deaths occurred in the Middle East/North Africa (30.8 percent), while a large proportion of nonfatal injuries occurred in East Asia (27.7 percent). Bombing accounted for the majority of attacks (59.7 percent), deaths (76.9 percent), and injuries (99.1 percent). Vehicle-based explosives were used in only 4.2 percent of attacks but carried an outsized share of deaths (42.3 percent) and injuries (30.4 percent). The Animal Liberation Front (ALF) (11.1 percent) and Tupac Amaru Revolutionary Movement (6.9 percent) were the most commonly identified perpetrators. In the US, animal rights extremist groups such as the ALF and the Earth Liberation Front together accounted for most domestic attacks (50.0 percent). CONCLUSIONS:American fast-food restaurants are an uncommon but symbolic target for terrorist attacks, leading to deaths, injuries, and damage worldwide. Future efforts should seek to prioritize corporate investment in protective infrastructure upgrades, integrate real-time threat intelligence systems, conduct routine emergency response drills, and expand public health initiatives such as tourniquet access and "Stop the Bleed" training.
OBJECTIVE:The healthcare disparity focus group within the Western Regional Alliance for Pediatric Emergency Management aimed to identify barriers to optimal care for children affected by disasters and potential opportunities for improvement. METHODS:The study was conducted in six focus groups during the summer of 2023. A survey was distributed to individuals in emergency management and disaster medicine to collect demographic data. The survey also assessed the total number of trainings that participants attended. The focus group discussions were led by experienced qualitative researchers. Participants could also respond to the questions during the meetings on a digital note-taking platform. These discussions were then transcribed and analyzed using ATLAS.ti. The data from the survey were analyzed using SPSS, Windows Version 29.0. RESULTS:The survey included 49 people. The focus group meetings revealed multiple themes and subthemes that reflected the challenges that emergency management and disaster medicine professionals face when combating health disparities and raising awareness for pediatric populations. The challenges that these professionals face include funding, communication, gaps in knowledge, gaps in technology, and a lack of emergency preparedness plans. The focus groups also highlighted facilitators to preparedness, team cohesion, engagement, and the presence of certain grants to help with funding as ways to combat health disparities and raise awareness for pediatric populations during emergencies. CONCLUSION:The results of the focus groups can effectively be utilized to assess the challenges emergency management and disaster medicine professionals experience. The results highlight the need to prioritize funding, communication, and addressing gaps in knowledge, gaps in technology, and a lack of emergency preparedness plans. The results can be used to explore different approaches to improve health disparities through awareness initiatives as a forefront priority for pediatric populations.
OBJECTIVE:To provide an overview of the literature on disaster preparedness regarding surge capacity with a particular focus on vulnerable populations during a pandemic. DESIGN:The Disaster Preparedness and Response Committee of the American College of Emergency Physicians addressed the topic of vulnerable populations during a pandemic. A workgroup of nine physicians with academic and/or disaster deployment experience was formed. A literature review focused on individuals with access and functional needs, also referred to as special healthcare needs (SHCN) or vulnerable individuals, was performed. Search terms included pandemic, public health emergency of international concern (PHEIC), disaster, vulnerable population, individuals with access and functional needs, special health care needs (SHCN), surge capacity, and communications, medical care, independence, supervision, and transportation (CMIST). Search strategies included medical sources such as PubMed, Medline, Google Scholar, ScienceDirect, Scopus, and the Cochrane Database of Systematic Reviews. Reviews were performed by a librarian. In addition, relevant articles from the bibliographies of included studies and more recent articles identified by committee members were included. The workgroup evaluated the literature and identified issues regarding surge capacity occurring during a pandemic that particularly impacted the SHCN population. Potential solutions were identified. RESULTS:Vulnerable individuals are at greater risk during a pandemic than the general population, although potential solutions to mitigate the impact of a pandemic on vulnerable individuals are possible. CONCLUSIONS:Although pandemics can have significant adverse effects on the general population, vulnerable individuals have the greatest morbidity and mortality and are at the greatest risk. Efforts are warranted to better address the negative impact of a pandemic, not just for the general population but also for individuals with access and functional needs, and to find solutions that can help mitigate the consequences of a pandemic.
OBJECTIVE:To provide an overview of the literature on disaster preparedness regarding surge capacity, with a particular focus on vulnerable populations during a pandemic. DESIGN:The Disaster Preparedness and Response Committee of the American College of Emergency Physicians addressed the topic of vulnerable populations during a pandemic. A workgroup of nine physicians with academic and/or disaster deployment experience was formed. A literature review focused on individuals with access and functional needs, also referred to as special healthcare needs (SHCNs) or vulnerable individuals, was performed. Search terms included pandemic, public health emergency of international concern, disaster, COVID-19, vulnerable population, individuals with access and functional needs, special healthcare needs (SHCN), surge capacity, and CMIST (communications, medical care, independence, supervision, and transportation). Search strategies included medical sources such as PubMed, Medline, Google Scholar, ScienceDirect, Scopus, and the Cochrane Database of Systematic Reviews. Reviews were performed by a librarian. In addition, relevant articles from the bibliographies of included studies and more recent articles identified by committee members were included. The workgroup evaluated the literature and identified issues regarding surge capacity occurring during a pandemic that particularly impacted the SHCN population. Potential solutions were identified. RESULTS:Vulnerable individuals are at greater risk during a pandemic than the general population, although potential solutions to mitigate the impact of a pandemic on vulnerable individuals are possible. CONCLUSIONS:Although pandemics can have significant adverse effects on the general population, vulnerable individuals have the greatest morbidity and mortality and are at greatest risk. Efforts are warranted to better address the negative impact of a pandemic, not just for the general population, but also for individuals with access and functional needs, and to find solutions that can help mitigate the consequences of a pandemic.
OBJECTIVE:To provide an overview of the literature on disaster preparedness regarding surge capacity with a particular focus on vulnerable populations during a pandemic. DESIGN:The Disaster Preparedness and Response Committee of the American College of Emergency Physicians addressed the topic of vulnerable populations during a pandemic. A workgroup of nine physicians with academic and/or disaster deployment experience was formed. A literature review focused on individuals with access and functional needs, also referred to as special healthcare needs (SHCN) or vulnerable individuals, was performed. Search terms included pandemic, public health emergency of international concern (PHEIC), disaster, COVID-19, vulnerable population, individuals with access and functional needs, special health care needs (SHCN), surge capacity, and CMIST (communications, medical care, independence, supervision, and transportation). Search strategies included medical sources such as PubMed, Medline, Google Scholar, ScienceDirect, Scopus, and the Cochrane Database of Systematic Reviews. Reviews were performed by a librarian. In addition, relevant articles from the bibliographies of included studies and more recent articles identified by committee members were included. The workgroup evaluated the literature and identified issues regarding surge capacity occurring during a pandemic that particularly impacted the SHCN population. Potential solutions were identified. RESULTS:Vulnerable individuals are at greater risk during a pandemic than the general population, although potential solutions to mitigate the impact of a pandemic on vulnerable individuals are -possible. CONCLUSIONS:Although pandemics can have significant adverse effects on the general population, vulnerable individuals have the greatest morbidity and mortality and are at the greatest risk. Efforts are warranted to better address the negative impact of a pandemic, not just for the general population but also for individuals with access and functional needs, and to find solutions that can help mitigate the consequences of a pandemic.
INTRODUCTION:Mass gatherings create complex operational challenges for emergency and disaster medical systems. While preparedness planning often emphasizes trauma, intoxication, and environmental illness, sexual violence represents an underrecognized but significant medical and operational concern with direct implications on emergency medical services (EMS) operations. These incidents not only threaten individual safety but also strain on-site medical and psychosocial response systems. Findings are discussed in the context of disaster preparedness and prehospital operations. OBJECTIVE:To synthesize the prevalence, risk factors, reporting patterns, and prevention/response strategies for sexual violence at mass gatherings, and to translate these findings into actionable implications for EMS systems and event medical planning. METHODS:Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews methodology, we searched nine databases (MEDLINE, Embase, Scopus, Web of Science, PsycINFO, EBSCOhost, PubMed, Science Direct, CINAHL) and gray literature for studies addressing sexual violence at events with >1,000 attendees. Two reviewers independently screened records; discrepancies were adjudicated by a third reviewer. Sixteen studies met eligibility criteria. Data were extracted on prevalence, risk factors, reporting behaviors, and prevention or response strategies. Findings were analyzed thematically to identify implications for EMS preparedness and patient care. RESULTS:Sexual violence was consistently underrecognized and underreported at mass gatherings. Six major themes emerged: (1) substance use, (2) environmental vulnerabilities, (3) risk concentration among young women, (4) bystander inaction, (5) normalization of harassment, and (6) limited effectiveness of prevention strategies. Victims often disclosed informally to friends or event staff rather than law enforcement or EMS clinicians. Across studies, opportunities emerged for EMS systems to strengthen preparedness through trauma-informed training, private treatment areas, surveillance integration, and referral pathways to sexual assault response services. CONCLUSION:EMS clinicians and event medical teams play a critical role in identifying, treating, and referring victims of sexual violence during mass gatherings. Event medical planning should explicitly anticipate sexual violence cases by incorporating trauma-informed training, private and secure treatment areas, and referral pathways to sexual assault response networks. By embedding these practices within incident command and preparedness frameworks, EMS agencies can play a proactive role in protecting vulnerable populations and enhancing survivor outcomes at high-risk events. These changes will strengthen both clinical care and overall safety at mass gatherings.
OBJECTIVE:To provide an overview of the literature on disaster preparedness regarding surge capacity with a particular focus on vulnerable populations during a pandemic. DESIGN:The Disaster Preparedness and Response Committee of the American College of Emergency Physicians addressed the topic of vulnerable populations during a pandemic. A workgroup of nine physicians with academic and/or disaster deployment experience was formed. A literature review focused on individuals with access and functional needs, also referred to as special healthcare needs (SHCN) or vulnerable individuals, was performed. Search terms included pandemic, public health emergency of international concern (PHEIC), disaster, COVID-19, vulnerable population, individuals with access and functional needs, special health care needs (SHCN), surge capacity, and communications, medical care, independence, supervision, and transportation (CMIST). Search strategies included medical sources such as PubMed, Medline, Google Scholar, ScienceDirect, Scopus, and the Cochrane Database of Systematic Reviews. Reviews were performed by a librarian. In addition, relevant articles from the bibliographies of included studies and more recent articles identified by committee members were included. The workgroup evaluated the literature and identified issues regarding surge capacity occurring during a pandemic that particularly impacted the SHCN population. Potential solutions were identified. RESULTS:Vulnerable individuals are at greater risk during a pandemic than the general population, although potential solutions to mitigate the impact of a pandemic on vulnerable individuals are possible. CONCLUSIONS:Although pandemics can have significant adverse effects on the general population, vulnerable individuals have the greatest morbidity and mortality and are at the greatest risk. Efforts are warranted to better address the negative impact of a pandemic, not just for the general population but also for individuals with access and functional needs, and to find solutions that can help mitigate the consequences of a pandemic.
BACKGROUND:Recently, in addition to the increasing number of terrorist attacks and school shootings, mass shootings in public places by psychiatric patients have become more common. OBJECTIVE:To investigate the psychological sequelae following a mall shooting at Fields in Copenhagen according to two diagnostic manuals. METHOD:A sample of 85 adults who were present during the shooting were assessed half a year later for post-traumatic stress disorder (PTSD) with two questionnaires based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and International Classification of Diseases, 11th Revision (ICD-11), respectively, together with measures of comorbid disorders, psychological factors, and social support. Hierarchical multiple regression analyses were performed to study the effects of demographics, trauma exposure, and psychological factors on PTSD. RESULTS:The number of participants who met the ICD-11 criteria for PTSD (29.7 percent) was higher than the ones who met the similar/who met the corresponding criteria according to DSM-IV (20.0 percent). The final regression model included gender, injury, sick leave, self-efficacy, and dissociation. It explained 68.1 percent of the variation of PTSD based on ICD-11 and 72.8 percent of the variation based on DSM-IV. CONCLUSION:The present study expands disaster research with finding close similarities between two diagnostic systems and aligns disaster research on findings of the role of gender, injury, and psychological factors. The results also point to the need for a proactive approach to intervention.
For decades, the global metric for health system disaster readiness has been the "bed." Preparedness is quantified in static integers: Intensive care unit (ICU) capacity, ventilator stockpiles, and surgeon-to-population ratios. This "inventory approach" assumes that a Mass Casualty Incident (MCI) is merely a volume problem. However, the epidemiological reality of modern disasters—from ballistic trauma to seismic crush injuries—demonstrates that survival is not a function of volume, but of velocity.
OBJECTIVE:To document and analyze the medical relief activities conducted following the 2025 Myanmar Earthquake and to contribute to the improvement of international disaster medical response frameworks. DESIGN:This is a descriptive qualitative study. SETTING:Disaster site in central Myanmar. INTERVENTIONS:In response to the extensive damage caused by the earthquake, the Government of Japan deployed a Japan Disaster Relief (JDR) medical team to Myanmar. This decision was made following the identification of urgent medical needs. The pharmaceutical responses of the JDR medical team to the Myanmar Earthquake were reviewed. MAIN OUTCOME MEASURES:Pharmacists pharmaceutical interventions in the context of disaster medical care extracted from daily activity reports, dispensing records, and chronological logs maintained by the medical team. RESULTS:Following the JDR medical teams pharmaceutical response, pharmacists protocol-based pharmacotherapy management (PBPM) in collaboration with physicians was enacted prior to the start of medical activities. Pharmacy roles were equitably distributed between dispensing and providing support to other professionals. The use of pictorial aids enabled pharmacists to effectively communicate medication instructions. Points for improvement include ensuring the quality of the cold chain for cold-stored pharmaceuticals and reviewing the list of topical medications according to the type of disaster. CONCLUSION:PBPM has emerged as an effective approach that allows pharmacists to assist in prescription management under predefined protocols, potentially reducing physician workload. The application of task shifting and sharing serves as a pragmatic strategy for the redistribution of clinical responsibilities, thereby enabling a more efficient deployment of limited medical personnel in disaster response settings.
AIM:This study aims to identify the primary causes of crowd-induced stampedes in football stadiums and the factors underlying the associated fatalities and injuries. METHODS:A quantitative research design using a semistructured questionnaire was employed. The study population consisted of 2,750 disaster-trained professionals actively working in disaster-related fields, with a final sample of 341 participants. Data on perceptions of stampede causes and related health outcomes were collected online via Google Forms® between September 2023 and July 2024. Digital informed consent was obtained, and safeguards were implemented to prevent duplicate responses. Data were analyzed using IBM SPSS 21. RESULTS:Participants identified several key causes of stampedes in football stadiums, including ticket overselling, inadequate physical -infrastructureeg, insufficient emergency exits and locked gatesfanatic and hooligan behaviors, lack of public awareness and training, excessive crowd density, and inappropriate actions by security forces, eg, tear gas use. Primary causes of fatalities and injuries were reported as trauma, eg, falls and crushing; respiratory emergencies, eg, suffocation and asphyxia; substance and alcohol use; cardiac events, eg, heart attacks; psychological distress, eg, panic and aggression; and neurological factors. CONCLUSION:Stampede incidents in football stadiums arise from a combination of environmental, organizational, and behavioral factors. Prevention and mitigation require a comprehensive risk management strategy integrating infrastructure improvements, effective crowd control, staff training, and public education. These findings underscore the need for multidisciplinary research and evidence-based policies to enhance safety at large sporting events.
OBJECTIVE:Determine relative effectiveness of two dry air decontamination methods to reduce residual airborne surrogate biological agent on litter-bound manikin patients during disrobing. DESIGN:Fluorescent 1 µm polystyrene latex (PSL) spheres were applied as a biological agent surrogate to a litter-bound manikin dressed in cold weather outer gear (parka and snow pants) representing the contaminated patient. Two dry air personal decontamination treatments were compared to that involving no -decontamination. SETTING:Cold region mass casualty biological aerosol contamination event. PARTICIPANTS:A litter-bound manikin. INTERVENTIONS:Two treatments were applied independently; high-efficiency particulate air (HEPA) filtered vacuum, and air-knife decontamination were compared to that involving no decontamination. After contaminating the manikin, a treatment was applied and the manikin disrobed. The disrobing process created the highest risk of re-aerosolization of the PSL spheres surrogate biological agent which could be inhaled by the attending medical personnel or the patient. MAIN OUTCOME MEASURES:Aerosolized PSL sphere quantification was sampled in the breathing zone of medical personnel and analyzed with ultraviolet microscopy. RESULTS:Analysis of variance revealed that treatment means of log-transformed data differed -significantly (p < 0.001). Tukeys Honestly Significant Difference test revealed a significant difference only between air-knife decontamination and no decontamination (p < 0.05). The HEPA vacuum reduced airborne contamination by 71 percent compared to no decontamination (not significantly different), while the air-knife reduced it by 91 percent (significantly different), after background correction. CONCLUSIONS:Considering ease of use and significant significance, air-knife decontamination was superior to HEPA vacuum in reducing airborne inhalational risk to attending medical personnel when disrobing the manikin.
BACKGROUND:Natural and man-made disasters displace millions of people each year. Children are disproportionately at risk due to their physiology and dependent living needs. Familial separation, resulting from displacement, causes physical, emotional, and psychological distress. Reunification depends, in part, on the collection of personally identifiable information (personal data). Children who provide personal data leading to their identification can aid in the reunification process. Despite its importance, there is little data on whether children can provide their personal data and at what age. This study addressed these gaps. OBJECTIVE:To evaluate the capability of children to provide personal data necessary for identification. DESIGN:A convenience sample of children from 4 to 10 years of age, presenting to the pediatric emergency department, were enrolled to participate. SETTING:This single-site, cross-sectional study was conducted at a pediatric emergency department in an urban tertiary hospital. PARTICIPANTS:Study team members successfully enrolled 140 children and their caregivers into the study. INTERVENTIONS:Children were asked to provide their personal data. These data were then compared to data provided by the childs caregiver to study the team members. MAIN OUTCOME MEASURES:Data were analyzed using descriptive statistics and a TukeyKramar multiple comparison test. RESULTS:Data indicated a dependent relationship between age and knowledge of personal data, and -personal data recitation accuracy differed (statistically significant difference) between age groups. CONCLUSION:Children 5 years of age and older supplied personal data sufficient for identification.
BACKGROUND:Triage is crucial in disaster management for effective resource allocation, especially in dealing with chemical, biological, radiological, and nuclear (CBRN) events. Specialized triage techniques are needed due to the increased rate of CBRN disasters. However, there is limited evidence on which contemporary modalities can make CBRN-adapted triage more effective in practice. OBJECTIVES:This study aims to systematically describe, compare, and contrast CBRN-specific triage with traditional mass casualty triage (non-CBRN) and explicitly identifies modern, high-impact but underused modalities that can operationalize a hybrid approach. METHODS:This systematic literature review was conducted using databases such as PubMed, EMBASE, Medline, OvidSP, Cochrane Central, Science Direct, and other relevant studies from 1998 to 2024. There were a total of 1,832 articles found, but with further strict screening and quality appraisal through the use of the Quality Assessment of Diagnostic Accuracy Studies and Critical Appraisal Skills Programme checklist, only 28 articles were included in the analysis. RESULTS:This review compares traditional and CBRN triage systems, focusing on specialized training, personal protective equipment (PPE) donning, and decontamination protocols. CBRN triage systems are more complex and time-consuming, but provide more accurate detection of hidden hazardous material exposures. Traditional triage methods can be faster and easier, but specificity is lost in CBRN scenarios. The systematic review emphasizes the need for additional training and simplified procedures, as well as the complexity of PPE and decontamination protocols. CBRN triage also uses different resource allocations and ethical considerations. CONCLUSION:The results highlight the need for advanced training for CBRN triage in disaster management. It suggests that existing CBRN triage systems need to be integrated with optimized training programs. Understanding the differences between CBRN and non-CBRN triage is crucial for effective disaster management. Further research should focus on simplifying the protocol while adapting it for both types of mass casualty events.
OBJECTIVE:This study evaluated two waterless air-based decontamination methods to reduce residual airborne expo-sure during the disrobing of a litter-bound surrogate patient mannequin exposed to a surrogate radiological aerosol. The mannequin was clothed in United States military extreme cold weather pants and a jacket. DESIGN:Copper oxide (CuO) powder was applied as a radiological agent surrogate to a litter-bound mannequin dressed in cold weather outer gear (parka and snow pants) representing the contaminated patient. Two dry air personal decontamination treatments were compared to no decontamination. SETTING:Cold region mass casualty radiological aerosol contamination event. PARTICIPANTS:Litter-bound mannequin. INTERVENTIONS:High-efficiency particulate air (HEPA) vacuum and an air-knife method were evaluated, and the results were compared to no decontamination trials, with CuO as the radiological aerosol surrogate. MAIN OUTCOME MEASURES:Aerosolized CuO was measured with handheld optical particle counters to measure particle size and count airborne particle concentrations during a 1-minute period directly after disrobing the mannequin. The parti-cle size and count concentrations were used to calculate an estimate of aerosol mass concentration posing an inhalational and surface contamination risk to the patients and the attending medical personnel. RESULTS:Patient disrobing presented the -highest potential airborne exposure. Nonparametric tests indicated that all treatments were significantly -different (p < 0.05). There was an 85 percent average reduction in CuO airborne aerosol us-ing the HEPA vacuum decontamination method compared to the no decontamination trials. However, the air-knife actually increased airborne risk by 305 percent compared to no decontamination. CONCLUSION:The successful vacuum trials in this research demonstrate possible waterless decontamination treat-ments for cold environments.
INTRODUCTION:This systematic review examines factors affecting the improvement of the National Incident Management System (NIMS) in addressing complex disaster risks and management challenges, spanning from January 1, 1980, to February 27, 2025. METHODOLOGY:A systematic search was performed in PubMed, Cochrane Library, Scopus, Science Direct, ProQuest, Web of Science, and Embase (1980-2025). Articles were selected using predefined keywords and analyzed for factors influencing the NIMS. Two researchers independently verified all stages. RESULTS:This systematic review identified 1,038 articles, with 13 meeting inclusion criteria. Findings emphasize that the NIMS necessitates multilevel engagement (national, state, local, tribal, governmental, private, and nongovernmental) and critical components: fostering intra- and interorganizational collaboration through preparedness culture, training, and knowledge-sharing; integrating strategic planning, engineering management, and professional institutions; prioritizing resilience, flexibility, and agility; establishing shared mental models and enabling civilmilitary coordination; ensuring strong leadership, mitigating environmental barriers, learning from past disasters, addressing political, governance, and managerial challenges, and leveraging financial/technical resources alongside emerging technologies. CONCLUSION:Strengthening the NIMS hinges on integrating four interconnected domains: I. OrganizationalManagerial: multilevel coordination, unified leadership, agile strategies, and resilience-building through past disaster lessons. II. HumanCultural: continuous personnel training, shared conceptual frameworks, and interorganizational collaboration. III. PoliticalEconomic: policy reforms to address systemic barriers, strategic planning, and sustainable funding. IV. TechnologicalEnvironmental: artificial intelligence, social media, adaptive infrastructure, and climate-resilient solutions. These factors must be cohesively embedded in macrolevel policymaking and strategic frameworks to optimize disaster management efficacy.
Objective: This work describes the evaluation of a wet decontamination protocol on a simulated patient mannequin during a simulated chemical agent response using an ultraviolet fluorescent aerosol and an image analysis method to measure the extent of contamination and subsequent decontamination. Design: Four clothing types were evaluated (the Joint Service Lightweight Integrated Suit Technology (JSLIST) military protective gear, black cotton clothing, and Tyvek suits worn in two ways) for their protectiveness against an ultrafine aerosol contaminant. These experiments also demonstrated the efficacy of each step in a two-step decontamination protocol (disrobing, followed by wet decontamination). Setting: Nonclinical, laboratory. Main outcome measures: The measures being evaluated were: Whether contamination can be reliably measured using the image analysis method, which clothing option was the most appropriate surrogate for the JSLIST, average expected decontamination from disrobing and wet decontamination, and whether disrobing removes 90 percent of contamination. Results: Results showed that Tyvek with the cuffs open may be the more suitable surrogate for the JSLIST, though further testing would be needed to establish this. In scenarios where body contamination was high, wet decontamination was shown to be highly effective (60-85 percent reduction), while disrobing was more effective when body contamination was minimal (85-90 percent reduction). Conclusions: This work demonstrated that the image analysis method was highly effective in visualizing contamination on vapor-barrier suits, though less effective on cotton. Evaluation of decontamination methods indicated that reduction from disrobing is unlikely to reach 90 percent except when people are wearing fully enclosed protective gear. In most cases, the wet decontamination step is necessary to approach that level of reduction.
Background: Large-scale religious gatherings, such as the Hajj, the Kumbh Mela, and Arbaeen, present unique public health challenges due to mass congregations, environmental stressors, and resource limitations. This study conducts a comparative analysis of health indicators across these events to identify challenges, opportunities, and context-specific interventions for improving health outcomes. Methods: A structured analytical review was performed using data from 39 peer-reviewed studies and official reports (2010-2024), sourced from PubMed, Scopus, Web of Science, and Google Scholar. Health indicators—including infectious diseases, injuries, mental health, sanitation, and access to care—were synthesized using the World Health Organization’s Health Emergency Indicators framework. Risk levels and mitigation strategies were compared across the Hajj (Saudi Arabia), the Kumbh Mela (India), and Arbaeen (Iraq), with inter-rater reliability ensured via dual coding (Cohen’s κ = 0.87). Results: Key challenges included infectious disease outbreaks, eg, meningitis during the Hajj, cholera during Arbaeen, crowd-related injuries (notably stampedes at the Kumbh Mela), and mental health strain. Environmental risks, such as heatstroke (during the Hajj) and water contamination (during the Kumbh Mela), further compounded health vulnerabilities. Cross-cutting issues included inadequate sanitation, limited healthcare access, and financial barriers. Opportunities for improvement emerged through mobile clinics, multilingual telehealth services, culturally tailored health education, and enhanced water, sanitation, hygiene infrastructure. The Kumbh Mela faced the highest sanitation risks (1 toilet/800 pilgrims), while the Hajj demonstrated moderate success in crowd management. Conclusion: This comparative analysis highlights the need for context-specific, multidisciplinary interventions to address health disparities in mass gatherings. Strategic collaboration among policymakers, religious leaders, and health authorities is critical for implementing preventive measures, leveraging technology, eg, drone-based medical logistics, and promoting health literacy. By integrating cultural sensitivity with evidence-based practices, stakeholders can mitigate risks and transform these events into platforms for advancing global public health. The proposed framework offers actionable insights for enhancing resilience in future mass gatherings.
Objective: Approximately half of all deaths among women and those assigned female at birth in low-and middle-income countries (LMICs) are attributable to noncommunicable diseases (NCDs). LMICs are not only disproportionately affected by NCDs but also experience the largest burden of humanitarian emergencies. Yet the literature describing sex-and gender-based trends in NCDs in disaster settings is limited. This systematic review assesses sex-and gender- based epidemiology, interventions, and treatment of four NCDs (cardiovascular disease, cancer, chronic respiratory disease, and diabetes) in disaster settings using a thematic analysis approach. Design: Formal search strategies used relevant controlled vocabulary terms and synonymous free-text words and phrases to capture the concepts of NCDs and humanitarian emergencies. We manually identified articles that reported sex-and gender-based differences in NCD epidemiology, healthcare access, or health outcomes among populations in disaster settings. Two separate screeners independently evaluated the titles, abstracts, and full text of the eligible articles, with vetting by a third reviewer. Results: Women were found to bear a disproportionate burden of NCDs associated with disaster-related stress, care-seeking behaviors, and a lack of empowerment to engage in disease management. Cancers that predominantly affect females were identified as common reasons for seeking care during humanitarian crises. NCDs associated with or exacerbated during pregnancy, such as hypertensive disorders, had lower odds of care and resulted in worse outcomes. Conclusions: Although we found frequent sex-based disparities in the context of healthcare access, disease prevalence, and health outcomes, no study specifically investigated the role of gender or sex in NCD care.
Objective: This study aimed to quantitatively describe the current disaster medicine (DM) physician workforce in the United States (US), analyzing demographics, training, employment, compensation, and career paths. Design: A cross-sectional survey study was conducted using a 48-question electronic instrument. Responses were collected anonymously via REDCap between April 2023 and January 2024. The survey employed descriptive statistical analysis without randomization or blinding. Setting: The study targeted US-based DM physicians affiliated with one professional emergency medicine (EM) organization (American College of Emergency Medicine), examining both academic and nonacademic settings. Patients and participants: Participants included members of the American College of Emergency Physician DM Section (n = 650), DM Committee (n = 40), and Council of Fellowship Directors (n = 18). A total of 68 responses were received, reflecting a 9.6 percent overall response rate. Main outcome measure(s): Primary outcomes included physician demographics, educational background, fellowship training, employment status, work distribution, compensation models, and time to first funded DM position. Results: Respondents were predominantly male (68 percent), with an average age of 52 years. Most of them were emergency physicians (74 percent) and held MD degrees (87 percent). Only 22 percent completed DM fellowships, and 64 percent reported working >40 hours weekly in DM-related roles. Compensation varied, with many relying on clinical shift reduction and about half feeling that they were fairly compensated for their disaster medicine work. Conclusions: The DM workforce is diverse but lacks standardization in training and compensation. Improved support and formalization would enhance this growing and critical field.
