As the global population ages, the vulnerability of elderly individuals during mass casualty incidents and disasters becomes an increasingly urgent public health concern. This article explores the multifaceted challenges faced by older adults in emergency situations, including physical frailty, chronic health conditions, cognitive impairments, mobility limitations, and social isolation. Through a review of major events such as the 2003 European heatwave, Hurricane Katrina, the Syrian conflict, and the 2023 Hawaiian wildfire, we highlight how the elderly are disproportionately affected during crises. These cases underscore systemic gaps in preparedness, evacuation logistics, and post-disaster support. The article outlines evidence-based strategies to mitigate these risks, including specialized training for responders, development of elderly-specific emergency protocols, early evacuation prioritization, integration of technology such as telemedicine, and community engagement. Emphasizing a multidisciplinary and inclusive approach, we advocate for proactive planning and policy-making to ensure that elderly individuals are not left behind during emergencies. Addressing these challenges is essential for building a resilient and equitable disaster response system that protects the most vulnerable populations.

This study examines the risk to a patient posed by the environment during a particular type of sterile compounding, namely, filtering an aqueous solution into sterile, sealed vials. The environments ranged from International Organization for Standardization 5, with all United States Pharmacopeia ⟨797⟩ requirements in place, all the way down to performing the same manipulations literally outside the building with no environmental protection at all.

Objective: High-volume, low-pressure water wash decontamination was used to reduce the residual viral agent that became aerosolized when fabric swatches were shaken. Design: The viral agent surrogate, bacteriophage Emesvirus zinderi (MS2), was used to contaminate swatches of military uniform fabric. MS2 was aerosolized at a 1010 plaque-forming units per milliliter (PFU/mL) concentration using a six-jet Collison nebulizer to contaminate swatches. Setting: Mass casualty decontamination of a viral aerosol agent. Participants: None. Interventions: High-volume, low-pressure water wash of contaminated fabric was compared to a control condition with no decontamination. After decontamination, MS2 particles were reaerosolized from the fabric by vibration at 50 Hz using a vortex, and an SKC BioSampler collected air samples with sterile deionized water as the collection liquid. Same-day plaque assay analyses were conducted to determine overall aerosol concentrations. Main outcome measures: Aerosolized MS2 virus was sampled in the air above shaken swatches of military uniform fabric. The samples were plated and counted using a plaque assay. Results: Student’s t-test (p = 0.0001) indicated a significant reduction in aerosolized MS2 virus when comparing no decontamination to a water wash. Results showed an average 83.5 percent reduction, which is less than a 1-log10 reduction in PFU/mL for reaerosolized MS2 after the decontamination procedure was applied. Conclusions: Viral agents can reaerosolize from military clothing fabric and present an airborne risk to patients and attending medics. A water wash significantly reduced residual aerosolized MS2 virus released from shaken fabric swatches by an average of 83.5 percent. While this is less than 1-log10 reduction, it is within the military-suggested range of 75-90 percent reduction.

Objective: To investigate the impact of knowledge gained during the coronavirus disease 2019 (COVID-19) pandemic on hospital disaster preparedness plans in the hospitals of Region Sjaelland, Denmark. Design: This is a multimethod qualitative study that uses both qualitative semistructured interviews and qualitative document analysis. Participants: Two members from each of the hospitals of Region Sjaelland’s disaster preparedness committees. Main outcome: A qualitative assessment of knowledge gained by members of the four participating hospitals’ disaster preparedness committees, and the impact this knowledge had on the hospitals’ disaster preparedness plans at the end of the COVID-19 pandemic. Results: Key areas of new knowledge are described based on the analysis of semistructured guided interviews. Disaster plans from the four hospitals before and after the COVID-19 pandemic are compared with respect to the areas identified in the interview analysis; no changes were made in the plans. Conclusion: This paper demonstrates that although much was learned during the COVID-19 pandemic, less was written down and very little was put into future plans for the next pandemic in the hospitals of Region Sjaelland in Denmark.

Disaster responders operate in high-pressure environments where ethical decision-making is critical to ensuring fairness, dignity, and harm minimization. This study explores the ethical perspectives and attitudes of disaster workers in the Middle East across all phases of the disaster management cycle: preparedness, response, recovery, and mitigation. Using a quantitative descriptive cross-sectional design, data were collected from 86 disaster personnel, including emergency medical staff, search and rescue teams, and humanitarian volunteers, through a structured questionnaire. The findings reveal a significant gap between theoretical knowledge of ethical principles and their practical application in the field. While 82 percent of respondents demonstrated a strong understanding of confidentiality, only 67 percent consistently applied it in field practice. Similarly, resource allocation and autonomy showed larger discrepancies, with only 45 and 35 percent of respondents, respectively, applying these principles in real-world scenarios. Cultural norms and local values further complicated ethical decision-making, highlighting the need for context-sensitive approaches. The study underscores the inadequacy of current training programs, which prioritize operational readiness over ethical preparedness. To bridge this gap, ethics must be integrated into disaster response training as a core component, reinforced through continuous professional development and structured debriefings. By fostering ethical competence, organizations can better equip responders to navigate the moral complexities of disaster scenarios. This research contributes to the growing discourse on ethical challenges in disaster management and provides actionable insights for improving training, policies, and organizational standards in the Middle East.

NYC Health + Hospitals/Bellevue Hospital (Bellevue) conducts quarterly drills to test the readiness and preparedness of its special pathogen program. As a Regional Emerging Special Pathogen Treatment Center, Bellevue maintains a state of readiness to respond to patients infected with highly infectious pathogens. On March 29, 2024, Bellevue conducted a no-notice drill to simulate the arrival of a pediatric patient suspected of a viral hemorrhagic fever (VHF). Notification of the special pathogens unit (SPU) activation for a suspected VHF patient was communicated to Bellevue supervisors and leadership. Once responders arrived at their respective reporting stations, they were informed that this was a drill and instructed to read through their role-specific Roles & Responsibilities sheet. All respondents reported to assume their role in the SPU activation within the expected time frame. The cost savings of running this drill, as opposed to a full unit activation, was estimated to be nearly USD 2,000. Following the exercise, participants were offered to complete an anonymous survey assessing their perceptions of the drill and readiness for SPU activation. Key findings were that while most staff felt adequately prepared and understood their roles and responsibilities, suggestions for improvement included more frequent training sessions. This study underscores the importance of regular preparedness exercises to maintain SPU readiness. Insights gained from this drill can inform future training models, enhance the effectiveness of communication strategies during real-world activations, and can be replicated to improve the special pathogen preparedness of healthcare institutions across the United States, regardless of resource availability.

Recent conflicts in the Middle East illustrate the urgent need for adaptive blood supply strategies. Lessons from the Iranian Blood Transfusion Organization’s (IBTO) response to the Kermanshah earthquake suggest that targeted donations can improve the availability of blood units and reduce wastage during crises. Considering this, we decided to report on the IBTO’s decisions during the Kermanshah earthquake, which may help improve blood management by transfusion organizations during the ongoing crises. The O-negative blood type, comprising nearly 10 percent of the population, is crucial in emergencies due to its universal compatibility. During the 2018 Sarpol-e Zahab earthquake in Kermanshah, Iran, the IBTO optimized its blood-collecting program, emphasizing Rh-negative donations, given the sufficiency of other blood type reserves. This retrospective study evaluates the effectiveness of this strategy by analyzing donation patterns, particularly focusing on first-time O-negative donors. During the earthquake, total volunteer donations surged to 20,840 per day, a 2.4-fold increase compared to the 6-month daily mean. First-time O-negative donors showed a remarkable 31.7-fold increase, comprising nearly half of all registrations on the second day. This experience suggests that targeted interventions during disasters can enhance blood supply efficiency, reduce wastage and align donor types with emergency needs.

Emergency Medical Services (EMS) stands at a critical juncture in the United States. Despite its indispensable role in the healthcare continuum—providing vital acute care and transportation during emergencies—EMS is confronted with significant challenges. Underfunding, personnel shortages, and an outdated financing model collectively undermine the sustainability and efficacy of EMS agencies nationwide. Urgent action is required to address these issues and prevent the collapse of EMS. In this article, we present recommendations from frontline EMS workers to revitalize the current EMS system. These recommendations include restructuring the financial framework to improve workforce compensation and retention; fostering professional development pathways within the EMS sector; and implementing community paramedicine initiatives while fully utilizing advanced Emergency Medical Technicians to enhance service value.

This study explores the threat of illicit fentanyls weaponized as transdermal agents, focusing on potency, affordability, and adaptability. Illicit fentanyls have favorable physicochemical and pharmacokinetic profiles for transdermal absorption. This paper highlights its potential for harm were it weaponized using pharmaceutical principles. Disaster implications of weaponized transdermal fentanyl exposure are significant. Diagnostic and response challenges would arise due to delayed toxidrome emergence. First responder training, strategic antidote allocation, decontamination and personal protective equipment protocols, and healthcare system surge in mass events must be revised with route- and agent-specific considerations.

This paper examines the critical challenges associated with the use of diethylenetriamine pentaacetic acid (DTPA) as a chelating agent in radiological mass casualty incidents (MCIs). While DTPA is effective in binding and removing certain radioactive isotopes from the body, its use in MCI is significantly restricted by logistical barriers that prevent timely administration to large numbers of individuals. The requirement for delivery either intravenously or by nebulizer, which is recommended only for inhalational exposure and not approved for pediatric use, necessitates specialized medical personnel and equipment, making DTPA infeasible for MCI. This paper emphasizes the urgent need for the development of alternative countermeasures that are easy to administer to large numbers of people, suitable for both adults and children, and capable of being rapidly deployed in the event of a radiological emergency.