This study explored emergency nurses' lived experiences and perceived challenges during the triage process. This qualitative study was conducted with 25 emergency department nurses at Atatürk University Research Hospital. Criterion sampling was used to include nurses with direct triage experience. Data were collected through face-to-face, semi-structured interviews and analyzed using Colaizzi's descriptive phenomenological method. Significant statements were extracted, meanings were formulated, and these were organized into theme clusters. To enhance credibility, 2 researchers conducted the analysis independently, and a consensus was reached through discussion. Four main themes, 10 sub-themes, and 35 codes were identified. Nurses reported multiple challenges, including lack of institutional support, high patient load, time pressure, and patient dissatisfaction. Decision-making was influenced by both environmental and individual factors. Triage assessment involved a combination of subjective judgment and objective tools. Common errors included misdirection and insufficient questioning. Nurses also suggested improvements related to staffing, training, and organizational conditions. Triage was experienced as a complex and demanding process shaped by workload, time pressure, and limited support. Findings highlight the importance of organizational and contextual factors in shaping triage practices.

No standardized cognitive aid (CA) exists to support the first medical responder during the initial organizational phase of a mass casualty incident (MCI). We aimed to develop such a tool through expert consensus using the Delphi method.A 2-round Delphi process was conducted with 20 expert prehospital physicians. Following a structured literature review, 46 items were submitted for evaluation using a 9-point Likert scale. Consensus criteria were defined a priori in accordance with HAS methodological guidelines. Retained items were ergonomically optimized using the Cognitive Aids in Medicine Assessment Tool (CMAT).All 20 experts participated in round 1 (100%); 18 completed round 2 (90%). After 2 rounds, 31 items were retained (acceptance rate 67%): 20 with strong agreement and 11 with relative agreement. The final CA is organized along the operational timeline of the first medical responder.This Delphi-based CA provides a structured, consensus-derived support tool for first medical responders during MCIs. Prospective studies in real or high-fidelity simulation settings are needed to evaluate its operational impact.

This study examined hospital preparedness and radiation risk perception among nurses in Iran, uniquely applying the Transtheoretical Model to identify behavioral predictors of emergency readiness. This cross-sectional study was conducted among 152 health care workers in three teaching hospitals. Four validated tools assessed hospital preparedness, knowledge, risk perception, and stages of change. Linear regression identified predictors of behavioral progression. While the hospital equipment domain scored highest (mean 18.3/21), the education domain scored lowest (mean 2.3/4). Notably, 85.5% of nurses remained in the passive stages of change, with only moderate levels of risk perception. Cognitive (β = 0.937) and behavioral processes (β = 0.763) strongly predicted stage advancement, extending previous findings on behavioral determinants of disaster preparedness. This study suggests that psychological readiness may play an important role in radiation emergency preparedness. Stimulus control and reinforcement management represent critical behavioral targets that are often overlooked in traditional training. Policymakers should consider shifting from awareness-only approaches to stage-matched, behaviorally driven interventions that address nurses' emotional barriers and support sustained readiness.

Patient transfers provide a critical mechanism for enhancing care capacity and distributing patient load across hospitals and communities. Yet, during disasters and surge events, decisions about where to send patients are often made by Medical Operations Coordination Centers and similar centralized regional coordination bodies, with limited visibility into how transfers are unfolding across the broader hospital system. This study proposes a spatial-network framework, informed by a typology of patient transfers, that represents interhospital transfers as patient flows across a geographic network of hospitals. The framework provides tools to identify and interpret transfer patterns that coordination bodies need to enhance situational awareness and make timely, informed decisions at the local, regional, and state levels. Using inpatient discharge data from a Florida health agency, this study further demonstrates the framework's applicability during a disaster and shows how administrative health data can be transformed into spatial networks that support interhospital transfer coordination decision-making.

In the aftermath of the 2023 Turkey earthquakes, severely damaged hospitals necessitated efficient patient transportation. This research aims to assess the applicability of trauma assessment tools (TRISS, ISS, RTS) in determining transportation methods for earthquake-affected patients when local hospitals are incapacitated, particularly for patients transported by air ambulance and those who self-arrive from a location 1,100 km away. This retrospective analysis involved 397 patients from a hospital 1,100 km away from the 2023 Turkey Earthquake. We assessed patients who arrived by air ambulance or self-transport following the earthquake, calculating TRISS, ISS, and RTS scores. We sought intergroup differences to establish transportation strategies. TRISS and ISS exhibited good predictive value (AUC 0.723 and 0.880, respectively), while RTS was less useful. The median RTS score was 8 for both the Air transfer and Walk-in patients' groups. The median RTS score was similar for air transfer and walk-in patients. For air transfer patients, most admissions occurred on the first day, while walk-in patients peaked on the eighth day. ISS and TRISS effectively identify patients requiring air transport post-earthquake. Distant hospitals should prepare to receive air transferred patients within the first five days, and self-admitted patients from the fourth day onward.

The Supply Chain and Pharmacy breakout session focused on participants' real-world experience with supply chain and pharmaceutical needs for their alternate care facility (ACF). This included details around acquisition and utilization of durable medical equipment, personal protective equipment (PPE), consumables, and pharmacy stock. Participants were encouraged to discuss supply chain management considerations, resource allocation and acquisition, and influencing factors that impacted these topics. Participants explored various approaches to obtain medical supplies and pharmaceuticals, including leveraging existing vendor relationships and establishing climate-controlled storage spaces, while emphasizing the importance of electronic tracking systems and documentation. The overarching goal was to focus on what participants did and how deficiencies were managed. The discussion covered challenges in healthcare coordination during disasters, including supply chain issues, the management of unsolicited donations and volunteers, and the need for innovative solutions like drones and alternative medical applications, concluding with reflections on regulatory oversight and opportunities for process and systems improvements. The group identified several key gaps in emergency response systems, particularly the disconnect between emergency management agencies and healthcare systems, while emphasizing the need for qualified liaisons, just-in-time training, and systematic approaches to ensure effective medical resource management during crises.

Following the 2011 Great East Japan Earthquake and Fukushima Daiichi nuclear accident, the Hamadori region of Fukushima Prefecture experienced severe physician shortages. To address this challenge, three hospitals established postgraduate clinical training programmes aimed at attracting early-career physicians. We reviewed publicly available information on 61 trainees who entered these programmes between 2013 and 2025. Approximately two-thirds graduated from medical schools outside Fukushima Prefecture, indicating successful recruitment from outside the region during the early recovery phase. Over time, the proportion of Fukushima Medical University graduates increased, suggesting a transition from emergency workforce recruitment to locally established training pathways. Among graduates with confirmed practice locations, nearly half remained working in Fukushima Prefecture. These findings suggest that postgraduate clinical training programmes may contribute to physician workforce recovery and long-term healthcare system resilience in disaster-affected, ageing, and depopulating regions.

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.

A nuclear detonation will result in thousands of casualties who will need to be monitored for the occurrence of delayed complications from their exposure to radiation. The National Academies of Sciences have published a report on the key elements of the long-term health monitoring of populations after an improvised nuclear device (IND) detonation incident. We describe the results of a modified Delphi study where we sought consensus among a group of experts on the importance and difficulty of achieving the items in a list of key elements they were presented with. The expert consensus meeting included 27 experts from relevant disciplines and agencies. Consensus was reached in round 3 of the Delphi process on the initial list of 79 items that were generated during the first 2 rounds. Consensus was reached on 59 items regarding the level of importance and on 13 items regarding the difficulty of achieving the element in the design of a long-term health study. The items identified in this study, including those where consensus was met among the experts, can guide emergency and public health planners in preparing for a long-term population health program after an IND incident.

On April 8, 2026, a series of large-scale airstrikes struck Lebanon, killing at least 254 people and injuring 1,165 others. The Lebanese American University Medical Center-Rizk Hospital, located in central Beirut, received 2 distinct waves of casualties totaling 42 patients: 28 red, 9 green, and 5 deceased. This report describes the hospital's emergency preparedness plan (EPP) response and examines challenges encountered across 3 sequential mass casualty incidents at the same institution: the Beirut Port Explosion (2020), the Pager Explosion (2024), and the April 2026 airstrikes. Each prior activation was formally debriefed, and its lessons incorporated into successive EPP revisions. The April 8 response exposed persistent and newly identified vulnerabilities: unassigned trainees accumulating in the red zone, premature code deactivation prior to a second casualty wave, surgical resident resource constraints, and the absence of a regional interfacility transfer network. Iterative debriefing and plan revision can produce an evolving EPP.