Don't forget the children-paediatric patients in mass casualty events and major incident planning.

Major incidents and mass casualty events can affect people of all ages. However, when planning the response to a major incident the focus is often on adult casualties rather than children. It is essential that the needs of paediatric patients are taken into account throughout major incident planning. Whether considering equipment, staffing or surgical and critical care capacity, hospitals should meet the needs of children as well as adults following a major incident and where possible, keep families together. The new Major Incident Triage Tool introduced in the National Health Service (NHS) in 2024 has a tendency to over triage paediatric casualties and so hospitals who may be receiving children following a UK major incident must be aware of this and plan for the potential implications. This article reviews the evidence and learning from previous mass casualty events and makes recommendations for hospitals to ensure that the needs of children will be met if a major incident occurs.

Designing a model of emergency medical services preparedness in response to mass casualty incidents: a mixed-method study.

BACKGROUND: Emergency medical services preparedness in mass casualty incidents is one of the most important concerns in emergency systems. A mass casualty incident is a sudden event with several injured individuals that overwhelms the local health care system. This study aimed to identify and validate the components of emergency medical services readiness in mass casualty incidents which ultimately led to designing a conceptual model. METHODS: This research was an explanatory mixed-method study conducted in five consecutive stages in Iran between November 2021 and September 2023. First, a systematic review was carried out to extract the components of emergency medical services preparedness in mass casualty incidents based on the PRISMA guideline. Second, a qualitative study was designed to explore the preparedness components through in-depth semi-structured interviews and analyzed using the content analysis approach. Third, the integration of the components extracted from the two stages of the systematic review and qualitative study was done by an expert panel. Fourth, the obtained components were validated using the Delphi technique. Two rounds were done in the Delphi phase. Finally, the conceptual model of emergency medical services preparedness in mass casualty incidents was designed by a panel of experts. RESULTS: 10 articles were included in the systematic review stage and sixteen main components were extracted and classified into four categories. In the second stage, thirteen components were extracted from the qualitative study and classified into five categories. Then, the components of the previous two phases were integrated into the panel of experts and 23 components were identified. After validation with the Delphi technique, 22 components were extracted. Lastly, the final components were examined by the panel of experts, and the conceptual schematic of the model was drawn. CONCLUSIONS: It is necessary to have an integrated framework and model of emergency medical service readiness in the planning and management of mass casualty incidents. The components and the final model of this research were obtained after the systematic scientific steps, which can be used as a scheme to improve emergency medical service preparedness in response to mass casualty incidents.

Forecasters, emergency managers, and residents: Building better risk communication.

The US National Weather Service (NWS) and emergency managers (EMs) around the country are tasked with communicating severe weather information to the public. Frequent interaction between professionals and residents is essential to building effective partnerships. This paper investigates these interactions and also explores the perspectives of NWS forecasters, EMs, and rural residents related to the efficacy of warning communication, message understanding, preferred platforms, and engagement in protective actions. Data for this study were collected through three original survey instruments that were directed to NWS forecasters and EMs across the country, and residents in four rural communities. Findings reveal that residents generally understand warning messages and generally feel tornado risk communication is effective in their communities. However, residents do not appear to have a plan of action formulated prior to a warning and are, therefore, making, rather than implementing, a plan when warning is issued. This study gives rural residents a voice in the warning communication process and a chance for forecasters and EMs to gain valuable information as they better plan to serve these communities.

Considering collaborative incident management: A study of the COVID-19 response and initial recovery in a rural West Virginia community.

Hierarchical command-style structures are commonplace in the management of disasters, though researchers have begun to recommend the exploration of networked approaches to incident management. Furthermore, few studies are explicitly looking at the rural context of disaster management. This study seeks to contribute to both topics by examining the motivations for emergent collaboration in the direction of the response and initial recovery to the coronavirus disease 2019 pandemic in a rural West Virginia community. Between March 2020 and March 2022, the primary investigator moderated regular briefings of a community task force convened to coordinate the pandemic response and recovery. As regular operations concluded, members completed a survey, and 10 randomly selected members participated in semistructured interviews regarding their experiences in the task force. Survey responses suggest that common motivations for collaboration in nondisaster contexts (as they appear in the scholarly literature) and potential benefits of networked approaches highlighted in the incident management literature could also serve as motivators within the disaster context. Qualitative interview data extend that discussion and identify the need to gain clear information regarding the concerned authorities and specific local information to better inform the expenditure of limited resources as two additional motivators for collaboration.

COVID-19 and CBRNE: Effects of the pandemic in the field of CBRNE.

The coronavirus disease 2019 (COVID-19) pandemic has affected our lives in all aspects, including key fields such as social interaction and economic supply chains. The field of chemical, biological, radiological, nuclear, and explosive substances (CBRNE) was already directly affected by the pandemic in that the COVID-19 virus is, in a sense, a biological agent. This paper elaborates on how the field of CBRNE has changed as a result of the COVID-19 pandemic. It does so by drawing on the results of an interview study with CBRNE practitioners (Fire Brigades, Law Enforcement Agencies, etc.) conducted as part of the European Union project PReparedness against CBRNE threats through cOmmon Approaches between security praCTItioners and the VulnerablE civil society, as well as findings from research literature on links between CBRNE and COVID-19. This paper highlights four areas where the influence of the pandemic on the CBRNE field has been evident. The four areas are as follows: preparedness for CBRNE incidents and likelihood of future CBRNE incidents (with a focus on terrorist attacks), CBRNE training and education, increased awareness of CBRNE-related behaviors and measures among the general public, and greater awareness of the needs of vulnerable groups (older people, etc.).

Decision-making drivers for pandemic response for Institutions of Higher Education.

The purpose of this research is to identify how decision-makers within anchor institutions, using the context of higher education, determine the course of action in response to an improbable disaster event, such as the recent coronavirus disease 2019 (COVID-19) pandemic. A survey was conducted among higher education decision-makers during spring 2020 at the moment they were adapting to COVID-19. The survey aimed to identify policies and planning measures that may help Institutions of Higher Education learn from this experience to maintain continuity of operations should similar or unanticipated events occur in the future. With this knowledge, both assets and detriments contributing to community vulnerability can be better balanced to inform decision-making. The outcomes of the analysis and shared reflections inform the development of future policy and strengthen existing processes for preparedness and mitigation planning for unexpected events.

Finalizing emergency management professionalization in 2024.

This editorial discusses the urgent need to finalize the emerging emergency management profession. Points of reference in the years immediately preceding and throughout the COVID-19 pandemic are recounted and frame some of the essential forward work slated to be started or completed this year in 2024. Activity taking place by connected associations and members of the emerging profession is shared. Legislation filed in Massachusetts to finalize the emerging profession is also shared. Activities needed for the emerging profession are described, and how professionals can help in their role to continue to move these fundamental initiatives forward is outlined. Present considerations should be accounted for, as they threaten the fabric of the emerging profession while at the same time giving us undeniable reasons for why we need to finalize this critical work in 2024 before the next major global disaster.

Improving the non-structural preparedness of the selected hospital based on the FOCUS-PDCA1 model: action research.

INTRODUCTION: With the intensification of the country's development process, the expansion of cities and population, and the inclusion of Iran in the accident-prone category, reducing the vulnerability of non-structures has received more attention from the organizations involved. In addition to damage to communities and infrastructure, accidents can affect hospitals and their non-organizational components. Hospitals, as the front line of providing medical services after accidents, must maintain their stability, ensure the safety of their patients and employees, and continue to operate without interruption as in normal conditions. Therefore, it is necessary to evaluate the non-structural safety and their preparedness to ensure they can perform acceptable in critical conditions. METHODS: This applied research was conducted in 2023 (September to December) using the participatory action research method in all selected hospital departments. The level of non-structural preparedness of the hospital was checked using the valid "Hospital Safety Index" questionnaire and the non-structural weaknesses of the hospital were identified. Then, in action research using the FOCUS-PDCA model, a program was implemented to improve the non-structural preparedness of different departments of hospitals in the face of accidents and disasters. The non-structural readiness level of the hospital was compared before and after the implementation of the change. RESULTS: Based on the evaluation conducted in the present study, the lowest level of safety was observed in the water supply system, office furniture and appliances, and fuel storage. The waste management systems, the fire protection system, and the long-distance communication systems were at a desirable performance level. Although in the evaluation before the change, the overall score of the hospital was 71.01%, and it had a desirable performance level in non-structural factors, in all the involved parts of the hospital, the sensitive, critical, and practical parts in the operation of the hospital had an average and sometimes low safety level. According to the obtained safety score, the safety level of the selected hospital before the change was 7 out of 10 (level seven of safety evaluation = medium). After the change and corrective measures, the non-structural safety assessment score was 76.93, and the hospital's safety level was raised by one step to 8 out of 10 (8th level of safety assessment = relatively favorable). CONCLUSION: The present study showed that the application of Total Quality Management (TQM), primarily its application tool FOCUS-PDCA, is efficient and helpful in improving the non-structural preparedness of hospitals. Using action research in the health field in accidents and disasters can open blind knots in different dimensions of preparedness (structural, non-structural, and functional).

Emergency preparedness in the central sterile supply department: a multicenter cross-sectional survey.

OBJECTIVE: To investigate the current situation of emergency preparation and emergency drill in the CSSD, and analyze its influence on the nurses' emergency attitude and ability. METHODS: This study employed a multicenter stratified sampling method, conducted from January to June 2023 using the online survey, participants completed the general data, emergency preparedness and drill questionnaire, public health emergency response questionnaire and emergency capacity scale. An independent samples t test or Kruskal-Wallis test was used to analyse differences in nurses' emergency capacity and attitudes. RESULTS: The data from 15 provinces 55 hospitals in China. Overall, 77.58% of participants' institutions set up emergency management teams, 85.45% have an emergency plan and revise it regularly. 92.12% store emergency supplies. All survey staff participated in the emergency drill, which predominantly consisted of individual drills (51.52%), with 90.30% being real combat drills, 49.09% of participants engaging in drills every quarter, and 91.52% of the drill's participants exceeding 50%. The respondents' emergency attitude score was (29.346 ± 6.029), their emergency ability score was (63.594 ± 10.413), and those with rescue experience showed a more positive attitude (Z = -2.316, P = 0.021). Different titles, education levels, rescue experience and the frequency of emergency drill affected the emergency rescue ability of the respondents (P < 0.05). CONCLUSIONS: Most medical institutions establish emergency management systems and plans, yet the content lacks geographical specificity.The duration and participation of emergency drills are high, but the effectiveness of the drills needs to be further improved, and the response capacity and attitudes of CSSD nurses are low. It is recommended that agencies develop comprehensive and targeted contingency plans to strengthen the inspection and evaluation of team strength, equipment and safeguards against the contingency plans, so as to ensure that the measures mandated by the contingency plans can be implemented promptly after the emergency response is initiated.

Pandemic preparedness and health system resilience in 14 European countries.

Objective: To assess national pandemic preparedness and response plans from a health system perspective to determine the extent to which implementation strategies that support health system performance have been included. Methods: We systematically mapped pandemic preparedness and response implementation strategies that improve resilience to pandemics onto the Health System Performance Assessment Framework for Universal Health Coverage. Using this framework, we conducted a document analysis of 14 publicly available national influenza pandemic preparedness plans, submitted to the European Centre for Disease Prevention and Control, to assess how well health system functions are accounted for in each plan. Findings: Implementation strategies found in national influenza pandemic preparedness plans do not systematically consider all health system functions. Instead, they mostly focus on specific aspects of governance. In contrast, little to no mention is made of implementation strategies that aim to strengthen health financing. There was also a lack of implementation strategies to strengthen the health workforce, ensure availability of medical equipment and infrastructure, govern the generation of resources and ensure delivery of public health services. Conclusion: While national influenza pandemic preparedness plans often include provisions to support health system governance, implementation strategies that support other health system functions, namely, resource generation, service delivery, and in particular, financing, are given less attention. These oversights in key planning documents may undermine health system resilience when public health emergencies occur.

Formal and informal hospital emergency management practices: managing for safety and performance amid crisis.

Although formal preparedness for unexpected crises has long been a concern of health care policy and delivery, many hospitals struggled to manage staff and equipment shortages, precarious finances, and supply chain disruptions among other difficulties during the Coronavirus disease pandemic. Our purpose was to analyze how hospitals used formal and informal emergency management practices to maintain safe and high-quality care while responding to crisis. We conducted a qualitative study based on 26 interviews with hospital leaders and emergency managers from 12 US hospitals, purposively sampled to vary along geographic location, urban/rural delineation, size, resource availability, system membership, teaching status, and performance levels among other characteristics. In order to manage staff, space, supplies, and system- related challenges, hospitals engaged formal and informal practices around planning, teaming, and exchanging resources and information. Relying solely only on formal or informal practices proved inadequate, especially when prespecified plans, the incident command structure, and existing contracts and communication platforms failed to support resilient response. We identified emergent capabilities-imaginative planning, recombinant teaming, and transformational exchange-through which hospitals achieved harmonious interplay between the formal and informal practices of emergency management that supported safe care and resilience amid crisis. Managing emergent challenges for and amid crisis calls for health care delivery organizations to engage creative planning processes, enable motivated workers with diverse skill sets to team up, and establish rich inter- and intra-organizational partnerships that support vital exchange.

[Terror attacks : Recommendations for cooperation between police, hospitals and non-police security services]. / Lebensbedrohliche Einsatzlagen : Handlungsempfehlung zur Zusammenarbeit zwischen Polizei, Kliniken und nichtpolizeilicher Gefahrenabwehr.

BACKGROUND: The risk of terrorist attacks in the Federal Republic of Germany is present and is currently increasing. Publicly funded acute care hospitals and their owners are involved in disaster control as part of their remit and are responsible for taking comprehensive precautions to ensure their operational capability in the event of disasters. This mandate must also be ensured in the event of terrorist attacks and amok incidents. For this purpose, an optimal cooperation between preclinical and clinical care is indispensable. AIM: Recommended actions for collaboration between nonclinical and clinical planning to manage a mass casualty incident in terrorist life-threatening response situations are presented. MATERIAL AND METHODS: The Inter-Hospital Security Conference Baden-Württemberg (IHSC BW) is an association of representatives of acute hospitals in Baden-Württemberg, the Ministry of the Interior, Digitalization and Migration Baden-Württemberg, the Ministry of Social Affairs and Integration Baden-Württemberg, the State Police Headquarters Baden-Württemberg and the Baden-Württemberg Hospital Association. From 2018 to 2020, the IHSC BW developed recommendations for action on cooperation between police, hospitals and non-police emergency response. The recommendations for action were agreed by the group members in 6 working sessions and initialled in two subsequent video conferences. A recommendation was considered adopted when the IHSC BW plenary assembly finally gave its approval with an absolute majority. RESULTS AND DISCUSSION: Competence-based interface solutions for a smooth cooperation between prehospital and hospital management in the care of patients who have become victims of a terrorist attack are to be demanded. For preliminary planning, the establishment of a local safety conference at the county disaster control authority level with the following participants is recommended: disaster control authority, fire department, regional police headquarters, chief emergency physician, rescue services and disaster control officers of affected clinics. It is recommended to set up a joint command and situation center (CSC), where management personnel from the police, rescue service, fire department and disaster control can meet to organize the handling of the incident jointly, competently and without loss of time. From this CSC, a liaison officer should then provide the clinics with information at regular intervals. Exercises should take place regularly. Cross-organizational exercises are particularly important, and this is one of the tasks of the local safety conference.

Vulnerabilities to disasters in healthcare facilities in the face of the COVID-19 pandemic: a scoping review. / Vulnerabilidades a desastres em estabelecimentos de saúde frente à pandemia de COVID-19: revisão de escopo.

This article maps the structural, nonstructural and functional vulnerabilities of healthcare facilities to the COVID-19 pandemic. It reports on a scoping review guided by JBI recommendations and structured by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The PubMed, CINAHL, LILACS, EMBASE, SciELO, Scopus and Web of Science Repositories and databases were consulted, as was the grey literature. The protocol was registered in the Open Science Framework. The 54 studies included summarised 36 vulnerabilities in three categories in 29 countries. Functional and non-structural vulnerabilities were the most recurrent. Limited material and human resources, service disruption, non-COVID procedures and inadequate training were the items with most impact. COVID-19 exposed nations to the need to strengthen health systems to ensure their resilience in future health crises. Prospective risk management and systematic analysis of health facility vulnerabilities are necessary to ensure greater safety, sustainability and improved standards of preparedness and response to events of this nature.

O objetivo do artigo é mapear as vulnerabilidades estruturais, não-estruturais e funcionais de estabelecimentos de saúde frente à pandemia de COVID-19. Revisão de escopo conduzida mediante recomendações do JBI e estruturada pelos Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Foram consultados repositórios e bases de dados: PubMed, CINAHL, LILACS, EMBASE, SciELO, Scopus e Web of Science, além de literatura cinzenta. O protocolo foi registrado em Open Science Framework, 54 estudos foram incluídos, sumarizando 36 vulnerabilidades entre as três categorias, em 29 países. As vulnerabilidades funcionais e não-estruturais foram as mais recorrentes. Recursos materiais e humanos limitados, interrupção dos serviços e procedimentos não-COVID, além de capacitação profissional insuficiente foram os itens que mais impactaram. A COVID-19 expôs às nações a necessidade de fortalecer os sistemas de saúde para garantir sua resiliência em futuras crises sanitárias. Ações de gestão de risco prospectivas e análise sistematizada de vulnerabilidades dos estabelecimentos de saúde são necessárias para garantir maior segurança, sustentabilidade e melhor padrão de preparação e resposta a futuros eventos dessa natureza.

A model of the organizational resilience of hospitals in emergencies and disasters.

BACKGROUND: In the health system, hospitals are intricate establishments that offer vital medical services. Their resilience plays a crucial role in mitigating the societal repercussions of disasters. A hospital must possess the capacity to withstand risks, preserve its fundamental structure and operations, and enhance its preparedness by augmenting various capabilities and promptly recovering from the impacts of potential risks. It enables the hospital to attain a heightened level of readiness. Therefore, this study aimed to develop a resilience model tailored for hospitals to navigate crises and disasters effectively. METHODS: This mixed-method study was conducted in 2023 in three phases: (1) Identification of the factors influencing the organizational resilience of the hospital, (2) Evaluation of the influential factors by an expert panel. (3) Following the standardization process, we administered 371 questionnaires to individuals, such as university staff managers and supervisors, nursing managers, and research unit managers. The sample size was determined by multiplying the components by 10, resulting in 360 (10 * 36). Therefore, we selected a sample size of 371 participants. Structural Equation Modeling (SEM) was employed to examine the causal relationships between variables. These steps were performed using SPSS 25.0 and AMOS 22 software. Finally, we identified and presented the final model. We utilized AMOS 22 and applied the SEM to assess the correlation between the variables, with a significance level of 0.05. RESULTS: Findings indicate that the appropriate modeling identified five dimensions comprising 36 components. These dimensions include vulnerability, preparedness, support management, responsiveness and adaptability, and recovery after the disaster. The model demonstrates a good fit, as indicated by the X2/d indices with a value of 2.202, a goodness of fit index (GFI) of 0.832, a root mean square error of estimation (RMSEA) of 0.057, an adjusted comparative fit index (CFI) of 0.931, and a smoothed fit index (NFI) of 0.901. CONCLUSION: Enhancing hospital resilience is crucial for effective preparedness and response to accidents and disasters. Developing a localized tool for measuring resilience can help identify vulnerabilities, ensure service continuity, and inform rehabilitation programs. The proposed model is a suitable framework for assessing hospital resilience. Key factors include human resource scarcity, hospital specialization, and trauma center capacity. Hospitals should prioritize efficient resource allocation, information technology infrastructure, in-service training, waste management, and a proactive organizational framework to build resilience. By adopting this approach, hospitals can better respond to crises and disasters, ultimately reducing casualties and improving overall preparedness.

HAZMAT Technician-level Emergency Response: A Mental Model Framework for Radiological Dispersal Device (RDD) Incidents.

ABSTRACT: This research examines the cognitive frameworks used by HAZMAT technicians when responding to incidents involving Radiological Dispersal Devices (RDDs), which are conventional explosive devices with radioactive materials incorporated. The objective is to introduce the Expected Mental Model State (EMMS) as a comprehensive evaluation tool for assessing and enhancing the expertise and situational awareness of emergency responders dealing with radiation crises. Through a series of expert focus group sessions using the well-established qualitative methodology of grounded theory, an Expected Mental Model State (EMMS) was developed. The methodology used an influence diagram architecture to conceptually capture and codify key areas relevant to effective emergency response. The research identifies fourteen EMMS key conceptual domains, further elaborated into 301 subtopics, providing a multi-dimensional structure for the proposed mental model framework. Three pivotal notions of mental model emerged within the EMMS framework: Knowledge Topology, Envisioning (Belief), and Response and Operability. These notions were found to align with previous theories of mental models and are vital for understanding how HAZMAT technicians conceptualize and respond to RDD incidents. The study emphasizes the critical role of mental models in enhancing preparedness and effective response strategies during radiation emergencies. The EMMS framework offers a versatile methodology that can be adapted across various kinds of emergency responders and high-risk situations, including the broader Chemical, Biological, Radiological, and Nuclear (CBRN) spectrum. Using this EMMS framework to develop an EMMS Diagnostic Matrix can provide a roadmap for identifying areas for the development of specialized training modules that have the potential to significantly elevate both the quality and efficacy of responder training and preparation.

A Community Mental Health Integrated Disaster Preparedness Intervention for Bushfire Recovery in Rural Australian Communities: Protocol for a Multimethods Feasibility and Acceptability Pilot Study.

BACKGROUND: Natural hazards are increasing in frequency and intensity due to climate change. Many of these natural disasters cannot be prevented; what may be reduced is the extent of the risk and negative impact on people and property. Research indicates that the 2019-2020 bushfires in Australia (also known as the "Black Summer Bushfires") resulted in significant psychological distress among Australians both directly and indirectly exposed to the fires. Previous intervention research suggests that communities impacted by natural hazards (eg, earthquakes, hurricanes, and floods) can benefit from interventions that integrate mental health and social support components within disaster preparedness frameworks. Research suggests that disaster-affected communities often prefer the support of community leaders, local services, and preexisting relationships over external supports, highlighting that community-based interventions, where knowledge stays within the local community, are highly beneficial. The Community-Based Disaster Mental Health Intervention (CBDMHI) is an evidence-based approach that aims to increase disaster preparedness, resilience, social cohesion, and social support (disaster-related help-seeking), and decrease mental health symptoms, such as depression and anxiety. OBJECTIVE: This research aims to gain insight into rural Australian's recovery needs post natural hazards, and to enhance community resilience in advance of future fires. Specifically, this research aims to adapt the CBDMHI for the rural Australian context and for bushfires and second, to assess the acceptability and feasibility of the adapted CBDMHI in a rural Australian community. METHODS: Phase 1 consists of qualitative interviews (individual or dyads) with members of the target bushfire-affected rural community. Analysis of these data will include identifying themes related to disaster preparedness, social cohesion, and mental health, which will inform the adaptation. An initial consultation phase is a key component of the adaptation process and, therefore, phase 2 will involve additional discussion with key stakeholders and members of the community to further guide adaptation of the CBDMHI to specific community needs, building on phase 1 inputs. Phase 3 includes identifying and training local community leaders in the adapted intervention. Following this, leaders will co-deliver the intervention. The acceptability and feasibility of the adapted CBDMHI within the community will be evaluated by questionnaires and semistructured interviews. Effectiveness will be evaluated by quantifying psychological distress, resilience, community cohesion, psychological preparedness, and help-seeking intentions. RESULTS: This study has received institutional review board approval and commenced phase 1 recruitment in October 2022. CONCLUSIONS: The study will identify if the adapted CBDMHI is viable and acceptable within a village in the Northern Tablelands of New South Wales, Australia. These findings will inform future scale-up in the broader rural Australian context. If this intervention is well received, the CBDMHI may be valuable for future disaster recovery and preparedness efforts in rural Australia. These findings may inform future scale-up in the broader rural Australian context. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53454.

The disaster liaison for pediatric and perinatal medicine: A new system in Japan.

BACKGROUND: Worldwide, children, newborns, and pregnant or postpartum women are vulnerable to disasters and emergency situations, and providing support to this population is of great concern. Japan is located in a disaster-prone area, so disaster response and risk reduction strategies are important priorities. METHODS: We introduce a system called the Disaster Liaison for Pediatric and Perinatal Medicine (DLPPM). This was created with a specific focus on perinatal children and pregnant women in Japan. We report the details of its activities, discuss its challenges, and draw on lessons learned for the further development of perinatal support systems, particularly for children. RESULTS: The lessons learned from the activities of the DLPPM include the following: (1) establish a support system for emergency specialists beyond those with pediatric and perinatal specialties; (2) mitigate the risk of indirect damage caused by primary disasters; and (3) establish a networking function linked to existing pediatric and perinatal medicine facilities. CONCLUSIONS: By establishing similar systems, we believe that it will be feasible to address pediatric and perinatal care needs in disaster response contexts in other countries and regions around the world.