Abstract: Background: Sepsis is a heterogeneous syndrome, yet current definitions and management guidelines emphasize standardized, blood pressure–driven interventions. This "one-size-fits-all" approach often obscures physiologically unstable patients who lack overt hypotension. We hypothesized that distinct, reproducible physiological phenotypes of sepsis exist and that some high-risk states remain under-recognized by traditional assessment. Methods: We conducted a retrospective observational study using the PhysioNet 2019 Challenge dataset, comprising high-frequency ICU data from two hospital systems. To ensure independence, we reconstructed unique patient trajectories, yielding 40,217 unique patients. Features included vital signs and markers of perfusion (lactate, creatinine), with engineered variables such as Shock Index (HR/SBP). Unsupervised K-Means clustering was applied to a derivation cohort (70%) to identify phenotypes, with internal validation in the remaining cohort. We assessed the prevalence of algorithmic Sepsis-3 criteria across phenotypes and benchmarked supervised models (logistic regression vs. gradient boosting) to test physiological non-linearity. Findings: Four stable phenotypes were identified: Stable (38.6%, low risk); Hyperdynamic (28.7%, hypertensive/wide pulse pressure); Renal Dysfunction (3.7%, organ-dominant failure); and Cryptic Shock (29.0%). The Cryptic Shock phenotype was characterized by normotension (mean MAP ~75 mmHg) but significant metabolic distress (tachycardia, elevated lactate, high Shock Index). This group demonstrated a significantly higher prevalence of meeting algorithmic sepsis criteria compared with the Stable phenotype (10.2% vs 5.8%; p < 0.001). Gradient boosting significantly outperformed logistic regression (AUC 0.744 vs 0.637), confirming that sepsis risk is driven by non-linear interactions poorly captured by linear scores. Interpretation: We identified a prevalent "Cryptic Shock" phenotype characterized by normotensive metabolic distress that is poorly detected by blood pressure–centric protocols. These findings have direct implications for early risk stratification and trial design, suggesting that blood pressure targets alone are insufficient endpoints for resuscitation in this subgroup.

Abstract: Background: Acute coronary syndrome (ACS) is a cannot miss diagnosis. The gold standard workup for this requires serial troponin biomarker evaluation over a period of hours. Traditionally, many of these patients required telemetry while being evaluated in this fashion, however high-quality literature suggesting that low risk patients do not require ongoing continuous cardiac monitoring. Further to this, it was found locally that over 70% of patients presenting with chest pain to our local high volume urgent care undergoing a cardiac work-up were transferred to the main hospital for this via emergency medical services (EMS). We felt this intersection of patient care and medical services could be streamlined to reduce critical resource utilization. Objective: The aim of this study is to reduce the usage of EMS for transport of chest pain patients from the urgent care to the main hospital by 25% over a 3- month period. Methods: This study was conducted as an uncontrolled before-after interrupted time series design. Comprehensive data drilldown was performed through chart review and structured clinical practise evaluation. This led to the creation of an evidence-based safe-for-self-transport tool to be applied in this patient population. The primary outcome measure was the proportion of patients transported via EMS with main balancing measures being proportion of self-transported patients admitted to hospital and time to troponin blood draw in self-transported patients. Results: The education and the newly developed transport tool resulted in a sustained shift below the previous baseline system mean control limit, indicating a significant reduction in EMS usage for patient transport. The overall reduction in usage was 30%. No change in balancing (safety) measures was identified post implementation. Conclusions: EMS remains a finite resource within many Canadian health regions. The results of this study show that by focusing on a cardinal emergency department presentation like chest pain, adapting evidence-based practise through quality improvement methodologies can result in a significant sustained reduction of EMS utilization.

Abstract:

Introduction: Pediatric acute appendicitis (PAA) remains challenging to diagnose despite existing diagnostic scores. The BIDIAP index is a three-item diagnostic tool with very high discriminative performance in a derivation cohort. This study aimed to prospectively and externally validate the BIDIAP index in a multicenter pediatric population.Material and Methods: We conducted a prospective, multicenter observational study across four tertiary pediatric centers, enrolling children presenting with suspected PAA. Two groups were analyzed: patients with histopathologically confirmed PAA and patients in whom appendicitis was confidently excluded after diagnostic work-up, classified as non-surgical abdominal pain (NSAP). The BIDIAP index was applied using a predefined cutoff (≥ 4 points), and diagnostic performance was assessed using ROC analysis, calibration metrics, and decision curve analysis (DCA).Results: A total of 644 patients meeting the prespecified analytical criteria were included in the primary analysis. The BIDIAP index demonstrated excellent diagnostic performance, with an area under the ROC curve of 0.93 (95% CI, 0.92–0.95). The calibration slope was 1.00, and the intercept was close to zero, indicating close agreement between predicted and observed risks. At the prespecified cutoff value of ≥ 4 points, the BIDIAP index achieved a sensitivity of 90.5% and a specificity of 81.6%. DCA showed a positive net clinical benefit of the BIDIAP index over treat-all and treat-none strategies across the full range of clinically relevant threshold probabilities. Conclusions: The BIDIAP index demonstrated excellent diagnostic performance for PAA. Its simplicity, based on only three items, and its potential applicability even when the appendix is not visualized on ultrasonography make the BIDIAP index a promising tool for supporting clinical decision-making in routine pediatric emergency practice.

Abstract: The current consensus model of sepsis is that it is a dysregulated host response to infection associated with severe organ dysfunction and failure. In 2023 the author proposed a new model of sepsis in that it was a physiological response and defence to infection that failed or became “dysregulated” particularly if the infection was overwhelming or there was a deficiency of thiamine and/or intracellular glucose to provide ongoing fuel for the immune response and/or mitochondrial production of adenosine triphosphate (ATP).This new model proposed that during sepsis, the immune system received priority access to available glucose, prompting insulin resistance that minimised glucose utilisation by less essential tissues. Concurrently, mitochondrial ATP production via oxidative phosphorylation (OXPHOS) was deprioritised, with the immune system relying on anaerobic glycolysis for ATP generation. This suppression of OXPHOS was only a temporary measure; mitochondrial ATP production had to be resumed for complete recovery. Its persistent suppression could culminate in critical ATP deficits and cell death.This paper reviews the consensus model of sepsis and evidence for the new model.It also reviews glucose, thiamine and insulin metabolism in sepsis and concludes that administering high-dose insulin alongside mild hyperglycaemia and intravenous thiamine—a pyruvate dehydrogenase kinase (PDK) inhibitor—may help restore physiological mitochondrial ATP production when administered during a crucial window in the sepsis process, potentially improving survival outcomes.The thrust of this new model may have been validated by a recent experiment on sepsis in mice that found superior survival following treatment with combined glucose and thiamine compared to antibiotics.

Abstract: The Surviving Sepsis Campaign (SSC) 1-hour bundle has transformed sepsis care in high-income countries. This bundle comprises rapid lactate measurements, blood cultures, broad-spectrum antibiotics, intravenous fluids, and vasopressors. However, in fragile systems such as Turkana County, Kenya, this protocol is largely impractical. This review synthesises current global and regional literature to contextualise the bundle’s limitations and propose evidence-based adaptations. Long travel distances, shortage of essential diagnostics and medicine, limited human resources, and inadequate critical care capacity remain significant systemic barriers. This review advocates for reframing the bundle from a fixed 1-hour metric to an “as soon as possible” (ASAP) framework, emphasising early recognition, timely empirical antibiotics, and pragmatic hemodynamic stabilisation using available resources. Key recommendations include replacing lactate measurements with clinical surrogates (such as capillary refill time), creating locally informed empirical antibiotic protocols, strengthening supply chains, investing in task-sharing and simulation-based training, and embedding community awareness initiatives. These adaptations can achieve meaningful mortality reduction and mitigate antimicrobial resistance.

Abstract:

Hospice and palliative care improve quality of life for patients with advanced illness, yet referrals from emergency departments (EDs) remain limited. This study aimed to establish a baseline rate of ED-initiated referrals from the Northwell’s Long Island Jewish Medical Center to its Health’s Hospice and Palliative Care Program between August and December 2024. Using an institutional database, we reviewed 262 referrals and identified referral sources, documentation of ED goals-of-care (GOC) discussions, and patient disposition. Only 5.3% of all palliative care referrals and 3.0% of actual hospice placement referrals originated from the ED, with a decline in ED GOC discussions over the study period. Nearly all referred patients were admitted or placed in observation rather than discharged home or directly to hospice. Persistent cultural, educational, and workflow barriers may limit integration of palliative care within the ED. Improved interdisciplinary communication, provider training, and structured ED-to-hospice pathways may increase appropriate referrals, reduce unnecessary hospitalizations, and promote goal-concordant end-of-life care. Establishing this baseline provides a foundation for future quality improvement initiatives aimed at enhancing patient-centered outcomes for Northwell patients with advanced illness.

Abstract: Background/Objectives: Prolonged stays in the emergency department (ED) may contribute to an increase in the rate of healthcare-associated infections (HAIs) with an increased risk of mortality. Early identification of the risk profile of these patients could reduce both complications and adverse outcomes. The study aimed to verify whether the development of an HAI was associated with mortality. Design, settings and participants: This prospective multicentre study involved all subjects, who required urgent admission to an acute care hospital from the ED, between 2023 and 2024. Outcome measures: The primary endpoint was 30-day mortality. A Cox proportional hazards model was used to test the hypothesis. Results: Of the 27,516 patients included in the analysis, with a mean age of 79 [20] years (median [IQR]), 1,575 (7.8%) died. The main features, in order of importance, selected for predicting mortality were: diagnosis of neoplasm; older age; NEWS; diagnosis of infectious diseases; HAIs; diagnosis of respiratory diseases; CCI; priority level on arrival; and male gender, yielding an accuracy of 0.804 ± 0.012. The development of a nosocomial infection was associated with a mortality risk ratio of 1.518 (95% confidence interval (CI): 1.338–1.721; p < 0.001), particularly high for bloodstream infections (2.54; 2.12–3.06) and pneumonia (1.44; 1.20–1.73). Conclusion: In patients admitted to acute care hospital from the ED, the development of HAIs is associated with an increased risk of mortality. This risk is particularly elevated in cases of bloodstream infections and pneumonia.

Abstract: Background: In-hospital immobilization of the spine is a critical component of major trauma care, particularly to prevent secondary neurological injury of the cervical spine (C-spine). While prehospital recommendations are relatively consensual, evidence-based, standardized procedures for the in-hospital transition phase are lacking. Objective: To experimentally and quantitatively assess C-spine motion reduction under in-hospital conditions with four commonly used whole-body immobilization devices (long spine board, soft positioning mattress, TraumaMattress, vacuum mattress) and to investigate the effect of a stabilization pillow on a soft positioning mattress. Methods: In a standardized trauma-room scenario, C-spine movements (flexion/extension, rotation, lateral flexion) were recorded using inertial sensors (IMUs; Xsens® MTi 10) during transport and transfers and analyzed as motion scores for each axis and as total composite. An ancillary experiment tested the effect of a stabilization pillow on the soft positioning mattress. Results: The devices differed markedly in motion reduction. The total motion score was lowest for the spine board (122.0), followed by the TraumaMattress (138.7). The soft positioning mattress (238.7) and vacuum mattress (276.3) showed higher motion values. On the soft positioning mattress, the stabilization pillow primarily reduced rotation, with minimal increases in flexion/extension and lateral flexion; the overall effect remained small. Conclusions: Under experimental in-hospital conditions, the spine board and the TraumaMattress achieved the greatest reduction in C-spine motion. For clinical protocols, a standardized, patient-centered positioning strategy with reliable fixation appears reasonable; prospective clinical studies involving trauma patients are required for external validation.

Abstract: Background and objectives: The purpose of this study was to investigate whether high ethmoid sinus volume (ESV) constitutes a risk factor for the formation of orbital blowout fractures (OBF) after craniofacial trauma and whether it affects the fracture pattern. Materials and Methods: This is a retrospective case-control study involving subjects over 15 years of age who presented to the emergency department with craniofacial trauma. The case group included subjects with OBF, while the control group included subjects without any facial fractures. The case group was divided into subgroups according to the fracture location. We performed volumetric measurements on computed tomography images of the ethmoid sinuses of subjects in the case and control groups using the fully automated 3D Slicer application. The mean ESV values of the groups were compared using the necessary statistical methods. P-values below 0.05 were considered significant. Results: The case group consisted of 108 (median age: 41.5 years; 76 males, 69%), and the control group consisted of 122 (median age: 38 years; 84 males, 69%) subjects. OBFs were more frequent in males (69%), most commonly detected in the orbital floor (68.2%), and were bilateral in two (1.8%) subjects. The mean ESV in the case group (3.91 ± 1.39 cm³) was significantly higher than that in the control group (2.82 ± 0.94 cm³) (p< 0.001). Unlike the cases with medial wall fractures and those with orbital floor fractures, there was no significant difference in mean ESV between the cases with medial wall and orbital floor fractures and the control group (p= 0.562). Conclusions: A large ethmoid sinus not only increases the risk of orbital blowout fracture but also has an impact on the fracture pattern. Based on the data obtained from our study, we identified a large ethmoid sinus as a predictive risk factor for orbital blowout fracture.

Abstract: Background: Type B aortic dissection management relies on risk stratification, yet evidence-based tool adoption remains inconsistent in NHS. Bridging the gap between Emergency Medicine and Vascular Surgery remains essential for timely diagnosis, optimal risk stratification, and appropriate intervention to improved outcomes and reduced mortality. Methods: A cross-sectional survey of EM consultants yielded n=173 valid responses from n=33 units across UK. Subgroup analyses was conducted using a Chi-square test (p < 0.05) alongside descriptive analysis. A pooled prevalence analysis of the literature, utilizing a random-effects model at a 95% confidence interval (CI), served as a benchmark for perception analysis. Agreement was evaluated using Bland-Altman analysis, incorporating upper, lower, and overall bias of agreeability. Results: Access to rapid CTA was 70% (95% CI: 63.3%–76.8%, p < 0.001), while 32% had SOPs for TBAD (95% CI: 25.3%–39.1%), and 26% were aware of any decision tool (95% CI: 20.6%–33.6%). Labetalol as a first-line antihypertensive was more common amongst least experience (p < 0.05). TBAD diagnosis increased 1.6-fold with every 4 years of additional experience (p < 0.05). Perception analysis showed strong agreement for pain (characteristics and location), hypertension, gender, and age with moderate-to-low agreement for other factors with reported bias of bias of 23.58% (-38.20% to 85.36%) (p = 0.02). Results: The survey suggests a degree of misperception and inconsistency in recognition of most and least prevalence factors for TBAD suspicion and management. This outcome advocates targeted strategies to enhance diagnostic accuracy using tools aligned with NHS resources and QALY frameworks.

Abstract: Background: Diagnosing coagulopathy in sepsis remains challenging, as current Conventional scoring systems based on routine coagulation biomarkers are insufficient to predict mortality accurately. Endothelial molecular markers may improve risk stratification. Objectives: To evaluate the prognostic value of thrombin–antithrombin complex (TAT), tissue-type plasminogen activator–inhibitor complex (t-PAIC), and antithrombin (AT) activity, and to develop a unified score augmenting International Society on Thrombosis and Hemostasis (ISTH) overt-DIC criteria. Methods: In this prospective, longitudinal study, adults with Sepsis-3 presenting to the emergency department underwent serial clinical assessment, routine coagulation testing, and measurement of endothelial markers on Days 1, 3, and 7. Receiver operating characteristic (ROC) analyses screened candidate biomarkers, and multivariable logistic regression identified independent predictors of 28-day mortality. A unified score (Unified ISTH+) was constructed by adding optimal molecular markers to ISTH components and compared with ISTH, JAAM, and SIC criteria. In addition, a non-parametric bootstrap procedure was performed to assess the internal stability and empirical power of the predictive models given the modest sample size. Results: Fifty-four patients (mean age 59.6 ± 16.6 years) were included; 28-day mortality was 31.5%. TAT, t-PAIC, and AT activity were independent predictors of mortality. Individual ROC performance was high for t-PAIC (AUC 0.846), TAT (AUC 0.845), and AT (AUC 0.789). The Unified ISTH+ score achieved superior discrimination (AUC 0.856; 95% CI 0.757–0.955) versus ISTH (0.783), JAAM (0.718), and SIC (0.676), and showed the greatest net benefit on DCA across clinically relevant thresholds. Unified ISTH+-positive patients had higher SOFA/APACHE II scores and worse survival (log-rank p < 0.001). Conclusions: t-PAIC, TAT, and AT activity are strong prognostic markers in sepsis-associated coagulopathy. Incorporating them into a unified ISTH+ score improves mortality prediction versus existing criteria and may enable earlier risk stratification and clinical decision-making.

Abstract: Introduction Emerging technologies have significantly transformed disaster preparedness and training in healthcare, especially for prehospital responders engaged in mass casualty incidents (MCIs). As scenarios grow more complex, traditional training methods alone are insufficient for developing critical skills such as triage, decision-making, and rapid coordination under pressure. Technology-enhanced solutions such as virtual reality (VR), wearable sensors, serious games, and AI-based systems offer immersive, scalable, and repeatable training experiences. While several studies have explored these tools individually, a comprehensive synthesis is lacking to map how diverse technologies are employed in MCI-focused prehospital training. Methods This scoping review is conducted as part of the MCI-PHER project (Mass Casualty Incident – Prehospital Emergency Response), a collaborative initiative to advance disaster medicine education and prehospital preparedness. The review will follow the Arksey and O’Malley framework, refined by Levac et al., and adhere to PRISMA-ScR guidelines. A systematic search will be conducted across databases, including PubMed, Embase, Scopus, CINAHL, PsycINFO, Cochrane Library, and ClinicalTrials.gov. Eligible studies must describe, implement, or evaluate technological training interventions targeted at healthcare professionals or students in simulated or actual prehospital MCI settings. Two independent reviewers will conduct study selection, data extraction, and quality checks, with disagreements resolved by a third reviewer. Data will be charted using a customized extraction tool, refined through piloting five relevant studies. Results and Analysis Studies will be synthesized using a combination of descriptive and narrative approaches. Key domains will include the type of technology and training modality, learning objectives, target professional groups, instructional design models, evaluation strategies, and reported outcomes. Quantitative findings will be summarized using descriptive statistics, while qualitative results, such as user perceptions and contextual insights, will be narratively organized to reflect patterns and diversity across studies. The synthesis will identify common applications, outcome trends, implementation barriers, and evidence gaps to inform future research and practice in prehospital MCI training. Dissemination and Ethics As no human subjects are involved, ethical approval is not required. Results will be disseminated via peer-reviewed publications, conference presentations, stakeholder briefings, and open-access platforms to inform EMS leaders, simulation educators, and health policymakers.

Abstract: Background: Late presentation of Congenital Diaphragmatic Hernia (CDH) is a herniation of abdominal contents through a diaphragmatic defect into the thoracic cavity and diagnosed after the neonatal period. The reported case is a left-sided congenital diaphragmatic hernia, diagnosed as pneumonia and seen as a pneumothorax on a chest radiograph.Case presentation: This is a seven-month-old female child who presented in the emergency department with fever and shortness of breath of four days' duration. Chest x-ray was suggestive of left pneumothorax with left mid-zone consolidation. Chest tube insertion was initially planned. While noticing clear localized air inferiorly with an indistinct left diaphragm, a late diaphragmatic hernia was suspected, and chest tube insertion was not done. A nasogastric tube was swallowed, and a chest radiograph was taken. The x-ray revealed the gastric tube in the left thorax. Surgical repair was carried out after resolution of the infection. The postoperative period was uneventful, and the patient was discharged from hospital after six days. At one month of follow-up visit, the patient was stable, and recovery was satisfactory.Conclusion: This case characterized the clinical manifestation and diagnostic delay of the patient. Early diagnosis and avoiding inappropriate treatment decreases morbidity and mortality. Late presentation of diaphragmatic hernia, although uncommon, needs to be considered in a child with respiratory distress and in unusual patient presentations.

Abstract: Background: Agitated adult trauma patients are common in Canadian emergency departments (EDs). Cooperation and monitoring constraints can delay essential imaging and risk missed injury. Objective: To synthesize current guidance and evidence into an educational framework for timely, safe imaging when the trauma exam is unreliable due to agitation. Methods: Narrative review using targeted searches of guideline/agency sources and peer‑reviewed trials/meta‑analyses on agitation control, eFAST, and selective versus whole‑body CT. Outputs were a conceptual evidence map and a worked case. Results: Current research prioritizes parallel resuscitation with early eFAST. Unstable, eFAST‑positive patients usually proceed to hemorrhage control rather than CT. For stable or stabilized adults with an unreliable exam, brief, monitored behavioral control (single, guideline‑supported regimen) creates a one‑trip imaging window under continuous SpO₂/NIBP/ECG (± capnography). Teams select an up‑front imaging approach: selective CT once cooperation returns and injuries localize (using CCHR/CCR where applicable), or whole‑body CT when multi‑region injury is likely or unreliability persists. The scanner‑side bundle includes named monitoring responsibility, an airway plan, and dose‑optimized protocols. Downstream steps include IR‑supported non‑operative strategies for eligible solid‑organ injury, a 24–48‑hour tertiary trauma survey, and a structured psychiatry handoff to limit re‑sedation. Conclusions: In agitated adult trauma, a single, monitored trip to obtain the necessary imaging after brief, guideline‑aligned behavioral control may improve safety and throughput. This educational synthesis requires local policy alignment and prospective evaluation.

Abstract: Introduction: Tabletop exercises (TTEs) are low-stress, discussion-based simulations designed to enhance decision-making, coordination, and communication in emergency scenarios. While recent articles have explored their use in medical emergencies, the role of TTXs in prehospital settings, specifically their impact on preparedness activities leading up to hospital admission, remains underexplored. This scoping review aims to map how TTXs have been utilized to assess and improve prehospital preparedness, identify outcome measures aligned with the Kirkpatrick Model, and explore the characteristics and contexts of these exercises. Methods: This scoping review is conducted as part of the MCI-PHER project (Mass Casualty Incident – Prehospital Emergency Response), a collaborative initiative to advance disaster medicine education and prehospital preparedness. The review will follow Arksey and O’Malley’s five-stage framework, enhanced by Levac et al., and report according to PRISMA-ScR guidelines. A comprehensive search of databases, including PubMed, Scopus, Embase, PsycINFO, CINAHL, Cochrane, and ClinicalTrials.gov, along with gray literature from Google Scholar, will be conducted. Eligible studies will include TTXs used in prehospital or EMS-related emergency preparedness, across all primary study designs. The outcomes will be mapped to the four levels of the Kirkpatrick Model. Two independent reviewers will conduct study selection, data extraction, and quality checks, with disagreements resolved by a third reviewer. Data will be charted using a customized extraction tool, refined through piloting five relevant studies. Results and Analysis: The scoping review will synthesize and map the evidence on the use of tabletop exercises (TTXs) in prehospital emergency preparedness. Findings will be organized and presented in tables, figures, and other visual formats to provide a structured overview. Studies will be categorized according to their focus and objectives, educational or training context, target populations, TTX characteristics, and reported outcomes. Quantitative data (e.g., frequencies, sample sizes, outcome measures) will be summarized descriptively, while qualitative evidence (e.g., participant experiences, lessons learned) will be analyzed narratively to capture contextual insights. This comprehensive synthesis will highlight current practices, underexplored areas, and evidence gaps to inform future research and guide the development of effective training strategies for prehospital emergency preparedness. Dissemination and Ethics: No ethical approval is required as no human subjects are involved. Findings will be disseminated through peer-reviewed publications, conference presentations, policy briefs, and stakeholder engagement.

Abstract: Introduction: Mass casualty incidents (MCIs), where casualty numbers exceed available emergency resources, are rising globally due to natural disasters, terrorism, and pandemics. Effective response requires well-trained healthcare professionals, yet training programs vary widely in structure and delivery. Previous reviews, such as Baetzner et al., focused on first responders and training effectiveness but offered limited insight into curriculum design across broader healthcare roles. Similarly, Bahattab et al. reviewed humanitarian health education in low- and middle-income countries but excluded high-income settings and did not examine the pedagogical design of MCI training for clinical professionals. This scoping review aims to map global evidence on how disaster and MCI training curricula are designed and implemented across diverse healthcare groups. Methods: This scoping review is conducted as part of the MCI-PHER project (Mass Casualty Incident – Prehospital Emergency Response), a collaborative initiative to advance disaster medicine education and prehospital preparedness. The review will follow the methodological framework by Arksey and O’Malley, with refinements from Levac et al., and will be reported according to the PRISMA-ScR guidelines. A comprehensive search of seven databases (PubMed, Embase, Scopus, PsycINFO, CINAHL, Cochrane Library, and ClinicalTrials.gov) will be conducted using a combination of MeSH terms and keywords. Studies published in English over the past ten years will be considered. Two independent reviewers will conduct study selection, data extraction, and quality checks, with disagreements resolved by a third reviewer. Data will be charted using a customized extraction tool, refined through piloting five relevant studies. Inclusion criteria will cover all healthcare learners (e.g., paramedics, nurses, physicians, medical students) in prehospital or in-hospital disaster training contexts. Both qualitative and quantitative studies, including grey literature, will be included. Results and Analysis: The review will map and synthesize existing literature on disaster and mass casualty incident (MCI) training curricula across healthcare disciplines. Extracted data will be organized into tables and figures, presenting curriculum structures, learner groups, instructional methods, competency frameworks, assessment strategies, and reported outcomes. Both quantitative findings (e.g., frequencies of approaches and participant characteristics) and qualitative insights (e.g., implementation experiences and contextual factors) will be summarized. This integrated analysis will highlight current practices, innovations, and gaps in disaster training education to inform future curriculum development and policy. Ethics and Dissemination: No ethical approval is required as no human participants are involved. Findings will be disseminated through peer-reviewed publications, conference presentations, policy briefs, and stakeholder engagement.

Abstract:

Background: In patients over 65 years who experience severe trauma the underlying health status has a significant impact on overall mortality. This study aims to assess if CT evaluation of skeletal muscle quality could be a risk stratification tool in the ED for these patients. Methods: Retrospective observational study between January 2018 and September 2021, including consecutive patients ≥ 65 years admitted to the ED for a major trauma (defined as Injury Severity Score > 15). Muscle quality analysis was made by specific software (Slice-O-Matic v5.0, Tomovision®, Montreal, QC, Canada) on a CT-Scan slice at the level of the third lumbar vertebra. Results: 263 patients were included (72.2% males, median age 76 [71-82]), and 88 (33.5%) deceased. The deceased patients had a significantly lower skeletal muscle area density (SMAd) compared to survivors. The multivariate Cox regression analysis confirmed that SMAd < 38 at the ED admission was an independent risk for death (adjusted HR 1.68 [1.1 – 2.7]). The analysis also revealed that, among the survivors after the first week of hospitalization, the patients with low SMAd had an increased risk of death (adjusted HR 3.12 [1.2 – 7.9]). Conclusions: The skeletal muscle density evaluated by a CT scan at ED admission could be a valuable risk stratification tool for patients ≥ 65 years with major trauma. In patients with SMAd <38 HU the in-hospital mortality risk could be particularly increased after the first week of hospitalization.

Abstract: Introduction: Iron deficiency is a common condition in the general population, with a higher incidence in critically ill patients. Anemia associated with these alterations is linked to increased morbidity and mortality in ICU patients. Objective: This pilot study explored whether provisional CRP and ferritin thresholds might relate to survival and examined preliminary associations with analytical and clinical variables in critically ill patients. Material and Method: A prospective, observational pilot study was conducted on 75 ICU patients over three months. Hematological and biochemical parameters (CRP, ferritin, iron, transferrin, hemoglobin) were analyzed at admission, 48 hours, and on days 4 and 7. Clinical data included age, sex, ICU stay, survival, SOFA and APACHE II scores, complications (AKI, acute lung injury), and interventions (mechanical ventilation, in-fections). Data were analyzed using mixed regression models and Wilcoxon tests. Results: In this pilot cohort (mean age 53.65 years; 61.33% male), survival was 82.67%. Higher CRP and ferritin levels were observed among non-survivors and those with AKI p< 0.05. A CRP level ≥145 mg/L was associated with a constellation of more unfavorable clinical indicators (older age, longer ICU stay, higher APACHE II and SOFA scores, more me-chanical ventilation, higher AKI and infection rates, and reduced survival) p< 0.05. Ferritin levels were higher in males and non-survivors and showed positive correlations with SOFA score and ICU length of stay. The exploratory prognostic performance of the CRP threshold was AUC=0.8103.

Abstract: Background Abdominopelvic computed tomography (APCT) is a frontline diagnostic modality for acute abdominal pain, but it often reveals incidental findings (IFs) that are unrelated to the presenting complaint. While many IFs are benign, some require structured follow-up and long-term management. In military settings, where healthcare access may be limited and continuity of care is vulnerable to frequent personnel transfers, IFs represent a critical challenge for health system readiness. Methods We retrospectively reviewed the records of 1,062 male Korean soldiers (aged 18–28 years) who underwent APCT for acute abdominal pain at a military emergency department between January 2021 and December 2022. Two board-certified radiologists independently re-assessed all scans to identify IFs and classify those requiring clinical follow-up. Prevalence estimates were calculated, and clinically significant findings were highlighted in the context of healthcare delivery. Results Incidental findings were identified in 218 of 1,062 patients (20.5%). The most frequent were renal cysts (6.2%) and hepatobiliary abnormalities (7.5%). Clinically significant lesions included Bosniak II-F renal cysts (0.3%), inherited cystic kidney diseases (0.2%), intraductal papillary mucinous neoplasm (0.1%), adrenal incidentalomas (0.4%), and appendiceal mucoceles (0.2%). These conditions required specialist follow-up or surgical management. Exploratory analysis also revealed clusters of co-occurring IFs, such as renal and hepatic cysts, highlighting potential shared risk factors. Conclusions Incidental findings on APCT are prevalent even in a young, ostensibly healthy military population. Their discovery reveals a gap between detection and effective follow-up in military healthcare systems. To mitigate long-term health risks and maintain operational readiness, implementation of structured reporting protocols, automated tracking systems, and cross-institutional referral pathways is essential. These measures are particularly critical in environments where access to subspecialty care is constrained and service members frequently change duty stations.

Abstract: Severe neonatal jaundice (SNJ) or hyperbilirubinemia is responsible for over 114,000 unnecessary neonatal deaths annually as the technology that can treat the condition is cost prohibitive for low- and middle-income countries. In this study an open-source neonatal light therapy device to treat SNJ is designed, built and validated against phototherapy technical specifications set by the American Academy of Paediatrics and UNICEF. The open source device can be built for a tenth of the cost of the least expensive proprietary alternative on the market, while producing treatment metrics equivalent to or exceeding commercial devices available in developed nations. The device, whose material costs are $93.00 USD, was shown to produce irradiance of 80 µW/cm²/nm within the acceptable range of 420 – 500 nm. It was further demonstrated that the unit could produce a uniform distribution of (34.5 ± 4.3) µW/cm²/nm over a surface area exceeding 3,200cm². These findings validate the effectiveness of the open-source neonatal light therapy device in delivering accurate, consistent, and reliable irradiance for neonatal jaundice management. By releasing full documentation in an open-source manner the device may be broadly distributed to ensure affordable and consistent low-cost means of improving the quality of care for newborns suffering from jaundice.