People are increasingly embarking on expeditions into remote wilderness environments and subjecting themselves to increased medical risk. Medical provisions for the management of anticipated injuries and illnesses must be selected carefully due to financial and size and weight constraints on expeditions. Literature suggests decisions surrounding medical resource provisioning are rarely made using evidence-based methods.

The aim of this study was to evaluate the medical provisions taken on expeditions against the medical provisions recommended as best practice in published treatment protocols for the management of conditions encountered on expeditions.

Firstly, a mixed methods study approach was used to develop a conceptual model linking injuries and illnesses with the medical resources (equipment and medications) recommended for their management. In the second part of the study, injuries and illnesses reported in four studies from the published literature were analyzed using the conceptual model.

Expected medical resources for the injury and illness burden were compared to the medical resources included in published equipment and medication lists. It was found that medical resources taken on expeditions were both significantly underequipped (p<0.01) compared with the list of provisions recommended by the treatment protocols, but also included a range of resources that were not indicated as part of best practice.

These findings suggest that unnecessary over-provisioning and under-provisioning risks are being assumed on expeditions. Further research supporting the development of a medical provision recommender system may provide a more evidence-informed method of matching medical resource requirements to anticipated injury and illness profiles on expeditions.

Smallpox has been eradicated, but advances in synthetic biology have increased the risk of its re-emergence. Residual immunity in individuals who were previously vaccinated may mitigate the impact of an outbreak, but there is a high degree of uncertainty regarding the duration and degree of residual immunity.

A systematic literature review using the PRISMA criteria was conducted to quantify the duration and extent of residual immunity to smallpox after vaccination. 29 papers related to quantifying residual immunity to smallpox after vaccination were identified.

Duration of protection of >20 years was consistently shown in the 16 retrospective cross-sectional studies, while the lowest estimated duration of protection was 11.7 years among the modeling studies. Childhood vaccination conferred longer duration of protection than vaccination in adulthood. Multiple vaccinations did not appear to improve immunity. Most studies suggest a longer duration of residual immunity (at least 20 years) than assumed in smallpox guidelines. Estimates from modeling studies were less but still greater than the 3-10 years suggested by the WHO Committee on International Quarantine or US CDC guidelines. These recommendations were probably based on observations and studies conducted while smallpox was endemic. The cut-off values for pre-existing antibody levels of >1:20 and >1:32 reported during the period of endemic smallpox circulation may not be relevant to the contemporary population but have been used as a threshold for identifying people with residual immunity in post-eradication era studies.

Of the total antibodies produced in response to smallpox vaccination, neutralizing antibodies have shown to contribute significantly to immunological memory. Although the mechanism of immunological memory and boosting is unclear, revaccination is likely to result in a more robust response. There is a need to improve the evidence base for estimates on residual immunity to better inform planning and preparedness for re-emergent smallpox.

Evidence-based training and curriculum are seen as vital in order to be successful in preparing paramedics for an effective disaster response. The creation of broadly recognized standard core competencies to support the development of disaster response education and training courses for general health care providers and specific health care professionals will help to ensure that medical personnel are truly prepared to care for victims of mass casualty events.

To identify current Australian operational paramedic’s specific disaster management education and knowledge as it relates to disaster management core competencies identified throughout the literature and the frequency of measures/techniques which these paramedics use to maintain competency and currency.

Paramedics from all states of Australia were invited to complete an anonymous online survey. Two professional bodies distributed the survey via social media and a major ambulance service was surveyed via email.

The study population includes 130 respondents who self-identified as a currently practicing Australian paramedic. Paramedics from all states except South Australia responded, with the majority coming from Queensland Ambulance Service (N= 81%). In terms of experience, 81.54% of respondents report being qualified for greater than 5 years. Initial analysis shows that despite the extensive experience of the practitioners surveyed when asked to rate from high to low their level of knowledge of specific disaster management core competencies a number of gaps exist.

Core competencies are a defined level of expertise that is essential or fundamental to a particular job, and serve to form the foundation of education, training, and practice for operational service delivery. While more research is needed, these results may help inform industry, government, and education providers to better understand and to more efficiently provide education and ongoing training to paramedics who are responsible for the management of disaster within the Australian community.

Opioid overdose deaths in the United States are increasing. Time to restoration of ventilation is critical. Rapid bystander administration of opioid antidote (naloxone) is an effective interim response but is historically constrained by legal restrictions.

To review and contextualize development of legislation facilitating layperson administration of naloxone across the United States.

Publicly accessible databases (1,2) were searched for legislation relevant to naloxone administration between January 2001 and July 2017.

All 51 jurisdictions implemented naloxone access laws between 2001 and 2017; 45 of these between 2012 and 2017. Nationwide mortality from opioid overdose increased from 3.3 per 100,000 population in 2001 to 13.3 in 2016, 42, and 35 jurisdictions enacted laws giving prescribers immunity from criminal prosecution, civil liability, and professional sanctions, respectively. 36, 41, and 35 jurisdictions implemented laws allowing dispensers immunity in the same domains. 38 and 46 jurisdictions gave laypeople administering naloxone immunity from criminal and civil liability. Forty-seven jurisdictions implemented laws allowing prescription of naloxone to third parties. All jurisdictions except Nebraska allowed pharmacists to dispense naloxone without a patient-specific prescription. Fifteen jurisdictions removed criminal liability for possession of non-prescribed naloxone. The 10 states with highest average rates of opioid overdose-related mortality had not legislated in a higher number of domains compared to the 10 lowest states and the average of all jurisdictions (3.4 vs 2.9 vs 2.7, respectively).

Effective involvement of bystanders in early recognition and reversal of opioid overdose requires removal of legal deterrents to prescription, dispensing, distribution, and administration of naloxone. Jurisdictions have varied in degree and speed of creating this legal environment. Understanding the integration of legislation into epidemic response may inform the response to this and future public health crises.

The US, as well as many countries, are being beseeched by more natural and man-made events; both small (e.g., shootings) and geographically vast (e.g., floods). Due to a myriad of issues, traditional first responders i.e., EMS, fire department, and police cannot be expected to be the only trained lifesavers on the scene. In the US (as in many countries), it is imperative to begin the discussion to better understand the role of the “injured” and “immediate” responders and how they interact with the “first” responders.

To open a discussion amongst disaster experts about the merits of training and subsequent promotion of a curriculum for “immediate” responders.

Literature review.

After recent evaluations of events, it is postulated that there are three categories of responders: the injured, the immediate, and the first (EMS, fire department, police). The premise upon which disaster risk reduction and building community resilience are achieved begin with strengthening, empowering, and equipping local populations with the appropriate tools. This would involve education, skills, and training. With the average general public trained, and if they are one of the first two categories, then the community would not only be better able to assist themselves, but also be able to integrate into the recovery process much more quickly and fully. By doing this, they will be empowered to take care of themselves, neighbors, and community, which in turn increases local resilience.

The Emergency Medical Team (EMT) Strategic Advisory Group of the World Health Organization has endorsed the EMT Minimum Data Set (MDS) as the standard methodology for EMT daily report. The MDS had been developed on a similar methodology called J-SPEED which developed in Japan. Thus, lessons learned from the J-SPEED can be applied to the MDS.

To review previous J-SPEED activations and to extract lessons learned.

Cases of the J-SPEED activation at the Kumamoto earthquake in 2016, West Japan Heavy Rain in 2018, and Hokkaido Earthquake in 2018 were reviewed.

The first large-scale activation of the J-SPEED at the Kumamoto earthquake revealed a significant burden in aggregations of submitted paper forms at the EMT Coordination Cell (EMTCC). To strengthen this function of the EMTCC, electronic system and human capacity development have been identified as key issues. To fulfill this gap, a smartphone app so-called J-SPEED+ has been developed. Also, the J-SPEED offsite analysis support team, which is a team to support analysis of data from outside of an affected area has been established. These two functions contributed to significant improvement of J-SPEED data flow at the West Japan Heavy Rain and Hokkaido Earthquake. These two responses reinforced the necessity of strengthening the capacity of J-SPEED onsite coordinator working at the ETMCC, and national education and training for all EMTs.

In order to strengthen the mechanism to run the J-SPEED, nationwide training for all EMTs, onsite coordinators, and the off-site analysis support team have been established. The authors regard this structural approach as a requirement for other countries to run the MDS.

After a 6.0 magnitude earthquake struck Hualien on February 6, 2018, over one hundred and fifty patients crammed into the emergency department of a nearby tertiary hospital within two hours. The mass casualty incident (MCI) call was activated, and over 300 related personnel responded to the call and engaged with the MCI management.

This research aimed to analyze the practice of an MCI call and to form the strategies to improve its efficiency and effectiveness.

The research was conducted in a tertiary hospital in Hualien, Taiwan. Questionnaires regarding the practice of the MCI call were sent out to the healthcare providers in the emergency department who responded to that MCI operation.

Thirty-seven responders in the emergency department were involved in this study. 78% had participated in training courses for hospital incident command system (HICS) or MCI management before this event. On arrival at the emergency department, 69.4% of the responders were aware of the check-in station and received a clear task assignment and briefing. During the operation, 25.7% reported the lack of confidence carrying out the assigned tasks and 54.1% of the participants experienced great stress (stress score over 7 out of 10).

MCI is an uncommon event for hospital management. It is universally challenging owing to its unpredictable and time-sensitive nature. Furthermore, the administration could be further complicated by the associated disasters. Despite regular exercises and drills, there are still a significant number of participants experiencing stress and confusion during the operation. The chaotic situation may further compromise the performance of the participants. This study showed that optimizing task briefing and on-site directions may improve the performance of the MCI participants.

The best first-aid treatment for cardiac arrest patients is Advanced Cardiac Life Support (ACLS) to not only hope to save lives but to also leave minimal sequelae. The American Heart Association (AHA) published updated ACLS guidelines for care in 2015 emphasizing the concept of teamwork in resuscitation. However, the actual use of ACLS is not easy due to stress and unfamiliarity with the process.

Therefore, we want to use the information technology to assist the medical team to implement the ACLS process. This information system can help us to save time and labor, as well as increase precision. In addition to this, data analysis is more convenient, which facilitates the management and supervision of resuscitation quality.

An information system was developed using responsive web design (RWD) website. It can be used on a variety of devices, such as desktops, tablets, or mobile phones, and can be updated simultaneously. The system requires non-synchronous operation to be used in a wireless network environment. When the information system is in operation, the medical personnel can perform the resuscitation actions according to voice prompts, which can periodically remind staff to check rhythm, give correct medication dose, and identify whether defibrillation shock is needed. At the same time, the entire process can be recorded instantly. After the file is uploaded, the medical records are complete at the same time.

After 3 months, the satisfaction of medical staff reached 80.3%, the rate of return of spontaneous circulation (ROSC) of OHCA cases elevated to 45% from 15%, and discharge without neurological sequelae elevated to 33% from 27.4%.

All hospital staff can use this system to assist in the correct implementation of advanced CPR. It improves the quality of resuscitation and reduces the burden on clinical and writing medical records of medical staff.

Disaster Medical Response is a challenging field where opportunities for advancement are welcomed. Small Unmanned Aerial Vehicle (sUAV) technology (i.e., drones) has made enormous strides in the past few years and is poised for utilization in the early disaster response phase.

To discuss current uses of UAVs, proposed utilization and logistical details, technological advancements, current deficits, and training.

Our Foundation, Luman Medical, is working in the field of UAV integration for small to large scale disaster response. The concept is to equip first responders with small, relatively inexpensive, programmable drones that come equipped with hardware and software that are easy to use for inexperienced as well as skilled sUAV pilots.

These UAVs could increase ease and speed of deployment for early assessments of disaster area mapping, thermal imaging, ingress and egress routes, the discovery of survivors, communications, and delivery of supplies. Drone technology offers a new and growing type of tool in the disaster response arena. It is our hope to explore an integration that is easy, safe, and affordable to augment and enhance existing disaster response planning.

Best practice first aid management of accidental hypothermia and cold injuries in the prehospital setting is relevant for disaster management in cold environments as well as for wilderness and expedition medicine, and space medicine. In the Australasian context, guidance is currently taken from the Australian Resuscitation Council (“ARC”) Guidelines dealing with these issues.

To review and update the recommendations of the ARC Guideline 9.3.3 Hypothermia: First-Aid Management (February 2009) and ARC Guideline 9.3.6 Cold Injury (March 2000).

Method: The review is being undertaken through a combination of a focused literature review and expert opinion. Through the author’s membership of the International Commission for Alpine Rescue (“ICAR”) Alpine Emergency Medicine Commission, two northern-hemisphere experts on hypothermia have reviewed the guidelines and provided commentary and recommendations.

Much of the literature around accidental hypothermia and cold injuries (including frostbite, frostnip, and chilblains), relies on expert opinion and case studies. There are relatively few randomized controlled trials, and these are often confined to the laboratory setting. As a result, there is a heavier reliance on expert opinion than in any other areas of medicine.

This presentation will summarize the current best practice recommendations for the first aid management of accidental hypothermia and cold injuries through combining the existing ARC Guidelines with key advances identified through the literature review, and the key management recommendations stemming from expert opinion. This will provide attendees with a cohesive set of clinical practice recommendations which can be used in the field.

Focused or point of care ultrasound applications have been integrated into prehospital assessments, triage capacities, military applications, trauma, and emergency health care settings, and medical school curriculums. Often, the inclusion of focused ultrasound is to answer specific clinical questions. However, the value is ultimately determined by the experience, skills, and training of the operator performing and interpreting the examination. Ultrasound was reserved for traditional imaging providers as little as two decades ago. However, as the application of ultrasound expands within clinical medicine, there is an increasing necessity for associated education and training.

To highlight the applications and uses of focused ultrasound in the current diverse health care landscape while identifying the associated educational considerations, including the undergraduate tertiary education sector.

A search of peer-reviewed published literature was undertaken to determine the range of current usage of ultrasound imaging across professions, and to identify the education and training available.

The results discussed within this presentation will highlight identified trends, ultrasound applications, educational considerations, and potential future practices based on the content of the literature explored.

Technology is rapidly advancing in the field of medical ultrasound with handheld ultrasound scanners now smaller, less expensive, and more accessible than ever before. Paralleled with these advances and the more generous use of ultrasound come the expectation and pressures of competent skill diversity among healthcare staff and specialists. Significantly, sonography is still considered by many as the most technically demanding and operator dependent medical imaging modality available. Therefore, as the application of ultrasound expands within clinical medicine, educational considerations must also align with this expansion to maintain diagnostic accuracy. This means an increasing demand for associated education and training, including in the undergraduate tertiary education sector.

The Hyogo and Sendai Frameworks for Disaster Reduction are well known and have been influential globally. However, less is known of their broader contexts.

A recent opportunity to visit Kobe, Japan, provided an opportunity to experience the rich, and largely unknown tapestry behind the scenes of the Hyogo and Sendai Frameworks. This paper aims to illuminate the journey of the Kobe Legacy and its global influence.

An experiential visit to Kobe and exploring its rich resources relating to disaster risk reduction.

The First World Conference on Natural Disasters, was held in Yokohama, Japan, in 1994. Almost immediately, Kobe experienced the Great Hanshin Earthquake, January 17, 1995, resulting in 6,434 dead, 43,792 injured, and 249,180 homes damaged. The United Nations International Strategy for Disaster Reduction (2000 – 2005) culminated in the Second World Conference on Disaster Reduction, Kobe, 2005 and the Hyogo Framework for Action 2005 – 2015. The Great East Japan Earthquake occurred on March 11, 2011, with 18,453 dead or missing, 6157 injured, 1.1M homes damaged, with a tsunami and nuclear accidents. The Third World Conference on Disaster Risk Reduction followed in Sendai in 2015 with the Sendai Framework for Disaster Risk Reduction 2015 – 2030 agreed on. Subsequently, the Sendai Framework has further evolved. However, behind the scenes, Kobe has developed a rich tapestry of insightful and valuable resources which will be outlined in this presentation.

In the words of the Mayor of Kobe, Mr. Tatsuo Yada in 2010, “I would like to reaffirm my determination to never allow our experiences of the disaster to fade away. It is our responsibility to make the utmost effort for disaster prevention and mitigation and keep passing on our experiences and the lessons learned to future generations”. This is the real legacy of Kobe.

Gender-based violence is endemic across the world. The current evidence suggests that gender-based violence increases after natural disasters. Factors leading to this increase following natural disasters include physical displacement, loss of community supports and protections, economic hardship, and gendered differences in coping. Multiple agencies are mobilized in response to natural disasters, however, personnel are often not adequately trained to recognize or address gender-based violence.

To identify challenges faced by disaster responders in recognizing and responding to gender-based violence in disaster settings, and to advocate for gender-sensitive training prior to deployment by responding personnel.

The world’s literature was reviewed to identify challenges for disaster teams in recognizing and responding to gender-based violence, and to identify principles of training which may be applicable for pre-deployment competency building by disaster response personnel

Disaster response programs should ensure:

• Collection of data to identify vulnerable populations

• Establishment of procedures for monitoring and reporting

• Inclusion of female staff at all levels of planning and response

• Implementation of holistic services including physical and psychosocial care and legal response

• Safety in designing accommodations and distribution centers

Pre-Deployment training should include:

• Gender-sensitive approach, knowledge of prevalence and impact of gender-based violence

• Familiarity with behaviors and conditions associated with gender-based violence

• Non-judgmental, supportive, and validating approach to inquiry and response

• Familiarity with risk assessment tools

• Mobilization of social supports

• Knowledge of resources, including medical and legal services

Natural disasters are destabilizing events which expose vulnerable populations, particularly women, to increased violence. Disaster response teams should be adequately trained on the prevalence and impact of gender-based violence to ensure gender-sensitive interventions. Standard training of response personnel can ensure adequate identification of victims of gender-based violence and referral to appropriate services.

Bruges is the largest city in the province of West-Flanders in Belgium. Because of its ample canals, it is sometimes referred to as “Venice of the North.” As such, it is a major tourist destination, and during New Year’s Eve, there are many festivities. The AZ Sint-Jan is the largest hospital providing medical care to the area.

To examine the impact of the New Year’s Eve festivities on the workload of the emergency department of AZ Sint-Jan.

Data was analyzed for every patient presenting to the emergency department from the 31st of December starting from 06:00 PM until the 1st of January 08:00 AM from 2009 until 2018. The time of entry, type of injury, gender, age, and whether the patient was intoxicated were evaluated. Ten other dates in this time period were obtained for comparison via a random date generator. Data were analyzed using Jasp©.

There were 826 patients included for analysis. On average, 41 patients presented themselves to the emergency department on New Year’s Eve between 06:00 PM and 08:00 AM. On a random day, there were only 31 patients. Most of the patients on New Year’s Eve arrived between 00:00 AM and 08:00 AM. 57% of all patients were male. 22% of all patients were intoxicated with alcohol. From 00:00 AM until 08:00 AM, one in three patients were intoxicated. The average age on admission was 36 years.

During New Year’s Eve there is a consistently higher workload in the emergency department. There is an influx of young males who are intoxicated. These patients tend to stay a long time to “sleep it off” and put considerable stress on the available resources. More attention should be given to risk mitigation strategies tailored to this group to prevent excessive drinking.

During mass gatherings, such as marathons, the provision of timely access to health care services is required for the mass gathering population as well as the local community. However, effective provision of health care during sporting mass gatherings is not well understood.

To describe the structures and processes developed for an emergency team to operate an in-event acute health care facility during one of the largest mass sporting participation events in the southern hemisphere, the Gold Coast marathon.

A pragmatic qualitative methodology was used to describe the structures and processes required to operate an in-event acute health care facility providing services for marathon runners and spectators. Content analysis from 12 semi-structured interviews with Emergency Department (ED) clinical staff working during the two-day event was undertaken in 2016.

Structural elements that underpinned the in-event health care facility included: physical spaces such as the clinical zones in the marathon health tent, tent access, and egress points; and resources such as bilingual staff, senior medical staff, and equipment such as electrocardiograms. Critical processes included: clear communication pathways, interprofessional care coordination, and engagement involving shared knowledge of and access to resources. Distinct but overlapping clinical scope between nurses and doctors was also noted as important for timely care provision and appropriate case management. Staff outlined many perceived benefits and opportunities of in-event health care delivery including ED avoidance and disaster training.

This in-event model of emergency care delivery enabled acute out-of-hospital health care to be delivered in a portable and transportable facility. Clinical staff reported satisfaction with their ability to provide a meaningful contribution to hospital avoidance and to the local community. With the number of sporting mass gatherings increasing, this temporary, in-event model of health care provision is one option for event and health care planners to consider.

Japan International Cooperation Agency has started the project for strengthening the ASEAN regional capacity on disaster health management (ARCH Project) since 2016. This project conducted the start-up regional collaboration drill in ASEAN. All participants from ASEAN countries realized the need for a standardized assessment tool. Several UN agencies and international organizations launched assessment tools, but there is no standard assessment tool.

To develop an integrated rapid health needs assessment (HNA) tool in the ASEAN region. This paper reports the development process of the HNA tool.

The project established the project working group (PWG) to developing some tools. PWG consisted of the expert team, project team, Japanese Advisory group and twenty delegates from ten ASEAN member states. PWG established the cycle of the developing process of the HNA tool.

We created a health needs assessment form and a summary form. The assessment form consists of (1) Informant information, (2) Site information, (3) Overall situation of the site, (4) Public health, (5) Health facility damage. The summary form consists of (1) Informant information, (2) Site information, (3) Critical areas for support, (4) Situation of the site.

Frequently, the public health emergency operation center in an affected country is not able to obtain the critical information of an affected area in the acute phase of disasters. This HNA tool would be used in the acute phase by the Emergency Medical Teams (EMTs) because the EMT has mobility and workforce for assisting the affected country. We have agreed on the usage of the assessment form as a kind of an “interview guide”. The purpose of this assessment form is to assess a disaster situation. The next step will be to provide more opportunities for the ASEAN member states to use and learn more about this HNA form.

The Humanitarian Emergency Settings Perceived Needs Scale (HESPER) evaluates experienced needs among disaster-affected populations and has been frequently used in both humanitarian emergencies and research. Today, the use of this tool is increasing among people affected by crises and emergencies. Web-based methods have shown to reduce several methodological and practical challenges in disaster health research.

This project aims to develop and evaluate HESPER SW (a self-administered, web-based version of the HESPER scale).

Alternative reliability and test-retest validity of HESPER SW were evaluated using different analytic statistical methods.

The first analysis suggests that HEPSER SW is a reliable and valid instrument which is easy to use and that it reduces several methodological and practical challenges in disaster health research.

HESPER SW can be used both for humanitarian and research purposes and offers a quick, self-administered, web-based, and scientifically robust way to investigate experienced needs in populations affected by disasters or humanitarian crises.

Despite a large number of nurses involved in disaster situations in different ways, there are few theories or models that define and describe the goal and content of disaster nursing.

This study aimed to present a model for disaster nursing, based on a literature review of the concept and content of disaster nursing.

A systematic literature review of 15 original qualitative or quantitative articles was conducted. A thematic synthesis was used to analyze the data.

The main theme of Disaster Nursing: Crossing Borders, included three dimensions (personal borders, professional borders and environmental borders) and four themes describing the process of disaster nursing (being hit by reality; adapting to the conditions; providing aid, relief, and caring; recovering, remembering, and growing). Based on these results the HOPE model was developed. ‘HOPE’ stands for ‘Holistic health assessment and promotion; Organization and management of immediate response; Professional adaptation; Endurance and recovery.

The HOPE model for disaster nursing describes the core element and essence of nursing in the disaster response phase and can serve as guidance both for nurses deployed in disasters and in disaster nursing training.

Healthcare facilities frequently use disaster codes as a way to communicate with employees that an emergency or incident is occurring. As increasing numbers of providers work at multiple facilities, and healthcare systems continue to build disaster response teams and protocols covering multiple facilities, standardization of disaster code terminology is critical. A lack of consistency in terminology can potentially have a devastating impact on the understanding and response of visiting or relief staff.

To evaluate the level of standardization in terminology of disaster codes in healthcare facilities.

A convenience sample was taken from a private Facebook™ group consisting of emergency department nurses from a wide range of facilities. The Facebook™ group was asked to share their hospital disaster codes. Of the 40,179 total members, 78 commented, including 55 photos of quick reference badges, and the rest were descriptions/lists of codes. One badge was excluded due to a blurry photograph. Results were collated and analyzed for trends and standardization.

The most common codes were, “Code Red” for fire (72.7%), “Code Blue” for cardiac arrest (44.9%), “Code Silver” for active shooter/weapons event (37.7%) and “Code Orange” for hazardous materials (33.8%). There were 168 instances of a code term being associated with a particular event by five or fewer facilities. Two facilities used numeric systems, with 11 using plain language descriptions.

Disaster code language is inconsistent. Few of the codes were consistently assigned to the same meaning, and none were universal. Color coding was the most common method, but there was little consistency even within color code systems. Additionally, some facilities used a combination of colors, numbers, terms, and plain language. Healthcare facilities should embrace standard terminology and create a consistent language for disaster codes to enhance response capabilities and medical security.

Antibiotic resistance is when bacteria change and adapt in response to antibiotics, becoming able to defeat these drugs when used to treat infections. A direct consequence of this adaptation is an increased difficulty in treating multiple diseases. Because of increased antibiotic resistance, the World Health Organization has declared it a significant threat to public health.

One frequent consequence of natural disasters is infections, as seen in the December 2004 Indian Ocean tsunami. Survivors sustained a variety of wound infections that ranged from common pathogens to rarely seen organisms including fungi.

This research analyzes the microbiology observed in wound infections associated with exposure to freshwater, seawater, soil, fecal, and other contamination after Hurricane Harvey in 2017 and Hurricane Florence in 2018.

Therapies for infections will also be discussed in addition to how the utilization of rapid detection technology for antimicrobial resistance and correct treatments require antimicrobial susceptibility knowledge to improve health outcomes, lower economic costs, prevent further spread of multi-drug resistant outbreaks and assist with antimicrobial stewardship.