At the time of a nuclear disaster, residents should evacuate from areas with high air dose rate. In the Great East Japan Earthquake, about 10% of patients died in a hospital evacuation in which medical teams were not involved in transportation.

To determine if hospital evacuation improved after the Fukushima nuclear accident.

This research investigates how the medical system of a nuclear disaster in Japan changed.

There are 41 hospitals designated as Nuclear Emergency Core Hospitals, and they have 53 Nuclear Emergency Medical Assistance Teams (NEMAT; disaster medical dispatching team specialized in nuclear disasters consisting of medical doctors, nurses, and radiological technologists) that can support hospitals and information in the acute phase.

At the time of a nuclear disaster, NEMAT is supposed to evacuate residents from the Urgent Protective Action Planning Zone (UPZ; within about 30 km radius). Tens of thousands to one million people live in this area. Hospital evacuation of more than several thousand patients is necessary. The entry of workers for transportation vehicles and lifeline restoration is limited within UPZ, so staying in a hospital is virtually impossible. There are over 2000 Disaster Medical Assistance Teams (DMAT), and many Red Cross Relief Teams; both of which are stipulated not to conduct clinical treatment in high dose areas and are not educated on nuclear disasters. Although there are Radiation Emergency Medical Assistance Teams (REMAT) consisting of doctors and technicians specializing in radiation medicine, they are few in number. They can perform dose assessment, but general medical care cannot be performed because an emergency physician is not included. Therefore, although NEMATs will conduct emergency and hospital evacuation in the affected area, the number of teams is too small to respond. The issue of which organization is responsible for massive hospital evacuation remains unsolved.

Sri Lanka Army is a valuable resource for the country as a capacity factor in disaster situations. Sri Lanka Army has established Search and Rescue teams (SAR teams) in all 25 districts.

To describe the knowledge, attitudes, and practices of SAR teams regarding search and rescue as a response to disasters.

A descriptive cross-sectional study was carried out from October to December 2017. Five platoons were selected randomly from high and medium risk district categories, and all five platoons were selected from the low-risk category. The total sample size was 465. A pre-tested self-administered questionnaire was employed.

The median age was 28 years. 3.2% were officers, 96.8% were soldiers, the majority (80.4%) were educated up to G.C.E. (O/L), and 62.4% were married. 52.9% of the population had undergone SAR training during the past three years in Sri Lanka, and none had undergone training outside of the country. Overall knowledge regarding search and rescue as a response to disasters seem to be good (57.2% received higher than a score of 75%). 93.8% has desirable positive attitudes. 73.5% had participated in search and rescue operation as a response to disasters. Overall practices seemed to be poor, (71.3% of the population received lower than a score of 75%). A statistically significant association was observed with a level of education (p = 0.001), designation (p = 0.004), and knowledge on search and rescue as a response to disasters. Level of education, designation, and SAR training had no significant association with attitudes on search and rescue as a response to disasters. A statistically significant association was observed with designation (p = 0.021) and practices.

Search and rescue drills should be carried out regularly. Knowledge of search and rescue as a response to disasters should be incorporated into training programs for officers and soldiers.

The time between injury and medical intervention is crucial in trauma care. Triage is essential to ensure prioritization and timely assessment of injured patients.

To investigate how the lack of triage system impacts timely intervention in a sub-Saharan hospital emergency department, and to investigate potential benefits of triage towards efficient management of trauma patients.

A prospective study including adult trauma patients admitted to the emergency department at Moi Teaching and Referral Hospital in Eldoret, Kenya, was conducted. Mode of arrival, vital parameters, time before physician’s assessment, and mortality were registered. Retrospectively, Injury Severity Score (ISS) was calculated, and patients were categorized according to the Rapid Emergency Triage and Treatment System (RETTS).

A total of 571 patients were analyzed, revealing a mean ISS of 12.2 (SD 7.7) and a mean length of stay of 11.6 (SD 18.3) days. 70% of the patients arrived by taxi, private car, or police car; only 17.6% were transported by ambulance. RETTS categorization was compared with ISS using a Kruskal-Wallis test with Dunn’s multiple comparisons post-test. A higher average ISS was found in the red category compared to other categories (H(df) = 24.47(4), p < 0.001). A Spearman correlation test between ISS and time to assessment revealed an r value of −0.041 (p = 0.43).

The results clearly illustrate a lack of correct prioritization of patients in relation to the need for timely assessment. Since there was no difference in time to assessment regardless of ISS, the need for a triage system is apparent. Currently, the implementation and evaluation of a validated triage tool at the emergency department are underway. Moreover, the finding that less than 18% of trauma patients are transported to the emergency department by ambulance illustrates the need to develop prehospital care systems.

Social isolation and death alone in the prefabricated temporary housing after a disaster has been a social concern. The importance of social ties among the community has been suggested and several reports pointed out the positive effect of “group allocation” which preserves pre-existing local social ties compared to the “lottery allocation”.

Japan Red Cross Society recommended “group allocation” as a better option than “lottery allocation” on their guidelines. However, many municipalities carried out “lottery allocation” for temporary housing arrangement after the Great East Japan Earthquake (GEJE).

To collect the information about the accelerating factors and bottlenecks when practicing the “group allocation”.

In-depth interview was conducted between August and November 2013. Interviewees were the professionals of disaster management, individuals who were involved in arranging the prefabricated housing and the residents. This research was supported by the Ministry of Education, Culture, Sports, Science, and Technology in Japan.

This study found the municipality which carried out “group allocation” had characteristics such as: (1.) the staff in charge of housing arrangement had the information about the positive effect of “group allocation”, and (2.) pre-existing community leaders were able to gather residents’ opinions, and citizens were involved in the decision making to some content.

Although this study is based on the experience of a limited number of key persons, it would be useful to give the insight about the possible bottleneck for the practitioners who will be in charge of housing arrangement under the disaster setting in future. Also, the relevancy and evidence about “group allocation” should be carefully examined in the context of preventing social isolation as well as various long-term effects. It would be essential that the knowledge and experience will be accumulated and shared between municipalities in a usable and comparable format.

There are some tools for teaching disaster countermeasure in Japan. Cross Road Game was developed to get a concrete image of a disaster situation and is based on interviews from Kobe city government officers in an area affected by the 1995 Great Hanshin-Awaji Earthquake. The alternative includes a lot of ‘dilemmas’ that sacrifice something based on whichever outcome is chosen. For example, “There are 2000 meals at the evacuation center with 3000 refugees. Do you distribute these foods or not?” This game was developed for five to seven players, however, it is not suitable for class lessons with a hundred students. Thus, we tried to employ the Clicker-Nano system for an interactive lesson.

To provide a brief introduction to this new style of teaching disaster countermeasure.

The study included involved a classroom discussion using Clickers-Nano system in addition to Cross Road Game.

Nursing students could learn the concrete details of disaster countermeasure in an enjoyable format. They could share thoughts and compare opinions while deciding how to resolve the dilemma at the time of disaster.

The most important issue faced was how to develop an educational effect for nursing students. Even if five or seven students (players) could enjoy the game, it would not lead to the accumulation of unified knowledge of disaster countermeasure compared to a lecture at the university. The use of the Clickers-Nano system avoided differences in the reach of learning due to differences of facilitators’ capabilities. This study suggests a new style that combines interactive discussion not only with small but also large numbers of students.

Understanding the difficulties of sharing knowledge generated from disaster situations is essential to allow for a better process of disseminating the “lessons learned” from the ongoing natural and man-made situations which result in healthcare crises.

To explore nurses ways of gaining knowledge from previous experiences, with a particular focus on earthquakes and natural disasters in the New Zealand (NZ) setting.

Initial analysis of a series of individual, semi-structured interviews with a small group (n=10) of emergency department registered nurses from a range of geographical areas in NZ.

While familiar with the major earthquake events that have recently affected different areas of NZ (most notably Canterbury, Kaikoura, and Wellington), few could recall detailed information or lessons generated from these events. When asked about the most effective means of learning about and from disasters, the direct experience was identified as the most effective, followed by narrative retelling and vicarious experience.

Recognition of the value of “story-telling” in sharing information, and of the importance of offering experiences in a way that allows colleagues to experience or place themselves in the situation in a “virtual” sense is necessary for learning to occur. This involves an emotional as well as an intellectual connection to occur. There is a risk for knowledge to be lost, and lessons to be constantly “re-learned,” as each succeeding generation needs direct involvement to retain the information and insight generated. We need to tailor the medium by which this information is shared, for maximum effect.

In 2017 the New Zealand Medical Assistance Team (NZMAT) were verified by the World Health Organization (WHO) as an Emergency Medical Team Type 1. During the verification process, the WHO highlighted the need for further NZMAT capability in the specialty areas of reproductive, sexual, and maternal health. The NZMAT consists of doctors and nurses from many different clinical subspecialties but with a predominance of emergency and rural medicine or general practice. Due to the subspecialist nature of hospital medicine in the New Zealand environment most GPs, emergency physicians, and nurses have very little exposure to normal labor and birth in their day-to-day work and limited exposure to obstetric complications.

To increase the knowledge and skill level of the NZMAT, a two day Basic Emergency Obstetric Care (BEOC) course was designed by Kass Jane, a midwifery educator, researcher, and member of NZMAT, in consultation with the NZMAT Clinical Director Emma Lawrey.

This presentation will outline the curriculum design, the course delivery, and the feedback from participants on this inaugural BEOC for the NZMAT, as well as the findings of a post-course review and plans for further BEOC courses for NZMAT members.

This presentation will address why courses of this type have value, especially where the delivery of basic obstetric care in a low technology or austere environment may translate into skills for other Australian clinicians wishing to work either in a humanitarian or developing world context.

The Great East Japan Earthquake (GEJE) and subsequent devastating tsunami struck the northeastern coast of Japan on March 11, 2011. According to the previous studies about displaced evacuees, increases in suicide rates and social isolation (especially among older adults) have been reported. However, the living condition of residents at prefabricated temporary housing after GEJE is unclear.

To explore potential factors which might relate to social isolation and suicidal thoughts among older adults by using a qualitative method.

Inclusion criteria for this study were older adults over 65 years living in prefabricated temporary housing since the GEJE. Data were collected by face-to-face-interviews with semi-structured questionnaire between October and December 2014. The protocol of this study was approved by the Ethics Board of the Tokyo Metropolitan Institute of Gerontology. This research was supported by the Ministry of Health, Labor, and Welfare of Japan (No.H25-iryou-shitei-003).

Twenty older adults participated in the study. Most of them had been engaged in agriculture or fishery and experienced the sudden loss of family members, friends, and property in the aftermath of the GEJE. Findings indicated that social connections formed through the collective construction of prefabricated temporary housing. The study found that individuals who had less emotional and financial support experienced a greater feeling of sadness, social isolation, and suicidal thoughts. The study also suggested that people who live in temporary housing are strongly affected by economic insecurity and that it aggravates the risks for social isolation and psychological distress.

Although there were limitations regarding standardization and compatibility, this research found that the qualitative method can obtain the data which the quantitative method cannot reach. Scale-up of universal guidelines including the knowledge from qualitative research and case report under the devastating disaster setting is anticipated for better evidence base for next coming disaster.

As the second largest metropolitan area in Canada, Montréal has its share of risks for disasters and major incidents. In such events, the interoperability of emergency services is critical to effective interventions. As the emergency medical service (EMS) for the cities of Montréal and Laval, the Urgences-santé Corporation (USC) has close ties with several emergency partners on the territory, including police and fire departments. These different organizations have joined forces to develop a tabletop exercise program (TEP) to train operational managers to initiate a better-coordinated response on joint interventions.

The TEP was designed to enhance interoperability in the field by improving communication and the understanding of the roles, responsibilities, methods of coordination and decision-making in each of the organizations involved. The aim is for all of USC’s operational managers to participate in at least one exercise of the TEP within the first year of the program.

Selection criteria were established to gather, for each exercise, managers that are likely to work with one another on a real intervention. The TEP was also designed in such a way that its implementation would require few resources and yield minimal impact on regular operations.

After four pilot exercises to fine-tune the approach, the program was launched on October 5, 2018. We have now run eight exercises, each involving one or more USC supervisor. The response has been very favorable from the participants as well as their directors.

In the short term, the TEP helps managers understand their counterparts’ key issues, and has already yielded improvements in our joint interventions. In the longer term, the program will help identify specific training needs to better equip responders.

Disaster Medicine training in most parts of the world is done in a practical manner to allow users to practice the skills of triage and resource allocation.

To develop a low-cost tabletop simulation and measure its effectiveness from the user perspective.

A modified Delphi approach was used in developing a low-cost tabletop simulation exercise. Simple playing cards were used as patients with specific vitals and injuries. Two Hundred trainees of the National Ambulance Service were used to test the exercise. All the participants had an equal chance to triage a patient and arrange transport to an appropriate facility.

All participants expressed their satisfaction in the design and implementation of the tabletop exercise. Over 90% showed interest in replicating the exercise in their respective setting due to the low-cost nature of the setup. During the exercise6. 0% of the patients were triaged correctly, while 80% were transported from the scene in an orderly manner. All the participants agreed on the useful and educational value of the exercise.

The use of a low-cost tabletop exercise in disaster medicine training is essential for low- and middle-income countries to promote education, and has been shown to be acceptable and feasible.

Sri Lanka has experienced a multitude of natural and man-made disasters during the last five decades. Man-made destructions were common during the 30-year-long conflict period. Though the local system in the country was able to manage the dead in such circumstances, the South-Asian tsunami in 2004 highlighted the limitations and deficiencies of the system that was in place to handle the management of the dead during major disasters. Though the first Disaster Management Act was introduced in 2005, it has no mentioning regarding management of dead in mass disasters. Inappropriate handling of the dead could hinder the establishment of the identity of the dead, loss of valuable forensic evidence, and dignified burial. Hence, the families could experience difficulties in calming insurances and inheritance, resulting in economic hardships. In this backdrop, the forensic community strongly felt the necessity of stipulating best practices in managing dead.

To critically assess the measures taken to improve the standards of managing dead in mass disasters in Sri Lanka over the past 15 years.

The process of drafting guidelines for management of dead was initiated with a series of consultative meetings with the Disaster Preparedness and Response Unit of the Ministry of Health, the Disaster Management Centre (DMC) and the Institute of Forensic Medicine and Toxicology (IFMT) in collaboration with the College of Forensic Pathologists of Sri Lanka. A working group representing forensic and legal experts, military, police, fire brigade department, and disaster management were involved in drafting these guidelines. Further guidelines for the effective conduct of mass burials following mass disasters were also prepared and published in 2007.

Despite all these efforts the efficacy of managing dead in recent mass disasters is still far from satisfactory.

Music and sporting events are mass gatherings with unique risks related to participation. “All-ages” events, which include participants below the age of majority (18 in many jurisdictions), have been observed to have an over-representation of patient presentations in the youth category. Peer helpers may lower the barrier to seeking on-site care. Youth (peer-aged) volunteerism provides opportunities for exposure to new environments, skills, and mentorship. Medical volunteerism may promote personal satisfaction through prosocial behavior (i.e., helping others), community engagement and immersion into a potential health professions career path.

We conducted an observational pilot feasibility study with feedback forms and semi-structured interviews. The pilot program paired youth with parents/guardians/responsible adults as health care volunteers at special events.

Youth/adult dyads volunteered for a variety of events in Canada during the 2018 event season. All participants in the “Juniors Program” completed at least a Standard First Aid course, including orientation to personal safety and confidentiality. Each pair worked in one of two areas: first aid or Festival Health (the harm reduction space at music events) providing peer-to-peer and “all-ages” support. Post-event feedback from the dyads revealed many positive experiences and universally called for more opportunities.

A strong volunteer base is an asset to any community. In this pilot study, the volunteer experiences were supervised by a team of credentialed health care professionals. The authors report on qualitative feedback in themes based on patient perspective, volunteer perspective, team perspective, and event management perspective. More research is needed to measure the outcomes of the Junior’s Program. More Investigation is needed to determine not only the long-term benefits of participation on event medical teams, but also to identify factors that shape a positive experience for youth, their parents, and the event participants that they support.

Nurses have long been utilized in disaster response and recovery and they possess broad skill sets, which are critical in times of crisis. However, studies show that more than 80% of nurses who volunteered in disasters settings have no disaster education.

This project explored the disaster knowledge, preparedness, and resilience of 2nd and 3rd-year undergraduate student nurses in a Bachelor of Nursing Science program in a regional university to garner support for the introduction of dedicated disaster nursing education, which is currently absent from Australian undergraduate nursing curricula. Whilst disaster management processes in Australia are robust and Australian health care systems have explicit plans in place, the same cannot be said for all countries and health care systems. Australian trained nurses are highly valued and actively sought in the global health workforce market. In a world marked by increasing change and instability, the lack of dedicated disaster education and skills in the largest health workforce increases the overall vulnerability.

Data were collected using the Disaster Preparedness Evaluation Tool, the Connor-Davidson Resilience Scale, simple demographics, and a previous disaster experience questionnaire.

The results highlight important gaps in current practice and vulnerabilities in the current disaster management framework. Local students scored higher results in preparedness and resilience.

Student nurses are an underutilized resource in disaster preparation and by response teams around the world. With a global intent of shared responsibility and increased resilience in individuals and communities before, during, and after disaster events, dedicated capacity building of nursing staff has the potential to address key factors and simultaneously utilize an underappreciated demographic of student nurses. To the best of the author’s knowledge, this project is the first to explore disaster knowledge, preparedness, and resilience in undergraduate student nurses using validated disaster preparedness and resilience tools in Australia.

The science supporting event medicine is growing rapidly. In order to improve the ability of researchers to access event data and improve the quality of publishing mass gathering cases, it would be of benefit to standardize event reports to permit the comparison of similar events across local and national boundaries. These data would support the development of practice standards across settings.

The authors propose the creation of a publication guideline to support authors seeking to publish in this field.

Method: Derivation study via analysis of published case reports using the Delphi process.

Data elements were inconsistently reported within published case reports. Categories of variables included: event demographics (descriptors of date, time, genre, activity, risks), attendance and population demographics, data related to climate and weather conditions, composition and deployment of an onsite medical team, highest level of care available onsite, patient demographics, patient presentations and measures of impact on the local health care system such as transfer to hospital rates. Of note, there was a high incidence of “missing” variables that would be of central interest to researchers.

Approaches to standardizing the collection and reporting of data are often discussed in the health care literature. The benefits of consistent, structured data collection are well understood. In the context of mass gathering event case reporting, the time is ripe for the introduction of a guideline (with accompanying guidance notes and dictionary). The proposed guideline requires the input of subject matter experts (in progress) to enhances its relevance and uptake. This work is timely as there is ongoing work on improving an international event medicine registry. If the evolution of both proceeds in lockstep, there is a good chance that access to a rigorous data set will become a reality.

We have repeatedly trained to use the SDF ship as a temporary medical facility during acute disasters. The Maritime Self Defense Force has various types of ships: supply ship (Oumei type), transport ship (Osumi type), and escort ship (hinge type, whip type) which has a large hangar and a treatable medical compartment.

The points of training are collaboration between the SDF and the commander’s line of medical personnel, construction of a method of contact with the outside, construction of contact method inside the ship, kind of patient, medical contents, use of medical zone, method of transporting to the ship, method of transporting to the outside of the ship, positioning of the ship in the afflicted area, etc.

Assuming the Nankai Trough Earthquake, the activities of SDF vessels in coastal areas are affected by the extent to which the functions of medical institutions in inland areas are kept, how transportation methods can be secured, and how many injured people there are.

As a result of the examination thus far, the range of activities of SDF vessels is limited. The function of the ship is considered to be offshore SCU, hospital evacuation support, etc. Tight collaboration and training with the SDF are necessary in the future.

The large number of casualties during major or mega-disasters are a global problem.

The role of medicine against mega-disasters is analyzed from a worldwide perspective.

Chernobyl incident, the Tokyo Subway Sarin Attack, the 9-11 attack, the Indian Ocean earthquake/tsunami, Hurricane Katrina, the Flu pandemic, the Higashi Nihon Earthquake followed by the Fukushima nuclear plant incident, etc. are critically analyzed, based on the actual medical experiences.

These mega-disasters often have a wide, severe negative influence. Linked catastrophes often form catastrophic circulus vitiosus (CCV) or malignant cycles on a global scale. The typical example is the Chernobyl incident which caused not only many deaths by radiation exposure/thyroid cancer and world anxiety, but also is considered to have contributed to the end of the Eastern European Communism system in 1989 (East Germany) and 1991 (ESSR).

Many roles of medical doctors and staff were requested, including creating preventive life-saving systems, in addition to the prevention of mega-disaster measurement to minimize the unhappiness. Moreover, medical ethics and philosophy are important, which were often overlooked. It is necessary for medical care and support to have a broad perspective. Although the classical philosophy of utilitarianism is often accepted without suspicion, it comes with the risk of disregarding vulnerable/weak people. The concept of justice according to John Rawls (USA) and the Minimal Unhappiness Theory by Naoto Kan (Japanese politician) should be considered, too. From such viewpoints, it is our conclusion to urge the establishment of systematic disaster medicine or to compile a disaster medicine compendium. Although the tentative first version was compiled with 22 volumes in 2005, only one-fourth was available in English. The English part increased up to nearly three-fourths by adding several new versions in which the nuclear/biological/chemical hazard version, tsunami measurement, and psychological care version are included at the moment.

Housing has always been a source of stress for people in Hong Kong (HK), especially to those living in sub-optimal settings. About 210,000 people are forced to live in subdivided flats in HK. Most of these flats cannot meet health standards set by the UN even for prisoners, in terms of the floor space, climatic conditions, lighting, air quality, and ventilation. Fire and public safety equipment are lacking. Most believed that the substandard environment has a negative impact on one’s mental health.

To investigate how the living condition in a subdivided flat affects a person’s mental health.

104 households living in the subdivided flats in Kwai Tsing, one of the 18 Districts of HK, were surveyed by HKJCDPRI’s Collaborating Partner, HKSKH Lady MacLehose Centre in February 2017; while a follow-up study with purposive sampling was conducted in October 2017 to interview 10 households on their mental health status. A mixed Methods was used combining the quantitative Results of the WHO Quality of Life-BREF scale and Depression Anxiety Stress Scale 21, and qualitative Results of face-to-face interviews.

80% of 104 households surveyed suffered from mental distress. The follow-up study revealed that seven of them displayed signs of depression and/or anxiety, while two were diagnosed with a mental disorder. Distress is proven to associate with the environmental and health risks, including fire and disease outbreak, as well as chronic issues resulting from poor indoor air quality and extreme weather.

Low level of perception and preparedness among HK people is making these public health risks more apparent. The already desperate housing and land policy don’t seem to offer any help in the near future. Public educations efforts need tremendous enhancement, to engage, mobilize and empower individuals and communities, to actively plan and prepare for future shocks.

The Misericord, or stabbing pike, was a frequently used battlefield implement in medieval times. The misericord was used by battlefield clerics to relieve the suffering of irreparably wounded soldiers. Its cultural parallels include the Roman gladius, the Japanese wakazashi, and the eponymous Liston knife used in pre-Victorian era surgery in England.

This demonstration will analyze modern misericord injuries in the light of the current epidemic of long knife (or zombie knife) attacks in London and the domestic terrorist threat in Australia.

A review of this weapon is pertinent to the projected low-technology, low-impact, and deep-penetrating wounds expected in urban terrorism in Australia and other cities globally. The talk will emphasize field discussion, demonstration, and disarming techniques against modern misericord-type weapons.

Two major public health issues facing Nigeria in 2017 and 2018 were the terrorist activity by the Boko Haram Islamist group and an unprecedented outbreak of Lassa fever.

To determine if Boko Haram activity was temporally or spatially related to the incidence of Lassa fever in Nigeria and if so, to identify potential concurrent causes and mitigation measures.

The study was a mixed-methods design. First, we conducted a secondary analysis of the Armed Conflict Location and Event Data (ACLED) Project for all known Boko Haram activity and of the weekly Nigeria Centre for Disease Control reports for suspected Lassa fever cases. Data were analyzed for January 2017 through June 2018. The ACLED data were spatially overlaid with suspected Lassa cases for each of Nigeria’s 36 states. Secondly, we conducted interviews with six aid workers in Nigeria regarding Boko Haram activities and Lassa fever cases.

In the study period, 596 Boko Haram activities occurred in 13 states (36.1%): 416 in 2017 and 180 between January and June of 2018. During the same period, 3,137 suspected Lassa cases were reported from 21 states (58.3%): 1,022 in 2017 and 2,115 in January through June 2018. Only one state, Sokoto, was unaffected by either issue. Aid workers reported a positive relationship between Boko Haram activity and increased negative health outcomes.

The investigation found little geographic overlap in Nigeria between Boko Haram activity and the 2018 Lassa fever outbreak, suggesting independence of these two issues. However, unmeasured factors, such as public fear and mistrust of governmental activities, may affect both issues. It is also critical to note that widespread co-occurrence (97.2% of 36 states) of these two issues presents significant public health, medical, and security challenges for Nigeria, calling for overarching solutions such as governmental stability and economic stimulus.

Fatalities at music festivals are seldom reported in the academic literature, making it difficult to understand the full scope of the issue. This gap in our knowledge makes it challenging to develop strategies that might reduce the mortality burden. It is hypothesized that the number of fatalities is rising. Building on earlier research, two further years of data on mortality at music festivals was analyzed.

Synthesis of grey/academic literature.

The grey literature for 2016-2017 documented a total of 201 deaths, including both traumatic (105; 52%) and non-traumatic (96; 48%) causes. Deaths resulted from acts of terror (n = 60), trampling (n = 13), motor-vehicle-related (n = 10), thermal injury (n = 6), shootings (n = 5), falls (n = 4), structural collapses (n = 3), miscellaneous trauma (n = 2), and assaults (n = 2). Non-traumatic deaths included overdoses/poisonings (n = 41), miscellaneous causes (n = 36), unknown/not reported (n = 18), and natural causes (n = 1). The majority of non-trauma-related deaths were related to overdose (44%). No academic literature documented fatalities that occurred while attending a music festival during 2016 or 2017.

Reports of fatalities at music festivals are increasingly common. However, the data for this manuscript were drawn primarily from media reports, a data source that is problematic. Currently no rigorous reporting system for fatalities exists. In the context of safety planning for mass gatherings, a standardized method of reporting fatalities would inform future planning and safety measures for festival attendees. The hypothesis that mortality rate reporting increased was substantiated. However, the proliferation of music festivals, the increase in attendance at these events, and the overall increase in internet usage may have influenced this outcome.