Search Results (122)

Background/Objectives: Mass suicide events represent complex socio-cultural phenomena requiring multidisciplinary investigation. The 1978 Jonestown event (>900 deaths) remains the most extensively documented modern case. Methods: We conducted a systematic literature review adhering to PRISMA guidelines, searching PubMed, Web of Science, and Scopus databases for peer-reviewed articles published between 1978 and 2026 using the query: ((mass) AND (suicide)) OR (suicide) AND (jonestown). Following screening, 10 papers were selected for inclusion. We integrated these findings with forensic autopsy reports (n = 7), toxicological analyses, discourse analysis of the 45 min audio recording preceding the mass deaths, field investigation data, scholarly monographs, reputable popular science publications, and archival materials from contemporary sources to examine the forensic and criminological aspects of the event. Results: Toxicological analysis detected cyanide in 2/7 autopsied bodies; multiple sedatives (promethazine, chlorpromazine, diphenhydramine, pentobarbital) in gastric tissue indicated recent ingestion. Two gunshot fatalities presented additional complexity. Manner of death was classified as undetermined due to ambiguous circumstances regarding volition versus coercion. Discourse analysis revealed the community’s response was actively debated and constructed through persuasive communication: Reverend Jones strategically framing the situation as hopeless while preserving the appearance of individual agency. Psychosocial analysis identified characteristic patterns: charismatic authoritarian leadership, progressive isolation, apocalyptic ideology, and deindividualization processes. Conclusions: The Jonestown event exemplifies the intersection of forensic pathology challenges in mass casualty investigations and complex group dynamics culminating in collective death. Analysis demonstrates group members actively participated in leadership–followership dynamics, constructing narrative fit between identity and action through discourse. Findings emphasize the importance of immediate toxicological sampling, preservation of forensic evidence, recognition of warning signs in high-control groups, and understanding how narratives of hopelessness and foreclosure of options can be exploited for extremist mobilization. Full article

Effective management of hazardous materials (hazmat) and chemical, biological, radiological, and nuclear (CBRN) incidents depends not only on technical capabilities but also on human behaviour. A critical challenge in mass decontamination operations is the potential for casualties to leave the scene before receiving treatment, increasing personal risk and the likelihood of secondary contamination. Despite its operational significance, little is known about the behavioural variables that influence whether casualties remain on scene. This paper presents a structured scenario development methodology, grounded in expert elicitation, to identify the key factors affecting casualty compliance during mass decontamination. A modified Delphi-inspired approach was used to design realistic scenarios that will inform future behavioural studies. The findings contribute to a more robust evidence base for emergency planning by integrating psychosocial variables into operational assumptions for hazmat/CBRN response. Full article

Widespread uses of nuclear materials increase the risk of accidental or intentional radiation exposure, which can result in acute radiation syndrome (ARS). Hematopoietic ARS (H-ARS) occurs at relatively low doses and is potentially lethal without intervention. While several FDA-approved cytokine-based radiomitigators exist, many require repeated dosing, complicating deployment in mass-casualty scenarios. This study evaluated a novel long-acting, murine-reactive granulocyte–macrophage colony-stimulating factor (LA-GM-CSF; mPDM608) as a prophylactic and mitigative countermeasure for H-ARS. Male and female C57BL/6 mice were exposed to lethal or sublethal total body irradiation (TBI) and treated with LA-GM-CSF using single- or multi-dose regimens administered before or after TBI. Safety, 30-day survival, hematologic recovery, bone marrow cellularity, serum GM-CSF pharmacokinetics, endothelial injury markers, and cytokine profiles were assessed using standard hematology, histopathology, ELISA, and multiplex assays. LA-GM-CSF was well tolerated at doses up to 30 mg/kg. Single or limited dosing conferred significant survival benefits compared with vehicle controls, with optimal efficacy observed at lower doses (3 mg/kg). Post-TBI administration as a single dose 24 h after exposure markedly improved survival in both sexes, with stronger hematopoietic recovery in males. LA-GM-CSF accelerated recovery of neutrophils, red blood cells, platelets, hematocrit, and sternal megakaryocytes, prolonged circulating GM-CSF levels, and favorably modulated endothelial injury markers and select cytokines. LA-GM-CSF demonstrates strong potential as a next-generation radiation countermeasure, providing robust survival benefit and hematopoietic recovery with minimal dosing. The results shown here support further development for H-ARS management under the FDA Animal Rule. Full article

This systematic review examines the effect of pre-incident information on public preparedness prior to an emergency or disaster. Preparing members of the public for adverse events can improve self-sufficiency and improve health outcomes, particularly during periods when emergency responders are not immediately available. Twenty-three studies were identified, addressing both natural and human-influenced events. All the studies investigated pre-incident training targeting members of the public rather than specialist responders. The synthesis considered training content, delivery approaches and evaluation methods. The studies included preparation, personal safety, triage, first aid and evacuation in scenarios involving terrorism, fire, earthquake, flood and CBRN events. Pre-incident education generally improves knowledge and intention to act, with higher-intensity and interactive training yielding greater engagement and response. Due to the difficulty of simulating emergencies and disasters, several studies used self-reporting and hypothetical testing, while others attempted to create real-life scenarios. The immediate effects of pre-incident education were generally positive, although many studies tested outcomes theoretically or within a classroom environment. It was also noted that few studies considered retention over the medium to long term; this is a concern as temporal decay may reduce preparedness. This review provides a basis for continued development of public-facing pre-incident education to increase resilience to both terrorist attacks and natural disasters. Full article

Background: Evaporative water loss from burn wounds is a major but often neglected component of early fluid requirements. Despite its physiological importance, no dedicated review has quantified acute post-burn evaporative water loss (TEWL) and its interaction with modern resuscitation strategies in over 40 years. Recent mass-casualty burn events in specialized centers have re-emphasized the clinical importance of accurate early fluid balance, which is particularly challenging. Methods: A scoping review (PRISMA-ScR) of historical quantitative studies and 23 contemporary (2015–2025) adult major-burn resuscitation cohorts was conducted. Expected TEWL was derived from Lamke benchmarks; interstitial edema was estimated from the only available regression of simultaneous fluid input and 24 h weight change. A novel TEWL/edema ratio was tested against resuscitation volume (mL/kg/%TBSA) and the established input/output (I/O) ratio. Results: In the acute phase, the median TEWL normalized to total body surface area was 71 mL/m²/h [52–79 mL/m²/h], allowing for calculation of the TEWL/edema ratio. The TEWL/edema ratio was inversely correlated with the resuscitation fluid dose (R² = 0.811) and the I/O ratio as well (R² = 0.86), crossing unity at 2.85 mL/kg/%TBSA. A ratio > 1 signals high evaporative drive and/or possible under-resuscitation; a ratio < 1 alerts to fluid creep before significant weight gain. Conclusions: The TEWL/edema ratio is the first physiology-grounded, easily calculable resuscitation endpoint that complements urine output by providing insight into whether administered fluid is lost as obligatory evaporation or sequestered as edema. Routine estimation of expected TEWL and early monitoring of the TEWL/edema ratio may help guide goal-directed burn resuscitation, especially when early excision is delayed or impossible. Given the substantial inter-individual variability, the ratio derived from aggregate data should not be interpreted as a patient-specific predictor. Full article

Hemorrhagic shock remains one of the leading causes of preventable death for both civilian and military trauma. Fluid resuscitation is the primary treatment but requires constant monitoring, particularly for volume non-responsive patients susceptible to fluid overload, pulmonary edema, and other life-threatening conditions. To overcome fluid non-responsiveness, vasoactive drugs or vasopressors can be necessary adjuvants to fluid therapy but require tedious titrations that can be difficult to manage during mass-casualty situations. This study developed and evaluated automated closed-loop vasopressor controllers for hemorrhage scenarios. Ten physiological closed-loop controller (PCLC) configurations with different underlying functionalities were tuned to be either more aggressive or conservative to reach the target mean arterial pressure. A hardware-in-loop test platform with fluid-pressure responsiveness, derived from animal data, tested each controller across three different starting pressure scenarios. The platform successfully differentiated controller designs based on performance metrics. While some configurations overshot the target and others could not reach the target pressure, strong-performing PCLCs consistently reached and maintained the target quickly. Three candidate PCLCs outperformed the rest and will be evaluated across wider scenarios to develop a robust controller design. This work accelerates PCLC-driven vasopressor administration development, providing a necessary fluid resuscitation adjuvant for precise hemodynamic management in hemorrhagic trauma. Full article

Forensic age estimation is a fundamental component of biological profiling for unidentified skeletal remains, particularly in mass casualty incidents where specimens are frequently fragmented or incomplete. This review evaluates the diagnostic utility of craniofacial suture closure—specifically across four facial regions—as a non-invasive methodology for age determination in adults. By analyzing the predictable fusion patterns of ectocranial and endocranial sutures, forensic practitioners can derive approximate age ranges when postcranial indicators are absent or unreliable. Despite its utility, the reliability of suture-based estimation remains a subject of academic debate. The rate of closure is influenced by a complex interplay of environmental and biological factors, including nutritional status, hormonal influences, and mechanical loading. Historically, the method has faced criticism due to significant inter-individual variability and limited sample sizes in cadaveric studies. To improve precision and novel detail, this review explores the integration of emerging technologies such as artificial intelligence (AI) and machine learning (ML). These tools can process extensive cranial datasets to identify subtle morphological patterns that may elude human observation. While craniofacial suture analysis remains an essential resource in the forensic toolkit, its accuracy is contingent upon accounting for multi-factorial biological factors. The authors emphasize the necessity for further external validation across diverse global populations to ensure the generalizability and refinement of the technique in forensic medicine and osteology. Full article

Organophosphate (OP) exposure can trigger seizures within minutes and can rapidly evolve into status epilepticus (SE). Early seizure generation is plausibly driven by acetylcholinesterase inhibition, leading to central cholinergic overstimulation. With increasing seizure duration, experimental data are consistent with a time-dependent shift toward glutamatergic maintenance (NMDA/AMPA), oxidative stress, neuroinflammation, and progressive failure of GABAergic inhibition. This framework predicts a narrow window in which benzodiazepine (BDZ) monotherapy is most effective and a rising probability of BDZ non-response when seizures are prolonged, while anti-glutamatergic strategies may retain relative efficacy later in the course. This narrative review integrates clinical phenomenology, diagnostic limitations, and mechanistic evidence to propose an operational approach for OP-related seizures and SE in emergency settings. We discuss a pragmatic “Stage 1 Plus” framing for patients presenting after prolonged seizures or in non-convulsive SE with coma. Human evidence remains limited and heterogeneous, and inference is constrained by confounding due to delayed recognition, variable decontamination/resuscitation pathways, sparse EEG confirmation, and selection bias in mass-casualty reporting. Full article

During a tunnel fire, the foremost priority is the safe evacuation of passengers. Extreme temperatures and toxic combustion products can quickly lead to mass casualties, so evacuation support systems require fast forecasts of how hazardous conditions will evolve in space and time. This study investigates whether sparse sensor measurements can be used to reconstruct future tunnel-wide fire conditions on two-dimensional sections that are directly relevant to structural assessment and human exposure. To this end, we develop 2D ST-FAM, a data-driven forecasting model that maps time-resolved measurements from 75 tunnel sensors to future temperature, soot, and carbon monoxide (CO) fields derived from 108 computational fluid dynamics (CFD) fire simulations. The study is organized around three questions: whether the model can accurately reconstruct future tunnel fields from sparse measurements, whether this performance is maintained on both the vertical center plane and the horizontal breathing plane, and which physical quantities remain most challenging to predict. Results show high structural agreement with the CFD reference fields over the full 1800 s prediction horizon, with average structural similarity index (SSIM) values of 0.964 for temperature, 0.984 for CO, and 0.937 for soot. These findings indicate that sparse-sensor forecasting is feasible for tunnel-scale temperature and toxic-gas field prediction, while soot prediction remains comparatively more difficult because of its sharper spatial structures. Full article

Emergency Departments (EDs) are the primary hospital interface during disasters and mass-casualty incidents, yet surge capacity assessments predominantly emphasize workforce and logistics while overlooking measurable spatial determinants. Observations from five tertiary hospitals in India indicate that circulation bottlenecks, incompatible functional adjacencies, and contamination risks can compromise safety and operational performance. This study develops and validates the Spatial Surge Capacity Assessment Framework (SSCAF) to operationalize spatial resilience as a quantifiable dimension of healthcare infrastructure preparedness. A sequential mixed-methods design was applied across five tertiary hospitals using structured spatial walkthroughs; architectural and disaster-planning document review; and focus group discussions involving 81 clinicians, administrators, and facility planners. The outcome of this thematic analysis produced 42 spatial indicators, refined through three Delphi rounds with a multidisciplinary expert panel. Consensus retained 30 key performance indicators (median ≥ 4/5; IQR ≤ 1; Kendall’s W = 0.855; χ² = 297.42; p < 0.001). Content validity was strong (I-CVI 0.75–1.00; S-CVI/Ave = 0.93), and reliability was high (ICC 0.82–0.91), structured into eight operational domains. The resulting weighted scoring matrix standardizes the measurement of spatial surge preparedness. The SSCAF provides an evidence-based audit and planning tool supporting resilient hospital infrastructure. It aligns with the Sendai Framework, enabling governance audits, guiding ED retrofitting, and supporting performance-based evaluation for planners and architects. Full article

No US Food and Drug Administration (FDA)-approved prophylaxis is currently available for Acute Radiation Syndrome (ARS), which remains a significant threat to military and civilian populations. In this study, we investigated Vasculotide (VT), a Tie2 receptor agonist mimic, as a novel pre-exposure prophylaxis designed to stabilize the vascular endothelium, one of primary targets of radiation-induced damage. To evaluate its efficacy, female B6D2F1/J mice were exposed to 9.5 Gy total body irradiation (TBI), with VT administered subcutaneously at 12 and 2 h prior to exposure. Assessments included 30-day survival, biomarkers of vascular injury, proinflammatory cytokine/chemokine profiling, and evaluation of hematopoietic (H) and gastrointestinal (GI) recovery. Our findings demonstrate that VT significantly increased 30-day survival in a dose-dependent manner, achieving a 30% survival advantage at the 20 μg/kg dose. Furthermore, VT provided robust protection against radiation-induced vascular activation and injury, effectively alleviating damage to the bone marrow (BM) and GI tract. Taken together, these results identify VT as a promising prophylactic countermeasure for ARS. By targeting the Tie2 pathway to preserve vascular integrity, VT addresses a critical gap in medical countermeasures, offering a viable strategy to enhance survival and accelerate multi-organ recovery in radiological mass-casualty scenarios. Full article

Background: Early diagnosis and identification of causative pathogens using blood culture in patients suspected of blood stream infection (BSI) and sepsis are critical for improving patient outcomes through earlier and more targeted treatment. There is a need for tools that can guide the use of microbiologic diagnostics, especially where resources are limited, such as in lower- and middle-income countries (LMICs), pandemic and mass-casualty scenarios, and prolonged field care settings during military operations. Methods: Post hoc retrospective analysis of individual patient data from three prospective clinical studies, conducted in North America, Europe and Africa, to investigate the association between SeptiCyte RAPID test results (SeptiScores) and blood culture (BC) results. Hypothesis: that a significant correlation exists between elevated SeptiScores and positive blood culture results, and between low SeptiScores and negative blood culture results. Results: The area under the receiver operating characteristic curve (ROC AUC) was 0.91 for 85 BC(+) versus 257 SIRS and was 0.80 for 164 BC(−) versus 257 SIRS. As the SeptiScore increases, the relative probability of a septic patient being BC(+) as opposed to BC(−) also increases. A non-linear positive correlation is observed. Below a crossover point at SeptiScore 10, the ratio of probabilities of BC(+) sepsis/BC(−) sepsis is <1, while above the crossover point, this ratio is >1. Thus, septic patients with SeptiScores >10 have a higher probability of being BC(+) compared to BC(−). Conclusions: Elevated SeptiScores, obtained before blood culture results, are indicative of increased blood culture positivity. This may have clinical utility, particularly in resource-limited settings, as an aid for improving the efficiency of blood culture practice, for instance, by informing patient selection and interpretation of blood culture results. Full article

Fireworks are an important element of celebrations globally, and while there are multiple reports of their negative impact on both domestic and wild animals, there is limited data directly linking them to casualties. In this article, we present a case of mass bird deaths (over 1000) in a forest near a town following New Year’s Eve fireworks. The necropsies showed multiple fractures, organ lacerations, and internal hemorrhages. Rapid tests for avian influenza were negative, and there were no suspicious substances in the gastrointestinal tracts or on the X-ray images. This suggests the most likely reason for the deaths was severe traumatic collision injury induced by unexpected nocturnal disturbance from the fireworks nearby. Full article

Extended Reality (XR) technologies have matured into powerful tools for training in high-stakes domains, from emergency response to search and rescue. Yet current systems often struggle to balance real-time AI-driven personalisation with the need for human oversight and calibrated trust. This article synthesizes the programmatic contributions of a multi-study doctoral project to advance a design-and-evaluation framework for trustworthy adaptive XR training. Across six studies, we explored (i) recommender-driven scenario adaptation based on multimodal performance and physiological signals, (ii) persuasive dashboards for trainers, (iii) architectures for AI-supported XR training in medical mass-casualty contexts, (iv) theoretical and practical integration of Human-in-the-Loop (HITL) supervision, (v) user trust and over-reliance in the face of misleading AI suggestions, and (vi) the role of interaction modality in shaping workload, explainability, and trust in human–robot collaboration. Together, these investigations show how adaptive policies, transparent explanation, and adjustable autonomy can be orchestrated into a single adaptation loop that maintains trainee engagement, improves learning outcomes, and preserves trainer agency. We conclude with design guidelines and a research agenda for extending trustworthy XR training into safety-critical environments. Full article

In mass-casualty incidents, emergency responders require access to accurate and timely information to support informed decision-making and ensure the efficient allocation of resources. This article presents a dataset derived from a case study conducted in Mexico City (CDMX) based on the earthquake of 19 September 2017. The dataset presents hypothetical scenarios involving multiple demand points and large numbers of victims, making it suitable for analysis using optimization techniques. It integrates voluntary collaborative geographic information, open government data sources, and historical records, and details the data collection, cleaning, and preprocessing stages. The accompanying Python 3 source code enables users to update the original data for consistent analysis and processing. Researchers can adapt this dataset to other cities with similar risk characteristics, such as Santiago (Chile), Los Angeles (USA), or Tokyo (Japan), and extend it to other types of catastrophic events, including floods, landslides, or epidemics, to support emergency response and resource allocation planning. Full article