Risk factors for long-term post-traumatic stress disorder among medical rescue workers appointed to the 2008 Wenchuan earthquake response in China

Psychological status of medical staff dedicated to nucleic acid collection in COVID-19 epidemic during closed-loop management: A cross-sectional study

Background

To investigate the depression, anxiety and somnipathy situation occurred in the nucleic acid collection staff during the closed-loop management period of COVID-19. And try to understand the influencing factors of related psychological status.

Methods

A cross-sectional study of 1,014 nucleic acid collection staff from seven Chinese hospitals was conducted. Various investigation methods were involved in the questionnaires to collect data, including 12-items self-made questionnaire survey of basic demographic information, 9-items patient health questionnaire depression scale (PHQ-9), 7-items generalized anxiety disorder scale (GAD-7) and Pittsburgh sleep quality index (PSQI). Data analysis was performed using SPSS version 26.0 and Excel software. Mann-Whitney U-test, Chi-square test, correlation analysis, mono-factor analysis and binary logistic regression were applied accordingly for further analysis.

Results

The positive rate of depression, anxiety and sleep disorder of 1,014 nucleic acid collectors under closed-loop management were 33.5, 27.2, and 50.1%, respectively. Depression was significantly positively correlated with anxiety and sleep (P < 0.05). The scores of depression scale were positively correlated with the age and the fear for infection (r = 0.106, 0.218, both P < 0.05); The scores of anxiety scale were also positively correlated with the age and the fear for infection (r = 0.124, 0.225, both P < 0.05); The length of service, collection time and the degree of worry about infection and was positively correlated with the score of sleep scale (r = 0.077, 0.074, 0.195, both P < 0.05); Education level had a significant negative association with PHQ-9, GAD-7 and PSQI (r = −0.167,−0.172, both P < 0.05). Binary logistic regression analysis showed that age, technical title, education level, collection time, collection frequency, collection location, fear for infection and external environment were important influencing factors of depression, anxiety and sleep disorders.

Conclusion

The results of this study suggested that when carrying out nucleic acid collection mission, managers should intervene to optimize the collection location, control the duration of each collection mission, replace the collection staff in time and pay close attention to the psychological state of the collection staff.

Post-traumatic stress disorder in medical workers involved in earthquake response: A systematic review and meta-analysis

Introduction

Medical workers involved in responding to the earthquake are exposed to frightening scenes and witness dead bodies and severely injured moaning people, predisposing them to multiple mental health consequences. This study was aimed to determine the prevalence of Post-Traumatic Stress Disorder (PTSD) after earthquakes among medical workers using a systematic review and meta-analysis.

Materials and methods

The review study was performed following PRISMA guidelines, and the study's protocol was registered in PROSPERO with the code CRD42022333069. The data resources of Google Scholar, Science Direct, Web of Science, PubMed, and Scopus were searched to specify the related studies. To perform meta-analysis, the random effects model was utilized, and the I² index was considered to assess heterogeneity between studies. The STATA software was used for data analysis.

Results

In the initial data resources search, 1399 articles were identified. From these articles, 13 were finally chosen for meta-analysis and quality assessment. The meta-analysis results indicated that the prevalence of post-earthquake PTSD among medical workers involved in the earthquake response was 16.37% (95% CI: 11.63-21.11, I² = 97.33%, p = 0 < 0.001).

Conclusion

The medical workers involved in response to the earthquake have a relatively high risk of PTSD in the short and long term. Therefore, medical workers involved in response to disasters should undergo screening for mental health disorders before and after disasters and receive the necessary training with regard to stress management, psychological resilience, and how to express their feelings and emotions.

The effect of hindrance stressors on the emotional exhaustion among front-line healthcare workers in the recuperation period during the COVID-19 epidemic in China: a prospective cross-sectional study

OBJECTIVES

This study aimed to examine the influence and conditioning process of hindrance stressors on the emotional exhaustion of the front-line healthcare workers during recuperation, examine the potential mediating process of rumination, and explore the moderating role of organisational and family factors.

SETTING

This cross-sectional study was conducted during 12-20 July 2020. Total 418 questionnaires were collected from front-line healthcare workers by random cluster sampling. Hierarchical regression was performed to analyse the mediating effect of affective rumination using SPSS25.0, while PROCESS was used to further investigate the moderating role of servant leadership and family support.

PARTICIPANTS

418 healthcare workers were investigated randomly from front-line medical teams. Inclusion criteria included worked as front-line health workers and participated in the fight against COVID-19 in Hubei; age ≥18 years; normal cognitive and comprehension abilities under physical and mental health; volunteer to participate in this study. Exclusion criteria included recently affected by major events other than COVID-19 or those with a history of neurasthenia and trauma.

RESULTS

Using descriptive analysis of average value and SD measured by a five-item scale (MBI-GS), we found that front-line healthcare workers' emotional exhaustion score (2.45±0.88) was at the medium level. Hindrance stressors, mediated by affective rumination, had a significant positive predictive effect on emotional exhaustion. Servant leadership negatively moderated the direct effect of hindrance stressors on emotional exhaustion (β=-0.106, p<0.01). Family support positively moderated the impact of hindrance stressors on emotional exhaustion (β=0.082, p<0.05).

CONCLUSIONS

During the recuperation period, after successfully controlling COVID-19 at the front line, the first-line healthcare workers should be screened through affective rumination evaluation to gain insight for targeted interventions. We find that servant leadership is beneficial in alleviating emotional exhaustion while family support worsens emotional exhaustion. We suggest that servant leadership should be further promoted in medical organisations, and family support should be applied correctly and cautiously.

Risk and resilience in trajectories of post-traumatic stress symptoms among first responders after the 2011 Great East Japan Earthquake: 7-year prospective cohort study

BACKGROUND

First responders to disasters are at risk of developing post-traumatic stress disorder (PTSD). The trajectories of post-traumatic stress symptom severity differ among individuals, even if they are exposed to similar events. These trajectories have not yet been reported in non-Western first responders.

AIMS

We aimed to explore post-traumatic stress symptom severity trajectories and their risk factors in first responders to the 2011 Great East Japan Earthquake (GEJE) - a historically large earthquake that resulted in a tsunami and a nuclear disaster.

METHOD

A total of 55 632 Japan Ground Self-Defense Force (JGSDF) personnel dispatched to the GEJE were enrolled in this 7-year longitudinal cohort study. PTSD symptom severity was measured using the Impact of Event Scale-Revised. Trajectories were identified using latent growth mixture models (LGMM). Nine potential risk factors for the symptom severity trajectories were analysed using multinomial logistic regression.

RESULTS

Five symptom severity trajectories were identified: 'resilient' (54.8%), 'recovery' (24.6%), 'incomplete recovery' (10.7%), 'late-onset' (5.7%), and 'chronic' (4.3%). The main risk factors for the four non-resilient trajectories were older age, personal disaster experiences and working conditions. These working conditions included duties involving body recovery or radiation exposure risk, longer deployment length, later or no post-deployment leave and longer post-deployment overtime.

CONCLUSIONS

The majority of first responders to GEJE were resilient and developed few or no PTSD symptoms. A substantial minority experienced late-onset and chronic symptom severity trajectories. The identified risk factors can inform policies for prevention, early detection and intervention in individuals at risk of developing symptomatic trajectories.

ICD-11 Posttraumatic Stress Disorder and Complex PTSD Among Hospital Medical Workers in China: Impacts of Wenchuan Earthquake Exposure, Workplaces, and Sociodemographic Factors

BACKGROUND

Previous studies address posttraumatic stress disorder (PTSD) following disasters as a public health issue. However, few studies investigate the long-term effect of disaster exposure on PTSD among hospital medical workers (HMWs).

OBJECTIVES

This study aimed to study the prevalence of ICD-11 PTSD and complex PTSD (CPTSD) among exposed and non-exposed HMWs 11 years after the Wenchuan earthquake in China, to identify the factors associated with PTSD and CPTSD scores, and to examine the factor structures of PTSD and CPTSD models.

METHODS

A cross-sectional study was conducted using a self-administered online questionnaire. Two thousand fifty-nine valid samples were collected from four hospitals in 2019. Descriptive statistical analysis, multivariate regression models, and confirmatory factor analysis (CFA) were performed.

RESULTS

The prevalence of PTSD and CPTSD was 0.58 and 0.34%, respectively. The unexposed group reported higher PTSD and CPTSD scores than the exposed group. The type of workplace and marital status were significantly associated with the PTSD and CPTSD scores of HMWs. The CFA results indicate that both the correlated first-order model and the correlated two-layer model were a good fit to explain the structure of PTSD and CPTSD.

CONCLUSION

These findings suggest that few HMWs who were exposed to the Wenchuan earthquake suffered from PTSD or CPTSD 11 years following the disaster. However, psychological support was still necessary for all HMWs, especially for unmarried HMWs who were Working in smaller hospitals. Further research is required to analyze mental health status using ICD-11 PTSD and CPTSD to provide ongoing evidence to help HWMs cope effectively with the challenges of future disasters.

Perceived organizational support and PTSD symptoms of frontline healthcare workers in the outbreak of COVID-19 in Wuhan: The mediating effects of self-efficacy and coping strategies

The present study aimed to examine the effect of perceived organizational support on the PTSD symptoms of frontline healthcare workers, and to examine the mediating effects of coping self-efficacy and coping strategies in this relationship. A short-term longitudinal study design was used to conduct two waves of online surveys in March and April 2020. Participants comprised 107 medical staff in both waves of investigation. Self-efficacy, coping strategies, and perceived organizational support were reported at Wave 1, and PTSD symptoms were reported at Wave 2. Results indicated that (1) The prevalence of probable PTSD was 9.3% and 4.7% on the Chinese version of the Impact of Events Scale-Revised of 33 and 35, respectively. Local healthcare workers had greater risks of PTSD than the members of medical rescue teams. Doctors reported higher PTSD symptoms than nurses. (2) Perceived organizational support had a significant indirect effect on PTSD symptoms through the mediation of problem-focused coping strategies and the sequential mediating effect of coping self-efficacy and problem-focused coping strategies. The findings highlight the importance of providing adequate organizational support to reduce PTSD symptoms in frontline medical staff during the COVID-19 pandemic.

Posttraumatic stress disorder and professional burnout among local government staff seven years after the Wenchuan earthquake in China: A longitudinal study

Although local government staff are crucial in post-quake reconstruction, their long-term psychological and professional consequences remain unclear. This longitudinal study investigated changes of posttraumatic stress disorder (PTSD) and professional burnout over seven years, and their underlying relationship. The study assessed 250 staff at one year (T_1y) after the earthquake, and 162 (64.8 %) were followed up at seven years (T_7y). PTSD and professional burnout were assessed with the Short Screening Scale for DSM-IV PTSD and the burnout subscale of Professional Quality of Life Scale (ProQOL), respectively, at both time points. Longitudinal changes in PTSD and burnout were examined and cross-lagged panel analyses were conducted to test the relationship between PTSD and burnout. The rates of positive cases of PTSD screening were 23.2 % at T_1y and 11.1 % at T_7y. The percentages of moderate burnout were 61.7 % at T_1y and 23.5 % at T_7y. Scores of PTSD (z = -5.70, p < 0.001) and burnout (t = 10.07, p < 0.001) from T_1y to T_7y decreased. The cross-lagged analysis indicated that burnout at T_1y predicted PTSD at T_7y (β = 0.19, p = 0.025). In conclusion, the Wenchuan earthquake has long-lasting negative effects on local government staff, although they can recover over time. Interventions to reduce professional burnout after disaster may does be beneficial to decrease the risk of PTSD in the long run.

Acute Stress Response Profiles in Health Workers Facing SARS-CoV-2

OBJECTIVE

The study is an explorative investigation aimed to assess the differences in acute stress response patterns of health workers facing coronavirus disease 2019 (COVID-19) during Italy's first lockdown.

METHODS

A cross-sectional investigation using convenience sampling method was conducted in Italy during April 2020. Eight hundred fifty-eight health workers participated in the research filling out self-report measures including Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), Insomnia Severity Index (ISI), and Impact of Event Scale-Revised (IES-R).

RESULTS

Moderate/severe depression was found in 28.9% (95% CI, 25.8-32.04), moderate/severe anxiety in 55.4% (95% CI, 51.9-58.8), insomnia in 15% (95% CI, 12.5-17.5), and distress in 52.5% (95% CI, 48.5%-56.6) of participants. The 3% of health workers reported frequent suicidal thoughts. Female sex, working for >15 h/week in a COVID-19 unit, and living apart from family were associated with a significantly higher risk of distress, anxiety, insomnia, depression, and functional impairment. Four profiles were identified on the basis of psychopathological measures: Profile_0 included 44% (N = 270); Profile_1, 25.6% (N = 157); Profile_2, 19.1% (N = 117); and Profile_3, 11.3% (N = 69) of participants. Results showed a significant effect for Profiles X IES-R (η2 = 0.079; f = 0.29), indicating that in all profiles, except for Profile_0, avoidance scale is lower than hyperarousal and intrusion symptoms scales of the IES-R. This characteristic could be a probable index of the control exerted by the responders to not fly away from their job.

CONCLUSION

The identification of specific profiles could help psychiatrists and emergency psychologists to build specific interventions in terms of both primary and secondary prevention to face future waves of the COVID-19 outbreak.

Mindfulness, Posttraumatic Stress Symptoms, and Posttraumatic Growth in Aid Workers: The Role of Self-Acceptance and Rumination

ABSTRACT

Objective: The risk for aid workers to develop posttraumatic mental problems highlights the importance of reducing the harm of posttraumatic stress symptoms (PTSS) and promoting the benefits of posttraumatic growth (PTG). This study examined the negative relationship between mindfulness and PTSS, and the positive relationship between mindfulness and PTG, and further explored the mediating roles of self-acceptance, intrusive rumination, and deliberate rumination. Methods: Aid workers from the Red Cross Organization (N = 298) were recruited in the study. They completed a series of questionnaires assessing mindfulness, self-acceptance, rumination, posttraumatic stress disorder (PTSD), and PTG. Results: Results showed that mindfulness was significantly and negatively associated with PTSD through positively predicting self-acceptance and negatively predicting intrusive rumination. Mindfulness was significantly and positively associated with PTG, although the mediating effect did not exist because the path between self-acceptance and deliberate rumination was impassable. Conclusion: The mechanisms between mindfulness, PTSD, and PTG were further explored. Limitations and implications for trauma intervention and future research were discussed.

Chronic and Traumatic Stress Among Emergency Medical Services Personnel

Abstract. Background: Emergency medical services (EMS) personnel are frequently confronted with multiple stressful and potentially traumatic events as well as adverse working conditions. Objective: This narrative review provides an overview of the impact of adverse mission experiences and working conditions on the mental and physical health of EMS personnel. Methods: We summarize the empirical findings on prevalence rates as well as individual vulnerability factors and resilience. Results: EMS personnel show the highest prevalence rates of stress-related health problems among first responders. The article outlines prevention and intervention approaches that contribute to maintaining and improving the mental and physical health of EMS personnel. Conclusion: In the future, further evidence-based intervention measures should be developed to adequately support this professional group.

Mental Health in Frontline Medical Workers during the 2019 Novel Coronavirus Disease Epidemic in China: A Comparison with the General Population

BACKGROUND

Since December 2019, China has been affected by a severe outbreak of coronavirus disease 2019 (COVID-19). Frontline medical workers experienced difficulty due to the high risk of being infected and long and distressing work shifts. The current study aims to evaluate psychological symptoms in frontline medical workers during the COVID-19 epidemic in China and to perform a comparison with the general population.

METHODS

An online survey was conducted from 14 February 2020 to 29 March 2020. A total of 899 frontline medical workers and 1104 respondents in the general population participated. Depression, anxiety, insomnia, and resilience were assessed via the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), Insomnia Severity Index (ISI), and abbreviated Connor-Davidson Resilience Scale (CD-RISC-10), respectively.

RESULTS

Overall, 30.43%, 20.29%, and 14.49% of frontline medical workers in Hubei Province and 23.13%, 13.14%, and 10.64% of frontline medical workers in other regions reported symptoms of depression, anxiety, and insomnia, respectively. In addition, 23.33%, 16.67%, and 6.67% of the general population in Hubei Province and 18.25%, 9.22%, and 7.17% of the general population in other regions reported symptoms of depression, anxiety, and insomnia, respectively. The resilience of frontline medical staff outside Hubei Province was higher than that of the general population outside Hubei Province.

CONCLUSION

A large proportion of frontline medical workers and the general public experienced psychological symptoms during the COVID-19 outbreak. Psychological services for frontline medical workers and the general public are needed.

Occupational post-traumatic stress disorder: an updated systematic review

BACKGROUND

Although numerous studies on occupational post-traumatic stress disorder (PTSD) have been conducted prior to the 1950-2010 seminal systematic review by Skogstad et al., the prevalence, risk factors, and impact of this disorder following traumatic events in occupational settings remain unclear. This study aims to address this knowledge gap by reviewing the literature published after 2010.

METHODS

We reviewed literature from databases such as PubMed and Google Scholar using PRISMA guidelines to identify studies that address occupational PTSD and examined the status (prevalence or incidence), the risk factors, and the health effects of PTSD among workers.

RESULTS

In total, 123 articles were identified, and finally, 31 (25.2%) articles were selected after excluding duplicates. Various occupational traumatic physical events were reported such as natural or manmade disaster, explosion, accident, handling refugee corpses, or bullying at work. Risk of PTSD was closely associated with working conditions, severity of injury, history of mental disorder, occurrence of psychiatric symptoms at the time of the event, personality, interpersonal relationships, etc. Workers with PTSD were likely to experience a deterioration of physical and psychological health and impairment of social and occupational functioning.

CONCLUSIONS

Our review suggests that many workers remain highly vulnerable to occupational PTSD and its consequences.

Prevalence and risk factors of post-traumatic stress disorder among elderly survivors six months after the 2008 Wenchuan earthquake in China

BACKGROUND

Several studies indicate that older age is a risk factor for probable post-traumatic stress disorder (PTSD). However, evidence on the prevalence and risk factors for elderly disaster survivors is limited.

METHODS

Multi-stage stratified sampling was applied in this cross-sectional study. The Revised Version of the Impact of Event Scale (IES-R) was used to evaluate symptoms of PTSD. Chi-squared test was used for univariable analysis of prevalence of probable PTSD by possible determinants. Multivariable logistic regression analysis was utilized to further explore risk factors for PTSD.

RESULTS

427 elderly survivors age 60 or older participated. The prevalence of probable PTSD was 40.5, 36.3, and 21.5% according to a cut off score of the IES-R of 33, 35, and 2 points on average across items, respectively. In multivariable logistic regression, elderly survivors with a higher number of diagnosed chronic illnesses were more likely to be screened positive for PTSD and those with a greater number of family members living in the same home were less likely to be classified as having probable PTSD for all cut off scores. Elderly survivors with improved economic status and those with primary school or lower education were more often estimated to have probable PTSD with a cut off score of 35 and 2 points on average.

CONCLUSIONS

Elderly survivors in a high impact area following a major earthquake are at high risk for developing PTSD. Those who live alone and report pre-existing chronic illness are particularly vulnerable.

Health Risks in Disaster Responders: A Conceptual Framework

INTRODUCTION

Disasters cause severe disruption to socio-economic, infrastructural, and environmental aspects of community and nation. While the impact of disasters is strongly felt by those directly affected, they also have significant impacts on the mental and physical health of relief/recovery workers and volunteers. Variations in the nature and scale of disasters necessitate different approaches to risk management and hazard reduction during the response and recovery phases.

METHOD

Published articles (2010-2017) on the quantitative and quantitative relationship between disasters and the physical and mental health of relief/recovery workers and volunteers were systematically collected and reviewed. A total of 162 relevant studies were identified. Physical injuries and mental health impacts were categorized into immediate, short-term, and chronic conditions. A systematic review of the literature was undertaken to explore the health risks and injuries encountered by disaster relief workers and volunteers, and to identify the factors contributing to these and relating mitigation strategies.

RESULTS

There were relatively few studies into this issue. However, the majority of the scrutinized articles highlighted the dependence of nature and scope of injuries with the disaster type and the types of responders, while the living and working environment and socio-economic standing also had significant influence on health outcomes.

CONCLUSION

A conceptual framework derived from the literature review clearly illustrated several critical elements that directly or indirectly cause damage to physical and mental health of disaster responders. Pre-disaster and post-disaster risk mitigation approaches may be employed to reduce the vulnerability of both volunteers and workers while understanding the identified stressors and their relationships.Khatri KC J, Fitzgerald G, Poudyal Chhetri MB. Health risks in disaster responders: a conceptual framework. Prehosp Disaster Med. 2019;34(2):209-216.

Long-Term PTSD Risks in Emergency Medical Technicians Who Responded to the 2016 Taiwan Earthquake: A Six-Month Observational Follow-Up Study

Although several factors associated with posttraumatic stress disorder (PTSD) in disaster rescue workers were identified in previous studies, the results were inconsistent. This study aimed to explore the prognostic factors of PTSD among disaster rescuers using different screening tools. A 6.4 magnitude earthquake struck southern Taiwan on February 6, 2016. Emergency medical technicians (EMTs) who responded to the earthquake were recruited. The initial survey was conducted one month after the earthquake using a standardized, self-reported, paper-based questionnaire. After six months, we re-evaluated the EMTs using the same questionnaire that was used in the baseline survey. A total of 38 EMT-paramedics were enrolled in the final analysis. Significant differences in PTSD scores at baseline existed between EMTs with and without certain risk factors. The interaction between survey time and risk factors was not significant, but several risk factors correlated with a nonsignificant improvement in the PTSD score after the 6-month follow-up. Perfectionism personality characteristics and several specific field experiences (managing injured patients, managing dead victims, managing dead victims who were pregnant, managing emotionally distraught families, or guilty feelings during the missions) might affect different subdomains of PTSD symptom improvement. Disaster rescuers should be followed up after their missions, regardless of their age, gender, or previous experience with disaster response. EMTs with certain personality characteristics or who are involved in specific field operations should be carefully monitored during and after disaster rescue missions.

Posttraumatic stress disorder following the 2008 Wenchuan earthquake: A 10-year systematic review among highly exposed populations in China

BACKGROUND

The 2008 Wenchuan earthquake was unprecedented in Chinese history both in terms of the magnitude of the quake itself and the scale of human suffering. Following the disaster, researchers reported on a wide range of mental health outcomes, especially posttraumatic stress disorder (PTSD). In this review, we assess the cumulative body of research evidence about PTSD across the first 10 years following the earthquake.

METHODS

We searched the literature in the PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) databases (from May 2008 to February 2018) using Wenchuan earthquake and PTSD as keywords.

RESULTS

We selected 58 relevant studies. Published findings from the selected period suggested a substantial burden of PTSD on highly exposed survivors. Studies have found that symptoms of PTSD have been associated with a range of risk factors, including sociodemographic factors, trauma exposure characteristics, post-disaster cognitive and emotional states, and social support. Studies have explored the factor structure of PTSD in the affected Chinese population, and researchers have developed a Chinese self-report measure of PTSD symptoms. Several treatments for PTSD have been evaluated, including some indigenous intervention methods.

LIMITATIONS

Only a relatively small number of the studies used longitudinal assessments, and the consistency and effectiveness of measurement tools for PTSD require further exploration. More rigorous investigations of the effectiveness of interventions for the prevention and treatment of PTSD are needed.

CONCLUSION

The 10-year body of literature is important for the future deployment of disaster relief and an increased understanding of PTSD in China.

Challenges in Implementing International Standards for the Field Hospital Emergency Department in a Disaster Zone: The Israeli Experience

BACKGROUND

Medical response to world disasters has too often been poorly coordinated and nonprofessional. To improve this, several agencies, led by the World Health Organization (WHO), have developed guidelines to provide accreditation for Foreign Medical Teams (FMTs). There are three levels, with the highest known as FMT Type-3 providing outpatient as well as inpatient surgical emergency care in addition to inpatient referral care. In November 2016, the WHO certified the Israel Defense Forces Field Hospital as the first FMT Type-3.

OBJECTIVES

The objectives of this article are to describe the challenges in implementing these international standards for the field hospital emergency department in a disaster zone.

DISCUSSION

There are general standards for all levels of FMTs, as well as specific requirements for the FMT-3. These include a mechanism of appropriate triage, two operating suites, 40 regular beds, four to six intensive care unit beds, radiology facilities, and various staff specialties. Despite the sophistication of the field hospital, there are many challenges. Logistical challenges include constructing the hospital in a disaster zone and equipment issues. There are staff challenges such as becoming oriented to a new and difficult environment. Patient challenges include cultural differences, language barriers, and issues of follow-up. There are often ethical challenges unique to the disaster zone.

CONCLUSION

By presenting the experience and challenges of the first FMT Type-3, we hope that more countries can join this initiative and improve disaster care throughout the world.