Military and emergency response remain inherently dangerous occupations that require the ability to accurately assess threats and make critical decisions under significant time pressures. The cognitive processes associated with these abilities are complex and have been the subject of several significant, albeit service specific studies. Here, we present an attempt at finding the commonalities in threat assessment, sense making, and critical decision-making for emergency response across police, military, ambulance, and fire services. Relevant research is identified and critically appraised through a systematic literature review of English-language studies published from January 2000 through July 2020 on threat assessment and critical decision-making theory in dynamic emergency service and military environments. A total of 10,084 titles and abstracts were reviewed, with 94 identified as suitable for inclusion in the study. We then present our findings focused on six lines of enquiry: Bibliometrics, Language, Situation Awareness, Critical Decision Making, Actions, and Evaluation. We then thematically analyse these findings to reveal the commonalities between the four services. Despite existing single or dual service studies in the field, this research is significant in that it is the first examine decision making and threat assessment theory across all four contexts of military, police, fire and ambulance services, but it is also the first to assess the state of knowledge and explore the extent that commonality exists and models or practices can be applied across each discipline. The results demonstrate all military and emergency services personnel apply both intuitive and formal decision-making processes, depending on multiple situational and individual factors. Institutional restriction of decision-making to a single process at the expense of the consideration of others, or the inappropriate training and application of otherwise appropriate decision-making processes in certain circumstances is likely to increase the potential for adverse outcomes, or at the very least restrict peak performance being achieved. The applications of the findings of the study not only extend to facilitating improved practice in each of the individual services examined, but provide a basis to assist future research, and contribute to the literature exploring threat assessment and decision making in dynamic contexts.

Ethical decision making in disaster and emergency management requires more than good intentions; it also asks for careful consideration and an explicit, systematic approach. The decisions made by leaders and the effects they have in a disaster must carry the confidence of the community to which they serve. Such decisions are critical in settings where resources are scarce; when decisions are perceived as unjust, the consequences may erode public trust, result in moral injury to staff, and cause community division. To understand how decisions in these settings are informed by ethics, a systematic literature review was conducted to determine what ethical guidance informs decision making in disaster and emergency management. This study found evidence of ethical guidance to inform decision making in disaster management in the humanitarian system, based on humanitarian principles. Evidence of the application of an ethical framework to guide or reference decision making was varied or absent in other emergency management agencies or systems. Development and validation of ethical frameworks to support decision making in disaster management practice is recommended.

Identification and profiling of current and emerging disaster risks is essential to inform effective disaster risk management practice. Without clear evidence, readiness to accept future threats is low, resulting in decreased ability to detect and anticipate these new threats. A consequential decreased strategic planning for mitigation, adaptation or response results in a lowered resilience capacity. This study aimed to investigate threats to the health and well-being of societies associated with disaster impact in Oceania. The study used a mixed methods approach to profile current and emerging disaster risks in selected countries of Oceania, including small and larger islands. Quantitative analysis of the International Disaster Database (EM-DAT) provided historical background on disaster impact in Oceania from 2000 to 2018. The profile of recorded events was analyzed to describe the current burden of disasters in the Oceania region. A total of 30 key informant interviews with practitioners, policy managers or academics in disaster management in the Oceania region provided first-hand insights into their perceptions of current and emerging threats, and identified opportunities to enhance disaster risk management practice and resilience in Oceania. Qualitative methods were used to analyze these key informant interviews. Using thematic analysis, we identified emerging disaster risk evidence from the data and explored new pathways to support decision-making on resilience building and disaster management. We characterized perceptions of the nature and type of contemporary and emerging disaster risk with potential impacts in Oceania. The study findings captured not only traditional and contemporary risks, such as climate change, but also less obvious ones, such as plastic pollution, rising inequality, uncontrolled urbanization, and food and water insecurity, which were perceived as contributors to current and/or future crises, or as crises themselves. The findings provided insights into how to improve disaster management more effectively, mainly through bottom-up approaches and education to increase risk-ownership and community action, enhanced political will, good governance practices and support of a people-centric approach.

Objective: Disaster impact databases are important resources for informing research, policy, and decision making. Therefore, understanding the underpinning methodology of data collection used by the databases, how they differ, and quality indicators of the data recorded is essential in ensuring that their use as reference points is valid.Methods: The Australian Disaster Resilience Knowledge Hub (AIDRKH) is an open-source platform supported by government to inform disaster management practice. A comparative descriptive review of the Disaster Mapper (hosted at AIDRKH) and the international Emergency Events Database (EM-DAT) was undertaken to identify differences in how Australian disasters are captured and measured.Results: The results show substantial variation in identification and classification of disasters across hazard impacts and hazard types and a lack of data structure for the systematic reporting of contextual and impact variables.Conclusions: These differences may have implications for reporting, academic analysis, and thus knowledge management informing disaster prevention and response policy or plans. Consistency in reporting methods based on international classification standards is recommended to improve the validity and usefulness of this Australian database.

Disasters induced by extreme weather events and terrorism-related activities, causing mass casualty incidents (MCIs) in Europe, are expected to increase in the upcoming years. This challenging scenario demands a high level of readiness and coordinated multi-disciplinary response to reduce morbidity and mortality. The European Society of Trauma and Emergency Surgery (ESTES) is one of the 23 partners of the European-funded project Novel Integrated Toolkit for Enhanced Pre-Hospital Life Support and Triage in Challenging and Large Emergencies (NIGHTINGALE), whose primary objective is to promote the exchange in experiences and define the best practices among first responders. Additionally, the project promotes multi-disciplinary and multi-institutional efforts to achieve technological innovation that will enhance preparedness in MCI management. This manuscript aims to describe the challenges of MCI triage, the education and training programs for MCI response in Europe, and the technological innovation that may aid optimal response. These three elements were discussed by ESTES Disaster and Military Surgery Section members during the German Society for Trauma Surgery session at the ECTES 2022 in Oslo “TDSC^® and beyond: ideas and concepts for education and training in Terror Preparedness”, additionally the manuscript describes the first steps of the cooperation between ESTES and the rest of the NIGHTINGALE consortium.

The application and provision of prehospital care in disasters and mass-casualty incident response in Europe is currently being explored for opportunities to improve practice. The objective of this translational science study was to align common principles of approach and action and to identify how technology can assist and enhance response. To achieve this objective, the application of a modified Delphi methodology study based on statements derived from key findings of a scoping review was undertaken. This resulted in 18 triage, eight life support and damage control interventions, and 23 process consensus statements. These findings will be utilized in the development of evidence-based prehospital mass-casualty incident response tools and guidelines.