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Published January; citation_volume=18"> <meta name="citation_reference" content="citation_title=Stress and resilience among military medical students completing a high-fidelity military medical simulation; citation_author=Cole, R; citation_author=Bronstein, MV; citation_publication_date=2024; citation_journal_title=Int J Healthc Simul"> <meta name="citation_reference" content="citation_title=Analysis of delphi study 7-point linear scale data by parametric methods: use of the mean and standard deviation; citation_author=Franc, JM; citation_author=Hung, KK; citation_author=Pirisi, A; citation_publication_date=2023; citation_journal_title=Methodol Innovations.; citation_volume=16; citation_firstpage=226; citation_lastpage=233; citation_doi=10.1177/20597991231179393"> <meta name="citation_reference" content="citation_title=Associations between short-term and long-term exposure to particulate matter and preterm birth; citation_author=Su, YF; citation_author=Li, C; citation_author=Xu, JJ; citation_publication_date=2023; citation_journal_title=Chemosphere.; citation_volume=313; citation_firstpage=137431; citation_doi=10.1016/j.chemosphere.2022.137431"> <meta name="citation_reference" content="citation_title=A consensus framework for the humanitarian surgical response to armed conflict in 21st century warfare; citation_author=Wren, SM; citation_author=Wild, HB; citation_author=Gurney, J; citation_publication_date=2020; citation_journal_title=JAMA Surg.; citation_volume=155; citation_firstpage=114; citation_lastpage=121; citation_doi=10.1001/jamasurg.2019.4547"> <meta name="citation_reference" content="citation_title=Perioperative risk assessment in humanitarian settings: a scoping review; citation_author=Wild, H; citation_author=Stewart, BT; citation_author=LeBoa, C; citation_publication_date=2023; citation_journal_title=World J Surg.; citation_volume=47; citation_firstpage=1092; citation_lastpage=1113; citation_doi=10.1007/s00268-023-06893-x"> <meta name="citation_abstract" content="ObjectivesThe SDMPH 10-year anniversary conference created an opportunity for a researcher to present at a professional association conference to advance their research by seeking consensus of statements using Delphi methodology.MethodsConference attendees and SDMPH members who did not attend the conference were identified as Delphi experts. Experts rated their agreement of each statement on a 7- point linear numeric scale. Consensus amongst experts was defined as a standard deviation &lt; = 1. Presenters submitted statements relevant to advancing their research to the authors to edit to fit Delphi statement formatting.Statements attaining consensus were included in the final report after the first round. Those not attaining consensus moved to the second round in which experts were shown the mean response of the expert panel and their own response for opportunity to reconsider their rating for that round. If reconsideration attained consensus, these statements were included in the final report. This process repeated in a third and final round.Results37 Experts agreed to participate in the first round; 35 completed the second round, and 34 completed the third round; 35 statements attained consensus; 3 statements did not attain consensus.ConclusionsA Delphi technique was used to establish expert consensus of statements submitted by the SDMPH conference presenters to guide their future education, research, and training."> <meta name="citation_doi" content="10.1017/dmp.2024.251"> <link rel="alternate" href="/core/journals/disaster-medicine-and-public-health-preparedness/article/sdmph-10year-anniversary-conference-modified-delphi-study/674EEF159F47C44B9A207CE66814B92B" hreflang="en" /> <link rel="icon" href="/core/cambridge-core/public/images/favicon.ico" type="image/x-icon"/> <link rel="shortcut icon" href="/core/cambridge-core/public/images/favicon.ico" type="image/x-icon"/> <link href='//fonts.googleapis.com/css?family=Noto+Sans:400,700,400italic,700italic' rel='stylesheet' 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</a></li><li class="page-breadcrumbs__item" data-v-3692cf84><span aria-hidden="true" class="breadcrumbs-wrapper__arrow" data-v-3692cf84>></span><a href="/core/journals/disaster-medicine-and-public-health-preparedness/volume/B4BDDE64E8E1C7D85A7C176762D9E977" class="app-link app-link__text app-link--accent" data-v-63dfaf6e data-v-3692cf84><span data-v-63dfaf6e>Volume 18</span> </a></li><li class="page-breadcrumbs__item" data-v-3692cf84><span aria-hidden="true" class="breadcrumbs-wrapper__arrow" data-v-3692cf84>></span><span data-v-3692cf84>SDMPH 10-year Anniversary Conference Modified Delphi...</span></li></ul></div></div> <div class="language" data-v-3692cf84><ul class="language-switch" data-v-6b1118dd data-v-3692cf84><li aria-label="English" data-v-6b1118dd><span class="language-option current divider" data-v-6b1118dd>English</span></li><li aria-label="Français" data-v-6b1118dd><span role="button" tabindex="0" href="#" lang="fr" class="language-option" data-v-6b1118dd> Français </span></li></ul></div></div></div></div> <div class="container container__modified" data-v-01274b1d>  <div class="row" data-v-01274b1d><div role="complementary" aria-label="table of content" class="column__left" data-v-01274b1d><div class="col journal-container row" data-v-146270e8 data-v-01274b1d><img src="https://static.cambridge.org/covers/DMP_0_0_0/disaster-medicine-and-public-health-preparedness.jpg" alt="" class="journal__image" data-v-146270e8> <a href="/core/journals/disaster-medicine-and-public-health-preparedness" class="app-link journal__title app-link__text app-link--underlined" data-v-63dfaf6e data-v-146270e8><span class="text" data-v-63dfaf6e>Disaster Medicine and Public Health Preparedness </span> </a> <hr aria-hidden="true" class="separator default" data-v-7036083a data-v-146270e8></div>  <div id="toc" class="table-of-content" data-v-01274b1d><h2>Article contents</h2> <div id="toc-list-wrapper" class="table-of-content__wrapper"><ul id="toc-list" class="list"><li class="list__item"><a href="#sec0" class="list__item__link"><span class="toc-title">Abstract</span></a></li> <li class="list__item"><a href="#sec1" class="list__item__link"> <span><div class="toc-title">Objectives</div></span></a></li><li class="list__item"><a href="#sec2" class="list__item__link"> <span><div class="toc-title">Methods</div></span></a></li><li class="list__item"><a href="#sec3" class="list__item__link"> <span><div class="toc-title">Results</div></span></a></li><li class="list__item"><a href="#sec4" class="list__item__link"> <span><div class="toc-title">Conclusions</div></span></a></li><li class="list__item"><a href="#sec5" class="list__item__link"> <span><div class="toc-title">Methodology</div></span></a></li><li class="list__item"><a href="#sec6" class="list__item__link"> <span><div class="toc-title">Results</div></span></a></li><li class="list__item"><a href="#sec7" class="list__item__link"> <span><div class="toc-title">Limitations</div></span></a></li><li class="list__item"><a href="#sec8" class="list__item__link"> <span><div class="toc-title">Discussion</div></span></a></li><li class="list__item"><a href="#sec9" class="list__item__link"> <span><div class="toc-title">Conclusion</div></span></a></li><li class="list__item"><a href="#sec10" class="list__item__link"> <span><div class="toc-title">Author contributions</div></span></a></li>  <li class="list__item"><a href="#references-list" class="list__item__link"><span class="toc-title">References</span></a></li></ul></div></div></div> <div class="column__main" data-v-01274b1d><div class="row" data-v-01274b1d><div class="column__main__left" data-v-01274b1d><div id="maincontent" class="col" data-v-862424e6 data-v-01274b1d> <hgroup data-v-862424e6><h1 data-v-862424e6>SDMPH 10-year Anniversary Conference Modified Delphi Study</h1> </hgroup>     <div class="row published-date" data-v-862424e6><p data-v-862424e6> Published online by Cambridge University Press: <strong data-v-862424e6>27 November 2024</strong></p></div>   <div class="contributors-details" data-v-99f6eb26 data-v-862424e6><div class="row contributors" data-v-99f6eb26><div class="col" data-v-99f6eb26><div class="row contributor-type" data-v-792406ce data-v-99f6eb26> <div class="contributor-type__contributor" data-v-792406ce><a href="/core/search?filters%5BauthorTerms%5D=Eric%20S.%20Weinstein&eventCode=SE-AU" class="app-link app-link__text app-link--accent" data-v-63dfaf6e data-v-792406ce><span data-v-63dfaf6e>Eric S. Weinstein</span> </a> <a target="_blank" href="https://orcid.org/0000-0002-1147-5656" data-test-orcid="Eric S. Weinstein" class="app-link contributor-type__contributor__orcid app-link__icon app-link--" data-v-63dfaf6e data-v-792406ce><img src="data:image/svg+xml;base64,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" alt="Open the ORCID record for Eric S. Weinstein" class="app-icon icon orcid" data-v-d2c09870 data-v-63dfaf6e> <span class="sr-only" data-v-63dfaf6e>[Opens in a new window]</span></a> <span data-v-792406ce>,</span></div><div class="contributor-type__contributor" data-v-792406ce><a href="/core/search?filters%5BauthorTerms%5D=Joseph%20Cuthbertson&eventCode=SE-AU" class="app-link app-link__text app-link--accent" data-v-63dfaf6e data-v-792406ce><span data-v-63dfaf6e>Joseph Cuthbertson</span> </a> <a target="_blank" href="https://orcid.org/0000-0003-3210-8115" data-test-orcid="Joseph Cuthbertson" class="app-link contributor-type__contributor__orcid app-link__icon app-link--" data-v-63dfaf6e data-v-792406ce><img src="data:image/svg+xml;base64,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" alt="Open the ORCID record for Joseph Cuthbertson" class="app-icon icon orcid" data-v-d2c09870 data-v-63dfaf6e> <span class="sr-only" data-v-63dfaf6e>[Opens in a new window]</span></a> <span data-v-792406ce>,</span></div><div class="contributor-type__contributor" data-v-792406ce><a href="/core/search?filters%5BauthorTerms%5D=Frederick%20Burkle&eventCode=SE-AU" class="app-link app-link__text app-link--accent" data-v-63dfaf6e data-v-792406ce><span data-v-63dfaf6e>Frederick Burkle</span> </a> <a target="_blank" href="https://orcid.org/0000-0002-5110-7284" data-test-orcid="Frederick Burkle" class="app-link contributor-type__contributor__orcid app-link__icon app-link--" data-v-63dfaf6e data-v-792406ce><img src="data:image/svg+xml;base64,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" alt="Open the ORCID record for Frederick Burkle" class="app-icon icon orcid" data-v-d2c09870 data-v-63dfaf6e> <span class="sr-only" data-v-63dfaf6e>[Opens in a new window]</span></a> <span data-v-792406ce>,</span></div><div class="contributor-type__contributor" data-v-792406ce><a href="/core/search?filters%5BauthorTerms%5D=Hannah%20B.%20Wild&eventCode=SE-AU" class="app-link app-link__text app-link--accent" data-v-63dfaf6e data-v-792406ce><span data-v-63dfaf6e>Hannah B. Wild</span> </a> <a target="_blank" href="https://orcid.org/0000-0003-0974-0956" data-test-orcid="Hannah B. Wild" class="app-link contributor-type__contributor__orcid app-link__icon app-link--" data-v-63dfaf6e data-v-792406ce><img src="data:image/svg+xml;base64,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" alt="Open the ORCID record for Hannah B. Wild" class="app-icon icon orcid" data-v-d2c09870 data-v-63dfaf6e> <span class="sr-only" data-v-63dfaf6e>[Opens in a new window]</span></a> <span data-v-792406ce>,</span></div><div class="contributor-type__contributor" data-v-792406ce><a href="/core/search?filters%5BauthorTerms%5D=Rebekah%20Cole&eventCode=SE-AU" class="app-link app-link__text app-link--accent" data-v-63dfaf6e data-v-792406ce><span data-v-63dfaf6e>Rebekah Cole</span> </a>  <span data-v-792406ce>,</span></div><div class="contributor-type__contributor" data-v-792406ce><a href="/core/search?filters%5BauthorTerms%5D=Tehnaz%20Boyle&eventCode=SE-AU" class="app-link app-link__text app-link--accent" data-v-63dfaf6e data-v-792406ce><span data-v-63dfaf6e>Tehnaz Boyle</span> </a> <a target="_blank" href="https://orcid.org/0000-0003-0328-3002" data-test-orcid="Tehnaz Boyle" class="app-link contributor-type__contributor__orcid app-link__icon app-link--" data-v-63dfaf6e data-v-792406ce><img src="data:image/svg+xml;base64,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" alt="Open the ORCID record for Tehnaz Boyle" class="app-icon icon orcid" data-v-d2c09870 data-v-63dfaf6e> <span class="sr-only" data-v-63dfaf6e>[Opens in a new window]</span></a> <span data-v-792406ce>,</span></div><div class="contributor-type__contributor" data-v-792406ce><a href="/core/search?filters%5BauthorTerms%5D=Jessica%20Ryder&eventCode=SE-AU" class="app-link app-link__text app-link--accent" data-v-63dfaf6e data-v-792406ce><span data-v-63dfaf6e>Jessica Ryder</span> </a>  <span data-v-792406ce>,</span></div><div class="contributor-type__contributor" data-v-792406ce><a href="/core/search?filters%5BauthorTerms%5D=Jeffrey%20Franc&eventCode=SE-AU" class="app-link app-link__text app-link--accent" data-v-63dfaf6e data-v-792406ce><span data-v-63dfaf6e>Jeffrey Franc</span> </a> <a target="_blank" href="https://orcid.org/0000-0002-2421-3479" data-test-orcid="Jeffrey Franc" class="app-link contributor-type__contributor__orcid app-link__icon app-link--" data-v-63dfaf6e data-v-792406ce><img src="data:image/svg+xml;base64,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" alt="Open the ORCID record for Jeffrey Franc" class="app-icon icon orcid" data-v-d2c09870 data-v-63dfaf6e> <span class="sr-only" data-v-63dfaf6e>[Opens in a new window]</span></a> <span data-v-792406ce>,</span></div><div class="contributor-type__contributor" data-v-792406ce><a href="/core/search?filters%5BauthorTerms%5D=Matthew%20Turek&eventCode=SE-AU" class="app-link app-link__text app-link--accent" data-v-63dfaf6e data-v-792406ce><span data-v-63dfaf6e>Matthew Turek</span> </a>  <span data-v-792406ce> and</span></div><div class="contributor-type__contributor" data-v-792406ce><a href="/core/search?filters%5BauthorTerms%5D=Donal%20O%E2%80%99Mathuna&eventCode=SE-AU" class="app-link app-link__text app-link--accent" data-v-63dfaf6e data-v-792406ce><span data-v-63dfaf6e>Donal O’Mathuna</span> </a> <a target="_blank" href="https://orcid.org/0000-0001-5331-3340" data-test-orcid="Donal O’Mathuna" class="app-link contributor-type__contributor__orcid app-link__icon app-link--" data-v-63dfaf6e data-v-792406ce><img src="data:image/svg+xml;base64,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" alt="Open the ORCID record for Donal O’Mathuna" class="app-icon icon orcid" data-v-d2c09870 data-v-63dfaf6e> <span class="sr-only" data-v-63dfaf6e>[Opens in a new window]</span></a> <span data-v-792406ce></span></div> <a href="#" class="app-link app-link__text-icon app-link--secondary reverse" data-v-63dfaf6e data-v-792406ce><img src="data:image/svg+xml;base64,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" alt="" class="app-icon icon arrow-down" data-v-d2c09870 data-v-63dfaf6e><span class="text" data-v-63dfaf6e>...Show all authors </span> </a></div> </div> <div class="col-2 collapse-link" data-v-99f6eb26><a href="#authors-details" data-toggle="collapse" aria-expanded="false" aria-controls="authors-details" class="app-link collapsed app-link__text-icon app-link--secondary reverse" data-v-63dfaf6e data-v-99f6eb26><img src="data:image/svg+xml;base64,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" alt="" class="app-icon icon arrow-down" data-v-d2c09870 data-v-63dfaf6e><span class="text" data-v-63dfaf6e>Show author details </span> </a></div></div> <hr aria-hidden="true" class="separator default" data-v-7036083a data-v-99f6eb26> <dl id="authors-details" class="authors-details collapse" data-v-2edb8da6 data-v-99f6eb26><div data-test-author="Eric S. Weinstein" class="row author" data-v-2edb8da6><dt class="col-12 col-sm-2 title" data-v-2edb8da6>Eric S. Weinstein*</dt> <dd class="col content d-inline d-sm-flex" data-v-2edb8da6><span class="content__title" data-v-2edb8da6>Affiliation:</span> <div class="d-sm-flex flex-column flex-sm-1 d-inline" data-v-2edb8da6><span data-v-2edb8da6><span data-v-2edb8da6>Department of Emergency Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA</span> </span><span data-v-2edb8da6><span data-v-2edb8da6>University of South Florida, Health Center for Advanced Medical Learning and Simulation (CAMLS), Tampa, FL, USA</span> </span><span data-v-2edb8da6><span data-v-2edb8da6>CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy</span> </span></div></dd></div><div data-test-author="Joseph Cuthbertson" class="row author" data-v-2edb8da6><dt class="col-12 col-sm-2 title" data-v-2edb8da6>Joseph Cuthbertson</dt> <dd class="col content d-inline d-sm-flex" data-v-2edb8da6><span class="content__title" data-v-2edb8da6>Affiliation:</span> <div class="d-sm-flex flex-column flex-sm-1 d-inline" data-v-2edb8da6><span data-v-2edb8da6><span data-v-2edb8da6>Monash University Disaster Resilience Initiative, Monash University, Monash, VIC, Australia</span> </span><span data-v-2edb8da6><span data-v-2edb8da6>Curtin University, Faculty of Health Sciences, Bentley, WA, Australia</span> </span></div></dd></div><div data-test-author="Frederick Burkle" class="row author" data-v-2edb8da6><dt class="col-12 col-sm-2 title" data-v-2edb8da6>Frederick Burkle</dt> <dd class="col content d-inline d-sm-flex" data-v-2edb8da6><span class="content__title" data-v-2edb8da6>Affiliation:</span> <div class="d-sm-flex flex-column flex-sm-1 d-inline" data-v-2edb8da6><span data-v-2edb8da6><span data-v-2edb8da6>Global Scholar Woodrow Wilson International Center for Scholars, Washington, D.C., USA</span> </span></div></dd></div><div data-test-author="Hannah B. Wild" class="row author" data-v-2edb8da6><dt class="col-12 col-sm-2 title" data-v-2edb8da6>Hannah B. Wild</dt> <dd class="col content d-inline d-sm-flex" data-v-2edb8da6><span class="content__title" data-v-2edb8da6>Affiliation:</span> <div class="d-sm-flex flex-column flex-sm-1 d-inline" data-v-2edb8da6><span data-v-2edb8da6><span data-v-2edb8da6>Program for Global and Rural Surgery University of Washington, Seattle, WA, USA</span> </span><span data-v-2edb8da6><span data-v-2edb8da6>Explosive Weapons Trauma Care Collective, International Blast Injury Research Network University of Southampton, Southampton, UK</span> </span></div></dd></div><div data-test-author="Rebekah Cole" class="row author" data-v-2edb8da6><dt class="col-12 col-sm-2 title" data-v-2edb8da6>Rebekah Cole</dt> <dd class="col content d-inline d-sm-flex" data-v-2edb8da6><span class="content__title" data-v-2edb8da6>Affiliation:</span> <div class="d-sm-flex flex-column flex-sm-1 d-inline" data-v-2edb8da6><span data-v-2edb8da6><span data-v-2edb8da6>Uniformed Services University of the Health Sciences, Bethesda, MD, USA</span> </span></div></dd></div><div data-test-author="Tehnaz Boyle" class="row author" data-v-2edb8da6><dt class="col-12 col-sm-2 title" data-v-2edb8da6>Tehnaz Boyle</dt> <dd class="col content d-inline d-sm-flex" data-v-2edb8da6><span class="content__title" data-v-2edb8da6>Affiliation:</span> <div class="d-sm-flex flex-column flex-sm-1 d-inline" data-v-2edb8da6><span data-v-2edb8da6><span data-v-2edb8da6>Boston Medical Center Department of Emergency Medicine, Boston, MA, USA</span> </span></div></dd></div><div data-test-author="Jessica Ryder" class="row author" data-v-2edb8da6><dt class="col-12 col-sm-2 title" data-v-2edb8da6>Jessica Ryder</dt> <dd class="col content d-inline d-sm-flex" data-v-2edb8da6><span class="content__title" data-v-2edb8da6>Affiliation:</span> <div class="d-sm-flex flex-column flex-sm-1 d-inline" data-v-2edb8da6><span data-v-2edb8da6><span data-v-2edb8da6>University of Colorado Anschutz Medical Campus School of Medicine, Emergency Medicine; Team Rubicon</span> </span></div></dd></div><div data-test-author="Jeffrey Franc" class="row author" data-v-2edb8da6><dt class="col-12 col-sm-2 title" data-v-2edb8da6>Jeffrey Franc</dt> <dd class="col content d-inline d-sm-flex" data-v-2edb8da6><span class="content__title" data-v-2edb8da6>Affiliation:</span> <div class="d-sm-flex flex-column flex-sm-1 d-inline" data-v-2edb8da6><span data-v-2edb8da6><span data-v-2edb8da6>Department of Emergency Medicine University of Alberta, Edmonton, Alberta Canada</span> </span></div></dd></div><div data-test-author="Matthew Turek" class="row author" data-v-2edb8da6><dt class="col-12 col-sm-2 title" data-v-2edb8da6>Matthew Turek</dt> <dd class="col content d-inline d-sm-flex" data-v-2edb8da6><span class="content__title" data-v-2edb8da6>Affiliation:</span> <div class="d-sm-flex flex-column flex-sm-1 d-inline" data-v-2edb8da6><span data-v-2edb8da6><span data-v-2edb8da6>Defense Advanced Research Projects Agency, Arlington, VA, USA</span> </span></div></dd></div><div data-test-author="Donal O’Mathuna" class="row author" data-v-2edb8da6><dt class="col-12 col-sm-2 title" data-v-2edb8da6>Donal O’Mathuna</dt> <dd class="col content d-inline d-sm-flex" data-v-2edb8da6><span class="content__title" data-v-2edb8da6>Affiliation:</span> <div class="d-sm-flex flex-column flex-sm-1 d-inline" data-v-2edb8da6><span data-v-2edb8da6><span data-v-2edb8da6>College of Nursing and the Center for Bioethics and Medical Humanities, The Ohio State University, Columbus, OH, USA</span> </span></div></dd></div><div data-test-author="Wayne Cascio" class="row author" data-v-2edb8da6><dt class="col-12 col-sm-2 title" data-v-2edb8da6>Wayne Cascio</dt> <dd class="col content d-inline d-sm-flex" data-v-2edb8da6><span class="content__title" data-v-2edb8da6>Affiliation:</span> <div class="d-sm-flex flex-column flex-sm-1 d-inline" data-v-2edb8da6><span data-v-2edb8da6><span data-v-2edb8da6>Environmental Protection Agency, Washington, D.C., USA</span> </span></div></dd></div><div data-test-author="Anja Westman" class="row author" data-v-2edb8da6><dt class="col-12 col-sm-2 title" data-v-2edb8da6>Anja Westman</dt> <dd class="col content d-inline d-sm-flex" data-v-2edb8da6><span class="content__title" data-v-2edb8da6>Affiliation:</span> <div class="d-sm-flex flex-column flex-sm-1 d-inline" data-v-2edb8da6><span data-v-2edb8da6><span data-v-2edb8da6>Örebro University Hospital, Emergency Department, Örebro, Sweden</span> </span></div></dd></div><div data-test-author="Manuela Verde" class="row author" data-v-2edb8da6><dt class="col-12 col-sm-2 title" data-v-2edb8da6>Manuela Verde</dt> <dd class="col content d-inline d-sm-flex" data-v-2edb8da6><span class="content__title" data-v-2edb8da6>Affiliation:</span> <div class="d-sm-flex flex-column flex-sm-1 d-inline" data-v-2edb8da6><span data-v-2edb8da6><span data-v-2edb8da6>CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy</span> </span></div></dd></div><div data-test-author="Marta Caviglia" class="row author" data-v-2edb8da6><dt class="col-12 col-sm-2 title" data-v-2edb8da6>Marta Caviglia</dt> <dd class="col content d-inline d-sm-flex" data-v-2edb8da6><span class="content__title" data-v-2edb8da6>Affiliation:</span> <div class="d-sm-flex flex-column flex-sm-1 d-inline" data-v-2edb8da6><span data-v-2edb8da6><span data-v-2edb8da6>CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy</span> </span></div></dd></div><div data-test-author="David Eisenman" class="row author" data-v-2edb8da6><dt class="col-12 col-sm-2 title" data-v-2edb8da6>David Eisenman</dt> <dd class="col content d-inline d-sm-flex" data-v-2edb8da6><span class="content__title" data-v-2edb8da6>Affiliation:</span> <div class="d-sm-flex flex-column flex-sm-1 d-inline" data-v-2edb8da6><span data-v-2edb8da6><span data-v-2edb8da6>UCLA School of Medicine, Division of GIM/HSR, Los Angeles, CA, USA</span> </span></div></dd></div><div data-test-author="Emily Holbrook" class="row author" data-v-2edb8da6><dt class="col-12 col-sm-2 title" data-v-2edb8da6>Emily Holbrook</dt> <dd class="col content d-inline d-sm-flex" data-v-2edb8da6><span class="content__title" data-v-2edb8da6>Affiliation:</span> <div class="d-sm-flex flex-column flex-sm-1 d-inline" data-v-2edb8da6><span data-v-2edb8da6><span data-v-2edb8da6>Department of Emergency Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA</span> </span></div></dd></div><div data-test-author="Angus Jameson" class="row author" data-v-2edb8da6><dt class="col-12 col-sm-2 title" data-v-2edb8da6>Angus Jameson</dt> <dd class="col content d-inline d-sm-flex" data-v-2edb8da6><span class="content__title" data-v-2edb8da6>Affiliation:</span> <div class="d-sm-flex flex-column flex-sm-1 d-inline" data-v-2edb8da6><span data-v-2edb8da6><span data-v-2edb8da6>Department of Emergency Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA</span> </span></div></dd></div> <div class="row" data-v-2edb8da6><dt class="col-sm-2 col-12 title" data-v-2edb8da6> * </dt> <dd class="col content" data-v-2edb8da6><div class="row" data-v-2edb8da6><div class="d-sm-flex d-inline flex-sm-1 flex-sm-wrap" data-v-2edb8da6><div class="d-inline" data-v-2edb8da6><span data-v-2edb8da6><div class="corresp"><span class="bold">Corresponding author:</span> Eric S. Weinstein; Email:<a href="mailto:eswein402@gmail.com">eswein402@gmail.com</a></div></span></div></div></div></dd></div> <hr aria-hidden="true" class="separator default" data-v-7036083a data-v-2edb8da6></dl></div></div> <div id="app-tabs" class="tabs" data-v-1d90c6ce data-v-01274b1d><div id="app-tabs-wrapper" class="tabs__wrapper" data-v-1d90c6ce><div role="navigation" aria-label="tab navigation" class="container" data-v-1d90c6ce><a data-toggle="collapse" href="#appTabs" role="button" aria-expanded="false" aria-controls="appTabs" class="tabs__collapse collapsed d-sm-none d-print-none" data-v-1d90c6ce><span data-v-1d90c6ce></span> <span class="tabs-arrow-up" data-v-1d90c6ce></span> <span class="tabs-arrow-down" data-v-1d90c6ce></span></a> <ul id="appTabs" role="tablist" class="nav nav-tabs tabs__list collapse show" data-v-1d90c6ce><li role="none" class="tabs__tab" data-v-1d90c6ce><a aria-selected="true" href="#article-tab" role="tab" aria-controls="article-tab" tabindex="-1" 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contents</span>  <span class="toc-arrow-up"></span> <span class="toc-arrow-down"></span></a> <ul id="toc-list-mobile" class="list collapse"><li class="list__item"><a href="#sec0" class="list__item__link"><span class="toc-title">Abstract</span></a></li> <li class="list__item"><a href="#sec1" class="list__item__link"> <span>Objectives</span></a></li><li class="list__item"><a href="#sec2" class="list__item__link"> <span>Methods</span></a></li><li class="list__item"><a href="#sec3" class="list__item__link"> <span>Results</span></a></li><li class="list__item"><a href="#sec4" class="list__item__link"> <span>Conclusions</span></a></li><li class="list__item"><a href="#sec5" class="list__item__link"> <span>Methodology</span></a></li><li class="list__item"><a href="#sec6" class="list__item__link"> <span>Results</span></a></li><li class="list__item"><a href="#sec7" class="list__item__link"> <span>Limitations</span></a></li><li class="list__item"><a href="#sec8" class="list__item__link"> <span>Discussion</span></a></li><li class="list__item"><a href="#sec9" class="list__item__link"> <span>Conclusion</span></a></li><li class="list__item"><a href="#sec10" class="list__item__link"> <span>Author contributions</span></a></li>  <li class="list__item"><a href="#references-list" class="list__item__link"><span class="toc-title">References</span></a></li></ul></div> <div class="action-bar" data-v-43a4d572><div class="row items"> <div class="app-dropdown d-print-none" data-v-fab090b8 data-v-113567da data-v-43a4d572><button aria-expanded="false" data-test-id="buttonSavePDFOptions" id="save-pdf-dropdown" class="app-button dropdown-menu-button app-button__text-icon app-button--secondary" data-v-2a038744 data-v-fab090b8><img src="/core/page-component/img/save-pdf-icon.080470e.svg" alt="" class="app-icon icon save-pdf" data-v-d2c09870 data-v-2a038744> <span class="text" data-v-2a038744>Save PDF</span></button> <div aria-labelledby="save-pdf-dropdown" class="app-dropdown__menu" 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data-v-63dfaf6e data-v-92ee52a2 data-v-43a4d572><img src="/core/page-component/img/rights-icon.d4a677c.svg" alt="" class="app-icon icon rights" data-v-d2c09870 data-v-63dfaf6e><span class="text" data-v-63dfaf6e>Rights & Permissions </span> <span class="sr-only" data-v-63dfaf6e>[Opens in a new window]</span></a></div> <hr aria-hidden="true" class="separator default" data-v-7036083a></div> <div class="share-modal-overlay" style="display:none;" data-v-43a4d572></div> <div data-spy="scroll" data-target="#toc" class="scrollspy-content" data-v-43a4d572> <div id="sec0" class="col article-abstract sec" data-v-2fa8b348 data-v-43a4d572><div class="abstract-text-container" data-v-2fa8b348><div lang="en"><h2>Abstract</h2>  <div class="abstract-content"><div class="abstract" data-abstract-type="normal"><div class="sec"><span class="bold">Objectives</span><p>The SDMPH 10-year anniversary conference created an opportunity for a researcher to present at a professional association conference to advance their research by seeking consensus of statements using Delphi methodology.</p></div><div class="sec"><span class="bold">Methods</span><p>Conference attendees and SDMPH members who did not attend the conference were identified as Delphi experts. Experts rated their agreement of each statement on a 7- point linear numeric scale. Consensus amongst experts was defined as a standard deviation < = 1. Presenters submitted statements relevant to advancing their research to the authors to edit to fit Delphi statement formatting.</p><p>Statements attaining consensus were included in the final report after the first round. Those not attaining consensus moved to the second round in which experts were shown the mean response of the expert panel and their own response for opportunity to reconsider their rating for that round. If reconsideration attained consensus, these statements were included in the final report. This process repeated in a third and final round.</p></div><div class="sec"><span class="bold">Results</span><p>37 Experts agreed to participate in the first round; 35 completed the second round, and 34 completed the third round; 35 statements attained consensus; 3 statements did not attain consensus.</p></div><div class="sec"><span class="bold">Conclusions</span><p>A Delphi technique was used to establish expert consensus of statements submitted by the SDMPH conference presenters to guide their future education, research, and training.</p></div></div></div> <hr aria-hidden="true" class="abstract-divider separator default" data-v-7036083a></div></div>   </div>  <div class="keywords" data-v-86c27100 data-v-43a4d572><h2 data-v-86c27100>Keywords</h2> <div class="row keywords__pills" data-v-86c27100><a href="/core/search?filters[keywords]=disaster medicine" data-v-f0b31360 data-v-86c27100><span data-v-f0b31360 data-v-86c27100>disaster medicine</span></a><a href="/core/search?filters[keywords]=education" data-v-f0b31360 data-v-86c27100><span data-v-f0b31360 data-v-86c27100>education</span></a><a href="/core/search?filters[keywords]=public health professional" data-v-f0b31360 data-v-86c27100><span data-v-f0b31360 data-v-86c27100>public health professional</span></a><a href="/core/search?filters[keywords]=weapons" data-v-f0b31360 data-v-86c27100><span data-v-f0b31360 data-v-86c27100>weapons</span></a><a href="/core/search?filters[keywords]=triage" data-v-f0b31360 data-v-86c27100><span data-v-f0b31360 data-v-86c27100>triage</span></a><a href="/core/search?filters[keywords]=mass casualty incidents" data-v-f0b31360 data-v-86c27100><span data-v-f0b31360 data-v-86c27100>mass casualty incidents</span></a></div> <hr aria-hidden="true" class="separator default" data-v-7036083a data-v-86c27100></div>  <dl class="article-details" data-v-6e32a161 data-v-43a4d572><div class="row" data-v-6e32a161><dt class="col-12 col-sm-3 col-md-2_5 title" data-v-6e32a161> Type </dt> <dd class="col content" data-v-6e32a161>Concepts in Disaster Medicine</dd></div> <div class="row" data-v-6e32a161><dt class="col-12 col-sm-3 col-md-2_5 title" data-v-6e32a161> Information </dt> <dd class="col content" data-v-6e32a161><div class="content__journal" data-v-6e32a161><a href="/core/journals/disaster-medicine-and-public-health-preparedness" class="app-link app-link__text app-link--underlined" data-v-63dfaf6e data-v-6e32a161><span class="text" data-v-63dfaf6e>Disaster Medicine and Public Health Preparedness </span> </a> <span data-v-6e32a161> , <a href="/core/journals/disaster-medicine-and-public-health-preparedness/volume/B4BDDE64E8E1C7D85A7C176762D9E977" class="app-link app-link__text app-link--underlined" data-v-63dfaf6e data-v-6e32a161><span class="text" data-v-63dfaf6e>Volume 18 </span> </a></span>  <span data-v-6e32a161>, 2024</span>   <span data-v-6e32a161>, e289</span></div> <div class="doi-data" data-v-6e32a161><div data-v-6e32a161>DOI: <a target="_blank" href="https://doi.org/10.1017/dmp.2024.251" class="app-link app-link__text app-link--accent" data-v-63dfaf6e data-v-6e32a161><span class="text" data-v-63dfaf6e>https://doi.org/10.1017/dmp.2024.251 </span> <span class="sr-only" data-v-63dfaf6e>[Opens in a new window]</span></a></div> </div>  </dd></div> <div class="row creative-commons" data-v-6e32a161><dt class="col-12 col-sm-3 col-md-2_5 creative-commons__title"> Creative Commons </dt> <dd class="col"><div class="creative-commons__content"><div class="creative-commons__icons"><img src="/core/page-component/img/license-cc-icon.e3a74ed.svg" alt="Creative Common License - CC" class="app-icon creative-commons__icon license-cc" data-v-d2c09870><img src="/core/page-component/img/license-by-icon.33e212c.svg" alt="Creative Common License - BY" class="app-icon creative-commons__icon license-by" data-v-d2c09870></div> <div class="creative-commons__description">This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (<a href="http://creativecommons.org/licenses/by/4.0" target="_blank">http://creativecommons.org/licenses/by/4.0</a>), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.</div></div></dd></div>  <div class="row" data-v-6e32a161><dt class="col-12 col-sm-3 col-md-2_5 title" data-v-6e32a161> Copyright </dt> <dd class="col content" data-v-6e32a161><div data-v-6e32a161> © The Author(s), 2024. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc. </div></dd></div></dl>  <div id="content-container" class="content-container" data-v-43a4d572><div class="content-box"><div class="article research-article NLM"> <div class="body"> <p class="p"> Professional association conference proceedings summarize presentations discussing advances in treatment or technologies without the interaction between the presenter and audience. A professional association conference summary may be provided for attendees, those interested in the subject, or members of the professional association or society to add to their reference library. An extension of these summaries may outline future endeavors or pursuits by the organizing professional association or society. Consensus opinions via survey can be derived by activities at designated professional association conferences with the intent to issue specific statements to promote advances in clinical guidelines, treatment, or therapies.</p> <p class="p"> The utilization of the scientific Delphi methodology at a conference of similarly educated and trained medical researchers and practitioners/responders to provide consensus statements as the sole objective of a professional association conference has proven to be a fruitful endeavor.<a class="xref bibr" href="#r1"><span class="show-for-sr">Reference Ryan, Kako and Garner</span> <sup class="sup">1</sup></a> These professional association conferences are designed based on the Delphi methodology, from the creation of the Delphi statements using an iterative process or discussion, to the conference participant in-person rounds of anonymous linear numeric responses of each statement until consensus or stability of answers is achieved. The <em class="italic">direct</em> output of these professional association conferences can be examined in the future to create clinical guidelines endorsed by conference attendees or the professional association or society that hosted or sent representatives to the conference.</p> <p class="p"> The Society for Disaster Medicine and Public Health (Society) 10-year anniversary conference (SDMPH) took place on December 4<sup class="sup">th</sup> and 5<sup class="sup">th</sup> 2023 at the American Geophysical Union Conference Center in Washington D.C. The theme was “10 years on: Building the Discipline of Disaster Medicine and Public Health.” The sessions (<a class="xref table" href="#tab1">Table 1</a>) presented aspects of disaster risk reduction, disaster response, and the effects on vulnerable populations following these themes:</p><ul class="list nomark"> <li class="list-item"> <p class="p"><span class="label">•</span> Climate change and disaster response</p> </li> <li class="list-item"> <p class="p"><span class="label">•</span> Conflict medicine and population health</p> </li> <li class="list-item"> <p class="p"><span class="label">•</span> Advanced technology, artificial intelligence, decision aids, devices and equipment and their effect on mass casualty incident response</p> </li> <li class="list-item"> <p class="p"><span class="label">•</span> Disaster medicine education, training, and competencies which are culturally and geographically relevant</p> </li> </ul> <div class="table-wrap" data-magellan-destination="tab1" id="tab1"> <div class="caption"> <p class="p"><span class="label">Table 1.</span> SDMPH Conference Presentations</p> </div> <span> <div class="figure-thumb"><img src="data:image/gif;base64,R0lGODlhAQABAIAAAMLCwgAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==" data-src="https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab1.png?pub-status=live" class="aop-lazy-load-image" width="1042" height="2516" data-original-image="/binary/version/id/urn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab1.png" data-zoomable="true"></div> </span> </div> <p class="p"> The distinction between the prior professional association conferences designed specifically as a Delphi conference and the SDMPH is that the education and instruction opportunity permitted each presenter to learn the attendee’s interest or appreciation of the relevance of their research and to guide future direction of their research, education, training, and competencies through the scientific Delphi methodology <em class="italic">after</em> the conference.</p> <div class="sec" data-magellan-destination="sec5" id="sec5"> <h2 class="A"> Methodology</h2> <p class="p"> The Delphi technique is a systematic process of forecasting using the collective opinion of panel members.<a class="xref bibr" href="#r2"><span class="show-for-sr">Reference Pill</span> <sup class="sup">2</sup></a> In this study, the Delphi expert panel included in-person and virtual SDMPH participants, as well as Society members who did not attend the SDMPH. The structured method of developing consensus among panel members using Delphi methodology has gained acceptance in diverse fields of medicine.<a class="xref bibr" href="#r3"><span class="show-for-sr">Reference Keeney, Hasson and McKenna</span> <sup class="sup">3</sup></a> The Delphi method assumed a pivotal role in the last few decades to develop best practice guidance using collective intelligence where research is limited, ethically or logistically difficult, or evidence is conflicting.<a class="xref bibr" href="#r4"><span class="show-for-sr">Reference Shang</span> <sup class="sup">4</sup></a> Delphi studies are modified by how the initial first round statements are created. This includes the use of open-ended questions to panel members; through an iterative process amongst authors, focus groups, or panel members; or other processes. Modified Delphi (mD) study statements were created by the SDMPH presenters and then an internal focus group of lead authors discussed and edited these statements to meet the format of Delphi statements for the Stat59 statistical analysis platform (Stat59 Services Limited, Alberta, Canada). The initial 32 statements submitted by presenters included statements from the Public Health Extreme Events Research (PHEER) network (Presentation # 3) and Telemedicine (Presentation # 9) (<a class="xref table" href="#tab1">Table 1</a>). These statements were excluded from consideration due to the Internal Focus Group determining that the total number of statements should ideally be less than 40 and both topic statements would attain consensus. In the end, statements were edited to fit the Delphi format leading to 38 statements to be presented to the Delphi Panel of SDMPH participants (<a class="xref table" href="#tab2">Table 2</a>).</p><div class="table-wrap" data-magellan-destination="tab2" id="tab2"> <div class="caption"> <p class="p"><span class="label">Table 2.</span> DELPHI Statement Review Process</p> </div> <span> <div class="figure-thumb"><img src="data:image/gif;base64,R0lGODlhAQABAIAAAMLCwgAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==" data-src="https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab2.png?pub-status=live" class="aop-lazy-load-image" width="1042" height="531" data-original-image="/binary/version/id/urn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab2.png" data-zoomable="true"></div> </span> </div> <p class="p"> SDMPH participants, in-person and virtual, were asked to participate as mD experts in a 3-round mD survey study seeking consensus of statements regarding research activities, training, education, and/or competencies related to topics presented at the SDMPH (<em class="italic">n</em> = 127). Also, Society members who were not attending were asked to participate in the Delphi (<em class="italic">n</em> = 230). Introductory emails were sent November 21, 2024 explaining the project objectives and the mD to these potential mD experts.</p> <p class="p"> mD experts that agreed (<em class="italic">n</em> = 37, 25 SDMPH participants and 12 Society members not participating) were sent an email from the Stat59 mD organizational program with a link to the Stat59 website consent page. Each mD expert registered an account, validated it, and was sent a new email to log into their secure webpage to begin the first mD expert consensus round no later than 1359 GMT 4 December 2023, the start of the SDMPH. mD experts that had not logged into the system were asked to verify their access and log in and asked to notify the author if they had not received the introductory email, with instructions on how to ensure future emails were received.</p> <p class="p"> Once the mD experts logged in, they were provided with a formal explanation of the mD methodology and informed consent was obtained. For informed consent (<a class="uri" href="https://www.stat59.com/projects/delphi-consent-view?pid=503">Supplemental Digital Content link to Stat59 Consent Page</a>), participants were notified that they were anonymous volunteers who could withdraw at any time, that participation or withdrawal would not impact their employment, and that their data was secure (<a class="uri" href="https://www.stat59.com/about/security">Supplemental Digital Content link to Stat59 Security Page</a>). mD experts received a reminder email to complete this first round before the round closed.</p> <p class="p"> The next page was the list of 38 statements with instructions to rate each statement on a 7-point linear numeric scale, where 1 = strongly disagree and 7 = strongly agree. With this initial set of statements, the mD expert was asked to answer 4 demographic questions. Consensus amongst mD experts was defined as a standard deviation ≤1.0. Statements that attained consensus after this first mD expert round were included in the final report.</p> <p class="p"> Each mD expert received an email from the Stat59 program on December 9, 2023 notifying them that the second round was open; reminder emails were sent before the close of the second round (December 19, 2023) from the author that asked participants to log back into their Stat59 page that showed the mean response of all the mD experts for each statement that did not attain consensus and their own response for that specific remaining statement; they were then asked to reconsider their 7-point linear numeric scale for these remaining statements.</p> <p class="p"> This process was repeated after the second mD expert round with statements that attained consensus included in the final report. The statements that did not attain consensus were advanced to the third and final round with the mD experts asked to reconsider these statements. Each mD expert received an email from the Stat59 program January 8, 2024 notifying them that the third and last round was open and reminder emails before the close of the third round January 18, 2024, similar to the above reminder emails. The third mD expert round produced statements that attained consensus to add to the first and second round consensus statements in the final report. Remaining statements after this third round were the final statements that did not attain consensus.</p> <p class="p"> The University of South Florida Institutional Review Board (Tampa, Florida, USA) determined STUDY006415 met the criteria for exemption.</p> </div> <div class="sec results" data-magellan-destination="sec6" id="sec6"> <h2 class="A"> Results</h2> <p class="p"> As summarized in <a class="xref fig" href="#fig1">Figure 1</a>, 37 mD experts (25 SDMPH participants and 12 Society members not participating) confirmed their participation, established a unique account on the Stat59, and completed the first mD expert round (<a class="xref table" href="#tab3">Table 3</a>). The majority of experts were from North America; worked at a university, or were involved in research, education, and training; were physicians; and had over 10 years of experience.</p><div class="table-wrap" data-magellan-destination="tab3" id="tab3"> <div class="caption"> <p class="p"><span class="label">Table 3.</span> Modified Delphi expert panel demographics</p> </div> <span> <div class="figure-thumb"><img src="data:image/gif;base64,R0lGODlhAQABAIAAAMLCwgAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==" data-src="https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab3.png?pub-status=live" class="aop-lazy-load-image" width="1042" height="2614" data-original-image="/binary/version/id/urn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab3.png" data-zoomable="true"></div> </span> </div> <section><div class="fig" data-magellan-destination="fig1" id="fig1"> <div class="figure-thumb"><img src="data:image/gif;base64,R0lGODlhAQABAIAAAMLCwgAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==" data-src="https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_fig1.png?pub-status=live" class="aop-lazy-load-image" width="1454" height="2301" data-original-image="/binary/version/id/urn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_fig1.png" data-zoomable="true"></div> <div class="caption"><p class="p"> </p><p class="p"><span class="label">Figure 1.</span> RESULTS</p> </div></div></section> <p class="p"> Twelve statements attained statistical significance with a standard deviation ≤1.0 after this first mD expert round, and achieved consensus (<a class="xref table" href="#tab4">Table 4</a>, first round, first section in bold). The 26 statements that did not attain statistical significance, with standard deviation >1.0, were advanced to the second mD expert round.</p><div class="table-wrap" data-magellan-destination="tab4" id="tab4"> <div class="caption"> <p class="p"><span class="label">Table 4.</span> Statements Attaining Consensus</p> </div> <span> <div class="figure-thumb"><img src="data:image/gif;base64,R0lGODlhAQABAIAAAMLCwgAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==" data-src="https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab4.png?pub-status=live" class="aop-lazy-load-image" width="2142" height="2980" data-original-image="/binary/version/id/urn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab4.png" data-zoomable="true"></div> </span> </div> <p class="p"> Thirty-five mD experts completed the second mD expert round, with 15 of the 26 statements that advanced to the second mD expert round achieving consensus (<a class="xref table" href="#tab4">Table 4</a>, second round middle section). The remaining 11 statements were unable to attain consensus and advanced to the third mD expert round.</p> <p class="p"> Thirty-four mD experts completed the third and final mD expert round, 8 of the remaining 11 statements achieved consensus, with a total of 35 statements achieving consensus. (<a class="xref table" href="#tab4">Table 4</a> third round, last section in bold). The remaining 3 statements were unable to attain consensus after 3 mD expert rounds and were not recommended for consideration for future research guidance (<a class="xref table" href="#tab5">Table 5</a>).</p><div class="table-wrap" data-magellan-destination="tab5" id="tab5"> <div class="caption"> <p class="p"><span class="label">Table 5.</span> Statements for not attaining consensus</p> </div> <span> <div class="figure-thumb"><img src="data:image/gif;base64,R0lGODlhAQABAIAAAMLCwgAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==" data-src="https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab5.png?pub-status=live" class="aop-lazy-load-image" width="2142" height="348" data-original-image="/binary/version/id/urn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab5.png" data-zoomable="true"></div> </span> </div> </div> <div class="sec" data-magellan-destination="sec7" id="sec7"> <h2 class="A"> Limitations</h2> <p class="p"> The PHEER and Telemedicine statements that were not included in the study impacted the overall number of statements but had no other bearing on the study.</p> <p class="p"> The Delphi method seeks to arrive at group consensus by the aggregate of a panel of experts who rate a statement on a linear numeric scale. Franc et al. concluded that the sampling distribution tends to normality for sample sizes greater than or equal to 5. For Delphi studies using a 1-7 linear numeric scale, the use of the standard deviation for assessment of consensus and the mean for ranking is acceptable. Use of these parametric tests presents minimal risk of false consensus or of false ranking when compared to the non-parametric statistics of interquartile range and mean. This suggests that the linear 1-7 scale analyzed using the mean and standard deviation should become the preferred statistical method for Delphi studies.<a class="xref bibr" href="#r5"><span class="show-for-sr">Reference Franc, Hung and Pirisi</span> <sup class="sup">5</sup></a></p> <p class="p"> Study participants were skewed to North America and were physicians. The impact on the data cannot be determined. Certainly, having more input from non-physicians with less experience and from low-middle income countries is the goal of future mD studies to impact statements that could potentially attain consensus to guide future disaster medicine and public health preparedness education, research, and training.</p> <p class="p"> The objective of the distribution of mD experts was to represent those involved with the education, training, and competencies of those who seek disaster risk reduction, disaster medicine response, or recovery as evidenced by their participation in the SDMPH or Society. The distribution of these mD experts favor those who had the means to attend the SDMPH or join the SDMPH, potentially impacting the study lacking the input from those from a resource-limited setting who could not attend or join.</p> <p class="p"> An essential component of the Central Limit Theorem is that the average of sample means will be the population mean, or if 1 finds the average of all of the standard deviations in the sample, then 1 will find the actual standard deviation for the population.<a class="xref bibr" href="#r6"> <sup class="sup">6</sup></a> This will hold true regardless of whether the source population is normal or skewed, provided the sample size is sufficiently large (usually ≥30, the number of mD experts in this study per round averaged 29.67).<a class="xref bibr" href="#r7"> <sup class="sup">7</sup></a> The application of the Central Limit Theorem to this study infers that the 35 statements that attained consensus can be recommended to guide presenters with their current and future research.</p> </div> <div class="sec discussion" data-magellan-destination="sec8" id="sec8"> <h2 class="A"> Discussion</h2> <p class="p"> The theme of the SDMPH “Building the discipline of Disaster Medicine and Public Health” is to retain the lessons learned after an exercise or an actual incident for the participating agencies or organizations to improve their unique education, training, competencies and response. The first day of the SDMPH focused on climate change and conflict in disaster medicine. The second day featured presentations on ethics and artificial intelligence, devices and equipment, equipment and training.</p> <p class="p"> Short-term and long-term exposure to ambient air particle pollution cause a myriad of health and ecological effects (statements #1, 2).<a class="xref bibr" href="#r8"> <sup class="sup">8</sup></a> <sup class="sup">,</sup> <a class="xref bibr" href="#r9"><span class="show-for-sr">Reference Rajak and Chattopadhyay</span> <sup class="sup">9</sup></a> In particular, short-term exposures lasting hours to a few weeks and long-term exposures lasting months to years adversely affect cardiopulmonary health as evidenced by increased premature mortality, and hospitalization for cardiovascular disease (#1, 2).<a class="xref bibr" href="#r10"><span class="show-for-sr">Reference Chen, Warrington and Dominici</span> <sup class="sup">10</sup></a> <sup class="sup">,</sup> <a class="xref bibr" href="#r11"><span class="show-for-sr">Reference Su, Li and Xu</span> <sup class="sup">11</sup></a> Individuals with prevalent heart disease, namely ischemic heart disease and heart failure, are at higher risk for having adverse health effects after exposure (#2).<a class="xref bibr" href="#r12"><span class="show-for-sr">Reference de Bont, Jaganathan and Dahlquist</span> <sup class="sup">12</sup></a> Wildland fire smoke is an important and growing source of particulate air pollution and is increasing overall average concentrations of fine particulate matter in most of the continental U.S. or at least arresting the overall improvement of air quality that has occurred over the next several years (#3).<a class="xref bibr" href="#r13"><span class="show-for-sr">Reference Cascio</span> <sup class="sup">13</sup></a> Yet, few health care professionals educate their patients to modify their exposure risk highlighting the potential benefit of education (#4, 5).<a class="xref bibr" href="#r14"><span class="show-for-sr">Reference Rappold, Reyes and Pouliot</span> <sup class="sup">14</sup></a> <sup class="sup">,</sup> <a class="xref bibr" href="#r15"><span class="show-for-sr">Reference Engebretson, Hall and Blades</span> <sup class="sup">15</sup></a> When questioned, the attendees showed strong agreement that the education of health care professionals should include training on the care of people affected by wildfire smoke and that health care systems should increase the care for patients affected by wildfire smoke (#17, 18). Similarly, study participants agreed that a transdisciplinary approach is required to anticipate and mitigate the impact of emerging risks of floods on public health systems due to compromised treatment and care for people with non-communicable diseases (#9, 23).</p> <p class="p"> Humanitarian surgical care (HSC) in 21st-century armed conflict poses a complex nexus of challenges related to factors including shifting conflict dynamics, security constraints, and proliferation of unconventional actors within the humanitarian space.<a class="xref bibr" href="#r16"><span class="show-for-sr">Reference Wren, Wild and Gurney</span> <sup class="sup">16</sup></a></p> <p class="p"> Study participants agreed that a focused approach is required to improve the quality of surgical care delivered to civilians in asymmetric conflict with forward surgical services with intact echelons of care to reduce mortality and morbidity (#19). The study participants agreed that HSC and the trauma stabilization point (TSP) should be considered to manage the full range of population needs including not only trauma-related but also non-traumatic emergencies (e.g., cesarean section), acute medical conditions, and uncomplicated minor injuries in addition to asymmetric warfare trauma (#12, 20, 24, 25).<a class="xref bibr" href="#r17"><span class="show-for-sr">Reference Chu, Stokes, Trelles and Ford</span> <sup class="sup">17</sup></a></p> <p class="p"> Study participants agreed that coordination between military and other armed groups must be developed based on the humanitarian trauma system needs of non-combatant citizens, military, and other armed groups (#26). At present, surgical training in high-resource settings is not well-suited for this breadth.<a class="xref bibr" href="#r18"><span class="show-for-sr">Reference Lin, Dahm and Kushner</span> <sup class="sup">18</sup></a> Study participants agreed that capacity and capability of the humanitarian trauma system should be based on available expertise of humanitarian responders and the local health care delivery system (#27). Standardized pre-deployment training and competency assessment in core HSC procedures may contribute to ensuring quality of care. To adequately benchmark care quality, it is necessary to establish a minimum dataset (MDS) with legitimate-use sharing agreements (#21).<a class="xref bibr" href="#r19"><span class="show-for-sr">Reference Wild and Wren</span> <sup class="sup">19</sup></a> Development of risk-adjusted perioperative mortality calculators for resource-constrained environments may support this process.<a class="xref bibr" href="#r20"><span class="show-for-sr">Reference Wild, Stewart and LeBoa</span> <sup class="sup">20</sup></a> Due to the high-threat environments in which HSC often occurs, there has been increased engagement from non-traditional actors.<a class="xref bibr" href="#r21"><span class="show-for-sr">Reference Gurney, Graf and Staudt</span> <sup class="sup">21</sup></a> Establishing transparent credentialing and training in international humanitarian law (IHL) among all actors providing HSC in conflict may help ensure protection of humanitarian principles (#22).</p> <p class="p"> Over the last 10 years ethical challenges presented and the rise of artificial intelligence provided disaster medicine researchers fertile subject matter to pursue. Three statements related to ethical issues with artificial intelligence (AI) in disasters attained consensus. Statement #34 noted that the ethical issues with AI for mass casualty incidents have not been thoroughly analyzed as examples are growing of specific situations where AI has been deployed during disasters without due consideration of its ethical considerations. These include cases where concerns about privacy and confidentiality of data occurred.<a class="xref bibr" href="#r22"><span class="show-for-sr">Reference Bhardwaj</span> <sup class="sup">22</sup></a> Another concern relates to the quality of datasets used to train AI.<a class="xref bibr" href="#r23"><span class="show-for-sr">Reference Velev and Zlateva</span> <sup class="sup">23</sup></a> <sup class="sup">,</sup> <a class="xref bibr" href="#r24"><span class="show-for-sr">Reference Fan, Zhang and Yahja</span> <sup class="sup">24</sup></a></p> <p class="p"> Statement #11 about biases in datasets raising serious ethical concerns attained consensus and affirmed the importance of research into this issue. Given that many disasters occur in low-income countries, issues of justice need research related to AI. Nature carried a headline accompanying the release of a 2024 World Health Organization (WHO) report into the ethics of AI stating, “Medical AI could be ‘dangerous’ for poorer nations.”<a class="xref bibr" href="#r25"><span class="show-for-sr">Reference Adam</span> <sup class="sup">25</sup></a> Statement #33 attained consensus, agreeing that AI may not benefit those impacted by disasters in low-income countries as much as those in higher-income countries. Further research is needed to examine and mitigate such disparities.</p> <p class="p"> Many other ethical issues remain under-investigated with analysis urgently needed to avoid undermining AI’s potential benefits. With regards to the need for encryption of patient identifiers in AI tools, the study participants attained consensus with strong support (mean 6.6, SD 0.8) (#2). The study participants showed moderate support (mean 5.5, SD 0.9) for the need for strict statistical validation of AI tools prior to implementation (#29). In contrast, study participants showed weak support (mean 3, SD 1) for the replacement of traditional printed disaster plans with AI guided just in time interfaces (#30). Though each statement attained consensus, additional studies in concert with developing ethical solutions should foster more dedicated research of AI models.</p> <p class="p"> Defense Advanced Research Projects Agency’s (DARPA’s) In the Moment (ITM) program will leverage insights from the statements that did [#6] and did not attain consensus (Not #1, 2). ITM research will assess how human decision-makers’ perceptions of an AI algorithm’s competence, value alignment and/or other factors might make a human decision-maker more likely to delegate a decision to the AI algorithm. ITM will also assess how the decision to delegate may vary depending on environmental conditions and/or personal context. DARPA shared insights from the study with the program’s performers. The insights will also inform the program’s Ethical, Legal, and Societal Implications (ELSI) processes through panel discussions at ITM workshops. The workshops are part of DARPA’s outreach to policymakers and practitioners.</p> <p class="p"> Development, creation, and subsequent implementation of devices in the disaster medicine setting impose additional layers of ethical and practical considerations. The value of point-of-care ultrasound technology in the prehospital and resource-scarce environment is evident (#32) but finding ways to share this technology and knowledge through effective training programs has challenges that include sustainability and quality assurance once the training programs have concluded. One potential feasible solution to this challenge is the use of virtual meeting platforms and remote image review as quality assurance measures once the technology is implemented in a community (#16). These measures provide a means to also gauge impact of training programs and should be incorporated into training programs during the early planning stages in coordination with the host communities as standard practice. With the implementation of programs, sustainability should be an important consideration, but consensus was not attained on whether sustainability should impact the decision to implement a point-of-care ultrasound training program in specific communities (Not #3). This may be partially due to the ethical dilemma of withholding lifesaving technology that could impact mortality from a community during a time of need, such as a sudden-onset disaster or conflict.</p> <p class="p"> Historically, after action reports (AARs) of exercises and incidents with long scene or transport times have identified gaps determining which patients require lifesaving interventions (LSI) and priority transport with the demand of patients exceeding the supply of monitoring devices. As the discipline of disaster medicine has grown over the last 10 years, government agencies cognizant of these AARs have dedicated research to address these gaps. Study participants support the design and creation of patient monitoring devices utilized in an MCI to enhance LSI and priority transport (#3, 4). Scene safety, ingress and egress routes, the placement of casualty collection points, advanced medical posts, transportation staging, incident command, and identification of patients in the continuous triage process of an MCI can be assisted by drones (#31). Data collected and stored by patient monitoring devices can be analyzed retrospectively to identify trends to improve prehospital processes during MCI responses (#5).</p> <p class="p"> The <a class="uri" href="https://www.nightingale-triage.eu/">NIGHTINGALE</a> research and innovation project funded by the European Union’s Horizon 2020 program convened experts in technology, research, medical practitioners, and leading organizations in Europe that specialize in MCI response. The objectives include to: (1) upgrade evaluation of injured and affected populations (triage) using digital identification, traceability, fast diagnosis, continuous monitoring, and accurate classification of medical conditions; (2) optimize pre-hospital LSI and enhance utilization of assets, resources and capacities using AI-based solutions; and (3) enable shared response across emergency services and communication between emergency teams and with patients by developing augmented reality tools for first responders. This is consistent with the statement that prehospital MCI response training should be delivered to all first responders (#28).</p> <p class="p"> High-fidelity simulation MCI response training will lead to evidenced-based practices for education and training of both civilian and conflict responders to enhance trainees’ stress tolerance and will accelerate trainees’ professional identity development (#8, 14, 15). As the discipline of disaster medicine has advanced, the recognition that responders are able to focus their attention through practices such as mindfulness breathing has led to research with military medical students investigating whether mindfulness-based practice can improve performance while under stress.<a class="xref bibr" href="#r26"><span class="show-for-sr">Reference Cole and Bronstein</span> <sup class="sup">26</sup></a> The Sendai Framework calls for disaster medicine education to be incorporated into standard health professional medical curriculums consistent with the study participants’ acknowledgement that high-fidelity MCI response simulation training increases readiness for deployment (#7, 13).<a class="xref bibr" href="#r27"><span class="show-for-sr">Reference Sakurai and Sato</span> <sup class="sup">27</sup></a> In addition, future studies should measure MCI response readiness outcomes during simulation within both civilian and conflict settings.</p> <p class="p"> Scenario based simulation for MCIs and HCRs should become more accessible along with training on the use of rapid systematic assessment tools. Together these would maximize health care readiness for deployment to help ensure dynamic data-driven decisions are made with high confidence levels. A tool that could provide the template to support such a capability is the <a class="uri" href="https://www.undrr.org/media/88207/download?startDownload=20240816">United Nations Public Health System Resilience Scorecard</a> (Scorecard) (#10). The Scorecard is versatile, scalable, and could be easily modified. It is well suited to gather insights systematically and rapidly on needs and priorities using a consensus-based approach to determine which priority actions and needs from earlier planning should be kept or removed prior to deployment. The Scorecard process is designed to ensure a multidisciplinary team discussion and systemwide exploration of healthcare mission readiness, providing a high level of confidence of what is needed for success.</p> </div> <div class="sec conclusions" data-magellan-destination="sec9" id="sec9"> <h2 class="A"> Conclusion</h2> <p class="p"> This study demonstrates how an mD conducted at a professional association conference with the objective to provide a forum for presenters conducting research in disaster risk reduction, disaster medicine response, and recovery can provide consensus statements to guide the presenter’s current and future research to advance education, training, and competencies.</p> </div> </div> <div class="back"> <div class="notes supplementary-material" data-magellan-destination="nts1" id="nts1"> <h2 class="A">Supplementary material</h2> <p class="p"> The supplementary material for this article can be found at <a class="uri" href="https://doi.org/10.1017/dmp.2024.251">http://doi.org/10.1017/dmp.2024.251</a>.</p> </div> <div class="sec" data-magellan-destination="sec10" id="sec10"> <h2 class="A"> Author contributions</h2> <p class="p"> ESW: concept, delphi, edit statements, wrote manuscript and abstract, and maintained manuscript review and edits, references; JC, FB: concept, edited statements, reviewed and edited manuscript; HW, RC, JR, JF: presented at the SDMPH, submitted and edited statements, reviewed and edited manuscript; TB: presented at the SDMPH, edited statements, reviewed and edited manuscript; DO, WC: presented at the SDMPH, submitted and edited statements, reviewed manuscript; AW, MV: edited statements, reviewed and edited manuscript; MC, DE: presented at the SDMPH; EH: IRB lead; AJ: concept and oversight.</p> </div> <div class="ack"> <h2 class="A"> Acknowledgements</h2> <p class="p"> With our sincere appreciation for their time and expertise, we thank the experts who consented to be acknowledged and those that did not consent: Rita Burke, Terry Donat, Romeo Fairley, Brian Flynn, David Glotzer, James Gosney, Heather Hayanga, Mariana Helou, Mayumi Kako, Deborah Kim, Allison Latif, Melissa Leming, Shawn Metzner, Veselin Mitrović, Chaverle Noel, Frederick Nolting, Georgina Nouaime, Chiadi Onwuka, Matteo Paganini, Luis Rios, Jamla Rizek, Jeff Rubin, Elias Saade, Cheryl Schmidt, Yasir Shafiq, Mark Shah, Eman Shaikh, Angelika Underwood, Nunzio Zotti. With profound humility and gracious appreciation: We thank Alice O’Donnell for her support and focus. We graciously thank Dr. James James for his vision and dedication to the SDMPH. 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data-enlarged-image="https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary-alt:20241126083604-29529-optimisedImage-png-S1935789324002519_tab1.jpg" class="graphic" data-v-241a4b23></div> <div data-v-241a4b23><div class="caption" data-v-241a4b23><p data-v-241a4b23><span class="label" data-v-241a4b23>Table 1.</span> <span data-v-241a4b23><span class="p">SDMPH Conference Presentations</span></span></p></div> </div></div> <hr aria-hidden="true" class="separator dashed" data-v-7036083a data-v-241a4b23></div><div data-v-241a4b23><div class="figures__item" data-v-241a4b23><div class="figures__item__image-box" data-v-241a4b23><button class="figures__ref" data-v-241a4b23> View in content </button> <img src="data:image/gif;base64,R0lGODlhAQABAIAAAMLCwgAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==" alt="Figure 1" data-zoomable="true" data-src="https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary-alt:20241126083604-62050-mediumThumb-png-S1935789324002519_tab2.jpg" data-enlarged-image="https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary-alt:20241126083604-61374-optimisedImage-png-S1935789324002519_tab2.jpg" class="graphic" data-v-241a4b23></div> <div data-v-241a4b23><div class="caption" data-v-241a4b23><p data-v-241a4b23><span class="label" data-v-241a4b23>Table 2.</span> <span data-v-241a4b23><span class="p">DELPHI Statement Review Process</span></span></p></div> </div></div> <hr aria-hidden="true" class="separator dashed" data-v-7036083a data-v-241a4b23></div><div data-v-241a4b23><div class="figures__item" data-v-241a4b23><div class="figures__item__image-box" data-v-241a4b23><button class="figures__ref" data-v-241a4b23> View in content </button> <img src="data:image/gif;base64,R0lGODlhAQABAIAAAMLCwgAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==" alt="Figure 2" data-zoomable="true" data-src="https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary-alt:20241126083604-92722-mediumThumb-png-S1935789324002519_tab3.jpg" data-enlarged-image="https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary-alt:20241126083604-12771-optimisedImage-png-S1935789324002519_tab3.jpg" class="graphic" data-v-241a4b23></div> <div data-v-241a4b23><div class="caption" data-v-241a4b23><p data-v-241a4b23><span class="label" data-v-241a4b23>Table 3.</span> <span data-v-241a4b23><span class="p">Modified Delphi expert panel demographics</span></span></p></div> </div></div> <hr aria-hidden="true" class="separator dashed" data-v-7036083a data-v-241a4b23></div><div data-v-241a4b23><div class="figures__item" data-v-241a4b23><div class="figures__item__image-box" data-v-241a4b23><button class="figures__ref" data-v-241a4b23> View in content </button> <img src="data:image/gif;base64,R0lGODlhAQABAIAAAMLCwgAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==" alt="Figure 3" data-zoomable="true" data-src="https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary-alt:20241126083604-49300-mediumThumb-png-S1935789324002519_fig1.jpg" data-enlarged-image="https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary-alt:20241126083604-07375-optimisedImage-png-S1935789324002519_fig1.jpg" class="graphic" data-v-241a4b23></div> <div data-v-241a4b23><div class="caption" data-v-241a4b23><p data-v-241a4b23><span class="label" data-v-241a4b23>Figure 1.</span> <span data-v-241a4b23><span class="p">RESULTS</span></span></p></div> </div></div> <hr aria-hidden="true" class="separator dashed" data-v-7036083a data-v-241a4b23></div><div data-v-241a4b23><div class="figures__item" data-v-241a4b23><div class="figures__item__image-box" data-v-241a4b23><button class="figures__ref" data-v-241a4b23> View in content </button> <img src="data:image/gif;base64,R0lGODlhAQABAIAAAMLCwgAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==" alt="Figure 4" data-zoomable="true" data-src="https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary-alt:20241126083604-02191-mediumThumb-png-S1935789324002519_tab4.jpg" data-enlarged-image="https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary-alt:20241126083604-94384-optimisedImage-png-S1935789324002519_tab4.jpg" class="graphic" data-v-241a4b23></div> <div data-v-241a4b23><div class="caption" data-v-241a4b23><p data-v-241a4b23><span class="label" data-v-241a4b23>Table 4.</span> <span data-v-241a4b23><span class="p">Statements Attaining Consensus</span></span></p></div> </div></div> <hr aria-hidden="true" class="separator dashed" data-v-7036083a data-v-241a4b23></div><div data-v-241a4b23><div class="figures__item" data-v-241a4b23><div class="figures__item__image-box" data-v-241a4b23><button class="figures__ref" data-v-241a4b23> View in content </button> <img src="data:image/gif;base64,R0lGODlhAQABAIAAAMLCwgAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==" alt="Figure 5" data-zoomable="true" data-src="https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary-alt:20241126083604-14460-mediumThumb-png-S1935789324002519_tab5.jpg" data-enlarged-image="https://static.cambridge.org/binary/version/id/urn:cambridge.org:id:binary-alt:20241126083604-16044-optimisedImage-png-S1935789324002519_tab5.jpg" class="graphic" data-v-241a4b23></div> <div data-v-241a4b23><div class="caption" data-v-241a4b23><p data-v-241a4b23><span class="label" data-v-241a4b23>Table 5.</span> <span data-v-241a4b23><span class="p">Statements for not attaining consensus</span></span></p></div> </div></div> </div></div> <div id="supplementary-materials-tab" class="supplementary-materials tab-pane"><div class="materials-table"><div class="materials-table__item"><div class="materials-table__row"><img src="data:image/svg+xml;base64,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" alt="Supplementary material: File" class="app-icon materials-table__row__left-elem file" data-v-d2c09870> <div class="materials-table__row__main-elem"><h3 class="materials-table__row__title">Weinstein et al. supplementary material</h3> <div class="materials-table__row__description">Weinstein et al. supplementary material</div></div> <a href="https://static.cambridge.org/content/id/urn%3Acambridge.org%3Aid%3Aarticle%3AS1935789324002519/resource/name/S1935789324002519sup001.docx" download="" class="app-link clickable-button materials-table__row__right-elem materials-table__row__download-button app-link__icon app-link--" data-v-63dfaf6e><img 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Wild",searchUrl:"\u002Fcore\u002Fsearch?filters%5BauthorTerms%5D=Hannah%20B.%20Wild&eventCode=SE-AU",orcidUrl:"https:\u002F\u002Forcid.org\u002F0000-0003-0974-0956"},{givenNames:"Rebekah",surname:"Cole",nameStyle:h,affiliations:[{text:"Uniformed Services University of the Health Sciences, Bethesda, MD, USA"}],isCorresponding:a,notes:b,isAnonymous:a,fullName:"Rebekah Cole",searchUrl:"\u002Fcore\u002Fsearch?filters%5BauthorTerms%5D=Rebekah%20Cole&eventCode=SE-AU",orcidUrl:e},{givenNames:"Tehnaz",surname:"Boyle",nameStyle:h,affiliations:[{text:"Boston Medical Center Department of Emergency Medicine, Boston, MA, USA"}],isCorresponding:a,notes:b,isAnonymous:a,fullName:"Tehnaz Boyle",searchUrl:"\u002Fcore\u002Fsearch?filters%5BauthorTerms%5D=Tehnaz%20Boyle&eventCode=SE-AU",orcidUrl:"https:\u002F\u002Forcid.org\u002F0000-0003-0328-3002"},{givenNames:"Jessica",surname:"Ryder",nameStyle:h,affiliations:[{text:"University of Colorado Anschutz Medical Campus School of Medicine, Emergency Medicine; Team Rubicon"}],isCorresponding:a,notes:b,isAnonymous:a,fullName:"Jessica Ryder",searchUrl:"\u002Fcore\u002Fsearch?filters%5BauthorTerms%5D=Jessica%20Ryder&eventCode=SE-AU",orcidUrl:e},{givenNames:"Jeffrey",surname:"Franc",nameStyle:h,affiliations:[{text:"Department of Emergency Medicine University of Alberta, Edmonton, Alberta Canada"}],isCorresponding:a,notes:b,isAnonymous:a,fullName:"Jeffrey Franc",searchUrl:"\u002Fcore\u002Fsearch?filters%5BauthorTerms%5D=Jeffrey%20Franc&eventCode=SE-AU",orcidUrl:"https:\u002F\u002Forcid.org\u002F0000-0002-2421-3479"},{givenNames:"Matthew",surname:"Turek",nameStyle:h,affiliations:[{text:"Defense Advanced Research Projects Agency, Arlington, VA, USA"}],isCorresponding:a,notes:b,isAnonymous:a,fullName:"Matthew Turek",searchUrl:"\u002Fcore\u002Fsearch?filters%5BauthorTerms%5D=Matthew%20Turek&eventCode=SE-AU",orcidUrl:e},{givenNames:"Donal",surname:"O’Mathuna",nameStyle:h,affiliations:[{text:"College of Nursing and the Center for Bioethics and Medical Humanities, The Ohio State University, Columbus, OH, USA"}],isCorresponding:a,notes:b,isAnonymous:a,fullName:"Donal O’Mathuna",searchUrl:"\u002Fcore\u002Fsearch?filters%5BauthorTerms%5D=Donal%20O%E2%80%99Mathuna&eventCode=SE-AU",orcidUrl:"https:\u002F\u002Forcid.org\u002F0000-0001-5331-3340"},{givenNames:"Wayne",surname:"Cascio",nameStyle:h,affiliations:[{text:"Environmental Protection Agency, Washington, D.C., USA"}],isCorresponding:a,notes:b,isAnonymous:a,fullName:"Wayne Cascio",searchUrl:"\u002Fcore\u002Fsearch?filters%5BauthorTerms%5D=Wayne%20Cascio&eventCode=SE-AU",orcidUrl:e},{givenNames:"Anja",surname:"Westman",nameStyle:h,affiliations:[{text:"Örebro University Hospital, Emergency Department, Örebro, Sweden"}],isCorresponding:a,notes:b,isAnonymous:a,fullName:"Anja Westman",searchUrl:"\u002Fcore\u002Fsearch?filters%5BauthorTerms%5D=Anja%20Westman&eventCode=SE-AU",orcidUrl:"https:\u002F\u002Forcid.org\u002F0000-0002-2794-5026"},{givenNames:"Manuela",surname:"Verde",nameStyle:h,affiliations:[{text:s}],isCorresponding:a,notes:b,isAnonymous:a,fullName:"Manuela Verde",searchUrl:"\u002Fcore\u002Fsearch?filters%5BauthorTerms%5D=Manuela%20Verde&eventCode=SE-AU",orcidUrl:"https:\u002F\u002Forcid.org\u002F0000-0003-0476-1723"},{givenNames:"Marta",surname:"Caviglia",nameStyle:h,affiliations:[{text:s}],isCorresponding:a,notes:b,isAnonymous:a,fullName:"Marta Caviglia",searchUrl:"\u002Fcore\u002Fsearch?filters%5BauthorTerms%5D=Marta%20Caviglia&eventCode=SE-AU",orcidUrl:e},{givenNames:"David",surname:"Eisenman",nameStyle:h,affiliations:[{text:"UCLA School of Medicine, Division of GIM\u002FHSR, Los Angeles, CA, USA"}],isCorresponding:a,notes:b,isAnonymous:a,fullName:"David Eisenman",searchUrl:"\u002Fcore\u002Fsearch?filters%5BauthorTerms%5D=David%20Eisenman&eventCode=SE-AU",orcidUrl:e},{givenNames:"Emily",surname:"Holbrook",nameStyle:h,affiliations:[{text:r}],isCorresponding:a,notes:b,isAnonymous:a,fullName:"Emily Holbrook",searchUrl:"\u002Fcore\u002Fsearch?filters%5BauthorTerms%5D=Emily%20Holbrook&eventCode=SE-AU",orcidUrl:e},{givenNames:"Angus",surname:"Jameson",nameStyle:h,affiliations:[{text:r}],isCorresponding:a,notes:b,isAnonymous:a,fullName:"Angus Jameson",searchUrl:"\u002Fcore\u002Fsearch?filters%5BauthorTerms%5D=Angus%20Jameson&eventCode=SE-AU",orcidUrl:e}]},translators:{contributors:[],label:"Translated by"}},collections:[],publishedDate:"27 November 2024",keywords:[{url:"\u002Fcore\u002Fsearch?filters[keywords]=disaster medicine",name:"disaster medicine"},{url:"\u002Fcore\u002Fsearch?filters[keywords]=education",name:"education"},{url:"\u002Fcore\u002Fsearch?filters[keywords]=public health professional",name:"public health professional"},{url:"\u002Fcore\u002Fsearch?filters[keywords]=weapons",name:"weapons"},{url:"\u002Fcore\u002Fsearch?filters[keywords]=triage",name:"triage"},{url:"\u002Fcore\u002Fsearch?filters[keywords]=mass casualty incidents",name:"mass casualty incidents"}],openPracticeBadges:[],doi:{url:"https:\u002F\u002Fdoi.org\u002F10.1017\u002Fdmp.2024.251",value:"10.1017\u002Fdmp.2024.251"},copyright:{statement:["© The Author(s), 2024. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc."],holder:["The Author(s)"],year:[2024]},creativeCommons:{descriptions:["This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (\u003Ca href=\"http:\u002F\u002Fcreativecommons.org\u002Flicenses\u002Fby\u002F4.0\" target=\"_blank\"\u003Ehttp:\u002F\u002Fcreativecommons.org\u002Flicenses\u002Fby\u002F4.0\u003C\u002Fa\u003E), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited."],oaLicenseType:"CC-BY",licenses:["CC","BY"]},acceptedManuscript:a,type:"research-article",typeDescription:"Concepts in Disaster Medicine",eNumber:"e289",resultTypes:[],commentsCount:t,topicsAndSubtopics:e},journal:{id:x,title:m,titleSlug:y,mnemonic:"DMP",titleHistory:[],isFirstView:a,journalSlug:y,isCompanion:a,parentCompanionJournalName:m,associatedParentCollection:e,paymentInfo:{prices:{"£":{price:26,sku:n,skuNew:l,currency:"£"},"€":{price:31,sku:n,skuNew:l,currency:"€"},US$:{price:36,sku:n,skuNew:l,currency:"US$"},AU$:{price:51,sku:n,skuNew:l,currency:"AU$"}}},url:z,firstViewUrl:"\u002Fcore\u002Fjournals\u002Fdisaster-medicine-and-public-health-preparedness\u002Ffirstview",coverUrl:"https:\u002F\u002Fstatic.cambridge.org\u002Fcovers\u002FDMP_0_0_0\u002Fdisaster-medicine-and-public-health-preparedness.jpg",submitMaterialsUrl:"\u002Fcore\u002Fjournals\u002Fdisaster-medicine-and-public-health-preparedness\u002Finformation\u002Fauthor-instructions\u002Fsubmitting-your-materials",hasHistory:a,latestTitle:m,latestId:x,hasPastTitle:a,volume:{id:"B4BDDE64E8E1C7D85A7C176762D9E977",number:u,title:A,publishedDate:o,printPublishTimestamp:1704067200000,url:B}},abstract:{textAbstracts:[{title:"Abstract",content:"\u003Cdiv class=\"abstract\" data-abstract-type=\"normal\"\u003E\u003Cdiv class=\"sec\"\u003E\u003Cspan class=\"bold\"\u003EObjectives\u003C\u002Fspan\u003E\u003Cp\u003EThe SDMPH 10-year anniversary conference created an opportunity for a researcher to present at a professional association conference to advance their research by seeking consensus of statements using Delphi methodology.\u003C\u002Fp\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"sec\"\u003E\u003Cspan class=\"bold\"\u003EMethods\u003C\u002Fspan\u003E\u003Cp\u003EConference attendees and SDMPH members who did not attend the conference were identified as Delphi experts. Experts rated their agreement of each statement on a 7- point linear numeric scale. Consensus amongst experts was defined as a standard deviation < = 1. Presenters submitted statements relevant to advancing their research to the authors to edit to fit Delphi statement formatting.\u003C\u002Fp\u003E\u003Cp\u003EStatements attaining consensus were included in the final report after the first round. Those not attaining consensus moved to the second round in which experts were shown the mean response of the expert panel and their own response for opportunity to reconsider their rating for that round. If reconsideration attained consensus, these statements were included in the final report. This process repeated in a third and final round.\u003C\u002Fp\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"sec\"\u003E\u003Cspan class=\"bold\"\u003EResults\u003C\u002Fspan\u003E\u003Cp\u003E37 Experts agreed to participate in the first round; 35 completed the second round, and 34 completed the third round; 35 statements attained consensus; 3 statements did not attain consensus.\u003C\u002Fp\u003E\u003C\u002Fdiv\u003E\u003Cdiv class=\"sec\"\u003E\u003Cspan class=\"bold\"\u003EConclusions\u003C\u002Fspan\u003E\u003Cp\u003EA Delphi technique was used to establish expert consensus of statements submitted by the SDMPH conference presenters to guide their future education, research, and training.\u003C\u002Fp\u003E\u003C\u002Fdiv\u003E\u003C\u002Fdiv\u003E",lang:C}]},content:{html:"\u003Cdiv class=\"article research-article NLM\"\u003E\n\n\u003Cdiv class=\"body\"\u003E\n\u003Cp class=\"p\"\u003E Professional association conference proceedings summarize presentations discussing advances in treatment or technologies without the interaction between the presenter and audience. A professional association conference summary may be provided for attendees, those interested in the subject, or members of the professional association or society to add to their reference library. An extension of these summaries may outline future endeavors or pursuits by the organizing professional association or society. Consensus opinions via survey can be derived by activities at designated professional association conferences with the intent to issue specific statements to promote advances in clinical guidelines, treatment, or therapies.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E The utilization of the scientific Delphi methodology at a conference of similarly educated and trained medical researchers and practitioners\u002Fresponders to provide consensus statements as the sole objective of a professional association conference has proven to be a fruitful endeavor.\u003Ca class=\"xref bibr\" href=\"#r1\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Ryan, Kako and Garner\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E1\u003C\u002Fsup\u003E\u003C\u002Fa\u003E These professional association conferences are designed based on the Delphi methodology, from the creation of the Delphi statements using an iterative process or discussion, to the conference participant in-person rounds of anonymous linear numeric responses of each statement until consensus or stability of answers is achieved. The \u003Cem class=\"italic\"\u003Edirect\u003C\u002Fem\u003E output of these professional association conferences can be examined in the future to create clinical guidelines endorsed by conference attendees or the professional association or society that hosted or sent representatives to the conference.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E The Society for Disaster Medicine and Public Health (Society) 10-year anniversary conference (SDMPH) took place on December 4\u003Csup class=\"sup\"\u003Eth\u003C\u002Fsup\u003E and 5\u003Csup class=\"sup\"\u003Eth\u003C\u002Fsup\u003E 2023 at the American Geophysical Union Conference Center in Washington D.C. The theme was “10 years on: Building the Discipline of Disaster Medicine and Public Health.” The sessions (\u003Ca class=\"xref table\" href=\"#tab1\"\u003ETable 1\u003C\u002Fa\u003E) presented aspects of disaster risk reduction, disaster response, and the effects on vulnerable populations following these themes:\u003C\u002Fp\u003E\u003Cul class=\"list nomark\"\u003E\n\u003Cli class=\"list-item\"\u003E\n\n\u003Cp class=\"p\"\u003E\u003Cspan class=\"label\"\u003E•\u003C\u002Fspan\u003E Climate change and disaster response\u003C\u002Fp\u003E\n\u003C\u002Fli\u003E\n\u003Cli class=\"list-item\"\u003E\n\n\u003Cp class=\"p\"\u003E\u003Cspan class=\"label\"\u003E•\u003C\u002Fspan\u003E Conflict medicine and population health\u003C\u002Fp\u003E\n\u003C\u002Fli\u003E\n\u003Cli class=\"list-item\"\u003E\n\n\u003Cp class=\"p\"\u003E\u003Cspan class=\"label\"\u003E•\u003C\u002Fspan\u003E Advanced technology, artificial intelligence, decision aids, devices and equipment and their effect on mass casualty incident response\u003C\u002Fp\u003E\n\u003C\u002Fli\u003E\n\u003Cli class=\"list-item\"\u003E\n\n\u003Cp class=\"p\"\u003E\u003Cspan class=\"label\"\u003E•\u003C\u002Fspan\u003E Disaster medicine education, training, and competencies which are culturally and geographically relevant\u003C\u002Fp\u003E\n\u003C\u002Fli\u003E\n\u003C\u002Ful\u003E\n\u003Cdiv class=\"table-wrap\" data-magellan-destination=\"tab1\" id=\"tab1\"\u003E\n\n\u003Cdiv class=\"caption\"\u003E\n\u003Cp class=\"p\"\u003E\u003Cspan class=\"label\"\u003ETable 1.\u003C\u002Fspan\u003E SDMPH Conference Presentations\u003C\u002Fp\u003E\n\u003C\u002Fdiv\u003E\n\u003Cspan\u003E\n\n\u003Cdiv class=\"figure-thumb\"\u003E\u003Cimg src=\"data:image\u002Fgif;base64,R0lGODlhAQABAIAAAMLCwgAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==\" data-src=\"https:\u002F\u002Fstatic.cambridge.org\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab1.png?pub-status=live\" class=\"aop-lazy-load-image\" width=\"1042\" height=\"2516\" data-original-image=\"\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab1.png\" data-zoomable=\"true\"\u003E\u003C\u002Fdiv\u003E\n\u003C\u002Fspan\u003E\n\u003C\u002Fdiv\u003E\n\u003Cp class=\"p\"\u003E The distinction between the prior professional association conferences designed specifically as a Delphi conference and the SDMPH is that the education and instruction opportunity permitted each presenter to learn the attendee’s interest or appreciation of the relevance of their research and to guide future direction of their research, education, training, and competencies through the scientific Delphi methodology \u003Cem class=\"italic\"\u003Eafter\u003C\u002Fem\u003E the conference.\u003C\u002Fp\u003E\n\u003Cdiv class=\"sec\" data-magellan-destination=\"sec5\" id=\"sec5\"\u003E\n\u003Ch2 class=\"A\"\u003E Methodology\u003C\u002Fh2\u003E\n\u003Cp class=\"p\"\u003E The Delphi technique is a systematic process of forecasting using the collective opinion of panel members.\u003Ca class=\"xref bibr\" href=\"#r2\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Pill\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E2\u003C\u002Fsup\u003E\u003C\u002Fa\u003E In this study, the Delphi expert panel included in-person and virtual SDMPH participants, as well as Society members who did not attend the SDMPH. The structured method of developing consensus among panel members using Delphi methodology has gained acceptance in diverse fields of medicine.\u003Ca class=\"xref bibr\" href=\"#r3\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Keeney, Hasson and McKenna\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E3\u003C\u002Fsup\u003E\u003C\u002Fa\u003E The Delphi method assumed a pivotal role in the last few decades to develop best practice guidance using collective intelligence where research is limited, ethically or logistically difficult, or evidence is conflicting.\u003Ca class=\"xref bibr\" href=\"#r4\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Shang\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E4\u003C\u002Fsup\u003E\u003C\u002Fa\u003E Delphi studies are modified by how the initial first round statements are created. This includes the use of open-ended questions to panel members; through an iterative process amongst authors, focus groups, or panel members; or other processes. Modified Delphi (mD) study statements were created by the SDMPH presenters and then an internal focus group of lead authors discussed and edited these statements to meet the format of Delphi statements for the Stat59 statistical analysis platform (Stat59 Services Limited, Alberta, Canada). The initial 32 statements submitted by presenters included statements from the Public Health Extreme Events Research (PHEER) network (Presentation # 3) and Telemedicine (Presentation # 9) (\u003Ca class=\"xref table\" href=\"#tab1\"\u003ETable 1\u003C\u002Fa\u003E). These statements were excluded from consideration due to the Internal Focus Group determining that the total number of statements should ideally be less than 40 and both topic statements would attain consensus. In the end, statements were edited to fit the Delphi format leading to 38 statements to be presented to the Delphi Panel of SDMPH participants (\u003Ca class=\"xref table\" href=\"#tab2\"\u003ETable 2\u003C\u002Fa\u003E).\u003C\u002Fp\u003E\u003Cdiv class=\"table-wrap\" data-magellan-destination=\"tab2\" id=\"tab2\"\u003E\n\n\u003Cdiv class=\"caption\"\u003E\n\u003Cp class=\"p\"\u003E\u003Cspan class=\"label\"\u003ETable 2.\u003C\u002Fspan\u003E DELPHI Statement Review Process\u003C\u002Fp\u003E\n\u003C\u002Fdiv\u003E\n\u003Cspan\u003E\n\n\u003Cdiv class=\"figure-thumb\"\u003E\u003Cimg src=\"data:image\u002Fgif;base64,R0lGODlhAQABAIAAAMLCwgAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==\" data-src=\"https:\u002F\u002Fstatic.cambridge.org\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab2.png?pub-status=live\" class=\"aop-lazy-load-image\" width=\"1042\" height=\"531\" data-original-image=\"\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab2.png\" data-zoomable=\"true\"\u003E\u003C\u002Fdiv\u003E\n\u003C\u002Fspan\u003E\n\u003C\u002Fdiv\u003E\n\u003Cp class=\"p\"\u003E SDMPH participants, in-person and virtual, were asked to participate as mD experts in a 3-round mD survey study seeking consensus of statements regarding research activities, training, education, and\u002For competencies related to topics presented at the SDMPH (\u003Cem class=\"italic\"\u003En\u003C\u002Fem\u003E = 127). Also, Society members who were not attending were asked to participate in the Delphi (\u003Cem class=\"italic\"\u003En\u003C\u002Fem\u003E = 230). Introductory emails were sent November 21, 2024 explaining the project objectives and the mD to these potential mD experts.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E mD experts that agreed (\u003Cem class=\"italic\"\u003En\u003C\u002Fem\u003E = 37, 25 SDMPH participants and 12 Society members not participating) were sent an email from the Stat59 mD organizational program with a link to the Stat59 website consent page. Each mD expert registered an account, validated it, and was sent a new email to log into their secure webpage to begin the first mD expert consensus round no later than 1359 GMT 4 December 2023, the start of the SDMPH. mD experts that had not logged into the system were asked to verify their access and log in and asked to notify the author if they had not received the introductory email, with instructions on how to ensure future emails were received.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E Once the mD experts logged in, they were provided with a formal explanation of the mD methodology and informed consent was obtained. For informed consent (\u003Ca class=\"uri\" href=\"https:\u002F\u002Fwww.stat59.com\u002Fprojects\u002Fdelphi-consent-view?pid=503\"\u003ESupplemental Digital Content link to Stat59 Consent Page\u003C\u002Fa\u003E), participants were notified that they were anonymous volunteers who could withdraw at any time, that participation or withdrawal would not impact their employment, and that their data was secure (\u003Ca class=\"uri\" href=\"https:\u002F\u002Fwww.stat59.com\u002Fabout\u002Fsecurity\"\u003ESupplemental Digital Content link to Stat59 Security Page\u003C\u002Fa\u003E). mD experts received a reminder email to complete this first round before the round closed.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E The next page was the list of 38 statements with instructions to rate each statement on a 7-point linear numeric scale, where 1 = strongly disagree and 7 = strongly agree. With this initial set of statements, the mD expert was asked to answer 4 demographic questions. Consensus amongst mD experts was defined as a standard deviation ≤1.0. Statements that attained consensus after this first mD expert round were included in the final report.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E Each mD expert received an email from the Stat59 program on December 9, 2023 notifying them that the second round was open; reminder emails were sent before the close of the second round (December 19, 2023) from the author that asked participants to log back into their Stat59 page that showed the mean response of all the mD experts for each statement that did not attain consensus and their own response for that specific remaining statement; they were then asked to reconsider their 7-point linear numeric scale for these remaining statements.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E This process was repeated after the second mD expert round with statements that attained consensus included in the final report. The statements that did not attain consensus were advanced to the third and final round with the mD experts asked to reconsider these statements. Each mD expert received an email from the Stat59 program January 8, 2024 notifying them that the third and last round was open and reminder emails before the close of the third round January 18, 2024, similar to the above reminder emails. The third mD expert round produced statements that attained consensus to add to the first and second round consensus statements in the final report. Remaining statements after this third round were the final statements that did not attain consensus.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E The University of South Florida Institutional Review Board (Tampa, Florida, USA) determined STUDY006415 met the criteria for exemption.\u003C\u002Fp\u003E\n\u003C\u002Fdiv\u003E\n\u003Cdiv class=\"sec results\" data-magellan-destination=\"sec6\" id=\"sec6\"\u003E\n\u003Ch2 class=\"A\"\u003E Results\u003C\u002Fh2\u003E\n\u003Cp class=\"p\"\u003E As summarized in \u003Ca class=\"xref fig\" href=\"#fig1\"\u003EFigure 1\u003C\u002Fa\u003E, 37 mD experts (25 SDMPH participants and 12 Society members not participating) confirmed their participation, established a unique account on the Stat59, and completed the first mD expert round (\u003Ca class=\"xref table\" href=\"#tab3\"\u003ETable 3\u003C\u002Fa\u003E). The majority of experts were from North America; worked at a university, or were involved in research, education, and training; were physicians; and had over 10 years of experience.\u003C\u002Fp\u003E\u003Cdiv class=\"table-wrap\" data-magellan-destination=\"tab3\" id=\"tab3\"\u003E\n\n\u003Cdiv class=\"caption\"\u003E\n\u003Cp class=\"p\"\u003E\u003Cspan class=\"label\"\u003ETable 3.\u003C\u002Fspan\u003E Modified Delphi expert panel demographics\u003C\u002Fp\u003E\n\u003C\u002Fdiv\u003E\n\u003Cspan\u003E\n\n\u003Cdiv class=\"figure-thumb\"\u003E\u003Cimg src=\"data:image\u002Fgif;base64,R0lGODlhAQABAIAAAMLCwgAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==\" data-src=\"https:\u002F\u002Fstatic.cambridge.org\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab3.png?pub-status=live\" class=\"aop-lazy-load-image\" width=\"1042\" height=\"2614\" data-original-image=\"\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab3.png\" data-zoomable=\"true\"\u003E\u003C\u002Fdiv\u003E\n\u003C\u002Fspan\u003E\n\u003C\u002Fdiv\u003E\n\u003Csection\u003E\u003Cdiv class=\"fig\" data-magellan-destination=\"fig1\" id=\"fig1\"\u003E\n\n\n\u003Cdiv class=\"figure-thumb\"\u003E\u003Cimg src=\"data:image\u002Fgif;base64,R0lGODlhAQABAIAAAMLCwgAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==\" data-src=\"https:\u002F\u002Fstatic.cambridge.org\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_fig1.png?pub-status=live\" class=\"aop-lazy-load-image\" width=\"1454\" height=\"2301\" data-original-image=\"\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_fig1.png\" data-zoomable=\"true\"\u003E\u003C\u002Fdiv\u003E\n\u003Cdiv class=\"caption\"\u003E\u003Cp class=\"p\"\u003E \n\u003C\u002Fp\u003E\u003Cp class=\"p\"\u003E\u003Cspan class=\"label\"\u003EFigure 1.\u003C\u002Fspan\u003E RESULTS\u003C\u002Fp\u003E\n\u003C\u002Fdiv\u003E\u003C\u002Fdiv\u003E\u003C\u002Fsection\u003E\n\u003Cp class=\"p\"\u003E Twelve statements attained statistical significance with a standard deviation ≤1.0 after this first mD expert round, and achieved consensus (\u003Ca class=\"xref table\" href=\"#tab4\"\u003ETable 4\u003C\u002Fa\u003E, first round, first section in bold). The 26 statements that did not attain statistical significance, with standard deviation >1.0, were advanced to the second mD expert round.\u003C\u002Fp\u003E\u003Cdiv class=\"table-wrap\" data-magellan-destination=\"tab4\" id=\"tab4\"\u003E\n\n\u003Cdiv class=\"caption\"\u003E\n\u003Cp class=\"p\"\u003E\u003Cspan class=\"label\"\u003ETable 4.\u003C\u002Fspan\u003E Statements Attaining Consensus\u003C\u002Fp\u003E\n\u003C\u002Fdiv\u003E\n\u003Cspan\u003E\n\n\u003Cdiv class=\"figure-thumb\"\u003E\u003Cimg src=\"data:image\u002Fgif;base64,R0lGODlhAQABAIAAAMLCwgAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==\" data-src=\"https:\u002F\u002Fstatic.cambridge.org\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab4.png?pub-status=live\" class=\"aop-lazy-load-image\" width=\"2142\" height=\"2980\" data-original-image=\"\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab4.png\" data-zoomable=\"true\"\u003E\u003C\u002Fdiv\u003E\n\u003C\u002Fspan\u003E\n\u003C\u002Fdiv\u003E\n\u003Cp class=\"p\"\u003E Thirty-five mD experts completed the second mD expert round, with 15 of the 26 statements that advanced to the second mD expert round achieving consensus (\u003Ca class=\"xref table\" href=\"#tab4\"\u003ETable 4\u003C\u002Fa\u003E, second round middle section). The remaining 11 statements were unable to attain consensus and advanced to the third mD expert round.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E Thirty-four mD experts completed the third and final mD expert round, 8 of the remaining 11 statements achieved consensus, with a total of 35 statements achieving consensus. (\u003Ca class=\"xref table\" href=\"#tab4\"\u003ETable 4\u003C\u002Fa\u003E third round, last section in bold). The remaining 3 statements were unable to attain consensus after 3 mD expert rounds and were not recommended for consideration for future research guidance (\u003Ca class=\"xref table\" href=\"#tab5\"\u003ETable 5\u003C\u002Fa\u003E).\u003C\u002Fp\u003E\u003Cdiv class=\"table-wrap\" data-magellan-destination=\"tab5\" id=\"tab5\"\u003E\n\n\u003Cdiv class=\"caption\"\u003E\n\u003Cp class=\"p\"\u003E\u003Cspan class=\"label\"\u003ETable 5.\u003C\u002Fspan\u003E Statements for not attaining consensus\u003C\u002Fp\u003E\n\u003C\u002Fdiv\u003E\n\u003Cspan\u003E\n\n\u003Cdiv class=\"figure-thumb\"\u003E\u003Cimg src=\"data:image\u002Fgif;base64,R0lGODlhAQABAIAAAMLCwgAAACH5BAAAAAAALAAAAAABAAEAAAICRAEAOw==\" data-src=\"https:\u002F\u002Fstatic.cambridge.org\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab5.png?pub-status=live\" class=\"aop-lazy-load-image\" width=\"2142\" height=\"348\" data-original-image=\"\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary:20241126083512078-0873:S1935789324002519:S1935789324002519_tab5.png\" data-zoomable=\"true\"\u003E\u003C\u002Fdiv\u003E\n\u003C\u002Fspan\u003E\n\u003C\u002Fdiv\u003E\n\u003C\u002Fdiv\u003E\n\u003Cdiv class=\"sec\" data-magellan-destination=\"sec7\" id=\"sec7\"\u003E\n\u003Ch2 class=\"A\"\u003E Limitations\u003C\u002Fh2\u003E\n\u003Cp class=\"p\"\u003E The PHEER and Telemedicine statements that were not included in the study impacted the overall number of statements but had no other bearing on the study.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E The Delphi method seeks to arrive at group consensus by the aggregate of a panel of experts who rate a statement on a linear numeric scale. Franc et al. concluded that the sampling distribution tends to normality for sample sizes greater than or equal to 5. For Delphi studies using a 1-7 linear numeric scale, the use of the standard deviation for assessment of consensus and the mean for ranking is acceptable. Use of these parametric tests presents minimal risk of false consensus or of false ranking when compared to the non-parametric statistics of interquartile range and mean. This suggests that the linear 1-7 scale analyzed using the mean and standard deviation should become the preferred statistical method for Delphi studies.\u003Ca class=\"xref bibr\" href=\"#r5\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Franc, Hung and Pirisi\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E5\u003C\u002Fsup\u003E\u003C\u002Fa\u003E\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E Study participants were skewed to North America and were physicians. The impact on the data cannot be determined. Certainly, having more input from non-physicians with less experience and from low-middle income countries is the goal of future mD studies to impact statements that could potentially attain consensus to guide future disaster medicine and public health preparedness education, research, and training.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E The objective of the distribution of mD experts was to represent those involved with the education, training, and competencies of those who seek disaster risk reduction, disaster medicine response, or recovery as evidenced by their participation in the SDMPH or Society. The distribution of these mD experts favor those who had the means to attend the SDMPH or join the SDMPH, potentially impacting the study lacking the input from those from a resource-limited setting who could not attend or join.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E An essential component of the Central Limit Theorem is that the average of sample means will be the population mean, or if 1 finds the average of all of the standard deviations in the sample, then 1 will find the actual standard deviation for the population.\u003Ca class=\"xref bibr\" href=\"#r6\"\u003E\n\u003Csup class=\"sup\"\u003E6\u003C\u002Fsup\u003E\u003C\u002Fa\u003E This will hold true regardless of whether the source population is normal or skewed, provided the sample size is sufficiently large (usually ≥30, the number of mD experts in this study per round averaged 29.67).\u003Ca class=\"xref bibr\" href=\"#r7\"\u003E\n\u003Csup class=\"sup\"\u003E7\u003C\u002Fsup\u003E\u003C\u002Fa\u003E The application of the Central Limit Theorem to this study infers that the 35 statements that attained consensus can be recommended to guide presenters with their current and future research.\u003C\u002Fp\u003E\n\u003C\u002Fdiv\u003E\n\u003Cdiv class=\"sec discussion\" data-magellan-destination=\"sec8\" id=\"sec8\"\u003E\n\u003Ch2 class=\"A\"\u003E Discussion\u003C\u002Fh2\u003E\n\u003Cp class=\"p\"\u003E The theme of the SDMPH “Building the discipline of Disaster Medicine and Public Health” is to retain the lessons learned after an exercise or an actual incident for the participating agencies or organizations to improve their unique education, training, competencies and response. The first day of the SDMPH focused on climate change and conflict in disaster medicine. The second day featured presentations on ethics and artificial intelligence, devices and equipment, equipment and training.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E Short-term and long-term exposure to ambient air particle pollution cause a myriad of health and ecological effects (statements #1, 2).\u003Ca class=\"xref bibr\" href=\"#r8\"\u003E\n\u003Csup class=\"sup\"\u003E8\u003C\u002Fsup\u003E\u003C\u002Fa\u003E\n\u003Csup class=\"sup\"\u003E,\u003C\u002Fsup\u003E \u003Ca class=\"xref bibr\" href=\"#r9\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Rajak and Chattopadhyay\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E9\u003C\u002Fsup\u003E\u003C\u002Fa\u003E In particular, short-term exposures lasting hours to a few weeks and long-term exposures lasting months to years adversely affect cardiopulmonary health as evidenced by increased premature mortality, and hospitalization for cardiovascular disease (#1, 2).\u003Ca class=\"xref bibr\" href=\"#r10\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Chen, Warrington and Dominici\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E10\u003C\u002Fsup\u003E\u003C\u002Fa\u003E\n\u003Csup class=\"sup\"\u003E,\u003C\u002Fsup\u003E \u003Ca class=\"xref bibr\" href=\"#r11\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Su, Li and Xu\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E11\u003C\u002Fsup\u003E\u003C\u002Fa\u003E Individuals with prevalent heart disease, namely ischemic heart disease and heart failure, are at higher risk for having adverse health effects after exposure (#2).\u003Ca class=\"xref bibr\" href=\"#r12\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference de Bont, Jaganathan and Dahlquist\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E12\u003C\u002Fsup\u003E\u003C\u002Fa\u003E Wildland fire smoke is an important and growing source of particulate air pollution and is increasing overall average concentrations of fine particulate matter in most of the continental U.S. or at least arresting the overall improvement of air quality that has occurred over the next several years (#3).\u003Ca class=\"xref bibr\" href=\"#r13\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Cascio\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E13\u003C\u002Fsup\u003E\u003C\u002Fa\u003E Yet, few health care professionals educate their patients to modify their exposure risk highlighting the potential benefit of education (#4, 5).\u003Ca class=\"xref bibr\" href=\"#r14\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Rappold, Reyes and Pouliot\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E14\u003C\u002Fsup\u003E\u003C\u002Fa\u003E\n\u003Csup class=\"sup\"\u003E,\u003C\u002Fsup\u003E \u003Ca class=\"xref bibr\" href=\"#r15\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Engebretson, Hall and Blades\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E15\u003C\u002Fsup\u003E\u003C\u002Fa\u003E When questioned, the attendees showed strong agreement that the education of health care professionals should include training on the care of people affected by wildfire smoke and that health care systems should increase the care for patients affected by wildfire smoke (#17, 18). Similarly, study participants agreed that a transdisciplinary approach is required to anticipate and mitigate the impact of emerging risks of floods on public health systems due to compromised treatment and care for people with non-communicable diseases (#9, 23).\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E Humanitarian surgical care (HSC) in 21st-century armed conflict poses a complex nexus of challenges related to factors including shifting conflict dynamics, security constraints, and proliferation of unconventional actors within the humanitarian space.\u003Ca class=\"xref bibr\" href=\"#r16\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Wren, Wild and Gurney\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E16\u003C\u002Fsup\u003E\u003C\u002Fa\u003E\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E Study participants agreed that a focused approach is required to improve the quality of surgical care delivered to civilians in asymmetric conflict with forward surgical services with intact echelons of care to reduce mortality and morbidity (#19). The study participants agreed that HSC and the trauma stabilization point (TSP) should be considered to manage the full range of population needs including not only trauma-related but also non-traumatic emergencies (e.g., cesarean section), acute medical conditions, and uncomplicated minor injuries in addition to asymmetric warfare trauma (#12, 20, 24, 25).\u003Ca class=\"xref bibr\" href=\"#r17\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Chu, Stokes, Trelles and Ford\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E17\u003C\u002Fsup\u003E\u003C\u002Fa\u003E\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E Study participants agreed that coordination between military and other armed groups must be developed based on the humanitarian trauma system needs of non-combatant citizens, military, and other armed groups (#26). At present, surgical training in high-resource settings is not well-suited for this breadth.\u003Ca class=\"xref bibr\" href=\"#r18\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Lin, Dahm and Kushner\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E18\u003C\u002Fsup\u003E\u003C\u002Fa\u003E Study participants agreed that capacity and capability of the humanitarian trauma system should be based on available expertise of humanitarian responders and the local health care delivery system (#27). Standardized pre-deployment training and competency assessment in core HSC procedures may contribute to ensuring quality of care. To adequately benchmark care quality, it is necessary to establish a minimum dataset (MDS) with legitimate-use sharing agreements (#21).\u003Ca class=\"xref bibr\" href=\"#r19\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Wild and Wren\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E19\u003C\u002Fsup\u003E\u003C\u002Fa\u003E Development of risk-adjusted perioperative mortality calculators for resource-constrained environments may support this process.\u003Ca class=\"xref bibr\" href=\"#r20\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Wild, Stewart and LeBoa\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E20\u003C\u002Fsup\u003E\u003C\u002Fa\u003E Due to the high-threat environments in which HSC often occurs, there has been increased engagement from non-traditional actors.\u003Ca class=\"xref bibr\" href=\"#r21\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Gurney, Graf and Staudt\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E21\u003C\u002Fsup\u003E\u003C\u002Fa\u003E Establishing transparent credentialing and training in international humanitarian law (IHL) among all actors providing HSC in conflict may help ensure protection of humanitarian principles (#22).\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E Over the last 10 years ethical challenges presented and the rise of artificial intelligence provided disaster medicine researchers fertile subject matter to pursue. Three statements related to ethical issues with artificial intelligence (AI) in disasters attained consensus. Statement #34 noted that the ethical issues with AI for mass casualty incidents have not been thoroughly analyzed as examples are growing of specific situations where AI has been deployed during disasters without due consideration of its ethical considerations. These include cases where concerns about privacy and confidentiality of data occurred.\u003Ca class=\"xref bibr\" href=\"#r22\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Bhardwaj\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E22\u003C\u002Fsup\u003E\u003C\u002Fa\u003E Another concern relates to the quality of datasets used to train AI.\u003Ca class=\"xref bibr\" href=\"#r23\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Velev and Zlateva\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E23\u003C\u002Fsup\u003E\u003C\u002Fa\u003E\n\u003Csup class=\"sup\"\u003E,\u003C\u002Fsup\u003E \u003Ca class=\"xref bibr\" href=\"#r24\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Fan, Zhang and Yahja\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E24\u003C\u002Fsup\u003E\u003C\u002Fa\u003E\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E Statement #11 about biases in datasets raising serious ethical concerns attained consensus and affirmed the importance of research into this issue. Given that many disasters occur in low-income countries, issues of justice need research related to AI. Nature carried a headline accompanying the release of a 2024 World Health Organization (WHO) report into the ethics of AI stating, “Medical AI could be ‘dangerous’ for poorer nations.”\u003Ca class=\"xref bibr\" href=\"#r25\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Adam\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E25\u003C\u002Fsup\u003E\u003C\u002Fa\u003E Statement #33 attained consensus, agreeing that AI may not benefit those impacted by disasters in low-income countries as much as those in higher-income countries. Further research is needed to examine and mitigate such disparities.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E Many other ethical issues remain under-investigated with analysis urgently needed to avoid undermining AI’s potential benefits. With regards to the need for encryption of patient identifiers in AI tools, the study participants attained consensus with strong support (mean 6.6, SD 0.8) (#2). The study participants showed moderate support (mean 5.5, SD 0.9) for the need for strict statistical validation of AI tools prior to implementation (#29). In contrast, study participants showed weak support (mean 3, SD 1) for the replacement of traditional printed disaster plans with AI guided just in time interfaces (#30). Though each statement attained consensus, additional studies in concert with developing ethical solutions should foster more dedicated research of AI models.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E Defense Advanced Research Projects Agency’s (DARPA’s) In the Moment (ITM) program will leverage insights from the statements that did [#6] and did not attain consensus (Not #1, 2). ITM research will assess how human decision-makers’ perceptions of an AI algorithm’s competence, value alignment and\u002For other factors might make a human decision-maker more likely to delegate a decision to the AI algorithm. ITM will also assess how the decision to delegate may vary depending on environmental conditions and\u002For personal context. DARPA shared insights from the study with the program’s performers. The insights will also inform the program’s Ethical, Legal, and Societal Implications (ELSI) processes through panel discussions at ITM workshops. The workshops are part of DARPA’s outreach to policymakers and practitioners.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E Development, creation, and subsequent implementation of devices in the disaster medicine setting impose additional layers of ethical and practical considerations. The value of point-of-care ultrasound technology in the prehospital and resource-scarce environment is evident (#32) but finding ways to share this technology and knowledge through effective training programs has challenges that include sustainability and quality assurance once the training programs have concluded. One potential feasible solution to this challenge is the use of virtual meeting platforms and remote image review as quality assurance measures once the technology is implemented in a community (#16). These measures provide a means to also gauge impact of training programs and should be incorporated into training programs during the early planning stages in coordination with the host communities as standard practice. With the implementation of programs, sustainability should be an important consideration, but consensus was not attained on whether sustainability should impact the decision to implement a point-of-care ultrasound training program in specific communities (Not #3). This may be partially due to the ethical dilemma of withholding lifesaving technology that could impact mortality from a community during a time of need, such as a sudden-onset disaster or conflict.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E Historically, after action reports (AARs) of exercises and incidents with long scene or transport times have identified gaps determining which patients require lifesaving interventions (LSI) and priority transport with the demand of patients exceeding the supply of monitoring devices. As the discipline of disaster medicine has grown over the last 10 years, government agencies cognizant of these AARs have dedicated research to address these gaps. Study participants support the design and creation of patient monitoring devices utilized in an MCI to enhance LSI and priority transport (#3, 4). Scene safety, ingress and egress routes, the placement of casualty collection points, advanced medical posts, transportation staging, incident command, and identification of patients in the continuous triage process of an MCI can be assisted by drones (#31). Data collected and stored by patient monitoring devices can be analyzed retrospectively to identify trends to improve prehospital processes during MCI responses (#5).\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E The \u003Ca class=\"uri\" href=\"https:\u002F\u002Fwww.nightingale-triage.eu\u002F\"\u003ENIGHTINGALE\u003C\u002Fa\u003E research and innovation project funded by the European Union’s Horizon 2020 program convened experts in technology, research, medical practitioners, and leading organizations in Europe that specialize in MCI response. The objectives include to: (1) upgrade evaluation of injured and affected populations (triage) using digital identification, traceability, fast diagnosis, continuous monitoring, and accurate classification of medical conditions; (2) optimize pre-hospital LSI and enhance utilization of assets, resources and capacities using AI-based solutions; and (3) enable shared response across emergency services and communication between emergency teams and with patients by developing augmented reality tools for first responders. This is consistent with the statement that prehospital MCI response training should be delivered to all first responders (#28).\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E High-fidelity simulation MCI response training will lead to evidenced-based practices for education and training of both civilian and conflict responders to enhance trainees’ stress tolerance and will accelerate trainees’ professional identity development (#8, 14, 15). As the discipline of disaster medicine has advanced, the recognition that responders are able to focus their attention through practices such as mindfulness breathing has led to research with military medical students investigating whether mindfulness-based practice can improve performance while under stress.\u003Ca class=\"xref bibr\" href=\"#r26\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Cole and Bronstein\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E26\u003C\u002Fsup\u003E\u003C\u002Fa\u003E The Sendai Framework calls for disaster medicine education to be incorporated into standard health professional medical curriculums consistent with the study participants’ acknowledgement that high-fidelity MCI response simulation training increases readiness for deployment (#7, 13).\u003Ca class=\"xref bibr\" href=\"#r27\"\u003E\u003Cspan class=\"show-for-sr\"\u003EReference Sakurai and Sato\u003C\u002Fspan\u003E\n\u003Csup class=\"sup\"\u003E27\u003C\u002Fsup\u003E\u003C\u002Fa\u003E In addition, future studies should measure MCI response readiness outcomes during simulation within both civilian and conflict settings.\u003C\u002Fp\u003E\n\u003Cp class=\"p\"\u003E Scenario based simulation for MCIs and HCRs should become more accessible along with training on the use of rapid systematic assessment tools. Together these would maximize health care readiness for deployment to help ensure dynamic data-driven decisions are made with high confidence levels. A tool that could provide the template to support such a capability is the \u003Ca class=\"uri\" href=\"https:\u002F\u002Fwww.undrr.org\u002Fmedia\u002F88207\u002Fdownload?startDownload=20240816\"\u003EUnited Nations Public Health System Resilience Scorecard\u003C\u002Fa\u003E (Scorecard) (#10). The Scorecard is versatile, scalable, and could be easily modified. It is well suited to gather insights systematically and rapidly on needs and priorities using a consensus-based approach to determine which priority actions and needs from earlier planning should be kept or removed prior to deployment. The Scorecard process is designed to ensure a multidisciplinary team discussion and systemwide exploration of healthcare mission readiness, providing a high level of confidence of what is needed for success.\u003C\u002Fp\u003E\n\u003C\u002Fdiv\u003E\n\u003Cdiv class=\"sec conclusions\" data-magellan-destination=\"sec9\" id=\"sec9\"\u003E\n\u003Ch2 class=\"A\"\u003E Conclusion\u003C\u002Fh2\u003E\n\u003Cp class=\"p\"\u003E This study demonstrates how an mD conducted at a professional association conference with the objective to provide a forum for presenters conducting research in disaster risk reduction, disaster medicine response, and recovery can provide consensus statements to guide the presenter’s current and future research to advance education, training, and competencies.\u003C\u002Fp\u003E\n\u003C\u002Fdiv\u003E\n\u003C\u002Fdiv\u003E\n\u003Cdiv class=\"back\"\u003E\n\u003Cdiv class=\"notes supplementary-material\" data-magellan-destination=\"nts1\" id=\"nts1\"\u003E\n\u003Ch2 class=\"A\"\u003ESupplementary material\u003C\u002Fh2\u003E\n\u003Cp class=\"p\"\u003E The supplementary material for this article can be found at \u003Ca class=\"uri\" href=\"http:\u002F\u002Fdoi.org\u002F10.1017\u002Fdmp.2024.251\"\u003Ehttp:\u002F\u002Fdoi.org\u002F10.1017\u002Fdmp.2024.251\u003C\u002Fa\u003E.\u003C\u002Fp\u003E\n\u003C\u002Fdiv\u003E\n\u003Cdiv class=\"sec\" data-magellan-destination=\"sec10\" id=\"sec10\"\u003E\n\u003Ch2 class=\"A\"\u003E Author contributions\u003C\u002Fh2\u003E\n\u003Cp class=\"p\"\u003E ESW: concept, delphi, edit statements, wrote manuscript and abstract, and maintained manuscript review and edits, references; JC, FB: concept, edited statements, reviewed and edited manuscript; HW, RC, JR, JF: presented at the SDMPH, submitted and edited statements, reviewed and edited manuscript; TB: presented at the SDMPH, edited statements, reviewed and edited manuscript; DO, WC: presented at the SDMPH, submitted and edited statements, reviewed manuscript; AW, MV: edited statements, reviewed and edited manuscript; MC, DE: presented at the SDMPH; EH: IRB lead; AJ: concept and oversight.\u003C\u002Fp\u003E\n\u003C\u002Fdiv\u003E\n\u003Cdiv class=\"ack\"\u003E\n\u003Ch2 class=\"A\"\u003E Acknowledgements\u003C\u002Fh2\u003E\n\u003Cp class=\"p\"\u003E With our sincere appreciation for their time and expertise, we thank the experts who consented to be acknowledged and those that did not consent: Rita Burke, Terry Donat, Romeo Fairley, Brian Flynn, David Glotzer, James Gosney, Heather Hayanga, Mariana Helou, Mayumi Kako, Deborah Kim, Allison Latif, Melissa Leming, Shawn Metzner, Veselin Mitrović, Chaverle Noel, Frederick Nolting, Georgina Nouaime, Chiadi Onwuka, Matteo Paganini, Luis Rios, Jamla Rizek, Jeff Rubin, Elias Saade, Cheryl Schmidt, Yasir Shafiq, Mark Shah, Eman Shaikh, Angelika Underwood, Nunzio Zotti. With profound humility and gracious appreciation: We thank Alice O’Donnell for her support and focus. We graciously thank Dr. James James for his vision and dedication to the SDMPH. We thank Dr. Frederick “Skip” Burkle for his altruism and perspicacity as we stand on your shoulders.\u003C\u002Fp\u003E\n\u003C\u002Fdiv\u003E\n\n\u003C\u002Fdiv\u003E\n\u003C\u002Fdiv\u003E",tableOfContent:[{level:i,current:a,title:"\u003Cdiv class=\"toc-title\"\u003EObjectives\u003C\u002Fdiv\u003E",url:"sec1"},{level:i,current:a,title:"\u003Cdiv class=\"toc-title\"\u003EMethods\u003C\u002Fdiv\u003E",url:"sec2"},{level:i,current:a,title:D,url:"sec3"},{level:i,current:a,title:"\u003Cdiv class=\"toc-title\"\u003EConclusions\u003C\u002Fdiv\u003E",url:"sec4"},{level:i,current:a,title:"\u003Cdiv class=\"toc-title\"\u003EMethodology\u003C\u002Fdiv\u003E",url:"sec5"},{level:i,current:a,title:D,url:"sec6"},{level:i,current:a,title:"\u003Cdiv class=\"toc-title\"\u003ELimitations\u003C\u002Fdiv\u003E",url:"sec7"},{level:i,current:a,title:"\u003Cdiv class=\"toc-title\"\u003EDiscussion\u003C\u002Fdiv\u003E",url:"sec8"},{level:i,current:a,title:"\u003Cdiv class=\"toc-title\"\u003EConclusion\u003C\u002Fdiv\u003E",url:"sec9"},{level:i,current:a,title:"\u003Cdiv class=\"toc-title\"\u003EAuthor contributions\u003C\u002Fdiv\u003E",url:"sec10"}],footnotes:[],fulltextNotes:[],references:[{id:"r1",displayNumber:E,existInContent:c,content:"\u003Cspan class=\"string-name\"\u003E\u003Cspan class=\"surname\"\u003ERyan\u003C\u002Fspan\u003E, \u003Cspan class=\"given-names\"\u003EBJ\u003C\u002Fspan\u003E\u003C\u002Fspan\u003E, \u003Cspan class=\"string-name\"\u003E\u003Cspan class=\"surname\"\u003EKako\u003C\u002Fspan\u003E, \u003Cspan class=\"given-names\"\u003EM\u003C\u002Fspan\u003E\u003C\u002Fspan\u003E, \u003Cspan class=\"string-name\"\u003E\u003Cspan class=\"surname\"\u003EGarner\u003C\u002Fspan\u003E, \u003Cspan class=\"given-names\"\u003ES\u003C\u002Fspan\u003E\u003C\u002Fspan\u003E, \u003Cspan class=\"etal\"\u003Eet al.\u003C\u002Fspan\u003E \u003Cspan class=\"article-title\"\u003EPrioritizing strategies for building the resilience of Public 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Scholar\u003C\u002Fa\u003E",item:[{googleScholarLink:"https:\u002F\u002Fscholar.google.com\u002Fscholar_lookup?title=Promoting+education+for+disaster+resilience+and+the+Sendai+Framework+for+Disaster+Risk+Reduction&author=Sakurai+A&author=Sato+T.&publication+year=2016&journal=J+Disaster+Res.&volume=11&doi=10.20965%2Fjdr.2016.p0402&pages=402-412",openUrlParams:{genre:g,atitle:aZ,jtitle:a_,title:a_,volume:ad,artnum:"674588431921644800fd8066",spage:"402",epage:"412",date:av,sid:f,aulast:b,aufirst:b,doi:a$,au:b},innerRefId:"ref27",title:aZ,doi:a$,crossRefLink:"https:\u002F\u002Fdx.doi.org\u002F10.20965\u002Fjdr.2016.p0402",pubMedLink:b}]}],figures:[{contentId:"tab1",label:"Table 1.",description:"\u003Cspan class=\"p\"\u003ESDMPH Conference Presentations\u003C\u002Fspan\u003E",thumbnailSrc:"https:\u002F\u002Fstatic.cambridge.org\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary-alt:20241126083604-57755-mediumThumb-png-S1935789324002519_tab1.jpg",enlargedSrc:"https:\u002F\u002Fstatic.cambridge.org\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary-alt:20241126083604-29529-optimisedImage-png-S1935789324002519_tab1.jpg",attrib:[]},{contentId:"tab2",label:"Table 2.",description:"\u003Cspan class=\"p\"\u003EDELPHI Statement Review Process\u003C\u002Fspan\u003E",thumbnailSrc:"https:\u002F\u002Fstatic.cambridge.org\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary-alt:20241126083604-62050-mediumThumb-png-S1935789324002519_tab2.jpg",enlargedSrc:"https:\u002F\u002Fstatic.cambridge.org\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary-alt:20241126083604-61374-optimisedImage-png-S1935789324002519_tab2.jpg",attrib:[]},{contentId:"tab3",label:"Table 3.",description:"\u003Cspan class=\"p\"\u003EModified Delphi expert panel demographics\u003C\u002Fspan\u003E",thumbnailSrc:"https:\u002F\u002Fstatic.cambridge.org\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary-alt:20241126083604-92722-mediumThumb-png-S1935789324002519_tab3.jpg",enlargedSrc:"https:\u002F\u002Fstatic.cambridge.org\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary-alt:20241126083604-12771-optimisedImage-png-S1935789324002519_tab3.jpg",attrib:[]},{contentId:"fig1",label:"Figure 1.",description:"\u003Cspan class=\"p\"\u003ERESULTS\u003C\u002Fspan\u003E",thumbnailSrc:"https:\u002F\u002Fstatic.cambridge.org\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary-alt:20241126083604-49300-mediumThumb-png-S1935789324002519_fig1.jpg",enlargedSrc:"https:\u002F\u002Fstatic.cambridge.org\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary-alt:20241126083604-07375-optimisedImage-png-S1935789324002519_fig1.jpg",attrib:[]},{contentId:"tab4",label:"Table 4.",description:"\u003Cspan class=\"p\"\u003EStatements Attaining Consensus\u003C\u002Fspan\u003E",thumbnailSrc:"https:\u002F\u002Fstatic.cambridge.org\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary-alt:20241126083604-02191-mediumThumb-png-S1935789324002519_tab4.jpg",enlargedSrc:"https:\u002F\u002Fstatic.cambridge.org\u002Fbinary\u002Fversion\u002Fid\u002Furn:cambridge.org:id:binary-alt:20241126083604-94384-optimisedImage-png-S1935789324002519_tab4.jpg",attrib:[]},{contentId:"tab5",label:"Table 5.",description:"\u003Cspan class=\"p\"\u003EStatements for not attaining 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J Surg.","S1935789324002519","Disaster Medicine and Public Health Preparedness","article_dmp_ind_pur","2024","5","SDMPH 10-year Anniversary Conference Modified Delphi Study","Department of Emergency Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA","CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Novara, Italy",0,"18","unknown","2021","03D33CB340FE0698DCD12DE4F229787A","disaster-medicine-and-public-health-preparedness","\u002Fcore\u002Fjournals\u002Fdisaster-medicine-and-public-health-preparedness","Volume 18","\u002Fcore\u002Fjournals\u002Fdisaster-medicine-and-public-health-preparedness\u002Fvolume\u002FB4BDDE64E8E1C7D85A7C176762D9E977","en","\u003Cdiv class=\"toc-title\"\u003EResults\u003C\u002Fdiv\u003E","1","Prioritizing strategies for building the resilience of Public Health Systems to disasters across multiple communities and countries","Int J Disaster Risk Sci.","15","17","10.1007\u002Fs13753-024-00537-x","The delphi method: Substance, context, a critique and an annotated bibliography","Soc Econ Plann Sci.","10.1016\u002F0038-0121(71)90041-3","A critical review of the Delphi technique as a research methodology for nursing","Int J Nurs Stud.","10.1016\u002FS0020-7489(00)00044-4","Use of Delphi in health sciences research: a narrative review","Medicine (Baltimore).","10.1097\u002FMD.0000000000032829","Analysis of delphi study 7-point linear scale data by parametric methods: use of the mean and standard deviation","Methodol Innovations.","16","10.1177\u002F20597991231179393","8","Short and long term exposure to ambient air pollution and impact on health in India: a systematic review","Int J Environ Health Res.","2020","10.1080\u002F09603123.2019.1612042","Temporal variation in association between short-term exposure to fine particulate matter and hospitalizations in older adults in the USA: a long-term time-series analysis of the US Medicare dataset","Lancet Planet Health.","10.1016\u002FS2542-5196(21)00168-6","11","Associations between short-term and long-term exposure to particulate matter and preterm birth","Chemosphere.","10.1016\u002Fj.chemosphere.2022.137431","Ambient air pollution and cardiovascular diseases: an umbrella review of systematic reviews and meta-analyses","J Intern Med.","2022","10.1111\u002Fjoim.13467","Wildland fire smoke and human health","Sci Total Environ.","2018","10.1016\u002Fj.scitotenv.2017.12.086","Community vulnerability to health impacts of wildland fire smoke exposure","Environ Sci Technol.","10.1021\u002Facs.est.6b06200","Characterizing public tolerance of smoke from wildland fires in communities across the United States","Journal of Forestry.","114","2016","10.5849\u002Fjof.14-142","A consensus framework for the humanitarian surgical response to armed conflict in 21st century warfare","JAMA Surg.","10.1001\u002Fjamasurg.2019.4547","Improving effective surgical delivery in 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Published online October","Challenges of artificial intelligence application for Disaster Risk Management","The International Archives of the Photogrammetry, Remote Sensing and Spatial Information Sciences","10.5194\u002Fisprs-archives-XLVIII-M-1-2023-387-2023","Disaster City Digital Twin: A Vision for integrating artificial and human Intelligence for disaster management","Int J Inf Manag.","10.1016\u002Fj.ijinfomgt.2019.102049","Medical AI Could be “Dangerous” for Poorer Nations, Who Warns","Nature News. Published January","Stress and resilience among military medical students completing a high-fidelity military medical simulation","Int J Healthc Simul","Promoting education for disaster resilience and the Sendai Framework for Disaster Risk Reduction","J Disaster Res.","10.20965\u002Fjdr.2016.p0402","Weinstein et al. supplementary material"));</script><script src="/core/page-component/06cd607.js" defer></script><script src="/core/page-component/20147ec.js" defer></script><script src="/core/page-component/66884fb.js" defer></script><script src="/core/page-component/6f4302c.js" defer></script> </div> </div> <div id="article-new-home-productCitations" class="product-citations-modal reveal-modal medium" data-reveal role="dialog" aria-labelledby="article-new-home-citedByModalHeader"> <div class="header"> <div class="heading_07 margin-bottom" id="article-new-home-citedByModalHeader">Cited by</div> </div> <div class="citation-content"> <div class="row collapse header margin-top 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Weinstein&eventCode=SE-AU" class="more-by-this-author ">Eric S. Weinstein</a><a target="_blank" class="orcid-logo " href="https://orcid.org/0000-0002-1147-5656" aria-label="Open the ORCID record for Eric S. 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class="more-by-this-author ">Wayne Cascio</a> <sup data-affiliation-id="a15" class="">(a15)</sup><span class="separator ">, </span><a href="/core/search?filters%5BauthorTerms%5D=Anja Westman&eventCode=SE-AU" class="more-by-this-author ">Anja Westman</a><a target="_blank" class="orcid-logo " href="https://orcid.org/0000-0002-2794-5026" aria-label="Open the ORCID record for Anja Westman in new tab/window"></a> <sup data-affiliation-id="a16" class="">(a16)</sup><span class="separator ">, </span><a href="/core/search?filters%5BauthorTerms%5D=Manuela Verde&eventCode=SE-AU" class="more-by-this-author ">Manuela Verde</a><a target="_blank" class="orcid-logo " href="https://orcid.org/0000-0003-0476-1723" aria-label="Open the ORCID record for Manuela Verde in new tab/window"></a> <sup data-affiliation-id="a3" class="">(a3)</sup><span class="separator ">, </span><a href="/core/search?filters%5BauthorTerms%5D=Marta Caviglia&eventCode=SE-AU" class="more-by-this-author ">Marta Caviglia</a> <sup 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If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. <a href="/core/help">Find out more about saving content to Google Drive</a>. </p> </div> </div> <div class="row book-title"> <div class="small-12 columns"> <div class="heading_08"><div class="title">SDMPH 10-year Anniversary Conference Modified Delphi Study</div></div> </div> </div> <div class="row book-details book-overview"> <div class="small-12 columns"> <ul> <li class="volume-issue">Volume 18</li> <li class="author"> <a href="/core/search?filters%5BauthorTerms%5D=Eric S. Weinstein&eventCode=SE-AU" class="more-by-this-author ">Eric S. Weinstein</a><a target="_blank" class="orcid-logo " href="https://orcid.org/0000-0002-1147-5656" aria-label="Open the ORCID record for Eric S. 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Wild&eventCode=SE-AU" class="more-by-this-author ">Hannah B. Wild</a><a target="_blank" class="orcid-logo " href="https://orcid.org/0000-0003-0974-0956" aria-label="Open the ORCID record for Hannah B. Wild in new tab/window"></a> <sup data-affiliation-id="a7" class="">(a7)</sup> <sup data-affiliation-id="a8" class="">(a8)</sup><span class="separator ">, </span><a href="/core/search?filters%5BauthorTerms%5D=Rebekah Cole&eventCode=SE-AU" class="more-by-this-author ">Rebekah Cole</a> <sup data-affiliation-id="a9" class="">(a9)</sup><span class="separator ">, </span><a href="/core/search?filters%5BauthorTerms%5D=Tehnaz Boyle&eventCode=SE-AU" class="more-by-this-author ">Tehnaz Boyle</a><a target="_blank" class="orcid-logo " href="https://orcid.org/0000-0003-0328-3002" aria-label="Open the ORCID record for Tehnaz Boyle in new tab/window"></a> <sup data-affiliation-id="a10" class="">(a10)</sup><span class="separator ">, </span><a href="/core/search?filters%5BauthorTerms%5D=Jessica Ryder&eventCode=SE-AU" class="more-by-this-author ">Jessica Ryder</a> <sup data-affiliation-id="a11" class="">(a11)</sup><span class="separator ">, </span><a href="/core/search?filters%5BauthorTerms%5D=Jeffrey 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class="more-by-this-author ">Wayne Cascio</a> <sup data-affiliation-id="a15" class="">(a15)</sup><span class="separator ">, </span><a href="/core/search?filters%5BauthorTerms%5D=Anja Westman&eventCode=SE-AU" class="more-by-this-author ">Anja Westman</a><a target="_blank" class="orcid-logo " href="https://orcid.org/0000-0002-2794-5026" aria-label="Open the ORCID record for Anja Westman in new tab/window"></a> <sup data-affiliation-id="a16" class="">(a16)</sup><span class="separator ">, </span><a href="/core/search?filters%5BauthorTerms%5D=Manuela Verde&eventCode=SE-AU" class="more-by-this-author ">Manuela Verde</a><a target="_blank" class="orcid-logo " href="https://orcid.org/0000-0003-0476-1723" aria-label="Open the ORCID record for Manuela Verde in new tab/window"></a> <sup data-affiliation-id="a3" class="">(a3)</sup><span class="separator ">, </span><a href="/core/search?filters%5BauthorTerms%5D=Marta Caviglia&eventCode=SE-AU" class="more-by-this-author ">Marta Caviglia</a> <sup 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r="17.5"/> <path fill="#0072CF" d="M20.4 25.3V15.2h-4.9v2.2h1.1v7.9h-1.1v2.2h6v-2.2h-1.1zm-1.9-11.4c1 0 1.9-1 1.9-2.2 0-1.2-.8-2.2-1.9-2.2s-1.9 1-1.9 2.2c0 1.2.9 2.2 1.9 2.2z"/> </svg> </a> </span> <div id="comment-conflict-tip" data-dropdown-content role="dialog" aria-modal="true" aria-hidden="true" tabindex="-1" class="f-dropdown content medium" data-remove-focus="true" aria-label="Conflicting interests information"> <div class="close-container"> <a href="#" class="button small transparent-no-border radius tooltip-close-btn" id="tooltip-close-link-comment-conflict-tip"> <span class="custom-tooltip-button-remove"> <span class="sr-only">Close Conflicting interests help</span> <svg width="20" height="20" viewBox="0 0 20 20" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" aria-hidden="true" focusable="false"> <defs> <path d="M9.986 0C4.479 0 0 4.434 0 9.916c0 5.469 4.465 9.916 9.986 9.916 5.507 0 9.986-4.433 9.986-9.916C19.958 4.434 15.493 0 9.986 0z" 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Please also list any non-financial associations or interests (personal, professional, political, institutional, religious or other) that a reasonable reader would want to know about in relation to the submitted work. 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fill="#0072CF" d="M20.4 25.3V15.2h-4.9v2.2h1.1v7.9h-1.1v2.2h6v-2.2h-1.1zm-1.9-11.4c1 0 1.9-1 1.9-2.2 0-1.2-.8-2.2-1.9-2.2s-1.9 1-1.9 2.2c0 1.2.9 2.2 1.9 2.2z"/> </svg> </a> </span> <div id="comment-email-tip_--x--" data-dropdown-content role="dialog" aria-modal="true" aria-hidden="true" tabindex="-1" class="f-dropdown content medium" data-remove-focus="true" aria-label="Email information"> <div class="close-container"> <a href="#" class="button small transparent-no-border radius tooltip-close-btn" id="tooltip-close-link-comment-email-tip_--x--"> <span class="custom-tooltip-button-remove"> <span class="sr-only">Close Email help</span> <svg width="20" height="20" viewBox="0 0 20 20" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink" aria-hidden="true" focusable="false"> <defs> <path d="M9.986 0C4.479 0 0 4.434 0 9.916c0 5.469 4.465 9.916 9.986 9.916 5.507 0 9.986-4.433 9.986-9.916C19.958 4.434 15.493 0 9.986 0z" id="a-comment-email-tip_--x--"/> <mask 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