German Institute for Disaster Medicine

Chronic wounds represent a major clinical challenge due to persistent infection, excessive inflammation, impaired angiogenesis, and defective tissue remodeling. Carbon dots (CDs)-based nanomaterials are promising candidates for addressing these issues, owing to their unique physicochemical properties, tunable surface functionalities, and excellent enzyme-mimetic activities. This review presents a comprehensive overview of recent advances in CDs-based nanomaterials for chronic wound repair under a framework from fundamental principles to translational applications. We first outline the pathophysiological features of chronic wounds and summarize the classification, synthesis, and functionalization strategies of CDs. We then elaborate on the rational design of CDs-based nanomaterials, including stimuli-responsive systems, nanozymes, and multifunctional composites. The multilevel therapeutic mechanisms are dissected, covering infection control, selective ROS scavenging, inflammatory modulation, angiogenesis, and extracellular matrix remodeling. We further highlight applications in real-time wound monitoring, dynamic phase-adaptive therapy, and smart dressings. Key challenges remain in scalable synthesis, long-term biosafety, and clinical translation. Future efforts should focus on green synthesis, engineering optimization, and AI-assisted development to link laboratory research with clinical practice. This review provides a systematic roadmap for the design and translation of next-generation CDs-based wound therapies.

Dynamic Patient and Situation Simulation in the Context of Mass Casualty Incidents -Insights from the Research Projects D2PuLs and D2PuLs PRO builds directly on this approach by presenting a modular digital training environment for mass-casualty incidents. Dynamic patient models, which react physiologically to interventions, are linked with situation and manikin simulators so that complete rescue chains-from prehospital triage to in-hospital trauma carecan be trained. The study demonstrates that such digital simulations can supplement resource-intensive live exercises and generate detailed data for debriefing and quality improvement.The systematic review Extended Reality Technology for Emergency Medical Service Training: Systematic Review adds an evidence-synthesis perspective on immersive training tools. The review reports that virtual, augmented, and mixed-reality applications can improve engagement, perceived realism, and skill acquisition in emergency medical services, especially for rare or high-risk scenarios. At the same time, it highlights methodological limitations of existing studies and practical barriers such as ergonomic issues, user fatigue, and technical instability. Taken together, these three articles support the role of simulation and extended reality as important elements of disaster preparedness, while emphasising the need for structured curricular integration and robust evaluation.A second set of contributions focuses on artificial intelligence (AI) and data-driven decision support. Applications of Artificial Intelligence-Guided Clinical Decision Support in Disaster Medicine: An International Delphi Study explores, using a Delphi process, which AI functions are prioritised by disaster medicine experts. The study finds broad agreement that AI is particularly useful for improving situational awareness and logistics-such as estimating affected populations, supporting hazard vulnerability analysis, allocating scarce resources, and optimising patient distribution-whereas there is significantly more caution regarding AI involvement in ethically sensitive triage or end-of-life decisions. These results provide important guidance for the design of AI systems that align with practitioner expectations.Anomaly detection and early risk identification in digital disaster response-based on deep learning in public health proposes a deep-learning framework to identify aberrant patterns in health-related data streams. By combining temporal and contextual modelling, the approach improves detection performance and reduces false alarms in comparison with traditional methods, illustrating how AI can support early recognition of emerging threats in digital operations centres. Filling the gap: Artificial Intelligence-driven One Health integration to strengthen pandemic preparedness in resource-limited settings extends the focus to One Health. This article discusses AI-enabled architectures that integrate human, animal, and environmental data for improved surveillance in low-and middle-income countries, and emphasises governance, capacity building, and offline-capable, context-sensitive tools as prerequisites for effective deployment. Finally, The Information Challenge in Public Health Crises: A Study on the reliability and readability of information provided by large language model for thunderstorm asthma examines large language models as direct information sources in crises. By assessing reliability and readability of responses to questions on thunderstorm asthma, the study shows that, although medically relevant content can often be generated, readability frequently exceeds recommended levels for lay audiences and quality differs between systems. The authors conclude that current models should not be used as unsupervised tools for public crisis communication and that professional review and adaptation to target groups are essential.Overall, the eleven articles in this Research Topic demonstrate that digital innovations already contribute to multiple core domains of disaster medicine: competence development through simulation and extended reality, AI-supported situational awareness and One Health surveillance, new service-delivery models via telemedicine and drones, and enhanced information processing using sentiment analysis, named entity recognition, and large language models. At the same time, they consistently show that technological sophistication alone is insufficient. Acceptance by professionals, integration into organisational structures, rigorous evaluation in real-world environments, ethical and legal governance, and a strong focus on equity-particularly in resource-limited settings-are decisive for whether digital tools will truly bridge gaps and improve outcomes in disasters.

Background: Schistosome egg deposition in pregnant women may affect the placenta of infected mothers and cause Placental Schistosomiasis (PS). Histopathological examination of placental tissue is an inadequate detection method due to low sensitivity. So far, there has not been any sys-tematic review on PS. Methods: We conducted a systematic literature search on PubMed and in-cluded relevant secondary literature found in the citations of the primarily included publications. Results: We found a total of 8 publications describing PS with a total of 92 cases, describing egg deposition of dead and/or viable eggs and worms of S. haematobium and S. mansoni in placental tissue. One cross-sectional study investigating the prevalence of PS and its association to adverse birth outcomes, found 22% of placentas to be infested using a maceration technique but only < 1% using histologic examination. Additionally, no direct link to deleterious pregnancy outcomes could be shown. Conclusions: PS is a highly unattended and underdiagnosed condition in en-demic populations, due to a lack of awareness as well as low sensitivity of histopathological examinations. However, PS may play an important role in mediating or reinforcing adverse birth outcomes (ABO) such as fetal growth restriction (FGR) in maternal schistosomiasis, possibly by placental inflammation.

Following the recommendations of the World Association for Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) to develop standards for training the undergraduates in disaster-relevant fields (2004), a German curriculum was approved in 2006. This paper aims to describe the level of training and interest of medical students nine years later. Problem The aim of this study was to assess the self-perception of medical students' knowledge and interest in disaster medicine nine years after the implementation of a standardized disaster medicine curriculum in German medical schools. This prospective, cross-sectional, observational study was conducted with medical students in Germany using a web-based, purpose-designed questionnaire consisting of 27 mandatory and 11 optional questions. Nine hundred ninety-two students from 36 of 37 medical schools in Germany participated. More than one-half of medical students were aware of the field of disaster medicine. One hundred twenty-one students undertook training internally within their university and 307 undertook training externally at other institutions. Only a small content of the curriculum was taught. A difference in self-perception of knowledge between trained and untrained participants was found, despite the level of training being low in both groups. Participants were generally highly motivated to learn disaster medicine in a variety of institutions. German students are still largely not well educated regarding disaster medicine, despite their high motivation. The curriculum of 2006 was not implemented as originally planned and the number of trained students still remains low as the self-perception of knowledge. Currently, there is no clear and standardized training concept in place. A renewal in the agreement of implementation of the curriculum at medical schools should be targeted in order to follow the recommendation of WADEM. Wunderlich R Ragazzoni L Ingrassia PL Della Corte F Grundgeiger J Bickelmayer JW Domres B . Self-perception of medical students' knowledge and interest in disaster medicine: nine years after the approval of the curriculum in German universities. Prehosp Disaster Med. 2017;32(4):374-381.

The custom of wearing labrets has a long tradition. Labrets appeared independently several thousand years ago in various culture groups in Asia, Europe, Africa and the Americas. Today, apart from diverse body modifications as increasingly practiced in western civilisations, lip plates and plugs are found among a small number of tribal groups only in Africa and Amazonia. We summarise the history of labrets in different societies, describe medical consequences of wearing lip plates and plugs for jaws and teeth and address relevant cultural issues.

This paper seeks to outline the development of disaster medicine services in Germany and the preparedness of the security and rescue forces for mass casualty incidents after an accident, a natural disaster or a terrorist attack. The method used was review of articles and interview with experts. The plane crash at the 1988 Ramstein air show highlighted problems in the approach to incident management. Following this event, Germany improved the medical management of major incidents. At the railway accident in Eschede in 1998, a "proof of concept" was evident. The newest increases of terrorist threats were also turning points in the further development of disaster medicine in Germany. Emergency medical training must be adapted to the increase in disasters, mass casualty incidents, and terrorist threats.

Co-infection of parvovirus B19 with hepatitis B virus has been found in patients with acute and chronic hepatitis. The clinical significance of parvovirus B19 in hepatitis B co-infected patients is still controversial. In this study parvovirus B19 antibodies and DNA were investigated in serum samples from 76 patients with HBV infection, 17 with HBV/HCV co-infection and 44 healthy controls. In the sera from patients with HBV infection, anti-B19V IgM and IgG antibodies were detected in 24/76 (32%) and 25/76 (33%), in 6/17 (35%) and 8/17 (47%) of HBV/HCV co-infected patients, and in 14/44 (32%) and 12/44 (12%) of a non-hepatitis healthy controls, respectively. B19V DNA was detected in 8/76 (11%) of patients with HBV infection and in 3/17 (18%) of patients with a HBV/HCV co-infection, and in 4/44 (9%) healthy controls. The occurrence of parvovirus B19 DNA was significantly higher in patients with symptomatic HBV 4/20 (20%) compared to asymptomatic HBV carrier 4/56 (7%) (P<0.05). Ten of the positive B19V DNA sequences belonged to B19V genotype 1 while two belonged to genotype 3. The results of this study showed a significant difference in the prevalence of parvovirus B19 DNA in symptomatic HBsAg positive as compared to asymptomatic HBsAg positive individuals; however, the conclusion that parvovirus B19 infection increased the frequency of liver disease was not supported. Long-term longitudinal studies are, however, required to determine the synergistic effect of parvovirus B19 infection in HBV or HBV and HCV co-infected persons.

The protozoan parasite Plasmodium falciparum is the only human malaria pathogen that exhibits a form of sequestration where late mature blood stages adhere to the endothelium, leading to diverse complications. This cytoadhesion is mediated by the parasites protein Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1), which is localized in the knobs of the infected red blood cell (iRBC). Adhesion of infected red blood cells (iRBC) to the main receptor CD36 was investigated for the first time by biosensors based on Thickness Shear Mode (TSM) under flow conditions.