The Mescalero Apache Family Listening Program (MAFLP) is a culturally centered family prevention program with third, fourth, and fifth graders; a parent/caregiver; and a family elder. The program follows a positive youth development model to develop stronger communication and shared cultural practices between elders, parents, and youth in the tribe to reduce substance initiation of use among the youth. The MAFLP was created using a community-based participatory research (CBPR) approach in partnership with the University of New Mexico. The research focus of MAFLP is centered on the adaptation of a family curriculum from a Navajo and Pueblo version of the Family Listening Program to an Apache version, the establishment of a (Apache) Tribal Research Team, and the piloting of the curriculum with Apache families. MAFLP was piloted twice, and evaluation measures were collected focused on formative and impact evaluation. This article provides a background on Mescalero Apache then introduces the Navajo and Pueblo version of a Family Listening and Family Circle Program, respectively, next, the CBPR research partnership between Mescalero Apache and the University of New Mexico and the creation of a Mescalero Apache Tribal Research Team followed by the development and adaptation of a Mescalero Apache Family Listening Program including implementation and evaluation, and concluding with preliminary findings. Substance abuse concerns have long plagued Native (American Indian/Alaska Native) communities, and health prevention approaches for Native children are in urgent need of attention. Existing mainstream programs fall short by failing to tailor culturally appropriate health messages and programs. Tribal communities have voiced a need for holistic programs that involve the whole family. The Mescalero Apache Family Listening Program (MAFLP) is a response to this request, and it integrates an evidence-based family-strengthening core, with Native cultural knowledge, history, values, and practices for late elementary-aged children and their parent/caregiver and family elder.Over the past two decades, Tribal oversight and participation in research has grown to oppose historical abuses of research on Tribal communities which have resulted in negative stereotyping. Tribes have been pro-active in the creation of their own research policies, guidelines, and even institutional review boards with recognition of Tribal sovereignty. These new research policies have included the requirement that research benefit their communities, any data collected will be owned by the tribe, and all publications and/or presentations require tribal approval –5, incluNew Mexico has a significant American Indian (AI) presence at 10.4% of the population, with rich historical traditions, including 23 Indian Tribes since time immemorial. According to the 2015 New Mexico Youth Risk and Resiliency Survey (YRRS) for high school students, Native youth in the state (~ 29% of the AI population are 17 years old and younger) reported several strengths: 64% plan to pursue higher education; 81% did not currently drink alcohol; and 84% did not currently use cigarettes. However, at-risk-behaviors were higher among Native youth as compared to the state: 33.8% marijuana use vs. 24.7% for the state; 17.9% used 2 or more illegal drugs vs. 11.7% for the state; and 34.9% used any tobacco product vs. 32.1% for the state .Evidence shows that connection to history, land, language, traditional food, and culture have a positive impact on Indigenous health –21. It i2 and has more than 5000 enrolled members with a matrilineal-centered culture and language spoken as Southern Athabasca [Mescalero Apache is located 3 h south of Albuquerque at the base of the Sacramento Mountains. The Mescalero Apache Tribe was established by Executive Order by President Ulysses S. Grant on May 29, 1873. The reservation became the central place for relocating three bands of Apaches—Chiricahua, Lipan, and Mescalero Apache. The Mescalero Apache homelands included the current reservation and greater Southwest regions of Texas, Arizona, and Mexico. The Lipan Apaches, whose original homelands spanned from Texas to Mexico, were relocated to Mescalero in the early 1900s. A couple hundred Chiricahua Apaches that were imprisoned at Fort Sill, Oklahoma, were moved to Mescalero around 1913. The Chiricahua Apaches homelands spanned throughout Arizona and Mexico. While the creation of the Mescalero Apache reservation is fairly recent (143 years), the histories of the three bands of Apaches span beyond hundreds of years. When the Tribe reorganized in 1936, the three bands became Mescalero Apache Tribal members, but families today still connect to their ancestral bands. The Mescalero Apache Reservation is approximately 720 mithabasca .In 1965, the Mescalero Apache revised their tribal constitution, which established an election process for Tribal President, Vice-President, and Tribal Council. That same year, the late Wendell Chino was elected as the first Tribal President and held the position for 43 years by being re-elected 16 consecutive times. Under Mr. Chino’s presidency, the Mescalero Apache became a leader in many Native sovereignty issues including business enterprises, natural resources, and water rights. Mr. Chino was an advocate for tribal sovereignty and believed that Tribes had the right to make their own decisions regarding their government, education, land, business affairs, and economic development. In the 1970s, the Mescalero Apache did not renew contracts with the Bureau of Indian Affairs, so they could manage their own resources that included timber, grazing rights, mining, and water use. The Mescalero Apache fought for land, hunting, and fishing rights through the legal system and successfully secured the right to manage their own lands . During In addition to securing land rights and successful economic development, Mr. Chino fought to secure funding to develop a K–12 school on the reservation. Prior to 1995, only an elementary school and middle school existed on the reservation. Mescalero Apache high-school students had to commute to two neighboring non-Native towns (30-min drive north or south) to attend these high schools. The Mescalero Apache K–12 School graduated its first class in 1996. Even though Mescalero Apache has a variety of well-established alcohol and medical treatment programs, the MAFLP was the first prevention program that focused on elementary-aged students and their parent/care giver.In 2000, the Native American Research Center for Health (NARCH) was established by the Indian Health Service and the National Institutes of Health (NIH) as a national American Indian/Alaska Native (AI/AN) research funding mechanism to reduce AI/AN health disparities, address the distrust of research by AI/AN communities, and support a pipeline for AI/AN researchers. The NARCH grant application process differs from the NIH process based on the fact that a NARCH application is submitted by a Tribe or inter-Tribal organization who then partners or subcontracts with a research institution , 33.Bii-Zin-Da-De-Dah program, translated as Listening to Each Other, funded by NIH. The program produced evidence of effectiveness as a psychosocial, cultural, educational intervention, resulting in a curriculum that combined both cultural messages and mainstream parenting communication skills. The Bii-Zin-Da-De-Dah found that the Anishinabe youth were better able to retain prevention messages if they were culturally embedded [Utilizing the NARCH mechanism, the Pueblo of Jemez  and the embedded , 22.Bii-Zin-Da-De-Dah program while utilizing a CBPR approach to develop a culturally centered Navajo and Pueblo curriculum, called Family Listening and Family Circle (FLCP), respectively. The program curriculum addressed literature on risk factors and integrated evidence-based theories such as change with cultural practices and values to support child, family, and community resiliencies and empowerment, including parent-child communication, having adult mentors and support, and empowerment strategies. By recognizing and addressing these risk factors, FLCP is a preventative approach to increase resiliency and delay substance use among third, fourth, and fifth graders as shown in the conceptual model  to adapt the del Fig. .Fig. 1FaDuring the NARCH III study, UNM-CPR presented on the Navajo FLP research project at an Albuquerque Area Indian Health Board (AAIHB) advisory meeting which at the time had research oversight through an administrative core of NARCH III. During this presentation, one of the AAIHB advisory members from Mescalero Apache heard about the program and requested that FLP also be brought to Mescalero Apache. In being true to the CBPR process, the initial request came from the community in the form of a resolution from the Mescalero Apache Tribal Council for UNM-CPR and Mescalero Apache to co-write and co-submit a NARCH V grant application. In 2009, Mescalero Apache and UNM-CPR were awarded NARCH V funding to establish a research partnership. The aim of the study was to utilize a CBPR approach to establish a Mescalero Apache Tribal Research Team to be trained in a CBPR research approach, to co-adapt an intergenerational family prevention curriculum for late elementary-aged youth and their families based on Mescalero Apache culture and values, and pilot the adapted curriculum with ten families. Over the course of this study, human research protection was obtained from the UNM Human Research Protection Office (HRPO-11-217) and the Southwest Tribal Institutional Review Board (SWT-2011-005) housed within the Albuquerque Area Indian Health Board.Recruitment of tribal members to serve on a research community advisory committee (CAC) in partnership with UNM-CPR was conducted in year one of the NARCH V research study, and continued relationship building and on-going recruitment occurred throughout the grant years. Community members who worked with children, youth, parents, and elders’ prevention programs were recruited from the following programs: Tribal Community Services Committee, Rehabilitation Center (Alcohol/Drug Addictions Treatment Center), Behavioral Health, the Indian Health Service Hospital, Mescalero Apache Housing Authority, Bureau of Indian Education (BIE) School, and the Boys and Girls Club. The CAC slowly came together with varying membership and participation from four to ten members to monthly meetings over the course of the study. Several trainings were conducted with the CAC and always in their community, such as public health 101, research 101, focus group facilitation, visioning facilitation, institutional review board (IRB) confidentiality, data collection/data analysis/interpretation training, and principles of participatory research. Based on the fact that the CAC had gained extensive research knowledge and skills, the UNM-CPR viewed them as a skilled research team and changed their title to Tribal Research Team (TRT). The first document developed in partnership between the TRT and UNM was a set of mutually agreed-upon principles of research team participation and roles and responsibilities with monthly meetings. This agreement and the roles and responsibilities were revised yearly but revisions were not required in the final grant years.Development of the MAFLP curriculum involved the initial review of the Pueblo and Navajo curriculum which were 14 sessions. Upon completion of initial review, the TRT planned and conducted focus groups with service providers, youth, parents, and elders around cultural aspects of the curriculum so that Mescalero Apache history and values could be included into a new Apache family curriculum. Sections from the Pueblo/Navajo curricula that required minimal modifications were the sessions with evidence-based findings, such as the sessions on anger management, parent communication skills, and help-seeking behavior. Some of these sessions were merged to pare down the Apache curriculum from 14 sessions to 12 since the TRT felt 14 weeks would be a challenge to sustain active involvement by families. While the sessions , and each facilitator would then complete a session evaluation. The family program continued this process over 11 sessions with the final session centered on families presenting their community action projects. The 12 sessions continued over 5 months, beginning in the fall and ending in early spring.All the instruments that were utilized were co-developed with the Navajo/Pueblo TRTs in the Navajo/Pueblo pilot , 26, theAll participants completed a baseline survey prior to their participation in the program and a follow-up survey immediately at the completion of the program; these questions were closed-ended. The follow-up survey included three additional questions which were open-ended. The child survey included questions around demographics, school safety, substance use, general health, home life, self-efficacy, social support, anxiety, and Apache culture. The adult survey included demographics, housing and reservation life, social support, traditional activities and culture, spirituality, identity and language, historical loss, discrimination, coping strategies, community problems, substance use, and parenting skills. The one difference between the child/adult baseline and follow-up surveys were the inclusion of three qualitative questions which centered on observational changes, for example (a) have you seen any changes in your family since participating in this program?; (b) have you seen any changes in your behavior since participating in this program?; and (c) have you seen any changes in your child/parent since participating in this program? Participants completed a paper format of the survey which was entered into SPSS for additional data management and analyses. SAS v9.3 was also used for data management and analyses. Quantitative data were Likert-type measures or categorical variables. Baseline and follow-up comparisons of continuous variables were analyzed using two-sample nonparametric Wilcoxon tests as our tribal IRB specified that identities not be tracked. Means and standard deviations are reported for continuous variables, and frequency and percent are used to summarize categorical variables.The qualitative measures included attendance sheets, facilitator logs, and observations of the facilitators by the UNM team. At the beginning of each of the 12 sessions, the participants signed in; the sheets helped to assess dose. At the completion of each session, the facilitators completed a facilitator evaluation form reflecting on their role as a facilitator with questions specific to the session topic  of the children answered that they had seen changes in their parents since participating in the program. On the problem-solving scale, the participants reported an increase in their problem-solving skills, such as working out their problems by talking or writing about them . The participants also recorded a significant impact on the culture scale: for example, a question asking if the child saw themselves as Apache reported a significant increase after program participation . On the depression and anxiety scale, participants reported feeling less restless and on edge upon program completion . The program participants recorded a significant positive change on the parenting question, which said “I punish child by taking privileges away with little if any explanation” .Twenty-one children completed the baseline survey and only 11 (52%) completed the follow-up survey. Sixty-three percent of children who completed the baseline survey were female with a majority of them in the fourth grade (40%). Of the children participating in the follow-up survey, seven (64%) reported seeing changes in their family after participating in the program, and six (55%) reported seeing changes in their behavior. Additionally, 70% (The facilitator logs were analyzed for themes, and a common theme found across all the sessions was that the facilitators enjoyed the session activities and that the participants were willing and eager to learn. A recommendation by the facilitators based on the logs noted that sessions could be improved through finding ways to encourage the participants to overcome shyness and finding ways to encourage the participants to return to the next session, such as personal follow-up either through a phone call or a home visit. The facilitators were also able to apply problem-solving strategies to every issue that arose during each session. An important theme focused on self-reflection and the fact that the facilitators shared a sense of increased confidence in their facilitation skills as the program continued. The observation by the UNM team provided opportunities to update the curriculum based on the facilitators’ recommendation, modifications to the flow of the session, and any other changes that were made to the program.A major finding from the journals from the child and adult participants reported having new learnings from each of the sessions. One child participant stated “I learnt how to trust and support”. One adult participant stated “I learnt that it is okay to be angry, but how you deal with it depends on you. Anger issues can be worked through discussing the issue that made you angry”. The children also reflected on learning new skills, such as problem solving, ways of listening, anger control, and ways of supporting their community. An area of concern raised by the children focused on the outlook of the community, particularly on substance use and abuse. Some parents shared similar concerns but also added concerns of lack of housing and alcohol use and abuse.The MAFLP was intended to focus on children; however, this unique program provided a whole family participation format, allowing parents and elders to experience this program alongside their child while learning skill-building exercises around communication, listening, anger management, respecting diversity, and building trust.The Mescalero Apache TRT and facilitators were pleased with the two pilots and the level of involvement by the participants in the session topics, session activities, and small group discussions. Based on the first pilot, it became apparent that there was a need to reach out to the participants and to remind the families of the upcoming session. In the second pilot, the facilitators were more active in reminding the families and felt that this was a positive change in the second pilot. Overall, the adult participants were pleased that their child learnt communication and problem-solving skills but more importantly he/she learnt the importance of being respectful, the Apache stages of life, ways of being helpful to the community, and the Apache history.Although this pilot study had a very small sample size, we were able to observe significant positive changes in problem-solving skills, cultural knowledge, depression and anxiety, and parenting skills. Positive coping skills and a strong cultural identity have been identified as protective factors against drugs and alcohol use as children move into adolescence. While we saw no difference in substance use, we believe this was based on the fact that the program only ran for 5 months from baseline to follow-up; we believe a second follow-up would have been beneficial. Fortunately, we have continued this research partnership with Mescalero Apache in a current R01 study that includes a longitudinal design with a comparison group.The Mescalero Apache and the University of New Mexico research teams successfully collaborated in a CBPR approach to create and twice pilot a culturally centered Mescalero Apache Family Listening Program based on the adaptation and lesson learnt from a Pueblo and Navajo version. The MAFLP child participants were able to increase their problem-solving skills and cultural identity while reducing depression and anxiety. The results of the pilot evaluation were promising although the long-term impact of the intervention remains to be seen and requires further evaluation. Our pilot findings provided us with data on fidelity and dose of intervention, satisfaction, and acceptability of the program by participants and feedback on areas of improvement. Based on the piloting of the FLCP, the three Tribal communities , 26 wereThe R01 study design includes a two-arm non-equivalent control group with baseline, immediate follow-up, and a 1-year follow-up. With this design, we will be able to analyze the impact of the FLCP intervention between the program participants and a comparison group aggregated across the three Tribal communities through four waves of implementation. We will also be able to analyze the diffusion of the program over time. Based on the pilot studies , 26, the


Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an effective and safe technique associated with a very low complication rate for the sampling of lymph nodes in those presenting with mediastinal and hilar adenopathy.” We report a rare case describing the development of pneumomediastinum following EBUS-TBNA in a young patient with mediastinal lymphadenopathy secondary to non-Hodgkin’s lymphoma. Conservative treatment led to spontaneous resolution of the pneumomediastinum. Pneumomediastinum is a rare but possible complication of EBUS-TBNA. Careful follow-up can reduce its severity and the associated morbidity. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an effective technique for the sampling of mediastinal and hilar adenopathy ,2. MoreoIn a nationwide survey performed by the Japan Society for Respiratory Endoscopy, pneumothorax was documented in 2 patients (0.03%), 1 of whom required tube drainage –8. We reA 42-year-old woman presented to the outpatient Pneumology Clinic with a complaint of a persistent cough without fever over a month and the onset of chest pain a week prior to presentation. A chest X-ray revealed a left-sided perihilar opacity . She repThe clinical presentation of pneumomediastinum can occasionally be misdiagnosed or completely missed because of its vague symptoms –11. MostBed rest and conservative management such as the prophylactic use of analgesics and antibiotics in addition to limitation of oral intake are indicated in patients presenting with pneumomediastinum ,12.Management of pneumomediastinum and pneumopericardium depends upon the clinical severity and underlying etiology of these conditions. Most patients respond adequately to the conservative management strategy outlined above. In rare instances, surgery may be required to treat pneumomediastinum that occurs secondary to severe tracheobronchial disruption . ComplicWe have described a rare complication of EBUS-TBNA. Our patient was known to experience chest pain prior to the bronchoscopy; however, the sudden regression in her chest pain noted after the bronchoscopy led to an underestimation of the possible procedural complication, although the patient’s pneumomediastinum resolved with supportive care. Although rare, clinicians must remain mindful of the complications associated with EBUS-TBNA, and careful follow-up is warranted to reduce the associated morbidity.


A total of 196 secondary schools participated in the Secondary 2 Program of the Full Implementation Phase of the Project P.A.T.H.S. . After completion of the Tier 1 Program, 30,731 students responded to the Subjective Outcome Evaluation Form (Form A) to assess their perceptions of the program, instructors, and perceived effectiveness of the program. Based on the consolidated reports submitted by the schools to the funding body, the research team aggregated the consolidated data to form a “reconstructed” overall profile on the perceptions of the program participants. Findings demonstrated that high proportions of the respondents had positive perceptions of the program and the instructors, and roughly four-fifths of the respondents regarded the program as beneficial to them. Correlation analyses showed that perceived program and instructor characteristics were positively associated with perceived benefits of the program.


A training and outreach program to increase public awareness of African swine fever (ASF) was implemented by Defense Threat Reduction Agency and the Ministries of Agriculture in Armenia, Georgia, Kazakhstan, and Ukraine. The implementing agency was the company SAFOSO (Switzerland). Integration of this regional effort was administered by subject matter experts for each country. The main teaching effort of this project was to develop a comprehensive regional public outreach campaign through a network of expertise and knowledge for the control and prevention of ASF in four neighboring countries that experience similar issues with this disease. Gaps in disease knowledge, legislation, and outbreak preparedness in each country were all addressed. Because ASF is a pathogen with bioterrorism potential and of great veterinary health importance that is responsible for major economic instability, the project team developed public outreach programs to train veterinarians in the partner countries to accurately and rapidly identify ASF activity and report it to international veterinary health agencies. The project implementers facilitated four regional meetings to develop this outreach program, which was later disseminated in each partner country. Partner country participants were trained as trainers to implement the outreach program in their respective countries. In this paper, we describe the development, execution, and evaluation of the ASF training and outreach program that reached more than 13,000 veterinarians, farmers, and hunters in the partner countries. Additionally, more than 120,000 booklets, flyers, leaflets, guidelines, and posters were distributed during the outreach campaign. Pre- and post-ASF knowledge exams were developed. The overall success of the project was demonstrated in that the principles of developing and conducting a public outreach program were established, and these foundational teachings can be applied within a single country or expanded regionally to disseminate disease information across borders; overall, this method can be modified to raise awareness about many other diseases. Introduction of African swine fever virus (ASFV) into domestic pig populations can incite economic catastrophe, resulting in loss of agricultural assets with an adverse impact on the international commercial pork trade .Asfarviridae family. Infection with this virus can result in hemorrhagic fever, causing high morbidity and mortality. The virus is efficiently transmitted from wild boars to domestic pigs, and between live pigs through contact or ingestion of contaminated meat. Soft ticks (Ornithodoros species) are the only known vectors of ASF (Ornithodoros ticks in the Caucasus region and eastern Europe remains unclear (African swine fever (ASF) is a highly infectious disease of most species in the Suidae family, including domestic pigs and African and European wild pigs . ASF is a vector-borne viral disease caused by an asfivirus, a DNA virus in the s of ASF . The pre unclear .Highly lethal and easily spread among domestic pig populations, ASF is one of the most serious transboundary swine diseases, often leading to significant socioeconomic consequences in countries where outbreaks occur. Before 1957, ASF had been detected only in Africa .This paper describes the implementation and evaluation of a public outreach campaign designed to bring together countries with shared regional interests to collaboratively develop a training program to increase public awareness about ASF and mitigate disease risk and economic losses.The training program was first developed in 2015 through a collaborative effort between the US Defense Threat Reduction Agency and the governments of Armenia, Georgia, Kazakhstan, and Ukraine. These four countries were selected for participation because of the importance of the pork industry as an agricultural asset and their potential for future ASF outbreaks. These four countries are located in the same general region and experience similar issues with ASF. The Ministries of Agriculture from each partner country implemented this project, with mentoring and support from SAFOSO, Biological Threat Reduction Integrating Contractors (BTRICs), and subject matter experts (SMEs). Important notes about the methodology followed were kept by each country so that similar outreach campaigns could be adapted to other diseases.The pedagogical framework creates the structure around the philosophy of teaching and learning. In this project, the project team mentors developed guidelines that outlined teaching and training best practices to share with representatives of the partner countries. The goal was to establish cross-border cooperation and to identify and introduce training methodologies that could be implemented across similar but divergent cultures for a common disease. In this regard, the hope was that all veterinarians who were trained (the students) could reach their full potential in sharing information on ASF with relevant audiences in their home countries. The main framework was to provide the trainers from each of these partner countries with the ability to create and deliver jointly developed curriculum based on best practices (as described by the facilitators and SMEs) and then relate it to the most effective way that students learn in their home countries. The goal of this project was to use a training-of-trainers (ToT) approach to enhance the regional network for ASF control and prevention by increasing awareness among workers who directly handle swine, and among governmental organizations responsible for preventing and responding to outbreaks in the Caucasus. Ultimately, this project has helped to establish a general approach for conducting and deploying a public outreach program. The fundamental principles of how this program was developed and implemented not only helped raise awareness about ASF but can also be applied to help mitigate future outbreaks of other diseases. Most importantly, this project also served as a basis for developing much-needed public outreach programs for other diseases of public concern.http://caninerabiesblueprint.org/Communications-plan?lang=en), to serve as a guideline for raising awareness about diseases. The 10 steps were the basis for project objectives and activities and were addressed during different project events . Most tasks and topics covered in the project development meetings and training activities are shown in Figure The project adapted a communication plan that was developed using the framework of the Canine Rabies Blueprint  and teach them how to recognize clinical signs and epidemiological patterns of ASF. Specifically, this included (i) common routes of exposure, (ii) preventative measures, (iii) how to recognize clinical signs and the importance of reporting to veterinary authorities, and (iv) how to respond to suspected ASF cases.To leverage these efforts in support of risk mitigation throughout regions of Eastern Europe that serve as focal points for ASF transmission, a regional approach was used to engage agricultural leadership (Ministries of Agriculture) from Armenia, Georgia, Kazakhstan, and Ukraine in collaboratively developing strategies for enhancing ASF public awareness in their respective countries.To strengthen the regional approach, this group oversaw the development and implementation of these learning objectives to eventually administer this training program in their home countries. Ultimately, we hoped to reduce the risk of epizootic emergence and economic losses from ASFV infection by formally educating those who can help to prevent its spread, including farmers, hunters, wild fauna management staff, and people engaged in the commercial pork supply chain. A key part of the training program was to stress the importance of reporting suspected outbreaks to the veterinary authorities and neighboring communities so that the disease and subsequent outbreaks can be swiftly controlled. An early reaction is critical to minimizing the impact of an ASF outbreak.This project’s overarching goal, and, collateral benefit, however, was to foster fellowship between project participants through achievement of a common goal that was based on shared interests, concerns, and challenges, providing a foundation upon which to build the capacity for future collaborative pursuits.To bring together four neighboring countries to develop and implement a public outreach campaign, the facilitators and SMEs set up a series of RMs, workshops, and outreach classes Table  in ArmenEach RM and workshop encompassed specific objectives, and the organization of working group sessions brought together partner country participants to address a common disease and shared public outreach effort. During the working group sessions, country-specific educational materials, implementation strategies, and methodologies were developed. In one of the first working group sessions, participants conducted gap analyses to identify limitations in the educational activities and materials that had been previously deployed in their home countries. Through this analysis, participants identified the best approaches to use in outreach and pitfalls from past programs to avoid.During the second RM, country representatives shared previously developed presentations on ASF that would later form the bases of their country-specific presentations. The purpose of this session was two-fold: first, to introduce participants to the latest information about ASF, and, second, to provide feedback on their individual country-specific presentations so that presenters could refine them before delivery to the target audiences. ASF was discussed in detail, including its etiology, epidemiology, transmission, pathogenesis and immunology, clinical signs and diagnostics, and mechanisms of prevention and control. Country representatives presented relevant ASF educational and awareness materials  that were already available in their countries. These existing materials were used to guide working groups as they selected content for new educational materials to be developed. Participants in the working groups were asked to (i) revise existing educational materials; (ii) select relevant materials to be used in the outreach programs; (iii) develop a specific communication toolkit for each target group; (iv) identify gaps and areas for improvement in the selected materials; (v) choose the key messages of the outreach program; and (vi) update and develop educational materials to include in the communication toolkit. Participants included the latest scientific information in the materials whenever possible. Finally, training materials were compiled and printed for distribution to target groups. Each country targeted different groups in their communication toolkits. Armenia’s communication toolkit is shown in Table To identify the target groups in each country, the principles of value chain analysis were introduced and applied during the second RM. The workshop participants were then asked to (i) describe the pig production chain and relevant stakeholders in their respective countries; (ii) identify final target groups for the outreach program; and (iii) finalize the objectives of the outreach program for each target group Table . The tarAnother working group session was focused on identifying the best strategies for implementing the outreach programs in each participating country. Country representatives in the working group session were asked to (i) identify realistic ways to integrate the goals of the project outreach program; (ii) determine which districts, provinces, and villages would be targeted in the outreach program; (iii) determine the number of participants that would be targeted by the outreach program; and (iv) discuss strategies to make the outreach program sustainable. In addition to developing implementation strategies for the outreach program, participants were also asked to develop a framework with which to assess the performance of the outreach programs. To do this, each country applied the logical framework concept during a country-specific working group session. Using this approach for each level of project implementation, country representatives identified objectives, indicators/targets, data sources, and personnel responsible for specific activities. For example, Kazakhstan defined the following tasks: conducting training for the trainers from each region in a ASF risk zone; developing a schedule for conducting workshops for in-country stakeholders, including veterinarians at the rayon level; providing population gathering in rayon and rural administrations for implementation of outreach goals on ASF with distribution of educational materials; and visiting farms to implement the ASF outreach program and distribute educational materials.Once target groups were identified, partner countries created implementation plans for each of their outreach goals. The implementation plan included the implementation strategy (and possible integration with other ongoing activities in the field), the geographical coverage (number of districts and regions covered by the project), and other local stakeholders involved in outreach activities. In Armenia, outreach classes were conducted through marz-level meetings with community veterinarians. During these meetings, the representatives that were trained under the ToT program trained community veterinarians on core ASF topics and provided educational materials to distribute during outreach. Training delivery was assessed by project staff who had participated in the RMs.The main faculty of the project was SAFOSO, who served as the main facilitator and implementer, and the BTRICs and SMEs in each of the partner countries, who provided mentoring. The BTRICs and SMEs helped to foster relationships between the recipient countries and introduced various ASF and veterinary health-focused SMEs. Additionally, BTRICs assisted in the education of local nationals to develop and implement veterinary health awareness campaigns, including creating literature for target groups and organizations. Finally, BTRICs assisted local teams in preparing workshop agendas and delivering final schedules and workshops in their respective home countries.Seventeen trainers were trained over the course of three RMs: five trainers from Armenia, four from Georgia, four from Kazakhstan, and four from Ukraine. A major goal of this program was training of trainers. These trainers were from the Ministries of Agriculture from each of their respective countries, and they became the “faculty,” or trainers, to the students  in each country. These faculty trainers, after completion of the RMs, were equipped to conduct the public outreach campaign and student training in their home countries. The success of the program was then evaluated on the ability of these trainers to conduct the public outreach campaigns in their respective countries and disseminate the information on ASF that they developed.In Armenia, trainers conducted 10 regional events to train 20 regional trainers who ultimately trained veterinarians, farmers, and hunters.In Georgia, trainers conducted 16 regional trainings to train 100 district trainers and 377 private veterinarians.In Kazakhstan, four oblast-level trainings were conducted at oblasts bordering Russia, and 81 regional trainers were trained through 18 rayon training events.In Ukraine, one regional training event was conducted to train 14 regional trainers who then trained countless farmers and hunters.The trainers conducted training in their home countries after completing the training program.The workshops and working group sessions established a foundation for the sustainability of ASF outreach programs and showed participants how to initiate future outreach programs. Each country could integrate the training program into their current educational program, thereby ensuring that the materials will continue to be presented to future cohorts.In a working group session, new trainers had the opportunity to receive feedback on their training delivery skills from the other trainers, BTRICs, SMEs, and SAFOSO. Country representatives evaluated presenter performance and the following aspects were discussed with the presenters: structure of the presentation, visualization, relevancy of content, timing, approach of the presenter, audiences’ understanding of the message, and technical language. Presentations and delivery methods were refined in response to this feedback.Reaction and Learning levels from Donald Kirkpatrick’s “The Four Levels of Learning Evaluation”  or a binary scale (yes/no) to capture trainee impressions of the course, trainer, and program. The questionnaires also included space to write in additional comments. As an example, the 15 questions asked in the Georgian evaluation were:How interesting was the training?How understandable were the presentations?Did the presentation complete the objectives of the training program?How comprehensive was the information presented?Was there enough time for each presentation?Was the training relevant to work in Georgia?Did the trainer provide interactive engagement?How comprehensive was the trainer at answering your questions?Have the trainers brought appropriate practical learning examples?Were the trainers sociable or not?Were the presentations about relevant issues?Will the training materials be useful for you?How useful will the received knowledge be in your job?Was the training well-organized?Would you participate in further training?The Learning portion of the evaluation was designed to assess the knowledge and skills trainees gained during the in-country workshops. A pre-training test was administered at the beginning of the course to assess trainees’ baseline knowledge, and the same test (post-training test) was given at the end of the course to measure knowledge gained. Results from the pre- and post-training tests were compared to evaluate improvement in trainee understanding. Country representatives developed the pre- and post-tests during the RMs.The The questionnaires focused on six specific topics: etiology (one question) and epidemiology of ASF (10 questions), pathogenesis and immunology (three questions), clinical signs and pathology (four questions), sample management and laboratory diagnosis (three questions), and prevention and control (three questions). Only results from trainees who completed both a pre- and post-test were included in the analysis.To assess the improvement of the trainees, we first calculated the median of percentages of correct answers by category of questions. Additionally, we calculated a global score (for pre- and post-tests) as the sum of right answers. This approach was also applied to specific categories or specific questions. We used the Wilcoxon signed-rank test for non-parametric data to evaluate the significance of improvement between pre- and post-tests.Planning for the ASF outreach program began during the first RM in Armenia in February 2015. Follow-up RMs took place in Kazakhstan, Ukraine, and Georgia later that year. Seventeen trainers developed the program and were effectively trained over the course of these RMs; these trainers went on to conduct in-country training and outreach activities between June and September 2015. As a result, 13,862 people were trained: 6,615 veterinarians, 7,110 farmers, 106 hunters, and 31 meat processing plant managers. In Armenia, there were 26 training events covering 10 regions. In Georgia, there were 117 trainings covering 11 regions and 61 districts. In Kazakhstan, there were 27 trainings covering 4 oblasts, 27 rayons, and 91 districts. In Ukraine, there were 14 trainings covering 14 oblasts. Table Trainer evaluations were conducted in each country to assess the utility of the outreach program. Table Learning questionnaire was 75% . Individual country response rates were 95, 80, and 50% for Armenia, Georgia, and Kazakhstan, respectively. Results from Ukraine are not included because the pre- and post-tests were not completed by the same personnel and could no longer be obtained in this project because of an ongoing ASF outbreak.Figure p < 0.05) for Georgia and Kazakhstan according to the Wilcoxon test. Additionally, when comparisons are made between participants’ global scores (medians) in a country, participants’ knowledge improved slightly in Armenia and Georgia, with more evident improvement in Georgia. Only Georgia and Kazakhstan showed significant differences in global scores between pre- and post-tests (p < 0.05). Figure Results shown in Table As a result of this project, the governments of Armenia, Georgia, Kazakhstan, and Ukraine are equipped with a standard approach for developing outreach programs targeted at diseases of local concern. The ability to implement an effective public outreach campaign may help to reduce the future spread and incidence of diseases in these countries. Having a standard approach for implementing a public outreach campaign will allow the governments to rapidly disseminate important information to prevent or limit the spread of human, animal, and plant diseases in the future.This program created a standard approach for conducting and applying a public outreach program to raise awareness of diseases of local concern. Implementation of the outreach program was achieved through training and development of an education campaign to enhance ASF public awareness by (i) identifying key personnel who could effectively implement necessary methods for reducing the spread of ASF; (ii) creating educational and training materials for dissemination to key personnel; (iii) educating key personnel on how to develop and implement a public awareness campaign; (iv) educating key personnel on the best strategies for mitigating the risk of ASF; and (v) developing a regional joint ASF working group.The long-term success of the outreach program may ultimately be reflected in changes in the behavior and attitudes of the target groups as a result of their new knowledge of ASF spread and etiology. This may be manifested in improved swine health and, ultimately, the reduced spread and occurrence of ASF in the partner countries. The countries represented in this project are not the only ones with similar issues. A recent study of English pig farms showed that farmers have little knowledge about ASF clinical signs and are less concerned about ASF than other pig diseases . The pigThe success of the training and outreach program is reflected in the overall increase in trainee knowledge about the disease, the large population that was reached, the number of educational materials that were distributed, and trainees’ satisfaction with the outreach and training program. Trainees in the program showed improvement in ASF knowledge after completing a training course, based on the results of pre- and post-test evaluations. In some cases, results were less satisfactory than expected. Trainers facilitated follow-up discussions on the results of the surveys immediately after the trainings, and participants highlighted some limitations of the approach.The outreach classes reached over 13,000 farmers, veterinarians, and hunters in Armenia, Georgia, Kazakhstan, and Ukraine. Partner country representatives received training on how to establish different technical and didactical capacities to successfully engage the target groups. Although many people participated, it was uniformly difficult to engage hunters and backyard farmers in the partner countries. Engaging hunters in the ASF outreach program is especially important, due to the need of a system where wild boar carcasses are regularly reported. Future campaigns should identify ways to reach more hunters, such as by engaging hunters’ associations. Kazakhstan has discussed the need to develop a network between veterinarians and small farmers, hunting entities, and managers of the meat industry.Although the program was tailored to each target group, it was not entirely successful. Georgian representatives noted that farmers were generally distrustful of veterinarian authorities and were often reluctant to follow recommendations from them. Additionally, backyard farming is usually a secondary household income, so there are few incentives and financial resources to improve biosecurity. Bringing about a change in attitude is not an easy task and will require long-term efforts. Future awareness campaigns should consider the social structure and network of the target groups to develop the most effective strategies for reaching them. For example, hunters might be better engaged by inviting members of hunters’ associations to participate in official meetings and workshops. Educational materials need to be continually renewed and improved for greater relevance to the target groups. Finally, to increase the impact of future projects, entities with a strong network at the village/community level  should be involved in future disease awareness campaigns alongside veterinarians.This project has provided each participating country with a sustainable public outreach program designed to educate local agricultural workers and first responders about ASF. Collectively, the effective implementation of these outreach programs has increased regional communication on the status of ASF and enhanced public knowledge. In addition, the approach used by this project was the first such effort that facilitated the development of the capacity to implement outreach campaigns for future disease outbreaks in the region. During this project, recipient countries were taught how to run an outreach campaign, including how to identify target audiences, and how to produce effective educational materials. This project also helped to establish and encourage collaboration between members of international veterinary communities. Because of this project, each partner country now has the tools to carry out future disease awareness campaigns. This project helped establish regional cooperation amongst multiple countries involved in preventing the spread of ASF.MN led and conducted the training program as a consultant, acted as a project mentor and implementer, and assisted with the writing of the manuscript. AL completed the statistical analysis of the test surveys. The following authors contributed to the implementation of the program and training and were part of the initial writing of the manuscript: TS, BK, TK, IS, ST, AA, SN, MS, ON, RD, TC, LA, OP, LN, NK, TN, ZA, DK, IM, and MZ. The following authors assisted as an implementer in each country and assisted with in-country coordination: LN, NM, BB, GZ, SS, MM, TG, and RO. TG designed the initial concept of the project, created the overall design, and structured the regional training approach and assisted with writing the proposal, reporting to the funding agency, and, implementation plan, and manuscript. RO served as the project manager, and assisted with the concept design, manuscript writing, and overall project implementation and manuscript writing.MN is employed by SAFOSO and was a project mentor and implementer. AL is employed by SAFOSO and worked on statistical analysis. TG and RO are employed by Avila Scientific. All authors declare no competing interests. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


This paper proposed an effective model for improving global health nursing competence among undergraduate students. A descriptive case study was conducted by evaluation of four implemented programs by the author. All programs were conducted with students majoring in nursing and healthcare, where the researcher was a program director, professor, or facilitator. These programs were analyzed in terms of students’ needs assessment, program design, and implementation and evaluation factors. The concept and composition of global nursing competence, identified within previous studies, were deemed appropriate in all of our programs. Program composition varied from curricular to extracurricular domains. During the implementation phase, some of the programs included non-Korean students to improve cultural diversity and overcome language barriers. Qualitative and quantitative surveys were conducted to assess program efficacy. Data triangulation from students’ reflective journals was examined. Additionally, students’ awareness regarding changes within global health nursing, improved critical thinking, cultural understanding, and global leadership skills were investigated pre- and post-program implementation. The importance of identifying students’ needs regarding global nursing competence when developing appropriate curricula is discussed. Advances in medical technology, free traffic between countries, and burgeoning multicultural families provide new challenges to nursing education. In Korea, and in other countries, how to prepare students majoring in healthcare sciences has generated fervent discussion. Appropriate methods for training students to demonstrate appropriate attitudes regarding a culturally diverse landscape are needed –3.Conceptualizing global health nursing has also been challenging. Archambault  outlinedIn other countries, several studies have clarified global health competency since the late 1990s , 5–9, anOn the other hand, the United Nations has enacted a resolution of outlining 17 sustainable development goals for global citizenry. This resolution is aimed at reducing health service inequalities while improving individuals’ overall health status . Prior tThis was a descriptive case study that analyzed global health and nursing programs, mostly Korean nursing students, for developing an effective program model regarding global nursing competency targeted toward undergraduate nursing students.Global health and nursing programs implemented from 2013 to 2015 were the focus of our study. Four programs were used, and operated in an Asian country within the development stage and dealing with low healthcare resources.Information regarding the program’s plan and effect of each program were collected from published research papers on these programs –18.All gathered data were analyzed for whether the programs assessed students’ needs, programs’ credit approval, program efficacy variables, and any other special characteristics regarding effectiveness.The programs were implemented during an academic vacation of less than 2 weeks  compared the effect of the program using paired n et al.  in termsIn conclusion, what would be an effective model for improving global nursing competency programs for undergraduate students? It is very useful to identity the benefits and limitations of analyzed programs in this research. As shown in Table During the second phase (design), program content is developed based on the prior needs assessment and comments from field experts. Participant selection should then proceed by considering requirements and course objectives. If participants are “global citizens,” sustainable developmental goals for health equality or any effort therein could maximize the field experience.In the implementation phase, grouping participants should help promote better understanding of the healthcare and cultural environment, providing a more mutually dynamic learning experience. Furthermore, real-time monitoring and feedback from staff, professors, and field experts can aid program efficacy.To evaluate the program’s effectiveness, both quantitative and qualitative methods are necessary to determine program effectiveness, as well as changes to knowledge and attitudes among participants. However, evaluations of participants’ critical thinking and leadership abilities may be somewhat inappropriate when addressing program effectiveness. This is because most participants embody these traits more than the average student.The present study outlined an effective model for improving global health nursing competency. Based on needs assessment pre-survey, specific variables representing program effectiveness should be scrutinized to better promote a program’s objectives.A few program limitations should be noted. For instance, only a small number of students could reasonably participate due to financial strains and the ability to select an appropriate field site. Thus, table-top case simulations and field program briefing sessions may be needed to provide indirect learning experiences. Nevertheless, both direct and indirect methods could have immense utility for facilitating global health nursing competency.The author confirms being the sole contributor of this work and approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Individual behavior was directly related to injuries, such as the first reaction after earthquake and fear. There is an obvious connection between earthquake-related injury and individual behavior characteristics. It is strongly suggested that victims receive mental health support from medical practitioners and the government to minimize negative effects. The initial reaction after an earthquake also played a vital role in victims’ trauma; therefore, earthquake-related experience and education may prevent injuries. Self-aid and mutual help played key roles in emergency, medical rescue efforts.Research concerning the impact of earthquake victims’ individual behavior and its association with earthquake-related injuries is lacking. This study examined this relationship along with effectiveness of earthquake rescue measures. The six most severely destroyed townships during the Lushan earthquake were examined; 28 villages and three earthquake victims’ settlement camp areas were selected as research areas. Inclusion criteria comprised living in Lushan county for a longtime, living in Lushan county during the 2013 Lushan earthquake, and having one’s home destroyed. Earthquake victims with an intellectual disability or communication problems were excluded. The earthquake victims (N (number) = 5165, male = 2396) completed a questionnaire (response rate: 94.7%). Among them, 209 were injured (5.61%). Teachers ( Natural disasters, especially earthquakes, cause vast destruction, often resulting in massive casualties and economic loss. Researchers pay great attention to injuries and rescue efforts after earthquakes ,2,3,4; hIn past research, post-earthquake injury evaluation and rescue management were more popular topics than proactive plans aimed at protecting individuals ,11,12. HIn particular, after an earthquake, people tend to be anxious, frightened and overwhelmed ,14,15. SConsequently, determining the relationships among individual behaviors, like the relationships among victims’ emotions after earthquake, first reaction during the earthquake, earthquake-related experience, self- and mutual-aid, and their injury are the main purpose of our research. We also tried to give some policy suggestions based on our results to the rescue organization after earthquake. This research focuses on the areas in western China most affected by earthquakes. Specifically, we investigated the aftermath of the Lushan earthquake. The six most severe earthquake-affected townships including 26 villages were surveyed with an on-site investigation and a large amount of injury- and rescue-related first-hand data were collected. We attempted to elucidate the relationships among personal characteristics, injury and rescue effectiveness.The area most severely affected by earthquake was Lushan county. The six most destroyed townships were selected, including Taiping, Shuangshi, Luyang, Baosheng, Longmen and Qingren. Twenty-eight villages and 3 earthquake victims’ settlement camp areas were selected as the research areas. As family members shared similar experiences as they stayed together at home, we preferred to investigate individuals from different families to get a holistic view of the earthquake and the related injury, which is more efficient. Two-step sampling was used in the research to avoid sampling bias. We used random sampling method both in the first step (choosing the families) and the second step (choosing the specific family member). With the help of Lushan county’s government, we conducted random sampling through the census registration system. We randomly chose 5452 families, which accounted for 33% of all families in Lushan county. Then, the family member whose birthday was closest to the investigation day was chosen as the participant. If the selected participant did not wish to participate for some reason, the individual with the second closest birthday participated, and so on. This sampling method was used until we found a participant from each family. Inclusion criteria comprised living in Lushan county for a long time, living in Lushan county during the 2013 Lushan earthquake, and having one’s home destroyed. Earthquake victims with an intellectual disability or communication problems were excluded.Three months after the Lushan earthquake in July 2013, our research group arrived at Lushan, Sichuan Province to conduct this research. Since researchers and native residents spoke different dialects, nine graduate students from local universities who had bachelors’ degrees in social science completed a three-day training course so that they would be able to administer the questionnaires competently. The training included the research purpose, explaining consent, instrument design, and communication skills. All students passed the test and conducted the investigation independently.After participants provided written consent to participate, they completed the questionnaire individually. Researchers explained any confusing questions or recorded the answers if participants could not read. In total, 5165 participants completed the questionnaire (response rate: 94.7%). Ethical approval was granted by the Ethics Committee of Second Military Medical University. The consent procedure was also approved by this committee.The questionnaire used in this study was designed based on the “earthquake survivor questionnaire,” created at the University of Cambridge, the UK, and Islamia College, Pakistan. This questionnaire assesses information about earthquake injury and influencing factors during and after an earthquake. Based on the geographic and cultural characteristics of western China, some questionnaire items were amended and combined with earthquake emergency medical rescue information such as timely medical treatment, medical evacuation, and rescue efficiency and effect. After consulting experts in the emergency rescue field several times, the final edition of the “Lushan earthquake victims” questionnaire was created. Although the questionnaire comprised six aspects, only three were included in this research: (1) demographic information such as name, sex, education, occupation, marriage, and so on; (2) personal behavioral characteristics such as experience with the 2008 Wenchuan earthquake, earthquake injury, earthquake evacuation training, fear level, first reaction, whether they were trapped, and their family members’ situation; and (3) victims’ injury and treatment including injury time, on-site medical treatment, first evacuation experience, and so on.p = 0.05.All data were analyzed via SAS version 9.0 . We first calculated the descriptive statistics  to show the basic information of the participants in the investigation. χ² analysis was used in analysis of all multi-category variables. The statistical method of an M:N pair design multivariate logistic regression was used in the multivariate analysis to determine the key factors influencing earthquake injuries. When matched with geographic location (the earthquake-affected area), the analysis can exclude the bias of influence of people’s traits in various geographic locations. Odds ratios (OR) and 95% confidence intervals (CI) were used to evaluate the risk of variables. The criterion for statistical significance was set at All subjects gave their informed consent before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Second Military Medical University and the ethical approval code was 2014LL015.Participants’ demographic details in terms of their injuries are shown in Details about participants’ individual characteristics are shown in Based on the findings of this research, self- and mutual-aid played a critical role. Among all interviewed victims, 290 were injured during the earthquake, which accounts for 10.45% of the families in the disaster area. The percentage of families that lost a member to death by the earthquake was 1.99%. Importantly, 33.98% of the families ascribed their relatives’ death to their severe injury while more than half of them blamed it on rescue delay due to a traffic jam or a lack of medical resources. Only two demographic factors in the research show an association with injury. It is easy to accept the fact that older people seem more likely to be injured during an earthquake. It is interesting that teachers and medical staff are more likely to be injured. Based on news reports after earthquakes, it can be observed that both these groups are more likely to help the others. The teachers are always responsible for their students’ safety and the medical staff are more likely to stay in the severely destroyed areas trying to help others, which greatly increases their possibility for injury.Our results revealed that there is an obvious connection between earthquake-related injury and individual behavioral characteristics. In the research, this kind of relationship is mainly reflected in four aspects: the relationships among victims’ emotions after earthquake, first reaction during the earthquake, earthquake-related experience, self- and mutual-aid, and their injury. In the emotion part, most victims felt extremely terrified during the earthquake, which added to the risk of injury. Extreme fear may negatively affect people’s cognition and judgment during an earthquake. Further research showed that these victims are also more susceptible to post traumatic stress disorder, which leads to an inferior quality of life ,17,18. CThe first reaction after an earthquake plays a vital role in victims’ experience of trauma. As shown in the results, most of the victims got injured during the main earthquake. Standing up immediately or running around without a destination will increase the risk rate for injury. It is commonly accepted that victims should hide under solid material to avoid being hit by falling objects . People should not run around until they are sure that the earthquake has stopped, and the building is safe. Research about the California earthquake in 1979 revealed that 50% of the victims got hurt by hitting desks or doors when running out of the house in a panic. Mahue-Giangreco . The resWe also revealed that surviving a previous earthquake can protect victims from getting hurt. However, injury during the previous earthquake increased the injury rate in the current earthquake. Perhaps after the previous earthquake, victims were more willing to practice earthquake rescue training and drills, which may prevent future injuries. Victims who are injured again may be able to escape due to a physical disability or being “too afraid to move,” based on the psychological effects of experiencing another earthquake. Consequently, victims injured in previous earthquakes should receive mental health support directly after the earthquake. However, our results suggest that effective planning including earthquake evacuation knowledge and psychological counseling can save lives more efficiently. For example, in the Northridge, California earthquake, one of the most severe earthquakes to ever strike North America, 2 in 12 families had prepared themselves with some type of emergency evacuation plan and food. The same was true in Turkey, where families even fixed their overhead heavy material based on the experience of the previous earthquake where many things fell down. The government of earthquake-prone areas should conduct emergency evacuation exercises periodically, which is the most efficient way to protect people from disasters.Being trapped was one of the key influencing factors for injury severity. Self- and mutual-aid plays an important role in the early time of rescue after earthquake. Being outside at the time of the earthquake or having escaped from the collapsing structure was crucial for survival. Many buildings were badly damaged after the Lushan earthquake. Almost half of the victims were trapped in the earthquake and most of them were buried under the ruins. Fortunately, 94% of the victims managed to be rescued in less than two hours. This could not have happened without the victims’ self-aid and mutual help in a timely fashion. In the research, 82% of victims got out of the ruin by themselves while only 1% got help from the professional rescue team. Additionally, 79% of them received medical first aid either by themselves or from their neighbors and relatives. Such a big percentage can really change the injury outcome and their loss. In the earthquakes in southern Italy and Mexico City, 80–90% of the victims assisted in post-earthquake rescue. In the Armenian earthquake, 89% of the survivors were rescued within 24 h . Of the According to the result, a low percentage of victims, especially the severely injured or trapped ones, were rescued by the professional rescue team due to the delay in the rescue work. For these two kinds of victims, to save time is to save their lives and only the professional rescue team including the medical personnel can save them. Previous research has shown that deaths were 100 times higher and injury rates were more than five times higher among trapped than non-trapped victims ,20. HoweThis research focuses on the relationship between the impact of earthquake victims’ individual behavior response and earthquake-related injuries, while also considering the effectiveness of earthquake rescue measures. All data were collected through interviews with the earthquake victims. We used a questionnaire to get first-hand information about earthquake victims’ individual actions right after the earthquake. This study makes a significant contribution to the literature because research about this issue is severely lacking and there is an obvious connection between earthquake-related injury and individual behavioral characteristics. It is strongly suggested that victims obtain mental health support from medical practitioners and the government to minimize its negative effects. The initial reaction after an earthquake also played a vital role in victims’ trauma; therefore, earthquake-related experience and education may prevent injuries. Self-aid and mutual help played key roles in emergency, medical rescue efforts.