Problem: While the COVID-19 pandemic threatened the entire world, the extremely remote Pitcairn Islands faced unique vulnerabilities. With only a physician and a nurse to care for an ageing population of fewer than 40 residents, and with very limited referral pathways, Pitcairn encountered distinct challenges in preparing for and responding to the COVID-19 pandemic. Context: The Pitcairn Islands is an overseas territory of the United Kingdom of Great Britain and Northern Ireland consisting of four islands in the South Pacific: Pitcairn, Henderson, Ducie and Oeno. Pitcairn is the only inhabited island with a local resident population of approximately 31 people, around half of whom were over 60 years old in 2023. The islands are only accessible by sea and are located more than 2000 km from the nearest referral hospital in French Polynesia. Actions: Pitcairn’s Island Council took aggressive action to delay the importation of SARS-CoV-2, vaccinate its small population and prepare for the potential arrival of the virus. Outcomes: As of May 2024, Pitcairn was one of the only jurisdictions in the world not to have had a single COVID-19 hospitalization or death. Nevertheless, the pandemic presented the islands’ population with many economic, social and health challenges. Discussion: Pitcairn’s population avoided COVID-19-related hospitalizations and deaths despite its elderly population’s vulnerability to COVID-19, a significant level of comorbidities, and limited clinical management capabilities and options for emergency referrals. The pandemic highlighted some of the population’s health vulnerabilities while also underscoring some of their innate strengths.

This article describes the development of an online, remote and interactive emergency medical team (EMT) training series to engage current and prospective Pacific EMT team members during the COVID-19 pandemic. This was done incorporating talanoa sessions. In many Pacific languages, talanoa means to tell a story or have a conversation.

This article describes the development of a national emergency medical team training package for Pacific island countries and areas. The training incorporates the logistical challenges faced in the Pacific and applies a mixed-method approach to training, with lectures, group discussions, hands-on activities and a simulation exercise.

Problem: Pacific island countries and areas represent some of the most disaster-vulnerable locations in the world, facing a range of natural and infectious hazards along with incredibly challenging logistics and limited human resource pools. Context: The World Health Organization supports the development of emergency medical teams across the Western Pacific Region. Since 2021, one aspect of this support has been supplying health emergency response equipment called cache kits for these unique island contexts. This report describes the process of designing and implementing standardized cache kits for these teams. Action: Emergency medical team cache kits were designed and sourced using a semi-structured six-step approach: 1) problem identification and review of existing literature; 2) targeted key informant interviews and stakeholder consultations; 3) the alignment of cache with the goals and objectives of the teams’ operations; 4) creation of the kits; 5) local and international procurement of selected items; and 6) monitoring of the delivery of cache to destination countries. Outcome: The Organization procured specialized cache kits for 12 teams across the Pacific subregion. They comprise portable, durable, lightweight equipment that enables teams to deliver high-quality emergency medical care in remote and resource-limited island contexts. Discussion: The Organization's centralized procurement of the cache kits in the Pacific aimed to facilitate nationally led health emergency responses, enhance team interoperability in the subregion, and ensure access to high-quality equipment in resource-constrained locations. The model established in the Pacific could serve as a blueprint for national emergency medical teams in low- and middle-income countries globally.

This article describes the development of a formal national Emergency Medical Team (EMT) in the Republic of Kiribati. It details how Kiribati’s Ministry of Health & Medical Services committed to establishing this deployable clinical response capability, and how support from the World Health Organization and United States Agency for International Development enabled the establishment of the Kiribati Medical Assistance Team, or KIRIMAT.

This article describes the development of national emergency medical teams in Pacific island countries and areas.

This regional analysis aims to provide a comprehensive review of emergency medical team development and action in health emergency response in the Western Pacific Region from 2010 to 2024. It details national, subregional and regional efforts to strengthen health emergency preparedness, response and resilience; it notes challenges faced by the teams in these efforts; and it provides examples that could be adopted or adapted to strengthen their development and action around the world. Emergency medical teams are critical components of national, regional and global health emergency workforces, enabling rapid, high-quality and self-sufficient responses to health emergencies domestically or internationally. They comprise clinical, mental health, public health, logistics and water/sanitation/hygiene personnel who collaborate in providing critical services to affected populations during health emergencies. By the end of 2024, emergency medical teams had been established in nearly every country in the Western Pacific Region, with 16 classified for international deployments, and many national teams developed to strengthen response to domestic emergencies. This analysis is based on published peer-reviewed literature on emergency medical team development and action in health emergencies in the Western Pacific Region, as well as publicly available data on team collaboration and deployment for health emergency response. This analysis considers the global evolution of the World Health Organization Emergency Medical Team Initiative and describes its development in the Western Pacific Region, including how the teams have contributed to emergency response efforts, and the key enabling factors and challenges faced as they develop and respond to emergencies. The analysis concludes by highlighting opportunities for future development, collaboration, research and insights that may be applicable to the global development of emergency medical teams.

Palau is a small island/large ocean nation in the Pacific that is vulnerable to natural or climate-related disasters. The national emergency medical team (EMT) was developed following a World Health Organization initiative to facilitate EMT training and cache procurement in the Pacific. As a result of the WHO initiative, Palau's EMT, known as KLEMAT, is fully self-sufficient and able to rapidly deploy in response to any local/national disaster or emergency. Imperative to any team development is the challenge of maintaining skills and motivation. Palau's experience is that by providing KLEMAT with regular education and training exercises, the team continues to advance as a cohesive, highly skilled group, which in turn ensures their ongoing preparedness for disaster/emergency response.

Problem: The undersea Hunga Tonga-Hunga Ha’apai volcano erupted on 15 January 2022, causing a tsunami that affected Tonga as well as other countries around the Pacific rim. Tonga’s international borders were closed at the time due to the coronavirus disease pandemic, but clinical surge support was needed to respond to this disaster. Context: Tonga’s Ministry of Health formed the Tonga Emergency Medical Assistance Team (TEMAT) in 2018 to provide clinical care and public health assistance during disasters, outbreaks and other health emergencies. TEMAT was activated for the first time in January 2022 to respond to medical and public health needs following the eruption and tsunami. Action: On 16 January 2022, a five-person TEMAT advance team was deployed to conduct initial damage assessments and provide casualty care. Subsequently, TEMAT rotations were deployed to provide clinical care and public health support across the Ha’apai island group for over 2 months. Outcome: TEMAT deployed to the islands most affected by the volcanic eruption and tsunami within 24 hours of the event, providing emergency clinical, psychosocial and public health services across four islands. TEMAT reported daily to the Ministry of Health and National Emergency Management Office, providing critical information for response decision-making. All TEMAT actions were documented, and an after-action review was conducted following the deployment. Discussion: TEMAT’s deployment in response to the 2022 volcanic eruption and tsunami highlighted the importance of national emergency medical teams that are prepared to respond to a range of emergency events.

Problem: On 15 November 2019, Samoa’s Government declared a state of emergency in response to a rapidly worsening measles outbreak. The outbreak overwhelmed Samoa’s health system, necessitating international assistance, including from emergency medical teams (EMTs). Context: Measles spread globally throughout 2019, with cases rising by more than 300% in the first quarter of 2019, as compared with 2018. Given Samoa’s low immunization coverage with a measles-containing vaccine at the time, at 40% for the first dose and 28% for the second, the country was soon overwhelmed with measles cases, hospitalizations and deaths. Action: Following a request for international assistance, 18 EMTs from around the world deployed to Samoa, bringing more than 550 additional clinical, public health and logistics personnel to the country’s measles response. Working alongside Samoan health workers, EMTs provided critical surge assistance in clinical management, vaccination, surveillance, infection prevention and control, risk communication and community engagement, and mental health and psychosocial support. Outcome: A total of 1867 hospitalized measles patients were treated from 30 September 2019 to 13 January 2020, with 83 measles-related deaths recorded. EMTs provided essential surge support across Samoa’s health system during the most acute phase of the response, helping to care for the ill and control the outbreak. Discussion: Samoa’s measles response triggered a large-scale and unique EMT activation, with teams integrated into Samoa’s hospitals and health centres. The response demonstrated the critical role that EMTs can play in outbreak response and the importance of strong coordination to ensure optimal use of international clinical surge support by a health system in crisis.