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Emergency Medical Services provider agencies and programs for systems of care for time-sensitive conditions in many communities and regions struggle with hospitals to obtain feedback data regarding patient outcomes and hospital processes relevant to EMS quality programs. EMS provider agencies also have issues in providing information to hospitals at the time of patient transfer to support continuity of care. The paper presents a position statement and supporting rationale from the National EMS Management Association on the bi-lateral exchange of data between EMS and hospitals. It examines the underlying issues and offers recommendations for how the various barriers to bi-lateral information exchange can be resolved. [ABSTRACT FROM AUTHOR]

EMS personnel in the U.S. continue to be overwhelmingly Caucasian and male, with 75% being male and 85% identifying as nonminority. While the population of the United States becomes more diverse in ethnicity, religion, and race, the EMS workforce remains largely homogenous and does not reflect the diversity of the population it serves. Given the growing diversity across the country, EMS personnel will increasingly be responding to calls for service involving patients with different cultural backgrounds than their own. This growing gap between providers and the population they serve may exacerbate already existing disparities in care. [ABSTRACT FROM AUTHOR]

This paper explores my first hand experience of illness during the first weeks of the pandemic, as a PhD student. Through an auto ethnographic lens, I narrate events which occurred during the month of March 2020. My memories, and their interpretation, continued to transform in the subsequent months, coinciding with the analysis of an earlier set of participants data and writing of the thesis. This paper draws upon such experiences to raise methodological and existential questions in relation to design research and healthcare. The short paper is structured in two parts; the first describes a few memory fragments to help the reader connect with that initial experience, whilst the second discusses the methodological and existential implications alongside a personal reflection, as an invitation for further dialogue within our research community. [ABSTRACT FROM AUTHOR]

Resilience is an important attribute of incident management teams (IMTs) for managing disasters. Previous research on resilience of IMTs has focused on comparing work-as-imagined (WAI) and work-as-done (WAD) but predominantly used narrative analyses which limited comparisons between IMTs. This paper presents a novel Interaction Episode Analysis (IEA) method to identify the IMT's WAI and WAD episodes by analyzing dynamic interactions that occur between different roles that carry out information management tasks. Observations and audio--visual recordings of two high-fidelity IMT exercises were conducted to capture WAD episodes, and semi-structured interviews with experts elicited corresponding WAI episodes. Quantitative analyses using five interaction-based measures were conducted to detect differences of the WAD episodes between two IMTs. Next, qualitative analyses were focused on identifying reasons why such differences have occurred by comparing the gaps between WAI and WAD episodes. Some of the reasons for WAI-WAD gaps included the non-occurrence of critical interactions that were expected and occurrence of unexpected interactions between IMT members. This paper also identifies cases of preparatory, proactive, and reactive performance adjustment that characterizes IMT resilience. The IEA method shows promise for investigating how and why the gaps between WAI and WAD in IMTs occur. With the identification of these gaps, future research can be conducted to reconcile the gaps between WAI and WAD episodes, and thus enhance resilience of IMTs in future disasters. [ABSTRACT FROM AUTHOR]

This article aims to summarize performance indicators used in telephone triage services research, and make recommendations for the selection of valid indicators to measure the performance of telephone triage. We describe what kind of frameworks, performance indicators, or variables have been used for evaluating telephone triage performance by systematically mapping the telephone triage performance measurement. The objective was to find measures for each Triple Aim dimension. A scoping review method was used following Joanna Briggs Institute guidelines. Using this method, we defined indicators to measure the performance of telephone triage. We used the Triple Aim framework to identify indicators to measure the overall performance of telephone triage. The Triple Aim framework consists of improving the patient experience of care, improving the health of populations, and reducing cost per capita. The scoping review was performed using CINAHL, Medline, EBSCOhost, and PubMed electronic databases. The eligibility criterion was research published in English between 2015 and 2023. The inclusion focused on the use and performance of telephone triage services and system-focused studies. A total of 1098 papers were screened for inclusion, with 57 papers included in our review. We identified 13 performance indicators covering all Triple Aim dimensions: waiting times, access, patient satisfaction, the accuracy of triage decision, severity and urgency of the symptoms, triage response, patient compliance with the advice given, follow-up healthcare service use, and running costs of service. We didn't find any earlier framework covering all Triple Aim dimensions properly. Measuring the performance of telephone triage requires an extensive and comprehensive approach. We presented performance indicators that may be included in the framework for measuring the performance of telephone triage to support overall performance measurements of telephone triage. [ABSTRACT FROM AUTHOR]

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Simulation models of emergency departments (EDs) are often built based on incomplete data, for example, missing arrival times or service-time durations. The difficulty in collecting reliable and complete data can subsequently lead to invalid simulation results. To tackle this problem, we propose a simulation and optimisation method to characterise the unavailable durations of service times. Since many services in an ED are sequential and dependent on each other, this paper considers these multiple process steps cooperatively. We first use lognormal distributions to characterise the key service durations. Then we propose a new meta-heuristic approach, which combines an Improved Adaptive Genetic Algorithm (AGA) and Simulated Annealing (SA), IAGASA, to search for the optimal set of service-time distribution parameters. To address the difficulties of applying IAGASA when noise is involved in the performance measures and improve the simulation efficiency, we jointly apply IAGASA and Optimal Computing Budget Allocation (OCBA) technology. OCBA minimises the total simulation cost for achieving a desired level of probability of correctly selecting the best set of distribution parameters, which improves the search efficiency significantly. The experimental results indicate that our proposed method can find accurate estimates of service-time distribution parameters within a relatively short time. [ABSTRACT FROM PUBLISHER]

Emergency Medical Service (EMS) is an integral part of the healthcare system that works dedicatedly to save the lives of people. The prime responsibility of any EMS provider is to offer a timely response to the person in need. The timely assistance increases the chances of survivability of a person. In India, escalating count of road accidents has increased the demand for ambulance services to provide pre-hospital treatment or transportation of victims to the hospital. This paper presents a new optimization strategy of Hybrid Particle Swarm Optimization and Genetic Algorithm (HPSOGA) for ambulance allocation to reduce the ambulance response time. Considering a set of assumptions, the authors have applied the new strategy for allocating 50 ambulances to 11 base stations in Southern Delhi. The working environment of EMS which includes stochastic requests, travel time, and dynamic traffic conditions have been taken into account to attain accurate results. The new optimization strategy of HPSOGA has been implemented in a MATLAB environment to find an optimized allocation plan with minimum response time. With the proposed algorithm the authors have been able to reduce the average response time by 11.61%. The paper also presents the comparison of HPSOGA, Genetic Algorithm (GA), and Particle Swarm Optimization (PSO) for the stated problem. The algorithms are compared in terms of objective value (response time), convergence rate, and constancy repeatability to conclude that HPSOGA performs better than the other two algorithms. [ABSTRACT FROM AUTHOR]

The practice of medicine frequently involves the unconsented restriction of liberty. The reasons for unilateral liberty restrictions are typically that being confined, strapped down, or sedated are necessary to prevent the person from harming themselves or others. In this paper, we target the ethics of chemical restraints, which are medications that are used to intentionally restrict the mental states associated with the unwanted behaviors, and are typically not specifically indicated for the condition for which the patient is being treated. Specifically, we aim to identify the conditions under which chemical restraints are ethically permissible. It is wrong to assume that what is morally true of physical restraints is also true of chemical restraints. Our aim is thus to identify the conditions under which chemical restraints are permissible while distinguishing these conditions from those of the application of physical restraints. [ABSTRACT FROM AUTHOR]

COVID-19 has challenged global health care systems and resulted in prehospital delays for time-sensitive emergencies, like stroke and transient ischemic attacks (TIA). However, there are conflicting international reports on the level of effect of the pandemic on ambulance response intervals and emergency call volumes for these conditions. The purpose of this study was to synthesize the international evidence on the effect of COVID-19 on ambulance response intervals and emergency call volume for suspected stroke and TIA. Following a published protocol, we conducted a systematic search of six databases through May 31, 2022. We re-ran this search on April 14, 2023, to check for any new papers. We considered for inclusion peer-reviewed quantitative studies comparing prehospital emergency care for adults with suspected stroke/TIA before and during the COVID-19 pandemic. Two authors screened title/abstract and full text articles. One author carried out data extraction, with a random selection of articles being checked by another author. We calculated overall pooled estimates of ambulance intervals (activation, response, patient care, and total prehospital intervals) and stroke/TIA emergency call volume. Subgroup and sensitivity analyses included location and stroke/TIA diagnosis. Two authors assessed study quality using the appropriate Joanna Briggs Institute tool. We worked with patient and public involvement contributors and clinical and policy stakeholders throughout the review. Of 4,083 studies identified, 52 unique articles met the inclusion criteria. Mean response interval (-1.29 min [-2.19 to -0.38]) and mean total prehospital interval (-6.42 min [-10.60 to -2.25]) were shorter in the pre-COVID-19 period, compared to the COVID-19 period. Furthermore, there was a higher incidence rate of emergency call volume for suspected stroke/TIA per day pre-COVID-19 compared with the COVID-19 period (log IRR = 0.17 [0.02 to 0.33]). Ambulance response interval definitions and terminology varied between regions and countries. Our review indicates that prehospital delays for suspected stroke/TIA increased during the COVID-19 pandemic. Furthermore, emergency call volume for suspected stroke/TIA decreased during this period. In order to minimize delays in future pandemics or other health care emergencies future research may involve understanding the potential reasons for these delays. [ABSTRACT FROM AUTHOR]

Proactive ambulance management is constructive to improve the response efficiency for emergency medical service (EMS) systems under uncertainty. In this paper, we present a dynamic optimisation model concerning the ambulance dispatching and relocation. We develop a flexible operation policy driven by the interval rolling to match vehicles with calls in batch. We formulate the problem in Markov Decision Process and incorporate M / G / c queues to minimise the average response and delay time. Considering the curse-of-dimensionality, we provide a simulation-based empirical dynamic programming with the state aggregation and post-decision state to solve the model. To further accelerate the computational efficiency, a greedy heuristic method is introduced to improve the quality of sampling operations. Then, a risk-averse model is developed based on the stochastic dominance strategy to improve operational reliability. We develop an equivalent linear programming to evaluate concave dominating functions. We test the performance by a numerical case and extract managerial insights for practitioners. Our results show that the proposed flexible and risk-averse solution outperforms the classic model on reducing the delay under uncertain calls. And the improvement is more active during peak hours, when real-time needs exceed available ambulances. [ABSTRACT FROM AUTHOR]

This paper uses conversation analysis to investigate how participants in emergency telephone calls in the United States use racial/ethnic categories to describe persons of interest such as suspects, victims, or persons needing assistance. It problematizes the use of racial/ethnic categories in these calls by first analyzing an instance of a caller's racial profiling (in which racial categories are used to justify the call). This instance of racial profiling is then compared with 15 routine emergency service calls to reveal how callers and call takers routinely introduced racial/ethnic categories. I describe how both deviant and routine uses of these categories could lead to racial profiling and/or displace information that might be more effective in creating useful descriptions of persons of interest. The conclusion addresses ideas for further research and practical implications for emergency telephone call takers and those working to transform the way race is tied to policing in the United States. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic, where the need-resource gap has necessitated decision makers in some contexts to ration access to life-saving interventions, has demonstrated the critical need for systematic and fair priority setting and resource allocation mechanisms. Disease outbreaks are becoming increasingly common and priority setting lessons from previous disease outbreaks could be better harnessed to inform decision making and planning for future disease outbreaks. The purpose of this paper is to discuss how priority setting and resource allocation could, ideally, be integrated into the WHO pandemic planning and preparedness framework and used to inform the COVID-19 pandemic recovery plans and plans for future outbreaks. Priority setting and resource allocation during disease outbreaks tend to evoke a process similar to the 'rule of rescue'. This results in inefficient and unfair resource allocation, negative effects on health and non-health programs and increased health inequities. Integrating priority setting and resource allocation activities throughout the four phases of the WHO emergency preparedness framework could ensure that priority setting during health emergencies is systematic, evidence informed and fair. [ABSTRACT FROM AUTHOR]

This paper reports findings from a qualitative study conducted on the Need for Social work interventions in the Emergency Department (ED) at a large tertiary care center in India. The emergency department is an important social work intervention point for individuals with various psychiatric, medical, and social needs who have little or no additional interaction with social services. Social workers are specially trained to understand the impact of social factors on health outcomes and provide interventions that address social barriers to improving health and accessing community resources; social workers are well prepared to provide services in the emergency department. However, limited research is available to understand the impact of psychosocial services in the emergency department. We aimed to identify areas which require integrated social work services and coordination to address the psychosocial issues within the ED. Interviews with 10 healthcare workers are analyzed thematically. Recurring themes throughout the interviews confirm the need for providing social work interventions to ensure the medical, psychological, and social care needs in the emergency department. [ABSTRACT FROM AUTHOR]

To develop the Glasgow Outcome Scale-Extended (GOSE) mobile application and examine the validity of the application against GOSE scoring based on traditional interview method. Concurrent validity was determined by comparing two independent raters' scoring for GOSE of 102 patients with traumatic brain injury, who had attended outpatient department of a tertiary neuro hospital. Agreement was assessed between the traditional interview-based pen and paper scoring and algorithm based mobile application scoring of GOSE. Agreement was tested using Cohen's kappa, and the analysis revealed near perfect agreement between two raters (0.89) (p < 0.01). The GOSE mobile application can measure GOSE Score similar to the traditional interview method. This application may help fasten the process of assessing outcome in TBI patients in clinical practice and in research. [ABSTRACT FROM AUTHOR]

The opioid crisis is a growing concern for Americans, and it has become the leading cause of injury-related death in the United States. An adjunct to respiratory support that can reduce this high mortality rate is the administration of naloxone by Emergency Medical Services (EMS) practitioners for patients with suspected opioid overdose. However, clear evidence-based guidelines to direct EMS use of naloxone for opioid overdose have not been developed. Leveraging the recent Agency for Healthcare Research and Quality (AHRQ) systematic review on the EMS administration of naloxone for opioid poisonings, federal partners determined the need for a clinical practice guideline for EMS practitioners faced with suspected opioid poisoning. Project funding was provided by the National Highway Traffic Safety Administration, Office of EMS, (NHTSA OEMS), and the Health Resources and Services Administration, Maternal and Child Health Bureau's EMS for Children Program (EMSC). The objectives of this project were to develop and disseminate an evidence-based guideline and model protocol for administration of naloxone by EMS practitioners to persons with suspected opioid overdose. We have four recommendations relating to route of administration, all conditional, and all supported by low or very low certainty of evidence. We recommend the intravenous route of administration to facilitate titration of dose, and disfavor the intramuscular route due to difficulty with titration, slower time to clinical effect, and potential exposure to needles. We equally recommend the intranasal and intravenous routes of administration, while noting there are variables which will determine which route is best for each patient. Where we are unable to make recommendations due to evidence limitations (dosing, titration, timing, and transport) we offer technical remarks. Limitations of our work include the introduction of novel synthetic opioids after many of the reviewed papers were produced, which may affect the dose of naloxone required for effect, high risk of bias and imprecision in the reviewed papers, and the introduction of new naloxone administration devices since many of the reviewed papers were published. Future research should be conducted to evaluate new devices and address the introduction of synthetic opioids. [ABSTRACT FROM AUTHOR]

This paper, as part of a European Commission-funded project entitled REBEL (Repurposing Education through Blended Learning), deconstructs school communities understanding of the challenges and opportunities for blended learning in the school sector in Ireland with perceptions shaped by experiences of enforced school closures during the pandemic. It provides an overview of five case studies in primary and post-primary schools in Ireland. The findings from this research indicate that the emergency remote teaching experience has cast an unhelpful shadow on blended learning. To avoid stigmatising online teaching and learning based on less than ideal experiences, in spring 2020, Hodges and co-authors referred to this period as 'emergency remote teaching.' (Hodges et al., 2020). Perhaps blended learning is also the victim of a similar stigmatising effect. The paper makes several contributions, including a need to differentiate between blended learning, emergency remote teaching and the suite of additional factors that impacted the school closure experience for teachers and schools. In addition, the findings signpost some succinct questions for consideration, that is, what conditions, social, cognitive, and teacher presence, resources and supports are necessary for effective intentional blended learning in schools. [ABSTRACT FROM AUTHOR]

Head-Worn Displays (HWD) can potentially support the mobile work of emergency responders, but it remains unclear whether teamwork is affected when emergency responders use HWDs. We reviewed studies that examined HWDs in emergency response contexts to evaluate the impact of HWDs on team performance and on team processes of situation awareness, communication, and coordination. Sixteen studies were identified through manual and systematic literature searches. HWDs appeared to improve the quality of team performance but they increased time to perform under some conditions; effects on team processes were mixed. We identify five challenges to explain the mixed results. We discuss four theoretical perspectives that might address the challenges and guide research needs—joint cognitive systems, distributed cognition, common ground, and dynamical systems. Researchers and designers should use process-based measures and apply greater theoretical guidance to uncover mechanisms by which HWDs shape team processes, and to understand the impact on team performance. Practitioner Summary: This review examines the effects of head-worn displays on teamwork performance and team processes for emergency response. Results are mixed, but study diversity challenges the search for underlying mechanisms. Guidance from perspectives such as joint cognitive systems, distributed cognition, common ground, and dynamical systems may advance knowledge in the area. Abbreviations: HWD: head-worn display; RC: remote collaboration; DD: data display; ARC: augmented remote collaboration; ACC: augmented collocated collaboration; SA: situation awareness; TSA: team situation awareness; CPR: cardiopulmonary resuscitation; SAGAT: situation awareness global assessment technique; SART: situation awareness rating technique. [ABSTRACT FROM AUTHOR]

The year 2020 will be synonymous with the coronavirus disease 2019 (COVID-19) for many global citizens. Millions have died from and tens of millions more have been infected globally by the COVID-19 pandemic. This has led to an urgent search for COVID-19 vaccines and treatments by the scientific and political communities and civil society. Through elements of events study and document and critical discourse analysis, this paper investigates the COVID-19 vaccines' regulatory emergency use authorisation and/or conditional marketing authorisation (regulatory authorisation) regimes and the contestations thereof. The key finding is that there was a regulatory authorisation rush, with at least 62, mostly high-income countries, doing so in 40 days from 2 December 2020–10 January 2021. This has led to one senior USA official describing the United Kingdom pioneer regulatory authorisation of the Pfizer-BioNTech vaccine as 'too quick'. Regulatory authorisation regimes took place amid severe civil society contestations and appropriate political pressure. The paper recommends that as the COVID-19 vaccines' regulatory authorisation continue in 2021, national vaccines and treatments regulatory bodies must be informed by science, with governments, civil society, politicians and other key stakeholders taking responsibility to educate the masses and continue taking the necessary precautions. [ABSTRACT FROM AUTHOR]

This paper considers a multi-period location and sizing problem for an emergency medical service (EMS) system based on a distributionally robust optimisation (DRO) chance-constrained programming approach. The dynamic uncertain emergency medical requests are described in the ambiguity set, which is constructed based on Wasserstein-metric. The model of this problem focuses on minimising long-term operation costs. The chance constraints ensure the reliability of EMS system for the entire geographic areas. A reformulation of chance constraints is provided in Mixed Integer Linear Program form. For problem solution, a generalised Benders decomposition (GBD) implementation is proposed. A numerical simulation is conducted to illustrate the performance of two solution approaches in terms of computational convergence speed and optimality of the problem. [ABSTRACT FROM AUTHOR]

Introduction: Extracorporeal membrane oxygenation (ECMO) is primarily used for the supportive treatment of patients suffering from severe cardiopulmonary failure. With the continued development of ECMO technology, the relevant scenarios also extend pre-hospital and inter-hospital. In order to meet the needs of emergency treatment in communities, disaster sites and battlefields, inter-hospital transfer and evacuation; miniaturized and portable ECMO has become a current research hotspot. Area covered: The paper first introduces the principle, composition and common modes of ECMO and summarizes the research status of portable ECMO, Novalung and wearable ECMO, analyzes the characteristics and shortcomings of existing equipment. finally, we discussed the focus and development trend of portable ECMO technology. Expert opinion: Currently, portable ECMO has many applications in interhospital transport and there are various studies on portable and wearable ECMO devices, but the development of portable ECMO still faces many challenges. In the future, research related to integrated components, rich sensor arrays, Intelligent ECMO system and lightweight technology can make future portable ECMO more suitable for pre-hospital emergency and interhospital transport. [ABSTRACT FROM AUTHOR]

This paper studies a location and sizing problem for an emergency medical service system using distributionally robust chance-constrained programming approach. The medical demands are uncertain and described in an ambiguity set, which is constructed based on Wasserstein-metric. The location problem is modelled through minimising the total expected costs, including construction costs of facilities, purchase of ambulances and maintenance costs. The chance constraints are introduced to guarantee the service level of geographical areas. For the chance constraints, three reformulations such as CVaR-approximation, the mixed integer linear programme exact reformulation and the physically bounded bilinear reformulation are studied. A numerical study is conducted to illustrate the computational performance and objective values. [ABSTRACT FROM AUTHOR]

The improvement of transport and logistics performance of Emergency Medical Services (EMSs) systems has been mainly addressed through mathematical modelling, operations research, and simulation methods. This paper proposes an alternative and/or complementary improvement approach based on the adaptation and simultaneous deployment of lean thinking and Theory of Constraint (TOC) methods and tools. The paper briefly reviews key aspects of the application of lean in the logistics and healthcare industries and conceptually develops the proposed lean-TOC approach. The approach is then tested, through an individual detail case study, in the EMS transport and logistic system of the Red Cross operating in the metropolitan area of Monterrey, Mexico. The results obtained from the case study suggest that the proposed systematic lean-TOC approach may be an effective alternative and/or complement to mathematical modelling, operations research, and simulation methods to improve EMS transport and logistics operations. [ABSTRACT FROM AUTHOR]

This paper examines communities' accessibility to critical facilities such as hospitals, emergency medical services, and emergency shelters when facing flooding. We use travel speed reduction to account for flood-induced partial road failure. A modified betweenness centrality metric is also introduced to calculate the criticality of roads for connecting communities to critical facilities. The proposed model and metric are applied to the Delaware road network under 100-year floods. This model highlights the severe critical facility access loss risk due to flood isolation of facilities. The mapped post-flooding accessibility suggests a significant travel time increase to critical facilities and reveals disparities among communities, especially for vulnerable groups such as long-term care facility residents. We also identified critical roads that are vital for post-flooding access to critical facilities. The results of this research can help inform targeted infrastructure investment decisions and hazard mitigation strategies that contribute to equitable community resilience enhancement. [ABSTRACT FROM AUTHOR]

Peer navigation is a model that includes connecting an individual in need of services with a peer who can navigate engagement in clinical treatment services and provide emotional and logistical support that is often unavailable through the traditional system. In the substance use field—where the use of peers is a relatively new phenomenon—peers are individuals with lived experiences who are in recovery themselves. In 2016, a peer program called RECOVERY was implemented in a northeastern U.S. state. This team of peers act as a bridge between a referral source (e.g., police, emergency services, hospital) and treatment facilities. Using semi-structured interviews from the team of peers (N = 5), this paper provides a case study of the implementation process for this peer recovery program. The findings identify potential barriers and facilitators to peer services and offer a feasible approach for implementing peer support programs in substance use settings. [ABSTRACT FROM AUTHOR]

Background: Given the increasing emphasis on community-based provision of palliative care and the view that good dying should occur at home, it is unsurprising that policy in many countries has started focusing on preventing hospital admissions at the end of life. However, little attention has been paid to the role of the emergency department (ED) in this regard, despite the fact that a high proportion of hospital admissions among patients with palliative care needs originate in the ED. This paper presents the next logical step in improving understanding of ED use within a palliative care context; as to determine what constitutes an avoidable ED presentation initially requires recognition of the reasons that such patients are presenting. Methods: A systematic, narrative approach was used to appraise the relevant studies. From August to December 2014, electronic databases, gray literature and guidelines were searched, using MeSH headings and keywords. As it was anticipated that reasons for presentation would be differently described, all papers addressing presentations to the ED among patients with palliative care needs were identified; information regarding reasons for presentation were then examined. Results: Twelve papers ultimately met the inclusion criteria and were accessible. The ‘reason’ for a patient's presentation was largely defined as their ‘presenting complaint’ or ‘underlying diagnosis.’ There was consistency in the studies in this respect; the majority found that people with lung cancer and those experiencing distressing respiratory symptoms were most likely the present to the ED. Subsequently, pain and gastrointestinal symptoms such as nausea and vomiting were uniformly found to be most common. The three prospective studies gathered information about reason for presentation from the patient perspective using structured questionnaires, but no study collected qualitative data from patients and families. Discussion: This systematic narrative review is the first to explore reasons for ED presentation among patients with palliative care needs. However, the data does not facilitate a detailed discussion about the difficulties that this population of patients face, and whether they may be best managed in an acute or community setting. A deep understanding of the perspectives of patients is urgently needed, so as to both understand their reasons for presentation and implement relevant patient-directed changes in service provision. [ABSTRACT FROM PUBLISHER]

This paper explores the factors that influence public trust in public organizations responsible for providing services before, during and after emergencies. We develop a research framework and test it using a survey distributed among a representative sample of the Israeli population. The analysis develops the concept of an emergency network and explains its advantages as a mechanism for coordinating emergency services. It shows that trust in emergency organizations is related to trust in the public sector in general, the perceived level of readiness of emergency organizations and the degree to which people fear that an emergency situation will occur. [ABSTRACT FROM AUTHOR]

Seemingly erratic pedestrian crossing has become a major source of vehicle-pedestrian collisions on highways in Bangladesh, and across other low- and middle-income countries (LMICs). In this article, we approach the challenge from a sociotechnical systems perspective by using the Accimap method to analyse a pair of time-separated yet interconnected road traffic collisions. The first event involved a truck colliding with a road divider; in the second, fatal incident, a bus hit a university student. The traditional-style investigation conducted immediately after the collision apportioned blame to end users, that is, drivers and pedestrian; however, application of sociotechnical systems thinking revealed the contribution from lack of emergency response and enforcement among many other important factors. Results and recommendations are discussed in terms of reducing the chance and severity of such collisions across LMICs, and in terms of the need to look beyond the end-user, a focus that remains dominant in such settings. Practitioner summary: This paper applies sociotechnical systems thinking to pedestrian safety in Bangladesh by analysing two inter-connected road traffic collisions using a single Accimap. The findings emphasise the importance of implementing road safety interventions that target all system levels, and draw attention to the importance of post-collision response in low-income settings. Abbreviation: BUET: Bangladesh University of Engineering and Technology [ABSTRACT FROM AUTHOR]

Background: Work schedules like those of Emergency Medical Services (EMS) personnel have been associated with increased risk of fatigue-related impairment. Biomathematical modeling is a means of objectively estimating the potential impacts of fatigue on performance, which may be used in the mitigation of fatigue-related safety risks. In the context of EMS operations, our objective was to assess the evidence in the literature regarding the effectiveness of using biomathematical models to help mitigate fatigue and fatigue-related risks. Methods: A systematic review of the evidence evaluating the use of biomathematical models to manage fatigue in EMS personnel or similar shift workers was performed. Procedures proposed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology were used to summarize and rate the certainty in the evidence. Potential bias attached to retained studies was documented using the Cochrane Collaboration's Risk of Bias tool for experimental studies. Results: The literature search strategy, which focused on both EMS personnel and non-EMS shift workers, yielded n = 2,777 unique records. One paper, which investigated non-EMS shift workers, met inclusion criteria. As part of a larger effort, managers and dispatchers of a trucking operation were provided with monthly biomathematical model analyses of predicted fatigue in the driver workforce, and educated on how they could reduce predicted fatigue by means of schedule adjustments. The intervention showed a significant reduction in the number and cost of vehicular accidents during the period in which biomathematical modeling was used. The overall GRADE assessment of evidence quality was very low due to risk of bias, indirectness, imprecision, and publication bias. Conclusions: This systematic review identified no studies that investigated the impact of biomathematical models in EMS operations. Findings from one study of non-EMS shift workers were favorable toward use of biomathematical models as a fatigue mitigation scheduling aid, albeit with very low quality of evidence pertaining to EMS operations. We propose three focus areas of research priorities that, if addressed, could help better elucidate the utility and impact of biomathematical models as a fatigue-mitigation tool in the EMS environment. [ABSTRACT FROM AUTHOR]

Aims: The aim of this paper is to address whether the introduction of a national licensing exam will improve preparedness for practice. This review will explore and identify the areas in which UK medical graduates are feeling underprepared. In addition, this review will discuss the need for the Medical Licensing Assessment in the UK. Methods: A literature search of several databases was performed in December 2018. Studies which identified the areas in which medical graduates were prepared/unprepared for, and those which explored whether UK medical schools were adequately preparing their graduates for practice, were included. Studies exploring the preparedness of international medical graduates were excluded. Results: Sixteen articles met the final inclusion criteria and are included in this review. All the final studies are cross-sectional and are varied in their use of methods used, with the vast majority using questionnaires to identify the preparedness of medical students and junior doctors. Conclusions: This review conveys that junior doctors are mostly underprepared in emergency work. This can be associated to a lack of exposure to emergency situations during their undergraduate training. Moreover, this review suggests that the preparedness of medical graduates may remain unaffected by the implementation of the MLA. [ABSTRACT FROM AUTHOR]

Focuses on the opposition of national emergency medical services (EMS) organizations on establishing a U.S. Emergency Medical Services Administration within the Department of Homeland Security. Aim of the EMS office to provide leadership and support for EMS terrorism preparedness and response; Steps undertaken to assess and provide additional federal support for EMS systems throughout the country; Belief of advocates that better coordination through the Federal Interagency Committee on Emergency Medical Services is the best approach to ensure that the needs of EMS at the federal level are addressed.

Mobile integrated health-community paramedicine (MIH-CP) uses patient-centered, mobile resources in the out-of-hospital environment to increase access to care and reduce unnecessary emergency department (ED) usage. The objective of this systematic review is to characterize the outcomes and methodologies used by MIH-CP programs around the world and assess the validity of the ways programs evaluate their effectiveness. The PubMed, Embase, CINAHL, and Scopus databases were searched for peer-reviewed literature related to MIH-CP programs. We included all full-length studies whose programs met the National Association of Emergency Medical Technicians definition, had MIH-CP–related interventions, and measured outcomes. We excluded all non-English papers, abstract-only, and incomplete studies. Our initial literature review identified 6434 titles. We screened 178 full-text studies to assess for eligibility and identified 33 studies to include in this review. These 33 include four randomized controlled trials, 17 cohort studies, eight 8 case series, and four 4 cross-sectional studies. Of the 29 non-randomized trials, five used matched controls, 13 used pre-post, and 11 used no controls. Outcomes measured were hospital usage (24 studies), ED visits (15), EMS usage (23), patient satisfaction (8), health-related outcomes (8), and cost (9). Studies that evaluated hospital usage reported one of several outcome measures: hospital admissions (11), ED length of stay (3), and hospital readmission rate (2). EMS usage was measured by ambulance transports (12) and EMS calls (10). Cost outcomes observed were ambulance transport savings (7), ED visit savings (4), hospital admission savings (3), and cost per quality-adjusted life year (2). Most studies assessing MIH-CP programs reported success of their interventions. However, significant heterogeneity of outcome measures and varying quality of study methodologies exist among studies. Future studies designed with adequately matched controls and applying uniform core metrics for cost savings and health care usage are needed to better evaluate the effectiveness of MIH-CP programs. [ABSTRACT FROM AUTHOR]

This paper proposes a foundation on which to consider post-traumatic growth (PTG) and addiction recovery. It considers addiction as a traumatic experience with a consequential impact on mental health that is a primer for PTG. It demonstrates the similarity of a prominent change model used in the field of addiction recovery with PTG theory, offering the Extended Transformational Model, a PTG life cycle model, as an output. This research considers previous positive psychology (PP) work, specifically surrounding PTG and addiction recovery. As a next step, further investigation is necessary to demonstrate the efficacy of the model comparison so it can mature into one that in application can integrate PTG theory with addiction treatment services as a recognized and effective pathway to recovery. While this is a first attempt at such a model comparison, demonstrating the similarity between PTG and addiction recovery through a life cycle model, offers the opportunity to develop effective interventions, in addition to building confidence in a recognized discipline of PTG in addiction recovery. [ABSTRACT FROM AUTHOR]

Background: End-of-life treatment decisions present special challenges for prehospital emergency providers. Paramedics regularly make value-laden choices that transcend technical judgment and professional skill, affecting the type of care, how and to whom it is provided. Changes in prehospital emergency care over the last decade have created new moral challenges for prehospital emergency providers; these changes have also accentuated the need for paramedics to make rapid and reasoned ethical judgments. Objective: The purpose of the study was to explore the decision-making process that occurs when prehospital emergency teams respond to an end-of-life call with a focus on how state authorized documents such as a Non-Hospital Do Not Resuscitate (NHDNR) or Medical/Physician's Orders for Life-Sustaining Treatment (MOLST/POLST) or lack thereof inform decision-making. This paper presents the specific circumstances that informed the need for intervention from Online Medical Direction (OLMD) framed in the perspectives and words of the prehospital providers seeking that assistance. Methods: This study involved in-depth in-person interviews with 50 providers to elicit participants' experiences in their own words using a semi-structured interview instrument. Interviews were audio recorded and transcribed with permission. Results: Five themes emerged that illuminated how and when OLMD was involved in emergency end-of-life decisions: Termination of Resuscitation (TOR); Family Revoked DNR; Missing Documents; No Documents and No CPR; and Unusual Situations. Participants illustrated how the decision to terminate efforts was best-supported when it was made by collaboration between the on-scene provider and OLMD. Participants described ethical dilemmas when families asked them to initiate CPR in the presence of DNR orders and cognitive dissonance when CPR has been initiated but a valid DNR/MOLST is subsequently located. Conclusions: The study findings demonstrate the invaluable contribution of OLMD for complex end-of-life care decisions by prehospital providers, especially when there are difficult legal, ethical, and logistical questions. OLMD provides far more than technical support. [ABSTRACT FROM AUTHOR]

Workplace wellbeing is a fast-developing subject in employment relations. This qualitative study examined the workplace wellbeing of police during COVID-19. There has been a significant critique of the narrow focus only on individual resilience and stress as the cause of workers' poor mental health and wellbeing. Research into frontline workers' mental health and wellbeing has mainly focused on the cumulative effect of trauma and operational stress injuries on individual resilience, with insufficient consideration of the impact of organisational culture, systemic and environmental factors. Drawing on a survey of 665 police professionals from all states and territories in Australia, this research investigated individual, the nature of work, organisational and environmental factors that negatively impacted worker wellbeing during the pandemic. The paper concludes that incorporating the full range of factors related to workplace wellbeing would inform an improved, holistic approach to maintaining and enhancing employee wellness. Understanding the influence of these factors during COVID-19 has implications for employment relations theory and the practical management of frontline emergency service workers' workplace wellbeing generally and in times of crisis and disruption. [ABSTRACT FROM AUTHOR]

This paper provides an in-depth analysis of the Big Data application in the field of medicine. This innovative technology is a significant topic because Big Data introduces new opportunities for medical practitioners and patients, including the improvement of patients' quality of life and healthcare systems, the mitigation of specific illnesses, and the reduction of state-level healthcare costs. This paper discusses implications relative to wearable sensing devices as well as personalised medicine. The advantages of the analytical capabilities of Big Data are also discussed. For instance, Big Data analytics can aid in the improvement of healthcare cost-efficiency and profit generating capabilities. The limitations and vulnerabilities of Big Data application in the healthcare field, such as the development of the domain-specific system architecture, are exposed. This paper examines the elements of architecture (data acquisition & transmission, cloud processing, and analytics) adapted to healthcare needs. A brief outline of the restrictions for official approval of the new devices and methodologies is presented. Specifically, the sensor data are heterogeneous and untagged. Previously, the implementation of clinical records into models was required. Currently, adaptation of machine-learning techniques is required. Ethical issues relative to the personal privacy involved in healthcare data acquisition, storage, and processing are considered. [ABSTRACT FROM AUTHOR]

Self-care is recognized as an important aspect of social work practice. Beginning in educational settings, developing social workers are encouraged to learn about and practice self-care. However, self-care is typically promoted through strategies and approaches outside of the practice context. Social workers are oftentimes encouraged to use individualized self-care plans, which often feature a variety of relaxation and secondary techniques; focus on self-awareness and self-reflection; and have proper use of supervision. Although these strategies are invaluable, they do little to directly benefit the social worker during direct practice or while in session with a client which is a time period when clinicians are particularly vulnerable to distress or burnout. The importance of real-time self-care strategies is particularly critical for clinicians, especially those who engage in trauma work, given the sensitivity of topics that clients may have endured or benefit from assistance in processing. Further, little information has been published on the use of self-care techniques during a session with a client or in a clinical context. The purpose of the present paper is to discuss self-care strategies that can be useful both outside of and within a clinical setting and present a model of such strategies that focus on integrating self-care in clinical practice particularly for those engaging in trauma work. The paper will conclude by discussing the relevancy of the developed model in practice. [ABSTRACT FROM AUTHOR]

This paper summarises a consultation–liaison nurse's journey as a senior mental health clinician working within the general hospital setting. It begins with a brief history of consultation–liaison nursing (CLN) and covers the CLN experience in both the general hospital and the emergency department showing how the role evolved to become more focused on the needs of the general hospital. It shares some experiences during a stimulating, challenging and rewarding career where clinical supervision is seen as essential not only to reflect on and improve practice but to assist the CL nurse in working through the emotional demands of the role. The paper aims to increase knowledge of the CLN experience and promote interest in this specialist area of mental health nursing which is developing rapidly internationally and in Australia. [ABSTRACT FROM AUTHOR]

A disaster is commonly thought of as an occurrence that results in property damage and physical injuries that exceed the response capabilities of local resources. History teaches that disasters also result in a surge in demand for psychological support amongst survivors and disaster responders. This surge quickly exceeds local response capacities and has the potential to exceed even the mental health resources that may be imported from neighbouring jurisdictions and disaster relief agencies. Efficient and effective acute mental health intervention is, therefore, needed. However, the effectiveness of traditional multi-session counselling during and shortly after disasters has been questioned. Instead, the utilization of efficient and effective crisis-focussed psychological interventions has been suggested as acute phase alternatives. This paper asserts psychological first aid (PFA) may be considered a specific crisis-focussed disaster mental health intervention for use during and after disasters. PFA is designed for use in assessing and mitigating acute distress, while serving as a platform for psychological triage complementing more traditional psychological and psychiatric interventions. PFA may be employed by mental health clinicians as well as 'peer responders'. [ABSTRACT FROM AUTHOR]

Disasters invariably result in a surge in demand for mental health services, and this surge quickly exceeds available mental health resources. The pursuit of alternative sources of psychological support for communities adversely affected by disasters has therefore been necessitated. This paper describes the application of an awarding-winner, empirically validated, model for psychological support and its applicability for enhancing community disaster mental health resources that are consistent with United Nations' recommendations for a "whole society" approach to disaster mental health. The model utilises the concept of peer-based psychological support. Peer psychological support is defined as the utilisation of individuals specially trained in the provision of acute psychological crisis interventions and psychological first aid, but who do not possess professional-level training or licensure in one of the mental health disciplines. These peer-based crisis intervention services may be delivered telephonically, via the internet, or face-to-face. This model, referred to as Reciprocal Peer Support (RPS), is the peer support activity provided at Rutgers University Behavioural HealthCare (UBHC) National Center for Peer Support in a variety of peer programs. More than 20 years of peer support interventions have been reviewed and assessed to clarify the lessons learned for the application of RPS as a prime exemplar for the utilization of peer support during and after a disaster. The Cop 2 Cop, NJ Vet 2 Vet, and several other UBHC peer support programs, which conform to best practices criteria, have been created, sustained, and expanded based on the RSP principles discussed in this article. RPS and derivative applications for human-made disasters such as the terrorist events of 9/11/2001 as well as natural disasters such as Hurricane Katrina or the COVID- 19 pandemic represent platforms for the implementation of peer psychological support and the establishment of a peer-based continuum of psychological connection. [ABSTRACT FROM AUTHOR]

This research paper has four strands: quantifying reporting of inquests; quantifying publicly available information from coroners' offices in England and Wales; investigating reasons for lack of coverage; and establishing solutions for making accounts and verdicts of inquests more accessible in a changed media landscape. Results of the study in May and June 2019 show an overall reporting rate of only 11 per cent. Coverage varies wildly, with some "news deserts" where inquests are rarely reported. Deaths of younger people are more likely to be reported, as are male deaths. Information provided by coroners' offices also varies wildly despite national guidelines updated three years' ago recommending greater transparency. This report investigates the reasons for a lack of public scrutiny of coroners' courts by local media. Deaths may go unreported due to: the collapse of local newspapers and reduced staff in surviving organisations; the centralisation of police and newspaper offices, leading to fewer direct contacts between police and journalists; and a general cultural shift of passing media inquiries to a "communications team" which means news is filtered to give a more positive sense of police success. Recommendations: better implementation of existing guidelines: routine release of information regarding all deaths at which emergency services attend; and closer relationships with coroners' officers at inquest opening stage. [ABSTRACT FROM AUTHOR]

This paper extends the approach of Lean transportation to improve the performance of emergency medical processes (EMP) by adapting its main concepts into the main characteristics of the EMP environment. The paper is based on an inductive theory-building process initiated from a case study in the field of emergency medical services. The development of the suggested performance improvement approach triggered from an exhaustive analysis of a process involved and an exploratory review of the existing improvement approaches available. The process of concern can be described as a specialized transportation process, where human lives are at risk. Its characteristics led to a natural application of Lean transportation. The results include, a novel approach for improving the agility and efficient EMS processes. This is validated with an application for improving ambulance response times and turnaround times of the Red Cross operations located in Monterrey, Mexico. The approach proved to be an integrated scheme for identifying waste opportunities at a systems level. This characteristic is important to let operations management prioritize improvement efforts in a limited budget situation. This work suggests the application of the emerging Lean transportation approach for increasing the agility performance of EMS processes. [ABSTRACT FROM AUTHOR]

Paramedics play an essential and distinct role as providers of care to the dying, deceased and bereaved in Aotearoa, New Zealand and around the world. In this paper, we highlight what is known about the features, barriers and facilitators of quality end-of-life care by emergency ambulance personnel. We also identify priorities for future policy and practice, education and research in this area. Paramedics provide urgent and after-hours support to those with known life-limiting illness and their caregivers, but also attend sudden deaths, from unexpected or unknown causes. Paramedic care at the end of life may involve attempted resuscitation; challenging decision-making and communication; symptom relief; recognition of irreversible dying; provision of compassionate, culturally responsive support for co-responders, bystanders and the bereaved. There is an insufficient acknowledgement of the critical and unique role of paramedics, as providers of urgent care to the dying deceased and bereaved. Ambulance personnel around the world want better preparation and support for end-of-life care. Future research should aim to evaluate and improve this vital care, explore the needs and experiences of those who call an ambulance in the context of death, dying or bereavement and address equity and cultural responsiveness. [ABSTRACT FROM AUTHOR]

Since the initial paper on event centrality was published by Berntsen and Rubin nearly 15 years ago, there has been a plethora of research demonstrating event centrality as one of the strongest and most reliable correlates of PTSS. Event centrality's ability to predict unique variance in PTSS after controlling for a variety of other factors in cross-lagged studies gives us reason to suspect that event centrality may be a causal factor in the development and maintenance of PTSS. We believe the progression of research on event centrality has reached a critical point, and researchers should turn their attention to attempts to reduce event centrality. A handful of studies have already begun this next line of work, and the preliminary results are encouraging. We argue that Acceptance and Commitment Therapy-based interventions that emphasize the self-as-context process have a strong theoretical rationale for being effective interventions. However, we also acknowledge that there are likely other ways to reduce event centrality, and all reasonable possibilities should be explored. Interventions that are capable of reducing event centrality hold great promise as a supplement to existing treatments for PTSS. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is a worldwide historical event that will continue to affect nearly every aspect of ordinary life, including affecting our economic, political, and healthcare eco-systems. An effective pandemic response demands a coordinated and integrated response across community healthcare stakeholders, including Public Health and Emergency Management Officials. EMS systems are in a unique position and perform an essential role on the frontlines of COVID-19, including facilitating coordination of response efforts to COVID-19 within their communities while supporting public health mitigation efforts to slow the spread of the SARS-CoV-2. EMS physicians serve their communities at a unique intersection as clinical leaders, population health experts, and advocates. This paper examines and recommends crucial roles for EMS physician leaders as communities work together in pandemic response. [ABSTRACT FROM AUTHOR]

In emergencies, such as the COVID-19 pandemic, there is an increased need for contact with emergency medical services (EMS), and call volume might surpass capacity. The Copenhagen EMS operates two telephone line the 1-1-2 emergency number and the 1813 medical helpline. A separate coronavirus support track was implemented on the 1813 medical helpline and a web-based self-triage (web triage) system was created to reduce non-emergency call volume. The aim of this paper is to present call volume and the two measures implemented to handle the increased call volume to the Copenhagen EMS. This is a cross sectional observational study. Call volume and queue time is presented in the first month of the COVID-19 pandemic (27th of February 2020 to 27th of march) and compared to the equivalent month from the year before (2019). Descriptive statistics are conducted on call volumes and queue times and spearman's rank correlation test are performed to test correlation between web triage and call volume. Total EMS call volume increase by 23.3% between 2019 and 2020 (92.670 vs. 114,250). The 1-1-2 emergency line total call volume increase by 4.4% (8,4942 vs. 8,870) and the 1813 medical helpline increased by 25.1% (84.176 vs. 105.380). The coronavirus support track handled 21,063 calls. The 1813 medical helpline queue time was a mean of 02 minutes and 23 seconds (CI: 2.22-2.25) in 2019 and 12 minutes and 2 seconds (CI 11:55-12:09) in 2020 (P < 0.001). The web triage was used 10,894 times. No correlation between call volume and web triage usage was seen. In the first month of the ongoing COVID-19 pandemic a significant increase in call volume was observed in the 1813 medical helpline compared to 2019. A large number of calls were handled by the additional coronavirus track and diverted away from the regular tracks of the 1813 medical helpline. This likely contributed to mitigating increased call volumes and queue times. The web triage was widely used but no significant correlation was seen with 1813 medical helpline call volume. Other EMS organizations can learn from this to enhance capacity in a future epidemics. [ABSTRACT FROM AUTHOR]

Tweets offer us early information on initial stages of diseases, since people often tweet the early symptoms of feeling unwell prior to presenting to an emergency department if their symptoms become more severe. Even when people do present at an emergency department, it generally takes over 24 hours for their information to be collected, diagnosed and transferred for analysis at a centralized location. The advantage of utilizing tweets is that they offer information on syndromes in real-time. This paper investigates the value of carrying out multivariate syndromic surveillance using daily counts of keywords. The dynamic bi-plot is used to detect unexpected changes in the daily counts. These methods can be easily generalized to hourly tweet syndromic counts. By following Twitter users that suffer certain symptoms over time we can better understand the burden of these health issues and better understand emerging health issues. Monitoring people who present with symptoms but are just not sick enough to go to emergency departments provides us with additional information not gathered by emergency departments. [ABSTRACT FROM AUTHOR]

This paper describes the methodology of a large emergency medical services (EMS) data linkage research project currently under way in the statewide EMS system of New South Wales, Australia. The paper is intended to provide the reader with an understanding of how linkage techniques can be used to facilitate EMS research. This project, the Australian Prehospital Outcomes Study of Longitudinal Epidemiology (APOStLE) Project, links data from six statewide sources (computer-assisted dispatch, EMS patient health care reports, emergency department data, inpatient data, and two death registries) to enable researchers to examine the patient's entire journey through the health care system, from the emergency 0-0-0 call to the emergency department and inpatient setting, through to discharge or death, for approximately 2.6 million patients transported by the Ambulance Service of New South Wales to emergency departments between June 2006 and July 2009. Manual, deterministic, and probabilistic data linkages are described, and potential applications of linked data in EMS research are outlined. [ABSTRACT FROM AUTHOR]

Most emergency medical service systems measure performance based on the coverage level for a given response time threshold, i.e., the proportion of 911 calls responded to within a fixed timeframe. The ultimate goal of emergency medical service systems is to save lives, which suggests that it might be worthwhile to consider using performance measures more closely tied to patient outcomes. This paper examines how the goal of maximizing coverage for different response time thresholds impacts patient survival rates in the context of emergency medical dispatch. Results illustrated using real-world data from Hanover County, Virginia indicate that dispatching ambulances to maximize an eight minute response time threshold simultaneously maximizes patient survival. A sensitivity analysis over different ambulance location configurations and call arrival rates confirms that seven and eight minute response time thresholds are robust. These results corroborate previous results that consider the decision context of locating ambulances. The results presented in this paper suggest that by choosing the right response time threshold performance measures for emergency medical dispatch, decision makers can achieve the best (aggregate) patient survival rates. [ABSTRACT FROM AUTHOR]