Exploring the structure and characteristics of the Anglo-American paramedic system in developed countries: a scoping review

PurposeThis study aims to map and examine the existing evidence to provide an overview of what is known about the structure and characteristics of the Anglo-American paramedic system in developed countries.Design/methodology/approachThe review includes results examining the structure and characteristics of the Anglo-American paramedic system in English-speaking developed countries. Databases, including Embase, MEDLINE, Web of Science, EBSCOhost, CINAHL, Google Scholar and Epistemonikos, were searched from the inception of the databases. A grey literature search strategy was conducted to identify non-indexed relevant literature along with forward and backward searching of citations and references of included studies. Two reviewers undertook title and abstract screening, followed by full-text screening. Finally, data extraction was performed using a customised instrument. Included studies were summarised using narrative synthesis structured around broad themes exploring the structure and characteristics of the Anglo-American paramedic system.Findings The synthesis of information shows that varying models (or subsystems) exist within the Anglo-American paramedic system. The use of metaphorical models based on philosophical underpinnings are used to describe two novel subsystems within the Anglo-American paramedic system. These are the professionally autonomous and directive paramedic systems, with the directive model being further categorised into the rescue and hospital-managed submodels.Originality/valueThis study is the first of its kind to explore the modern subcategorisation of the Anglo-American paramedic system using a realist lens as the basis for its approach.

Can ambulance dispatch categories discriminate traffic incidents that do/do not require a lights and sirens response?

PurposeTraffic incidents vary considerably in their severity, and the dispatch categories assigned during emergency ambulance calls aim to identify those incidents in greatest need of a lights and sirens (L&S) response. The purpose of this study was to determine whether dispatch categories could discriminate between those traffic incidents that do/do not require an L&S response.Design/methodology/approachA retrospective cohort study of ambulance records was conducted. The predictor variable was the Traffic/Transportation dispatch categories assigned by call-takers. The outcome variable was whether each incident required an L&S response. Possible thresholds for identifying dispatch categories that require an L&S response were developed. Sensitivity and specificity were calculated for each threshold.FindingsThere were 17,099 patients in 13,325 traffic incidents dispatched as Traffic/Transportation over the study period. “Possible death at scene” ‘had the highest odds (OR 22.07, 95% CI 1.06–461.46) and “no injuries” the lowest odds (OR 0.28 95% CI 0.14–0.58) of requiring an L&S response compared to the referent group. The area under the ROC curve was 0.65, 95% CI [0.64, 0.67]. It was found that Traffic/Transportation dispatch categories allocated during emergency ambulance calls had limited ability to discriminate those incidents that do/do not require an L&S response to the scene of a crash.Originality/valueThis research makes a unique contribution, as it considers traffic incidents not as a single entity but rather as a number of dispatch categories which has practical implications for those emergency medical services dispatching ambulances to the scene.

Evaluating the effectiveness of the fatigue and shift working risk management strategy for UK home office police forces: a pilot study

PurposeTo evaluate the effectiveness of a fatigue-management training and sleep health promotion intervention in a sample of officers from UK Home Office Police Forces.Design/methodology/approachUsing a pre- and post-design we exposed 50 officers from selected UK police forces to a fatigue-management training intervention. Pre- and post-intervention data collection included wrist actigraphy, a physiological and objective measure of sleep quantity and quality, as well as surveys including the Pittsburg Sleep Quality Index (PSQI), the World Health Organization Quality of Life (WHOQOL) instrument, the Epworth Sleepiness Scale (ESS), the Perceived Stress Scale (PSS) and the PTSD Checklist (PCL-5).FindingsWe found the training significantly increased sleep quantity by 25 min per 24-h period, from 6.9 h to 7.3 h (f = 9.2; df = 519; p = 0.003), and improved sleep quality scores from 84% before the intervention, to 87% after the training (f = 10.6; df = 519; p = 0.001).Research limitations/implicationsContinued research is necessary to guide nationwide implementation of fatigue-management and sleep health promotion programs.Practical implicationsOur findings show that a fatigue-management training resulted in a significant and meaningful increase in sleep among police officers.Originality/valueThis is the first piece of research to emerge from a full population survey (response rate 16.6%) of the UK police service exploring issues of sleep and fatigue.

Mental health patterns during COVID-19 in emergency medical services (EMS)

PurposeThis study aims to explore patterns of Emergency Medical Services (EMS) personnel's mental health, regarding their levels of anxiety, depression, stress, COVID-19 anxiety, obsessive-compulsive symptoms and well-being; and to explore variables that contribute to these patterns, among sociodemographic/professional and COVID-19 experience variables.Design/methodology/approachParticipants were 214 EMS personnel, who answered the Patient-Health Questionnaire, Perceived Stress Scale, COVID-19 Anxiety Scale, Obsessive-Compulsive Inventory, Well-Being Questionnaire and COVID-19 related questions.FindingsEMS personnel showed an adequate psychological adjustment during COVID-19. Two clusters/patterns were found: the poorly (34%) and the well (66%) psychologically-adjusted. Personnel's age, COVID-19 fear and workplace security measures' adequacy contributed to which pattern they were more likely to belong to.Research limitations/implicationsDespite being cross-sectional and not controlling for pre-COVID-19 data, this study adds to the COVID-19 literature. Findings call for the need to explore: other COVID-19 fears; how personnel perceive workplace security measures; COVID-19 valid instruments; pre-COVID-19 data; and mental health patterns with different rescuers.Practical implicationsFindings explored EMS personnel's patterns of mental health during the COVID-19, as well as its covariates. Results allow to better prepare emergency management, which can develop prevention strategies focused on older professionals, COVID-19 related fears and how personnel assess security measures.Originality/valueThis study contributes to the scarce literature focused on COVID-19 mental health patterns instead of focussing on isolated mental health variables, as well as what contributes to these patterns. Moreover, it is one of the few studies that focused on EMS personnel rather than hospital staff.

Selecting the field hospital location for earthquakes: an application for Ankara Province in Turkey

PurposeThe authors present a location selection model for the field hospital to build after a possible earthquake in Ankara, Turkey using the VIKOR method.Design/methodology/approachCompanies or governments that make location selection decisions to improve their performance in new investment decisions for different service industries. On the other hand, disasters, especially earthquakes, force the governments to evaluate their existing potentialities and develop action plans to improve their middle and long-term preparations. This paper proposes a VIKOR method-based location selection model for the field hospital to build after a possible earthquake. Also, the authors present a methodology using the VIKOR method that how government agencies take action for the field hospital's location selection process via VIKOR methodology.FindingsThe modeling and application results show that the field hospital's location selection decision-making process improves considerably using the VIKOR model. This paper shows that the proposed VIKOR-based model can rank alternatives suitability at various criteria targeting to minimize the possible earthquake's impact and obtains a single overall ranking score to select the best alternative.Research limitations/implicationsThe study does not consider the uncertain nature of the field hospital selection problem. The application part is restricted to the Ankara case. But the proposed model can easily extend for different locations in the world.Originality/valueThis paper presents the multi-criteria decision-making (MCDM) framework study of the establishment of field hospitals and demonstrates its importance when criteria diversity is restricted.

Determining response time factors of emergency medical services during the COVID-19 pandemic

PurposeThe lack of studies about the response time of emergency medical service during the coronavirus disease 2019 (COVID-19) pandemic in a dense city of a developing country has triggered this study to explore the factors contributing to a high response time of ambulance service to reach patients in need. An evaluation of contributing factors to the response time is necessary to guide decision-makers in keeping a high service level of emergency medical service.Design/methodology/approachThis research employed an agent-based modeling approach with input parameters from interviews with emergency medical service staff in Bandung city, Indonesia. The agent-based model is established to evaluate the relevant contribution of the factors to response time reduction using several scenarios.FindingsAccording to agent-based simulation, four factors contribute to the response time: the process of preparing crew and ambulance during the pandemic, coverage area, traffic density and crew responsiveness. Among these factors, the preparation process during the pandemic and coverage area significantly contributed to the response time, while the traffic density and crew responsiveness were less significant. The preparation process is closely related to the safety procedure in handling patients during the COVID-19 pandemic and normal time. The recommended coverage area for maintaining a low response time is 5 km, equivalent to six local subdistricts.Research limitations/implicationsThis study has explored the factors contributing to emergency medical response time. The insignificant contribution of the traffic density showed that citizens, in general, have high awareness and compliance to traffic priority regulation, so crew responsiveness in handling ambulances is an irrelevant factor. This study might have different contributing factors for less dense population areas and focuses on public emergency medical services provided by the local government.Practical implicationsThe local government must provide additional funding to cover additional investment for ambulance, crew and administration for the new emergency service deployment point. Exercising an efficient process in ambulance and crew preparation is mandatory for each emergency deployment point.Originality/valueThis study evaluates the contributing factors of emergency medical response time in the pandemic and normal situation by qualitative analysis and agent-based simulation. The performance comparison in terms of medical response time before and after COVID-19 through agent-based simulation is valuable for decision-makers to reduce the impact of COVID-19.

Hiring schedule optimization at the Surrey fire department

PurposeThe Surrey (British Columbia, Canada) fire department has an annual cycle for hiring full-time firefighters. This paper optimizes the timing of the annual hiring period. A key issue is handling workplace absences, which can be covered by overtime cost or full-time hires.Design/methodology/approachShort-term and long-term absences patterns are analyzed according to season and age cohorts of the firefighters. These are then used in both an explanatory and time series model to predict future absences. The hiring schedule is optimized based on these predictions and additional constraints.FindingsThe current practice fares well in the analysis. For the time period studied, moving to earlier hiring dates appears beneficial. This analysis is robust with respect to various assumptions.Originality/valueThis is a case study where analytic techniques and machine learning are applied to an organizational practice that is not commonly analyzed. In this case, the previous method was not much worse than the optimized solution. The techniques used are quite general and can be applied to various organizational decision problems.

Effectiveness of travel time during evacuation in high-rise residential buildings: a case study in Selangor, Malaysia

PurposeIn recent years, the number of high-rise buildings in Malaysia has been increasing. Therefore, it is essential to take evacuation into consideration especially for emergency conditions such as fire, explosion and natural disasters. This research aims to evaluate the effectiveness of the escape time in typical Malaysian high-rise residential buildings.Design/methodology/approachThis work comprises simulation on three buildings around the Selangor area in Malaysia. Quantitative methodology is adopted using Pathfinder software to simulate the evacuation process and time of the three typical Malaysian high-rise residential buildings. Four parameters were studied namely, the occupant load density, walking speed of first and last occupants, average of evacuation time per floor for the three buildings and effect of placement of emergency staircase on travel time.FindingsFindings show that 12 m2 which is double the allowable occupants' density in Malaysia increases evacuation time by 67.9% while the placement of the emergency staircase on the left and middle section of a building significantly affects the evacuation time by 21.2%. In conclusion, from the simulation studies, it is recognized that a higher occupant's density affects the evacuation time.Originality/valueThis work could provide information on escape time for future construction of high-rise buildings in Malaysia. Hence, the specification and design of buildings could be reviewed based on the results obtained from this simulation. This information could be beneficial to the building regulators and developers thus enhancing the knowledge of building constructor and possible issues in the design of staircases, corridors and height of buildings.

Utilizing DMAIC method to optimize law enforcement official willingness to respond to disasters: an exploratory study

PurposeThe purpose of this case study is to develop a lean six sigma (LSS) define–measure–analyze–improve–control (DMAIC) procedure to optimize the willingness to respond (WTR) of Louisiana-based law enforcement officials (LEO) to disasters.Design/methodology/approachVarious LSS tools were used to implement DMAIC to clearly define the problem of WTR, measure the self-reported WTR through a survey, perform statistical analysis on the measured data to identify significant variables to WTR, brainstorm issues and improvements with stakeholders, develop mitigation strategies, implement a pilot solution survey and develop control measures.FindingsLouisiana LEO showed an average of 73.9% of WTR to all disasters. Seven significant variables influenced WTR, which are prior experience, transportation, duty to organization, risk to self, conflicting roles, training and incentive pay. The results from pilot solutions showed that utilizing incentive pay, adequate training and personal protective equipment (PPE) increased WTR from 0.5% up to 16%.Originality/valueThis study developed and validated a unique procedure to improve LEO WTR to disasters, providing a set of DMAIC tools and concepts that can be used by other emergency response agencies. This research was performed during the COVID-19 pandemic and after Hurricane Laura impacted Louisiana.

Resilience levels in paramedic students: a cross-sectional study

PurposeParamedics responding to emergencies have proven to have an impact on their mental health and well-being. Therefore, measuring and initiating resilience promotion and development during the educational process could promote health in this group. This study aims to cross-sectionally examine the self-reported resilience levels of bachelor paramedic students at a large Australian university.Design/methodology/approachA cross-sectional study using a convenience sample of first-, second- and third-year bachelor paramedic students was used from a large Australian university. The student’s resilience was measured using the 25-item Connor-Davidson Resilience Scale (CD-RISC) during 2019.FindingsTwo-hundred and twenty-nine students participated in the study, of which 55% were females. The total mean score for the CD-RISC was 72.6 [standard deviation (SD) = 13.2). The CD-RISC mean score of the first-, second- and third-year levels were 75.3 (SD = 13.2), 70.5 (SD = 14.4) and 73.8 (SD = 10.4), respectively, with no significant statistical difference (p-value = 0.1) and of which the second year formed the major sample (44.5%). Additionally, our findings show no significant variation in the CD-RISC mean score between males [70.8 (SD = 12.9)] and females [74.1 (SD = 13.3)], with p-value = 0.09.Originality/valueThe study findings suggest that paramedic students have moderate levels of self-reported resilience. These results, while specific to one university, provide essential data for the paramedic profession in addressing an important issue facing all paramedics around the world.