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Emergency services are critical for high‐quality healthcare service provision to support acute illness, trauma and disaster response. The greater availability of emergency services decreases waiting time, improves clinical outcomes and enhances local community well being. This study aims to assess United States (US) acute care hospital staff's ability to provide emergency medical services by evaluating the number of emergency departments and trauma centers.

Data were obtained from the 2003 and 2007 American Hospital Association (AHA) annual surveys, which included over 5,000 US hospitals and provided extensive information on their infrastructure and healthcare capabilities.

US acute care hospital numbers decreased by 59 or 1.1 percent from 2003 to 2007. Similarly, US emergency rooms and trauma centers declined by 125, or 3 percent. The results indicate that US hospital staff's ability to respond to traumatic injury and disasters has declined. Therefore, US hospital managers need to increase their investment in emergency department beds as well as provide state‐of‐the‐art clinical technology to improve emergency service quality. These investments, when linked to other clinical information systems and the electronic medical record, support further healthcare quality improvement.

This research uses the AHA annual surveys, which represent self‐reported data by individual hospital staff. However, the AHA expends significant resources to validate reported information and the annual survey data are widely used for hospital research.

The declining US emergency rooms and trauma centers have negative implications for patients needing emergency services. More importantly, this research has significant policy implications because it documents a decline in the US emergency healthcare service infrastructure.

This article has important information on US emergency service availability in the hospital industry.

This study reports on a survey of experienced emergency management personnel in Australia and New Zealand to identify the influence of organisational features in perceived emergency management performance. The purpose of this paper is to analyse the influence of organisational features in emergency response performance and to discuss how this knowledge can be used to enhance the response capacity of emergency services organisations.

Based on a review of the literature, a conceptual theoretical model for organisational performance is first developed based on four organisational features found to be previously important in emergency management organisation. These are, adaptability, leadership, stability (mission and direction) and stakeholder communication. An organisational survey was distributed to all 25 fire and emergency services agencies in Australia and New Zealand which included indicators of these elements. Responses were received from experienced emergency management personnel from fire and emergency services agencies. The sample was stratified into the three main organisational types, namely, established, expanding and extending organisations.

The findings reveal that the predictive significance of organisational features in emergency response performance vary among established, expanding and extending organisations. The predictive significance of stability, adaptability and leadership for perceived success is strong in all organisational types. It is interesting to note that the predictive significance of communication with external stakeholders is low in all organisation types. This indicates the preference of emergency services agencies to look internally within their own operations than externally to build relationships with different specialism.

The theoretical model in this study makes a first attempt to understand the role of organisational features in emergency response performance of organisations in Australia and New Zealand. This work contributes to theorizing emergency operations by highlighting how organisations need to manage two orientations simultaneously: their own internal as well as external orientations, together with their processes for managing both mission and direction and the need for change and flexibility.

The purpose of this paper is twofold: first, to identify occupational groups who can act as semi-professional first responders, in order to shorten the response times to frequent emergencies, and second, to identify related opportunities, challenges and needs of training, emergency supplies and information technology (IT) support.

A case study approach was taken, combining future workshops, focus groups and an exercise. Network governance was used as an analytical lens.

The identified potential groups are security guards, home care personnel, fire services day personnel and facility service personnel. The results show that semi-professionals have a large potential to complement professional resources by carrying out first response or supportive actions vital to the emergency, partly by using already existing cars and equipment. The identified needs include additional basic equipment such as fire extinguishers and first-aid kits, training in basic firefighting, first aid and risk assessment, as well as mobile phone application-based IT support to manage alarms. The major challenges are organisational, economic and juridical, including ambiguities in responsibilities and related insurances. The analysis recognises the new collaboration as a hybrid form of hierarchical government and network governance.

The study suggests that using semi-professional resources can be one of many innovative solutions to recent public sector challenges that have put a huge strain on professional emergency response organisations.

The study provides a novel view of using semi-professional resources in emergency response, based on the joint perspectives of various occupational groups, and the fire services.

This paper explores how fire and rescue services in England responded to the challenges and opportunities presented by the COVID-19 pandemic. It examines the form and nature of fire and rescue services’ collaborations with the ambulance, police and other services and how effective their emergency planning arrangements prepared them for the pandemic.

The authors briefly set out the background to the emergency services response to recent events of national significance in the UK and North America, focussing on the collaborative aspects of the emergency services response. The authors then examine three sets of secondary sources, namely documents specifically related to Fire and Rescue Services’ response to the COVID-19 pandemic in the UK.

All three investigations found that the pandemic had provided an opportunity for issues relating to planning and collaboration to be re-examined and for the emergence of new innovations (both technological and organisational) to provide new responses and solutions. Although the Inspectorate found that the services had generally responded well, it controversially criticised the role of the Fire Brigades Union in the national and local response to the pandemic.

The research is situationally bound to England although there may be transferable lessons to other services and jurisdictions.

Potential future improvements are identified at national and local levels for policy and for the operational response to widespread and long-term emergencies.

England has had very few contemporary public health emergencies on the scale of the COVID-19 pandemic; this research presents an important opportunity for seeking to understand what is working well and where improvements are required to improve both the local and national response in relation to such a complex and dynamic environment.

This paper aims to report on research undertaken in an National Health Service (NHS) emergency department in the north of England, UK, to identify which patients, with which clinical conditions are returning to the emergency department with an unscheduled return visit (URV) within seven days. This paper analyses the data in relation to the newly introduced Integrated Care Boards (ICBs). The continued upward increase in demand for emergency care services requires a new type of “upstreamist”, health system leader from the emergency department, who can report on URV data to influence the development of integrated care services to reduce further demand on the emergency department.

Patients were identified through the emergency department symphony data base and included patients with at least one return visit to emergency department (ED) within seven days. A sample of 1,000 index visits between 1 January 2019–31 October 2019 was chosen by simple random sampling technique through Excel. Out of 1,000, only 761 entries had complete data in all variables. A statistical analysis was undertaken using Poisson regression using NCSS statistical software. A review of the literature on integrated health care and its relationship with health systems leadership was undertaken to conceptualise a new type of “upstreamist” system leadership to advance the integration of health care.

Out of all 83 variables regressed with statistical analysis, only 12 variables were statistically significant on multi-variable regression. The most statistically important factor were patients presenting with gynaecological disorders, whose relative rate ratio (RR) for early-URV was 43% holding the other variables constant. Eye problems were also statistically highly significant (RR = 41%) however, clinically both accounted for just 1% and 2% of the URV, respectively. The URV data combined with “upstreamist” system leadership from the ED is required as a critical mechanism to identify gaps and inform a rationale for integrated care models to lessen further demand on emergency services in the ED.

At a time of significant pressure for emergency departments, there needs to be a move towards more collaborative health system leadership with support from statistical analyses of the URV rate, which will continue to provide critical information to influence the development of integrated health and care services. This study identifies areas for further research, particularly for mixed methods studies to ascertain why patients with specific complaints return to the emergency department and if alternative pathways could be developed. The success of the Esther model in Sweden gives hope that patient-centred service development could create meaningful integrated health and care services.

This research was a large-scale quantitative study drawing upon data from one hospital in the UK to identify risk factors for URV. This quality metric can generate important data to inform the development of integrated health and care services. Further research is required to review URV data for the whole of the NHS and with the new Integrated Health and Care Boards, there is a new impetus to push for this metric to provide robust data to prioritise the need to develop integrated services where there are gaps.

To the best of the authors’ knowledge, this is the first large-scale study of its kind to generate whole hospital data on risk factors for URVs to the emergency department. The URV is an important global quality metric and will continue to generate important data on those patients with specific complaints who return back to the emergency department. This is a critical time for the NHS and at the same time an important opportunity to develop “Esther” patient-centred approaches in the design of integrated health and care services.

Modern emergency management policy is built around the concepts of shared responsibility and the development of resilient communities. Drawing on the Australian context, this chapter argues that giving effect to these policy directions will require negotiation between stakeholders and an inevitable trade in values, interests, and resources. The chapter identifies an apparent contradiction at the heart of modern disaster management: that improvements in establishing professional emergency and risk management services may have reduced the capacity of individuals and local communities to take responsibility for disaster preparation and response.

The purpose of this paper is to provide the rationale underpinning this new journal in addressing the apparent gap and fragmented nature of the emergency services research, to introduce the papers in this inaugural issue and encourage readers and potential contributors to support the International Journal of Emergency Services (IJES).

The paper introduces the new journal, and its intention to challenge the current “silo approach” which isolates the academic and practitioner community. It also outlines the editorial intentions for the journal, linking the theme and selected papers for the inaugural issue to the future editorial direction of the journal.

Emergency function resides with a host of agencies including the three “blue light” services (police, fire and ambulance). IJES is an opportunity to publish up‐to‐date and original research contributions for the benefit of scholars, policy makers and practitioners in these areas, including the interface of policy and practice at national, regional and global level.

Articulating the IJES vision in addressing the apparent gaps in emergency services research, including the theory‐practise divide, this paper provides useful knowledge to potential readers who are interested in emergency services research. It also highlights some potential areas for research.

The purpose of this paper is to analyse how the police, the rescue services and the emergency medical services perceive the threat of terrorism and preparedness for a terrorist-induced crisis. It also aims to unravel differences among the emergency organizations and to discuss their potential implications for emergency preparedness.

Data were collected using a questionnaire distributed to operational personnel from the emergency services in eight Swedish counties; 864 responses were received and analysed.

There were significant differences between the police, rescue and ambulance services regarding perceptions of event likelihood, willingness to respond, estimated management capability and level of confidence with tasks to be performed on-scene. Perceived likelihood of events appeared affected by institutional logic; events within their respective domain of responsibility were perceived as more likely. The police stood out in many aspects, with more personnel with experience of violence on duty and a high grading of the probability of terrorist attacks compared to the other organizations. Fewer police had high estimates of their organizations’ management capability and knowledge of tasks on-scene.

Differences in perspectives of terrorism preparedness and response among the emergency services were shown, highlighting the importance of enabling inter-organizational insights on safety culture, with risk awareness and management strategies, as well as knowledge of the other organizations’ institutional logics and main tasks, so as to achieve an effective, collaborative response to terrorism-induced crises.

Little research has been conducted comparatively with regard to the emergency services and their perceptions of terrorism-specific threats and preparedness, particularly in the Swedish context.

Ambulance services staff worldwide have long been at risk of encountering violence and aggression directed towards them during their work. Verbal forms of violence and aggression are the most prevalent form, but sometimes incidents involve physical injury, and on rare occasions homicides do occur. Exposure to such violence and aggression can have a lasting negative impact upon ambulance staff and has been associated with increased levels of stress, fear, anxiety, emotional exhaustion, depersonalisation and burnout syndrome. Despite the significance of this issue, little progress has been made to tackle it. The purpose of this paper is to describe this multi-agency approach being taken in Wales (UK) to reduce such harms from violence and aggression directed towards ambulance services staff.

An interpretative post-positivist narrative methodology and policy analysis approach was followed. Snowball methods of gathering data were used to construct this narrative involving meetings, telephone calls, review of policy documents, legislation and academic literature.

The authors report how tackling violence and aggression directed towards emergency workers has become a priority within Wales (UK), resulting in policy developments and initiatives from groups such as the UK and Welsh Government, the Welsh Ambulance Services National Health Services (NHS) Trust, Health Boards, the NHS Wales Anti-Violence Collaborative and the Joint Emergency Services Group (JESG) in Wales. This has included changes in legislation such as the Assaults on Emergency Workers (Offences) Act 2018 that came into force on 13th November 2018 and policy changes such as the obligatory responses to violence in health care and the JESG #WithUsNotAgainst Us campaign. Our study however reflects the complexity of this issue and the need for further high-quality research.

The experiences and activities of Wales (UK) reported in this paper adds to the international body of knowledge and literature on violence and aggression directed towards ambulance services staff.

In emergency services, maximizing population coverage with the lowest cost at the peak of the demand is important. In addition, due to the nature of services in emergency centers, including hospitals, the number of servers and beds is actually considered as the capacity of the system. Hence, the purpose of this paper is to propose a multi-objective maximal covering facility location model for emergency service centers within an M _(t)/M/m/m queuing system considering different levels of service and periodic demand rate.

The process of serving patients is modeled according to queuing theory and mathematical programming. To cope with multi-objectiveness of the proposed model, an augmented ε-constraint method has been used within GAMS software. Since the computational time ascends exponentially as the problem size increases, the GAMS software is not able to solve large-scale problems. Thus, a NSGA-II algorithm has been proposed to solve this category of problems and results have been compared with GAMS through random generated sample problems. In addition, the applicability of the proposed model in real situations has been examined within a case study in Iran.

Results obtained from the random generated sample problems illustrated while both the GAMS software and NSGA-II almost share the same quality of solution, the CPU execution time of the proposed NSGA-II algorithm is lower than GAMS significantly. Furthermore, the results of solving the model for case study approve that the model is able to determine the location of the required facilities and allocate demand areas to them appropriately.

In the most of previous works on emergency services, maximal coverage with the minimum cost were the main objectives. Hereby, it seems that minimizing the number of waiting patients for receiving services have been neglected. To the best of the authors’ knowledge, it is the first time that a maximal covering problem is formulated within an M _(t)/M/m/m queuing system. This novel formulation will lead to more satisfaction for injured people by minimizing the average number of injured people who are waiting in the queue for receiving services.