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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 aims to examine trauma room staff’s perception of factors that influence workflow in trauma care from a physical environment standpoint.

A semi-structured focus group method was used. Trauma team members, representative of various roles within a team, were recruited from five Level I trauma centers in the USA, through a convenience sampling method. A total of 53 participants were recruited to participate in online focus groups. The Systems Engineering Initiative for Patient Safety model was used to analyze the findings.

In addition to factors directly related to the physical environment, aspects of people and technology, such as crowding and access to technology, were found to be related to the physical environment. Examples of factors that improve or hinder workflow are layout design, appropriate room size, doors, sink locations, access to resources such as X-ray or blood and access to technology. Seamless and uninterrupted workflow is crucial in achieving efficient and safe care in the time-pressured environments of trauma rooms. To support workflow, the physical environment can offer solutions through effective layout design, thoughtful location of resources and technology and room size.

Trauma rooms are time-pressured and complex environments where seconds matter to save a patient’s life. Ensuring safe and efficient care requires seamless workflow. However, the literature on workflow in trauma rooms is limited.

The purpose of this paper is to describe an American healthcare organization's experience creating the first multi-facility trauma system managed by a private, nonprofit organization.

A leadership structure was established to initiate the first steps of system development, followed by needs assessments that identified key components essential to creating the interconnected system. The key components were applied as a result of evidence-based system development. After system implementation, early benefits were explored.

Data collection and research, prehospital support, system-wide quality improvement, rural outreach, communication, and system evaluation were identified as key components essential to creating an interconnected trauma system. The system currently connects 12 trauma centers throughout the state of Colorado while working within the parameters of an established statewide system. Early benefits included improved designation review results, the utilization of system-wide best practice protocols, a rich trauma registry, and closer relations with rural, out-of-network facilities.

This study describes the process undertaken to implement a unique medical system that provides regionalized care and complements an existing statewide trauma system. The authors hope their experience may serve as a roadmap for healthcare professionals wishing to develop an integrated, patient-centered model of care.

The development of this multi-facility trauma system within a private, not-for-profit healthcare organization is the first of its kind.

This integrative literature review aims to explore themes within higher education that may be applicable to leadership education including: descriptions of trauma, trauma-informed practices and trauma-informed practitioners.

Integrative, systematic literature review.

The results suggest that trauma and trauma-informed practices may have a place in leadership education pedagogy.

There is no work being done in trauma informed practice in leadership education. This study provides future direction for both research and practice.

This study aims to discover how leadership emerges in a hospital’s trauma team in a simulated trauma care situation. Instead of investigating leadership from a leader-centric perspective, or using a metrics-based approach to reach generalizable results, the study aims to draw from post-heroic theories by applying leadership-as-practice and sociomaterial perspectives that emphasize the cultural-historical context and emergent nature of leadership.

The study was conducted in a Finnish central hospital through ethnographic observations of 14 in situ trauma simulation trainings over a period of 13 months. The data consist of vignettes developed and written from field notes. The analysis was informed by the cultural-historical activity theory.

Leadership in a trauma team during an in situ simulation training emerges from a complex system of agencies taking place simultaneously. Contextual elements contributed to the goal. Clarity of roles and task division, strong execution of leadership at critical points, active communication and maintenance of disciplined communication helped to overcome difficulties. The team developed coordination of the process in conjunction with the care.

The study considers trauma leadership to be a practical phenomenon emerging from the trauma team’s sociomaterial context. The results can be used to develop non-technical skills training within the field of simulation-based medical training.

The research is an administrative case study based on an extensive review of Hawaii government documents and interviews with key personnel of the Hawaii Emergency Preparedness Committee, civil defense and other relevant officials. Describes the interagency coordination at the federal, state, county, and community level to improve capability. Also described and critically evaluated are the roles of interagency emergency preparedness training, disaster drills, and coordination and partnership with the private sector, such as medical centers and the Federal Emergency Management Agency’s designated “disaster resistant communities” in Maui and Hawaii County. Recommends that more frequent interagency drills, increased funding for family emergency preparedness and local community response teams, and continuous training by emergency response coordinators could improve state and county disaster preparedness and concludes that, overall, Hawaii is adequately prepared in emergency response capability, particularly in the areas of medical services and interagency coordination.

Complex clinical situations, involving multiple medical specialists, create potential for tension or lack of clarity over leadership roles and may result in miscommunication, errors and poor patient outcomes. Even though copresence has been shown to overcome some differences among team members, the coordination literature provides little guidance on the relationship between coordination and leadership in highly specialized health settings. The purpose of this paper is to determine how different specialties involved in critical medical situations perceive the role of a leader and its contribution to effective crisis management, to better define leadership and improve interdisciplinary leadership and education.

A qualitative study was conducted featuring purposively sampled, semi-structured interviews with 27 physicians, from three different specialties involved in crisis resource management in pediatric centers across Canada: Pediatric Emergency Medicine, Otolaryngology and Anesthesia. A total of three researchers independently organized participant responses into categories. The categories were further refined into conceptual themes through iterative negotiation among the researchers.

Relatively “structured” (predictable) cases were amenable to concrete distributed leadership – the performance by micro-teams of specialized tasks with relative independence from each other. In contrast, relatively “unstructured” (unpredictable) cases required higher-level coordinative leadership – the overall management of the context and allocations of priorities by a designated individual.

Crisis medicine relies on designated leadership over highly differentiated personnel and unpredictable events. This challenges the notion of organic coordination and upholds the validity of a concept of leadership for crisis medicine that is not reducible to simple coordination. The intersection of predictability of cases with types of leadership can be incorporated into medical simulation training to develop non-technical skills crisis management and adaptive leaderships skills.

The purpose of this paper is to identify the main reasons for discharge against medical advice (DAMA) in the emergency department (ED) of a teaching hospital in Tehran, Iran.

This cross-sectional study was conducted on all the patients who left the ED of a referral teaching hospital against medical advice (AMA) in 2008. A questionnaire was filled out for each patient to determine the reasons behind patient leaving AMA.

In total, 12.8 percent of the patients left the hospital AMA. Dissatisfaction with being observed in the ED, having a feeling of recovery and hospital personnel encouraging patients to leave the hospital were the main reasons for leaving the hospital AMA.

Like many other centers, the results showed that poor communication skill and work overload were the main contributing factors to DAMA. The center managed to improve patient satisfaction and thus lowered DAMA rates following this study. Considering the similarities reported in the reports and that of other studies, it could be concluded that policy makers in other centers can also benefit from the results to adopt effective approaches to reduce DAMA rate.

To the knowledge no study has evaluated the rate and the reasons behind DAMA in the Iranian EDs.

This case was written using primary data through various channels, including in-depth structured interviews with the CEO and other individuals at the Crisis Center of Tampa Bay (CCTB), as well as exchanging email messages and phone conversations with employees at CCTB. All interviews were recorded and transcribed. In addition, one of the authors took a tour of the main offices of CCTB and took notes on the physical facilities as well as the information provided by the tour guide. Public information from CCTB was used to enhance the information and provide background. All accounts presented in this case are real, and no information was altered or fabricated.

Clara Reynolds had been CEO of CCTB for over eight years. The agency had almost tripled its budget in the time she had been there. Her leadership style had positively impacted the culture of the organization. Employees valued her open and transparent leadership style. Employees saw her commitment to training employees, creating work–life balance and helping employees be exceptional at their jobs. There was an issue, however, with Transcare, the organization’s ambulatory service. The performance of the business was declining, and Clara wanted to update the board within 60 days at the next quarterly board meeting. She was not sure what she could do to increase engagement with Transcare’s staff, which would show the board that the staff was fully willing to do what was necessary.

This case is appropriate for teaching undergraduate or graduate-level courses in leadership, organizational behavior or principles of management. It is designed to be discussed during one class period. It will save time and improve the flow if the students read the case before class and are prepared when they arrive. Any information needed for the case discussion has been presented in the case; no further research by the students is necessary. Students should think about the role of leadership in a nonprofit. They should put themselves in the protagonist’s shoes throughout the reading of the case.