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For the purpose of reducing the incidence of hazardous materials transport accident, eliminating the potential threats and ensuring their safety, aiming at the shortcomings in the process of current hazardous materials transportation management, this paper aims to construct the framework of hazardous materials transportation safety management system under the vehicle-infrastructure connected environment.

The system takes the intelligent connected vehicle as the main supporter, integrating GIS, GPS, eye location, GSM, networks and database technology.

By analyzing the transportation characteristics of hazardous materials, this system consists of five subsystems, which are vehicle and driver management subsystem, dangerous sources and hazardous materials management subsystem, route analysis and optimization subsystem, early warning and emergency rescue management subsystem, and basic information query subsystem.

Hazardous materials transportation safety management system includes omnibearing real-time monitoring, timely updating of system database, real-time generation and optimization of emergency rescue route. The system can reduce the transportation cost and improve the ability of accident prevention and emergency rescue of hazardous materials.

This study describes preparedness of emergency physicians and general practitioners following chemical, radiological and nuclear incidents.

Five emergency physicians and six general practitioners were interviewed individually, and data was analysed using qualitative content analysis.

The study results showed that physicians' preparedness for chemical, radiological and nuclear incidents is linked to one main category: to be an expert and to seek expertise and two categories: preparations before receiving CRN patients, and physical examination and treatment of CRN patients with subcategories.

The results have implications for further research on the complexity of generalist vs specialist competence and knowledge when responding to chemical, radiological and nuclear incidents.

This study provides insights regarding chemical, radiological and nuclear preparedness among physicians at emergency departments and primary healthcare centres.

The purpose of this paper is to investigate the medical incident responses from two public hospitals in Hong Kong, namely, Kowloon Hospital and Caritas Medical Centre, in order to improve the strategic preparation for crisis management in hospitals.

The paper analyses two medical incidents using Situational Crisis Communication Theory by Coombs (2007). The two case studies presented herein demonstrate the importance of consistency in terms of crisis responses.

For the first case, the crisis responses from different parties after the incident, including Hospital Authority, the doctor and the nurses from Kowloon Hospital, are contradicting to each other. First, Hospital Authority confirmed that the incident is solely an accident which is a denial response. Second, the doctor passed the responsibility to the nurses which is a scapegoating response. Third, the nurses tend to reduce the responsibility for the death of patient by excusing strategy. As a whole, their responses are inconsistent to each other. For the second case, Caritas had initially denied the responsibilities, but finally had given partial apology under public pressure. That makes people think that Caritas does not really regret.

Rebuilding posture should be used instead of denial and diminishment posture. However, public organization and civil servants are reluctant to use a full apology due to possible legal consequences. The apology ordinance would ease the pressure to express regret and sympathy.

Emergency room have particularly stressful work situations. Emergency room personnel cope with stressors on a daily basis. These stressors can be risks factor for burn out and for reduced quality of life and work motivation. Emergency room staff of one of ASP 3 CT urban hospital in Acireale, Italy participated to stress management program by autogenic training twice a month for 16 weeks. This program were prepared based on existing research and studies, and were conducted by clinical psychologists. We found that the mean value in pre-test is significantly different from mean value in post-test for: Perceived Stress Scale PPS (t=7.72 with 27 df and P<0.001); Euro Quality for life (t=-14,13 with 27 df and P<0.001); Work motivation assessed by Visual Analogue scale VAS (t=-4.52 with 27 df and P<0.001). In the Maslach Burnout Inventory, the mean value is significantly different for emotional exhaustion sub-scale (t=5.64 with 27 with 27 df and P<0.001) and for depersonalization subscale (t=6.67 with 27 df and P<0.001). No significant difference was observed for the personal accomplishment sub-scale. This research suggests that psychological interventions with emergency room staff are effective. Our study showed effectiveness of an auto-genic and stress management training in improvement of quality of life, work motivation, burn-out and stress perceptions for emergency department team.

The purpose of this paper is to review the causes of long waiting time in Hong Kong public hospitals and to suggest solutions in the service, organisational, systems, financial and policy perspectives.

The paper is a review of waiting time of public hospital services. Total joint replacement, which is one of the elective surgeries in public hospitals, is presented as a case study.

The average waiting time of semi-urgent and non-urgent patients in the accident and emergency departments of public hospitals is two hours, and that of specialist outpatient (SOP) clinics is from 1 to 144 weeks. For total joint replacement, it is from 36 to 110 months. Measures like Government subsidisation programme for the replacement surgery and employing adequate physiotherapists, Chinese medicine practitioners, clinical psychologists and nurses to reduce the waiting time are suggested. Issues concerning the healthcare system of Hong Kong, such as structural reform, service delivery model, primary care, quality and process management, and policy reviews, are also discussed.

The ‬over-reliance of public services has resulted in long waiting time in public hospitals in Hong Kong, particularly in the emergency services and SOP clinics. However, the consequences of long waiting period for surgical operations, though much less discussed by the media and public, can be potentially detrimental to the patients and families, and may result in more burdens to the already stretched public hospitals‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬.

The purpose of this study was to describe experiences of working as a paid part-time firefighter (PTF) in Swedish rural areas.

An inductive explorative design was used, based on interviews with 18 paid PTFs in Sweden. Data were analyzed using qualitative latent content analysis.

Three themes emerged from the interviews and describe paid PTFs’ experiences. The findings provide insights into how firefighters share a strong commitment, how support plays a crucial role, and how training and call-outs contribute to their experiences. Paid PTFs’ experiences are nuanced, ranging from personal limitations and challenges to satisfaction and the contrast with ordinary life.

The implications for fire and rescue service organizations are that they can encourage firefighters’ commitment and pride, as well as the commitment and support of their families and main employers. Further, highlighting the importance of support and facilitating flexibility when on call is crucial. Finally, acknowledging and promoting personal development and facilitating an inclusive culture are important factors for both motivation and satisfaction.

Paid PTFs are under-represented in the literature, despite the reliance on them in Sweden, and this study begins to address the knowledge gap. To improve retention, it is vital to understand paid PTFs work situation: what motivates them, what barriers they face, and how those challenges influence their experiences.

The purpose of this paper is to explore the challenges that are experienced by staff responsible for commissioning liaison psychiatry services and to establish if these are shared by other health professionals.

Using a mixed-methods design, the findings from a mental health commissioner workshop (n = 12) were used to construct a survey that was distributed to health care professionals using an opportunistic framework (n = 98).

Four key themes emerged from the workshop, which was tested using the survey. The importance of secure funding; a better understanding of health care systems and pathways; partnership working and co-production and; access to mental health clinical information in general hospitals. There was broad convergence between commissioners, mental health clinicians and managers, except in relation to gathering and sharing of data. This suggests that poor communication between professionals is of concern.

There were a small number of survey respondents (n = 98). The sampling used an opportunistic framework that targeted commissioner and clinician forums. Using an opportunistic framework, the sample may not be representative. Additionally, multiple pairwise comparisons were conducted during the analysis of the survey responses, increasing the risk that significant results were found by chance.

A number of steps were identified that could be applied in practice. These mainly related to the importance of collecting and communicating data and co-production with commissioners in the design, development and monitoring of liaison psychiatry services.

This is the first study that has specifically considered the challenges associated with the commissioning of liaison psychiatry services.

Major incidents in road tunnels remain a collaborative challenge for the emergency services (fire and rescue service, police and ambulance), emergency dispatch centres (EDCs) and infrastructure owners. The aim of this paper is to investigate how collaborative partners to the ambulance services perceive the rescue effort and to identify factors that may influence its efficiency.

Focus group and individual interviews were conducted with 19 participants who were infrastructure owners or had operational or tactical responsibilities with the emergency services or EDCs in two regions in Sweden with multiple road tunnels. The collected data were analysed using qualitative content analysis.

Three main categories described efficiency factors during and after an incident: (1) coordinating the initial information (using a shared terminology), (2) achieving situational awareness (identifying those persons in need) and (3) lessons (not) learnt (lack of joint tactical plans and exercises). The emerging theme was access, assess and evaluate.

The findings suggest that establishing national policies and collaborative forums might yield more efficiently managed rescue efforts in road tunnel incidents in Sweden and other countries with similar organisational structures.

This study offers new insights on interoperability during responses to complex underground incidents.

Many patients referred by their GP for an assessment by secondary mental health services are unlikely to ever meet eligibility thresholds for specialist treatment and support. A new service was developed to support people in primary care. “the authors evaluate” whether the phased introduction of the Lambeth Living Well Network (LWN) Hub to a population in south London led to: a reduction in the overall volume of patients referred from primary care for a secondary mental health care assessment; and an increase in the proportion of patients referred who met specialist service eligibility criteria, as indicated by the likelihood of being accepted in secondary care.

The evaluation applied a quasi-experimental interrupted time series design using electronic patient records data for a National Health Service (NHS) provider of secondary mental health services in south London.

Scale-up of the Hub to the whole of the population of Lambeth led to an average of 98 fewer secondary care assessments per month (95% CI −118 to −78) compared to an average of 203 assessments per month estimated in the absence of the Hub; and an absolute incremental increase in the probability of acceptance for specialist intervention of 0.20 (95% CI; 0.14 to 0.27) above an average probability of acceptance of 0.57 in the absence of the Hub.

Mental health outcomes for people using the service and system wide-service impacts were not evaluated preventing a more holistic evaluation of the effectiveness and cost-effectiveness of the LWN Hub.

Providing general practitioners with access to service infrastructure designed to help people whose needs cannot be managed within specialist mental health services can prevent unnecessary referrals into secondary care assessment teams.

Reducing unnecessary referrals through provision of a primary-care linked mental health service will reduce delay in access to professional support that can address specific mental-health related needs that could not be offered within the secondary care services and could prevent the escalation of problems.

The authors use NHS data to facilitate the novel application of a quasi-experimental methodology to deliver new evidence on whether an innovative primary care linked mental health service was effective in delivering on one of its key aims.

Following publication of a new vision for the English National Health Service (NHS) in 2014, known as the NHS Five-Year Forward View, a Vanguard programme was introduced by NHS England charged with the task of designing and delivering a range of new care models (NCMs) aimed at tackling deep-seated problems of a type facing all health systems to a greater or lesser degree. Drawing upon recent theoretical developments on the multilevel nature of context, we explore factors shaping the implementation of five NCM initiatives in the North East of England.

Data collection was based on semi-structured interviews (66 in total) between December 2016 and May 2017 with key informants at each site and a detailed review of Trusts' internal documents and policies related to the implementation of each NCM. Our analysis explores factors shaping the implementation of five NCM pilot sites as they touched on the multiple levels of context ranging from the macro policy level to the micro-level setting of workforce redesign.

It is far too early to conclude with any confidence that a successful outcome for the NCM programme will be forthcoming although the NHS Long-Term Plan seeks to build on the earlier vision set out in the Five-Year Forward View. Early indications show some signs of promise, especially where there is evidence of the ground having been prepared and changes already being put in place prior to the official launch of NCM initiatives. At the same time our findings demonstrate that all five pilot sites experienced, and were subject to, unrealistic pressure placed upon them to deliver outcomes.

Our findings demonstrate the need for a deeper understanding of the multilevel nature of context by exploring factors shaping the implementation of five NCMs in the North East of England. Exploring the wider national policy context is desirable as well as understanding the perceptions of front-line staff and service users in order to establish the degree of alignment or, conversely, to identify where policy and practice are at risk of pushing and pulling against each other.