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Untimely responses to emergency situations in urban areas contribute to a rising mortality rate and impact society's primary capital. The efficient dispatch and relocation of ambulances pose operational and momentary challenges, necessitating an optimal policy based on the system's real-time status. While previous studies have addressed these concerns, limited attention has been given to the optimal allocation of technicians to respond to emergency situation and minimize overall system costs.

In this paper, a bi-objective mathematical model is proposed to maximize system coverage and enable flexible movement across bases for location, dispatch and relocation of ambulances. Ambulances relocation involves two key decisions: (1) allocating ambulances to bases after completing services and (2) deciding to change the current ambulance location among existing bases to potentially improve response times to future emergencies. The model also considers the varying capabilities of technicians for proper allocation in emergency situations.

The Augmented Epsilon-Constrained (AEC) method is employed to solve the proposed model for small-sized problem. Due to the NP-Hardness of the model, the NSGA-II and MOPSO metaheuristic algorithms are utilized to obtain efficient solutions for large-sized problems. The findings demonstrate the superiority of the MOPSO algorithm.

This study can be useful for emergency medical centers and healthcare companies in providing more effective responses to emergency situations by sending technicians and ambulances.

In this study, a two-objective mathematical model is developed for ambulance location and dispatch and solved by using the AEC method as well as the NSGA-II and MOPSO metaheuristic algorithms. The mathematical model encompasses three primary types of decision-making: (1) Allocating ambulances to bases after completing their service, (2) deciding to relocate the current ambulance among existing bases to potentially enhance response times to future emergencies and (3) considering the diverse abilities of technicians for accurate allocation to emergency situations.

Public safety (communicators; e.g. 9-1-1, police, fire and ambulance call-takers and dispatchers), like many other public safety personnel (e.g. police, paramedics), (re)suffer operational stress injuries (OSIs) that are too often hidden and at a prevalence higher than the general population. Unfortunately, there are very little data for OSI rates in Canadian communicators. To the authors’ knowledge, this is the only pan-Canadian study focusing on organizational culture, and its potential influence on OSIs, within the communicator context.

The authors conducted a 179-item online survey of Canadian communicators comprising 17 validated screenings for occupational stress injuries and symptoms and four open-ended questions relating to their agency's organizational culture. The authors thematically analysed participants' open-ended responses and their screening scores.

A semi-grounded thematic approach revealed that managers and supervisors were significant contributors to negative perceptions (n = 165) of organizational culture, potentially resulting in or worsening existing OSIs. Specifically, leadership was viewed as ineffective, inconsistent, unsupportive, abusive and toxic, with limited understanding of communicator roles. Communicators described feeling devalued, particularly when leaders fail to recognize communicator OSIs, which can perpetuate stigma. Conversely, positive leaders (n = 24) were described as supportive, communicative and encouraging.

The findings suggest that while leadership behaviours are a key factor in employee well-being, it varies considerably across agencies, impacting treatment-seeking behaviours. The authors’ new understandings of leaders' roles in OSIs may help reduce the frequency and severity of communicator OSIs, helping ensure that emergency services are delivered to Canadians.

In Trinidad and Tobago, there is significant reliance on the traditional and centralized police service to engage in crime response and suppression in urban and rural areas. In this regard, policing scholarship has largely focused on the impact of policing within urban areas, producing a gap in knowledge on what policing rural spaces entails. Despite this, there is some understanding that policing rural spaces can engender diverse challenges and calls for variability in policing strategies. The current study examines the lived experiences of police officers stationed in rural communities in Trinidad and Tobago.

Using the descriptive phenomenological approach, semi-structured interviews were conducted with eleven police officers stationed in rural communities throughout the country.

Interviewees narrated the importance of community dynamics and community-specific needs in shaping their roles and functions when operating in and serving these communities. Three major themes were identified: (1) network activity in policing; (2) engagement in localistic and service-oriented approaches and (3) community-specific challenges.

The findings suggest that while there is an emphasis on traditional law enforcement responsibilities, in the rural context, police responsibilities and duties are constantly being redefined, reframed and broadened to meet the contextual community and geographic-specific diversities and demands.

Paramedics became nationally registered in 2018 in Australia. Prior to this, there was no central regulation of the profession with reliance on organisational regulation through employers. As paramedics expanded their scope, role and range of employers, especially outside statutory agencies, there was increasing need to engage in professional regulation. Regulation is more than a legal and bureaucratic framework. The purpose of the paper states that the way paramedics interact with their new regulatory environment impacts and is influenced by the professionalisation of the discipline. Regulation also redefines their positionality within the profession.

Two mixed-method surveys were undertaken. A pre-registration survey occurred in the month prior to regulation commencing (N = 419) followed by the second survey 31 months later (N = 407). This paper reports the analysis of qualitative data from the post-registration survey and provides comparison to the pre-registration survey which has been previously reported. Analysis was undertaken using interpretive phenomenological analysis (IPA).

Themes from the pre-registration survey continued however became more nuanced. Participants broadly supported registration and saw it as empowering to the profession. Some supported registration but were disappointed by its outcome, others rejected registration and saw it as divisive and oppressive.

Paramedics are beginning to come to terms with increasing professionalisation, of which regulation is one component. Changes can be seen in professional identity and engagement with professional practice; however, this is nascent and is deserving of additional research to track the profession as it continues to evolve.

This study examines potential ways to break the inequality reproduction circle faced by ethnic minority health workers and sustained by key performance indicators (KPIs)-centred management in the National Health Service (NHS) in England. It does so through the lens of signalling theory.

Three years panel data for 2018–2020 covering 207 hospitals was compiled from the annual NHS staff survey and matched with relevant administrative records. Structural equation modelling was used to test the proposed hypotheses at the organisational level.

The moderated mediating model reveals that persistent racial discrimination by managers and coworkers can disadvantage the career progression of ethnic minority health workers, which in turn reinforces and reproduces economic and health inequalities among them. More importantly, we show how the collective agreement that the senior management team acts (SMTA) on staff feedback can break this vicious circle.

While our research focuses on the not-for-profit health care sector, it opens important opportunities to extend the proposed model to understand organisational inequality and how to address it.

Perceived SMTA can send strong signals to reduce deep-rooted discrimination (race, gender, age, etc.) through resource allocations and instrumental functions. This is also a way to address the current staff burnout and shortage issues in the healthcare sector.

This article reveals why the purpose of organisations that provide public service to reduce social inequality was comprised during their business-like operations and more importantly, how to reflect their foundational purpose through management practice.

This study offers a way forward to resolve one of the unintended consequences of KPI-centred management in the not-for-profit sector through unpacking the process of inequality reproduction and, more importantly, how it is possible to break this vicious circle.

The migration of physicians is a global interest, causing imbalances between developed and developing countries. Romania is one of Europe's major providers of physicians, not because there is a surplus, but because physicians are drawn to places with better living and working conditions. Medicine in Romania is increasingly highly advanced, and Romanian physicians are well appreciated all over the world. Despite being one of the countries with the most medical graduates in the world, Romania is suffering a doctor exodus. After joining the EU, the problem of physician migration became widespread, resulting in a deficient and inefficient healthcare system. Therefore, the purpose of this study is to estimate the losses registered by Romania because of physicians' decision to migrate.

These losses were calculated in two ways: utilizing the statistical life value and the amount of money invested in training a medical graduate.

According to the findings, the losses in 2018 were 104.16 million euros, approximately 0.12% of GDP.

The originality of this paper consists in data, being provided by the College of Physicians from Romania and the method used, this study being the only one that estimates the cost of Romanian physicians' migration. The paper adds to existing knowledge an empirical results regarding quantifying the value reflecting the departure of physicians, using value of statistical life and the amount of money invested in preparing a medical graduate.

As populations are ageing and the global average life expectancy is rising, the provision of care for older people is an increasingly salient issue. This paper aims to focus on family-provided care for older immigrants, examining how older immigrants and care providers experience and construct family caregiving.

Based on interviews with care recipients, family care providers, municipal staff and representatives for migrant organisations in Sweden, this study presents a typology of family caregiving for older immigrants.

The authors found three caregiving types, namely, solely family-provided care and a combination of family care and public care (predominantly one or the other). The decision to select family-provided or publicly-funded care depends on personal and institutional factors.

The paper makes three empirical contributions to the literature on care provision for older immigrants. Firstly, this study provides insights into the structural and personal factors that shape care-giving arrangements for older immigrants. Secondly, this study examines the perspectives of care recipients and care providers on family-provided care. Care expectations differ between both groups and sometimes result in intergenerational disagreement. Thirdly, in terms of institutional support, this study finds that the Swedish state’s notion of individual needs does not match the needs of immigrant elderly and their caregivers. The paper places the care types in a broader discussion about eldercare provision in the Swedish welfare state, which has experienced a decline in publicly funded care services and an increase in family caregiving in the past 30 years. In addition, it addresses questions of dignified ageing from a minority perspective.

Vehicle allocation problems (VAPs), which are frequently confronted in many transportation activities, primarily including but not limited to full truckload freight transportation operations, induce a significant economic impact. Despite the increasing academic attention to the field, literature still fails to match the needs of and opportunities in the growing industrial practices. In particular, the literature can grow upon the ideas on sustainability, Industry 4.0 and collaboration, which shape future practices not only in logistics but also in many other industries. This review has the potential to enhance and accelerate the development of relevant literature that matches the challenges confronted in industrial problems. Furthermore, this review can help to explore the existing methods, algorithms and techniques employed to address this problem, reveal directions and generate inspiration for potential improvements.

This study provides a literature review on VAPs, focusing on quantitative models that incorporate any of the following emerging logistics trends: sustainability, Industry 4.0 and logistics collaboration.

In the literature, sustainability interactions have been limited to environmental externalities (mostly reducing operational-level emissions) and economic considerations; however, emissions generated throughout the supply chain, other environmental externalities such as waste and product deterioration, or the level of stakeholder engagement, etc., are to be monitored in order to achieve overall climate-neutral services to the society. Moreover, even though there are many types of collaboration (such as co-opetition and vertical collaboration) and Industry 4.0 opportunities (such as sharing information and comanaging distribution operations) that could improve vehicle allocation operations, these topics have not yet received sufficient attention from researchers.

The scientific contribution of this study is twofold: (1) This study analyses decision models of each reviewed article in terms of decision variable, constraint and assumption sets, objectives, modeling and solving approaches, the contribution of the article and the way that any of sustainability, Industry 4.0 and collaboration aspects are incorporated into the model. (2) The authors provide a discussion on the gaps in the related literature, particularly focusing on practical opportunities and serving climate-neutrality targets, carried out under four main streams: logistics collaboration possibilities, supply chain risks, smart solutions and various other potential practices. As a result, the review provides several gaps in the literature and/or potential research ideas that can improve the literature and may provide positive industrial impacts, particularly on how logistics collaboration may be further engaged, which supply chain risks are to be incorporated into decision models, and how smart solutions can be employed to cope with uncertainty and improve the effectiveness and efficiency of operations.

To facilitate the reception and care of discharged patients, streamlining processes at the University Hospital and promoting a seamless transition to continuity of care services post-discharge.

Hospitalised patients undergo the Blaylock risk assessment screening score (BRASS), a screening tool identifying those at risk of complex discharge.

Pre-pandemic, patients with a medium-to-high risk of complex discharge were predominantly discharged to their residence or long-term care facilities. During the pandemic, coinciding with an overall reduction in hospitalisation rates, there was a decrease in patients being discharged to their residence.

The analysis of discharges, with the classification of patients into risk groups, revealed a coherence between the BRASS score and the characteristics of the studied sample. This tool aids physicians in decision-making by identifying the need for a planned discharge in a systematic and organised manner, preventing the loss of crucial information.