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In North America, delegated practice “medical direction” models are often used as a proxy for clinical quality and safety in paramedic services. Other developed countries favor a combination of professional regulatory boards and clinical governance frameworks that feature paramedics taking lead clinician roles. The purpose of this paper is to bring together the evidence for medical direction and clinical governance in paramedic services through the prism of paramedic self-regulation.

This narrative synthesis critically examines the long-established North American Emergency Medical Services medical direction model and makes some comparisons with the UK inspired clinical governance approaches that are used to monitor and manage the quality and safety in several other Anglo-American paramedic services. The databases searched were CINAHL and Medline, with Google Scholar used to capture further publications.

Synthesis of the peer-reviewed literature found little high quality evidence supporting the effectiveness of medical direction. The literature on clinical governance within paramedic services described a systems approach with shared responsibility for quality and safety. Contemporary paramedic clinical leadership papers in developed countries focus on paramedic professionalization and the self-regulation of paramedics.

The lack of strong evidence supporting medical direction of the paramedic profession in developed countries challenges the North American model of paramedics practicing as a companion profession to medicine under delegated practice model. This model is inconsistent with the international vision of paramedicine as an autonomous, self-regulated health profession.

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.

Based on the service eco-systems perspective, this paper evaluates the strategies and actions adopted by the Government of Pakistan to handle the COVID-19 crisis with the involvement of multiple actors including public, private, third-sector organizations and civil society.

The paper is based on an in-depth analysis of secondary sources including research articles, policy documents, policy briefs, governmental reports, third party evaluations/reports and media publications.

A multi-stakeholder approach was evident during the pandemic with an effort to better manage the crisis which has exerted immense social, cultural, economic and political impacts on the lives of the citizens. Collaborative efforts among stakeholders (government, private and third sector) were witnessed, resulting in a coherent response. The successful management of COVID-19 in Pakistan is attributed to multiple factors including the formation of a specialized public organization which effectively and proactively took data-driven informed decisions and aggregated the efforts of the federal and provincial governments for a timely response.

This paper gives insights for policymakers to create a sustainable post-pandemic socio-economic environment by building resilient structures across the government while promoting cooperation and collaboration. It suggests strategies for policymakers responsible for providing sustainable societal solutions to combat the social, economic and administrative challenges under the pandemic. As Pakistan has managed and contained the pandemic in a relatively efficient way, it is hoped that this paper can provide a learning experience for other countries with similar national contexts.

The Arab world is made up of 22 countries in the Middle East and North Africa. These countries are subjected to many social, economic, political and geographical vulnerabilities contributing to increased risks or ineffective emergency and disaster management. This paper examines these vulnerabilities, how they may impact the country's ability to face disasters, and how they can improve disasters' overall management.

The author selected Qatar, Oman to represent the Arab oil-rich countries, while Jordan, Egypt and Morocco to represent non-oil rich countries. The research was conducted in a qualitative, inductive systematic literature review based on a well-established systematic literature review methodology. Selected literature was based on its recency and the countries in question.

The review reveals population gaps that could threaten the social system in the event of a disaster in countries like Qatar and Oman. The majority of the countries lack community engagement and pre-planning for emergency preparedness due to social and cultural barriers. Other nations like Jordan, Egypt and Morocco are prone to long-lasting economic challenges due to lack of resources, mismanagement or corruption. The paper also highlights the need to raise the educational attainment among citizens to understand disaster risk reduction.

This study utilized the research method developed by Williams et al. (2017) to present a comprehensive systematic and comparative review of disaster management in the Arab world. Considering that disaster and emergency management has remained disproportionately unexplored in the Arab world, this paper reviewed several vulnerabilities and how those vulnerabilities may affect disaster and emergency management efforts in the Arab countries.

Emergency Department (ED) presentations in older people are associated with a wide range of adverse events, which increase the risk of lengthy hospitalisation and poor outcomes. Pathfinder is an inter-organisational initiative delivered in partnership between Beaumont Hospital Occupational Therapy and Physiotherapy departments and the National Ambulance Service. Pathfinder responds to non-serious and non-life-threatening emergency medical service (EMS) calls. This study aims to demonstrate how Pathfinder can safely treat a proportion of older people at home by using alternative care pathways (ACPs), therefore avoiding unnecessary ED presentations. Once a decision has been reached to treat the person at home, the Pathfinder follow-up team delivers functional rehabilitation and case management in the persons’ home over the subsequent days.

This paper outlines the Pathfinder assessment, management and interventions in one clinical case example. Outcome measures include the level of patient satisfaction obtained via routine telephone feedback questionnaire and re-presentation to Beaumont Hospital within 30 days.

This paper illustrates through a case example the benefit of a collaborative multi-disciplinary rapid response team for non-serious and non-life-threatening EMS calls in older adults. The patient in this case example had no further EMS calls or ED presentations for 30 days after Pathfinder intervention and reported a high level of satisfaction with the service.

ED presentation was avoided through comprehensive multi-disciplinary assessment, including immediate access to intensive follow-up support in the person’s own home.

The Pathfinder service is improving access to ACPs for older people in the Beaumont Hospital catchment area. Pathfinder will now be spread nationally, with local adaptation, so that older people in other parts of Ireland will also benefit from this integrated model of care.

Patient feedback surveys confirm older adults want access to alternative care pathways.

The purpose of this paper is to describe and analyse two approaches to paramedic service clinical governance and quality management from the perspective of two groups of paramedics and paramedic managers working in North America.

A case study approach was utilised to describe and analyse paramedic service medical direction in North America and contrast this with the professional self-governance and clinical governance systems operating in other high-income countries. Researchers interviewed participants at two remote North American sites, then completed transcription and thematic analysis.

Participants identified three themes: first, resourcing, regulatory frameworks and fragmentation; second, independent practice facilitators and barriers; and third, paramedic roles and professionalisation. Those trained outside North America tended to identify self-regulation and clinical governance as the preferred approach to quality management. Few participants had considered paramedicine becoming a self-regulating health profession.

In North America, the “medical direction” model is the dominant approach employed to ensure optimal patient outcomes in paramedic service delivery. In contrast, other comparable countries employ paramedic self-regulatory systems combined with clinical governance to achieve the same ends. This is one of two studies to examine medical direction from the perspective of paramedics and paramedic managers.

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 study is to analyse the crisis network response of European countries and the role played by defence organizations (DOs) during the early response phase of the pandemic, here set to encompass 75 days.

Published materials – reports, news and communications – provided by authorities and DOs were used. Some of the authors actively participated in national pandemic response networks. An exploratory approach and qualitative content analysis were applied. The data were collected in national languages from 13 European countries, and they were coded and analysed using the actors, resources and activities (ARA) framework.

This study identified three main categories of activity structures in which the DOs interacted with civilian members of response networks, health-related services, logistics services and public support services. These networks among actors were found within formal response systems and emergent networks. The DOs engaged as actors that provided a range of services when civil authorities could not cope with the huge demand for specific services and when resources were scarce in the initial response phase.

This study contributes by filling an important research gap with regard to the civil-military relations associated with the use of DO resources in the civil response to the pandemic crisis in Europe, which is described as an untraditional response. The ARA network approach provides a framework for arranging ARA and extends the wider civil-military network to expand the formal networks of the early crisis response. The study lays knowledge about the co-operation between civilian and military actors in different contexts and provides a broader understanding of the roles that DOs played in the response operations.

This study explored the experiences of Irish emergency medical services (EMS) first responders during the first nationwide restrictions to curb the spread of COVID-19.

A systematic literature review (SLR) of research into healthcare workers' and first responders' experiences during the COVID-19 and 2003 SARS pandemics was performed. The SLR informed the content of an online questionnaire distributed via the Irish Pre-Hospital Emergency Care Council to 2,092 first responders on its live register. Data analysis used both descriptive and content analysis.

EMS first responders faced many challenges including PPE quality, training on its use, issues with decontamination facilities, and organisational effectiveness. Emotional challenges included the anxiety experienced, the impact on families, and ethical dilemmas confronted related to patient care. Positive findings also emerged, such as first responders' dedication to working through the pandemic, collegiality, and the community goodwill displayed.

While investigations of the impact of the COVID-19 pandemic on healthcare workers have been undertaken globally, studies focussing exclusively on the experiences of EMS first responders have been rare. This study addressed this knowledge gap, providing an insight into the challenges and successes experienced by first responders and identifying opportunities for learning that can be applied to future public health emergencies.

Suicide and attempted suicide is an important health issue and the number of people who die of suicide exceeds that of conflicts. Kashmir has been suffering from a low intensity war since last 20 years in which thousands have been killed or injured. There has been phenomenal increase in cases of psychological disorders along with suicide and and suicide attempters. Suicide in a conflict zone is viewed with indifference due to focus on the physical part of trauma. Difficulties faced by the suicidal patient and his attendants are seldom highlighted. 1408 patients who reported to emergency room for suicide attempt from 2000 to 2008 were taken for the study. All the patients underwent the hospital protocol for poisoning management. Patients were subjected to detailed psychiatric evaluation and questions were specifically asked about the difficulties encountered during management. Most of the cases were females with 92.11% belonging to the Muslim religion. 76.20% cases were from a rural background. 32.5% had been referred because of the lack of specific antidotes. Forty-three percent required arrangement of transportation by their own family members. Fifty-seven percent had been stopped for security checks along the way. Seventy-three percent felt that the attitude of the staff hostile. Twenty-three percent of patients had to share a bed. Almost all patients were questioned by security agencies within the hospital. More than 68% patient reported hostility amongst their neighbors. Suicidal poisoning is a significant health problem in Kashmir and management of these cases is fraught with difficulties across the spectrum of health care. Educating the doctors at primary care about first aid, improvement in community services followed by long term resolution of the conflict would go some way in alleviating the difficulties faced by a suicidal patient and his family in a conflict zone.