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Article
Publication date: 15 June 2021

Sarandis Mitropoulos, Christos Mitsis, Petros Valacheas and Christos Douligeris

The purpose of this paper is to investigate the way technology affects the provision of prehospital emergency care, upgrading the quality of services offered and…

Abstract

Purpose

The purpose of this paper is to investigate the way technology affects the provision of prehospital emergency care, upgrading the quality of services offered and significantly reducing the risk of premature termination of the patients.

Design/methodology/approach

The paper presents the development of the eEKAB, a pilot emergency medical information system that simulates the main services offered by the Greek National Instant Aid Centre (EKAB). The eEKAB was developed on an agile system methodology. From a technical perspective, the features and the technology were mainly chosen to provide reliable and user-friendly interfaces that will attract many users. eEKAB is based on three important pillars for offering health care to the patients: the “On-time Incident Reporting”, the “On-time Arrival at the Incident” and “Transfer to the Health Center”. According to the literature review, the emergency medical services (EMS) systems that combine all the features are very few.

Findings

It reduces the total time of the EMS procedures and it allows for an easier management of EMS, by providing a better allocation of human resources and a better geographical distribution of ambulances. The evaluation displayed that it is a very helpful application for the ambulance drivers as it reduces the ambulance response time to arrive in the patient's location and contributes significantly to the general performance of the prehospital medical care system. Also, the survey verified the importance of implementing eEKAB on a larger scale beyond the pilot usage. It is worth mentioning that the younger ambulance drivers had a more positive view for the purpose of the application.

Research limitations/implications

The paper clearly identifies implications for further research. Regarding interoperability, the mobile app cooperates with the Operational Center of EKAB, while further collaboration could be achieved with other operational ambulance handling center, mainly, of the private sector. The system can evolve to include better communications among the EKAB departments. Particularly, the ambulance crew as well as the doctors should be informed with more incident features such as the emergency signal so that they know whether to open the siren, the patient's name, etc. The authors are currently working on implementing some features to provide effective medical health services to the patient in the ambulance.

Practical implications

eEKAB will have very significant implications in case of its enforcement, such as the reduction of the total time of EMS procedures with a corresponding reduction of the operating costs of an accident management system and an ambulance fleet handling system while in parallel informing in time the doctors/clinics. It will provide better distribution of ambulances as well as of total human resources. It will greatly assist ambulance drivers, while reducing ambulance response time to reach the patient's location. In other words, the authors will have a better performance of the whole prehospital care system.

Social implications

Providing emergency care before the hospital is of great importance for upgrading the quality of health services provided at the accident site, thus significantly reducing the risk of premature death of patients. This in itself has a significant social implication.

Originality/value

The paper demonstrates a solid understanding in the field of the EMS systems and the corresponding medical services offered. It proposes the development of an effective, feasible and innovative EMS information system that will improve the existing emergency health care system in Greece (EKAB). An in depth literature review and presentation of the adopted new technologies and the respective architecture take place. An evaluation and statistical validation were conducted for proving the high applicability of eEKAB in case of real-life running.

Details

Applied Computing and Informatics, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2634-1964

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Article
Publication date: 27 November 2019

Mike Brady

Telephone triage or hear and treat (H&T) describes the process of UK ambulance services nurses and paramedics undertaking enhanced telephone assessments of patients to…

Abstract

Purpose

Telephone triage or hear and treat (H&T) describes the process of UK ambulance services nurses and paramedics undertaking enhanced telephone assessments of patients to determine the most appropriate response, which can sometimes result in no ambulance being sent. Given, however, that 999 is not considered an advice service, it may be reasonable to assert that the expectation of those calling 999 is always an immediate ambulance response. This may not always be realised and may affect patient experience. The purpose of this paper is to ascertain the following: to what extent are the views of UK ambulance telephone triage service users being gathered? In answering this research question, this review also aims to explore the findings to determine service users’ expectations of ambulance telephone triage and the possibility that these expectations are influenced by the UK media. The findings of which could be used to inform the need and nature of future research.

Design/methodology/approach

Phase one consisted of a computerised literature search of online databases CINAHL, Pubmed, Science Direct, Cochrane library, Web of Science and UK government-funded databases. Phase two consisted of searches of all UK ambulance services websites and the submission of freedom of information requests. Phase three consisted of a computerised literature search of the ProQuest international news-stream database.

Findings

A total of 78 results were identified and after further screening 34 results were excluded, leaving 44 for final review. The extent to which users experience of ambulance service telephone triage are being gathered is low; and often limited to one off pieces of non-peer reviewed work. Patients felt overall that they were treated with respect, dignity and care. However, being listened to, reducing anxiety and a need for prompt assurances remain important to those whose overriding expectation is that an ambulance should attend every time a 999 call is made. There appears to be a balanced media portrayal of H&T with the UK media. However, unrealistic public expectations represent a significant barrier to providing sustainable care that users consider to be of high quality.

Research limitations/implications

Some user experiences may have been gathered in more broad research exercises which explored various aspects of 999 ambulance service experience. This was not included if it could not be clearly differentiated as being related to H&T and thus may have resulted in data being omitted. It was not possible to systematically search social media platforms (such as facebook or twitter) for any media results related to this search strategy; only traditional print and online media platforms. This also may have resulted in data being omitted. The inclusion of non-peer reviewed research results and grey literature represents a possible limitation to the conclusions drawn within this review. The concept of Insider Research Bias cannot be ignored within this review. The author himself practices in telephone triage within a UK ambulance service; however, this insider bias is mitigated by the clearly articulated systematic methodology and use of the Critical Appraisal Skills framework. In a similar vein, reviews of this nature are also often conducted as part of a team, to reduce bias, increase objectivity and ensure the validity of findings. This review was a sole effort, and while this is not uncommon, there were no cross checks by peers of the search terms, strategy, paper selection, exclusion criteria or data extraction. This lack of peer critique is considered a possible limitation in mitigating selection and reviewer bias.

Practical implications

The results of this review would suggest a need to increase the amount of research and patient feedback gathered from those being assessed and managed by ambulance service telephone triage within the UK. Ambulance services could hold regular monthly small-scale qualitative interviews with patients and families to ascertain their views, perceptions and anxieties which can then provide an up-to-date understanding of user expectations and the health educational needs of local communities. Patient feedback received directly to ambulance services or via the Patient Advice and Liaison Service could be retrospectively analysed by researchers to determine key themes of positive practice or negative patient experience. Such feedback can be tracked through time and be used as a pre and post community intervention measure, to determine any changes. Moving forward, nationally standardised research frameworks should be adopted to provide more easily collated local and national data, which can monitor improvement strategies and provide a comparison between services to aid the sharing of best practice principles.

Originality/value

There is no other piece of work published which has reviewed the data in this area of clinical practice within the UK.

Details

International Journal of Emergency Services, vol. 9 no. 2
Type: Research Article
ISSN: 2047-0894

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Article
Publication date: 26 June 2020

Hesam Adarang, Ali Bozorgi-Amiri, Kaveh Khalili-Damghani and Reza Tavakkoli-Moghaddam

This paper addresses a location-routing problem (LRP) under uncertainty for providing emergency medical services (EMS) during disasters, which is formulated using a robust…

Abstract

Purpose

This paper addresses a location-routing problem (LRP) under uncertainty for providing emergency medical services (EMS) during disasters, which is formulated using a robust optimization (RO) approach. The objectives consist of minimizing relief time and the total cost including location costs and the cost of route coverage by the vehicles (ambulances and helicopters).

Design/methodology/approach

A shuffled frog leaping algorithm (SFLA) is developed to solve the problem and the performance is assessed using both the ε-constraint method and NSGA-II algorithm. For a more accurate validation of the proposed algorithm, the four indicators of dispersion measure (DM), mean ideal distance (MID), space measure (SM), and the number of Pareto solutions (NPS) are used.

Findings

The results obtained indicate the efficiency of the proposed algorithm within a proper computation time compared to the CPLEX solver as an exact method.

Research limitations/implications

In this study, the planning horizon is not considered in the model which can affect the value of parameters such as demand. Moreover, the uncertain nature of the other parameters such as traveling time is not incorporated into the model.

Practical implications

The outcomes of this research are helpful for decision-makers for the planning and management of casualty transportation under uncertain environment. The proposed algorithm can obtain acceptable solutions for real-world cases.

Originality/value

A novel robust mixed-integer linear programming (MILP) model is proposed to formulate the problem as a LRP. To solve the problem, two efficient metaheuristic algorithms were developed to determine the optimal values of objectives and decision variables.

Details

Journal of Humanitarian Logistics and Supply Chain Management, vol. 10 no. 3
Type: Research Article
ISSN: 2042-6747

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Article
Publication date: 12 July 2011

Paresh Wankhade

The purpose of this paper is to assess the performance measurement in the UK NHS ambulance service documenting various unintended consequences of the current performance…

Abstract

Purpose

The purpose of this paper is to assess the performance measurement in the UK NHS ambulance service documenting various unintended consequences of the current performance framework and to suggest a future research agenda.

Design/methodology/approach

The paper reviews the literature on ambulance performance targets and documents several unintended consequences of the current performance system through an in‐depth case study analysis based on interviews with Trust staff and policy experts along with observation of performance review meetings in the chosen Trust. Ethical approval for the study was obtained from a local NHS research ethics committee.

Findings

Significant unintended consequences of the ambulance performance targets based on response times have been systematically documented, which are likely to put the target under spotlight, especially that of the eight‐minute response. The current policy focus to reform the eight‐minute target by making it more stringent has the potential of jeopardising the reform agenda based on developing clinical skills of the paramedics and introducing clinical management in the service.

Practical implications

The paper makes an objective assessment of the sustainability of the current policy framework and identifies future lines of enquiry for further research.

Originality/value

This paper makes an original contribution in identifying and documenting the disjuncture between stated and unintended consequences of ambulance performance measurement, which will be of value to academics, practitioners and policy makers.

Details

International Journal of Public Sector Management, vol. 24 no. 5
Type: Research Article
ISSN: 0951-3558

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Article
Publication date: 4 December 2018

Juliet Harrison

The purpose of this paper is to establish if organisational factors are leading to a negative effect on ambulance personnel’s health. In recent years, frontline ambulance

Abstract

Purpose

The purpose of this paper is to establish if organisational factors are leading to a negative effect on ambulance personnel’s health. In recent years, frontline ambulance personnel have displayed a consistent high rate of sickness amongst healthcare workers within the National Health Service in the UK. Post-traumatic stress disorder (PTSD) has previously been cited, but organisational factors may be stressors to health.

Design/methodology/approach

A search of electronic databases MEDLINE EBSCO, MEDLINE OVID, MEDLINE PUBMED, AMED, CINAHL, Web of Science, Zetoc within the time period of 2000–2017 resulted in six mixed methods studies. Hand searching elicited one further study. The literature provided data on organisational and occupational stressors (excluding PTSD) relating to the health of 2,840 frontline ambulance workers in the UK, Australia, Norway, the Netherlands and Canada. The robust quantitative data were obtained from validated questionnaires using statistical analysis, whilst the mixed quality qualitative data elicited similar themes. Narrative synthesis was used to draw theories from the data.

Findings

Organisational factors such as low job autonomy, a lack of supervisor support and poor leadership are impacting on the health and well-being of frontline ambulance workers. This is intertwined with the occupational factors of daily operational demands, fatigue and enforced overtime, so organisational changes may have a wider impact on daily occupational issues.

Originality/value

The findings have possible implications for re-structuring organisational policies within the ambulance service to reduce staff sickness.

Details

International Journal of Emergency Services, vol. 8 no. 2
Type: Research Article
ISSN: 2047-0894

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Article
Publication date: 14 March 2017

Sreekanth V.K. and Ram Babu Roy

The purpose of this paper is to apply agent-based modeling and simulation concepts in evaluating different approaches to solve ambulance-dispatching decision problems…

Abstract

Purpose

The purpose of this paper is to apply agent-based modeling and simulation concepts in evaluating different approaches to solve ambulance-dispatching decision problems under bounded rationality. The paper investigates the effect of over-responding, i.e. dispatching ambulances even for doubtful high-risk patients, on the performance of equity constrained emergency medical services.

Design/methodology/approach

Agent-based modeling and simulation was used to evaluate two different dispatching policies: first, a policy based on maximum reward, and second, a policy based on the Markov decision process formulation. Four equity constraints were used: two from the patients’ side and two from the providers’ side.

Findings

The Markov decision process formulation, solved using value iteration method, performed better than the maximum reward method in terms of number of patients served. As the equity constraints conflict with each other, at most three equity constraints could be enforced at a time. The study revealed that it is safe to over-respond if there is uncertainty in the risk level of the patients.

Research limitations/implications

Further research is required to understand the implications of under-responding, where doubtful high-risk patients are denied an ambulance service.

Practical implications

The need for good triage system is apparent as over-responding badly affects the operational budget. The model can be used for evaluating various dispatching policy decisions.

Social implications

Emergency medical services have to ensure efficient and equitable provision of services, from the perception of both patients and service providers.

Originality/value

The paper applies agent-based modeling to equity constrained emergency medical services and highlights findings that are not reported in the existing literature.

Details

Team Performance Management: An International Journal, vol. 23 no. 1/2
Type: Research Article
ISSN: 1352-7592

Keywords

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Article
Publication date: 5 October 2018

Bilal El Itani, Fouad Ben Abdelaziz and Hatem Masri

Ambulance response time is an important factor in saving lives and is highly linked with the ambulance location problem. The Maximum Expected Covering Location Problem…

Abstract

Purpose

Ambulance response time is an important factor in saving lives and is highly linked with the ambulance location problem. The Maximum Expected Covering Location Problem (MEXCLP), introduced by Daskin (1983), is one of the most used ambulance location models that maximize the probability of stratifying demands for emergency medical service (EMS) centers. Due to huge increase in the operational costs of EMS centers, ambulance location models must consider the cost of coverage and the opportunity to use other companies’ private ambulances to answer emergency calls. The paper aims to discuss these issues.

Design/methodology/approach

In this paper, the authors propose to extend the MEXCLP to a bi-objective optimization problem where the cost of satisfying emergency calls is minimized.

Findings

The proposed model is tested using data retrieved from the Lebanese Red Cross (LRC) in Beirut capital of Lebanon. The reported findings show significant enhancements in the results where the LRC can fully satisfy the perceived demands from all areas in Beirut within 9 min with an affordable cost.

Originality/value

The model is a first attempt to reduce operational costs of EMS centers while constraining the response time to satisfy emergency calls at an acceptable rate.

Details

Management Decision, vol. 57 no. 2
Type: Research Article
ISSN: 0025-1747

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Article
Publication date: 7 November 2016

Paresh Wankhade

There is a growing academic interest in the examination and exploration of work intensification in a wide range of healthcare settings. The purpose of this paper is to…

Abstract

Purpose

There is a growing academic interest in the examination and exploration of work intensification in a wide range of healthcare settings. The purpose of this paper is to explore the differing staff perceptions in emergency ambulance services in the UK. It provides evidence on the challenges for the paramedic professionalisation agenda and managing operational demands and work intensity in emotionally challenging circumstances, with significant implications for patient safety.

Design/methodology/approach

Drawing on the evidence from an empirical study in a large National Health Service ambulance trust in England, this paper examines the challenges and differing staff perceptions of the changing scope and practice of ambulance personnel in the UK. Amidst the progress on the professionalisation of the paramedic agenda, individual trusts are facing challenges in form of staff attitudes towards meeting performance targets, coupled with rising demand, fear of loss of contracts and private competition.

Findings

Research findings highlight differing perceptions from various sub-cultural groups and lack of clarity over the core values which are reinforced by cultural and management differences. Need for greater management to explore the relationship between high sickness levels and implications for patient safety including the need for policy and research attention follows from this study. The implications of work intensity on gender equality within the ambulance settings are also discussed.

Research limitations/implications

Ambulance services around the world are witnessing a strain on their operational budgets with increasing demand for their services. Study evidence support inconclusive evidence for patent safety despite the growing specialist paramedic roles. Organisational implications of high staff sickness rates have been largely overlooked in the management literature. This study makes an original contribution while building upon the earlier conceptions of work intensification.

Practical implications

The study findings have significant implications for the ambulance services for better understanding of the staff perceptions on work intensity and implications for patient safety, high sickness absence rates amidst increasing ambulance demand. Study findings will help prepare the organisational policies and design appropriate response.

Social implications

Societal understanding about the organisational implications of the work intensity in an important emergency response service will encourage further debate and discussion.

Originality/value

This study makes an original contribution by providing insights into the intra-organisational dynamics in an unusual organisational setting of the emergency ambulance services. Study findings have implications for further research inquiry into staff illness, patient safety and gender issues in ambulance services. Evidence cited in the paper has further relevance to ambulance services globally.

Details

International Journal of Emergency Services, vol. 5 no. 2
Type: Research Article
ISSN: 2047-0894

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Article
Publication date: 1 May 1995

Kathryn M. Young and Cary L. Cooper

The Occupational Stress Indicator (OSI) was used to investigate jobstress in an ambulance service in the north‐west of England. Sevendifferent aspects of the stress‐strain…

Abstract

The Occupational Stress Indicator (OSI) was used to investigate job stress in an ambulance service in the north‐west of England. Seven different aspects of the stress‐strain relationship were assessed and the findings compared with those from the fire service. Ambulance service employees were found to be experiencing major stress outcomes of low job satisfaction and poor mental and physical health. Fire service employees revealed significantly poorer physical health. Assesses the sources of job stress, type A behaviour, locus of control and coping styles and discusses them in the light of change in the public services.

Details

Journal of Managerial Psychology, vol. 10 no. 3
Type: Research Article
ISSN: 0268-3946

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Article
Publication date: 1 March 1991

Alma E.C. James and Peter L. Wright

A study of perceived sources of stress in the Devon AmbulanceService was carried out using interview and questionnaire surveys.Semi‐structured and non‐directive interview…

Abstract

A study of perceived sources of stress in the Devon Ambulance Service was carried out using interview and questionnaire surveys. Semi‐structured and non‐directive interview surveys were used to identify broad areas which were regarded as being stressful, while the questionnaire survey attempted to establish more precisely the levels of stress associated with different situations faced by Ambulance Service personnel. Factor analysis of the questionnaire results yielded four main elements: organisational and managerial aspects; new, unfamiliar and difficult duties/uncertainty; work overload; and interpersonal relations. The questionnaire results indicated that the most significant sources of stress were extrinsic, mainly involving the way Ambulance Service personnel were treated by other people. Based on the interview survey results, however, it is argued that the format of the questionnaire survey may have led to an underestimation of the role of intrinsic factors as a source of stress, particularly those involved with dealing with patients.

Details

Journal of Managerial Psychology, vol. 6 no. 3
Type: Research Article
ISSN: 0268-3946

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