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1 – 10 of over 2000
Article
Publication date: 28 September 2022

Catherine Powell, Beth Fylan, Kathryn Lord, Fiona Bell and Liz Breen

The 999 ambulance call handler is critical in responding to emergency patient treatment; however, the call handlers are often a hidden component of the healthcare…

Abstract

Purpose

The 999 ambulance call handler is critical in responding to emergency patient treatment; however, the call handlers are often a hidden component of the healthcare workforce and an under-researched group. The objective of this study is to understand stress triggers experienced by 999 ambulance call handlers that could lead to burnout and examine personal and organisational mechanisms and strategies which reduced the risk of burnout.

Design/methodology/approach

A single interview case study approach applying qualitative methods was undertaken. Participants were identified through a purposive sample of 999 ambulance call handlers with the Yorkshire Ambulance Service National Health Service Trust (UK). Participants were interviewed via telephone between July 2019 and September 2019.

Findings

In total, 18 staff participated in this study. Societal factors including public incivility and media representation and organisational factors, such as a demanding environment, lack of appreciation and career progression, training issues and protocols were key stressors. Organisational well-being services were helpful for some, but for others lacked accessibility and appropriateness. Positive public feedback and speaking with peers bolstered well-being. 999 ambulance call handlers suggested that sufficient breaks, co-design or feeding back on training and protocols and creating more informal opportunities to discuss ongoing everyday stressors as methods to reduce stress and burnout.

Originality/value

This paper explores a previously under researched area on stressors and potential burnout in 999 call handlers. This paper highlights the need for improved organisational support services and appropriate public and sector peer recognition of the role of ambulance 999 ambulance call handlers.

Details

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

Keywords

Article
Publication date: 27 April 2022

Alan Slater

Mass casualty incidents are characterised by an immediate, unforeseen and unquantifiable surge in demand for ambulance services which soon becomes apparent and will exceed…

Abstract

Purpose

Mass casualty incidents are characterised by an immediate, unforeseen and unquantifiable surge in demand for ambulance services which soon becomes apparent and will exceed any “local” resources available. Casualties require the correct treatment, promptly, at an appropriate resource without incurring any further harm. In the absence of firm operational guidelines, this paper provides templates for ambulance commanders both at call centre and on-site to approach the management of mass casualty incidents.

Design/methodology/approach

Desk research indicated that there were both guidelines on how various elements of the emergency services should work together plus academic papers on techniques to adopt in mass casualty situations. Standing orders or written protocols for ambulance commanders, however, provide little or no specific guidance or an outline plan upon how they should command in a mass casualty situation. Following analysis of relevant public enquiry reports and discussions with ambulance commanders and using the materials from desk research, a four-stage approach was devised for testing using retrospective analysis from field and desktop exercises.

Findings

To have confidence, each commander needs simple digital real-time templates from which they understand their role and how the overall plan defines priorities with the greatest need. A plan should cover call-centre and on-site operations including a basic operational checklist from start to finish; resource structure and inter-relationships; sources and availability of resources plus information and control procedures to impose limited quality control procedures.

Originality/value

The design and implementation of digital templates to provide minute-by-minute visibility to all commanders which have not been recorded before. Such templates give commanders confidence to determine, locate and call forward relevant resources to attend casualties in order of priority of need. Time-lapsed records are useful not just in the minute-by-minute decision processes but also for critical organisational learning and in any post-event review by either a coroner or lawyers at a public enquiry.

Details

International Journal of Emergency Services, vol. 11 no. 2
Type: Research Article
ISSN: 2047-0894

Keywords

Article
Publication date: 27 December 2021

Nigel Rees, Patrick Rees, Lois Hough, Dylan Parry, Nicola White and Brady Bowes

Ambulance services staff worldwide have long been at risk of encountering violence and aggression directed towards them during their work. Verbal forms of violence and…

Abstract

Purpose

Ambulance services staff worldwide have long been at risk of encountering violence and aggression directed towards them during their work. Verbal forms of violence and aggression are the most prevalent form, but sometimes incidents involve physical injury, and on rare occasions homicides do occur. Exposure to such violence and aggression can have a lasting negative impact upon ambulance staff and has been associated with increased levels of stress, fear, anxiety, emotional exhaustion, depersonalisation and burnout syndrome. Despite the significance of this issue, little progress has been made to tackle it. The purpose of this paper is to describe this multi-agency approach being taken in Wales (UK) to reduce such harms from violence and aggression directed towards ambulance services staff.

Design/methodology/approach

An interpretative post-positivist narrative methodology and policy analysis approach was followed. Snowball methods of gathering data were used to construct this narrative involving meetings, telephone calls, review of policy documents, legislation and academic literature.

Findings

The authors report how tackling violence and aggression directed towards emergency workers has become a priority within Wales (UK), resulting in policy developments and initiatives from groups such as the UK and Welsh Government, the Welsh Ambulance Services National Health Services (NHS) Trust, Health Boards, the NHS Wales Anti-Violence Collaborative and the Joint Emergency Services Group (JESG) in Wales. This has included changes in legislation such as the Assaults on Emergency Workers (Offences) Act 2018 that came into force on 13th November 2018 and policy changes such as the obligatory responses to violence in health care and the JESG #WithUsNotAgainst Us campaign. Our study however reflects the complexity of this issue and the need for further high-quality research.

Originality/value

The experiences and activities of Wales (UK) reported in this paper adds to the international body of knowledge and literature on violence and aggression directed towards ambulance services staff.

Details

Journal of Aggression, Conflict and Peace Research, vol. 14 no. 2
Type: Research Article
ISSN: 1759-6599

Keywords

Open Access
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…

1149

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

Keywords

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…

3284

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

Keywords

Article
Publication date: 29 September 2020

Andy Newton

Review of major policy paper in relation to the ambulance service [in England] efficiency and productivity with reference to observed “unacceptable variation”.

Abstract

Purpose

Review of major policy paper in relation to the ambulance service [in England] efficiency and productivity with reference to observed “unacceptable variation”.

Design/methodology/approach

Critical review of ambulance service/EMS policy approach in England.

Findings

Lord Carter’s review describes failings in performance of UK ambulance service/EMS. However, the identified failings are essentially a repetition of many almost identical similar findings. There is a tendency of policy in respect of the ambulance service in England, as exemplified by Lord Carter’s report to consider analysis of the problem a more significant task that actually addressing the shortcoming defined.

Research limitations/implications

This viewpoint comment piece is produced as a viewpoint with all the attendant limitations implied in this approach. However, it has been produced from an informed position.

Practical implications

Challenge to current UK ambulance policy. Previous repetitious finding need to be addressed definitively.

Social implications

The efficiency of UK ambulance services/EMS is seriously impaired, and indeed these findings have been acknowledge previously. However, little by way of active remediation has been attempted. The current approach as exemplified in Lord Carter's recent review appears to ensure that analysis of the long- standing problems that exist is sufficient and possible preferable to active remediation and improvement.

Originality/value

No previous critical review of this type has been attempted (as it would be career-limiting).

Details

International Journal of Emergency Services, vol. 10 no. 1
Type: Research Article
ISSN: 2047-0894

Keywords

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

Keywords

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

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

Keywords

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…

1071

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

Keywords

1 – 10 of over 2000