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The purpose of this study is to discuss the principles and factors that influence the site selection of emergency medical facilities for public health emergencies. This paper discusses the selection of the best facilities from the available facilities, proposes the capacity of new facilities, presents a logistic regression model and establishes a site selection model for emergency medical facilities for public health emergencies in megacities.

Using Guangzhou City as the research object, seven alternative facility points and the points' capacities were preset. Nine demand points were determined, and two facility locations were selected using genetic algorithms (GAs) in MATLAB for programing simulation and operational analysis.

Comparing the results of the improved GA, the results show that the improved model has fewer evolutionary generations and a faster operation speed, and that the model outperforms the traditional P-center model. The GA provides a theoretical foundation for determining the construction location of emergency medical facilities in megacities in the event of a public health emergency.

First, in this case study, there is no scientific assessment of the establishment of the capacity of the facility point, but that is a subjective method based on the assumption of the capacity of the surrounding existing hospitals. Second, because this is a theoretical analysis, the model developed in this study does not consider the actual driving speed and driving distance, but the speed of the unified average driving distance and the driving distance to take the average of multiple distances.

The results show that the method increases the selection space of decision-makers, provides them with stable technical support, helps them quickly determine the location of emergency medical facilities to respond to disaster relief work and provides better action plans for decision makers.

The results show that the algorithm performs well, which verifies the applicability of this model. When the solution results of the improved GA are compared, the results show that the improved model has fewer evolutionary generations, faster operation speed and better model than the intermediate model GA. This model can more successfully find the optimal location decision scheme, making that more suitable for the location problem of megacities in the case of public health emergencies.

The research findings provide a theoretical and decision-making basis for the location of government emergency medical facilities, as well as guidance for enterprises constructing emergency medical facilities.

The lack of studies about the response time of emergency medical service during the coronavirus disease 2019 (COVID-19) pandemic in a dense city of a developing country has triggered this study to explore the factors contributing to a high response time of ambulance service to reach patients in need. An evaluation of contributing factors to the response time is necessary to guide decision-makers in keeping a high service level of emergency medical service.

This research employed an agent-based modeling approach with input parameters from interviews with emergency medical service staff in Bandung city, Indonesia. The agent-based model is established to evaluate the relevant contribution of the factors to response time reduction using several scenarios.

According to agent-based simulation, four factors contribute to the response time: the process of preparing crew and ambulance during the pandemic, coverage area, traffic density and crew responsiveness. Among these factors, the preparation process during the pandemic and coverage area significantly contributed to the response time, while the traffic density and crew responsiveness were less significant. The preparation process is closely related to the safety procedure in handling patients during the COVID-19 pandemic and normal time. The recommended coverage area for maintaining a low response time is 5 km, equivalent to six local subdistricts.

This study has explored the factors contributing to emergency medical response time. The insignificant contribution of the traffic density showed that citizens, in general, have high awareness and compliance to traffic priority regulation, so crew responsiveness in handling ambulances is an irrelevant factor. This study might have different contributing factors for less dense population areas and focuses on public emergency medical services provided by the local government.

The local government must provide additional funding to cover additional investment for ambulance, crew and administration for the new emergency service deployment point. Exercising an efficient process in ambulance and crew preparation is mandatory for each emergency deployment point.

This study evaluates the contributing factors of emergency medical response time in the pandemic and normal situation by qualitative analysis and agent-based simulation. The performance comparison in terms of medical response time before and after COVID-19 through agent-based simulation is valuable for decision-makers to reduce the impact of COVID-19.

Resilience can be of assistance to paramedics in order to maintain their own mental balance in stressful work environments. Since it is not well defined which personality traits are correlated with resilience in these personnel, the purpose of this paper is to explain the relationship between personality traits and levels of resilience.

This cross-sectional study was conducted on paramedics in Eastern Iran through field research. The study participants were selected by convenience sampling method. The data collection instruments included NEO-Five Factor Inventory-Short Form and Connor-Davidson Resilience Scale. The data obtained were also analyzed using descriptive and inferential statistics (correlation and regression analysis) through the SPSS 16.0 software.

A total of 252 paramedics with a mean age of 28.9±5.1 years participated in this study. The personality traits of neuroticism (r=−0.24), openness to experience (r=−0.22), and agreeableness (r=−0.18) were significantly correlated with resilience. In contrast, extraversion (r=0.26) and conscientiousness (r=0.32) were in a significant relationship with resilience. In this respect, the given personality traits could account for 31.5 percent of changes in resilience.

It was concluded that the paramedics with lower scores of neuroticism had higher levels of resilience and they could similarly show better compliance with their work conditions in stressful situations and consequently maintain their mental health.

It is recommended to conduct psychological examinations of personality traits in recruitment and selection stages of medical emergency personnel and to implement psychological interventions for those medical emergency staff with the personality trait of neuroticism.

Resilient paramedics may also perceive less stress and it may be negatively associated with burnout.

The study examined the relationship between personality traits and resiliency in order to clarifying recruitment criteria in emergency medical services.

Enormous numbers of people suffer from the effects of disasters and humanitarian crises in Africa, including medical and healthcare emergencies. International response to the 2014–2016 Ebola pandemic in West Africa and COVID 19 pandemic vividly demonstrates the need for efficient and effective logistics and supply chain systems in bringing succor to impacted and vulnerable communities. This paper critically reviews the academic literature on logistics models for sourcing, delivery and distribution of medical and healthcare products for humanitarian emergencies in Africa from 1990 to 2018. The paper suggests areas for further research and proposes an effective logistics model useful for international and national humanitarian organizations as well as public health authorities in Africa and developing areas.

The viewpoint paper draws upon a structured comprehensive and critical review of the academic literature on logistics and supply chain management and a qualitative analysis of the literature in 13 leading academic databases covering over 5,550 articles.

The paper finds significant gaps in the body of logistics and supply chain management research on practical deployable logistics models for sourcing, delivery, and distribution of medical and healthcare products for humanitarian emergencies. The paper suggests a model worthy of consideration by humanitarian and disaster response stakeholders as well as public health authorities in developing countries.

This is a critical literature review paper based on a comprehensive literature research and analysis for the period from 1990 to 2018 from which a viewpoint is formed.

This paper advocates for further research on appropriate models of logistics for the sourcing, delivery and distribution of medical and healthcare products to enhance the basic human rights and dignity of vulnerable people in developing countries.

The paper contributes directly to policy on logistics, humanitarian aid, disaster management, public health and health security policy in the developing world including Africa.

The research is an administrative case study based on an extensive review of Hawaii government documents and interviews with key personnel of the Hawaii Emergency Preparedness Committee, civil defense and other relevant officials. Describes the interagency coordination at the federal, state, county, and community level to improve capability. Also described and critically evaluated are the roles of interagency emergency preparedness training, disaster drills, and coordination and partnership with the private sector, such as medical centers and the Federal Emergency Management Agency’s designated “disaster resistant communities” in Maui and Hawaii County. Recommends that more frequent interagency drills, increased funding for family emergency preparedness and local community response teams, and continuous training by emergency response coordinators could improve state and county disaster preparedness and concludes that, overall, Hawaii is adequately prepared in emergency response capability, particularly in the areas of medical services and interagency coordination.

Following a large-scale disaster, medical assistance is a critical component of the emergency response. The paper aims to discuss this issue.

Academic and practitioner literature is used to develop a framework studying the effectiveness of the humanitarian medical supply chain (HMSC). The framework is validated by using the findings of interviews conducted with experts and the case study of a serious humanitarian medical crisis (Ebola outbreak in 2014).

The factors affecting the effectiveness of the HMSC are identified.

To get an expert opinion on the major logistical challenges of the medical assistance in emergencies only 11 interviews with practitioners were conducted.

While the existing academic literature discusses the distribution of various supplies needed by the affected population, limited research focuses specifically on studying the HMSC aspect of the response. This paper closes this gap by describing the HMSC in the case of disaster response, and identifying the factors affecting its effectiveness, especially focusing on the factors that are unique to the medical aspect of the humanitarian supply chain.

Emergency services are critical for high‐quality healthcare service provision to support acute illness, trauma and disaster response. The greater availability of emergency services decreases waiting time, improves clinical outcomes and enhances local community well being. This study aims to assess United States (US) acute care hospital staff's ability to provide emergency medical services by evaluating the number of emergency departments and trauma centers.

Data were obtained from the 2003 and 2007 American Hospital Association (AHA) annual surveys, which included over 5,000 US hospitals and provided extensive information on their infrastructure and healthcare capabilities.

US acute care hospital numbers decreased by 59 or 1.1 percent from 2003 to 2007. Similarly, US emergency rooms and trauma centers declined by 125, or 3 percent. The results indicate that US hospital staff's ability to respond to traumatic injury and disasters has declined. Therefore, US hospital managers need to increase their investment in emergency department beds as well as provide state‐of‐the‐art clinical technology to improve emergency service quality. These investments, when linked to other clinical information systems and the electronic medical record, support further healthcare quality improvement.

This research uses the AHA annual surveys, which represent self‐reported data by individual hospital staff. However, the AHA expends significant resources to validate reported information and the annual survey data are widely used for hospital research.

The declining US emergency rooms and trauma centers have negative implications for patients needing emergency services. More importantly, this research has significant policy implications because it documents a decline in the US emergency healthcare service infrastructure.

This article has important information on US emergency service availability in the hospital industry.

The purpose of this paper is to report on the implementation of the World Health Organization (WHO) trauma care checklist (TCC) (WHO, 2016) in an emergency department in a tertiary hospital in Nepal. This research was undertaken as part of a Hybrid International Emergency Medicine Fellowship programme (Subedi et al., 2020) across UK and Nepal, incorporating a two-year rotation through the UK National Health Service, via the Medical Training Initiative (MTI) (AoMRC, 2017). The WHO TCC can improve outcomes for trauma patients (Lashoher et al., 2016); however, significant barriers affect its implementation worldwide (Nolan et al., 2014; Wild et al., 2020). This article reports on the implementation, barriers and recommendations of WHO TCC implementation in the context of Nepal and argues for Transformational Leadership (TL) to support its implementation.

Explanatory mixed methods research (Creswell, 2014), comprising quasi-experimental research and a qualitative online survey, were selected methods for this research. A training module was designed and implemented for 10 doctors and 15 nurses from a total of 76 (33%) of clinicians to aid in the introduction of the WHO TCC in an emergency department in a hospital in Nepal. The quasi-experimental research involved a pre- and post-training survey aimed to assess participant’s knowledge of the WHO TCC before and after training and before the implementation of the WHO TCC in the emergency department. Post-training, 219 patients were reviewed after four weeks to identify if process measures had improved the quality of care to trauma patients. Subsequently six months later, a qualitative online survey was sent to all clinical staff in the department to identify barriers to implementation, with a response rate of 26 (n = 26) (34%) (20 doctors and 6 nurses). Descriptive statistics were used to evaluate quantitative data and the qualitative data were analysed using the five stepped approach of thematic analysis (Braun and Clarke, 2006).

The evaluation of the implementation of the WHO TCC showed an improvement in care for trauma patients in an emergency setting in a tertiary hospital in Nepal. There were improvements in the documentation in trauma management, showing the training had a direct impact on the quality of care of trauma patients. Notably, there was an improvement in cervical spine examination from 56.1% before training to 78.1%; chest examination 125 (57.07%) before training and 170 (77.62%) post-training; abdominal examination 121 (55.25%) before training and 169 (77.16%) post-training; gross motor examination 13 (5.93%) before training and 131 (59.82%) post-training; sensory examination 4 (1.82%) before training and 115 (52.51%) post-training; distal pulse examination 6 (2.73%) before training and 122 (55.7%) post-training. However, while the quality of documentation for trauma patients improved from the baseline of 56%, it only reached 78% when the percentage improvement target agreed for this research project was 90%. The 10 (n = 10) doctors and 15 (n = 15) nurses in the Emergency Department (ED) all improved their baseline knowledge from 72.2% to 87% (p = 0.00006), by 14.8% and 67% to 85%) (p = 0.006), respectively. Nurses started with lower scores (mean 67) in the baseline when compared to doctors, but they made significant gains in their learning post-training. The qualitative data reported barriers, such as the busyness of the department, with residents and medical officers, suggesting a shortened version of the checklist to support greater protocol compliance. Embedding this research within TL provided a steer for successful innovation and change, identifying action for sustaining change over time.

The study is a single-centre study that involved trauma patients in an emergency department in one hospital in Nepal. There is a lack of internationally recognised trauma training in Nepal and very few specialist trauma centres; hence, it was challenging to teach trauma to clinicians in a single 1-h session. High levels of transformation of health services are required in Nepal, but the sample for this research was small to test out and pilot the protocol to gain wider stakeholder buy in. The rapid turnover of doctors and nurses in the emergency department, creates an additional challenge but encouraging a multi-disciplinary approach through TL creates a greater chance of sustainability of the WHO TCC.

International protocols are required in Nepal to support the transformation of health care. This explanatory mixed methods research, which is part of an International Fellowship programme, provides evidence of direct improvements in the quality of patient care and demonstrates how TL can drive improvement in a low- to medium-income country.

The Nepal/UK Hybrid International Emergency Medicine Fellowships have an opportunity to implement changes to the health system in Nepal through research, by bringing international level standards and protocols to the hospital to improve the quality of care provided to patients.

To the best of the authors’ knowledge, this research paper is one of the first studies of its kind to demonstrate direct patient level improvements as an outcome of the two-year MTI scheme.

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.

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.

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.

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.

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.

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.

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.

Refugee camps can be severely struck by pandemics, like potential COVID-19 outbreaks, due to high population densities and often only base-level medical infrastructure. Fast responding medical systems can help to avoid spikes in infections and death rates as they allow the prompt isolation and treatment of patients. At the same time, the normal demand for emergency medical services has to be dealt with as well. The overall goal of this study is the design of an emergency service system that is appropriate for both types of demand.

A spatial hypercube queuing model (HQM) is developed that uses queuing-theory methods to determine locations for emergency medical vehicles (also called servers). Therefore, a general optimization approach is applied, and subsequently, virus outbreaks at various locations of the study areas are simulated to analyze and evaluate the solution proposed. The derived performance metrics offer insights into the behavior of the proposed emergency service system during pandemic outbreaks. The Za'atari refugee camp in Jordan is used as a case study.

The derived locations of the emergency medical system (EMS) can handle all non-virus-related emergency demands. If additional demand due to virus outbreaks is considered, the system becomes largely congested. The HQM shows that the actual congestion is highly dependent on the overall amount of outbreaks and the corresponding case numbers per outbreak. Multiple outbreaks are much harder to handle even if their cumulative average case number is lower than for one singular outbreak. Additional servers can mitigate the described effects and lead to enhanced resilience in the case of virus outbreaks and better values in all considered performance metrics.

Some parameters that were assumed for simplification purposes as well as the overall model should be verified in future studies with the relevant designers of EMSs in refugee camps. Moreover, from a practitioners perspective, the application of the model requires, at least some, training and knowledge in the overall field of optimization and queuing theory.

The model can be applied to different data sets, e.g. refugee camps or temporary shelters. The optimization model, as well as the subsequent simulation, can be used collectively or independently. It can support decision-makers in the general location decision as well as for the simulation of stress-tests, like virus outbreaks in the camp area.

The study addresses the research gap in an optimization-based design of emergency service systems for refugee camps. The queuing theory-based approach allows the calculation of precise (expected) performance metrics for both the optimization process and the subsequent analysis of the system. Applied to pandemic outbreaks, it allows for the simulation of the behavior of the system during stress-tests and adds a further tool for designing resilient emergency service systems.