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A new triage method, MBCE (Medical Bio Social Ethics), is presented with social justice, bio, and medical ethics for critical resource distribution during a pandemic. Ethical triage is a complex and challenging process that requires careful consideration of medical, social, cultural, and ethical factors to guide the decision-making process and ensure fair and transparent allocation of resources. When assigning priorities to patients, a clinician would evaluate each patient’s medical condition, age, comorbidities, and prognosis, as well as their cultural and social background and ethical factors.

A statistical analysis shows no interactions among the ethical triage factors. It implies the ethical components have no moderation effect; hence, each is independent. The result also points out that medical and bioethics may have an affinity for interactions. In such cases, there seem to be some ethical factors related to bio and medical ethics that are correlated. Therefore, the triage team should be careful in evaluating patient cases. The algorithm is explained with case histories of the selected patient. A group of triage nurses and general medical practitioners assists with the triage.

The MBCE triage algorithm aims to allocate scarce resources fairly and equitably. Another ethical principle in this triage algorithm is the principle of utility. In a pandemic, the principle of utility may require prioritizing patients with a higher likelihood of survival or requiring less medical care. The research presents a sensitivity analysis of a patient’s triage score to show the algorithm’s robustness. A weighted score of ethical factors combined with an assessment of triage factors combines multiple objectives to assign a fair triage score. These distinctive features of the algorithm are reasonably easy to implement and a new direction for the unbiased triage principle.

The idea is to make decisions about distributing and using scarce medical resources. Triage algorithms raise ethical issues, such as discrimination and justice, guiding medical ethics in treating patients with terminal diseases or comorbidity. One of the main ethical principles in triage algorithms is the principle of distributive justice.

Overcrowding continues to afflict emergency departments (EDs), and its attendant consequences are becoming increasingly severe. The burden of the COVID-19 pandemic is further escalating the situation worldwide. One of the most critical questions is how to adequately quantify what constitutes overcrowding and determine implications for operations management in improving service efficiency. This paper aims to discuss the aforementioned.

The authors propose the time and class complexity measures for ED service systems, taking into account important patient-level and system characteristics. Using an extensive data set from a Canadian ED, the authors investigate the performance of complexity-based measures in predicting service delays.

The authors find that the complexity measure is potentially more important than some well-known crowding metrics. In particular, EDs can improve service efficiency by managing the level of complexity within a desirable interval. Furthermore, complexity exposes how the interplay between demand-side behavioral changes and supply-side responses affects operational performance. Moreover, the results suggest that arrival patterns—the number of patients of each class arriving per time and times between events (arrivals and service completions)—increase the risk of service delays more than the demand volume.

This paper is the first to provide an extensive investigation into the application of the complexity-based measure for ED crowding. The study demonstrates potential values to be gained in ED service systems if complexity measure is incorporated into their operations management decisions.

The purpose of this study is to explore the sustainability of innovations introduced during the coronavirus disease 2019 (Covid-19) pandemic in remote and rural primary care advanced clinical practice.

The methodology includes an exploratory qualitative study of eight key stakeholders from Scottish remote and rural primary care advanced practice (three policymakers and five advanced practitioners). Data were collected using semi-structured interviews during 2022 and analysed thematically.

Advanced practice in remote and rural primary care is characterised by a shortage of doctors, close-knit communities and a broad scope of practice. Covid-19 catalysed changes in the delivery of healthcare. Innovations which participants wanted to sustain include hybrid working, triage, online training and development, and increased inter-professional support networks.

Findings provide valuable insights into how best to support remote and rural advanced practice which may have implications for retaining healthcare professionals. They also identified useful innovations which could benefit from further investment.

Given current healthcare workforce pressures, identifying and sustaining innovations which will support and retain staff are imperative. Hybrid consultations and online access to training, development and support should be sustained to support the remote and rural advanced practice workforce. Further research should explore the sustainability of innovations introduced during the Covid-19 pandemic in other care contexts.

This paper conceptualises how managers psychologically experience and respond to crises via metaphor analysis.

This paper uses a discourse dynamics approach to metaphor analysis. Conceptual metaphors were analysed and developed into concept maps through 37 semi-structured interviews with senior managers from different portfolios within 16 public universities in South Africa after #FeesMustFall protests.

Five domains emerged, including (1) looming crisis, (2) crisis onset, (3) crisis triage and containment, (4) (not) taking action and (5) post-crisis reflection. These domains shape a framework for the crisis adaptation cycle.

This study suggests that organisations should pay more attention to understanding emotions in crises and can use the adaptation model to develop their managers. It shows how metaphors can help explain affective and cognitive experiences and how emotions shift and evolve during a crisis. Managers should be aware of early signs of the crisis and its potential impact on their business operation in the looming and recognition stages, analyse the situation and work collectively on possible actions to minimise losses and maximise gains.

This is a rare investigation into the emotions of senior managers in the public sector in a social movement and national crisis via unconventional research methods to advance cognitive appraisal theory in crisis management.

This study aims to facilitate access to vascular disease screening for low-income individuals living in remote and conflict areas based on the results of a pilot trial in Colombia. Also, to increase the amount of diagnosis training of vascular surgery (VS) in civilians.

The operation method includes five stages: strategy development and adjustment; translation of the strategy into a real-world setting; operation logistics planning; strategy analysis and adoption. The operation plan worked efficiently in this study’s sample. It demonstrated high sensibility, efficiency and safety in a real-world setting.

The authors developed and implemented a flow model operating plan for screening vascular pathologies in low-income patients pro bono without proper access to vascular health care. A total of 140 patients from rural areas in Colombia were recruited to a controlled screening session where they underwent serial noninvasive ultrasound assessments conducted by health professionals of different training stages in VS.

The plan was designed to be implemented in remote, conflict areas with limited access to VS care. Vascular injuries are critically important and common among civilians and military forces in regions with active armed conflicts. As this strategy can be modified and adapted to different medical specialties and geographic areas, the authors recommend checking the related legislation and legal aspects of the intended areas where we will implement this tool.

Different sub-specialties can implement the described method to be translated into significant areas of medicine, as the authors can adjust the deployment and execution for the assessment in peripheral areas, conflict zones and other public health crises that require a faster response. This is necessary, as the amount of training to which VS trainees are exposed is low. A simulated exercise offers a novel opportunity to enhance their current diagnostic skills using ultrasound in a controlled environment.

Evaluating and assessing patients with limited access to vascular medicine and other specialties can decrease the burden of vascular disease and related complications and increase the number of treatments available for remote communities.

It is essential to assess the most significant number of patients and treat them according to their triage designation. This management is similar to assessment in remote areas without access to a proper VS consult. The authors were able to determine, classify and redirect to therapeutic interventions the patients with positive findings in remote areas with a fast deployment methodology in VS.

Access to health care is limited due to multiple barriers and the assessment and response, especially in peripheral areas that require a highly skilled team of medical professionals and related equipment. The authors tested a novel mobile assessment tool for remote and conflict areas in a rural zone of Colombia.

The dermatology service on the islands of Orkney, with a population of approximately 22,500, was taken over by National Health Service (NHS) Tayside in August 2018. This paper aims to provide an overview of the planning and review of a highly efficient and effective dermatology service for a rural island population.

The service includes visiting dermatology consultants, enhanced electronic referral vetting, skin surgery services, a General Practice (GP) with extended role (GPwER) in dermatology, specialist virtual clinics, urgent advice for inpatients at the local district general hospital and remote systemic therapy monitoring. A new phototherapy service has been set up in an island GP practice.

Local GPs and consultant dermatologists find the enhanced vetting service useable, efficient and educational. Between August 2018 and November 2022, there have been 1,749 referrals. Of these referrals, 60% were seen in clinic or a GPwER surgery, with 40% managed remotely by providing advice back to the referring GP. The number of consultations performed by the GPwER has grown over the past 3 years, and in the last year, it accounted for more than 50% of patient appointments. The waiting time has been significantly reduced using this model.

This remote service uses an integrated approach of teledermatology (TD) whilst offering continual in-person services using local capabilities including a GPwER and island general surgeons. New treatment facilities are provided to the island population. Continual educational feedback to the primary care referrer is provided, and it enhances relationships that greatly aid the high-quality dermatology service provided.

This study aimed to compare mortality rate, length of stay (LOS) and hospitalization costs at different priority levels for a patient admitted to an intensive care unit (ICU) at a public tertiary hospital in Qazvin, Iran. This study also aimed to predict influencing factors on patients’ mortality, ICU LOS and hospitalization costs in different admission groups.

The authors conducted a retrospective cohort study among patients who mainly suffered from internal diseases admitted to an ICU of a public hospital. This study was conducted among 127 patients admitted to ICU from July to September 2019. The authors categorized patients into four groups based on two crucial hemodynamic and respiratory status criteria. The authors used a logistic regression model to predict the likelihood of mortality in ICU admitted patients during hospitalizations for the four prioritization groups. Furthermore, the authors conducted a multivariate analysis using the “enter” method to identify risk factors for LOS.

Results showed a statistically significant relationship between the priority of being admitted to ICU and hospitalization costs. The authors’ findings revealed that age, LOS and levels of consciousness had a predictability role in determining in-hospital mortality. Besides, age, gender, consciousness level of patients and type of the disease were mentioned as affecting factors of LOS.

This study’s findings emphasize the necessity of categorizing patients according to specific criteria to efficiently use available resources to help health-care authorities reduce the costs and allocate the budget to different health sectors.

The purpose of this study is to identify LGBTQ+ perceptions of and experiences with hazards, vulnerabilities and disasters in the San Francisco Bay Area in the USA and to co-develop applied projects to “queer” disaster knowledge production and risk reduction activities in the region.

This is a community science project in which we collaborate with community members to enhance both community and scientific knowledge with the goal of utilizing it to produce a positive change to pressing social issues and their underlying causes. We do this through a series of four focus group workshops to identify community priorities, hazards, vulnerabilities and local action. We follow this with further ethnographic research and projects to apply findings from phase one.

The authors have found that: LGBTQ+ people in the Bay Area have unique experiences with hazards, vulnerabilities and disasters; there are significant gaps in the representation of LGBTQ+ hazard exposure in local scientific models that we can address through alternative methodologies; and tabletop exercises, learning modules and podcasts help orient and train disaster response agencies and personnel on LGBTQ+ inclusive operations.

This initiative entails novel approaches to community science for disaster risk reduction and creative collaboration with community-based organizations to foster the development of LGBTQ+ inclusive disaster risk reduction and response.

This study aims to deepen the understanding of the challenges and implications entailed by deploying mobile clinics in conflict zones to reach populations affected by violence and cut off from health-care services.

This research combines an integrated literature review and an instrumental case study. The literature review comprises two targeted reviews to provide insights: one on conflict zones and one on mobile clinics. The case study describes the process and challenges faced throughout a mobile clinic deployment during and after the Iraq War. The data was gathered using mixed methods over a two-year period (2017–2018).

Armed conflicts directly impact the populations’ health and access to health care. Mobile clinic deployments are often used and recommended to provide health-care access to vulnerable populations cut off from health-care services. However, there is a dearth of peer-reviewed literature documenting decision support tools for mobile clinic deployments.

This study highlights the gaps in the literature and provides direction for future research to support the development of valuable insights and decision support tools for practitioners.