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The general population relies on the healthcare system for needed care during disasters. Unfortunately, the system is already operating at capacity. Healthcare facilities must develop plans to accommodate the surge of patients generated during disasters. The purpose of this paper is to examine a concept for providing independent, technologically advanced medical surge capacity via a Convertible Use Rapidly Expandable (CURE) Center.

To develop this concept, a site was chosen to work through a scenario involving a large earthquake. Although the study‐affiliated hospital was built with then state‐of‐the‐art technologies, there is still concern for its continued functioning should a large earthquake occur. Working within these parameters, the planning team applied the concepts to a specific educational complex. Because this complex was in the initial building stages, required attributes could be incorporated, making the concept a potential reality. Challenges with operations, communications, and technologies were identified and addressed in the context of planning for delivery of quality healthcare.

The process highlighted several requirements. Planning must include community leaders, enhanced by agencies or individuals experienced in disaster response. Analyzing regional threats in the context of available resources comes first, and reaching a consensus on the scope of operation is required. This leads to an operational plan, and in turn to understanding the needs for a specific site. Use of computer modeling and virtual deployment of the center indicates where additional planning is needed.

Previous strategies for increasing surge capacity rely on continued availability of hospital resources, alternative care sites with minimal medical capability, or, costly hospital expansions. Development of a site‐specific CURE Center can allow communities to provide fiscally responsible solutions for sustained medical care during disasters.

The purpose of this paper is to show how elements from queueing theory can be used to obtain objective measures of effective capacity in the triage function at Skaraborg Hospital in Sweden without direct observation of the function itself.

Approximately 30,000 patients arrived to the emergency department at Skaraborg Hospital in Sweden during 2011. The exact time of arrival and the exact time of triage were recorded for each patient on an individual level. Basic queueing theory uses arrival rates and system capacity measures to derive average queueing times. The authors use the theoretical relation between these three measures to derive system capacity measures based on observed arrival rates and observed average queueing times.

The effective capacity in the triage process is not a linear function of the number of nurses. However, the management of capacity seems well adapted to the actual demand, even though service levels vary substantially during the day and night.

This paper uses elements from queueing theory in an innovative way to measure the effective capacity of a service process without direct observation, thereby also avoiding the potential risk of the Hawthorne effect.

Relief item distribution to victims is a key activity during disaster response. Currently many humanitarian organizations follow simple guidelines based on experience to assess need and distribute relief supplies. However, the interviews with practitioners suggest a problem in efficiency in relief distribution efforts. The purpose of this paper is to develop a model and solution methodology that can estimate relief center (RC) performance, measured by waiting time for victims and throughput, for any RC design and analyze the impact of key design decisions on these performance measures.

Interviews with practitioners and current practice guidelines are used to understand relief distribution and a queuing network model is used to represent the relief distribution. Finally, the model is applied to data from the 2015 Nepal earthquake.

The findings identify that dissipating congestion created by crowds, varying item assignment decisions to points of distribution, limiting the physical RC capacity to control congestion and using triage queue to balance distribution times, are effective strategies that can improve RC performance.

This research bases the RC designs on Federal Emergency Management Agency guidelines and assumes a certain area and volunteer availability.

This paper contributes to humanitarian logistics by discussing useful insights that can impact how relief agencies set up and operate RCs. It also contributes to the queuing literature by deriving analytic solutions for the steady state probabilities of finite capacity, state dependent queues with blocking.

In the USA, terrorist threats captured government attention following 11 September 2001. Cities remain the most likely setting for terrorist incidents. Many cities, building on a successful federal program begun in 1997, have developed metropolitan medical response systems (MMRS) to address the consequences of terrorist incidents. The basic system design has been tested both through drills and incidents – including the attacks on the World Trade Center – and appears to function well. This paper describes the philosophy and elements of the MMRS model. The model has considerable value as a readily exportable strategy for responding to municipal terrorist incidents.

The purpose of this paper is to explore the configuration of factors affecting the accuracy of triage decision-making. The contribution of the work is twofold: first, it develops a protocol for applying a fuzzy-set qualitative comparative analysis (fsQCA) in the context of triage decision-making, and second, it studies, through two pilot cases, the interplay between individual and organizational factors in determining the emergence of errors in different decisional situations.

The methodology adopted in this paper is the qualitative comparative analysis (QCA). The fuzzy-set variant of QCA (fsQCA) is implemented. The data set has been collected during field research carried out in the Emergency Departments (EDs) of two Italian public hospitals.

The results of this study show that the interplay between individual and contextual/organizational factors determines the emergence of errors in triage assessment. Furthermore, there are some regularities in the patterns discovered in each of the investigated organizational contexts. These findings suggest that we should avoid isolating individual factors from the context in which nurses make their decisions.

Previous research on triage has mainly explored the impact of homogeneous groups of factors on the accuracy of the triage process, without considering the complexity of the phenomenon under investigation. This study outlines the need to consider the not-linear relationships among different factors in the study of triage’s decision-making. The definition and implementation of a protocol to apply fsQCA to the triage process in EDs further contributes to the originality of the research.

As a key component of the American health care system, the physician office could be the front line in a bioterrorist attack. Nationally and locally, the primary focus on this subject appears to be from a hospital preparedness and public health agency perspective, with little attention devoted to primary physician providers in their own offices, and those specialists to whom patients may be referred. While unrelated to bioterrorism, the recent SARS outbreak also brings to the forefront the need for physicians offices to be able to clinically, operationally, and managerially respond to illnesses that mirror the symptoms of known illnesses, but may be more virulent new organisms or hybrids of existing organisms. If the face of bioterrorism is subtle and slow in its presentation, physicians, in their own offices, could be the first providers of care. Will they be prepared, or will they be among the first fatalities in a bioterrorist attack?

This article explains how joint agency services for children with special needs have been operating in Devon for a number of years. The business processes and ICT systems underpinning the service are described and specific key worker services are explained. The Fair Access to Carers' Breaks model explains how Devon has allocated financial resources to meet individual users' needs. This will be relevant to any authority looking for a transparent means of distributing equitably financial resources such as the additional resources provided by Aiming High for Disabled Children. The article goes on to describe how child and adolescent mental health services were added to the joint agency service and how the choice and partnership approach (CAPA) has virtually removed the waiting list for this service in Devon. The article then describes how further integration of services will be achieved by establishing early response and further response services which will include the Public Health Nursing Service and Education staff.

Presents an exploratory study of principals’ (n = 104) experience, meaning, and learning and development in the contexts of pre‐service, preparation, and over the career span using qualitative methods of in‐depth interview and narrative analysis. Reports that the nature and quality of experiences in pre‐service influenced interpretations of experiences in preparation and practice and, similarly, the meaning of experiences in practice were influenced by experiences in preparation. Also reveals that striking contrasts emerged in the interpretations of experience by principals who were prepared in traditional and non‐traditional programmes. Concludes that the meaning of building human capacity through involvement, opportunity, participation, and advocacy was particularly consistent across the career span.

This chapter explores correspondences between the costs and benefits of financial and circus safety nets. The author stresses the idea that the character of a country's net cannot be static. It must adapt promptly to changes in the market, legal, bureaucratic, and ethical problems it is intended to alleviate.

Safety nets expand over time for two reasons. First, large firms whose operations lie formally outside the net have strong incentives to make themselves too difficult for authorities to fail and unwind in crisis circumstances. Second, in good times, safety-net managers underinvest in crisis planning. As a result, crisis-generated changes in the ordering of regulatory norms dispose them to rescue firms that are difficult to fail and unwind without holding themselves closely accountable for either the costs or the distributional effects of the subsidies the rescue engenders.

Specialist physicians, specialist nurses and personnel in the intensive care unit (ICU) work to treat patients. Compared with other hospital units, ICUs are full-fledged and provide 24-h services. However, patients are admitted to this unit because of conditions such as severe trauma, organ failure or dysfunction and poisoning. The life expectancy of such patients is considerably low.

This study developed a reduced rule-based expert system to determine life expectancy. The purpose of this study is to determine the life expectancy of patients using ten variables. The rules were determined by evaluating 210 = 1,024 results. These rules were minimized using Boolean rules for simplification.

Conclusions were drawn by evaluating the minimized cases rather than evaluating 1,024 different cases. ICU patients were evaluated using this method, and the mean success rate was 63.75 per cent.

No rule-based expert system has been designed to determine the death risks of patients in the ICU.