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The purpose of this study/paper is to identify the importance of the partnership between the public and private health-care institutions to improve interhospital patient transfers. Scientific research and statistical data show the increased number of interhospital transportation services; therefore, timely and qualified patient transportation between different health-care institutions must be considered, the activity that directly and significantly impacts the patient’s health status and overall quality of the health-care services. The successful patient transportation from the smaller hospitals to the health-care institutions with advanced intensive care or urgent care units can be enhanced through the partnership between private and public health-care institutions.

The methodology included quantitative method, statistical data analysis and theoretical data generalization. Both primary and secondary data were collected and analyzed during the research. Expert quantification was performed using the survey research method. The survey was conducted in Lithuania. The respondents were selected to be the general managers of the health-care and urgent care institutions, the chief doctors of the reanimation and intensive care department also the chief doctors of the emergency department.

Because of the centralization and regionalization of health-care services, the number of patients transferred between hospitals by the emergency medical services (EMS) and personal health-care institutions has increased. University hospitals are not sufficiently prepared to accept an increasing flow of patients in accordance with the Ministry of Health orders. Not all regional or district hospitals have the right to provide such assistance, which increases transportation time and costs as well as requires additional human resources. The five EMS categories could be used to improve the patient transfer between different levels of health-care institutions. To increase partnership between private and public health-care organizations, incentives should be provided for the development of private health-care organizations, as well as encouraging actions should be taken to increase the demand for private health-care services by Lithuanian patients.

Five EMS categories identified in this paper could be used to ensure a smooth mechanism for the patient transfer between different levels of the personal health-care institutions. The proposed categories should also be used in the pre-stationary emergency phase (for reducing the interhospital patient transportation amount).

Properly organized secondary and tertiary interhospital patient transfers influence the availability and quality of the EMS and reduce inequalities in the provided services and social exclusion.

This paper presents the classification of the interhospital transfer issues, determines the main reasons for the patient interhospital transfer, creates the model for the EMS patient process flows and defines five EMS categories for the assessment of patient conditions. Therefore, the research conducted and the results obtained have both theoretical and social-practical value.

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.

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.

Emergency service departments face changing mission requirements, budget constraints and a demanding work environment. This study examined the perceptions of fire chiefs, officers and firefighters who attended the National Professional Development Symposium on the use of a tiered approach when responding to calls, the continued increase in medical calls and mental health services available to fire service personnel.

This study examined the perceptions of fire chiefs, officers and firefighters who attended the National Professional Development Symposium on the use of a tiered approach when responding to calls, the continued increase in medical calls and mental health services available to fire service personnel.

Survey respondents indicated that they either are currently or would consider using a tiered approach to sending a fire engine and crew or a lighter vehicle to medical or other calls based requirements identified using a tiered approach.

This idea has future implications regarding the vehicle mix of fire stations as administrators seek to meet the needs of the public most effectively. Survey responses also noted the need for mental health services arguing that care seeking firefighters should have the option of getting mental health services within the station or at an external location. Calls involving babies or young children were overwhelming cited as the most difficult. Additionally, 95% of respondents indicated a belief that most firefighters suffer from PTSD.

Recommendations include: A larger scale survey and analysis of first responder perceptions based on this study. Identifying “best practices” of the most effective “tiered response” approaches to deploying emergency services resources to calls. Studying Mental Health services combating PTSD to identify best practices. Lastly, emergency services administrators should consider changes to the “vehicle mix” when equipping or reequipping stations.

Social implications include use of a “tiered response” approach to emergency calls and focusing how best to support the mental health needs of firefighters.

Fire Departments are only beginning to explore the idea of using a tiered response to respond to emergencies. This study identifies both short and long term implications of using a tired approach. A secondary emphasis of this study explores difficult calls and PTSD issues faced by firefighters.

Accident emergency hospital (AEH) services require cohesive, collective, uninterrupted streamlined medical diagnostic and satisfactory patient care. Medical service efficiency in AEHs is difficult to quantify due to the clinical complexity involved in treatment involving various units, patient conditions, changes in contemporary medical practices and technological developments. This paper aims to show how to measure efficiency by eliminating waste in AEH system, identify service failure points, identify benchmark medical services, identify patient throughput time and measure treatment time when AEH services are nonstandard. The applications shown in this paper are distinct in particular; we the authors use nontraditional and systems engineering approach to collect data as the traditional data collection is difficult in real-time AEHs.

The authors show in this study how to measure overall patient treatment time from admission to discharge. Project evaluation and review technique (PERT) captures the inconsistencies involved in measuring treatment time, including measures of variability. The irregular treatment time and complexity involved in the emergency health-care services are usual. The research methodology illustrates how the time function map and service blueprint can improve value-added time in AEHs and benchmark services between similar AEHs.

The inconsistency in treatment time between AEH in public and private hospital is found to be in ratio of 1:20. The private hospital suggests variety of treatments and long stays for recovery. The PERT computations show that the average time a patient remains in a government AEH is about 10 days. The standard deviation of the AEH treatment time is about 0.043 per cent of the expected patient care time. The inconsistency is not significant as compared to the expected value. In 89.64 per cent of the cases, a patient may be discharged in less than 10 days’ time. The patient on average is discharged in 13 days in a private hospital.

The patient treatment time of an AEH is evaluated with PERT project management approach to account for inconsistencies in treatment time. This research makes new contributions in benchmarking AEH throughput time, identify medical service failure points with service blueprint, measure the efficiency with time function map and collect patient data with nontraditional methods. The inherent inconsistencies in a clinical process are identified by PERT analysis with the variance as a characteristic of the treatment time. Improvement of variability implies cost reduction in AEH system.

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.

This paper aims to set out the relationship between business process reengineering (BPR) and data warehouse (DW) and identify the advantages brought by the integration of DW technology in BPR projects.

This paper is primarily based on a case study which was conducted in a Tunisian hospital and allowed some lessons to be learned.

Introducing changes in the field of healthcare services has become a necessity to provide better satisfaction to patients and to offer faster services and of better quality. So, the BPR approach can be applied to introduce these changes and provide better satisfaction to recipients of services, i.e. the hospital patients. This study is based on a case study based on the BPR application for healthcare process in some services of Farhat Hached Hospital in Sousse, Tunisia. This case study has mainly contributed to a proposed DW for healthcare services.

The proposed DW and the new corresponding process have not yet been implemented in the real life of the considered services. The research work in this project allowed the provision of detailed and rational justifications for the information technology introduction in BPR applied in healthcare services and in particular to the implementation of the DW concept. In addition to the detailed justifications, the research paper provided the prerequisite for the success of the project as well as its technical specifications and appropriateness to the specifity to the local setting.

The lessons learned were related in one hand to the particularities of BPR projects using the DW technology and on the other hand to the advantages brought by the DW technologies in the BPR projects. The following questions are considered in this paper: what are the particularities of the BPR projects using the DW technology? What are the main contributions of the DW technology to BPR projects?

In North America, delegated practice “medical direction” models are often used as a proxy for clinical quality and safety in paramedic services. Other developed countries favor a combination of professional regulatory boards and clinical governance frameworks that feature paramedics taking lead clinician roles. The purpose of this paper is to bring together the evidence for medical direction and clinical governance in paramedic services through the prism of paramedic self-regulation.

This narrative synthesis critically examines the long-established North American Emergency Medical Services medical direction model and makes some comparisons with the UK inspired clinical governance approaches that are used to monitor and manage the quality and safety in several other Anglo-American paramedic services. The databases searched were CINAHL and Medline, with Google Scholar used to capture further publications.

Synthesis of the peer-reviewed literature found little high quality evidence supporting the effectiveness of medical direction. The literature on clinical governance within paramedic services described a systems approach with shared responsibility for quality and safety. Contemporary paramedic clinical leadership papers in developed countries focus on paramedic professionalization and the self-regulation of paramedics.

The lack of strong evidence supporting medical direction of the paramedic profession in developed countries challenges the North American model of paramedics practicing as a companion profession to medicine under delegated practice model. This model is inconsistent with the international vision of paramedicine as an autonomous, self-regulated health profession.

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.

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.