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Although adverse events are less studied in the prehospital setting, the evidence is beginning to paint an alarming picture. Consequently, improvements in Emergency Medical Services (EMS) demand a paradigm shift regarding the way care is conceptualized. The chapter aims to (1) support the dialogue on near-misses and adverse events as a learning opportunity and (2) to provide insights on applications of multiteam systems (MTSs).

To offer discussion on near-misses and adverse events and knowledge on how MTSs are applicable to emergency medical care, we review and dissect a complex patient case.

Throughout this case discussion, we uncover seven pertinent issues specific to this particular MTS: (1) misunderstanding with number of patients and their locations, (2a) lack of context to build a mental model, (2b) no time or resources to think, (3) expertise-facilitated diagnosis, (4) lack of communication contributing to a medication error, (5) treatment plan selection, (6) extended time on scene, and (7) organizational culture impacting treatment plan decisions.

By dissecting a patient case within the prehospital setting, we can highlight the value in engaging in dialogue regarding near-misses and adverse events. Further, we can demonstrate the need to expand the focus from simply teams to MTSs.

The purpose of this paper is to explore the workload and shared workload awareness in a staff performing command and control (C2) work during a planned major incident (MI) empirical case in Sweden.

Data on workload and shared awareness were collected during live C2-work using qualitative observations and in-situ interviews mixed with quantitative questionnaires.

A content analysis of the qualitative data revealed categories of workload sources. Quantified workload estimates showed changes in workload levels over time and staff roles, which were also contextualized using the results of the qualitative data. Data on shared awareness indicated that team workload awareness shifted over time according to common patterns. This study demonstrates a promising methodology to study C2-related factors during live EMS work.

The observed variations in workload imply that research that relies only on post-task measurements of workload may be inaccurate. Future research could use this method to investigate the connection between workload and performance during different types of MIs.

The results can be used to inform future Göteborgsvarvet C2-teams in terms of when, why, and for whom task load changes, which would support predictive allocation of resources.

Simple Triage and Rapid Treatment (START) is a unique triage system used by prehospital providers during disasters to quickly categorize and prioritize patient care according to severity. This study aims at evaluating knowledge about the START triage system among field emergency medical service (EMS) personnel working at the Saudi Red Crescent Authority (SRCA) in the stations of the city of Riyadh.

This is a cross-sectional study that examined data collected from August 2019 to January 2020. The statistical population is from all field EMS personnel working in the SRCA located in Riyadh, Saudi Arabia. Using simple random sampling, 239 field EMS personnel were assessed, and 235 completed the study (98.3% response rate). Data were collected electronically using demographics and 15 multiple choice emergency scenarios based on the START protocol.

The mean correct score is 8.21 ± 3.36 out of 15 questions of triage knowledge (score of 0–15 points), indicating that those respondents have moderate knowledge levels on the START triage tool. Physicians and paramedics have higher mean scores (10.13 ± 3.42 and 9.07 ± 3.22, respectively), which are significantly higher than emergency medical technicians and nurses (7.25 ± 3.15 and 5.63 ± 2.72, respectively; p < 0.05). The providers who attended the training course had higher mean scores (p < 0.05).

Based on the results of the study, field EMS personnel did not reflect full knowledge of START triage tool. An interdisciplinary approach that adopts reinforcement education and periodical training courses is highly recommended to improve the respondents' performance and productivity. Moreover, there was a noticeable correlation between performance of respondents on the one hand and their education levels and prior training on the other hand.

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.

As a human right, people need to arrive early at the hospitals when they are injured in traffic accidents. Both the mean and equality of the time of arriving at the hospital are important. This study aimed to investigate inequality in arrival time of emergent traffic accident patients to the hospital in 2018–2019 in a city in the North of Iran.

The authors extracted the data from the Guilan province trauma system databank in Poursina Hospital in Rasht in 2018 and 2019. The Gini coefficient was used to calculate inequality, and a regression model was estimated for determining the reason for inequality in time to receive hospital services.

The study showed that patients’ arrival time from the time of the accident to the time of arrival to the hospital was 64.48 ± 47.63 min (minimum of 9 min and maximum 462 min). Gini coefficient was 0.31 (p <0.001), which does not show high inequality. Regression results showed that the transfer time of patients by car was 40 min longer (p-value <0.001) than ambulances (p = 0.036). In children, the transfer time was 42 min less (p = 0.003). Other variables did not explain the inequality (p > 0.05).

According to the time of arrival of patients and Gini index, in Rasht, inequality in providing services is not in a bad condition. This indicates that the emergency department does not systematically transport people to the hospital late.

Epidemics and pandemics can result in sudden morbidity and mortality as well as social and economic disruption. However, the humanitarian logistics and supply chain management (HLSCM) field has been mostly focusing on life saving operations after natural disasters such as earthquakes and hurricanes. There is no research within the HLSCM literature neither on the unique properties of vulnerable groups, nor their underlying risk factors or how to mitigate them. The COVID-19 pandemic highlighted the uniqueness of some vulnerable groups and motivated us to conduct a structured literature review to identify research needs in HLSCM with regards to vulnerable populations.

The authors conduct a systematic review of literature on the intersection of epidemics/pandemics, humanitarian operations and vulnerable populations. They utilize the Scopus database to search for peer-reviewed journal articles published in English. Our search results in 366 articles which we reduced to 139 after filtering.

There is no research within the HLSCM literature on the unique properties of various vulnerable populations. The authors show that HLSCM scholars can contribute to literature by investigating operational and logistical challenges of serving vulnerable populations through multi-disciplinary research, research on the intersection of public health and supply chain management, research on the intersection of ethics and operations management, and research on cross-sectoral partnerships.

The authors’ work is limited to peer-reviewed journal articles published in English. They did not include books, conference proceedings and think-tank or NGO reports. However, the authors do recognize that these sources can be very valuable.

To best of authors’ knowledge, this is the first study to review the literature on vulnerable populations under the threat of epidemics and pandemics.

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 COVID-19 pandemic, and the responses to it that were required from frontline healthcare providers and others working in healthcare settings including environmental, clerical, and security staff, has challenged our healthcare systems in unprecedented ways. The threats to the financial, physical, and psychological well-being of healthcare professionals – many of whom entered the field due at least in part to a deep commitment to caring for and helping others – will have profound and long-lasting personal and professional impacts. Early in the pandemic response, healthcare professionals knew little about the risks they, their patients, and their loved ones faced from COVID-19 as they operated under crisis standards of care and without adequate supplies of personal protective equipment. As the pandemic response progressed, the lack of clear, science-based guidance, and the politicization of the pandemic presented new medical, ethical, and moral dilemmas. New psychological support mechanisms, including crisis counseling and evidence-based interventions, are needed for all workers in healthcare settings, regardless of their job role.

The purpose of this study was from a Swedish perspective to map experts' opinions on theoretical statements of essential collaboration activities for management of mining injury incidents.

A Delphi technique was performed, asking opinions from experts in iterative rounds to generate understanding and form consensus on group opinion around multi-agency management. The experts were personnel from emergency medical service, rescue service and mine industry, all with operative command positions.

Three iterative rounds were performed. The first round was conducted as a workshop to collect opinions about the most important multi-agency collaboration activities to optimize victim's outcome from an injury incident in an underground mine. This resulted in 63 statements and additional three were added during the second round. The statements were divided into one trajectory and seventh time phases and comprised, e.g. early alarm routines, support of early life-saving interventions, relevant resources and equipment for the assignment and command and control center and functions with predefined action plans for response. It also comprised shared and communicated decisions about each agency's responsibility and safety. All statements reached consensus among the experts in Round 3.

The experts included in this study seem to be adequate but there could be other experts and different statements that other researchers might consider.

These statements could be used to evaluate collaboration in major incidents exercises. The statements can also be quality indicators for reporting results from multi-agency management.

This paper contributes to the research field of collaboration and joint practices between and among personnel involved in rescue operations.

Ambulance personnel face a diversity of stressful events that could be potentially traumatic, putting their health and well-being at risk. The purpose of this paper is to explore, from this group perspective, sources of stress, coping strategies and support measures.

The authors interviewed 14 ambulance workers of Portuguese Red Cross local structures from the north of Portugal. Data were analyzed according to thematic analysis procedures.

The authors identified three themes: operational and organizational factors, control and predictability; anticipating scenarios, focusing on procedures and dealing with reactions; and from undervalued support to support as routine. Dealing with human lives, the unpredictability of calls and working under pressure are the main sources of stress, causing, in some of them, insomnia, fatigue, anxiety and intrusive thoughts. Road accidents, situations involving children and cardiac arrest are the most distressing events. During events, they cope focusing on technical procedures, but after them they prefer to talk with colleagues and seek support from family and friends. All participants emphasize the inexistence of structured support measures.

It is important to develop support measures tailored to ambulance personnel’s needs, leading to enhancements of theirs work performance, health and well-being.

Contrarily to most of the studies that explore mostly PTSD and/or burnout, the authors explored, from the perspective of professionals, other dimensions such as sources of stress, coping strategies and support measures, adopting a qualitative approach, which has been rarely used.