Formal Emergency Research Articles

Preferences for coordinated care for rare diseases: discrete choice experiment

BackgroundEvidence suggests that coordination of care for people affected by rare diseases is poor. In order to improve the way that care is coordinated it is necessary to understand the preferences of people affected by these conditions, and providers. The aim of this study was to examine patient, parent and carer, and health care professional preferences for different attributes of care coordination for people affected by rare diseases. We conducted a discrete choice experiment using online surveys. There were no restrictions on participants in terms of rare conditions, demographic factors other than age, or geographical location within the UK. Choice scenarios were based on the following attributes: annual cost of attending appointments; access to health records; access to clinical expertise; support of a care coordinator; access to a specialist centre; and, the existence of a documented plan for emergency care. Data were analysed using alternative-specific conditional logit regression models.ResultsValid responses were obtained from 996 individuals (528 patients, 280 carers, 188 health care professionals) between August and December 2019. All attributes significantly influenced the type of service respondents preferred. Patients, carers and health professionals’ preferences for care coordination were influenced by: the cost of attending appointments; access to health records; clinical expertise; role of care coordinators; access to specialist centres; and the existence of plan for emergency care. There were no statistically significant differences in the preferences between patients and carers. Preferences of health professionals differed to those of patients and carers. Both patients and carers selected responses which granted them a greater degree of autonomy in relation to the role of care coordinators, whereas health professionals preferred services where care coordinators had more autonomy. Health care professionals also expressed a stronger preference for a documented formal emergency plan to be in place.ConclusionsThe findings highlight that people value better coordinated care, in line with policy documents emphasising commitments to coordinated care for people affected by rare diseases. This study highlights the factors that could be included in service provision as ways of improving the coordination of care for people affected by rare diseases.

Reflections and contributions to the debate on the origin of the discipline of International Relations

The purpose of this paper is to contribute some ideas to the debate on the origin of the International Relations discipline. The argumentative line of the essay is that, due to the enormous impact of the First World War, the discipline of International Relations emerged formally, independently, and with its own identity, starting in 1919. In this sense, the essay states that the revisionists have not taken into account, with the necessary depth, the effect that this conflict had on establishing that date as the official appearance of this discipline. The text is divided into four parts. The first seeks to clarify the difference between the terms international relations and International Relations. The second part discusses the first studies linked to global affairs before 1919. The third part discusses the formal emergence of the discipline. The last section of the text explains the development and consolidation of the discipline after the Second World War.

Formal and informal hospital emergency management practices: managing for safety and performance amid crisis.

Although formal preparedness for unexpected crises has long been a concern of health care policy and delivery, many hospitals struggled to manage staff and equipment shortages, precarious finances, and supply chain disruptions among other difficulties during the Coronavirus disease pandemic. Our purpose was to analyze how hospitals used formal and informal emergency management practices to maintain safe and high-quality care while responding to crisis. We conducted a qualitative study based on 26 interviews with hospital leaders and emergency managers from 12 US hospitals, purposively sampled to vary along geographic location, urban/rural delineation, size, resource availability, system membership, teaching status, and performance levels among other characteristics. In order to manage staff, space, supplies, and system- related challenges, hospitals engaged formal and informal practices around planning, teaming, and exchanging resources and information. Relying solely only on formal or informal practices proved inadequate, especially when prespecified plans, the incident command structure, and existing contracts and communication platforms failed to support resilient response. We identified emergent capabilities-imaginative planning, recombinant teaming, and transformational exchange-through which hospitals achieved harmonious interplay between the formal and informal practices of emergency management that supported safe care and resilience amid crisis. Managing emergent challenges for and amid crisis calls for health care delivery organizations to engage creative planning processes, enable motivated workers with diverse skill sets to team up, and establish rich inter- and intra-organizational partnerships that support vital exchange.

Bibliometric and literature synthesis on assisted natural regeneration: an evidence base for forest and landscape restoration in the tropics

Assisted Natural Regeneration (ANR) is a set of restoration strategies and interventions primarily based on natural regeneration, aimed at accelerating succession and providing multiple benefits in degraded ecosystems and landscapes. These strategies have the potential to significantly contribute to global Forest and Landscape Restoration efforts. However, ANR faces challenges due to limited recognition, support, and formal integration into relevant sectors and restoration policies, particularly in tropical regions. The dearth of evidence-based syntheses further compounds these challenges. To address this gap, a bibliometric analysis of selected scientific publications on ANR (n = 208) from 1987 to 2023 was conducted, using Web of Science and Google Scholar databases. A systematic review was undertaken, using a subset of original research articles (n = 44), to synthesize published data on interventions, contexts, costs, and benefits of ANR and to identify major knowledge gaps. Analysis of bibliometric metadata revealed an increasing annual output of ANR publications in over 80 journals, encompassing various document types and authors from over 40 countries. Despite ANR’s formal emergence in the Philippines, Brazil has taken the lead in both its research and implementation, and international collaboration in ANR research has grown. While ANR research focused mostly on ecosystem services and ecological outcomes, social aspects have been poorly studied. Diverse ANR interventions align not only with ecological restoration but also with integrated land management, biodiversity conservation, forest and landscape restoration, and forest management. The cost-effectiveness of ANR implementation, especially in restoration for carbon storage, exhibited considerable variability when compared to active tree planting, and varied with intervention types, time, land use history, and long-term costs. This synthesis provides critical insights and evidence to enhance the effective integration of ANR into restoration and reforestation programs and policies.

The emergency burden in low and middle-income countries

Injuries are the greatest single cause of surgical disease globally, disproportionately affecting low and middle-income countries and representing 10% of global mortality and 32% greater annual mortality than HIV/AIDS, tuberculosis, and malaria combined. Road traffic injuries are the single greatest contributor to the global injury burden and the leading cause of death for young people aged 5 to 29 years. In May 2023, the 76th World Health Assembly resolved that emergency, critical, and operative care services are an integral part of a comprehensive national primary health care approach and foundational for health systems to effectively address emergencies. However, robust trauma systems and emergency medical services are lacking in low and middle-income countries to adequately address the prehospital injury burden in systematic and financially sustainable approaches, despite the disproportionate burden faced. Replicating formal Tier 2 emergency medical services (staffed by professional emergency responders within well-defined jurisdictions using dedicated vehicles and equipment) from high-income countries has failed, and the World Health Organization recommends Tier 1 systems (community bystander-driven prehospital care by provided by lay first responders) as the first step toward formal emergency medical services in these same settings. The Global Prehospital Consortium has identified 7 priority areas as a framework for future emergency medical services development, forming the basis for the remaining articles in this series, spanning infrastructure and operations, communication, education/training, impact evaluation, financing, governance/legal, and transportation/equipment.

Two decades of bibliometric exploration on leadership in disaster management

Leadership plays a vital role in empowering communities to reduce disaster risks, yet there is limited information on this topic. This study presents a bibliometric analysis concentrated on leadership in disaster management, specifically addressing natural hazards. Utilizing the Scopus database, a total of 152 documents published between 1999 and 2023 were identified. The growth in publications annually has shown an upward trend, particularly since 2012. The International Journal of Disaster Risk Reduction emerged as the primary source. Yet, the most impactful documents in terms of citations predominantly originate from non-disaster-related journals. There remains a notable imbalance in contributions from authors across countries, with the United States of America and Australia exerting significant influence in both document quantity and citation count. Keyword analysis revealed various disasters as pivotal moments driving scholarly advancements, notably Hurricane Katrina in 2005. The role of leadership is not limited to formal institutions and emergency responses but can extend to various actors and sectors in all stages of disaster management. Ultimately, this bibliometric study sheds light on the progression and emerging focal points within the research landscape of leadership in disaster management.

Emergency medical dispatch technologies: Addressing communication challenges and coordinating emergency response in low and middle-income countries

A majority of emergency response in low and middle-income countries (LMICs) without formal emergency medical services (EMS) rely on uncoordinated layperson first responders (LFRs) to respond to emergencies using readily available mobile phones and private transport. Although formally trained LFRs are an important foundation for nascent emergency medical services (EMS) development, without coordination by standardized emergency medical dispatch (EMD) systems, LFR response is limited to witnessed emergencies, which provides significant but incomplete coverage. After training and equipping LFRs, EMD implementation using telecommunications technologies is the next step in formal EMS development and is essential to coordinate response, given the impact of timely prehospital response, intervention, and transportation on reducing morbidity/mortality. In this paper, we describe the current state of dispatch technologies used for emergency response in LMICs, focusing on the role of communication technologies, current approaches, and challenges in communication, and offer potential strategies for future development.

Future directions for emergency medical services development in low- and middle-income countries

The lack of prehospital care access in low- and middle-income countries is one of the greatest unmet needs and, therefore, one of the most urgent priorities in global health. Establishing emergency medical services in low- and middle-income countries poses significant challenges and complexities, requiring solutions tailored to prevailing conditions, informed by needs assessments, and adapted to meet local demands in a culturally appropriate and sustainable manner. In areas without existing emergency medical services, patients must rely on informal networks of untrained bystanders and community members to provide first aid and transport to definitive care. Since 2005, training lay first responders has been recommended by the World Health Organization as the first step toward formal emergency medical services development. However, efforts to formalize lay first responders networks have not expanded with the increasing need for prehospital emergency care in low- and middle-income countries, despite their potential. The rapid expansion of communication technologies like mobile smartphones penetrating resource-limited settings offers effective and inexpensive options for dispatching and coordinating lay first responders that were not previously available. These technologies can also be used for more advanced emergency medical services, obviating expensive communications and dispatch infrastructure. Despite disproportionately bearing the global injury burden, lay first responders frequently lack accurate and comprehensive surveillance data secondary to widespread underreporting, especially for non-fatal events. Lay first responders expand surveillance, which may inform future targeted prevention efforts, assisting in the development of tailored countermeasures suited to local hazards and diseases. Emergency medical services development in low- and middle-income countries involves a strategic approach focused on understanding the unique needs of diverse communities, requiring broad stakeholder involvement to create a sense of ownership to maintain volunteer networks and enhance sustainability. By embracing these relatively low-cost, bottom-up strategies, low- and middle-income countries can develop more accessible, efficient, and community-oriented emergency medical systems, ultimately improving public health outcomes and averting preventable deaths to address the emergency burden.

Leveraging transportation providers to deploy lay first responder (LFR) programs in three sub-Saharan African countries without formal emergency medical services: Evaluating longitudinal impact and cost-effectiveness

IntroductionIn 2019, the World Health Assembly declared emergency care essential to achieve the 2030 Sustainable Development Goals. Few sub-Saharan African (SSA) countries have developed robust approaches to sustainably deliver emergency medical services (EMS) at scale, as high-income country models are financially impractical. Innovative reassessment of EMS delivery in resource-limited settings is necessary as timely emergency care access can substantially reduce mortality. Materials and methodsWe developed the Lay First Responder (LFR) program by training 1,291 pre-existing motorcycle taxi drivers, a predominant form of short-distance transport in sub-Saharan Africa, to provide trauma care and transport for road traffic injuries. Three pilot programs were launched in staggered fashion between 2016 and 2019 in West, Central, and East Africa and a 5.5 h curriculum was iteratively developed to train first responders. Longitudinal data on patient impact (patient demographics, injury characteristics, and treatment rendered), emergency care knowledge acquisition/retention, and social/financial effects of LFR training were collected and pooled across three sites for collective analysis. Novel cost-effectiveness ratios were calculated based on prospective cost data from each site. Previously projected aggregate disability-adjusted life years (DALYs) addressable by LFRs were used to inform cost-effectiveness ratios($USD cost per DALY averted). Cost-effectiveness ratios were then compared against African per capita gross domestic product (GDP), following WHOCHOICE guidelines, which state ratios less than GDP per capita are "very cost-effective." ResultsIn 2,171 total patient encounters across all three pilot sites, LFRs most frequently provided hemorrhage control in 61 % of patient encounters and patient transport by motorcycle in 98.5 %. Median pre-/post-test scores improved by 34.1 percentage points (39.5% vs.73.6 %, p < 0.0001) with significant knowledge retention at six months. 75 % of initial participants remain voluntarily involved 3 years post-course, reporting increased local stature and customer acquisition(income 32.0 % greater than non-trained counterparts). Locally sourced first-aid materials cost $6.54USD/participant. Cost-effectiveness analysis demonstrated cost per DALY averted=$51.65USD. ConclusionLFR training is highly cost-effective according to WHOCHOICE guidelines and expands emergency care access. The LFR program may be an alternative approach to formal ambulance-reliant EMS that are cost-prohibitive in resource-limited, sub-Saharan African settings. A novel social/financial mechanism appears to incentivize long-term voluntary LFR involvement, which may sustain programs in resource-limited settings.

Testing for SARS-CoV-2: lessons learned and current use cases.

SUMMARYThe emergence and worldwide dissemination of SARS-CoV-2 required both urgent development of new diagnostic tests and expansion of diagnostic testing capacity on an unprecedented scale. The rapid evolution of technologies that allowed testing to move out of traditional laboratories and into point-of-care testing centers and the home transformed the diagnostic landscape. Four years later, with the end of the formal public health emergency but continued global circulation of the virus, it is important to take a fresh look at available SARS-CoV-2 testing technologies and consider how they should be used going forward. This review considers current use case scenarios for SARS-CoV-2 antigen, nucleic acid amplification, and immunologic tests, incorporating the latest evidence for analytical/clinical performance characteristics and advantages/limitations for each test type to inform current debates about how tests should or should not be used.

Where's the theory contribution? An answer in four parts

The requirement for a theory contribution in empirical papers causes consternation among some and confusion among many. We address this issue by articulating alternative approaches to theory that include formal modeling, paradigm elaboration, problem solving, and theory emergence from observations. Knowledge about these different approaches will, we believe, help ameliorate disagreement and incomprehension across the research tribes that dominate social science and business school research. Each approach requires different assumptions about truth and the representation of reality. We outline each approach, provide examples, and a short critique. We suggest that what may seem mundane to the critical realist may be eye-opening to the pragmatist who directs attention to practitioners. For the scholar immersed within the walls of a paradigm, a set of stylized facts may challenge and inspire. The secret to innovative theory contributions is to synthesize ideas from the different tribes to use within your own focused research program.

The “we” factor in improvisational statecraft: frontline repair of the state in Indonesia’s crisis response amidst resource constraints

Street-level bureaucrats, confined by meager discretion, often find themselves reconciling the challenging terrain of inflexible policies with messy frontline realities. With a phenomenological lens, we examine how Indonesia’s frontline healthcare workers exercise discretion and improvise informal practices to adapt policies and deliver care despite scarce resources during the COVID-19 crisis. As formal emergency protocols lie encumbered under conditions of austerity, a grassroots motivation for communal action occurs from exchanges between peers mired in resource quandaries, encapsulating an improvisational “we” cohering frontline allies. Manifesting through focused responses drawing on unwritten collegial knowledge, these collaborative efforts embody the relational essence and defining contours of frontline policy repair, as opposed to isolated discretion. Probing further into these repair processes surfaces how shared struggles have the power to ignite collective capacity, empowering bureaucrats to govern complexity in concert, construct agency despite constraints, and promote equity in times of scarcity. Our findings champion tending to institutional receptivity and solidarity-anchored creative frontline initiatives, endorsing agile, adaptive processes finely tuned to situational realities that contests paradigms fixated solely on compliance.

Comparative epidemiology and outcomes among trauma patients transported by private and formal pre-hospital care modes in Kigali, Rwanda

INTRODUCTION: The burden of injuries is high in low- and middle-income countries where pre-hospital systems are being developed to improve acute injury care. This study compares the characteristics and outcomes between trauma patients transported by formal emergency medical services (EMS) and by private transport to the emergency department (ED) of the Centre Hospitalier Universitaire de Kigali (CHUK) in Rwanda.&#x0D; METHODS: This retrospective cohort study analyzed a random sample of trauma patients presenting between 1 August 2015 and 30 July 2016. Descriptive analyses were performed, and differences in outcomes were assessed based on transport modalities via Pearson Chi-Squared or Fisher’s Exact tests.&#x0D; RESULTS: Of the 556 trauma patients analyzed, 87.1% were transported by private transport and the remainder by EMS. The median inpatient length of stay for private transport patients was 7 days (IQR:3-16 days), compared to 9.5 days for EMS patients (IQR:4-18 days) (p=0.301). More EMS-transported patients died in the ED (p=0.005), and more were admitted to the hospital. There was a higher mortality rate among patients admitted to the hospital who arrived by private transport, but the difference was not statistically significant.&#x0D; CONCLUSION: The higher ED death rate among EMS-transported patients and the higher in-hospital death rate among private transport patients suggest that major differences in the two groups may or may not be related to how trauma patients are brought to the ED.

The 1 + 1 = 1 and 1 + 1 = 3 Integration Formulas in Mixed Methods Research: A Poem Promoting Peaceful and Productive Co-Existence

In their editorial published in the International Journal of Multiple Research Approaches, Archibald and Onwuegbuzie (2020) called for the inclusion of poetic representation in mixed methods research. With this in mind, in this editorial, I provide a poetic representation that synthesizes my thoughts regarding the recent formal emergence of two integration formulas, namely, the 1 + 1 = 3 integration approach (Fetters &amp; Freshwater, 2015) and the 1 + 1 = 1 integration approach (Onwuegbuzie, 2017; Onwuegbuzie &amp; Hitchcock, 2019). In this editorial, I present only a poem, with no further commentary, in order to ensure that this poem takes center stage. This poem represents an integration of found poetry (Prendergast, 2006) and research poetry (Faulkner, 2009). Found poetry involves the creation of poems by selecting and (re-)arranging existing text from research works, emphasizing themes or ideas present in the source text in order to create new meaning. In contrast, research poetry involves integrating academic research and scholarly content into poetic compositions in order to present the concept of integration in mixed methods research in a creative, accessible, understandable, and engaging manner through poetry. This poem, which also can be classified as a literature-voiced poem (i.e., stemming from literature; Prendergast, 2009), represents a quatrain (Chisholm, 2014)—specifically, a poem with four-line stanzas that involve a traditional rhyme wherein the end of every pair of lines within each stanza rhymes (i.e., an AABB rhyme scheme, wherein each letter indicates which lines rhyme). These stanzas do not have a common metric, with the number of feet per line varying—hopefully, yielding what Lahman et al. (2011) referred to as “good enough research poetry” (p. 894) that is characteristic of novice research poets like me. I hope you find the research poem meaningful.

The Impact of Volunteerism on Community Resilience in Disaster Management

This research investigates the indispensable role of volunteers in disaster management and their profound impact on communities grappling with the aftermath of natural disasters. The study comprehensively explores the motivations that propel volunteers into action, their effectiveness in disaster response, and the far-reaching consequences of their involvement. The primary motivation of volunteers is revealed to be altruism, accompanied by a strong sense of duty and personal experience with disasters. Their effectiveness in disaster management is evident in their rapid response times and versatile contributions, complementing formal emergency services. Importantly, the impact of volunteers extends beyond immediate relief efforts, fostering heightened community resilience, accelerated economic recovery, improved psychological well-being among survivors, and community empowerment. The research also highlights the need for nuanced investigations into the psychological well-being of volunteers, the influence of cultural contexts on volunteer motivations, and ethical considerations within the framework of disaster volunteering. This study underscores the transformative potential of volunteers in disaster management and calls for policies and practices that recognize, empower, and support these altruistic individuals. By fostering a culture of volunteerism and enhancing disaster preparedness, response, and recovery efforts, communities can become more resilient and better equipped to navigate the challenges posed by natural disasters.

Cooperativism as a solution or as an obligation? The formation of cooperatives in small-scale mining in Brazil

The Brazilian state, through the 1988 Federal Constitution, the 1999 Mining Permit Law, and the 2008. Garimpeiro Statute, endorsed the cooperative organizational model as a priority for organizing mineral activity in artisanal and small-scale mining (ASM) in the country. Brazil's policymakers understood that the cooperative model could more efficiently reduce the sector's informality and promote cooperation. Against this backdrop, this paper seeks to problematize whether the formalization of cooperatives alone can solve many of the governance problems associated with ASM, as well as offer useful insights into the mechanisms by which cooperatives are constituted. This discussion brought up the question of how mineral cooperatives in Brazil function and whether the way they are constituted influences their ability to organize work and how they function. In order to empirically analyze this question, the research delimited the cooperatives in the state of Minas Gerais, in the southeastern region of the country, as the universe of analysis. Fourteen mineral cooperatives were identified. Data collection was carried out by means of on-site interviews and analysis of the founding by-laws and minutes of incorporation of these organizations. Interviews were also held with agents of the local government. The results presented point out that the formation of cooperatives in Minas Gerais is more linked to external demand and to pressure from the environment than to the endogenous motivation of a group. The cooperatives that were created by the workers' initiative tend to follow the principles of cooperativism in an endogenous way. On the other hand, the cooperatives that were created due to the requirements of regulatory agencies have great difficulties assimilating the cooperative model. Finally, we conclude that the pressure for the formalization of cooperatives was not accompanied by the structuring of public policies that support social organization and collective action, thus motivating the merely formal emergence of cooperatives.

Ukraine as the Hub of Postimperial Formalism. Ukrainness, Revolutionary Populism, and the Theory of Poetical Language ‘in’ Russia and ‘in’ Poland

AbstractThe notion of ‘postimperial formalism’ accounts of the interconnectedness of Russian, Ukrainian, and Polish variants of formalism, whose distinctive character is contingent on the dialectics of liberation and subjugation (or autonomy and heteronomy) operating in the multinational entity of the Russian empire. Specifically, the theory of poetic language – the pars pro toto of early literary theory – carries with itself the survivals of the conditions of the multinational empire. This is most eloquently expressed in the writings of Polish and Jewish-Ukrainian populist activists turned ethnographic researchers, who prepared a theory of poetic language to which the formalists could have recourse. I first map the dimensions of the Ukrainian investment into the formulation of the theory of poetic language. Secondly, I describe the role of the constructed Ukrainness – under the guise of the so-called Ukrainian school of Polish romanticism – in the emergence of Polish formalism.

Using Novel Technologies to Implement Belize's First Formal Prehospital Emergency System

Introduction:Belize has no formal prehospital emergency medical system, leaving the majority of acutely sick and injured persons overwhelmingly dependent on private transport. To address this issue, a collaboration of public and non-profit partners worked with the Belize National Fire Service to implement the country's first formal prehospital emergency medical service using novel communications technologies. With new resources and vehicles already donated to the fire service, the collaboration focused specifically on the communications component of the response system, specifically to improve the handling of incoming requests for emergency assistance from the public, as well as to improve the process of dispatching prehospital personnel using readily-available mobile technologies.Method:Working with the Belize National Fire Service, program partners implemented the country's first emergency communications center, trained new dispatchers, field-tested the dispatch technology through intensive training sessions, and launched the system in the capital district of Cayo.Results:Launched in June 2022, the program has thus far achieved the following outcomes: Active Dispatchers: 26Active Responders: 104Emergencies Dispatched: 156Average Scene Response Time: 7m45sConclusion:Over the past year, partner NGOs Trek Medics and Empact Northwest have worked collaboratively to implement a first-ever centralized emergency dispatch system for the Belize National Fire Service, using a novel cloud-based dispatch software running on readily-available mobile phones and mobile. In addition to drastic improvements in response performance, satisfaction among system managers and response personnel is high, with plans currently underway to scale the program nationally.

Emergency care in post-conflict settings: a systematic literature review

BackgroundEmergency care systems (ECS) organize and provide access to life-saving care both during transport and at health facilities. Not enough is known about ECS in uncertain contexts such as post-conflict settings. This review aims to systematically identify and summarize the published evidence on the delivery of emergency care in post-conflict settings and to guide health sector planning.MethodsWe searched five databases (PubMed MEDLINE, Web of Science, Embase, Scopus, and Cochrane) in September 2021 to identify relevant articles on ECS in post-conflict settings. Included studies (1) described a context that is post-conflict, conflict-affected, or was impacted by war or crisis; (2) examined the delivery of an emergency care system function; (3) were available in English, Spanish, or French; and (4) were published between 1 and 2000 and 9 September 2021. Data were extracted and mapped using the essential system functions identified in the World Health Organization (WHO) ECS Framework to capture findings on essential emergency care functions at the scene of injury or illness, during transport, and through to the emergency unit and early inpatient care.ResultsWe identified studies that describe the unique burden of disease and challenges in delivering to the populations in these states, pointing to particular gaps in prehospital care delivery (both during scene response and during transport). Common barriers include poor infrastructure, lingering social distrust, scarce formal emergency care training, and lack of resources and supplies.ConclusionTo our knowledge, this is the first study to systematically identify the evidence on ECS in fragile and conflict-affected settings. Aligning ECS with existing global health priorities would ensure access to these critical life-saving interventions, yet there is concern over the lack of investments in frontline emergency care. An understanding of the state of ECS in post-conflict settings is emerging, although current evidence related to best practices and interventions is extremely limited. Careful attention should be paid to addressing the common barriers and context-relevant priorities in ECS, such as strengthening prehospital care delivery, triage, and referral systems and training the health workforce in emergency care principles.

We Are Still Here: Living with HIV in the UK

ABSTRACT In this article we highlight a number of the ongoing challenges faced by people living with HIV in the UK today (2021). Based on in-depth interviews with 23 respondents drawn from a range of ages, backgrounds and walks of life, we offer an insight into deeply personal experiences of what it means to have HIV. We demonstrate the degree to which, 40 years on from the formal emergence of the HIV pandemic, stigma and related structural violence remain both extremely present and extraordinarily debilitating. In essence, social responses to HIV remain mired in a past age.