Emergency Patient Transport Research Articles

Development and psychometric testing of a scale to measure effective rural emergency transfer (RET)

BackgroundThe process of transferring patients from small rural primary care facilities to referral facilities impacts the quality of care and effectiveness of the referral healthcare system. The study aimed to develop and evaluate the psychometric properties of a scale measuring requirements for effective rural emergency transfer.MethodsAn exploratory sequential design was utilized to develop a scale designed to measure requirements for effective emergency transport. Phase one included a qualitative, interview study with 26 nursing transport providers. These transcripts were coded, and items developed for the proposed scale. Phase two included a content validity review by these 16 transport providers of the domains and items developed. Phase three included development and evaluation of psychometric properties of a scale designed to measure requirements for effective emergency transport. This scale was then tested initially with 84 items and later reduced to a final set of 58 items after completion by 302 transport nurses. The final scale demonstrated three factors (technology & tools; knowledge & skills; and organization). Each factor and the total score reported excellent scale reliability.ResultsThe initial item pool consisted of 84 items, generated, and synthesized from an extensive literature review and the qualitative descriptive study exploring nurses’ experiences in rural emergency patient transportation. A two-round modified Delphi method with experts generated a scale consisting of 58 items. A cross-sectional study design was used with 302 nurses in rural clinics and health in four rural health districts. A categorical principal components analysis identified three components explaining 63.35% of the total variance. The three factors, technology, tools, personal knowledge and skills, and organization, accounted for 27.32%, 18.15 and 17.88% of the total variance, respectively. The reliability of the three factors, as determined by the Categorical Principal Component Analysis (CATPCA)’s default calculation of the Cronbach Alpha, was 0.960, 0.946, and 0.956, respectively. The RET Cronbach alpha was 0.980.ConclusionsThe study offers a three-factor scale to measure the effectiveness of emergency patient transport in rural facilities to better understand and improve care during emergency patient transport.

Experiences of rural nurses with emergency patient transport in a resource limited setting

BackgroundRegistered nurses are primary care providers during most patient transfers from rural areas. Various local conditions and circumstances impact the provision of nursing care prior to and during transportation. These include clinic staffing, uneven access to functioning equipment and other necessary infrastructure across settings, the wide-ranging clinical need for specialty care, and complex social and interpersonal circumstances that play a role in care-seeking and transport decision-making. This study explored the experiences of nurses with emergency patient transport in rural health facilities in Botswana. MethodA qualitative descriptive approach was used using a semi structured interview. Twenty-six registered nurses from four remote, isolated rural health districts in Botswana participated in this study. Purposive convenience sampling technique was employed. ResultsThe ten main themes under transporter were infringement of scope of practice, inadequate knowledge and skills, distressful practice, restriction from making decisions, challenges with staffing, Ineffective facilities clustering, lack of support from the managers, shortage of technology and tools, non-enabling infrastructure, and transport related tasks. Discussion and ConclusionThe perceived ineffective emergency transfer of patients was associated with work system shortfalls. The work system needs to be balanced and consider the requirements of the various stakeholders involved in the processes for optimal performance of patient transport.

Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on Emergency Patients Hospitalized With Cardiocerebrovascular Diseases in Osaka Prefecture, Japan - A Population-Based Study.

Little is known about the transport and outcomes of emergency patients with cardiocerebrovascular diseases in Japan before and during the COVID-19 pandemic. Data were extracted from a population-based registry in Osaka, Japan, from 2019 to 2021. There were almost no differences in the numbers of emergency patients hospitalized with myocardial infarction, stroke, or heart failure or their deaths. However, the number of cases of difficulty obtaining patient acceptance by hospitals increased in 2020 and 2021 compared with 2019. The numbers of emergency patients hospitalized with cardiocerebrovascular diseases and their deaths in Osaka were not affected by the COVID-19 epidemic.

Applying Crew Resource Management tools in Emergency Response Driving and patient transport—Finding consensus through a modified Delphi study

BackgroundEmergency Response Driving (ERD) comprises a significant risk to safety in Emergency Medical Services (EMS). Crew Resource Management (CRM) tools play a major role in securing actions in high-risk procedures. The aim of this study was to find consensus on the important factors to consider when applying CRM tools in ERD and patient transport. MethodsERD experts (n = 50) were recruited for a modified three-round Delphi study. Round 1 was based on previous research. The experts evaluated the items as important, neutral, or not important. The predetermined level of consensus was set at ≥ 80%. Answers given to the open-ended questions were analyzed using inductive content analysis. ResultsPredetermined consensus was reached on 64 of 86 presented items (74.4 %). The mean values of items reaching consensus varied between 3.81 and 4.86 on a five-point Likert scale. The items where consensus was reached were rated as “important” on a trichotomized scale. ConclusionMultiple important factors to consider when applying CRM tools to ERD and patient transport were highlighted. This study provides valuable information to consider regarding EMS safety improvements. Further scientific research is needed to develop comprehensive recommendations.

Prehospital management in trauma patients and the increasing number of helicopter EMS transportations : An epidemiological study of the TraumaRegister DGU®

To compare the prehospital treatment modalities and intervention regimens for major trauma patients with comparable injury patterns between Austria and Germany. This analysis is based on data retrieved from the TraumaRegister DGU®. Data included severely injured trauma patients with an injury severity score (ISS) ≥ 16, an age ≥ 16 years, and who were primarily admitted to an Austrian (n = 4186) or German (n = 41,484) levelI trauma center (TC) from 2008 to 2017. Investigated endpoints included prehospital times and interventions performed until final hospital admission. The cumulative time for transportation from the site of the accident to the hospital did not significantly differ between the countries (62 min in Austria, 65 min in Germany). Overall, 53% of all trauma patients in Austria were transported to the hospital with ahelicopter compared to 37% in Germany (p < 0.001). The rate of intubation was 48% in both countries, the number of chest tubes placed (5.7% Germany, 4.9% Austria), and the frequency of administered catecholamines (13.4% Germany, 12.3% Austria) were comparable (Φ = 0.00). Hemodynamic instability (systolic blood pressure, BP ≤ 90 mmHg) upon arrival in the TC was higher in Austria (20.6% vs. 14.7% in Germany; p < 0.001). Amedian of 500 mL of fluid was administered in Austria, whereas in Germany 1000 mL was infused (p < 0.001). Patient demographics did not reveal arelationship (Φ = 0.00) between both countries, and the majority of patients sustained ablunt trauma (96%). The observed ASA score of 3-4 was 16.8% in Germany versus 11.9% in Austria. Significantly more helicopter EMS transportations (HEMS) were carried out in Austria. The authors suggest implementing international guidelines to explicitly use the HEMS system for trauma patients only a)for the rescue/care of people who have had an accident or are in life-threatening situations, b)for the transport of emergency patients with ISS > 16, c)for transportation of rescue or recovery personnel to hard to reach regions or, d)for the transport of medicinal products, especially blood products, organ transplants or medical devices.

Wildfire Threat to Inpatient Health Care Facilities in California, 2022.

Objectives. To assess wildfire risks to California inpatient health care facilities in 2022. Methods. Locations of inpatient facilities and associated inpatient bed capacities were mapped in relation to California Department of Forestry and Fire Protection fire threat zones (FTZs), which combine expected fire frequency with potential fire behavior. We computed the distances of each facility to the nearest high, very high, and extreme FTZs. Results. Half (107 290 beds) of California's total inpatient capacity is within 0.87 miles of a high FTZ and 95% (203 665 beds) is within 3.7 miles of a high FTZ. Half of the total inpatient capacity is within 3.3 miles of a very high FTZ and 15.5 miles of an extreme FTZ. Conclusions. Wildfires threaten a large number of inpatient health care facilities in California. In many counties, all health care facilities may be at risk. Public Health Implications. Wildfires in California are rapid-onset disasters with short preimpact phases. Policies should address facility-level preparedness including smoke mitigation, sheltering measures, evacuation procedures, and resource allocation. Regional evacuation needs, including access to emergency medical services and patient transportation, must also be considered. (Am J Public Health. 2023;113(5):555-558. https://doi.org/10.2105/AJPH.2023.307236).

Assessment of novel ICT-EMS systems to improve emergency patient transportation during the COVID-19 pandemic

ObjectivesThis study aimed to examine the usability, feasibility, acceptability, and appropriateness of the information and communication technology for emergency medical services (ICT-EMS) systems to improve the transportation of emergency patients during the COVID-19 pandemic. MethodsEmergency medical technicians (EMTs) (n = 229) employed at 7 fire stations operated by the North Chungcheong Fire Service Headquarters, South Korea were trained to use ICT-EMS devices prior to a 1-month implementation period. System Usability Scale (SUS), Feasibility of Intervention Measure (FIM), Acceptability of Intervention Measure (AIM), and Intervention Appropriateness Measure (IAM) questionnaires were conducted in the 4th week of the 1-month implementation period to assess the perceived usability, feasibility, acceptability, and appropriateness of the ICT-EMS systems. ResultsAmong a total of 229 EMTs, 187 EMTs (81.7%) completed the survey. The overall SUS score was significantly low (score of 35.6) indicating an overall negative perception of the ICT-EMS systems. With regard to the feasibility, acceptability, and intervention appropriateness of ICT-EMS, roughly 50 (26.7%) participants agreed that ICT-EMS implementation was possible, appealing, and suitable. ConclusionMany potential areas of improvement were identified within the ICT-EMS systems. System alterations regarding usability, feasibility, acceptability, and appropriateness may be necessary to successfully implement the ICT-EMS systems.

Evaluating the Performance of Emergency Centers during Coronavirus Epidemic Using Multi‐Criteria Decision‐Making Methods (Case Study: Sari City)

In this study, due to the importance of emergency centers and patient transport vehicles in epidemic conditions, the performance of emergency centers has been evaluated based on health protocols. The criteria were first divided into preventive and operational sections by collecting opinions, health experts, standard criteria, and the Delphi method. Preventive criteria for evaluating emergency centers and operating criteria for assessing vehicles in these centers are considered. The weighting of the determined criteria was done by the triangular fuzzy aggregation method. According to the standard criteria, the emergency centers have been evaluated for a 30‐day period. The results have been assessed as a qualitative and quantitative matrix using the PROMETHEE method. The results showed better performance of Center A (63%) due to proper performance and better compliance with protocols in both criteria (preventive and operational). The reason for the superiority of this center over Center B can be considered the better performance of this center in terms of prevention indicators and better performance of the center’s vehicles (Ambulance A‐1 and Ambulance A‐2) in the performance index by observing the standards.

Research Progress on Safety of Emergency Patient Transport

Research Progress on Safety of Emergency Patient Transport

Review of Emergency Medical Services Vulnerability to High Consequence Infectious Disease in the United States.

Purpose: Emergency medical services (EMS) responders are a group of medically skilled professionals who perform a wide range of essential medical services within a community including emergency response, patient transport, and mobile integrated healthcare. The proper functioning of the EMS system is paramount to the well-being of the medical system and public health. The intent of this paper is to review current EMS standards and practice to determine the danger a high consequence infectious disease (HCID) may pose to these healthcare workers and the community.Areas Addressed: Through the review of EMS practice several areas were identified as vulnerabilities to the EMS network. These vulnerabilities consisted of the lack of standardized licensing practice, inconsistent medical direction, and the inability to properly implement the use of personal protective equipment (PPE). The compounding of these vulnerabilities allows for HCIDs to pose a serious threat to EMS personnel with the possibility of devastating and crippling the EMS infrastructure within the US.Discussion: The vulnerabilities identified must be addressed both to protect EMS providers and to enhance the resilience of the US healthcare system. Ways to address the identified vulnerabilities should focus on improving the EMS curriculum and increasing minimum levels of education for first responders. Targeting minimum education and training standards could be the most effect method of reducing the dangers of HCIDs to EMS systems.

Safety Checklists for Emergency Response Driving and Patient Transport: Experiences from Emergency Medical Services.

Emergency response driving (ERD) is considered one of the most significant occupational risk factors affecting both patient and traffic safety in emergency medical services (EMS). The majority of the risk factors in ERD are crew related and could be affected positively with crew resource management (CRM). The aim of this study was to examine how the safety checklists developed for ERD and patient transport are experienced in practical work in EMS by paramedics. Safety checklists for ERD and patient transport were developed and then piloted in practical work among 30 paramedics in five different EMS areas around Finland for a two-month period in fall 2019. Afterward, semistructured thematic interviews were performed with the pilot participants, and the material was analyzed using inductive content analysis. Paramedics experienced that use of ERD and patient transport safety checklists improved safety, and deployment of the checklists required systematic planning. Use of the safety checklists was seen as changing the mindset of the ERD drivers to a more safety critical stance and increasing a systematic approach to ERD. Paramedics also stated that when deploying the checklists in EMS, their use should be standardized as a nationwide operating model and that service-dependent fine-tuning is required. This study's findings support the use of ERD and patient transport safety checklists in practical work in EMS for promoting safety. In addition to safety checklists, other sections of CRM and its applications to EMS should also be studied.

Outpatient care in acute and prehospital emergency medicine by emergency medical and patient transport service over a 10-year period: a retrospective study based on dispatch data from a German emergency medical dispatch centre (OFF-RESCUE)

BackgroundThe number of operations by the German emergency medical service almost doubled between 1994 and 2016. The associated expenses increased by 380% in a similar period. Operations with treatment on-site, which retrospectively proved to be misallocated (OFF-Missions), have a substantial proportion of the assignment of the emergency medical service (EMS). Besides OFF-Missions, operations with patient transport play a dominant role (named as ON-Missions). The aim of this study is to work out the medical and economic relevance of both operation types.MethodsThis analysis examined N = 819,780 missions of the EMS and patient transport service (PTS) in the catchment area of the emergency medical dispatch centre (EMDC) Bad Kreuznach over the period from 01/01/2007 to 12/31/2016 in terms of triage and disposition, urban-rural distribution, duration of operations and economic relevance (p < .01).Results53.4% of ON-Missions are triaged with the indication non-life-threatening patient transport; however, 63.7% are processed by the devices of the EMS. Within the OFF-Mission cohort, 78.2 and 85.8% are triaged or dispatched for the EMS. 74% of all ON-Missions are located in urban areas, 26% in rural areas; 81.3% of rural operations are performed by the EMS. 66% of OFF-Missions are in cities. 93.2% of the remaining 34% of operations in rural locations are also performed by the EMS. The odds for both ON- and OFF-Missions in rural areas are significantly higher than for PTS (ORON 3.6, 95% CI 3.21–3.30; OROFF 3.18, 95% CI 3.04–3.32). OFF-Missions last 47.2 min (SD 42.3; CI 46.9–47.4), while ON-Missions are processed after 79.7 min on average (SD 47.6; CI 79.6–79.9). ON-Missions generated a turnover of more than € 114 million, while OFF-Missions made a loss of almost € 13 million.ConclusionsThis study particularly highlights the increasing utilization of emergency devices; especially in OFF-Missions, the resources of the EMS have a higher number of operations than PTS. OFF-Missions cause immensely high costs due to misallocations from an economic point of view. Appropriate patient management appears necessary from both medical and economic perspective, which requires multiple solution approaches.

Simulation study on flow rate accuracy of infusion pumps in vibration conditions during emergency patient transport.

Infusion pumps are frequently used when transferring critically ill patients via patient transport cart, ambulance, or helicopter. However, the performance of various infusion pumps under these circumstances has not been explored. The aim of this study was to evaluate the flow rate accuracy of infusion pumps under various clinical vibration conditions. Experiments were conducted with four different types of pumps, including two conventional syringe pumps (Injectomat MC Agilia, Fresenius Kabi and TE-331, Terumo), one conventional peristaltic pump (Volumed μVP7000; Arcomed), and one new cylinder pump (H-100, Meinntech). The flow rate was measured using an infusion pump analyzer on a stable table (0m/s2) for 1h with 1ml/h and 5ml/h. Experiments were repeated in mild vibration (2m/s2) (representing vibration of patients in a moving stretcher or ambulance), and in moderate vibration (6m/s2) (representing vibration in helicopter transport). Any accidental bolus occurrence in extreme vibration situations (20m/s2) was also analyzed. Simulated vibrations were reproduced by a custom-made vibration table. In the resting state without vibration and in mild vibration conditions, all pumps maintained good performance. However, in moderate vibration, flow rates in syringe pumps increased beyond their known error ranges, while flow rates in peristaltic pumps remained stable. In extreme vibration, accidental fluid bolus occurred in syringe pumps but not in peristaltic pumps. The newly developed cylinder pump maintained stable performance and was unaffected by external vibration environments.

Blood product transfusion during air medical transport: A needs assessment.

Early administration of blood products to patients with hemorrhagic shock has a positive impact on morbidity and mortality. Smaller hospitals may have limited supply of blood, and air medical systems may not carry blood. The primary outcome is to quantify the number of patients meeting established physiologic criteria for blood product administration and to identify which patients receive and which ones do not receive it due to lack of availability locally. Electronic patient care records were used to identify a retrospective cohort of patients undergoing emergent air medical transport in Ontario, Canada, who are likely to require blood. Presenting problems for blood product administration were identified. Physiologic data were extracted with criteria for transfusion used to identify patients where blood product administration is indicated. There were 11,520 emergent patient transports during the study period, with 842 (7.3%) where blood product administration was considered. Of these, 290 met established physiologic criteria for blood products, with 167 receiving blood, of which 57 received it at a hospital with a limited supply. The mean number of units administered per patient was 3.5. The remaining 123 patients meeting criteria did not receive product because none was unavailable. Indications for blood product administration are present in 2.5% of patients undergoing time-sensitive air medical transport. Air medical services can enhance access to potentially lifesaving therapy in patients with hemorrhagic shock by carrying blood products, as blood may be unavailable or in limited supply locally in the majority of patients where it is indicated.

The Correlation of Transport Time and Boarding Time to Unexpected Events During Transport of Emergency Patients to Critical Care Unit

Background: Transport of emergency patients requires special attention because it has unexpected eventrisks. The vulnerable emergency department situation with complex cases, limited resources and multidiscipline makes the transfer risky. The emergency department patients that are worth to be transferred toinpatient rooms sometimes must wait until the referred rooms and their equipment are ready. Critical patientsare vulnerable to any worsening condition due to acceleration or deceleration of movements. This researchaims to find out the correlations among the nurses’ experiences, hemodynamics monitoring and equipmentpreparation with unexpected things during transport of Emergency Patients to the Critical Care Unit.Method: This quantitative study uses perspective-observational design. The sample consisted of 151emergency patient transfer processes (the Emergency Department patients) that were transported to theCritical Care Unit. The ages of the sample are older than 16-year-old. The exclusion criteria are patientspassing away in the Emergency Department or referred to other hospitals. The numerical data were analyzedby the Eta test while the categorical data were analyzed by Cramer’s V test.Results: From 151 observed patients, 119 patients experienced unexpected events. The bivariate analysisshows correlation between transport time and unexpected event (F = 10.8, F table = 2.67, r = 0.425).However, there is no correlation between boarding time in the Emergency Department to unexpected events(p = 0.087, r = 0.208).Conclusion: Longer transport time leads to a higher risk of unexpected event occurrence. The companionofficers should be able to prepare the patients properly, to ensure the routes of transport to be free, to promotestrict monitoring during the transport process.

Transport of ventilated emergency patients from the air rescue service to the hospital destination (HOVER study) : Results of an online survey

In Germany more than 110,000 helicopter emergency medical service (HEMS) missions are carried out annually. Aconsiderable number of patients are ventilated during the flight. So far, structured surveys with respect to the ground transport from the helipad to the hospital facility and handover of ventilated patients in the emergency room (ER) are not available in the German-speaking HEMS system. The handover of ventilated HEMS patients in the ER (HOVERI study) explored the use of the helicopter ventilator and medical equipment during the transport from the hospital landing site to the ER. After approval by the HEMS operators, emergency medical doctors and HEMS technical crew members (HEMS-TC) of 145 German-speaking HEMS bases were invited to participate in an anonymous online survey (period: 1 February 2018-1 March 2018). Each participant was only allowed to submit the survey once. Data of 569 participants were completely analyzed, with responses from 429 emergency physicians and 140 HEMS-TC (75% from Germany, 13% Switzerland, 11% Austria, 1% Italy and Luxembourg). The most frequent type of aircraft used was the Eurocopter (EC)/Airbus helicopter(H) 135 (60.5%) followed by the EC/H 145 (33%). The majority of the respondents (53%) principally used the helicopter ventilator machine for patient transport from the helipad to the ER, 38% used it depending on the circumstances and 7% never used it. Of the participants 52% always took the emergency backpack for patient transport to the ER, 43% depending on the situation and 5% never took it along. The availability of oxygen or aventilator at the helipad was considered to be helpful (59% and 45%, respectively), obligatory (25% and 14%, respectively) but was also considered unnecessary by some participants (16% and 40%, respectively). The collection of the HEMS team by ahospital team at the helipad was rated as helpful (64%) or mandatory (19%), 12% considered it to be unimportant and 5% even disturbing. For most respondents (58.5%) the responsibility for the patient ended after astructured handover on reaching the internal hospital target area (e.g. the ER). The management of the handover of ventilated emergency patients in German-speaking HEMS is heterogeneously structured. Only approximately 50% of the participants frequently carried the helicopter ventilator and emergency equipment during patient transport to the ER. Depending on the situation, more than 90% of the respondents used the helicopter ventilator and emergency backpack during the transport. The collection of the HEMS team by ahospital team at the helipad was appreciated by the majority of participants. The use of the helicopter ventilator for patient transport to the ER needs to be explored in future studies. The study was registered at the Research Registry ( www.researchregistry.com ) under the following number: researchregistry2925.

Study on Emergency Patients Care by Korea Coast Guard Center Workers Focused on Drowning, Fall and Isolation

The purpose of the study was to investigate the first response, rescue, and transport of emergency patients in Korea coast guard center workers. A self-administered questionnaire was carried out by 333 maritime police workers working at Korea coast guard center from March-June, 2016. The questionnaire consisted of 25 question items. Data were analyzed using SPSS WIN 21.0. Majority of the study subjects worked at the Korea Coast Guard Center and of them, 96.7% were composed of staff who did not possess emergency medical technician certificate, followed by 2.7% possessing level 2 emergency medical technician certificate, and 0.6% possessing level 1 emergency medical technician certificate. And in terms of the possession of lifeguard certificate, 60.1% of the staff possessed lifeguard certificate which was higher percentage than the staff who did not possess lifeguard certificate at 39.9%. In the case of lifeguard certificate, staff who possess lifeguard certificate had better knowledge about the usage instructions for Automated External Defibrillator, than the staff who did not possess the certificate, and meaningful difference was seen in accordance with the possession of the lifeguard certificate(t=4.31, p<.001). Paramedics, also referred to as prehospital emergency personnel, must also be recognized as expert manpower and accordingly, there is a need for a system to allow them to receive corresponding reward.

A telemedicine support for improving medical emergency management

In this paper, we introduce a telemedicine architecture for supporting emergency patient stabilization and patient transportation to a fully equipped health care center. In particular, we focus on the description of a set of mobile apps, designed for supporting data recording and transmission duri

TEEM

In this article, the authors describe a client-server architecture, designed for supporting data recording and transmission during emergency patient transportation by ambulance. The clients are a set of mobile apps, interfaced to the monitoring devices in the ambulance, that automatically send all the recorded data to a server at the destination center. One additional app enables the travelling personnel to input and transmit further significant patient data, or comments. At the destination center, the specialist physician logs onto the server, receives the data in real time, and is allowed to plot/analyze them, assessing the patient's situation, and possibly sending immediate feedback to the operators in the ambulance. The system is currently under evaluation at the Neonatal Intensive Care Unit (NICU) of Alessandria Children Hospital, Italy. The system, by allowing real time data communication, is able to provide clear advantages from the organizational and economical viewpoint.

A dynamic simulation–optimization approach for managing mass casualty incidents

To handle mass casualty incidents (MCIs), emergency medical services in central European countries such as Austria or Germany are used to build up small field hospitals called advanced medical posts (AMPs). The main policy behind is to categorize, treat, and stabilize emergency patients before they are transported to hospitals. To investigate the organization of the AMP type operated in Austria such as by Austrian Samaritan Organization, we developed a discrete event simulation (DES) policy model for MCIs regarding advanced process management including staff allocation (physicians, medics) for emergency patient treatment and transport at the incident site. As health care policy makers aim at improving the training of emergency staff, we developed a management policy game as a training tool adapted from the DES policy model. In this paper, we address the research question whether or not the policy decisions made by simple heuristics or disaster management players could be further improved by using advanced simulation–optimization techniques. We present a generic method consisting of (i) an automated policy for dynamic staff re-allocation at an AMP with arbitrary structure, and (ii) a simulation–optimization approach for optimally parametrizing this automated policy. Three simulation–optimization techniques with two complexity levels are investigated in detail for the purpose of incorporation in our system applied to the Austrian AMP case study: the method by Kiefer–Wolfowitz, the metaheuristic OptQuest approach, and the Response Surface Methodology. Our results show that the optimized automated policies can improve the performance of the AMP compared to the management by simple heuristics or by human decision makers. We discuss policy implications for improving strategic decision making and process management for incident commanders at the Austrian AMP based on the results of the dynamic simulation–optimization techniques.