Emergency Station Research Articles

Location and hierarchical allocation disaster with combined ε-constraint and simulation-based optimization approach

The increasing frequency of natural disasters and the necessity of proper planning to minimize the impact and casualties of such crises have always been matters of great concern to human societies. In this study, a hybrid mathematical-simulative location-allocation model is proposed to carry out disaster management (DM) efforts with maximum coverage in the immediate aftermath of an earthquake. The proposed model consists of two phases: determining the optimal location of the temporary emergency stations (TECs), followed by optimal and hierarchical allocation of casualties to said temporary medical centers (TMCs). Given the contradictory nature of the model’s two objectives, that is, minimizing the cost of setting up TMCs and the time taken to transfer casualties to TMC. In the second phase, a simulation-based optimization approach is employed to simulate casualties’ behavior at the onset of the disaster and to determine the optimal capacity of the medical centers. The findings indicate that the costs and distance traveled by casualties during the earthquake have been reduced by 15%.

Accessibility Assessment of Prehospital Emergency Medical Services considering Supply-Demand Differences

The reasonable accessibility assessment method is an important basis for the measurement of the level of prehospital emergency medical services. There is no general model for prehospital emergency care in traditional accessibility evaluation, and its supply-demand characteristics have also been ignored. Based on the three-step floating catchment area (3SFCA) model, the supply-demand three-step floating catchment area (SD3SFCA) model is proposed in this paper, which can express the difference between supply and demand of prehospital emergency medical services and accurately simulate unified dispatching of emergency centers. The unified dispatching behavior of emergency centers is simulated based on the potential service capacity of emergency stations with a supply-demand difference. The supply capacity of different emergency facilities is quantified from the perspective of infrastructure and technical quality. The needs of typical population densities are taken into account and adjusted by the weighting index. The validity of the model is verified, with the prehospital emergency medical service in the West Coast New District of Qingdao as an example. The results show that the model can effectively measure the accessibility level of prehospital emergency services and truly reflect the characteristics of supply and demand. Compared with previous models, the model has been significantly improved, which can provide an important reference for optimizing the allocation of prehospital emergency resources.

PERENCANAAN GEDUNG PARKIR MOTOR DI PAVILIUN RSUD dr. SAIFUL ANWAR KOTA MALANG

Saiful Anwar Hospital in Malang is one of A-class hospitals in East Java. Since there are many facilities and personnel offered by this hospital, it makes this hospital become one of the most active hospitals in Malang in serving patients. In order to maintain comforts and services in the hospital, it’s necessary to evaluate two-wheeled vehicles parking area characteristics in each motorcycle parking area of RSUD, to find out the available parking spaces to accommodate motorcyle, and also solutions to solve parking problems. The data is taken from the results of the patrol survey which was conducted on June 17 2019. From the results of the survey that has been analyzed the biggest accumulation amount of parking lots was 464 vehicles in the visitor's motorcycle parking building, 150 vehicles on the Emergency Station motorcycles parking, and 205 vehicles on the pavilion motorcycle parking lot with an average duration of parking at each location 4 hours to 5 hours. From the data that has been analyzed, the author provides a solution by expanding the parking space on the Pavilion motorcycle parking lot, where the motorcycle parking area exceeds the capacity or the demand is greater than the available capacity of two-wheeled vehicles parking area.

First Russian experience in liver and kidney transplantation from donors with out-of-hospital cardiac arrest: 3 years’ results

Introduction. In megacities, the use of organs obtained from those who died as a result of sudden out-of-hospital cardiac arrest (OHCA) for transplantation is one of the promising ways of addressing the problem of organ donor shortage. In St. Petersburg, the model of transition from life support via extracorporeal membrane oxygenation (ECMO) of patients after OHCA to ECMO life support for organs of potential donors was tested for the first time.Materials and methods. In order to implement the program, round-the-clock ECMO and transplantation teams were organized at the inpatient emergency ward of Pavlov First St. Petersburg State Medical University. Interaction with the St. Petersburg City Emergency Station, St. Petersburg was established. The protocol of work with potential donors brought to the hospital after a sudden circulatory arrest was developed, approved by the ethics committee, and implemented in clinical practice. This was the first in Russia and in international practice. Between 2017 and 2020, 67 patients with sudden OHCA were brought to the inpatient emergency ward. In 4 (5.97%) cases, advanced cardiovascular life support was successful, and 11 (16.42%) patients became effective donors. Mortality among this group of patients without subsequent postmortem donation was 77.61% (52 patients).Results. Liver transplantation from non-heart-beating donors (NHBDs) whose blood circulation was restored by ECMO (ECMO NHBD) was performed in 5 recipients who were in severe condition against the background of liver failure. In 1 (20%) case, there was severe liver allograft dysfunction for 33 days with subsequent complete restoration of function. Kidney transplantation was performed in 22 patients. Immediate graft function occurred in 10 (45.45%), while delayed function occurred in 12 (54.55%) patients. Kidney graft survival was 86.4%, kidney graft recipient survival was 95.5%, liver graft recipient survival was 80%, and the follow-up period was 24.1 ± 7.15 months.Conclusion. The use of ECMO to save the lives of patients with sudden OHCA can be implemented in conditions of a high degree of organization and synchronization of the work of the city emergency medical station and the emergency department of a multidisciplinary hospital. If cardiopulmonary resuscitation with ECMO (ECMO CPR) fails, it is possible to launch the ECMO NHBD donor program. Long-term outcomes of liver and kidney transplantation from ECMO NHBD are consistent with those using organs from brain-dead donors. Widespread implementation of the new organ donation model will increase the availability of transplant care.

A resilience-oriented two-stage recovery method for power distribution system considering transportation network

In recent years, extreme weather events have resulted in a number of severe power outages and economic losses. It is becoming urgent to study approaches to enhance power distribution system resilience. This paper presents a two-stage optimization method for improving resilience of power distribution systems. The two-stage method is influenced by a transportation network, which considers the interdependence between traffic roads and overhead distribution lines. In the first stage, based on the Bayesian network and the Monte Carlo method, the locations of emergency stations, e.g., charging stations and repair stations are pre-positioned to improve the recovery speed of interrupted loads after disasters. Then the second stage is to co-optimize the dispatch of mobile energy storage systems and repair crews on transportation network to minimize the shedding of critical loads while considering operation constraints of power, voltage and power flow for power distribution system. The dispatch of mobile energy storage systems and repair crews are affected by the locations of emergency stations in the first stage. The route of mobile energy storage systems and repair crews on transportation network can be obtained from the results in the second stage. The proposed method is tested on a modified IEEE 33-bus distribution test system with a corresponding transportation network. Simulation results demonstrate the effectiveness of the proposed method in enhancing power distribution system resilience by pre-positioning emergency stations and co-dispatching mobile energy storage systems and repair crews.

Presenting A Multi-objective Location Model in GIS Environment: A Case Study in East Tehran Emergency Stations

Background: This study aims to design a multi-objective model for locating emergency relief bases with maximum coverage and minimum costs. As a result, this model is expected to reduce mortality by increasing the efficiency of relief services. Materials and Methods: Based on the ambulance distribution in the east of Tehran City, Iran, and the statistical information on demand (at least 30 samples for data normalization) in the last six months of 2018, we introduced and implemented a definitive mathematical model. We also evaluated the model with GAMS software. Using previous studies and interviews, we identified key and practical indicators of site locations. These indicators are being easy to access, locating in high-demand areas, such as an urban area, and not being too close to another relief base. These factors were then prioritized using the hierarchical method, and the output indicates the high weight of the factor of “being in a place with high demand”. The objective functions are to maximize coverage, minimize costs, and provide equity in relief time. To deal with the uncertainty of the parameters, we used the robust optimization approach. To initially select potential proposed sites to establish the database, we used Geographic Information System (GIS). To test the above mathematical model in the real world, we conducted a case study in East Tehran. Results: Based on the designed model, the initial points proposed by GIS were identified. Finally, it was found that the number of stations in East Tehran must increase from 27 to 34 bases. Conclusion: By implementing this model, the emergency medical service can provide the highest level of coverage. Also, the maximum relief time at stations will be reduced to 8 minutes.

Research on functional space of community-based medical-nursing combined facilities for the aged in small cities

ABSTRACT The aging of the population is accelerating. In China, the relationship between the differences in aged care and medical resources is being explored, but there is a lack of research on the aged care and medical needs of older people in the community and the functional space of aged care institutions. In this paper, questionnaires, interviews and observations were conducted with older adults over 60 years of age in a small urban community. Statistical methods were used to analyze their real needs in terms of living and health requirements. The results showed that 1) The number of members in the whole family was significantly associated with the choice of home care model. 2) There was a high demand for day care, emergency stations and home services among the seniors in the community. 3) Watching television, drinking tea, and growing vegetables and flowers were the most popular activities among the seniors. 4) There was a high demand for nursing services, medical services and medical equipment among the seniors in the community. Conclusion. Family service station, ornamental room, tea room, vegetable garden and healthy green environment should be the most basic functional spaces. Professional medical places for the seniors should be provided in the community.

Logistics of deep tunnel construction sites without portal access – SBT2.1 Semmering Base Tunnel

AbstractThe 27.3 km long Semmering Base Tunnel is a major component of the Baltic‐Adriatic Corridor trans‐European rail link. The SBT2.1 Fröschnitzgraben Tunnel section involves more construction work than any other contract section of the Semmering Base Tunnel project. First, two shafts over 400 m deep had to be sunk down to tunnel level in order to create the emergency station. From here, the tunnels are being driven towards Gloggnitz and Mürzzuschlag. The falling drives towards Gloggnitz, each approx. 8.5 km long, are being excavated with two tunnel boring machines (TBM), while conventional tunnelling methods (drill and blast) are being used to drive the 4.3 km long rising section towards Mürzzuschlag. Another major component of the contract is the creation and management of the Longsgraben landfill site.With a complex construction project of this nature, the local conditions, changing construction phases, different tunnelling methods, geological conditions, safety and contractual aspects, and the long duration of the construction, must all be given careful consideration when planning the logistics. The overall scope of logistics is broken down into individual areas; this enables several logistical concepts to be developed which do not necessarily have to correlate with one another. Through the involvement of the client, it has been possible to develop efficient and, for the most part, straightforward organisational measures and solutions for this construction project.

Development of unmanned aerial vehicle (UAV) networks delivering early defibrillation for out-of-hospital cardiac arrests (OHCA) in areas lacking timely access to emergency medical services (EMS) in Germany: a comparative economic study

ObjectivesThis study wants to assess the cost-effectiveness of unmanned aerial vehicles (UAV) equipped with automated external defibrillators (AED) in out-of-hospital cardiac arrests (OHCA). Especially in rural areas with longer response...

Clinical performance of medical students in Korea in a whole-task emergency station in the objective structured clinical examination with a standardized patient complaining of palpitations

This study assessed the clinical performance of 150 third-year medicalstudents in Busan, Korea in a whole-task emergency objective structured clinical examination station that simulated a patient with palpitations visiting the emergency department. The examination was conducted from November 25 to 27, 2019. Clinical performance was assessed as the number and percentage of students who performed history-taking (HT), a physical examination (PE), an electrocardiography (ECG) study, patient education (Ed), and clinical reasoning (CR), which were items on the checklist. It was found that 18.0% of students checked the patient’s pulse, 51.3% completed an ECG study, and 57.9% explained the results to the patient. A sizable proportion (38.0%) of students did not even attempt an ECG study. In a whole-task emergency station, students showed good performance on HT and CR, but unsatisfactory results for PE, ECG study, and Ed. Clinical skills educational programs for subjected student should focus more on PE, timely diagnostic tests, and sufficient Ed.

A YOLOv3 Based Smart City Application For Children’s Playgrounds

According to the reports of Public Health Institution, approximately 250,000 rabies-risk animal bites occur per year in Turkey. Most of these bites are caused by dogs and most of the victims are the children who play in playgrounds. With the development of deep learning-based computer vision technology, autonomous detection of dangerous objects (handguns, knives, dogs, etc.) in these children’s playgrounds has become a crucial security application. In this paper, a real-time dog detection model based on YOLOv3 deep learning algorithm is proposed as a new smart city security application and this model is applied to the selected children’s playground. Firstly, in view of the problem of insufficient stray dog image data in the original datasets, new images of stray dogs have been taken from an animal shelter and they have been added to the dataset. These new images have effectively enriched the diversity of training data and improved the training performance of the proposed model. The proposed model has been optimized by utilizing various hyperparameters and the results have been compared with each other. The model with the best evaluation scores is proposed and applied to detect dogs automatically by the fast emergency station located in the selected children’s playground. The real-time application has achieved 82.59% of AP with adjusted hyperparameters.

Experience of the Pavlodar Regional Emergency Station in the context of the COVID-19 pandemic

Due to the complicated epidemiological situation in the region, the number of calls to the emergency station has increased. In order to prevent a decrease in operational work, a number of changes were introduced which made it possible to reduce the time of arrival of the teams from the moment the call was received at the 103 console to 7 minutes and contributed to the provision of high-quality medical care to the population by emergency medical teams.

A city-scale assessment of emergency response accessibility to vulnerable populations and facilities under normal and pluvial flood conditions for Shanghai, China

This paper describes the development of a scenario-based approach that couples 2D hydrodynamic modeling with Geographic Information System (GIS) network analysis to assess the vulnerability of emergency services to surface water flooding at a large city scale. The method is demonstrated for Emergency Medical Service and Fire & Rescue Service in the city of Shanghai, China. Considering four representative traffic conditions, accessibility in terms of service area, response time, and population coverage within specified timeframes (8-, 12-, and 15-minute for Emergency Medical Service and 5-, 10-, and 15-minute for Fire & Rescue Service) is quantified and mapped under normal as well as pluvial flood scenarios of various magnitudes (5-, 20-, and 100-year return periods). Results show that the performance of operational responses largely depends on the functioning of transportation system, dramatically decreasing from unobstructed to congested traffic. Surface water flooding is found to result in limited (i.e. site-specific) but nonlinear impacts on the city-wide emergency service provisions. The results provide detailed information for optimizing the distribution of emergency stations and developing strategic contingency planning for vulnerable populations and facilities.

Emotional burnout syndrome in workers of emergency medical services

Swiftness in carrying out the resuscitation measures, when every second counts, constant tension and readiness for action, critical patients, and death are an integral part of the work at the emergency station. It comes as no surprise that emotional burnout syndrome (BOS) develops in workers in this sphere much faster and more frequently.

Adaptive overcurrent protection scheme suitable for station blackout power supply of nuclear power plant operated through an integrated microgrid

Inclusion of distributed energy resources based integrated microgrid (IMG) into emergency station blackout (SBO) (EM-SBO) power system of nuclear power plant (NPP) has complicated its existing protection scheme due to varying system fault level with bidirectional flow of power. During SBO in NPP, it is of topmost priority to safeguard the reactor through EM-SBO supply. However, if any severe fault occurs, it may lead to complete collapse of the safety power supply in the NPP. So, availability of this tiny power system is most important as compared to the tripping of reactor safety of the NPP. In this paper, a 460 MWe NPP station has been considered to implement IMG into its EM-SBO power system and focuses on its overcurrent protection coordination scheme as a case study. The combined fuse and numerical relays inter-linked with digital logic-based adaptive overcurrent protection (AOP) scheme has been proposed after load flow analysis and calculating short circuit fault level through ETAP software. The sensitivity, the selectivity and the speed of the protection scheme have been evaluated in different network configurations like on-grid, semi-islanding and islanding mode of operation of IMG. Finally, it is proposed that the protection schemes vary from case-to-case basis leading to necessity of communication among the relays. So, an advanced AOP scheme with digital logic linked through peer-to-peer Hi-speed communication (IEC 61,850 confirmed GOOSE technology) has been proposed to resolve the protection issue of the modern NPPs operated through IMG.

A Method for Optimal Allocation of Regional Rail Transit Emergency Resources Based on Resource Sharing

Regional rail transit is a composite rail transit system that includes multiple types of rail transit. Compared with single-standard rail transit, the types of risks increase, the risk impact is greater, and the consequences are more serious. Therefore, it is urgent to optimize the allocation of regional rail transit emergency resources to improve the overall efficiency of emergency operation and maintenance. Aiming at the characteristics of regional rail transit, this paper proposes a method for optimal allocation of regional rail transit emergency resources based on resource sharing. Firstly, according to the overall requirements of emergency services, the number of emergency stations is set, and then an emergency resource optimization allocation model for regional rail transit is built based on the p-median model. Secondly, through the multi-standard emergency resource sharing, the overall efficiency improvement of emergency operation and maintenance is achieved. Finally, a case study was carried out using Chongqing regional rail transit as an example to verify the effectiveness of the method.

Site Selection for Pre-Hospital Emergency Stations Based on the Actual Spatiotemporal Demand: A Case Study of Nanjing City, China

Rapid economic and social development has been accompanied by the occurrence of many major issues throughout the world. Specifically, there is an ever-increasing demand for emergent medical services among the public. In order to ensure timely responses to emergency demands, it is critical to reasonably configure the emergency stations. In general, emergency stations are mostly distributed according to the distribution of emergency demands and response time, which, however, fails to consider the negative impacts of randomly occurring emergency demands and traffic delays. In this study, first aid demands are combined with traffic states based on the spatiotemporal big data set covering model, which alleviates the negative impacts of randomly occurring first aid demands and traffic delay time on the planning of pre-hospital first aid stations. Moreover, the accuracy of the site selection model is improved, which meets the requirements that all randomly occurring simulated first aid demands can be approached within the target time under planning conditions and actual traffic constraints. Taking Nanjing City as an example, this study obtains multi-source big data, such as ambulance-carried GPS data from June 2018 to June 2019, Gaode Map-recorded traffic congestion data, and survey data of emergency rescue facilities. Basing on the processing and analysis of these data, it shows that first aid demands in Nanjing City are highly region-specific with high time delay. Various required factors are determined based on modeling and analysis, and the target time is agreed to be 8 min. The average vehicle speed on each road is calculated, accompanied by the establishment of an actual road network model. In this context, the transit time from the randomly distributed first aid stations to the hospital can be calculated, which are set to satisfy the model conditions so as to obtain the solution. Finally, such a solution is adjusted and verified according to the land-use situation. The results of this study, based on spatiotemporal big data, are expected to provide insights into improving the site selection model and enhancing efficiency while providing new technical methods.

Site selection methodology for emergency centers in Silk Road based on compatibility with Asian Highway network using the AHP and ArcGIS (case study: I. R. Iran)

Road transportation is a necessary part of the economic, cultural, martial, social, and tourism development of nations throughout history. For several centuries, Silk Road (SR) could provide a secure way of connecting Asian and European nations. Despite historical successes, the old SR has been inactive for several centuries. China has recently decided to revive the old road through the New SR Initiative. In this paper, the existing Asian highway (AH) network which passes through Iran and reaches Turkey is considered to revive SR. Most of the suggested routes of SR passing through Iran also pass through the AH network. One of the critical considerations for such a project is the issue of accident-wise road safety. According to the descriptive and spatial data analyses, and by leveraging ArcGIS, tentative routes in Iran were analyzed. The mentioned routes contain parts of the SR and parts of the existing AH network. Therefore, the goal of the analyses was to propose the best locations for the construction of the medical emergency centers, which can elevate the road's safety measures. To identify higher risk locations, four different criteria that affect safety were considered. These criteria include the distance from the city centers, the number of the available emergency stations, the number of rest, service, and lodging stations, and finally, the road accident frequency. To identify each factor's significance, a questionnaire was developed and filled by the road and transportation experts. This analysis was performed using the analytic hierarchical process in the ArcGIS platform. The risk assessment showed that the road between Garmsar and Tehran has the highest car accident risk among all other routes. Results can be used for further remedial actions to elevate safety along this route.

A concept for the development of a pioneer regional Out-of-Hospital Cardiac Arrest Program to improve patient outcomes.

Immediate initiation of cardiopulmonary resuscitation (CPR) increases chances of restoring spontaneous circulation and survival after out‑of‑hospital cardiac arrest (OHCA). For some refractory cases, extended cardiopulmonary resuscitation (ECPR) may be a promising option. The aim of the study was to estimate the possibility of implementation of ECPR procedure to improve current early outcomes of patients after OHCA. The medicalcharts of the Province Emergency Station in Poznań from a 12‑month periodwere assessed retrospectively. All OHCA cases were identified and the following potential inclusion criteria for ECPR were analyzed: initial defibrillation rhythm, age between 18 and 65 years, CPR conducted by bystanders, and time to hospital arrival less than 40 minutes. In 576 (46.7%) of 1233 identified OHCA cases, CPR wasinitiated by bystanders and automated external defibrillatorwas applied only 17 times. An initial defibrillation rhythm was noted in 138 individuals (11.2%). Out of 65 patients who met the ECPR age criterion, 55 underwent CPR by bystanders which lead to a no‑flow time that did not exceed 10 minutes. The additional 9 of them would be excluded due to time to hospital arrival. This means that ECPR would be applicable in 46 patients after OHCA. Our analysis showed that in some patients after sudden cardiac arrest, it would have been possible to implement ECPR as a crucial part of the Regional Out-of-Hospital Cardiac Arrest (OHCA) Program, and in consequence, probably to improve early outcomes of patients with refractory and potentially reversible cardiac arrest.

Air and ground ambulance location-allocation-routing problem for designing a temporary emergency management system after a disaster.

Disasters cause a huge number of injured patients in a short time while existing emergency facilities encountered devastation and cannot respond properly. Here, the importance of implementing temporary emergency management becomes clear. This study aims to locate some temporary emergency stations across the area by maximal covering after a disaster. Furthermore, a multi-mode fleet is used for transferring patients using different modes of transportation (e.g. helicopter ambulance and bus ambulance). Since the type of patients may change over periods, medical servers can displace among temporary emergency stations dynamically according to disaster severity. For this purpose, a new bi-objective dynamic location-helicopter ambulance allocation-ambulance routing model with multi-medical servers is presented. The first objective function minimizes the operational costs related to the newly designed Emergency Medical Service along with the rate of human loss. The second objective function minimizes the critical time spent before the medical treatment. To validate the developed model, the augmented ε-constraint method is used and applied for the Tehran city, which shows the applicability of the model. Finally, two meta-heuristic algorithms are customized for large-sized problems, and the related results are compared based on multi-objective algorithms' performance comparison metrics to find the more efficient one.