Emergency Transport Research Articles

Research on emergency transport planning for E-commerce logistics network based on simulated annealing algorithm

In response to the issue of insufficient demand for logistics facilities during holidays or the temporary or permanent closure of logistics facilities due to sudden events such as epidemics, natural disasters, etc., this paper proposes a planning model and solution algorithm based on multi-objective dynamic decision-making to optimize the emergency transport plan and structure of the e-commerce logistics network. Firstly, an LSTM model is utilized to predict the transportation demand for a certain period in the future. Decision variables are introduced to indicate whether to open or close new routes after closing a logistics facility. The objective functions are set to minimize the number of routes with changes in cargo volume, minimize the load imbalance of each route, and minimize the cumulative total of parcels that cannot circulate normally. Considering factors such as normal circulation of parcels, circulation capacity, transportation capacity after opening or closing facilities, and time constraints, a multi-objective planning model is constructed. Finally, the simulated annealing algorithm is employed for solution, obtaining a circulation plan that meets the requirements. Simulation experiment results demonstrate that the model can rapidly and accurately respond to the paralysis of the e-commerce logistics network caused by sudden events, showcasing high efficiency and practical application value.

Emergent parallel transport and curvature in Hermitian and non-Hermitian quantum mechanics

Studies have shown that the Hilbert spaces of non-Hermitian systems require nontrivial metrics. Here, we demonstrate how evolution dimensions, in addition to time, can emerge naturally from a geometric formalism. Specifically, in this formalism, Hamiltonians can be interpreted as a Christoffel symbol-like operators, and the Schroedinger equation as a parallel transport in this formalism. We then derive the evolution equations for the states and metrics along the emergent dimensions and find that the curvature of the Hilbert space bundle for any given closed system is locally flat. Finally, we show that the fidelity susceptibilities and the Berry curvatures of states are related to these emergent parallel transports.

Physician-assisted interhospital transfer-an analysis from Schleswig-Holstein

The need for interhospital transport (IHT) of intensive care patients is increasing due to changes in the hospital environment. Interhospital transports are challenging and require careful operational planning of personnel and rescue vehicles. To investigate the need for IHT, an analysis was conducted in the service area of the emergency medical service central dispatch center (IRLS) in Schleswig-Holstein. Emergency physician-assisted IHT were analyzed in the period from 01.10.2021 to 30.09.2022. Of atotal of 158,823 documented IRLS missions, 2264 (1.4%) records could be identified and included as IHT: 1389IHT (61.4%) were managed by specialized ambulances, 875(38.6%) by primary care ambulances. Primary care ambulances were mainly used for time-critical transfers and outside the duty hours of the intensive care ambulances, 21.2 % were by air. Of all IHT, 43.1% were required to hospitals with ahigher level of medical care. Emergency physician-assisted IHT are arelevant part of the emergency service's operational spectrum and concern both primary care and specialized rescue vehicles. Arelevant number of urgent IHT were recorded outside the duty hours of the intensive care ambulances. For emergency transports during nighttime, an expansion of air-based transfer capacities should be considered due to the time advantage. For less urgent IHT, an adjustment of the capacities of specialized ground-based vehicles in Schleswig-Holstein seems reasonable.

RARET’s coalition-based model: Addressing complex life-sustaining transportation during emergencies

Emergencies intensify existing vulnerabilities and create new ones for people in their impact areas. In the case of transportation, for example, disasters have the capacity to isolate individuals from the services on which they rely not for only their health and wellbeing, but for their very lives. This paper discusses the Regional Alliance for Resilient and Equitable Transportation (RARET) — a coalition-based model created to address non-life-saving transportation coordination needs during emergencies. RARET focuses on the provision of lifesustaining transportation, serving vulnerable individuals who may require first-responder assistance if their unaddressed needs remain unmet. Using examples from the COVID-19 pandemic as well as seasonal and regional disasters, the paper highlights how leveraging a coalition built to break down the sector and geographical silos leads to better outcomes for the public and bolsters regional resiliency. The paper underlines how the novel nature of RARET delivers ongoing process improvements via a new emergency transportation provider network. Lastly, the paper suggests methods to adapt this model to other jurisdictions.

A Three-Stage Stochastic Model to Improve Resilience with Lateral Transshipment in Multi-Period Emergency Logistics

Driven by the growing threat of natural disasters caused by climate change, there is an urgent need to strengthen the emergency rescue logistics network. However, insufficient research has been conducted on optimizing both pre-disaster preparation and post-disaster response, resulting in lower resilience and inefficiency of emergency logistics management. To this end, this study explores the optimization of emergency rescue resource allocation and transportation network design, considering the uncertainty and multi-period nature of natural disaster rescue. By employing a lateral transshipment strategy, a three-stage stochastic programming model is established, which aims to balance economic benefits with the need for devastations, thereby enhancing the resilience of the logistics network. Numerical experiments verify the effectiveness of the proposed model with different instances and the performance of the lateral transshipment strategy by comparing it with a two-stage stochastic programming model. Sensitivity analysis is performed on the costs of constructing a depot and the penalties for unmet needs. The analysis yielded valuable insights that can be used to enhance emergency rescue operations, supply chain network design, and logistics network design. The research outcome can benefit emergency responders and logistics professionals in optimizing their operations.

Business Model Innovation for Ambulance Systems in Low- and Middle-Income Countries: “Coordination and Competition”

Several low- and middle-income countries’ emergency transportation systems (ETSs) do not have a centralized emergency number. Instead, they have many independent ambulance providers, each with a small number of ambulances. As a result, ETSs in these contexts lack coordination and ambulances. Using a free-entry equilibrium model, we show that in such decentralized systems, the probability that any given call can be served by at least one ambulance, that is, its coverage, is at most 71.54%, regardless of the ETS’s profitability. We examine three business models that can address the ETS’s lack of coordination and ambulances: (i) a competitor-only business model, where an entrepreneur enters the ETS and acquires ambulances to compete with existing providers; (ii) a platform business model, where an entrepreneur coordinates existing providers; and (iii) an innovative platform-plus business model, where an entrepreneur combines (i) and (ii): setting-up a platform and acquiring platform-owned ambulances. We also examine a government-run platform that takes no commissions from providers. Using a game-theoretic approach, we find that it is optimal for all platform models to incentivize all providers to join. However, only the government-run platform may incentivize providers to acquire additional ambulances. Furthermore, a government-run platform offers higher coverage than a platform-plus only when the platform’s power to coordinate ambulance providers is moderate. Our results can help entrepreneurs and policymakers in LMICs navigate various tradeoffs in improving their countries’ ETS.

The 2024 revision of the Norwegian standard for the safe practice of anaesthesia.

The Norwegian standard for the safe practice of anaesthesia was first published in 1991, and revised in 1994, 1998, 2005, 2010 and 2016 respectively. The 1998 version was published in English for the first time in Acta Anaesthesiologica Scandinavica in 2002. It must be noted that this is a national standard, reflecting the specific opportunities and challenges in a Norwegian setting, which may be different from other countries in some respects. A feature of the Norwegian healthcare system is the availability, on a national basis, of specifically highly trained and qualified nurse anaesthetists. Another feature is the geography, with parts of the population living in remote areas. These may be served by small, local emergency hospitals. Emergency transport of patients to larger hospitals is not always achievable when weather conditions are rough. These features and challenges were considered important when designing a balanced and consensus-based national standard for the safe practice of anaesthesia, across Norwegian clinical settings. In this article, we present the 2024 revision of the document. This article presents a direct translation of the complete document from the Norwegian original.

Predicting the effects of introducing an emergency transport system in low-income and middle-income countries: a spatial-epidemiological modelling study

IntroductionMany low-income and middle-income countries lack an organised emergency transportation system, leaving people to arrange informal transport to hospital in the case of a medical emergency. Estimating the effect of...

Lessons learnt and best practices in scaling up an emergency transportation system to tackle maternal and neonatal mortality: a qualitative study of key stakeholders in Shinyanga, Tanzania

ObjectiveThis study aimed to document lessons learnt and best practices for scaling up an innovative emergency transportation system, drawing insights from the m-mama programme implemented in Shinyanga, Tanzania. The m-mama...

Abstract TP54: Ready to Ride

Background: For stroke patients initially presenting to a primary stroke center with large vessel occlusions (LVO), treatment involves evaluation and subsequent transfer for thrombectomy. Our institution has utilized many of the AHA best practice strategies for improving door-in-door-out (DIDO), though targeting efficiency of the hand-off to the transporting team was not previously targeted. Purpose: This process sought to streamline hand-offs to the transporting team to improve overall DIDO times at our primary stroke center, specifically through decreasing the average transport team arrival to patient departure time. Methods: We identified multiple opportunities for intervention: improved documentation of Emergency Department departure time, standardized communication with transport team, and need for consistent path to helipad. A standard method of communicating transport team estimated arrival was established to ensure readiness of emergency department staff and patient for transport to helipad. A structured report including the required paperwork was created for all transfers between the emergency department providers and transport team. Lastly, a consistent path to the helipad itself was identified. A Mann Whitney Test was used to compare the means of door in to transport departure and transport arrival to transport departure. Transport departure was used as the standard for door out. Results: Mean for door to transport departure pre intervention was 126.47 (STD of 33.13). Post-intervention was 126. 43 with STD of 56.62. This was not significant (p=0.76). Mean for transport arrival to transport departure prior to intervention was 26.72 minutes (STD of 8.44) and post intervention was 19.86 (STD of 16.65). This was significant (p=0.01). Conclusions: Standardizing hand-offs and improving transport efficiency and communication are feasible interventions in overall efforts to improve care delivery and efficiency. Early data suggests these interventions decrease time between transport arrival and door out. Further work is necessary to assess impact on DIDO.

Neonatal Transport Network Services: Preparedness of healthcare systems in Southern Nigeria.

Nigeria remains a major contributor to neonatal deaths worldwide, yet little consideration has been given to intra/inter health facility transfer of sick neonates. The dearth of Neonatal Transport Network Services (NNTS) is probably an underappreciated driver of the abysmally high national neonatal mortality indices. This study aimed to evaluate neonatal transport services and the healthcare workers' preparedness among health facilities in Port Harcourt Metropolis, Rivers State, Nigeria. Twenty-eight selected health facilities (tertiary, private hospitals Primary Health Centers] were assessed on the availability, modality and practice of NNTS. Data was analyzed using SPSS Version 23. Routine transfer of high-risk pregnant mothers to higher levels of care occurred always in 14 (50%) and sometimes in 6 (21.4%) facilities; Private cars and taxis were the most common mode of transport in 24 (85.7%) facilities. Two facilities (7.2%) had ambulances equipped with transport incubators. Nurses and nurse attendants with no formal training in NNTS accompanied referred neonates in 2 (7.2%) facilities. Most referring facilities (78.6%) neither rarely or never contacted receiving centres before the arrival of neonates and most nor gave back referrals after offering neonatal care. None (100%) of the facilities had a trained emergency transport team. Health facilities in Southern Nigeria lack a standardized Neonatal Transport Network and are characterized by poor communication between health facilities and inadequately trained personnel for inter-facility transfer of sick neonates. Urgent action is required to address these gaps, including training of healthcare workers on neonatal transport and sharing findings with relevant stakeholders/policymakers to establish a functional neonatal transport network among health facilities.

An application of BWM for risk control in reverse logistics of medical waste.

The pollution posed by medical waste complicate the procedures of medical waste logistics (MWL), and the increasingly frequent occurrence of public health emergencies has magnified the risks posed by it. In this study, the authors established an index of the factors influencing the risks posed by MWL along five dimensions: the logistics business, emergency capacity, equipment, personnel, and management. The best-worst case method was used to identify the critical risk-related factors and rank them by importance. Following this, we assessed the risk posed by MWL in four major cities in China as an example and propose the corresponding measures of risk control. The results showed that the linking of business processes was the most important factor influencing the risk posed by MWL. The other critical risk-related factors included the location of the storage site, the capacity for emergency transportation, measures to manage emergencies, and the safety of packaging. Of the cities considered, Beijing was found to be a high-risk city, and its MWL needed to be improved as soon as possible in light of the relevant critical risks. Shanghai, Guangzhou, and Shenzhen were evaluated as general-risk cities, which meant that the risks of MWL were not a priority in these areas, and the other goals of urban development should be comprehensively considered during the long-term planning for MWL in these municipalities.

Epidemiology of emergency transport at sports stadiums and facilities in Japan

Epidemiology of emergency transport at sports stadiums and facilities in Japan

Assessing the effect of physical and social parameters on seismic risk of urban transportation networks

In this paper, a comprehensive model is presented to assess the seismic risk of urban transportation networks. Hazard, vulnerability, response capacity and functional components are considered in the proposed model to estimate the risk index of transportation network at each urban zone. The hazard index accounts for both direct and indirect hazards, such as ground motion, landslide and fire. The vulnerability index is evaluated using physical elements (such as bridges, tunnels and pavement) as well as social factors (such as population density and percentage of casualties). The response capacity index is assessed based on the preparedness of response teams and availability of tools and equipment. The functional components comprise physical parameters related to road topology and characteristics, social parameters and the intelligent transportation system (ITS). The proposed model was tested in district 4 of the city of Qom in Iran to estimate the seismic risk level based on local conditions. The effectiveness of short-to long-term interventions for risk reduction also were assessed. The results indicated that road widening and development of emergency transportation network, reducing the risk of landslides and improving the ITS had considerable effects on risk reduction in the study area that can be implemented by long-to short-term interventions. The proposed model provides a practical tool for decision makers to assess and reduce the seismic risk of transportation networks.

Potential prevention of stillbirth caused by placental abruption: a regional population-based study in Japan.

Placental abruption is associated with adverse perinatal outcomes including intrauterine fetal demise, which subsequently results in stillbirth. However, few studies have demonstrated the preventability of stillbirth due to placental abruption. Therefore, we evaluated the possibility of preventing stillbirth caused by placental abruption by reviewing all stillbirths in our region. This study reviewed all stillbirths after 22 weeks of gestation in Shiga Prefecture, Japan from 2010 to 2019, excluding lethal disorders. We evaluated 350 stillbirth cases, with and without placental abruption. There were 32 stillbirths with PA and 318 without placental abruption. The probability of preventing stillbirth was significantly higher in patients with placental abruption than in those without (30% vs. 8%, p < 0.001). We also determined the recommendations for preventing stillbirths with placental abruption. Some stillbirths caused by placental abruption can be prevented. We recommend improvements to perinatal maternal-fetal care and perinatal emergency transport systems.

Emergency transportation for acute alcohol intoxication four years after the coronavirus disease 2019 pandemic: a retrospective observational study.

In a study conducted in Kochi Prefecture, Shikoku, Japan, during the early stages of the pandemic in spring 2020, we found that emergency transportations due to acute alcohol intoxication decreased. We aimed to determine how the decline in the number of emergency transportations due to acute alcohol intoxication changed during the four years following the COVID-19 pandemic's onset. This study used data of 107,013 emergency transportations from the Kochi-Iryo-Net database, Kochi Prefecture's emergency medical and wide-area disaster information system. We categorized emergency transportation cases according to the diagnoses entered into the system by the attending physician, which were then divided into alcohol- and non-alcohol-related intoxication cases based on the diagnostic codes in the International Classification of Diseases Manual, 10th edition, Clinical Modification. We performed chi-square tests and multiple logistic regression to examine the association between emergency transportations and acute alcohol intoxication. The number of emergency transportations due to acute alcohol intoxication was 412 (1.8%) in 2019, and it declined to 268 (1.4%), 248 (1.2%), 270 (1.2%), and 283 (1.3%) in 2020, 2021, 2022, and 2023, respectively. After adjusting for confounding factors such as fire department and age, a significant decrease was observed in the subsequent years compared with 2019 (2020: adjusted odds ratio, 0.79; 95% confidence interval, 0.68-0.93; 2021: adjusted odds ratio, 0.74; 95% confidence interval, 0.63-0.87; 2022: adjusted odds ratio, 0.73; 95% confidence interval, 0.62-0.85; 2023: adjusted odds ratio, 0.76; 95% confidence interval, 0.65-0.89). This study examined changes in emergency transportation due to acute alcohol intoxication during and after the COVID-19 pandemic, especially when social events and other activities returned to "normal." Compared with 2021, which was when emergency transportations due to acute alcohol intoxication were at their lowest, a slight increase was observed in the number of transportations in subsequent years.

Validation of the Saga Fall Injury Risk Model.

Background: Predicting fall injuries can mitigate the sequelae of falls and potentially utilize medical resources effectively. This study aimed to externally validate the accuracy of the Saga Fall Injury Risk Model (SFIRM), consisting of six factors including age, sex, emergency transport, medical referral letter, Bedriddenness Rank, and history of falls, assessed upon admission. Methods: This was a two-center, prospective, observational study. We included inpatients aged 20 years or older in two hospitals, an acute and a chronic care hospital, from October 2018 to September 2019. The predictive performance of the model was evaluated by calculating the area under the curve (AUC), 95% confidence interval (CI), and shrinkage coefficient of the entire study population. The minimum sample size of this study was 2,235 cases. Results: A total of 3,549 patients, with a median age of 78 years, were included in the analysis, and men accounted for 47.9% of all the patients. Among these, 35 (0.99%) had fall injuries. The performance of the SFIRM, as measured by the AUC, was 0.721 (95% CI: 0.662-0.781). The observed fall incidence closely aligned with the predicted incidence calculated using the SFIRM, with a shrinkage coefficient of 0.867. Conclusions: The external validation of the SFIRM in this two-center, prospective study showed good discrimination and calibration. This model can be easily applied upon admission and is valuable for fall injury prediction.

A Home-Visiting Clinic Decreased the Emergency Transportation in Rural Japan: A Quasi-Experimental Approach.

A Home-Visiting Clinic Decreased the Emergency Transportation in Rural Japan: A Quasi-Experimental Approach.

Timeliness and accuracy of the 7-Item Japan Urgent Stroke Triage (JUST-7) score, a prehospital stroke triage tool, assessed by emergency medical services.

The prompt initiation of stroke treatment significantly influences patient outcomes, highlighting the crucial role of prehospital triage. This study aimed to assess the implementation of the 7-Item Japan Urgent Stroke Triage (JUST-7) score by emergency medical services (EMS) in our region and its effect on emergency transportation for suspected stroke patients. Data were collected from patients suspected of having an acute stroke with a Cincinnati Prehospital Stroke Scale (CPSS) score of 1 or more who were transferred by ambulance within 24 h of symptom onset. Two prehospital stroke scales were employed during different periods: period 1 with CPSS alone (January to December 2020) and period 2 with both CPSS and JUST-7 (January 2021 to March 2023). On-scene time data were obtained from the EMS crews, and data regarding the final diagnosis of patients and their outcomes were obtained from the respective hospitals to which the patients were transferred. These data were compared between periods 1 and 2 and between the CPSS and JUST-7. The results revealed that additional evaluation with JUST-7 did not affect ambulance transport time. The CPSS+JUST-7 approach demonstrated higher specificity in identifying stroke and major artery occlusion than with the CPSS alone; however, an appropriate cut-off value needs to be considered. The JUST-7 achieved a diagnostic concordance rate of 35.9% for the most likely stroke type and 64.0% for the first two most likely types. This research emphasizes the potential of JUST-7 as a valuable addition to prehospital stroke diagnosis protocols. Its flexibility in adapting cut-off values based on regional factors and available medical resources optimizes its utility in diverse healthcare settings. The JUST-7 score is a promising tool for improving patient outcomes through prompt and accurate prehospital assessments.

Identifying and prioritising barriers to injury care in Northern Malawi, results of a multifacility multidisciplinary health facility staff survey.

The burden of injuries globally and in Malawi is substantial. Optimising both access to, and quality of, care in health systems requires attention. We aimed to establish how health facility staff in Karonga, Malawi, perceive barriers to seeking (delay 1), reaching (delay 2) and receiving (delay 3) injury care. We conducted a cross-sectional survey of health facility staff who treat patients with injuries in all health facilities serving the Karonga Demographic Surveillance Site population. The primary outcome was participant perceptions of the importance of delays 1 to 3 following injury. Secondary outcomes were the barriers within each of these delays considered most important and which were considered the most important across all delays stages. 228 staff completed the survey: 36.8% (84/228) were female and 61.4% (140/228) reported being involved in caring for an injured person at least weekly. Delay 3 was most frequently considered the most important delay 35.1% (80/228), with 19.3% (44/228) and 16.6% (38/228) reporting delays 1 and 2 as the most important respectively; 28.9% (66/228) of respondents either did not know or answer. For delay 1 the barrier, "the perceived financial costs associated with seeking care are too great", was considered most important. For delay 2, the barrier "lack of timely affordable emergency transport (formal or informal)" was considered most important. For delay 3, the barrier, "lack of reliably available necessary physical resources (infrastructure, equipment and consumable material)" was considered most important. When considering the most important overall barrier across all delays, the delay 3 barrier, "lack of reliably available necessary physical resources" received the most nominations (41.7% [95/228]). Given the awareness of health facility staff of the issues facing their patients, these findings should assist in informing health system planning.