Organization Of Medical Services Research Articles

Oleg Konstantinovich Bumay (in memory of a teacher, colleague, comrade)

January 1, 2024 marked the 70th anniversary of the birth of the former head of the organization and tactics of the medical service of the fleet (with a course of tactics and combat weapons of the fleet) department of the S.M. Kirov Military Medical Academy, effective director for modern topics of the Federal State Budgetary Institution Research Institute of Industrial and Marine Medicine FMBA of Russia, candidate of medical sciences, associate professor Oleg Konstantinovich Bumay (1954–2022). O.K. Bumay was born in the village of Bogudenka, Belarus. He was alumnus the faculty of training doctors for the Navy of the S.M. Kirov Military Medical Academy. After graduating from the academy in 1977, for a decade he provided and organized medical support for nuclear submarines as the head of the ship’s medical service, the cheef of medical a submarine forces in the Northern Fleet, and subsequently served as a senior medical officer in the Baltic Fleet. Over the course of two decades, O.K. Bumay was associated with the organization and tactics of the naval medical service (with a course of tactics and combat weapons of the fleet) department of S.M. Kirov Military Medical Academy. In 1991, he entered the adjunct program at the department; upon completion of his studies, he was appointed as a teacher, subsequently as a senior teacher, and since 2009 — deputy head of the department. He received the rank of Philosophy doctor of Medical Sciences (1994), associate professor (1998). After leaving the Armed Forces of the Russian Federation in 2007, he continued his career as deputy director for special topics at the Federal State Budgetary Institution Research Institute of Industrial and Marine Medicine of the Federal Medical and Biological Agency of Russia. O.K. Bumay developed origins medical support system for the domestic nuclear submarine fleet. Was appointed on the post the head of the ship’s medical service and after that officer of the command-and-control body of an operational-tactical formation. Throughout their career he left a multifaceted scientific and practical legacy, which is used by new generations of naval doctors.

Advanced-level paramedic perspectives on competence requirements for responding to radiological/nuclear incidents

The threat of chemical, biological, radiological, and nuclear (CBRN) incidents has been a topic of increasing concern in recent years, and the need for increasing preparedness and competence among the first responder professions is widely recognized. This qualitative study explored advanced-level paramedic perspectives on competence requirements for responding to radiological/nuclear (R/N) incidents. This study utilized reflective essays (n = 26) written by advanced-level paramedics after familiarizing themselves with a fictional accidental nuclear power plant incident scenario. The material was analyzed using inductive content analysis. Three main categories were found: 1) Awareness of operating in multi-authority RN incidents, 2) Consideration of occupational safety, and 3) Competence in emergency care nursing and management during RN incidents. The results can be utilized for enhancing the competence management and training provision of Emergency Medical Services organizations.

Methodological Approaches to Assessing the Quality of Life of Older People in Russia

The paper presents the core findings of a study on improving methodological approaches to adequate assessment of dynamics of the quality of life of older people in Russia. The author has identified challenges in implementing some international recommendations on the topic thereon. These challenges resulted from differences in the socio-economic development of the Russian Federation and its ethnocultural traditions. The article defines domestic information and statistical base for studying the quality of life of the population, in particular, the older population.The author describes a system of basic indicators that includes key measures of health status of older people, their financial security and economic activity. Based on the proposed approach and official statistics, the situation with the older generation in Russia in 2010–2020 is analyzed. An assessment is made of the significance of both positive trends in improving the quality of life in the older generation (increased life expectancy, improved health, increased economic activity of the population aged 60 years and older), as well as unresolved problems, primarily, relatively low level of pensions compared to the subsistence level and high degree of interregional differentiation of pensions.The paper concludes with proposals concerning directions and sequence of organizational and financial measures aimed at improving the quality of life of pensioners, proposed by the author, based on specific results of statistical analysis. Among the top priorities are: indexation of pensions for non-working pensioners ahead of the inflation rate, indexation of pensions for working pensioners at 1/2 of the inflation rate, registration and, if necessary, organization of medical and social services for older citizens living alone.

Private Equity Investment in Surgical Care.

To characterize the extent of private equity investment affecting surgical care. Over the last decade, investor-backed, for-profit private equity groups have invested in healthcare at an unprecedented rate, but the breadth of these investments affecting surgical practice remains largely unknown. Four nationally representative databases were used to identify all merger/acquisitions involving surgical practices between 2015-2019, determine private equity investment in those transactions, and link the acquisitions with a physician dataset. 1,542 unique transactions were identified, of which 539 were financed by private equity. 58 transactions were then classified into their respective categories within surgical care: digestive disease, orthopedics, urology, vascular surgery, and plastic/cosmetic surgery. These transactions accounted for 199 practice sites and 1,405 physicians, averaging 24.2 physicians per transaction. Acquisition activity peaked in 2017 with a total of 63 practices involved. Digestive disease, urology, and orthopedic surgery accounted for the most activity. General surgeons were involved in a small share of the digestive disease practice acquisitions. Three "surgery-adjacent" categories were also identified: anesthesiology, ambulatory surgery centers, and surgical staffing firms. Among these, anesthesia was the largest category in terms of practices (194) and physicians (2,660) involved in transactions across the study period. Medical Service Organizations (MSOs) were a key mechanism through which private equity firms invested in surgical care. Private equity has engaged in substantial investment within surgical specialties, creating increased practice consolidation. These investments affect all levels of medical care and have notable implications for patients, practitioners, and policymakers.

Learning Lessons for Future Preparedness: Exploring Work Well-Being-Related Leadership Challenges among Paramedics during the Early Stage of the COVID-19 Pandemic-A Qualitative Study.

The beginning of the COVID-19 pandemic majorly impacted the population and public services. In Finland, a state of emergency was declared to ensure the security of healthcare resources, and prehospital emergency medical service (EMS) organizations faced emergency conditions for the first time. This study explores the leadership challenges related to well-being experienced during the early phase of the pandemic. This qualitative study utilized reflective essay material written between August and November 2020 by experienced advanced-level paramedics (n = 30) who participated actively in EMS fieldwork at the beginning of the pandemic. The material (32,621 words) was analyzed with inductive content analysis. The work well-being-related leadership challenges experienced by paramedics during the early phase of the pandemic were divided into four upper categories: inadequate guidance, workplace reorganization, atmosphere mismanagement, and insufficient resources to cope. These upper categories were comprised of 17 subcategories. Several actions can be taken to enhance personnel well-being and prepare for similar challenges. Guidance and support should be clear and timely. Visible leadership should be emphasized and enhanced with modern communication. Efforts should be made to strengthen the work atmosphere to support those on the front lines of healthcare. This study was not registered on a publicly accessible registry.

Creation and Establishment of the State Emergency Medical Services and Disaster Medicine Services in Russia (to the 100th Anniversary of the N.V. Sklifosovsky Research Institute for Emergency Medicine)

After the October Revolution of 1917, the creation of the state healthcare and medical education system in the country played a decisive role in the organization of emergency medical services (EMS) in Moscow on the basis of the former Sheremetev Hospital which later became a large multidisciplinary medical institution — N.V. Sklifosovsky Institute of Emergency Medicine (since 1943 — N.V. Sklifosovsky Research Institute for Emergency Medicine), — and the city EMS station as a part of it.In the pre-war period, the working out of the main principles for the EMS provision was critically important for the development of the services. It became possible to solve scientific and methodological problems related to the training of specialists. The Institute grew into a large institution, research in the field of emergency medicine was carried out at the world level. This contributed to the organization of a network of EMS institutions in the country during 1926–1935.The years of the Great Patriotic War of 1941–1945 enriched the practice of providing emergency medical care, including during mass patient admission.In the post-war years (1946–1970s), the Institute became the leading institution on the problems of EMS in the country. Corresponding divisions were created within the Institute, and on its basis — “Emergency Medicine” scientific and practical association, research and organizational structures of the USSR Ministry of Health, the RSFSR Ministry of Health and the USSR Academy of Medical Sciences. Thanks to this, outstanding results were achieved in the EMS organization: the specialty of “emergency medicine physician” was introduced; emergency hospitals were created in a number of the country’s regions; government programs for EMS provision were successfully implemented; а large number of regulatory documents were prepared to facilitate the further EMS development.N.V. Sklifosovsky Research Institute for Emergency Medicine was among the main initiators of the disaster medicine service, which made it possible to fundamentally solve its organizational and technical problems. Thus, a significant contribution was made to the foundation of this service in Moscow and around the country.At the current stage (from 1992 to the present), EMS improvement has been continued, many developments turned out to be relevant for this services in the Russian Federation. In particular, the created structure of the Institute’s admission and intensive care unit remained the flagship among emergency care institutions in the country for about 20 years. The state program “Improving medical care for road accident victims” was successfully implemented. The Institute’s departments are being actively specialized, making it possible to obtain fundamentally new scientific and practical results for widespread implementation.Since 2011, “Scientific achievements in the field of emergency medical care in the Russian Federation” - collections of research works - have been published annually. The information presented in them can be used throughout the country.The experience in treatment for the novel coronavirus infection COVID-19 allowed the Institute to begin a new page in the history of emergency medical services.The recent opening of an emergency inpatient complex at the Institute contributed to optimizing the work of the hospital’s resuscitation and intensive care units and expanding their treatment and diagnostic capabilities.For more than 10 years, the public and consolidating activities of the scientific and practical society of emergency medicine specialists have been effective. Its work primarily concerns the organization and conduct of scientific and practical events, especially congresses of emergency medicine physicians, as well as the publication of Sklifosovsky Journal Emergency Medical Care, which has unifying significance for a large number of Russian specialists in the field of EMS. The decisions made at the congresses and conferences became the basis for expanding the introduction of advanced medical technologies in the Russian regions, as well as for carrying out important structural reforms in EMS institutions.One of the main achievements of the N.V. Sklifosovsky Research Institute for Emergency Medicine is the creation of the state EMS as a separate branch of healthcare in the country. Over the 100 years of the Institute’s activity, the foundations of its theory and practice have been developed, moreover, a contribution of world significance was made to the EMS development, thereby strengthening the scientific foundation for the activities of the Institute for many years to come.

FLORENCE NIGHTINGALE – THE MONUMENT OF HUMANITY IN THE CRIMEAN WAR 1853.-1856.

Background: Ms. Florence Nightingale (F.N.) has been recognized as the founder of modern nursing. She had a prominent role in organizing the medical service for the British army in the Crimean War. Aim: The goal of the research was to determine the role and contribution of F.N. to the medical service during the Crimean War, her original organizing arrangements, and novel treatment modalities in the setting of a mass casualty situation. The impact of her war experience on her psychological condition has been assessed. Methodology: The research was done through a review of the historical documents, considering the work and the role of F.N. in the British Army medical service during the Crimean War. Result: The passionate work of F.N. in the field hospital earned her the nickname Angel of Crimea. She introduced novel methods of nursing and sanitation that reduced the mortality rate in the British Army by 70%. However, after the war, on her return home to England, she showed mood changes consistent with what is nowadays known as posttraumatic stress disorder. Conclusion: Engagement in the medical service during the war carries the inevitable risk of the development of posttraumatic stress disorder. This should be considered a real and obvious threat for medical personnel involved with the treatment of the injured during the war, i.e., the mass casualty situation. The contribution of F.N. to the organization and efficacy of the military medical service of the British Army has been discussed.

Trusted sources for COVID-19 testing and vaccination: lessons for future health communication

ABSTRACT Background Promoting COVID-19 vaccination (both the primary series and boosters) remains a priority among healthcare professionals and requires understanding the various sources people trust for acquiring COVID-19 information. Method From October 2021 to May 2022, we interviewed 150 people who called 2–1–1 helplines in Connecticut and North Carolina about their COVID-19 testing and vaccination experiences in order to (1) better understand where people obtain trusted COVID-19 health information and (2) identify how public health professionals can share emergency health information in the future. We used a mixed methods approach in which semi-structured qualitative interviews and survey data were collected in parallel and analyzed separately. Results Participants were mostly female (74.0%), Black (43.3%) or White (38.0%), and had a high school degree or higher (88.0%). Most had prior COVID-19 testing experience (88.0%) and were vaccinated (82.7%). A variety of information sources were rated as being very trustworthy including medical professionals and social service organizations. We found that repetition of information from multiple sources increased trust; however, perceived inconsistencies in recommendations over time eroded trust in health communication, especially from government-affiliated information sources. Observations such as seeing long lines for COVID-19 testing or vaccination became internalized trusted information. Conclusions Public health professionals can leverage the reach and strong community ties of existing, reputable non-government organizations, such as physician groups, schools, and pharmacies, to distribute COVID-19 information about vaccination and testing.

The ‘Accountability Factor’ as a Predictor of Medical Group Leadership Culture

Physician leaders interested in approaching organizational culture from the perspective of “accountability” are encouraged to begin with quality of care and the patient experience. The “accountability factor,” an item in the CulturePulse© leadership culture evaluation tool, is a strong predictor of how providers and staff perceive the overall condition of the leadership culture of medical services organizations.

Territorial Organization of Medical Care for the Rural Population on the Example of Russia

This article discusses the features of the territorial organization of medical services for the rural population of Russia, taking into account the development of new technologies and the use of these services during the period of the Covid 19 coronovirus infection pandemic. The foreign experience of some countries in the provision of medical services to rural residents at the present stage is analyzed. In particular, what measures are being taken in different countries to improve the provision of primary health care to the rural population, including how telemedicine is used in different regions of the world for this and historical, social-economic and natural factors of the territorial differences in medical care for the rural population in Russia. Among the socio-economic factors, special attention is paid to regional differences in the system of population resettlement, population density, and the level of economic development of the regions. The authors also present regional differences in the development of telemedicine in rural areas of Russia.

Organizational factors influencing clinical reasoning in a Swedish emergency medical service organization: An explorative qualitative case study

Introduction Clinical reasoning (CR) among healthcare professionals working in emergency medical services (EMS) who focus on ambulance care is a vital part of ensuring timely and safe patient care. The EMS environment continually fluctuates, so clinicians constantly need to adapt to new situations. Organizational support is described as important for CR, but overall, research on organizational influences for CR in an EMS context is lacking. An increased understanding of these influencing factors can assist in the development of EMS by strengthening CR among clinicians. Therefore, the purpose of this study was to investigate the organizational factors influencing EMS clinicians’ CR. Methods Using a qualitative single case study design, an EMS organization in southwestern Sweden was explored. Data were collected from participant observations of patient encounters, individual and group interviews with clinicians and organizational representatives, and organizational document audits. Data were analyzed using qualitative content analysis and triangulation of data sources. Results The results revealed several organizational influencing factors. Collaboration and information sharing internally and externally were emphasized as essential components influencing CR. Additionally, the structure for the clinicians’ ‘room for action’ appeared confused and created uncertainties for CR related to decision mandates. Conclusion The conclusion is that organizational factors do play an important role in clinicians’ CR. Moreover, the EMS community needs to develop suitable forums for discussing and developing these influencing factors across organizational hierarchies. Finally, clarification is needed on clinicians’ ‘room for action’ within their own organization but also with possible collaborators.

Organization of medical service for the population of Kabardino-Balkaria during the Great Patri-otic war

Organization of medical service for the population of Kabardino-Balkaria during the Great Patri-otic war

Standards of Medical Planning and Response for Emergency Medical Teams During Mass Gatherings: A Systematic Review

Introduction:Mass gathering events (MGE), organized or unplanned, can attract sufficient attendees to strain the planning and response resources of the host community, state, or nation, thereby delaying the response to emergencies. MGEs also have the potential to cause a mass casualty incident. But MGE can also lead to improvements in the organization of local emergency medical services or public health that form the legacy of that MGE. Emergency medical teams (EMTs) could be deployed to ensure health security as a surge in MGE. But these EMTs should be built on guiding principles and core standards. However, to the best of our knowledge, there are no standards on medical planning and response during any type of MGE (e.g., sports, religious, or festivals).Method:A systematic review was performed in accordance with current guidelines, using six databases, namely Medline (via the PubMed interface), Scopus, Embase, Cochrane Library, ScienceDirect, and CINAHL, as well as literature sourced by Google Scholar and The Journal of Prehospital and Disaster Medicine. Studies published on minimum standards or medical planning and response during MGE from 2002-2022, written in English, were selected and assessed for eligibility by two reviewers.Results:From a total of 20,159 articles, 138 were screened, and 32 were assessed for eligibility. Two were only abstracts, and the others did not contain any description of minimal standards available for medical planning or response in different types of MGE.Conclusion:No studies were found that describe any form of standards for medical planning and the response of emergency medical teams in different types of mass gathering events (e.g., sports, religious, festivals). There is a need for minimum standards for emergency medical teams deploying as a surge in mass gathering events.

Challenges of implementing diagnostic-related groups and healthcare promotion in Iran: A strategic applied research.

Implementing the diagnostic-related groups (DRGs) promotes the efficiency of healthcare. Therefore, the present study aimed to identify the challenges facing implementing the DRGs in Iran. The present study is a strategic applied research conducted in two phases. In the first phase, the challenges facing DRGs were extracted through a literature review. Then the collected data is entered into a checklist consisting of five sections including technological, cultural, organizational, strategic, and natural challenges. In the second phase, data were collected by purposive sampling and semistructured interviews with 10managers of the Medical Services Organization of Tehran, Iran. Data analysis was performed by conventional content analysis using MAXQDA software and descriptive using SPSS software version 19. The challenges facing the implementing DGRs from the experts'perspective included technological, organizational, nature, strategic, and cultural in order of priority. The three main fundamental challenges were reported; lack of integrating the DGRs with health information system(70%),frequent changes of management (70%),reducing the quality of care following early patient discharge (60%). The results of the present study showed that the DRG system faced with challenges and healthcare officials should apply policies and guidelines to reform the system before changing the reimbursement system in Iran. By considering the leading countries experiences in the nationalizing the DRG system field, the problems and solutions of the system can be identified and aid in the more successful implementation of these systems.

ON ISSUE OF HIGH-QUALITY STOMATOLOGICAL SERVICE IN UKRAINE.

The aim: To detect the main problems regarding available high-quality stomatological service in Ukraine and define their main solutions. Materials and methods: The authors used general scientific methods of synthesis, generalization, scientific data interpreting, systemic approach method, medical statistic method, and analysis of the activity of state and private institutions dealing with stomatological service in Ukraine. The paper is based on the materials of a representative selective study of Ukrainian households, held by the State Committee of Statistics of Ukraine to study people's self-estimation of their health and the availability of certain medical services. Results: Most citizens of Ukraine (60-80%) are treated in the state/public healthcare sector. Though, during the last century, a decrease in dental visits per citizen in the state and public institutions has been noted, as well as a decrease of all medical service types' volume, offered in the mentioned institutions. In Ukraine the observed trends are represented as the decrease in the network institutions number, insufficient budgeting of state/public medical institutions, prevailing commercial characteristics of stomatological service and people's low income, which leads to decreased affordability, and quality of medical service, thus negatively affecting people's health. Conclusions: The fundamental studies of the quality assessment show that the medical service requires strong structure, process quality, and result quality. The quality of medical service organization is extremely important and it should be maintained high on all levels of management and treatment processes, regarding the conditions of medical process and resources of medical organizations. Medical service should be patient-centered. To solve the problem, the entire state system of quality management is required in Ukraine.

Regulation Of Medical Activity In Russia And Europe In The 10th – Early 20th Centuries: Correlation Between Ethical And Legal Principles

The legal and ethical regulation of medical activity in Russia vs. European countries has common features and a number of specific differences. The regulation of medical activity in the Old Russian state and European medieval states was carried out within the framework of legal norms and Christian worldview, the main principle of which was service to one’s neighbor. For instance, these were ethical issues that came to the fore. The secular state form, began its historical path with the emergence of the first secular doctors at the courts of ancient Russian princes. From the 16th century on, it became part of the state apparatus extending its influence to the social estate of the military servicemen. In the middle of the 19th century, during the period of the Zemstvo Reform, it became the main form of servicing rural population. The specificity of zemstvo medicine was the organization of medical activities based on of local self-government bodies and medical societies. At the beginning of the 19th century, with the increasing complexity of scientific knowledge and organization of medical services, European medical codes of ethics aimed at developing the rules of conduct to be followed by the members of newly emerging national medical associations. Despite regulating medical activity, the issues of healthcare were not given due attention, and there were no specific legislative acts affecting the health care regulation in prerevolutionary Russia. In Europe, too, for a long time, the responsibility of a medical professional for mistakes was considered from the standpoint of private relationships based on contractual and commercial principles.

FILE OF LIFE: OLDER ADULT PERSPECTIVES AND SUGGESTIONS TO INCREASE FOL USAGE

Abstract IntroductionIn a home emergency, an accurate patient medical history is vital for proper medical decision-making. One method to provide medical information in an emergency is through the FILE OF LIFE™ (FOL); a document distributed by local medical centers and public service organizations completed by community adults and placed on their refrigerator in a magnetic folder. To date, there was no known study, until this one, conducted with older adults to check the FOL design suitability for older adults; the goal of this project. MethodsOlder adults were recruited through the UNE COM Geriatrics Education Mentor (GEM) program for this pilot qualitative research. Twenty-one GEMs volunteered to participate in five 90-minute focus groups. Questions were specific for each section - Patient Identifiers, Emergency Contacts, Medical Data, Medical Conditions, Allergies, and Medical Insurance Information, and the usability of the FOL. Qualitative content analysis followed by NVivo 12+ analysis applied inter-rater reliability methods and changes for each FOL section were based on reaching data saturation. ResultsFILE OF LIFE™ comments (N=328) were coded to the following themes: Layout, Font Size, Spacing, and Section Ordering. Sections were edited accordingly with “Identifiers,” Medical Data, Medical Conditions, Allergies, and Emergency Contacts requiring substantive changes. Other minor changes were made throughout the form. ConclusionFurther research will ensure efficient usability by older adults and emergency response personnel. The FILE OF LIFE™, although a trusted resource for older community dwelling residents, has a chance to increase usability by incorporating the suggested changes from this research.

Organization of air medical service in the Republic of Crimea

The article presents an analysis of the activities of the Department of Emergency Advisory Medical Care and Medical Evacuation of the Territorial Center of Disaster Medicine of the Republic of Crimea for the period 2019–2021 in the issues of sanitary and aviation evacuation of patients, as well as victims in emergency situations. In general, over the past three years, 207–238 departures have been carried out annually with the transportation of 203–258 patients by one full-time aviation resuscitation team of the Territorial Center of Disaster Medicine with the involvement of other specialists, if necessary. For the first time, the feature of professional activity in the «flight crew — aviation medical team» system is revealed. The training of the aircraft crew (pilot, navigator) on the basics of medical evacuation is proposed. Also, in order to optimize the activities of the specialists in aviation medical teams during the flight, it is recommended to conduct instructor trainings and simulators on the rules of operation of on-board medical equipment on the ground.

Experience in implementing a patient-centered approach in a private medical organization

Currently, taking into account the pronounced competition among modern medical organizations, attracting patients and forming a high degree of their loyalty requires significant efforts both in the field of ensuring the quality of medical services provided, and in the field of full implementation of legally enshrined patient rights, compliance with ethical and deontological norms, the formation of effective communication and integration processes between employees of a medical organization and patients and/ or their relatives, and in the context of the activities of a private medical organization, special work is also largely required to optimize the main business processes. All the activities described above are united by the concept of «patient-centered approach».Purpose of the study. To increase the degree of satisfaction of patients with the organization of medical care through the introduction of a patient-centered approach.Materials and methods. This study was undertaken using methods of analysis and synthesis, experiment and sociological measurements (questionnaires, qualitative interviews of 64 patients and 10 employees), included the study and generalization of specialized research and practical experience, work with local regulatory documents.Results. Сomprehensive work on the introduction of patient-centered principles into the activities of a medical organization had a positive impact on both the degree of patient satisfaction with the organization of medical services provided and on the assessment of modified working conditions by employees of a medical organization.Conclusion. Сonstructive optimization of the activities of a medical organization through the introduction of patient-centered principles should be carried out using an integrated approach based on international experience using project management, risk management and patient-orientation methodologies. To determine the main areas of activity and monitor the effectiveness of implemented measures, the most appropriate, relevant tools are internal audit and conducting a patient survey.

The Crowd Crush at Mount Meron: Emergency Medical Services Response to a Silent Mass Casualty Incident.

On April 30, 2021, a total of 45 died and 112 were injured in a crowd crush at a religious festival on Mount Meron, Israel. Unlike a bomb blast, building collapse, mass shooting, or stampede, the incident lacked a dramatic, noticeable trigger and may be termed a "silent mass casualty incident (MCI)." This may have resulted in a slight delay in response. Magen David Adom (MDA)-Israel's National Emergency Medical Services Organization-was the main prehospital response to the MCI. MDA's intense planning, organization of medical infrastructure, and on-site MCI drill before the event allowed for the rapid, coordinated treatment and evacuation of casualties by ambulance and helicopter. The use of volunteers facilitated an effective response to the event. A "rolling reinforcement" system of ambulances helped treat and transport those at the scene while placing staff at stations throughout the country to serve routine emergency calls.