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Impact of two-level filtering organization on population’s accessibility to an emergency medical communication centre
Background
Emergency Medical Communication Centres (EMCCs) play a critical role in the timely coordination of out-of-hospital emergency responses. As demand for emergency services continues to rise, these centres face significant challenges in maintaining operational efficiency and service quality in order to provide a priority response to life-threatening emergencies. While the two-level answering system – i.e. a two-tiered response by call takers – has shown promise in simulation studies, its effectiveness in real-world settings has yet to be fully evaluated.
Objective
This study aimed to assess the impact of implementing a two-level answering system on service quality (rate of answered calls) at 30 s (QS30) across three EMCCs, marking the first evaluation of this system in everyday operations. We also investigated how variations in organizational structure among the EMCCs may influence QS30.
Methods
We conducted a multicentric, observational, retrospective study analyzing call data collected between May and June of 2022 and 2023, in France. Three EMCCs—35, 44, and 86—were included, with EMCCs 35 and 44 having implemented the two-level system, while EMCC 86 served as the control. Each EMCC employed distinct organizational models for the two-level system. Key performance indicators were assessed using non-parametric statistical tests, including the Wilcoxon and Kruskal-Wallis tests. Additionally, structural equation modeling was used to explore relationships between variables affecting service quality.
Results
A total of 255,438 calls were analyzed, with 152,108 calls during the two-level period. The QS30 for EMCC 35 ranged from 93% in 2022 to 91% in 2023 (
p
< 1e-4), while EMCC 44 saw an increase from 91 to 100% (
p
< 1e-4). In contrast, EMCC 86 maintained a stable QS30 of 100%, with no significant change in activity (
p
= 0.1). Further analysis revealed significant differences in QS30 across the three EMCCs, suggesting that the distinct organizational structures of the two-level systems influence overall service quality. Structural equation modeling also highlighted strong correlations between call volume, agent workload, and QS30, emphasizing the impact of staffing and organizational structure on service quality.
Conclusion
The findings suggest that the two-level answering system may be effective in enhancing EMCC performance, particularly in managing increased call volumes. Additionally, the study highlights the potential importance of organizational differences in shaping QS30 outcomes. Future research should focus on longitudinal effects and explore innovative strategies to sustain high-quality EMCCs amidst evolving demands.
Journal Article
Effective writing for social work : making a difference
This textbook, aimed at students in the field of social work practice, is designed to help them to understand the importance of good writing and to give them the tools they need to write well. It explores the ways in which both students and practicing social workers can be more effective in their writing through an awareness of the purpose, context, and audience for their work. It also highlights the differences between classroom writing assignments and workplace writing as well as the effects that new technologies have had on both academic and professional writing.
Book
Technical requirements framework of hospital information systems: design and evaluation
Background
Implementing the health information system (HIS) is more complex and costly than implementing other information systems. The present study was conducted to design and evaluate technical requirements for the HIS.
Methods
The present study was conducted in 2016 by determining technical requirements for the HIS using the Delphi technique and then evaluating this system using a checklist based on the approved requirements.
Results
The first part of the study designed a 73-item final list of technical requirements for the HIS in four domains, i.e. communication service, system architecture, security service and system response time. The evaluation results obtained in the second part showed that communication service was met in 63.8% of the HIS programs, system architecture in 65.5%, security service in 72.4% and system response time in 76.3%.
Conclusions
A technical evaluation tool was designed and used to select and evaluate the HIS. The evaluation results suggested the study HIS was poorer in terms of communication service and system architecture than in the other two dimensions.
Journal Article
Hacking 9-1-1: Infrastructure Vulnerabilities and Attack Vectors
9-1-1 call centers are a critical component of prehospital care: they accept emergency calls, dispatch field responders such as emergency medical services, and provide callers with emergency medical instructions before their arrival. The aim of this study was to describe the technical structure of the 9-1-1 call-taking system and to describe its vulnerabilities that could lead to compromised patient care. 9-1-1 calls answered from mobile phones and landlines use a variety of technologies to provide information about caller location and other information. These interconnected technologies create potential cyber vulnerabilities. A variety of attacks could be carried out on 9-1-1 infrastructure to various ends. Attackers could target individuals, groups, or entire municipalities. These attacks could result in anything from a nuisance to increased loss of life in a physical attack to worse overall outcomes owing to delays in care for time-sensitive conditions. Evolving 9-1-1 systems are increasingly connected and dependent on network technology. As implications of cybersecurity vulnerabilities loom large, future research should examine methods of hardening the 9-1-1 system against attack.
Journal Article
Megaphone bureaucracy : speaking truth to power in the age of the New Normal
\"Once relegated to the anonymous back rooms of democratic debate, our bureaucratic leaders are increasingly having to govern under the scrutiny of a 24-hour news cycle, hyperpartisan political oversight, and a restless populace that is increasingly distrustful of the people who govern them. Megaphone Bureaucracy reveals how today's civil servants are finding a voice of their own as they join elected politicians on the public stage and jockey for advantage in the persuasion game of modern governance. In this timely and incisive book, Dennis Grube draws on in-depth interviews and compelling case studies from the United States, the United Kingdom, Australia, Canada, and New Zealand to describe how senior bureaucrats are finding themselves drawn into political debates they could once avoid. Faced with a political climate where polarization and media spin are at an all-time high, these modern mandarins negotiate blame games and manage contradictory expectations in the glare of an unforgiving spotlight. Grube argues that in this fiercely divided public square a new style of bureaucratic leadership is emerging, one that marries the robust independence of Washington agency heads with the prudent political neutrality of Westminster civil servants. These \"Washminster\" leaders do not avoid the public gaze, nor do they overtly court political controversy. Rather, they use their increasingly public pulpits to exert their own brand of persuasive power. Megaphone Bureaucracy shows how today's senior bureaucrats are making their voices heard by embracing a new style of communication that brings with it great danger but also great opportunity\"-- Provided by publisher.
Book
Investigating usability of mobile health applications in Bangladesh
Background
Lack of usability can be a major barrier for the rapid adoption of mobile services. Therefore, the purpose of this paper is to investigate the usability of Mobile Health applications in Bangladesh.
Method
We followed a 3-stage approach in our research. First, we conducted a keyword-based application search in the popular app stores. We followed the affinity diagram approach and clustered the found applications into nine groups. Second, we randomly selected four apps from each group (36 apps in total) and conducted a heuristic evaluation. Finally, we selected the highest downloaded app from each group and conducted user studies with 30 participants.
Results
We found 61% usability problems are catastrophe or major in nature from heuristic inspection. The most (21%) violated heuristic is aesthetic and minimalist design. The user studies revealed low System Usability Scale (SUS) scores for those apps that had a high number of usability problems based on the heuristic evaluation. Thus, the results of heuristic evaluation and user studies complement each other.
Conclusion
Overall, the findings suggest that the usability of the mobile health apps in Bangladesh is not satisfactory in general and could be a potential barrier for wider adoption of mobile health services.
Journal Article
Elvis and the underdogs
All his life Benji, now ten, has been sickly and he has long been targeted by the school bully, but after a seizure Benji gets a therapy dog that is not only big enough to protect him, it can also talk.
Book
An expected coverage model with a cutoff priority queue
Emergency medical services provide immediate care to patients with various types of needs. When the system is congested, the response to urgent emergency calls can be delayed. To address this issue, we propose a spatial Hypercube approximation model with a cutoff priority queue that estimates performance measures for a system where some servers are reserved exclusively for high priority calls when the system is congested. In the cutoff priority queue, low priority calls are not immediately served—they are either lost or entered into a queue—whenever the number of busy ambulances is equal to or greater than the cutoff. The spatial Hypercube approximation model can be used to evaluate the design of public safety systems that employ a cutoff priority queue. A mixed integer linear programming model uses the Hypercube model to identify deployment and dispatch decisions in a cutoff priority queue paradigm. Our computational study suggests that the improvement in the expected coverage is significant when the cutoff is imposed, and it elucidates the tradeoff between the coverage improvement and the cost to low-priority calls that are “lost” when using a cutoff. Finally, we present a method for selecting the cutoff value for a system based on the relative importance of low-priority calls to high-priority calls.
Journal Article