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Background The World Health Organization Emergency Care Systems Framework (WHO ECSF) was designed to offer guidance in establishing and developing effective Emergency Medical Services (EMS) systems. However, evolving disease patterns, changing community needs, and a rising demand for emergency care services, highlight the need for more integrated and patient-centered EMS systems. This evolution should be mirrored in the WHO ECSF. Hence, this study explores system components of the Copenhagen (CPH) EMS that may enhance the WHO ECSF´s emphasis on integrated and patient-centered care. Methods A qualitative case study was conducted from April through June 2021, including (i) semi-structured interviews with researchers and professionals at the CPH EMS and (ii) a scoping literature review using PubMed, Google Scholar, expert recommendations and snowballing. Results Thirteen expert interviews and 35 records were analyzed, revealing key integrated care components within the CPH EMS. These include education and citizen participation programs, early triaging, differentiated care pathways coordinated with primary care and out-of-hours services, and specialized mobile care units complementing “traditional” ambulance services. Technology supports integrated and patient-centered care by facilitating early differentiation of care, efficient dispatching, and communication. Data-driven approaches were fostered through technology-aided data collection, supporting research, quality improvement, and patient safety. The identified components were mapped within the WHO ECSF´s four domains: scene, transport, facility, and cross-cutting elements. Due to the prehospital focus of the CPH EMS, limited data was available for the “facility” site. Conclusions The CPH EMS demonstrates an integrated, patient-centered systems approach that emphasizes seamless coordination along the patient care pathway, bridging EMS with broader health and social systems. Research-informed initiatives and intelligent technology solutions underscore the potential for enhancing the WHO ECSF. These findings highlight the importance of continued system integration and a holistic health perspective, including in emergency settings. Further research is needed to assess the transferability of these components across diverse global contexts. Trial registration Not applicable.

Objective From a community-based perspective, this study aims to scientifically construct an evaluation indicator system for assessing the emergency management capacity of urban communities in response to major infectious diseases. Methods A research team was established to oversee the selection of the theoretical framework and principles for constructing indicators. This team defined the first-level and second-level indicators, developed a pool of third-level indicator candidates, conducted a Delphi expert consultation, and finalized the third-level indicators based on the consultation results. This study aims to analyze theories of emergency management, co-construction, co-governance, and shared benefits to identify relevant first- and second-level indicators. The Octopus big data collection tool was employed to gather policies related to infectious diseases and emergency responses. Through theoretical analysis, the entities responsible for managing emergencies during major infectious disease outbreaks in urban communities were identified, informing the selection of subsequent third-level evaluation indicators. A systematic literature retrieval strategy was developed, encompassing both domestic and international publications on emergency management capacity. The literature was categorized into two groups: those with and those without a direct relation to the evaluation indicator system. Based on the identified second-level indicators, relevant literature was extracted, supplemented by additional materials from non-evaluation categories. The outcomes of the literature review were presented to the research team for deliberation on the selection of third-level indicators, ensuring alignment with established principles for constructing indicator systems. This process integrated theoretical foundations with findings related to identified responsible entities, resulting in an initial evaluation indicator system. The modified Delphi method was applied to refine the third-level indicators for the evaluation system. Indicators were selected on the basis of the mean importance values and coefficients of variation, leading to the establishment of the final evaluation system. Hierarchical analysis was employed to validate the structure of the evaluation indicator system for assessing emergency management capacity in urban communities during major infectious disease outbreaks, with weights systematically assigned. Results Twenty-two experts were invited to participate in three rounds of opinion solicitation, and the positive coefficient of experts was 1.0, the average authority coefficient was 0.88, and the Kendall’s W coefficient of the third round was 0.175 ( P  < 0.001). This system consisted of 4 first-level indicators, 19 second-level indicators, and 54 third-level indicators. Conclusion The developed evaluation indicator system for emergency management capabilities in urban communities regarding major infectious diseases demonstrates both innovation and scientific rigor, with a well-considered allocation of weights. This system serves as a crucial reference for the collaborative efforts of various stakeholders in managing emergencies associated with significant infectious disease outbreaks in urban areas. Furthermore, it provides a systematic framework for assessing the emergency management capabilities of urban communities in response to major infectious disease epidemics.

Background The health crisis during the pandemic and its aftermath have caused multidimensional shifts within the economic and societal structure for refugees and other marginalized communities. Many countries have implemented programs to cater for the additional needs of underserved populations, but refugees and other migrants are usually not covered by these programs. In this context, this study attempts to explore the impact of the crisis on Afghan refugee's vulnerability and the relationship between health services, relief packages, and risk communication. Methods The proposed model is tested with 427 Afghan refugees’ families from five major cities of Pakistan. The partial least squares structural equation modelling (PLS-SEM) is used to test the vulnerability significance with the crisis and government response in facilities. Findings The research findings show that post pandemic economic crisis, the access to health services, relief packages and risk communication is directly associated with Afghan refugees’ vulnerability (β = 0.471, β = 0.501, β = 0.271 & β = 0.259). Notably the relationship between post pandemic economic crisis and Afghan refugees’ vulnerability is mediated by limited access to health services and unavailability of relief packages. Unavailability of relief packages and lack of risk communication mediates the effect of refugees’ crisis on vulnerability. Overall, the proposed model explains 63.3% of the variance in Afghan refugees’ vulnerability with government services. It indicates that Afghan refugees are unable to access relief packages, and there is insufficient communication of risk factors. The lack of government facilities is due to the harder closed-door policy of the Pakistani government which has worsened the vulnerability of Afghan refugees after the sudden victory of the Taliban in Afghanistan. Conclusions In spite of hosting Afghan refugees for the last forty years, the government of Pakistan has no clear systemized policy towards Afghans till now. The paper offers practical policy implications as there is a need for migration policy management combining flexibility and friendliness cooperation to provide government services to refugees. Government preparedness has to include refugee populations in responses to emergencies and look into the current state of new Afghan refugees’ flows, and take further extension in the continuation of migration management.

Background The COVID-19 pandemic has led to a surge in the use of telemedicine as a means of delivering healthcare services remotely. Healthcare providers play a key role in the adoption and implementation of telemedicine for its effectiveness. Despite its benefits, there have been unclear concerns about its effectiveness and acceptance in the process of implementing telemedicine. The objective of the study was to assess health professionals’ perceptions towards the implementation of telemedicine during the COVID-19 pandemic. Methods A cross-sectional study design was conducted among eight hundred forty-five study participants from December 2020 to February 2021. A pre-test was performed on 5% of the total sample size, and the quality of the data was ensured by checking its completeness and consistency. Descriptive statistics and bivariable and multivariable logistic regression were used. The Variables with a P -value equal to or less than 0.25 in bivariable logistic regression were entered into a multivariable logistic regression, and model fitness was assessed. Result The study revealed that 60.9% of professionals had a good perception toward telemedicine implementation, with an 87.2% response rate. Health professionals with IT support staff, ICT training, who use social media platforms regularly, and availability of computer or smartphone within/outside their health facility were 4.7, 3.3, 3.7, and 13.2 times more likely to have a positive association towards telemedicine implementation respectively. Conclusion More than half of the health professionals had a good perception of telemedicine. Social media use, ICT training, computer accessibility, and the presence of IT support staff were all found to have positive associations with the telemedicine perception. In the era of the COVID-19 pandemic, the government should take the initiative to strengthen opportunities for health professionals to learn and apply telemedicine in their medical practice by providing ICT training, IT infrastructure and support staff, improving computer access, and recommending health professionals’ positive use of social media in the health facility.

Background First responders, when arriving at a disaster, need a rapid analysis of the environment in which they are going to operate, as they have to assess the conditions surrounding potential victims and neutralize any risks that may exist.The EU-funded INTREPID develops a new technology platform to assist first responders when arriving on the scene of a disaster. The project INTREPID aims to support safer operations in the form of more efficient, fast, and safe disaster site assessments. The objective of the study is to implement new technologies into rescue operations to facilitate and improve situational awareness and operation management capabilities to save lives. The focus of the study is relevant to the field of mass casualty incident management and disaster, as proper communication is extremely relevant in the management of catastrophes. Method The first phase of the project started with a qualitative methodology SCRUM, for catching the end user’s feedback and requirements to design the interface platform. It was developed a platform to support first responders in disasters areas improving the 3D scanning and analysis of disaster areas. This platform is based on the concepts of intelligence amplification and eXtended Reality, with hololens, drones and robots. The project continued with a β phase in which the platform with all tools integrated were tested in simulated mass casualty disasters. Results These technologies are tested in different disaster scenarios: A flooded subway stop in Stockholm, an accident in the chemical industry in Marseille, and a man-made explosion in a hospital in Madrid. Through this platform, first responders can immediately initiate operations without exposing personnel to potential harmful risks without specialized equipment, with all important information shared and coordinated, among all responders, whether they are security, firefighters, or emergency health professionals. Conclusions The performance pilots and the questionnaire results validated the effectiveness and usability of the final version of the INTREPID platform and tools.

Background The recent crises of bushfires, floods, and the COVID-19 pandemic on the southeast coast of Australia were unprecedented in their extent and intensity. Few studies have investigated responses to cumulative disasters in First Nations communities, despite acknowledgement that these crises disproportionately impact First Nations people. This study was conducted by Aboriginal and non-Aboriginal researchers in partnership with Waminda, South Coast Women’s Health and Wellbeing Aboriginal Corporation, an Aboriginal Community Controlled Health Organisation (ACCHO). It investigated the collective experiences of people affected by cumulative disasters to identify the practices that support healing, and recovery for Aboriginal communities. The study addresses a knowledge gap of how Waminda, designs, manages and delivers responses to address complex health and social issues in the context of cumulative disasters. Methods Underpinned by practice theory this study employed Indigenous-informed, narrative inquiry. Culturally-appropriate, multiple interpretive methods were used to collect data including: observations; yarns with Aboriginal community members, yarns with Waminda practitioners, management and board members; interviews-to-the-double, visual images and documentation. The data were collated and analysed using the phases of reflexive thematic analysis. Results The paper articulates a suite of culturally safe and place-based practices that enhance social, emotional and spiritual well-being following cumulative disasters. These practice bundles include: adopting a Country-centred conception of local communities; being community-led; viewing care as a collective, relational, sociomaterial accomplishment and having fluid boundaries. These practice bundles ‘hang together’ through organising practices including the Waminda Model of Care, staff wellbeing framework and emergency management plan which orient action and manage risks. The paper demonstrates the need for disaster responses to be community-led and culturally situated. ACCHOs are shown to play a crucial role, and their local responses to immediate community needs are grounded in contextual knowledge and use existing resources rather than relying on mainstream system-wide interventions. Conclusions The paper suggests crafting responses that focus on assisting communities (re)gain their sense of belonging, hope for the future, control over their lives and their capacities to care for and to be cared for by Country, are key to both enhancing healing, health and well-being and harnessing the strengths of communities.

Background The COVID-19 pandemic globally posed a great challenge to the existing healthcare system for delivering routine services. Community Healthcare Workers (CHWs) play an important role in delivering routine as well as COVID-19-related services at the forefront. Understanding the complexity of service delivery and the challenges faced by them is very crucial. This study aims to investigate the specific challenges for community-based routine healthcare services during COVID-19. Methods The cross-sectional study was conducted in Ahmedabad City, Gujarat, from November 2021 to October 2022. A mixed-methods approach was adopted for carrying out this study. Ahmedabad was selected as the site of this study as it is a large populous city and has witnessed the outbreak of other diseases like CCHF and SARS, and it also experiences a significant impact of Covid-19. Results A total of 150 CHWs were included in the study for the quantitative survey, and nine CHWs were interviewed to gather qualitative information. The results show the disruption in the community-based routine services, especially during the first wave. Increased workload (93% of CHWs) was a major challenge during COVID-19 was one of the biggest challenges from the provider side, while fear of leaving the house (97%) was reported as one of the biggest challenges from the demand side. During the first wave, services for Non-Communicable Diseases (NCD) were highly affected. CHWs reported that they were motivated to work in the pandemic to provide the necessary care and services to the community. Findings from this study also suggest the need for structured training in emergency preparedness, mental health support, and coordination skills, with policy implications for urban health systems' resilience. Conclusion The results suggest that additional training for CHWs on pandemic response and infection control would be highly helpful during emergencies. Recruitment of trained human resources and intersectoral collaboration are very important for the appropriate management of and preparedness for such pandemics in future. These are some of the main pillars of strengthening the health system. This study uniquely contributes by documenting the use of CHWs in a large urban setting and highlighting innovative intersectoral collaboration mechanisms that emerged during the crisis. Further, this study provides an insight into the lessons learnt from the COVID-19 pandemic towards maintaining healthcare services during crises.

Background Lebanon ratified the International Health Regulations (IHR) (2005) in 2007, and since then, it has been facing complex political deadlocks, financial deterioration, and infectious disease emergencies. We aimed to understand the IHR capacities’ scores of Lebanon in comparison to other countries, the IHR milestones and activities in Lebanon, the challenges of maintaining the IHR capacities, the refugee crisis's impact on the development of these capacities; and the possible recommendations to support the IHR performance in Lebanon. Methods We used a mixed-method design. The study combined the use of secondary data analysis of the 2020 State Party Self-Assessment Annual Report (SPAR) submissions and qualitative design using semi-structured interviews with key informants. Semi-structured interviews were conducted with nine key informants. The analysis of the data generated was based on inductive thematic analysis. Results According to SPAR, Lebanon had levels of 4 out of 5 (≤ 80%) in 2020 in the prevention, detection, response, enabling functions, and operational readiness capacities, pertaining that the country was functionally capable of dealing with various events at the national and subnational levels. Lebanon scored more than its neighboring countries, Syria, and Jordan, which have similar contexts of economic crises, emergencies, and refugee waves. Despite this high level of commitment to meeting IHR capacities, the qualitative findings demonstrated several gaps in IHR performance as resource shortage, governance, and political challenges. The study also showed contradictory results regarding the impact of refugees on IHR capacities. Some key informants agreed that the Syrian crisis had a positive impact, while others suggested the opposite. Whether refugees interfere with IHR development is still an area that needs further investigation. Conclusion The study shows that urgent interventions are needed to strengthen the implementation of the IHR capacities in Lebanon. The study recommends 1) reconsidering the weight given to IHR capacities; 2) promoting governance to strengthen IHR compliance; 3) strengthening the multisectoral coordination mechanisms; 4) reinforcing risk communication strategies constantly; 5) mobilizing and advancing human resources at the central and sub-national levels; 6) ensuring sustainable financing; 7) integrating refugees and displaced persons in IHR framework and its assessment tools; 8) acknowledging risk mapping as a pre-requisite to a successful response; and 9) strengthening research on IHR capacities in Lebanon.

Introduction This paper presents a structured review of the use of crisis management, specifically examining the frameworks of surge capacity, resilience, and dynamic capabilities in healthcare organizations. Thereafter, a novel deductive method based on the framework of dynamic capabilities is developed and applied to investigate crisis management in two hospital cases during the COVID-19 pandemic. Background The COVID-19 pandemic distinguishes itself from many other disasters due to its global spread, uncertainty, and prolonged duration. While crisis management in healthcare has often been explained using the surge capacity framework, the need for adaptability in an unfamiliar setting and different information flow makes the dynamic capabilities framework more useful. Methods The dynamic capabilities framework’s microfoundations as categories is utilized in this paper for a deductive analysis of crisis management during the COVID-19 pandemic in a multiple case study involving two Swedish public hospitals. A novel method, incorporating both dynamic and static capabilities across multiple organizational levels, is developed and explored. Results The case study results reveal the utilization of all dynamic capabilities with an increased emphasis at lower organizational levels and a higher prevalence of static capabilities at the regional level. In Case A, lower-level managers perceived the hospital manager as brave, supporting sensing, seizing, and transformation at the department level. However, due to information gaps, sensing did not reach regional crisis management, reducing their power. In Case B, with contingency plans not initiated, the hospital faced a lack of management and formed a department manager group for patient care. Seizing was robust at the department level, but regional levels struggled with decisions on crisis versus normal management. The novel method effectively visualizes differences between organizational levels and cases, shedding light on the extent of cooperation or lack thereof within the organization. Conclusion The researchers conclude that crisis management in a pandemic, benefits from distributed management, attributed to higher dynamic capabilities at lower organizational levels. A pandemic contingency plan should differ from a plan for accidents, supporting the development of routines for the new situation and continuous improvement. The Dynamic Capabilities framework proved successful for exploration in this context.

Background The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on health systems worldwide, resulting in disruptions to essential health service delivery, such as routine immunizations, maternal and child health, and treatment for communicable and noncommunicable diseases. These services have been disrupted due to the diversion of resources towards the COVID-19 response. Therefore, the objective of this scoping review was to identify the strategies and challenges associated with maintaining the continuity of essential health services during a pandemic. Methods This scoping review study was conducted in 2023 using the proposed Arksey and O’Malley framework. We conducted searches on PubMed, Scopus, ProQuest, and Web of Science using relevant keywords. Additionally, we searched Google Scholar, hand-searched reference lists of included studies, and reviewed organizational reports, websites, and other sources of information. Content analysis was employed to summarize the themes from the selected articles. Results Our search of major databases yielded 3,732 results. After the screening process, 47 articles were included in the scoping review. The extracted interventions were classified into six groups based on the building blocks of the World Health Organization health system: leadership and governance, access to essential medicines, health systems financing, the health workforce, health service delivery, and health information systems. Conclusions The implementation of effective strategies and interventions can help ensure the provision of essential health services during a pandemic. These strategies include leveraging technology for remote care, ensuring the safety of healthcare workers and patients, strengthening supply chains, and establishing flexible and adaptive healthcare systems.