Ambulance response time in a Brazilian emergency medical service

Research efforts on ambulance response times for Emergency Medical Services (EMS) calls have been made for decades, especially in developed countries, using different techniques and with varying objectives. In Brazil, a developing country, the scarce scientific production on this vital indicator prioritizes scenarios for EMS in cities with more than one million inhabitants. This shows the importance of extending research to the reality of small and medium-sized cities. This paper presents SAMU, the Brazilian EMS that follows the Franco-German emergency medicine model, compiling numbers related to service at the national level. The use of quantile regression allows the identification of the RT for the EMS and helps to explain the effects of factors at the system level, at the patient level, and specific factors on response time intervals of Southwest Paraná SAMU. This specific EMS, characterized as an inter-municipal consortium of prehospital services, is responsible for prehospital emergency care for an approximate population of 635,000 inhabitants in 42 small towns in the State of Paraná in southern Brazil. From the analysis of the records of 12,050 ambulance dispatches, it was possible to identify the average ambulance response time of 14 min and 25 s. The regression model was able to explain the influence of the independent variables at the system level (presumed severity of the emergency, ambulance dispatch time, and ambulance travel time), at the patient level (age, gender, and characteristic of the emergency) and specific variables of the emergency (day of the week and time of day) on the dependent variable response time over the quantiles, showing that the dispatch time, travel time, time of day, service to male patients and critical cases influence the ambulance response time. This work contributes to deepening the understanding of the management of EMS operations in a developing country, allows the comparison of the RT identified in relation to other countries, and identifies factors that impact the RT for other actors directly or indirectly involved. The practical implications are also presented, as well as how the study impacts the decision-making and management process of the EMS in the short, medium and long term.     

A minimum expected response model: Formulation, heuristic solution, and application

Responding to true emergencies in the shortest possible time saves lives, prevents permanent injuries and reduces suffering. Most covering models consider an emergency cover if an ambulance is available within a given time or distance threshold. From a modeling perspective, shorter or longer responses within this threshold are all tallied as covered; conversely, the emergencies immediately outside the threshold are considered uncovered. However, if the shorter responses are given more weight along with the volume of such incidents, while still meeting system-wide coverage requirements, both customers and providers can benefit from reduced response times. We formulate a model to determine the locations for a given set of ambulances to minimize the system-wide expected response distances while meeting coverage requirements. We solve the model with a heuristic search algorithm and present computational and comparative statistics using data from an existing Emergency Medical Services agency.     

Modeling emergency medical response to a mass casualty incident using agent based simulation

Emergency managers have to develop plans for responding to disasters within their jurisdiction. This includes coordinating multiple independent agencies participating in the response. While much of this is currently done by use of intuition and expert judgment, models can be used to test assumptions and examine the impact of policies and resource levels. The autonomous nature of responders as well as the rapidly changing information during a disaster suggests that agent based models can be especially suited for examining policy questions. In this work, we built an agent based model of a given urban area to simulate the emergency medical response to a mass casualty incident (MCI) in that area. The model was constructed from publicly available geographic information system and data regarding available response resources (such as ambulances, EMS personnel and hospital beds). Three different agent types are defined to model heterogeneous entities in the system. By simulating various response policies, the model can inform emergency responders on the requirements and response protocols for disaster response and build intuition and understanding in advance of facing actual incidents that are rare in the day-to-day operating experiences.     

Data-driven forecasting for operational planning of emergency medical services

Emergency medical services (EMS) play a vital role in delivering pre-hospital care. The operational efficiency of such services is critical and adequate demand forecasts can contribute to such a goal. But for that, the available data need to be well characterized before being used. Previous studies have failed to address some important aspects of this need, such as exploring a comprehensive list of contextual data to decide which are relevant to explain the EMS demand behavior. Moreover, modern forecasting techniques have been explored in the EMS context, including neural networks, but the computational complexity inherent to the methods and their use was not discussed. Finally, it is also unclear how different demand patterns can be when predicting the volume of emergency calls considering the priority level and the number of dispatches according to vehicle type. This study proposes a generic data-driven forecasting method to address these shortcomings and to support operational decisions. The results obtained with the proposed method indicate that each priority call and vehicle type shows different patterns, which suggests that such differentiation should contribute to better resource allocation. At the same time, the operational impact of the demand shared by neighboring zones proved to be significant at bases near the border. The models developed resulted in important decision tools that can be used to predict the dynamic demand of EMS on an hourly or shift basis. Additionally, the method adds value for decision-makers that want to plan not only when and how many but also where resources are demanded, avoiding assumptions that impact the operational performance.     

Pains and gains of environmental management system certification for the sustainable development of manufacturing companies: Heterogeneous effects of industry peer learning

Environmental sustainability is a growing global concern. Environmental management systems (EMS) could be an effective strategic tool to help firms deal with their sustainable development. However, whether EMS certification pays off financially and how it takes effect can be debated. Thus far, these questions remain largely under‐researched. In particular, the effects of EMS certification on financial performance are inconclusive, and the reasons explaining the effects are underdeveloped. This study aims to enrich the current research by exploring the mediating and moderating roles from the perspective of cost‐efficiency trade‐offs to reveal how EMS certification affects financial performance. Applying a PROCESS procedure analysis and causal mediation analysis to a sample of 1,751 Chinese listed manufacturing firms from 2008 to 2016, this study shows that the effect of EMS certification on firms' financial performance is insignificant because their operating costs burden increases while their marketing efficiency and managerial efficiency improve. For the first time, this study demonstrates the moderating role of industry peer learning, as the mediating effects decrease with the growth of industry peer learning.     

应急物流服务网点选址模型研究

应急物流是应对突发事件的重要保障。应急物流可以降低灾害影响程度,缩短受害持续时间,使突发性事件造成损失最小化。而在进行应急物流决策时,首先会面临应急物流服务网点的选址问题。应急物流服务网点置于合理的位置,不仅可以降低成本,而且还能够保证提供应急物资的时效性,从而避免可能导致的更大损失。在给定限制条件下应急服务网点选址模型基础上,综合考虑应急需求的随机性和由灾害导致应急配送时间模糊的不确定情况,研究新的模糊和随机混合机会约束规划选址模型。     

Environmental management systems,communicative action and organizational learning

In recent years, an increasing number of private as well as public organizations have been engaged with implementation and use of environmental management systems (EMSs). This raises questions as to the reasons for implementing an EMS and, not least, about the roles and contributions of an EMS in an organization. Based in particular on research on contemporary municipal environmental management in Sweden, and also drawing on EMS research and experiences in other countries, this paper argues that an EMS may be understood not only as a technical tool for analytical management, as is traditionally done, but also as a tool for communicative action and organizational learning. Copyright © 2002 John Wiley & Sons, Ltd and ERP Environment.     

Simulation modeling and optimization for ambulance allocation considering spatiotemporal stochastic demand

To ensure a timely response to emergencies, governments are obliged to implement effective ambulance allocation plans. In practice, an emergency medical service (EMS) system works in an uncertain environment, with stochastic demand, response-times, and travel-times. This uncertainty significantly affects ambulance allocation planning. However, few studies in this field adequately consider the effect of spatiotemporal uncertainty in demand, because it is difficult to measure it quantitatively. As a result, few analytic models capture the dynamic nature of an EMS system and, thus, the allocation plans they generate are not efficient in practice. Therefore, this study proposes a simulation-based optimization method for ambulance allocation. A simulation model is constructed to mimic the operational processes of an EMS system, and to evaluate the performance of an ambulance allocation plan in an uncertain environment. Gaussian mixture model clustering is used to derive the uncertain spatial demand. Then, the simulation generates emergency demand based on the obtained spatial distribution. A Gaussian-process-based search algorithm is used together with the simulation model to identify optimal solutions. To validate the proposed method, a case study is conducted using data on emergency patients in the Shanghai Songjiang District. Compared with the current plan adopted in Songjiang, the experimental results demonstrate that the delay time and frequency of the EMS system can be reduced significantly by employing the proposed methods. Furthermore, nearly 41% of the allocation cost can be saved.     

A goal programming model for the siting of multilevel EMS systems.

Facility siting models known as location covering techniques have proven to be useful particularly for emergency medical services (EMS) planning, given the importance of ambulances responding to demand within some maximum time constraint. These models represent a set of methods which focus the health planner's attention on the access of people to health care, since they attempt to “cover” people in need of service within some specified time standard.This research develops a technique for the locational planning of sophisticated EMS systems, characterized by multiple levels of emergency health services. Specifically, a two-tiered system with “basic life support” and “advanced life support” capabilities is modeled as a goal program.By applying location covering techniques within a goal programming framework, this study develops a method for the siting of multilevel EMS systems so that (1) each service level maximizes coverage of its own demand population, and (2) “back-up” coordination between levels is assured. The usefulness of this goal program as a health planning tool is evidenced in the model's explicit articulation of EMS policy objectives and its ability to link system levels in terms of “goal-directed behavior”. The working of this multilevel covering model is demonstrated by reference to EMS planning scenarios and related numerical examples.     

Analyzing the volume and nature of emergency medical calls during severe weather events using regression methodologies

An effective emergency medical service (EMS) response to emergency medical calls during extreme weather events is a critical public service. Nearly all models for allocating EMS resources focus on normal operating conditions. However, public health risks become even more critical during extreme weather events, and hence, EMS systems must consider additional needs that arise during weather events to effectively respond to and treat patients. This paper seeks to characterize how the volume and nature of EMS calls are affected during extreme weather events with a particular focus on emergency preparedness. In contrast to other studies on disaster relief, where the focus is on delivery of temporary commodities, we focus on the delivery of routine emergency services during blizzards and hurricane evacuations. The dependence of emergency service quality on weather conditions is explored through a case study using real-world data from Hanover County, Virginia. The results suggest that whether it is snowing is significant in nearly all of the regression models. Variables associated with increased highway congestion, which become important during hurricane evacuations, are positively correlated with an increased call volume and the likelihood of high-risk calls. The analysis can aid public safety leaders in preparing for extreme weather events.     

配置同步在xPON网管中的设计和实现

为了解决现有技术中配置数据每次都需要全部上传和下载导致的同步时间过长、同步效率和可靠性低的问题,研究一种实现图形界面EMS和xPON局端设备配置数据增量式上传和下载的方法,对原有的配置方式存在的弊端进行了分析,提出了一种新的配置同步的设计方案。该方案通过比较配置项的循环冗余校验码,保证了不用修改程序就可以解决多个不同版本的xPON局端设备OLT共存时配置数据上传和下载存在的问题。     

The role of accounting and the accountant in the environmental management system

This paper explores the role of accounting and the accountant in the Environmental Management System (EMS). This study was founded on a postal survey of chief executive officers (CEOs) and chief financial officers (CFOs) from the top 500 listed Australian companies. From responses to the surveys, this paper firstly documents the adoption of environmental accounting processes by respondent companies and secondly management attitudes as to the role of environmental accounting in these companies. The senior executives responding to the survey suggest that they believe the environment is an important issue, and recognize the need for a business response. However, there appeared to be limited participation of the accountant in the EMS, which suggests there is a gap between the aggregate observations of this sample and literature support with respect to the role of environmental accounting. It is suggested that this might reflect a lack of understanding of the potential role accounting and the accountant could (and arguably should) play as a member of the EMS team. It is the intention of this paper to provide some input to enhance an understanding of the potential and important role accounting and the accountant could play in the EMS. Copyright © 2001 John Wiley & Sons, Ltd. and ERP Environment     

Environmental management systems and green supply chain management: complements for sustainability?

Some researchers question the legitimacy of EMSs since organizations can claim to have one when in fact they make no attempt to reduce their environmental harm. In instances where EMSs enhance an organization's environmental performance, critics argue that improvements are likely to occur within the organization's operational boundaries rather than being extended throughout the supply chain. However, previous research suggests that the organizational capabilities required to adopt an EMS may facilitate GSCM implementation and the institutional pressures to adopt both management practices are similar. Consequently, EMS adopters may have a greater propensity to expand their focus beyond their organizational boundaries and utilize GSCM practices to minimize system‐wide environmental impacts. This research illuminates the debate by empirically evaluating the relationship between EMS and GSCM practices. Copyright © 2006 John Wiley & Sons, Ltd and ERP Environment.     

Challenges in designing,implementing and operating an environmental management system

Introducing an effective environmental management system (EMS) to an organization is a complex process. This complexity is belied by current EMS models that concentrate on EMS frameworks and components, and present a relatively simple approach to the process, especially the introduction and implementation phases. While these models outline what should be introduced, they provide little guidance on how EMSs may be implemented. Experience indicates that effective EMS introduction may be adversely affected by a number of conditions, but EMS literature has yet to recognize these barriers. There is a significant gap between EMS theory and application. This paper discusses the degree to which current EMS models address practical EMS design and implementation, barriers to successful EMS introduction, strategies and tactics for overcoming these barriers and implications for EMS practice. Copyright © 1999 John Wiley & Sons, Ltd and ERP Environment.     

免疫算法在应急物流配送车辆优化调度中的应用

应急物流是处理各类突发事件对物资、人员的需求进行紧急保障的一种特殊物流活动？文章根据应急物流的特点，将免疫算法用于应急物流车辆调度研究中，同时通过算例，证明用免疫算法优化车辆行驶路径的有效性和可行性。     

Factors for succeeding in ISO 14001 implementation in Italian construction industry

The main aim of this research is to find the most relevant factors for a successful ISO 14001 implementation in the construction industry. Thousands of companies, including those in the construction industry, are interested in an ISO 14001 environmental management system (EMS). Italy holds one of the largest databases of ISO 14001 certified organisations; in this database, the construction industry represents the second largest sector. Using a questionnaire, the research tested six potential factors that affect the success of an ISO 14001 EMS implementation. Moreover, the quantitative results were discussed together with qualitative notes left by respondents. The results showed that only three out of the six factors really affect ISO 14001 EMS implementation in the construction industry: involvement of employees, top management commitment, and development of environmental technical skills. It seems that the respondents perceived that economic and financial results, identification of environmental aspects and impacts, and the involvement of stakeholders have a limited or null effect on ISO 14001 implementation. Particular issues concerning developing workers' awareness, evaluating all the environmental impacts, and obtaining real economic advantages were raised in the respondents' comments. Conclusions highlight specific contributions for practitioners and other stakeholders involved in EMS.     

邮政速递物流企业营销策略创新研究

在当前激烈的市场竞争环境下,如何通过有效的市场营销策略,将改制后的邮政速递物流企业的产品和服务为越来越多的客户所认可并长期使用,进而不断扩大邮政速递物流的市场占有份额,是摆在全体速递物流人面前的首要任务。文中结合速递物流企业改革发展实际,就专业化经营改革后邮政速递物流企业的营销策略创新问题进行简要论述。     

EMS models for business strategy development

This research investigation identifies the organizational barriers that can occur within large organizations to impede the introduction and development of environmental management systems (EMSs). The findings from the six case study investigations into multinational electronic and telecommunications organizations enabled the construction of four categorical models: devoid, isolated, devolved and integrated. They provide a profile of the way organizations use their EMSs and detail the types of organizational barrier that are likely to occur in each case. The models are designed to offer insight into the profile of the organization, the type of EMS being used and the operational advantages and disadvantages of using each model. They offer managers additional decision‐making tools with which to assess the EMS profile of their own organization and those of competitor organizations and to assess the effectiveness of an organization's EMS in weak and strong economic conditions. Copyright © 2002 John Wiley & Sons, Ltd. and ERP Environment     

ISO 14001 – experiences,effects and future challenges: a national study in Austria

More than 60000 organizations worldwide have implemented environmental management systems (EMSs). About 800 of them are located in Austria. As Austria was one of the leading countries in promoting the EU scheme EMAS, and as there has been no specific study on Austrian experiences with ISO 14001, the purpose of this study is to describe the experiences with and effects of ISO 14001 in Austria. The results show that ISO 14001 often leads to reduced environmental impact, especially in the area of waste. A strong driving force behind implementation is the expected improvement of an organization's image. The average repayment time on an investment in an EMS is less than two years. Legal compliance tends to be difficult to implement, but on the other hand it works well in daily practice. To develop an EMS into a sustainability management system, the two most important challenges are to improve coordination between the EMS and the organization's strategies and to synchronize the EMS with central value chains. Copyright © 2006 John Wiley & Sons, Ltd and ERP Environment.