Purpose/rationale– Building and property managers face a difficult task because they have to balance the legal requirements that will protect occupants of the high-rise buildings. Most developers do not abide by fire or building codes that require the buildings to be effective in providing emergency evacuation measures1.
The purpose of this study is to evaluate the effectiveness of the present evacuation plans. Strategies that are used in building evacuations are very crucial in high-rise building fire safety. According to Butler, most studies have focused on elevators and exit stairs evacuation systems2.
The responses that were attributed to the evacuees during the 2001 attack at the WTC have ignited a lot of interest in the studies on evacuations in tall buildings. As stated by Winerman, architects have failed to consider appropriate emergency cases on evacuation3.
Aim– This study aims at developing strategies to assist planning committees to develop effective building evacuations in high-rise buildings for fire safety.
Objective– The objective of this study is to evaluate possible improvements to be used in high-rise buildings through an investigation of occupant relocation and strategies for evacuation that involve the use of modern technology. This study involves a review and compilation of available information on this subject.
In addition, this study provides an overview of architectural design, regulatory, as well as, a better understanding of the existing and emerging evacuation strategies.
Literature review– Evacuation plans for high- rise buildings is a controversial issue4. Building and regulatory agencies have taken a sensitive look at planning and evacuation phases for high-rise buildings. Some of the issues regarding evacuation plans involving tall buildings are concerned with the losses that occupants may encounter when they have to evacuate their premises5.
Because of their large scale and great height, the relation between existing technology and architectural design has been very dynamic in high-rise buildings6. The current architecture can be better understood through the recognition of the directions used in the design of architectural buildings7.
In the recent years, high-rise structures have become even much taller and the importance of the optimal structure design has become even more significant. The issues of vertical transportation, life safety, as well as fire safety have become very crucial in the high-rise buildings8.
Due to their great heights, the high-rise buildings have a design with enormous amount of resources and energy during their occupancy9. Currently, sustainability has become an important issue in the design of high-rise buildings in order to save the existing limited resources.
With the prevailing status, there is concern that these types of structures have generated a more thorough work on investigation into their roles and the technologies, which has become very important in the construction industry.
However, the suggestion that high-rise buildings are necessary to prevent congestion is impossible to sustain10. It is important to ascertain higher densities than the medium or low-rise developments, which in some instances may be less effective in utilizing space than other building alternatives.
High-rise buildings are important to prevent congestion in urban areas, in addition, high-rise buildings are energy efficient and improve other land uses such as transportation in the urban areas11. However, tall buildings are often associated with beauty of the landscape and efficient developments12.
Methodology – This study seeks to evaluate systems of developing sustainable evacuation systems for high-rise buildings. It will use descriptive methodology that will be aim at obtaining data regarding available evacuation systems from respondents. The descriptive methods are beneficial and the type data obtained will be used to provide tentative results of the study.
This study will also develop procedures that will include interviewing the respondents and will include questions to obtain information from development managers. In addition, questionnaires will be designed to obtain information from development managers and officials from fire departments.
Thus, this study will involve both primary and secondary sources of data collection. The primary sources will include observations of the groups identified for five hours per week for a period of four weeks; it will focus on conversations at group meetings.
Interviews will be conducted to provide an insight into the conversations; I will attempt to conduct the interviews shortly after the conversations that will be of great interest.
The general strategy of the interviews will begin with broad questions and follow up on the responses of the respondents to capture their meanings and avoid imposing my meanings on the respondents. The secondary sources of data will be derived from scholarly journals or articles and books that will be relevant to the topic of study.
Limitation: The anticipated limitation is the time constraint that may be appropriate for this study, since there will be need for aspects of leadership practice, organization culture as well as team communication that may not be ascertained during the study.
Bibliography
BRE Methodology for Environmental Profiles of Construction Materials, Components and Buildings, 1999, pp. 19-21.
Butler, J, ‘Getting the Best of Fire Evacuation Drills,’ Fire Prevention, Vol.200, 1987, 26-28.
Corral, E A, Conducting Fire Drills in High-Rise Buildings, City of Houston Fire Department, Houston. 2007.
Inyengar, JH, Tall Building Systems for the Next Century, 4th International Kerensky Conference, 1997, pp. 22-34.
Jones, D L, Architecture and the Environment, Bioclimatic Building Design, Laurence King, London, 1998.
McCarthy, B, Multidisciplinary Engineering, Capability statement, London, 2001, pp. 12-23.
McCarthy, B, Structural Engineering, Building Services, Environmental Engineering, and Landscape Architecture Planning Supplementary Report, 2000.
National Fire Safety Association (NFPA), Life Safety Code (NFPA 101). Quincy. MA, National Fire Safety Association, 2006, pp. 12-23.
National Safety Council, Evacuation Systems for High-Rise Buildings, National Safety Council, IL, 2008, pp.21-29.
Newman, P & R Kenworthy, Cities and Automobile Dependence, An International Sourcebook, Gower Technical, London, 1989, pp 20-45.
Swamy, RN, Holistic Design – Key to Sustainability in Concrete Construction, Proceedings of the Institution of Civil Engineers, Vol 1. 2001, pp 1-5.
Winerman, L, Fighting Fire with Psychology, American Psychology Association, Monitor on Psychology, V. 35, No 8, 2004, pp. 28.
Footnotes
1 BRE Methodology for Environmental Profiles of Construction Materials, Components and Buildings, 1999, pp. 19-21.
2 J Butler, Getting the Best of Fire Evacuation Drills. Fire Prevention, V.200, 1987, 26-28.
3 L Winerman, Fighting Fire with Psychology. American Psychology Association, Monitor on Psychology, V. 35, No 8, 2004, pp. 28.
4 E A Corral, Conducting Fire Drills in High-Rise Buildings. City of Houston Fire Department. Houston, Texas. 2007.
5 P Newman & R Kenworthy, Cities and Automobile Dependence. An International Sourcebook, Gower Technical, 1989, pp 20-45.
6 National Fire Safety Association (NFPA).Life Safety Code (NFPA 101). Quincy. MA: National Fire Safety Association, 2006, pp. 12-23.
7 National Safety Council. Evacuation Systems for High-Rise Buildings. IL: National Safety Council, 2008, pp.21-29.
8 JH Inyengar, Tall Building Systems for the Next Century, 4th International Kerensky Conference, 1997, pp. 22-34.
9 B McCarthy. Structural Engineering, Building Services, Environmental Engineering, and Landscape Architecture Planning Supplementary Report, 2000.
10 D L Jones. Architecture and the Environment, Bioclimatic Building Design, Laurence King, London, 1998.
11 RN Swamy. Holistic Design – Key to Sustainability in Concrete Construction, Proceedings of the Institution of Civil Engineers, Vol 1. 1-5, 2001.
Human beings will react differently whenever exposed to various disasters or fire outbreaks. Engineers and firefighters have conducted numerous studies in order to understand the issues associated with human behavior during evacuation.
Different evacuation models “are critical because they determine the time take to safeguard the lives of many civilians after a disaster” (Kuligowski, 2009, p. 3). Many scholars and theorists have analyzed the major issues associated with different human behaviors.
This situation explains why many engineers have not incorporated different human behaviors into their evacuation models. According to Simonovic (2011, p. 16), “every action performed by individuals in a dangerous situation results from a unique decision-making process”.
This decision-making process has encouraged many scholars to predict different human behaviors during evacuations. This essay analyzes the current literature on human behaviors during evacuations.
Theory of Human Behavior during Disasters
Occupants in different buildings or structures will react in a specific manner after encountering a disaster. Human beings perceive specific cues before performing certain actions. The next stage is interpreting the nature of the targeted risk or situation.
This interpretation usually depends on the cues perceived by every individual in the first stage. The individuals will “eventually make specific decisions in order to deal with the disaster” (Kuligowski, 2009, p. 3). This discussion explains why human beings follow a unique process whenever making their decisions.
However, some external and internal factors determine what individuals perceive or interpret whenever there is a disaster. According to Fahy and Proulx (2011, p. 718), “the phases of disaster response will vary significantly depending on the targeted individuals, the nature of structure, and the aspects of the situation”.
For example, the occupants in a building can perceive different cues depending on the targeted disaster. Individuals can see smoke, debris, or receive phone calls from their friends. The individuals in the targeted structure or building will gather different thoughts within the shortest time possible.
The second phase of the Disaster Response Model (DRM) occurs when the individuals interpret the perceived information (Kuligowski, 2009). The individuals might also decide to ignore the above signs. They “might also decide to ignore the threat if it is not serious” (Fahy & Proulx, 2011, p. 718).
The third phase will ensure the individuals make appropriate decisions depending on their interpretations. The fourth phase will produce a specific behavioral process. This phase will ensure the occupants in the targeted building or structure perform specific actions.
The above phases will produce a unique behavioral process whenever there is an evacuation effort. A new behavioral response can also emerge if the individuals get different ideas and information about the disaster. That being the case, human beings will act in a unique manner after identifying the existing danger.
The behavior of “the occupants will depend on the manner in which they perceive the initial information” (Simonovic, 2011, p. 64). The people will “also interpret the nature of the risk and make the appropriate decisions in order to deal with it” (Simonovic, 2011, p. 104).
Human Behaviors during Evacuation
The above discussion examines how human beings make specific decisions after identifying a new disaster. Human beings will also behave in a unique manner during every pre-evacuation, evacuation, and post-evacuation process. The first human behavior that emerges after a disaster is panic.
This form of panic can be an extreme behavior that disorients the goals of the affected individuals. Some studies have examined “how different individuals will experience a tormenting state of mind after witnessing a dangerous event such as a terrorist attack” (Fahy & Proulx, 2011, p. 719).
More studies are needed in order to understand how human beings behave after interpreting the presented cues. The use of mobile phones and telephones has become a common human behavior whenever there is a disaster. For instance, a number of studies have been conducted on different human behaviors after September 11.
Many studies have identified how different evacuees communicated with their friends and relatives about the event. According to these studies, several phone calls were made to different friends, colleagues, parents, and children. According to Fahy and Proulx (2011, p. 719), “15 percent of the telephone calls were made to different emergency departments and services”.
Most of the phone calls were executed during the pre-evacuation phase. This behavior is common because many individuals will always inform their relatives after a disaster occurs. Many individuals tend to communicate with others in order to get the best support.
However, many experts have identified the dangers associated with the practice (Okaya, Takahashi, & Southern, 2013). For instance, the practice can affect the effectiveness of every evacuation process. Many occupants use telephones without understanding the magnitude of the targeted event or disaster.
This unique human behavior also occurs whenever there is a disaster. Some individuals “might form new imaginations and thoughts after experiencing the event” (Gagnon, 2008, p. 37). Some behaviors are also recorded during the evacuation phase.
The most notorious behavior “during the evacuation process is the formation of different groups” (Gagnon, 2008, p. 45). This human practice “is called Group Behavior” (Gagnon, 2008, p. 45). According to Simonovic (2011, p. 89), “over 80 percent of victims of a disaster will come together in order to form a group”.
Many individuals form such groups without their knowledge. This behavior will “depend on several factors such as the number of victims, the nature of the building, and the nature of the disaster” (Gagnon, 2008, p. 46). The agreeable fact is that many individuals will form different groups in an attempt to get the required support.
Another common behavior “observed in different emergency situations is the obstruction of human flow” (Gagnon, 2008, p. 56). The non-injured individuals in a specific building will locate different exits. Many individuals “might decide to use one pathway thus affecting the evacuation process” (Gagnon, 2008, p. 46).
Some engineers might also block different exits thus affecting the evacuation process. The problem of obstruction has affected the effectiveness of many Disaster Response Programs (DRPs). Some individuals move in the same direction without examining the existing dangers.
Human behaviors and responses to various disasters will depend on different factors. For instance, some individuals “will scramble for resources and support systems during the evacuation process” (Okaya et al., 2013, p. 5). This observation is common during every evacuation process.
The four phases of “the decision-making process will also determine the manner in which the targeted persons react to the disaster” (Gagnon, 2008, p. 46). Screaming is also common whenever the disaster is unbearable. Such behaviors can make it impossible for many rescuers and evacuators to achieve their objectives.
Sometimes the evacuees might fail to cooperate and even interfere with the rescue mission. Some people might decide to locate different exits, fire extinguishers, and alarms. Such equipments are relevant because they improve the level of communication in a building.
This approach makes it easier for more individuals to understand the facts of the disaster. This discussion explains why different behaviors are exhibited whenever there is a fire outbreak or disaster. It cannot be possible to predict the behaviors exhibited by different individuals after a disaster.
Researchers should undertake “new studies in order to understand the major issues associated with various disasters” (Gagnon, 2008, p. 74). This understanding will produce new concepts in order to deal with different events such as terrorist attacks, fire outbreaks, and floods.
Using Human Behaviors to Design Effective Evacuation Models
Many evacuation models focus on the best practices, resources, and approaches that can safeguard the lives of more people within the shortest time possible. This knowledge has encouraged many engineers to identify better ideas and strategies that can make every evacuation model successful.
The main focus of every “evacuation model is to reduce the time taken to evacuate every individual to a safer place” (Fahy & Proulx, 2011, p. 719). Some engineers have examined the effectiveness of different theories in order to produce the best evacuation processes. However, such models have failed to predict the behaviors of different individuals involved in the process.
As discussed earlier, every occupant in the targeted building will act differently depending on the nature of the event. For instance, the occupants can engage in different activities in order to help others. The individuals might also make phone calls in an attempt to collect and share different information.
The targeted persons might also be ready to deal with the disaster. For example, the occupants might decide to deal with the targeted event. According to Okaya et al. (2013, p. 5), “these practices might make it impossible for the rescuers to achieve the best goals”. Many engineers tend to ignore the behaviors of the targeted occupants. The behaviors and actions of different people can affect the evacuation process.
The actions of these people will also delay their safety and also make the evacuation process less effective. This gap explains why “engineers and scholars should generate a comprehensive and robust theory on these behaviors” (Kuligowski, 2009, p. 95).
The presented theory will ensure every evacuation strategy achieves the best results (Okaya et al., 2013). The important thing is to identify the best responses to these gaps. The knowledge of the above human behaviors will also encourage engineers and architects to design new buildings that can improve every evacuation process.
Many evacuation designs and models have failed to produce the best results because of the above gap. Human beings will react differently depending on the disaster. Engineers should undertake new studies in order to produce better frameworks for rescuing more people.
The social cues dictating the responses and decisions made by different people “can make it easier for designers to produce better structures” (Kuligowski, 2009, p. 93). This “knowledge will make it easier for engineers to have fire extinguishers and alarm alert systems in place” (Gagnon, 2008, p. 63).
Some new factors and tools have emerged in order to promote the best Occupant Escape Behavior (OEB). Such tools include “alarm systems, building designs, occupancy types, and Fire Safety Management” (Okaya et al., 2013, p. 6). These tools can make it easier for different institutions to develop the best evacuation strategies.
This knowledge can be applied in different areas such as Fire Fighting Practice (FFP) and Disaster Management (DM). Engineers can use the same ideas to quantify various human behaviors especially after an emergency. This approach will make it easier for engineers to produce better transport systems and buildings that can support every evacuation model.
Many studies have identified the factors contributing to various human behaviors during an evacuation process. The existence of various gaps and weaknesses explain why fire fighters should consider the implications of different human behaviors. The approach will address the needs of many occupants in different structures.
Gagnon (2008, p. 72) “encourages scholars to develop new conceptual models of human behaviors whenever there terrorist attacks, typhoons, and building fires”. This practice will produce the best strategies in order to safeguard the lives of many people.
Conclusion
Different human behaviors during an evacuation process results from several decision-making phases. The behavioral process begins when “the occupants acquire some information about the surrounding environment” (Okaya et al., 2013, p. 6).
Every human behavior will determine the effectiveness of the targeted evacuation process. Many individuals will make phone calls in order to inform their relatives about the disaster. According to Kuligowski (2009, p. 93), “other individuals will form new groups in order to overcome the challenges associated with the disaster”.
These behaviors can “offer evidence-based concepts that can support different fields such as Fire Management (FM), disaster response, engineering, and architecture” (Kuligowski, 2009, p. 14). Engineers and architects can study the behaviors of human beings during every evacuation process. This practice will produce better structures that can safeguard the lives of many citizens.
Reference List
Fahy, R., & Proulx, G. (2011). Human Behavior in the World Trade Center Evacuation. Fire Safety Science, 1(1), 713-724.
Gagnon, R. (2008). Design of Special Hazard and Fire Alarm Systems. Clifton Park, NY: Thomson Delmar Learning.
Okaya, M, Takahashi, T, & Southern, M. (2013). Effect of Guidance on Evacuation Behavior Simulations Using Agent Communication. Proceedings of the Workshop on Multi-agent Interaction Networks, 1(1), 1-7.
Simonovic, S. (2011). Systems Approach to Management of Disasters: Methods and Applications. New York, NY: Wiley.
Emergency medical services (EMS) provide crucial, life-saving care to patients in a variety of settings. In particular, ambulance and air evacuation services are critical, as they can save a patient who cannot get to a hospital on their own. To provide effective care, it is essential for ambulances and air evacuation services to arrive and deliver patients to a care facility promptly. The present literature review will reflect the importance of studying the topic, the standards for an ambulance and air evacuation in different countries, and the use of geographic information systems (GIS) in emergency services.
The Importance of the Topic
EMS is an essential part of health care that helps to ensure adequate care delivery in urgent circumstances. EMS usually involve call centres, dispatchers, and ambulances staffed with qualified paramedics (Gholami-Zanjani, Pishvaee, & Ali Torabi, 2017). Due to the complex structure, operations in EMS include a set of procedures from receiving calls and dispatching ambulances or air evacuation to providing medical treatment on-site and delivering a patient to the nearest facility (Gholami-Zanjani et al., 2017). As the following sections will show, improving ambulance and air evacuation using research supports care provision, improves response time, and allows addressing healthcare disparities.
Care Provision
First of all, the research of ambulance and air evacuation helps to outline the population’s needs with regards to emergency medical care. For example, stroke is among the most critical acute illnesses, and it threatens the patient’s life if not addressed promptly. In Australia, approximately 56,000 cases of stroke are recorded each year (The Council of Ambulance Authorities [CAA], 2018). Fast response to stroke is crucial because, for every minute that passes without adequate treatment, the patient loses up to 2 million neurones, which contributes to brain damage (CAA, 2018).
An ambulance can provide urgent medical services and deliver the patient to the nearest medical institution, thus reducing brain damage and increasing their chances of survival. Research into ambulance services and stroke enabled to development of guidelines to determine if a patient has a stroke and requires to be taken to the hospital (CAA, 2018).
Moreover, research also showed that there are certain issues with delivering patients to a facility that meets the requirements to provide adequate stroke treatment. For instance, CAA (2018) reported that after ambulances usually transport stroke patients to the nearest facility, they often need to be transferred to a different institution for neurosurgical or endovascular care, which worsens patient outcome due to time delays. Further research into the subject would improve the capacity of Australian EMS to provide timely and efficient care to patients with stroke, thus enhancing survival and recovery rates.
Another example of using research to improve the work of ambulance and air evacuation is determining procedures and treatment that would be beneficial to emergency medical care. Naumann et al. (2018) studied the use of intravenous fluids during air ambulance treatment of patients in the United Kingdom. The research found that most patients received 0.9% saline for hypotensive trauma, and some also received Hartmann’s solution (Naumann et al., 2018).
The authors also found that there was a gap in services provided by air ambulance due to the lack of prehospital blood products (PHBP). The research showed that providing PHBP would save approximately 800 patients annually by making care delivery more efficient (Naumann et al., 2018). This research can be used to improve the capacity of national EMS to respond to emergencies by proving the necessity of expanding the range of treatments offered by air ambulances.
Response Time
Response time is also a prevalent topic of research with regards to EMS. Insufficient response time affects patient outcomes by delaying the administration of treatment. In life-threatening circumstances, two or three minutes can be crucial, as seen in the example of stroke patients. Lower response time promotes the accessibility of services and vice versa (Gholami-Zanjani et al., 2017). However, there are multiple factors that affect response time, from internal operations to the patient’s distance from an EMS station. Research can assist in understanding these factors and ensuring adequate coverage of EMS services.
For example, a study by Lam et al. (2015) sought to determine the variables affecting ambulance response time. According to the researchers, weather, traffic, and patient location were the most critical factors influencing response time. Long average response time was almost 13 times more common under heavy traffic conditions than under light traffic conditions (Lam et al., 2015). In a similar manner, heavy rain doubled the possibility of long response time (Lam et al., 2015).
Although the distance to a patient was significant, the researchers found an interesting correlation between the type of buildings where patients were located and the response time. For homes and commercial destinations, the average response time of an ambulance was significantly higher than for road incidents (Lam et al., 2015). Studying the factors influencing response time can assist in reducing it through opening more EMS stations, developing new routes, and making changes to operations.
The location of EMS facilities is crucial to reducing the average response time of ambulance or air evacuation services. According to Gholami-Zanjani et al. (2017), the operations in most EMS systems choose a dispatch facility automatically, based on factors such as staff availability and time to destination. The systems used by EMS have three key goals: minimising the average response time, minimising the maximum response time, and maximising the geographical area that can be covered within a particular response time (Gholami-Zanjani et al., 2017).
Research on system configurations and supporting tools, such as geographic information systems (GIS), is essential to achieving these goals and increasing the responsiveness of EMS. For instance, GIS can contribute to decision support systems that choose options for reducing response time (Gholami-Zanjani et al., 2017). Overall, considering the response time of EMS from the perspective of the ambulance and air evacuation services provides insight into problems and helps to generate solutions.
Addressing Healthcare Disparities
Disparities in access to care and patient outcomes exist in most countries. Reducing these disparities has a positive effect on population health. EMS services, in particular, are concerned with improving access to care regardless of patients’ background and their location. Geographical justice is a critical concept in EMS as it considers location-based healthcare disparities (Rosenberg, 2013). Research on the use of EMS services, including ambulance and air evacuation, can help to underline and address existing disparities, thus contributing to population health outcomes.
Firstly, improving the efficiency of the ambulance and air evacuation can lead to a significant reduction in location-based disparities. Research showed that the use of ambulance services decreases in less developed areas (Liu et al., 2015). Neighbourhood characteristics, such as health infrastructure and demographic make-up, can also create geographical health disparities (Rosenberg, 2013). Improving the coverage of EMS could contribute to the development of health infrastructure in remote areas, thus addressing location-based disparities.
Research on the ambulance and air evacuation services can also generate ideas for policy changes needed to reduce healthcare disparities. According to multiple studies, socioeconomic factors play an essential role in determining patients’ utilisation of emergency services. One of the most crucial variables was insurance status. According to a study by Seo, Begley, Langabeer, and DelliFraine (2014), over 85% of those willing to use emergency services were insured.
In countries where there is no universal healthcare, such as the United States, the correlation of insurance coverage and EMS use can have a critical influence on population health. Income was also a significant predictor of EMS use due to the burden of medical costs (Seo et al., 2014). This information can assist governments in reducing health disparities and increasing access to care through policy changes.
Lastly, racial and ethnic disparities can also be addressed in research studies and programs. As noted by Mochari-Greenberger et al. (2015), racial and ethnic minorities are less likely to use EMS than white people, which contribute to health disparities experienced by these populations. Determining reasons for racial and ethnic differences in an ambulance or air evacuation use can provide insight and help generate viable, long-term solutions.
For instance, Phung et al. (2015) studied inequality in ambulance care received by people of colour. According to researchers, “Inequalities in prehospital care for ethnic minority groups are underpinned by problems of cultural awareness in professionals; language and communication difficulties; and a limited understanding of how the healthcare system operates for some minority groups” (p. 37). Improving EMS delivery to and use by ethnic minorities would thus require policy and organisational changes addressing these issues. Providing paramedics with training on culturally sensitive care or creating linguistically diverse emergency response teams could be among the useful strategies.
National Standards in Emergency Services
There are numerous variables that affect how national standards in emergency services are set and updated. For example, the duties of EMS service providers might differ from one country to another. In most countries, EMS providers are responsible for receiving and processing emergency calls and arranging patient transportation (Reuter-Oppermann, van den Berg, & Vile, 2017). However, different types of ambulances can also perform various functions, such as life support (Reuter-Oppermann et al., 2017). The standard service time for different types of calls will vary depending on the availability and workload of various ambulances.
An excellent example of differences in standards is the differentiation between patient transports and emergency calls. Emergency calls are made in life-threatening events, whereas patient transport calls are made for patients who require assistance with transportation to a hospital due to injury or illness (Reuter-Oppermann et al., 2017). In the Netherlands, the standard response time is 30 minutes for patient transports and 15 minutes for emergency calls, whereas, in the UK, the standards are 8 minutes for emergencies (Care Quality Commission, 2014; Reuter-Oppermann et al., 2017).
The set standards are influenced by the capacity of the national EMS system, as well as the demand for services. The UK has a robust EMS system with a large number of ambulances on call at all times, thus allowing for a reduced response time.
The present section will seek to compare EMS standards used in the USA, Germany, Saudi Arabia, and Australia. In particular, response time and classification of calls will be taken into account to allow for comparing EMS functions in these countries. The section will also attempt to provide a rationale for setting a particular standard for response time based on previous research and geospatial analysis.
USA
In the United States, EMS services are guided by the NFPA 1710 standard, which is regularly updated to ensure coherence. NFPA 1710 provides guidelines and standards for fire departments, EMS, and special operations (NFPA, 2016). There are three different levels of EMS treatments set out by the standards: First Responder, Basic Life Support (BLS), and Advanced Life Support (ALS). According to the International Association of Fire Fighters (IAFF, 2017), personnel deployed to ALS emergency responses shall include, at a minimum, two paramedics and two BLS members.
There are no standard response times set on the federal level, which allows states, districts, and counties to regulate response times based on needs and available resources. However, as reported by Racht and Turpen (2013), in 90% of communities, First Responders had a standard response time of 4 minutes, and ALS ambulances had a standard of 8 minutes. Although there are various factors impacting the response time of a particular ambulance, a short standard response time reflects the overall capacity of EMS services in America.
Germany
In Germany, EMS operations are somewhat similar in terms of geospatial distribution. There are 16 critical areas in the country, each having a separate EMS system (Malteser, 2018). There are three types of EMS available to the public in case of a medical emergency: road ambulances, air rescue, and emergency doctor service (Malteser, 2018). There are no specific guidelines for EMS operations on the national level, although some standards are developed locally (Malteser, 2018).
However, the local EMS systems are structured in a way that allows for a fast response to any location. Malteser (2018) reports that there are at least 88 helicopters utilised by the country’s EMS, which means that in any place, an EMS helicopter is available within a 50-kilometre radius. As a result, the maximum response time of EMS services in Germany is 15 minutes (Malteser, 2018). The effectiveness of Germany’s EMS functions is also evident from research. For example, a study by Bürger et al. (2018) found that the response time of German EMS services was always between 1 and 10 minutes. The results show that despite the lack of national EMS standards, local EMS systems in Germany are efficient in providing medical care to patients.
Saudi Arabia
In Saudi Arabia, EMS is provided by the Saudi Red Crescent Authority (SRCA), which is a national healthcare agency. There are two levels of the national EMS system in Saudi Arabia, including a network of public health centres and specialised hospitals in large cities (Al Mutairi et al., 2018). SRCA acts as an assistance agency to other medical facilities in the kingdom, which allows it to ensure the presence of staffed ambulances on call at all times (Al Mutairi et al., 2018).
There are two types of ambulance services based on patients’ needs: ALS and BLS. ALS is staffed with paramedics who are qualified to perform invasive procedures in the ambulance to preserve a patient’s life until arrival at the nearest facility Al Mutari et al., 2018). There are no national standards of EMS operations in Saudi Arabia and no guidelines for implementing such standards locally. The international standard of 8 minutes is usually applied in research. Nevertheless, the average response time of ambulances in Saudi Arabia was found to be 13 minutes in its capital city, Riyadh (Alnemer et al., 2016). This allows suggesting that response time in remote areas may be higher due to the lower availability of ambulances and fewer hospitals.
Australia
EMS in Australia are regulated by state governments, and thus there are no formal national standards with regards to EMS procedures. Incidents are classified based on the level of urgency, and ambulances respond to an emergency (code 1), urgent (code 2), and non-emergency (codes 3, 4) calls (Productivity Commission, 2018). There are no national standards for ambulance response times in Australia. According to the Productivity Commission (2018), 90% of state-wide ambulances reach patients in 14.3 to 31.4 minutes, depending on the incident. For instance, in New South Wales, the median response time for emergency cases was 7.47 minutes in 2016-2017 (NSW Government, 2018). However, as only 50% of ambulances arrived within this time, it can be assumed that in many cases, the response time for emergency or urgent calls can be much higher.
Comparison
Out of the four countries, formal standards for response times and EMS operations were only adopted in the United States and Germany. These countries also had lower response times of ambulances in comparison to Saudi Arabia and Australia. This finding suggests a correlation between formal standards and EMS systems performance. However, it could also mean that countries that perform well on EMS services have a greater overall capacity of their EMS systems. Research on average response times in Saudi Arabia and Australia shows that, in both cases, there is room for significant improvement (Alnemer et al., 2016; NSW Government, 2018).
Lowering the average response time on a national level would benefit patients by promoting their health outcomes and reducing geographical healthcare disparities. In order to achieve this goal, it is critical to adopt formal standards of EMS operations and response time, as well as ensure that there is a robust network of ambulances in all parts of the country.
Rationale
Standards for ambulance response times are mostly based on previous research and the capacity of EMS systems. For example, a study by Bürger et al. (2018) showed that, in life-threatening circumstances, increases in mean response time reduce discharge rates. The researchers note that “among patients who did not receive bystander resuscitation, the discharge rate declined from 12.9% at a mean response time of 1 minute and 10 seconds to 6.4% at a mean response time of 9 minutes and 47 seconds” (Bürger et al., 2018, p. 541).
Another study by Goto, Funada, and Goto (2018) highlighted that, with every minute of response time, the patient’s odds of neurologically intact survival at one month after cardiac arrest decreased. The authors concluded that response times of 11-13 minutes would only result in neurologically intact survival if patients receive defibrillation or cardiopulmonary resuscitation by bystanders (Goto et al., 2018). Assuming that there is no bystander intervention, setting a standard response time under 10 minutes is justified.
Another reason for lower standard response time in certain countries is the use of geospatial analysis, as it helps to expand the capacity of EMS systems. Firstly, geospatial analysis allows estimating the average response time for EMS systems operating in a specific area. Thus, if a state or county government seeks to set a new standard response time, it can use data from medical research and geospatial analysis to determine a time that is beneficial for patients and operationally feasible. Secondly, the use of geospatial analysis for ambulance deployment also results in decreased arrival times, both for road ambulances and air ambulances (Alharbi, 2015; Ong et al., 2010; Swalehe & Atkas, 2016). Therefore, EMS systems that utilise geospatial analysis as part of their operations can set a lower standard response time.
Recent Research on GIS
Recent research on the use of GIS in EMS operations focuses primarily on utilising the system for improving service delivery and optimising operations. For example, a study by Baloyi, Mokgalaka, Green, and Mans (2017) considered his use of a GIS-based accessibility analysis to evaluate service levels of public ambulances. In particular, the study aimed to determine if the distribution of EMS stations in a specific area was sufficient and adequate to ensure arrival within the standard time frame. The research showed that GIS could be used to evaluate the capacity of local EMS systems and outline gaps in their operations (Baloy et al., 2017).
In the given case, the area showed satisfactory results in EMS distribution, but the allocation of vehicles was uneven (Baloy et al., 2017). A GIS-based framework was used to predict system performance under different scenarios, which shows its value for improving EMS delivery and operations.
Another recent study of GIS considered its use for optimising regional health emergency services in Morocco. Khalfaoui and Hammouche (2018) used GIS mapping to achieve several important goals. First of all, GIS helped to evaluate the overall capacity of the regional network and its current effectiveness. Secondly, the researchers tested the performance of regional health emergency network under different scenarios, such as a traffic incident requiring fast EMS response and a high number of EMS urgent calls for individual patients.
Finally, based on the results of the analysis, the authors suggested a decision-support model based on GIS that would help to improve the performance of regional EMS networks (Khalfaoui & Hammouche, 2018). The study is valuable to the topic, as it portrays several possible applications of GIS for improving EMS delivery to the public. Modelling EMS activity in different scenarios is particularly beneficial because it allows testing the current system for emergency preparedness instead of evaluating it under regular circumstances.
The possible influence of GIS on evacuation planning is also a popular topic in recent research. Mohamed, Kosba, Mahar, and Mesbah (2017) used a combination of GIS and decision-support systems to devise local emergency preparedness and response plans. The application of GIS, in this case, enabled the assessment of different route options and planned for optimal response to various emergency scenarios.
For example, the authors applied GIS to modelling different evacuation routes and established the best alternative (Mohamed et al., 2017). GIS also allowed determining the nearest safe destinations that could be used for evacuation purposes in a variety of emergencies. Based on this study, the application of GIS in evacuation planning can be beneficial because it improves EMS system capacity indirectly by optimising its operations in different scenarios.
A different study by Alharbi (2015) considered the potential use of GIS to reduce the response time of air ambulance services. The author used GIS to develop an extensive decision-support system that could optimise air ambulance performance through improving allocation, direction, and distance analysis (Alharbi, 2015). This is one of a few studies that assessed the application of GIS to air ambulance services, and thus it contributes to the growing body of knowledge regarding the importance of GIS. Aminzadeh, Rabiee, Rezaei, and Bahmanabadi (2017) also evaluated the usefulness of GIS to EMS systems by applying it to decision-making processes in hospitals and ambulance centres.
The study showed that GIS has numerous applications in the field of EMS. The authors found that it helps to reduce ambulance response time by routing, assists in emergency operations planning, and ensures optimal allocation of ambulance patients to hospitals based on distance, availability, and disease prevalence (Aminzadeh et al., 2017). This is a useful study that reviews general applications of GIS in EMS operations, thus highlighting the importance of the system.
GIS Application Issues
Despite the potential benefits of GIS that are well-described in various research studies, the application of GIS for location and relocation of health services poses some problems. First of all, as described by Fletcher-Lartey and Caprarelli (2016), geographical information systems use highly complex data that cannot be applied to all areas and settings evenly. For example, GIS can conflict with traditional applications used for location and relocation of health services, thus producing contradicting analysis results. The possibility to use GIS for simulation is also limited due to the need for specialised analysis of information obtained from it (“Limitations and challenges of GIS,” 2018). Therefore, when planning location or relocation using GIS, facilities and service providers might experience issues that require utilising additional applications.
The second issue that comes with the use of GIS for location and relocation is the lack of necessary GIS infrastructure (Fletcher-Lartey & Caprarelli, 2016). GIS software and tools required for analysing GIS data are usually very expensive, which creates problems for applying GIS in resource-limited settings (Fletcher-Lartey & Caprarelli, 2016). As the healthcare budget in most countries is limited, this can prove to be a crucial problem impeding GIS application. Additionally, due to the complexity of the system, it is not possible to use a single GIS function to solve a specific problem (e.g., reducing ambulance response time). The use of GIS for any purpose requires a complex operational infrastructure, which limits the scope of its application in practice.
Thirdly, limited access to high-quality spatial data in GIS is also an important issue. Fletcher-Lartey and Caprarelli (2016) state that the availability of high-quality spatial and healthcare data in GIS is limited. Finally, there is a shortage of staff that is qualified in using GIS and has prior experience with the system (Fletcher-Lartey & Caprarelli, 2016). As location and relocation of health services are usually performed within a tight timeframe, poor access to qualified personnel makes GIS application in these settings problematic. Nevertheless, as GIS becomes more popular all over the globe, these two issues might resolve.
Conclusion
Overall, effective EMS operations are critical to preserving a patient’s life and reducing the possibility of long-term consequences. The analysis of EMS systems in the United States, Germany, Saudi Arabia, and Australia showed that the application of EMS standards is uneven, leading to higher ambulance response time in certain countries. Geospatial analysis and GIS could be used to address common issues in EMS, including ambulance response time. Nevertheless, the lack of GIS infrastructure, the complexity of the system, and the limited availability of resources create issues for GIS implementation. Future development of GIS technology could enhance its applicability; in the current circumstances, using GIS for location and relocation creates more problems than opportunities.
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The case study investigates an inferno at a perilous waste facility situated at Apex, North Carolina. The inferno started on the eve of October 6th, 2006, at the EQ hazardous waste facility on Investment Boulevard in Apex; a neighborhood of Raleigh, North Carolina. In response to the disaster, city authorities planned an evacuation exercise for tens of thousands of city dwellers for two days as the inferno kept raging.
Around 30 residents sought medical treatment. The U.S. Chemical Safety Board (CSB) demanded a new national fire code for hazardous waste installations and for enhancing the disaster response mechanisms to community emergency planners with regard to the chemicals stored, and handled by these facilities. This can improve safety of sites.
What exactly caused the horrific fire?
According to the investigations done by CSB, an inferno started in the building that stored oxygen cylinders. The bays that stored wastes were brought for storage in preparation for transportation to final treatment sites and disposal facilities. It is believed that the oxygen chemicals were activated. The bay contained several chemical oxygen generators, which were brought from Mobile, Alabama.
These are wastes generated from airplane. Conversely, the oxygen generators had not been securely activated. Chemicals that contained chlorine in its solid state were heaped above the box that contained active oxygen generators. This is what was theorized to have started the fire at the facility. All these events may have triggered the fire in the storage bay.
The violation of the code on fire
The National Fire Protection Association (NFPA) promulgates information on fire protection standards for different industrial installations. For example, NFPA 820 is the “Standard for Fire Protection in Wastewater Treatment and Collection Facilities”).
Rob Hall, P. E. , a CSB lead Investigator who led the investigation discovered that there was only one fire control equipment at the site with portable and manually operated fire extinguishers. Buildings are supposed to have automatic fire extinguishers.
The enquiry into the fire accident found out that RCRA rules formulated by EPA call for facilities to install “fire control equipment” although do not spell out what equipment and systems should be in installed. Furthermore, it noted that a national fire code for proper fire protection measures for hazardous waste facilities was non-existent.
The EQNC hazardous waste edifice was not well equipped with fire or smoke sensing devices, automatic fire containment equipment, or fire barriers, despite the fact that the building served as a storage facility for drums of flammables and explosive materials. In summary we can say that NFPA 820 is the code that was violated.
The impact of the fire (damages, loss, and consequences)
The fire incident caused air pollution, damages to nearby buildings. More residents were displaced. When the fire occurred, around 30 people (together with 13 first responders) went to seek medical treatment at neighboring hospitals for respiratory complications and nausea.
As a result of this fire incident, CSB issued a safety advisory to ensure that chemical oxygen generators are securely activated and discharged prior to transportation and disposal.
The final verdict of CSB to EPA and Environmental Technology Council was to find proper ways of dealing with disaster planning, fire protection and managing hazardous waste facilities. It is the responsibility of each and every stakeholder to put measures in place to avert any future fire outbreaks.