Passenger Flows in Underground Railway Stations and Platforms, MTI Report 12-43

Urban rail systems are designed to carry large volumes of people into and out of major activity centers. As a result, the stations at these major activity centers are often crowded with boarding and alighting passengers, resulting in passenger inconvenience, delays, and at times danger. This study examines the planning and analysis of station passenger queuing and flows to offer rail transit station designers and transit system operators guidance on how to best accommodate and manage their rail passengers. The objectives of the study are to: 1) Understand the particular infrastructural, operational, behavioral, and spatial factors that affect and may constrain passenger queuing and flows in different types of rail transit stations; 2) Identify, compare, and evaluate practices for efficient, expedient, and safe passenger flows in different types of station environments and during typical (rush hour) and atypical (evacuations, station maintenance/ refurbishment) situations; and 3) Compile short-, medium-, and long-term recommendations for optimizing passenger flows in different station environments

CARE-PACT: a new paradigm of care for acutely unwell residents in aged care facilities

Describes the Comprehensive Aged Residents Emergency and Partners in Assessment, Care and Treatment (CARE-PACT) program: a hospital substitutive care and demand management project that aims to improve, in a fiscally efficient manner, the quality of care received by residents of aged care facilities. Background Ageing population trends create a strong imperative for healthcare systems to develop models of care that reduce dependence on hospital services. People living in residential aged care facilities (RACFs) currently have high rates of presentation to emergency departments. The care provided in these environments may not optimally satisfy the needs of frail older persons from RACFs.   Objective To describe the Comprehensive Aged Residents Emergency and Partners in Assessment, Care and Treatment (CARE-PACT) program: a hospital substitutive care and demand management project that aims to improve, in a fiscally efficient manner, the quality of care received by residents of aged care facilities when their acute healthcare needs exceed the scope of the aged care facility staff and general practitioners to manage independently of the hospital system.   Discussion The project delivers high-quality gerontic nursing and emergency specialist assessment, collaborative care planning, skills sharing across the care continuum and an individualised, resident-focused approach

Growth in Western Australian emergency department demand during 2007–2013 is due to people with urgent and complex care needs

Objectives: To determine the magnitude and characteristics of the increase in ED demand in Western Australia (WA) from 2007 to 2013. Methods: We conducted a population-based longitudinal study examining trends in ED demand, stratified by area of residence, age group, sex, Australasian Triage Scale category and discharge disposition. The outcome measures were annual number and rate of ED presentations. We calculated average annual growth, and age-specific and age-standardised rates. We assessed the statistical significance of trends, overall and within each category, using the Mann–Kendall trend test and analysis of variance ANOVA. We also calculated the proportions of growth in ED demand that were attributable to changes in population and utilisation rate. Results: From 2007 to 2013, ED presentations increased by an average 4.6% annually from 739 742 to 945 244. The rate increased 1.4% from 354.1 to 382.6 per 1000 WA population (P = 0.02 for the trend). The main increase occurred in metropolitan WA, age 45+ years, triage category 2 and 3 and admitted cohorts. Approximately three-quarters of this increase was due to population change (growth and ageing) and one-quarter due to increase in utilisation. Conclusion: Our study reveals a 4.6% annual increase in ED demand in WA in 2007–2013, mostly because of an increase in people with urgent and complex care needs, and not a shift (demand transfer) from primary care. This indicates that a system-wide integrated approach is required for demand management

Characteristics of Real-Time, Non-Critical Incident Debriefing Practices in the Emergency Department.

INTRODUCTION: Benefits of post-simulation debriefings as an educational and feedback tool have been widely accepted for nearly a decade. Real-time, non-critical incident debriefing is similar to post-simulation debriefing; however, data on its practice in academic emergency departments (ED), is limited. Although tools such as TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) suggest debriefing after complicated medical situations, they do not teach debriefing skills suited to this purpose. Anecdotal evidence suggests that real-time debriefings (or non-critical incident debriefings) do in fact occur in academic EDs;, however, limited research has been performed on this subject. The objective of this study was to characterize real-time, non-critical incident debriefing practices in emergency medicine (EM). METHODS: We conducted this multicenter cross-sectional study of EM attendings and residents at four large, high-volume, academic EM residency programs in New York City. Questionnaire design was based on a Delphi panel and pilot testing with expert panel. We sought a convenience sample from a potential pool of approximately 300 physicians across the four sites with the goal of obtaining \u3e100 responses. The survey was sent electronically to the four residency list-serves with a total of six monthly completion reminder emails. We collected all data electronically and anonymously using SurveyMonkey.com; the data were then entered into and analyzed with Microsoft Excel. RESULTS: The data elucidate various characteristics of current real-time debriefing trends in EM, including its definition, perceived benefits and barriers, as well as the variety of formats of debriefings currently being conducted. CONCLUSION: This survey regarding the practice of real-time, non-critical incident debriefings in four major academic EM programs within New York City sheds light on three major, pertinent points: 1) real-time, non-critical incident debriefing definitely occurs in academic emergency practice; 2) in general, real-time debriefing is perceived to be of some value with respect to education, systems and performance improvement; 3) although it is practiced by clinicians, most report no formal training in actual debriefing techniques. Further study is needed to clarify actual benefits of real-time/non-critical incident debriefing as well as details on potential pitfalls of this practice and recommendations for best practices for use

Cumulative Risk and a Call for Action in Environmental Justice Communities

Health disparities, social inequalities, and environmental injustice cumulatively affect individual and community vulnerability and overall health; yet health researchers, social scientists and environmental scientists generally study them separately. Cumulative risk assessment in poor, racially segregated, economically isolated and medically underserved communities needs to account for their multiple layers of vulnerability, including greater susceptibility, greater exposure, less preparedness to cope, and less ability to recover in the face of exposure. Recommendations for evidence-based action in environmental justice communities include: reducing pollution in communities of highest burden; building on community resources; redressing inequality when doing community-based research; and creating a screening framework to identify communities of greatest risk

Occupational violence and aggression in urgent and critical care in rural health service settings : a systematic review of mixed studies

Rural/remote health services are vulnerable to occupational violence and aggression due to factors such as weapon accessibility, poor network coverage and distance to backup. This systematic review investigated (1) the nature of occupational violence and aggression perpetrated in rural/remote health service urgent care settings and (2) the availability and effectiveness of policies/interventions/recommendations that address occupational violence and aggression in this context. We searched Business Source Complete, CINAHL Complete, Health & Society, APAIS Health, Health Collection, PsycINFO, PubMed, Scopus, SocIndex and Web of Science. Included articles (peer-reviewed, no grey literature and English language) addressed occupational violence and aggression in rural health service urgent care settings. Fifteen articles matched these criteria (total [rural/remote only, where specified] N ~ 2555) and were included in the final analysis. The Mixed Methods Appraisal Tool was applied to assess the risk of bias. A data extraction table and narrative synthesis are presented. The most common occupational violence and aggression type was verbal aggression. The primary perpetrator was patients. Risk factors reflected practitioner age, remoteness, sector, staffing, shift type and area of practice. Precipitating factors were alcohol/drugs, dissatisfaction and mental health conditions. Policy content and limitations and education/training programme effectiveness were not addressed. Community collaboration supported occupational violence and aggression prevention/management. Organisational culture should promote reporting, debriefing and post-incident care for staff well-being. Work environment and job/task design are priorities for safety, but with possible limitations for traumatised clients. Occupational violence and aggression policies/interventions in rural health settings must be systematically evaluated to inform best practices. Co-funded by Swinburne Social Innovation Research Institute Interdisciplinary Seed Funding Scheme and SMART Rural Health Network. © 2022 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd

An Online Decision-Theoretic Pipeline for Responder Dispatch

The problem of dispatching emergency responders to service traffic accidents, fire, distress calls and crimes plagues urban areas across the globe. While such problems have been extensively looked at, most approaches are offline. Such methodologies fail to capture the dynamically changing environments under which critical emergency response occurs, and therefore, fail to be implemented in practice. Any holistic approach towards creating a pipeline for effective emergency response must also look at other challenges that it subsumes - predicting when and where incidents happen and understanding the changing environmental dynamics. We describe a system that collectively deals with all these problems in an online manner, meaning that the models get updated with streaming data sources. We highlight why such an approach is crucial to the effectiveness of emergency response, and present an algorithmic framework that can compute promising actions for a given decision-theoretic model for responder dispatch. We argue that carefully crafted heuristic measures can balance the trade-off between computational time and the quality of solutions achieved and highlight why such an approach is more scalable and tractable than traditional approaches. We also present an online mechanism for incident prediction, as well as an approach based on recurrent neural networks for learning and predicting environmental features that affect responder dispatch. We compare our methodology with prior state-of-the-art and existing dispatch strategies in the field, which show that our approach results in a reduction in response time with a drastic reduction in computational time.Comment: Appeared in ICCPS 201

Designing and Operating Safe and Secure Transit Systems: Assessing Current Practices in the United States and Abroad, MTI Report 04-05

Public transit systems around the world have for decades served as a principal venue for terrorist acts. Today, transit security is widely viewed as an important public policy issue and is a high priority at most large transit systems and at smaller systems operating in large metropolitan areas. Research on transit security in the United States has mushroomed since 9/11; this study is part of that new wave of research. This study contributes to our understanding of transit security by (1) reviewing and synthesizing nearly all previously published research on transit terrorism; (2) conducting detailed case studies of transit systems in London, Madrid, New York, Paris, Tokyo, and Washington, D.C.; (3) interviewing federal officials here in the United States responsible for overseeing transit security and transit industry representatives both here and abroad to learn about efforts to coordinate and finance transit security planning; and (4) surveying 113 of the largest transit operators in the United States. Our major findings include: (1) the threat of transit terrorism is probably not universal—most major attacks in the developed world have been on the largest systems in the largest cities; (2) this asymmetry of risk does not square with fiscal politics that seek to spread security funding among many jurisdictions; (3) transit managers are struggling to balance the costs and (uncertain) benefits of increased security against the costs and (certain) benefits of attracting passengers; (4) coordination and cooperation between security and transit agencies is improving, but far from complete; (5) enlisting passengers in surveillance has benefits, but fearful passengers may stop using public transit; (6) the role of crime prevention through environmental design in security planning is waxing; and (7) given the uncertain effectiveness of antitransit terrorism efforts, the most tangible benefits of increased attention to and spending on transit security may be a reduction in transit-related person and property crimes