This dissertation explores conceptual, normative, and institutional dimensions of the emergency problematic and defends judicial participation in emergency governance. I develop my arguments on the basis of Posner and Vermeule’s discussion in their book Terror in the Balance. I reject their institutional account of emergency governance captured in their deference thesis by showing its incompatibility with fundamental liberal democratic commitments. As I argue, Posner and Vermeule’s call for across-the-board judicial deference to the executive during emergencies is unwarranted in a number of cases, most notably those involving conflicts of constitutional rights. I also reject Posner and Vermeule’s account of emergency policymaking captured in their tradeoff thesis by showing that it does not provide a suitable criterion by means of which the legitimacy of emergency policies could be determined. My arguments against the tradeoff and deference theses are based in part on my critique of Posner and Vermeule’s conception of emergency situations. In fleshing out my conception of emergency, I present and defend a methodological approach to studying the emergency problematic and offer an extensive discussion of exceptionality associated with emergencies. My conclusion is that it is necessary to take in account liberal democratic commitments in the process of emergency policymaking and that judicial review of the executive during periods of emergency is conducive to legitimate emergency governance. / Thesis / Doctor of Philosophy (PhD) / Some national security crises pose serious challenges to western liberal democracies. On the one hand, because such crises threaten individual lives and the welfare of the political community, there is a strong case in favor of demanding that the government do everything in its power to quash such threats by any means necessary. On the other hand, a number of constitutional commitments seem to prevent liberal democracies from using some means in addressing national security crises. In particular, emergency measures such as coercive interrogation and indefinite detention seem to undermine a number of values and commitments that are fundamental to liberal democratic regimes. In addition, there is a controversy surrounding the role of the judiciary during emergencies. Should judges review executive action to ensure its legitimacy during emergencies or should the executive be the final authority on the legitimacy of its policies? My dissertation develops answers to these questions. I begin by exploring conceptual issues surrounding emergencies. On the basis of this exploration, I provide an account of the role of fundamental liberal democratic commitments in the project of emergency governance and argue in favor of judicial participation in governing liberal democratic communities during periods of emergency.

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Rising demands and market competition have forced many emergency departments to improve their quality of service. This improvement is usually achieved at the cost of increasing resources in the emergency department in order to increase the patient satisfaction. This research deals in part with both problems, i.e., increasing patient satisfaction and keeping costs in the ED to a minimum. The research has schedules designed on the patient contacts for physicians and residents in the academic emergency department at York hospital such that the resource costs and patient waiting costs are kept at a minimum. The emergency department is simulated using Arena 7.0 and the minimum cost objective is achieved by running OptQuest for Arena to get the near optimal number of staff working the designed schedules in order to achieve the objective. Efficiently scheduling doctors and residents resulted in waiting cost reductions of almost 80%. There was also an increase in patient satisfaction, considering the time taken by patients to see a doctor or resident for the first time. The time was reduced by 33% for critical patients and was reduced by almost 29% for intermediate care patients with the schedules designed herein. / Master of Science

This study addresses the issue of household disaster preparedness. This work contributes two elements to disaster research. The first contribution improve the knowledge of the factors that affect household disaster preparedness. The review of literature yielded three categories of variables that can jointly explain household disaster preparedness: household structure, demographics, and risk-perception factors. In this study 19 variables compose these factors. A second contribution constitutes a theoretical exploration of the concept of disaster preparedness. In this work, four different constructs of disaster preparedness were tested. These constructs include material preparedness, preparedness activities, a combined index, and a weighted and combined index. The study presents the logic and methodology of the index construction and validation. The data used in this study came from households in the Montreal Urban Community (MUC) in Canada. A random sample of 1,003 English- and French-speaking heads of households adequately represents the 1.8 million persons within the MUC. An independent survey firm conducted the interviews in 1996. Results show that the weighted combined household disaster preparedness index constitutes the best construct to represent the concepts under study. Study results also reveal that risk-perception variables (attitudinal factors) offered the strongest explanatory power. Household structure and demographic variables collectively explained less than 8% of the dependent variable. The model used in this study yielded a coefficient of determination of .320, explaining 32% of the variance in the household disaster preparedness level. Concluding this study, the discussion offers implications for both disaster managers and researchers. Researchers should add to their analysis the household perspective as a complement to the organizational one. Also, it is clear that many other conceptual issues must be explored in understanding and measuring disaster preparedness. Disaster managers should base their efforts on sound research rather than on misconceptions about social behavior. Such implications can contribute to bridging the gap and also putting into practice the knowledge drawn from this growing and collective effort of studying disasters.

Hospitals stand to lose millions of dollars in revenue due to patients who leave without treatment (LWT). Grounded in queueing theory, the purpose of this correlational study was to examine the relationship between daily arrivals, daily staffing, triage time, emergency severity index (ESI), rooming time, door-to-provider time (DTPT), and LWT rates. The target population comprised patients who visited a Connecticut emergency room between October 1, 2017, and May 31, 2018. Archival records (N = 154) were analyzed using multiple linear regression analysis. The results of the multiple linear regression were statistically significant, with F(9,144) = 2902.49, p < .001, and R2 = 0.99, indicating 99% of the variation in LWT was accounted for by the predictor variables. ESI levels were the only variables making a significant contribution to the regression model. The implications for positive social change include the potential for patients to experience increased satisfaction due to the high quality of care and overall improvement in public health outcomes. Hospital leaders might use the information from this study to mitigate LWT rates and modify or manage staffing levels, time that patients must wait for triage, room placement, and DTPT to decrease the rate of LWT in the emergency room.

<p>The study aimed to investigate the acute medical chain consisting of SOS operator, ambulance nurse, emergency nurse and emergency physician with regard to the assessment and prioritization of the victim.</p><p>The design of this journal study is retrospective with descriptive approach. Data were collected from all ambulance missions carried out in Uppsala county 2009-01-01 between the hours 00:00 to 12:00. Sample period was chosen because the prerequisite for high frequency on the ambulance mission was supposed to be good. In order to be able to systematize the compilation of data a protocol were prepared and used. Applicable data were collected from three databases SOS Alarms, ambulance operations, and the University Hospital in Uppsala. The study was divided into three stages and record documents usefulness was assessed individually based on inclusion criteria's. During the measurement period the SOS operator assessed need of an ambulance at 62 occasions in Uppsala County. Of these 62 ambulance missions there were 18 that could be followed during the whole acute medical chain.</p><p>The results showed that the participants of the acute medical chain most of the time did the same assessment of the victim main problem/symptom and thus the criterion. Without considering the priority it appeared that the criteria were the same in 83% of all 18 included ambulance missions. SOS operator assessed ambulance mission as a priority one in 39% (7/18), and the ambulance nurse judged that priority one on the way to the hospital was justified in 17% (3/18). Of the 18 victims who were transported by ambulance to the emergency department at the University Hospital in Uppsala 72% (13/18) went home the same day.</p> / <p>Studiens syfte var att undersöka den akutmedicinska vårdkedjan bestående av SOS operatör, ambulanssjuksköterska, akutsjuksköterska och akutläkare med avseende på bedömning och prioritering av drabbad.</p><p>Designen på denna journalstudie är retrospektiv med deskriptiv ansats. Data insamlades från samtliga ambulansuppdrag som genomfördes i Uppsala län 2009-01-01 mellan klockan 00:00 - 12:00. Urvalsperioden valdes därför att förutsättningen för hög frekvens på ambulansuppdrag förmodades vara goda. För att systematisera sammanställningen av data utarbetades och användes ett protokoll. Tillämpbara uppgifter inhämtades från tre databaser SOS Alarms, ambulansverksamhetens och Akademiska sjukhusets. Studien delades upp i tre steg och journalhandlingarnas användbarhet bedömdes var för sig utifrån inklusionskriterier. Under mätperioden bedömde SOS operatören behov av ambulans vid 62 tillfällen i Uppsala län. Av dessa 62 ambulansuppdrag gick 18 att följa under hela vårdkedjan.</p><p>Resultatet visade att aktörerna i akutmedicinska vårdkedjan för det mesta gjorde samma bedömning av den drabbades huvudproblem/symtom och därmed kriteriet. Utan hänsyn taget till prioritet så visade det sig att kriterierna övrrensstämde vid 83% av alla 18 inkluderade ambulansuppdrag. SOS operatören bedömde ambulansuppdraget som prioritet ett i 39% (7/18) och ambulanssjuksköterskan bedömde att prioritet ett på väg till sjukhus var motiverat i 17% (3/18). Av de18 drabbade som transporterats med ambulans till akutmottagningen på Akademiska sjukhuset fick 72% (13/18) åka hem samma dag.</p>

The study aimed to investigate the acute medical chain consisting of SOS operator, ambulance nurse, emergency nurse and emergency physician with regard to the assessment and prioritization of the victim. The design of this journal study is retrospective with descriptive approach. Data were collected from all ambulance missions carried out in Uppsala county 2009-01-01 between the hours 00:00 to 12:00. Sample period was chosen because the prerequisite for high frequency on the ambulance mission was supposed to be good. In order to be able to systematize the compilation of data a protocol were prepared and used. Applicable data were collected from three databases SOS Alarms, ambulance operations, and the University Hospital in Uppsala. The study was divided into three stages and record documents usefulness was assessed individually based on inclusion criteria's. During the measurement period the SOS operator assessed need of an ambulance at 62 occasions in Uppsala County. Of these 62 ambulance missions there were 18 that could be followed during the whole acute medical chain. The results showed that the participants of the acute medical chain most of the time did the same assessment of the victim main problem/symptom and thus the criterion. Without considering the priority it appeared that the criteria were the same in 83% of all 18 included ambulance missions. SOS operator assessed ambulance mission as a priority one in 39% (7/18), and the ambulance nurse judged that priority one on the way to the hospital was justified in 17% (3/18). Of the 18 victims who were transported by ambulance to the emergency department at the University Hospital in Uppsala 72% (13/18) went home the same day. / Studiens syfte var att undersöka den akutmedicinska vårdkedjan bestående av SOS operatör, ambulanssjuksköterska, akutsjuksköterska och akutläkare med avseende på bedömning och prioritering av drabbad. Designen på denna journalstudie är retrospektiv med deskriptiv ansats. Data insamlades från samtliga ambulansuppdrag som genomfördes i Uppsala län 2009-01-01 mellan klockan 00:00 - 12:00. Urvalsperioden valdes därför att förutsättningen för hög frekvens på ambulansuppdrag förmodades vara goda. För att systematisera sammanställningen av data utarbetades och användes ett protokoll. Tillämpbara uppgifter inhämtades från tre databaser SOS Alarms, ambulansverksamhetens och Akademiska sjukhusets. Studien delades upp i tre steg och journalhandlingarnas användbarhet bedömdes var för sig utifrån inklusionskriterier. Under mätperioden bedömde SOS operatören behov av ambulans vid 62 tillfällen i Uppsala län. Av dessa 62 ambulansuppdrag gick 18 att följa under hela vårdkedjan. Resultatet visade att aktörerna i akutmedicinska vårdkedjan för det mesta gjorde samma bedömning av den drabbades huvudproblem/symtom och därmed kriteriet. Utan hänsyn taget till prioritet så visade det sig att kriterierna övrrensstämde vid 83% av alla 18 inkluderade ambulansuppdrag. SOS operatören bedömde ambulansuppdraget som prioritet ett i 39% (7/18) och ambulanssjuksköterskan bedömde att prioritet ett på väg till sjukhus var motiverat i 17% (3/18). Av de18 drabbade som transporterats med ambulans till akutmottagningen på Akademiska sjukhuset fick 72% (13/18) åka hem samma dag.

published_or_final_version / Public Administration / Master / Master of Public Administration

Thesis (M. Sc.)--University of Canterbury, 2007. / Typescript (photocopy). Includes bibliographical references (leaves 123-127). Also available via the World Wide Web.