Failure to recognize and respond to changes in a patient’s condition is a limitation in the effective utilization of Medical Emergency Teams (METs). A system that uses smartphone technology to facilitate vital signs collection at bedside has been developed. The alerts engine, based upon Mount Sinai Hospital’s (MSH) MET calling criteria, can automatically alert the MET of patients exhibiting abnormal vital signs. The system, without automated alerting, was piloted at MSH. Sensitivity and specificity calculations revealed that the MSH algorithm had a lower sensitivity and specificity than the Cuthbertson or the Modified Early Warning Score algorithms. This suggests that the MSH algorithm, compared to the others, was poor at identifying patients that did and did not require a MET consultation. Furthermore, the low positive predictive value suggests that the majority of alerts were not associated with a MET call. Therefore, the MSH algorithm is not recommended for the automated system.

Patient satisfaction is a key outcome measure being examined by researchers exploring the relationships between patient outcomes and hospital structure and care processes. Only a few non-generalizable studies, however, have explored the relationship of nurse staffing and patient satisfaction with nursing care in emergency departments of hospitals. This dissertation aims to address that gap. Using more than 182,000 patient satisfaction surveys collected over a five-year period from 153 emergency departments (EDs) in 107 hospitals throughout Ontario, this study explores the relationship between nurse staffing and patient perceptions of nursing care in a range of Canadian ED settings, including urban and rural, community and academic, and small and large healthcare institutions with varying sizes and case mix. Using an established conceptual framework for investigating the relationship between nurse staffing and patient outcomes, nineteen nurse staffing variables were initially investigated. Ultimately, however, only five staffing variables were used in the multi-level regression analyzes. These five variables included registered nurse (RN) proportion, RN agency proportion, percent full-time nurse worked hours, RN worked hours per patient length of stay and registered practical nurse (RPN) worked hours per length of stay. Emergency department case mix index, patient age and gender, hospital peer group, size, wait times, cleanliness of the emergency department, physician courtesy, and year of measurement were controlled to account for their effect on the relationship between nursing staffing and patient satisfaction in the ED. The study revealed a subset of six patient satisfaction variables representing the overall variation in patient satisfaction with nursing care in the ED. Although RN proportion and RPN worked hours per length of stay were found to have a statistical association with patient satisfaction in the ED, the association was weak and not administratively actionable. Interpersonal and environmental factors such as physician and nurse courtesy, ED cleanliness and timeliness, however, were areas which hospital administrators should consider since they were highly associated with patient satisfaction in EDs.

The number of states requiring humanitarian assistance after a disaster has doubled every decade since 1960. Extreme weather like flooding and violent storms associated with climate change are predicted to continue to increase with intensity and in frequency in the future. Traditionally, emergency shelters have been given in the form of two options: the tent or the tarp. While both do a great job at addressing immediate shelter needs, they are not durable enough habitations to provide adequate transitional shelter for the time period between six months and two years. Most emergency shelters provided by humanitarian agencies fail before six months. This thesis will investigate the development of an emergency shelter solution that improves upon the current options for affected regions following a disaster within warm climates. The thesis proposes that by employing more robust materials for emergency shelters the life expectancy can be extended to meet the required needs. Several materials and designs were explored, tested, and evaluated as plausible shelter solutions to accomplish this task. Design shapes including Roman and Gothic arches were tested with smoke simulations, wind load calculations, and continuous frame loading. The most successful design tested, the Roman arch, was then contrasted and compared to currently used disaster relief shelters for durability and cost. Thesis findings indicate that there is potential for economical and durable emergency shelter solutions. Further research on this topic will increase the number of shelter options available to humanitarian organizations in order to help both emergency and transitional shelter roles simultaneously.

Background: The demand for hospice palliative care (HPC) services is expected to grow due to the increasing number of seniors living into advanced old age, the changing nature of death, and the changing family structure. HPC is a philosophy of care that aims to relieve suffering and improve the quality of life for clients with life-threatening illnesses or end of life issues. The goals of HPC are not only to ameliorate clients’ symptoms but also to reduce unneeded or unwanted medical interventions such as emergency room visits or hospitalizations (ERVH). Hospitals are considered a setting ill-prepared for end of life issues. Therefore, use of such acute care services has to be considered an indicator of poor quality end of life care. It is important to understand the factors that contribute to ERVH in order to determine how to minimize the number of avoidable hospital visits. Objectives: The objectives of this study were to report the proportion of palliative home care clients with ERVH, describe the characteristics of clients with ERVH, and identify the predisposing, enabling, and need-for-care variables associated with ERVH. Methods: Analysis of secondary data was performed on a palliative home care dataset from the Hamilton Community Care Access Centre (CCAC). All palliative home care clients receiving services from the Hamilton branch were assessed using the interRAI Palliative Care (interRAI PC), which is a comprehensive, standardized instrument. One assessment for each client assessed between April 2008 and July 2010 was used, for a final sample size of 764. Results: Half of the palliative home care clients had one or more ERVH. Visits to the emergency department by time of the day and day of the week were relatively stable. Logistic regression and Cox regression analyses showed that wish to die at home and advance care directives are protective against ERVH. Unstable health, identified by a Changes in Health End stage disease and Signs and Symptoms scale (CHESS) score of 3 or higher, was associated with reduced odds of ERVH, while infections such as prior pneumonia and prior urinary tract infections increased odds of ERVH. Conclusions: Predisposing characteristics (i.e., wish to die at home and advance care directives) are nearly as important as need variables (i.e., CHESS and prior urinary tract infection) in determining ERVH among palliative home care clients, which challenges the assumption that need variables are the most important determinants of ERVH. There was a lack of significant association between many assessed needs and ERVH, perhaps due to the fluctuating health status among such clients and the stability of measurements. Ongoing assessment of palliative home care clients is essential in reducing ERVH, as reassessments at specified intervals will allow care and service plans to be adjusted with clients’ changing health needs and end of life preferences.

Michael Walzer has forwarded an argument that defends an exemption from adherence to Jus in Bello when a state finds itself in a situation of "supreme emergency." The argument is morally problematic due to the fact that it defends the direct and intentional targeting of non-combatants, a restriction which has traditionally been considered as inviolable in the Just War tradition. This thesis seeks to demonstrate a further problem for Walzer's position, the fact that his argument is sufficiently broad that it may be co-opted by parties whom Walzer wishes to exclude, practitioners of contemporary terrorism. My method will be to demonstrate certain deficiencies in Walzer's argument, through analysis of the paradigm case he presents. I will then proceed to present two cases for the adoption of his "supreme emergency" defense by the terrorist organizations Al Qaeda and Hamas. I will show that both of these cases may ultimately fail under closer scrutiny, but will conclude that the ability for two such cases to be constructed demonstrates the ability for Walzer's defense to be adopted by an entity which does not suffer these same failings, ultimately dooming Walzer's argument.

The past three years have witnessed unprecedented growth of user-generated volunteered geographic information (VGI) on the Web. Although scholars, decision makers, and citizens have recognized the potential value of VGI in emergency management, there exists no rigorous study on the availability, quality, and feasibility of VGI for applications related to emergency management. This dissertation applies methodologies of GIScience and computer science to present an overview of VGI and explore its value in emergency management with the goal of developing a wiki GIS approach for community emergency preparedness. This dissertation research concludes that VGI and wiki GIS represent new development in public participation in the production and use of geographic information. In emergency management, VGI and wiki GIS suggest a new approach to incorporate the general public in emergency response activities. By incorporating VGI in emergency management, official agencies and the general public gain better situational awareness in emergency management.

In light of the competitions of different medical services and the National Health Insurance¡¦s patient-oriented goal, the quality of medical care in the emergency room has been a top priory for improvement in many major medical centers. The purpose of this research is to evaluate the differences of medical quality after adjustment of physician manpower in three emergency departments of three separate hospitals. We will attempt to suggest ways to improve medical quality and make good use of medical resources. This is a retrospective survey using data from three emergency departments of three separate hospitals. The date ranged from March to April of 2002 and March to April of 2003. A total of 66,025 cases were gathered, minus 311 cases with incomplete data, the total valid data were 65,714 cases. The three hospitals A, B, C have 24,010 cases, 17,690 cases, and 24,014 cases, respectively. The result of this study showed that hospital A had increased the number of medical staff when comparing 2003 to 2002 data, however, the quality of care did not improve. Hospital B had increased the number of physicians on duty, decreased the waiting time for the patients, and the number of patients taken care per doctor had been increased too. However, within the 72-hour clinic follow-up patient numbers have increased. Hospital C have decreased the number of physicians on duty, but the waiting time have also decreased. The number of patients being taken care of by physicians, and 72-hour clinic follow-up are all increased. When compare the month between March and April of 2002, the highest ratio of 72-hour clinic follow-up is hospital A, followed by hospital B and C, in descending order. When compare the two study period of March and April of 2002 and 2003, waiting time and the ratio of waiting time in emergency department more than 6 hours is hospital A more than hospital C more than hospital B; the ratio of waiting time less than 2 hours is hospital C more than hospital B more than hospital A. The ratio of waiting time more than 2 hour but less than or equal to 4 hours and waiting time more than 4 hours but less than or equal to 6 hours is hospital A more than hospital B more than hospital C. This study suggests that the hospitals must establish a complete quality indicators, and must conduct periodic evaluation. At the same time, we must incorporate these indicators into our hospital information system and monitoring the effectiveness, in order to promote the quality of care.

The medical quality becomes a very important issue of a scholar and the public opinion. The high quality medical service of patients center and customer direction already has been necessarily prepare conditions to get the best competition advantage of all levels hospital in Taiwan, now.¡CTherefore, all hospital manager believe that promote medical quality is the very important issue¡CThe medical service quality of Emergency Department plays the very important role in the whole hospital. The medical service quality indicator is acknowledged well trusty medical quality measurement tool. Donabedian point out that medical quality measurement is compose of structure¡Bprocess and outcome, and that the outcome quality indicator measurement is the trend¡CAsthma is one of the most common diseases among children. Because of rising morbidity, mortality and medical costs all over the world, asthma becomes a very important issue. So, The purpose of this study is to identify the key factors associated with the of outcomes quality. The example of Pediatric Asthma in a Teaching Hospital. Data take from the Teaching Hospital¡¦s TQIP database through 2003. There are 534 Pediatric asthma patients who are research samples and care take by 25 physicians. The research analyze patient¡¦s and physician¡¦s characteristic to described data, Correlation and Regression with SPSS software. Look for the characteristic what influence the outcome quality of Emergency Department. The outcome quality include that patient¡¦s state after the treatment, patient¡¦s stay time and unscheduled revisit to Emergency Department.¡CRegression analysis showed that. 1.patient¡¦s state after the treatment trend to be inpatient who care by experienced physician, younger, illness serious and reach on day shift. 2.patient¡¦s stay time longer who care by experienced physician, so that the consultations effectiveness should promote to reduce .patient¡¦s stay time¡C3.patient¡¦s stay time longer who younger, so that the staff take care more careful and pay attention to patient¡¦s condition change frequently¡Ato reduce uneasy of long-term stay in Emergency Department. 4.unscheduled revisit ratio in the study is 4.7%¡Abut not discover the correlation factor¡C Integrate above-mentioned¡Athe study find that ¡Aphysician¡¦s and patient¡¦s characteristic will influence medical outcome quality. The project hospital should with different influence factor to draw quality manage policy and stratagem, and improve Emergency Department quality will raise the satisfied degree.

Along with the rapid development of industrial and commercial industries, the extent of disasters in Kaohsiung city in recent years due to highly concentrated population, newly erected skyscrapers and factories is far beyond one's imagination. By using the Kaohsiung Emergency Operation Center (KEOC) as an example, this study investigates practical operations, including disaster prevention, disaster emergency action, restoration and reconstruction after disaster, etc., of the emergency operation center at a special municipality level. Methodologies utilized in this study include literature review, direct observation, questionnaire survey, and statistical analysis by using the SPSS software package for Windows (Version 8.0). Main conclusions of this study are summarized as follows: 1. The regional plan for disaster prevention and response needs to be specified. 2. Manpower for disaster prevention and response of Kaohsiung city needs to be increased and the duties need to be specified. 3. Budgets for disaster prevention and response need to be prepared liberally. More equipments and devices for disaster prevention and response need to be purchased. 4. Personnel training, exercise and teamwork/cooperation for disaster prevention and response should be conducted seriously. 5. Persuade the public that prevention is better than rescue. 6. Actions for disaster prevention and response should be incorporated into the local communities. 7. Modern emergency operation centers need to be well constructed. 8. Data for disaster prevention and response need to be integrated and processed into useful information. 9. Set up standard operating procedures (SOP) for disaster rescue and crisis management. 10. Integration and utilization of volunteers for disaster prevention and response need to be institutionalized. 11. Task schedules need to be well controlled, supervised, and checked. Recommendations from this study are summarized as follows: 1. Set up short, medium, and long-term objectives properly for disaster prevention and response. 2. Set up a duty-oriented unit for disaster prevention and response according to the law. 3. It is more appropriate than the current organizational system to combine the KEOC and Rescue Command Center, Fire Bureau into one task force and fulfill the services at one site. 4. It is recommended that Kaohsiung city government should actively pursue the establishment of the Southern Stand-by Supporting Unit, Central Emergency Operation Center in Kaohsiung city . 5. Amend related laws and regulations for disaster prevention and response as soon as possible. All recommendations mentioned above provide not only Kaohsiung city, but other counties and cities as well, with valuable references pertaining to establishing and operating the most efficient emergency operation center.

Thesis (MCur (Nursing Science))--University of Pretoria, 2009. / Summary in English. Includes bibliographical references.