Purpose The purpose of this article is to provide a comprehensive overview of patient transfers within the Cyclades islands, Greece, in order to contribute to a better understanding of the islanders' healthcare needs and optimise the provision of emergency medical services. Design/methodology/approach A retrospective quantitative study of medical air and sea transport records of 4,169 patients from the Cyclades islands to Syros, from 1st January 2017 to 31st December 2022. Findings Most of the patient transfers (20.3%) were recorded in 2022. Half of them were transported from Tinos (25.6%) and Paros (25.3%), 60.1% in summertime, 12.4% in August, 15.1% on Saturdays and 44.7% between 12.00 and 18.00 h. Private-owned boats were the main medical transport providers, although the average transport time by private-owned means was longer than that by state-owned means (p < 0.001). The average transport cost was & euro;3,526.06 and the total cost was & euro;14,682,525.14. 92.3% of the patients transferred were admitted to Syros General Hospital. They were treated for an average of 4.7 days, and the reason for their transfer had a significant impact on their hospitalisation (p < 0.001). The most common reason for patient transfers (6.2%) was a stroke. Originality/value This research is original and aims at forming the basis for future studies on patient transfers in the Cyclades, as well as for the development of healthcare policies for the islanders themselves.
Purpose This study investigates patterns of strengths and weaknesses in incident command performance across UK Fire and Rescue Services (FRS) and explores how these insights can support the development of evidence-informed training and development strategies.Design/methodology/approach Assessment data from 43 UK FRSs were analysed, incorporating formal exercises, real-incident monitoring and structured training events across four command levels (ICL1-ICL4). Using behavioural markers from the Effective Command framework, the study examined competence profiles and recurring performance themes.Findings Strengths were consistently observed in early situational information gathering, while deficits in anticipation, communication and risk assessment were common, particularly among less experienced commanders. Novice officers tended to rely on procedural checklists, whereas experienced commanders demonstrated more intuitive, adaptive decision-making. These patterns indicate the need for differentiated, level-specific training interventions.Practical implications Findings show how documented assessment data can strengthen both individual development plans and organisational strategies for enhancing and sustaining command competence.Originality/value The study provides empirical evidence on variations in incident command competence and demonstrates how structured assessment data can be used to inform organisational learning and guide training priorities in emergency services.
Purpose Despite advances in disaster risk reduction research, the intersection of gender and social capital remains unevenly examined (Enarson, 2016; Zaidi and Fordham, 2021). While scholarship shows that access to resources, information, and support during disasters is unequally distributed and shaped by gender (Fordham, 1999; Enarson et al., 2007, 2017), most studies rely on binary gender categories. This leaves significant gaps in understanding how non-binary, transgender, and other gender-diverse individuals engage with and benefit from social capital in crisis contexts. This study systematically analyzes how the literature conceptualizes gender identity and examines the relationship between gender and social capital across disaster phases. Design/methodology/approach Using a PRISMA-guided systematic review, this study examines how research on gender identity, social capital, and disaster affects access to social capital across disaster phases. This review also assesses where conceptual, geographic, and empirical gaps persist. Findings Findings highlight the need for intersectional, gender-inclusive approaches to disaster risk reduction that recognize how social capital operates differently across diverse gender identities. Understanding how gender identity shapes access to, mobilization of, and benefit from social capital is essential for developing equitable and inclusive disaster management policies and plans. Originality/value This study examines how gender affects access to social capital across disaster phases and identifies where conceptual, geographic, and empirical gaps persist, emphasizing the need for gender-inclusive approaches that account for diverse identities in disaster risk reduction research.
Purpose Response times of emergency medical services (EMS) are critical for patient outcomes and survival rates. This review synthesizes evidence on factors affecting EMS response times and their impacts, aiming to identify disparities and recommend optimization strategies. Design/methodology/approach A systematic search was conducted in Web of Science, PubMed and Scopus for English-language studies published between January 1, 2000, and October 20, 2024. Inclusion criteria focused on studies examining EMS response times and associated outcomes, such as mortality and disparities. Exclusion criteria ruled out studies on non-EMS services, case reports and non-English publications. Two independent reviewers screened studies, and risk of bias was assessed using the Cochrane Risk of Bias 2 tool for randomized controlled trials and the Joanna Briggs Institute for observational studies. A narrative synthesis was performed, and meta-analysis was considered where data permitted. Findings Of 105 initial articles, 45 studies met the inclusion criteria. Key findings identified five domains impacting EMS response times: ambulance deployment strategies, mortality correlations, optimal placement of ambulances, socioeconomic and geographic disparities and specialized service performance. Quantitative analysis demonstrated that strategic ambulance placement and addressing inequities reduced response times and improved survival rates. Research limitations/implications This research highlights several limitations, including data limitations, challenges in addressing geographic and socioeconomic disparities and the need to overcome technological and ethical hurdles. Key research implications include fostering multidisciplinary collaboration, conducting longitudinal studies and prioritizing cost-effectiveness. Addressing inequities in access to care is paramount, requiring targeted interventions and a focus on patient-centred care. Integrating technology while ensuring data security and privacy is crucial. Finally, standardized data collection methods and a focus on continuous improvement through rigorous evaluation are essential for optimizing EMS systems globally. Originality/value Although previous systematic reviews have analysed EMS response times and patient outcomes, these studies often fail to address the impact of socio-economic disparities and geographic isolation comprehensively. Furthermore, methodological inconsistencies, including varying definitions of response times, limit comparability across studies.
Purpose Emergency services often find themselves without the time, personnel and resources they need to provide the care they wish to. Such situations of scarcity are likely to grow more common due to increasing demand and pressures on recruitment and retention. But existing research into how emergency services cope with resource constraints during incidents is fragmented and focused almost entirely on the medical sector. This article provides a framework of the ways in which emergency services more broadly (police, fire, ambulance, military) cope with resource insufficiency. It answers the question: How do emergency services adjust their emergency response in situations of scarcity? Design/methodology/approach This research takes an abductive approach, combining insights from the literature with interviews with first responders across seven Dutch emergency services (N = 16) as well as four focus groups (N = 21), participant observations, and an analysis of incident logs. Findings Emergency services respond to excess demand by adjusting their emergency response. We identify seven ways in which they do so. Emergency services adjust the supply of help by expanding capacity, increasing efficiency, decreasing standards of care and/or prioritising. Emergency services manage the demand on their services by filtering incoming requests, calling on citizens to reduce risky behaviour and/or investing in citizens' self-reliance and resilience. Overall, findings from the medical sector translate well to emergency services more broadly, though important differences emerge in triage approaches and decision-making contexts. Research limitations/implications The research's generalisability may be limited by its focus on the Netherlands, and findings may suffer from the limited number of respondents per organisation and a dependence on respondents' retroactive reporting of decision-making. Practical implications This research provides emergency managers with a practical overview of their strategic options in situations of scarcity, allowing them to choose between supply-side and demand-side responses. Originality/value This article proposes a categorisation of the different ways in which emergency services cope with scarcity during incidents, moving beyond the current predominant focus on the medical sector and drawing attention to the ways in which emergency services attempt to manage the demand for their services, rather than just adjusting supply.
Purpose Emergency management volunteers (EMVs) are frequently exposed to incidents involving dying and death, yet psychosocial risk management strategies remain uneven and predominantly reactive. Adopting a systems approach, this study explored the strategies EMVs identify as necessary to support well-being and safety following exposure to dying or death, and examined how these strategies operate across interconnected system levels. Design/methodology/approach A qualitative phenomenological methodology was employed. Thirty-two EMVs from the Victorian State Emergency Service and Country Fire Authority participated in semi-structured interviews. Data were analysed using reflexive thematic analysis, with themes generated inductively and subsequently mapped deductively to system levels. Findings Four interconnected themes were identified: (1) increased access to training, (2) improved local leadership response, (3) improved organisational response, and (4) a coordinated and harmonised cross-agency approach. EMVs described these themes as interdependent, with the protective impact of individual-level strategies contingent on integration across local, organisational, and broader emergency service contexts. They prioritised consistent follow-up processes, strengthened leadership engagement, and equitable access to training as critical to sustaining well-being following exposure. EMVs emphasised the need to shift from predominantly reactive post-incident responses toward proactive, coordinated, and sustainable approaches implemented before, during, and after exposure. Originality/value This study extends the application of systems-based occupational health and safety frameworks to volunteer emergency contexts. It demonstrates that psychosocial safety in EMVs depends not only on discrete interventions, but on integration across system levels. By privileging EMVs’ perspectives, the findings provide evidence-informed guidance for strengthening sustainable support structures within and across emergency service organisations.
Purpose Firefighters face sleep disruption and repeated trauma exposure, contributing to insomnia, psychological distress and PTSD - often interrelated conditions. Around 70% of individuals with PTSD report co-occurring sleep issues. Alarmingly, Australian emergency service workers have higher rates of suicidal thoughts and plans than the general population. This study examined whether insomnia is associated with suicidality in firefighters, independent of PTSD symptoms and psychological distress.Design/methodology/approach A cross-sectional survey was completed by 578 Metropolitan Fire Service firefighters. Participants self-reported insomnia, PTSD symptom severity, psychological distress and suicidality. Logistic regression assessed whether insomnia was associated with suicidality after controlling for PTSD symptoms and psychological distress. Cluster analysis identified profiles of firefighters most at risk.Findings Nine percent of participants reported suicidality in the previous 12 months. Insomnia was initially associated with suicidality; each one-point increase on the insomnia index was linked to 1.42 times greater odds of suicidality. However, this association was no longer significant after accounting for PTSD symptoms and psychological distress. Firefighters with high levels of insomnia, PTSD symptoms and psychological distress had the greatest risk of suicidality.Practical implications Interventions targeting insomnia may be beneficial, but a more holistic mental health approach is likely to be more effective in reducing suicide risk.Originality/value Findings highlight that while insomnia is associated with suicidality in firefighters, this appears to be part of a broader pattern involving PTSD and psychological distress.
Purpose-To evaluate disaster preparedness and surge capacity perception at the Armed Forces Hospital Southern Region (AFHSR), Kingdom of Saudi Arabia. Design/methodology/approach-A cross-sectional study was conducted using an instrument assessing perceived hospital preparedness and surge capacity within the AFHSR, which was developed based on a review of the literature. The items used in this instrument were adapted from the framework and thematic findings of Shabanikiya et al. (2016), covering eight domains: surge capacity, command and control, human resources, triage, communication, logistics and supply, safety and security and recognition and continuity. A total of 600 healthcare providers' valid responses (response rate: 30.0%). Data were analyzed using descriptive statistics and correlation analysis. Findings-High awareness of disaster policies (89.5%) and prior real-world disaster exposure (58.5%) were reported. Strong perceived preparedness was observed in triage (1.12 +/- 0.263) and safety and security (1.13 +/- 0.266). Lowerperceived performance was noted in human resources (1.22 +/- 0.322) and communication training (1.19 +/- 0.202). Awareness of the disaster plan significantly correlated with preparedness perceptions (r = 0.407**, p < 0.001), and awareness of the disaster policy significantly correlated with preparedness perceptions (r = 0.448**, p < 0.001). Research limitations/implications-The single-center design and moderate response rate may limit generalizability. Results underscore the need for targeted improvements in workforce planning and structured communication training to strengthen institutional resilience. Practical implications-Findings provide actionable guidance for hospital leadership to enhance surge capacity, optimize human resource strategies and reinforce communication frameworks. Social implications-Strengthened disaster preparedness improves patient safety, operational continuity and community confidence during public health emergencies and mass casualty incidents. Originality/value-This study delivers a structured, domain-based benchmarking of perceived preparedness in a major Saudi military hospital, contributing regional evidence to the limited literature on hospital surge capacity and disaster readiness.
Purpose This research examines evacuation performance during fire emergencies in a high-rise residential building in Saudi Arabia. It assesses how selected design variables, such as stair configuration and door width, affect evacuation time, flow patterns and congestion. Design/methodology/approach Using a building information modeling model derived from as-built drawings and simulated in Pathfinder, the study simulates evacuation in the selected high-rise building under predefined occupant movement assumptions. The simulations evaluate total evacuation time, occupant flow and congestion under different design scenarios while also assessing compliance with selected Saudi Building Code (SBC) egress requirements. Findings The simulations show that total evacuation time remains relatively high across all scenarios. However, stair placement and wider egress doors improve efficiency, while adding extra stairs in some layouts offers only limited benefit. Research limitations/implications The study highlights the challenges of achieving substantial improvements through design modifications. It identifies directions for future research on how design decisions influence emergency evacuation efficiency. Practical implications The research provides fire safety engineers, architects and emergency planners with insights into how selected design decisions influence evacuation efficiency in high-rise residential buildings. The findings support interventions such as optimizing stair location, assessing stair width and widening egress doors to reduce congestion and improve evacuation performance. Originality/value This study presents a BIM-based case of evacuation performance in a high-rise residential building in Saudi Arabia and assesses its compliance with selected SBC egress requirements. It provides context-specific evidence on how design variables affect evacuation efficiency.
PurposeThis study aims to examine the relationships between occupational safety, disaster risk perception, and anxiety among emergency medical service (EMS) professionals, and to assess whether disaster risk perception mediates the relationship between occupational safety and anxiety.Design/methodology/approachThe study sample consisted of 603 EMS professionals. Data were collected using the Occupational Safety Scale for healthcare personnel (OSS), the Beck Anxiety Inventory (BAI), and the Disaster Risk Perception Scale (DRPS). Descriptive statistics and correlation analyses were conducted to explore relationships among variables. Structural equation modeling (SEM) was used to test the hypothesized relationships and to examine the mediating role of disaster risk perception between occupational safety and anxiety.FindingsThe findings indicated that higher levels of occupational safety among EMS professionals were significantly associated with lower disaster risk perception and anxiety levels. In contrast, disaster risk perception was positively and significantly associated with anxiety. Mediation analysis further revealed that disaster risk perception partially mediates the relationship between occupational safety and anxiety.Originality/valueThis study contributes to the literature by examining the relationships between occupational safety, disaster risk perception, and anxiety among EMS professionals, a combination of variables that has not previously been investigated together within this professional group.
PurposeHumanitarian organizations (HOs) continue to lag in adopting the benefits of vehicle-sharing during disaster relief operations. Therefore, the primary objective of this study's investigation is to scrutinize and rank the important challenges that hinder vehicle-sharing initiatives among HOs.Design/methodology/approachThis study employs a multi-method approach, incorporating both interviews and surveys. Initially, interviews are conducted with officials from HOs to explore the challenges associated with vehicle-sharing. Next, surveys are administered to officials of HOs to rank these identified challenges. This study is framed through the perspective or lens of innovative resistance theory.FindingsThe absence of government support and incentives emerges as the most critical challenge. This is followed by the unwillingness of top management and severe inter-organizational competition, which are the next most significant challenges. Subsequent challenges, in order of importance, include lack of trust, corruption and unethical behavior, lack of internal coordination, absence of a neutral third party, unawareness of potential benefits, varying characteristics of vehicles and compliance standards.Research limitations/implicationsBy ranking these important challenges, the study offers a framework for prioritizing efforts and resources for interorganizational collaboration. The findings emphasize the need for policy interventions and strategic initiatives to address challenges to vehicle-sharing among HOs.Practical implicationsKey obstacles like the lack of government support, management unwillingness and inter-organizational competition highlight the importance of fostering collaboration.Originality/valueThe findings provide the first insights into vehicle-sharing challenges among HOs.
PurposeSafety behaviors among firefighters and emergency responders are critical to protecting personnel, fellow responders and the public. However, key determinants of these behaviors have not been thoroughly explored among Aircraft Rescue and Firefighting (ARFF) professionals. This study examined whether effective safety training was associated with safety compliance and safety participation behaviors among airport-based responders whose roles extend beyond structural firefighting to complex aviation-related emergencies.Design/methodology/approachCross-sectional survey data from 241 ARFF professionals were analyzed using structural equation modeling to test relationships between effective safety training and two safety behavior outcomes, including safety compliance and safety participation.FindingsModel fit was good and all hypothesized relationships were supported. Effective safety training was positively and significantly associated with both safety compliance and safety participation behaviors, confirming the distinctiveness of these behavioral constructs. These findings showed that high-quality training not only reinforced adherence to safety procedures but also promoted proactive engagement in safety-enhancing activities.Originality/valueThis study extended research on an under-examined occupational group and provided empirical evidence supporting the strategic role of training in ARFF operations. The results provided practical guidance for ARFF administrators, suggesting that investing in comprehensive, scenario-based, applied, risk-informative training that is continuously evaluated can strengthen both procedural compliance and proactive safety participation, ultimately improving operational readiness and reducing risk.
PurposeTo examine household- and hospital-level disaster preparedness in Dodoma Municipality, Tanzania, and to identify factors associated with readiness to respond to acute and slow-onset hazards.Design/methodology/approachThis research utilized a cross-sectional quantitative approach to evaluate the disaster preparedness of both hospitals and communities in Dodoma Municipality, Tanzania. A survey was administered to community members (n = 205) and healthcare professionals (n = 75). Preparedness was measured using a checklist covering awareness, plans/protocols, drills, supplies, communication, and coordination. Data were analysed using descriptive statistics and multivariable regression to identify correlates of preparedness scores.FindingsPreparedness levels were uneven. Higher household preparedness aligned with prior hazard experience, receipt of risk-communication messages, and participation in community drills. At the facility level, the presence of written emergency plans, routine drills, minimum emergency supply stock, and defined incident-command roles was associated with higher preparedness.Research limitations/implicationsThe findings are limited to Dodoma Municipality, suggesting the need for studies in other regions for broader applicability.Practical implicationsPriorities include institutionalising regular drills, clarifying roles through incident-command job cards, and safeguarding minimum emergency stocks while strengthening ward-level risk communication. The checklist can support routine monitoring and targeting of lower-scoring wards/facilities.Originality/valueBy jointly assessing communities and health facilities in an African municipal context through a single quantitative design, the study provides an integrated view of readiness and pragmatic entry points for resilience strengthening in resource-constrained settings.
PurposeThe increased dependence on information technology for storage, access and analysis of information has increased the vulnerability of states, organisations and individuals in the last decade. Despite cyberattacks being one of the major risks perceived by citizens, little research has addressed how the public sector at local level is managing the challenges that raising society's preparedness in relation to cyber threats entails. The aim of this study is therefore to analyse the extent to which municipalities are taking measures to increase citizens' awareness of information and cybersecurity risks and to discuss why potential challenges might arise.Design/methodology/approachA cross-sectional survey was used by the Swedish Association of Local Authorities and Regions (SALAR) to collect data from 234 of Sweden's 290 municipalities in the period 10/3-25/4 2023.FindingsThe results show that 81% of the municipalities are not engaged in raising citizens' awareness of information and cybersecurity risks, and that established working procedures for information and cybersecurity are relevant in understanding this lack of engagement. Interpretive insight from previous literature also shows the relevance of the range of professional logics, which does not provide sufficient incentives for the profession engaged in planning and managing the information and cyber risks to cooperate.Originality/valueThe paper addresses the citizen perspective in relation to work carried out on information and cybersecurity risks at the municipal level. The article's contribution is to show that the citizen's perspective does not have any prominence in the work that municipalities conduct on information and cybersecurity risks.
PurposeThis paper reconceptualizes accessibility in emergency communication as a strategic capability that strengthens contingency planning and public resilience in the European Union (EU). It addresses disparities in access for persons with disabilities and their implications for crisis management.Design/methodology/approachA mixed-methods design combines Eurostat disability indicators (communication, mobility, self-care; EU-27, ages 16-64) with three European Commission reports (2020, 2022, 2024). A comparative case study of sixember states (Romania, Croatia, the Netherlands, France, Italy and Latvia) illustrates varied accessibility pathways and alignment with EU obligations.FindingsImplementation is fragmented, creating resilience asymmetries. France and the Netherlands have advanced multi-channel systems (real-time text, relay and apps), while Romania and Croatia remain short message service-reliant. Correlation analysis shows that communication, mobility and self-care difficulties cluster, underscoring the need for integrated accessibility. Accessibility emerges as a determinant of preparedness and operational efficiency.Research limitations/implicationsUse of official EU data restricts causal inference; future work should include interviews with call-takers and disabled users and track reforms beyond 2025.Practical implicationsEmergency managers should embed multi-channel accessibility, train operators in inclusive workflows and co-design exercises with Disabled Persons' Organisations to reduce errors and strengthen trust.Social implicationsAccessible call systems ensure no caller is excluded, reinforcing trust and promoting social cohesion in crises.Originality/valueThe study reframes accessibility from compliance to a strategic management capability, linking digital maturity, governance and frontline operations to resilience.
PurposeRural communities experience disasters differently than their more urban counterparts and tend to be more susceptible to natural disasters. Simultaneously, rural areas have smaller governments, less diversified economies and fewer financial reserves to manage emergencies than larger communities. As nearly half of the world's population resides in rural communities that are increasingly prone to natural disasters, it is vital to understand what often-overlooked rural communities need for creating disaster resiliency as their needs may differ from urban contexts.Design/methodology/approachWe conduct a mixed-methods study employing an all-of-society approach in four rural communities with recent disaster experience in Montana, the United States. Drawing on qualitative and quantitative data collected from local government officials, small business owners and residents in the region over the course of two years, we employ the community capitals framework (CCF) to identify key drivers of successful rural disaster recovery and resilience, from the perspective of local communities.FindingsFindings from this study suggest that building rural resilience to disasters requires a nuanced and community-specific configuration of resources. Our findings additionally point to a potentially missing element of the CCF, which has thus far been overlooked, as a key component of resilient rural communities.Originality/valueLimited research examines rural disaster resiliency, and even less considers it from the perspective of the community's own residents. This study's all-of-society approach centers local voices and identifies key lessons for disaster managers regarding what rural communities need to be more disaster resilient.
PurposeThis article explores how to ensure effective digital emergency management.Design/methodology/approachDrawing on organizational information processing theory and design science research methodology, the research employs Interpretive Structural Modeling and the MicMac analysis.FindingsThis research approach enabled the development of a model for effective use of digital technologies in emergency management. The model identifies six levels of developing digital technology utilization in emergency management. Appropriate factors are assigned to each level and categorized according to their influence on other factors. The findings demonstrate how high operational effectiveness can be achieved in emergency management through digitalization. The study also found that operational effectiveness improves alongside trust in digital technologies. The resulting model outlines the conditions for effective digital emergency management.Originality/valueThis article is among the few that provide a comprehensive analysis of the factors that enable effective use of digital technologies in emergency management. Its originality also stems from the research methodology employed.
PurposeIn recent years, the increasing frequency and severity of natural disasters have exposed significant weaknesses in disaster response systems, particularly within the humanitarian supply chain (HSC). However, limited studies have systematically prioritized the key drivers that influence HSC effectiveness in disaster management. This study aims to bridge this gap by identifying and evaluating the most influential drivers of the HSC in disaster contexts.Design/methodology/approachA structured framework was developed to identify critical HSC drivers based on expert input and literature review. The best-worst method (BWM) is a multi-criteria decision-making technique (MCDM) used to prioritize key drivers. Data were collected from experts at the Iranian Red Crescent Society (IRCS) in Rasht, Iran, using a BWM questionnaire from May to August 2024. The study categorized the drivers into four main criteria and 16 sub-criteria.FindingsThe results revealed that resource scarcity is the most influential sub-driver in disaster-related HSC, while the system and information integrator ranked as the least significant sub-driver.Originality/valueThis study provided a structured decision-making framework that supports humanitarian organizations in recognizing and prioritizing key HSC drivers. The findings help managers and policymakers enhance disaster preparedness and response by allocating resources more effectively and planning strategically.
Purpose The electricity distribution industry is among the most hazardous sectors globally, with Iran experiencing a particularly high rate of severe accidents. While safety performance is traditionally measured using reactive, lagging indicators (e.g. accident rates), modern safety science advocates the use of proactive, leading indicators to predict and prevent incidents. However, a validated model integrating both indicator types is lacking for the Iranian context. This study aims to develop and empirically validate an integrated safety performance evaluation model that links leading and lagging indicators to provide an actionable tool for the electricity distribution industry.Design/methodology/approachThis applied, cross-sectional study was conducted within an Iranian power distribution company. A comprehensive framework was constructed, categorizing 14 leading safety criteria into organizational, technical and human dimensions. Data on these leading indicators were collected from 158 safety personnel across 27 subsidiaries using a binary-scored questionnaire. The relative weight of each dimension and criterion was determined using the fuzzy analytic hierarchy process (FAHP). An overall safety performance score (SPS) for each subsidiary and the mother company was calculated by integrating the leading indicator scores with their FAHP weights. Concurrently, standard lagging indicators - accident frequency rate (AFR), accident severity rate (ASR) and frequency-severity indicator (FSI) - were calculated from 1 year of archival data. Model validation was performed using Spearman's correlation and linear regression analysis in Statistical Package for the Social Sciences (SPSS) to examine the relationship between the SPS (leading index) and the lagging indicators.FindingsThe overall company SPS was 0.67 out of 1.00. The organizational dimension was identified as the most critical (weight = 0.431), while the technical dimension was the weakest performer. Statistical analysis confirmed a significant negative correlation between the SPS and both AFR and ASR. Linear regression demonstrated that a one-unit increase in the SPS predicts a 55.0% decrease in AFR and a 54.6% decrease in FSI, thereby validating the predictive power of the proposed model.Research limitations/implicationsThis study, like any other study, has faced limitations, including the fact that in this study, safety criteria were examined in three dimensions: organizational, technical and human. Other dimensions of safety, including environmental and behavioral dimensions, which have also been mentioned in the research background, can be considered, and appropriate criteria can be presented. Binary logic was used to score the indicators in this study, and in future research, the radar logic of the organizational excellence model can be used to measure the status of the indicators. This method helps to calculate the performance score for the company and also to define corrective actions to improve the safety performance status. One of the limitations of the research is that the study was conducted in one of the Iranian electricity distribution companies (Khorasan Razavi Province Electricity Distribution Company), and naturally, cultural characteristics can affect its results, thus limiting the possibility of generalizing its results to other countries.Practical implicationsThe research findings can be used to develop safety policies for the power industry across three dimensions: organizational, technical and human. Based on the criteria and indicators of each of the mentioned dimensions, operational plans can be developed considering the score of each indicator. This is not a universal proposition, but it should be done based on the differing situations such as company and country.Social implicationsThis study provides an empirically validated model that effectively links proactive safety management with reactive outcomes in a high-risk industry. The findings demonstrate that strategic improvement in leading indicators - particularly by addressing identified weaknesses in the technical dimension - can significantly reduce accident rates. The model offers managers a practical and diagnostic dashboard for transitioning from a reactive to a proactive, data-driven safety management strategy, with potential applicability in other high-risk sectors in similar cultural contexts.Originality/valueThis study offers a theoretical base for preventing workplace accidents and improving safety of power distribution companies in Iranian culture as a unique culture.
PurposeDespite increasing demand, the capacity for emergency medical services (EMSs) is limited. Thus, understanding EMS use patterns by different societal segments is important for developing strategies for appropriate EMS use. This study characterized the causes and rates of EMS use among college students residing on and/or near campus and examined the factors associated with ambulance use.Design/methodology/approachAn exploratory sequential mixed method was used to collect data on EMS calls by university students residing on and/or near Artvin Coruh University campus in 2019-2023. Qualitative data obtained through semi-structured interviews with university students and EMS professionals were analyzed using descriptive and content analysis approaches. Quantitative data were analyzed using descriptive (mean and standard deviation) and predictive (independent sample t-tests and one-way analysis of variance) statistical techniques.FindingsEMS calls were highest in December and January. Most calls (92.4%) were made from dormitories and/or apartments, with 79.5% made by female students between 23:00 and 00:59. Among these calls, 48.2% resulted in hospitalization. Pain, general medical examination and psychiatric illness were the most common diagnoses. EMS professionals stated that most cases were not sufficiently urgent to require an ambulance. The EMS professionals and students commonly reported social factors (e.g. nervous breakdowns, attracting attention, attracting a boyfriend's attention, enabling late-hour dormitory departures and problems with lovers or meeting with lovers) as reasons for non-emergency ambulance use.Originality/valueThis study is the first to comprehensively review characterize the causes and rates of EMS use among college students residing on or near campus.
