This document summarizes a study that calculates the monetary value of reducing response times for Thai ambulance services. The study uses over 1 million emergency response records from Thailand to analyze the relationship between response time and outcomes like fatalities and injuries. Logistic regressions are used to estimate how changes in response time impact these outcomes while controlling for other factors. Monetary values from a previous study are then applied to fatalities and injuries to calculate the total monetary benefit of reducing average response times by 1 minute. The results suggest the total 1-year benefit of a 1-minute reduction in response time would be 1.6 billion Thai Baht, while the benefit of reducing operational time would be 800 million Thai Baht. These values could be used in
Pengetahuan dalam melakukan tindakan awal apabila berlaku sesuatu kejadian kecemasan seperti kebakaran amat penting. Tanpa pengetahuan asas atau kesedaran dikalangan penghuni sesuatu organisasi tidak kira ianya melibatkan besar atau kecil mereka harus tahu perlaksanaan tindakan kecemasan dengan cara yang betul dan sistematik.
Kegagalan organisasi mengaktifkan plan bertindak kecemasan dengan efektif akan mengakibatkan kesan buruk yang melibatkan kerosakan dan kemusnahan kepada harta benda selain daripada kecederaan atau kehilangan nyawa.
8410 Application 1 Identification of a Practice Issue for the Evide.docxsleeperharwell
8410 Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Project
Note: Have an APA Level 1 header for Each Area Noted below in Blue (a level 1 header is centered, bolded, using upper and lower case letters—see APA manual area 3.03)
Grading Area
Points Possible
Points Earned
Potential areas for earning points:
Header: Summary of Practice Issue
Summary of practice issue. (Note: The issue you select must be suitable for completing the entire EBP Project in 8410.)
2
Header: Exploration of Research Literature
Exploration of the research literature on
this issue.
3
High level of scholarship commensurate with doctoral level evident
1
Potential areas for losing points:
Grammar, Spelling, and APA errors
Up to 2 pt. deduction
Went Over Page Limit (2 pages max)
Up to 2 pt. deduction
*Improper credit & citation issue
1-6 pt. deduction
Late Submission
(posted X.XX.20XX, due X.XX.20XX )
20% deduction (1.2 pts) per day late (per syllabus)
6 Total Points possible
? Total Points Earned
Running head: EBP Project 1
EBP Project 4
Evidence-based Practice Project: PIICOT Statement
Student’s Name
Institution
Date
Evidence-based Practice Project: PIICOT Statement
Delayed patient transfers from the intensive care unit (ICU) is a significant practice problem that affects the quality and safety of healthcare delivery as well as the costs and efficiency of service delivery in a healthcare institution. It is nurses’ role to identify issues and develop strategies for quality improvement (Stillwell, Fineout-Overholt, Melnyk & Williamson, 2012). The following PIICOT Statements seeks to develop an intervention to reduce the rates of delayed transfers to enhance patient experiences and outcomes.
PIICOT Statement
In patients in extended intensive care within an urban acute care facility in Eastern United States, how does early mobilization as recommended by National Institute of Health and Care Excellence clinical guidelines on rehabilitation of patients after critical illness impact early transfers from intensive care as measured 6 months post-implementation when compared to the current standard of care including minimal mobilization of patients?
P: Adult patients
I: in extended intensive care within an urban acute care facility
I: increased mobilization of the patients
C: minimal mobilization of the patients
O: early transfers of the patients from intensive care
T: 6 months
Salient Elements that Inform the Research Question
The research question above has been developed based on observations in clinical practice of patients in intensive care, who overstay their admission in the ICU. Past research shows that delayed transfers of patients from the ICU to non-intensive care wards or the community settings have a negative effect on patient experiences and the patient outcomes. Some of the common negative effects of delayed patient transfers that have been identified by past researchers include an increased risk .
Presentation by David Wonderling, Head of Health Economics at National Guideline Centre, Royal College of Physicians and Lauren Ramjee, Senior Health Economist, Royal College of Physicians.
This workshop outlines the principles of health economic evaluation for the NHS.
HQR Framework optimization for predicting patient treatment time in big datadbpublications
Today most of the hospital face overcrowded with patients long queues for different tasks. Hospital management face difficulty to handle these patients to provide optimal treatment time for each patients waiting in the long queue. Unnecessary and annoying waits for long periods result in substantial human resource and time wastage and increase the frustration endured by patients.It would be convenient and preferable if the patients could receive the most efficient treatment plan and know the predicted waiting time updates in real time. Because of the large-scale, realistic data-set and the requirement for real-time response, the PTTP algorithm and HQR system mandate efficiency and low-latency response. Extensive experimentation and simulation results demonstrate the effectiveness and applicability of the proposed model to recommend an effective and convenient treatment plan for patients to minimize their wait times in hospitals.
HQR Framework optimization for predicting patient treatment time in big datadbpublications
Today most of the hospital face overcrowded with patients long queues for different tasks. Hospital management face difficulty to handle these patients to provide optimal treatment time for each patients waiting in the long queue. Unnecessary and annoying waits for long periods result in substantial human resource and time wastage and increase the frustration endured by patients.It would be convenient and preferable if the patients could receive the most efficient treatment plan and know the predicted waiting time updates in real time. Because of the large-scale, realistic data-set and the requirement for real-time response, the PTTP algorithm and HQR system mandate efficiency and low-latency response. Extensive experimentation and simulation results demonstrate the effectiveness and applicability of the proposed model to recommend an effective and convenient treatment plan for patients to minimize their wait times in hospitals.
Cost-effectiveness of electroconvulsive therapy compared to repetitive transc...Pydesalud
Póster sobre el coste-efectividad de la terapia electroconvulsiva frente a la estimulación magnética transcraneal en depresión resistente. Fue presentado por Laura Vallejo (técnica del SESCS) en la XXXIV edición de las Jornadas de Economía de la Salud organizadas por la Asociación de Economía de la Salud (AES). Pamplona, 27-30 mayo de 2014.
CORONARY HEART DISEASE WITH CASE STUDY AND FOLLOW THE OUTLINES BE.docxbobbywlane695641
CORONARY HEART DISEASE WITH CASE STUDY AND FOLLOW THE OUTLINES BELOW
3000 WORDS
Introduction
In this section guide the reader through your assignment journey by:
Identifying the topic: State what you are going to discuss (this should link to the learning outcomes) CORONARY HEART DISEASE
Background
One short paragraph re-prevalence of LTC (CORONARY HEART DISEASE) and impact on NHS/quality of life – this justifies your choice of LTC (setting the scene)
The context you have nursed the patient in – hospital/community/primary care/secondary care etc.
What has brought them into your care? i.e. an acute exacerbation/bi-annual review with case manager/increase in symptoms etc Present the background here and present your patients signs and symptoms that made them seek help at this point.
Articulate a succinct history, ‘like a bedside handover’, presenting clinical manifestations…….(CASE STUDY ABOUT PATIENT)
THIS IS AN EXAMPLE
Peter has Heart failure,62yrs, lives alone/recently bereaved/married etc smokes, unable to work/retired etc…. he presented in hospital, he could have presented with an array of problems for example, short of breath, fatigue, weakness, oedema/swelling, low mood/anxiety, persistent cough, admits to not understanding his medication and/or taking his medication etc, etc etc
LO1: Pathophysiology and related clinical manifestations
Give a very brief overview of normal A&P (your chosen Long Term condition) then link this to: -
· Changes that have occurred to the structures/function – this is the pathophysiology part, Then…….
· Link the pathophysiology to your patient symptoms/how they presented (clinical manifestations/signs/symptoms) this then creates some analysis and demonstrates a deeper level of understanding allowing you to fully meet with the LO and to demonstrate that you understand why they have these signs and symptoms.
· Sticking with the example above; Peter presented with oedema, cough and low mood/not coping. Explain/link the pathophysiology to the cough/oedema etc, why is this happening?
LO4: The nursing process
What is the nursing process – a holistic and systematic way to assess patients etc.
Where does care planning fit in with this? Why is it important, who is involved? (nurse, patient, MDT approach to care delivery is needed).
For this section, a clear and concise overview of the importance of a systematic approach (APIE) to nursing care delivery is required. Discussion relating to how this can impact on the management of your case studies disease with focus on self-care strategies. The importance of MDT and family in promoting self-care strategies needs to be included. What are self-care strategies?
Planning and delivering care for patients involves a collaborative approach, this includes the patient, carers, family, nurse, MDT etc, the focus is on individualised care, holistic care, person cantered care, patient focussed care/Link with the evidence that supports why we do this. Link in with ca.
Pengetahuan dalam melakukan tindakan awal apabila berlaku sesuatu kejadian kecemasan seperti kebakaran amat penting. Tanpa pengetahuan asas atau kesedaran dikalangan penghuni sesuatu organisasi tidak kira ianya melibatkan besar atau kecil mereka harus tahu perlaksanaan tindakan kecemasan dengan cara yang betul dan sistematik.
Kegagalan organisasi mengaktifkan plan bertindak kecemasan dengan efektif akan mengakibatkan kesan buruk yang melibatkan kerosakan dan kemusnahan kepada harta benda selain daripada kecederaan atau kehilangan nyawa.
8410 Application 1 Identification of a Practice Issue for the Evide.docxsleeperharwell
8410 Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Project
Note: Have an APA Level 1 header for Each Area Noted below in Blue (a level 1 header is centered, bolded, using upper and lower case letters—see APA manual area 3.03)
Grading Area
Points Possible
Points Earned
Potential areas for earning points:
Header: Summary of Practice Issue
Summary of practice issue. (Note: The issue you select must be suitable for completing the entire EBP Project in 8410.)
2
Header: Exploration of Research Literature
Exploration of the research literature on
this issue.
3
High level of scholarship commensurate with doctoral level evident
1
Potential areas for losing points:
Grammar, Spelling, and APA errors
Up to 2 pt. deduction
Went Over Page Limit (2 pages max)
Up to 2 pt. deduction
*Improper credit & citation issue
1-6 pt. deduction
Late Submission
(posted X.XX.20XX, due X.XX.20XX )
20% deduction (1.2 pts) per day late (per syllabus)
6 Total Points possible
? Total Points Earned
Running head: EBP Project 1
EBP Project 4
Evidence-based Practice Project: PIICOT Statement
Student’s Name
Institution
Date
Evidence-based Practice Project: PIICOT Statement
Delayed patient transfers from the intensive care unit (ICU) is a significant practice problem that affects the quality and safety of healthcare delivery as well as the costs and efficiency of service delivery in a healthcare institution. It is nurses’ role to identify issues and develop strategies for quality improvement (Stillwell, Fineout-Overholt, Melnyk & Williamson, 2012). The following PIICOT Statements seeks to develop an intervention to reduce the rates of delayed transfers to enhance patient experiences and outcomes.
PIICOT Statement
In patients in extended intensive care within an urban acute care facility in Eastern United States, how does early mobilization as recommended by National Institute of Health and Care Excellence clinical guidelines on rehabilitation of patients after critical illness impact early transfers from intensive care as measured 6 months post-implementation when compared to the current standard of care including minimal mobilization of patients?
P: Adult patients
I: in extended intensive care within an urban acute care facility
I: increased mobilization of the patients
C: minimal mobilization of the patients
O: early transfers of the patients from intensive care
T: 6 months
Salient Elements that Inform the Research Question
The research question above has been developed based on observations in clinical practice of patients in intensive care, who overstay their admission in the ICU. Past research shows that delayed transfers of patients from the ICU to non-intensive care wards or the community settings have a negative effect on patient experiences and the patient outcomes. Some of the common negative effects of delayed patient transfers that have been identified by past researchers include an increased risk .
Presentation by David Wonderling, Head of Health Economics at National Guideline Centre, Royal College of Physicians and Lauren Ramjee, Senior Health Economist, Royal College of Physicians.
This workshop outlines the principles of health economic evaluation for the NHS.
HQR Framework optimization for predicting patient treatment time in big datadbpublications
Today most of the hospital face overcrowded with patients long queues for different tasks. Hospital management face difficulty to handle these patients to provide optimal treatment time for each patients waiting in the long queue. Unnecessary and annoying waits for long periods result in substantial human resource and time wastage and increase the frustration endured by patients.It would be convenient and preferable if the patients could receive the most efficient treatment plan and know the predicted waiting time updates in real time. Because of the large-scale, realistic data-set and the requirement for real-time response, the PTTP algorithm and HQR system mandate efficiency and low-latency response. Extensive experimentation and simulation results demonstrate the effectiveness and applicability of the proposed model to recommend an effective and convenient treatment plan for patients to minimize their wait times in hospitals.
HQR Framework optimization for predicting patient treatment time in big datadbpublications
Today most of the hospital face overcrowded with patients long queues for different tasks. Hospital management face difficulty to handle these patients to provide optimal treatment time for each patients waiting in the long queue. Unnecessary and annoying waits for long periods result in substantial human resource and time wastage and increase the frustration endured by patients.It would be convenient and preferable if the patients could receive the most efficient treatment plan and know the predicted waiting time updates in real time. Because of the large-scale, realistic data-set and the requirement for real-time response, the PTTP algorithm and HQR system mandate efficiency and low-latency response. Extensive experimentation and simulation results demonstrate the effectiveness and applicability of the proposed model to recommend an effective and convenient treatment plan for patients to minimize their wait times in hospitals.
Cost-effectiveness of electroconvulsive therapy compared to repetitive transc...Pydesalud
Póster sobre el coste-efectividad de la terapia electroconvulsiva frente a la estimulación magnética transcraneal en depresión resistente. Fue presentado por Laura Vallejo (técnica del SESCS) en la XXXIV edición de las Jornadas de Economía de la Salud organizadas por la Asociación de Economía de la Salud (AES). Pamplona, 27-30 mayo de 2014.
CORONARY HEART DISEASE WITH CASE STUDY AND FOLLOW THE OUTLINES BE.docxbobbywlane695641
CORONARY HEART DISEASE WITH CASE STUDY AND FOLLOW THE OUTLINES BELOW
3000 WORDS
Introduction
In this section guide the reader through your assignment journey by:
Identifying the topic: State what you are going to discuss (this should link to the learning outcomes) CORONARY HEART DISEASE
Background
One short paragraph re-prevalence of LTC (CORONARY HEART DISEASE) and impact on NHS/quality of life – this justifies your choice of LTC (setting the scene)
The context you have nursed the patient in – hospital/community/primary care/secondary care etc.
What has brought them into your care? i.e. an acute exacerbation/bi-annual review with case manager/increase in symptoms etc Present the background here and present your patients signs and symptoms that made them seek help at this point.
Articulate a succinct history, ‘like a bedside handover’, presenting clinical manifestations…….(CASE STUDY ABOUT PATIENT)
THIS IS AN EXAMPLE
Peter has Heart failure,62yrs, lives alone/recently bereaved/married etc smokes, unable to work/retired etc…. he presented in hospital, he could have presented with an array of problems for example, short of breath, fatigue, weakness, oedema/swelling, low mood/anxiety, persistent cough, admits to not understanding his medication and/or taking his medication etc, etc etc
LO1: Pathophysiology and related clinical manifestations
Give a very brief overview of normal A&P (your chosen Long Term condition) then link this to: -
· Changes that have occurred to the structures/function – this is the pathophysiology part, Then…….
· Link the pathophysiology to your patient symptoms/how they presented (clinical manifestations/signs/symptoms) this then creates some analysis and demonstrates a deeper level of understanding allowing you to fully meet with the LO and to demonstrate that you understand why they have these signs and symptoms.
· Sticking with the example above; Peter presented with oedema, cough and low mood/not coping. Explain/link the pathophysiology to the cough/oedema etc, why is this happening?
LO4: The nursing process
What is the nursing process – a holistic and systematic way to assess patients etc.
Where does care planning fit in with this? Why is it important, who is involved? (nurse, patient, MDT approach to care delivery is needed).
For this section, a clear and concise overview of the importance of a systematic approach (APIE) to nursing care delivery is required. Discussion relating to how this can impact on the management of your case studies disease with focus on self-care strategies. The importance of MDT and family in promoting self-care strategies needs to be included. What are self-care strategies?
Planning and delivering care for patients involves a collaborative approach, this includes the patient, carers, family, nurse, MDT etc, the focus is on individualised care, holistic care, person cantered care, patient focussed care/Link with the evidence that supports why we do this. Link in with ca.
The Evaluation of Time Performance in the Emergency Response Center in Kerman...Emergency Live
The Evaluation of Time Performance in the Emergency Response
Center to Provide Pre-Hospital Emergency Services in Kermanshah
http://www.ccsenet.org/journal/index.php/gjhs/article/view/38288
Health And Safety help the organization to fulfill the requirement of service users and retain the employees for a long period of time. Read this report to know more about Health And Safety.
Key Performance Indicator Assignment Capstone Written Case ConcepTatianaMajor22
Key Performance Indicator Assignment: Capstone Written Case Conceptualization (20 points) (The client selected should be a high school student. I did my intern at a high school) The student will select a client from their internship site and complete an 8-page (minimum) case conceptualization report detailing the following ten competencies,
1. Assessment Skills: Includes a summary of the DSM-5 diagnosis, biopsychosocial assessment, mental status exam, substance use, risk assessment, and any other assessment instruments used.
2. Intervention & Conceptualization Skills: Includes a summary of how the assessment informs treatment, treatment plan, goals, and interventions used. Incorporates any relevant cultural, racial, ethical, and legal (if applicable) issues related to the case, and reflects the intern’s personal theory of counseling.
3. Writing Skills and Document Organization: Paper clearly and succinctly communicates clinical impressions. Paper is organized, with appropriate grammar, spelling, and APA Style.
4. Use of Supervision: Includes a summary of how supervision impacted clinical decision making and case conceptualization.
5. Knowledge & Application of Site-Specific Information: Includes a description of how the site’s clinical services and structure affect the assessment, treatment, and conceptualization of the selected case. Any relevant policies, regulatory processes, and program evaluation measures associated with service delivery are included.
6. Professional Counseling Competencies: Includes a description of how the case was conceptualized from the professional counseling framework compared to other mental health professions (e.g., counseling promotes clients' optimal human development, wellness, and mental health through prevention, education, and advocacy activities, including advocacy for those with mental health issues.)
7. Personal Attributes & Self-Understanding: Includes a summary of 1. intern’s reactions, awareness of own emotional response, and effective countertransference management related to the client case, and 2. awareness of intern’s impact on client (i.e., intern’s race, gender, religion) and client’s transference responses.
8. Interpersonal Competencies: Includes a summary of how the intern’s interactions with supervisor, interdisciplinary team, and site colleagues informed the case. Describe how the use of Generated: 10/22/2021 Page 7 of 23 empathy, compassion, and respect for client’s autonomy were evident in the client’s treatment.
9. Student’s Strengths: Identify and describe at least three of the intern’s personal strengths that enhanced the client’s treatment.
10. Student’s Areas for Development: Identify and describe at least three of the intern’s areas for development that would further enhance the client’s treatment. This paper must be written in APA Style
Due date 11/13/21
Please see attached “final capstone correct” I have started the paper but I need help completing the rest. I have in ...
14Application 1 Identification of a Practice Issue for th.docxdrennanmicah
1
4
Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Project
Note: Have an APA Level 1 header for Each Area Noted below in Blue (a level 1 header is centered, bolded, using upper and lower case letters—see APA manual area 3.03)
Grading Area
Points Possible
Points Earned
Potential areas for earning points:
Header: Summary of Practice Issue
Summary of practice issue. (Note: The issue you select must be suitable for completing the entire EBP Project in 8410.)
2
1.5
Header: Exploration of Research Literature
Exploration of the research literature on
this issue.
3
2.75
High level of scholarship commensurate with doctoral level evident
1
1
Potential areas for losing points:
Grammar, Spelling, and APA errors
Up to 2 pt. deduction
-0
Went Over Page Limit (2 pages max)
Up to 2 pt. deduction
-0
*Improper credit & citation issue
1-6 pt. deduction
-0
Sent back to re-do
1 pt deduction
-1
Late Submission
(posted X.XX.20XX, due X.XX.20XX )
20% deduction (1.2 pts) per day late (per syllabus)
n/a: posted on time
6 Total Points possible
4.25 Total Points Earned
In this assignment you were consider a practice issue at your practicum site, summarize that issue, and outline the research literature associated with it. Please see my edits/notes below. Good job!
Some things for ALL to remember/consider (you may have done this already-this is just a gentle reminder):
· Use a heading for each of the main areas noted in the assignment grading rubric for all assignments (I posted the rubrics in the announcement area-the headers to be used are in blue font).
· Related to your topic of interest, does the agency have a process/policy/clinical practice guideline/practice approach/nurse education/patient education in place already? All of them? Are they being implemented according to the best evidence? If not, could that be an appropriate focus for your project?
· How will you go about updating the processes/policies/education materials so they are more consistent with national recommendations/guidelines/research?
· What is your revised PICOT for this EBP (PICOT was not a mandatory part of the paper—but it is nice to tie this all together at the end of your paper with that information).
· *All students should review their Safe Assign reports regularly (use the draft folders to run a report prior to submitting your assignment). You should not have more than 3 words in a row that are the same as another source unless you use quotation marks and properly cite that source (with author, year, and page number). You need to reword your paper to avoid this. You should reserve using quotations for the rare instances wherein you cannot reword information without losing meaning. Also, you need to cite each sentence with information that a layperson would not know. There are many resources online that you can use to review proper citation and common plagiarism errors. All students should review the Walden Plagiarism Tutorial at h.
There has been increasing demand in improving service provisioning in hospital resources management. Hospital industries work with strict budget constraint at the same time assures quality care. To achieve quality care with budget constraint an efficient prediction model is required. Recently there has been various time series based prediction model has been proposed to manage hospital resources such ambulance monitoring, emergency care and so on. These models are not efficient as they do not consider the nature of scenario such climate condition etc. To address this artificial intelligence is adopted. The issues with existing prediction are that the training suffers from local optima error. This induces overhead and affects the accuracy in prediction. To overcome the local minima error, this work presents a patient inflow prediction model by adopting resilient backpropagation neural network. Experiment are conducted to evaluate the performance of proposed model inter of RMSE and MAPE. The outcome shows the proposed model reduces RMSE and MAPE over existing back propagation based artificial neural network. The overall outcomes show the proposed prediction model improves the accuracy of prediction which aid in improving the quality of health care management.
There has been increasing demand in improving service provisioning in hospital resources
management. Hospital industries work with strict budget constraint at the same time assures quality care.
To achieve quality care with budget constraint an efficient prediction model is required. Recently there has
been various time series based prediction model has been proposed to manage hospital resources such
ambulance monitoring, emergency care and so on. These models are not efficient as they do not consider
the nature of scenario such climate condition etc. To address this artificial intelligence is adopted. The
issues with existing prediction are that the training suffers from local optima error. This induces overhead
and affects the accuracy in prediction. To overcome the local minima error, this work presents a patient
inflow prediction model by adopting resilient backpropagation neural network. Experiment are conducted to
evaluate the performance of proposed model inter of RMSE and MAPE. The outcome shows the proposed
model reduces RMSE and MAPE over existing back propagation based artificial neural network. The
overall outcomes show the proposed prediction model improves the accuracy of prediction which aid in
improving the quality of health care management
Does Electronic Medical Records make cost benefits to non-profit seeking heal...IJSRP Journal
Sri Lanka provides a free public health care service to its permanent residents. Currently Sri Lankan health care system is in the process of using EMR systems both public and private sector healthcare institutions. There are few published data available regarding cost-benefits of EMR in profit seeking institutes in some countries and no published data on non-profit seeking institutes. Therefore, main objective of the study is to perform a cost benefit analysis (CBA) of EMRs in the public health care system in Sri Lanka and secondary objectives are to evaluate the perception of EMRs among patients, health care professionals and supporting staff. Methodology: Two Sri Lankan government hospitals’ OPDs; hospitals belong to Type A divisional category, were selected for the study. Those two hospitals were named as Hospital D and Hospital AR. Hospital D has an EMR system and hospital AR has traditional paper-based recording. A modified cost- benefit analysis was done using achievable costs and benefits. Meanwhile, three different questionnaires were distributed among health care professionals, supporting staff and patients to determine their perception on EMRs. Results: This study found that Benefits-to-Costs ratio of OPD of the hospital D for the year 2015 was 0.269 and for hospital AR was 0.0589. From CBA four basic cost reductions were found as costs for stationeries, patient queue waiting time, supporting staff number and indirect costs such as drug balancing. Health care professionals, supporting staff and patients had a positive perception on EMR systems. Conclusion: Implementing EMRs to Sri Lankan health care system leads to cost reductions. If Sri Lankan government implements an EMR system only in OPDs of government hospitals, it will lead to save millions of rupees. There are thirty-five, Type A divisional hospitals in Sri Lanka. If this EMR system is implemented only in OPDs, Sri Lankan public health care system would have saved Rs192 million ($ 1.3 million) in 2015.Finally, it can be concluded that implementing EMRs in non-profit seeking health care institutes lead to cost reductions and save money.
Part 1 Interest RatesMacroeconomic factors that influence inter.docxssuser562afc1
Part 1: Interest Rates
Macroeconomic factors that influence interest rates in general
The variables influencing microfinance interest rates for MFIs can be characterized into two general gatherings: 1) interior – the components MFIs can impact: for example work costs, specialized help, creations; or 2) outer – political risks, full scale factors, authoritative risk, and four fundamental parts reflected in the microfinance interest rates: working costs, cost of assets, advance misfortune costs, and benefit. Working expenses speak to around 60 % of the all out MFI costs and generally rely upon the credit size, age, area and customer's appraising, and so on.
Macroeconomic factors is your industry most sensitive
Like most businesses, the carrier business is affected by the monetary cycle's pinnacles and troughs. The present development in created economies—like the U.S. that is driven by the extricating money related strategy—has brought about an ascent in business certainty, mechanical creation, and universal exchange.
Impacts on the interest rates experienced within your chosen industry
In any industry, the economy assumes a urgent job that incorporates the general development of the division, and common flight, with the ever-developing interest, is no special case. To give a major picture, Airbus GMF 2016 evaluations the 20-year interest for new traveler and cargo airplane to be a little more than 33,000 airplane comprising a market estimation of over USD $5.2 trillion underlining and setting up the effect of market development.
Part 2: Stock Valuation, Risk and Returns
Stock Valuation. As indicated by the Bureau of Economic Analysis (or BEA), the genuine total national output (or GDP) expanded 4% every year in 2Q14 in the wake of diminishing 2.1% in 1Q14. With financial and modern development, work rates have expanded. This has prompted higher genuine extra cash.
From Video
My company doesn't have stocks right now, so I'll use Costco Wholesale as an example to explain the stock valuation. Future Costco Wholesale Corp stock predictions formula:
P0 = Div1 / (r – g)
P0 = Stock Price;
Div1= Estimated dividends for the next period;
r = Required Rate of Return;
g = Growth Rate
In this formula, we need to know the value of estimated dividends for the next period; required rate and return as well as growth rate. Let’s get each number individually.
g: Growth Rate = Retention Ratio x ROE
0.52 x 0.24 = 0.1248
r: Required Rate of Return.
R = D / P0 + g
0.65 / 296.09 + 0.1248 = 0.1269
Div1: Estimated dividends for the next period is 65c. Therefore, the future Costco Wholesale Corp stock predictions are:
P0 = Div1 / (r – g)
0.65 / 0.0021 = $309.52
The present stock worth and the assessed stock worth utilizing the Dividend Discount Model is higher on account of the contenders are attempting to get into the membership segment showcase. Likewise, Amazon and Sam's club have improved their online store distribution centers. So all in all, financing an organi.
Part 1 Interest RatesMacroeconomic factors that influence inter.docxkarlhennesey
Part 1: Interest Rates
Macroeconomic factors that influence interest rates in general
The variables influencing microfinance interest rates for MFIs can be characterized into two general gatherings: 1) interior – the components MFIs can impact: for example work costs, specialized help, creations; or 2) outer – political risks, full scale factors, authoritative risk, and four fundamental parts reflected in the microfinance interest rates: working costs, cost of assets, advance misfortune costs, and benefit. Working expenses speak to around 60 % of the all out MFI costs and generally rely upon the credit size, age, area and customer's appraising, and so on.
Macroeconomic factors is your industry most sensitive
Like most businesses, the carrier business is affected by the monetary cycle's pinnacles and troughs. The present development in created economies—like the U.S. that is driven by the extricating money related strategy—has brought about an ascent in business certainty, mechanical creation, and universal exchange.
Impacts on the interest rates experienced within your chosen industry
In any industry, the economy assumes a urgent job that incorporates the general development of the division, and common flight, with the ever-developing interest, is no special case. To give a major picture, Airbus GMF 2016 evaluations the 20-year interest for new traveler and cargo airplane to be a little more than 33,000 airplane comprising a market estimation of over USD $5.2 trillion underlining and setting up the effect of market development.
Part 2: Stock Valuation, Risk and Returns
Stock Valuation. As indicated by the Bureau of Economic Analysis (or BEA), the genuine total national output (or GDP) expanded 4% every year in 2Q14 in the wake of diminishing 2.1% in 1Q14. With financial and modern development, work rates have expanded. This has prompted higher genuine extra cash.
From Video
My company doesn't have stocks right now, so I'll use Costco Wholesale as an example to explain the stock valuation. Future Costco Wholesale Corp stock predictions formula:
P0 = Div1 / (r – g)
P0 = Stock Price;
Div1= Estimated dividends for the next period;
r = Required Rate of Return;
g = Growth Rate
In this formula, we need to know the value of estimated dividends for the next period; required rate and return as well as growth rate. Let’s get each number individually.
g: Growth Rate = Retention Ratio x ROE
0.52 x 0.24 = 0.1248
r: Required Rate of Return.
R = D / P0 + g
0.65 / 296.09 + 0.1248 = 0.1269
Div1: Estimated dividends for the next period is 65c. Therefore, the future Costco Wholesale Corp stock predictions are:
P0 = Div1 / (r – g)
0.65 / 0.0021 = $309.52
The present stock worth and the assessed stock worth utilizing the Dividend Discount Model is higher on account of the contenders are attempting to get into the membership segment showcase. Likewise, Amazon and Sam's club have improved their online store distribution centers. So all in all, financing an organi ...
Presentation by Ms. Tuula Eloranta (Research Manager, University of Helsinki) on "Better Productivity and the Quality of Working Life through Collaborative Development of Work: Experiences from the Finnish Food Industry Businesses" during the study visit of the sub-committee on Innovative workplaces to Helsinki on 25 January 2011
A parallel patient treatment time prediction algorithm and its applications i...redpel dot com
A parallel patient treatment time prediction algorithm and its applications in hospital.
for more ieee paper / full abstract / implementation , just visit www.redpel.com
1 SAMPLE BUSINESS MEMORANDUM (The business memo format .docxaryan532920
1
SAMPLE BUSINESS MEMORANDUM
(The business memo format is best suited for presenting analysis and results of an issue that requires no more
than 2 -3 pages of text and a couple of tables and exhibits. Anything longer should use a business report format
with a very short transmittal memo ).
DATE: March 13, 2004
TO: Martha Glamour, CEO Stylish Living Magazine
FROM: Simpson and Lee Consulting Associates (This tells the reader your role as writer – e.g.
consultant, analyst to reporting to manager, etc.)
Thomas Simpson (Principal Writer) Richard Lee (Principal Editor). (The w ords
principal writer and editor do not appear in a real business memo; they are here for grading
purposes only. In the real world you would substitute the titles of the authors, e.g. Partner or
Senior Manager).
RE: Analysis of existing cost system and desirability of switching to ABC.
Thank you for allowing us the opportunity to work with your company (simple courtesy and positive
start). As requested, we have evaluated the strengths and weaknesses of your company’s existing
cost system and evaluated the desirability of switching from the existing cost system to an
activity based cost system ABC). (This sentence should clearly state the “big” issue in the case. It should
also help to remind the intended audience of the purpose of this memo). Our analysis uses Products X and
Y as test cases to understand how the existing and proposed ABC systems would compute
product costs. Based on our study, we have reached the following conclusions:
1. The cost of Product X is higher than Product Y under the current system; the cost Product X is
lower than Product Y under the ABC system.
2. The existing cost system has several weaknesses that make the data unreliable and misleading.
3. We recommend that the company should abandon the existing system and replace it with an
activity based cost system as it will provide better product cost information for decision making.
(The three points above are what the writing guide refers to as “headlines”. They state the major conclusions of
your memo and should (like a newspaper headline) grab the reader’s attention. Note a headline does not contain
detailed results such as cost of Product X is $3.45 per unit.).
The rest of this memo explains the basis of our conclusions. We will present our analysis in four parts.
The first part deals with product cost under the existing system. This is followed by . . . The next section
. . . The last section . . .
(The purpose of these sentences is to give the reader a road map to follow your discussion. Note that the four
parts probably correspond to the detailed questions at the back of the case. These questions typically lead you to
address the big issue in the case. If the memo is longer than 2 pages, you may have to use subheadings to avoid
long bodies of texts).
Product Cost Analysis
Our analysis begins by computing th ...
L’immobilizzazione in caso di trauma pediatricoMario Robusti
Come utilizzare al meglio i presidi pediatrici?
Soccorrere un bambino è una delle attività più complesse e delicate fra per un soccorritore. Fortunatamente i casi in cui l’attività di soccorso traumatico riguardano un paziente in età pediatrica sono rari.
La rarità dei casi in passato ha fatto trascurare lo sviluppo di dotazioni medicali dedicate in modo specifico all’intervento sul lattante, il neonato o sul bambino.
Oggi è chiaro che il bambino non è un piccolo adulto.
Il supporto aereo nell’evacuazione medica di emergenza Degli operatori specia...Mario Robusti
Come si fornisce un valido supporto aereo nell’evacuazione medica di emergenza per gli operatori di forze speciali? Ne ha parlato il dirigente medico della Polizia di Stato il dottor Fabio Ciciliano, esperto di medicina delle catastrofi e parte del dipartimento di Protezione Civile
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The Evaluation of Time Performance in the Emergency Response
Center to Provide Pre-Hospital Emergency Services in Kermanshah
http://www.ccsenet.org/journal/index.php/gjhs/article/view/38288
Health And Safety help the organization to fulfill the requirement of service users and retain the employees for a long period of time. Read this report to know more about Health And Safety.
Key Performance Indicator Assignment Capstone Written Case ConcepTatianaMajor22
Key Performance Indicator Assignment: Capstone Written Case Conceptualization (20 points) (The client selected should be a high school student. I did my intern at a high school) The student will select a client from their internship site and complete an 8-page (minimum) case conceptualization report detailing the following ten competencies,
1. Assessment Skills: Includes a summary of the DSM-5 diagnosis, biopsychosocial assessment, mental status exam, substance use, risk assessment, and any other assessment instruments used.
2. Intervention & Conceptualization Skills: Includes a summary of how the assessment informs treatment, treatment plan, goals, and interventions used. Incorporates any relevant cultural, racial, ethical, and legal (if applicable) issues related to the case, and reflects the intern’s personal theory of counseling.
3. Writing Skills and Document Organization: Paper clearly and succinctly communicates clinical impressions. Paper is organized, with appropriate grammar, spelling, and APA Style.
4. Use of Supervision: Includes a summary of how supervision impacted clinical decision making and case conceptualization.
5. Knowledge & Application of Site-Specific Information: Includes a description of how the site’s clinical services and structure affect the assessment, treatment, and conceptualization of the selected case. Any relevant policies, regulatory processes, and program evaluation measures associated with service delivery are included.
6. Professional Counseling Competencies: Includes a description of how the case was conceptualized from the professional counseling framework compared to other mental health professions (e.g., counseling promotes clients' optimal human development, wellness, and mental health through prevention, education, and advocacy activities, including advocacy for those with mental health issues.)
7. Personal Attributes & Self-Understanding: Includes a summary of 1. intern’s reactions, awareness of own emotional response, and effective countertransference management related to the client case, and 2. awareness of intern’s impact on client (i.e., intern’s race, gender, religion) and client’s transference responses.
8. Interpersonal Competencies: Includes a summary of how the intern’s interactions with supervisor, interdisciplinary team, and site colleagues informed the case. Describe how the use of Generated: 10/22/2021 Page 7 of 23 empathy, compassion, and respect for client’s autonomy were evident in the client’s treatment.
9. Student’s Strengths: Identify and describe at least three of the intern’s personal strengths that enhanced the client’s treatment.
10. Student’s Areas for Development: Identify and describe at least three of the intern’s areas for development that would further enhance the client’s treatment. This paper must be written in APA Style
Due date 11/13/21
Please see attached “final capstone correct” I have started the paper but I need help completing the rest. I have in ...
14Application 1 Identification of a Practice Issue for th.docxdrennanmicah
1
4
Application 1: Identification of a Practice Issue for the Evidence-Based Practice (EBP) Project
Note: Have an APA Level 1 header for Each Area Noted below in Blue (a level 1 header is centered, bolded, using upper and lower case letters—see APA manual area 3.03)
Grading Area
Points Possible
Points Earned
Potential areas for earning points:
Header: Summary of Practice Issue
Summary of practice issue. (Note: The issue you select must be suitable for completing the entire EBP Project in 8410.)
2
1.5
Header: Exploration of Research Literature
Exploration of the research literature on
this issue.
3
2.75
High level of scholarship commensurate with doctoral level evident
1
1
Potential areas for losing points:
Grammar, Spelling, and APA errors
Up to 2 pt. deduction
-0
Went Over Page Limit (2 pages max)
Up to 2 pt. deduction
-0
*Improper credit & citation issue
1-6 pt. deduction
-0
Sent back to re-do
1 pt deduction
-1
Late Submission
(posted X.XX.20XX, due X.XX.20XX )
20% deduction (1.2 pts) per day late (per syllabus)
n/a: posted on time
6 Total Points possible
4.25 Total Points Earned
In this assignment you were consider a practice issue at your practicum site, summarize that issue, and outline the research literature associated with it. Please see my edits/notes below. Good job!
Some things for ALL to remember/consider (you may have done this already-this is just a gentle reminder):
· Use a heading for each of the main areas noted in the assignment grading rubric for all assignments (I posted the rubrics in the announcement area-the headers to be used are in blue font).
· Related to your topic of interest, does the agency have a process/policy/clinical practice guideline/practice approach/nurse education/patient education in place already? All of them? Are they being implemented according to the best evidence? If not, could that be an appropriate focus for your project?
· How will you go about updating the processes/policies/education materials so they are more consistent with national recommendations/guidelines/research?
· What is your revised PICOT for this EBP (PICOT was not a mandatory part of the paper—but it is nice to tie this all together at the end of your paper with that information).
· *All students should review their Safe Assign reports regularly (use the draft folders to run a report prior to submitting your assignment). You should not have more than 3 words in a row that are the same as another source unless you use quotation marks and properly cite that source (with author, year, and page number). You need to reword your paper to avoid this. You should reserve using quotations for the rare instances wherein you cannot reword information without losing meaning. Also, you need to cite each sentence with information that a layperson would not know. There are many resources online that you can use to review proper citation and common plagiarism errors. All students should review the Walden Plagiarism Tutorial at h.
There has been increasing demand in improving service provisioning in hospital resources management. Hospital industries work with strict budget constraint at the same time assures quality care. To achieve quality care with budget constraint an efficient prediction model is required. Recently there has been various time series based prediction model has been proposed to manage hospital resources such ambulance monitoring, emergency care and so on. These models are not efficient as they do not consider the nature of scenario such climate condition etc. To address this artificial intelligence is adopted. The issues with existing prediction are that the training suffers from local optima error. This induces overhead and affects the accuracy in prediction. To overcome the local minima error, this work presents a patient inflow prediction model by adopting resilient backpropagation neural network. Experiment are conducted to evaluate the performance of proposed model inter of RMSE and MAPE. The outcome shows the proposed model reduces RMSE and MAPE over existing back propagation based artificial neural network. The overall outcomes show the proposed prediction model improves the accuracy of prediction which aid in improving the quality of health care management.
There has been increasing demand in improving service provisioning in hospital resources
management. Hospital industries work with strict budget constraint at the same time assures quality care.
To achieve quality care with budget constraint an efficient prediction model is required. Recently there has
been various time series based prediction model has been proposed to manage hospital resources such
ambulance monitoring, emergency care and so on. These models are not efficient as they do not consider
the nature of scenario such climate condition etc. To address this artificial intelligence is adopted. The
issues with existing prediction are that the training suffers from local optima error. This induces overhead
and affects the accuracy in prediction. To overcome the local minima error, this work presents a patient
inflow prediction model by adopting resilient backpropagation neural network. Experiment are conducted to
evaluate the performance of proposed model inter of RMSE and MAPE. The outcome shows the proposed
model reduces RMSE and MAPE over existing back propagation based artificial neural network. The
overall outcomes show the proposed prediction model improves the accuracy of prediction which aid in
improving the quality of health care management
Does Electronic Medical Records make cost benefits to non-profit seeking heal...IJSRP Journal
Sri Lanka provides a free public health care service to its permanent residents. Currently Sri Lankan health care system is in the process of using EMR systems both public and private sector healthcare institutions. There are few published data available regarding cost-benefits of EMR in profit seeking institutes in some countries and no published data on non-profit seeking institutes. Therefore, main objective of the study is to perform a cost benefit analysis (CBA) of EMRs in the public health care system in Sri Lanka and secondary objectives are to evaluate the perception of EMRs among patients, health care professionals and supporting staff. Methodology: Two Sri Lankan government hospitals’ OPDs; hospitals belong to Type A divisional category, were selected for the study. Those two hospitals were named as Hospital D and Hospital AR. Hospital D has an EMR system and hospital AR has traditional paper-based recording. A modified cost- benefit analysis was done using achievable costs and benefits. Meanwhile, three different questionnaires were distributed among health care professionals, supporting staff and patients to determine their perception on EMRs. Results: This study found that Benefits-to-Costs ratio of OPD of the hospital D for the year 2015 was 0.269 and for hospital AR was 0.0589. From CBA four basic cost reductions were found as costs for stationeries, patient queue waiting time, supporting staff number and indirect costs such as drug balancing. Health care professionals, supporting staff and patients had a positive perception on EMR systems. Conclusion: Implementing EMRs to Sri Lankan health care system leads to cost reductions. If Sri Lankan government implements an EMR system only in OPDs of government hospitals, it will lead to save millions of rupees. There are thirty-five, Type A divisional hospitals in Sri Lanka. If this EMR system is implemented only in OPDs, Sri Lankan public health care system would have saved Rs192 million ($ 1.3 million) in 2015.Finally, it can be concluded that implementing EMRs in non-profit seeking health care institutes lead to cost reductions and save money.
Part 1 Interest RatesMacroeconomic factors that influence inter.docxssuser562afc1
Part 1: Interest Rates
Macroeconomic factors that influence interest rates in general
The variables influencing microfinance interest rates for MFIs can be characterized into two general gatherings: 1) interior – the components MFIs can impact: for example work costs, specialized help, creations; or 2) outer – political risks, full scale factors, authoritative risk, and four fundamental parts reflected in the microfinance interest rates: working costs, cost of assets, advance misfortune costs, and benefit. Working expenses speak to around 60 % of the all out MFI costs and generally rely upon the credit size, age, area and customer's appraising, and so on.
Macroeconomic factors is your industry most sensitive
Like most businesses, the carrier business is affected by the monetary cycle's pinnacles and troughs. The present development in created economies—like the U.S. that is driven by the extricating money related strategy—has brought about an ascent in business certainty, mechanical creation, and universal exchange.
Impacts on the interest rates experienced within your chosen industry
In any industry, the economy assumes a urgent job that incorporates the general development of the division, and common flight, with the ever-developing interest, is no special case. To give a major picture, Airbus GMF 2016 evaluations the 20-year interest for new traveler and cargo airplane to be a little more than 33,000 airplane comprising a market estimation of over USD $5.2 trillion underlining and setting up the effect of market development.
Part 2: Stock Valuation, Risk and Returns
Stock Valuation. As indicated by the Bureau of Economic Analysis (or BEA), the genuine total national output (or GDP) expanded 4% every year in 2Q14 in the wake of diminishing 2.1% in 1Q14. With financial and modern development, work rates have expanded. This has prompted higher genuine extra cash.
From Video
My company doesn't have stocks right now, so I'll use Costco Wholesale as an example to explain the stock valuation. Future Costco Wholesale Corp stock predictions formula:
P0 = Div1 / (r – g)
P0 = Stock Price;
Div1= Estimated dividends for the next period;
r = Required Rate of Return;
g = Growth Rate
In this formula, we need to know the value of estimated dividends for the next period; required rate and return as well as growth rate. Let’s get each number individually.
g: Growth Rate = Retention Ratio x ROE
0.52 x 0.24 = 0.1248
r: Required Rate of Return.
R = D / P0 + g
0.65 / 296.09 + 0.1248 = 0.1269
Div1: Estimated dividends for the next period is 65c. Therefore, the future Costco Wholesale Corp stock predictions are:
P0 = Div1 / (r – g)
0.65 / 0.0021 = $309.52
The present stock worth and the assessed stock worth utilizing the Dividend Discount Model is higher on account of the contenders are attempting to get into the membership segment showcase. Likewise, Amazon and Sam's club have improved their online store distribution centers. So all in all, financing an organi.
Part 1 Interest RatesMacroeconomic factors that influence inter.docxkarlhennesey
Part 1: Interest Rates
Macroeconomic factors that influence interest rates in general
The variables influencing microfinance interest rates for MFIs can be characterized into two general gatherings: 1) interior – the components MFIs can impact: for example work costs, specialized help, creations; or 2) outer – political risks, full scale factors, authoritative risk, and four fundamental parts reflected in the microfinance interest rates: working costs, cost of assets, advance misfortune costs, and benefit. Working expenses speak to around 60 % of the all out MFI costs and generally rely upon the credit size, age, area and customer's appraising, and so on.
Macroeconomic factors is your industry most sensitive
Like most businesses, the carrier business is affected by the monetary cycle's pinnacles and troughs. The present development in created economies—like the U.S. that is driven by the extricating money related strategy—has brought about an ascent in business certainty, mechanical creation, and universal exchange.
Impacts on the interest rates experienced within your chosen industry
In any industry, the economy assumes a urgent job that incorporates the general development of the division, and common flight, with the ever-developing interest, is no special case. To give a major picture, Airbus GMF 2016 evaluations the 20-year interest for new traveler and cargo airplane to be a little more than 33,000 airplane comprising a market estimation of over USD $5.2 trillion underlining and setting up the effect of market development.
Part 2: Stock Valuation, Risk and Returns
Stock Valuation. As indicated by the Bureau of Economic Analysis (or BEA), the genuine total national output (or GDP) expanded 4% every year in 2Q14 in the wake of diminishing 2.1% in 1Q14. With financial and modern development, work rates have expanded. This has prompted higher genuine extra cash.
From Video
My company doesn't have stocks right now, so I'll use Costco Wholesale as an example to explain the stock valuation. Future Costco Wholesale Corp stock predictions formula:
P0 = Div1 / (r – g)
P0 = Stock Price;
Div1= Estimated dividends for the next period;
r = Required Rate of Return;
g = Growth Rate
In this formula, we need to know the value of estimated dividends for the next period; required rate and return as well as growth rate. Let’s get each number individually.
g: Growth Rate = Retention Ratio x ROE
0.52 x 0.24 = 0.1248
r: Required Rate of Return.
R = D / P0 + g
0.65 / 296.09 + 0.1248 = 0.1269
Div1: Estimated dividends for the next period is 65c. Therefore, the future Costco Wholesale Corp stock predictions are:
P0 = Div1 / (r – g)
0.65 / 0.0021 = $309.52
The present stock worth and the assessed stock worth utilizing the Dividend Discount Model is higher on account of the contenders are attempting to get into the membership segment showcase. Likewise, Amazon and Sam's club have improved their online store distribution centers. So all in all, financing an organi ...
Presentation by Ms. Tuula Eloranta (Research Manager, University of Helsinki) on "Better Productivity and the Quality of Working Life through Collaborative Development of Work: Experiences from the Finnish Food Industry Businesses" during the study visit of the sub-committee on Innovative workplaces to Helsinki on 25 January 2011
A parallel patient treatment time prediction algorithm and its applications i...redpel dot com
A parallel patient treatment time prediction algorithm and its applications in hospital.
for more ieee paper / full abstract / implementation , just visit www.redpel.com
1 SAMPLE BUSINESS MEMORANDUM (The business memo format .docxaryan532920
1
SAMPLE BUSINESS MEMORANDUM
(The business memo format is best suited for presenting analysis and results of an issue that requires no more
than 2 -3 pages of text and a couple of tables and exhibits. Anything longer should use a business report format
with a very short transmittal memo ).
DATE: March 13, 2004
TO: Martha Glamour, CEO Stylish Living Magazine
FROM: Simpson and Lee Consulting Associates (This tells the reader your role as writer – e.g.
consultant, analyst to reporting to manager, etc.)
Thomas Simpson (Principal Writer) Richard Lee (Principal Editor). (The w ords
principal writer and editor do not appear in a real business memo; they are here for grading
purposes only. In the real world you would substitute the titles of the authors, e.g. Partner or
Senior Manager).
RE: Analysis of existing cost system and desirability of switching to ABC.
Thank you for allowing us the opportunity to work with your company (simple courtesy and positive
start). As requested, we have evaluated the strengths and weaknesses of your company’s existing
cost system and evaluated the desirability of switching from the existing cost system to an
activity based cost system ABC). (This sentence should clearly state the “big” issue in the case. It should
also help to remind the intended audience of the purpose of this memo). Our analysis uses Products X and
Y as test cases to understand how the existing and proposed ABC systems would compute
product costs. Based on our study, we have reached the following conclusions:
1. The cost of Product X is higher than Product Y under the current system; the cost Product X is
lower than Product Y under the ABC system.
2. The existing cost system has several weaknesses that make the data unreliable and misleading.
3. We recommend that the company should abandon the existing system and replace it with an
activity based cost system as it will provide better product cost information for decision making.
(The three points above are what the writing guide refers to as “headlines”. They state the major conclusions of
your memo and should (like a newspaper headline) grab the reader’s attention. Note a headline does not contain
detailed results such as cost of Product X is $3.45 per unit.).
The rest of this memo explains the basis of our conclusions. We will present our analysis in four parts.
The first part deals with product cost under the existing system. This is followed by . . . The next section
. . . The last section . . .
(The purpose of these sentences is to give the reader a road map to follow your discussion. Note that the four
parts probably correspond to the detailed questions at the back of the case. These questions typically lead you to
address the big issue in the case. If the memo is longer than 2 pages, you may have to use subheadings to avoid
long bodies of texts).
Product Cost Analysis
Our analysis begins by computing th ...
L’immobilizzazione in caso di trauma pediatricoMario Robusti
Come utilizzare al meglio i presidi pediatrici?
Soccorrere un bambino è una delle attività più complesse e delicate fra per un soccorritore. Fortunatamente i casi in cui l’attività di soccorso traumatico riguardano un paziente in età pediatrica sono rari.
La rarità dei casi in passato ha fatto trascurare lo sviluppo di dotazioni medicali dedicate in modo specifico all’intervento sul lattante, il neonato o sul bambino.
Oggi è chiaro che il bambino non è un piccolo adulto.
Il supporto aereo nell’evacuazione medica di emergenza Degli operatori specia...Mario Robusti
Come si fornisce un valido supporto aereo nell’evacuazione medica di emergenza per gli operatori di forze speciali? Ne ha parlato il dirigente medico della Polizia di Stato il dottor Fabio Ciciliano, esperto di medicina delle catastrofi e parte del dipartimento di Protezione Civile
Il modulo sanitario nella Protezione civileMario Robusti
Benvenuti in questo episodio podcast di Rescue Press, dedicato ad approfondimenti scientifici nel mondo dell’emergenza e del soccorso. Oggi, grazie alla collaborazione con il dottor Alberto Baratta del 118 di Massa, direttore della base di Elisoccorso Pegaso 3, e alla collaborazione della HEMS Association, possiamo presentarvi un estratto dell’HEMS Congress 2019.
Dalla sessione dedicata alle attività di Protezione Civile ascolterete l’intervento integrale della dottoressa Isabella Bartoli Referente Sanitario della Regione Sicilia per le Grandi Emergenze, e direttore della SUES 118 di Catania.
Durante HEMS Congress, Bartoli ha presentato la struttura dei moduli sanitari per le maxi emergenze allestite presso i vari centri di soccorso, per fornire aiuto rapidamente in caso di calamità.
Godetevi questo intervento e ricordatevi che questo podcast è disponibile sul sito web academy.rescue.press insieme a tutte le novità del mondo del soccorso pre-ospedaliero saranno online su www.rescue.press. Vi basterà cliccare sul link e registrarvi per commentare, discutere e inviare i vostri contenuti scientifici per migliorare il mondo del soccorso, a qualsiasi livello voi ne facciate parte.
Il funzionamento della C.R.O.S.S. e il sistema di aiuto alla Regione colpita ...Mario Robusti
Benvenuti a questo episodio podcast di Rescue Press, dedicato ad approfondimenti scientifici nel mondo dell’emergenza e del soccorso. Oggi, grazie alla collaborazione con il dottor Alberto Baratta del 118 di Massa, direttore della base di Elisoccorso Pegaso 3, e alla collaborazione della HEMS Association, possiamo presentarvi un estratto dell’HEMS Congress 2019. Dalla sessione dedicata alle attività di Protezione Civile ascolterete l’intervento integrale della dottoressa Rita Rossi, del Dipartimento Interaziendale per l’emergenza sanitaria territoriale, e direttore del 118 della città metropolitana di Torino. Come direttore della CROSS di Torino, la dottoressa Rossi ha presentato nell’occasione proprio il funzionamento della C.R.O.S.S. e il sistema di aiuto alla Regione colpita da calamità.
Ascoltiamo quindi l’intervento, e vi ricordiamo che questo podcast è disponibile sul sito web academy.rescue.press e che tutte le novità del mondo del soccorso pre-ospedaliero saranno online su www.rescue.press. Vi basterà cliccare sul link e registrarvi per commentare, discutere e inviare i vostri contenuti scientifici per migliorare il mondo del soccorso, a qualsiasi livello voi ne facciate parte.
Grazie e buon ascolto.
Tubi flessibili per il settore farmaceutico e medicaleMario Robusti
Universalflex commercializza tubi tusil view per aspirazione di prodotti alimentari, cosmetici e farmaceutici.
Queso tubo supera i test di migrazione in accordo alla normativa BfR Recommendation XV & XXI Cat. 2.
Non è adatto ad essere utilizzato come materiale da innesto ed impianto in esseri viventi. Non è adatto per sangue o per altri fluidi umani.
Civil Protection Forum 2015: Draft programMario Robusti
The European Civil Protection Forum is organised by the European Commission, Directorate General Humanitarian Aid and Civil Protection (DG ECHO) every two years.
The ability to provide safe, urgent and integrated care is fundamental to the future
delivery of the health and social care system. We need information to follow the
patient along their pathway, so clinicians and patients can have access to the right
information at the right time. In addition, commissioners need to be able to link patient information across multiple settings to improve the services provided to their population. This needs an underpinning primary identifier across the system - the NHS Number (NHSN)
LAVORO: Bando di selezione per operatori professionali infermieristici catego...Mario Robusti
L'Ente per i Servizi Tecnico-Amministrativi di Area Vasta Sud Est ha pubblicato il 5 novembre un avviso che da 20 giorni ai potenziali candidati per entrare nelle selezioni.
EBOLA - Trasporto in E.R. solo di competenza ASLMario Robusti
Esclusi i servizi convenzionati e le associazioni per ragioni di sicurezza e attrezzature. Il documento integrale emesso dalla Regione Emilia-Romagna
www.emergency-live.com
Avviso pubblico per selezione autisti ambulanza ASUR Marche zona 5Mario Robusti
Il 25 novembre scade il termine per l'iscrizione al concorso di selezione per autisti soccorritori di ambulanza organizzato dall'Asur Marche, zona vasta numero 5, che serve a stilare una graduatoria di operatori tecnici specializzati con cui effettuare assunzioni a tempo determinato perl'area di Ascoli Piceno e San Benedetto del Tronto.
Contributors to the frequency of intense climate disasters in asia pacific co...Mario Robusti
The frequency of intense natural disasters increased notably from the 1970s to the 2000s. Around half of these events happen in Asia and Pacific Area. Intense hydrometeorological disasters and climatological disasters accounted for most of the worldwide increase in natural disasters.The Springer.com Open Access Science and Media website publish a new paper about disaster prevention and climate action. This pubblication is an indipendent evalutaion at the Asian Development Bank.
The Fire and Rescue Service Books is a guidance for organize a safe system of...Mario Robusti
Operational guidance for incidents involving hazardous material.
In everyday language "hazardous materials" means solids, liquids, or gases that can wound people, other living organisms, or damage property, or the environment. They not only include materials that are toxic, radioactive, flammable, explosive, corrosive, oxidizers, asphyxiates, biohazards, pathogen or allergen substances and organisms, but also materials with physical conditions or other characteristics that render them hazardous in specific circumstances, such as compressed gases and liquids, or hot/cold materials.
The Department for Communities & local Government, with collaboration of CFRA (Chief Fire & Rescue Adviser) publish in 2012 an interesting guideline for a bettere organization of the incident ground, following safe and correct procedure. The target of this operational guidance, about the "incident involving hazardous materials" is to provide an unvaried approach for common operational practices. This simple rules could give a better explanation about the interoperability between fire and rescue services, other emergency responders, industry experts and other relevant groups. These common principles, practices and procedures are intended to support the development of safe systems of work on the incident ground and to enhance national resilience.
This book promotes and enhance good practice within the Fire and Rescue Service and is offered as a current industry standard. It is envisaged that this will help establish high standards of efficiency and safety in the interests of employers, employees and the general public.
The Guidance, which is compiled using the best sources of information known at the date of issue, is intended for use by competent persons. The application of the guidance does not remove the need for appropriate technical and managerial judgement in practical situations with due regard to local circumstances, nor does it confer any immunity or exemption from relevant legal requirements, including by-laws.Those investigating compliance with the law may refer to this guidance as illustrating an industry standard.
This book could contain interesting suggestion that could interest also Firefighters, first responder and EMS from different country, wich not follow law, guidelines or practices from United Kingdom or Commonwealth Countries.
Major incidents involving hazardous materials in the United Kingdom are rare. Such incidents place significant demands on local fire and rescue services and often require resources and support from other fire and rescue services and emergency responders.
However smaller scale incidents involving hazardous materials are more prevalent and these may require a response from any fire and rescue service in England.
The Fire and Rescue Service Operational Guidance – Incidents involving hazardous materials provid
UNOCHA Global Humanitarian Overview. Status Report of august 2014Mario Robusti
2014 has seen a major surge in humanitarian crises around the world. Inter-agency strategic response and regional response plans now target over 76 million people in thirty-one countries compared to 52 million in December 2013. 102 million people are estimated to be in need of humanitarian assistance compared to 81 million in December 2013. Global financial requirements to cover humanitarian needs rose from US$12.9 billion in 2013 to $17.3 billion now. More and more crises are having a regional impact with a spill-over effect on countries which are already fragile.
NHS review: transforming urgent and emergency care services in EnglandMario Robusti
NHS England published an update on the Urgent and Emergency Care Review, which builds on NHS England’s future vision for urgent and emergency care in Transforming urgent and emergency care services in England.
READ THE ARTICLE OF EMERGENCY-LIVE HERE:
http://www.emergency-live.com/en/health-and-safety/legislation/nhs-review-transforming-urgent-and-emergency-care-services-in-england
Flambées épidémiques de Ebola et Marburg: préparation, alerte, lutte et évalu...Mario Robusti
Ce document a pour objectif de décrire les mesures de préparation, de prévention et de lutte qui ont été mises en place avec succès au cours des épidémies précédentes.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Time is money, but how much? The Monetary Value of Response Time for Ambulance
1. Dept. of Economics (Web page)
Karlstad University
SE-651 88 Karlstad Sweden
Phone: +46-54-700-10-00
Karlstad University Working Paper in Economics
# 2013 / 2
Time is money, but how much?
The monetary value of response time for Thai ambulance emergency services
Dr. Henrik Jaldell a
, Dr. Lebnak P b
, Dr. Anurak A. b
, Ms. Krongkan B., Ms. Khanisthar P. b
a
Department of Economics, Karlstad University
b
Emergency Medical Institute Thailand, EMIT
2. 2
Time is money, but how much?
The monetary value of response time for Thai ambulance emergency services
Dr. Henrik Jaldell
Karlstad University
Department of Economics
S-651 88 Karlstad
Sweden
henrik.jaldell@kau.se
Phone: +46547001369
Fax: +46547001799
Dr. Lebnak P., Dr. Anurak A., Ms. Krongkan B., Ms. Khanisthar P.
Emergency Medical Institute Thailand, EMIT,
Bangkok, Thailand
Abstract:
The monetary values for how much ambulance emergency services are calculated for two different
time factors, response time, which is the time from when a call is received by the EMS call-taking
centre until the response team arrives at the emergency scene, and operational time, which is the
time from alarm to the accident scene and to the hospital. The study is performed in three steps.
First, marginal effects of reduced fatalities and injuries for a minute change of the time factors are
calculated using logistic regressions. Second, monetary values are chosen for fatalities and injuries;
third, the marginal effects and the monetary values are put together to find a value per minute. The
values are found to be 5.5 million Thai Baht per minute for fatality, 326,000 Baht per minute for
severe injury, and 2,100 Baht per minute for slight injury. The total value of fatality, severe injury
and slight injury for a one-minute improvement for each dispatch, summarized over one year, is 1.6
billion Thai Baht using response time. The resulting total values could be used on the benefit side in
an economic cost-benefit analysis of investments, such as new technology, which could reduce the
response and operational times.
Keywords:
Response time, cost-benefit, medicine, emergency, EMS
JEL codes:
D61, I31, R53,
Acknowledgement:
Financial support from Swedish Ministry of Foreign Affairs is acknowledged. Many thanks to Anders
Edberg, Ericsson (Thailand), without whom this project would not have been possible.
3. 3
1. Introduction
The success of all emergency responses is dependent on the time taken to get to the place where
someone is lying ill or where a traffic accident has occurred. The faster the response the better the
outcome will be. Hence, it is reasonable to say that all efforts should be made to decrease the time
factor in the alarm chain from calling to taking the call, to dispatching, to getting ready to leave, to
driving to the injured or accident, to taking care of the injured or suppressing the fire, and to getting
the injured to hospital. On the other hand, should all efforts be made solely to decrease the time
factor? Such efforts are costly and there are other health matters that could be invested in: better
ambulances with more technical equipment, more training of the staff, better hospitals, provision of
self-help equipment etc. The economical way of dealing with this problem of the public sector is to
perform cost-benefit analyses. If benefits outweigh costs, in monetary terms, then an investment
should be made since it can be said to increase welfare in society. If costs outweigh benefits, the
investment should not be made.
The purpose of this study is to find a monetary value for the time factor of the emergency responses
in Thailand. It is not a cost-benefit analysis, since it only considers the benefit side of the time factor.
Notwithstanding, the results of the study could be used in a cost-benefit analysis. For example, if the
Thai emergency sector intends to invest in new alarm technology that could save 1 minute in
response time for all responses, how much will such an investment lead to in benefits measured in
economic welfare terms?
As noted by Blanchard et al. (2012), there are only a few studies on the relation between the
response time of emergency medical service (EMS) and the saving of lives. When it comes to cardiac
arrest, reducing ambulance response time has been shown to increase survival rate (Pons et al.
2005; Pell et al. 2001; O’Keefe et al. 2011). Gonzales et al. (2009) found increased EMS pre-hospital
time to be associated with higher mortality rates. Using fire and rescue services, which have shorter
response times than traditional ambulances for health care responses, has been found to increase
survival rate (Mattsson and Juås 1997; Jaldell 2004; Sund et al. 2011). However, there are also
studies that have concluded that there is no relation between the response time and outcome of the
patient (Blackwell et al. 2002; Blackwell et al. 2009; Pons and Markovchick 2002).
There are five motivations behind this paper. The first is that, as noted above, there is not much
research done on the effect of the response time. The second is that most of the studies mentioned
have taken up one health problem (cardiac arrest), while from a planning perspective there are of
course many more reasons for having ambulance services. Furthermore, most of the analyses have
evaluated the 8-minute response time goal for American ALS units responding to life-threatening
events, for example, by comparing the survival rate below or above the 8-minute response time
using non-continuous measures of response time. This analysis focuses instead on a continuous
measure of the response time. The third is that this study examines not only the relation between
response time and mortality, but also the effect of the illness condition for non-mortality cases. The
fourth is that the number of observations in this study is over a million, compared to hundreds or
thousands in the papers mentioned above. The fifth is that the analysis done does not stop at the
outcome of the patient, but instead takes on an economic perspective, where the purpose is to find
a monetary value for the total benefits of reducing the response time. This value could be used in a
4. 4
cost-benefit analysis for evaluating investments in new alarm technology that would speed-up the
response time.1
To find the monetary value of the time factor for emergency responses in Thailand, the analysis is
performed in two steps. The first step is to analyze the emergency response data from the call-
taking and dispatch centre database of the Emergency Medical Institute of Thailand. The data used is
for 19 months (from March 2009 to September 2010) with 1,160,391 emergency response records
representing 73 % of all emergency response cases in Thailand during this time period. In the
statistical analysis a logistic regression analysis is used to find the relation, expressed as marginal
effects, between an independent variable and dependent variables. The dependent variables are
fatality, severe injury and slight injury. The independent variable is the response time or the
operational time, i.e. the time factor of the emergency response. Holding other independent
variables and risk factors constant, the marginal effect describes the increase or decrease in the time
factor for a one minute change and how this will affect the risk of fatality, severe injury and slight
injury.
Using results from a Thai cost-of-illness study (Thanirananon et al. 2008) the total value of fatality,
severe injury and slight injury for a one-minute improvement for each dispatch summarized over
one year is 1.6 billion Thai Baht for response time, where response time is the time from when a call
is received by the EMS call-taking centre until the response team arrives at the emergency scene. For
operational time, it is 800 million Thai Baht, where operational time is the time from when a call is
received by the EMS call-taking centre until the patient is admitted to a hospital emergency room.
The above values for a one-minute improvement to the time factor for one year are calculated using
the provinces included in the Narenthorn database. The number of emergency response cases in
these provinces represents 73 % of the total number of the emergency responses in Thailand during
the study period. Therefore, if we were to extrapolate the loss values for the whole of Thailand the
value would be 2.2 billion Thai Baht for response time and 1.1 billion million Thai Baht for
operational time. These figures represent the positive welfare effect, for one year, of reducing the
emergency responses in Thailand by one minute on average.
Assuming, for example, that an investment could be made in a new call taking and dispatch system
with a technology life of 20 years, which could decrease the response time and operational time by
one minute, the present value of the benefits of such an investment will be between 12.8 and 25.6
billion Thai Baht, assuming a social discount rate of 6 %.
Section 2 describes the Thai emergency system and section 3 contains the data used. The model and
the results are presented in sections 4 and 5, respectively. Section 6 concludes the study with a
discussion and conclusion.
1
No similar cost-benefit study has been found and there have been very few economic studies of out-of-
hospital emergency care (see Lerner et al. 2006).
5. 5
2. Emergency System in Thailand
Currently, the emergency call number “1669” is being used as the emergency medical contact
number in Thailand. The system has been installed in each province at the main hospital or the
provincial health office. The call taker asks the caller for information and tries to understand the
symptoms or other relevant information. He/she then gives the caller some essential medical
suggestions and advice, such as first-aid, and then asks for further information about the location
and situation to be able to make a decision about the next step. A dispatcher controls the resources
by using different EMS-levels including the first response unit (FR), the basic life support unit (BLS)
and the advanced life support unit (ALS). He/she also addresses their suitability to operate at the
scene of the problem and their capacity to aid the patient. The FR-unit is able to assess and give
primary care to the emergency patient, e.g. first-aid and simple procedures. The BLS-unit has more
capability to take care of the emergency patient than the first response unit, e.g. basic medical
operation, oxygen giving and non-invasive emergency care. The ALS-unit has the capability to
provide care similar to the emergency unit in a hospital, e.g. CPR (Cardiopulmonary resuscitation)
with defibrillator, ventilation support, intravenous infusion, intravenous injection and invasive
treatments. The important role of the call taking and dispatch system is to receive the correct
information quickly, to evaluate the situation and to supply personnel, vehicles, equipment, etc,
which can support the emergency case in the best way possible and reach the location of the
incident rapidly, especially to assist an emergency patient who could be severely injured or die if the
assistance is delayed. There are 12 million emergency cases per year, 30% of which are for critical or
emergency patients, i.e. those who need the emergency services to prevent life threatening
situations. Of the total amount of emergency cases, approx. 60,000 emergency patients died
outside hospitals. If Thailand had an efficient emergency medical service, 15 – 20% of emergency
patients, or 9,000-12,000 people would be saved per year.
6. 6
3. Data
Definition of response time and operational time
The emergency operation system can be described as having the operational flow shown in figure 1.
Figure 1: Emergency Medical Time
T0 – T1 is the time from when the person who sees or is involved in the incident makes a decision to
call the emergency number 1669 in order to request for medical assistance. This time cannot be
measured accurately because the caller cannot always accurately recall or measure the time (in
minutes) from seeing or being involved in the incident to the time of calling the emergency medical
service. T1 - T2 is the time between the caller making a phone call to the emergency services (1669)
and the call-taker answering the call, which is usually 5-10 seconds. In the case of a call taker being
unavailable, the communication supplier for the emergency operation will generally place the
emergency phone call into a queuing system; the call is connected as soon as the next free call taker
is available. T2 – T3 is the time from the call taker collecting data from the caller to when he/she
makes a decision to dispatch the appropriate emergency operation unit to the scene of the incident.
The necessary data is the location, the patient’s details, symptoms, the safety of the location, etc.
The duration might be between 15 seconds and several minutes depending on the severity and
complexity of the incident. T3 – T4 is the time from when the commander informs and dispatches
7. 7
the emergency operation unit, until the unit vehicle leaves from its base. Normally, this will depend
upon the technology of the communication system used for transferring the entire case data to the
emergency operation unit. Also, it will depend upon the call procedure for the unit staff and the
distance between the base and their vehicle. Several emergency units are specified to move out of
the base within 1 minute after being informed of the incident, but this has not been implemented
officially, and cannot be considered as the standard service as of yet.
T4 – T5 is the time taken for the vehicle to move from the base to the incident location. T5 – T6 is
the time from arriving at the location until reaching the patient. This might differ; for example, for a
traffic accident it may take less than 15 seconds. Alternatively, if the incident is in a skyscraper in the
city centre, it will take longer (e.g. 5 minutes) to arrive at the patient’s side. T6 – T7 is the time it
takes to deliver medical care at the location, which will most likely be different from case to case.
For example, for a patient involved in a traffic accident, it will be more advantageous if he/she can
arrive at a hospital rapidly and receive medical care in the operating room as fast as possible (Scoop
and Run). On the other hand, if the patient has cardiac arrest symptoms, it will be more
advantageous if he/she can receive the necessary invasive care at the location until the situation is
stabilized, and then he/she can be transferred to the hospital (Stay and Play). T7 – T8 is the time
taken to transfer the patient to the hospital. This may differ depending on the urgency. The
decision to take the patient to the hospital will be taken by the unit leader and confirmed by the
commander, who receives the report of the emergency patient from the operation unit before
arriving at the hospital.
In this study response time and operational time are defined as:
Response Time: the response time is the time from when the call taker receives the phone call until
the operational unit arrives at the scene site. (T2-T5)
Operational time: the time from when the call taker receives the phone call to the operational unit
transfer of the patient to the hospital. (T2-T8)
The Emergency Medical Institute of Thailand (EMIT) creates the monitoring and implementation
report by extracting relevant data and information from the online-dispatch system called the
“Narenthorn Emergency Medical Database”. The local agencies report data through this system in
order to obtain financial reimbursement for the emergency medical operations they have
successfully performed. The reports in the system include basic information on the dispatch centre,
location and notification, but also time information and information about the injury. The
information consists of the time the information is received, the command time, the vehicle dispatch
time, the scene arrival time, the scene departure time, the hospital arrival time, the base returning
time, the total response time, the distance (in kilometres) and the type of operation unit.
The information on accident or emergency injury is categorized into 12 items, and for disaster into 6
items. There is also categorized information of the injury based on seriousness levels, type of
operation unit and operational staff. The reports also include information on the preliminary
operation results on scene categorized by the type of treatment and identified by the referral, for
example, death and no treatment, heart attack, onsite treatment, etc. The hospital treatment
consists of admission time, treatment duration, treatment result, referrals, continuous treatment,
death, etc.
8. 8
The Narenthorn database has been used nationwide, except for eight provinces, and covers the
regions with about 3/4 of the population of Thailand.2
For the period studied here, 2009 – 2010,
there are 1,489,800 reports, or 73.2% of total reports, which are generated through the system.
However, there are problems with the reports from October 1, 2009 to March 31, 2010. Some
obviously contain wrong time data, for instance, a response time of over 248 minutes and an
operational time of 314 minutes3
, so in total only 1,186,067 reports are used in the analysis.
Descriptive statistics
Treatment results have been categorized into three levels: slight injury, severe injury and fatality.
Slight injury means all patients who receive medical care on scene or at the hospital. Recovery is
allowed to take place at home before or after the rescue services arrive at the scene or after the
patients have received emergency care. Severe injury means patients who receive medical care, and
are admitted to a hospital, and when there is no death before or after the rescue arrives on the
scene, or after the patients receive emergency care. Fatality means patients who die before or after
the rescue services arrive at the scene, or after the patients receive emergency care, and includes
death at the hospital.
Cause of incident is divided into four groups: physical trauma, medical emergency, traffic accident
and others. Physical trauma includes a fall and collapse, fall from a height, building collapse, physical
assault, trauma from an external object, trauma from an animal, fire, electrocution, burns, bombing,
natural hazards, and hazmat. Medical emergency includes drowning, suicide and medical
emergency, while traffic accident includes motor vehicle collision. The number of dispatches for
each incident group with regard to EMS-level and treatment result is found in tables 1a- 1c. Medical
emergency is the most frequent cause of incident, followed by traffic accidents. ALS-units are more
often dispatched to medical emergencies than BLS- and FR-units, while BLS-units are more often
dispatched to traffic accidents. It can be seen that ALS-units are dispatched to a higher degree to
more serious injuries, followed by BLS-units and FR-units. In tables 2a-2b the response and
operational times are reported for different EMS-levels and treatment results. ALS-units also have
the longest response times followed by BLS-units and FR-units. However, the operational time is
similar for all three units.
2
The provinces not included are Bangkok, NongKhai, NongBualamphu, Udonthani, Kalasin, Khonkaen,
Mahasalakham and Roiet.
3
The maximum time is chosen according to mean + one standard deviation.
9. 9
Table 1. Number of dispatches for each EMS-level and treatment results.
a. Total EMS LEVEL
EMERGENCY ALS BLS FR
n n n n
Medical emergency 670,313 56.5% 117,560 64.4% 139,085 53.7% 413,668 55.5%
Traffic accident 358,173 30.2% 47,523 26.1% 83,237 32.1% 227,413 30.5%
Physical trauma 128,410 10.8% 13,491 7.4% 29,370 11.3% 85,549 11.5%
Other 29,171 2.5% 3,845 2.1% 7,227 2.8% 18,099 2.4%
Total 1,186,067 100.0% 182,419 100.0% 258,919 100.0% 744,729 100.0%
b. Treatment results
EMERGENCY Total FATALITY SEVERE SLIGHT
n n % n % n %
Medical emergency 670,622 56.5% 12,476 58.7% 180,126 62.0% 462,082 56.3%
Traffic accident 358,435 30.2% 6,915 32.6% 71,393 24.6% 247,374 30.1%
Physical trauma 128,478 10.8% 1,694 8.0% 26,814 9.2% 95,392 11.6%
Other 29,207 2.5% 151 0.7% 11,971 4.1% 16,119 2.0%
Total 1,186,742 100.0% 21,236 100.0% 290,304 100.0% 820,967 100.0%
FATALITY=worst of injuries, SEVERE=worst of injuries, SLIGHT=worst of injuries.
c.
EMS LEVEL Total FATALITY SEVERE SLIGHT
ALS 182,419 15.4% 14,647 69.0% 94,046 32.4% 62,994 7.7%
BLS 258,919 21.8% 2,372 11.2% 67,376 23.2% 173,196 21.1%
FR 744,729 62.8% 4,205 19.8% 128,814 44.4% 584,275 71.2%
Total 1,186,067 100.0% 21,224 100.0% 290,236 100.0% 820,465 100.0%
FATALITY=If fatality was worst of injuries, SEVERE=If severe injury was worst of injuries, SLIGHT=If slight injury was worst of injuries.
Table 2. Percent of each treatment and response and operational time in minutes for each
emergency group and for each EMS-level.
a.
EMERGENCY FATALITY
%
SEVERE
%
SLIGHT
%
Response
time
Median
Response
time
Mean
Response
time
Std
Operational
time
Median
Operational
time
Mean
Operational
time
Std
Medical
emergency 1.9% 26.9% 68.9%
9 37.6 206.5 26 66.3 241.0
Traffic accident 1.9% 19.9% 69.0% 7 38.4 221.5 19 67.3 260.9
Physical trauma 1.3% 20.9% 74.2% 7 36.7 210.5 23 65.0 244.5
Other 0.5% 41.0% 55.2% 9 37.9 208.7 29 69.8 247.7
Total 1.8% 24.5% 69.2% 8 37.8 211.6 24 66.6 247.7
b.
EMS LEVEL FATALITY
%
SEVERE
%
SLIGHT
%
Response
time
Median
Response
time
Mean
Response
time
Std
Operational
time
Median
Operational
time
Mean
Operational
time
Std
ALS 8.0% 51.6% 34.5% 12 36.6 191.4 25 61.9 225.9
BLS 0.9% 26.0% 66.9% 9 30.2 177.3 23 61.5 224.6
FR 0.6% 17.3% 78.4% 7 40.7 226.8 24 69.5 260.2
Total 1.8% 24.5% 69.2% 8 37.8 211.6 24 66.6 247.7
10. 10
In figure 2 we can see the relation between the response time variable and the percent of death and
severe injury for all cases and for each emergency type. The risk of fatality increases by up to a
response time of 20-25 minutes, but after 25-30 minutes the curves seem to be quite horizontal and
thus the risk of dying is no longer increasing.
Figure 2. Proportion of fatalities related to response time.
For severe injuries the relations have about the same shapes (not shown here). There is an increased
risk of a severe injury for shorter response times, but after about 30 minutes (shorter for traffic
accidents) a longer response time no longer leads to an increased risk of a severe injury.
3.2 Monetary value of emergency injury or accident
The purpose of an economic cost-benefit analysis, CBA, is to measure the welfare impacts of public
investments. If the benefits of the investment are larger than the costs, measured in monetary units,
then welfare can be increased by investing in the project. Therefore, in this analysis we need figures
in Thai Baht for saving lives and reducing injuries.
There are two main methods of finding such monetary values: the cost-of-illness (COI) method and
the willingness to pay (WTP) approach. WTP is based on the idea that people can assess the risk of
having an accident, and that they will pay for reducing or minimizing that risk (see e.g. Viscusi and
Aldy, 2003; Bellavance et al., 2009; Lindhjem et al. 2011). The monetary value is derived either from
questions asked of people (stated preference technique) or by studying people’s behaviour, e.g. how
much they pay when buying risk reducing protection or how high a wage they want for accepting a
job with a higher risk (revealed preferences).
11. 11
When it comes to estimating the value of a statistical life, VSL, there have been only a few studies
that cover Thailand. Vassanadumrongdee and Matsuoka (2005), using surveys in Bangkok with 1,080
questionnaires (680 for the air pollution sample and 400 for the traffic accident sample), employed
the stated preference technique contingent valuation to estimate VSL in the context of air pollution
and traffic accidents. For both risk contexts they used the same reductions in risk level with
reductions of 30/1000000 and 60/1000000. The income adjusted VSL was found to be 59 million
Baht for the smaller risk reduction and 38 million Baht for the larger for air pollution, and 61 million
Baht for the smaller risk reduction and 38 million Baht for the larger for traffic accidents. Chestnut et
al. (1998) tried to find a VSL for air pollution in Bangkok. They referred to studies done in other
countries and used a benefit transfer to calculate a value of US $0.80 to $2.78 million. Gibson et al.
(2006) calculated a VSL of US $0.25 million for landmine clearance in rural Thailand using the
contingent valuation method. Miller (2000) compared the VSL of transport between different
countries, by means of benefit transfer using countries’ different GDP levels, to calculate “best
estimates” for each country. The “best estimate” for Thailand was US $0.38 million.4
The above studies only calculate values of a statistical life. However, we are also interested here in
the monetary value of severe injury and slight injury. For our monetary values results from a study
by Pichai Thanirananon et al. (2008), which employed a cost-of-illness method to calculate the cost
of traffic accidents in Thailand in 2004, has been used. The cost-of-illness method is a way to
calculate the consequences of accidents in monetary values (see e.g. Tarricone, 2006; Larg and
Moss, 2011). That is, it is the sum of emergency costs, hospital costs, productivity loss etc.
Thanirananon et al. focused on five regional hospitals which had a department for providing service
data on the injuries caused by traffic accidents. The loss value was categorized into 3 groups as
follows: 1) The human cost group (loss of productivity, quality of life, medical costs, emergency
medical service costs, long-term costs, etc) 2) The damaged property cost group (vehicle and other
properties damages). 3) The crash cost group (management expenditure of insurance companies,
police, courts, rescue services and the delay of transportation). The loss value for 2004 was also
recalculated to values for fatality of 63,317 million Baht, for severe injury 58,963 million Baht and for
slight injury 1,299 million Baht for 2011 by adjusting for inflation (increasing by 25 %).
4
Another question is whether the same value should be used for different injuries; some studies have found
different values depending on the context (e.g. Savage, 1993; Jones-Lee and Loomes, 1995; Hammitt and Liu,
2004; Carlsson et al., 2010). However, this problem has not been taken into account in this study.
12. 12
4. The Model
We have chosen logistic regressions because of the structure with binary dependent variables. The
problem is choosing how to find a model that both best fits the data and performs well in calculating
the marginal effects of a change in response time that is true for all dispatches. For an example of
how this can be discussed, let us look at the relation between response time and deaths in traffic
accidents in figure 2. Since there seems to be no change in deaths after about 25 minutes, one
choice of model is to restrict the data to only those dispatches where the response time is less than
or equal to 25 minutes. The problem with such a model is that it will predict a much higher
proportion of deaths above 25 minutes than is reasonable according to the data. Consider figure 2
where we can see that about 5.5 % deaths is reasonable for a response time of 40 minutes.
However, a logistic regression model that is restricted to less than 25 minutes would predict this to
be about 40 %. Another suggestion is to choose something like a moving average logistic regression
model, where the first model includes only data for 1 to 5 minutes, the second from 2 to 6 minutes,
the third from 3 to 7 minutes and so forth. Predictions and marginal effects are then calculated for 3
minutes for the first model, 4 minutes for the second model and so forth. Such a model fits the data
much better, but is not very general of course since it has different parameter values for each
minute of response time. Yet another alternative is to try to include as many data points as possible.
This is used here and all response times including median time + one standard deviation are
included. All three models are shown in figures 3 (predictions of proportions of deaths) and 4
(marginal effects).
What we are after is a value for a change of one minute in response time for an average dispatch.
Here, we use the model with the median + 1 standard deviation for response time included, even if
it does not fit the data perfectly. However, choosing one of the other two models would result in
much too high a marginal effect for an average dispatch. The models thus contain response times up
to 249 minutes and operational times up to 313 minutes. Since the relation between the outcome
and the response time seems to be somewhat different, depending on the case of the emergency,
we have chosen to perform different statistical analyses for each case of emergency (traffic
accidents, medical emergency, physical trauma and others).
0
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
0 5 10 15 20 25 30
Proportiondead
Response time, min
Pred value moving average
Pred value response time
<=249min
Pred value response time
<=25 min
Figure 3. Relation between response time and predicted proportion of deaths using different models.
13. 13
-0.003
-0.002
-0.001
0
0.001
0.002
0.003
0.004
0.005
0.006
0.007
0 5 10 15 20 25 30
Proportiondead
Response time, min
Marg eff moving average
Marg eff response time
<=249 min
Marg eff response time
<=25 min
Figure 4. Relation between response time and marginal effect for proportion of deaths using different
models.
14. 14
5. Results
Since the dependent variables have been set to be binary, logit regression analyses have been used
to find out the relation between the independent variables, response time and operational time, and
the dependent variable. The parameter estimates for the independent variables are recalculated
into marginal effects, which show how much the risk of fatality, severe injury and slight injury
changes when the time variable is changed by one minute.
The analyses have thus proceeded in three steps. First, logistic regression models have been used to
find parameter estimates for how the time variables affect the three injury types (equation 1).
Equation 1 has been estimated for each injury and emergency type, and for response and
operational time respectively, that is 3*4*2=24 models have been estimated.
*
*
( ) Prob( 1)
1
TIME
TIME
e
E Y Y
e
(1)
Second, since the model is nonlinear the parameter estimates have been recalculated into marginal
effects (equation 2). The marginal effects are evaluated at the median response and operational
time.5
*
* 2
( )
Marginal effect=
(1 )
TIME
TIME
E Y e
TIME e
(2)
The marginal effects for response time are presented in table 3. They are higher for severe injury
than for fatalities, meaning that a marginal decrease of response time leads to more people saved
from severe injury than from fatality. For fatality the marginal effect is highest for traffic accidents,
while for severe injury it is highest for others followed by medical emergency. For slight injuries the
marginal effects are negative and will therefore not be used in the next step. For operational time
(not showed here) the marginal effects are lower than for response time, indicating that there is a
decreasing marginal value of time, since operational time is longer than response time.
Third, the marginal effects have been recalculated into number of persons affected by a minute
change in response and operational time in one year (equation 3), as presented in table 4 and 5. If
the marginal effect is not statistically significant or negative, the value is set to zero.
*
* 2
( )
Marginal effect in one year= * *
(1 )
TIME
TIME
E Y e
n n
TIME e
, (3)
where n is equal to total number of responses in one year for each emergency type. A one-minute
change would save most people from fatality when it comes to traffic accidents. For severe injuries a
one-minute change would save most in the treatment group others, followed by medical
emergency.
Fourth, the monetary values have been summed up in Thai baht, ฿, for one year, for each
emergency type and totally for all emergency responses. Using the monetary values of lives and
5
Normally marginal effects are evaluated at the sample means of the data or the sample averages of the
individual marginal effects are used (Greene 2008). However, since the median in the sample used here better
describes the typical response and operation time than the mean value does, the median has been used here.
15. 15
injuries, we can calculate a total value per EMS type. The results are shown in table 6. For both
response time and operational time the most important treatment type is medical emergency,
followed by traffic accident. The values for operational time are lower than the values for response
time, reflecting the decreasing marginal value of time. However, the ratio between response and
operational time differs for the different emergency types. The relative difference is smallest for
traffic accident and largest for others, and about 1/2 for the total emergencies. Different ambulance
types have different marginal benefit values per minute. For response time, ALS has a value of 1130
Baht per minute, BLS a value of 644 baht per minute and FR a value of 445 baht per minute.
Table 3. Marginal effects and P(.) >0 results for response time evaluated at median response time
(=8 min).
Injury type /
emergency type
Physical Trauma Medical
Emergency
Traffic Accident Others
Fatality 0.0001473
(0.000)
0.0001912
(0.000)
0.0002861
(0.000)
0.0000287
(0.309)
Severe injury
0.0027129
(0.000)
0.0040699
(0.000)
0.0017932
(0.000)
0.0047531
(0.000)
Slight injury
-0.0004476
(0.000)
-0.0002977
(0.000)
-0.001437
(0.000)
-0.0003409
(0.000)
Table 4. Deaths and injuries saved per year calculated given marginal effect per minute for
response time.
Injury type / emergency type
Physical Trauma Medical
Emergency
Traffic
Accident
Others
Fatality 11.9 15.5 23.2 2.2
Severe injury 220.0 330.0 145.4 398.3
Slight injury 0 0 0 0
Number of dispatches 81101 423356 226215 18424
Table 5. Deaths and injuries saved per year calculated given marginal effect per minute for
operational time.
Injury type / emergency type
Physical Trauma Medical
Emergency
Traffic Accident Others
Fatality 8.8 8.7 17.0 -
Severe injury 88.5 109.8 51.4 136.5
Sligth injury 0 0 0 0
Number of dispatches 81101 423356 226215 18424
Table 6. Monetary value per minute and year.
Baht/Year/Minute/
emergency type
Physical Trauma Medical
Emergency
Traffic Accident Others Total
Response time
(at median 8 minutes)
฿ 135,401,000 ฿ 987,186,000 ฿ 484,352,000 ฿ 27,349,000 ฿ 1,634,289,000
Operational time
(at median 24 minutes)
฿ 76,177,000 ฿ 427,974,000 ฿ 304,957,000 ฿ 9,370,000 ฿ 818,477,000
The loss values for a one-minute improvement in the time factor for one year are calculated using
the provinces in the Narenthorn database. Eight provinces, including Bangkok, are not included in
the Narenthorn database. The number of emergency response cases in these provinces represents
16. 16
26.8% of the total number of the emergency responses in Thailand during the period considered
here. Therefore, if we were to extrapolate the loss values for the whole of Thailand we should,
therefore, increase the total loss value by dividing the study result with 73.2%.
The result of such an extrapolation for a response time is 2,232,600,000 Thai Baht and for an
operational time 1,118,100,000 Thai Baht. These figures represent the positive welfare effect, for
one year, of reducing the emergency responses in Thailand by one minute on average.
17. 17
6. Discussion and conclusion
This study shows that using a logistic regression analysis makes it possible to find a correlation
between response time and the severeness of injury. The correlation indicates that a faster response
time results in fewer fatalities and milder severeness of injury. Furthermore, the time factor is most
important for medical emergency, followed by traffic accidents and physical trauma. The results also
show that the more advanced the ambulance that is used the more important the response time is.
For operational time the correlation has the same sign, but it is not as strong as for response time,
which seems reasonable since there should be a decreasing marginal utility of time.
One limitation of the study is that the emergency response data cannot categorize permanent
disability as a final outcome; thus, the additional loss value of disability is excluded in the analysis,
and the loss value for those cases is covered under the category severe injury.
The planned investment thought of here is a better alarm system which could reduce the time from
accident or injury to dispatch of ambulance, and result in a one-minute decrease in response time. In
comparison, a study in Canada showed that the introduction of base paging reduced the call-
response interval by 30 seconds (Jermyn 2000). Considering operational time, Spaite et al. (1993)
listed several observed problems on-scene, for example with communication, equipment and
uncooperative patients. Most of the time was concerned primarily with logistics and not with
medical care, and operation problems occurred in more than 40 % of the dispatches. Another way to
decrease time is to enforce a single alarm number in Thailand (as in the EU, 112, or North America,
911) instead of the different numbers to police, fire and rescue services and emergency response,
together with dialling directly to hospitals for ambulances. Thus, there seems to be possibilities for
increased effectiveness. However, high speed driving could perhaps be the solution to faster
response time in rural areas (Petzäll et al. 2011), but probably not in populated areas; and using
lights and sirens when driving ambulances has both pros and cons such as high risk of crashes
(Lemonick, 2009; see also Salvucci et al., 2004).
Assume that an investment could be made, one which could decrease the response time and
operational time by one minute: for example, a new call taking and dispatch system with a
technology life of 20 years. Using the results of this study, the present value of the benefits of such
an investment is between 12.8 and 25.6 billion Thai Baht, assuming a social interest rate of 6 %.
18. 18
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