Evaluating emergency service response to COVID-19: A scoping review.

INTRODUCTION: The issue of how emergency services (police, fire, ambulance, local authorities) respond to pandemics has received greater research focus recently in relation to the COVID-19 outbreak, which saw agencies going beyond usual roles to support communities for prolonged periods. A critical appraisal is needed of this published evidence to take stock of what is known about the effectiveness of emergency service response to Covid-19. METHOD: A scoping review of scientific and grey literature identified 17 qualitative (N = 9), quantitative (N = 6), or mixed methods (N = 2) studies from across the UK and internationally that focus on the effectiveness of emergency service response to the Covid-19 outbreak. A narrative review was conducted using an interpretive approach. Papers were read, summarised, and then sorted into inductive themes that addressed some aspect of the review question. Eight critical themes emerged from the narrative review. RESULTS: Across countries, emergency services were required to quickly adapt working practices to reduce spread of infection, support partner agencies facing unprecedented demands, and make effective use of limited resources. Use of technology, access to timely, accurate and relevant information, strong leadership, prior experience, and emergency training were critical to this. However, most research is descriptive rather than evaluative. CONCLUSIONS: Overall, findings highlight the need for further research that examines what mechanisms facilitate and hinder emergency response to pandemics. This scoping review provides a knowledge framework for informing future research that can support emergency services in preparing for events of national and international significance.

Hazardous, harmful, and dependent alcohol use in healthcare professionals: a systematic review and meta-analysis.

Background: Healthcare professionals work in high-pressured and demanding environments, which has been linked to the use of alcohol as a coping strategy. This international review aimed (i) to determine the pooled prevalence of hazardous, harmful, dependent, and frequent binge drinking in healthcare professionals, and (ii) to explore factors associated with variation in these outcomes. Methods: Scopus, MEDLINE, and PsycINFO were searched from 2003 to 17th November 2022, for studies reporting a prevalence estimate for any outcome among healthcare professionals. Random-effects meta-analyses determined pooled prevalence estimates. Sub-group analyses were conducted, stratifying the meta-analyses by pandemic period vs pre-pandemic period. Meta-regressions explored factors that were associated with variation in the outcomes. PROSPERO (CRD42020173119). Results: After screening 9,108 records, 64 studies were identified as eligible. The pooled prevalence was 19.98% [95% Confidence Intervals [CI]: 16.05-24.23%] for hazardous alcohol use (K = 52), 3.17% [95% CI: 0.95-6.58%] for harmful drinking (K = 8), 14.59% [95% CI: 7.16-25.05%] for dependent drinking (K = 7), and 17.71% [95% CI: 8.34-29.63%] for frequent binge drinking (K = 11). The prevalence of hazardous drinking was greater during the pandemic (28.19%) compared with pre-pandemic estimates (17.95%), though this was not statistically significant (p = 0.049). Studies including all hospital staff (32.04%) showed higher prevalence estimates for hazardous drinking compared with studies of doctors (16.78%) and nurses (27.02%). Conclusion: Approximately one fifth of healthcare professionals drink to hazardous levels, with higher prevalence estimates observed during the COVID-19 pandemic. It may be that healthcare professionals used alcohol to cope with the additional trauma and stressors. Further research is needed to investigate whether this is sustained in the post-pandemic period.

Cost-benefit analysis of partnership working between fire and rescue and health services across England and Wales during the COVID-19 pandemic.

OBJECTIVES: Fire and rescue services undertook a range of additional activities to support the National Health Service (NHS) in managing extreme service demand during the COVID-19 pandemic. This study aims to examine the cost-benefit of partnership work between fire and rescue services and the NHS during the COVID-19 pandemic. SETTING: England and Wales. DESIGN: A cost-benefit approach was used. Data relating to resources and outcomes was accessed from a National Data Portal commissioned by the National Fire Chiefs Council to record fire and rescue service responses throughout the pandemic. Literature-based economic estimates were applied to establish the potential cost-benefit of fire and rescue services undertaking support activities. RESULTS: Fire and rescue services commonly undertook eight activities to support ambulance services and hospitals in three key areas: (1) driving ambulances, (2) provision of personal protective equipment for healthcare workers and (3) mass testing and mass vaccination. Benefits outweighed costs for all activities. Total costs were estimated at £93.26 million and total benefits were between £171.46 million and £1.10 billion. CONCLUSIONS: This is the first economic evaluation of partnership working between fire and rescue and health services during a pandemic. Findings highlight the social and economic value of co-operation between fire and rescue services and the NHS and provides important evidence for informing public sector decisions regarding the allocation of resources in future public health crises.

"Dare to Share": Improving Information Sharing and Risk Assessment in Multiteam Systems Managing Offender Probation.

Managing offenders released from prison requires a multiteam system (MTS) approach, with teams from across police, probation, and other criminal justice agencies. However, public inquiries highlight current approaches are impaired by poor information sharing that compromises risk assessment and recall decisions, which can allow serious further offences to occur. Little research has focused on the causes of these information sharing difficulties. The current study draws on the perspectives and experiences of probation and police officers to improve understanding of causes of information sharing difficulties. The research is conducted within the context of a new enhanced information sharing 'Direct Access' initiative implemented in one region of the UK (Devon and Cornwall) that permits probation to directly access police information technology systems. This provides a novel opportunity to cross validate MTS theory to the real-world context of offender management and considers what works in practise to overcome information sharing challenges. Eleven semi-structured interviews were conducted with police (N = 4) and probation (N = 7) officers. Thematic analysis revealed six themes: i) information sharing difficulties and impact; ii) causes of information sharing difficulties; iii) impact of 'Direct Access' on information sharing practices; iv) workload inequality; v) training; and vi) evolution of 'Direct Access'. Overall, findings highlight that information sharing difficulties are causes by not knowing what information to request or share, limited resources, lack of clarity about General Data Protection Regulation and concern about consequences of breaching this. These barriers can result in delays and failures to share information, which hinders the accuracy of risk assessments and ability to safeguard. Findings also highlight that providing statutory partners with 'Direct Access' to I.T systems can improve the relevance and timeliness of information. However, 'daring to share' is not enough to address trust issues without also clarifying expectations regarding information use and perceived workload inequalities.

Rapid Evidence Assessment of Mental Health Outcomes of Pandemics for Health Care Workers: Implications for the Covid-19 Pandemic.

Background: Little is known about the long-term mental health (MH) impact of the Covid-19 pandemic on health care workers (HCWs). However, synthesizing knowledge from past pandemics can help to anticipate this, along with identifying interventions required, when, and target populations most in need. This paper provides a balanced evaluation of what is currently known about short- and long-term MH impacts of pandemics on HCWs and effect of methodological limitations on knowledge claims. Method: A rapid evidence assessment (REA) was conducted on 41 studies published in the past two decades that examined MH outcomes for HCWs in relation to pandemics. Results: Findings of literary synthesis highlight common MH outcomes across pandemics, including increased stress, distress, burnout, and anxiety in the short-term, and post-traumatic stress and depression in the long-term. Findings also show the key role that organizations and public health bodies play in promoting adaptive coping and reducing health worries and the emotional and psychological distress caused by this. Evidence highlights particular groups at risk of developing MH issues (contact with patients that are infected, having children), and time points where risk may increase (initial response phase, when quarantined). However, inconsistencies in measures, analysis, and reporting all create limitations for pooling data. Conclusions: Findings can be used by researchers to provide a knowledge framework to inform future research that will assist HCWs in responding to pandemics, and by policy makers and service planners to provide an evidence-led brief about direction and evidence base for related policy initiatives, interventions or service programmes.

Facilitators and barriers to effective information sharing during international disaster response.

Effective information sharing is essential for the successful management of disasters. But as 30 years' worth of UK public inquiries repeatedly highlight, differences in terminology and goals across agencies can make this difficult to achieve. The growing scale and intensity of disasters raises additional challenges, with emergency responders being required to work across regions and even countries. The following study focuses on identifying facilitators and barriers to information sharing in dynamic contexts, where interdisciplinary teams from across geographic regions form ad hoc to rapidly address challenges. This case study draws on 257 naturalistic observations made by subject-matter experts during the largest disaster management exercise to take place in Europe to date. The 4-day exercise, funded by the European Commission, involved over 5,000 emergency responders from the UK, Cyprus, Hungary, and Italy, providing a unique opportunity to examine information sharing practices across international boundaries. Results of a mixed-method analysis highlight that barriers within and between countries are particularly prevalent during periods of greater uncertainty. These barriers include language and technological difficulties, differences in roles and responsibilities, and failure to co-locate and coordinate activities. Developing shared frames of reference, including adopting common structures for presenting information and understanding roles and responsibilities, facilitates information sharing, potentially reducing cognitive load. Implications for developing evidence-based approaches to disaster response are discussed.

Information sharing in interteam responses to disaster.

Research demonstrates that information sharing is facilitated by familiarity, and having a common understanding of problems, use of lexicon, and semantic meaning. These factors can be difficult to develop within extreme environments such as disasters as members of the multi-agency system that responds often have limited experience of working together. Public inquiries repeatedly highlight the impact of information sharing difficulties on public safety, but limited academic research has focused on identifying concrete behaviours that facilitate interteam information sharing within such environments. This paper presents a case study of a national disaster response exercise involving 1,000 emergency responders. Data consist of structured observations, recordings of interteam meetings, and interviews with emergency responders. Results of mixed-method analysis indicate that interteam information sharing is delayed by limited situation awareness and poor articulation. Conversely, adopting behaviours that promote common frames for understanding interteam capabilities and information requirements improves information sharing and potentially reduces cognitive effort required to process information. Findings contribute to interteam communication theory by highlighting that in complex, time-constrained environments, having a shared understanding of responsibilities and information requirement is important for minimizing redundant deliberation and improving relevance and speed. PRACTITIONER POINTS: Facilitating the exchange and interpretation of relevant information is important for improving situation assessment, decision-making, and the implementation of appropriate actions for addressing risks.Interteam information sharing can be particularly challenging when teams are comprised of members from across different organizations with different language and cultures that must form ad hoc to rapidly respond to problems in extreme environments.Adopting communication strategies that develop common frames-of-reference can facilitate information sharing and interteam responses to disasters.

A taxonomy of endogenous and exogenous uncertainty in high-risk, high-impact contexts.

By reference to a live hostage negotiation exercise, this study presents a taxonomy of uncertainty that can be usefully applied to assist in the categorization and application of findings from decision-making research conducted in naturalistic (specifically critical incident) settings. Uncertainty was measured via observational methods (during the exercise and by reference to video footage), decision logs, and postincident simulated recall interviews with trainee police officers. Transcripts were coded and analyzed thematically. Uncertainty was dichotomized as deriving from either endogenous sources (about the problem situation itself) or exogenous sources (about the operating system that is dealing with the incident). Overall, exogenous uncertainty (75%) was more prevalent than endogenous uncertainty (25%), specifically during discussions on plan formulation and execution. It was also qualitatively associated with poor role understanding and trust. Endogenous uncertainty was more prevalent during discussions on situation assessment and plan formulation. The taxonomy provides a useful way for organizational researchers to categorize uncertainty during the naturalistic observations of workplace interactions and decision making. It reduces the complexity associated with observational research to allow organizational psychologists to better tailor their recommendations for reducing uncertainty. Dealing with endogenous uncertainties would entail targeting decision making specific to the problem incident (e.g., introduce training or policy to reduce redundant fixation on rote-repetitive superordinate goals and focus on more short-term actionable goals during situation assessments). Dealing with exogenous uncertainties would entail improving decision making relating to management and team processes across critical incidents (e.g., training to clarify distributed roles in critical incident teams to aid plan formulation and execution). Organizational researchers interested in uncertainty management in the workplace should utilize this taxonomy as a guide to (a) categorize uncertainty and (b) generate applicable recommendations from their findings.

When do we believe experts? The power of the unorthodox view.

This paper examines the extent to which orthodoxy (degree of typicality) and congruence (degree of similarity with own opinion) mediate the influence of expert advice on decision makers' judgments. Overall, 227 members of the public and 60 police officers completed an online questionnaire involving an investigation into a child sex offence. Participants were asked to first (i) formulate their own "profile" of a likely offender then (ii) estimate the guilt of two presented suspect descriptions (orthodox vs. unorthodox), and, following the presentation of an "expert's" profile that matched either the orthodox or the unorthodox suspect, (iii) re-evaluate their guilt judgments of the two suspects based on this new advice. Finally, (iv) the perceived similarity (congruence) between the participants' own and the expert profile was assessed. Results revealed two key findings. First, expert profiles that matched a suspect's description elevated perceptions of guilt in that suspect, whilst also, simultaneously, very significantly decreasing the perception of guilt of the alternative suspect. This suggests a powerful rejection and downward revision of the other suspect. Second, perceived similarity of the profile (to one's own profile) was only a significant factor in increasing guilt judgments when assigning guilt to the unorthodox (as opposed to orthodox) suspect. Comparisons of lay judgments with those of police officers revealed few significant differences in effects. The finding that advice is most influential when unorthodox and incongruent suggests that decision makers are more likely to reevaluate judgments when expert advice contributes novel information that contradicts their beliefs. The practical implications of these findings are discussed for profilers, police, and decision research in general.