RESUMO
Background: In response to climate change challenges, a main policy emphasis is on transitioning the energy system from high- to low-carbon energy supply. The German energy transition is first and foremost based on political decisions and interventions. These decisions need to be assessed ex ante to ensure a good governance approach to energy policies, for which this paper introduces the Integrated Policy Package Assessment approach (IPPA). IPPA consists of four steps: design, assessment, evaluation and discourse. Results: The results section illustrates the IPPA framework by applying it to urban passenger transport as an example case. First, the design phase was used to elaborate two complementary policy packages each consisting of several policy measures in the transformation pathways of "multi- and inter-modality", and "alternative drive". Second, the individual measures of the packages were impact-analysed by a large number of individual impact studies from various disciplines. Synthesizing the individual study results, we developed an impact assessment matrix for impact evaluation. The matrix covers the impact categories: technology development, sector integration, environment, social resonance, and institutional factors. In a further step, the key findings of the impact assessment were reflected and reviewed from the perspectives of various stakeholders and practice experts through a practice-science dialogue on transforming the urban passenger transport system. Conclusions: The discussion and conclusion sections outline the main findings relating to content and process aspects, when applying the IPPA framework to a policy package in urban transport.
RESUMO
BACKGROUND: German emergency medical services are a 2-tiered system with paramedic-staffed ambulances as the primary response, supported by prehospital emergency doctors for life-threatening conditions. As in all European health care systems, German medical practitioners are in short supply, whereas the demand for timely emergency medical care is constantly growing. In rural areas, this has led to critical delays in the provision of emergency medical care. In particular, in cases of cardiac arrest, time is of the essence because, with each passing minute, the chance of survival with good neurological outcome decreases. OBJECTIVE: The project has 4 main objectives: (1) reduce the therapy-free interval through widespread reinforcement of resuscitation skills and motivating the public to provide help (ie, bystander cardiopulmonary resuscitation), (2) provide faster professional first aid in addition to rescue services through alerting trained first aiders by mobile phone, (3) make more emergency physicians available more quickly through introducing the tele-emergency physician system, and (4) enhance emergency care through improving the cooperation between statutory health insurance on-call medical services (German: Kassenärztlicher Bereitschaftsdienst) and emergency medical services. METHODS: We will evaluate project implementation in a tripartite prospective and intervention study. First, in medical evaluation, we will assess the influences of various project measures on quality of care using multiple methods. Second, the economic evaluation will mainly focus on the valuation of inputs and outcomes of the different measures while considering various relevant indicators. Third, as part of the work and organizational analysis, we will assess important work- and occupational-related parameters, as well as network and regional indexes. RESULTS: We started the project in 2017 and will complete enrollment in 2020. We finished the preanalysis phase in September 2018. CONCLUSIONS: Overall, implementation of the project will entail realigning emergency medicine in rural areas and enhancing the quality of medical emergency care in the long term. We expect the project to lead to a measurable increase in medical laypersons' individual motivation to provide resuscitation, to strengthen resuscitation skills, and to result in medical laypersons providing first aid much more frequently. Furthermore, we intend the project to decrease the therapy-free interval in cases of cardiac arrest by dispatching first aiders via mobile phones. Previous projects in urban regions have shown that the tele-emergency physician system can provide a higher availability and quality of emergency call-outs in regular health care. We expect a closer interrelation of emergency practices of statutory health insurance physicians with the rescue service to lead to better coordination of rescue and on-call services. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/14358.
RESUMO
A major issue in all risk communication efforts is the distinction between the terms "risk" and "hazard." The potential to harm a target such as human health or the environment is normally defined as a hazard, whereas risk also encompasses the probability of exposure and the extent of damage. What can be observed again and again in risk communication processes are misunderstandings and communication gaps related to these crucial terms. We asked a sample of 53 experts from public authorities, business and industry, and environmental and consumer organizations in Germany to outline their understanding and use of these terms using both the methods of expert interviews and focus groups. The empirical study made clear that the terms risk and hazard are perceived and used very differently in risk communication depending on the perspective of the stakeholders. Several factors can be identified, such as responsibility for hazard avoidance, economic interest, or a watchdog role. Thus, communication gaps can be reduced to a four-fold problem matrix comprising a semantic, conceptual, strategic, and control problem. The empirical study made clear that risks and hazards are perceived very differently depending on the stakeholders' perspective. Their own worldviews played a major role in their specific use of the two terms hazards and risks in communication.
