Emergency services (Ambulance Service; Fire & Rescue Service) play a crucial role during flood response, as they participate in joint command-control structures and are central to rescue and relief efforts (Frost 2002). Emergency services are often legislated to meet defined response times. UK legislation requires that emergency responders comply with strict timeframes when reacting to incidents. Category 1 responders such as the Ambulance Service and the Fire & Rescue Service are required to reach 75% of 'Red 1' (high-priority, life-threatening incidents) in less than 8 and 10 minutes respectively from the time when the initial call was received. This includes blue-light incidents such as life-threatening and traumatic injury, cardiac arrest, road collisions, and individuals trapped by floodwaters. In 2015-16, only one England ambulance trust met the response time targets and 72.5% of the most serious (Red 1) calls were responded to within 8 minutes, against a legislative target of 75% (National Audit Office, 2017). Between 2007-2014, the highest percentage Scottish Ambulance Service achieved was 74.7% in 2013 (HEAT standard). Rising demand combined with inefficient call handling and dispatch systems are often cited as the reasons for missing the above targets. However, response times can also be affected by flood episodes which may limit the ability of emergency responders to navigate through a disrupted road network (as was the case during the widespread UK flooding in 2007). The impact of flooding on road networks is well known and is expected to get worse in a changing climate with more intense rainfall. For example, in Portland, USA under one climate change scenario, road closures due to flooding could increase time spent travelling by 10% (Chang et al. 2010). The impact of an increased number of flooding episodes, due to climate change, on road networks has also been modelled by for the Boston Metropolitan area, USA (Suarez et al., 2005). This study found that between 2000 and 2100 delays and trip-time losses could increase by 80% and 82% respectively. The Pitt Review (2008) suggested that some collaborative decision making during the 2007 event was hampered by insufficient preparation and a lack of information, and better planning and higher levels of protection for critical infrastructure are needed to avoid the loss of essential services such as water and power. More recently, the National Flood Resilience Review (HMG, 2016) exposes the extent to which a significant proportion of critical assets are still vulnerable to flooding in England and Wales. In particular, it highlights that the loss of infrastructure services can have significant impacts on people's health and wellbeing. This project will combine: (i) an established accessibility mapping approach; (ii) existing national flood datasets; and (iii) a locally tested, recent-expanded real-time flood nowcasting/forecasting system to generate accessibility mapping, vulnerability assessment and adaptation evaluation for various flood conditions and at both the national and city-region scale. The project will be delivered via three sequential Work Packages, including: (a) Mapping emergency service accessibility according to legislative timeframes; (b) Assessing the vulnerability of populations (care homes, hospices and schools); and (c) Evaluating adaptation strategies (e.g. positioning standby vehicles).

Since 2001 government policy has created a new set of professionals, Emergency Care Practitioners (ECPs), and a new style of urgent healthcare provision to support the vision of a healthcare service designed around the patient. ECPs are paramedics and nurses with additional training to treat patients at home, in minor injuries units or to stabilise patients for transport to specialist clinical units. Although professional training has been developed for ECPs there has been no research to look at the technologies needed to support this new role. This project is looking at emergency and urgent care work in detail. We propose that supporting technologies can be delivered as Smart Pods with three components: a vehicle/docking system, a treatment (vehicle) unit and a treatment package system (equipment and consumables). The first stage of the project is to model the operational systems to determine the distribution of the vehicle/docking systems for the Smart Pods to deliver the right care at the right time in the right place. At the same time we will be working with clinical partners in the East Midlands and South West to look at 4-6 treatment types (including chest pain, minor head injuries, minor illnesses and falls). These treatment types will be analysed in detail in A&E departments, minor injuries units and ambulance services to look for similarities and differences in clinical practice to provide the framework for the treatment packages and initial data for the layout in the treatment (vehicle) unit. We will propose a standardised pathway for the treatment types and will use a simulation mannequin to test the clinical treatment unit layout in a laboratory with doctors, nurses and ECPs.We will start working on the design of the vehicle by reviewing the current systems and looking at distribution and delivery systems in other industries, e.g. military, car breakdown services, food delivery. We will look at how new emergency care vehicles are ordered, purchased and manufactured and compare this with other low-volume vehicle manufacturing (e.g. Lotus, Maclaren) to help us develop viable solutions. This information will be used to look at both manufacturing and purchasing issues to explore if the Smart Pods concept is viable.Vehicle engineering and associated systems options will be surveyed, in particular chassis/drive chain and intelligent vehicle technologies and we will consider sustainability issues in terms of full life-cycle energy usage. Computer models and animation scenarios covering the full range of proposed SmartPod applications will be developed. The final part of this first phase of the project will start to consider issues of implementation in more depth with patient groups representing people affected by a range of urgent and emergency care conditions. We will also consult members of the lay public, clinicians, and those involved in the planning for, managing, and evaluating urgent and emergency care to investigate views on change in the provision of urgent and emergency care and to identify any unanticipated challenges (e.g. political, organisational, cultural) in implementing change.

Since 2001 government policy has created a new set of professionals, Emergency Care Practitioners (ECPs), and a new style of urgent healthcare provision to support the vision of a healthcare service designed around the patient. ECPs are paramedics and nurses with additional training to treat patients at home, in minor injuries units or to stabilise patients for transport to specialist clinical units. Although professional training has been developed for ECPs there has been no research to look at the technologies needed to support this new role. This project is looking at emergency and urgent care work in detail. We propose that supporting technologies can be delivered as Smart Pods with three components: a vehicle/docking system, a treatment (vehicle) unit and a treatment package system (equipment and consumables). The first stage of the project is to model the operational systems to determine the distribution of the vehicle/docking systems for the Smart Pods to deliver the right care at the right time in the right place. At the same time we will be working with clinical partners in the East Midlands and South West to look at 4-6 treatment types (including chest pain, minor head injuries, minor illnesses and falls). These treatment types will be analysed in detail in A&E departments, minor injuries units and ambulance services to look for similarities and differences in clinical practice to provide the framework for the treatment packages and initial data for the layout in the treatment (vehicle) unit. We will propose a standardised pathway for the treatment types and will use a simulation mannequin to test the clinical treatment unit layout in a laboratory with doctors, nurses and ECPs.We will start working on the design of the vehicle by reviewing the current systems and looking at distribution and delivery systems in other industries, e.g. military, car breakdown services, food delivery. We will look at how new emergency care vehicles are ordered, purchased and manufactured and compare this with other low-volume vehicle manufacturing (e.g. Lotus, Maclaren) to help us develop viable solutions. This information will be used to look at both manufacturing and purchasing issues to explore if the Smart Pods concept is viable.Vehicle engineering and associated systems options will be surveyed, in particular chassis/drive chain and intelligent vehicle technologies and we will consider sustainability issues in terms of full life-cycle energy usage. Computer models and animation scenarios covering the full range of proposed SmartPod applications will be developed. The final part of this first phase of the project will start to consider issues of implementation in more depth with patient groups representing people affected by a range of urgent and emergency care conditions. We will also consult members of the lay public, clinicians, and those involved in the planning for, managing, and evaluating urgent and emergency care to investigate views on change in the provision of urgent and emergency care and to identify any unanticipated challenges (e.g. political, organisational, cultural) in implementing change.