Strategies for scarcity: how emergency services provide care when demand exceeds supply
Charlotte Boin, Adriëlle de HaanPurpose
Emergency services often find themselves without the time, personnel and resources they need to provide the care they wish to. Such situations of scarcity are likely to grow more common due to increasing demand and pressures on recruitment and retention. But existing research into how emergency services cope with resource constraints during incidents is fragmented and focused almost entirely on the medical sector. This article provides a framework of the ways in which emergency services more broadly (police, fire, ambulance, military) cope with resource insufficiency. It answers the question: How do emergency services adjust their emergency response in situations of scarcity?
Design/methodology/approach
This research takes an abductive approach, combining insights from the literature with interviews with first responders across seven Dutch emergency services (N = 16) as well as four focus groups (N = 21), participant observations, and an analysis of incident logs.
Findings
Emergency services respond to excess demand by adjusting their emergency response. We identify seven ways in which they do so. Emergency services adjust the supply of help by expanding capacity, increasing efficiency, decreasing standards of care and/or prioritising. Emergency services manage the demand on their services by filtering incoming requests, calling on citizens to reduce risky behaviour and/or investing in citizens' self-reliance and resilience. Overall, findings from the medical sector translate well to emergency services more broadly, though important differences emerge in triage approaches and decision-making contexts.
Research limitations/implications
The research's generalisability may be limited by its focus on the Netherlands, and findings may suffer from the limited number of respondents per organisation and a dependence on respondents' retroactive reporting of decision-making.
Practical implications
This research provides emergency managers with a practical overview of their strategic options in situations of scarcity, allowing them to choose between supply-side and demand-side responses.
Originality/value
This article proposes a categorisation of the different ways in which emergency services cope with scarcity during incidents, moving beyond the current predominant focus on the medical sector and drawing attention to the ways in which emergency services attempt to manage the demand for their services, rather than just adjusting supply.