Introduction

The success of any organisation solemnly depends on how effective or ineffective their strategic marketing is. Strategic marketing can be defined as the analysis, actions and decisions made by an organisation aimed at creating and sustaining itself an acquire competitive advantage. An organisations strategic marketing encompasses the company visons, missions and strategic objectives. In addition, the environment in which an organization operates- the internal and external environment is crucial for an organization’s strategic management. Often strategic management asks questions that answer questions depending on the analysis done and depending on the decisions needed in terms of which industries to compete in and how they should maintain their competition levels from immediate competitors. The company, together with the management leaders should allocate resources that include finances, time and labour while developing an effective strategy. The development of an effective strategy will create room for the implementation of effective strategies and has been identified as an ongoing, evolving process by strategic managers.  Advancement in technology has attracted investors and customers to diversify their businesses and organizations into international markets. Working with consultancy firms essential for companies that wish t branch into unknown global markets and conduct primary research before entry. The Ashanti Marketing Solutions (AMS) Limited is a marketing consultancy firm based in Europe. Gregg remains to be the finest bakers in Europe and recently wishes to diverse into Romania. This paper is a strategic marketing report of Greggs Inc. that aims to evaluate their sustainable market capabilities through the use of business marketing tools that include PESTLE and Porters Five Forces analysis. Also effective recommendations that can improve the organisations competitive advantage in Romania.
 

Company Background

Gregg’s inception occurred in the 1930s where the Company focused on delivering eggs and years on a bike to families in New Castle upon Tyne. Jon Gregg, the company founder, opened a small bakery shop in New Castle on Gosforth high street in 1951, following positive feedback from his immediate customers. Through this single shop, Jon Gregg’s popularity grew from baking high quality bread from finely milled wheat which gave his products a distinctive sense of taste and texture. The Company’s expansion began in 1984 after John Gregg’s death, and Ian Gregg took over the business.  The Company expanded to up to 5 shops within the nearby regions. Ian oversaw the Company through to the 21^st century (Greggs, 2021). In the 1970s, Ian further expanded the business beyond northern England, and by 1974, Gregg had acquired properties across different regions (About Gregg, 2012). The management switch hands in 1984 with Mike Darington as the managing director. Mike shared the company mission and visions and further expanded the business by opening 260 within two decades. Gregg was listed on the stock exchange and has continued to depict immense expansion in the midlands. And in North London (Greggs, 2021). Today the Company has over 1600 stores globally and aims at launching 600 more stores within the next few years. Notably, the Company achieved revenues of 734.5 million in 2012 (Greggs, 2021). The Company’s operating profit also increased to 51.8 million in 2012. The Company has tried to enter into new foreign markets such as Belgium, which closed down following their considerable concentrations in the UK market.  Recently, the Company seeks to enter Romania, and this report will provide a strategic external analysis using Porter Five Analysis and the Pestle analysis business tools.

Objectives of the Report

This report aims at understanding the external and internal factors that go into launching a business in a foreign country. It also explores the various decision that is of primary concern that the business should consider before making this decision. A marketing segmentation research will be conducted to determine the appropriate marketing mix for Gregg’s entry into Romania.

Entry into new markets

Over the past years, Gregg has tried severally to entrant foreign markets. Some of these entrants have proven successful, while others have been deemed disappointing. The first time Gregg expanded into international markets was when they opened a market in Belgium. However, the stores were closed down following high competition levels and lack of a strategic management strategy. Gregg aims to look back at their failures and venture into a new market, Romania, Europe. Greggs Inc. There are various reasons why a company chooses to branch into other markets locally and internationally, thereby increasing their increasing company growth, increasing their customer base, reducing labor costs, and gaining a competitive advantage are some of the key concerns. According to Greggs Chief Executive Ken McMeikan, “Over the past two years particularly, I’ve been travelling to different parts of the world and trying to look at the countries where I believe there is demand from a customer base in terms of their tastes, and also maybe where there is a competitive opportunity for us to go into those countries.”. Therefore, depending on the market, these factors should be of primary concern before the Company decides to venture into European markets by conducting business analysis tools to determine whether or not Greggs can venture into the country.

Business analysis

Pestle analysis

Organizations need to identify external factors within which the Company operates because it provides and forms a context in which events such as procurement, production, and marketing are based. According to Al-Turki, (2011), a pestle analysis evaluates a companys impact over a range of six external factors which include the Political, Economic, Social, Technological, Environmental, and Legal Issues. However, it is unfortunate that organisations have no control over these factors, yet it affects a business’s operations. The pestle analysis is a fundamental requirement during marketing and entry into the foreign market because it exposes the opportunities that the company might take advantage of as well as identify possible threats that the company needs to be on the lookout. Moreover, a detailed pestle analysis will assist the organisation to develop and set clear goals and objectives that will simplify ensure efficiency when tracking and monitoring a firm.

Political factors

These are the political factors that an organization needs to consider before setting up a business in another country. These include factors such as government policy, trade policy, and politics. Generally, Romani has been recognized as a peaceful country free from terrorism threats and political instability (OECD, 2002). This environment will offer Gregg Inc an environment to set up and conduct business in a foreign land. In addition, the peaceful nature of the Company will create a space where customers can freely purchase their bakery goods and services from the store. The government also supports and encourages new entrants into the market because it positively supports the country’s economy. Therefore, the political analysis promotes easy entry into Romania.

Economic factors

These are the factors that define how profitable an organisation will be in international markets. These include factors such as inflation, growth of the domestic product, inflation, among others. For Gregg Inc., Foreign direct investments will pose a huge challenge especially if Romania’s policies are strict. The existing European laws favour direct investments since they are free from business regulations which could potentially discourage potential investors into the country (ITA, 2020). Europeans’ Foreign direct investments are protected by legal frameworks which permits transactions through Foreign Trade and Payment Acts. The policies chaperon all businesses, including industries in the bakery and produce industry. However, Romania’s economy has been on a surge over the past few years. In 2017, the country recorded a 7% growth rate in their GDP (ITA, 2020). This will favor Greggs Inc because the Company will be established in a country whereby growth is expected.

Social factors

These are the day-to-day factors that promote the development of an organization. The social factors comprise religion, education, culture, population, among others. Most Romanians are Christians, which means that there are no religious factors that could affect business. The country’s population growth rate has continued to grow over the years, meaning that the region provides a great customer base for their products and services (Chief’s pencil, 2020). According to (Gregg, 2020), Roman’s cuisine includes starters, main course, and dessert. It is widely known that people from Romain consume food depending on their social status, although they majorly have three meals a day. The tenaculum, the prandium, and Cena taken in the morning, midmorning, and afternoon. However, it is true that Romanians do not prefer sausages; hence should not be added to the Greggs. Inc menu rather focuses on incorporating the foods and snacks that individuals from Romania will enjoy, such as Sandwiches and soups (Chief’s pencil, 2020). Additionally, the products’ affordability will be another factor that will play a huge role in attracting and retaining customers in Germany. Although the nature and scope of the market competition are high, the Company should remain adept at providing goods and services that will attract and retain more customers, which will gain the Company a competitive advantage.

Technology factors

These are the factors that affect how innovation will affect a company. Gregg Inc should incorporate innovation strategies that will gain them a competitive advantage. These include developments such as company drive-throughs. These have ensured that individuals can get their meals, snacks, and drinks without necessarily getting into the store. In addition, there are delivery services that have industrialized this sector over the past years, which has increased sales for various companies within the country. Gregg should attract customers through the use of various social media platforms, Facebook, Instagram, and Twitter, to gain more customers. The Company could also develop customization strategies for major events such as Halloween and Christmas packages to attract more customers to their Company.

Legal Factors

These are the external factors that affect how a business operates and how customers behave. Some of the legal factors that Greggs. Inc should consider include adherence to consumer law, employment law, health and safety laws, clean neighbourhood and environment law and food safety laws in accordance to the Romanian Government.

Environmental factors.

These factors adhere to the policies that adhere to the set principle and regulations within a certain country. Greggs should ensure that their Company adheres to the Romanian government laws and regulations to prevent potential problems for the Company. Also, opening stores at equally and busy places and providing affordable and tasty meals will increase the Company’s competitive advantage.

Justification of Entry in the International Market

The success of any organisation across foreign markets depends on their preferred mode of entry. Focusing on Greggs Inc main line of business, the products and services they will venture with include, but not limited to Sandwiches, cakes and pastries, sweet snacks and the newly launched vegan products. These are the main products that the company seeks to launch in the country following their pre-determined possibility of gaining competitive advantage in the country. Although high competition is expected, the company will penetrate through the industry successfully, guided by the unique taste of their products and their outstanding services.
When an organisation has made the decision to venture into foreign markets, there are a variety of options that the company can use. The options vary on costs, risks and the locus of control that can be exercised over them. Simple forms of foreign market entry include exporting products using either direct or indirect means as such as an agent and countertrading. According to (NAME) these market strategies best work with companies dealing with non-perishable products. Thus, Greggs Inc. should not consider this because they produce perishable bakery products. Besides exporting, other market entry strategies include licencing, joint ventures, partnerships and alliances, mergers and acquisitions.  These are some of the strategies that Gregg Inc. that may incorporate when venturing into Romania; a foreign market.
. For Greggs Inc, forming partnerships and alliances will ensure successful penetration into foreign markets. This will in turn promote competitive advantage for the company over other businesses in the sector. Greggs Inc. will target a local bakery that is well versatile and understands the needs of their consumers promptly. Also, strategic alliances will ensure that all contractual agreements between Greggs Inc and a Romanian based company are well understood prior to making and agreements. Understanding partnerships is also important for companies because they will determine the future growth or the company (Maekelburger et al., 2012, 458).  Also, the local partner should be aware of the market trends and population that will help the business. Therefore, getting a local partner will yield more advantages for Gregg Inc.
According to Eurostat (2019), Romania is expected to record a 2% increase in total sales in the food and beverage sector by 2021. The national institute of statistics of data for 2018 explained that the total number of foodstuffs accounted for € 1794 million in terms of exports and € 3377 million in terms of imports having a trade balance of € 1583 million (Eurostat 2019). In the bakery sector, Romania recorded a turnover of € 422 million, which increased compared to 2017 reports (southeast European Industrial Market 2020). The number has increased ever since, with more advancement in technology. Besides, allying with another brand means increased consumer numbers since attracting customers will not be a challenge (E-commerce news, 2018). Contractual agreements are therefore important across major company departments, notwithstanding company rules and policies which are crucial for smooth company operations.
Another mode of entry into foreign markets are Mergers and acquisitions. This is an expensive mode of entry, yet appealing since the company gets to be in control and can easily access new markets promptly. The acquiring organization gets exposed to the market but may face challenges in case they change the method of operation. Although European laws favour company acquisition, it could be disadvantageous following the value of its currency.
Conclusively, based on the various modes of entry discussed, it is best that Greggs. Inc settles with forming strategic alliances and partnerships with another bakery company in Romania for the following reasons, First, Romania is expected to record a 2% increase in total sales in the food and beverage sector by 2021. This means that Gregg is speculated to benefit largely using another pre-exist company. Additionally, the home company is aware of local partner is aware of the market trends and population, meaning that Greggs Inc. will not start from scratch at understanding the market and the needs of their consumers. It will therefore be more appropriate for Greggs Inc to identify a company in Romania to form strategic alliances.

Standardization

Standardization is a vital element and vital when making new investments across foreign markets. The standardization process calls for prompt understanding of the 4Ps in marketing. These are Price, place, product and promotion. The 4Ps in marketing will assist organisations to understand more about their consumers interests and the amount they are willing to spend on purchasing bakery products such as a sandwich. Global standardization helps the organization understand how the customers perceive the products and services they offer. From the perception, the organization can improve the quality of the goods and the type of services they offer. For example, in e-commerce, global standardization has helped the business use similar marketing strategies over different countries with different beliefs and cultures.

Market Segmentation and Targeting

Market segmentation can be defined as the segregation of potential buyers into groups or segments based on their daily needs and how they tend to react to a marketing action. Marketing segregation allows customers to attract different consumers who have different expectations of goods and services. It was agreed that since Romania nears the UK, their taste habits should be similar. Europe is one of the highest consumers of bread globally, making in approximately 80kg per person per year. Therefore, having a concentration strategy will provide operational focus on a single familiar market, giving Gregg Inc. a competitive advantage (Dolnicar, Grun & Leisch, 2018). The Company’s target market is for all individuals across all ages, especially those between 9years to 40 eras respectively. According to (Gregg 2020), the Company strives to offer and adjust according to its customers’ demands and behaviours. Greggs Inc. can segment the Company demographically, behaviourally, geographically, or psychologically (McDonald and Dunbar, 2012). Effective market segmentation will allow a company to increase its overall efficiency by focusing on efforts that produce the highest return rate.

Porter’s Generic Strategy

Organizations operate in challenging and highly competitive business atmospheres where uncertainty about what will happen in the future. Therefore, companies must understand their strategic environment to identify their competitive environment. Gregg’s Inc. should adopt the Porters’ Generic Strategy to achieve their competitive advantage over other Romania bakeries. Porter’s generic strategy is an essential framework used by organizations when identifying potential markets; they can gain a competitive advantage. These strategies include cost leadership, Differentiation, cost focus, and differentiation focus. To effectively implement these strategies, commitment and supporting organizational arrangement are essential for an organization to achieve a complete profitability index. These strategies will be discussed in detail. (Appendix 1)

Differentiation

This strategy involves the uniqueness of a product that will allow a price premium for target consumers (Moraes, 2017). According to Peng (2014), a product’s uniqueness depends on factors such as quality, sophistication, and prestige. These factors are essential when attracting consumers willing to pay premiums, thus achieving a competitive advantage. Therefore, Greggs Inc. should consider providing target consumers with unique products that will attract consumers in Romania. However, to accomplish this, Greggs should balance both product costs and benefits relative to underlying competitors.

Cost Leadership

This is a strategy involving achieving the lowest costs in an industry to gain a competitive advantage. According to Li & Li (2008), cost leadership strategy strives to supply a standard, no-frills, high volume product at the most competitive price to customers”. For Gregg Inc, this means that the company should out from its competitors by getting cost-efficient product suppliers. This, in turn, reduces the production costs, which increases the product’s potential success that was lowly priced. There are four major cost drivers that Greggs Inc can adopt when delivering cost leadership; these include reduced input costs, economies of scale, experience, and product design. Greggs Inc. should therefore determine their most efficient cost drivers to gain significant market share and competitive advantage.

Focused Strategy

This is a strategy that revolves around creating a specific target exemplary well. Essentially, this strategy ensures that companies narrow down their target market specifically to keep up with competitors competing in broader ways (Porter, 1980). Gregg Inc should adopt this strategy by offering products and services to a particular niche at reduced prices or higher values than competitors. This is an effective strategy when implemented when the correct propositions are adopted.

Hybrid Strategy

According to Acquaah & Ardekani, (2008), a hybrid strategy is where the company can simultaneously involve cost leadership and differentiation strategies. Thus, Gregg Inc should adopt the hybrid strategy to gain and take advantage of both cost leadership and differentiation strategies.

Conclusion

Greggs is among the top bakery producers in the United Kingdom. Investing in a different country calls for stringent analysis and research concerning the people’s culture most especially when dealing with foreign markets. Departments that should be involved during this process include human resources and market departments. Human resource and marketing departments will ensure that customer satisfaction is attained, and there is maximization of profits. Besides, organisations need to ensure that their modes of entry into an international market are clear especially when dealing with a country with currency stability. Germany and Europe are some of the countries that have adopted the use of technology, therefore making the industry attractive globally. The practices and culture of the citizens in Germany have facilitated the growth of this industry. Therefore, it is evident that Investing Greggs Inc. into Romania will largely benefit the organisation.
 
 
 
 
 

References

Acquaah, M. & Ardekani, Y. (2008). Does the implementation of a combination competitive strategy yield incremental performance benefits? A new perspective from a transition economy in Sub-Saharan Africa. Journal Business Research, (61)4, p. 346-354.
About Greggs, (2012). Greggs plc. http://corporate.greggs.co.uk/aboutgreggs
Chef’s pencil. (2020). Top 10 Romanian Foods – Most Popular Dishes in Romania. Retrieved from; https://www.chefspencil.com/top-10-romanian-foods/
Dolnicar, S., Grün, B., & Leisch, F. (2018). Market segmentation analysis: understanding it, doing it, and making it useful. https://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=5471159.
E-commerce News (2018). Ecommerce in Germany – Ecommerce News. [online] Ecommerce News. Available at: https://ecommercenews.eu/ecommerce-in-europe/ecommerce-germany/ [Accessed March 12, 2021].
Eurostat. (2019). Food Manufacturing in EU regions. Retrieved from; https://ec.europa.eu/eurostat/en/web/products-eurostat-news/-/edn-20191015-1
Greggs. (2021). Strategy in Action. Retrieved from; https://corporate.greggs.co.uk/strategy/strategy-in-action
Greggs. (2021). Vison and Values. Retrieved from; https://corporate.greggs.co.uk/at-a-glance/vision-and-values
https://link.springer.com/article/10.1057/jibs.2012.12
https://onlinelibrary.wiley.com/doi/abs/10.1002/smj.804
International Trade administration (ITA) (2020). Romania – Country Commercial Guide. Retrieved from; https://www.trade.gov/knowledge-product/romania-temporary-entry
Lee, G.K. and Lieberman, M.B., 2010. Acquisition vs. internal development as modes of market entry. Strategic Management Journal, 31(2), pp.140-158.
Li, C. & Li, J. . (2008). Achieving superior Financial performance in China: Differentiation, Cost, leadership, or both? Journal of International Marketing, (3)16, pp. 1-22
Maekelburger, B., Schwens, C. and Kabst, R., 2012. Asset specificity and foreign market entry mode choice of small and medium-sized enterprises: The moderating influence of knowledge safeguards and institutional safeguards. Journal of International Business Studies, 43(5), pp.458-476.
Mcdonald, M., & Dunbar, I. (2012). Market segmentation: how to do it and how to profit from it. Chichester, John Wiley & Sons.Bottom of Form
Moraes, A.J.D. (2017). Strategic Choices and Business Strategy. Egham: Royal Holloway University of London.
Organisation for economic Co-operation and development. (OECD). 2002. Romania Enterprise Policy Performance Assessment. Retrieved from; https://www.oecd.org/countries/romania/1955188.pdf

Exercise 1: Code of Professional Ethics
Almost every professional society has developed and posted on-line its code of conduct which members of that profession are expected to follow in order to remain “members of good standing”. In this exercise, I want you to examine the code of conduct that is most closely associated with Business Management. In a 2 typewritten page review of your profession’s code of conduct (please attach the code to the exercise) I want you to examine and discuss such things as:
1.) What issues/topics are covered? Why these?
2.) What topics are not covered? Why not?
3.) What are the strengths of the code of conduct?
4.) What are the weaknesses of the code?
5.) How effective is the code in preventing misconduct? Proof?

Compare and contrast the case studies in an effort to describe highly effective organizations.
Then, assess the behavior and structure of the organizations. Explain what is effective, what is not effective, and identify specific approaches to make organizations more effective.
Use at least two credible sources
This assignment should be 1300 to 1500 words (4–5 pages) when completed.
CASE STUDY 1
At approximately 15:45 PM, Strike Team 2642 carefully navigated the one-lane gravel road that led to Rodgers Ridge, where they had been ordered to engage in some brush clearing and structural defense operations around three large vacation homes that were distributed across the ridge top. Captain Doug Chandler was leading a strike team for the first time, and he cautiously watched the two separate smoke columns that spouted from the 1600-acre Camp Creek Fire and the 2300-acre Jones Ranch Fire in the valley just beyond the ridge. For the moment, the wind was at their backs and would be pushing the fire away from the ridge.
The five units that made up Captain Chandler’s strike team were all heavy brush (HB) units, each staffed with one officer and three fire fighters and carrying 500 gallons (1892.5 liters) of water, foam, and the normal complement of tools. As they reached the large turnaround near the ridge top, the captain noted that all three homes were built within 50 ft (15.2 m) of each other, with one being the closest to the lip of the canyon, and the other two set back along a single driveway that led off the main road. At 4:20 PM, Captain Chandler ordered two of his brush units, HB26 and HB27, to proceed all the way down the driveway to the house at the end and to “prepare the residence house for defensive operations.” He sent brush units HB28 and HB29 to the two remaining houses and ordered them to prep those structures, while he stayed in a “lookout” position in HB25 near the driveway entrance.
At 4:27 PM, Captain Chandler received a call on his cell phone from the Operations Division. They informed him that the weather was due to change, and that he could expect temperatures to increase for another 30 minutes to a high of 94°F. Humidity was expected to stay extremely low, and the winds were to turn 180° by 7:00 PM. Captain Chandler in turn contacted his strike team by radio, telling them, “Strike Team 2642, all units, just be advised we’re due for a wind change.” He issued no further orders, and radio records showed that only HB26 acknowledged the message. Eighteen minutes later, at 4:45 PM, Captain Chandler in HB25 again communicated a message to his strike team: “ST 2642, all units, from my position it appears the wind has changed and may be pushing the fire toward the ridge.” This time, both HB26 and HB27 acknowledged, both with the single word “Copy.”
Just 12 minutes later, at 4:57 PM, HB26 frantically radioed that they were in danger. “HB26 and 27 here, we’ve … we’ve got lots of fire rolling toward us and it appears it’ll cut between our location and yours.” (Postincident analysis indicated the fire was moving at a speed of greater than 10 ft per second [3.1 m per second] at that point.)
As Captain Chandler attempted to radio his Operations Division for assistance, he was “walked on” by HB26, who again called out, “27 from 26 … we’re taking cover inside the house, you should follow us.”
At this point, Captain Chandler ordered HB28 and HB29 to “pull back immediately from your positions, pull back to the gravel turnaround where my rig is based.” He then radioed, “Break … HB26, what do you need?” HB26 responded, “The fire has rolled over our position … both units HB26 and HB27 are on fire. We are in the house in need of assistance.”
CASE STUDY 2
Rescue Flight Four, a Bell 430 helicopter, hammered through the hot August day, eating up the miles between its base station in the city center and the rural Cherry River, where fire crews were searching for a lost child who was believed trapped underwater. Paramedic Maria Gomez, sitting up front with Pilot Marty Chase, eyed the towering thunderclouds that appeared to grow in front of them. Frantic radio transmissions could be heard from the scene: Fire fighters in a boat, using an underwater camera, had spotted the little girl and would be deploying divers any moment. Gomez flipped the visor of her helmet up and looked over at Marty, expecting him to comment on the weather. At that very moment, Marty pulled his microphone close to his mouth and said to the medical crew, “I need your full attention here.”
Nurse Tom Polk, who was riding in the back of the aircraft preparing medical equipment, turned in his seat and stuck his head into the front compartment. Tom could see the heavy rain falling from the clouds, and he also could hear the ground crews as they prepared to attempt a rescue. The pressure was on.
Marty spoke up, “I can divert around to the west of these squalls, but it will take an extra 10 to 12 minutes. Alternatively, we can turn around and tell the ground crews to transport by ground.”
Gomez looked at Polk, who had far more airborne experience. Polk said, “Let’s try going around, Marty, and if you see anything at all that makes you worried, abort and we’ll let the fire fighters know immediately.”
Marty then restated to the crew his intentions. “We’re going to try an approach that diverts us to the west. If any of you gets uncomfortable, or if you think it’s going to take too long and we should advise them to go by ground, speak up.” Gomez gave the ground crews the new updated estimated arrival time, and Marty banked the aircraft to the left. Thankfully, the crew was able to skirt the storm, and 20 minutes after taking off from their hospital base, the big 430 settled onto the grass near a large camping area.
Gomez and Polk with their medical equipment bags stepped from the helicopter moments after it touched down. Both crouched low and hurried toward the group of fire fighters who were working near the bank of the Cherry River. Gomez, who also worked as a fire fighter/paramedic in the city where the aircraft was based, noticed that none of the local fire fighters working next to the river were wearing personal flotation devices (PFDs). She knew that at the agency where she worked, PFDs were standard safety equipment for anyone working near a body of water. Glancing over at the fire department pickup that had towed the boat to the scene, she noted several PFDs stored in the pickup bed. Before she could say anything to the incident commander, however, the little girl was pulled from the water and placed into the boat.
Thirty minutes earlier, three-year-old Susie Bailey had slipped away from her family, who had been seated at a nearby picnic table. After searching for a few minutes, the family called the local fire department, who responded with their water rescue team.
Paramedic Gomez and Nurse Polk started resuscitative efforts the moment Susie was removed from the boat. After they placed a breathing tube in her trachea and started CPR, they moved Susie to the aircraft for the return trip to Samaritan Trauma Center.
As Rescue Flight Four landed on the helipad at Samaritan Trauma Center, the flight crew was met by a team from Samaritan’s emergency department. During the short flight, Nurse Polk and Paramedic Gomez had been able to restore Susie’s pulse, but the little girl had not yet started breathing on her own. With Polk managing the airway and Gomez stabilizing the intravenous lines they had started, Susie was wheeled into the brightly lit trauma bay.
As the flight crew handed off care of their patient, they watched the highly trained physician and nursing team go to work. Even though every movement looked well choreographed, Polk and Gomez could see that Susie’s cardiac rhythm was starting to falter. Several minutes went by as the flight crew stood on the side watching a medical resident and the attending pediatric emergency medicine physician continue the resuscitation.
Paramedic Gomez then observed that the patient’s abdomen was distended, and she turned to comment about it to Nurse Polk. However, Nurse Polk had left the trauma bay, and the physician team continued to work. Gomez then leaned in and mentioned the distended abdomen to the nurse taking notes. Her concern was that the decrease in ventilatory capacity caused by a distended abdomen could make the child retain carbon dioxide, creating an acidosis that could cause cardiac problems.
However, even after Gomez’s comments, the recording nurse remained silent, unwilling to challenge a doctor. After several minutes Paramedic Gomez spoke up and mentioned the distended abdomen to the attending physician, suggesting that decompressing the abdomen might help. A quick assessment by the trauma team revealed a high carbon dioxide level and a low pH. The medical team decompressed the stomach, ventilations became easier, and the cardiac rhythm stabilized. However, Susie died a day later from complications.
CASE STUDY 3
Scenario A
In a large California city, Engine 38 turned onto Bay View Boulevard with its siren blaring. Fire Fighter Andrea Collins looked across the cab at Fire Fighter Ian Ainoa and noticed that he had not fastened his seat belt. She wondered whether to say something to him. Ian was far more experienced than she was and had been working the busy Engine 38 for seven years. Andrea was a “newbie,” and this was her first shift working at the busiest and most decorated station in the department.
Scenario B
Paramedics Gill Pryor and Mandy Humphrey, working for an urban EMS program in Florida, arrived on scene at Crescent Bay Park, where a 26-year-old woman lay unconscious on the boat dock. Patient Karli Kumar had just been pulled off of a ski boat. Fifteen minutes earlier, she had been struck by another boat while water skiing, and she had suffered a serious head injury. Gill noted that the local fire service was already on scene, and they had started preparing to intubate Karli using paralytic medications. As Gill walked up to the patient’s side, the fire medic handed Gill a syringe and said “Push the meds. We are ready with the tube.” Gill cleaned off the intravenous port and started administering the medication, all the while wondering what exactly was in the syringe.
Scenario C
Captain Ronald Goldhaber walked the one block from where his crew had parked their ladder truck to the scene of the fire in a suburban Oregon town. Three stores at the east end of the 10-year-old strip mall were fully involved, with fire pushing out the large front windows. The next exposure was a large jewelry store, and Goldhaber’s four-person crew from Ladder 7 had just been ordered to vertically ventilate that particular store. Goldhaber noted that the fire had not yet penetrated the wall separating this store from its neighbors, but there was a considerable amount of black smoke pushing hard from under the front eaves. Captain Goldhaber turned to his most experienced fire fighter, Ted Hackman, and asked him what he thought of the order they had just been given. In the postincident investigative notes, Goldhaber reported that Fire Fighter Hackman had simply rolled his eyes and said nothing. In those same notes, Hackman said that he “knew this was a bad situation,” but didn’t say anything because “I’m just the fire fighter.”
After Ladder 7 climbed onto the roof from the rear of the building, the truss structures in the involved stores failed, pulling the wall of the jewelry store down and subsequently collapsing the jewelry store roof. Miraculously, the roof failed in a rearward direction, and the crew from Ladder 7 literally slid into the parking lot with minor injuries.

Is there a health-related cause that the Bill and Melinda Gates Foundation is not currently covering that you would like to see included?
Introduction
The Bill and Melinda Gates Foundation is a private foundation that was started in the year 2000. The foundation was started by former Microsoft chairman and founder Bill Gates and the wife Melinda Gates and was previously known as William H. Gates Foundation. The foundation is guided by their vision “every life has equal value” where they strive to make people live productive and healthy lives. The foundation has made an impact in developing countries especially in Africa where health programs have been funded to fight tropical diseases like malaria. The foundation has also funded the research for finding a vaccine for the novel corona virus (Mandal, 2020).
Global Health Organizations
Global health challenges require partnership between governments and private organizations in order to fight such challenges. International organizations have assisted in funding health programs that has ensured the success of health programs. According to Anbazhagan and Anbazhagan (2016) NGOs can work with international agencies and institutions to fund, implement and evaluate health programs. The Bill and Melinda Gates Foundation is one organization that has thrived in funding health programs that have been beneficial for populations. The foundation is the largest private foundation in the world started by Bill and Melinda Gates. The recent novel corona virus that has disrupted the lives of people globally has had adverse effects when it comes to health and health care. The Bill and Melinda Gates Foundation have committed more than $350 million towards the fight of the virus. According to Mandal (2000) some of the funding is being used to find a potential vaccine.
Conclusion
International organizations play an important role in dealing with the challenges of global health. These organizations provide funding and the resources needed when it comes to addressing global health challenges. It is through these organizations that health programs are able to run professional leading to success of global health programs.
References
Anbazhagan, Suguna & Anbazhagan, Surekha. (2016). Role of non-governmental organizations in global health. International Journal of Community Medicine and Public Health. 17-22. 10.18203/2394-6040.ijcmph20151544.

Mandal Ananya. (2020). Bill and Melinda Gates fund potential vaccine against COVID-19. News Medical Life Sciences. Retrived from https://www.news-medical.net/news/20200407/Bill-and-Melinda-Gates-fund-potential-vaccine-against-COVID-19.aspx

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