mohammadjavad moradian

Considering the challenging prehospital services given to pregnant women and the high sensitivity of this population, this qualitative study was conducted to find challenges and solutions to improve prehospital emergency services given to Iranian pregnant women in 2021.

The present qualitative study was carried out using content analysis in Fars, Bandar Abbas, and Tehran provinces, Iran during winter 2020 and spring 2021. In this research, emergency physicians, obstetricians, gynecologists, health professionals in disasters, emergency medicine specialists, midwives, and pregnant women were interviewed. The data were collected using in-depth interviews with 18 specialists and policymakers. The interviews were analyzed using thematic analysis.

The findings were divided into two groups of challenges and solutions. The challenges included five categories, namely "structural and systematic problems," "staff’s problems," "equipment's problems," "problems of pregnant women," and "traffic problems." These five categories included 19 subcategories. Moreover, the solutions consisted of five categories including "solutions for structure and system," "solutions for staff," "improvement of equipment," "reconstruction of roads," and "solutions for pregnant women's issues." The mentioned five categories consisted of 17 subcategories.

Since many health infrastructures have remained undeveloped in developing and undeveloped countries, policymakers and prehospital emergency professionals must cooperate before the occurrence of emergencies in order to discover and solve defects, so that there will be fewer health challenges and problems while providing prehospital services for pregnant women. This will also reduce the number of deaths and injuries amongst pregnant women.

Stroke is recognized as the second leading cause of death and the primary cause of disability in developing and underdeveloped countries. This study investigated the time trend of calls for suspected stroke received by the Emergency Medical Services (EMS) from 2013 to 2019 in Shiraz, Iran.

This was a descriptive - ecological study using time series data. The necessary data were extracted from the Shiraz Emergency Medical Center from 2013 to 2019. Excel 2013 and SPSS (version 24.0) were used for data analysis. The results were then presented in figures and tables.

From 2013 to 2019, the EMS call center in Shiraz City received 844,004 calls, of which 6,620 were suspected stroke cases. The number of suspected stroke cases demonstrated a steady trend within a certain range from 2013 to 2016. However, there was a significant increase between 2016 and 2017, after which the number of stroke cases reached relative stability. In the short-term seasonal trend, we found that the number of suspected stroke cases reported to EMS was higher in cold seasons compared to warm seasons.

The results showed that the long-term trend of reported suspected stroke cases to EMS is currently stable, following a previous increase in Iran.

One of the success factors in treatment is timely delivery of the injured to the treatment center. The aim of this study was to investigate the effect of different factors on the response time to traffic jams. In this cross-sectional-analytical study, the cases of traffic accidents injured by Fars emergency management were censored. Identify the injured and his case was merged with the admissions record of Shahid Rajaie Hospital. Early diagnosis and external causes were recorded in accordance with the International Standard Classification of Diseases. Using STATA software version 14, the analysis was performed and the tests were evaluated with a 0.05 error. One-way analysis of variance was used to compare the means in several groups and t-test of two independent samples was used to compare the means in the two groups. In these studies, 11047 patients admitted to the hospital due to traffic accidents were investigated. Men accounted for 72.6% of the injured. The average age of injuries was 33.6 years. The average response time in the survivors was 53.7 and in the deceased 51.48. The average response time for in-city injuries was 52.35 and the extra-urban injuries were 58.71. The highest average response time was in southeastern Shiraz. The mechanism of occurrence and the location and time of the accident occurred as a feature that significantly affected the time of arrival at the hospital. Minimizing the time of patient's transfer to the hospital is possible by increasing the number of emergency bases, equipping relief vehicles, providing more training to emergency medical staff and increasing the number of hospitals based on the spatial dispersion of traffic accidents which requires more attention to traffic problems inside and outside the city of Shiraz.

Drowning is one of the health problems in the world and one of the top ten causes of traumatic deaths in Iran. Managers' awareness of the characteristics of drowning clients helps to formulate and implement an intervention plan. The aimof this study was to investigate the epidemiology of drowning clients in Shiraz Emergency Medical Service (EMS) from 2019 to 2020.

Using the census method, the names of 62 people (all drowning emergency clients) and their information(age, sex, time and place of drowning, and the result of the emergency team mission) were extracted from Shiraz EMS in the years 2019-2020 and analyzed using SPSS (Version 23).

Of all EMS clients, 0.02% were emergency drowning cases; 70.2% of them were male and 29.8% were female. Their mean age was 20.5 years (29.8% of children, 15.8% adolescents, 33.4% youth, 17.5% middle-aged, and 3.5% the elderly). About half of the drownings (47.4%) happened in the spring and 31.6% in the summer. More than half of the drownings (56.1%) occurred at 11 AM-3 PM and 32.3% at 4 PM-8 PM. Regarding the outcome of drowning, 42.1% of the drowned died, 42.1% were admitted to the hospital, 7% were cared at the scene and 8.8% of them did not cooperate to be transported to the hospital. Moreover, 42.9% of them had concomitant trauma with drowning, 54.2% of whom had head trauma, 12.5% had shoulder and back trauma and the rest had multiple trauma.

Public awareness should be raised on the possible dangers of drowning through health and media. EMS managers should emphasize considering traumas with drowning by technicians in the EMS. Public education about the EMS duty should be enhanced to gain more trust, participation, and cooperation of clients. Protection and safety enhancement of public pools, ponds, domestic and lakes, etc. should be emphasized by the authorities.

To investigate and understand the current status of inter-organizational management in relief organizations as well as the relief organizations personnel behavior when facing mass traffic incidents (MCTI). The inter-organizational barriers and facilitators are also discussed in response to MCTI management and in order to help direct future actions to improve pre-hospital emergency services.

The current qualitative study was performed through face-to-face, semi-structured interviews with 31 individuals from pre-hospital emergency services authorities and personnel, Red Crescent and Yazd, Kohgiluyeh and Boyer-Ahmad, Fars, and Qom provinces police. These provinces were selected by purposive sampling in 2018-2019. The conventional content analysis method was applied to analyze the data in this research.

Three main categories and 14 subcategories were determined. The categories are including relief organizations coordination (having four subcategories: independent relief organizations, interdepartmental services integration, insufficient knowledge of organizations about one other, and performance based on job descriptions), resource and infrastructure management (having four subcategories: adverse information management, proper information management, lack of medical resources and capacities considered, and upgrading of medical resources and capacities considered), and response management of relief organizations (having six subcategories: incomplete assessment, improving the quality of assessment, weakness in establishing scene security, scene security management, poor response, and cooperation in response).

Relief organizations need to perform under a unified command. It has inter-organizational cooperation and provide integration of interdepartmental services in order to manage responsiveness at the scene. It also prevents an independent, chaos, and inability of the injured to properly understand and needs in MCTI.

Falling is the second leading cause of fatalities after road traffic accidents. Emergency care, particularly prehospital emergency care, is amongst the most important bases of therapeutic care. The present study aimed to assess the falling of children and adolescents and determining the time indices of the emergency115 service provider.

A cross-sectional study was conducted on3622 individuals based on the data recorded in the emergency care center dated 2017. The target population includes the injured people who had contacted the emergency115service. Demographic variables and time indices were evaluated. Univariate analysis was done using the chi-square test and multivariate analysis was carried out via a logistic regression model.

The results indicated that out of the 3622 participants, 1228(33.9%) were female and 2394 (66.1%) were male. The mean age of the injured people was 11.35+4.27 years. The highest and lowest prevalence rates of falling belonged to the13-18-years (99.6 per10000 population) and <6 years(72.1per10000 population)age groups, respectively. The results revealed a significant relationship between the consciousness level based on Glasgow Coma Scale(GCS)and male sex,13-18-years age group, and height above two meters (p<0.001).The mean response time was found to be7.5 minutes.

The study results demonstrated that 28.9% of the contacts to the emergency115 service were due to fall accidents. Besides, sex, age, height, and location were the effective risk factors in the prevalence of fall accidents. Therefore, individuals’ living places should be designed appropriately and accurately for providing safe conditions specifically for children. Increasing individuals’ safety can, in turn, reduce the rate of fall accidents in society.

Injuries and deaths from RTC are critical health problems of societies and one of the main causes of death especially among the young.

This study aimed to design and compile a guideline for emergency medical communication centers (EMCC) staff to provide direct assistance offered by road traffic crash (RTC) bystanders.

Based on prior literature, the RTC bystanders' initial draft guideline contained 20 domains and 28 items. As a validation step, the draft guideline was reviewed by content experts (one emergency medicine and two disaster specialists) and modified based on their recommendations. The subsequent draft guideline was then reviewed in three Delphi rounds by 67 participants, including health professionals in emergencies and disasters, emergency medicine, nurses, emergency medical experts, and EMCC staff. The accepted agreement coefficient was set at ≥70%. As the final step, an expert consensus meeting was held to review the guideline.

The participants agreed on 56 items regarding 20 domains, including scene safety, hand precautions, and personal protection, alertness assessment, respiration, cardiopulmonary resuscitation (CPR), bleeding control, recovery position, splinting, rapid evacuation, scene management, patient transfer, triage, spinal cord injury prevention and immobilization, injured transportation, psychological support, hypothermia prevention, water and food, amputated limb protection, and support of deceased people. Two items in relation to airway opening maneuvers were added to the guideline during the expert consensus meeting.

Compared to other RTC bystander guidelines for EMCC staff, more comprehensive guidelines can be served as a basis for directing RTC bystanders to provide assistance. Important areas of hand care and personal protection, breathing, airway, splinting, scene management, mental and psychological support, and support of deceased people were included in this guideline. EMCC staff can provide guidance to be performed by RTC bystanders. RTC bystanders can play important roles at crash scenes, including preventing secondary injury, supporting scene management, and providing first aid for the injured people. This guideline can be used to help direct appropriate care and behavior by RTC bystanders.

Diabetes is currently one of the most prominent causes of mortality and among the intensifying concerns of public health in the world. Education and enhancement of people’s knowledge about this disease can play an effective role in diabetes prevention and control. The present study was aimed at assessment of the effects of the Health week’s programs about diabetes on the citizens of Fars Province.

In this descriptive-analytical research, carried out interventionally, 501 people participated in the study both before and after the Health week. To define the sample’s volume, we used multi-stage cluster sampling. The study was conducted by using a made questionnaire which consisted of two parts, one part for demographic information and the other part for information about the people’s knowledge level of the Health Week and diabetes. The obtained data was analyzed by using descriptive statistics and Mc Nemar test, Paired t test, and independent sample t test in SPSS19.

The results indicated that holding up the Health Week had significant effect on enhancement of the participants’ knowledge about the disease and the ways of its diagnosis as well as the prevention methods (P-value < .001). In addition, there was a significant change in the frequency of health informational resources in mass media such as TV, radio, social media and internet, pamphlets and poster (P-value < .001), while no significant difference was observed through billboards, Healthcare centers’ staff, etc. before and after the week.

Informing people about the Health week and its programs through mass media can play an effective role in enhancement of people’s health knowledge and lead to prevention of  the disease and proper behavior to fight it.

 The fastest way to transport patients and the injured to hospital is to use air emergency services. Transporting patients by helicopter provides faster medical services to patients and reduces mortality and disability. This study was conducted to investigate the reasons for transporting patients by air ambulance to hospitals in Shiraz.

 The present study was a descriptive cross-sectional one conducted in 2018. The cases of 107 patients transported by air ambulance in 102 missions out of 219694 from Fars emergency to Shiraz hospitals were investigated using the census method.

 From among all patients transported by air ambulance, 68% were male and 53% lived in urban areas of Fars province. Moreover, 43% of patients were aged between 30 and 60 years old and 99% were taken to hospital. Of these, 50.5% were in the ward, 29% underwent intensive care, 9% underwent surgery, and 4.7% died in the hospital. Accidents and trauma were the most common causes of requests for helicopter transport.

 Continuous monitoring of the reasons for transporting patients by air ambulance is necessary to plan and make interventions, increase public awareness (especially among men) to self-health care and prevent incidents and diseases so as to reduce the number of critically ill patients.

Dear Editor, We appreciate the interest of the authors in our article entitled “A productive proposed search syntax for health disaster preparedness research”. They have rightly emphasized on the standard reporting of systematic reviews. However, as it is clear from the title and objective of the published article, we did not report results of a systematic review, our article instead aimed to present a syntax validation process which guide with creating a proper search strategy for systematic reviews on disaster preparedness [1-4].

Stroke is the third leading cause of death and the most common disease of old age. Pre-hospital care time is very important in these patients. The purpose of this study was to determine the status of time indices of pre-hospital emergency services in stroke patients of Fars province.

This cross-sectional descriptive study was performed from March 2018 to December 2018. Medical files of 327 stroke patients received emergency cares by Emergency 115 were selected through census sampling and reviewed. Data gathering tool was a checklist and data were analyzed through SPSS20 software package.

Stroke patients comprised 0.2% of all emergency 115 patients. Among stroke patients, 51% were men and 80% were elderly. From all, 88.7% were transferred to the hospital, 11% received urgent care in place and one patient had died. Among the studied cases, 32% had a history of stroke, 41% had high blood pressure and 8% had heart disease. The mean time of transforming stroke patients to the hospital was 37 minutes from the first calling of Emergency 115. For other transferred patients, mean times of transferring by ambulance and Air Emergency were respectively 52 and 38 minutes.

Monitoring the performance of Emergency Technicians reduces service time and the rate of mortality and morbidity of stroke patients. By screening for health and increasing public awareness in the field of health, mortality and disability can be prevented in these patients.

To find a proper search strategy to do a systematic review related to preparedness for disasters. MeSH and Emtree terms were searched to detect synonyms for two main search terms “disaster” and “preparedness”. Expert opinion on the synonyms was examined applying a Google form. The adopted syntax was searched in PubMed and results were sifted. Hand searching in two top key journals was done and sensitivity was calculated. Out of 1120 articles, 122 were included. In PDM journal, 10 articles were included by hand searching, out of which 5 were not spotted in PubMed search with the proposed syntax. In DMPHP journal, 13 publications were included, with 5 not found in PubMed search. Because of human error in hand searching 2 articles were added. The proposed syntax in this study achieves a sensitivity of search of 0.6 in PubMed which could be quite applicable for researchers. Moreover, in case only MeSH or Emtree terms were applied in search strategy or where hand searching was not performed, there were a number of articles missed.

To compare the effect of lecture and game methods in disaster risk education on high school students' knowledge. This research was a randomized field trial of educational intervention for high school’s students in Shiraz, Iran. Through cluster sampling, the 332 students were randomly selected and their knowledge was compared in two randomized allocated intervention groups by pretest and posttest. For one group a classic lecture about the basic concepts of disaster risk management were presented. In the other group through a game base method and demonstrations the mentors tried to educate the considered concepts. In this study 332 students were participated in lecture (n=166) and game (n=166) groups. There was a significant increase between the mean of students' knowledge in the two groups of lectures and games method after educational intervention. The mean of students' disaster risk knowledge in the lecture and game methods were 17.47 and 29.77 percent respectively (p<0.001). The game's educational method was more effective than the traditional lecture method on students' knowledge and it can be considered as a new approach for promoting the behaviors on disaster risk management.

Crisis management plays an important role in preparing hospitals for responding to disasters. Therefore, improvement of knowledge and attitude of the crisis management team is an unavoidable necessity for increasing the preparedness of the hospitals in the response phase to critical conditions and real disasters. Since, based on previous studies, lack of knowledge and proper attitude is one of the main problems of disaster management in Iran, teaching crisis management using simulated training method has been considered as a solution. Therefore, the aim of this study was determining the effect of teaching crisis management in traffic accidents with a high rate of mortality using simulated training (maneuver) method on the knowledge and attitude of nursing staff of Hospital. The present experimental interventional study was performed from September 2017 to January 2018, in Shahid Motahari Hospital, Marvdasht. The study population consisted of the nursing staff of the hospital and the sample included all of the emergency department nurses of the hospital (100 nurses). Data were gathered with the attitude scale in crisis, emergency preparation questionnaire and triage knowledge test of accidents before and 2 weeks after intervention. Intervention included a one-day workshop training for all of the study population and then performing table maneuver and stimulated road accident maneuver for the test group. Analysis of data was done using SPSS 22 and descriptive statistics, paired t-test and ANCOVA test. Mean score of emergency preparation knowledge showed a statistically significant difference between the 2 groups of test (166.69 ±25.47) and control (136.14±39.24) after intervention (p<0.0001). In addition, the overall score of attitude towards crisis management after intervention was significantly different between test (21.44±1.10) and control (20.92±1.57) groups (p=0.02). The results showed that training via simulation method and workshop could improve knowledge and attitude towards crisis management better than educational workshop alone. Therefore, simulation training of educational programs is suggested for improvement of knowledge and attitude regarding crisis management.

There is a lack of epidemiological data on emergency Medical service (EMS) missions for accidents in Iran. The present study aimed at obtaining representative data on the epidemiology of emergency Medical service missions for accidents in Tehran.

Active EMS stations in Tehran were selected through stratified random sampling in different regions of the city during a twelve-month period from March 2012 to March 2013. Data was collected through a questionnaire on demographic information, which extracted from events recorded on dispatch electronic forms in EMS. Data was analyzed by Excel using descriptive statistics.

Based on the type of accidents, Road Traffic Accidents (RTA) and downfall in the North, stab wound in the East, burning in the West, and poisoning with CO in the East region of Tehran megacity had the highest rates compared to other areas. The most common of all were Road Traffic Accidents (RTA) (77.9%) stab wound (11.1%), falling down (4.6%), burns (2.1%), and Carbon Monoxide (CO) poisoning (1.5%). Most accidents occurred in males and 20- to 40-year-old age group (45.51%), and the western district had the first rank in Tehran.

According to demographic and geographical rate of accidents, It is recommended to develop preparedness programs and response plan according to epidemiological information of accidents. This programs includes EMS staff trainings and community educations.

Identification of the effective factors in reducing response time in prehospital emergency medical service (EMS) can assist in improving its services. This study aimed at reviewing the effect of applying global positioning system (GPS) on response time of Tehran EMS ambulances.
Of 132 Tehran EMS stations, 24 ones were randomly selected, and relevant data, including the response time of all missions in 2009 (without GPS) and in 2011 (with GPS) as well as number of daily calls to each dispatch center were extracted. The average number of daily calls in the call centers were categorized into 3 groups as follows: I) ≤10 calls, II) 10 to 15 calls, and III) >15 calls. The statistical analysis of the obtained data was carried out by paired t test.
The findings revealed that the average response times in 2009 for the 3 groups (I, II, and III) were 10.11, 11.25, and 10.92 minutes, respectively. These times recorded for groups (I, II, and III) in 2011 were 9.86, 10.71, and 11.58 minutes, respectively, which were significantly less than the response times recorded in 2009 (P This research has demonstrated that the application of GPS in the ambulances may be essential in the reduction of response time, especially in emergency stations with more average mission numbers

One of the important aspects of hospital preparedness in disasters is its rapid early warning system. In this study, the activation of early warning system was evaluated under the monitoring of disasters workgroup of the Ministry of Health based on the national program of “hospitals preparedness in disasters” in Shahid Motahari Hospital.
The sample was composed of 801 adults exposed to the earthquake. Two months after the earthquake, all subjects were surveyed with measures administrated in a standard order as follows: demographic data sheet, disaster experiences scale (DES), general health questionnaire (GHQ), and symptom checklist 90-revised (SCL-90-R).
The results revealed that 23% of the survivors in the exposed group had ASD, 10% had anxiety symptoms, 7.5% depression, 4% MADD, 5% psychosomatic disorders, 10% phobia, 7% aggressive behavior, and 10% insomnia.
This article has summarized the current status of information on mental disorders caused by experiencing or witnessing a life threatening severe earthquake. The experience of fear, helplessness, and panic during the earthquake, and the appraisal by the victims of serious psychological, social, as well as demographical consequences after the earthquake, were positively related to the subscale scores and the total score of GHQ, SCL-90-R, and DES.

Prehospital Emergency Medical System is one of the critical parts in health care sector which has been usually unnoticed. Delivering quick، efficient and high quality care in this system has a large impact on mortality and morbidity of patients. In this descriptive and cross-sectional study، 20662 cases in 4 months in the middle of the year 2008. Missions over 8 minutes from when the time of call receiving to arrival on the scene were detected and survivedFor statistical analysis ANOVA was used. Most of the missions were done between 8 to10 minutes. Nine reasons were detected for this arrival delay: 1) destruction of the road، 2) traffic، 3) rainy weather، 4) long way to the scene، 5)scarcity of ambulance in the center near the scene، 6)wrong address، 7) cannot find the address، 8) delay in dispatching the ambulance، 10)delay in arrival because of technicians. in Shiraz Emergency Medical system the most important reasons for missions over 8 minutes were scarcity of ambulance in the center near the scene، traffic، long way to the scene. Quick arrival on the scene has a large effect on patients، though، health ministry and emergency centers should pay more attention on this sector and deliver financial support for equipped emergency centers due to the population and demand for emergency centers.

Rabies is an acute and fatal infectious disease that is very important due to high economic losses to livestock and the amounts of expenditures that are paid for purchasing serum and vaccine. The main way of disease transmitting is bites by rabid animals. Animal bite is an important threat for human health. The main aim of this research was epidemiological study of animal bite in the students of Hashtrood town. In this cross-sectional study, animal bitten students’ data were collected trough the records of Hashtrood health centers registry lists between 2006-2009. The census data collecting method was used and the data were analyzed with statistical software SPSS15. The incidence of animal bites in the past 5 years was 9.07 per 1,000 students. From 439 animal bitten students, 80.9% were male and 19.1% were female. According to the results, 88.4% were rural and 11.2% were urban residents. Dogs bite was the cause of 87.92%. In 86.5% of the cases, the bite was superficial and in 8.4% of the cases, bites were deeper. Among them, 16.6% received anti rabies serum, 16.2% received vaccine. This study showed that 4.8% had a previous history of bite. Of total, 78.8% made a visit to health centers in the first 24 hours, 11.4% within 25 to 48 hours, and 3.6% within 49 to 72 hours after bites. There was no human death report from rabies. Results showed that 95.2% were given incomplete vaccination and 4.1% had received five complete vaccines. Regarding the high prevalence of animal bites among students, educating students about the importance of rabies, students’ behavior with dogs and immediate visit to health centers after exposure to dogs should be taken serious. Restraining dogs by training dog owners and legal means should be attempted.

Pre-hospital Emergency Medical Services (EMS) is one of the most important components of health care systems. Community awareness about its services could improve the performance. This study is aimed at assessing the citizens’ awareness and satisfaction about Shiraz EMS. Through this cross-sectional study, 1680 residents of Shiraz citizens have been selected by cluster random sampling. Each person has been asked some questions about their knowledge and also satisfaction of EMS performance with a valid and reliable questionnaire through phone interview. The data were analyzed with SPSS using T- test, Anova and Regression with “0.05” level of significance. This study revealed that the knowledge of the residents who are living in lower socioeconomic part of the city is lower than the residents of the other areas. The mean awareness score of each area was significantly different comparing to the other areas, based on their socioeconomic status. In better socioeconomic status, the knowledge score was higher. There was also significant relationship between education and gender with knowledge about EMS performance. Meanwhile, the relationship with age was reverse. Although 48.6% had no idea about EMS, 527 (31.4%) were satisfied by its services. There was only 7.3% dissatisfaction. While the awareness about EMS’s duties could decrease irrelevant calls to EMS, education, especially for the residents of lower socioeconomic areas of the city is recommended. In addition, it is suggested that in feasibility studies or using other methods of evaluating EMS performance, socioeconomic status should be considered as independent variables.