Bulletin of Emergency And Trauma
Volume:11 Issue: 3, Jul 2023

This study aimed to comprehensively determine the factors that affect the hospitals’ functionalpreparedness in response to disasters.

A systematic review of studies published in English and Persian up to the end of 2022 was performedby searching PubMed Central, Web of Science, Scopus, ProQuest, SID, and Elmnet databases. Articles thatassessed hospitals’ functional preparedness were searched by using a combination of medical subject headingterms and keywords including disaster, emergency, preparedness, hospital preparedness, health care facilitiespreparedness, hospital functional preparedness, health care facilities functional preparedness, readiness, andeffective factors. Additionally, journals and gray literature were manually searched. Two independent reviewersscreened the eligible papers. The inclusion criteria were the full text should be published up to the end of 2022,in both Persian and English, and focus on hospital preparedness. The extracted data were manually analyzed,summarized, and reported using the content analysis method.

Of the 3465 articles, 105 studies were eventually included in the final analysis. Eighty-two influentialfactors were identified and classified into seven categories: government, coordination, control, and commanding(7 factors), existing guidelines and preparedness plans (12 factors), regulations (6 factors), supplying of resources(37 factors), education and training (8 factors), multi-layered information management and communicationsystems (8 factors), and contextual factors (4 factors).

There are different dimensions of hospital preparedness for disasters, each of which is influencedby several independent factors. Addressing these factors will enhance the actual functional preparedness ofhospitals encountering disasters.

To investigate the use of prognostic markers such as C-reactive protein (CRP) and D-dimer forclinical outcomes in patients with mild traumatic brain injury (TBI). This cross-sectional study was conducted on patients with mild head trauma who were admittedto the Emergency Department of Imam Khomeini Hospital (Sari, Iran). Data were collected from 2018 to2019. Age, sex, the time of injury hospitalization, length of hospitalization, length of unconsciousness, bloodpressure, heart rate, respiratory rate, and concomitant symptoms were all recorded using a pre-designedchecklist. The patient’s Glasgow Coma Scale (GCS), CRP, and D-dimer were also measured. Moreover, allpatients underwent CT scan. This study included 74 patients with TBI. The mean age of the participants was 36.92±3.54. Themean CRP and D-dimer values were 5.69±0.77 and 0.58±0.11 in these patients, respectively. At the cut-offpoint of 11.50 for CRP, the sensitivity and specificity to detect the pathological lesions in CT scan was 75%and 95.50%, respectively (p<0.001). Additionally, with a D-dimer cut-off point of 0.90, the sensitivity andspecificity for diagnosing pathological lesions in CT scan were 100% and 98.50%, respectively (p<0.001). In general, the CRP and D-dimer levels of patients with mild TBI (GCS≥13) can be assessed toprotect against CT-induced radiation exposure and subsequent disorders; if they do not exhibit clinical signs toincrease the risk of adverse brain damage, such as reduced level of consciousness, drowsiness, and prolongedperiods of unconsciousness.

To determine the causal relationship between aging and nighttime driving and the odds of injuryamong elderly drivers. In this cross-sectional study, 5460 car accidents were investigated from 2015 to 2016. The data wereextracted from the Iranian Integrated Road Traffic Injury Registry System. Pedestrian accidents, motorcyclecrashes, and fatalities were excluded from the study. To account for major confounders, Bayesian-LASSO, andtreatment-effect cutting-edge approaches were used. Overall, 801 injuries (14.67%) were evaluated. The results of the univariable analysis indicated thataging and nighttime had adverse effects on the odds of road traffic injuries (RTIs), even after adjusting forthe effect of other variables, these effects remained statistically significant. According to a newly developedapproach, the overall effects of aging and nighttime were significantly and directly correlated with the odds ofbeing injured for older adults (both p<0.001). Our findings indicated that drivers over 75 years old experienced23% higher injury odds (OR=1.23, 95% CI:1.11 to 1.39; p<0.001), while driving at night increased the odds by1.78 times (OR=1.78, 95% CI:1.51 to 1.83; p<0.001). Aging and nighttime driving are significant risk factors for RTIs among elderly drivers. Thishighlights the importance of implementing targeted interventions to enhance road safety for this vulnerablepopulation. Furthermore, the use of advanced Bayesian-LASSO and treatment-effect statistical methodshighlights the importance of utilizing sophisticated methodologies in epidemiological research to effectivelycapture and adjust for potential confounding factors.

To identify the distinctive features of acutely injured patients who were presented to the emergency department (ED) and their association with mortality and surgical intervention outcomes. This cross-sectional study was conducted on all trauma patients resuscitated in the ED of ShahidRajaee (Emtiaz) Trauma Hospital (Shiraz, Iran) from May 2018 to June 2019. Demographic information, themechanism of trauma, trauma type, injured body regions, criteria of abbreviated injury scale (AIS) score,injury severity score (ISS), and surgical intervention was all taken into consideration. The items related to themortality and surgical performance outcomes among the patients were analyzed. Of all 1281 cases, 82.9% were men, and the mean age of the patients was 37.9±19.1 years. The mostcommon mechanism of injury was a car accident, and the thorax was the most prevalent injured area of thebody. The majority of the patients had moderate blunt trauma. The mechanism of trauma, ISS, and the severityof head trauma were all significantly correlated with operation interventions. Moreover, age, the mechanismand type of trauma, ISS, and the necessity for the surgery were significantly associated with death occurrence.Additionally, head, thorax, and abdomen trauma were significantly related to a high mortality rate. Age, trauma mechanism and type, ISS, and the necessity for surgery were significantly associatedwith the mortality rate of injured patients. The severity of the trauma, particularly head injuries and themechanism of damage were important determinants in concern for surgery the necessity.

Emergency medical technicians (EMTs) are at risk of developing post-traumatic stress disorder(PTSD) as a result of seeing painful events involving suspected COVID-19 patients and being concerned aboutpotentially infecting themselves and their families. Therefore, screening for these disorders is essential in thepost-Corona era. This study aimed to investigate the prevalence of PTSD among EMTs and its relationship withoccupational stress and depression when dealing with patients with suspected COVID-19. This cross-sectional study was conducted on EMTs at Zanjan University of Medical Sciences usinga convenience sampling method. Data were collected using a demographic information questionnaire, PTSDchecklist, occupational stress questionnaire, and the Goldberg depression scale. The data were analyzed using SPSSsoftware. Statistical tests such as Pearson correlation and logistic regression analysis were used to evaluate the data. 205 EMTs participated in this cross-sectional study. The mean and standard deviation of PTSD was37.13±12.93 (17-85), and according to the cut-off (45), the prevalence of PTSD was 30.7%. There was a direct andsignificant association between the total PTSD and depression scores (r=0.435, p=0.001). Some occupational stressdomains, such as demand (r=0.306, p=0.001), colleague support (r=0.149, p=0.033), and communication (r=0.293,p=0.001) had a significant association with PTSD. The domains of sadness in depression (OR=1.074, p=0.027)and demands in occupational stress (OR=1.872, p=0.029) were the most important predictors of PTSD. Amongdemographic variables, employment status was the most important protective factor for PTSD (OR=0.378, p=0.038). PTSD affected one-third of EMTs, and it had a significant relationship with various dimensionsof depression and occupational stress. Due to the chronic nature of these diseases, policymakers are advised toprioritize psychological screening of EMTs as part of the post-Corona policy.

Breaking bad news (BBN) is a critical aspect of healthcare delivery that can have significantimplications for patients’ outcomes. Inadequate and inappropriate delivery of bad news can result in detrimentalpsychological and emotional effects. This study aimed to compare the performance of emergency department(ED) personnel and patients’ preferences in BBN. This descriptive-analytical study was conducted in 2022, and 135 patients who were admitted to theED were included using quota sampling. Data were collected using a demographic questionnaire, a researchermadequestionnaire, and a standard questionnaire on attitudes toward the methods of BBN in the ED. The datawere analyzed using SPSS software (version 16), and a p-value<0.05 was considered statistically significant. The results showed that the majority of patients (69.6%) received bad news from nurses. Based on theconditions mentioned in the standard questionnaire, the overall performance of personnel was 6.08±4.22 out of19, while the overall attitude score (59.66±7.66 out of 76) revealed patients’ high tendency to receive bad news.There was a statistically significant difference between the total score of personnel performances and the totalscore of patients’ attitudes (p=0.001). The performance of ED personnel concerning patients’ attitudes toward the method of BBN inthe emergency department was not optimal. Therefore, it is recommended to implement appropriate trainingprograms for medical professionals, especially physicians, and nurses, to enhance their communication skillsand reduce the detrimental effects of inappropriate delivery of bad news in medical settings.

Considering the growing use of emergency medical services (EMS), we evaluated the level ofpublic awareness of emergency situations in Iran. This cross-sectional study was conducted from August 2021 to January 2023 on Iranian residentsin Tehran, who were older than 18 years old. The participants were directed to a URL for an online surveylink and asked to select their preferred options for the predetermined scenarios. We divided the participantsinto three groups: abuse, misuse, and non-use. At least 12 correct answers were required to qualify asacceptable knowledge and practice responses (KP score). Then, the relationship between participants’ baselinecharacteristics and their level of awareness was investigated. Totally, 3864 people participated in the study, of whom 50.5% were men. The participants’ agesranged from 18 to 90 years old, with a mean age of 40.01±11.30 years. In general, the rate of abuse, misuse,and not-use in at least one scenario was 74.5%, 64%, and 70.4%, respectively. The results of the multivariableregression analysis indicated that female sex (OR=1.29), a higher education level (OR=3.36), a higher incomelevel (OR=1.64), and Turkish ethnicity (OR=1.20) were significantly associated with the correct KP score. The degree of inappropriate utilization of EMS services in Iran was significant. We found thatthe proper knowledge regarding the appropriate use of EMS was significantly associated with the participant’slevel of education, academic field, job, and income.

Due to the specific features of the adrenal glands, traumatic adrenal injury is a rare phenomenon. Themajority of these rare types of traumas are caused by blunt force injuries and rarely by penetratingmechanisms. In such cases, a whole-body computed tomography scan is essential for early diagnosis.This paper describes an uncommon case of adrenal hematoma and contusion followed by blunt abdominaltrauma. A 35-year-old woman was admitted to the emergency department after a high-speed vehicle-pedestriancollision. She presented with decreasing level of consciousness. Additionally, a thoracoabdominal CT scanrevealed a left flank hematoma. Blunt adrenal injury, often accompanied by multiorgan damage, is a rareoccurrence resulting from severe accidents. Accurate diagnosis based on clinical symptoms requires highclinical suspicion, particularly in isolated cases, and treatment depends on the patient’s condition.