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      Prehospital Emergency Medical Services Challenges in Disaster; a Qualitative Study


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          Prehospital Emergency Medical Care (EMC) is a critical service in disaster management. The aim of this study was to explore the challenges of prehospital Emergency Medical Services (EMS) during disaster response in Iran.


          A qualitative study was conducted from April 2015 to March 2017. Data were collected through in-depth, semi-structured interviews with 23 experienced individuals in the field of disaster that were selected using purposeful sampling. Data were analyzed using content analysis approach.


          Fifteen sub-themes and the following six themes emerged in the analysis: challenges related to people, challenges related to infrastructure, challenges related to information management systems, challenges related to staff, challenges related to managerial issues and challenges related to medical care.


          Iran’s prehospital EMS has been chaotic in past disasters. Improvement of this process needs infrastructure reform, planning, staff training and public education.

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          Most cited references 26

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          A national evaluation of the effect of trauma-center care on mortality.

          Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. To address this gap, we examined differences in mortality between level 1 trauma centers and hospitals without a trauma center (non-trauma centers). Mortality outcomes were compared among patients treated in 18 hospitals with a level 1 trauma center and 51 hospitals non-trauma centers located in 14 states. Patients 18 to 84 years old with a moderate-to-severe injury were eligible. Complete data were obtained for 1104 patients who died in the hospital and 4087 patients who were discharged alive. We used propensity-score weighting to adjust for observable differences between patients treated at trauma centers and those treated at non-trauma centers. After adjustment for differences in the case mix, the in-hospital mortality rate was significantly lower at trauma centers than at non-trauma centers (7.6 percent vs. 9.5 percent; relative risk, 0.80; 95 percent confidence interval, 0.66 to 0.98), as was the one-year mortality rate (10.4 percent vs. 13.8 percent; relative risk, 0.75; 95 percent confidence interval, 0.60 to 0.95). The effects of treatment at a trauma center varied according to the severity of injury, with evidence to suggest that differences in mortality rates were primarily confined to patients with more severe injuries. Our findings show that the risk of death is significantly lower when care is provided in a trauma center than in a non-trauma center and argue for continued efforts at regionalization. Copyright 2006 Massachusetts Medical Society.
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            The initial health-system response to the earthquake in Christchurch, New Zealand, in February, 2011.

            At 1251 h on Feb 22, 2011, an earthquake struck Christchurch, New Zealand, causing widespread destruction. The only regional acute hospital was compromised but was able to continue to provide care, supported by other hospitals and primary care facilities in the city. 6659 people were injured and 182 died in the initial 24 h. The massive peak ground accelerations, the time of the day, and the collapse of major buildings contributed to injuries, but the proximity of the hospital to the central business district, which was the most affected, and the provision of good medical care based on careful preparation helped reduce mortality and the burden of injury. Lessons learned from the health response to this earthquake include the need for emergency departments to prepare for: patients arriving by unusual means without prehospital care, manual registration and tracking of patients, patient reluctance to come into hospital buildings, complete loss of electrical power, management of the many willing helpers, alternative communication methods, control of the media, and teamwork with clear leadership. Additionally, atypical providers of acute injury care need to be integrated into response plans. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Toward Disaster-Resilient Cities: Characterizing Resilience of Infrastructure Systems with Expert Judgments


                Author and article information

                Emerg (Tehran)
                Emerg (Tehran)
                Shahid Beheshti University of Medical Sciences (Tehran, Iran )
                26 April 2018
                : 6
                : 1
                [1 ]Department of Health in Emergencies and Disasters, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
                [2 ]Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
                [3 ]University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
                [4 ]Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden.
                [5 ]Department of Medical library and Information Science, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
                Author notes
                [* ]Corresponding author: Sogand Tourani; Number 6, Yasemi st , Kurdsistan ave, Tehran, Iran. Tel: 0098-2188772086 – 989127544205, Fax: 0098-2188772086, Email: soga.tourani@gmail.com
                Copyright (2018) Shahid Beheshti University ofMedical Sciences

                This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0)( https://creativecommons.org/licenses/by-nc/3.0/).

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