Are our hospitals safe against disasters? An evaluation of hospital safety index in Tabriz, Iran

Introduction: Iran's hazard level against disasters is estimated to be 8 out of 10. The Farsi version of Hospital Safety Index (FHSI) has been designed by the World Health Organization (WHO) to simply scan the hospital safety standards for disasters. This study was designed to investigate the uncertainty about the safety level of hospitals in Tabriz, Iran, against disasters and the importance of the issue. Methods: In this study, 21 hospitals in Tabriz City were evaluated. The items in the hospital safety index (HSI) were provided with a checklist. The collected data were entered into the SPSS statistical software. Finally, the safety levels of the hospitals were determined and compared with one another. Results: The average hospital safety score was 6.70 ± 1.16. Only 6 hospitals were in good condition, with the 4 cases being non-academic hospitals. The functional safety of the hospitals was acceptable, and the structural and non-structural safety levels were modest. The highest and lowest scores were related to functional safety and structural safety, respectively. The rate of safety of general hospitals was significantly higher than that of the specialized hospitals with rates 7.07 ± 1.03 and 5.75 ± 0.88, respectively. There was no significant correlation between the number of hospital beds with the level of safety score. Conclusion: The results of this study indicated the weak safety of Tabriz hospitals against disasters, especially in structural aspect. However, the probability of occurrence of various disasters in this area including earthquakes, extreme cold weather, etc. is very high. So, it seems to be necessary to attract attention to change policies about hospital management

Promotion of knowledge, skill, and performance of emergency medical technicians in prehospital care of traumatic patients: An action-research study

Background: Annually, there is a high rate of mortality due to trauma. Prehospital emergency personnel are the first caregivers present beside trauma patients, and their dexterity to take care of trauma patients is of great significance in the vast majority of patients' survival. Materials and Methods: This study was action research with the participation of 125 prehospital emergency personnel from May 2016 to December 2018 in five stages (observation, reflection, planning, action, and evaluation) in Iran. Knowledge, skills, and performance of personnel were assessed before and after the action. Data collection tools included knowledge questionnaire and PERFECT skill assessment checklist by Objective Structured Clinical Examination method and researcher-made checklist for performance. Data were analyzed using SPSS-21 software. Results: The findings indicated that 67.82 and 84.4 of prehospital emergency staff have median to low knowledge and expertise in respect to trauma care, respectively. Their performance of necessary measurements for trauma patients was poor prior to training. There was a significant difference between the mean knowledge, skills, and performance of medical emergency technicians before and after the training course (P = 0.00). Conclusions: Participation of beneficiaries in planning for trauma patient's care is helpful. Establishment of prehospital trauma life support training in the medical emergency, training curriculum, and its instruction to prehospital emergency personnel while serving in trauma care will be of great benefit

Gray area; a novel strategy to confront COVID-19 in emergency departments

Introduction: Coronavirus disease 2019 (COVID-19) pandemic, affects almost every aspect of human life. To confront this crisis, a separate ward called gray area was designed for emergency departments (EDs) and applied at the provincial level in East-Azerbaijan, Iran. This study aimed to evaluate the effectiveness of this project, increase the serviceability and segregation of the location of infected patients, and show how feasible and fruitful it can be. Methods: This study is an analytical study. The statistical data collection from 39 hospitals was performed between 20 March to 21 September 2020. Descriptive Statistics as well as correlation coefficients were calculated using the 26th version of IBM SPSS. Results: Among 77489 COVID-19 patients admitted to the EDs, approximately 0.38% of patients died in EDs. 22.63% of EDs area was allocated to COVID-19 patients and 70.46% of ED nurses, worked in the gray area. There was no significant correlation between area, number of patients, number of nurses, number of shifts of nurses, number of nurses for each patient, number of nurse shifts for each patient, and area for each patient with mortality rate and rates of disposition in 6 and 12 hours. Conclusion: Gray area is an appropriate strategy to confront COVID-19 in EDs and if more studies approve these results, this strategy can be used to confront this pandemic and future similar conditions in resource-limited countries

Role of anesthesiology curriculum in improving bag-mask ventilation and intubation success rates of emergency medicine residents: a prospective descriptive study

<p>Abstract</p> <p>Background</p> <p>Rapid and safe airway management has always been of paramount importance in successful management of critically ill and injured patients in the emergency department. The purpose of our study was to determine success rates of bag-mask ventilation and tracheal intubation performed by emergency medicine residents before and after completing their anesthesiology curriculum.</p> <p>Methods</p> <p>A prospective descriptive study was conducted at Nikoukari Hospital, a teaching hospital located in Tabriz, Iran. In a skills lab, a total number of 18 emergency medicine residents (post graduate year 1) were given traditional intubation and bag-mask ventilation instructions in a 36 hour course combined with mannequin practice. Later the residents were given the opportunity of receiving training on airway management in an operating room for a period of one month which was considered as an additional training program added to their Anesthesiology Curriculum. Residents were asked to ventilate and intubate 18 patients (Mallampati class I and ASA class I and II) in the operating room; both before and after completing this additional training program. Intubation achieved at first attempt within 20 seconds was considered successful. Successful bag-mask ventilation was defined as increase in ETCo₂to 20 mm Hg and back to baseline with a 3 L/min fresh gas-flow and the adjustable pressure limiting valve at 20 cm H₂O. An attending anesthesiologist who was always present in the operating room during the induction of anesthesia confirmed the endotracheal intubation by direct laryngoscopy and capnography. Success rates were recorded and compared using McNemar, marginal homogeneity and paired t-Test tests in SPSS 15 software.</p> <p>Results</p> <p>Before the additional training program in the operating room, the participants had intubation and bag-mask ventilation success rates of 27.7% (CI 0.07-0.49) and 16.6% (CI 0-0.34) respectively. After the additional training program in the operating room the success rates increased to 83.3% (CI 0.66-1) and 88.8% (CI 0.73-1), respectively. The differences in success rates were statistically significant (P = 0.002 and P = 0.0004, respectively).</p> <p>Conclusions</p> <p>The success rate of emergency medicine residents in airway management improved significantly after completing anesthesiology rotation. Anesthesiology rotations should be considered as an essential component of emergency medicine training programs. A collateral curriculum of this nature should also focus on the acquisition of skills in airway management.</p

Determining a National Trauma Prognostic Scale (TPS) to Predict Preventable Trauma Death in Iran: the Research Protocol

Methods: A 7-phases methodology will be applied to conduct this study as following; 1- Identification of trauma severity parameters and scales predicting mortality from literature, 2- Developing a data collection tool for research data collection), 3- Data collection in selected clinical settings, 4- Statistical modeling, 5- Model adaptation with three levels of trauma care settings including pre-hospitals, general hospitals and trauma specialty hospitals, 6- Scale-up and extrapolation, and 7- comparison with international models and selection of Iranian national model. Results: The content validity of the tool was confirmed with a total scale-level content validity (S-CVI) = 0.93. The reliability of the final instrument was calculated using the Pearson correlation coefficient and the Spearman correlation was evaluated above 0.7 for all cases. Up to date April 2020, From the hospital of the study, 210 patients participated in the study. The mean and standard age deviation of patients was 35.18 ± 18.44 and 165 (78.57 %) of these patients were male. The most important cause of trauma in patients was a motorcycle accident (27.62 %). Keywords: Trauma, Modeling, Injury severity assessment, Mortality predictor, Trauma scal

Determining a National Trauma Prognostic Scale (TPS) to Predict Preventable Trauma Death in Iran: the Research Protocol

Methods: A 7-phases methodology will be applied to conduct this study as following; 1- Identification of trauma severity parameters and scales predicting mortality from literature, 2- Developing a data collection tool for research data collection), 3- Data collection in selected clinical settings, 4- Statistical modeling, 5- Model adaptation with three levels of trauma care settings including pre-hospitals, general hospitals and trauma specialty hospitals, 6- Scale-up and extrapolation, and 7- comparison with international models and selection of Iranian national model. Results: The content validity of the tool was confirmed with a total scale-level content validity (S-CVI) = 0.93. The reliability of the final instrument was calculated using the Pearson correlation coefficient and the Spearman correlation was evaluated above 0.7 for all cases. Up to date April 2020, From the hospital of the study, 210 patients participated in the study. The mean and standard age deviation of patients was 35.18 ± 18.44 and 165 (78.57 %) of these patients were male. The most important cause of trauma in patients was a motorcycle accident (27.62 %). Keywords: Trauma, Modeling, Injury severity assessment, Mortality predictor, Trauma scal

Utilization of Emergency Medical Services among Older People: A Case Study in Iran

Introduction: The need for emergency medical services (EMS) is growing because of the rapidly aging population. This study aimed to assess the utilization of EMS among older people in Tabriz, Iran. Methods: This retrospective study used data from the missions carried out by EMS in 2014-15. All of EMS records were analyzed over a continuous 12-month period by choosing selected profiles from the middle month of each quarter. Results: Among all 10940 missions accomplished in four months, 4175 (38.16 %) calls were for patients aged 60 years and older. A significant association was found between service characteristics and gender/age groups. Women and older people aged 80 - 84 years were more likely to use emergency services. Moreover, the older people had a higher proportion of histories for cardiovascular disease, respiratory difficulties, cerebrovascular accident, fall-related injuries, poisoning, and suicide. Conclusion: Older people constituted a large proportion of EMS which mostly were transferred to emergency departments. As the older adult population grows, health systems should prepare appropriate services by making changes in training, operations, and equipment.&nbsp

A Studying the myoglobin changes and its effect on sepsis severity and outcome

Introduction: Sepsis refers to a set of systemic inflammatory responses to infection that cause harmful effects on the human body. Myoglobin can be used as a beneficial marker in determining the status of patients with sepsis. This study aims to investigate the changes in myoglobin and its effect on the severity and outcome of sepsis in the hospital. Methods: In this study, patients were divided into three groups: sepsis, severe sepsis, and septic shock. Data about their age, gender, myoglobin level in 4 different times (entrance time, 6, 12 and 24 hours later) and sofa index was obtained and compared. Blood culture was taken for all patients and results were evaluated for gram-positive or gram-negative. Results: The patients of the three groups were not significantly different in terms of age (P=0.59) and heart rate (P=0.18). While in terms of myoglobin, there was a significant difference in every 4 times (P=0.00), hospital days (P=0.01), fever (P=0.00), and SOFA (P=0.00) so that with increasing sepsis severity, this Variables rate increased. There is no significant difference in the gender distribution ratio between groups (P&gt;0.05). The highest rate of involvement in each group of patients is related to the respiratory tract. The outcome of patients (survival/death) in different groups is significantly different (P=0.00). A higher percentage of the cultures was gram-negative and the frequency of cultures was not significantly different between different groups. (P-value=0.86). Conclusion: The level of myoglobin measured in patients had an increasing trend. Elevated myoglobin levels were also significantly associated with sepsis and mortality