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

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

Success Rate of Pre-hospital Emergency Medical Service Personnel in Implementing Pre Hospital Trauma Life Support Guidelines on Traffic Accident Victims

SUMMARY: Objectives: Road traffic injuries are responsible for a vast number of trauma-related deaths in middle- and low-income countries. Pre-hospital emergency medical service (PHEMS) provides care and transports the injured patients from the scene of accident to the destined hospital. The PHEMS providers and paramedics were recently trained in the Pre Hospital Trauma Life Support (PHTLS) guidelines to improve the outcome of trauma patients in developing countries. We decided to carry out a study on the success rate of PHEMS personnel in implementing PHTLS guidelines at the scene of trauma. Methods: Severe trauma patients who had been transferred to the emergency department were included in the study. Evaluations included transfer time, airway management, spinal immobilization, external bleeding management, intravenous (IV) line access, and fluid therapy. All evaluations were performed by an expert emergency physician in the emergency department. Results: The mean response time was 17.87±9.1 minutes. The PHEMS personnel immobilized cervical spine in 60.4% of patients, out of whom 16.7% were not properly immobilized. Out of 99 (98%) cases of established IV line access by the PHEMS providers, 57% were satisfactory. Fluid therapy, which was carried out in 99 (98%) patients by the PHEMS personnel, was appropriate in 92% of the cases. Conclusions: PHEMS personnel need more education and supervising to provide services according to PHTLS guidelines. ÖZET: Amaç: Orta ve düşük gelirli ülkelerde travmayla ilişkili ölümlerin büyük bir bölümünden karayollarındaki trafik kazalarındaki yaralanmalar sorumludur. Hastane öncesi acil tıp ekibi (PHEMS) yaralı kişilere kaza yerinden gidilecek hastaneye kadar nakleder ve bu arada onlara tıbbi bakım sunar. Son zamanlarda gelişmekte olan ülkelerde acil tıbbi bakım ve tedaviyi üstlenenlerle tıp teknisyenleri travma hastalarından alınan sonuçları iyileştirme amacıyla Hastane Öncesi Travma Yaşam Desteği (PHTLS) kılavuz ilkeleri konusunda eğitilmektedir. Yaralanma mahallinde bu personele verilen eğitimin başarı oranına ilişkin bir çalışma yapmaya karar verdik. Gereç ve Yöntem: Çalışmaya acil servise aktarılan ağır travma hastaları alındı. Hasta nakli sırasında geçen süre, hava yolu açılması, omurganın stabilize edilmesi, dış kanama tedavisi, intravenöz (IV) giriş yolu açılması ve sıvı tedavisi değerlendirildi. Değerlendirmelerin tümü acil servisteki acil tıp uzmanı tarafından gerçekleştirildi. Bulgular: Ortalama yanıt verme süresi 17.87±9.1 dakika idi. Acil tıp ekibi, hastaların %60.4'ünün boyun omurlarını stabilize etmiş olup bunların %16.7'si usulüne uygun biçimde gerçekleştirilmemişti. Acil tıp ekibi tarafından %57'si tatminkâr olmak üzere 99 (%98) yaralıya IV damar yolu açılmıştı. Yine 99 (%98) yaralıya verilen sıvı tedavisinin %92'si usulüne uygundu. Sonuç: Acil tıp ekibi, hastane öncesi acil bakım ilkelerine uygun hizmet vermesi için daha fazla eğitim ve denetimden geçmelidir. Key words: Pre-hospital emergency medical service, pre hospital trauma life support, trauma, Anahtar sözcükler: Hastane öncesi acil tıbbi hizmet, hastane öncesi travmada yaşam desteği, travm