The Necessity of Evaluating the Stability of Pre-Hospital Emergency Service Drugs in Different Climates

One of the indices of development in a society is providing the necessary healthcare for all people. One of the most important pillars of healthcare is emergency care, especially the pre-hospital type. Pre-hospital emergency care starts on the patient’s bedside and ends in the emergency service of a hospital. Emergency organizations train 4 groups for providing emergency service and pre-hospital care: 1) first responder; 2) emergency medical technician (EMT)-Basic; 3) EMT-Intermediate; 4) EMT-Paramedic. Prescribing drugs for the patients in need is one of the many responsibilities of the last 2 groups (EMT-Intermediate and EMT-Paramedic) that treat many patients each year. Proper and timely use of drugs can minimize threats to patients’ lives and keep them from dying. It is obvious that those who use drugs for treating patients need to have a safe deposit of drugs in addition to accurate and correct information to be able to take the first step of treatment correctly and safely. Currently, all emergency drugs in pre-hospital emergency care of Iran are kept in a box with no insulation and in an environment with temperature changes. Although some drug companies do not consider little changes in temperature as a cause of change in drug effectiveness, the conditions in medical emergencies are very different and harder than laboratory environments. In some countries including Iran, the temperature of the ambulance cabin may vary from -30°C in winter in Ardebil to +65°C in summer in Khouzestan. However, world health organization (WHO) suggests storing drugs in a dry environment between 15°C and 25°C and based on the climate of the region up to a maximum of 30°C. Little data exists regarding the stability of drugs in changing temperatures. Johansen et al. carried out a study in this regard on atropine, naloxone, and lidocaine in Utah in 1992 and reported that no considerable change was found in the concentration of drugs. In 2005, Priston et al. carried out a study in the UK on 11 drugs in -15°C and found that some of the drugs have relatively lower stability if frozen. In addition, in the drug instructions of some drugs including atropine, calcium, and morphine the highest storing temperature is indicated to be 30°C and nebulized albuterol should also be stored in 25°C. Obviously, drug treatment is very important in pre-hospital emergency services, which in turn is the first line of treatment in medical emergencies, accidents and disasters and sometimes an injection of atropine or adrenaline can save someone’s life at the onset of a problem. Therefore, the effect of extreme climates of some provinces in Iran on the effectiveness and safety of the drugs used in pre-hospital emergency services should be studied and evaluated. The authors have decided to point out the importance of drug stability in pre-hospital emergency service in various climates hoping that researchers who have the ability and equipment for doing this research evaluate this topic so that the obtained results are shared with managers and any possible corrective measures needed are taken

لزوم بررسی پایداری داروهای اورژانس پیش بیمارستانی در اقلیم های متفاوت

One of the indices of development in a society is providing the necessary healthcare for all people. One of the most important pillars of healthcare is emergency care, especially the pre-hospital type. Pre-hospital emergency care starts on the patient’s bedside and ends in the emergency service of a hospital. Emergency organizations train 4 groups for providing emergency service and pre-hospital care: 1) first responder; 2) emergency medical technician (EMT)-Basic; 3) EMT-Intermediate; 4) EMT-Paramedic. Prescribing drugs for the patients in need is one of the many responsibilities of the last 2 groups (EMT-Intermediate and EMT-Paramedic) that treat many patients each year. Proper and timely use of drugs can minimize threats to patients’ lives and keep them from dying. It is obvious that those who use drugs for treating patients need to have a safe deposit of drugs in addition to accurate and correct information to be able to take the first step of treatment correctly and safely. Currently, all emergency drugs in pre-hospital emergency care of Iran are kept in a box with no insulation and in an environment with temperature changes. Although some drug companies do not consider little changes in temperature as a cause of change in drug effectiveness, the conditions in medical emergencies are very different and harder than laboratory environments. In some countries including Iran, the temperature of the ambulance cabin may vary from -30°C in winter in Ardebil to +65°C in summer in Khouzestan. However, world health organization (WHO) suggests storing drugs in a dry environment between 15°C and 25°C and based on the climate of the region up to a maximum of 30°C. Little data exists regarding the stability of drugs in changing temperatures. Johansen et al. carried out a study in this regard on atropine, naloxone, and lidocaine in Utah in 1992 and reported that no considerable change was found in the concentration of drugs. In 2005, Priston et al. carried out a study in the UK on 11 drugs in -15°C and found that some of the drugs have relatively lower stability if frozen. In addition, in the drug instructions of some drugs including atropine, calcium, and morphine the highest storing temperature is indicated to be 30°C and nebulized albuterol should also be stored in 25°C. Obviously, drug treatment is very important in pre-hospital emergency services, which in turn is the first line of treatment in medical emergencies, accidents and disasters and sometimes an injection of atropine or adrenaline can save someone’s life at the onset of a problem. Therefore, the effect of extreme climates of some provinces in Iran on the effectiveness and safety of the drugs used in pre-hospital emergency services should be studied and evaluated. The authors have decided to point out the importance of drug stability in pre-hospital emergency service in various climates hoping that researchers who have the ability and equipment for doing this research evaluate this topic so that the obtained results are shared with managers and any possible corrective measures needed are taken. یکی از معیارهای توسعه جوامع، ارائه مراقبت های بهداشتی درمانی لازم به تمام مردم است. یکی از مهمترین ارکان مراقبت های درمانی را مراقبت های اورژانسی به خصوص نوع پیش بیمارستانی آن تشکیل می دهند. مراقبت های پیش بیمارستانی به مواردی می گویند که از بالین بیمار شروع و در بخش اورژانس بیمارستان ختم می شوند. سازمان های اورژانس جهت ارائه خدمات اورژانسی و مراقبت های پیش بیمارستانی خود 4 گروه را تربیت می کنند: 1) امدادگر اورژانس (First responder) ؛ 2) تکنسین اورژانس پایه (EMT – Basic)؛ 3) تکنسین اورژانس میانی (EMT - Intermediate)؛ 4) تکنسین اورژانس پیشرفته (EMT - Paramedic). تجویز دارو برای مصدومین و بیماران نیازمند یکی از چندین وظیفه دو گروه آخر یعنی تکنسین های اورژانس میانی و پیشرفته می باشد که سالانه خواه یا ناخواه تعداد زیادی از بیماران و مصدومان را مورد درمان قرار می دهند. استفاده صحیح و به موقع از داروها می تواند بسیاری از خطرات جانی که برای مددجو یا حادثه دیده ایجاد شده را به حداقل برساند و مددجو را از خطر مرگ برهاند. کاملا آشکار است که افرادی که از دارو جهت درمان بیماران استفاده می کنند، علاوه بر داشتن اطلاعات دقیق و صحیح، باید منابع دارویی مطمئنی نیز در اختیار داشته باشند تا بتوانند گام اول در درمان را درست و با اطمینان بردارند. در حال حاضر کلیه داروهای اورژانسی در فوریتهای پزشکی کشور ما در یک جعبه بدون عایق و در شرایط متغیر دمایی نگهداری می گردند. هر چند بعضی شرکت های دارویی تغییرات کم و متغیر دمایی را دلیلی بر از بین رفتن مواد موثر داروها نمی دانند اما شرایط در فوریتهای پزشکی بسیار متفاوت و سخت تر از شرایط آزمایشگاهی می باشد. در برخی کشورها از جمله کشور ایران بعضاً دمای هوای کابین آمبولانس در زمستان از 30- درجه در اردبیل تا 65+ درجه در گرمای تابستان در خوزستان می تواند متفاوت باشد. این در حالی است که سازمان بهداشت جهانی توصیه می کند داروها در یک محیط خشک بین 15 الی 25 درجه و بسته به اقلیم و آب و هوای منطقه تا حداکثر 30 درجه سانتیگراد نگهداری شوند. اطلاعات کمی مبنی بر مقاومت داروها در شرایط دمایی متغیر موجود است. جانسون و همکاران در ایالت یوتای آمریکا در سال 1992 پژوهشی آزمایشگاهی بر روی سه داروی آتروپین، نالوکسان و لیدوکایین به همین منظور انجام دادند و بیان نمودند که تغییر قابل ملاحظه ای در غلظت داروها مشاهده نشد. ملانی جی و همکاران در سال 2005 در انگلستان پژوهشی روی 11 دارو در دمای 15- درجه سانتیگراد انجام دادند و دریافتند برخی از این داروها در صورت انجماد پایداری شان نسبتا کاهش می یابد. همچنین در دستورالعمل دارویی برخی داروها از جمله آتروپین، کلسیم و مورفین حداکثر درجه حرارت قابل ذخیره سازی 30 درجه سانتیگراد می باشد و همچنین اسپری آلبوترول (nebulized albuterol) نیز باید در دمای 25 درجه سانتیگراد نگهداری گردد.بدیهی است دارو درمانی در فوریتهای پزشکی، که خود نیز خط اول درمان در اورژانسهای پزشکی، حوادث و بلایا می باشد، بسیار با اهمیت است و بعضا تزریق یک داروی آتروپین و یا آدرنالین می تواند جان انسانی را در لحظه اول بیماری نجات دهد. بنابراین بررسی تاثیر شرایط سخت اقلیمی برخی استانها بر کیفیت و سلامت داروهای مورد استفاده در اورژانس پیش بیمارستانی، نیازمند تحقیق و بررسی می باشد. نویسندگان در نظر دارند تا اهمیت بررسی پایداری داروهای اورژانس پیش بیمارستانی در شرایط اقلیمی متفاوت را گوشزد نموده، به امید اینکه محققان محترمی که توانایی و امکانات انجام چنین کاری را دارند بتوانند به بررسی این موضوع بپردازند تا نتایج احتمالی به سمع و نظر مدیران رسانده شود تا اقدامات اصلاحی در صورت لزوم انجام گردد

مواجهه شغلی با وسایل تیز و برنده در پرسنل اورژانس پیش بیمارستانی؛ یک مطالعه اپیدمیولوژیک

Introduction: Sharp tools are among the major risk factors for transmission of blood borne infections. Therefore, the present study was carried out with the aim of determining epidemiologic aspects of occupational exposure and injury with sharp tools in emergency medical service (EMS) of Dezfoul, Iran, in 2014-2015. Methods: This cross-sectional study was carried out on 140 EMS staff who met the inclusion criteria, using census method. The tool used for data gathering was a questionnaire prepared by the researcher including demographic and personal health data, prevalence and cause of injury with sharp tools, knowledge, mental state, reporting exposure, measures taken, and follow-ups. Data were analyzed using statistical tests such as chi square. Results: Overall, 75% of the participants had been exposed to sharp tools at least once in the past year. Most injuries had occurred during venipuncture of the patient (41.09%). 54.2% of all exposures had happened during transfer. In addition, sadly, 63.9% of the exposures of the staff to patients’ infected secretions were not reported. 63% of injuries with sharp objects had occurred in the night shift. There was a correlation between working experience and frequency of exposure (p=0.02, r=0.19). Conclusion: The results of the present study are indicative of the high occupational exposure to sharp tools among staff of the studied EMS, a significant number of which had not been reported. مقدمه: وسایل تیز و برنده از عوامل خطر عمده برای انتقال عفونت های منتقله از راه خون می باشد. از این رو این مطالعه با هدف تعیین جنبه های اپیدمیولوژیک مواجهه شغلی با وسایل تیز و برنده در اورژانس پیش بیمارستانی شهر دزفول، ایران در سال 94-1393 انجام شد. روش کار: این پژوهش مقطعی بر روی 140 نفر از پرسنل فوریتهای پزشکی که معیارهای ورود به مطالعه را داشتند، به روش سرشماری انجام شد. ابزار جمع آوري اطلاعات پرسشنامه ای محقق ساخته شامل مشخصات دموگرافیک و سلامت فردي، شیوع و علل مواجهه با وسایل تیز و برنده، میزان آگاهی، شرایط روحی – روانی، گزارش مواجهات، اقدامات و پیگیری ها بود. داده ها با استفاده از آزمونهای آماری از جمله کای اسکوئر تجزیه و تحلیل شد. يافته ها: بطور کلی 75 درصد از شرکت کنندگان در یک سال گذشته حداقل یکبار با وسایل تیز و برنده مواجهه داشتند. بیشترین مواجهه (09/41 درصد) حین رگ گیری از بیمار بود. 2/54 درصد از کل مواجهات در حین انتقال اتفاق افتاده بود. همچنین 3/69 درصد از مواجهه پرسنل با ترشحات آلوده بیمار متاسفانه گزارش نشده بودند. 63 درصد مواجهات با وسایل تیز و برنده در شیفت شب اتفاق افتاده بود. بین سابقه کاری و فراوانی مواجهات همبستگی وجود داشت (19/0=r، 02/0=p). نتيجه گيری: نتايج مطالعه حاضر حاكي از بالا بودن ميزان مواجهات شغلی با وسایل تیز و برنده بین پرسنل فوریتهای پزشکی مورد مطالعه بود که تعداد قابل توجهی از این موارد گزارش نشده بودند

Occupational Exposure to Sharp Tools in Emergency Medical Service Staff; an Epidemiologic Study

Introduction: Sharp tools are among the major risk factors for transmission of blood borne infections. Therefore, the present study was carried out with the aim of determining epidemiologic aspects of occupational exposure and injury with sharp tools in emergency medical service (EMS) of Dezfoul, Iran, in 2014-2015. Methods: This cross-sectional study was carried out on 140 EMS staff who met the inclusion criteria, using census method. The tool used for data gathering was a questionnaire prepared by the researcher including demographic and personal health data, prevalence and cause of injury with sharp tools, knowledge, mental state, reporting exposure, measures taken, and follow-ups. Data were analyzed using statistical tests such as chi square. Results: Overall, 75% of the participants had been exposed to sharp tools at least once in the past year. Most injuries had occurred during venipuncture of the patient (41.09%). 54.2% of all exposures had happened during transfer. In addition, sadly, 63.9% of the exposures of the staff to patients’ infected secretions were not reported. 63% of injuries with sharp objects had occurred in the night shift. There was a correlation between working experience and frequency of exposure (p=0.02, r=0.19). Conclusion: The results of the present study are indicative of the high occupational exposure to sharp tools among staff of the studied EMS, a significant number of which had not been reported

Triage live lecture versus triage video podcast in pre-hospital students’ education

Introduction: Triage is the process of determining the priority of patients’ treatments based on the severity of their conditions. The aim of the present study was to survey the effect of triage video podcasting on the knowledge and performance of pre-hospital students. Methods: Sixty pre-hospital students were randomly divided into two groups of a 30-subject control group and a 30-subject intervention group. A pre-test was administered among all students. Afterwards, for the first group, triage education was offered through lectures using PowerPoint, while for the second group, audio and video podcasts tailored for this training program were employed. Right after the training as well as one month later, post-tests were run for both groups, and the results were analysed using an independent t-test and covariance. Results: No significant difference was observed between the effects of both types of education on knowledge and performance, either immediately, or one month after training. Discussion: We suggest that video podcasts are ready to replace traditional teaching methods in triage. Keywords: Triage, Lecture, Podcast, Pre-hospital, Education, Emergenc

The Incidence of Lung Cancer and Smoking in Iran, Turkey, England, and the USA: A Comparative Study

Objectives: Lung cancer is the deadliest and the costliest cancer in the world. In this study, we compared the situation of this disease in several countries by considering the most important risk factor of lung cancer (smoking). Methods: This is a comparative study, a comprehensive one which was done on lung cancer rates in four countries: Iran, Turkey, England, and the USA, during the past twenty years (2002-2021). Age-standardized rate (ASR) index and the percentage of smokers were extracted from available information in the World Health Organization (WHO) databases, The Organization for Economic Co-operation and Development (OECD) Health Statistics 2021, and other valid related articles. After comparison, control procedures were examined. Results: England, with an ASR of 46, has the highest rate of lung cancer, and Iran, with an ASR of 21, has the lowest rate. Turkey has the highest percentage of smokers (29.3%), and the lowest percentage belongs to Iran (20%). Regarding the increasing trend of the ASR index, lung cancer in Iran and Turkey has had an upward trend, and England and the United States have a downward trend. Taxes on cigarettes are a significant factor in smoking reduction. Among these 4 countries, the lowest cigarette tax belongs to Iran (4.83%). Discussion: The result of this study shows that the incidence of lung cancer in Iran is rising, so following successful countries in imposing cigarette taxes can be an effective step to reduce smoking. Training programs, cultural improvement, and new diagnostic methods can also be useful in reducing lung cancer ASR