پیمان اسدی

Objective (s):

 Pre-hospital emergency centers need proper equipment and facilities to provide adequate and satisfactory services. Therefore, the present study aimed to compare the pre-hospital emergency equipment in Guilan province with the pre-hospital emergency medicine and equipment guidelines of the Ministry of Health of Iran (6th edition).

 This cross-sectional descriptive study was conducted in year 2022. All urban and road pre-hospital emergency centers of Guilan province were assessed (a province in the north of Iran). The conditions of the equipment were checked and determined based on the pre-hospital emergency medicine and equipment instructions of the Ministry of Health of Iran (6th edition). SPSS version 22 software was used for data analysis.

 In all 78 centers were studied. The average score obtained for medical equipment was 556 (76%), non-medical equipment was 46 (63%), and in total, pre-hospital emergency centers scored 602 (75%) from the instructions for medical and non-medical equipment, which is classified as average.

 Comparing the condition of the equipment in pre-hospital emergency ambulances with the directives of the Iranian Ministry of Health showed that there is need for systematic planning to upgrade and improve the quality of the equipment, funding and continuous monitoring, which can lead to improve the quality of pre-hospital emergency services.

Side effects caused by taking medications can have different consequences, ranging from sensitivity to death. Medications used to relieve chronic spasms include baclofen. Poisoning with baclofen is a rare problem, and in poisoning with baclofen, absorption of the drug is longer and more complete, so baclofen in therapeutic doses shows its effect first in the spine, but in higher doses, the drug penetrates more easily and crosses the blood-brain barrier, showing symptoms such as brain death, which is manifested as dilated pupils and their asymmetry, as well as hypotonia and hyporeflexia. Although few studies have reported deaths from baclofen use, poisoning has been associated with baclofen at doses above 270 mg.

Case report:

 The present study reports on a case who, after taking only 50 mg of baclofen, suffered from severe decreased consciousness and drowsiness and whose muscle tone was greatly reduced.

Since albumin, the most abundant protein in the blood, is responsible for the transport of most drugs in plasma, albumin level has a great impact on the pharmacology and pharmacokinetics of the drug in plasma and may cause intoxication in patients. Therefore, it is suggested that nurses pay attention to the blood albumin level as an intervening factor in the patient's response and reaction to treatment with baclofen when examining the patient's condition and providing their care.

 Emergency Medical Services (EMS) personnel are often the first to provide healthcare services to the patient in different situations outside the hospital. Due to the sensitivity of this work, knowledge of ambulance equipment can affect the performance of Emergency Medical Services personnel. 
Objective This study aims to assess the knowledge of pre-hospital EMS personnel in Rasht, Iran about ambulance equipment.

 This cross-sectional analytical study was conducted on 84 EMS personnel who were selected from 17 medical centers in Rasht, Iran using a convenience sampling method. The data collection tool was a two-part questionnaire. The first part surveys demographic characteristics (age, gender, work experience, type of employment, education, field of study, history of retraining courses) and the second part assesses the knowledge of ambulance equipment according to the Pre-hospital Emergency Medicine/Equipment User Manual of Iranian Ministry of Health and Medical Education (fourth edition). The data were analyzed in SPSS v. 22 software and the significance level was set at 0.05. 

Most of participants had a bachelor’s degree, were under permanent employment, and had a degree in nursing and emergency medicine. Their mean work experience was 9.84±6.41 years, and most of them had a history of participating in retraining courses. Their knowledge of ambulance equipment was at a good level. Kruskal-Wallis test showed that their knowledge level had a significant relationship with their type of employment (P<0.001).

 It is necessary to increase the knowledge level of pre-hospital EMS personnel about ambulance equipment by holding short-term training courses and using simulation methods.

Spiritual intelligence leads to understanding between people, calmness, and management of changes. The spiritual intelligence of emergency personnel May affects the correct performance of emergency procedures. This type of intelligence exists in all people, but due to the challenging working conditions of medical staff in the emergency department and the need to do the best work at the best time, it Can be more important. The objective of this study was to evaluate the effect of spiritual intelligence on efficacy of health personnel in the emergency department.

This study was a descriptive cross-sectional study that was performed on 83 medical personnel working in the emergency department of Poursina educational, research and therapeutic center, in Rasht, Iran, in 2021. The sampling method was census. The data were collected using a tool that consisted of demographic characteristics and King's questionnaire. Data were analyzed using SPSS24 software and descriptive statistical methods (frequency, percentage, mean and standard deviation) and Kolmogorov-Smirnov, independent T-test, Pearson test and analysis of variance. The significance level was considered P <0.05.

The mean age of the research participants was 29.15±7.39 years and 47 (56.6%) of participants were female. The findings of the present study showed that people with higher spiritual intelligence had better occupational efficiency than others (P<0.001), but there was no statistically significant relationship between spiritual intelligence with age, sex, marital status, and education.

Medical personnel who had higher spiritual intelligence were more efficient than others. Apart from the effect of spiritual intelligence on reducing people's stress, improving the spiritual intelligence of personnel in critical departments such as emergency can increase their efficiency, especially in difficult situations that require management.

 Safety against disasters and accidents is one of the basic components of preparedness planning for dealing with disasters and it is important for controlling complications or minimizing the risks. The purpose of this research is to analyze the level of safety of Guilan province’s hospitals in dealing with accidents and disasters.

 In this cross-sectional, descriptive-analytical study, all hospitals affiliated to Guilan University of Medical Sciences or Social Security Organization, and private centers of Guilan province in 2021, which were 35 hospitals in total, were evaluated regarding safety and preparedness for facing disasters and accidents. The data was collected using the 150-question national standard tool checklist for evaluating hospital safety index, and the results were presented in the form of points in each component and overall score, preparedness rank, and comparison with the overall average of the province.

 The average relative preparedness in the studied hospitals in facing disasters was 65.66%. The 25 hospitals affiliated to Guilan university of Medical Sciences had 62.36% preparedness and 10 private hospitals affiliated to social insurance had 73.89% preparedness. Out of the 25 hospitals affiliated to Guilan University of Medical Sciences, 3 hospitals had good preparedness, 17 hospitals had average preparedness, and 5 hospitals were had poor preparedness, and among private hospitals and those affiliated to Social Security Organization, 6 hospitals had good preparedness and 2 hospitals had average preparedness.

 A significant portion of the hospitals in Guilan province, like other hospitals in the country, have inadequate preparedness in the face of disasters, and it is necessary and vital to pay attention to the improvement of hospital preparedness in all its dimensions in order to adequately deal with accidents and disasters.

Traumatic brain injury is one of the leading causes of death and disability. Traumatic brain injuries have multifactorial injury mechanisms and are often associated with other injuries. A large proportion of patients who suffer from traumatic brain injury also have facial injuries. Due to the anatomical proximity of the face and skull, patients with facial injuries are expected to be at higher risk for brain injuries. The present study was performed with the aim of investigating the relationship between facial and cranial fractures and brain consequence in head trauma patients.

 This is an analytical cross-sectional study. The study population consisted of patients with skull and facial injuries due to head trauma. Fractures of the skull and face were classified into two categories: mandibular and middle part of the face. Brain consequence was considered as intracranial concussion and injury. Age, sex, mechanism of trauma, time and type of fracture, associated clinical symptoms, and level of consciousness of patients were recorded. Data were analyzed using STATA software.

Out of 1625 patients with head injuries, 958 (60%) suffered facial and skull fractures. 700 people (71%) suffered brain injuries following a head injury, of which only 29% had no brain consequences. 50% of brain outcomes following facial and cranial bone fractures together, cranial bone fractures accounted for 29%, and facial fractures accounted for 21% of total brain outcomes. Most patients had brain concussions. Local pain was the most common symptom (75.2%). Overall, 36% of all facial fractures and 88% of skull fractures resulted in brain outcome.

 There is a direct relationship between cranial and facial bone fractures and brain consequences in head trauma patients and concussion was the most common brain outcome in these patients. Urgent and timely measures are required in patients with skull and facial bone fractures to reduce the consequences and brain damage.

Traumatic brain injuries are one of the main causes of death and disability worldwide. Anemia may lead to worse outcomes in patients with traumatic brain injury. Considering that there have been limited studies on the role of anemia and blood transfusion in primary resuscitation of patients with traumatic brain injuries, the purpose of this study was to investigate the relationship between hemoglobin level and mortality rate in patients suffering from this condition.

This is a retrospective analytical cross-sectional study. The study population consisted of patients with traumatic brain injuries admitted to the emergency department of Poursina Hospital in Rasht, Iran, in 2017. Patients were classified into two groups, according to blood hemoglobin level, anemic (Hb ≤10) and non-anemic (Hb>10). Age, sex, clinical information, treatment measures, duration of hospitalization, and mortality rate in these two groups were recorded and compared. Also, in order to determine the risk factors for mortality in patients with traumatic brain injury, the above variables, along with laboratory findings, were compared in the two groups of patients with survival and death. Data were analyzed using SPSS21 software, and descriptive and inferential statistical tests.

The total number of participants in the study was 297 (249 (83.8%) male and 48 (16.2%) female), with a mean age of 41.8 ± 22.3 years. 120 (40.4%) patients had anemia. Patients without anemia had higher levels of consciousness than those with anemia (P <0.001). There was a statistically significant difference between the anemic and non-anemic patients in terms of the use of vasopressor and patient status at discharge (P <0.0001). The number of packed cells received showed a statistically significant difference between the patients with and without anemia (P <0.0001). Multivariate analysis based on logistic regression model showed that the duration of hospitalization, hypotension, blood transfusion, and hypothermia are risk factors associated with mortality.

The results of this study showed that although anemia is not a predictor of mortality, but blood transfusion is one of the most important factors associated with mortality in patients with traumatic brain injury.

Occupational burnout is more likely to be caused in occupation, including medicine, due to their stressful nature and has wide effects on individuals᾽ performance. Despite the high level of burnout among professor and residents of emergency medicine, few studies have compared burnout between the two groups in Iran.So this study with the aim of comparing occupational burnout of professor and residents of emergency medicine in the educational and medical centers of Iran University of Medical Sciences in 2018 has been done.

In this analytical cross-sectional study Maslach 1981 (MBI-22) burnout questionnaires with questions regarding demographic characteristics of subjects were used. The sampling method was cluster random sampling across Iran. Data was analysed by independent t-test, One-way ANOVA and chi-squre using SPSS.

Totally, 81 professors and 95 residents participated in the present study. The mean of the component of depersonalization of the professors was 54.05± 22.80 and the resident was51.73± 24.73, the average component of the emotional exhaustion of the professors was33.40 ± 14.77 and the residents was32.84 ± 13.20 and the average component was the Lack of personal accomplishment‏‏ of the prof 39.41±10.23 and the resident was 9.56± 0.98.There was no significant difference in all three components and prof and Resident were equal. According to the regression model, Residents' job burnout with gender variables (P = 0.02) and Having a child (P = 0.02) and the number of on call per month (P = 0.08) had a significant relationship.

According to the results, the level of burnout among medical emergency professors and residents is high and this affect the quality of caring and educational process of medical emergency and consequently disturb these process. Based on the results on the curriculum of these students, it was necessary to make the necessary corrections to reduce burnout and improve quality of life.

Olanzapine (2-methyl-4-(4-methylpiperazin-1-yl)-10H-thieno [2, 3-b][1, 5]benzodiazepine) is an antipsychotic drug with poor water-solubility that has a suitable affinity to some receptors. This benzodiazepine derivative is a new (atypical) antipsychotic drug and has a wide range of efficacy, especially in treatment of patients with negative psychiatric symptoms of schizophrenia. Olanzapine is used in psychotic disorders, mood disorders, and acute restlessness in bipolar patients. Its oral absorption is low and about 40% of the drug is metabolized in first-pass hepatic metabolism. This drug has low permeability into the brain related to remove by p-glycoprotein efflux and blood-brain-barrier (BBB) existence. Emerging nanotechnology during recent years demonstrated the tremendous ability of nanoparticles as versatile nanocarrier systems. This emerging technology has raised promising attempts to address the significant impact on decreasing side effects of drugs and their associated defects. Olanzapine can be administrated by different routes. Intranasal delivery of olanzapine to the brain due to lack of blood-brain-barrier in the olfactory system has facilitated its delivery. In this review article, several olanzapine nano-drug delivery systems are listed by reviewing their results, including nanosuspensions, nanoemulsions, solid lipid nanoparticles (SLN), niosomes, transfersomes, nanostructured lipid carriers (NLC), polymeric nanoparticles (PNP), etc.

The concept of job satisfaction is an important phenomenon in the field of health care. Lack of job satisfaction will have negative effects on the performance of people. Pre-hospital emergency personnel face a lot of stressful situations during their work day. These stresses will definitely affect the quality of their work. In this study, the relationship between job satisfaction and occupational stressors was assessed among the pre-hospital emergency personnel of Rasht city in 2017.

This research was a cross-sectional descriptive study and the study population of the present investigation consisted of all technicians of Rasht’s urban emergency stations. The required information in the study was obtained from individuals using 3 questionnaires. In this study, demographic data, job satisfaction, and occupational stress questionnaires were used.

Most of the studied participants were in the age group of 31 to 40 years and in terms of education level, the majority had a bachelors’ degree (52.2%). The highest level of satisfaction was observed in the field of colleagues with a mean of 3.71 and a median of 3.75. The lowest level of satisfaction was observed in the field of salary. The highest level of stressors was related to the field of patient care with a mean of 3.04 and the median of 3.16 and the lowest level of stressors was related to interpersonal stressors with a mean of 2.62.

From the findings of this study, it can be concluded that pre-hospital emergency personnel will be more satisfied if they face less occupational stress, so the level of satisfaction of pre-hospital emergency personnel can be improved by reducing these factors. Health system policymakers can increase pre-hospital emergency personnel’s job satisfaction by paying more attention to their salaries and benefits. They can also help emergency technicians increase the quality of their working life and improve their performance by providing solutions to reduce their occupational stress.

Given the importance of emergency medical technicians' performance in saving lives and considering rapid advancements in medical sciences, there is a need for technicians to gain new specialized knowledge through acquiring the necessary skills and undergoing trainings in these areas. Additionally, making improvements in the quality of services provided by the emerency medical services (EMS) personnel in accidents and emergencies necessitates determining their level of knowledge, attitude, and skill and assessing their educational needs. Therefore, the purpose of this study was to determine the educational needs of operational pre-hospital emergency personnel in Rasht city in 2019-2020.

This study was a descriptive cross-sectional study carried out in 2019-2020. The statistical population of this survay consisted of all the pre-hospital emergency service personnel in Rasht, with Associate, Masters, and higher degrees; all of whom were included. The sampling method was census. The data was collected using a questionnaire that measured the training needs of Rasht Emergency Center staff in five domains of management, communication, evaluation skills, equipment, and operational skills.

Training needs of the pre-hospital emergency operations staff in the five domains of management, communication, evaluation skills, equipment, and operational skills were 41.21±22.27, 41.94±21.1, 48.29±22.69, 40.29±21.48, and 76.87±18.22, respectively.

Overall, the educational needs of the studied pre-hospital emergency personnel were high, and training classes should be designed to meet these training needs.

Pelvic fracture is the second most common cause of death in patients with multiple trauma, after head trauma. The present study was performed with the aim of determining the frequency of genitourinary tract injuries in patients with pelvic fractures referring to Poursina Hospital, Rasht, Iran, so that the initial steps required for treating patients (with pelvic fractures) in the emergency department can be specified.

In this retrospective study, the records of 170 patients with pelvic fractures, who referred to Poursina Hospital in Rasht from the beginning of January 2018 until the beginning of January 2019 were reviewed. Using the prepared checklist and based on the patient's clinical examination by the resident, information including age, sex, level of education, presence or absence of hematuria, type of trauma, and type of pelvic fracture were collected. Data were analyzed using STATA - Se v 13.1 software.

Out of the 170 patients referring to the hospital due to pelvic fracture, 70% were male. The patients’ mean age was 45.02 ± 20.10 years and their mean length of hospital stay was 8.11 ± 7.13 days. Motor vehicle accidents were the most important cause of pelvic fractures and urethral injury. Fifty-five patients (33.4%) with pelvic fractures had a genitourinary tract injury. Hematuria was present in 48 of them, and blood at the tip of the meatus and perineal hematoma were symptoms that were significantly associated with genitourinary tract injury following pelvic fracture.

Considering the relatively high prevalence of genitourinary tract injury in pelvic trauma, it is best to perform a complete examination in all patients who present with high-energy trauma, especially in people with pelvic fractures; and if any of the above-mentioned symptoms are observed, genitourinary tract injuries should be suspected and the location of the injury should be further investigated and treated.

Burn injuries are one of the most important causes of disability and death, which can endanger health and also have severe economic and social consequences in human societies. The aim of this study was to determine the knowledge of pre-hospital emergency personnel in Rasht, Iran, in dealing with burn patients in 2018-2019.

The present study was a cross-sectional-descriptive one, and the study population consisted of all pre-hospital emergency personnel in Rasht in 2018. The sampling method of the study was census and the tool used in the study was a questionnaire, which evaluated the demographic information of the personnel in the first part, and in the second part of the questionnaire, participants' awareness was assessed using 15 questions. Data analysis was performed using descriptive and inferential tests and a significance level of p <0.05 was considered.

The majority of staff had between 10-20 years of work experience (33.7%), and in terms of education, most of them were undergraduates (44.2%). The majority had encountered burn cases (62.1%), and had underwent training in relation to burn injuries (69.1%). In terms of knowledge status, only 3.2% (3 people) had good knowledge (score above 10) and the majority had moderate knowledge (53.7%) or poor knowledge (43.2%).

Due to the fact that the level of knowledge was moderate in the majority of the studied pre-hospital emergency personnel, proper planning should be done to hold training courses.

Nowadays one of the most important dangers that affect health promotion and societies developing is increasing of the traffic accidents thus we decided to assess the epidemiological aspects of the traffic accidents helped by EMS in Guilan 2013-2017.

The present study is a cross-sectional analytical study. A survey of 82432 emergency driving accidents was carried out by emergency departments in 115 provinces in the years 1995-1995. Verification of mission sheets completed by emergency technicians. The information collected is a checklist that includes age, gender, The location of accidents (urban, urban road, rural roads), injured condition (driver, pedestrian, occupant, motorcyclist, ...) and severity of injuries and driving accidents season were completed by statistical software spss19 and statistical analyzes of chisquer, ttest and In order to observe ethical standards in research, and based on the objective of studying information The tabs 115 emergency mission completed, the profile of clients is confidential and inaccessible to outsiders.

The results of this study showed that with regarding to14/4 % increasing in the prevalence of traffic accidents and helping to the injured people by EMS, in 2013-2017 in front of 2013-2017. (74.5%) of the patients were male and (25.4%) were female. Most of patients were in the age range of 18 to 24(11.2 %) years old.The most traffic accidents were (53%) cases that occurred in the country side roads. The most of the patients´ situation in males were motor accidents in (11/2%). Among the all the injured people (57.7%) were admitted in the hospital and (42.2%) were treated as outpatients.

presented that most of the injured people were young motor drivers, that represents the high prevalence of using it among guilan province young peoples and being inattention to thetraffic rules,need to necessary attention to prevention of this problem.

Nowadays one of the most important dangers that affect health promotion and developing in society is increasing of the traffic accidents. Traffic accidents one of the most causes of mortality due to trauma in the world and Iran. With regarding to increase of incidence of traffic accidents, we decided to assess the mortality due to traffic accidents in guilan province in 2011-2012.

in this descriptive cross sectional study the samples include all the people died due to traffic accidents in 2011-2012.Sampling method is numb ration. For each person a check list include sex, month of accidents occurrence, site of death (accidents site, in ambulance, hospital and the house), site of accidents(in the city, out of the city and the country road), cause of death(head trauma, bleeding, multiple trauma, burning and etc) and the city of accidents occurrence were recorded. Data was inserted in SPSS Ver 17 and analyzed.

There was 1620 death due to traffic accidents in guilan province in 2011-2012. Among them 1329 (82%) were male and 291(18%) were female.1147 (70/8%) of all accidents occurred in the city road about the site of death864 (53/3%) in accidents site. Data about the cause of death showed that941 (58/1) of persons died due to head trauma. The most prevalent season of the accidents as autumn458 (28/3) and about the month of death mehr170 (10/5).

Results of this study showed that the most of death occurred in the months of season summer. With regarding to these subjects it was advised that educational prevention and the efforts of all the organs in traffic accidents will be noted.