کتایون جهانگیری

 Service delivery in the health sector often takes place in a tense atmosphere, which makes violent behavior among employees a common occurrence. Therefore, this study aimed to investigate the experiences of students and clinical and non-clinical staff who faced violence from their colleagues in one of the educational hospitals in Tehran.

 This descriptive-analytical research was conducted in a general hospital in 2018. The sample consisted of 468 students and employees working in clinical and non-clinical departments, selected using a stratified sampling method. Data were collected through a 31-question questionnaire with proven validity and reliability (α=0.8). The data was then analyzed using SPSS software.

 About 50% of the participants reported experiencing violence. Mental and verbal violence were the most common types of violence experienced by students and employees, respectively. The violence was often within the same group as the victim, and resulted in the silence. Students and clinical staff expressed a greater desire for support and countermeasures. Lower levels in the organizational hierarchy was associated with a significant increase in the chance of encountering violence (p<0.05). Administrative staff experienced violence significantly more frequently than hospital support and maintenance staff (p<0.05).

 Given the high prevalence of violence, it is recommended to implement solutions such as training, developing acceptable codes of conduct, implementing tension and wellness management programs, delegating the responsibility of dealing with violence cases to committees, and using safety officers and psychologists to prevent and monitor the problem effectively.

 Hospital and patient safety is a global necessity and efforts to evaluate the readiness of hospitals in emergencies and crises are essential in every country. The purpose of this study is to investigate the Farsi Hospital Safety Index (FHSI) in the teaching hospitals of Tehran University of Medical Sciences in a four- year period from 2018-2021.

 This research is quantitative, descriptive, cross- sectional and applied. By census method, all 14 teaching hospitals of Tehran University of Medical Sciences were selected from 2018-2021. The completed FHSI tool of these hospitals in the mentioned 4 years was examined. In this evaluation tool, there are 3 sections: structural safety (18 items); non- structural safety (93 items); and emergency and disaster management (40 items). In the analysis of the results, descriptive statistics indicators of average and percentage in spss 22 have been used. High safety score or category a (66% - 100%), medium safety score or category B (36% - 65%) and low safety score is grade C (0% - 35%).

 The average total FHSI index in these hospitals in the mentioned 4 years was 67.97% ± 0.97, which has increased from 67.49% in 2018 to 69.11% in 2021 and has increased in category A. The non- structural safety score has reached 66.44% ± 1.16% with an average of 4 years, from 64.84% in 2018 to 66.99% in 2021, the structural safety score is 70.27% ± 1.52% with a 4-year average. From 71.67% in 2018 to 70.77% in 2021 and the safety score of emergency and disaster management, with an average of 4 years of%64.52 ± 3.14, from 61.01% in 2018 to 68.12% it reached in 2021.

 Considering that the safety rating of university teaching hospitals in emergencies and disasters is at a high level and they are able to continue working, but considering the importance of these hospitals in Tehran 3 province and the country, it is recommended that policy makers of universities and hospitals, by improving safety in systems Fire protection and water supply, increasing communication channels, providing necessary training to managers and hospital staff, and allocating funds in three dimensions, structural, non-structural and emergency management, put preventive, mid- term and long-term measures on the agenda.

  Parking areas that are gathering places for tank trucks are potentially dangerous places. This study analyzes accident consequences of oil products carriers, to check and compare the hazard radius with recommended separation distances.

This descriptive-analytical study was carried out in 5 stages, including: scenario selection, determination of the accidents source parameters, determination of atmospheric conditions, selection of reference values, and modeling the analysis of scenarios and its consequences. The process hazard analysis software tool (PHAST) is used to analyze the consequences of accidents in liquid petroleum gas and gasoline tankers.

  Based on average values, the appropriate separation distances are 50±25.8 m and 361.4±184.8 m for leakage and catastrophic rupture of a liquefied petroleum gas (LPG) tanker, and 28.3±14.9 m and 571.2±137.6 m for leakage and catastrophic rupture of a petrol tanker, respectively. The separation distance based on the catastrophic rupture is so large that it is not practical for the design and management of road tanker parking area. According to the leakage scenario, a safety distance of 28.3-50 m is required. Separation distance based on catastrophic rupture is so great, it has no applicability in designing and managing road tanker parking areas. According to the leakage scenario, a safety distance of approximately 28.3-50 m is needed.

 With the existing separation criteria a tanker accident may spread to other parts of the parking lot and it can lead to a disaster. Therefore, it seems necessary to review and update the guidelines and standards in parking lot design and separation distances as well as emergency planning.

National Disaster Response Framework has been developed in order to properly direct the operation process and response to various types of disasters in the health system in order to use this framework to unify the guidelines related to disaster risk management and according to the current structures. , Related laws and regulations are implemented. The aim of this study was to investigate the effectiveness of the implementation of the national program of the health system response to disasters and emergencies based on the views of healthcare providers working at North Khorasan University of Medical Sciences in 2021.

This descriptive-analytical study was conducted in 1400. The target population was healthcare providers. The data collection tool was a researcher-made questionnaire with two areas of preparation and response, which was designed and developed according to the areas of the National Health System Response Program. SPSS software version 22 was used for data analysis and logistic regression was used to analyze the data to examine the relationship between variables. In this study, the principles of the Helsinki Declaration were considered.

The number of participants in this study was 453, of which 146 (32.2%) were male and the rest were female. 65.6% of the participants in this study considered the effectiveness of the national health system response program in disasters and emergencies as favorable. The effectiveness of effectiveness in the field of preparedness was equal to 66.7% and in the field of response 55.6%. According to the results of multivariate logistic regression tests, there is a significant relationship between the experience in disaster situations, responsibilities in disasters, city of providing care, place of employment with effectiveness score status, and sub-areas of preparedness and response.

It seems that the national response plan is far from achieving the desired results in terms of the areas under study, and measures such as staff training, in-service orientation courses, and training should be provided to increase staff preparedness to deal with the crisis.

Patient safety is a global concern in the field of health services and an essential component of the quality requirements of health care, so the present study aimed to assess the level of patient safety substructures in three selected Mashhad’s teaching hospitals in 2017.

This Descriptive-Analytical and cross-sectional study was performed using WHO patient safety assessment protocol as a research tool. The study population consisted of senior and middle managers, staff, physicians, and patients of hospitals that a total of 54 sample people were selected by purposeful sampling method. Questionnaire data were collected by observation, review of documents, completion of checklists and structured interviews, and then analyzed through descriptive and analytical tests using version 21 of SPSS software.

In this study, a total of 20 critical patient safety standards were evaluated, the overall average level to achieve the standards was calculated to be 75.8%. Among the four domains studied, the domain of governance and leadership with a ratio (83.3%) had the best and the domains of a safe environment and patient and community participation with a ratio (50%) had the weakest status. There was no statistically significant difference between the three hospitals in terms of the level of compliance with the standards (p <0.05).

In general, the overall situation of patient safety substructure hospitals was evaluated at a relatively good level. The commitment of senior managers to the priority of patient safety, improving staff training, and increasing the informed participation of patients and companions to eliminate weaknesses and improve the current situation, can qualify for the title of patient safety friendly hospital for these hospitals that have a special place in the field of health tourism in the region and country

After natural disasters the likelihood of outbreak of infectious diseases especially water and foodborne diseases, increases due to population displacement, increasing risk factors, environmental changes, changing living conditions and increasing vulnerability to pathogens. This research was conducted with the aim of designing a model for controlling the outbreak of water and foodborne diseases after natural disasters in Iran.

This study is an applied research that was done in mixed methods and seven stages. The first stage was conducted as a descriptive cross-sectional study. Confirmatory factor analysis was used to validate the initial model. Data were analyzed by SPSS23 and LISREL9.1 software. The relations of variables were extracted by using structural equation modeling (SEM) and the validity of the model was confirmed.

Generally, 6 factors have been identified that affect the control of the outbreak of water and foodborne diseases after natural disasters, including: human resources, syndromic surveillance system, management, public education, logistics and equipment, and national program.

Developing policies and guidelines at a national level, planning and determining the resources and local management structure, increasing knowledge and improving attitudes and skills at individual level, situational analysis, providing resources and equipment based on type of risk, continuous education and exercises, reinforcement syndromic surveillance system order to manage and control the outbreak of water and foodborne diseases after natural disasters, can be considered as proposed strategy.

 Crush injury may follow prolonged continuous pressure on muscle tissue. It can lead to crush syndrome. Ischemia reperfusion is the main mechanism of muscle injury in crush syndrome. Acute renal failure and Compartment syndrome are the most important side effects of crush syndrome. This case report introduced 24 years old woman who was affected by crush syndrome after her leg crush. After that, Patient leg's compartment became ischemic, and compartment syndrome was developed. Delayed fasciotomy and subsequent reperfusion syndrome caused acute renal failure and severe limb edema caused muscles necrosis. Subsequently, acute necrotizing fasciitis developed. Finally, the patient was rescued from death by crushed limb amputation. As a result, in such cases the key point is managing and predicting clinical conditions before they present themselves. Amputation at an early stage may prevent crush syndrome. Developing standard treatment protocol and providing training courses for clinicians and health care providers can prevent similar problems.

 

The concept of safety culture was first used in the 1987 report of the Nuclear Agency on the Chernobyl disaster, and then the weakness of the safety culture was identified as the cause of the major disasters. Since the creation of the word safety culture in this report, it has been widely used and described and practically evaluated for its popularity. Safety culture defines as a group and individual values, attitudes and beliefs, capabilities, and behavior patterns that determine the commitment, manner, and skill of the organization's health and safety management.

A descriptive-analytical cross-sectional study was conducted on automotive workers for evaluating the status of their safety culture. The target population was employees of the automobile industry of an Iranian automobile company (SAIPA) in 2014.

The results of this study showed that there was no relationship between safety culture and marital status. It was found that people with a college education had a significantly lower level of safety culture than those with a high school diploma or lower (P<0.05). There was a positive relationship between work experience and safety culture. There was no relationship between safety culture and those having a second job. Job tasks had a diverse safety culture. The mean safety culture score in employees who had experienced an accident was significantly lower than those who did not. Older employees showed to have a higher safety culture score.

Safety culture had a positive relationship with various factors such as (please name a few). Unfortunately, these factors were not studied thoroughly in Iranian automotive industries. According to the results of this study, on the job training and considering, incentives for the workers could be useful for promoting their safety culture

Choosing the right tool for assessing inequalities of the distribution and allocation of health financial resources is one of the major challenges in health financing. The Fairness Benchmarks are the comprehensive policy tools for evaluation of fairness in the health system which includes Financial Barriers to Equitable Access, Equitable Financing, Administrative Efficiency, and Accountability. This study aimed to determine the most influential financial indicators on the distribution and allocation of health resources based on the fairness benchmarking framework.

The present descriptive-analytic study was conducted in 2019. Fifty health system financial indicators were selected from three sources: WHO, the Equity and Human Rights Commission, and the United State Agency of International Development and were compared with the national health and health equity indicators. After experts' accreditation, 15 financial indicators were selected and by survey among 206 experts from 31 provinces and using the confirmatory factor analysis, the effect of each indicator on the distribution and allocation of financial resources were evaluated.

Factor analysis showed that the ratio of out of pocket to total health expenditures and the share of health expenditure as percent of GDP in equitable financing, the need-based health resource allocation, in accountability, and the health insurance coverage based on vulnerability, in financial barriers to equitable access were the most influential indicators.

Health policy makers can be used indicators to assess inequalities in the allocation and distribution of financial resources, based on fairness benchmarks, to assess and determine the ethical priorities of reform in health financing.

Nowadays, medication errors as the most common medical error are among the most important health and safety issues for patient safety. The aim of this study was Assessing and Management of Clinical Risk in medication Process of CCU in Mashhad teaching hospitals by HFMEA Method.

The present study is a combination (qualitative – quantitative, cross sectional -descriptive) method. Data was collected through direct observation, review of documents, FGD technique by Non-probabilistic sampling based on purpose and by HFMEA standard work-sheet to risk analysis, decision tree analysis, identifying the root causes of failure states and suggestion of Improvement measures. In this study Fuzzy AHP (Analytical hierarchy process) Technique for selecting Priority Process, the Eindhoven model (ECM) was used and the Idea Generation Method was used to suggestion Improvement measures. Finally, data was analyzed using Excel software by descriptive statistics.

A total of 50 failure states in the 5-step medication process were identified, so that failure states were identified as unacceptable risk.so that from the total root causes of erorrs were categorized based on the ECM model, 62.7% of latent errors and 37.3% of obvious errors and Improving measures were suggested., if these strategies are implemented, in the re-evaluated Controlled Risk The ratio of unacceptable risks will decrease from 56.9% to 21.6%.

The essential medication process due to Medicinal errors in some cases instead of treatment may increased costs, injury and prolonged hospital stay. The HFMEA Method with preventive approach and the focusing of systems rather than individual errors, in order to identify and resolve increases the agreement on process and organizational weakness and can play an Effectiveness role in eliminate the root causes of errors, especially in the sensitive and complex of the CCU ward.

Individual self-care is a kind of self-care that a person is responsible for taking care of himself, his family and others. The role of Islamic councils in advancing health policy is very important. Present research aimed to investigate the effect of empowerment of Islamic councils on the implementation of individual self-care programs. This quasi-experimental study was conducted among the members of Rural Islamic Council of two villages of Johkhah and Behesht-Abad close to Tabas city. The empowerment program was implemented for members of the Council of Jokahah Village as an intervention group and the Behesht-abad village was considered as a control group. Two months after the intervention, the status of individual self-care program in two villages was examined and compared with before intervention. The data were analyzed using SPSS17 software and single-sample T-test method. The results showed that after intervention, the number of health ambassadors which had increased up to 31 people in Johkhah however the growth was up to two in Behesht-Abad. Also, in the two months after the intervention, there was no change in Behesht-Abad village, and the registered ambassadors did not perform any activities in the area, but in the village of Jokhah, ambassadors of health had a significant activity. Empowerment of members of Islamic councils causes the participation of people in health system programs and in particular in individual self-care programs. This increase is not just voluntary, it creates a partnership in which we see dynamic and influential activities.

Patient safety is one of the most important and vital issues in the health systems of different countries. Team working and communication are very important in preventing and reducing medical errors. This Study aimed to investigate the relationship between the patient's safety and nurse's team working in surgical and intensive care units in Gilan province selected hospitals.
This analytical study was conducted in 30 selected hospitals in Gilan province in 2015. The statistical population of the study consisted of all nurses working in surgical and intensive care units (n = 600), and safety authorities of 30 selected hospitals. Team working data were collected by the teamwork assessment questionnaire and the patient's safety data by the checklist of mandatory standards of patient safety. Data were analyzed by spearman correlation and SPSS 16 software.
According to the results, there was a significant relationship between the patient's safety and nurse's team working (p According to relationship between team working and patient's safety, financing in teamwork culture promotion can prevent serious injuries and possible complications from patients and returns the investment to the hospital.

Hundreds of millions of people affected from natural and man-made disasters in the world and about 80 percent of these people are women and children. Women and girls for various social, economic, cultural and health reasons are more vulnerable in times of disaster. This study aimed to investigate the impact of displacement on women's mental and social health.
This research is an analytical review of articles that was studied by searching articles in Iranian databases: SID, Magiran and Irandoc, and foreign databases: Web of Science, Scopus, PubMed, Google Scholar and by using of keywords such as: Psychological vulnerability, mental health, women in disasters, refugees, disasters and their possible combinations.
According to the different needs of women in disaster such as deprivation in access to health services, prenatal care, specific health concerns, forcing in nutrition of children, the risk of sexual violence, sexually transmitted diseases, emotional and economic dependence and difficulty in social interactions, the vulnerability of this group in terms of displacement can be classified in five dimensions (1) health, (2) self-care, (3) livelihoods, (4) social capital and (5) social support.
In disasters, cultural barriers, physical health problems, communication barriers, language and social and economic problems are the most important struggles of women that lead to mental disorders. Therefore, programs should be designed related to prevention, preparedness and response based on women’s needs and challenges with them participating; it is important that sufficient political and economic support from governments and involved organizations in these programs will be allocated.

Accreditation is a tool for assessing the patients’ safety and quality improvement. The aim of this study was to compare quality management evaluation between Tehran hospitals with Europe hospital with accreditation approach.
This comparative, cross sectional, multilevel study was conducted among 21 systematic selected hospitals and their quality managers and hospital departments and patients between 2016, June and 2017, June. Anonymous Quality management system index (QMSI) questionnaire was conducted among quality managers. Quality management compliance index (QMCI) and clinical quality implementation index (CQII) and Clinical review (CR), specialized expertise and responsibility (SER), evidence base organization (EBO), patient safety strategy (PSS) were used during on- site visits by trained external surveyors. Retrospective and case note reviews, and direct observation were used for patient’s level data gathering. The validity and reliabity of constructs were tested. The choice of instruments was based on “Deeping our understanding of quality improvement in Europe” (DuQuE) project. Instruments were translated and back translated and changed base on third generation of Iran hospital accreditation that was developed by ministry of health and medical education (MOHME). We assessed patient- specific process and outcomes for acute myocardial infarction, stroke, hip fracture and deliveries at patient level.
Management specific indexes at hospital level in Tehran hospitals, alike Europe hospitals, were related. In Tehran hospitals, an association was observed between QMSI and departmental levels in EBOP and CR and SER at four clinical conditions. In Europe hospitals, an association was observed between three levels of hospital quality management.
The comparative evaluation for quality management for hospitals in Tehran and European hospitals showed similar results in terms of quality improvement at the management level.

Among non-communicable diseases, endocrine, nutritional, and metabolic diseases have increased in recent decades, especially in developing countries. This study was conducted to evaluate and predict deaths from this group of diseases in Iran
In this analytical cross-sectional study, the study population comprised all deaths of endocrine, nutritional, and metabolic diseases recorded in the Ministry of Health and Medical Education during the years 2006 to 2016. In order to forecast the trend of cause of death, the Lee Carter model was employed in the demographic package 18/1 of the R software version 3/3/1.
The death rate from endocrine, nutritional, and metabolic diseases increased in all age and sex groups from 2006 to 2015. It was predicted that death rate of this group of diseases would reach 197/71 in 100,000 in the total population, 202/97 in 100,000 women, and 188/99 in 100,000 men in 2035.
Several factors play a role in endocrine and metabolic diseases, one of which is aging and aging population. Considering the change in the age structure of the population of Iran by 2035 and the increase in population’s age, an increasing trend is expected in the mortality rate due to these diseases. Because of this rapid increase, policymakers need to adopt intergovernmental population-based plans and policies in this regard.

Health system management in Iran requires changes in health care system for population that goes to aging and are faced with changes in diseases patterns. One of these needs is the fundamental changes that must be made in the near future in the distribution of inpatient beds based on the needs of society. The purpose of this study was, therefore, to foresight the distribution of hospitals’ inpatient beds over the next 20 years.

This study is a applied research. At first, the age and sex structure of Iranian population was investigated and predicted through using data from census and mathematical methods. Then the rates of general groups of causes of death were calculated for the years of study and their 20-year trends were predicted using Lee-Carter's model. Next, based on the related data, the number of hospital beds were calculated by means of linear regression. To analyze the data, the demographic package of 18. 1 in R software, version 3. 3. 1, was adopted.

It was found that while in 2006, the population over 60 years comprised 7. 3% of the total population, until 2035, the growth of the elderly population in Iran will be on the rise; so much so that and it is estimated that in year 2035, it will reach 17 percent of the population. Endocrine, nutritional, and metabolic diseases will have the greatest increase in the rate of death in the general population from 2006 to 2035, with an increase of 1878. 52 in 1000 people. Accordingly, the number of hospital beds with the highest and the lowest fertility assumptions will be 160,687 and 157,208 beds, respectively.

The findings indicate that over the next 20 years, the elderly population of Iran will increase and non-communicable diseases will account for a large percentage of the diseases and causes of death. Therefore, proper and accurate planning and policies are essential to meet the society needs, especially in the treatment sector for the allocation of beds.

Coronary heart disease risk factors assessment and control is critical for preventing cardiovascular attacks and improving the health of people. The aim of the present study was to compare the status of control of the epidemic of heart coronary artery diseases in selected countries and Iran.
This comparative study was carried out in 11 countries (with define criteria). Databases, such as Medline, PubMed, Rozent, Elsevier, and Google Scholar were used with keywords of "Non communicable diseases", "coronary artery disease", "cardiovascular disease”, and "epidemic control". Ninety printed and electronic articles were obtained. Data was collected using “Check List of Control on the Epidemic of Heart Coronary Artery Diseases" in five dimensions with 35 items. The content validity index of the check list was evaluated and confirmed with 17 experts and Cronbach's alpha with 12 experts.
The findings of this study showed similarities, for instance all countries had common risk factors for coronary artery disease. Most countries, had responsive systems for controlling and preventing coronary artery diseases in their structure. The differences included major issues, such as “total expenditure on health as a percentage of gross domestic product”, “general government expenditure on health as a percentage of total expenditure on health”, “private expenditure on health as a percentage of total expenditure on health”, “general government expenditure on health as a percentage of total government expenditure”, and “social security expenditure on health as a percentage of general government expenditure on health”. Also, “out-of-pocket expenditure as a percentage of private expenditure on health” was very different in Iran compared with the selected countries.
The comparison of responsive systems, health financing, and risk factors for coronary artery disease in Iran and selected countries had several differences and similarities. It is suggested to create a policy framework for regulation and public education for the prevention and control of coronary heart disease.

Since Iran is accident-prone, paying attention to the issue of crisis, particularly earthquake, is very important. On Friday, December 26, 2003 at 5:26 a.m., a devastating earthquake converted Bam City, Iran, and its surrounding villages to the mound of soil. In this study, we surveyed the impact of the earthquake on the lives of people who experienced earthquake. Because the knowledge of prevention, preparedness, and appropriate response for earthquakes and other disasters can be achieved only through the experiences of people who had a perception of these disasters.
This article was part of a content analysis qualitative study conducted from December to March, 2015 in the Bam city. Purposeful sampling method used and continued until code completion and data saturation. To collect the data semi-structured interviews were used.
Of 10 participants in this study, 50% (5 participants) were women and 50% (5 participants) were men. Mean age of participants was 39.70 ± 13.07 years. The mean duration of the interviews was
51.30 ± 10.86 minutes. One of the main themes emerging from the interviews was “the sudden collapse of life in a few seconds”.
Based on interviews, the essence of life suddenly collapse was achieved. It represents the value of qualitative studies on understanding problems of victims and survivors of natural disasters, especially earthquake. It is hoped that real aspects of the crisis on the lives of survivors be achieved and used in planning timely and accurate crisis management based on the real needs of injured people.

Priority setting and resource allocation are assumed to be the most important issues of health-sector and fairness thereof requires considering various criteria. This study was performed to identify the criteria used for priority setting and resource allocation in the world health systems through comprehensive review.
Cochrane, PubMed and SCOPUS database were searched systematically from Jan.1,2005 to Oct.10,2016. The English articles with codified and specified qualitative and quantitative criteria in the resource allocation context in health sector were included in the study. The obtained data were synthetized thematically.
Overall, 9162 papers were extracted. At the beginning of review of the included articles, 9089 papers were removed due to duplication and also based on the title. The abstracts of the remained papers were reviewed and 17 papers were removed. Full text of 59 remained papers were reviewed and based on matching with the inclusion criteria, 34 other papers were removed, too, and ultimately 25 papers were included in the final phase of the study. Extracted criteria were categorized into four dimentions based on economic, management, structural and contextual, out of which the most frequent ones were related to cost, health system goals, local capacity and disease status, respectively.
In this study, the most important criteria used by policy makers and decision makers of health system in the world were extracted for priority setting and resource allocation. The results indicated that in the world, priority setting and resource allocation in the health system is made mainly based on criteria such as cost-effectiveness, disease status, equity/equality and the need.

Half of the world’s refugees comprise children and adolescents. Confronting conflicts and difficulties before, during, and after migration and seeking asylum affect their mental health. The present study aimed at investigating the challenges of mental health of migrant and refugee adolescents and children.
A systematic review was conducted in the second half of 2016 using PubMed, Scopus, Magiran, SID, and Google Scholar databases. From the 2014 studies initially selected, 20 articles that specifically attended to examining the mental health of migrant and refugee adolescents and children were finally extracted.
According to previous studies, the refugee adolescents and children encounter much harm. In addition to psychological disorders such as depression, anxiety, post-trauma stress disorder and psychosomatic pains, this group of refugees also suffers from a decline in flexibility and behavioral and cognitive functions. These conditions have been reported more often in refugee adolescents and children who have been separated from their parents or left far away from them.
Before a crisis occurs, policymakers and planners should formulate and implement educational programs along with the participation of parents and teachers in order for children to cope with conditions of disasters, and in order to promote the culture of resilience. The health system, while developing special care programs must prioritize the training of its employees in order to provide services. Most studies have attended to the incidence of symptoms of refugees’ psychological disorders, while it seems necessary to conduct intervention studies with the aim of identifying elements of risk and ways to resolve these elements.

Intentional releases or threat to use viruses, bacteria, fungi, or toxins produced by living organisms to cause death or pathogenicity in humans, animals and plants is bioterrorism. Contamination with biological agents could occur before or during the journey. In Iran the risk of such attacks is high because of the strategic situations and the presence of hostile forces in neighboring waters. The aim of this study is to present a scenario based prevention and response planning for battle cruiser and biological threats.
This is a qualitative and comparative study in which by using the risk management methods and mitigation planning and resiliency in different social environments, we propose a model in dealing with biological attacks in cruisers.
The beginning phase of disaster management cycle is mitigation and risk reduction. Hazards will be analyzed according to potential threats in the region, the environment, human recourses, equipment and time. According to the threats in the Middle East, biological agents in group” A” can be the biological hazards in the cruisers. We can determine the points of risk by calculating the return period, the severity of impacts and vulnerability of resources and the target group in a geographical area. According to the probability of each risk, we can identify priorities and regulate the possible scenarios. Then, the problems, which extracted from the scenarios, will be analyzed and the possible strategies for prevention and response will be developed. At least the scenario based response plan was developed. These plans need the planning teams and scenarios to develop. The biological attacks warning plan includes: the isolation of patients and carriers, surveillance system, drug prophylaxis and vaccination programs, Treatment, dead bodies management, provision of water and healthy food, a multi-layered system designed to communicate with the outside of the disaster area, decontamination, Triage, rescue and transfer to the referral hospitals and etc.
Scenario-based risk management model in bioterrorist attacks reduces the biological effects of the bioterrorism agents

One of the problems in disaster management is mass casualty incident (MCI). Red Crescent is one of the most important organs during and after accident. The objective of study was to the effect of education of MCI on knowledge, attitude and satisfaction Red Crescent workers Hamadan.
First, Red Crescent officials Hamadan were interviewed. According to their views, MCI as the most important challenge was considered. This study was a single group intervention. The study population comprised all relief workers of Red Crescent. Available or purposeful sampling was done and 40 persons participated in this study. Knowledge and attitudes were assessed before and after the workshop. Instruments included demographic characteristics and questionnaire of knowledge and attitude were. Data were statistically analyzed by SPSS version 15 and paired t test.
The mean score of knowledge were before the workshop 5/4 ± 0/4 and after the workshop 11/2 ± 1/3; the mean scores of attitude were before the workshop 6/1 ± 0/6 and after holding workshop 21/2 ± 3/5.
Since the knowledge and attitude of workers increased after training so we recommend it be used in other fields also.

Emergency medical services are a crucial component in the treatment of critically ill patients. A common principle in pre-hospital emergency services is defined as a target “8 minutes or less response time of advanced life support for people in life-threatening events”. Therefore this research is aimed to evaluate on performance of pre-hospital emergency stations in Yazd, based on essential time for attending at patient's bedside.
The present study is analytic descriptive conducted cross-sectional. Method of collecting data based on census and its analyzing method had been qualitative. According to Likert, performance is considered excellent with action less than 8 minutes, good with action by 8 minutes, and weak higher than 8 minutes.
according to the results, the best average performance time (In 1392 among stations of Yazd) belong to 4th District station with 8.58 minutes and the weakest time to 6th District station with 12.01 minutes. The average of performance of Yazd emergency medical services at urban missions had been 9.84 minutes. Findings show that the highest average time activity recorded on winter that was 10.2 minutes and lowest average time activity was recorded on summer which was 9.47 minutes. Also results show even though the number of missions in the summer were higher than the winter, but the mortality rate were less in contrast.
By comparing the obtained information from the research results, the impact of mission duration on mortality rate reduction has turned out. Also according to the sensitivity of pre-hospital emergency, the necessity of attention to urban missions’ timeframe in Yazd emergency service is another conclusion that this is achieved by authorities supervisory and provision of requirements and adequate facilities.

The most important factor in effective management of natural and man-made disasters is human resources. The least expensive and the shortest time and route to upbringing human resources as valuable assets to provide efficient and effective service in disasters is education. The objective in this survey is curriculum development comparison at U.S.A. Universities “disaster and emergency management” major and Iran institutes “man-made and natural disaster management” major.
The research is comparative with interpretative approach. Data is collected by international and national formal informative bases. At first, two curriculum developments in B.Sc. level were compared each other, and then some offers were suggested based on analyzing of their similarities and differences, after categorization of their kinks.
Findings: In Iran, despite of interest, talent and occupational requires of students in all center, curriculum development and content in field of science, general management, social science and communication, natural science and disaster, disaster management in both Associate and B.Sc. levels are changeless and invariable. Optional and selective lessons were not designed.
The curriculum development and content in both levels and in both man-made and natural disaster is considered according to disaster management global pattern to emphasis on national and local needs. Using of optional, variable and high flexible lessons in the curriculum development and content appropriate to interest, talent and occupational requires of students is suggested to effective disaster management in Iran. In according to variety of disasters in Iran, new courses designing with professional curriculum development to each group of disaster and emergencies situation is necessary.

To develop a valid and reliable instrument for assessing hospital preparedness against nuclear and radiologic events.
This cross-sectional study was conducted through two stages: preparing initial framework for providing the instrument through literature review and a panel of experts; and then determining facet and content validity through impact factor (IF), content validity index (CVI) and reliability through Cronbach's alpha coefficient. The participants included experts and key informants of related disciplines (n=60) selected by purposive sampling method. Data were analyzed using SPSS software.
The final valid and reliable tool consisted of five domains and 56 questions. Preparing physical environments, equipments, human resources, communication, and organizational coordination have been extracted as the main aspects of the tool. Accordingly, all validity and reliability indicators were examined and were found satisfactory (IF ≥ 1.5, CVI ≥ 0.8, Cronbach's alpha ≥ 0.7)
Using such valid and reliable tool for assessing hospital preparedness against nuclear and radiological events can provide valid data for health managers in order to be prepared for such events. Further research is needed for developing valid and reliable tools to assess hospital preparedness against all man-made hazards.