peyman saberian

The continuity and development of rescue and relief services requires recognition and improvement of the capacities of this field, and above all, it requires a tool to measure the capacity of this policy. The purpose of this research is to design a model for measuring the policy capacity of providing rescue and relief services in Iranian Red Crescent Society (IRCS).

This qualitative and applied research was conducted with the content analysis method. In order to collect data, the policy capacity literature and laws in the field of "rescue and relief " and "crisis management" were reviewed. About 12 experts were selected and studied as the statistical population using the snowball method until reaching theoretical saturation. Data were analyzed by qualitative content analysis method (inductive approach) and Maxqda-20 software. Content validity and reliability were checked with Content Validity Index (CVI) test and Holsti’s method, respectively.

According to the findings, about 113 indicators were identified which were classified in three levels including individual (34 indicators), organizational (48 indicators) and systemic (31 indicators). All these three levels consist of the subcategories such as analytical, operational and political-social capacity.

Policy capacity is a multi-level and multi-dimensional concept. For the development of rescue and relief services, the capacity status of this policy should be determined at different levels and dimensions and due to the needs and conditions, capacities should be upgraded. However, it should not be enough to develop the capacity at one level or one dimension.

Trauma-related injuries are the leading cause of death and disability in the active population, withdevastating economic, health, and social consequences for nations. TThis study aimed to assess the economicburden of injuries in Iran.

In this study, the economic impact of trauma in Iran in 2019 was estimated using a prevalence-basedapproach. The prevalence was estimated based on available statistics in Iran and the GBD website. Directmedical expenditures were calculated using a top-down approach. The cost of lost production due to injuriesand premature death was also estimated using the DALY value. Microsoft Excel 2019 and Stata softwareversion 13.0 were used for the analysis.

In Iran, approximately 16,500,000 individuals were estimated to have sustained injuries in a singleyear. The average direct medical expenses for each trauma patient were around $226. Fractures contributedto 39% of the financial impact of trauma. The overall economic burden of trauma in Iran was calculatedto be $10,214,403,423. Approximately 66% of this economic burden was attributed to lost productivity andpremature death resulting from trauma, while direct medical costs made up 34%.

The economic burden of trauma in Iran is expected to significantly rise in the future. It maybe necessary to enhance awareness of injury-related mortality and disability, improve therapies, and expandevidence-based interventions to reduce the economic impact of injuries.

Considering the growing use of emergency medical services (EMS), we evaluated the level ofpublic awareness of emergency situations in Iran. This cross-sectional study was conducted from August 2021 to January 2023 on Iranian residentsin Tehran, who were older than 18 years old. The participants were directed to a URL for an online surveylink and asked to select their preferred options for the predetermined scenarios. We divided the participantsinto three groups: abuse, misuse, and non-use. At least 12 correct answers were required to qualify asacceptable knowledge and practice responses (KP score). Then, the relationship between participants’ baselinecharacteristics and their level of awareness was investigated. Totally, 3864 people participated in the study, of whom 50.5% were men. The participants’ agesranged from 18 to 90 years old, with a mean age of 40.01±11.30 years. In general, the rate of abuse, misuse,and not-use in at least one scenario was 74.5%, 64%, and 70.4%, respectively. The results of the multivariableregression analysis indicated that female sex (OR=1.29), a higher education level (OR=3.36), a higher incomelevel (OR=1.64), and Turkish ethnicity (OR=1.20) were significantly associated with the correct KP score. The degree of inappropriate utilization of EMS services in Iran was significant. We found thatthe proper knowledge regarding the appropriate use of EMS was significantly associated with the participant’slevel of education, academic field, job, and income.

There are several methods for teaching emergency medical technicians (EMTs) cardiopulmonary resuscitation (CPR); but choosing the most effective option depends on several factors. This study was designed to compare the effectiveness of three different CPR training methods, including traditional, peer, and virtual methods, for EMTs.

This study was a pretest-posttest study, which was performed from March to September 2020 in Tehran, Iran. Participants were EMTs working in the operations department of the EMS center. In the first step, for the pretest evaluation, an Objective Structured Clinical Evaluation (OSCE) exam was held for all participants. Thereafter, the subjects were divided into 3 groups including master-centered traditional collective education, peer training, and virtual courses. Then the participants underwent educational intervention and after that, another OSCE exam was held about 1 week after the sessions to evaluate the effect of interventions.

At first, 156 volunteers entered the study and participated in the pretest OSCE exam, of which 125 volunteers participated in the posttest OSCE exam. Of these, 51 volunteers participated in the peer education group, 35 volunteers were in the virtual education group, and 39 volunteers in the classic education group. The mean score of the participants in all 4 assessed skills, including endotracheal intubation, laryngeal mask airway insertion, basic life support, and advanced life support, increased significantly after educational intervention in all 3 groups (p<0.05); and this increase was higher in the virtual group compared to the other two groups (p<0.05).

We found that virtual training was more effective than classic and peer training for CPR training of EMTs.

To assess the cost-effectiveness of sacubitril/valsartan compared with enalapril in patients with heart failure with reduced ejection (HFrEF).

A systematic literature search was conducted searching in major electronic databases from inception to January 1, 2021. All relevant full economic evaluation studies of sacubitril/valsartan versus enalapril for the treatment of patients with HFrEF were identified using ad hoc search strategies. Mortality, hospital admissions, quality-adjusted life years (QALYs), life-years (LYQs), annual drug costs, total lifetime costs, and incremental cost-effectiveness ratio (ICER) were considered as the outcomes. The quality of the included studies was assessed using the CHEERS checklist. This study was conducted and reported in accordance with the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines.

The initial search yielded a pool of 1026 articles, of which 703 unique articles were screened, 65 full-text articles were assessed for eligibility and 15 studies finally included in the qualitative synthesis. Studies show that sacubitril/valsartan reduces mortality and hospitalization rate. The mean of death risk ratio and hospitalization were computed at 0.843 and 0.844, respectively. Sacubitril/valsartan produced higher annual and total lifetime costs. The lowest and highest lifetime costs for sacubitril/valsartan were found in Thailand ($4,756) and Germany ($118,815), respectively. The lowest ICER was reported in Thailand ($4857/QALY) and the highest in the USA ($143,891/QALY).

Sacubitril/valsartan is associated with better outcomes and may be cost-effective compared to enalapril for the management of HFrEF. However, in developing countries such as Thailand, sacubitril-valsartan costs must be reduced to yield an ICER below the threshold.

After recovery from acute phase of the COVID-19, some patients suffer from persistent/late-onset complications. The main objective of this study was to investigate the prevalence of such complications in a large scale of COVID-19 patients in Tehran, Iran. In this cross-sectional study, those patients who called Tehran emergency medical services center and were visited by the emergency medical technicians from 20 March 2020 until 21 September 2020 and diagnosed as a confirmed COVID-19 case were enrolled. The minimum required sample size was estimated 385 cases, and they were selected randomly. The patients were interviewed by phone at least 4 weeks since initiation of their symptoms. Using a pre-prepared checklist, made by an expert panel who were involved in management of COVID-19 patients, data were collected on the types and duration of the complications, clinical information, and factors which could interfere with developing the complications. All analyses were performed using STATA 16 software. The association of the prevalence of each complication with independent factor was assessed using Chi-square test (or Fisher’s exact test) for categorical variable, and the mean difference of numerical variables in the two groups (with and without complication) was assessed using independent t-test. Statistical significance was accepted at P value<0.05. Four-hundred forty-seven patients participated in the study. Among our total population, 345 (77.2%) patients experienced at least one of the persistent/late-onset complications. Cardiopulmonary and then skin-related symptom categories were reported in 179 (40.0%) and 173 (38.7%) patients, respectively, and were the most prevalent persistent/late-onset complications. The associations of long term persistent/late-onset complications with older ages (P=0.04), female (P<0.001), psychological stress (P=0.01), and inadequate rest after illness (P<0.001) were significant. The findings of this study indicate that a significant number of patients will experience persistent/late-onset complications, both physically and mentally, after recovering from acute phase of COVID-19. Thus, physicians should have adequate resources and support to care for the patients to help them cope with the condition.

This study was implemented to assess various types of violent incidents involving emergency medical technicians (EMTs) working in Tehran, Iran. Furthermore, the characteristics of violent people and possible causes of their violence were assessed. 

In this cross-sectional study, 500 EMTs working in the capital city of Tehran were randomly invited. The participants were asked to fill out a questionnaire of workplace violence. Univariate and multivariate logistic regression were also performed for identifying the possible risk factors of violence. In addition, the distribution and association of violence patterns were also analyzed considering demographic features and characteristics of violent people. 

In total, 320 EMTs with the mean age of 31.8 ± 6.7 years participated, 315 (98.4%) of whom were men. Overall, 279 (87.2%) out of the 320 participants experienced 654 episodes of violence, mostly bullying, in the last 4 months. The relationship between the level of education and experiencing violent incidents was statistically significant (p=0.035). Also, non-Persian EMTs had experienced significantly more violent behaviors than Persian EMTs [171 (91.0%) vs. 108 (81.8%); p=0.016]. Nonetheless, the prevalence of violent incidents was not significantly correlated with marital status, years of work experience, employment situation, and working hours. The odds of facing violent behavior among EMTs with associate degree was 2.9 times higher than those with technical diploma (p=0.048). Furthermore, the odds of experiencing violence among non-Persian EMTs was 2.2 times higher than Persian EMTs (p=0.039). 

We found that EMTs had faced numerous episodes of violence in their workplace, especially verbal threats, which were more prevalently committed by patients’ relatives during night shifts.

To improve the quality of services provided by emergency medical services (EMS), a correct understanding of the current situation and analysis of possible problems is required. The purpose of this study was to investigate the level of clients’ satisfaction regarding the missions performed by ambulances and motor ambulances (motorlances) of the Tehran EMS center, and also identify the factors affecting their satisfaction.   

This cross-sectional study was conducted for 1 month in Tehran, Iran. All clients in the age range of 18 to 87 years who were approached by Tehran EMS motorlances or ambulances were eligible. Those with wrong registered phone numbers, uninformed callers (passers, coworkers), and those who were not willing to participate in the study were excluded. A valid and reliable researcher-made questionnaire was used to assess the clients’ satisfaction. Missions were surveyed routinely, 1 to 2 days following their performance. The questionnaires were filled out by the investigators via a telephone call to the patients or the patients’ siblings. The collected data were statistically analyzed using IBM SPSS Statistics 24.0. An independent t test and 1-way analysis of variance were used to compare the mean satisfaction score between the groups. Other tests, such as the Pearson correlation coefficient, were also used to examine the relationship between quantitative variables. P<0.05 were considered statistically significant.  

In total, the data of 1100 missions were analyzed. The age range of the patients was between 1 and 100 years and their mean age was 52.1 ± 19.2 years, and the mean age of interviewees was 44.4 ± 13.4 years (18-87 years); of all the interviewees, 610 (55.5%) were women. The overall satisfaction of people with the Tehran EMS was rated as "very satisfied" in 78.5% of the cases; However, 11.2% of the participants had moderate and low satisfaction. We found that overall satisfaction was related to dependence on the health group (p≤0.001), educational status (p=0.006), economic status (p=0.002), sent vehicle (p=0.040), and diagnosis (p<0.001).  

Almost 80% of the participants were highly satisfied with the services provided by Tehran EMS motorlances/ambulances, according to this study. Those with a higher educational level, higher socioeconomic class, accurate diagnosis, proper sent car, and health dependency showed a higher level of happiness than the others.

 The prehospital emergency system is the first initiator of medical care as an alternative to hospitals and health care services that helps patients and injured people in critical situations and accidents. This study aimed to evaluate the cost-effectiveness of air ambulance versus ground ambulance regarding the patient’s transportation and treatment.  

 In this cost-effectiveness analysis study, 300 patients who were transferred to the Shohadaye HaftomTir hospital by air ambulance and 300 patients transferred by ground ambulance during the study period were selected in 2021-2022. This study examined the costs from the society’s perspective. After drawing the decision tree model in TreeAge software, the incremental cost-effectiveness ratio was calculated; and to evaluate the strength of the analysis results, one-way and two-way sensitivity analyses were done on all costs and consequence parameters.  

 The effectiveness rate in the ground ambulance group and in the air ambulance group was 0.42591 and 0.5566, respectively, and the total cost of transportation and treatment by ambulance in these patients was $412.88 and for patients transported and treated by air ambulance was $11898.05. Therefore, air ambulance costs more and is more effective than ground ambulance, and the amount of incremental cost and effectiveness of air ambulance compared with ground ambulance was $11485.17 and 0.130773 units, respectively. The incremental cost-effectiveness ratio (ICER) of the 2 strategies was 87825.28, and the cost-effectiveness threshold was $7200. To determine the strength of the study results, one-way and two-way sensitivity analyses were done and the results of the cost-effectiveness analysis was not changed.   

 Our study showed that ground ambulance is more cost-effective than air ambulance and the most important reason is that the total cost of air ambulance is 26 times more than ground ambulance, however, it is more effective than ground ambulance.

Knowledge, attitude, and practice of people, especially high-risk ones, are essential for managing COVID-19. Previous studies have shown that inappropriate knowledge and attitude may influence people's decisions.

This study aimed to evaluate the knowledge and attitudes of patients towards COVID-19 who called emergency medical service (EMS) while suffering from a chronic underlying disease, whether they were transferred to the hospital during the pandemic or not.

This cross-sectional study was conducted from 21 May 2020 to 20 June 2020 in Tehran, Iran. Using the registered data in the databank of the Tehran EMS center, eligible participants were selected and divided into transferred and non-transferred groups based on the recorded data. A valid and reliable questionnaire comprising four parts (demographic information, patients' knowledge about COVID-19, patients' attitude towards COVID-19, and patients' fear) was used. A researcher-made checklist was also used for recording the consequences and reasons for refusal. Select eligible individuals who agreed to enter the survey were interviewed by telephone.

Totally, 201 transferred patients and 158 non-transferred patients were enrolled. The mean age of the transferred group was lower than that of the non-transferred one (57.1 ± 16.1 vs. 62.0 ± 17.4 years; P = 0.006). The mean knowledge score was not statistically different between transferred and non-transferred patients (28.8 ± 5.7 vs. 28.2 ± 5.4; P = 0.320). The mean attitude score was lower in the transferred group than in the non-transferred group (0.75 ± 3.7 vs. 2.2 ± 3.5; P = 0.001). The mean fear score was higher in the non-transferred group than in the transferred group, but the difference was not statistically significant (16.0 ± 5.1 vs. 15.0 ± 5.6; P = 0.101).

Most participants in both transferred and non-transferred groups did not have sufficient knowledge of the disease, but the average attitude had a positive score.

 We conducted this study to evaluate the prevalence of concomitant COVID-19 in acute ischemic stroke (AIS) patients admitted to stroke centers of Tehran, Iran. 

We conducted a retrospective cross-sectional study in a 45-day period. AIS patients transferred by emergency medical service (EMS) to all medical centers of the city were included. Information was recorded and compared in two groups: patients who tested positive for COVID-19 and those who were negative. 

Emergency medical technicians (EMTs) screened 348 patients as AIS cases, of whom, AIS was ultimately confirmed in 311 (89.4%) patients; and 58 (18.6%) of the 311 AIS patients were diagnosed with concomitant COVID-19 infection. The National Institutes of Health Stroke Scale (NIHSS) scores of COVID-19 positive AIS patients were significantly higher than non-COVID-19 AIS patients (16.3±3.7 vs. 11.8±4.3; p<0.001). There was also a significant difference in length of hospital stay between the two groups (11.1±1.8 vs. 8.8±4.3 days; p<0.001). However, data showed no significant difference regarding prevalence of in-hospital mortality between the two groups (1.6% vs. 3.5%; p=0.320). 

 Our study results showed that AIS patients with concomitant COVID-19 infection had higher NIHSS scores and longer length of hospital stay compared to patients without concomitant COVID-19 infection.

COVID-19 pandemic, which started in late 2019, has brought various ups and downs worldwide. Planned policies were highly useful in the first wave of the COVID-19 pandemic in Iran. However, due to several reasons, the country faced the second wave.

The current study aimed to compare patients’ features in the first two waves of the COVID-19 pandemic in the city of Tehran, Iran.

Following a retrospective, cross-sectional design, the current study was carried out on 5000 suspected/confirmed COVID-19 cases who were randomly selected from all cases transferred by ambulance to hospitals located in the city of Tehran. The first wave of the COVID-19 epidemic was from February 20 to May 04, 2020, and the second wave was from May 05 to August 05, 2020. Data for both waves, were collected using a researcher-made checklist.

In this study, data of 5000 suspected/confirmed COVID-19 cases were analyzed (2773 cases belonged to the first wave and 2227 to the second one). The older mean age of patients (P < 0.001), the frequency of cigarette smoking (P < 0.001), opium abuse (P = 0.004), and the presence of underlying diseases (P < 0.05) were more frequent in the second wave than in the first one. The notable finding in this study was the significant increase of non-respiratory symptoms of patients in the second wave. The number of cases who reported close contact with COVID-19 patients was higher in the second wave. Also, hypoxia, intubation during the hospital stay, length of hospitalization, and mortality rates were significantly lower in the second wave. During the second wave, the odd ratio of positive findings in lung CT-scan was 3.4 times more (95% confidence interval: 2.51 to 4.55) compared to the first wave (P < 0.001).

This study demonstrated considerable differences between the first and second waves of the COVID-19 pandemic concerning the patients’ features.

This study aims to design a multi-objective model for locating emergency relief bases with maximum coverage and minimum costs. As a result, this model is expected to reduce mortality by increasing the efficiency of relief services.

Based on the ambulance distribution in the east of Tehran City, Iran, and the statistical information on demand (at least 30 samples for data normalization) in the last six months of 2018, we introduced and implemented a definitive mathematical model. We also evaluated the model with GAMS software. Using previous studies and interviews, we identified key and practical indicators of site locations. These indicators are being easy to access, locating in high-demand areas, such as an urban area, and not being too close to another relief base. These factors were then prioritized using the hierarchical method, and the output indicates the high weight of the factor of “being in a place with high demand”. The objective functions are to maximize coverage, minimize costs, and provide equity in relief time. To deal with the uncertainty of the parameters, we used the robust optimization approach. To initially select potential proposed sites to establish the database, we used Geographic Information System (GIS). To test the above mathematical model in the real world, we conducted a case study in East Tehran.

Based on the designed model, the initial points proposed by GIS were identified. Finally, it was found that the number of stations in East Tehran must increase from 27 to 34 bases.

By implementing this model, the emergency medical service can provide the highest level of coverage. Also, the maximum relief time at stations will be reduced to 8 minutes.

Stroke is one of the most common debilitating diseases. Although effective treatment is available, a golden time has been defined in this regard. Therefore, prompt action is needed to identify patients with stroke as soon as possible, even in the pre-hospital stage. In recent years, several clinical scales have been introduced for this purpose. We performed the present study to examine the accuracy of eight clinical scales in terms of stroke diagnosis.

This multicenter diagnostic accuracy study was conducted in 2019. All patients older than 18 years who were admitted to the emergency department (ED) and underwent brain magnetic resonance imaging (MRI) for a suspected stroke were eligible. All data were gathered through a pre-prepared checklist consisting of three sections, using the clinical records of the patients. The first section of the checklist included basic characteristics and demographic data. The second part included physical examination findings of 19 items related to the 8 scales. The third part was dedicated to the final diagnosis based on the interpretation of brain MRI, which was considered the gold standard for the diagnosis of acute ischemic stroke (AIS) in the current study.

The data from 805 patients suspected of stroke were analyzed. In all, 463 patients (57.5%) were male. The participants’ age was 6-95 years with a mean age of 66.9 years (SD = 13.9). Of all the registered patients, 562 (69.8%) had an AIS. The accuracy of screening tests was 63.0% to 84.4%. The sensitivity and specificity were 71.9% to 95.7% and 46.5% to 82.8%, respectively. Among all the screening tests, Los Angeles Pre-Hospital Stroke Screening (LAPSS) had the lowest sensitivity, and Medic Prehospital Assessment for Code Stroke (Med PACS) had the highest sensitivity. In addition, PreHospital Ambulance Stroke Test (PreHAST) had the lowest specificity and LAPSS had the highest specificity.

Based on the findings of the present study, highly sensitive tests that can be used in this regard are Cincinnati Prehospital Stroke Scale (CPSS), Face-Arm-Speech-Time (FAST), and Med PACS, all of which have about 95% sensitivity. On the other hand, none of the studied tools were desirable (specificity above 95%) in any of the examined cut-offs

Mapping of COVID-19 infection in the city can help us know more about how the disease is dis-tributed and spread. This study was conducted to investigate the geographical distribution of probable COVID-19 patients who were transferred to destination hospitals by emergency medical services (EMS) in the first waveof the epidemic, in Tehran, Iran.

This cross-sectional study was performed based on recorded mis-sions during the first 3-month period of the pandemic in Tehran, Iran. All probable cases of COVID-19 who weretransferred to the hospitals following contact with Tehran EMS during the study period were enrolled. Arc-GISsoftware was utilized to draw the distribution map of the contact places of the cases.

In this study, thedata of 4018 patients were analyzed (60.9% male). The mean age of the patients was 54.1 ± 20.7 years; and themean age of the patients had increased with time during the studied 3 months (p = 0.003). The average inci-dence rate of this disease in Tehran during the study period was 4.6 per 10,000 population. Generally, the lowestand highest raw frequencies of Tehran COVID-19 contamination were seen in municipal districts 21 and 4, re-spectively. The raw frequency of cases during the 3-month study period also showed that the highest numberof cases in Tehran occurred in municipal districts 5 and 4, respectively.

In the present study, usinggeographic information systems (GIS), geographical distribution map of COVID-19 in Tehran, Iran, during thefirst 3 months of the pandemic was drawn.

Like other infectious diseases, it is expected that COVID-19 will mostly end with the developmentof neutralizing antibody immunity. This study aimed to evaluate the value of COVID-19 antibody rapid test as-sessment in emergency medical services (EMS) personnel.

This cross-sectional study was conductedin Tehran, Iran from 20th March until 20th May 2020. The results of chest computed tomography (CT) scan,and antibody rapid test were compared in EMS personnel with confirmed COVID-19, as well as symptomaticand asymptomatic ones who had exposure to a probable/confirmed COVID-19 teammate. In symptomatic orasymptomatic individuals who were only IgM-positive, chest CT scan or RT-PCR was recommended.

Atotal of 243 EMS personnel with the mean age of 36.14±8.70 (range 21 to 59) years took part in this study (87.7%were males). Most of the participants (73.3%) had history of exposure. One hundred sixty-three EMS personnelwere tested using either RT-PCR test or chest CT-scan or both, and 78 (47.9%) of them had at least one positiveresult. Among the participants who had undergone chest CT-scan and/or RT-PCR test (n=163), 78 had positivechest CT-scan and/or RT-PCR test; of these, 18 individuals had negative results for IgM and IgG. The rate of pos-itive IgM and IgG in participants with positive chest CT-scan was 1.6 or 1.3 times more than those with negativechest CT-scan, respectively (p < 0.05). The percentage of positive results for both IgM and IgG in participantshaving positive RT-PCR test was 1.7 times more than those having negative RT-PCR test (p < 0.05).

Rapid antibody test could help in diagnosis of COVID-19 in asymptomatic or symptomatic EMS personnel whodid not undergo RT-PCR test or the test was reported as negative. However, its sensitivity could be enhancedthrough use along with other diagnostic methods.

To assess the possible factors associated with increasing risk of COVID-19 among EMTs.

This study was a case-control study conducted in Tehran, Iran. Case group was consisted of confirmed COVID-19 EMTs based on the results of reverse transcriptase polymerase chain reaction and/or lung computed tomography scan. Healthy EMTs were randomly selected as control group. Patients were asked to fill out a checklist including demographic data, data related to the work situation (such as number of missions and type of mask and cloth) and PPE precautions.

Sixty-eight patients and 148 healthy persons took part in this study as case and control group, respectively. Having two EMTs involved directly in taking care of patients (p <0.001) and working with a confirmed case teammate (p <0.001), considering the precautions such as seal check after wearing the mask (p=0.015), covering the hair with a medical hat (p <0.001), not using personal items despite protective clothing (p <0.001), and avoiding contact with the outer surface of clothing while removing (p <0.001) had significant difference in two groups.

We found that the type and method of use of PPE were correlated with the increasing risk of COVID-19 in EMTs. Also, we found that when two EMTs were involved directly in taking care of the patients, and those who worked with a confirmed case teammate, more frequently affected.

COVID-19 pandemic led to various consequences in medical care that had been long provided for the patients referred to the hospitals. 

We conducted this study to derive and validate a new scoring system that can accurately differentiate COVID-19 patients who may have a worse outcome from others at the prehospital stage. 

This study was performed on probable/confirmed COVID-19 patients, who were transferred to the hospitals by Tehran emergency medical services (EMS). Occurrence of one of the items including: in-hospital death, intensive care unit (ICU) admission, or hospitalization for more than 20 days was considered to indicate a “severe disease”. Univariate and multivariate logistic regression were used for assessment of the relationship between all independent variables and the outcome. In the validity assessment step, area under the receiver operating characteristic (ROC) curve was calculated for a data set independent from the data based on which the model was designed. The sensitivity and specificity were also presented based on the best suggested cut-off point. 

In this study, the data of 557 cases were analyzed in the derivation step and 356 cases were assessed in the validation step. The univariate logistic regression showed that age, weakness and fatigue, disease history, systolic blood pressure, SpO2, respiratory rate, and Glasgow coma scale (GCS) were statistically significant in severe disease group. The area under the ROC curve (AUC-ROC) of the tool was 0.808 (95% CI: 0.779, 0.834). The best cut-off point for screening was the score of ≥4, in which the sensitivity and specificity of the tool for the best cut-off point were 71.87% and 78.06%, respectively. In the validation step, the AUC-ROC of the tool was 0.723. 

Seven criteria of severe COVID-19 (SCSC) tool could properly differentiate probable/confirmed COVID-19 patients with severe outcomes in the pre-hospital stage.

This study aimed to evaluate the efficiency of pre-hospital triage tools including the qSOFA, NEWS, and PRESEP in determining the prognosis of probable COVID-19 patients.

In this diagnostic accuracy study, all probable COVID-19 patients older than 16-year-old who were transferred to the hospital by the Tehran Emergency Medical Services (EMS) during the first month of the pandemic, entered to the study. The scores of qSOFA, NEWS, and PRESEP were calculated using data gathered while providing pre-hospital care. The primary outcome was death; and the secondary outcomes were ICU admission, length of stay in the ICU, and length of hospital stay.

The data of 557 individuals with the mean age of 56.93±18.31 were analyzed of whom 67.5% were males. The area under the ROC curve (AUC) of qSOFA, NEWS, and PRESEP for ICU admission was 0.553, 0.557, and 0.551, respectively. The AUC of qSOFA, NEWS, and PRESEP for death was 0.596, 0.566, and 0.604, respectively. The best obtained cut-off point for qSOFA was a score >0 (the sensitivity and specificity were 25.0 and 85.68%, respectively), for NEWS was a score >2 (the sensitivity and specificity were 83.61 and 32.67%, respectively), and for PRESEP was a score >1 (the sensitivity and specificity were 54.10 and 55.56%, respectively).

Based on the findings of the current study, it is likely that the available pre-hospital triage tools (qSOFA, NEWS, and PRESEP) do not have proper efficacy to predict death, ICU admission, and disease severity of COVID-19 patients.

The investigation of trauma-related mortality is one of the key components in trauma studies and it is used as a performance index and measure of health care quality.

The present study aimed to evaluate the performance of pre-hospital interventions and identify possible mismanagements in dealing with trauma patients transferred by emergency medical services (EMS) to the hospital and died.

This study was conducted in 2019, in Tehran, Iran. All trauma patients who were transferred to the emergency department (ED) of three main referral hospitals, by Tehran EMS and died at the hospital within 24 hours of admission, were studied retrospectively. The required information was collected from the EMS and the hospital records. A panel of experts was asked to identify possible errors based on standards for each patient.

During the one-year study period, almost 14000 trauma patients were transported by Tehran EMS to the studied hospitals. Of them, a total of 197 deaths were recorded. The most and least provided services were breathing management (87.3%) and intravenous (IV) fluid therapy (12.2%), respectively. Needle thoracostomy, IV fluids therapy, life supports (basic and advanced cardiac), and airway management had the highest percentage of mismanagement among provided services. Bleeding control and resuscitation were consistent with the recommended standard.

In the current study, bleeding control and immobilization was performed appropriately. Needle tracheostomy was not performed at all. Airway management and life supports of the victims were not performed properly.

Supraglottic airway management tools such as the laryngeal mask airway (LMA) have recently emerged as the first choice in pre-hospital and hospital airway management guidelines as well as an alternative strategy after endotracheal tube (ETT) placement failure. However, the pros and cons of the LMA compared to endotracheal intubation are still debated. Given that no study has been conducted to date on the skills of emergency medical technician (EMT) in airway management using LMA compared to endotracheal intubation, we decided to do a study in this regard.

In this objective structured clinical examination (OSCE), EMTs who had a degree of associate or bachelor were participated. The examiner asked the examinees the required information and entered it in the pre-prepared checklists. The participants took part in a two-stage exam. In the first stage, the airway management of the simulated trauma patient was performed by endotracheal intubation, and in the second stage, the same scenario was performed with LMA. At each stage, the examiner evaluated the examinee's performance in 4 fields of Preparation, Pre-oxygenation, Position and Placement, and Post-intubation management using a standard checklist. In addition, the duration of the procedure from the beginning to the time of fixing the ETT or LMA was recorded and compared.

Totally, 105 EMTs participated in this study, of whom, 102 were male (97.1%). The mean age of the subjects was 36.4± 7.3 years old. Of the total participants, 72 passed both practical exams successfully, and they generally insert the LMA faster; so that the duration of intubation and LMA insertion in 1.4% and 30.6% were <1 min, respectively (p< 0.001). However, no significant difference was observed in terms of the mean time (p= 0.427).

In the present study, the skills of the technicians participating in the study in performing advanced airway procedures were moderate, and also, it was found that their skills in LMA insertion were less than endotracheal tube insertion.

One of the most frequent complaints that emergency medical services (EMS) deal with is seizure. The missions of EMS on these cases may lead to transferring the patient to the emergency department (ED).

Therefore, the present study was conducted to compare the short-term outcome of transported versus not-transported cases.

Our population sample was selected retrospectively from medical records in Tehran EMS center for 6 months in which the plan was transferring to a specific hospital. The cases were divided into transported or not-transported. W extracted and compared the cases’ demographic data, vital signs, conducted prehospital management, patient disposition, Outcome Seizure Patient Transfer Emergency Medical Services and their short-term outcome.

We evaluated 486 cases, 173 of whom were males (35.6%) and the mean age of patients was 34.8 ± 32.0 years old. 329 (67.7%) and 157 (32.3%) were in the not-transported and the transported group, respectively. Among all not-transported cases, we could follow 172 patients, 52 of whom had gone to hospital during the next 72 hours. 22 out of the 52 cases were discharged from ED the same day. Overall, the ED discharge rate was significantly more in the transported group (P < 0.001). Short-term mortality had no significant difference in the two study groups (P = 1.00).

Most of the not-transported patients did not go to the hospital during further 72 hours, and some were hospitalized. Most of the patients transported to the hospital were discharged from the ED. The short-term mortality rate was not different.

We intended to map the geographical distribution of patients with acute stroke who called the Tehran EMS center based on the geographic information of the incident location on a map. The distributions of these centers and patients’ access within a standard period were evaluated.

A cross-sectional study based on the registered data was conducted on suspected acute stroke patients > 18 years of age that were transferred by EMS. The analysis was performed based on pointing the patients’ locations and locating the hospitals in ArcGIS software plus a review of the polygons and focal points.

Totally, 1,606 patients suspected to stroke with a mean age of 64.89 ± 17.48 years were evaluated, of whom 947 (58.6%) were male. The mean time of arrival of an ambulance in the patient’s location from the EMS station was 11.94 ± 6.67 minutes, and the longest time was 69.32 minutes. The mean time from the patient’s location to the stroke center was 17.79 ± 11.42 minutes (range 2.4 - 83.70 minutes). Stroke centers in Tehran are not distributed in a balanced manner, and they are concentrated on the central and northern parts of Tehran, limiting access to hospital services.

The multiplicity of hospitals in the west and center of Tehran led to an increase in access times in eastern Tehran. It emphasizes the necessity of revision of service locating, especially because the east of Tehran has a denser texture than the west.

The current study was performed to provide real-time bedside ultrasonography for emergency medical technicians (EMTs) and assess the advantages and disadvantages of its application in dealing with trauma patients in pre-hospital setting from their viewpoints.

This semi-experimental study was conducted in Tehran, Iran. Twenty EMTs were selected purposefully and underwent a training program. Thereafter, they were asked to perform extended focused assessment with sonography in trauma (eFAST) using a handheld ultrasound device on trauma patients, and also filled a questionnaire prepared (in four components including C1: coherence, C2: cognitive participation, C3: collective action, and C4: reflexive monitoring) based on the normalization process theory (NPT).

All 20 participants were men and their average age was 37.8 years (SD = 4.7). For C1, the median total score was 10.5 out of a score of 4-20; For C2, the median score was 6 out of 3-15; For C3, the median total score was 18 out of a score of 6-30; and for C4, the median total score was 11 out of a score of 5-25.

Overall, it seems that EMTs welcomed using ultrasonography in dealing with trauma patients in pre-hospital setting. Although they thought that it might somewhat lead to an increase in their workload; but they believed that sufficient training was not provided for them yet. The EMTs were uncertain about the viewpoints of the patients and did not know how it could affect patients’ outcome.

Context: While the clinical practice recommends field stabilization in trauma patients, in some situations, the speed of transport is crucial.

This study aimed to evaluate the association between emergency medical services (EMS) time intervals (response time [RT], scene time [ST], and transport time [TT]) and in‑hospital mortality in trauma patients in Tehran, the largest metropolis of Iran. Settings and Design: A prospective cohort study was conducted between May 2017 and April 2018.

All EMS operations related to trauma events in the Tehran city that were transferred to three targeted major trauma centers were included. Statistical Analysis: Logistic regression analysis was used to assess the relationship between EMS time intervals and other risk factors of trauma death.

A total of 14,372 trauma patients were included in the final analysis. In‑hospital mortality occurred in 225 (1.6%) patients. After adjustment for confounding variables, older age (odds ratio [OR] = 1.04/year), female gender (OR = 2.16), low Mechanism, Glasgow Coma Scale (GCS), age, and arterial pressure score (OR = 0.84 for each unit), low GCS (OR = 0.56 for each unit), longer ST (OR = 1.17/10 min), and longer TT (OR = 1.21/10 min) were found to be risk factors for death in trauma.

Our study showed that in‑hospital mortality of trauma patients correlated with longer EMS ST and TT, but the RT was not associated with mortality. Our results recommend that the EMS system should consider ST and TT rather than RT, as indexes of quality control in prehospital care of trauma patients.