zohreh ghomian

During disasters and emergencies, healthcare systems, particularly hospitals, as the leading providers of care, play an important role; accordingly, this study examines the preparedness of hospitals affiliated with Shahid Beheshti University of Medical Sciences for biological incidents.

This descriptive cross-sectional study assessed the preparedness level of 14 teaching hospitals in response to biological incidents in 2022. The preparedness of the hospitals in facing biological incidents was evaluated by the secretaries of the hospitals’ risk and disaster management committees using a standard questionnaire (hospital preparedness questionnaire in response to biological incidents) to assess different dimensions of hospital preparedness, including the development of managerial structures, capacity building, training and practice, information and communication management, healthcare system and laboratory, safety and security, patient management, and hospital resilience.

The assessment of different hospital preparedness dimensions in facing biological incidents showed that the mean scores of the managerial structure development, capacity building, training and practice, information and communication management, safety and security, healthcare system and laboratory, patient management, and hospital resilience were 20.12, 44.71, 14.14, 19.21, 46.64, 20.42, 27.42, 15.92, respectively. The highest score was related to safety and security and information and communication management, with average scores of 50.78 and 22, respectively. Also, the dimension of training and practice, with an average score of 16.28 and an average percentage of 64.29%, attained the lowest score among the eight dimensions of hospital preparedness. The net score of hospital preparedness in response to biological incidents was obtained at 230.28. According to the final score of hospital preparedness, 9(64.3%) hospitals had a good preparedness status, while 5(35.7%) hospitals acquired an average level of preparedness.

The preparedness of the investigated hospitals in response to biological events was favorable. However, coping with biological incidents mandates the highest level of preparedness; therefore, it is necessary to maintain good preparedness and try to improve the condition to an optimal level by focusing on all dimensions, especially those acquiring lower scores.

Vaccination is the most efficient strategy to tackle the COVID-19 epidemic, and it is important in many ways. Additionally, healthcare workers represent an important vaccine information source for the general population. This systematic review and meta-analysis aimed to evaluate the COVID-19 vaccine acceptance rate among healthcare workers.

Methods & Materials:

 This study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, and the protocol of this study was registered in PROSPERO with the registration number CRD42023402082. Searches were conducted up to 20 October 2023 in data resources, including PubMed, Scopus, Web of Science, and Google Scholar. The random-effects model was used for meta-analysis, and the I2 index was used to evaluate heterogeneity among studies. The STATA software (version 14) was used for data analysis.

During the initial search, 6132 articles were selected. After the screening, study selection, and quality assessment, 93 studies entered the meta-analysis process, and a total of 196235 healthcare workers were examined. The overall vaccine acceptance rate among healthcare workers was reported as 68.56% (95% confidence interval (CI) =18.7-99.7; I2 = 99.750%; p< 0.001).

The overall acceptance rate of the COVID-19 vaccine in healthcare workers was lower than expected. Also, some determining factors were identified. The analysis of the vaccine acceptance rate and the factors affecting it can help healthcare officials and policymakers with proper healthcare planning.

The coronavirus disease 2019 (COVID-19) pandemic has increased the psychological problems of people all over the world. In this crisis, nurses experienced complex physical and psychological stress.

This study aimed to determine the relationship of perceived stress with moral distress and the spiritual intelligence of clinical nurses in the context of COVID-19.

This cross-sectional study was conducted on 285 clinical nurses working in public hospitals in the city of Shahroud, Iran. Data collection instruments included a demographic data sheet, the Perceived Stress Scale (PSS), Corley’s Moral Distress Scale (MDS), and King’s Spiritual Intelligence Scale (SISRI-24). Descriptive (frequency, mean, and standard deviation) and inferential statistics (the independent t-test, Pearson correlation coefficient, and logistic regression analysis) were used to analyze the data.

The findings showed that nurses reported high levels of perceived stress (36.12 ± 5.14). Perceived stress was positively and significantly correlated with moral distress (P = 0.001, r = 0.09). Perceived stress was also significantly correlated with age (P < 0.01, r = 0.29) and work experience (P = 0.001, r = -0.85).

According to the findings, nurses must strive to reduce moral distress during the COVID-19 pandemic. For this purpose, psychosocial support for clinical nurses, stress management courses, and providing welfare facilities for nurses are essential.

The preparedness of petrochemical industries against disasters is important to control risks, reduce losses and possible damages. Studies have shown that preparedness is an important factor in the disaster response phase. This study aimed to explore the factors influencing industry preparedness in fire.

This study was conducted from July 2020 to December 2021, with a qualitative case study design. The population included 22 people including 12 crisis managers, three Health, Safety, and Environment chief officers, two operational commanders in the fire department, two policymakers and three university professors. The data were collected through semi‑structured interviews and purposeful sampling, which continued until saturating the data. The strategies recommended by Guba and Lincoln were used for evaluating the trustworthiness of the data. The data were analyzed using the conventional content analysis method according to the method suggested by Graneheim and Lundman.

The effective components of the petrochemical industry preparedness for fire were classified into six main categories and 16 subcategories. Categories and subcategories covered fire characteristics (nature and chain of fire), policy‑making (regulations, incident information documentation, and incident insurance incentives), and management factors (commitment and leadership, incident command, communication and information, and planning). The others involved support factors (equipment supply, coordination and cooperation, and training and awareness), safety culture (risk management, monitoring and auditing, inherently safe design), and sanction consequence (software and hardware).

Many factors affect the petrochemical industry’s preparedness for fire. Adopting effective management and appropriate policy regarding preparedness with strategies for promoting and developing a safety culture can improve the preparedness of petrochemical industries in disasters.

 Risk communication is a complex, multifaceted process that plays a significant role in disaster management. One of the criticisms of Iran's health system risk communication is the existence of legal gaps and deficiencies in upstream documents.

 This research evaluated national documents to identify and assess the legislative gap in health system risk communication.

 This research is a gap analysis study using the qualitative content analysis method. National documents from 2002 to 2022 related to disaster management were collected. Documents were entered into the blueprint designed by the researcher and analyzed.

 In the present study, 58 documents due to disaster management were extracted. After the initial review, 36 documents involving 266 items concentrating on risk communication were included in the research. In initial thematic analysis, 47 approvals due to the mitigation phase (five subcategories of information, education and public awareness, infrastructure development, community engagement, and preparation and maintenance of information systems), 61 approvals due to the preparedness phase (nine subcategories of monitoring, information and maintenance of database, creation and maintenance of network and communication infrastructure, coordination, organizational training, planning, determining level of access to information, communication, monitoring and evaluation), 133 approvals due to the response phase (11 subcategories of information management, informing, communication management, media management, trust building, organization and coordination, appointing a spokesperson, monitoring and control, use and management of social media, content production, and supply and maintenance of equipment and infrastructure), 25 approvals due to the phase of rehabilitation and reconstruction (four subcategories of documentation, information, training, and community engagement).

 The field of risk communication has been mentioned according to the revision and updating of documents in recent years, but in these documents, many aspects of risk communication were dim; therefore, experts in the field of disaster management should pay more attention to a review of these papers and the creation of a special document on risk communication.

To manage life-threatening conditions and reduce morbidity and mortality, pre-hospital’s on-scene decision making is an influential factor. Since pre-hospital’s decision making is a challenging process, it is necessary to be identified this process. This study was conducted to explore the model of Iranian emergency medical technicians’ decision making in emergency situations.

This study was applied through grounded theory method using direct field observations and semi-structured interviews. Purposeful sampling with 26 participants including 17 emergency medical technicians including dispatchers, physicians of medical directions, managers and 1 representative for court affairs was performed. Interviews were lasted from October 2018 to July 2019. Corbin and Strauss approach, 2015 (open, axial and selective coding) were used toanalyzedata.

A paradigm model was developed to explain the relationships among the main categories. Decision making in the context of fear and concern was emerged as the core category. Unclear duties, insufficient authorities and competencies as well as lack of enough decision making’s protocols and guidelines were categorized as casual conditions. Other important categories linked to the core category were interactions, feelings and “customer focus approach”. Action–interaction strategies were taken by Emergency Medical technicians lead to some negative consequences that can threaten clinical outcome and patient safety.

Based on the finding of this study, Emergency Medical technicians’ decision making in the context of fear and concern, as the core concept of this model, lead to decrease in quality of the pre-hospital services, stakeholders’ dissatisfaction, hospital emergency units’ overload, decrease in reputation of the Emergency Medical Technicians, threat to patient clinical outcome and patient safety. To prevent of these negative consequences, facilitation of the Emergency Medical Technicians’ on-scene decision making is recommended

Road Traffic injuries (RTIs) are major global health issues, but they have been neglected. RTIs are multi-faceted in nature and, like many injuries, are costly but preventable. Iran has one of the highest rates of deaths due to traffic accidents among middle-income countries. Hence, there is a need for effective and preventive approaches in road safety management. One of the new approaches to road safety is the Vision Zero. The aim of this study was to design a Vision Zero implementation model in Iran.

This present study was conducted using the qualitative grounded theory approach. Purposive, snowball and maximum variety sampling were used to select participants. In-depth interviews were used to collect data. Grounded theory method was used to analyze the data using Corbin and Strauss method.

In this study, 19 interviews were conducted with 17 participants. Based on data analysis, a total of 4 main categories and 13 subcategories were obtained. According to the participants, the lead agency was recognized as the core category. Other concepts were categorized as causal conditions, intervening conditions, contextual conditions, action/interaction strategies, and consequences.

Establishing a lead agency with inter-organizational coordination through political support and legislation and changing the approach of road safety can be effective in implementing a Vision Zero. Also, improving the safety attitude of the stakeholders and changing their approach through training and advocacy from various organizations related to road safety is effective in creating a lead agency and implementing a vision zero. In addition, in order to implementation of the model, it is very important to pay attention to the economic, political and ethical underlying factors towards human beings

COVID-19 has infected more than 196717202 people and killed more than 4203769 cases worldwide ever since its emergence until July 29th, 2021. The creation of centers for prehospitalization and post-hospitalization of patients as makeshift hospitals were principal actions for Covid-19 management. The study aimed to assess the safety of the largest makeshift Hospital for COVID-19 management in Iran. This cross-sectional study was conducted in Iran, from March 29, 2020, through May 20, 2020. Ever since the outbreak of COVID-19, the IRAN MALL complex dedicated a part of its exhibition space to the Medical Center in the COVID-19 disaster to help the national campaign. The research team designed a makeshift hospital risk assessment tool based on COVID-19 and visited the big makeshift hospital in Iran to evaluate its non-structural and functional situation. Also, dimensions of setting up a convalescent home and the importance of structural or non-structural items were investigated. The non-structural safety, functional and managerial safety points were calculated separately. The total safety rating was determined at 870 as a very high safety level. In this makeshift hospital, there were 16 items with ultra-low, nine items with low, 18 with moderate, 28 with high, and 134 with very high safety. Most of the low to ultra-low safety issues were related to non-structural items. The non-structural and functional safety is an essential factor to be resilient in disasters and pandemics.  Strengthening health infrastructure, empowering health care providers, using new technologies in early warning, assessing the phenomenon, and providing services, will reduce the workload and financial burden of health effects and lead to health system adaptation.

Bioterrorism is an important health issue all overthe world. Rapid identification and preparation in dealing with bioterrorism attacks are the best methods of defense against bioterrorism. Therefore, the present study was conducted to investigate the knowledgeand organizational readiness of health care providers in dealing with bioterrorist attacks.

This study was a cross-sectional study conducted by census and with the informed participation of all health care providers of Bukan health center with 105 people.In order to do the work, a researcher-made questionnaire was used in three sections: demographic, knowledge(16 questions) and organizational readiness (14 questions). The validity of the questionnaire was confirmed by the faculty membersShahid Beheshti University, School of Public Health and Safety.Cronbach's alpha test was used to determinethe reliability of the questionnaire in two areas of knowledge and organizational readiness for 20 samples. Cronbach's alpha of the questionnaire was (70.9% and 76.4%), respectively, and SPSS v. 21 software was used for data analysis.

Organizational readiness of health care providers in dealing with bioterrorismattacks was 23.6%. In addition, awareness of bioterrorismand biological defense was 89.5% with maximum score in fighting bioterrorism equal to 89.5% and minimum score in recognizing bioterrorism equal to 67.6%. There was a directand statistically significant relationship between awareness and work experience (p=0.022).

The results of the present study can be helpful in managing health policy makers in order to do educational interventions to promote participation in healthmanagement, performance and integration of front-line forces against bioterrorism in the community.

To avoid making decisions based on the unproven opinions of emergency medical technicians (EMTs), many emergency medical service (EMS) systems rely on emergency medical protocols. As protocol‑based on‑scene decision‑making is influenced by many challenges, identifying these challenges can result in providing appropriate conditions for EMTs’ decision‑making. Therefore, this study aimed to identify the barriers and requirements in the off‑line emergency medical protocols implementation m in the prehospital emergency medical system.

To conduct this study, qualitative content analysis using 10 field observations, 22 interviews, and 2 rounds of focus group discussions was applied. The duration of interviews lasted from October 2019 to January 2020. The Graneheim and Lundman approach was used to analyze the data.

Seven categories (15 subcategories) including education and awareness (professional training and education and community‑based education); attitudes (professional attitude and community attitude); interactions and coordination (interpersonal interactions, organizational interferences, and community’s interactions); rules and instructions (instructions and supportive rules); control system (monitoring and evaluation and motivational system); accessibility (recourses and communication); and organization (structure and process) were obtained as the obstacles and challenges in the offline emergency medical protocol implementation in the prehospital system.

There are many challenges in implementing offline emergency medical protocols in the prehospital emergency system. To achieve the effectiveness and efficiency of offline prehospital emergency protocols, it is necessary to facilitate these challenges and improve the EMTs’ knowledge, attitude, and performance through cooperative and skill‑based education. The findings of this study can be useful for EMS systems from national to local levels.

Nowadays, air ambulances have been developed as part of advanced emergency medicine services with many countries employing these services for transferring patients in usual and emergency conditions. However, there are challenges concerning the optimal development of air ambulance base. The present research aimed to identify factors affecting the development of air ambulance bases to provide the opportunity of planning to improve the quality of emergency medical services. In this systematic literature review, the peer-reviewed papers in fiv electronic databases, including Medline through PubMed, Scopus, Web of Science, ScienceDirect, and ProQuest, as well as available gray literature, were searched and selected. Two combinations of groups were used as keywords: the Health Planning and development factor, air ambulance base. The focus was on the PRISMA checklist, with no time limitations until from 1990 to January 2020. Finally, through 5156 related citations, 20 articles were included. Descriptive and thematic content analyses were evaluated. The factors affecting the development of the air ambulance base were classified in fiv categories and 14 subcategories as follows: navigation criteria, process indications and standards, sociopolitical factors, and current situation of the area. There are few studies on factors affecting the development of air ambulance bases. It is necessary to apply multidimensional models to consider various factors for development. The development of high populated cities, events and ceremonies with a crowd of participants, and increase of human-made disasters are making these services increasingly indispensable.

Road Traffic accidents are one of the most common accidents killing 1.35 million people annually around the globe. Approximately 86% of deaths occur from trauma before hospitalization. In such circumstances as a pre-hospital service, air ambulance can play an important role in accessing the patients and transferring them from the accident scene securing survival of patients. This study aimed to identify the affecting factors in-air ambulance response to traffic accident sites. This qualitative study conducted from November 6, 2019 to April 6, 2020, in which a semi-structured interview was carried out on 17 participants. To analyze the data of this qualitative study, the Graneheim and Lundman method was used, and a conventional content analysis approach was employed. The majority 41% were in the age range of 30-40 years.  Individuals with a master's or doctoral degree made up 70% of the participants. People with 11-20 years of work experience made up 52% and 58% of the participants were at the managerial level. Factors influencing the development of air ambulance bases in 6 main categories, included resources and infrastructure, training of specialized personnel, indicators and standards, information and communication, safety and security, and management factors were studied. Based on the findings, infrastructure improvement and allocation of resources as well as training specialized forces can play an important role in developing air ambulance bases in Iran, Further research is needed to develop a measurement tool to evaluate the affecting factors before establishing air ambulance bases in Iran.

 Vision Zero is a public policy approach that aims to achieve a road traffic system with no fatalities or serious injuries caused by road traffic crashes (RTCs).

 This study aimed to investigate the history of Vision Zero's evolution and trends in road safety worldwide.

 This scoping review was conducted based on the Arksey and O’Malley and the Joanna Briggs Institute framework. This framework consists of five steps: research question identification; identifying relevant studies; selection of study; data charting; gathering, summarizing, and reporting the results.

 Finally, 37 articles met the inclusion criteria. The trend of deaths caused by RTCs in the countries implementing Vision Zero showed a decreasing rate in deaths caused by RTCs. Although this rate varies in different countries, generally in some countries like Sweden it was explicit.

 Vision Zero has had an evolutionary development in many countries. Due to the significant impact of the implementation of Vision Zero, many countries are seeking to adopt or implement this approach. Despite the challenges of implementing Vision Zero in different countries, there is a growing interest in implementing it in different settings based on its philosophy.

The Cluster model is designed as a solution to promote humanitarian response management. This approach is used as an effective model for cooperation and participation of the relevant aid organizations.

This study aimed to identify the type and method of humanitarian aid to support people affected by the Kermanshah earthquake and discuss the importance of the cluster approach in humanitarian response.

In this descriptive cross-sectional study, the data were collected in two steps. First, NEWS and national reports were reviewed and then scientific articles were reviewed for the use of cluster approach for humanitarian aids in disaster. Finally, the findings were compared with the cluster approach of humanitarian aid and analyzed gap and duplication issues in the humanitarian aid related to the Kermanshah earthquake.

Findings showed 308 pieces of NEWS and reports on humanitarian aid transmission were found, 38 % (33) of which were from government agencies and 62% from non-governmental institutes. A review of the NEWS agencies revealed that 150 non-governmental organizations (NGOs) and 33 government agencies had helped Kermanshah by sending financial and non-financial aids. Therefore, the cluster approach is necessary for improving humanitarian responses in developing countries, especially countries located in disaster-prone zones. Therefore, the cluster model can be used in the social donation and can be managed by volunteer organizations during disasters for collecting and transferring the donations.

The Cluster model is designed as a solution to promote humanitarian response management. This approach is used as an effective model for cooperation and participation of the relevant aid organizations. There are currently 11 clusters including agriculture, camp management, rapid recovery, education, shelter, telecommunications, health, support, water and sanitation, nutrition, protection and health.

Mass gatherings are human community held for specific purposes and ceremonies, worldwide. Many of them originate from the beliefs, culture and traditions of societies. Several gatherings of religious, national, sports, political, scientific, are held in the Islamic Republic of Iran, which some of them are on very large scales. The aim of this paper is key planning considerations for the organizers of mass gatherings in the context of the novel coronavirus (COVID-19) outbreak.

This paper published by using the WHO’s Public health for mass gatherings key considerations and other reliable national and international references and websites.

Meeting organizers should consider three phases in planning appropriate preparedness measures (Planning, Operational, and Post-event phases). Specific actions to be taken in each phase are discussed:In Planning phase: Liaison with local and national public Health authorities; Risk assessment; Specific action plan for COVID-19; Capacity and resource assessment; and Risk communication and community engagement plan In Operational phase: Risk communication; Surveillance of participants; Testing and diagnostic arrangements; Treatment facilities; Decision-making; and Operational practices for reducing event-related transmission of the COVID-19 virus.
In Post-event phase: Support the response of authorities, if public health authorities suspect that transmission of the COVID-19 virus has occurred; Risk communication; Use and fallow the lessons identified;

A basic medical action plan must be created for every mass gathering event. Providing safety, security and health of the participants during the ceremonies is one of the most important tasks, have been considered in the mission of various organizations such as police, fire stations, hospital emergencies, etc. According to the services they provide, health organizations play an important role in providing and restoring health before, during and after gatherings.

Participating in mass gatherings puts people at risk of incidents. The distribution of resources should be based on need. The purpose of this study was to investigate the distribution of trauma care facilities based on need and access at a religious mass gathering in Iran. This national cross-sectional study is based on obtained data including the number of visits to health centers (NVHC) and the number of injuries visits health center (NIVHC) as needs and the number of physicians, paramedic, ambulance, and treatment center as access in border cities of Iran and Iraq in 2016. Gini coefficient, Lorenz curve and the Pearson correlation coefficient were applied to measure the level of equality in the distribution of trauma care and the correlation between access and need. The facilities were relatively distributed equally at the border towns in Iran; however, were not equally distributed in Iraq. There is no significant association between the paramedic for NIVHC and ambulance for NIVHC and NVHC. Moreover, there was a significant association between physician for NIVHC and NVHC, a paramedic for NVHC, and treatment centers for NIVHC and NVHC. The consequences of incidents could be reduced if distributing trauma care facilities equals at mass gatherings.

Becoming aware of experiences, and lessons learned in challenges can help optimize planning and improve efficiency and effectiveness. The present study aimed to address the challenges of helicopter emergency medical services (HEMS) from the viewpoint of the managers involved in HEMS in Kermanshah earthquake. This qualitative research was done using the content analysis method. The data were collected by semi-structured interviews. The study population consisted of directors who participated in management and transfer of injured people in the earthquake-stricken area of Kermanshah. Sampling was purposeful in the first stage and then by the snowballed method. In the present study, 479 codes were initially extracted regarding participants' perspectives and experiences and after eliminating duplicates, 53 codes were finalized. After analyzing the data, 4 categories and 12 sub-categories were extracted. In this research, lack of integrated management and process-oriented preparedness were the subjects with the highest number of codes. According to the findings of this study, it is suggested that comprehensive training programs should be implemented for effective management of the air emergency process during disasters such as earthquakes.

The dust and sand storms (DSS) in Iran increased in recent years, which have caused adverse health effects. Regarding the effects of DSS on the health indicators, the health system plays a key role based on the mission and the services which it provides. The present study was conducted, in Iran, to fill the existing knowledge gap and to understand the preparedness challenges of the health system in response to the DSS.

Twenty‑one semi‑structured interviews, in 2016–2017, were undertaken. This study carried out using purposeful sampling with key informants in the Khuzestan Province, national policymakers in Tehran, as well as people affected by this phenomenon. A qualitative approach, using the conventional content analysis, was employed to analyze the collected data.

Four main categories that appear to explain the preparedness challenges of the health system for DSS include the risk assessment, knowledge management, organizational elements, as well as monitoring and evaluation.

It is imperative that policymakers of the country pay special attention to the hazard risk understanding and managing the various aspects of the beliefs and attitudes associated with DSS. The development of early warning system, regular drills and exercises, as well as public and specialized health promotion training related to this phenomenon are suggested.

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.

Many types of natural disasters are sudden and calamitous events that create a large socioeconomic burden with significant negative impact on health care, social infrastructure, and the environment; especially in the low and middle income countries; therefore, it is necessary to reduce or control this kind of disasters by understanding the specific risks and negative impacts. Recognition of disaster events helps us to plan effectively, coordinate and invest on disaster risk reduction projects.
The current article was a narrative review of the epidemiological data available on natural disasters in MNA countries (Egypt, Jordan, Lebanon, Morocco, Oman, Tunisia,and Yemen) and their trends from 1900 to 2015. The statistical data were obtained from international disaster sources (EM-DAT, DesInventar and Gapminder) and literature reviews of international reports and journals. To find related articles from journals, data bases such as Pubmed, Escopus, Google Scholar, and SID were searched for the following key words: natural disasters, Middle-East, disasters and Middle-East, disasters and North Africa, natural disasters and Middle-East, natural disasters and North Africa, and disaster and trend.
In the last century, more than 80% of natural disaster events occurred in MNA and concentrated in just 9 countries as Afghanistan, Pakistan, Iran, Sudan, Somalia, Algeria, Morocco, Yemen, and Egypt. Hydrological disasters (flood and landslide) with 63% had the largest share in 2015 and were more than that of the last century. In 2015, mortality rate of flood with 11% and landslides with 32% had increasing trend compared to last century. In the last 2 years, conversely, damages and victims from flood were about 85%, which were more than those of the last century, but in landslides no change was observed. In 2015, meteorological disasters such as storms and extreme temperatures represented 19% of the total disaster occurrence that had an increasing trend compared to that of the last century with 12%. Extreme temperatures with 57% of all deaths and storm with 72% of total victims had the highest levels among other natural disasters in this period. In the previous years, the total number of death, affected people, and damages of metrological disasters had increasing trend compared to the last century. In addition, in 2015, the frequency of climatological disasters (drought) and geophysical disasters (earthquake) did not change significantly, but the number of affected people, deaths, and damages from drought and earthquakes had a noticeable decrease compared to those of the last century.
The trends of natural disasters frequency from 1900 to 2015 in MNA has increased and effective mitigation and preparedness is necessary, both at individual and governance levels. This issue in the middle income and developing countries in MNA should be considered as a high priority in national planning.

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.

Strategic planning and objectives at the provincial and local levels should be consistent with the requirements, obligations, and official standards.

In the present study, we sought to assess the health system’s informative documents on disaster management used by the decision- makers.

This was a qualitative research, which utilized content analysis. Seven national documents were selected from 9 national documents on disaster management. Valid checklists and data extraction forms were used for data collection.

Based on the United Nations disaster preparedness (UNDP) protocol, preparedness and mitigation strategies were investigated in national documents. We identified 52 strategies in disaster preparedness and 19 in disaster mitigation. The most mentioned strategies were related to organizational structure, resource planning mobilization, and strategies on evaluation, vulnerability assessment, and disaster response mechanisms.

According to the findings of the present study, more attention should be paid to the mission and vision of the organizations in disaster preparedness. To improve the disaster preparedness measures, more emphasis should be placed on other disaster preparedness strategies such as response mechanisms and information systems.