Health in Emergencies and Disasters Quarterly
Volume:4 Issue: 3, Spring 2019

Disasters are medically defined as events in which the demands for patients’ care far exceed the available resources. In such situations, triage and rationing of limited resources are inevitable. A decision regarding triage needs not only scientific guidelines but also an ethical framework and supporting policies. This study aims to provide a comprehensive review of the criteria for ethical decision-making in disasters triage. Medline (Via pubMed.com), Scopus, Web of Science, and ProQuest databases will be searched from 1990 to July 2017 using a defined search strategy. Other search resources include Google Scholar, World Health Library, Global Ethics Library, Gray Literature Report website, and World Health Organization (WHO), which will be searched using a modified search strategy. The manual search will be conducted in two journals with the highest number of retrieved titles in the Scopus search and the reference list of selected articles. Study selection, quality assessment, and data extraction will be done by the first author, and the second reviewer will check the results, and probable disagreements will be resolved through discussion and review by a third reviewer.  This systematic review will identify all factors a triage officer should be considered when he or she would like to make an ethical decision. Transparency and consistency are two main procedural ethical values of disaster triage. The result of this review could be used to make a consistent decision in disaster triage.

Researchers have already highlighted the safety and health issues in workplaces. The necessity of these issues and their close relations to the environment have more transparently called for the management control of three critical dimensions of Health, Safety, and the Environment (HSE). Furthermore, following the rapid development of technology and the complexity of the activities tailored to the needs of companies and industries, a set of guidelines called HSE was developed to minimize the damages to human, equipment, and environment. Therefore, today presenting the academic education of HSE management system as a university Major, especially in universities affiliated with the Ministry of Health and Medical Education, like the University of Social Welfare and Rehabilitation Sciences seems necessary. In particular, USWR, besides rendering health, treatment, and rehabilitation services is a provider of the third level of the health system. Therefore, considering the importance of the issue, approximately a quarter century history of USWR establishment, and the fundamental nature of the health and prevention areas, this university attempted to use the comprehensive view of HSE management, to complete its activities in the field of Welfare and Rehabilitation Sciences. This paper aimed to investigate the necessity of establishing the HSE management Major at the USWR. The investigation was conducted using library review research, field study, community wisdom, and expert knowledge. The obtained data and results suggested that the USWR and its subsidiary centers recognized establishing HSE Major as beneficial in expanding research and science fields in rehabilitation services. It may also help pay more attention to the elderly, disabled, and children, both in terms of occupational hazards, and the general safety and various levels of life. Further in-depth research in these areas can ultimately help improve the wellbeing of all society members.

The most crucial issue in the disaster and accidents is the health management of the affected community because accidents and disasters always have a significant impact on hygiene, general health, and the wellbeing of the stricken community. Considering the hospitals’ function and their front line position in managing the victims of accidents and having to continue and even increase their activity at the time of accidents and disasters, they should have a program of coping with accidents. In this regard, the current study investigated the preparedness of hospitals in Ardabil Province, Iran, in response to unexpected events. This was a descriptive, analytical, and cross-sectional study conducted in 15 hospitals in Ardabil Province in 2017. To collect study data, a two-part questionnaire was used. Its first part investigated the demographic data of the hospitals. The second part was the national tool to assess hospital preparedness in accidents and disasters with 91 questions in 9 areas of preparedness (command and control, communication, safety and security, triage, capacity increasing, continuity of essential services, workforce, resource management, and post-disaster recovery). The collected data were analyzed using descriptive statistics. The findings of this study revealed that out of the 15 studied hospitals, only 4 were well prepared, 3 were poorly prepared, and 8 hospitals were moderately prepared for crisis management. On average, out of the 9 investigated aspects, triage, human resource management, and recovery after disasters had the lowest status. Considering the obtained results and the importance of preparing for unexpected events, it can be useful to plan and have an explicit instruction, and then implement and evaluate it to increase the preparedness to confront unexpected accidents in all hospitals.

Among the various components of disaster management during unexpected accidents, health care systems, especially hospitals, play the most important role in providing primary care services in the initial phase of the disaster. Health services in natural and human-made disasters are the main cause of human survival. Accidents and disasters always have a significant impact on the safety, general health, and welfare of the affected population.   In this paper, by collecting relevant data and their analyses in SPSS, we reviewed the response of the headquarters of the operation command of Alborz University of Medical Sciences to the Kermanshah earthquake in November 2017. According to the obtained results, 25-27 years old and 80 years old groups had the highest number of casualties to receive relief services. Based on the results of the analysis in SPSS, the number of injured men who received health care services was higher than women (38 men vs. 37 women). Madani Hospital admitted the highest number of victims by accepting 54 (72%) injured people. Based on our analysis, multiple trauma had the highest prevalence (24%) among injured people, then trauma to the foot (9%), followed by the trauma of the lower back and hand fractures (6.8%). Of the total 75 injured people transferred to the hospital, 39 (52%) underwent the operation. One case was sent to a hospital in Tehran Province, and 7 (9%) casualties were settled temporarily. There was a case of amputation. One patient was re-hospitalized. Finally, 4 (5%) of the injured people left the hospital. Regarding the services provided, it can be acknowledged that the headquarters of the Crisis Operation of the Alborz University of Medical Sciences (in spite of its new establishment) had an excellent performance regarding the type and amount of the services provided to the injured people in the field of risk management of accidents/disasters in Kermanshah earthquake in November 2017. Some of the positive and essential measures of  the headquarters of crisis operation command were planning operations; triage at the airport; transfer of the injured people; coordination with the hospitals;  declaration of yellow status to all medical centers; use of the full capacities of the Medical Sciences University; assignment of beds and the issue of surge capacity of health centers; communication with organizations, centers, and hospitals affiliated to Alborz University of Medical Sciences.

To achieve the highest possible level of health for individuals and societies involved in the crisis, a high level of individual and professional competency is needed in nurses for their active participation in the crisis. The acquisition of professional qualifications by nurses to provide care in the crisis is very important. The present study aimed to determine the effect of disaster and accident response training on the enhancement of professional competence of nurses in response to the crisis. This research was a quasi-experimental study with pre-test, post-test design. The statistical population consisted of all nurses working in Shahid Chamran Hospital in Saveh City, Iran, in 2017. In total, 80 nurses were selected through the convenience sampling method and were randomly divided into the intervention and control groups. The intervention group received training through lectures and workshops for 16 hours in 4 days. The samples completed a professional nursing competency assessment questionnaire before and one month after the intervention. The obtained data were analyzed by the Chi-squared test, Fisher’s exact-test, Independent samples t-test, and Paired samples t-test in SPSS. The findings revealed no significant difference between the two groups concerning demographic variables. After the intervention, the average improvement of professional competence of nurses in their ability to manage the accident scene increased from 63.3 to 74.07, teamwork skill from 56.7 to 74, individual specific abilities from 61.4 to 70, ethical performance from 67.8 to 76.9, and professional skills from 54 to 60. The Mean±SD pretest score of professional competency of nurses in the intervention and control groups were 163.5±28.6 and 155.73±34, respectively. After the intervention, these scores increased to 185.13±28.8 and 158.48±33.3 in the intervention and the control groups, respectively. The difference was statistically significant in the intervention group (P<0.001). The findings of this study indicated that the competence of nurses to provide care in crises was not at a desirable level. Thus, assessing the competence of nurses and identifying the gaps in their knowledge and skills before attending crises is essential. Also, the incident and disaster education can dramatically increase nurses’ professional competence in responding to the crisis. Therefore, we suggest the method used in this study as a feasible, simple, low cost and effective method in this regard.

Iran is a country with a high rate of natural disasters like earthquake. The environmental conditions slow down the delivery of health services, especially in the event of disasters. The modern technologies such as telemedicine are appropriate for facilitating disaster relief operations after an earthquake. This study aimed to develop a model for the implementation of telemedicine in an earthquake. The study was carried out using a mixed-methods research in three phases: 1. review of the literature; 2. qualitative study (modeling); and 3. Delphi method (validation of the model). Databases of Google Scholar, Web of Science, Scopus, and PubMed were searched from 1990 to 2019 with the keywords of “telemedicine” AND “disaster” OR “emergency” AND “earthquake”. After screening of the retrieved records, 13 articles met the eligibility criteria and were included in the review study. Ten experts extracted all key elements of telemedicine in the disaster from the articles and categorized them in 6 themes with 38 subthemes. The model of telemedicine in the earthquake was finalized with 2 rounds of Delphi with groups of selected volunteer experts.  In the first phase of the study, 6 key themes (telecommunication infrastructure, technical infrastructure, financial infrastructure, health infrastructure, organizational infrastructure, social infrastructure, and cultural infrastructure) with 38 subthemes of telemedicine for implementing in the disaster were obtained. At the conclusion of the third phase of the study, 6 key themes with 33 subthemes contributed to the model of telemedicine in the earthquake. Telecommunication infrastructure with a maximum score of 9.24 earned the priority, and social and cultural infrastructure themes with the minimum score of 7.53 came in the end. The model derived from this study can be used as an applied telemedicine model in an earthquake. We suggest that the results of this study be implemented as a theoretical model, or in a pilot study in a region of the country, and to be evaluated by regarding mortality reduction. We also recommend that a comparative study for using telemedicine in other types of disasters be undertaken.

Road traffic accidents in Iran are a critical issue that hinders economic development and one of the main threats to the health and safety of people in the community. The statistics indicate that after cardiovascular diseases, traffic accidents are the second leading cause of death in different age groups, which reflects the necessity of prediction in this area. The present study investigated the data of the traffic-accident injured people between April 2009 and March 2012 in Golestan, Mazandaran, Guilan, and Ardebil provinces, presented to forensic medicine. We used the Box-Jenkins method as one of the most advanced methods in prediction and future studies in the field of health systems, to estimate the number of injuries by province, for the years 2016 to 2019. The obtained results suggested the appropriate time series patterns for predicting injured people in Golestan Province with autoregressive integrated moving average (ARIMA) (4, 2, 4), Mazandaran Province with ARIMA (3, 1, 5), Guilan Province with ARIMA (3, 1, 4), and Ardabil Province with ARIMA (5, 1, 2). Furthermore, the mean percentages of absolute error for different provinces were as follows: Golestan Province, 0.114; Mazandaran Province, 0.064; Guilan Province, 0.078; and Ardabil Province, 0.1250. These data demonstrate the high precision of the Box-Jenkins method in predicting the number of traffic-accident injured people, especially in Mazandaran and Guilan provinces. Estimated values for 2016 to 2019 indicate that the road traffic injuries are increasing in Golestan Province and decreasing in Mazandaran, Guilan, and Ardebil provinces. The high precision of the Box–Jenkins method makes it an appropriate way for experts and authorities to predict traffic accident injuries in Golestan, Guilan, Mazandaran, and Ardebil provinces. The reduced number of casualties in Mazandaran, Guilan, and Ardebil indicate a progressive improvement in the transportation system conduct in these provinces. Moreover, Golestan Province is moving towards an increase in traffic accidents, requiring re-planning to reduce accidents there.

On May 3, 2017, at 11:58 AM local time, an explosion occurred in the Zemestan-Yurt coal mine in Azadshahr City of Golestan Province, northern Iran, which resulted in mass casualty incident. In total, more than 126 miners were affected. Of them, 43 miners were killed, 73 other workers who helped their coworkers were also injured and taken to the hospital, and 10 injured people received on-site prehospital medical care. Many defects in the response phase were identified in the scene management and the triage.  It seems necessary to establish a response plan for mass casualty incident, hold regular education, and plan to prepare involved units for appropriate responses. These measures are the first steps needed to improve preparedness and response to a mass casualty incident.