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Papers by Health in Emergencies and Disasters Quarterly (USWR)
Background: Iran detected its first COVID-19 case in February 2020 in Qom province, which rapidly... more Background: Iran detected its first COVID-19 case in February 2020 in Qom province, which
rapidly spread to other cities in the country. Iran, as one of those countries with the highest
number of infected people, has officially reported 1812 deaths from a total number of 23049
confirmed infected cases that we used in the analysis.
Materials and Methods: Geographic distribution by the map of calculated incidence rates for
COVID -19 in Iran within the period was prepared by GIS 10.6 Spatial autocorrelation (Global
Moran’s I) and hot spot analysis were used to assess COVID -19 spatial patterns. The ordinary
least square method was used to estimate the relationship between COVID -19 and the risk
factors. The next step was to explore Geographically Weighted Regression (GWR) models
that might better explain the variation in COVID -19 cases based on the environmental and
socio-demographic factors.
Results: The spatial autocorrelation (Global Moran’s I) result showed that COVID-19 cases
in the studied area were in clustered patterns. For statistically significant positive z-scores, the
larger the z-score is, the more intense the clustering of high values (hot spot), such as Semnan,
Qom, Isfahan, Mazandaran, Alborz, and Tehran. Hot spot analysis detected clustering of a hot
spot with confidence level 99% for Semnan, Qom, Isfahan, Mazandaran, Alborz, and Tehran,
as well. The risk factors were removed from the model step by step. Finally, just the distance
from the epicenter was adopted in the model. GWR efforts increased the explanatory value of
risk factor with better special precision (adjusted R-squared=0.44)
Conclusion: The highest CIR was concentrated around Qom. Also, the greater the distance
from the center of prevalence (Qom), the fewer the patients. Hot spot analysis also implies that
the neighboring provinces of prevalence centers exhibited hot spots with a 99% confidence
level. Furthermore, the results of OLS analysis showed the significant correlation of CIR
is with the distance from epicenter (Qom). The GWR can result in the spatial granularity
providing an opportunity to well understand the relationship between environmental spatial
heterogeneity and COVID-19 risk as entailed by the infection of CIR with COVID-19, which
would make it possible to better plan managerial policies for public health.
139 Short Report: Measures to Control Covid-19 Epidemic in Public and Reduce the Patient Load in ... more 139
Short Report: Measures to Control Covid-19 Epidemic in
Public and Reduce the Patient Load in Hospitals: A Report
From Iran
Reza HabibiSaravi1 , Yahya Saleh Tabari1 , Fariba Ghasemihamedani2,3*
1. Center for Disaster Management and Medical Emergencies, Mazandaran University of Medical Sciences, Sari, Iran.
2. Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
3. Red Crescent Society of the Islamic Republic of Iran, Mazandaran Province, Sari, Iran.
* Corresponding Author:
Fariba Ghasemihamedani
Address: Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
E-mail: fghasemihamedani@gmail.co
After presenting the novel coronavirus (SARS-CoV-2) in china, it has spread rapidly in
the community and now has declared as a pandemic causing coronavirus disease 2019
(COVID-19). At the date of writing this report, the COVID-19 has affected 192 countries
and one international conveyance (the Diamond Princess cruise ship harbored in Yokohama,
Japan) around the world with the total cases of 341,529. In Iran, the emergence of the disease
was reported with two cases of COVID-19 deaths in Qom city on February 19, 2020, that
caused great concern for the health system and the general public. It was rapidly spread
around the country and reach to 21,638 definite cases by March 22, 2020. The special nature
of the disease in rapid transmission among individuals in society requires urgent measures
and serious actions to control it as quickly as possible. In this report, we describe the current
status of the COVID-19 response strategy for reducing transmission in public and patient
load in hospitals in Iran. Although Iran has tried to use the successful experience of other
countries, such as China, for various reasons, such as non-quarantine of Qom province, as the
primary site of disease propagation, lack of public quarantine, lack of seriousness by some
citizens and officials, the lack of facilities and personal protective equipment needed for staff
use, and restrictions regarding purchasing equipment from other countries due to international
sanctions, have served as obstacles to achieve good results
Materials and Methods: This study was conducted with a qualitative methodology employing the conv... more Materials and Methods: This study was conducted with a qualitative methodology employing the conventional content analysis method. Data of anxieties and concerns of the general population were collected through social workers working at university/ medical schools throughout the country, affiliated healthcare centers, hotline 190, and social networks. The data collection process was saturated with 2920 theoretical data from February 27, 2020, to April 3, 2020. Results: Anxieties and concerns of community members were categorized into 8 areas: 1-Confusion in communication with the surrounding environment, 2-Concerns about vulnerable groups being affected, 3-The necessity of informational support, 4-Economic turmoil, 5-Shortage of preventive and treatment facilities, 6-weakness of social capital, 7-Stressful and destructive atmosphere, 8-Approaches for crisis management situation. Conclusion: Based on the research findings, focusing and attention on people's concerns in a transparent manner, and designing novel psychosocial support systems based on people's real needs to control the disease spread result in the enhancement of social capital between community members to get through this crisis quickly.
Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent c... more Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus. Iran is one of the countries affected by the disease. Health center services have a critical role in response to the COVID-19 outbreak. This study with the aim of providing the functions and services of primary health care was performed by a health center in Iran during the COVID-19 outbreak. Based on the results, of the functions and services of the primary health care included purposive inter-organizational interaction and cooperation, risk analysis, planning, education and consultation, exercise, risk communication, environmental health, occupational health, and development of health infrastructures. Iran established and developed specific approaches for case identification, screening, and resource allocation to protect public health by primary health care services. Health center services are effective for a proper response to COVID-19 and a reduction in mortality by screening, rapid identification, and public education.
Health in Emergencies & Disasters Quarterly, 2020
Background: Volunteering has great economic and social benefits, but it is neglected due to the n... more Background: Volunteering has great economic and social benefits, but it is neglected due to the nature of the work. This study aimed to assess the monetary aspect of the voluntary activities in the National Plan of Safety and Health of Nowruz Passengers and analyze the cost of the implementation of this plan, regarding youth volunteers.
Materials and Methods: In this descriptive-analytical study, 1574 volunteers outlined in the plan were analyzed with the wage replacement and replacement cost approach for the monetary evaluation of voluntary activities. Also, the cost-benefit analysis of the Red Crescent voluntary plan was calculated by the volunteer investment and value audit technique.
Results: In the mentioned road safety plan, the sum of the economic values of volunteering work was multiplied by the number of working hours of youth volunteers per day. Thus, the number of young people was determined, considering the average wage per hour for these people, the monetary value of 69885.6wasobtainedforthevoluntaryactivities.Also,thevolunteerinvestmentandvalueauditratewas69 885.6 was obtained for the voluntary activities. Also, the volunteer investment and value audit rate was 69885.6wasobtainedforthevoluntaryactivities.Also,thevolunteerinvestmentandvalueauditratewas10.6; it means that every dollar spent by Red Crescent would cost more than $10 if it were not voluntary.
Conclusion: According to the present findings, it seems that the National Plan of Safety and Health of Nowruz Passengers had been economically profitable for the Red Crescent population and the government because of its high revenue, compared with its cost.
Health in Emergencies & Disasters Quarterly, 2020
Background: Road accidents are one of the most important causes of death and severe bodily injuri... more Background: Road accidents are one of the most important causes of death and severe bodily injuries and financial damages, and its social, cultural, and economic consequences have severely threatened human societies. The purpose of this study was to use Data Envelopment Analysis (DEA) to measure the efficiency of provincial traffic police in reducing accidents in 2018 and determining the amount of optimal input resources of each provincial unit. Materials and Methods: The model used in this research had three inputs, including the level of equipment at the disposal, the level of the approved provincial budget, and the level of manpower at the disposal. It also had two outputs, including the score of reduction of casualties and the score of reduction of deaths in traffic accidents. The "returns to scale" was considered as a variable model, and the input model was an axial-type model. The DEAP software was used for data analysis. Results: The highest decrease in deaths in traffic accidents (in 2018) was related to Fars Province with 119 people, and the highest decrease in the number of injured cases was related to Khorasan Razavi Province with 1495 people. The RAHVAR Police (Traffic Police of Iran) in Tehran Province had the highest level of input resources, including manpower, equipment, and approved budget. Performance measurement for 2018 showed that out of 31 provinces studied, 10 provinces had a good performance and 21 provinces had acted inefficiently. The research results showed that the proper allocation of resources could push all units to the brink of efficiency. Conclusion: The trend of accidents in Iran is declining. Most of the RAHVAR Police units operate at an inefficient level, which by increasing their efficiency, the number of accidents can be reduced with a greater slope.
Health in Emergencies & Disasters Quarterly, 2020
Background: Pre-hospital emergency is usually the first phase of treatment. The most serious emer... more Background: Pre-hospital emergency is usually the first phase of treatment. The most serious emergency cases before any action in health care unit is to know what services are the cause of satisfaction or dissatisfaction of the patients with the overall emergency care. The aim of this study was to evaluate the satisfaction of recipients of pre-hospital emergency care in Qom City. Materials and Methods: In this descriptive study 400 patients who transported to the hospitals by Qom EMS were selected by using simple random sampling. Data were collected by using of satisfaction questionnaire. The data gathered through telephone interviews. Data were collected by using a demographic questionnaire and a Consumer Emergency Care Satisfaction Scale (CECSS) and then analyzed by SPSS v. 16 software using descriptive and Chi-square tests. Results: The results showed that the satisfaction rate from emergency ambulances and the efficiency of the emergency staff was moderate, and the satisfaction from technicians, the rate of acting professionally, performance of technicians, and the general opinion of patients were high. Also, the highest level of satisfaction (70%) belonged to technicians and the least satisfaction (26%) belonged to ambulance. Conclusion: Although the satisfaction rate of Qom pre-hospital emergency staff related to the performance of ambulance was low due to some shortcomings and deficiencies;however the overall rate of satisfaction from pre-hospital emergency care in Qom City was at a good and acceptable level.
Health in Emergencies and Disasters Quarterly, 2020
Background: Paying attention to physical, health and safety issues in educational environments is... more Background: Paying attention to physical, health and safety issues in educational environments is the most effective and fundamental factor for physical, mental and psychological development of students. Therefore, one of the most important and effective health issues of the school is to observe environmental health and safety. This study was conducted with the aim of surveying the environmental health and safety of schools in Khalkhal city with a crisis management approach. Materials and Methods: This is a descriptive study with cross sectional design. The study population consists of all primary, middle and high schools in Khalkhal city (n=28). For sampling, census method was used. Data collection tool was an 87-item checklist that surveys the health status of schools and its classrooms in terms of health and safety facilities. It was completed by visiting schools and observing, interviews and measurements. Collected data were analyzed in SPSS and Excel software. Results: 10% of schools had newly constructed buildings and 90% had old buildings. The minimum required area per student was observed in all schools. The green space area required for each student is 0.5 square meters, which was not observed in 73.83% of schools. Only 87.5% of schools had one toilet for every 40 students. Sewage disposal in 98% of schools was hygienic, and 100% of schools had sanitary trash cans. In 60% of the schools, the toilets did not meet the hygiene standards. In 84% of the schools, the number of washbasins was proportional to the number of students (1 per 60). All the classrooms had maximum use of natural light. Moreover, in most schools, health policies, safety policies and emergency and personal hygiene standards were met. Conclusion: Most schools in Khalkhal city were at moderate level in terms of environmental health and safety and compliance with national school environmental health regulations as well as being prepared to deal with emergencies and crises which indicates a need for more attention and support from the relevant authorities for improving their status. Citation: Vosoughi M, Dargahi A, Teymouri P. Environmental Health and Safety Assessment of Schools in Khalkhal City Using Crisis Management Approach.
Health in Emergencies & Disasters Quarterly, 2020
Background: One of the most important concerns after disasters is managing their health consequen... more Background: One of the most important concerns after disasters is managing their health consequences. This study examines the experiences of Primary Healthcare Workers (PHCWs) who involved in managing the health effects of the Arasbaran twin earthquakes of August 2012. Materials and Methods: This study was conducted using a qualitative approach. Data were collected through semi-structured deep interviews. The collected data were analyzed by content analysis using the code extraction of subthemes and themes. Study participants included health managers, healthcare workers, and individuals who received the health services in response to the health effects of the Arasbaran twin earthquakes. A total number of 16 participants were interviewed. The study sample was selected purposefully. Results: Interview analysis provided 14 subthemes and five main themes, including the lack of preparedness, the challenges of the PHCWs' contributions in providing healthcare, the inessentiality of the PHCWs' involvement in health response, the continuity of healthcare by the PHCWs, and the facilitation of coordination. Conclusion: The involvement of the PHCWs in managing the health effects of the earthquakes was a successful experience that could prevent health problems. Challenges faced during this experience were mainly caused by the lack of preparedness.
Health in Emergencies & Disasters Quarterly, 2020
Background: Road traffic accidents are currently among the most essential public health issues. A... more Background: Road traffic accidents are currently among the most essential public health issues. According to the World Health Organization, given the rapid growth of road transport globally, road traffic accidents could be the third leading cause of death and disability in the world by 2020. This article examined the role of the human factor in road accidents during the Nowruz holidays, as a major cultural event in Iran.
Materials and Methods: We explored the data of road accidents that occurred in Nowruz in 2016 and 2017 in Iran. Traffic accident data concerning the Nowruz holidays of 2016 and 2017 were collected by census method of sampling and based on the report of highway police. Additionally, the frequency of these accidents was analyzed according to travel time, accident type, gender, age, education, and vehicle type in different provinces.
Results: The present study findings suggested that among human factors affecting Nowruz accidents in 2016 and 2017, the highest frequency belonged to unnecessary speeding. As in 2016 and 2017, it was the main responsible characteristic for 56.42% and 55.01% of accidents, respectively. In Nowruz 2016, the provinces of Tehran, Khorasan Razavi, Isfahan, Fars, and Khuzestan; in Nowruz 2017, the provinces of Tehran, Isfahan, Khorasan Razavi, Fars, and Gilan encountered the highest rates of accidents leading to injuries and deaths.
Conclusion: To control unnecessary speeding and regulations disregard, planning for culturizing and the community-level education are suggested. Besides, increasing the quality and intelligence of vehicles and the construction of sliders, vertical lines on the road, warning signs, and billboards could help reduce the rate of accidents. Creating a working group of experts in psychology, traffic, etc., to study the pathology of dangerous behaviors, useless haste, and disregard for regulations and providing solutions could also be effective.
Health in Emergencies & Disasters Quarterly, 2020
Background: Occurring natural crises and lack of meticulous planning for confronting their damage... more Background: Occurring natural crises and lack of meticulous planning for confronting their damages and casualties can result in losing human and material resources. Moreover, it should be considered that crisis management is a kind of management in which prevention, intervention, and confrontation with the crisis are very important because these measures can decrease the detrimental impact of crises, especially at schools by saving students' lives. Therefore, regarding the importance of the subject, this study aimed to review studies on crisis management at Iranian schools. Materials and Methods: The study took place by a systematic search using Persian and English keywords on databases like Google Scholar, SID, and Magiran to find relevant research studies conducted in Iran until October 2018. Furthermore, the lists of references were checked to find more relevant studies. Out of 575 articles, the full texts of 12 studies were considered and the results of the searching were examined independently based on inclusion and exclusion criteria by two researchers after dismissing duplicates. Finally, 4 studies were qualified to be included in this review. Results: All studies used some questionnaires for assessing the outcomes. The target population consisted of students, teachers, principals, and experts of crisis management. Among the examined articles, two studies were about earthquake crisis management, and the other two discussed crisis management at schools. The level of preparedness for confrontation with the crisis, the effectiveness of crisis management course, dimensions and components of crisis management, and the priority of effective factors for readiness to confront crises were reported in the studies. Conclusion: Findings showed that students, teachers, and principals should receive necessary training about crisis management for preventing any probable injuries to children while confronting the crisis at schools. Consequently, it is suggested that the officials take crisis management at schools into serious consideration.
Background: Indonesia is home to approximately 400 active volcanoes located on three different te... more Background: Indonesia is home to approximately 400 active volcanoes located on three different
tectonic plates, which put it at risk of natural disasters. Accordingly, healthcare in emergencies
and disasters is of great importance in Indonesia. Therefore, this study aimed at describing nursing
students’ experiences of nursing education in disaster nursing in a university in Indonesia.
Materials and Methods: This qualitative content analysis with an inductive approach was
conducted by semi-structured interviews with eight nursing students from a university in Indonesia.
Results: One category, namely, “Being prepared for a natural disaster”, and three subcategories,
namely, “Feeling prepared in nursing”, “Managing limitations in nursing education” and
“Managing uncertainty in nursing”, were identified. Nursing students considered that theory in
disaster nursing was valuable; however, they lacked reality-based education to feel be prepared
to perform the required tasks as forthcoming nurses.
Conclusion: Increased and repeated practical training using case studies in nursing education
is important for improving nursing students’ preparedness in disaster nursing.
Background: Nowadays, safety management plans have an effective role in reducing the incidence of... more Background: Nowadays, safety management plans have an effective role in reducing
the incidence of accidents. Therefore, this study aimed at investigating the role of safety
management systems on accidents and the status of safety performance indicators in a
combined cycle power plant in 2011.
Materials and Methods: This descriptive-analytical research was carried out in two stages
in all Yazd Combined Cycle Power Plant units on accident victims from 2004-2011, based on
the documentation of the previous years and using census sampling. The Accident Frequency
Rate (AFR), Accident Severity Rate (ASR), and Frequency Severity Rate (FSI) indices were
derived from the OSHA standard using the formulas and data obtained from the completed
questionnaires and interviews with the people.
Results: The total number of accidents was 287 cases through the studied period (8 years).
The results showed a significant relationship between age and work experience, as well as
between age and marital status. The main causes of accidents were unsafe acts. The lowest
level of personal protective equipment was used in 2004 (15.2%), whereas the highest rate was
used in 2011 (30%). After the implementation of the Integrated Management Systems (IMSs),
accident indicators showed a decreasing trend regarding the washing time. Also, the amount
of AFR, ASR and FSI indices of the accidents in terms of work shift indicated a significant
decrease in 2004 than after the implementation of the safety management systems.
Conclusion: According to the results, due to the positive impact of safety programs (IMS),
incident indicators had a downward trend and unsafe acts were decreased.
Background: Early Discharge is one of the most well-known strategies to increase hospital capacit... more Background: Early Discharge is one of the most well-known strategies to increase hospital capacity during disasters, which is applicable by recognizing the patients appropriate for early discharge. Therefore, the current study was conducted to estimate a model for predicting hospitalized children appropriate for early discharge during disasters based on the attending physician's opinion. Materials and Methods: This cross-sectional study was conducted on 210 pediatric patients hospitalized in the emergency and pediatrics wards of the hospitals covered by Mashhad University of Medical Sciences. A researcher-made questionnaire was used to collect data. Questionnaires were completed at the patient's bedside by a trained questioner. The logistic regression was used to analyze the data. Results: Five variables, such as consciousness level (OR=4.677), dehydration status (2.596), ability to take milk/swallow (OR=1.930), blood oxygen saturation level (OR=1.186), and body temperature (OR=0.530) were determined as predictors for children appropriate for early discharge during disasters. The area under the ROC curve was calculated 0.848, which indicated a good curve fit of the estimated model. Conclusion: The model presented in the current study can help clinical staff identify hospitalized children appropriate for early discharge during disasters.
Background: Communicable diseases are one of the main health problems in Iran. This study aimed a... more Background: Communicable diseases are one of the main health problems in Iran. This study aimed at demonstrating the progress of communicable diseases management in more than 30 years of its implementation and pointing out its strengths and weaknesses, as well. Materials and Methods: This interview-based study using content analysis method was conducted in 2014. Data were collected through deep interviews. Fifteen interviews were conducted with all experts and health system managers at Iran's communicable diseases management center. The collected data were analyzed using the principles suggested by Strauss and Corbin. Results: The establishment of the communicable disease surveillance system was a revolution in the health system of Iran. The strengths of the system are as follows: network-based and integrated health services, well-organized and knowledgeable personnel, national and international supports, strategic and operational plans, and expanded programs of immunization. On the other hand, its weaknesses mentioned by the participants were: disease-based case definition, poor public awareness, poor inter-sectoral collaboration and coordination, insufficient resources, delayed or no notifying target diseases, lack of district laws or incomplete implementation of legislation, failure to provide feedback or ignoring for the results of the analysis, and lack of performance evaluation. Conclusion: Although the implementation of the communicable diseases surveillance system was a huge achievement in the health system of Iran, however, it needs more improvements based on the present situation. Revision of the rules, restoration and strengthening of the existing structure, the use of modern information and communication technologies, and the establishment of the monitoring and evaluation system are helpful to increase its success.
Background: Due to the unpredictable nature of disasters, it is crucial to anticipate, define and... more Background: Due to the unpredictable nature of disasters, it is crucial to anticipate, define and
divide tasks as preparedness activities to respond efficiently. This is because the organizations
involved in, becoming aware of their own tasks and other organizations’ tasks. The aim of this
study is to explore disparities in the viewpoints of members of Kerman University of medical
sciences and Red Crescent in emergent tasks after Bam Earthquake in Iran.
Materials and Methods: During January and February 2017 a total of 30 members from
Kerman Red Crescent and Kerman University of Medical Sciences were recruited through
snowball sampling with exploratory interviews and Self-administered questionnaire. The
content validity of the questions was tested through obtaining opinion of expert which was
acceptable (CVR=0.6, CVI=0.8).
Results: The results of our study showed that there was no predefined agreement about
emergent tasks over response phase to the Bam earthquake; buried corpses, and management of
received national and international aids from other organizations. Also, involved organizations
were not aware the specific tasks of other organizations.
Conclusion: During the disaster response phase in Bam earthquake, there was no agreement
about the responsible of organizations for undertaking emergent tasks. This disparity was a
barrier for effective response for involved organization.
Background: Schools, as social infrastructure and an integral part of society, play an essential ... more Background: Schools, as social infrastructure and an integral part of society, play an essential role in creating the resilience of the community to natural disasters. This study aims to systematically review and identify and categorize the components affecting schools' resilience against emergencies and disasters. Materials and Methods: Without any time limit, we will search the PubMed, Scopus, Web of Science, and Google Scholar databases using the three keywords of "Disaster", "School", "resilience", and their synonyms according to the MeSH website terms defined in the PubMed database. The inclusion criteria will be the articles related to school resilience, schools and emergencies and disasters, and school safety and resistance to threats. There will be no restrictions on the type of documentation, and all articles, books, and conference papers will be evaluated in this study. Search syntax strategies will be defined based on the guidance of each database. The final version of EndNote X8 is used to manage databases, delete duplicate and irrelevant articles, and extract relevant articles. The evaluation and selection of articles are based on the research question and the PRISMA checklist. Dissemination: The results of this systematic review determine appropriate criteria for school resilience, which are valuable for decision-makers and politicians, researchers in the field of education, Ministry of Health and Medical Education, Welfare Organization, Red Crescent, and people interested in research in the field of students and schools, especially in the event of emergencies and disasters. Also, according to the criteria extracted from this systematic review, the difference between resilient and non-resilient schools can be shown from an international perspective.
Background: Because of the complexity, stressfulness, and the threatening nature of the working e... more Background: Because of the complexity, stressfulness, and the threatening nature of the working environment of prehospital Emergency Medical Technicians (EMTs), they encounter many ethical challenges during making decisions and providing quick and accurate care to patients. The present study aimed to investigate the ethical challenges among prehospital EMTs. Materials and Methods: To review all published studies, we searched SID, Medlib, Iran Medex, Magiran, Web of Science, Medline, Google Scholar, CINAHL, PubMed, Ovid, and Scopus databases from 2000-18. The keywords were "ethical challenges", "emergency medical technicians", and "prehospital emergency". Results: According to the evaluation of the studies, the ethical challenge regarding prehospital emergencies included decision over dispatching an ambulance to the scene, cardiopulmonary resuscitation, triage in crisis and disaster, irrational interventions of the patient or patient's family, intervention in accordance with patient's informed consent, and safe driving. Conclusion: Considering the unique conditions of prehospital caring, identifying, and discovering the ethical conflicts in this field of the health care system and providing the appropriate solution are very important.
Background: Iran detected its first COVID-19 case in February 2020 in Qom province, which rapidly... more Background: Iran detected its first COVID-19 case in February 2020 in Qom province, which
rapidly spread to other cities in the country. Iran, as one of those countries with the highest
number of infected people, has officially reported 1812 deaths from a total number of 23049
confirmed infected cases that we used in the analysis.
Materials and Methods: Geographic distribution by the map of calculated incidence rates for
COVID -19 in Iran within the period was prepared by GIS 10.6 Spatial autocorrelation (Global
Moran’s I) and hot spot analysis were used to assess COVID -19 spatial patterns. The ordinary
least square method was used to estimate the relationship between COVID -19 and the risk
factors. The next step was to explore Geographically Weighted Regression (GWR) models
that might better explain the variation in COVID -19 cases based on the environmental and
socio-demographic factors.
Results: The spatial autocorrelation (Global Moran’s I) result showed that COVID-19 cases
in the studied area were in clustered patterns. For statistically significant positive z-scores, the
larger the z-score is, the more intense the clustering of high values (hot spot), such as Semnan,
Qom, Isfahan, Mazandaran, Alborz, and Tehran. Hot spot analysis detected clustering of a hot
spot with confidence level 99% for Semnan, Qom, Isfahan, Mazandaran, Alborz, and Tehran,
as well. The risk factors were removed from the model step by step. Finally, just the distance
from the epicenter was adopted in the model. GWR efforts increased the explanatory value of
risk factor with better special precision (adjusted R-squared=0.44)
Conclusion: The highest CIR was concentrated around Qom. Also, the greater the distance
from the center of prevalence (Qom), the fewer the patients. Hot spot analysis also implies that
the neighboring provinces of prevalence centers exhibited hot spots with a 99% confidence
level. Furthermore, the results of OLS analysis showed the significant correlation of CIR
is with the distance from epicenter (Qom). The GWR can result in the spatial granularity
providing an opportunity to well understand the relationship between environmental spatial
heterogeneity and COVID-19 risk as entailed by the infection of CIR with COVID-19, which
would make it possible to better plan managerial policies for public health.
139 Short Report: Measures to Control Covid-19 Epidemic in Public and Reduce the Patient Load in ... more 139
Short Report: Measures to Control Covid-19 Epidemic in
Public and Reduce the Patient Load in Hospitals: A Report
From Iran
Reza HabibiSaravi1 , Yahya Saleh Tabari1 , Fariba Ghasemihamedani2,3*
1. Center for Disaster Management and Medical Emergencies, Mazandaran University of Medical Sciences, Sari, Iran.
2. Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
3. Red Crescent Society of the Islamic Republic of Iran, Mazandaran Province, Sari, Iran.
* Corresponding Author:
Fariba Ghasemihamedani
Address: Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
E-mail: fghasemihamedani@gmail.co
After presenting the novel coronavirus (SARS-CoV-2) in china, it has spread rapidly in
the community and now has declared as a pandemic causing coronavirus disease 2019
(COVID-19). At the date of writing this report, the COVID-19 has affected 192 countries
and one international conveyance (the Diamond Princess cruise ship harbored in Yokohama,
Japan) around the world with the total cases of 341,529. In Iran, the emergence of the disease
was reported with two cases of COVID-19 deaths in Qom city on February 19, 2020, that
caused great concern for the health system and the general public. It was rapidly spread
around the country and reach to 21,638 definite cases by March 22, 2020. The special nature
of the disease in rapid transmission among individuals in society requires urgent measures
and serious actions to control it as quickly as possible. In this report, we describe the current
status of the COVID-19 response strategy for reducing transmission in public and patient
load in hospitals in Iran. Although Iran has tried to use the successful experience of other
countries, such as China, for various reasons, such as non-quarantine of Qom province, as the
primary site of disease propagation, lack of public quarantine, lack of seriousness by some
citizens and officials, the lack of facilities and personal protective equipment needed for staff
use, and restrictions regarding purchasing equipment from other countries due to international
sanctions, have served as obstacles to achieve good results
Materials and Methods: This study was conducted with a qualitative methodology employing the conv... more Materials and Methods: This study was conducted with a qualitative methodology employing the conventional content analysis method. Data of anxieties and concerns of the general population were collected through social workers working at university/ medical schools throughout the country, affiliated healthcare centers, hotline 190, and social networks. The data collection process was saturated with 2920 theoretical data from February 27, 2020, to April 3, 2020. Results: Anxieties and concerns of community members were categorized into 8 areas: 1-Confusion in communication with the surrounding environment, 2-Concerns about vulnerable groups being affected, 3-The necessity of informational support, 4-Economic turmoil, 5-Shortage of preventive and treatment facilities, 6-weakness of social capital, 7-Stressful and destructive atmosphere, 8-Approaches for crisis management situation. Conclusion: Based on the research findings, focusing and attention on people's concerns in a transparent manner, and designing novel psychosocial support systems based on people's real needs to control the disease spread result in the enhancement of social capital between community members to get through this crisis quickly.
Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent c... more Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus. Iran is one of the countries affected by the disease. Health center services have a critical role in response to the COVID-19 outbreak. This study with the aim of providing the functions and services of primary health care was performed by a health center in Iran during the COVID-19 outbreak. Based on the results, of the functions and services of the primary health care included purposive inter-organizational interaction and cooperation, risk analysis, planning, education and consultation, exercise, risk communication, environmental health, occupational health, and development of health infrastructures. Iran established and developed specific approaches for case identification, screening, and resource allocation to protect public health by primary health care services. Health center services are effective for a proper response to COVID-19 and a reduction in mortality by screening, rapid identification, and public education.
Health in Emergencies & Disasters Quarterly, 2020
Background: Volunteering has great economic and social benefits, but it is neglected due to the n... more Background: Volunteering has great economic and social benefits, but it is neglected due to the nature of the work. This study aimed to assess the monetary aspect of the voluntary activities in the National Plan of Safety and Health of Nowruz Passengers and analyze the cost of the implementation of this plan, regarding youth volunteers.
Materials and Methods: In this descriptive-analytical study, 1574 volunteers outlined in the plan were analyzed with the wage replacement and replacement cost approach for the monetary evaluation of voluntary activities. Also, the cost-benefit analysis of the Red Crescent voluntary plan was calculated by the volunteer investment and value audit technique.
Results: In the mentioned road safety plan, the sum of the economic values of volunteering work was multiplied by the number of working hours of youth volunteers per day. Thus, the number of young people was determined, considering the average wage per hour for these people, the monetary value of 69885.6wasobtainedforthevoluntaryactivities.Also,thevolunteerinvestmentandvalueauditratewas69 885.6 was obtained for the voluntary activities. Also, the volunteer investment and value audit rate was 69885.6wasobtainedforthevoluntaryactivities.Also,thevolunteerinvestmentandvalueauditratewas10.6; it means that every dollar spent by Red Crescent would cost more than $10 if it were not voluntary.
Conclusion: According to the present findings, it seems that the National Plan of Safety and Health of Nowruz Passengers had been economically profitable for the Red Crescent population and the government because of its high revenue, compared with its cost.
Health in Emergencies & Disasters Quarterly, 2020
Background: Road accidents are one of the most important causes of death and severe bodily injuri... more Background: Road accidents are one of the most important causes of death and severe bodily injuries and financial damages, and its social, cultural, and economic consequences have severely threatened human societies. The purpose of this study was to use Data Envelopment Analysis (DEA) to measure the efficiency of provincial traffic police in reducing accidents in 2018 and determining the amount of optimal input resources of each provincial unit. Materials and Methods: The model used in this research had three inputs, including the level of equipment at the disposal, the level of the approved provincial budget, and the level of manpower at the disposal. It also had two outputs, including the score of reduction of casualties and the score of reduction of deaths in traffic accidents. The "returns to scale" was considered as a variable model, and the input model was an axial-type model. The DEAP software was used for data analysis. Results: The highest decrease in deaths in traffic accidents (in 2018) was related to Fars Province with 119 people, and the highest decrease in the number of injured cases was related to Khorasan Razavi Province with 1495 people. The RAHVAR Police (Traffic Police of Iran) in Tehran Province had the highest level of input resources, including manpower, equipment, and approved budget. Performance measurement for 2018 showed that out of 31 provinces studied, 10 provinces had a good performance and 21 provinces had acted inefficiently. The research results showed that the proper allocation of resources could push all units to the brink of efficiency. Conclusion: The trend of accidents in Iran is declining. Most of the RAHVAR Police units operate at an inefficient level, which by increasing their efficiency, the number of accidents can be reduced with a greater slope.
Health in Emergencies & Disasters Quarterly, 2020
Background: Pre-hospital emergency is usually the first phase of treatment. The most serious emer... more Background: Pre-hospital emergency is usually the first phase of treatment. The most serious emergency cases before any action in health care unit is to know what services are the cause of satisfaction or dissatisfaction of the patients with the overall emergency care. The aim of this study was to evaluate the satisfaction of recipients of pre-hospital emergency care in Qom City. Materials and Methods: In this descriptive study 400 patients who transported to the hospitals by Qom EMS were selected by using simple random sampling. Data were collected by using of satisfaction questionnaire. The data gathered through telephone interviews. Data were collected by using a demographic questionnaire and a Consumer Emergency Care Satisfaction Scale (CECSS) and then analyzed by SPSS v. 16 software using descriptive and Chi-square tests. Results: The results showed that the satisfaction rate from emergency ambulances and the efficiency of the emergency staff was moderate, and the satisfaction from technicians, the rate of acting professionally, performance of technicians, and the general opinion of patients were high. Also, the highest level of satisfaction (70%) belonged to technicians and the least satisfaction (26%) belonged to ambulance. Conclusion: Although the satisfaction rate of Qom pre-hospital emergency staff related to the performance of ambulance was low due to some shortcomings and deficiencies;however the overall rate of satisfaction from pre-hospital emergency care in Qom City was at a good and acceptable level.
Health in Emergencies and Disasters Quarterly, 2020
Background: Paying attention to physical, health and safety issues in educational environments is... more Background: Paying attention to physical, health and safety issues in educational environments is the most effective and fundamental factor for physical, mental and psychological development of students. Therefore, one of the most important and effective health issues of the school is to observe environmental health and safety. This study was conducted with the aim of surveying the environmental health and safety of schools in Khalkhal city with a crisis management approach. Materials and Methods: This is a descriptive study with cross sectional design. The study population consists of all primary, middle and high schools in Khalkhal city (n=28). For sampling, census method was used. Data collection tool was an 87-item checklist that surveys the health status of schools and its classrooms in terms of health and safety facilities. It was completed by visiting schools and observing, interviews and measurements. Collected data were analyzed in SPSS and Excel software. Results: 10% of schools had newly constructed buildings and 90% had old buildings. The minimum required area per student was observed in all schools. The green space area required for each student is 0.5 square meters, which was not observed in 73.83% of schools. Only 87.5% of schools had one toilet for every 40 students. Sewage disposal in 98% of schools was hygienic, and 100% of schools had sanitary trash cans. In 60% of the schools, the toilets did not meet the hygiene standards. In 84% of the schools, the number of washbasins was proportional to the number of students (1 per 60). All the classrooms had maximum use of natural light. Moreover, in most schools, health policies, safety policies and emergency and personal hygiene standards were met. Conclusion: Most schools in Khalkhal city were at moderate level in terms of environmental health and safety and compliance with national school environmental health regulations as well as being prepared to deal with emergencies and crises which indicates a need for more attention and support from the relevant authorities for improving their status. Citation: Vosoughi M, Dargahi A, Teymouri P. Environmental Health and Safety Assessment of Schools in Khalkhal City Using Crisis Management Approach.
Health in Emergencies & Disasters Quarterly, 2020
Background: One of the most important concerns after disasters is managing their health consequen... more Background: One of the most important concerns after disasters is managing their health consequences. This study examines the experiences of Primary Healthcare Workers (PHCWs) who involved in managing the health effects of the Arasbaran twin earthquakes of August 2012. Materials and Methods: This study was conducted using a qualitative approach. Data were collected through semi-structured deep interviews. The collected data were analyzed by content analysis using the code extraction of subthemes and themes. Study participants included health managers, healthcare workers, and individuals who received the health services in response to the health effects of the Arasbaran twin earthquakes. A total number of 16 participants were interviewed. The study sample was selected purposefully. Results: Interview analysis provided 14 subthemes and five main themes, including the lack of preparedness, the challenges of the PHCWs' contributions in providing healthcare, the inessentiality of the PHCWs' involvement in health response, the continuity of healthcare by the PHCWs, and the facilitation of coordination. Conclusion: The involvement of the PHCWs in managing the health effects of the earthquakes was a successful experience that could prevent health problems. Challenges faced during this experience were mainly caused by the lack of preparedness.
Health in Emergencies & Disasters Quarterly, 2020
Background: Road traffic accidents are currently among the most essential public health issues. A... more Background: Road traffic accidents are currently among the most essential public health issues. According to the World Health Organization, given the rapid growth of road transport globally, road traffic accidents could be the third leading cause of death and disability in the world by 2020. This article examined the role of the human factor in road accidents during the Nowruz holidays, as a major cultural event in Iran.
Materials and Methods: We explored the data of road accidents that occurred in Nowruz in 2016 and 2017 in Iran. Traffic accident data concerning the Nowruz holidays of 2016 and 2017 were collected by census method of sampling and based on the report of highway police. Additionally, the frequency of these accidents was analyzed according to travel time, accident type, gender, age, education, and vehicle type in different provinces.
Results: The present study findings suggested that among human factors affecting Nowruz accidents in 2016 and 2017, the highest frequency belonged to unnecessary speeding. As in 2016 and 2017, it was the main responsible characteristic for 56.42% and 55.01% of accidents, respectively. In Nowruz 2016, the provinces of Tehran, Khorasan Razavi, Isfahan, Fars, and Khuzestan; in Nowruz 2017, the provinces of Tehran, Isfahan, Khorasan Razavi, Fars, and Gilan encountered the highest rates of accidents leading to injuries and deaths.
Conclusion: To control unnecessary speeding and regulations disregard, planning for culturizing and the community-level education are suggested. Besides, increasing the quality and intelligence of vehicles and the construction of sliders, vertical lines on the road, warning signs, and billboards could help reduce the rate of accidents. Creating a working group of experts in psychology, traffic, etc., to study the pathology of dangerous behaviors, useless haste, and disregard for regulations and providing solutions could also be effective.
Health in Emergencies & Disasters Quarterly, 2020
Background: Occurring natural crises and lack of meticulous planning for confronting their damage... more Background: Occurring natural crises and lack of meticulous planning for confronting their damages and casualties can result in losing human and material resources. Moreover, it should be considered that crisis management is a kind of management in which prevention, intervention, and confrontation with the crisis are very important because these measures can decrease the detrimental impact of crises, especially at schools by saving students' lives. Therefore, regarding the importance of the subject, this study aimed to review studies on crisis management at Iranian schools. Materials and Methods: The study took place by a systematic search using Persian and English keywords on databases like Google Scholar, SID, and Magiran to find relevant research studies conducted in Iran until October 2018. Furthermore, the lists of references were checked to find more relevant studies. Out of 575 articles, the full texts of 12 studies were considered and the results of the searching were examined independently based on inclusion and exclusion criteria by two researchers after dismissing duplicates. Finally, 4 studies were qualified to be included in this review. Results: All studies used some questionnaires for assessing the outcomes. The target population consisted of students, teachers, principals, and experts of crisis management. Among the examined articles, two studies were about earthquake crisis management, and the other two discussed crisis management at schools. The level of preparedness for confrontation with the crisis, the effectiveness of crisis management course, dimensions and components of crisis management, and the priority of effective factors for readiness to confront crises were reported in the studies. Conclusion: Findings showed that students, teachers, and principals should receive necessary training about crisis management for preventing any probable injuries to children while confronting the crisis at schools. Consequently, it is suggested that the officials take crisis management at schools into serious consideration.
Background: Indonesia is home to approximately 400 active volcanoes located on three different te... more Background: Indonesia is home to approximately 400 active volcanoes located on three different
tectonic plates, which put it at risk of natural disasters. Accordingly, healthcare in emergencies
and disasters is of great importance in Indonesia. Therefore, this study aimed at describing nursing
students’ experiences of nursing education in disaster nursing in a university in Indonesia.
Materials and Methods: This qualitative content analysis with an inductive approach was
conducted by semi-structured interviews with eight nursing students from a university in Indonesia.
Results: One category, namely, “Being prepared for a natural disaster”, and three subcategories,
namely, “Feeling prepared in nursing”, “Managing limitations in nursing education” and
“Managing uncertainty in nursing”, were identified. Nursing students considered that theory in
disaster nursing was valuable; however, they lacked reality-based education to feel be prepared
to perform the required tasks as forthcoming nurses.
Conclusion: Increased and repeated practical training using case studies in nursing education
is important for improving nursing students’ preparedness in disaster nursing.
Background: Nowadays, safety management plans have an effective role in reducing the incidence of... more Background: Nowadays, safety management plans have an effective role in reducing
the incidence of accidents. Therefore, this study aimed at investigating the role of safety
management systems on accidents and the status of safety performance indicators in a
combined cycle power plant in 2011.
Materials and Methods: This descriptive-analytical research was carried out in two stages
in all Yazd Combined Cycle Power Plant units on accident victims from 2004-2011, based on
the documentation of the previous years and using census sampling. The Accident Frequency
Rate (AFR), Accident Severity Rate (ASR), and Frequency Severity Rate (FSI) indices were
derived from the OSHA standard using the formulas and data obtained from the completed
questionnaires and interviews with the people.
Results: The total number of accidents was 287 cases through the studied period (8 years).
The results showed a significant relationship between age and work experience, as well as
between age and marital status. The main causes of accidents were unsafe acts. The lowest
level of personal protective equipment was used in 2004 (15.2%), whereas the highest rate was
used in 2011 (30%). After the implementation of the Integrated Management Systems (IMSs),
accident indicators showed a decreasing trend regarding the washing time. Also, the amount
of AFR, ASR and FSI indices of the accidents in terms of work shift indicated a significant
decrease in 2004 than after the implementation of the safety management systems.
Conclusion: According to the results, due to the positive impact of safety programs (IMS),
incident indicators had a downward trend and unsafe acts were decreased.
Background: Early Discharge is one of the most well-known strategies to increase hospital capacit... more Background: Early Discharge is one of the most well-known strategies to increase hospital capacity during disasters, which is applicable by recognizing the patients appropriate for early discharge. Therefore, the current study was conducted to estimate a model for predicting hospitalized children appropriate for early discharge during disasters based on the attending physician's opinion. Materials and Methods: This cross-sectional study was conducted on 210 pediatric patients hospitalized in the emergency and pediatrics wards of the hospitals covered by Mashhad University of Medical Sciences. A researcher-made questionnaire was used to collect data. Questionnaires were completed at the patient's bedside by a trained questioner. The logistic regression was used to analyze the data. Results: Five variables, such as consciousness level (OR=4.677), dehydration status (2.596), ability to take milk/swallow (OR=1.930), blood oxygen saturation level (OR=1.186), and body temperature (OR=0.530) were determined as predictors for children appropriate for early discharge during disasters. The area under the ROC curve was calculated 0.848, which indicated a good curve fit of the estimated model. Conclusion: The model presented in the current study can help clinical staff identify hospitalized children appropriate for early discharge during disasters.
Background: Communicable diseases are one of the main health problems in Iran. This study aimed a... more Background: Communicable diseases are one of the main health problems in Iran. This study aimed at demonstrating the progress of communicable diseases management in more than 30 years of its implementation and pointing out its strengths and weaknesses, as well. Materials and Methods: This interview-based study using content analysis method was conducted in 2014. Data were collected through deep interviews. Fifteen interviews were conducted with all experts and health system managers at Iran's communicable diseases management center. The collected data were analyzed using the principles suggested by Strauss and Corbin. Results: The establishment of the communicable disease surveillance system was a revolution in the health system of Iran. The strengths of the system are as follows: network-based and integrated health services, well-organized and knowledgeable personnel, national and international supports, strategic and operational plans, and expanded programs of immunization. On the other hand, its weaknesses mentioned by the participants were: disease-based case definition, poor public awareness, poor inter-sectoral collaboration and coordination, insufficient resources, delayed or no notifying target diseases, lack of district laws or incomplete implementation of legislation, failure to provide feedback or ignoring for the results of the analysis, and lack of performance evaluation. Conclusion: Although the implementation of the communicable diseases surveillance system was a huge achievement in the health system of Iran, however, it needs more improvements based on the present situation. Revision of the rules, restoration and strengthening of the existing structure, the use of modern information and communication technologies, and the establishment of the monitoring and evaluation system are helpful to increase its success.
Background: Due to the unpredictable nature of disasters, it is crucial to anticipate, define and... more Background: Due to the unpredictable nature of disasters, it is crucial to anticipate, define and
divide tasks as preparedness activities to respond efficiently. This is because the organizations
involved in, becoming aware of their own tasks and other organizations’ tasks. The aim of this
study is to explore disparities in the viewpoints of members of Kerman University of medical
sciences and Red Crescent in emergent tasks after Bam Earthquake in Iran.
Materials and Methods: During January and February 2017 a total of 30 members from
Kerman Red Crescent and Kerman University of Medical Sciences were recruited through
snowball sampling with exploratory interviews and Self-administered questionnaire. The
content validity of the questions was tested through obtaining opinion of expert which was
acceptable (CVR=0.6, CVI=0.8).
Results: The results of our study showed that there was no predefined agreement about
emergent tasks over response phase to the Bam earthquake; buried corpses, and management of
received national and international aids from other organizations. Also, involved organizations
were not aware the specific tasks of other organizations.
Conclusion: During the disaster response phase in Bam earthquake, there was no agreement
about the responsible of organizations for undertaking emergent tasks. This disparity was a
barrier for effective response for involved organization.
Background: Schools, as social infrastructure and an integral part of society, play an essential ... more Background: Schools, as social infrastructure and an integral part of society, play an essential role in creating the resilience of the community to natural disasters. This study aims to systematically review and identify and categorize the components affecting schools' resilience against emergencies and disasters. Materials and Methods: Without any time limit, we will search the PubMed, Scopus, Web of Science, and Google Scholar databases using the three keywords of "Disaster", "School", "resilience", and their synonyms according to the MeSH website terms defined in the PubMed database. The inclusion criteria will be the articles related to school resilience, schools and emergencies and disasters, and school safety and resistance to threats. There will be no restrictions on the type of documentation, and all articles, books, and conference papers will be evaluated in this study. Search syntax strategies will be defined based on the guidance of each database. The final version of EndNote X8 is used to manage databases, delete duplicate and irrelevant articles, and extract relevant articles. The evaluation and selection of articles are based on the research question and the PRISMA checklist. Dissemination: The results of this systematic review determine appropriate criteria for school resilience, which are valuable for decision-makers and politicians, researchers in the field of education, Ministry of Health and Medical Education, Welfare Organization, Red Crescent, and people interested in research in the field of students and schools, especially in the event of emergencies and disasters. Also, according to the criteria extracted from this systematic review, the difference between resilient and non-resilient schools can be shown from an international perspective.
Background: Because of the complexity, stressfulness, and the threatening nature of the working e... more Background: Because of the complexity, stressfulness, and the threatening nature of the working environment of prehospital Emergency Medical Technicians (EMTs), they encounter many ethical challenges during making decisions and providing quick and accurate care to patients. The present study aimed to investigate the ethical challenges among prehospital EMTs. Materials and Methods: To review all published studies, we searched SID, Medlib, Iran Medex, Magiran, Web of Science, Medline, Google Scholar, CINAHL, PubMed, Ovid, and Scopus databases from 2000-18. The keywords were "ethical challenges", "emergency medical technicians", and "prehospital emergency". Results: According to the evaluation of the studies, the ethical challenge regarding prehospital emergencies included decision over dispatching an ambulance to the scene, cardiopulmonary resuscitation, triage in crisis and disaster, irrational interventions of the patient or patient's family, intervention in accordance with patient's informed consent, and safe driving. Conclusion: Considering the unique conditions of prehospital caring, identifying, and discovering the ethical conflicts in this field of the health care system and providing the appropriate solution are very important.