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During the past 12 years we have been developing our military medical unit through collaboration between the public health system and military system. We found that one system could not work separate without another. Experts from public health system are incorporated into the military structure which provides efficient technical support and logistics. Through such a system we can cooperate in international projects.
Our level one trauma center with a service area covering a population of approximately four-million people treats approximately 80,000 patients per year. In 2010, we anticipate more than 23,000 patients admitted, and to experience more than 850,000 patient encounters within the network. Trauma research is an important component to any level one trauma center, as well as a requirement of the American College of Surgeons/Committee on Trauma (ACS/COT). Our trauma center has recently gained level one designation and began an emergency preparedness research and trauma research (EPR/TR) program in earnest. We are fortunate to have support from executive administrators. Stewardship is a necessary element of our planning, in part because we are a county hospital serving a large uninsured patient population. The following are a few of the necessary steps we took to build an (EPR/TR) department from the beginning, to the point of submitting abstracts, manuscripts, funding grants, and presentations to regional, national, and international conferences, journals, and agencies. Structure the Emergency Preparedness Office to be a component of Trauma Services, allowing a unique opportunity for real-time disaster and mass casualty research. Secure a commitment from senior executives. Secure an experienced researcher, capable of research administration. Ensure the (EPR/TR) director, trauma medical director, trauma services director, and emergency preparedness coordinator can be a cohesive team with complimentary skills. Encourage trauma surgeons to perform research with assistance from the (EPR/TR) Office. Seek federal and foundation funding. Seek alliances with appropriate consortiums and associations. Develop a research relationship with pre-hospital emergency services. The above steps represent only some of the components used to build our (EPR/TR) department. We anticipate the planned expansion of the above steps will take our EPR/TR to the next level and increase extramural funding.
The history of triage started from the French battle field. In- hospital ED triage started in early 1960's from Baltimore. It is now an essential component of modern ED. Triage is not only to sort out patients as per their criticality, but it also serves the purpose of streamlining the patients so that the patient receives right treatment at the right time in the appropriate area. It helps to manage the ED overcrowding by better flow of patients. AKUH-ER experience of triage dates back to the year 2000, when triage was conducted by physicians and there used to be a manual documentation of patient's particulars such as complaints, vitals and BP. With the expansion of AKU-ED in 2008 responsibility of triage shifted to nursing services. Triage policy was drafted and implemented and for guidance and uniformity of care, triage protocols were developed. Another important development is replacement of register with triage data entry software. This help us to monitor some indicators like number of patients triaged, the time between triaging and actual bed assignment, triage categorization, length of stay, dispositions and return visits. The available information now helps us to make decisions based on evidence and also paves the way for future direction.
Physical Medicine and Rehabilitation is a goal oriented and patient centered specialty which focuses on functional restoration and quality of life of persons with disability. The patterns of injuries among survivors of recent disasters have, range from mild (single limb fracture) to catastrophic (spinal cord injury, amputation, traumatic brain injury). Historically physiatrists have not participated the acute disaster management phase or in the emergent post disaster rehabilitation planning. This task is usually relegated to the trauma, orthopedic and general surgeons.
Methodology
Authors had firsthand experience in the acute and emergent care and rehabilitation of trauma patients after Pakistan, China and Haiti earthquakes. An electronic literature search (English, 1965–2010, Key words: trauma, rehabilitation, disability, spinal cord injury, amputation, disaster, nerve injury) was carried out. Experience sharing through committees, online forum, and communications were conducted with physiatry colleagues internationally.
Results
In these three recent earthquakes, Physiatrists provided direct patient care, including guidance in the evacuation of survivors with pre-existing disabilities, transport of persons with spinal trauma, treatment of wounds, fractures, pain, spinal trauma patients and persons with amputations. Physiatrists devised appropriate plans for conservative management of fractures. Education of local staff and coordination of rehabilitation was initiated. Monitoring, prevention and treatment of secondary complications including prolonged immobility, pressure ulcers, chronic pain, urinary, bowel and respiratory dysfunction was performed. Physiatrists helped in patient counseling and family education.
Conclusion
Physiatrists by virtue of their training and skills are in a better position to manage the disabilities, including direction of rehabilitation and community integration, prevention of complications, and education and training of health workers and teams. Timely rehabilitation interventions for Spinal cord injuries and lower limb amputations following the Pakistan, China and Haiti earthquakes resulted in reduction in morbidity and mortality among those with catastrophic injuries.
A Mass-Casualty Event (MCE) involving pediatric victims could overwhelm existing pediatric resources. Therefore, early recognition of critically ill infants and children is essential for proper distribution among pediatric capable hospitals. However, emergency medical services (EMS) personnel have limited experience with pediatric assessments, and less with pediatric mass-casualty triage (MCT). To address these gaps, the New York City (NYC) Pediatric Disaster Coalition (PDC) in collaboration with the Fire Department (FDNY) and Office of Emergency Management, made simple alterations to the START-based NYC-MCT Algorithm that can be rapidly and accurately applied by EMS personnel in the field with minimal additional education and preparation, obviating the requirement for extensive and expensive retraining.
Methods
The PDC includes experts in pediatric emergency preparedness, emergency medicine, critical care, and trauma surgery in NYC, as well as DOHMH, FDNY-OMA, and OEM. Its Triage Subcommittee determined the minimum essential pediatric alterations to the Algorithm, which then was tested by FDNY-EMS.
Results
After focused literature review and multiple draft revisions aimed to maximize pediatric benefit yet minimize unnecessary complexity, the Algorithm was modified to ensure that: (1) five rescue breaths will be provided to infants or children prior to being categorized as Dead or Expectant; (2) infants under 12 months old will be categorized as Critical and receive priority transport, and (3) children initially categorized as Delayed or Minor will be uptriaged to a new Urgent (Orange) category to receive such care in a rapid manner. To date, > 3,000 FDNY personnel have been trained in its use, and tested its accuracy using tabletop scenarios. Mean accuracy is 80–90%.
Conclusions
The model is an effective, multidisciplinary approach to planning. Minimum alterations to the Algorithm were adopted by the regional EMS system. The Modified Algorithm improves identification of critically ill infants and children. This approach could be adopted by other large urban centers.
Mass gatherings involving hazardous materials (HAZMAT) poses unique challenges to the operations of any emergency department. A screening station is essential for risk stratification and identification of HAZMAT casualties. Existing patients and relatives in the emergency department must be restricted and controlled. Prompt segregation and decontamination of casualties is crucial in a HAZMAT incident. Identification of such a facility with planning of inflow and outflow routes must not be undermined. Crowd control should be performed by securing all entrances and exits, minimizing cross-contamination The topography of the emergency department must be examined with the objectives of minimizing acquaintance and cross-contagion in mind. Directional leadership is crucial during chaotic situations. Clarity of thought and decisiveness is critical. Good communication channels must be established with internal and external agencies in all phases of emergency department response. Apart from the acute response mechanism, training is an important factor in enhancing staff preparedness. Regular continuity of education is essential to keep staff up-to-date with the latest procedures and legislation. Drills and audits are useful for assessing staff competency levels. Familiarity and easy accessibility to overall response plans and detailed individual action cards also are important. The availability and adequacy of operationally ready equipments and consumables must not be underestimated. All equipment and consumables must be easily accessible and clearly labeled. Bimonthly audits are recommended to ensure defect-free equipment and validity of consumables. In conclusion, regardless of these difficulties, emergency departments continue to be the main provider of care to contaminated individuals. Thus, it is imperative that all emergency departments in Singapore be vigilant during peace time.
Due to the limited resources of specialized hospital departments, the allocation of patients to different hospitals according to the severity of their condition is an extraordinarily complex and time-critical problem. The emergency capacity was determined for all medical centers (n = 135) in the State of Hessen, for patients of the various hospitalization triage categories (red, yellow, green), for normal working hours, for weekends and nights, including logistic specifications of a potential helicopter landing. This data was entered into a state register. Using the data from the “acute-care-register”, a Ticket System was developed that allows the operations management to assign patients according to the severity of their condition, urgency and necessary specialization (e.g., neurosurgery, ophthalmology, pediatrics) to a hospital without exceeding the admission and/or treatment capacity of the hospital/facility. During a non-critical period, the order of allocations depending on the distance of the clinic to the site of the emergency is planned in advance so that no further modifications are necessary during the acute intervention phase of an emergency response. Additional notification of hospital capacities for severe casualties provided during the emergency response can be easily and immediately supplemented. Due to the relatively low frequency of such emergency responses, a cost-effective concept that is easily adaptable to the respective fields of application has been discovered. The system is a sticker set customized for the respective rescue teams. The sets will be carried permanently in the rescue equipment by the organization manager of the rescue service team. The equipment is not dependent on electronic components. The cost per sticker set is approximately US$50. Keeping track of the patient allocations is assured.
The earthquake that struck Chile on February 27th, 2010 produced profound damage of hospital services with 4249 bed lost especially in the regions of Maule and Bio. The capacity of the health was critically reduced in ability to assure health access to affected people by the disaster.
Discussion of Interventions
The first strategy to maintain health services was the deployment of 18 field hospitals from Chilean organizations (Army and Air Force), international organizations and foreign governments. This measure allowed for 533 beds and 16 surgical blocks in the first weeks. There were 14 field hospitals until November. Taking into account the beginning of the winter season, the national government set up another sort of strategy to increase the capacity of the health care facilities: § Strengthening of hospitals without damage that were close to the disaster area. These hospitals were used as referral centers. § Purchasing of 708 beds from the private health sector. § Habilitation of free spaces to be used for inpatients. § Increasing the capacity of home care health programs to release beds. § Construction of some small temporary units to admit patients. § Small-scale interventions to repair damages in hospitals. § Extending the work time until 16 hours in the primary health care facilities. § Improving of the efficient of the using of human and physical resources. § Restructuration of the hospital network that allowed adding 300 new beds.
Results
The ministry of health recovered more than 94% of loss beds and 92% of surgical blocks through July. However, it is necessary to identify US$ 2720 million for reconstruction program and to establish a national strategy of safe hospitals in order to reduce the future costs of the recovery of damaged health care facilities. *Based on information from PAHO – Chile.
The January 12 2010 7.0 magnitude earthquake's epicenter hit just 10 miles west of Port-au-Prince and its 2 million inhabitants at 4:53 pm. Estimates of dead 222,517 at the time of writing, with thousands missing and hundreds of thousands living in tent cities. Haiti is the poorest country in the Western Hemisphere with approximately 80% of the population living under the poverty line. There is a lack of seismic risk perception and planning at the national level. As a result in many areas there are no, or poorly followed, road, highway or bridge building codes.
Need
Although assistance arrived to major ports and cities from all corners of the globe, access from rural and remote areas to centralized hospitals remained difficult. Our group, a mobile medical team able to negotiate difficult terrain by foot with vehicle support in close proximity, deployed to these remote areas. EMS systems were poor in rural areas prior to the earthquake and now are nonexistent, in areas where no access to phones or even addresses (tent cities) to respond to. We found many injured without access to transportation even a month after the earthquake. No family or friends had access to vehicles to transport them. Many knew help was available, but did not know where or how to access. They waited in situ for help not knowing if it was coming. Limb threatening injuries were left to get necrotic and infected, no doubt adding to the morbidity and mortality. Our groups identified patients requiring transport and arranged for drivers, many times using paid locals from cities.
Call for future action
Implementation of a disaster plan for International NGOs to provide organized EMS transport for remote victims without access. Coordination with local community leaders and OCHA to identify areas in need of this service.
The “Health Legal Preparedness Model” developed in the US aims to provide better health-related responses in times of emergency. It includes four components: (1) law; (2) competencies; (3) information; and (4) coordination.
Objective
The aim of this study is to examine the usefulness of the “Health Legal Preparedness Model” in the present state of affairs in the field of emergency preparedness in Israel.
Methods
A qualitative study was conducted. In-depth interviews were performed with leading experts in the past or at present in the Israeli emergency health system.
Results
The Israeli healthcare system already has elements of the model in place at various levels. The relative perceived importance of each of the four aspects of the model varied between the experts. Of the four components, law and coordination were perceived as a major system concern. Training of specialists in emergency legislation was controversial. In addition, differences were found in the experts' perceptions as of the optimal way to operate the health system during an emergency. Variability also was found in the perception of the private sector growth and in the importance of its incorporation into emergency response plans. The study found that the emergency preparedness system resembles military practices in its conduct. Nevertheless, there is willingness toward mutual emergency systems drills, including aspects of legal preparedness.
Conclusions
The model already is applied partially in the Israeli emergency healthcare system. Results indicate that the Health Legal Preparedness Model might be useful in identifying gaps in emergency response plans. It also crystallized gaps related to optimal operation during emergencies in the country. Therefore, it is important to reach agreement upon solutions that will incorporate a regulatory guideline in order to improve the function of the emergency healthcare system.
The main trends in the development of the ideology of humanism in disaster medicine can be formulated in the following theses: 1. Responsibility of governmental bodies for providing medical safety of a human being in emergencies; 2. Responsibility of public health in the society; 3. Main tasks in nuclear threats connected as applied to disaster medicine are the responsibility of United Nations; 4. History of humanitarian medicine and the development of the World Health Organization's activities in providing medical humanitarian assistance; 5. Ethics of modern physical investigations in the light of development of nuclear and thermonuclear hazards; 6. Roles and trends of humanitarian medicine in modern society; 7. Philosophical and humanitarian approaches and ethics in the modern scientific investigations in the whole; 8. Ethics in modern medicine, biology, and disaster medicine; 9. Rights of victims to receive humanitarian medical assistance in local military conflicts; and 10. Threat of acts of terrorism with the use of chemical, biological, radiological, or nuclear agents and technologies; The paradox of the modern age is that the “principal basis and aim of disaster medicine are humanitarian by their primordial nature”, but the reduction of common human values can lead to a global disaster. On the other hand, emergencies should lead mankind to unity, to the deep understanding of biosocial aspects of survival when the best qualities of human nature are revealed. International disaster medicine problems should be considered as tools for providing an optimal basis for the development of human relations. The development of humanitarian and disaster medicine should be realized with consideration of deep-laid moral positions, on the basis of ethic principles and high moral values, among which, the primordial values are individual existence of everybody and survival of mankind as a species.
A well sounded education in a peaceful environment is a stepping stone to a good future of a society. Therefore, we can say the foundation and potentiality of economic and socioeconomic of any country is well defined by this.
Discussion
Not everyone receives the reward of education that plays a vital part in their lives. The main reasons as to why this is the case, Is due to the environment the person/individual lives in. For example, when a child is living in conflict and poverty as a major crisis the need for education will be ignored. Children in war torn countries such as Afghanistan where children are constantly under physical and psychological stress due to their schools being destroyed by bombardment and also the killing of their educators. Furthermore, children in war torn countries have a high risk of concern for a pointless education as they don't get a chance to attend school regularly, but they will dapper with educational stress. In this situation all the educators and their students will be whirling in the storms and floods of psychological stress. Education is very emotional and traumatic as it is in Afghanistan, where they suffered through the unfair interference of outsiders in their home country as the Russian did by the name of democracy in 1979–1998. Unfortunately, following 09/11 a new time has set with a new kind of invasion which is going on. We now observe more tragic situation which again external powers are injecting their culture and foreign bodies in Afghanistan. It's obviously drying out the water of our culture.
Conclusions
Where the Culture itself is one of the most important and valuable aspect of life it is a tower of education. Without culture, education would never have been built and so never could be improved.
Hospitals are highly complex facilities that play a key role in the medical response to disasters. However, they are susceptible to the impact of disasters with respect to their structural, non-structural and functional elements. Many hospitals have collapsed or been damaged and rendered nonfunctional as a consequence of disasters. The resilience of a hospital along with the capability of effective medical response to disasters is a key part of a community based disaster plan.
Objective
The objective of this study was to evaluate and compare hospitals in Iran with respect to safety.
Methods
This study was performed as a survey in four hospitals in Iran. The Hospital Safety Index package from WHO was used as an evaluation tool. The evaluation team consisted of: a PhD in structural engineering, an architect with a Master's degree, a specialist in electrical and mechanical maintenance, a medical doctor, a specialist in disaster management, and an expert in health care planning. The hospitals were evaluated in three elements; structural, non-structural, and organizational. The hospital safety calculator was used.
Results
The most important hazard for these hospitals was earthquakes. The structural safety at three hospitals was inadequate or at risk; and consequently needs intervention in a near future. Also, the administrative and organizational element of these hospitals was inadequate or at risk. All hospitals need intervention in the near future due to non-structural safety being inadequate. The overall safety index at one hospital was A (functional); in two hospitals B (at risk); and in one hospital C (inadequate).
Conclusions
The Iranian hospitals which had been assessed were on the whole unsafe. Also, these hospitals do not have a disaster management plan. Implementing a comprehensive disaster plan, including mitigation and a preparedness plan, would most likely enhance the safety of these hospitals.
The impacts of disasters on the community are not necessarily determined by the scale of a disaster, but are influenced significantly by the preparedness of the community, including the health community. Resilience is a dynamic quality within a community that is developed and strengthened over time. Evidence of the Western Australian (WA) health system resilience was demonstrated on 22 March 2010 when two severe weather fronts crossed the Perth metropolitan area and severely impacted a significant number of hospitals, the State pathology service, radiological services in tertiary and secondary hospitals, as well as aged care, mental health and other key health facilities. This storm has resulted in more than 120,000 claims and the total estimated cost is expected to exceed 1 billion Australian dollars, making it the most costly disaster due to natural hazards in WA history. Damage to these facilities included: (1) flooding, ceiling collapse, and broken windows in intensive care units, emergency departments, and operating theatres; (2) loss of radiological services; (3) sewerage inflow into wards, resulting in evacuation of mental health inpatients; (4) infrastructure damage to aged care facilities requiring relocation of residents; and (5) extensive loss of electricity and communications throughout Perth, which impacted on home oxygen therapy clients. A public health response also was required due to sewerage overflow into Perth's main river systems. This presentation will provide an overview of the event, lessons learned and how these lessons learned will be used to further enhance the health community's resilience.
Pericardiocentesis is rare but life saving procedure that all emergency physicians should be competent in performing. Improper technique can place patients at significant risk for iatrogenic injury. Proper training is needed to familiarize physicians with proper pericardiocentesis technique.
Training Model
In order to facilitate training of this relatively rare procedure, a cadaveric pericardiocentesis model was developed. Described is a step by step procedure for creating a cadaveric model that can be used to train and evaluate providers in pericardiocentesis competency.
Utilization
This unique teaching innovation can be utilized in a variety of settings to train providers, including those in resource limited environments. It has already been utilized in the training of emergency medicine residents in Thailand and in the United States.
The problems of pre-hospital care and training in the developing world are very similar – resource limitations and training deficiencies. Humanitarian conditions in the Sudan have been among the worst in the world including both man-made and natural disasters. Effectively responding to emergencies is of paramount importance.
Methods
The information was collected by a group of Sudanese physicians working in the emergency department at a large urban public hospital in Khartoum, Sudan and in the U.S. for the purpose of establishing structured training programs for pre-hospital responders.
Results
There are currently 37 registered state operated mini-van ambulances serving ∼8 million people in the capital city of Khartoum. There is 1 central dispatching command center operated by the state Ministry of Health (MOH) that serves 29 hospitals. Services are available by calling a central “999” emergency response number. There are no private ambulances in Khartoum; however, most patients are transported by private or public transportation. Ambulance transport teams consist of ∼2 ambulance emergency assistants with limited medical training. Ambulance transport costs are covered either by insurance for the insured; however, the majority of patients are self paid. Emergencies are also managed by the Department of Civil Defense, which is a branch of the Sudanese MOH that responds to natural and man-made disasters. There are 2 layers of this team; 420 physician with masters degrees in DM and emergency rescue workers. These emergency rescue workers do not have formalized training. Other important findings are: lack of training centers for first emergency responders, no standardized practice guide lines among pre-hospital care personnel.
Conclusion
Emergency response in the Sudan is a relatively new practice but has shown a promising trend for the continued development of a highly advanced and functional pre-hospital/emergency response system. More structured training through collaborative efforts and substantial resources are needed.
Following the Buizingen train-crash disaster on February 15, 2010, nineteen dead bodies were evacuated to the morgue of the Military Hospital. According to the hospital's emergency incident management system, the reception plan for the deceased was activated and an EM organized. Aim: To determine the psychological impact of exposure to current death and to evaluate the effect of proactive outreach in DRW deployed in an EM.
Methods and Results
For five consecutive days 62 hospital staff personnel were involved in the daily activities of an EM: disaster victim identification, autopsies, care for the dead, logistic support and reception and mental relief of the families. Besides a critical incident debriefing on day 5, a postal questionnaire survey of these 62 DRW was conducted, including the Davidson Trauma Scale (DTS) – detecting acute post-traumatic stress reactions/symptoms (ASR/S) – and the Symptom Checklist SCL 90 self-report inventory – measuring primary symptoms and global distress – administered 2, 4 and 7 months following the train-crash. Out of these, 35 (56%) initially responded (informed consent), followed by a return rate of 80% (28/35) and 68% (19/28) respectively. Six out of the 35 participants were identified suffering from acute psychological distress according to DTS and SCL 90 and subsequently followed up in the hospital's dedicated Military Centre for Crisis Psychology. In five of them, normalization of symptoms had occurred by the second inquiry and persisted. Ten months post-event, only 1 patient still needs psychological counseling, whereas 34 demonstrated psychological resilience.
Conclusion
Prevalence of chronification is low (1/35) compared to literature (5 to 10%). Timely detection of acute distress and proactive outreach may effectively counterbalance chronification in tertiary victims following a critical incident. Education and training should help hospital staff deal with ASR/S and improve coping. Hospitals should support professionals in the most disturbing situations.
Crimean-Congo Hemorrhagic Fever (CCHF) is a fatal zoonotic viral infection. The agent belongs to the Nairovirus of the Bunyaviridae species. The virus naturally recycles in vector-vertebrate-vector. This study aimed to evaluate cases of tick bites admitted to Infectious Diseases and Emergency Departments in 2008, and to develop management recommendations of such cases. Fifty-seven patients who admitted to a hospital due to tick bites in 2008 were included in the study. A 10-day clinical follow-up was performed to assess for symptoms including fever, fatigue, abdominal pain, headache, nausea/vomiting, diarrhea, disseminated somatic pain, and other hemorrhagic signs. During this period, laboratory analyzes, including white blood cells, thrombocytes, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase, lactate dehydrogenase, creatinine phosphokinase (CK), and pentylenetetrazol were performed. Personal data of the patients, location of the bite, and the removal of the tick were recorded.
Results
Of the 57 patients, 37% were from the city, and 63% were from rural areas. The tick was removed by health staff in 25 (44%) of the cases. The bites occurred on body areas including the head/neck, trunk, upper extremities, and lower extremities in 14%, 24%, 27%, and 13% of the cases, respectively. During the follow-up period, none of the patients exhibited any of the signs or symptoms listed above. Laboratory tests did not reveal any abnormalities, except for high levels of CK in 15 patients. Thus, 57 cases did not develop CCHF.
Discussion and Conclusion
Since 2002, CCHF has caused an increased mortality in Turkey, and has resulted in high anxiety and concern among the Turkish public regarding tick bites. This has resulted in a rise in the number of patients admitting to emergency departments with tick bites. Due to CCHF's incubation period, patients with tick bites should be evaluated for 10 days using a multidisciplinary approach involving both clinical and laboratory evaluations in order to prevent the unnecessary administration of ribavirine.
Recent studies have discussed major deficiencies in the preparedness of emergency medical services (EMS) providers to effectively respond to disasters, terrorism and other public health emergencies. Lack of funding, lack of national uniformity of systems and oversight, and lack of necessary education and training have all been cited as reasons for the inadequate emergency medical preparedness in the United States.
Methods
A nationally representative sample of over 285,000 emergency medical technicians (EMTs) and Paramedics in the United States was surveyed to assess whether they had received training in pediatric considerations for blast and radiological incidents, as part of their initial provider education or in continuing medical education (CME) within the previous 24 months. Providers were also surveyed on their level of comfort in responding to and potentially treating pediatric victims of these events. Independent variables were entered into a multivariate model and those identified as statistically significant predictors of comfort were further analyzed.
Results
Very few variables in our model caused a statistically significant increase in comfort with events involving children in this sample. Pediatric considerations for blast or radiological events represented the lowest levels of comfort in all respondents. Greater than 70% of respondents reported no training as part of their initial provider education in considerations for pediatrics following blast events. Over 80% of respondents reported no training in considerations for pediatrics following events associated with radiation or radioactivity. 88% of respondents stated they were not comfortable with responding to or treating pediatric victims of a radiological incident.
Conclusions
Out study validates our a priori hypothesis and several previous studies that suggest deficiencies in preparedness as they relate to special populations - specifically pediatrics. Increased education for EMS providers on the considerations of special populations during disasters and acts of terrorism, especially pediatrics, is essential in order to reduce pediatric-related morbidity and mortality following a disaster, act of terrorism or public health emergency.
The prehospital time delay in acute health problem still is a problem in most low- and middle-income countries, like Iran. It often is possible to minimize adverse consequences by promptly providing effective prehospital services
Aim
This study was designed to compare the response time interval occurring during the prehospital care process in Tehran during the last decade.
Methods
A retrospective, comparative study was designed, and the mean response time intervals in relation to prehospital care were identified from September 1999 until September 2000 were compared with data from September 2009 until September 2010. Data were collected from Tehran emergency medical services (EMS) center registries.
Results
The EMS center of Tehran dispatched 213 ambulances every day in 1999–2000 compared with 1,200 in 2009–2010. During the 2009–2010 period, the mean response time for city locations was 14.18(+ /−4) minutes, compared with 1999–2000 the mean response time for city location was 16(+ /− 8). The mean response time from the time period of 1999–2000 also was longer than for 2009–2010 (14.18 vs. 16.58 minutes).
Conclusions
Despite the prominent increase in the number of ambulance dispatching everyday, the mean response time in Tehran decreased during last decade. This improvement can be due to the improvement of the prehospital system in Tehran, including the number of: ambulances, trained staff, EMS stations, etc. However, it still is far from a national standard (eight minutes for city).