Background: Situations involving ambulance dispatch can be influenced by environmental factors, such as weather and climate. Therefore, this study investigates how temperature impacts the response time of emergency medical services in Golestan Province, Iran. Materials and Methods: A study was conducted to analyze the impact of temperature on EMS response times in Golestan Province, Iran, from March 21, 2019 to March 20, 2024. Data were collected from the pre-hospital care report (PCR) and the Golestan Meteorological Department using the convenience sampling method. Also, the variability in ambulance response time was examined in relation to the documented temperatures. Results: Our research findings revealed that the highest rate of calls leading to ambulance dispatches occurred at an average temperature of 25–30 °C (25.79%). In contrast, the lowest frequency of calls resulting in ambulance deployments was recorded at temperatures below 5 °C (2.17%), a difference that is statistically significant. Additionally, we found that the response times at temperatures under 5 degrees and above 30 °C were longer than at other temperature ranges and surpassed the national standard. Conclusion: Our research found that the highest number of calls resulting in ambulance dispatch occurred during times of increased average temperatures. Additional studies support our findings, indicating that EMS responses tend to rise with rising temperatures. This study provides data-driven proof for planners to address the challenges presented by climate change. By predicting surges in service demands during climate fluctuations, we can strategize for effective resource distribution and reduce patient wait times.
Background: After the earthquake, communities faced various psychological challenges in safety and security assumptions and experienced ontological insecurity. Considering the role of ontological security and housing reconstruction on long-term psychological trauma recovery, the purpose of the research was based on the development and validation of a standard tool to measure this concept. Materials and Methods: The research has a mixed method approach. In the qualitative phase, three primary earthquake survivors in Iran (the 1990 Manjil-Rudbar, the 2003 Bam, and 2017 Ezgeleh Sarpol-e Zahab earthquakes) participated, and preliminary concepts were defined using the Grounded Theory. In the second phase, the psychometric properties of the ontological security in the housing reconstruction framework were developed and examined through validity and reliability indices. In the quantitative phase, the developed questionnaire surveyed 322 earthquake survivors. Finally, a questionnaire of 48 items was developed. Results: According to the findings in post-earthquake housing considering factors such as reconstruction flexibility, personalization, place familiarity, safety reassurance, physical-environmental characteristics affecting survivors’ protective behavior, coping with physical-environmental concerns, safety perception through participation and interaction, safe refuges in the settlement and reconstruction acceleration would be effective in ontological security feeling and as a result psychological trauma recovery. Conclusion: Achieving ontological security in housing is a cognitive, emotional, and behavioral need which is possible through environmental control, stability, trust, and continuity. The ontological security tool with a reliability value of 0.941 can measure this factor in post-earthquake housing reconstruction with the lens of psychological recovery of survivors.
Background: Emergency medical services, more commonly known as EMS, is the first level of health care. The first step to be protected against legal traps is to gain the due legal knowledge. The current study surveyed the knowledge and attitude of prehospital emergency workers regarding professional legal issues at Mazandaran University of Medical Sciences in Iran. Materials and Methods: This is an analytical, cross-sectional study conducted in 2021. The study statistical community included all emergency medical staff working in headquarters and the personnel of 115 emergency service centers and the emergency staff of Mazandaran Province. The data were collected by a researcher-built questionnaire about the status of knowledge and attitude of emergency medical service staff considering legal issues. To study the relationship between the scores of knowledge, attitude, the Pearson correlation was used and to evaluate the factors influencing the score of knowledge, attitude, multiple linear regression was employed. SPSS software, version 22 was used for data analysis and significance level 0.05 was considered. Results: The study consisted of 267 participants whose mean age was 33.31±6.99 y. The majority of the participants were men (88%) and married (79.8%). The variables, including marital status, education, the type of employment, service base, presence in judicial communities, age and work experience revealed to be meaningfully related with the score of attitude. In terms of knowledge, 77.9% of the staff were at satisfactory level. Considering attitude, 55.4% were at good level. Conclusion: The level of legal knowledge and attitude of prehospital emergency workers was at favorable level. However, it is recommended to organize training courses as clinical scenarios in order to increase and update the information on the criminal and penal codes relevant to the profession. Therefore, it is suggested to identify the legal challenges of pre-hospital emergency workers.
Background: Physical and mental health promotion as well as social well-being of all employees is a central element of occupational health practice. It is becoming more evident that climate change is a core challenge confronting various global sectors, with substantial effects not only on environmental, social, and economic systems, but also on occupational health and safety in numerous industries. Due to the growing significance of climate change, the 2024 world day for safety and health at work has focused on its impact on occupational health and safety. Consequently, this study aimed to investigate how climate change influences workplace health and safety conditions. Materials and Methods: Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol, this research was designed as a systematic review. To identify studies, relevant keywords were searched in reputable databases (Scopus, PubMed, Web of Science, ScienceDirect, Cochrane, Embase, and Google Scholar) between 2000 and 2024. The retrieved scientific studies were reviewed by two researchers based on inclusion and exclusion criteria. Duplicate and irrelevant articles were removed from the study. Key information, including the implications of climate change on health and occupational safety, the study location, a summary of the findings, the study design, sample size or study period, and the tools used for data collection, was extracted from the selected studies and analyzed using a descriptive approach. Results: In this systematic review, 28 eligible studies were reviewed. The identified effects were divided into 9 different groups: 1) increase in heat stress; 2) consequences, symptoms and diseases related to heat; 3) decrease in work capacity and productivity; 4) increase in exposure to ultraviolet rays; 5) increase in air pollution in the workplace; 6) increase in infectious diseases and contagious; 7) increase in occupational accidents; 8) increase in cognitive impairment, psychological and behavioral effects; and 9) increase in severe weather events. Conclusion: Adopting effective adaptation strategies to climate change to prevent the hazards associated with climate change and improve workplace conditions necessitates cooperation between different government sectors, academic institutions, fields of study, and local communities.
This policy brief aims to identify structural, cultural, and operational barriers to effective psychosocial rehabilitation after natural disasters in Iran and provide actionable recommendations for improving the existing framework. A mixed-methods approach was applied, including a scoping review of international and national literature and qualitative interviews with 23 experts in mental health, social work, and disaster management. Findings reveal persistent institutional fragmentation, lack of binding frameworks, limited resources, and inequalities in access—particularly for vulnerable groups. Effective rehabilitation requires stronger national coordination, localized and culturally sensitive interventions, adequate training for responders, and sustained community engagement.
Background: Fire safety in emergencies and health care centers is a morally and legally sensitive issue, so if patients or staff are affected by external factors such as fire, the quality of the overall system management and health care will directly be touched. Medical centers are among the places with many fire accidents each year due to the lack of standardization of buildings in terms of fire safety. This study aimed to model and analyze the fire emergency response in emergency department of hospital by hospital fire emergency response prediction network (HFERP-net) method. Materials and Methods: This cross-sectional study was performed in the Emergency Department of a hospital affiliated with Iranian Social Security Organization in 2019. The risk assessment of the hospital was done using (FRAME) method and after that a model was developed according to the Petri net structure for fire emergency response. Results: Task description, task scheduling, and the relationship between them were not well defined and it was time consuming. By developing the model and performing a fire drill in the unit, the tasks being identified and the time required for the proper communication between them was reduced. Conclusion: The results showed that the fire risk level in the studied unit was unacceptable and the fire safety principles should be upgraded to an acceptable level. This method can be effective for emergency response planning and identifying high fire risks in health centers. By performing drills, potential conflicts of the tasks and resources will be identified and then the emergency response plan can be improved.
The convergence of emergency and disaster risk and climate change presents one of the most pressing health challenges of our time. The frequency and intensity of extreme weather events, like floods, heatwaves, wildfires, rising seas, and storms have increased markedly, placing unprecedented pressure on already fragile health systems. Climate change is a threat and risk multiplier, compounding vulnerabilities, and triggering cascading disasters that severely affect population health, particularly in developing countries with low-resource and high-risk settings.
Background: The rising incidence of healthcare-associated infections underscores the need for strict adherence to standard precautions. The prehospital emergency service is the initial contact point for patients, where infection risks can start. This study was conducted to evaluate the factors influencing adherence to standard precautions among prehospital emergency personnel. Materials and Methods: This descriptive-analytical cross-sectional study was conducted in 2023. Data were collected using a demographic questionnaire and the compliance with standard precautions scale. Statistical analysis was performed using SPSS software, version 25 and Kolmogorov-Smirnov, chi-square, Fisher exact test, and Spearman correlation. P<0.05 was considered statistically significant. Results: This study of 206 prehospital emergency personnel in Tehran found low compliance with standard precautions (mean score: 13.27±3.38). Standard precaution compliance was significantly and positively associated with marital status, history of health check-ups, history of exposure to body fluids, and the quality of personal protective equipment (PPE), with higher compliance observed among individuals possessing these characteristics. No significant links were found with base type (urban/rural) or PPE access. Weak, non-significant correlations were observed with age (r=-0.031, P=0.668) and work experience (r=-0.075, P=0.292). Discussion: Given the low compliance with standard precautions among prehospital emergency personnel and the rise of emerging and antibiotic-resistant infectious diseases, developing specialized infection control policies and strategies tailored to prehospital emergency care is imperative. Conclusion: Improving adherence to standard precautions among prehospital emergency personnel is crucial. Strengthening the factors influencing adherence can enhance infection control from the initial stage of medical service delivery.
Background: Climate change and its consequences affect all aspects of human life, and with their escalation, short-term and long-term impacts are also intensified. One of the most important issues affected by climate change is public health. Tehran (capital city of Iran) as a densely populated metropolis with a semi-arid climate is located at the tip of the arrow, facing the risks caused by climate change. Materials and Methods: This study analyzed ERA5 (fifth generation the European Centre for Medium-Range Weather Forecasts [ECMWF]) reanalysis data (1988-2022), validated using statistical indices. Trends were evaluated with the non-parametric Mann-Kendall test. Thermal waves are assessed by warm spell duration index (WSDI) and cold spell duration index (CSDI). The correlations between temperature, hospital visits, and population (2014-2022) were also examined. Results: Tehran experienced a significant long-term temperature increase over 34 years, particularly in spring, winter, and July. Heatwave frequency increased, while cold waves decreased. Average temperatures during extreme events also rose. Temperature and hospital visits showed a 0.61 correlation rate. Population, hospital visits, and annual average temperature increased by 4.98%, 16.42%, and 2.11%, respectively. Conclusion: Hotter conditions and rising temperatures directly influence public health. The disproportionate growth in disease occurrence compared to population highlights the critical impact of extreme temperature events on hospital visit rates, emphasizing the escalating health burden from observed climate change. This research confirms a shift towards hotter conditions and a rising temperature trend in Tehran. The significant correlation between temperature and hospital visits, alongside disproportionate disease growth, strongly suggests that extreme temperature events and rising temperatures are key drivers for increased hospital visit.
Background: Coronavirus disease (COVID-19) affected health professionals and humans around the globe. The World Health Organization (WHO) announced COVID-19 as pandemic on March 11, 2020. Hence the purpose of the research was to evaluate knowledge, attitude, and practice of dentist in southern state of India, during COVID-19 lockdown. Materials and Methods: A descriptive online questionnaire-based survey was executed on knowledge, attitude, and practice of dentist in southern state of India, during October 2020 to December 2020. It was a self-directed, unidentified questionnaire and comprised 25 close questions with 4 possible answers. A total of 40 clinical dental students, interns, practicing dentist, dental specialists and academician were recruited using non-probability availability sampling. Results: The questionnaire contained questions about personal information (5), knowledge (7), attitudes (6), and practices (6). About 60% of the respondents belonged to 20-30 years while 30% to 31-45 years old group. The participants were 59% undergraduates, 30% postgraduates, 7% academician, and 3.6% academician and private practitioner. Most of them were aware that SARS-CoV2 belonged to RNA virus, route of imparting was through respiratory droplets, and the effectiveness of hand washes and sanitizers in killing the virus evoked mixed response. However, only 66.6% of respondents said that hand washes and sanitizers were effective in killing the virus. Conclusion: The practicing dentists and academicians had enough knowledge to manage COVID-19 situation very well compared to students and interns. Hence, the academician should conduct regular online classes to inform the students and interns the importance of personal protective equipment (PPE) kit, N-95 mask, sterilization, hand sanitization, and vaccination during COVID-19.
Background: Gender equality is a foundational aspect of the nursing profession. However, there is limited documentation of how gender considerations were incorporated into policy-making during the COVID-19 pandemic. This study explored nurses’ perspectives on gender equality policies during the pandemic response phase. Materials and Methods: A qualitative content analysis was conducted using semi-structured interviews with 14 nurses working in COVID-19 wards. Participants were selected through purposive sampling, continuing until data saturation. Data were analyzed following Graneheim and Lundman’s method. Results: The central theme identified was “gender inequality in management policies and resource allocation,” derived from four categories: Inefficient management, inequality in interactions, inequality in resource management, and inadequate attention to staff needs. Nurses reported experiencing gender bias in decision-making and observed unequal access to resources and support during the pandemic. Conclusion: Nurses perceived significant gender inequality in policy-making during the COVID-19 response phase. Health system leaders and policymakers should prioritize gender equity in all stages of disaster preparedness and response. Further research is necessary to explore gender perspectives in similar high-stress healthcare environments.
Background: The emergency ambulance service is crucial in delivering emergency medical services (EMS) to patients. This study aimed to assess the driving behavior of ambulance drivers, who are emergency medical personnel. Materials and Methods: Between June and August 2023, a descriptive, cross-sectional study was conducted in the pre-hospital emergency department of Ardabil Province. The study included 400 working staff who were chosen using the census method. The Manchester driver behavior questionnaire (MDBQ) and a demographic questionnaire, were used to collect data. The MDBQ is a 50-item questionnaire consisting of four subscales: Lapse errors, slips, deliberate, and unintentional violations. The data collected were analyzed with descriptive statistics, such as mean and standard deviation, as well as inferential analysis, including analysis of variance, independent t-test, and multiple regression, using SPSS software, version 22. Results: There was a statistically significant relationship between age, work experience, education, and type of work shift and the driving behavior of personnel. The total mean score of personnel driving behavior was 37.95±7.26. Also, the mean scores of driving slips, mistakes, intentional violations, and unintentional violations were 14.52±4.26, 6.53±3.05, 13.99±4.04 and 2.88±1.87, respectively. The results of multiple linear regression analysis showed that age, education, and type of work shift were predictors of driving behavior. Conclusion: Training, promotion of a driving culture, risk awareness, and management by drivers may be effective approaches to reducing the occurrence of emergency vehicle accidents.
Background: Pre-hospital paramedics providing immediate care to patients with contagious disease are at a high risk of infection. This study aimed to assess the exposure risk and risk management practices of pre-hospital paramedics during the COVID-19 pandemic. Materials and Methods: A cross-sectional study was conducted among 335 paramedics from 49 emergency medical stations in two cities located in northwestern of Iran, who were recruited through census. Data were collected using a World Health Organization (WHO) questionnaire to assess the COVID-19 exposure risk among health workers. Results: The results showed that the highest risk of exposure (86.0%) was in the domain of occupational exposure, and 55.2% of paramedics were at high risk of exposure to COVID-19. Among paramedics, 95.2% used personal protective equipment (PPE) when caring for patients and 93.1% when performing aerosol-generating procedures. Conclusion: A significant number of pre-hospital paramedics were found to be at high exposure risk to COVID-19 during ambulance missions. Therefore, adherence to contact and droplet precautions, implementation of airborne precautions during aerosol-generating procedures, access to appropriate PPE, proper use of PPE, and participation in appropriate training courses may lead to improved exposure risk management and enhance their safety.
Background: The time taken for pre-hospital emergency services to arrive at the scene of an accident plays an effective role in saving patients’ lives, and identifying factors affecting this time needs to be investigated. Therefore, the present study was conducted to explain the factors influencing the arrival time of pre-hospital emergency personnel at the emergency scenes. Materials and Methods: The present qualitative study was conducted at Shahrekord University of Medical Sciences in 2022 using the conventional content analysis method. Seventeen pre-hospital emergency staff members were purposively selected based on inclusion criteria, which included willingness and ability to express experiences, as well as having at least six months of experience working in pre-hospital emergency settings. Data were collected through in-depth, individual, semi-structured interviews and analyzed using Granheim and Lundman’s approach. Results: The results included three categories (barriers to care, systemic barriers, and environmental barriers) and seventeen subcategories (human barriers, barriers related to inter-organizational inconsistency, inappropriate urban planning, unsafe care environment, facility and equipment deficiencies, lack of professional staff, and systemic barriers). Conclusion: Effective training and the provision of sufficient manpower to meet regional needs play an important role in improving the performance of the emergency response system. Coordinating with city managers to improve area and city addresses can significantly reduce the time it takes for personnel to reach the scene of an incident.
Background: Emergencies and disasters pose serious health risks, including injuries, diseases, and fatalities, which significantly impact communities. To address both existing and emerging threats to public health, the framework of health emergency and disaster risk management (Health EDRM) emphasizes community participation (CP) as a fundamental component of resilience-building. While previous studies have explored various aspects of Health EDRM, there remains a critical gap in identifying the specific factors, components, and indicators that influence CP. This study aims to address the existing gap by systematically reviewing existing literature to provide a comprehensive framework for enhancing CP in Health EDRM. Materials and Methods: To achieve the objectives of this study, we will employ a scoping review approach inspired by the foundational framework developed by Arksey and O'Malley and later refined by Levac and Peters. This method comprises several essential phases. It begins with formulating clear research questions, followed by identifying relevant studies. These studies will then be subjected to a rigorous screening process. After selection, the data will be systematically organized and categorized. The findings will be synthesized and presented, and finally, input from experts and stakeholders will be gathered to enhance the depth and relevance of the results. This review protocol was designed following the PRISMA-ScR guidelines to ensure a transparent and methodologically sound approach. Results: This scoping review will identify key factors, components, and indicators that influence CP in Health EDRM, offering an in-depth summary of the existing body of evidence. Discussion: The review will clarify concepts related to CP approaches in Health EDRM, evaluating study designs, types of CP approaches, and contextual factors. The findings are expected to offer a conceptual framework for future research and guide policymakers in evidence-based decision-making to advance resilience-building strategies. Conclusion: By learning from both national and global experiences, this review will contribute to enhanced community resilience in emergency and disaster settings. It will offer meaningful insights for professionals, policymakers, and researchers to support more efficient risk reduction and resilience-building strategies.
The Sendai Framework for Disaster Risk Reduction (SFDRR) 2015–2030 places health at the center of its agenda, calling for the protection of lives, livelihoods, and health services before, during, and after disasters. With over 30 health-specific references, it outlines four core priorities—understanding risk, strengthening governance, investing in resilience, and enhancing preparedness for recovery (“Build Back Better”)—all directly relevant to national health systems.
Background: Natural hazards pose threats and opportunities for enhancing health literacy among chronic patients. This study aimed to investigate temporal distribution patterns of health literacy literature in disasters, depict collaborations among researchers and leading countries, and provide insights for future research directions in this domain. Materials and Methods: Mapping studies using bibliographic tools and an oriented scoping review were conducted. A search strategy utilizing synonymous terms for “disaster literacy and chronic diseases” was implemented on Scopus, Web of Science (WoS), and PubMed from inception to 2024, resulting in the retrieval of 1,885 articles. VOSviewer, UCINET, and NetDraw software performed analyses. Results: The concept of disaster health literacy (DHL) has grown since 2019. Patients with diabetes, hypertension, respiratory diseases, asthma, cancer, those on dialysis, and stroke survivors faced the most challenges during disasters. Seven thematic clusters of studies were identified, encompassing research methods, types of literacy, vulnerable groups, chronic patients, study locations, disease management, and comorbidity types. Conclusion: Improving DHL plays a pivotal role in empowering individuals with chronic conditions to navigate crises with greater resilience and informed decision-making. To mitigate adverse outcomes, it is essential that national emergency frameworks integrate targeted health literacy interventions tailored to the needs of vulnerable populations.
