Global Prevalence of Workplace Violence Against Paramedics: A Systematic Review and Meta-analysis

Background: Violence is increasing in societies and workplaces around the world. This study aimed to review the literature on violence against paramedics in the prehospital setting and estimate the related exposure rates and types. Materials and Methods: The study was conducted based on the guidelines of systematic reviews and meta-analyses. The literature on the prevalence of workplace violence against paramedics published from January 1990 to September 2019 was searched in PubMed, Web of Science, Scopus, ProQuest, and Embase databases. The prevalence of violence was measured by using the random-effects model in Stata software. Sub-group analysis and meta-regression models were applied to explain the sources of heterogeneities. Results: The prevalence of overall violence, physical violence, verbal violence, and sexual harassment among study subjects were calculated to be 0.66 (95% CI CI: 0.20-1.11), 0.25 (CI: 0.16- 0.34), 0.58 (CI: 0.29-0.86) and 0.16 (CI: 0.09-0.22), respectively. There was no significant difference between male and female paramedics in terms of violence types. However, the prevalence of sexual harassment among women was higher than men (24% vs. 6%). The highest rate of physical violence and sexual harassment belonged to Europe and North America, while they had the lowest verbal violence. Asia and Australia had the lowest rate of physical violence and sexual harassment. Conclusion: Prehospital emergency service providers face a higher risk of potential exposure to violence in health care settings. This issue necessitates the special attention of prehospital care administrators to reduce the risk and related consequences of workplace violence by taking effective measures.

Modeling the Relationship Between Occupational Accidents, Work-Family Conflict, and Quality of Work-Life in Emergency Room Nurses

Background: This study aimed to model the relationship between occupational accidents, work-family conflict, and quality of work-life in emergency room nurses. Materials and Methods: This correlational research uses path analysis. The study population consisted of all nurses working in the emergency rooms of hospitals in Tehran City, Iran, in 2020. Of them, 200 samples were selected by the available sampling method. To obtain the data, we used the occupational accidents questionnaire, the quality of work-life questionnaire, and the work-family conflict scale. SPSS v. 24 and Amos v. 24 software were used for data analysis. Results: The analysis of the findings showed that occupational accidents and work-family conflict have a negative and direct effect on the quality of work-life (P<0.01). Occupational accidents also have a positive and direct effect on work-family conflict (P<0.01). On the other hand, the mediating role of work-family conflict between occupational accidents and quality of work-life was confirmed (P<0.01). Conclusion: The relationship model of occupational accidents with quality of work-life mediated by work-family conflict has a good fit, and there is a relationship between family, job, and environmental stressors with the quality of work-life.

The Revolution in the Iranian Disaster Management System in Controlling COVID-19 Pandemic

Managing the disastrous consequences of pandemics depends on the capacity of the governments to mitigate them. As the health system in Iran was undertaking economic issues because of sanctions, the government has been forced to make major and urgent decisions while anticipating the economic, social, and political effects of the COVID-19 pandemic. Therefore, Iran has integrated all critical sections of the community to provide a unified command structure to involve all stakeholders. In this regard, we present a disaster management structure in response to the COVID-19 pandemic in Iran. We hope to provide information on the advantages that might change disaster management structure in pandemics.

Ability of the So-called APURO® Air-washing Process to Disinfect Germs Like COVID-19 in the Indoor Air and on Surfaces

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Comparative Study of Road Traffic Accident Victims Transferred by Air and Ground Emergency to Shahid Beheshti Medical Center in Qom City, Iran, 2015-2018

Background: Prehospital emergency department provides land, air, boat, and rail ambulance care. This study aimed to compare the situation of air and ground emergency casualties in road traffic accidents transferred to Shahid Beheshti Medical Center in Qom City, Iran, 2015-2018. Materials and Methods: The present study is a retrospective descriptive-analytical study. All road traffic accident victims transferred to Shahid Beheshti Medical Center in Qom by prehospital emergency land or air staff from 2015 to 2018 at 6 to 20 o’clock were included in this study (census method). The exclusion criteria included burns, death, transmission during cardiopulmonary resuscitation or by urban ambulances, and information deficiencies. We used a researcher-made checklist to examine victims’ age, sex, type of transmission, type of accident, type of trauma, distance, initial vital signs, time intervals, and day of the accident. SPSS software version 16 was used to analyze the data. Data were compared in two groups with the t test and the Chi-square test. Results: A total of 2057 casualties were included in the study: 566 casualties were transferred by air emergency and 1491 by ground emergency. The mean age of air emergency casualties was significantly lower than the ground emergency (P=0.008). Trauma to the neck, chest, abdomen and lower back was significantly higher in air emergency casualties, but hand and foot trauma were more common in ground emergency casualties. Most air missions took place on holidays or weekends, while most ground missions were done during weekdays (P<0.001). The mean distance of the air emergency missions was more than Beheshti Medical Center (P<0.001). Compared with ground emergency casualties, air emergency casualties had average systolic blood pressure, lower level of consciousness, and higher heart rate and respiration (P<0.001). The mean duration of transfer from the accident scene to the medical center in the air emergency was significantly shorter (P<0.001). Conclusion: Air emergency casualties were usually accompanied by more critical vital signs and severe injuries to the neck, chest, abdomen, and back. This study can provide clinical triage criteria that focus on key environmental factors and reduced transport time. Further studies are needed to investigate the consequences of traffic accident casualties at the medical center to determine which subgroups will benefit most from using air emergency.

Lessons Learned of Tehran-Zahedan Train Derail, Iran, 2019

Background: There has been a significant increase in the number of train crashes worldwide, mainly due to the extension of the rail network and the use of the most sophisticated and cutting-edge technology. Incident Report: The Tehran-Zahedan train had 260 passengers on board and left for Tehran City at 14:50 local time on Wednesday, September 25, 2019. The accident happened at 16:20 local time at 100 km distance from Zahedan City. Results: Five train cars derailed 2 km from Shorou Station, where four people died, and 157 were injured. According to the investigations, the accident occurred due to the unscrewing of some bolts and spring washers. There were 170-180 screws and spring washers removed along 50-60 m, which resulted in the creation of a dangerous point and derailment of the train. This study examined the challenges, strengths, and learned lessons of the incident. Conclusion: Concerning standard and vast rail networks in Iran and the latest train crashes that mainly occurred just outside the cities, accessibility to the accident scene should be considered one of the most important physical vulnerability indexes. As a result, accessibility to special firefighting and rail rescue train car at some stations in crowded routes effectively decreases the consequences of such accidents.

Presenting A Multi-objective Location Model in GIS Environment: A Case Study in East Tehran Emergency Stations

Background: This study aims to design a multi-objective model for locating emergency relief bases with maximum coverage and minimum costs. As a result, this model is expected to reduce mortality by increasing the efficiency of relief services. Materials and Methods: Based on the ambulance distribution in the east of Tehran City, Iran, and the statistical information on demand (at least 30 samples for data normalization) in the last six months of 2018, we introduced and implemented a definitive mathematical model. We also evaluated the model with GAMS software. Using previous studies and interviews, we identified key and practical indicators of site locations. These indicators are being easy to access, locating in high-demand areas, such as an urban area, and not being too close to another relief base. These factors were then prioritized using the hierarchical method, and the output indicates the high weight of the factor of “being in a place with high demand”. The objective functions are to maximize coverage, minimize costs, and provide equity in relief time. To deal with the uncertainty of the parameters, we used the robust optimization approach. To initially select potential proposed sites to establish the database, we used Geographic Information System (GIS). To test the above mathematical model in the real world, we conducted a case study in East Tehran. Results: Based on the designed model, the initial points proposed by GIS were identified. Finally, it was found that the number of stations in East Tehran must increase from 27 to 34 bases. Conclusion: By implementing this model, the emergency medical service can provide the highest level of coverage. Also, the maximum relief time at stations will be reduced to 8 minutes.

Evaluation of Operational Readiness of Prehospital Emergency Department of Mazandaran University of Medical Sciences in Encountering COVID-19 Epidemic in 2020

Background: The ability to respond to any emergency before happening is a potential issue that manifests as operational readiness. This study aimed to evaluate the preparedness of prehospital emergency services of Mazandaran University of Medical Sciences in response to the epidemic of COVID-19. Materials and Methods: This cross-sectional study was performed in April 2020 using a translated standard checklist of the Pan American World Health Organization (PAHO). The list consists of four components of call management (6 items), first responders (operational codes with 3 items), medical transportation (including primary and interhospital with 16 items), and emergency medical services administration (including medical guidelines, human resources, and education with 11 items). Results: There were 168 operational logistics facilities and 555 personnel to cover organizational missions. Except for two items that scored half a point, the rest of the measures received total points (35 out of a maximum of 36 points with 97% of the total points). According to the complete scores, operational readiness was at a good level. Conclusion: The preparedness of the Center for Disaster Management and Medical Emergencies at Mazandaran University of Medical Sciences in the face of the COVID-19 epidemic has been at a good level. However, because of the continuation of the epidemic, strengthening the supply chain and empowering personnel are essential to sustainable readiness.

Lived Experience of Transportation Network Company Driver About the Causes of High-risk Driving Behaviors: A Thematic Analysis

Background: Nowadays, industrialization, using cars and consequently traffic jams are part of human life which grows every day. Along with the expansion of communication and transportation speed, the number and severity of traffic accidents increases. According to the World Health Organization, traffic accidents are now recognized as the ninth cause of death worldwide. In Iran, traffic accidents after cardiovascular diseases are the second leading cause of death. Materials and Methods: This qualitative study was designed and implemented to determine driver’s views and opinions in two cities of Warsaw, Poland, and Tabriz, Iran, about driver’s high-risk behaviors. This study was conducted using in-depth interviews with 27 drivers. The study results were divided into four main questions about driving behaviors, reasons for driving abnormal behaviors, the prevalence and causes of abnormal behaviors, and suggested measures to correct these behaviors. Results: The study results were divided into six main themes of driving norms, individual factors, social factors, external factors, driving skills, and driving laws. Our findings indicate that drivers are more likely to rely on individual skills in driving in unacceptable conditions. In other words, they ignore the rules and regulations. But, when driving in high standards conditions and good facilities, drivers accept the rules and prioritize them. Conclusion: Internal control should be considered a helpful complement to external control, and that external control provides the highest efficiency when it comes with internal control. To internalize norms and observe driving laws and regulations, the authors suggest removing obstacles such as distrust among drivers regarding the effectiveness of driving laws, unawareness of breaking the laws, lack of job satisfaction, low level of participation, and structural barriers. Also, roads and vehicle safety must be improved along with a better track of the drivers’ behavior.

Factors Affecting the Entrepreneurial Supply Chain in Disasters in Iran From the Perspective of Experts

Background: Supply chain includes all related parts that directly or indirectly meet the customers’ demands. During disasters, the supply chain disrupts. It seems that paying attention to innovation and entrepreneurship can solve some of these disruptions. This study was conducted to extract the factors affecting the technology-oriented entrepreneurial rescue supply chain in the Red Crescent Society from experts and specialists in Iran. Materials and Methods: This qualitative content analysis was conducted in 2020. Using the content analysis method, the considered criteria were collected through open-ended questions and interviews. To determine the desired indicators, 30 people were interviewed in-depth in a purposeful manner using snowball sampling. The thematic analysis method was also used to analyze the interviews. Results: A total of 30 experts with a mean age of 46 years were interviewed, of whom 21 cases were male. Also, 16 cases had a PhD degree, and 14 had a Master’s degree. After analyzing and extracting the criteria from the interviews, 123 codes were obtained. Finally, the codes were divided into two classes: supply chain management and technology indicators. The supply chain management class included subclasses of customer integration, supplier integration, internal integration, and innovative orientation. The technology indicators class included subclasses of individual characteristics, attitudinal factors, educational factors, technical factors, economic factors, environmental factors, and human and managerial factors. Conclusion: Supply chains are essential for entrepreneurship because of the involvement of different parts of the Red Crescent Organization of Iran in joint activities. Because of the expansion of entrepreneurship issues in the supply chain, presenting a technology-oriented comprehensive model of the entrepreneurial supply chain in the Red Crescent Organization is of great importance. In today’s competitive environment, supply chain management is a strategic and robust basis for the Red Crescent Organization to achieve success and competitive advantage.