Background and purpose: Prehospital emergency medical service (EMS) is an important part of the health care system. Today, the need for integrated emergency care services and delivering qualified preventive and care services felt more than before in accidents and emergencies. This survey aimed to investigate the views of emergency medical personnel on the concept and nature of preventive and care services and current challenges in delivering these services in prehospital EMS centers in Golestan province, Iran. Materials and methods: A qualitative study was done with 16 emergency medical personnel working in EMS sites in Golestan province using purposeful sampling. Data was collected by semi- structured interview guide and framework analysis was implemented to analyze the data. Results: Two general themes were identified including 1) the concept of preventive and care services in the EMS and 2) the challenges in providing qualified services in the EMS sites in Golestan province. Also, five sub-themes and 12 subclasses were determined. Conclusion: To enhance and promote services, the EMS system of Golestan province need reforms in organizational structure, laws and administrative regulations, training programs, the system of monitoring and evaluation of personnel, also provision of equipment and manpower and provision of personnel amenities to improve the staff performance. Furthermore, it is necessary to boost emergency services at the community level through training people and enhancing collaboration and participation with other organizations.

http://jmums.mazums.ac.ir/article-1-5824-fa.pdf

Concept and Challenges of Delivering Preventive and Care Services in Prehospital Emergency Medical Service: A Qualitative Study

Results: In this study, overall rate of patients' satisfaction (year 2018), was obtained to be 14.1% (95% CI: 11.6%-17.2%). The highest level of patients' satisfaction, was recorded in educational hospitals of Tehran in 2009, was 65.1% (95% Cl: 56.2%-73.1%) and the lowest patients' satisfaction, was found in educational hospitals of Ahvaz (year 2015), 0.2% (95% Cl: 0%-6.2%). A significant statistical correlation was observed between year of assessment, sample size, and patients' satisfaction (p<0.05).

http://journal.muq.ac.ir/article-1-2361-en.pdf

Patients' Satisfaction in Hospitals of Iran: A systematic Review and Meta-Analysis

Introduction: Prehospital care is a fundamental and decisive component in the treatment of emergency patients. In accidents, the first contact with emergency patients is by emergency prehospital staff. Hence, they must have sufficient knowledge and skills in all fields with airway management been one of the important measures. Various factors are involved in emergency personnel's knowledge and skills whereas the evidences show that staff performance is not desirable. This study aimed to investigate emergency medical technicians' cognitive and practical skills in airway management and its relationship with some related factors. Materials and Methods: This study is a cross-sectional, descriptive-analytical research. Sixty-eight emergency medical technicians were randomly selected by simple convenience sampling method. The tools used for data collection were personal and demographic characteristics form, cognitive skills inventory, and clinical skills checklist, including five skills in airway management. Face and content validities of tools were investigated and verified by ten experts and lecturers. The data were collected using personal and demographic characteristics form, cognitive skills inventory, and filling out the clinical skills checklist and observing the skills performed by technicians and then analyzed by SPSS version 20 software. Results: The results showed that, in airway management, 49.2% of technicians had good cognitive skills and 81% of them had practical skills. There was a direct relationship between the score of cognitive skills and the score practical skills (P

A study of emergency medical technicians' cognitive and practical skills in airway management and its relationship with some related factors in emergency medical centers selected in Isfahan in the year 2015–2016

Introduction. Pseudo-Bartter syndrome encompasses a heterogenous group of disorders similar to Bartter syndrome. We are presenting an infant with pseudo-Bartter syndrome caused by congenital chloride diarrhoea. Case Outline. A male newborn born in the 37th gestational week (GW) to young healthy and non-consanguineous parents. In the 35th GW a polyhydramnios with bowel dilatation was verified by ultrasonography. After birth he manifested several episodes of hyponatremic dehydration with hypochloraemia, hypokalaemia and metabolic alkalosis, so as Bartter syndrome was suspected treatment with indomethacin, spironolactone and additional intake of NaCl was initiated. However, this therapy gave no results, so that at age six months he was rehospitalized under the features of persistent watery diarrhoea, vomiting, dehydration and acute renal failure (serum creatinine 123 μmol/L). The laboratory results showed hyponatraemia (123 mmol/L), hypokalaemia (3.1 mmol/L), severe hypochloraemia (43 mmol/L), alcalosis (blood pH 7.64, bicarbonate 50.6 mmol/L), high plasma renin (20.6 ng/ml) and aldosterone (232.9 ng/ml), but a low urinary chloride concentration (2.1 mmol/L). Based on these findings, as well as the stool chloride concentration of 110 mmol/L, the patient was diagnosed congenital chloride diarrhoea. In further course, the patient was treated by intensive fluid, sodium and potassium supplementation which resulted in the normalization of serum electrolytes, renal function, as well as his mental and physical development during 10 months of follow-up. Conclusion. Persistent watery diarrhoea with a high concentration of chloride in stool is the key finding in the differentiation of congenital chloride diarrhoea from Bartter syndrome. The treatment of congenital chloride diarrhoea consists primarily of adequate water and electrolytes replacement.

/pdf/pseudo-bartter-syndrome-in-an-infant-with-congenital-2wo52wv661.pdf

Pseudo-Bartter syndrome in an infant with congenital chloride diarrhoea

This study evaluated the time performance in the emergency response center to provide pre-hospital emergency services in Kermanshah. This study was a descriptive retrospective cross-sectional study. In this study 500 cases of patients from Shahrivar (September) 2012 to the end of Shahrivar (September) 2013 were selected and studied by the non-probability quota method. The measuring tool included a preset cases record sheet and sampling method was completing the cases record sheet by referring to the patients’ cases. Data were analyzed using SPSS version 18 and the concepts of descriptive and inferential statistics (Kruskal-Wallis test, benchmark Eta (Eta), Games-Howell post hoc test). The results showed that the interval mean between receiving the mission to reaching the scene, between reaching the scene to moving from the scene, and between moving from the scene to a health center was 7.28, 16.73 and 7.28 minutes. The overall mean of time performance from the scene to the health center was 11.34 minutes. Any intervention in order to speed up service delivery, reduce response times, ambulance equipment and facilities required for accuracy, validity and reliability of the data recorded in the emergency dispatch department, Continuing Education of ambulance staffs, the use of manpower with higher specialize levels such as nurses, supply the job satisfaction, and increase the coordination with other departments that are somehow involved in this process can provide the ground for reducing the loss and disability resulting from traffic accidents.

/pdf/the-evaluation-of-time-performance-in-the-emergency-response-1tuxpvgchi.pdf

The evaluation of time performance in the emergency response center to provide pre-hospital emergency services in Kermanshah.

Background & Aim: A significant part of \"Golden Hour\" for urgent health care of children is wasted in prehospital setting, and delays in providing health care may be followed by undesirable outcomes. The current study was conducted with the aim of assessing time indices of pediatric prehospital emergency care in Tehran. Patients and Method: In this cross-sectional observational study, 115 calls requesting urgent health care services for children at the age of 15 and less were extracted from all recorded calls between 2005 and 2006. Demographic variables, accident type, very early outcomes, and time indices(Response time, Scene time, Total run time, Transport time, Round trip time) were registered. We described qualitative variables using frequency tables, and mean and standard deviation were used to describe quantitative variables. Independent t-test and Chi-square were applied to analyze the data. Results: Out of 6787 calls, 1052(15.5%) were related to children. 717(68%) of these calls were because of the problems of internal medicine and the rest(32%) were related to trauma. Road accident(18.7%), epilepsy(18.3%), unconsciousness(12.4%) and respiratory disorders(10.4%) were among the most common causes for 115 calls. 21 subjects(5.36%) died before ambulance arrival, but no one died while being taken to the hospital. The means(SD) of response time, scene time, total run time, transport time, round trip time were 14.98±6.72, 20.90±11.12, 52.60±23.98, 18.45±12.10 and 60.79±30.34 respectively. The mean ages of deceased and survived patients were 7.95±5.04 and 10.74±4.41 respectively(p=0.009). Average ambulance response time was 16.75±3.88 vs. 14.23±6.31 in deceased and survived patients respectively(p=0.022), which was indicative of a significant difference. Conclusion: Some of the time indices in this study are at the level of reported standards around the world but some others are not. The rate of very early mortality in our country is higher than other countries. Therefore, careful planning to improve time indices, assessing the causes of prolonged time indices, and making effective interventions are highly recommended. Also, staff training courses should focus on more common problems such as trauma, convulsion, unconsciousness, and respiratory disorders.

Time indices of pediatric prehospital emergency care in tehran, 2006

Aims: The patients' viewpoint is as important as that of managers and planners of health system in promoting the quality of treatment services. The present study was conducted to investigate hospitalized patients' satisfaction from the hospital services in 6 military hospitals located in different parts of the country. Methods: In this descriptive cross-sectional study, 696 hospitalized patients were selected from 6 military hospitals located in different parts of country (116 patients from each hospital), using random sampling method from July to September 2001. After the release, a checklist containing personal demographic information and a questionnaire determining the patients' satisfaction level from hospital services were completed for all patients. Answers were designed in Likert 5-point scale of "completely dissatisfied" (1 point) to "completely satisfied" (5points). At the final analysis, the point 3 and the lower were considered as dissatisfaction and more than 3 as satisfaction from services. Data were analyzed using descriptive statistics and chi square test. Results: 684 patients (98.2%) of referred patients were satisfied with the hospital services. Patients' satisfaction from hospital services had statistically significant difference in different parts (p=0.013). The most number of "dissatisfied" and "completely dissatisfied" were related to welfare facilities and the least number was related to medical services. Conclusion: Bedridden patients have a desirable satisfaction from military hospitals' services. Managers need to pay special attention to the reform of administrative processes and development of insurance services beside the acceptable medical and nursing services.

/pdf/satisfaction-rate-of-hospitalized-patients-in-military-31penq6n0x.pdf

Satisfaction rate of hospitalized patients in military hospitals from presented services

Objective: Congenital chloride diarrhea (CCD) is a rare autosomal recessive disorder of intestinal chloride absorption. Pathognomonic features consist of watery diarrhea, failure to thrive, dehydration and hypokalemic hypochloremic metabolic alkalosis. 
Case Presentation: This is the report on an 8-month old Iranian girl with severe and complicated course of CCD and poor response to current treatment. In addition, she had a renal tubular defect in uric acid handling, resulted in persistent hyperuricosuria and hypouricemia.
Conclusion: Specific characteristics of CCD in our population need additional investigation. But, it is recomm¬ended to consider CCD in any patient with severe resistant diarrhea to prevent its irreversible and long term organ damage.

/pdf/prehospital-emergency-service-for-internal-medicine-problems-3qvbyqpz5v.pdf

Prehospital emergency service for internal medicine problems in pediatrics; causes, time indices and outcomes

Community-based participatory research (CBPR) is believed to be a potent means for the promotion of health in the community. To that end, Iran has conducted several CBPR projects in various community research centers (CRCs). We aimed to assess the quality of some of these CBPR projects in Iran from the perspective of Iranian academicians. In this cross-sectional study, carried out during 2005, five CBPR projects implemented in Iranian CRCs (Tehran, n=3; Qazvin, n=1; and Bandar Abbas, n=1) were selected. Three academic members involved in each project were interviewed using a structured questionnaire that appraised the extent to which the research project was aligned with the principles of participatory research. Results show that the CRCs and the academic members in our CBPR projects should receive further training and consultation. Quality assessment of CBPR projects seems essential from the view point of other participants of such projects, namely community and stakeholders.

H R Khodami Vishteh

Papers

Time indices of pediatric prehospital emergency care in tehran, 2006

Satisfaction rate of hospitalized patients in military hospitals from presented services

Prehospital emergency service for internal medicine problems in pediatrics; causes, time indices and outcomes

Community-Based Participatory Research: How Do Academicians Rate Success in Iran?

Risk Factors of Readmission Due to Exacerbation in Chemical Injured Patients with Chronic Pulmonary Diseases