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Abstract Despite the frequent occurrence of heat waves in the Middle East, there is a lack of evidence regarding the overall estimates for the effect of heat waves on mortality in this region. This study aimed to review the effect of exposure to heat and cold waves and daily cause-specific mortality. Four electronic databases were searched. The titles, abstracts, and full-texts of the articles were carefully reviewed by two researchers. Once eligible studies were identified, the required data were extracted. Separate meta-analyses were conducted based on gender, age group, and health endpoint combinations. According to the meta-analysis, heat waves had a statistically significant effect on all-cause mortality with an RR of 1.23 (CI 95%: 1.08, 1.39). Cardiovascular mortality significantly increased in heat waves with an RR of 1.08 (CI 95%: 1.05, 1.10). However, the increase in respiratory mortality was not statistically significant. Compared to young people (age

Abstract Background Cities, as frontline responders to climate change, necessitate a precise understanding of climate-adaptive features. This systematic review aims to define and outline the characteristics of climate-adaptive cities, contributing vital insights for resilient urban planning. Methods This systematic review, initiated on March 6, 2018, and concluded on August 26, 2021, involved reviewing multiple electronic databases based on the study's objectives. The Critical Appraisal Skills Program (CASP) tool was used for quality assessment and critical evaluation of articles retrieved through a comprehensive and systematic text search. Descriptive and thematic analyses were conducted to extract definitions, features, and characteristics of climate-adaptive cities. Results Out of 6104 identified articles, 38 articles met the inclusion criteria. In total, 20 definitions and 55 features for climate-adaptive cities were identified in this review. Codes were categorized into two categories and ten subcategories. The categories included definitions and features or characteristics of climate-adaptive cities. Conclusion A climate-adaptive city, as derived from the findings of this study, is a city that, through effective resource management, future-oriented planning, education, knowledge utilization, innovation in governance and industry, decentralized management, and low-carbon economy, leads to the adaptability, resilience, sustainability, and flexibility of the capacity of individuals, communities, institutions, businesses, and systems within a city against all climate change impacts and reduces their negative consequences.

BACKGROUND: The Resilience Evaluation Scale (RES) is a new, free and short self-report questionnaire for measuring psychological resilience. This study aims to translate and assess the psychometric properties of the RES. MATERIALS AND METHOD: In the present methodological study, after the translation process, face and content validity were conducted through qualitative and quantitative methods. To determine the construct validity, exploratory and confirmatory factor analysis (CFA) was used, and for the reliability, Cronbach’s α test and inter-counter coefficient test were calculated. Persian version of the Connor-Davidson Resilience Scale was used to determine the convergent validity of the questionnaire. RESULTS: Results show that the face and content validity of 9 items of RES were acceptable and they were all approved [Impact scores (IS) >1.5, S-CVI/Ave = 0.97, I-CVI = 0.93]; the Internal consistency of the scale was confirmed by the Cronbach’s α coefficient (0.82) and McDonald’s omega (0.83). The reliability of the scale also was confirmed by the Spearman’s correlation coefficient and intra-group correlation coefficient (ICC), with results obtained above 0.8 for all items. The factor analysis identified two factors that accounted for about 56% of the variance. Also, the CFA model fitted well according to the results of the fitting indices (RMSEA = 0.084, CFI = 0.98, SRMR = 0.064, and TLI = 0.97). In addition, the convergent validity of the scale was equal to 0.65 (P < 0.001). CONCLUSION: Development of a valid and reliable psychological resilience scale may bring great benefits to the Persian society. Our findings suggest that the Persian RES has good psychometric properties, and it may serve as a valuable instrument in research and clinical practice.

BACKGROUND: Useful experiences of the elderly in adapting to the environment may play an important role in formulating future policies. This study was conducted to explain the past experiences of the elderly in Dezful in adapting to heat. MATERIALS AND METHODS: This study was conducted with a qualitative research approach and a qualitative content analysis method in 2020 and 2021. The experiences of 18 elderly in Dezful were collected through semi-structured interviews via recording, face-to-face interviews, and data observation. Sampling was performed by the purpose-based method, and the data of this stage were analyzed using a content analysis approach using the Zhang and Wildemuth method. RESULTS: During the data analysis process, three main themes were extracted, including psychophysiological, socioeconomic, and environmental adaptation. Also, twelve subthemes including changes in physiological conditions, urban architecture, house architecture, diet, clothing, business conditions, mindset, life conditions, and the use of factors (spirituality, experience, and natural capacities) were extracted. CONCLUSION: Explaining the experiences of the elderly in Dezful, who have lived with heat for many years, can provide better identification of solutions and more tangible experiences of adaptation to heat for other communities. These experiences can be used in urban, cultural, and social planning.

Background: We aimed to evaluate the impact of heatwaves on daily deaths due to non-accidental, cardiovascular and respiratory causes in the city of Dezful in Iran from 2013 to 2019. Method: We collected daily ambient temperature and mortality and defined 2 types of heatwaves by combining daily temperature ⩾90th in each month of the study period or since 30 years with duration ⩾2 and 3 days. We used a distributed lag non-linear model to study the association between each type of heatwave definition, and deaths due to non-accidental, cardiovascular and respiratory causes with lags up to 13 days. Results: There was no discernible correlation in this area, despite the fact that heatwaves raised the risk of death from cardiovascular causes and lowered the risk from respiratory causes. On the other hand, the risk of total non-accidental mortality on days with the heatwaves is significantly higher than normal days. In main effects, the heatwaves have a significant relationship with the risk of total non-accidental mortality (in the first heatwave definition, Cumulative Excess Risk (CER) in lag 0-2 was 10.4 and in second heatwave definition, CER values in lag 0, 0-2, and 0-6 were 12.4, 29.2, and 38.8 respectively). Also, in added effects, heatwaves have a significant relationship with the risk of total non-accidental mortality (in the first heatwave definition, CER in lag 0 and 0-2 were 1.79 and 4.11 and in the second heatwave definition, CER values in lag 0, 0-2, and 0-6 were 7.76, 18.35 and 24.87 respectively). In addition, heatwaves appeared to contribute to a cumulative excess risk of non-accidental death among the male group as well as the older adults. Conclusion: However, the results showed that heatwaves could have detrimental effects on health, even in populations accustomed to the extreme heat. Therefore, early warning systems which monitor heatwaves should provide the necessary warnings to the population, especially the most vulnerable groups.

Background: Despite the fact that Iran has been exposed to severe dust storms during the past 2 decades, few studies have investigated the health effects of these events in Iran. This study was conducted to assess the association between dust storms and daily non-accidental, cardiovascular, and respiratory mortality in Dezful City (Khuzestan Province, Iran) during 2014 to 2019. Methods: In this study, mortality, meteorological, and climatological data were obtained from the Dezful University of Medical Sciences, Iranian Meteorological Organization, and Department of Environment in Khuzestan Province, respectively. Days of dust storm were identified based on the daily concentration threshold of particulate matter with an aerodynamic diameter of less than 10 μm (PM 10 ) according to Hoffmanns҆ definition, and then an ecological time-series was used to estimate the short-term effects of dust storms on daily mortality. Statistical analysis was performed using a distributed lag linear model (DLM) and a distributed lag non-linear model (DLNM) packages by R software and the study results were reported as excess mortality. Results: During the study period, 15 223 deaths were recorded, and 139 dust storms occurred in Dezful city. In addition, there was statistically significant excess risk of mortality due to dust storms in Dezful City (mortality in the group under 15 years of age, lag 4 : 34.17% and 15-64 years of age groups, lag 5 : 32.19%, lag 6 : 3.28%), also dust storms had statistically significant effects on respiratory mortality (lag 6 : 5.49%). Conclusion: The findings of the current study indicate that dust storms increase the risk of mortality with some lags. An evidence-based early warning system may be able to aware the people of the health effects of dust storms.

Introduction: This study was conducted to determine the relation between exposure to particulate matter less than 10 microns (PM10) caused by dust storms and the risk of cardiovascular, respiratory and traffic accident missions carried out by Emergency Medical Services (EMS). Methods: This was a time-series study conducted in Dezful city, Iran. Daily information on the number of missions by the EMS due to cardiovascular, respiratory and crash problems and data on PM10 were inquired from March 2013 until March 2016. A generalized linear model (GLM) with distributed lag models (DLMs) was used to evaluate the relation between the number of EMS missions and the average daily PM10. The latent effects of PM10 were estimated in single and cumulative lags, up to 14 days. Results: In the adjusted model, for each IQR increase in the average daily PM10 concentration, the risk of EMS missions in the total population in single lags of 2 to 7 days, and the cumulative lags of 0-7 and 0-14 days after exposure had a 0.8, 0.8, 0.8, 0.8, 0.7, 0.6, 6.7 and 1.4% significant increase. Also, for each IQR increase in the daily mean concentration of PM10 in single 1 to 7, and cumulative lags of 0-2, 0-7, and 0-14 days after exposure, respectively, a 2.4, 2.7, 2.8, 2.9, 2.9, 2.7, 2.5, 7.4, 23.5 and 33. 3 % increase was observed in the risk of EMS cardiovascular missions. Conclusion: Increase in daily PM10 concentrations in Dezful is associated with an increase in the risk of EMS missions in lags up to two weeks after exposure.

Introduction: Triage is the process of determining the priority of patients’ treatments based on the severity of their conditions. The aim of the present study was to survey the effect of triage video podcasting on the knowledge and performance of pre-hospital students. Methods: Sixty pre-hospital students were randomly divided into two groups of a 30-subject control group and a 30-subject intervention group. A pre-test was administered among all students. Afterwards, for the first group, triage education was offered through lectures using PowerPoint, while for the second group, audio and video podcasts tailored for this training program were employed. Right after the training as well as one month later, post-tests were run for both groups, and the results were analysed using an independent t-test and covariance. Results: No significant difference was observed between the effects of both types of education on knowledge and performance, either immediately, or one month after training. Discussion: We suggest that video podcasts are ready to replace traditional teaching methods in triage. Keywords: Triage, Lecture, Podcast, Pre-hospital, Education, Emergency

Background: Dust storms and their impacts on health are becoming a major public health issue. The current study examines the health impacts of dust storms around the world to provide an overview of this issue. Method: In this systematic review, 140 relevant and authoritative English articles on the impacts of dust storms on health (up to September 2019) were identified and extracted from 28 968 articles using valid keywords from various databases (PubMed, WOS, EMBASE, and Scopus) and multiple screening steps. Selected papers were then qualitatively examined and evaluated. Evaluation results were summarized using an Extraction Table. Results: The results of the study are divided into two parts: short and long-term impacts of dust storms. Short-term impacts include mortality, visitation, emergency medical dispatch, hospitalization, increased symptoms, and decreased pulmonary function. Long-term impacts include pregnancy, cognitive difficulties, and birth problems. Additionally, this study shows that dust storms have devastating impacts on health, affecting cardiovascular and respiratory health in particular. Conclusion: The findings of this study show that dust storms have significant public health impacts. More attention should be paid to these natural hazards to prepare for, respond to, and mitigate these hazardous events to reduce their negative health impacts. Registration: PROSPERO registration number CRD42018093325

BACKGROUND: Heat wave adaptation is a new concept related to experiencing heat. The present study aims at investigating a conceptual definition, that is, the mental framework of heat wave adaptation and its strategies. MATERIALS AND METHODS: A phenomenological study was performed to explain the mental concept. At the same time with the data collection process, data analysis was also performed using Colaizzi method. Semi-structured interview method and purposeful sampling with maximum variety were used. Interviews were conducted with 23 different subjects in the community. The accuracy of the data was guaranteed using Lincoln & Guba scientific accuracy criteria. RESULTS: The two main themes of the adaptation paradigm as well as its strategies were divided into the main categories of theoretical and operational concepts, as well as personal care measures and government measures. Under the category of individual measures, we obtained “clothing, nutrition, building, place of residence and lifestyle,” and under the category of governance actions, the “managerial, research, health, organizational” subcategories were obtained. CONCLUSION: According to the results of the conceptual-operational definition, heat wave adaptation is an active process and an effort to reduce the adverse effects of heat waves on individual and social life, and striking a balance that will not only result in individual awareness and actions that will lead to lifestyle changes, but also mostly requires integrated and comprehensive planning in the community. On the one hand, heat waves could not only be regarded as a threat or danger, but can also become an opportunity for the development of a community through identification and smart measures, and for adaptation, the community must take it as a risk. The community should have a plan in advance, apply the necessary rules and training, and use the new facilities and rules where necessary. This practical concept definition includes the main features of heat wave adaptation.

Objectives There are few studies about the association between breathing polluted air and increased risk of cardiovascular diseases and cardiac death in the Middle East. This study aimed to investigate the relation between air pollutants and cardiovascular mortality (based on ICD-10) in Ahvaz. Material and methods In this ecological study, the data about cardiovascular disease mortality and air pollutants from March 2008 until March 2015 was inquired from the Ahvaz City Authority and the Khuzestan Province Environmental Protection Agency. The quasi-Poisson, second degree polynomial constrained, distributed lag model; using single and cumulative lag structures, adjusted by trend, seasonality, temperature, relative humidity, weekdays and holidays was used for the data analysis purposes. Results Findings indicated a direct significant relation between an interquartile range (IQR) increase in ozone and cardiovascular deaths among men after 3 days’ lag. There was also a significant relation between an IQR increase in particulate matter below 10 μm and cardiovascular deaths for all people, over 60 years old and under 18 years old after 3 and 13 days’ lags. There was a significant relation between an IQR increase in nitrogen dioxide and carbon monoxide, and cardiovascular deaths in the case of under 18-year-olds (in the lag 11) and over 60-year-olds (in the lag 9), respectively. We finally found a significant association between an IQR increase in sulfur dioxide and cardiovascular deaths in the case of men, under 18-year-olds and from 18- to 60-year-olds in the lag 9, 0, and 11, respectively (p-values < 0.05). Conclusions It appears that air pollution is significantly associated with cardiovascular deaths in Ahvaz City. Int J Occup Med Environ Health 2018;31(4):459–473

Introduction: Sharp tools are among the major risk factors for transmission of blood borne infections. Therefore, the present study was carried out with the aim of determining epidemiologic aspects of occupational exposure and injury with sharp tools in emergency medical service (EMS) of Dezfoul, Iran, in 2014-2015. Methods: This cross-sectional study was carried out on 140 EMS staff who met the inclusion criteria, using census method. The tool used for data gathering was a questionnaire prepared by the researcher including demographic and personal health data, prevalence and cause of injury with sharp tools, knowledge, mental state, reporting exposure, measures taken, and follow-ups. Data were analyzed using statistical tests such as chi square. Results: Overall, 75% of the participants had been exposed to sharp tools at least once in the past year. Most injuries had occurred during venipuncture of the patient (41.09%). 54.2% of all exposures had happened during transfer. In addition, sadly, 63.9% of the exposures of the staff to patients’ infected secretions were not reported. 63% of injuries with sharp objects had occurred in the night shift. There was a correlation between working experience and frequency of exposure (p=0.02, r=0.19). Conclusion: The results of the present study are indicative of the high occupational exposure to sharp tools among staff of the studied EMS, a significant number of which had not been reported.

Introduction: One of the important indices of preparedness for accidents and disasters is evaluation of knowledge and performance of emergency medical services (EMS) staff regarding principles of triage. Therefore, the present study was done with the aim of determining the knowledge and performance of EMS staff regarding START pre-hospital triage in 2016. Methods: This cross-sectional study was carried out on EMS staff in north of Khuzestan province. Individuals who met the inclusion criteria were included via census sampling. Data were gathered via a questionnaire consisting of 5 demographic data questions, 15 triage knowledge questions and 19 triage performance questions. The data were then statistically analyzed. Results: 117 individuals with the mean age of 33.21 ±6.08 years and mean job experience of 7.35 ± 4.32 years participated all of whom were male. Mean knowledge of the studied population regarding triage was average (mean score: 9.44) and their performance score revealed that their performance was also average (mean score: 9.58). Conclusion: Based on the findings of the current study, knowledge and performance of EMS staff in north of Khuzestan province was average regarding pre-hospital triage.

One of the indices of development in a society is providing the necessary healthcare for all people. One of the most important pillars of healthcare is emergency care, especially the pre-hospital type. Pre-hospital emergency care starts on the patient’s bedside and ends in the emergency service of a hospital. Emergency organizations train 4 groups for providing emergency service and pre-hospital care: 1) first responder; 2) emergency medical technician (EMT)-Basic; 3) EMT-Intermediate; 4) EMT-Paramedic. Prescribing drugs for the patients in need is one of the many responsibilities of the last 2 groups (EMT-Intermediate and EMT-Paramedic) that treat many patients each year. Proper and timely use of drugs can minimize threats to patients’ lives and keep them from dying. It is obvious that those who use drugs for treating patients need to have a safe deposit of drugs in addition to accurate and correct information to be able to take the first step of treatment correctly and safely. Currently, all emergency drugs in pre-hospital emergency care of Iran are kept in a box with no insulation and in an environment with temperature changes. Although some drug companies do not consider little changes in temperature as a cause of change in drug effectiveness, the conditions in medical emergencies are very different and harder than laboratory environments. In some countries including Iran, the temperature of the ambulance cabin may vary from -30°C in winter in Ardebil to +65°C in summer in Khouzestan. However, world health organization (WHO) suggests storing drugs in a dry environment between 15°C and 25°C and based on the climate of the region up to a maximum of 30°C. Little data exists regarding the stability of drugs in changing temperatures. Johansen et al. carried out a study in this regard on atropine, naloxone, and lidocaine in Utah in 1992 and reported that no considerable change was found in the concentration of drugs. In 2005, Priston et al. carried out a study in the UK on 11 drugs in -15°C and found that some of the drugs have relatively lower stability if frozen. In addition, in the drug instructions of some drugs including atropine, calcium, and morphine the highest storing temperature is indicated to be 30°C and nebulized albuterol should also be stored in 25°C. Obviously, drug treatment is very important in pre-hospital emergency services, which in turn is the first line of treatment in medical emergencies, accidents and disasters and sometimes an injection of atropine or adrenaline can save someone’s life at the onset of a problem. Therefore, the effect of extreme climates of some provinces in Iran on the effectiveness and safety of the drugs used in pre-hospital emergency services should be studied and evaluated. The authors have decided to point out the importance of drug stability in pre-hospital emergency service in various climates hoping that researchers who have the ability and equipment for doing this research evaluate this topic so that the obtained results are shared with managers and any possible corrective measures needed are taken.

Pain is an unpleasant feeling and experience that is caused by a potential or practical injury and its control is so important that the American Pain Society has introduced pain as the 5th vital sign for emphasizing the importance of pain and controlling it. Almost all humans have experienced moderate to severe pain and most of the time the experience has happened following surgical procedures, medical conditions or trauma. When pain manifests in a clinical condition, health care staff are responsible for following it and relieving it as a goal and responsibility. Pain affects all individuals regardless of age, sex, race, and socioeconomic status and untreated pain can negatively affect various systems of the body and lead to many consequences. Increase in serum level of cortisol, nor epinephrine, and renin angiotension, hyperglycemia, decrease in insulin, manifestation of anxiety, cardiac effects such as ischemia, dysrhythmia, increase in pulse, increase in cardiac load, increased oxygen uptake, increased blood coagulation potential, hypertension especially in patients with head injuries, decreased blood oxygen level, increased body fluid volume, drop in blood potassium, fatigue, muscle cramps, decreased immune system function, decreased ability for wound healing and etc. are among the undesirable side effects of pain. In addition, not treating acute pains also leads to bearing unnecessary pain, elongated duration of hospitalization, increased medical costs and probability of acute pain progressing and developing into chronic pain. The financial burden of not treating pain in America has been estimated to be about 100 billion dollars per year. Pain is a common complaint and makes up a considerable portion of reasons that patients call pre-hospital emergency services and is usually present in the injured and trauma patients. Study results showed that 20% to 31% of the patients presenting via ambulances had moderate and severe pain. Additionally, with 52% to 86% prevalence in emergencies, pain is a key topic in health care of various countries. Pre-hospital emergency staff members are the first in line among health care staff that face patients at times of disaster and accident and are more exposed to the patients’ pain. Despite the quantitative growth of pre-hospital emergency bases to 1900 bases throughout Iran, observations of researchers and evidence and instructions of emergency medical services (EMS) of Iran are indicative of not using enough analgesic drugs, especially opioid analgesic drugs, as a means to relieve patients’ pain in EMS ambulances. Some studies have mentioned that about one third of the pre-hospital patients and more than 80% of patients with bone fractures report moderate to severe pain and on the other hand the positive effect of using pain killers in the regions that used them have been shown to be obvious in most patients. It seems that using analgesics in EMS is a very important topic and researchers express that proper pain management is an important principle in pre-hospital care and opioid analgesics such as morphine and fentanyl have a special place in the instructions of EMS as treatments for acute trauma and non-trauma pains, especially cardiac chest pains, in some advanced countries regarding emergency care. Considering the afore-mentioned points concerning the importance of pain and its treatment, especially the importance of treating pain in traumatic and ischemic cardiac diseases, high prevalence of pain in pre-hospital missions, severity and type of pre-hospital missions, which are mostly associated with pain, high costs of not treating pain and the obvious need for using pain killers in trauma and ischemic cardiac diseases, isn’t it time to introduce a more effective and scientific approach in EMS? Isn’t it better to add a few types of analgesics and opioid drugs to the equipment provided at patients’ bedside, at least for ischemic cardiac diseases and severe trauma? Although the result of a study carried out in Khuzestan province showed that EMS staff members were weak regarding drug information and calculations and other studies have also expressed that drug dosage and use of opioid drugs might not be done correctly or opioid drugs might be abused in some cases, none are convincing reasons for not using these drugs. These problems could be solved by more and better training for EMS staff, creating offline and online protocols and useful programs for preventing abuse of analgesic drugs and these drugs could be effectively used in EMS. Therefore, we again note that this treatment priority should not be overlooked for any reason.

درد احساس و تجربه حسی ناخوشایند می باشد که در نتیجه یک آسیب بالقوه و بالفعل بوجود می آید و کنترل آن به قدری مهم است که انجمن درد آمریکا برای تأکید بیشتر بر درد و کنترل آن، از درد بعنوان پنجمین علامت حیاتی نامبرده است. تقریبا همه انسانها تجربه دردهای متوسط تا شدید را داشته اند و بیشتر اوقات به دنبال انجام پروسیجرهای جراحی، شرایط پزشکی و یا تروما، این تجربه اتفاق افتاده است. وقتی درد و رنج در یک موقعیت بالینی مشخص می گردد، دنبال کردن و رفع آن به عنوان یک هدف و وظیفه بر عهده پرسنل سیستم بهداشتی درمانی می باشد. از این رو درد و درمان آن یک اولویت درمانی است. درد بر تمام افراد با هر سن، جنس، نژاد و طبقه اجتماعی و اقتصادی تأثیرگذار است و درد درمان نشده می تواند بر سیستم های مختلف بدن اثر منفی گذاشته و منجر به عوارض فراوانی گردد. افزایش سطح سرمی کورتیزول، نوراپی نفرین و رنین آنژویوتانسیون، افزایش قند خون، کاهش انسولین، بروز اضطراب، اثرات قلبی مثل ایسکیمی، دیس ریتمی، افزایش نبض، افزایش بار قلبی، افزایش مصرف اکسیژن، افزایش انعقادپذیری خون، افزایش فشار خون بخصوص در بیماران با صدمات سر، کاهش اکسیژن خون، افزایش حجم مایعات بدن، کاهش پتاسیم خون، خستگی، گرفتگی عضلانی، کاهش عملکرد سیستم ایمنی، کاهش قدرت ترمیم زخم و غیره، از جمله عوارض نامطلوب درد می باشند. همچنین عدم درمان دردهای حاد نیز منجر به تحمل دردهای غیرضروری، افزایش طول مدت بستری، افزایش هزینه های پزشکی و احتمال پیشرفت و تبدیل شدن درد حاد به درد مزمن می شود. چنانچه بار اقتصادی عدم درمان درد در آمریکا حدود 100 میلیارد دلار در سال برآورد شده است. درد شکایت بسیار شایعی بوده و بخش قابل توجهی از علل تماس بیماران با سیستم اورژانس پیش بیمارستانی را شامل شده و همچنین در مصدومان و بیماران ترومایی معمولا وجود دارد. نتایج مطالعات نشان می دهد که بین 20 الی 31 درصد بیماران منتقل شده با آمبولانس دارای درد متوسط و شدید بوده اند. همچنین درد با شیوع 52 الی 86 درصد در اورژانس ها یکی از موضوعات اصلی بهداشتی درمانی کشورهای مختلف می باشد. پرسنل اورژانس پیش بیمارستانی نیز اولین اعضای کادر درمانی هستند که در بلایا و سوانح با این بیماران مواجه شده و بیشتر در معرض درد و رنج بیماران قرار دارند. علیرغم رشد کمی پایگاههای فوریتهای پزشکی کشور ایران به بیش از 1900 پایگاه در سراسر کشور، مشاهدات پژوهشگر و شواهد و دستورالعمل های موجود در اورژانس پیش بیمارستانی 115 ایران، نشان دهنده عدم بکارگیری کافی داروهای ضد درد، علی الخصوص ضد دردهای اپیوئیدی به عنوان راهکاری برای کاهش درد بیماران و مصدومان در آمبولانس های فوریتهای پزشکی 115 می باشد. برخی مطالعات ذکر می کنند نزدیک به یک سوم بیماران پیش بیمارستانی و بیش از 80 درصد بیماران دارای شکستگی درد متوسط تا شدید را گزارش می کنند و از طرفی تأثیر مثبت کاربرد مسکن ها در مناطقی که بکار رفته به وضوح بر اکثریت بیماران نشان داده شده است. به نظر می آید که کاربرد داروهای ضد درد در فوریتهای پیش بیمارستانی مبحث بسیار مهمی می باشد و محققان بیان می کنند که مدیریت مناسب درد یک اصل مهم در اقدامات پیش بیمارستانی و خدمت رسانی به بیماران می باشد و مسکن های مخدر نظیر مورفین و فنتالین جایگاه ویژه ای در دستورالعمل های اورژانس پیش بیمارستانی برخی کشورهای پیشرفته در فوریتهای پزشکی بعنوان درمان دردهای حاد ترومایی و غیرترومایی و به ویژه درد قفسه سینه مربوط به بیماری های قلبی دارند. با نگاهی به مطالب پیشگفت در مورد اهمیت درد و درمان آن به خصوص اهمیت درمان درد در تروما و بیماری های ایسکمیک قلبی، شیوع بالای درد در مأموریت های پیش بیمارستانی، شدت درد و نوع ماموریت های پیش بیمارستانی که اکثراً با درد همراه می باشند، هزینه های بالای عدم درمان درد و نیاز مبرم به استفاده از مسکن در تروما و بیماری های ایسکمیک قلبی، آیا زمان آن نرسیده است که فکری به حال درمان مؤثر و علمی تر درد در فوریت های پزشکی گردد؟ آیا بهتر نیست در کنار این همه امکانات که بر بالین بیمار مهیا کرده ایم، چند نوع داروی ضد درد مسکن و مخدر حداقل برای بیماری های ایسکمیک قلبی و یا ترومای شدید نیز در نظر گرفته شود؟ هرچند نتایج مطالعه ای که در خوزستان انجام شد نشان داد که پرسنل فوریتهای پزشکی 115 از نظر اطلاعات و محاسبات دارویی بسیار ضعیف می باشند. بعضا مطالعاتی نیز بیان کرده اند که ممکن است دوزاژ دارویی و کاربرد داروهای مخدر درست انجام نگردد و یا بعضاً ممکن است از داروهای مخدر سوء استفاده شود، اما همه اینها دلیل قانع کننده ای برای عدم کاربرد این داروها نمی باشد و می توان با ارایه راهکارهای بهتر نظیر آموزش بیشتر و بهتر پرسنل فوریتهای پزشکی، ایجاد پروتکل های آفلاین و آنلاین و برنامه های مثمر ثمر در جهت جلوگیری از سوء استفاده از داروهای مسکن بطور مؤثری از این دارو در فوریتهای پزشکی 115 استفاده نمود . از این رو مجدد متذکر می شویم که این اولویت درمانی نباید به هیچ دلیل نادیده گرفته شود.

Background. This study compares different risk factors in patients visiting a hospital during five rainfall-associated bronchospasm epidemics in Ahvaz and those visiting on other occasions. Methods. This case-control study was conducted on 5307 patients with bronchospasm admitted to the Emergency Department of Imam Khomeini Hospital in Ahvaz (Iran) from late October to December (as the epidemic) and 916 patients admitted from late January to March (as the nonepidemic) in 2011 to 2015. Results. A total of the 41.7% of the cases and 48.8% of the controls had episodes of bronchospasm, suggesting a significant difference between the two groups (P

مقدمه: وسایل تیز و برنده از عوامل خطر عمده برای انتقال عفونت های منتقله از راه خون می باشد. از این رو این مطالعه با هدف تعیین جنبه های اپیدمیولوژیک مواجهه شغلی با وسایل تیز و برنده در اورژانس پیش بیمارستانی شهر دزفول، ایران در سال 94-1393 انجام شد. روش کار: این پژوهش مقطعی بر روی 140 نفر از پرسنل فوریتهای پزشکی که معیارهای ورود به مطالعه را داشتند، به روش سرشماری انجام شد. ابزار جمع آوري اطلاعات پرسشنامه ای محقق ساخته شامل مشخصات دموگرافیک و سلامت فردي، شیوع و علل مواجهه با وسایل تیز و برنده، میزان آگاهی، شرایط روحی – روانی، گزارش مواجهات، اقدامات و پیگیری ها بود. داده ها با استفاده از آزمونهای آماری از جمله کای اسکوئر تجزیه و تحلیل شد. يافته ها: بطور کلی 75 درصد از شرکت کنندگان در یک سال گذشته حداقل یکبار با وسایل تیز و برنده مواجهه داشتند. بیشترین مواجهه (09/41 درصد) حین رگ گیری از بیمار بود. 2/54 درصد از کل مواجهات در حین انتقال اتفاق افتاده بود. همچنین 3/69 درصد از مواجهه پرسنل با ترشحات آلوده بیمار متاسفانه گزارش نشده بودند. 63 درصد مواجهات با وسایل تیز و برنده در شیفت شب اتفاق افتاده بود. بین سابقه کاری و فراوانی مواجهات همبستگی وجود داشت (19/0=r، 02/0=p). نتيجه گيری: نتايج مطالعه حاضر حاكي از بالا بودن ميزان مواجهات شغلی با وسایل تیز و برنده بین پرسنل فوریتهای پزشکی مورد مطالعه بود که تعداد قابل توجهی از این موارد گزارش نشده بودند.

یکی از معیارهای توسعه جوامع، ارائه مراقبت های بهداشتی درمانی لازم به تمام مردم است. یکی از مهمترین ارکان مراقبت های درمانی را مراقبت های اورژانسی به خصوص نوع پیش بیمارستانی آن تشکیل می دهند. مراقبت های پیش بیمارستانی به مواردی می گویند که از بالین بیمار شروع و در بخش اورژانس بیمارستان ختم می شوند. سازمان های اورژانس جهت ارائه خدمات اورژانسی و مراقبت های پیش بیمارستانی خود 4 گروه را تربیت می کنند: 1) امدادگر اورژانس (First responder) ؛ 2) تکنسین اورژانس پایه (EMT – Basic)؛ 3) تکنسین اورژانس میانی (EMT - Intermediate)؛ 4) تکنسین اورژانس پیشرفته (EMT - Paramedic). تجویز دارو برای مصدومین و بیماران نیازمند یکی از چندین وظیفه دو گروه آخر یعنی تکنسین های اورژانس میانی و پیشرفته می باشد که سالانه خواه یا ناخواه تعداد زیادی از بیماران و مصدومان را مورد درمان قرار می دهند. استفاده صحیح و به موقع از داروها می تواند بسیاری از خطرات جانی که برای مددجو یا حادثه دیده ایجاد شده را به حداقل برساند و مددجو را از خطر مرگ برهاند. کاملا آشکار است که افرادی که از دارو جهت درمان بیماران استفاده می کنند، علاوه بر داشتن اطلاعات دقیق و صحیح، باید منابع دارویی مطمئنی نیز در اختیار داشته باشند تا بتوانند گام اول در درمان را درست و با اطمینان بردارند. در حال حاضر کلیه داروهای اورژانسی در فوریتهای پزشکی کشور ما در یک جعبه بدون عایق و در شرایط متغیر دمایی نگهداری می گردند. هر چند بعضی شرکت های دارویی تغییرات کم و متغیر دمایی را دلیلی بر از بین رفتن مواد موثر داروها نمی دانند اما شرایط در فوریتهای پزشکی بسیار متفاوت و سخت تر از شرایط آزمایشگاهی می باشد. در برخی کشورها از جمله کشور ایران بعضاً دمای هوای کابین آمبولانس در زمستان از 30- درجه در اردبیل تا 65+ درجه در گرمای تابستان در خوزستان می تواند متفاوت باشد. این در حالی است که سازمان بهداشت جهانی توصیه می کند داروها در یک محیط خشک بین 15 الی 25 درجه و بسته به اقلیم و آب و هوای منطقه تا حداکثر 30 درجه سانتیگراد نگهداری شوند. اطلاعات کمی مبنی بر مقاومت داروها در شرایط دمایی متغیر موجود است. جانسون و همکاران در ایالت یوتای آمریکا در سال 1992 پژوهشی آزمایشگاهی بر روی سه داروی آتروپین، نالوکسان و لیدوکایین به همین منظور انجام دادند و بیان نمودند که تغییر قابل ملاحظه ای در غلظت داروها مشاهده نشد. ملانی جی و همکاران در سال 2005 در انگلستان پژوهشی روی 11 دارو در دمای 15- درجه سانتیگراد انجام دادند و دریافتند برخی از این داروها در صورت انجماد پایداری شان نسبتا کاهش می یابد. همچنین در دستورالعمل دارویی برخی داروها از جمله آتروپین، کلسیم و مورفین حداکثر درجه حرارت قابل ذخیره سازی 30 درجه سانتیگراد می باشد و همچنین اسپری آلبوترول (nebulized albuterol) نیز باید در دمای 25 درجه سانتیگراد نگهداری گردد. بدیهی است دارو درمانی در فوریتهای پزشکی، که خود نیز خط اول درمان در اورژانسهای پزشکی، حوادث و بلایا می باشد، بسیار با اهمیت است و بعضا تزریق یک داروی آتروپین و یا آدرنالین می تواند جان انسانی را در لحظه اول بیماری نجات دهد. بنابراین بررسی تاثیر شرایط سخت اقلیمی برخی استانها بر کیفیت و سلامت داروهای مورد استفاده در اورژانس پیش بیمارستانی، نیازمند تحقیق و بررسی می باشد. نویسندگان در نظر دارند تا اهمیت بررسی پایداری داروهای اورژانس پیش بیمارستانی در شرایط اقلیمی متفاوت را گوشزد نموده، به امید اینکه محققان محترمی که توانایی و امکانات انجام چنین کاری را دارند بتوانند به بررسی این موضوع بپردازند تا نتایج احتمالی به سمع و نظر مدیران رسانده شود تا اقدامات اصلاحی در صورت لزوم انجام گردد.

مقدمه: یکی از شاخص های مهم آمادگی در حوادث و بلایا بررسی میزان آگاهی و عملکرد پرسنل فوریتها از اصول تریاژ می باشد. لذا این پژوهش با هدف تعیین میزان آگاهی و عملکرد کارکنان فوریتهای پزشکی درباره تریاژ پیش بیمارستانی استارت در سال 1395 انجام شد. روش کار: این مطالعه مقطعی بر روی پرسنل فوریت های پزشکی شمال استان خوزستان انجام شد. افرادی که شرایط ورود به مطالعه را داشتند، بصورت سرشماری وارد مطالعه شدند. داده ها با استفاده از پرسشنامه ای متشکل از 5 پرسش (اطلاعات جمعیت شناختی)، پانزده پرسش (آگاهی تریاژ) و نوزده پرسش (عملکرد تریاژ) جمع آوری شد. سپس اطلاعات حاصل مورد تجزیه و تحلیل آماری قرار گرفت. يافته ها: در مجموع 117 نفر با میانگین سنی 08/6±21/33 سال و میانگین سابقه کاری 32/4 ± 35/7 سال در این مطالعه شرکت کردند که همگی مرد بودند. میزان میانگین آگاهی افراد مورد مطالعه از تریاژ در حد متوسط ( میانگین نمره: 44/9) و همچنین نتایج بخش عملکرد نیز حاکی از عملکرد متوسط (میانگین نمره: 58/9) ایشان بود. نتيجه گيری: بر اساس یافته های حاصل از مطالعه حاضر میزان آگاهی و عملکرد پرسنل اورژانس پیش بیمارستانی شمال استان خوزستان درباره تریاژ پیش بیمارستانی در حد متوسط بود.