Tehran Emergency Medical Services Research Articles

The Effect of Rescue and Relief Services on the Severity of Traffic Accidents

INTRODUCTION: According to the official statistics, a high rate of road traffic deaths occurs during the transportation of the injured and in medical centers. The way of transporting the injured to the medical centers, the standard time of dispatch and timely treatment in the hospitals, the land use planning of medical centers and rehabilitation are the three missing links of the post-event phase. Therefore, the researchers aimed to assess the effect of rescue and relief services on the severity of traffic accidents in this study. METHODS: This applied research was conducted based on an exploratory mixed method. The statistical population in the qualitative section included Amin Police Academy professors, experts of both Red Crescent Society (RCS) of Tehran province and Tehran Emergency Medical Service (EMS), who were selected via purposive sampling method. In the qualitative section, the theme analysis method was used and analyzed by using Maxqda-2020 software. The statistical population of the quantitative part included excellent accident experts of 28 districts of Tehran and experts of the RCS and EMS of Tehran province in a stratified random method. In the following, confirmatory factor analysis using structural equation modeling method was used and analyzed with SmartPLS3 software. FINDINGS: The dimensions of the impact of rescue and relief services on the severity of traffic accidents from the perspective of Red Crescent Society and Emergency Medical Services experts included equipment (31.077), land use planning (25.610), expertise (23.598), and education (8.243). The most marked impact was related to equipment, and the least impact pertained to education. Furthermore, the dimensions of the effect of rescue and relief services on the severity of traffic accidents from the perspective of accident experts included equipment (42.009), land use planning (34.419), education (33.770), and expertise (8.951). The greatest impact was related to equipment, and the least effect pertained to expertise. In addition, the factor loadings of all dimensions were more than 0.5 being significant at the 0.95 level. CONCLUSION: Strengthening and developing equipment, land use planning balanced with the geography of missions, and continuous specialized training of rescue and relief of RCS and EMS experts will positively reduce the severity of traffic accidents in the country.

Clients' Satisfaction with Services Provided by Ambulances and Motor Ambulances of Tehran Emergency Medical Services: A Cross-sectional Study.

Background: To improve the quality of services provided by emergency medical services (EMS), a correct understanding of the current situation and analysis of possible problems is required. The purpose of this study was to investigate the level of clients’ satisfaction regarding the missions performed by ambulances and motor ambulances (motorlances) of the Tehran EMS center, and also identify the factors affecting their satisfaction. Methods: This cross-sectional study was conducted for 1 month in Tehran, Iran. All clients in the age range of 18 to 87 years who were approached by Tehran EMS motorlances or ambulances were eligible. Those with wrong registered phone numbers, uninformed callers (passers, coworkers), and those who were not willing to participate in the study were excluded. A valid and reliable researcher-made questionnaire was used to assess the clients’ satisfaction. Missions were surveyed routinely, 1 to 2 days following their performance. The questionnaires were filled out by the investigators via a telephone call to the patients or the patients’ siblings. The collected data were statistically analyzed using IBM SPSS Statistics 24.0. An independent t test and 1-way analysis of variance were used to compare the mean satisfaction score between the groups. Other tests, such as the Pearson correlation coefficient, were also used to examine the relationship between quantitative variables. P<0.05 were considered statistically significant. Results: In total, the data of 1100 missions were analyzed. The age range of the patients was between 1 and 100 years and their mean age was 52.1 ± 19.2 years, and the mean age of interviewees was 44.4 ± 13.4 years (18-87 years); of all the interviewees, 610 (55.5%) were women. The overall satisfaction of people with the Tehran EMS was rated as "very satisfied" in 78.5% of the cases; However, 11.2% of the participants had moderate and low satisfaction. We found that overall satisfaction was related to dependence on the health group (p≤0.001), educational status (p=0.006), economic status (p=0.002), sent vehicle (p=0.040), and diagnosis (p<0.001). Conclusion: Almost 80% of the participants were highly satisfied with the services provided by Tehran EMS motorlances/ambulances, according to this study. Those with a higher educational level, higher socioeconomic class, accurate diagnosis, proper sent car, and health dependency showed a higher level of happiness than the others.

Persistent/Late-Onset Complications of COVID-19 in General Population: A Cross-Sectional Study in Tehran, Iran.

ABSTRACTBackground: After recovery from acute phase of the COVID-19, some patients suffer from persistent/late-onset complications. The main objective of this study was to investigate the prevalence of such complications in a large scale of COVID-19 patients in Tehran, Iran.Methods: In this cross-sectional study, those patients who called Tehran emergency medical services center and were visited by the emergency medical technicians from 20 March 2020 until 21 September 2020 and diagnosed as a confirmed COVID-19 case were enrolled. The minimum required sample size was estimated 385 cases, and they were selected randomly. The patients were interviewed by phone at least 4 weeks since initiation of their symptoms. Using a pre-prepared checklist, made by an expert panel who were involved in management of COVID-19 patients, data were collected on the types and duration of the complications, clinical information, and factors which could interfere with developing the complications. All analyses were performed using STATA 16 software. The association of the prevalence of each complication with independent factor was assessed using Chi-square test (or Fisher’s exact test) for categorical variable, and the mean difference of numerical variables in the two groups (with and without complication) was assessed using independent t-test. Statistical significance was accepted at P value<0.05.Results: Four-hundred forty-seven patients participated in the study. Among our total population, 345 (77.2%) patients experienced at least one of the persistent/late-onset complications. Cardiopulmonary and then skin-related symptom categories were reported in 179 (40.0%) and 173 (38.7%) patients, respectively, and were the most prevalent persistent/late-onset complications. The associations of long term persistent/late-onset complications with older ages (P=0.04), female (P<0.001), psychological stress (P=0.01), and inadequate rest after illness (P<0.001) were significant.Conclusion: The findings of this study indicate that a significant number of patients will experience persistent/late-onset complications, both physically and mentally, after recovering from acute phase of COVID-19. Thus, physicians should have adequate resources and support to care for the patients to help them cope with the condition.

At-risk COVID-19 Patients; Knowledge and Attitude of Those in Need of Transfer to Hospital and Consequences in Non-transferred Patients

Background: Knowledge, attitude, and practice of people, especially high-risk ones, are essential for managing COVID-19. Previous studies have shown that inappropriate knowledge and attitude may influence people's decisions. Objectives: This study aimed to evaluate the knowledge and attitudes of patients towards COVID-19 who called emergency medical service (EMS) while suffering from a chronic underlying disease, whether they were transferred to the hospital during the pandemic or not. Methods: This cross-sectional study was conducted from 21 May 2020 to 20 June 2020 in Tehran, Iran. Using the registered data in the databank of the Tehran EMS center, eligible participants were selected and divided into transferred and non-transferred groups based on the recorded data. A valid and reliable questionnaire comprising four parts (demographic information, patients' knowledge about COVID-19, patients' attitude towards COVID-19, and patients' fear) was used. A researcher-made checklist was also used for recording the consequences and reasons for refusal. Select eligible individuals who agreed to enter the survey were interviewed by telephone. Results: Totally, 201 transferred patients and 158 non-transferred patients were enrolled. The mean age of the transferred group was lower than that of the non-transferred one (57.1 ± 16.1 vs. 62.0 ± 17.4 years; P = 0.006). The mean knowledge score was not statistically different between transferred and non-transferred patients (28.8 ± 5.7 vs. 28.2 ± 5.4; P = 0.320). The mean attitude score was lower in the transferred group than in the non-transferred group (0.75 ± 3.7 vs. 2.2 ± 3.5; P = 0.001). The mean fear score was higher in the non-transferred group than in the transferred group, but the difference was not statistically significant (16.0 ± 5.1 vs. 15.0 ± 5.6; P = 0.101). Conclusions: Most participants in both transferred and non-transferred groups did not have sufficient knowledge of the disease, but the average attitude had a positive score.

Comparing the Number of Emergency Medical Dispatchers (EMDs) Scheduled Based on the Judgment of the Managers with Predictions of the Erlang C Formula: A Brief Report

Introduction Currently, at Tehran Emergency Medical Service (EMS) centre, Emergency Medical Dispatchers (EMDs) are scheduled based on the managers’ experimental estimates. In this study, we planned to evaluate the conformity of managers’ predictions with the Erlang C formula estimates in scheduling EMDs. Methods First, the Emergency Medical Communication Centre (EMCC) performance was evaluated over one week. Afterwards, the number of required EMDs was calculated using the Erlang C formula. Finally, the predictions of the Erlang C formula were compared with those of managers’ judgments. Results During the study period, 79,583 calls were received by the Tehran EMCC. The average number of EMDs per hour ranged between 9.5 and 22.7. The actual number of EMDs was more than Erlang C formula predictions during the 24 hours in all but three time points, i.e. 14:00-1 4:59, 1 5:00-1 5:59 and 1 8:00-1 8:59. In all hours, 90% of calls were answered in less than 10 seconds, and the average waiting time for a total of one week was 7.3 seconds. Also, only 2.1 % of all calls were answered after 10 seconds. Conclusion In the current study, we found that the number of EMDs scheduled based on the managers’ experimental estimates was higher than that of the Erlang C formula calculations. Also, it was found that the waiting time for emergency calls was lower than the defined standards. Although the primary results of the current study indicated that, at least on paper, the Erlang C formula has the potential to be used as a predicting model in the Tehran EMCC, further research is required to evaluate its effect on the actual performance of the EMCCs.

Performance evaluation of an EMS system using queuing theory and location analysis: A case study.

In emergency medical services (EMS), response time is a key factor that shows the performance of the system. This factor is composed of two parts including activation time and travel time. The activation time of an emergency call is the time a call center spends on taking an incoming call for EMS and decides whether an ambulance should be dispatched or the emergency can be resolved by giving some medical advices. Having a good number of call center operators including call takers and dispatchers can help to reduce this time and thus the response time. However, this alone may not be enough to have a reasonable cycle time. In fact, having idle ambulances located in right places when emergency calls occur is an influential factor to reduce the travel time and thus have an optimal response time and save people's lives. Although many researchers have studied improving either the activation time or the travel time, to the best of our knowledge, there exists no study focusing on both. Motivated by this gap, in this study, a framework is proposed which uses queuing theory and location analysis to address both activation and travel times. In this regard, first, queuing theory is applied to evaluate the performance of an EMS call center and reduce the average activation time. Then, three mathematical models including mobile stations, MEXCLP and MECRP are applied to locate ambulances such that the average travel time is minimized. To shed light on the merits of using queuing theory and location models, computational results based on the real-world data from Tehran EMS Center are provided. The proposed methodology can reduce the average response time by approximately four minutes and increase the average coverage by 35%. This work is an example of the tremendous positive impact that the application of queuing theory and mathematical modeling can have. The proposed framework can significantly decrease the cycle time and increase the ambulance coverage level. The findings of this study help the policy makers of EMS centers with evaluating the performance of their systems and determining the optimal number of operators and locations of ambulances in a way that enhances the quality of emergency services.

Changes in COVID-19 IgM and IgG antibodies in emergency medical technicians (EMTs).

IntroductionSerologic testing can provide a safe and fast approach for assessing SARS-CoV-2 antibodies. These tests can be utilized as a complementary method in diagnosis and patients' follow-up, and can also be helpful in epidemiological studies. This study aimed to describe temporal changes in the incidence of COVID-19 IgM and IgG antibodies in emergency medical technicians (EMTs) within a specified time period.MethodsAll EMTs working for Tehran Emergency Medical Service (EMS) center during May to September 2020 were eligible for this study. Those EMTs who were suspected/probable/confirmed cases of COVID-19, based on WHO defined criteria and were willing to participate, entered the study. The EMTs underwent serology testing four weeks after the occurrence of exposure (in suspected cases) or onset of their symptoms (in probable/confirmed cases). Cases were further confirmed by RT-PCR and/or lung CT, and antibody testing was performed for the second and third time with 12-week intervals. Finger-stick blood sampling was utilized for the specimen collection in three different phases. Samples were then analyzed by a commercial immunochromatography-based kit for qualitative measurement of serum IgM and IgG antibodies against the COVID-19 S-protein antigen.ResultsTwo hundred eighty-four participants met the inclusion criteria; their mean age was 35.9 (SD = 7.6) years and consisted of 244 (85.9%) males. COVID-19 was confirmed in 169 out of 284 participants. Subsequently, 142 and 122 participants were included in phases 2 and 3 of the study, respectively. The number of seronegative patients exceeded seropositive ones in all three phases. At baseline, 162 (57%) patients were seronegative, 27 (9.5%) were only positive for IgG, 3 (1.1%) were only positive for IgM, and 92 (32.4%) were positive for both antibodies; Seventy-eight (54.9%) were seronegative, and 31 (21.8%) were positive for both antibodies in the second phase; These values were 85 (69.6%) and 8 (6.6%) for the third phase, respectively. Among the people who were positive IgG in the first phase (80 people), 56.3% were still positive in the second phase and 27.5% in both subsequent phases.ConclusionThe results of our study show that there is a significant reduction in COVID-19 antibody seropositivity over time.

Characteristics of Emergency Medical Service Missions in Out-of-Hospital Cardiac Arrest and Death Cases in the Periods of Before and After the COVID-19 Pandemic.

Some studies in countries affected by the coronavirus disease of 2019 (COVID-19) pandemic have shown that the missions of Emergency Medical Service (EMS) have changed during the COVID-19 pandemic, and the rate of death and out-of-hospital cardiac arrest (OHCA) has been increased due to the direct and indirect effects of COVID-19. The aim of this study was to determine the effect of the COVID-19 pandemic on the process of EMS missions, death, and OHCA. This cross-sectional study was performed in Tehran, Iran. All conducted missions in the first six months of the three consecutive solar years of March 21 until September 22 of 2018-2020, which were registered in the registry bank of the Tehran EMS center, were assessed and compared. Based on the opinion of experts, the technician's on-scene diagnoses were categorized into 14 groups, and then death and OHCA cases were compared. In this study, the data of 1,050,376 missions performed in three study periods were analyzed. In general, the number of missions in 2020 was 17.83% fewer than that of 2019 (P < .001); however, the number of missions in 2019 was 30.33% more than that of 2018. On the other hand, the missions of respiratory problems, cardiopulmonary arrest, infectious diseases, and poisoning were increased in 2020 compared to that of 2019. The raw number of OHCA and death cases respectively in 2018, 2019, and 2020 were 25.0, 22.7, and 28.6 cases per 1,000 missions. Of all patients who died in 2020, 4.9% were probable/confirmed COVID-19 cases. The history of heart disease, hypertension, diabetes, and respiratory disease in patients in 2020 was more frequent than that of the other two years. This study showed that the number of missions in the Tehran EMS in 2020 were decreased compared to that of 2019, however the number of missions in 2019 was more than that of 2018. Respiratory problems, infectious diseases, poisoning, death, and OHCA were increased compared to the previous two years and cardiovascular complaints, neurological problems, and motor vehicle collisions (MVCs) in 2020 were fewer than that of the other two years.

Seven Criteria of Severe COVID-19 (SCSC): A New Pre-Hospital Prognostic Scoring Tool Suggested for Screening of Probable/Confirmed COVID-19 Patients with Severe Outcomes

Introduction: COVID-19 pandemic led to various consequences in medical care that had been long provided for the patients referred to the hospitals. Objective: We conducted this study to derive and validate a new scoring system that can accurately differentiate COVID-19 patients who may have a worse outcome from others at the prehospital stage. Methods: This study was performed on probable/confirmed COVID-19 patients, who were transferred to the hospitals by Tehran emergency medical services (EMS). Occurrence of one of the items including: in-hospital death, intensive care unit (ICU) admission, or hospitalization for more than 20 days was considered to indicate a “severe disease”. Univariate and multivariate logistic regression were used for assessment of the relationship between all independent variables and the outcome. In the validity assessment step, area under the receiver operating characteristic (ROC) curve was calculated for a data set independent from the data based on which the model was designed. The sensitivity and specificity were also presented based on the best suggested cutoff point. Results: In this study, the data of 557 cases were analyzed in the derivation step and 356 cases were assessed in the validation step. The univariate logistic regression showed that age, weakness and fatigue, disease history, systolic blood pressure, SpO2, respiratory rate, and Glasgow coma scale (GCS) were statistically significant in severe disease group. The area under the ROC curve (AUC-ROC) of the tool was 0.808 (95% CI: 0.779, 0.834). The best cut-off point for screening was the score of ≥4, in which the sensitivity and specificity of the tool for the best cut-off point were 71.87% and 78.06%, respectively. In the validation step, the AUCROC of the tool was 0.723. Conclusions: Seven criteria of severe COVID-19 (SCSC) tool could properly differentiate probable/confirmed COVID-19 patients with severe outcomes in the pre-hospital stage.

The Geographical Distribution of Probable COVID-19 Patients Transferred by Tehran Emergency Medical Services; a Cross Sectional Study.

Introduction:Mapping of COVID-19 infection in the city can help us know more about how the disease is distributed and spread. This study was conducted to investigate the geographical distribution of probable COVID-19 patients who were transferred to destination hospitals by emergency medical services (EMS) in the first wave of the epidemic, in Tehran, Iran.Methods:This cross-sectional study was performed based on recorded missions during the first 3-month period of the pandemic in Tehran, Iran. All probable cases of COVID-19 who were transferred to the hospitals following contact with Tehran EMS during the study period were enrolled. Arc-GIS software was utilized to draw the distribution map of the contact places of the cases. Results:In this study, the data of 4018 patients were analyzed (60.9% male). The mean age of the patients was 54.1 ± 20.7 years; and the mean age of the patients had increased with time during the studied 3 months (p = 0.003). The average incidence rate of this disease in Tehran during the study period was 4.6 per 10,000 population. Generally, the lowest and highest raw frequencies of Tehran COVID-19 contamination were seen in municipal districts 21 and 4, respectively. The raw frequency of cases during the 3-month study period also showed that the highest number of cases in Tehran occurred in municipal districts 5 and 4, respectively.Conclusion:In the present study, using geographic information systems (GIS), geographical distribution map of COVID-19 in Tehran, Iran, during the first 3 months of the pandemic was drawn.

Assessing the Usefulness of Instant Feedback and the Hawthorne Effect: An Audit of Time Indexes of Ems Missions in Tehran

Introduction It has been well established that if a person is aware that they are being monitored their commitment and effort will be maximised (the Hawthorne effect), which then leads to efficiency increase and optimal workflow. Objective Our aim was to evaluate the efficacy of instant feedback and the Hawthorne effect of this intervention on pre-hospital time indexes during emergency medical service (EMS) missions. Methods This is a cross-sectional auditing study on the missions of the Tehran EMS Center (performed over a 12-month period) in three phases: pre-intervention, instant feedback, and monitoring without feedback. The measured time indexes were the different parts of mission times. To collect data, a pre-prepared checklist was set up. For the first phase, data were extracted from the database of the Tehran EMS Center. In the second and third phases, the data were entered into the relevant forms for each mission by the researcher and executive colleagues. Results The data of 229,847 missions were analysed. In the instant feedback phase, compared to the pre-intervention phase, the mean activation time, response time, scene time, transfer time and hospital delay time were decreased. When we compared the mean time indexes in the monitoring phase compared to the instant feedback phase, we saw that the average activation time, response time and transfer time were increased but they were still less than that in the pre-intervention phase. However, the scene time and hospital delay time were not changed compared to the instant feedback phase but were lower than that in the pre-intervention phase. Conclusion Auditing was effective in reducing the total time of missions and this effect was largely maintained in the monitoring phase under the Hawthorne effect.

How the COVID-19 Epidemic Affected Prehospital Emergency Medical Services in Tehran, Iran.

IntroductionCoronavirus disease 2019 (COVID-19) has substantially impacted the healthcare delivery system in Tehran, Iran. The country’s first confirmed positive test for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was on February 18, 2020. Since then, the number of cases has steadily increased in Iran and worldwide. Emergency medical services (EMS) quickly adapted its operations to accommodate a greater number of patients, and it worked to decrease the risk of COVID-19 spread among EMS personnel, given the disease’s high transmissibility.MethodsWe evaluated the chief complaint as well as the pattern and number of EMS calls and dispatches during the 28-day intervals before and after the February 18, 2020, COVID-19 outbreak in Iran.ResultsEMS calls increased from 355,241 in the pre-outbreak period to 1,589,346 in the post-outbreak period, a 347% increase (p<0.001). EMS dispatches rose more modestly from 82,282 to 99,926, a 21% increase (p<0.001). The average time on telephone hold decreased from 10.6 ± 12.7 seconds pre-outbreak to 9.8 ± 11.8 seconds post-outbreak, a 7% decrease (p<0.001). The average length of call also decreased from 1.32 ± 1.42 minutes pre-outbreak to 1.06 ± 1.28 minutes post-outbreak, a 20% decrease (p<0.001). The highest number of daily dispatches occurred during the second and third weeks of the four-week post-outbreak period, peaking at 4557 dispatches/day. After the first reported case of SARS-CoV-2, there were significant increases in chief complaints of fever (211% increase, p<0.001) and respiratory symptoms (245% increase, p<0.001).ConclusionThe number of EMS calls and dispatches in Tehran increased 347% and 20%, respectively, after the outbreak of COVID-19. Despite this, the time on hold for EMS response decreased. The Tehran EMS system accomplished this by increasing personnel hours, expanding call-center resources, and implementing COVID-19-specific training.

Audit on in-hospital mortality of trauma patients: EMS Management and Mismanagement

Background: The investigation of trauma-related mortality is one of the key components in trauma studies and it is used as a performance index and measure of health care quality. Objective: The present study aimed to evaluate the performance of pre-hospital interventions and identify possible mismanagements in dealing with trauma patients transferred by emergency medical services (EMS) to the hospital and died. Methods: This study was conducted in 2019, in Tehran, Iran. All trauma patients who were transferred to the emergency department (ED) of three main referral hospitals, by Tehran EMS and died at the hospital within 24 hours of admission, were studied retrospectively. The required information was collected from the EMS and the hospital records. A panel of experts was asked to identify possible errors based on standards for each patient. Results: During the one-year study period, almost 14000 trauma patients were transported by Tehran EMS to the studied hospitals. Of them, a total of 197 deaths were recorded. The most and least provided services were breathing management (87.3%) and intravenous (IV) fluid therapy (12.2%), respectively. Needle thoracostomy, IV fluids therapy, life supports (basic and advanced cardiac), and airway management had the highest percentage of mismanagement among provided services. Bleeding control and resuscitation were consistent with the recommended standard. Conclusion: In the current study, bleeding control and immobilization was performed appropriately. Needle tracheostomy was not performed at all. Airway management and life supports of the victims were not performed properly.

Short-Term Outcome of Transported Versus Not-Transported Seizure Patients by Tehran Emergency Medical Services; a Retrospective Cohort Study

Background: One of the most frequent complaints that emergency medical services (EMS) deal with is seizure. The missions of EMS on these cases may lead to transferring the patient to the emergency department (ED). Objectives: Therefore, the present study was conducted to compare the short-term outcome of transported versus not-transported cases. Methods: Our population sample was selected retrospectively from medical records in Tehran EMS center for 6 months in which the plan was transferring to a specific hospital. The cases were divided into transported or not-transported. W extracted and compared the cases’ demographic data, vital signs, conducted prehospital management, patient disposition, and their short-term outcome. Results: We evaluated 486 cases, 173 of whom were males (35.6%) and the mean age of patients was 34.8 ± 32.0 years old. 329 (67.7%) and 157 (32.3%) were in the not-transported and the transported group, respectively. Among all not-transported cases, we could follow 172 patients, 52 of whom had gone to hospital during the next 72 hours. 22 out of the 52 cases were discharged from ED the same day. Overall, the ED discharge rate was significantly more in the transported group (P &lt; 0.001). Short-term mortality had no significant difference in the two study groups (P = 1.00). Conclusions: Most of the not-transported patients did not go to the hospital during further 72 hours, and some were hospitalized. Most of the patients transported to the hospital were discharged from the ED. The short-term mortality rate was not different.

The impact of telecardiology on the outcome of patients with myocardial infarction transported by Tehran’s emergency medical services to selected hospitals of Tehran city

Background &amp; Aim: Clinical outcomes and mortality rate of patients with ST-segment elevation myocardial infarction (STEMI) strongly depend on the time of percutaneous coronary intervention (PCI). One way to reduce the delay in this treatment is to use telecardiology in the prehospital setting. The purpose of this study was for comparison of telecardiology on the first medical contact to balloon time and outcome (size of infarct area, left ventricular ejection fraction, and major adverse cardiac events) of patients with myocardial infarction (MI) transported by Tehran Emergency Medical Services to selected hospitals in Tehran, Iran. Methods &amp; Materials: The present retrospective, comparative study was conducted in 2018 in Tehran city on the medical records of 300 patients with STEMI transported with and without telecardiology (150 records per group). Data for this study included demographic characteristics; how to transport the patients to medical centers, first medical contact to balloon time (FMCTB), and clinical outcomes. Data were analyzed using independent t-test, Fisher's exact test, Chi-square, Mann-Whitney and Kruskal-Wallis test by SPSS software, Version 20. Results: First medical contact to balloon (FMCTB) time, infarction size based on creatine kinase, the patient mortality rate in one month, and repeated PCI in the group transported with telecardiology was significantly lower than that of the group transported without telecardiology (P&lt;0.05). Left ventricular ejection fraction (LVEF) in the first 24 hours, infarction size based on troponin I level, the rate of readmission due to acute coronary syndrome (ACS) and the rate of coronary artery bypass grafting (CABG) were not statistically significant between the two groups (P&lt;0.05). Conclusion: The results of this study showed that the use of telecardiology could reduce the delay in performing PCI and improve some of the clinical outcomes of patients with STEMI. These results can be used to improve the quality of care for patients with STEMI by pre-hospital emergency personnel, physicians and nurses involved in the care of these patients.

Accuracy of the pre-hospital triage tools (qSOFA, NEWS, and PRESEP) in predicting probable COVID-19 patients' outcomes transferred by Emergency Medical Services.

Background:This study aimed to evaluate the efficiency of pre-hospital triage tools including the qSOFA, NEWS, and PRESEP in determining the prognosis of probable COVID-19 patients.Methods:In this diagnostic accuracy study, all probable COVID-19 patients older than 16-year-old who were transferred to the hospital by the Tehran Emergency Medical Services (EMS) during the first month of the pandemic, entered to the study. The scores of qSOFA, NEWS, and PRESEP were calculated using data gathered while providing pre-hospital care. The primary outcome was death; and the secondary outcomes were ICU admission, length of stay in the ICU, and length of hospital stay.Results:The data of 557 individuals with the mean age of 56.93±18.31 were analyzed of whom 67.5% were males. The area under the ROC curve (AUC) of qSOFA, NEWS, and PRESEP for ICU admission was 0.553, 0.557, and 0.551, respectively. The AUC of qSOFA, NEWS, and PRESEP for death was 0.596, 0.566, and 0.604, respectively. The best obtained cut-off point for qSOFA was a score >0 (the sensitivity and specificity were 25.0 and 85.68%, respectively), for NEWS was a score >2 (the sensitivity and specificity were 83.61 and 32.67%, respectively), and for PRESEP was a score >1 (the sensitivity and specificity were 54.10 and 55.56%, respectively).Conclusion:Based on the findings of the current study, it is likely that the available pre-hospital triage tools (qSOFA, NEWS, and PRESEP) do not have proper efficacy to predict death, ICU admission, and disease severity of COVID-19 patients.

Epidemiological Features of Injured Patients Examined by Tehran Emergency Medical Service Technicians.

Introduction:Knowledge of epidemiological aspects can be a useful guide in determining the resources for better prevention and management of injuries. There are some performed studies on this topic in Iran, based on the limited hospital database. However, to the best of our knowledge, there is not any survey based on the pre-hospital databaseObjective:The purpose of this study was to assess baseline characteristics of the traumatic patients according to the records of Tehran Emergency Medical Service (EMS) Center to present descriptive statistics of their epidemiological features.Method:This cross-sectional study was conducted retrospectively, using Tehran EMS center data registry. All traumatic patients examined by EMS in Tehran, Iran following call to emergency medical dispatcher were included. By reviewing the EMS technicians’ mission forms, required data were extracted. The mission form contains information such as age, sex, injured location, damage mechanism, accident location (home, workplace, street), time of call, the outcome of the patient’s ambulance mission and the results of the assessment of the technician, etc.Results:Totally, 56612 injured cases with the mean age of 33.1±15.6 years were examined by EMS during one-year study period of whom 80.4% were male. Crude Incidence Rate was 10.5 and 2.5 per 1000 in male and female, respectively. Traffic accident and then fall were the two most prevalent mechanism of injuries. All types of injuries were significantly more prevalent in males (P<0.001). Most injuries were in winter season with 15570 cases (27.5%). Car accident was prevalent in winter and other injuries were significantly prevalent in spring (P<0.001). The most frequent places of injuries occurred on main roads and streets (55.7%). All of the road-related injuries was prevalent in winter, whereas injuries in other places were prevalent in spring (P<0.001). Most of the cases (78.3%) were transferred to the health centers, but 20.7% did not consent to treatment and transmission. Only 222 cases (0.4%) died, that 95% was due to traffic accident. there was a significant relationship between the number of injured organs and the death; So that the highest death rate occurred for those with more than 5 injured organs (P <0.001).Conclusion:Based on the findings, traffic accident was the most frequent cause of trauma that led to visiting a traumatic patient by an EMS technician in Tehran, Iran. Injuries in all age groups were more prevalent in males, and the involvement of 5 or more injured organ had a significant relationship with mortality.

Innovation in the use of motor ambulance for prehospital emergency care.

BACKGROUND:Prehospital emergency care system is one of the important parts of the health system. Heavy traffic, increasing urban population, and growing demands for prehospital emergency services are challenges faced by this section of the health system. One of the approaches to deal with this issue is using motor ambulances.AIMS:This study aims to investigate the missions of motor ambulances, ambulances, and the effects of motor ambulance services on response time and ambulance missions.MATERIALS AND METHODS:This applied research has been designed as a descriptive and cross-sectional study. Overall, 267,836 missions carried out by ambulances and motor ambulances of Tehran emergency medical service (EMS) Center in the years 2014 and 2015 were investigated. The data were gathered personally by visiting Tehran EMS Center. The data were analyzed by Excel (2013) software.RESULTS:The average response time for ambulances and motor ambulances were 16 min and 14 min and 13 s, respectively. Most of the ambulance and motor ambulance missions were reportedly due to weakness (20%) and heart problems (16%). In 57% of ambulance missions and 71.5% of motor ambulance missions, the patients refused to being transferred to the hospital. Most of the transport missions to hospital (24%) were caused by traffic accidents.CONCLUSIONS:According to the results, the response time was higher than the national standards. Locating motor ambulances on the streets and outside emergency stations during peak traffic times decreased the response time by 2 min and by providing the necessary services in the scene and transferring fewer patients to the hospital, it is possible to provide further services by assigning ambulances to more urgent missions. Thus, it is recommended to employ more seasoned staff, multiply motor ambulances, and locate motor ambulances precisely to decrease response time and also at a lower cost more citizens are provided with prehospital care.

Epidemiology of Accidents in Tehran Emergency Medical Service During 2012 to 2013

Background: There is a lack of epidemiological data on emergency Medical service (EMS) missions for accidents in Iran. The present study aimed at obtaining representative data on the epidemiology of emergency Medical service missions for accidents in Tehran. Methods: Active EMS stations in Tehran were selected through stratified random sampling in di erent regions of the city during a twelve-month period from March 2012 to March 2013. Data was collected through a questionnaire on demographic information, which extracted from events recorded on dispatch electronic forms in EMS. Data was analyzed by Excel using descriptive statistics. Results: Based on the type of accidents, Road Tra c Accidents (RTA) and downfall in the North, stab wound in the East, burning in the West, and poisoning with CO in the East region of Tehran megacity had the highest rates compared to other areas. The most common of all were Road Tra c Accidents (RTA) (77.9%) stab wound (11.1%), falling down (4.6%), burns (2.1%), and Carbon Monoxide (CO) poisoning (1.5%). Most accidents occurred in males and 20- to 40-year-old age group (45.51%), and the western district had the first rank in Tehran. Conclusions: According to demographic and geographical rate of accidents, It is recommended to develop preparedness programs and response plan according to epidemiological information of accidents. This programs includes EMS sta trainings and community educations. Copyright 2017, Trauma Monthly.

The Pattern of Pre-hospital Medical Service Delivery in Iran; a Cross Sectional Study.

Pre-hospital emergency systems provide service by Franco-German and Anglo American models. This study was carried out to compare the Iranian emergency medical service (EMS) with the two models regarding timing and equipment. In this cross sectional study, response time, scene time, and transport time to hospital as well as ambulance equipment of five hundred thousand Tehran EMS recorded missions, during one year, were compared with Franco-German and Anglo American models, trying to determine the pattern of EMS delivery in Iran. The mean response time, scene time, and transport time to hospital were 15.00 ±10.88, 18 ±11.48, and 15.00 ±11.20 minutes, respectively. The mean response time (p<0.035), scene time (p<0.033), and transport time to hospital (p<0.015) were more than the standard time. Percentage of ambulances quipped with automated external defibrillator (45%, p<0.001), ventilator (2%, p<0.001), disposable splint (0%, p<0.001), and wheelchair (0%, p<0.001) were very far from standards. The pattern of EMS delivery in Iran was a combination of Anglo American and Franco-German system.