Challenges to Use Response Time Standard in Assessing Emergency Medical Services in Iran: A Systematic Review
Seyyed Mohammad Reza
Hosseini
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences,
author
Mohammadreza
Maleki
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences
author
Hasan Abolghasem
Gorji
Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences
author
Davoud
Khorasani-Zavareh
1Safety Promotion and
Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, 2Department of Health in Disaster and Emergency, School of Health Safety and
Environment, Shahid Beheshti University of Medical Sciences
author
Masoud
Roudbari
Antimicrobial Resistance Research Center, Rasoul-e-Akram Hospital, Department of Bio-Statistics,
School of Public Health, Iran University of Medical Sciences, Tehran, IR Iran
author
text
article
2017
eng
Response time (RT) accounts as a common tool for emergency medical services (EMS) assessment. While the national standard RT has been established in Iran since 2007, its application has hardly been put into scrutiny. This study aimed at investigating the use of RT standard in assessing EMS in Iran. This systematic review included papers focusing on prehospital EMS assessment published in Google Scholar, Scopus, Embase, PubMed, and the Persian databases of Magiran and SID. Selection criteria involved all English and Persian studies focusing on RT as an assessment of prehospital EMS in the context of Iran. Repetitious papers and those presented in conferences were omitted, which left 21 papers published from 2007 to mid‑2016 for systematic review. A data collection form was designed. This provided both inclusive information about the papers and indicators used to report RT in each paper (i.e., mean and percentages of RT below 8 min) as well as the use of these indicators vis‑a‑vis that of the standard. From among the 21 papers focusing on RT, seven (33%) reported RT as percentages of operations performed in the means of RT; nine studies compared mean and the national standard as expressed in percentage. Limited use of the national standard to report RT was identified as a challenge to EMS assessment. Further, the inconsistency that exists when comparing RT in terms of means and percentage is a challenge to the validity of judgments expressed in some previous studies. Employment of uniform methods to report and evaluate performance based on the national standard will lead to greater transparency in emergency operation performance.
Archives of Trauma Research
Kashan University of Medical Sciences
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https://archtrauma.kaums.ac.ir/article_87786_bfded30421d35511ac79779ea7588026.pdf
dx.doi.org/10.4103/atr.atr_29_17
An Epidemiologic Study of Deceased Pedestrians in Road Traffic Accidents in Iran during 2012–2013
Jalil
Hasani
Department of Public Health, Torbat Jam Faculty of Medical Sciences, Torbat‑e Jam,
author
Noushin Sadat
Ahanchi
Department of Epidemiology, Shahid Beheshti University of Medical Sciences
author
Abdolhalim
Rajabi
Department of Community Medicine, Golestan University of Medical
Sciences, Gorgan
author
Mohammadreza
Ghadirzadeh
Department of Forensic Medicine, Forensic Medicine
Organization
author
Seyed Saeed
Hashemi Nazari
Department of Epidemiology, Safety Promotion and Injury Prevention Research Center, School of Public Health, Shahid Beheshti University of Medical
Sciences, Tehran, Iran
author
text
article
2017
eng
Background and Objectives: Due to the high rate of pedestrian deaths in traffic accidents and given that describing demographic profiles
of pedestrian deaths and features of accident locations is an important factor in the prevention, management, and analysis of road traffic
accidents, this study aimed at describing the demographic and personal patterns as well as environmental factors affecting the occurrence of
road traffic accidents among pedestrians in Iran. Materials and Methods: This cross‑sectional study was conducted on all pedestrian deaths
caused by traffic accidents referred to the Forensic Medicine Organization in Iran from March 20, 2012, to March 19, 2013. In this study,
demographic information as well as the information related to the accidents and other information including trauma location, the final cause
of death, date of accident, date of death, time of death, and time of accident were examined. The information received from the Forensic
Medicine Organization was first controlled and then analyzed using the Stata 11 software. Results: From a total of 4371 pedestrians died in
2012 due to traffic accidents, 3201 cases (73.2%) were males with a mean age of 48.1 ± 0.46 years, and 1170 cases (23.8%) were females
with the mean age of 46.1 ± 0.77 years. In terms of age, education, and marital status, the highest frequencies of pedestrian deaths were,
respectively, observed in the age group 65 years old and above (33.4%), the illiterate group (44.5%), and married people (67.9%). The highest
and the lowest incidence rates of death were seen in Gilan (11 per 1000 people) and South Khorasan Provinces (2.4 per 100,000), respectively.
Conclusions: Pedestrians as the most vulnerable people in traffic accidents comprise a large proportion of deaths and disabilities caused by
road traffic accidents. It seems necessary to take some measures including paying special attention to physiological characteristics of the age
group above 65 years old, doing close monitoring by the traffic police in October and the rush hours, and providing facilities for pedestrians
to cross in busy locations of suburban areas.
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https://archtrauma.kaums.ac.ir/article_87787_d41d8cd98f00b204e9800998ecf8427e.pdf
dx.doi.org/10.4103/atr.atr_57_17
Analysis of Direct Medical Expenses Resulting from Road Traffic Injuries in the City of Tabriz
Narges
Shadkam
Department of Health Care Management, Tabriz Health Service Management Research Center, School of Management and Medical Information, Tabriz University of Medical Sciences
author
Alireza
Mahboub-Ahari
Department of Health Care Management, Tabriz Health Service Management Research Center, School of Management and Medical Information, Tabriz University of Medical Sciences
author
Ali
Imani
Department of Health Care Management, Tabriz Health Service Management Research Center, School of Management and Medical Information, Tabriz University of Medical Sciences
author
Mohamad
Asghari Jafarabadi
Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
author
text
article
2017
eng
Background: Road crashes as a major global public health problem cost 3% of most countries and 5% of low‑ and middle‑income countries’
gross domestic product (GDP). The World Health Organization has predicted that without sustained action, road traffic crashes will become
the seventh leading cause of death by 2030. Objectives: The aim of this study was to analyze the death rate, severity of injuries, and direct
medical costs caused by road traffic injuries (RTI) in the city of Tabriz in 2014. Methods: Trauma injury admissions due to RTI in Imam
Reza Hospital in Tabriz City were investigated in terms of etiology and the direct medical costs during 2014–2015. Data were collected using
a researcher‑made checklist after being confirmed by relevant experts in terms of face validity. All information on direct medical costs are
extracted from several sources including hospitals, database of the Ministry of Health and Medical Education, disaster and emergency medical
management center, and public and private physiotherapy clinics across the city. Results: Review of the hospital records showed that the mean
age of the patients (67.9% males and 32.1% females) was 34 ± 17.3 years. In addition, 79.2% of the patients were treated on an outpatient
basis, and 20.8% were treated on a hospitalization basis (hospitalization or death). The mean times of inpatient and outpatient hospitalization
for injuries were 3 h and 6.7 ± 5.3 days, respectively. Total direct medical costs were 11.631 dollars, of which 8% was for hospital costs, 9.7%
for prehospital costs, and 2.3% for physiotherapy costs. Chest and lower part injuries had highest medical costs. From etiological standpoints,
the greatest reason of being injured and hospitalization is multiple injuries and bruises, and the prominent cause of death was blow to the head
and neck (70%). Conclusions: The results of the present study showed that direct medical costs in Tabriz during 2014–2015 were equal to
0.1% of GDP, which is a considerable amount. High economic and social costs of road accidents and their harmful physical and psychological
effects on individuals and community require the attention of professionals and experts in the transportation industry and health‑care system
to determine appropriate strategies for interventions in reducing accidents’ burden and injuries.
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https://archtrauma.kaums.ac.ir/article_87788_4f6e6347064bad0e127324b75997a090.pdf
dx.doi.org/10.4103/atr.atr_31_17
The Epidemiology, Management, and Outcome of Field Hockey‑related Fractures in a Standard Population
Greg
Robertson
Department of Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, Scotland
author
Alexander
Wood
Department of Orthopaedic, Leeds General Infirmary, Leeds,
England, United Kingdom
author
Stuart
Aitken
Department of Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, Scotland
author
Charles
Court‑Brown
Department of Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, Scotland
author
text
article
2017
eng
Background: Field hockey is one of the most popular sports in the world, yet little is known about patient outcome following fracture
injuries sustained during this sport. Objectives: The aim of this study is to describe the epidemiology, management, and outcome of
field hockey‑related fractures in a known UK population at all skill levels. Materials and Methods: All fractures sustained during field
hockey from 2007 to 2008 within the adult Lothian population were prospectively recorded and confirmed by an orthopedic surgeon
during treatment at the sole adult orthopedic center in the region. Nonresident individuals were not included in the study. Follow‑up data
were obtained in September 2010 to determine return rates and times to field hockey. Results: Nineteen fractures were recorded over the
study period in 19 patients. Seventeen (89%) of the fractures were recorded in the upper limb, with 15 (79%) recorded in hand. Eighteen
fractures (85%) in 18 patients (95%) were followed up at a mean interval of 31 months (range: 25–37 months; standard deviation [SD]
2.1 months). The mean time for return to field hockey from injury was 10.8 weeks (range: 3–26 weeks; SD 7.1 weeks). For patients with
upper limb injuries, the mean time was 9.2 weeks (range: 3–20 weeks; SD 5.7 weeks), compared to 22 weeks (range: 18–26 weeks; SD
5.7 weeks) for patients with lower limb injuries. Eleven percent of the cohort did not return to field hockey. Seventy‑eight percent of
the cohort returned to field hockey at the same level or higher. Fifty percent had ongoing related problems, yet only 17% had impaired
field hockey ability because of these problems. Fractures with the highest morbidity in not returning to field hockey were as follows:
Metacarpal 14% and finger phalanx 13%. Conclusions: The significant majority of field hockey‑related fractures are sustained in the
upper limb, notably the hand. Around ninety percent of patients sustaining a fracture during field hockey will return to this sport at a
similar level. While half of these will have persisting symptoms 2 years postinjury, only one‑third of symptomatic patients will have
impaired field hockey ability because of this.
Archives of Trauma Research
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https://archtrauma.kaums.ac.ir/article_87795_552a4d8c4121ff6b404ee5ec636ebdf3.pdf
dx.doi.org/10.4103/atr.atr_56_17
The Effects of Mindfulness‑based Stress Reduction on Emotional Regulation and Psychological Well‑being of Iranian Veteran’s Homemakers with Secondary Posttraumatic Stress Disorder
Abdollah
Omidi
Departments of Clinical Psychology, Kashan University of Medical Sciences
author
Mahboobeh
Shabanzadeh Fini
Clinical Psychology, Islamic Azad University, Science and Research Branch, Tehran (Isfahan), Iran
author
Hossein
Akbari
Epidemiology and Biostatistics, Kashan University of Medical Sciences
author
Goodarz
Akasheh
Department of Psychiatry, Faculty of Medicine,
Kashan University of Medical Sciences, Kashan,
author
text
article
2017
eng
Background: Problems of emotional regulation and lack of social skills in veterans’ families are very common and like psychological complications have unpleasant consequences for them. Therefore, effective and helpful interventions and therapies are highly important. Objectives: The current study aimed at evaluating the effect of mindfulness‑based stress reduction (MBSR) on the improvement of emotional regulation and psychological well‑being in veterans’ homemakers with secondary posttraumatic stress disorder. Patients and Methods: In the current study, the permuted blocked randomization method was used. Participants were selected from veterans’ homemakers referred to the counseling center of veterans in Kashan city (Iran) in 2015. They were randomly assigned into two groups (30 controls and 31 cases). The case group underwent the MBSR treatment. Results: Results showed no significant difference between the two groups at the baseline (P < 0.05). No significant difference was observed in the total score of MBSR on emotional regulation between the groups. However, the difference between pre‑ and post‑test of rejection of emotional response subscale was significant. In addition, the total score in the psychological well‑being at pre‑ and post‑test was significant. Conclusions: It seems that MBSR significantly affects the psychological well-being, but it has no effect on the emotional regulation except the subscale of emotional response rejection.
Archives of Trauma Research
Kashan University of Medical Sciences
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https://archtrauma.kaums.ac.ir/article_87789_a416550d1dac2e75b65a92bc8a98cba3.pdf
dx.doi.org/10.4103/atr.atr_4_18
Explorative Analysis of Motorcyclists’ Injury Severity Pattern at a National Level in Iran
Ali
Tavakoli Kashani
Department of Transportation Engineering, School of Civil Engineering, Iran University of Science and Technology, 2Road Safety Research Center,
Iran University of Science and Technology, Tehran, Iran
author
Ahmad
Mohammadian
Department of Transportation Engineering, School of Civil Engineering, Iran University of Science and Technology
author
Mohammad Mehdi
Besharati
1Department of Transportation Engineering, School of Civil Engineering, Iran University of Science and Technology, 2Road Safety Research Center,
Iran University of Science and Technology, Tehran, Iran
author
text
article
2017
eng
Objectives: This study aimed at examining the hidden patterns of motorcycle crashes and riders’ injury severity at the national level in
Iran. Methods: Hierarchical clustering (HC) and latent class clustering (LCC) techniques were used in combination to analyze riders’ injury
pattern in 6638 motorcycle crashes occurred in Iran during 2009–2012. First, the HC was performed to classify the provinces into homogeneous
groups, based on the percentage of different crash factors in each province and a new variable called “province group” was added to the crash
database as the output of the HC analysis. Next, the LCC was conducted to cluster the crash data and to investigate the riders’ injury pattern
across the country. Results: Among the six crash clusters identified by the LCC, Clusters 1 and 5, in which, respectively, 91% and 84%, of the
riders were under 30 as well as Cluster 2, in which 65% of the riders were above 30 years had the highest percentages of injured motorcyclists
(86%, 84%, and 88%, respectively). Cluster 5 had also the lowest percentage of helmet usage (about 5%) and licensed riders (5%). Moreover,
Cluster 6 had the highest fatality rate among the six clusters. In this cluster, 73% of the crashes were occurred in nonresidential/agricultural
land uses, and 94% were occurred in rural areas. Conclusions: Since a significant share of crashes in Cluster 5 was occurred in province
Groups C and E; this might be regarded as an indication of weak law enforcement over helmet usage and licensure in these provinces. In
addition, as the pattern of helmet usage was different among province clusters, future studies might be conducted regarding motorcyclists’
helmet‑wearing intentions among several provinces. Moreover, crashes occurred in rural roads, particularly in the vicinity of nonresidential
or agricultural land uses were more severe and need special future attention.
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https://archtrauma.kaums.ac.ir/article_87792_c4646f2e558074f8eb7c65982e744aee.pdf
dx.doi.org/10.4103/atr.atr_38_17
A Very Rare Cause of Shoulder Weakness: Concurrent Traumatic Neuropathies of Accessory, Long Thoracicus, and Suprascapular Nerves
Halil
Onder
Department of Neurology, Hacettepe University Hospital, Ankara, Turkey
author
F. Gokcem
Yildiz
Department of Neurology, Hacettepe University Hospital, Ankara, Turkey
author
Gulay
Nurlu
Department of Neurology, Hacettepe University Hospital, Ankara, Turkey
author
Kubilay
Varli
Department of Neurology, Hacettepe University Hospital, Ankara, Turkey
author
text
article
2017
eng
Accessory nerve is one of the most sensitive cranial nerves to injury, and its injuries are usually caused by iatrogenic interventions. As many
other causes can mimic its clinical presentation, careful physical examination should be performed while evaluating a patient suspected of
accessory neuropathy. In this report, we aimed to illustrate a very rare case with concurrent traumatic cranial neuropathies of accessory nerve,
suprascapular nerve, and long thoracicus. A 16‑year‑old boy was admitted with complaints of shoulder weakness and pain following a trauma of
strain injury. He had first taken the misdiagnosis of brachial plexopathy; however, after a detailed physical examination and electrophysiological
study, the diagnosis of concurrent traumatic neuropathies of accessory, suprascapular, and long thoracicus nerves was made. In our opinion,
during evaluation of these rare traumatic neuropathies, detailed clinical evaluations combined with detailed electromyography investigations
may give crucial data for the proper diagnosis.
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https://archtrauma.kaums.ac.ir/article_87793_058e21124bb44d8cd41fe315d5cfb635.pdf
dx.doi.org/10.4103/atr.atr_61_17
Unique Case of Gossypiboma following Treatment of the Orbitozygomatic Complex Fracture
Saeed
Nezafati
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz
author
Seyed Ahmad
Arta
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz
author
Masoomeh
Amani
Department of Oral and Maxillofacial Surgery,
Faculty of Dentistry, Zanjan University of Medical Sciences, Zanjan, Iran
author
Farzin
Ahmadpour
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz
author
text
article
2017
eng
Transmaxillary approach to the orbital floor has been used successfully to treat the blowout fracture by antral packing to support the orbital floor.
However, antral packs are associated with a high incidence of infection and persistent oroantral fistula. A 30‑year‑old man with a history of the
orbitozygomatic complex fracture 8 years ago presented with a persistent facial wound on the right side of the cheek. The patient underwent
an exploratory surgery under general anesthesia, and the maxillary sinus was approached through the Caldwell‑Luc operation and a long
2‑m nasal tampon was found in the sinus. Foreign bodies including gossypibomas are rare, hard to diagnose, and mostly asymptomatic and
in chronic cases do not reveal specific radiological and clinical signs for differential diagnosis. Therefore, in the evaluation of the soft‑tissue
lesions in patients with a history of a prior operation, it is wise to consider foreign bodies in the differential diagnosis.
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https://archtrauma.kaums.ac.ir/article_87794_91e7b96999f901e394728583cb946cbb.pdf
dx.doi.org/10.4103/atr.atr_37_17
Different Aspects of Penile Amputation; Surgery, Forensics, and Psychiatry (Case Report and Short Review)
Hamid
Pakmanesh
Departments of Urology, Kerman University of Medical Sciences, Kerman, Iran
author
Rayka
Sharifian
Departments of Urology, Kerman University of Medical Sciences, Kerman, Iran
author
Mahmoodreza
Ashabyamin
Departments of Plastic Surgery, Kerman University of Medical Sciences, Kerman, Iran
author
text
article
2017
eng
Penile amputation (PA) is a rare genitourinary injury. Three main etiologies of PA consist of iatrogenic, accidental, and self‑mutilation.
Eighty‑seven percent of the self‑mutilated patients suffer from psychiatric disorders. Nowadays, microsurgical techniques with neurovascular
anastomosis are the best approach for PA. This paper insists on psychiatric and legal consequences, which may involve health‑care team.
A 25‑year‑old male patient presented to our emergency department with self‑inflicted PA. As he had a history of some psychiatric problems,
psychiatric consultation was requested. The patient did not accept any surgical interventions. We informed his relatives completely; however,
they did not agree with surgical intervention because they predicted that he might repeat amputation again. According to the forensic medicine
specialist consultation, we took the coroner’s warrant for emergency surgical intervention and transferred the patient to the operating room
without any consent. Microsurgical penile replantation was performed. There was no leakage in retrograde pericatheter urethrography on
the 3rd postoperative week, and the urethral catheter was removed. The patient was able to void normally, and cystostomy tube was removed
at the same time. Consent for all medical procedures is an important part of national and international human right law and medical ethics.
Physicians should inform patients about their problem and take a reliable consent. If the patient was unreliable for informed consent, relatives
could do it. However, in an emergency, there is an exception in the law that let surgeons do the operation without consent for these cases.
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https://archtrauma.kaums.ac.ir/article_87797_7e065e994feceb40cd792aba3022a8e1.pdf
dx.doi.org/10.4103/atr.atr_13_17
Tetanus after Trauma: Still Existed Problem in Tropical Country
Viroj
Wiwanitkit
Department of Tropical Medicine, Hainan Medical University, Haikou, China
author
text
article
2017
eng
Dear Editor,
An important concern on the management of trauma case
is the tetanus prevention. In the past, when tetanus toxoid,
is not easily available, the rate of posttraumatic tetanus was
very high. In tropical countries, the problem of tetanus is still
existed. Here, the author discusses and summarizes the problem
of tetanus after trauma in the local reports[1,2] in Thailand, a
tropical country in Asia. Based on database review (PubMed,
Scopus, and Thai Index Medicus) on case reports of tetanus
in Thailand in the past 15 years period (2001–2016), there are
at least 132 accumulated cases of posttraumatic tetanus. The
male‑to‑female ratio was 2:1. The mortality rate is 8.02%. In
all cases, the patients did not receive the tetanus toxoid.
Archives of Trauma Research
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https://archtrauma.kaums.ac.ir/article_87798_f97026acb9636087290582040c34983b.pdf
dx.doi.org/10.4103/atr.atr_59_17