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Introduction: Iran is a disaster-prone country and it can be considered as one of the most vulnerable countries for disasters in the world. Hospitals play an important role in disasters. This paper aims to study the preparedness of public and private hospitals in Shiraz dealing with disasters; to investigate and to identify problems and issues comparing current status with standards.
Methods: In this cross-sectional study, 15 public and private hospitals were evaluated in Shiraz in 2010. The data was collected by using observation, interview and also a checklist including 10 fields and 220 questions. Then the collected data were analyzed by using SPSS.
Findings: Totally, the results are as follows: the average disaster preparedness in the mentioned hospitals was 62/3%; evacuation , transport , traffic, communication and security fields were in the middle level; and emergency services, reception, training, logestics, human resources, commanding and management were in a good average level.
Conclusion: Despite having an adequate preparation in the studied hospitals in Shiraz, appropriate measures should be taken to improve some fields such as evacuation, transport, traffic, communication, and security.

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Background: One of the important tasks of medical centers is to provide emergency services to the injured during an earthquake. Therefore, these medical centers always should be prepared to deal with such circumstances. Non-structural elements are the important components of medical centers that should be considered. In this study, qualitative and quantitative performance of equipment and non- structural vulnerability of seven public hospitals in Tehran city have been evaluated during an earthquake.
Methods: In this cross-sectional research, all public hospitals in Tehran city were studied including governmental or public, private, military and also social security. Using WHO / PAHO Standard Checklist, seven public hospitals were selected and evaluated by convenience sampling method in eleven sections.
Findings: According to the results, the lowest functional level was observed in emergency exit systems, communication systems, furniture and equipment. The studied hospitals were at a satisfactory level in heating and cooling systems, ventilation systems of care units, fire detection and extinguisher. Although 56% of the mentioned hospitals were at a satisfactory level in overall assessment of performance in non-structural features, the critical, vital and effective sections of the hospitals were functioning at an average and some in even low levels of safety.
Conclusion: Totally, the hospitals lacked a proper preparation in disaster in non-structural evaluation; furthermore, there was a standard instruction in non-structural immunization that hospitals should consider in preparation.

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Background: The patients' first encounter is usually with the prehospital emergency. In order to meet the clients and beneficiaries' needs, it is necessary the prehospital emergency nurses be a competent decision maker ba sed on the patients' unstable conditions.This study aims to examine the factors influencing on the manner of prehospital emergency nurses' decision making in emergencies and during the mission.
Methods: In this qualitative study, 18 nurses of prehospital emergency ba ses of Shahrekord University of medical sciences were studied. Data was collected by using semi-structured and in-depth interviews, and also it was used content analysis to analyze the qualitative data. The interviews were transcribed verbatim and analyzed concurrently with the data collection.
Findings: By analyzing the data, five main themes were known as the influencing factors in prehospital emergency nurses' decision making which are as follows: 1) patient-related factors; 2) nurse-related factors; 3) environmental factors; 4) colleagues related factors; 5) the factors related with the type of event and mission.
Conclusions: The findings provide a deep understanding of the effective factors in prehospital emergency nurses' decision making. Deep understanding of the manner of prehospital emergency nurses' decision making can facilitate more effective decisions in emergencies, during the mission as well as its related factors and also influence on the output of nursing and medical cares.

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Background: Iran is the fourth disaster prone country in Asia and tenth in the world. It constantly exposed to natural and manmade disasters and terrorist attacks. The paper is going to develop a crisis management plan for Shohada hospital.
Methods: In this study, firstly crisis management programs in America and Europe are amended and compiled. Then, by providing aerial maps and positioning of units' establishment, the involved officials will provide necessary training and functional exercises in order to examine the lessons learned when the hospital is intact or has been destroyed
Findings: Regarding the pre-designed organization chart training immediately after disaster, the program should be planned and hospital crisis committee comprising various units of the hospital should be established and a responsible associated with three successors considered for each unit. The operation should be started following the issuance of Chief of Staff to the hospital president and to the authorities of the units. Then, the authorities should recall their personnel, accomplish the predetermined tasks and also should end the operation by top officials command.
Conclusion: The results indicated that the hospital crisis management programs should be compiled ba sed on available facilities and equipment regarding the natural disasters around the world, failure of managers responsible for controlling crises such as Taiwan earthquake, and lack of adequate facilities to deal with nuclear and chemistry crises in America. At the end, the strength and weak points should be examined by providing the necessity training and performing as maneuver for the involved authorities in the hospital.

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Introduction: Earthquake is the most destructive disaster among all nature disasters due to its unpredictability. Tehran, with a population of 7/8 million people, has high seismic potential with many active faults. Hospitals are one of the most effective land uses in decreasing damages caused by earthquake. Hospitals have so many problems with their locations. Inappropriate locations reduce the efficiency of the hospitals in critical conditions. The studies conducted in hospitals about earthquake situations were not comprehensive up to now and each of them investigates the hospitals from one point. So in this research, the indexes for assessing the hospitals were codified comprehensively and then they were integrated with each other. At the end, the results were compared with the current status of hospitals; the situations of each hospital were specified to cope with earthquake.
Methods: In this desc riptive and analytical study, data was collected by library and collection of archives and documents. Data was analyzed by Analysis Hierarchical Process (AHP) to weight the criteria using GIS and Spatial Analysis extension for combination of criteria.
Findings: According to the results, the most adequate places for Tehran hospitals are adjacent, accessibility and spatial points in normal and crisis situations ba sed on the mentioned zones.
Conclusion: The results show that more than half of Tehran hospitals has placed in inappropriate zones. If hospitals don’t become resistance, they cannot play their vital role in critical conditions. So, the hospitals must be equipped regarding their problems in adjacent or accessibility or location.

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Background: The ability of hospitals continues to function without interruption in disaster situations is a matter of life and death. The Hospital Safety Index provides an overview of the probability of a hospital or health facility remaining operational in emergency situations. This study was done in order to assess the safety of one of the referral hospitals related to social security organization in disasters.
Methods: In this applied study, a referral hospital in Tehran city was studied ba sed on structural, nonstructural and functional factors by using WHO/PAHO standard checklist.
Findings: According to the results, the final Safety Index score places this hospital into C category of three categories of safety. That it means the lives and safety of occupants of this hospital are deemed at risk during disasters.
Conclusion: The Hospital Safety Index helps authorities to quickly determine where interventions can improve safety. The safety index is not only a tool for making technical assessments, but it provides a new approach to disaster prevention and mitigation for the health sector. Calculating the safety score allows hospital to establish maintenance and monitoring routines and look at actions to improve safety in the medium term. This quick overview will give decision makers a starting point for establishing priorities and reducing risk and vulnerability in healthcare facilities.

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Introduction: Prehospital Emergency Medical System is one of the critical parts in health care sector which has been usually unnoticed. Delivering quick, efficient, and high quality care in this system has a large impact on mortality and morbidity of patients.
Methods: In this descriptive and cross-sectional study, 20662 cases in 4 months in the middle of the year 2008. Missions over 8 minutes from when the time of call receiving to arrival on the scene were detected and survived, ANOVA software was used for analyzing.
Findings: Most of the missions were done between 8 to10 minutes. Nine reasons were detected for this arrival delay:1) destruction of the road, 2) traffic, 3) rainy weather , 4) long way to the scene, 5)scarcity of ambulance in the center near the scene, 6)wrong address, 7) cannot find the address, 8) delay in dispatching the ambulance, 10)delay in arrival because of technicians. In Shiraz Emergency Medical system the most important reasons for missions over 8 minutes were scarcity of ambulance in the center near the scene, traffic, long way to the scene.
Conclusion: Quick arrival on the scene has a large effect on patients, though, health ministry and emergency centers should pay more attention on this sector and deliver financial support for equipped emergency centers due to the population and demand for emergency centers.

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Introduction: Burns prevalence in the world is about one person at every 17 seconds and approximately 6 million people in a year. Therefore, from the pre-hospital emergency care viewpoint, paramedics, ambulance staff, nurses etc. are the first groups that help burned patients before hospital cares. According to the previous studies, there is a lack of pre-hospital care instructions and guidelines for the pre-hospital care services; unfortunately, this can causes anxiety and reduction of appropriate care. This paper aims to evaluate the way of pre-hospital care for burned patients in Iran in comparison with other countries.
Methods: In this systematic review, from the 676 obtained articles, 102 ones were relevant to the subject and finally 91 articles were selected and studied by using international databases and Persian resources.
Findings: The results indicated that there is not the same instruction for pre-hospital care of burned patients not only in different countries but also in Iran. Therefore, it is necessary to establish a standard model for the pre-hospital procedures.
Conclusions: The researchers decided to study this model as a PhD dissertation due to the limited knowledge in field of pre-hospital care of burns and lack of exact definition of burn phenomena.

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Introduction: Prehospital emergency is an important part of the health care system. The prerequisite for providing appropriate services in this sector is existence the necessary equipment, particularly equipped ambulances which to play plays an important role in Save the life of patients who need emergency measures. Given the high incidence of traffic accidents and other emergencies, this study was concluded to investigate the current status of medical equipment of ambulances of emergency medical services in Rasht and were compared with Iranian standards.
Methods: This study is a descriptive-analytical and functional study that was performed in Rasht in 2013. The samples consisted of 13 active ambulances of emergency medical services. Data collection tools were included the standard medical examination card checklist of B type ambulances of Ministry of Health and Checklist of 4374 of rescue vehicles and equipment of the National Iranian Standard Organization. The checklists has been completed by observation of the medical equipment all emergency medical services ambulances by researchers. Data were analyzed using descriptive and inferential statistics appropriate.
Findings: The overall, average medical equipment of EMS ambulances in Rasht, according stands of MOH (Ministry of Health) & Iran Standard National organization, was 66.5 and 64.8%, respectively that had significant difference with standards (p<0.05). Also, the average equipment according to the two standards, in the diagnosis group was 80 and 82.4%, equipment of respiration/ventilation, 97%, injection/drugs: 73 and 58.4%, equipment of treatment-critical management 65.3 and 55.7%, nursing care/ bandage 58.3 and 53.8%, respectively, that have significant difference with Iran defined standards in all cases (p<0.05). According to results and according the two standards, 84% of ambulances had all equipment related to airway/ventilation management.
Conclusion: The best condition of medical equipment of ambulances of emergency medical services was related to equipment of airway/ventilation management. There was a significant deficiency in other equipment groups. The deficiencies of medical equipment of ambulances will reduce the efficiency of emergency medical services, therefore, it seems reducing of the deficiencies, and achieving the national standards is essential.

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Introduction: Hospital Emergency preparedness in dealing with crises and disasters is essential for success in providing quality services. The aim of this study was to evaluate emergency preparedness in hospitals of Qazvin University of Medical Sciences in responding to crisis.
Methods: In this cross - sectional research, six hospital emergencies of Qazvin University of medical sciences were studied in 2013. Data was collected by hospital emergency response checklists with 90 questions in different areas (such as command and control, communication, safety and security, triage, surge capacity, continuity of essential services, human resources, management of materials and inventory area, post-disaster recovery) which has been developed by WHO through observation and interview.
Data analysis was performed using central indexes; also, tables and graphs were used to describe the results.
Findings: According to the findings, the maximum and minimum level of preparedness against disasters were in command and control area (80/83%) and management of materials and inventory area (57%) respectively. Generally, the level of emergency preparedness of hospitals to deal with disasters evaluated about 70/72%.
Conclusion: Regarding the history of disasters in the studied province and appropriate preparedness of the hospitals, it will be effective to estimate essential sources and medicines, equipment maintenance, rapid preparation of materials and strengthening the hospital buildings in order to enhance the preparation of the hospitals.

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Background: Disaster preparedness and management in hospitals are attractive topics for researchers. According to the studies, this research was performed in order to collect and compare the published studies about preparation in all hospitals dealing with disaster in the country.
Methods: In this review study, data and information was searched and collected the keywords consist of "hospital disaster readiness", "hospital disaster", "disaster management system" in databa ses such as Iranmedex, SID, Magiran and also PubMed and Google scholar. Quality assessment of papers was evaluated and result was compared and analyzed finally.
Finding: A total of 32 articles were found; 21relevant articles were analyzed.
Conclusion: In most studies, hospital preparation to deal with the crisis was moderate. Therefore, planning is important in order to Implement the crisis management program for hospitals and improve their preparedness in the country.

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Introduction: Tehran, Iran, has many old urban districts. Thus, it seems that in the event of an incident, pre-hospital care will face obstacles and problems in Tehran. District 11 of Tehran municipality was considered for this research due to the specific characteristics of its old texture and the research experience of the authors. The aim of the present study was to identify and analyze strategic problems and provide suggestions for resolving these problems.
Methods: In this study, strategic strengths, weaknesses, opportunities, and threats (SWOT) analysis was used. The data gathering tool was a questionnaire and its validity and reliability were confirmed by experts and through calculating Cronbach's alpha coefficient (α = 0.8), respectively. The statistical population of the study consisted of all rescue workers of the fire department and residents of district 11 of Tehran. According to the 2011 census, the total population of district 11 of Tehran municipality was 288884. The study sample size was 120 individuals. The study subjects consisted of 30 rescue workers selected with the introduction of the regional fire department experts and 90 ordinary individuals and workers randomly selected from among the residents of District 11. In this study, after completing the questionnaire, the SWOT model was used to evaluate and analyze the data.
Findings: By combining the four factors in the production of strategies of WO, WT, SO, and ST, they were ranked as SO strategy with mean of 3.65 in the first place, ST strategy with mean of 2.74 in the second place, WO strategy with mean of 1.81 in the third place, and WT strategy with mean of 2.72 in the fourth place. The acceptable strategy in this region, given that it is located in the first quarter of the outer and inner matrix, was aggressive strategy. The findings showed that in the framework of this strategy, strengths can be used to exploit external opportunities.
Conclusion: Erosion and compactness, inappropriate roads, ruined residential areas, excavation sites, erosion of energy corridors, high traffic load, the mounted and dismounted capacity at the entrance were the main weaknesses of the region. On the other hand, historical background, social structure, geographical location, proximity to downtown, history and historical identity, and strong neighborhood relationships were the most important strengths of the region. The dominant strategy of organizing district 11 was aggressive SO type and favorable opportunities and conditions can be used to eliminate external threats.

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Introduction: Hospitals as the strong part in providing health services to people considered the first referral place for health care in crises; so locating hospitals in a wrong place leads to both irrecoverable financial losses and human casualties. However, due to the significance of these applications in crisis, the importance of paying attention to the proper principles and criteria become more and more based on passive defense approach in locating and designing them. This study aims to determine the importance items in the locations of hospitals with the passive defense approach.
Method: In this review study, the library method and internet searching from databases and specialized journals related to passive defense and locating of hospitals and etc. have been used.
Findings: According to the results, hospitals location should be secure and far from incompatible uses. The most significant cases in locating hospitals with a passive defense approach are as follows: safety of hospital location (avoiding of hazardous centers); access to high-speed routes and subway, proximity to densely populated areas, city scattering, proximity to green and open spaces and firefighting centers and away from faults and rivers.
Conclusion: The results show that an appropriate location is one of the most important factors in success of a healthcare center. Thus, in order to respond affected people in times of crisis, the hospital location should be chosen so as to minimize damages during natural and man-made disasters and to expand it and also affected people should have easy access.

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Introduction: Hospitals are valuable assets and represent welfare and health of communities as well. Destruction or damage to hospital caused by fire may result in a loss of trust in local authorities and injury to patients and staff that causes health services is not provided correctly. This study aimed to assess both the fire risk assessment quantitatively and the effect of trained crisis management team on fire risk.
Method: In this descriptive analytical study, fire risk was calculated for the 15 wards of Hazrat Rasoul-e Akram hospital of Fereydunshahr through fire risk assessment method for engineers (FRAME) firstly. Then, crisis management team was formed and trained; in the following, the effects of fire risk were calculated. Data analyzed by SPSS-20 at a significant level of P <0.05 with Wilcoxon test.
Findings: According to the results, the building fire risk and their contents was on average (mean=0/57, SD=0/51), the risk of fire for individuals was (mean=4/60, SD=2/37) and the risk of fire for activities was (mean=1/81, SD=1/56); Given the unacceptable extent in the FRAME method, the risk of fire for activities and individuals were in an undesirable range.  In addition, a trained crisis management team reduced the fire risk level by an average of 31.4%. The effect of crisis management team was significant in reducing the risk of fire. (P<0.05)
Conclusion: Due to the unfavorable conditions of fire safety in the mentioned hospital, fire risk can be reduced greatly by organizing the crisis management team at the hospital.
 

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Introduction: Prehospital care plays an important role in emergency patients’ management. More correct, proper, and faster management of the patients will reduce the mortality and morbidity.
Methods: In this cross-sectional and descriptive-analytical research, all five EMS stations of Shahrekord city were studied in 2016. Data were collected from staff and equipment in Shahrekord EMS stations by using checklists. In addition, about 742 recorded mission reports of central station studies. The status of manpower, equipment status and response time compared with the standards & regulations of Ministry of Health, the standards provided by Institute of Standards & Industrial Research of Iran, reference standards of Iran and North America respectively using excel software and descriptive statistics (percent, cumulative distribution, and standard deviation).
Findings: The results of the study in Shahrekord EMS system are as follows: none of the stations has enough human resources; none of the emergency ambulances was equipped with the necessary equipment; the greatest shortage is related to critical-therapeutic management equipment that only 57.4% of the ambulances used this equipment. The best condition was that about 95.9% of ambulances have respiratory ventilation equipment. Another point was that 81.5% of the requests were answered in less than 6 minutes.
Conclusion: The results indicated that response time is a very important factor in reducing the incidence of illnesses and emergencies, but shortcomings in manpower and ambulance equipment can reduce the effectiveness of missions. Therefore, eliminating the shortage of manpower and equipment seems necessary.