طب انتظامی (Jan 2022)
A Review of Studies Conducted to Evaluate the Preparedness of Medical Centers Against the Potential Risks of Natural Disasters in Iran
Abstract
INTRODUCTION ... [1, 2]. Iran is one of the 10 most prosperous countries in the world due to its extent, geographical location, and climatic diversity [3]. In 2015, the Islamic Republic of Iran ranked ninth in the world in terms of the number of deaths due to disasters with 319,000 deaths, most of which were due to earthquakes and floods [4]. ... [5, 6]. In the event of an unexpected disaster, hospitals are considered to be the most important centers for victims of accidents [1] and their effective and timely medical care services can play a vital and decisive role in reducing mortality and rescuing victims [7]. Although the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has set specific standards for the preparation of hospitals, unfortunately, many hospitals do not follow these standards [6]. ... [8, 9]. In a review study conducted by Bazyar et al. in 2020, the results showed that the readiness of Iranian hospitals is 53%, which is at the average level [10]. Also, the results of a study in Iran show that the low level of disaster readiness in hospitals in the western and southern regions of the country is more noticeable [11]. AIM(S) The purpose of this study was to review the readiness of medical centers against the potential risks of natural disasters in Iran RESEARCH TYPE The present study is a review study. RESEARCH SOCIETY, PLACE AND TIME All articles resulting from studies conducted in Iran, using the checklist of ten domains of Hojjat et al. [12] and reporting the readiness of hospitals were reviewed. SAMPLING METHOD AND NUMBER Four databases including Google Scholar, PubMed, Scopus, and Web of Science, and four Iranian databases including SID, Magiran, Civil, and Irandoc were examined. Keywords such as hospital, disaster, earthquake, flood, readiness, natural disaster, Iran, were used to access the resources. The resources list (Reference of Reference) of the articles was also reviewed to identify other related studies. Published sources in Persian and English were studied and the study period was limited from 2008 to 2019. USED DEVICES & MATERIALS The quality of the articles was evaluated based on the STROBE checklist and the poor quality articles (including one article) were removed from the study and other studies entered the content analysis level. The most important difference between the present study and other review studies conducted in Iran (concerning the readiness of hospitals against potential disaster risks) is that only studies were reviewed that used a common checklist of the Hojjat et al. in this questionnaire, the readiness status based on the obtained percentage is respectively 0-19 very poor readiness, 20-39 poor, 59-40 moderate, 60-79 good and 80-100 very good. FINDING BY TEXT Among 17 published articles, one article was excluded due to poor quality and finally, 16 articles were entered for final analysis. Among the studies selected for the final analysis, two studies were conducted throughout the country, two in Tehran, three in the west, three in the east, five in the south, and one in the northwest. In total, 118 hospitals were studied that 41 state hospitals, 17 military hospitals, 8 private hospitals, and three of them were social security hospitals. The type of possession of other hospitals (49 hospitals) was not mentioned in the studies (Table 1). The highest level of readiness was related to Kermanshah hospitals with 75% readiness and the lowest level was related to Bandar Abbas hospitals with 38.6% readiness (Table 2). In general, the readiness of the studied hospitals with a score of 52.18% was at an average level. The lowest level was related to the acceptance with a score of 37.98% and the highest level was related to the support with a score of 62.31% (Table 3). MAIN COMPARISON TO THE SIMILAR STUDIES Based on the findings, the level of general readiness of the studied hospitals against disasters was assessed at a moderate level (52.18%). In line with the results of the present study, the results of the study of Asefzadeh et al. (2016) have shown that the overall readiness of hospitals in all three dimensions of structural, non-structural, and functional is moderate [25]. The results of the study by Djajali et al. (2013) show that all Swedish hospitals are at a high level of readiness; while Iranian hospitals are at an average level [26]. ... [27]. According to the studies compared with the present study, it was found that hospitals in developed countries such as Sweden, England, Lithuania, and Luxembourg were more prepared than Iranian hospitals. The present study showed that the level of readiness of the studied hospitals was poor (37.98%) in terms of admission. The results of this study are consistent with the study of Bazyar et al. [10], which was performed on 36 studies with the research community of 181 hospitals in Iran. Also, the results of a review study conducted by Rezaei et al. (2018) to assess the readiness of 1,047 hospitals in 50 countries using the WHO guideline, show that hospital readiness for disasters in the area of triage is poor (16.28%) [28]. Therefore, hospital admissions in Iran, like many other countries, do not have the appropriate level of disaster readiness. In the study of Kazemzadeh et al., the readiness of emergency departments of 51 Iranian hospitals in the face of disasters has been assessed at a moderate to the high level, which is in line with the present study [29]. One of the reasons why the emergency department is more prepared than other departments may be related to the nature of the emergency department's work. ... [30]. LIMITATIONS In assessing the readiness of hospitals for emergencies, many variables are involved, including time, geographical conditions, type of accident, the hospital’s involvement in the crisis, and the number of clients, which make comparisons difficult. The research team also did not have information about the people who completed the checklists in the hospitals, and the views or tastes of different people may have influenced the scoring. SUGGESTIONS To identify weaknesses and strengthen all aspects related to hospital readiness, a disaster response maneuver should be held at least once a year under the supervision of the Ministry of Health. Maneuvering helps hospitals improve their capacity through practice. It is also suggested to use international standards such as WHO standards to improve the level of disaster readiness of Iranian hospitals and to accredit hospitals through international institutions. It is also recommended to conduct supplementary research on the most important problems of hospital admissions during disasters. The role of the military in all aspects of disasters, especially security, can complement the actions of hospitals. It is suggested that researchers study the coordination and interactions between hospitals and the military and examine the strengths and weaknesses, threats and opportunities of these interactions. CONCLUSIONS The readiness of Iranian hospitals is average. Also, the readiness of the studied hospitals was poor in terms of admission and moderate in terms of emergency, transfer and evacuation, traffic, communications, safety, human resources, as well as management and command. In terms of education and support, the level of readiness of the studied hospitals is good. ACKNOWLEDGMENTS This study was conducted with the support of the Deputy of Research and Technology of Lorestan University of Medical Sciences in the form of a research project number IR.LUMS.REC.1399.154. Thus, the mentioned deputy is appreciated and thanked. CONFLICT OF INTEREST The authors state that there is no conflict of interest in the present study. FUNDING SOURCES This study was conducted with the financial support of the Deputy of Research and Technology of Lorestan University of Medical Sciences.
Keywords
