| 1. |
- Djalali, Ahmadreza, et al.
(författare)
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A fundamental, national, medical disaster management plan : an education-based model
- 2009
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Ingår i: Prehospital and Disaster Medicine. - Stockholm : Karolinska Institutet, Dept of Clinical Science and Education, Södersjukhuset. - 1049-023X .- 1945-1938.
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Tidskriftsartikel (refereegranskat)abstract
- During disasters, especially earthquakes, health systems are expected to play an essential role in reducing mortality and morbidity. The most significant naturally occurring disaster in Iran is earthquakes; they have killed >180,000 people in the last 90 years. According to the current plan in 2007, the disaster management system of Iran is composed of three main work groups: (1) Prevention and risk management, (2) Education, and (3) Operation. This organizational separation has resulted in lack of necessary training programs for experts of specialized organizations, e.g., the Ministry of Health and Medical Education (MOHME). The National Board of MOHME arranged a training program in the field of medical disaster management. A qualified training team was chosen to conduct this program in each collaborating center, based on a predefined schedule. All collaborating centers were asked to recall 5–7 experts from each member university. Working in medical disaster management field for ≥2 years was an inclusion criterion. The training programs lasted three days, consisted of all relevant aspects of medical disaster management, and were conducted over a six-month period (November 2007–April 2008). Pretest and post-tests were used to examine the participants’ knowledge regarding disaster management; the mean score on the pre-test was 67.1 ±11.6 and 88.1 ±6.2, respectively. All participants were asked to hold the same training course for their organizations in order to enhance knowledge of related managers, stakeholders, and workers, and build capacity at the local and provincial levels. The next step was supposed to be developing a comprehensive medical disaster management plan in the entire country. Establishing nine disaster management regional collaborating centers in the health system of Iran has provided an appropriate base for related programs to be rapidly and easily accomplished throughout the country. This tree-shaped model is recommended as a cost-benefit and rapid approach for conducting training programs and developing a disaster management plan in the health system of a developing country.
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| 2. |
- Djalali, Ahmadreza, et al.
(författare)
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Facilitators and obstacles in pre-hospital medical response to earthquakes : a qualitative study
- 2011
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - Stockholm : Karolinska Institutet, Dept of Clinical Science, Intervention and Technology. - 1757-7241.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Earthquakes are renowned as being amongst the most dangerous and destructive types of natural disasters. Iran, a developing country in Asia, is prone to earthquakes and is ranked as one of the most vulnerable countries in the world in this respect. The medical response in disasters is accompanied by managerial, logistic, technical, and medical challenges being also the case in the Bam earthquake in Iran. Our objective was to explore the medical response to the Bam earthquake with specific emphasis on pre-hospital medical management during the first days. METHODS: The study was performed in 2008; an interview based qualitative study using content analysis. We conducted nineteen interviews with experts and managers responsible for responding to the Bam earthquake, including pre-hospital emergency medical services, the Red Crescent, and Universities of Medical Sciences. The selection of participants was determined by using a purposeful sampling method. Sample size was given by data saturation. RESULTS: The pre-hospital medical service was divided into three categories; triage, emergency medical care and transportation, each category in turn was identified into facilitators and obstacles. The obstacles identified were absence of a structured disaster plan, absence of standardized medical teams, and shortage of resources. The army and skilled medical volunteers were identified as facilitators. CONCLUSIONS: The most compelling, and at the same time amenable obstacle, was the lack of a disaster management plan. It was evident that implementing a comprehensive plan would not only save lives but decrease suffering and enable an effective praxis of the available resources at pre-hospital and hospital levels.
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| 3. |
- Djalali, Ahmadreza, et al.
(författare)
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Hospital disaster preparedness as measured by functional capacity : a comparison between Iran and Sweden
- 2013
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Ingår i: Prehospital and Disaster Medicine. - : Cambridge University Press. - 1049-023X .- 1945-1938. ; 28:5, s. 454-461
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Hospitals are expected to continue to provide medical care during disasters. However, they often fail to function under these circumstances. Vulnerability to disasters has been shown to be related to the socioeconomic level of a country. This study compares hospital preparedness, as measured by functional capacity, between Iran and Sweden.METHODS: Hospital affiliation and size, and type of hazards, were compared between Iran and Sweden. The functional capacity was evaluated and calculated using the Hospital Safety Index (HSI) from the World Health Organization. The level and value of each element was determined, in consensus, by a group of evaluators. The sum of the elements for each sub-module led to a total sum, in turn, categorizing the functional capacity into one of three categories: A) functional; B) at risk; or C) inadequate.RESULTS: The Swedish hospitals (n = 4) were all level A, while the Iranian hospitals (n = 5) were all categorized as level B, with respect to functional capacity. A lack of contingency plans and the availability of resources were weaknesses of hospital preparedness. There was no association between the level of hospital preparedness and hospital affiliation or size for either country.CONCLUSION: The results suggest that the level of hospital preparedness, as measured by functional capacity, is related to the socioeconomic level of the country. The challenge is therefore to enhance hospital preparedness in countries with a weaker economy, since all hospitals need to be prepared for a disaster. There is also room for improvement in more affluent countries.
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| 4. |
- Djalali, Ahmadreza, et al.
(författare)
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Hospital incident command system (HICS) performance in Iran : decision making during disasters
- 2012
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - Stockholm : Karolinska Institutet, Dept of Clinical Science and Education, Södersjukhuset. - 1757-7241.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Hospitals are cornerstones for health care in a community and must continue to function in the face of a disaster. The Hospital Incident Command System (HICS) is a method by which the hospital operates when an emergency is declared. Hospitals are often ill equipped to evaluate the strengths and vulnerabilities of their own management systems before the occurrence of an actual disaster. The main objective of this study was to measure the decision making performance according to HICS job actions sheets using tabletop exercises. Methods: This observational study was conducted between May 1st 2008 and August 31st 2009. Twenty three Iranian hospitals were included. A tabletop exercise was developed for each hospital which in turn was based on the highest probable risk. The job action sheets of the HICS were used as measurements of performance. Each indicator was considered as 1, 2 or 3 in accordance with the HICS. Fair performance was determined as < 40%; intermediate as 41-70%; high as 71-100% of the maximum score of 192. Descriptive statistics, T-test, and Univariate Analysis of Variance were used. Results: None of the participating hospitals had a hospital disaster management plan. The performance according to HICS was intermediate for 83% (n = 19) of the participating hospitals. No hospital had a high level of performance. The performance level for the individual sections was intermediate or fair, except for the logistic and finance sections which demonstrated a higher level of performance. The public hospitals had overall higher performances than university hospitals (P = 0.04). Conclusions: The decision making performance in the Iranian hospitals, as measured during table top exercises and using the indicators proposed by HICS was intermediate to poor. In addition, this study demonstrates that the HICS job action sheets can be used as a template for measuring the hospital response. Simulations can be used to assess preparedness, but the correlation with outcome remains to be studied.
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| 5. |
- Djalali, Ahmadreza, et al.
(författare)
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Identifying deficiencies in national and foreign medical team responses through expert opinion surveys: implications for education and training.
- 2014
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Ingår i: Prehospital and disaster medicine. - 1049-023X. ; 29:4, s. 364-8
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Tidskriftsartikel (refereegranskat)abstract
- Unacceptable practices in the delivery of international medical assistance are reported after every major international disaster; this raises concerns about the clinical competence and practice of some foreign medical teams (FMTs). The aim of this study is to explore and analyze the opinions of disaster management experts about potential deficiencies in the art and science of national and FMTs during disasters and the impact these opinions might have on competency-based education and training.
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| 6. |
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| 7. |
- Djalali, Ahmadreza, et al.
(författare)
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Nonstructural Safety of Hospitals for Disasters : A Comparison Between Two Capital Cities
- 2014
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Ingår i: Disaster Medicine and Public Health Preparedness. - : Cambridge University Press. - 1935-7893 .- 1938-744X. ; 8:2, s. 179-184
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Hospitals are expected to function as a safe environment during disasters, but many become unusable because of nonstructural damage. This study compares the nonstructural safety of hospitals to disasters in Tehran and Stockholm.METHODS: Hospital safety in Tehran and Stockholm was assessed between September 24, 2012, and April 5, 2013, with use of the nonstructural module of the hospital safety index from the World Health Organization. Hospital safety was categorized as safe, at risk, or inadequate.RESULTS: All 4 hospitals in Stockholm were classified as safe, while 2 hospitals in Tehran were at risk and 3 were safe. The mean nonstructural safety index was 90% ± 2.4 SD for the hospitals in Stockholm and 64% ± 17.4 SD for those in Tehran (P = .014).CONCLUSIONS: The level of hospital safety, with respect to disasters, was not related to local vulnerability. Future studies on hospital safety should assess other factors such as legal and financial issues. (Disaster Med Public Health Preparedness. 2014;0:1-6).
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| 8. |
- Djalali, Ahmadreza, et al.
(författare)
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The hospital incident command system: modified model for hospitals in iran.
- 2015
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Ingår i: PLoS currents. - : Public Library of Science (PLoS). - 2157-3999. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- Effectiveness of hospital management of disasters requires a well-defined and rehearsed system. The Hospital Incident Command System (HICS), as a standardized method for command and control, was established in Iranian hospitals, but it has performed fairly during disaster exercises. This paper describes the process for, and modifications to HICS undertaken to optimize disaster management in hospitals in Iran.
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| 9. |
- Khorram-Manesh, Amir, 1958, et al.
(författare)
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Education in Disaster Management and Emergencies: Defining a New European Course.
- 2015
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Ingår i: Disaster medicine and public health preparedness. - : Cambridge University Press (CUP). - 1938-744X .- 1935-7893. ; 9:3, s. 245-255
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Tidskriftsartikel (refereegranskat)abstract
- Unremitting natural disasters, deliberate threats, pandemics, and humanitarian suffering resulting from conflict situations necessitate swift and effective response paradigms. The European Union's (EU) increasing visibility as a disaster response enterprise suggests the need not only for financial contribution but also for instituting a coherent disaster response approach and management structure. The DITAC (Disaster Training Curriculum) project identified deficiencies in current responder training approaches and analyzed the characteristics and content required for a new, standardized European course in disaster management and emergencies.
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| 10. |
- Murphy, Jason
(författare)
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Disaster response and preparedness : Focus on hospital incident command groups and emergency department registered nurses
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: While disasters per definition are rare, incidents that cause mass casualties that threaten to overwhelm its limited resources are an ever-present risk. Disaster medicine is a specific discipline of medicine dedicated to providing adequate health care to patients of major incidents through the development of preventive-, preparedness-, response and recovery interventions. Emergency department registered nurses are among the first to receive, assess and treat patients of a major incident, highlighting the importance of their preparedness and disaster medicine competencies. However, when an incident threatens to overwhelm health care’s resources, a specific type of management group may be required to aid and guide hospital response. The hospital incident command group aids in hospital response through timely decision-making and allocation of resources. Despite these two groups being recognized as vital components of disaster response, little has been known concerning the disaster preparedness of these two groups. emergency department registered nurses’ disaster preparedness. The overall aim of the thesis was to assess disaster medicine preparedness in Stockholm, Sweden through the evaluation of hospital incident command groups and emergency department registered nurses.The aim of study I was to identify the essential disaster nursing competencies. Sixty-nine specific disaster medicine competencies were identified through a modified Delphi method in which experts within the field of emergency- or disaster medicine reached consensus concerning necessary disaster medicine competencies for emergency department registered nurses.The aim of study II was to assess emergency department registered nurses’ self-perceived disaster preparedness using the results in study one as the basis of a questionnaire. A cross- sectional method was used to assess the preparedness of nurses in the study setting. The results of this study indicate that emergency department registered nurses may be less than competent and overestimate their preparedness.The aim of study III was to assess hospital incident command groups’ preparedness. This was done through an observational study in which measurable indicators were used to evaluate hospital incident command groups during simulations. The results in this study indicate that proactive decision-making correlates with overall command group response. Shortly after the simulations in study III, an antagonistic incident occurred in Stockholm, Sweden. This provided a unique opportunity to compare planned preparedness with actual preparedness. through exploration of disaster preparedness coordinators' experiences of hospital response during a major incident.Thus, the aim of study IV was to explore registered nurses’ experiences as disaster preparedness coordinators (DPC) of hospital incident command groups during an MI. This was done through one focus group discussion with six disaster preparedness coordinators and six follow-up interviews with the same coordinators were conducted. Data were analyzed using inductive content analysis. One main category, Expectations, prior experiences, and uncertainty affect HICG response during a major incident and three categories. Gaining situational awareness, transitioning to management, and actions taken during uncertainty were identified.The thesis concludes that disaster medicine preparedness in the study setting may be adequate but that response may be dependent upon several factors including the type and timing of the incident, frequency and type of training, education, experience, and the ability to reduce uncertainty in order to make timely and relevant decisions.
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