Iranian Journal of Emergency Medicine

Introduction: The prevalence of acute myocardial infarction in urban communities is rapidly increasing and the need for timely and appropriate actions is felt. Pre-hospital emergency service can aid in providing a quick response to this problem. Therefore, the aim of this study was to investigate and compare outcomes between hospital visits via hospital emergency services (ambulance) and patients visiting the hospital on their own (private car) among those with myocardial infarction.

Methods: The present cross-sectional study was performed on patients diagnosed with myocardial infarction in two groups of those who called the emergency services and those who visited the hospital themselves, from March 2018 to September 2019, in Shahid Chamran Heart Training Medical Center in Isfahan. After recording patients' profile information, Chi-Square and independent T-test were used to compare the two methods of referring to the hospital.

Results: The records of 281 patients were reviewed. More than 80% of the patients were men. Among them, only 21 (7.5%) died, most of whom (17 patients) were in the group visiting using private cars (p = 0.002). In addition, the initial evaluation variables (p = 0.044), hypertension (p = 0.039), creatinine (p = 0.010) and systolic blood pressure (p = 0.031) were different between the two groups of presenting via ambulance and via private car.

Conclusion: The correlation between death outcome and type of hospital referral is a testament to the effectiveness of pre-hospital emergency services in preventing secondary adverse events. Based on this finding, it could be said that the type of transfer to the hospital and pre-hospital services provided for patients are impactful and important.

Introduction: The need for the training of emergency physicians was felt in the mid-20^th century in response to rising public expectations for access to quality and specialized medical care around the clock. This study was conducted with the aim of comparing the decision-making status of patients referring to Imam Reza Hospital’s Emergency Department in Birjand before and after the establishment of emergency medicine.

Methods: In this comparative study, 800 patients who were admitted to the emergency department of Imam Reza Hospital, Birjand, Iran, from March to September in 2011 (before the establishment of emergency medicine) and 2017 (after the establishment of emergency medicine) were compared regarding the status of decision-making. Patient information (including patient demographics, reason for referral, length of hospital stay, and time to assignment, discharge or referral) was collected from a paper file or the hospital information system (HIS). After collecting the data, they were entered in SPSS software version 16 and Mann-Whitney and Chi-square tests were used at a significance level of 0.05.

Results: Mean time to decision-making had reduced from 343.1 ± 222.73 minutes to 200.19 ± 174.33 minutes after the deployment of emergency medicine specialists (P<0.001). There was a significant difference between the frequency of discharge against medical advice, and decision-making regarding the patients in less than 6 hours and 12 hours between the two time periods (P<0.05). The number of patients who were referred to other medical centers and other wards was not significantly different between the two time periods (P>0.05).

Conclusion: The presence of emergency medicine specialists, as a successful model in the health system, led to an increase in speed, quality, and accuracy of providing services to patients admitted to the emergency department.

Introduction: Due to the high volume of trauma patients, the total amount of pelvic X-rays performed is very high, which both imposes a high cost on the health care system and society, and exposes patients to side effects of X-rays. Therefore, the aim of this study was to assess the accuracy of clinical pelvic examination findings in identification of trauma patients in need of a pelvic X-ray (PXR).

Methods: In this prospective cross-sectional study, all multiple-trauma patients referring to the emergency department of Ayatollah Kashani Hospital in Shahrekord during September 2020 who underwent PXR were included. Clinical examination findings were recorded for all patients and the accuracy of these findings in determination of the need for performing PXR was evaluated.

Results: 131 patients with a mean age of 34.18±22.96 years were studied (75.6% male). 124 people (94.6%) had normal PXR and 7 people (5.4%) had abnormal PXR.  The two groups were in the same condition in terms of age (p = 0.993), sex (p = 0.679), weight (p = 0.953), blood pressure (p = 0.848), heart rate per minute (p = 0.907), the number of breaths per minute (p = 0.996), the level of consciousness (p = 1.00) and the mechanism of trauma (p = 0.996). Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and finally, the accuracy of clinical pelvic examination of trauma patients in determining the need for simple pelvic x-rays were 100%, 79.03%, 98.82%, 100%, 4.77, 0, and 98.87%, respectively.

Conclusion: According to the results of the present study, if the patient met at least one of the eight clinical criteria, the diagnosis of pelvic fracture was considered, indicating that this general criterion could easily succeed in identifying all fractures with 100% sensitivity and unnecessary PXR could easily be avoided in more than 70% of these patients.

Introduction: Emergency department is one of the most important departments in a hospital, the performance of which has a great impact on the functionality of other departments and patient satisfaction. The aim of this study was to determine the effect of the emergency department length of stay (EDLOS) of critically ill patients on their hospital outcome.

Methods: In a descriptive-analytical study, 450 critically ill patients who referred to the emergency department of Sina and Imam Reza (AS) Hospitals affiliated to Tabriz University of Medical Sciences in the period between November 2019-September 2020 were enrolled. The EDLOS was registered based on the time taken to leave the emergency department. The patients were followed until their final discharge from hospital and their final outcome was recorded. Data were collected and analyzed using SPSS version 17. The final outcome of the patients was compared based on their EDLOS.

Results: In this study, 450 critically ill patients were included. The median of their EDLOS was 3 hours and their median duration of hospitalization was 6 days. Among the studied patients, 100 patients (22.22%) died. There was no statistically significant relationship between patients' mortality and EDLOS (P˂0.05).

Conclusion: Based on the results, there was no statistically significant relationship between EDLOS and hospital outcome of critically ill patients. Therefore, it can be concluded that either the time of discharge from the emergency department has been appropriate or the treatment measures required by critically ill patients have been provided in the emergency department with the same quality as special wards.

Introduction: The emergency department is one of the most important departments of educational and medical centers that despite the crowds of patients must provide immediate and vital services in the shortest possible time with high efficiency to different patients. Therefore, it is necessary to use the standard method in transmitting this information between emergency medicine assistants.

Methods: This research is a quasi-experimental interventional study that was conducted and completed by survey-analytical method during the years (1398-99) during three phases. In the first phase, information on the current status of the patient delivery process was collected among emergency medicine assistants. In the second phase, a workshop based on the I-PASS method was held. In the final phase, the process of patient delivery by I-PASS method was practically implemented and the obtained information was collected through a researcher-made questionnaire and analyzed using statistical methods.

Results: First, the average and qualitative value of all research variables are high and very high. Second, there is a significant relationship between I-PASS indicators and patient delivery process improvement indicators. In other words, there is a direct relationship between all I-PASS indicators and all indicators of patient delivery process improvement between emergency medical assistants Inter-Shift Handoffs. Third, the main purpose of the research has been met. Therefore, this study has an innovative and new aspect for the effectiveness of the I-PASS system.

Conclusion: The use of I-PASS system has a high impact on improving the patient delivery process between emergency medicine assistants Inter-Shift Handoffs in Imam Khomeini Educational and Medical Center of Mazandaran University of Medical Sciences. As this effect is in most cases, above 70%.

Introduction: Providing pre-hospital emergency services always puts employees at risk of infectious diseases and spreading the infection in the community. Observing the principles of infection control plays an important role in the continuity of the performance of these employees. The aim of this study was to assess the knowledge and performance of pre-hospital emergency staff in Shahrekord regarding the principles of infection control.

Methods: This cross-sectional analytical study was carried out on 100 of pre-hospital emergency staff working in emergency operations unit of Shahrekord city. Convenience sampling was used in this study. Data was collected using a reliable and valid questionnaire on knowledge and performance of the staff regarding standard precautions for infection control. Data were analyzed using SPSS software version 15.

Results: The mean age of the participants was 30.21±8.34 years. 30% of the participants had a history of needle stick. There was no significant relationship between knowledge and performance of the staff (p>0.05), but there was a significant relationship between their knowledge and level of education (p<0.05). The mean knowledge score of the participants regarding infection control standard precautions was at a low level (45.16±75.25) and the mean score of their performance was at a moderate level (51.48±41.97).

Conclusion: According to the results of the present study, it is necessary to plan for improving the awareness and performance of pre-hospital emergency personnel regarding observation of the principles of infection control by holding in-service training courses and preparing training packages.

Introduction: Intertrochanteric fractures, which are one type of hip fracture, have been considered as a major public health issue in many nations. This study was carried out with the aim of comparing the rate of fusion between patients with intertrochanteric fractures treated with short sliding and non-sliding Gamma nail implants.

Methods: This is a retrospective cross-sectional study performed in 2018 and 2019, and 47 patients with intertrochanteric fractures, who referred to Imam Hussein Hospital, and were treated using either sliding or non-sliding gamma nail implants were compared. The rates of bone fusion, fused union, and bone repairments were all assessed using radiography 1, 3, 7 and 12 months after the operation.

Results: In the current survey, 68.6% of cases were treated with non-sliding gamma nail implants, while 31.4% were treated with sliding gamma nail implants. The mean period of bone fusion was 4.5 months in patients with non-sliding gamma nail implants and 5.5 months in patients with sliding gamma nail implants. In patients treated with sliding gamma nail implants, treatment of 28.5% of patients failed, and in the group of patients treated with non-sliding gamma nail, treatment failure was reported in 12.5% of patients. In addition, mean postoperative Harris Hip Score (HHS) in the group treated with non-sliding gamma nail implants was significantly higher than the group treated with sliding gamma nail implants (P = 0.002).

Conclusion: Based on the findings of the present study, it seems that treatment with short non-sliding gamma nail implants is a better method compared to treatment with sliding gamma nail implants.

Introduction: Hospitals play an important role in crisis management in the society. Since the outbreak of Coronavirus Disease 2019 (COVID-19) in the world, hospital's readiness to continue providing medical care during the COVID-19 crisis has received much attention. The aim of the current study was to assess the readiness of the Emergency Department (ED) of Khatam Al-Anbia Hospital in Zahedan, Iran for facing COVID-19 crisis in 2020.

Methods: The present study was performed on all emergency personnel of Khatam Al-Anbia Hospital in Zahedan, 100 in number. The sampling method was random and to collect information, two questionnaires of psychological readiness to deal with COVID-19, and the questionnaire of epidemiological and clinical variables (COVID-19 coping rate) were used. Data were collected and analyzed using SPSS software version 26. Pearson test was used to find correlations between study variables. P-values <0.05 were considered significant.

Results: There was a significant positive correlation between all three psychological components of the Cognitive Readiness Questionnaire against Corona (behavioral, cognitive, and emotional dimensions) as well as its total score with the total score of the Epidemiological and Clinical Variables Questionnaire (COVID-19 coping rate).

Conclusion: Based on the results of the present study, psychological components have a significant correlation with the rate of coping with COVID-19 among hospital emergency personnel. It was also found that psychological readiness of the emergency treatment staff of Khatam Al-Anbia Hospital in Zahedan, in the face of COVID-19, was at an acceptable level. Considering the newness of COVID-19, the importance of recognizing the effective factors in combating this disease among the medical staff, and scarcity of studies in this regard, it is recommended to conduct further studies in other medical centers in the country.

Introduction: The growing prevalence of the new corona virus covid -19 has challenged the public health of the world and has led to a morbid fear of contracting it in different people. Damage to various organs of the body and organ damage due to infection with this virus have been reported in various studies. This study aimed to investigate the frequency of multi-organ injury in definitive patients with covid -19 hospitalized in teaching hospitals of Shahid Beheshti University of Medical Sciences.

Materials & Methods: A descriptive cross-sectional study on 600 patients with Covid-19 based on RT_PCR diagnostic test and findings of CT scan of lungs of patients referred to Shohada-e-Tajrish and Imam Hossein hospitals by Easy and accessible sample method. Data were collected by using a researcher-made checklist. To analyze the data, SPSS 26 software and descriptive-comparative statistical methods, Chi-square and independent T were used.

Results: The results showed that out of 600 patients participating in this study, 58.5% were male and 41.5% were female with a mean age of 60.26 ± 17.78 years. 24.2% of patients have multi-organ injury. There was no statistically significant relationship between gender and multi-organ injuries, while there was a statistically significant relationship between mean age, pathological findings of lung, intubation or non-intubation of patients and past medical history of patient with multi-organ injuries.

Conclusion: Multi-organ injuries are relatively common in patients with Covid-19 and are associated with age, past medical hisory, pathological findings in the lung and the degree of pulmonary involvement. Most organs involved in multi-organ injury include the lungs, liver, heart, kidneys and coagulation system.

Introduction: Low back pain is one of the most common diseases in different societies of the world. About 65% to 80% of people experience low back pain during their lifetime. Low back pain is the most common cause of chronic pain syndrome, which leads to limited activity in people younger than 45 years. This study was carried out on the patients referred to the emergency department of Peymanieh hospital in 2019. The study aimed to evaluate and compare the effects of pethidine, Ketorolac, and a combination of ketorolac-diazepam on patients with acute low back pain.

Methods:  In this double-blind, randomized clinical trial, 90 patients referred to the emergency department of Peymanieh Hospital in Jahrom due to acute low back pain were included in the study. Patients were randomly divided into three groups.  First group 50 mg of pethidine, Second group 30 mg ketorolac and 10 mg diazepam and Third group 30 mg of Ketorolac. Blood pressure, heart rate, arterial blood oxygen saturation, and pain of patients were measured and recorded before drug injection, immediately after drug injection, and then at 5, 10, 20, 60, and 90 minutes. Pain intensity was measured and analyzed by the visual analog scale (VAS). Data analysis was performed using SPSS software version 21 and using descriptive and inferential statistical tests.

Results: The results of the present study showed that the mean pain reduction in the pethidine group in 10 minutes (P = 0.006), 20 (P = 0.001), 60 (P = 0.001) and 90 minutes after injection (P = 0.001), respectively. Significance was greater than the ketorolac groups and the combination of ketorolac and diazepam.

Conclusion:  The present study results indicated that pethidine is more effective in reducing acute low back pain than ketorolac-diazepam and Ketorolac. The use of pethidine in these patients seems to be a suitable alternative to other drugs used for pain control in patients with acute low back pain referred to the emergency department.

Introduction: Trauma patients are the main emergency visitors in need of in-hospital transfer, who are exposed to a wide range of complications. This study was performed to evaluate intra-hospital transportation of trauma patients using a checklist.

Methods: This cross-sectional study was performed in AlGhadir Hospital, Abhar, Iran, from 2020 to 2021, on 216 adult trauma patients with triage levels 1, 2 and 3, who needed to be transferred to other wards or required transportation for undergoing diagnostic and therapeutic measures. Evaluations were made before, during, and after the transfer and the results and complications of transportation in these three stages were compared.

Results: In this study, 216 patients with an average age of 18.9 ± 70.3 years were examined. Most of the admitted patients were male (74.1%), with emergency referral (83.3%), and presented following an accident (68.1%). Most transportations were performed for diagnostic purposes (52.3%) and in those with triage level 2 (69.4%). The transfer quality score was calculated to be 93.99% before the transfer, 84.65% during the transfer, and 91.02% after the transfer. Complications were observed in 14.36% of transfers, which included hypotension or hypertension, drop in arterial oxygen pressure, and hypothermia. In addition, most errors had occurred during the transfer and were related to not using monitoring (18.1%), pulse oximetry (17.6%), and not checking peripheral vein line (13.9%). The errors that occurred during the pre-transfer phase included not using pulse oximetry, monitoring, and face mask (1.9%) and those occurring in the post-transfer phase were not controlling Foley and nasogastric catheters (0.5%).

Conclusion: The findings of the study showed that the incidence rate of complications is high, especially during transfer. This can be used in analyzing the causes of errors and planning to increase the safety level of patients. Identification and management of risk factors in the transportation process ensures the safety of patients.

Introduction: The occurrence of various crises in Iran is undeniable and hospitals are among the organizations that are directly affected by these crises. This study was performed with the aim of evaluating the level of information of the staff of Imam Khomeini Hospital in Jiroft and to assess their readiness in the event of a crisis in 2020.

Methods: This was a cross-sectional descriptive study. Census method was used for sampling and all of the personnel working in the Emergency Department of Imam Khomeini Hospital  in Jiroft were included in the study. Data were collected using a valid and reliable researcher-made questionnaire of "Disaster Preparedness", which has 3 parts. Data were collected, coded, and entered to SPSS software, and then analyzed using descriptive and analytical statistical tests.

Results: 63 of the personnel of Imam Khomeini Hospital in Jiroft were included in the study. The mean age of the personnel of Imam Khomeini Hospital was 47.3±2.07 years. Minimum age of the participants was 22 year and the maximum was 59 years. Most of the personnel participating in this study were female (41 people, 65.1%). Most of the personnel had a Bachelor’s degree. No statistically significant correlation was observed between the level of awareness of personnel and age, gender, level of education, or job experience of personnel (P_value>0.05). There was a statistically significant correlation  between the level of awareness of personnel and participation in crisis management training courses (P_value = 0.002). There was a statistically significant correlation  between the level of readiness and participation in crisis maneuvers (P_Value = 0.04).  A statistically significant correlation was observed between the level of awareness and membership in Crisis Committee (P_Value = 0.05). There was a statistically significant correlation between the level of awareness and readiness with sending the enactments of the Crisis Committee to the departments (P_Value = ???).

Conclusion: Since it is very important to raise the awareness of the staff working in healthcare centers on managing crises that occur unexpectedly, it is necessary to continue and expand the activities of the Crisis Committee and to provide more accurate training and information in this regard.

Introduction: Silent myocardial ischemia is defined as the presence of objective evidence of cardiac ischemia in the absence of chest discomfort or one of the symptoms equivalent to angina. The aim of this study was to evaluate the electrocardiography (ECG) findings related to cardiac ischemia in non-cardiac patients with suspected silent myocardial ischemia referring to the emergency department.

Methods: This retrospective cross-sectional study (March 2018-March 2019) was conducted on adult patients with non-cardiac complaints referring to the Emergency Department of Shiraz Namazi Hospital, southern Iran, with triage levels 1 and 2, who were suspected to have silent myocardial ischemia, and underwent ECG and two troponin tests after admission. Patients with trauma, triage levels 3-5, those with typical chest pain, and patients with diagnosis of ST-Elevation Myocardial Infarction (STEMI) were excluded from the survey. Demographic data, the results of two troponin tests, and cardiac ischemia-related findings on ECG, including ST depression and T inversion, were evaluated. Then, the data were statistically analyzed using SPSS version 16 and descriptive and analytical statistical tests.

Results: Overall, 180 patients were enrolled. The mean (± standard deviation) of patients’ age was 69.3±15.01 years. 92 patients (51.1%) were male. ST depression and T inversion were found in ECG of 90 (50.0%) and 88 (48.9%) patients, respectively. ST depression and/or T inversion was observed in 168 (93.3%) patients. There was no statistically significant relationship between mean age, gender, and cause of referral with ST depression or T inversion. Two positive troponin test results were observed in 23 (12.8%) and both tests were negative in 59.4% of patients. There was no statistically significant relationship between having at least one positive troponin test and having ST depression or T inversion findings (P-value=0.56 and P-value=0.90, respectively).

Conclusion: ST depression and T inversion were present in ECG of half of the patients. Two positive troponin and both negative tests were observed in 23 (12.8%) and 59.4% of patients, respectively. This finding indicates that the matching of ECG findings and multistage troponin test is great important in the final diagnosis of cardiac ischemia, however, ECG changes in patients with non-cardiac complaints do not necessarily is indicated the myocardial infarction.

Introduction: The rise of medical errors has become a public concern among health policymakers. Due to the importance of knowing the causes of medical errors and preventing their continuation, especially in the emergency department, so this study was conducted to investigate the frequency of negligence of emergency medicine specialists referred to forensic medicine in Fars province from 2012 to 2019.

Methods: The present study was a descriptive study based secondary data analysis. The study population included all negligence referred to the office of the Medical Commission of the General Directorate of Forensic Medicine of Fars Province with the subject of complaints from emergency medicine specialists during the years 2012 to 2020. The method of data collection is based on a questionnaire and the use of information in the files of the Medical Commission of the General Directorate of Forensic Medicine of Fars Province. Data collection form including patient's age, patient's education, patient's occupation, underlying illness, causes of negligence, type of treatment center, cause and motive of complaint, type of service provided, how to obtain information about negligence, location of injury, type of injury and amount of injury is. Data analysis was performed using SPSS software version 21 and descriptive Statistics.

Results: Out of 92 cases, 91 were male physicians (98.9%) and 1 was a female physician (1.1%). The highest frequency of voting was in 1398 with 40 votes (43.5%) and in 1397 with 28 votes (30.4%). 54 (58.7%) of the complainants died and 19 (20.7%) had disabilities. Also, the number of complainants was improving 11 (0.12%) and improved 6 (6.5%). Of the 92 cases reviewed, 77 (83.7%) were finally acquitted and 15 (16.3%) were convicted. The highest frequency of confirmed negligence was negligence negligence 9 (9.8%) and negligence 2 (2.2%).

Conclusion: The results of this study indicated that the most common cause of medical malpractice in emergency medicine specialists is negligence. Therefore, it is suggested to reduce this type of negligence by holding training workshops for emergency medicine specialists.

Introduction: Job-related stresses and their causes are among the most important issues in psychology and psychiatry and have attracted the attention of many researchers. Meanwhile, the health of treatment staff is one of the most critical fields because of the nature of their work. Currently, due to the outbreak of a type of coronavirus, mental health of treatment staff, as a high-risk group, requires more attention than before. The purpose of this study is to assess the level of stress, anxiety and depression among medical staff when faced with the crisis of coronavirus pandemic.

Methods: This cross-sectional study was performed in April 2020 in order to measure stress, anxiety, and depression among 106 treatment staff members of Dr. Gharazi and Imam Hossein Hospitals in Malayer city at the time of the COVID-19 pandemic. Data collection tool was a standardized 21-item Depression Anxiety Stress Scales (DASS) questionnaire for evaluation of stress, anxiety, and depression.

Results: The study population consisted of 106 medical staff members, 0.9% of which were subspecialty physicians, 8.5% were specialist physicians, 4.7% were professional physicians, and 80.2% were nurses. The findings showed that, 26.4% of the treatment staff had very severe stress, 80.2% of them had very severe anxiety, while 43.4% had very severe depression. By examining the relationship between individual characteristics and the parameters of stress, anxiety and depression, and considering the significance of relationships, there was no significant relationship between individual characteristics and the mentioned disorders.

Conclusions: According to the findings of the present study, the prevalence of stress, anxiety, and depression among the treatment staff during the COVID-19 pandemic was very high. This result shows the importance of timely psychological policy-making and interventions to promote the mental health of the staff in crises. Through using preventive strategies, it is possible to reduce the occurrence of psychological problems among medical staff and take steps to maintain and improve the quality of their mental health and their professional ability.

Introduction: Pelvic fracture is the second most common cause of death in patients with multiple trauma, after head trauma. The present study was performed with the aim of determining the frequency of genitourinary tract injuries in patients with pelvic fractures referring to Poursina Hospital, Rasht, Iran, so that the initial steps required for treating patients (with pelvic fractures) in the emergency department can be specified.

Methods: In this retrospective study, the records of 170 patients with pelvic fractures, who referred to Poursina Hospital in Rasht from the beginning of January 2018 until the beginning of January 2019 were reviewed. Using the prepared checklist and based on the patient's clinical examination by the resident, information including age, sex, level of education, presence or absence of hematuria, type of trauma, and type of pelvic fracture were collected. Data were analyzed using STATA - Se v 13.1 software.

Results: Out of the 170 patients referring to the hospital due to pelvic fracture, 70% were male. The patients’ mean age was 45.02 ± 20.10 years and their mean length of hospital stay was 8.11 ± 7.13 days. Motor vehicle accidents were the most important cause of pelvic fractures and urethral injury. Fifty-five patients (33.4%) with pelvic fractures had a genitourinary tract injury. Hematuria was present in 48 of them, and blood at the tip of the meatus and perineal hematoma were symptoms that were significantly associated with genitourinary tract injury following pelvic fracture.

Conclusion: Considering the relatively high prevalence of genitourinary tract injury in pelvic trauma, it is best to perform a complete examination in all patients who present with high-energy trauma, especially in people with pelvic fractures; and if any of the above-mentioned symptoms are observed, genitourinary tract injuries should be suspected and the location of the injury should be further investigated and treated.

Introduction: Organophosphate poisoning is among the most common types of poisoning. Rapid diagnosis and initiation of treatment for this poisoning can significantly affect the treatment outcome. The definitive method of diagnosis for this poisoning is measuring blood choline esterase level, which requires a lot of time and is not appropriate for timely treatment in the emergency department. Atropine challenge test is one of the tests commonly used in emergency settings. The aim of this study was to assess the effectiveness of this test in diagnosis of organophosphate poisoning.

Methods: This cross-sectional study was performed by evaluating the results of atropine challenge test recorded in the medical profiles of 91 patients with suspected organophosphate poisoning, presenting to the poisoning center of Loghmane Hakim Hospital throughout 2018, and comparing the results with those of their serum acetylcholinesterase levels as the gold standard.

Results: Out of the 420 patients presenting to the hospital with organophosphate poisoning throughout 2018, there were 108 patients who had symptoms, for 91 of which atropine challenge test was performed. After comparing the results with the results of the standard test, the sensitivity of atropine challenge test was calculated to be 68.8\% and its specificity was 82.6\%. The test had 26.9\% false negative, 20.5\% false positive, positive predictive value of 79.48, negative predictive value of 73.07\%, positive likelihood ratio of 3.95, and negative likelihood ratio of 0.37.

Conclusion: Considering the high prevalence of poisoning with organophosphates in developing countries and the significant effect of rapid diagnosis and treatment of patients on improving their treatment outcome, atropine challenge test can be used as an acceptable test for screening and confirming the diagnosis of poisoning in suspected cases in the emergency setting.

Introduction: The need for providing specialized and professional services in emergency situations in the community and outside hospitals, multiplies the importance of professionalism in pre-hospital medical emergencies. This article tries to examine the factors affecting professionalism from the perspective of pre-hospital emergency medical technician students.

Methods: This study was a qualitative content analysis. The study population consisted of pre-hospital emergency medical students of Kurdistan University of Medical Sciences. Participants were selected from the interns (10 students) and semi-structured interviews were used to collect data until data saturation was reached. Interviews were conducted and their resulting transcriptions were carefully and repeatedly reviewed and then coded and classified using the Strauss and Corbin method.

Results: Based on data analysis, 4 main categories (factors related to education, individual factors, factors related to the nature of the profession, and social factors) and 17 sub-categories (factors related to professors, factors related to students, educational space and facilities, educational planning, criteria for accepting students, expertise, interest, experience, ethics, personal ability, commitment, working conditions, support of officials, knowledge of rights and laws, culture and customs governing the society, and advertising in schools) were extracted.

Conclusion: From the perspective of the participants in this study, professionalism is affected by factors related to education, individual factors, factors related to the nature of the profession and social factors. Since the ultimate goal of various medical professions is to promote the health of individuals in the community, the results of this study can be used by educational planning officials as well as policy makers in employment of pre-hospital emergency medical graduates.

Introduction: One of the basic criteria in improving the level of public health is to increase the level of citizens' access to medical services, especially emergency services. The old districts of cities have many problems including problems in accessing medical services. The aim of this study is to investigate the obstacles to having access to emergency medical services in a standard time in the historical area of Semnan. Methods: The present research was an applied descriptive field study, which was performed in the Emergency Medical Center (115 Emergency) of Semnan using interviews and questionnaires. The study population in determining the obstacles included the staff and the director of Semnan Emergency Medical Center. The obstacle confirmation phase, included 15 experts who were selected via convenience sampling. First, based on library studies, previous information, consultation with 115 emergency personnel of Semnan, and field inspection, the indicators affecting accessibility to 115 emergency medical services in the old area of Semnan were extracted. The extracted indicators were assessed using Delphi method and a questionnaire was prepared using these indicators, based on the pairwise comparison matrix of the present study. The prepared questionnaire was distributed and explanations were given on how to answer the questions and they were collected after being filled out. The data obtained from the questionnaire were entered into decision making trial and evaluation laboratory (DEMATEL) software and were analyzed using Dematel technique.Results: The most important barriers to accessing emergency medical services in the studied area, from the perspective of research experts, were found to be transportation standards with a weight of (35/318), architecture with a weight of (35/163), education with a weight of (34/778), time with a weight of (34/665), and communication with a weight of (34/238), respectively.Conclusion: 3 of the 5 criteria constituting barriers to access to emergency medical services were of the effective type and only two criteria of transportation and communication were of the affected type. Therefore, these factors have a high weight and are confirmed as barriers to accessing emergency medical services in the studied area. Also, considering that there were no evaluation errors (including lack of supervision) in the model of this research, it can be said that these factors are the most important barriers to accessing emergency medical services.

Introduction: the emergence of pandemic of COVID19 raised many concerns in medical approaches. One of these issues was whether medical staffs are able to perform cardiopulmonary resuscitation (CPR) safely regarding the transmission of the infection. So the aim of this study was to evaluate  knowledge of  the medical experts in Sabzevar University of  Medical Sciences about CPR of COVID-19 patients.

Methods: In this study, 129 people working in the hospital of Sabzevar University of Medical Sciences, including nurses, physicians, operating room experts and medical emergencies were assessed. The checklist consists of 21 questions that assess the knowledge of the medical experts about CPR of  COVID19 patients and the content validity of this checklist was confirmed by 10 specialist physicians. Also information on demographic variables are measured including age, sex, work experience by year, history of participation in CPR workshops for COVID19 patients, number of attendance at the workshop, hospital of work, field of study and degree. The association between these variables and the score of each person in the test has been assessed.

Results: The study showed that the Score of answering the questions was directly related to the workshops held on resuscitation of COVID19 patients, age and work experience. And questions that were not answered correctly by most participants were related to ventilation and intubation of COVID19.  Vaseei and Emdadi hospitals received higher scores than other hospitals.

Conclusion: The role of participating in the workshop is directly related to the level of knowledge of the treatment experts and getting a better score. Mobini and Heshmatiyeh hospitals, which had lower scores than other hospitals and should pay more attention to the issue of training and workshops.

Introduction: In the last two decades, the lack of facilities has been one of the reasons that has increased the average triage time. This delay prolongs the patient's waiting time and increases the likelihood of errors and mortality. Limited studies have been conducted on the type of facilities required for a fast triage. The purpose of this study is to express the opinions of physicians and nurses regarding the necessary facilities for a rapid triage in Poursina Hospital, Rasht, Iran, in 2021. Methods: This was a qualitative study using conventional content analysis method, which was performed on the opinions of twenty people in the fields of emergency medicine, general medicine, and nursing. The four Guba and Lincoln criteria were used for strengthening the data. Results: The opinions of 20 participants resulted in 4 categories and 17 subcategories under the titles: providing human resources, empowering human resources, improvement of triage process, and provision of physical necessities. Conclusion: Human resources is a valuable component in triage. Careful planning is needed for the growth and development of this valuable asset. By providing the required staff and upgrading their capabilities through training and experience, the speed of triage can be increased. Giving employees a proper understanding of triage is also effective in accelerating the triage process. The provision of physical resources has also been identified as a facilitator, and those in charge should seek solutions for providing them.

Introduction: The concept of job satisfaction is an important phenomenon in the field of health care. Lack of job satisfaction will have negative effects on the performance of people. Pre-hospital emergency personnel face a lot of stressful situations during their work day. These stresses will definitely affect the quality of their work. In this study, the relationship between job satisfaction and occupational stressors was assessed among the pre-hospital emergency personnel of Rasht city in 2017.

Methods: This research was a cross-sectional descriptive study and the study population of the present investigation consisted of all technicians of Rasht’s urban emergency stations. The required information in the study was obtained from individuals using 3 questionnaires. In this study, demographic data, job satisfaction, and occupational stress questionnaires were used.

Results: Most of the studied participants were in the age group of 31 to 40 years and in terms of education level, the majority had a bachelors’ degree (52.2%). The highest level of satisfaction was observed in the field of colleagues with a mean of 3.71 and a median of 3.75. The lowest level of satisfaction was observed in the field of salary. The highest level of stressors was related to the field of patient care with a mean of 3.04 and the median of 3.16 and the lowest level of stressors was related to interpersonal stressors with a mean of 2.62.

Conclusions: From the findings of this study, it can be concluded that pre-hospital emergency personnel will be more satisfied if they face less occupational stress, so the level of satisfaction of pre-hospital emergency personnel can be improved by reducing these factors. Health system policymakers can increase pre-hospital emergency personnel’s job satisfaction by paying more attention to their salaries and benefits. They can also help emergency technicians increase the quality of their working life and improve their performance by providing solutions to reduce their occupational stress.

Introduction: The health care personnel showing sympathy with the family of the deceased is not only of moral value but may also affect the relatives’ overall perception of the quality of the performance of medical and service staff. This study aimed to investigate the effect of sending a condolence letter to the family of the deceased in the hospital on their perception of the performance of the medical and service staff of Rasoul-e-Akram Hospital. Methods: This interventional study was performed from October 2017 to March 2018 in Rasoul-e-Akram Hospital, Tehran, Iran. Both experiment and control groups included families that lost their loved ones during the study period. A condolence letter was sent to the bereaved families included in the experiment group. Consequently, t-test was used to determine the difference between the experiment and control groups and SPSS software was used for final data analysis. Results: The level of satisfaction of the experiment group in comparison with the control group was considered as the basis for evaluating the effect of sending a condolence letter. There was a significant difference in the ratings of availability of nurses and the compassionate behavior of the ward staff towards the patient between the groups (p-value <0.05). The mean scores of providing medical services when the patient felt pain and spending sufficient time with the patient showed differences, but the differences were not significant (p-value = 0.06). Also, difference was observed between mean scores in the categories of proper description of the patient's condition, treatment process and provision of appropriate treatment for reducing pain, provision of sufficient explanation by the physician, and provision of the possibility of family members visiting the patient by the ward. For all variables in which the results were significantly different, men had a higher satisfaction score than women. Conclusion: Presence of a better and stronger relationship between doctors and medical staff with patients and their companions plays a more important role than sending a condolence letter in their family's perception of the hospital's medical performance and services. A condolence letter can be complementary to this process, but as the results of the present study showed, sending a condolence messages alone is not effective.

Introduction: The general public’s awareness of pre-hospital emergency medical services (EMS) and how they use the service is not very clear. Therefore, the aim of this study was to investigate the awareness of the general public and potential users regarding pre-hospital emergency medical services.

Methods: In this descriptive cross-sectional study, 1100 people were selected from the general public and potential users of pre-hospital emergency. To collect data, a questionnaire of public awareness of emergency services was used, and after determining its validity and reliability, it was filled out via telephone interviews. Data were analyzed using SPSS software (version 21) and inferential and descriptive statistics.

Results: In this study, the mean knowledge score of interviewees was moderate (65.72±14.98) and knowledge in men was reported to be higher than women. The highest level of knowledge was related to the field of medical emergencies (75.92±6.87) and the lowest level of knowledge was related to how to contact EMS (58.59±21.65). The results showed that there was a significant relationship between the level of awareness and gender, age, marital status, education level, income level, and frequency and purpose of contact with EMS (P>0.001).

Conclusion: The results showed that The general public had moderate knowledge of pre-hospital emergency services. It is best to plan to increase public and potential users’ awareness of contact numbers, patient emergencies, available resources, and capabilities of the staff using the mass and social media. Therefore, with proper education at different ages and having programs for different social groups, it is possible to purposefully increase the community's awareness of different areas of emergency.

Introduction: Two items of the Health Transformation Plan have been specifically related to increasing the quality of visit and Hoteling services. So far, no study has examined the effect of the Health Transformation Plan on the perceived quality of hospital services in Kermanshah. This study was performed with the aim of investigating the relationship between the Health Transformation Plan and the quality of health services. Methods: This is a descriptive study and examines the 22 areas of perception and expectation of patients from the services provided in hospitals in Kermanshah using SERVQUAL model. Significance of the relationship between the Health Transformation Plan and each of the quality variables has been determined using an appropriate test. Data analysis was performed using descriptive statistics, t-test (to test hypotheses), and Friedman test (to rank each of the factors related to service quality components). Analyzes were performed in SPSS software. Results: 283 people (mean age: 37.7 years) participated in the study. The negative gap between patients' perceptions and expectations before and after the Health Transformation Plan indicates that patients' perception was that the quality of services was poor; but this gap has narrowed since the implementation of the Health Transformation Plan. In Imam Reza Hospital, among the quality indicators, assurance (3.61 and P = 0.001) ranked the highest and tangible factors (2.50 and P = 0.001) ranked the lowest. In Farabi Hospital, responsiveness quality indicators (3.38 and P = 0.001) ranked the highest and tangible factors (2.61 and P = 0.001) ranked the lowest. The results obtained using t-test show that the Health Transformation Plan has had a significant effect on all dimensions of quality.  Conclusion: Although the Health Transformation Plan did not completely eliminate dissatisfaction, it reduced its extent and improved the quality perceived by individuals; therefore, changes in the way health services are provided can still improve people's perceived quality and increase their satisfaction.

Introduction: Burn injuries are one of the most important causes of disability and death, which can endanger health and also have severe economic and social consequences in human societies. The aim of this study was to determine the knowledge of pre-hospital emergency personnel in Rasht, Iran, in dealing with burn patients in 2018-2019.

Methods: The present study was a cross-sectional-descriptive one, and the study population consisted of all pre-hospital emergency personnel in Rasht in 2018. The sampling method of the study was census and the tool used in the study was a questionnaire, which evaluated the demographic information of the personnel in the first part, and in the second part of the questionnaire, participants' awareness was assessed using 15 questions. Data analysis was performed using descriptive and inferential tests and a significance level of p <0.05 was considered.

Results: The majority of staff had between 10-20 years of work experience (33.7%), and in terms of education, most of them were undergraduates (44.2%). The majority had encountered burn cases (62.1%), and had underwent training in relation to burn injuries (69.1%). In terms of knowledge status, only 3.2% (3 people) had good knowledge (score above 10) and the majority had moderate knowledge (53.7%) or poor knowledge (43.2%).

Conclusion: Due to the fact that the level of knowledge was moderate in the majority of the studied pre-hospital emergency personnel, proper planning should be done to hold training courses.

Introduction: Given the importance of emergency medical technicians' performance in saving lives and considering rapid advancements in medical sciences, there is a need for technicians to gain new specialized knowledge through acquiring the necessary skills and undergoing trainings in these areas. Additionally, making improvements in the quality of services provided by the emerency medical services (EMS) personnel in accidents and emergencies necessitates determining their level of knowledge, attitude, and skill and assessing their educational needs. Therefore, the purpose of this study was to determine the educational needs of operational pre-hospital emergency personnel in Rasht city in 2019-2020.

Methods: This study was a descriptive cross-sectional study carried out in 2019-2020. The statistical population of this survay consisted of all the pre-hospital emergency service personnel in Rasht, with Associate, Masters, and higher degrees; all of whom were included. The sampling method was census. The data was collected using a questionnaire that measured the training needs of Rasht Emergency Center staff in five domains of management, communication, evaluation skills, equipment, and operational skills.

Results: Training needs of the pre-hospital emergency operations staff in the five domains of management, communication, evaluation skills, equipment, and operational skills were 41.21±22.27, 41.94±21.1, 48.29±22.69, 40.29±21.48, and 76.87±18.22, respectively.

Conclusion: Overall, the educational needs of the studied pre-hospital emergency personnel were high, and training classes should be designed to meet these training needs.

Introduction: Hospital triage is part of the structure of the emergency department, which is performed by nurses. Little information is available about the level of nurses' knowledge of triage. The present study was performed with the aim of evaluating the knowledge of nurses in the emergency department of Imam Khomeini Hospital, Jiroft, Iran, on hospital triage.

Methods: This study was a cross-sectional (descriptive-analytical) study. Census method was used for sampling and 60 of the emergency personnel of Imam Khomeini Hospital, Jiroft, Iran in 2019 were selected entered the study. Data were gathered using a valid and reliable questionnaire. After codifying and entering the data, they were analyzed using STATA statistical software and descriptive and analytical statistical tests.

Results: 60 of the emergency personnel of Imam Khomeini Hospital in Jiroft entered the study. The mean age of the staff was 30.43 ± 8.23 years, the minimum age of the participants was 23 years and the maximum was 51 years. The mean score of nurses' knowledge was 11.2 ± 3.84. Among the studied staff, 39 (65%) had poor scores, while only 21 (35%) had moderate scores. There was no significant correlation between demographic variables and knowledge score.

Conclusion: Nurses' poor knowledge on hospital triage can be due to the lack of formal specialized triage training courses and the lack of obligation for emergency departments to make evidence-based decisions. Considering that guidelines in this regard are very important and necessary and not adhering to them might put the life of the patients at risk, workshops need to be held for the personnel in this regard to improve the level of knowledge of nurses.

Introduction: Regarding the vital role and function of pre-hospital emergency and the need for regular performance monitoring, particularly for determining indicators, we investigated the association of pre-hospital emergency time indicators and clinical status and outcome in patients transferred to emergency in Zanjan.

Methods: In this descriptive cross-sectional study, from all pre-hospital emergency missions in Zanjan province registered in 2018, we randomly selected 806 calls that led to patients’ transfer to medical centers. Next, we extracted their corresponding information (e.g., time indicators) and demographics using 115 emergency forms. Patients’ outcomes and clinical status after transfer were extracted using their emergency files.

Results: Of 806 patients transferred by pre-hospital emergency, 61% (490 patient)  were male and 39.2% (316 patient) were female. The mean age of patients was 28 years. Most pre-hospital emergency contacts were related to trauma caused by accidents (50.1%) and internal trauma (15.7%), respectively. In terms of time indicators, the average time was 0.9 min (delay time), 8.41 min (response time), 11.9 min (scene time), 39.92 min (mission time), 19.96 min (Transfer time), and 74.61 minutes (total mission time). Regarding the outcome of transferred patients, the highest frequency was related to patient discharge (55.9%), hospitalization (12.7%), transfer to other centers (1.1%), and death (2%). In terms of vital signs, 1% of the patients had 3 and 0 Glasgow coma scale, 89.3% had Glasgow scale of 15, 91.4% support above 90%, 7.7% oxygen saturation below 90%, and  32% had a heart rate in the normal range of 70 to 78.

Conclusion: The results showed that traffic accidents in Zanjan are the top causes of trauma in its hospitals. Overall, the dispatch timing was appropriate, and emergency personnel operated quickly in patients with poor clinical conditions.Based on the results of this study and future studies, appropriate planning was done to improve the indicators.

Introduction: Traumatic brain injury (TBI) is one of the leading causes of morbidity and mortality around the world, which can have long-term effects on cognitive, physical, and physiological functions, and the family and caregivers of the affected patients. The prognosis of TBI varies based on various factors and identifying factors affecting the prognosis of TBI can play an important role in the management of patients with this problem. Therefore, this study was designed and conducted to investigate practical models in determining the clinical outcome of TBI.

Methods: This study is a narrative review on studies found in PubMed, Scopus, EmBase, ScienceDirect and Google Scholar databases using keywords extracted from MeSH including "Traumatic brain injury", "Glasgow Coma Scale", "Treatment Clinical Outcome", "Glasgow Clinical Outcome Scale", "Simplified Motor Scale", "Brain Bleeding" and the combination of these keywords. Also, in order to cover the maximum number of studies conducted in this field, the references of the extracted articles were reviewed in order to find useful articles in line with this study.

Results: A total of 106 articles published between 2004 and 2019 were included in the study; the most important TBI review models such as IMPACT (International Mission on Prognosis and Analysis of Clinical Trials in TBI) and CRASH (Medical Research Council Corticosteroid Randomization after Significant Head Injury), which have studied many patients, and tools such as GCS ( Glasgow Coma Scale), SMS (Simplified Motor Score), GOS (Glasgow Outcome Scale), GOSE (Glasgow Outcome Scale-Extended), AIS (Abbreviated Injury Score), Marshall computed tomography (CT) Scale, Rotterdam CT Scale and FSS (Functional Status Scale), which, alone or in combination, can provide a relatively good prognosis for patient diagnosis and treatment, as well as clinical conditions and symptoms including subdural hematoma (SDH), arterial hypotension, hypothermia, hypoxia, neurological deterioration, and various physiological and pathological factors were studied. In addition, the strengths and weaknesses of each item in diagnosis of a clinical event in TBI were evaluated so that perhaps a more appropriate clinical decision could be made using them.

Discussion: Considering the wide range of scales and tools available for predicting the clinical prognosis of patients with TBI, choosing the appropriate scale and timely estimation of the patient's clinical prognosis can be of great help in allocating hospital resources, choosing the appropriate diagnostic and treatment methods, and reducing the rate of mortality and disability in patients with TBI.

Introduction: Scientometrics is a scientific field that can guide readers, academic institutions, and researchers in objective evaluation of the path that human knowledge takes. In recent years, new indicators have been used to rank and validate journals. The aim of this study was to investigate the relationship between new and common scientometric indicators of journals in the field of emergency medicine and trauma.

Methods: In the present descriptive-analytical study, journals specialized in emergency medicine were identified in Scopus and ISI databases. Our target indicators were related to data of journal publications published in 2019, which were collected using online databases of Clarivate Analytics, SCOPUS, PubMed, and SJR. Statistical analysis was performed using SPSS software version 19 and R software.

Results: In the present study, 57 journals in the field of trauma and emergency medicine were included. Among the journals indexed in Scopus, 24 were also indexed in ISI. In terms of article rankings in the Scopus database, Annals of Emergency Medicine, a Journal based in America and published by Elsevier, ranked first. The average CiteScore of journals specialized in trauma and emergency medicine was 2.16 ± 1.7. Their mean SJR was 0.53 ± 0.34. Mean h-index of these journals was 34.55 ± 28.27 and their mean impact factor (IF) was 1.88 ± 1.08. The average Eigenfactor Score was 0.0047 ± 0.00501. Eigenfactor Score was more correlated with IF and number of published articles compared to CiteScore and SJR.

Conclusion: Our findings may help authors figure out which indicators are most relevant to Total Cites or IF. Authors can use this information to make a decision regarding choosing the best bibliographic index to rank the target journals in the field of emergency medicine before submitting articles.

Introduction: The outcomes of driving accidents are one of the main causes of ill health in the community and from various dimensions, including psychological outcomes related to accidents, can be problematic for families and the entire community and will change the quality of life of individuals. The aim of this study was conducted of systematic review the quality of life of injured people after road-driving accidents.

Methods: In this research, searching for the results of the quality of life of injured people after traffic accidents, using the keywords of road accidents, driving accidents, traffic accidents and quality of life, are searched in Persian and English language databases.

Results: Of the 850 retrieved articles, 26 full-text articles were reviewed and finally 24 articles were selected for final synthesis and final studies with entry criteria were entered into the statistical society and were analyzed. The findings of the study showed that road accidents have a negative impact on the quality of life associated with stress, anger and nerve disorders, especially in the subgroup of children, in addition to costs imposed on the individual, the family and the community.

Introduction: Hospitals are considered the most important referral centers for victims at the time of disasters and accidents. Iran is one of the disaster-prone countries in the world and the unpreparedness of hospitals in the event of disaster causes a lot of damage to the country's healthcare system. Therefore, the purpose of this study was to assess the level of preparedness of Iranian hospitals for accidents and disasters through a systematic review.

Methods: The present study is a systematic review. Studies published in Persian on the level of preparedness of Iranian hospitals for accidents and disasters were searched for, using the keywords "contingencies", "disasters", "hospital preparedness", and investigated, using the Prisma checklist. Search for studies was performed in Google Scholar, Sid (Scientific Information Database), and Magiran databases without setting any time limit.

Results: Out of the 365 articles reviewed, 33 studies were finally included in the study. 10 studies were performed in Tehran province, 5 studies were done in Kermanshah, and Ahvaz, Ilam, Mazandaran, Yazd, Markazi, Isfahan, Qazvin, Birjand, Tabriz, northern Iran, Jahrom, Zabol, Semnan, Urmia, Shiraz, Zanjan, and all of Iran were evaluated in 1 study each. Most of the studied hospitals were educational. Three studies evaluated military hospitals and one study assessed a private hospital. Among the included studies, 20 were cross-sectional descriptive studies, 12 were descriptive-analytical studies, and one was a field study. In addition, more than half of the studies reported that hospitals were moderately prepared, 7 studies concluded that the hospitals were well prepared (desirable preparedness), and 8 studies stated that the hospitals were poorly prepared (low preparedness).

Conclusion: The results of the present study indicated that overall, the preparedness of the hospitals in Iran is at a moderate level. It seems that crisis management teams in Iranian hospitals should prepare as much as possible, obtain the required information regarding crisis management, and plan before the occurrence of disasters so that they can make correct and logical decisions at the time of disasters and more effectively perform their role as crisis management team.

Introduction: Evaluating the studies conducted in the field of emergency medicine and finding a comprehensive view of the current situation of research in emergency medicine in Iran can provide a model for prioritizing research topics according to the needs and resources of the country. The present review study has been performed with the purpose of evaluating papers published in the field of emergency medicine in Iran over a 10-year period.

Methods: To conduct this study, search engines such as Google Scholar and databases such as Web of Science, Pubmed, Scopus, Embase, Cochrane, ISC, and SID, were searched to find all articles published in the field of emergency medicine in Iran using keywords listed based on the review of articles, and published articles were evaluated based on the subject of the study, type of study, methodology, etc.

Results: The number of published articles related to emergency medicine in Iran over the period of this study (2001-2018) was 774. Out of these 774 articles, due to similarity and unavailability of the full text of some articles, they were removed along with duplicates and only 120 articles were analyzed and the information related to each article was entered into Excel software, separately. Analyzes showed that the number of researches has been growing since 2011 so that nearly 90% of the articles were published during this period. Appropriate treatment measure was the most studied area, among which more attention was paid to heart diseases. These articles were published in more than 33 domestic and foreign journals, with Emergency Medicine Journal having the highest number of articles. The average index of articles was 0.87, which despite its growth in recent years, still seemed low. The number of citations was examined and Iranian emergency medicine articles had few citations. Also, the review of articles based on the pyramid of evidence showed that group studies had the highest value.

Conclusion: This study showed that the production of articles by Iranian authors in the field of medical emergencies has steadily improved. However, the quality indicators of articles and authors, such as the number of citations, are low and need more attention.

Introduction: Recently, patients' satisfaction with the delivery of medical services in the emergency departments of hospitals has received much attention. Therefore, this systematic review study was conducted to evaluate patients' satisfaction with services provided in the emergency department.

Methods: The present study is a systematic review. Studies on the level of satisfaction of patients with the services provided in the emergency department published in Persian were searched for, using Persian keywords meaning "satisfaction", "emergency department", and "services provided in emergency department". Searches were performed in Google scholar, Sid, and Magiran databases to find studies published from 2001 to 2020 and retrieved studie were examined using the Prisma checklist.

Results: After searching for, screening, and qualitatively evaluating the studies for the systematic review, in the end, the final synthesis was performed on 24 articles. Among the studied articles, the level of satisfaction with the services provided in the emergency department was desirable in 20, unfavorable in 2, and not mentioned in two. The highest level of satisfaction with the services provided in the emergency department was mostly related to the services provided by doctors and nurses and the way the doctor treated them. Additionally, the lowest level of satisfaction was related to welfare facilities and the physical environment of the emergency department and the security not treating the patients properly.

Conclusion: The results of the present study showed that patient satisfaction was at a desirable level in most studies. Assessing the level of patient satisfaction can increase the awareness of the relevant authorities about the current situation in hospital emergency departments. It also reveals the weaknesses in providing services to patients and helps the relevant authorities to eliminate the shortcomings and improve the quality and quantity of services.

Introduction: Poisoning is one of the most common causes of visits to hospital emergency departments in many countries. Considering the prevalence of poisoning in Iran, this study aims to investigate the epidemiology of child poisoning in Iran as a systematic review study.

Methods: The present study is a systematic review. Studies published in Persian on the epidemiology of child poisoning were searched using Persian keywords translating to "poisoning", "children", and "poisoning in children" and examined using the Prisma checklist. Searches were performed in Google scholar, Sid, and Magiran databases to find studies published in the period from 2001 to 2020.

Results: After searching, screening, and qualitatively evaluating the studies during the systematic review, in the end, syntheses were performed on 21 articles. In terms of gender, in 20 studies, poisoning had a higher prevalence among boys and in one study the prevalence was higher in girls. The highest prevalence of poisoning was observed among children under 3 years of age. Also, in terms of the prevalence of poisoning in various seasons, one study reported the highest prevalence in spring, 6 studies in summer, and 2 studies in autumn. The toxic agent was reported to be medication in 10 studies, opium in 8 studies, and hydrocarbons (oil) in 3 studies. The most common cause of poisoning was accidental in 17 studies and intentional in one study.

Conclusion: The results of this study showed that medication poisoning is the most common cause of poisoning in Iran and has increased in recent years. Considering the fact that most of the poisonings in the studies were accidental, it is necessary to inform parents about the proper storage of medications and also paying attention to the labels of medications.

Introduction: Violence in the workplace against health care workers is a global issue and it is being observed in the workplace, especially in emergency personnel. Due to the relative increase in violence in the emergency department, this study was conducted to investigate violence in emergency department personnel.

Methods: This study is a systematic review of studies on violence against hospital emergency team staff by searching the databases of Google Scholar, magiran, SIDdatabase with the keyword of Violence, Nurses, Emergency Department, between 2001 and 2021 Out of a total of 599 related articles extracted from the databases, reviewing the title and abstracts, based on the study inclusion and exclusion criteria, finally, 11 articles were included in review and analysis.

Results: A total of 11 studies were reviewed according to the study subject. In three studies were conducted in Tehran, two in Ahvaz and one in Sabzevar, Arak, Tabriz, Urmia, Hamedan, and Rasht. The incidence of violence was high in ten studies and not reported in one study. In the studies, there was a significant relationship between gender and the level of violence in some studies. In terms of the relationship between gender and violence in the emergency department, in some studies more violence in men and some in women, and in some cases, there were no differences between women and men. The most violent induvial in the studies was that the visitors of the patient. Also, the most common type of violence in all studies was verbal violence.

Conclusion: According to the results of this study, the incidence of violence in the emergency departments of Iranian hospitals is high, and also in most studies, violence has been more by patients' visitors. It seems that by creating a waiting room with a suitable capacity, the unnecessary presence of visitors in the ward area can be prevented.

Introduction: Patient care is the main goal of the emergency department and its staff and respect for patient privacy is an essential part of the care process. Although many studies have examined patients' perceptions of their privacy, fewer studies have specifically addressed this issue in the emergency department, which is often a busy area and may pay less attention to privacy. The purpose of this study is to systematically review studies that have studied patient privacy in the emergency department.

Methods: This study is a systematic review of published studies on patient privacy in the emergency department conducted according to PRISMA teachings. To answer the study questions, the sources of electronic databases MEDLINE, Embase, ScienceDirect and PsycINFO, and SID and Persian sources were searched with appropriate keywords. Criteria for eligibility of studies for review in this study were English or Persian language and study in the emergency department. No temporal or geographical restrictions were imposed.

Results: 14 studies were included in this systematic review. The studies were published between 2003 and 2020. 2 studies of organizational intervention, and other studies were performed cross-sectionally. Most studies were performed in Iran (seven cases) and then two studies in Australia. The cumulative number of participants in all studies was 1406 patients. The main concepts presented that seemed to affect the level of patient privacy were divided into three general categories: factors related to the emergency environment, patient-dependent, and staff-dependent.

Conclusion: In terms of factors related to the medical staff, there is a need to increase their awareness of the definitions of patients' privacy; Regarding the environment of the emergency department, it seems that the structure and design of the emergency department (including the type of separation of beds from each other by a room or curtain) should be revised in order to protect patient's privacy. Patient-related factors (including gender, culture) are not subject to change and are categorized only to determine the importance for further attention of the treatment staff.

Introduction: Renal colic is the most common clinical manifestation of urinary stones and one of the most common urological emergencies that is very agonizing for the patient due to excruciating pain. Different therapeutic interventions are performed for relieving the pain in patients with renal colic. This narrative review study was performed, aiming to evaluate the medications used for pain management in patients with renal colic.

Methods: The present study is a narrative review. In this study, to find related articles, researchers conducted a computer search in SID, Magiran, and Google Scholar databases using Persian keywords meaning renal colic and kidney colic. Studies were searched in Persian language databases without any time limit.

Results: In reviewing the articles, various studies were performed on different drugs for controlling pain in patients with renal colic. Most of the studied drugs were opioids (morphine, buprenorphine, tramadol, and pethidine) and non-steroidal anti-inflammatory drugs (NSAIDs) (paracetamol, diclofenac, and ketorolac). Additionally, drugs such as ketamine, desmopressin, aminophylline, and intradermal administration of distilled water were also evaluated.

Conclusion: Although narcotics are most effect for relieving pain in patients with renal colic, but the development of side effects such as inhibition of the respiratory center in the medulla and activation of the vomiting center (chemoreceptor trigger zone; CTZ) has limited the use of narcotics. Due to having analgesic effects similar to opioids and fewer side effects, it is recommended to use NSAIDs (Ketorolac) as the first line of treatment for renal colic patients.

Introduction: The Covid-19 epidemic in the world has triggered innumerable stress and anxiety among people. Since medical staff play a leading role in the fight against Covid-19, they experience the highest level of risk and anxiety. Consequently, as a systematic study, this study aimed to investigate the anxiety of medical staff and the psychological factors affecting it during the pandemic of Covid-19 in Iran.

Method: In the current study, a systematic review was done to search for Persian database articles, Scientific Information Database (SID), Magiran, and Google Scholar search engine from 2018 to 2021 using Persian keywords; anxiety, coronavirus, Covid-19, medical staff, nurses. To select studies and extract the data, the titles of all articles obtained were reviewed by two people, and duplicates were removed. Information about selected articles, including first author, year of publication, study title, study population, study method, sample size, study tools, and finally, the results were recorded in the data extraction form.

Results: In the initial stage of the studies search, 624 studies were reviewed. Due to lack of relevance to the subject and duplication and lack of access to the full article, 610 studies were deleted. Lastly, 14 studies were used to write this study. Numerous psychological factors (stress, depression, burnout, resilience, family social support, suicidal ideation, emotion regulation, anxiety sensitivity, psychological stubbornness, caring behaviors, rumination, health beliefs, and physical activity) played a role in the incidence and prediction of anxiety. Among the studies, five were related to 2021, and 9 were related to 2020. The study population in three studies is Ardabil, in two studies is Malayer, in two studies is  Jahrom, and in one study are Zahedan, Zarandieh, Alborz, Kerman, Torbat Heydariyeh, Miyaneh, and Rasht. The instrument in 10 studies was CDAS, two studies used Beck anxiety, and two studies used DASS.

Conclusion: The results of this study disclosed that various psychological factors are influential in the incidence of anxiety in health care professionals, each of which can play a role in the incidence of anxiety. Consequently, recognizing the cause of these psychological disorders in these people is essential to maintain the mental health of these people by using appropriate methods.

Introduction: Postoperative nausea and vomiting are common and uncomfortable postoperative complications. Different pharmacological and non-pharmacological methods can be used to reduce or control nausea and vomiting after cholecystectomy. The present study investigates the effectiveness of pharmacological and non-pharmacological methods in reducing or controlling nausea and vomiting in cholecystectomy.

Methods: In this narrative and systematic review, to find articles in Persian language, SID and Magiran databases, and Google Scholar search engine, from 2000 to 2020, were searched by 2 authors, separately, using Persian keywords equal to cholecystectomy, nausea, and vomiting. Information of the selected articles including: first author, year of publication of the article, title of the study, sample size, drug used, tools studied, and finally, patients’ outcomes were recorded in the data extraction form. The quality of the reviewed articles was evaluated using a checklist related to clinical trial studies.

Results: In the initial stage of searching for articles, 558 studies were reviewed. The researchers then reviewed the articles found and 544 studies were eliminated due to not being relevant to the subject under study, duplication, and lack of access to the complete article. Finally, 14 studies were used to write this study. Among the studied articles, metoclopramide was evaluated in 7 studies, ondansetron in 6 studies, dexamethasone in 6 studies, gabapentin in 2 studies, and intraperitoneal bupivacaine, propofol, promethazine, ginger, acupressure, and intravenous crystalloid were examined in one study each.

Conclusion: The results of the present study showed that among the pharmacological methods to control nausea and vomiting in patients undergoing cholecystectomy, the first choice of anesthesiologist can be ondansetron. Also, in non-pharmacological methods, acupressure and ginger can both reduce nausea and vomiting after surgery.

Introduction: Accidents are one of the most important causes of child mortality in the world and in Iran. Epidemiological studies play an effective role in preventing and controlling pediatric accidents by identifying the causes of accidents and environmental factors affecting the occurrence of accidents. Therefore, this study was conducted to investigate the epidemiology of accidents in Iranian children as a systematic review study.

Methods: The present study is a systematic review. Studies published in Persian on the epidemiology of accidents and incidents in Iranian children in Persian journals were searched with the keywords "accidents", "accidents", "children" and examined using the Prisma checklist. Review of studies from 2000 to 2020 was searched in Google scholar databases, Sid, Magiran.

Results: In the present study, 531 studies were selected to review the title and abstract. The studies started in 2000 in Tehran and the last article is related to the year 2020 in Mazandaran. After deleting low quality studies based on study quality review criteria and deleting studies that had shortcomings in data reporting, 17 studies entered our quantitative synthesis. Out of 17 articles, 2 studies were in Tehran province, 2 studies in Fars and one study in Ahvaz, Mazandaran, Yazd, Qazvin, Birjand, Hamedan, Tuyserkan, Fasa, Kerman, Aligudarz, Mashhad, Rafsanjan, Yasuj. Among the studied studies, the highest prevalence of gender was related to boys with 14 studies. The highest age group is related to children under 5 years with 10 studies. The highest prevalence of accidents in children was in summer with 6 studies. The highest frequency in terms of the cause of the accident is related to trauma with 5 studies. The highest incidence of accidents is related to home with 7 studies. The highest area of ​​damage is related to urban areas with 10 studies.

Conclusion: The results of the present study showed that the highest prevalence of accidents in children in summer and the highest frequency in terms of the cause of the accident is related to trauma and the highest location of the accident is related to home. Therefore, training should be appropriate for each age group and the events that are most involved; and should be given more attention in control and prevention planning. Planning to promote parental culture in this area can also be effective.

It seems that computed tomography (CT) scan, which does not have the limitations of plain cervical spine radiography, can be considered as the first line modality in decision-making for patients with neck trauma and performing radiography can be omitted. The findings of the present study on 100 patients over the age of 16 years with stable hemodynamics, who presented to a university affiliated trauma center in Tehran, Iran, following multiple trauma indicated an overall agreement of 79% between radiography and CT scan findings based on the calculation of kappa coefficient (p = 0.001). In addition, sensitivity of radiography in detection of injuries in this study was estimated as 82% and its specificity was estimated as 76%. It seems that the role of plain radiography in evaluation of neck traumas should be revised as it has low accuracy, especially where CT scan is available.

Careful review of articles published in a journal is one of the most important methods for improving the quantity and quality of that journal. Therefore, the present study was conducted by journal manager with the aim of investigating the publication process and quality of articles in the Iranian Journal of Emergency Medicine.

In this self-assessment, information was collected about articles published in the Iranian Journal of Emergency Medicine in 2021. This review may help authors who are interested in working with us become more familiar with the journal's goals and scopes, as well as editorial priorities and preferences.

This journal is indexed in DOAJ, EBSCO, CINAHL, COPE, Index-copernicus, IMEMR, etc. databases.

In 2021, the journal published 47 articles. More than 150 authors from Tehran, Shahid Beheshti, Isfahan, Mashhad, Zahedan, Shiraz, Tabriz, Mazandaran, Arak, Rasht, Birjand, Jahrom, Shahrekord, etc. universities participated.

The acceptance rate of articles in 2021 was 57.21%, while 32.34% of the articles were fast rejected and 10.45% were declined after the review process. It took an average of 45 days to reach a decision to accept the articles. Out of the 57 published articles, 29 articles were original articles (61.7%), 13 were reviews (27.6%), 3 were case reports (6.3%), and 2 were letters to the editor (4.2%).

All published articles were in the field of emergency medicine and complied with the journal's commitments. Regarding the structure of articles, the average number of words in the text, and Persian and English abstracts were standardized based on the journal instructions. The type of study was mentioned in all articles and all references were added Endnote software (Vancouver format). Ethical considerations were observed in all articles.

Introduction: Imaging technique plays an important role in management of chest trauma and chest x-ray, ultrasonography, and computed tomography (CT) scan are used to diagnose chest injuries. Chest CT scan is the Gold standard for diagnosing chest injuries. The aim of this study was to evaluate the positive findings of chest CT scan in patients referring to the emergency department of Imam Reza Hospital, Tabriz, in 2016-2017.

Methods: This is a descriptive study performed on multiple trauma patients referring to Imam Reza Hospital in Tabriz from April 2016 to March 2017. The sampling method was census and all patients with multiple trauma and chest trauma who had referred to Imam Reza Hospital during the study period and had undergone a chest spiral CT were included in the study. Independent t-test was used to compare quantitative data and chi-square was used to compare qualitative data.

Results: During the study period, 390 patients with chest trauma and multiple trauma had undergone chest CT. Of which, 296 were male (75.9%) and 94 (24.1%) were female. The mean age of the patients was 48.35 years. Traffic accidents were the most common cause of trauma. In nearly half of the patients there was no positive finding on chest spiral CT scan. However, there were multiple findings in 21 patients. The most common injuries were: rib fracture (11.3%), pneumothorax (12.3%), pneumomediastinum (2%), hemothorax (4.6%), and pulmonary contusion (4.9%).

Conclusion: In patients with multiple trauma, the most common positive CT findings were rib fractures, followed by pneumothorax, subcutaneous emphysema and hemothorax. In cases where there is a fracture of the first three ribs or flail chest, or a fracture of the scapula and high-energy trauma, the rate of visceral damage inside the chest and abdomen is higher, and chest CT scan can diagnose hemothorax and minor pneumothorax, which are not detectable in chest x-ray.

Hypothyroidism is a common condition in the general population, which can be treated through replacing thyroid hormone with a proper dose. Myxedema coma is an extremely severe hypothyroidism, which manifests as hypothyroidism, hypotension, bradycardia, and altered mental state associated with severe hypothyroidism. In this article, we introduce a patient with a history of controlled secondary hypothyroidism, who, despite having normal thyroid test results, showed myxedema coma presentations after laparoscopic sleeve gastrectomy, and finally improved after treatment with oral levothyroxine.

Idiopathic basal ganglia calcification (IBGC) or Fahr Syndrome is a rare disease caused by idiopathic calcification of the basal ganglia, which mainly presents as psychiatric symptoms, such as delirium, hallucination, and depression, or motor and cognitive neurological symptoms. The disease is usually accidentally diagnosed in brain computed tomography (CT) of patients with mental disorders. In this case study, a 70-year-old female patient is presented, who had referred to Peymaniyeh Hospital in Jahrom many times with complaints of dizziness, imbalance, irritability of the face, and frequent spasms of the fingers. Her medical history revealed hypertension, since several years ago, osteoporosis, hyperlipidemia, and genetic diseases of the heart and liver. Due to balance and neurological disorders, a CT scan of the patient's brain was obtained. CT scan showed calcification of the basal ganglia of the brain. To differentiate IBGC from other diseases that cause brain calcification, after CT scan, blood tests and evaluation of serum levels of the relevant indices were performed. Finally, the diagnosis of IBGC was confirmed and the patient was treated with calcitriva, calcium, and vitamin D drugs. She had improved and was discharged from the hospital after three days with prescription of oral medication. The calcification of the basal ganglia in this disease is similar to other infectious, metabolic, congenital, and etc. diseases that lead to nervous system disorders, so complete evaluations must be performed to rule out other causes in order to make a correct diagnosis and apply appropriate treatment.