Designing a model for trauma system management using public health approach: the case of Iran

Trauma is a leading cause of death and disability around the world. Injuries are responsible for about six million deaths annually, of which ninety percent occur in developing countries. In Iran, injuries are the most common cause of death among age groups below fifty. Trauma system development is a systematic and comprehensive approach to injury prevention and treatment whose effectiveness has been proved. The present study aims at designing a trauma system management model as the first step toward trauma system establishment in Iran. In this qualitative research, a conceptual framework was developed based on the public health approach and three well-known trauma system models. We used Benchmarks, Indicators and Scoring [BIS] to analyze the current situation of Iran trauma care system. Then the trauma system management was designed using the policy development phase of public health approach The trauma system management model, validated by a panel of experts, describes lead agency, trauma system plan, policy-making councils, and data-based control according to the four main functions of management: leading, planning, organizing and controlling. This model may be implemented in two phases: the exclusive phase, focusing on resource integration and the inclusive phase, which concentrates on system development. The model could facilitate the development of trauma system in Iran through pilot studies as the assurance phase of public health approach. Furthermore, the model can provide a practical framework for trauma system management at the international level

Trauma care system in Iran / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to describe the current status of trauma system regarding the components and function.</p><p><b>METHODS</b>The current status of trauma system in all components of a trauma system was described through expert panels and semi-structured interviews with trauma specialists and policy makers.</p><p><b>RESULTS</b>Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of public education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training standards of the front line medical team and continuing education and evaluation are yet to be addressed. Trauma registry has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance, financial resources), it is not yet established in our system of trauma care.</p><p><b>CONCLUSIONS</b>It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system.</p>

Survival after in-hospital cardiopulmonary resuscitation in a major referral center during 2001-2008

Despite efforts to save more people suffering from in-hospital cardiac arrest, rates of survival after in-hospital cardiopulmonary resuscitation [CPR] are no better today than they were more than a decade ago. This study was undertaken to assess the demographics, clinical parameters and outcomes of patients undergoing CPR by the code blue team at our center during 2001 to 2008. Data were collected retrospectively from adult patients [n=2262] who underwent CPR. Clinical outcomes of interest were survival at the end of CPR and survival at discharge from the hospital. Factors associated with survival were evaluated using binomial and Chi Square tests. Of the patients included [n=2262], 741 patients [32.8%] had successful CPR. The number of male patients requiring CPR was more than females in need of the procedure. The majority of patients requiring CPR were older than 60 years [56.4 +/- 17.9]. The number of successful CPR cases in long-day shift [7:00 to 19:00] was more than that in the night shift [19:00 to 7:00]. Furthermore, 413 [18.4%] cases were resuscitated on holidays and 1849 [81.7%] on the working days. The duration of CPR was 10 min or less in 710 [31.4%] cases. Cardiopulmonary resuscitations which lasted less than 10 minutes were associated with better outcomes. The findings of the present study indicate that some manageable factors including the duration of CPR, working shift, working day [holiday or non-holiday] could affect the CPR outcomes. The findings might also be taken as evidence to suggest that the allocation of more personnel in each shift especially in night shifts and holidays, planning to increase the personnel's CPR skills, and decreasing the waste time would result in the improvement of CPR outcome

[Prehospital emergency service for internal medicine problems in pediatrics; causes, time indices and outcomes]

Although pediatric pre-hospital emergency medical services [EMS] are a main challenge of health care systems, few data exists over it. Current study of ambulance calls for medical causes relating to children in Tehran was conducted with the following aims: 1] assessment of the frequency of causes of EMS call, 2] assessment of time indices of service providing by EMS, and 3] to assess the correlation between outcomes and time indices. In this retrospective study, all calls to Tehran EMS system [Dial 115] for medical causes of children=<15 years old in Tehran between December 2005 and May 2006 were extracted. Demographic variables, accident type, patient outcome before hospital arrival, and ambulance time indices [response time, scene time, total run time, total run time hospital, transport time, round trip time] were registered. 1052 [15.5%] calls were for children. From these, 717 [68%] were due to problems of medic problems. The most frequent problem was epilepsy [26.8%], unconsciousness [18.1%] and respiratory disorders [15.2%]. 12 [5. 6%] subjects died before ambulance arrival, but no one died between scene and hospital arrival. Mean [SD] delay time, response time and scene time were 3.8 +/- 1.8, 15.1 +/- 6.9, and 23.5 +/- 10.9, respectively. The pre-hospital mortality was not correlated with any of the time intervals. One of six ambulance calls in Tehran is related to pediatric patients, most of them with a medical cause. Epilepsy, unconsciousness and respiratory disorders as the most frequent causes for EMS calls for medical problems highlights the need for planning for training of the EMS personnel with these problems. There is still a need for further improvement in time intervals of EMS services, which may be possible by proper management and equipping by more ambulances