Emergencies in dental surgery during the COVID-19 pandemic

Introduction: Patients' negligence and difficult access to healthcare have an impact on the worsening of emergency conditions, which require immediate treatment due to the possibility of exacerbation in a short period of time. Untreated intra- and extraoral abscesses can have serious consequences on the patient's health and in many cases are life-threatening conditions increasing risk of respiratory obstruction, thrombophlebitis, meningitis, mediastinitis and septicemia. Background: The aim of this study is to investigate the impact of the pandemic and the resulting impediments to accessing medical care on the incidence and type of emergencies in the Oral Surgery Department. Material and methods: This was a retrospective study of 85375 patients aged 2 months to 90 years old with diagnosed intra- and extraoral abscesses before COVID-19 pandemic (2018,2019), and during pandemic (2020, 2021) in the Department of Oral Surgery of the Medical University in Lublin. The obtained results were statistically analyzed with the use of a computer program. Conclusions: The fewest patients were admitted in 2020, and the most in 2021, where we can already see the effects of the pandemic. Emergencies occurred most frequently in people aged 21-30, then 31-40. In 365 cases, tooth extraction was performed, and only in 28 cases, root canal treatment was attempted. Conclusions. Oral health service provision has been significantly affected by COVID-19. Patients came to their appointments too late, which in most cases resulted in the necessity of tooth extraction without attempting root canal treatment.

In-Person Versus Virtual Instruction and Simulation for Unplanned Out-of-Hospital Births

INTRODUCTION: Unplanned out-of-hospital births are uncommon and associated with serious complications. Most emergency medical services (EMS) personnel receive little or no instruction on emergent vaginal delivery. Our in-person (IP) lecture and simulation training on emergent vaginal delivery for EMS personnel previously demonstrated improvement in knowledge and confidence. With COVID-19 we adapted the same curriculum into a virtual training session (VTS). In-person simulation increases confidence and knowledge, but less is known about virtual simulation training. The purpose of this study was to assess EMS personnel's knowledge and confidence after IP versus VTS in emergent vaginal delivery. METHODS: The IP and VTS participants received the same lecture on emergent delivery either in-person or virtually. The IP group received in-person simulation training using a birth simulator. The VTS group received simulation training via virtual demonstration on the same model. Participants completed pretraining and posttraining surveys to assess knowledge and confidence. Responses were analyzed and compared using Student's t test. RESULTS: Ninety-eight participants (59 IP, 39 VTS) participated with 100% survey completion. Pretraining knowledge scores were similar (IP 45% versus VTS 37%, P =.22). Although both groups showed improvement, the IP group had significantly higher posttraining knowledge scores (IP 99% versus VTS 75%, P <.01). More IP participants reported confidence in performing emergent delivery after training (IP 100% versus VTS 51%, P <.01). CONCLUSION: Live in-person instruction and simulation training of emergent vaginal delivery among EMS personnel results in higher knowledge scores and confidence when compared to virtual instruction and simulation training. Further evaluation is needed to determine generalizability to other learner groups. [ FROM AUTHOR] Copyright of Obstetrics & Gynecology is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

An Analytical Approach for Dispatch Operations of Emergency Medical Services: A Case Study of COVID-19

: Emergency medical services (EMS) aims to deliver timely ambulatory care to incidents in communities. However, the operations of EMS may contend with suddenly increasing demands resulting from unexpected disasters such as disease outbreaks (e.g., COVID-19) or hurricanes. To this end, it usually requires better strategical decisions to dispatch, allocate, and reallocate EMS resources to meet the demand changes over time in terms of demographic and geographic distribution of incidents. In this study, we focus on the operation of the EMS resources (i.e., ambulance dispatch) in response to a demand disruption amid the COVID-19 pandemic. Specifically, we present a analytical framework to (1) analyze the underlying demographic and geographic patterns of emergency incidents and EMS resources;(2) develop a mathematical programming model to identify potential demand gaps of EMS coverage across different districts;and (3) provide a remedial reallocation solution to the EMS system with the existing ambulance capacity. The proposed method is validated with emergency response incident data in New York City for the first COVID-19 surge from March to April 2020. We found that it takes a long incident response time to scenes which reflects unexpected incident demands during COVID-19 surge. To cover such disruptive demands, ambulances need to be reallocated between service districts while meeting the response time standard. The proposed framework can be potentially applied to similar disruptive scenarios in the future and other operational systems disrupted by other disasters. Highlights: We propose an analytical framework using optimization modeling and simulation techniques for EMS resource allocation in response to a demand disruption amid the COVID-19 pandemic.We propose mathematical programming models to identify potential demand gaps of EMS coverage across different districts.We provide a remedial reallocation solution to the EMS system with the existing ambulance capacity. © 2023, The Author(s).

Engineering Design of a Health Service Station Sewage Treatment Station under COVID-19 Epidemic

Health service station is a place in which close contacts with the COVID-19 and other key populations are centralized quarantined for medical observation.A newly built health service station is equipped with 4 700 beds and a supporting sewage treatment station with a designed treatment scale of2 200 m~3/d.The treatment process consists of enhanced biological treatment system,sewage virus disinfection and sterilization system,aerosol disinfection and sterilization system and sludge disinfection and sterilization system.After treatment,the effluent and waste gas can meet the limit specified in Discharge Standard of Water Pollutants for Medical Organization （GB 18466-2005）.The average COD,NH3-N and SS in effluent are 14.53 mg/L,1.26 mg/L and 9.11 mg/L,respectively,and the average concentrations of H2S,NH3 and odor at the outlet are 0.01 mg/L,0.8 mg/L and 6.3,respectively.The sludge is disinfected regularly and then transported outside for disposal.This project can provide reference for sewage treatment design of emergency medical temporary isolation and observation facility and cabin hospital.

Decision on non-conveyance of patients suspected of COVID-19 in a novel arrangement with assessment visits by paramedics at home.

BACKGROUND: During the first weeks of the outbreak of the coronavirus disease 2019 (COVID-19), the North Denmark emergency medical services authorised paramedics to assess patients suspected of COVID-19 at home, and then decide if conveyance to a hospital was required. The aim of this study was to describe the cohort of patients who were assessed at home and their outcomes in terms of subsequent hospital visits and short-term mortality. METHODS: This was a historical cohort study in the North Denmark Region with consecutive inclusion of patients suspected of COVID-19 who were referred to a paramedic's assessment visit by their general practitioner or an out-of-hours general practitioner. The study was conducted from 16 March to 20 May 2020. The outcomes were the proportion of non-conveyed patients who subsequently visited a hospital within 72 hours of the paramedic's assessment visit and mortality at 3, 7 and 30 days. Mortality was estimated using a Poisson regression model with robust variance estimation. RESULTS: During the study period, 587 patients with a median age of 75 (IQR 59-84) years were referred to a paramedic's assessment visit. Three of four patients (76.5%, 95% CI 72.8;79.9) were non-conveyed, and 13.1% (95% CI 10.2;16.6) of the non-conveyed patients were subsequently referred to a hospital within 72 hours of the paramedic's assessment visit. Within 30 days from the paramedic's assessment visit, mortality was 11.1% [95% CI 6.9;17.9] among patients directly conveyed to a hospital and 5.8% [95% CI 4.0;8.5] among non-conveyed patients. Medical record review revealed that deaths in the non-conveyed group had happened among patients with 'do-not-resuscitate' orders, palliative care plans, severe comorbidities, age ≥ 90 years or nursing home residents. CONCLUSIONS: The majority (87%) of the non-conveyed patients did not visit a hospital for the following three days after a paramedic's assessment visit. The study implies that this newly established prehospital arrangement served as a kind of gatekeeper for the region's hospitals in regard to patients suspected of COVID-19. The study also demonstrates that implementation of non-conveyance protocols should be accompanied by careful and regular evaluation to ensure patient safety.

Opioid prescriptions and patients' health services utilization and cost before and during the COVID-19 pandemic: an exploratory population-based administrative data analysis.

The objective was to explore percentages of the population treated with prescribed opioids and costs of opioid-related hospitalizations and emergency department (ED) visits among individuals treated with prescription opioids and costs of all opioid-related hospitalizations and ED visits in the province (i.e., provincial costs) before and during the coronavirus disease 2019 (COVID-19) pandemic in Alberta, Canada. In administrative data, we identified individuals treated with prescription opioids and opioid-related hospitalizations and ED visits among those individuals and among all individuals in the province between 2015/16 and 2021/22 fiscal years. Services used were counted on an item-by-item basis and costed using case-mix approaches. Annually, from 9.98% (2020/21-2021/22) to 14.52% (2017/18) of the provincial population was treated with prescription opioids. Between 2015/16 and 2021/22, annual costs of opioid-related hospitalizations and ED visits among individuals treated with prescription opioids were ∼$5 and ∼$2 million, respectively. In 2020/21-2021/22, the provincial costs of opioid-related hospitalizations (∼$14 million) and ED visits (∼$7.0 million) were almost twice the costs observed in 2015/16 and immediately before the pandemic (2019/20). Our findings suggest that increases in the opioid-related utilization of inpatient and ED services between 2015/16 and 2021/22, including the drastic increases observed during the COVID-19 pandemic, were likely driven by unregulated substances.

Evaluation of the psychological distress and mental well-being of pre-hospital care providers in Saudi Arabia during COVID-19.

Background: Pre-hospital care providers are the first line of contact when emergencies occur. They are at high risk of mental health disorders associated with trauma and stress. The magnitude of their stress could increase during difficult times such as the COVID-19 pandemic. Objectives: This study reports on the state of mental well-being and the degree of psychological distress among pre-hospital care workers (paramedics, emergency medical technicians, doctors, paramedic interns and other healthcare practitioners) during the COVID-19 pandemic in Saudi Arabia. Methods: The study was a cross-sectional survey study in Saudi Arabia. A questionnaire was distributed among pre-hospital care workers in Saudi Arabia during the first wave of the COVID-19 pandemic. The questionnaire was based on the Kessler Psychological Distress Scale (K10) and the World Health Organization Well-Being Index (WHO-5). Results: In total, 427 pre-hospital care providers completed the questionnaire; 60% of the respondents had scores of more than 30 in the K10 and were likely to have a severe disorder. The WHO-5 showed a similar percentage of respondents with a score of more than 50 and coded as having poor well-being. Conclusions: The findings of this study provide evidence around mental health and well-being for pre-hospital care workers. They also highlight the need to better understand the quality of mental health and well-being for this population and to provide appropriate interventions to improve their quality of life.

The role of lean in healthcare during COVID-19 pandemic

PurposeThe impact of the COVID-19 pandemic on healthcare operations has raised questions about the applicability and capacity of the lean approach to respond to critical events. Thus, with a dearth of studies addressing this issue, this study aims to understand the role of lean in healthcare operations under the disruptive impact of the COVID-19 pandemic.Design/methodology/approachDrawing on a case study carried out in an emergency department in Brazil during the COVID-19 outbreak, the author presents results from semi-structured interviews and document analysis.FindingsThe results show three prominent themes that respond to this study's purpose: lean applicability during the pandemic, lean challenges during the pandemic and the pandemic impact on the lean processes. Furthermore, the study underscores that lean is not the panacea to operational problems caused by the pandemic in healthcare organisations, but it eases the impact on their operations. Finally, this study contributes to the discipline of operations management and highlights the need to rethink lean applications during disruptive events, focusing on flexibility, adaptability and patients' needs.Research limitations/implicationsThe literature addressing the pandemic impact on healthcare operations is still new and emerging;therefore, it is possible that some of the studies that are under review and could contribute to this study were not considered.Practical implicationsThe study provides a better understanding of the lessons learned from the real-world experiences gained during the pandemic, helping managers to make informed decisions when developing contingency plans to improve healthcare readiness and responsiveness under crisis conditions (e.g. untenable demand and constrained capacity).Originality/valueGiven the contemporary nature of this pandemic, only few emerging studies addressing the impact of the pandemic on lean healthcare operations are available and scholars are calling for more empirical studies. Furthermore, there is an increasing criticism and scepticism about the applicability of lean in healthcare during a pandemic. Thus, this research both provides original contributions by responding to scholars' calls for novel research in this area and further contributes towards filling the void in the literature.

A Secure and Efficient Scheme for Mutual Authentication for Integrity of Exchanged Data in IoMT

The emergence of pandemic diseases like Covid-19 in recent years has made it more important for Internet of Medical Things (IoMT) environments to build contact between patients and doctors in order to control their health state. Patients will be able to send their healthcare data to the cloud server of the medical service provider in remote medical environments through sensors connected to their smart devices, such as watches or smartphones. However, patients' worries surrounding their data privacy protection are still present. In order to ensure the security and privacy of patients' healthcare data in remote medical environments, a number of different schemes have been proposed by researchers. However, these schemes have not been able to take all security requirements into account. Consequently, in this study, we have proposed a secure and effective protocol to safeguard the privacy of patients' medical data when it is sent to the server. This protocol entails two components: mutual authentication of the patient and the server of the medical service provider, as well as the integrity of the exchanged data. Also, our scheme satisfies security requirements and is resistant to well-known attacks. Following this, we used the Scyther tool to formally analyze our proposed scheme. The results showed that the scheme is secure, and in the section on performance analysis, we demonstrated that the proposed scheme performs better than comparable schemes. © 2023 IEEE.

Smart Ambulance Monitoring System Using Iot

A vehicle which is used to transport patients to hospitals is called as ambulance, this ambulance vehicle is equipped with some vital lifesaving equipment's and first aid medicines. With these medicines and equipment's, the patients are given first aid till it reaches the desired hospital. Whenever a patient is in life-threatening emergency, then the ambulance paramedics should act promptly and must update the status of the patient to their doctors. This type of treatment or service is called Emergency Medical Service (EMS). It deals with immediate treatment and timely movement of the patients. For implementing EMS in ambulance several solutions have been developed for faster means of communication between the equipment's used in ambulance and the doctors. But the solutions are not viable in emergency situations. In additions during Covid wave in 2020 there was a scarcity for hospitals beds, it was filled with many covid patients. In many hospitals there was a queue of ambulances with patients waiting outside the hospitals. In some cases, the patients even died before getting any treatment, to overcome such crucial situations we have come out with a new system combining IoT, Sensor system and Embedded Controllers. The system developed here has sensors to monitor patients' vital parameters and transmits to the hospital server, such that a doctor can know the live condition of the patient and he can give instructions to the paramedics to do emergency aids. The system is a compactable and connects to the server with a mobile hotspot. The information is updated every 10 seconds. By implementing this system in ambulances, it saves many valuable lives of the people.

The value of probabilistic forecasting in emergency medical resource planning under uncertainty

PurposeMost epidemic transmission forecasting methods can only provide deterministic outputs. This study aims to show that probabilistic forecasting, in contrast, is suitable for stochastic demand modeling and emergency medical resource planning under uncertainty.Design/methodology/approachTwo probabilistic forecasting methods, i.e. quantile regression convolutional neural network and kernel density estimation, are combined to provide the conditional quantiles and conditional densities of infected populations. The value of probabilistic forecasting in improving decision performances and controlling decision risks is investigated by an empirical study on the emergency medical resource planning for the COVID-19 pandemic.FindingsThe managerial implications obtained from the empirical results include (1) the optimization models using the conditional quantile or the point forecasting result obtain better results than those using the conditional density;(2) for sufficient resources, decision-makers' risk preferences can be incorporated to make tradeoffs between the possible surpluses and shortages of resources in the emergency medical resource planning at different quantile levels;and (3) for scarce resources, the differences in emergency medical resource planning at different quantile levels greatly decrease or disappear because of the existing of forecasting errors and supply quantity constraints.Originality/valueVery few studies concern probabilistic epidemic transmission forecasting methods, and this is the first attempt to incorporate deep learning methods into a two-phase framework for data-driven emergency medical resource planning under uncertainty. Moreover, the findings from the empirical results are valuable to select a suitable forecasting method and design an efficient emergency medical resource plan.

Privacy-Preserving Fast Three-Factor Authentication and Key Agreement for IoT-Based E-Health Systems

Electronic healthcare (e-health) systems have received renewed interest, particularly in the current COVID-19 pandemic (e.g., lockdowns and changes in hospital policies due to the pandemic). However, ensuring security of both data-at-rest and data-in-transit remains challenging to achieve, particularly since data is collected and sent from less insecure devices (e.g., patients' wearable or home devices). While there have been a number of authentication schemes, such as those based on three-factor authentication, to provide authentication and privacy protection, a number of limitations associated with these schemes remain (e.g., (in)security or computationally expensive). In this study, we present a privacy-preserving three-factor authenticated key agreement scheme that is sufficiently lightweight for resource-constrained e-health systems. The proposed scheme enables both mutual authentication and session key negotiation in addition to privacy protection, with minimal computational cost. The security of the proposed scheme is demonstrated in the Real-or-Random model. Experiments using Raspberry Pi show that the proposed scheme achieves reduced computational cost (of up to 89.9% in comparison to three other related schemes).

Metaverse: An Innovative Model for Healthcare Domain

Present situation after the Coronavirus has made every one of us understand the deficiencies and the impediments of India's medical services area. There was an intense shortage of clinical staff, beds, and other such essential things, which made us believe this is the future to be lived with, and provided that this is true, then, at that point, it is a significant eye-opener for specialists, designers, government and each capable individual to think of an answer for this. This occasion touched off the inclination for the tracking down the arrangement or possibly a stage towards settling or, in any event, restricting this destruction. Metaverse, and its ground-breaking capacities are the same old thing to the world. It's been anticipated that it will revolutionize gaming, association with companions, shopping, and whatnot. But this paper is kept to spotlight the most deserving space, the healthcare sector. Metaverse can change the fortunes of the medical care area. This paper will examine all the potential ways this innovation can be valuable. It can work on obsolete facilities for treatment and educational purposes, and numerous such up-sides have been highlighted beneath. © 2023 IEEE.

Infection prevention and control practices and related factors among paramedics during the coronavirus disease 2019 outbreak in Korea.

This study aimed to investigate the coronavirus disease 2019 (COVID-19) infection prevention and control (IPC) practices and related factors among paramedics. We selected 249 paramedics using convenience sampling from three areas in Korea. Data on the demographics, infection-related characteristics, awareness, and practice of IPC were collected using self-reported questionnaires. The mean IPC practice score was 4.47 ± 0.54. The compliance with IPC practices was relatively high among those with a disease history (B = 0.194, p = 0.045) and who were aware of the safety management standard guidelines. Provision of sufficient protective equipment and infection prevention monitoring were associated with higher IPC practice scores. Education for increasing awareness of the recent IPC guidelines and the allocation of personal protective equipment would be helpful in improving the practice.

Management of centralized transition ward in a large general hospital in Shanghai during the epidemic caused by Severe acute respiratory syndrome coronavirus 2 omicron variant infection

The epidemic of coronavirus disease 2019 (COVID-19) has seriously affected people's normal work, life, and medical treatment. Since Mar. 2022, there has been a pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variant in Shanghai. In order to meet the needs of hospitalization for patients, and at the same time for better control of epidemic and nosocomial infections, a large hospital in Shanghai innovatively set up a centralized transition ward in the hospital, and established scientific rules of medical work, regulations for prevention of nosocomial infections and efficient norms for patient admission. During the operation of the ward, a total of 211 patients were treated and one of the patients was confirmed of COVID-19 recurrence. All work was carried out methodically, and neither hospitalized patients nor medical staff had nosocomial infection of COVID-19. The preparation, operation and management of the central transition ward in our hospital are summarized here to provide guidance and reference for general hospitals to carry out similar work under the epidemic.

Thoughts on diagnosis and treatment plan of patients infected with severe acute respiratory syndrome coronavirus 2 omicron variant in large shelter hospitals in Shanghai

The epidemic caused by the infection of severe acute respiratory syndrome coronavirus 2 omicron variant broke out in Shanghai in Mar. 2022. Omicron variant has characteristics such as strong concealment and rapid transmission, resulting in significant differences between the current round of epidemic and that in Wuhan. The number of infected patients (mainly asymptomatic infected patients) increased rapidly in a short term. Based on dynamic zero policy, shelter hospitals were set up in time in Shanghai to treat the patients. It is suggested that medical resources and patient characteristics should be taken into account in the independent cabin of a shelter hospital with more than 10 000 beds, and the clinical medical practice should be divided to 5 modes (universal education and management, community outpatient clinic, ward duty, emergency rescue, and temporary observation and transport) to optimize the allocation of medical resources, so as to further enhance the treatment capacity and efficiency of shelter hospitals.

Patients' satisfaction with teleconsultations during the COVID-19 pandemic in the Kingdom of Bahrain

Background: The SARS-CoV-2 pandemic led to the restructuring of traditional clinical activity;hence, globally, 58% of countries implemented the use of telemedicine to meet their healthcare needs. Background: To examine patients' satisfaction with telemedicine medical service and experience at the level of primary care in the Kingdom of Bahrain. Methods: A retrospective cross-sectional study was conducted on 335 patients who used teleconsultations in January 2022 in primary care. A validated questionnaire was modified to assess patients' satisfaction with teleconsultation medical services and experience during the COVID-19 pandemic. Results: A total of 315 responses were included in the final analysis (response rate 94%). Almost all expressed extreme satisfaction with the medical service as they were able to easily explain their medical problem over the phone and fully understood their illness after the consultation. They were also satisfied with the ability of the doctor to understand their problem, explain their treatment, and provide appropriate management over the phone. Over 90% were satisfied with the consultation time that it does not require transportation and would like to use it in the future. Sharing private or personal information over the phone received the lowest satisfaction rate (77.5%). Conclusion: The overall satisfaction expressed by respondents of this survey with the teleconsultation medical service and experience is very high. Such a result confirms that patients have a positive attitude towards telemedicine services in primary care and are willing to use it again and, therefore, must be adopted as a proactive strategy to ensure long-term sustainability.

Reasons for the termination of resuscitation in out-of-hospital cardiac arrests before and after the COVID-19 pandemic in Korea

The incidence of out-of-hospital cardiac arrest (OHCA) gradually increased during the coronavirus disease 2019 (COVID-19) pandemic, and the number of cases requiring termination of resuscitation (TOR) also rose. This study aimed to analyze the reasons for TOR of OHCA cases over 2 years (2019–2020). This retrospective observational study was conducted using data gathered from prehospital emergency medical service (EMS) care reports generated in Seoul between 01 January 2019, and 31 December 2020. We included OHCA cases reported to the EMS system in this study. Patients who experienced cardiac arrest for a non-medical cause and received cardiopulmonary resuscitation (CPR) from EMS paramedics at the scene were excluded. The variables of demographics and comorbidities, arrest location, identity of the bystander, cause of cardiac arrest, first monitored electrocardiographic (ECG) rhythm, and reason for TOR were investigated. We compared data for 1 year before and after the start of the COVID19 pandemic. A total of 10,872 OHCAs with TOR were included in this study;of these, 6238 cardiac arrest cases were terminated without resuscitation attempts during the COVID-19 period compared to 4634 during the pre-COVID-19 period. During the COVID-19 period, the proportion of women in the total population decreased, while the median age increased (p < 0.001). Patients with comorbidities, the frequency of asystole rhythm at first monitoring, and the number of witnessed cardiac arrests significantly increased (p < 0.001). The proportion of TOR cases due to decisions made by a medical director and refusal of CPR by family members also significantly increased, while that due to clear evidence of death decreased (p < 0.001). In conclusion, there was a significant change in the reason for TOR before and after the COVID-19 pandemic in Korea. [ FROM AUTHOR] Copyright of Signa Vitae is the property of Pharmamed Mado Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Post-epidemic era: changing and restructuring

The changes in the fields of education, business administration, transportation, science and technology innovation, logistics and supply chain management, etc. caused by the COVID-19 pandemic in the post-epidemic era are reviewed in this paper, with research topics such as China's management of medical and health institutions, public health emergency governance, community governance, and national governance being emphasized. The "resilient governance" which is more flexible and resilient has become the common choice both at the national governance level under the background of globalizaiton and at the emergency of public health governance level which pays more attention on the community governance. At the same time, building an institutional coordination and collaboration mechanism that is more adaptable to the post-epidemic era is also a major challenge to future governance. Based on the above analysis, this paper conducts an in-depth analysis of the vague definition of the concept of "post-epidemic era", and discusses the current problems of inadequate use of research methods, inadequate research design, and separation of theoretical and practical values of the research. Finally, from the perspective of restructuring, the future governance concepts and governance models in the post-epidemic era are prospected.

Challenges of Emergency Medical Services Response to Arasbaran Twin Earthquakes; a Content Analysis.

Introduction: One of the most important concerns in responding to disasters is providing Basic Life Support (BLS) services. Considering the key role of Emergency Medical Services (EMS) in providing BLS, the purpose of this study is to investigate the experience of provincial EMS during their response to the Arasbaran twin earthquakes and its challenges in Iran. Methods: This study was conducted using a qualitative approach and the conventional content analysis method. Data were collected through Focused Group Discussions (FGD) and semi-structured in-depth interviews with purposively-selected EMS paramedics and officials in East Azerbaijan Province, Iran. To form the main categories, the interviews were encoded in three stages and the similar codes were placed under the same subcategories and merged. Results: A total of 26 EMS paramedics participated in the study. The codes extracted from the interviews, after three stages of reduction, were placed in the top ten categories, including the lack of preparedness and coordination, dead bodies' management challenges, responders' psychosocial support, deficiencies in supplies and ambulances, difficulty of access to rural areas, volunteer management, non-documentation of the experiences, communication challenges, recalling, and deploying of EMS responders. Conclusion: Timely response of the EMS and paramedics' sense of responsibility for providing services were positive and successful points about the emergency response operations. The weaknesses of EMS should, therefore, be addressed through transferring of experiences and by planning and arranging training courses.