Ethical Considerations for Living in Temporary Shelters (i.e., camps) Following a Natural Disaster.

BACKGROUND: Some disasters, such as earthquake and flood make the majority of affected people homeless. The accommodation of these people in temporary shelters and camps requires some specific ethical issues. The aim of the present study was to discuss ethical issues regarding living in camps following natural disasters. METHODS: This study is conducted utilizinga qualitative content analysis approach. The required data were collected from four Focus Group Discussions (FGDs). Subsequently, 11 in-depth interviews were completed using the individuals who had the experience of receiving care following natural disasters and continued until data saturation. Data were analyzed using Graham content analysis method. RESULTS: According to the results obtained from affected people's views, the most important ethical issues that are not considered important in temporary shelters and camps include:1) the violation of privacy,2) the shortage of basic needs (e.g., food, water, and sanitation) and type and quality of services rendered,3) lack of attention to cultural and religious views of the affected people, 4) cause of evacuation, 5)lack of co-operation among disaster managers, 6)respecting the properties of the affected people, 7)conditions and geographic location of camps, 8)property care, and 9)community-based care. CONCLUSION: Without paying attention to ethical issues, living in temporary shelters (i.e., camps) violates the dignity of affected people and then the affected people will not have appropriate cooperation with the managers. All these issues expose them to more harm than before.

Ethical Issues in Technological Disaster: A Systematic Review of Literature.

BACKGROUND: Industrialization could bring risk of Technological Disaster (TD) such as happened in Chernobyl, Bhopal and Fukushima crisis. Little has been discussed about its related ethical issues. In this study, we aimed to investigate ethical issues have been stated for technological disasters. METHODS: A systematic search was conducted on the main international literature databases including Pubmed, Embase, Scopus and ISI (Jan 1, 2000 to Jan 1, 2018). From 64articles were eligible for investigation of ethical issues in Natural disaster, 6 was related to Technological Disaster. The articles were in English language. RESULTS: Our result show that there are seven articles discussing ethical issues during Technological disaster. All of them are related to nuclear crisis in Fukushima resulting from Japan tsunami 2011. These articles discussed mainly three ethical issues in providing medical care to victims of Technological Disasters as follow: 1- Duty of care 2- Mandatory evacuationand3- Resource Allocation. CONCLUSION: Victim health is the main factor for making decision and implementation of any programs during response to disasters. Mandatory Evacuation for reasons other than providing health to people (such as: maintain public order) and if bring health risk to people will be unjustified. Duty of health workers for providing care is based on General beneficence meanwhile it is necessary to provide facilities to protect them from dangers that treat them in the field. For act ethically, Health workers must have adequate preparedness for response to T-D meanwhile it is necessary to provide guidelines for individuals that participation in relief operation. It is necessary to discuss more about Technological Disaster Ethics especially in industrial countries and where there is especial industrial with potential of huge crises.

Trend of elevator-related accidents in tehran.

BACKGROUND: Elevator-related accidents are uncommon, but can cause significant injury. However, little data exist on these types of accidents. To compile and analyze accident data involving elevators in an effort to eliminate or at least significantly reduce such accidents. METHODS: In this retrospective study we investigated 1,819 cases of elevator-related accidents during a four-year period (1999-2003) in Tehran. The data were obtained from the Tehran Safety Services & Fire Fighting Organization (TSFO) that is officially and solely responsible to conduct rescue missions of civilians in Tehran. RESULTS: The number of elevator accidents has increased steadily during the four year study period. During these four years there was a positive upward trend for serious injuries and mortality resulting from elevator accidents. Technical problems were the main cause with 74.5%, followed by power loss and overcapacity riding with 11.5% and 7.9% respectively. Sixty-three individuals sustained serious injury and 15 people died as a result of elevator accidents. The number of accidents was significantly higher in summer (x2=18.32, P=0.032) and a considerable proportion of incidences (54%, 947 cases out of 1819) occurred between 5 and 12 pm. CONCLUSIONS: Establishment of an organization to inspect the settings, maintenance, and repair of elevators is necessary.

Mortality and injuries among Iranians in Iraq-Iran war: a systematic review.

BACKGROUND: The Iraq-Iran war was one of the longest conflicts in the twentieth century. The aim of our research was to review the incidence of mortality and injuries of the war. METHODS: A search strategy was designed and run in Medline, EMBASE, Scopus, and Iranian databases including Scientific Information Database (SID), IranMedex, and Magiran. Also, searching grey literature, checking references, tracking citations, hand-searching of focused journals, and websites were utilized for retrieval of related studies. All of articles which studied epidemiology of mortality or injuries of the war were included. The excluding criteria were case reports, case series, laboratory researches, and nonoriginal studies. RESULTS: Fourteen articles out of 1751 primary results were selected to be included in the study. During the war (1980 - 1988), 188,015 to 217,489 Iranians were killed (about 70 people per day). The mean age of mortality was 23 years. Six thousand four hundred twenty-seven (2.9%) of those who died during the war were females. One thousand five chemical warfare victims died between 1983 and 1994. From 1985 through 1998, 82 veterans had successful suicides too. At the end of war, we had 398, 587 veterans who needed follow- up. Among them, there were 52,000 chemical warfare victims. Between 1988 and 2003, 1400 people died and 2313 injured due to landmines and unexploded ordnances in five border provinces. CONCLUSION: The war caused a lot of mortalities and morbidities in our country. Now, 24 years after the war, many physically, mentally, and chemically injured victims have remained. We suggest other studies about indirect impacts of the war on societies, families, friends, and affiliates of the victims.

Civilian casualties of Iraqi ballistic missile attack to Tehran, capital of Iran.

OBJECTIVE: To determine the pattern of causalities of Iraqi ballistic missile attacks on Tehran, the capital of Iran, during Iraq-Iran war. METHODS: Data were extracted from the Army Staff Headquarters based on daily reports of Iranian army units during the war. RESULTS: During 52 days, Tehran was stroked by 118 Al-Hussein missiles (a modified version of Scud missile). Eighty-six missiles landed in populated areas. During Iraqi missile attacks, 422 civilians died and 1 579 injured (4.9 deaths and 18.3 injuries per missile). During 52 days, 8.1 of the civilians died and 30.4 injured daily. Of the cases that died, 101 persons (24%) were excluded due to the lack of information. Among the remainders, 179 (55.8%) were male and 142 (44.2%) were female. The mean age of the victims was 25.3 years+/-19.9 years. Our results show that the high accuracy of modified Scud missiles landed in crowded areas is the major cause of high mortality in Tehran. The presence of suitable warning system and shelters could reduce civilian casualties. CONCLUSION: The awareness and readiness of civilian defense forces, rescue services and all medical facilities for dealing with mass casualties caused by ballistic missile attacks are necessary.

Trauma care system in Iran.

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Seat belt use during pregnancy in Iran: attitudes and practices.

OBJECTIVE: Seat belt use during pregnancy reduces injury to the mother and her fetus. During recent years, the use of seat belts has been mandated by law in Iran. The purpose of this study was to determine the attitudes and practices of pregnant women regarding seat belt use. METHODS: In this cross-sectional study, we asked 335 pregnant women at a hospital-based prenatal care clinic on the use of safety belt before and during pregnancy. SPSS version 13.0 was used for data analysis. RESULTS: The mean age of study subjects was 27.3 years ± 5.3 years with the median of 27 years. Compared with the seat belt use before pregnancy, no change was detected in 48.7% of the women; seat belt use had increased in 17.5 % of them and decreased in 33.8 %. Eighty-one percent of women knew the correct placing of both lap belt and shoulder belt. Only 4% of women had received education on proper restraint use during pregnancy. CONCLUSIONS: The prevalence of seat belt use during pregnancy is lower than reports which are mostly from developed nations. The fact that about one-third of women have decreased their seat belt usage during pregnancy highlights the importance of education of mothers on this topic.

Traumatic vascular injuries of the lower extremity: report of the Iranian National Trauma Project.

BACKGROUND: This study aimed to determine the pattern of traumatic lower extremity vascular injuries in Iran. METHODS: Patients with vascular injury of the lower extremity were selected from the Iranian National Trauma Project. This project was conducted in eight major cities during 2000-2004 and consisted of more than 17000 patients. RESULTS: Sixty-three subjects (54 men) with a total of 92 vascular injuries of the lower extremity were identified. Mean age of the patients was 25.87 +/- 13.37 years. Blunt trauma was more frequent than penetrating (62% vs. 38%). In 36 cases (57%), road traffic crash (RTC) was the cause of injury. In 21% of the patients (n=24), vascular injury resulted from occupational trauma. Workers (n=23, 20%) were the most frequently affected group. Three patients (5%) died due to severity of the associated injuries. CONCLUSION: Our results revealed that RTC is the most frequent cause of lower extremity vascular injuries in Iran. Our findings also showed that occupational injuries have considerable prevalence. Establishment of preventive strategies to reduce the frequency of these injuries is recommended.

Extremity fractures in children: a hospital based study in Tehran.

OBJECTIVE: Although long bone fracture in children is not life-threatening, it may cause major disability, loss of working days and severe psychological distress. We conducted this study to determine the pattern of extremity fracture due to trauma in children. METHODS: During one year in six general hospitals in Tehran, trauma patients who were hospitalized for more than 24 hours and sustained injuries within seven days before admission were included in the study. The records of children (< or = 16 years old) hospitalized in six general hospitals in Tehran due to trauma were reviewed prospectively. RESULTS: During the study period, 1 274 children had sustained extremity fractures. Male to female ratio was 3.6/1, with the mean age of (10.3+/-4.2) years. Falls and traffic crashes were the main causes of injuries, with the percentages of 57.3% and 37.1%, respectively. Simple fall (falling on the ground) consisted 60% of patients that sustained fall-related injuries. Pedestrians and bicycle riders comprised most of the cases that were injured due to traffic crashes. Of our cases, 56.8% sustained fractures in the upper extremities and 43.2% in the lower extremities. Forearm was the most common fracture site (34.1%). Comparing our results in preschool and school-age children, falls were the main cause of injuries in both groups, but fractures of lower extremities were significantly more common in preschool children. CONCLUSIONS: Improvement of physical condition of sidewalks and crossings in roads will be necessary for prevention of injuries. More attention to safety of home environment should be paid for control of preschools'injury at home. Education of children and adults is necessary to reduce injuries resulting from road traffic crashes.

Civilian casualties of Iranian cities by ballistic missile attacks during the Iraq-Iran war (1980-1988).

OBJECTIVE: To determine the nature and extent of Iranian casualties by ballistic missile attacks during the eight years of the Iraq-Iran war. METHODS: The data collected about Iraqi missile strikes on Iranian cities included the following: date and time, number and type of missiles, cities targeted, and injuries and deaths resulting from impacts of missiles in civilian areas. The data were extracted from a database that was constructed by the army staff headquarters based on daily reports of Iranian army units during the war. RESULTS: Over a period of eight years (1980-1988), Iraqi army fired 533 ballistic missiles at Iranian territories. From those, 414 missiles (77.7%) landed on Iranian cities. The impacts of these missiles caused the deaths of 2,312 civilians and injured 11,625 others. Three types of ballistic missiles were used: FROG-7, Scud, and Al-Hussein (a modified version of the Scud missile). Twenty-seven cities in Iran were struck by Iraqi ballistic missiles. The highest mortalities from ballistic missiles were in Dezful and Tehran. Iraqi missile attacks continued for 90 months (2,748 days). CONCLUSION: Our results point to the necessity of investigating the psychological consequences of Iraqi ballistic missile attacks among survivors in 27 Iranian cities during the eight years of the Iraq-Iran war.

Epidemiology of outpatient burns in Tehran: an analysis of 4813 cases.

This study aims to demonstrate the epidemiologic characteristics of outpatient burn injuries in Tehran. This cross-sectional study was performed over a 1-year period in a referral burn centre in Tehran and included all outpatient burns. The required data were recorded by two trained physicians. Of the 4813 studied patients, including 293 infants, 2901 patients (60%) were male (P<0.001). The mean age of the adult patients was 31.3+/-18.3 years, while for infants it was 10.68+/-2.27 months. In all age groups and both genders, scalding was the most common aetiology. Majority of the burns were non-intentional (n=4808) and 70.5% of the injuries occurred at home. Housewives consisted of 24% of the burn patients. With respect to the site of burn, multiple injuries were the most frequent (53%) followed by upper extremities (37%). Most of the burns (96%) were partial thickness. Significant association was present between the aetiology and depth of burn (P<0.001). The mean affected total body surface area (TBSA) was 3.16+/-2.92% and there was significant association between burnt TBSA and the mechanism of injury (P<0.001). In conclusion, it seems that women aged 21-30 years and children younger than 10 years are at greater risk of these injuries and therefore should be the target for preventive strategies.

Trauma research in Iran: a report of the Sina Trauma Data Bank.

BACKGROUND: Injuries are a major health problem in developing countries. Recently, the occurrence of injuries and those related to mortality have increased dramatically in Iran. We have conducted this study to report domestic research publications in the field of trauma from 2000 to 2006 in Iran. METHODS: The contents of 128 biomedical journals were analyzed. Sina Trauma Data Bank (STDB) was selected as an indicator of trauma related articles that have been published in Iranian biomedical journals. RESULTS: The number of trauma related articles in Iran increased during the seven year period (2000 - 2006), but the percentage of total publications was not significantly different. The mean number of authors per article was 2.7+1.3 (1 to 12) and all first authors were Iranian. Females constituted 15.4% (n=156) of first authors. Original articles were the most frequently published articles (n=871; 86.2%). Treatment of injuries and ensuing complications were the most common topics (42%) followed by war injuries (14.1%). Traffic accidents, as the leading cause of trauma death in Iran, were investigated in 27 (2.7%) articles. CONCLUSION: According to our results, it seems that more attention from researchers and health-policy makers towards trauma is necessary in our country. In addition, publishing a journal with the main theme of injury and trauma could be an effective means for increasing the proportion of trauma related articles.

Hospital management of abdominal trauma in Tehran, Iran: a review of 228 patients.

OBJECTIVE: Today, trauma is a major public health problem in some countries. Abdominal trauma is the source of significant mortality and morbidity with both blunt and penetrating injuries. We performed an epidemiological study of abdominal trauma (AT) in Tehran, Iran. We used all our sources to describe the epidemiology and outcome of patients with AT. METHODS: This study was done in Tehran. The study population included trauma patients admitted to the emergency department of six general hospitals in Tehran during one year. The data were collected through a questionnaire that was completed by a trained physician at the trauma center. The statistical analysis was performed using the SPSS software (version 11.5 for Windows). The statistical analysis was conducted using the chi-square and P < 0.05 was accepted as being statistically significant. RESULTS: Two hundred and twenty-eight (2.8%) out of 8,000 patients were referred to the above mentioned centers with abdominal trauma. One hundred and twenty-five (54.9%) of the patients were in their 2nd and 3rd decades of life and 189 (83%) of our patients were male. Road traffic accidents (RTA) were the leading cause of AT with 119 (52.2%) patients. Spleen was the commonly injured organ with 51 cases. Following the analysis of injury severity, 159 (69.7%) patients had mild injuries (ISS < 16) and 69 (30.3%) patients had severe injuries (ISS equal to 16). The overall mortality rate was 46 (20.2%). CONCLUSIONS: Blunt abdominal trauma is more common than penetrating abdominal trauma. Road traffic accidents and stab wound are the most common causes of blunt and penetrating trauma, respectively. Spleen is the most commonly injured organ in these patients. The mortality rate is higher in blunt trauma than penetrating one.

Mortality of the Iranian ex-prisoners of war in Iraqi detention camps (1980-1990).

BACKGROUND: The present study aimed to determine the rate and cause of the mortality of the Iranian ex-prisoners of war in Iraqi detention camps during a ten- year period (1980 - 1990) according to the documented reports. METHODS: The information extracted from the documented death certifications that have been provided by the Iraqi authorities and the Red Cross delegation. RESULTS: At least a total of 564 Iranian prisoners of war died due to the various reasons in Iraqi detention camps that show a mortality rate of 1.4% (564/40,000). The mean captivity-to-death interval was 440 (from one to 3582) days and the registered prisoners had more duration of captivity than the unregistered (1285 vs. 215 days, P= 0.001). The median and mean ages of the individuals at the time of death were 22 and 26.4+/-13 years, respectively. The mean age of the civilians was higher than the others (45.3 vs. 23.7, P=0.0001). The cause of death was not clear for 44.3% of the individuals but among the others, infectious diseases (such as dysentery, sepsis, and meningitis) and injuries (resulting from war injuries and/or torture by Iraqi forces) were the main causes of death with 15.4% and 15.6%, respectively. CONCLUSION: It seems that the mortality of the Iranian ex-prisoners of war in Iraq is more than previously reported. Therefore, more investigation is recommended to determine the exact number of the Iranian prisoners who died in Iraq.

Patterns of extremity traumas leading to amputation in Iran: results of Iranian National Trauma Project.

OBJECTIVE: To determine the patterns of traumatic extremity injuries leading to amputation in Iran. METHODS: Data of Iranian National Trauma Project was used to identify patients with upper and lower extremity traumas undergoing amputation. This project was conducted in 8 major cities during 2000-2004. RESULTS: Of 17 753 traumatic patients, 164 (0.92%) had injuries to the extremities that resulted in the limb amputation. Of these, 143 (87.2%) were men. The patient's mean age was 29.0 years +/- 15.4 years and the highest incidence was seen in the age group of 21 to 30 years (34.1%). One hundred and four cases were occupational accidents (63.4%). Blunt trauma was in 54.9% of the cases. The most common reasons for amputation were respectively stabbings (37.8%) and crush injuries (31.7%). Amputation of hand fingers was the most frequent type of amputation (125 cases, 76.2 %). One patient died from severe associated injuries. CONCLUSIONS: This study shows the patterns of traumatic limb amputation in Iran, a developing country. Results of this study may be used in preventive strategic planning.

Analysis of 274 patients with extremity injuries caused by the Bam earthquake.

OBJECTIVE: The extremity injury pattern after a major earthquake is not well understood because data on this type of injury and management are limited. The aim of this study was to analyze the data of trauma patients with extremity injury in the earthquake of Bam Iran, registering 6.6 on the Richter scale. METHODS: We reviewed medical records of 486 patients admitted to hospitals of Tehran University of Medical Sciences. Among them, 274 patients sustained extremity injuries. This group was composed of 138 females (50.4%) and 136 males (49.6%) and 213 cases (77.7%) were under 40 years of age. RESULTS: Fracture was the major type of injury (58.4% of extremity injuries). The most common sites of injury were lower extremities (185 patients, 67.5% of all victims). Pelvic and rib fractures and abdominal injuries were the most frequently associated injuries. The mean ISS was 6.2+/-4.0, and 61% of the patients had ISS less than 7. Amputation and death occurred in 2.9% and 2.5% of cases, respectively. CONCLUSIONS: Special attention should be given to dealing with orthopedic injuries in similar disasters in the future.

Civilian traumatic vascular injuries of the upper extremity:report of the Iranian national trauma project.

PURPOSE: The determination of the pattern of traumatic vascular injuries of the upper extremity in Iran was the aim of this study. METHODS: Data of the Iranian national trauma project were used to identify patients with upper extremity vascular injuries. This project was conducted in 8 major cities from 2000-2004. RESULTS: A total of 113 cases with 130 vascular injuries were found, including 2 axillary, 18 brachial, and 69 radial and ulnar arteries. In 91 cases (81%), penetrating trauma was responsible. Associated nerve and/or upper extremity fractures were seen in 20% and 18% of cases, respectively. End-to-end anastomosis, interposition of saphenous graft, and ligation were used for the management of 44%, 28%, and 17%, respectively, of brachial artery injuries. Ulnar and radial artery injuries had been either ligated (n = 36; 52%) or sutured (n = 33; 48%). Median, ulnar, and radial nerve injuries, except for one, had all been sutured primarily. No patients needed fasciotomy. Amputation and mortality resulting from associated injuries occurred in 3 (2.6%) and 5 (4.4%) patients, respectively. CONCLUSION: This study revealed that stabbings are the most frequent causes of these injuries in Iran, in spite of the management of patients in level 3 trauma centers; the rate of amputation is acceptable. However, this study does not provide limb functions of the patients.

Prognostic factors in the persistence of posttraumatic epilepsy after penetrating head injuries sustained in war.

OBJECT: The goal of this paper was to investigate the long-term outcome and the possible prognostic factors that might have influenced the persistence of posttraumatic epilepsy after penetrating head injuries sustained during the Iraq-Iran war (1980-1988). METHODS: In this retrospective study, the authors evaluated 189 patients who sustained penetrating head injury and suffered posttraumatic epilepsy during the Iraq-Iran war (mean 18.6 +/- 4.7 years after injury). The probabilities of persistent seizures (seizure occurrence in the past 2 years) in different periods after injury were estimated using the Kaplan-Meier method. The possible prognostic factors (patients and injury characteristics, clinical findings, and seizure characteristics) were studied using log-rank and Cox regression analysis. RESULTS: The probability of persistent seizures was 86.4% after 16 years and 74.7% after 21 years. In patients with < 3 pieces of shrapnel or no sphincter disturbances during seizure attacks, the probability of being seizure free after these 16 and 21 years was significantly higher. CONCLUSIONS: Early seizures, prophylactic antiepileptics drugs, and surgical intervention did not significantly affect long-term outcome in regard to persistence of seizures.

Childhood injuries in Tehran: a review of 1281 cases.

Childhood injuries cause significant mortality and morbidity in Iran, like in other developing countries. This study was undertaken to describe the pattern of pediatric trauma in a multi-center hospital-based study. Pre-hospital and hospital data were prospectively gathered on all hospitalized trauma patients admitted to six major trauma hospitals in Tehran from August 1999 to September 2000. Data from patients 12 years of age and younger were analyzed for this article. About 15.1% of the hospitalized trauma cases belonged to children. Mean age was 7.35 +/- 3.25 years and 69.1% of cases were male. Most of the cases were injured accidentally. More than half of the cases were injured due to falls, followed by road traffic accidents. Injuries in streets were the most common, followed by injuries at home. Recently, several injury prevention strategies have been designed and developed in Iran, and it is hoped these may contribute to decreasing the burden of childhood injuries in Iran.