Evaluating the performance of selected military hospitals in Tehran in response to Covid-19 pandemic: A cross-sectional study.

Background and Aims: The rapid spread of coronavirus disease 2019 (Covid-19) led the need to admit a large number of infected people to hospitals in a short period of time, turning them into one of the most important responsive organizations. This study aims to evaluate the performance of selected military hospitals because they carried out a military operation in Tehran in response to the recent pandemic. Methods: This is a descriptive-analytical study. The statistical population of this study consisted of military hospitals responding to Covid-19 pandemic in Tehran. A checklist to evaluate the performance of hospitals in response to Covid-19 pandemic (six areas, 23 sub-areas and 152 items) was used as a data collection tool in this study. This tool had six domains, including risk management and planning, coordination and communication, infection prevention and control, diagnosis and treatment, education and training, and resource management. Results: The overall performance of selected hospitals was 63%, which indicated a good performance. The domain of coordination and communication obtained the lowest score. Conclusion: The investigated hospitals had good performance because they had a desirable access to resources. Periodic self-assessment and accreditation is recommended to improve the performance of these hospitals.

Hospital Performance Evaluation Checklist in Context of COVID-19 Pandemic: Design and Validation.

OBJECTIVE: Around the world, pandemics have been considered among the main hazards in the last 2 decades. Hospitals are 1 of the most important organizations responding to pandemics. The aim of this study was to design and develop a valid checklist for evaluating the hospitals' performance in response to COVID-19 pandemic, for the first time. METHODS: This study is a mixed method research design that began in February, 2020 and was conducted in 3 phases: Designing a conceptual model, designing a primary checklist structure, and checklist psychometric evaluation. Known-groups method has been used to evaluate construct validity. Two groups of hospitals were compared: group A (COVID-19 Hospitals) and group B (the other hospitals). RESULTS: The checklist's main structure was designed with 6 main domains, 23 sub-domains, and 152 items. The content validity ratio and index were 0.94 and 0.79 respectively. Eleven items were added, 106 items were removed, and 40 items were edited. Independent t-test showed a significant difference between the scores of the 2 groups of hospitals (P < 0.0001). Pearson correlation coefficient test also showed a high correlation between our checklist and the other. The internal consistency of the checklist was 0.98 according to Cronbach's alpha test. CONCLUSIONS: Evaluating the hospitals' performance and identifying their strengths and weaknesses, can help health system policymakers and hospital managers, and leads to improved performance in response to COVID-19.

Components of Health Surveillance System in Natural Disasters that Affect Military Health Services: A Systematic Review.

Background: Military health surveillance system, as the first responder in natural disasters, plays an important role in public health. This study aimed to identify those components of the health surveillance system, which influence military health services in natural disasters. Methods: Five databases of Medline, SCOPUS, Web of Science, ProQuest, Cochrane Library, and search engines of Scholar Google, scienceopen.com, openGery.eu, and WHO.int were reviewed from Jan 1990 to Jan 2022. Due to the heterogeneity of the included studies, various JBI quality assessment tools were applied and the extracted data were analyzed by meta-synthesis method. Results: Out of 6538 retrieved studies, after the duplicates and irrelevant studies identified in screening stage were removed, 174 studies extracted from the electronic search of databases and 16 studies retrieved from the manual search of other sources were reviewed based on the study inclusion criteria. Finally, 24 studies with inclusion criteria were selected for data extraction. Ten criteria of monitoring, detecting, data collection and reporting, tracking, type of surveillance system, operational readiness, coordination and interaction, feasibility, flexibility, and acceptability were identified as effective components in the surveillance system of military health services. The identified components were classified into two main categories of structural and operational components. Conclusion: The structural components of the military health surveillance system describe the important infrastructural features of the health surveillance system to preparing for natural disasters; and the operational components explains the effective functional features of military health surveillance system in response of natural disasters. The results of this study help policymakers in military health services implement a more effective health surveillance system in natural disasters.

Structural Elements and Requirements in Forming Prehospital Health Response Teams in Response to Chemical, Biological, Radiation, and Nuclear Incidents (CBRN), a Comparative Review Study.

One of the important indicators of increasing the capacity of the health system and the chances of survival of patients and injured immediately after chemical, biological, radiation and nuclear (CBRN) accidents is rapid access to medical services. Establishing prehospital health response teams is one of the main strategies to improve the capacity and ability to respond to unusual events. The aim of this study was to investigate the factors influencing the formation of rapid response teams in the field of health in response to chemical, biological, radiation and nuclear accidents (CBRN EDMRT). In this study, the comparative review method was used. The study period was from November 1, 2021 to March 2022. Forming and deploying rapid health response teams based on an extensive multi-step search and keywords in multiple databases such as PubMed, CINHAL, Blackwell, Iranmedex, SID, Cochrane Database of Systematic Reviews, Google Scholar, Scopus Also, the websites of the Ministry of Health and the responsible organizations in different countries and the proposed structure were done by international institutions and sites. After accessing the resources and documents, the process of analysis and comparison of different team structures was performed. After the initial search, the structure and required elements of their teams were extracted. According to published articles and texts, 10 teams from the International Atomic Energy Agency (IAEA), the US Centers for Disease Control and Prevention (CDC), the US Department of Homeland Security, and the North Atlantic Treaty Organization (NATO), Australia, the British Public Health Organization, and the Japanese Red Cross were compared. Team requirements, population distribution, type of accident, level of team activity and training, equipment required by the team after the accident, according to which, each country/organization should consider the above factors to design and establish the structure of CBRN EDMRT to take. A study should be conducted to design a comprehensive and evidence-based structure.

Respond quickly and effectively! Components of the military health surveillance system in natural disasters: A qualitative study.

BACKGROUND: The systematic collection, analysis, and interpretation of health data by health surveillance systems provide timely and comprehensive surveillance of public health, identification health priorities, and, consequently, a quick and timely response to reduce damage during natural disasters. Since military forces appear as first responders at the scene of accidents, the present study aimed to identify the components of the military health care system during natural disasters. MATERIALS AND METHOD: Qualitative data collected through semi-structured interviews were analyzed via the conventional content analysis approach to identify the components of the military health care system in natural disasters. The participants consisted of 13 experts who were experienced in providing health services in the military and the civilian health care system during natural disasters in January 2022 to June 2022. RESULT: The identified components were classified into four main categories, namely, pre-requisite components (comprehensive health care, defined position, and providing information), driving components (system efficiency, effective communication), operational components (contingent performance, effective response), and promotional components (purposeful support, pre-disaster preparation). CONCLUSION: In conclusion, the military health surveillance system is a cooperative service for the national health system in which data is essential for making decisions on health and treatment measures during disasters. This study-by identifying four categories of the important components in the design, implementation, and development of the military health surveillance system-provides a comprehensive view of an appropriate and evidence-based military surveillance system in disasters.

Hospital disaster risk management improving strategies: A systematic review study.

OBJECTIVE: Hospitals are the basic infrastructure for disaster response. While they themselves are exposed to disasters, they also play an important role during the disaster response period. Therefore, they are expected to be able to maintain their performance during and immediately after disasters. The aim of this study is to discover strategies to improve the hospital disaster risk management. DESIGN: This study is a systematic qualitative study with thematic analysis. Data sources including Persian and international databases were searched using the "Hospital, Disaster, Risk management, Risk reduction, Improvement, and Strategy" keywords and their combinations of them. The search time period ranged from January 2010 to January 2020. Data were extracted by two independent arbitrators for qualitative thematic analysis. RESULTS: In total, 889 articles and documents were retrieved. Of which, 166 articles were deleted due to duplication, 436 articles did not meet the objectives of the research, and 263 articles did not meet the eligibility criteria and were deleted. Finally, 24 articles were included in the study. After thematic analysis, 33 subthemes were obtained and classified into five themes of organizational-managerial strategies, preventive and risk reduction strategies, preparedness strategies, response strategies, and recovery strategies. Not all articles discuss all categories. CONCLUSION: Applying strategies to improve the hospital disaster risk management resulting from this study can be useful in improving the preparedness of hospitals in the face of disasters.

Disaster risk management challenges in military hospitals: A qualitative study.

BACKGROUND: Disaster can pose significant challenges to the health infrastructure in the community. Hospitals are the central unit for providing health services in the disaster response plan. With regard to the vital role of military hospitals in health response to disaster, this study was carried out with the aim of investigating the disaster risk management (DRM) challenges in military hospitals in Iran. MATERIALS AND METHODS: The current study was qualitative research performed in 2020 in military hospitals in Iran. Participants consisted of 12 managers and staff of the military hospitals in Tehran and professionals in health in emergencies and disasters who were included in the study by the purposive sampling technique. Semistructured individual interviews based on the interview guide were exploited for the data collection, and a content analysis method was used to analyze them. RESULTS: DRM challenges in military hospitals were explained in the form of six categories: "management and leadership, planning, prevention and mitigation, preparedness, response, and recovery" and 22 subcategories. CONCLUSION: Managers' awareness of DRM challenges in hospitals, particularly military hospitals, and the design and implementation of solutions can lead to the promotion of hospital DRM and hospital preparedness to deal with disasters.

Level of Fear in Front-Line Nurses During the COVID-19 Pandemic, a Cross-Sectional Study in Iran.

INTRODUCTION: The front-line nurses are at risk of physical and psychological damage during an epidemic. This study aimed to investigate the level of nurses' fear in coronavirus disease 2019 (COVID-19) central hospitals in Iran. METHODS: The study is cross-sectional. The questionnaire was designed in 2 parts (demographic and the level of fear). The sampling method was quota and random. The questionnaires were completed by the same nurses after 4 weeks. RESULTS: A total of 345 questionnaires were distributed (the response rate was 89.27%). A total of 121 nurses (39.3%) were female. Most participants were in the 26-30 y group. paired t-test showed the mean fear of COVID-19 in the first and the fourth weeks was significant (P < 0.001). There was a statistical relationship between demographic variables of gender, age, marriage, number of working shifts, having children, and work experience of nurses with the level of fear. CONCLUSIONS: Health-care providers have shown resilience and a spirit of professional sacrifice to overcome problems. The nurses experienced a level of disease-related fear in close contact with COVID-19 patients. It is essential to apply strategies to optimize safe working conditions and minimize psychological harm and provide regular and intensive training to all health-care providers to improve preparedness.

The Current State of Infectious Disasters Preparedness Around the World: A Qualitative Systematic Review (2007-2019).

Infectious disasters have specific features which require special approaches and facilities. The main challenge is the rate of spread, and their ability to traverse the Earth in a short time. The preparedness of hospitals to face these events is therefore of the utmost importance. This study was designed to assess the preparedness of countries facing biological events worldwide. A qualitative systematic review was done from PubMed (National Library of Medicine, Bethesda, MD), Scopus (Elsevier, Amsterdam, Netherlands), Web of Science (Thomson Reuters, New York, NY), ProQuest (Ann Arbor, MI), and Google Scholar (Google Inc, Mountain View, CA). Two journals were searched as key journals. The search period was from January 1, 2007 to December 30, 2018. Twenty-one (21) documents were selected including 7 (33%) from Asia, 7 (33%) from Europe, 4 (19%) from USA, 2 (10%) from Africa, and 1 (5%) multi-continental. Forty-six (46) common sub-themes were obtained and categorized into 13 themes (infection prevention control, risk perception, planning, essential support services, surveillance, laboratory, vulnerable groups, education and exercise and evaluation, human resource, clinical management of patients, risk communication, budget, and coordination). Not all articles discussed all the identified categories. There is an extended process required to reach complete preparedness for confronting biological events, including adequate and well-managed budget. Medical centers may have trouble dealing with such events, at least in some respects, but most developed countries seem to be more prepared in this regard.

Challenges of Hospital Disaster Risk Management: A Systematic Review Study.

OBJECTIVE: This study aimed to investigate the challenges of hospital disaster risk management so that it can take a step to provide strategies and interventions to remove these barriers and improve the hospital disaster risk management (HDRM) through identifying and introducing them to disaster experts. METHODS: This is a systematic qualitative review study. Data sources included Persian and international databases, which were searched using the keywords of hospital, disaster, risk management, risk reduction, disaster and challenge, and the combination of them. The search period ranged from January 2010 to January 2020. Data were extracted by 2 independent examiners for qualitative thematic analysis. RESULTS: A total of 762 articles and documents were recovered. Finally, 12 articles entered the study, including 7 studies from Asia, 2 articles from Europe, 2 articles from the United States, and 1 article about Africa. After thematic analysis, 17 sub-themes were achieved and were classified into 4 subjects of technical-physical barriers, organizational-managerial barriers, financial barriers, and human barriers. All articles have not discussed on all categories. CONCLUSIONS: The results of evaluating the challenges of hospital disaster risk management gained from this study can be beneficial in developing a roadmap to improve the status of HDRM.

Designing and Validation of the Nurses' Preparedness to Response to COVID-19 Questionnaire in Iran.

OBJECTIVE: Nurses are considered key members to respond to incidents and disasters. As many patients are hospitalized during the coronavirus disease (COVID-19) pandemic, and nurses are directly in contact with these patients; their preparedness enables them to respond to this situation more effectively and protects their health. Therefore, the present study aimed to design and validate a questionnaire to measure the nurses' preparedness in response to COVID-19 in Iran in 2020. METHODS: This study was a mixed research aiming to develop and validate a psychometric research instrument in 2020. Based on the review of the literature regarding COVID-19 and other viral respiratory infections, the items were extracted, rewritten, and validated. In the quantitative phase, the validity of the questionnaire was evaluated in terms of face, content, and construct validity, and its reliability was evaluated based on internal consistency and stability (Cronbach's alpha and Intra-class Correlation Coefficient [ICC]). To fill out the questionnaire, the nurses were selected by random sampling. Data analysis was done by the SPSS software, version 23 (IBM Corp, Armonk, NY). RESULTS: The designed questionnaire included 9 dimensions and 50 items. The dimensions included (1) Incident Command System (ICS); (2) risk assessment and management; (3) information and communication management; (4) psychological approaches; (5) personal protective equipment; (6) prevention of contamination, isolation, and quarantine; (7) education and training; (8) patient management; and (9) features of the new coronavirus. The content and face validity of the questionnaire were approved by the specialists and experts of nursing and health in disasters and emergencies. The content validity ratio was > 0.7 for all items. The content validity index was also approved for all items. The Cronbach's alpha coefficient and ICC were respectively 0.71 and 0.72 for the total questionnaire. The total score was determined based on 5 ranges, including 50-89 (very low preparedness), 90-129 (low preparedness), 130-170 (medium-level preparedness), 171-210 (high preparedness), and 211-250 (very high preparedness). CONCLUSION: Nurses' preparedness to respond to this pandemic requires multilateral measures. Measuring the nurses' preparedness can clarify the challenges in hospital measures taken to respond to this crisis. Evaluating the nurses, determining the challenges and priorities, and finding solutions to resolve them can improve the nurses' performance in providing health care services. Preparation of nurses during pandemics can reduce the damages to this group and maximize their efforts to protect the patients. Thus, health planners and policy-makers should try to promote the nurses' awareness and preparedness.

Management Challenges of Informal Volunteers: The Case of Kermanshah Earthquake in Iran (2017).

OBJECTIVES: Two of the 5 great earthquakes have occurred in Iran between 1990 and 2005. Informal volunteers' management is a determinant factor in disaster management. This research was conducted to investigate the management challenges of informal volunteers after the Kermanshah earthquake. METHODS: The study is qualitative, done by content analysis. Data were gathered by observation and semi-structured interview. RESULTS: Analysis of 12 interviews resulted in 4 main categories (inappropriate dispatch, volunteers' inefficiency, decrease in volunteers' incentive, deficiency of welfare services) and 11 subcategories. DISCUSSION: To avoid mistrust and decrease in motivation, proposed actions are: standardize information collection, apply effective communication, create registration networks and accreditation of certificates and expertise, and perform periodic drills. CONCLUSION: We recommend the start of extracurricular programs and applying potential volunteers within the preparedness phase, and follow-up at the beginning of the response phase. Decrease of motivation to participate in future events needs to be studied more comprehensively.

Factors affecting hospital response in biological disasters: A qualitative study.

Background: The fatal pandemics of infectious diseases and the possibility of using microorganisms as biological weapons are both rising worldwide. Hospitals are vital organizations in response to biological disasters and have a crucial role in the treatment of patients. Despite the advances in studies about hospital planning and performance during crises, there are no internationally accepted standards for hospital preparedness and disaster response. Thus, this study was designed to explain the effective factors in hospital performance during biological disasters. Methods: Qualitative content analysis with conventional approach was used in the present study. The setting was Ministry of Health and related hospitals, and other relevant ministries responsible at the time of biologic events in Islamic Republic of Iran (IR of Iran) in 2018. Participants were experts, experienced individuals providing service in the field of biological disaster planning and response, policymakers in the Ministry of Health, and other related organizations and authorities responsible for the accreditation of hospitals in IR of Iran. Data were collected using 12 semi-structured interviews in Persian language. Analysis was performed according to Graneheim method. Results: After analyzing 12 interviews, extraction resulted in 76 common codes, 28 subcategories, and 8 categories, which are as follow: detection; treatment and infection control; coordination, Resources; training and exercises; communication and information system; construction; and planning and assessment. Conclusion: Hospital management in outbreaks of infectious diseases (intentional or unintentional) is complex and requires different actions than during natural disasters. In such disasters, readiness to respond and appropriate action is a multifaceted operation. In IR of Iran, there have been few researches in the field of hospital preparation in biologic events, and the possibility of standardized assessment has be reduced due to lack of key skills in confronting biological events. It is hoped that the aggregated factors in the 8 groups of this study can evaluate hospital performance more coherently.

Civil-Military Coordination (CIMIC) Model in Natural Disasters in Iran.

OBJECTIVE: The present study aimed at codifying a native model of civil-military coordination (CIMIC) in natural disasters in Iran. METHODS: This manuscript is a part of a larger study. The present cross-sectional study was conducted in 2019 using a two-stage Delphi technique. The factors confirmed by the technique were prioritized via a pairwise questionnaire. In doing so, 24 elites and experts in civil-military coordination were presented with the indicators in the course of classic Delphi technique and pairwise comparison. At the end, the nationalized model was finalized by sending the model to ten experts and asking their ideas. RESULTS: The results obtained from the two rounds of Delphi indicated that 36 coordination factors could be classified into three primary classes of staff, stuff, and system. All factors were confirmed by the experts. Considering the weight of each class, "staff" and "stuff" classes were considered to be the highest and lowest priorities, respectively. CONCLUSION: Application of the coordination factors in the context of military and civil organizations leads to a better response to natural disasters. The organizations in charge of responding to disasters should be obliged to apply this model in the highest organizational commitment level as the final goals of disaster management. The results of the present study can be applied for codification of a comprehensive plan for assessing the civil-military coordination in natural disasters.