Risk communication and community engagement as an emerging pillar of health emergency management in Iran: Achievements and the way forward.

This article is part of the Research Topic Health Systems Recovery in the Context of COVID-19 and Protracted Conflict. Risk communication and community engagement (RCCE) is an essential component of emergency preparedness and response. In Iran, RCCE is a relatively new area of public health. During the COVID-19 pandemic in Iran, the national task force relied on conventional methods, which is to utilize existing primary health care (PHC) structure to implement RCCE activities around the country. The PHC network and the community health volunteers embedded in it enabled the country to bridge the health system and communities from the very beginning of the COVID-19 pandemic. The RCCE strategy to respond to COVID-19 was adapted over time with the development of a national program, commonly known as the "Shahid Qassem Soleimani" project. This project consisted of six steps including case detection, laboratory testing through the establishment of sampling centers, scale up of clinical care to vulnerable groups, contact tracing, home care for vulnerable population, and COVID-19 vaccination roll out. Nearly 3 years into the pandemic, the importance of designing RCCE for all types of emergencies, allocating a dedicated team to RCCE, coordinating with different stakeholders, improving the capacity of RCCE focal points, practicing more efficient social listening, and using social insight for better planning were identified as some lessons learned. Further, Iran's RCCE experience during the COVID-19 pandemic underscores the importance of continuing to invest in the health system, particularly PHC.

Prioritized Criteria for Casualty Distribution following Trauma-related Mass Incidents; a Modified Delphi Study.

INTRODUCTION: In the aftermath of mass casualty incidents (MCIs), many decisions need to be made in a fast and influential manner in a high pressure environment to distribute the limited resources among the numerous demands. This study was planned to rank the criteria influencing distribution of casualties following trauma-related MCI. METHODS: This study utilized a modified Delphi methodology, concentrating on extracted criteria attained from preceding systematic literature reviews. The 114 extracted criteria were classified into eight sections including space, staff, equipment, system and structures, triage, treatment, transport, and uncategorized criteria and were imported into an online survey tool. In the first round, experts were asked to rank each criterion on a five-point Likert scale. The second round incorporated feedbacks from the first round, stating percent and median scores from the panel as a whole. Experts were then called upon to reassess their initial opinions regarding uncertain remarks from the first round, and once again prioritize the presented criteria. RESULTS: Fifty-seven criteria were regarded as relevant to the following sections: space: 70% (7/10); staff: 44% (4/9); system / structure: 80% (4/5); equipment: 39.1% (9/23); treatment; 66.7% (6/9); triage: 73.7% (14/19); transport: 38.7% (12/31) and other sections: 12.5% (1/8). The first round achieved nearly 98% (n=48) response rate. Of the 114 criteria given to the experts, 68 (almost 60%) were approved. The highest percentage of approval belonged to the system and structures sections (4/5=80%). The response rate for the second round was about 86% (n=42). A consensus could be reached about nearly 84% (57) of the 68 criteria presented to experts. CONCLUSION: "Casualty Level of Triage on the Scene" and "Number of Available Ambulances" were the two criteria that obtained the highest level of consensus. On the other hand, "gender of casualty", "Number of Non-Medical staff in each Hospital" and "Desire to transport family members together" got lowest level of consensus. This sorted list could be used as a catalogue for developing a decision support system or tool for distribution of victims following mass casualty incidents.

A systematic literature review of criteria and models for casualty distribution in trauma related mass casualty incidents.

INTRODUCTION: Mass casualty incidents impose a large burden on the emergency medical systems, hospitals and community infrastructures. The pre-hospital and hospital capacities are usually bear the burden of casualties large numbers. One of the challenging issues in mass casualty incidents is the distribution of casualties among the suitable health care facilities. OBJECTIVE: To review models and criteria affecting the distribution of casualties during the trauma-related mass causality incidents. MATERIALS AND METHODS: A systematic literature search in the scientific databases which included: PubMed, Scopus and Web of Science was conducted. Relevant literature which was published before August 2017 was searched. Neither the publication date nor language limitations were considered in the literature search. All the trauma-related mass casualty incidents are included in this study. Two independent reviewers conducted the data extraction and quality assessment of the documents was considered using a checklist developed by the researchers. RESULTS: Literature search yielded 4540 documents of which 493 were duplicated and removed. After reviewing the titles and abstracts of the remaining documents (4047), only 73 documents were considered relevant. Finally, the inclusion and exclusion criteria were applied and only 30 documents were considered for data extraction and quality assessment. The study found 491 criteria to be affecting the distribution of casualties following trauma-related mass casualty incidents. These are categorized as pre-hospital (triage, treatment and transport); hospital (space, staff, stuff, system / structure); incidents' characteristics and others. The criteria which were extracted from the models are termed as "model extracted" while the other labeled as "author suggested". CONCLUSION: To the best of our knowledge, this is the first systematic literature review on criteria affecting distribution of casualties following trauma-related mass casualty incidents based on the pre-hospital and hospital capacities. SYSTEMATIC REVIEW REGISTRATION NUMBER: This review was registered in international prospective register of systematic reviews (PROSPERO) with registration number CRD42016049115.

Criteria and models for the distribution of casualties in trauma-related mass casualty incidents: a systematic literature review protocol.

BACKGROUND: One of the most critical practices in mass casualty incident management is vacating the victims from scene of the incident and transporting them to proper healthcare facilities. Decision on distribution of casualties needs to be taken on pre-developed policies and structured decision support mechanisms. While many studies tried to present models for the distribution of casualties, no systematic review has yet been conducted to evaluate the existing models on casualty distribution following mass casualty incidents. A systematic review is therefore needed to examine the existing models of patient distribution and to provide a summary of the models. This systematic review protocol is aimed to examine the existing models and extracting rules and principles of mass casualty distribution. METHODS: This study will comprehensively investigate existing papers with search phrases and terms including "mass casualty incident", distribution, evacuation, and Mesh terms directly corresponding to search phrases. No limitations on the type of studies, date of publication, or language of the relevant documents will be imposed. PubMed, Web of Science, Scopus, and Google Scholar will be searched to access the relevant documents. Included papers will be critically appraised by two independent reviewers. The data including incidents type, scene characteristics, patient features, pre-hospital resources, and hospital resources will be categorized. Subgroup analysis will be conducted when possible. DISCUSSION: To the best of our knowledge, no study has yet addressed the effects and interaction of contributing factors on the decision-making processes for casualty's distribution. This is the first study that comprehensively assesses and critically appraises the current models of casualty distribution. This study will provide evidences about models and criteria for casualty distribution following mass casualty incidents. SYSTEMATIC REVIEW REGISTRATION: PROSPERO Registration Number: CRD42016049115.