نشریه علمی پژوهشی طب انتظامی Journal of Police Medicine
Volume 11, Issue 1 (2022)
J Police Med 2022, 11(1) |
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Ethics code: IR.LUMS.REC.1399.154
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asadi H, Bajoulvand R, Garavand A, mohammadi R, mirshekar-jahangiri L. A Review of Studies Conducted to Evaluate the Preparedness of Medical Centers Against the Potential Risks of Natural Disasters in Iran. J Police Med 2022; 11 (1) : e17
URL: http://jpmed.ir/article-1-1061-en.html
URL: http://jpmed.ir/article-1-1061-en.html
Heshmatollah Asadi1, Razyeh Bajoulvand2, Ali Garavand3, Rasool Mohammadi4, Leila Mirshekar-jahangiri *5
1- Department of Health Economics, School of Medicine, Shahed University, Tehran, Iran
2- Department of Public Health, School of Health & Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
3- Department of Health Information Management, School of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran
4- Department of Biostatistics & Epidemiology, School of Health & Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
5- Department of Environmental Health, School of Health and & Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran ,leila.mg.mu@gmail.com
2- Department of Public Health, School of Health & Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
3- Department of Health Information Management, School of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran
4- Department of Biostatistics & Epidemiology, School of Health & Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
5- Department of Environmental Health, School of Health and & Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran ,
English Extended Abstract: (2067 Views)
INTRODUCTION
... [1, 2]. Iran is one of the 10 most prosperous countries in the world due to its extent, geographical location, and climatic diversity [3]. In 2015, the Islamic Republic of Iran ranked ninth in the world in terms of the number of deaths due to disasters with 319,000 deaths, most of which were due to earthquakes and floods [4]. ... [5, 6]. In the event of an unexpected disaster, hospitals are considered to be the most important centers for victims of accidents [1] and their effective and timely medical care services can play a vital and decisive role in reducing mortality and rescuing victims [7]. Although the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has set specific standards for the preparation of hospitals, unfortunately, many hospitals do not follow these standards [6]. ... [8, 9]. In a review study conducted by Bazyar et al. in 2020, the results showed that the readiness of Iranian hospitals is 53%, which is at the average level [10]. Also, the results of a study in Iran show that the low level of disaster readiness in hospitals in the western and southern regions of the country is more noticeable [11].
AIM(S)
The purpose of this study was to review the readiness of medical centers against the potential risks of natural disasters in Iran
RESEARCH TYPE
The present study is a review study.
RESEARCH SOCIETY, PLACE AND TIME
All articles resulting from studies conducted in Iran, using the checklist of ten domains of Hojjat et al. [12] and reporting the readiness of hospitals were reviewed.
SAMPLING METHOD AND NUMBER
Four databases including Google Scholar, PubMed, Scopus, and Web of Science, and four Iranian databases including SID, Magiran, Civil, and Irandoc were examined. Keywords such as hospital, disaster, earthquake, flood, readiness, natural disaster, Iran, were used to access the resources. The resources list (Reference of Reference) of the articles was also reviewed to identify other related studies. Published sources in Persian and English were studied and the study period was limited from 2008 to 2019.
USED DEVICES & MATERIALS
The quality of the articles was evaluated based on the STROBE checklist and the poor quality articles (including one article) were removed from the study and other studies entered the content analysis level. The most important difference between the present study and other review studies conducted in Iran (concerning the readiness of hospitals against potential disaster risks) is that only studies were reviewed that used a common checklist of the Hojjat et al. in this questionnaire, the readiness status based on the obtained percentage is respectively 0-19 very poor readiness, 20-39 poor, 59-40 moderate, 60-79 good and 80-100 very good.
FINDING BY TEXT
Among 17 published articles, one article was excluded due to poor quality and finally, 16 articles were entered for final analysis. Among the studies selected for the final analysis, two studies were conducted throughout the country, two in Tehran, three in the west, three in the east, five in the south, and one in the northwest. In total, 118 hospitals were studied that 41 state hospitals, 17 military hospitals, 8 private hospitals, and three of them were social security hospitals. The type of possession of other hospitals (49 hospitals) was not mentioned in the studies (Table 1). The highest level of readiness was related to Kermanshah hospitals with 75% readiness and the lowest level was related to Bandar Abbas hospitals with 38.6% readiness (Table 2). In general, the readiness of the studied hospitals with a score of 52.18% was at an average level. The lowest level was related to the acceptance with a score of 37.98% and the highest level was related to the support with a score of 62.31% (Table 3).
MAIN COMPARISON TO THE SIMILAR STUDIES
Based on the findings, the level of general readiness of the studied hospitals against disasters was assessed at a moderate level (52.18%). In line with the results of the present study, the results of the study of Asefzadeh et al. (2016) have shown that the overall readiness of hospitals in all three dimensions of structural, non-structural, and functional is moderate [25]. The results of the study by Djajali et al. (2013) show that all Swedish hospitals are at a high level of readiness; while Iranian hospitals are at an average level [26]. ... [27]. According to the studies compared with the present study, it was found that hospitals in developed countries such as Sweden, England, Lithuania, and Luxembourg were more prepared than Iranian hospitals. The present study showed that the level of readiness of the studied hospitals was poor (37.98%) in terms of admission. The results of this study are consistent with the study of Bazyar et al. [10], which was performed on 36 studies with the research community of 181 hospitals in Iran. Also, the results of a review study conducted by Rezaei et al. (2018) to assess the readiness of 1,047 hospitals in 50 countries using the WHO guideline, show that hospital readiness for disasters in the area of triage is poor (16.28%) [28]. Therefore, hospital admissions in Iran, like many other countries, do not have the appropriate level of disaster readiness. In the study of Kazemzadeh et al., the readiness of emergency departments of 51 Iranian hospitals in the face of disasters has been assessed at a moderate to the high level, which is in line with the present study [29]. One of the reasons why the emergency department is more prepared than other departments may be related to the nature of the emergency department's work. ... [30].
LIMITATIONS
In assessing the readiness of hospitals for emergencies, many variables are involved, including time, geographical conditions, type of accident, the hospital’s involvement in the crisis, and the number of clients, which make comparisons difficult. The research team also did not have information about the people who completed the checklists in the hospitals, and the views or tastes of different people may have influenced the scoring.
SUGGESTIONS
To identify weaknesses and strengthen all aspects related to hospital readiness, a disaster response maneuver should be held at least once a year under the supervision of the Ministry of Health. Maneuvering helps hospitals improve their capacity through practice. It is also suggested to use international standards such as WHO standards to improve the level of disaster readiness of Iranian hospitals and to accredit hospitals through international institutions. It is also recommended to conduct supplementary research on the most important problems of hospital admissions during disasters. The role of the military in all aspects of disasters, especially security, can complement the actions of hospitals. It is suggested that researchers study the coordination and interactions between hospitals and the military and examine the strengths and weaknesses, threats and opportunities of these interactions.
CONCLUSIONS
The readiness of Iranian hospitals is average. Also, the readiness of the studied hospitals was poor in terms of admission and moderate in terms of emergency, transfer and evacuation, traffic, communications, safety, human resources, as well as management and command. In terms of education and support, the level of readiness of the studied hospitals is good.
ACKNOWLEDGMENTS
This study was conducted with the support of the Deputy of Research and Technology of Lorestan University of Medical Sciences in the form of a research project number IR.LUMS.REC.1399.154. Thus, the mentioned deputy is appreciated and thanked.
CONFLICT OF INTEREST
The authors state that there is no conflict of interest in the present study.
FUNDING SOURCES
This study was conducted with the financial support of the Deputy of Research and Technology of Lorestan University of Medical Sciences.
TABLES AND CHARTS
Table 2) Findings of the studies based on the questionnaire of Hojjat et al
Table 3) Hospital readiness status based on ten dimensions
... [1, 2]. Iran is one of the 10 most prosperous countries in the world due to its extent, geographical location, and climatic diversity [3]. In 2015, the Islamic Republic of Iran ranked ninth in the world in terms of the number of deaths due to disasters with 319,000 deaths, most of which were due to earthquakes and floods [4]. ... [5, 6]. In the event of an unexpected disaster, hospitals are considered to be the most important centers for victims of accidents [1] and their effective and timely medical care services can play a vital and decisive role in reducing mortality and rescuing victims [7]. Although the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has set specific standards for the preparation of hospitals, unfortunately, many hospitals do not follow these standards [6]. ... [8, 9]. In a review study conducted by Bazyar et al. in 2020, the results showed that the readiness of Iranian hospitals is 53%, which is at the average level [10]. Also, the results of a study in Iran show that the low level of disaster readiness in hospitals in the western and southern regions of the country is more noticeable [11].
AIM(S)
The purpose of this study was to review the readiness of medical centers against the potential risks of natural disasters in Iran
RESEARCH TYPE
The present study is a review study.
RESEARCH SOCIETY, PLACE AND TIME
All articles resulting from studies conducted in Iran, using the checklist of ten domains of Hojjat et al. [12] and reporting the readiness of hospitals were reviewed.
SAMPLING METHOD AND NUMBER
Four databases including Google Scholar, PubMed, Scopus, and Web of Science, and four Iranian databases including SID, Magiran, Civil, and Irandoc were examined. Keywords such as hospital, disaster, earthquake, flood, readiness, natural disaster, Iran, were used to access the resources. The resources list (Reference of Reference) of the articles was also reviewed to identify other related studies. Published sources in Persian and English were studied and the study period was limited from 2008 to 2019.
USED DEVICES & MATERIALS
The quality of the articles was evaluated based on the STROBE checklist and the poor quality articles (including one article) were removed from the study and other studies entered the content analysis level. The most important difference between the present study and other review studies conducted in Iran (concerning the readiness of hospitals against potential disaster risks) is that only studies were reviewed that used a common checklist of the Hojjat et al. in this questionnaire, the readiness status based on the obtained percentage is respectively 0-19 very poor readiness, 20-39 poor, 59-40 moderate, 60-79 good and 80-100 very good.
FINDING BY TEXT
Among 17 published articles, one article was excluded due to poor quality and finally, 16 articles were entered for final analysis. Among the studies selected for the final analysis, two studies were conducted throughout the country, two in Tehran, three in the west, three in the east, five in the south, and one in the northwest. In total, 118 hospitals were studied that 41 state hospitals, 17 military hospitals, 8 private hospitals, and three of them were social security hospitals. The type of possession of other hospitals (49 hospitals) was not mentioned in the studies (Table 1). The highest level of readiness was related to Kermanshah hospitals with 75% readiness and the lowest level was related to Bandar Abbas hospitals with 38.6% readiness (Table 2). In general, the readiness of the studied hospitals with a score of 52.18% was at an average level. The lowest level was related to the acceptance with a score of 37.98% and the highest level was related to the support with a score of 62.31% (Table 3).
MAIN COMPARISON TO THE SIMILAR STUDIES
Based on the findings, the level of general readiness of the studied hospitals against disasters was assessed at a moderate level (52.18%). In line with the results of the present study, the results of the study of Asefzadeh et al. (2016) have shown that the overall readiness of hospitals in all three dimensions of structural, non-structural, and functional is moderate [25]. The results of the study by Djajali et al. (2013) show that all Swedish hospitals are at a high level of readiness; while Iranian hospitals are at an average level [26]. ... [27]. According to the studies compared with the present study, it was found that hospitals in developed countries such as Sweden, England, Lithuania, and Luxembourg were more prepared than Iranian hospitals. The present study showed that the level of readiness of the studied hospitals was poor (37.98%) in terms of admission. The results of this study are consistent with the study of Bazyar et al. [10], which was performed on 36 studies with the research community of 181 hospitals in Iran. Also, the results of a review study conducted by Rezaei et al. (2018) to assess the readiness of 1,047 hospitals in 50 countries using the WHO guideline, show that hospital readiness for disasters in the area of triage is poor (16.28%) [28]. Therefore, hospital admissions in Iran, like many other countries, do not have the appropriate level of disaster readiness. In the study of Kazemzadeh et al., the readiness of emergency departments of 51 Iranian hospitals in the face of disasters has been assessed at a moderate to the high level, which is in line with the present study [29]. One of the reasons why the emergency department is more prepared than other departments may be related to the nature of the emergency department's work. ... [30].
LIMITATIONS
In assessing the readiness of hospitals for emergencies, many variables are involved, including time, geographical conditions, type of accident, the hospital’s involvement in the crisis, and the number of clients, which make comparisons difficult. The research team also did not have information about the people who completed the checklists in the hospitals, and the views or tastes of different people may have influenced the scoring.
SUGGESTIONS
To identify weaknesses and strengthen all aspects related to hospital readiness, a disaster response maneuver should be held at least once a year under the supervision of the Ministry of Health. Maneuvering helps hospitals improve their capacity through practice. It is also suggested to use international standards such as WHO standards to improve the level of disaster readiness of Iranian hospitals and to accredit hospitals through international institutions. It is also recommended to conduct supplementary research on the most important problems of hospital admissions during disasters. The role of the military in all aspects of disasters, especially security, can complement the actions of hospitals. It is suggested that researchers study the coordination and interactions between hospitals and the military and examine the strengths and weaknesses, threats and opportunities of these interactions.
CONCLUSIONS
The readiness of Iranian hospitals is average. Also, the readiness of the studied hospitals was poor in terms of admission and moderate in terms of emergency, transfer and evacuation, traffic, communications, safety, human resources, as well as management and command. In terms of education and support, the level of readiness of the studied hospitals is good.
ACKNOWLEDGMENTS
This study was conducted with the support of the Deputy of Research and Technology of Lorestan University of Medical Sciences in the form of a research project number IR.LUMS.REC.1399.154. Thus, the mentioned deputy is appreciated and thanked.
CONFLICT OF INTEREST
The authors state that there is no conflict of interest in the present study.
FUNDING SOURCES
This study was conducted with the financial support of the Deputy of Research and Technology of Lorestan University of Medical Sciences.
TABLES AND CHARTS
Table 1) Description of studies (Tools used: Hojjat et al. Checklist)
| Row | Author and the year | Type of study | Province (city) | Number of studied hospitals | Type of hospital studied | The result of evaluating the quality of articles (Score) |
|||
| Public | Private | Social security | Military | ||||||
| 1 | Sobhani et al. 2012 | Cross section | Bandar abbas | 9 | 4 | 2 | - | 3 | Medium(12) |
| 2 | Hosseini et al. 2016 | Cross section | North Khorasan | 9 | Unknown | Unknown | Unknown | Unknown | Good (15) |
| 3 | Salari et al. 2011 | Cross section | shiraz | 14 | 8 | 6 | - | - | Good (18) |
| 4 | Daneshmandi et al. 2009 | Cross section | Iran | 30 | Unknown | Unknown | Unknown | Unknown | Medium(13) |
| 5 | Amerion et al 2013 | Cross section | Iran | 12 | - | - | - | 12 | Medium(13) |
| 6 | Kardan Moghadam et al 2011 | Cross section | Birjand | 3 | 2 | - | 1 | - | Good (15) |
| 7 | Motaghyan Nejad et al 2017 | Cross section | Mashhad | 1 | - | - | - | 1 | Medium(8) |
| 8 | Jalil et al 2016 | Cross section | Kohgiluyeh and Boyer-Ahmad | 3 | 3 | - | - | - | Good (16) |
| 9 | Hojjat et al 2006 | Cross section | Tehran | 13 | 13 | - | - | - | Medium(14) |
| 10 | Hojjat et al 2010 | Cross section | Jahrom | 2 | 2 | - | - | - | Good (19) |
| 11 | Vali et al 2011 | Cross section | Tabriz | 6 | 6 | - | - | - | Medium(13) |
| 12 | Daneshmandi et al 2014 | Cross section | Tehran | 1 | Unknown | Unknown | Unknown | Unknown | Good (17) |
| 13 | Mansoori et al 2017 | Cross section | Kermanshah | 1 | - | - | - | 1 | Medium(14) |
| 14 | Vahedparast et al 2009 | Cross section | Bushehr | 9 | Unknown | Unknown | Unknown | Unknown | Good (17) |
| 15 | Ezzati et al 2016 | Cross section | Kermanshah | 2 | - | - | 2 | - | Medium(14) |
| 16 | Mohammadi et al 2016 | Cross section | Kermanshah | 3 | 3 | - | - | - | Good (17) |
Table 2) Findings of the studies based on the questionnaire of Hojjat et al
| Row | Author and year | Result | Readiness status |
| 1 | Qasem Sobhani et al. 2012 [13] | According to the readiness scores, 3 hospitals were very poor, 2 hospitals were poor, 2 hospitals were moderate, 1 hospital was good and 1 hospital was very good. The readiness of the studied hospitals in each of the areas is 55.1% emergency, 31.4% admission, 28.1% transfer, 33.3% traffic, 30.6% communication, 34.6% security,. 53.5% training, 53.5% support, 38.6% human resources, 20.1% management and command, respectively. | The general condition was poor readiness (Poor). The overall readiness score of 85.3 was equal to 38.6%. |
| 2 | Seyed Hamid Hosseini et al. 2016 [5] | According to the scores, the readiness of 2 hospitals was poor, 5 hospitals were moderate and 2 hospitals were good. The readiness of the studied hospitals in each of the areas are 50% emergency, 33.33% admission, 33.33% transfer, 46.66% traffic, 38.89% communication, 41.18% security, education 02,. 46.4%, support 61.90%, human resources 44.44%, management and command 41.92%, respectively. |
The general condition was moderate. The overall readiness score was 88.3% and equivalent to 46.4%. |
| 3 | Hedayat Salari et al. 2011 [6] | According to the scores, the readiness of 3 hospitals was poor, 4 hospitals were moderate, 6 hospitals were good and 2 hospitals were very good. The readiness of the studied hospitals in each of the areas is 77.6% emergency, 64.1% admission, 48.1% transfer, 48.8% traffic, 52.3% communication, 53.6% security. Training was 61.5%, support 63.7%, human resources 71.7%, management and command 67%, respectively. |
The general condition was good. The overall readiness score of 138.4 was equal to 62.38%. |
| 4 | Daneshmandi et al. 2010 [14] | According to the scores, the readiness of all 3 hospitals was average. The readiness of the studied hospitals in each of the areas are 64.4% emergency, 20.8% admission, 48.8% transfer, 48.8% traffic, 54.2% communication, 45% security, education 6, 68.2%, support 70.2%, human resources 44.3%, management and command 80%, respectively. |
The general condition was moderate. The overall readiness score was 54.5%. |
| 5 | Ahmad Ameriun et al. 2013 [15] | The readiness of the studied hospitals in each of the areas is 53.29% emergency, 46.89% admission, 45.65% transfer, 58.81% traffic, 69.09% communication, 68.87% security, Training was 69.61%, support 52.58%, human resources 51.46%, management and command 52.40%, respectively. | The general state of readiness was moderate. The overall readiness score was 56.80%. |
| 6 | Vida Kardan Moghadam et al. 1390 [16] | According to the readiness status scores, only the studied hospital was moderate. The readiness of the studied hospitals in each of the areas are 36.37% emergency, 58.26% admission, 45.43% transfer, 52.77% traffic, 28.51% communication, 49.07% security, Training was 44.17%, support 66.41%, human resources 60.92%, management and command 56.11%, respectively. | The general state of readiness was moderate. The overall readiness score was 52.27%. |
| 7 | Abbas Motaghiannejad et al. 2017 [17] | According to the readiness status scores, only the studied hospital was moderate. The readiness of the studied hospitals in each of the areas is 58.92% emergency, 38.43% admission, 40.69% transfer, 26.41% traffic, 44.59% communication, 53.34% security, Training was 27.06%, support 25.87%, human resources 52.37%, management and command 47.19%, respectively. | The general state of readiness was moderate. The overall readiness score was 41.48%. |
| 8 | Mohsen Jalil et al. 2016 [18] | According to the scores, the readiness of 1 hospital was poor and 2 hospitals were moderate. The readiness of the studied hospitals in each area is 49% emergency, 37.6% admission, 33.2% transfer, 42.33% traffic, 39.56% communication, 35.26% security, education 57,. Percentage was 53.8% support, 54.6% human resources, 47% management and command, respectively. | The general state of readiness was moderate. The overall readiness score was 44.8%. |
| 9 | Mohsen Hojjat et al. 2006 [12] | The readiness of the studied hospitals in each of the areas are 48.20% emergency, 38.32% admission, 39.63% transfer, 52.33% traffic, 52.14% communication, 61.19% security. Training was 66.65%, support 68.97%, human resources 43.80%, management and command 48.17%, respectively. | The general state of readiness was moderate. The overall readiness score was 51.94%. |
| 10 | Mohsen Hojjat et al. 2010 [19] | According to the scores, the readiness of 1 hospital was poor and 1 hospital was well prepared. The readiness of the studied hospitals in each of the areas is 53.8% emergency, 31.66% admission, 10.27% transfer, 36.66% traffic, 34.16% communication, 50.41% security. Training was 85%, support 41.66%, human resources 47.33%, management and command 38.33%, respectively. | The general state of readiness was moderate. The overall readiness score was 42.78%. |
| 11 | Leila vali et al. 2011 [3] | According to the scores, the readiness of 1 hospital was very poor, 4 hospitals were moderate and 1 hospital was good. The readiness of the studied hospitals in each of the areas are 54% emergency, 30% admission, 45% transfer, 58% traffic, 49% communication, 47% security, 45% education, 57% support, 45% human resources, management and command was 48%, respectively. | The general state of readiness was moderate. The overall readiness score was 48%. |
| 12 | Mohammad Daneshmandi et al. 2016 [20] | According to the readiness status scores, only the studied hospital was moderate. The readiness of the studied hospital in each of the areas is 66.7% emergency, 41.7% admission, 46.7% transfer, 33.3% traffic, 50% communication, 64.7% security, education 2/2, 41%, support 64.3%, human resources 61.9%, management and command 68.2%, respectively. | The general state of readiness was moderate. The overall readiness score was 54%. |
| 13 | Hossein Mansouri et al. 2017 [21] | According to the readiness status scores, only the studied hospital was moderate. The readiness of the studied hospital in each of the areas are 46.7% emergency, 54.2% admission, 63.3% transfer, 33.3% traffic, 25% communication, 70.7% security, education 59%, Support was 67.9% and management and command was 40.9%, respectively. | The general state of readiness was moderate. The overall readiness score was 46.8%. |
| 14 | Hakimeh Vahedparast et al. 2009 [22] | The readiness of the studied hospitals in each area is 53.80% emergency, 40.47% admission, 43.33% transfer, 19.04% traffic, 45.53% communication, 35.29% security, Training was 38.65%, support 53.26%, human resources 49.65%, management and command 36.36%, respectively. | The general state of readiness was moderate. The overall readiness score was 40.94%. |
| 15 | Ebrahim Ezzati et al. 2016 [23] | According to the scores, the readiness of both hospitals was good. The readiness of Shohada Hospital in each of the areas is 56.6% for emergency, 30% for admission, 56.6% for transfer, 13.3% for traffic, 81.3% for communications, 61.2% for security, 94.1% for education. Percentage was 71.5% support, 60% human resources, 86.4% management and command, respectively The readiness of Hazrat Masoumeh Hospital in each of the areas is 90% emergency, 33.3% admission, 50% transfer, 53.3% traffic, 56.2% communication, 83.3% security, and 82.3% education, Support was 75.5%, human resources 60%, management and command 77.2%, respectively. |
The general state of readiness was good. The overall readiness score of Shohada Hospital was equal to 61%. The overall readiness score of Hazrat Masoumeh Hospital was 66%. |
| 16 | Saeed Mohammadi et al. 2016 [24] | The readiness of 1 hospital was moderate and 2 hospitals were good. The mean readiness of these three hospitals was 43.4%, 84.5% and 99.1%, respectively. The readiness of the studied hospitals in each of the areas are 76.6% emergency, 75% admission, 77.7% transfer, 68.8% traffic, 70.8% communication, 79.6% safety, education 4, 76%, support 65.9%, human resources 70%, management and command 89.4%, respectively. | The general state of readiness was good. The overall readiness score was 75%. |
Table 3) Hospital readiness status based on ten dimensions
| Dimensions | Readiness (percentage)* | Readiness level |
| Emergency | 58.90 | medium |
| the reception | 37.98 | Weak |
| Transfer and evacuation | 43.72 | medium |
| the traffic | 46.58 | medium |
| connections | 50.30 | medium |
| Safety | 50.25 | medium |
| Education | 60.51 | Good |
| Support | 62.13 | Good |
| human resources | 49.74 | medium |
| Management and command | 57.12 | medium |
| Total | 52.18 | medium |
* Standard deviation has not been reported in the records.
Article number: e17
Keywords: Hospitals [MeSH], Disasters [MeSH], Iran [MeSH], Natural Disaster [MeSH], Emergency Preparedness [MeSH]
Article Type: Systematic Review |
Subject:
Crisis Medicine
Received: 2021/11/15 | Accepted: 2022/04/4 | Published: 2022/04/17
Received: 2021/11/15 | Accepted: 2022/04/4 | Published: 2022/04/17
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