Iranian Emergency Medical Service Response in Disaster; Report of three Earthquakes

Saberian, Peyman; Kolivand, Pir-Hossein; Hasani-Sharamin, Parisa; Dadashi, Fatemeh; Farhoud, Amir Reza

Over the past 10 years, natural disasters have killed 760000 people, injured 2 million people and affected more than 2 billion people worldwide (1) . The earthquake is one of the most natural catastrophic crises that can cause a lot of casualties (2) . Considering an earthquake-prone country, Iran is ranked as one of the world's most dangerous countries. The occurrence of 23 earthquakes with an intensity of more than 5 magnitudes has been recorded in Iran since 2000 (3, 4) . In the past, Iran has experienced several earthquakes in different areas, causing severe economic damage and heavy casualties, and the record number of people killed in the earthquakes in the last century has been over 73,000, which the actual number is likely to be more than that (5) (6) (7) . After an earthquake, various components of the health system and treatment centers are encountered with a large number of patients (2) . Emergency medical service (EMS) is an important component of the health care system in this situation (8) . The main goal of EMS in responding to a crisis is coordination and management of the health system services, as well as the continuation of medical services through triage, life-saving activities on the scene, rapid diagnosis and treatment, or the transfer of the injured to emergency departments (9) . It has been proven that timely emergency services will improve the outcome of patients, especially the time-sensitive ones (10) . Although there is a structured approach to the response of the EMS system to crises, recent studies indicate that more activities are still needed to improve (11, 12) . One of the last earthquakes recorded in Iran occurred on November 12, 2017, near the town of Sarpol-e-Zahab, Kermanshah province. Iranian Seismological Center reported this earthquake 7.3 magnitudes and a depth of 18.1 kilometers. The earthquake had three foreshocks: 1.9, 2.3, and 4.4 magnitudes one hour before the main earthquake and hundreds of aftershocks. This big event was felt across a large area in all directions with a maximum intensity in the eight focal areas of the earthquake. According to the statistics, 620 people lost their lives and thousands of structures suffered serious damage, and the two major cities of Ezgeleh (10 km north of the earthquake center) and Sarpol-e-Zahab (36 km south-east of the earthquake center) collapsed completely. Despite the great challenges that existed in responding to this major crisis, the responses of local and national organizations to address this crisis were significant, and the EMS as the first responder in the health system was responsible for coordinating and managing health services in this incident. Earlier, other earthquakes like the one occurred in Bam of magnitude 6.6 in 2003, as well as in Varzaghan of magnitude 3.6 in 2012, resulted in significant casualties. The experience of large events can have a positive impact on the awareness of organizations and direct their policies to the conduct of incident management activities (13) . In this article, we describe the actions taken by EMS after the earthquake in Kermanshah, Varzaghan, and Bam and compared the strengths and weaknesses of the emergency response program and the limitations and challenges of this system in dealing with these major crises.