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

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

Comparing the performance of the EMS system in three recent earthquakes in rapid response and warning highlighted the importance of the existence of the EOC structure at local, regional and national levels. In Bam earthquake, the lack of these structures and infrastructure communication at 3 levels resulted in more than 3 hours of delay in the presence of the first relief teams in the region. The coordination between the LEOC and the NEOC lead to a quicker and more coherent response in the Varzagan and Sarpol-e Zahab earthquakes. Also, the preparation and deployment of emergency teams on the western border of the country for the ceremony of Arbaeen led to the timely presence of these teams in the Sarpol-e-Zahab earthquake. To increase the capacity of the emergency medical and therapeutic system, the experiences recorded in 3 earthquakes indicate lack of a comprehensive surge capacity in Bam, which could be a reason to increase the number of mortality and morbidity following the incident. Comparing the program of surge capacity in Varzaghan and Sarpol-e-Zahab earthquakes, the focus of the medical emergency system in the Varzaghan earthquake was on using its provincial capacities through converting non-therapeutic centers to the therapeutic ones, the discharge of non-emergent patients and the conversion of single-specialty hospitals to general ones. In order to increase EMS capacity, about one-third of the province's capacity has been deployed to the earthquake-affected area. The strengths of this program are reducing the need for the transfer of the injured to other provinces and the costeffectiveness of this program. On the other hand, in the recorded experiences of an earthquake, it is recommended that the treatment of the injured be carried out near the site of the incident so that the patient's relationship with family members and relatives is not discontinued. The negative aspect of the program was that the use of provincial capacity would disrupt the provision of the relief process and routine services and could lead to the collapse of health systems in the region. In the Sarpol-e-zhahab earthquake, coordination and support of other organizations such as Islamic Revolutionary Guard Corps (IRGC) and the Army led to an increase in the capacity of the health systems, on the other hand, the presence of relief and medical units at the western border and the recall of these forces on the scene immediately after the occurrence of the earthquake led to decrease of need to surge capacity of the province which in turn caused organizing the provision of medical services to the injured without triage and the patients who went to local health facilities on their own cars. Nor did there be a disruption in routine processes. The weakness of this program is being costly and moving the patient away from the place of his/her residence which requires a registry system for the distribution of the injured and strong follow-up systems. Existence of the comprehensive MCMC system for managing and coordinating the distribution of patients resulted in a faster and more regular distribution of patients in provincial hospitals and hospitals of other provinces and in addition facilitated the registration of patients' information and follow up. The uniform Incident Command System (ICS) was developed through the EMS of the country for the integrated coordination and management of health services so that the management of facilities and resources of cooperator or