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A Lesson Learned from Iran's Recent Earthquake July 2018, Volume 3, Number 4 Case Report: Kermanshah Health Care Services: A Lesson Learned From Iran’s Recent Earthquake Hamidreza Khankeh1 , Pir Hossein Kolivand2 , Mehdi Beyrami Jam3 , Elham Rajabi3* 1. Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden. 2. Emergency Medical Services, Iran Ministry of Health and Medical Education, Tehran, Iran. 3. Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Use your device to scan and read the article online Citation: Khankeh H, Kolivand PH, Beyrami Jam M, Rajabi E. Kermanshah Health Care Services: A Lesson Learned From Iran’s Recent Earthquake. Health in Emergencies and Disasters Quarterly. 2018; 3(4):221-233. : Funding: See Page 232 Copyright: The Author(s) A B S T R A C T Background: Earthquake has always been a serious threat for humans’ health and properties. In this Article info: regard, the most urgent services for people after the occurrence of incidents and disasters, especially Received: 23 Feb. 2018 earthquake, is health services. Iran due to its geographic location along the Alpine-Himalayan belt is vulnerable to the occurrence of earthquakes with magnitudes of 6 and 7 on the Richter scale. Accepted: 15 May 2018 Prevention of earthquake is impossible; however, it is important to use the lessons learned to reduce Available Online: 01 Jul. 2018 the physical and financial damages in similar future incidents. This study was conducted with the objective of examining the lessons learned by the workgroup of Health and Treatment in response to 7.3 magnitude Kermanshah Province earthquake. Materials and Methods: In This case study, the triangulation method including interview, participatory observation and expert panel in three sections of prehospital emergency services, medical center, and health and treatment centers, was used to assess the performance of health and treatment workgroup in response to Kermanshah earthquake. For this purpose, in addition to recording the information resulting from observation by the researchers, the reports related to EOC (Emergency Operations Center) of Kermanshah and expert assessors were examined. Furthermore, interviews were conducted with experts, directors, commanders and responsible authorities in the field of incident and the State Emergency Organization central headquarters’ staff. Finally, the collected data were analyzed. Results: Based on the study findings, the positive points were the rapid response by the Emergency and Health system organization, effective command on the scene of incident from the first moments, fine management of human resources and the injured within reasonable time, dispatching more than 7350 injured people to treatment centers in less than 20 hours, carrying out 1980 successful operations in less than 3 days, establishing and running 6 mobile hospitals in less than 12 hours, complete supply of blood and blood derivatives, medicines, equipments and specialist force, and sustainability of health and treatment services in less than 24 hours. However, the most important problems were deficiency in protocol, absence of special assessment team and failure to use rapid assessment national standard, lack of national response plan in crisis management and the high vulnerability of hospitals’ infrastructures. Conclusion: Although in this earthquake, thanks to positive steps taken by health and treatment workgroup, great progress was observed in response operations in the area of health; based on the study findings, there are challenges that the health system should resolve in order to improve Keywords: health services in incidents and disasters. Developing the emergency organization and especially emergency air service, advancement of the status of the State Crisis Management Organization, Earthquakes, Health services, accurate planning for aid services such as temporary sheltering and provision of latrines and bath Disasters, Iran and establishing mobile hospitals under unified management are recommended. * Corresponding Author: Elham Rajabi, PhD Student Address: Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. E-mail: [email protected] 221 July 2018, Volume 3, Number 4 1. Introduction cess to emergency health services [7]. In other words, such peril can directly influence the affected population, ealth and treatment services have always and indirectly with disruption in supply of health services, been considered as the most important lead to lack of access of large section of the population demands of the people in the event of to emergency health services in the short period after the incidents and disasters, because among occurrence of earthquake and subsequently increase the their numerous consequences, the most magnitude of health injuries [8]. On the other hand, de- important concern is injuries inflicted on livering health and treatment services in earthquake has people’sH health and life [1]. Today, the incidence of di- significant differences with other situations[1] . This issue sasters in large scale has led to injury and harm inflicted is very important that disruption in providing health ser- upon a great number of people and makes it imperative vices in an earthquake will lead to a great challenge in the to use considerable amount of emergency health services life of vulnerable people, therefore, its occurrence in the [2]. Especially in an earthquake that is one of the most current extensive scale requires earnest presence of health destructive natural disasters, a significant number of- af and treatment services on the scene of such events [2]. fected people may need health services. Furthermore, after the earthquake, health requirements should neces- As such it is necessary that responsible organizations sarily be provided within a limited time period [1]. allocate their resources and time toward survival of in- dividuals after such disasters, and in particular focus on Earthquakes have always been a serious threat to the supplying emergency health services and rescuing peo- health and properties of human beings and on average ple from the disaster’s consequences. Without such valu- each year 16 earthquakes occur throughout the world able investment, the opportunity to learn lessons from that inflict many damages, especially economically and experience for future events may be lost [9]. Apart from many injuries on human society [3]. Based on report by the fact that disasters could be natural or man-made, it the World Health Organization, 564.4 million people is evident that for developing a plan for comprehensive were affected by natural disasters in 2016, of which two disaster risk management approved by all international millions were affected by the earthquake and approxi- agreements from Yokohama to Sendai, it is necessary mately 70000 persons lost their lives. One of the regions that services provided in all incidents should be exam- that report the highest number of earthquake fatalities is ined carefully in the form of lessons learned and applied East Asia [4]. Iran because of its geographical position for developing risk management plans [10]. along the Alpine-Himalayan belt is also considered one of the earthquake prone areas of the world. Provision of effective health services in disasters -re quires a vast and clear vision from different angles; -be The seismicity of most regions of Iran has made it cause factors influencing the success of health care and likely that disasters of this kind would occur and earth- services in disasters are not limited to the area of health, quake has always been one of the historical concerns of but interaction and close communication between dif- the people of Iran. According to official reports, each ferent sections in disaster management should be estab- year on average one earthquake with magnitude of 6 on lished [1]. For example in Iran, 14 workgroups interact the Richter scale occurs in Iran and every ten years one and cooperate with each other. In this regard, the work- earthquake occurs with magnitude of 7 on the Richter group of Ministry of Health with 9 committees under ad- scale [5]. The 7.4 Richter scale magnitude earthquake in ministration of the Minister of Health as the director and Rudbar and Manjil on June 21, 1990 and 6.6 magnitude supervision of the director of Emergency Organization earthquake on the Richter scale on December 26, 2003 as the secretary embark on policymaking, planning and in the city of Bam, that left 40000 and 30000 fatalities, coordination between other crisis management work- respectively are considered two instances of the greatest groups in the country. In this way, they can act in the best earthquakes that took place in Iran in the past 30 years manner and in the shortest time possible to respond to [6]. Recently, the earthquake in the province of Kerman- incidents and disasters. shah on November 12, 2017 with magnitude of 7.3 Rich- ter was another experience of this peril. It is important to understand that earthquake will hap- pen again and the lessons learned from previous events In particular in earthquakes, not only trauma and inju- can save the lives of many people in future incidents [9]. ry can put the survival of individuals at serious risk [1], In order to develop health and treatment services and damages incurred upon the health-treatment system and provide suitable response in disasters, it is necessary to increase in demand,
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