Doi: 10.32592/jorar.2020.13.1.7

Spatial Analysis of Pre-Hospital Emergency Bases in Disasters in Province,

Zahra Mollamohammad Alian Mehrizi1 , Seyed Ahmad Mirshojaee2

Date of submission: 24 Jan. 2021 Date of acceptance: 3 Feb. 2021

Original Article Abstract INTRODUCTION: Tehran is always exposed to various dangers due to its high population density. A geographic information system (GIS) can be very useful for reducing the financial and human burden caused by accidents, disasters, and diseases. METHODS: This field study was performed using a practical and descriptive research method. The pre-hospital emergency bases in the east of and all the emergency bases covered by Shahid Beheshti University of Medical Sciences in disasters were evaluated as a case study. The population of these cities amounted to 1,149,485 people and included cities in the east of Tehran province, Iran, including Damavand, Firoozkooh, , , , and . FINDINGS: Rational maps were created and analyzed in the areas where emergency bases were located using ArcGIS software, as well as analysis of regions, distances, point density, and a combination of these factors. Regarding the standards and indicators, it was determined that the Disaster and Emergency Medical Management Center needs to have130 emergency medical technicians, 23 ambulances, and one ambulance bus to equip the exiting emergency bases according to the standard pre-hospital regulations. Other requirements in this regard include the replacement of worn-out ambulances with new ones, construction of two emergency bases in Qarchak, Tehran, Iran, and three emergency bases in Pakdasht, Tehran, Iran, as well as the transfer of bases in the proximity of faults and flood-prone areas to safe places. CONCLUSION: Based on the obtained results, a comprehensive pre-hospital database was designed for the use of managers and officials in the occurrence of accidents, which might be used as a pilot work that can be expanded to other areas of Tehran, Iran, and other provinces in managing disasters and accidents. Keywords: Geographic Information System; Management of Accident; Pre-hospital Emergency; Spatial Analysis

How to cite this article: Mollamohammad Alian Mehrizi Z, Mirshojaee SA. Spatial Analysis of Pre- Hospital Emergency Bases in Disasters in Tehran Province, Iran. Sci J Rescue Relief 2021; 13(1): 61-76.

Introduction ost of the deaths and disabilities caused treatment team when they receive timely, prompt, by accidents occur in the interval of the and appropriate care in the pre-hospital phase (1). injured or sick person’s transfer from The financial burden of disabilities and the Downloaded from jorar.ir at 19:07 +0330 on Thursday September 30th 2021 [ DOI: 10.32592/jorar.2021.13.1.7 ] M the accident site to the hospital. In this mortality rate will be reduced through the proper regard, the preparedness of pre- management of pre-hospital emergency resources hospital emergency bases, as the front line of the and facilities, proper access to all parts of the Ministry of Health, is very important before and province, especially densely populated areas, provision of first aid, and timely rescue of patients during the crisis. While there is considerable and victims’ lives. Although only three decades evidence of patient care, there is ample evidence have passed since the official launch of the that shows patients get better results from the emergency medical system, ample evidence

1-Assistant Professor, Applied Science Higher Education Institute Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran 2-Master of DMIS, Tehran, Iran Correspondence to: Zahra Mollamohammad Alian Mehrizi, Email: [email protected]

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shows that this system has provided valuable locate roadside emergency bases more easily and services to the health system in this short period coordinate traffic police patrol plans (4). of time (2). In another study entitled “Site selection for Regarding the data integration capabilities of post-earthquake relief centers using GIS and the geographic information system (GIS) as well analytic hierarchy process (AHP)” Zebardast et as the possibility of performing complex analyzes al. of spatial and non-spatial data, this system is have proposed criteria for locating emergency considered the best decision-making tool in the bases according to environmental and physical management of the crisis. Moreover, GIS can be capabilities after the examination of one area in used to locate pre-hospital emergency bases Tehran, Iran, in terms of accident rate using before the crisis and identify high-risk areas in GIS (5). times of accidents. In a study conducted by Chen Albert et al. Much scientific research has been conducted (2014), American Society of Civil Engineers, inside and outside the country to study the entitled “Ambulance service area considering the situation of emergency services and other relief disturbance of disasters on transportation organizations in the cities. Some examples of infrastructure” the impact of accidents was these researches have been considered in the considered as a disruptive factor in the emergency present study. medical service system. This study aimed to assess Moghaddasi et al. (2014) conducted a the area of emergency medical services after an comparative study on pre-hospital emergency accident and investigate the deviation of services information systems in the United States and the before and after disruption in the emergency United Kingdom on the components of an transport infrastructure (6). information system including data, hardware and A study conducted by Sari (2017), investigated software, people, as well as the processing of the shortest response time for emergency vehicles, data, reports, and information. The result was the taking into account obstacles such as speed bumps, design and creation of a national pre-hospital traffic lights, the condition of street parking, emergency information system and the provision railways, and intersections that reduce the speed of of hardware and software systems and equipment emergency vehicles. These items were considered for the coefficient of intervention time increase in this the management of pre-hospital emergency study and the results were compared with the information regarding the mobile nature of shortest path and shortest-time path (7). emergency services. The possibility of extensive In another study, a powerful and emerging tool electronic processing has been proposed in this was optimized for solving random and dynamic emergency service in order to meet the need for problems encountered in operational research using information. Furthermore, there is the possibility dynamic approximate programming (ADP). of reporting and receiving the required Dependence on time-dependent information, such information based on user’s searches at local, as the arrival time of the ambulance and its provincial, and national levels (3). consequences, in the stage of modeling and Talebi and Faryabi (2014) investigated the role optimization, leads to non-optimal decisions. of information systems in road accident Therefore, extensive parameters were used for the

Downloaded from jorar.ir at 19:07 +0330 on Thursday September 30th 2021 [ DOI: 10.32592/jorar.2021.13.1.7 ] management in their study entitled “Application proposed algorithm in this study [8]. of GIS in road accident management”. This article introduces a provincial experience in the Description of the studied area application of GIS in the field of transportation The studied area included the cities located at information analysis, especially road accidents. In the east of Tehran province, Iran, including this project, an attempt has been made to produce Varamin, Firoozkooh, Damavand, Pakdasht, a model that predicts the probability of accidents Pishva, and Qarchak cities, which are under the in the West Azerbaijan roads through the design supervision of Shahid Beheshti University of of software (GIS) and analyzing spatial and Medical Sciences in terms of pre-hospital descriptive data of accidents using genetic emergency bases. The total, population of these methods. Moreover, this analysis was used to six cities was estimated at 1,149,485 people, who were distributed in 11 districts, 14 cities, 24

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villages, and 537 rural districts, according to the Subsequently, a unit map was compiled for all latest census. The length of the communication six cities and was properly georeferenced. routes in these areas was estimated at 3,734 km. In the following analysis, the urban and road According to the information of the Statistics bases have been distributed as a single map in Unit of the Plan and Budget Organization of Iran each criterion, considering the location of faults, (2017) (9), Varamin, Tehran, Iran, included two watercourses, earthquakes, and other hazards. districts, two cities, and four villages, Firoozkooh Tehran, Iran, included two districts, two cities, and Communication routes in the east of Tehran five villages, Damavand, Tehran, Iran, included province two districts, five cities, and five villages, The total length of communication routes in Pakdasht, Tehran, Iran, included two districts, the east of Tehran province is specified in Table 1 three cities, and six villages, Pishva, Tehran, Iran, and Map 1.

included two districts, one city, and two villages, Map data analysis in ArcGIS software and Qarchak, Tehran, Iran, included one district, Location of emergency bases in the studied one city, and two rural areas, at the time of areas conducting the general population and housing Map 2 presents seven information layers that census in 2016. show the location of pre-hospital emergency bases using ArcGIS software. Each color on the map Methods indicates the emergency bases of a city. This applied, descriptive-evaluative study was The health of the manpower and facilities and conducted based on library and field research equipment of an emergency base are prerequisites method. Sampling was not performed in the of proper and timely service in an accident and present study and its statistical population crisis by the relief forces. In case any of the included emergency bases in Tehran province. mentioned sources have problems, the relief However, only pre-hospital bases in the areas process will be disrupted. The following maps covered by the Medical Emergency and Accident present the distance of pre-hospital emergency Management Center of Shahid Beheshti bases from potential hazards, floods, earthquakes, University of Medical Sciences were examined and access and communication routes. due to time constraints. The required information was obtained from relevant sources, such as the Distance from seismic points Iran National Cartographic Center, Statistical In Map 3, the distance from seismic points is Centre of Iran, and the raw and basic information prioritized from the highest risk (score 1) to the was gathered from the areas covered by the lowest risk (score 6) using ArcGIS software, two- Medical Emergency and Accident Management layer integration, and analysis. The closest and the Center of Shahid Beheshti University of Medical farthest places to risk get the lowest and highest Sciences as well as oral interviews with scores, respectively. Moreover, the most dangerous respective experts. and the least dangerous areas are marked in yellow The covered areas were the eastern cities of and blue colors, respectively.

Tehran province, Iran, including Damavand, Distance of emergency bases from flood points Varamin, Pakdasht, Qarchak, Pishva, and Map 4 presents the distance of pre-hospital Downloaded from jorar.ir at 19:07 +0330 on Thursday September 30th 2021 [ DOI: 10.32592/jorar.2021.13.1.7 ] Firoozkooh. Such information as emergency emergency bases from flood-prone areas and is bases, number of personnel, number of vehicles, prepared by a combination of one vector and one latitude, and longitude of emergency bases, raster layer and the distance analysis. The closer population, and geodatabase information were bases to the flood-prone areas get the lowest scores prepared separately for each city. After that, the and the farther ones get the highest scores. In this GPS receiving points of the pre-hospital map, the most and the least dangerous areas are emergency bases, presented in minutes and marked in red and in dark blue, respectively. seconds, were converted to understandable Moreover, Map 5 is the result of a combination of coordinates in the UTM coordinate system (as eight layers in ArcGIS software. Some bases are WGS_1984_UTM_Zone_39) and the points were located in the path of flood-prone areas and should correctly located on the map of each city. be moved to a safe place.

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Table 1. The length of communication routes in the studied area (extracted from the road layer by the author) Highway and Dirt Total Item Asphalt road Railway Roadway Trail freeway road length Length of 99km km 910 km 151 km 2067 km 340 km 167 km 3734 routs

Map 1. Communication routes in the east of Tehran province (author source)

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Map 2. Status of pre-hospital emergency bases (author source)

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Map 3. Distance from earthquake points (author source)

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Map 4. Distance from flood-prone areas and location of emergency bases (author source) Distance of emergency bases from the fault line composed of eight layers graded from completely Map 6 presents the distance of pre-hospital inappropriate to appropriate, respectively. The emergency bases from the fault line and is yellow and blue colors indicate completely

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inappropriate and appropriate places for such as snow, blizzard, and avalanche, and is constructing an emergency base, respectively. As composed of 2 layers. The most dangerous and is indicated in the map some bases are located the least dangerous areas for the construction of near the fault line and should be moved from a emergency bases are specified on the map in high-risk location to a safe place. yellow and blue colors, respectively. Moreover, it is scored based on proximity to the danger Map of distance from other hazards areas. The closer and the farther areas to the Map 7 presents distance from other hazards, danger zone get the lowest and the highest scores, respectively.

Map 5. Location of emergency centers in flood-prone areas (author source)

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Map 6. Distance of emergency areas from the fault line (author source)

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Risk rating map in areas Distance of road emergency bases from rural Map 8 is the hazard map of the east of Tehran areas province, which is graded from safe to very high- Map 10 presents the location of road risk areas. The safe areas are a good place for the emergency bases relative to the distance from construction of emergency bases. rural areas. In this map, seven layers of information are combined and superimposed, with Distance of urban emergency bases from urban priority given to proximity to village bases. The areas closest bases (perfectly appropriate) and the Map 9 presents the location of emergency farthest location to the village centers (completely bases by the city from a road at a distance from inappropriate) get the highest and the lowest the urban areas of each city and is a combination scores and are specified by green and red colors, of seven vectors and one raster layer using respectively. The position of the bases can be distance analysis. The proximity of bases to urban evaluated regarding the deficits of these areas. In centers is regarded as appropriate and distance addition, Qarchak, Tehran, Iran, does not have a from urban centers is completely inappropriate, road emergency base and among the studied cities, which are specified by yellow and blue colors on Damavand, Tehran, Iran, possesses the most road the map, respectively. bases with six emergency bases.

Map 7. Distance from other hazards (author source)

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Map 8. Vulnerability of the eastern regions of Tehran province (author source)

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Location of urban areas regarding the distance Furthermore, the black and red colors are indicative from faults: of low and high-density areas, respectively. Map 11 presents the location of urban areas regarding the distance from faults and is a Location of road emergency bases regarding the combination of three vector layers. The places are rural density: graded in terms of proximity (completely Map 14 presents the location of road inappropriate) and distance (appropriate) from emergency bases regarding the rural population the fault line and are specified in red and green density. The proximity of the emergency bases to colors, respectively. Emergency bases can be densely populated centers accelerates the presence set up in relatively appropriate to appropriate of emergency base personnel in the accidents and locations. disaster areas. This map is a combination of five vectors and one raster layer in which the distance Location of rural areas regarding the distance and proximity to the densest areas get the lowest from faults and the highest scores, respectively. The black Map12 is a combining three vector layers and and red colors are indicative of the lowest and the presents the location of rural areas regarding the highest density of rural areas, which is a good distance from faults. It is graded based on criterion for the construction of emergency bases proximity to (completely inappropriate) and regarding population density. distance from the (appropriate) fault line. The appropriate and inappropriate location is shown Distance of road emergency bases from main in green and red, respectively. roads Map 15 presents the distance from the main Position of urban emergency bases regarding roads of the studied area. Due to the fact that all urban population density: land, air and, rail access routes are disrupted during Map 13 presents the position of urban accidents and regarding the possibility of blocking emergency bases regarding urban population the communication routes, the side roads are used density. The proximity of the emergency bases to as an alternative. The map is a combination of one densely populated areas accelerates the arrival of vector and one raster layer and indicates the emergency base personnel in the accidents and distances from and proximity to the main roads disaster areas. This map is a combination of six using distance analysis. Here, the proximity to and vector layers and one raster layer. The distance and distance from the main road is indicated by yellow proximity to the densely populated areas receive and blue colors that can be used as a guide for the the lowest and highest scores, respectively. construction of emergency bases.

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Map 9. Location of urban emergency bases regarding the distance from urban studied areas (author source)

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Map 10. Location of road emergency bases regarding the distance from rural areas (author source)

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Map 11. Location of urban areas regarding the distance from faults (author source)

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Map 12. The location of rural areas regarding the distance from the fault line (author source)

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Distance of road emergency bases from the combination of one vector and one raster layer, railway and distances from and proximity to the railway Map 16 presents the distance of road emergency have been determined using distance analysis. bases from the railway in the studied area. Moreover, the proximity to (the highest score) Considering the destruction probability of land roads and distance from (the lowest score) the railway as a result of accidents, it is possible to provide is shown in yellow and blue colors, respectively, transportation services through other means of which can be used as a guide for the construction communication, such as railways. This map is a of emergency bases.

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Map 14. Location of road emergency bases in relation to rural population density (author source)

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Map 16. Distance of road emergency bases from the railway (author source)

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Discussion and Conclusion in the above urban areas that need to be Today the need to reduce the effects of natural compensated. disasters in Tehran province through research and According to the last census in 1995, the rural planning is felt more than ever. The reason for this population of the studied areas is 240,649 people. is the geographical position of Tehran province, the An agreement entitled the provision of emergency importance of this city as the capital of the country, medical services to residents of rural, nomadic, as well as its high population density. Therefore, and urban areas with a population of less than major natural disasters and crises that can cause 50,000 people were reached between the deputy irreparable loss of life and property, such as floods ministers of health and medical treatment and and earthquakes threaten this city due to the medical education on 07/07/2015 with the letter existence of many faults. These natural disasters number 308/8/10259. According to this have happened in recent years and the probability agreement, the recipients of the emergency of their recurrence is very high. services include people in rural and nomadic Iran Emergency Organization working under areas, the residents of cities with a population of the Ministry of Health and Medical Education is less than 50,000 people in the country. Moreover, one of the organizations responsible for villages with a population of less than 20,000 transferring emergency support equipment from people, and cities with a population of between the accident scene to medical centers. Disaster 20,000 to 50,000 people in the country are in and Emergency Medical Management Center of priority of receiving the services. Currently, 15 medical sciences university in each city is road stations with one ambulance are available in undertaking this mission in the areas covered by non-urban areas that meet the standards. this center and provides emergency services to According to the standards and indicators, people through emergency bases. six people must do shift work per each active The present study aimed to investigate the east ambulance. In other words, two people are of Tehran province in terms of spatial analysis of needed for each ambulance in each 24-hour accidents in pre-hospital emergency bases shift. Therefore, about 300 people are needed (covered by Shahid Beheshti University of for these active emergency bases and Medical Sciences) and three hypotheses are ambulances. However, only 171 people are discussed in this regard: serving in these areas, and there is an obvious Hypothesis 1: The status of resources and shortage of workforce. equipment of pre-hospital emergency bases in the The useful life of pre-hospital emergency areas covered by Shahid Beheshti University of ambulances is about 5 to 10 years. However, 40 Medical Sciences in Tehran is favorable ambulances out of a total of 61 ambulances in considering the standard indices. However, these areas have a lifetime of over 10 years and regarding the information obtained from should be replaced with new ambulances. emergency bases and in comparison with indices Moreover, another important issue in this and standards some shortcomings were observed regard is the exact location of emergency bases in the pre-hospital centers under the study, which regarding the possible dangers, including will be discussed in the following. proximity to floodplains and faults. A solution Regarding the respective standards and needs to be found for these dangers to provide

Downloaded from jorar.ir at 19:07 +0330 on Thursday September 30th 2021 [ DOI: 10.32592/jorar.2021.13.1.7 ] indicators, one ambulance bus should be allocated relief to the injured people and prevent damage to every one million people to provide emergency to the emergency bases in times of crisis. medical services to patients in mass accidents and Regarding the above-mentioned issues, there emergencies. Disaster and Emergency Medical are deficiencies in the resources and equipment Management Center of this university lack an of the areas covered by Shahid Beheshti ambulance bus (despite the population of University of Medical Sciences that need to be 1,149,485 people in this area) which should be addressed in order to respond better and faster to provided by the Ministry of Health and the people of the region in the crises. This Emergency. requires the great effort of the Ministry of Two ambulances have to serve in each urban Health and the country’s emergency emergency station in a 24-hour shift. organization to resolve resource constraints Unfortunately, there is a deficit of 23 ambulances before the occurrence of the crisis.

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Hypothesis 2: A comprehensive pre-hospital Distribution of pre-hospital emergency bases in emergency information system is available for Damavand, Tehran, Iran disaster management in the areas covered by There are two urban and six road emergency Shahid Beheshti University of Medical Sciences bases in Damavand city with a population of about in Tehran province, Iran. 125,000 people (93,201 urban and 32,279 rural Based on the field surveys and referrals to this people) in an area of 1905 km2. The distribution of center, there are no comprehensive information emergency bases in this city is very desirable based and map facilities available in the Medical on the standards (Map 18). Emergency and Accident Management Center of Shahid Beheshti University of Medical Sciences. Distribution of pre-hospital emergency bases in To resolve this issue, an information bank has Pakdasht, Tehran, Iran been created that provides resources and There are two urban and two road emergency population census in one place for each city. The bases in Pakdasht, Tehran, Iran, which is the most figure below presents an example of these populous city in the studied area, with a population databases that are connected to the map and of about 350,000 (276,282 are urban and 74,684 are geographical points and are geo-referenced. rural) in an area of 675 km2. This condition is far below the standard in terms of the number of bases Hypothesis 3: The current pre-hospital emergency and will reach the desired level with the construction bases are proportional to the population density of of three other bases (Map 19). the respective areas in Tehran province. The urban population of the studied area was Distribution of pre-hospital emergency bases in estimated at 908,791 people according to the Firoozkooh, Tehran, Iran last census of 1995 and after reviewing the There are one urban and four road emergency maps bases in Firoozkooh, Tehran, Iran, with a and resources available in the pre-hospital population of about 34,000 people (18,577 people emergency centers of the studied areas. in urban and 14981 people in the rural area) in an Considering the standard, there must be one area of about 2383 km2. The distribution ratio of urban emergency base per 50,000 people. At these bases exceeds the density of population in present, there are 13 urban bases available in this city (due to the large area and small this region, while according to the standards, population distribution of this city). Therefore, there must be 18 urban bases with two active the number of bases in this area is higher than ambulances. Therefore, there is a lack of about the standard (Map 20). five urban bases in all cities specified in the

following maps that will be resolved through the resources allocated by the Ministry of Distribution of pre-hospital emergency bases in Health and the country’s Emergency Pishva, Tehran, Iran Organization. There are one urban base and one road emergency base in Pishva, Tehran, Iran, with a Distribution of pre-hospital emergency bases in population of about 86,000 people (59,184 Qarchak, Tehran, Iran people in the urban and 27,417 people in the rural area) in an area of 201 km2. The Downloaded from jorar.ir at 19:07 +0330 on Thursday September 30th 2021 [ DOI: 10.32592/jorar.2021.13.1.7 ] The distribution of pre-hospital emergency bases in the studied areas shows that the distribution of emergency bases is desirable population of Qarchak city amounts to 269,000 based on the standard (Map 21). people (231,075 people in urban and 38,063 people in rural areas), according to the Statistical Center of Distribution of pre-hospital emergency bases in Iran. The vastness of the area is 90 km2 in which Varamin, Tehran, Iran three emergency bases exist. There is a need to There are four urban and two road emergency build two more bases according to the standard and bases in Varamin, Tehran, Iran, with a population index of the regulation of comprehensive coverage of about 283, 000 people (230,472 people in the of pre-hospital emergency medical services (Map urban and 53,270 people in the rural area) in an 17). area of about 1541 km2. The distribution of

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emergency bases in this city is desirable according human resources, number of ambulances by type to related standards (Map 22). of vehicle, number of permanent and temporary National Cartographic Center has designed a emergency bases by city and road. Moreover, the comprehensive information pre-hospital center demographic, topography, geology maps of the for the use of respective managers and officials National Cartographic Center of Iran from the at the occurrence of emergencies and disasters, covered areas were integrated with the data taken which can be useful in the management of from the emergency center using ArcGIS accidents as a pilot work that can be expanded to software. Various analyses were performed on other areas of Tehran and other provinces. This output data obtained from the target areas and pre-hospital center has been designed using such evaluated based on indicators and standards in information as the location of bases, number of terms of specific strengths and weaknesses.

Map17. Location of Qarchak city bases & surrounding villages (author source) Downloaded from jorar.ir at 19:07 +0330 on Thursday September 30th 2021 [ DOI: 10.32592/jorar.2021.13.1.7 ]

Map 18. Location of Damavand emergency bases (author source)

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Map19. Location of Pakdasht emergency bases (author source)

Map 20. Location of Firoozkooh Emergency bases (author source) Downloaded from jorar.ir at 19:07 +0330 on Thursday September 30th 2021 [ DOI: 10.32592/jorar.2021.13.1.7 ]

Map 21. Location of Pishva Emergency bases (author source)

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Map 22. Location of Varamin emergency bases (author source)

Acknowledgments None 4. Talebi B, Faryabi F. Application of GIS in road accident management. Tehran: Instruction of Conflict of Interests Intercity Rescue Bases; 2014 [In Persian]. 5. Zebardast E, Mohammadi A. Site selection for post- Authors have no conflict of interests. earthquake relief centers using GIS and analytic hierarchy process (AHP). Honar-Ha-Ye-Ziba 2005; 21: 5-16. [In Persian]. References 6. Chen AY, Yu TY, Chuang WL, Lai JS, Yeh CH, 1. Karamizadeh Z, Zarifsanayei N, Faghihi AA, Ma HM, et al. Ambulance service area considering Mohammadi H, Habibi M. The study of the disturbance of disasters on transportation effectiveness of blended learning approach for infrastructure. Design Construct Maintain Bridges medical training courses. Iran Red Crescent Med J 2014; 44: 94-101. 2012; 14(1): 41. 7. Fatih SA. A GIS based new navigation approach 2. Blackwell TH, Kaufman JS. Response time for reducing emergency Vehicle's response time. effectiveness: comparison of response time and Selcuk Univ J Eng Sci Technol 2017; 5(1): 47-60. survival in an urban emergency medical services 8. Schmid V. Solving the dynamic ambulance system. Acad Emerg Med 2002; 9(4): 288-95. relocation and dispatching problem using 3. Moghaddasi H, Rabiei R, Mastaneh Z, approximate dynamic programming. Eur J Operat Movahedinia S, Shayan ZP, BastaniTehrani M, et Res 2012; 219(3): 611-21. al. Pre-hospital emergency information system in 9. Ghasemi Moghar J. General results of the general America and England: a review. Payesh 2014; population and housing census 2016. Tehran: Plan 13(4): 383-91 [In Persian]. and Budget Organization of Iran; 2017. [In Persian]. 10. Downloaded from jorar.ir at 19:07 +0330 on Thursday September 30th 2021 [ DOI: 10.32592/jorar.2021.13.1.7 ]

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