|Year : 2013 | Volume
| Issue : 1 | Page : 2-6
A comparative study of road ambulances equipment based on the national standards in Guilan province
Soodabe Vatankhah1, Ehsan Kazamneghad2, Majid Pourshaikhian3
1 Department of Health Services and Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
2 Department of Biostatistics, Guilan University of Medical Sciences, Rasht., Tehran, Iran
3 Disasters Health and Management, School of Health Management and information Sciences, Iran University of Medical Sciences, Tehran, Iran
|Date of Web Publication||30-Nov-2013|
School of Health Management and Information Sciences, No. 6, Rashid Yasemist., Vali-e-asr Ave., Tehran - 1995614111
Source of Support: This study was sponsored by the Guilan University of Medical Sciences, Conflict of Interest: None
Introduction and Objectives: Prehospital emergency care is a part of healthcare delivery systems. Despite the high incidence of road traffic injuries and socioeconomic consequences and importance of the quality of early interventions on the scene, few studies have been conducted in this field. This study was conducted to compare road ambulances equipment based on the national standards in Guilan province. Subjects and Methods: This is a descriptive, cross-sectional/analytical study in 2012 and its population included all active province relief road centers' ambulances. Data collection tools included merged checklists that was completed by the researchers which referred to all relief road centers. Data collections were performed using census method and analysis of data by using descriptive and analytical statistics. Results: The overall average road equipments of ambulances of Guilan Province, according to standards of Ministry of Health (MOH) and Iran's Standard National Organization was about 51 and 49%, respectively. The average equipments according to the two standards, in fixed appliances group: 72 and 72%, the equipments of respiration/ventilation: 95.3 and 94%, diagnosis group: 56.6 and 62%, injection/drugs: 74 and 59%, equipments of treatment critical management: 19 and 21%, nursing care/bandage: 29 and 26.6%, and protection/rescue were 43 and 38.5%, respectively. According to results and according to the two standards, 76.7 and 66.7% of ambulances had all equipments related to airway/ventilation management, respectively. Conclusion: The best state of ambulance equipments was related to the airway/ventilation management and the poorest state of facilities was about equipments of treatment critical management, that it is very important. The deficiencies of emergency ambulance equipments reduce the efficiency of emergency road performance, therefore, it seems eliminating the deficiencies in ambulances equipments and achieving the national standards is essential.
Keywords: Ambulance, emergency medical services, prehospital care
|How to cite this article:|
Vatankhah S, Kazamneghad E, Pourshaikhian M. A comparative study of road ambulances equipment based on the national standards in Guilan province. Int J Health Syst Disaster Manage 2013;1:2-6
|How to cite this URL:|
Vatankhah S, Kazamneghad E, Pourshaikhian M. A comparative study of road ambulances equipment based on the national standards in Guilan province. Int J Health Syst Disaster Manage [serial online] 2013 [cited 2019 Aug 24];1:2-6. Available from: http://www.ijhsdm.org/text.asp?2013/1/1/2/122407
| Introduction|| |
Today, the emergency situations management is an important problem of the health systems in all societies  that can be adjusted to limit morbidity and mortality.  In order to provide appropriate prehospital emergency medical services (EMS), many factors such as skilled staff, speed of services, and affordable medical equipment's are involved. ,,, Road traffic accidents are a major problem of public health threats.
Estimates: In the world, due to accidents, annually, 1.2 million people died and 50 million people were injured.  Statistics: Iran is one of the first countries in the world, in the prevalence of accidents.  The results of a study in Guilan: Traumatic injuries resulting in hospitalization is relatively high (about 3,600 cases in 10 months). 
The equipped and prepared ambulances have the most important role in the saved lives of patients in critical condition.  In Iran, despite the high incidence of accidents and injuries in emergency situations and its consequences and the importance of quality early intervention stage, very few studies have been conducted in this context. In the Guilan province, in addition to emergency medical situations, because the position of tourism and density of population and vehicles have high injuries traffic accidents,  it has not been able to study and assess the ambulance equipments.
This study was performed to evaluate the status of medical equipments of road ambulances and comparison with the standards of Ministry of Health (MOH)  and National Standard Organization (NSO) of Iran (a higher standard).  Researcher hopes that results of this study help emergency policy makers in order to improve patient care and ultimately helping promote health.
| Subjects and Methods|| |
This is a descriptive, cross-sectional study in 2012, in the Road Relief Centers in Guilan province. Include criteria: All active ambulances (30 cases). Data collection: The integrated checklist of 1-standard medical examination card of B type ambulance of medical emergencies and disasters management of MOH  (includes 53 cases) and 2-revised checklist of 4,374 of rescue vehicles and equipments of NSO  (65 cases). Data collection: With observation of the ambulance equipment's condition, number 1 for existing devices/safe and zero for the lack/faulty was devoted.
Check list include medical equipments of ambulances according to Iran's standards. Ambulance equipment's divided in nine groups (based on the 4,374 standard booklets of NSO, include: Patient handling equipments, diagnosis equipments, sustaining upper extremity and spine, respiration/ventilation equipment, supplies or materials injection equipment, critical care management bandage and nursing equipments, and protection/rescue and communications equipments. Sample collection was census method. Data was analyzed using descriptive and analytical statistics (t-test) to compare the current situation with the standards.
- The prehospital EMS: The EMS that are presented in cases of accidents, acute medical emergencies, and disasters in the network before reaching the sick or injured patients to hospital. 
- The B type ambulance: In order to transfer or initial treatment and monitoring of patients equipped with the emergency equipments, including: Oxygen, trolley bags, cardiopulmonary resuscitation (CPR), and suction. 
- Road relief station: It is created in roads and port cities with populations of less than 50,000 people, with a maximum distance of 40 km. Each station has one active B type ambulance. 
| Results|| |
The medical equipment of 30 ambulances in 26 stations in Guilan province was surveyed according to standard of ambulance of MOH and NSO. Group's fixation equipment maintenance body averaged double standard equipment with the majority of different types of splint around 72%, but only 46.7% had body established traction. The immobilization group's equipments: The average of equipments according to double Iran standards was 72%.The majority of cases has different types of splint, but only 46.7% had an extremity established traction. The equipments of nursing and bandages: The average equipment's according to dual standards was approximately 29 and 27%, respectively; the majority of cases had the stomach tube. There were burn care items and sterile gloves, only 20 and 30% of cases, respectively. None of the units had cold box.
The frequency of facilities in groups of patient handling, diagnostic, respiration/ventilation, injections, and treatment critical management is separately shown in [Table 1] and [Table 2].
|Table 1: The frequency of medical equipment's of ambulances based on type of standard in equipment's groups of patient handling, diagnostic, and supplies of injection equipment's; separately|
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|Table 2: The frequency of medical equipments of ambulances, based on type of standard in equipment's groups of respiration/ventilation and treatment critical management equipment's; separately|
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Protection/rescue and communications equipment: The average of existing equipments due to the double standards was 46%. There were transmitter/receiver, radio, reflective and reflex protective clothing, flashlight, and fire extinguisher in the majority of ambulances. About half of the units have a pager and triangle warning light. There was cutting safety belt tool and protective vest per person in about one-third of the units. There were safety gloves only in 20% of the units. None of the ambulances had helmets for their staff.
Comparison of ambulance equipments with each of double standards of MOH and NSO of Iran, using the t-test showed statistically significant differences in all nine equipment's groups (P < 0.05).
In respiration/ventilation equipments group, although the difference was statistically significant (P = 0.003 and 0.006, respectively; with a confidence interval of − 1 to −10 with country standards, but it is not clinically significant [Table 3].
|Table 3: Comparison of Guilan road ambulances equipment's based on country standards, in separate groups|
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The comparison of medical equipments of prehospital emergency ambulances in nine groups according to standards of MOH and NSO show that most deficiency was related to the treatment critical management group. The existing equipments of drugs and injection group, diagnostic equipments, and protecting/rescue group have more space with NSO, and are closer to the MOH standards [Figure 1].
|Figure 1: The comparison of medical equipments of road ambulances in Guilan province based on the Ministry of Health and the National standard Organization standards of Iran|
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| Discussion|| |
In this study, the medical equipment's of Guilan road prehospital ambulances were compared according to standard of ambulance (type B) MOH and NSO. The medical equipments are one of the important factors for proper functioning of prehospital EMS.
The findings showed that road ambulances have an average of about 51 and 49% of needed equipments, respectively, and so they have far distance from their respective standard (MOH) and the reference standard (NSO). The results of study of descriptive/analytical of Bahrami in Yazd, which was published in 2010, showed that the average emergency ambulances equipments based on the NSO was 61%, which showed relatively better condition. 
The average of equipments of respiration/ventilation (about 94%) and fixation of limbs and spine (72%) was closed to optimal double standards. The equipments of injections (about 74 and 60%, respectively), diagnosis (about 62 and 57%, respectively), and patient handling (55%) was above average of standards. But, the equipments of protection/rescue (about 40%), nursing care and bandage (about 27%), and critical management (about 20%) were undesirable. Thus, none of the road ambulances were full complement needed equipments.
The best condition was related to breathing/ventilation, and most deficiency related to critical management equipments. Also, in the study of Bidari in Tehran, best condition was related to respiration/ventilation (approximately 98%) and the lowest condition to critical care management (17.4%), and other equipments was more or less similar to our results. 
The strengths of surveyed equipments: Results showed that all ambulances have main stretchers, fixed and portable oxygen cylinders, manual sphygmomanometer and stethoscopes. The results showed that there were the injection equipments in 96.7%, serum and mask ventilation in 93.3%, adults and children AMBU 83.3 and 96.7%, respectively; fixed and manual suction at about 90%, the neck brace in 93.3%, thermometer in 83.3%, and the glucometer in 76.7% of ambulances. I did not found any study on these types of ambulances equipment in literature review.
In the group of critical management equipments and according to NSO, none of the ambulances have injection microset, chest tube, and Pacemaker. There was no heart monitoring system in 93.3%, Electroshock in 96.7%, ventilators and aerator in 93.3%, of ambulances; but there were CPR sets including laryngoscope, airway, and ETT in 86.7% cases. The results of Bidari in Tehran, which were published in 2007, showed that 22% of the 60 emergency ambulances of Tehran have heart monitoring and electroshock;  although, indicating better condition than our results, but is far that country standards. The results of Bahrami in Yazd showed that electrocardiogram (ECG) and cardiac monitoring was found only in one ambulance  which is similar to the results of our study. The study by Ridgway et al., published in the UK in 2004 showed that in 100% of ambulances, laryngoscope with a curved blade was found and our results are close to it.  Schmid's study entitled "Medical equipments of land emergency in German" showed that there was heart monitoring device and ventilator in 88% and 93% of ambulances, respectively;  indicating better results than ours.
| Conclusion|| |
The medical equipments of road ambulances in Guilan have less or more away with MOH and NSO of Iran. The best and worst of the road ambulances medical equipment's in Guilan was respiration/ventilation and critical treatment management equipments, respectively; that it has considerable importance, according to the responsibilities of EMS in emergency/critical conditions. The effectiveness of human or physical resources of the effectiveness of human or physical resources of EMS will be affected patient care, if medical equipment is not provided adequately.
| Acknowledgement|| |
The effectiveness of human or physical resources of EMS will be affected patient care, if medical equipment is not provided adequately. The authors sincerely wish to thank the Head of Emergencies Medical Center of Giulan province and all participants for their support and involvement in this study. This study was sponsored by the Guilan University of Medical Sciences.
| References|| |
|1.||Kouroubali A, Vourvahakis D, Tsiknakis M. Innovative Practices in the Emergency Medical Services in Crete. Proceedings of the 10 th International Symposium on Health Information Management Research, ISHIMR 2005. |
|2.||Agouridakis P, Michaloudis D. Mortality in emergency medical practice-is it preventable? Current anesthesia and critical care 1999;10:105-10. |
|3.||The center for catastrophe preparedness and response, New York University. Emergency medical services: The forgotten first responder, a report on the critical gaps in organization in resources for America'n medical first responders. Available from: http://www.nyu.edu/ccpr/NYUEMS report pdf. [Last accessed on 2011]. |
|4.||Imaniyeh MH, Rahmdar Sh. Medical technology standards. Shiraz: Tafrai Publication, 2004. |
|5.||Veitch C, Aitken P, Elcock M. The organization of trauma services for rural Australia. Journal of Emergency Primary Health Care (JEPHC) 2009;7:1-14. |
|6.||The National Highway Traffic Safety Administration, Department of Transportation and the Maternal and Child Health Bureau and Health Resources Services Administration, Department of Health and Human Services. National EMS Research Agenda. Washington DC: December 2001. |
|7.||Sankaran-Kutty M, Bener A, Muralikuttan KP, Sebastian M. Road traffic accident admissions in the United Arab Emirates. Ann Saudi Med 1998;18:349-51. |
|8.||Naghavi M, Jafar N, Alaeddini F, Akbari M. Epidemiology of external causes of injuries in I.R. Iran. Tehran, Iran, Ministry of Health and Medical Education; 2004. |
|9.||Hemmati H, Yousefzadeh Sh, Dehnadimoghadam A, Mohammadi HM, Shabani S. Trauma in Guilan province (North of Iran): An Epidemiologic Study. Acta Medica Iranicaacta.tums.ac.ir, Vol 47, No. 5 2009. |
|10.||Bidari A, Abbasi S, Farsi D, Saeedi H, Mofidi M, Radmehr M, et al. Performance assessment of pre-hospital emergency at transported patients to the Rasoole Akram hospital. Medical Journal of Tabriz University of Medical Sciences, Vol 29, No 3, 2008, p. 46-3. |
|11.||Law "coverage of the pre-hospital emergency medical service" Resolution No: 155081/34 389 (d) (e), 2007, available at: ww.behdasht.gov.ir/index.aspx?. |
|12.||National standard organization of Iran, Code of 4374 "Relief vehicles and their equipment - ambulance", the first revision: 2004. |
|13.||Bahrami MA, Maleki A, Ranjbar-Ezzatabadi M, Asqari, R. Pre-hospital Emergency Medical Services in developing countries: A case Study about EMS response time in Yazd, Iran. Journal of Tolooe Behdasht, Yazd, 2009; 4. |
|14.||Ridgway I Hodzovic M, Latto IP. Pre-hospital airway management in Ambulance Services in the United Kingdom. Anesthesia 2004;59:1091-4. |
|15.||Schmid MC, Deisenberg M, Strauss H, Schüttler J, Birkholz T. Equipment of land-based emergency medical services in Bavaria: A questionnaire. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16906427. [Last accessed on 2011 Jan 08]. |
[Table 1], [Table 2], [Table 3]