|Year : 2013 | Volume
| Issue : 3 | Page : 184-189
Spatial distribution of prehospital emergency medical services bases in Isfahan province in 2012 using GIS
Masoud Ferdosi1, Mohammad H Yarmohammadian1, Saied Karimi1, Ghafour Rastin2, Mehrzad Artang3, Farzaneh Mohammadi4, Maryam Mofid5, Farzaneh Rejalian6
1 Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Emergency Medical Affairs, Tehran University, Tehran, Iran
3 Emergency Medical Unit, Tehran University, Tehran, Iran
4 Health Economics, Tehran University, Tehran, Iran
5 Healthcare Management, Faculty of Management and Medical Informatics, Isfahan University of Medical Sciences, Isfahan, Iran
6 Master's Student, Healthcare Management, Yazd University of Medical sciences, Yazd, Iran
|Date of Web Publication||20-Mar-2014|
Department of Healthcare Management and Informatics, Isfahan University of Medical Sciences, Isfahan
Source of Support: None, Conflict of Interest: None
Introduction: Human are constantly exposed to natural and non-natural disasters and when facing such problems, always try to seek a way out. In such situations, he/she would be in need of help from others particularly from rescue organizations such as emergency services. Thus, to provide such services in time, spatial distribution of facilities is of great importance. The spatial distribution of emergency medical services (EMS) units in Isfahan province would be studied in this article. Materials and Methods: This is a case report which describes the distribution of physical and human resources of prehospital emergency care bases. Based on available documents, the number of mentioned resources in different cities of the province was surveyed and then, using Google Earth and Geographic Information System (GIS) software, the density and coverage of the constructed facilities were shown. Results: The density and coverage of EMS units in the western province are more and in the eastern and northern parts including Khoor va biabanak, Nain, Ardestan, and Aran va Bidgol, the coverage is less due to vastity. Conclusion: Based on the results, allocation of resources in different cities of Isfahan province has great differences. Actually, the need to the resources must be determined and the emergency needs must be answered by equitable distribution of resources before entering the hospital in order to prevent further harms and costs.
Keywords: Equity, land use planning, pre-hospital emergency medical services, resource allocation, spatial distribution
|How to cite this article:|
Ferdosi M, Yarmohammadian MH, Karimi S, Rastin G, Artang M, Mohammadi F, Mofid M, Rejalian F. Spatial distribution of prehospital emergency medical services bases in Isfahan province in 2012 using GIS. Int J Health Syst Disaster Manage 2013;1:184-9
|How to cite this URL:|
Ferdosi M, Yarmohammadian MH, Karimi S, Rastin G, Artang M, Mohammadi F, Mofid M, Rejalian F. Spatial distribution of prehospital emergency medical services bases in Isfahan province in 2012 using GIS. Int J Health Syst Disaster Manage [serial online] 2013 [cited 2021 May 15];1:184-9. Available from: https://www.ijhsdm.org/text.asp?2013/1/3/184/129184
| Introduction|| |
Each human in the community is a member of moral support of the country. In the government, authorities of planning for this great family are legally responsible to maintain health and provide emergency medical services (EMS) when needed to each individual. Certainly, danger is always lurking, since man is always exposed to different disease and natural and non-natural disasters and does not know when the illness would come to him/her. When facing such problems, everyone tries to seek a way out of the problem and in such situations; he/she would be in need of help from others particularly from rescue organizations such as emergency services. Actually, what improves the safety factor and health security for the citizens in the community is the availability of EMS units that provide services day and night.  On the other hand, one of the most important criteria for community development is providing healthcare for all people. Perhaps, the most important element of healthcare is emergency care, especially prehospital ones. Prehospital medical services (EMS) is called to those services which begins at patient's bed and ends in the hospital emergency unit.  Emergency response centers play a vital role in ensuring public health and saving people lives in emergency situations. 
Also, providing EMS is one of the most important aspects of patient's treatment. Since providing accurate and fast services in emergency situations can lead to the survival of patients, it is of a high value. 
Thus, EMS has the priority in medical care and requires ongoing attention. Hence, to provide better services, the resources must be allocated appropriately in the province in order to cover all areas and provide services in the least time possible. 
Throughout the world, health systems and organizations related to healthcare are facing limitations in resources and do not have necessary resources to deal with all health problems and target groups at the same time. Thus, determining priorities and logical use of resources is inevitable at all health systems. 
One way to ensure equitable allocation of resources and health services is land use planning or spatial planning, and examining the spatial distribution of facilities and services is of great importance. Actually, by the emphasis land use planning has put on three elements of people, environment, and resources; it tries to set up a logical and systematic relation among human, land, and various activities in order to sustainably use economic, social, and natural resources, to achieve mid- and long-term goals of economic, social, and cultural development of the country in line with the 20-year vision plan. If we consider the land use planning as a spatial planning, then it is an attempt to determine the allocation of resources to different places and regions, so that the regional investment would have the most social benefits, and productive activities and facilities in the region are available to all, and a kind of spatial structure would be established that has potential to substantiate regional development plans. ,
Considering the importance of emergency situations in medical cares, in this study we investigated the spatial distribution of physical facilities and human resources among different cities of Isfahan province to determine regions having less accessibility to the facilities and accordingly, step towards providing these services.
| Materials and Methods|| |
This is a case report which evaluates the current status of physical facilities and human resources of EMS units in different cities of Isfahan province in 1391. The statistical population includes EMS units of different cities of Isfahan province, and sample size is the whole statistical population. Required data were obtained based on available documents collected from responsible center which was the emergency medical affairs of Isfahan. First, number of EMS units of each city was determined in separation for cities and roads, and other ways of providing EMS (such as air and motor rescue, bus ambulance) were determined. Then, location of bases was determined using Google Earth and finally, using Geographic Information System (GIS), the coverage of these facilities was shown with separation for urban and hospital emergency units within a radius of 40 and 8 km and for roads out of urban a radius of 40 km, respectively. The radius was selected considering the average maximum time to reach the accident site which is 15 min. 
| Results|| |
The number of EMS units is shown in [Table 1]. The total number of prehospital EMS units in Isfahan province was 123 of which 58 bases were urban and 65 were road bases. Of course, this category is just about the place of activities not the kind of them. Among urban bases, Isfahan had the highest number with 27 bases and the least number of urban bases was one base which was in the cities of Ardestan, Tiran va Karvan, Chadegan, Khansar, Dehaghan, Semirom, Fereydan, Fereydoonshahr, Falavarjan, Golpayegan, Mobarakeh, Nain, Natanz, and Aran va Bidgol. Also, cities of Borkhar and Khoor had no urban medical EMS units.
|Table 1: Number of prehospital EMS units in different cities of Isfahan province, 1391|
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Khansar and Fereydoonshahr had no road EMS units. The highest number of road units was in the city of Isfahan with nine bases. The least number of road units was one base which was in the cities of Golpayegan, Fereydan, Najafabad, Tiran va Karvan, Dehaghan, and Chadegan. Within Isfahan province, there is only one air emergency base which belongs to the city of Isfahan that services to Isfahan province and other provinces around it. About motor EMS units and bus ambulance bases, there were one bus ambulance and 2 motor EMS units in either cities of Isfahan and Kashan. If we consider a radius of 40 km coverage for road bases, the density and covered areas in Isfahan province would be as follows [Figure 1].
|Figure 1: The density and covered areas of road prehospital EMS units. OR Reference: Career Planning and Deputy Governor of Isfahan, Isfahan Science and Technology Town|
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According to the above figure, it can be seen that almost all cities are under the coverage of road bases, and only small parts of Khoor va Biabanak, Nain, Ardestan, Aran va Bidgol, Isfahan, and Fereydoonshahr do not have appropriate coverage which are mostly in northern parts of the province. The density and coverage of urban prehospital EMS units and hospitals in Isfahan province is shown in [Figure 2].
|Figure 2: The density and covered areas of urban prehospital EMS units. Reference: Career Planning and Deputy Governor of Isfahan, Isfahan Science and Technology Town|
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According to the above figure, the highest density of urban prehospital EMS units and hospitals in the province is in the city of Isfahan and the most coverage is in the western parts of the province.
In addition, the number of personnel of prehospital EMS units in separation for educational level is shown in [Figure 3] and [Table 2].
|Figure 3: The number of personnel of prehospital EMS units in separation for educational level in the cities of Isfahan province|
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|Table 2: Number of prehospital EMS units personnel in terms of degree - discipline in 1391|
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Note: Data about personnel of Aran va Bidgol are not provided.
Based on the above figure, it may be seen that the highest number of personnel is in Isfahan city with a total number of 296 of which 114 persons hold a bachelor's degree and only two people have a master's degree. Also, Khansar had the least number of personnel with four personnel.
| Discussion|| |
Today, the way of allocation of resources and ultimately health justice, and removal of injustice in regions is one of the main concerns of the health system in the world, especially in developing countries.  Lack of balance among cities of Isfahan province in different socioeconomic and cultural fields causes a disorder in spatial order of Isfahan city and leads to isolation and marginalization of many other cities of the province. To control current status and to reduce imbalances among cities, attention must be paid to spatial planning studies.  According to the necessity of prehospital emergency care, studying spatial distribution of EMS units through land use planning and GIS data units is of great importance. Based on the results obtained, the most prehospital EMS coverage is in the western parts of the province, and the coverage is not enough in the eastern parts. Also, the highest density and coverage of the services are in the city of Isfahan. Khansar had the least number of personnel with four. Also, since cities of Khoor va Biabanak, Nain, Ardestan, and Aran va Bidgol are widely spread, the coverage in these areas is not enough. In his studies, Bayram says that an integrated EMS system can only be accessible through appropriate allocation of resources, having foresight, cooperation, transparency, and accountability in all sections of health system.  In this study, emphasize has been put on resources allocation. In his study, Ali has investigated the distribution of facilities proportional with the characteristics of each area and proportional with population density at urban areas.  Symons and Shuster has studied the component of accessibility as an important component and described its details, so that paying attention to an inclusive integrated access, regardless of location, is an important requirement for appropriate operation of prehospital emergency care services.  In this study, paying attention to regional situation in order to have more access to mentioned services has been investigated. According to Bahadori et al., due to scarce resources and unlimited needs, by examining resources, it must be determined that which resources have the most impact on development of emergency care services. For example, he argues that using ambulance type B and motor ambulance had more efficiency in providing such services.  Bahrami et al., discusses that the response time to emergency injuries in Yazd province compared to the national standard is acceptable, and this can be caused by many factors such as proper investment in EMS units, geographical situation, distribution of services, and distribution of EMS units, population density, and traffic level in the city. However, continuous monitoring and a national investment on EMS are necessary for health justice to be developed.  In this study, the resource allocation has been emphasized which can also lead to health justice. Haghparast-Bidgoli has studied the access to EMS and related factors (such as ambulance, personnel, etc.) by determining the injustice index, Gini index, and Lorenz curve, and explains that facilities and resources are unfairly allocated to different provinces.  Haghparast-Bidgoli findings indicate that improper and inadequate distribution of resources is a major obstacle in providing EMS services in Iran. Actually, a mismatch of number of ambulances and other services with population number and density has led to improper distribution of resources in EMS.  Important differences in population density, geographical situation, and other conditions may imply different types of EMS systems. Therefore, large differences may be seen among medical care services provided in different areas. ,
Yousefi et al., showed that different countries use a combination of indices of population, mortality, socioeconomic indices, costs related to common diseases, costs related to remote and rural areas, and resources usage rate, for allocation of their resources. Based on this model and its localization, one may set resources allocation among cities of a certain province, so that the health justice is established.  Tourani et al., showed that allocation of resources to plans, regions, and universities is not done based on the needs and other factors are involved among which are number of beds, number of facilities, the capability of managers in fundraising, and political matters.  Therefore, by conducting studies such as current study, different needs of cities of a province may be determined and modifications may be applied to current status of allocation of resources.
Asthana and Gibson argues that allocation of resources should be based on geographical needs, and this cannot be obtained by only studying the disease indices in people, but also other issues such as the age and socioeconomic indices must be considered.  Chen showed that two decision-making strategies are used for allocation of resources by public health officials: Allocation of resources based on a formula and allocation of resources based on competition. In formulaic method, the resources allocation proportion is calculated using mathematical equations, while in competitive method, it is based on reviewing received application. While formulaic methods are simple and clear, the competitive methods are much more useful in examining local situation related to public health.  In this study, great attention has been paid to needs. According to mentioned studies, it can be seen that the way of allocation of resources in different levels is a challenging issue and a new approach based on different needs should be adopted, and using only formulaic methods is not enough to come up with different health needs of people. Actually, it can be said that when allocating resources, different factors such as population distribution and their needs, based on health indices, must be well considered. Also, considering that providing prehospital emergency care in the least possible time and with good quality can prevent following accidents, by allocating sufficient resources to this section, many occurring costs can be prevented.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]