Background: The unique characteristics of each emergency situation and the necessity to make prompt decisions cause emergency medical services (EMS) staff’ s ethical conflicts and moral distress. Objectives: This study aimed to explore EMS staff’ s experiences of the factors behind their moral distress. Methods: This qualitative study was conducted on 14 EMS staff using the conventional content analysis. Data were collected through unstructured and semi‑ structured interviews. Each interview was started using general questions about moral issues at workplace and barriers to professional practice. The five‑ step content analysis approach proposed by Graneheim and Lundman was used for data analysis. Results: The factors behind EMS staff’ s moral distress were categorized into 13 subcategories and 5 main categories. The main categories were staff’ s lack of knowledge and competence, inability to adhere to EMS protocols, restraints on care provision, ineffective interprofessional communications, and conflicts in value systems. The subcategories were, respectively, inadequate knowledge and experience, working with incompetent colleagues, artificial services, working in unpredictable situations, lay people’ s interference in care provision, resource and equipment shortages, barriers to early arrival at the scene, obligatory obedience to the system, poor interprofessional interactions, inadequate interprofessional trust, refusal of care, challenges in obtaining consent, and challenges in telling the truth. Conclusion: EMS staff experience moral distress at work due to a wide range of factors. Given the negative effects of moral distress on EMS staff’ s physical and mental health and the quality of their care services, strategies are needed to prevent or reduce it through managing its contributing factors.

Objective: Patients’ satisfaction (PS) is recognized as an important emergency department service design and it has received a high interest and attention in the health management where many studies have focused on determining factors affecting PS in health-related circumstances. In this study, we aimed to examine PS in emergency department (ED) of the European Gaza Hospital (EGH) in the Gaza Strip (GS). Methods: A descriptive-analytical cross sectional study was performed at ED-EGH between March, 15 and June 20, 2015. Press Ganey questionnaire was used as a tool for data collection. For each patient, a self-administered questionnaire including 22 questions was filled based on a Likert scale. Results were analyzed using SPSS version 22. Results: Overall, 200 respondents were included in the study. About 73% of respondents were satisfied with overall medical services. The term of nurses’ concern provided to patients elicited the highest score (83. 1%), followed by physicians’ concern with patients (72. 0%) and communication skills with patients (71. 4%), while the lowest score was reported in waiting time and security staff. Furthermore, our findings show an association between PS and level of education, gender differences, living area, and work shifts. Conclusion: The study results conclude that areas of medical and nursing care, respects of staff, physical comfort and waiting time ED-EGH is highly acceptable and offer in appropriate manners.

Response time (RT) accounts as a common tool for emergency medical services (EMS) assessment. While the national standard RT has been established in Iran since 2007, its application has hardly been put into scrutiny. This study aimed at investigating the use of RT standard in assessing EMS in Iran. This systematic review included papers focusing on prehospital EMS assessment published in Google Scholar, Scopus, Embase, PubMed, and the Persian databases of Magiran and SID. Selection criteria involved all English and Persian studies focusing on RT as an assessment of prehospital EMS in the context of Iran. Repetitious papers and those presented in conferences were omitted, which left 21 papers published from 2007 to mid‑ 2016 for systematic review. A data collection form was designed. This provided both inclusive information about the papers and indicators used to report RT in each paper (i. e., mean and percentages of RT below 8 min) as well as the use of these indicators vis‑ a‑ vis that of the standard. From among the 21 papers focusing on RT, seven (33%) reported RT as percentages of operations performed in <8 min according to the national standard and compared the percentage with the national standard. A total of 18 (86%) reported the means of RT; nine studies compared mean and the national standard as expressed in percentage. Limited use of the national standard to report RT was identified as a challenge to EMS assessment. Further, the inconsistency that exists when comparing RT in terms of means and percentage is a challenge to the validity of judgments expressed in some previous studies. Employment of uniform methods to report and evaluate performance based on the national standard will lead to greater transparency in emergency operation performance.

Objective: To evaluate the efficacy and preparedness of emergency medical services (EMS) in Islamic Republic of Iran to face Ebola. Methods: The present study is cross-sectional and somehow descriptive. We used a standard questionnaire that was designed by “ center for disease control and prevention” . This questionnaire was captioned “ emergency medical services (EMS) checklist for Ebola preparedness” . We collected a lot of data by studying that questionnaire and every manager in every province of Iran were informed about that info in 2016. This data was analyzed by using SSPP software version 16. Results: Findings have showed the average score related to preparation level of EMS in facing Ebola in Iran was 63. 73± 12. 77 percent. There was no significant difference between the country regions regarding the preparedness of to detect (p=0. 975), protect (p=0. 275) and respond (p=0. 344) to ebola outbreaks. The highest score had been achieved by region number 5 and the lowest score belonged to region number 7. Conclusion: Although the acquired average score in this study is higher than standards, considering the increased threat of breaking out biologic threats especially Ebola infection, using and practicing some measures in order to enhance preparation level of emergency medical services counter this infection and similar infectious diseases is inevitable.