Identification of 31 hazards by pre-hospital emergency centers shows that Iran is a disaster-prone country. The findings from the present study showed that hazards such as earthquakes, traffic accidents, floods, epidemics, and droughts are among the top five hazards reported by most EMS facilities. Since the present study was conducted during the COVID-19 outbreak in Iran, it was expected that the risk of the spread of epidemic diseases would be one of the important hazards for many EMS facilities. In addition to the hazards identified in this study, EMS facilities were also exposed to other hazards that were less serious compared to the five main hazards detailed above. Similarly, Khankeh et al. (2021) (11) introduced a hazard assessment tool and identified the first top 20 hazards rated by Iranian universities of medical sciences. They reported traffic accidents, earthquakes, droughts, floods, and epidemics to be the five most serious health hazards. The authors identified 61 hazards in the first phase of the study. Afterward, they extracted 20 hazards with high priority in the healthcare system.
The data in the present study indicated that the EMS facilities in Iran have a moderate level of disaster preparedness. The hazards in this study were assessed using an all-hazard approach. The findings indicated that the level of preparedness for a specific natural or man-made hazard can be different. In a similar vein, Jadidi et al. (2019) investigated the level of preparedness of EMS facilities in 31 provinces of Iran in the face of Ebola. The results showed that the EMS facilities in Iran were highly prepared in response to Ebola (12). Studies conducted in other countries have indicated that emergency medical are not adequately prepared to respond to disasters. For instance, Alotaibi et al. (2019) found that the EMS system of Saudi Arabia has limited preparedness in response to high mass casualty incidents (13). Furthermore, Jama et al. (2016) (14) found that the Finnish emergency medical services are not sufficiently prepared to respond to and manage chemical emergencies. Maguire et al. (2007) (15) also reported that most EMS agencies in the United States do not have formal and extensive plans to respond to bioterrorism attacks and widespread epidemics.
The present study also examined the core components of disaster preparedness in EMS facilities. The data showed that the EMS facilities had poor performance in terms of coordination- cooperation, and surge capacity. Coordination and cooperation involve the degree of coordination of EMS facilities with partner organizations (e.g. the Red Crescent Society, fire departments, and healthcare centers) and support organizations (police departments, water, electricity, and fuel organizations, telecommunication centers, highway management departments, hazardous materials and CBRN[1] specialists, etc.) in emergency operation plans (EOP) to respond to disasters, holding joint DRM training courses with partner and support organizations, as well as concluding mutual aid agreements and sharing information related to resources when responding to emergencies and disasters. The results showed that EMS facilities should take more action in all core areas. Having coordination and close working relationships within and outside the organization in the pre-disaster phase (such as cooperation to the development of SOPs) and during disasters (such as the joint operation room at the scene of the incident), membership of the EMS in the High Disaster Committee or Council, and the interaction of local centers of EMS facilities with provincial (state) EMS facilities are some activities and strategies highlighted in the literature to improve disaster preparedness in EMS facilities (12, 15). The findings also indicated that developing strategies and plans to increase the response capacity in human resources (staff), medical and logistic equipment, physical spaces and structures, and financial resources can enhance surge capacity. The results showed that at least 11% of the EMS facilities need more effort to improve their preparedness in these core areas. Furthermore, resources should be allocated to strategies such as launching and distribution of operation and emergency centers based on the population, recruiting sufficient and expert staff to meet the needs of EMS facilities, providing medical and logistical equipment, including alternative and transport vehicles to be used in mass casualty incidents and personal protective equipment (PPE) according to possible hazards and scenarios (12, 15–17).
The findings from the present study also indicated that more than half of the EMS facilities had a good performance in terms of “training and practice”. Training for pre-hospital emergency service providers is a critical element of disaster preparedness. The evidence from previous studies suggests that planning and implementing DRM training programs improves the perception of disaster preparedness (2, 18, 19). The observations made in the present study revealed that organizing and holding training courses and the attendance of the manager of the EMS in DRM training courses can improve the disaster preparedness of EMS facilities in Iran.