Background The main aim of reconstructive surgery (RS) is to restore the integrity of soft tissues damaged by trauma, surgery, congenital deformity, burns or infection. Microsurgical techniques consist of harvesting tissues that are separated from the vascular sources of the donor site and anastomosed to the vessels of the recipient site. In these procedures, there are some preoperative modifiable factors that have the potential to influence the outcome of the flap transfer and its anastomosis. Methods Chronic inflammatory anaemia (ACD) is a constant condition in patients who have undergone RS and correlates with the perfusion of the free flap. In RS, it is important to maintain good tissue oxyporesis, avoiding blood hyperviscosity. From January 2017 to September 2019, we studied 16 patients (16 males, mean age 38 years) who underwent microsurgical procedures for RS. Haemoglobin (Hb) levels, Corpuscular Indexes, Transferring saturation (TSAT) ferritin concentrations and creatinine clearance have been measured the first day after surgery (T0), after the first week (T1) and after five weeks (T2). At T0 all patients showed low hemoglobin levels (average 7.4 g/dl, STD 0,71range 6,2-7,4 g dL-1), with an MCV of 72, MCH 28, MCHC 33, RDW 16, Sideremy 35, Ferritin 28, Ret% 1,36, TRF 277 and Creatinine Clearance 119. . We assessed all patients for clinical status, medical history and comorbidities before starting therapy. Results. In collaboration between the two departments, we started a therapeutic protocol with erythropoietic stimulating agents (ESAs) (Binocrit 6000 UI/week) and intravenous iron every other day, on the second day after surgery. Thirteen patients received ESAs and FCM (500-1000 mg per session), three patients received ESAs and iron gluconate (1 vial every other day). No patients received blood transfusions. No side effects were observed and, most importantly, no limb or flap rejection. Conclusions Preliminary data from our protocol show an optimal therapeutic response in a surgical setting with limited data in the scientific literature. The enrolment of further patients will allow us to validate this therapeutic protocol with statistically significant data.

On April 17, 2019, a coach with tourists from Germany crashed in Madeira requiring repatriation by the German Air Force. The Advance Trauma Life Support (ATLS) concept was the central component of patient care. Data in Madeira were collected through a structured interview. The analysis of the Aeromedical Evacuation was based on intensive care transport records. In Germany all available were reviewed for data collection. Quality of life (HRQoL) was evaluated by the 12-item Short-Form Health Survey (SF-12). Twenty-eight prehospital patients were transported to the Level III Trauma Center in Funchal (Madeira). Five operative procedures were performed. Fifteen patients were eligible for Aeromedical Evacuation (AE). In the second hospital phase in Germany in total 82 radiological images and nine operations were performed. Hospital stay lasted 11 days (median, IQR 10–18). Median Follow-up (14 of 15 patients) was 16 months (IQR 16–21). 80% (8 out of 10) showed an increased risk for post-traumatic stress disorder (PTSD). Six key findings were identified in this study: divergent injury classification, impact of AE mission on health status, lack of communication, need of PTSD prophylaxis, patient identification, media coverage. Those findings may improve AE missions in the future e.g. required after armed conflicts.

Background: Pulmonary emboli (PE) is a life threatening condition that is discovered in many patients only "post mortem". Adequate and timely detection of PE is crucial, because of the high mortality and morbidity and the sudden unexpected hemodynamic collapse that may occur in patients with PE. Objectives: To assess the ability to predict clinical outcome of patients with acute PE, using a non-gated computed tomography pulmonary angiography (CTPA), based on the dimensions of the right ventricle. Methods: A retrospective study that analyzed CTPA images of patients admitted with acute PE during the years 2012-2017 in Baruch Padeh Medical Center. The cohort study included 300 patients with documented acute PE, among them 255 were hospitalized in medical (non-intensive care unit) wards, and 45 were patients were hospitalized in an intensive care unit (ICU). Results: Among the 45 patients admitted to the ICU, 8% died. Larger RV diameters predicted mortality (OR=10.14, 95% CI [1.09-93.86]) as well as lower systolic and diastolic blood pressure measurements (p=0.001 and 0.01). Among the 255 patients that were admitted in the Internal Medicine Ward 7% died. Older age (p=0.028), sepsis and cancer (both p<0.001), high WBCs count (p<0.001), and renal failure (p<0.001) predicted death. Overall, of all 300 patients that were admitted, lower blood pressure (systolic and diastolic) (p<0.001, 0.008), older age (p<0.007), sepsis (p<0.001), cancer (p=0.006), higher WBCs count (p<0.001), and impaired renal function (p<0.001) predicted death among patients admitted with confirmed acute PE. Conclusions: Clinical parameters and hematological parameters could predict the outcome of patients admitted with acute PE. RV diameter, measured by the non-ECG gated CTPA had an additive predictive value for patients who were hemodynamically unstable on admission and were hospitalized in the ICU.

The length of stay (LOS) in the hospital emergency department (ED) is a crucial key performance indicator that is used to track and manage the performance of the ED as a whole. Our study had two objectives. Firstly, we aimed to evaluate the association between LOS and the most common primary ICD-10 diagnoses. To achieve this, we examined LOS in groups with specific (internal, surgical, neurological, and traumatic diseases) and non-specific diagnoses in adult ED visits at a tertiary referral hospital between 2017 and 2019 (134,675 visits in total). Our secondary objective was to measure LOS by age, day of the week, time of day, and season. The mean LOS was 254 minutes and was the shortest in the traumatic group (160 minutes), while in other groups it was significantly longer: neurological by 185 minutes, internal medicine by 158 minutes, surgical by 36 minutes, and non-specific by 24 minutes. In conclusion, non-specific diagnoses accounted for 21% of all ICD-10 primary diagnoses. In this group of patients, the percentage of hospitalizations was the highest. Other significant determinants of LOS were the patients’ age, the day of the week, the time of arrival, and repeated visits.

(1) Background: Frailty assessment allows identification of patients at risk of death, and is a challenge in the emergency department or its support wards. The aim is to study Frail-VIG Index (FI-VIG) ability to discriminate frailty groups of older adults and its correlation with mortality in an short-stay unit; (2) Methods: observational, single-center, prospective study consecutively included patients over 65 years old admitted to the unit between March 1, 2021-April 30, 2021. (3) Results: 302 patients were included (56% women); mean age 82.6±7.7 years; 39.1% of them had functional disability and 16.5% had dementia. Of them, 174 patients (58%) met frailty criteria (FI-VIG ≥0.2; 111 (63.8%) mild frailty (FI-VIG 0.2 - 0.36); 52 (29.9%) moderate frailty (FI-VIG 0.36 - 0.55) and 11 (6.3%) advanced frailty (FI-VIG &gt;0.55). Mortality at one year was analyzed: no frailty (n=16; 12.5%); mild frailty (n=25;22.5%); moderate (n=22;42.3%); advanced (n=7;63.6%), showing significant differences between groups (p&lt;0.003). Mild Frailty vs Non-Fragile HR 2.47 (95%CI 1.12 - 5.46; Moderate Frailty vs Non-Fragile HR 6.93 (95%CI 3.16 - 15.23); Advanced Frailty vs Non-Fragile HR 11.29 (95%CI 3.54 - 36.03). (4) Conclusions: There was a strong correlation between frailty degree and mortality at 1, 6 and 12 months. FI-VIG Index is a fast, easy-to-use tool and allows personalization of care.

Community-acquired pneumonia (CAP) is among the most common causes of death and one of the leading healthcare concerns worldwide. It can evolve into sepsis and septic shock, which have a high mortality rate, especially in critical patients and comorbidities. The definitions of sepsis were revised in the last decade as “life-threatening organ dysfunction caused by a dysregulated host response to infection”. Procalcitonin (PCT), C-reactive protein (CRP), and complete blood count including white blood cells are among the most commonly analyzed sepsis-specific biomarkers also used in pneumonia in a broad range of studies. It appears to be a reliable diagnostic tool to expedite care of these patients with severe infections in the acute setting. PCT was found superior to most other acute phase reactants and indicators, including CRP as a predictor of pneumonia, bacteremia, sepsis and poor outcome. In addition, PCT use is beneficial to judge timing for cessation of antibiotic treatment in most severe infectious states. The clinicians should be aware of strengts and weaknesses of known and potential biomarkers in expedient recognition and management of severe infections. This manuscript is intended to present an overview of the definitions, complications and outcomes of CAP and sepsis, with special regard to PCT and other important markers.

Economic globalisation has promoted the extensive circulation of commodities around the world, and international trade has increasingly been a strong booster for economic growth in China. As an foundation for national economy, the shift of agricultural products (AP) from production to distribution has become the focus of agricultural development, and in recent years, the international trade of agricultural products in China has been the highest in the world. While, cross-border e-commerce (CBE), as one of the important modes of agricultural products circulation, has brought new opportunities for China's fresh agricultural products to carry out online import and export trade under the favourable policies continuously introduced internationally. This research analyses status of APCBE in Yunnan Province, China, and propose strategies for developing CBE of Yunnan AP.

COVID-19 has proven to be detrimental across the globe, most notably affecting the United States at an alarming rate compared to comparable countries. The pandemic has had multifactorial implications on the way communities in the United States prevent, prepare for, and address the virus; however, the impact of the pandemic on rural health is less well understood. Historically, rural communities have faced a unique set of challenges regarding accessing and receiving adequate healthcare, addressing chronic illness, and eliminating health disparities closely associated with the population’s socioeconomic status; the pandemic has exacerbated these challenges. The purpose of the current study was to conduct a systematic review of the literature to evaluate the effect of the COVID-19 pandemic on rural populations both at the individual and community level. Results indicated that rural health disparities increased both at the individual and system-wide levels as a direct result of the pandemic. Budget cuts significantly affected the infrastructure of rural hospitals resulting in them being unequipped to handle such high volumes of COVID-19 cases. The lack of infectious disease specialists, access to larger medical centers with substantial numbers of ICU beds and ventilators, and an overall lack of preparedness overwhelmed rural communities. Although comorbidities such as diabetes and heart disease were associated with poorer health outcomes for a multitude of reasons, the lack of clinic and physician availability for routine care during the pandemic further exacerbated the clinical link from COVID-19 positivity to comorbidities. Furthermore, mental health deteriorated as substance use increased to a greater extent in rural communities compared to urban, during the pandemic. This study shows that health comorbidities, mental health, substance use, health literacy, access to healthcare, among others can serve as key indicators for improving healthcare in rural communities. Future studies should seek to identify key issues that disproportionately affected rural communities in comparison to their urban counterparts considering the pandemic, as well as identify gaps in the availability of rural health resources that can improve the lives of millions of Americans now and during the next pandemic.

The COVID19 pandemic had a major impact on emergency medical communication centres (EMCC). A live video facility was made available to second-line physicians in an EMCC with a first-line paramedic to receive emergency calls. The objective of this study was to measure the contribution of live video to remote medical triage. The single-centre retrospective study included all telephone assessments of patients with suspected COVID19 symptoms from 01.04.2020 to 30.04.2021 in Geneva, Switzerland. The organisation of the EMCC and the characteristics of patients who called the two emergency lines (official emergency number and COVID19 number) with suspected COVID19 symptoms were described. A prospective web-based survey of physicians was conducted during the same period to measure the indications, limitations and impact of live video on their decisions. 8,957 patients were included. 2,157 (48.0%) of the 4,493 patients assessed on the official emergency number had dyspnoea. 4,045 (90.6%) of 4,464 patients assessed on the COVID19 number had flu-like symptoms. 1,798 (20.1%) patients were reassessed remotely by a physician, including 405 (22.5%) with live video, successfully in 315 (77.8%) attempts. The web-based survey (107 forms) showed that physicians used live video to assess mainly the breathing (81.3%) and general condition (78.5%) of patients. They felt that their decision was modified in 75.7% (n=81) of cases, and caught 7 (7.7%) patients in life-threatening emergency. Medical triage decisions for suspected COVID19 patients are strongly influenced by the use of live video.

This study aimed to investigate the prevalence, location, and characteristics of new-onset chronic pain by using a new definition in long-term survivors after discharge from a tertiary emergency center. We conducted a single-center ambidirectional cohort study from January to May 2022. A survey of patients was conducted by postal mail 2-2.5 years since their discharge from a tertiary emergency center. We used the Brief Pain Inventory to investigate chronic pain parameters, and the painDETECT questionnaire to investigate neuropathic pain. Patient information during hospitalization was collected retrospectively from medical records. The survey was sent to 78 patients, 63 (81%) of whom responded and were included in the analysis. Nine of the 63 patients (14%) had new-onset chronic pain. Of these, six (67%) had chronic pain of moderate or severe intensity which interfered with daily life. The most frequent location of chronic pain was the ankle/foot (n=4, 44%). Neuropathic pain was present in four (44%) patients with new-onset chronic pain. New-onset chronic pain may occur for up to 2-2.5 years after discharge from a tertiary emergency center, and this may interfere with daily life. Therefore, a follow-up system for chronic pain is warranted.

Introduction: Acute compartment syndrome (ACS) is a surgical emergency that requires urgent intervention in order to prevent permanent structural damage and irreversible functional disability. The diagnosis of ACS depends on a high index of suspicion, relying on the following diagnostic criteria commonly known as the 5 Ps; Pain, Paresthesia, Paralysis, Pallor, and Pulse-lessness. When the diagnosis is uncertain, intracompartmental pressure greater than 30 mmHg is suggestive of ACS. Case Presentation: We report a case of an underdiagnosed ACS, with a lack of classical presentation in a thirty-seven-years-old male patient with a history of myopathy. The patient was admitted to the emergency room due to direct trauma to his right hip, without a significant Visual Analogue Score. On his hip radiograph a subtrochanteric fracture of the right femur was demonstrated. An additional masked ipsilateral subcapital fracture was detected during the operation. The diagnosis of ACS was made during the operation while relying on the clinical appearance of the thigh and the clinical findings during surgery. Fasciotomies were performed, and open reduction with internal fixation via Proximal Femoral Nail was done. The diagnosis of ACS was confirmed later on, by the biopsy results. Conclusion: This case suggests that myopathy can mask the classical presentation of ACS. Furthermore, the extent of pain complaints and accompanying paresthesia cannot be relied on in this regard and other clinical features should be considered in order to diagnose ACS.

PurposeThis study was designed to characterize the psychometric properties of the Persian version of the Fear of Hospitalization Scale (P-FHS).Design and methodsIn order to evaluate the validity and reliability of the translated scale, a cross-sectional design was employed. Ten experts evaluated the content validity of the Fear of Hospitalization Scale (FHS) after it had been back-translated into Persian. With 612 patients having emergency surgery, construct validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The STROBE checklist for cross-sectional studies was followed.FindingsThe results of EFA (n = 306) showed that the fear of hospitalization had three factors. These three factors accounted for 45.28% of the total variance. Also, these factors were confirmed by CFA (n = 306) (root-mean-square error of approximation = (90%. confidence interval) = 0.050 [0.041, 0.058], goodness-of-fit index = 0.945, comparative fit index = 0.968, Non-Normal Fit Index = 0.948, incremental fit index = 0.968, Tucker-Lewis Index = 0.959). The coefficients of Cronbach’s alpha, McDonald’s omega, composite reliability, and maximum reliability for all three factors were greater than 0.7, demonstrating satisfied internal consistency.Practice implicationAccording to the published results, the P-FHS is effective at measuring hospitalization anxiety in patients undergoing emergency surgery. It is advised that nurses in Iranian culture use a legitimate and trustworthy technique to pinpoint the causes of hospitalization anxiety in patients undergoing emergency surgery to give optimal care.

Background: The Sequential Organ Failure Assessment (SOFA) is a scoring system used for the evaluation of disease severity and prognosis of critically ill patients. The impedance ratio (Imp-R) is a novel mortality predictor. Aims: This study aimed to evaluate the combination of SOFA + Imp-R in the prediction of mortality in critically ill patients admitted to the emergency department (ED). Methods: A retrospective cohort study was performed in adult patients with acute illness admitted to the ED of a tertiary-care referral center. Baseline SOFA score and bioelectrical impedance analysis to obtain the Imp-R were performed within the first 24 hours after admission to the ED. A Cox regression analysis was performed to evaluate mortality risk of initial SOFA score plus Imp-R. Harrell's C-statistic and decision curve analyses (DCA) were performed. Results: Out of 325 patients, 240 were included for analysis. Overall mortality was 31.3%. Only 21.3% of non-surviving patients died after hospital discharge, and 78.4% died during hospital stay. Of the latter, 40.6% died in the ED. SOFA and Imp-R values were higher in non-survivors and were significantly associated with mortality in all models. The combination of SOFA + Imp-R significantly predicted 30-day mortality, in-hospital mortality, and ED mortality with area under the curve (AUC) of 0.80 (95% CI: 74-0.86), 0.79 (95% CI: 0.74-0.86) and 0.75 (95% CI: 0.66-0.84) respectively. The DCA showed that combining SOFA + Imp-R improved the prediction of mortality through the lower risk thresholds. Conclusion: The addition of Imp-R to baseline SOFA score at admission to the ED improves mortality prediction in severely acutely ill patients admitted to the ED.

This study examines the relation between ambient air pollution and emergency department (ED) visits due to certain infectious diseases in Toronto, Canada. The National Ambulatory Care Reporting System database was used to draw the corresponding health cases. Daily data on ED visits, ambient air pollution concentration levels, and weather conditions during the period from April 2004 to December 2015 (4,292 days in total) were linked together and used in statistical models. Six air pollutants (fine particulate matter PM2.5, CO, NO2, SO2, ozone O3 as a daily average, and ozone O3-8 hour ozone, as a maximum eight hour average) were investigated. In addition, the Air Quality Health Index (combining NO2, O3, and PM2.5) was also considered. The time-stratified case-crossover technique was applied in the study design. Conditional Poisson models were created using the daily counts of ED visit data. The considered factors, air pollutants and weather, were lagged by the same number of days, from 0 to 14. In the period of the study 339,644 ED visits were identified; 177,619 for females and 162,025 for males. For each air pollutant 270 models were realized (15 lags x 18 strata). Ambient air pollution concentrations lagged by 2, 3, and 5 days have the highest impact on ED visits, with 34, 32, and 35 positive associations, respectively. For all patients and an increase in a one interquartile range (IQR=1.2 ppb) of sulphur dioxide, the following values of the relative risks (RR) were estimated: RR=1.005 (95% confidence interval: 0.998, 1.013), 1.008 (1.001, 1.016), 1.009 (1.001, 1.016), 1.011 (1.004, 1.019), 1.007 (0.987, 1.028), and 1.009 (1.002, 1.016) for lags from 0 to 5, respectively. The results suggest that exposures for certain air pollutants (mainly CO, O3, and SO2) in urban environment affect the number of ED visits related to infectious diseases.

Extracorporeal membrane oxygenation (ECMO) is an established rescue therapy for patients with chronic respiratory failure waiting for lung transplantation (LTx). The therapy inherent immobilization may result in fatigue, consecutive deteriorated prognosis and even lost eligibility for transplantation. We conducted a feasibility study on a novel system designed for the deployment of a mobile ECMO device, enabling physical exercise of awake patients prior to LTx. The system comprises a novel mobile oxygenator with a directly connected blood pump, a double lumen cannula, gas blender and supply, as well as control, and energy management. In-vitro experiments included tests regarding performance, efficiency, and blood damage. A reduced system was tested in vivo for feasibility using a novel large animal model. Six anesthetized pigs were first positioned in supine position, followed by a 45° angle, simulating an upright position of the patients. We monitored performance and vital parameters. All in-vitro experiments showed good performance for the respective subsystems and the integrated system. The acute invivo trials of 8h duration confirmed the results. The novel mobile ECMO-system enables adequate oxygenation and decarboxylation sufficient for, e.g., physical exercise of designated LTx-recipients. These results are promising and suggest further preclinical studies on safety and efficacy to facilitate translation into clinical application.

Background: ED overcrowding is described as one of the main issues in emergency departments (EDs) of any hospital. In Saudi Arabia, the ministry of health applied new telemedicine technology to serve patients by using the mobile application which include Sehha application and 937 medical call center. The main aim of this study is to determine the role of different telemedicine services in reducing non-urgent visits to EDs in Saudi Arabia. Methods: A cross-section study was conducted during August 2020 - May 2021 among 319 patients were using two telemedicine services in Saudi Arabia, including medical call center, and Sehha smart phone application. The primary endpoint of this study aims to determine the role of different telemedicine services in reducing non-urgent visits to EDs in Saudi Arabia. Results: This study analyzed the data from 319 patients who completed the survey provided by the Saudi Ministry of Health that concerning on information related to their health status, and ED visits. Among patients that had the intention to visit the ED (N=159), 53 of them did not go to EDs after using telemedicine services (p-value < 0.01). Regarding medical call center and Sehha application, 9.6% and 24.4%, respectively of the patients used these telemedicine services had changed their mind concerning visiting ED after taking the medical advice (p-values < 0.01).Conclusion: The implemented telemedicine services in Saudi Arabia, namely Sehha application and medical call center showed to be effective in reducing ED overload by providing medical advices to less- and non-urgent patients and deal with their minor medical issues.

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 01.01.2009 to 01.01.2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of "obvious death" or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardio-pulmonary resuscitation (CPR). Prognostic factors known at the time of EP's decision were included in a multivariable logistic regression model. 784 patients were included. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR=2.14, 95%CI1.43–3.20) and bystander CPR (OR=4.10, 95%CI2.28–7.39). Traumatic aetiology (OR=0.04, 95%CI0.02–0.08), age >80 years (OR=0.14, 95%CI0.09–0.24) and a Charlson comorbidity index greater than 5 (OR=0.12, 95%CI0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.

This study was conducted to determine whether overcrowding in the emergency department (ED) affects the occurrence of a return visit (RV) within 72 hours. The crowding indicator of index visit was the average number of total patients, patients under observation, and boarding patients during the first 1 and 4 hours from ED arrival time and the last 1 hour before ED departure. Logistic regression analysis was conducted to determine whether each indicator affects the occurrence of RV and post-RV admission. Of the 87,360 discharged patients, 3,743 (4.3%) returned to the ED within 72 hours. Of the crowding indicators pertaining to total patients, the last 1 hour significantly affected decrease in RV (p=0.0046). Boarding patients were found to increase RV occurrence during the first 1 hour (p=0.0146) and 4 hours (p=0.0326). Crowding indicators that increased the likelihood of admission post-RV were total number of patients during the first 1 hour (p=0.0166) and 4 hours (p=0.0335) and evaluationg patients during the first 1 hour (p=0.0059). Overcrowding in the ED increased the incidence of RV and likelihood of post-RV admission. However, overcrowding at the time of ED departure was related to reduced RV.

Most pathologies in emergency departments(EDs) can be detected with using non-invasive, extremely safe magnetic resonance imaging (MRI). MRI is highly sensitive to abnormality, so when compared to Computed Tomography(CT), a negative MRI far exceeds the value of a negative CT. This was a retrospective cohort study comparing resource utilization between September 2016 and September 2017 in a university hospital ED. Descriptive statistics are presented with frequency, percentage, mean, standard deviation, minimum and maximum values. A chi-square analysis was conducted to examine the relationships. Analyses were conducted using the SPSS 22.0 package program. In the ED, MRI is available 24/7. MRI was performed on 954 (479 female, 475 male) patients. A total of 212 cranial, 604 diffusion, 57 lumbar, 40 cervical, 38 dorsal, two abdominal, and one orbital MRIs were performed. In most groups, the average age was over 40, and the age distribution was similar (p = 0.12). There was no significant sex difference except for lumbar MRI. Lumbar MRI and diffusion MRI groups were admitted to the hospital mostly in the day hours (p = 0.03); in other groups, night and day admissions were almost the same. Neuroimaging takes the majority part of MRI examinations in our ED.

Introduction: The attitudes of doctors and nurses toward patient safety is a significant factor in hospital safety climates and medical error rates. Yet, there are very few studies of patient safety attitudes in Saudi hospitals and none conducted in hospital emergency departments. Aims: The current study aims to investigate the discrepancy between the patient safety attitudes of doctors and nurses in a Saudi hospital emergency department. Materials and Method: The study employed a qualitative research designvia semi-structured interviews with Saudi and non-Saudi doctors and nurses working in a Saudi hospital emergency department to determine their attitudes and experiences about the patient safety climate. Results: The findings showed doctors and nurse held some similar safety attitudes, however, nurses reported issues with doctors with respect to their teamwork, communication, and patient safety attitudes. Moreover, several barriers to the patient safety climate were identified such as limits to resources, teamwork, communication, and incident reporting. Conclusion: The findings provide one of the few research contributions to knowledge on the differential patient safety attitudes of Saudi and non-Saudi doctors and nurses and suggest the application of such knowledge would enhance positive patient outcomes in emergency departments.

Introduction: The management performance of hospitals in emergency departments in coping with clinical hazards is necessary for their success in providing quality services. The purpose of this study is to provide an optimization procedure and applying management performance in health and medical emergency on the rate of emergency preparedness of the suburb city hospitals. Research method: A semi-experimental and interventional descriptive study in the emergency department of Shahid Motahari Hospital in 2015-2016. Data was collected through the standard checklist of hospital emergency responsiveness test to WHO disasters with 90 questions in 9 domains which is codified by the World Health Organization, in the form of interviews and observing evidences , and if necessary a numerical analysis. Initially, the situation was measured according to this checklist. In the next stage, a set of solutions was developed and then the solutions were implemented according to the obtained information. Data analysis before and after proposing the procedure and its application in order to improve the quality of health management performance and emergency preparedness was performed using central indices, and for describing and presenting the survey results, tables and graphs were used. Results: The highest and lowest emergency preparedness rates for disasters and emergencies before the proposed procedure were the Communication Factor (%77/8) and Human resource factor (%2/8) respectively. The degree of preparedness of the medical center was measured in the management performance according to the model (WHO) before proposing the procedure (%77.98). The researcher's procedure provided and applied based on the information obtained from survey environment, location and type of hospital structure. After providing the procedure, the maximum and minimum rates were the continuity of service factor (%58.3) and post-accident rebuilding factor (%100), respectively. Generally, the rate of emergency preparedness of studied medical center in management performance for coping with disasters and medical emergencies was measured (%97.2) according to hospital emergency responsiveness test for accidents and (WHO). The significance level is less than 0.05, so we can say that the effectiveness with confidence (95%) was effective. Conclusion: According to the statistics of accidents and disasters in the suburb cities, the results of the research and the importance of the role of emergency departments in interurban hospitals in controlling accidents, the need for planning and implementation of practical measures such as conducting training courses on health management in disasters and emergencies, having an estimate of critical and essential resources, changing the structure, providing manpower (emergency management) in order to more precise control and ease of service, maintenance and repair of equipment, timely triage and retrofitting of hospitals were effective in improving their preparedness.