title: Facilitators and obstacles in pre-hospital medical response to earthquakes: a qualitative study.
abstract: BACKGROUND
  Earthquakes are renowned as being amongst the most dangerous and destructive types of natural disasters. Iran, a developing country in Asia, is prone to earthquakes and is ranked as one of the most vulnerable countries in the world in this respect. The medical response in disasters is accompanied by managerial, logistic, technical, and medical challenges being also the case in the Bam earthquake in Iran. Our objective was to explore the medical response to the Bam earthquake with specific emphasis on pre-hospital medical management during the first days.
  
  
  METHODS
  The study was performed in 2008; an interview based qualitative study using content analysis. We conducted nineteen interviews with experts and managers responsible for responding to the Bam earthquake, including pre-hospital emergency medical services, the Red Crescent, and Universities of Medical Sciences. The selection of participants was determined by using a purposeful sampling method. Sample size was given by data saturation.
  
  
  RESULTS
  The pre-hospital medical service was divided into three categories; triage, emergency medical care and transportation, each category in turn was identified into facilitators and obstacles. The obstacles identified were absence of a structured disaster plan, absence of standardized medical teams, and shortage of resources. The army and skilled medical volunteers were identified as facilitators.
  
  
  CONCLUSIONS
  The most compelling, and at the same time amenable obstacle, was the lack of a disaster management plan. It was evident that implementing a comprehensive plan would not only save lives but decrease suffering and enable an effective praxis of the available resources at pre-hospital and hospital levels.
authors.affiliation: Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden.
authors.forename: Ahmadreza
authors.initials: A
authors.lastname: Djalali
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Khankeh
authors.forename: Gunnar
authors.initials: G
authors.lastname: Öhlén
authors.forename: Maaret
authors.initials: M
authors.lastname: Castrén
authors.forename: Lisa
authors.initials: L
authors.lastname: Kurland
mesh_terms: D000328:Adult; D004189:Disaster Planning / Q000458:organization & administration*; D055866:Earthquakes; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014218:Triage