Different potential factors can affect the outcomes of Out of Hospital Cardiac Arrest (OHCA). The present study aimed to identify important factors contributing to the Return of Spontaneous Circulation (ROSC) and Survival to Hospital Discharge (SHD) in these patients. This cross-sectional study was conducted on all the OHCA patients who underwent Cardiopulmonary Resuscitation (CPR) in emergency medical service (EMS) of Hamedan province during 2016-2017. All the relevant data were retrieved from three sources, according to Utstein's style. In addition, univariate and multivariate logistic regressions were employed to identify predictive factors of ROSC and SHD using SPSS software, version 20. Among the 3214 eligible patients whose data were collected, most OHCA patients were female (59.7%) with the mean age of 58 years. Moreover, the majority of OHCAs (77.8%) occurred at home during 8pm-8am (65.1%) and about 26.3% of OHCAs were witnessed, with only 5.1% bystander-initiated CPR. Furthermore, the median ambulance response time and CPR duration were 6.0 and 20 minutes, respectively. Overall, ROSC and SHD success rates were 8.3 and 4.1%, respectively. Bystander CPR was found to be the most effective predicting factor for the success rate of ROSC (AOR=3.26, P<0.001) and SHD (AOR=3.04, P<0.001) after adjusting for the Utstein variables including the patients' age, gender, cardiac disease history, arrest time, CPR duration, response time, being witnessed, bystander CPR, and endotracheal intubation (ETI). The overall success rates of ROSC and SHD were 8.3% and 4.1%, respectively. The age, ambulance response time, CPR duration, and cardiac disease history were negatively associated with the outcomes of ROSC and SHD, while being witnessed, bystander CPR, ETI, and initial shockable rhythm were positively related to both of the above-mentioned outcomes.

Introduction: The unpredictability of prehospital emergencies combined with constantly changing circumstances can lead to increased stress and mental health issues among Emergency Medical Technicians (EMTs). To accurately determine the stress-inducing factors in the prehospital environment, it is important to first identify the stressful events that occur in this environment. Therefore, this study strives to provide a thorough analysis of the stressors in the prehospital environment. Methods: Sequential explanatory mixed methods were conducted in Hamadan prehospital emergency centers in 2022. The study included 251 EMTs, who were selected through a method in the quantitative phase. The quantitative part used a questionnaire consisting of basic information and the Posttraumatic Stress Questionnaire (PCL-5). In the qualitative phase, 17 with extensive experience in dealing with prehospital stressors were selected based on their PCL-5 scores (above 33). The qualitative phase analysis was carried out using the contractual content method using the Graneheim and Ladman's approach. Statistical analyzes for the quantitative and qualitative phases were performed using SPSS 21 and maxqda 10, respectively. Results: The study revealed that the EMTs had an average PTSD score of 21. 60 ± 11. 45. Multivariate linear regression analysis showed that the number of shifts had a statistically significant relationship with PTSD scores (t = 26.38, P < 0.001). The qualitative phase of the study included 17 interviews, resulting in 14 subcategories, which consisted of four categories: “the overall impact of the stress crisis on technicians,” “missing links in the communication network in incident management,” "professional shortcomings in pre-hospital care,” and “the complex and multifaceted context of stressful pre-hospital emergencies.” Additionally, the study's theme was centered around “surveying the experiences of EMTs in stressful environments.” Conclusion: As the number of shifts increased, the primary cause of the high prevalence of PTSD in EMTs was revealed. Prehospital emergency stress can be reduced and managed more skillfully by adjusting various factors such as shortening workdays, offering continuous training, augmenting workforce, supplying ambulance equipment insurance, refraining from hiring personnel devoid of clinical training, hiring psychologists, hiring midwives in an emergency, updating prehospital protocols and guidelines, encouraging cooperation between EMTs and other relief groups, and utilizing cutting-edge technologies.

Background: Emergency medical service providers are frequently exposed to a variety of stressors as a result of their work environment. These stressors can have detrimental effects on both the physical and mental well-being of individuals. This study was conducted with the aim of exploring stress management strategies in emergency medical service providers.Methods: This study was conducted in 2023 using a qualitative approach and content analysis method. A purposive sampling method was used to include 16 emergency medical system providers from Hamadan city. Semi-structured interviews, with a duration of 45–60 min, were conducted for data collection. The Data were analyzed using Graneheim and Lundman’s conventional content analysis approach.Results: The analysis of the interview data revealed three themes: readiness for the worst conditions, assistance based on supportive partnerships, and striving for balance. The six categories within these three themes were mental preparation, risk management, collaborations in emergency response, supportive communication, adaptive behaviors, and maladaptive responses.Conclusions: The results of this study shed light on the various stress management strategies employed by emergency medical service providers. Understanding and implementing effective stress management strategies can not only enhance the well-being of emergency medical service providers but also improve the quality of patient care. Further research and action are essential to promote the resilience and mental health of these professionals, ensuring their overall well-being and job satisfaction.

Introduction: Emergency medical services (EMS) providers encounter a variety of challenges due to the unpredictable, uncontrollable, and dynamic conditions in the pre-hospital field. This study explored the perceived professional challenges among EMS providers. Materials and methods: This study was conducted using a qualitative research approach and the method of content analysis. Eighteen EMS providers were purposively selected from EMS stations in Hamadan, Iran. The collected data were then analyzed based on the Granheim and Lundman's method. Results: Based on data analysis, five categories and one theme were identified. The extracted theme was professional challenges. The five categories were as follows: Ineffective policies; multicultural and multidisciplinary factors; ambulance dispatch route problems; legal issues; and abuse against the emergency medical services Conclusion: In general, it has been found that EMS providers encounter numerous and complex professional challenges during their work. EMS managers can utilize the findings of the present study to develop strategies for reducing the professional challenges faced by EMS providers. By doing so, they can improve the quality of care in the prehospital field.

The migration of nurses, nursing students, and graduates has become a global phenomenon shaped by various factors influencing their decision to relocate for education and employment. Understanding these factors is crucial because nurse migration directly impacts workforce availability, retention, and the equity of healthcare services worldwide. This study aimed to rank the factors driving nurse migration from the perspective of nurses in Hamadan Province, western Iran. The research team implemented a summative content analysis on Porsline’s electronic survey system to collect data. Research participants included nurses serving in government hospitals and nursing students from both government and private institutions in Hamadan Province, located in western Iran. A total of 724 nursing students and nurses participated in the study, which was conducted through convenience sampling. They provided open-ended responses to the inquiry: “Have you ever considered migrating abroad as a nursing student, graduate, or practicing nurse?” What reasons and factors have led you to consider migration?”. Data analysis, within the framework of the global chain of care theory, identified five key themes, which were ranked and assessed on the basis of frequency and their perceived impact: (1) economic drivers (666 frequency), including factors such as low salaries, high living costs, and the pursuit of improved living standards; (2) the workplace environment and career development (432 frequency), addressing issues such as poor working conditions, workplace hostility, limited career advancement opportunities, and the allure of better prospects abroad; (3) sociopolitical and systemic challenges (92 frequency), encompassing weaknesses in the healthcare system, political instability, and economic uncertainty; (4) personal and family motivations (47 frequency), which include aspects such as family welfare and sociocultural aspirations; and (5) global demand and recruitment (31 frequency), emphasizing the influence of peers and active international recruitment strategies. The findings of this study led to the creation of a new theme (theme 3) outside the theoretical framework, which includes factors such as political instability, health care system weaknesses, and structural constraints—elements not directly addressed in the global chain of care (GCC) theory. This study revealed that nurse migration in Iran is predominantly influenced by economic and workplace-related challenges, with distinct variations observed among nursing students, graduates, and practicing nurses. The primary factors contributing to this phenomenon include economic issues, such as insufficient salaries and elevated living expenses, as well as unfavorable working conditions and limited opportunities for career advancement. To mitigate these challenges, policymakers are urged to implement strategies focused on increasing salaries, improving workplace conditions, and providing avenues for professional development. Not applicable

The literature has identified numerous factors that contribute to workplace violence, ranging from environmental stressors to interpersonal conflict. However, a gap remains in our understanding of the specific factors associated with physical violence, particularly concerning its frequency and perceived significance. A summative content analysis was conducted via the electronic survey platform Porsline in Iran for data collection. In April 2024, EMTs working in urban, road, and air bases in western Iran participated in the study. In total, 358 EMTs were selected via convenience sampling. They provided open-ended responses to the following question: “What do you believe are the most significant factors contributing to physical violence in your workplace?” The analysis resulted in a comprehensive list of 1,407 descriptions, organized into 20 subcategories and further consolidated into ten main categories. The category with the highest frequency was “legal and policy deficiencies,” with a frequency of 3103, and the category with the lowest frequency was “workplace culture and professional satisfaction,” with 579. The categories based on frequency and significance included “legal and policy deficiencies,” “cultural and societal barriers,” “insufficient training and practical skills,” “shortcomings in organizational safety and support,” “interpersonal and operational pressures,” “organizational culture and workforce dynamics,” “barriers to effective prehospital care,” “resource and infrastructure limitation,” “challenges in interagency coordination and support,” and “workplace culture and professional satisfaction.” Legal reforms addressing legal inadequacies, enhancing organizational support systems, and implementing targeted training programs to mitigate conflicts are essential for fostering a safer working environment. By addressing these pressing issues, healthcare facilities can enhance emergency care, safeguard the well-being of emergency responders, and increase the quality of emergency medical services for communities.