Fears and Concerns of Bystanders to Help People Injured in Traffic Accidents: A Qualitative Descriptive Study.

In most traffic accidents, bystanders arrive at the scene before the rescuers. If they provide the right help, they can play an important and effective role in reducing the number of deaths and complications caused by these accidents. However, in many cases, fears and concerns prevent bystanders from providing assistance. This study aims to investigate and understand the fears and concerns of bystanders when they decide to help in traffic accidents. In 2022, this study was carried out in Iran using a qualitative content analysis approach. The data was collected through semistructured interviews. Participants were 15 males and females who had experience providing assistance in traffic accidents. Interviews, after digital recording, were transcribed verbatim. A purposeful and theoretical sampling method was performed. Data analysis and the determination of codes, categories, and subcategories were done using qualitative analysis software. O'Brien's qualitative research reporting standard was used. The results of the study include a category of fears and concerns and five subcategories. The subcategories include fear and concern caused by lack of information, fear of legal troubles, stress caused by previous experience, fear and anxiety caused by anticipation, and anxiety of unknown origin. The results of this study showed that some of the fears and concerns of the bystanders were related to a lack of information about providing assistance. By increasing bystanders' information about assistance, such as first aid training, fear and anxiety caused by a lack of information can be reduced. Another part of the fear and concern of bystanders is due to legal issues. Passing and implementing laws that protect bystanders can help reduce this fear and concern. Bystanders should be trained to provide assistance according to the rules of assistance so that they do not get into legal problems. A part of the bystander's fear and concern stems from their previous experiences providing assistance in traffic accidents. These experiences can also affect the fear and anxiety caused by anticipation. It is necessary to conduct more studies on the role of bystanders' experiences in creating fear and anxiety in them, as well as their effect on anticipatory fear.

The Effect of the COVID-19 Pandemic on Environmental Health (Two Sides of the Same Coin): A Systematic Review.

BACKGROUND: The outbreak of the COVID-19 pandemic in late 2019 has led to many changes such as reduced human activities and effects on the environment. There is no big picture of the effects of pandemics on the environment using related evidence. OBJECTIVES: This study was conducted to investigate the effect of the COVID-19 pandemic on environmental health. METHODS: A systematic search of English language studies was performed in major electronic databases; Web of Science, PubMed, Scopus, and Google scholar web search engine from December 2019 to February 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard guidelines were used to follow up the review process. finally 58 articles entered the review procedure. RESULTS: The results of indicate a significant reduction of air pollutants and improved air quality. It improved the water quality of some rivers, canals, and seas during the lockdown of the COVID-19 pandemic. The effects of this disease on the environment cannot be fully described yet. CONCLUSION: In the short term, the amount of air, water, and coastal pollution has been reduced. few studies have examined the effects of pandemics on the environment in the long run, which paves the way for more researches.

Systematic scoping review protocol of Stroke Patient and Stakeholder Engagement (SPSE).

This protocol describes a systematic scoping review of Stroke Patient and Stakeholder Engagement (SPSE), concepts, definitions, models, implementation strategies, indicators, or frameworks. The active engagement of patients and other stakeholders is increasingly acknowledged as essential to patient-centered research to answer questions of importance to patients and their caregivers. Stroke is a debilitating, long-lasting burden for individuals, their families, and healthcare professionals. They require rehabilitation services, health care system assistance, and social support. Their difficulties are unique and require the continued involvement of all parties involved. Understanding SPSE in research is fundamental to healthcare planning and extends the role of patients and stakeholders beyond that of the study subject. We will conduct a systematic literature search to identify the types of existing evidence related to SPSE, implementation strategies, indicators, or frameworks related to Patient and Stakeholder Engagement (PSE); clarify key concepts, definitions, and components of SPSE; compile experiences and prerequisites; and identify stroke research internationally. Two independent reviewers will extract data from selected studies onto a customized extraction form that has already been piloted. We integrate existing knowledge to address gaps in the literature on SPSE research by presenting the model, implementation strategies, indicators, and frameworks for stroke patients. We hope that these findings will offer future researchers a clear picture and conceptual model of SPSE.

Design and psychometric properties of the acute care quality in trauma emergency units scale.

BACKGROUND: Systematic trauma care scale could be designed and used by nurses to completely and adequately fulfill a complex care to improve trauma care quality. The purpose of this study was to design and evaluate the psychometric property of the Nursing Care Quality in Trauma Emergency Units and trauma care promotion. METHODS: This methodological study was conducted in 2022. The process of designing and psychometric assessment of the scale was performed in two steps such as Generating an Item Pool and Validity and Reliability evaluation (Item reduction). The construct validity was determined using the experimental intervention; for determining the reliability of the scale and internal consistency, we measured the inter-rater reliability (IRR). Data were analyzed using the SPSS software, version 22. RESULTS: Based on our findings, the CVI and CVR of the scale were 1 and 0.83-1, respectively. A significant difference between the pre- and post-intervention scores in group 1 supports the inference that the construct has been appropriately represented, and the instrument has construct validity (p < 0.001). We found that there was a significant difference in the scores of Patient assessment, Planning and Implementations, and Evaluation of the care plan. The inter-rater reliability method allows the optimal reliability assessment of observational instruments, which was used in this study, and the results confirmed excellent reliability of the instrument. CONCLUSIONS: The validity and reliability of the Nursing Care Quality in Trauma Emergency Units Scale were confirmed. The instrument could successfully assess the process of nursing care in the trauma emergency ward. The use of this checklist is recommended as a valid observational tool for other researchers. STUDY TYPE: Therapeutic/care management.

Development and Psychometric Properties of Decision-Making Scale for Emergency Hospital Evacuation in Disasters.

BACKGROUND: The evidence shows that the need for emergency evacuation in hospitals has arisen. Designing an emergency evacuation decision making tool increases the confidence of hospital managers in the decision made. Therefore, this study was aimed at the development, and the psychometric properties, of the decision-making scale for emergency hospital evacuation in disasters. METHODS: This study was done in 2 phases of qualitative study and literature review and designing and psychometric properties of the instrument. After development of the primary item pool, the psychometric properties of the questionnaire were evaluated. In this regard, face and content validity, internal consistency (Alpha's Cronbach), reliability (ICC), and stability were assessed. RESULTS: In the validity stage of the instrument, 4 items were removed. Also, 4 items were modified and 2 items were merged. The number of items was thus decreased to 64. After CVI calculation, 5 items were removed, 4 items were modified, and 2 items were merged. As a result of this, the number of items decreased to 58 items. The scale has good reliability and stability. CONCLUSION: It seems that the instrument could be useful in decision-making for emergency hospital evacuation in disasters.

Road safety lead agency challenges of three decades of intervention for road safety in Iran: implications for policy-makers.

BACKGROUND: Road traffic crashes and associated injuries and mortalities are one of the big public health challenges, especially in low/middle-income countries. Road safety lead agency (RSLA) is a vital factor in the sustainable prevention and promotes road safety. In the recent decades, various policy interventions have been conducted for road safety in Iran. This study aimed at exploring the challenges of RSLA from the perspectives of stakeholders at various levels. METHODS: A qualitative study was conducted. In-depth interviews and document reviews were used for data collection. To conduct interviews, different stakeholders at various levels such as policy-makers, senior national authorities, researchers and faculty members were selected. Data collection was conducted between November 2019 and June 2020. Thematic content analysis approach was used for data analysis. RESULTS: The experts' perspectives were analysed and then categorised under five main themes including the role and position of the lead agency, the role and duties of the actors and players, translating policy into practice, intrasectoral and intersectoral cooperation and coordination and evidence production and application and a total of 22 subthemes were identified. The current structure of the RSLA is one of the main challenges emphasised by the research participants. CONCLUSION: To achieve significant improvements in road safety at the national level, a strong management system and leadership body is a critical issue. Organisational reform to establish an effective unique lead agency is proposed to cope with RSLA challenges.

Process and components of disaster risk communication in health systems: A thematic analysis.

Risk communication (RC) is one of the necessary functions in disaster management. Establishing communication processes such as planning, transparency of policies and guidelines, RC expert training, providing communication infrastructure and evaluation in the shortest period reduces confusion and management inconsistency. One of the existing challenges is not knowing the exact dimensions of risk communication and its components in disasters. The aim was to identify the components of disaster risk communication in the health system. This research was conducted by systematic review and searching of the databases of PubMed, Scopus, Web of Science, ProQuest, Google Scholar and ScienceOpen 2000-2021 to identify the components of disaster risk communication in the health system. Thematic content analysis was used for data analysis. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 chart was used for systematic search, and a modified Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was used for quality determination. Out of 12 342 articles extracted, 25 studies were included for analysis. The components of disaster risk communication were analysed in 6 categories and 19 subcategories. These categories include communication (communication processes, communication features and infrastructure), information (content production, content characteristics and publishing), risk communication management (risk perception assessment, planning, coordination and logistics), monitoring and control (monitoring and evaluation, accreditation, documentation), education and training (public and organisational) and ethics and values (culture and social beliefs, ethics and trust). According to this research, the establishment of communication infrastructure and advanced equipment such as various structured formats for communication and artificial intelligence; online and offline communication support systems; and timely and accurate notice can help achieve goals such as coordination and organisation in the health system and increase social participation. Contribution: This study has clarified and explained all the main components and measures of risk communication that can be used for planning scientifically.

Challenges of prehospital aerial operations in response to earthquake hazards: A qualitative study.

BACKGROUNDS: Due to the severity of the earthquake, it may need immediate treatment and transfer of the injured people to advanced medical centers, as well as dispatch of the expert team and specialized health equipment to the accident-affected area. Aerial emergency is an important responsibility of the health care system in this situation. The study aimed to extract the prehospital emergency challenges of Iran aerial operations emergency in response to the earthquake. MATERIALS AND METHODS: The study was qualitative content analysis with conventional approach. Sampling was done in a purposive method and data were collected through semi-structured interview. The panel involved consists of 26 health professionals in medical emergencies. Recorded interviews were transcribed into written and then conventional content analysis was used to derive coding categories directly from the text data. RESULTS: Content analysis is provided 97 initial codes, 20 subcategories and 4 main categories including challenges of "response assessment," "support," "pre-hospital staff-management," and "response operation," respectively. CONCLUSIONS: The results showed that the necessity to assess the affected area, staffing, and management actions, including integrated operations command and the development of a dedicated response plan, as well as the use of strategies inter-organizational coordination in the response phase to earthquake. This study also emphasized that providing standard equipment, support actions, and strengthening communication infrastructure, and updating the aerial emergency system should be considered as one of the priorities of the emergency organization of Iran to provide a desired response to the earthquake.

The Main Features of Resilience in Healthcare Providers: A Scoping Review.

Background: Resilience refers to the capacity for suitable responding to stress in achieving the objectives at the least physical and psychological costs. The present review aims to illustrate the individual and contextual features of resilience improvement in healthcare professions. Methods: A scoping review was conducted according to the PRISMA-ScR guidelines and searching the online databases as PubMed, Embase, Scopus, Web of Science, and Google Scholar from January 2014 to December 2020 using a combination of MESH and EMTREE entry terms and free keywords. The English articles, book chapters, and grey literature were included in the study. The data were recorded to an extraction form designed in Excel. The quality assessment of studies wasn't performed due to scoping review. Thematic analysis was used to synthesize the data. Results: 5434 articles were identified via searching in the databases. 63 articles were reviewed that most of them from the USA (30 articles, 46%) and conducted as a qualitative study (32 articles, 50%). The main aspects of resilience that were extracted from the included studies were personal resilience, resilience in the emergency department, and resilience in healthcare providers. The main feature of resilience among healthcare providers was coping. Conclusion: Studies with more accurate methodology should investigate the situation of the healthcare providers' resilience in difficult healthcare conditions instead of the mere emphasis on providing a fixed concept for all persons without considering the system impacts.

Factors Influencing the Decision-making of Healthcare Providers Regarding the Transition of Patients from the Intensive Care Unit to the General Ward in Iran: A Qualitative Study.

Background: The process of making decisions to discharge patients from the intensive care unit (ICU) is very complex and risky, and decisions need to be made under time constraints and based on fair allocation of resources. In this situation, decision-making requires team participation, which is often accompanied by tension and conflict between team members and sometimes family members, which in turn affects patient safety and quality of care. Objectives: The aim of this study was to explore the experiences and perceptions of physicians and nurses regarding the decision-making process in transition of patients from the ICU to the general ward. Materials and methods: This qualitative study was conducted based on purposive sampling among six nurses and six physicians in Governmental teaching hospitals. The data collection process was conducted from July 2018 to January 2019 through a semistructured interview. Interviews were transcribed and data analysis was accomplished according to the steps proposed by Graneheim and Lundman (2004). Results: Data analysis revealed six themes that reflected factors influencing decision-making in transition of patients from the ICU to the general ward: contingent decision-making, risky decision-making, lack of coherence in team decision-making, differences in clinical judgment, legal and ethical responsibility, and lack of clear criteria. Conclusion: The process of decision-making regarding patient transfer from the ICU is a complex and stressful one. It is affected by situations, team participation, clinical judgment skill, legal issues, and multifactorial challenges. To improve decision-making processes, we need to develop abilities and knowledge and design proper interventions to achieve a principled and correct decision-making process. How to cite this article: Ghorbanzadeh K, Ebadi A, Hosseini M, Maddah SSB, Khankeh H, Pishkhani MK, et al. Factors Influencing the Decision-making of Healthcare Providers Regarding the Transition of Patients from the Intensive Care Unit to the General Ward in Iran: A Qualitative Study. Indian J Crit Care Med 2022;26(5):568-573.

Exploration and prioritization of strategies to improve clinical reasoning skills among coronary care nurses: A qualitative study.

INTRODUCTION: Clinical reasoning (CR) is the most important competency for safe and quality care delivery in coronary care unit (CCU). Nonetheless, evidence shows that nurses in CCU do not have the necessary CR skills to manage challenging situations and provide quality care in these units. Identifying the possible strategies for CR skill improvement is a key step in improving nurses' CR skills. AIM: The aim of the study was to explore and prioritize strategies for CR skill improvement among nurses in CCU. DESIGN: A qualitative design was used. METHODS: This qualitative study was conducted in 2020 in the CCU of a subspecialty heart hospital. Participants were nurses, head nurses, nursing supervisors, nursing manager, clinical nursing instructors, and cardiologists. Initially, necessary data to identify strategies for CR skill improvement were collected through semistructured interviews with 16 participants and were analyzed through conventional content analysis. Then, the determined strategies were prioritized through quantitative scoring by 24 participants in three focus group discussions. The Suitability, Feasibility, and Flexibility matrix was used for scoring. RESULTS: The main three strategies of CR skill improvement were improvement of the efficiency of nursing education, effective management in nursing, and development of professional nursing. The mean scores of these categories in the possible range of 3-9 were 8.20, 8.04, and 7.83, respectively. CONCLUSION: This study provides a firm scientific basis for strategies to improve CR skills among nurses in CCU. Strategies determined in the present study can be used to develop interventions to improve nurses' CR skills and promote strength-based nursing.

Bio-psycho-social health assessment in prehospital emergency technicians: A systematic review.

BACKGROUND: Health is a complex structure and has physical, psychological, and social approaches. The importance and impact of health assessment have caused considerable attention to be paid to the employees of the health system and the determining factors of this relationship. Hence, the main purpose of this study was to find out the bio-psycho-social health situation in prehospital emergency technicians as the research question staff. MATERIALS AND METHODS: The present study is a systematic review and data have retrieved through extensive search in Scopus, Web of Science, PubMed (including Medline), Cochrane Library, Irandoc, Magiran, MedLib, and SID databases with a combination of keywords of "Health, " "Assessment, " "Social," "Psychological," "Biological," "Emergency," and "prehospital," according to the search strategy, between 2000 and 202111 studies were reviewed; then, they were entered based on the objectives of the study and narrative analysis was performed by the researcher. RESULTS: After analyzing the articles, a total of 4 factors affecting bio-psycho-social health in prehospital emergency technicians have been extracted and identified, which included health management, bio-psycho-social factors, occupational factors, and behavioral factors. CONCLUSION: This research showed four factors, namely health management, bio-psycho-social factors, occupational factors, and behavioral factors which could be effective in Bio-Psycho-Social health. Since prehospital emergency services have an important role in maintaining the health of the community, which requires attention to the bio-psycho-social health of emergency personnel, more studies have focused on health management among the four mentioned factors, but the need to examine the other three factors for a more accurate assessment of the health of emergency personnel seems necessary. Therefore, prevention and response strategies based on bio-psycho-social health assessment models are proposed to promote the health of prehospital emergency technician staff.

Developing and psychometric testing of the evaluation tool for disaster exercises design stage: A mixed method study.

BACKGROUND: Exercise in different health sectors is an important step in preparing programs for disaster risk management. The present study aimed to develop and validate a tool for evaluating disaster exercises during the design stage in the health sector. METHODS: This methodological study was conducted in two phases using an explanatory sequential mixed method approach. Semi-structured interviews with 25 disaster-related health professionals were conducted during the qualitative phase (item generation), and a systematic review was done to evaluate items pool of disaster exercises design stage tool. The quantitative phase (item reduction) assessed both face and content validity, as well as reliability using Cronbach's alpha and intra-class correlation coefficient. RESULTS: At the first stage four main categories and eleven subcategories were extracted from the data, the main categories including "coordination, command and guidance of exercise", "hardware and software requirements of exercise ", "organizational exercise resources", and "communication and exercise public information". The initial items pool included 164 items that were reduced to 50 after the assessment of validity (face and content). Cronbach's alpha (0.89) and intra-class correlation coefficient (ICC = 0.72) tests indicated that the tool is also reliable. CONCLUSION: The research findings provide a new categorization perspective to understand the disaster exercises evaluation in the health sector. The existing 50-item tool can evaluate disaster exercises design stage in the health sector through collecting data with appropriate validity and reliability.

Providing telenursing care for victims: a simulated study for introducing of possibility nursing interventions in disasters.

INTRODUCTION: Uncertainty occurrence of disasters requires special attention and a shortage of health care specialists is a challenge for health care systems; therefore, the use of telenursing care during a disaster is an appropriate way to provide care. This study aimed to investigate telenursing operational possibilities in disasters. METHODS: A cross-sectional study was performed by implementing a functional exercise (Drill) for the possibility of nursing interventions in the response phase to disasters at Kerman University of Medical Sciences in 2021. Two evaluators examined and scored the possibility of providing telenursing care using a researcher-made checklist and we surveyed Inter-rater agreement between two evaluators by Cohen's kappa coefficient. Data were analyzed using descriptive tests and SPSS 20 software. RESULTS: Findings showed that implementation of telenursing care would be helpful in future disasters. The scores received from assessment of the evaluation checklist for this simulated exercise program by the first evaluator was 83.25 and for the second evaluator was 72.00. The results of the study showed that the mean score of the possibility of telenursing in disasters was at a high level 77.50. Thus, the quality of the telenursing care in simulated conditions was satisfactory. CONCLUSION: Today, disaster management is almost impossible without using new technologies. This study found that due to the lack of specialized nursing staff in the deprived areas affected by disasters, the most important way to provide health care for a large group of the population is to develop effective health services so that everyone can use these services equally and fairly.

Qualitative Study of Health System Preparedness for Successful Implementation of Disaster Exercises in the Iranian Context.

OBJECTIVES: Implementing disaster exercises in different parts of the health system is one of the important steps in providing and developing disaster risk management plans. Considering the importance of promoting health system preparedness through exercise, the present study aimed to identify and explain necessary and original components for successful implementation of preparedness exercises of the health-care system in disaster. METHODS: The study was a qualitative content analysis. Data were collected by purposeful sampling through in-depth and semi-structured individual interviews with 25 health professionals in disaster. Directed content analysis was used to analyze the data, which extracted the initial codes after performing the recorded interviews on paper and immersing them in the data analysis. RESULTS: The data analysis resulted in the production of 100 initial codes, 14 subcategories, 6 main categories of "coordination and information management," "standards and indicators," "conduction and control of the process," "logistic management and supplies," "management of treatment operation," and "management of health operation," under the original theme of "implementation of exercise." CONCLUSIONS: The findings of this study can greatly increase the attention of senior managers to preparedness in all areas of the health system, especially managers of prehospitals and hospitals who are the forefront of the response to the disaster. The findings of this study can be considered as a guideline for the implementation of principle and standardized health system preparedness exercises.

Hospital Preparedness Challenges in Biological Disasters: A Qualitative Study.

OBJECTIVE: Identification of hospital preparedness challenges against biological events such as coronavirus disease 2019 (COVID-19) is essential to improve dynamics, quality, and business continuity confidence in the health system. Accordingly, the purpose of the present study is to evaluate the challenges of hospital preparedness in biological events. METHODS: This study used a qualitative method using content analysis in which 20 health-care managers and experts who are experienced in biological events were selected through purposeful sampling. The data collection was done through semi-structured interviews, which continued until data saturation. The data were analyzed using qualitative content analysis as well as the Landman and Graneheim Approach. RESULTS: Six main concepts (training and practice, resource management, safety and health, patient management, risk communication, and laboratory and surveillance) and 14 subconcepts were extracted on hospital preparedness challenges in biological events through analyzing interviews. CONCLUSIONS: The present study indicated that the health system of the country faces many challenges in response to biological events and threats. Moreover, study participants indicated that Iranian hospitals were not prepared for biological events. It is recommended to design preparedness plans of hospitals based on preparedness standards for biological events. In addition, comprehensive measures are required to enhance their capacity to respond to biological emergencies.

Disaster Risk Reduction in Iranian Primary and Secondary School Textbooks: A Content Analysis.

OBJECTIVE: School textbooks have a significant role in transferring knowledge to the students and changing their behavior. This work aims to analyze school textbooks to find the representation of natural hazards in Iran, which is vital for supporting children in disaster situations. METHODS: In this study, a qualitative content analysis was used. Data were analyzed qualitatively by using MAXQDA 2018 software. For the 2019-2020 school year, 300 Iranian school textbooks in Persian language were collected. RESULTS: Findings of this work show that students receive information about disaster risk reduction (DRR) education through the primary and secondary grade levels in all 12 grades. The educational content covers various types of natural hazards, including geophysical, hydrological, climatological, meteorological, and biological disasters. In addition, the textbooks contain discussions about local hazards, causes and effects of disasters, and the disaster management cycle. CONCLUSIONS: The coverage of DRR and the relevant contents in school textbooks reveals that the discourse of natural hazards is important for Iranian authorities, especially in the education system. This study helps decision-makers and practitioners design more effective interventions to prepare children for disasters.

Developing a Context-Bound Model for Hospital Triage in Disasters and Mass Casualty Incidents in the Health System of Iran.

OBJECTIVE: The aim of this study was to develop a context-bound model of hospital triage in disasters and mass casualty incidents in the health system of Iran. METHODS: This study was done using a sequential mixed method. Data were analyzed using Expert Choice software program. RESULTS: In the qualitative phase, 27 specialists were interviewed. Walking and purposeful movement, airway and respiration, circulatory status, and mental indices were included in the finalized model. In the quantitative phase, 21 participants responded to a questionnaire for weighting and ranking the final indices based on 3 competing options, including clinical importance of the index, lack of complexity and simplicity in implementation, and speed of implementation. The index of walking and purposeful movements weighing 0.300 and ranking 1, airway and respiration weighing 0.276 and ranking 2, blood circulatory status weighing 0.245 and ranking 3, and finally mental status weighing 0.179 and ranking 4 were obtained. CONCLUSIONS: This is the first attempt to design and develop a new context-bound model of hospital triage in disasters and mass casualties in Iran. The development of new triage models is a dynamic and continuous process, and changes will be applied to them, in case further developments and improvements are required.

Risk Assessment of COVID-19 in the Iranian Health System.

OBJECTIVE: The outbreak of coronavirus disease 2019 (COVID-19) has exerted unprecedented pressure on healthcare systems throughout the world. This study was designed to develop a national health emergency management program based on risk assessment for COVID-19. METHODS: Mixed-methods research was used. Based on recommendations of the national epidemiology committee, 2 risk scenarios were used as basic scenarios for risk assessment. Two rounds of Focus Group Discussions (FGDs) were conducted between January and May 2020 with 30 representatives of the health system. The data were collected, analyzed, and integrated by the research team. RESULTS: In the risk matrix, "contamination of environment and individuals" and "burnout of medical staff" occupied the red zone (intolerable risk). "Defects in screening and admissions," "process disruption in medical care and rehabilitation," "increased mental disorders," "social dissatisfaction," "the decline in healthcare services," and "loss of medical staff" were identified as the orange zone (significant risk) of the matrix. CONCLUSIONS: The avoidance of environmental and individual contamination and healthcare worker burnout are the priorities in Iran. Attention to intersectoral cooperation, the involvement of non-governmental organizations and private center capacities, integration of information health systems, and developing evidence-based protocols are other measures that can improve the health system's capacity in the response COVID-19.