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The result of requesting C.C.U. Bed by hospital Emergency ward from the Emergency Medical Services (EMS) in Shiraz university of Medical Sciences in year 2003


S.Habibollah Kavari, PhD.

Address for correspondence
S.Habibollah Kavari, PhD.
Principal Lecturer of School of Management ,
and Medical Information Sciences
Shiraz University of Medical Sciences, Shiraz, Iran.

Email: kavarih@sums.ac.ir, hkavari2000@yahoo.com


Inter Hospital transport is one of the most important parts in Emergency Systems. Aim of this study is to determine the result of requesting C.C.U bed from EMS in the year 2003
Methods: In a sectional study, the records of 2688 patients who go to Shiraz hospital Emergency wards and requesting C.C.U beds from EMS were examined. These patients were divided into 2 groups: Those who are successful in getting the bed in other hospitals and those who are not.
Findings: 68.5% of these cases were successful. There is a close relationship between using logistic regression, recognition hospital and being successful.
Conclusion: Increasing the C.C.U beds and providing the necessary equipment in these wards are the most important factors that should have priority in Shiraz.


Inter hospital transport is one of the most important parts in Emergency systems in each country. So much so that most of the developed countries in the world have a practical definitive protocol for this matter. (1&2)

Unfortunately in Iran we do not have such a system . The patient goes to hospital, for primary treatment , and if the patient needs to be confined to bed, then other events can occur, which may be harmful to the patient's health.

Emergency Medical Services of Shiraz University of Medical Sciences has been established in Shiraz with the help of remedy system management.

This department (section) coordinates the inter hospital free beds. When the hospital declines a bed , this section start to look for a free bed in other hospitals , governmental centers ,charity institutions and social and private services. When its search is finished and it finds a free bed, it notifies the relevant hospital to transport the patient to this new locale . This provides a service to the hospital, overcoming many difficulties as EMS cannot work well without this service of finding C.C.U free beds.

For solving the possible problems and seeing the effectiveness of the plan, they practice the drill. (3, 4 &5)


A sectional study has been done on those patients who came to hospitals and needed to be confined to bed in C.C.U wards which EMS found for them The Shiraz. Records of 2688 patients were reviewed and information gathered by looking at the questionnaires that had been completed by Emergency supervisors in EMS.

This information was reviewed and analyzed. 1510 patients (56.2%) were men , and all more than 2 years of age. You can see the absolute and relative frequency distribution of requested hospitals on the table 1.

Among these cases , 587 cases (21.8%) were transported to other centers and confined to bed in spring , 658 cases (25.5%) in summer ,791 cases(29.4%) in autumnl and 652 cases (24.3%) in winter . With other definitions , patients were confined to bed in the same hospital that they came to its emergency ward , died , released or cancel their admissions for any reason.

The relationship of sex, season, days of a week, and place of patient's residence, work rotation, recognition of C.H.F and MI, I.H.D in requested hospital with related factors were reviewed and analyzed by using a logistic regression model.

The effect of independent factors that have a significant statistical relation with related factors (1% or less) were reviewed and analyzed too.

Table 1: Relative & absolute frequency distribution of recorded cases according to requested hospital


623 23.2
Faghihi 943 35.1
Hafez 173 6.4
Chamran 189 7
Ghalb al Zahra 240 8.9
Zienabiyeh 340 12.6
Etc. 180 6.7
total 2688


1840 cases were successful and they were accepted by other hospitals.

Table 2: Relative & absolute frequency distribution of recorded cases according to the result of request


Accepted in other hospital 1840 68.5
Accepted in the same hospital 308 11.5
Died 29 1.1
Released 352
Canceled the admission for any reason 159 5.9

Table 3: Relative & absolute frequency distribution of successful acceptance according to different factors:


Percent of success
68.4 0/9
Female 68.5


Spring 66.4 <0/0001
Summer 74.3
Fall 69.5
Winter 63

Days of a week

Saturday to Wednesday 69.3


Thursday 68.5
Friday 64.5
Place of residence Shiraz city 68.3
Fars province 70.6
Work rotation Morning
71.5 <0/0001
Noon 72.7
Evening & night 63.2
Recognition MI,IHD 70.8 <0/0001
CHF, pulmonary edema 52.6

Requested hospital

Namazi 74


Faghihi 71.3
Hafez 77.8
Chamran 67.1
Ghalb-e- alzahra 53.2
Etc. 74.4

2346 Cases (78.3%) were accepted for MI and I.H.D. and 342 cases (12.7%) were accepted for pulmonary edema and cardiac arrest.
The average time from the beginning to the end was 229 minutes. Minimum time was 1 minute and maximum time was 8040 minutes and average was 120 minutes. (SD=360)

The number of hospitals that were called for acceptance were at least 5.8, at most 40 and the average was 3(SD=6.6)
The relation of different factors with the rate (degree) of success was shown in table 3. By looking at this table you will see a significant relationship between season, work rotation, recognition, type of requested hospital and success in acceptance. By using a logistic regression we gain a multi variable equation that you can see its result on table 4.

Table 4: gained outcomes in accordance with logistic regression model

Variable in the model
B SE Wald Sig
Spring 0/26 0/12 4/4 0/000 1/3
Summer 0/96 0/13 30/4 0/037
Fall 0/40 0/12 11/9 0/000 1/5
Work rotation     20/4 0/001  
Morning 0/36 0/11 11/3 0/001 1/4
Noon 0/43 0/10 16/7 0/000 1/5
Recognition of MI, IHD 0/73 0/12 35/3 0/000  
Requested hospital     74/3   2/1
Namazi 0/07 0/20 0/1 0/7 1/1
Faghihi 0/09 0/19 0/2 0/6 0/9
Hafez 0/95 0/24 16/2 0/000 0/4
Chamran 0/20 0/25 0/7 0/4 1/2
Ghalb-e- al Zahra 0/12 0/23 0/3 0/6 0/9
Zeinabiyeh 0/85 0/21 16/8 0/000 0/4
Fixed number 0/21 0/23 0/8 0/4 0/8

In this table you can see that season, shift and recognition factors have a close relation with success and this relation can be seen in Hafez & Zeinabiyeh hospitals.

Comparison of seasons shows that the probability of acceptance is not the same in different seasons. Spring, Summer and fall have more acceptance than Winter. These probabilities are 3% in Spring, 5.1% in Summer and 1.2 % in fall.

Comparison of work rotation shows that acceptance is more in morning and noon shifts. Evening and night shifts has fewer acceptances. Rate of increase in acceptance in morning /noon shifts are sequentially: 1.4 &1.5 times more than evening and night shifts.

The probability of I.H.D and MI acceptance is 2.1 times more than pulmonary edemas and cardiac arrest among mentioned hospitals just Hafez and Zeinabiyeh hospitals have less probability to accept such cases.


Inter hospital transport is one of the most important aspects in Medical Emergency Services in each country.

Emergency center, in international standards, is a place that get acceptance for all the patients who come to hospitals with prehospital emergency helps and those patients who transport from one hospital to another (1&2).

Most countries have the immediate and necessary information about free beds in all hospitals and they can, in critical events, transport the patient that its bed is gotten before. (1)

As you see in the result of this research, we still have problems with the rate of C.C.U bed acceptance. Although so many activities have been done for establishing C.C.U wards in Tehran and other cities, the rate of acceptance is 68.5 % and in about 31.5% of other patients we still have problem.

It seems that the main problem in C.C.U wards is human power, equipment, physical situation and budget. (Money). And as you know the last mentioned factor (budget) is very important.

There is no justification for significant relation between success in rate of C.C.U acceptance and seasons.

Maybe because our hospitals are training hospitals or because of epidemiological factors, our C.C.U beds are more occupied in Summer than other seasons.

More studying should be done to find a logic relationship between season and rate of acceptance.

At last based on findings we have some suggestions:

  1. increase the number of C.C.U beds in Shiraz
  2. Develop the facilities in those hospitals that have C.C.U beds.
  3. Centralized the emergency acceptance in Shiraz emergency center with emergency automation. So that the patient will not keep in emergency wards for long time.
  4. Increase the Emergency personnel and equipments.


1. Maryland institute for Emergency Medical service system inter hospital transfer guidelines manual, USA, 3rd edition, 2000
2. Bayast A, Placo M. Dynamic of bed use in accommodations Emergency admissions, BmJ,1999, 319(7203):755-
3. Office of standard and evaluation, ministry for health, remedy and medical education, standard guide directions of emergency wards.
Iran-e-farda, year 1379
4. Remedy & Drug assistants. ministry f health , remedy and medical education , guide direction drafts of establishment and management of emergency wards in training hospitals in the country , edition year 1379
5. Dr. Gholamreza Ajorloo. " collection of health, remedy and educational laws and regulations ", fist edition, NASHR-E- JAHAN , year 1376
6. State organization for remedial services, enforceable guide directions of Tehran emergency centers, approved in board of ministers session dated 17/3/1355