Journal of

Background: Nowadays, researchers pay special attention to patients' satisfaction with emergency care services, as the first line of hospital health care services. However, few researches have been done about its related factors in our country. The aim of this study was assessment of patients' satisfaction with emergency care services in six military hospitals in our country and its related factors.

 Material and Methods: In this cross-sectional study, Satisfaction level of 360 patients of emergency care services in six military hospitals of Iran in 2007 was assessed. After discharge from emergency ward, a checklist containing basic information and a 12-item questionnaire about their satisfaction level with emergency care services was completed for each patient. A 5-level Likert scale was used for the response of each item. 20 to 100 scores were allocated to each response (completely dissatisfied to completely satisfied), respectively.

 Results: 3559/4220 responses (82.4%) were completely satisfied or satisfied. In respect to priority "Observation of moral points", "giving information" and "behavior of reception personnel" had the highest and on the other hand, "variety of medical specialists", "emergency ward facilities" and "speed in calling doctor" had the lowest satisfaction scores. The total satisfaction score which was reported by patients older than 35 yr(p=0.022), insurance coverage(p=0.002) and with history of previous referring to that emergency ward(p=0.017) were significantly higher than others. Sex, marital status and educational level had no statistical correlation with the total satisfaction score(p>0.05).

 Conclusion: The findings of this study revealed favorable satisfaction level of patients with emergency care services in military hospitals. However, it seems that using a variety of expert physicians and more facilities and also improvement in the process of calling doctor in emergency ward are the aspects which need the most amount of concern of health care managers in emergency centers.

Background: Pre hospital emergency medical service (EMS) as the first line of emergency care and treatment in the out- of -hospital has a considerable importance in the health care system. Planning on finding about strengths and weaknesses and improve the quality of EMS by exploring the problems of this section has considerable important.This study aimed to explore the challenges of pre hospital emergency medical service in Mashhad.

Materials and methods: A qualitative study was done with 14 personnel working in EMS sites in Mashhad using purposeful sampling. Data was collected by semi structured interview and analyzed using conventional content analysis approach according to Graneheim and Lund man 2004 with ATLAS.ti  software.

Results: Three general themes were identified including 1) "challenges in Human resources"( Individual characteristics of human resources and personnel's dissatisfaction 2) "challenges in organization" (Structural challenges, lake of equipment and human resource limitation 3) "socio-cultural challenges"(Environmental-social challenges and cultural challenges) were determined.

Conclusion: personnel's dissatisfaction, structural challenges, human resource limitation, lake of equipment   and Environmental-social challenges were the most important challenges in pre-hospital emergency system. Organizational independence , create organizational rows, regulation of laws and administrative regulations reform in relation to the range of services offered by emergency personnel, attention to the facilities and cooperation And the participation of other organizations, such as media and traffic to enhance pre-hospital emergency services at the community level can be effective in reducing the challenges in hospital emergency system.