Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 31 3 2026 05 01 Explaining the Challenges Hospitals Face in Managing Mass Casualty Incidents: A Qualitative Study in Teaching Hospitals 1816 1827 248498 10.30491/tm.2026.558039.1900 EN Adel Eftekhari PhD in Health in Disasters and Emergencies, Department of Nursing, Meybod School of Medical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 0000-0001-7961-2699 Najmeh Baghian PhD in Healthcare Services Management, Clinical Research Development Center, Shahid Rahnemoon Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 0000-0003-1837-0408 Somayeh Bagheri Trauma Research Center, Shahid Rahnemoon Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran Journal Article 2025 11 06 Introduction: Mass casualty incidents (MCIs) impose unprecedented pressure on hospital capacities and resources, complicating the provision of standard services. Continuous preparedness for regional crises is essential. This qualitative study was designed to identify and analyze the challenges faced by teaching hospitals affiliated with Shahid Sadoughi University of Medical Sciences in Yazd when addressing mass casualties. Method: This qualitative descriptive study used conventional content analysis and was conducted in 2025 at teaching hospitals under Shahid Sadoughi University of Medical Sciences, Yazd. Participants included 33 purposively selected managers, physicians, nurses, health professionals specializing in disasters and emergencies, and members of crisis and passive defense committees. Data collection continued until code saturation was achieved, which was confirmed after the 30th interview and validated through three additional interviews. Data were gathered through semi-structured, recorded interviews and analyzed using conventional content analysis. MAXQDA version 22 software was used for coding and organizing data, with methodological rigor ensured through Guba and Lincoln’s framework, including credibility, transferability, dependability, and confirmability. Result: Data analysis revealed that effective hospital responses to mass incidents encounter multifaceted obstacles. At the macro level, weak governance and policymaking, ineffective risk management, and inadequate training in command structures create uncertainty in critical decision-making. On the support level, this results in exacerbated physical constraints, shortages of vital resources (such as medicines and equipment), and inadequacies in supply chains and psychosocial support. From an organizational perspective, both interdepartmental and intra-organizational information flows were severely disrupted, and the existing technical infrastructure was unable to handle the high volume of data or establish necessary communications. Additionally, clinical service delivery declined significantly due to poor management of incoming patient volumes and a lack of trained specialists to manage multiple casualties simultaneously. Conclusion: The findings indicate that enhancing hospitals’ resilience in the face of mass casualties requires a comprehensive policy approach from senior management. This involves strengthening hospital infrastructure with dedicated budgets, empowering healthcare staff at all levels, providing psychosocial support, and conducting regular exercises based on local hazards. Implementing these layered solutions will significantly improve hospitals’ response capacities and fortify the health system against future crises.

https://www.traumamon.com/article_248498_af73b0668b5b6354a27da47b4e240300.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 31 3 2026 05 01 Epidemiology and Seasonality of Interpersonal Violence in Southeastern Iran: A Cross-Sectional Study 1827 1833 247102 10.30491/tm.2026.585249.1938 EN Saeedeh Sarhadi Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. 0000-0001-9692-6673 Farshid Ahmad Zadeh Medical student, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Alireza Bahmani Associate Professor of Emergency Medicine Department of Emergency Medicine Zahedan University of Medical Science, Zahedan, Iran. 0000-0003-2690-9784 Reza Taghizade Khanlegh Medical student, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Narjes Sargolzaei MD, Community Medicine Department, Medical School, Zahedan University of Medical Sciences, Zahedan, Iran 0000-0002-7869-1564 Journal Article 2026 06 06 Introduction: Interpersonal violence can be affected by many different environmental factors, including ethnic diversity, regional deprivation, and border location. Given the lack of local data from southeastern Iran, this study aimed to examine the pattern and characteristics of injuries resulting from interpersonal violence among patients referred to the emergency department of Khatam Al-Anbia Hospital in Zahedan. Methods: This is a descriptive cross-sectional study that involved all patients admitted to the emergency department because of interpersonal violence from 2023 to 2024. Data were collected from the patient's files and analyzed using SPSS version 27. Results: A total of 1,838 victims of interpersonal violence were included. The majority were male (93%), and the median age was 23 years. Firearms accounted for 202 (10.9%) of cases, while 418 (22.8%) involved cold weapons. Penetrating trauma occurred in nearly 1,010 (55%) of conflicts, and most injuries involved the extremities. In assessing seasonal changes, the frequency of injury severity and the types of interpersonal violence showed statistically significant differences (p < 0.001 and p = 0.02, respectively). The highest prevalence of interpersonal violence was observed during the summer season (587, 31.9%). Also, the most severe injuries (ESI levels 1 and 2: 558, 95.1%) occurred in this season. Conclusions: It can be seen from the results that interpersonal violence in Zahedan conforms to national trends, but the greater use of weapons necessitates regional preventative measures.

https://www.traumamon.com/article_247102_83e93382fbf8f91d42fba3396c4cef50.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 31 3 2026 05 01 Identification and Prioritization of Evaluation Indicators for Rescue and Relief Operations in Crisis: A Case Study of the Iranian Red Crescent Society 1834 1843 248499 10.30491/tm.2026.563285.1911 EN Mazyar Karamali Research Center for Health Management in Mass Gathering, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran. Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. 0000-0002-1914-9206 Azadeh Soleimaninejad Department of Business Management and Entrepreneurship, Faculty of Management, Farabi College, University of Tehran, Iran PirHossein Kolivand Department of Health Economics, Faculty of Medicine, Shahed University, Tehran, Iran. 0000-0002-0532-4130 Taher Doroudi Research Center for Health Management in Mass Gathering, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran. Mohammadkarim Bahadori Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran 0000-0002-7157-9908 Journal Article 2025 11 30 Introduction: Rescue and relief operations are a critical component of crisis response, where efficiency and effectiveness can directly reduce human casualties and enhance community resilience. However, systematic frameworks and standardized indicators for evaluating the performance of crisis management organizations face several challenges. This study aimed to identify and prioritize key standardized criteria and indicators for assessing rescue and relief operations within the Iranian Red Crescent Society (IRCS). Method: A descriptive mixed-methods study was conducted in two sequential phases, qualitative and quantitative, in 2025. The study population consisted of experts employed by the IRCS, among whom 34 participants were selected through purposive sampling. For the qualitative phase, content analysis was employed, while the quantitative phase utilized multi-criteria decision-making methods, including the Analytic Hierarchy Process (AHP) and Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS). Result: In the qualitative phase, based on expert evaluation, 58 key indicators were prioritized (17 input indicators, 11 efficiency indicators, 15 effectiveness indicators, and 15 impact indicators. The highest scores were assigned to the following indicators: deployment level of information and communication systems (score: 0.886) under the input dimension; time required to activate early warning systems (score: 1.000) under the efficiency dimension; number of specialized teams organized (e.g., high-altitude rescue, medical, firefighting) (score: 0.872) under the effectiveness dimension; and number of post-incident performance analysis reports (score: 1.000) under the impact dimension. Conclusion: The standardized criteria and key indicators across the four dimensions of inputs, efficiency, effectiveness, and impact can provide a comprehensive structural framework for analyzing rescue and relief operations. This framework can enhance organizational performance, improve operational readiness, increase transparency and accountability, and build public trust in responsible institutions. It is recommended that operational activities be monitored based on this framework to support learning, improvement, and capacity building for community resilience, with further development of composite indicators and integration of innovative technologies.

https://www.traumamon.com/article_248499_126aa59c0ff8e2bcc2f734a7e3480f88.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 31 3 2026 05 01 Criteria for Patient Admission to the Intensive Care Unit during Mass Casualty Incidents: A Scoping Review 1844 1853 248505 10.30491/tm.2026.585186.1937 EN Behnam Esbakian Bandpey Ph.D. Candidate, Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 0000-0001-7386-2419 Katayoun Jahangiri Full professor of Health in Disasters and Emergencies Department, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 0000-0003-2061-1418 Sanaz Sohrabizadeh Associate Professor of Health in Disasters and Emergencies Department, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-9170-178X Mir Mohammad Miri Full Professor of Critical Care Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0003-3918-6802 Abbas Ebadi Full Professor of Nursing, School of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran 0000-0002-2911-7005 Hasanali Jafarpoor Assistant Professor of Nursing, School of Allied Medical Sciences, Babol University of Medical Sciences, Babol, Iran Journal Article 2026 06 05 Introduction: Mass casualty incidents (MCI) elevate the demand for ICU admissions. With limited resources and many injured, prioritizing and triaging patients is essential. However, there are no standardized criteria for ICU admissions during MCIs. This study aimed to identify the criteria for ICU admission during mass casualty incidents. Methods: This study used a scoping review based on the PRISMA 2020 protocol. Searches were conducted in the PubMed, Web of Science, and Scopus databases using specific keywords, applying inclusion and exclusion criteria for relevant references through December 2024. A manual search of Google Scholar, books, and reference lists was also performed. EndNote software version 20 was used for data management. Results: Of the 298 studies reviewed, 18 were ultimately selected, resulting in the identification of practical criteria for admitting patients to the intensive care unit during mass casualty incidents. These criteria were summarized and categorized into seven components: respiratory disorders, cardiovascular disorders, neurological disorders, injuries and bleeding, multisystem issues, probability of survival, and diagnostic tests. Conclusions: This scoping review first determines ICU admission criteria from MCI-specific literature within a seven-component framework. It highlights components and criteria of the respiratory (respiratory rate, oxygen saturation, need for mechanical ventilation), cardiovascular (systolic blood pressure, pulse rate, inotropic medications), and nervous systems (Glasgow Coma Scale) as the three most frequently cited areas. These criteria may support faster and more informed ICU admission decisions and may help researchers develop guidelines or triage tools for ICU admission during mass casualty incidents.

https://www.traumamon.com/article_248505_184dabd78100c805cd6d2f11aad11be4.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 31 3 2026 05 01 Emergency Management of a Symptomatic Mandibular Second Molar with a Fractured Instrument Using Intentional Replantation 1854 1863 248506 10.30491/tm.2026.587840.1947 EN Mehran Taheri Khafri Oral and Maxillofacial Surgery Department, School of Dentistry, Baqiyatallah University of Medical Sciences, Tehran, Iran Mohammad Gharishvandi Endodontist, Tehran, Iran Amirali Asadi Oral and Maxillofacial Surgeon, Tehran, Iran Seyede Aye Shekarbaghani Department of Endodontics, School of Dentistry, Baqiyatallah University of Medical Sciences, Tehran, Iran 0009-0007-1775-7826 Journal Article 2026 06 20 Introduction: Fracture of endodontic instruments represents a significant clinical challenge, particularly in emergencies where infection and severe pain are present. When nonsurgical retreatment and apical surgery are not feasible, intentional replantation may serve as a valuable tooth-salvage option. Case Presentation: A 60-year-old female presented with severe spontaneous pain (Visual Analog Scale [VAS] 9/10) in a mandibular second molar associated with an inadequate root canal filling and a fractured endodontic instrument in the mesial root. Emergency palliative care was initiated on the day of presentation, including a nonsurgical retreatment attempt, chemomechanical debridement to the extent possible, and intracanal medicament placement. This resulted in rapid symptom resolution (VAS reduced to 2/10 within 24 hours). Subsequently, at a scheduled follow-up visit, the fractured instrument was confirmed to be irretrievable. Given the persistence of the etiological factor and anatomical constraints precluding surgical endodontic access, intentional replantation was selected as the definitive elective treatment. The tooth was extracted atraumatically, and extraoral root-end management was performed, including removal of the fractured instrument, apical resection, and retrograde filling with Cold Ceramic. Histopathologic examination of the periapical tissue confirmed a diagnosis of periapical granuloma. The tooth was immediately replanted with suture splinting for 2 weeks, and occlusion was adjusted. Postoperatively, the patient experienced complete symptom resolution, and no complications were observed. At 6-month follow-up, clinical and radiographic examination revealed favorable short-term healing with evidence of bone regeneration. Conclusion: Intentional replantation can be an effective tooth-salvage procedure in cases of symptomatic apical periodontitis complicated by a fractured endodontic instrument when conventional retreatment and apical surgery are not feasible. However, it should be clearly distinguished from emergency palliative care, which addresses the acute symptoms, whereas intentional replantation is an elective definitive procedure. Longer-term follow-up is necessary to confirm the long-term prognosis of the replanted tooth.

https://www.traumamon.com/article_248506_5334512f578599eaf0609cf6a54c61d9.pdf

Official Publication of the National Center for Trauma Research Trauma Monthly 2251-7464 31 3 2026 05 01 Multiple Sclerosis and a History of Traumatic Brain Injury 1864 1869 248510 10.30491/tm.2026.588487.1950 EN Masoud Etemadifar Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran. 0000-0003-3318-7513 Seyed Faridaldin Hosseini Department of General Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Mostafa Ghardashi Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran. Kimia Ghorbani Department of General Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Zahra Zarei Department of General Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Davood Mohammadi Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0002-4435-1449 Journal Article 2026 06 24 Introduction: Given the potential impact of traumatic brain injury on the onset and severity of multiple sclerosis and its clinical importance, this study was conducted to compare the prevalence of multiple sclerosis in patients with a history of traumatic brain injury occurring before and after childhood and adolescence. Method: This descriptive-analytical, cross-sectional study was conducted between 2024 and 2025 at the Multiple Sclerosis Center in Isfahan. The sample was selected through a census and included patients with a definitive diagnosis of multiple sclerosis during this period who were included in the study. Patients were interviewed using a checklist, and the severity of disability caused by multiple sclerosis was determined through examination. Finally, patients were divided into two groups, those with and without a history of traumatic brain injury, and compared. Result: Significant differences were observed between the two groups in terms of age at MS onset, smoking, pregnancy history, and spinal injury history (P<0.05). The age of MS onset was notably lower in patients who sustained TBI during childhood. Furthermore, the number of smokers in this group was significantly higher than in the other groups (P<0.05). Pregnancy history was significantly less frequent among patients who experienced TBI during childhood. Conversely, spinal injury was significantly less common in this group. The mean time between TBI and MS onset differed significantly between the two groups (P<0.05). Patients who experienced TBI during childhood developed MS after an average of 18 years—a significantly longer interval than those in the other group. Conclusion: Traumatic brain injury at a young age can be a factor in reducing the age of onset of MS.

https://www.traumamon.com/article_248510_21edff1c15cd9eebddbf275549d05426.pdf