---

Background and purpose: Waiting time to receive appropriate services in emergency departments is considered as an important indicator for evaluating hospitals. Triage is the most important and the first stage of patient’s management at the time of arrival to hospital emergency department. This study aimed at determining the length of waiting time to receive treatment and diagnostic services and related factors within 5 level triage system in Imam Khomeini Hospital in Sari. Material and Methods: This cross-sectional study was done in Imam Khomeini Hospital of Sari in December 2012. The subjects included 365 individuals who were selected through Morgan table. Waiting time for receiving treatment and diagnostic services for each patient was calculated by researcher from medical records of the patients and the triage sheet and entered in data collection forms. These forms contained two sections. The first part included demographic data and the second part contained information on the emergency department service delivery. The statistical analysis was performed in SPSS V.16 Results: The mean time of first consultant by physician was 6.4 + 7.2 mins, the mean time to receive the first nursing service was 14.9 + 14.4 mins, and the mean time to determine the patients’ status was 136.6 + 143 mins. There was a significant relation between the working shift and the mean time of first consultant by doctor and determination of the patients’ status. The same relation was also found for triage level. Conclusion: This study indicated a good level of service provided by emergency department of Sari Imam Khomeini Hospital.

---

Background and purpose: Blood transfusion is one of the essential and important parts of modern medicine. Blood transfusions are life saving for some patients, but some risks such as body's response should always be considered. This study was conducted to determine the incidence of transfusion outcomes and identifying the relationship between demographic profile of patients and some properties of blood products.

Materials and methods: This descriptive study was carried out in all patients being admitted to the emergency department in Sari Imam Khomeini hospital whom underwent blood transfusions (in 2014). After recording demographic data, the history of transfusion reactions, clinical signs and symptoms, severity of side effects, the numbers of blood infusion packs over the last 24 hours were evaluated. Statistical analyses were performed in SPSS ver. 16 applying T-test and Chi square test.

Results: A total of 961 patients had blood transfusion including 529 (55%) males and 432 (45%) females. Twelve patients (1.24%) developed acute blood transfusion complications. The most common reactions included chills (83%, n=10), fever (58%, n= 7), and dyspnea (58 %, n= 7). There were no significant correlations between the incidence of complications and other variables such as age, sex, initial hemoglobin level, previous medical history, and the age and number of injected blood products (P>0.05).

Conclusion: In this study, the incidence of acute transfusion reactions was lower than that in other studies in Iran. Reduction in the number of red blood cell packs injected into patients can be one of the reasons for reducing the risk of acute transfusion reactions.

---

 Background and purpose: Acute ischemic stroke is one of the main causes of death and long-term disability worldwide. Prehospital emergency diagnosis and subsequent transfer of stroke patients to the nearest stroke center for starting an appropriate treatment are critical steps in stroke rescue chain. In Iran, emergency medical technicians implement the SAMA code, following the diagnosis of acute stroke using FAST protocol, to manage the patients.
Materials and methods: This retrospective cross-sectional study was conducted on patients who were referred to the prehospital emergency department of Hazrat Rasool Akram Hospital with the announcement of the SAMA code in 2019. The aim of this study was to evaluate the positive predictive value of the prehospital emergency technicians in the announcement of the SAMA code.
Results: Of the 95 patients referred with the SAMA code, 19 patients diagnosed with hemorrhagic stroke (based on brain CT-scan) were excluded from the study. In 17.1% of the remaining 76 patients, diagnoses other than acute ischemic stroke were proposed. Ultimately, diagnosis of acute ischemic stroke was confirmed in 63 patients, and 25% of them were eligible for intravenous thrombolytic therapy, however, merely 5.26% of the eligible patients received the treatment. The positive predictive value of prehospital emergency service in referring patients diagnosed with acute ischemic stroke was determined to be 86.3%. Additionally, the positive predictive value for identifying acute cerebral stroke patients eligible for intravenous thrombolytic therapy was calculated to be 25%.
Conclusion: This study revealed that prehospital emergency's positive predictive value for acute ischemic stroke identification was adequate. However, activating the SAMA code with greater diagnostic accuracy can save time and costs.