Table 2 Results of validity of measurements
Item | Impact score | CVR | CVI | K |
|---|---|---|---|---|
1-A pre-hospital emergency preparedness plan or instruction for terrorist incidents has been developed. | 5 | 0.8 | 1 | 1 |
2-A special plan to improve the level of preparedness and effective response to terrorist incidents has been pre-designed and developed. | 3.8 | 0.6 | - | - |
3-Charts and processes related to terrorist incident response management have been periodically and regularly updated. | 4.7 | 0.8 | 0.9 | 0.98 |
4-There is an annual risk assessment plan for terrorist incidents including risk identification, capacity and vulnerability. | 4.9 | 1 | 1 | 1 |
5-The incident command system is defined and designed based on the national model of pre-hospital emergency in the incident field. | 5 | 0.8 | 0.9 | 0.98 |
6-A standard program and process has been developed for how resources are distributed. | 3.8 | 0.4 | - | - |
7-There are instructions for the initial assessment of the terrorist incident and the necessary resources for the implementation of the principles by the assessment team. | 4.7 | 1 | 0.9 | 0.98 |
8-A plan has been designed and developed to follow up and fully monitor the provision of supplies and services required to carry out terrorist incident missions. | 3.8 | 0.6 | - | - |
9-There are enough standard instructions for arranging resources, support equipment, and physical protection team members at the scene. | 4.6 | 0.8 | 1 | 1 |
10-Lessons learned and experiences from previous incidents have been used in developing new plans and processes. | 3.8 | 0.6 | - | - |
11-Necessary coordination has been made with experts to advise and support operations in response to various terrorist incidents. | 4.2 | 0.8 | 1 | 1 |
12-There is an internal and external memorandum of understanding with agencies related to the management of terrorist incidents, including the military and security forces, to manage the response to terrorist incidents. | 4.8 | 1 | 0.9 | 0.98 |
13-Special measures have been taken to replace key individuals in the incident command system chart. | 4.2 | 0.4 | - | - |
14-There are instructions for leveling, activating and deactivating the response program to all types of terrorist incidents. | 4.8 | 0.8 | 1 | 1 |
15-There are standard instructions for special response operations for a variety of terrorist incidents. | 4.7 | 0.8 | 0.8 | 0.78 |
16-There are instructions for scoping review and recording of lessons learned, experiences, reports and actions taken related with terrorist incidents. | 5 | 0.8 | 0.9 | 0.98 |
17-Description of the duties of the various pre-hospital emergency committees, including the determination of macro-preparedness policies, the adoption of the required instructions and standards related to the implementation of preparedness processes against terrorist incidents. | 4.6 | 1 | 1 | 1 |
18-Responsible and substitute persons and their job descriptions in different positions of the incident command system as well as the standard response schedule of 0 to 2, 2 to 12 and more than 12 hours are specified and defined. | 4.3 | 1 | 1 | 1 |
19-Pre-hospital emergency staff and operational personnel are aware of their job descriptions in accordance with the Terrorist Incident Response Operational Plan. | 4.8 | 0.8 | 0.9 | 0.98 |
20-Necessary coordination has been made with the relevant authorities to hold self-defense training courses for managers and pre-hospital emergency staff. | 4.9 | 1 | 0.9 | 0.98 |
21-The incident command system is implemented based on the roles and tasks and pre-determined people at the scene of the incident. | 4.9 | 1 | 0.6 | 0.64 |
22-A continuing education program on how to use safety and personal protection equipment for operational personnel is tailored to the type of terrorist incident. | 4.3 | 0.8 | 1 | 1 |
23-Specialized and experienced instructors in terrorist incidents are used to train and increase staff knowledge. | 4.6 | 0.8 | 1 | 1 |
24-Senior pre-hospital emergency officials, especially the incident commander, have full knowledge of those in charge and their duties and role in the incident command system. | 3.8 | 0.4 | - | - |
25-Dedicated training courses are held annually for dispatch and operations management staff on how to run and guide ambulances continuously and coordination between hospitals. | 5 | 0.8 | 1 | 1 |
26-Authentic books and resources related to terrorist incidents are available at pre-hospital emergency bases for the use and study of shift staff. | 4.2 | 0.8 | 0.9 | 0.98 |
27-Necessary measures have been taken to distribute the duties fairly and correctly and not to entrust multiple responsibilities and duties to one person. | 3.8 | 0.4 | - | - |
28-There is a scoping monitoring and evaluation of the educational-skills status of pre-hospital emergency personnel in terrorist incidents. | 3.8 | 0.8 | 1 | 1 |
29 Training of all staff and operational staff on their roles, responsibilities and job descriptions in terrorist incidents is carried out periodically. | 4.3 | 0.8 | 1 | 1 |
30-The content of the personnel training program is developed and implemented in accordance with the model published by the Ministry of Health. | 3.8 | 0.6 | - | - |
31-Training of all staff and operational staff on their roles, responsibilities and job descriptions in terrorist incidents is carried out periodically. | 4.8 | 0.8 | 1 | 1 |
32-The effectiveness of the training given to pre-hospital emergency staff in relation to terrorist incidents is evaluated periodically. | 4.9 | 1 | 1 | 1 |
33-The Disaster Management and Terrorism Management Matrix is designed to identify what categories of employees should be trained for what subject. | 3.8 | 0.4 | - | - |
34-Topics related to the management of terrorist incident operations are included in the training topics of the Training Office of the pre-hospital emergency Center. | 4.7 | 0.8 | 0.8 | 0.78 |
35-A memorandum of understanding has been established to use and employ qualified instructors of the security and law enforcement agencies to teach the security points of terrorist incidents to pre-hospital emergency staff. | 4.6 | 0.8 | 0.49 | 0.78 |
36-Necessary trainings have been given to the managers and emergency operations staff regarding the knowledge and how to use the correct and principled means of communication, urban planning and map reading. | 0.8 | 0.9 | 0.98 | |
37-A local memorandum of understanding has been signed between the pre-hospital emergency department and the Radio and Television to create a culture and increase the level of public awareness about providing first aid to the injured and victims of these incidents before the emergency arrives. | 1 | 0.8 | 0.98 | |
38-Personnel have been trained in the communication protocols provided. | 0.4 | - | - | |
39-Appropriate measures have been devised to motivate and interest pre-hospital emergency staff to participate in training related to terrorist incidents and increase their awareness. | 1 | 1 | 1 | |
40-Training needs assessment and setting a minimum standard of adequacy of staff performance to deal with terrorist incidents. | 1 | 1 | 1 | |
41-Children and adolescents receive the necessary training to deal with terrorist incidents while in school. | 0.6 | - | - | |
42-Orientation sessions are held regularly and periodically at least once a month in each shift for staff at the bases. | 0.6 | - | - | |
43-The passive defense of the pre-hospital emergency center holds the necessary training courses to increase the awareness of all staff on a periodic basis. | 0.8 | 1 | 1 | |
44-Periodic (at least annual) operational exercises are planned and carried out based on possible scenarios of terrorist incidents at different operational levels. | 1 | 1 | 1 | |
45-Monitoring and evaluating the effectiveness of exercises, identifying strengths and weaknesses, and reviewing terrorist response programs. | 0.8 | 0.49 | 0.98 | |
46-Necessary measures have been taken regarding the initial acquaintance of the pre-hospital emergency personnel with the common language, dialects and culture of the people in the area where they are taking shifts. | 0.4 | - | - | |
47-Practical defensive driving training courses are held to increase the skill level and readiness of pre-hospital emergency staff. | 0.8 | 1 | 1 | |
48-Common exercises will be held with other organs involved in responding to terrorist incidents to achieve greater coordination in incident scene management. | 1 | 1 | 1 | |
49-Pre-hospital emergency staff have the necessary physical and mental readiness to participate in the exercise, including motivation, seriousness and desire. | 0.8 | 1 | 1 | |
50-Training and exercise programs have been developed and implemented to improve stage management skills for staff. | 1 | 1 | 1 | |
51-Physical fitness courses for pre-hospital emergency staff and managers are held periodically and regularly. | 0.8 | 1 | 1 | |
52-The contact number list of all managers and operational staff, especially employees who shift in important and vital places, is available and is updated regularly and periodically. | 4.6 | 0.8 | 1 | 1 |
53-All lessons learned from events and exercises are scopingally recorded by a specific person. | 3.8 | 0.6 | - | - |
54-The physical fitness of pre-hospital emergency personnel and managers is monitored periodically and regularly. | 3.8 | 0.6 | - | - |
55-There are necessary measures for continuous monitoring of physical health and providing medical services to pre-hospital emergency staff during terrorist incidents. | 4.9 | 1 | 1 | 1 |
56-Details of the response to terrorist incidents are specified as special incidents in the incident command system. | 3.8 | 0.6 | - | - |
57-In critical and important centers, based on the capacity and capability of the emergency medical center of that province and the opinion of relevant experts, a special operations team has been considered to respond to terrorist incidents. | 4.7 | 0.8 | 0.6 | 0.98 |
58-Pre-hospital emergency staff are actively involved in designing and reviewing programs related to terrorist incidents. | 4.9 | 0.8 | 0.9 | 0.98 |
59-A memorandum of understanding has been reached with insurance organizations to insure managers and operational personnel in the event of possible damage. | 3.8 | 0.4 | - | - |
60-There are appropriate instructions for handling and following up on the affairs of injured operational staff, including incident insurance. | 4.6 | 0.8 | 1 | 1 |
61-Necessary measures have been devised to track the personnel on duty. | 3.8 | 0.2 | - | - |
62-Strategies for caring for employee families are designed to increase employee flexibility to recall and extend longer working hours. | 4.7 | 1 | 1 | 1 |
63-Relevant pre-hospital emergency authorities have developed a program to identify potential manpower capacities. | 3.8 | 0.6 | - | - |
64-The correct arrangement of more experienced and skilled operational staff in shifts is emphasized by importance of the presence of an experienced technician with a new technician. | 4.6 | 0.8 | 1 | 1 |
65-There is a process for recruiting, distributing and properly employing pre-hospital emergency staff, including determining the appropriate rotation shift, determining the appropriate force mix for units, especially operational units. | 4.7 | 0.8 | 0.9 | 0.98 |
66-Necessary measures have been considered to complete the form and follow up on personnel injury reports. | 3.8 | 0.6 | - | - |
67-A process is envisaged to honor the services of operational personnel involved in responding to terrorist incidents and to appreciate them and their families. | 4.3 | 1 | 1 | 1 |
68-In order to reduce the medical errors of the operational staff, a plan has been developed and operated for periodic rotation and change of the staff shift. | 4.6 | 0.8 | 1 | 1 |
69-Necessary measures have been considered regarding psychological support and mental health of employees and their families in the short and long term. | 5 | 1 | 1 | 1 |
70-In each shift, specialized and trained human resources are allocated on a case-by-case basis to prepare for terrorist incidents. | 4.8 | 0.8 | 1 | 1 |
71-Continuous supply, distribution and monitoring of medical and non-medical equipment required for urban and road pre-hospital emergency ambulances in accordance with various terrorist incidents. | 4.1 | 0.8 | 1 | 1 |
72-The free time of the operational personnel in the shift is used optimally and usefully in order to prepare and increase their skill level. | 3.8 | 0.6 | - | - |
73-Pre-hospital emergency equipment is updated and completed according to the latest standards, and all ambulances have the same arrangement. | 4.4 | 0.8 | 1 | 1 |
74-The geographical map of the covered area and the main and secondary traffic routes of pre-hospital ambulances are drawn and available at the emergency operations center. | 4.8 | 1 | 1 | 1 |
75-Necessary measures have been taken to provide and equip ambulances for terrorist attacks, depending on the type of incident. | 4.9 | 1 | 1 | 1 |
76-The plan is to provide alternative equipment to respond to terrorist incidents. | 3.8 | 0.8 | 0.6 | 0.58 |
77-Equipment and support resources for responding to terrorist incidents are available for at least 72 hours in the store of the Emergency Operations Center. | 4.8 | 1 | 1 | 1 |
78-Necessary measures have been taken in connection with concluding contracts with pharmaceutical and medical equipment companies to supply drugs and equipment required in terrorist incidents. | 5 | 1 | 1 | 1 |
79-All emergency equipment and devices have property numbers to prevent them from disappearing at the scene of the incident. | 3.8 | 0.4 | - | - |
80-A specific list of all the equipment and supplies needed for various types of terrorist attacks has been prepared. | 4.7 | 1 | 0.49 | 0.78 |
81-All types of replacement ambulances with all equipment are envisaged to support the response to terrorist incidents at 20% of the original capacity. | 4.4 | 0.8 | 1 | 1 |
82-A memorandum of understanding has been reached with the rescue and security forces to be present in time to provide security at the scene of the incident for pre-hospital emergency staff. | 4.8 | 1 | 0.9 | 0.98 |
83-All members of the terrorist incident management system are present at the scene with a special cover and label and can be identified. | 4.2 | 0.8 | 0.9 | 0.98 |
84-Necessary measures have been taken to restrict the access of ordinary people to the ambulances present at the scene of the incident and to enter the front or rear cabins of the ambulances. | 4.7 | 1 | 1 | 1 |
85-There are good guidelines for the correct location of a pre-hospital emergency ambulance in terms of proper geographical distribution, security, and facilitation of physical access to the scene. | 5 | 1 | 0.9 | 0.98 |
86-There are instructions required to inspect the scene of the incident for hazardous materials and conditions by the Chief of Safety and Security of the Command System. | 5 | 1 | 1 | 1 |
87-In order to manage various terrorist incidents, the necessary coordination has been done with partner and support organizations. | 4.1 | 0.8 | 1 | 1 |
88-Necessary coordination has been done with organizations related to incident management, including military, security, fire, etc., to zoning the scene of the incident during the terrorist attacks. | 4.3 | 0.8 | 1 | 1 |
89-There is a valid way to identify pre-hospital emergency staff and patients and ordinary people present at the scene. | 3.8 | 0.6 | - | - |
90-The necessary instructions have been devised to maintain the equipment of the injured who are not conscious and to deliver them to the relevant authorities. | 4.6 | 0.8 | 0.9 | 0.98 |
91-There is an instruction or process for identifying hazardous materials and decontamination at the scene by pre-hospital emergency staff. | 4.4 | 0.8 | 1 | 1 |
92-An appropriate mechanism has been considered for combining pre-hospital emergency laws and disciplinary laws to carry out security operations at the scene of an incident. | 3.8 | 0.4 | - | - |
93-Personal protective equipment suitable for all types of terrorist incidents is provided for pre-hospital emergency staff to be present at the scene. | 4.9 | 1 | 1 | 1 |
94-Pre-hospital emergency operations personnel are fully aware of the proper and principled use of personal protective equipment in terrorist incidents. | 4.2 | 0.8 | 0.9 | 0.98 |
95-Necessary coordination has been made with security teams to move and transfer the corpse. | 3.8 | 0.6 | - | - |
96-The pre-hospital staff quarantine protocol is in place to prevent the spread of contaminated and hazardous materials from biological terrorist incidents. | 4.8 | 0.8 | 0.8 | 0.98 |
97-There is a proper way to identify pre-hospital emergency personnel and identify them when they enter the scene of a terrorist incident. | 3.8 | 0.4 | - | - |
98-There is a standard decontamination process for patients, staff, equipment and corpses in biological terrorist incidents. | 5 | 0.8 | 1 | 1 |
99-Necessary measures have been considered to inspect the suspected abandoned vehicles at and around the scene of the incident and to evacuate them to safe places. | 3.8 | 0.6 | - | - |
100-There is a specific protocol to prevent ordinary people from entering the scene of the incident and creating congestion and interference in the work of emergency personnel. | 3.8 | 0.4 | - | - |
101-There are instructions for the safe pre-hospital transfer process for the injured or sick person contaminated with hazardous materials from terrorist incidents. | 4.6 | 0.8 | 1 | 1 |
102-The incident commander has the necessary scientific, physical and psychological capabilities to manage and command terrorist incidents. | 4.3 | 0.8 | 1 | 1 |
103-To manage the response, the unit command is specified according to the level and type of terrorist incident in the incident area. | 4.9 | 1 | 1 | 1 |
104-Necessary measures have been considered in relation to the vaccination of personnel in the face of diseases and respiratory problems. | 3.8 | 0.6 | - | - |
105-Necessary measures have been considered to control all personnel present in the terrorist incident regarding the occurrence of special symptoms that result from the incident. | 3.8 | 0.8 | 0.8 | 0.64 |
106-The pre-hospital incident command system is designed and implemented for all types of terrorist incidents. | 4.9 | 1 | 1 | 1 |
107-The incident command post is set up at the scene of the incident in accordance with the chronological order of events and the operational plan of the incident specified in the operations guidance center, and can be easily identified. | 4.1 | 0.8 | 0.8 | 0.88 |
108-Numerous periodic meetings (at least once a year) have been held between the directors of various organizations involved in terrorist incidents to better understand their duties and responsibilities, to establish interaction and to update the required actions. | 4.4 | 0.8 | 0.9 | 0.98 |
109-A memorandum of understanding has been drafted with the protection of important and vital places in the country to confirm the identity and facilitate the rapid entry and exit of pre-hospital emergency operations staff at the time of response. | 5 | 0.8 | 0.9 | 0.98 |
110-The role of partner and supporting organizations in responding to terrorist incidents is at the pre-hospital operations guidance center for further coordination. | 3.9 | 0.8 | 1 | 1 |
111-Memoranda of Understanding have been concluded and are available with private, military and charitable hospitals near critical areas for the reception of the injured or sick. | 4.9 | 1 | 1 | 1 |
112-Necessary measures have been devised to obey all managers and operational personnel of the main commander of the scene. | 3.8 | 0.6 | - | - |
113-There is a plan or instruction to use the helicopter in terrorist attacks and to obtain flight permits quickly with the relevant organizations. | 4.5 | 1 | 1 | 1 |
114-Necessary coordination has been made with responsible partner and support organizations outside the geographical area in order to respond to terrorist incidents. | 4.1 | 0.8 | 1 | 1 |
115-A memorandum of understanding has been concluded with partner, support and private sector organizations to provide the necessary resources and equipment in the event of a terrorist incident. | 4.9 | 0.8 | 1 | 1 |
116-Coordination with local military and security organizations to ensure the safety of staff, ambulances on the scene, casualties, equipment and pre-hospital emergency resources. | 4.7 | 0.8 | 0.9 | 0.98 |
117-Numerous meetings have been held between emergency security and security of vital places to confirm the identity and rapid entry and exit of operational personnel to these places in critical situations with the coordination of competent structures at the provincial and city levels and the security of the relevant University of Medical Sciences. | 3.8 | 0.4 | - | - |
118-A comprehensive database including telephone numbers, contact methods and addresses of all members of the organization has been prepared to participate in responding to terrorist incidents. | 3.6 | 0.8 | 1 | 1 |
119-An appropriate communication program with a variety of efficient and multi-layered communication platforms between different levels of people present at the scene of the incident has been designed in the operations guidance center of the organization. | 5 | 1 | 1 | 1 |
120-The necessary equipment for communication, including radio or telecommunication communication between the internal and external units of the participating organization in response to terrorist incidents has been provided. | 4.8 | 0.8 | 1 | 1 |
121-Necessary arrangements have been made with the relevant authorities to take off and use the helicopter in these incidents and to obtain flight permits quickly. | 3.8 | 1 | 0.6 | 0.58 |
122-Updated form Contact information for other centers and organizations related to responding to terrorist incidents is available at the organization's operations guidance center. | 5 | 1 | 1 | 1 |
123-Necessary public information has been provided through the local media about the aims, process and location of the incident to prevent intimidation, panic, rumors and disturbance of public order. | 5 | 1 | 1 | 1 |
124-There is a standard instruction or action plan for the process of gathering information about a terrorist incident from the time the incident is confirmed to the end of the incident. | 5 | 1 | 1 | 1 |
125-There is a program to activate the rapid alert system and determine the level of alert to internal and external organizational units and operational response groups. | 4.4 | 0.8 | 1 | 1 |
126-An instruction or program has been designed and developed to inform the danger and to produce and transmit clear messages from the incident situation to the users of the messages, including employees, relevant organizations and people. | 4.8 | 0.8 | 1 | 1 |
127-Appropriate information systems inside and outside the organization in terrorist incidents have been designed and developed. | 4.1 | 0.8 | 0.9 | 0.98 |
128-There are instructions for creating a local database on terrorist incidents and documenting all incident information. | 3.9 | 0.8 | 0.9 | 0.98 |
129-A trusted liaison and spokesperson in the field of health has been identified to communicate with the public, the media and health officials regarding the various stages of responding to a terrorist incident. | 4.2 | 1 | 1 | 1 |
130-A multi-layered communication program and appropriate communication platforms between operational units have been prepared and designed. | 4.6 | 0.4 | - | - |
131-Planning has been done to record the information and identify the injured. | 4.6 | 0.8 | 1 | 1 |
132-Necessary measures have been considered to ensure the security of information on the terrorist incident based on the availability, confidentiality and integrity of the information. | 4.8 | 0.8 | 1 | 1 |
133-Necessary measures have been taken to complete and update the information related to the incident, the injured and the dead quickly and continuously. | 4.6 | 0.6 | - | - |
134-There are clear instructions and procedures for triage of victims of terrorist incidents at the scene. | 5 | 0.8 | 1 | 1 |
135-A plan has been developed and implemented to obtain information from reliable sources. | 4.6 | 0.6 | - | - |
136-The equipment and supplies needed to triage the victims of terrorist incidents are available in accordance with the geographical area. | 5 | 1 | 1 | 1 |
137-There is a suitable training program for the triage team, based on the standard triage of the victims of terrorist incidents. | 4.8 | 0.8 | 0.9 | 0.98 |
138-The local standard protocol and process for evacuating casualties from terrorist incidents is available at the Medical Emergency and Incident Management Center. | 4.9 | 1 | 1 | 1 |
139-Planning has been done in order to acquaint the pre-hospital emergency staff with various methods of horizontal evacuation, vertical evacuation and complete evacuation. | 5 | 1 | 1 | 1 |
140-Instructions or the process of selecting evacuation models (geographic model, resource model, and patient status model) for various types of terrorist incidents are available at the Incident and Emergency Management Center. | 4.6 | 0.8 | 1 | 1 |
141-A list of approved and reputable mass media has been prepared in advance to inform the news and ways to communicate with them. | 4.6 | 0.4 | - | - |
142-Instructions for familiarizing pre-hospital emergency staff with a safe emergency evacuation plan, exit routes for evacuating public, critical and important local facilities. | 5 | 1 | 1 | 1 |
143-Necessary coordination has been done with hospitals close to important and vital places in relation to the rapid admission of patients to terrorist incidents and proper cooperation with pre-hospital emergency ambulances. | 4.6 | 0.4 | - | - |
144-Danger maps of important and vital local places have been prepared by the University Operations Guidance Center. | 5 | 1 | 1 | 1 |
145-An experienced person or persons are assigned to oversee all stages of the triage. | 4.6 | 0.8 | 0.6 | 0.58 |
146-There is a specific plan for determining the routes of entry and exit of ambulances and pre-hospital emergency staff in terrorist incidents. | 4.9 | 1 | 1 | 1 |
147-Geographic satellite imagery (live, recorded) of the local community is available at the pre-hospital emergency center dispatch unit. | 4.7 | 1 | 1 | 1 |
148-Specific planning has been done to form a special team in the Emergency Medical Management Center. | 4.6 | 0.6 | - | - |
149-Appropriate mechanism for creating a pad (helicopter landing point) is provided due to the dynamic scene of the incident. | 3.9 | 0.8 | 0.9 | 0.98 |
150-An appropriate mechanism has been envisaged to establish a temporary morgue to better manage the bodies and the dead. | 4.6 | 0.4 | - | - |
151-Necessary coordination has been made with the police and the corridors to open the routes for ambulance traffic and to create shortcuts and alternative routes. | 4.8 | 0.8 | 0.9 | 0.98 |
152-Regular visits of pre-hospital emergency managers to important and vital places and coordination with the officials of these places to determine and review the entry, exit and alternative routes. | 4.2 | 1 | 0.6 | 0.78 |
153-Necessary coordination has been made by security and military teams to ensure the security of emergency personnel, ambulances and their equipment. | 4.6 | 0.4 | - | - |
154-Necessary measures have been considered regarding the signboards in case of emergency and the route in terrorist incidents. | 4.6 | 0.6 | - | - |
155-There is a guide program for choosing the right route to lead the pre-hospital emergency fleet in the context of Internet and traditional methods in the dispatch of the pre-hospital emergency operations center. | 4.9 | 1 | 0.9 | 0.98 |
156-Patrols and urban planning, especially in the streets and important areas, have been carried out by emergency operations personnel and dispatch personnel. | 4.6 | 0.8 | 0.6 | 0.6 |
S-CVI /Average=0.97 |