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Kheyrati L, Keshvari H, Fatehi F, Hemmati M, Khankeh H, Habibisaravi R et al . Presenting a Model for Telemedicine in Earthquake for Iran. Health in Emergencies and Disasters Quarterly 2019; 4 (3) :157-164
URL: http://hdq.uswr.ac.ir/article-1-258-fa.html

Background: Iran is a country with a high rate of natural disasters like earthquake. The environmental conditions slow down the delivery of health services, especially in the event of disasters. The modern technologies such as telemedicine are appropriate for facilitating disaster relief operations after an earthquake. This study aimed to develop a model for the implementation of telemedicine in an earthquake.
Materials and Methods: The study was carried out using a mixed-methods research in three phases: 1. review of the literature; 2. qualitative study (modeling); and 3. Delphi method (validation of the model). Databases of Google Scholar, Web of Science, Scopus, and PubMed were searched from 1990 to 2019 with the keywords of “telemedicine” AND “disaster” OR “emergency” AND “earthquake”. After screening of the retrieved records, 13 articles met the eligibility criteria and were included in the review study. Ten experts extracted all key elements of telemedicine in the disaster from the articles and categorized them in 6 themes with 38 subthemes. The model of telemedicine in the earthquake was finalized with 2 rounds of Delphi with groups of selected volunteer experts. 
Results: In the first phase of the study, 6 key themes (telecommunication infrastructure, technical infrastructure, financial infrastructure, health infrastructure, organizational infrastructure, social infrastructure, and cultural infrastructure) with 38 subthemes of telemedicine for implementing in the disaster were obtained. At the conclusion of the third phase of the study, 6 key themes with 33 subthemes contributed to the model of telemedicine in the earthquake. Telecommunication infrastructure with a maximum score of 9.24 earned the priority, and social and cultural infrastructure themes with the minimum score of 7.53 came in the end.
Conclusion: The model derived from this study can be used as an applied telemedicine model in an earthquake. We suggest that the results of this study be implemented as a theoretical model, or in a pilot study in a region of the country, and to be evaluated by regarding mortality reduction. We also recommend that a comparative study for using telemedicine in other types of disasters be undertaken.