Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2022 09 01 e3 e3 Melaku Getachew Department of Emergency & Critical Care Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia Habtamu Tadesse Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia Natanim Degefu Department of Pharmaceutics, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia 2022 08 07 2022 08 30 Objective: This study assesses the severity of mental health problems in healthcare professionals (HCPs) and its associated risk factors during COVID-19 pandemic at a tertiary hospital in Harar, Eastern Ethiopia. Methods: An institutional-based cross-sectional study was done from November 01 to 15, 2020. Data was collected by using a web-based self-administered questionnaire. Descriptive statistical analysis, cross tabs, and logistic regressions were utilized. Results: Out of 238 HCPs, 54.6% of them had a mental health problem. The prevalence of depression, anxiety, and stress was 44.1%, 48.3%, and 29.0%, respectively.  Cigarette smoking was the only factor associated with depression. Being female, a cigarette smoker, and previously diagnosed with COVID-19 were associated with anxiety, while cigarette smoking and previous COVID-19 suspect had a significant association with stress. Conclusion: The burden of mental health problems among HCPs is high. The Federal Ministry of Health should incorporate psychosocial support for healthcare professionals during pandemics. This study highlights the need for developing policies to decrease mental health problems among HCPs during the COVID-19 pandemic. https://fem.tums.ac.ir/index.php/fem/article/view/1061 https://fem.tums.ac.ir/index.php/fem/article/download/1061/422

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2022 12 31 e10 e10 Devendra Richhariya Department of Emergency Medicine Sarvodaya Hospital & Research Center, Delhi, India. Rakesh Gupta Department of Emergency Medicine Sarvodaya Hospital & Research Center, Delhi, India. 2022 11 10 The patient was a 61-year-old smoker male, who presented to emergency department (ED) with complaints of sudden onset of headache followed by painless blurring of vision of the right eye that was started 10 hours prior to the admission. Due to blood pressure of 190/104 mmHg at home, the patient had taken amlodipine 10mg orally. The patient reported some episodes of transient ischemic attacks in his past medical history, for which he did not take any advice from physicians. The patient was also found to be hypertensive with deranged cholesterol. On examination in ED, the patient was afebrile, and had pulse rate= 88/min, blood pressure (BP)= 130/90 mmHg, respiratory rate=22/min, and O2 Saturation=99% in room air. There was not any positive finding in systemic examination. Patient was admitted for further evaluation and management. Paraclinical lab tests were all reported in normal range. Echocardiography revealed left ventricular ejection fraction (LVEF) of 60%, with no regional wall motion abnormality (RWMA), mild concentric left ventricular hypertrophy (LVH) and normal cardiac chambers. In view of Headache, brain computed tomography (CT) scan was performed, in which, there was prominence of sulci, basal cistern, sylvian fissure and ventricular system suggestive of age-related diffuse cerebral atrophy. Ill-defined hypodensities were seen in bilateral periventricular white matter, suggestive of chronic ischemic changes. Later, brain magnetic resonance imaging (MRI) was also performed, which revealed multiple discrete and confluent areas of hyperintensity scattered in subcortical deep and periventricular white matter of both cerebral hemispheres, suggestive of nonspecific small vessel ischemic changes, likely a combination of ischemic demyelination chronic lacunar infarcts and prominent perivascular space. The ventricular system and subarachnoid space were prominent, suggestive of age-related cerebral atrophy. In the next step, cervical and brain MRI angiography was performed, which revealed 100% occlusion of right internal carotid artery at its origin, with no distal reformation of the artery in the neck and intracranial part. The right middle and anterior cerebral artery were filling via circle of Willis and were severely diffusely narrowed in calibre. There were mild atheromatous changes in the left common carotid artery and carotid bulb causing mild narrowing. Bilateral vertebral arteries were normal. There was evidence of diffuse severe narrowing and poor visualization of entire left anterior cerebral artery. Ophthalmology reference was taken and fundus examination was done. On examination, the patient was found to have finger counting close to face with no improvement with glasses. In the right eye, anterior segment examination showed relative afferent pupillary defect (RAPD), while fundus examination revealed retinal background pale white with cherry red spot in macula and absent venous pulsation in the right eye, suggestive of Central Artery Retinal Obstruction (CRAO), and thread like blood vessels and Grade II Hypertensive retinopathy. After starting the low molecular weight heparin, antiplatelet and steroid, vision improved from finger counting close to face to finger counting at 3 feet distance. Patient was later discharged under follow-up for further recovery. https://fem.tums.ac.ir/index.php/fem/article/view/1109 https://fem.tums.ac.ir/index.php/fem/article/download/1109/421

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2022 12 26 e8 e8 EN Charles Hwang Department of Emergency Medicine, University of Florida, Gainesville, FL, USA Travis Murphy Cardiothoracic Critical Care, Miami Transplant Institute, University of Miami, Miami, FL, USA Jesseca Antoine Department of Emergency Medicine, University of Florida, Gainesville, FL, USA K. Leslie Avery Division of Pediatric Critical Care, Department of Pediatrics, University of Florida, Gainesville, FL, USA Casey Carr Department of Emergency Medicine, University of Florida, Gainesville, FL, USA Francis Han Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA Garrett Snipes Department of Internal Medicine, University of Florida, Gainesville, FL, USA Sonya Zhou Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA Torben Becker Department of Emergency Medicine, University of Florida, Gainesville, FL, USA 2022 11 07 2022 12 08 The Interdisciplinary Cardiac Arrest Research Review (ICARE) group was formed in 2018 to conduct an annual search of peer-reviewed literature relevant to cardiac arrest. Now in its fourth year, the goals of this review are to highlight annual updates on clinically relevant and impactful clinical and population-level studies in the interdisciplinary world of cardiac arrest research from 2021.  To achieve these goals, a search of PubMed using keywords related to clinical research in cardiac arrest was conducted. Titles and abstracts were screened for relevance and sorted into seven categories: Epidemiology & Public Health; Prehospital Resuscitation; In-Hospital Resuscitation & Post-Arrest Care; Prognostication & Outcomes; Pediatrics; Interdisciplinary Guidelines; and Coronavirus disease 2019. Screened manuscripts underwent standardized scoring of methodological quality and impact by reviewer teams lead by a subject matter expert editor. Articles scoring higher than 99th percentile by category were selected for full critique.  Systematic differences between editors’ and reviewers’ scores were assessed using Wilcoxon signed-rank test. A total of 4,730 articles were identified on initial search; of these, 1,677 were scored after screening for relevance and deduplication.  Compared to the 2020 ICARE review, this represents a relative increase of 32% and 63%, respectively.  Ultimately, 44 articles underwent full critique. The leading category was In-Hospital Resuscitation, representing 41% of fully reviewed articles, followed by Prehospital Resuscitation (20%) and Interdisciplinary Guidelines (16%). In conclusion, several clinically relevant studies in 2021 have added to the evidence base for the management of cardiac arrest patients including implementation and incorporation of resuscitation systems, technology, and quality improvement programs to improve resuscitation. https://fem.tums.ac.ir/index.php/fem/article/view/1107 https://fem.tums.ac.ir/index.php/fem/article/download/1107/429

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2023 01 03 e2 e2 EN Payman Salamati Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Mohammad Reza Zafarghandi Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran 2022 12 03 2022 12 08 Dear editor We read with interest Abdolrazaghi and his colleague’s paper entitled ‘’ Brachial plexus injury following blunt trauma; an anatomical variation in electrodiagnostic findings’’ and enjoyed it a lot. They presented a brachial plexus injury (BPI) case, which was rare in clinical practice because blunt traumas did not commonly cause BPI. There is ample evidence that most cases are men and adolescents aged 15 to 25 years, and the main mechanism of injury (70%) is motor vehicle accidents. As BPI is increasing, we will provide some epidemiologic and clinical characteristics of our cases registered at Sina Hospital, affiliated with the National Trauma Registry of Iran (NTRI). The Sina Trauma and Surgery Research Center launched the NTRI in 2016 and first recorded the related data from Sina Hospital. As the registry expanded, the NTRI included some other Iranian hospitals from different cities in the next step. The inclusion criteria were discussed elsewhere. We have registered 10 cases of BPI since 2016 at Sina Hospital. All of them were men, ranging from 19 to 45 years. The cause of injury was cut/stab in nine and road traffic accidents in one patient; seven were intentional, and most were due to interpersonal violence. Five of the injuries happened outdoors, three cases in commercial and service departments, and two at homes. Furthermore, the median injury severity score (ISS) was 5.0 (IQR=1). All of the patients had surgical operations. No death or need for ventilators was reported. Only one patient needed intensive care unit (ICU) admission and stayed for three days in the ward. We hope this information can be helpful for the Frontiers in Emergency Medicine’s readers to know more about BPI and can compare similarities and differences between our cases and the others included in the literature. https://fem.tums.ac.ir/index.php/fem/article/view/1121 https://fem.tums.ac.ir/index.php/fem/article/download/1121/425

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2023 01 05 e9 e9 Adem Tunçekin Urology Department, Faculty of Medicine, Harran University, Şanlıurfa, Turkey Mehmet Demir Urology Department, Faculty of Medicine, Harran University, Şanlıurfa, Turkey İsmail Yağmur Urology Department, Faculty of Medicine, Harran University, Şanlıurfa, Turkey Eyyup Sabri Pelit Urology Department, Faculty of Medicine, Harran University, Şanlıurfa, Turkey Bülent Katı Urology Department, Faculty of Medicine, Harran University, Şanlıurfa, Turkey Halil Çiftçi Urology Department, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey 2022 10 30 2022 12 04 The diagnosis and treatment of foreign bodies in the urogenital system are difficult and it’s rare in children; It may also cause secondary injuries. In this article, we present a 14-year-old male patient who was admitted to the emergency outpatient clinic with complaints of difficulty in voiding and dysuria. He was diagnosed with a pin in the urethra and treated using an endoscopic method. He was hospitalised for foreign body removal after he admitted in his anamnesis about insertion a pin into his urethra the day before his complaints started. A pin was seen in the urethra on the urethrocystoscopy, and was successfully removed. Since foreign body in the urogenital system is rare in children, it is necessary to suspect, in order to make the diagnosis. In most cases, endoscopic intervention is sufficient. Psychiatric consultation should be requested for the patients, especially for pediatrics. https://fem.tums.ac.ir/index.php/fem/article/view/1102 https://fem.tums.ac.ir/index.php/fem/article/download/1102/424

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 7 1 2023 01 06 e1 e1 Alireza Baratloo Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran 2023 01 06 In 2022, Frontiers in Emergency Medicine published 60 papers in four distinct issues with authors from various nationalities, including Mexico, Turkey, Egypt, India, Yemen, the USA, Palestine, Poland, Saudi Arabia, the Netherlands, the UAE, Algeria, Ethiopia, Jordan, Cameroon, the UK, and Iran. As we did last year, we decided to review and evaluate various aspects of our work in the previous year. In the year 2022, despite the not-yet-ended pandemic, COVID-19 apparently missed its priority as the hottest topic of research and it seems that researchers took time to focus on their main research lines. Therefore, we were able to publish articles in different fields and cover more topics; however, we still received so many papers on COVID-19 and published some of them, not only on treatment but also on other aspects of the disease, and also some case reports. We also published a letter in which the authors pointed to increased prevalence of bloodstream infection with Klebsiella species in patients with recent COVID-19 infection, which may be an interesting issue for further investigations. We had two other papers that were published as “Letter to the Editor”. One was related to blunt abdominal injuries in the National Trauma Registry of Iran, and the other was concerned with Eye emergencies during wars, which was published around the beginning of Russia's war against Ukraine. There were 25 published papers in 2022 that fulfilled the criteria of an original article. Of these, only 7 were focused on COVID-19, and the rest covered other topics including critical care, neurological emergencies, experimental studies, point of care ultrasound, cardiovascular emergencies, emergency department management topics, trauma, and prehospital emergency care. Interestingly, the most viewed article was the one in which a series of oleander poisoning cases were reported by a group of authors from India. In addition to original articles, there were also one umbrella review, one systematic review, and some other types of reviews that have their own value and specific audiences, in which some recommendations were reviewed by experts in the fields. Case presentation maybe the most popular part of the journals. We have various structures in this regard, so that we can respond to the passion of our addressees. We published 5 Case reports, and also 5 papers categorized as “case-based learning points”. However, there are some other structures available for those interested in sharing their experience with their patients, which we regularly suggest to the authors in the peer review process of their submissions. We are honored to have published a series of educational papers on “electrocardiogram interpretation”, all written by Jerry W. Jones as an invited author, and we are very grateful for his participation and companionship. We also intend to introduce historical aspects of emergency medicine in various countries; therefore, an editorial paper written by Ozgur Karcioglu was published, which points to the emergency medicine journey in Turkey. We are very eager to have this type of papers from other countries and we will certainl: The results from this review indicate that the chest CT scan should be used for symptomatic and hospitalized patients. Moreover, chest CT scan should not be used as a primary screening tool for diagnosing COVID-19. Application of RT-PCR as the first line diagnosis is still recommended. https://fem.tums.ac.ir/index.php/fem/article/view/459 https://fem.tums.ac.ir/index.php/fem/article/download/459/311

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 4 2s 2020 04 05 e37 e37 Mohammad Jalili Department of Emergency Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2020 04 05 Emergency medical services (EMS) play a vital role in the management of public health emergencies such as epidemics of infectious diseases. Unique challenges, however, are expected under these circumstances beyond what occurs during normal conditions. EMS personnel often have limited information about their patients, work under uncontrolled conditions, and accompany their patients in enclosed spaces of the ambulance. They are at particular risk of contracting the infectious agent unless standard and transmission-based precautions are implemented. Appropriate use of personal protective equipment (PPE) by responding personnel is, therefore, of paramount importance. Since the report of the first cases of COVID-19 in late December 2019, the disease has spread beyond China. As of March 29th, a total of 634,835 confirmed cases have been reported globally and 29,975 people have died. The Center for Diseases Control (CDC) and other authorities and advisory agencies have prepared guidelines regarding safety precautions for EMS personnel, including appropriate selection and use of PPE . https://fem.tums.ac.ir/index.php/fem/article/view/376 https://fem.tums.ac.ir/index.php/fem/article/download/376/274

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 4 2s 2020 04 09 e40 e40 EN Zahid Hussain Khan Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Jalil Makarem Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Mojgan Rahimi Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran 2020 04 04 2020 04 05 The novel coronavirus (COVID-19) emerged for the first time in China and then rapidly spread and swept the entire world like a tornado killing thousands of patients around the planet. People were advised to stay in-doors to prevent the spread of this deadly disease, and this slogan helped to a greater extent in containing the spread of the virus. Unfortunately, there is no treatment for the disease at present, but extensive research is going on to find a definitive treatment. Regarding endotracheal intubation (ETI) of COVID-19 patients, data are scarce and no randomized clinical trials are available to develop and formulate succinct and acceptable guidelines in tackling the problem of ETI in these highly risky and vulnerable patients. https://fem.tums.ac.ir/index.php/fem/article/view/374 https://fem.tums.ac.ir/index.php/fem/article/download/374/276

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 4 2s 2020 04 22 e59 e59 Debkumar Chowdhury Emergency Department, University Hospital Ayr, Ayr, Scotland, UK 2020 04 22 2020 04 22 Context: There is a significant burden on all emergency services in the management and prevention of the novel COVID-19 transmission. The effects are felt right across the World with certain geographical areas being most affected, it has affected all countries irrespective of their healthcare infrastructure. It has been suggested that certain parts of World that are prone to natural disasters are better prepared for pandemics. However, this is completely unfound as major economies are overwhelmed with the effects of the COVID-19 and it becomes completely irrelevant of any past experiences as these have been in never seen before scale. Evidence acquisition: The national fight against COVID-19 has been dubbed as the greatest fight for the National Health Service (NHS) with the entire United Kingdom under lockdown and the unfamiliar situation not seen before in peacetime. The general understanding of the disease process is that it has profound effects on the elderly and those with significant underlying health conditions such as cardiovascular, respiratory amongst others. However, it has surfaced from time to time that the very young are being affected and at times unfortunately been fatal. Results/Measures: The United Kingdom has been in a lockdown just like several nations across the globe in a desperate measure to limit the spread of the virus. There have been weeks of planning at every level for all possible eventualities with regards to the ongoing COVID-19 pandemic. All routine operations and procedures have been cancelled only procedures that emergency life and limb saving and cancer surgery continue to take place in hospitals all across the hospitals in the NHS. Widespread measures such as social distancing, calling a dedicated helpline for information and advice rather than attending the nearest Emergency Department have led to a significant number of presentations to the Emergency Department. Conclusions: The main concerns that remains for the NHS and other countries that have been affected is that once the lockdown restrictions are slowly eased will lead to a significant resurgence of cases that will overwhelm their respective healthcare infrastructures. From a clinician perspective, the main concern is the potential late presentations of the acutely unwell patients. This is the sentiment that is likely to be felt by many of my critical care colleagues working across NHS hospitals. https://fem.tums.ac.ir/index.php/fem/article/view/398 https://fem.tums.ac.ir/index.php/fem/article/download/398/283

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 4 2s 2020 05 10 e50 e50 Anitha Silvery Department of Emergency Medicine, Nizams Institute of Medical Sciences, Panjagutta, Hyderabad, India Mohammed Ismail Nizami Department of Emergency Medicine, Nizams Institute of Medical Sciences, Panjagutta, Hyderabad, India Ashima Sharma Department of Emergency Medicine, Nizams Institute of Medical Sciences, Panjagutta, Hyderabad, India Lakshmi Bhaskar Department of Hospital Administration, Nizams Institute of Medical Sciences, Panjagutta, Hyderabad, India 2020 04 30 2020 05 03 Introduction: Since the outbreak of Coronavirus on December 31, 2019 in Wuhan, Hubei Province, People’s Republic of China, the number of cases from China that have been imported into more than 180 countries and regions around the world.  Objective: The goal of this study is to flatten the curve of new infection, through nosocomial transmission by health care system along with early identification of asymptomatic COVID-19 cases.  Methods: A Survey was conducted over a period of 35 days. A total of 1709 individuals were screened (647 patients and 1062 patient attendees) coming to emergency Department. The waiting area of Emergency Care was divided into 3 screening zones and a separate second triage is established. The individuals entering are ensured that they are screened at all the 3 zones. Individuals were divided into two Groups after screening: Group A (suspected COVID-19) and Group B (unsuspected COVID-19). In Acute emergencies, the patient was directly treated at second triage.  Results: A total of 1709 individuals, 247 in Group A (Suspected COVID-19) and 1462 in Group B (Unsuspected COVID-19). Among 247 individuals, 141 were males and 106 were females. Age ranged from 14-72 years with a mean age of 46.7years. Among 247 individuals (Group A), 81 were patients, of which one case was found to be COVID-19 Positive. Two Health care workers (HCW’s) found to be positive.  Conclusion: Challenges from the widespread pandemic underscores the importance of early implementation of a second triage and vigorous screening for all the individuals to minimize the spread of infection, failing which pandemic infection may turn into an epidemic. https://fem.tums.ac.ir/index.php/fem/article/view/410 https://fem.tums.ac.ir/index.php/fem/article/download/410/295

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 4 2s 2020 05 11 e54 e54 Shervin Farahmand Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran Shahram Bagheri-Hariri Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran 2020 05 11 Introduction: It is likely that high rate of healthcare workers (HCWs) infection has occurred in Iran, but there is not any proof yet. Objective: This study was conducted to highlight the rate of Iranian HCWs infected by COVID-19 and some of its surrounding points. Methods: This cross-sectional study was conducted in Tehran, Iran. Using web-based applications including WhatsApp, Telegram, Instagram and Facebook, the link to the questionnaire was sent and exposed to the eligible ones. The target population of the study was HCWs who were diagnosed as approved cases of COVID-19. They were asked about their baseline characteristics and also possible source of infection, symptoms onset, hospitalization and etc. All findings presented by frequency and percent. Results: From March 29, 2020 to April 5, 2020, a total of 452 HCWs had completed the online questionnaire of whom 50.9% were women; mostly were in the age range of 25-29 years old. Among the participants, physicians had the largest population with 312 people (69.0%). The most frequent clinical symptoms were fatigue, fever and myalgia, respectively. The highest frequency with 85 cases (18.8%) was reported their symptoms onset within 20-24th February, 2020. The most commonly used piece of equipment was gloves, which was used in 57.3% of the cases, followed by simple surgical mask, which was used by 47.1% of the participants. In 21.9% cases no personal protective equipment was used. Totally, 348 cases (91.6%) were treated in an outpatient setting and only 36 cases (9.5%) needed to be hospitalized. In 160 cases (35.4%), at least one other person was infected with COVID-19 in their household. Conclusions: Considerable number of participants that declared their infection in this study, emphasizes on the considerable rate of Iranian HCWs infected by COVID-19. https://fem.tums.ac.ir/index.php/fem/article/view/425 https://fem.tums.ac.ir/index.php/fem/article/download/425/296

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 4 2s 2020 04 12 e41 e41 Davood Farsi Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran Mani Mofidi Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran Babak Mahshidfar Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran Peyman Hafezimoghadam Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran 2020 04 05 2020 04 06 Health care workers (HCWs) are heavily involved in the fight against COVID-19 in all over the world. They have the vital role of treating patients and searching for the proper treatment for the disease, while supporting and protecting their families. It is imperative that the systems should try hard to keep them safe and healthy. World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) have recently published guidelines for keeping HCWs safe and protected. The Personal Protective Equipment (PPE) is the cornerstone of recommendations and contains face mask (air purifying respirator), goggles or face shield, gown, and gloves. There is no doubt that a proper mask (e.g. N95) is the most important element of the protective gear when it comes to transmission of COVID-19. https://fem.tums.ac.ir/index.php/fem/article/view/378 https://fem.tums.ac.ir/index.php/fem/article/download/378/277

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 4 2s 2020 04 28 e60 e60 EN Fariba Asghari Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran Saeedeh Saeedi Tehrani Department of Medical Ethics, Iran University of Medical Sciences, Tehran, Iran 2020 04 18 2020 04 19 At present, the biggest challenge to health and economic systems around the world is the emergence of COVID-19 pandemic. Several ethical questions have been raised at the macro-, meso- and micro-levels with respect to proper management and control of this pandemic. The most important factor in creating fear and public anxiety and disturbances of social functions is the fatalities caused by the epidemic by an unknown pathogen in most countries. Decisions for epidemic control measures are made among many uncertainties, and prioritize public health over individual rights. People's trust and compliance with recommendations play a decisive role in public actions. Therefore, during an epidemic, necessities such as adherence to the values of honesty, respect, human dignity, solidarity, justice, reciprocity, transparency, and responsiveness in the response system need to be considered. The major ethical considerations in macro and micro levels of decision-making responding to the COVID-19 will be reviewed in this paper. Ethical dilemmas arise in different domains of a pandemic such as restriction on freedom of movement, individual’s refusal of preventive or therapeutic interventions, health care workers’ rights and duty to care, the allocation of scarce resources, off-label use of diagnostic and therapeutic measures and research. The purpose of this article is to pay attention to ethical principles in solving these challenges and does not necessarily respond to all ethical problems; however, it draws the reader's attention and moral sensitivity to the issues raised in this area. https://fem.tums.ac.ir/index.php/fem/article/view/390 https://fem.tums.ac.ir/index.php/fem/article/download/390/286

Tehran University of Medical Sciences Frontiers in Emergency Medicine 2717-3593 4 2s 2020 05 21 e55 e55 Samad Azari Health Management and Economics Research Center, Iran University