Editorial In light of the recent 12-day conflict (Israel and Iran) and escalating regional tensions, the necessity to re-evaluate the preparedness of Iran’s healthcare system for crisis and war has become a matter of national urgency. More than three decades have passed since the end of the Iran-Iraq war, and a new generation of physicians, nurses, technicians, and emergency responders now serves in healthcare facilities. Demographic analysis reveals that the majority of current healthcare workers in Iran, including general practitioners, residents, nurses, and emergency technicians, were born after 1991. Most of them have no direct experience in dealing with complex wartime trauma, mass casualty events, or military emergency protocols. Even at managerial levels, very few individuals have operational experience from the Iran-Iraq war. This generational gap, coupled with structural challenges in the healthcare system, poses a strategic threat to the nation’s ability to respond effectively in the event of a full-scale war or coordinated terrorist attacks. It is therefore imperative to enhance individual, systemic, and infrastructural readiness across medical education, hospital preparedness, and trauma research centers.Over the past decade, Iran’s health infrastructure has focused on chronic disease management, maternal and child health, and public epidemics like COVID-19. While these areas are essential, they have led to a significant neglect in preparing for special emergencies, including those related to war.Currently, very few hospitals in Iran possess dedicated military medicine departments or conduct regular drills for mass casualty incidents. Even in major trauma centers, crisis management protocols at hospital, interdepartmental, and city levels are not often updated, and joint field exercises with military, emergency, and relief organizations are rarely performed.[1,2] Trauma research centers affiliated with medical universities must take a leading role in promoting emergency preparedness. Their responsibilities include developing trauma protocols tailored to local conditions, organizing hands-on training programs for healthcare staff, conducting forward-looking studies based on realistic wartime scenarios, engaging in collaborative drills with military and disaster agencies, and applying lessons learned from international war-torn regions.[3-5] To strengthen national preparedness for wartime trauma, the following actions are essential:targeted re-training programs, use of simulators and realistic drills, establishment of rapid alert and command systems, development of national policies on military medicine, strategic stockpiling of essential supplies and trauma kits, and deployment of offline and virtual learning systems for medical personnel.[6]History repeatedly teaches us that preparedness during times of peace is essential for survival in times of crisis. Health systems cannot rely solely on institutional memory; rather, they must pursue structured, continuous, and scientific preparedness for trauma on a national scale. This is not only a professional imperative, it is a national duty.

Objectives: Increasing bicycle ridership is accompanied by ongoing bicycle-related accidents in many urban cities. There is a need for improved understanding of patterns and risks of urban bicycle usage. We describe the injuries and outcomes of bi cycle-related trauma in Boston, Massachusetts, and determine accident-related factors and behaviors associated with injury severity. Methods: We conducted a retrospective review via chart review of 313 bicycle-related injuries presenting to a Level 1 trauma center in Boston, Massachusetts. These patients were also surveyed regarding accident-related factors, personal safety practices, and road and environmental conditions during the accident. Results: Over half of all cyclists biked for commuting and recreational purposes (54%), used a road without a bike lane (58%), and a majority wore a helmet (91%). The most common injury pattern involved the extremities (42%) followed by head injuries (13%). Bicycling for commuting rather than recreation, cycling on a road with a dedicated bicycle lane, the absence of gravel or sand, and use of bicycle lights were all factors associated with decreased injury severity (p<0. 05). After any bicycle injury, the number of miles cycled decreased significantly regardless of cycling purpose. Conclusion: Our results suggest that physical separation of cyclists from motor vehicles via bicycle lanes, regular cleaning of these lanes, and usage of bicycle lights are modifiable factors protective against injury and injury severity. Safe bicycling practices and understanding of factors involved in bicycle-related trauma can reduce injury severity and guide effective public health initiatives and urban planning.

This conceptual paper argues the need for narrative preparedness, understood as the ability to engage and empathize with peoples’ stories and the values they encode, assess them based on the universe in which people live, and acknowledge the narrative rationality of each story – even when it conflicts with the rationality of science. Expanding ‘health preparedness’ to encompass ‘narrative preparedness’ complements the ideals of patient centeredness, which are sometimes betrayed when implemented into concrete decisions because the rationality of science that underpins medical practice fails to make sense of patients’ stories. We outline the central tenets of narrative preparedness and demonstrate its relevance by discussing various responses to mainstream discourses on COVID-19 as a case in point. We discuss and further develop Fisher’s narrative paradigm, which provides a model that complements traditional, scientific rationality with attention to narrative rationality and a radical democratic ground for health political critique. Applying the narrative paradigm to authentic examples of vaccine hesitancy and anti-vaccination demonstrates how closer attention to the way narratives are assessed by different constituencies might help us mitigate some of the sources of resistance and misunderstanding that continue to plague public communication about important medical issues such as pandemics. Health authorities must acknowledge and engage with the stories people believe in and their reasons for doing so. The crucial question for the success of health policy interventions is not only ‘what are the facts’ but ‘how do these facts make sense to people, and why.’ To be prepared for the next pandemic, health professionals must learn to engage with people’s stories and the processes by which they come to be understood and assessed differently by various constituencies.