Introduction: Mass casualty incidents (MCIs) impose unprecedented pressure on hospital capacities and resources, complicating the provision of standard services. Continuous preparedness for regional crises is essential. This qualitative study was designed to identify and analyze the challenges faced by teaching hospitals affiliated with Shahid Sadoughi University of Medical Sciences in Yazd when addressing mass casualties.
Method: This qualitative descriptive study used conventional content analysis and was conducted in 2025 at teaching hospitals under Shahid Sadoughi University of Medical Sciences, Yazd. Participants included 33 purposively selected managers, physicians, nurses, health professionals specializing in disasters and emergencies, and members of crisis and passive defense committees. Data collection continued until code saturation was achieved, which was confirmed after the 30th interview and validated through three additional interviews. Data were gathered through semi-structured, recorded interviews and analyzed using conventional content analysis. MAXQDA version 22 software was used for coding and organizing data, with methodological rigor ensured through Guba and Lincoln’s framework, including credibility, transferability, dependability, and confirmability.
Result: Data analysis revealed that effective hospital responses to mass incidents encounter multifaceted obstacles. At the macro level, weak governance and policymaking, ineffective risk management, and inadequate training in command structures create uncertainty in critical decision-making. On the support level, this results in exacerbated physical constraints, shortages of vital resources (such as medicines and equipment), and inadequacies in supply chains and psychosocial support. From an organizational perspective, both interdepartmental and intra-organizational information flows were severely disrupted, and the existing technical infrastructure was unable to handle the high volume of data or establish necessary communications. Additionally, clinical service delivery declined significantly due to poor management of incoming patient volumes and a lack of trained specialists to manage multiple casualties simultaneously.
Conclusion: The findings indicate that enhancing hospitals’ resilience in the face of mass casualties requires a comprehensive policy approach from senior management. This involves strengthening hospital infrastructure with dedicated budgets, empowering healthcare staff at all levels, providing psychosocial support, and conducting regular exercises based on local hazards. Implementing these layered solutions will significantly improve hospitals’ response capacities and fortify the health system against future crises.