Document Type : Original Article
Authors
1
PhD candidate, Emergency & disaster Health department, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
2
Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3
Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
10.30491/tm.2026.591598.1959
Abstract
Background: Trauma-related mass casualty incidents (MCIs) can rapidly overwhelm hospital capacity and disrupt routine care processes. Hospitals therefore have central roles in receiving, triaging, treating, and coordinating casualty management. Despite the burden of trauma-related MCIs in Iran, evidence for hospital response planning based on expert experience remains limited. This study explored experiences of hospital experts involved in MCIs in Iran and developed a hospital response framework for traumatic mass casualty incidents.
Methods: This study is qualitative in nature and was carried out in 2025 in eight provinces of Iran utilizing semi-structured interviews. The participants in this study were selected based on purposive and snowball sampling—eligibility factors included at least five years of hospital-based work experience involving traumatic MCIs. Data collection and analysis were conducted simultaneously until themes were saturated after analyzing a total of 20 interviews. Interviews were audio-recorded, transcribed verbatim in Persian, and analyzed using inductive thematic analysis. Lincoln and Guba's criteria ensured trustworthiness, and reporting followed the COREQ checklist.
Results: A total of twenty individuals took part in the study. The analysis produced a total of seventy-four codes, eleven subcategories, and three main categories that concern the actions taken by hospitals across all stages of operation. The Immediate Stage, which consisted of the initial notification and the implementation of the Hospital Incident Command System, the use of surge capacity and resource management technology, triage and patient identification technology, work with communication and information technology, and security and traffic management practices, was noted. The Intermediate Stage included treatment and continuity of care, transfer, referral to other health care institutions, and management by specialists. The Continuing/Recovery stage was characterized by monitoring discharged patients and completing patient folders.
Conclusion: The findings provided a three-phase framework for hospitals' response to traumatic MCIs based on the input of an expert panel in Iran. The framework mainly concentrates on coordinated command, quick expansion of capacity, organized flows of patients, involvement of specialists, mental care provided, and organized recovery efforts. It will allow hospitals to increase coordination in their responses, continue care provision, and improve the management of traumatic MCIs.
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