Prehospital emergency nurses' response: using the socioecological framework to guide health policy recommendations

Nurses play a vital role in disaster response during emergencies. Nevertheless, limited attention has been paid to factors that influence nurses' responses and challenges in prehospital settings. These issues became evident during the October 7, 2023, terror attack on Israel, when nurses heroically provided medical treatment, but there was no organized nurse-led initiative to provide emergency care in a prehospital setting.

(1) To examine the factors associated with nurses' intentions to provide prehospital emergency reponse during disasters; and (2) To understand multilevel determinantsof nurses' prehospital emergency response to inform health policy recommendations.

This study employed an explanatory sequential mixed-methods design. Between February and December 2024, a self-reporting questionnaire was distributed to Israeli nurses (n = 315), followed by a qualitative phase involving an open-ended questionnaire completed by 20 healthcare professionals involved in medical care during the attack or in senior emergency preparedness roles. Descriptive and inferential statistics and qualitative content analysis were employed. We applied the socioecological framework to organize the results from both phases.

High personal resilience, readiness and self-efficacy, along with positive attitudes, low hesitancy, and residence in a rural-type settlement significantly predicted nurses' intention to provide prehospital emergency care. Qualitative analysis revealed four key themes related to nurses' prehospital roles: (1) individual barriers and facilitators, (2) interprofessional relationships and teamwork, (3) nurses' roles within the community, and (4) organizational and policy challenges. Findings from both phases were synthesized using the socioecological framework for analysing prehospital nursing care during emergencies.

Nurses' prehospital emergency response intentions are shaped by personal, professional, and policy-level factors. Beyond education, targeted health policies must clearly define nurses' roles, strengthen interprofessional collaboration, and integrate nursing into disaster preparedness frameworks to improve system resilience and patient outcomes, particularly in the face of escalating environmental crises globally.