Developing a Model for Hospital Staff Preparedness in Patient Evacuation During Disasters: A Mixed-Methods Study

Hospital staff preparedness for patient evacuation during disasters is a component of healthcare resilience. Current protocols may lack evidence-based foundations and tend to rely on static, checklist-driven approaches. Competency-based models have been proposed as an alternative, but empirical evidence supporting their effectiveness is limited.

This study aimed to develop a model for hospital evacuation readiness, grounded in global evidence and local expertise.

An explanatory sequential mixed-methods design was conducted in Iran (2023-2025) across five phases: 1) systematic review; 2) qualitative interviews with hospital staff; 3) data integration and expert refinement using a Modified Nominal Group Technique; 4) Delphi consensus validation with specialists; and 5) final model design. The model was developed as a theoretical framework; empirical testing of its effectiveness was beyond the study's scope.

Of 52 initially identified components, 50 were validated through Delphi consensus. The framework identifies five domains: individual factors; education and empowerment; resources; evacuation processes; and communication and coordination. The model introduces practical elements such as stress-tested drills, preemptive resource mapping, and structured near-miss learning.

This research proposes a reconceptualization of evacuation preparedness as an evolving, competency-driven system. The framework offers hospitals strategies to strengthen training, optimize resources, and institutionalize near-miss learning. However, its effectiveness compared with static approaches remains theoretical and requires longitudinal empirical evaluation. Hospitals in resource-constrained regions may particularly benefit from its emphasis on adaptive capacity and low-cost, simulation-based training.