Challenges faced by the Iranian health system in response process to terrorist explosive attacks: a descriptive phenomenology qualitative study of live experiences.

Introduction: Mass casualty incidents present significant challenges not only for healthcare providers and emergency service responders at the incident scene, but also for the hospitals that receive those affected. Terrorism related mass casualty incidents can lead to a diverse array of circumstances, necessitating those hospitals and their personnel be adequately prepared to manage more complex and demanding requirements. This study aimed to explore the health system challenges related to the response process to terrorist explosive bombing attacks from the perspective of Iranian health system managers and experts.

Methods: The present qualitative study employs a descriptive phenomenology approach conducted in Iran. Data were gathered through in-depth individual interviews with 16 health managers and experts, using purposive sampling. The Data analysis was conducted utilizing Colaizzi's 7-step method. To ensure the trustworthiness of the findings, the study adhered to the recommendations set forth by Lincoln and Guba.

Results: After multiple rounds of analyzing and summarizing the data and taking into consideration similarities and differences, 230 initial codes, 18 sub-categories, 5 categories and 2 main themes were created based on the results of data analysis. Theme 1: Intra-organizational challenges including categories of (prehospital and hospital challenges). Theme 2: Inter-organizational challenges including categories of (chain of command, insufficient security and ineffective communication and information).

Conclusion: This study explored healthcare workers and managers experiences with internal and external organizational challenges in responding to terrorist explosive bombing attacks. Findings reveal that such incidents pose unique demands distinct from other emergencies, requiring tailored preparedness strategies, especially in prehospital, hospital, and logistical sectors, despite existing general disaster plans. An effective response needs multisectoral collaboration with security forces and aid organizations. The presentation of real-world insights can inform targeted preparedness programs for high-risk, chaotic terrorist scenarios.

Clinical trial number: Not applicable.