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Challenges of Hospital Response to the Twin Earthquakes of August 21, 2012, in East Azerbaijan, Iran

  • Mahboub Pouraghaei (a1), Ali Jannati (a2), Peyman Moharamzadeh (a1), Amir Ghaffarzad (a1), Moharram Heshmati Far (a1) and Javad Babaie (a2) (a3)...



As the cornerstone of any health system, hospitals have a crucial role in response to disasters. Because hospital experiences in disaster response can be instructive, this study examined the challenges of hospital response to the twin earthquakes of 2012 in East Azerbaijan, Iran.


In this qualitative study, the challenges of hospital response in the East Azerbaijan earthquakes were examined through focus group discussions. Participants were selected purposefully, and focus group discussions continued until data saturation. The data were manually analyzed by using Strauss and Corbin’s recommended method.


Hospitals were faced with 6 major challenges: lack of preparedness, lack of coordination, logistic deficiencies, patient/injured management, communication management, and other smaller challenges that were categorized in the “other challenges” category. The main theme was the lack of preparedness for disasters.


Although hospital preparedness is emphasized in credible references, this study showed that lack of preparedness is a major challenge for hospitals during disasters. Thus, it seems that hospital officials’ disaster risk perception and hospital preparedness should be improved. In addition, hospital preparedness assessment indexes should be included in the hospital accreditation process. (Disaster Med Public Health Preparedness. 2017;11:422–430)


Corresponding author

Correspondence and reprint requests to Javad Babaie, PhD, Daneshgah Ave, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran (e-mail:


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1. Araghizadeh, H, Saghafi Nia, M, Entezari, V. Analyzing medical management in disasters: a review of the Bam Earthquake experiences. J Mil Med. 2004;5(4):259-268.
2. Ardalan, A, Sabzghabaie, A, Najafi, A, et al. Hospital Disaster Risk Assessment. Tehran: Moaffag; 2010.
3. Khankeh, HR. Hospital Preparedness Plan: National Hospital Preparedness Program. Tehran: University of Social Welfare and Rehabilitation Sciences; 2012.
4. Khankeh, HR, Mohammadi, R, Ahmadi, F, et al. Management of health care services at time of natural disasters. J Rehabil. 2006;7(25):49-55.
5. Khankeh, H, Mohammadi, R, Ahmadi, F. Barriers and facilitators of health care services at the time of natural disasters. Rehabil J. 2005;6(1):23-30.
6. Maleki, M, Shojaie, P. Hospitals preparation in disasters: security. J Health Admin. 2007;10(28):65-70.
7. Djalali, AR, Casteren, M, Hosseini Jenab, V, et al. Hospital incident command system (HICS) performance in Iran: decision making during disasters. Scand J Trauma Resusc Emerg Med. 2012;20(14). doi: 10.1186/1757-7241-20-14.
8. Arab, M, Zeraati, H, Akbari Haghighi, F, et al. A study on the executive managers’ knowledge and performance, and their hospitals preparedness against earthquake events and their relationships at public hospitals (affiliated by Tehran University of Medical Sciences (TUMS) 2005-2006). J Health Admin. 2009;11(34):7-14.
9. Djalali, AR, Hosseinijenab, V, Hasani, A, et al. A fundamental, national, medical disaster management plan: an education-based model. Prehosp Disaster Med. 2012;24(6):565-569.
10. Bissell, R, Pinet, I, Nelson, M, et al. Evidence of the effectiveness of health sector preparedness in disaster response. Fam Community Health. 2004;27(3):193-203.
11. Powers, R, Daily, E. Disaster Nursing. New York, NY: Cambridge University Press; 2010.
12. Gregory, RC, Philip, DA, Erik, ADH, et al. Disaster Medicine. Philadelphia: Mosby Elsevier; 2006.
13. JCAHO Emergency management standards. Response Systems website. Accessed November 2, 2016.
14. International Institute of Earthquake Engineering and Seismology. Ahar-Varzeghan Twin Earthquakes of 11 August 2012, Mw.6.4 and Mw.6.3. IIEES website. September 23, 2012. Accessed December 19, 2016.
15. Keim, ME, Giannone, P. Disaster Medicine. 3rd ed. Ciottone GR, Darling RG, Anderson PH, et al, eds. Philadelphia: Mosby Elsevier; 2006:160-172.
16. Talati, S, Bhatia, P, Kumar, A, et al. Strategic planning and designing of a hospital disaster manual in a tertiary care, teaching, research and referral institute in India. World J Emerg Med. 2014;5(1):35-41.
17. Zhong, Z, Clark, M, Hou, XY, et al. Progress and challenges of disaster health management in China: a scoping review. Global Health Action. 2014;7:24986.
18. Khankeh, HR, Khorasani-Zavareh, D, Johanson, E, et al. Disaster health-related challenges and requirements: A grounded theory study in Iran. Prehosp Disaster Med. 2011;26(3):151-158.
19. Masoudi Alavi, N. Disaster: are we prepared? Nurs Midwifery Stud. 2014;3(2):1-2.
20. Bahrami, M, Alliakbari, F, Aein, F. Iranian nurses’ perception of essential competences in disaster response: a qualitative study. J Health Promot. 2014;3:81.
21. Crane, MA, Levy-Carrick, NC, Crowley, L, et al. The response to September 11: a disaster case study. Ann Glob Health. 2014;80(4):320-331.
22. Malekshahi, F, Mardani, M. Abilities and limitations of crisis management in Shohadaye Ashayer and Social Security hospitals of Khorramabad in 2007. Iranian J Crit Care Nurs. 2008;1(1):29-34.
23. Nakhaei, M, Khankeh, HR, Masoumi, GR, et al. Health management in past disasters in Iran: a qualitative study. Health in Emergencies and Disasters Quarterly. 2014;1(2):107-115.
24. Pourhosseini, SS, Ardalan, A, Mehrolhassani, MH. Key aspects of providing health services in disaster response stage. Iran J Public Health. 2015;44(1):111-118.
25. Khankeh, HR, Fallahi, M, Ranjbar, M, et al. Health management in disasters with focusing on rehabilitation. J Rehabil. 2008;9(2):66-72.
26. Ozoilo, KN, Pam, IC, Yiltok, SJ, et al. Challenges of the management of mass casualty: lessons learned from the Jos crisis of 2001. World J Emerg Surg. 2013;8(1):44.
27. Nekooei Moghaddam, M, Saeed, S, Khanjani, N, et al. Nurses requirement for relief and casualty support disasters: A qualitative study. Nurs Midwifery Stud. 2014;3(1):1-12.
28. VanDevanter, N, Kovner, CT, Raveis, VH, et al. Challenges of nurses’ deployment to other New York City hospitals in the aftermath of Hurricane Sandy. J Urban Health. 2014;91(4):603-614.
29. Chaffee, MW, Oster, NS. The role of hospital in disasters. In: Ciottone GR, Darling RG, Anderson PH, et al, eds. Disaster Medicine. 3rd ed. Philadelphia: Mosby Elsevier; 2006:34-42.
30. Schultz, CH, Koenig, KL, Lewis, RJ. Implications of hospital evacuation after the Northridge, California, earthquake. N Engl J Med. 2003;348(14):1349-1355.
31. Medford-Davis, LN, Kapur, GB. Preparing for effective communications during disasters: lessons from a World Health Organization quality improvement project. Int J Emerg Med. 2014;7(1):15.


Challenges of Hospital Response to the Twin Earthquakes of August 21, 2012, in East Azerbaijan, Iran

  • Mahboub Pouraghaei (a1), Ali Jannati (a2), Peyman Moharamzadeh (a1), Amir Ghaffarzad (a1), Moharram Heshmati Far (a1) and Javad Babaie (a2) (a3)...


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