Factors Affecting Disaster Preparedness in Prehospital Emergency Dispatch Centers: Mapping of Expert Perspectives

Factors Affecting Disaster Preparedness in Prehospital Emergency Dispatch Centers: Mapping of Expert Perspectives | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors Affecting Disaster Preparedness in Prehospital Emergency Dispatch Centers: Mapping of Expert Perspectives Mohammadreza Shafiei, Mahmood Nekoei-Moghadam, Seyed Mobin Moradi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7544681/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Nov, 2025 Read the published version in International Journal of Emergency Medicine → Version 1 posted 12 You are reading this latest preprint version Abstract Background and Objectives: Prehospital emergency dispatch centers are critical components of disaster response, but their operational capacity is often overwhelmed by a surge in call volume during such events. Given Iran's high vulnerability to a wide range of disasters and the absence of a comprehensive tool for assessing the preparedness of these centers, this qualitative study was conducted to identify the factors influencing their readiness. Methods This study employed a conventional content analysis approach from October 2024 to May 2025. Twenty participants, including managers and staff from emergency medical services (EMS) and dispatch centers, were selected through purposive and snowball sampling. Data were collected via semi-structured interviews, lasting 20 to 120 minutes, until theoretical saturation was reached. The data were subsequently analyzed using MAXQDA-2020 software. Trustworthiness was established using the criteria proposed by Guba and Lincoln. Results Data analysis revealed 13 main categories and 63 subcategories as factors influencing the disaster preparedness of dispatch centers. These categories were: Exercises, Security, Safety, Communication, Early Warning Systems, Planning, Resources, Individual Skills, Environmental Factors, Organizational Structure, Monitoring and Evaluation, Coordination, and Training. Conclusion The preparedness of emergency dispatch centers in Iran is a product of a complex interplay among resources, knowledge, skills, structure, communication, and organizational culture. A thorough understanding of these factors is essential for policymaking, resource allocation, and the design of targeted training programs to enhance the preparedness of these vital centers and thereby strengthen the resilience of the national health system against disasters. Preparedness Dispatch Centers Prehospital Emergency Care Disasters Iran Figures Figure 1 Introduction Natural and anthropogenic disasters, such as earthquakes, floods, and chemical, industrial, or biological incidents, pose a significant and persistent threat to health systems worldwide. (1, 2). In such circumstances, healthcare infrastructure is rapidly disrupted, while the demand for emergency services increases exponentially. Particularly in the initial moments of a crisis, sound and swift decision-making by emergency systems can prevent substantial mortality, morbidity, and irreversible harm. (3, 4) Among the core components of emergency response, prehospital emergency dispatch centers play a pivotal role. (5, 6). Emergency Medical Dispatch (EMD) centers serve as the vital link between the public and the healthcare system during crises, acting as the primary point of contact for individuals seeking immediate medical assistance.(7, 8) Disasters invariably lead to a dramatic surge in emergency calls to prehospital dispatch centers, far exceeding their normal operational capacity. (9–11). This sudden and significant This sudden and significant increase in call volume places immense strain on human resources, communication systems, and ambulance availability. The consequences of this pressure often include delayed response times, reduced efficiency in call handling, and a potential decrease in the overall effectiveness of the emergency response system. (7, 11) In the event of a disaster, whether natural or human-made, the preparedness and response capability of these centers are paramount for minimizing casualties and ensuring the effective allocation of resources. (8, 12). Telecommunicators perform a multifaceted role that includes coordinating Emergency Medical Services (EMS) resources, providing critical pre-arrival instructions to callers, and relaying essential information to responding units and other relevant agencies. (8, 13). The dispatch center analyzes incoming calls to determine the most appropriate response, and when a team is required, the telecommunicator assigns the most suitable rescue unit based on pre-defined protocols, considering the severity of the call and the nearest available ambulance.(14) Their responsibilities extend from initial caller interrogation to critical triage decisions, transmission of vital information to responders, provision of telephonic medical interventions, and management of logistics and resource coordination throughout the disaster. (14, 15). ). The efficiency and effectiveness of these dispatch centers directly impact the overall success of disaster response efforts, influencing factors such as the speed of aid delivery, the appropriate allocation of resources, and ultimately, the mortality and morbidity rates associated with the event.(16)The increasing frequency of natural disasters around the world The increasing frequency of disasters globally underscores the growing need for prehospital emergency dispatch centers to be adequately prepared and highly responsive to effectively manage the heightened demand and complexities associated with such events. (17, 18). In a country like Iran, which is prone to a wide spectrum of natural and human-made disasters, ensuring the preparedness and efficient response of emergency dispatch centers is a strategic priority for the national health and disaster management systems, necessitating a deep understanding of the factors that influence it (19, 20). However, numerous studies have shown that dispatch systems in many countries, particularly in low-resource settings, face structural, technical, and human-related challenges. These challenges include the lack of standardized disaster protocols, insufficient specialized training for operators, weak communication infrastructure, an absence of digital decision-support tools, and, most importantly, poor inter-organizational coordination. (21–24) . The effectiveness of dispatch centers during disasters is heavily dependent on the training and preparedness of their personnel. (25, 26). Yet, studies have identified significant gaps in training, especially concerning less common or complex emergency scenarios and the challenges associated with integrating new technologies into operations. (27, 28). Research strongly emphasizes the need for comprehensive training programs that address both the technical skills and the psychological aspects of disaster response. (29, 30) In developing countries, research has also indicated persistent weaknesses in preparedness, response, coordination, infrastructure, and training. (19, 22, 31). A study by Sorani et al. (2018) identified challenges related to management, infrastructure, information, and personnel within Iran's EMS, proposing solutions such as infrastructure reform and targeted training for both personnel and the public to improve preparedness. (19) A primary concern in emergency medical dispatch is the issue of response time. Many systems aim to achieve specific response time benchmarks, leading to intense debates about their appropriateness and impact on outcomes. (32–34). Ultimately, the preparedness of EMD centers is crucial for mitigating the effects of disasters and requires a comprehensive approach that combines rigorous training, strategic resource management, technological integration, and the development of standard operating procedures.(21) Addressing existing challenges and leveraging new opportunities will be vital for enhancing the resilience and efficiency of prehospital emergency dispatch centers (EMDCs) in the face of future emergencies. This study was designed within a qualitative framework, utilizing a conventional content analysis method to address the gap identified by the lack of validated quantitative tools and indicators for measuring the preparedness of prehospital emergency dispatch centers for disasters. Although the preparedness of EMS systems for disasters has been the subject of numerous studies, independent and in-depth research specifically focusing on the factors influencing the preparedness of dispatch centers remains limited and fragmented. In this context, the present study sought to identify and categorize the human, organizational, environmental, and technological factors that affect the preparedness level of these centers by conducting semi-structured interviews with experts and managers in the prehospital emergency field. This qualitative approach facilitates a deep, context-specific, and indigenous understanding of the various dimensions of preparedness and can serve as a foundation for developing future models, formulating policies to enhance preparedness, designing educational interventions, and improving the performance of dispatch centers in disaster situations. Methods This qualitative study was conducted from October 2024 to May 2025 as part of a larger research project aimed at developing a disaster preparedness and response model for prehospital emergency dispatch centers in Iran. Data were collected through individual interviews and focus group discussions, all conducted by the lead researcher. To ensure reflexivity, the researcher maintained a reflective journal throughout the study. This practice involved critically examining personal biases and assumptions to prevent them from unduly influencing the data collection and analysis processes. The study employed Conventional Qualitative Content Analysis (CQCA) with an inductive approach. This approach is particularly suited for exploring areas with limited theoretical and empirical background, especially within local, complex, and context-specific settings. In CQCA, concepts and themes are derived directly from the raw data, without relying on predefined categorization frameworks, to generate novel insights within a particular domain (35–38). This characteristic distinguishes CQCA from other content analysis approaches, such as Directed Content Analysis or Summative Analysis, as well as from methods like Grounded Theory. While Grounded Theory aims to discover relationships between themes and build an integrated, abstract, and overarching theory, CQCA primarily focuses on extracting and describing tangible, context-specific themes directly within the data(39). Given that the primary aim of this study was to identify and elucidate the context-specific factors influencing the performance of emergency dispatch centers in disaster settings, rather than to generate a comprehensive, abstract theory, the grounded theory methodology was not aligned with the research objective. Grounded theory is principally employed for explaining processes and building theory from the ground up. Consequently, conventional qualitative content analysis was selected as the analytical method for this study. This approach is particularly well-suited for inductively identifying a wide range of relevant factors from the practical experiences and insights of experts and practitioners. Moreover, its adaptability to complex and underexplored contexts made it the most appropriate methodology for addressing the research question. Research Paradigm This study was underpinned by the interpretivist paradigm. Interpretivism posits that reality is subjective, multiple, and socially constructed, emerging from the interactions among individuals and their interpretations of their experiences. (37) The aim of this study was to develop an in-depth understanding of the lived experiences and perspectives of experts in prehospital emergency dispatch centers when confronting the complex, high-pressure conditions of disasters. In such settings, decision-making is shaped by a confluence of human, organizational, environmental, and technological factors. The selection of this paradigm was therefore critical, as it enabled a deep exploration of the participants' subjective meanings, beliefs, and perceptions—grounded in both their personal experiences and their professional knowledge and expert analyses—within their authentic, high-stakes operational context. Unlike the positivist paradigm, which emphasizes generalizability, causal relationships, and statistical regularities, the interpretivist framework centers on a qualitative understanding of meaning-making processes, interpretive frameworks, and individual experiences within real-world social settings. This approach provides the necessary lens to deeply examine complex issues such as risk perception, inter-organizational dynamics, communication barriers, and decision-making pressures during disasters, directly from the viewpoint of frontline practitioners and subject-matter experts (40). Study Population, Participant Selection, and Data Collection The study population comprised emergency managers, dispatch center personnel and managers, Emergency Medical Technicians (EMTs), and managers and specialists from Iran's prehospital emergency operations centers. Participants (n = 20) were selected using a purposive sampling strategy, supplemented by snowball sampling, to ensure maximum variation in terms of gender, age, educational background, professional experience, and role. Prior to each interview, the researcher provided a verbal explanation of the study's objectives, emphasizing the voluntary nature of participation, the confidentiality and anonymity of their data, and their right to withdraw at any stage. Oral informed consent was obtained from all participants for conducting and audio-recording the interviews. To foster an open and comfortable environment where participants could freely share their experiences and perceptions, they were invited to choose a time and location for the interview at their convenience. Each interview was conducted individually in the pre-agreed setting. Interviews were conducted either face-to-face at dispatch centers or via telephone, with each session lasting between 20 and 120 minutes. All interviews were audio-recorded and transcribed verbatim immediately afterward. During this process, significant statements were highlighted, and the accuracy of the transcribed data was reviewed and confirmed. Any ambiguities in participant statements were resolved by requesting further clarification. The researcher actively bracketed personal presuppositions and prior knowledge to avoid influencing participant responses. The data derived from these interviews focused on factors influencing the preparedness and response of prehospital emergency dispatch centers during disasters, with the ultimate aim of designing a tailored model for Iran. Semi-structured interviews commenced with an open-ended question. Based on the participants' initial responses, more specific and probing questions were asked. The core open-ended questions included: Could you describe your experiences with disaster response and management within the dispatch center? In your view, what are the most critical factors influencing your center's preparedness for disasters? Please describe your center's current Emergency Operations Plans (EOPs) or Standard Operating Procedures (SOPs) for disasters. How comprehensive and practical do you find these plans? What is the current state of disaster training for dispatch personnel? What additional specialized training do you believe is necessary? Are disaster-related exercises conducted regularly at your center? If so, could you explain how they are implemented and evaluated? In terms of resources—personnel, equipment, and infrastructure—how prepared is your dispatch center for a disaster? What are the key shortfalls? How reliable are your center's communication systems during a disaster? Are redundant or backup systems in place? Data saturation was reached after 18 interviews. To confirm that no new themes were emerging, two additional interviews were conducted, after which sampling was concluded. Inclusion and Exclusion Criteria Inclusion criteria were having sufficient experience and knowledge of prehospital emergency dispatch center operations and a willingness to participate in the study. Exclusion criteria included an unwillingness to cooperate or a lack of relevant information on the topic. Data Analysis First, the interviews were transcribed verbatim. The principal investigator and a co-researcher then independently read each transcript multiple times to achieve immersion. Open coding was performed, where meaningful phrases and sentences were assigned descriptive conceptual labels. Subsequently, similar codes were grouped into subcategories. These subcategories were then organized into main categories based on their conceptual relationships. Finally, overarching themes were identified by consolidating related categories (41). Data analysis was conducted by members of the research team experienced in qualitative methodologies. Initially, two researchers independently performed the open coding of the interviews. Subsequently, the generated codes were reviewed and verified by two other researchers. Any discrepancies or ambiguities were then resolved through discussion in a consensus meeting attended by the entire research team and an experienced external researcher. The final coding framework was established based on this team consensus. This collaborative, consensus-driven process enhanced the rigor, consistency, and credibility of the analysis. This consensus-based approach enhanced the rigor and consistency of the analysis. The analysis was performed concurrently with data collection, and the final analysis was facilitated using MAXQDA software (version 2020). In this study, a total of 910 initial codes were generated from the analysis of interview transcripts and qualitative data. Through an iterative process of rereading, conceptual comparison, and merging of similar codes, these initial codes were subsequently organized into seven main categories and their associated subcategories. Trustworthiness To ensure the rigor of the study, the trustworthiness criteria proposed by Guba and Lincoln—credibility, confirmability, dependability, and transferability—were employed (42). ). To enhance the credibility of the research, the researcher achieved an in-depth understanding of the phenomenon through prolonged engagement in the field and persistent interaction with the data. Furthermore, member checking was conducted by presenting the extracted themes to the participants for their review. Their feedback was subsequently incorporated to refine and finalize the analysis. Regarding confirmability , several measures were implemented to ensure that the findings were grounded in the data rather than the researcher's biases. Initially, two researchers coded the interviews independently. Following this, 20% of the coded transcripts were re-coded by two different researchers, and the results were compared. Any discrepancies were resolved through consensus in group meetings attended by the research team and an external researcher. Two faculty members, serving as independent auditors, reviewed the interview transcripts, initial codes, and the developed categorical structure, confirming their validity. Rather than using quantitative inter-rater reliability coefficients like Cohen's kappa, a consensus-based approach and collective reflexivity were employed to strengthen analytical coherence. Additionally, through peer debriefing , the preliminary findings and categorical framework were reviewed by a group of experts external to the research team. Their feedback was integrated to improve the clarity, coherence, and applicability of the results. To address transferability , purposeful sampling with maximum variation was utilized. This strategy ensured the inclusion of participants with diverse professional roles, work histories, and from various geographical locations. Finally, the dependability of the study was secured by transparently documenting every stage of the research process, from design through data collection, coding, and analysis. A comprehensive audit trail was established, enabling other researchers to evaluate and potentially replicate the research process, thereby ensuring the stability of the findings . Table 1 presents the demographic characteristics of the study participants. Table 1 : Demographic Data of Participants Source: Authors’ own work Participant Work Experience (Years) Degree Job Title 1 14 BSc Nursing Dispatch Center Manager 2 20 MSc Emergency Nursing Air Ambulance Manager 3 18 BSc Nursing Dispatch Center Manager 4 22 BSc Nursing Dispatch Center Manager 5 16 BSc Nursing Emergency Medical Technician 6 25 BSc Nursing Dispatch Center Manager 7 20 PhD Health in Disasters and Emergencies Head of Pre-hospital Emergency Center 8 17 BSc Nursing Dispatch Center Manager 9 9 BSc Nursing Emergency Medical Technician 10 18 BSc Anesthesia Technician Dispatch Center Manager 11 16 BSc Nursing Dispatch Center Manager 12 20 BSc Nursing Emergency Communications Manager 13 8 Emergency Medicine Specialist Head of Pre-hospital Emergency Center 14 20 BSc Emergency Medical Services Operations Command Center Expert 15 27 PhD Management Deputy Head of Pre-hospital Emergency Center 16 12 BSc Nursing Dispatch Center Personnel 17 19 BSc Nursing Dispatch Center Manager 18 18 BSc Nursing Dispatch Center Personnel 19 20 BSc Emergency Medical Services Dispatch Center Manager 20 18 BSc Nursing Operations Command Center Expert Results The data analysis, conducted using conventional content analysis, involved an iterative process of coding, categorization, and comparison. This process resulted in the identification of 13 main categories and 63 sub-categories, as detailed in Table 2 and Fig. 1 , which represent the factors influencing the disaster preparedness of emergency dispatch centers in Iran. These categories included: exercises, security, safety, communication, early warning systems, planning, resources, individual skills, environmental factors, organizational structure, monitoring, evaluation, performance improvement, coordination, and education. Table 2 Categories, Subcategories, and Themes Extracted in this Study Theme Category Subcategory Sample Code Preparedness 1. Exercises Exercise Implementation Institutionalization of structured exercises Types of Exercises Implementation of specialized dispatch exercises Exercise Evaluation and Lessons Learned Targeted evaluation during dispatch exercises Exercise Planning and Design Systematic design and implementation of exercise programs 2. Security Physical and Psychological Security of Personnel Managing psychological threats from abusive and nuisance calls Physical Security Ensuring multi-layered security (physical, psychological, legal) Legal Security Reinforcing the legal framework to support telecommunicator decision-making Information and Communication Security Establishment and maintenance of secure communication and information infrastructure 3. Safety Operational Safety Standardization of operational safety Non-structural and Equipment Safety Optimization of non-structural safety in the workplace Structural Safety Structural reinforcement of dispatch centers 4. Communications Alternative Communication Systems Establishment of a multi-layered, redundant communication network Primary Communication Systems Reducing system dependency on vulnerable infrastructure 5. Early Warning System Warning Reception and Processing Establishing two-way communication channels between dispatch and the EOC Warning Dissemination and Timely Notification Immediate activation of the hospital alert network Warning Tools and Technologies Utilization of location-based systems (GIS) Warning Information Sources Use of a multi-hazard warning dashboard 6. Planning Incident Action Plan (IAP) Designing rapid Incident Action Plans Emergency Operations Plan (EOP) Development of localized Emergency Operations Plans Standard Operating Procedure (SOP) Creation of role-based SOPs Continuity of Operations Planning (COOP) Maintaining dispatch continuity during disruptions using backup lines 7. Resources Materiel and Equipment Optimal management of hardware and software resources Infrastructure and Structures Pre-planning alternative solutions for critical infrastructure failure Staff (Human Resources) Optimization of workforce capacity 8. Individual Competencies Teamwork Skills Fostering team synergy between operational experience and specialized knowledge Occupational Burnout Management of job-related fatigue and workload Psychological and Behavioral Attributes Enhancing analytical competency and intuitive decision-making Decision-Making Optimization of decision-making in resource allocation Communication Skills Enhancement of telecommunicators' communication skills Motivational Factors and Job Satisfaction Creation of financial and non-financial incentive systems Specialized Skills Development of spatial and geographical knowledge (urban topography) Mental Health and Resilience Strengthening the psychological resilience of personnel 9. Environmental Factors Socioeconomic Factors of the Host Community Improving public crisis literacy Temporal Factors Managing operational limitations during low-staffing hours Cultural Factors Leveraging local personnel familiar with the geographic and cultural environment Geographical Factors [Merged with 'Cultural Factors' as per the provided code's context] 10. Organizational Structure Structural Flexibility in Disaster Conditions Establishing flexible structures to allow for decisional autonomy Roles and Responsibilities Defining clear, crisis-oriented roles and responsibilities Command and Management On-site presence of emergency managers in the field Structural Model and Design Integration of dispatch centers at the provincial level 11. Performance Monitoring, Evaluation, and Improvement Feedback Mechanisms and Continuous Improvement Systematic analysis and feedback on call recordings Lessons Learned Institutionalizing the lessons-learned process Evaluation Standardization of call performance evaluation 12. Coordination Intra-organizational Coordination Strengthening multi-level coordination (technicians, dispatch, management) Inter-organizational Coordination Expanding inter-agency communication networks 13. Training and Education Experience and Clinical Skills Enhancing the experience and clinical acumen of telecommunicators Training Methods and Tools Adopting an all-hazards approach to training Public Education Improving public literacy on emergencies and disasters Onboarding Training Planning specialized training programs for new recruits Continuing and In-service Training Utilizing continuous training as a catalyst for performance enhancement Specialized Training Improving geographical familiarity through field visits 1. Exercises Execution of Exercises: The regular and systematic execution of exercises, guided by established protocols and including critical scenarios such as automation failure and inter-agency collaboration, was identified as essential for achieving operational readiness. However, a significant deficiency noted was the lack of exercises specifically designed for dispatch centers. One participant stated: "The majority of exercises conducted in the health system and EMS focus on field units and ambulances. Very few exercises are specifically designed for the communications and dispatch center." (P7) Types of Exercises: Participants emphasized the necessity of conducting diverse types of exercises—including dispatch-specific exercises (e.g., operating backup systems), tabletop simulations, and full-scale inter-agency maneuvers—to ensure comprehensive preparedness. A participant remarked: "These exercises are effective only when executed operationally and step-by-step; realistic and detailed scenarios should be designed as tabletop exercises and implemented in a simulated, intra-group setting by dispatch center members around a table, using visualizations of the situations." (P7) Exercises Evaluation and Lessons Learned: The critical importance of conducting detailed, dispatch-focused evaluations after each exercises was highlighted. Providing structured feedback to all participants is vital for identifying lessons learned and driving continuous improvement in preparation for future events. As one participant noted: "During exercises, the dispatch center must be specifically evaluated and assessed to identify its strengths and weaknesses, which in turn allows for the improvement of future preparedness plans." (P14) Exercises Planning and Design: The effectiveness of exercises hinges on meticulous planning and design. This involves holding specialized sessions to clearly define objectives, develop realistic scenarios, and establish evaluation metrics. A participant explained: "We collaborate in a group of five to six people, along with the head of field units and the quality control manager—seven of us in total—to plan the exercises and prepare the necessary equipment." (P13) 2. Security Physical and Psychological Security of Personnel: Ensuring the physical and psychological security of dispatch personnel is critical. Measures such as providing psychological support, demonstrating managerial commitment, and mitigating nuisance calls were deemed essential for preserving staff morale and optimizing decision-making under pressure. The security of personnel's families was also noted as a direct influence on their professional commitment. "The psychological security of individuals is heavily influenced by public awareness. For instance, in Tehran EMS, it has been reported that nuisance calls disrupt the dispatch center as frequently as once per minute, which can harm the personality and mental health of the staff." (P7) Physical Security: Protecting the dispatch center facility, equipment, and staff from external threats is vital for operational continuity. This includes ensuring the structural integrity and physical defense of the building. "Physical security is a major challenge. For example, we have seen instances where, during an incident, some individuals have attacked the dispatch center, attempting to break the windows of the dispatch section." (P7) Legal Security: A supportive legal framework is necessary to protect telecommunicators from liability concerning their operational decisions. This legal security enhances their psychological well-being and promotes more confident and effective performance. "If a telecommunicator decides to deploy all resources to an incident scene, it must be clear whether this decision is supported by a legal basis and a specific protocol, or if it is based solely on personal judgment." (P1) Information and Communication Security: Information and communication security—ensuring the confidentiality, integrity, and availability of data and systems—is a cornerstone of disaster operations. Continuous training on data confidentiality was identified as a key component of this principle. "In disasters, the security of communications and the confidentiality of information in dispatch centers are crucial. Secure communication systems must be designed—encompassing software, hardware, and management aspects—to prevent sensitive information leaks and mitigate communication risks." (P7) 3. Safety Functional Safety: Functional safety is achieved by establishing and adhering to standardized protocols and guidelines. This ensures a consistent and safe operational environment for both service delivery and the management of communication and information systems. "The functional aspects are primarily related to areas like protocols, guidelines, and training, which I believe we touched upon at the beginning of our discussion." (P27) Non-Structural and Equipment Safety: Ensuring the safety of non-structural components and equipment is vital for operational continuity. This includes maintaining a standardized and safe physical workspace and verifying the integrity of all operational and communication equipment. "Non-structural components in residential buildings must meet safety standards and requirements. Although there are no specific mandates for dispatch centers, their critical role necessitates special attention to designing and evaluating them with a higher safety perspective." (P7) Structural Safety: The structural safety of the dispatch center is paramount. The facility must be designed and maintained to withstand prevalent local hazards, adhering to modern engineering standards and undergoing necessary structural reinforcement to ensure its resilience during a disaster. "Dispatch centers must be designed according to current global standards to ensure they can execute their processes correctly in a safe environment with an appropriate structure." (P13) 4. Communication Alternative Communication Systems: To counter potential failures of primary networks, it is vital to equip dispatch centers with multi-layered, redundant communication systems (e.g., telephone, radio, satellite). This requires identifying coverage gaps and acknowledging the limitations of each system. Radio systems were recommended as a cost-effective and resilient option, along with the establishment of hotlines and mobile dispatch units. "The updated systems are the 'Asayar' systems. These systems must use modern and new equipment to be efficient in terms of both time and cost." (P3) Current Communication Systems: Challenges within the existing communication infrastructure must be addressed. These include line congestion from non-essential calls, difficulties communicating with non-native speakers, communication and internet outages, and the reliance of automation systems on internet connectivity. Effective communication management by telecommunicators and efficient interaction with field teams are also critical. "In critical situations, due to telephone line disruptions, radio becomes the primary tool for rapid notification about the incident and its location." (P10) 5. Early Warning System (EWS) Warning Reception and Processing: The processes for receiving and handling initial alerts within the dispatch center are crucial for a rapid response. The 115 emergency number was identified as a primary source of initial information, highlighting the key link between dispatch and the Emergency Operations Center (EOC). There is a need for regional hazard assessments and a centralized, integrated EWS, preferably located at the EOC, which incorporates meteorological data. "In many cases, the 115 emergency line can be the first source of warning, even before the media and cameras." (P20) Warning Dissemination and Timely Notification: Rapid, accurate, and targeted dissemination of warnings to all relevant internal and external personnel, teams, units, and agencies is essential for a coordinated response. "In early warning, the dispatch center has a specific role; we pass the alert to the MCMC [Mass Casualty Management Center], then to the EOC, and finally it is communicated to the hospitals." (P1) Warning Tools and Technologies: The use of modern tools and technologies, such as news networks, Geographic Information Systems (GIS), and monitoring of traffic and city cameras within the dispatch center, is recommended to improve the efficiency, speed, and accuracy of the warning process. "A GIS system allows for the consolidation and analysis of information such as the number of health posts, ambulances, and personnel, and can play an effective role in the early warning of disasters." (P16) Sources of Warning Information: Identifying, accessing, and utilizing credible, diverse, and reliable information sources, such as an all-hazards early warning system dashboard, is necessary for the timely detection of threats and a reduction in response time. "In an earthquake, the lack of a rapid warning system causes delays; the system and the telecommunicator's duties must be configured for an immediate response." (P18) 6. Planning Business Continuity Planning (BCP): Developing strategies to maintain continuous and uninterrupted operations of the dispatch center during crises and disasters is a key component of preparedness. "Planning for and immediately determining the logistical needs of ambulances at the dispatch unit is essential for the continuity of services." (P4) Incident Action Plan (IAP): The development and implementation of specific, localized IAPs tailored to the type and severity of an incident are crucial. This includes forming a disaster committee and defining different disaster levels within the dispatch center. Well-vetted action plans were considered more important than generic Emergency Operation Plans (EOPs). "For unexpected events like a train derailment, there is usually no specific action plan; in such cases, protocols for similar mass casualty incidents are used for triage." (P2) Emergency Operations Plan (EOP): A documented, comprehensive, and executable EOP that is localized and covers all phases of preparedness, response, and recovery is vital. The EOP should incorporate factors affecting dispatch preparedness and requirements, such as voice logging and pre-disaster coordination meetings. "The factors affecting the preparedness and response of dispatch centers in disasters must be considered in the Emergency Operations Plan." (P19) Standard Operating Procedures (SOPs): The development, training, implementation, and continuous updating of dispatch center SOPs, especially for disasters, are essential for standardizing performance, reducing errors, and clearly defining staff roles. This is critical despite challenges such as the proliferation of guidelines and the need for localization. "Guidelines should cover the general principles, while the specifics should be delegated to each region to determine based on its unique geographical, cultural, and economic conditions." (P19) 7. Resources Stuff (Materiel and Equipment): Procuring, maintaining, and updating sufficient, standard, and reliable equipment is a necessity. This includes advanced communication systems (radio, satellite phone, analog equipment), emergency power generators, and uninterruptible power supplies (UPS) to counteract the dependency on internet-based automation during connectivity disruptions. "The center's equipment must be complete during disasters, and hotlines must be active. Additionally, Geofencing and GPS systems should be interconnected to provide precise timings." (P5) Structure (Physical and Organizational Infrastructure): The existence of resilient and appropriate physical infrastructure (e.g., a secure building, adequate space, a backup or mobile dispatch center) and efficient organizational structures (e.g., robust servers, separation of triage and dispatch units) is essential. Strengthening weak communication infrastructure (internet and radio) and mandating a backup dispatch center are necessary for service continuity. "Our servers are designed to handle a maximum of 20,000 concurrent calls. Although we may never reach this limit, by establishing a powerful infrastructure, we prevent call disruptions." (P13) Staff (Human Resources): Securing sufficient, skilled, trained, motivated, and resilient human resources is crucial. This includes attending to their physical and mental well-being to address challenges such as staff shortages, the attrition of experienced personnel, and the need to expand capacity with specialized staff and language interpreters. "Disasters require a larger and more well-trained workforce. This is one of the persistent challenges we face." (P10) 8. Individual Skills Teamwork Skills: Effective teamwork within the dispatch center, achieved by creating a coordinated blend of experienced and newly trained personnel and fostering constructive interaction, is essential for optimal performance. "Success in emergency services depends on teamwork and coordination. Even the most capable individuals are ineffective without a role in the team." (P18) Psychological and Behavioral Traits: Personnel should possess psychological resilience, up-to-date knowledge, analytical ability, intuitive decision-making, rapid response capabilities, high emotional intelligence, multitasking skills, and an extroverted personality. The ability to manage caller anger and demonstrate accountability under stress was particularly emphasized. "In disasters, individuals must have sufficient psychological, physical, and mental resilience to manage the pressures of the crisis and make sound decisions. They must be able to maintain composure and react rationally to stress and diverse behaviors." (P2) Job Burnout: Job burnout among dispatch staff is caused by high-stress calls, heavy workloads, and nuisance calls, leading to diminished focus and response quality. "Optimizing human resources by reducing calls and nuisances can enhance performance quality and prevent job burnout." (P4) Decision-Making: The ability to make timely and correct decisions regarding resource deployment is critical. Empowering telecommunicators in operational decision-making, supported by decision support systems and avoiding reactive or emotional judgments, is vital for effective disaster management. "While adhering to protocols, telecommunicators must have the flexibility to make decisions based on the situation." (P15) Communication Skills: Possessing effective communication skills with patients and callers—including managing their anger and stress, building interpersonal rapport, proficiency in GPS and map-reading, and using clear verbal communication and active listening—is essential for gathering accurate information and providing effective services. "Through effective communication and the use of key vocabulary, a telecommunicator can obtain a relatively accurate understanding of the incident scene without being physically present." (P7) Motivational Factors and Job Satisfaction: Providing financial and motivational support, encouraging staff, receiving supervisor support, fostering intrinsic motivation, and using positive feedback are important for increasing job satisfaction and employee commitment. "Senior managers and officials should motivate and encourage staff before a crisis occurs, during exercises, or based on past experiences, so they feel seen and are prepared." (P7) Specialized Skills: Proficiency in specialized skills such as urban geography and precise address location, estimating the number of casualties, providing professional advice, guiding ambulances, performing correct telephone triage, and map-reading is necessary for efficient telecommunicator performance. "For hiring dispatch personnel, familiarity with routes, proper elocution, and the ability to manage stress are of particular importance." (P15) Mental Health and Resilience: Maintaining professional conduct, managing anxiety and stress, and strengthening psychological resilience through reduced workloads, increased support, and composure are prerequisites for system effectiveness in disasters. Ensuring psychological, physical, legal, and ethical security is also crucial, and ethical issues such as the potential for job abandonment must be considered. "Low psychological resilience among dispatch staff can lead to a loss of control over professional behavior when facing crises." (P17) 9. Environmental Factors Socioeconomic Factors of the Host Community: Factors such as a lack of public awareness regarding the role of emergency services in disasters and the impact of personnel's family issues on their performance can affect preparedness and response. "Callers put immense pressure on the telecommunicator, forcing them to send more ambulances, which stemmed from the public's lack of awareness about the emergency system." (P2) Temporal Factors: Effective planning must account for the increase in incidents during nighttime hours, challenges related to surging capacity and staff recall for after-midnight crises, and seasonal variations in the type and number of incidents. "In the summer, because people stay awake later and spend more time outdoors, the number of incidents increases." (P5) Cultural Factors: There is a need for public education on how to properly contact emergency services, promoting community awareness of hazards and disasters, and addressing the impact of local dialects on communication. The latter presents a challenge for centralized dispatch centers and requires telecommunicators to be familiar with regional dialects and for protocols to be localized. "One of the most significant issues was external factors beyond the dispatch's control, which were influenced by public culture and social conditions." (P7) Geographical Factors: Proper siting of the dispatch building, considering access and security, is essential. Zoning provinces and assigning local telecommunicators familiar with the area, as well as establishing resilient or mobile dispatch units, are necessary for better coverage of large regions. "The dispatch center should be built in a secure location, away from high-risk zones, because constructing it in a crisis-prone area could disrupt the system's functionality in the event of unrest or an incident." (P9) 10. Organizational Structure Structural Flexibility in Disaster: An effective response requires moving beyond rigid adherence to protocols and allowing for creativity and autonomy in telecommunicators' critical decision-making during crises. "The limitations of protocols in the dispatch system reduce operators' creativity and may be rooted in the organizational structure." (P20) Roles and Responsibilities: A clear, precise, and up-to-date definition of roles and responsibilities for all personnel, especially during disasters, is necessary to prevent confusion and task overlap. This can be achieved through horizontal task division and designing specific job descriptions for disaster situations. "In a disaster, responsibilities must be clearly defined; for instance, one person should be responsible for statistics and information dissemination to avoid confusion and interference with operational staff." (P7) Command and Management: An efficient management structure avoids direct intervention from senior executives in real-time operational decisions, instead routing communication through middle management. The center director should be informed and present on-scene to lead and activate the management team. An integrated incident command system, with a clear separation between triage and dispatch units and relative autonomy for the dispatch center, is essential. "In my opinion, direct communication from senior managers to dispatch leads to unprofessional interference and 'VIP management,' and is not recommended." (P7) Structural Model and Design: It is important to evaluate and select from various structural models, such as a centralized provincial dispatch with benefits like data consolidation and cost reduction, integration with other relief agencies, and the design of a layered, defense-in-depth dispatch system to enhance efficiency and resilience. "The initial idea was to design the dispatch in a layered, defense-in-depth model, so that different centers in various cities could act as backups for each other and support the central dispatch. However, due to telecommunication limitations, its implementation was not feasible." (P11) 11. Monitoring, Evaluation, and Performance Improvement Feedback Mechanisms and Continuous Improvement: Establishing systematic feedback mechanisms (e.g., voice-log monitoring and reports) to assess personnel and system performance is essential. This feedback should be used to identify strengths and weaknesses and drive continuous improvement, benchmarked against current standards. "After incidents, the emergency headquarters should conduct a specialized analysis, compare performance with current standards, identify strengths and weaknesses, and provide appropriate feedback based on these findings." (P5) Lessons Learned: Systematically extracting lessons learned from operational experiences in real incidents and exercises, and applying them to revise and improve plans, guidelines, and training programs, helps enhance preparedness. This can be informed by the experiences of other successful countries. "To upgrade our dispatch systems, we must draw on the experiences and lessons learned from advanced countries in disaster management and modernize our systems accordingly." (P12) Evaluation: Regular individual and system-level performance evaluations using standardized methods are necessary for process correction and preparedness enhancement. Methods include voice-log monitoring, self-assessment, peer review, direct observation, surveys, analysis of triage times, pre-employment and periodic testing, and training classes based on identified errors. This is crucial despite challenges like the absence of a proper oversight system. "The problem of increased triage time is addressed by reviewing and evaluating call audio, followed by providing the necessary training to improve performance." (P19) 12. Coordination Intra-organizational Coordination: Effective, transparent, and continuous communication and coordination among different EMS units—including dispatch, field units, deployed teams, and management levels—are vital for rapid and effective decision-making. This can be facilitated by text message alerts to managers, a centralized dispatch, joint briefing sessions, virtual collaboration groups, and the presence of EOC and MCMC liaisons in the dispatch center. "Intra-organizational coordination of the dispatch plays a key role in improving the rapid and effective response to incidents and crises." (P2) Inter-organizational Coordination: Close and active collaboration with other relief agencies (e.g., Red Crescent, Fire Department), law enforcement, utility services, healthcare facilities, and disaster management authorities is essential for integrated disaster management. This can be achieved through shared radio channels, hotlines, and coordination via the EOC. However, challenges persist, such as the unresponsiveness of some organizations on radio channels. Separating EOC functions from dispatch or co-locating them could be beneficial. "We placed the EOC team at the dispatch location to manage inter-organizational coordination effectively, without needing dedicated systems." (P7) 13. Education and Training Experience and Skill: Work experience, particularly clinical and operational backgrounds (male telecommunicators with field experience, female telecommunicators with hospital experience), is emphasized for accurate situational awareness, appropriate decision-making, and disaster management. Staying current with information and utilizing experienced personnel in disasters is critical. "Dispatch personnel should have clinical experience in hospital emergency departments and be familiar with different triage situations." (P7) Training Methods and Tools: Employing diverse and modern training methods such as error-based learning, realistic scenarios, simulations, morning reports, case reports, posters, and all-hazards training is necessary to increase training effectiveness. A focus on separate training for triage and dispatch units is also important. "Dispatch must receive all-hazard and special-hazard training, especially in areas like CBRN and special communications, where some information must remain confidential and communication methods must be unique and specific." (P15) Public Education: Educating the public on the correct way to contact emergency services, avoiding unnecessary line occupation, providing accurate and complete information, and increasing community awareness and preparedness for disasters is important. This includes preparing pre-recorded educational messages for use during crises. "Automated messages for disaster situations should be designed so that a caller without an injured person is prompted to hang up quickly and free the line." (P13) Initial (Onboarding) Training: Providing comprehensive, specialized, and standardized training to new recruits before they begin work, particularly in telephone triage and familiarity with dispatch center processes, is essential for their initial preparation. "The initial training for dispatch personnel includes a three-day triage simulation course in a simulated environment, and this training is very important." (P8) Continuing and In-Service Education: Planning and conducting continuous training courses, regular refresher training, and updates for all staff (e.g., morning reports, seasonal triage training, and staff participation in teaching) play a vital role in enhancing and maintaining the quality of personnel performance. "Personnel first learn triage and the software system, then they get to know the city, and then they enter in-service training such as CPR and ambulance status." (P17) Specialized Training: There is a fundamental need for training in specialized areas such as stress and disaster management, mental health, advanced communication skills, specialized telephone triage, use of new software and systems, detailed map-reading and urban geography, familiarity with local hazards, disaster information management, and rapid decision-making techniques. The scarcity of dispatch-centric specialized training is a major challenge. Cross-training between technicians and telecommunicators could also be beneficial. "Specialized disaster training for dispatch in Iran is limited to cards and paper, whereas other countries use advanced simulations." (P19) Discussion This qualitative study, utilizing conventional content analysis, identified thirteen main categories and sixty-three subcategories concerning the factors that influence the disaster preparedness of prehospital dispatch centers in Iran. These categories included planning, training, exercises, resources, communication, early warning systems, safety, security, coordination, organizational structure, human resources, individual skills, monitoring and evaluation, and environmental and cultural factors. Planning , identified as a foundational category, was described as the cornerstone of effective preparedness. The findings indicated that the absence of codified action plans, a lack of structural and functional standards, and a deficit of localized guidelines tailored to geographical variations were significant barriers. Participants particularly emphasized the necessity of developing formal Incident Action Plans (IAPs), Emergency Operation Plans (EOPs), and Standard Operating Procedures (SOPs), which align with the findings of Smith et al. (2016).(43) A study by Agri et al. (2023), which aimed to assess prehospital preparedness for major incidents in Sweden, also stressed the importance of standardizing guidelines, conducting regular exercises, and performing periodic evaluations. While these findings are consistent with our study, the present research highlights dimensions less emphasized by Agri et al. by focusing on the specific context of Iran, including the need for the localization of planning, training, and inter-sectoral collaboration. (18). In the domain of training , a deficiency in dispatch-centric specialized education, a lack of training in crisis decision-making, geographical proficiency (topographical knowledge), telephone triage, and stress management, as well as insufficient use of simulation in training, were identified as serious weaknesses. Furthermore, the role of structured and continuous in-service training—including morning reports, feedback based on call audits, and lessons-learned sessions—was deemed critical for enhancing personnel performance, especially during disasters. This emphasis on operational training is consistent with the results of Smith et al. (2016) (43). The study by Donford et al. (2002) also underscored the necessity of developing standardized telephone triage protocols and providing continuous training for operators, a theme that was also identified as a key component of training in our study. However, the present research expands upon this by also addressing topics such as topographical training, soft skills, and the localization of triage algorithms. (44). Exercises and operational exercises were recognized as another essential need for enhancing preparedness. Participants pointed to a shortage of dispatch-specific exercises, tabletop and simulation-based exercises, and a lack of systematic post-exercise evaluation. The implementation of scenario-based exercises, joint inter-agency maneuvers, and the analysis of their outcomes were considered vital for fostering coordination, improving decision-making, and enhancing individual and team skills. Regarding resources , challenges such as staff shortages, equipment obsolescence, the absence of a backup infrastructure like mobile or secondary dispatch centers, and weak communication infrastructure were among the most significant obstacles identified. In particular, the reliance on internet-based automation was identified as a serious threat to service continuity during communication outages, which is consistent with Chen et al. (2024) (3). Accordingly, the use of two-way radios, satellite phones, analog equipment, power generators, and uninterruptible power supplies (UPS) was recommended. From the perspective of early warning systems , the integration of alert systems, effective communication with the Emergency Operations Center (EOC), and the use of GIS data, urban monitoring cameras, and hazard-forecasting dashboards were identified as effective strategies. Additionally, multi-layered communication channels, hotlines, and the use of resilient communication systems were introduced as essential components for maintaining communication stability during disasters. Organizational structure was another influential factor. The findings showed that having clear job descriptions, an Incident Command System (ICS) model, a crisis-specific organizational chart, and flexible management structures can play a key role in ensuring cohesive dispatch performance during disasters. Participants also emphasized the need to separate triage and dispatch units, have a liaison officer for the EOC, and grant dispatch centers relative autonomy from direct intervention by senior management. Continuous monitoring and evaluation of dispatch performance was another prominent theme. The use of call audits, evaluations based on standardized forms, morning report sessions, theoretical and practical tests for personnel, and structured feedback were identified as essential tools for process improvement and preparedness enhancement. Individual skills , mental health, resilience, and job motivation also play a role in elevating preparedness levels, which aligns with the study by Giaume et al. (2024).(45) Intuitive decision-making, emotional intelligence, skill in de-escalating angry callers, and accountability under stressful conditions were among the characteristics emphasized in this study. Ensuring the psychological and physical safety of staff, providing legal and ethical support for telecommunicators, and supporting their mental health were considered prerequisites for maintaining system effectiveness during disasters, consistent with the findings of Hosseini et al. (2018) (46). Furthermore, the findings of Montassier et al. (2015), which examined the impact of shift length and rotation on telecommunicator performance, align with our study's findings. The present research also emphasized the effect of fatigue, shift type, and critical periods (e.g., midnight) on telecommunicator efficiency and offered suggestions for designing an optimal shift system. (47). From the perspective of the participants, the readiness of dispatch centers is not From the participants' perspective, the preparedness of dispatch centers is not merely dependent on resources and structure but is the product of an interaction between resources, knowledge, skills, structure, communication, and organizational culture. Therefore, it is imperative that an integrated, systems-based approach be adopted in designing models for preparedness enhancement. The research by Lee et al. (2011) proposed the use of algorithms based on a preparedness index to optimize ambulance dispatch. Our study also underscores the importance of operational and regional preparedness indicators; however, our approach goes further by encompassing the structural, cultural, and managerial aspects that influence the level of preparedness. (48). Conclusion The findings of this qualitative study reveal that disaster preparedness in Iran's prehospital emergency dispatch centers is a complex, multidimensional construct that transcends the mere possession of resources. Derived from an in-depth analysis of experts' lived experiences, the findings indicated that effective preparedness emerges from the systematic interplay of 13 core factors that collectively define the capacity of these centers to respond to disasters. These factors—comprising planning, training, drills, resources, communications, early warning systems, safety, security, coordination, organizational structure, individual skills, monitoring and evaluation, and environmental factors—provide a comprehensive framework for understanding the key dimensions of this domain. The efficacy of this system is directly influenced by factors such as information integration (through warning and communication systems), the effectiveness of operational processes (rooted in planning, drills, and individual skills), inter-organizational coordination, access to sufficient resources, and the continuous empowerment of personnel. The use of lived experiences from dispatch professionals has furnished a deep understanding of decision-making processes in high-pressure situations, an insight that quantitative studies are unable to provide. The diversity of participants and adherence to credibility principles, such as theoretical saturation and independent re-coding, have strengthened the robustness of the findings. This study's focus on the Iranian context, coupled with an analysis of global challenges, makes its findings applicable and actionable for domestic policymaking and for health systems with similar characteristics. By presenting a holistic picture of the requirements for effective dispatch center preparedness in disasters, these results can provide a solid foundation for developing operational frameworks and redesigning structures to enhance health system resilience. Unlike predominantly quantitative studies that focus on discrete indicators and mathematical modeling, this research, with its qualitative and context-specific approach, addresses a significant knowledge gap in the "science of dispatch" literature. The findings of this study address several critical gaps in the existing literature. First, it responds to the scarcity of qualitative evidence on dispatch preparedness in disasters, particularly in developing countries, by systematically documenting the lived experiences of dispatchers and managers. Second, based on the analysis of empirical data, a framework comprising thirteen main categories and sixty-three subcategories was extracted, which holistically integrates human, organizational, and contextual dimensions—aspects often overlooked in previous studies that were predominantly quantitative and model-driven, typically focusing on only one or a few facets. This study introduces several scientific innovations, including an in-depth exploration of less-examined components such as the psychological safety of personnel, individual and organizational resilience, and multi-level coordination during crises. Furthermore, in contrast to most quantitative and model-based studies that have primarily concentrated on indicators like response times or resource capacity, this research, by drawing on the lived experiences of experts, presents a realistic and context-sensitive depiction of the preparedness requirements for disaster dispatch centers. For the first time, this study independently, deeply, and systematically investigates the preparedness of dispatch centers as a distinct unit of analysis—a domain often studied implicitly within the broader framework of Emergency Medical Services (EMS). The findings show that the existence of rapid and efficient early warning systems leads to an effective response only when coupled with targeted training and regular drills for their application. Similarly, the development and updating of operational plans (EOPs & SOPs) will be effective only when supported by flexible organizational structures and continuous monitoring and evaluation mechanisms. This study also demonstrates that the alignment of management structures with national and international standards and the utilization of modern technologies play a pivotal role in enhancing the speed and accuracy of the response and are considered fundamental requirements for improving the resilience of these centers. Moreover, the research outcomes reflect the realities and challenges of dispatch centers in Iran and can be relevant for countries with similar cultural, organizational, and resource constraints. In addition to its practical value at the national level, the findings of this research are transferable to countries with cultural, structural, and health system development contexts similar to Iran. These nations can leverage the results of the present study to design context-specific policies, strengthen training programs, and enhance the disaster resilience of their prehospital emergency dispatch centers. Accordingly, the findings of this research, despite their local origins, can serve as a foundation for examining, improving, and adapting preparedness frameworks in other health systems' dispatch centers. The adaptability of these findings is contingent upon a thorough understanding of and alignment with the unique cultural characteristics, available resources, and managerial structures of each specific context. Policy and Practical Recommendations The findings of this study underscore the critical need for a comprehensive, systemic approach to enhance the preparedness of emergency dispatch centers. This approach must encompass the concurrent development of human and technical capacities, the strengthening of intra- and inter-organizational coordination, and the establishment of a resilient communications infrastructure capable of withstanding disaster conditions. Accordingly, the following strategic measures are recommended for policymakers and health system administrators: Strategic Planning and Standardization : Develop and institutionalize comprehensive Emergency Operation Plans (EOPs) and Standard Operating Procedures (SOPs). These protocols should not only align with national standards but also be adaptable to the specific hazards and contexts of each region. Furthermore, these plans must undergo periodic review and updates to ensure their continued relevance and effectiveness. Investment in Human Capacity Building : Design and implement contextualized training programs for dispatchers that focus on critical competencies such as decision-making under pressure, stress management, advanced telephone triage, and situational awareness. The use of high-fidelity simulations and crisis scenarios, complemented by cognitive aids like checklists and step-by-step guides, can significantly improve response accuracy and timeliness. Fortification of Technical Infrastructure and Security : Prioritize targeted investments to ensure the holistic security (physical, psychological, and legal) of personnel and to harden the physical infrastructure of dispatch centers against potential threats. Additionally, establishing and maintaining disruption-resilient communication protocols, including redundant systems (e.g., analog or satellite-based) for use during digital network failures, is essential. Implementing multi-layered communication channels will ensure operational continuity and coordination among units. To this end, conducting regular joint exercises with other emergency response agencies is vital for improving inter-agency collaboration and interoperability. Institutionalization of Monitoring and Continuous Improvement : Establish a systematic framework for regular performance monitoring and evaluation within dispatch centers. This system should be designed to identify vulnerabilities, conduct root-cause analyses of errors, and drive process refinement. The findings from these assessments must directly inform the revision of training programs and operational protocols, creating a cycle of continuous improvement. Development of Resilient Data Management Systems : Develop robust information management and monitoring systems capable of functioning in austere or degraded environments. This includes low-tech solutions, such as standardized paper-based forms and lightweight offline applications, alongside AI-driven analytical tools, to guarantee the continuity of critical functions. The deployment of simple, geo-referenced dashboards can also enhance real-time decision-making regarding resource allocation and mission prioritization. Optimization of Organizational Structure and Human Resources : From an organizational standpoint, strengthening the operational command structure within dispatch centers is crucial. This can be achieved through targeted leadership training and by empowering mid-level supervisors with delegated authority during crises to enhance decision-making agility and response readiness. Furthermore, integrating trained volunteers into predefined support roles (e.g., auxiliary call-taking, data entry, logistical support) can significantly augment human resource capacity during surge events, provided that this integration is governed by standardized and safety-oriented protocols to ensure operational integrity and mitigate risk. Suggestions for Future Research Building upon the comprehensive conceptual framework developed in this study, future research is recommended in the following areas. First, the development and validation of a standardized quantitative instrument based on the 13 identified factors to assess and compare the preparedness levels of dispatch centers on a national scale. Second, conducting interventional studies to evaluate the effectiveness and cost-benefit of the proposed interventions, such as specific training programs or new technologies. Finally, undertaking comparative studies to adapt successful international strategies to the local Iranian context could pave the way for continuous improvement and the achievement of a resilient and efficient national dispatch system. Limitations of the Study Despite efforts to ensure scientific rigor, this qualitative study was subject to several limitations. First, due to its qualitative nature, the findings, while information-rich, are not generalizable to all prehospital emergency dispatch centers in the country. Second, the purposive sampling strategy, although diverse, may not have fully captured the perspectives of all relevant groups or specific geographical regions. Third, the data were based on self-reports from interviews, which are susceptible to recall and social desirability biases. Fourth, time and resource constraints limited a more in-depth exploration of certain aspects. Fifth, the potential for researcher bias during the qualitative analysis process cannot be entirely eliminated. Future studies are encouraged to employ quantitative, mixed-methods, and longitudinal designs to better assess causal relationships and the impact of interventions. Abbreviations EMS Emergency Medical Services EOC Emergency Operations Center EOP Emergency Operations Plan SOP Standard Operating Procedure AIP Action/Incident Plan EMDCs Emergency Medical Dispatch Centers EMD Emergency Medical Dispatcher EMTs Emergency Medical Technicians Declarations Ethics approval and consent to participate : This study was approved by the Ethics Committee of Kerman University of Medical Sciences, Kerman, Iran (Ethics Code: IR.KMU.REC.1403.573). All participants provided verbal informed consent prior to participation. Consent for publication : Not applicable. Availability of data and materials : The datasets (interview transcripts and qualitative materials) generated and analyzed during the current study are not publicly available due to confidentiality and privacy considerations of participants. Data may be made available from the corresponding author on reasonable request. Competing interests : The authors declare that there are no conflicts of interest related to this study. Mohammad Reza Shafiei: No conflict of interest Mahmood Nekoei-Moghadam: No conflict of interest Seyed Mobin Moradi: No conflict of interest Vahid Saadatmand: No conflict of interest Asghar Tavana: No conflict of interest Funding : This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors’ contributions : Mohammad Reza Shafiei: Conceptualization, Data Curation, Investigation, Writing – Original Draft Mahmood Nekoei-Moghadam: Supervision Seyed Mobin Moradi & Vahid Saadatmand: Formal Analysis, Data Management Asghar Tavana: Methodology, Validation, Writing – Review & Editing All authors meet the four authorship criteria defined by the ICMJE. Acknowledgements : The authors gratefully acknowledge the dispatchers, EMS managers, and emergency experts who generously shared their time and experiences during the interviews. References Kilungo AP, Chukwuonye GN, Okpanachi VP, Hussein M, editors. Assessing Sub-Saharan Africa's Readiness to Address the Impact of Climate Change and Health: A Scoping Review. medRxiv; 2024 . WHO. Health emergency and disaster risk management framework . World Health Organization Geneva; 2019 . Chen S, Xing D, Wang Q, An Y, Chen Y, Zhou X, et al. A study of prehospital EMS response time and influencing factors in the main urban area of Chongqing, China. International Journal for Quality in Health Care . 2024;36(3): mzae065 . Bachmann DJ, Jamison NK, Martin A, Delgado J, Kman NE. Emergency preparedness and disaster response: there’s an app for that. Prehospital and disaster medicine. 2015;30(5):486-90 . Goldfine S, Volpi N. The Role of the Louisiana EMS Designated Regional Coordinator in Emergency Response During 2020/2021 COVID Pandemic and Hurricane Season. Prehospital and Disaster Medicine. 2023;38:s43 - s . Cvetković VM, Tanasić J, Renner R, Rokvić V, Beriša H, editors. Comprehensive Risk Analysis of Emergency Medical Response Systems in Serbian Healthcare: Assessing Systemic Vulnerabilities in Disaster Preparedness and Response. Healthcare; 2024: MDPI . Sakamoto T, Suzuki H, Machida T, Nishimura H, Noguchi Y, Amagai T. Victim profiles and revealed issues of type 1 emergency medical team in the first minutes of a mega earthquake in Turkey. American journal of disaster medicine. 2023;18(1):5-15 . Alsofayan YM, Almakhalas K, Alabdali A, Arafat MS, Aljerian NA, Cluntun AA, et al. An Innovative Curriculum Development Experience: Emergency Medical Dispatch Role in the Healthcare Transformation Vision of Saudi Arabia. Saudi Journal of Emergency Medicine. 2021 . Ventura CAI, Denton EE, David JA, Schoenfelder BJ, Mela L, Lumia RP, et al. Emergency medical services prehospital response to the COVID-19 pandemic in the US: a brief literature review. Open Access Emergency Medicine. 2022:249-72 . Chae J, Yun SJ. Study on Effective Response Plans for Disaster Sites with Multiple Casualties. Fire Science and Engineering. 2021 . Penverne Y, Leclere B, Labady J, Berthier F, Jenvrin J, Javaudin F, et al. Impact of two-level filtering on emergency medical communication center triage during the COVID-19 pandemic: an uncontrolled before-after study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2020;28:1-6 . Shen Z, Gao G, Wang Z. Accessibility Assessment of Prehospital Emergency Medical Services considering Supply‐Demand Differences. Journal of Advanced Transportation. 2021;202 1(1):1925354. Johnsen BH, Espevik R, Eid J, Østerås Ø, Jacobsen JK, Brattebø G. Coordinating mechanisms are more important than team processes for geographically dispersed emergency dispatch and paramedic teams. Frontiers in Psychology. 2022;13:754855 . Ferrari T, Camara MVO, Nassi CD, Ribeiro GM, Costa Junior RR, Ribeiro Júnior C, et al. Analysis of the location of rescue ambulance dispatch bases: a case study in Rio de Janeiro, Brazil. Geographical Analysis. 2018;50(4):397-421 . Janerka C, Leslie GD, Mellan M, Arendts G. Prehospital telehealth for emergency care: A scoping review. Emergency Medicine Australasia. 2023;35(4):540-52 . Bartolucci A, Mackway-Jones K, Redmond AD. Decision support framework for deployment of emergency medical teams after earthquakes. Disaster Medicine and Public Health Preparedness. 2021;15(6):727-34 . Caviglia M, Da Silva-Moniz J, Venturini F, Jambai A, Vandi M, Wurie A, et al. Response to Mass-Casualty Incidents and Outbreaks: A Prehospital Disaster Training Package Developed for the National Emergency Medical Service in Sierra Leone. Prehospital and Disaster Medicine. 2023;38(S1):s138-s9 . Agri J, Söderin L, Hammarberg E, Lennquist-Montán K, Montán C. Prehospital preparedness for major incidents in Sweden : a National Survey with focus on mass-casualty incidents. Prehospital and disaster medicine. 2023;38(1):65-72 . Sorani M, Tourani S, Khankeh HR, Panahi S. Prehospital emergency medical services challenges in disaster; a qualitative study. Emergency. 2 018;6(1): e26 . Beyrami Jam M, Aminizadeh M, Akbari-Shahrestanaki Y, Khankeh HR. Evaluating the disaster preparedness of emergency medical services (EMS) facilities: a cross-sectional investigation in Iran. BMC emergency medicine. 2024;24(1):48 . Beyramijam M, Farrokhi M, Ebadi A, Masoumi G, Khankeh HR. Disaster preparedness in emergency medical service agencies: A systematic review. Journal of Education and Health Promotion. 2021;10(1):258 . Pouraghaei M, Babaie J, Saeed LR. Challenges of emergency medical services response to Arasbaran Twin Earthquakes; a content analysis. Archives of Academic Emergency Medicine. 2022;10(1):e35 . Friesen J, Kharel R, Delaney PG. Emergency medical dispatch technologies: Addressing communication challenges and coordinating emergency response in low and middle-income countries. Surgery. 2024;176(1):223-5 . Van Duijn S. Effective Task Arrangement in Emergency Dispatch Centers. 2015 . Weeks BC, Spencer C. Emergency Nursing in Mass Casualty Incidents: Effects on Staff Turnover at a Large Suburban Hospital Emergency Department. Prehospital and Disaster Medicine. 2017;32(S1):S141-S2 . Behghadami A, Janati A, Sadeghi-Bazargani H, Gholizadeh M, Rahmani F. Preparedness of Non-Hospital Health Centers to Deal with Life-Threatening Emergencies: A †ŽQualitative Study of Healthcare Providers’ and Experts’ Perspectives. Journal of Injury and Violence Research. 2019;11 (4). Gupta I, Siddiqui ZK, Phillips MD, Singh A, Eid SM, Wortman L, et al. Recruitment, readiness, and retention of providers at a field hospital during the pandemic. Disaster medicine and public health preparedness. 2023;17:e102 . Brown GD, Largey A, McMullan C, O'Shea G, Reilly N. Voices from the frontline: a review of EMS first responders ' experience of COVID-19 in Ireland. International Journal of Emergency Services. 2022;12(1):103-18 . Huard C, Deschênes A-A, Rioux C-A. Emotional self-efficacy and workplace psychological health in emergency dispatchers. International Journal of Emergency Services. 2021;10(2):276-87 . Wheeler AL, Gardett I. 3440 Emergency Dispatch Research Workshop: Engaging a Forgotten Professional Population in Research. Journal of Clinical and Translational Science. 2019;3(s1):69 -. Motamedi MHK, Saghafinia M , Bafarani AH, Panahi F. A reassessment and review of the Bam earthquake five years onward: what was done wrong? Prehospital and disaster medicine. 2009;24(5):453-60 . Alshammari AD, Alobaid AM, Azharuddin A. Professionalizing Emergency Medical Service Response Time. Emergency Health Services Journal. 2024;1(2):37-41 . Al Abbas HMA, Al Hussin YMM, Alabbas MAS, Al-Duways RM, Alhareth HSM, Al-Bakri MAS, et al. Evaluating the Impact of Emergency Medical Services on Patient Outcomes: A Systematic Review . Journal of Ecohumanism. 2024;3(8):9048–54-–54 . Kubota H, Amagasa S, Kashiura M, Yasuda H, Kishihara Y, Ishiguro A, et al. Association between response time and time from emergency medical service contact with the patient to hospital arrival as well as survival and neurological outcomes in pediatric out-of-hospital cardiac arrest. Prehospital Emergency Care. 2025(just-accepted):1-12 . Kyngäs H. Inductive content analysis. The application of content analysis in nursing science research: Springer ; 2019. p. 13-21 . Graneheim UH, Lindgren B-M, Lundman B. Methodological challenges in qualitative content analysis: A discussion paper. Nurse education today. 2017;56:29-34 . Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qualitative health research. 2005;15(9):1277-88 . Neuendorf KA. Content analysis—A methodological primer for gender research. Sex roles. 2011;64:276-89 . Snodgrass JG, Clements KR, Nixon WC, Ortega C, Lauth S, Anderson M. An iterative approach to qualitative data analysis: Using theme, cultural models, and content analyses to discover and confirm a grounded theory of how gaming inculcates resilience. Field Methods. 2020;32(4):399-415 . Tshabangu I, Ba S, Madondo SM. Approaches and processes of social science research: IGI Global; 2020 . Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse education today. 2004;24(2):105-12 . Lincoln YS, Guba EG. But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New directions for program evaluation. 1986;1986(30):73-84 . Smith SW, Braun J, Portelli I, Malik S, Asaeda G, Lancet E, et al. Prehospital indicators for disaster preparedness and response: New York City emergency medical services in hurricane sandy. Disaster medicine and public health preparedness. 2016;10(3):333-43 . Dunford JV. Emergency medical dispatch. Emergency Medicine Clinics. 2002;20(4):859-75 . Giaume L, Daniel Y , Jimenez A, Burlaton G, Jost D, Petitclerc M, et al. 112 What’s your emergency? Overview of mental health and sleep disorders among emergency medical dispatchers in a French 112 call center. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2024;32(1):55 . Hosseini SMR, Maleki M, Gorji HA, Khorasani-Zavareh D, Roudbari M. Factors affecting emergency medical dispatchers’ decision-making: a qualitative study. Journal of multidisciplinary healthcare. 2018:391-8 . Montassier E, Labady J, Andre A, Potel G, Berthier F, Jenvrin J, et al. The effect of work shift configurations on emergency medical dispatch center response. Prehospital Emergency Care. 2015;19(2):254-9 . Lee S. The role of preparedness in ambulance dispatching. Journal of the Operational Research Society. 2011;62(10):1888-97 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 22 Nov, 2025 Read the published version in International Journal of Emergency Medicine → Version 1 posted Editorial decision: Revision requested 05 Oct, 2025 Reviews received at journal 03 Oct, 2025 Reviews received at journal 03 Oct, 2025 Reviews received at journal 30 Sep, 2025 Reviewers agreed at journal 24 Sep, 2025 Reviewers agreed at journal 22 Sep, 2025 Reviewers agreed at journal 18 Sep, 2025 Reviewers agreed at journal 18 Sep, 2025 Reviewers invited by journal 18 Sep, 2025 Editor assigned by journal 17 Sep, 2025 Submission checks completed at journal 15 Sep, 2025 First submitted to journal 05 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7544681","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":521745960,"identity":"db253f03-d488-4d6a-80b6-5ffea3a4b5b7","order_by":0,"name":"Mohammadreza Shafiei","email":"","orcid":"","institution":"Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman","correspondingAuthor":false,"prefix":"","firstName":"Mohammadreza","middleName":"","lastName":"Shafiei","suffix":""},{"id":521745961,"identity":"2b2bc55f-2f83-4979-87ae-0f2914bc52b0","order_by":1,"name":"Mahmood Nekoei-Moghadam","email":"","orcid":"","institution":"Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman","correspondingAuthor":false,"prefix":"","firstName":"Mahmood","middleName":"","lastName":"Nekoei-Moghadam","suffix":""},{"id":521745962,"identity":"976f680e-f73e-4566-8335-cb28a85cc310","order_by":2,"name":"Seyed Mobin Moradi","email":"","orcid":"","institution":"Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman","correspondingAuthor":false,"prefix":"","firstName":"Seyed","middleName":"Mobin","lastName":"Moradi","suffix":""},{"id":521745963,"identity":"f79a62df-bbeb-474d-a725-3cb8bb36eb6a","order_by":3,"name":"Vahid Saadatmand","email":"","orcid":"","institution":"University of Medical Sciences, Jahrom University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Vahid","middleName":"","lastName":"Saadatmand","suffix":""},{"id":521745964,"identity":"50f94511-190f-43bd-9815-0104fb9e69bf","order_by":4,"name":"Asghar Tavan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYDADfgYGNiKVsjEwNoBoyQaStRgcIFYL//wG9gc/2+zyjG8kP3vwoYJBnl/sAH4tEscYGBt725KLzW6kmRvOOMNgOHN2AgFrgFoaeM4wJ267kWAmzdvGkGBwm4AWeZAtf87UJ26ekf6NOC0GQC3NPBWHEzdI5BBpi+GxxMbZMhXHE2eceVMmOeOMBGG/yB0+fODjG4PqxP729G0SHyps5PmlCWhhgEYLA4MAWKUEIeXIgP8AKapHwSgYBaNgJAEAc2BCSbxYBngAAAAASUVORK5CYII=","orcid":"","institution":"Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman","correspondingAuthor":true,"prefix":"","firstName":"Asghar","middleName":"","lastName":"Tavan","suffix":""}],"badges":[],"createdAt":"2025-09-05 13:23:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7544681/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7544681/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12245-025-01053-5","type":"published","date":"2025-11-22T15:57:09+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":92476643,"identity":"1164a664-8a05-47e5-bb0d-190216e255d6","added_by":"auto","created_at":"2025-09-30 07:22:46","extension":"png","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1059321,"visible":true,"origin":"","legend":"","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7544681/v1/7982a9a9aac65ea9e6c6451b.png"},{"id":92476645,"identity":"109e31ff-fd87-42b4-9d75-2f65a9796e3f","added_by":"auto","created_at":"2025-09-30 07:22:46","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":426150,"visible":true,"origin":"","legend":"","description":"","filename":"whitaouthor.docx","url":"https://assets-eu.researchsquare.com/files/rs-7544681/v1/f8164c82bf2de2515fcc2c2d.docx"},{"id":92476648,"identity":"b4c59eb5-cdc7-40e6-bbe4-539776d05034","added_by":"auto","created_at":"2025-09-30 07:22:46","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":22010,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7544681/v1/e8f30f638dc0b8e078697b68.docx"},{"id":92476646,"identity":"26d98052-8c3d-4751-9e69-9fb4f23747f8","added_by":"auto","created_at":"2025-09-30 07:22:46","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":16818,"visible":true,"origin":"","legend":"","description":"","filename":"table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7544681/v1/f27a997e290ae785a9330870.docx"},{"id":92476652,"identity":"4b572675-aa70-4fbc-bc6e-fd89405aa891","added_by":"auto","created_at":"2025-09-30 07:22:46","extension":"json","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7165,"visible":true,"origin":"","legend":"","description":"","filename":"5a8023373b56488aaaea279f2882933c.json","url":"https://assets-eu.researchsquare.com/files/rs-7544681/v1/df84f560a19e64bee02ed4fe.json"},{"id":92476654,"identity":"ada2588a-cbe0-42e6-8364-65fe5674d78e","added_by":"auto","created_at":"2025-09-30 07:22:47","extension":"xml","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":148040,"visible":true,"origin":"","legend":"","description":"","filename":"5a8023373b56488aaaea279f2882933c1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7544681/v1/d9b07d4cba066afe95ab164f.xml"},{"id":92476653,"identity":"8fb469f6-7f08-4bef-a764-475681386e7e","added_by":"auto","created_at":"2025-09-30 07:22:47","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1059321,"visible":true,"origin":"","legend":"","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7544681/v1/216079b44a21fb96851ccd3b.png"},{"id":92476659,"identity":"a4103c07-6965-4afc-b09c-b02736cfadf2","added_by":"auto","created_at":"2025-09-30 07:22:47","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":322783,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7544681/v1/48c9edadd6cb1eea0b1c12b1.png"},{"id":92476650,"identity":"0d1ee9e6-0617-4ef9-b88b-e47ba92062cf","added_by":"auto","created_at":"2025-09-30 07:22:46","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":277885,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefigure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7544681/v1/05fa9f0c2441711c38a039ea.png"},{"id":92476647,"identity":"875374a7-9958-4e91-86c4-b6f1fed3be83","added_by":"auto","created_at":"2025-09-30 07:22:46","extension":"png","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":83506,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7544681/v1/836c751563c4eba80da3512f.png"},{"id":92476660,"identity":"6abedc02-c54f-4bf6-8bea-b85aa6ce55f6","added_by":"auto","created_at":"2025-09-30 07:22:47","extension":"xml","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":144651,"visible":true,"origin":"","legend":"","description":"","filename":"5a8023373b56488aaaea279f2882933c1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7544681/v1/ddaca4c3e14fb495683ca2f9.xml"},{"id":92476661,"identity":"f6ca38ff-386f-4af5-8bf0-dc4399d7c956","added_by":"auto","created_at":"2025-09-30 07:22:47","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":157301,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7544681/v1/d2f423ae5613113dc95e2eec.html"},{"id":92476640,"identity":"e7ca9128-91ae-4d7f-85a8-403ee21ea89d","added_by":"auto","created_at":"2025-09-30 07:22:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1059321,"visible":true,"origin":"","legend":"\u003cp\u003eCategories, Subcategories, and Themes Extracted in this Study\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7544681/v1/d7c97cafc43afd8d11e6b9fa.png"},{"id":96650031,"identity":"9976a223-6126-4173-80c3-c9629f57de24","added_by":"auto","created_at":"2025-11-24 16:05:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2058197,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7544681/v1/dcfdd435-56d0-4ce8-b071-79899927de75.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors Affecting Disaster Preparedness in Prehospital Emergency Dispatch Centers: Mapping of Expert Perspectives","fulltext":[{"header":"Introduction","content":"\u003cp\u003eNatural and anthropogenic disasters, such as earthquakes, floods, and chemical, industrial, or biological incidents, pose a significant and persistent threat to health systems worldwide. (1, 2). In such circumstances, healthcare infrastructure is rapidly disrupted, while the demand for emergency services increases exponentially. Particularly in the initial moments of a crisis, sound and swift decision-making by emergency systems can prevent substantial mortality, morbidity, and irreversible harm. (3, 4)\u003c/p\u003e\u003cp\u003eAmong the core components of emergency response, prehospital emergency dispatch centers play a pivotal role. (5, 6). Emergency Medical Dispatch (EMD) centers serve as the vital link between the public and the healthcare system during crises, acting as the primary point of contact for individuals seeking immediate medical assistance.(7, 8)\u003c/p\u003e\u003cp\u003eDisasters invariably lead to a dramatic surge in emergency calls to prehospital dispatch centers, far exceeding their normal operational capacity. (9\u0026ndash;11). This sudden and significant This sudden and significant increase in call volume places immense strain on human resources, communication systems, and ambulance availability. The consequences of this pressure often include delayed response times, reduced efficiency in call handling, and a potential decrease in the overall effectiveness of the emergency response system. (7, 11)\u003c/p\u003e\u003cp\u003eIn the event of a disaster, whether natural or human-made, the preparedness and response capability of these centers are paramount for minimizing casualties and ensuring the effective allocation of resources. (8, 12). Telecommunicators perform a multifaceted role that includes coordinating Emergency Medical Services (EMS) resources, providing critical pre-arrival instructions to callers, and relaying essential information to responding units and other relevant agencies. (8, 13).\u003c/p\u003e\u003cp\u003eThe dispatch center analyzes incoming calls to determine the most appropriate response, and when a team is required, the telecommunicator assigns the most suitable rescue unit based on pre-defined protocols, considering the severity of the call and the nearest available ambulance.(14)\u003c/p\u003e\u003cp\u003eTheir responsibilities extend from initial caller interrogation to critical triage decisions, transmission of vital information to responders, provision of telephonic medical interventions, and management of logistics and resource coordination throughout the disaster. (14, 15). ). The efficiency and effectiveness of these dispatch centers directly impact the overall success of disaster response efforts, influencing factors such as the speed of aid delivery, the appropriate allocation of resources, and ultimately, the mortality and morbidity rates associated with the event.(16)The increasing frequency of natural disasters around the world The increasing frequency of disasters globally underscores the growing need for prehospital emergency dispatch centers to be adequately prepared and highly responsive to effectively manage the heightened demand and complexities associated with such events. (17, 18).\u003c/p\u003e\u003cp\u003eIn a country like Iran, which is prone to a wide spectrum of natural and human-made disasters, ensuring the preparedness and efficient response of emergency dispatch centers is a strategic priority for the national health and disaster management systems, necessitating a deep understanding of the factors that influence it (19, 20).\u003c/p\u003e\u003cp\u003eHowever, numerous studies have shown that dispatch systems in many countries, particularly in low-resource settings, face structural, technical, and human-related challenges. These challenges include the lack of standardized disaster protocols, insufficient specialized training for operators, weak communication infrastructure, an absence of digital decision-support tools, and, most importantly, poor inter-organizational coordination. (21\u0026ndash;24) .\u003c/p\u003e\u003cp\u003eThe effectiveness of dispatch centers during disasters is heavily dependent on the training and preparedness of their personnel. (25, 26). Yet, studies have identified significant gaps in training, especially concerning less common or complex emergency scenarios and the challenges associated with integrating new technologies into operations. (27, 28). Research strongly emphasizes the need for comprehensive training programs that address both the technical skills and the psychological aspects of disaster response. (29, 30)\u003c/p\u003e\u003cp\u003eIn developing countries, research has also indicated persistent weaknesses in preparedness, response, coordination, infrastructure, and training. (19, 22, 31). A study by Sorani et al. (2018) identified challenges related to management, infrastructure, information, and personnel within Iran's EMS, proposing solutions such as infrastructure reform and targeted training for both personnel and the public to improve preparedness. (19) A primary concern in emergency medical dispatch is the issue of response time. Many systems aim to achieve specific response time benchmarks, leading to intense debates about their appropriateness and impact on outcomes. (32\u0026ndash;34). Ultimately, the preparedness of EMD centers is crucial for mitigating the effects of disasters and requires a comprehensive approach that combines rigorous training, strategic resource management, technological integration, and the development of standard operating procedures.(21) Addressing existing challenges and leveraging new opportunities will be vital for enhancing the resilience and efficiency of prehospital emergency dispatch centers (EMDCs) in the face of future emergencies.\u003c/p\u003e\u003cp\u003eThis study was designed within a qualitative framework, utilizing a conventional content analysis method to address the gap identified by the lack of validated quantitative tools and indicators for measuring the preparedness of prehospital emergency dispatch centers for disasters. Although the preparedness of EMS systems for disasters has been the subject of numerous studies, independent and in-depth research specifically focusing on the factors influencing the preparedness of dispatch centers remains limited and fragmented. In this context, the present study sought to identify and categorize the human, organizational, environmental, and technological factors that affect the preparedness level of these centers by conducting semi-structured interviews with experts and managers in the prehospital emergency field. This qualitative approach facilitates a deep, context-specific, and indigenous understanding of the various dimensions of preparedness and can serve as a foundation for developing future models, formulating policies to enhance preparedness, designing educational interventions, and improving the performance of dispatch centers in disaster situations.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis qualitative study was conducted from October 2024 to May 2025 as part of a larger research project aimed at developing a disaster preparedness and response model for prehospital emergency dispatch centers in Iran.\u003c/p\u003e\u003cp\u003eData were collected through individual interviews and focus group discussions, all conducted by the lead researcher. To ensure reflexivity, the researcher maintained a reflective journal throughout the study. This practice involved critically examining personal biases and assumptions to prevent them from unduly influencing the data collection and analysis processes.\u003c/p\u003e\u003cp\u003eThe study employed Conventional Qualitative Content Analysis (CQCA) with an inductive approach. This approach is particularly suited for exploring areas with limited theoretical and empirical background, especially within local, complex, and context-specific settings. In CQCA, concepts and themes are derived directly from the raw data, without relying on predefined categorization frameworks, to generate novel insights within a particular domain (35\u0026ndash;38). This characteristic distinguishes CQCA from other content analysis approaches, such as Directed Content Analysis or Summative Analysis, as well as from methods like Grounded Theory. While Grounded Theory aims to discover relationships between themes and build an integrated, abstract, and overarching theory, CQCA primarily focuses on extracting and describing tangible, context-specific themes directly within the data(39). Given that the primary aim of this study was to identify and elucidate the context-specific factors influencing the performance of emergency dispatch centers in disaster settings, rather than to generate a comprehensive, abstract theory, the grounded theory methodology was not aligned with the research objective. Grounded theory is principally employed for explaining processes and building theory from the ground up. Consequently, conventional qualitative content analysis was selected as the analytical method for this study. This approach is particularly well-suited for inductively identifying a wide range of relevant factors from the practical experiences and insights of experts and practitioners. Moreover, its adaptability to complex and underexplored contexts made it the most appropriate methodology for addressing the research question.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eResearch Paradigm\u003c/h2\u003e\u003cp\u003eThis study was underpinned by the interpretivist paradigm. Interpretivism posits that reality is subjective, multiple, and socially constructed, emerging from the interactions among individuals and their interpretations of their experiences. (37) The aim of this study was to develop an in-depth understanding of the lived experiences and perspectives of experts in prehospital emergency dispatch centers when confronting the complex, high-pressure conditions of disasters. In such settings, decision-making is shaped by a confluence of human, organizational, environmental, and technological factors. The selection of this paradigm was therefore critical, as it enabled a deep exploration of the participants' subjective meanings, beliefs, and perceptions\u0026mdash;grounded in both their personal experiences and their professional knowledge and expert analyses\u0026mdash;within their authentic, high-stakes operational context.\u003c/p\u003e\u003cp\u003eUnlike the positivist paradigm, which emphasizes generalizability, causal relationships, and statistical regularities, the interpretivist framework centers on a qualitative understanding of meaning-making processes, interpretive frameworks, and individual experiences within real-world social settings. This approach provides the necessary lens to deeply examine complex issues such as risk perception, inter-organizational dynamics, communication barriers, and decision-making pressures during disasters, directly from the viewpoint of frontline practitioners and subject-matter experts (40).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Population, Participant Selection, and Data Collection\u003c/h3\u003e\n\u003cp\u003eThe study population comprised emergency managers, dispatch center personnel and managers, Emergency Medical Technicians (EMTs), and managers and specialists from Iran's prehospital emergency operations centers.\u003c/p\u003e\u003cp\u003eParticipants (n\u0026thinsp;=\u0026thinsp;20) were selected using a purposive sampling strategy, supplemented by snowball sampling, to ensure maximum variation in terms of gender, age, educational background, professional experience, and role. Prior to each interview, the researcher provided a verbal explanation of the study's objectives, emphasizing the voluntary nature of participation, the confidentiality and anonymity of their data, and their right to withdraw at any stage. Oral informed consent was obtained from all participants for conducting and audio-recording the interviews. To foster an open and comfortable environment where participants could freely share their experiences and perceptions, they were invited to choose a time and location for the interview at their convenience. Each interview was conducted individually in the pre-agreed setting.\u003c/p\u003e\u003cp\u003eInterviews were conducted either face-to-face at dispatch centers or via telephone, with each session lasting between 20 and 120 minutes. All interviews were audio-recorded and transcribed verbatim immediately afterward. During this process, significant statements were highlighted, and the accuracy of the transcribed data was reviewed and confirmed. Any ambiguities in participant statements were resolved by requesting further clarification. The researcher actively bracketed personal presuppositions and prior knowledge to avoid influencing participant responses. The data derived from these interviews focused on factors influencing the preparedness and response of prehospital emergency dispatch centers during disasters, with the ultimate aim of designing a tailored model for Iran.\u003c/p\u003e\u003cp\u003eSemi-structured interviews commenced with an open-ended question. Based on the participants' initial responses, more specific and probing questions were asked. The core open-ended questions included:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eCould you describe your experiences with disaster response and management within the dispatch center? In your view, what are the most critical factors influencing your center's preparedness for disasters?\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePlease describe your center's current Emergency Operations Plans (EOPs) or Standard Operating Procedures (SOPs) for disasters. How comprehensive and practical do you find these plans?\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eWhat is the current state of disaster training for dispatch personnel? What additional specialized training do you believe is necessary?\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAre disaster-related exercises conducted regularly at your center? If so, could you explain how they are implemented and evaluated?\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eIn terms of resources\u0026mdash;personnel, equipment, and infrastructure\u0026mdash;how prepared is your dispatch center for a disaster? What are the key shortfalls?\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eHow reliable are your center's communication systems during a disaster? Are redundant or backup systems in place?\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eData saturation was reached after 18 interviews. To confirm that no new themes were emerging, two additional interviews were conducted, after which sampling was concluded.\u003c/p\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eInclusion criteria were having sufficient experience and knowledge of prehospital emergency dispatch center operations and a willingness to participate in the study. Exclusion criteria included an unwillingness to cooperate or a lack of relevant information on the topic.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eFirst, the interviews were transcribed verbatim. The principal investigator and a co-researcher then independently read each transcript multiple times to achieve immersion. Open coding was performed, where meaningful phrases and sentences were assigned descriptive conceptual labels. Subsequently, similar codes were grouped into subcategories. These subcategories were then organized into main categories based on their conceptual relationships. Finally, overarching themes were identified by consolidating related categories (41).\u003c/p\u003e\u003cp\u003eData analysis was conducted by members of the research team experienced in qualitative methodologies. Initially, two researchers independently performed the open coding of the interviews. Subsequently, the generated codes were reviewed and verified by two other researchers. Any discrepancies or ambiguities were then resolved through discussion in a consensus meeting attended by the entire research team and an experienced external researcher. The final coding framework was established based on this team consensus. This collaborative, consensus-driven process enhanced the rigor, consistency, and credibility of the analysis.\u003c/p\u003e\u003cp\u003eThis consensus-based approach enhanced the rigor and consistency of the analysis. The analysis was performed concurrently with data collection, and the final analysis was facilitated using MAXQDA software (version 2020).\u003c/p\u003e\u003cp\u003eIn this study, a total of 910 initial codes were generated from the analysis of interview transcripts and qualitative data. Through an iterative process of rereading, conceptual comparison, and merging of similar codes, these initial codes were subsequently organized into seven main categories and their associated subcategories.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eTrustworthiness\u003c/h3\u003e\n\u003cp\u003eTo ensure the rigor of the study, the trustworthiness criteria proposed by Guba and Lincoln\u0026mdash;credibility, confirmability, dependability, and transferability\u0026mdash;were employed (42). ). To enhance the \u003cb\u003ecredibility\u003c/b\u003e of the research, the researcher achieved an in-depth understanding of the phenomenon through prolonged engagement in the field and persistent interaction with the data. Furthermore, member checking was conducted by presenting the extracted themes to the participants for their review. Their feedback was subsequently incorporated to refine and finalize the analysis.\u003c/p\u003e\u003cp\u003eRegarding \u003cb\u003econfirmability\u003c/b\u003e, several measures were implemented to ensure that the findings were grounded in the data rather than the researcher's biases. Initially, two researchers coded the interviews independently. Following this, 20% of the coded transcripts were re-coded by two different researchers, and the results were compared. Any discrepancies were resolved through consensus in group meetings attended by the research team and an external researcher. Two faculty members, serving as independent auditors, reviewed the interview transcripts, initial codes, and the developed categorical structure, confirming their validity. Rather than using quantitative inter-rater reliability coefficients like Cohen's kappa, a consensus-based approach and collective reflexivity were employed to strengthen analytical coherence. Additionally, through \u003cb\u003epeer debriefing\u003c/b\u003e, the preliminary findings and categorical framework were reviewed by a group of experts external to the research team. Their feedback was integrated to improve the clarity, coherence, and applicability of the results.\u003c/p\u003e\u003cp\u003eTo address \u003cb\u003etransferability\u003c/b\u003e, purposeful sampling with maximum variation was utilized. This strategy ensured the inclusion of participants with diverse professional roles, work histories, and from various geographical locations.\u003c/p\u003e\u003cp\u003eFinally, the \u003cb\u003edependability\u003c/b\u003e of the study was secured by transparently documenting every stage of the research process, from design through data collection, coding, and analysis. A comprehensive audit trail was established, enabling other researchers to evaluate and potentially replicate the research process, thereby ensuring the stability of the findings\u003c/p\u003e\u003cp\u003e. Table\u0026nbsp;1 presents the demographic characteristics of the study participants.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTable\u0026nbsp;1\u003c/b\u003e:\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eDemographic Data of Participants\u003c/h2\u003e\u003cp\u003eSource: Authors\u0026rsquo; own work\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipant\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWork Experience (Years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDegree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eJob Title\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBSc Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDispatch Center Manager\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMSc Emergency Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAir Ambulance Manager\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBSc Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDispatch Center Manager\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBSc Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDispatch Center Manager\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBSc Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEmergency Medical Technician\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBSc Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDispatch Center Manager\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhD Health in Disasters and Emergencies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHead of Pre-hospital Emergency Center\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBSc Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDispatch Center Manager\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBSc Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEmergency Medical Technician\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBSc Anesthesia Technician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDispatch Center Manager\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBSc Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDispatch Center Manager\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBSc Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEmergency Communications Manager\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEmergency Medicine Specialist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHead of Pre-hospital Emergency Center\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBSc Emergency Medical Services\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOperations Command Center Expert\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhD Management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDeputy Head of Pre-hospital Emergency Center\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBSc Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDispatch Center Personnel\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBSc Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDispatch Center Manager\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBSc Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDispatch Center Personnel\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBSc Emergency Medical Services\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDispatch Center Manager\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBSc Nursing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOperations Command Center Expert\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe data analysis, conducted using conventional content analysis, involved an iterative process of coding, categorization, and comparison. This process resulted in the identification of 13 main categories and 63 sub-categories, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, which represent the factors influencing the disaster preparedness of emergency dispatch centers in Iran. These categories included: exercises, security, safety, communication, early warning systems, planning, resources, individual skills, environmental factors, organizational structure, monitoring, evaluation, performance improvement, coordination, and education.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCategories, Subcategories, and Themes Extracted in this Study\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSubcategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSample Code\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"50\" rowspan=\"51\"\u003e\u003cp\u003e\u003cb\u003ePreparedness\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003e1. Exercises\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercise Implementation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInstitutionalization of structured exercises\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTypes of Exercises\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eImplementation of specialized dispatch exercises\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercise Evaluation and Lessons Learned\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTargeted evaluation during dispatch exercises\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExercise Planning and Design\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSystematic design and implementation of exercise programs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003e2. Security\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhysical and Psychological Security of Personnel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eManaging psychological threats from abusive and nuisance calls\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhysical Security\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEnsuring multi-layered security (physical, psychological, legal)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLegal Security\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReinforcing the legal framework to support telecommunicator decision-making\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInformation and Communication Security\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEstablishment and maintenance of secure communication and information infrastructure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e3. Safety\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOperational Safety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStandardization of operational safety\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-structural and Equipment Safety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOptimization of non-structural safety in the workplace\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStructural Safety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStructural reinforcement of dispatch centers\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e4. Communications\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAlternative Communication Systems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEstablishment of a multi-layered, redundant communication network\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePrimary Communication Systems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReducing system dependency on vulnerable infrastructure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003e5. Early Warning System\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWarning Reception and Processing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEstablishing two-way communication channels between dispatch and the EOC\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWarning Dissemination and Timely Notification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eImmediate activation of the hospital alert network\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWarning Tools and Technologies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUtilization of location-based systems (GIS)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWarning Information Sources\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUse of a multi-hazard warning dashboard\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003e6. Planning\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIncident Action Plan (IAP)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDesigning rapid Incident Action Plans\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEmergency Operations Plan (EOP)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDevelopment of localized Emergency Operations Plans\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard Operating Procedure (SOP)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCreation of role-based SOPs\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eContinuity of Operations Planning (COOP)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMaintaining dispatch continuity during disruptions using backup lines\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e7. Resources\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMateriel and Equipment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOptimal management of hardware and software resources\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInfrastructure and Structures\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePre-planning alternative solutions for critical infrastructure failure\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStaff (Human Resources)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOptimization of workforce capacity\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003e\u003cb\u003e8. Individual Competencies\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTeamwork Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFostering team synergy between operational experience and specialized knowledge\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOccupational Burnout\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eManagement of job-related fatigue and workload\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePsychological and Behavioral Attributes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEnhancing analytical competency and intuitive decision-making\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDecision-Making\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOptimization of decision-making in resource allocation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCommunication Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEnhancement of telecommunicators' communication skills\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMotivational Factors and Job Satisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCreation of financial and non-financial incentive systems\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSpecialized Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDevelopment of spatial and geographical knowledge (urban topography)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMental Health and Resilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStrengthening the psychological resilience of personnel\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003e9. Environmental Factors\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSocioeconomic Factors of the Host Community\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eImproving public crisis literacy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTemporal Factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eManaging operational limitations during low-staffing hours\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCultural Factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLeveraging local personnel familiar with the geographic and cultural environment\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGeographical Factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e[Merged with 'Cultural Factors' as per the provided code's context]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003e10. Organizational Structure\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStructural Flexibility in Disaster Conditions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEstablishing flexible structures to allow for decisional autonomy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRoles and Responsibilities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDefining clear, crisis-oriented roles and responsibilities\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCommand and Management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOn-site presence of emergency managers in the field\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStructural Model and Design\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIntegration of dispatch centers at the provincial level\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003e11. Performance Monitoring, Evaluation, and Improvement\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFeedback Mechanisms and Continuous Improvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSystematic analysis and feedback on call recordings\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLessons Learned\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInstitutionalizing the lessons-learned process\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEvaluation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStandardization of call performance evaluation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e12. Coordination\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntra-organizational Coordination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStrengthening multi-level coordination (technicians, dispatch, management)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInter-organizational Coordination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExpanding inter-agency communication networks\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e\u003cb\u003e13. Training and Education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExperience and Clinical Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEnhancing the experience and clinical acumen of telecommunicators\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTraining Methods and Tools\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdopting an all-hazards approach to training\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePublic Education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eImproving public literacy on emergencies and disasters\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOnboarding Training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePlanning specialized training programs for new recruits\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eContinuing and In-service Training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eUtilizing continuous training as a catalyst for performance enhancement\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSpecialized Training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eImproving geographical familiarity through field visits\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e1. Exercises\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eExecution of Exercises: The regular and systematic execution of exercises, guided by established protocols and including critical scenarios such as automation failure and inter-agency collaboration, was identified as essential for achieving operational readiness. However, a significant deficiency noted was the lack of exercises specifically designed for dispatch centers. One participant stated:\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"The majority of exercises conducted in the health system and EMS focus on field units and ambulances. Very few exercises are specifically designed for the communications and dispatch center.\" (P7)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eTypes of Exercises: Participants emphasized the necessity of conducting diverse types of exercises\u0026mdash;including dispatch-specific exercises (e.g., operating backup systems), tabletop simulations, and full-scale inter-agency maneuvers\u0026mdash;to ensure comprehensive preparedness. A participant remarked:\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"These exercises are effective only when executed operationally and step-by-step; realistic and detailed scenarios should be designed as tabletop exercises and implemented in a simulated, intra-group setting by dispatch center members around a table, using visualizations of the situations.\" (P7)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eExercises Evaluation and Lessons Learned: The critical importance of conducting detailed, dispatch-focused evaluations after each exercises was highlighted. Providing structured feedback to all participants is vital for identifying lessons learned and driving continuous improvement in preparation for future events. As one participant noted:\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"During exercises, the dispatch center must be specifically evaluated and assessed to identify its strengths and weaknesses, which in turn allows for the improvement of future preparedness plans.\" (P14)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eExercises Planning and Design: The effectiveness of exercises hinges on meticulous planning and design. This involves holding specialized sessions to clearly define objectives, develop realistic scenarios, and establish evaluation metrics. A participant explained:\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"We collaborate in a group of five to six people, along with the head of field units and the quality control manager\u0026mdash;seven of us in total\u0026mdash;to plan the exercises and prepare the necessary equipment.\" (P13)\u003c/p\u003e\u003cp\u003e2. Security\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003ePhysical and Psychological Security of Personnel: Ensuring the physical and psychological security of dispatch personnel is critical. Measures such as providing psychological support, demonstrating managerial commitment, and mitigating nuisance calls were deemed essential for preserving staff morale and optimizing decision-making under pressure. The security of personnel's families was also noted as a direct influence on their professional commitment.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"The psychological security of individuals is heavily influenced by public awareness. For instance, in Tehran EMS, it has been reported that nuisance calls disrupt the dispatch center as frequently as once per minute, which can harm the personality and mental health of the staff.\" (P7)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003ePhysical Security: Protecting the dispatch center facility, equipment, and staff from external threats is vital for operational continuity. This includes ensuring the structural integrity and physical defense of the building.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"Physical security is a major challenge. For example, we have seen instances where, during an incident, some individuals have attacked the dispatch center, attempting to break the windows of the dispatch section.\" (P7)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eLegal Security: A supportive legal framework is necessary to protect telecommunicators from liability concerning their operational decisions. This legal security enhances their psychological well-being and promotes more confident and effective performance.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"If a telecommunicator decides to deploy all resources to an incident scene, it must be clear whether this decision is supported by a legal basis and a specific protocol, or if it is based solely on personal judgment.\" (P1)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eInformation and Communication Security: Information and communication security\u0026mdash;ensuring the confidentiality, integrity, and availability of data and systems\u0026mdash;is a cornerstone of disaster operations. Continuous training on data confidentiality was identified as a key component of this principle.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"In disasters, the security of communications and the confidentiality of information in dispatch centers are crucial. Secure communication systems must be designed\u0026mdash;encompassing software, hardware, and management aspects\u0026mdash;to prevent sensitive information leaks and mitigate communication risks.\" (P7)\u003c/p\u003e\u003cp\u003e3. Safety\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e Functional Safety: Functional safety is achieved by establishing and adhering to standardized protocols and guidelines. This ensures a consistent and safe operational environment for both service delivery and the management of communication and information systems.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e \"The functional aspects are primarily related to areas like protocols, guidelines, and training, which I believe we touched upon at the beginning of our discussion.\" (P27)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eNon-Structural and Equipment Safety: Ensuring the safety of non-structural components and equipment is vital for operational continuity. This includes maintaining a standardized and safe physical workspace and verifying the integrity of all operational and communication equipment.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"Non-structural components in residential buildings must meet safety standards and requirements. Although there are no specific mandates for dispatch centers, their critical role necessitates special attention to designing and evaluating them with a higher safety perspective.\" (P7)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eStructural Safety: The structural safety of the dispatch center is paramount. The facility must be designed and maintained to withstand prevalent local hazards, adhering to modern engineering standards and undergoing necessary structural reinforcement to ensure its resilience during a disaster.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"Dispatch centers must be designed according to current global standards to ensure they can execute their processes correctly in a safe environment with an appropriate structure.\" (P13)\u003c/p\u003e\u003cp\u003e4. Communication\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eAlternative Communication Systems: To counter potential failures of primary networks, it is vital to equip dispatch centers with multi-layered, redundant communication systems (e.g., telephone, radio, satellite). This requires identifying coverage gaps and acknowledging the limitations of each system. Radio systems were recommended as a cost-effective and resilient option, along with the establishment of hotlines and mobile dispatch units.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"The updated systems are the 'Asayar' systems. These systems must use modern and new equipment to be efficient in terms of both time and cost.\" (P3)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eCurrent Communication Systems: Challenges within the existing communication infrastructure must be addressed. These include line congestion from non-essential calls, difficulties communicating with non-native speakers, communication and internet outages, and the reliance of automation systems on internet connectivity. Effective communication management by telecommunicators and efficient interaction with field teams are also critical.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"In critical situations, due to telephone line disruptions, radio becomes the primary tool for rapid notification about the incident and its location.\" (P10)\u003c/p\u003e\u003cp\u003e5. Early Warning System (EWS)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eWarning Reception and Processing: The processes for receiving and handling initial alerts within the dispatch center are crucial for a rapid response. The 115 emergency number was identified as a primary source of initial information, highlighting the key link between dispatch and the Emergency Operations Center (EOC). There is a need for regional hazard assessments and a centralized, integrated EWS, preferably located at the EOC, which incorporates meteorological data.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"In many cases, the 115 emergency line can be the first source of warning, even before the media and cameras.\" (P20)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eWarning Dissemination and Timely Notification: Rapid, accurate, and targeted dissemination of warnings to all relevant internal and external personnel, teams, units, and agencies is essential for a coordinated response.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"In early warning, the dispatch center has a specific role; we pass the alert to the MCMC [Mass Casualty Management Center], then to the EOC, and finally it is communicated to the hospitals.\" (P1)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eWarning Tools and Technologies: The use of modern tools and technologies, such as news networks, Geographic Information Systems (GIS), and monitoring of traffic and city cameras within the dispatch center, is recommended to improve the efficiency, speed, and accuracy of the warning process.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"A GIS system allows for the consolidation and analysis of information such as the number of health posts, ambulances, and personnel, and can play an effective role in the early warning of disasters.\" (P16)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eSources of Warning Information: Identifying, accessing, and utilizing credible, diverse, and reliable information sources, such as an all-hazards early warning system dashboard, is necessary for the timely detection of threats and a reduction in response time.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"In an earthquake, the lack of a rapid warning system causes delays; the system and the telecommunicator's duties must be configured for an immediate response.\" (P18)\u003c/p\u003e\u003cp\u003e6. Planning\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eBusiness Continuity Planning (BCP): Developing strategies to maintain continuous and uninterrupted operations of the dispatch center during crises and disasters is a key component of preparedness.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"Planning for and immediately determining the logistical needs of ambulances at the dispatch unit is essential for the continuity of services.\" (P4)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eIncident Action Plan (IAP): The development and implementation of specific, localized IAPs tailored to the type and severity of an incident are crucial. This includes forming a disaster committee and defining different disaster levels within the dispatch center. Well-vetted action plans were considered more important than generic Emergency Operation Plans (EOPs).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"For unexpected events like a train derailment, there is usually no specific action plan; in such cases, protocols for similar mass casualty incidents are used for triage.\" (P2)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eEmergency Operations Plan (EOP): A documented, comprehensive, and executable EOP that is localized and covers all phases of preparedness, response, and recovery is vital. The EOP should incorporate factors affecting dispatch preparedness and requirements, such as voice logging and pre-disaster coordination meetings.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"The factors affecting the preparedness and response of dispatch centers in disasters must be considered in the Emergency Operations Plan.\" (P19)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eStandard Operating Procedures (SOPs): The development, training, implementation, and continuous updating of dispatch center SOPs, especially for disasters, are essential for standardizing performance, reducing errors, and clearly defining staff roles. This is critical despite challenges such as the proliferation of guidelines and the need for localization.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e \"Guidelines should cover the general principles, while the specifics should be delegated to each region to determine based on its unique geographical, cultural, and economic conditions.\" (P19)\u003c/p\u003e\u003cp\u003e7. Resources\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eStuff (Materiel and Equipment): Procuring, maintaining, and updating sufficient, standard, and reliable equipment is a necessity. This includes advanced communication systems (radio, satellite phone, analog equipment), emergency power generators, and uninterruptible power supplies (UPS) to counteract the dependency on internet-based automation during connectivity disruptions.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"The center's equipment must be complete during disasters, and hotlines must be active. Additionally, Geofencing and GPS systems should be interconnected to provide precise timings.\" (P5)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eStructure (Physical and Organizational Infrastructure): The existence of resilient and appropriate physical infrastructure (e.g., a secure building, adequate space, a backup or mobile dispatch center) and efficient organizational structures (e.g., robust servers, separation of triage and dispatch units) is essential. Strengthening weak communication infrastructure (internet and radio) and mandating a backup dispatch center are necessary for service continuity.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"Our servers are designed to handle a maximum of 20,000 concurrent calls. Although we may never reach this limit, by establishing a powerful infrastructure, we prevent call disruptions.\" (P13)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eStaff (Human Resources): Securing sufficient, skilled, trained, motivated, and resilient human resources is crucial. This includes attending to their physical and mental well-being to address challenges such as staff shortages, the attrition of experienced personnel, and the need to expand capacity with specialized staff and language interpreters.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"Disasters require a larger and more well-trained workforce. This is one of the persistent challenges we face.\" (P10)\u003c/p\u003e\u003cp\u003e8. Individual Skills\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eTeamwork Skills: Effective teamwork within the dispatch center, achieved by creating a coordinated blend of experienced and newly trained personnel and fostering constructive interaction, is essential for optimal performance.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"Success in emergency services depends on teamwork and coordination. Even the most capable individuals are ineffective without a role in the team.\" (P18)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003ePsychological and Behavioral Traits: Personnel should possess psychological resilience, up-to-date knowledge, analytical ability, intuitive decision-making, rapid response capabilities, high emotional intelligence, multitasking skills, and an extroverted personality. The ability to manage caller anger and demonstrate accountability under stress was particularly emphasized.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"In disasters, individuals must have sufficient psychological, physical, and mental resilience to manage the pressures of the crisis and make sound decisions. They must be able to maintain composure and react rationally to stress and diverse behaviors.\" (P2)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eJob Burnout: Job burnout among dispatch staff is caused by high-stress calls, heavy workloads, and nuisance calls, leading to diminished focus and response quality.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"Optimizing human resources by reducing calls and nuisances can enhance performance quality and prevent job burnout.\" (P4)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eDecision-Making: The ability to make timely and correct decisions regarding resource deployment is critical. Empowering telecommunicators in operational decision-making, supported by decision support systems and avoiding reactive or emotional judgments, is vital for effective disaster management.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"While adhering to protocols, telecommunicators must have the flexibility to make decisions based on the situation.\" (P15)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eCommunication Skills: Possessing effective communication skills with patients and callers\u0026mdash;including managing their anger and stress, building interpersonal rapport, proficiency in GPS and map-reading, and using clear verbal communication and active listening\u0026mdash;is essential for gathering accurate information and providing effective services.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e \"Through effective communication and the use of key vocabulary, a telecommunicator can obtain a relatively accurate understanding of the incident scene without being physically present.\" (P7)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eMotivational Factors and Job Satisfaction: Providing financial and motivational support, encouraging staff, receiving supervisor support, fostering intrinsic motivation, and using positive feedback are important for increasing job satisfaction and employee commitment.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"Senior managers and officials should motivate and encourage staff before a crisis occurs, during exercises, or based on past experiences, so they feel seen and are prepared.\" (P7)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eSpecialized Skills: Proficiency in specialized skills such as urban geography and precise address location, estimating the number of casualties, providing professional advice, guiding ambulances, performing correct telephone triage, and map-reading is necessary for efficient telecommunicator performance.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"For hiring dispatch personnel, familiarity with routes, proper elocution, and the ability to manage stress are of particular importance.\" (P15)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eMental Health and Resilience: Maintaining professional conduct, managing anxiety and stress, and strengthening psychological resilience through reduced workloads, increased support, and composure are prerequisites for system effectiveness in disasters. Ensuring psychological, physical, legal, and ethical security is also crucial, and ethical issues such as the potential for job abandonment must be considered.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"Low psychological resilience among dispatch staff can lead to a loss of control over professional behavior when facing crises.\" (P17)\u003c/p\u003e\u003cp\u003e9. Environmental Factors\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eSocioeconomic Factors of the Host Community: Factors such as a lack of public awareness regarding the role of emergency services in disasters and the impact of personnel's family issues on their performance can affect preparedness and response.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"Callers put immense pressure on the telecommunicator, forcing them to send more ambulances, which stemmed from the public's lack of awareness about the emergency system.\" (P2)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eTemporal Factors: Effective planning must account for the increase in incidents during nighttime hours, challenges related to surging capacity and staff recall for after-midnight crises, and seasonal variations in the type and number of incidents.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"In the summer, because people stay awake later and spend more time outdoors, the number of incidents increases.\" (P5)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eCultural Factors: There is a need for public education on how to properly contact emergency services, promoting community awareness of hazards and disasters, and addressing the impact of local dialects on communication. The latter presents a challenge for centralized dispatch centers and requires telecommunicators to be familiar with regional dialects and for protocols to be localized.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"One of the most significant issues was external factors beyond the dispatch's control, which were influenced by public culture and social conditions.\" (P7)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eGeographical Factors: Proper siting of the dispatch building, considering access and security, is essential. Zoning provinces and assigning local telecommunicators familiar with the area, as well as establishing resilient or mobile dispatch units, are necessary for better coverage of large regions.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"The dispatch center should be built in a secure location, away from high-risk zones, because constructing it in a crisis-prone area could disrupt the system's functionality in the event of unrest or an incident.\" (P9)\u003c/p\u003e\u003cp\u003e10. Organizational Structure\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eStructural Flexibility in Disaster: An effective response requires moving beyond rigid adherence to protocols and allowing for creativity and autonomy in telecommunicators' critical decision-making during crises.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"The limitations of protocols in the dispatch system reduce operators' creativity and may be rooted in the organizational structure.\" (P20)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eRoles and Responsibilities: A clear, precise, and up-to-date definition of roles and responsibilities for all personnel, especially during disasters, is necessary to prevent confusion and task overlap. This can be achieved through horizontal task division and designing specific job descriptions for disaster situations.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"In a disaster, responsibilities must be clearly defined; for instance, one person should be responsible for statistics and information dissemination to avoid confusion and interference with operational staff.\" (P7)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eCommand and Management: An efficient management structure avoids direct intervention from senior executives in real-time operational decisions, instead routing communication through middle management. The center director should be informed and present on-scene to lead and activate the management team. An integrated incident command system, with a clear separation between triage and dispatch units and relative autonomy for the dispatch center, is essential.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"In my opinion, direct communication from senior managers to dispatch leads to unprofessional interference and 'VIP management,' and is not recommended.\" (P7)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eStructural Model and Design: It is important to evaluate and select from various structural models, such as a centralized provincial dispatch with benefits like data consolidation and cost reduction, integration with other relief agencies, and the design of a layered, defense-in-depth dispatch system to enhance efficiency and resilience.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"The initial idea was to design the dispatch in a layered, defense-in-depth model, so that different centers in various cities could act as backups for each other and support the central dispatch. However, due to telecommunication limitations, its implementation was not feasible.\" (P11)\u003c/p\u003e\u003cp\u003e11. Monitoring, Evaluation, and Performance Improvement\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eFeedback Mechanisms and Continuous Improvement: Establishing systematic feedback mechanisms (e.g., voice-log monitoring and reports) to assess personnel and system performance is essential. This feedback should be used to identify strengths and weaknesses and drive continuous improvement, benchmarked against current standards.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"After incidents, the emergency headquarters should conduct a specialized analysis, compare performance with current standards, identify strengths and weaknesses, and provide appropriate feedback based on these findings.\" (P5)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e Lessons Learned: Systematically extracting lessons learned from operational experiences in real incidents and exercises, and applying them to revise and improve plans, guidelines, and training programs, helps enhance preparedness. This can be informed by the experiences of other successful countries.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"To upgrade our dispatch systems, we must draw on the experiences and lessons learned from advanced countries in disaster management and modernize our systems accordingly.\" (P12)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eEvaluation: Regular individual and system-level performance evaluations using standardized methods are necessary for process correction and preparedness enhancement. Methods include voice-log monitoring, self-assessment, peer review, direct observation, surveys, analysis of triage times, pre-employment and periodic testing, and training classes based on identified errors. This is crucial despite challenges like the absence of a proper oversight system.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"The problem of increased triage time is addressed by reviewing and evaluating call audio, followed by providing the necessary training to improve performance.\" (P19)\u003c/p\u003e\u003cp\u003e12. Coordination\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eIntra-organizational Coordination: Effective, transparent, and continuous communication and coordination among different EMS units\u0026mdash;including dispatch, field units, deployed teams, and management levels\u0026mdash;are vital for rapid and effective decision-making. This can be facilitated by text message alerts to managers, a centralized dispatch, joint briefing sessions, virtual collaboration groups, and the presence of EOC and MCMC liaisons in the dispatch center.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"Intra-organizational coordination of the dispatch plays a key role in improving the rapid and effective response to incidents and crises.\" (P2)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eInter-organizational Coordination: Close and active collaboration with other relief agencies (e.g., Red Crescent, Fire Department), law enforcement, utility services, healthcare facilities, and disaster management authorities is essential for integrated disaster management. This can be achieved through shared radio channels, hotlines, and coordination via the EOC. However, challenges persist, such as the unresponsiveness of some organizations on radio channels. Separating EOC functions from dispatch or co-locating them could be beneficial.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"We placed the EOC team at the dispatch location to manage inter-organizational coordination effectively, without needing dedicated systems.\" (P7)\u003c/p\u003e\u003cp\u003e13. Education and Training\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eExperience and Skill: Work experience, particularly clinical and operational backgrounds (male telecommunicators with field experience, female telecommunicators with hospital experience), is emphasized for accurate situational awareness, appropriate decision-making, and disaster management. Staying current with information and utilizing experienced personnel in disasters is critical.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"Dispatch personnel should have clinical experience in hospital emergency departments and be familiar with different triage situations.\" (P7)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eTraining Methods and Tools: Employing diverse and modern training methods such as error-based learning, realistic scenarios, simulations, morning reports, case reports, posters, and all-hazards training is necessary to increase training effectiveness. A focus on separate training for triage and dispatch units is also important.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"Dispatch must receive all-hazard and special-hazard training, especially in areas like CBRN and special communications, where some information must remain confidential and communication methods must be unique and specific.\" (P15)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003ePublic Education: Educating the public on the correct way to contact emergency services, avoiding unnecessary line occupation, providing accurate and complete information, and increasing community awareness and preparedness for disasters is important. This includes preparing pre-recorded educational messages for use during crises.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"Automated messages for disaster situations should be designed so that a caller without an injured person is prompted to hang up quickly and free the line.\" (P13)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eInitial (Onboarding) Training: Providing comprehensive, specialized, and standardized training to new recruits before they begin work, particularly in telephone triage and familiarity with dispatch center processes, is essential for their initial preparation.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"The initial training for dispatch personnel includes a three-day triage simulation course in a simulated environment, and this training is very important.\" (P8)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eContinuing and In-Service Education: Planning and conducting continuous training courses, regular refresher training, and updates for all staff (e.g., morning reports, seasonal triage training, and staff participation in teaching) play a vital role in enhancing and maintaining the quality of personnel performance.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"Personnel first learn triage and the software system, then they get to know the city, and then they enter in-service training such as CPR and ambulance status.\" (P17)\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eSpecialized Training: There is a fundamental need for training in specialized areas such as stress and disaster management, mental health, advanced communication skills, specialized telephone triage, use of new software and systems, detailed map-reading and urban geography, familiarity with local hazards, disaster information management, and rapid decision-making techniques. The scarcity of dispatch-centric specialized training is a major challenge. Cross-training between technicians and telecommunicators could also be beneficial.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\"Specialized disaster training for dispatch in Iran is limited to cards and paper, whereas other countries use advanced simulations.\" (P19)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis qualitative study, utilizing conventional content analysis, identified thirteen main categories and sixty-three subcategories concerning the factors that influence the disaster preparedness of prehospital dispatch centers in Iran. These categories included planning, training, exercises, resources, communication, early warning systems, safety, security, coordination, organizational structure, human resources, individual skills, monitoring and evaluation, and environmental and cultural factors.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePlanning\u003c/b\u003e, identified as a foundational category, was described as the cornerstone of effective preparedness. The findings indicated that the absence of codified action plans, a lack of structural and functional standards, and a deficit of localized guidelines tailored to geographical variations were significant barriers. Participants particularly emphasized the necessity of developing formal Incident Action Plans (IAPs), Emergency Operation Plans (EOPs), and Standard Operating Procedures (SOPs), which align with the findings of Smith et al. (2016).(43)\u003c/p\u003e\u003cp\u003eA study by Agri et al. (2023), which aimed to assess prehospital preparedness for major incidents in Sweden, also stressed the importance of standardizing guidelines, conducting regular exercises, and performing periodic evaluations. While these findings are consistent with our study, the present research highlights dimensions less emphasized by Agri et al. by focusing on the specific context of Iran, including the need for the localization of planning, training, and inter-sectoral collaboration. (18). In the domain of \u003cb\u003etraining\u003c/b\u003e, a deficiency in dispatch-centric specialized education, a lack of training in crisis decision-making, geographical proficiency (topographical knowledge), telephone triage, and stress management, as well as insufficient use of simulation in training, were identified as serious weaknesses. Furthermore, the role of structured and continuous in-service training\u0026mdash;including morning reports, feedback based on call audits, and lessons-learned sessions\u0026mdash;was deemed critical for enhancing personnel performance, especially during disasters. This emphasis on operational training is consistent with the results of Smith et al. (2016) (43).\u003c/p\u003e\u003cp\u003eThe study by Donford et al. (2002) also underscored the necessity of developing standardized telephone triage protocols and providing continuous training for operators, a theme that was also identified as a key component of training in our study. However, the present research expands upon this by also addressing topics such as topographical training, soft skills, and the localization of triage algorithms. (44).\u003c/p\u003e\u003cp\u003e\u003cb\u003eExercises and operational exercises\u003c/b\u003e were recognized as another essential need for enhancing preparedness. Participants pointed to a shortage of dispatch-specific exercises, tabletop and simulation-based exercises, and a lack of systematic post-exercise evaluation. The implementation of scenario-based exercises, joint inter-agency maneuvers, and the analysis of their outcomes were considered vital for fostering coordination, improving decision-making, and enhancing individual and team skills.\u003c/p\u003e\u003cp\u003eRegarding \u003cb\u003eresources\u003c/b\u003e, challenges such as staff shortages, equipment obsolescence, the absence of a backup infrastructure like mobile or secondary dispatch centers, and weak communication infrastructure were among the most significant obstacles identified. In particular, the reliance on internet-based automation was identified as a serious threat to service continuity during communication outages, which is consistent with Chen et al. (2024) (3). Accordingly, the use of two-way radios, satellite phones, analog equipment, power generators, and uninterruptible power supplies (UPS) was recommended.\u003c/p\u003e\u003cp\u003eFrom the perspective of \u003cb\u003eearly warning systems\u003c/b\u003e, the integration of alert systems, effective communication with the Emergency Operations Center (EOC), and the use of GIS data, urban monitoring cameras, and hazard-forecasting dashboards were identified as effective strategies. Additionally, multi-layered communication channels, hotlines, and the use of resilient communication systems were introduced as essential components for maintaining communication stability during disasters.\u003c/p\u003e\u003cp\u003e\u003cb\u003eOrganizational structure\u003c/b\u003e was another influential factor. The findings showed that having clear job descriptions, an Incident Command System (ICS) model, a crisis-specific organizational chart, and flexible management structures can play a key role in ensuring cohesive dispatch performance during disasters. Participants also emphasized the need to separate triage and dispatch units, have a liaison officer for the EOC, and grant dispatch centers relative autonomy from direct intervention by senior management.\u003c/p\u003e\u003cp\u003eContinuous \u003cb\u003emonitoring and evaluation\u003c/b\u003e of dispatch performance was another prominent theme. The use of call audits, evaluations based on standardized forms, morning report sessions, theoretical and practical tests for personnel, and structured feedback were identified as essential tools for process improvement and preparedness enhancement.\u003c/p\u003e\u003cp\u003e\u003cb\u003eIndividual skills\u003c/b\u003e, mental health, resilience, and job motivation also play a role in elevating preparedness levels, which aligns with the study by Giaume et al. (2024).(45) Intuitive decision-making, emotional intelligence, skill in de-escalating angry callers, and accountability under stressful conditions were among the characteristics emphasized in this study. Ensuring the psychological and physical safety of staff, providing legal and ethical support for telecommunicators, and supporting their mental health were considered prerequisites for maintaining system effectiveness during disasters, consistent with the findings of Hosseini et al. (2018) (46).\u003c/p\u003e\u003cp\u003eFurthermore, the findings of Montassier et al. (2015), which examined the impact of shift length and rotation on telecommunicator performance, align with our study's findings. The present research also emphasized the effect of fatigue, shift type, and critical periods (e.g., midnight) on telecommunicator efficiency and offered suggestions for designing an optimal shift system. (47).\u003c/p\u003e\u003cp\u003eFrom the perspective of the participants, the readiness of dispatch centers is not From the participants' perspective, the preparedness of dispatch centers is not merely dependent on resources and structure but is the product of an interaction between resources, knowledge, skills, structure, communication, and organizational culture. Therefore, it is imperative that an integrated, systems-based approach be adopted in designing models for preparedness enhancement.\u003c/p\u003e\u003cp\u003eThe research by Lee et al. (2011) proposed the use of algorithms based on a preparedness index to optimize ambulance dispatch. Our study also underscores the importance of operational and regional preparedness indicators; however, our approach goes further by encompassing the structural, cultural, and managerial aspects that influence the level of preparedness. (48).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this qualitative study reveal that disaster preparedness in Iran's prehospital emergency dispatch centers is a complex, multidimensional construct that transcends the mere possession of resources. Derived from an in-depth analysis of experts' lived experiences, the findings indicated that effective preparedness emerges from the systematic interplay of 13 core factors that collectively define the capacity of these centers to respond to disasters. These factors\u0026mdash;comprising planning, training, drills, resources, communications, early warning systems, safety, security, coordination, organizational structure, individual skills, monitoring and evaluation, and environmental factors\u0026mdash;provide a comprehensive framework for understanding the key dimensions of this domain. The efficacy of this system is directly influenced by factors such as information integration (through warning and communication systems), the effectiveness of operational processes (rooted in planning, drills, and individual skills), inter-organizational coordination, access to sufficient resources, and the continuous empowerment of personnel. The use of lived experiences from dispatch professionals has furnished a deep understanding of decision-making processes in high-pressure situations, an insight that quantitative studies are unable to provide. The diversity of participants and adherence to credibility principles, such as theoretical saturation and independent re-coding, have strengthened the robustness of the findings. This study's focus on the Iranian context, coupled with an analysis of global challenges, makes its findings applicable and actionable for domestic policymaking and for health systems with similar characteristics. By presenting a holistic picture of the requirements for effective dispatch center preparedness in disasters, these results can provide a solid foundation for developing operational frameworks and redesigning structures to enhance health system resilience.\u003c/p\u003e\u003cp\u003eUnlike predominantly quantitative studies that focus on discrete indicators and mathematical modeling, this research, with its qualitative and context-specific approach, addresses a significant knowledge gap in the \"science of dispatch\" literature. The findings of this study address several critical gaps in the existing literature. First, it responds to the scarcity of qualitative evidence on dispatch preparedness in disasters, particularly in developing countries, by systematically documenting the lived experiences of dispatchers and managers. Second, based on the analysis of empirical data, a framework comprising thirteen main categories and sixty-three subcategories was extracted, which holistically integrates human, organizational, and contextual dimensions\u0026mdash;aspects often overlooked in previous studies that were predominantly quantitative and model-driven, typically focusing on only one or a few facets. This study introduces several scientific innovations, including an in-depth exploration of less-examined components such as the psychological safety of personnel, individual and organizational resilience, and multi-level coordination during crises. Furthermore, in contrast to most quantitative and model-based studies that have primarily concentrated on indicators like response times or resource capacity, this research, by drawing on the lived experiences of experts, presents a realistic and context-sensitive depiction of the preparedness requirements for disaster dispatch centers. For the first time, this study independently, deeply, and systematically investigates the preparedness of dispatch centers as a distinct unit of analysis\u0026mdash;a domain often studied implicitly within the broader framework of Emergency Medical Services (EMS). The findings show that the existence of rapid and efficient early warning systems leads to an effective response only when coupled with targeted training and regular drills for their application. Similarly, the development and updating of operational plans (EOPs \u0026amp; SOPs) will be effective only when supported by flexible organizational structures and continuous monitoring and evaluation mechanisms. This study also demonstrates that the alignment of management structures with national and international standards and the utilization of modern technologies play a pivotal role in enhancing the speed and accuracy of the response and are considered fundamental requirements for improving the resilience of these centers. Moreover, the research outcomes reflect the realities and challenges of dispatch centers in Iran and can be relevant for countries with similar cultural, organizational, and resource constraints.\u003c/p\u003e\u003cp\u003eIn addition to its practical value at the national level, the findings of this research are transferable to countries with cultural, structural, and health system development contexts similar to Iran. These nations can leverage the results of the present study to design context-specific policies, strengthen training programs, and enhance the disaster resilience of their prehospital emergency dispatch centers. Accordingly, the findings of this research, despite their local origins, can serve as a foundation for examining, improving, and adapting preparedness frameworks in other health systems' dispatch centers. The adaptability of these findings is contingent upon a thorough understanding of and alignment with the unique cultural characteristics, available resources, and managerial structures of each specific context.\u003c/p\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003ePolicy and Practical Recommendations\u003c/h2\u003e\u003cp\u003eThe findings of this study underscore the critical need for a comprehensive, systemic approach to enhance the preparedness of emergency dispatch centers. This approach must encompass the concurrent development of human and technical capacities, the strengthening of intra- and inter-organizational coordination, and the establishment of a resilient communications infrastructure capable of withstanding disaster conditions. Accordingly, the following strategic measures are recommended for policymakers and health system administrators:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eStrategic Planning and Standardization\u003c/b\u003e: Develop and institutionalize comprehensive Emergency Operation Plans (EOPs) and Standard Operating Procedures (SOPs). These protocols should not only align with national standards but also be adaptable to the specific hazards and contexts of each region. Furthermore, these plans must undergo periodic review and updates to ensure their continued relevance and effectiveness.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eInvestment in Human Capacity Building\u003c/b\u003e: Design and implement contextualized training programs for dispatchers that focus on critical competencies such as decision-making under pressure, stress management, advanced telephone triage, and situational awareness. The use of high-fidelity simulations and crisis scenarios, complemented by cognitive aids like checklists and step-by-step guides, can significantly improve response accuracy and timeliness.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eFortification of Technical Infrastructure and Security\u003c/b\u003e: Prioritize targeted investments to ensure the holistic security (physical, psychological, and legal) of personnel and to harden the physical infrastructure of dispatch centers against potential threats. Additionally, establishing and maintaining disruption-resilient communication protocols, including redundant systems (e.g., analog or satellite-based) for use during digital network failures, is essential. Implementing multi-layered communication channels will ensure operational continuity and coordination among units. To this end, conducting regular joint exercises with other emergency response agencies is vital for improving inter-agency collaboration and interoperability.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eInstitutionalization of Monitoring and Continuous Improvement\u003c/b\u003e: Establish a systematic framework for regular performance monitoring and evaluation within dispatch centers. This system should be designed to identify vulnerabilities, conduct root-cause analyses of errors, and drive process refinement. The findings from these assessments must directly inform the revision of training programs and operational protocols, creating a cycle of continuous improvement.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eDevelopment of Resilient Data Management Systems\u003c/b\u003e: Develop robust information management and monitoring systems capable of functioning in austere or degraded environments. This includes low-tech solutions, such as standardized paper-based forms and lightweight offline applications, alongside AI-driven analytical tools, to guarantee the continuity of critical functions. The deployment of simple, geo-referenced dashboards can also enhance real-time decision-making regarding resource allocation and mission prioritization.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eOptimization of Organizational Structure and Human Resources\u003c/b\u003e: From an organizational standpoint, strengthening the operational command structure within dispatch centers is crucial. This can be achieved through targeted leadership training and by empowering mid-level supervisors with delegated authority during crises to enhance decision-making agility and response readiness. Furthermore, integrating trained volunteers into predefined support roles (e.g., auxiliary call-taking, data entry, logistical support) can significantly augment human resource capacity during surge events, provided that this integration is governed by standardized and safety-oriented protocols to ensure operational integrity and mitigate risk.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eSuggestions for Future Research\u003c/h2\u003e\u003cp\u003eBuilding upon the comprehensive conceptual framework developed in this study, future research is recommended in the following areas. First, the development and validation of a standardized quantitative instrument based on the 13 identified factors to assess and compare the preparedness levels of dispatch centers on a national scale. Second, conducting interventional studies to evaluate the effectiveness and cost-benefit of the proposed interventions, such as specific training programs or new technologies. Finally, undertaking comparative studies to adapt successful international strategies to the local Iranian context could pave the way for continuous improvement and the achievement of a resilient and efficient national dispatch system.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eLimitations of the Study\u003c/h2\u003e\u003cp\u003eDespite efforts to ensure scientific rigor, this qualitative study was subject to several limitations. First, due to its qualitative nature, the findings, while information-rich, are not generalizable to all prehospital emergency dispatch centers in the country. Second, the purposive sampling strategy, although diverse, may not have fully captured the perspectives of all relevant groups or specific geographical regions. Third, the data were based on self-reports from interviews, which are susceptible to recall and social desirability biases. Fourth, time and resource constraints limited a more in-depth exploration of certain aspects. Fifth, the potential for researcher bias during the qualitative analysis process cannot be entirely eliminated. Future studies are encouraged to employ quantitative, mixed-methods, and longitudinal designs to better assess causal relationships and the impact of interventions.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEMS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEmergency Medical Services\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEOC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEmergency Operations Center\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEOP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEmergency Operations Plan\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSOP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandard Operating Procedure\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAIP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAction/Incident Plan\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEMDCs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEmergency Medical Dispatch Centers\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEMD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEmergency Medical Dispatcher\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEMTs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEmergency Medical Technicians\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Kerman University of Medical Sciences, Kerman, Iran (Ethics Code: IR.KMU.REC.1403.573).\u003cbr\u003e\u0026nbsp;All participants provided verbal informed consent prior to participation.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets (interview transcripts and qualitative materials) generated and analyzed during the current study are not publicly available due to confidentiality and privacy considerations of participants. Data may be made available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interest related to this study.\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eMohammad Reza Shafiei: No conflict of interest\u003c/li\u003e\n \u003cli\u003eMahmood Nekoei-Moghadam: No conflict of interest\u003c/li\u003e\n \u003cli\u003eSeyed Mobin Moradi: No conflict of interest\u003c/li\u003e\n \u003cli\u003eVahid Saadatmand: No conflict of interest\u003c/li\u003e\n \u003cli\u003eAsghar Tavana: No conflict of interest\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eFunding\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eMohammad Reza Shafiei: Conceptualization, Data Curation, Investigation, Writing \u0026ndash; Original Draft\u003c/li\u003e\n \u003cli\u003eMahmood Nekoei-Moghadam: Supervision\u003c/li\u003e\n \u003cli\u003eSeyed Mobin Moradi \u0026amp; Vahid Saadatmand: Formal Analysis, Data Management\u003c/li\u003e\n \u003cli\u003eAsghar Tavana: Methodology, Validation, Writing \u0026ndash; Review \u0026amp; Editing\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAll authors meet the four authorship criteria defined by the ICMJE.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the dispatchers, EMS managers, and emergency experts who generously shared their time and experiences during the interviews.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eKilungo AP, Chukwuonye GN, Okpanachi VP, Hussein M, editors. Assessing Sub-Saharan Africa\u0026apos;s Readiness to Address the Impact of Climate Change and Health: A Scoping Review. medRxiv; 2024\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eWHO. Health emergency and disaster risk management framework\u003cspan\u003e.\u0026nbsp;\u003c/span\u003eWorld Health Organization Geneva; 2019\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eChen S, Xing D, Wang Q, An Y, Chen Y, Zhou X, et al. A study of prehospital EMS response time and influencing factors in the main urban area of Chongqing, China. International Journal for Quality in Health Care\u003cspan\u003e. 2024;36(3):\u003c/span\u003emzae065\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eBachmann DJ, Jamison NK, Martin A, Delgado J, Kman NE. Emergency preparedness and disaster response: there\u0026rsquo;s an app for that. Prehospital and disaster medicine. 2015;30(5):486-90\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eGoldfine S, Volpi N. The Role of the Louisiana EMS Designated Regional Coordinator in Emergency Response During 2020/2021 COVID Pandemic and Hurricane Season. Prehospital and Disaster Medicine. 2023;38:s43 - s\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eCvetković VM, Tanasić J, Renner R, Rokvić V, Beri\u0026scaron;a H, editors. Comprehensive Risk Analysis of Emergency Medical Response Systems in Serbian Healthcare: Assessing Systemic Vulnerabilities in Disaster Preparedness and Response. Healthcare; 2024: MDPI\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eSakamoto T, Suzuki H, Machida T, Nishimura H, Noguchi Y, Amagai T. Victim profiles and revealed issues of type 1 emergency medical team in the first minutes of a mega earthquake in Turkey. American journal of disaster medicine. 2023;18(1):5-15\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eAlsofayan YM, Almakhalas K, Alabdali A, Arafat MS, Aljerian NA, Cluntun AA, et al. An Innovative Curriculum Development Experience: Emergency Medical Dispatch Role in the Healthcare Transformation Vision of Saudi Arabia. Saudi Journal of Emergency Medicine. 2021\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eVentura CAI, Denton EE, David JA, Schoenfelder BJ, Mela L, Lumia RP, et al. Emergency\u003cspan\u003e\u0026nbsp;\u003c/span\u003emedical services prehospital response to the COVID-19 pandemic in the US: a brief literature review. Open Access Emergency Medicine. 2022:249-72\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eChae J, Yun SJ. Study on Effective Response Plans for Disaster Sites with Multiple Casualties. Fire Science and Engineering. 2021\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003ePenverne Y, Leclere B, Labady J, Berthier F, Jenvrin J, Javaudin F, et al. Impact of two-level filtering on emergency medical communication center triage during the COVID-19 pandemic: an uncontrolled before-after study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2020;28:1-6\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eShen Z, Gao G, Wang Z. Accessibility Assessment of Prehospital Emergency Medical Services considering Supply‐Demand Differences. Journal of Advanced Transportation. 2021;202\u003cspan\u003e1(1):1925354.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eJohnsen BH, Espevik R, Eid J, \u0026Oslash;ster\u0026aring;s \u0026Oslash;, Jacobsen JK, Bratteb\u0026oslash; G. Coordinating mechanisms are more important than team processes for geographically dispersed emergency dispatch and paramedic teams. Frontiers in Psychology. 2022;13:754855\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eFerrari T, Camara MVO, Nassi CD, Ribeiro GM, Costa Junior RR, Ribeiro J\u0026uacute;nior C, et al. Analysis of the location of rescue ambulance dispatch bases: a case study in Rio de Janeiro, Brazil. Geographical Analysis. 2018;50(4):397-421\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eJanerka C, Leslie GD, Mellan M, Arendts G. Prehospital telehealth for emergency care: A scoping review. Emergency Medicine Australasia. 2023;35(4):540-52\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eBartolucci A, Mackway-Jones K, Redmond AD. Decision support framework for deployment of emergency medical teams after earthquakes. Disaster Medicine and Public Health Preparedness. 2021;15(6):727-34\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eCaviglia M, Da Silva-Moniz J, Venturini F, Jambai A, Vandi M, Wurie A, et al. Response to Mass-Casualty Incidents and Outbreaks: A Prehospital Disaster Training\u003cspan\u003e\u0026nbsp;\u003c/span\u003ePackage Developed for the National Emergency Medical Service in Sierra Leone. Prehospital and Disaster Medicine. 2023;38(S1):s138-s9\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eAgri J, S\u0026ouml;derin L, Hammarberg E, Lennquist-Mont\u0026aacute;n K, Mont\u0026aacute;n C. Prehospital preparedness for major incidents in Sweden\u003cspan\u003e:\u0026nbsp;\u003c/span\u003ea National Survey with focus on mass-casualty incidents. Prehospital and disaster medicine. 2023;38(1):65-72\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eSorani M, Tourani S, Khankeh HR, Panahi S. Prehospital emergency medical services challenges in disaster; a qualitative study. Emergency. 2\u003cspan\u003e018;6(1):\u003c/span\u003ee26\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eBeyrami Jam M, Aminizadeh M, Akbari-Shahrestanaki Y, Khankeh HR. Evaluating the disaster preparedness of emergency medical services (EMS) facilities: a cross-sectional investigation in Iran. BMC emergency medicine. 2024;24(1):48\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eBeyramijam M, Farrokhi M, Ebadi A, Masoumi G, Khankeh HR. Disaster preparedness in emergency medical service agencies: A systematic review. Journal of Education and Health Promotion. 2021;10(1):258\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003ePouraghaei M, Babaie J, Saeed LR. Challenges of emergency medical services response to Arasbaran Twin Earthquakes; a content analysis. Archives of Academic Emergency Medicine. 2022;10(1):e35\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eFriesen J, Kharel R, Delaney PG. Emergency medical dispatch technologies: Addressing communication challenges and\u003cspan\u003e\u0026nbsp;\u003c/span\u003ecoordinating emergency response in low and middle-income countries. Surgery. 2024;176(1):223-5\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eVan Duijn S. Effective Task Arrangement in Emergency Dispatch Centers. 2015\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eWeeks BC, Spencer C. Emergency Nursing in Mass Casualty Incidents: Effects\u003cspan\u003e\u0026nbsp;\u003c/span\u003eon Staff Turnover at a Large Suburban Hospital Emergency Department. Prehospital and Disaster Medicine. 2017;32(S1):S141-S2\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eBehghadami A, Janati A, Sadeghi-Bazargani H, Gholizadeh M, Rahmani F. Preparedness of Non-Hospital Health Centers to Deal with Life-Threatening Emergencies: A \u0026acirc;\u0026euro; ŽQualitative Study of Healthcare Providers\u0026acirc;\u0026euro;\u0026trade; and Experts\u0026acirc;\u0026euro;\u0026trade; Perspectives. Journal of Injury and Violence Research. 2019;11\u003cspan\u003e(4).\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eGupta I, Siddiqui ZK, Phillips MD, Singh A, Eid SM, Wortman L, et al. Recruitment, readiness, and retention of providers at a field hospital during the pandemic. Disaster medicine and public health preparedness. 2023;17:e102\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eBrown GD, Largey A, McMullan C, O\u0026apos;Shea G, Reilly N. Voices from the frontline: a review of EMS first responders\u003cspan\u003e\u0026apos;\u0026nbsp;\u003c/span\u003eexperience of COVID-19 in Ireland. International Journal of Emergency Services. 2022;12(1):103-18\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eHuard C, Desch\u0026ecirc;nes A-A, Rioux C-A. Emotional self-efficacy and workplace psychological health in emergency dispatchers. International Journal of Emergency Services. 2021;10(2):276-87\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eWheeler AL, Gardett I. 3440 Emergency Dispatch Research Workshop: Engaging a Forgotten Professional Population in Research. Journal of Clinical and Translational Science. 2019;3(s1):69\u003cspan\u003e-.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eMotamedi MHK, Saghafinia M\u003cspan\u003e,\u0026nbsp;\u003c/span\u003eBafarani AH, Panahi F. A reassessment and review of the Bam earthquake five years onward: what was done wrong? Prehospital and disaster medicine. 2009;24(5):453-60\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eAlshammari AD, Alobaid AM, Azharuddin A. Professionalizing Emergency Medical Service\u003cspan\u003e\u0026nbsp;\u003c/span\u003eResponse Time. Emergency Health Services Journal. 2024;1(2):37-41\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eAl Abbas HMA, Al Hussin YMM, Alabbas MAS, Al-Duways RM, Alhareth HSM, Al-Bakri MAS, et al. Evaluating the Impact of Emergency Medical Services on Patient Outcomes: A Systematic Review\u003cspan\u003e.\u0026nbsp;\u003c/span\u003eJournal of Ecohumanism. 2024;3(8):9048\u0026ndash;54-\u0026ndash;54\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eKubota H, Amagasa S, Kashiura M, Yasuda H, Kishihara Y, Ishiguro A, et al. Association between response time and time from emergency medical service contact with the patient to hospital arrival as well\u003cspan\u003e\u0026nbsp;\u003c/span\u003eas survival and neurological outcomes in pediatric out-of-hospital cardiac arrest. Prehospital Emergency Care. 2025(just-accepted):1-12\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eKyng\u0026auml;s H. Inductive content analysis. \u0026nbsp;The application of content analysis in nursing science research: Springer\u003cspan\u003e; 2019.\u0026nbsp;\u003c/span\u003ep. 13-21\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eGraneheim UH, Lindgren B-M, Lundman B. Methodological challenges in qualitative content analysis: A discussion paper. Nurse education today. 2017;56:29-34\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eHsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qualitative health research. 2005;15(9):1277-88\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eNeuendorf KA. Content analysis\u0026mdash;A methodological primer for gender research. Sex roles. 2011;64:276-89\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eSnodgrass JG, Clements KR, Nixon WC, Ortega C, Lauth S, Anderson M. An iterative approach to qualitative data analysis: Using theme, cultural models, and content analyses to discover and confirm a grounded theory of how gaming inculcates resilience. Field Methods. 2020;32(4):399-415\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eTshabangu I, Ba S, Madondo SM. Approaches and processes of social science research: IGI Global; 2020\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eGraneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse education today. 2004;24(2):105-12\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eLincoln YS, Guba EG. But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New directions for program evaluation. 1986;1986(30):73-84\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eSmith SW, Braun J, Portelli I, Malik S, Asaeda G, Lancet E, et al. Prehospital indicators for disaster preparedness and response: New York City emergency medical services in hurricane sandy. Disaster medicine and public health preparedness. 2016;10(3):333-43\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eDunford JV. Emergency medical dispatch. Emergency Medicine Clinics. 2002;20(4):859-75\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eGiaume L, Daniel Y\u003cspan\u003e,\u0026nbsp;\u003c/span\u003eJimenez A, Burlaton G, Jost D, Petitclerc M, et al. 112 What\u0026rsquo;s your emergency? Overview of mental health and sleep disorders among emergency medical dispatchers in a French 112 call center. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2024;32(1):55\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eHosseini SMR, Maleki M, Gorji HA, Khorasani-Zavareh D, Roudbari M. Factors affecting emergency medical dispatchers\u0026rsquo; decision-making: a qualitative study. Journal of multidisciplinary healthcare. 2018:391-8\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eMontassier E, Labady J, Andre A, Potel G, Berthier F, Jenvrin J, et al. The effect of work shift configurations on emergency medical dispatch center response. Prehospital Emergency Care. 2015;19(2):254-9\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003eLee S. The role of preparedness in ambulance dispatching. Journal of the Operational Research Society. 2011;62(10):1888-97\u003cspan\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Preparedness, Dispatch Centers, Prehospital Emergency Care, Disasters, Iran","lastPublishedDoi":"10.21203/rs.3.rs-7544681/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7544681/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground and Objectives:\u003c/h2\u003e\u003cp\u003ePrehospital emergency dispatch centers are critical components of disaster response, but their operational capacity is often overwhelmed by a surge in call volume during such events. Given Iran's high vulnerability to a wide range of disasters and the absence of a comprehensive tool for assessing the preparedness of these centers, this qualitative study was conducted to identify the factors influencing their readiness.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis study employed a conventional content analysis approach from October 2024 to May 2025. Twenty participants, including managers and staff from emergency medical services (EMS) and dispatch centers, were selected through purposive and snowball sampling. Data were collected via semi-structured interviews, lasting 20 to 120 minutes, until theoretical saturation was reached. The data were subsequently analyzed using MAXQDA-2020 software. Trustworthiness was established using the criteria proposed by Guba and Lincoln.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eData analysis revealed 13 main categories and 63 subcategories as factors influencing the disaster preparedness of dispatch centers. These categories were: Exercises, Security, Safety, Communication, Early Warning Systems, Planning, Resources, Individual Skills, Environmental Factors, Organizational Structure, Monitoring and Evaluation, Coordination, and Training.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe preparedness of emergency dispatch centers in Iran is a product of a complex interplay among resources, knowledge, skills, structure, communication, and organizational culture. A thorough understanding of these factors is essential for policymaking, resource allocation, and the design of targeted training programs to enhance the preparedness of these vital centers and thereby strengthen the resilience of the national health system against disasters.\u003c/p\u003e","manuscriptTitle":"Factors Affecting Disaster Preparedness in Prehospital Emergency Dispatch Centers: Mapping of Expert Perspectives","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 07:22:41","doi":"10.21203/rs.3.rs-7544681/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-05T05:46:11+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-03T16:47:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-03T11:38:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-30T19:06:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"148715983134183061708629863569227063291","date":"2025-09-24T06:16:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44311355273076722362033509919733297852","date":"2025-09-22T07:50:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83710380805752629525396684199567133671","date":"2025-09-18T13:24:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"75690325398579605040609948752090041637","date":"2025-09-18T11:57:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-18T11:53:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-17T12:19:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-15T08:28:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Emergency Medicine","date":"2025-09-05T13:14:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijem","sideBox":"Learn more about [International Journal of Emergency Medicine](https://intjem.biomedcentral.com/)","snPcode":"12245","submissionUrl":"https://submission.nature.com/new-submission/12245/3","title":"International Journal of Emergency Medicine","twitterHandle":"@IntJEmergMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f4386ec8-972d-4d92-9cc9-79543fdd5d9e","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-24T16:00:15+00:00","versionOfRecord":{"articleIdentity":"rs-7544681","link":"https://doi.org/10.1186/s12245-025-01053-5","journal":{"identity":"international-journal-of-emergency-medicine","isVorOnly":false,"title":"International Journal of Emergency Medicine"},"publishedOn":"2025-11-22 15:57:09","publishedOnDateReadable":"November 22nd, 2025"},"versionCreatedAt":"2025-09-30 07:22:41","video":"","vorDoi":"10.1186/s12245-025-01053-5","vorDoiUrl":"https://doi.org/10.1186/s12245-025-01053-5","workflowStages":[]},"version":"v1","identity":"rs-7544681","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7544681","identity":"rs-7544681","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}