Perceptions of experts and institutional directors about emergency preparedness in long-term care facilities in Sichuan, China: A descriptive qualitative study

Perceptions of experts and institutional directors about emergency preparedness in long-term care facilities in Sichuan, China: A descriptive qualitative study | 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 Perceptions of experts and institutional directors about emergency preparedness in long-term care facilities in Sichuan, China: A descriptive qualitative study Yanping Peng, Jiong Liu, Lan Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9257182/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Long-term care facilities (LTCFs) frequently suffer mass casualties during major destructive emergencies. The frequent occurrence of such events threatens the normal operation of institutional care services and exacerbates social unrest. Therefore, it is imperative to prioritize the emergency capabilities of LTCFs. Aim To explore the perspectives of long-term care facility(LTCF) managers and experts on emergency preparedness and analyzes the vulnerabilities in these institutions' preparedness efforts. Materials and Methods Purposive and snowball sampling was used to recruit participants. Mainly according to the Crisis Life Cycle Theory, and the Prevention, Preparedness, Response, and Recovery (PPRR) model was established analysis framework of this work. The directed content analysis was conducted for data analysis through the analysis framework. Findings : Data from 15 key processes and 5 key links of emergency preparedness were coded using a text analysis framework. The analysis revealed that LTCFs inadequately prioritize ongoing operations and social services in their preparedness processes. Additionally, monitoring and early warning systems receive insufficient emphasis. Examination of various emergencies highlighted a general lack of focus in overall preparedness efforts. Conclusions : This study provides new insights into emergency preparedness for major emergencies in LTCFs. The findings can help agency directors and experts adapt strategies to improve preparedness. Furthermore, the results address gaps between empirical evidence and theoretical expectations, offering valuable input to refine current emergency preparedness policies. Emergency preparedness Long-term care facilities Qualitative study Figures Figure 1 Figure 2 Highlights • Integrating the perspectives of experts and institutional managers, this study explores the emergency preparedness cognition of LTCFs in Sichuan Province from a multi-disaster perspective. • Early prevention and emergency response are links that experts and directors consider important aspects in emergency preparedness. • Monitoring and early warning and assisting response are relatively weak links in the study of emergency preparedness in LTCFs. 1. Introduction Nurses constitute the largest proportion of professionals within healthcare emergency response teams globally. The International Council of Nurses (ICN) has delineated four core competencies in disaster nursing: prevention, preparedness, response, and recovery (Hutton et al., 2016 ). Comprehensive assessments of long-term care facilities' (LTCFs) emergency preparedness are essential to ensure timely care delivery and assistance during crises. Nursing professionals must synthesize stakeholder perspectives to systematically refine emergency preparedness assessment frameworks tailored to LTCFs. China has one of the fastest-aging populations globally. According to the 2020 Seventh National Census, adults aged 60 and older constitute 18.7% of China's population, totaling 264 million individuals (National Bureau Of Statistics). Sichuan Province, with a disproportionately large elderly population, reported 14.16 million residents aged 65 and above by the end of 2021, ranking third nationally in absolute numbers (Hu, 2025 ). Driven by family demand and supportive policies, the number of LTCFs in China has grown by an average of 10% annually over the past decade (Shum et al., 2015 ). By the end of 2023, China housed over 400,000 LTCFs offering 8.206 million beds (Ministry of Civil Affairs of the People's Republic of China) Sichuan Province alone accounted for 2,553 registered elderly care institutions and 316,000 beds, positioning it among the top regions nationally. LTCFs play a critical role in meeting the care demands of China's rapidly expanding aging population . However, considering the clustering of older adults, shortage of professional personnel, and other factors, the organizational vulnerability of LTCFs is intensified, and LTCFs lead to mass death and injury in major emergencies. It is estimated that up to half of all COVID-19 deaths in Europe occurred in care homes in 2019 (Graham et al., 2020 ); Similarly, after Hurricane Katrina hit the United States, 103 deaths occurred in LTCFs out of a total countable death toll of 877 (Brunkard et al., 2008 ); During the Northridge earthquake in the United States, 88% of the LTCFs had business difficulties (Lan, 2022 ). When an emergency occurs, the mortality rate of LTCFs is much higher than that of the society. In February 2024, the World Health Organization (WHO) issued a public warning of a possible outbreak of "Disease X" ( https://www.who.int director-general speeches detail who director general s speech at the world governments summit-12-february-2024). Therefore, it is imperative to analyze the emergency preparedness ability of LTCFs to deal with major emergencies. Sichuan Province, located in southwest China, is highly susceptible to earthquakes, floods, and other emergencies. Situated in a seismically active zone, Sichuan has experienced numerous severe earthquakes, including the 2008 Wenchuan earthquake (Li et al., 2020 ). The high frequency of major emergencies significantly exacerbates the organizational vulnerability of LTCFs. According to a risk analysis study, the top five emergencies for LTCFs in Sichuan are earthquakes, floods, fires, infectious diseases, and foodborne illnesses (Lan, 2022 ). Given Sichuan’s unique geographical challenges, aging population, regional imbalances in nursing resources, and frequent disasters, research on LTCFs' emergency preparedness is both practically relevant and of long-term significance. The top director typically serves as the primary responsible for emergency management in the event of major emergencies at LTCFs (Kusmaul et al., 2021 ). To ensure preparedness measures are comprehensive, feasible, and compliant with legal and regulatory frameworks, directors frequently collaborate with professional consultants or external specialists in emergency management, disaster mitigation, or public health. These specialists contribute to the development of empirically grounded and systematically structured emergency preparedness strategies. Although existing research has predominantly examined preparedness for singular disasters, the escalating frequency of emergencies necessitates that nursing institutions cultivate integrated, multi-tiered emergency response capabilities. The findings of this study may serve as a practical framework for institutional directors and specialists to devise evidence-based strategies for enhancing emergency preparedness in LTCFs. Additionally, the identified vulnerabilities may provide policymakers with actionable insights to rectify systemic gaps in emergency preparedness through targeted policy interventions. 2. Materials and Methods 2.1Methods A descriptive qualitative study uses content analysis to describe the experiences and perspectives of research subjects (Willis et al., 2016 ). It is suitable for direct description of a phenomenon or for finding information to develop and refine a questionnaire or intervention, such as exploring patient and clinician wound care experiences (Woo et al., 2017 ) and analyzing healthcare professionals' perceptions of patient safety issues (Pelzang and Hutchinson, 2018 ). This study employed descriptive qualitative methods to explore the perceptions of experts and directors about disaster preparedness in LTCFs. 2.2 Participants According to the inclusion and exclusion criteria, the research objects that can provide the most and most abundant information are selected by the method of purposive sampling. At the same time, considering the late development of LTCFs in China, the emergency management policy documents of LTCFs need to be improved. To understand the connotation of emergency preparedness of LTCFs from multiple perspectives, in addition to disaster nursing, geriatric nursing, disaster medicine, and geriatric medicine, this study also includes experts in the fields of fire rescue and emergency management. Meanwhile, use a snowball sampling strategy to ensure that the study subjects are sufficient. 2.3 Inclusion and exclusion criteria 2.3.1 Inclusion and exclusion criteria of experts in the related field (1) Inclusion criteria: 1) Experts meeting the following conditions are eligible for participation: Research or work experience in disaster nursing, disaster medicine, fire rescue, geriatric nursing, geriatric medicine, disease prevention and control, or emergency management; 2) Engagement in emergency rescue operations at least once with a minimum of 5 years' work experience, holding an intermediate title or higher, or possessing a master's degree or above; 3) Absence of prior involvement in emergency rescue necessitates a minimum of 10 years of research or work experience in the relevant field, along with an associate vice-senior professional title or a doctoral degree; 4) Proficiency in clear and thorough communication and a willingness to share personal insights and professional experiences. (2) Exclusion criteria: 1) Individuals whose research or professional practice does not align with the aforementioned fields are excluded from participation. 2.3.2 Inclusion and exclusion criteria of directors of LTCFs (1) Inclusion criteria: 1) The management personnel of LTCFs include the president, vice president and nursing supervisor; 2) At least five years of experience in the management and operation of LTCFs; 3) Familiar with the management work of LTCF at present; 4) Have participated in the emergency management of at least one emergency; 5) Proficiency in clear and thorough communication and a willingness to share personal insights and professional experiences. (2) Exclusion criteria: 1) Directors of LTCFs who have left the organization; 2) Directors who are not or are minimally involved in the daily operations of LTCFs. 2.4 Data collection The purpose of developing effective emergency preparedness is to minimize the number of casualties for LTCFs. This study formulated an interview outline for three stages of emergency preparedness: pre-crisis, mid-crisis, and post-crisis according to the crisis life cycle theory (Wang and Wang, 2024 ). Before the formal interview, respectively, an emergency management expert and a director working in LTCFs meeting the inclusion criteria were selected for pre-interview, to check whether the interview outline needed to be modified, and to ask the subjects about their feelings about participating in the interview, to adjust the interview strategy and communication skills. Finally, we discussed the semi-structured interview questions in depth and confirmed that they would not be revised. The interview outline was agreed upon by all researchers. The semi-structured interview guide mainly included open‐ended questions about the perceptions of experts and directors: What measures should be taken to minimize the number of casualties when faced with serious earthquakes/fires/rainstorms/floods/foodborne illnesses/major infectious diseases in your served LTCFs? Before the interview, an appointment was made to confirm that the interviewee was in a quiet and uninterrupted room with enough time. During November 2020 and February 2021, a semi-structured interview was used to collect data by two trained researchers. Interviews ranged from 34 to 120 min with an average duration of 65 min. Transcripts returned to participants for correction at the end of the interview. Through face-to‐face interviews, the researchers established rapport with every participant. The sample became saturated after the 28th interview, and two more interviews were conducted to ensure that no further data could be collected, respectively. No participant dropped out during the interview. 2.5 Data analysis This study applied a two-phase process for its directed content analysis. First, mainly according to the Crisis Life Cycle Theory and the Prevention, Preparedness, Response, and Recovery (PPRR) model carried out literature analysis, and then through expert meetings and two rounds of expert consultations developed the text analysis framework (Murray and McCutcheon, 1999 ). It has constructed 5 key links of emergencies (e.g., early prevention, monitoring and early warning, emergency response, collaborative response, recovery and development) and 15 key processes of emergencies (e.g., environmental prevention and control, organizational system, emergency plan, training and learning, material expenses, risk monitoring, risk warning, communication, early response, medical first aid, external assistance, social services, ongoing operations, aftermath disposal, and cultural construction) (Lan, 2022 , Li et al., 2023 ). Second, the collected qualitative data were analyzed and coded by NVivo Plus 12 from the key links of emergencies and key processes. Within 24 hours of the end of the interview, the interview data were transcribed in time, marked, saved, and backed up in detail. 2.6 Ethical considerations This study has been approved by the Ethics Committee of West China University Hospital, Sichuan University (Approval ID: 2018 − 589). Informed consent was obtained from all participants before the study. The study purpose and methodology were explained to the participants, who allowed their voices to be recorded. The time and place of the interviews were determined with the participants' agreement. Participants were aware that their participation was absolutely voluntary and that they could withdraw from the study at any time. All participants received assurances of confidentiality and anonymity. 2.7 Rigour and Reflexivity The study adhered to four trustworthiness criteria: credibility, reliability, confirmability, and transferability. To standardize the interview protocol and strengthen researchers’ qualitative analysis competencies, the team completed structured courses and specialized training. Researchers established rapport with participants throughout the interview process to foster open communication. Data were systematically collected through audio recordings, verbatim transcripts, and reflective journals, with secure storage protocols implemented to ensure long-term accessibility. Post-interview, two researchers independently transcribed the data verbatim and cross-verified transcripts for accuracy. To ensure analytical rigor, preliminary findings were subjected to member-checking procedures, allowing participants to validate the interpretations. During data analysis, researchers actively mitigated potential biases stemming from personal predispositions or prior assumptions, anchoring interpretations exclusively to participants’ narratives. The research team provided ongoing supervision to maintain methodological consistency and reflexivity. 3. Findings 3.1. Specific characteristics 3.1.1. Specific information about being included of LTCFs In this study, directors interviewed represented 12 LTCFs, with institutional characteristics summarized as follows: The sample comprised 2 public and 10 private LTCFs. Operational duration ranged from 3 to 70 years, older adult resident capacity ranged from 40 to 1,000 individuals, and staff size varied between 8 and 260 employees. Geographically, 2 facilities were situated in townships, 1 in rural areas, and the remaining 9 in urban settings. The residents of the 12 LTCFs are all elderly people aged 60 and above. 3.1.2. Characteristics of directors in LTCFs The characteristics of the 12 participants are shown in Table 1 . Among the directors of institutions, including 10 directors of LTCFs and 2 directors of nursing departments. In addition, in gender, the group comprised four females and eight males. Aged between 30 and 63. Table 1 The demographic information of directors (N = 12) Number Age Gender Education Professional Years Type of work Experience M1 45 Male undergraduate 4 Director Infectious diseases, Flood M2 32 Male undergraduate 5 Director Infectious diseases M3 58 Male Post-secondary 22 Director Earthquake, Infectious diseases, Flood M4 30 Male undergraduate 5 Director Infectious diseases, Flood M5 49 Female Post-secondary 5 Head nurse Earthquake, Infectious diseases M6 63 Male Senior high 20 Director Earthquake, Fire, Infectious diseases, Flood M7 63 Male Elementary 16 Director Earthquake, Flood M8 51 Female Senior high 5 Head nurse Fire, Infectious diseases, Flood M9 36 Female Post-secondary 6 Director Infectious diseases, Flood M10 43 Male Post-secondary 10 Director Infectious diseases M11 42 Female Post-secondary 10 Director Infectious diseases M12 38 Male undergraduate 15 Director Earthquake, Fire, Infectious diseases 3.1.3. Characteristics of experts in LTCFs The characteristics of 20 experts are shown in Table 2 , including 4 disaster care experts, 4 geriatric care experts, 3 disaster medicine specialists, 2 geriatrics experts, 2 fire rescue experts, 2 disease prevention and control experts, 2 emergency management experts, and 1 aging policy expert. In gender, the group comprised 9 females and 11 males. Aged between 32 and 71. Table 2 The demographic information of experts in emergency preparedness(N = 20) Number Age Gender Education Professional title Field Professional Years Experience Z1 48 Female doctoral High emergency management 5 NR Z2 37 Male doctoral High emergency management 15 Earthquake Z3 38 Male Master Middle Disaster nursing 7 Earthquake Z4 32 Male Master None Fire rescue 10 Earthquake, Fire, Flood Z5 32 Male Master None Fire rescue 8 Fire, Flood Z6 39 Female Master High Disaster nursing 12 Infectious diseases Z7 54 Male doctoral High Disaster medicine 7 Earthquake Z8 71 Female undergraduate High Disaster nursing 44 Earthquake, Infectious diseases Z9 57 Male undergraduate None aging policy 10 Fire,Flood Z10 45 Male Master Middle Disaster medicine 4 Earthquake, Fire, Infectious diseases, Flood Z11 52 Female doctoral None Disaster nursing 15 Infectious diseases Z12 55 Female undergraduate High Disaster nursing 10 Earthquake, Fire, Infectious diseases Z13 44 Female undergraduate High geriatric medicine 8 Earthquake, Infectious diseases Z14 49 Female undergraduate High Disaster nursing 25 NR Z15 34 Female Master Middle geriatric medicine 10 Fire Z16 45 Female doctoral High Disaster nursing 5 NR Z17 41 Male undergraduate High Disaster medicine 14 Earthquake, Fire, Infectious diseases, Flood, Food poisoning Z18 52 Male Master High disease prevention 30 Earthquake, Infectious diseases, Flood, Food poisoning Z19 51 Male Master High Disaster nursing 20 Earthquake, Fire, Infectious diseases, Flood Z20 39 Male Master High disease prevention 16 Earthquake, Infectious diseases, Flood, Food poisoning Note: Experts are numbered in the order of Z1-Z20. NR-Not Reported 3.2 Characteristics of texts analysis The ranking of reference point counts at the event level in descending order is as follows: earthquake, fire, foodborne illnesses, flood, infectious disease, and overall emergency. The order of reference points in the emergency preparation important links in descending order is as follows: emergency response, early prevention, recovery and development, monitoring and early warning, and collaborative response (in Fig. 1 ). The number of reference points in the emergency preparedness key process is ranked in descending order as follows: early response, medical first aid, emergency plan, material expenses, cultural construction, risk warning, aftermath disposal, risk monitoring, training and learning, environmental prevention and control, communication, external assistance, organizational system, ongoing operations, and social services (in Fig. 2 ). 3.3 Results of codes and supporting quotes Among the interview texts on emergency preparedness, a total of 36 codes related to earthquakes, 32 codes related to floods, 36 codes related to fires, 25 codes related to infectious diseases, 30 codes related to foodborne illnesses and 18 codes related to emergencies were obtained (in Table 3 ). Table 3 Analysis framework and codes of interviewed text Key link Key process Earthquake Flood Fire Infectious disease Food poisoning Emergencies 1. Early prevention 1. Environmental prevention and control Seismic assessment, Fixed items Smooth drainage NR Cleaning and disinfection, Ventilation and air change Kitchen waste, Cleaning and disinfection, Food preservation NR 2. Organization system Division of responsibilities Division of responsibilities Division of responsibilities, fire fighting system Emergency team, Emergency process, Division of responsibilities Emergency system, Division of responsibilities Emergency team, Emergency process, Division of responsibilities 3.Emergency plan Plan formulation, Plan drill Plan drill, Plan formulation, Plan update Plan formulation, Plan drill, Plan update, Plan revision Plan formulation, Plan drill Plan formulation, Plan drill Plan formulation, Plan drill, Plan update 4. Training and learning NR Training object, Training content Training object, Training frequency, Training content Training content, Training plan Training content, Training form Training content 5.Material expenses Physical supply Funding guarantee, Physical supply Funding guarantee, Physical supply Funding guarantee, Physical supply Funding guarantee, Physical supply Funding guarantee, Physical supply 2. Monitoring and early warning 6. Risk monitoring NR Weather forecast, Flood patrol, Water level change Fire patrol Monitoring method Food material procurement, Food sample retention, Occupational health NR 7. Risk warning Official forecast NR Fire and electricity, fire prevention typical symptoms High-risk food, Food cooking, symptom recognition NR 3. Emergency response 8. Communication Disaster report, Public opinion control Disaster report, Disaster notification, Public opinion control Public opinion control, Disaster report, Command personnel Disaster report,Public opinion control Public opinion control, Disaster report, Command personnel, Disaster notification Public opinion control, Disaster report, Command personnel, Disaster notification 9. Early response Evacuation transfer, Shock avoiding indoor, Rescue principle Evacuation transfer Fire fighting, Evacuation transfer Access control, Check and isolate, Reduce aggregation, Assisted flow modulation Check and isolate, Field storage Evacuation and transfer 10. Medical first aid Transfer to hospital, Emergency treatment, Nursing rescue Transfer to hospital, Emergency treatment, Nursing rescue Transfer to hospital, Emergency treatment, Nursing rescue Transfer to hospital Transfer to hospital, Emergency treatment, Nursing rescue, Assisted flow modulation Nursing rescue, Transfer to hospital 4. Collaborative response 11. External assistance NR Social organizations Social organizations NR NR NR 12. Social services NR Social service project NR NR NR NR 5. Recovery and development 13. Ongoing operations NR NR NR NR NR NR 14. Aftermath disposal Loss assessment, Psychological care, Building safety, Restart operations, Secondary disasters, Personal safety Psychological care, Secondary disasters, Rewards and punishments, Loss assessment Loss assessment, Legal dispute, Rewards and punishments, Restart operations Rewards and punishments, Restart operations, Psychological care, Cadaver care Food destruction, Rewards and punishments Personal safety, Rewards and punishments, 15. Cultural construction Earthquake prevention propaganda Flood Control Concept Experience summary, Fire propaganda Experience summary, Prevention and control concept, Science propaganda, Scientific research NR Experience summary Note: NR-Not Reported Key link 1: early prevention Complete early prevention is conducive to effective response to major emergencies (Erkhembayar et al., 2020 ). Early prevention were categorized into five key processes, including environmental prevention and control, organization system, emergency plan, training and learning, and material expenses. Environmental prevention and control For specific emergencies, LTCFs have taken corresponding measures to prevent and control the environment (e.g., process layout and building assessment). One of the respondents remarked: Because elevators can't be used in earthquakes. So right now we're still thinking about that. Now is to slowly adjust the application area, and try to plan on the first floor. (M12) Organization system For major emergency, LTCFs need establish the corresponding organizational system to prevent (e.g., emergency team and emergency process). One of the respondents remarked: Because older adults have weak escape abilities, we must cooperate with some surgeons for treatment. Although doctors from some departments may be able to participate in the treatment, they have little effect. (Z13) Emergency plan Emergency plans usually need to include plan formulation, plan drill, and plan update. One of the respondents remarked: We are holding fire drills at least twice a year for the fire evacuation part, which is now the norm. (M12) Training and learning Training learning generally includes training object, training record, training frequency, and training content. One respondent remarked: So the first one we will emphasize the daily fire safety to the staff, the morning shift will be emphasized to the staff, the evening shift will be emphasized to the staff. This is the first important education for employees (M1). Material expenses Materials expenses include funding guarantee, physical supply and special funds. One respondents remarked: Including umbrellas, tents, including raincoats, rain boots, helmets these are put up on each floor......And a gas explosion, or a gas leak. The gas masks are all ready (Z3). Key link 2: Monitoring and early warning A complete monitoring and early warning system is conducive to improving the ability of accurate response to major emergencies and reducing the loss of life and property caused by emergencies (Kamalrathne et al., 2023 , Xiong et al., 2021 ). However, monitoring and early warning technology is a relatively weak link in the emergency preparedness. Risk monitoring and risk warning were the two key processes of monitoring and early warning. Risk monitoring For different kinds of emergencies, the focus of risk monitoring is inconsistent, (e.g., mechanism location for earthquake; weather forecast, watch patrol, high incidence season, and mechanism location for flood; and fire patrol for fire). One respondent remarked: First of all, Panzhihua was not in the earthquake zone, so it did not suffer a destructive earthquake. At the same time, when selecting the location of LTCFs it selects an open place that can avoid the possibility of people being unable to escape in the event of an earthquake. (M2) Risk warning Risk early warning usually includes official forecast, early warning identification, fire and electricity, high-risk itinerary, typical symptoms, and so on. One of the respondents remarked: When the earthquake comes, the earthquake warning will tell us the magnitude of the earthquake. The first time I will assess whether the magnitude of the earthquake is large or small, and then decide whether to transport older adults. (M9) Key link 3: Emergency response The core of LTCFs to deal with emergencies is emergency response. Timely and effective emergency response is conducive to reducing the adverse effects caused by emergencies to the greatest extent (Ibrahim and Aitken, 2021 ). This theme consists of three key processes: communication, early response, and medical first aid. Communication Communication often includes disaster report, disaster notification, public opinion control, and command personnel. One respondent remarked: More than three people is a group foodborne illnesses, more than five people is a serious group foodborne illnesses, then more than five people will be reported to the city, it is necessary to take the initiative to report to the city CDC (M6). Early response Early response needs to do a good job of evacuation transfer, shock avoiding indoor, evacuation transfer, shelter in place, fire fighting, access control, check and isolate, reduce aggregation and other measures. One respondent remarked: Evacuation is to directly open all the channels, and then let the self-care elderly people hurry to the open space, and at the same time, for the elderly who are bedridden, it is carried out by the nursing staff (Z4). Medical first aid Medical first aid included transfer to hospital, emergency treatment, sudden illness, and nursing rescue. One respondent remarked: Bandaging, fixation, transport, and some methods of hemostasis. I think the staff of LTCFs must have some professional first-aid skills (Z19). Key link 4: Collaborative response Collaborative response plays a vital role in controlling major emergencies (Schwartz and Yen, 2017 ). However, due to the imperfection of policies and laws, collaborative response in emergency preparedness is a relatively weak link (Abubakar et al., 2021 ). There are two key processes of collaborative response, including external assistance and social services. External assistance Government departments, medical institutions, social organizations, relatives of elderly, fire protection agency can all be part of external assistance. One respondent remarked: Do they have a good team that can do these things? If not, they have to set up a volunteer team, that is, a public welfare team, to help them do these things (M7). Social services Social service projects have been identified only during earthquakes and floods. One respondent remarked: The first is to send medical assistance in time, and the second is to pay compensation through the national pension institution liability insurance (M2). Key link 5: Recovery and development Promoting recovery and development of LTCFs after major emergencies can not only help to return to normal life as soon as possible, but also help to accumulate relevant scientific experience to cope with similar emergencies next time (Schoch-Spana et al., 2022 ). Ongoing operations, aftermath disposal, and cultural construction are the three key processes of recovery and development. However, ongoing operations have only been identified in infectious diseases, which is a relative weak process in emergency preparedness. Ongoing operations Manpower support is an important component of ongoing operations but is only considered in infectious diseases. One respondent remarked: During this period of the epidemic is the most urgent period of time, doctors and nurses are also working two shifts, and all live in LTCFs (N16). Aftermath disposal Aftermath disposal usually includes loss assessment, psychological care, building safety, restart operations, secondary disasters.This process has received the attention of experts and directors. One respondent remarked: For example, some elderly people who have psychological disorders themselves, or some older adults who are very emotional, need timely prevention and psychological intervention if these situations occur (Z8). Cultural construction Cultural construction usually includes experience summary, scientific research, supervision and evaluation, self-help idea, and so on. One respondent remarked: The first thing is to improve their ability to save themselves, because when any rescue team or any organization or medical organization or rescue force is mobilized, it takes time. You only have a chance if you save yourself first (M8). 4. Discussion This study centers on emergency preparedness measures for diverse emergencies in LTCFs, including earthquakes, fires, floods, infectious diseases, foodborne illnesses, and general emergencies, constituting the most comprehensive investigation to date on this topic. Anchored in Crisis Life Cycle Theory and the PPRR model, the study constructs an analytical framework comprising five core dimensions and 15 critical processes for LTCF preparedness. By addressing the limitations of single-hazard or single-stakeholder approaches common in the literature, it offers empirical insights into emergency preparedness in a disaster-prone and rapidly aging region. According to interviewee perspectives, earthquakes are prioritized as critical emergencies, whereas general emergency preparedness is perceived as less urgent. This prioritization likely stems from participants’ proximity to Sichuan, China—a region prone to seismic hazards, as evidenced by catastrophic events such as the 2008 Wenchuan earthquake (M8.0), the 2013 Lushan earthquake (M7.0), and the 2017 Jiuzhaigou earthquake (M7.0) (Yong et al., 2020 ). While such earthquakes have caused substantial casualties and economic damage, they have also driven advancements in disaster preparedness frameworks and policy reforms. However, generic emergency plans are deemed less critical than scenario-specific measures. Tailored preparedness strategies are perceived as more effective, as generic plans often lack the specificity needed to address unique emergency scenarios. This limitation undermines their practical applicability and operational utility (Wasserman and Konetzka, 2022 ). Substantial variations in emergency types, geographical contexts, and institutional categories complicate efforts to standardize disaster-specific plans or assess their efficacy (Festa et al., 2023 ). Consequently, developing a generalizable emergency preparedness framework merits further investigation. Analysis of the core components of emergency preparedness reveals that early prevention is prioritized by experts and institutional directors. In contrast, monitoring and early warning are comparatively underemphasized. This disparity may stem from early prevention’s pivotal role in shaping effective crisis responses. Proactive disaster prevention is indispensable for ensuring swift restoration of LTCF functionality post-emergency (Eltaybani et al., 2022 ). Furthermore, early prevention strategies inform the development of targeted security policies and optimize their practical implementation. However, effective monitoring and early warning systems remain among the most deficient areas in LTCFs’ disaster preparedness frameworks. Current human resource constraints hinder the implementation of robust monitoring and warning mechanisms, resulting in reactive rather than proactive measures. The complexity and unpredictability of earthquakes, floods, and infectious disease outbreaks complicate the simulation of reliable monitoring systems, impeding progress in this field (Cheng et al., 2023 ). Despite these limitations, proactive surveillance and early warning systems remain essential elements of emergency preparedness in LTCFs. Timely identification of emergency precursors enables rapid stakeholder communication and preparedness, reducing logistical and financial burdens during crisis mitigation. From the perspective of key emergency preparedness processes, early response emerges as a significantly important theme for LTCFs. Conversely, social service and ongoing operations are considered less critical aspects of emergency preparedness. Prompt and appropriate action is essential, requiring LTCFs to swiftly coordinate all rescue resources and implement preemptive measures by the nature and severity of the emergency (ShiYou, 2010 ). Experts and institutional leaders underscore the centrality of early response in LTCF emergencies, acknowledging that ineffective interventions may precipitate systemic disarray. Proactive early response measures, such as evacuations during earthquakes, floods, or fires, and containment protocols for infectious diseases or foodborne outbreaks, are critical for mitigating secondary risks and restoring stability (Zhou et al., 2023 ). Moreover, LTCFs frequently become focal points of public attention during crises, subjecting them to heightened scrutiny. Mismanagement during emergencies risks exacerbating public distrust, disrupting operations, and undermining institutional credibility (Qin, 2022 ). While social service and ongoing operations are considered less critical in the context of emergency preparedness, it’s important to note that LTCFs are inherently social welfare service providers. Furthermore, LTCFs face numerous challenges, including limited human resources, overall quality concerns, and a pressing need for system optimization(Beltran et al., 2024 ). The devastating impact of sudden major disasters often makes it challenging for LTCFs to effectively execute social service and operational tasks related to emergency preparedness and subsequent recovery. However, previous studies have focused less on this aspect of emergency preparedness. Future efforts should focus on enhancing operational and management standardization in LTCFs, improving employee professional competency, bolstering job satisfaction, and establishing robust talent reserves to adequately support LTCFs’ operations. 4.1 Strengths and Limitations of the Work Our findings should be viewed cautiously and considered within the context of certain critical limitations. First, data were collected during the COVID-19 pandemic from 2020 to 2021, which may have led to an overemphasis on infectious disease preparedness among participants, or insufficient elaboration on other hazards due to the heavy burden of pandemic prevention, potentially biasing the perceptions obtained. Additionally, participants were exclusively recruited from Sichuan, a disaster-prone region in western China, which limits the generalizability of our findings to other areas and fails to capture perceptions of hazards such as typhoons and tsunamis. Nevertheless, despite these constraints, the research provides valuable insights into LTCFs’ experiences with emergency preparedness during major crises. Future research could replicate this study in the post-pandemic period to enable cross-temporal comparative analysis. A nationwide multicenter study across disaster-prone regions in eastern, central, and western China is also warranted to develop a complete framework for understanding emergency preparedness perceptions in LTCFs. 4.2 Recommendations for Further Research Future research should investigate additional stakeholders’ perspectives on mentoring practices, particularly the barriers they encounter in facilitating its integration. Furthermore, research is warranted to establish sustainable frameworks for embedding mentoring within rehearsal practices, fostering its systematic integration into organizational culture. 4.3 Implications for Policy and Practice Proactively fostering interdisciplinary collaboration among agency administrators, healthcare providers, domain experts, and governmental bodies will be critical to enhancing emergency response efficacy and minimizing human casualties and material losses within institutions. Policy frameworks must formally mandate support for nurses’ leadership roles in emergency risk mitigation and preparedness planning. These measures would serve as a pivotal mechanism for stabilizing institutional operations during crises. 5. Conclusion LTCFs are particularly vulnerable during major emergencies. The rising frequency of large emergencies underscores the critical imperative to develop enhanced, institution-specific preparedness planning and management frameworks. This study offers critical empirical insights to guide institutionally tailored crisis preparedness strategies. Beyond prioritizing proactive prevention and rapid response protocols, emphasis must be placed on enhancing real-time monitoring systems, establishing robust early warning mechanisms, implementing timely stakeholder communication protocols, and streamlining response coordination to reduce operational disruptions and resource expenditures during emergencies. Declarations Declaration of competing interest The authors declare no conflicts of interest. Clinical trial number Not applicable. Data sharing statement Due to ethical reasons, the raw data would remain confidential and would not be shared. The processed data that support the findings of this study are available from the corresponding author Li Lan, upon reasonable request. CRediT authorship contribution statement Yanping Peng: Formal analysis, Data curation, Methodology, Writing-original draft, Writing - review & editing. Jiong Liu: Formal analysis, Data curation, Writing - review & editing. Lan Li: Conceptualization, Methodology, Resources, Data curation, Writing - review & editing, Supervision, Project administration. Ethics approval and consent to participate This study adhered to the Declaration of Helsinki. The research protocol involving human participants was reviewed and approved by the Ethics Committee of West China University Hospital, Sichuan University (Approval ID: 2018-589). Before participating in the study, the participants provided written informed consent. Funding sources This research was supported by the National Natural Science Foundation of China (72404005); the 76th batch project of China Postdoctoral Science Foundation (2024M760162); the Science and Technology Strategic Cooperation Programs of Luzhou Municipal People's Government and Southwest Medical University (2024LZXNYDJ063); the key project of Sichuan Key Laboratory of Nursing in 2024 (HLKF2024 (Z)-1). References Abubakar I, Dalglish SL, Ihekweazu CA, Bolu O, Aliyu SH. 2021. Lessons from co-production of evidence and policy in Nigeria's COVID-19 response. BMJ Glob Health 6 (3). Beltran SJ, Wagner J, Dorris L, Miller VJ. Navigating the Storm: Challenges and Career Implications for Nursing Home Administrators in the Wake of COVID-19. J Gerontol Nurs. 2024;50(6):17–24. Brunkard J, Namulanda G, Ratard R. Hurricane Katrina deaths, Louisiana, 2005. Disaster Med Public Health Prep. 2008;2(4):215–23. Cheng Z, Peng C, Chen M. 2023. Real-Time Seismic Intensity Measurements Prediction for Earthquake Early Warning: A Systematic Literature Review. Sensors (Basel) 23 (11). Eltaybani S, Suzuki H, Igarashi A, Sakka M, Amamiya Y, Yamamoto-Mitani N. Long-term care facilities' response to the COVID-19 pandemic: A protocol of a cross-sectional, multi-site, international survey. Nurs Open. 2022;9(5):2506–17. Erkhembayar R, Dickinson E, Badarch D, Narula I, Warburton D, Thomas GN, Ochir C, Manaseki-Holland S. Early policy actions and emergency response to the COVID-19 pandemic in Mongolia: experiences and challenges. Lancet Glob Health. 2020;8(9):e1234–41. Festa N, Heaphy NM, Throgmorton KF, Canavan M, Gill TM. Evaluating California nursing homes' emergency preparedness for wildfire exposure. J Am Geriatr Soc. 2023;71(3):895–902. Graham N, Junghans C, Downes R, Sendall C, Lai H, McKirdy A, Elliott P, Howard R, Wingfield D, Priestman M, Ciechonska M, Cameron L, Storch M, Crone MA, Freemont PS, Randell P, McLaren R, Lang N, Ladhani S, Sanderson F, Sharp DJ. SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes. J Infect. 2020;81(3):411–9. https://www.who.int director-general speeches detail who director general s speech at the world governments summit-12-february-2024. Hu H. Actively develop the silver economy and promote the high-quality development of Sichuan's older care industry. NEI JIANG KE JI. 2025;46(01):74–100. Hutton A, Veenema TG, Gebbie K. Review of the International Council of Nurses (ICN) framework of disaster nursing competencies. Prehosp Disaster Med. 2016;31(6):680–3. Ibrahim JE, Aitken G. A Proactive Nursing Home Risk Stratification Model for Disaster Response: Lessons Learned from COVID-19 to Optimize Resource Allocation. J Am Med Dir Assoc. 2021;22(9):1831–9. Kamalrathne T, Amaratunga D, Haigh R, Kodituwakku L. Need for effective detection and early warnings for epidemic and pandemic preparedness planning in the context of multi-hazards: Lessons from the COVID-19 pandemic. Int J Disaster Risk Reduct. 2023;92:103724. Kusmaul N, Beltran S, Buckley T, Gibson A, Bern-Klug M. Structural Characteristics of Nursing Homes and Social Service Directors that Influence Their Engagement in Disaster Preparedness Processes. J Gerontol Soc Work. 2021;64(7):775–90. Lan L. Research on risk analysis and emergency preparedness assessment tool of long term care facilities. Chengdu: Sichuan University; 2022. Li L, Hu X, Wang Y. Content Analysis of Chinese National Laws and Regulations on Emergencies from the Perspective of Disaster Nursing on the Basis of Crisis Life Cycle Theory. Sichuan Da Xue Xue Bao Yi Xue Ban. 2023;54(4):831–6. Li L, Reinhardt JD, Pennycott A, Li Y, Chen Q. Prevalence of and Risk Factors for Depression Among Older Persons 6 Months After the Lushan Earthquake in China: A Cross-Sectional Survey. Front Psychiatry. 2020;11:853. Murray G, McCutcheon S. Model framework and principles of emergency management. Rev Sci Tech. 1999;18(1):15–20. National Bureau Of Statistics(. 2021). Bulletin of the Seventh National Population Census (No. 5)[EB/OL]. https://www.stats.gov.cn/sj/tjgb/rkpcgb/qgrkpcgb/202302/t20230206_1902005.html Pelzang R, Hutchinson AM. 2018. Patient safety issues and concerns in Bhutan's healthcare system: a qualitative exploratory descriptive study. BMJ Open 8 (7), e22788. Qin Y. 2022. Discussion on the governance mechanism of negative Internet public opinion under the epidemic situation. J Beijing Vocat Coll Political Sci Law (03), 61–8. Schoch-Spana M, Ravi SJ, Martin EK. Modeling epidemic recovery: An expert elicitation on issues and approaches. Soc Sci Med. 2022;292:114554. Schwartz J, Yen MY. Toward a collaborative model of pandemic preparedness and response: Taiwan's changing approach to pandemics. J Microbiol Immunol Infect. 2017;50(2):125–32. ShiYou L. The problems and causes of early handling of emergency disaster events and countermeasures. Emerg Manage China. 2010;03:58–60. Shum MH, Lou VW, He KZ, Chen CC, Wang J. The leap forward in nursing home development in urban China: future policy directions. J Am Med Dir Assoc. 2015;16(9):784–9. Wang M, Wang J. Performance Evaluation of Urban Emergency Governance: Conceptual Connotations and Empirical Research Based on the Crisis Life Cycle Theory. Eval Rev. 2024;48(5):945–74. Wasserman M, Konetzka RT. Beyond Compliance: A More Integrated Public Health Approach To Outbreaks In Nursing Homes And Other Disasters. Health Aff (Millwood). 2022;41(6):831–7. Willis DG, Sullivan-Bolyai S, Knafl K, Cohen MZ. Distinguishing Features and Similarities Between Descriptive Phenomenological and Qualitative Description Research. West J Nurs Res. 2016;38(9):1185–204. Woo KY, Wong J, Rice K, Coelho S, Haratsidis E, Teague L, Rac VE, Krahn M. Patients' and clinicians' experiences of wound care in Canada: a descriptive qualitative study. J Wound Care. 2017;26(Sup7):S4–13. Xiong L, Hu P, Wang H. Establishment of epidemic early warning index system and optimization of infectious disease model: Analysis on monitoring data of public health emergencies. Int J Disaster Risk Reduct. 2021;65:102547. Yong Z, Zhuang L, Liu Y, Deng X, Xu D. Differences in the Disaster-Preparedness Behaviors of the General Public and Professionals: Evidence from Sichuan Province, China. Int J Environ Res Public Health. 2020;17:14. Zhou Z, Zhang Y, Gou J, Kan N, Zhao F, Yao L, Hou S. 2023. Successful Large Hospital Evacuation With 11 350 Patients Transferred in the 2021 Zhengzhou Flood. Disaster Med Public Health Prep 17, e434. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 12 May, 2026 Reviewers agreed at journal 07 May, 2026 Reviewers invited by journal 05 May, 2026 Editor invited by journal 10 Apr, 2026 Editor assigned by journal 09 Apr, 2026 Submission checks completed at journal 08 Apr, 2026 First submitted to journal 08 Apr, 2026 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-9257182","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":639268873,"identity":"c2a3cb2e-3d23-4a5a-95b5-e3ca5d9f18ca","order_by":0,"name":"Yanping Peng","email":"","orcid":"","institution":"Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yanping","middleName":"","lastName":"Peng","suffix":""},{"id":639268874,"identity":"3d721446-7891-4825-a590-a1070a2fd613","order_by":1,"name":"Jiong Liu","email":"","orcid":"","institution":"Affiliated Hospital of Southwest Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jiong","middleName":"","lastName":"Liu","suffix":""},{"id":639268875,"identity":"91cb1c3c-e553-49a6-a111-a8a665c23c61","order_by":2,"name":"Lan Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIie3QMQrCMBSA4VcK0eFpNwlU2yu0dHHwCB6iXZw6eIRKIS52V7xER8eUQF30BC6Ks9BRB9G4ipi4OeSf38d7CYDJ9I+1rBkHGCFp5Zw3Vx1iW5kkE6+LdVKtFloEQBIReXQciTbREE5uZ/y2sRNGsRGA4Ds9/p1QYWVVsSMJc4tSTIcQrtaxYo0kvMMwYf19KZYIcXBQEP+15c6oPCw9CiQaJJBEdFgQEZqCHglfZMBij2AdyE+m6rd42/npdGEP9Of5uWmuI99xFeQ9+tu4yWQymT73BOx7SQGN6a70AAAAAElFTkSuQmCC","orcid":"","institution":"Southwest Medical University","correspondingAuthor":true,"prefix":"","firstName":"Lan","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2026-03-29 07:53:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9257182/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9257182/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109187913,"identity":"792447b0-a414-4a36-ba58-555e7b2fc3fe","added_by":"auto","created_at":"2026-05-13 11:30:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":106154,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of the numbers of interview text files of relevant experts and directors of LTCFs and their reference points (key links)\u003c/p\u003e\n\u003cp\u003eNotes: The dashed line represents the number of key process reference points for emergency preparedness. The solid line represents the number of interview text files.\u003c/p\u003e","description":"","filename":"Onlinefloatimage13.png","url":"https://assets-eu.researchsquare.com/files/rs-9257182/v1/0717c22c3ca85dea72f9b447.png"},{"id":109187914,"identity":"025275a5-aa7a-44d4-8a6f-76d1207b4eff","added_by":"auto","created_at":"2026-05-13 11:30:21","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":165351,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of the numbers of interview text files of relevant experts and directors of LTCFs and their reference points (key processes)\u003c/p\u003e\n\u003cp\u003eNotes: The dashed line represents the number of key process reference points for emergency preparedness. The solid line represents the number of interview text files.\u003c/p\u003e","description":"","filename":"Onlinefloatimage25.png","url":"https://assets-eu.researchsquare.com/files/rs-9257182/v1/7c692d94fc7e8dcb48411baa.png"},{"id":109205458,"identity":"05289d67-8a25-48f4-a83d-26951a4b3aee","added_by":"auto","created_at":"2026-05-13 15:04:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":552025,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9257182/v1/9a78c42b-7e76-44ff-b52b-5ca029e268a9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perceptions of experts and institutional directors about emergency preparedness in long-term care facilities in Sichuan, China: A descriptive qualitative study","fulltext":[{"header":"Highlights","content":"\u003cp\u003e\u0026bull; Integrating the perspectives of experts and institutional managers, this study explores the emergency preparedness cognition of LTCFs in Sichuan Province from a multi-disaster perspective.\u003c/p\u003e\u003cp\u003e\u0026bull; Early prevention and emergency response are links that experts and directors consider important aspects in emergency preparedness.\u003c/p\u003e\u003cp\u003e\u0026bull; Monitoring and early warning and assisting response are relatively weak links in the study of emergency preparedness in LTCFs.\u003c/p\u003e"},{"header":"1. Introduction","content":" \u003cp\u003eNurses constitute the largest proportion of professionals within healthcare emergency response teams globally. The International Council of Nurses (ICN) has delineated four core competencies in disaster nursing: prevention, preparedness, response, and recovery (Hutton et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Comprehensive assessments of long-term care facilities' (LTCFs) emergency preparedness are essential to ensure timely care delivery and assistance during crises. Nursing professionals must synthesize stakeholder perspectives to systematically refine emergency preparedness assessment frameworks tailored to LTCFs.\u003c/p\u003e \u003cp\u003eChina has one of the fastest-aging populations globally. According to the 2020 Seventh National Census, adults aged 60 and older constitute 18.7% of China's population, totaling 264\u0026nbsp;million individuals (National Bureau Of Statistics). Sichuan Province, with a disproportionately large elderly population, reported 14.16\u0026nbsp;million residents aged 65 and above by the end of 2021, ranking third nationally in absolute numbers (Hu, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Driven by family demand and supportive policies, the number of LTCFs in China has grown by an average of 10% annually over the past decade (Shum et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). By the end of 2023, China housed over 400,000 LTCFs offering 8.206\u0026nbsp;million beds (Ministry of Civil Affairs of the People's Republic of China) Sichuan Province alone accounted for 2,553 registered elderly care institutions and 316,000 beds, positioning it among the top regions nationally. LTCFs play a critical role in meeting the care demands of China's rapidly expanding aging population .\u003c/p\u003e \u003cp\u003eHowever, considering the clustering of older adults, shortage of professional personnel, and other factors, the organizational vulnerability of LTCFs is intensified, and LTCFs lead to mass death and injury in major emergencies. It is estimated that up to half of all COVID-19 deaths in Europe occurred in care homes in 2019 (Graham et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2020\u003c/span\u003e); Similarly, after Hurricane Katrina hit the United States, 103 deaths occurred in LTCFs out of a total countable death toll of 877 (Brunkard et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2008\u003c/span\u003e); During the Northridge earthquake in the United States, 88% of the LTCFs had business difficulties (Lan, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). When an emergency occurs, the mortality rate of LTCFs is much higher than that of the society. In February 2024, the World Health Organization (WHO) issued a public warning of a possible outbreak of \"Disease X\" (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int\u003c/span\u003e\u003cspan address=\"https://www.who.int\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e director-general speeches detail who director general s speech at the world governments summit-12-february-2024). Therefore, it is imperative to analyze the emergency preparedness ability of LTCFs to deal with major emergencies.\u003c/p\u003e \u003cp\u003eSichuan Province, located in southwest China, is highly susceptible to earthquakes, floods, and other emergencies. Situated in a seismically active zone, Sichuan has experienced numerous severe earthquakes, including the 2008 Wenchuan earthquake (Li et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). The high frequency of major emergencies significantly exacerbates the organizational vulnerability of LTCFs. According to a risk analysis study, the top five emergencies for LTCFs in Sichuan are earthquakes, floods, fires, infectious diseases, and foodborne illnesses (Lan, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Given Sichuan\u0026rsquo;s unique geographical challenges, aging population, regional imbalances in nursing resources, and frequent disasters, research on LTCFs' emergency preparedness is both practically relevant and of long-term significance.\u003c/p\u003e \u003cp\u003eThe top director typically serves as the primary responsible for emergency management in the event of major emergencies at LTCFs (Kusmaul et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). To ensure preparedness measures are comprehensive, feasible, and compliant with legal and regulatory frameworks, directors frequently collaborate with professional consultants or external specialists in emergency management, disaster mitigation, or public health. These specialists contribute to the development of empirically grounded and systematically structured emergency preparedness strategies. Although existing research has predominantly examined preparedness for singular disasters, the escalating frequency of emergencies necessitates that nursing institutions cultivate integrated, multi-tiered emergency response capabilities. The findings of this study may serve as a practical framework for institutional directors and specialists to devise evidence-based strategies for enhancing emergency preparedness in LTCFs. Additionally, the identified vulnerabilities may provide policymakers with actionable insights to rectify systemic gaps in emergency preparedness through targeted policy interventions.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1Methods\u003c/h2\u003e \u003cp\u003eA descriptive qualitative study uses content analysis to describe the experiences and perspectives of research subjects (Willis et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). It is suitable for direct description of a phenomenon or for finding information to develop and refine a questionnaire or intervention, such as exploring patient and clinician wound care experiences (Woo et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) and analyzing healthcare professionals' perceptions of patient safety issues (Pelzang and Hutchinson, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). This study employed descriptive qualitative methods to explore the perceptions of experts and directors about disaster preparedness in LTCFs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Participants\u003c/h2\u003e \u003cp\u003eAccording to the inclusion and exclusion criteria, the research objects that can provide the most and most abundant information are selected by the method of purposive sampling. At the same time, considering the late development of LTCFs in China, the emergency management policy documents of LTCFs need to be improved. To understand the connotation of emergency preparedness of LTCFs from multiple perspectives, in addition to disaster nursing, geriatric nursing, disaster medicine, and geriatric medicine, this study also includes experts in the fields of fire rescue and emergency management. Meanwhile, use a snowball sampling strategy to ensure that the study subjects are sufficient.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Inclusion and exclusion criteria\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 Inclusion and exclusion criteria of experts in the related field\u003c/h2\u003e \u003cp\u003e(1) Inclusion criteria: 1) Experts meeting the following conditions are eligible for participation: Research or work experience in disaster nursing, disaster medicine, fire rescue, geriatric nursing, geriatric medicine, disease prevention and control, or emergency management; 2) Engagement in emergency rescue operations at least once with a minimum of 5 years' work experience, holding an intermediate title or higher, or possessing a master's degree or above; 3) Absence of prior involvement in emergency rescue necessitates a minimum of 10 years of research or work experience in the relevant field, along with an associate vice-senior professional title or a doctoral degree; 4) Proficiency in clear and thorough communication and a willingness to share personal insights and professional experiences.\u003c/p\u003e \u003cp\u003e(2) Exclusion criteria: 1) Individuals whose research or professional practice does not align with the aforementioned fields are excluded from participation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 Inclusion and exclusion criteria of directors of LTCFs\u003c/h2\u003e \u003cp\u003e(1) Inclusion criteria: 1) The management personnel of LTCFs include the president, vice president and nursing supervisor; 2) At least five years of experience in the management and operation of LTCFs; 3) Familiar with the management work of LTCF at present; 4) Have participated in the emergency management of at least one emergency; 5) Proficiency in clear and thorough communication and a willingness to share personal insights and professional experiences.\u003c/p\u003e \u003cp\u003e(2) Exclusion criteria: 1) Directors of LTCFs who have left the organization; 2) Directors who are not or are minimally involved in the daily operations of LTCFs.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Data collection\u003c/h2\u003e \u003cp\u003eThe purpose of developing effective emergency preparedness is to minimize the number of casualties for LTCFs. This study formulated an interview outline for three stages of emergency preparedness: pre-crisis, mid-crisis, and post-crisis according to the crisis life cycle theory (Wang and Wang, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Before the formal interview, respectively, an emergency management expert and a director working in LTCFs meeting the inclusion criteria were selected for pre-interview, to check whether the interview outline needed to be modified, and to ask the subjects about their feelings about participating in the interview, to adjust the interview strategy and communication skills. Finally, we discussed the semi-structured interview questions in depth and confirmed that they would not be revised. The interview outline was agreed upon by all researchers. The semi-structured interview guide mainly included open‐ended questions about the perceptions of experts and directors: What measures should be taken to minimize the number of casualties when faced with serious earthquakes/fires/rainstorms/floods/foodborne illnesses/major infectious diseases in your served LTCFs?\u003c/p\u003e \u003cp\u003eBefore the interview, an appointment was made to confirm that the interviewee was in a quiet and uninterrupted room with enough time. During November 2020 and February 2021, a semi-structured interview was used to collect data by two trained researchers. Interviews ranged from 34 to 120 min with an average duration of 65 min. Transcripts returned to participants for correction at the end of the interview. Through face-to‐face interviews, the researchers established rapport with every participant. The sample became saturated after the 28th interview, and two more interviews were conducted to ensure that no further data could be collected, respectively. No participant dropped out during the interview.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data analysis\u003c/h2\u003e \u003cp\u003eThis study applied a two-phase process for its directed content analysis. First, mainly according to the Crisis Life Cycle Theory and the Prevention, Preparedness, Response, and Recovery (PPRR) model carried out literature analysis, and then through expert meetings and two rounds of expert consultations developed the text analysis framework (Murray and McCutcheon, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). It has constructed 5 key links of emergencies (e.g., early prevention, monitoring and early warning, emergency response, collaborative response, recovery and development) and 15 key processes of emergencies (e.g., environmental prevention and control, organizational system, emergency plan, training and learning, material expenses, risk monitoring, risk warning, communication, early response, medical first aid, external assistance, social services, ongoing operations, aftermath disposal, and cultural construction) (Lan, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Li et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Second, the collected qualitative data were analyzed and coded by NVivo Plus 12 from the key links of emergencies and key processes. Within 24 hours of the end of the interview, the interview data were transcribed in time, marked, saved, and backed up in detail.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Ethical considerations\u003c/h2\u003e \u003cp\u003e This study has been approved by the Ethics Committee of West China University Hospital, Sichuan University (Approval ID: 2018\u0026thinsp;\u0026minus;\u0026thinsp;589). Informed consent was obtained from all participants before the study. The study purpose and methodology were explained to the participants, who allowed their voices to be recorded. The time and place of the interviews were determined with the participants' agreement. Participants were aware that their participation was absolutely voluntary and that they could withdraw from the study at any time. All participants received assurances of confidentiality and anonymity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.7 Rigour and Reflexivity\u003c/h2\u003e \u003cp\u003eThe study adhered to four trustworthiness criteria: credibility, reliability, confirmability, and transferability. To standardize the interview protocol and strengthen researchers\u0026rsquo; qualitative analysis competencies, the team completed structured courses and specialized training. Researchers established rapport with participants throughout the interview process to foster open communication. Data were systematically collected through audio recordings, verbatim transcripts, and reflective journals, with secure storage protocols implemented to ensure long-term accessibility. Post-interview, two researchers independently transcribed the data verbatim and cross-verified transcripts for accuracy. To ensure analytical rigor, preliminary findings were subjected to member-checking procedures, allowing participants to validate the interpretations. During data analysis, researchers actively mitigated potential biases stemming from personal predispositions or prior assumptions, anchoring interpretations exclusively to participants\u0026rsquo; narratives. The research team provided ongoing supervision to maintain methodological consistency and reflexivity.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Findings","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1. Specific characteristics\u003c/h2\u003e\n \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\n \u003ch2\u003e3.1.1. Specific information about being included of LTCFs\u003c/h2\u003e\n \u003cp\u003eIn this study, directors interviewed represented 12 LTCFs, with institutional characteristics summarized as follows: The sample comprised 2 public and 10 private LTCFs. Operational duration ranged from 3 to 70 years, older adult resident capacity ranged from 40 to 1,000 individuals, and staff size varied between 8 and 260 employees. Geographically, 2 facilities were situated in townships, 1 in rural areas, and the remaining 9 in urban settings. The residents of the 12 LTCFs are all elderly people aged 60 and above.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\n \u003ch2\u003e3.1.2. Characteristics of directors in LTCFs\u003c/h2\u003e\n \u003cp\u003eThe characteristics of the 12 participants are shown in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Among the directors of institutions, including 10 directors of LTCFs and 2 directors of nursing departments. In addition, in gender, the group comprised four females and eight males. Aged between 30 and 63.\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe demographic information of directors (N\u0026thinsp;=\u0026thinsp;12)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eProfessional Years\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eType of work\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eExperience\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eM1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eundergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDirector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eInfectious diseases, Flood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eM2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eundergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDirector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eInfectious diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eM3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003ePost-secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDirector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eEarthquake, Infectious diseases, Flood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eM4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eundergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDirector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eInfectious diseases, Flood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eM5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003ePost-secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eHead nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eEarthquake, Infectious diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eM6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eSenior high\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDirector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eEarthquake, Fire, Infectious diseases, Flood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eM7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eElementary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDirector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eEarthquake, Flood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eM8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eSenior high\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eHead nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eFire, Infectious diseases, Flood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eM9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003ePost-secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDirector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eInfectious diseases, Flood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eM10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003ePost-secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDirector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eInfectious diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eM11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003ePost-secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDirector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eInfectious diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eM12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eundergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDirector\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eEarthquake, Fire, Infectious diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\n \u003ch2\u003e3.1.3. Characteristics of experts in LTCFs\u003c/h2\u003e\n \u003cp\u003eThe characteristics of 20 experts are shown in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, including 4 disaster care experts, 4 geriatric care experts, 3 disaster medicine specialists, 2 geriatrics experts, 2 fire rescue experts, 2 disease prevention and control experts, 2 emergency management experts, and 1 aging policy expert. In gender, the group comprised 9 females and 11 males. Aged between 32 and 71.\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe demographic information of experts in emergency preparedness(N\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eProfessional title\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eField\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eProfessional Years\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eExperience\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003edoctoral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eemergency management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003edoctoral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eemergency management\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eEarthquake\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eMaster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDisaster nursing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eEarthquake\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eMaster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eFire rescue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eEarthquake, Fire, Flood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eMaster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eFire rescue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eFire, Flood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eMaster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDisaster nursing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eInfectious diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003edoctoral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDisaster medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eEarthquake\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eundergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDisaster nursing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eEarthquake, Infectious diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eundergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eaging policy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eFire,Flood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eMaster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDisaster medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eEarthquake, Fire, Infectious diseases, Flood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003edoctoral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDisaster nursing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eInfectious diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eundergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDisaster nursing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eEarthquake, Fire, Infectious diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eundergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003egeriatric medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eEarthquake, Infectious diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eundergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDisaster nursing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eMaster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eMiddle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003egeriatric medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eFire\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003edoctoral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDisaster nursing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eundergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDisaster medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eEarthquake, Fire, Infectious diseases, Flood, Food poisoning\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eMaster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003edisease prevention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eEarthquake, Infectious diseases, Flood, Food poisoning\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eMaster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDisaster nursing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eEarthquake, Fire, Infectious diseases, Flood\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eZ20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eMaster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003edisease prevention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eEarthquake, Infectious diseases, Flood, Food poisoning\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\"\u003eNote: Experts are numbered in the order of Z1-Z20. NR-Not Reported\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Characteristics of texts analysis\u003c/h2\u003e\n \u003cp\u003eThe ranking of reference point counts at the event level in descending order is as follows: earthquake, fire, foodborne illnesses, flood, infectious disease, and overall emergency. The order of reference points in the emergency preparation important links in descending order is as follows: emergency response, early prevention, recovery and development, monitoring and early warning, and collaborative response (in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eThe number of reference points in the emergency preparedness key process is ranked in descending order as follows: early response, medical first aid, emergency plan, material expenses, cultural construction, risk warning, aftermath disposal, risk monitoring, training and learning, environmental prevention and control, communication, external assistance, organizational system, ongoing operations, and social services (in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 Results of codes and supporting quotes\u003c/h2\u003e\n \u003cp\u003eAmong the interview texts on emergency preparedness, a total of 36 codes related to earthquakes, 32 codes related to floods, 36 codes related to fires, 25 codes related to infectious diseases, 30 codes related to foodborne illnesses and 18 codes related to emergencies were obtained (in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAnalysis framework and codes of interviewed text\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eKey link\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eKey process\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eEarthquake\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eFlood\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eFire\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eInfectious disease\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eFood poisoning\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eEmergencies\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\n \u003cp\u003e1. Early prevention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1. Environmental prevention and control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eSeismic assessment, Fixed items\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eSmooth drainage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eCleaning and disinfection, Ventilation and air change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eKitchen waste, Cleaning and disinfection, Food preservation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e2. Organization system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eDivision of responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eDivision of responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eDivision of responsibilities, fire fighting system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eEmergency team, Emergency process, Division of responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eEmergency system, Division of responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eEmergency team, Emergency process, Division of responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e3.Emergency plan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003ePlan formulation,\u003c/p\u003e\n \u003cp\u003ePlan drill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003ePlan drill, Plan formulation, Plan update\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003ePlan formulation,\u003c/p\u003e\n \u003cp\u003ePlan drill, Plan update, Plan revision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003ePlan formulation, Plan drill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003ePlan formulation, Plan drill\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003ePlan formulation, Plan drill, Plan update\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e4. Training and learning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eTraining object, Training content\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eTraining object, Training frequency, Training content\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eTraining content, Training plan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eTraining content, Training form\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eTraining content\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e5.Material expenses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003ePhysical supply\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eFunding guarantee, Physical supply\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eFunding guarantee, Physical supply\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eFunding guarantee, Physical supply\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eFunding guarantee, Physical supply\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eFunding guarantee, Physical supply\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003e2. Monitoring and early warning\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003e6. Risk monitoring\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eNR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eWeather forecast, Flood patrol, Water level change\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eFire patrol\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eMonitoring method\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eFood material procurement, Food sample retention, Occupational health\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eNR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003e7. Risk warning\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eOfficial forecast\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eNR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eFire and electricity, fire prevention\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003etypical symptoms\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eHigh-risk food, Food cooking, symptom recognition\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eNR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\n \u003cp\u003e3. Emergency response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e8. Communication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eDisaster report, Public opinion control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eDisaster report, Disaster notification, Public opinion control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003ePublic opinion control, Disaster report, Command personnel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eDisaster report,Public opinion control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003ePublic opinion control, Disaster report, Command personnel, Disaster notification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003ePublic opinion control, Disaster report, Command personnel, Disaster notification\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e9. Early response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eEvacuation transfer, Shock avoiding indoor, Rescue principle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eEvacuation transfer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eFire fighting, Evacuation transfer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eAccess control, Check and isolate, Reduce aggregation, Assisted flow modulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eCheck and isolate, Field storage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eEvacuation and transfer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e10. Medical first aid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eTransfer to hospital, Emergency treatment, Nursing rescue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eTransfer to hospital, Emergency treatment, Nursing rescue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eTransfer to hospital, Emergency treatment, Nursing rescue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eTransfer to hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eTransfer to hospital, Emergency treatment, Nursing rescue, Assisted flow modulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eNursing rescue, Transfer to hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003e4. Collaborative response\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003e11. External assistance\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eNR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eSocial organizations\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eSocial organizations\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eNR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eNR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eNR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003e12. Social services\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eNR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eSocial service project\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eNR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eNR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eNR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003e\u003cspan style=\"background-color: rgb(251, 160, 38);\"\u003eNR\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\n \u003cp\u003e5. Recovery and development\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e13. Ongoing operations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e14. Aftermath disposal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eLoss assessment, Psychological care, Building safety, Restart operations, Secondary disasters, Personal safety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003ePsychological care, Secondary disasters, Rewards and punishments, Loss assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eLoss assessment, Legal dispute, Rewards and punishments, Restart operations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eRewards and punishments, Restart operations, Psychological care, Cadaver care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eFood destruction, Rewards and punishments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003ePersonal safety, Rewards and punishments,\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e15. Cultural construction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eEarthquake prevention propaganda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eFlood Control Concept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eExperience summary, Fire propaganda\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eExperience summary, Prevention and control concept, Science propaganda, Scientific research\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c8\"\u003e\n \u003cp\u003eExperience summary\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\"\u003eNote: NR-Not Reported\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\u003cstrong\u003eKey link 1: early prevention\u003c/strong\u003e\n \u003cp\u003eComplete early prevention is conducive to effective response to major emergencies (Erkhembayar et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Early prevention were categorized into five key processes, including environmental prevention and control, organization system, emergency plan, training and learning, and material expenses.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEnvironmental prevention and control\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFor specific emergencies, LTCFs have taken corresponding measures to prevent and control the environment (e.g., process layout and building assessment). One of the respondents remarked:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eBecause elevators can\u0026apos;t be used in earthquakes. So right now we\u0026apos;re still thinking about that. Now is to slowly adjust the application area, and try to plan on the first floor. (M12)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eOrganization system\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFor major emergency, LTCFs need establish the corresponding organizational system to prevent (e.g., emergency team and emergency process). One of the respondents remarked:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eBecause older adults have weak escape abilities, we must cooperate with some surgeons for treatment. Although doctors from some departments may be able to participate in the treatment, they have little effect. (Z13)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEmergency plan\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eEmergency plans usually need to include plan formulation, plan drill, and plan update. One of the respondents remarked:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eWe are holding fire drills at least twice a year for the fire evacuation part, which is now the norm. (M12)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTraining and learning\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eTraining learning generally includes training object, training record, training frequency, and training content. One respondent remarked:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eSo the first one we will emphasize the daily fire safety to the staff, the morning shift will be emphasized to the staff, the evening shift will be emphasized to the staff. This is the first important education for employees (M1).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMaterial expenses\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMaterials expenses include funding guarantee, physical supply and special funds. One respondents remarked:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIncluding umbrellas, tents, including raincoats, rain boots, helmets these are put up on each floor......And a gas explosion, or a gas leak. The gas masks are all ready (Z3).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eKey link 2: Monitoring and early warning\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eA complete monitoring and early warning system is conducive to improving the ability of accurate response to major emergencies and reducing the loss of life and property caused by emergencies (Kamalrathne et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, Xiong et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). However, monitoring and early warning technology is a relatively weak link in the emergency preparedness. Risk monitoring and risk warning were the two key processes of monitoring and early warning.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRisk monitoring\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFor different kinds of emergencies, the focus of risk monitoring is inconsistent, (e.g., mechanism location for earthquake; weather forecast, watch patrol, high incidence season, and mechanism location for flood; and fire patrol for fire). One respondent remarked:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eFirst of all, Panzhihua was not in the earthquake zone, so it did not suffer a destructive earthquake. At the same time, when selecting the location of LTCFs it selects an open place that can avoid the possibility of people being unable to escape in the event of an earthquake. (M2)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRisk warning\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eRisk early warning usually includes official forecast, early warning identification, fire and electricity, high-risk itinerary, typical symptoms, and so on. One of the respondents remarked:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eWhen the earthquake comes, the earthquake warning will tell us the magnitude of the earthquake. The first time I will assess whether the magnitude of the earthquake is large or small, and then decide whether to transport older adults. (M9)\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eKey link 3: Emergency response\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe core of LTCFs to deal with emergencies is emergency response. Timely and effective emergency response is conducive to reducing the adverse effects caused by emergencies to the greatest extent (Ibrahim and Aitken, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This theme consists of three key processes: communication, early response, and medical first aid.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCommunication\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eCommunication often includes disaster report, disaster notification, public opinion control, and command personnel. One respondent remarked:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eMore than three people is a group foodborne illnesses, more than five people is a serious group foodborne illnesses, then more than five people will be reported to the city, it is necessary to take the initiative to report to the city CDC (M6).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEarly response\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eEarly response needs to do a good job of evacuation transfer, shock avoiding indoor, evacuation transfer, shelter in place, fire fighting, access control, check and isolate, reduce aggregation and other measures. One respondent remarked:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eEvacuation is to directly open all the channels, and then let the self-care elderly people hurry to the open space, and at the same time, for the elderly who are bedridden, it is carried out by the nursing staff (Z4).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMedical first aid\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMedical first aid included transfer to hospital, emergency treatment, sudden illness, and nursing rescue. One respondent remarked:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eBandaging, fixation, transport, and some methods of hemostasis. I think the staff of LTCFs must have some professional first-aid skills (Z19).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eKey link 4: Collaborative response\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eCollaborative response plays a vital role in controlling major emergencies (Schwartz and Yen, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). However, due to the imperfection of policies and laws, collaborative response in emergency preparedness is a relatively weak link (Abubakar et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). There are two key processes of collaborative response, including external assistance and social services.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eExternal assistance\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eGovernment departments, medical institutions, social organizations, relatives of elderly, fire protection agency can all be part of external assistance. One respondent remarked:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eDo they have a good team that can do these things? If not, they have to set up a volunteer team, that is, a public welfare team, to help them do these things (M7).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSocial services\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSocial service projects have been identified only during earthquakes and floods. One respondent remarked:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThe first is to send medical assistance in time, and the second is to pay compensation through the national pension institution liability insurance (M2).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eKey link 5: Recovery and development\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003ePromoting recovery and development of LTCFs after major emergencies can not only help to return to normal life as soon as possible, but also help to accumulate relevant scientific experience to cope with similar emergencies next time (Schoch-Spana et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Ongoing operations, aftermath disposal, and cultural construction are the three key processes of recovery and development. However, ongoing operations have only been identified in infectious diseases, which is a relative weak process in emergency preparedness.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eOngoing operations\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eManpower support is an important component of ongoing operations but is only considered in infectious diseases. One respondent remarked:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eDuring this period of the epidemic is the most urgent period of time, doctors and nurses are also working two shifts, and all live in LTCFs (N16).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAftermath disposal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eAftermath disposal usually includes loss assessment, psychological care, building safety, restart operations, secondary disasters.This process has received the attention of experts and directors. One respondent remarked:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eFor example, some elderly people who have psychological disorders themselves, or some older adults who are very emotional, need timely prevention and psychological intervention if these situations occur (Z8).\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCultural construction\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eCultural construction usually includes experience summary, scientific research, supervision and evaluation, self-help idea, and so on. One respondent remarked:\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eThe first thing is to improve their ability to save themselves, because when any rescue team or any organization or medical organization or rescue force is mobilized, it takes time. You only have a chance if you save yourself first (M8).\u003c/em\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study centers on emergency preparedness measures for diverse emergencies in LTCFs, including earthquakes, fires, floods, infectious diseases, foodborne illnesses, and general emergencies, constituting the most comprehensive investigation to date on this topic. Anchored in Crisis Life Cycle Theory and the PPRR model, the study constructs an analytical framework comprising five core dimensions and 15 critical processes for LTCF preparedness. By addressing the limitations of single-hazard or single-stakeholder approaches common in the literature, it offers empirical insights into emergency preparedness in a disaster-prone and rapidly aging region.\u003c/p\u003e \u003cp\u003eAccording to interviewee perspectives, earthquakes are prioritized as critical emergencies, whereas general emergency preparedness is perceived as less urgent. This prioritization likely stems from participants\u0026rsquo; proximity to Sichuan, China\u0026mdash;a region prone to seismic hazards, as evidenced by catastrophic events such as the 2008 Wenchuan earthquake (M8.0), the 2013 Lushan earthquake (M7.0), and the 2017 Jiuzhaigou earthquake (M7.0) (Yong et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). While such earthquakes have caused substantial casualties and economic damage, they have also driven advancements in disaster preparedness frameworks and policy reforms. However, generic emergency plans are deemed less critical than scenario-specific measures. Tailored preparedness strategies are perceived as more effective, as generic plans often lack the specificity needed to address unique emergency scenarios. This limitation undermines their practical applicability and operational utility (Wasserman and Konetzka, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Substantial variations in emergency types, geographical contexts, and institutional categories complicate efforts to standardize disaster-specific plans or assess their efficacy (Festa et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Consequently, developing a generalizable emergency preparedness framework merits further investigation.\u003c/p\u003e \u003cp\u003eAnalysis of the core components of emergency preparedness reveals that early prevention is prioritized by experts and institutional directors. In contrast, monitoring and early warning are comparatively underemphasized. This disparity may stem from early prevention\u0026rsquo;s pivotal role in shaping effective crisis responses. Proactive disaster prevention is indispensable for ensuring swift restoration of LTCF functionality post-emergency (Eltaybani et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Furthermore, early prevention strategies inform the development of targeted security policies and optimize their practical implementation.\u003c/p\u003e \u003cp\u003eHowever, effective monitoring and early warning systems remain among the most deficient areas in LTCFs\u0026rsquo; disaster preparedness frameworks. Current human resource constraints hinder the implementation of robust monitoring and warning mechanisms, resulting in reactive rather than proactive measures. The complexity and unpredictability of earthquakes, floods, and infectious disease outbreaks complicate the simulation of reliable monitoring systems, impeding progress in this field (Cheng et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Despite these limitations, proactive surveillance and early warning systems remain essential elements of emergency preparedness in LTCFs. Timely identification of emergency precursors enables rapid stakeholder communication and preparedness, reducing logistical and financial burdens during crisis mitigation.\u003c/p\u003e \u003cp\u003eFrom the perspective of key emergency preparedness processes, early response emerges as a significantly important theme for LTCFs. Conversely, social service and ongoing operations are considered less critical aspects of emergency preparedness. Prompt and appropriate action is essential, requiring LTCFs to swiftly coordinate all rescue resources and implement preemptive measures by the nature and severity of the emergency (ShiYou, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Experts and institutional leaders underscore the centrality of early response in LTCF emergencies, acknowledging that ineffective interventions may precipitate systemic disarray. Proactive early response measures, such as evacuations during earthquakes, floods, or fires, and containment protocols for infectious diseases or foodborne outbreaks, are critical for mitigating secondary risks and restoring stability (Zhou et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Moreover, LTCFs frequently become focal points of public attention during crises, subjecting them to heightened scrutiny. Mismanagement during emergencies risks exacerbating public distrust, disrupting operations, and undermining institutional credibility (Qin, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile social service and ongoing operations are considered less critical in the context of emergency preparedness, it\u0026rsquo;s important to note that LTCFs are inherently social welfare service providers. Furthermore, LTCFs face numerous challenges, including limited human resources, overall quality concerns, and a pressing need for system optimization(Beltran et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The devastating impact of sudden major disasters often makes it challenging for LTCFs to effectively execute social service and operational tasks related to emergency preparedness and subsequent recovery. However, previous studies have focused less on this aspect of emergency preparedness. Future efforts should focus on enhancing operational and management standardization in LTCFs, improving employee professional competency, bolstering job satisfaction, and establishing robust talent reserves to adequately support LTCFs\u0026rsquo; operations.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Strengths and Limitations of the Work\u003c/h2\u003e \u003cp\u003eOur findings should be viewed cautiously and considered within the context of certain critical limitations. First, data were collected during the COVID-19 pandemic from 2020 to 2021, which may have led to an overemphasis on infectious disease preparedness among participants, or insufficient elaboration on other hazards due to the heavy burden of pandemic prevention, potentially biasing the perceptions obtained. Additionally, participants were exclusively recruited from Sichuan, a disaster-prone region in western China, which limits the generalizability of our findings to other areas and fails to capture perceptions of hazards such as typhoons and tsunamis. Nevertheless, despite these constraints, the research provides valuable insights into LTCFs\u0026rsquo; experiences with emergency preparedness during major crises. Future research could replicate this study in the post-pandemic period to enable cross-temporal comparative analysis. A nationwide multicenter study across disaster-prone regions in eastern, central, and western China is also warranted to develop a complete framework for understanding emergency preparedness perceptions in LTCFs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Recommendations for Further Research\u003c/h2\u003e \u003cp\u003e \u003cp\u003eFuture research should investigate additional stakeholders\u0026rsquo; perspectives on mentoring practices, particularly the barriers they encounter in facilitating its integration. Furthermore, research is warranted to establish sustainable frameworks for embedding mentoring within rehearsal practices, fostering its systematic integration into organizational culture.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Implications for Policy and Practice\u003c/h2\u003e \u003cp\u003eProactively fostering interdisciplinary collaboration among agency administrators, healthcare providers, domain experts, and governmental bodies will be critical to enhancing emergency response efficacy and minimizing human casualties and material losses within institutions. Policy frameworks must formally mandate support for nurses\u0026rsquo; leadership roles in emergency risk mitigation and preparedness planning. These measures would serve as a pivotal mechanism for stabilizing institutional operations during crises.\u003c/p\u003e\u003c/div\u003e"},{"header":"5. Conclusion","content":" \u003cp\u003eLTCFs are particularly vulnerable during major emergencies. The rising frequency of large emergencies underscores the critical imperative to develop enhanced, institution-specific preparedness planning and management frameworks. This study offers critical empirical insights to guide institutionally tailored crisis preparedness strategies. Beyond prioritizing proactive prevention and rapid response protocols, emphasis must be placed on enhancing real-time monitoring systems, establishing robust early warning mechanisms, implementing timely stakeholder communication protocols, and streamlining response coordination to reduce operational disruptions and resource expenditures during emergencies.\u003c/p\u003e "},{"header":"Declarations","content":"\u003ch2\u003eDeclaration of competing interest\u003c/h2\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eClinical trial number\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eData sharing statement\u003c/h2\u003e\n\u003cp\u003eDue to ethical reasons, the raw data would remain confidential and would not be shared. The processed data that support the findings of this study are available from the corresponding author Li Lan, upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eCRediT authorship contribution statement\u003c/h2\u003e\n\u003cp\u003eYanping Peng: Formal analysis, Data curation, Methodology, Writing-original draft, Writing - review \u0026amp; editing. Jiong Liu: Formal analysis, Data curation, Writing - review \u0026amp; editing. Lan Li: Conceptualization, Methodology, Resources, Data curation, Writing - review \u0026amp; editing, Supervision, Project administration.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThis study adhered to the Declaration of Helsinki. The research protocol involving human participants was reviewed and approved by the Ethics Committee of West China University Hospital, Sichuan University (Approval ID: 2018-589). Before participating in the study, the participants provided written informed consent.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eFunding sources\u003c/h2\u003e\n\u003cp\u003eThis research was supported by the National Natural Science Foundation of China (72404005); the 76th batch project of China Postdoctoral Science Foundation (2024M760162); the Science and Technology Strategic Cooperation Programs of Luzhou Municipal People\u0026apos;s Government and Southwest Medical University (2024LZXNYDJ063); the key project of Sichuan Key Laboratory of Nursing in 2024 (HLKF2024 (Z)-1).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbubakar I, Dalglish SL, Ihekweazu CA, Bolu O, Aliyu SH. 2021. Lessons from co-production of evidence and policy in Nigeria's COVID-19 response. BMJ Glob Health 6 (3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeltran SJ, Wagner J, Dorris L, Miller VJ. 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J Wound Care. 2017;26(Sup7):S4\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiong L, Hu P, Wang H. Establishment of epidemic early warning index system and optimization of infectious disease model: Analysis on monitoring data of public health emergencies. Int J Disaster Risk Reduct. 2021;65:102547.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYong Z, Zhuang L, Liu Y, Deng X, Xu D. Differences in the Disaster-Preparedness Behaviors of the General Public and Professionals: Evidence from Sichuan Province, China. Int J Environ Res Public Health. 2020;17:14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou Z, Zhang Y, Gou J, Kan N, Zhao F, Yao L, Hou S. 2023. Successful Large Hospital Evacuation With 11 350 Patients Transferred in the 2021 Zhengzhou Flood. Disaster Med Public Health Prep 17, e434.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Emergency preparedness, Long-term care facilities, Qualitative study","lastPublishedDoi":"10.21203/rs.3.rs-9257182/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9257182/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cdiv id=\"ASec1\" class=\"AbstractSection\"\u003e \u003cdiv class=\"Heading\"\u003eBackground\u003c/div\u003e \u003cp\u003eLong-term care facilities (LTCFs) frequently suffer mass casualties during major destructive emergencies. The frequent occurrence of such events threatens the normal operation of institutional care services and exacerbates social unrest. Therefore, it is imperative to prioritize the emergency capabilities of LTCFs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"ASec2\" class=\"AbstractSection\"\u003e \u003cdiv class=\"Heading\"\u003eAim\u003c/div\u003e \u003cp\u003eTo explore the perspectives of long-term care facility(LTCF) managers and experts on emergency preparedness and analyzes the vulnerabilities in these institutions' preparedness efforts.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"ASec3\" class=\"AbstractSection\"\u003e \u003cdiv class=\"Heading\"\u003eMaterials and Methods\u003c/div\u003e \u003cp\u003e Purposive and snowball sampling was used to recruit participants. Mainly according to the Crisis Life Cycle Theory, and the Prevention, Preparedness, Response, and Recovery (PPRR) model was established analysis framework of this work. The directed content analysis was conducted for data analysis through the analysis framework.\u003c/p\u003e \u003c/div\u003e \u003cp\u003e \u003cb\u003eFindings\u003c/b\u003e: Data from 15 key processes and 5 key links of emergency preparedness were coded using a text analysis framework. The analysis revealed that LTCFs inadequately prioritize ongoing operations and social services in their preparedness processes. Additionally, monitoring and early warning systems receive insufficient emphasis. Examination of various emergencies highlighted a general lack of focus in overall preparedness efforts.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusions\u003c/b\u003e: This study provides new insights into emergency preparedness for major emergencies in LTCFs. The findings can help agency directors and experts adapt strategies to improve preparedness. Furthermore, the\u003c/p\u003e \u003cp\u003eresults address gaps between empirical evidence and theoretical expectations, offering valuable input to refine current emergency preparedness policies.\u003c/p\u003e","manuscriptTitle":"Perceptions of experts and institutional directors about emergency preparedness in long-term care facilities in Sichuan, China: A descriptive qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-13 11:30:18","doi":"10.21203/rs.3.rs-9257182/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"115405160044940803706442094893793444540","date":"2026-05-12T16:16:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"158342877409059378993778630902097330341","date":"2026-05-07T15:56:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-05T15:10:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-10T12:57:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-09T13:25:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-09T02:30:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2026-04-09T02:25:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"31ecb3ef-ac31-476e-867b-7e8d2f584e8f","owner":[],"postedDate":"May 13th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"115405160044940803706442094893793444540","date":"2026-05-12T16:16:35+00:00","index":68,"fulltext":""},{"type":"reviewerAgreed","content":"158342877409059378993778630902097330341","date":"2026-05-07T15:56:14+00:00","index":49,"fulltext":""},{"type":"reviewersInvited","content":"30","date":"2026-05-05T15:10:11+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T11:30:18+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-13 11:30:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9257182","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9257182","identity":"rs-9257182","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}