A direct qualitative content analysis on the
design, implementation, and evaluation
of prehospital earthquake exercises aligned
with the HSEEP framework

A direct qualitative content analysis on the
design, implementation, and evaluation
of prehospital earthquake exercises aligned
with the HSEEP framework

Preparedness, Prehospital, Earthquake, Exercise

Abstract
Introduction Disaster exercises are a vital strategy for enhancing Emergency Medical Services (EMS) operational
preparedness. This study aimed to extract “Golden Keys” for Design, Implementation and Evaluation of earthquake
exercises aligning these key components with the internationally recognized Homeland Security Exercise and
Evaluation Program (HSEEP) Framework from the perspective of experienced Iranian prehospital technicians.
Method A qualitative study was conducted using a directed content analysis. Data were systematically gathered
through in-depth semi-structured interviews with 11 prehospital technician that purposefully selected based on their
demonstrated expertise in prehospital exercise management. Data analysis was conducted in five steps following
Granheim and Lundman’s approach and the study used Lincoln and Guba’s recommendations to assess data
trustworthiness.
Result After multiple rounds of data analysis and summarization 386 initial codes, 13 subcategories, and five main
categories were identified. These main categories included “Exercise Foundation and Program Governance”, “Exercise
Design, Coordination, and Control”, “Operational Implementation of the Exercise”, “Performance Evaluation and
Capability Assessment” and “Learning, Workforce Empowerment”, and “System Improvement”.
Conclusion Earthquake preparedness exercises must be sustained as an ongoing effort to enhance prehospital
system resilience. The indicators identified in this study provide an actionable, evidence-based framework for EMS
managers and policymakers to design, implement, and evaluate exercises aligned with system priorities. Translating
exercise outcomes into actionable evidence facilitates informed decision-making targeted resource allocation and
evidence-based policy formulation. Future research should focus on contextualizing this framework within localized
programs and conducting quantitative validation of the proposed indicators.
Keywords Preparedness, Prehospital, Earthquake, Exercise

Asiye Aminafshar1

, Ali Moradi Chaleshtori2

, Ali Khosravizad3

, Ali Sahebi3* and Hojjat Farahmandnia4*

https://doi.org/10.1186/s12245-026-01135-y

2026

peri irawan

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