Dear Editor,
In the 21st century, hospitals encounter numerous challenges in both normal and abnormal situations. A wide range of internal, external, or international disasters and emergencies, such as earthquakes, floods, and war, threaten hospitals and healthcare centers (1). One of the most severe man-made disasters is armed conflict or war (2). Due to the continuous nature of healthcare services provided in hospitals, their vulnerability increases under certain emergency conditions (3). For instance, many patients were evacuated to countries like Norway and Poland following Russia’s attack on Ukraine on 24 February 2022. The experience of hospital nursing managers in Norway receiving patients from Ukraine highlighted the importance of coordination and preparedness in the receiving hospitals (4). Furthermore, nurses faced various challenges in providing care under war conditions during the Lebanon conflict (5). During the 12-day war between Israel and Iran, several hospitals in Tehran experienced emergency evacuations. On 17 June 2025, following an air raid warning and the life-threatening danger to staff and patients, a vertical emergency evacuation of a pediatric specialty hospital in district 18 of Tehran was carried out at 3:00 AM. Challenges encountered during this hospital evacuation included shortages of supplies such as blankets, bottled water, flashlights, and safe equipment for patient transport, as well as insufficient preparedness and training of nurses for emergency evacuations.
On 24 June 2025, both vertical and horizontal evacuations were performed at another pediatric specialty hospital located in district 7 of Tehran Municipality. In this case, in addition to the challenges of equipment shortages and lack of evacuation experience among nurses, the hospital also faced difficulties in accessing a safe open-space location for relocated patients. Another case was the complete emergency evacuation of a burn specialty hospital in district 3 of Tehran on 23 June 2025. The major challenges identified during the evacuation processes of these hospitals can be categorized into communication, education, transportation, equipment, energy, and management. Nursing managers reported specific issues such as the lack of consideration for pediatric medical needs in hospital risk management plans, inadequate efforts to secure safe alternative locations for patients, poor communication between hospital evacuation teams and government organizations, and weak coordination for transferring patients to receiving hospitals (6). Given that emergency hospital evacuation is unavoidable in some situations, hospitals should be prepared to conduct an effective emergency evacuation during the response phase. To achieve this goal, nursing managers of hospitals should actively participate in the development of hospital emergency evacuation plans, incorporating various scenarios such as explosions, fires, floods, earthquakes, etc., as well as defining the roles and responsibilities of emergency evacuation team members within the hospitals’ clinical departments. The most important measures that need to be conducted in the preparedness phase for emergency evacuations are summarized as follows: (1) Developing emergency evacuation plans for various scenarios; (2) establishing a dedicated hospital emergency evacuation team in hospitals’ clinical departments; (3) providing appropriate tools and equipment in sufficient quantities for the safe transportation of patients; (4) offering effective and relevant training to all hospital staff, including nurses, nurse aides, service workers, and security personnel; (5) holding regular tabletop and operational exercises with various scenarios in different hospital departments.
By implementing the above measures, hospital nursing managers can ensure that staff are well-prepared to respond effectively to various disaster scenarios. Upon activation of the evacuation code by the hospital incident commander, patient transfers can be conducted safely and quickly from dangerous areas to safe zones.
