Adaptation of prehospital emergency medical services to the incident command system during the Kahramanmaraş earthquake: A qualitative evaluation

Abstract

Background

The Incident Command System is a critical framework for coordinating emergency response; however, large-scale disasters often expose operational, structural, and communication gaps. Understanding how Emergency Medical Services personnel navigate these challenges is essential to strengthening disaster readiness and improving coordinated field operations.

Objective

This study aimed to explore the challenges faced by prehospital Emergency Medical Services personnel in adapting to the Incident Command System during the Kahramanmaraş Earthquakes.

Methods

A qualitative phenomenological design was employed to investigate the lived experiences of Emergency Medical Services professionals who participated in disaster response operations. Twenty participants were recruited through purposive sampling from the Paramedic and Pre-Hospital Emergency Medicine Association. Semi-structured interviews were conducted via Microsoft Teams between March and May 2024. Data were analyzed using inductive content analysis following Braun and Clarke's six-phase framework, supported by MAXQDA 2020 software.

Results

Seven major themes were identified: absence of a pre-incident plan, communication breakdown, inadequate scene safety, lack of inter-agency coordination, resource insufficiency, challenges in disaster triage, and inefficiencies in patient transport. These findings highlight systemic and organizational weaknesses that hindered Emergency Medical Services professionals adaptation to the Incident Command System.

Conclusion

Findings demonstrate that fragmented command structures, disrupted communication, and insufficient logistical planning impeded effective Emergency Medical Services coordination under chaotic disaster conditions. Strengthening scenario-based Incident Command System training, communication infrastructure, and inter-agency governance mechanisms is essential to improve Emergency Medical Services adaptability and resilience in future large-scale emergencies.