• Arezou Karampourian, Zohreh Ghomian, and Davoud Khorasani-Zavareh.
• Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: a.karampourian@sbmu.ac.ir.
• Injury. 2019 May 1; 50 (5): 1097-1104.

Background And ObjectivesTraumatic incidents may occur during religious mass gatherings. A lack of preparedness by the health system to respond to traumatic incidents may increase the mortality rate. This study investigated the factors that affect the preparedness of a health system to respond to traumatic incidents, and we provide appropriate suggestions for improving the response to such incidents during religious mass gatherings.MethodsA qualitative research method was used with a conventional content analysis approach. In total, 22 semi-structured interviews were conducted employing the content analysis method. The data were analyzed based on the means of the meaning units, condensed meaning units, sub-themes, themes, and codes.ResultsFour main categories and nine sub-categories emerged from the data: factors that increased or decreased the occurrence of incidents (with three sub-categories comprising risk perception and fatalism, pilgrims' responses to incidents, and health system response to traumatic events); medical infrastructure (with two sub-categories comprising medical infrastructure in the host country and medical structures in border cities); organizational resource category (with two sub-categories comprising manpower, and equipment and facilities); and coordination of responsible organizations (with two sub-categories comprising inter-organizational coordination and inter-agency collaboration). All of the data were extracted from the experiences of the participants.ConclusionSimilar to other mass gatherings, Arbaeen requires multi-sectoral and international planning, organizing, and management. The key factors that could improve the preparedness to respond to traumatic events in Arbaeen include training, increasing the perception of risk, changing the attitudes and behavior of pilgrims, developing a national strategic plan of the health system preparedness for policymakers, and implementing scenario-based exercises for executives.Copyright © 2018. Published by Elsevier Ltd.

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