Massive influx of victims: staff preparedness and facility readiness of Tunisian general University Hospitals.

Introduction: Hospital preparedness for a massive influx of victims relies, to a certain extent, on actions, programs, and systems that are created and executed ahead of time, but also on the knowledge, skills, and professional competences of the hospital's staff. Aim: This study aims to understand the factors influencing the preparedness of Tunisian University Hospital staff in facing a massive influx of victims. Methods: This is a multi-method qualitative descriptive study conducted in nine general University Hospitals in Tunisia. The first component was a phenomenological design via open-ended interviews. The second component was a qualitative observational non-participatory design via field observations. Results: 17 participants were recruited in an intentional, non-probabilistic way. Participants to this study discussed issues related to the material and financial resources of their hospitals as well as the psychological impact of managing an influx of victims. They also discussed their training, their involvement in the process, and the norm versus the circumstances in the field which led to the conclusion that: "For multiple reasons, the Tunisian University Hospitals are not ready to properly manage a massive influx of victims". Conclusions: This multi-method qualitative study discussed the factors that affected the preparedness of staff and readiness of University Hospitals included, which were mainly resources (material and financial), psychological burden, lack of training, lack of involvement in the process, and issues related to evidence-based practice. These findings support the idea that more research and more practical interventions needs to be performed to increase the preparedness level of Tunisian University Hospitals and their staff.