Considering the need for hospital disaster preparedness post-Nepal earthquake 2015, the Ministry of Health and Population of Nepal developed a Hospital Disaster Preparedness and Response Plan (HDPRP) for mass casualty management. However, until now, there is no scientific literature on how the district hospitals, which are the major health service providers in Nepal, implemented their HDPRP during mass casualty incidents (MCIs). So, this study aims to understand how the HDPRP was implemented during MCIs in three district public hospitals of Nepal.

A mixed sequential QUANT-QUAL study was designed. Out of seven districts under the severely hit category by Nepal Earthquake 2015, three districts were selected randomly. For the quantitative component, the WHO hospital emergency response checklist was adapted which was self-administered in each hospital. Based on a scoring system, each hospital was placed in one of three categories (effective, insufficient, unacceptable), to assess the level of HDPRP implementation. For the qualitative component, semi-structured interviews were conducted to understand how the HDPRP was implemented in each hospital. An inductive thematic analysis was carried out. All information was collected for the most recent management of MCI reported in the hospital.

Out of three hospitals, two hospitals have effectively implemented their HDPRP, whereas one has insufficient implementation. Three themes emerged during the data analysis: enablers in implementation of HDPRP, barriers in implementation of HDPRP, and recommendations for the future. Multiple enablers and barriers were identified for the implementation of HDPRP, and the recommendations were identified for the hospital, hospital staff, and external stakeholders.

Implementation of HDPRP as per the protocol is difficult due to many external and internal factors that arise while managing the MCIs. The findings of this study provide the basis for the Ministry of Health and Population and district hospitals for the future update of HDPRP and planning of MCIs.