Introduction: The delivery of special care services at disaster scenes is a core component of an advanced health-system response for casualties with life-threatening conditions. Through timely, life-saving, and specialized interventions, such services can play a pivotal role in reducing mortality and severe injury-related outcomes. Despite their importance and given Iran’s high exposure to disasters, available evidence indicates that a documented, context-specific and structured model aligned with national conditions is lacking. Therefore, this study aimed to design a model for the delivery of special care services at disaster scenes in Iran.

Methods: This study was developmental applied in nature and conducted using a qualitative approach. To achieve the first objective (identifying the dimensions and components of disaster-scene special care service delivery worldwide), a systematic review of national and international sources was performed. Next, to address the second objective (elucidating Iranian experts’ experiences and perspectives regarding context-specific requirements and components), a qualitative study was conducted using semi-structured interviews with 24 key informants, and the data were analyzed using content analysis. Finally, to accomplish the third objective (designing the model for Iran), findings from the previous two phases were integrated using the constant comparative method to develop a preliminary model; the proposed model was then validated and finalized using the Delphi technique with the participation of 20 experts.

Results: In the systematic review phase, following study selection and screening, 31 studies were included, and the relevant dimensions and components of delivering special care services at disaster scenes were identified, including "patient care", "operational efficiency", "personnel and training", "technology and equipment", "coordination and preparedness", and "ethical and contextual considerations". In the second phase, analysis of interview data yielded four main themes: "management of vital resources", "clinical interventions and processes", "enhancement and development of critical care services", and "challenges and barriers to service delivery". In the third phase, the proposed model was assessed through the Delphi technique and was refined based on consensus among 20 experts, so that all 32 components of the model achieved over 75% agreement. Ultimately, the Iranian model for delivering special care services at disaster scenes was developed and presented by mapping the relationships among the identified themes.

Conclusion: The main achievement of this study is the presentation of a comprehensive, multi-dimensional, and context-specific model for the delivery of special care services at disaster scenes in Iran, which is built upon four key pillars: "management of vital resources", "specialized clinical interventions", "development and enhancement of services", and " challenges and barriers". It is hoped that this model can serve as a strategic tool to enhance the resilience of the health system, improve the quality of disaster response, reduce mortality, and increase the effectiveness of prehospital interventions, with a special focus on specialized and life-saving care at the scene of the incident, and provide a scientific basis for policymaking, planning, training, and the development of specialized services in disaster settings

Keywords: Disasters, Special care, Disaster scene, Model, Iran