Purpose This paper aims to identify the specific parameters in developing a framework to assess the structural vulnerability of hospital buildings in Sri Lanka against tsunami. Along with that, the adaptability and suitability of the existing global frameworks in the Sri Lankan context are to be assessed. Design/methodology/approach In this study, Papathoma tsunami vulnerability assessment (PTVA)-4 model was used as the base in developing the abovementioned framework. Its adaptability and suitability in assessing hospital buildings in the country were considered under the case studies conducted in six selected hospitals in the Southern coastal belt of Sri Lanka. Under these case studies, data collection was done using the Rapid Visual Screening method where assessments were carried out through visual observations. The collected data were analyzed according to the aforementioned model for its suitability in evaluating the structural vulnerability of hospitals in Sri Lanka, against tsunami hazard. Findings From these case studies, it was identified that the use of the PTVA-4 model alone was insufficient to assess the structural vulnerability of the hospital buildings against the tsunami. Therefore, the model must be further improved with more relevant assessing attributes related to hospitals, suitable for the Sri Lankan context. Originality/value This paper identifies the specific structural assessment parameters required in assessing hospitals in the coastal belt of Sri Lanka, considering tsunami as the main hazard condition.