Document Type : Original Article


1 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

2 Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran, Nursing Faculty, Baqiyatallah University of Medical Scienses, Tehran, Iran

3 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Emergency Management Research Center, Iran University of Medical Sciences, Tehran, Iran

4 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden


The Emergency Medical Services (EMSs) are in the frontline between the health-care systems and
people in emergencies and disasters. With the increase in the frequency of natural or man-made
disasters around the world, the need for prepared EMS services is increasing. This study aimed to
evaluate the current disaster preparedness status of the EMS agencies in the literature and exploring
the key preparedness elements and the strategies to improve the EMS disaster preparedness. The
electronic database such as PubMed, Web of Science, Scopus, and Google Scholar was searched
from 2000 to 2019. The searching keywords included: “EMS,” “Disaster,” “Preparedness,” “Emergency”
“Preparedness,” “Disaster Preparedness,” “Readiness,” and the terms related to “disaster types” were
used in combination with Boolean operators OR and AND. Out of 1412 articles, 7 articles were
included in the review. The most important elements of the EMS disaster preparedness include the
size and scope of the incident, surge capacity, planning, communication, training and education,
policymaking, financial support, coordination, safety and security, early warning system, disaster
response experience, and legal considerations. This systematic review showed that the EMS agencies
in the world generally are inadequately prepared for an effective response to major emergencies and
disasters. This study provides valuable information to EMS educators, EMS administrators to adopt
and perform appropriate activities to improve the EMS disaster preparedness.


  1. James J, Rifino and Selwyn E, Mahon. Role of Emergency
    Medical Services in Disaster Management and Preparedness.
    Ciottone’s Disaster Medicine. 2 nd 2015.
    2. Maguire BJ, Dean S, Bissell RA, Walz BJ, Bumbak AK. Epidemic
    and bioterrorism preparation among emergency medical services
    systems. Prehospital and disaster medicine. 2007;22(3):237.
    3. Jadidi A, Irannejad B, Bahrami P, Moradi Y, Tarzam MZ. Is
    Emergency Medical Services (EMS) in Islamic Republic of Iran
    Practical and Efficient in Facing Ebola? Bulletin of Emergency &
    Trauma. 2019;7(3):315.
    4. Ho AFW, De Souza NNA, Blewer AL, Wah W, Shahidah N,
    White AE, et al. Implementation of a National 5‐Year Plan for
    Prehospital Emergency Care in Singapore and Impact on Out‐of‐
    Hospital Cardiac Arrest Outcomes From 2011 to 2016. Journal of
    the American Heart Association. 2020;9 (21):e015368.
    5. Labrague L, Hammad K, Gloe D, McEnroe‐Petitte D, Fronda D,
    Obeidat A, et al. Disaster preparedness among nurses: a
    systematic review of literature. International nursing review.
  2. 6. COVID‑19 Coronavirus Pandemic; 2020. Available from: https:// [Last accessed on 2020
    Jun 03]
    7. UNISDR. Proposed Updated Terminology on Disaster
    Risk Reduction A Technical Review; 2015. Available
    backgoundpaperonterminologyaugust20.pdf. [Last accessed on
    2020 Jun 01]
    8. UNO. Sendai Framework for Disaster Risk Reduction 2015‑2030:
    UNDRR; 2015. Available from:
    files/43291_sendaiframeworkfordrren.pdf. [Last accessed on
    2020 Jun 01]
    9. Elliott RW. Measuring Disaster Preparedness of Local Emergency
    Medical Services Agencies. Naval Postgraduate School Monterey
    CA; 2010.
    10. Security DO. Target Capabilities List: A Companion to the
    National Preparedness Guidelines. DHS Washington; 2007.
    11. Moher D., Liberati A., Tetzlaff J., Altman D.G.; PRISMA Group.,
    2009. Preferred reporting items for systematic reviews and
    meta‑analyses: the PRISMA statement. British Medical Journal.
    339, b2535.
    12. Beyramijam M, Khankeh HR, Farrokhi M, Ebadi A, Masoumi G,
    Nouri‑Sari H. Evaluating the disaster preparedness of emergency
    medical service agencies in the world: A systematic literature
    review protocol. Journal of Education and Health Promotion.
    13. Phelps S. Mission failure: Emergency medical services response to
    chemical, biological, radiological, nuclear, and explosive events.
    Prehosp Disaster Med 2007;22:293‑6.
    14. Shirm S, Liggin R, Dick R, Graham J. Prehospital preparedness
    for pediatric mass‑casualty events. Pediatrics 2007;120:e756‑61.
    15. Furbee PM, Coben JH, Smyth SK, Manley WG, Summers DE,
    Sanddal ND, et al. Realities of rural emergency medical services
    disaster preparedness. Prehosp Disaster Med 2006;21:64‑70.
    16. Alotaibi MS, Khan AA. Assessing the pre‑hospital care
    preparedness to face mass casualty incident in Saudi Arabia in
    2017‑2018. Saudi Med J 2019;40:1032‑9.
    17. Jama TJ, Kuisma MJ. Preparedness of finnish emergency medical
    services for chemical emergencies. Prehosp Disaster Med
    18. Sutton J, Tierney K. Disaster Preparedness: Concepts, Guidance,
    and Research. Colorado: University of Colorado; 2006.
    19. McManus J, Huebner K, Scheulen J. The science of surge: Detection
    and situational awareness. Acad Emerg Med 2006;13:1179‑82.
    20. DiMaggio C, Markenson D, T. Loo G, RedlenerI. The willingness
    of US emergency medical technicians to respond to terrorist
    incidents. Biosecurity and bioterrorism: Biodefense strategy.
    Practice Sci 2005;3:331‑7.
    21. Reilly MJ, Markenson D, DiMaggio CJ. Comfort level of
    emergency medical service providers in responding to weapons
    of mass destruction events: impact of training and equipment.
    Prehosp Disaster Med 2007;22:297‑303.
    22. Smith E, Morgans A, Qureshi K, Burkle F, Archer F. Paramedics’
    perceptions of risk and willingness to work during disasters.
    Australian J Emerg Manag 2009;24:21.
    23. WaughWL. Terrorism and the All‑hazards Model. J Emerg Manag
    24. Bremer R. Policy development in disaster preparedness and
    management: Lessons learned from the January 2001 earthquake
    in Gujarat, India. Prehosp Disaster Med 2003;18:372‑84.
    25. AlexanderDE. Disaster and Emergency Planning for Preparedness,
    Response, and Recovery. london’s global university: Oxford
    University Press; 2015.
    26. Nekoie‑Moghadam M, Kurland L, Moosazadeh M, Ingrassia PL,
    Della Corte F, Djalali A. Tools and checklists used for the
    evaluation of hospital disaster preparedness: A systematic review.
    Disaster Med Public Health Prep 2016;10:781‑8.
    27. Heidaranlu E, Ebadi A, Khankeh HR, Ardalan A. Hospital disaster
    preparedness tools: A systematic review. PLoS Curr 2015;7:1‑19.
    28. Olivieri C, Ingrassia PL, Della Corte F, Carenzo L, Sapori JM,
    Gabilly L, et al. Hospital preparedness and response in
    CBRN emergencies: TIER assessment tool. Eur J Emerg Med
    29. Sheikhbardsiri H, Raeisi AR, Nekoei‑Moghadam M, Rezaei F.
    Surge capacity of hospitals in emergencies and disasters with a
    preparedness approach: A systematic review. Disaster Med Public
    Health Prep 2017;11:612‑20.
    30. Bonnett CJ, Peery BN, Cantrill SV, Pons PT, Haukoos JS,
    McVaney KE, et al. Surge capacity: A proposed conceptual
    framework. Am J Emerg Med 2007;25:297‑306.
    31. Physicians AC. Health care system surge capacity recognition,
    preparedness, and response. Ann Emerg Med 2005;45:239.
    32. Handel DA, Sklar DP, HollanderJE, Asplin BR, Hedges JR, Group
    IoMAoAMCP. Executive summary: The Institute of Medicine
    report and the future of academic emergency medicine: the Society
    for Academic Emergency Medicine and Association of Academic
    Chairs in Emergency Medicine Panel: Association of American
    Medical Colleges annual meeting, October 28, 2006. Acad Emerg
    Med 2007;14:261‑7.
    33. Palttala P, Boano C, Lund R, Vos M. Communication gaps in
    disaster management: Perceptions by experts from governmental
    and non‐governmental organizations. J Conting Crisis Manag
    34. WHO The World Health Report 2006: Working Together for
    Health. Geneva: World Health Organization; 2006. Available
    from: [Last accessed on
    2008 Apr 27].
    35. Chaput CJ, Deluhery MR, Stake CE, Martens KA, Cichon ME,
    et al. Disaster training for prehospital providers. Prehosp Emerg
    Care 2007;11:458‑65.
    36. Corrigan E, Samarasinghe I. Disaster preparedness in an
    Australian urban trauma center: Staff knowledge and perceptions.
    Prehosp Dis Med 2012;27:432‑8.
    37. Hammad KS, Arbon P, Gebbie K, Hutton A. Nursing in the
    emergency department (ED) during a disaster: A review of the
    current literature. Australasian Emerg Nurs J 2012;15:235‑44.
    38. Al Thobaity A, Plummer V, Innes K, Copnell B. Perceptions of
    knowledge of disaster management among military and civilian
    nurses in Saudi Arabia. Australasian Emerg Nurs J 2015;18:156‑64.
    39. Baack S, Alfred D. Nurses’ preparedness and perceived
    competence in managing disasters. J Nurs Scholarship
    40. Nilsson J, Johansson E, Carlsson M, Florin J, Leksell J, Lepp M,
    et al. Disaster nursing: Self‑reported competence of nursing
    students and registered nurses, with a focus on their readiness
    to manage violence, serious events, and disasters. Nurs Educat
    Pract 2016;17:102‑8.
    41. Rebmann T, Charney R, Loux T, TurnerJ, Abbyad Y, Silvestros M.
    Emergency medical services personnel’s pandemic influenza
    training received and willingness to work during a future
    pandemic. Prehosp Emerg Care 2020;24(5): 601‑609.