Document Type : Original Article


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

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

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

4 Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran

5 National Emergency Medical Organization, Ministry of Health and Medical Education, Tehran, Iran

6 Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, Department of Clinical Science and Education, Karolinska Instituted, Stockholm, Sweden, Europe


INTRODUCTION: The objective of the present study was to systematically review the current research
knowledge on hospital preparedness tools used in biological events and factors affecting hospital
preparedness in such incidents in using a scoping review methodology.
MATERIALS AND METHODS: The review process was conducted in accordance with the Preferred
Reporting Items for Systematic reviews and Meta‑Analyses extension for Scoping Reviews
guideline. Online databases (PubMed, Scopus, Web of Science, and Google Scholar) were used to
identify papers published that evaluated instruments or tools for hospital preparedness in biological
disasters (such as influenza, Ebola, and bioterrorism events). The search, article selection, and data
extraction were carried out by two researchers independently.
RESULTS: A total of 3440 articles were screened, with 20 articles identified for final analysis. The
majority of research studies identified were conducted in the United States (45%) and were focused
on CBRN incident (20%), Ebola, infectious disease and bioterrorism events (15%), mass casualty
incidents and influenza pandemic (10%), public health emergency, SARS, and biological events (5%).
Factors that were identified in the study to hospitals preparedness in biological events classified in
seven areas including planning, surge capacity, communication, training and education, medical
management, surveillance and standard operation process.
CONCLUSIONS: Published evidences of hospital preparedness on biological events as well as the
overall quality of the psychometric properties of most studies were limited. The results of the current
scoping review could be used as a basis for designing and developing a standard assessment
tool for hospital preparedness in biological events, and it can also be used as a clear vision for the
healthcare managers and policymakers in their future plans to confront the challenges identified by
healthcare institutes in biologic events.


1. Sandström BE, Eriksson H, Norlander L, Thorstensson M,
Cassel G. Training of public health personnel in handling CBRN
emergencies: A table‑top exercise card concept. Environ Int
2. Khankeh H. Disaster Hospital Preparedness, National Plan.
Tehran: University of Social Welfare and Rehabilitation; 2012.
3. Hopkins RS, Misegades L, Ransom J, Lipson L, Brink EW. SARS
preparedness checklist for state and local health officials. Emerg
Infect Dis 2004;10:369‑72.
4. Reidy M, Ryan F, Hogan D, Lacey S, Buckley C. Preparedness of
hospitals in the republic of Ireland for an influenza pandemic, an
infection control perspective. BMC Public Health 2015;15:847.
5. Dewar B, Barr I, Robinson P. Hospital capacity and management
preparedness for pandemic influenza in victoria. Aust N Z J Public
Health 2014;38:184‑90.
6. Wong CH, Stern S, Mitchell SH. Survey of ebola preparedness in
Washington state emergency departments. Disaster Med Public
Health Prep 2016;10:662‑8.
7. Sarti AJ, Sutherland S, Robillard N, Kim J, Dupuis K, Thornton M,
et al. Ebola preparedness: A rapid needs assessment of critical care
in a tertiary hospital. CMAJ Open 2015;3:E198‑207.
8. Rebmann T, Wilson R, LaPointe S, Russell B, Moroz D. Hospital
infectious disease emergency preparedness: A 2007 survey of
infection control professionals. Am J Infect Control 2009;37:1‑8.
9. Toyokawa T, Hori N, Kato Y. Preparedness at Japan’s hospitals
designated for patients with highly infectious diseases. Health
Secur 2017;15:97‑103.
10. Wetter DC, Daniell WE, Treser CD. Hospital preparedness for
victims of chemical or biological terrorism. American Journal of
Public Health. 2001 May; 91 (5):710.
11. Thorne CD, Levitin H, Oliver M, Losch‑Skidmore S, Neiley BA,
Socher MM, Gucer PW. A pilot assessment of hospital
preparedness for bioterrorism events. Prehospital and disaster
medicine. 2006 Dec; 21 (6):414‑22.
12. Li X, Huang J, Zhang H. An analysis of hospital preparedness
capacity for public health emergency in four regions of China:
Beijing, Shandong, Guangxi, and Hainan. BMC Public Health
13. Bishop JF, Murnane MP, Owen R. Australia’s winter with
the 2009 pandemic influenza A (H1N1) virus. N Engl J Med
14. Fineberg HV. Pandemic preparedness and response – Lessons
from the H1N1 influenza of 2009. N Engl J Med 2014;370:1335‑42.
15. Johnstone MJ, Turale S. Nurses’ experiences of ethical
preparedness for public health emergencies and healthcare
disasters: A systematic review of qualitative evidence. Nurs
Health Sci 2014;16:67‑77.
16. Olivieri C, Ingrassia PL, Della Corte F, Carenzo L, Sapori JM,
Gabilly L, Segond F, Grieger F, Arnod‑Prin P, Larrucea X, Violi C.
Hospital preparedness and response in CBRN emergencies: TIER
assessment tool. European Journal of Emergency Medicine.
2017 Oct 1;24 (5):366‑70.
17. Hick JL, Hanfling D, Burstein JL, DeAtley C, Barbisch D,
Bogdan GM, Cantrill S. Health care facility and community
strategies for patient care surge capacity. Annals of emergency
medicine. 2004 Sep 1;44 (3):253‑61.
18. Higgins W, Wainright C, Lu N, Carrico R. Assessing hospital
preparedness using an instrument based on the mass casualty
disaster plan checklist: Results of a statewide survey. Am J Infect
Control 2004;32:327‑32.
19. Mortelmans LJ, Van Boxstael S, De Cauwer HG, Sabbe MB.
Preparedness of Belgian civil hospitals for chemical, biological,
radiation, and nuclear incidents: are we there yet?. European
journal of emergency medicine. 2014 Aug 1;21 (4):296‑300.
20. Edwards NA, Caldicott DG, Aitken P, Lee CC, Eliseo T. Terror
australis 2004: Preparedness of australian hospitals for disasters
and incidents involving chemical, biological and radiological
agents. Crit Care Resusc 2008;10:125‑36.
21. Bennett RL. Chemical or biological terrorist attacks: An analysis
of the preparedness of hospitals for managing victims affected by
chemical or biological weapons of mass destruction. Int J Environ
Res Public Health 2006;3:67‑75.
22. Tartari E, Allegranzi B, Ang B, Calleja N, Collignon P, Hopman J,
Lang L, Lee LC, Ling ML, Mehtar S, Tambyah PA. Preparedness
of institutions around the world for managing patients with
Ebola virus disease: an infection control readiness checklist.
Antimicrobial resistance and infection control. 2015 Dec; 4 (1):22.
23. Hui Z, Jian‑Shi H, Xiong H, Peng L, Da‑Long Q. An analysis
of the current status of hospital emergency preparedness for
infectious disease outbreaks in Beijing, China. Am J Infect Control
24. Treat KN, Williams JM, Furbee PM, Manley WG, Russell FK,
Stamper CD Jr. Hospital preparedness for weapons of mass
destruction incidents: An initial assessment. Ann Emerg Med
25. Mitchell CJ, Kernohan WG, Higginson R. Are emergency care
nurses prepared for chemical, biological, radiological, nuclear
or explosive incidents? Int Emerg Nurs 2012;20:151‑61.
26. Rebmann T; 2008 APIC Emergency Preparedness Committee.
APIC state‑of‑the‑art report: The role of the infection preventionist
in emergency management. Am J Infect Control 2009;37:271‑81.
27. Rebmann T. Pandemic preparedness: Implementation of infection
prevention emergency plans. Infect Control Hosp Epidemiol
2010;31 Suppl 1:S63‑5.
28. Bayntun C, Rockenschaub G, Murray V. Developing a health
system approach to disaster management: A qualitative analysis
of the core literature to complement the WHO Toolkit for
assessing health‑system capacity for crisis management. PLoS
currents. 2012 Aug 22;4.
29. Adini B, Verbeek L, Trapp S, Schilling S, Sasse J, Pientka K,
Böddinghaus B, Schaefer H, Schempf J, Brodt R, Wegner C.
Continued vigilance–development of an online evaluation tool for
assessing preparedness of medical facilities for biological events.
Frontiers in public health. 2014 Apr 14;2:35.
30. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D,
et al. PRISMA extension for scoping reviews (PRISMA‑scR):
Checklist and explanation. Ann Intern Med 2018;169:467‑73.
31. Dixon‑Woods M, Bonas S, Booth A, Jones DR, Miller T,
Sutton AJ, Shaw RL, Smith JA, Young B. How can systematic
reviews incorporate qualitative research? A critical perspective.
Qualitative research. 2006 Feb; 6 (1):27‑44.
32. Colquhoun HL, Levac D, O’Brien KK, Straus S, Tricco AC,
Perrier L, et al. Scoping reviews: Time for clarity in definition,
methods, and reporting. J Clin Epidemiol 2014;67:1291‑4.
33. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC,
Vandenbroucke JP, et al. The strengthening the reporting of
observational studies in epidemiology (STROBE) statement:
Guidelines for reporting observational studies. PLoS Med
34. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting
qualitative research (COREQ): A 32‑item checklist for interviews
and focus groups. Int J Qual Health Care 2007;19:349‑57.
35. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA
Group. Preferred reporting items for systematic reviews and meta‑analyses: The PRISMA statement. PLoS Med
36. Barnes K. Cost of anthrax attacks ‘‘surges.’’BBC News, October
31, 2001.
37. Vardell E. Chemical hazards emergency medical
management (CHEMM). Med Ref Serv Q 2012;31:73‑83.
38. Hung K, Lam E, Wong M, Wong T, Chan E, Graham C. Emergency
physicians’ preparedness for CBRNE incidents in Hong Kong.
Hong Kong J Emerg Med 2013;20:90‑7.
39. FEMA, D. “Developing and Maintaining Emergency Operations
Plans.” (2010): 1‑124.
40. Thomas J. Draft Capacity Assessment Guidelines & The Program
Approach, Assessment Levels and Methods; 2004.
41. 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.
42. Dayton C, Ibrahim J, Augenbraun M, Brooks S, Mody K,
Holford D, et al. Integrated plan to augment surge capacity.
Prehosp Disaster Med 2008;23:113‑9.
43. DeLia D. Annual bed statistics give a misleading picture
of hospital surge capacity. Annals of Emergency Medicine.
2006 Oct 1;48 (4):384‑8.
44. Balicer RD, Barnett DJ, Thompson CB, Hsu EB, Catlett CL,
Watson CM, et al. Characterizing hospital workers’ willingness
to report to duty in an influenza pandemic through threat – And
efficacy‑based assessment. BMC Public Health 2010;10:436.
45. von Strauss E, Paillard‑Borg S, Holmgren J, Saaristo P. Global
nursing in an ebola viral haemorrhagic fever outbreak: Before,
during and after deployment. Glob Health Action 2017;10:1371427.
46. Dooley JR, Wang JW, Bodduluri RM, West JB, inventors; Accuray
Inc, assignee. Flexible treatment planning. United States patent
US 7,298,819. 2007 Nov 20.
47. World Health Organization. Risk Reduction and Emergency
Preparedness: WHO Six‑Year Strategy for the Health Sector and
Community Capacity Development. World Health Organization;
48. Siddle J, Tolleson‑Rinehart S, Brice J. Survey of emergency
department staff on disaster preparedness and training for ebola
virus disease. Am J Disaster Med 2016;11:5‑18.
49. Khorram‑Manesh A, Ashkenazi M, Djalali A, Ingrassia PL,
Friedl T, von Armin G, et al. Education in disaster management
and emergencies: Defining a new european course. Disaster Med
Public Health Prep 2015;9:245‑55.
50. Williams J, Nocera M, Casteel C. The effectiveness of disaster
training for health care workers: A systematic review. Ann Emerg
Med 2008;52:211‑22, 222.e1‑2.
51. Crupi RS, Asnis DS, Lee CC, Santucci T, Marino MJ, Flanz BJ.
Meeting the challenge of bioterrorism: Lessons learned from west
nile virus and anthrax. Am J Emerg Med 2003;21:77‑9.
52. Keramarou M, Evans MR. Completeness of infectious disease
notification in the United Kingdom: A systematic review. J Infect
53. Hiller KM, Stoneking L, Min A, Rhodes SM. Syndromic
surveillance for influenza in the emergency department‑a
systematic review. PLoS One 2013;8:e73832.
54. HaverkortJJ, MinderhoudAL, WindJD, LeenenLP, HoepelmanAI,
Ellerbroek PM. Hospital preparations for viral hemorrhagic fever
patients and experience gained from admission of an ebola
patient. Emerg Infect Dis 2016;22:184‑91.
55. Jacobsen KH, Aguirre AA, Bailey CL, Baranova AV, Crooks AT,
Croitoru A, et al. Lessons from the ebola outbreak: Action items
for emerging infectious disease preparedness and response.
Ecohealth 2016;13:200‑12.
56. Sickbert‑Bennett EE, Weber DJ, Poole C, MacDonald PD,
Maillard JM. Completeness of communicable disease reporting,
North Carolina, USA, 1995‑1997 and 2000‑2006. Emerg Infect Dis
57. Healthcare E. Emory healthcare Ebola preparedness protocols.
Atlanta: Emory Healthcare https://www. emoryhealthcare. org/
ebola‑protocol/ehc‑message. html. 2014 Nov.
58. Luther M, Lenson S, Reed K. Issues associated in chemical,
biological and radiological emergency department response
preparedness. Australas Emerg Nurs J 2006;9:79‑84.