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Investigating Hospital Preparedness Evaluation Tools in the Face of Nuclear And Radiation Threats: A Systematic Review

Published online by Cambridge University Press:  13 January 2026

Fatemeh Esmaili ,
Ali Moradi ,
Abdollah Saghafi  and
Esmail Heidaranlu
Fatemeh Esmaili
Affiliation:
Radiation Injuries Research Center, Systems Biology and Poisonings Institute, Nursing Care Research Center, Clinical Sciences Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences , Tehran, Islamic Republic of Iran
Ali Moradi
Affiliation:
Nursing Care Research Center, Clinical Sciences Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
Abdollah Saghafi
Affiliation:
Nursing Care Research Center, Clinical Sciences Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
Esmail Heidaranlu*
Affiliation:
Nursing Care Research Center, Clinical Sciences Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
*
Corresponding author: Esmail Heidaranlu; Email: eheidaranlu@gmail.com
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Abstract

Purpose

Assessing hospital preparedness for nuclear and radiological threats is one of the most effective methods for evaluating the condition of hospitals in relation to such incidents. This study aimed to review the tools used to assess hospital preparedness for nuclear and radiological threats and to analyze the strengths and weaknesses of these instruments.

Materials and Methods

In this systematic review, the full texts of 98 studies identified through database searches and 7 studies identified through manual searches were reviewed. Data were extracted from studies that addressed the measurement tools for assessing hospital preparedness for nuclear and radiological threats from 2000 to 2024, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The content quality of the tools was evaluated based on the World Health Organization (WHO) preparedness criteria, and the psychometric properties of the tools were examined using the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) study criteria.

Results

Among the studies reviewed, only 21 met the inclusion criteria, within which 9 tools for assessing hospital preparedness were identified. Eight tools directly assessed vulnerability in terms of physical space, related equipment, and hospital personnel, while one tool used a different criterion as an indicator of hospital preparedness for nuclear and radiological threats. The findings showed that most of the tools focused solely on evaluating a hospital’s vulnerability in terms of physical space, equipment, and personnel, with insufficient attention given to other critical aspects such as protocols, triage, and other important issues.

Conclusion

Given the limitations of existing tools in terms of psychometric evaluation, the lack of theoretical models, the reliance on empirical findings for tool design, and considering the critical importance of measuring and assessing hospital preparedness for nuclear and radiological threats, there is a pressing need in the health sector for the development of scientific tools based on the experiences of process owners and hospital specialists. These tools should adhere to rigorous processes of instrument development and validation.

Keywords

hospital preparednesstoolnuclear and radiological threatssystematic review

Information

Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 20 , 2026 , e17
Copyright
© The Author(s), 2026. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

Introduction

Over the past decade, the number of global disasters has almost doubled.Reference Zheng, Zhong and Wang 1 These incidents can claim the lives of thousands within a matter of minutes.Reference Gale, Armitage and Hashmi 2 Moreover, the long-term effects of such disasters can also result in thousands of additional deaths over weeks and years. In the last 20 years, disasters stemming from CBRNe hazards have affected thousands of households worldwide and have caused significant financial losses.Reference Carbonelli, Iannotti, Malizia and Masys 3 According to statistics, approximately 3.4 billion people globally reside in high-risk areas.Reference Chen and Tsai 4

The occurrence of an incident within a community can threaten all economic, political, and cultural infrastructures.Reference Chen and Tsai 4 , Reference Quesada-Román 5 Similar to natural disasters, CBRNe incidents exert considerable pressure on the health system by causing a substantial influx of patients and casualties. The impacts of these disasters usually persist long after the initial crisis has passed.Reference Yahya, Ali and Halim 6 During such events, hospitals are among the first centers expected to provide timely and optimal services, playing a vital role in reducing mortality and saving the lives of victims.Reference Kang 7 It is generally assumed that hospitals are designed to withstand any kind of crisis.Reference Haraguchi, Hoshino and Tomoyasu 8 However, disasters transcend political, economic, and professional constraints, creating serious crises in health care institutions, particularly hospitals.Reference Yahya, Rahmat and Termizi 9

An appropriate response in the health sector to disasters and incidents requires sufficient preparedness for crises.Reference Farhat, Alinier and Chaabna 10 Prevention, risk reduction, and hospital preparedness in facing CBRNe threats have consistently been among the main concerns of the World Health Organization (WHO).Reference Suryawanshi, Surekha and Divya 11 To date, various studies have been conducted globally, using diverse tools, to assess the level of hospital preparedness against nuclear and radiological threats.Reference Nagata, Arishima and Yamaguchi 12 Despite efforts aimed at improving and enhancing preparedness programs for nuclear and radiological threats, experts believe that a standard and comprehensive tool for evaluating hospital preparedness in this context has yet to be developed.Reference Munasinghe, O’Reilly and Cameron 13 Therefore, the aim of this study is to examine the strengths and weaknesses of assessment tools for hospital preparedness in response to nuclear and radiological threats, focusing on both their content and psychometric properties.

Materials and Methods

Databases and Search Strategy

This systematic review was conducted in accordance with the PRISMA guidelines. The study protocol included the phases of designing and formulating the systematic review question, defining inclusion criteria, developing the search strategy, selecting studies, data extraction, quality appraisal, data analysis, and dissemination of findings, all of which were designed and executed by the research team. All published articles in English from 2000 to 2024 concerning hospital preparedness in response to nuclear and radiological threats were examined through both electronic and manual searches.

The following databases were searched without restriction: Web of Science, MEDLINE, Google Scholar, CINAHL, Cochrane, PubMed, Scopus, Ovid, ScienceDirect, and ProQuest. Search keywords were determined in consultation with experts and specialists in health crisis management, as follows:

Hospital, functional preparedness, nuclear and radiation disaster, operational preparedness, readiness, instrument, questionnaire, test, assessment, measurement, tool, inventory.

Following the electronic search, a manual search was also performed to identify additional relevant sources referenced in related articles. Due to the large volume of retrieved articles, subject-specific searches were also conducted, utilizing relevant medical subject headings. The titles and abstracts of the identified resources were screened, and the full texts of those meeting the inclusion criteria were reviewed.

Inclusion and Exclusion Criteria

To select articles relevant to the study objectives, the following criteria, as determined by the research team, were applied at all stages of the literature search to include or exclude articles:

Inclusion Criteria

  1. – Articles in the field of disaster

  2. – Articles about hospital preparedness for nuclear and radiation threats

  3. – Theoretical and empirical studies

  4. – Language: English

  5. – Study design: qualitative, quantitative, and mixed-methods

  6. – Subjects: Humans

  7. – Topics: Health disaster, medicine

Exclusion Criteria

  1. – Articles published in languages other than English

  2. – Articles without an abstract

  3. – Articles in non-medical fields

  4. – Medical articles unrelated to the research topic

Studies meeting the inclusion criteria advanced to the next stage. The abstracts of these studies were reviewed, and studies meeting any exclusion criteria were eliminated; furthermore, duplicate articles were also removed.

The full texts of the selected articles were assessed by the first and second researchers to determine the domains addressed by each tool for evaluating hospital preparedness against nuclear and radiological threats. These 2 investigators independently reviewed the selected articles and identified the indicators each article proposed for assessing hospital preparedness in the face of these threats, constituting a step toward the final selection of articles.

To enhance the accuracy of the study, the tools were evaluated independently by 2 researchers, with discrepancies resolved through discussion or with the assistance of a third researcher.Reference Mugavero, Costanzo and Thorossian 14

Data Extraction

For the quality assessment of the articles in terms of psychometric properties, the 4-point COSMIN checklist was utilized. According to this framework, the most important psychometric characteristics of an instrument include: content validity, construct validity, criterion validity, reliability, internal consistency, responsiveness, and interpretability.Reference Mugavero, Costanzo and Thorossian 14

According to the COSMIN criteria, the aim was to answer the following questions:

  1. – Is the instrument specific or generic?

  2. – How was the tool developed?

  3. – What is the response format of the tool?

  4. – Has the construct of the instrument undergone psychometric evaluation?

  5. – For what concept or construct is the instrument designed to measure?

  6. – Is the tool based on a theoretical framework?

  7. – How is the instrument completed?

  8. – Is the instrument easy and convenient to complete?

  9. – Does calculating the final score require complex statistical analyses?

  10. – Is the instrument intended for a specific culture, or does it have international applicability?

Based on these considerations, a quality assessment form for the instruments was developed by the researchers, incorporating the COSMIN study criteria. This form enabled the research team to evaluate the tools in terms of their methodological development, efficiency, and relevance to the objectives of the present study.

After data entry for 3 studies, the assessment form was revised by the researchers, and the final information was entered into the finalized version of the form. To evaluate the content quality of the tools, the WHO preparedness criteria were applied, encompassing 4 main domains: physical space, medications and equipment, human resources, and coordination (Table 1).

Table 1.

Content quality assessment of the reviewed tools in four domains of preparedness (physical space, medication and equipment, human resources, coordination)

To enhance the accuracy of the study, the instruments were independently evaluated by 2 researchers. Any discrepancies between the 2 investigators were resolved through discussion or with the intervention of a third researcher.

Ethical Considerations

To conduct this research effectively, approval was first obtained from the Ethics Committee of Baqiyatallah University of Medical Sciences under the code IR.BMSU.REC.1403.023. We confirm that all methods were performed in accordance with the relevant guidelines and regulations.

Findings

Following the systematic search of databases, articles relevant to the research objectives were screened from among 105 titles stored in EndNote software (see Figure 1). After removing duplicate articles and reviewing the abstracts and full texts, a total of 21 studies meeting the research objectives were selected. These studies specifically addressed the use of instruments for assessing hospital preparedness against CBRNe threats. Upon further review of the full texts, 9 articles were evaluated in greater detail based on indices of hospital preparedness for nuclear threats and the content compatibility of the tools with WHO preparedness criteria. These criteria comprised 6 main domains: physical space, medications and equipment, standards and indicators, human resources, communications, and coordination (see Table 1).

Figure 1.

The retrieval and selection process of articles in the literature review process.

To enhance the accuracy of the study, the tools were independently reviewed by 2 researchers, and any discrepancies in assessments were resolved through discussion or with the intervention of a third researcher.

From a psychometric perspective:

  1. – Two instruments addressed criterion validity,

  2. – Seven instruments assessed construct validity,

  3. – All selected articles reported the reliability of the tools used,

  4. – Despite sensitivity being a critical aspect of psychometrics, only 3 instruments evaluated this property (see Table 2).

    Table 2.

    Psychometric quality assessment of the reviewed tools

It should be noted that, due to the nature of the subject, the selected articles had a very low risk of bias.

Discussion

Currently, experts believe that nuclear and radiological preparedness encompasses more than merely possessing appropriate equipment, and the effective performance of hospitals in response to such threats is considered one of the most critical dimensions of preparedness. 15 In order to assess the nuclear and radiological preparedness of hospitals, crisis managers require the use of tools that have precise and suitable criteria.Reference DiCarlo, Homer and Coleman 16

Globally, there is no standardized or unified instrument for evaluating nuclear and radiological preparedness in hospitals. To date, the WHO has only endorsed the tool introduced by the International Atomic Energy Agency (IAEA). Other instruments are generally specialized and consider or assess only one aspect of nuclear and radiological preparedness.Reference Rockwood, Mayhew and Lazarev 17 , Reference Veljkovikj, Ilbawi and Roitberg 18

Conducting a systematic review of studies related to the development of these instruments serves to draw researchers’ attention to their strengths and weaknesses. This review also highlights the necessity of improving research focused on designing appropriate assessment tools.Reference Chiossi, Tsolova and Ciotti 19 Although no systematic review can definitively determine the accuracy and validity of a tool, it can bridge the gap between scientific evidence and informed decision-making, thereby providing a foundation for future studies.Reference Munasinghe, O’Reilly and Cameron 13

The tool introduced by the IAEA was designed to assist hospitals in reviewing safety, prioritizing planning, and preventing damage to health care centers resulting from nuclear and radiological threats.Reference Saindane, Murali and Dhole 20 However, this instrument addresses the domains of communication and human resources in a rather general manner and does not offer sufficiently objective or practical indicators for assessing these specific aspects of hospital preparedness.Reference Paez, Marengo and Bomanji 21

In order to evaluate the extracted instruments, the researcher considered the following criteria, based on instrument development guidelines, and presents the assessment results below: (The following includes the criteria, evaluation method, and findings.)

Results by Evaluation Criterion

1. Is the instrument specific or general?

According to established standards, each hospital’s preparedness level should be assessed based on its unique mission and using an appropriate instrument.Reference Dowlati, Seyedin and Moslehi 22 While some studies have reported on the validity and reliability of general instruments such as the IAEA tool for assessing nuclear and radiological preparedness in hospitals,Reference Munasinghe, O’Reilly and Cameron 23 accurate evaluations are only feasible using specialized instruments.Reference Wuthisuthimethawee and Khorram-Manesh 24

The findings of the present study revealed that each of the existing instruments specifically evaluates a particular dimension of hospital nuclear and radiological preparedness. However, none of the tools comprehensively covers all aspects deemed essential by domain specialists, and overall, the existing instruments tend to focus more on evaluating hospital vulnerability.

2. How was the instrument developed?

Ahmadi Marzaleh and colleagues have stated that the best instruments are those that carefully adhere to all standard steps of instrument design.Reference Marzaleh, Rezaee and Rezaianzadeh 25 Results from the present study indicate that the construction methods for hospital nuclear and radiological preparedness assessment instruments are varied and do not follow a single, standardized procedure. This lack of uniformity makes it impossible to compare the instruments with each other.

In many studies—including those by Stinson,Reference Stinson 26 Liutsko,Reference Liutsko, Oughton and Sarukhan 27 and HupfReference Hupf, Zimmermann and Maier-Stocker 28—the purpose of development, target group, or approach to item generation was not clearly defined. Furthermore, during the item design process, expert input from health crisis specialists was often not utilized, and the methods for executing item construction were generally ambiguous.

3. What is the response method for the instrument items?

The mode of response to the instrument items is of high importance, as it can affect the depth and quality of the information obtained.Reference Ghaffari, Pishgooie and Zareiyan 29 In the current study, among the 9 analyzed instruments, a 4-point Likert scale was most commonly used. However, some instruments employed a 3-point or 5-point Likert scale, while others ranged between a 2-point Yes/No format and a 5-point Likert scale. Such diversity in item response methods not only influences outcomes but also poses significant challenges for the standardization of these instruments.

4. Has the instrument undergone a psychometric validation process?

Instruments designed to assess hospital preparedness should have robust psychometric properties, and their content validity must be constructed based on actual dimensions of hospital performance in disaster response.Reference Kuday, Çalışkan and Kınık 30

  1. – Content validity: This assesses the instrument’s ability to measure its intended objective (specific population, context, or action). Ensuring content validity requires qualitative studies utilizing the opinions of experts and specialists.Reference Munasinghe, O’Reilly and Cameron 31

  2. – Construct validity and reliability: The instruments must exhibit strong construct validity and reliability.Reference Nazari, Sharififar and Marzaleh 32

  3. – Instrument sensitivity: The instrument should be capable of detecting subtle changes, which necessitates high sensitivity.Reference Munasinghe, O’Reilly and Cameron 31

Findings from this study revealed a lack of information regarding the psychometric process among many instruments, representing a major limitation.

  1. – In many cases, the psychometric process was either incomplete or inadequately reported.

  2. – Important aspects such as interpretability and sensitivity of the instruments received less attention, with only a limited number of studies addressing these dimensions (for example, studies by Al-Ibraheem,Reference Al-Ibraheem, Moghrabi and Abdlkadir 33 Dağ,Reference Dağ, Çalışkan and Koçak 34 and the IAEA.Reference Havlova, Mayer and Degnan 35

  3. – Only half of the studies included in this research reported the process of content validation, and few utilized qualitative methods such as interviews to generate instrument items.

This lack of information prevents researchers from correctly and accurately selecting optimal instruments for evaluating hospital nuclear and radiological preparedness.

5. The concept measured by the instrument

The concept of hospital nuclear and radiological preparedness encompasses 4 main domains:

  1. – Physical space, Medications and equipment, Human resources, Intra- and inter-organizational coordination.Reference Al-Ibraheem, Moghrabi and Abdlkadir 33 , Reference Koçak, Dağ and Çalışkan 36 , 37

The results of this study indicated that the majority of existing instruments for evaluating hospital nuclear and radiological preparedness focus primarily on either the physical space or medications and equipment. However, according to the WHO, nuclear and radiological preparedness in hospitals should be defined based on 5 domains, and must necessarily include communication and coordination, particularly intra- and inter-organizational coordination. Current instruments rarely measure these crucial areas.

One of the reasons for this shortcoming is the lack of a clear definition for the concept of hospital nuclear and radiological preparedness in disaster contexts. It remains unclear:

  1. – What precisely “hospital nuclear and radiological preparedness” entails,

  2. – Which indicators should be measured as outcomes of hospital preparedness?

Consequently, this lack of conceptual clarity has led to the development of inefficient and incomplete instruments that are insufficient for comprehensive hospital preparedness evaluation.Reference Foulon, Abdelouahed and Bogovac 38

6. Is the instrument based on a theoretical framework?

According to instrument development guidelines, the design of instruments should rely on an appropriate theoretical framework.Reference Qzih and Ahmad 39 The American Psychological Association has also emphasized that each construct for which an instrument is developed must be defined within a theoretical framework.Reference Lambert and Newman 40

The construct of “hospital nuclear and radiological preparedness” comprises multiple concepts, and instruments designed to assess this construct must examine these concepts systematically and based on a theoretical framework.

The results of the present study indicate that none of the reviewed instruments have used a specified theoretical framework during their development process. These tools are mainly focused on hospital vulnerability, with an emphasis only on physical space and medications and equipment. As a result, the concept of “hospital nuclear and radiological preparedness” is not adequately addressed in these instruments, and many of its key components remain neglected.

Recommendation: Given these deficiencies, it is essential to develop a precise theoretical framework for hospital nuclear and radiological preparedness in the context of disasters. Related instruments should be devised using this conceptual framework in order to enable a comprehensive and accurate assessment of all critical and essential aspects.

7. How is the instrument completed?

Instruments for assessing hospital nuclear and radiological preparedness may be administered in 2 ways:

  1. – Self-administered: In this approach, the participant or expert completes the instrument independently.

  2. – Interview-based: Here, the instrument is completed by the researcher through interview questions, which ensures that no questions remain unanswered and allows the participant’s ambiguities to be addressed directly.Reference Shubayr 41

The results of this study showed that completing existing tools for evaluating hospital preparedness is generally time-consuming and costly. For example:

  1. – The IAEA instrument recommends that information for the physical space section be provided by process owners (such as the hospital president, hospital manager, director of nursing services, and human resources manager). This section must be completed by the head of the hospital or university risk committee, which requires extensive teamwork, wide coordination, and significant time. 37

  2. – The Liutsko instrument, on the other hand, is designed for self-assessment, meaning a single crisis expert can easily complete it.Reference Liutsko, Oughton and Sarukhan 27

8. Is the instrument easy and straightforward to complete?

The question of whether the instrument is logically structured and quick to complete, or whether it involves operational complexities, is important. A review of instruments measuring the “coordination” domain of hospital nuclear and radiological preparedness—such as the Dağ,Reference Dağ, Çalışkan and Koçak 34 and the IAEA,Reference Havlova, Mayer and Degnan 35 Liutsko,Reference Liutsko, Oughton and Sarukhan 27 and Jahangiri toolsReference Jahangiri, Sohrabizadeh and Sadighi 42—showed that:

  1. – These instruments often pose challenges for the evaluator, since they require the formation of an assessment team and a considerable investment of time.

  2. – This characteristic can reduce the efficiency of the instruments and result in their limited adoption in practice.

9. Does scoring the instrument require complex statistical analyses?

Among the reviewed instruments, determining the final score did not generally require complex statistical analyses. Instead, most tools utilized qualitative scales, such as:

  1. – Excellent, good, moderate, weak, unacceptable,

  2. – Low, medium, high,

  3. – Yes and No.

Such qualitative scales, however, introduce ambiguity and overlap at the threshold between “prepared” and “unprepared” statuses. It is therefore recommended that these tools adopt more quantitative scoring methods in order to enhance the transparency of results and enable more accurate assessment of preparedness levels.

10. Was the instrument designed for a specific culture or for international use?

The systematic review of the studies found no reports indicating that the instruments were designed with consideration for cultural variations across communities. However:

  1. – The cultural context of different societies, as reflected in their health care systems, disaster response strategies, and preparedness levels, can differ significantly.

  2. – It appears that the human resources and coordination aspects of hospital nuclear and radiological preparedness are especially influenced by cultural factors.

Given this cultural diversity, designing instruments tailored to the specific characteristics of different cultures could lead to more accurate and practical results. This represents a major gap in the currently available assessment tools.

Conclusion

The present study revealed that standard principles of instrument development have not been reported in the design and construction of the reviewed hospital nuclear and radiological preparedness assessment tools. As a result, important and latent dimensions of hospital preparedness indicators in the face of disasters may have been overlooked. Comprehensive and precise evaluation of hospital nuclear and radiological preparedness during disasters requires the development of practical, reliable, and valid instruments that are designed and created in accordance with rigorous methodological standards and scientific processes. The findings of this study further demonstrate that, to date, no comprehensive, scientific, and internationally applicable tool has been developed to assess hospital nuclear and radiological preparedness and their effective response in disasters. A key shortcoming of the existing tools is their inability to comprehensively assess hospital preparedness based on the standards and guidelines recommended by the WHO. Existing instruments tend to focus mainly on domains such as physical space preparedness, medicines and equipment, human resources, and coordination, while paying less attention to the practical standards and operational guidelines advocated by experts in this field. Furthermore, the reviewed instruments suffer from limitations such as weaknesses in psychometric evaluation, theoretical frameworks, or lack of development based on empirical findings. The health care sector requires the design of instruments that are based on the experiences of process owners and hospital specialists, and that are developed through a rigorous scientific procedure including instrument construction and validation. This systematic review aimed to examine all specific and general tools related to evaluating hospital nuclear and radiological preparedness in the context of disasters and emergencies. However, since the aim of systematic reviews is not to definitively determine the accuracy and validity of the instruments themselves, this study likewise did not evaluate the validity of the reviewed tools. One limitation of this study was the inclusion of only English-language articles, and it is possible that relevant studies published in other languages were not captured.

Recommendations for Future Research

Based on the findings of this study, which clarify the shortcomings of existing nuclear and radiological hospital preparedness assessment tools, it is recommended that future research utilize qualitative and hybrid approaches to operationally define the concept of hospital nuclear and radiological preparedness. Such studies should examine the concept in detail, taking into account the specific context and sensitivity of the subject. According to the definitions emerging from these studies, it is essential to design and develop scientific and standardized tools to effectively and accurately assess hospital nuclear and radiological preparedness in the context of disasters and emergencies.

Author contribution

Authors’ contributions were to the manuscript on the following 4 criteria:

  1. 1. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND

  2. 2. Drafting the work or reviewing it critically for important intellectual content; AND

  3. 3. Final approval of the version to be published; AND

  4. 4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Introduction (FE, AM, EH), materials and methods (FE, AS, EH), findings (FE, AM, EH), discussion (FE, AS, EH), and conclusion(FE, AM).

Acknowledgments

The author would like to thank the “Clinical Research Development Unit” of Baqiyatallah and Najmiyah Hospitals for their kind cooperation.

Competing interests

None.

References

Zheng, Z, Zhong, Y, Wang, J, et al. Building damage assessment for rapid disaster response with a deep object-based semantic change detection framework: from natural disasters to man-made disasters. Remote Sens Environ. 2021;265:112636.10.1016/j.rse.2021.112636CrossRefGoogle Scholar
Gale, RP, Armitage, JO, Hashmi, SK. Emergency response to radiological and nuclear accidents and incidents. Br J Haematol. 2021;192(6):968–972.10.1111/bjh.16138CrossRefGoogle ScholarPubMed
Carbonelli, M, Iannotti, A, Malizia, A. Disaster management of a major CBRN accident. In: Masys, A, ed. Handbook of Security Science. Springer; 2022:661–677.10.1007/978-3-319-91875-4_36CrossRefGoogle Scholar
Chen, T-L, Tsai, C-E. Coping with extreme disaster risk through preventive planning for resettlement. Int J Disaster Risk Reduct. 2021;64:102531.10.1016/j.ijdrr.2021.102531CrossRefGoogle Scholar
Quesada-Román, A. Disaster risk assessment of informal settlements in the Global South. Sustainability. 2022;14(16):10261.10.3390/su141610261CrossRefGoogle Scholar
Yahya, NY, Ali, M, Halim, A, et al. Disaster preparedness in case of chemical, biological, radiological, nuclear and explosive (CBRNE) events: a review. Turk Online J Qual Inq. 2021;12(6):9616–9625.Google Scholar
Kang, I-H. Analysis of medical response system for CBRNE special disaster accidents. 한국웰니스학회지. 2021;16(2):27–34.Google Scholar
Haraguchi, Y, Hoshino, M, Tomoyasu, Y, et al. Disaster medicine compendium and the necessity of preparation of medical techniques for handling NBC/CBRNE hazards, for general surgeons. Prehosp Disaster Med. 2023;38(S1):s159–s160.10.1017/S1049023X23004156CrossRefGoogle Scholar
Yahya, NYB, Rahmat, RB, Termizi, MSBA, et al. Preparedness towards chemical, biological, radiological, nuclear, and explosive (CBRNE) threats among healthcare personnel in Pasir Gudang, Johor, Malaysia. Int J Disaster Risk Reduct. 2022;82:103235.10.1016/j.ijdrr.2022.103235CrossRefGoogle Scholar
Farhat, H, Alinier, G, Chaabna, K, et al. Preparedness and emergency response strategies for chemical, biological, radiological and nuclear emergencies in disaster management: a qualitative systematic review. J Conting Crisis Manag. 2024;32(3):e12592.10.1111/1468-5973.12592CrossRefGoogle Scholar
Suryawanshi, DM, Surekha, A, Divya, R, et al. Awareness and preparedness of first responders regarding chemical, biological, radiological, nuclear and explosive (CBRNE) disaster management of a tertiary medical institute in South India: a mixed methods study. J Family Med Prim Care. 2022;11(10):6115–6120.10.4103/jfmpc.jfmpc_202_22CrossRefGoogle ScholarPubMed
Nagata, T, Arishima, T, Yamaguchi, Y, et al. Radiation emergency medical preparedness in Japan: a survey of nuclear emergency core hospitals. Disaster Med Public Health Prep. 2023;17:e78.10.1017/dmp.2021.348CrossRefGoogle Scholar
Munasinghe, NL, O’Reilly, G, Cameron, P. Establishing the domains of a hospital disaster preparedness evaluation tool: a systematic review. Prehosp Disaster Med. 2022;37(5):674–686.10.1017/S1049023X22001212CrossRefGoogle ScholarPubMed
Mugavero, R, Costanzo, P, Thorossian, W. Enhancing the capacity of data collection tools to detect, prepare and respond to emerging CBRNEe threats through engaging with stakeholders. J CBRNE. 2022;5(1):1–12.Google Scholar
Organization WH. National Stockpiles for Radiological and Nuclear Emergencies: Policy Advice. World Health Organization; 2023.Google Scholar
DiCarlo, AL, Homer, MJ, Coleman, CN. United States medical preparedness for nuclear and radiological emergencies. J Radiol Prot. 2021;41(4):1420.10.1088/1361-6498/ac0d3fCrossRefGoogle ScholarPubMed
Rockwood, L, Mayhew, N, Lazarev, A, et al. IAEA Safeguards: Staying Ahead of the Game. Report by the Swedish Radiation Safety Authority, Report; 2021.Google Scholar
Veljkovikj, I, Ilbawi, AM, Roitberg, F, et al. Evolution of the joint International Atomic Energy Agency (IAEA), International Agency for Research on Cancer (IARC), and WHO cancer control assessments (imPACT reviews). Lancet Oncol. 2022;23(10):e459–e468.10.1016/S1470-2045(22)00387-4CrossRefGoogle ScholarPubMed
Chiossi, S, Tsolova, S, Ciotti, M. Assessing public health emergency preparedness: a scoping review on recent tools and methods. Int J Disaster Risk Reduct. 2021;56:102104.10.1016/j.ijdrr.2021.102104CrossRefGoogle Scholar
Saindane, SS, Murali, S, Dhole, SD, et al. Planning, preparedness, and response to nuclear/radiological emergency. Radiat Prot Environ. 2021;44(1):47–53.10.4103/rpe.rpe_9_21CrossRefGoogle Scholar
Paez, D, Marengo, M, Bomanji, J, et al. Quality improvement initiative of the IAEA in nuclear medicine: a tool to assess staffing needs within the QUANUM framework. World J Nucl Med. 2022;967–969.Google ScholarPubMed
Dowlati, M, Seyedin, H, Moslehi, S. Hospital preparedness measures for biological hazards: a systematic review and meta-synthesis. Disaster Med Public Health Prep. 2021;15(6):790–803.10.1017/dmp.2020.132CrossRefGoogle ScholarPubMed
Munasinghe, NL, O’Reilly, G, Cameron, P. Examining the components and validity of hospital disaster preparedness tools. Prog Disaster Sci. 2023;20:100305.10.1016/j.pdisas.2023.100305CrossRefGoogle Scholar
Wuthisuthimethawee, P, Khorram-Manesh, A. Development and validation of a scoring assessment tool for hospital safety: a pilot study comparing hospital preparedness in Thailand. Risk Manag Healthc Policy. 2021;14:3617–3624.10.2147/RMHP.S313311CrossRefGoogle ScholarPubMed
Marzaleh, MA, Rezaee, R, Rezaianzadeh, A, et al. Emergency department preparedness of hospitals for radiation, nuclear accidents, and nuclear terrorism: a qualitative study in Iran. Iran Red Crescent Med J. 2019;21(5):361–370.Google Scholar
Stinson, NL. Preparedness of Metropolitan-Area Hospitals for Responding to a Radiological or Nuclear Emergency. Capella University; 2021.Google Scholar
Liutsko, L, Oughton, D, Sarukhan, A, et al. The SHAMISEN Recommendations on preparedness and health surveillance of populations affected by a radiation accident. Environ Int. 2021;146:106278.10.1016/j.envint.2020.106278CrossRefGoogle ScholarPubMed
Hupf, J, Zimmermann, M, Maier-Stocker, C, et al. Evaluation of CBRN preparedness of German hospitals with higher level of care: a cross-sectional survey. Disaster Med Public Health Prep. 2024;18:e133.10.1017/dmp.2024.130CrossRefGoogle ScholarPubMed
Ghaffari, F, Pishgooie, S, Zareiyan, A, et al. Factors affecting the preparedness of hospital emergency departments staff in responding to HazMat and CBRN incidents: a scoping review (2005-2024). Iran J War Public Health. 2025;17(1):1001–1023.Google Scholar
Kuday, AD, Çalışkan, C, Kınık, K, et al. Development of the Perceived Challenges in Disaster Response Scale (PCDRS): validity and reliability study. Prehosp Disaster Med. 2023;38:1–8.Google Scholar
Munasinghe, NL, O’Reilly, G, Cameron, P, et al. Developing a hospital disaster preparedness evaluation tool for Sri Lanka—a modified Delphi study. Int J Disaster Risk Reduct. 2023;95:103866.10.1016/j.ijdrr.2023.103866CrossRefGoogle Scholar
Nazari, S, Sharififar, S, Marzaleh, MA, et al. Structural elements and requirements in forming prehospital health response teams in response to chemical, biological, radiation, and nuclear incidents (CBRN), a comparative review study. Disaster Med Public Health Prep. 2023;17:e300.10.1017/dmp.2022.259CrossRefGoogle ScholarPubMed
Al-Ibraheem, A, Moghrabi, S, Abdlkadir, A, et al. An overview of appropriate medical practice and preparedness in radiation emergency response. Cureus. 2024;16(6):e60644.Google ScholarPubMed
Dağ, N, Çalışkan, C, Koçak, H, et al. Factors affecting the intervention of health-care professionals in radiological events: a systematic review. Disaster Med Public Health Prep. 2023;17:e348.10.1017/dmp.2023.17CrossRefGoogle ScholarPubMed
Havlova, V, Mayer, S, Degnan, P. International Atomic Energy Agency (IAEA) support for the management of site investigations for radioactive waste disposal facilities. Saf Nucl Waste Disposal. 2023;2:35–36.10.5194/sand-2-35-2023CrossRefGoogle Scholar
Koçak, H, Dağ, N, Çalışkan, C, et al. Design and development of a self-report competence scale for the assessment of prehospital health professionals’ competence in response to radiological events. Disaster Med Public Health Prep. 2024;18:e332.10.1017/dmp.2024.337CrossRefGoogle Scholar
International Atomic Energy Agency. Preparedness and response for a nuclear or radiological emergency. IAEA Safety Standards Series No. GSR Part 7. Vienna: IAEA; 2015.Google Scholar
Foulon, F, Abdelouahed, HB, Bogovac, M, et al. IAEA nuclear science and instrumentation laboratory: support to IAEA member states and recent developments. EPJ Web Conf. 2020;225:10005. doi:10.1051/epjconf/202022510005CrossRefGoogle Scholar
Qzih, ES, Ahmad, MM. Hospital-based preparedness measures for CBRNE disasters: a systematic review. Environ Health Insights. 2024;18:11786302241288859.10.1177/11786302241288859CrossRefGoogle ScholarPubMed
Lambert, LS, Newman, DA. Construct development and validation in three practical steps: recommendations for reviewers, editors, and authors. Organ Res Methods. 2023;26(4):574–607.10.1177/10944281221115374CrossRefGoogle Scholar
Shubayr, N. Evaluating Saudi Arabian nurses’ willingness to respond to nuclear and radiological disasters. Int Nurs Rev. 2025;72:e13040. doi:10.1111/inr.13040CrossRefGoogle ScholarPubMed
Jahangiri, K, Sohrabizadeh, S, Sadighi, J, et al. Assessing hospital preparedness for nuclear and radiological events: development a valid and reliable instrument. Payesh (Health Monitor). 2016;15(6):619–627.Google Scholar
Figure 0

Table 1. Content quality assessment of the reviewed tools in four domains of preparedness (physical space, medication and equipment, human resources, coordination)

Figure 1

Figure 1. The retrieval and selection process of articles in the literature review process.

Figure 2

Table 2. Psychometric quality assessment of the reviewed tools