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Eur J Emerg Med. 2017 Oct;24(5):366-370. doi: 10.1097/MEJ.0000000000000399.

Hospital preparedness and response in CBRN emergencies: TIER assessment tool.

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aIntensive Care Unit, Maggiore della Carità University Hospital bCenter for Research and Education in Emergency and Disaster Medicine - CRIMEDIM, Università degli Studi del Piemonte Orientale cResearch and Development, Novareckon, Novara, Italy dPoison Control Center of Lyon eUniversity of Lyon fDisaster Medicine Unit, Hospices Civils de Lyon, Lyon gResearch and Development, Viseo company, Paris, France hisw Institute for Structural Policy and Economic Development, Halle (Saale), Germany iTecnalia, Parque tecnologico de Bizkaia, Derio, Spain.



Chemical, biological, radiological, and nuclear (CBRN) emergencies need particular hospital preparedness and resources availability. Also, specific skills and capabilities are required for efficient response to these types of events. The aim of this study was to develop an assessment tool to evaluate hospital preparedness and response performance with respect to CBRN emergencies.


An evaluation tool was developed using the Delphi technique. A panel of experts from 10 countries, both European and non-European, with more than 5 years of experience in research or practice in CBRN emergency management was involved in this study. The study was run online, and the experts were asked to evaluate a list of items on hospital preparedness and response in CBRN emergencies. A threshold of 85% agreement level was defined as the consensus of experts in this study.


The first-round questionnaire was answered by 13 experts. Consensus on the preparedness section was reached for all 29 items during the first round and one item was also added by the experts. Consensus on the response performance indicators were reached in 51 out of the 59 items, during the first round, and eight items were modified and then approved in the second round by the experts.


Hospitals need a specific level of preparedness to enable an effective response to CBRN emergencies. The assessment tool, developed through experts' consensus in this study, provides a standardized method for the evaluation of hospital preparedness and response performance with respect to CBRN emergencies. The feasibility and reliability of this assessment tool could be evaluated before and during simulated exercises in a standardized manner.

[Indexed for MEDLINE]

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