Developing a Model for Hospitals' Emergency Department Preparedness in Radiation and Nuclear Incidents and Nuclear Terrorism in Iran

Hospital-Based Preparedness Measures for CBRNE Disasters: A Systematic Review

Chemical, Biological, Radiological or Nuclear and Explosive (CBRNe) disasters have historically caused significant fatalities and posed global threats. The inadequate preparedness of hospital equipment for CBRNe incidents underscores the urgent need for hospitals to modernize and standardize their equipment to effectively manage these high-risk situations. The purpose of this systematic review was to examine hospital-based preparedness measures for CBRNe incidents. The PRISMA guidelines were followed for this review. A comprehensive search of English-language peer-reviewed literature from January 2010 to 2023 was conducted, identifying 2191 items from PubMed, ScienceDirect, EBSCO, and Google Scholar. The modified ROBINS-I instrument was used to assess bias, ensuring the reliability and validity of the studies. Data synthesis was conducted jointly by both authors. After eliminating duplicates and reviewing abstracts, 124 studies remained. Upon full-text examination, only 20 studies met the criteria for inclusion in this review. The review identified three key interrelated domains of preparedness: personal, technological, and structural measures. Most studies emphasized decontamination, Personal Protective Equipment (PPE), and detection, while the management of deceased bodies, transportation, and Points of Dispensing (PODs) were largely overlooked. These findings may assist hospital administrators and policymakers in enhancing their facilities' readiness for CBRNe emergencies.

Managing CBRN mass casualty incidents at hospitals-Find a simple solution for a complex problem: A pilot study

OBJECTIVE

Chemical, biological, radiological, and nuclear (CBRN) incidents are a major challenge for emergency medical services and the involved hospitals, especially if decontamination needs to be performed nearby or even within the hospital campus. The University Hospital Wuerzburg has developed a comprehensive and alternative CBRN response plan. The focus of this study was to proof the practicability of the concept, the duration of the decontamination process, and the temperature management.

METHODS

The entire decontamination area can be deployed 24/7 by the hospitals technical staff. Fire and rescue services are responsible for the decontamination process itself. This study was designed as full-scale exercise with 30 participants.

RESULTS

The decontamination area was ready for operation within 30 minutes. The decontamination of the four simulated patients took 5.5 ± 0.6 minutes (mean ± SD). At the end of the decontamination process, the temperature of the undressed upper body of the training patients was 27.25 ± 1°C (81.05 ± 2°F) (mean ± SD) and the water in the shower was about 35°C (95°F).

CONCLUSION

The presented concept is comprehensive and simple for a best possible care during CBRN incidents at hospitals. It ensures wet decontamination by Special Forces, while the technical requirements are created by the hospital.

A Fuzzy Hybrid MCDM Approach for Assessing the Emergency Department Performance during the COVID-19 Outbreak

The use of emergency departments (EDs) has increased during the COVID-19 outbreak, thereby evidencing the key role of these units in the overall response of healthcare systems to the current pandemic scenario. Nevertheless, several disruptions have emerged in the practical scenario including low throughput, overcrowding, and extended waiting times. Therefore, there is a need to develop strategies for upgrading the response of these units against the current pandemic. Given the above, this paper presents a hybrid fuzzy multicriteria decision-making model (MCDM) to evaluate the performance of EDs and create focused improvement interventions. First, the intuitionistic fuzzy analytic hierarchy process (IF-AHP) technique is used to estimate the relative priorities of criteria and sub-criteria considering uncertainty. Then, the intuitionistic fuzzy decision making trial and evaluation laboratory (IF-DEMATEL) is employed to calculate the interdependence and feedback between criteria and sub-criteria under uncertainty, Finally, the combined compromise solution (CoCoSo) is implemented to rank the EDs and detect their weaknesses to device suitable improvement plans. The aforementioned methodology was validated in three emergency centers in Turkey. The results revealed that the most important criterion in ED performance was ER facilities (14.4%), while Procedures and protocols evidenced the highest positive D + R value (18.239) among the dispatchers and is therefore deemed as the main generator within the performance network.

Radiation Emergency Medical Preparedness in Japan: A Survey of Nuclear Emergency Core Hospitals

OBJECTIVE

Based on experiences following the Great East Japan Earthquake and nuclear power plant accident in 2011, Nuclear Emergency Core Hospitals (NECHs) were designated as centers for radiation disaster management in Japan. This study aimed to investigate their current status and identify areas for improvement.

METHODS

This cross-sectional study was conducted in October 2018. Demographic data were collected by a questionnaire with free text responses about attitudes toward NECHs. Considerations regarding risk communications during a radiation disaster were analyzed using qualitative text mining analysis.

RESULTS

A total of 36 hospitals participated in this study. Only 31% of NECHs anticipated a radiation disaster. The importance of business continuity plans and risk communications was shown. Text analysis identified 7 important categories for health care workers during a radiation disaster, including media response, communications to hospital staff, risk communications, radiation effects on children, planning for a radiation disaster in the region, rumors, and the role in the region.

CONCLUSION

The radiation disaster medical system and NECHs in Japan were surveyed. The importance of risk communications, planning for a radiation disaster in each region, and the role in the region are identified as issues that need to be addressed.

A Bayesian BWM and VIKOR-based model for assessing hospital preparedness in the face of disasters

Hospitals are the first point of contact for people in the face of disasters that interfere with the daily functioning of life and endanger health and social life. All preparations should be made considering the worst possible conditions and the provided service should continue without interruption. In this study, a multi-criteria decision-making model was developed to evaluate disaster preparedness of hospitals. This decision model includes Bayesian best-worst method (BBWM), the VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR) and technique for order preference by similarity to ideal solution (TOPSIS) methods. With the proposed decision model, six main criteria and 34 sub-criteria related to disaster preparedness of hospitals were considered. The criteria and sub-criteria evaluated in pairwise comparison manner by the experts were weighted with BBWM. These weight values and the data obtained from the six Turkish hospitals were combined to provide inputs for VIKOR and TOPSIS. In addition, a comparative study and sensitivity analysis were carried out using weight vectors obtained by different tools. BBWM application results show that the "Personnel" criterion was determined as the most important criterion with an importance value of 26%. This criterion is followed by "Equipment" with 25%, "Transportation" with 14%, "Hospital building" and "Communication" with 12%, and "Flexibility" with 11%. Hospital-2 was determined as the most prepared hospital for disasters as a result of VIKOR application. The VIKOR Q value of this hospital was obtained as 0.000. According to the results of the comparative study, Hospital-2 was determined as the most disaster-ready hospital in all six different scenarios. This hospital is followed by Hospital-4 (Q = 0.5661) and Hospital-5 (Q = 0.7464). The remaining rankings were Hospital-6, Hospital-3 and Hospital-1. The solidity of the results was checked with TOPSIS. Based on TOPSIS application results, Hospital-2 was again found the most-ready hospital. The usage of BBWM in this study enabled the expert group's views to be combined without loss of information and to determine the criteria and sub-criteria weights with less pairwise comparisons in a probabilistic perspective. Via the "Credal ranking", which is the contribution of BBWM to the literature, the interpretation of the hierarchy between each criterion has been performed more precisely.

Evaluation of hospital disaster preparedness by a multi-criteria decision making approach: The case of Turkish hospitals

Considering the unexpected emergence of natural and man-made disasters over the world and Turkey, the importance of preparedness of hospitals, which are the first reference points for people to get healthcare services, becomes clear. Determining the level of disaster preparedness of hospitals is an important and necessary issue. This is because identifying hospitals with low level of preparedness is crucial for disaster preparedness planning. In this study, a hybrid fuzzy decision making model was proposed to evaluate the disaster preparedness of hospitals. This model was developed using fuzzy analytic hierarchy process (FAHP)-fuzzy decision making trial and evaluation laboratory (FDEMATEL)-technique for order preference by similarity to ideal solutions (TOPSIS) techniques and aimed to determine a ranking for hospital disaster preparedness. FAHP is used to determine weights of six main criteria (including hospital buildings, equipment, communication, transportation, personnel, flexibility) and a total of thirty-six sub-criteria regarding disaster preparedness. At the same time, FDEMATEL is applied to uncover the interdependence between criteria and sub-criteria. Finally, TOPSIS is used to obtain ranking of hospitals. To provide inputs for TOPSIS implementation, some key performance indicators are established and related data is gathered by the aid of experts from the assessed hospitals. A case study considering 4 hospitals from the Turkish healthcare sector was used to demonstrate the proposed approach. The results evidenced that Personnel is the most important factor (global weight = 0.280) when evaluating the hospital preparedness while Flexibility has the greatest prominence (c + r = 23.09).