SYSTEMATIC REVIEW

Tools and Checklists Used for the Evaluation of Hospital

Disaster Preparedness: A Systematic Review
Mahmood Nekoie-Moghadam, MSc, PhD; Lisa Kurland, MD, EMDM, PhD;
Mahmood Moosazadeh, MPH, PhD; Pier Luigi Ingrassia, MD, EMDM, PhD;
Francesco Della Corte, MD; Ahmadreza Djalali, MD, EMDM, PhD

ABSTRACT
Hospitals need to be fully operative during disasters. It is therefore essential to be able to evaluate
hospital preparedness. However, there is no consensus of a standardized, comprehensive and reliable
tool with which to measure hospital preparedness. The aim of the current study was to perform a
systematic review of evaluation tools for hospital disaster preparedness. A systematic review was
conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) guidelines. The key words crisis, disaster, disaster medicine, emergency, mass
casualty, hospital preparedness, hospital readiness, hospital assessment, hospital evaluation,
hospital appraisal, planning, checklist, and medical facility were used in combination with the
Boolean operators OR and AND. PubMed (National Library of Medicine, Bethesda, MD), ISI Web of
Science (Thomson Reuters, New York, NY), and Scopus (Elsevier, New York, NY) were searched. A total
of 51,809 publications were screened. The following themes were required for relevance: logistics,
planning, human resources, triage, communication, command and control, structural and nonstructural
preparedness, training, evacuation, recovery after disaster, coordination, transportation, surge capacity,
and safety. The results from 15 publications are presented. Fifteen articles fullled the criteria of
relevance and considered at least 1 of the 14 predetermined themes. None of the evaluated checklists
and tools included all dimensions required for an appropriate hospital preparedness evaluation. The
results of the current systematic review could be used as a basis for designing an evaluation tool for
hospital disaster preparedness. (Disaster Med Public Health Preparedness. 2016;page 1 of 8)
Key Words: systematic review, disaster, hospital, preparedness

D
isaster is dened as a resource imbalance
during an incident.1 Hospitals need to uphold
normal functions during a disaster.2 However,
studies of previous disasters have shown that hospitals
located in disaster areas are not well prepared and
usually become inoperative either as the result of
direct damage or functional collapse.1-3 Confusion
over roles and responsibilities, poor communication,
lack of planning, suboptimal training, and a lack of
hospital integration into community disaster planning
can lead to unprepared hospitals.1,4
Hospital preparedness is part of the disaster plan and
should build on a standardized protocol.5-9 Checklists
and other evaluation tools should be incorporated
into the hospital disaster plan in order to recognize
possible gaps and weaknesses.10 Several hospital dis-
aster preparedness evaluation methods have been
created.1,2,9,10 However, no consensus exists on a
standardized, comprehensive and reliable tool with
which to measure hospital preparedness.10
The aim of the current study was to perform a
systematic review of evaluation tools for hospital
disaster preparedness. The results from the current
study may serve as guidance for the development of a
standardized evaluation tool as part of a comprehen-
sive hospital disaster plan.
METHODS
The present study was a systematic review of publica-
tions and documents relating to evaluation tools for
hospital disaster preparedness. The review was con-
ducted according to the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA)
guidelines.11
Search Strategy
The search was conducted during October 2013.
Articles, checklists, and guidelines published between
January 1, 1990, and October 10, 2013, were extracted.
PubMed (National Library of Medicine, Bethesda,
MD), Scopus (Elsevier, New York, NY), and Google
Scholar (Google Inc, Mountain View, CA) were sear-
ched. The search was restricted to English. The fol-
lowing key words and combinations thereof were used:
crisis, disaster, disaster medicine, emergency,

Disaster Medicine and Public Health Preparedness 1

Copyright 2016 Society for Disaster Medicine and Public Health, Inc. DOI: 10.1017/dmp.2016.30
 Evaluation of Hospital Disaster Preparedness

mass casualty, hospital preparedness, hospital readiness, Recovery after disaster

hospital assessment, hospital evaluation, hospital appraisal,
planning, checklist, and medical facility.
Selection of Articles and Documents
The selection of relevant publications was done indepen-
dently by 2 of the authors (MNM, AD). The titles and
abstracts of extracted articles and documents were screened to
select relevant articles.
The selected publications were then read in full. The refer-
ence lists of the selected publications were also used to screen
for additional relevant publications. Disparate opinions on
relevance were solved through arbitration (MN). Duplicates
were excluded.
Evaluation of Selected Publications
Inclusion Criteria
A publication or document that contained at least one of the
hospital disaster preparedness elements, as listed below, in
addition to obtaining a minimum of 8 yes of the 12 possible
according to Table 1 were included in current study. These
12 questions reected the study method, data collection tool,
variable evaluation status, studied target group (hospitals),
and key components of the publication and analysis status.
Coordination
Transportation
Surge capacity
Safety and security
Twelve questions that reected the study method, data
collection tool, variable evaluation status, studied target
group (hospitals), key components of the publication, and
analysis status (Table 1) were considered for each publication.
Publications that obtained the minimum score of 8 were
selected for further data extraction and analysis.12
Inclusion Criteria
An article or document that considered at least one of the
hospital disaster preparedness elements, as listed above, in
addition to obtaining a minimum of 8 yes of the 12 possible
according to Table 1 were included in current study.
Exclusion Criteria
Publications lacking tools or checklists with which to eval-
uate hospital preparedness or for which the full text article
was not available were excluded.

Logistic/supplies/facilities/resource RESULTS
Planning and protocol Database Search
Human resources A total of 51,809 documents were identied according to key
Management of patient care and triage words and screened for relevance in the rst step. A total of
Communication 50,801 were removed in accordance with the inclusion
Command and control criteria, leaving 1008 potentially relevant articles. Of these
Structural and nonstructural resilience 1008 publications, 347 articles were excluded owing to the
Drill and training overlap of databases and redundancy. This left 661 publica-
Evacuation tions to be considered.

TABLE 1
The Following Questions Were Assessed for Each of the Selected Articles and
Documents Relevant to Evaluation Tools for Hospital Disaster Preparedness
Score

No. Question Yes = 1 No = 0

1 Are the research questions clearly stated?

2 Is the approach appropriate for the research question?
3 Is the study context clearly described?
4 Is the role of the researcher clearly described?
5 Is the sampling method clearly described?
6 Is the sampling strategy appropriate for the research question?
7 Is the method of data collection clearly described?
8 Is the data collection method appropriate to the research question?
9 Is the method of analysis clearly described?
10 Are the main characteristics of the population well described?
11 Is the analysis appropriate for the research question?
12 Are the claims made supported by sufcient evidence?

2 Disaster Medicine and Public Health Preparedness

 Evaluation of Hospital Disaster Preparedness

FIGURE 1
Review Selection Process and Results, in Accordance With the PRISMA Guidelines.11

Articles identified through electroinc

database search (n=51809)
(PubMed:957;Scopus:3952;Google
scholar: 46900)

Eliminated studies after

limiting Search (n=50801)

Papers Relatively relevant

to the topic (n=1008)

Removed duplicates
articles (n=347)

Articles screened by title

and abstract (n=661)

Excluded non-relevant
articles (n=525)

Retrieved Full text

(n=136)

Articles identified through Excluded after screened by

reference checking (n=1) full text (n=70)

Full text articles assessed

for eligibility (n=67)

Excluded full texts (n=52)

Studies included in this study (n=15)

Selection of Relevant Articles elements of hospital preparedness, whereas the other 14

The title and abstract of the 661 remaining publications were
considered for relevance, and 525 articles were omitted for
being irrelevant. An additional 70 articles were omitted after
the full article was read, and 1 new article was added after
review of the references. A total of 67 articles1,9-10,13-74 were
relevant and were evaluated with respect to hospital
preparedness elements and the checklist in Table 1.
Of the 67 evaluated articles, 5210,13-58,60,61,65,71 did not
fulll the stipulated inclusion criteria. Fifteen relevant
articles1,9,59,62-64,66-70,72-74 fullled the criteria and are
reviewed in the current study (Figure 1).
Twelve of these 15 articles were published in 2008. The
majority had been performed in the United States. One
publication72 included an assessment tool with all 13
articles1,9,59,62-64, 66-70,73,74 included between 4 and 12 of the
stipulated elements (Table 2).
The most common elements included in the articles were
procedures and protocols, which were included in 13 arti-
cles. Training and exercise were included in 11 articles and
triage and medical care were included in 9 articles
(Table 2). The assessment tools reported in the current study
considered various subthemes for each of the hospital disaster
preparedness elements (Table 3).
DISCUSSION
The results of the current systematic review of evaluation
tools and checklists for hospital disaster preparedness
screened an initial 51,809 articles. Fifteen publications

Disaster Medicine and Public Health Preparedness 3

4

Evaluation of Hospital Disaster Preparedness

Disaster Medicine and Public Health Preparedness

TABLE 2
Hospital Disaster Preparedness Evaluation Tools Fullling the Criteria of Relevance and Considering at Least One of the Predened Themesa
Preparedness Elements Considered in the Assessment Tool

Procedures Command Triage and Logistic Safety Structural and Training

and and medical Surge and Human and non-structural and
Ref Year Location protocols control Coordination Communication care capacity resources resources security resiliency exercise Evacuation Transportation Recovery

1 2006 USA - - - - - - - -
9 2011 WHO/ - -
Europe
59 2013 Japan - - - - - -
62 2009 USA - - -
63 1995 PAHO/ - - -
WHO
64 2009 USA - - - - - -
66 2008 USA - - - - - - - - - -
67 2007 USA - - - - - - -
68 2010 Pakistan - - - - - - - - - -
69 2011 Namibia - - - - - - -
70 2008 PAHO/ - - - - - - - -
WHO
72 2008 Colombia -
73 2008 USA - - - - - - - -
69 2011 Namibia - - - - - - - -
74 2010 Turkey - - - - - - -
a
Abbreviations: PAHO, Pan American Health Organization; WHO, World Health Organization.
 Evaluation of Hospital Disaster Preparedness

TABLE 3
Elements and Subthemes of Hospital Disaster Preparedness From the 15 Included Articles
Hospital Preparedness
No. Element Subthemes

1 Logistic and resources Medicine and clinical equipment, specialist equipment, enough beds, alarm, stocks, phone lines, equipment to call
staff, medicine, tent, generator, food, computers that contain vital records and nancial information, drinking water,
single-bed facilities, emergency disaster kits (ashlights, batteries), enough ambulances, mobile x-ray units,
special entrance, water supply, electricity, gas supply, external trafc ow, internal trafc ow, loGIstics, bed
tracking, appropriate backup arrangements like water and oxygen, list of essential services, maintain essential
services, identify resources for essential services, update inventory, estimate consumption of supplies, ensure
continuity of provision, request quality certications, physical space for storage and stockpiling/stockpile according
to standards guide, dene hospital pharmacy role, resource categorization, inventory process, long-care facilities,
current number of ventilators, warm water, availability of Geiger counter, garbage, laundry
2 Procedures and protocols Disaster planning committee, committee review and critique disaster drills, plans to care for community, super plan,
protocols and functional chart, disaster plan, strategic plan, operational plan, operational manual, mobilization
guide, physical plant plan
3 Human resources Organize staff, call-back roster, representatives from the medical staff, support staff, stress management, family
support, availability of emergency team, hospital staff contact list, monitor staff absenteeism, minimum need for
health workers, prioritizing staff needs, recruit staff, temporary licensing issues, system for providing health
personnel, adequate shift rotation, adequate psychological support team, ensure vaccination of staff
4 Triage and medical care Triage, protocol to determine which patients require staff accompaniment, medicine management, treatment of
emergency patients, triage tag, identify patient rooms, visitors management, epidemiological surveillance, asset
management including inventory of assets, tracking of assets, resupply during disaster, distant triage ofcer, area for
receiving patients, triage area is near other areas, identify entrance and exit triage areas, site for receipt and triage,
alternative area, establish triage protocols, alternative care site, treatment decontamination, hygiene, control and
disease surveillance, admission and fast track
5 Communication Emergency medical information system, other communication tool, communication links, existence of emergency
information, plan for communication, internal communication plan, external communication plan, media
communication plan, appoint information spokesman, designate a place for press conferences, draft for audiences
approval about incident commander, mechanism of information exchange, mechanism of collection and reporting
information, availability of backup and primary communication system, standardized communication type, inter-
organizational communication and incident information plan, communication facilities and messages, management
information system, communication system, alternative communication system, agreement with local
communication company
6 Command and control Command Center, command integrated with community A command center, designate replacement director
command, ensure training of all staff about command, use of Incident Command System, use of incident action
planning, logistic function of Incident Command System, command center module
7 Structural and non-structural Physical location, access to person in charge, building earthquake and reproof, location of the hospital, structural,
resiliency physical space, waste management, mechanism for repair supplies, nance and administration, condition of
building, proximity of building, structural redundancy, structural detailing, foundation, irregularities in plan,
irregularities in height, structural resilience, architecture elements
8 Training and exercise Training and education, disaster drill, disaster manual corrected, drills include testing external agreements, training
plan, disaster-specic training, regular drill, cross-train health workers, train and exercise, disaster plan exercise,
training course, realistic exercise, public education, predrill, decontamination training, disaster training with other
agencies, drill involving multiple agencies, responsible for education and training, formal training of staff, workshops
9 Evacuation Space of emergency evacuation, who authorizes evacuation, evacuation routes identied, identify who accompanies
relocated patients, existence of a plan and a person in charge, lifts, re alarm, elevator, emergency exit, point of
entry and exit
10 Recovery Contact with your insurance agent, made a damage assessment, broken windows and roof openings have been
covered, established a crisis counseling opportunity for staff, supplies that need to be protected, damage
assessment to the hospital, plan for recovery, appoint recovery responsible, determine system recovery, safety
assessment of building after disaster, determine time and resource need to repair organize a team for recover,
provide after-action report, disaster employee recovery assistance, family support program, critical incident
debrieng, group or individual counseling services
11 Coordination Contact has been made to coordinate each others role during a disaster, coordinate with other hospitals or vendors,
coordinate with local amateur radio operators, mutual agreements have been signed with another hospital,
agreements have been made with vendors, a person in charge for media, coordination with health authorities,
hospital network, other health facilities and other vendors
12 Transportation Heliport, accessibility car, arrangements have been made for transportation of those patients being transferred
13 Surge capacity Early discharge of patients, collection of elective surgery, calculate maximal capacity, estimate for increasing demand,
methods for expanding hospital capacity, car area for overow, outsourcing patient to other department, inter-facility
patient transfer, additional sites for patient care, cancel nonessential services, adapt admission and discharge, use
temporary morgue, formulate plan for postmortem care, space surge characteristics (bed capacity, isolation room,
ambulance diversion, impacted by nursing shortage, elective surgery, early discharge)
14 Safety and security Security plan, facilities security, appoint security responsible, priorities for security needs, early control of facility
access, escorting medical staff, rules for crowd control, solicit input from hospital security team, identify insecurity
risks, establish an area for chemical and biological decontamination, re prevention, safety of structure and
materials, personnel proactive and precaution, measures for monitoring

Disaster Medicine and Public Health Preparedness 5

 Evaluation of Hospital Disaster Preparedness
fullled the criteria for relevance and considered at least 1 of
the 14 predetermined themes: logistic/supplies/facilities/
resource, planning and protocol, human resources, manage-
ment of patient care and triage, communication, command
and control, structural and nonstructural resilience, drill and
training, evacuation, recovery after disaster, coordination,
transportation, surge capacity, and safety and security
(Table 2). In addition, each theme included subthemes,
which reected a further detail of evaluation (Table 3). These
results may be used to create an evaluation tool for the
assessment of hospital disaster preparedness.
Hospitals are an important link in the chain of disaster
response. It is essential to consider estimations of hazard risk
for the specic hospital when planning for an effective
medical disaster response.74,75 Surge capacity is one of the
most important themes to consider with respect to hospital
preparedness. The possibility to expand the capacity of hos-
pitals and developing a community-wide response to natural
or manmade incidents is crucial for mitigating effects on
health care. The reviewed articles considered various aspects
of surge capacity, eg, the elements of surge capacity, methods
of increasing the surge capacity, and how to calculate the
maximum capacity that can be surged.1,9,62
All phases of disaster management require protocols and
plans, which was another predetermined theme for the eva-
luation tools, since all aspects of disaster management deal
with the processes used to protect populations or property or
from the effects of disasters.7,10 The phases of the disaster
management are mitigation, preparedness, delivery of medical
support during the disaster, and recovery and support after
any disaster.10,65 In order to develop a comprehensive disaster
plan, it is necessary that the responsibility to develop the plan
be given to a committee or a subcommittee of the safety
committee. The committee should include representatives
from every department in the hospital.9 This committee
should include representatives from the medical staff (emer-
gency room physician or trauma surgeon), administration
(including risk manager) or management, nursing staff,
emergency department, security, communications, public
relations, medical records and admissions, engineering/
maintenance, laboratory, radiology, and respiratory therapy.71
Communication and coordination is the theme that involves
activities that provide accurate and reliable information
to and cooperation with the public, other organizations,
and community institutions responding to the disaster. The
information that appears to be needed focuses on health and
safety, continuity of operations and government, critical
facilities and infrastructure, delivery of services, the envir-
onment, and economic and nancial conditions.75
Health care personnel training in disaster preparedness is
another theme of importance and affects maintenance and
promotion of human resources. Training methods that can be
6 Disaster Medicine and Public Health Preparedness
used include maneuvers, practical drills, and facing actual
events.75
Hospital preparedness has previously been evaluated from
different perspectives and has shown divergent
results.58,59,60,61,66,68 Dormes et al68 showed that human
resource is the highest level of hospital preparedness and the
lowest rank is for training activities. Daneshmandi et al58
studied hospitals in Iran and reported that the level of
preparedness depends on training, logistics, and management
units, whereas safety, evacuation and transport, stafng, com-
munication, and trafc were at a weak level of preparedness.
In a comprehensive study including 45 hospitals in the
United States, 43 of 45 (96%) had hospital disaster plans
based on the hospital Incident Command System and
all had protocols for hospitals (100%). All hospitals had
emergency medical services-compatible radios and more than
3 days worth of food supplies. Fewer hospitals involved law
enforcement (56%) or had mutual aid agreements with other
hospitals (20%) or long-term care facilities (7%). Although
the vast majority (96%) conducted mitigating drills, only
16% actually involved other agencies in their disaster train-
ing. Only 13 of the 45 hospitals (29%) had a surge capacity of
greater than 20 beds. Less than half (42%) had 10 or more
isolation rooms and 27 hospitals (66%) were on diversion for
greater than 20% of them. Less than half had contamination
(42%), whereas approximately one-half (51%) had anti-
biotics and 42% had stockpiles.1
Disaster preparedness consists of a wide range of measures, with
both long- and short-term effects, designed to save lives and
limit the damage that may otherwise be caused by the inci-
dent. Preparedness is concerned with policies and programs to
minimize the impact of disasters. Corresponding measures are
taken in elds other than medical, eg, legislative, physical and
urban planning, public works. Short-term preparedness
measures can be taken during a warning period before the
impact of an incident and need to be supported by legislation
and should include operational planning, education and
training of the population at large, and the technical training,
stockpiling, and emergency funding arrangements. Prepared-
ness measures also need to include vulnerability analyses and
warning systems in addition to evacuation plans. The more
effectively these measures are carried out in advance, the more
readily it will be possible to take the action necessary during
the emergency phase itself and in the later phases of mitiga-
tion, rehabilitation, and reconstruction.9 Hence, the evalua-
tion of hospital preparedness needs to be performed.
The present systematic review showed that none of the
evaluated checklists and tools included all dimensions
required for an appropriate hospital preparedness evaluation.
The results of this systematic review could be used to
prepare a standardized tool to evaluate hospital disaster
preparedness.

CONCLUSION
The results of the current systematic review of evaluation
tools and checklists for hospital disaster preparedness
screened 51,809 articles. Fifteen articles fullled the criteria
of relevance and considered at least 1 of the 14 predetermined
themes. None of the evaluated checklists and tools included
all dimensions required for an appropriate hospital pre-
paredness evaluation. The results of this systematic review
could be used to prepare a standardized tool to evaluate
hospital disaster preparedness.
About the Authors
Research Center for Health Services Management, Institute for Futures Studies in
Health, Kerman University of Medical Sciences, Kerman, Iran (Dr Nekoie-
Moghadam); Department of Clinical Sciences and Education, Karolinska
Institutet, Department of Emergency Medicine, Sdersjukhuset, Stockholm,
Sweden (Dr Kurland); Health Sciences Research Center, School of Health,
Mazandaran University of Medical Sciences, Sari, Iran (Dr Moosazadeh); Center
for Research and Education in Emergency and Disaster Medicine - CRIMEDIM,
University degli Studi del Piemonte Orientale A. Avogadro, Novara, Italy,
(Drs Ingrassia, Della Corte, and Djalali).
Correspondence and reprint requests to Mahmood Moosazadeh, Health Sciences
Research Center, School of Health, Mazandaran University of Medical Sciences,
Sari, Iran (e-mail: mmoosazadeh1351@gmail.com).
REFERENCES
1. Kaji AH, Lewis RJ. Hospital disaster preparedness in Los
Angeles County. Acad Emerg Med. 2006;13(11):1198-1203.
2. Krajewski MJ, Sztajnkrycer M, Baez AA. Hospital disaster preparedness
in the United States: new issues, new challenges. The Internet Journal of
Rescue and Disaster Medicine. 2005;4(2):22-25.
3. Eitzen EM Jr. Education is the key to defense against bioterrorism. Ann
Emerg Med. 1999;34(2):221-223.
4. Manley WG, Furbee PM, Coben JH, et al. Realities of disaster
preparedness in rural hospitals. Disaster Manag Response. 2006;4(3):
80-87.
5. A summary of the new standards, discussion of the underlying
philosophy. Joint Commission Perspectives. 2001;21(12).
6. Timm N, Kennebeck S. Impact of disaster drills on patient ow in a
pediatric emergency department. Acad Emerg Med. 2008;15(6):544-548.
7. Brevard SB. An analysis of disaster response plans and the aftermath of
hurricane Katrina. J Trauma. 2008;5(5):1126-1132.
8. Bartram T, Joiner TA, Stanton P. Factors affecting the job stress and job
satisfaction of Australian nurses: implications for recruitment and
retention. Contemp Nurse. 2004;17(3):293-304.
9. Hospital emergency response checklist: an all-hazards tool for hospital
administrators and emergency managers. WHO Regional Ofce for
Europe. http://www.euro.who.int/en/health-topics/emergencies/disaster-
preparedness-and-response/publications/2011/hospital-emergency-response-
checklist. Published 2011. Accessed May 2, 2016.
10. Djalali A, Castren M, Khankeh H, et al. Hospital disaster preparedness as
measured by functional capacity: a comparison between Iran
and Sweden. Prehosp Disaster Med. 2013;28(5):454-461.
11. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for
reporting systematic reviews and meta-analyses of studies that evaluate
health care interventions: explanation and elaboration. PLoS Med.
2009;6(7):e1000100. doi:10.1371/journal.pmed.1000100.
12. Moosazadeh M, Nekoei-Moghadam M, Emrani Z, et al. Revalence of
unwanted pregnancy in Iran: a systematic review and meta-analysis. Int J
Health Plann Mgmt. 2014;29(3):e277-e290. doi: 10.1002/hpm.2184.
Disaster Medicine and Public Health Preparedness
Evaluation of Hospital Disaster Preparedness
13. Aghababian R, Lewis C, Gans L, et al. Disaster within hospitals. Ann
Emerg Med. 1994;23(4):771-777.
14. Li x, Huang J, Zhang H. An analysis of hospital preparedness capacity for
public health emergency in four region of China :Beijing, Shandong,
Guangxi and Hainan. BMC Public Health. 2008;8:319.
15. Mchugh MD. Hospital nurse stafng and public health emergency
preparedness: implication for policy. Public Health Nurs. 2010;27(5):442-449.
16. Hospital Emergency Preparedness Planning. Bioterrorism Preparedness
and Response. Texas Institute for Health Policy Research. http://biotech.
law.lsu.edu/blaw/states/texas01.pdf. Published March 24, 2003. Accessed
May 2, 2016.
17. Higgins W, Wainright C, Lu N, et al. Assessing hospital preparedness
using an instrument based on mass casualty disaster plan checklist: results
of a statewide survey. Am J Infect Control. 2004;32(6):327-332.
18. Burgess J, Blackmon GM, Brodkin A, et al. Hospital preparedness for
hazardous materials incidents and treatment of contaminated patients.
West J Med. 1997;167(6):387-391.
19. Daub E. Hospital emergency preparedness assessment : a framework for
integrated bioterrorism planning and response. JAMA. 2002;278(5):
389-395.
20. Recommended disaster core competencies for hospital personnel. Florida
Department of Health website. http://www.calhospitalprepare.org/sites/
main/les/le-attachments/corecompetenciesoridadh2011.pdf. Revised
Spring 2011.
21. Niska R, Shimizu IM. Hospital preparedness for emergency response:
United States, 2008. Natl Health Stat Report. 2011;24(37):1-14.
22. OSHA Best Practices for Hospital-Based First Receivers of Victims from
Mass Casualty Incidents Involving the Release of Hazardous Substances.
US Department of Labor website. https://www.osha.gov/dts/osta/best-
practices/rstreceivers_hospital.html. Published January 2005. Accessed
May 3, 2016.
23. Perry RW, Lindell MK. Hospital planning for weapons of mass
destruction incidents. J Healthc Prot Manage. 2007;23(1):27-39.
24. Rebmann TC, Carrico R, English JF. Hospital infectious disease
emergency preparedness :a survey of infection control professionals.
Am J Infect Control. 2007;35(1):25-32.
25. Cosgrove S, Jenckes M, Wilson I, et al. Tool for evaluating core elements
of hospital disaster drill. AHRQ publication. http://www.archive.ahrq.
gov/prep/drillelements/. Published 2008.
26. Adini B, Goldberg A, Laor D, et al. Assessing levels of hospital
emergency preparedness. Prehosp Disaster Med. 2006;21(6):451-457.
27. Burstein J. Smoke and shadow: measuring hospital disaster preparedness.
Ann Emerg Med. 2008;52(3):230-231.
28. Gibbs T. A holistic approach to ensuring that hospitals function at
maximum efciency following severe hurricanes in the Caribbean.
Advances in Hurricane Engineering. 2012:1160-1170. http://www.asceli-
brary.org/doi/abs/10.1061/9780784412626.101.
29. Rambhia KJ, Waldhorn RE, Selck F, et al. A survey of hospitals to
determine the prevalence and characteristics of healthcare coalitions for
emergency preparedness and response. Biosecur Bioterror. 2012;10(3):
304-313.
30. Valesky W, Roblin P, Patel B, et al. Assessing hospital preparedness:
comparison of an on-site survey with a self-reported, internet-based,
long-distance tabletop drill. Prehosp Disaster Med. 2013;28(5):441-444.
31. Improving Health System Preparedness for Terrorism and Mass-Casualty
Events. American Medical Association, American Public Health
Association. https://stacks.cdc.gov/view/cdc/6891. Published July 2007.
Accessed May 3, 2016.
32. Bonnett C, Perry B, Cantrill S, et al. Surge capacity: a proposed
conceptual framework. Am J Emerg Med. 2007;25(3):297-306.
33. Carrier E, Yee T, Cross D, et al. Emergency preparedness and community
coalitions: opportunities and challenges. Res Brief. 2012;(24):1-9.
34. Hospital safe from disaster.world health organization.2008-2009.
Translate, http://www.euro.who.int/pubrequest.
35. Disaster risk management and planning for hospitals and
healthcare facilities. Department of Health, Republic of South Africa.
7
 Evaluation of Hospital Disaster Preparedness
http://www.preventionweb.net/les/11214_FreeStateProvincedisaster
riskmanage.pdf. Published October 14, 2009. Accessed May 3, 2016.
36. World Health Organization. The public safety risk management frame-
work. http://www.who.int/hac/techguidance/tools/WHO_strategy_safety_
risk_management.pdf. Accessed May 3, 2016.
37. Bissell R, Pinet L, Nelson M, et al. Evidence of the effectiveness of
health sector preparedness in disaster response: the example of four
earthquakes. Fam Community Health. 2004;27(3):193-203.
38. Daily E, Padjen P, Birnbaum M. A review of competencies developed for
disaster healthcare providers: limitations of current processes and
applicability. Prehosp Disaster Med. 2010;25(5):387-395.
39. Healthcare Preparedness Capabilities. Ofce of the Assistant Secretary of
Preparedness and Response Hospital Preparedness Program. http://www.
phe.gov/preparedness/planning/hpp/reports/documents/capabilities.pdf.
Published January 2012. Accessed May 3, 2016.
40. Chen KT, Chen WJ, Twu HJ. The public health response to the Chi-Chi
earthquake in Taiwan, 1999. Public Health Rep. 2003;118(6):493-499.
41. Abbasi M, Salehnia H. Disaster medical assistance teams during
earthquake crisis in Iran: propose a localized model. Iranian Red Crescent
Medical Journal. 2013;15(9).
42. OCarroll P, Thompson J, Ambrosio L, et al. A framework for assessing
regional public health preparedness. Northwest Center for Public Health
Practice, University of Washington. http://www.nwcphp.org/documents/
evaluation/assessing-ph-preparedness. Published February 2007. Accessed
May 3, 2016.
43. Florida Department of Health Hospital Preparedness Program 2002-2010.
Floridas Public Health and Medical System. http://www.oridahealth.gov/
preparedness-and-response/healthcare-system-preparedness/_documents/
hpp-report-combined.
44. Takahashi A, Ishil N, Kawashima T, Nakao H. Assessment of medical
response capacity in the time of disaster: the estimate formula of hospital
treatment capacity the maximum reciveable number of patient in
hospital. Kobe J Med Society. 2007;53(5):189-198.
45. Kai T, Ukai T, Ohta M, et al. Hospital disaster preparedness in Osaka.
Japan. Prehosp Disaster Med. 1994;9(1):29-34.
46. Levi L, Bregman D, Geva H, et al. Hospital disaster management
simulation system. Prehosp Disaster Med. 1998;13(1):29-34.
47. Col L, Adini B, Goldberg A, et al. Assessing levels of hospital emergency
preparedness. Prehosp Disaster Med. 2006;21(6):451-457.
48. Davis LM, Ringel K, Cotton S, et al. Public health preparedness:
integrating public health and hospital preparedness programme. Center for
Domestic and International Health Security. http://www.rand.org/pubs/
technical_reports/TR317.html. Published 2006. Accessed May 3, 2016.
49. Hospital Preparedness for Mass Casualties. American Hospital Associa-
tion. US Department of Health and Human Services. http://www.aha.
org/content/00-10/2000forumreport. Published 2000.
50. Shkan A. Public health preparedness and response in the USA since
9/11. A national health security imperative. Lancet. 2011;378:953-956.
51. Shao X. The role of health sectors in disaster preparedness. Floods in
southeastern China, 1991. Prehosp Disaster Med. 1993;8(2):173-175.
52. Savoia E, Sarah BM, Rodday A, et al. Public health system research in
emergency preparedness. Am J Prev Med. 2009;37(2):150-157.
53. Williams J, Nocera M, Casteel C. Effectiveness of disaster training for
health care workers:a systematic review. Ann Emerg Med. 2008;52(3):
211-222.
54. Most urban hospitals have emergency plans but lack certain capacities for
bioterrorism response. United States General Accounting Ofce. http://
www.gao.gov/products/GAO-03-924. Published August 6, 2003.
Accessed May 3, 2016.
55. Ingrassia PL, Prato F, Geddo A, et al. Evaluation of medical management
during a mass casualty incident exercise: an objective assessment tool to
enhance direct observation. J Emerg Med. 2010;39(5):629-636.
56. Wisniewski R, Dennik G, Peltier JW. Emergency preparedness
competencies: assessing nurses educational needs. J Nurs Adm. 2004;
34(10):475-480.
8 Disaster Medicine and Public Health Preparedness
57. Kahn KS, Chultz CH, Miller K, et al. Does start triage work? An
outcomes assessment after a disaster. Ann Emerg Med. 2009;54(3):
424-430.
58. Daneshmandi M, Amiri H, Vahedi M, et al. Assessing the level of
preparedness for confronting crisis such as ood, earthquake, re and
storm in some selected hospital of Iran. Iranian Journal of Military
Medicine. 2010;12(3):167-171.
59. Mulyasari F, Lnoue S, Sunil P, et al. Disaster preparedness: looking
through the lens of hospitals in Japan. Int J Disaster Risk Sci. 2013;
4(2):89-100.
60. Vahedparast H. Assessing hospital disaster preparedness of Bushehr
province. Iranian Southern Med J. 2013;16(1):69-76.
61. Elazeem H, Adam S, Mehamed G. Awareness of hospital disaster
management plan among health team memebers In a university hospital.
Life Sci J. 2011;8(2):42-52.
62. Toner E, Waldhorn R, Franco C, et al. Hospitals Rising to the Challenge.
The First Five Years of the U.S Hospital Preparedness Program and
Priorities Going Forward. Center for Biosecurity of UPMC. http://www.
upmchealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2009/2009-04-
16-hppreport.pdf. Published March 2009. Accessed May 3, 2016.
63. Guidelines for Assessing Disaster Preparedness in the Health Sector. Pan
American Health Organization. Regional Ofce of the World Health
Organization. http://www.mona.uwi.edu/cardin/virtual_library/docs/1241/
1241.pdf. Published 1995. Accessed May 3, 2016.
64. Jl Jenkis, Kelen GD, Souer M, et al. Review of hospital preparedness
instrument for national incident management system compliance.
Disaster Med Public Health Prep. 2009;3(2):83-89.
65. Smith SM, Gorski J, Vennelakanti HC. Disaster preparedness and
response: a challenge for hospitals in earthquake-prone countries. Int J
Emerg Manage. 2010;7(3):209-220.
66. Calderon LJP. Importance of investing on emergency and disaster
preparedness at country level. Procedia Soc Behav Sci. 2006;2(5):
7130-7136.
67. Jenckes MW, Catlett CL, Hsu EB, et al. Development of evaluation
modules for use in hospital disaster drills. Am J Disaster Med. 2007;2
(2):87-95.
68. Dormes B, HamedBadi R, Gromer S, et al. Disaster Preparedness of
Hospitals Khyber Pakhtunkhwa. Field study of 1st, 2nd level hospitals
2009. Report of the GTZ (Gesellschaft Technische Zusammenarbeit)
[dissertation]. University Tuebingen; 2010. http://www.stiftung-katastro
phenmedizin.de/wp-content/uploads/2011/08/Disaster-Preparedness-of-
Hospitals-Khyber-Pakhtunkhwa.
69. Chimenya GT. Hospital Emergency and Disaster Preparedness: A Study of
Onandjokwe Luthern Hospital, Northen Namibia [masters thesis]. Disaster
Management Training and Education Center for Africa, University of Free
State; 2011. http:// natagri.ufs.ac.za/dl/userles/Documents/00002/2281.
70. Pan American Health Organization. Hospital Safety Index: Guideline
for Evaluators. http:// www.paho.org/disasters/index.php?option=com_
docman. Published 2008.
71. Richter PV. Hospital disaster preparedness: meeting a requirement or
preparing for the worst? Healthc Facil Manag Ser. 1997:1-11.
72. Bremer R. Policy development in disaster preparedness and management:
lessons learned from the January 2001 earthquake in Gujarat, India.
Prehosp Disaster Med. 2003;18(4):372.
73. Belmont E, Fried BM, Gonen JS, et al. Emergency preparedness, response
& recovery checklist: beyond the emergency management plan. J Health
Law. 2004l;37(4):503-565.
74. Top M, Gider M, Tas Y. An Investigation of hospital disaster
preparedness in Turkey. Journal of Homeland Security and Emergency
Management. 2010;7(1):1-21.
75. Tang R, Fitzgerald G, Hou XY, Wu YP. Building an evaluation
instrument for Chinas hospital emergency preparedness: a systematic
review of preparedness instruments. Disaster Med Public Health Prep.
2014;8(1):101-109. doi: 10.1017/dmp.2014.10.