Effective Factors in Improving the Emergency Department Preparedness of Hospitals in Radiation and Nuclear Incidents and Nuclear Terrorism: A Systematic Review

  • Milad AHMADI MARZALEH Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
  • Rita REZAEE Department of Health Information Management, Health Human Resource Research Center, School of Management and Medical In-formatics, Shiraz University of Medical Sciences, Shiraz, Iran
  • Abbas REZAIANZADEH Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
  • Mahnaz RAKHSHAN Department of Nursing, School of Nursing & Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
  • Mahmoudreza PEYRAVI 1. Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran 2. Research Center of Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
Preparedness, Emergency department, Hospital, Radiation incidents, Nuclear incidents, Terrorism


Background: Due to existence of nuclear power plant sites in various parts of the world, as well as political threats in disaster-prone areas throughout the world, there is a probability of nuclear and radiation incidents. The present study aimed to extract effective criteria in emergency department preparedness of hospitals in radiation, nuclear incidents and nuclear terrorism in different countries around the world.

Methods: A systematic search was carried out in Cochrane Library, PubMed, Scopus, Science Direct, Web of Science, ProQuest and Embase databases between Jan 1970 and Jul 2018. The systematic search was carried out according to the PRISMA standard. The required information was extracted from the papers based on the abstract and collection form.

Results: Overall, 1091 papers were finally extracted. The initial search included research papers. After reviewing the papers’ titles, abstracts and full texts, 15 papers were selected for final analysis. Next, 32 criteria were extracted. The criteria were divided into 3 categories. The categories included staff, stuff and systems (structure). The most frequent criteria included training criteria, personal protective equipment, decontamination and practice.

Conclusion: The results of the systematic review provided an overview of the effective factors in improving the emergency department preparedness during radiation and nuclear incidents. In addition to the mentioned criteria in different studies, other hidden factors affect the emergency department preparedness in radiation and nuclear incidents. Thus, the highest level of preparedness should be considered.


1. Amis ES, Butler PF, Applegate KE et al (2007). American College of Radiology white paper on radiation dose in medi-cine. J Am Coll Radiol, 4(5): 272-84.
2. Shabestani Monfared A (2004). Nuclear weapons, triage of injured and therapeutic approach to the acute radiation syn-drome. Annals of Military and Health Sciences Research, 2(8): 463-6.
3. Goans RE (2010). Medical management of radio-logical casualties. Armed Forces Radiobiolo-gy Research Inst Bethesda Md.
4. Veenema TG, Thornton CP (2015). Under-standing Nursing's Role in Health Sys-tems Response to Large-Scale Radiologic Disasters. J Radiol Nurs, 34(2): 63-72.
5. Murrain-Hill P, Coleman CN, Norwood AE et al (2015). Medical planning and response manual for a nuclear detonation incident: a prac-tical guide. Mac Hill.
6. Krajewski MJ, Sztajnkrycer MD, Baez AA (2005). Hospital disaster preparedness in the United States: new issues, new chal-lenges. J Disaster Med, 4(2): 22-5.
7. Auf der Heide E (1989). Disaster response: prin-ciples of preparation and coordination: Cana-dá. CV Mosby Company.
8. Schleipman AR, Gerbaudo VH, Castronovo FP (2004). Radiation disaster response: preparation and simulation experience at an academic medical center. J Nucl Med Technol, 32(1):22-7.
9. Davari F, Zahed A (2015). A management plan for hospitals and medical centers facing radiation incidents. J Res Med Sci, 20(9): 871-8.
10. Koenig KL (2009). Preparedness for terror-ism: managing nuclear, biological and chemical threats. Ann Acad Med Singapore, 38(12): 1026-30.
11. Hrdina CM, Coleman CN, Bogucki S et al (2009). The “RTR” medical response sys-tem for nuclear and radiological mass-casualty incidents: a functional TRiage-TReatment-TRansport medical response model. Prehosp Disaster Med, 24(3): 167-78.
12. Mortelmans LJ, Van Boxstael S, De Cauwer HG et al (2014). Preparedness of Belgian civil hospitals for chemical, biological, ra-diation, and nuclear incidents: are we there yet? Eur J Emerg Med, 21(4): 296-300.
13. Rassin M, Avraham M, Nasi-Bashari A et al (2007). Emergency department staff pre-paredness for mass casualty events in-volving children. Disaster Manag Resp, 5(2): 36-44.
14. Lim HCS, Ng KS, Tan HH et al (2011). Hospital preparedness for radiation emergencies and medical management of multiple combined radiation injury vic-tims. Proceedings of Singapore Healthcare, 20(3): 197-207.
15. Dallas CE, Klein KR, Lehman T et al (2017). Readiness for radiological and nuclear events among emergency Medical Per-sonnel. Front Public Health, 5: 202.
16. O’Sullivan TL, Dow D, Turner MC et al (2008). Disaster and emergency manage-ment: Canadian nurses’ perceptions of preparedness on hospital front lines. Pre-hosp Disaster Med, 23(3): s11-8.
17. Becker SM, Middleton SA (2008). Improv-ing hospital preparedness for radiological terrorism: perspectives from emergency department physicians and nurses. Disas-ter Med Public Health Prep, 2(3): 174-84.
18. Hung KKC, Lam ECC, Wong MCS et al (2017). Emergency physicians' prepared-ness for CBRNE incidents in Hong Kong. Hong Kong J Emerg Med, 20(2): 90-7.
19. Considine J, Mitchell B (2009). Chemical, biological and radiological incidents: pre-paredness and perceptions of emergency nurses. Disasters, 33(3): 482-97.
20. Mortelmans LJM, Gaakeer MI, Dieltiens G et al (2017). Are Dutch Hospitals Pre-pared for Chemical, Biological, or Radio-nuclear Incidents? A Survey Study. Prehosp Disaster Med, 32(5): 483-91.
21. Mitchell CJ, Kernohan WG, Higginson R (2012). Are emergency care nurses pre-pared for chemical, biological, radiologi-cal, nuclear or explosive incidents? Int Emerg Nurs, 20(3): 151-61.
22. Treat KN, Williams JM, Furbee PM et al (2001). Hospital preparedness for weap-ons of mass destruction incidents: an ini-tial assessment. Ann Emerg Med, 38(5): 562-5.
23. Edwards NA, Caldicott DG, Aitken P et al (2008). Terror Australis 2004: prepared-ness of Australian hospitals for disasters and incidents involving chemical, biologi-cal and radiological agents. Crit Care Re-susc, 10(2): 125-36.
24. Moore BL, Geller RJ, Clark C (2015). Hos-pital preparedness for chemical and radi-ological disasters. Emerg Med Clin North Am, 33(1): 37-49.
25. Jasper E, Miller M, Sweeney B et al (2005). Preparedness of hospitals to respond to a radiological terrorism event as assessed by a full-scale exercise. J Public Health Manag Pract, Suppl: S11-6.
26. Kollek D (2003). Canadian emergency de-partment preparedness for a nuclear, bio-logical or chemical event. Can J Emerg Med, 5(1): 18-26.
27. Aten JD, Boan D, Davis EB, Schruba AN (2018). The Humanitarian Disaster Insti-tute: A training model for graduate-level psychology and counseling programs. J Psychol Christ, 37(1): 80-6.
28. Hammad KS, Arbon P, Gebbie K, Hutton A (2018). Why a disaster is not just nor-mal business ramped up: Disaster re-sponse among ED nurses. Australas Emerg Care, 21(1): 36-41.
29. Kaji AH, Lewis RJ (2006). Hospital disaster preparedness in Los Angeles county. Acad Emerg Med, 13(11): 1198-203.
How to Cite
AHMADI MARZALEH M, REZAEE R, REZAIANZADEH A, RAKHSHAN M, PEYRAVI M. Effective Factors in Improving the Emergency Department Preparedness of Hospitals in Radiation and Nuclear Incidents and Nuclear Terrorism: A Systematic Review. Iran J Public Health. 49(3):437-446.
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