Designing a model for hospital preparedness against chemical weapons of mass destruction terrorist incidents: a...

Health systems play a pivotal role in managing chemical weapons of mass destruction (WMD) terrorist incidents, particularly in reducing casualties and facilitating crisis management. The growing recognition of the need for precise and effective preparedness in these sectors underscores the importance of this research. The present study aimed to identify the essential components of hospital preparedness and to develop and validate a comprehensive model for hospital readiness in response to chemical WMD terrorist incidents.

This study was conducted in 2025 using a three-phase exploratory sequential mixed-methods approach. First, a scoping review was conducted in accordance with Arksey and O'Malley's methodological framework and the PRISMA guideline to identify key components of hospital preparedness for chemical WMD terrorist incidents. Second, a qualitative study was conducted using semi-structured interviews, and the data were analyzed through a conventional content analysis approach to further identify preparedness components. Third, the components derived from the previous two phases were integrated and validated through two rounds of the Delphi technique. Ultimately, a comprehensive hospital preparedness model was developed.

Following integration of the scoping review and qualitative findings by an expert panel, 88 preparedness components were identified. After two rounds of the Delphi technique, 82 preparedness components were finalized and classified into 16 subcategories and seven main categories: specialized training and empowerment; psychological support and ethical considerations; security measures; specialized clinical and therapeutic processes; optimal management of surge capacity; integrated information and communication management; and contingency strategic management and planning. Finally, based on the Delphi assessment, the proposed preparedness model was approved by the expert panel.

Hospitals facing chemical terrorism require a comprehensive preparedness strategy encompassing specialized training, psychological support, and robust clinical systems. Effective management, intersectoral coordination, and security measures are essential for an effective response. Implementing preparedness strategies aligned with the proposed model can significantly enhance health systems' readiness and resilience to chemical WMD threats.