Preparedness and emergency response strategies for chemical, biological, radiological and nuclear emergencies in disaster management: A qualitative systematic review

Disaster management, mainly related to chemical, biological, radiological and nuclear (CBRN) incidents, is a critical field that requires constant evaluation to improve preparedness and response strategies. This review synthesises evidence on global health sector strategies for CBRN preparedness, gathering lessons to enhance policymaking for future response and readiness. This review included original English and French research addressing healthcare preparedness for CBRN threats. Database searches, such as EBSCO, ScienceDirect, PubMed, Ovid, Lissa, and Sant & eacute;com, were conducted until November 2022. The Joanna Briggs Institute's tools were utilised to assess the risk of bias. Al-Raayan (R) and Nvivo (R) version 12 software were employed for the review and analysis. 57 articles in English and 6 in French met the inclusion criteria. The analysis identified numerous strategies, concentrating on chemical and biological incidents (Chemical and biological bioterrorism: n = 27; Epidemics and Outbreak: n = 15). "Hospitals", "responsibility", and "health" emerged as prominent keywords, emphasising institutional roles and health outcomes in CBRN incidents preparedness. Key findings highlighted the need for a unified global definition of bioterrorism to align international efforts. Hospital-level initiatives were emphasised as the foundation for national preparedness, emphasising specialised training, community engagement, and robust coordination mechanisms. Geographical variability in response strategies was noted, necessitating a harmonised global approach. Continuous research, epidemic management, and addressing radiological/nuclear threats emerged as crucial elements. Among others, strategies defined under "Emergency Response Preparedness" and "Intersectoral Policy Development" outlined comprehensive preparedness contexts for CBRN incidents. The review suggests an imperative shift towards building collaborative networks and enhancing health sector operational readiness to mitigate the impacts of CBRN incidents.