Designing a model for hospital preparedness
against chemical weapons of mass

destruction terrorist incidents: a mixed-
method study

Designing a model for hospital preparedness
against chemical weapons of mass

destruction terrorist incidents: a mixed-
method study

Preparedness model, Hospital, Preparedness, Terrorist incidents, Chemical, Weapons of mass destruction

Abstract
Introduction 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.
Methods 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.
Results 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.
Conclusions Hospitals facing chemical terrorism require a comprehensive preparedness strategy encompassing
specialized training, psychological support, and robust clinical systems. Effective management, intersectoral

Zoha Dorri1
, Leila Mohammadinia2,3, Azadeh Fatehpanah1,4, Farzan Madadizadeh5

, AbbasAli Dehghani Tafti1
and

Samaneh Mirzaei1,6*

https://doi.org/10.1186/s12245-026-01124-1

2026

peri irawan

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