Hospital Disaster Response Research Articles

The impact of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response: an action research study

IntroductionHospitals as the main providers of healthcare services play an essential role in the management of disasters and emergencies. Nurses are one of the important and influential elements in increasing the surge capacity of hospitals. Accordingly, the present study aimed to assess the effect of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response.MethodsAll nursing managers employed at Motahari Hospital in Tehran took part in this interventional pre- and post-test action research study. Ultimately, a total of 20 nursing managers were chosen through a census method and underwent training in hospital capacity fluctuations. The Iranian version of the “Hospital Emergency Response Checklist” was used to measure hospital disaster preparedness and response before and after the intervention.ResultsThe overall hospital disaster preparedness and response score was 184 (medium level) before the intervention and 216 (high level) after the intervention. The intervention was effective in improving the dimensions of hospital disaster preparedness, including “command and control”, “triage”, “human resources”, “communication”, “surge capacity”, “logistics and supply”, “safety and security”, and “recovery”, but had not much impact on the “continuity of essential services” component.ConclusionThe research demonstrated that enhancing the disaster preparedness of hospitals can be achieved by training nursing managers using an action research approach. Encouraging their active participation in identifying deficiencies, problems, and weaknesses related to surge capacity, and promoting the adoption and implementation of suitable strategies, can enhance overall hospital disaster preparedness.

Hospital professional staff awareness of hospital plans for the provision of teams for medical support in case of disasters

Background/Aim. Resuscitation and surgical medical aid are the most important medical procedures in disaster re-lief operations. The limited time frame available for life-saving activities in such circumstances demands that resuscitation and surgical medical teams be established and trained for timely reaction and disaster medical support prior to disaster occurrence. The aim of the study was to analyze the awareness among the hospital medical staff in the Plovdiv Region of the hospital response plan in case of disaster, which concerns surgical and resuscitation team composition and tasks for disaster medical support. Methods. An anonymous survey, consisting of 55 questions about hospital staff awareness of the medical activities described in the hospital disaster medical support plan, was conducted between July and September 2019 among 295 hospital medical professionals in the Plovdiv Region, Bulgaria. Descriptive statistics and Pearson?s ?2 test were used in the statistical analysis of results. Results. The survey showed that the majority of medical staff demonstrated complete ignorance regarding the presence, number, and tasks of the specialized medical teams planned for hospital disaster response. Employees of multidisciplinary hospitals for active treatment were more familiar with the aforementioned plans than their colleagues from the university multidisciplinary hospitals. Conclusion. Insufficient awareness about human resources foreseen for disaster medical support negatively impacts the hospital surge capacity, leading to inadequate medical assistance in such cases. Hospital tactical disaster preparedness must be ameliorated by conducting a more rigorous training program among medical staff related to the planned hospital activities in case of disastrous events, especially for those working in emergency departments, intensive care units, and surgical departments.

Development and update of hospital disaster preparedness and response plan of 25 hub hospitals of Nepal – process documentation

Hospital disaster preparation involves creating systems and processes to enhance a hospital's readiness for emergencies. The first step in crisis management is having a disaster management strategy, mandated by international agreements like the Sendai Framework. The 2015 Nepal earthquake highlighted hospitals' capacity concerns, leading to the inclusion of hub and satellite hospitals in disaster plans. Later, infectious disease management and lessons from COVID-19 were incorporated. The disaster plans for Nepal's 25 hub hospitals, collaborating with Health Emergency Operation Center (HEOC) and Provincial Health Emergency Center (PHEOC), were updated. Workshops aimed to empower participants to own hospital plans. The Hospital Disaster Preparedness and Response Plan (HDPRP) addresses preparedness, response, and recovery, including COVID-19 management. Developed through testing, the HDPRP, along with workshops and engagement strategies, bolsters hospitals' disaster response capabilities.

Hospital-Level Implementation Barriers, Facilitators, and Willingness to Use a New Regional Disaster Teleconsultation System: Cross-Sectional Survey Study.

The Region 1 Disaster Health Response System project is developing new telehealth capabilities to provide rapid, temporary access to clinical experts across US jurisdictions to support regional disaster health response. To guide future implementation, we identified hospital-level barriers, facilitators, and willingness to use a novel regional peer-to-peer disaster teleconsultation system for disaster health response. We used the National Emergency Department Inventory-USA database to identify all 189 hospital-based and freestanding emergency departments (EDs) in New England states. We digitally or telephonically surveyed emergency managers regarding notification systems used for large-scale no-notice emergency events, access to consultants in 6 disaster-relevant specialties, disaster credentialing requirements before system use, reliability and redundancy of internet or cellular service, and willingness to use a disaster teleconsultation system. We examined state-wise hospital and ED disaster response capability. Overall, 164 (87%) hospitals and EDs responded-126 (77%) completed telephone surveys. Most (n=148, 90%) receive emergency notifications from state-based systems. Forty (24%) hospitals and EDs lacked access to burn specialists; toxicologists, 30 (18%); radiation specialists, 25 (15%); and trauma specialists, 20 (12%). Among critical access hospitals (CAHs) or EDs with <10,000 annual visits (n=36), 92% received routine nondisaster telehealth services but lacked toxicologist (25%), burn (22%), and radiation (17%) specialist access. Most hospitals and EDs (n=115, 70%) require disaster credentialing of teleconsultants before system use. Among 113 hospitals and EDs with written disaster credentialing procedures, 28% expected completing disaster credentialing within 24 hours, and 55% within 25-72 hours, which varied by state. Most (n=154, 94%) reported adequate internet or cellular service for video-streaming; 81% maintained cellular service despite internet disruption. Fewer rural hospitals and EDs reported reliable internet or cellular service (19/22, 86% vs 135/142, 95%) and ability to maintain cellular service with internet disruption (11/19, 58% vs 113/135, 84%) than urban hospitals and EDs. Overall, 133 (81%) were somewhat or very likely to use a regional disaster teleconsultation system. Large-volume EDs (annual visits ≥40,000) were less likely to use the service than smaller ones; all CAHs and nearly all rural hospitals or freestanding EDs were likely to use disaster consultation services. Among hospitals and EDs somewhat or very unlikely to use the system (n=26), sufficient consultant access (69%) and reluctance to use new technology or systems (27%) were common barriers. Potential delays (19%), liability (19%), privacy (15%), and hospital information system security restrictions (15%) were infrequent concerns. Most New England hospitals and EDs have access to state emergency notification systems, telecommunication infrastructure, and willingness to use a new regional disaster teleconsultation system. System developers should focus on ways to improve telecommunication redundancy in rural areas and use low-bandwidth technology to maintain service availability to CAHs and rural hospitals and EDs. Policies and procedures to accelerate and standardize disaster credentialing are needed for implementation across jurisdictions.

Implementation of Hospital Disaster Preparedness and Response Plan in Nepal: A Mixed Study in 3 Public Hospitals of Nepal

Introduction:Considering the need for hospital disaster preparedness post-Nepal earthquake 2015, the Ministry of Health and Population of Nepal developed a Hospital Disaster Preparedness and Response Plan (HDPRP) for mass casualty management. However, until now, there is no scientific literature on how the district hospitals, which are the major health service providers in Nepal, implemented their HDPRP during mass casualty incidents (MCIs). So, this study aims to understand how the HDPRP was implemented during MCIs in three district public hospitals of Nepal.Method:A mixed sequential QUANT-QUAL study was designed. Out of seven districts under the severely hit category by Nepal Earthquake 2015, three districts were selected randomly. For the quantitative component, the WHO hospital emergency response checklist was adapted which was self-administered in each hospital. Based on a scoring system, each hospital was placed in one of three categories (effective, insufficient, unacceptable), to assess the level of HDPRP implementation. For the qualitative component, semi-structured interviews were conducted to understand how the HDPRP was implemented in each hospital. An inductive thematic analysis was carried out. All information was collected for the most recent management of MCI reported in the hospital.Results:Out of three hospitals, two hospitals have effectively implemented their HDPRP, whereas one has insufficient implementation. Three themes emerged during the data analysis: enablers in implementation of HDPRP, barriers in implementation of HDPRP, and recommendations for the future. Multiple enablers and barriers were identified for the implementation of HDPRP, and the recommendations were identified for the hospital, hospital staff, and external stakeholders.Conclusion:Implementation of HDPRP as per the protocol is difficult due to many external and internal factors that arise while managing the MCIs. The findings of this study provide the basis for the Ministry of Health and Population and district hospitals for the future update of HDPRP and planning of MCIs.

Analysis of Hospital’s Emergency and Disaster Preparedness Using Hospital Safety Index in Indonesia

Indonesia is country with abundant high-risk areas for various disasters that can affect both the structural and non-structural safety of various vital establishments, particularly hospitals. This present study aims to examine the level of the hospital safety index in nine hospitals in four provinces based on the guidelines from the WHO/PAHO (World Health Organization/Pan American Health Organization). The Hospital Safety Index (HSI) guidelines consist of four parameters that include the types of hazards, structural safety, non-structural safety, disasters and emergency managements. This study was a cross-sectional study on data obtained through interviews, focus group discussions (FGDs), observations, and document reviews to assess the parameters of the HSI. Data were calculated for the HSI score, and descriptive statistics and multiple correspondence analysis (MCA) were carried out. The SPSS software version 25.0 was used for the statistical analysis. Results show that the overall safety index was 0.673 (Level A), meaning that it is likely the hospital will maintain functionality in emergencies and disasters. By province, the level A index was identified in DKI Jakarta (0.76), Yogyakarta (0.709), and West Java (0.673), showing that hospitals in these provinces will maintain functionality in emergency and disaster situations; however, in North Sumatera, the index was categorized in B category (0.507), demonstrating that the hospital’s ability to function during and after emergencies and disasters is potentially at risk. The multiple correspondence analysis shows that the hospitals in the provinces of Yogyakarta and West Java tend to achieve similar categories in almost all assessment modules; therefore, control measures of preparedness should be considered, such as improvements in equipment and facilities; hospital emergency and disaster response and recovery planning; communication and information management; training; and relevant stakeholders awareness.

Results From a Systematic Review of the Literature: Lessons Identified From Terrorist Attacks Must Become Lessons Learnt - What Are We Waiting For?

Background: The threat of national and international terrorism remains high. More than ever, the principle applies that the preparation for extraordinary disastrous incidents is the decisive prerequisite for successful coping. The lack of preparedness for the pandemic has taught modern society this lesson. It is obligatory to prepare our health systems on the basis of the best possible data. Hence we conducted a systematic literature review in order to evaluate the existing evidence on lessons learnt from terroristic attacks and summarised them in a concise manner. Methods: We conducted an advanced literature search around the three key words terrorism, medical management and lessons learnt. We included all countries that are part of the Organization for Economic Cooperation and Development (OECD). The time frame was set between 2001 and 2017. All articles were evaluated against the PRISMA criteria. Findings: The extended Pubmed search yielded 1634 articles out of which 1434 articles were eliminated on title selection only. This reduced the number of articles down to 201. The abstracts of these articles were evaluated and finally 68 articles got included in the research. From the 68 articles, 616 lessons learned were extracted and divided into 15 overwhelming categories. The data shows clearly that despite the difference in attacks, countries, social and political systems and casualties involved, many of the lessons learnt are similar. We also found that the pattern of lessons learnt is repeated continuously over the period studied. Interpretation: The lessons learnt follow a certain pattern, which seems to be independent of the country, the medical system and the type of terrorist attack and hence allows for great international applicability. The reported lessons remained constant over time. Therefore, it is more accurate to talk about lessons identified rather than lessons learnt. Funding Statement: There was no funding of the work. Declaration of Interests: Nora Schorscher: No Conflict of interests Patrick Meybohm: No Conflict of interests Thomas Wurmb: Vice-Chairman of the Association of Emergency Physicians Working in Bavaria, Vice Chairman of the German Society of Hospital Disaster Response Planning and Crisis Management.

Effect of providing information to promote hospital disaster response plans for nursing managers of non-designated disaster hospitals

Effect of providing information to promote hospital disaster response plans for nursing managers of non-designated disaster hospitals

Factors inhibiting the promotion of hospital disaster response plans for nursing manager

Factors inhibiting the promotion of hospital disaster response plans for nursing manager

Command and control in hospitals during SARS-CoV-2 pandemic: The windmill model of disaster response.

Hospitals are the focus of the fight against SARS-CoV-2 pandemic. To meet this challenge hospitals need a Disaster Response Plan and a Hospital Incident Command System (HICS) as a crisis leadership tool. The complex dependency between the systems staff, supplies, and space during the SARS-CoV-2 pandemic is a major problem for hospitals. To take the appropriate countermeasures, the effects of the crisis on these systems must be detected, analyzed, and displayed. The presentation and interpretation of such complex processes often poses serious problems for the hospitals' incident commanders. In this article, we describe a new model that is able to display these complex interrelationships within the command process. The model was developed and deployed during the disaster response to SARS-CoV-2 pandemic in order to facilitate the entire command process and to improve hospital disaster response. The approach of the model is as simple as it is innovative. It perfectly symbolizes the basic principle of disaster medicine: keep is safe and simple. It will help hospitals to improve command and control and to optimize the disaster response during SARS-CoV-2 pandemic.

Hospital preparedness for mass critical care during SARS-CoV-2 pandemic

Mass critical care caused by the severe acute respiratory syndrome corona virus 2 pandemic poses an extreme challenge to hospitals. The primary goal of hospital disaster preparedness and response is to maintain conventional or contingency care for as long as possible. Crisis care must be delayed as long as possible by appropriate measures. Increasing the intensive care unit (ICU) capacities is essential. In order to adjust surge capacity, the reduction of planned, elective patient care is an adequate response. However, this involves numerous problems that must be solved with a sense of proportion. This paper summarises preparedness and response measures recommended to acute care hospitals.

Disaster Preparedness and Professional Competence Among Healthcare Providers: Pilot Study Results

The preparedness of a hospital for mass-casualty incident and disaster response includes activities, programs and systems developed and implemented before the event. These measures are designed to provide the necessary medical care to victims of disasters, and to minimize the negative impact of individual events on medical services. Up until now, there has been no systematic survey in Poland concerning the readiness of hospitals, as well as medical personnel, to deal with mass-casualty incidents. Consequently, little is known about the knowledge, skills, and professional competences of healthcare workers. The objective of this pilot study was to start an exploration and to collect data on the competences of healthcare workers, in addition to assessing the preparedness of hospitals for mass-casualty incidents. Utilizing an anonymous survey of a random sample, 134 healthcare providers were asked to respond to questions about the competencies they needed, and hospital preparedness during disaster response. It turned out that the test subjects evaluate their own preparedness for mass-casualty incidents and disasters better than the preparedness of their current place of work. The pilot study demonstrated that a properly designed questionnaire can be used to assess the relationship between hospital and staff preparedness and disaster response efficiency. Evaluation of the preparedness and effectiveness of disaster response is a means of finding and removing possible gaps and weaknesses in the functioning and effective management of a hospital during mass-casualty incidents.

Determining the Level of Preparedness in Yazd Shahid Sadoughi Hospital for Confronting to Emergencies and Disasters after Development of Hospital Disaster Response Plan

Introduction: According to the importance of preparation of health care facilities against incidents and disasters, the aim of this study is to determine the level of preparation of Yazd Shahid Sadoughi Hospital for responding to incidents and disaster after the Development of a hospital disaster-response plan. Methods: This cross-sectional, descriptive study has investigated the level of vulnerability of the hospital against incidents and disasters and has identified the hazards threatening the Yazd Shahid Sadoughi Hospital in 2016. The used tool was the Farsi Hospital Safety Index (FHSI) questionnaire in three scopes of functional, structural and non-structural and the results were analyzed using the Excel software. Results: The results showed that the frequency of natural disasters in hospital was about 48%, functional safety level of about 56.39%, non-structural safety level was about 53.33, structural elements safety level was about 73.33, the score of weighted safety was about 63.94%, and the score of safety without weighing was about 56.41%. Conclusion: According to the results, it could be concluded that the amount of preparation of the hospital is in acceptable level and by developing a disaster response plan, the level of preparation of Yazd Shahid Sadoughi Hospital to confront the incidents and disasters could be improved, especially in structural and functional vulnerability sections.

Factors affecting hospital response in biological disasters: A qualitative study.

Background: The fatal pandemics of infectious diseases and the possibility of using microorganisms as biological weapons are both rising worldwide. Hospitals are vital organizations in response to biological disasters and have a crucial role in the treatment of patients. Despite the advances in studies about hospital planning and performance during crises, there are no internationally accepted standards for hospital preparedness and disaster response. Thus, this study was designed to explain the effective factors in hospital performance during biological disasters. Methods: Qualitative content analysis with conventional approach was used in the present study. The setting was Ministry of Health and related hospitals, and other relevant ministries responsible at the time of biologic events in Islamic Republic of Iran (IR of Iran) in 2018. Participants were experts, experienced individuals providing service in the field of biological disaster planning and response, policymakers in the Ministry of Health, and other related organizations and authorities responsible for the accreditation of hospitals in IR of Iran. Data were collected using 12 semi-structured interviews in Persian language. Analysis was performed according to Graneheim method. Results: After analyzing 12 interviews, extraction resulted in 76 common codes, 28 subcategories, and 8 categories, which are as follow: detection; treatment and infection control; coordination, Resources; training and exercises; communication and information system; construction; and planning and assessment. Conclusion: Hospital management in outbreaks of infectious diseases (intentional or unintentional) is complex and requires different actions than during natural disasters. In such disasters, readiness to respond and appropriate action is a multifaceted operation. In IR of Iran, there have been few researches in the field of hospital preparation in biologic events, and the possibility of standardized assessment has be reduced due to lack of key skills in confronting biological events. It is hoped that the aggregated factors in the 8 groups of this study can evaluate hospital performance more coherently.

Exploring the necessary disaster plan components in Saudi Arabian hospitals

This study aimed to identify the necessary or essential components for inclusion in hospital disaster plans in Saudi Arabia, components that can be applied in education, planning, preparedness, and further research. The study involved a cross-sectional survey with questionnaires developed using a six-point Likert scale (1 = strongly disagree; 6 = strongly agree). Eight governmental hospitals from two cities were selected as the study's settings, and 850 questionnaires were distributed to doctors and nurses. Principal Component Analysis (PCA), using Varimax rotation with a loading of more than 0.40 for items, was used to extract the factors from the data; redundant items loaded on two or more factors were deleted. In total, 492 healthcare providers responded to the study (58% response rate). Both genders participated: 76% females and 20% males. Of the sample population, approximately 73% were nurses and 25% were physicians. After interpretation, five key factors (with a total variation of 63%) in hospital disaster plans emerged: (1) surge capacity, (2) decontamination, (3) communication, (4) safety and security, and (5) survivor support. The extracted components will inform hospital disaster preparedness and response; however, more research is needed to elaborate the needs, barriers, and enablers associated with these components.

The August 24, 2016, Central Italy Earthquake: Validation of the "Modified Utstein Template for Hospital Disaster Response Reporting" As a New Tool for Reporting Hospitals' Response to Disasters.

After-action reports analyze events and improve knowledge about how to prevent and react to unexpected situations. Anyway, there is no consensus among the templates developed for disaster events reporting, and there is not a specific model for reporting hospital disaster response. The study was aimed to pilot the use of a new assessment tool for hospital response to natural disasters. A data collection tool, focused on hospital disaster response to natural disasters, was created modifying the "Utstein-Style Template for Uniform Data Reporting of Acute Medical Response in Disasters" and tested the reaction of the nearest hospitals to the epicenter after the August 24, 2016, Central Italy earthquake. Four hospitals were included. The completion rate of the tool was 97.10%. A total of 613 patients accessed the 4 emergency departments, most of them in Rieti Hospital (178; 29.04%). Three hundred thirty-six (54.81%) patients were classified as earthquake-related, most with trauma injuries (260; 77.38%). This template seemed to be a valid instrument for hospital disaster management reporting and could be used for better comprehension of hospital disaster reaction, debriefing activities, and hospital disaster plan revisions.

Pretraining and Precredentialing Staff for Disaster: A Lesson Learned From the Experience of the 2016 Kumamoto Earthquakes.

The integration of external staff into a hospital's disaster response can present technical challenges. Although hospitals will always prefer to use their own staff in disaster response, there have been many historical examples where external staffing is required. During the 2016 Kumamoto Earthquakes, the Oita Prefectural Hospital required medical professionals to expand disaster response staff. They were able to identify 2 appropriate emergency physicians belonging to a remote hospital who had previously worked at the Oita Prefectural hospital. The physicians were effectively able to supplement the hospital staff, providing care for additional patients, and giving the existing on-duty staff some respite. Based on our experience, we suggest that hospital coalitions and disaster response authorities explore mechanisms of cross-credentialing and cross-training staff to make it easier to share staff in a disaster.

The Quest for Quality and Performance Indicators in Mass Disasters

Introduction:Indicators are used as a benchmark for the quality of disaster response. Desirable attributes of indicators include precision, clear definition, improvement opportunity, unbiased, flexibility, and validity. Due to a lack of universally acceptable, objective indicators, it is currently difficult to gauge improvements in mass casualty preparedness within a hospital.Aim:To describe existing indicators relevant to hospital disaster response, and to explore the use of two new indicators (decanting and chain of command).Methods:A structured literature search in indexed databases was used to identify articles related to the measurement of hospital performance in mass casualties using a matrix technique and snowballing. Relevant websites of disaster management organizations were also reviewed and local disaster management experts were interviewed. Proposed indicators were compared against attributes and some (triage time by category, notification time, time to adequate staff response, preventable deaths, decanting times and chain of command for intensive care unit, and emergency department) were tested and measured in two exercises involving more than 90 staff each, held at two Southeast Queensland hospitals in 2017 and 2018.Results:Over 50 proposed indicators, including indicators within large sets, were identified. Measurement of some indicators was found to be highly subjective. The decanting and chain-of-command indicators emerged as most useful. Intensive Care Unit required 40 mins to decant beds by 50%, while ED required 25 mins to decant beds by 80%. With regards to the chain of command, ED and triage staff performed best, with 66.7% correctly identifying their immediate supervisor. Overall, staff members were able to correctly identify immediate supervisor better compared to team leaders (59.3% and 40% respectively).Discussion:There is a need to narrow down, simplify, and objectify indicators for mass casualty performance. Baseline measurements from actual disasters will provide important comparative data.

August 24th, 2016 Central Italy Earthquake - Validation of “Modified Utstein Template for Hospital Disaster Response Reporting,” A New Tool for Reporting Hospital’s Reaction to Disasters

Introduction:After Action Reports analyze events and recommend actions to facilitate preparedness and response to future similar disasters. However, there is no consensus among the templates developed to collect data during disasters and little is known about how to report hospital responses.Aim:The hypothesis was that the use of a new assessment tool for hospital response to natural disasters facilitates the systematic collection of data and the delivery of a scientific report after the event.Methods:A data collection tool, focused on hospital response to natural disasters, was created modifying the “Utstein-Style Template for Uniform Data Reporting of Acute Medical Response in Disasters”,1 and tested the reaction of the hospitals involved in the response to the Central Italy earthquake on August 24th, 2016.Results:Four hospitals were included. The completion rate of the tool was of 97.10%. A total of 613 patients accessed the four emergency departments, most of them in Rieti hospital (178; 29.04%). Three hundred and thirty – six patients were classified as earthquake-related (54.81%), most of which with trauma injuries (260; 77.38%).Discussion:The new reporting tool proved to be easy to use and allowed to retrospectively reconstruct most (97.10%) of the actions implemented by hospital responders. Details about activation, patient fluxes, times, and actions undertaken were easily reconstructed throughout in-field interviews of hospital managers and patients’ charts. Patients were uniformly distributed across the four hospitals, and the hospital capabilities were able to cope with this mass influx of casualties. The Modified Utstein Template for Hospital Disaster Response Reporting is a valid tool for hospital disaster management reporting. This template could be used for a better comprehension of hospital disaster reaction, debriefing activities, and revisions.

Hospitals: Soft Target for Terrorism?

In recent years, the world has been rocked repeatedly by terrorist attacks. Arguably, the most remarkable were: the series of four coordinated suicide plane attacks on September 11, 2001 on buildings in New York, Virginia, and Pennsylvania, USA; and the recent series of two coordinated attacks in Brussels (Belgium), on March 22, 2016, involving two bombings at the departure hall of Brussels International Airport and a bombing at Maalbeek Metro Station located near the European Commission headquarters in the center of Brussels. This statement paper deals with different aspects of hospital policy and disaster response planning that interface with terrorism. Research shows that the availability of necessary equipment and facilities (eg, personal protective clothing, decontamination rooms, antidotes, and anti-viral drugs) in hospitals clearly is insufficient. Emergency teams are insufficiently prepared: adequate and repetitive training remain necessary. Unfortunately, there are many examples of health care workers and physicians or hospitals being targeted in both political or religious conflicts and wars. Many health workers were kidnapped and/or killed by insurgents of various ideology. Attacks on hospitals also could cause long-term effects: hospital units could be unavailable for a long time and replacing staff could take several months, further compounding hospital operations. Both physical and psychological (eg, posttraumatic stress disorder [PTSD]) after-effects of a terrorist attack can be detrimental to health care services. On the other hand, physicians and other hospital employees have shown to be involved in terrorism. As data show that some offenders had a previous history with the location of the terror incident, the possibility of hospitals or other health care services being targeted by insiders is discussed. The purpose of this report was to consider how past terrorist incidents can inform current hospital preparedness and disaster response planning. De Cauwer H , Somville F , Sabbe M , Mortelmans LJ . Hospitals: soft target for terrorism? Prehosp Disaster Med. 2017;32(1):94-100.