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Are Dutch Hospitals Prepared for Chemical, Biological, or Radionuclear Incidents? A Survey Study

  • Luc J.M. Mortelmans (a1) (a2), Menno I. Gaakeer (a3), Greet Dieltiens (a1), Kurt Anseeuw (a1) and Marc B. Sabbe (a2) (a4)...
Abstract Introduction

Being one of Europe’s most densely populated countries, and having multiple nuclear installations, a heavy petrochemical industry, and terrorist targets, the Netherlands is at-risk for chemical, biological, or radionuclear (CBRN) incidents. Recent world and continental events show that this threat is real and that authorities may be underprepared.


The hypothesis of this study is that Dutch hospitals are underprepared to deal with these incidents.


A descriptive, cross-sectional study was performed. All 93 Dutch hospitals with an emergency department (ED) were sent a link to an online survey on different aspects of CBRN preparedness. Besides specific hospital information, information was obtained on the hospital’s disaster planning; risk perception; and availability of decontamination units, personal protective equipment (PPE), antidotes, radiation detection, infectiologists, isolation measures, and staff training.


Response rate was 67%. Sixty-two percent of participating hospitals were estimated to be at-risk for CBRN incidents. Only 40% had decontamination facilities and 32% had appropriate PPE available for triage and decontamination teams. Atropine was available in high doses in all hospitals, but specific antidotes that could be used for treating victims of CBRN incidents, such as hydroxycobolamine, thiosulphate, Prussian blue, Diethylenetriaminepentaacetic acid (DTPA), or pralidoxime, were less frequently available (74%, 65%, 18%, 14%, and 42%, respectively). Six percent of hospitals had radioactive detection equipment with an alarm function and 22.5% had a nuclear specialist available 24/7 in case of disasters. Infectiologists were continuously available in 60% of the hospitals. Collective isolation facilities were present in 15% of the hospitals.


There is a serious lack of hospital preparedness for CBRN incidents in The Netherlands.

Mortelmans LJM , Gaakeer MI , Dieltiens G , Anseeuw K , Sabbe MB . Are Dutch Hospitals Prepared for Chemical, Biological, or Radionuclear Incidents? A Survey Study. Prehosp Disaster Med. 2017;32(5):483491.

Corresponding author
Correspondence: LJM Mortelmans, MD, FESEM, FRBSS Department of Emergency Medicine, ZNA Camp Stuivenberg Lange Beeldekensstraat 267 B2060 Antwerp, Belgium E-mail
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Conflicts of interest: The authors declare that they have no competing interests.

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4. M Nathallee , A Curphey , N Beeching , S Carley , I Crawford , K Mackway-Jones . Emergency departments (EDs) in the United Kingdom (UK) are not prepared for emerging biological threats and bioterrorism. J Infect. 2007;54(1):12-17.

5. P Horby , V Murray , A Cummins , K Mackway-Jones , R Euripidou . The capability of accident and emergency departments to safely decontaminate victims of chemical incidents. J Accid Emerg Med. 2000;17(5):344-347.

6. J Williams , D Walter , K Challen . Preparedness of emergency departments in Northwest England for managing chemical incidents: a structured interview survey. BMC Emerg Med. 2007;7:20-25.

7. LJM Mortelmans , S Van Boxstael , HG De Cauwer , MB Sabbe . Preparedness of Belgian civil hospitals for chemical, biological, radiation, and nuclear incidents: are we there yet? Eur J Emerg Med. 2014;21(4):296-300.

8. D Kollek , AA Cwin . Hospital emergency readiness overview study. Prehosp Disaster Med. 2011;26(3):159-165.

9. X Li , J Huang , H Zhang . An analysis of hospital preparedness capacity for public health emergency in four regions of China: Beijing, Shandong, Guangxi and Hainan. BMC Public Health. 2008;8:319-330.

11. W Higgins , C Wainright , N Lu , R Carrico . Assessing hospital preparedness using an instrument based on the mass casualty disaster plan checklist: results of a statewide survey. Am J Infect Control. 2004;32(6):327-332.

12. RL Bennett . Chemical or biological terrorist attacks: an analysis of the preparedness of hospitals for managing victims affected by chemical or biological weapons of mass destruction. Int J Environ Res Public Health. 2006;3(1):67-75.

13. ME Keim , N Pesik , NA Twum-Danso . Lack of hospital preparedness for chemical terrorism in a major US city: 1996-2000. Prehosp Disaster Med. 2003;18(3):193-199.

14. KN Treat , JM Williams , PM Furbee , WG Manley , FK Russel , CD Stamper Jr. Hospital preparedness for weapons of mass destruction incidents: an initial assessment. Ann Emerg Med. 2001;38(5):562-565.

15. SM Becker , SA Middleton . Improving hospital preparedness for radiological terrorism: perspectives from emergency department physicians and nurses. Disaster Med Public Health Prep. 2008;2(3):174-184.

16. I Tur-Kaspa , EI Lev , I Hendler , R Siebner , Y Shapira , J Shemer . Preparing hospitals for toxicological mass casualty events. Crit Care Med. 1999;27(5):1004-1008.

17. T Okumura , N Takasu , S Ishimatsu . Report of 640 victims of the Tokyo subway sarin attack. Ann Emerg Med. 1996;28(2):129-135.

19. JL Stewart-Evans , A Sharman , J Isaac . A narrative review of secondary hazards in hospitals from cases of chemical self-poisoning and chemical exposure. Eur J Emerg Med. 2013;20(5):304-309.

23. RN Bradley . Health care facility preparation for weapons of mass destruction. Prehosp Emerg Care. 2000;4(3):261-269.

24. S Hildebrand , A Bleetman . Comparative study illustrating difficulties educating the public to respond to chemical terrorism. Prehosp Disaster Med. 2007;22(1):35-41.

25. D Baker . The problem of secondary contamination following chemical agent release. Crit Care. 2005;9(4):323-324.

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Prehospital and Disaster Medicine
  • ISSN: 1049-023X
  • EISSN: 1945-1938
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