Background: The aim of this review was to explore hospital socio-natural disaster resilience by identifying: studies assessing structural and non-structural aspects of building resilience; components required to maintain a safe and functional health facility; and if the checklists used were comprehensive and easily performed. Methods: A review systemic approach using PRISMA was taken to search the literature. The search focused on articles that discuss hospital disaster resilience. This includes assessments and checklists for facility structural and non-structural components. Results: This review identified 22 articles describing hospital assessments using checklists containing structural and non-structural elements of resilience. These studies identified assessments undertaken in ten countries, with eight occurring across Iran. A total of seven differing checklists were identified as containing aspects of structural or non-structural aspects of building resilience. The World Health Organization (WHO) has authored three checklists and four others were developed independently. The structural resilience domain includes building integrity, building materials, design standards, and previous event damages as important elements to determine resilience. Within the internal safety and resilience domains, 11 differing elements were identified as important to non-structural or internal infrastructure resilience. These included the safety of power, water, telecommunication, medical gas supply, and medical equipment resupply systems. Independent evaluation methods were reported in the majority of articles, with a small number highlighting the benefits of both self-evaluation and independent review processes. Implementation of training programs to evaluators was mentioned in three papers with the assessor’s knowledge and understanding of all checklist elements being highlighted as important to the validity of the evaluation. Conclusion: The review identified the assessment of hospital resilience as important for management to determine areas of vulnerability within the hospital’s infrastructure and to inform improvement strategies. Assessment criteria must be comprehensive, highlighting structural and non-structural aspects of facility infrastructure. These assessments are best done as a multi-disciplinary collective of experts, involving hospital employees in the journey. This collaborative approach provides a key educational tool for developing disaster capacity, engaging ownership of the process, and the resulting improvements. The on-going development of health facility and wider health system resilience must remain a key strategic focus of national governments and health authorities. The development of standardized procedures and guidelines must be embedded into daily practice.

Objectives: This research evaluated the resilience of 6 tertiary and rural health facilities within a single Australian Health Service, using the World Health Organization (WHO) Hospital Safety Index (HSI). This adaptation of the HSI was compared with existing national accreditation and facility design Standards to assess disaster preparedness and identify opportunities for improvement. Methods: This cross-sectional descriptive study surveyed 6 hospitals that provide 24/7 emergency department and acute inpatient services. HSI assessments, comprising 151 previously validated criteria, were conducted by Health Service engineers and facility managers before being externally reviewed by independent disaster management professionals. Results: All facilities were found to be highly disaster resilient, with each recording high HSI scores. Variances in structure, architectural safety, continuity of critical services supply, and emergency plans were consistently identified. Power and water supply vulnerabilities are common to previously reported vulnerabilities in health facilities of developing countries. Conclusion: Clinical, engineering, and disaster management professionals assessed 6 Australian hospitals using the WHO HSI with each facility scoring highly, genuine vulnerabilities and practical opportunities for improvement were identified. This application of the WHO HSI, intended for use primarily in developing countries and disaster-affected regions, complimented and extended the existing Australian national health service accreditation and facility design Standards. These results support the expansion of existing assessment tools used to assess Australian health facility disaster preparedness and resilience.

Results: The main issues raised by the respondents included the following:• The interpretation of definitions introduced in the new model for the mass casualty preparedness model and the terrorist attack approach differed among respondents. • All respondents supported the six points of departure in the CRBN and terrorist attack approach. • Awareness of optimal personal safety ('safety first principle') specific for CBRN and terrorism is lacking. • Respondents reported that several rescue workers did not feel competent to perform specific newly introduced tasks, such as the command and control of the first ambulance arriving at the scene and the coordination task of emergency transport by the dispatch nurse. • Current regional differences in preparedness may complicate interregional collaboration.Discussion: As the approach is new and experience is primarily based on the outcome of exercises, the systematic planning and evaluation of exercises, and sharing of opinions and knowledge, as a result, is important to ensure an unambiguous approach in a real situation.Introduction: Hospitals and the healthcare sector suffer from chronic work overload and personnel shortages in many nations. This poses strong incentives to rationalize all activities not directly related to care, such as the preparations for disasters and other hazards. One such rationalization is to turn from a rulebased to a risk-based approach. However, the risk landscape of hospitals and the relationship to the risk landscape of public authorities are ill-defined. Health Care Coalitions (HCCs) are in a good position to fill this gap and serve as an intermediary. We developed a scheme for defining the risk landscape of HCCs and its members and performed a prioritization process. Aim: Objectives were to develop a knowledge platform of hospitals on risk assessment, promote integrated risk management by the HCC and its members, and determine the limiting (response) state for all relevant hazards. Methods: We put maximum effort in limiting the time consumption for hospitals and align with the regular practices in hospitals for business continuity management. Strong points included the cooperation with the public authorities for safety and for health, a stepwise development of risk awareness and stepwise guidance for the assessment by hospitals, and formalization of the scenario-selection and choice of priorities by the HCC board.Results: A gross list of (>230) safety hazards was produced along with a netlist of (>80) hazards relevant to health care.In addition, an impact-scale for the continuity of care serving as a measurement stick for all health care sectors was developed. Risk diagrams were developed to present the results in a simple and clear format. Discussion: The HCC risk landscape served its purpose in improving the mutual understanding with the public authorities. The formal assessment provides a solid basis for operational planning, education, training, and future investments.