Development of a Conceptual Model and Validated Tool for Assessing Hospital Readiness in Chemical Incidents

Chemical incidents pose a major threat to public health because of the wide availability of hazardous chemicals and their potential to cause mass casualties, often overwhelming health systems that lack specialized preparedness tools. This study aimed to develop and validate a conceptual model and a measurement instrument for assessing hospital readiness for chemical incidents in both military and civilian settings.

A sequential exploratory mixed-methods design was used. In the qualitative phase, semi-structured interviews were conducted with 9 experts selected through purposive and snowball sampling, and the data were analyzed in MAXQDA10 to identify codes and components. The resulting conceptual model was reviewed in two Delphi stages by the same expert panel. In the quantitative phase, a questionnaire was assessed for content validity by 10 specialists, and the finalized tool was assessed for inter-rater reliability by four independent evaluators.

The analysis identified six core components — organizing and planning, structural facilities and physical space, medicines and medical equipment, communications and coordination, safety and security, and training and practice — comprising 28 sub-components, with decontamination emerging as a cross-cutting element. From 121 interview-derived candidate items, a 95-item preliminary questionnaire was developed; after content-validity review, deletion of 17 items, and modification/merging of 44 items, the final tool contained 66 items. Content validity was assessed by 10 specialists using CVR and CVI; the final tool was then assessed by four independent evaluators using inter-rater agreement and Cohen’s kappa.

The six components reflect the multidimensional nature of hospital readiness for chemical incidents, with decontamination as the pivotal factor differentiating it from other disaster types. The model extends existing CBRN preparedness frameworks, such as the WHO Hospital Safety Index and the European TIER assessment tool, by incorporating elements specific to Iranian military-civilian healthcare settings.

This study offers a content-validated conceptual model and a preliminary assessment tool for hospital readiness in chemical incidents. Because construct and criterion validity and test–retest reliability were not established in the thesis, the tool should be regarded as a first step rather than a finished instrument; it nonetheless provides a structured starting point for evaluating and strengthening chemical-incident readiness. Future work should validate the tool against real incidents or simulations before it is used for accreditation or benchmarking purposes.