Audit of preparedness of a selected hospital in the face of radiation and nuclear threats: participatory action research

In recent years, the risk of chemical, biological, radiological, nuclear and explosive (CBRNe) terrorist attacks has been on the rise. Radiological emergencies can occur not only due to accidents but also as a consequence of nuclear terrorism. In the event of disasters and emergency situations, healthcare systems, particularly hospitals as the primary units of service delivery in the initial phase, play the most significant roles. Therefore, the present study was designed with the aim of auditing the preparedness of a selected hospital in the face of radiological and nuclear incidents. This participatory action research was carried out over one year (2025) in relevant departments of a selected hospital. The study was conducted in a specialized hospital in central Tehran, with an approximate capacity of 150 active beds. The hospital has an established emergency management structure and active risk committees. Data were collected using a researcher-made checklist covering six dimensions: physical infrastructure, pharmaceuticals and equipment, nuclear-radiological standards and indicators, human resources, communication, and inter-organizational coordination. During the audit cycle, a program was implemented to improve work processes and enhance hospital preparedness against radiological-nuclear threats. The hospital’s preparedness score before and after the intervention was compared and analyzed using SPSS version 22. According to the six evaluated dimensions, non-compliance indicators in each area were identified by process owners under the supervision of the hospital risk committee. Operational changes were carried out on three key criteria: low cost, short time consumption, and high feasibility. The hospital’s preparedness score in facing nuclear-radiological threats increased from 84 to 146, and the preparedness percentage improved from 24% to 41.71% (i.e., from weak to moderate). Among the six dimensions evaluated, the greatest improvement was observed in pharmaceuticals/equipment and inter-organizational coordination (20% each), while the lowest improvement occurred in the human resources domain (4%). Implementing solutions derived from audit findings, along with adequate resource allocation and management requirements, can enhance hospital resilience and preparedness levels against complex radiological and nuclear threats. Ultimately, this study emphasizes preparedness as a dynamic process that requires periodic review, continuous training, and inter-sectoral collaboration to ensure effective response and life-saving actions during nuclear-radiological crises.