title: Art of disaster preparedness in European union: a survey on the health systems.
abstract: BACKGROUND
  Naturally occurring and man-made disasters have been increasing in the world, including Europe, over the past several decades. Health systems are a key part of any community disaster management system. The success of preparedness and prevention depends on the success of activities such as disaster planning, organization and training. The aim of this study is to evaluate health system preparedness for disasters in the 27 European Union member countries.
  
  
  METHODS
  A cross-sectional analysis study was completed between June-September 2012. The checklist used for this survey was a modified from the World Health Organization toolkit for assessing health-system capacity for crisis management. Three specialists from each of the 27 European Union countries were included in the survey. Responses to each survey question were scored and the range of preparedness level was defined as 0-100%, categorized in three levels as follows: Acceptable; Transitional; or Insufficient.
  
  
  RESULTS
  Response rate was 79.1%. The average level of disaster management preparedness in the health systems of 27 European Union member states was 68% (Acceptable). The highest level of preparedness was seen in the United Kingdom, Luxemburg, and Lithuania. Considering the elements of disaster management system, the highest level of preparedness score was at health information elements (86%), and the lowest level was for hospitals, and educational elements (54%).
  
  
  CONCLUSIONS
  This survey study suggests that preparedness level of European Union countries in 2012 is at an acceptable level but could be improved. Elements such as hospitals and education and training suffer from insufficient levels of preparedness. The European Union health systems need a collective strategic plan, as well as enough resources, to establish a comprehensive and standardized disaster management strategy plan. A competency based training curriculum for managers and first responders is basic to accomplishing this goal.
  
  
  BACKGROUND
  Disaster medicine; Disaster preparedness; Disaster epidemiology; Health systems; European Union.
authors: CRIMEDIM - Research Center in Emergency and Disaster Medicine and Computer Science applied to Medical Practice; Università del Piemonte Orientale, Novara, Italy.
authors: Ahmadreza
authors: A
authors: Djalali
authors: CRIMEDIM - Research Center in Emergency and Disaster Medicine and Computer Science applied to Medical Practice; Università del Piemonte Orientale, Novara, Italy.
authors: Francesco
authors: F
authors: Della Corte
authors: CRIMEDIM - Research Center in Emergency and Disaster Medicine and Computer Science applied to Medical Practice; Università del Piemonte Orientale, Novara, Italy.
authors: Marco
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authors: Foletti
authors: CRIMEDIM - Research Center in Emergency and Disaster Medicine and Computer Science applied to Medical Practice; Università del Piemonte Orientale, Novara, Italy.
authors: Luca
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authors: Ragazzoni
authors: CRIMEDIM - Research Center in Emergency and Disaster Medicine and Computer Science applied to Medical Practice; Università del Piemonte Orientale, Novara, Italy.
authors: Alba
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authors: Ripoll Gallardo
authors: URGENTA, Clinical Emergency Hospital, Bucharest, Romania.
authors: Olivera
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authors: Lupescu
authors: Hanover Associates, Teddington, London, United Kingdom.
authors: Chris
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authors: Arculeo
authors: NHCS, National Health Career School of Management, Hennigsdorf/Berlin, Germany.
authors: Götz
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authors: von Arnim
authors: NHCS, National Health Career School of Management, Hennigsdorf/Berlin, Germany.
authors: Tom
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authors: Friedl
authors: Bonn International Center for Conversion, Bonn, Germany.
authors: Michael
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authors: Ashkenazi
authors: University Clinic Bonn, Department of Orthopedics and Trauma Surgery, Bonn, Germany.
authors: Philipp
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authors: Fischer
authors: CROUMSA, Croatian Urgent Medicine and Surgery Association, Slav. Brod, Croatia.
authors: Boris
authors: B
authors: Hreckovski
authors: Prehospital and Disaster Medicine Centre, Sahlgrenska Academy, Gothenburg, Sweden.
authors: Amir
authors: A
authors: Khorram-Manesh
authors: SBC, General &Teaching Hospital Celje, Medical Faculty Ljubljana, Slovenia.
authors: Radko
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authors: Komadina
authors: German Aerospace Center (DLR), Oberpfaffenhofen, Germany.
authors: Konstanze
authors: K
authors: Lechner
authors: Clinical Emergency Hospital Bucharest, Romania.
authors: Cristina
authors: C
authors: Patru
authors: Harvard Humanitarian Initiative, Harvard School of Public Health, Harvard University, Cambridge, Massachusetts, USA.
authors: Frederick M
authors: FM
authors: Burkle
authors: CRIMEDIM - Research Center in Emergency and Disaster Medicine and Computer Science applied to Medical Practice; Università del Piemonte Orientale, Novara, Italy.
authors: Pier Luigi
authors: PL
authors: Ingrassia