Abstract 
Background Recent global events have highlighted an increasing risk of chemical, biological, radiological and nuclear (CBRN) incidents, emphasising the urgent need for enhanced preparedness in the health sector worldwide, especially in low-income countries where burden of exposure is high and limited resources pose significant challenges to effective response. This study aims to develop an assessment tool to evaluate hospital preparedness for CBRN incidents in Lebanon, a low-resource country at high risk for CBRN incidents.
Methods A two-round modified Delphi method was conducted on 21 January 2025 at the American University of Beirut Medical Center (AUB-MC) involving 11 subject matter experts with various expertise in the CBRN medical and public health fields. The experts used a weblink to vote on the inclusion of tool items, with a predefined consensus at 70% or higher.
Results Consensus was established for 88 items with the completion of the Delphi study representing 92% of the total number of items. The items were classified into nine essential categories for CBRN preparedness planning that included: facility information, policies and planning, governance, communication (internal/external), training, safety and security, decontamination, pharmaceutical countermeasures, recovery phase and post event management planning. Access to CBRN experts as part of response team, pharmaceutical inventory, gender-related cultural factors particularly in decontamination protocols and preparedness drills emerged as distinctive features within this assessment tool. Parameters concerning special populations and emergency medical services were excluded from the assessment tool.
Conclusion A comprehensive expert-developed hospital assessment tool for CBRN preparedness was created to enhance CBRN preparedness in resource-limited settings like Lebanon. The standarised tool facilitates the evaluation of Lebanese hospitals’ readiness. It also guides policymakers and health authorities in developing targeted policies and strategic interventions to strengthen the health sector’s CBRN incidents response capabilities.
