[Structural resilience and robustness of German hospitals: results form a nationwide survey of emergency departments].

BACKGROUND

Hospital disaster response planning (KAEP) is a core component of health security and civil protection. In the context of escalating security threats and climate-related extreme events, its practical implementation is gaining importance. Adequate medical care requires structurally and organizationally resilient healthcare facilities; however, the structural and infrastructural prerequisites in Germany have scarcely been examined systematically.

OBJECTIVE

To analyze the current status of structural and infrastructural conditions that affect the effectiveness and feasibility of KAEP.

METHODS

From January 24 to February 21, 2025, physician leaders of emergency departments (ED) at 1065 German hospitals were surveyed online using a standardized questionnaire. Analyses were descriptive and stratified by levels of care.

RESULTS

Of 313 responses (response rate 29%), 246 questionnaires were eligible for analysis. Structural protective measures were absent in 50% of facilities, and access control to critical areas was lacking in 43%. Dedicated protected areas for contaminated patients existed in 29%. While 95% reported having plans to ensure continuity of critical infrastructures, essential service systems exhibited full redundancy in only 43%. Merely 18% of facilities participated in the Federal Government's medical supplies stockpiling program.

CONCLUSION

Findings indicate a substantial gap between conceptual preparedness and the structural-infrastructural implementation of KAEP. To strengthen resilience, binding minimum standards, earmarked financing mechanisms, and regular training and exercises are needed to ensure hospitals remain functional under crisis and disaster conditions.