The changing security landscape in Europe underscores the critical importance of disaster preparedness. In Sweden, healthcare is publicly funded and regionally organized, with hospital-based emergency departments forming a central part of the national emergency care system. Emergency Department (EDs) personnel — comprising nurses, nurse assistants, and physicians — play a vital role in managing crises, both in peacetime and during armed conflicts. However, levels of preparedness and educational preparation among emergency department staff vary.
“The Sweden’s National Board of Health and Welfare (NBHW) has therefore developed national recommendations concerning education and training for preparedness in both peacetime crises and armed conflict,” Henrik Andersson says, registered nurse, senior lecturer and associate professor in emergency care at the University of Borås, and researcher at the Centre for Disaster Medicine, first author of the study.
Does current practice align with national recommendations?
Together with Michaela Hult, lecturer, and Anders Sterner, senior lecturer — both at the University of Borås — Henrik Andersson conducted a cross-sectional study to provide a national overview of preparedness in Swedish emergency departments. The study was published in BMC Emergency Medicine (2026) 26:63.
The study included all 70 hospital-based EDs in Sweden, providing a comprehensive national perspective. It is based on a questionnaire consisting of 45 items covering areas related to the Swedish National Board of Health and Welfare’s recommendations, as well as specific aspects of International Humanitarian Law — a legal framework that regulates the protection of civilians and healthcare services during armed conflict.
“The aim was to investigate to what extent education and training for emergency department personnel align with the National Board of Health and Welfare’s recommendations on preparedness for peacetime crises and armed conflicts in Swedish emergency departments.”
When EDs have a designated employee for disaster preparedness, more training takes place
The results show that EDs are taking steps and providing education and training to strengthen staff knowledge and skills in organizing and managing emergency care during disaster situations, as well as their capacity to deliver care under such conditions.
“However, education and training related to emergency care during extreme weather events and armed conflicts remain incomplete. As a result, staff may lack the education and training necessary to respond effectively to all types of major incidents.”
The survey also revealed that disaster preparedness education and training were more common in EDs that had a designated employee responsible for coordinating these activities — indicating that organizational structure and clear responsibility influence implementation.
Long-term investments in continuous professional development
However, resilient emergency care is not only about managing the consequences of extreme weather events and armed conflicts. It is also about prevention, protection, and building a healthcare system capable of delivering emergency care under pressure and with limited resources.
“Long-term investments in continuous professional development, realistic exercises, clear guidelines, and an organizational culture that promotes learning, reflection, and interprofessional collaboration will be required to manage disaster situations.”
Future research may help identify both barriers and enabling factors that influence the development of staff expertise in disaster preparedness. This could contribute to a better understanding of the conditions necessary to deliver safe, high-quality care during both peacetime crises and armed conflicts.
Text: Susanne Lj Westergren
