Counterterrorism Preparedness of Flemish Hospitals - a Cross-Sectional Descriptive Study

Introduction: The Flemish-speaking northern part of Belgium has a history of terror attacks. Hospitals are particularly vulnerable due to their accessibility, visibility, and high density of patients, staff, and visitors. Cybercrime and terror are extremely booming, with health institutions as ideal targets. This study aims to assess the extent to which Flemish hospitals are prepared for terrorist attacks and extremism. Methods: All acute hospitals with a specialized Emergency Department (ED) were sent an online survey on demographics, access control, online security, ED security, and security in terror events. Results: 56 out of the 59 (95%) hospitals responded. None use metal detectors, 8% plan security control for weapons in crises. 3% have 24/7 security personnel for entrance control, 59% have none. 55% have no alternative location for an incident in the ED, 37% have any control on radiation, and only 13% 24/7. 61% provide decontamination, in 14% inside the ED! 33% state that personnel are adequately decon-trained. 49% have adequate personnel protective equipment for CBRN situations, and only 42% of the hospitals have trained personnel to use them. Blocked cyberattacks were reported in 33%, in 3.7% the attack caused leaking of patient data, in 5.6% there was unavailability of files, and in 3.7% patient care had to be canceled or seriously delayed. 48% of the hospitals have their own 24/7 service to counter cyberattacks. There had been a real terror threat in 9% of the hospitals, and the overall threat for physical attacks was scored at 3/10. The threat of cyberattacks scored 5.9/10. 66% have no protocol for terror attacks in their region, 45% have no scenario for an incident inside the hospital, and 91% have no scenario for secondary attacks on the hospital. Conclusion: Counterterrorism defense measures vary across our hospitals but seem frequently inadequate. Cyberattacks are a real threat with serious impacts.