Chemical, biological, radiological, nuclear, and explosives (CBRNEs) preparedness for sporting event mass gatherings: A systematic review of the literature




CBRNE, sporting events, terrorism, Olympics, World Cup, disaster medicine


Objective: Sporting events often constitute mass gatherings (MGs) featuring large crowds of spectators and participants. Our objective is to understand the current state of emergency preparedness for sporting events by examining past MG sporting events to evaluate mitigation, preparedness, response, and recovery against chemical, biological, radiological, nuclear, and explosive (CBRNE) events.

Methods: In accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature review was carried out among 10 literature databases. The quality and risk of bias in each reviewed publication was assessed using the Mixed Methods Appraisal Tool.

Results: A total of 5,597 publications were identified. Of these, 81 papers were selected for full text reads and 25 publications were accepted. The included articles documented sporting events worldwide, ranging from incidents occurring from 1972 to 2020. Cross-cutting themes found in best practices and recommendations were strategic communication, surveillance, planning and preparedness, and training and response.

Conclusion: More evidence-based guidelines are needed to ensure best practices in response and recovery for CBRNE incidents at sporting events. Public health risks as well as implementation barriers and opportunities to prepare for potential CBRNE threats at sporting event MGs require further investigation.


Author Biographies

Sonny S. Patel, MPH, MPhil

Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts; Transcultural Conflict and Violence Initiative, Georgia State University, Atlanta, Georgia

Julian H. Neylan, MS

Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts

Katerina Bavaro

Health Studies Program, University College, University of Toronto - St. George, Toronto, Canada

Peter R. Chai, MD, MS

Division of Medical Toxicology, Department of Emergency Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts

Eric Goralnick, MD, MS

Ariadne Labs, Brigham and Women’s Hospital, Boston, Massachusetts; Harvard T.H. Chan School of Public Health Boston, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts

Timothy B. Erickson, MD

Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts; Division of Medical Toxicology, Department of Emergency Medicine, Brigham Health, Harvard Medical School, Boston, Massachusetts.



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How to Cite

Patel, MPH, MPhil, S. S., J. H. Neylan, MS, K. Bavaro, P. R. Chai, MD, MS, E. Goralnick, MD, MS, and T. B. Erickson, MD. “Chemical, Biological, Radiological, Nuclear, and Explosives (CBRNEs) Preparedness for Sporting Event Mass Gatherings: A Systematic Review of the Literature”. American Journal of Disaster Medicine, vol. 17, no. 1, Mar. 2022, pp. 57-74, doi:10.5055/ajdm.2022.0420.




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