Risk-Based Modeling Approach for Strengthening Hospital Preparedness Against CBRNE Threats to Enhance Public Health

Background: Indonesia’s geographic position at the convergence of three major tectonic plates, its location along the Ring of Fire, tropical climate, and exposure to both natural and non-natural hazards demand robust and resilient disaster mitigation, response, and management capabilities. Objectives: This study examines the current readiness of civilian and military hospitals in addressing CBRNE threats, analyzes regulatory fragmentation, and formulates evidence-based policy recommendations. Methods: An exploratory mixed-methods design was employed using both primary and secondary data. Data were collected through interviews and structured questionnaires. Qualitative analysis was conducted with NVivo, while quantitative analysis employed SEM-PLS 4. The study was conducted in two hospitals—one civilian and one military - located in the Jakarta region. Results: Qualitative findings reveal that CBRNE threats in Indonesia are real, recurrent, geographically dispersed, and primarily chemical, biological, radiological, and explosive in nature. These threats constitute a complex system, necessitating civil-military interoperability in management. The lack of permanent cooperation agreements represents a major barrier to effective mitigation, response, and management. Quantitative results show that hospital capacity, preparedness, and response capabilities significantly and negatively affect the effectiveness of CBRNE threat management, with a path coefficient of –0.622, T-statistics of 9.442, a p-value of 0.000, and an effect size (F²) of 0.632. This negative relationship reflects empirical limitations in human resources, technology, and governance that directly reduce response effectiveness. Conclusion: Strengthening hospital preparedness requires integrated measures, including regulatory harmonization, permanent civil-military cooperation mechanisms, and improvements in human resources, technology, and governance. Novelty: This study proposes a risk-based modeling framework that quantitatively integrates hospital capacity, emergency response readiness, and CBRNE hazard characteristics, providing a systematic approach to enhance hospital preparedness and public health resilience.