Emergency response system for missile and drone-related threats: Ukraine model
M Moskalenko, O Adamenko, T Vezhnovets, I Katsitadze, T Orabina, T LebedievaAbstract
Background
By 2026, Ukraine’s fifth year of full-scale war has required a shift from reactive repair to systemic healthcare resilience. Within the “Safe and Resilient Hospital” project, supported by UNICEF, the focus is on mitigating the impact of infrastructure damage and workforce disruption on maternal and neonatal outcomes. The approach integrates structural safety with emergency preparedness, enabling facilities to respond to missile and drone attacks and mass-casualty events.
Objectives
To strengthen maternal and children’s hospitals’ capacity to provide a safe environment and ensure continuity of care through implementation of a facility-level Emergency Response System (ERS) and enhanced operational command via the Hospital Incident Command Team (HICT).
Methods
A practice-based implementation design was applied. The ERS is structured as a command system - a set of processes, algorithms, and tools enabling timely decision-making, coordination of limited resources, and delivery of care. The model includes adaptation to missile and drone threats, phase-based response algorithms, role-based teams, and strengthened coordination through the HICT. Assessment used 40 indicators grouped into five modules and was applied as a facility-level benchmarking and maturity framework. Results were interpreted as: 0–39% critically low; 40–69% low; 70–84% satisfactory; 85–100% safe and resilient.
Results
Facilities transitioned from autonomous departments to a unified system with centralized decision-making within the HICT. Role-based management improved coordination, clarified roles, and supported continuity of care. Benchmarking enabled measurement of progress and prioritization of improvements.
Conclusions
The ERS demonstrates a shift from fragmented, person-dependent response to structured, system-based management. As a benchmarking and maturity model, it supports continuous improvement and provides a scalable approach to strengthening healthcare resilience under sustained threats.