The KAEPacity Study Analyzes Hospital Emergency and Disaster Plans From Hospitals Across Germany to Evaluate How Well Hospitals Are Prepared for Crises and Disasters Organizational Structures Communication Leadership Training Are Examined Within These Plans No Medical Intervention is Performed (KAEPacity)

KAEPacity - Eine Vergleichende Analyse Der Krankenhausalarm- Und Einsatzpläne (KAEP) Deutscher Krankenhäuser

Hospital Emergency and Disaster Plans (Krankenhausalarm- und Einsatzplan-KAEP) are a central component of hospital preparedness in Germany. Despite national and international recommendations, considerable variability exists in structure, responsibilities, communication pathways, and training concepts across hospitals. This study aims to systematically analyze and compare KAEP documents from German hospitals using a structured qualitative and quantitative document analysis. The goal is to identify strengths, deficits, institutional influencing factors, and best-practice elements to support evidence-based improvements and harmonization of hospital emergency planning.

Study Overview

• Status: Recruiting
• Conditions: Emergency Medical Services; Disaster Planning; Germany

Detailed Description

KAEPacity is an observational, mixed-methods, descriptive-comparative document analysis of Hospital Emergency and Disaster Plans (Krankenhausalarm- und -einsatzpläne; KAEP) from hospitals in Germany. The aim is to characterize and compare how hospitals operationalize preparedness for exceptional events (e.g., mass casualty incidents, technical failures, security incidents, pandemics) through their written emergency planning documents, and to derive evidence-informed recommendations for quality improvement and harmonization.

Participating hospitals provide their current KAEP documents (and, if available, related materials such as exercise plans, training concepts, evaluation reports, and "lessons learned" documentation). All received documents are stored in a secure institutional environment and processed confidentially. Prior to analysis, documents are pseudonymized: identifying information about hospitals and individuals is removed as far as feasible, and each hospital is assigned a study code (e.g., KH01). Hospital-level characteristics relevant for comparative analyses (e.g., care level, size category, ownership/management type, region) are recorded in a separate, access-restricted key file and used only for aggregated comparisons.

The analysis is conducted using a structured criteria framework derived from national guidance (including the BBK KAEP handbook) and international recommendations (including the WHO Hospital Emergency Response Checklist), complemented by findings from current hospital preparedness and disaster medicine literature. The framework covers core preparedness domains such as: plan structure and governance, leadership and command arrangements, alerting and activation processes, triage concepts and patient flow organization, internal and external communication pathways, defined hazard scenarios and functional annexes, and training, exercises, evaluation, and plan maintenance.

Qualitative analysis follows a deductive-inductive content analytic approach: an initial codebook is developed from guidelines and established models, and then iteratively refined by adding inductive subcategories when additional recurring themes or organizational patterns emerge from the material. In addition to explicit content, the analysis considers aspects such as role logic, implied assumptions, handling of uncertainty, and indications of preparedness culture as reflected in the documents' structure and language.

To support comparability across hospitals, selected structural and process features are additionally rated on an ordinal 0-5 scale (0 = not present; 1 = insufficient; 2 = partially present; 3 = adequate; 4 = well developed; 5 = fully operationalized). This allows descriptive summaries and stratified comparisons across hospital categories without identifying individual institutions. Where feasible, interrater reliability procedures are implemented (e.g., double-coding of a subset and consensus review) to increase the robustness of coding and ratings.

The study does not involve patient recruitment, clinical interventions, or collection of personal health data. Results will be reported exclusively in aggregated form to prevent identification of individual hospitals. The primary intent is to generate an evidence base on current KAEP practice in Germany and to highlight best-practice elements and development needs that can inform future preparedness guidance, training, and quality assurance initiatives.

• Study Type: Observational
• Enrollment (Estimated): 319

Contacts and Locations

• Study Contact: Name: Maik von der Forst, Dr. med.; Phone Number: +49 6221-5632939; Email: maik.forst@med.uni-heidelberg.de
• Study Contact Backup: Name: Lea Kölsch; Email: l.koelsch@student.maastrichtuniversity.nl

Study Locations

• Germany
  • Heidelberg, Germany, 69120
    • Recruiting
    • Stabsstelle Krisen- und Katastrophenmanagement
    • Contact: Maik von der Forst, Dr. med.; Phone Number: +49 6221-5632939; Email: maik.forst@med.uni-heidelberg.de

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

Hospitals in Germany with an existing documented Hospital Emergency and Disaster Plan (KAEP).

Description

Inclusion Criteria:

German hospitals with a documented KAEP Institutional consent to provide KAEP documents for analysis

Exclusion Criteria:

Hospitals declining participation Specialized facilities without emergency or acute care services (e.g., rehabilitation clinics)

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maturity of Hospital Emergency Plans	Overall maturity of hospital emergency and disaster plans assessed using a predefined composite score. The score is calculated by aggregating four predefined domains (structure, operational processes, communication, training/exercises) each rated on a standardized 0-5 ordinal scale. Domain scores are summed to generate a single overall maturity score per hospital.	Baseline
Derivation of Practice-Oriented Recommendations	Identification of strengths, weaknesses, and improvement potential across hospitals.	through study completion, an average of 1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Institutional Influencing Factors	Association between KAEP quality and hospital characteristics (care level, size, ownership, region).	through study completion, an average of 1 year
Training and Exercise Practices	Frequency, documentation, and evaluation mechanisms related to KAEP exercises.	Baseline
Best-Practice Elements	Identification of recurring high-quality structural or procedural elements.	through study completion, an average of 1 year
Use of Digital or AI-Supported Components	Exploratory assessment of digital tools referenced in KAEP documents.	Baseline

Collaborators and Investigators

• Sponsor: Lea Kölsch
• Collaborators: University Hospital Heidelberg Department of Crisis and Disaster Management; Prof. Erik Popp - Head, Department of Crisis and Disaster Management; Prof. Markus Ries - Head of Research, Department of Crisis and Disaster Management; Hanne Schäfer - Head of Operational KAEP, Department of Crisis and Disaster Management; PD Dr. med. Fabian Weykamp - Senior Physician, Department of Radiotherapy; Dr. med. Maik von der Forst - Deputy Head, Department of Crisis and Disaster Management

Publications and helpful links

General Publications

• Mayring, P. (2014). Qualitative content analysis: theoretical foundation, basic procedures and software solution. Social Science Open Access Repository (GESIS - Leibniz Institute for the Social Sciences), 143. http://www.ssoar.info/ssoar/handle/document/39517
• Wurmb, T., Kurz, S., Schwarzmann, G., Trautner, H., Kinstle, U., Wagenhäuser, U., Koch, F., Münch, M., Meybohm, P., & Kippnich, M. (2024). Application of quality indicators and critical lessons learned assessment as a research approach for the evaluation of rescue missions during terrorist attacks. Scientific Reports, 14(1), 25087. https://doi.org/10.1038/s41598-024-7626
• Was sind Kritische Infrastrukturen? (n.d.). Bundesamt Für Sicherheit in Der Informationstechnik. Retrieved November 20, 2025, from https://www.bsi.bund.de/dok/kritis-allgemein
• Walcher, F., Ramshorn-Zimmer, A., Janssens, U., Hoffmann, F., Werdehausen, R., & Wurmb, T. (2025). 10 Punkte zur Verbesserung der Notfall- und Katastrophenversorgung im deutschen Gesundheitswesen. Notarzt, 41(02), 76-79. https://doi.org/10.1055/a-2549-8964
• Von Der Forst, M., Popp, E., Weigand, M. A., & Neuhaus, C. (2023). Sonderlagen und Gefahrenabwehr in deutschen Krankenhäusern - eine Umfrage zum Ist-Zustand. Die Anaesthesiologie, 72(11), 784-790. https://doi.org/10.1007/s00101-023-01349-2
• Von Der Forst, M., Germann, B. J., Schaefer, H., Salg, G. A., Weigand, M. A., Schmitt, F. C., Dietrich, M., Mohr, S., Küllenberg, J., Ries, M., & Popp, E. (2025). Impact of a full-scale mass casualty exercise on hospital staff and implications for future preparedness - A pre-post study. Progress in Disaster Science, 28, 100478. https://doi.org/10.1016/j.pdisas.2025.100478
• Von Der Forst, M., Dietrich, M., Schmitt, F. C. F., Popp, E., & Ries, M. (2025). Perennial disaster patterns in Central Europe since 2000 and implications for hospital preparedness planning - a cross-sectional analysis. Scientific Reports, 15(1), 620. https://doi.org/10.1038/s41598-024-84223-4
• Speicher, C., Wurmb, T., Schwarzmann, G., Zech, C., Jansen, H., Weismann, D., Anger, F., Paul, M., Münch, A., Ohr, M., Meybohm, P., & Kippnich, M. (2024). Evaluation der Krankenhausalarm- und -einsatzplanung anhand einer Übung eines Massenanfalls von Verletzten. Die Anaesthesiologie, 73(12), 810-818. https://doi.org/10.1007/s00101-024-01475-5
• Sorensen, B. S., Zane, R. D., Wante, B. E., Rao, M. B., Bortolin, M., Brigham and Women's Hospital, Harvard Humanitarian Initiative, Harvard Medical School, Rockenschaub, G., & WHO Regional Office for Europe. (2011). Hospital emergency response checklist. In Hospital emergency response checklist (p. 6). https://www.who.int/docs/default-source/documents/publications/hospital-emergency-response-checklist.pdf
• Schulz, M., Oestmann, J., & Schütz, T. (2023). Resilienz deutscher Kliniken in Amok- und Terrorlagen. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, 66(10), 1146-1152. https://doi.org/10.1007/s00103-023-03752-x
• Schorscher, N., Kippnich, M., Meybohm, P., & Wurmb, T. (2022). Lessons learned from terror attacks: thematic priorities and development since 2001-results from a systematic review. European Journal of Trauma and Emergency Surgery, 48(4), 2613-2638. https://doi.org/10.1007/s00068-021-01858-y
• Rohde, A., Schmidbauer, W., Didion, N., Ritter, D., Demare, T., & Jänig, C. (2024). Medizinische Herausforderungen in der Starkregenkatastrophe im Ahrtal 2021. Notfall + Rettungsmedizin, 28(1), 1-8. https://doi.org/10.1007/s10049-024-01428-w
• Ramshorn-Zimmer, A., Wurmb, T., Walcher, F., Werdehausen, R., Grashey, R., Drewitz, K., & Brod, T. (2025). Status quo der Krankenhausalarm- und -einsatzplanung in Deutschland. Notfall + Rettungsmedizin, 28(5), 344-351. https://doi.org/10.1007/s10049-025-01578-5
• Künstliche Intelligenz im Krankenhaus - Fraunhofer IAIS. (n.d.). Fraunhofer-Institut Für Intelligente Analyse- Und Informationssysteme IAIS. https://www.iais.fraunhofer.de/de/publikationen/studien/2020/lotte.html
• Imach, S., Lefering, R., Kölbel, B., Wolf, M., Hackenberg, L., & Bieler, D. (2024). Nutzung von Registern zur Schaffung eines evidenzbasierten Vorgehens im Katastrophen- und Zivilschutzfall. Die Unfallchirurgie, 127(12), 855-860. https://doi.org/10.1007/s00113-024-01487-1
• Franke, A., Tralls, P., Wurmb, T., & Heller, A. R. (2025). Rahmenbedingungen und Grundannahmen bei der Erstellung der Leitlinie Klinische Katastrophen Medizin Deutschland (LeiKliKatMeD). Die Unfallchirurgie, 128(9), 645-653. https://doi.org/10.1007/s00113-025-01608-4
• Coffey, A. (2014). Analysing Documents. In Types of Documents and their analysis (pp. 367-379). https://doi.org/10.4135/9781446282243.n25
• Bundesamt für Bevölkerungsschutz und Katastrophenhilfe (BBK), Kowalzik, B., Hähn, F., Helmerichs, J., Stolzenburg, K., Weber, M., Rebuck, J., Degenhardt, L., Braubach, A., Scholtes, K., Wurmb, T., Kolibay, F., Franke, A., Tralls, P., Lücking, G., Jung, H. G., Lampe, I., Scheidmantel, S., Gottschalk, A., . . . Eberl, S. (2020). Handbuch Krankenhausalarm- und -einsatzplanung (KAEP). https://www.bbk.bund.de/SharedDocs/Downloads/DE/Mediathek/Publikationen/Gesundheit/KAEP/handbuch-kaep.pdf?__blob=publicationFile&v=15
• Achatz, G., Bieler, D., Schweigkofler, U., Hoefer, C., Lehmann, W., & Franke, A. (2024). Berücksichtigung und Umsetzung der Elemente der Krankenhausalarm- und Einsatzplanung in den Kliniken der TraumaNetzwerke DGU®. Die Unfallchirurgie, 127(12), 867-877. https://doi.org/10.1007/s00113-024-01494-2

Study record dates

Study Major Dates

• Study Start (Actual): March 9, 2026
• Primary Completion (Estimated): July 30, 2026
• Study Completion (Estimated): December 30, 2026

Study Registration Dates

• First Submitted: January 28, 2026
• First Submitted That Met QC Criteria: February 23, 2026
• First Posted (Actual): February 27, 2026

Study Record Updates

• Last Update Posted (Actual): March 11, 2026
• Last Update Submitted That Met QC Criteria: March 9, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Crisis Management; Disaster Preparedness; hospital preparedness; Healthcare Resilience
• Other Study ID Numbers: S-672/2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Only aggregated, anonymized results will be published. No individual hospital data will be shared.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No