Today, due to international travel, rare but extremely dangerous pathogens can spread much faster than ever before. An additional potential threat occurs when such infectious agents are released by accident or even as a result of intentional application (bioterrorism). That is why hospitals should be as well prepared as possible for the diagnosis and treatment of pathogens of this type.


The BEPE service analyses the state of preparedness of hospitals relative both to individual patients with highly infectious diseases and to potential bio-terrorist emergencies in Germany and Israel. It takes more than diagnostic capabilities alone to effectively treat patients stricken with highly infectious diseases and prevent the further spread of those diseases: personnel also have to be adequately trained in the proper handling of personal protective equipment and isolation stations have to be equipped accordingly.

To this end, surveys were conducted in both countries. Major synergies are anticipated from the cooperation between the German and Israeli partners here. Germany has experience, above all, with the care of individual patients suffering from highly infectious diseases such as SARS and Lassa fever. Israel, on the other hand, has experience in handling large numbers of affected people.


The BEPE project has created a comprehensive and reliable Internet-based software tool which can be used to assess how well individual healthcare facilities and the associated healthcare personnel are prepared for a potential outbreak of contagious diseases. The tool will also indicate how the facility’s state of preparedness can be improved. The software supports quality management in the hospitals by raising the awareness and the level of knowledge of the personnel in the respective clinics relative to extremely dangerous pathogens.

The aim is to significantly reduce the time between admission of the patients, diagnosis of the suspected condition and the required isolation of the afflicted persons. This is a basic prerequisite for preventing further infections and slowing the spread of highly infectious diseases. This service will make a major contribution toward improving the preparation of healthcare institutions for biological emergencies. Moreover, highly infectious diseases inspire fear and anxiety and can lead to widespread panic in the general population, thereby severely impairing public life. A better prepared healthcare system can also counteract these consequences.


A comprehensive literature review of publications was conducted. An in-depth analysis of each of the identified articles was impelmented in order to extract components relevant to biological events. The components were classified to categories relevant to manage biological events, and were then transformed into measurable parameters that can be integrated in an evaluation tool.

In the framework of a modified Delphi process, the parameters were disseminated to more than 200 content experts. These experts were from various fields of public health and emergency management, including healthcare systems' managers, front line clinicians, medical professionals, first responders, and infectious diseases specialists. The Delphi process was run electronically on a protected internet platform designed and developed in the scope of this project. This web based, multilingual and inter-active tool allows also to perform "real-time Delphi studies".Importantly, it co mpares inputs immediately, that is in real time, with the assessments from the other participating experts.  Consequently, this method dispenses with the need for classical rounds or cycles. However, repeats of the survey are possible and, indeed, desirable. Every time a user logs in, the most recent results and opinions are presented and the user is able to adjust their own input in light of this information.

This Delphi service was developed for BEPE and is now available.

Delphi website


The parameters integrated in the evaluation tool serve as benchmarks for the healthcare facilities that delineate actions that need to be implemented in order to achieve preparedness for biological events.

Development of clear and well-defined indicators is a vital component of evaluation tools. Indicators clearly present the level of performance of each parameter. They provide focus and direction to help identify strengths and gaps in emergency-preparedness levels and facilitate target quality improvement efforts. These indicators were developed through the adoption of the SMART criteria (specific, measurable, achievable, relevant, and time-bound).
Categories in BEPE tool
Five major categories


Following the Delphi cycles, a focus group study was conducted to identify the psychosocial needs of the hospital staff in a biological event.
A qualitative data collection method was used to maintain openness for unanticipated emerging themes. The focus groups were recorded, analyzed and edited.

Results from the analysis were added to the tool and published by the Robert Koch Institute (German language only).


Exercises in six hospitals were conducted to review the applicability of the evaluation tool to hospitals' needs. The scenario simulated one index patient accompanied by one contact person that presented to the emergency department of the hospital, arriving a few days after their return from a vacation trip.

Firstly, the hospitals performed a table-top exercise to present their plan to respond to the described scenario. In the following practical exercise actors simulated the scenario at the emergency department. The performance was analyzed in order to adjust hospitals' institutional plans as well as rewiew and modify the evaluation tool.

Initial changes in material stocking, workflow and information flow were implemented immediately after review of the exercises. The adotion of the tool is an important component of assuring public health and effective emergency management.
This service tool is the outcome of the German-Israeli collaboration research project "BEPE - Development of a Tool for Biological Event Preparedness Evaluation" under the framework of the "Research of Civil Security".

BEPE . Be Prepared

This service is provided by CSO .smart .web .solutions. It is developed and supervised by an international research team under participation of the Robert Koch Institute, Germany.

For more than 25 years we build web based data base solutions, medical and geographical information systems.


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