Inclusive emergency management after CBRN incidents: adapting decontamination for individuals with disabilities and assistive devices

Background: Emergency decontamination procedures overlook people with disabilities, particularly those dependent on assistive devices. This study examines how decontamination protocols can be adapted to enhance inclusivity and effectiveness during accidental or intentional release of chemical or biological agents referred to as CBRN incidents.

Methods: A qualitative study was conducted through 28 semi-structured interviews with patient representatives and professionals working with individuals with disabilities. Participants discussed physical and psychological needs before, during, and after decontamination. Data was analysed using Rapid Assessment Procedure (RAP) sheets to identify key themes.

Results: Participants highlighted that disabilities are heterogenous and complex, often involving multiple impairments. Limited first responders (FRs) experience with disabilities may lead to exclusion from care and inappropriate responses. Physical needs include safe handling, tracking and preservation of assistive devices, particularly those with electronic or customised equipment. Devices should remain with or return them to their owners whenever possible. Alternative methods, such as sitting decontamination using plastic wheelchairs, were suggested to improve autonomy. Psychological considerations included emotional attachment to assistive devices, clear communication, involvement of trusted caregivers, and minimising distress. The physical environment (e.g., noise, lighting) influences stress levels and must be adapted. Participants emphasised the importance of fair triage, informed consent, and integrating inclusive protocols.

Conclusion: Standard decontamination protocols should incorporate accessible communication strategies, electronic-friendly procedures, and environmental adaptations to better accommodate individuals with disabilities. The next phase of this project will focus on developing European guidelines for decontaminating assistive devices sensitive to conventional water-based methods, enhancing inclusivity and effectiveness in CBRN emergency response.

1 Introduction

According to the World Health Organisation (WHO), one in six people worldwide live with a significant disability. In the event of an accidental or intentional release of chemical or biological agents, referred to as a CBRN incident, first responders (FR) are likely to encounter individuals with disabilities who may require specialised assistance. However, recent data from the United Nations Office for Disaster Risk Reduction (UNDRR) show that 84% of people with disabilities lack an individual disaster preparedness plan (1, 2). Additionally, 17% (1,098) of surveyed individuals reported facing major evacuation difficulties, while 6% (357) would be unable to evacuate independently (2). More importantly, only 8% of participants in the global consultation reported that local disaster risk reduction plans addressed the specific needs of people with disabilities (2).

To bridge this gap, the UNDRR has emphasised the need for Disability Inclusive Disaster Risk Reduction (DiDRR) (1) advocating for greater involvement of people with disabilities in preparedness and response planning. In line with this recommendation, this project incorporates user perspectives to develop more inclusive and effective decontamination procedures, ensuring they align with the needs and preferences of affected individuals.

User involvement is increasingly recognised as essential in healthcare service development, including in the creation of clinical guidelines or emergency procedures. Previous research has documented the value of integrating user perspectives in patient care (3–7). However, their inclusion in emergency medical care and CBRN decontamination protocols remains rare (8). Some European projects, such as H2020-PROACTIVE, have attempted to incorporate victim's needs, yet full participation—beyond focus group or interviews—remains limited (9). True user involvement implies establishing a research partnership in which affected individuals contribute their perspectives alongside researchers and professionals (3).

By integrating user insights and creating opportunities to refine recommendations, decontamination procedures can be more effectively adapted to real-world conditions. By improving communication between victims and FRs and enhancing adherence to instructions, the overall decontamination process could be accelerated.

In the context of a CBRN incident, end users are directly affected. During such incidents, victims require triage, emergency medical care, and decontamination by FRs. Current decontamination procedures are primarily designed for an adult population without any physical or cognitive impairments reflecting a mass casualty emergency approach where FRs must treat the highest number of victims in the shortest time possible.

However, victims represent a diverse population with varying needs. Some face additional vulnerabilities due to complex conditions, particularly those who rely on assistive devices that cannot always be properly decontaminated.

This study explores how decontamination procedures can be adapted to better meet the needs of people with disabilities who rely on assistive devices. We aim to enhance decontamination protocols by integrating user perspectives, particularly focusing on electronic assistive devices vulnerable to water-based methods. This study was conducted as part of the European project eNOTICE-2, a continuation of Horizon 2020 eNOTICE project (https://www.h2020-enotice.eu/). eNOTICE-2 is the European Network of CBRN Training Centres for Preparedness to CBRN Events co-funded by DG ECHO Knowledge Network mechanism. It aims to enhance preparedness and response capacity for local, regional, and cross-border CBRN crises involving chemical and biological agents, either individually or in combination. The project supports FRs, across multiple disciplines (police, fire brigades, paramedics, civil protection) through training modules, an open-access digital library, synthetic operational data, collaborative activities among network members, including field exercises, and pan-European guidelines for CBRN decontamination, with particular attention to electronic-friendly decontamination of assistive devices (https://civil-protection-knowledge-network.europa.eu/projects/enotice-2) (Figure 1).

Figure 1

Figure 1. CBRN decontamination of individuals with disabilities and their assistive devices during mass decontamination field exercise (UCPM-KAPP-PREP eNOTICE-2 project). This mass decontamination CBRN field exercise was conducted at the Fire Department of Dortmund (FDDO), Germany, on 20th April 2024. It was the first simulation exercise within the UCPM-KAPP-PREP project eNOTICE-2.

This paper examines the first stage of the user involvement in the eNOTICE-2 project. The second stage is ongoing and will be completed by the end of 2025.

2 Material and methods

2.1 Design

This study employed qualitative research design, selecting stakeholders with expertise in disabilities and assistive devices. A qualitative approach was chosen due to the complexity of the topic and the public's limited familiarity with decontamination procedures, both in general and specifically for chemical and biological incidents (10). This method also allowed for a deeper exploration of both physical and psychological requirements.

Two target groups were identified: (1) people who use assistive devices (user group) and (2) professionals working with individuals who rely on assistive devices, such as educators, working in disability institutions (professional group). Assistive devices include technological and/or material supports that help people function in daily life. Examples include wheelchairs, walking aids, canes, glasses for blind and visually impaired individuals, prosthetics, and hearing aids.

Participants were recruited through Belgian umbrella patient associations, direct outreach to patient organisations, and personal networks. Purposive sampling was used and guided by ongoing analysis (10).

2.2 Interview structure and process

We used a semi-structured interview guide divided into five parts: (1) participant introduction & icebreaker, (2) preparedness for emergencies, (3) knowledge and perceptions of CBRN incidents & decontamination, (4) needs regarding the decontamination of assistive devices, and (5) closing discussion. The interview guide incorporated a section on preparedness based on the Person-Centred Emergency Preparedness tool (11), as well as EU definitions of CBRN and decontamination, to help participants contextualise the discussion. The guide was tested with one person living with a chronic disease and one occupational therapist for clarity, length and structure. No adaptation was necessary after the test. After 20 interviews, additional questions were added to further explore the acceptability of proposed solutions (10).

The first author conducted the interviews in French. She is trained as a community health nurse and has been a FR with the Belgian Red Cross since 2011, with experience in collective emergencies. She has previously conducted research on healthcare access for individuals with disabilities (12) and CBRN preparedness (13). She is also hearing impaired and uses an auditory prosthesis.

2.3 Data analysis

Following each interview, a concise descriptive synthesis was drafted based on sessions notes, then supplemented by a full transcription using the automated transcription features of Microsoft Teams. Data were progressively integrated into a Rapid Assessment Procedure (RAP) sheet (14), enabling the swift compilation of psychological and physical requirements identified during the interviews. RAP sheets are increasingly used in Expedited Qualitative Research (15), facilitating the rapid identification of emerging themes, data triangulation, and recognition of topics requiring further investigation to refine recruitment strategies and interview questions.

2.4 Ethical aspects

According to the Belgian law, this study did not require approval from an Ethics Committee, as participants were not asked to share personal experience, health-related data, or other personal data. Instead, they provided opinions on how to improve FR training. Participation was voluntary, and no incentives were offered. All participants provided informed consent and received informational material on emergency preparedness after the interview. Data was anonymised and stored in compliance with the privacy policies of the UCLouvain.

2.5 Context of the data collection

Estimates from 2022 indicate that around 25.5 % of the Belgian population lives with one or more disabilities. However, no accurate data are available to further describe this population: even the number of Belgian citizens receiving a disability allowance underestimates the actual situation (12). Regarding assistive devices, European data report that 60% of people living with a disability use at least one assistive device daily, all types combined (16). To date, no detailed data by device type are available for Belgium.

Concerning the DiDRR, both the Belgian Disability Forum and UNIA (the Belgian independent public institution against discrimination), have highlighted the lack of inclusivity in emergency plans at the local, provincial and national levels, despite a positive self-assessment by public authorities (17). Crisis communication is particularly seen as inadequate for vulnerable groups: this was notably denounced during the COVID-19 pandemic and the 2021 floods, in which 39 Belgians lost their lives.

Regarding CBRN preparedness, Belgium has only a confidential national emergency plan (Royal Decree 19 June 2018) for dealing with a criminal or terrorist incidents involving CBRN agents (accidental incidents are not included). By law, Belgian Civil Protection is responsible for population decontamination. However, following a drastic reduction in the number of civil protection stations (from 6 to 2 nationwide), firefighters are increasingly involved in victim decontamination during CBRN incidents. Guidance has been issued to strengthen healthcare preparedness, including for the FR providing prehospital medical care, but none of the recommended actions have yet been implemented (13).

3 Results

We conducted 28 interviews: 14 with patient representatives and 14 with professionals caring for individuals with disabilities. A total of 26 individual interviews and two group interviews (one with a couple and one with a group of three people) were conducted, involving 32 participants (23 women and nine men). Twenty-two interviews were held online, while the remaining individual and group interviews took place in person at locations chosen by the participants. Participants' ages ranged from 20 to 80 years.

Among the professionals (n = 14), six had experience responding to mass emergencies as volunteer FRs in medical and psychosocial care. Two patient representatives had previously served as FRs until their condition no longer allowed them to continue.

All but three user representatives had disabilities themselves. The remaining three were parents of an individual with disabilities. In our sample, disabilities were primarily caused by neurological conditions (e.g., multiple sclerosis, neuromuscular diseases, cerebral palsy), rare diseases (e.g., Ehlers-Danlos syndrome or osteogenesis imperfecta, also known as brittle bone disease), or cognitive disorders (e.g., autism, bipolar disorder).

3.1 Multiple facets of handicap

Participants emphasised that disability is a highly individual experience, with each person having unique needs and resources. Individuals with complex conditions often experience multiple disabilities, such as severe mobility impairments combined with respiratory, cognitive, or sensory limitations. They also highlighted the importance of recognising invisible disabilities, which may not be immediately apparent to FRs, such as Ehler-Danlos syndrome or multiple sclerosis. Several participants noted that cognitive or mental health conditions pose additional challenges, as their reactions may be unpredictable, requiring a tailored and personalised approach. This was particularly noted for children or adults with autism, whose responses can be aggressive or distressing for FRs. Professionals also noted that, in general, FRs have limited experience working with individuals with disabilities, which can sometimes lead to inappropriate responses (e.g., infantilisation, speaking too loudly, impatience). As a result, some participants feared that individuals with disabilities might be excluded from proper care during an emergency. Others were concerned that FRs might employ force, coercion, or restraint to enforce compliance with decontamination procedures. A participant suggested that administering an anxiolytic could help alleviate anxiety for individuals undergoing extreme stress during decontamination processes.

3.2 Physical requirements

Table 1 outlines the physical requirements of vulnerable groups, including individuals with disabilities across different phases of decontamination (pre-, during, and post-decontamination).

Table 1

Table 1. Vulnerable groups: physical requirements.

When considering physical requirements, participants suggested distinguishing between assistive devices that can be removed without harm (e.g., hearing aids, wheelchairs) and those that cannot be removed or must be replaced immediately (e.g., respiratory support devices). Devices whose removal is life-threatening should be replaced within minutes. In contrast, participants noted that certain devices can be temporarily removed, provided that adequate support is available, such as a mechanical wheelchair, a temporary stay in a healthcare facility can be arranged instead of returning home without assistive devices, or the prompt provision of a substitute device. Some participants emphasised that saving and preserving life should be the priority. However, others stressed that, if a device is removed, restoring the patient's autonomy as quickly as possible should also be a key priority.

Additionally, participants distinguished between tailor-made assistive devices, designed for individual needs, and generic devices that do not require specific programming. Generic devices were seen as easier to replace.

Participants recommended keeping assistive devices with the person whenever possible. If removal is necessary, the device should be clearly labelled before decontamination. Since these technologies are highly personalised, being adjusted to the needs and physical features of every individual, participants favoured rapid and safe decontamination of the individual's own device over replacing it with a substitute. Some suggested establishing a “material decontamination chain” parallel to the “human decontamination chain” to ensure assistive devices are cleaned efficiently and returned to their owners promptly.

For individuals with mobility impairments, proper handling is essential. Some people may suffer from neuromuscular diseases and be unable to assist in their own movement (e.g., some cannot even raise their heads). If time permits, having a patient lift in the red zone could assist with transfers. Patients can remain lying down, so providing a wheelchair for everyone may not always be necessary. Individuals with both respiratory and neuromuscular conditions may need to be positioned in a half-sitting posture making a stretcher with a lift-up backrest essential. In contrast, some people with disabilities retain partial mobility, making transfer to a stretcher unnecessary or even restrictive. For these individuals, a “shower plastic wheelchair” offers greater autonomy while also reducing the responder burden.

While awaiting decontamination or travelling to the decontamination tent, it is important to recognise that individuals who appear capable of walking may struggle to cover the distance or stand for extended periods. Therefore, seating in waiting areas and wheelchairs for internal transfers should be available. After decontamination, comfortable lying down positions should be ensured, particularly for individuals with muscular conditions.

Additionally, some participants stressed that not all assistive devices are externally visible, such as urinary catheters, stomas or parenteral probes. Participants questioned how FRs could be manage these, as—in their view—such medical devices are not typically included in standard equipment in standard ambulance equipment. One participant also noted that some people may experience incontinence, especially if the incident occurs near a nursing home, a elder care facility, or specialised care centre for individuals with multiple disabilities. After the decontamination shower, once dressed, appropriate protective garments should be provided.

Some additional devices were identified as difficult to replace and unsuitable for intensive washing, including compression garments, orthopaedic insoles, adapted shoes, compression splints, and cuddly toys.

Throughout the interviews, another category of essential devices emerged: tablets and smartphones used by people with sensory and/or cognitive impairments for communication. For instance, those with severe hearing loss rely on specific applications on their phones to communicate, as do some individuals with autism spectrum disorders. Without these devices, communication would be impossible. Several participants stressed that removing these devices for longer than the decontamination process would be unconceivable. Additionally, it was noted that individuals with diabetes use their cell phones or similar devices to regulate their insulin pumps and monitor their blood glucose level.

3.3 Psychological requirements

Table 2 delineates the psychological needs of vulnerable populations, including individuals with disabilities, across different phases of decontamination (pre-, during, and post-decontamination).

Table 2

Table 2. Vulnerable groups: psychological requirements.

Regardless of the type of impairment or disability, all participants emphasised the need for clear, continuous and calm communication. As one participant noted, maintaining ongoing communication reassures individuals and facilitates the removal of assisting devices when necessary. Some participants acknowledged that emergencies require quick actions, leaving little time for in-depth discussions. Consequently, they suggested that regular communication during non-emergency situations could help individuals better prepare for such scenarios.

The choice of words during emergencies is also important. For instance, using terms like “disabled individuals” vs. simply “disabled” can be perceived as more respectful and ease the dialog with an individual with disability.

While verbal communication is essential, additional strategies are needed to ensure accessibility. Participants highlighted the importance of pictograms to assist individuals who are deaf or hard of hearing, a finding also supported by the H2020 PROACTIVE project. Since masks worn by the FRs can hinder visual communication, some participants suggested using transparent masks to facilitate lip-reading. Additionally, several participants recommended sign language interpreters be available before, during and after the decontamination process, while acknowledging that not all individuals are fluent in sign language. Participants also identified colour codes, pictograms, and videos as useful supplementary materials to enhance communication during emergencies.

Maintaining a continuous presence, whether by an FR, a trusted relative, or a volunteer, was highlighted as essential during the interviews. Participants emphasised that individuals should never be left alone, particularly those with cognitive impairments, as having a trusted person nearby can provide reassurance, especially for those who may not fully understand the situation. Some participants also questioned whether families could remain together during decontamination to provide additional support.

In addition to the presence of a trusted person, several participants highlighted the importance of the physical environment in reducing stress and anxiety. Excessive sensory stimulations, particularly noise, and bright lights, can contribute to distress. For example, individuals with hearing loss may struggle to distinguish sounds, and an overload of auditory input can disrupt communication. One participant suggested reducing the intensity of headlamp lighting to minimise discomfort.

Participants also recommended paying special attention to the waiting area physical environment, both before and after decontamination. Suggestions included dimmed lighting, reduced noise levels, designated quiet rooms, and adherence to social distancing rules to accommodate different needs. For individuals with behavioural difficulties, specialised educators proposed providing activities or distractions to help them stay calm while waiting.

Participants suggested that familiar professionals should be involved as early as possible in managing the situation. For example, if residents of a nursing home require decontamination, their nurses and caregivers should take over after the process is completed to provide continuity of care in a familiar environment for the disabled individual. Similarly, for individuals with disabilities living in an institution, being quickly reunited with familiar faces, without masks or personal protective equipment (PPE), can help reduce anxiety and stress. One participant proposed that familiar professionals remain in the contaminated (red) zone longer to assist with people's decontamination. This would mean that these professionals might not be decontaminated immediately as a priority but instead wait until all people requiring assistance have been decontaminated. However, participants emphasised that not all professionals may be willing to take on this non-priority role and that it should never be imposed on them.

Another interviewee suggested that professionals accompanying individuals with disabilities should be decontaminated, equipped with PPE, and actively involved in the decontamination process to provide reassurance and support. However, this approach may not be practically feasible as its full effectiveness would require specialised training in decontamination procedures, ensuring safety and security of the support person, and integrating them into the FR team.

Some participants also raised concerns about consent, fearing that during emergencies, they may be compelled to comply with orders that could be perceived as disrespectful, intrusive, or even abusive (e.g., having to undress in front of male FRs). They suggested that a debriefing session be offered after the incident to allow individuals to express any discomfort or distress they experienced. Other participants pointed out that for people with cognitive or behavioural conditions, even physical contact can be a source of significant distress and anxiety. In such cases, involving a trusted person, whether a family member or a professional caregiver, was seen as an effective way to facilitate the decontamination process while ensuring the individual's comfort and cooperation.

Drawing on experiences from the COVID-19 pandemic, a participant discussed the importance of fair triage. People need to be assured that triage decisions are based solely on clinical criteria rather than their disability status. This includes classification according to T1/T2/T3 triage groups, vital prognosis, and level of consciousness, just as it applies to all other victims. The participant recounted a case during COVID-19 where a young girl with autism was denied admission to intensive care because she was perceived primarily as a disabled person rather than a patient in need. He also shared testimonies from severely disabled individuals whose healthcare providers wrongly assumed they had a poor quality of life and should therefore not be resuscitated, despite these individuals having a strong will to live. Considering such concerns, he emphasised the need for more dialogue between FRs and individuals with severe disabilities to foster a better understanding of what “quality of life” truly means for those living with significant physical or cognitive impairments. Several participants also highlighted the importance of involving patient associations in the training and education of FR. This approach was seen as an asset in helping FRs develop a deeper understanding of the realities of living with disabilities.

It has also to be kept in mind that some people with disabilities perceive themselves as having a lower chance of survival in an emergency. Those with mobility impairments were particularly concerned, acknowledging that if an incident occurs, they may be unable to evacuate on their own. Some even feared they might not survive long enough for FRs to reach them or that, in a mass casualty scenario, they would not be prioritised.

Finally, an important aspect of the psychological dimension is the relationship individuals have with their assistive devices. While some devices can be removed without endangering a person's life, their removal can trigger a wide range of emotional and behavioural reactions, including anxiety, panic attacks, verbal or physical aggression, withdrawal, refusal, or resistance. This underscores the need for careful assessment by responders when deciding whether to remove a device, even something as seemingly simple as a pair of glasses or a hearing aid. Whenever possible, responders should work with a trusted caregiver or family member to help reassure the individual and facilitate the decontamination process.

4 Discussion

This study aimed to identify the needs of people with disabilities regarding decontamination procedures. Participants highlighted clear and continuous communication as the most crucial factor. Even when immediate solutions for assistive device replacement are unavailable, effective communication reduces anxiety, fosters cooperation, and improves adherence to decontamination procedures. This finding aligns with previous studies on addressing the specific needs of people with disabilities exposed to accidental or intentional release of chemical or biological agents requiring decontamination (18–22). Taking the time to explain procedures in a clear and accessible language is recognised as a fundamental best practise. Effective communication reduces anxiety and stress, improves collaboration and adherence to instructions, expedites procedures, and minimises the risk of further complications (18, 19). While some individuals are aware of the complexity of decontamination and the diverse needs of individuals with disabilities, others may not fully understand the constraints of emergency response. Even when aware of protocols, individuals still need reassurance and clear explanations from FRs. This underscores the need for accessible communication and information materials in multiple formats, using simple language and designed for use in contaminated (red) zones (23). Emergency information should be developed while keeping the most vulnerable person in mind, following universal principles (24, 25). Ensuring accessibility will not only benefit individuals with severe disabilities but also children, non-native speakers, and those with low literacy, enabling them to understand and follow basic instructions. Since improving access to information is one of the targets of the Sendai Framework, it can be regarded as a priority for action (26).

While communication is crucial, exhaustive preparation for every potential risk may not be practical. Instead, personal emergency plans tailored to individual needs should be prioritised. It is more relevant to ensure that all people with disabilities have a personal emergency plan outlining actions to take if they must stay home for a prolonged period or evacuation. Such plan may include copies of identity documents, an up-to-date medication list, emergency contact numbers, a spare set of crutches or the serial numbers of assistive devices. These preparations should be tailored to individual needs and resources while remaining applicable to any emergency scenario. Following UNHCR and UN recommendations, preparedness should be generic and adaptable rather than specific to every possible emergency (1, 11, 27). For individuals living in institutions, managers should maintain a resident list detailing mobility capacity, the presence of assistive devices (e.g., hearing aids, prostheses, oxygen therapy), and other critical information relevant to decontamination procedures. This could help strengthen disaster risk governance in the area of risk management (Priority 2 of the Sendai Framework) (26).

Finally, it is important for FR to recognise that having a disability does not prevent people from actively participating in the decontamination process. Currently, decontamination is conducted either by undressing and then walking through a decontamination facility (e.g., a container or a tent) or by being transported on a stretcher while professionals carry out the procedure which primarily involves showering and washing with water. A third option, “sitting decontamination,” involves placing the individual in a plastic wheelchair, which can be less stressful for the victim and more efficient, as only one FR is needed for assistance. Another alternative is involving informal caregivers in the decontamination process, allowing victims to remain with someone they trust who understands their needs. This approach can further reduce stress, shorten the procedure, and help prevent difficulties arising from a lack of familiarity with disabilities.

This study has several limitations. Interviews were conducted with French-speaking Belgian participants, which may introduce selection bias as individuals whose mother tongue is French are more likely to live in Brussels or Wallonia. However, since our sample was heterogeneous in terms of age, gender and disability type, our findings are likely to reflect the perspectives of individuals with disabilities in other European countries, particularly those where attention to DiDRR and decontamination needs to be strengthened. That said, preparedness levels may vary between countries, as some nations invest more in citizen awareness, for instance by conducting regular national evacuation exercises or organising civil security events. Additionally, cultural differences in approach to disability care may influence perceptions. For example, a practise considered standard in Belgium may be perceived as abusive elsewhere, and vice versa. By documenting the needs of persons living with disabilities, this study aligns with the Sendai Framework which emphasises the importance of enhancing disaster preparedness (priority 4) (26).

This study focused on adults using assistive devices for mobility or sensory disability. However, participants, including both professionals and patient representatives, emphasised the complex nature of disabilities, highlighting the likelihood of encountering individuals with multiple disabilities, including cognitive and/or behavioural impairments, who rely on communication assistive devices. One interview was conducted with a type 1 diabetic patient (insulin-dependent) whose condition does not technically qualify as a disability but still requires assistive devices that cannot be self-decontaminated. We did not include more people with chronic diseases or cognitive impairments who rely also on an assistive device, but a future study could triangulate their needs with those of individuals with disabilities to provide a more comprehensive analysis. Finally, the emerging recommendations should be viewed as being at the conceptual level and will require further discussions with first responders and follow-up investigations to be translated into operational guidance.

5 Conclusions

To ensure inclusiveness in emergency response, decontamination procedures must be adapted for people with disabilities. The next phase of this project will establish standardised procedures for decontaminating electronic assistive devices and refine European decontamination protocols. By doing so, we hope to better include the needs of persons living with disabilities, in line with the United Nation's Sendai Framework.

Data availability statement

The datasets presented in this article are not readily available because participants did not give their consent for the content of the interviews to be made available, Consequently the original data cannot be shared online as part of a repository. Requests to access the datasets should be directed to the correspondence author.

Author contributions

MD: Writing – original draft, Formal analysis, Writing – review & editing, Conceptualization, Methodology. OV: Writing – review & editing, Investigation, Software, Supervision, Funding acquisition, Resources, Visualization, Data curation, Validation, Conceptualization, Project administration, Formal analysis, Methodology. J-LG: Supervision, Methodology, Data curation, Investigation, Conceptualization, Software, Writing – review & editing, Validation, Visualization, Resources, Formal analysis, Project administration, Funding acquisition.

Funding

The author(s) declare that financial support was received for the research and/or publication of this article. This study was part of the project eNOTICE-2 EU Network of Training Centres for preparedness to CBRN Events funded by the Union Civil Protection Mechanism (UCPM) of the European Commission (UCPM-2023-KAPP-PREP Grant Agreement n°101139905).

Acknowledgments

We would like to acknowledge our colleagues from the eNOTICE-2 project: Sylvia Pratzler-Wanczura, Enes Derin, Nico Soballa, Fabian Kulms (Fire Department of Dortmund, Germany), Maaike van de Vorst, Luc Calluy (Campus Vesta, Belgium), Wolfgang Karl-Heinz Reich, Tomáš Michalčík (Joint CBRN Defense Centre of Excellence, Czech Republic), Elizabeth Benson (West Midlands Police, UK), Daniele di Giovanni (University of Rome Tor Vergata, Italy), Stefano Mazzaro (Fondazione SAFE, Italy). We also warmly thank the patient umbrella association for disseminating our study among their members and, finally, all the participants to the interviews for their time and their willingness to contribute to our study.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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The author(s) declare that no Gen AI was used in the creation of this manuscript.

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