The timing of the review is no accident. The authors frame their work explicitly against the European Union’s Preparedness Union Strategy, launched in 2025, and the Common Security and Defence Policy, both of which reflect a continent grappling with the return of large-scale war to Europe. Global instability and ongoing conflict mean that civil defence, once viewed in many member states as a Cold War relic, has been thrust back onto the policy agenda. The nature of modern hybrid warfare, which blends conventional military force with cyberattacks, disinformation, sabotage and attacks on critical infrastructure, produces complex humanitarian emergencies that include mass casualty events. In such scenarios, civilian health systems become part of the defence apparatus, and nurses, who make up the single largest professional group within health services across the continent, become frontline actors in societal resilience whether or not they have been prepared for that role.

To map the existing evidence, the researchers conducted a scoping review following the PRISMA extension for scoping reviews, the internationally recognised reporting standard for this type of literature synthesis. The protocol was registered on the Open Science Framework on June 23, 2025, a step that increases transparency and guards against selective reporting. The team then carried out a comprehensive electronic search covering articles published between January 2000 and June 2025, a twenty-five-year window chosen to capture the full arc of contemporary security thinking in Europe. Five major bibliographic databases were searched: MEDLINE via PubMed, Embase via Ovid, CINAHL via EBSCO, PsycINFO and Web of Science. Supplementary searching of Google Scholar was also undertaken to catch grey literature and recently published work not yet indexed in the commercial databases.

The yield from this exhaustive search tells its own story. Of 836 articles identified in the initial sweep, only 16 survived screening and were included in the final review. That attrition rate, barely two percent of the retrieved literature, is the review’s most striking quantitative finding. It means that in twenty-five years of published health research, only a handful of studies have specifically examined the role of civilian nursing in civil defence within Europe against the backdrop of the current emerging threat landscape. For a workforce numbering in the millions across the European Union, and for a policy environment that now explicitly demands societal preparedness, the evidence base is essentially a void.

Where the literature does exist, it comes overwhelmingly from elsewhere. The review found that most of the relevant research emanated from the United States and the Middle East, regions where mass casualty events, military deployments and large-scale disasters have forced health systems to confront these questions directly. American nursing research has a long tradition of engagement with disaster preparedness, driven in part by events such as Hurricane Katrina and the post-September 11 emphasis on homeland security, while nursing scholarship from the Middle East reflects the brutal realities of protracted conflict. European nursing research, by contrast, has largely treated disaster and conflict response as someone else’s problem, a gap the authors argue can no longer be sustained given the security environment on the Union’s own borders.

Despite the scarcity of European evidence, the 16 included articles did converge on a central finding: nurses possess essential attributes for civil defence but are under-prepared for conflict scenarios. The attributes are not trivial. Nurses bring clinical skills in triage, trauma care and mass casualty management; they bring organisational experience in stretched, resource-constrained environments; and they bring a public-facing presence in virtually every community, hospital and primary care setting on the continent. In a hybrid war scenario, where attacks on civilian infrastructure may produce casualties distributed across time and geography, this distributed clinical capacity is precisely what a civil defence structure would need to mobilise. Yet the review indicates that this capacity remains latent, unrecognised in workforce planning and unsupported by dedicated training.

The authors characterise this as a significant policy-practice gap in disaster nurse workforce planning and training for Europe’s security landscape. On the policy side, the Preparedness Union Strategy and the Common Security and Defence Policy articulate ambitious goals for societal resilience, stockpiling, crisis coordination and civil-military cooperation. On the practice side, there is no pan-European framework for preparing nurses to operate within a civil defence structure, no standardised curriculum content on conflict-related mass casualty care, and no consensus on the ethical and legal dimensions of nursing practice under wartime conditions. The result is a strategy that implicitly depends on a workforce that has never been asked to think of itself in those terms.

The remedy the authors propose is correspondingly structural rather than rhetorical. They argue that within the framework of the Preparedness Union Strategy, the European Union must prioritise the development and implementation of policies that promote pan-EU standardised training integrating nurses into civil defence planning. The emphasis on standardisation matters: health workforce readiness that varies from member state to member state would leave predictable seams in any coordinated response, particularly for cross-border emergencies where mutual assistance mechanisms would be invoked. Because nurses constitute the largest professional group within health services, any comprehensive civil defence strategy intended to support European societal resilience and meet people’s health needs during conflict will succeed or fail largely on whether that group is included by design or left out by omission.

The review also carries implications that reach beyond workforce planning into education and ethics. If nursing curricula across Europe are to incorporate civil defence competencies, educators will need clarity on what those competencies are, and the near-absence of European primary research means that curriculum development would currently rest on evidence generated in very different health systems and conflict contexts. Questions of professional ethics also loom: the obligations of civilian nurses during armed conflict, the boundaries between humanitarian and military roles, and the protection of health workers under international humanitarian law are all areas where the review’s thin evidence base offers little European guidance. These are the kinds of questions that a follow-up research agenda, which the review implicitly calls for, would need to address.

What the study ultimately delivers is a diagnosis rather than a cure. By systematically demonstrating that only 16 relevant articles exist across five databases and twenty-five years, Wells and colleagues have quantified the gap between Europe’s stated preparedness ambitions and the professional group on whom those ambitions would most heavily depend. The review’s conclusion is measured but pointed: if the European Union wants a comprehensive civil defence strategy that genuinely supports societal resilience during conflict, it must treat nurses not as incidental participants but as central planners, and it must build the training, policy and research infrastructure to match. As the Preparedness Union Strategy moves from declaration to implementation, the review suggests that the most numerous members of Europe’s health workforce are also its most important unprepared reserve.

Subject of Research: The role of nurses in European civil defence and disaster preparedness under the EU Preparedness Union Strategy

Article Title: Complex disaster and conflict-related civil defence – nurses’ role in European civil defence within the context of emerging threats and the European union preparedness union strategy – a scoping review

Article References: Wells, J. S. G., Bennett, L., Crowley, J., Dobrowolska, B., Pajnkihar, M., Palese, A., Rajendran, A., Vrbnjak, D., Zdunek, K., & Scheibein, F. (2026). Complex disaster and conflict-related civil defence – nurses’ role in European civil defence within the context of emerging threats and the European union preparedness union strategy – a scoping review. BMC Nursing. https://doi.org/10.1186/s12912-026-05106-9

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05106-9

Keywords: nurses, civil defence, European Union, hybrid warfare, disaster preparedness, scoping review, Preparedness Union Strategy, mass casualty events, nursing education, health policy, workforce planning, societal resilience