# The role, challenges, and solutions of laboratories in disaster medicine: a systematic review

## TL;DR

This paper reviews how laboratories support disaster response, identifies challenges, and proposes solutions to improve their resilience.

## Contribution

A structured framework is proposed to enhance laboratory system resilience during disasters, based on systematic review findings.

## Key findings

- Clinical, public health, and veterinary labs form the 'National Core Layer', while POCT and mobile labs act as flexible extensions.
- Disaster-related laboratory challenges align along three axes: Scarcity, Complexity, and Security.
- Documented solutions showed mixed effectiveness in addressing these challenges.

## Abstract

Laboratory systems play a critical role in disaster response, yet evidence remains fragmented. This systematic review aimed to describe the roles of clinical, public health, and veterinary laboratories, specifically characterizing Point-of-Care Testing (POCT) and Mobile Laboratories (ML) as flexible operational extensions of the central laboratory system across disaster phases; identify and compare laboratory-related challenges by disaster type; and synthesize documented solutions and their effectiveness.

4,323 studies published between 2000 and 2025 were identified through searches in PubMed, Embase, Scopus, grey literature, and snowballing. Study screening, data extraction, and methodological quality appraisal were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Risk of bias was assessed using the critical appraisal checklist for qualitative research developed by the Joanna Briggs Institute (JBI).

Fifty-two studies were included. While clinical, public health, and veterinary laboratories form the “National Core Layer,” POCT and rapid response mobile laboratory were identified as the “Surge Capacity Layer,” functioning as flexible extended arms. Instead of random barriers, laboratory challenges were found to align along three operational axes: (1) Scarcity (infrastructure fragility and workforce shortages), predominantly in low-resource settings; (2) Complexity (data fragmentation and quality assurance variability), driven by technological heterogeneity in high-income settings; and (3) Security (regulatory barriers and cybersecurity risks), characterizing conflict and bio-risk environments. Documented solutions showed mixed effectiveness.

Building on these insights, we propose a structured framework to guide scalable strategies that enhance laboratory system resilience for disaster preparedness and response.

The protocol was prospectively registered in PROSPERO (CRD420251053068) https://www.crd.york.ac.uk/PROSPERO/view/CRD420251053068.