Table 2.

Summary and recommendations from included publications

Reference no.	Country/countries	Main sporting event(s) discussed	Year(s) of sporting event discussed	CBRNE threat type(s)	Recommendations given for training, management, planning, surveillance, communications, and strategies
9	Dominican Republic	Pan-American Games	2003	Chemical, biological, radiological, explosives, terrorism broadly	Advocate integrated tactical and medical strike teams as well as use of surveillance tools Extensive preplanning must be conducted
10	United Kingdom	Olympics	2012	Explosives, terrorism broadly	Use of standardized Olympic security model Acknowledge model does not suit all contexts
11	Brazil	Olympics	2016	Explosives, terrorism broadly	Advocate using multicriteria decision support-constructivist approach when designing a system capable of integrating security forces and ensuring the public’s safety Share information from meetings to stakeholders Use strengths, weaknesses, opportunities, threats matrix to identify strengths and weaknesses
12	Greece	Olympics	2004	Biological, terrorism broadly	Advocate using the Pulsar technique when conducting syndromic surveillance to detect biological threats
13	UK, Iran, Germany, USA, Greece	Olympics	2012	Chemical, biological, radiological, nuclear, explosives	Plans need to predict crowd behavior Resources toward hospitals rather than scene of CBRNE incident Training population and medical personnel in CBRNE response Fixed decontamination stations International CBRNE committee Exercise test plans, day or night drills
14	USA	Marathon	2013	Explosives, terrorism broadly	Emphasize that healthcare facilities perform gap assessments Emphasize importance of reevaluation, training, and preparation
15	USA	Olympics	2002	Biological	Culture of cooperation helpful for preparation of surveillance system Negotiations around health data sharing were time consuming
16	USA	Marathon	2013	Explosives, terrorism broadly	Information systems in healthcare facilities were the greatest bottleneck High volume of communication after incident Highly flexible and collaborative leadership structure across institutions led to successful response
17	Australia, USA	Olympics	2000	Biological	Surveillance for bioterrorism and infectious disease Cooperation between public health and intelligence committee effective communication
18	UK	Olympic and Paralympic Games	2012	Biological	Use of surveillance effective Could use online reporting tool
19	Germany, USA, UK, China, Australia, Brazil	Olympics	1972, 1976, 1996, 2008, 2012	Explosives, terrorism broadly	The authors advocate for awareness of terrorism and antiterrorist technology Training in customs matters CCTV Surveillance Cyber security Stop and search authorization Redevelopment programs
20	UK	Olympics	2012	Chemical biological radiological nuclear explosives terrorism	Use of computer simulation in planning to examine potentially dangerous scenarios Training to prepare for threats
21	UK	Olympics and Paralympic Games	2012	Biological	Surveillance tool effective 2-Year planning essential International trainings Surveillance models not universally applicable
22	Australia	Olympics	2000	Biological, terrorism broadly	Carefully planning, comprehensive coverage of public health issues Timely reporting and communication process contributed to the success of public health surveillance The future system needs to be flexible enough to detect unexpected incidents Detailed planning for the surveillance system started roughly 3 years before the games Automated production of reports allowed for more time for analysis Clearly defined communication structure helpful Emergency department be issued with influenza diagnostic kits in future events
23	Greece	Olympics	2004	Radiological, nuclear	Physical protection of nuclear facilities Improved response training Improved threat assessment
24	USA	Hockey games	2008	Explosives	Use of multiple technologies and systems to detect explosive threats Tests such as vendor acceptance tests, integration tests, scoping tests, and countermeasure characterization Larger crowds created blocking effects for the surveillance technology
25	Worldwide	Sport megaevents	2020	Biological	Because volunteers constitute a large part of preparation for events, they must be considered part of security management
26	UK, USA, Australia, Singapore, Greece, China	Olympics and Paralympics	2012	Chemical, biological, radiological	Collaboration and planning to identify threats Reassuring government and media there is not health incidents Robust communication Information brought to a single point Wide range of sources for surveillance system
27	USA	Super Bowl	2019	Biological, terrorism broadly	Utilized the 6 E framework for security preparation and advocated for its use for other events Public health actors need to have explicitly clarified roles before the event and need to have effective partnerships Advocate tabletop exercises
28	Russia	FIFA world championship	2018	Biological	Utilize legal documents to see safety requirements Stop actors working with infectious agents before the games
29	Brazil, Italy, USA, Indonesia, West Africa, Thailand, Micronesia, Philippines, Easter Island South-Pacific	Olympics	2016	Biological	Zika specific advice for travelers to the Olympic games Precautions recommended regarding hygiene, standard, and contact behaviors
30	USA	Olympics	1996	Chemical, biological, explosives	Prioritization of potential threats Training in recognition and treatment of CBRNE threats Use existing infrastructure Preparatory plans and policies Need resources to conduct epidemiological investigation Aid from specialists in CBRNE required
31	Japan	Sports festival and Olympics	2013 and 2020	Biological	Surveillance allowed for earlier response Allow for government to be in contact with necessary parties
32	Australia	Olympics	2000	Explosives, terrorism broadly	Cost of surveillance and security measures in rights and privacy
33	USA	Marathon	2013	Explosives, terrorism broadly	Use of unified command structure for response Need to understand dangers specific to the race (weather, number of runners) Training of staff and volunteers Ensuring proper supply Ensuring multiple lines of communication