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INTRODUCTION: The 24-hour operation of medical emergency units involves crucial first-hand information and medical treatments, which could involve potential complications and disputes if not handled with the utmost professionalism. Effective logistical support and timely activation are crucial in mass casualty triage to prevent systematic treatment issues and chaos. OBJECTIVE: This study explores the integration of Healthcare Failure Mode and Effect Analysis (HFMEA) with a service blueprint to mitigate medical risks and enhance mass casualty triage efficiency in emergency units. METHOD: An expert team analyzed emergency unit standard operating procedure cases using a service blueprint to visually represent mass casualty triage scenarios. The HFMEA identified potential hazards and failure risks in healthcare service delivery during mass casualty triage. RESULTS: Fifteen high-risk hazard indexes exceeding the standard score of eight were identified among three main processes and thirty-one potential failure reasons. The initial operational time for mass casualty triage was approximately 104 min, significantly reduced to 34 min after process revision (p = 0.043, <0.05). CONCLUSIONS: This study demonstrates effective time management in mass casualty triage, potentially saving up to an hour. Improved operational efficiency allows for focused resuscitation efforts, alleviating concerns about timely patient flow initiation.
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Major incidents and mass casualty events can affect people of all ages. However, when planning the response to a major incident the focus is often on adult casualties rather than children. It is essential that the needs of paediatric patients are taken into account throughout major incident planning. Whether considering equipment, staffing or surgical and critical care capacity, hospitals should meet the needs of children as well as adults following a major incident and where possible, keep families together. The new Major Incident Triage Tool introduced in the National Health Service (NHS) in 2024 has a tendency to over triage paediatric casualties and so hospitals who may be receiving children following a UK major incident must be aware of this and plan for the potential implications. This article reviews the evidence and learning from previous mass casualty events and makes recommendations for hospitals to ensure that the needs of children will be met if a major incident occurs.
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Planejamento em Desastres , Incidentes com Feridos em Massa , Triagem , Humanos , Triagem/organização & administração , Criança , Planejamento em Desastres/organização & administração , Reino Unido , Serviço Hospitalar de Emergência/organização & administraçãoRESUMO
INTRODUCTION: Medical First Responders (MFRs) in the emergency department SUMMA 112 are tasked with handling the initial management of Mass Casualty Incidents (MCI) and building response capabilities. Training plays a crucial role in preparing these responders for effective disaster management. Yet, evaluating the impact of such training poses challenges since true competency can only be proven amid a major event. As a substitute gauge for training effectiveness, self-efficacy has been suggested. OBJECTIVE: The purpose of this study is to employ a pre- and post-test assessment of changes in perceived self-efficacy among MFRs following an intervention focused on the initial management of MCI. It also aimed to evaluate a self-efficacy instrument for its validity and reliability in this type of training. METHOD: In this study, we used a pretest (time 1 = T1) - post-test (time 2 = T2) design to evaluate how self-efficacy changed after a training intervention with 201 MFRs in initial MCI management. ANOVA within-subjects and between subjects analyses were used. RESULTS: The findings reveal a noteworthy change in self-efficacy before and after training among the 201 participants. This suggests that the training intervention positively affected participants' perceived capabilities to handle complex situations like MCI. CONCLUSION: The results allow us to recommend a training program with theory components together with practical workshops and live, large-scale simulation exercises for the training of medical first responders in MCI, as it significantly increases their perception of the level of self-efficacy for developing competencies associated with disaster response.
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Socorristas , Incidentes com Feridos em Massa , Autoeficácia , Humanos , Masculino , Feminino , Socorristas/psicologia , Socorristas/educação , Adulto , Planejamento em Desastres , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
This compilation covers emergency medical management lessons from the February 6th Kahramanmaras earthquakes. The objective is to review relevant literature on emergency services patient management, focusing on Koenig's 1996 Simple Triage and Rapid Treatment (START) and Secondary Assessment of Victim Endpoint (SAVE) frameworks. Establishing a comprehensive seismic and mass casualty incident (MCI) protocol chain is the goal. The prehospital phase of seismic MCIs treats hypovolemia and gets patients to the nearest hospital. START-A plans to expedite emergency patient triage and pain management. The SAVE algorithm is crucial for the emergency patient secondary assessment. It advises using Glasgow Coma Scale, Mangled Extremity Severity Score, Burn Triage Score, and Safe Quake Score for admission, surgery, transfer, discharge, and outcomes. This compilation emphasizes the importance of using diagnostic tools like bedside blood gas analyzers and ultrasound devices during the assessment process, drawing from 6 February earthquake research. The findings create a solid framework for improving emergency medical response strategies, making them applicable in similar situations.
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Terrorist attacks involving children raised concern regarding the preparedness to treat pediatric trauma patients during mass casualty incidents (MCIs). The purpose of this project was to assess the resources available in Milan to respond to MCIs as the 2016 Bastille Day attack in Nice. Literature and guidelines were reviewed and minimal standard requirements of care of pediatric trauma patients in MCIs were identified. The hospitals that took part in the study were asked to answer a survey regarding their resource availability. An overall surge capability of 40-44 pediatric trauma patients was identified, distributed based on age and severity, hospital resources, and expertise. The findings showed that adult and pediatric hospitals should work in synergy with pediatric trauma centers, or offer an alternative if there is none, and should be included in disaster plans for MCIs. Simulations exercises need to be carried out to evaluate and validate the results.
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Planejamento em Desastres , Incidentes com Feridos em Massa , Terrorismo , Humanos , Incidentes com Feridos em Massa/estatística & dados numéricos , Itália , Planejamento em Desastres/métodos , Terrorismo/estatística & dados numéricos , Criança , Inquéritos e Questionários , Pediatria/métodos , Pediatria/estatística & dados numéricos , Pediatria/normas , Pré-Escolar , Adolescente , Capacidade de Resposta ante Emergências/estatística & dados numéricosRESUMO
BACKGROUND: Clinical acumen represents only part of being adequately equipped to attend a major incident. The emotive sights, sounds and smells of these dynamic environments are all-encompassing experiences, and responders must also be armed with the emotional preparedness to perform their clinical or managerial duties effectively, as well as the mental resilience to facilitate professional continuance. Despite this, limited training and a sparsity of evidence exists to guide developments within this domain. Historically, major incident training has focused on clinical theory acquisition, but irrespective of how comprehensive the learning materials, they are of little consequence if tandem steps to cultivate mental resilience and emotional preparedness are absent. High-Fidelity Simulation (HFS) has a growing reputation as an effective means of bridging important gaps between theory and practice. This pilot study aimed to measure student's self-reported perception of their readiness to respond to a major incident following a large-scale HFS. METHODS: Quantitative data was obtained from a sample of 108 students undertaking paramedic science, physician associate studies and adult nursing degree programmes. A bespoke questionnaire was developed to measure self-reported clinical acumen, mental and emotional preparedness. RESULTS: 91% of students agreed the combination of theoretical training and HFS provided made them feel clinically prepared to attend a real major incident; 86% agreed this experience had developed their mental resilience and 90% agreed that they felt emotionally prepared to attend a major incident. CONCLUSION: Within this pilot study, the blend of theoretical training and HFS contributed to self-reported clinical acumen, mental and emotional preparation, in learners training to work in disaster environments or emergency medicine settings.
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Incidentes com Feridos em Massa , Resiliência Psicológica , Humanos , Projetos Piloto , Masculino , Feminino , Adulto , Emoções , Inquéritos e Questionários , Treinamento com Simulação de Alta Fidelidade , Adulto Jovem , Competência ClínicaRESUMO
The primary ethical principle guiding general medical practice is autonomy. However, in mass casualty (MASCAL) or disaster scenarios, the principles of beneficence and justice become of foremost concern. Despite multiple reviews, publications, and training courses available to prepare for a MASCAL incident, a minority of physicians and healthcare providers are abreast of these. In this review, we describe several MASCAL scenarios and their associated ethical, moral, and medicolegal quandaries in attempts to curb potential future misadventures.
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On October 7, 2023, Israel experienced the worst terror attack in its history - 1,200 people were killed, 239 people were taken hostage, and 1,455 people were wounded. This mass-casualty event (MCE) was more specifically a mega terrorist attack. Due to the overwhelming number of victims who arrived at the two closest hospitals, it became necessary to implement secondary transfers to centers in other areas of the country. Historically, secondary transfer has been implemented in MCEs but usually for the transfer of critical patients from a Level 2 or Level 3 Trauma Center to a Level 1 Center. Magen David Adom (MDA), Israel's National Emergency Pre-Hospital Medical Organization, is designated by the Health Ministry as the incident command at any MCE. On October 7, in addition to the primary transport of victims by ambulance to hospitals throughout Israel, they secondarily transported patients from the two closest hospitals - the Soroka Medical Center (SMC; Level 1 Trauma Center) in Beersheba and the Barzilai Medical Center (BMC; Level 2 Trauma Center) in Ashkelon. Secondary transport began five hours after the event started and continued for approximately 12 hours. During this time, the terrorist infiltration was still on-going. Soroka received 650 victims and secondarily transferred 26, including five in Advanced Life Support (ALS) ambulances. Barzilai received 372 and secondarily transferred 38. These coordinated secondary transfers helped relieve the overwhelmed primary hospitals and are an essential component of any MCE strategy.
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Ambulâncias , Incidentes com Feridos em Massa , Terrorismo , Israel , Humanos , Serviços Médicos de Emergência/organização & administração , Transferência de PacientesRESUMO
BACKGROUND: Medical professionals can use mass-casualty triage systems to assist them in prioritizing patients from mass-casualty incidents (MCIs). Correct triaging of victims will increase their chances of survival. Determining the triage system that has the best performance has proven to be a difficult question to answer. The Advanced Prehospital Triage Model (Modelo Extrahospitalario de Triaje Avanzado; META) and Sort, Assess, Lifesaving Interventions, Treatment/Transport (SALT) algorithms are the most recent triage techniques to be published. The present study aimed to evaluate the META and SALT algorithms' performance and statistical agreement with various standards. The secondary objective was to determine whether these two MCI triage systems predicted patient outcomes, such as mortality, length-of-stay, and intensive care unit (ICU) admission. METHODS: This retrospective study used patient data from the trauma registry of an American College of Surgeons Level 1 trauma center, from January 1, 2018 through December 31, 2020. The sensitivity, specificity, and statistical agreement of the META and SALT triage systems to various standards (Revised Trauma Score [RTS]/Sort Triage, Injury Severity Score [ISS], and Lerner criteria) when applied using trauma patients. Statistical analysis was used to assess the relationship between each triage category and the secondary outcomes. RESULTS: A total of 3,097 cases were included in the study. Using Sort triage as the standard, SALT and META showed much higher sensitivity and specificity in the Immediate category than for Delayed (Immediate sensitivity META 91.5%, SALT 94.9%; specificity 60.8%, 72.7% versus Delayed sensitivity 28.9%, 1.3%; specificity 42.4%, 28.9%). With the Lerner criteria, in the Immediate category, META had higher sensitivity (77.1%, SALT 68.6%) but lower specificity (61.1%) than SALT (71.8%). For the Delayed category, SALT showed higher sensitivity (META 61.4%, SALT 72.2%), but lower specificity (META 75.1%, SALT 67.2%). Both systems showed a positive, though modest, correlation with ISS. For SALT and META, triaged Immediate patients tended to have higher mortality and longer ICU and hospital lengths-of-stay. CONCLUSION: Both META and SALT triage appear to be more accurate with Immediate category patients, as opposed to Delayed category patients. With both systems, patients triaged as Immediate have higher mortality and longer lengths-of-stay when compared to Delayed patients. Further research can help refine MCI triage systems and improve accuracy.
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Incidentes com Feridos em Massa , Triagem , Humanos , Estudos Retrospectivos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Algoritmos , Ferimentos e Lesões/terapia , Ferimentos e Lesões/mortalidade , Serviços Médicos de Emergência , Sistema de Registros , Centros de Traumatologia , Escala de Gravidade do Ferimento , IdosoRESUMO
Mass casualty incidents and massive transfusion requirements continue to plague the USA with hemorrhage remaining the number one cause of death in trauma. The unfortunate reality of numerous mass shootings in Southwest Texas has led to the need for a way in which to provide blood during these events as rapidly as it is required. Multiple agencies within the Southwest Texas system have united to help provide this life-saving blood to people when they need it most. This effort began with the development of a system for safe, efficient, and now widespread use of whole blood in the region. After demonstrating the success of delivering large quantities of blood during the Uvalde shooting, we have begun to develop a walking blood bank that is similar to what the miliary uses on the battlefield. The concept behind this initiative is to have a cohort of whole blood donors who are preselected to join the program which is now dubbed 'Heroes in Arms'. These donors will be called upon to donate whole blood during a massive transfusion event. Their blood will be rapidly screened prior to transfusion to the patient. This blood will still undergo the normal rigorous testing and, should any potentially transmissible diseases by discovered post-transfusion, the individual who received that product will be treated accordingly. Given the low rate of transmissible disease among this preselected population, combined with rapid screening prior to transfusion, the risk of a person receiving a transmissible disease is insignificant in comparison to the benefit of having blood to transfuse during hemorrhage. This model is a promising collaborative effort to provide in a timely and sufficient blood product in cases of major need which will consequently minimize the number of traumatically injured civilian patients who die from hemorrhage.
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INTRODUCTION: Intentional mass-casualty incidents (IMCIs) involving motor vehicles (MVs) as weapons represent a growing trend in Western countries. This method has resulted in the highest casualty rates per incident within the field of IMCIs. Consequently, there is an urgent requirement for a timely and accurate casualty estimation in MV-induced IMCIs to scale and adjust the necessary health care resources. STUDY OBJECTIVE: The objective of this study is to identify the factors associated with the number of casualties during the initial phase of MV-IMCIs. METHODS: This is a retrospective, observational, analytical study on MV-IMCIs world-wide, from 2000-2021. Data were obtained from three different sources: Targeted Automobile Ramming Mass-Casualty Attacks (TARMAC) Attack Database, Global Terrorism Database (GTD), and the vehicle-ramming attack page from the Wikipedia website. Jacobs' formula was used to estimate the population density in the vehicle's route. The primary outcome variables were the total number of casualties (injured and fatalities). Associations between variables were analyzed using Spearman's correlation coefficient and simple linear regression. RESULTS: Forty-six MV-IMCIs resulted in 1,636 casualties (1,430 injured and 206 fatalities), most of them caused by cars. The most frequent driving pattern was accelerating whilst approaching the target, with an average speed range between four to 130km/h and a distance traveled between ten to 2,260 meters. The people estimated in the MV-IMCI scenes ranged from 36-245,717. A significant positive association was found of the number affected with the estimated crowd in the scene (R2: 0.64; 95% CI, 0.61-0.67; P <.001) and the average vehicle speed (R2: 0.42; 95% CI, 0.40-0.44; P = .004). CONCLUSION: The estimated number of people in the affected area and vehicle's average speed are the most significant variables associated with the number of casualties in MV-IMCIs, helping to enable a timely estimation of the casualties.
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Planejamento em Desastres , Incidentes com Feridos em Massa , Terrorismo , Humanos , Triagem/métodos , Aglomeração , Veículos AutomotoresRESUMO
OBJECTIVE: As disasters are rare and high-impact events, it is important that the learnings from disasters are maximized. The aim of this study was to explore the effect of exposure to a past disaster or mass casualty incident (MCI) on local hospital surge capacity planning. METHODS: The current hospital preparedness plans of hospitals receiving surgical emergency patients in Finland were collected (n = 28) and analyzed using the World Health Organization (WHO) hospital emergency checklist tool. The surge capacity score was compared between the hospitals that had been exposed to a disaster or MCI with those who had not. RESULTS: The overall median score of all key components on the WHO checklist was 76% (range 24%). The median surge capacity score was 65% (range 39%). There was no statistical difference between the surge capacity score of the hospitals with history of a disaster or MCI compared to those without (65% for both, P = 0.735). CONCLUSION: Exposure to a past disaster or MCI did not appear to be associated with an increased local hospital disaster surge capacity score. The study suggests that disaster planning should include structured post-action processes for enabling meaningful improvement after an experienced disaster or MCI.
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Planejamento em Desastres , Incidentes com Feridos em Massa , Humanos , Capacidade de Resposta ante Emergências , Finlândia , Hospitais , Serviço Hospitalar de EmergênciaRESUMO
BACKGROUND: Repeated triage training is necessary to maintain and improve the accuracy of simple triage and rapid treatment (START), a popular triage method. Virtual reality (VR) may be more effective than conventional training methods. This study aimed to verify the educational usefulness of START using VR originally developed for students. METHODS: A VR was initially developed with a function that allowed students to select the triage procedure and its evaluation. Triage was performed using a simple modified START method, and eight scenarios were developed. The participants included 70 paramedic students classified into VR and live lecture groups. They took a 20-question written test that evaluated their academic ability before the course. After the course, a practical test and a 20-question written test were conducted. The total score of the practical test was 43 points. Triage procedure (1 point), observation and evaluation (1-5 points), and triage categories (1 point) were evaluated in this test. RESULTS: The VR and live lecture groups consisted of 33 and 29 participants, respectively. No significant differences were observed pre- and post-test. In the practical test, the median (interquartile range) score was 29 (26-32) and 25 (23-29) for the VR and live lecture groups, respectively, with the VR group scoring significantly higher (P=0.03). CONCLUSION: Our results confirmed the educational usefulness of selective VR for active learning of START. Therefore, VR combined with live lectures and simulations would be an optimal educational technique.
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Incidentes com Feridos em Massa , Realidade Virtual , Humanos , Triagem/métodos , Competência Clínica , EstudantesRESUMO
PURPOSE: To investigate prehospital preparedness work for Mass Casualty Incidents (MCI) and Major Incidents (MI) in Norway. METHOD: A national cross-sectional descriptive study of Norway's prehospital MI preparedness through a web-based survey. A representative selection of Rescue and Emergency Services were included, excluding Non-Governmental Organisations and military. The survey consisted of 59 questions focused on organisation, planning, education/training, exercises and evaluation. RESULTS: Totally, 151/157 (96%) respondents answered the survey. The results showed variance regarding contingency planning for MCI/MI, revisions of the plans, use of national triage guidelines, knowledge requirements, as well as haemostatic and tactical first aid skills training. Participation in interdisciplinary on-going life-threatening violence (PLIVO) exercises was high among Ambulance, Police and Fire/Rescue Emergency Services. Simulations of terrorist attacks or disasters with multiple injured the last five years were reported by 21/151 (14%) on a regional level and 74/151 (48%) on a local level. Evaluation routines after MCI/MI events were reported by half of the respondents (75/151) and 70/149 (47%) described a dedicated function to perform such evaluation. CONCLUSION: The study indicates considerable variance and gaps among Prehospital Rescue and Emergency Services in Norway regarding MCI/MI preparedness work, calling for national benchmarks, minimum requirements, follow-up routines of the organisations and future reassessments. Implementation of mandatory PLIVO exercises seems to have contributed to interdisciplinary exercises between Fire/Rescue, Police and Ambulance Emergency Service. Repeated standardised surveys can be a useful tool to assess and follow-up the MI preparedness work among Prehospital Rescue and Emergency Services at a national, regional and local level.
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Planejamento em Desastres , Serviços Médicos de Emergência , Incidentes com Feridos em Massa , Humanos , Noruega , Estudos Transversais , Serviços Médicos de Emergência/normas , Serviços Médicos de Emergência/organização & administração , Planejamento em Desastres/organização & administração , Inquéritos e Questionários , Triagem/normasRESUMO
Medical surge events require effective coordination between multiple partners. Unfortunately, the information technology (IT) systems currently used for information-sharing by emergency responders and managers in the United States are insufficient to coordinate with health care providers, particularly during large-scale regional incidents. The numerous innovations adopted for the COVID-19 response and continuing advances in IT systems for emergency management and health care information-sharing suggest a more promising future. This article describes: (1) several IT systems and data platforms currently used for information-sharing, operational coordination, patient tracking, and resource-sharing between emergency management and health care providers at the regional level in the US; and (2) barriers and opportunities for using these systems and platforms to improve regional health care information-sharing and coordination during a large-scale medical surge event. The article concludes with a statement about the need for a comprehensive landscape analysis of the component systems in this IT ecosystem.
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Planejamento em Desastres , Tecnologia da Informação , Incidentes com Feridos em Massa , Humanos , Atenção à Saúde , Sistemas de Informação , Capacidade de Resposta ante Emergências , Estados UnidosRESUMO
Mass casualty events particularly those requiring multiple simultaneous operating rooms are of increasing concern. Existing literature predominantly focuses on mass casualty care in the emergency department. Hospital disaster plans should include a component focused on preparing for multiple simultaneous operations. When developing this plan, representatives from all segments of the perioperative team should be included. The plan needs to address activation, communication, physical space, staffing, equipment, blood and medications, disposition offloading, special populations, and rehearsal.
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Using a discrete-event simulation (DES) model, the current disaster plan regarding the allocation of multiple injured patients from a mass casualty incident was evaluated for an acute specialty hospital in Vienna, Austria. With the current resources available, the results showed that the number of severely injured patients currently assigned might have to wait longer than the medically justifiable limit for lifesaving surgery. Furthermore, policy scenarios of increasing staff and/or equipment did not lead to a sufficient improvement of this outcome measure. However, the mean target waiting time for critical treatment of moderately injured patients could be met under all policy scenarios. Using simulation-optimization, an optimal staff-mix could be found for an illustrative policy scenario. In addition, a multiple regression model of simulated staff-mix policy scenarios identified staff categories (number of radiologists and rotation physicians) with the highest impact on waiting time and survival. In the short term, the current hospital disaster plan should consider reducing the number of severely injured patients to be treated. In the long term, we would recommend expanding hospital capacity-in terms of both structural and human resources as well as improving regional disaster planning. Policymakers should also consider the limitations of this study when applying these insights to different areas or circumstances.
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Background and Aims: The effective response of emergency medical services in mass casualty incidents (MCIs) calls for sufficient preparation. The components of preparation must be determined first to achieve this goal. This study aimed to describe the elements of preparedness of emergency medical services for MCIs. Methods: A qualitative study was carried out on emergency medical service systems in Iran (from April 2022 to mid-March 2023), using in-depth semistructured interviews with participants who were managers and members of the incident command team, experts, technicians, paramedics, and telecommunicators of emergency medical services. Interviews were carried out face-to-face and via telephone. The data were collected using voice recorder and transcript and analyzed by content analysis method. This study was conducted using the consolidated criteria for reporting qualitative research. Results: Thirty-six participants were included in the study. A total of 834 codes were analyzed. Thirteen components were extracted from the study and classified as five categories including "Strengthening management and organization," "individual and group empowerment," "capacity expansion," "technology and infrastructure development," and "operational response measures." Conclusion: Emergency medical service preparedness in response to MCIs is a critical issue. For improving preparedness, the main components must be identified. The study results described the elements of emergency medical service preparedness, which could be used as a framework for developing the national model of emergency medical service preparedness in MCIs.
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BACKGROUND AND RESEARCH QUESTION: In case of events such as a cyber attack or a mass casualty incident, ad hoc measures have to be taken in hospitals. As part of the critical infrastructure, hospitals are required by law to prepare, update and exercise alarm and emergency plans for various special situations. The processes and instruments involved for emergency response are defined in the hospital alert and emergency planning. The present study aims to explain with which resources and for which special situations hospitals are prepared. METHODS: A prospective, exploratory, anonymous survey of hospitals in Germany was conducted. Hospitals with both internal medicine and surgery departments were included. Out of 2497 hospitals listed in the German Hospital Directory ( www.deutsches-krankenhaus-verzeichnis.de ), 1049 met the inclusion criteria. After correcting for hospital groups with shared administrations, 850 employees were identified and contacted by email. Quality and risk management managers were asked about resources, risks, and content of their own hospital alert and emergency planning using a standardized questionnaire. The survey was conducted using the online platform EFS Survey (Tivian XI GmbH, Cologne) via www.unipark.de . Access to the survey was via a nonpersonalized hyperlink. Apart from the size and type of hospital surveyed, no data were collected that would allow identification of an individual person. RESULTS: Of the participating hospitals 45% (nâ¯= 43) were primary care hospitals, 24% (nâ¯= 23) were specialty care hospitals, 10% (nâ¯= 9) were nonuniversity maximum care hospitals, and 21% (nâ¯= 20) were university maximum care hospitals. In total 95 hospitals participated in the survey, of which 98% (nâ¯= 93) reported having a hospital alert and emergency plan. Preparation for individual scenarios varied widely. Of the participating hospitals 45% (nâ¯= 43) reported having been the target of cyber attacks with an emphasis on maximum care hospitals (55%, nâ¯= 11 of 20). Technical redundancy for computer systems is available in 67% (nâ¯= 63) of participating hospitals, while independent means of communication exist in 50% (nâ¯= 47) of hospitals. A physician-staffed crisis and disaster management unit existed in 60% (nâ¯= 56) of the surveyed hospitals. At least a part time position for planning issues was installed in 12 hospitals. CONCLUSION: Most participating hospitals are aware of the need for a hospital alert and emergency plan and have various scenario-specific plans in place. Especially mass casualty events, fire and hospital evacuation scenarios are uniformly covered among participating hospitals; however, gaps appear to exist not only for chemical, biological or radionuclear situations but also especially in the area of extreme weather events and infrastructure failures. Only about two thirds of all participating hospitals have contingency plans for water supply and/or heating failures. An important limitation of the study is the comparatively low response rate of 12.9% (nâ¯= 95 of 850). While primary care hospitals were underrepresented in the study, 32% of Germany's larger hospitals (>â¯800 beds) participated. In the future, there is a particular need to engage enough medical staff in the area of hospital alert and emergency planning and refunding of these measures by hospitals.