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Additional file 1: Study questionnaire.

Additional file 1: Table S1. List of tags representing the set of concepts conveyed in the interviews

Additional file 2: Heatwave-protective answers given by respondents per country.

Though hospitals' operational continuity is crucial, full institutional evacuation may at times be unavoidable. The study's objective was to establish criteria for discharge of patients during complete emergency evacuation and compare scope of patients suitable for discharge pre/post implementation of criteria.Standards for patient discharge during an evacuation were developed based on literature and disaster managers. The standards were reviewed in a two-round Delphi process. All hospitals in Israel were requested to identify inpatients' that could be released home during institutional evacuation. Potential discharges were compared in 2013-2014, before and after formulation of discharge criteria.Consensus exceeding 80% was obtained for four out of five criteria after two Delphi cycles. Average projected discharge rate before and after formulation of criteria was 34.2% and 42.9%, respectively (p0.001). Variance in potential dischargeable patients was 31-fold less in 2014 than in 2013 (MST=8,452 versus MST=264,366, respectively; p0.001). Differences were found between small, medium and large hospitals in mean rate of dischargeable patients: 52.1%, 41.5% and 42.2%, respectively (p=0.001).The study's findings enable to forecast the extent of patients that may be released home during full emergency evacuation of a hospital; thereby facilitating preparedness of contingency plans.

Background Conducting a thorough after-action review (AAR) process is an important component in improving preparedness for mass casualty incidents (MCIs). Purposes The study aimed to develop a structured AAR tool for use by medical teams in emergency departments after an MCI and to identify the best possible procedure for its conduct. Basic procedures On the basis of knowledge acquired from an extensive literature review, a structured tool for conducting an AAR in the emergency department was developed. A modified Delphi process was conducted to achieve content validity of the tool, involving 48 medical professionals from all 6 level I trauma centers in Israel. The AAR tool was tested during a simulated MCI drill. Main findings All experts support the conduct of an AAR in the ED after an MCI to build and maintain capacity for an adequate emergency response. More than 80% agreement was achieved regarding 14 components that were implemented in the proposed AAR tool. Ninety-four percent perceived that AARs should be conducted within 24 hours from the event using both written reports and face-to-face discussions. Both physicians and nurses should participate. The incident manager should lead the AAR, limiting the time allocated for each speaker and for the AAR in whole. Principle conclusions Conducting a structured AAR in all emergency departments after an MCI facilitates both learning lessons regarding the function of the medical staff and ventilation of feelings, thus mitigating anxieties and expediting a speedy return to normalcy.

The risk of bioterrorism in Israel has been perceived in the last few decades as a very serious threat. Maintaining preparedness for both natural and human-made biological events poses a great challenge to the healthcare system. The Israeli model for emergency preparedness is based on five main components: (1) comprehensive contingency planning, (2) command of operations, (3) central control, (4) coordination and cooperation, and (5) capacity building of healthcare personnel. The response for all types of emergencies is based on the all-hazards approach. Three main legal frameworks facilitate effective management of the healthcare system during times of emergency, including the Public Health Ordinance (1940), the Civil Defense Law (1951) and the National Health Insurance Act (1995). These allow for great flexibility and wide authority of the health care leaders to manage responses to communicable diseases, pandemics and bioterror events.