[Disasters and emergency situations: what have we learned from the past to prepare for the future?]

Israel has gained extensive experience in the mass casuaLty field, especially from dealing with terrorism events. This special issue of "Harefuah" includes articles that describe and analyze several aspects and approaches related to mass casualty event (MCE) preparedness and response strategies, based on Israel's experience. Feigenberg reports that Magen David Adom (MDA) was able to evacuate all urgent injuries during an MCE from the site to a hospital in 28 minutes, on average. Of the MCE casualties, 71% were evacuated directly to level 1 trauma centers. Rafalowski notes that the ability of MDA to implement organizational and operational Learning processes close to the time of the incident, as well as their modular operational approach, which allows flexibility in responding to simultaneous events, are probably among the reasons that have helped MDA reach a high Level of success in dealing with MCEs. Analysis of terrorism injury data demonstrates that these injuries, suffered by both children and adults, are characterized by increased complexity, with higher severity, higher in-patient mortality rates, and significantly greater use of precious hospital resources such as intensive care, operating rooms, CT, and days of hospitalization. Extensive experience dealing with MCEs has brought managerial insights to the entire health system, for instance in the hospitalization system and clinical management of injuries. In her article, Adini defines five major components for assessing the Israeli health system in emergencies. Shasha's article discusses the principles of hospital preparedness while working under fire. The importance of this subject has in recent years helped bring a more academic approach to emergency and disaster management in the world and in Israel, as enacted at Tel Aviv University's Multidisciplinary Master's Program in Emergency and Disaster Management, and also in other universities that focus on specific disciplines. In summary, achieving improvement requires continuous focus on preparedness, integration of new technologies, routine debriefings, and developing new coping strategies, education, training, and drills. These should all be part of daily preparedness routines. Only in this way can a high quality level of preparedness be maintained over time.