Preparedness in Practice: Strengthening Healthcare System Disaster Response and Resilience

The mass casualty incident following the October 7, 2023 attack in Israel tested the limits of healthcare systems' emergency preparedness and offers important insights for institutions worldwide. Tel Aviv Medical Center (TLVMC), a Level I Trauma Center, played a frontline role in responding to the crisis, while continuing routine operations under persistent threats. Despite years of disaster preparation, TLVMC faced unprecedented operational strain. Approximately 30% of medical staff were mobilized for military reserve duty, while many remaining personnel worked under direct threat or coped with personal losses. To evaluate TLVMC's performance and extract transferable lessons, an internal review was conducted using a questionnaire distributed to 14 deputy directors of TLVMC's senior management. Participants represented all core hospital divisions, including finance, human resources, operations, emergency medicine, disaster preparedness, nursing, medical staff, rehabilitation, patient safety, research and development, logistics (including IT), ambulatory care, marketing (customer service and patient experience), and the spokesperson's office. Analysis of responses identified actionable strategies categorized by priority - essential, recommended, and optional - across clinical and administrative domains. Core clinical imperatives included early psychiatric integration, robust rehabilitation services, and routine multidisciplinary emergency simulations. Important administrative measures involved securing risk-appropriate protected treatment zones, ensuring uninterrupted communication channels, and establishing emergency-specific financial reserves. These findings align with The Sendai Framework for Disaster Risk Reduction, which emphasizes proactive investment, governance, and continuous preparedness as key to healthcare system resilience. Lessons from TLVMC underscore the need for legislation-backed emergency budgets, standardized coordination protocols, and infrastructure capable of withstanding sustained crisis conditions. As large-scale disasters ranging from natural hazard to war to pandemic become increasingly complex, healthcare institutions must evolve from reactive to anticipatory systems. Tel Aviv Medical Center's model presents a globally relevant approach to institutional learning and readiness. By translating frontline insights into scalable strategies, healthcare systems can strengthen their preparedness and resilience in future crises.