title: An after-action review tool for EDs: learning from mass casualty incidents.
abstract: BACKGROUND
  Conducting a thorough after-action review (AAR) process is an important component in improving preparedness for mass casualty incidents (MCIs).
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  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.
authors.affiliation: Department of Emergency Medicine, The Leon and Mathilda Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Greenberg
authors.initials: G
authors.lastname: Tami
authors.forename: Adini
authors.initials: A
authors.lastname: Bruria
authors.forename: Eden
authors.initials: E
authors.lastname: Fabiana
authors.forename: Chen
authors.initials: C
authors.lastname: Tami
authors.forename: Ankri
authors.initials: A
authors.lastname: Tali
authors.forename: Aharonson-Daniel
authors.initials: AD
authors.lastname: Limor
mesh_terms: D003697:Delphi Technique; D004189:Disaster Planning / Q000379:methods / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D007398:Interpersonal Relations; D007557:Israel; D007858:Learning; D054527:Mass Casualty Incidents; D010348:Patient Care Team / Q000458:organization & administration