title: Adequacy of US Hospital Security Preparedness for Mass Casualty Incidents: Critical Lessons From the Israeli Experience.
abstract: BACKGROUND
  Due to Israel's threat environment, Israeli hospitals have developed effective and innovative security preparations for responding to all-hazards incidents. Although Israeli hospital preparedness has been the subject of international praise and attention, there has been a dearth of research focused specifically on applying Israeli hospital security measures to the US hospital setting to augment emergency planning.
  
  
  OBJECTIVE
  This study examined practical and cost-effective lessons from the Israeli experience for improving US hospital security preparedness for a wide range of mass casualty incidents, both natural and man-made.
  
  
  METHODS
  Sixty semi-structured interviews were conducted with officials throughout Israel's and America's health, defense, and emergency response communities. Hospital preparedness was examined and disaster drills were evaluated in both countries, with San Francisco hospitals analyzed as a case study. Qualitative analysis was conducted and recommendations were made on the basis of an all-hazards approach to emergency preparedness.
  
  
  RESULTS
  US hospitals examined in this study had not undertaken crucial preparations for managing the security consequences of a large-scale disaster. Recommendations from Israel included installing permanent emergency signage, improving security perimeter protocols and training, increasing defense against primary and secondary attacks, enhancing coordination with law enforcement, the National Guard, and other outside security agencies, and conducting more frequent and realistic lockdown exercises.
  
  
  CONCLUSIONS
  A number of US hospitals have overlooked the important role of security in emergency preparedness. This study analyzed practical and cost-effective security recommendations from Israel to remedy this dangerous deficiency in some US hospitals' disaster planning.
authors.affiliation: Office of the General Counsel, Department of Homeland Security, Department of Homeland Security, Washington, District of Columbia.
authors.forename: Michele
authors.initials: M
authors.lastname: Golabek-Goldman
mesh_terms: D003362:Cost-Benefit Analysis; D004189:Disaster Planning / Q000592:standards*; D004636:Emergency Service, Hospital; D006801:Humans; D007407:Interviews as Topic; D007557:Israel; D054527:Mass Casualty Incidents; D036301:Qualitative Research; D017751:Safety Management / Q000592:standards*; D014481:United States