The trap of sufficient preparation

Most hospitals in Europe have an emergency plan. Many have updated it recently. Some run drills.

Yet the evidence, and the experience of working alongside health systems under real pressure, consistently points to the same gap: the distance between having a plan and being able to execute it is wider than most institutions realize, and it is almost never visible until the moment it matters.

In 2017, during the mass casualty event in Las Vegas, numerous hospitals did not respond when emergency dispatch attempted to notify them of the incoming surge. The regional communication network took over an hour to activate. In many cases, hospitals learned about the incident only when the first patients walked through the door.

This was not a failure of planning. These hospitals had plans. It was a failure of practiced readiness, of the kind that only becomes visible under real conditions, or under simulated ones designed to replicate them.

A recent national study of hospital preparedness in Norway, a country with a mature emergency management culture and well-developed contingency frameworks, found that while structural preparedness was largely in place, training and education for specific roles and functions was absent in the majority of hospitals surveyed.

Norway is not an outlier. It is a data point.

The current security environment in Europe, combined with the increasing frequency of climate-related disruptions, means that the probability of a hospital facing a genuine mass casualty event is no longer theoretical. The question is not whether a plan exists. It is whether the people responsible for executing it have ever actually practiced doing so, under pressure, with incomplete information, and without the luxury of reading the document first.