**5. Discussion**

The creation of hospital crisis managemen<sup>t</sup> plans, evacuation plans and procedures in the event of mass-casualty incidents, and the necessity for staff to be familiar with them, is an important step towards preparing for such events. However, the lack of such plans may lead to chaos and complete disorientation [38–42].

The research shows that the majority of the respondents knew that the institution at which they currently worked had a plan for dealing with mass-casualty incidents and disasters. Moreover, over 70% of respondents reported that they knew who was responsible for the managemen<sup>t</sup> of operations in crisis situations and were aware of the procedures to be followed during a disaster.

In mass-casualty incidents and disasters, due to the limited capacity and resources of the emergency services on site, it is not possible to provide medical assistance to all victims simultaneously. Some of them will have to wait for such assistance. In the first instance, medical assistance must be provided to victims who need it at that moment, i.e., people in immediate danger of death. This assistance must be effective. The aim is to provide maximum benefits to as many people as possible under specified conditions. The need to do what is best for victims of a mass-casualty incident or disaster makes it necessary to continuously apply medical segregation of the victims. Triage is one of the most important and often the only undertaking of rescue services providing quick control of the situation in the area of a mass-casualty incident or disaster [43].

In the study concerning triage, almost all respondents declared having the ability to conduct triage.

Each hospital should have its own evacuation plan, as every healthcare facility is different, with different architectural features, number of floors in the building, numbers of patients and their physical and mental condition, equipment, and many other features. Additionally, each event is

di fferent. Evacuation can take place in connection with a bomb threat when there are no obstacles in the form of smoke, fire, toxic products from combustion, problems with visibility, or time pressure—as happens in the case of fire. Proper evacuation of a hospital requires a well-thought-out strategy and good preparation and, in order to achieve this, drills carried out in advance [13].

The research demonstrates that the respondents are familiar with the procedures to be followed in case of evacuation in the event of a mass-casualty incident at their workplace. The developing of an evacuation plan for the healthcare facility, familiarizing the entire sta ff with it, and performing regular evacuation drills, are necessary to ensure the safety of patients and workers [13].

The impact of catastrophes can be avoided or reduced by adopting risk managemen<sup>t</sup> measures, which should be implemented by taking advantage of local resources and taking appropriate actions in terms of planning, education and training [44,45].

The human factor is a significant problem in the proper, continuous preparation for emergency situations or disasters in healthcare organizations. The shortage of medical personnel [46], the overload of current work, the increasing amount of documentation, and the completion of a number of necessary formalities can make doctors reluctant to participate in such training, especially during prolonged periods of relative calm when there are no unexpected events. It can be a problem to force sta ff to familiarize themselves with the documentation, operating procedures and evacuation plans for mass-casualty events and disasters. In most cases, this consists of a quick, cursory, thoughtless review, because in times of prolonged security, people do not feel an approaching threat, so they do not have a strong motivation to prepare for crisis situations [47].

More than half of the respondents (54.5%) reported a lack of organization of drills concerning disaster managemen<sup>t</sup> in their workplace. As far as the frequency of organizing drills is concerned, the majority indicated that such drills were organized less frequently than once every 3 years.

The challenges faced by the healthcare services force them to provide continuous training in the organization of responses to mass-casualty incidents and disasters, and in cooperation with other emergency services. Simulations and drills are organized from time to time, but this is not enough. It is worth remembering that every event, even seemingly simple to perform, is di fficult, and not every scenario can be foreseen. There can never be too many drills. Only through continuous practice can the most appropriate procedures and skills to deal with crisis situations be developed. Besides having excellent equipment and access to appropriate personal protective equipment (e.g., in the case of a patient infected with the SARS-CoV-2 coronavirus), above all, working in accordance to safety procedures that have been prepared in advance is an example of exemplary disaster managemen<sup>t</sup> [48].

The only drawback after the exercises is usually the lack of review and feedback for the participants. This problem was reported by the respondents in the conducted research.

Theory will never equate to practice. Only practiced procedures provide the opportunity to verify the knowledge and skills of sta ff, and make it possible to carry out an analysis of the speed and effectiveness of the drills, and if necessary to make corrections, eliminate errors and, above all, acquire habits that will guarantee proper behavior [49].

Each hospital should have properly prepared disaster managemen<sup>t</sup> procedures. Such guidelines should be prepared well in advance. When a threat occurs, it should be su fficient enough to adapt them to the specific situation, so that there is no need to create everything from scratch.

Humanity has experienced many disasters and pandemics in the past, but these have been overcome (e.g., smallpox, plague, measles, polio, whooping cough, typhus, rabies and cholera).

The current pandemic has very clearly shown the speed with which even the best healthcare systems in di fferent countries can be overwhelmed and devastated. These observations show that health should be at the top of the political agenda.
