**1. Introduction**

In a globalized world, in which crisis incidents are becoming more frequent, more devastating and have a significant impact on the health and lives of societies, the quality of healthcare services, including in particular the operational capacity of hospitals, is crucial for health security. A well-established preparedness program is a prerequisite for the effective response to emergencies of healthcare systems, including hospitals.

The preparedness of a hospital for mass-casualty incident and disaster response includes activities, programs and systems developed and implemented before the event. These measures are designed to provide the necessary medical care to victims of disasters, and to minimize the negative impact of individual events on medical services. These undertakings include, in particular, the appropriate training of medical personnel, appropriate safeguarding of logistics, and having validated emergency response procedures in place in the hospital. Evaluation of preparedness for incidents and disasters, as well as the effectiveness of response, is one way in which to locate and remove possible gaps and weaknesses in the functioning and effective managemen<sup>t</sup> of the hospital during mass-casualty incidents (events that overwhelm the local healthcare system, where the number of casualties vastly exceeds the local resources and capabilities in a short period of time) [1–3].

Even in a well-prepared hospital, responding e ffectively to a disaster is a complex challenge. In the literature, there are many methods and evaluations [4–10] of the level of hospital emergency preparedness, but there is no consensus on correct and standardized methods and tools that would clearly define how individual institutions should prepare for crisis incidents [11–14]. This is largely due to the allocation of individual hospitals as well as, among others, geographical, demographic, climatic, social and economic factors, which may impact upon or be associated with the occurrence of particular events in a given region, or the response to them. It is also unclear whether individual procedures can reliably predict, in real time, the e ffectiveness of hospital functions [15–17]. Although many studies [18–27] have assessed the correlation between the level of hospital preparedness and disaster response, only a few functional elements have actually been assessed.

Although the World Health Organization (WHO) has developed the Hospital Safety Index (HSI) [28], a checklist of all hazards, which is a standardized, globally accepted method for assessing hospital preparedness, to date there have been no legally regulated international standards for hospital preparedness and response to crisis incidents [29–32].

Up until now, there has been no systematic survey in Poland concerning the readiness of hospitals, as well as medical personnel, to deal with mass-casualty incidents. Consequently, little is known about the knowledge, skills, and professional competences of healthcare workers [33–35]. This information is crucial for the development of e ffective response plans for individual hospitals, as well as for the preparation of training tailored to the needs of medical personnel [36,37]. The above-mentioned factors prompted the authors to undertake this study.
