When the hospital becomes the battlefield: patients as stakeholders in mass casualty incidents.

Abstract

Hospitals are uniquely positioned during disasters, functioning as first-line responders and at risk themselves. While system preparedness and staff resilience have been widely studied, the experience and preparedness of patients admitted to hospitals during mass casualty incidents (MCIs) have received little attention. This commentary was prompted by the recent study of Wolff et al., which assessed inpatients’ knowledge of how to respond during an MCI and the barriers they perceived in such situations. Their work highlights gaps in patient awareness and preparedness, raising the question of whether and how inpatients should be involved in disaster response. Drawing on the experience of Soroka Medical Center during the June 2025 Israel–Iran conflict, we reflect on these findings in the context of a real-world missile strike on a major tertiary medical center. On June 19, 2025, Soroka was directly struck by a ballistic missile that destroyed a surgical inpatient building, rendering 562 beds unusable and necessitating mass evacuation and transfers. The event revealed the complexity of patient reactions—from acute fear and uncertainty to pragmatic acceptance of crowding in compromised conditions. Hospital leadership rapidly instituted patient education on air-raid protocols, relocated vulnerable patients, and implemented staff refresher training. Despite these efforts, challenges in communication, rumor control, and logistics significantly affected inpatients’ sense of safety and continuity of care.  CONCLUSIONS: Wolff et al.’s study and Soroka’s lived experience converge on a critical insight: patients cannot be passive bystanders in disasters. Their perceptions, behaviors, and resilience have a direct impact on hospital functionality. Future research should define the scope of patient roles in preparedness, assess the psychological impact of preparedness training, and inform scalable policies for integrating patients into hospital resilience frameworks. Incorporating patient preparedness into disaster planning is crucial, especially during times of heightened alert and in regions prone to conflict or natural disasters.