Hospitals have disaster plans. So why don't staff read them?
In 2026, I asked 201 of my colleagues at a Greek hospital one simple question: have you read our disaster plan? Only 22.9 per cent said yes. Most knew it existed. But 42.8 per cent said they did not have access to it.
I work at the General Hospital of Rethymno on the island of Crete. Like most hospitals in Greece, we have plans. These are the hospital's own emergency response plans, not treatment protocols: they set out how we would protect patients and staff, keep essential services running, receive mass casualties and, if necessary, evacuate during an earthquake, fire, flood or chemical incident. They exist. They sit in binders and on shared drives.
But when I walk through the corridors and talk to nurses, doctors, and administrative staff, I hear the same thing again and again: "I know there's a plan somewhere. I'm not sure what it says."
What I found when I started asking
I decided to study this systematically. Between January and April 2026, I surveyed staff across all departments – nursing, medical, administrative, allied-health and technical. Of 220 staff I approached, 201 completed the questionnaire: a response rate of 91.4 per cent, covering about half of the hospital's 411 eligible staff. It is one hospital and the answers are self-reported, so the results are not a national picture. People wanted to talk about this.
The findings were sobering. Only 29.9 per cent said they felt highly prepared to respond to a mass casualty event. And while 65.7 per cent knew a plan existed, only 22.9 per cent had read it; the other 42.8 per cent said they could not access it.
But here's the part that gave me hope: every respondent said staff need training on the plans. Asked which formats they preferred (they could choose more than one), 86.1 per cent chose hands-on exercises, compared with 51.2 per cent for seminars and 20.9 per cent for classroom lessons. The willingness is there. The system is not meeting it.
This is not just my hospital
What I found in Rethymno echoes earlier studies in Crete and elsewhere in Greece. A 2019 study in Attica found 21.7 per cent of staff knew the disaster plans, and 7.7 per cent had taken part in a mass-incident or disaster-related activity. In a 2012 survey at my own hospital, 15 per cent of staff had read the preparedness plans. In a 2014 study of 364 doctors and nurses, 55.7 per cent did not know whether their workplace had a disaster plan, and 61 per cent considered themselves inadequately prepared.
These studies used different samples and questions, so they cannot be compared directly or show a national trend. But they point to the same gap.
Internationally, tools exist to help. The WHO has developed the Hospital Safety Index. The Sendai Framework invites countries to make health infrastructure resilient by 2030. But frameworks and indices alone don't prepare staff. Regular, practical drills are essential.
Why the gap persists
Three reasons come up repeatedly in my conversations with colleagues about Greek hospitals. They reflect what colleagues tell me and my own experience; the survey did not test them.
First, training is not experienced as a regular requirement. Colleagues describe no regular cycle, no refresher training and no check that staff know their part of the plan.
Second, accountability is unclear. Knowing the plan is rarely checked or recognized, and in my experience preparedness does not feature in staff performance evaluations.
Third, chronic understaffing. When you are covering multiple roles, taking time for a drill feels like a luxury you cannot afford.
What we can do about it
The solutions are not complicated.
Make training mandatory and regular.
Hands-on and scenario-based, not a PowerPoint. I propose every six months as a starting point – my own suggestion, not an established standard – adjusted to each hospital's risks, resources and exercise findings. A Greek study of a five-hour disaster course found that staff knowledge improved but had partly fallen back one month later, which supports repeating training rather than relying on a single course.
Create a national registry of hospital vulnerability assessments.
A national registry would make it possible to track how many Greek hospitals have completed vulnerability assessments – structured reviews of hazards and weak points in buildings, utilities, supplies and procedures – and when they were last updated. It should build on any existing reporting arrangements.
Fund a permanent preparedness officer in every hospital.
Someone whose only job is to keep plans current, run exercises, and maintain relationships with ambulance services and fire brigades. This role should also have a reporting line beyond hospital management – for example, to the regional health authority or the Ministry of Health – so that plans and exercise programmes survive changes in hospital management.
Measure readiness.
Add it to hospital evaluations. Useful measures include the share of staff who can find the current plan on their shift, completion of role-specific training, drill participation by staff group and shift, and whether exercise objectives and corrective actions are achieved. Attendance should be reported separately from demonstrated competence. What gets measured gets done.
The bottom line
We don't need new plans. We need to make the plans we have real. We need to train the people who will use them. We need to practice until the response becomes automatic.
When I asked my colleague why she hadn't read the plan, she said: "I hope I never need to." I understand that feeling. But hope is not a strategy. Preparation is.
Vaitsis Koutsipetsidis (Βαΐτσης Κουτσιπετσίδης) is a Registered Nurse (TE), Head of the Anesthesiology Department at Rethymno General Hospital in Crete, Greece. He holds an MSc in Public Health and Health Care Management from the University of Crete School of Medicine and is actively engaged in hospital disaster management research, policy development, and clinical operational planning.