Israel, in part because it has confronted numerous mass casualty events, has been at the forefront of medical preparedness planning, and has developed sophisticated structures and processes for dealing with such medical emergencies. As described by Adini, et al. [1] , Sarpy, et al. [2] , and Einav, et al. [3] , elements of this system include standard operating procedures, drills and exercises for most conceivable events, and measures to inform continuous improvement following each drill, exercise, and actual event. Given the state of the evidence, these authors have relied on a rigorous use of expert opinion to develop their measures; many of the experts involved have had frequent and direct response experience.