Within hours, the emergency department was treating waves of patients suffering from gunshot wounds, blast injuries, and burns while the hospital itself was under rocket fire.<\/p>\n
The new study was published in the journal Disaster Medicine and Public Health Preparedness under the title \u201cWartime mass casualty incident plan operation: Staff experiences from a civilian hospital in southern Israel on October 7, 2023.\u201d\u00a0<\/p>\n
MAXIMILIAN NERLANDER (credit: Courtesy)<\/p>\n
It was led by Maximilian Nerlander, a doctoral candidate at Link\u00f6ping University in Sweden and a visiting scholar at the Hebrew University of Jerusalem\u2019s Braun School of Public Health and Community Medicine<\/a>.<\/p>\n It offers one of the most detailed accounts yet of how a modern civilian hospital functioned during an unprecedented wartime emergency.<\/p>\n He conducted it together with Prof. Adam Rose of the Braun School and Dr. Debra West of the emergency medicine department at the Ashdod hospital.<\/p>\n Based on in-depth interviews with 19 staff members from the emergency department and the head of trauma and disaster management who worked during the Hamas attacks, the study offers practical lessons for hospitals around the world as many countries strengthen their preparedness for large-scale armed conflict.<\/p>\n Unlike previous terrorist attacks in cities like London, Paris, or Boston, the Oct. 7 assault unfolded over many hours, across multiple communities, while large parts of the surrounding region remained under active attack.<\/p>\n Ambulances struggled to reach casualties, communications broke down, and hospital staff often had little awareness of the rapidly evolving situation beyond what they could piece together from patients, soldiers, and social media.<\/p>\n Yet despite the chaos, the hospital continued to function.<\/p>\n The research team found that one of the greatest strengths was not sophisticated technology but preparation. Years of frequent mass casualty drills meant doctors, nurses, and support staff instinctively understood their roles, allowing them to focus on solving unexpected problems.<\/p>\n The hospital\u2019s reinforced, missile-protected emergency department also enabled teams to continue caring for patients without needing to seek shelter, preserving both workflow and morale.<\/p>\n The interviews also revealed weaknesses that became apparent only under real wartime conditions. Many staffers faced an impossible choice after being called by both the military reserve system and the hospital.<\/p>\n Others hesitated to leave home because their own families were in danger. Administrative personnel responsible for registering patients were unable to report to work, creating unexpected bottlenecks.<\/p>\n Plans to relocate less critical patients out of the emergency department proved impossible because other hospital areas were not protected against incoming rockets.<\/p>\n The researchers found that perhaps most striking was the lack of reliable information.<\/p>\n Emergency department staff often knew little about the broader situation outside the hospital, forcing them to rely on fragmented updates from military personnel, emergency responders, patients, and even social media videos to anticipate what might arrive next.<\/p>\n The study also uncovered an unexpected consequence of the day\u2019s events. While some hospitals were overwhelmed with casualties, the emergency department staff thought they could have safely treated many more patients.<\/p>\n The finding suggests that future emergency planning should put more stress on apportioning patients efficiently among hospitals during large-scale crises rather than allowing some facilities to become overloaded while others retain available capacity.<\/p>\n Rose told The Jerusalem Post that he felt it was important to document the hospital staff\u2019s experiences scientifically rather than simply as eyewitness accounts by using qualitative research to understand what went well, what went less well, and what could be improved in the future.<\/p>\n \u201cWhile many of the world\u2019s hospitals conduct disaster drills, our simulation revealed something that the others didn\u2019t: Israeli planners hadn\u2019t ever considered the possibility that our country would not control part of its own territory for a period of time,\u201d he said.<\/p>\n If he could rewrite the hospital\u2019s emergency plan today, the first changes Rose said he would make would be to \u201chave an organized central body controlling which casualties are sent where and when, to reduce the likelihood of one hospital being overwhelmed while others are underutilized.<\/p>\n \u201cAnd making sure that if there was a plan to move less-sick patients to a second area, that area would also be missile-proof; and for people who could be called to work in the hospital or to be in the army, there would have to be a way to decide where they would go and to call them to only one.\u201d<\/p>\n Relying on social media to understand what was happening \u201cwas the best they could do, but there needs to be a more organized and proactive way to share information. Many communication strategies failed that day,\u201d Rose noted.<\/p>\n \u201cHospitals, ambulance services, the military, and government agencies should be part of a dedicated mechanism for sharing such information and make it part of the emergency drills.\u201d<\/p>\n Having a missile-protected emergency department at Assuta was very important, he continued.<\/p>\n \u201cI think that\u2019s one of the two central things that went so right, the other being the monthly emergency drills. This was largely an example of two big things that went extremely right accompanied by many medium-to-small things that went wrong.<\/p>\n \u201cThe overall effect was a big success, and this is one of the two reasons why. Any hospital without such a protected area must make it happen as soon as possible.\u201d<\/p>\n So far, none of the team\u2019s recommendations have been adopted by other Israeli hospitals or the Health Ministry, but \u201cclearly they should be.\u201d<\/p>\n The findings arrive at a time when governments across Europe and North America are reevaluating civilian preparedness amid rising geopolitical tensions.<\/p>\n Hospitals have traditionally planned for isolated mass casualty incidents such as terrorist attacks or natural disasters.<\/p>\n The experience of Oct. 7<\/a> proved that prolonged warfare presents a different challenge altogether \u2013 one in which hospitals must continue operating while transportation, communications, and emergency response systems are simultaneously under strain.<\/p>\n \u201cThe lessons from Oct. 7 extend well beyond Israel,\u201d said Rose.<\/p>\n \u201cOur findings show that hospitals preparing for future conflicts need plans that account not only for treating casualties, but also for protecting staff, maintaining communication in rapidly changing situations, and adapting operational plans when reality departs from even the best rehearsed scenarios.\u201d<\/p>\n West, who ran Assuta\u2019s emergency department on that terrible day almost three years ago, said that \u201cunlike a conventional mass casualty event, one under fire disrupts every aspect of hospital operations \u2013 from patient flow and emergency department evacuation to staffing and the ability of personnel to work while their families are under threat.<\/p>\n \u201cThese experiences offer lessons beyond clinical care for hospitals preparing for disasters in which the healthcare system itself becomes part of the crisis.\u201d<\/p>\nADAM ROSE (credit: Levi Rose)What can be improved upon<\/p>\n
DR. DEBRA WEST (credit: Courtesy)Looking back to look forward<\/p>\n