Model for preparedness of a public institution for a terrorist attack.

Public institutions such as governmental facilities, hospitals, universities, and amusement parks may be targeted by terrorists using weapons of mass destruction due to their potential to cause large numbers of casualties. Consequentially, these institutions should be prepared to manage such an event by the development and implementation of specific preparedness guidelines for any conventional or unconventional terrorist attacks. In order to test the preparedness of such an institution for a chemical event, a large-scale drill focusing on the first medical team to respond was conducted. Some important lessons regarding the way the medical team operates and communicates were learned from this drill. Periodic drills should be performed in order to assess the practicality and applicability of these guidelines.

A multicasualty event: out-of-hospital and in-hospital organizational aspects.

UNLABELLED: In a wedding celebration of 700 participants, the third floor of the hall in which the celebration was taking place suddenly collapsed. While the walls remained intact, all three floors of the building collapsed, causing Israel's largest disaster. OBJECTIVES: To study the management of a multicasualty event (MCE), in the out-of-hospital and in-hospital phases, including rescue, emergency medical services (EMS) deployment and evacuation of casualties, emergency department (ED) deployment, recalling staff, medical care, imaging procedures, hospitalization, secondary referral, and interhospital transfer of patients. METHODS: Data on all the victims who arrived at the four EDs in Jerusalem were collected through medical files, telephone interviews, and hospital computerized information. RESULTS: The disaster resulted in 23 fatalities and 315 injured people; 43% were hospitalized. During the first hour, 42% were evacuated and after seven hours the scene was empty. Ninety-seven basic life support ambulances, 18 mobile intensive care units, 600 emergency medical technicians, 40 paramedics, and 15 physicians took part in the out-of-hospital stage. At the hospitals, about 1,300 staff members arrived immediately, either on demand or voluntarily, a number that seems too large for this disaster. Computed tomography (CT) demand was over its capability. CONCLUSIONS: During this MCE, the authors observed "rotating" bottleneck phenomena within out-of-hospital and in-hospital systems. For maximal efficiency, hospitals need to fully coordinate the influx and transfer of patients with out-of-hospital rescue services as well as with other hospitals. Each hospital has to immediately deploy its operational center, which will manage and monitor the hospital's resources and facilitate coordination with the relevant institutions.

Israeli Defense Forces Medical Corps humanitarian mission for Kosovo's refugees.

In April 1999, during the crisis in Kosovo, the Israeli government launched a medical, field hospital in order to provide humanitarian aid to the Albanian refugees that fled from their homes in Kosovo. This facility was set up by the Medical Corps of the Israeli Defense Forces, in a refugee camp located in Northern Macedonia. During the 16 days during which the hospital functioned, the medical staff treated 1,560 patients and hospitalized >100. The field hospital served as a referral center for all of the other primary clinics that were hastily erected in the camp and its surroundings. This communication elaborates on the various aspects of the humanitarian medical aid that were provided by this medical facility and the conclusions that learned from such a mission.

Pre - earthquake vulnerability assessment

In view of the possibility of an earthquake of significant magnitude in Israel, published data of earthquake health effects were studied and applied to relevant conditions in Israel and to an earthquake there. A predisaster vulnerability assessment was thus obtained, pointing to the nature, size, space, and time distribution of tasks the health sector would be expected to perform should an earthquake occur in Israel

Terrorist bombing experiences during 1975 - 1979 in Jerusalem

During 41/2 years, 24 terrorist explosions occurred in Jerusalem. Of 511 casualties, 340 were evacuated to the Emergency Department of our hospital. Of a total of 272 admissins grades by the Injury Severity Score (ISS), 87 percent were light injuries, 2.9 percent medium and 10 percent severe. The hight proportion of light injuries may be explained by the evacuation of all casualties to the nearest hospital by the public. The distribution of injuries to body areas is discussed. Head and neck injuries comprised 19.3 percent and extremely injuries 39 percent. The most common primary blast effect was acoustic trauma encountered problems in the Emergency Department are discussed