Managing a Mega Mass Casualty Event by a Civilian Emergency Medical Services Agency: Lessons From the First Day of the 2023 Hamas-Israel War.

On 7 October 2023, Israel faced an unexpected attack by Hamas, causing over 1,200 deaths and injuring more than 9,000 individuals. This report delves into the rapid medical response spearheaded by Israel's civilian Emergency Medical Service, Magen David Adom (MDA), during this crisis. Utilizing data from MDA's electronic database, 4,097 dispatch records from the day were analyzed. Of these, 39.3% were directly related to the attack. EMS teams faced multiple challenges, including handling an overwhelming number of casualties and navigating active combat zones, which impeded safe access to victims, posed significant risks to teams' safety, and constrained patient evacuation strategies. This incident underscores the importance of reinforcing healthcare resilience, particularly emphasizing the need for centralizing various aspects of response efforts. These include streamlined communication, national coordination of pre-hospital resources, and systemic management of patient evacuations. Moreover, providing substantial support for EMS personnel, who operated in highly challenging conditions, is imperative.

[Lessons learned from Magen David Adom's activities during the 2nd Lebanon War].

The activities of Magen David Adom (MDA) during the 2nd Lebanese War led to a series of conclusions (some established during the fighting) regarding the operational concept of the organization, the response to the needs of the team members, and the resource requirements. The fighting led to an update in the operational concept, moving to the smaller based operational unit--the station, creating a flexible concept, enabling response to various simultaneous scenes, quickly generating a common situational awareness, and relocation of resources to the more relevant events. TechnoLogy must support the operational concept. The response to stress-related victims should be part of the operational concept during conflict. Debriefing and learning processes are part of the response and enable adaptation to the changing reality. A comprehensive response to the needs of the team members is required, by relocation of family members, meeting the daily needs and preventing stress-related reactions among them. A rotation of leave of absence, central management of human resources and the management of volunteers--spontaneous and those who return to active work, are other components of this issue. The required resources--personal protective equipment, collective protection, command control and communications equipment, the supplies level and the different vehicles required for the operation, are important issues in the operational program of the organization. Collecting blood, maintaining a strategic stockpile and protecting the units, are all part of MDA missions.