JERUSALEM, Aug. 27 /PRNewswire/ -- Everybody in Jerusalem is familiar with the screaming sounds of multiple sirens, as ambulances race through the streets notifying the city that something has happened. It is the telltale sign of a terror attack, alerting residents that a bus or a restaurant has been blown up, and there are likely to be many casualties.
Everyone rushes to a radio or a TV to see what, where, who; but for the staff at Shaare Zedek Medical Center, it is no less than a veritable call to arms, a mobilizing signal telling everyone to immediately report for duty and man the battle stations -- and there's not a second to lose.
Indeed, the staff at Shaare Zedek can truly be called an army, because it takes no less than the highly detailed and organized military maneuver for everyone to prepare for a hospital's worst nightmare: a mass casualty terrorattack.
"There is a very carefully planned course of action, minute by minute," explains Prof. Jonathan Halevy, chief administrator of the hospital. "If it is a mass casualty event, if we hear 'there's been an explosion in Mahane Yehuda, there are many wounded, we don't know how many' -- that's what they usually say -- we start by delivering messages simultaneously to the cellular phones, the beepers and home phones of close to 200 functionaries, from the head of the hospital, the chief surgeons, down to the stretcher bearers -- everybody is called in."
As the only major hospital centrally located in the capital, the staff at Shaare Zedek has had a lot of experience -- too much -- over the last four years dealing with the horrors of terror attacks. The routine is familiar, and they are always prepared, for among Shaare Zedek's staff can be found the foremost experts in the world dealing with terrorist incidents.
"We were always ready when the first casualty arrived -- which usually is 16 to 22 minutes after the bomb detonated in Jerusalem -- and we were ready with enough orthopedic surgeons, anesthesiologists, nurses, stretchers outside, the doors of the emergency room wide open and ready for mass absorption of casualties."
That battalion of 200 people is divided into teams, with everyone knowing his purpose, where to report for duty, and what he or she has to do from the second the ambulances arrive. One after another they pull in and drop off patient after patient, presenting a logistic exercise in figuring out how to immediately treat all the victims -- whose numbers can sometimes reach upwards of 50 casualties within 25 minutes, over 120 within the hour.
"You really have to divide the professionals into teams," says Halevy. "The first team is working in the shock and trauma room, and they get the most severe cases. Then you work down from the most severe cases -- there is a special site in the emergency room to take care of medium-size casualties.
"In a different location outside the emergency room area we have a place for the lightly injured, and then you have a special site for people who are shell-shocked. These are people who arrive in a severe state of anxiety, in emotional shock, and this site is manned by psychiatrists and social workers. So these 200 people who are divided into teams -- everybody knows his function, where to report for duty, what he has to do, and it works very smoothly."
Every casualty that arrives through the door is assigned to a team headed by a surgeon that includes a nurse, sometimes an anesthesiologist if it's high-level trauma, as well as someone who writes the records. This team stays with the patient until he is moved to a recuperating floor.
The top surgeon assigned manages the case, ordering the consultants, the diagnostic imaging, and deciding when the patient will go into the operating theater. He books the patient into the operating theater based on the information he receives from the central command room, which lets him know if his case has priority or if there are other more severe cases that must be tended to immediately.
Each patient brought in is given an electronic tag number, and can be instantly tracked where they are. Doctors too have electronic tags, so one can see at a glance at the monitoring board which doctor is standing beside which patient.
Even before a patient is wheeled in, a senior surgeon goes into the ambulance to check the victim's condition, doing a triage and making a decision where the patient should first be brought.
"Sometimes the surgeon bypasses the trauma unit and sends the patient straight to the operating room, and lives are saved by this decision," Halevy notes, citing the story of 15 year old Liz Montielo, who was critically injured in February's No. 14 bus bombing. A medic saw Montielo on the bus covered with blood as were many others, and for some reason tended to her immediately. He made the decision to bring her straight to Shaare Zedek, the closest hospital.
"She was bleeding from the main artery that led to the limb, she was in shock, and I don't know how he picked her from all the casualties there," says Halevy, shaking his head at the memory of the miracle. "He put her in the ambulance, and within six minutes she was here. We did triage, and bypassed the trauma unit and sent her immediately to the operating room. She arrived there with no blood pressure, pulse-less, actually clinically dead. And they gave her blood immediately, resuscitated her, massaged her, reconstructed the artery and the vein and two weeks later she was running on that foot."
Such miracles are the product of a medic's instinct and Shaare Zedek's efficient emergency facilities -- which are about to get even better. A brand new $15 million ER will be dedicated on August 6, which will be three times the size of the present facility and incorporate all the latest state of the art emergency equipment.
While the hospital has been extremely successful in treating some 600 terror victims over the last four years, it was not just for them that the new emergency room was built. There are approximately 60,000 people who come to the emergency room every year, and it is expected that the new ER will be bringing in a lot more patients. There is already concern that the new influx of patients will require an upgrading of the surgical operating center.
But Halevy is confident that Shaare Zedek will be prepared for whatever happens in Jerusalem, as it has been for the last 102 years of its existence.
"The new emergency room will be better equipped, better monitored," he said. "In terms of the trauma unit, the ability to save lives when patients come in in a critical situation because the elaborate diagnostic imaging facilities, and the ability to perform surgery on the spot -- life saving surgery and resuscitation -- that will be an edge over what we have now."
August 27, 2004
CONTACT: Stuart Paskow of MITCH-STU, INC., +1-305-534-4487, spaskow@mitchstu.com, for Shaare ZedekMedical Center
