Evaluating emergency response at a hospital near the Gaza border within 24 h of increased conflict.

BACKGROUND: Frontline hospitals near active hostilities face unique challenges in delivering emergency care amid threats to infrastructure and personnel safety. Existing literature focuses on individual aspects like mass casualty protocols or medical neutrality, with limited analysis of operating acute services directly under fire. OBJECTIVES: To describe the experience of a hospital situated meters from hostilities and analyze strategies implemented for triage, expanding surge capacity, and maintaining continuity of care during attacks with limited medical staff availability due to hazardous conditions. A focus will be placed on assessing how the hospital functioned and adapted care delivery models in the event of staffing limitations preventing all teams from arriving on site. METHODS: A retrospective case study was conducted of patient records from Barzilai University Medical Center at Ashkelon (BUMCA) Medical Center in Israel within the first 24 h after escalated conflict began on October 7, 2023. Data on 232 admissions were analyzed regarding demographics, treatment protocols, time to disposition, and mortality. Missile alert data correlated patient surges to attacks. Statistical and geospatial analyses were performed. RESULTS: Patients predominantly male soldiers exhibited blast/multisystem trauma. Patient surges at the hospital were found to be correlated with the detection of incoming missile attacks from Gaza within 60 min of launch. While 131 (56%) patients were discharged and 55 (24%) transferred within 24 h, probabilities of survival declined over time reflecting injury severity limitations. 31 deaths occurred from severe presentation. CONCLUSION: Insights gleaned provide a compelling case study on managing mass casualties at the true frontlines. By disseminating BUMCA's trauma response experience, strategies can strengthen frontline hospital protocols optimizing emergency care delivery during hazardous armed conflicts through dynamic surge capacity expansion, early intervention prioritization, and infrastructure/personnel protection measures informed by risks.

To command is to serve: Senior leadership and policy-making predict hospital ward functioning in emergency.

AIM: To examine personal, ward and organisational factors related to the functioning of general hospital staff under missile attack. BACKGROUND: The summer of 2014 is remembered in Israel for missile attacks from the Gaza Strip targeting the civilian population of southern Israel. METHODS: The study was carried out in two steps: (1) Qualitative-a focus group to identify the issues faced by the staff of a hospital under fire, (2) Quantitative-a cross-sectional study among 409 hospital workers to explore: (a) personal involvement in decision-making, (b) clarity of directives, (c) coping with emergency on the ward and on (d) the management level, (e) personal professional functioning. RESULTS: A statistically significant positive correlation was found between personal involvement in decision- and policy-making, the clarity of directives and hospital ward functioning. A regression analysis demonstrated that executive management and leadership, clarity of directives and workers' personal functioning statistically significantly explained 46.1% (R2  = 0.461) of the variance in ward functioning during emergency. CONCLUSION: Clarity of directives and executive management and leadership in emergency were positively associated with ward functioning and coping with emergency. IMPLICATIONS FOR NURSING MANAGEMENT: To ensure proper hospital functioning during emergency, managers must demonstrate personal involvement and leadership, providing clear directives.

Assessment of Predictors for SARS-CoV-2 Antibodies Decline Rate in Health Care Workers after BNT162b2 Vaccination-Results from a Serological Survey.

Background: SARS-CoV-2 is a novel human pathogen causing Coronavirus Disease 2019 that has caused widespread global mortality and morbidity. Since health workers in Israel were among the first to be vaccinated, we had a unique opportunity to investigate the post-vaccination level of IgG anti-S levels antibodies (Abs) and their dynamics by demographic and professional factors. Methods: Prospective Serological Survey during December 2020−August 2021 at Barzilai Medical Center among 458 health care workers (HCW) followed for 6 months after the second BNT162b2 vaccine dose. Results: Antibody levels before the second dose, and 30, 90 and 180 days after were 57.1 ± 29.2, 223 ± 70.2, 172.8 ± 73.3 and 166.4 ± 100.7 AU/mL, respectively. From GEE analysis, females had higher Abs levels (ß = 26.37 AU/mL, p = 0.002). Age was negatively associated with Abs, with a 1.17 AU/mL decrease for each additional year (p < 0.001). Direct contact with patients was associated with lower Abs by 25.02 AU/mL (p = 0.009) compared to working with no such contact. The average decline rate overall for the study period was 3.0 ± 2.9 AU/mL per week without differences by demographic parameters and was faster during the first 3 months after vaccination than in the subsequent 3 months. Conclusions: All demographic groups experienced a decline in Abs over time, faster during the first 3 months. Findings of overall Abs lower in males, workers with direct contact with patients, and older workers, should be considered for policy-making about choosing priority populations for additional vaccine doses in hospital settings.

[Knowledge management in health organizations].

BACKGROUND: In 2002 the head of the Israel Defense Forces (IDF) Technology and Logistics Command took a strategic decision to manage knowledge across the organization. The IDF Medical Corps was one of the initiation sites selected. Insights from the process of establishment of a knowledge management (KM) system in the IDF Medical Corps as a health organization (HO) are described. METHODS: IDF's medical services were identified, mapped and their participants interviewed, as were KM personnel in Israeli HOs. Information analysis pointed to the medical rendezvous (MR) as the central process for initiation of KM. The knowledge challenges were identified, and knowledge services and administrative interventions were planned. RESULTS INCLUDING KM CHALLENGES AND RESPONSE: The MR was found to be the process in which most of the clinically and administratively significant decisions in HO's were taken. Practitioners had large clinical and administrative knowledge gaps. Medical and administrative knowledge originated from various sources, in many formats. It could not be retrieved either easily or completely, was usually presented in an inconvenient form for assimilation, and was not always updated. Therefore, the MR was selected as the initial intervention point. Optimally, a comprehensive solution providing access to high quality knowledge can be a knowledge portal, including diagnostic indexing as a key for retrieval of information. Furthermore, indexed clinical, administrative, services list, quality assurance, risk management, and continuing medical education knowledge services, as well as a collegial and administrative feedback, link all entities involved into a knowledge community. This may increase the opportunity for optimal and efficient managed care.

[The IDF evacuation from southern Lebanon in 2000: impact on the delivery of health care to displaced Lebanese population].

BACKGROUND: The State of Israel controlled a protective security zone in southern Lebanon from 1982 until May 2000, when the Israel Defense Forces (I.D.F.) evacuated this area within two days. Officers and soldiers of the South Lebanese Army, a local militia, which had formerly cooperated with the I.D.F., chose to come to Israel with their families. The provision for the health needs of this displaced population of over 5,861 persons was coordinated by the Northern Region Health Office of the Ministry of Health. AIM: To describe the deployment and provision of health care for this displaced population and to present the lessons learned. METHODS: Data was collected from interviews with the personnel most actively involved in the decisions and execution of the enterprise, as well as from relevant documents. RESULTS: The main health needs of the displaced South Lebanese were related to anxiety, outbreak of chickenpox, dental problems and provision of medical equipment for the disabled. CONCLUSION: The experience accrued by the Northern Region Health Office over the years in provision of care to displaced populations at short notice was implemented. Cooperation within the health sector and between the health services and the military and defense forces was invaluable and essential to deal successfully with this unusual situation.