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.

No heat, no eat: (Dis)entangling insecurities and their implications for health and well-being.

This study explores the associations between energy poverty, food insecurity, and a set of outcomes-including the self-reported burden of chronic illness, physical disabilities, and mental health-among social-aid recipients across Israel. We highlight the socio-demographic characteristics and housing conditions of energy-poor households and analyze the association between energy poverty and health and well-being using multivariate regression models. Of 1390 aid-recipient respondents, more than 85% met the criteria for living in an energy-poor household, and almost all of them also struggled with food insecurity and were raised in poor households as children. In addition, the severity of energy poverty was positively and significantly associated with the occurrence of diabetes, hypertension, and mental illness, and, as compared with energy-secure households, severely energy-poor households were more prone to forgo acquiring prescription medications, medical aid, or required health treatments due to financial hardships. These findings highlight the nuanced negotiation over necessities that aid-supported households make; despite being at greater risk of being sick, energy-poor households are more likely to forgo buying medicines and seeking healthcare so as to pay the electricity bills. Hidden energy poverty, coupled with what might be hidden morbidity, may have significant implications for healthcare systems, and a climate-sensitive health policy at both the municipal and national levels is required to strengthen resilience among low-income households.

Parent-adolescent coping with prolonged geopolitical conflict: A qualitative analysis focusing on distress and resilience.

Adolescents who were raised in conflict-ridden areas may face unique challenges that may also impact their transition to adulthood. We explored coping processes, distress symptoms, and resilience resources of late adolescents and their parents residing in Israeli communities bordering Gaza and exposed to ongoing conflict-related violence. We conducted in-depth interviews with late adolescents and one of their parents (n = 8 dyads, 16 individual interviews). Four main themes emerged: (a) dynamic adaptation - complex movement between coping styles; (b) distress symptoms; (c) siblingship - the central role of siblings in shaping adolescent resilience; and (d) community impacts - the ways in which social and physical environment can foster resilience. The findings broaden existing coping theories and offer practical implications for practitioners providing support to populations exposed to prolonged conflicts.

Matching Digital Intervention Affordances with Tasks: The Case of a Zoom and WhatsApp Mental Health Intervention for Seniors during the COVID-19 Pandemic.

During the first COVID-19 wave, we conducted a Zoom and WhatsApp digital group intervention that promoted community-dwelling seniors' mental health. A total of 82 community-dwelling adults participated in this intervention. Based on the media richness theory (MRT) and the affordances approach, we used netnography to explore how group moderators and technical support team members (n = 9), but not the seniors themselves, perceived the ways Zoom and WhatsApp technological affordances/constraints matched intervention tasks and increased intervention performance. We identified four Zoom and WhatsApp affordances: temporality, interactivity, multimediality, and portability. Empirically, our findings represent a first step in creating a conceptual framework for analyzing digital intervention performances that addresses users' perceptions of technologies and intervention goals. Theoretically, our synergic analysis of MRT and the affordances approach offers a cohesive framework that shifts from a focus on users' interactions with one type of media to their interactions with all media that are used in attaining intervention goals.

Prevalence of Long-COVID Among Low-Income and Marginalized Groups: Evidence From Israel.

Objective: To identify the socioeconomic and demographic factors associated with the prevalence of self-reported long-COVID symptoms. Method: We examined the association between acute-COVID (SARS-CoV-2) and long-COVID symptoms, by a cross-sectional analysis of data obtained on a prospective online-survey, conducted from November to December 2021 on a nationally-representative sample of the Israeli population (N = 2,246). Results: Findings suggest that there is a greater likelihood of experiencing long-COVID symptoms among low-income and among marginalized groups. After controlling for demographic and socioeconomic attributes, those who had moderate/severe acute-COVID were 1.3 (p < 0.05) times more likely to experience a long-term symptom and also reported more long-term symptoms (2.2 symptoms) than those who have not been infected (1.4 symptoms; p < 0.01). Among the low-income group, a larger gap in symptom count was found between those who had moderate/severe acute-COVID (3.3 symptoms) and those who had not been infected (1.8 symptoms, p < 0.05). Conclusion: Our findings highlight the importance of raising awareness of long-COVID among marginalized population groups, and to the therapeutic options available. Such efforts should be tailored and should consider the unique socioeconomic and cultural characteristics, as well as the preexisting low access to healthcare services among these groups.

Integrating drones in response to public health emergencies: A combined framework to explore technology acceptance.

The aim of the study was to propose and test an integrated model combining the technology acceptance model (TAM), task-technology fit (TTF), social motivation, and drone-related perceived risks to explore the intention to use drones in public health emergencies (PHEs). We conducted a survey among the Israeli population, yielding a sample of 568 participants. Structural equation modeling was implemented to test the research hypotheses. The results showed that our integrated model provided a robust and comprehensive framework to perform an in-depth investigation of the factors and mechanisms affecting drone acceptance in PHEs. First, ease of use, attitudes, individual-technology fit, task-technology fit, and social influence significantly and directly influenced users' behavioral intention to utilize drone technology. Second, attitudes were significant mediators of the effects of social influence and perceived risks on the intention to use drones. Finally, significant relationships between TAM, TTF, social motivation, and perceived risks were also observed. Theoretical aspects and practical implications-which can serve as the basis for shaping a positive development in drone public acceptance in PHEs and in general-are discussed.

Effect of distinct psychological interventions on changes in self-reported distress, depression and loneliness among older adults during COVID-19.

BACKGROUND: Older adults have been considered a primary at-risk population during the coronavirus disease 2019 (COVID-19) pandemic, and many efforts have been and still are directed toward supporting them and enhancing their capacity to cope with the pandemic. Evidence shows that by enhancing proactive coping abilities through psychological interventions, in which cognitive-behavioral and mindfulness techniques are taught and practiced effectively, these interventions have supported older adults throughout the pandemic. However, the underlying mechanisms by which specific intervention components affect various mental states such as distress, depression and loneliness among older adults remain unclear and warrant investigation. AIM: To determine the effect of an intervention using cognitive-behavioral and mindfulness techniques on changes in distress, depression and loneliness. METHODS: We performed a secondary analysis on data from a previous study in which community-dwelling older adults attended a short-term, internet-based intervention during the first COVID-19 wave in Israel. The intervention included seven sessions during which various cognitive-behavioral and mindfulness techniques were learned and practiced. In-session changes in psychological distress were measured using the Subjective Units of Distress Scale (SUDS), which participants rated at the beginning and end of each session. Participants also filled out questionnaires that evaluated levels of depression [Patient Health Ques-tionnaire (PHQ-9)] and loneliness (UCLA loneliness Scale) prior to and after the entire intervention process. The effect of in-session changes in the SUDS on changes in post-intervention depression and loneliness levels were assessed, as a proxy for distinct technique effectiveness. RESULTS: The findings indicated in-session differences in terms of a decrease in psychological distress (SUDS). Sessions that included relaxation exercises and guided imagery, as well as sessions that included cognitive restructuring and mindfulness meditation, demonstrated the largest decreases in in-session psychological distress (≥ 35%). Two multivariate regression models, one for levels of post-intervention depression (PHQ-9 score) and the other for levels of post-intervention loneliness (UCLA loneliness score), were fitted. The results revealed two statistically significant explanatory variables for depression: The SUDS difference for sessions in which cognitive restructuring and mindfulness meditation were practiced, beta = -0.25, 95%CI: -1.23 to -0.1, and the pre-intervention level of depression, beta = 0.62, 95%CI: 0.37-0.75. The second model for loneliness revealed only one significant explanatory variable: The SUDS difference for sessions in which relaxation and guided imagery were practiced, beta = 0.41, 95%CI: 0.14-0.65. CONCLUSION: Different psychological techniques seem to have different effects on distress, loneliness and depression. Understanding the pathways by which distinct techniques affect negative mental symptoms has implications for future intervention design.

Long-Term Health Impacts of Wildfire Exposure: A Retrospective Study Exploring Hospitalization Dynamics Following the 2016 Wave of Fires in Israel.

BACKGROUND: Climate-related events, including wildfires, which adversely affect human health, are gaining the growing attention of public-health officials and researchers. Israel has experienced several disastrous fires, including the wave of fires in November 2016 that led to the evacuation of 75,000 people. The fires lasted six days (22-27 November) with no loss of life or significant immediate health impacts. The objective of this study is to explore the long-term hospitalization dynamics in a population exposed to this large-scale fire, including the effects of underlying morbidity and socio-economic status (SES). METHODS: This is a retrospective crossover study, conducted in 2020, analyzing the electronic medical records of residents from areas exposed to a wildfire in northern Israel. The study spans from one year before exposure to two years after it (22 November 2015-27 November 2018). The hospitalization days during the study period were analyzed using the Poisson regression model. The rate of hospitalization days along with 95% confidence intervals (CIs) were plotted. RESULTS: The study included 106,595 participants. The median age was 37 (IQR = 17-56), with a mean socio-economic ranking of 6.47 out of 10 (SD = 2.01). Analysis revealed that people with underlying morbidity were at greater risk of experiencing long-term effects following fires, which was manifested in higher hospitalization rates that remained elevated for two years post-exposure. This was also evident among individuals of low socio-economic status without these background illnesses. CONCLUSIONS: Healthcare services should prepare for increased hospitalization rates during the two years following wildfires for populations with underlying morbidity and those of low socio-economic status. Implementing preventive-medicine approaches may increase the resiliency of communities in the face of extreme climate-related events and prevent future health burdens. Additional research should focus on the specific mechanisms underpinning the long-term effects of wildfire exposure.

Teaching and Practicing Cognitive-Behavioral and Mindfulness Skills in a Web-Based Platform among Older Adults through the COVID-19 Pandemic: A Pilot Randomized Controlled Trial.

The outbreak of the COVID-19 pandemic has led to an acceleration in the development of web-based interventions to alleviate related mental health impacts. The current study explored the effects of a short-term digital group intervention aimed at providing cognitive behavioral and mindfulness tools and skills to reduce loneliness and depression and to increase social support among older adults in Israel. This pilot randomized controlled trial included community-dwelling older adults (n = 82; aged between 65-90 years; 80% female) who were randomized either to an intervention group (n = 64) or a wait-list control group (n = 18). The intervention included seven online sessions, over 3.5 weeks. Depression, loneliness, and social support measures were administered at baseline, immediately post-intervention, and at 1-month follow-up. Repeated measures ANOVA revealed statistically and clinically significant reductions in depression in the intervention group, with results maintained at one-month follow-up. Loneliness levels also significantly decreased post-intervention; however, this benefit was not maintained at one-month follow-up. Social support slightly increased both post-intervention and 1-month follow-up-but these changes were not statistically significant. There were no overall changes for the wait-list control group. Our intervention provided promising evidence regarding the effectiveness of an online group intervention to alleviate mental health effects and to promote the coping of older adults during the COVID-19 pandemic. This relatively simple model can be effectively utilized by communities globally to help connect lonely and isolated older inhabitants, both during the pandemic and in more routine times.

Evaluation of a Short-Term Digital Group Intervention to Relieve Mental Distress and Promote Well-Being Among Community-Dwelling Older Individuals During the COVID-19 Outbreak: A Study Protocol.

Older individuals are at an increased risk of experiencing adverse social and health consequences due to both the COVID-19 pandemic and the measures taken to manage it, such as social distancing. To promote community-dwelling older individuals' well-being during this time, the aims of the current project are to develop effective strategies in order (a) to increase older individuals' digital literacy, and (b) to help them acquire behavioral and cognitive skills that will improve their coping abilities with the stressful situation created as a result of the pandemic, as well as reducing adverse mental health effects. The project comprises an intervention arm that includes digital group sessions for older individuals meant to improve their digital literacy, promote their effective coping, and relieve their mental distress and loneliness. Subjects receive a short-term (seven sessions), twice-weekly, digitally guided group intervention through Zoom (a video conferencing app), and WhatsApp (instant messaging app). The wait list control-group participants receive twice-weekly telephone calls from a research assistant during a parallel period. Web-based questionnaires are filled in pre- and post-participation. The effectiveness of the intervention will be analyzed by comparing pre- and post-measures, between intervention and control groups. This protocol offers a model for helping to support vulnerable populations during the COVID-19 pandemic. However, it is applicable regardless of the outbreak of a global health crisis or the imposition of lockdown rules; in fact, it has the potential to contribute to the social inclusion of vulnerable populations during routine times as well as during emergencies. Furthermore, ideas for future expansion include the integration of multilingual facilitators in order to reach seniors from underserved minority groups in various social contexts, even across borders.

A pilot randomized controlled trial of a group intervention via Zoom to relieve loneliness and depressive symptoms among older persons during the COVID-19 outbreak.

While effective in reducing infections, social distancing during the COVID-19 outbreak may carry ill effects on the mental health of older adults. The present study explored the efficacy of a short-term digital group intervention aimed at providing seniors with the tools and skills necessary for improving their coping ability during these stressful times. A total of 82 community-dwelling adults aged between 65 aged 90 (Mage = 72 years, SD = 5.63) were randomized to either an intervention group (n = 64) or a wait-list control group (n = 18). The intervention comprised online guided sessions in small groups in which behavioral and cognitive techniques were learned and practiced via the ZOOM videoconferencing platform. Loneliness and depression levels were measured pre- and post-participation. The results demonstrated a significant improvement in the intervention group in terms of both loneliness and depressive symptoms, compared with the control group. Results of mixed effect models indicated a medium ameliorative effect on loneliness (d = 0.58), while that for depressive symptoms was only marginally significant and smaller in size (d = 0.43). Our intervention presents a relatively simple and effective technique that can be efficiently utilized to support older adults both during emergencies such as the COVID-19 outbreak, as well as in more routine times for older adults who live alone or reside in remote areas.

Giving a voice to medically vulnerable populations: A mixed-methods investigation of their unique perceptions and needs in emergency situations.

Older adults in poor health represent a growing sector of the population worldwide. These medically vulnerable individuals often tend to be ill-prepared for emergencies. In times of crisis they are at higher risk of experiencing adverse health outcomes and are liable to place an additional burden on health and social care services. The aim of this study was to explore the unique perceptions and diverse needs of community-dwelling medically vulnerable individuals in Israel in order to gain insights that could be used to promote future preparedness. A mixed methods design was employed that included 16 in-depth interviews, followed by a quantitative survey of 179 participants. Data were collected between 2016 and 2017. The analysis process included thematic analysis for qualitative data. Quantitative data analysis focused on estimating associations between preparedness levels and participants' characteristics and perceptions. The results indicated low levels of preparedness-only 13.5% of participants reported having prepared a full emergency kit with supplies. Family members played a key role in almost every dimension related to emergency preparedness; alongside certain authorities perceived by the participants as responsible for initiating the preparedness process. Additional issues that emerged were related to information and communication and to the logistics of medication handling and special nutrition. The findings suggest that it is vital to adopt a proactive approach to the problem of preparedness in this population. This conclusion should be of value to health and social care practitioners in the community as well as to family members and caregivers. Practical and simple recommendations for enhancing preparedness based on these findings are provided. Viewing preparedness as a process that is the joint responsibility of the individual, the family, caregivers, and community health and social welfare services could contribute to maintaining continuity of care among vulnerable populations and mitigate adverse health outcomes in future events.

Confidence in Health-Services Availability during Disasters and Emergency Situations-Does it Matter?-Lessons Learned from an Israeli Population Survey.

The association between health and community resilience is well established in the literature. However, maintaining continuity of healthcare services during emergencies, and their contribution in the context of community resiliency have not been sufficiently studied. This study aims to explore the relationship between the public's confidence in the availability of healthcare services during and following emergencies, and community resilience. A cross-sectional study was conducted among 3478 Israeli adults, using the Conjoint Community Resilience Assessment Measurement (CCRAM) tool. Associations between confidence in health services availability during emergencies, socio-demographic variables, and community resilience as measured by the CCRAM score were analyzed. The results revealed that confidence in the availability of health services positively correlated with community resilience score (r(3377) = 0.580, p < 0.001), and that it contributed significantly to increasing resilience (OR = 2.67, 95% CI (2.4-2.9), p < 0.001). Maintaining continuity of healthcare services during emergencies has effects beyond the provision of medical treatment. For instance, the confidence of the population in the availability of these services contributes to community resilience. In turn, this finding can be translated into practical resilience building actions and to facilitate community health.

Healthcare workers' willingness to respond following a disaster: a novel statistical approach toward data analysis.

BACKGROUND: The willingness of healthcare workers (HCW) to respond is an important factor in the health system's response capacity during emergencies. Although much research has been devoted to exploring this issue, the statistical methods employed have been predominantly traditional and have not enabled in-depth analysis focused on absenteeism-prone employees during emergencies. The present study employs an innovative statistical approach for modeling HCWs' willingness to respond (WTR) following an earthquake. METHODS: A validated questionnaire measuring knowledge, perceptions, and attitudes toward an earthquake scenario was distributed among Israeli HCWs in a hospital setting. Two regression models were employed for data analysis - a traditional linear model, and a quantile regression model that makes it possible to examine associations between explanatory variables across different levels of a dependent variable. A supplementary analysis was performed for selected variables using broken line spline regression. RESULTS: Females under the age of forty, and nurses were the most absenteeism-prone sub-groups of employees (showed low WTR) in earthquake events. Professional commitment to care and perception of efficacy were the most powerful predictors associated with WTR across all quantiles. Both marital status (married) and concern for family wellbeing, designated as statistically significant in the linear model, were found to be statistically significant in only one of the WTR quantiles (the former in Q10 and the latter in Q50). Gender and number of children, which were not significantly associated with WTR in the linear model, were found to be statistically significant in the 25th quantile of WTR. CONCLUSIONS: This study contributes to both methodological and practical aspects. Quantile regression provides a more comprehensive view of associations between variables than is afforded by linear regression alone. Adopting an advanced statistical approach in WTR modeling can facilitate effective implementation of research findings in the field.

An Integrated and Interdisciplinary Model for Predicting the Risk of Injury and Death in Future Earthquakes.

BACKGROUND: A comprehensive technique for earthquake-related casualty estimation remains an unmet challenge. This study aims to integrate risk factors related to characteristics of the exposed population and to the built environment in order to improve communities' preparedness and response capabilities and to mitigate future consequences. METHODS: An innovative model was formulated based on a widely used loss estimation model (HAZUS) by integrating four human-related risk factors (age, gender, physical disability and socioeconomic status) that were identified through a systematic review and meta-analysis of epidemiological data. The common effect measures of these factors were calculated and entered to the existing model's algorithm using logistic regression equations. Sensitivity analysis was performed by conducting a casualty estimation simulation in a high-vulnerability risk area in Israel. RESULTS: the integrated model outcomes indicated an increase in the total number of casualties compared with the prediction of the traditional model; with regard to specific injury levels an increase was demonstrated in the number of expected fatalities and in the severely and moderately injured, and a decrease was noted in the lightly injured. Urban areas with higher populations at risk rates were found more vulnerable in this regard. CONCLUSION: The proposed model offers a novel approach that allows quantification of the combined impact of human-related and structural factors on the results of earthquake casualty modelling. Investing efforts in reducing human vulnerability and increasing resilience prior to an occurrence of an earthquake could lead to a possible decrease in the expected number of casualties.

Knowledge, perceptions, attitudes and willingness to report to work in an earthquake: A pilot study comparing Canadian versus Israeli hospital nursing staff.

BACKGROUND: Health practitioners are expected to respond effectively to an earthquake event and provide lifesaving treatment to an influx of casualties. Understanding the factors that may influence nurses' willingness to report (WTR) in different social contexts and preparedness approaches is crucial for improving preparedness of medical facilities. METHODS: A questionnaire based on a previously validated methodology was used to assess demographic characteristics, knowledge, perceptions, attitudes and WTR of nurses after an earthquake. The questionnaire was disseminated among a sample of 56 Israeli and 127 Canadian nurses, from two tertiary care hospitals, located in risk regions. RESULTS: WTR was generally higher among Canadian versus Israeli nurses (74% vs. 64%). Knowledge and perceptions of organizational-efficacy were generally higher among Israeli nurses. 'Concern for family's well-being' and 'professional commitment to care' were reported by the largest proportion of nurses as factors that might influence WTR. A common significant predictor of WTR among both samples was the belief that 'colleagues will also report to work'. CONCLUSION: Although different preparedness approaches or emergency experience in Canada and Israel may cause differences in nurses' preparedness, some factors seem to be cross-cultural and may play a key role in increasing nurses' willingness to report after an earthquake.

Health Care Workers' Knowledge and Confidence in Personal Protective Equipment During the H1N1 Pandemic in Israel.

OBJECTIVES: Healthcare workers (HCW) are at increased risk of infection during pandemics. HCW personal protective equipment (PPE) use has been shown to lower infection rates among HCW and patients. However, low compliance and misuse are frequent. Since future outbreaks are unavoidable, this issue needs to be addressed. METHODS: A validated questionnaire was distributed to 617 HCWs (nurses and physicians) in 21 hospitals and 40 primary care clinics in Israel at the peak of the A/H1N1 pandemic. RESULTS: PPE confidence was higher among HCWs with higher tested and self-perceived knowledge. Confidence was also higher among nurses compared with physicians and among employees in hospitals compared with those in primary care clinics. Experience treating A/H1N1 patients was related to higher self-perceived knowledge and PPE confidence. CONCLUSIONS: High levels of PPE knowledge were significantly correlated to HCWs' confidence in PPE and may help increase PPE usage and reduce absenteeism. (Diaster Med Public Health Preparedness. 2014;0:1-8).