• Avi Benov, Irena Shkolnik, Elon Glassberg, Roy Nadler, Sami Gendler, Ben Antebi, Jacob Chen, Noam Fink, and Tarif Bader.
• From the Israel Defense Forces, Medical Corps (A.B., I.S., E.G., R.N., S.G., J.C., N.F., T.B.), Tel Hasomer, Ramat Gan; The Azrieli Faculty of Medicine (A.B., I.S., E.G.), Bar-Ilan University, Safed, Israel; the Uniformed Services University of the Health Sciences (E.G.), Bethesda, Maryland; Department of General Surgery and Transplantation (R.N.), Sheba Medical Center, Tel Hashomer; Department of Surgery (S.G.), Rabin Medical Center, Petah Tikva, Israel; United States Army Institute of Surgical Research (B.A.); University of Texas at San Antonio (B.A.), San Antonio, Texas; and Department of Military Medicine (T.B.), Hebrew University, Jerusalem, Israel.
• J Trauma Acute Care Surg. 2019 Jul 1; 87 (1S Suppl 1): S165-S171.

BackgroundThe Israeli Defense Force Medical Corps (IDF-MC) is routinely collecting prehospital data to establish a prehospital registry. Since February 2013, Israel has been providing medical care to Syrian refugees. This unique humanitarian aid begins in prehospital settings and typically culminates in Israeli civilian hospitals. This report describes the accumulated experience of the IDF-MC to provide Syrian refugees with prehospital treatment.MethodsCare provided by IDF-MC medical teams, including prehospital casualty care, is regularly documented and after-action reports are conducted. Records of casualties arriving at the Israeli-Syrian border from February 16, 2013, to December 31, 2017, were prospectively extracted from the IDF Trauma Registry. Patients who did not have a casualty card were excluded. The database included demographic information, injury signature and treatment given.ResultsDuring the study period, 2,785 Syrian casualties were treated, of whom 2,339 were trauma victims. The most common mechanism of injury was penetrating (60.4%). Prehospital lifesaving interventions included 127 endotracheal intubations, 30 cricothyroidotomies, 55 chest decompressions, and 58 tourniquets for extremity hemorrhage control. Remote Damage Control Resuscitation included reconstituted freeze-dried plasma (n = 75) and tranexamic acid (n = 222 casualties) with no adverse effects.ConclusionThe experience of the IDF-MC teams in caring for civilian casualties along a hostile international border is unique. In this capacity, the IDF-MC has demonstrated effectiveness in providing lifesaving and resuscitative interventions including tranexamic acid and freeze-dried plasma. In this experience, tourniquets have been effective in controlling hemorrhage when applied early and endotracheal intubation and cricothyroidotomy have provided effective airway options in select patients. Prehospital combat casualty care presents a significant challenge both in terms of providing adequate care and in terms of data collection and analysis. The experience described in this article is one example of effective, ongoing prehospital data gathering process. Efforts to provide medical relief to victims of the Syrian civil war continue to this day. While we hope for a better future, as long as these lessons continue to accumulate, it is our obligation to use them to support improvement of trauma care and hopefully save more lives.Level Of EvidenceTherapeutic, level III.

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