• Matan Peer, Zachary A Trotzky, Joseph Offenbacher, David Mazor, Aya Cohen, Eldar Azar, Gal Pachys, Baruch Berzon, and Daniel Trotzky.
• Department of Emergency Medicine, Shamir Medical Center (Formerly Assaf Harofeh), Zerifin, Israel; Clalit Health Services, Dan District, Petah Tikvah, Israel.
• Am J Emerg Med. 2025 Jan 8; 90: 414641-46.

BackgroundMass Casualty Events (MCI) which have a direct and persisting impact on the safety and well-being of an emergency department (ED) and its staff, secondary to specific targeting of the healthcare setting, represent a distinct and complex operational challenge. ED physicians may be faced with the prospect of providing ongoing patient care while simultaneously experiencing direct threats to their own health or physical safety. In our study we considered the unique operational challenges encountered, and management strategies adopted, by the ED staff and its leadership to an all-hazard MCI impacting an academic urban emergency department.MethodsWe conducted a retrospective, observational study of data from a tertiary academic medical center of patients arriving to the ED during a protracted MCI lasting from May 11th to May 21st, 2021. No arriving patients were excluded from analysis. Patient demographics, ED resource utilization, throughput, disposition and other pertinent data were considered. Analysis was done of three distinct patient populations including the event-group (EG), a non-event-group (NEG) and a control group (CG). Descriptive statistics were used to evaluating observational findings.ResultsWe reviewed the records of 8527 total patients presenting to the Shamir Medical Center ED during the event and control periods. Of those, 283 patients were identified as an EG consisting of casualties from the MCI. 3563 patients were identified as the NEG presenting with complaints not related to the event. Our CG consisted of the 4681 patients who presented in the two weeks prior to the MCI. EG patients were noted to have important characteristics including higher relative numbers of men n = 173 (61.6 %), higher CTAS triage acuities [n = 10 (3.8 %), classified as CTAS 1], and an increase utilization of specialty consultation and admission consistent with observed injury patterns, most notably for the orthopedic services [orthopedic consultations: n = 126 (44.5 %) / orthopedic admissions: n = 13 (4.6 %)].ConclusionFindings from our observational study suggested that in the absence of larger public health interventions a manmade MCI, with direct threats to an ED and its staff, could force EDs to concurrently address the unique clinical needs of two distinct patient populations while simultaneously needing to take measures to protect hospital staff. Additionally, a higher burden of patient volumes and clinical acuity are likely to be encountered by select specialty consultation services. Further studies could focus on quantitative analysis to better understand the operational impact of these types of events on both patients and staff.Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.

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