• Moshe Pinkert, Adi Leiba, Eilon Zaltsman, Onn Erez, Amir Blumenfeld, Shkolnick Avinoam, Daniel Laor, Dagan Schwartz, Avishay Goldberg, Yehezkel Levi, and Yaron Bar-Dayan.
• Israel Defense Forces Home Front Command, and Department of Healthcare Systems Management, Faculty of Health Sciences, Ben Gurion University, 16 Dolev Street, Neve Savion, Or-Yehuda, Israel.
• Disasters. 2007 Sep 1; 31 (3): 227-35.

AbstractTerrorist attacks can occur in remote areas causing mass-casualty incidents MCIs far away from level-1 trauma centres. This study draws lessons from an MCI pertaining to the management of primary and secondary evacuation and the operational mode practiced. Data was collected from formal debriefings during and after the event, and the medical response, interactions and main outcomes analysed using Disastrous Incidents Systematic Analysis through Components, Interactions and Results (DISAST-CIR) methodology. A total of 112 people were evacuated from the scene-66 to the nearby level 3 Laniado hospital, including the eight critically and severely injured patients. Laniado hospital was instructed to act as an evacuation hospital but the flow of patients ended rapidly and it was decided to admit moderately injured victims. We introduce a novel concept of a 'semi-evacuation hospital'. This mode of operation should be selected for small-scale events in which the evacuation hospital has hospitalization capacity and is not geographically isolated. We suggest that level-3 hospitals in remote areas should be prepared and drilled to work in semi-evacuation mode during MCIs.

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