Harefuah
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In the last decade, the Israeli healthcare system dealt with many casualties that resulted from terrorist actions and at the same time maintained preparedness for other potential hazards such as natural disasters, toxicological, chemical, radiological and biological events. There are various models for emergency preparedness that are utilized in different countries. The aim of the article is to present the structure and the methodology of the Israeli healthcare system for emergencies. ⋯ The ability of the medical system to operate in optimal coordination with interface bodies, including the Israel Defense Forces, is derived from three main elements: the shortage of resources necessitate that all agencies work together to develop an effective response to emergencies; the Israeli society is characterized by transition of personnel from the military to the civilian system which promotes joint operations, whereas in most other countries these systems are completely separated; and also developing mechanisms for continuous and coordinated operation in routine and emergency times, such as the Supreme Health Authority. The Israeli healthcare system was put to the test several times in the Last decade, during the terror wave that occurred between 2001-2006, the 2nd Lebanon War and in operation "Cast Lead". An extensive process of learning lessons, conducted during and following each of these periods, and the existence of a mechanism which facilitated the definition of a systematic policy and the examination of its implementation, enabled the healthcare system to provide medical services to the population and to improve its preparedness by an ongoing process.
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Counterfeit drugs are a major threat to public health and safety around the world. This review describes the various distribution methods and channels of counterfeit drugs, including the growing use of the internet. National, regional and international efforts to confront this problem are presented, as well as a wide range of technologies that may assist in detection and enforcement. Finally, the Israeli perspective and actions are illustrated.
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[Disasters and emergency situations: what have we learned from the past to prepare for the future?].
Israel has gained extensive experience in the mass casuaLty field, especially from dealing with terrorism events. This special issue of "Harefuah" includes articles that describe and analyze several aspects and approaches related to mass casualty event (MCE) preparedness and response strategies, based on Israel's experience. Feigenberg reports that Magen David Adom (MDA) was able to evacuate all urgent injuries during an MCE from the site to a hospital in 28 minutes, on average. ⋯ In summary, achieving improvement requires continuous focus on preparedness, integration of new technologies, routine debriefings, and developing new coping strategies, education, training, and drills. These should all be part of daily preparedness routines. Only in this way can a high quality level of preparedness be maintained over time.
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This article deals with the pre-hospital medical treatment provided by Magen David Adom (MDA) teams to the victims of 36 multi-casualty incidents caused by suicide bombers during the Al-Aksa Intifada. A total of 2048 people were injured in those 36 incidents--an average of 57 injured per incident. The data collection and analysis is based on operational and medical debriefing performed after each incident, with the participation of all MDA teams that treated and evacuated injured that were defined as urgent. The medical debriefing focused on: triage--the definition of the injured situation: urgent or not urgent, priority for treatment and priority for evacuation; the Level of treatment--advanced life support (ALS) (paramedics and physicians) in comparison with basic life support (BLS) [medics]; life saving procedures performed on the scene; and the way in which the teams on the scene decided on the hospital in the region to evacuate the injured. ⋯ Triage data showed that: 70% of the injured defined on the scene as urgent had a moderate--ISS > 9, or severe ISS> 16 injury. Life-saving procedures were performed on the scene on 99 victims [24% of all injured defined as urgent by MDA teams). Findings on decision-making regarding which hospital to evacuate the urgently injured revealed: 9 incidents took place in regions where Level 1 trauma centers were not available--all urgently injured were evacuated to regional hospitals, 63% of these patients were secondarily transferred to a Level 1 trauma center. In 27 incidents--one or more Level 1 trauma centers were available in the region and 71% of the urgently injured were transported directly from the scene to Level 1 trauma centers. Only 12% of those transported to regional hospitals were secondarily transported to Level 1 trauma centers. Even in multi-casualty incidents caused by explosions of suicide bombers, incidents that are characterized by stress, confusion and chaos--MDA teams succeeded in organizing the medical activity on the scene, acted professionally and provided medical treatment to those who were severely injured. This pre-hospital performance of MDA teams had a significant contribution to the successful treatment of the victims of those events by the entire trauma system in Israel.
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Multi-casualty events are characterized by a large number of wounded people arriving at trauma centers in a short period of time. These wounded suffer distinctive injuries in accordance with the cause of the event. Close to 50 percent of all injuries in a multi-casualty event are musculoskeletal injuries. ⋯ A "damage control" policy should be implemented in all stages of the patient's care. Orthopedic care has been revolutionized several times--developing from delayed care, to early total care and finally to "damage control" orthopedics. "Damage control" orthopedics emphasizes initial stabilization and control of injuries, due to the systemic cytokine storm after polytrauma, prior to final corrective surgery of the patient's fractures. In this article the authors review the orthopedic care in a multi-casualty event, and the specific care given to each of the wounded in such an event.