What does it mean that hospitals are preparing for mass casualty incidents?

I went to a drill at Rambam Hospital in Haifa to see for myself.

“Drill, drill, drill,” the authoritative woman’s voice announced over Rambam Hospital’s PA system yesterday morning. “This is the control center. Implement the procedures for a mass casualty incident.” Thus began a practice run for handling 100 casualties from a single missile attack to which journalists were invited to observe readiness for the impending war that seems inevitable.  I was one of those journalists.

I live a few blocks away from Rambam Hospital. Comes in handy because parking has become so difficult since parts of the underground parking facility serve as fortified hospital wards. This is the largest fortified hospital in the country – and in the world. It was built after the 2006 Lebanon War during which missiles rained down around the hospital.

I have walked to the hospital many times before – as a patient, as a visitor to other patients. This time I went as a journalist. I was curious to see what a drill looked like, to be able to imagine in my mind’s eye what the real thing will look like when we need it.

As I passed through the outside security barrier, I saw ambulances lined up by the gate, with medics and soldiers either getting last-minute instructions or just hanging around. The whole entry patio to the hospital was alive with yellow-vested staff, their positions written in big black letters on their backs. Then I found the group of journalists with David Retner, hospital spokesman. I listened, recorded a bit, and put the green neon sticky label around my lower arm (it didn’t fit around my upper arm) like a hospital patient’s identity bracelet – others put on their backs or their bags. It read “Press” in English and Hebrew and gave free access to the Emergency Rooms above and below ground.

About ten long minutes after the announcements that the drill had begun, ambulances calmly rolled into the drop-off zone in front of Rambam’s emergency wing to convey “patients” to the hospital. The emergency ward, partly cleared of regular patients to make room for the incoming “casualties” from the attack, was soon populated with dolls standing in for real people. The patients were triaged here, examined to determine the urgency of treatment required for each individual and where they will be treated. I heard one doctor calling for the operating room to be readied for a patient. I didn’t hear what response he got on his communication device but I was told that he was really talking to the operating rooms and they were responding as they would in real time. (All photos are my own.)

If it will not be safe for ambulances to park outside, they will be directed to the first floor in the underground parking facility and triage will take place there.

“Patients” entering the hospital had tags around their necks with information jotted down in the field by the medics who tended to them. In real life, the tags are color-coded to distinguish fatalities from survivors and the whether they are mortally, seriously, moderately, or lightly injured.

In the drill, each doll or, in some cases, actor playing the role of a patient, wore a prepared tag, such as this one. It identified a 13-year-old girl who was fully conscious, breathing independently, and ambulatory, rescued from a burning apartment. She had ash on her face, neck, and upper limbs, and was confused and worried about her family, who were also taken to the hospital.

When I shut the other journalists out of my mind, it felt as if I was watching the real thing. All medical and auxiliary staff behaved as if the dolls were real people: the latter transporting or accompanying them with respect and a sense of urgency, the former examining them, taking blood samples, affixing oxygen masks, and more, finally marking down observations and conclusions on medical charts.

The mental health professionals worked with actors as if it was a real incident.

One social worker told me this was his first drill. He described the importance of the practice run beyond his theoretical training in working with acute traumatic responses. Participation in the drill gave him the confidence he will need to be in the right place at the right time and to function independently when all his colleagues will be busy themselves in a real-time incident.

At the end of the drill, there was a "call" from the army saying the next phase is a war and that the entire hospital has to be moved to the underground facility.  In this case, this was the end of the single missile drill.

At one point, I became more interested in the foreign journalists than in the drill. Two agreed to speak with me for a few moments in the patio outside the hospital. Both have been to Israel several times and were now here to cover the impending inevitable war against Iran.

The Japanese journalist said the Japanese people cannot understand why we and the Palestinians cannot make peace given their experience with having made peace with former enemies. Perhaps I should have told him that Japan was soundly and most horrifically defeated before their emperor prepared the population for moving on to a better future. He said the Japanese can, however, identify with living normal daily lives alongside constant threat of danger and just the previous night, a 6-point earthquake shook a part of Japan. We talked a bit about the difference between the dangerous cruelty of nature and the dangerous cruelty of human enemies.

The French journalist I spoke to said that the French cannot fathom what it is like to live a normal daily life when it is really so abnormal right now. He discussed a skill he developed whereby he connects emotionally with interviewees to the degree that they respond to him openly but he keeps a barrier between this level of connection and his deeper inner self in order not to be overwhelmed and lose his professionalism. (I could identify with that skill as a former therapist, as did a MADA medic with whom I spoke.) This self-protectiveness did not hold out, however, when he was with a NOVA (music festival) survivor and he told me he had had to shut down the conversation. I noted that the survivor was probably about the same age as him. I wonder if his sudden rush to leave me and run to interview a doctor inside the hospital was because just mentioning this was a trigger to that memory and he was afraid to continue.  

A full-scale war drill is conducted at the hospital every three to five years. The last one was four years ago so it is about time for another one.

It appears, however, that the next full-scale war drill will be the real thing. From my observations of this dry run, Rambam is ready for it.

You can see what I describe above in action in this videoclip produced by Rambam’s photography unit. I hope watching it will mean as much to you as it does to me since I was there to see it take place.

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