Secondary Casualty Evacuation on October 7, 2023

Summary: On October 7, 2023, Israel experienced an unprecedentedly severe terrorist attack, resulting in more than 1,200 fatalities, 1,455 injuries, and 239 hostages. The scale of the attacks on civilians placed an immense strain on hospitals, particularly in the south. This necessitated a significant shift in hospital operations, including the activation of Mass Casualty Event (MCE) protocols. Soroka and Barzilai hospitals were forced to transition to a MEGA MCE mode, dramatically altering the operation of their emergency departments, trauma units, operating rooms, and internal medicine wards. Due to the overwhelming number of casualties and the significant strain on southern hospitals, secondary evacuation operations were conducted for the first time since the Yom Kippur War (1973). Hundreds of casualties were transferred from overwhelmed southern hospitals to those in the central and northern regions of the country. This massive operation involved the coordinated efforts of the Home Front Command, the Ministry of Health, and hospitals across the nation, all operating in emergency mode. The success of these rapid and effective actions can be attributed to ongoing training, exercises, and cooperation spearheaded by the Hospital Preparedness Branch. This multi-year readiness program, involving 28 hospitals, included comprehensive emergency room training, tabletop drills and simulations for hospital headquarters, and large-scale drills. The annual training program encompassed MEGA, SURPRISE, SAMPLE, and MTE drills, ensuring all hospitals were prepared for large-scale emergencies. This presentation aims to share the lessons learned from both hospital-level and national-level evaluations regarding hospital preparedness for MCES. It will also provide insights derived from the secondary evacuation processes, which involved transferring hundreds of casualties daily, using Magen David Adom ambulances and helicopter evacuation rounds by the Israeli Defense Forces (IDF).