From Simulation to Survival: Managing an Emergency Department Under the Threat of a Ballistic Missile Attack

On April 14 and October 1, 2024, and then for 10 days from June 13, 2025, Israel was under ballistic missile attacks, causing casualties and destruction. This report describes the response of an emergency department (ED) in Jerusalem to maintain quality care and safety during these attacks. It was vital to minimize the number of ED patients in unprotected zones. Patients in the unprotected area of the ED were relocated to protected zones, and a mechanism was implemented to close blast doors that had been blocked by a technical issue. Lessons learned included: adapting protected areas in the ED for continued patient care, properly closing blast doors, and maintaining flexible emergency protocols to address evolving hazards.