Real-time Innovative Solutions for Ensuring Continuity and Safety of Medical Care in a Hospital Under Wartime Physical Threat

Abstract The recent conflict in the Middle East posed unprecedented threats, with hundreds of long-range ballistic missiles launched toward Israel, targeting military and civilian facilities including hospitals. Organizational and logistic actions were taken in Sheba Medical Center, both pre-emptively and during the conflict, preparing for a mass casualty incident while maintaining routine medical care to the population and maintaining safety of patients and staff. These included discharging patients and increasing home hospitalizations, ward evacuations, transferring patients to protected areas, and classifying patients by their vulnerability and status of protection, accelerated structural adaptation of underground spaces to house patients, and construction of a tented field hospital underground. An effective command and control system was in place to monitor protective status, and an ethical committee was convened to assist in decision-making. These measures enabled continued delivery of emergency and medical care under fire while ensuring the safety of patients and staff.