Civil Preparedness in Asymmetric Conflicts: A Bystander Mass Casualty Training Concept by Israel’s Emergency Medical Services

Introduction: The October 7, 2023, terrorist attack in Israel and the 2022 Russian invasion of Ukraine have highlighted the need for lay bystanders to be able to assist victims during mass casualty incidents (MCIs) before the arrival of Emergency Medical Services (EMS). The “First Seven Minutes” (F7M) training has been developed by Israel’s EMS to train lay bystanders to respond medically in this context by teaching a seven-step approach to administering an MCI scene. A programmatic study was conducted to understand if F7M increased the self-assessed ability among participants to respond and whether this varied with the participants’ level of personal resilience. Methods: This was a survey-based before-after intervention study where all F7M participants from 2018-19 were invited to participate. A 5-point Likert scale questionnaire was administered before and after training to investigate self assessed ability to respond medically in conflict-related MCIs. Personal resilience was assessed using a modified Brief Resilience Scale. The Wilcoxon signed-rank test was used to test for significance between mean scores. Results: The analysis included a total of 128 participants. Following training, self-assessed ability to respond increased significantly (Mean Difference 0.5, p<0.05). Low-resilience participants benefited more than participants with normal or high resilience (MD 1.14, p<0.05 vs MD -0.38, p<0.05, CI: 0.73 – 1.56 vs CI: -0.52 – -0.23). Conclusion: In contemporary armed conflicts with escalating violence against civilians, F7M may be a useful tool for building capacity in bystanders to assist during MCIs. Further, it may be of benefit in wider preparedness efforts to mitigate civilian loss of life during armed conflicts. The relevance of F7M in this context will be more extensively discussed during an oral or poster presentation.