Orthopaedic Management During the First 24 Hours of the October 7 Mass Casualty Event in Israel

➢ On October 7, 2023, a large-scale attack in southern Israel resulted in a major mass casualty event (MCE). One of the first hospitals to receive patients was Barzilai Medical Center (BMC) in Ashkelon, located approximately 10 km north of the Gaza border. ➢ During the first 24 hours, BMC managed a substantial extremity injury burden, placing orthopaedic surgeons in central operational roles. These extended beyond surgical care to include emergency department (ED) triage, operating room (OR) prioritization, and interhospital coordination. ➢ Israel’s longstanding experience with MCE preparedness enabled rapid nationwide mobilization of medical personnel, and the country’s compact geography and integrated trauma network facilitated early transfer of patients across hospitals. ➢ Patient arrival did not occur immediately and only peaked several hours after the onset of the attack. This delay allowed for staff mobilization, OR preparation, and establishment of coordinated patient transfer. ➢ The preservation of operative capacity required selective surgical management. Essential stabilization measures performed in the ED, including hemorrhage control, tourniquet reassessment, vascular evaluation, wound debridement, and provisional immobilization, enabled safe stabilization and patient transfer, while reducing the risk of preventable ischemic injury. ➢ These findings support the role of frontline trauma centers as early stabilization hubs within regional trauma systems, where preserving capacity depends on rapid triage, selective intervention, and timely transfer.