The Health System Surge Capacity and Response to the Sudden Conflict that Developed into an Ongoing War

Summary: Mega MCI poses a significant challenge to the health system, particularly in combat zones under fire. Such an event affects the ability of the EMS and health services to evacuate and provide adequate medical care. On 7 October 2023, Hamas forces attacked southern Israel from Gaza. The attacks resulted in over 3,000 casualties (wounded and dead) who were brought to hospitals; some of them were brought to hospitals a long time after their injury due to the difficulty of evacuation under fire, a fact that influenced their condition and their survival. The massive influx of casualties overwhelmed the two hospitals in the nearest war zone, which were located approximately 40 and 20 km from the attacked sites. Since the attack, the State of Israel has been in a continuous state of war, creating a challenge to the health system, which is faced with the need to provide an adequate response to the war casualties and, at the same time, to continue the routine medical activity to meet the needs of the entire population in the time of “emergency “routine.” This work presents the Ministry of Health (MoH) Emergency Operation Center (EOC) activity during and since the October attack, the cooperation with the Home Front Command (HFC), and the coordinated patient management, transfers in and between hospitals, and field evacuations by ambulances and military forces. It also discusses the ongoing hospital and EMS functions during the “Emergency Routine.” This presentation will provide an initial analysis of what happened, provide insights from the management level, and share lessons learned.