The city of Netanya in Israel is a hotspot in more ways than one: It is a scenic tourist destination on the shores of the Mediterranean Sea north of Tel Aviv and a frequent target for terrorist attacks, due to its proximity to Palestinian settlements.
As a result, Laniado Hospital — founded there in the mid-1970s by a rabbi who survived the Holocaust — has been transformed into an institution with much expertise when it comes to dealing with mass casualty incidents, or MCIs.
This is precisely why a delegation of experts visited Children’s Hospital Los Angeles from June 1-9. A week of events with the theme “Living Prepared,” sponsored by the West Coast Friends of Laniado Hospital, included lectures and presentations by experts in the field of disaster management.
The week, branded as a response to the April 15 Boston Marathon bombings, wasn’t the first time that American medical personnel have sought advice from Israelis in this arena. A doctor at Massachusetts General Hospital in Boston said its response to the bombings was aided by a visit a few years earlier with Israeli emergency medical experts. And L.A. Sheriff Lee Baca visited Laniado in 2011.
Lydia Lanxner, co-coordinator of the emergency task force at Laniado, spoke at Children’s Hospital on June 7. She talked about what steps her hospital took to prepare and react to mass casualty incidents, such as terrorist attacks.
Because Netanya is so small, the hospital staff often become aware of an attack only as the victims’ stretchers are being wheeled into the hospital. Instead of referencing the standard “golden hour” — the preparation time between news of an MCI and the arrival of victims — Lanxner therefore refers to her staff’s preparation time as “golden minutes.”
The patients are moved through a one-way system to prevent bottlenecks as doctors decide where they need to go. MCI reporting instructions for the staff are printed on the backs of their hospital badges, because the chaos and anxiety of the moment can make the hospital staff forget their own names and titles.
“It could be your child, it could be your wife, it could be your neighbor,” Lanxner said of the victims.
Dr. Michael Frogel, a disaster preparedness consultant who also is involved in the American Friends of Laniado Hospital, discussed aspects of disaster relief that are often neglected during an MCI, including child care and mental health services. He said perhaps 10 times as many people suffer adverse psychological effects from disasters as suffer physical injuries, but psychological first aid is rarely administered. Trauma can induce acute stress reactions, including such symptoms as a fast heartbeat, an inability to function and feeling surreal, as if the experience is not really happening. If not treated, illnesses like depression and post-traumatic stress disorder can affect victims the rest of their lives, he said.
Both Lanxner and Frogel have had personal experiences with MCIs. In the spring of 2002, Lanxner and her family had planned to celebrate Passover at the Park Hotel in Netanya with many others. They changed their plans at the last minute, deciding to celebrate at home. That night, a suicide bomber killed 30 people and injured 140 at the hotel.
“Every citizen [in Netanya] has had an ‘almost’ encounter with terrorism,” Lanxner said.
Frogel was living in New York during Hurricane Sandy in 2012. At least one home on every block in his neighborhood was destroyed. After the hurricane, rumors spread that there was E. coli bacteria in the air, despite his efforts to explain that this was not possible. To prevent a panic and reassure people, the Environmental Protection Agency tested the air. It’s important that the public feel that they can trust the information they are given, he said.
Dr. Jeffrey Upperman, director of the trauma program at Children’s Hospital, said that Israel approaches disaster preparedness and management differently than in the United States. Upperman noted that support of Israel’s medical system does not come from the grass-roots level but from the national level. The emphasis that Israel places on preventative planning and awareness has paid off.
“They have made it a part of their DNA. … They have decided they want to be on the forefront,” he said.
During his presentation, Frogel showed the audience a picture of a group of smiling Israeli children who heard warning sirens while hanging out in a parking lot one afternoon and immediately ran to a shelter. Minutes later, a missile landed exactly where the children had been standing. The shelter that saved their lives had been finished the previous day, he said.
Upperman expressed concern at the lack of disaster preparedness — particularly related to a possible influx of young patients — among local hospitals and other institutions, such as schools, citing a 2010 study that he helped facilitate. Children’s Hospital, for example, currently has 603 “licensed beds.” In the event of a disaster, many children would have nowhere to go, especially if they needed care tailored to their particular age group, Upperman said.
Meanwhile, he uses what resources he has. Upperman helped conceptualize the “Disaster Olympix,” in which the staff finds creative ways to provide disaster relief. He said he is always looking for better and more efficient preparedness methods.
“We steal from everywhere!” he emphasized during his presentation.
“We are happy to share.”
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