1. Dr. J. Yahav Director, Beilinson Campus Deputy Director General, Rabin Medical Center THE BEILINSON EMERGENCY MEDICAL PREPARDNESS – ON CONSTANT ALERT

2. 2 The Major Challenges of Medical Preparedness for Emergencies  Preparedness for all potential scenarios.  Assimilation of knowledge amongst medical personnel.  Maintenance of capabilities over time.  Assuring staff protection while saving lives of contaminated casualties.  Stockpiles of vital equipment.

3. 3 Medical Agencies Pediatric + psychiatric hospitals Clalit - HMO Home front command Ministry of Health Municipal services

4. 4 Disaster Health System Structure in Israel National Emergency Council Supreme Health Authority Health Services Control Center Psychiatric Hospitals Preventive Medicine Primary Care Clinics Geriatric Hospitals General Hospitals EMS Services Home Front Command Chief Medical Officer IDF Surg. Gen. headquarters Epidemiological Management Team (EMT)

5. 5 GOAL Ensuring optimal medical services in all potential emergencies

6. 6 Potential Threats Terrorism: Conventional MCI Chemical MCI Toxicological MCI Bio-terrorism Accidents: conventional or non conventional materials Natural disasters Peacetime Conventional casualties Non-conventional casualties Wartime

7. 7 Contingency Plans  Conventional MCI  Toxicological MCI - MTE  Biological events

8. 8 Multi Casualties Incident (MCI) Definition An incident in which the number and type of casualties surpass the capability of optimal treatment based on existing resources

9. 9 No. of casualties Casualties Since 29.9.2000 Updated14.3.05 Casualties Since 29.9.2000 Updated 14.3.05 * In more than 20,000 terrorist events

10. 10 Details of Security Forces and Israeli Civilians Killed - UpdatedSeptember 2004 Details of Security Forces and Israeli Civilians Killed - Updated September 2004 Type of Attack

11. 11 Deployment of MCI in the Field  Triage  Evacuation of casualties

12. 12 Deployment of MCI in Hospitals  Defining admittance capabilities of each hospital (20% of total bed capacity)  Deployment of admitting sites  Immediate call-up of senior medical personnel  Preparedness and availability of life-saving equipment  Triage according to severity (immediate & ambulatory)  Implementing MCI protocols  Information centers – computerized casualty identification – “ADAM”

13. 13 Contingency Planning  Conventional MCI  Toxicological MCI - MTE  Biological events

14. 14 Basic Assumptions  An event can occur in an industrial factory, during transport of hazardous material or due to terrorism  Hazardous materials classified according to similar traits  Admittance capacity based on the preparedness for MCI (20% of bed capacity)

15. 15 Main Industrial Areas in Central Zone of Israel Netanya Petach Tikva Holon Rehovot

16. 16 Types of Chemical Warfare Mustard Nerve gas agents Persistent Volatile VX tabun sarin soman Others

17. 17 Hospital Deployment for MTE  Treatment of casualties – ATLS + BLS integrated with guidelines of treating casualties from toxic materials  Protection of personnel from secondary contamination  Hospital preparedness based on the deployment of MCI & chemical warfare

18. 18  Undressing & decontamination  Triage of casualties  Treatment protocols (antidotes & supportive care)  Deployment of admitting sites  Preparedness for admittance of ambulatory casualties & “worried well” Main Principles

19. 19 Contingency Plans  Conventional MCI  Toxicological MCI - MTE  Biological events

20. 20 Biological Warfare Agents toxins Aflatoxin Botulinum Perfringens Ricin Staph. Enterotoxin b T - 2 Mycotoxins bacteria Anthrax Brucellosis Cholera Glanders Plague Q fever Tularemia viruses Viral encephalitides Viral hemorrhagic fevers Smallpox

21. 21 Main Challenges  Early detection of exceptional morbidity  Early (laboratory) detection & identification of pathogen  Risk assessment and incident control  Deployment of medical systems

22. 22 Detecting and follow-up of exceptional event Hospital HQ ER Community clinics Epidemiological department ICUs laboratories Infectious Diseases Specialists Hospitalization rates mortality Morbidity Monitoring in the Hospital Integration & Data analysis

23. 23 anthrax Bio Terrorism hospitalization Preventive antibiotics distribution Limiting areas

24. 24 Major Milestones of Preparedness

25. 25 Manpower Resources Personnel on shift Personnel Recall (from Homes) Re-enforcement: from wards Volunteers Military – discharged personnel

26. 26 Training  Development of instruction kits.  Clinical training in Medical Simulation Center.  Annual simulation exercises.  Periodic drill program.

27. 27 Types of Drills  Conventional MCI  Toxicological MCI  Chemical warfare drills  Sentinel identification of biological event

28. 28 Procurement  Procurement and storage of critical equipment in immediate availability  Antidotes and pharmaceuticals for CW and BW  Life saving equipment (ventilation machines and monitors) Storage in hospitals Reserves in Emergency Division

29. 29 Vital Logistic Elements  Decontamination sites  Heliopads  Oxygen tanks  Warehouses  Generators  Water reservoirs  Specific computer programs  Communication & radio equipment

30. 30 After Action Reviews Policies + doctrines Lessons learned recommendations

31. 31 Conclusions Effective preparedness for emergencies necessitate: * Constant alert * Continuous debriefing & learning * Preplanning Keeping one step ahead

32. 32 Thank You !