Managing a Mega Mass Casualty Event by a Civilian Emergency Medical Services Agency: Lessons From the First Day of the 2023 Hamas-Israel War

Abstract

On 7 October 2023, Israel faced an unexpected attack by Hamas, causing over 1,200 deaths and injuring more than 9,000 individuals. This report delves into the rapid medical response spearheaded by Israel’s civilian Emergency Medical Service, Magen David Adom (MDA), during this crisis. Utilizing data from MDA’s electronic database, 4,097 dispatch records from the day were analyzed. Of these, 39.3% were directly related to the attack. EMS teams faced multiple challenges, including handling an overwhelming number of casualties and navigating active combat zones, which impeded safe access to victims, posed significant risks to teams’ safety, and constrained patient evacuation strategies. This incident underscores the importance of reinforcing healthcare resilience, particularly emphasizing the need for centralizing various aspects of response efforts. These include streamlined communication, national coordination of pre-hospital resources, and systemic management of patient evacuations. Moreover, providing substantial support for EMS personnel, who operated in highly challenging conditions, is imperative.

October 7th 2023 Mass Casualty Incident in Southern Israel: Lessons for Emergency Preparedness and Management.

“…Ongoing armed attacks on the roads leading to hospitals resulted in injured individuals enduring lengthy delays before evacuation, while the transportation of both staff and casualties to medical facilities faced signi cant challenges. 14 Casualties arrived by ambulances, helicopters and private vehicles, often without medical care provided prior to arrival at the hospital. Due to the ongoing attack, it was unsafe for ambulances to enter many of the areas.…”

“…Due to the ongoing attack, it was unsafe for ambulances to enter many of the areas. 14 Civilians evacuated whoever they could in their private cars. Obviously, these arrivals were unannounced.…”

“…It has been previously shown that response time of emergency medical services (EMS) can be delayed dramatically as an impact of MCIs in the same area 27 . In the described incident, the ongoing shooting during the evacuation rendered it impossible for ambulances to access many areas 14 , prolonging the critical time from injury to arrival at SUMC and compelling civilians to undertake the evacuation of casualties in their own vehicles, without medical treatment in the eld besides the placement of tourniquets. Unlike standard operations where EMS communicate with the emergency department en-route to facilitate trauma team preparation, these arrivals occurred without any forewarning.…”