Israel Medical Association Journal

In June 2025, amid an escalating military conflict between Israel and Iran, hospitals across Israel were required to reassess and reinforce their emergency preparedness. Civilian populations in central Israel faced direct threats, including missile strikes on residential areas. In response, hospital leadership at Meir Medical Center, a secondary hospital in the center of Israel, issued a directive for an immediate mass casualty incident (MCI) simulation to be designed and executed within 48 hours. The objective was to test the hospital’s operational readiness under real-time wartime conditions, stress key interfaces between pediatric and adult emergency services, and identify latent system vulnerabilities.

Background: Blood pressure (BP) is routinely measured while triaging children presenting to the pediatric emergency department (PED).

Objectives: To determine whether a medical clown shortens the time to acquire a BP measurement among children undergoing triage in the PED.

Methods: The study comprised 133 children. Patients were assigned to one of two groups: with a medical clown or without a medical clown.

Results: The presence of a medical clown led to a significantly shorter time to acquire a blood pressure measurement (60 ± 23 seconds vs. 81 ± 43.5 seconds, P < 0.001. Clowns had a significant effect on shortening total triage length among children of Jewish ethnicity compared to Arab ethnicity (113 ± 353.6 seconds vs. 154 ± 418 seconds, P = 0.012).

Conclusions: Using medical clowns while measuring BP during triage when used in a culturally appropriate manner shortens time.