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עמוד בית
Thu, 30.05.24

September 2019 (Issue 43)


Introduction
Articles & Reviews
Coral Spector, Avi Benov, Roy Nadler, Sami Gendler, Tomer Erlich, Yair Barak, Anat Sabbag, Itzik Malka, Avi Yitzhak, Bader Tarif, Elon Glassberg
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Introduction: Since February 2013, the Israel Defense Forces- Medical Corp (IDF-MC) has provided medical care to injured victims of the ongoing civil war raging in neighboring Syria. Initial medical care to these casualties was provided by Role 1 medical teams stationed at the border. The series of patients described in this unique scenario are an example of the IDF-MC’s focused efforts on Role 1 medical care.

Methods: Care provided by IDF-MC medical teams, including Role 1 casualty care, is regularly
documented and after-action reports are conducted. Records of casualties arriving at the Israeli Syrian border from February 16th to December 12th, 2017 were extracted from the Israel National Trauma Registry (ITR). Patients who did not have a casualty card were excluded.

Results: Over the study period, 2,785 Syrian casualties received initial Role 1 care, most of whom, 2,339, were trauma casualties. The median age was 24, and 93.3% were men. Overall, 15% (350) patients were under the age of 18. Role 1 life-saving interventions performed included 134 (5.7%) patients receiving airway management and 55 (2.4%) patients received treatment for chest injuries. Damage control resuscitation with the use of Transexamic Acid (TXA) and reconstituted freeze-dried plasma (FDP) was given to 222 (9.5%) and 75 (32%) casualties respectively.

Conclusions: The experience of the IDF-MC Role I facilities in caring for civilian injuries along a hostile international border is unique. In this capacity, the IDFMC has demonstrated effectiveness in triaging patients and providing life-saving and resuscitative interventions including TXA and freeze-dried plasma. In select patients, endotracheal intubation and cricothyroidotomy were able to provide effective airway opening. Efforts to provide medical relief to victims of the Syrian civil war continue. While we hope for a better future, it is our obligation to take what we have learned and continue to learn and use it to support the improvement of trauma care and hopefully save more lives.

Keywords: Trauma; Israel Syria; Casualties.
Ophir Aruse, Arik Eisenkraft
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In recent years, we have witnessed the utilization of chemical weapons and other dangerous substances by armies and terrorist organizations. These substances lead to severe respiratory injures, resulting in the appearance of Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS), that are often fatal. To date, the relevant field medical response is relatively poor and needs to be improved. Many clinical trials testing locally administered drugs or systemic treatments against these clinical conditions have failed. In this review we will present various developments in inhalation therapies (e.g. delivery of drugs using inhalers) to treat injuries such as Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS), which may be relevant for pre-hospital treatment in the future.

Keywords: Acute Lung Injury (ALI); Acute Respiratory Distress Syndrome (ARDS); Chemical weapons; Hazardous materials; Inhalation
therapy.
Aviv Ohana, Ilana Gens, Diana Vinitsky-Hertzog, Alon Glantz, Eyal Furman, Sara Goldberg, Ofer Merin
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Medical care systems are primarily focused on providing medical and organizational responses to emergencies. However, the doctrine of preparedness does not normally consider instances in which the healthcare providers and medical facilities themselves are affected by the emergencies.

In these instances, hospitals are requested to reduce any possible damage to patients while continuing to provide the necessary medical care. Under some circumstances, partial or full evacuation of the medical facility is required. During the last decade, Israel has experienced two instances in which psychiatric hospitals were evacuated due to emergency events. These hospitals did not have evacuation protocols or procedures. These instances substantiated the need for the development of generic evacuation protocol for hospitals in different emergency situations.

In 2012, the Ministry of Health Commission circulated recommendations and guidelines for hospital evacuation. These generic recommendations and guidelines need to be adapted by each hospital, followed by the approval of the hospital director. According to the guidelines, the evacuation protocol should include four main steps: decision to evacuate, preparation for evacuation, evacuation and rehabilitation.

Following these exercises, lessons were learned particularly pertaining to aspects of logistics and operations. In the future, hospitals will be obliged to identify, in advance, the specific means that are required in order to ensure evacuation of the hospital, such that, if needed, there will be a comprehensive list of all equipment necessary for each hospital. This list will be kept available at the hospital and at the Ministry of Health. This will enable quicker organization and effective assistance to be provided during the complex evacuation process indicative of hospitals.

Keywords: Hospitals; Evacuation; Emergency; Preparednesss.
Daniel Barsky, Lt. Col. Arik Eisenkraft
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Recent armed conflicts around the world, including conflicts involving the Israel Defense Forces, have been marked by increased usage of explosive devices, especially Improvised Explosive Devices (IEDs). Due to the increasing use of IEDs, there has been a constant rise in the rate of blast-induced injuries, including blast-induced Traumatic Brain Injuries (bTBI). The rise in bTBIs has generated an increase in research in this field, particularly with regard to the mechanism of injury, the search for diagnostic tools and methods, treatment options, and protective measures for the active combat soldier against the threat of bTBI. This review presents several animal models that contributed to the research of bTBI – the rat model, the pig model and the drosophila fly model, as well as the various conclusions made following the use of these models, including the advantages and disadvantages of each model.

Keywords: bTBI–blast induced Traumatic Brain Injury; Animal models; Improvised explosive device; non-Penetrating head injury;
Blast injury.
In Retrospect
Hen Goren, Ayala Haker, Lea Shelef.
"It is true that the Air Force headquarters did not take us seriously.
Ee said we will not fly to Sodom, because on the landing side there is a huge mountain
- and we flew, and said we would not fly if there was no tarpaulin
On the planes - and we flew, and said we would not land on the runway at
Eshel airport, because it is laden with sand and too short - and we landed ... and at the headquarters
The air just smiled at us and ignored all the demands.
And here one day a psychiatrist, Dr. Louis Miller, came to us.
That was when the war was almost over and they decided we would move on
Exams. And really he turned to the nurse and said: Everyone is crazy ...
But this is the great miracle of the country. "
Eran Dolev, Elon Glassberg
From the beginning of the medical profession the term time is used in context
Of diseases, and as a measure of their course and development, in the form of terms
Such as "incubation time". On the other hand, the time index stood out in its absence from its domains
Operational medicine, where it is reflected in terms of urgency,
Especially in the face of the process of deterioration and damage to organs and tissues.
A historical review reveals that the centrality of the time index in medicine
Operational today, as reflected first and foremost
Aiming for medical treatment of casualties in the area in the high vicinity
Most at the time of the injury, had not been there since time immemorial. Documentation
In first-hand scriptures from bloody systems
That have taken place in the last centuries shows that wounded
Were lying on the battlefield for long hours and even days in the field,
And as a result many of them were killed.
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