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עמוד בית
Fri, 29.09.23

April 2017 - Knives Intifada (Issue 35)

Col. Dr. Hagai Frenkel
The "size of the hour" terror wave began in the Temple Mount riots in September 2015, as a milestone in the escalation of violence and terrorist attacks for nationalist motives, against the background of the Israeli-Palestinian conflict. The power to carry out acts of terrorism.
Along with the shooting and bombing attacks, a large number of "low-tech" attacks - sometimes stabbing and trampling - were observed, often on a daily basis. Hundreds of attacks were carried out in this terrorist wave, most of them in Judea and Samaria and Jerusalem.
Israelis were killed and hundreds were injured. The flood of events was a great test hour for the entire chain of the Central Command's medical system - from the lifeguard to the medical commander (RAF) - and it can be said that the system was up to the task.
Readers Response
Col. (Res.) Dr. Uriel Dreyfus
Response from Col. (Res.) Dr. Uriel Dreyfus to the article - "Teleproa capsule - is it at any cost?"
Capt. Noam Ben-Yosef, Maj. Keren Zilka, Sa’ar Minha, Lt. Col. Adi Leiba, Col. Hagay Frenkel
Background: An escalation of terror activity has begun in
October 2015 throughout the State of Israel. Most of these
attacks have been executed by terrorists acting spontaneously
and on their own. The knife – an efficient an easily
accessible weapon – was commonly used by the terrorists.
During the current escalation, 43 stabbing attacks have
been executed in the territory of the Judea and Samaria
division, harming soldiers and civilians (23 and 20, respectively).
Amongst all soldiers injured during this escalation,
stabbing was involved in 34% of cases.
Aim: To describe the characteristics of stab injuries due
to terror activity against soldiers. We hypothesized these
would differ from similar attacks directed towards civilians,
or from stab injuries caused by criminal activity.
Methods: Data was collected prospectively for all soldiers
injured by terror activity in the Central Command. Information
was acquired from the medical teams in the field,
hospital records, and soldiers’ medical files. End of follow
up was defined as return to active military service, or applying
a medical profile incompatible with military service
resulting in termination of service.
Results: 23 soldiers were wounded, most of them have
been stabbed at more than one site. Most commonly injured
were the chest, face and hands (23.9%, 19.6% and
17.4% respectively). 14 soldiers required hospitalization,
and 9 required surgery. Only 2 soldiers sustained a fatal
Conclusions: Stab injuries targeting soldiers differ from
similar attacks involving citizens; the common anatomical
sites of injury are different, and outcomes are less devastating.
This may be due to use of protective gear and
due to the ability of soldiers to defend themselves from
the attacker.
Sa’ar Minha, Capt. Noam Ben-Yosef, Lt. Col. Adi Leiba, Maj. Keren Zilka, Col. Hagay Frenkel,
Background: A rise in terror activity was initiated in October
2015 in Israel and The West Bank. This was reflected
in higher than normal prevalence of stone-throwing (ST),
stabbing, vehicular ramming (VR) and gun shots (GS). Most
of the events occurred in IDF’s central command territory.

Objectives: Assessing injuries, medical therapy and return
to service (RTS) during this escalation.

Methods: Prospective data collection.

Results: Between October 2015 and March 2016, 146 IDF
soldiers were injured. The average age of the injured was
22.8±4.1 years. Four soldiers died. ST was the most frequent
mechanism of injury (40%) with head and neck injuries
(62.7%) leading the frequency of injuries. Most of
the injured (91.5%) RTS within 7 [4-9.75] days. Lower limb
injuries were the most frequent injuries (78.8%) sustained
by VR injured soldiers. Within these soldiers, 48.5% RTS
after 5.5 [1.75-18] days. Head and neck injuries were the
most frequent area of injury in stabbed soldiers (41.3%).
Around half of the wounded RTS (after 19 [12.7-109.2]
days). Orthopedic injuries were the most frequent injuries
sustained by GS wounded soldiers (76.9%). Only 35% of
these soldiers RTS after 10 [5-19] days. The evacuation
of soldiers from the scene was performed by civilian EMS
(Emergency Medical Service) in 46.9% of the cases.

Conclusions: Most of the wounded in the present terror
escalation sustained light wounds with the majority of soldiers
returning to service. The coordination with civilian
EMS for evacuation from the scene allowed prompt return
of IDF’s medical forces to their operational positions.
Maj. Keren Zilka, Capt. Noam Ben-Yosef, Sa’ar Minha, Lt. Col. Adi Leiba, Col. Hagay Frenkel
Introduction: Between October 2015 and May 2016, a terror
wave of vehicle ramming, stabbings, stone throwing,
and shootings against soldiers and civilians took place
within the area of the Central Region Command of Israel,
in The West Bank.

Objective: To perform a data survey of injuries from vehicle
ramming incidents and compare them to injury data
from other forms of attacks during the same period and to
pedestrian injuries from regular traffic accidents.

Methods: An updated database was created by collecting
perspective data taken during each incident.

Results: 36 soldiers were injured in 14 vehicle ramming
attacks during these months. The majority of the vehicle
ramming victims (61.1%) sustained complex injuries. Megan
David Adom (MDA) ambulances executed the medical
evacuation of in most incidences (77.8%) of vehicle ramming
attack, and most of the victims (82.4%) were evacuated
by mobile intensive care units. Two thirds of the vehicle
ramming victims were classified as lightly wounded
(66.6%), and a minority were characterized as severe or
fatal (11.1%). The distribution of severity of injuries for
vehicle ramming victims who were admitted to a hospital
matched that of victims of civilian traffic accidents. Half of
the vehicle ramming victims returned to military service
(52.8%) after 29.8 days (±37.6) on average.
Discussion & Conclusions: The injuries sustained during
vehicle ramming are more complex than injuries from
other hostile attack mechanisms, and require a more extended
recovery. One possible explanation is the mechanism
of vehicle acceleration and collision. Evacuation of
IDF soldiers from scenes of vehicular attacks was mostly
performed by MDA, and was usually performed by a mobile
intensive care unit, unlike the evacuation of injured
pedestrians from civilian traffic accidents. This highlights
the importance of inter-organizational cooperation between
Central Region Command medical staff and local
civilian emergency authorities
Lt. Col. Adi Leiba, Sa’ar Minha, Maj. Keren Zilka, Liat Pesach-Gelblum, Sgt. 1st Class Nofar Magen, Capt. Noam Ben-Yosef, Col. Hagay Frenkel
Background: The utilization of advanced simulators in
medical training was reported to improve the operational
capabilities and teamwork. Simulation based training is
usually limited to civilian medical centers which enable
optimal learning and debriefing experience but requires
physical detachment from the operational arena. IDF’s
central command initiated three simulation centered
training modules for its forward operational forces; simulation
center module, mobile simulation center unit performing
the training in proximity to the deployment area
within a large structure and a minimized module based
on one simulator arriving to the team’s post and training
them in their actual environment.

Aim: To evaluate trainees’ perceptions to these modules.

Methods: Post training questionnaires were collected prospectively
from all trainees

Results: The present analysis is based on response of 88
trainees (40-simulation center; 25-mobile simulation unit;
23-”in-house” simulation). Highly rated responses were
recorded regarding questions concerning the improvement
of knowledge and care for trauma patients alongside
the ability to work as team. Further, the feedback given by
the instructor was highly rated as effective. No differences
were noted in the ratings given by trainees for the three
training modulus.

Conclusions: Simulation based training was perceived as
relevant possibly improving improving teamwork and care
for field trauma patients. All three modules may be implemented
to facilitate effective training of forward operational
medical teams.
Jimmage - Case Study
Capt. Noam Ben-Yosef, Col. Hagay Frenkel
An escalation of terror activity has begun in October 2015
throughout the State of Israel. Most of these attacks have
been executed by single individual terrorists, acting spontaneously,
without any organizational guidance. The knife
– an efficient an easily accessible weapon – was commonly
used by the terrorists, attacking soldiers and civilians.
The case describes a terror attack using a simple knife
caused a complicated and potentially lethal wound. The
treatment given quickly, accurately and efficiently, has
saved the patient’s life. There is much to learn from this
case, regarding the treatment given by all medical personnel,
from the field to the operating room. As well as
describing this interesting case, the readers can try to
answer two questions concerning issues that have influenced
the decisions of the medical team treating the patient.
Major Akiva Esterson, Lt. Col. Ronen Bar
Israel has no inherent independent submarine rescue capabilities, and it relies on the assistance of its allies. Thus, in the last two years, the Israeli Navy and its Italian counterpart have performed joint drills to rescue divers from a sunken submarine. The first exercise took place in 2015 in Haifa, and the second in 2016 in Trento, Italy. In the exercises, Israeli divers were rescued from an Israeli submarine by the Italian rescue services. This article reviews the main constraints in rescuing submarine divers from a submarine as part of exercises you.
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