Although millions of Israelis who are busy with the routine of daily life don’t feel it, there are 200,000 rockets and missiles pointed at the country’s population, and any future war could involve an initial onslaught of enemy projectiles.

Additionally, while the probability of a missile or terrorist attack on Israel involving unconventional weapons is very low, the threat cannot be dismissed out of hand.

Under the shadow of these extreme and plentiful security threats – faced by no other population in the world – Israeli military and health officials have quietly been developing an inter agency network designed to ensure that hospitals in Israel will be able to cope with the worst-case scenarios, without any costly delays or confusion.

In fact, the safety system they have put into place is ready to be activated at any moment, and forms an invisible protective layer that, one must hope, will never be needed.

The agency at the heart of preparations for the unthinkable is called the Hospital Preparedness Branch (HPB), and is a part of the medical department of the IDF’s Home Front Command.

“This is a unique body,” a senior source from the HPB told The Jerusalem Post this week. “Here, we write our own doctrine.”

Funded by the Home Front Command and the Health Ministry, the HPB represents a maze of inter organizational connections that, like the roots of several neighboring trees, have ended up twisted around one another in a way that looks confusing to the outside viewer, but works with remarkable efficiency.

All year-round, the HPB checks to see if Israel’s 27 hospitals are ready for chemical, biological, or radiological attacks, as well as pandemics and earthquakes.

It stores the chemical protective suits paramedics would need to reach victims, and practices showering the injured at hospital entrances before passing them on to doctors, who are trained to identify the attack and inject the patient with the lifesaving antidote.

The HPB has its own army units that can be instantly dispatched to hospitals to set up showers for victims of chemical attacks. In drills, a “yellow line” forms a key feature – this is the line that patients cross after they have been cleansed outside of poisonous chemicals and passed on to civilian nurses and doctors.

The HPB has its own medics, who can treat unconventional attack victims in the field as well. Should an unconventional weapon be deployed in Israel, the HPB will be the agency that will broadcast information over mass media to civilians on how to identify symptoms and when to come to hospitals.

And it is the agency that stocks up on protective suits against chemical, biological, and radiological incidents (each incident requires its own special suit).

But the HPB’s role isn’t limited to these nightmarish emergencies. It also jumps into action in case of a conventional missile attack, acting as an oil to smooth a hospital’s transition from peacetime to a time of war.

“During a war, we will hold around the- clock evaluations to take many decisions. We will decide whether a senior hospital doctor, who is also a reserve soldier in the IDF Medical Corps, will treat civilians in the home front, or soldiers [in a field hospital],” the source said.

An “inner cabinet” – already formed – is the decision-making body for such dilemmas. It is made up of the Health Ministry’s director-general, the head of the IDF’s Medical Corps and the head of the HPB.

This cabinet meets every Sunday at the Health Ministry’s Emergency Branch in Tel Aviv to pore over the results of drills and monitor the progress of hospitals in preparing for the worst.

Construction of hospital wards that are immune to rocket strikes, or the number of showers for chemical attacks in each district, are normal topics of discussion in this cabinet. The outcomes of drills are also analyzed and discussed.

“We have to be ready at all times,” the source said. “The aim is to minimize injury in the best way possible.”

During real emergencies, hospitals will become very different places from the centers of treatment they now are.

All non-critical surgeries will be postponed.

Many beds will be set up in corridors.

Patients that can be released to their homes will be sent on their way.

The “cabinet” will take, in accordance with the conditions on the ground, life-and-death decisions.

The HPD is, in the most Israeli of ways, a work in progress. It first saw life during the Second Lebanon War, when it assigned Home Front Command units to the entrances and parking lots of every hospital in northern Israel to assist with patient reception.

After the war, the HPD decided that its units would be partially called up in all future conflicts, not just extreme scenarios involving unconventional weapons.

“Everything is very fresh, but we’re advancing forward in leaps and bounds,” the source said.

The agency has full access to the Health Ministry’s computer systems, and knows how full each hospital is at any given time.

During Operation Cast Lead in Gaza in 2008-2009, when southern Israel was under rocket bombardment, the HPD evacuated hospital wings that were not protected against rocket fire.

It was the first time that the organization’s units arrived at hospitals within an hour of receiving an official IDF call-up notice.

“For the first time, military units solely designed to assist hospitals were called up. That is an upgrade,” the source said. Today, the HPD has evolved to deal with any mass-casualty incident.

It houses a national medical control room, which is staffed by Health Ministry personnel who provide an initial alert of a developing incident. Then, if necessary, the relevant hospitals go into emergency mode, and units are deployed.

“We’re not in the era of wars on the frontlines,” the source pointed out. “Today, the home front is the target.”

Hospitals, much like air force bases and the government, will have to ensure “operational continuity” – a key term in the IDF today, used to describe the ability of a complex body to function under heavy enemy attack.

Between 25 and 30 drills involving every imaginable scenario occur a year, a major increase from the past. Until 2007, there were 17- 20 such annual exercises.

During chemical drills, a mock missile is planted in the ground, releasing a yellow gas that represents a deadly chemical attack.

Within minutes, masked paramedics and medics are on the scene, loading “injured” people onto stretchers, hosing them down with water and ferrying them to the first reception areas set up in parking lots outside hospitals.

“At first, a hospital might not know it has patients from a chemical attack,” the source said. “The symptoms will only be recognized later.”

On Thursday, the Nahariya’s Western Galilee Hospital became the latest medical center to practice for a chemical attack.

Members of the public would prefer not to think about such awful developments. But the staff of the HPB makes it their business to ensure that Israel can’t be caught off guard.

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