A new approach to emergency treatment at Ichilov Hospital

Due to Tel Aviv’s fast-paced urban life with its accompanying casualties, the hospital has recently begun the process of building a large and modern Emergency Room Department.

By ALAN ROSENBAUM
September 26, 2018 12:50
A new approach to emergency treatment at Ichilov Hospital

DR. DANIEL TROTZKY, director of Ichilov’s Emergency Medicine Department, has gravitated to emergency medicine so he can be in a ‘place where I can influence and help patients in the most critical moments of their lives.’. (photo credit: SOURASKY MEDICAL CENTER)

 
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Tel Aviv’s Sourasky Medical Center, commonly known as Ichilov Hospital, is undergoing a radical face-lift in its Emergency Medicine Department, in terms of both its physical design and medical approach, all of which should result in better treatment for the more than 145,000 ER patients who pass through its doors each year.

Dr. Daniel Trotzky, 39, newly appointed director of the hospital’s Emergency Medicine Department, explains the need for the changes.

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“Ichilov’s emergency room is one of the biggest in the country and it is an urban ER. We live the pace of the city and we see many trauma events.”

Trotzky, whose interest in medicine dates to his teenage years when he worked with Magen David Adom, says that he was always attracted to emergency medicine.

“I want to be in a place where I can influence and help patients in the most critical moments of their lives,” he said.

He explains that victims of traffic accidents – drivers, pedestrians, motorcycle riders and bicycle riders – are brought into Ichilov’s ER daily. He adds that all types of motorized vehicles are dangerous.

“Electric bicycles, electric scooters – we see a lot of accidents from these things and many people are seriously injured,” he lamented.

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Ichilov’s ER receives other trauma injuries that are typical to large cities, ranging from people who have fallen from heights, to victims of brawls and violence. The Emergency Medicine Department serves residents of the greater Tel Aviv metropolitan area, as well as commuters, visitors and tourists.

Due to Tel Aviv’s fast-paced urban life with its accompanying casualties, the hospital has recently begun the process of building a large and modern Emergency Room Department that will cover 8,000 square meters over a total of three floors – including 100 beds, two CT scanning units, an ambulatory unit and a short-hospitalization section, making it one of the largest emergency room departments in the Middle East. In addition, it will be protected against missiles and can be hermetically sealed in the event of chemical attack. Construction of the new department will be started in the coming months and it is expected to be completed by August 2020.

Ichilov’s emergency room revamp extends beyond the physical design to its overall treatment approach. Dr. Trotzky explains that the hospital is adapting the holistic urgent care method, in which primary emergency room care is provided by specialized ER doctors who can deal with virtually all types of cases that are encountered, ranging from trauma to surgery to orthopedics for children, adults and the elderly.

“We are training many ER specialists now,” explains Trotzky, “and our goal is to have as much manpower available as possible to staff the ER and give the proper medical treatment to everyone who comes,” he said.

While emergency medicine was recognized in the United States, Canada and Britain as a distinct discipline in the 1970s, the field was underdeveloped in Israel until relatively recently. Israeli emergency departments were compartmentalized and specialists provided care in their specific areas of expertise. Finally, in 1992, the Israeli Association for Emergency Medicine was created, and in 1999, emergency medicine was recognized as a “super specialty.” Trotzky explains that today, more and more Israeli hospitals are adapting the models of trained ER doctors.

“These past five years have been the golden hour of ER medicine in Israel. Today, emergency rooms are being built in Israel that are following the global trend. We are building the profession here.”

Trotzky explains that in an emergency-room setting, there will frequently be collaboration between the ER specialist and a trauma specialist.

“If someone fell from a window and the cause was a heart-related event, or if someone was involved in an auto accident because his blood sugar was low, the ER doctor will deal with the organic issues, and the trauma doctor will treat the specific trauma.”

When an ER trauma case occurs, it is likely that Dr. Eyal Hashavia will be involved. Hashavia, 47, is a senior surgeon and assistant manager of the trauma division at Ichilov. After spending 10 years at Sheba Medical Center in Tel Hashomer, Hashavia served as a surgical resident at New York’s Mount Sinai Hospital, and as part of a fellowship, worked in trauma surgery and acute care surgery at Jackson Memorial Hospital in Miami, one of the busiest trauma centers in the US. Since his return to Israel three years ago, Hashavia has managed trauma treatment in multi-casualty events as well as terrorist attacks. Whenever there is a major trauma, he is in the emergency room, guiding the ER team in the trauma bay and taking care of the patient until discharge.

“We coordinate the team that treats the trauma patient,” Hashavia explains. “The results are much better, because there is one person in control of everything. We are aware of the implications of every modality, so that we can make the best decisions for our patients. Our expertise is in making decisions under uncertain circumstances.”

Hashavia says that the relationship with trauma patients extends beyond their immediate treatment.

“Every patient is a major case. We take them as they come in, from the ambulance to the ER’s trauma center, and follow them along their medical journey, including CT scans, catheterization, surgery and intensive care hospitalization, ending when they return home or go to rehabilitation. There is an intense emotional bond between us and the injured people that we treat.”

Hashavia praised the coming revamp and reorganization of Ichilov’s Emergency Medicine Department.

“It’s going to be a major multi-disciplinary emergency department. It’s good for the treatment of trauma, because the doctors in the emergency room will be emergency physicians who know how to work in intense conditions,” he explained. “The new design of Ichilov’s emergency room is much better for us as trauma surgeons, and very good for injured patients. They will receive better care. The prognosis and the results are much better. It’s a good move for better medicine, and medicine of the future.”

Says Trotzky, “I feel the responsibility on my shoulders. Managing the Emergency Medicine Department is a difficult mission, especially at a time when medicine is seen not only for its clinical quality but also as a service. We are trying to do our best to shorten wait times – to improve the service – the explanations to patients, the facilities, the medical treatment, to shorten times as much as possible. It is a challenge.”

“We must not only provide excellent care, but we have to provide excellent service as well.”


This article was written in cooperation with Sourasky Medical Center.

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