Care improves from one war to the next

At a Beersheba conference on medical treatment under combat, Israeli experts impressed foreign visitors whose front lines – unlike here – are far from home.

April 12, 2015 00:19
Wounded soldiers are airlifted to Soroka University Medical Center

During the 50 days of battle in Operation Protective Edge, Soroka University Medical Center treated 1,263 military and civilian wounded, most arriving by helicopter. (photo credit: Courtesy)

When wars cannot be prevented by national leaders, at least the military’s medical experts can try to prevent injuries and provide the wounded with the best and fastest care available.

There are few armies in the world that invest so much money, thought and effort in saving those wounded in battle than the Israel Defense Forces, or ones that face so many actual threats.

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Foreign participants in the recent conference called “New Frontiers in Integrated Lifesaving Care Under Combat” who listened to Israeli physicians and military experts were humbled by what they learned at Beersheba’s Soroka University Medical Center, which is the largest in the south and – with some 1,000 inpatient beds – the fourth largest in Israel.

“I don’t think I actually taught anybody at the conference. I myself learned,” said assistant professor of surgery George D. Garcia, of the University of Miami’s Miller School of Medicine, who was making his first visit to this country. “Israelis have fought all wars right here or very close by. Your front line is your border. We from the US fight halfway around the world.”

A retired reserve lieutenant-colonel in the US Army Medical Corps and director of education and training at the Florida medical school’s William Lehman Injury Research Center, Garcia was a guest speaker at the one-day conference. He has for years pushed the concept of immediate treatment on the battlefield by surgeons who operate on the critically wounded as close as possible to the front lines.

While Israeli doctors and medics treat the wounded very soon after they are hurt, the closeness of the border makes it possible to transport them via helicopter or ground vehicle to the nearest hospital or the most advanced tertiary medical center if needed within a matter of minutes.

The only time Garcia found himself in a battle zone was between January and July 2008 in Afghanistan, but he also visited non-combatant soldiers in Honduras and Panama.

“The challenges there were different than they are here. In Israel, it’s touching to see the families rush to see wounded soldiers and musicians coming to entertain them and cheer them up. Wounded US soldiers take a long time to get home. One can appreciate how strong national solidarity with soldiers is here,” he said in an interview with The Jerusalem Post.

Before Garcia came, he admitted, “I didn’t understand the geography here very well. Being in danger and fighting on our own soil is all a foreign concept to us. The September 11th attacks occurred only once in our history. But here, surgeons doing operations worry about their own families under attack in their homes and the civilian casualties. Being so close to war is sad, because it’s your home, but having such quick access to help is good for the wounded.”

The IDF uses freeze-dried plasma, however this is not common in the US military. The Israeli innovation, which has saved lives, was developed by Core Dynamics, a Nes Ziona biotechnology company. The freeze-dried blood, a pint of which is taken from every soldier at enlistment, travels with him in a small bag to the battlefield to be reconstituted if he is wounded for immediate life-saving infusion.

But in the US, said Garcia, “We use whole blood given by personnel whose blood type is known. It’s thus called a walking blood bank, as the pints are transferred fast from a healthy soldier to a wounded one. At the front, we can’t store blood supplies.”

DR. EHUD Davidson, Soroka’s director-general, who presided over the conference, said that his hospital was the recipient of the most severely wounded of the Protective Edge Operation in Gaza last summer, along with the smaller Barzilai Medical Center in Ashkelon, which received less severely wounded soldiers.

“During the 50 days of battle, we treated 1,263 military and civilian wounded. These were 777 soldiers and 486 civilians, of them 53 seriously wounded.”

At Soroka’s helipad, more than 60 helicopters landed at the hospital bearing wounded soldiers serving in Gaza, and in our surgical theaters, hundreds of operations were carried out by experts in different specialties.

“The trauma unit, emergency rooms, operating theaters, imaging institutes and inpatient departments worked round the clock in cooperation with IDF medical teams that made possible the best treatment,” said Davidson, an internal medicine specialist who previously directed Meir Medical Center in Kfar Saba before taking over Soroka in 2013.

Among the subjects discussed at the Soroka conference were initial battlefield treatment by the IDF medical Corps, preparedness in the hospitals, running medical centers under fire, continuity of care, ethical issues in clinical treatment of the wounded, and even the media coverage of the war.

Prof. Kobi Peleg, director of the National Center for Trauma and Urgent Medicine Research at the Gertner Institute at Tel Hashomer provided data on Protective Edge wounded compared to those in the Second Lebanon War in 2006. His team’s research found that the share of wounded soldiers in the Lebanon conflict constituted 74.3 percent of the wounded in Operating Protective Edge. Eighty-seven percent of the wounded were soldiers in the Gaza operation, while the rate of those evacuated by helicopter was 50% in the Gaza war compared to only 37% in the Lebanon war.

Peleg added that in Operation Protective Edge, there were more seriously wounded than in Lebanon and the rate of soldiers who needed intensive care was 15% compared to just 11% in the war in the north.

The rate of Gaza operation soldiers who had to be shifted from a smaller hospital to a tertiary medical center was 11% in Operation Protective Edge compared to nearly a third in the Second Lebanon War – a figure that shows treatment of the wounded in the later war was more efficient.

In Operation Cast Lead in Gaza between 2008 and 2009, 153 soldiers were shot or otherwise wounded, but “only” 10 died. The enemy’s weapons were less deadly than they were in the Second Lebanon War, but the Medical Corps was also better trained and equipped. There has also been a significant upgrade in the diagnosis and treatment of psychological and psychiatric problems among soldiers.

The IDF Medical Corps’ treatment on the battlefield and in hospitals was more successful in the Gaza operation than in the north, Peleg said.

“This was clear from the fact that wounded soldiers arrived at the hospital in better condition because they had been better treated in the field. Soroka doctors were both in the field and in evacuating helicopters.”

The Medical Corps showed off at the conference examples of its knowhow, some of it unique, on first aid on the battlefield, trauma care and protection against unconventional (atomic, bacteriological and chemical) warfare.

ANOTHER GUEST speaker from the US is in fact an Israeli and reserve lieutenant-colonel in the IDF – surgical Prof. Mauricio Lynn, who is medical director of the trauma resuscitation unit in the Ryder Trauma Center at the University of Miami School of Medicine. He delivered his address on “The Dramatic Influence Of Military Medicine on Trauma Victims.”

With the development of organized armies and the creating of advanced arms, “New ways of treating and evacuating the wounded have been created. This includes building mobile treatment centers on the battlefield,” said Lynn. “The main developments in military medicine occurred in the last century, when the First and Second World Wars, the Korean and Vietnam Wars, the Yom Kippur War and Lebanon wars were important ‘experimental fields’ for new strategies in military medicine that were suited almost completely to civilian systems,” he added.

Using tourniquets, blood banks, treating surgical infections and respiratory insufficiency resulting from massive bleeding, plastic surgery, burns and rehabilitation medicine were some of the “main examples of the huge influence of military medicine on modern trauma treatment,” he continued, wearing both his Israeli and American medical “hats.”

“One could say,” suggested Lynn, “that the medical protocols used today in hospitals are the direct result of medical treatment given during military conflicts over the years.”

Lynn has known Garcia, his Miami medical center colleague, for about a decade.

“Maricio actually served in Golani. His son served in Gaza during Operating Protective Edge. Soroka is a very impressive hospital. I followed the news constantly during the war,” Garcia said.

Lynn has lived in numerous countries.

“I was born in Romania, immigrated to Israel in the 1960s, and then left for England with my parents. We moved next to Brazil, where we lived for 15 years and I went to medical school. Then I came back to Israel and remained for 15 years. I had a career at Sheba Medical Center at Tel Hashomer. But then I did a fellowship in Miami in the early 90s. In 1994, I was the first foreign medical graduate accepted at Ryder; all the others had done their residency in the US. When I returned to Israel, I was asked to open the trauma unit at Assaf Harofe Medical Center in Tzrifin, followed by work as head of the trauma branch in the IDF.”

But then he went back to Miami to work as a trauma surgeon. “I and my family have dual Israeli-American citizenship. My wife, from a kibbutz near Haifa, and I love both countries. I vote here, and I come back six or seven times a year,” said Lynn, who speaks Spanish, Portuguese and Romanian in addition to Hebrew and English.

“The bottom line of the Soroka conference was that soldiers deserve the best medical care. One must get them to the hospital alive and make it possible for them to leave the hospital alive.”

The Miami facility has trained 10 Israeli trauma surgeons (including Lynn), and eight of those have become directors of their departments in Israeli medicine centers.

“The 11th is coming in July from the Rabin Medical Center-Beilinson Campus in Petah Tikva, while the 11th will arrive in July of next year from Jerusalem’s Shaare Zedek Medical Center.”

His own hospital in Florida receives 10 or 15 new trauma patients daily, victims of car accidents, gunshots, stab wounds, falls from heights and similar trauma.

“We don’t have exploding buses, but we have pedestrians hit by cars,” Lynn said. “I hope both come to a stop in Israel as well.”

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