The hidden side of Haifa's Rambam Medical Center

'During the Second Lebanon War in 2006, I was triage chief at the hospital, evaluating incoming wounded. We were receiving casualties, and the building was shaking from the missiles falling around us.” The speaker is Dr. Michael “Miki” Halberthal, CEO of Haifa's Rambam Medical Center, recalling the tumultuous events of the 34-day conflict, when 60 rockets fell within a half-mile radius of Rambam. At that time, neither the hospital, nor its patients and staff were protected from enemy attack. After the war's conclusion, Halberthal explains, hospital management decided that those circumstances could not be allowed to reoccur. Rambam Medical Center, the primary hospital for northern Israel, is committed to treat patients under all scenarios. Dr. Halberthal, who has held numerous professional leadership positions at Rambam since 2001, and who became general director in 2019, says, “Rambam is committed to treating patients under all circumstances. We don't have the right to say that we are not ready,” At that time, the hospital was dealing with two major issues – enabling adequate protection from attack and addressing the need to add additional parking for hospital visitors. Rambam Medical Center ingeniously solved both problems simultaneously by building an immense, three-floor underground parking area – each floor is 20,000 sq.m. (5 acres) – that can accommodate 1,400 cars, and, in emergency, can be transformed into a 2,000-bed underground hospital, fully protected and secured from both conventional and non-conventional attack. Construction of the underground facility, known as the Sammy Ofer Fortified Underground Emergency Hospital, was funded primarily by the Ofer family. Dr. Halberthal also expressed his gratitude to the International Fellowship of Christians and Jews and its founder, the late Rabbi Yechiel Eckstein, who raised the funds for the underground hospital's fortified command center. DR. MICHAEL (MIKI) HALBERTHAL, CEO of Haifa's Rambam Health Care Campus. (Credit: COURTESY OF RAMBAM MEDICAL CENTER) Initially, the work was done by the hospital. Later, the government decided to partner with the hospital, and Halberthal says that now, “It is a strategic facility of Israel, much more than just Rambam.” Work began in 2009 and the subterranean structure was completed in 2014. “It can be made operational very quickly once the decision is made to activate,” he says. “Within six to eight hours we can begin evacuating patients to the underground hospital, and we can reach full capacity in 48-72 hours.” A decision to move underground would be made by the high commission of hospitalization of Israel, the emergency services of the Health Ministry and the IDF, says Halberthal. The underground hospital can accommodate 2,000 patients, includes four operating rooms, full electronic and communications gear, oxygen, and all necessary information technology resources required for accessing medical records. Everything – the layout of the hospital, all the checklists and every scenario – is computerized. The underground hospital can be used not only in the event of a military confrontation, but for any bio-hazard situation and major isolation scenario, and in an instance of chemical warfare, decontamination would be done underground. “This facility is huge,” marvels Halberthal. “In the case of a military confrontation or other scenario that requires it to be used, we'll have close to 8,000 people underground, including two thousand patients, three thousand medical staff, and families. If something were to develop, we have a solution to treat patients, casualties and deliveries in a protected area without endangering patients and staff.” The Sammy Ofer Fortified Underground Emergency Hospital is intended to be a regional solution, and Dr. Halberthal notes that in the event of a conflict, it would be difficult to provide services within individual northern communities for patients, especially those requiring dialysis. The underground facility can house 94 dialysis units for patients from northern Israel who would be unable to receive services in their local communities during wartime, as well as birth and delivery units, and space for 120 intensive care patients. Though the underground hospital has never been actually used, the hospital conducts drills and tests regularly to make sure that it is ready to be activated at a moment's notice. Part of the tests also involve soldiers from the IDF Home Front Command, which would be involved in moving the hospital underground. There are other hospitals in Israel that have protected areas and shelters, but none have the capability of taking an entire 1,000-bed facility, moving it underground, and providing almost double the amount of beds. “We had to write the operational manual for it, including protocols and checklists, because there is nothing like this anywhere in the world. Every unit of the hospital including both clinical, and non-clinical units, has a special red book, explaining what to do in case we have to move underground.” Halberthal says that the underground hospital can remain operational for 35 days, provided that it receives supplies from the outside. In extreme circumstances, without delivery of supplies, the hospital could operate for three days. “We are ready, under certain scenarios, to close the doors, and be self-sufficient, without any help from the outside,” he adds. IN ADDITION to the Sammy Ofer Fortified Underground Emergency Hospital, additional areas of the above-ground sections of the hospital have been fortified. Infants in the neo-natal intensive care unit of the colorful and spacious Ruth Rapaport Children's Hospital are protected from both conventional and non-conventional attack, as will patients on the lower floors of the Eyal Ofer Cardiology Center, which is under construction, including those in the intensive care units, the catherization lab and its operating rooms. The hospital's emergency room is completely protected as well. Rambam Medical Center, as the largest academic tertiary referral center in the region and its only Level 1 Trauma Center, has used its knowledge of coping with trauma and emergency preparedness to assist other hospitals around the world. “Throughout the years,” says Dr. Halberthal, “we have accumulated a great deal of knowledge on how to cope with these types of circumstances, and as a result, we developed the International Center for Trauma, Emergency and Mass Casualty Situations, which I chair. The center offers an educational program aimed at all professionals who are involved in the organization and treatment of mass casualty incidents; pre-hospital forces, hospital staff, physicians, nurses and administrators. “While not everyone is facing a war situation, we need to prepare for all types of emergencies – whether they are man-made or caused by nature. We travel around the world, teach, and exchange knowledge, helping others prepare. This is part of our mission.” Referring to the underground hospital, Dr. Halberthal says, “We hope we will not need to use it.” Nevertheless, it's comforting to know that Rambam Medical Center is well-prepared, both above ground and below, to treat and protect its patients in the North. This article was written in cooperation with Rambam Medical Center.

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