A study of how a southern Israeli hospital responded to the Oct. 7, 2023 Hamas attack and later rocket fire has identified both strengths and gaps in disaster preparedness that could help hospitals worldwide prepare for prolonged conflicts and large-scale emergencies.
Researchers analyzed interviews with 19 staff members from the emergency department at Assuta Ashdod Medical Center, including physicians, nurses, administrators and the hospital's head of trauma and disaster management. The study, led by doctoral candidate Maximilian Nerlander of Linköping University and conducted with Prof. Adam Rose of the Hebrew University and Dr. Debra West of Assuta, was published in the peer-reviewed journal Disaster Medicine and Public Health Preparedness.
The hospital's extensive pre-war mass-casualty drills proved crucial. Regular training meant staff understood their responsibilities instinctively, allowing them to focus on unexpected problems. A reinforced emergency department designed to protect against rocket attacks also enabled continuous patient care despite nearby strikes.
However, interviews revealed challenges that drills alone could not identify. Some staff received simultaneous call-up orders from the Israel Defense Forces and the hospital. Others hesitated to report for duty because their families were under threat. Administrative personnel unable to reach the hospital created bottlenecks in patient registration, while plans to transfer less seriously injured patients elsewhere proved impractical because other hospital areas lacked rocket protection.
Staff also struggled with limited situational awareness, lacking reliable official information about the evolving situation outside the hospital and piecing together fragmented reports from multiple sources to anticipate casualty waves.
The researchers recommended hospitals rethink disaster planning to account for prolonged armed conflicts rather than isolated incidents. They called for more realistic drills simulating repeated casualty waves, communications failures and staffing shortages, along with stronger coordination between civilian hospitals, emergency services and military authorities.
The study also urged health systems to develop contingency plans for staffing shortages and regional casualty management, including securing transportation for healthcare workers during conflict and cross-training personnel for critical administrative functions.
"Unlike a conventional mass-casualty event, a mass-casualty event under fire disrupts every aspect of hospital operations, from patient flow and emergency department evacuation to staffing and the ability of personnel to work while their families are under threat," West said.
Nerlander added: "It is becoming increasingly evident that at some point in the future, other parts of the world will face the same type of high-intensity asymmetric warfare as Israel did on Oct. 7."