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Israel teaches the world how to cope under the worst emergency conditions

Posted By ISRAEL21c Staff On October 10, 2004 @ 5:00 pm In | No Comments

The Shaare Zedek Hospital Weinstock Department of Emergency Medicine – exporting expertise.Shaare Zedek Hospital never intended to become the expert in the field of emergency medicine, but circumstances in Jerusalem over the last four years demanded that its staff learn to be just that. Because of this knowledge, emergency rooms in hospitals throughout the United States can now learn how to prepare for mass causalities in the event of a terror attack.

“We want to export our expertise,” says Todd Zalut, acting director of the Emergency Department, speaking last month at the dedication ceremony of the hospital’s new emergency room. “Within the next few months we’re going to start publicizing the fact that we have so much experience…over the last four years, and we’re going to start to ‘sell’ it throughout the world. It’s an expertise that only Shaare Zedek has.”

What Zalut and his staff are able to export to American hospitals is an integration of the technical know-how of treating mass-casualty patients with an advanced concept of patient care, all on display in their state-of-the-art emergency room.

It’s not about the equipment, because you can pretty much find the same machines in any major emergency room in the world. It’s not about the doctors, who are also at the top of their field; and it’s not about the nurses and personnel, though Shaare Zedek takes pride in having a staff well known for patient care.

What makes the new Weinstock Department of Emergency Medicine different – not just state of the art, but cutting-edge revolutionary – is the emergency room itself, the design of its layout and the attention given to detail for providing the highest standard of patient care in any emergency room in the world.

Zalut and Dr. David Applebaum, the head of the ER who was killed in a terrorist attack on Sept. 9, 2003, visited hospitals in New York, Illinois, Georgia, Wisconsin, and England looking at emergency rooms to see how they functioned, and how they didn’t.

“We took bits and pieces from different departments that we thought were good ideas, and added them and worked them into this plan, “Zalut told ISRAEl21c. “We took the
fact that we had a lot of space, for example, and split up the main nurse station into a few stations to be closer to the patients, to take their equipment and supplies and leave them out at the peripheral stations so they wouldn’t have to run around looking for what they needed. There’s also the tracking system we installed, which monitors where every patient and doctor is at all times, so that we can follow their progress instantly.”

The result, he said, is that “this emergency department is very user friendly. It’s very private; there is a lot of thought that has gone into patient comfort, and also the efficiency of how this staff is going to work. We’re hoping that our patients will get not only excellent care, but they’ll get excellent care in a quick and efficient way, and the disposition of the patients will be done in a timely fashion.”

At the dedication ceremony, dignitaries like U.S. Ambassador Dan Kurtzer and Minister of Diaspora Affairs Natan Sharansky sung praises to the donors who built it, like the Gottesfeld Heller, Jonas and Kushner families, and also to the hospital’s staff, noting their commitment and sacrifice in saving lives in the face of four years of terror. And their words rang true, as any citizen of Jerusalem can testify.

But for those on the inside of the business, doctors who have seen dozens, if not hundreds, of hospitals operating in all kinds of emergencies, Shaare Zedek’s new ER was something else entirely, according to Dr. Peter Rosen, the father of emergency medicine.

“It would appear to have a combination of logistic pragmatics with marked attention to patient privacy, to sound privacy, to visual privacy, and yet to enable immediate and effective scientific care of a large number of patients,” Rosen told ISRAEL21c.

That attention to privacy, Rosen said, is something that emergency room personnel all across America can learn from and bring into their own hospitals. Rosen is the recipient of numerous awards and honors for his important contributions to the field of emergency medicine. He is also a senior board member and
consultant to the American Board of Emergency Medicine.

“I was recently visiting two emergency departments in the D.C. area, and I was absolutely shocked by the lack of space the patients were being treated under,” Rosen said. “There were literally bodies in every corner of the emergency department in a way that I would have thought was no longer possible in a modern emergency department.”

The Weinstock ER is not only three times the size of the previous emergency room, but it has several new elements including a full-fledged shock and trauma unit. This, say doctors, will make the difference between life and death, as patients suffering from traumatic injuries or conditions will be able to begin treatment sooner in situations where every second counts.

Contrary to popular belief, the new ER was not built as a response to the past four years of terror, though clearly the victims of such attacks will benefit enormously from the new facilities.

“I have to stress that you build an emergency department, and you work in an emergency department, based upon day-to-day functioning, and not based upon how we’re going to work under the conditions of a terrorist attack,” said Zalut. “But this emergency department will work in that situation too because it has enough space to absorb the number of casualties, and it has the technology to care for them in the way they need to be cared for.”

Shaare Zedek’s Department of Emergency Medicine was built in 1978 in accordance with patient demand at the time. But that number has climbed dramatically: in 1990 the emergency room received 24,439 patients, but by 2003 the number had jumped to 59,980, a 250% increase in 12 years.

And then everything changed dramatically in September 2000, when the current round of Palestinian terrorism exploded on the streets of Israel, and Jerusalem in particular. As the most centrally located hospital in the city, Share Zedek was the first hospital to which many of the injured — almost 40% — were brought.

While these victims make up only a small percentage of the total number of emergency patients – approximately 600 terror victims in the last four years, versus 60,000 per year being cared for in the emergency room – the ability to handle dozens arriving at the hospital within minutes of a terror attack stretched the ability of even Shaare Zedek’s ER.

But as the hospital in the center of town that has seen more trauma and mass casualties than anybody else over the last four years, Shaare Zedek learned to cope, and to handle the worst of emergencies.

“Jerusalem has been hit harder than anybody else in the world, and as a result we have a very unique experience,” said Zalut. “And we’ve turned that experience into a certain expertise that I feel is unmatched anywhere in the world.”

In some ways, you’d expect that a new urban emergency room built in a city that has seen over 35 suicide bombings and terror attacks in the last four years to be state of the art. What you don’t expect are details that you might consider in your home, like, say, what color are the walls?

“It’s esthetically pleasing — something one doesn’t ordinarily bother about in an ER, but something which [plays] a part in recovering from illness,” noted Rosen. “Just walking in there is a tremendous expression of the desire to nourish and nurture people – which is what emergency medicine is all about. They didn’t shirk on space, and they didn’t shirk on attention to color, which is a big part of whether you feel comfortable in a frightening situation. The colors are soft rather then harsh. It would be a privilege to work in that emergency department.”


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