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Coping With War Mass Casualties in a Hospital Under Fire: The Radiology Experience

¹ Department of Medical Imaging, Rambam Health Care Center, 8 Ha'aliya Ha'shniya, 31096 Haifa, Israel.
² Bruce and Ruth Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel.
³ Department of Vascular Surgery, Rambam Health Care Center, Haifa, Israel.

OBJECTIVE. We report the role of the imaging department at a level 1 trauma center during the Second Lebanon War (summer 2006). Our institution received 849 military and civilian casualties, an average of 25 war-injured patients per day, 338 with acute traumatic stress disorders and 511 physically injured, coming in waves after a rocket attack or a battle confrontation. About 12 potentially critical physically injured patients per day were referred to the imaging department for sometimes complex imaging procedures. The unpredictable waves of casualties and nature of the injuries forced us to reorganize our routine workflow to provide adequate care to casualties and to nonemergent patients. Our nurses' station was transformed into a small emergency department. The radiology staff was distributed into 12 diagnostic stations, providing 24-hour service. Communication was improved by means of walkie-talkies. Three ultrasound units were placed at the emergency department for immediate focused assessment with sonography for trauma performance enabling initial triage of patients. The site and extent of injuries were accurately diagnosed on CT and CT angiography. Digital angiography allowed definitive vascular diagnosis and interventional procedures.

CONCLUSION. Adequate communication, strict workflow, and correct use of imaging protocols ensured optimal triage, diagnosis, and therapy of casualties while maintaining care for nonwar patients.

Keywords: emergency radiology • focused abdominal sonography for trauma • multiple-casualty incidents • trauma • triage

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