As Boston and the world reels from the recent terrorist attacks and violence there, Massachusetts General Hospital has emerged as a major actor. This world-renowned medical center treated dozens of victims of the Marathon bombing. As an important center for trauma and orthopedic surgery, it’s helping in the recovery of victims suffering from lost limbs and other injuries.
Dr. Conn at a news
conference last week.
Aish.com recently interviewed Dr. Alasdair Conn, Chief of the Department of Emergency Medicine at Massachusetts General, during the lockdown that engulfed Boston and its suburbs during the manhunt for bomber Dzhokhar Tsarnaev. Dr. Conn sounded concerned yet resolute, ready to perform his job to the utmost even under extremely difficult conditions.
He described the important collaboration with Israeli doctors who travelled to Boston to help set up their trauma response. Collaboration began after 9/11 when staff at Massachusetts General realized they wouldn’t be prepared for an attack of that magnitude closer to home.
“We could manage to treat patients from a multiple car crash – with three or four or five patients – pretty well,” recalls Dr. Alasdair Conn, Chief of the Department of Emergency Medicine, “but what would happen if we had many more patients, simultaneously and with very little warning?”
Dr. Conn and his colleagues looked to Israel for advice, and turned to Dr. Pinchas Halpern, Chief of the Emergency Department at Tel Aviv Medical Center. A world-renowned expert on trauma care, Dr. Halpern had helped make Tel Aviv’s Sourasky Medical Center one of the world’s leaders in emergency medicine.
Israeli doctors developed better medical responses to terrorist attacks and are sharing their hard-won wisdom with doctors around the world.
Dr. Halpern remembers his initial visit to Boston in 2005, the first of many, very well. Israel was in the midst of repeated, severe terrorist attacks. Bombs left in busses and other public places in Israel were often packed with nails and ball bearings – much like the explosives at the Boston Marathon – designed to create a huge amount of shrapnel and wreak maximum damage.
“We had gained much experience” in treating terrorist-related injuries Dr. Halpern said. In the midst of terrorist violence at home, he and his Israeli colleagues reacted by channeling their efforts into healing, developing better medical responses to terrorist attacks, and sharing their hard-won wisdom with doctors around the world. Dr. Halpern began travelling, meeting with trauma teams across the United States, and Canada, Asia, Africa and China.
For the doctors at Massachusetts General, the visit was ground-breaking. “To this day I remember a comment,” Dr. Conn recalls. One of the Israelis said that here in the United States we have a terrorist event every few years, but ‘unfortunately, in Israel,’ he said, ‘we have a situation where a bomb is put on a bus once every three weeks. We have no notice, and we get 50 or 60 or 70 casualties with no warning.’”
Logistics emerged as a main point of education. Israeli doctors taught their American colleagues lessons they’d learned in organizing responses to large-scale disasters. “Only a small part of dealing with such an event is medical, much of it is logistical,” Tel Aviv’s Dr. Halpern explains.
He and his colleagues developed a unique triage system, moving casualties indoors as soon as possible and streamlining processes to make it more rapid. “We did away with a lot of the structure that was in the textbook that was never really tested,” Dr. Halpern said. They developed protocols like doing extra CT scanning to detect small pieces of shrapnel from bombs designed to cause maximum damage.
Israeli trauma doctors learned to alter their lab testing procedures, and streamline the way they identified victims after terror attacks. They learned not to discharge blast victims right away, because often their injuries don’t show symptoms until later. Mass. General’s Dr. Paul Biddinger notes that “we improved our plans for triage, site security, reassessment and inter-specialty coordination” after consulting with the Israelis.
Another lesson the Israelis learned was to call up large numbers of staff as soon as the hospital hears of a terrorist attacks in case they are needed. This was an innovation that particularly benefited the doctors in Boston.
“As soon as we heard about the blasts we didn’t let any anesthesiologists or general or trauma surgeons or pediatricians leave the hospital,” says ER head Dr. Alasdair Conn. “We learned that from the Israelis. I remember walking through the emergency department two hours after the bomb victims arrived. Many of the acute patients had already been moved, and it looked like there were more staff than patients in the ER. If there had been a third or a fourth bomb that day – we could have managed.”
As Massachusetts General coped with over 30 blast victims, each patient was given its own dedicated medical team, ensuring top quality care; it was an important lesson learned from the Israelis.
Learning from Experience
Another lesson is how challenging it is to live with the threat of terrorist attacks, as Israelis do every day. “Places I’ve been to as a trauma expert,” says Dr. Halpern, “have a much better understanding of the situation in Israel.”
“We’re not smarter than other doctors,” Dr. Halpern says, explaining why Israel has emerged as a leading provider of innovation and advice in emergency care. “But we have two things going for us. One, unfortunately, is the high level of terrorism Israel faces. The other factor is Israel’s advanced medical system. In general, countries with lots of terrorism have a lower level of academic research and writing; countries with sophisticated medical systems have lower levels of terrorism. Israel combines both.”
Instead of becoming cynical or bitter, the challenges Israel faces have only spurred Israeli doctors to work harder, and to share their expertise with the rest of the world. In recent years, Israel has emerged as one of the major centers for trauma medicine.
”I believe it is incumbent upon us as Jews and Israelis to help whomever we can.”
Israel’s Rambam Medical Center, for instance, has run a major annual conference on disaster preparedness for doctors from around the world for the past decade. “So much of what we learn here will help in our center,” said Dr. Buland Thopa, the head of a new 200-bed trauma center in Kathmandu, who last year travelled to Israel for the conference.
Moral Obligation to Help
Noting that Israelis had been first on the scene at disasters in Turkey, Haiti, Romania, and other places, Dr. Halpern said, “We can help, so we feel we have a moral obligation. We respond very quickly and efficiently. We think out of the box, not dogmatically, and we are often first on the scene… There’s a very strong sense to apply the skills we’ve gained morally. I choose to live in Israel in the face of much adversity, and I believe it is incumbent upon us as Jews and Israelis to help whomever we can.”
In fact, working together on trauma teams seems to have given Israeli medics a stronger sense of purpose. “At the height of the intifada a few years ago,” Dr. Halpern notes, when bombs were exploding in crowded areas in Israel every few weeks, Israeli emergency organizers looked for post traumatic stress among medical personnel.
What they found surprised them: “We found zero loss of staff. Staff was strengthened by participating in these events. It fostered a sense of camaraderie and gave a very significant boost of morale.”
In Boston, the emergency team is experiencing this sort of challenge for the first time. One of Massachusetts General’s trauma surgeons, Dr. David King, had just completed the Boston Marathon and was resting in a tent when the explosions occurred. He ran to aid the injured, and took several of the injured into surgery. A nurse who works at the hospital was critically wounded in the attack, and another staff member suffered injuries as well.
“As I walked through the emergency department ten or fifteen minutes after the first patients arrived, the atmosphere was overwhelming,” notes Boston’s Dr. Conn. “One patient had lost an incredible amount of blood – perhaps as a result of her tourniquet slipping – she was resuscitated – and so many of the patients had horrific injuries.” Within a short time, they all went into surgery, he notes.
“When we were preparing for mass casualties we realized the Israelis had the expertise in this type of situation,” Dr. Conn said, “and we turned to them. This week it really paid off.”