A multicasualty event: out-of-hospital and in-hospital organizational aspects.
In a wedding celebration of 700 participants, the third floor of the hall in which the celebration was taking place suddenly collapsed. While the walls remained intact, all three floors of the building collapsed, causing Israel's largest disaster.


OBJECTIVE
To study the management of a multicasualty event (MCE), in the out-of-hospital and in-hospital phases, including rescue, emergency medical services (EMS) deployment and evacuation of casualties, emergency department (ED) deployment, recalling staff, medical care, imaging procedures, hospitalization, secondary referral, and interhospital transfer of patients.


METHODS
Data on all the victims who arrived at the four EDs in Jerusalem were collected through medical files, telephone interviews, and hospital computerized information.


RESULTS
The disaster resulted in 23 fatalities and 315 injured people; 43% were hospitalized. During the first hour, 42% were evacuated and after seven hours the scene was empty. Ninety-seven basic life support ambulances, 18 mobile intensive care units, 600 emergency medical technicians, 40 paramedics, and 15 physicians took part in the out-of-hospital stage. At the hospitals, about 1,300 staff members arrived immediately, either on demand or voluntarily, a number that seems too large for this disaster. Computed tomography (CT) demand was over its capability.


CONCLUSIONS
During this MCE, the authors observed "rotating" bottleneck phenomena within out-of-hospital and in-hospital systems. For maximal efficiency, hospitals need to fully coordinate the influx and transfer of patients with out-of-hospital rescue services as well as with other hospitals. Each hospital has to immediately deploy its operational center, which will manage and monitor the hospital's resources and facilitate coordination with the relevant institutions.
Avitzour
Malka
M
Department of Orthopedic Surgery, Trauma Unit, Hadassah Medical Organization, School of Public Health, PO Box 12000, Jerusalem 91120, Israel. amalka@hadassah.org.il.
Libergal
Meir
M
Assaf
Jacob
J
Adler
Jakov
J
Beyth
Shaul
S
Mosheiff
Rami
R
Rubin
Amir
A
Feigenberg
Zvi
Z
Slatnikovitz
Ruth
R
Gofin
Rosa
R
Shapira
Shmuel Chaim
SC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000552:Ambulances / Q000458:organization & administration / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004189:Disaster Planning / Q000458:organization & administration* / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018635:Rescue Work / Q000458:organization & administration / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000628:therapy*