title: Impact of military conflict on a civilian receiving hospital in a war zone.
abstract: OBJECTIVE
  To study the impact of war on the workload/finances of a community hospital adjacent to the front.
  
  
  BACKGROUND
  Community hospitals located nearby/within military conflict zones treat trauma casualties while providing routine surgical services to the community.
  
  
  METHODS
  Observational study conducted in Ziv hospital (1 of 3 designated receiving hospitals during the second Lebanon War (12/7/2006-14/8/2006). Data were documented in real-time and retrieved retrospectively from computerized databases.
  
  
  RESULTS
  Ziv treated 1509 military/civilian casualties. Seven percent were at least moderately injured. 27.5% of the casualties required admission, preferentially to surgical wards. Critical mortality rate was 7%. There were 48 secondary transfers, half from the department of emergency medicine (ED) and half after in-hospital stabilization/emergency surgery including 7 to free intensive care (ICU) beds to accommodate expected casualties. The General Surgery department (GSD) performed 81 operating room (OR) procedures, including explorations/debridements for casualties (n = 24, 0-3 per-day), laparotomies for acute abdomen (n = 33) and cancer surgery (n = 11).Compared with previous/later years, there were 23% more trauma casualties presenting to the ED and an increased OR workload for Orthopedic surgery. Decreases occurred in the number of elective and emergency admissions (10%), obstetric deliveries (28%), OR procedures (33%), GSD OR procedures (44%), hospital revenues (up to 43%), yearly hospitalization days (7%), number of hospitalized patients, bed occupancy rates, and visits to outpatient clinics (all 5%).
  
  
  CONCLUSIONS
  Treatment of civilian/military casualties resulted in reorganization of hospital operations with significantly decreased accrued revenue. The bulk of the GSD workload shifts from the OR to the ED/wards while Orthopedic procedures and ICU beds become bottlenecks to patient flow during war.
authors.affiliation: Depatment of General Surgery, Ziv Medical Center, Safed, Israel. amram.h@ziv.health.gov.il
authors.forename: Amram
authors.initials: A
authors.lastname: Hadary
authors.forename: William
authors.initials: W
authors.lastname: Schecter
authors.forename: Oscar M
authors.initials: OM
authors.lastname: Embon
authors.forename: Sharon
authors.initials: S
authors.lastname: Einav
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006764:Hospitals, Community / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D008887:Military Medicine / Q000706:statistics & numerical data*; D014857:Warfare; D016526:Workload; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult