Challenges of a regional trauma center in treating combat and civilian casualties. The experience of Assuta Ashdod Hospital in the Iron Swords War.

Itay Zoarets, Dalia Bider, Mohamad Molham, Hanoch Kashtan, Erez Barenboim
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Abstract

Introduction: Assuta Ashdod Hospital is a regional trauma center. The hospital received casualties on the first day of the civilian massacre of October 7th and thereafter. The Assuta Ashdod Hospital was designated as an emergency landing site only for unstable or deteriorating patients who would not survive longer flights to a central trauma center. The aim of this study is to share our experience and challenges as a new regional trauma center in a war zone.

Methods: A descriptive cohort study consisting of all trauma patients admitted in the Emergency Department, between October 7, 2023, and December of the same year. The data is part of the Israel National Trauma Registry.

Results: A total of 397 heavily wounded patients were admitted, of which 3 were declared dead on arrival, 95 were hospitalized and 299 were discharged from the emergency department after initial care. Of the 95 wounded patients hospitalized, 60 (63.1 %) had a single mechanism of injury, of which, 35.7 % were penetrating injuries. The most frequent injury was to the extremities (60 %) followed by chest and abdomen, 35.7 % and 14.7 % respectively. Multi-trauma injuries were present in 40 % of the wounded patients. The average ISS was 15 (median=9). Of all patients, 10.5 % of patients were considered to have severe and 23.1 % to have profound (very-severe) injuries by the ISS classification. Twelve patients received whole blood transfusions, fourteen received the Massive Transfusion Protocol. Sixty-one of the 95 (64 %) patients underwent surgery, with a total of 137 surgeries performed. Sixty-seven percent of surgical procedures were orthopedic and 16.7 % were of general surgery. The average length of stay was 6.5 days (median=6). We transferred 14 patients to central trauma centers, 3 of which did not survive.

Conclusion: The outcomes of patients admitted to the Assuta Ashdod Hospital were good in treating major trauma patients in a mass casualty event, reaffirming its capabilities as an excellent regional trauma center. Therefore, we suggest that the guidelines for evacuation of battle or major casualty events victims only to central trauma centers unless patients are unstable should be reconsidered, and regional trauma centers could effectively share the burden of the treatment of those patients.

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地区创伤中心在治疗战斗和平民伤员方面面临的挑战。阿苏塔-阿什杜德医院在铁剑战争中的经验。
简介阿什杜德 Assuta 医院是一家地区创伤中心。该医院在 10 月 7 日平民大屠杀的第一天及其后接收了伤员。阿苏塔-阿什杜德医院被指定为紧急着陆点,仅用于救治病情不稳定或恶化的病人,这些病人无法在前往中心创伤中心的长途飞行中存活下来。本研究旨在分享我们作为战区新成立的地区创伤中心的经验和挑战:描述性队列研究包括 2023 年 10 月 7 日至同年 12 月期间急诊科收治的所有外伤患者。这些数据是以色列国家创伤登记处的一部分:共有 397 名重伤患者入院,其中 3 人在抵达时被宣布死亡,95 人住院治疗,299 人在急诊科接受初步治疗后出院。在住院的 95 名伤员中,60 人(63.1%)的受伤机制单一,其中 35.7% 为穿透伤。最常见的受伤部位是四肢(60%),其次是胸部和腹部,分别占 35.7% 和 14.7%。40%的伤员有多处创伤。平均ISS值为15(中位数=9)。根据国际伤残标准分类,10.5%的患者伤势严重,23.1%的患者伤势极重。12 名患者接受了全血输注,14 名患者接受了大规模输血方案。95 名患者中有 61 名(64%)接受了手术,共进行了 137 次手术。67%的手术为骨科手术,16.7%为普外科手术。平均住院时间为 6.5 天(中位数=6)。我们将14名患者转至中心创伤中心,其中3人未能存活:阿苏塔-阿什杜德医院在治疗大规模伤亡事件中的重大创伤患者方面取得了良好的疗效,再次证明了该医院作为优秀的地区创伤中心的能力。因此,我们建议重新考虑关于除非患者病情不稳定,否则只能将战斗或重大伤亡事件受害者后送至中心创伤中心的指导方针,地区创伤中心可以有效分担这些患者的治疗负担。
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