Avishay Goldberg

Twitter in the cross fire--the use of social media in the Westgate Mall terror attack in Kenya.

On September 2013 an attack on the Westgate mall in Kenya led to a four day siege, resulting in 67 fatalities and 175 wounded. During the crisis, Twitter became a crucial channel of communication between the government, emergency responders and the public, facilitating the emergency management of the event. The objectives of this paper are to present the main activities, use patterns and lessons learned from the use of the social media in the crisis. Using TwitterMate, a system developed to collect, store and analyze tweets, the main hashtags generated by the crowd and specific Twitter accounts of individuals, emergency responders and NGOs, were followed throughout the four day siege. A total of 67,849 tweets were collected and analyzed. Four main categories of hashtags were identified: geographical locations, terror attack, social support and organizations. The abundance of Twitter accounts providing official information made it difficult to synchronize and follow the flow of information. Many organizations posted simultaneously, by their manager and by the organization itself. Creating situational awareness was facilitated by information tweeted by the public. Threat assessment was updated through the information posted on social media. Security breaches led to the relay of sensitive data. At times, misinformation was only corrected after two days. Social media offer an accessible, widely available means for a bi-directional flow of information between the public and the authorities. In the crisis, all emergency responders used and leveraged social media networks for communicating both with the public and among themselves. A standard operating procedure should be developed to enable multiple responders to monitor, synchronize and integrate their social media feeds during emergencies. This will lead to better utilization and optimization of social media resources during crises, providing clear guidelines for communications and a hierarchy for dispersing information to the public and among responding organizations.

Assessing levels of hospital emergency preparedness

INTRODUCTION Emergency preparedness can be defined by the preparedness pyramid, which identifies planning, infrastructure, knowledge and capabilities, and training as the major components of maintaining a high level of preparedness. The aim of this article is to review the characteristics of contingency plans for mass-casualty incidents (MCIs) and models for assessing the emergency preparedness of hospitals. CHARACTERISTICS OF CONTINGENCY PLANS Emergency preparedness should focus on community preparedness, a personnel augmentation plan, and communications and public policies for funding the emergency preparedness. The capability to cope with a MCI serves as a basis for preparedness for non-conventional events. Coping with chemical casualties necessitates decontamination of casualties, treating victims with acute stress reactions, expanding surge capacities of hospitals, and integrating knowledge through drills. Risk communication also is important. ASSESSMENT OF EMERGENCY PREPAREDNESS An annual assessment of the emergency plan is required in order to assure emergency preparedness. Preparedness assessments should include: (1) elements of disaster planning; (2) emergency coordination; (3) communication; (4) training; (5) expansion of hospital surge capacity; (6) personnel; (7) availability of equipment; (8) stockpiles of medical supplies; and (9) expansion of laboratory capacities. The assessment program must be based on valid criteria that are measurable, reliable, and enable conclusions to be drawn. There are several assessment tools that can be used, including surveys, parameters, capabilities evaluation, and self-assessment tools. SUMMARY Healthcare systems are required to prepare an effective response model to cope with MCIs. Planning should be envisioned as a process rather than a production of a tangible product. Assuring emergency preparedness requires a structured methodology that will enable an objective assessment of the level of readiness.

Mass casualty incident management, triage, injury distribution of casualties and rate of arrival of casualties at the hospitals: lessons from a suicide bomber attack in downtown Tel Aviv

Background: Terrorist attacks in Israel cause mass events with varying numbers of casualties. A study was undertaken to analyse the medical response to an event which occurred on 17 April 2006 near the central bus station, Tel Aviv, Israel. Lessons are drawn concerning the management of the event, primary triage, evacuation priorities and the rate and characteristics of casualty arrival at the nearby hospitals. Methods: Data were collected both during and after the event in formal debriefings. Their analysis refers to medical response components, interactions and main outcomes. The event is described according to the DISAST-CIR methodology (Disastrous Incidents Systematic AnalysiS Through – Components, Interactions and Results). Results: 91 casualties were reported in this event; 85 were evacuated from the scene including 3 already dead on arrival, 9 severely injured, 14 moderately injured and 59 mildly injured. Six were declared dead at the scene. Emergency medical service (EMS) vehicle accumulation was rapid. The casualties were distributed between five hospitals (three level 1 and two level 2 trauma centres). The first evacuated casualty arrived at the hospital within 20 min of the explosion and the last urgent victim was evacuated from the scene after 1 h 14 min. Evacuation occurred in two phases: the first, lasting 1 h 20 min, in which most of the patients with evident trauma were evacuated and the second, lasting 8 h 15 min, in which most patients presented with tinnitus and symptoms of somatisation. The most common injuries were upper and lower limb injuries, diagnosed in 37% of the total injuries, and stress-related disturbances (anxiety, tinnitus, somatisation) diagnosed in 41%. Conclusion: Rapid accumulation of EMS vehicles, effective primary triage between urgent and non-urgent casualties and primary distribution between five hospitals enabled rapid conclusion of the event, both at the scene and at the receiving hospitals.

Distribution of casualties in a mass-casualty incident with three local hospitals in the periphery of a densely populated area: lessons learned from the medical management of a terrorist attack.

INTRODUCTION A mass-casualty incident (MCI) can occur in the periphery of a densely populated area, away from a metropolitan area. In such circumstances, the medical management of the casualties is expected to be difficult because the nearest hospital and the emergency medical services (EMS), only can offer limited resources. When coping with these types of events (i.e., limited medical capability in the nearby medical facilities), a quick response time and rational triage can have a great impact on the outcome of the victims. The objective of this study was to identify the lessons learned from the medical response to a terrorist attack that occurred on 05 December 2005, in Netanya, a small Israeli city. METHODS Data were collected during and after the event from formal debriefings and from patient files. The data were processed using descriptive statistics and compared to those from previous events. The event is described according to Disastrous Incidents Systematic Analysis Through Components, Interactions, Results (DISAST-CIR) methodology. RESULTS Four victims and the terrorist died as a result of this suicide bombing. A total of 131 patients were evacuated (by EMS or self-evacuation) to three nearby hospitals. Due to the proximity of the event to the ambulance dispatch station, the EMS response was quick. The first evacuation took place only three minutes after the explosion. Non-urgent patients were diverted to two close-circle hospitals, allowing the nearest hospital to treat urgent patients and to receive the majority of self-evacuated patients. The nearest hospital continued to receive patients for >6 hours after the explosion, 57 of them (78%) were self-evacuated. CONCLUSION The distribution of casualties from the scene plays a vital role in the management of a MCI that occurs in the outskirts of a densely populated area. Non-urgent patients should be referred to a hospital close to the scene of the event, but not the closest hospital. The nearest hospital should be prepared to treat urgent casualties, as well as a large number of self-evacuated patients.

Response of Thai hospitals to the tsunami disaster.

The disaster caused by the Tsunami of 26 December 2004 was one of the worst that medical systems have faced. The aim of this study was to learn about the medical response of the Thai hospitals to this disaster and to establish guidelines that will help hospitals prepare for future disasters. The Israeli Defense Forces (IDF) Home Front Command (HFC) Medical Department sent a research delegation to Thai hospitals to study: (1) pre-event hospital preparedness; (2) patient evacuation and triage; (3) personnel and equipment reinforcement; (4) modes used for alarm and recruitment of hospital personnel; (5) internal reorganization of hospitals; and (6) admission, discharge, and secondary transfer (forward management) of patients. Thai hospitals were prepared for and drilled for a general mass casualty incident (MCI) involving up to 50 casualties. However, a control system to measure the success of these drills was not identified, and Thai hospitals were not prepared to deal with the unique aspects of a tsunami or to receive thousands of victims. Modes of operation differed between provinces. In Phang Nga and Krabi, many patients were treated in the field. In Phuket, most patients were evacuated early to secondary (district) and tertiary (provincial) hospitals. Hospitals recalled staff rapidly and organized the emergency department for patient triage, treatment, and transfer if needed. Although preparedness was deficient, hospital systems performed well. Disaster management should focus on field-based first aid and triage, and rapid evacuation to secondary hospitals. Additionally, disaster management should reinforce and rely on the existing and well-trusted medical system.

Case study of the terrorist bombing in Tel Aviv market – putting all the eggs in one basket might save lives

Objectives: On 1 November 2004 a suicide bomber detonated himself in Tel Aviv, in a crowded open market space, resulting in 3 dead victims and 34 casualties. This event in a central urban area was handled quickly by experienced emergency medical service (EMS) teams. We analysed evacuation destinations of urgent casualties in order to learn whether severe casualties should all be evacuated to the closest trauma centre. Alternatively, they might be distributed to all nearby hospitals, both trauma and non‐trauma centres. A third possibility is directing urgent casualties only to trauma centres, dividing them between the close trauma centre and a ‘second cycle’ distant level A trauma centre. Methods: Data were collected from formal debriefings carried out after the event in the Ministry of Health, in the Israeli Defense Forces Medical Corps (IDF MCs) and in the Home Front Command (HFC). Other debriefings, in which we took part, were those of the EMS and participating hospitals. We analysed these data to learn...

Complementary Medicine in Israel

In recent years, the status of complementary medicine in Israel has appeared frequently on the public agenda. The debates and the newspaper headlines concerned with this subject usually deal with legal aspects of the subject, including the relation between complementary medicine and the medical establishment. With the enactment in 1995 of the Compulsory Health Insurance Law, debate over the issue intensified, with the public divided over any proposal to make complementary medicine part of the services guaranteed by law. This paper addresses the current status of complementary medicine in Israel, describes the introduction of complementary medicine to Israel, attitudes toward it of both consumers and medical professionals, and the question of its legal status. While no comprehensive survey describing all aspects of this subject in Israel has yet been undertaken, this paper is based on a survey of the professional literature in Israel, especially that of the Israeli scientific-medical community, a survey of the general press, and an analysis of the health insurance law and its position with respect to the complementary medicine.

The relationship between demographic/educational parameters and perceptions, knowledge and earthquake mitigation in Israel

Perceptions, knowledge and mitigation are factors that might play a role in preventing injury and loss of life during a major earthquake.(2) Little is known about the relationships between different demographic and educational parameters and these factors. A national representative sample of 495 adults was investigated in order to determine the relationship between demographic and educational parameters in terms of the perceived threat, perceived coping, knowledge and mitigation of earthquakes in Israel. Compared to females, males perceived the threat of earthquakes to be lower (t = 3.183, p = 0.002), manifested higher levels of perceived coping (t = 2.55, p = 0.011), and had higher levels of earthquake related knowledge (t = 2.047, p = 0.041). We conclude that there are gender differences in perceptions and knowledge regarding earthquakes.

Disaster Healthcare System Management and Crisis Intervention Leadership in Thailand–Lessons Learned from the 2004 Tsunami Disaster

INTRODUCTION Quarantelli established criteria for evaluating the effectiveness of disaster management. OBJECTIVES The objectives of this study were to analyze the response of the healthcare system to the Tsunami disaster according to the Quarantelli principles, and to validate these principles in a scenario of a disaster due to natural hazards. METHODS The Israeli Defense Forces (IDF) Home Front Command Medical Department sent a research team to study the response of the Thai medical system to the disaster. The analysis of the disaster management was based on Quarantellis 10 criteria for evaluating the management of community disasters. Data were collected through personal and group interviews. RESULTS The three most important elements for effective disaster management were: (1) the flow of information; (2) overall coordination; and (3) leadership. Although pre-event preparedness was for different and smaller scenarios, medical teams repeatedly reported a better performance in hospitals that recently conducted drills. CONCLUSIONS In order to increase effectiveness, disaster management response should focus on: (1) the flow of information; (2) overall coordination; and (3) leadership.

Relationship Between Standards of Procedures for Pandemic Flu and Level of Hospital Performance in Simulated Drills

STUDY OBJECTIVE Standard operating procedures are the basis of a consistent response to varied threats. The aim of this study is to investigate the relationship between the quality of standard operating procedures developed by hospitals for the management of a pandemic influenza outbreak and the level of performance in a H5N1 flu drill. METHODS Standard operating procedures developed by all general hospitals in Israel for the management of pandemic influenza were evaluated with a tool developed for this purpose. The hospital standard operating procedure score was then compared with the score obtained by the hospital in a simulated drill. RESULTS Cronbachs alpha was used to determine the reliability of the standard operating procedure evaluation scores and the scores obtained on the drill. Reliability of both scores was high (>0.70). Hospital standard operating procedure scores were found to be moderately related to the scores obtained on the simulated drill. An important relationship was found between performance on the drill and the following components of the standard operating procedure: protection of staff and patients, staffing coordination and control, and infrastructure maintenance and minimizing overload. Hospital characteristics were not found to be important in determining either the hospital standard operating procedure score or performance on the simulated drill. CONCLUSION A reasonably strong relationship was found between quality of the standard operating procedures developed by hospitals to deal with a pandemic influenza and performance on a pandemic drill. Components of the standard operating procedure that dealt with areas that were relatively unfamiliar to staff or topics that were perceived by personnel as posing a risk to their well-being were found to be more important. The quality of the standard operating procedures was found to be important in relation to performance in a pandemic flu drill; therefore, we suggest investing effort in developing standard operating procedures that are comprehensive and cover relatively new domains in detail.