Mass casualty like nothing before, says SA doctor

The hospital where South African olah Dr Gila Nussbaum works in Israel was the first place emergency services brought the injured from the Supernova Music Festival on 7 October because it was the one closest time-wise from the northern border of Gaza.

“The situation was declared a mass casualty event. It was apocalyptic. Our little hospital was overwhelmed,” said Nussbaum, speaking at the Sydenham-Highlands North Shul on Sunday, 3 December. “We got 84 patients over a few hours from the music festival and the other surrounding areas.”

On this particular day, however, Nussbaum, who is an emergency medicine physician at the Assuta Ashdod University Hospital in Ashdod, was in Johannesburg celebrating a family simcha.

Nussbaum, who made aliya in January 2017, grew up in Glenhazel and following her medical internship at Tambo Memorial Hospital in Boksburg, Ekurhuleni, she chose to specialise in emergency medicine, which she did in Ashdod. Since finishing her residency two years ago, Nussbaum is a senior emergency medicine physician at the hospital, where she also runs a national course for emergency medicine for medical residents in Israel.

“Like most people involved in emergency medical services, I’ve become accustomed to having my cell phone on me at all times,” Nussbaum said.

“I was awoken on 7 October to many alerts, and I thought, here we go again,” Nussbaum said. “Working in Ashdod over the past six years, this is something we’ve become accustomed to. It happens every few months.”

But over the following hour, Nussbaum realised this was nothing like before. “The rockets were unforgiving. I started to see messages coming from our head of department calling for whoever was back on call to please come in if available and safe as they needed extra hands,” said Nussbaum.

Nussbaum said her colleagues told her all the patients came in with horrific injuries that even she, as a “jungle doctor”, which was her nickname in the hospital due to her training in South Africa, had never seen before.

“I’m no stranger to trauma, but if I had been there, I know I would have been completely horrified by what happened that day,” she said.

While Nussbaum would have jumped on a plane to be of service, she was advised to sit tight, enjoy the family simcha, and come back when she had originally planned to. “We were physically in Johannesburg, but emotionally our hearts and heads were in Israel,” said Nussbaum.

However, on 19 October, she returned to work, travelling from her home in Modi’in to Ashdod every day.

She said once the initial wave of casualties was over, the hospital got very quiet. The war had started, and people were afraid to leave their homes so the usual things in an emergency room, like heart attacks and car accidents, weren’t coming in.

Once the war was in full swing, the hospital shifts were extended from nine to 12 hours because of additional patients and a lack of manpower. “Six of our 17 doctors were called up as reserves,” said Nussbaum.

The fear, which was all pervasive, didn’t stop at the hospital, she said, and her journey from Modi’in to Ashdod was scary in itself. “We learned that Hamas has preferable hours to fire rockets, namely peak-hour traffic. This happened to be the same time I would be travelling to work because of our adjusted shift hours,” said Nussbaum.

In one incident, a rocket intercepted by the Iron Dome had a fragment fall on the highway, and led to a car exploding, preventing her from getting to the hospital on time. When she arrived, she discovered there had been multiple rocket attacks and two buildings in Ashdod had been hit. Because of this, many patients were coming in with a range of conditions from sheer panic and heart palpitations, to actual injuries from buildings collapsing or being hit by the rockets.

“The situation just adds to the whole feeling of unease and chaos in the emergency department. We have received many injured soldiers into our hospital. Our hospital is five minutes away from Gaza by air, so often we’re the first place they consider.

“We’re not considered a level-one trauma facility because of the fact that we don’t have neurosurgical capabilities and we don’t have on-site cardiothoracic capabilities. So, preference for the army is to take injured soldiers to a level-one facility, but the closest one is in Ramat Gan and that can take an additional eight or nine minutes from Ashdod.

“When a soldier deteriorates in the air and they don’t have those extra eight minutes to go to Ramat Gan, they come to us. In situations like this, we’re given only four minutes notice that we’re getting the patient. This means that we’re getting the most critically injured and most ill of the soldiers”.

“Anywhere between four to five helicopters, each carrying six soldiers, land a day,” Nussbaum said.

Nussbaum’s involvement in emergency medicine training isn’t limited to her hospital as she has been providing training in life-saving procedures and mass casualty incidents at various branches, beginning with older hospitals, especially ones in Nahariah and Tzfat in the north, whose emergency protocols haven’t been updated in 20-30 years. There, she’ll run mass casualty event exercises to make sure they are prepared. Nussbaum also trains in life-saving field procedures, saying “most people talk about the golden hour when it comes to injuries, but there’s a golden minute in emergency medicine that’s almost more important”. She’s also involved in first-call groups, who are the first to respond to any emergencies and mass casualty events in a certain area.

“I would have never anticipated that our little hospital would have to deal with something like this. But I’ve learned that though you can never be ready, you can always be prepared. We were never ready, but we were very prepared,” Nussbaum said.