Emergencies provide opportunities for deep systemic intra-action and after-action reviews, followed by changes and adaptations that are aimed at enhancing resilience against future health emergencies. One of the most prevalent lessons learned from the COVID-19 pandemic is the need to intensify the investment in the health workforce. Diverse groups of health workers have brought their expertise from the benches to patients’ beds, and the desks of the decision-makers.

Match skill mix of health staff with the needed level of care: those with mild diseases can be cared for by basic nursing staff. Critical patients require advanced skilled nursing that is familiarized with advanced technologies such as ECMO, and use “out-of-the-box” thinking.

Developing the capabilities of the communities and civil society organizations to respond to emergencies. Cooperation agreements with partners that are not involved in medical care during “regular days” should be set before emergencies strike.

Formulate civil-military-police cooperation as well as the Good Samaritan Law is an important legal instrument to allow for humanitarian aid from within and outside the country.

Matching the skill mix of the health staff with the needed level of care for basic nursing for minor patients as well as advanced nursing for critical patients, while using “out of the box “ thinking to develop a high level of knowledge is important to maintain quality care during emergencies.

The COVID-19 pandemic and other emergencies provide us with the opportunity to switch from bouncing back to bouncing forward, and from just coping to anticipating and transforming. Investing in the health workforce would enhance preparedness and readiness so that emergencies will not turn into disasters and crises. The presentation will highlight some of the new approaches and methods applied during the COVID-19 outbreak, as well as those applied in countries that are faced with wars and military conflicts.

The use of ECMO devices began about 50 years ago. The purpose of the ECMO device is to enable gas exchange (oxygen and carbon dioxide) and/or hemodynamic support in situations of pulmonary or heart failure to recover or to serve as a bridge in a waiting period for heart pulmonary, heart, or artificial heart transplantation. The COVID-19 outbreak increased the need for the use of ECMO as a life-saving treatment. As a result, there was an increasing demand for qualified personnel in overloaded hospitals' ICUs to care for COVID-19 patients in general, specifically for those who required ECMO treatment. These required rapid team training and new methodology development collaboration between the Ministry of Health (MOH), multi-disciplinary teams, and a national professional committee that set the treatment protocols based on universal standards.

A professional national committee was appointed by the MoH. The committee included Physicians, Nurses, Cardiopulmonary Bypass Machine Operators/Perfusionists as well as MoH representatives. The role of the committee was to establish guidelines and standards for operating ECMO services. These guidelines were adopted by the MoH and are the basic recommendations for operating ECMO units in Israeli hospitals.

The whole process had a dual challenge. One challenge was establishing new ECMO units according to the guidelines and the universal standards created by the committee. The other challenge was to motivate the old and experienced ECMO units to adopt and work according to the official standards set by the committee.

These days the committee started the evaluation of the old ECMO Units to bring all ECMO units in Israel to work by the same guidelines and standards.

The project was provided under the auspice and support of the Israel Agency for International Development Cooperation (MASHAV) at the Ministry of Foreign Affairs (MFA). Togo, one of the smallest and least developed countries in West Africa, has a population of ~7.9 million. About 65% of its population lives in rural areas. Due to the lack of medical resources, Togo suffers from health problems including those related to trauma and mass events. In May 2017, a trauma and disaster team came to Togo to train the medical team in the new trauma unit, donated and built by the MFA. The unit was built in the Atakpame Regional Hospital (ARH), located 160km north of the capital, Lomé. ARH serves one million inhabitants, mostly from rural areas.

The training included lectures, simulations, drills, case studies, bedside teaching, and operation of medical technologies.

Following the training, it was recommended to continue the program and to move forward with advanced training. Following the team’s recommendations, MASHAV decided to expand the program and to provide a multilateral project to Togo and ten other West African countries within five months after the first training ended. Twenty participants (mostly senior doctors) were chosen from ten Western African countries and brought to Lomé. The participants joined a two-day Trauma and Disaster Preparedness seminar. Following the seminar, they were moved to Atakpame to join the local team and the facilitators, to visit the trauma unit, and to learn about it as a model for trauma care that can be modified to the capabilities of the local facility.

Lessons learned and recommendations from those two projects were brought to the MFA that will try to develop more training and cooperation models to help and establish better trauma care and disaster response, supported by the Israeli team.

Clinic Communal de Miniera is a small hospital located in the poor Dixinn district in Guinea Conakry. The hospital functions with seven general physicians, three surgeons, one gynecologist, one dentist, and fifteen nurses. The facility provides small admitting wards for medical, gynecologist (mostly maternity), and pediatric patients. The average number of patients per day is about forty, including acute and ambulatory patients. Although there is a medical director, the daily work is run by the Head Nurse (HN) who is specialized (on spot) as an Emergency Nurse. Management of all emergency patients is based on her experience, personality and the reality of the organization.

The circumstances emphasized the gaps between the managerial needs and existent reality, and raised the HN role to a team leader. The work will present the situation in the hospital as a case study related to “non-conventional” management due to a “deferent” situation and will highlight questions related to capabilities and risk factors.

Terrorist attacks have occurred in Tel-Aviv that have caused mass-casualties.The objective of this study was to draw lessons from the medical response to an event that occurred on 19 January 2006, near the central bus station, Tel-Aviv, Israel. The lessons pertain to the management of primary triage, evacuation priorities, and rapid primary distribution between adjacent hospitals and the operational mode of the participating hospitals during the event.

Data were collected in formal debriefings both during and after the event. Data were analyzed to learn about medical response components, interactions, and main outcomes. The event is described according to Disastrous Incidents Systematic AnalysiS Through—Components, Interactions and Results (DISAST-CIR) methodology.

A total of 38 wounded were evacuated from the scene, including one severely injured, two moderately injured, and 35 mildly injured. The severe casualty was the first to be evacuated 14 minutes after the explosion. All of the casualties were evacuated from the scene within 29 minutes. Patients were distributed between three adjacent hospitals including one non-Level-1 Trauma Center that received mild casualties. Twenty were evacuated to the nearby, Level-1 Sourasky Medical Center, including the only severely injured patient. Nine mildly injured patients were evacuated to the Sheba Medical Center and nine to Wolfson Hospital, a non-Level-1 Trauma Center hospital. All the receiving hospitals were operated according to the mass-casualty incident doctrine.

When a mass-casualty incident occurs in the vicinity of more than one hospital, primary triage, evacuation priority decision-making, and rapid distribution of casualties between all of the adjacent hospitals enables efficient and effective containment of the event.

The classical doctrine of mass toxicological events provides general guidelines for the management of a wide range of “chemical” events. The guidelines include provisions for the: (1) protection of medical staff with personal protective equipment; (2) simple triage of casualties; (3) airway pro-tection and early intubation; (4) undressing and decontamination at the hos-pital gates; and (5) medical treatment with antidotes, as necessary. A number of toxicological incidents in Israel during the summer of 2005 involved chlo-rine exposure in swimming pools. In the largest event, 40 children were affected. This study analyzes its medical management, in view of the Israeli Guidelines for Mass Toxicological Events.

Data were collected from debriefings by the Israeli Home Front Command, emergency medical services (EMS), participating hospitals, and hospital chart reviews. The timetable of the event, the number and severity of casualties evacuated to each hospital, and the major medical and logistical problems encountered were analyzed according to the recently described methodology of Disastrous Incident Systematic Analysis Through-Components, Interactions, Results (DISAST-CIR).

The first ambulance arrived on-scene seven minutes after the first call. Emergency medical services personnel provided supplemental oxygen to the vic-tims at the scene and en route when required. Forty casualties were evacuated to four nearby hospitals. Emergency medical services classified 26 patients as mild-ly injured, 13 as mild-moderate, and one as moderate, suffering from pulmonary edema. Most children received bronchodilators and steroids in the emergency room; 20 were hospitalized. All were treated in pediatric emergency rooms. None of the hospitals deployed their decontamination sites.

Event management differed from the standard Israeli toxico-logical doctrine. It involved EMS triage of casualties to a number of medical centers, treatment in pediatric emergency departments, lack of use of protec-tive gear, and omission of decontamination prior to emergency department entrance. Guidelines for mass toxicological events must be tailored to unique scenarios, such as chlorine intoxications at swimming pools, and for specific patient populations, such as children. All adult emergency departments always should be prepared and equipped for taking care of pediatric patients.