DISASTERS AND OTHER emergencies can strain and even damage – at least transiently – a health care system. The increased awareness of natural and manmade disasters has created a relatively new need for health care providers: preparedness and response for medical emergencies. To remain both robust and flexible, the medical systems must establish protocols, perform exercises, and learn from the experience of others. Facing threats since it was born 62 years ago, the Israeli medical system has conducted a comprehensive preparedness activity that has been tested in large-scale exercises and in large- and small-scale violent conflicts.

AN OVERVIEW OF THE ISRAELI MEDICAL SYSTEM

Israel has 24 public acute care hospitals in addition to its geriatric, psychiatric, and private hospitals. The hospital system serves both the civilian and the military population. Six are trauma centers (level 1) located in densely populated urban areas; 14 others are acute care medical centers without cardiosurgery or neurosurgery services (level 2), and the rest are relatively remote community hospitals (level 3) that can offer triage and limited surgical and surge capacity. All Israeli hospitals maintain continuous alert for mass casualty incidents (MCIs) in line with a unified national doctrine. Thus, we regard the hospitals as part of the first-responders system. In the extrahospital arena, there is a highly developed network of outpatient clinics, part of the four health maintenance organizations' (HMOs') network of primary care clinics.