Trauma registries are a crucial component of trauma systems, as they could be utilized to perform a benchmarking of quality of care and enable research in a critical but important area of health care. The aim of this study is to compare the performance of two national trauma systems: Germany (TraumaRegister DGU ®,TR-DGU) and Israel (Israeli National Trauma Registry,INTR) in a retrospective analysis.

Patients from both registries treated during 2015-2019 with an Injury Severity Score (ISS) ≥ 16 points were included. Patient demographics, pre-hospital care, hospital treatment, and outcome were compared.

Data were available from 12,585 Israeli patients and 55,660 German patients. Age and sex distribution were comparable, and road traffic accidents were the most prevalent cause of injuries. The ISS of German patients was higher (ISS 24 versus 20), more patients were treated in an intensive care unit (92% versus 32%), and mortality was higher(19.4% versus 9.5%) as well.

Despite similar inclusion criteria (ISS ≥ 16), remarkable differences between the two national datasets were observed. Most likely, this was caused by different recruitment strategies of both registries like trauma team activation and the need for intensive care in TR- DGU. More detailed analyses are needed to uncover similarities and differences between both trauma systems.

The experience of terrorist incidents involving a secondary explosive device that targeted rescue forces led to changes in the safety protocols of these forces in most countries of the world. These protocols are the foundation of the current “Stage-and-Wait” paradigm that prohibits the entry of Emergency Medical Services (EMS) from entering the scene and treating casualties until it is deemed safe. These guidelines were established absent of an evidence-base detailing the risk to responders and the potential consequences to the injured on-scene. The lack of clarity is compounded by the fact that different situations, as well as operational considerations, such as the length of time until bomb squad arrival at the scene versus time of massive bleeding injuries, for example, impact outcomes must be taken into account.

This study sought to shed light on this matter while employing an evidence-based approach exploring the investigations of the frequency of secondary explosion threats in terrorist attacks over the last 20 years and discussing some of the ethical challenges and ramifications ensuing. While this study does not propose an outright change to current guidelines, in light of the evidence gathered, an open review and discussion based on the findings may be beneficial.

The Global Terrorism Database (GTD) was used as the data source of bombing incidents world-wide.

The results revealed that approximately 70 per-1,000 bombing incidents involved secondary explosions across regions and countries within the study period.

This study emphasizes the need to rethink the current “Stage-and-Wait” paradigm by recommending brainstorming conferences comprised of multi-sectoral experts aimed at deliberating the matter. World-wide experts in emergency medicine, bioethics, and disaster management should cautiously consider all aspects of bomb-related incidents. These brainstorming deliberations should consider the calculated risk of secondary explosions that account for approximately 70 per-1,000 bombing incidents. This study highlights the need to re-examine the current versus new paradigm to achieve a better balance between the need to ensure EMS safety while also providing the necessary and immediate care to improve casualty survival. This ethical dilemma of postponing urgent care needs to be confronted.

Appropriate pain management indicates the quality of casualty care in trauma. Gender bias in pain management focused so far on the patient. Studies regarding provider gender are scarce and have conflicting results, especially in the military and prehospital settings.

The purpose of this study is to investigate the effect of health care providers’ gender on pain management approaches among prehospital trauma casualties treated by the Israel Defense Forces (IDF) medical teams.

This retrospective cohort study included all trauma casualties treated by IDF senior providers from 2015-2020. Casualties with a pain score of zero, age under 18 years, or treated with endotracheal intubation were excluded. Groups were divided according to the senior provider’s gender: only females, males, or both female and male. A multivariate analysis was performed to assess the odds ratio of receiving an analgesic, depending on the presence of a female senior provider, adjusting for potential confounders. A subgroup analysis was performed for “delta-pain,” defined as the difference in pain score during treatment.

A total of 976 casualties were included, of whom 835 (85.6%) were male. Mean pain scores (SD) for the female only, male only, and both genders providers were 6.4 (SD = 2.9), 6.4 (SD = 3.0), and 6.9 (SD = 2.8), respectively (P = .257). There was no significant difference between females, males, or both female and male groups in analgesic treatment, overall and per specific agent. This remained true also in the multivariate model. Delta-pain difference between groups was also not significant. Less than two-thirds of casualties in this study were treated for pain among all study groups.

This study found no association between IDF Medical Corps providers’ gender and pain management in prehospital trauma patients. Further studies regarding disparities in acute pain treatment are advised.

To compare injury patterns of different types of explosions.

A retrospective study of 4508 patients hospitalized due to explosions recorded in the Israel National Trauma Registry between January 1997 and December 2018. The events were divided into 4 groups: terror-related, war-related, civilian intentional explosions, and civilian unintentional explosions. The groups were compared in terms of injuries sustained, utilization of hospital resources, and clinical outcomes.

Civilian intentional and terror-related explosions were found to be similar in most aspects except for factors directly influencing mortality and a larger volume of severely injured body regions among terror-victims. Comparisons between other groups produced some parallels, albeit less consistent. Civilian intentional explosions and civilian unintentional explosions were different from each other in most aspects. The latter group also differed from others by its high volume of life-threatening burns and a higher proportion of children casualties.

While consistent similarities between explosion casualties exist, especially between victims of intentional civilian and terror-related explosions, the general rule is that clinical experience with a type of explosion cannot be directly transferred to other types.

An effective way to reduce casualties from earthquakes is to increase population preparedness. During 2011 to 2013, Israeli authorities executed 3 national-level earthquake awareness campaigns. We aimed to assess the impact of these campaigns on the populace and the ability of the campaigns to produce a cumulative effect throughout the study period.

Two surveys were conducted 2 weeks after the end of the first campaign and the third campaign in a similar randomly selected representative sample.

Exposure to the campaign proved to be a significant factor in increasing the knowledge of the respondents, giving a knowledge advantage of 1.5 times to respondents exposed to the campaign. However, the period of assessment proved to be an even more significant factor, with knowledge in 2013 being 2.3 times that in 2011. Additionally, a gap of up to 40% between the levels of trust and the perceived responsibility of respective authorities in the times of earthquake was found.

This study found an improvement in public knowledge regarding earthquake preparedness over the 3 years of the study. This may mean that an awareness campaign does not stand by itself, but should be part of an integrated long-term process in order to have a lasting effect on the population. (Disaster Med Public Health Preparedness. 2016;10:74–79)

The most effective way to reduce the number of expected victims and amount of damage from earthquakes is by effective preparedness. The Israeli government launched a national campaign to change its citizens’ behavior. This study assessed the effectiveness of the campaign on the Israeli population.

The survey was conducted 2 weeks after the campaign ended. It was based on a randomly selected representative sample of the adult Israeli population.

Of the 42% of the Israeli public exposed to the campaign, 37% estimated that a strong earthquake might occur in Israel during the coming years. Only 23% of those who were exposed to the campaign (9% of the Israeli public) said that the campaign improved their awareness; 76% reported that after their exposure to the campaign they did nothing to prepare. However, exposure to the campaign significantly increased the knowledge of dealing with earthquakes (30% vs 21% among those not exposed).

Although the campaign increased knowledge and awareness, it did not achieve the goal of improving public preparedness. The campaign was not effective by itself, and it should be part of a multiyear activity. (Disaster Med Public Health Preparedness. 2015;9:138-144)

An earthquake of 9.0 magnitude, followed by a tsunami, hit Japan in 2011 causing widespread destruction. Fukushima Nuclear Power Plant had been damaged, causing a spread of radioactive materials.

The aim of this study was to assess personal willingness to respond to a disaster as a part of an international delegation, to an area with unknown and unclear risk of radioactive materials. The Israeli delegation to the Japan 2011 earthquake had been chosen as a case study.

The survey was conducted during the first two weeks after the tsunami in Japan. The population was selected randomly. After distributing the survey form, 94 anonymous answers were received, which give a 69% participation rate. The sample was divided into two groups (participated or didn't participate in an international delegation in the past).

It was found that as the situation on the ground became worse, the willingness to be deployed dropped dramatically, although no significant difference was found in willingness between the two study groups. When both groups were combined into one group, significant differences were found in their willingness to be deployed in a delegation between the three levels (no radioactive leak, possible radioactive leak, and uncontrolled leak).

The willingness to serve on a delegation that responds to a scene with a potential radioactive leak will be dramatically influenced by the risk at the site.

ShenharG , RadomislenskyI , RosenfeldM , PelegK . Willingness of International Delegations to be Deployed to Areas With High Risk of Radiation. Prehosp Disaster Med. 2014;29(4):1-5.