Few countries stage more frequent, more realistic and more wide-ranging emergency-preparedness drills than Israel, a place where yet another war or more terrorist attacks are all but certain.
In previous years, I have seen heart-pounding simulations of a nationwide emergency response to a smallpox attack and a radiological bomb. Last month, authorities staged a dramatic preparedness exercise where the scenario flowed from a fictional airplane crashing into a residential area, causing hundreds of casualties — all simulated. This so-called Mega Mass Casualty Incident, the type of disaster that occurs without warning, exceeding the capabilities of a single municipality or region, tests the limits of medical, security and other emergency systems.
Some would call the drills alarmist, but disasters of this scale have occurred many times, in the United States on 9/11, in the London bombings of 2005 and the Madrid attacks of 2004 among them.
As Dr. Amir Blumenfeld, who spent past eight months preparing this exercise said, “You need to be prepared in advance. You cannot just wait to react when the event happens.”
Emergency officials from dozens of countries, who were in Israel to attend the emergency preparedness conference, IPRED, observed the exercise with rapt attention. The simulation was strikingly realistic. It started in a repurposed former military base in central Israel, not far from Ben Gurion, the country’s main airport.
Initially, the lot where the plane “crashed” in the simulation stood behind a screen showing a picture of modern apartment buildings. Suddenly, a loud explosion shook the ground, the screen fell away revealing collapsed buildings, real airplane engines still smoldering atop the rubble and actors displaying all manner of wounds, crying out for help. Some were walking in a daze, others helping nearby casualties move away from the smoldering ruins.
Secondary explosions struck repeatedly, adding to the cacophony of the disaster, with the constant wailing of ambulances and other emergency vehicles arriving in an endless stream.
Before long, workers from the Magen David Adom, Israel’s version of the Red Cross, started rushing in, removing the wounded and the dead. Police, firefighters, even journalists started appearing. It was a scene of seeming chaos, but behind it personnel from a host of agencies followed protocols developed over years of planning, drills and real-life disasters. Hundreds of casualties received attention, with medics performing triage and providing basic medical care before evacuations.
Israel’s Home Front Command, the civil defense authority from the Israel Defense Forces (IDF), took charge. The IDF’s Medical Corps took its positions, and command posts were set up to coordinate the operations, keeping track of emergency vehicles, available hospital beds, road closures and other logistical elements.
Officials updated the media and hospitals in the area received word they should prepare for large numbers of casualties.
At the disaster scene, helicopters arrived to help evacuations and nearby key roads were closed, open only to emergency vehicles. Not far from the simulated crash, Israel’s Tel Hashomer Hospital, the largest in the country, activated its emergency protocols, as well. Elective surgeries would have to be canceled and some existing patients evacuated to other hospitals.
Stretchers lined up at the emergency entrance to the hospital, and each ambulance was met by a team trained to make a quick assessment of the patients’ condition, raising a flag of a different color indicating the urgency of the case and tagging patients with the triage color indicating the urgency — red, yellow, green — or black when patients died en route or were beyond help.
Information services for relatives looking for missing loved ones also went into action, staffed by social workers trained to provide psychosocial support for people experiencing enormous stress, even if they were not at the site of the disaster.
The exercise itself is just one part of the drill. Afterward, a painstaking evaluation of the performance of each element will be assessed and graded and the plans adjusted to reflect the lessons learned.
Major drills occur regularly in Israel, often involving large sections of the civilian population. A few months ago, the Home Front Command staged a nationwide five-day drill to prepare the population for a massive missile attack, including non-conventional rockets such as chemical, biological and nuclear-tipped missiles.
Observers frequently remark on the seriousness with which everyone participates. That is hardly surprising. In 2006, thousands of rockets were fired at Israel by Hezbollah from Lebanon. Arsenals are now restocked. In Syria, radicals both sides of the civil war vow to attack Israel after they finish fighting one another. And rockets from Hamas-controlled Gaza were launched at Israel as recently as this week.
Organizers hope the lessons will never have to be put into practice, but everyone knows why drills are necessary.
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