When is a parking lot not a parking lot? At the Western Galilee Hospital (WGH) in Nahariya, Israel, the parking lot can be quickly transformed into a decontamination area for victims of a chemical attack. In such an event, parked cars would be removed, hoses would be connected to water inlet valves on the parking lot, and patients would be identified, undressed, washed, and dressed in gowns before entering the hospital. Color- and number-coded tags to track patients and their belongings would also be applied in the parking lot.

This process was one of many that I and 17 other health care professionals experienced firsthand while taking the fifth Annual Emergency Response Group (ERG) course for mass casualty disasters, given at the WGH Sept. 18-22.

The ERG course is sponsored by Partnership With Israel, in which 14 Jewish federations in the central United States — including Dayton’s — join with the Western Galilee region in a variety of programs, including student exchanges, summer camps, and arts projects.

ERG participants were mostly but not exclusively physicians and Jewish. Specialties included emergency medicine, Ob-Gyn, pediatric surgery, orthopedics, anesthesiology, infectious diseases, internal medicine, and gastroenterology (myself). Dr. Shulamit Adler, a neuropsychologist from Dayton, attended the course with us, as well as hospital administrators, a nurse, and an emergency medical technician.

The course provided an excellent overview of the approach to mass casualty disasters. Lectures on the initial assessment and management of trauma patients were followed by procedure drills using mannequins.

Feedback by the instructors was given continuously during the exercises. We also had lectures on chemical and biological events, earthquakes, disaster planning at the hospital, local, and national levels, and the psychological aspects of mass casualty disasters. A highlight was a mass casualty drill in which young acting students served as patients or hysterical family members.

The WGH has unique facilities that make it particularly suitable for a course on mass casualty disasters. There is an underground facility that can be rapidly converted to a 400-bed hospital (in addition to the 600 existing beds) if needed.

Special charcoal filters for poison gas (ironically, made in Germany) are part of a dedicated air and water filtration system. Ambulances can be driven inside the underground hospital facility, which is in close proximity to the operating rooms. These facilities were developed because of the close proximity of the WGH to the border with Lebanon.

I observed and performed endoscopic procedures in the Department of Gastroenterology, and I gave a lecture on hepatitis C.

Dr. Adler lectured the Neurology Department on the latest information from the United States on Posttraumatic Stress Disorder and seizures, and delivered a lecture on differential diagnosis of psychiatric and neurological conditions in the Inpatient Child Psychiatry Department.

She also participated in a family-oriented eating disorders treatment, and consulted with rehabilitation medicine and physical therapy staff.

Another important purpose of the ERG course is to provide a mechanism whereby American physicians could help staff the WGH in the event of a major emergency in Israel. At the end of the course, attendees were given the option of joining the ERG. Several speakers mentioned that Dr. Sidney Miller, a physician from Dayton, was instrumental in establishing the first ERG course.