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Haifa under attack during the Second Lebanon War, July 2006. Red arrows indicate Katyusha rocket strikes from Hezbollah terrorists in Lebanon

 

Learning from Northern Israel's emergency preparedness

By Marshall Weiss, The Dayton Jewish Observer

In May 2006, Dr. Richard Schuster led a group of Wright State University and community emergency response professionals to Northern Israel. Their mission was to study Israel’s emergency preparedness with the ultimate goal of incorporating best practices into the Dayton region’s planning.

In July 2006, the Western Galilee Hospital in Nahariya received a direct hit from a Hezbollah Katyusha rocket during the Second Lebanon War.
Six weeks later, the Second Lebanon War broke out. Northern Israel was barraged with more than 4,000 Katyusha rockets from Hezbollah terrorists in Lebanon over a 33-day period.

In December 2007, Schuster returned to Israel with a similar group to find out if Israel’s planning really worked.

"We were told that there were more rocket attacks on Northern Israel than bombings during the Blitz of World War II," said Schuster, Oscar Boonshoft chair and director of the Center for Global Health Systems, Management and Policy of Wright State University’s Boonshoft School of Medicine.

On the trip with Schuster were Montgomery County Health Commissioner Jim Gross, a U.S. Air Force physician, and faculty and students from Wright State’s schools of medicine and professional psychology.

Both trips were funded by grants from Dayton’s Levin Family Foundation and were an outgrowth of the Jewish Federation’s participation in the Partnership With Israel program.

Dr. Richard Schuster
"Many of us living in the United States didn’t realize how dramatic the (Second) Lebanese War was to the people living in Northern Israel." Schuster said. "It had dramatic psychological effects on the population. As we went around and learned, they showed us evidence — that I believe is accurate — that they (Hezbollah) actually targeted the big hospitals for rocket attack. They did hit Western Galilee Hospital."

Schuster said the group found that Western Galilee Hospital was very well prepared for the attacks.

"The previous medical director had convinced the government to build a facility underground in the event that they were attacked," Schuster said. "And he received a lot of criticism for this as being an unnecessary extravagance."

Western Galilee Hospital received four hours’ warning before Israel launched its military response to Hezbollah at the outset of the Second Lebanon War.

"In an hour, they moved 250 people," Schuster said. "These are hospital-bed occupied patients. Within those four hours, they evacuated all the at-risk areas of the hospital. They carried out their plans and did so successfully. That hospital operated throughout this war without problems, based on a sophisticated emergency preparedness plan, a tremendous spirit of the people working there."

Western Galilee Hospital is staffed and occupied by Arab, Jewish and Druze citizens of Israel.

"It’s amazing to see that harmony, particularly in times of stress," Schuster said.

Wright State Associate Director of Public Health Practice Dr. Raymond P. Ten Eyck led the Wright State team that evaluated the hospital’s response. They confirmed that the hospital was able to handle the "surge," when masses of people showed up at the emergency room following rocket attacks.

Psychological care

"The hospital was always able to handle whatever problem came in," Schuster said, noting that most injuries were psychological. "They have a sophisticated system for handling psychological injuries that is not nearly as developed in the United States."

Dr. Scott Fraser, a professor of psychology with Wright State’s school of professional psychology, took his evaluation team to Kiryat Shmona to study the world-class psychological stress prevention and treatment program there.

The Community Stress Prevention Center at Tel Hai College in Kiryat Shmona opened in 1981, with funding from the Jewish Agency for Israel, to help the population along Israel’s northern border deal with stressful and emergency situations. CSPC has assisted with disasters around the globe, in places such as Sri Lanka, Turkey and in the Gulf Coast after Hurricane Katrina.

Fraser participated on the 2006 trip and helped develop the current emergency plan for Dayton and Montgomery County. His team is studying how the Dayton region can model Israel’s psychological analysis and treatment.

"The psychological group was applying what they had learned unfortunately over more than 30 years," Fraser said of the Israelis. "With the (Montgomery) County, we are looking into how you identify and triage those people who might surge into the emergency room who are not physically injured but are heavily impacted by terror, disaster, pandemic flu: how to serve them and not just send them away."

"If you look at what happened here in New Orleans," Schuster said, "look at all the psychological stress, the social stress. We didn’t see that same thing happen in Israel because they were well prepared."

Montgomery County Health Commissioner Jim Gross, who completed the master of public health program at Wright State in 2005, said the magnitude of the psychological issues of the Second Lebanon War impacted him.

Gross became public health commissioner in September; he is also responsible for Montgomery County’s emergency preparation and is the regional coordinator for nine counties beyond Montgomery.

His predecessor, Health Commissioner Bill Bines, was on the 2006 trip.

Montgomery County Health Commissioner Jim Gross (3rd from L) at the Haifa Emergency Command Center
"Some might say that the situation in Israel is different than that in Dayton," Gross said. "First, we are susceptible to a terrorist attack, though not as much here. Second, even a pandemic flu situation would have a huge psychological impact. Only a percentage of the population would contact pandemic flu, but 100 percent of the population will worry about getting it and their loved ones getting it. There are a lot of similarities between all public events when it comes to psychological impact. It may even be more so with the pandemic flu."

Fraser’s recommendation is to "take a leaf out of what Israel has done and keep it well integrated."

"We’re not prepared right now to handle the psychological impact from an event," Gross said, referring to the Dayton region.

"This is something we all need to become familiar with," Gross said. "I’m going to gear up to organize a system of psychological trauma and how we respond. We can now begin to prepare for that. It will pay dividends to our entire community."

Gross headed the Wright State team that studied community preparedness, mainly in the city of Haifa, with a population similar to Dayton’s. During the Second Lebanon War, Haifa received approximately 800 missile hits.

The team visited Haifa’s emergency command center, located two levels underground, which is fitted with air filtration, water and electric systems.

"The emergency command center in Montgomery County," Schuster said, "is on the seventh floor of the county government building. It’s great unless something happens. It’s a different planning mentality. Obviously, I don’t think we need air filters like the Israelis do, in the sense that our risk of having some sort of chemical attack is not what theirs is. But still, in all, if we had a tornado blowing through town, you don’t want to be on the seventh floor of a building."

Communication with public

Gross said that in Haifa, he learned of the importance of leadership taking charge to communicate with the entire community about the status of a crisis situation and what leadership is doing to protect the people.

"Communication must be meaningful and frequent and several times a day," he said. "You must tell what you know and what you don’t know. Instead of holding a press conference once a day, provide updates throughout the day using several tools."

Haifa's Mobile Command Center
In addition to print and electronic media, radio and television, Gross said Haifa has a mobile command center that travels out to the community.

"On the mobile command center is a loudspeaker connected to city hall," he said. "They mayor can get any message across."

According to Schuster, a third of the population of Haifa left during the summer 2006 bombings. For those who stayed, life went on. "When a rocket hit a street and produced a crater, within two hours that crater was filled," he said. "If a rocket came in and blew up a palm tree, they had a new palm tree there in the same afternoon, because they were going to show everybody. A fear you have of a big city is panic. There was no panic."

Wright State established the medical school’s Center for Global Health Systems, Management and Policy to improve the quality, efficiency and access to health care in the local community as well as to help develop national models.

Karen Levin — executive director of the Levin Family Foundation and a student in the center’s master of public health program — introduced Schuster and center staff to Ruvie Rogel, co-CEO of the Kiryat Shmona Community Stress Prevention Center, when Rogel visited Dayton in 2006 during a Partnership With Israel visit.

Montgomery County Ohio Health Commissioner Jim Gross (L) with Haifa City Council Member Shlomo Gilboa
Since the inception of Partnership With Israel in 1996, Dayton’s Jewish Federation and local physicians have been involved in medical exchanges with Western Galilee Hospital and helped establish its international Emergency Response Group.

Last year, Rogel returned to Ohio and conducted several workshops on emergency communication, including one at Wright State.

"Wright State University is actively moving toward more elaborate disaster and trauma-oriented facilities and training on a large scale," said Fraser. "We can clearly benefit by things hard-learned in Israel."

 

Continuing the work

"We need to prepare, prepare, prepare for a catastrophic event," Gross said. "Not that I didn’t know that, but it reinforces it seeing the Israeli exercises, education and drills. We do some, but if anything, we probably need to do more. You can’t do enough preparation. For example, Western Galilee Hospital had a drill a day or two before the bombings in 2006. It helped them respond."

"Our work is not done," Schuster said. "We hope to continue this work and expand it."

The global health center and Levin Family Foundation will bring Rogel to Dayton in April to conduct a workshop for public health and first responders in dealing with psychological stress of public health emergencies. Rogel now has a faculty appointment at Wright State and will continue to work in Israel and with the university.

Eyck is studying the detailed impact of the war on the emergency department at Western Galilee Hospital.

Fraser and his students will evaluate Israeli teams that provide psychological triage training to first responders.

The two psychology graduate students who went on the trip are planning to undertake their doctoral theses in Israel.

Second-year medical student Katie Imhoff is also planning to work on an emergency preparedness research project in Israel next year.

"I found the biggest reason they’re prepared is because they have to be," Imhoff said. "They face it on a daily basis."

Schuster believes the United States has much to learn from the Israeli medical system. He is currently working on 12 research projects in Israel including why heart attack rates there are lower than in the United States and "what it is about the medical-care system that is better in Israel than in the United States."

"One critical measure of the health of a society," he said, "is the infant mortality rate, the number of infants that die at or shortly after birth. Infant mortality rates are substantially lower for Israeli Arabs (8.6 per 1,000 births) than they are for African-Americans in the U.S. (13.9 per 1,000 births). For that matter, Israeli Jews have safer births (4 deaths per 1,000 births) than Caucasians in the U.S. (5.8 deaths per 1,000 births). Finally, being born in Israel (with a rate of 5.4 infant deaths per 1,000 births) is safer than being born in the U.S. (with a rate of 7 infant deaths per 1,000 births)."

His wife, Dr. Barbara Schuster, a professor in the department of internal medicine of Wright State’s medical school, is studying medical education and training of physicians in Israel versus the U.S.

"We are pleased so much more is coming out of it," Levin said. "That’s exactly what we were looking for."

 

Members of the Wright State group meet with staff at Western Galilee Hospital