The volume of general surgery emergency cases in a government hospital during the COVID-19 pandemic and two other periods: a comparative, retrospective study

Background During March and April 2020, reductions in non-COVID-19 hospital admissions were observed around the world. Elective surgeries, visits with general practitioners, and diagnoses of medical emergencies were consequently delayed. Objective To compare the characteristics of patients admitted to a northern Israeli hospital with common surgical complaints during three periods: the lockdown due to the COVID-19 outbreak, the Second Lebanon War in 2006, and a regular period. Methods Demographic, medical, laboratory, imaging, intraoperative, and pathological data were collected from electronic medical files of patients who received emergency treatment at the surgery department of a single hospital in northern Israel. We retrospectively compared the characteristics of patients who were admitted with various conditions during three periods. Results Patients’ mean age and most of the clinical parameters assessed were similar between the periods. However, pain was reportedly higher during the COVID-19 than the control period (8.7 vs. 6.4 on a 10-point visual analog scale, P < 0.0001). During the COVID-19 outbreak, the Second Lebanon War, and the regular period, the mean numbers of patients admitted daily were 1.4, 4.4, and 3.0, respectively. The respective mean times from the onset of symptoms until admission were 3, 1, and 1.5 days, P < 0.001. The respective proportions of surgical interventions for appendiceal disease were 95%, 96%, and 69%; P = 0.03. Conclusions Compared to a routine period, patients during the COVID-19 outbreak waited longer before turning to hospitalization, and reported more pain at arrival. Patients during both emergency periods were more often treated surgically than non-operatively.

Israeli underground hospital conversion for treating COVID-19 patients

Objective: This paper describes how a large academic medical center solved the challenges of war preparedness and subsequently adapted them for the COVID-19 pandemic.Setting: A 1,000-bed academic medical center in Northern Israel has faced two extreme challenges since 2006: operating under missile attack during the 2006 Second Lebanon War, and rapid establishment of a scalable infrastructure for COVID-19 patients. The first challenge led to construction of a dual-use facility: a parking lot during peacetime, and a fully functioning fortified underground emergency hospital (FUEH) in times of emergency. Several drills have confirmed readiness for various scenarios including conventional and unconventional warfare, and treating isolated patients during the Ebola and SARS threats.Results: The hospital achieved preparedness for patient care during the COVID-19 pandemic, including all facilities and personnel, including infrastructure, laboratories, and innovations, to maintain standard patient care and separate COVID-19 treatment facilities. The hospital’s second challenge represented by the COVID-19 pandemic led to adaptation of the FUEH as a key strategic facility in Northern Israel for treating hundreds of COVID-19 patients. Each solution was supported by innovations targeted for specific purposes and needs.Conclusions: The function and unique mechanisms used to leverage use of a dual facility was proven viable for several emergency conditions, including the COVID-19 pandemic. Infrastructure and technological flexibility is essential when planning for handling different emergencies situations.

The Volume of General Surgery Emergency Cases in a Government Hospital During the COVID -19 Pandemic and Two Other Periods: A Comparative Study

Objective: We compared characteristics of patients admitted to a northern Israeli hospital with common surgical complaints during three periods: the lockdown due to the COVID-19 outbreak, the Second Lebanon War in 2006, and a regular period. Background: During March and April 2020, reductions in non-COVID-19 hospital admissions were observed around the world. Elective surgeries, visits with general practitioners, and diagnoses of medical emergencies were consequently delayed.Methods: Demographic, medical, laboratory, imaging, intraoperative, and pathological data were collected from electronic medical files of patients who received emergency treatment at the surgery department of a single hospital in northern Israel. We compared characteristics of patients who were admitted with various conditions during three periods. Results: Patients’ mean age and most of the clinical parameters assessed were similar between the periods. However, pain was reportedly higher during the COVID-19 than the control period (8.7 vs. 6.4 on a 10-point visual analog scale, P < 0.0001). During the COVID-19 outbreak, the Second Lebanon War, and the regular period, the mean numbers of patients admitted daily were 1.4, 4.4, and 3.0 , respectively. The respective mean times from the onset of symptoms until admission were 3, 1, and 1.5 days, P<0.001. The respective proportions of surgical interventions for appendiceal disease were 95%, 96%, and 69%; P = 0.03. Conclusion: Compared to a routine period, patients during the COVID-19 outbreak waited longer before turning to hospitalization, and reported more pain at arrival. Patients during both emergency periods were more often treated surgically than non-operatively.

From Routine Security Operations to War

The chapter explores the personal and organizational cognitive and command challenges in the rapid transition from peacetime or RSO to war. The challenge is three fold: identifying the change against the background of previous personal and organizational experience; assimilating the need for a transition in superior and subordinate echelons; implementing the change, mainly in the field of C2. Three cases are presented in the Yom Kippur War: the ground forces on the southern and northern fronts and the IAF. The Second Lebanon War case is discussed first from the GHQ perspective and then from the 91st Galilee Division's perspective. Lessons for the future are drawn.

The Outbreak of War during Conceptual or Doctrinal Change

While conceptual and doctrinal debates are the "bread and butter" of military organizations in peacetime, what happens when war begins before the debate is settled? The chapter explores two cases – the debate over the defensive concept on the Suez Canal line prior to the Yom Kippur War and the IDF's 2006 concept of operations and operational concept for fighting Hezbollah in Lebanon prior to the Second Lebanon War. The aim of the chapter is to illuminate the fact that conceptual debates should be monitored and managed in a way that minimizes the likelihood of conceptual incoherency when war suddenly breaks out.

The Effect of Prolonged Routine Security Operations on Wartime Capabilities

The chapter presents the consequences of long periods of low intensity engagements on the ability of military organizations to shift successfully from a routine security operations (RSO) mindset (fighting norms, C2 procedures) to war, and the potential loss of doctrinal knowledge and organizational competency needed for fighting a full-scale war. The historical cases include the impact of 1967-1973 RSO on the IDF's performance in the Yom Kippur War (mainly the IAF) and the effect of RSO between 1995 and 2006 on the IDF's performance in the Second Lebanon War (mainly the ground forces). Lessons are brought forth for the necessary balance between winning the current low intensity conflict and preparing for the initial battles in a suddenly erupting war.

The volume of general surgery emergency cases in a government hospital during the COVID -19 pandemic and two other periods: A comparative study

Objective We compared characteristics of patients admitted to a northern Israeli hospital with common surgical complaints during three periods: the lockdown due to the COVID-19 outbreak, the Second Lebanon War in 2006, and a regular period. Background During March and April 2020, reductions in non-COVID-19 hospital admissions were observed around the world. Elective surgeries, visits with general practitioners, and diagnoses of medical emergencies were consequently delayed. Methods Demographic, medical, laboratory, imaging, intraoperative, and pathological data were collected from electronic medical files of patients who received emergency treatment at the surgery department of a single hospital in northern Israel. We compared characteristics of patients who were admitted with various conditions during three periods. Results Patients’ mean age and most of the clinical parameters assessed were similar between the periods. However, pain was reportedly higher during the COVID-19 than the control period (8.7 vs. 6.4 on a 10-point visual analog scale, P < 0.0001). During the COVID-19 outbreak, the Second Lebanon War, and the regular period, the mean numbers of patients admitted daily were 1.4, 4.4, and 3.0, respectively. The respective mean times from the onset of symptoms until admission were 3, 1, and 1.5 days, P < 0.001. The respective proportions of surgical interventions for appendiceal disease were 95%, 96%, and 69%; P = 0.03. Conclusion Compared to a routine period, patients during the COVID-19 outbreak waited longer before turning to hospitalization, and reported more pain at arrival. Patients during both emergency periods were more often treated surgically than non-operatively.