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An Academic Medical Center Under Prolonged Rocket Attack—Organizational, Medical, and Financial Considerations

Bar-El, Yaron MD, MHA; Michaelson, Moshe MD; Hyames, Gila RN, MA; Skorecki, Karl MD; Reisner, Shimon A. MD; Beyar, Rafael MD, DSc, MPH

doi: 10.1097/ACM.0b013e3181b18bd6
Institutional Issues

The Rambam Medical Center, the major academic health center in northern Israel, serving a population of two million and providing specialized tertiary care, was exposed to an unprecedented experience during the Second Lebanon War in the summer of 2006. For more than one month, it was subjected to continuous rocket attacks, but it continued to provide emergency and routine medical services to the civilian population and also served the military personnel who were evacuated from the battlefront. To accomplish the goals of serving the population while itself being under fire, the Rambam Medical Center had to undertake major organizational decisions, which included maximizing safety within the hospital by shifting patients and departments, ensuring that the hospital was properly fortified, managing the health professional teams’ work schedules, and providing needed services for the families of employees. The Rambam Medical Center’s Level I trauma center expertise included multidisciplinary teams and extensive collaborations; modern imaging modalities usually reserved for peacetime medical practice were frequently used. The function of the hospital teams during the war was efficient and smooth, based on the long-term actions taken to prepare for disasters and wartime conditions. Routine hospital services continued, although at 60% of normal occupancy. Financial losses incurred were primarily due to the decrease in revenue-generating activity. The two most important components of managing the hospital under these conditions are (1) the ability to arrive at prompt and meaningful decisions with respect to the organizational and medical hospital operations and (2) the leadership and management of the professional staff and teams.

Dr. Bar-El is associate director, Rambam Medical Center, Rambam Health Care Campus, Haifa, Israel.

Dr. Michaelson is director, Trauma Unit, Rambam Medical Center, Rambam Health Care Campus, Haifa, Israel.

Ms. Hyames is director of nursing, Surgical Division, and trauma coordinator, Rambam Medical Center, Rambam Health Care Campus, Haifa, Israel.

Dr. Skorecki is director, Medical and Research Development, Rambam Medical Center, Rambam Health Care Campus, and director, Rappaport Institute for Medical Research, Technion–Israel Institute of Technology, Haifa, Israel.

Dr. Reisner is associate director, Rambam Medical Center, Rambam Health Care Campus, Haifa, Israel.

Dr. Beyar is director, Rambam Medical Center, Rambam Health Care Campus, Haifa, Israel.

Correspondence should be addressed to Dr. Beyar, Rambam Medical Center, Haifa, Bat Galim 31096, Israel; telephone: (9) 728-54-2903; fax: (9) 728-54-2907; e-mail: (r_beyar@rambam.health.gov.il).

© 2009 Association of American Medical Colleges