Improving emergency care in Gaza’s busiest hospital

Al Shifa Hospital, in Gaza City, is Gaza’s main trauma hospital. During Israel’s 2014 military offensive on Gaza, the Emergency Department received high numbers of casualties and became a hub for international journalists covering the conflict.

With such high demand for emergency medical care, the Department struggled to cope. There were not enough beds for patients, the hospital had no specialist emergency doctors, and essential drugs and medical disposables were severely depleted.

Even during more peaceful times it is a busy department and often struggles to cope with the needs of a growing population in Gaza. Roughly 35-50% of emergency admissions to the hospital are trauma injuries, sustained from incidents such as vehicle collisions, falls and industrial accidents.

Currently the Emergency Department has only one Emergency Consultant, the department has no pager system to alert medical teams when a trauma patient comes in, and there is no system for ambulances to pre-alert the Department to incoming cases.

With a clear need for better trauma care in Gaza, Medical Aid for Palestinians (MAP) and IDEALS have been working with Shifa Hospital to develop the Emergency Department since 2016. This work has included providing essential drugs, disposables and equipment, implementing new systems for dealing with trauma cases, and developing a specialised 24-hour trauma team. MAP and IDEALS have provided practical training on resuscitation and the management of traumatic injuries such as burns, shock, and head, chest and spinal injuries.

Last month, this programme took its latest step forward with a visit from Darren Darby (St Bartholomew’s Hospital, London) and Grant O’Keefe (University of Washington Medical Centre). Through a series of seminars and site visits, they worked with senior clinicians and a selected group of medical residents from previous trainings to develop new protocols for dealing with trauma patients: essential guidelines which will enable staff at the Department to know how patients should be treated, and the responsibilities of different members of the team.

Such protocols are vital to ensuring consistent and quality care for injured people entering the hospital. These protocols specifically focused on the triage of mass casualties, airway management, and cases of chest and abdominal trauma.

Grant, Darren and the local teams walked through these new protocols at the busy Emergency Department to ensure they make sense in context. They discussed issues such as communications between different hospital departments, bed management, and team-members’ responsibilities in different scenarios.

Dr Andy Ferguson, MAP’s Director of Programmes, said: “With trauma accounting for 30-50% of all emergency admissions to hospitals in Gaza, and escalations in the conflict placing massive strain on systems of trauma care, this is a hugely important project. We are extremely fortunate to have, in Darren and Grant, two experienced specialists in trauma care who have earned the respect and trust of their colleagues in Gaza.”

Soon, as part of this project, the hospital will receive a new, modern calling system so that members of the trauma team can be notified of when they are needed at the Emergency Department. This vital piece of infrastructure can cut vital minutes from the response time to serious cases, potentially saving lives.

This project is helping Al Shifa Hospital to deal with the day-to-day needs of any busy general hospital, as well as helping Gaza prepare for the worst-case-scenario of a repeat of 2014’s mass casualties.

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