A new world of emergency medicine

At Western Galilee Hospital, six miles from the Lebanese border, emergency drills are commonly conducted to ensure that physicians, nurses, and emergency service personnel are ready to respond when disaster strikes. “On 16 July, 2006, it was no longer an exercise,” recalled Dr. Arie Eisenman, head of the Medical Emergency Room at that hospital, located in Nahariya, Israel. “Hostilities broke out with Hezbollah, due to the abduction of two Israeli soldiers.”

Last Monday, at Holy Name Hospital in Teaneck, Eisenman recreated the scene. During the Lebanon war in 2006, cities in the north of Israel were subjected to frequent rocket attacks. There were hundreds of soldier and civilian victims who needed medical attention. “All the patients were evacuated to the underground facility in less than an hour,” said Eisenman. “We stayed there for six weeks. The whole facility above ground was totally empty.” The hospital continued to provide its regular services, such as dialysis, to critically ill patients, except that all the beds and treatment facilities were underground. New casualties arrived by ambulance as well as helicopter, and were transferred to the subterranean facility.

Eisenman’s U.S. visit was funded by UJA Federation of Northern New Jersey and sponsored by Partnership 2000, a program of the Jewish Agency, UJA-NNJ, and Keren Hayesod/United Israel Appeal. According to Miriam Allenson, director of marketing services for UJA-NNJ, northern New Jersey’s involvement with the Western Galilee Hospital includes both a training component – once a year, the federation’s Emergency Response Group brings local doctors to Nahariya to learn about mass trauma medicine – and financial support.

“During the Israel Emergency Campaign two years ago, we gave $140,000 to WGH, $100,000 of which was for its protected emergency room,” said Allenson. “Money from the Partnership 2000 budget also went directly to the training of WGH hospital personnel at Englewood Hospital to establish a bloodless medicine program at the hospital, the first of its kind not just in Israel but in the entire Middle East.” The Holy Name Hospital event provided an opportunity for physicians, ER personnel, and emergency responders to learn how an Israeli hospital on the front lines handles crises in its unique underground facility, and also gave the Israeli doctor a chance to see the new Holy Name emergency room facilities and equipment in action.

“During the war it was extremely dangerous to ride on the roads,” Eisenman reported. Since staff members were discouraged from going home, it was necessary to provide a way to care for their families in a safe environment. More than 50 children of hospital personnel moved into the underground facility and were provided with kindergartens, classes, and other organized activities. Once the children were nearby and safe, staff members were able to perform much better and focus on the job at hand, said Eisenman.

Rabbi Lawrence Zierler of the Jewish Center of Teaneck attended Eisenman’s talks. Zierler had visited Western Galilee Hospital back in 1998 as a presenter at a bioethics conference held there. The underground hospital had not yet been built, but, he recalled, “there was a huge wall [protecting the hospital] because they had already extensive experience of being hit by enemy fire. When staying there in 1998 you could hear the gunfire from Lebanon. I am impressed with the manner in which they were able to create a field hospital with superior facilities underground.”

Zeirler pointed out that other major hospitals in Israel, particularly in Jerusalem, tend to get more attention. “Everybody knows about Shaare Zedek and Hadassah hospitals. The ones that get celebrity status are Jerusalem-based. But very few have heard of Western Galilee Hospital,” which, he said, has a unique story to convey as it serves a diverse community of Jews, Muslims, and Druze. “When they were bombing the hospital they weren’t just bombing its Jewish components,” said Zierler. At the hospital “they treat people irrespective of their peoplehood, religion, nationality.”

In fact, Eisenman reported that the director general of the hospital, Dr. Masad Barhoum, is a Christian Arab. He grew up in Shraram and Haifa and received his medical training at the Technion”“Israel Institute of Technology and Rambam Medical Center, both in Haifa. He served as medical director of the Italian Sisters of the Holy Family Hospital in Nazareth for almost a decade before being tapped for the leadership position at Western Galilee.

In its mission statement, Western Galilee Hospital declares that it “will extend all its service to all sectors of the populations – Jews, Arabs, Druze, civilians, and soldiers – and will integrate them in our activities … will welcome immigrant physicians and other healthcare [professionals], training them to continue their careers in their new country and contributing to their social assimilation into Israeli society.” To further illustrate the diversity of the hospital community, Eisenman showed a photo of an Arab woman doctor treating an Orthodox Jewish man.

Dr. Arie Eisenman of Western Galilee Hospital speaking in Teaneck to emergency responders. John Hirsch/Holy Name Hospital

“My visit has several purposes,” said Eisenman. “We are about to build a new emergency room and invest a lot of money – about $60 million. It is useful to collect ideas from others’ experiences to apply in our ER, to avoid mistakes in building it. The other reason is to talk to medical professionals in emergency medicine and share experiences, in the methods of emergency department organization, the way of treating patients, reducing the length of waits. Also to share our unique experiences we went through [during] the last war with Lebanon, in which we had to remove about 400 patients to underground level in order to protect them.”

Western Galilee Hospital established ties with Holy Name when Holy Name’s president and CEO, Michael Maron, visited the hospital in August. He went to Israel on a mission led by Englewood businesswoman and philanthropist Angelica Berrie. Former Teaneck Mayor Jacqueline Kates, now Community Relations Coordinator for Holy Name, reported that during the dedication ceremony for the new Holy Name Emergency facility, “Mike spoke of his trip to Israel. It was life-altering to him.”

“I was so struck as a relatively new employee, standing in Marion Hall named for the Virgin Mary, with the bishop sprinkling holy water, that Mike Maron was talking about Israel ’embracing plurality to advance humankind,'” said Kates.

“The mission of the Sisters of St. Joseph of Peace is social justice and peace,” Kates continued. “Israel’s aspirations for peace and embracing plurality coincide with the mission of Holy Name Hospital.”

Eisenman was impressed with his tour of the Holy Name ER. He noted that it is “medically the same,” but organizationally different from his own facility. “We have different sections – medical, surgical, orthopedic. They have the tendency to mix them all. It will be much easier to decide which way we will choose [to organize], because of what I have seen.” He noted that Western Galilee is much busier than Holy Name, with about the same size staff. For instance, Western Galilee has about 120,000 ER visits per year compared with 44,000 at Holy Name (see sidebar).

From left are Dr. Paul Mendelowitz, chief medical officer at Holy Name Hospital; Michael Maron, CEO of Holy Name; and Eisenman. John Hirsch/Holy Name Hospital

One unique feature of the Holy Name facility is that the ER was built just above the new conference facility, which includes Marion Hall, a large underground conference room. Paul Ostrow, community outreach coordinator (and former Teaneck mayor), explained that in the event of a large-scale emergency, Marion Hall could be converted into a treatment area. “We could triage 400 here, if necessary,” he said.

Paul Mendelowitz, chief medical officer at Holy Name, reflected on Eisenman’s presentation. “The lessons they’ve learned in emergency preparedness are lessons all hospitals are trying to put into effect since [the World Trade Center and Pentagon attacks]. When we began preparations for construction of the emergency room we had a lot of emergency preparedness in mind.”

“The conference center [Marion Hall] is underneath the emergency room,” said Mendelowitz. “There’s a lot built in there that would help us to use it as a patient care area if, God forbid, the need arose. We have access to storage areas where we have stretchers and oxygen tanks if need be.” He explained that the hosptial also has the capacity to set up outdoor tents to perform decontamination, if necessary.

On July 28, 2006, less than two weeks into the Lebanon War, Western Galilee Hospital suffered a direct missile hit, destroying much of the fourth floor. “Fortunately there was nobody there,” said Eisenman.

“The thing that impressed me about Dr. Eisenman is that he’s such a humble, down-to-earth and pragmatic guy, but he’s right in the thick of it.” said Mendelowitz. “He’s at the front line, only six miles from the Lebanese border. I can imagine him keeping his cool in the most dire of circumstances.”

Maron said that Eisenman had “demonstrated the passion and purpose that has become the hallmark of all the professionals I’ve been introduced to through the efforts of the UJA and the Russ Berrie Foundation.”

He called Eisenman “a soft-spoken, humble yet inspiring and enlightening physician. All of us at Holy Name who met him, ” Maron added, “look forward to the establishment of a long and mutually beneficial relationship.”

For information on Partnership 2000, go to www.jewishagency.org/JewishAgency/English/Israel/Partnerships.

For more information on Western Galilee Hospital, go to www.wgh.org.il.