Under fire and without a situational picture: The study that reveals how the Ashdod hospital functioned on October 7

A new study recently examined the functioning of the Assuta Public Hospital in Ashdod during the first hours of October 7. The study found that years of drills and the fortified emergency department allowed the teams to continue treating the wounded at a high medical standard, even during rocket fire.

Following the findings, the researchers called for changing the preparedness of hospitals worldwide for emergency events and adapting it to a reality of prolonged combat in which the hospital itself operates under threat. Alongside this, challenges were revealed that could not be simulated in drills: staff members called up for IDF reserve duty, employees who had difficulty arriving when their families were under threat, a lack of reliable information, and difficulty transferring patients to non-fortified areas.

The events of that day revealed a series of challenges that are not characteristic of a standard mass-casualty incident, to which hospitals in Israel have become accustomed. According to the researchers, these findings may provide lessons for hospitals in Israel and around the world in preparation for future wars and emergency events.

The study was published in the scientific journal "Disaster Medicine and Public Health Preparedness" and was based on in-depth interviews with 19 staff members from the emergency department at Assuta Ashdod: doctors, nurses, and administrative staff who worked on the day of the attack, as well as with the person in charge of trauma and disaster preparedness at the hospital.

Drills paid off: "Knew almost instinctively what to do"

Ambulances had difficulty reaching some of the casualties, communication systems were damaged, and hospitals had limited information about what was happening on the ground. Despite the difficult conditions, Assuta Ashdod continued to treat patients even during rocket fire in the vicinity of the hospital.

The researchers found that one of the hospital's significant advantages was early preparation. Drills for mass-casualty incidents that were conducted routinely even before the war meant that doctors, nurses, and staff knew their roles well. Thus, instead of dealing with the question of who is supposed to perform each task, they could focus on the unexpected problems that arose in real time.

Another significant advantage was the hospital's fortified emergency department. The fact that the emergency room was designed to protect patients and staff from rocket fire allowed treatment to continue without stopping activity at every siren to seek shelter.

Despite the readiness - the difficulties could not be foreseen

However, as the event continued, problems began to emerge that even emergency drills could not fully predict. One of them was manpower. Some of the hospital employees received calls at that time to report both to the IDF reserve system and to the hospital. Other employees hesitated to arrive for their shift while their own family members were under threat.

The difficulty, according to the study, did not end with doctors and nurses. Administrative staff responsible for registering and admitting patients could not reach the hospital, a situation that created unexpected bottlenecks. The finding led the researchers to recommend training additional employees to perform essential administrative roles, so that the system would not be dependent on a limited group of employees in an emergency.

Another problem was discovered in the attempt to clear space in the emergency room. Emergency plans included the possibility of transferring patients in milder condition to other parts of the hospital, but during continuous fire, it turned out that the move was not simple: other areas of the hospital were not fortified to the same level, and therefore transferring patients to them was complex.

One of the main challenges pointed out by the study was the lack of a reliable situational picture. Staff members did not always receive official and up-to-date information about what was happening on the ground outside the hospital, and therefore had difficulty knowing how many casualties were on the way, what the severity of their condition was, and when the next wave of wounded was expected to arrive.

To complete the picture, staff members had to piece together information that arrived from soldiers, paramedics, patients, and even from social networks. The researchers point out that in a prolonged war, information becomes a medical resource almost as much as manpower and equipment.

The recommendation - to drill prolonged crisis situations

The study also raised a broader issue regarding the distribution of casualties between hospitals. While on October 7 there were hospitals in Israel that received numbers of casualties that strained their capacity, at Assuta Ashdod they believed they had the capacity to treat a significantly larger number of wounded than actually arrived.

Following the findings, the researchers call for changing the way hospitals prepare for disasters. Instead of scenarios that focus on a point-in-time mass-casualty incident, they suggest drilling situations where the crisis lasts for hours and even longer, when the hospital itself is operating under threat.

Among other things, the researchers recommend conducting drills that simulate recurring waves of casualties, the collapse or disruption of communication systems, and manpower shortages. The study also calls for strengthening coordination between civilian hospitals, emergency medical services, and the military, to allow for faster and more reliable information transfer.

Dr. Galit Kaufman, CEO of Assuta Public Hospital Ashdod, stated: "This study is first and foremost a tribute to the hundreds of staff members who acted with professionalism, dedication, and courage on one of the most difficult days that the State of Israel has known."

Dr. Hagit Sarbagil-Maman, Medical Director and Deputy CEO of Assuta Public Hospital Ashdod, concluded: "On the most difficult day that the State of Israel has known, when we were still in the midst of immense uncertainty, we drew strength from the work in the emergency department and from our ability to treat the wounded who continued to arrive. In those moments, years of practice and preparation became reality - the teams knew exactly what to do and worked together with exceptional professionalism."