Impact of repeated military conflicts on civilian patterns of emergency medical services utilization: A retrospective cohort study
DOI:
https://doi.org/10.5055/ajdm.2022.0428Keywords:
war, military conflict, emergency medical services, Magen David Adom, IsraelAbstract
Objective: To assess the impact of repeated rocket attacks on a civilian population during successive military conflicts on the patterns of emergency medical services (EMS) utilization.
Design: This retrospective cohort study (2008-2021) analyzed EMS data from one region of Israel characterized by intensive rocket attacks on a civilian population during four successive military conflicts. EMS activity for the periods prior to, during, and after the conflicts was compared. Data included call volume, type of calls (“medical illness,” “motor vehicle collision (MVC),” and “other-injuries”), and level of response (advanced life support (ALS) or basic life support (BLS)).
Results: Compared to the Pre-Conflict period, there were statistically significant decreased volumes of calls during the 2008 (−20 percent), 2012 (−13 percent), and 2021 (−11 percent) military conflicts for “medical illness” and during the 2008 (−23 percent), 2012 (−30 percent), and 2021 (−31 percent) for “MVC.” Decreases in calls for “medical illness” were accompanied by decreased ALS dispatches (−28, −33, and −18 percent for 2008, 2012, and 2021, respectively). The number of calls returned to preconflict values during the Post-Conflict periods. No change was evidenced in numbers of calls during the 2014 military conflict.
Conclusion: Military conflicts involving a civilian population were usually found to be associated with lower numbers of calls for the categories of “medical illness” and “MVC.” Less calls for “medical illness” were associated with fewer ALS dispatches. There was a rapid return of call volumes to preconflict levels shortly after a ceasefire was reached. The absence of change in calls during the 2014 conflict suggests involvement of habituation processes.
References
Smith CM, Graffeo CS: Regional impact of hurricane Isabel on emergency departments in coastal southeastern Virginia. Acad Emerg Med. 2005; 12(12): 1201-1205.
Mortensen K, Dreyfuss Z: How many walked through the door? The effect of hurricane Katrina evacuees on Houston emergency departments. Med Care. 2008; 46(9): 998-1001.
Frykberg ER: Medical management of disasters and mass casualties from terrorist bombings: How can we cope? J Trauma. 2002; 53(2): 201-212.
Catlett C, Jenkins J, Millin M: Role of emergency medical services in disaster response: Resource document for the national association of EMS physicians position statement. Prehosp Emerg Care. 2011; 15: 420-425.
Maguire BJ, Dean S, Bissell RA, et al.: Epidemic and bioterrorism preparation among emergency medical services systems. Prehosp Disaster Med. 2007; 22(3): 237-242.
Hart J, Weingarten MA, Druckman A, et al.: Acute cardiac effects of ‘SCUD’ missile attacks on a civilian population. Med War. 1993; 9(1): 40-44.
Nakar S, Kahan E, Nir T, et al.: The influence of SCUD missile attacks on the utilization of ambulatory services in a family practice. Med Confl Surviv. 1996; 12: 149-153.
Bar-El Y, Michaelson M, Hyames G, et al.: An academic medical center under prolonged rocket attack—organizational, medical, and financial considerations. Acad Med. 2009; 84(9): 1203-1210.
Jaffe E, Sonkin R, Alpert EA, et al.: Responses of a pre-hospital emergency medical service during military conflict versus COVID-19: A retrospective comparative cohort study. Mil Med. DOI:10.1093/milmed/usab437.
Jewish Virtual Library: Rockets and mortars attacks against Israel by date. Available at https://www.jewishvirtuallibrary.org/palestinian-rocket-and-mortar-attacks-against-israel. Accessed January 12, 2022.
Bodas M, Ben-Gershon B, Rubinstein Z, et al.: The evolution of the emergency mental health system in Israel—From the 1980’s until today. Isr J Health Policy Res. 2015; 4(1): 25.
Jaffe E, Strugo R, Wacht O: Operation protective edge—A unique challenge for a civilian EMS agency. Prehosp Disaster Med. 2015; 30(5): 539-542.
Bard M: Operation Guardian of the Walls. The Jewish Virtual Library. Available at https://www.jewishvirtuallibrary.org/operationguardian-of-the-wall. Accessed June 8, 2022.
Jaffe E, Bin E: Israeli national prehospital emergency medical services annual report. Magen David Adom. 2018.
Lahad M, Leykin D: Ongoing exposure versus intense periodic exposure to military conflict and terror attacks in Israel. J Traum Stress. 2010; 23(6): 691-698.
Ciottone GR: Introduction to disaster medicine. In Ciottone GR, Anderson PD, Der Heide EA (eds.): Disaster Medicine. Philadelphia: Mosby, 2006: 3-6 (Chapter 1). DOI: 10.1016/B978-0-323-03253-7.50008-X.
Koçak H: The role of disaster medicine in disaster management and preparedness. Integr Disaster Sci Manag. 2018; 423-432. DOI: 10.1016/B978-0-12-812056-9.00025-7.
Stein J, Levin Y, Gelkopf M, et al.: Traumatization or habituation? A four-wave investigation of exposure to continuous traumatic stress in Israel. Int J Stress Manag. 2017; 25. DOI: 10.1037/str0000084.
Weinberg M, Besser A, Campeas M, et al.: Reactions of civilians exposed to terrorism and war trauma in Israel: The role of intra- and interpersonal factors. In Columbus AM (ed.): Advances in Psychology Research, vol. 94. Hauppauge, New York: Nova Science Publishers, 2014: 1-53.
Waxman D: Living with terror, not living in terror: The impact of chronic terrorism on Israeli society. Perspect Terror. 2011; 5(5/6): 4-26.
Besser A, Neria Y, Haynes M: Adult attachment, perceived stress, and PTSD among civilians exposed to ongoing terrorist attacks in Southern Israel. Personal Individ Differ. 2009; 47: 851-857.
Neria Y, Besser A, Kipper D, et al.: A longitudinal study of posttraumatic stress disorder, depression and generalized anxiety disorder in civilians exposed to war trauma. J Traum Stress. 2010; 23: 322-333. DOI: 10.1002/jts.20522.JTrauma Stress.
Ayer L, Venkatesh B, Stewart R, et al.: Psychological aspects of the Israeli-Palestinian conflict: A systematic review. Trauma Violence Abuse. 2015; 18: 322-338.
Gelkopf M, Solomon Z, Bleich A: A longitudinal study of changes in psychological responses to continuous terrorism. Isr J Psychiatry Relat Sci. 2013; 50(2): 100-109.
Plakht Y, Shiyovich A, Francine L, et al.: The emergency department in a region under missile attack: Utilization patterns during Operation Cast Lead. Isr Med Assoc J IMAJ. 2011; 13: 69-75.
Braun-Lewensohn O, Musseri-Rubin M: Personal and communal resilience in community exposed to missile attacks: Does intensity of exposure matter? J Posit Psychol. 2014; 9: 175-182.
Bodas M, Siman-Tov M, Kreitler S, et al.: Perception of the threat of war in Israel-implications for future preparedness planning. Isr J Health Policy Res. 2015; 4(1): 35.
Richter ED: Fewer injuries but more deaths from road accidents during the Persian Gulf war. Isr J Med Sci. 1991; 27(11–12): 631-635.
Retallack AE, Ostendorf B: Current understanding of the effects of congestion on traffic accidents. Int J Environ Res Public Health. 2019; 16(18): 3400.
Cook CH, Muscarella P, Praba AC, et al.: Reducing over-triage without compromising outcomes in trauma patients. Arch Surg. 2001; 136(7): 752-756.
Armstrong MJ: The effectiveness of rocket attacks and defenses in Israel. J Glob Secur Stud. 2018; 3(2): 113-132.
Published
How to Cite
Issue
Section
License
Copyright 2007-2023, Weston Medical Publishing, LLC
All Rights Reserved
