Preparing a Small Rural Hospital for Mass Casualty Incidents: Lessons from Yoseftal Medical Center in Eilat, Israel

Introduction: Mass Casualty Incidents (MCIs) overwhelm health care systems, necessitating effective preparedness. Yoseftal Medical Center is a small community hospital in Eilat, on the southern tip of Israel. The massacre on October 7, 2023, unmasked significant gaps in emergency preparedness protocols, prompting a comprehensive rehaul. Since the beginning of the Iron Swords War, Yoseftal has faced unprecedented challenges in providing medical care to its local population and the waves of evacuees from across Israel. In parallel, it must reckon with new threats of missile attacks and the risk of large-scale MCIs, particularly challenging due to its remote and isolated location. In a matter of weeks, Yoseftal successfully transformed its capabilities to manage a large-scale MCI, thanks to assistance from institutions within the broader healthcare system. This study explores how Yoseftal enhanced its MCI readiness using available resources and innovative approaches. Methods: The methodology included a literature review, a review of procedural data from the Israeli Ministry of Health, an on-site survey, participation in a simulation exercise, and interviews. Results: Three preparedness stages were observed: 1) Pre-October 7, 2023: The hospital complied with routine emergency drills and inspections suitable for small-scale casualty incidents. 2) October 7, 2023, to February 2024: This capacity-building phase included consultations, coordination with local and national institutions, equipment and personnel reinforcement, infrastructure upgrade, protocol updates, and drills, including guided isolated exercises and full-scale institutional exercises. 3) February 2024-present: This phase is characterized by the ongoing maintenance of standby teams and managers, equipment reinforcement, and drills. Each phase was driven and maintained by solidarity within the local community and the broader health system. Conclusion: Collaboration, intensive training, and community solidarity are critical for effective MCI preparedness in small community hospitals.