3rd Opinion: Evacuating Israelis from Bulgaria

The need to send an Israeli medical team was evident as soon as news arrived of the bombing of a bus carrying Israelis.

By GABI BARBASH, MD MPH
Burgas MDA (R370) (photo credit: REUTERS)
Burgas MDA (R370)
(photo credit: REUTERS)
The need to send an on-site Israeli medical team was evident as soon as the news arrived about the bombing of a bus carrying Israeli tourists in Burgas, Bulgaria, last Wednesday.
The urgency stemmed from the difficulty to obtain accurate information on the number of casualties or the nature of their injuries, as well as from the considered opinion that the capabilities of available hospital services were inadequate to deal with the complicated situation of mass casualties and the severity of their injuries in that out-of-the-way resort area.
Post factum, it is important to acknowledge that the medical response of the hospital in Burgas to a complex situation it had never before encountered was outstanding.
Its conversion from a resort town’s first response medical station to a “triage” medical operation was excellent. The staff correctly evaluated the clinical situation of each casualty, and capably orchestrated the immediate evacuation of the three most severely injured among them to tertiary hospitals in the capital city of Sofia, thus almost certainly saving their lives.
The prompt organization of combined Magen David Adom and Tel Aviv Sourasky Medical Center resources that facilitated the rapid recruitment of a group of paramedics and senior trauma and intensive care physicians enabled the dispatch of a medical delegation in a record time of five hours after the bomb exploded.
Burgas Airport was closed for all flights after the event and reopened exclusively for the incoming flights of our medical delegation.
At the entrance to the terminal, we were met by a group of about 80 Israelis from the three buses that did not explode but who choose to cancel their vacation and fly back to Israel. Our deplaning was greeted by their heartwarming applause, reminiscent of other similar events from the past when a vanguard Israeli crew joined Israelis in trouble on foreign soil.
We landed in Burgas Airport around midnight. The airport was empty and it felt as if time had stopped after the explosion. There were scraps of blood-stained bandages under the seats where some of the wounded had been treated and outside, near the terminal exit, we could glimpse the sooty skeleton of the exploded bus. There was some understandable confusion among the Bulgarian officials who were responsible for admitting us into the country under such extraordinary circumstances, but a bus arrived for us around one hour later and, after another delay until the arrival of the security escort that was in place as a precaution against the possibility of more terrorists waiting outside, we were on our way to the hospital where most of the casualties had been brought and were being treated.
At the hospital entrance, we were met by the local Chabad rabbi whom I had seen explaining the situation on Israeli television before our departure. He offered his services to take us to the Israeli wounded.
Instead, I chose to first meet with the hospital management as a courtesy as well as to obtain reliable professional information about the status of the hospitalized patients. I reasoned that it was essential to create the all-important direct lines of professional communication, as well as establish a respectful and collaborative relationship, all of which are so critical in such delicate situations.

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The language barrier turned out to be more difficult than we had expected. Almost no one spoke English and the very few who did were difficult to understand. The situation was saved by a young woman who was fluent in English: She met us at the hospital entrance and offered her help.
Her name was Kalina Krumova, and she accompanied us throughout the small hours of the night and into the morning. We eventually discovered that at 27 years of age, she was the youngest a member of the Bulgarian parliament. She was a native of the city of Burgas and hurried there from Sofia to provide any assistance that she could as soon as she had heard about the terrorist attack. She became known in the Israeli media as the “Angel from Burgas” and, I hope, she will be invited to Israel as an honored guest so that the nation can thank her for extending her help to the Israeli casualties and to those of us in the medical delegation.
After we had examined all of the casualties, we discovered that most of the injuries ranged from mild to moderate in degree, and that the three severely wounded casualties had already been evacuated to tertiary hospitals in the capital city by the quick thinking local medical team.
AT FIRST, the local hospital staff and management were understandably suspicious and even a little hostile to what they may have perceived as an “Israeli takeover.”
However, our focused efforts to dissuade those suspicions started to pay off, and soon there were more and more smiles all around. We even had some discussions on the management of a moderately injured victim, a 20-year-old who was hospitalized in their ICU.
With dawn, a virtual armada of Red Cross ambulances was waiting at the entrance of the hospital, ready to move patients to the airport, where, in perfect timing, two Israel Air Force Hercules airplanes had just landed. Each of the Israeli wounded was escorted from the hospital room to the ambulance by a MDA paramedic and asked to which hospital in Israel he/she wished to be sent after landing. This information was channeled to the MDA control room in Israel so that an ambulance would be waiting to transport him/her to the designated hospital upon landing in Israel.
The convoy of ambulances from the hospital in Sofia to the airport was secured by the police, and two police motorcycles cleared the traffic en route. Large groups of Bulgarian citizens lined the roads as if they came to salute the Israelis. It was later reported that many Bulgarians came to the hospital and offered to donate blood for the Israeli casualties. We are reminded that Bulgaria was one of the very few countries that resisted the deportation of Jews during World War II.
At the airport, the experience on the tarmac was both fascinating and exciting. The sight of the two enormous airplanes surrounded by the Israel Air Force’s elite 699 Airborne Rescue And Evacuation Unit teams who were busy with the admission and boarding of the wounded resounds with a national commitment that knows no bounds. The Bulgarians who were with us in the security zone of the airport, among them the young parliament member, were surprised at the lengths to which the State of Israel will go to aid its citizens hit by terrorism.
They were clearly amazed, touched and appreciative. Three hours later, the planes were in the air with 34 wounded Israelis – less than 24 hours from the moment they were injured – and in Israeli hands on their way home.
Dr. Gabi Barbash, the CEO of the Tel Aviv Sourasky Medical Center, headed the Israeli medical delegation to Burgas.