Thousands of Hamas rockets have terrorized Israeli society in the last week. Some two-thirds of Israelis are under attack and hundreds have been injured as a result of the rockets.
When hospitals report that people were treated for shock or are in moderate condition, what does it really mean?
Dr. Debra Gershov West, director of the Samson Assuta Ashdod University Hospital’s Emergency Department, helped explain:
MATZAV ANUSH – – MORTALLY WOUNDED
As the name implies, someone who is mortally wounded is in immediate, life-threatening danger requiring emergent resuscitative efforts in order to survive either in the trauma bay in the emergency department, the operating theater or in the intensive-care unit.
West said an example is someone who has multiple injuries, including a severe penetrating head trauma, who arrives at the emergency department unresponsive, without a blood pressure and unable to breathe on his own accord. In such a situation, the patient must be immediately intubated and his blood pressure and intracranial pressure (pressure inside the skull) urgently controlled just to enable him to make it to surgery in order to have any chance of surviving.
He may require the removal of shrapnel or drainage of bleeding from the brain.
These patients often do not survive to surgery let alone survive the surgery itself.
MATZAV KASHEH – SERIOUS CONDITION
A person who is seriously wounded is someone whose life is in immediate danger requiring emergency intervention but who is not undergoing resuscitation at that particular time.
West explained that serious patients, categorized as “seriously wounded,” are compromised in at least one of the three systems critical to survival: A, B or C - airway, breathing or circulation.
For example, a patient could have a traumatic injury to his neck that is obstructing his airway (A), a hole in his lungs with air leaking out or a tear in the lungs bleeding out (B), or extensive bleeding into the abdomen, such as if the spleen or liver is punctured (C).
“They are people whose life is in immediate danger if we don’t control the problem,” West said.
MATZAV BEINONI – MODERATE CONDITION
These patients’ lives are not in immediate danger, however they may have a significant injury to a limb, even an amputation, or a significant injury to the lower spinal cord that could result in paralysis.
“Their blood pressure and heart rate are stable,” West said. “Their life is overturned, but they are in no immediate danger, so we describe them as moderate.”
MATZAV KAL – MILD CONDITION
A person in mild condition – “lightly injured” – is neither in immediate, life-threatening danger, nor is his or her limb in immediate danger. Examples could be people with broken limbs, dislocation of limbs or major lacerations.
“These injuries are primarily often musculoskeletal,” West said, noting that some of these people require orthopedic or plastic surgery.
When patients enter the emergency department, they are divided between critical, serious, moderate and mild and are treated accordingly, she said, adding: “We have to prioritize because we have more injured people than resources.”
WHAT ABOUT “SHOCK”?”
Many patients arrive at the emergency room with the first signs of post-trauma. They are confused, bewildered and anxious and usually do not understand what is happening, West said.
The first thing the hospital does when someone comes in after a trauma is to make sure there is not a bodily injury they are unaware of because sometimes shock can result from a physical wound.
“If someone is losing a lot of blood, they can look anxious, be sweating and confused,” West said. “When people are in shock, they don’t pay attention to pain and could have a shrapnel wound and not feel it because they are running on adrenaline.”
The doctor asks how close the person was to a missile or shrapnel and fully undresses the individual to look for injuries. Only then will the doctor diagnose a person with shock.
People who are diagnosed with shock undergo a psychological assessment with the aim of preventing post-traumatic stress disorder as much as possible. The hospital will also assess the social situation and sometimes bring in a social worker to assist the person or family.
“One family last week came in together, and they had a dog on their lap,” West said. “Who brings a dog to the emergency room? It turned out that their home had been destroyed, and so we had a social worker help find a solution.”
Post-trauma can be “more debilitating than physical injury” and can “have an even longer-lasting effect,” she said.
Finally, how do people die on the way to the bomb shelter even when they are not hit by shrapnel?
“Elderly people fall and hit their heads, they are on blood thinners, and they bleed into their brains and die,” West said as an example.“People die of heart attacks from psychological trauma, too... These people are direct casualties of war.”