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Foreign Exchange Hospital Underground A top trauma center learns the lessons of war...and finds a novel way to protect patients Rambam Medical Center and its surrounding campus comprise one of the most important healthcare entities in Israel. It’s the nation’s biggest Level 1 trauma center, receiving most of its worst-injured patients, while serving as the major tertiary healthcare center in the country’s north. It features a medical school and research institute, as well as a trauma teaching center and other key facilities. In 2010 it recorded around 81,000 admissions and more than 118,000 ED visits. During the 2006 war between Israel and Lebanon, it was also a little too close to the action for comfort. The surrounding city of Haifa, with a metro population of more than 750,000, absorbed around 100 rockets and 12 deaths. That August 13, at least 60 rockets fell within half a mile of the Rambam campus. None scored direct hits, but a new need was apparent. Building on the successful relo- cation that month of the hospital’s oncology department into a vacant basement during the fi ghting—a move achieved in 48 hours, with full working power, water and information connec- tivity—Rambam offi cials launched construction of a new, sheltered underground parking lot that can convert in an emergency to a fully protected working hospital with 2,000 beds. The Sammy Ofer Underground Emergency Hospital will be the world’s largest underground hospital facility, named after the Haifa-born tycoon whose donation helped fund it. of sheltered space with 880 beds, an OR, ICU, labor room and nursery, and dialysis center. Built within a headland and surrounded on three sides by the When the project is completed next summer, it will provide 1,500 needed parking spaces, but in a major event will be convertible within 48 hours, with full power, water, oxygen and portable sanitary tools. The fi rst level of the garage will feature a decontami- nation area, emergency department and post-trauma area. The second will have 8,200 fully sheltered square meters containing 757 beds plus staff and service space. The third will have 14,800 m2 Mediterranean Sea, the facility will fully protect patients and staff from bomb blasts and chemical and biological attacks. It will be able to generate its own power and store three days’ worth of oxygen, water and medical supplies. In the meantime, the lessons of war and terrorism inform how Rambam deals with mass-casualty events. Plans are required for all types. Rambam’s 4,444 employees have standing orders and well-practiced schemes for trauma, biological, radiological and toxi- cological incidents in peacetime and conven- tional and nonconventional scenarios of war. Those plans are validated by an intense Left: Construction progresses on Rambam’s underground parking garage/Sammy Ofer Underground Emergency Hospital. Above: Outdoor decontamination showers. All decon is handled at the hospitals in Israel. MDA crews simply strip patients, give them basic covering, and transport. 12 JULY 2011 EMS WORLD