Patient flow, triage, and mortality in Al-Shifa hospital during the Israeli operation Protective Edge, 2014, in the Gaza Strip: a review of hospital record data

Abstract

BackgroundThe Israeli Army military operations against Gaza from July 8 to Aug 26, 2014, left more 2100 Palestinians dead and injured over 11000. According to UN data, at least 551 of those killed and at least 3436 were those injured were children aged 18 years or younger. We assessed patient flow, triage, and mortality at Al-Shifa Hospital in Gaza City (Shifa) during this period. MethodsWe reviewed hospital records for the emergency room, intensive care unit, and operating rooms in Shifa. Total numbers of casualties seen in the emergency room, admissions, deaths, operations, and ICU admissions were recorded. Findings8592 people came to the Shifa emergency department following bombardments and other attacks. After crude emergency room triage, 4389 (51·1%) needed further medical attention, while 490 (5·7 %) were dying or dead on arrival. 1808 (21·0 %) live patients were admitted after detailed triage, of whom 78 (4·3 %) died in hospital. Most patients were civilians injured by aerial bombing (drones, F-16 jets, helicopters) or heavy ground or naval artillery shelling. 842 (46·6 %) admitted patients needed major life-saving surgery with anaesthesia, including 190 laparotomies, 146 orthopaedic fixations, 106 craniotomies, 69 thoracotomies/airway interventions, 38 vascular procedures, 49 amputations, 68 debridements, and 176 other procedures. Because most patients needed more than one intervention, the total number of procedures exceeded 842. The surgical intensive care unit treated 253 patients, including 197 (77·9 %) male and 56 (22·1 %) female patients. 87 (34·4 %) of cases were children. 164 (64·8 %) patients were discharged alive, 51 (20·2 %) died in intensive care, and 38 (15%) were transferred to other hospitals. InterpretationA high proportion of fatal injuries presented dead on arrival at hospital. The rate of admission to ICU doubled and ICU mortality rates nearly tripled compared with those during the the Israeli operation Pillar of Defence in November, 2012, probably because of the extreme character of the 2014 attacks, combined with shortages of supplies and hampered evacuation caused by siege. Despite severe shortages of medical staff and unpaid salaries, Shifa staff and volunteers managed the long-lasting influx of patients with serious trauma. FundingNone.