The emergency department in a region under missile attack: Utilization patterns during operation cast lead

Background: During military escalations emergency departments provide treatment both to victims of conflict-related injuries and to routine admissions. This requires special deployment by the hospitals to optimize utilization of resources. Objectives: To evaluate routine visits to the ED during Operation Cast Lead in Israel in 2008-2009. Methods: We obtained data regarding routine visits to the ED at Soroka University Medical Center throughout OCL. The visits one month before and after OCL and the corresponding periods one year previous served as controls. Results: The mean number of daily visits throughout the study period (126 days) was 506 ± 80.9, which was significantly lower during OCL (443.5 ± 82) compared with the reference periods (P < 0.001). Compared to the reference periods, during OCL the rates were higher among Bedouins, visitors from the region closest to the Gaza Strip (< 30 km), patients transported to the ED by ambulance and patients of employment age; the rates were lower among children. No difference in the different periods was found in the rate of women patients, the rate of patients referred to the ED by a community physician, and hour of arrival. The overall inhospital admission rate increased during OCL, mainly in the internal medicine and the obstetric departments. There was no change in the number of in-hospital births during OCL; however, the rate of preterm labors (32-36 weeks) decreased by 41% (P = 0.013). Conclusions: Throughout OCL the number of routine ED visits decreased significantly compared to the control periods. This finding could help to optimize the utilization of hospital resources during similar periods.