[Management of "Iron Swords" War Casualties at Shaare Zedek Medical Center: The Operational and Clinical Impact of Establishing a Dedicated Helicopter Landing Pad].
Harefuah · 2026-03-01 · Registry study
Abstract
INTRODUCTION: The events of October 7, 2023, and the ensuing war presented unprecedented challenges to Israel's healthcare system. In response to the large-scale influx of casualties, a helicopter landing pad was emergently established at Shaare Zedek Medical Center (SZMC), facilitating direct aeromedical evacuation to the hospital for the first time in its history and enabling redistribution of the trauma care burden among Israel's supra-regional trauma centers. METHODS: A retrospective review was conducted using trauma registry data from SZMC and the Israel Defense Forces Medical Corps. All patients evacuated by helicopter between October 2023 and December 2024 were included. Data analyzed included demographics, injury severity according to the Injury Severity Score (ISS), anatomical injury distribution, trauma bay and operative interventions, length of hospital stay, and clinical outcomes. RESULTS: A total of 183 trauma patients were transported during 89 helicopter evacuation missions. The majority were military personnel (88%, N=161), with a mean age of 25.6 years (range: 14-65). Most patients were male (96%, N=175). Injury severity distribution according to ISS showed that 58% (N=106) sustained minor injuries (ISS 1-8), 16% (N=29) moderate injuries (ISS 9-15), 9% (N=16) severe injuries (ISS 16-24), and 17% (N=31) were categorized as critical (ISS >24). Overall, 91% (N=167) of patients required hospital admission. Among those admitted, 45% (N=75) were hospitalized in the Intensive Care Unit (ICU), and 49% (N=82) underwent surgical intervention. Common operative procedures included exploratory laparotomy (N=17), craniotomy (N=1), limb amputation (N=6), and fracture fixation (N=18). The median length of hospitalization was 4 days (IQR=8). No in-hospital mortality was recorded. CONCLUSIONS: The rapid establishment of a helicopter landing pad at SZMC as an emergency measure transformed its trauma unit into a significant contributor to the care of war casualties, thereby reducing surgical workload and inpatient resource utilization at other hospitals receiving combat casualties. Further research is warranted to evaluate long-term outcomes and to optimize aeromedical evacuation triage policies in both military and civilian settings.