The Emergency Department was partially full when news came of a mass casualty situation (M.C.S.), defined as requiring a hospital to treat a number of injured exceeding its usual capacity. Key personnel began urgently transferring patients out of the department in order to free the beds for an expected onslaught of wounded. These arrived quickly in five waves.

"Where does the Head Nurse stand?" prompted Dr. Moshe Michaelson, Director of the Trauma Unit at Rambam.  

"Here," replied a visiting physician, "or maybe here."

"No 'or!'" Dr. Michaelson insisted. "You have ten seconds to decide!
 
The board game, presented by guest moderator Dr. Michael Stein, Director of Trauma in the Department of Surgery at Rabin Medical Center, was part of a 3-day advanced capacity building course, "The Best Way of Training for Mass Casualty Situations (M.C.S.)," given in Haifa on November 16th-18th by Rambam's Teaching Center for Trauma Emergency and Mass Casualty Situations.  

The course was initiated by Rambam and organized in joint partnership with NATO, whose Science for Peace and Security (SPS) Committee granted scholarships in order to enable it to take place in Israel, and also enjoyed assistance from the Israeli Health Ministry and MASHAV – the Center for International Cooperation of the Foreign Ministry of Israel.

It was designed for senior physicians, nurses and administrators of hospitals and pre-hospitalization (paramedical) organizations from Commonwealth of Independent States (CIS) and Mediterranean Dialogue countries. Representatives of Azerbaijan, Croatia, Georgia, Malta, Moldova, Russia, Serbia, and Ukraine, and of Israel's neighbor, Jordan, participated.

The training stressed the central importance of logistical pre-planning and organization, and of periodic drilling and debriefing of personnel.

Co-directing the course with Dr. Michaelson was Brigadier General (ret.) Dr. Leo Klein of the Czech Republic, Head of the Department of Field Surgery in the Faculty of Military Health Sciences at the University of Defence. The course was coordinated by Gila Hyams, RN, who directs the Teaching Center for Trauma Emergency and M.C.S and coordinates the Trauma Unit at Rambam.

American, European and Israeli specialists in the field of trauma trained participants in various best practices for coping with the pre-hospital, hospital and non-conventional aspects of M.C.S.

In keeping with the course's learning-by-doing methodology, the visitors closely observed an M.C.S. drill (pictured) at Rambam's new Emergency Trauma Center, and then actively debriefed their Rambam counterparts.
 
The course's primary aim was to give participants methods for teaching their knowledge of M.C.S. preparedness to medical professionals in their home hospitals and countries.