A renovated Emergency Trauma Center is currently the top priority of Rambam’s campus wide Vision of Adam master plan, with a more than triple expansion from 800 sq m to 3,000 sq m planned to meet the high turnover of referred patients, and protective features required in the event of natural or manmade catastrophic disasters.

“Our dream is to render ER into a full emergency medicine center 24/7. That means a self-reliant ER with emergency medicine specialist physicians trained to provide primary care to every incoming patient, backed up by nurses qualified in emergency medicine (e.g., trained to perform an x-ray for a contusion of the hand or to understand the results of an EKG), by consultants and by a fully computerized and equipped department.

“Currently our patients are divided into internal medicine, surgical, trauma, ENT and other subspecialties, but our ideal and the leading concept in the world today is that emergency and trauma treatment should be holistic – a myocardial infarction [patient] lying next to a trauma [patient] lying next to a gynecological [patient] and so forth. It would be ideal if I had all my own doctors and nurses 24/7 because then I could implement protocols and control the scene.”

The speaker is Dr. Fuad Basis, Medical Director of ER at Rambam. He strides into a late-afternoon interview with Rambam On Call straight from having spent 20 minutes resuscitating a patient in the Shock Trauma Room. His stethoscope dangles over the shoulders of his open medical coat, and he’s in blue jeans. He doesn’t sit down. The skin at the corners of his eyes betrays fatigue, but as soon as he begins describing his profession and the needs of his patients and staff, the dark eyes flash with energy, warmth and wry humor. He’s been an emergency physician for 20 years; “It’s in my blood,” he says. “I like the adrenalin, the action, making fast and crucial decisions.”

Dr. Basis counts off ER’s troubles on his fingers, speaking urgently as if in bullet points:

“Physical Overcrowding – ER was built 20 years ago and can accommodate barely 70,000 patients, but it actually receives more than 120,000. It’s so overcrowded that sometimes we shove 2 beds within the same cell, and some beds are even scattered outside of ER. We have only 50 beds, but sometimes we have 90 patients; we put them in wheelchairs because we lack beds. We have no place for our physicians to sleep, either – they sleep on the floor, in the storeroom; it’s veterinarian conditions, like a kennel!

“Lack of Staff – Emergency medicine is a specialty that you learn by doing. For example, someone comes in with a trauma and a blood pressure condition, or a chest contusion and a cardiac infarction. For the moment, in Israel, emergency medicine is a second specialty – first you qualify in internal medicine, surgery, pediatrics, anesthesiology or family medicine and then you spend an additional 2.5 years to qualify as an emergency doctor. Today, I have about 9 emergency physicians, but I need an additional 12 to 15 – the American Dream [laughs]. Between 3:30 PM and 7 AM, we have a huge consumption of consultants because we have only 2 emergency medicine residents; the rest are residents in other specialties.

“Lack of Equipment – For example, if I have to perform an emergency echocardiogram in the Shock Room, I have to order [the device] from the cardiology department 200 meters from here; I have to call in a technician or cardiologist, and that could take more than half an hour, or maybe I have to transfer the patient.

“If I want to perform a FAST [Focused Assessment with Sonography for Trauma] to check intra-abdominal bleeding, the x-ray guy has to come with it. Or a C-PAP – that means Continuous Positive Airway Pressure [to facilitate breathing] in case of pulmonary edema – it’s noninvasive, but the equipment isn’t permanently here, so we have to intubate the patient, to invade. It lowers the quality of care and endangers the patient; it‘s an impossible situation!

“And we need small equipment for subspecialties – an ultrasound to check urinal retention, a slit lamp to examine the eye for foreign bodies, basic equipment for ENT and for measuring blood pressure. We are lacking electrothermometers, a glucometer, an EKG, a saturometer… Also, the plan is to render ER into a paperless environment, and for that we need a lot of hardware and software.

“Unsafe! – Half of ER is under the [9-floor Central Wing] building [est. 1973], but half is in the air. During the [2nd Lebanon] war, they could have hit us."

In August 2007, in response to these unacceptable conditions, Friend of Rambam Mr. Nochi Dankner partnered with the Jewish Agency to contribute $4 million toward enlarging, equipping and fortifying a new Emergency Trauma Center at RHCC, and the cornerstone was laid.

Another $7 million in donor funding is required before the plan is realized, but when Dr. Basis imagines the future, he smiles broadly and speaks in present tense: “The new building? It’s very practical and very beautiful! We built it – I and Head of Department Dr. [Moshe] Michaelson – a world renowned traumatologist and our chief trauma physician – and Head Nurse Hagar Baruch, Deputy Head Nurse Tzvi (Gregory) Mushnik, and others. We met with the architects and planned our new ER with the emergency vision in mind.”