Models of Field Hospital Emergency Departments: The Israeli Experience

The World Health Organization has classified Emergency Medical Teams (EMTs) into 3 types for international disaster response. They range from those that operate as daytime clinic facilities to those that have complete hospital capabilities that can provide 24/7 inpatient care. The most complex EMT (Type 3) includes a full-scale emergency department (ED), operating rooms, a medical/surgical ward, an intensive care unit, and laboratory services. The Israel Defense Forces Field Hospital was the first to be officially designated as a Type 3 EMT. Two models have been used by the Israeli EMT depending on the disaster response: standalone and hybrid. The standalone model is where the ED and hospital are set up in tents independent of any existing health care facilities. The hybrid model is where the equipment and personnel are combined with existing structures. Pediatric patients are examined in either a designated area staffed by specialized pediatric emergency physicians and nurses or integrated into the general ED. Models of ED layout, staffing, scheduling, and equipment are also described. While the Israeli team is a Type 3 EMT, the different models of ED organization can also be applied to other types of field hospitals to maximize care in the disaster setting.