The injuries and trauma caused by the Hamas brutal attack on October 7th and the ongoing rocket, missile and drone onslaught on multiple fronts, presented Israeli physicians with a whole new level of the type of challenges they have encountered over the last seventy-five years. Their innovative use of medical breakthroughs and advanced technologies, both home-grown and imported, has continued to help them deliver exceptional care. Years of responding to attacks prompted the Israeli healthcare sector to develop a unique expertise which it has actively shared with the world to aid the victims of natural disasters and mass casualty events.
A leading example of this innovative and generous medical practice is Israel’s National Burns Center at Sheba Medical Center. The center is a purpose-built, level 1 burns trauma center that has received patients from Israel, Gaza, the West Bank, and other countries since it was established ten years ago. Treatment is provided by plastic surgeons, nurses who are specially trained in intensive care and burn treatment, physiotherapists, clinical psychologists, and social workers. This multidisciplinary team, together with specialists from other departments at Sheba, prepares patients for the long rehabilitation process that they must face.
When I talked recently with the director of the center, Dr. Josef Haik, he illustrated the “multidimensional trauma” of the patients currently treated by his team with the story of a young couple and their 18-month-old baby. Residents of Kfar Aza, a kibbutz near the Gaza border, they were critically injured when the terrorists had set fire to their home.
“They were cooked alive inside the safe room of their house,” says Dr. Haik. Ever since the 1991 Gulf War, in which Israel was attacked by Iraqi missiles, Israeli homes are required to have fortified “safe rooms” that can withstand a rocket attack. As Dr. Haik notes, Israel is probably the only country in the world with such a mandated building code, and the safe room protected the family until they managed to escape. Critically injured, they survived the attack, unlike 72 of their Kfar Aza neighbors that were killed that day and 18 that were kidnapped.
Rescued by Israeli soldiers from where they were hiding in the fields near the kibbutz, the family was airlifted to Sheba Medical Center where all three were sedated and put on ventilators. The father had burns on 50 percent of his body surface and the mother had 60 percent burns, reports Dr. Haik. Both were protecting the baby with their bodies, so she had “only” 30 percent burns.
The quality of care, however, helped ensure a relatively speedy recovery and improved healing process. The father and baby were discharged after 30 days. The mother, who was admitted with inhalation injury and pulmonary embolism and suffered from many complications, was discharged after 80 days and is currently undergoing rehab. “Fortunately,” says Dr. Haik, “we didn’t have to take the mother to surgery, thanks to recent innovations such as NexoBrid.”
NexoBrid is an enzymatic therapy for non-surgical burn treatment that, by replacing surgical interventions, minimize associated costs and complications. Its developer, biotherapeutics company MediWound, recently announced it has secured an additional $6.7 million (for a total budget of $14.4 million) in funding from the U.S. Department of Defense to advance development and production of a new, temperature-stable formulation of NexoBrid, for treating severe burn injuries in pre-hospital settings. The simplest way to describe NexoBrid, says Dr. Haik, is that it contains an enzyme that “eats proteins that are dead,” but does not touch healthy skin, “cleaning everything very selectively,” without surgery, helping with scarring and healing.
Other innovative solutions used at the Sheba burns center include Nanomedic Spincare, a unique, portable electrospinning system that prints a matrix onto the patient. The matrix behaves as a temporary skin substitute and provides the wound with an optimal environment for healing; and Pelnac Dermal Substitute pads, developed by Eurosurgical, a temporary dermal substitute matrix that treats skin loss wounds resulting from burns.
The development and use of innovative wound dressings and early debridement agents, assisting in the less-invasive removal of damaged tissue, as well as the constant improvement in patient management procedures, have led to a reduction in blood loss, requirement for surgical excision, wound infection, and hospital length of stay for patients with burn injuries. “For patients over the age of 70, we had about 30% improvement of our mortality and a morbidity rate over 10 years,” says Dr. Haik.
The knowledge gained from the healthcare innovations implemented successfully in Israel has been shared with the world through training programs, humanitarian delegations, and work with the UN, the Red Cross, the World Health Organization and other global healthcare entities. For example, in 2020, with other Israeli physicians, Dr. Haik, who is a Professor at the Sackler School of Medicine at Tel-Aviv University, mentored 30 surgeons, nurses, and therapists from six hospitals in Haiti and the Dominican Republic on how to use Haiti’s first medical laser.
Two years later, Dr. Haik was back in Haiti, leading a delegation of Israeli physicians—some coming directly from serving in Israel’s field hospital in Ukraine—treating victims of a fuel tank explosion that killed 65 people and injured dozens of others. According to the World Health Organization, an estimated 180,000 deaths every year are caused by burns with the vast majority in low- and middle-income countries.
“I’ve been to Congo, Uganda, Romania, Indonesia, Turkey, Azerbaijan, India, and so on, even helping with the aftermath of Hurricane Katrina,” says Dr. Haik. He also participated in the World Health Organization’s Emergency Medical Teams initiative which works with the UN to develop and publish protocols and standards, aimed to improve local, national and international response to disasters.
As the chairman of the Israeli Association for Plastic Surgery, Dr. Haik helped organize on October 8 the country’s entire community of plastic surgeons. This included identifying all the plastic surgeons in state hospitals and private practice and assigning them to specific hospitals, as well as providing refreshment courses. This rapid response was crucial given the fact that some of the physicians working in hospitals were mobilized.
Working with reduced staff and in an ongoing traumatic situation is a heavy burden on the medical team. “It’s a huge burnout,” says Dr. Haik, “but we are resilient and strong. We’ll survive.”
