Pulse 2023

A lifeline for those in need

Shaare Zedek has changed the face of medicine for Jerusalem, for Israel and for the world. Every day brings new challenges and achievements. From responding to terror attacks to leading research innovations, we pride ourselves on our ability to adapt to any situation and to provide excellent care when it is needed the most.

The hospital serves as a lifeline for those in need and our Emergency and Trauma Departments embody our commitment to excellence and compassionate care.

On a recent visit we were fortunate to meet with Director General of Shaare Zedek, Professor Ofer Merin. As we sat down in his office, he informed us that he might need to head off shortly as he’d just received notification of a road traffic accident involving a bus and a young boy on his bike. Just as he finished his sentence we heard the sound of an ambulance heralding his arrival. We continued our meeting for a few moments before quickly joining Professor Merin on a walk down three flights of stairs to the Emergency and Trauma Departments; he wanted to just make sure everything was under control. It was amazing to see this man, the head of the entire hospital who juggles so many responsibilities, still so connected and heavily involved in patient care.

As we made our way through the department we were overwhelmed by how busy it was. Patients lined the corridors waiting to be seen, family members crowded round sick relatives

and we saw a very frantic mother (of the young boy) being supported by a social worker, being looked after at an incredibly difficult time.

‘Busy’ hardly does justice to the constant activity that characterises this department. The relentless flow of patients and the urgency of their needs represents the critical role Shaare Zedek’s Weinstock Family Department of Emergency Medicine plays for the people of Jerusalem. The hospital has recognised this pressing demand, and plans for the expansion of the Emergency Department are well underway. By the time you read this, we hope the department will be complete and welcoming it’s first patients.

The growth of the Emergency Department is not without its challenges. To ensure our doctors can continue to deliver life-saving care and provide hope to those in need, ongoing financial support is paramount. Equipping our medical teams with the necessary tools and resources is essential to maintain the high standard of care for which Shaare Zedek is known.

The Emergency Department is a place of constant action, where lives are saved, hope is restored, and compassionate care is provided to those in distress. This Rosh Hashanah we are asking you to donate to Shaare Zedek to ensure that no matter what challenges we face, everyone walking through Shaare Zedek’s doors knows they have a place of safe refuge, and that they will receive the best possible care.

In conversation with Dr Todd Zalut

Dr Todd Zalut is the Director of our Weinstock Family Department of Emergency Medicine. In 2004 he was elevated to the position of department Director after the tragic death of Dr David Applebaum, the previous year. In the twenty years since Dr Applebaum’s death, Dr Zalut has skilfully nurtured the department, overseeing its remarkable growth whilst managing the mounting pressure it faces. Audrey Gross, Guest Relations at Shaare Zedek Medical Centre, recently sat down with Dr Zalut to talk to him about the challenges he faces in 2023 and what the future holds for the Emergency Department at Shaare Zedek.

What are the biggest challenges that you encounter in the Emergency Department at Shaare Zedek?

Since 2007 Shaare Zedek’s ER has been the busiest in Jerusalem, which in turn means we are seeing a huge volume of patients. The care that people receive is excellent, but our biggest aim is to cut down on waiting time and to do that we need more doctors and nurses. Interestingly there are not a lot of doctors in the State of Israel who are interested in training to be Emergency Medicine doctors so because of this we try and recruit any doctor who is trained in Emergency Medicine who makes Aliyah!

Waiting times are a big problem and one of the biggest reasons for our expansion project. We really are committed to our patients and it’s important for us that they don’t have to wait too long, so we are hoping that with the development and expansion of the department, waiting times will significantly improve.

How has the Emergency Department adapted and improved its processes in response to the unique medical needs and security concerns in Israel?

The first thing was having Emergency Medicine recognised as a specialty. This didn’t happen until 1999 and was followed in 2004 by the introduction of our Residency Programme. It has taken time to teach doctors about the speciality. Emergency Medicine doctors are so skilled that they can perform the many different roles needed in the Emergency Department.

Surgeons are very good at doing what surgeons do, but they can’t do what the Anaesthesiologist does when taking care of a trauma patient, they can’t do what the Orthopaedist does. A doctor trained in Emergency Medicine can. They cross over and are able to jump in whenever and however they are needed in the trauma bay.

Shaare Zedek for lack of an option has had more experience with mass casualty than anybody else in the world, and as a result we have become very good at developing a system for mass casualties. I would say that we have it very fine-tuned. We have several protocols that we use when there’s an event including immediately activating Emergency Medicine doctors, surgeons, anaesthesiologists, orthopaedists, intensive care physicians and nursing staff.

Compared to the rest of the world, Israel has been hit harder than anywhere else by terrorism. Jerusalem has been hit harder than anywhere else in the country and although Jerusalem benefits from 2 hospitals, at Shaare Zedek we treat an average of 55-60% of the injured following a terror attack, so we really do have more experience than anybody else.

Can you describe any specific instances where the Emergency Department played a crucial role in responding to emergencies or providing medical care during times of conflict or crisis?

The Emergency Department is on the frontline in any medical crisis, conflict, mass casualty or medical emergency.

The department was designed both physically and personnel wise to care for any eventuality.

Yesterday for example, we got a call to say there was some sort of chemical leak in a plant and we should expect to receive a number of casualties suffering with inhalation and toxic exposure. We didn’t know what the chemicals were, but because we are prepared for every situation, there is a whole system in place to prepare ourselves and to protect our staff whilst taking exceptional care of the patients. That’s not warfare, mass casualty or terrorist attack, that’s just living in the capital of the State of Israel where you have loads of people coming and going, trucks carrying chemicals from place to place.

Things happen and the Emergency Department has to be ready to care for these people at any given time, 24/7, and that’s what we do. We are designed and prepared for pretty much anything that can happen.

How does the Emergency Department work with other departments, such as Trauma, Surgery, or Paediatrics, to provide comprehensive care for patients in critical conditions?

One of the great things about working in the Emergency Department is that we work with every department of the hospital. We need to be able to call upon our colleagues at any given time at any given situation.

Take for example a trauma patient shot in the chest. This patient will likely need every kind of specialist. The Anaesthesiologist, the Cardiothoracic Surgeon, the General Surgeon, the Emergency Medicine doctor and the Emergency Medicine nurses. This one patient with a gunshot wound to the chest requires a team of 5/6 doctors and nurses to care for them. This is just one example of how important it is that we can work with other departments in the hospital.

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We work closely with all of our colleagues in all the different departments whether its medicine, trauma, surgery, orthopaedics, it doesn’t matter.

Are there any advancements or innovations in Emergency Medicine or technology that you are particularly excited about implementing in your department?

In the world of Emergency Medicine one thing I’m excited about is the way that ultrasound is becoming part of the physical examination. I remember when I first started my career many, many moons ago, when doctors in any department would be running around with a white coat and their stethoscope in their pocket or on their neck and you would know that they are the doctor of the department.

Today while many doctors are using a stethoscope less and ultrasound more, there are many of us who are still using both, and I would say that in the next 5 to 10 years we will start to see the end of the stethoscope and only have ultrasound machines in our pockets.

Technology is getting smaller and smaller: I already have an ultrasound probe that hooks up to my phone and the phone screen is the screen for the ultrasound. We use ultrasound a lot especially in people who are unstable, to try to understand why.

About one month ago I had a senior resident looking after a combat soldier from a very prestigious combat unit, he was actually a sniper in that unit, he came to the Emergency Department with a few of his soldier friends because he was experiencing chest pain. They were of course all in uniform and his friends were teasing him saying, what kind of combatant are you having chest pain?

The doctor put the ultrasound machine on his heart and saw that his heart wasn’t functioning well. It turns out he probably started with an infection of his heart which then contributed to a significant reduction of the overall functioning of his heart. Needless to say, he finished his military career on the spot, but it undoubtedly helped him to get the right kind of treatment that will help him live a healthy life.

Can you share any success stories or examples of remarkable patient outcomes that demonstrate the effectiveness of your Emergency Department team?

I talk about this a lot with my children. People wake up in the morning and they go to work or school and they are healthy, but they don’t always finish the day so healthy. A lot of things can happen to people during the course of the day and each one of those events for that particular patient is a major event.

We have, thank G-d, an excellent staff in the Emergency Department, excellent nurses, excellent doctors! Every day we’re dealing with people who have started that day healthy but who are clearly not going to finish that day so healthy. It could be anything like a 55-year-old man who goes to work and is having a heart attack and is sent off to the CATH LAB to get his arteries open. It could be a 75-year-old man who is still working and has a stroke.

We give more clot busting medicine than anybody else in the country, we do more brain catheterisation than certainly anybody in Jerusalem. That patient is having a major life event.

At the end of the day, he or she could walk out of the hospital neurologically intact because of the excellent staff of both the Emergency Department and the Neurology Department and the interventional neurology department. It’s really a team effort! People vote with their feet, the fact that we have such ongoing increasing number of patients coming to us shows that Shaare Zedek is a first choice.

As you look to the future and the expansion of the Emergency Department what is your vision for the department?

The goal is very clear. We want to extend the services that our Emergency Medicine doctors

provide and cut back a little bit on the services that colleagues from other departments provide in the Emergency Department. We have received the ok to hire four more residents so that will help us towards our goal of having more of our patients seen and treated directly by our specialised Emergency Medicine doctors.

Being treated by an ER doctor rather than calling in specialists from a different department will cut down on time, will be more efficient and the patients will feel more confident. We are looking to improve services to make it a faster and smoother experience for everyone.

Do you still feel Dr Applebaum’s presence, mark, and legacy?

When you walk into the ER you can see a picture of David standing there with his arms crossed and I can hear him say “nu Todd get busy, you haven’t done anything yet, get to work.”

I was a “talmid” of Rabbi Dr Applebaum, his vision and what he wanted for the department is what we also want. We expanded it in many different ways, and we’ve added and developed certain ideas just with the development of technology. David was never satisfied, he would say ok, now what next?

We must continue with that in mind, move forward and take the next steps to continue his legacy.

Remembering Dr David Applebaum z”l

On September 9th 2003 Dr David Applebaum, Head of Shaare Zedek’s Department of Emergency Medicine, was murdered on the eve of his daughter Naava’s wedding. He had taken Naava to a local café for a last-minute father daughter talk before the wedding. Before they could even get out of the car, they were killed, along with five others in the most tragic of circumstances, the victims of a terrorist attack at Café Hillel in the German Colony, Jerusalem.

As ambulances began arriving at Shaare Zedek, delivering the wounded from the attack, the Director General of Shaare Zedek at the time, Professor Halevy was nervous. He knew that Dr Appelbaum was usually the first to report to the hospital after a bombing and there was no sign of him. Staff grew concerned when Dr Applebaum did not respond to his beeper within the first few minutes after the attack.

“It was clear to me from very early on when he didn’t show up and I knew he was in Jerusalem and he hadn’t called, that a terrible tragedy had occurred,” Professor Halevy shared with Haaretz newspaper soon after the attack. “Confirmation of my suspicions came shortly afterwards.”

Word that he was one of the victims came from a rescue worker who recognised him at the scene. “When news broke, we were in the midst of treating victims. Every person on the staff was crying. The hospital staff had to cope with their own grief as they treated the wounded, of which there were many.”

Dr Applebaum’s murder was described by The Lancet as a tragic irony: This victim of a suicide bomber was himself an ‘emergency room doctor who treated victims of dozens of suicide bombings in Israel.’ His untimely death, along with his daughter, sent shockwaves through the whole medical community and the Shaare Zedek family.

At Dr Applebaum’s funeral, hundreds of his patients came to pay their respects to a doctor whose dedication knew no bounds. Dr Nathan Cherny, Director of Cancer Pain & Palliative Medicine at

Shaare Zedek shared, “David insisted on personal accountability. He took personal responsibility for the functioning of the Emergency Room. At night, when the department was overstressed and understaffed, he would return to pitch in through the crisis.”

“Doctors are a rare breed in the ultra-orthodox world. His religiosity, however, never hindered his readiness to deliver care or return to the hospital whenever needed, be it Shabbat, High Holidays or a fast day. In the care of patients, and in his relations with staff, David was oblivious to the divide between Jew and Palestinian. Everyone was treated with the same respect and patience.”

This year marks the 20th Yahrzeit of Dr David Applebaum. He was an incredible man who dedicated his life to healing and changed the path of emergency medicine. David’s vision extended far beyond Jerusalem. He pioneered the idea of immediate care clinics in Israel (Terem), to divert non-emergency cases from hospital emergency rooms and was considered ‘a master of emergency medicine’ by President of Shaare Zedek Medical Centre, Professor Jonathan Halevy.

Dr Todd Zalut, Director of the Weinstock Family Department of Emergency Medicine told us “David was more than a boss, he was a mentor, and a comrade in arms. We fought to bring worldclass emergency medicine to Israel.” Dr Zalut still feels Dr Applebaum’s presence at Shaare Zedek.

Our legacy at Shaare Zedek is to carry on his life’s work.

“David had very high standards and he had a very clear vision of where we needed to go. We are definitely working towards it; I think we would have got there much faster had he not been killed.”

Operation Olive Branch

Dr Giora Weiser, Director of the Paediatric Emergency Department

at

Shaare Zedek

and Deganit Kobliner,

Senior Nurse of

the Emergency Department, were part of the medical team who joined Director General of Shaare Zedek, Professor Ofer Merin and the IDF Medical Corp in Turkey earlier this year.

The team landed in Kahramanmaraş, a city of about a million people that had been struck by two particularly powerful tremors. Hundreds of buildings had collapsed and well over 10,000 people already accounted for as being killed in Turkey alone.

Unlike previous missions in which Professor Merin had participated, this time he established the field hospital in collaboration with a local hospital, and not as an independent medical unit.

During Operation Olive Branch, the medical team were able to save a number of people, some who had spent days under the ruins! One of them was a four-year-old boy who arrived in serious condition and hypothermic and a man who spent 110 hours under the rubble. Locked in an air pocket, he survived without food and water where the night temperatures drop to -7˚C (19˚F) at night. His first request after being rescued was… a cigarette!

Professor Merin shared, “Humanitarian efforts in situations like these should be recognised as important not only for saving lives, but also in helping the population to resume some degree of stability and normality as soon as possible.”

“Being part of the Israeli field hospital was a unique experience. It was my third time participating in Israel’s reaching out to other nations and offering it’s best. I am proud to have been part of this team and hope that as Jews from the state of Israel we continue to do good and make the world better for all.” Dr

Giora Weiser

A heroic battle for life

On the 20th June 2023, a terror attack near the West Bank settlement of Eli claimed the lives of four Israeli’s. The attack took place at the entrance to a restaurant at a petrol station on Route 60 located near Eli, which is north of Ramallah and south of Nablus.

Injured in the shooting was 20-year-old Eran Tobolski who was rushed to Shaare Zedek’s Trauma Unit in serious condition. When Eran arrived, he was fighting for his life. Dr Alon Schwartz, Director of the Trauma Unit at Shaare Zedek said, “Eran arrived with serious upper body gunshot wounds which required immediate surgery.” The medical team worked tirelessly to stabilise his condition and thankfully his surgery was successful.

Eran’s miraculous progress amazed both medical professionals and his loved ones, who had feared the worst. The dedication, skill, and compassion exhibited by the medical team during those critical moments played a crucial role in Eran’s survival and after a week of care at Shaare Zedek, Eran was discharged to complete his recovery at home.

Dr Shwartz shared, “We are happy that the surgery he immediately underwent was successful and we are very grateful to the entire medical team who contributed to his care. Eran is now in better condition and is recovering, and we are delighted to see him leave the hospital for his continued rehabilitation. We all wish him a speedy recovery and only continued good health.”

Eran’s parents Naama and Avi Tobolski were overcome with emotion when they shared: “We’ve experienced some very challenging days and thank G-d we are leaving the hospital with our son in an improved condition. From the bottom of our hearts, we are so grateful to the doctors, nurses and all the professional teams for the dedication they gave to Eran. They showed such compassion and professionalism. We are also so thankful to everyone who prayed for Eran. We know there were so many prayers and other actions on his behalf and we truly felt the warm embrace of all the people of Israel. We know that we still have a journey ahead and we pray for Eran’s continued recovery as well as the recovery of all the victims of the terrible attacks over the recent period. We express our sincere condolences to the families of the murdered and pray that they should have to deal with no more sorrow.”

We need your support

Every three minutes, another patient arrives at the Emergency Department at Shaare Zedek Medical Centre. 24 hours a day, seven days a week.

Some arrive in life threating condition, following a heart attack, stroke or serious injury. Others have a worrying medical condition. Whatever the reason, they know they will get expert treatment, along with compassionate care at Shaare Zedek.

Your donation today will enable us to ensure our doctors and nurses have the tools they need to deliver the innovative top level of care for which Shaare Zedek is known. No matter how big or small, your support makes a valuable difference. Your

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