Gaza Pediatric (Children) Casualty Evacuation Plan

Area of Operations:

• GAZA STRIP- small area of land, bordered by the Mediterranean to the west, Egypt to the South, and Israel to the north and east. It is densely populated with large combat operations being commenced by the Israeli Defense Forces against Hamas.
• Surrounding Countries- functioning infrastructure with multiple ways of supplying collaborating hospitals.

Key Locations:

• Casualty Collection Points
• Logistic Hubs
• Communication Centers (co-located at Logistic Hubs)
• Subordinate Logistic Hubs
• Hospitals Collaborating.

Obstacles

• Current fighting has left roads damaged, destroyed or too dangerous for emergency vehicles to travel.

Avenues of Approach:

• Multiple border crossings to the north, east, and south. Can travel along these at relatively high speeds.
• Western Gaza is composed of the Mediterranean. Watercraft can access Gaza if permitted by the IDF.
• Many potential Landing Zones for helicopters throughout Gaza, especially outside the densely populated cities. Many of the hospitals are located within these cities making it difficult to get helicopters to them if necessary.

Key Terrain

• Large open fields outside of city centers that can act as Landing Zones. Ample room for Casualty Collection Points where PTs can be triaged, supplies flown in, and PTs medically evacuated.

Cover and Concealment

• Hesco barriers can be employed to protect people inside the CCPs from small arms fire.
• Limited cover and Concealment in these open areas.
• Shelters at CCPs will be needed in the event these sites come under fire.

• Begins with designated commanders completing this plan based off of available resources and personnel. They will need to coordinate with hospitals, NGOs, Governments, and local agencies.
• Commander establishes task organization for the force. Tentative structure currently in place encompasses. 
  • Headquarters composed of
    • Planning
    • Communications
    • Education and Training
    • Finance
    • Contracting
    • Legal
    • Public Affairs Officer
    • Coordinator
    • Logistics 
    • Operations 
    • Security Manager
    • Personnel Manager 
  • Medical
    • CCP Locations
    • Hospital Coordination
    • MEDEVAC
      • AIR
      • Ground
  • Transport and Logistics 
    • Ground Transport
    • Air Transport
    • Maintenance 
    • Sustainment
  • Security
    • CCP Security 
    • Processing
• Command begins collaboration between militaries, hospitals, NGO's, international aid organizations, and local authorities. Their primary focuses are to
  • Establish connections between these groups and a framework for working together.
  • Task Organization for Subordinate Commands such as medical, transportation, security, and headquarters.
  • Determine resources available. What supplies and equipment can be provided for this mission and how many are available? How many vehicles do we have, fuel, medical supplies, maintenance materials, communication equipment, and more.
  • Determine personnel available. How many trained personnel do we have?
  • Determine Casualty Collection Point locations.
  • Determine Logistic Hubs. Primary and Subordinate Logistics Hubs. Where will storage locations be for vehicles, supplies, equipment.
  • Ensure all sides in the conflict understand 
    • Where the CCPs will be.
    • Where the routes will be.
    • Those who will be involved. 
    • What vehicles will be involved.
    • The system to communicate when MEDEVAC Vehicles are transporting.
• Obtain permissions from the combatants to 
  • Allow for Medical evacuations of critical pediatric patients, and 
• Obtain permissions from outside countries where routes will travel through and where hospitals are located. 
• Finalize the plan. By this time command and control, communications, coordination, locations, routes, supplies, assets, and personnel should be understood and integrated into this operation. 

• After the plan is finalized, command coordinates with outside agencies to begin gathering assets and personnel at pre-established locations outside of Gaza. 
• Administrative functions and communications are functioning across the region to enable this movement. 
• Database for tracking where patients are going needs to be established.
• Logistics hubs are established.
• Hospitals that have been identified begin receiving aid to deal with the coming influx. 
• Local agencies are briefed on where the CCPs will be, when they will be established, and how they will operate. Communication channels are finalized between them and command. 
• Vehicles, Equipment, and Personnel are staged for moving towards the CCPs. 
• Combatants are notified of planned movement times and routes.

• Once combatants confirm they have received the notification, Vehicles, Equipment, and Personnel begin movement towards the predetermined CCP Locations. 
• On arrival to locations, security is established, CCP groups begin establishing field hospitals, Landing Zones for Helicopters, Power established with Generators, and Storage Areas set up for fuel, food, water, and supplies.
• CCP Locations are broadcast to Gaza.
• Local first responders begin bringing patients to the CCPs.
• Security ensures the safety and orderly movement of patients in and out of the CCPs. 
• At the CCPs patients are triaged, where medical staff determine who needs to be medically evacuated out of Gaza and what priority they will be. Patients identified and put into a database where they can be tracked. 
• First Helicopters, Ground Ambulances, and Buses begin movement towards collaborating hospitals.
• Once at the hospitals, patients are logged and receive the critical treatment they require. 
• Helicopters, Ambulances, and Buses move towards their nearest Logistics hub to refuel, refit, crew swap, and receive any necessary repairs. It is Possible they could go directly to some of the CCP locations, but it will be situationally dependent. 
• Process repeats until Gaza is able to adequately treat critical pediatric patients.
• Pediatric patients will have to stay at temporary locations if they recover until they are able to be reunited with their parents. They will not be sent back to a warzone against their will or their parents will.

Some Suggestions to think about.

Medical

Medical Supplies:

• Bandages (Various Sizes): 45,000 units
• Surgical Gloves: 1,800 boxes
• IV Fluids (Normal Saline): 90,000 liters
• Antibiotics (Broad Spectrum): 90,000 doses
• Painkillers (Acetaminophen/Ibuprofen): 45,000 doses each
• Sterile Gauze Pads: 18,000 units
• Sutures (Various Types and Sizes): 4,500 packs
• Antiseptic Solution: 900 liters
• Hemostatic Dressings: 9,000 units
• Tourniquets: 2,250 units
• Quick Clotting Agents: 4,500 units
• Trauma Kits: 2,250 units
• Burn Dressings: 4,500 units
• Combat Gauze: 9,000 units
• Advanced Airway Management Supplies: 1,800 units
• Splints
• C-collars
• Head stabilizers

Medical Equipment:

• Portable X-ray Machine: 90 units
• Ultrasound Machine: 90 units
• Back boards
• Oxygen Concentrators: 450 units
• Defibrillator: 90 units
• Portable Ventilators: 180 units
• Patient Monitors: 450 units
• Surgical Instruments (Basic Set): 180 sets
• Field Surgical Kits: 45 units
• Emergency Airway Equipment: 900 units
• Automated External Defibrillator (AED): 90 units

Personal Protective Equipment (PPE):

• N95 Masks: 45,000 units
• Surgical Masks: 90,000 units
• Disposable Gowns: 45,000 units
• Face Shields: 18,000 units
• Disposable Gloves: 90,000 pairs
• Tactical Combat Casualty Care (TCCC)-Compliant Combat Boots: 1,000 pairs
• Ballistic Eyewear: 1,000 units
• Ballistic Helmets: 500 units
• Body Armor (Plate Carriers): 500 units

Infrastructure and Support:

• Tents (Medical): 450 units
• Portable Generators: 180 units
• Lighting Equipment (Portable): 450 units
• Sanitation Supplies (Disinfectants, Cleaning Agents): As needed
• Blast-Resistant Medical Tents: 450 units
• Portable Power Generators: 180 units
• Tactical Lighting Equipment: 450 units
• Portable Field Sanitation Systems: 180 units
• Fuel for Generators and Vehicles: As needed
• Water Supply (Potable): As needed

Miscellaneous:

• Medical Charts and Forms: 9,000 units
• Stretchers: 900 units
• Wheelchairs: 450 units
• Field Medical Records System (Digital or Paper-Based): 90 units
• Evacuation and Transportation Equipment (Stretchers, Litters): 900 units
• Communication Equipment (Radios, Satellite Phones): 450 units

Medical Evacuation 

Evacuation and Transport Vehicles:

• Ambulances (4x4 for rough terrain): 30 units
• Helicopters (Medevac-configured): 5 units
• Buses (for non-critical, ambulatory patients): 10 units

Medical Supplies for Evacuation:

• Portable Oxygen Tanks: 200 units
• IV Fluids (Normal Saline, Dextrose): 1,000 liters
• Emergency Medication Kits (including pain relief, anti-emetics, anticonvulsants): 100 kits
• Trauma Kits: 100 units
• Tourniquets: 300 units
• Blankets (thermal and standard): 500 each

Medical Equipment:

• Portable Ventilators: 50 units
• Defibrillators: 30 units
• Patient Monitoring Systems (portable): 50 units
• Stretchers and Wheeled Gurneys: 200 units
• Scoop Stretchers: 100 units

Communication and Navigation Equipment:

• Satellite Phones: 20 units
• GPS Devices: 50 units
• Radios (Handheld, for communication between vehicles and base): 100 units

Personnel Protective Equipment (PPE) for Crew and Patients:

• N95 Masks: 1,000 units
• Face Shields: 500 units
• Disposable Gowns: 1,000 units
• Gloves (assorted sizes): 2,000 pairs

Support and Miscellaneous:

• Water (Bottled, for patients and crew): 2,000 liters
• Food Supplies (Non-perishable, easy-to-eat items): Sufficient for 500 persons
• Fuel (for vehicles and backup generators): As needed based on distance and route
• Maps (Detailed, of the area including alternate routes): 20 sets

Hospital Request

Medical Supplies:

• Bandages (Various Sizes): 10,000 units
• Surgical Gloves: 500 boxes
• IV Fluids (Normal Saline, Dextrose): 5,000 liters
• Antibiotics (Broad Spectrum): 5,000 doses
• Painkillers (Acetaminophen, Ibuprofen, Morphine): 10,000 doses
• Sterile Gauze Pads: 5,000 units
• Sutures (Various Types): 1,000 packs
• Antiseptic Solutions: 200 liters
• Hemostatic Agents: 1,000 units
• Tourniquets: 500 units
• Glucose 

Medical Equipment:

• Portable X-ray Machines: 5 units
• Ultrasound Machines: 5 units
• Additional ICU Beds: 50 units
• Ventilators: 50 units
• Defibrillators: 20 units
• Patient Monitors: 100 units
• Surgical Instruments (for emergency and trauma surgery): 20 sets

Personal Protective Equipment (PPE):

• N95 Masks: 5,000 units
• Surgical Masks: 10,000 units
• Protective Gowns: 5,000 units
• Face Shields: 2,000 units
• Gloves (Various Sizes): 20,000 pairs

Pharmaceuticals:

• Broad-spectrum Antibiotics: Sufficient for 1,000 treatments
• Pain Management Medications: Sufficient for 1,000 patients
• Sedatives and Anesthetics: Sufficient for 500 surgeries
• Emergency Medication (Adrenaline, Atropine): 500 doses each

Infrastructure and Support:

• Additional Hospital Tents (for triage and overflow patients): 10 units
• Portable Water Purification Systems: 2 units
• Additional Bedding and Blankets: 500 sets
• Mobile Sanitation Units: 10 units

Nutritional and Care Supplies:

• Bottled Water:
• Non-perishable Food Supplies: 
• Hygiene Kits (toothbrush, toothpaste, soap): 1,000 kits

Location of Command: Command Center will be located at one of the main logistics hubs outside of Gaza. 

Communications: There will be several networks in place.

• Internal Communications to allow for coordination of mission assets.
  • There will be communication networks between site locations, command teams, dispatch, hospitals, etc.
• External Communications to reduce the risk of Hamas or Israel targeting these medical assets.

MORE DETAILS TO COME ON THE EVACUATION OF CRITICAL PEDIATRIC PATIENTS FROM GAZA PLAN

THIS SHOULD BE DONE AT THE EARLIEST POSSIBLE POINT IN PHASE ONE. This will require its own plan, but is entirely feasible. Some key points. 

1. The IDF already currently has a medical plan in place for their Soldiers. Humanitarian aid groups are on the ground trying to provide medical care.
2. Make an agreement with neighboring countries to allow for the transport of critical casualties to their hospitals. Especially children. 
3. Establish Casualty Collection Points (CCPs) inside Gaza. This is not to different from what is currently in place, the difference will be these are locations for evacuations of casualties. Medical staff will triage patients and determine who can be treated on site and who requires transport to fully functioning hospitals outside of Gaza.
4. The Aid will be ramped up in order to staff and supply established hospitals to maximum capacity. The aid will go towards these CCPs and any hospital agreeing to take critical patients from Gaza. 
5. There could be an opportunity for volunteers to travel to these outside hospitals to help staff them, equip them, provide training, and logisitical support to these locations.
6. Aid Organizations will likely need to build more field hospitals to deal with the influx of Palestinians seeking care. 
7. A transportation system will need to be established. There will likely need to be ground and air transport from these CCPs to the hospitals identified. This will require transport vehicles, fuel, medical personnel, medical supplies, and more. It is entirely feasible. Many of the supplies can be from donations by Non-Government Organizations and other Governments.
8. At minimum establish one for pediatric patients.
   1. Governments can turn away adults easily, but it is more difficult, and morally wrong, to turn away injured children.

1. IDF continues their medical plan. 
2. Hospitals will be a major priority for rebuilding. 
3. Palestine will need to be flooded with staffing, equipment, and supplies in order to overcome the surge in medical needs as refugees return to their homes.
   1. The fighting will be over, but thousands are going to return. There will be many in critical care from the war in the early stages. Hospitals may struggle to meet the demand.
4. Transport system of patients who are very critical to hospitals in Israel will be needed.

1. IDF Continues their Plan, They will withdraw in this Phase.
2. Hospitals will be running at normal operations. They will still require generous donations from outside. 
3. Continue the Transport System as long as necessary.