Lieutenant Colonel Dr. A. was discharged after 77 active days of reserve duty. A doctor, an Air Force man through and through, he has served in the reserves as an airborne physician in the Search and Rescue Unit, Unit 669, specializing in evacuating the wounded under fire. He documented the war and his brave actions in a wartime diary.
Lt. Col. Dr. A. specializes in two fields and holds a senior position at one of Israel's leading medical centers. He is believed to be the doctor with the highest academic credentials among all the physicians who have participated in the Gaza war so far. Every day, he treats countless patients, teaches students, trains residents, and serves as a role model for young specialists, conducting numerous research studies and publishing scientific articles.
On October 7, Lt. Col. Dr. A. reported for reserve duty. "We're entering an event we've never experienced before," the unit commander told them then. But as a doctor who has treated hundreds of casualties to date, including children, he thought he had seen it all. This war hit home when a family member was murdered in the Nova music festival, and when one of his patients was abducted by Hamas. Before the war, he separated his professional life from his personal life, but the war brought that wall down.
And so, almost every night, initially during training and later during operational activities, he kept a journal on his smartphone. He knows this is his way to vent, his way to cope with the horrors of Hamas, with all the evil. After 77 days of reserve duty, he returned to his work at the hospital. We present his diary in his own words.
'Whole Blood - War Diary'
October 9
Israel. The southern settlements along the Gaza Strip border. A diabolical group visited there.
Three days and I'm already drafted and still can't process what happened here.
I arrived on the afternoon of October 7. The teams were already in the air. They have been experiencing hell incarnate for the past two days. The unit evacuated more than 200 wounded from the Gaza border area. For a helicopter unit, this is an unimaginable number of evacuations. The teams had no time to breathe.
An endless stream of civilians and soldiers was flown from the carnage to hospitals. The wounded were loaded onto helicopters almost like in a moving picture, taking off, landing, and back again. We had to adhere to the trauma medicine basics, ensuring an open airway, breathing, circulation (normal blood circulation, pulse/blood pressure), and bringing the wounded to the trauma room as quickly as possible. And the wounded did not stop coming.
There was a terrible massacre of innocent civilians - women, children and the elderly - in the south. And there are hostages. But we are Israelis, we must somehow overcome this, survive, dream of peace that may never come. We have children to raise, grandchildren. Will there never be another Holocaust? Never again?
October 10
I last saw Orel, a close family member, at the family holiday dinner on Rosh Hashanah. Only 20 years old, a young man, left the holiday dinner earlier to meet friends. His mother stayed to chat with us even after he left. Orel was at the Nova music festival on Black Saturday, where more than 250 youths were killed. His mother hasn't found him since. She has already checked all the hospitals in the south of the country to see if anyone has seen him. God help us.
October 11
Yesterday I found out that among the captives is also R., who was a patient in my clinic as a child. Her smile under her tangled hair and the thoughts of what her parents are going through do not leave my mind. The nights are getting longer for me. Angry at my country for breaking its most important moral code of existence – protecting children. At night I can't stop thinking about children and our commitment to protect them.
October 12
Six days have already passed since I was called to the reserves. Everyone has arrived. Salt of the earth. From the center, from the periphery, right-wingers, left-wingers, religious, secular, Bibi haters, Bibi lovers, everyone. Full of Israeli determination.
Most of them sleep on mattresses in the sports hall of the base. I could have gotten a normal room on the base, but I feel much more connected to reality here, in the hall, with all the guys.
October 14
It's been eight days since being called to reserve duty.
I am proud to serve as a combat physician.
I left everything behind. Shifts, schedules, meetings, research. My research projects are stuck, an important research grant probably went to waste because I'm stuck here.
My absence from the hospital, it seems it will be long and significant. Such a shame, I had so many plans. In this country, all plans are backup plans.
October 15
Medical work in the helicopter is mainly technical despite being a type of mobile intensive care unit. The emphasis is on stopping bleeding, oxygenation, perfusion and maintaining an airway, opening fluid pathways. Whole blood has been proven to be the most effective treatment for trauma patients in a state of hemorrhagic shock.
Quite amazing:
This is the first war where we treat patients in a state of shock with whole blood. A unit of whole blood contains all components of blood, as opposed to blood units that were conventionally given in these situations and contained only red blood cells (RBCs), without the other blood components.
New studies, particularly in recent years, have shown with high evidence that treatment with whole blood is preferable to treatment with RBCs alone, and therefore the IDF, rightfully so, rushed to implement it, pushed by the chief medical officer whose expertise lies in this field.
There's no doubt. In the impossible situation of 10-20 minutes of intensive care in a cramped space, in the skies, whole blood is a "game-changing therapy."
October 16
Advanced simulation training is the basis for quality emergency medicine. For three weeks now, we have been training daily: Buddy drills on the ground. Transfer and information acquisition during flights. Proper placement of IV lines. Mission-oriented information, confined space drills, full trauma team drills, specialized trauma team management, airway management in low-light conditions, short flights, long flights.
Procedures like chest tube insertion, intramuscular injections and needle decompression are just part of the medical procedures we train on daily. We are ready for any scenario. Ready to give everything to our future patients.
Working in pairs: treatment, two patients lying down, three, treatment during descent, and again - buddy drills, procedures, mass casualty incidents, cases and responses. And at the end of each day - debriefing and more debriefing, cases and responses, and endless command meetings for daily lessons learned.
October 17
Yesterday I spoke with a younger doctor for a long time. He's younger than me, relatively experienced in treating shock patients from road traffic accidents in the emergency room of a hospital, but less experienced in treating combat casualties. The conversation continued until the small hours of the night, long hours.
He spoke confidently but stopped abruptly at times. Struggling. On that cursed Saturday, he was on the base in routine reserve duty and was therefore among the first to deal with evacuating casualties from the combat zone.
30 seconds. That's the maximum time we can spend on the ground.
He talked about seeing dead parents lying on their dead children. Dozens of cars with bodies of parents who tried to shield their children. The images are running through his head and he can't sleep. Both the parents and the children were hit by countless bullets. Bodies of children burned inside cars that were set on fire while they were in them. Unbearable. "The mission was to locate and treat the wounded," he said, "I didn't find one wounded, just bodies of children and parents. And blood, lots of blood. Have you ever seen anything like this?" he asked. "Let's go to sleep," I replied.
October 18
Today, Orel's mother was informed that he is no longer "missing" because his body was found. The girl from my clinic is still a hostage in Gaza. It's impossible to contain it anymore.
November 1
In combat medicine, the goal is to reach every casualty within minutes. Saving the lives of the saveabl;e injuries. Most casualties are savable, meaning that rapid and proper treatment of their injuries can save them. But not all. And it's important to know that, important to remind ourselves: there are injuries that even the fastest medical treatment in the world cannot save.
The current war is different from previous conflicts. We manage to reach the wounded very quickly, sometimes right in the ongoing skirmish, sometimes we even hear the shooting and the sounds of battle on the helicopter's communication network. My feeling is that the medical teams' arrival and work in the field are very efficient. The wounded arrive quickly at the hospitals. Sometimes less than an hour from the time of the injury. The IDF is probably the only army in the world that knows how to do this.
November 3
The basics of managing severe casualties at the pre-hospital stage is recognizing the physiological condition of the casualty. Only then can the required treatment be prioritized, and only then can lives be saved. But it's not always straightforward in this type of practice of medicine that is required of us. I'm trying to pass on professional tips to young doctors from what I know from civilian life: How to conduct a rapid casualty assessment, what to look for, what to pay attention to, how vital signs fit into the picture.
"Airway-Breathing-Circulation." It's crucial that vital organs (brain, heart, kidneys) receive oxygen, and it must be ensured that this happens. Effective management of shock resulting from blood loss is a critical factor in saving casualties. Medical teams in the field save casualties by stopping bleeding - we, in the helicopter, ensure that bleeding is indeed stopped, that there is no new bleeding, and that we deal with the state of shock by administering whole blood during the flight.
November 6
It's been over a week since ground forces entered Gaza. Many casualties. All the ambulances have already been extracted from the area. And the harder it is in training, the easier it is in combat. 30 seconds. That's the maximum time we can spend on the ground. The communication between the helicopter-medic team and the field team is super efficient. We've worked on it, and there are results: landings, smooth insertion, aggressive approach, medical work in tight quarters.
Helicopter evacuations significantly shorten the time from injury to trauma room arrival, and the training truly proves itself: starting treatment within seconds of casualties being loaded onto the helicopter, identifying the physiological condition, and intervening correctly.
Proper airway management (more stringent than before), giving whole blood. We see and feel that giving whole blood stabilizes and significantly improves the chances of survival. It's symbolic that whole blood brings casualties back to life.
November 17
Day 20 of the ground invasion.
The years have shown me that the daily test of a doctor is not necessarily the complexity of the medical case. The injured person brought into the helicopter is a tank commander. Opening an axis in the streets of Gaza, first tank after the bulldozer. Injured by an RPG, caught shrapnel. Initially treated on-site. Fully conscious, shrapnel mainly in the limbs. Regular bleeding control inspection. Oxygen, open vein. Sedation, more sedation, a lot of sedation. This is a big part of our role.
2 View gallery
Injured soldiers evacuated in helicopters to save more lives
(Photo: IDF Spokesperson's Unit)
Life has taught me that with the conscious injured, eye/hand communication is just as important as devices, medications and procedures. His hands and eyes and mine were talking, and you couldn't miss that his eyes were studying me, trying to understand if I was worried or how stressed I was. I signaled to him with my hand in "divers' communication" that everything is fine. He smiled out of the corner of his mouth under the oxygen mask. "I'm a Moshavnik," he muttered under the dust on his face and sent me a look of thanks.
Back on the return flight, I fell asleep. I dreamt about his worried parents and about picking tomatoes in the moshav. About the red of the tomato, and about the red of whole blood.
November 18
Luck.
In war injuries, luck is needed. A lot of luck.
This morning we treated a soldier with a chest injury. You could clearly see an entry wound above the rib, but there was no exit wound on the back. He arrived with stable vitals to the trauma room. In CT, it was found that the bullet's trajectory passed millimeters in front of the main arteries and was located in the abdominal cavity. He was millimeters away from certain death. On the way back to the base, I fell asleep again, like in the middle of a movie. I dreamed about this soldier, who not long ago was a high school student and now he'll have a scar along his abdomen, a "souvenir" from what he experienced here.
November 20
I'm living in a movie, a bad movie that never ends. The girl from my clinic is still held hostage in Gaza. She has two more sisters and a brother, all were treated in my clinic. I know her mother well, torn with worry; I see her being interviewed on every media channel, hoping for her daughter's return. I follow her through the TV screen. Her pale face, pleading, saying everything. Bring her back to me.
November 21
The soldiers' parents are the real heroes here. I evacuated four injured soldiers from a mortar bomb attack. All of them are stable, just simple injuries, a breeze for the field force. They only needed initial assessment and monitoring. Easy transfer to a hospital in the center of the country.
After transferring the wounded, we stood in the inner corridor near the trauma room, preparing to return to the helicopter. At the end of transferring the wounded to the trauma room team, suddenly the door opened and the head of an older man appeared, asking, "Has soldier R. arrived here?" The security guard at the entrance to the trauma room escorted him out politely, but I understood immediately. I've seen such faces hundreds of times in my professional life, the face of a parent facing the worst nightmare. I approached him and introduced myself as the doctor who treated his son. I explained that although his son underwent initial assessment in the trauma room, there is no concern for his life. I assured him that I would update him after the CT scan, which indeed showed no significant injury. The relief that washed over his face said it all.
I hugged him. I apologized. In my name, on behalf of the trauma room team, on behalf of the helicopter team, on behalf of the country.
On the way back to the base, I thought about this father and thanked God that I don't have a son who is now in Gaza.
December 10
The night before, we evacuated a severely wounded soldier. A gunshot wound. Unstable. In the helicopter, we performed urgent procedures, including medication, airway management, and giving whole blood. The team's work was amazing. Minutes after our arrival, he was stable enough for emergency surgery. During surgery, the bullet was removed from the abdominal cavity, and the injured was out of danger. Another proof that the training paid off, tremendous satisfaction.
December 12
Two wounded soldiers are brought into the helicopter. The examination in the helicopter does not show life-threatening injuries. I work on both of them almost at the same time. Mostly shrapnel injuries to the limbs. One of them has a tourniquet on the left arm. In the heat of battle, the injured soldier did not realize that something to stop the bleeding was applied to his artery. "I can't feel my left hand," he tells me. "Is my hand gone?," he asks in a muffled voice.
"You have a tourniquet on your arm," I explained to him. "Sometimes you don't feel the limb because of it. Don't worry," I smiled, "you have a hand, and soon we'll remove the artery tourniquet from you." I lifted his hand towards his face so he could see it. "You'll be okay," I said to him with my eyes. He calmed down and smiled. I explained that we prefer to remove the artery tourniquet in a controlled manner at the hospital, so it will be done in the hospital and not in the helicopter. It will take a few more minutes.
December 14
There are many wounded. Some of them are deeply engraved in my memory. A young soldier with a terrifying injury. The bursting hemorrhages were stopped by correct actions in the field. The most accurate. A successful surgical airway opening was performed. He receives two units of whole blood in the helicopter. For a moment, it seems that he's stabilizing. We land in the hospital with reasonable vital signs. We enter the trauma room. The trauma team's treatment is highly optimal: He immediately starts receiving blood units rapidly through a central vein. Another chest tube insertion is performed. There are no leaks from the chest tubes, no intra-abdominal bleeding in the ultrasound scan. Within minutes, blood pressure drops dramatically.
The treatment fails. I received the news of his death from the hospital's trauma unit manager. The feeling is tough. Losing an injured person you treated in a helicopter is not like losing an injured person you treated in a hospital. In the helicopter, the feeling is that every soldier is a family member, one you always knew. It turns out that his assessment showed he wasn't saveable. This fact is somewhat comforting. What is mainly comforting is that he did not suffer. That's what I believe.
December 16
Yesterday, on the flight back to the base, I fell asleep again. I dreamt that the country came back. I dreamt of the blue that is seen from my home window near the beach, and the sun, the yellowest in the world. I dreamed that R.'s curls were fluttering on the beach, and our Orel was spending time with friends over a beer.
And there are no sad mothers, no worried fathers, and no blood on the helicopter floor.
Hilla Alroy is a health correspondent on Channel 13
First published: 19:52, 03.25.24