Adult Emergency Room There are no adequate emergency medical services in Ashdod, Israel’s fifth largest city. Ashdod is served today only by Magen David paramedical services with two ambulances, two intensive care ambulances - one fully staffed and the other lacking a physician - and one small night emergency site, all with limited staff and relatively old equipment. Evacuation time to emergency rooms in other cities is unacceptably long when time is of the essence (and also expensive). When someone has suffered a heart attack, a major trauma, a severe head injury, is experiencing severe difficulty in breathing, anytime a patient is unconscious or bleeding severely, the AMC ER will save lives.
The heart of AMC will be the forward ER. This ER will offer immediate care to a variety of medical conditions that demand urgent patient stabilization in response to quickly deteriorating situations due to injury or existing medical conditions. Advanced, digital portable equipment for resuscitation, diagnostic imaging and emergency surgery will be immediately available.
The ER Suite floor space will be divided into four separate major areas, each one with its own specialist teams:

• triage
• general emergency, internal and women's medical services, day hospital
• surgical/orthopedic emergency, and
• ambulatory emergency care (including the cast room, enema room, acute treatment room).

When a patient arrives at the AMC ER the first stop is usually with the Triage Nurse, a registered nurse who has been specially trained to perform a rapid assessment of the seriousness of injury or illness.
The patient or accompanying person will be asked why he came to the ER, what medical problems he has, what medications he is currently taking and if he is allergic to anything. The triage nurse will also take and record vital signs -temperature, heart rate, blood pressure, respiration, pulse oximeter indirectly measures the oxygen saturation of a patient'sblood - and, when indicated, weight.
After the assessment the patient is assigned a triage category according to which patients are assigned treatment priority.
There are five triage categories:

• Triage category 1: need for resuscitation - patients seen immediately. People in this group are critically ill and require immediate attention.
• Triage category 2: emergency - patients seen within 10 minutes. People in this group will probably be suffering a critical illness or very severe pain.
• Triage category 3: urgent - patients seen within 30 minutes. People in this group include patients suffering from severe illnesses, people with head injuries but who are conscious, and people with major bleeding from cuts, major fractures, persistent vomiting or dehydration.
• Triage category 4: semi-urgent - patients seen within 60 minutes. People in this group usually have less severe symptoms or injuries, although the condition may be potentially serious.
• Triage category 5: non-urgent - patients seen within 120 minutes. People in this group usually have minor illnesses or symptoms that may have been present for more than a week, like rashes or minor aches and pains.

After first medical assessment, the patient may be assigned to one of the other ER Suite areas. If for example a bone is broken and no surgery is required, the patient will be transferred to the cast room. Or if stitching of a deep wound is indicated, the on-call plastic surgeon will be contacted to meet the patient in the acute treatment room. The ER will include an observation unit for patients who require relatively prolonged treatment or a large number of diagnostic tests.
Additionally the emergency room will include a section constructed as a protective shelter against conventional, biological and chemical weapons, conforming to the latest requirements of the Israeli Home Front Command thus enabling emergency staff to continue caring for patients regardless of the external security threats. The need for this is being forcefully demonstrated now in Operation Cast Lead as rockets rain down upon the Ashdod Medical Center catchment area.