Emergency care and combat often meet in the world of military medicine, and every minute can make the difference between life and death.

Lt.-Col. Dr. Gilad Twig, outgoing chief medical officer of the Gaza division, told JNS about the latest techniques the Israel Defense Forces Medical Corps is employing to get its personnel ready for some of the toughest situations imaginable.

Twig has also served as a combat battalion doctor for many years. He was the doctor of the secretive, elite Shayetet 13 naval commando unit. For the past 18 months, he has been deployed on the Gaza border, where he has been helping to get the Gaza division better prepared for providing medical care under fire.

“The past 18 months have been the most significant time that I have served,” Twig told JNS. “The division is located very near to the Gaza Strip, with all of the implications of being in close proximity to Hamas,” he said. “But it also lives and breathes the civilian communities in the Gaza border area. This was a great opportunity to see the creativity of these communities and to view just how significant the military’s role is here.”

Twig described some of the training programs he oversaw to ensure readiness for combat situations, which can break out at a moment’s notice, as recent incidents have shown. Four IDF soldiers sustained injuries—two of them serious—when a bomb hidden in a flag mast planted on the border blew up on Feb. 10. Armed Gazan factions are active on the other side of the border.

The division must be able to deal with a big incident leading to multiple injuries. At the Re’im base in Israel’s south, the medical corps created a learning and simulation center, where army medics and doctors study past incidents to better apply military medicine.

From stopping blood loss to remaining functional while giving first aid under enemy fire, training focuses on a number of key acts that “we do as soon as we can to save lives,” said Twig. “We first move the injured to a place that is more secure [from enemy fire]. Then we try to stop the bleeding in all sorts of ways. We do this quickly, based on the understanding that an incident can catch us in a hostile environment.”

However, he added, “we do not only prepare for catastrophes,” referring to the need for routine medicine year-round for soldiers hard at work along the Gazan border. “We transported more than 400 patients to clinics over the past years.”

While training through various scenarios, Twig’s department films the medical personnel with four different video cameras. Then they go to an inquiry room to see how they performed. When they watch videos of themselves, Twig said, they become their own “best critics” and their own most effective trainers. Even highly trained and experienced military doctors often see themselves from the side for the first time this way, he said.

“This makes the learning process very clear and very simple. Someone can see that during the simulated incident, they don’t strive to engage [the patient] as much. They will see this much more clearly than if someone tells them,” he explained. “This reflects the level of performance much more clearly during incidents.”

Twig added that this type of learning experience is both intense and formative.

To date, some 300 medical personnel have passed through the training and personnel center over the past four months. “Some came especially to train here,” noted Twig. “Some are members of special forces. We trained medical crews belonging to the [IDF’s] commando brigade twice.”

Twig’s unit also trains medics that are part of armed civilian-response teams located in Gaza border communities, known in Israel as “Readiness Squads.”

“They represent the first response to every incident,” said Twig.

In addition, breakthrough treatments have begun entering service. Some were used for the first time during the summer 2014 conflict with Hamas. Others arrived afterwards. These include new, powerful painkillers, more advanced arterial tourniquet (devices for restricting heavy bleeding from arteries) and new military ambulances for evacuating the wounded out of combat zones.

The ambulances come with advanced vital-sign monitors. “It is very important for us to get the wounded into hospital as soon as possible,” said Twig. “The new ambulances are much faster and roomy inside. They are of the highest standard.”

The officer said that “without doubt, there has been a big step forward. We expect that the evacuation process will take less time. The main prerogative is getting the seriously wounded to hospitals as soon as possible.”

Aside from military trauma care in the field, the IDF Medical Corps has also launched a transport system for soldiers who need to receive routine medical care, but who are located in far-flung bases. Without the transport, soldiers could spend most of a day getting to and from a 40-minute physiotherapy session.

According to Twig, this “helps the soldiers’ commanders evade logistical headaches.”

And once a soldier comes in for physiotherapy, which is a common need, “we see what else we can provide for them since they are already at the clinic,” he said. Examples include using the opportunity to provide dental care.

Asked to look back at his time as the doctor of the famous Shayetet 13 naval commandos, Twig noted that “this is a unit that faces very significant challenges, and which operates in the air, sea and ground. The challenge for doctors is knowing how to adapt and building medical responses that suit these things. These are very different needs. Injuries from the battlefield or from training can be very complex. I can say that it was a big privilege to serve there—and a big challenge.”