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Aim: To describe the feasibility of transfusion of low titer O+ whole blood in a military prehospital setting.

Methods: A case series of prehospital whole blood transfusions performed en route by military paramedics while transporting casualties.

Results: Between March 31, 2022 and December 31, 2022, 13 units of whole blood were administered. Ten units were transfused due to an indication of severe hypovolemic shock, while three units were administered as part of our trauma loss of life resuscitation protocol. All transfusions were performed according to our protocol and no adverse events were observed.

Conclusions: Prehospital whole blood transfusions by military paramedics are feasible. Preliminary findings demonstrate a favorable safety profile.

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Operation Break the Wave, which was initiated in March 2022 and lasted approximately one year in the
Central Command sector, presented unique mental health challenges and demands for resilience among Israel Defense Forces )IDF( soldiers and commanders. This operation involved continuous security threats and instability, exposing personnel to operational incidents that sometimes resulted in casualties, task overloads, personal safety concerns on travel routes, and uncertainty regarding the duration of the operation. These conditions necessitated a dual response: command-leadership and mental health interventions at both individual and systemic levels.

The IDF has established protocols for immediate group interventions following traumatic events, commonly known as "group questioning", led by trained commanders. This protocol aims to mitigate stress reactions, support continued functional operation, and decrease long-term morbidity risks. Additionally, for cases of stress symptoms that persist weeks or months post-event, ongoing interventions have been developed. These are co-led by organic commanders and military mental health officers, and focus on emotional processing of events and leveraging group support.

This paper details 12 such interventions conducted during Operation Break the Wave with units frequently exposed to traumatic scenarios, including medical teams, female observers and operations sergeants, and special combat unit soldiers. The prevalent emotional responses identified were anxiety, a profound sense of responsibility, guilt, and signs of "moral injury". The findings underscore the critical need for organizational support post-trauma and psycho-educational training to manage stress responses effectively.

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Introduction
March 31, 2022 marked the beginning of the Israel Defense Forces operation Break the
Wave. During the operation, a significant increase in the number of military incidences
was observed throughout the West Bank. The current study aimed to evaluate the
effect of the operation and the concurrent increase in military activity on the medical
teams deployed and medical care provided.

Methods
A retrospective cohort study. Data were extracted from the Israel Defense Forces
Trauma Registry. All patients treated by IDF medical teams within the Judea and
Samaria division were included. Demographics, injury characteristics and information
on the medical care provided were compared to controls (injuries during the year
preceding the operation within the Judea and Samaria division, as well as patients
from other regions during the same period).

Results
During the first year of operation Break the Wave, the number of trauma patients
increased, with 800 patients requiring medical care compared to 582 patients during
the preceding year. For patients suffering injuries in a military scenario, there were
more penetrating injuries, with 140 (80%) patients suffering penetrating injuries
compared to 92 (66%) during the preceding year (p=0.011). There were no significant
differences in the interventions performed.

Conclusions
While the results of the current analysis indicate several differences in the number of
injured patients and injury characteristics, the variances are within a narrow range.
The differences observed suggest that for this specific region, long-term force buildup
and training can be planned based on data derived from ongoing routine security
missions.

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Introduction
Operation Break the Wave was initiated during March 2022, resulting in a significant
inflow of military forces into the territory protected by the Central Command.
Goal and methods: Examine trends in the requirement for dental emergency treatment
during this period of increase in soldier population in the Judea and Samaria area,
followed by an increase in military and civilian trauma injuries.

Methods
Data were retrieved from the computerized dental files, and prevalence of dental
emergencies as recorded by dental practitioners was collected between March
2022 and March 2023 (operation Break the Wave) and compared with the same data
collected in the preceding year. Data regarding the nature of the treatment performed
were also collected (extraction, restoration etc.).


Results
The overall prevalence of dental emergencies recorded by dental practitioners in the
IDF and in Judea and Samaria was similar in both periods of time examined; however,
an increase in dental emergencies was recorded in the central dental clinic. A twofold
increase in the amount of dental trauma was demonstrated in the central dental clinic
during the operation in comparison to the previous year.


Conclusion
Increasing military forces did not necessarily increase dental emergency needs, since
the intensive nature of the operation made it very challenging to get immediate
dental treatment during Break the Wave. This effect may explain the increase in dental
emergency treatment in the central dental clinic, since it is more likely to be attended
on the way home or to the base.