JERUSALEM -- As a surgeon at Tel Aviv's Sheba Medical Center, Dr. Raphi Walden has treated hundreds of victims of violence, but he remembers Monique Goldwasser presenting him with "a real nightmare."
Injured when a Palestinian drove into pedestrians at a bus stop Feb. 14, the 19-year-old Israeli Army corporal arrived at the hospital with abdominal injuries, a broken pelvis, a broken leg, deep cuts and bruises to her head and bleeding inside "from everywhere."
Over the next 11 hours, Walden supervised five teams of doctors who tried to stop the bleeding, repair her internal organs, mend her hip and leg and, finally, perform plastic surgery on the young woman's face. A month later, she's on the mend.
As a surgeon at Jerusalem's Augusta Victoria Hospital, Dr. Jawad Sinokrot had likewise treated many injuries, suffered by Palestinians. But when he saw a 32-year-old man with an abdomen torn by Israeli gunfire, he tried something new. Using his training in laparoscopic surgery, Sinokrot found and treated a kidney torn by a rubber-coated bullet. The patient, a Muslim who had been kneeling in prayer before the shooting, survived.
The current Israeli-Palestinian conflict might not make medical history, but on both sides, doctors, nurses and emergency medical technicians are pushing the limits of their skill and ingenuity, writing a new chapter in the annals of emergency response.
From ambulance drivers maneuvering around roadblocks and coping with hysterical crowds to surgeons prying bullets from brain tissue, the two medical communities have settled into a combat mode, fusing past lessons with new techniques to undo the damage wrought by snipers and suicide bombers.
At least 11,772 Palestinians and 779 Israelis have been injured since violence erupted in September -- in addition to the 342 Palestinians and 64 Israelis who have been killed, according to the Israeli human rights group B'tselem. Most of those injured have required at least a brief visit to a hospital.
If a person is unlucky enough to fall victim to an attack, his chances of surviving might be greater in Israel than anywhere else in the world.
When an explosion shook the Israeli town of Netanya this month, scattering body parts across the pavement, the doctors and staff at nearby Laniado Hospital knew what they had to do.
On cue, students from the ultra-Orthodox Sanz Yeshiva next door pulled aprons over their black coats and began working as hospital orderlies, pushing stretchers. Two doctors took up position at the ambulance entrance to perform triage, steering patients to different sections of the hospital depending on the severity of injury.
Avinoam Skolnik, 55, the hospital's medical director, presided calmly. "I'm like an old mechanic who raises the hood, looks inside and knows what to do," says the one-time medical officer in a paratrooper unit.
The spirit of improvisation, so prized by Israel's military in wartime, doesn't work when it comes to mass medical emergencies, Skolnik says. Israel's hospitals now follow a precise American-inspired protocol, with regular drills, to prepare for everything from bus bombings to poison gas attacks.
The protocol stresses "the golden hour" -- the first 60 minutes after an injury -- that can spell the difference between survival or death, depending on how medical teams respond.
The rules also dictate which patients get priority. If someone's chances of survival are only slight, "you don't waste too many resources to deal with them. ... Otherwise, you would spend all your resources and cause harm to those who could be saved," Skolnik says.
In the operating theater, improvisation is part of a day's work. "The first challenge is to find out what's wrong. And sometimes there are surprises," says Walden. Then decisions are made on what to treat first. In Monique Goldwasser's case, it took four hours and the aid of clotting drugs just to control her bleeding.
"You need to be very thorough and very meticulous," says Walden, 58, chairman of surgery at the Sheba Medical Center.
Palestinians, having learned from the 1987-1993 Intifada, also stress the need to stabilize patients immediately after injury. They have 70 ambulances and 17,000 emergency technicians, 5,000 of them trained since the outbreak of the uprising.
Where bloodied youths once were hoisted on friends' shoulders and roughly hauled to taxis, Palestinians now try to keep ambulances waiting near the scenes of clashes, stretchers at the ready.
"Our first-aid teams are the most experienced in the world in treating tear gas," says Mustafa Barghouti, director of the Union of Palestinian Medical Relief Committees.
But from this point on, the logistics get complicated. Israel has maintained roadblocks throughout the territories, frequently severing parts of the West Bank and Gaza Strip.
With few major hospitals, the Palestinian Health Ministry hastily converted small primary-care clinics into full-fledged hospitals, and set up several field hospitals in tents in the West Bank.