JMIR Publications

ABSTRACT

Background:

Managing Mass Casualty Incidents (MCIs) during active warfare environment presents unique challenges, including operating under extreme uncertainty. Traditionally, emergency communications rely on strict, hierarchical channels from pre-hospital services to receiving hospitals. However, informal digital communication streams, particularly instant messaging applications like WhatsApp and Telegram, are increasingly utilized within medical workflows. Despite international interest in public social media during disasters, empirical research regarding how hospital leadership echelons utilize informal messaging tools for real-time operational and clinical decision-making during active warfare remains sparse.

Objective:

To characterize the adoption of social media and instant messaging platforms as early information sources among hospital based MCI managers during wartime, and to evaluate their specA multicenter, cross-sectional study was conducted using a structured questionnaire distributed across all 24 national medical centers authorized to receive MCIs during wartime in Israel. Target respondents encompassed diverse leadership echelons, including Emergency Department directors, trauma service directors, trauma coordinators, charge nurses, emergency team members, and hospital executive leadership.ific impact on real time operational and clinical decision making.

Methods:

A multicenter, cross-sectional study was conducted using a structured questionnaire distributed across all 24 national medical centers authorized to receive MCIs during wartime in Israel. Target respondents encompassed diverse leadership echelons, including Emergency Department directors, trauma service directors, trauma coordinators, charge nurses, emergency team members, and hospital executive leadership.

Results:

Overall, 76 medical professionals (N=76) representing key decision makers across national receiving centers completed the survey. WhatsApp emerged as the most frequently used platform (median 3.0, IQR 2.00–4.00). Although these informal channels provided rapid initial intelligence, 65.3% of respondents encountered false information during emergency events. Consequently, 81.3% reported routinely verifying social media data against official channels before executing major actions. Structurally, multivariate regression analysis revealed distinct pathways of influence: higher platform use intensity was strongly and independently associated with enhanced situational awareness (p=0.002) and greater operational decision-making influence (p=0.019). In addition, participants' level of trust and reliance was associated with clinical decisions (p=0.014) and real-time team management (p=0.025). Furthermore, active platform engagement during live threat conditions positively correlated with heightened situational awareness during missile launch alerts (p<0.001) and missile fall alerts (p<0.001). Platform utilization and trust behaviors remained consistent across years of professional experience, qualifications, and executive roles.

Conclusions:

Informal digital platforms, dominated by WhatsApp, serve as vital, rapid early information channels for hospital MCI leadership during wartime emergencies. While usage intensity directly enhances situational awareness and operational control during active missile threats, clinical and team management actions remain strictly contingent on trust. Given the high exposure to unverified data, formalizing structured verification protocols and incorporating informal digital communication strategies into hospital disaster preparedness frameworks are essential to optimize real time decision making in future large scale health emergencies.