May 10, 2011
The low-budget rescue team
Are the volunteers of Hatzolah a model for emergency rescue teams as community services shrink?
At 10:32 on a Tuesday morning, exactly seven minutes after he ran out the door of his real estate management office, Steve Fleichman, a volunteer with Hatzolah of Los Angeles, pulled an ambulance up to the front of the Goodwill shop on Beverly Boulevard. Other Hatzolah responders’ cars were already parked outside. Nobody from the Los Angeles Fire Department (LAFD) had arrived yet.
Fleischman, 38, is a broad-shouldered man with a beard and sidelocks tucked behind his ears. He is one of the 86 Orthodox Jewish emergency medical technicians, or EMTs, who work for Hatzolah, the only volunteer ambulance corps in this city. Hatzolah — Hebrew for rescue — is a household name among Orthodox Jews who live in the Hancock Park, Pico-Robertson and Valley Village neighborhoods that the corps serves. But outside the Orthodox community — even among Jews who live, work or worship in those neighborhoods — the group is all but unknown, despite the fact that it just celebrated its 10th anniversary.
The name alone, for starters, trips many people up. All three vowels are pronounced “uh,” with the emphasis placed on the middle syllable. Many people who see the word printed on the side of one of the group’s vehicles think it says “Haz Mat.” Others mistake the name for a terrorist organization. “We got Hezbollah a couple of times,” said Ari Stark, a volunteer responder who also works as the unpaid spokesman for the group.
There is also a perception that Hatzolah, which is run and funded by the Orthodox community, provides its services only to the Orthodox. In fact, the group does not ask for or keep track of any patient’s religion or style of Jewish observance and will respond to anyone who calls its number with an emergency taking place within its coverage area.
Nevertheless, most of Hatzolah’s calls do come from Orthodox Jews. This may be, in part, because the number for the Hatzolah hotline is not listed on its Web site — because, Stark said, of the group’s limited coverage. (It is circulated to the group’s mailing list of about 6,000 only on printed matter and promotional materials, like Hatzolah’s toylike ambulance-shaped tzedakah boxes.)
Stark says that Hatzolah is working to change its image among the non-Orthodox. “We want the broader Jewish community to know that there’s an emergency response service that’s free, that’s all-volunteer, that operates 24/7 and that’s available to them,” Stark said.
There are two situations that could instantly raise Hatzolah’s profile in Los Angeles — and neither is good. The first would be if a major earthquake or other disaster were to hit the city. Hatzolah has been preparing for “the big one” since the group’s president saw how long residents of New Orleans were stranded without assistance in the aftermath of Hurricane Katrina.
The second could arise as early as next week, if the Los Angeles City Council approves Mayor Antonio Villaraigosa’s 2011-12 budget, which calls for a $14 million cut to the LAFD budget — over and above the $66 million reduction in funding it has suffered over the last two fiscal years.
The mayor’s plan allocates $481 million for the LAFD and will permanently eliminate 18 fire companies and four LAFD ambulances. It does not call for any fire stations to be closed, nor will any personnel to be laid off.
But the city has not hired a new firefighter since 2009, and if the plan is approved, 31 stations will see their staff numbers reduced.
At Station 58, on Robertson, south of Pico, two fire engines could be eliminated and station staff halved by July. A fact sheet circulated by the LAFD predicts only a “minimal increase to the average response time.”
Critics of the plan have said that even a minimal increase could cost lives. One firefighter, a paramedic who did not want to be named, warned against thinning the ranks of paramedics available to respond. “The old saying is, ‘Never be the second heart attack,’ ” she said.
Hatzolah, which was founded to supplement existing emergency response coverage, not replace it, has encouraged its supporters to contact their representatives about the proposed cuts at Station 58. But if the budget is passed, and response times do increase, Angelenos will be looking for faster ways to get medical care in emergency situations.
Enter Hatzolah — which answered more than 800 emergency calls in 2009 on a budget of just under $250,000 — thanks to a well-organized group of dedicated, trained and community-funded volunteers who boast an average response time to emergencies of less than 90 seconds. Could a small group like this one — which responded to more than 1,200 calls in 2010, one call for every 625 that LAFD did — help pick up the slack? And could it be a model for similar community-based volunteer emergency response groups?
I met Fleischman early that Tuesday morning at his office on Third Street.
When I arrived, he was juggling a telephone call while checking his BlackBerry. He was also talking with one of his property managers who was about to go out for the day and trying to revive a finicky printer. In the corner of his cramped, windowless office, Fleischman’s brother-in-law was working with data on an Excel spreadsheet.
Despite all the distractions, at 10:25, when Fleischman’s Hatzolah-issued walkie-talkie squealed out an address, he immediately jumped out of his seat, motioned for me to follow and ran out the door.
Although there are Hatzolah chapters all around the world, they’re all independent of one another. In Los Angeles, Hatzolah’s system works like this: Someone experiencing or witnessing an emergency will call Hatzolah’s toll-free number. That hotline is monitored 24/7, including on Shabbat, by any one of about 20 different dispatchers. All of the dispatchers are Orthodox, most of them are women, and every single one has a dedicated telephone line in her home or office to which the Hatzolah hotline can be forwarded. The dispatcher will then relay the message via radio to the responders. Each Hatzolah responder — they are all men — carries a bag of equipment, a helmet and a vest identifying him as an emergency responder, as well as a large, black walkie-talkie. All of the responders are trained, certified and insured EMTs, qualified to provide basic life-support services. And if they’re close by — and they often are — they will respond.
Hatzolah has seven vehicles with decals, lights and sirens — including three ambulances — all of them legally authorized by the California Highway Patrol (CHP) to stop traffic in the same way that any ambulance or Los Angeles Police Department vehicle can. But, today, many Hatzolah EMTs still respond to calls in the same way that they have for most of the group’s 10-year history, driving their own cars and obeying all traffic laws.
At the Goodwill store, Fleischman jumped out of the ambulance and retrieved a spare bright-yellow vest from the back. He handed it to me, and as I put it on, Fleischman spotted another ambulance — this one painted LAFD red — coming toward us from the west.
I followed Fleischman into the store, around the cashier’s counter and into the shoe section where a man in his mid-60s was lying on his back on the floor. The man had fallen, and one of the Hatzolah EMTs had taped up his nose and put something underneath his head.
The firefighters were right behind us and immediately began taking over for the Hatzolah responders. With LAFD in control, Fleischman stepped back from the patient and headed for the door.
Over the course of a day, I accompanied Fleischman on three very different calls. After the Goodwill shop, I watched as one of Fleischman’s colleagues bandaged up a 7-year-old’s head at an all-girls school on Beverly Boulevard, then handed the girl off to her mother with instructions to take her to the hospital to get stitches. And, near the end of the day, we were first on the scene at an apartment in Hancock Park, where we found a 93-year-old woman, a Holocaust survivor, sitting on the floor by her bed, unable to get up. The woman had a history of falling down, and the Hatzolah EMTs who showed up decided that advanced life support was going to be necessary, so they called the LAFD paramedics.
These are not the stories supporters usually tell about Hatzolah. More typically they sound a lot like this one, about Motty Stock and his wife.
In 2003, Stock found his wife, Freda, lying on the floor of their bedroom, but he didn’t just call 911. He also called Hatzolah, and the volunteer responders arrived within minutes, about 15 minutes before the Fire Department did. The volunteers identified the problem — she was having a seizure and choking on her own vomit; they stabilized her and helped save her life. “Thank God I had the Hatzolah sticker on my phone,” Stock said.
Stock told this story to a Jewish Journal reporter in 2004, and again, on March 1 of this year, he retold it at the first-ever gala dinner benefiting Hatzolah of Los Angeles.
Standing next to the Stocks in the dimly lit ballroom were the two Hatzolah responders who had saved Freda’s life eight years earlier. One of them was Fleischman, who had stayed on to look after Motty, even after Freda was safely in the care of the LAFD paramedics.
“‘You have a 3-week-old baby in the room,’ ” Motty Stock recalled Fleischman asking. “ ‘Do you have anything to feed her?’ ”
After helping to save the mother’s life, Fleischman, who today has five children of his own, went out and bought baby formula for the Stocks’ child.
The Stocks’ story illustrates the two most-lauded qualities of Hatzolah responders. The first — rapid response — is at the heart of Hatzolah. The first chapter was established in the Williamsburg section of Brooklyn, N.Y., in the 1960s, when getting an ambulance to arrive could take more than half an hour. Setting up local infrastructure worked remarkably well there, and similar volunteer ambulance companies quickly began springing up in many parts of New York City and its vicinity.
Even in Los Angeles, where the average response time for the first paramedic on scene is just five minutes and 30 seconds, Hatzolah volunteers often arrive more quickly because they live in the neighborhoods they serve.
The second quality — providing sensitive care to members of a community who might otherwise not feel comfortable being cared for by ordinary responders — is, in the minds of many elected officials as well as Hatzolah backers, the primary reason for the group’s existence in Los Angeles.
“The purpose of Hatzolah was — and let’s be clear about this — the original purpose was to provide emergency response with a sensitivity to a particular community from within the community,” Los Angeles County Supervisor Zev Yaroslavsky said.
Yaroslavsky helped set up initial meetings for Tzvika Brenner, Hatzolah’s long-serving president, with city and county fire department officials. “That was the whole raison d’être for this. It was not to duplicate the work of the L.A. City Fire Department and the L.A. County Fire Department,” Yaroslavsky said.
On the four calls I went on — hardly a representative sample, to be sure — the volunteer EMTs seemed phenomenally fast, and they did a good job of being sensitive. But I saw nothing as dramatic as Freda Stock’s life-threatening situation. On one ride-along, I watched Hatzolah responders tend to a young, otherwise very healthy man who had been injured while surfing in Huntington Beach. He called Hatzolah only upon his return home to Pico-Robertson, more than an hour (and a few more waves) after the initial injury.
Despite the situation’s apparent lack of urgency, the Hatzolah volunteers splinted the surfer’s leg and took him in their ambulance to Cedars-Sinai Hospital, free of charge. Had the patient called 911, he (or his insurer) would have been billed the standard fees for the care and transfer — $712 for the same level of basic life support care that Hatzolah volunteers provided at no charge — not including LAFD’s additional charges for supplies used and miles driven to the hospital.
Why did he call Hatzolah? “Because we’re Jewish,” one of the surfer’s friends, who did not want to give his name, told me.
They knew about Hatzolah — but, for the most part, word hasn’t gotten out beyond the Orthodox community, despite the fact that the group spent $29,443 on “Community Awareness Material” in 2009, the largest category of spending that year.
A telephone survey of synagogue staff members at three synagogues in Valley Village showed that while Hatzolah volunteers had been called to the Orthodox Shaarey Tzedek synagogue on more than one occasion (some of the synagogue’s members are Hatzolah responders), nobody in the office of the Reform Temple Beth Hillel nearby had even heard of the group. Neither had Sue Bloom, who has worked for 13 years at Adat Ari El, a Conservative synagogue in the neighborhood.
At Temple Beth Am in Pico-Robertson, Facilities Manager James Collins had heard of Hatzolah in his five years at the Conservative synagogue, but he didn’t have their number. “I’ve seen their units around the area, but I’m not very familiar with them,” he said.
Hatzolah of Los Angeles may be the only Hatzolah chapter in the world with a detailed plan to respond to large-scale emergencies. Even though Brenner helped found the chapter, on a recent Sunday morning he seemed particularly excited to demonstrate this newest aspect of the group’s operation.
Brenner, 59, works for a company that supplies specialty doors and windows to contractors. He moved to Los Angeles from Israel in 1975, and, like many Angelenos, he believes a massive disaster at some point in the future is inevitable. “It’s not a question of if,” Brenner said. “It’s a question of when.”
Brenner calls the dark blue bakery truck parked behind the Yeshivat Yavneh School in Hancock Park a “garage on wheels.” It is stuffed — very neatly — with fold-up cots, medical supplies, generators, halogen lights and large blue plastic drums filled with clean water for washing — everything a group of responders might need to establish a small field hospital.
When a massive disaster hits Los Angeles, Hatzolah will be able to serve 50 patients at a time and will have enough supplies to care for 500 patients in total at the Yavneh School. The organization has at the ready two more trailers with similar materials in Pico-Robertson and Valley Village.
The group has dealt with disaster before: In 2003, Hatzolah volunteers responded to the crash of a light aircraft into a building on Fairfax, and in 2008 they were ready to deploy when the Metrolink train crashed in Chatsworth. But in anticipation of that really big emergency, Brenner and his team will continue to run drills and to check that supplies are up to date and stocked up, just in case.
Frank Quiambao, special adviser to the secretary of the California Emergency Management Agency, is very supportive of the preparatory work Hatzolah is doing.
Should the catastrophic event occur — and, like all emergency preparedness professionals, Quiambao is certain it is only a matter of time before it does — Quiambao said community groups will have an essential role to play.
“We know that public agencies are not going to be able to handle it,” Quiambao said. “They’re going to be overwhelmed, so we have to get organizations like Hatzolah to be equal partners with us.”
As fire chief, Peaks’ job is to figure out how to manage a department of 3,500 firefighters, who in 2010 responded to 795,693 emergency calls, but with an ever-shrinking pool of city funds. “They give me the money, they tell me to manage it, and I manage it the best way that I can,” Peaks said in a recent interview.
Peaks suggested that in a time of budgetary crisis like the one we’re in now, groups like Hatzolah help alleviate some of the increased pressure on public safety agencies. “We were real hopeful that the economy would’ve turned around by now, but the revenues aren’t coming in,” Peaks said. “This partnership is more important now than it ever has been.”
That was in March. In April, Villaraigosa unveiled his citywide budget for the fiscal year starting July 1, 2011, and this one allocates only $481 million to LAFD – down $14 million from the prior year. In response, Peaks has proposed a new deployment plan, which would permanently close 18 fire companies and leave four ambulances sitting unstaffed, in “ready reserve,” at stations around the city.
While LAFD is trying to downplay the impact of budget cuts on response times, Pat McOsker, president of United Firefighters of Los Angeles City, takes a different view of the effect of the proposed closures on patient outcomes. “Lives will be lost because of it,” McOsker told the Los Angeles Times in late April.
McOsker, who leads the union that represents LAFD firefighters, is an outspoken critic of Hatzolah. He worries about a lack of coordination between LAFD and Hatzolah responders, and worked to stop the volunteers from being authorized to drive vehicles equipped with lights and sirens. “I have real concerns about patient care and about the danger of them driving emergency,” McOsker said.
At Hazolah’s gala dinner in March, no such opinions were in evidence, and many public officials said Hatzolah can be particularly helpful in a time of belt-tightening. “We all have a role in lifting up our community in times like these,” California State Assemblyman Mike Feuer said. Feuer helped Hatzolah get permission to use lights and sirens on its vehicles from CHP. “Hatzolah is an important program now. It’s an important program in all times.”
In 2009, the most recent year for which data is publicly available, Hatzolah spent just $233,688 on its operations (yes, that’s thousands). The group has no paid staff; even its bookkeeper and Web designers are volunteers. Most, if not all, of the group’s funds come from individual donations.
Hatzolah responded to about 800 calls in 2009, and it is possible many of those were calls the LAFD didn’t have to get. (Neither Hatzolah nor LAFD keeps track of how frequently the two groups work together.) And cash-strapped cities are now trying to think creatively about how to make use of volunteer workers to do jobs they can no longer afford to pay public-sector workers to do. The city of Redlands in San Bernardino County, for example, was featured in the April 2011 issue of the magazine Governing, in an article titled “Does Government Work Require Government Employees?” The Redlands police force, which has 75 sworn officers, is now aided by nearly 300 active volunteers who manage crime scenes, patrol city parks, write parking tickets and do other assorted jobs once reserved for uniformed personnel.
And although Hatzolah of Los Angeles does not intend to seek public funding to assist in its efforts, other Jewish volunteer ambulance corps have taken public money. In July 2010, the New York Jewish Week reported that Chevra Hatzalah, a volunteer ambulance group in Brooklyn’s Borough Park neighborhood, accepted a $445,000 capital grant from its local New York state assemblywoman. The 35-year-old group, which had never before accepted public funding, used the grant to improve its communications systems.
Hatzolah of Los Angeles cannot replace LAFD, and it’s quite clear that the group wouldn’t wish to. Shortly after the proposed cuts to fleet and staff at Station 58 became public — large red signs in front of the station announce the looming cuts to passers-by — Hatzolah began letting people in Pico-Robertson know about the plan and encouraging them to contact their elected officials.
Whatever the reason, citizens have been calling. As of May 6, City Councilman Paul Koretz’s office had received about 50 phone calls and 25 e-mails about the proposed cuts to service at LAFD Station 58.
“Whoever saves a life, it is as if he saved an entire world.”
Hatzolah supporters often invoke this talmudic saying, and their appreciation for metaphysical math, which equates one life with the world, helps explain why none of the Hatzolah responders I spoke with even brought up the possibility of the group’s impacting the city’s budget.
Ask Hatzolah responders why they dedicate their time and energy to the group, why many of them carry automated external defibrillators — which can restart a person’s heart — in the trunks of their cars, why they’ll get up in the middle of the night or from a Shabbat dinner table to answer a call, and they’ll tell you that it comes from a sincere desire to help, to potentially save a life.
Although many of the responders said that dropping everything to respond is the hardest part of being in Hatzolah, at the end of my day with Fleischman, he told me that if he could, he would train to be a paramedic. “If I felt time would allow, I would go to the next level,” Fleischman said.
And Stark said he is proud to be able to respond to all people in a state of emergency — even those who don’t really know what Hatzolah is, or who don’t see much of a difference between the volunteers and other responders.
“Most people see the uniform, and there’s a sigh of relief,” Stark said. “ ‘Oh, they’re here,’ people say. We get to be the ‘they.’”