July 11, 2012
Israel’s fast, free and innovative way to save lives
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The nature of the emergency sets the rules of conduct: “Hatzalah first responders from the Charedi community know how to respect this kind of job. They are allowed to drive on Shabbat, take care of women; it’s all for medical reasons, according to the Torah,” Beer said.
First responders also act according to their level of medical training. A paramedic, certified after two years of rigorous instruction, can perform life-saving techniques ranging from intubation (inserting an airway into a patient’s trachea to aid in breathing) to administering medications or performing field operations. Medics, on the other hand, are permitted to perform any external functions, including defibrillation and compressions and administering oxygen.
How they get the call, however, can be confusing — and Beer points to problems and rifts in Israel’s emergency response system that, ironically, United Hatzalah’s very success has revealed.
Each of Israel’s different rescue organizations and agencies has its own emergency phone number — including United Hatzalah, MDA, the police and the fire department. MDA operates Israel’s 101 emergency number, and its dispatchers send ambulances to the scene of an accident or medical emergency as the calls come in. United Hatzalah, on the other hand, uses 1221 — which has to be called independently. Many people in need call more than one number, because they are familiar with them through advertising or through word of mouth and believe that by calling two they can decrease the response time.
Competition between the two organizations further complicates some emergencies. This is where the miracle of Israel’s emergency response innovation turns messy — and, some would say, very Israeli.
Magen David Adom (Red Shield of David) is the grandfather of Israel’s emergency medical services. It was established by law in 1939, and recently it became the country’s official associate of the International Committee of the Red Cross. MDA’s size dwarfs all of the emergency medical organizations in Israel, with 1,880 full-time staff, 800 ambulances, more than 14,000 volunteers, 5,000 youth volunteers and 3.000 first response teams, including 150 motor bikes. It is also the guardian of Israel’s blood supply, according to a spokesman.
MDA’s annual budget is nearly $179 million, according to MDA spokesman Zaki Heller. Most of it is raised through Friends of Magen David Adom organizations around the world.
“The [Israeli] government purchases services [and] supplements costs for ambulances to boost their presence in sensitive areas like the northern border,” Heller said, adding that the government also pays for “extra checks on the blood, beyond what we require.”
United Hatzalah defers to MDA when an MDA ambulance arrives. But Beer maintains that MDA has been taking steps to prevent other organizations from responding to its calls, including instituting measures to prevent locations from being read off of pagers and disciplining its members who cooperate with United Hatzalah.
“Up until a few years ago, all of our EMTs [emergency medical technicians] and paramedics received all of our emergency calls from MDA,” Beer said. “Since United Hatzalah became a national organization, in order to stop our ability to expand, MDA disconnected hundreds of our volunteers from the ability to receive their emergency calls. The Ministry of Health instructed MDA to connect all of our volunteers to continue to get our emergency calls, [but] unfortunately they have still not done so.”
MDA spokesman Heller told The Media Line that MDA does not recognize Hatzalah, because MDA is denied the access necessary to certify that Hatzalah’s volunteers’ training and equipment measure up to MDA standards. He said that MDA works exclusively with its own volunteers to aid in emergencies, and he accuses Hatzalah of sometimes homing in inappropriately on MDA calls.
Dr. Michael Dor, head of the General Medicine Division of the Ministry of Health, was emphatic that MDA does not have jurisdiction to be checking other organizations. “That’s the ministry’s job,” he said.
“We have 7,000 volunteers,” the MDA’s Heller said, “and we give them a MIRS [communicator], and that’s how we call them. They [United Hatzalah] are pirating with some eavesdropping method to intercept our messages — in simple words, they are stealing our messages that we are dispatching to our 7,000 volunteers and are reaching these sites by eavesdropping or wiretapping or whatever you call it. They listen to our beepers, and that’s how they arrive. It’s not as if I’m sending them.”
The competition becomes intense at times, particularly because a first responder on a motorbike so often arrives before an ambulance, according to Beer. He said that in many cases, people call both MDA and United Hatzalah, and in other cases, a volunteer with United Hatzalah has access to an MDA pager and has relayed the call to other United Hatzalah volunteers.
Israel’s official policy is for organizations to cooperate when arriving at the same situation, according to the Ministry of Health’s Dor.
“The calls are directed to MDA, and they are in charge of the treatment. If Hatzalah gets there first, they can do the treatment until MDA arrives. Training for volunteers is a function of the Ministry of Health,” Dor said. “Both organizations are excellent, well-trained and dedicated.”
Hatzalah’s medical adviser is Hadassah Hospital’s Dr. Avi Rifkind, who through the Second Intifada — a period of unbridled Palestinian violence against Israeli targets between 2000 and 2005 — became Israel’s face of emergency medicine.