July 11, 2012
Israel’s fast, free and innovative way to save lives
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Questions of cooperation and competition between Hatzalah and Magen David Adom bring home the issue of whether Israel should institute a single, all-purpose emergency number in the image of America’s 911, or if the public is best served by having two or more numbers so the patient can choose a rescue organization.
“This question has been discussed on a number of levels of the government,” said MDA’s Heller, “and the decision was against unifying these emergency numbers. MDA’s opinion, and it is not according to the quickness of the response and the medical instructions, is that there is not to be a unified number.”
Other experts interviewed by The Media Line, including the Ministry of Health’s Dor, were unanimous in expressing preference for a single-number system.
“The ideal is one number for everyone.” Dor said.
Dr. Arye Eldad, a member of Knesset who served as surgeon general of the Israeli army from 1997 to 2000, told The Media Line, “One number is very much needed … [it’s being prevented by] political organizations trying to preserve their power.”
Asked if a single number is preferable, Dr. Jacob Assaf, head of Hadassah Hospital’s Center for Emergency Medicine in Jerusalem, was adamant: “Do you remember you’re in a Jewish country? The police, fire brigade, Hatzalah, MDA, Natali [the ambulance service that provides first aid in Israeli schools] all have different numbers. The answer is yes. If I could fulfill my dream with EMS, we would have one response center, one dispatch center … that can work with 20 organizations — some professional, some private, some national and volunteers.”
Riding with Hatzalah
I spent an evening going on calls with Hatzalah to witness how the system works. My shift began at 5 p.m. on a Thursday afternoon at a warehouse building housing the Jerusalem dispatch center. It’s a small room with multiple computer screens displaying feeds from cameras perched along roadways throughout the country. The space also houses hundreds of thousands of dollars worth of state-of-the-art lifesaving equipment.
Within minutes of my arrival, a dispatch call set us on our way: “Grossberg Street, difficulty breathing.” I traveled with three medics to the scene by ambulance [United Hatzalah owns several ambulances], and we proceeded to climb the steps of a third-floor walk-up, to an apartment where a 94-year-old woman was short of breath. While medic Chaim Attias checked the woman’s blood pressure, Yehuda Goldberg checked her pulse, and Matan Nitsky reviewed her medications. Ruling out a stroke, heart failure, blood pressure complications and neurological disorders, they administered oxygen. Fortunately, the woman required no further treatment or transportation to a hospital.
Medic Nitsky was one of my escorts that night; he’s a 26-year-old yeshiva student who is married and the father of two children. Nitsky works for both Hatzalah and Natali while finishing his studies. Six years ago, he completed 200 hours (six months) of training for MDA, learning everything from helping birth a child, to how to care for a multitude of emergency situations. Although MDA does not require in-hospital training, Hatzalah adopts the American protocol, requiring six emergency room shifts and six hospital shifts as a prerequisite to certification. Hatzalah’s policy is to include 200 hours of practical work in recognition of the reality that medics often will find themselves in a position where they will have to work alone on an emergency call.
Not surprisingly, veteran medics have their own favorite stories to tell. Nitsky recalled performing CPR in a synagogue a short distance from the seminary where he was a student. Arriving first on the scene, he came upon a man lying unconscious on the floor. “It was 6 o’clock in the morning, and there was no one else around who could help me but the man’s son. With no other choice, I told the son to help me with CPR on his own father. Right then and there, I taught him how to do compressions … on his father. I can’t imagine what the son felt doing CPR on his own father, but we saved him.”
En route to our next call — this one a three-car accident on the Begin Highway — I asked Goldberg to tell me about the most difficult case he had encountered as a medic. He described arriving to find a 1-month-old unconscious. “I came there first, we worked on her for 45 minutes, and, sadly, she didn’t make it,” he said, fighting for composure. “I was going to cry, but I had to be strong, because I had to work on her and use every minute to help her.”
In Israel, if an MDA ambulance arrives, the patient pays for the service. For Hatzalah, or any other ambucylists giving on-the-scene service, the treatment is provided gratis. Asked whether first-response organizations are worth the expense, Hadassah’s Assaf said, “It’s not [whether] they are important, they are essential.”
Explaining the importance of first responders shaving minutes off of ambulance-arrival time, Assaf said, “If there’s a cardiac arrest and the heart stops pumping, then you have minutes. If you don’t renew circulation in five to eight minutes, you have death, or irreversible damage. … In economics, we say ‘time is money.’ In cardiology, time is muscle. The earlier you treat the heart attack, the more heart muscle you save. … It’s a very significant difference if the ambulance gets there 15 to 20 minutes later. From the moment someone collapses, you need to start resuscitation within five minutes — a good, efficient resuscitation. You’ve got to know how to do it.”
Which clearly was the case with those caring medics who resuscitated the man in the Mamilla Mall. I witnessed those volunteers enter the man’s room at Shaare Zedek Medical Center just a few days later. As the medics approached their patient and all three made eye contact, it became clear why so many future medics are waiting in line: His heart was beating strong.