Israeli EMS organizations: Blood, sweat and tears

No one denies that Magen David Adom saves many lives, but there are some criticisms, including feuding with all-volunteer United Hatzalah.

Magen David Adom ambulances (photo credit: MAGEN DAVID ADOM)
Magen David Adom ambulances
(photo credit: MAGEN DAVID ADOM)
Although the sound of shrieking alarms automatically turns one’s thoughts to Magen David Adom, the organization deals with more than treating the sick and injured and rushing them to the hospital.
MDA, first conceived in 1915 by a Jewish physician in Switzerland to help the wounded and Jewish prisoners in World War I, is much more.
It provides advanced blood collection, processing and supply; teaches first aid to laymen and advanced lifesaving to medics and paramedics; is Israel’s Red Cross Society providing humanitarian aid (as civilian auxiliaries to the IDF) and training to countries hit by mass-casualty events; collects food for those in need; traces individuals separated from their families; and even makes dreams come true for the immobile and terminally ill.
Even though nobody disputes that its professionals and volunteers in the field are skilled and dedicated, MDA still faces criticism.
Required by law to charge for its first aid, ambulance and other services, it even sends debt collectors to individuals who can’t pay the bills.
A recent Yisrael Hayom news story disclosed an internal MDA letter admitting that its ambulances have taken an “inordinate amount of time” to reach the sick and injured.
Organization management maintained that its response time is among the best in the world and that the letter was “part of our refresh procedures.” Moreover, MDA management has been feuding for years with United Hatzalah (UH), the all-volunteer first aid and rescue organization that is very efficient but does not charge for any of its services.
The Yisrael Hayom report appeared, inconveniently for MDA, a day before its management held an unusual Press Day for English-speaking journalists at its Jerusalem station, renovated thanks to a generous gift from former New York mayor Michael Bloomberg. Although 30 journalists were expected, only half a dozen turned up, and they were outnumbered by MDA employees (all of them wearing crisp white shirts with military-like, red-and-silver insignias on their shoulders). Even MDA director-general Eli Bin, who according to the invitation was supposed to appear at the catered lunch, didn’t show up and was said to have appeared in the Knesset instead.
The superfluous press kits, plastic containers of red-and-white-coated chocolate hearts, disk-on-keys and fancy chocolates and colored macarons at coffee breaks went largely untouched.
GUY CASPI, head of MDA’s operations division who joined the organization in 1979 as a youth volunteer, said it has 2,020 employees, 14,000 volunteers and 3,500 first responders to emergencies. In addition, it owns and operates some 1,000 ambulances and the more-recently introduced 250 motorcycles (set to rise to 400 by the end of the year) from 130 dispatch posts around country.
MDA received 2.1 million emergency calls, and 818,394 ambulances were dispatched in 2016, one every 38 seconds.
“There are physicians on duty 24 hours a day to give consultation to medics and paramedics in the field,” Caspi said. “We have GPS devices in ambulances to get to addresses and can now reach a patient in less than five minutes. We aim at four minutes and 40 seconds.”
Listing on a PowerPoint presentation what MDA does, Caspi noted that it “cooperates with the IDF, the fire services, the Home Command, the Health Ministry emergency division, the Israel Police and hospitals, but he neglected to mention that UH, the largest independent, non-profit, fully volunteer emergency medical services organization founded in 2006 by Eli Beer (not to be confused with Bin) that claims to provide the fastest first response for free throughout Israel. (See box) Caspi noted that MDA ambulances now have body armor to cope with suspected bombs and treats those hurt according to whoever needs the most urgent care.
“We don’t know who is a terrorist, such as what happened in Beersheba [when an innocent African was mistaken for one]. Terrorism is everywhere. Hundreds have been killed and wounded in Europe and the US. I was in Berlin and saw what happened when there was a suspicious object. The police moved people only five meters. The place was not evacuated. This is contrary to what is done in Israel. We have been operating workshops on mass-casualty events in Kenya, the Philippines, Ecuador, the Ukriaine and elsewhere,” the MDA official added.
MDA also has programs to debrief medics in the field who are witnesses to blood and death and are at risk of post-traumatic stress disorder.
“We try to recognize signs and symptoms. I don’t know of any MDA staffers or volunteers who left because of this, but there have been people affected by trauma,” Caspi concluded.
“Sometimes I wake up in the middle of the night and just go to my kids’ rooms to hug them.”
ALSO AT MDA for 25 years since he was a teenage volunteer, Uri Shacham, an assistant to the director-general and manager of the Red Cross department, said that emergency 911 services in the US are much less organized and efficient.
“There are 6,000 different dispatching services, and usually they can’t speak to each other or transfer calls because they buy different software. There are times when systems are overloaded with calls, and nobody answers. This problem is worldwide. They don’t all have automatic identification of caller location. There was a case of a woman who fell into a river with her car, and 911 couldn’t find her. By the time an ambulance arrived, she had died. They can’t find one of five callers.”
MDA, however, has “nine regional dispatches around the country. We all use the same system, and whatever reaches one region reaches all of the others automatically.
If one district is overwhelmed with calls, it they are shifted to another. Callers don’t have to stay on the line for even 30 seconds to report an incident,” Shacham said.
“We automatically send a text message to those in trouble. If he presses a link, his location goes into the MDA computer so we know where he is. I remember the case of a Jordanian tourist who riding his bike off the road and hurt his head, and we quickly managed to find him.”
After a serious wave of crank calls, MDA developed a system that knows how to detect frequent calls not involving an emergency.
“The phones are temporarily prevented from contacting MDA,” he said. It also launched live video from a scene, which helps medics at dispatch centers to instruct callers what to do until an ambulance arrives.
“Three months ago, a baby stopped breathing, and his neighbor sent live video from the scene. We could see that the child had an epileptic attack and had not swallowed a foreign object, whose treatment is very different.”
As it takes time for ambulances to arrive, MDA established a year ago the Life Guardians – doctors, nurses and others who know first aid but are not MDA volunteers – who are given some training and contacted when someone nearby needs help. There are 6,000 registered – an obvious adoption by MDA of the basic innovation of UH, which has over 3,000 trained volunteers around the country who rush to help as first responders.
Asked about UH, Shacham said, “Health Ministry regulations require that ambulance services use MDA’s app, so that information is coordinated. Some UH volunteers are not willing to install the app.”
THE INTERNATIONAL Committee of the Red Cross, established by Swiss businessman Henry Dunant in 1863 to treat soldiers and victims of strike after witnessing a battle in Italy, now brings together 80 national societies.
It took a long time to recognize MDA, allegedly on the grounds that its Red Star of David emblem was not a recognized symbol, even though the Red Crescent and Iranian Lion-and-Sun symbol were. There was also opposition from Arab countries. Finally, in 2005, MDA was admitted as a fully fledged member and allowed when it was operating abroad to have a red Star of David inside a red crystal. On the ground, there is good cooperation with the Palestinian Red Crescent (even though it was founded in 1968 by Yasser Arafat’s brother Dr. Fathi Arafat).
SINCE 1950 there has been a national blood services law in which hospitals and the IDF are supplied with blood collected by MDA.
Longtime National Blood Services division Prof. Eilat Shinar told journalists that last year it collected 263,000 units, from which it processes blood components such as red cells, white cells, platelets and others. About 80% of the blood is processed at its center in Tel Hashomer, with the rest in a Haifa facility.
To ensure that blood recipients do not get infected with HIV, hepatitis B and C or other dangerous conditions, the division must be extremely careful. It evaluates donors with a detailed questionnaire, allows them to give only if they are unpaid volunteers, sifts out high-risk behavior and then tests a sample of each. The “time window” in which a donor could be newly infected is narrowing, and soon here will be more advanced tests, to be introduced in the summer, thus allowing Ethiopian immigrants and homosexuals to give blood if they meet criteria. In two years, said Shinar, MDA will introduce pathogen inactivation that will kill viruses and bacteria, still allowing the blood to be used.
There are 240,000 registered volunteer blood donors. Most of them are males aged from 17 to 40 and Israeli born, but now one can give at any age and not only up to 70.
Most are civilians, with only 26% in the IDF.
Red blood cells expire in up to 42 days, plasma in a year and platelets in five days. “Every day we need 1,000 donors,” said Shinar.
Because the existing division center was built in 1980 and is crowded and unprotected in the event of a missile, rocket attack or earthquake, MDA is building a new one in Ramle. The Atlanta-based Marcus Foundation gave $25 million for the 20-dunam Marcus Blood Services and Logistics Center.
“It’s my favorite subject. We will have an underground area with all the labs in one place protected against conventional and unconventional attacks, Shinar concluded.”
United Hatzalah presents its side
United Hatzalah founder and president Eli Beer was actually a MDA volunteer after he witnessed, at age 15, the deadly terrorist bombing of an Egged bus in Jerusalem. At 17, Beer realized that a more flexible system had to be established to improve emergency response times. He was familiar with the Hatzalah model established in the US and began to organize a similar model by launching a volunteer unit in his Jerusalem neighborhood. In the 1990s, Hatzalah Israel existed and was an umbrella organization, incorporating many Hatzalah chapters that had been established throughout the country. Citing a lack of transparency and administrative effectiveness in Hatzalah Israel, Beer formally left the organization and established United Hatzalah of Israel.
A core group of professionals quickly joined the new organization and were followed by Hatzalah chapters throughout the country. Beer has personally saved many lives here and abroad and received numerous citations here and abroad, including the Presidential Award for Volunteerism, and became a Young Global Leader in Davos.
Asked to comment on MDA’s statements, Beer said: “I would like to clarify a few points regarding the ongoing reasons that MDA refuses to cooperate with UH, Israel’s first all-volunteer national emergency medical services organization. We are the first to provide all medical services free of charge. In addition to maintaining a national average response time of fewer than three minutes, in many large cities such Jerusalem and parts of the Tel Aviv, our average response time is less than 90 seconds.
“We were the first in the world to come up with and apply advanced GPS tracking technology, known as the Moskowitz Lifecompass technology, to the field of EMS in order to notify community- based, highly trained medical first responders of a medical emergency in their vicinity. Our organization was the first in Israel to incorporate ambucycles – motorcycles that contain all of the medical equipment that an ambulance has, with the exception of a backboard, stretcher, chair, and bed, in an effort to severely decrease medical response times. We were also the first to incorporate ambutractors, first responder bicycles, an ambuboat and jet skis that enable us to help any patient regardless of the terrain. If someone is in need of medical assistance, we are there to help, and we are prepared to arrive to help that person as fast as we possibly can. We are always looking to innovate new technology in order to decrease response time and the time it takes to treat a patient once we arrive on scene.
“Our community-based responder model, which in Israel can alert and activate any of our 3,200 responders at any time of day or night, is one that is revolutionizing EMS systems around the world. Our technology and community-based model are being used in numerous locations in 10 different countries. While we did not invent the idea of a Hatzalah community-based response, we are the first to nationalize it and to expand this model to provide free medical services to anyone, in any community in Israel, regardless of faith, gender, race, or financial capability.
“All of our services, including our applications and technologies that can be downloaded by anyone for free, such as our Ten Kavod project that sends EMS volunteers to provide free checkups for the elderly and help them manage their health care, and our psychotrauma unit, which provides free psychological and emotional treatment during traumatic emergency calls. In addition, we have also begun providing free transport to hospitals via our growing fleet of ambulances. In the 11 years of UH, we have treated over two million patients, and never once did any of them receive a bill for services.
Following a recent article publicized in The Marker that described how 27% of Israelis who had a heart attack refused to call an MDA ambulance due to the high cost involved, UH has taken upon itself to increase its ambulance fleet to give free transport to the hospital for anyone who cannot afford an ambulance.
“We want to work together with MDA. We currently cooperate very effectively and amicably with dozens of other ambulance services here, and we have a bilateral agreement to share all information between us and both sides do so effectively. We don’t want to replace MDA nor have we ever wanted to. We want to cooperate with them, as they too are a great organization involved in saving hundreds of lives each day. Unfortunately, MDA’s director Eli Bin continually finds reasons to avoid working with us.
“MDA works together with the Red Crescent and shares with it information and even hands over patients. Why is it that they cannot work with us, their natural partners to save Israelis? They even seem to try to impede our volunteers from responding as fast as they can by not providing critical information, such as the exact address of people who have called for help. They have even gone so far as to remove the exact addresses from all beeper messages sent out to their volunteers, including their apps, partly to prevent volunteers who work with both organizations from receiving the information.
“We want their dispatch center to work with ours so that EMS personnel can arrive at a medical emergency faster, regardless of who arrives first. The sharing of information will save lives. If our responders can arrive in 90 seconds, then they should have all of the information necessary to provide medical treatment as fast as possible. If they are kept waiting for long minutes, the critical minutes that matter, by MDA dispatch centers to receive an exact address, that time can cost a choking baby its life.
“The request by Magen David Adom to force all UH volunteers to use their application is a direct attempt to control the volunteers who wish to work only with our organization. And that cannot be allowed to come to pass. We are an independent and nationally recognized EMS provider, and we intend to remain so. I hereby call upon Eli Bin to meet with me and work out any grievances he has to put this matter to rest and allow for the sharing of all pertinent information between our two organizations and to cooperate with us in saving lives.”