In an ideal world, all Israelis aged 12 and above would be given a free Magen David Adom (MDA) lifesaving course and presented upon graduation with an authoritative manual like Ezra Rishona Lehatzalat Haim (Saving Life with First Aid); every few years, they would receive a refresher course. Death rates from heart attacks, road and home accidents, drowning and other events would plummet, with fewer spouses and children plunged into mourning. It sounds utopian, but it can be done! Years ago, Prof. Mickey Eisenberg, a long-time expert at the University of Washington's School of Medicine and director of the university medical center's emergency medicine service, launched a program that taught the basics of lifesaving to about three-quarters of all Seattle adults. When people fell ill or were injured in an accident, there was almost always a bystander who knew what to do. Death rates dropped significantly, because when someone starts CPR (cardiopulmonary resuscitation, which combines artificial respiration and cardiac massage) before the ambulance arrives, survival rates can double. CPR courses are today included in the curriculum in all Seattle schools, and defibrillators to restart hearts are widely available in public facilities. BUT HERE, where Treasury pennypinching in the face of public health needs is legendary, anyone who takes an MDA course must pay for it. And even the Israel Defense Forces lack the money to purchase the third - 2007 - edition of the hardcover volume for its medics. The 336-pages, chock full of realistic photos and illustrations, was written by Prof. Yoel Donchin and Natan Kudinsky, who wrote the first edition in 1997 and an update about seven years ago. The latest one, published by the Defense Ministry, MDA and the Hadassah Medical Organization, is available only in Hebrew and is expected to sell around 30,000 copies. It includes basic lessons in anatomy, physiology, how to describe what part of the body is harmed and - very importantly - what equipment and procedures should be used to avoid exposing the rescuer to danger. It even describes how to treat frostbite, which is not very relevant in this country, except for soldiers and others in the snowy Golan Heights. Donchin and Kudinsky say an Arabic version is already in the works. "There is no such book in Arabic; not even the Red Crescent Societies in Arab countries have produced one. Israeli Arabs and Palestinians are very eager to have our book," Kudinsky says. There are no plans for an English version, the authors say, because the American Red Cross writes its own first-aid manual, as do other organizations in English-speaking countries, so there would not be enough demand here to make translation economical. Donchin, a veteran anesthesiology and urgent care expert who has often accompanied ill Israelis back home on emergency flights, studied medicine and his specialty at the Hadassah University Medical Center in Jerusalem's Ein Kerem, doing post-graduate work in Florida and at the University of Illinois. He established the Israel Defense Forces' medical trauma network and later was lent by Hadassah to serve as MDA's medical director. KUDINSKY, 59, was born in Poland to Holocaust survivors who brought him to Israel at the age of two. Raised in the Beit Shean Valley, he went to the IDF after graduating from high school, and was chosen to be a first-aid counsellor, leading dozens of courses. "I didn't seek it out," Kudinsky told The Jerusalem Post in an interview. "As a youth, I couldn't even stand the sight of blood. But I was found suitable for the job. After completing my military service, I was called to MDA, which was then very small and undeveloped. I started as a counsellor, until the late Dr. Nancy Caroline came from the US and greatly upgraded lifesaving training. I have been in MDA now for 38 years, 22 of them as head of its training department." The two authors got to know each other in the IDF and later in MDA and decided - with their different backgrounds - that they were a good team to work on the manual. Certain chapters such as that on burns, diving accidents, dental problems and emotional stress were written partially by outside experts. Donchin and Kudinsky update their manual according to amendments in the American Heart Association's guidelines. "We in Israel follow the AHA and its protocols" says Donchin, who notes that not all countries do so, but the AHA is very professional and bases its recommendations on evidence-based medicine. Every new MDA staffer and volunteer receives a Saving Life with First Aid book in Hebrew. Staff members receive it as a gift, but volunteers get it as part of a package that includes a uniform and insurance. It is sold to everyone else for NIS 118 in bookstores, and is available to all who participate in lifesaving courses so they can review the material. The new third edition has a variety of subjects that were missing or given minimal space in the original 1997 edition, including road accidents, chemical and biological weapons, radiation dangers, terror attacks, international humanitarian law and the history of MDA. Kudinsky notes that there are many Israelis who think the International Red Cross is a religious organization. "We included MDA's history in this edition because, after decades, the Red Cross Movement has made us a fully fledged member with our Red Star of David symbol inside a red 'crystal' - if necessary - when we send delegations abroad. We waited for membership for a long time." He adds that there have been changes in resuscitation protocols and training. "Once we taught trainees to first check a patient's pulse rate, but many people didn't know how. So now we teach how to check respiration and do chest compression if the heart has stopped. It must be done quickly and powerfully. We also changed protocols for the treatment of children and babies." NONE OF the three volumes even mentions the Heimlich Maneuver, "invented" and promoted by Dr. Henry Heimlich, an American Jewish doctor, and for years considered the best way to eliminate a foreign object from the trachea. But Donchin says this maneuver has not been proven effective and can even be dangerous. Instead, first aid should be given by trying to remove the foreign object without pushing it deeper into the victim's breathing tube, especially by tapping on the back when the face is facing downwards, and then rushing the victim to hospital. Kudinsky and Donchin agree that just reading - even studying - their book is not enough. They recommend that everyone takes an MDA lifesaving course - a short one with the basics if not the longer courses. "The book is great for going over the material learned in courses," says Donchin, "but it is also useful for telling laymen who haven't taken a course what not to do - things that would endanger a patient - and for telling bystanders how to act at an accident site." THE ENTIRE previous edition, noted Kudinsky, was put on the Internet, but was removed, adds Donchin, "because we feared that people would just browse the site and not know enough to handle a real emergency; just reading the book is not enough. An MDA course and the book must be integrated." Kudinsky noted that the latest lifesaving techniques described in the book enabled MDA medics to save TV journalist and author Yisrael Segal, who around two years ago had a heart attack while driving and smashed into a wall, causing clinical death. Segal, who is now recovering, was so grateful that he agreed to make a TV film, but after his story was told in a Yediot Aharonoth magazine feature, says Kudinsky, Israel TV bowed out of the project. Photos in the new edition are realistic, including one of a bloody compound fracture in an arm that looks more like meat. But Donchin says that while such illustrations are off-putting, they had to be included, as people have to be trained to identify real-life injuries, and dozens of other first-aid books in Donchin's library are "too sanitized" to be useful. An intra-osteo needle for giving infusions directly to a bone - invented by an Israeli company - is also shown in one photo. "We have these in our mobile intensive-care units, when a vein cannot be found or used for infusions," Kudinsky explains. MDA has decided on an outreach policy to promote the study of lifesaving. A trained MDA counselor with simulation equipment will come to the homes of those who ask for a workshop on resuscitation, and the participants - up to eight at a time - can practice on mannequins. Kudinsky says most Israelis want to learn first aid, but he has difficulty getting them to attend courses. Now, they can learn in a workshop at a convenient time in their home. Kudinsky said the price for a two-hour lesson is NIS 295. "We have nearly 300 paramedics around the country ready to do it, and they have already given 70 or 80 of these mini-courses. We won't make a profit, as the price covers only costs, but they will lead to the saving of lives." Kudinsky notes that studies show people who learn first-aid and resuscitation in small groups remember it better than if they were members of large groups. Participants will learn how to save choking victims, victims of heart attacks and cardiac arrest and other emergencies. MDA expects that family members of those who have had heart attacks or other medical emergencies will be among the most likely to ask for a workshop. (For more information, go to www.mdais.org or call (03) 639-0396.) "We are also working on advanced cardio-life support courses in hospitals. Currently, 800 doctors and nurses at the Rabin Medical Center-Beilinson Campus are doing it." Donchin concludes that it would be great if free public service ads were required by law of TV stations. Then first-aid lessons could appear on the screen, educate the public of all ages, and induce more individuals to go for courses. "These would certainly save lives. But there is no such law, and the organizations can't afford to pay for the messages themselves."

How to be a lifesaver

Newest Israeli first-aid manual offered with at-home MDA courses