United Response

Miriam Ballin’s Psychotrauma Unit is changing the face of Israeli volunteer medic response.

Miriam Ballin in her medic’s vest with baby Lolly, in Mahaneh Yehuda, having just returned from CPR in the Knesset after a staff member passed out in the gym. (photo credit: UNITED HATZALAH‏)
Miriam Ballin in her medic’s vest with baby Lolly, in Mahaneh Yehuda, having just returned from CPR in the Knesset after a staff member passed out in the gym.
(photo credit: UNITED HATZALAH‏)
Miriam Ballin grew up with Zionist values in her blood. The Jerusalem- based, Texas-born Ballin has an American hippie mother and an Israeli father who imbued her with a deep love for Israel.
Ballin’s family moved to San Francisco when she was a teenager, and then eventually to New York. It was during this time that she became more connected to her Judaism. In college, she met her husband, Adam, who is Australian. They moved to Australia for five years while he was in medical school, but always knew that they wanted to move to Israel.
Ballin and her husband made aliya five years ago. He joined Maccabi Healthcare Services as a doctor and she began completing her master’s degree in clinical psychology and working as a psychotherapist in couple’s counseling and trauma. Adam had been a volunteer emergency medical technician (EMT) in Australia while she watched enviously for years.
“He got to go out and save lives and would come home on this adrenaline high,” Ballin says. “I couldn’t even imagine what he was actually feeling. The Australian Hatzalah told me that they didn’t allow women. So they let me be the dispatcher. I would get all the calls from people in distress and it was frustrating for me to be on the other end of the line, sending people to the scene and not be one of those people going.”
Shortly after making aliya, Adam joined United Hatzalah as a volunteer doctor. Ballin desperately wanted to join as a volunteer medic, and was told that because 50% of the people being treated on the scene were women, they needed more female responders. A women’s training course was put together for the first time in Jerusalem in 2014. While United Hatzalah has female medics all over Israel, it was not the prevalent practice in Jerusalem, where they had managed to refrain from letting women into the course due to the rabbinate’s strong opinions on the matter. This was the first time ever.
“The doors I had to push and break open were unbelievable,” Ballin shares. “First they let me take the course, but said it could only be for my own knowledge. Then they said I could go to calls, but only in my own neighborhood and without a radio. Then they let me have a radio, but I could only go to calls in Jerusalem. At this point, I can go to calls all over Israel just like anybody else, but it was really a process. It took time and it was a matter of managing it sensitively enough but aggressively enough to be able to get the desired end result.”
She has been trying to recruit other women to follow in her trailblazing footsteps, especially other Orthodox women. However, she emphasizes that the female medics come from every conceivable background. She cites friends from east Jerusalem who volunteer alongside her. The emphasis on diversity is what United Hatzalah is all about; the team of volunteers reflects those in need of medical assistance. Anybody and everybody can give help because anybody and everybody needs it. United Hatzalah began as an ultra-Orthodox organization, in terms of the responders and volunteers. But that has since changed drastically, given the diverse array of neighborhoods that wanted to have this kind of volunteer medical response system in place for their community in those crucial minutes before an ambulance arrives.
President Eli Beer’s wife, Gitty Beer, recently joined United Hatzalah as a medic after 15 years of supporting her husband’s volunteer work. She is now the head of the women’s medic unit in Jerusalem, which currently boasts more than 150 women. Beer and Ballin work together tirelessly in recruiting new women to join United Hatzalah.
“I remember my first call ever came in on a Friday night,” Ballin says. “I was making a salad for Shabbat dinner and I got a call that a woman in the building next door was having a baby. I got there first. Within 10 minutes, I had a baby in my hand. I saw right away the difference that a woman makes. A man is more methodical. A woman has the ability to give a whole different level of care, I think. It meant so much to her. Every time I see the baby, it’s so meaningful. That was really the catalyst for me to be able to do a lot more.”
For Ballin, doing more came as a reaction to an unforeseen situation. One day when she was crossing Azza Road in Rehavia, she was hit by a speeding motorcycle that neither she nor the driver of the car who motioned her to cross saw. She went flying into the middle of the road, unconscious. Medics from United Hatzalah came to the scene. After a trip to the hospital revealed that she was badly bruised but had sustained no serious injuries, she returned to the spot where had been hit to thank all of the shopkeepers who had come to her aid.
“When I came back, I saw that they were still totally traumatized by what they had seen,” Ballin states. “They told me that they were dreaming about it and were still scared to cross the street. They were so shaken up by the whole thing. I thought that we had to change this because not every story has a happy ending like mine. Whether it’s a largescale terrorist attack or something on a smaller scale like an infant crib death, there are people who are there on the side who are really suffering. We have a responsibility to stabilize and support somebody going through that trauma and to be able to provide the psycho-education and resources for them to get the help that they need later on as well.”
From this realization, the Hatzalah psychotrauma unit was born. Ballin’s goal was to treat the emotional trauma suffered by all of those who witness or are involved in the incidents to which United Hatzalah responds. The organization was reluctant at first. But after a while, they gave her the go-ahead to build a team. The team is comprised of more than 150 mental health workers.
Ballin found that there was already a protocol being used around the world called psychological first aid. The difference was that the American Red Cross was using it only days or weeks after a major incident. Ballin thought that it could be used in the moments right after the trauma occurred, and not only with major incidents, but any situation that is potentially traumatic. The Psychotrauma Unit has now been to hundreds of calls. Its average response time is less than 10 minutes; faster than an ambulance. They are there with the person experiencing the trauma as it is unfolding.
“The medics feel so much better when they go back to their car after there has been an unsuccessful CPR and instead of feeling like a total failure, they have handed the situation over to a team who specializes in knowing how to help that family,” Ballin explains. “That gives them a huge feeling of satisfaction and peace of mind.”
Everyone in United Hatzalah is a volunteer, both the medics and the Psychotrauma Unit. There are no formal shifts; they are always on call. Whoever is nearest to the scene responds, and then returns to their everyday lives. Thus United Hatzalah volunteers often find themselves in need of counseling for trauma and an opportunity to process what they have seen.
“We don’t have time to mentally prepare ourselves,” Ballin says. “I opened up a hotline for our 3,500 volunteers to be able to access 24 hours a day after they’ve been at a really bad incident, they can call up. Usually they just need a conversation, but sometimes they need more than that and we can direct them to where to get that help. We have psychologists and social workers who answer the phones on rotations. We’re giving courses now not just to mental health workers, but also to our medics, so that they’ll be able to know what to do and what to say on the scene, at least until somebody more senior like a psychologist can get there.”
The medics are typically on the scene in 90 seconds. Training them to be able to respond to emotional trauma in that critical period before the Psychotrauma Unit and later, the ambulance, arrive could change the face of EMS in Israel. With the Psychotrauma Unit, Ballin is addressing the ripple effect of trauma in a way that has never been done before. The procedure is fairly basic, but complicated to administer in such stressful circumstances. The idea is to first give people the chance to feel human again. If they were out in the cold, bring them something warm to drink. Suggest they go to the bathroom. Giving them the necessary things, however simple, allows them to relax. Only then can emotional needs be addressed.
Ballin explains that what happens in a trauma mind is that the right and left sides of the brain stop communicating. Once that occurs, the person is unable to process and it becomes much more overwhelming for them. Stabilizing them allows them to process. The Psychotrauma Unit uses a special procedure based on bilateral stimulation where the right and left sides of the brain are reconnected and able to communicate again.
“We’re a network of community responders to be there in the first moments until the ambulance arrives. It could be five minutes or it could be 25. In our Psychotrauma Unit, that’s what we’re doing also. Knowing where our job ends is not always so clear because every situation is so complex with its own components. We’re really trying to address everybody’s emotional needs. It was taboo up until now in the EMS world. Nobody felt comfortable talking about it or asking for help. Israelis especially are not inclined to ask for help. But the Psychotrauma Unit is changing that.
“When you find a lack in something and you decide that you’re going to do something about it, I really feel like you get the power and blessing that you need. I watched it firsthand, not just with myself. We decided to do something and we did it. Now it’s tangible and it’s amazing. I want other women and other people to feel like they can do that; to take their dreams and run with them. ”
To learn more about United Hatzalah’s Psychotrauma Unit: psychotrauma.israelrescue.org/