A U.S.-Style 911 System in Israel is Not the Answer

Because MDA has its own system, they’ve been able to design it to meet their specific needs – or, more importantly, the emergency medical needs of the Israeli people.

Magen David Adom ambulances (photo credit: MAGEN DAVID ADOM)
Magen David Adom ambulances
(photo credit: MAGEN DAVID ADOM)
When you dial the emergency number 101 in Israel for medical help, the call is answered in four seconds on average. And it’s not answered by a 911 operator, but rather by a Magen David Adom EMT or paramedic – a trained medical professional – who is not reading from a script, rather giving instantaneous medical instructions based on years of experience and training. If the regional dispatch center happens to be too busy to answer in seconds, the call is automatically kicked to a different regional dispatch center, where dispatchers can handle the call just as readily as the local region.
If you have ever called 911 in the US you frequently would be put on hold before an actual human picks up. If it’s a medical emergency, you are transferred to a dispatcher, a process that can take minutes more before an ambulance is sent your way. That’s not what happens here. The speed at which ambulances and first responders are dispatched in Israel and the innovative technology that has been able to be put in place, because MDA owns and programs the dispatch system itself, have saved thousands – if not hundreds of thousands – of lives.
Because the person answering the phone at MDA is a medical professional, they can make informed decisions that can play a critical role in patient outcomes. They can decide, based on the information they get from the caller, whether to send a Basic Life Support Ambulance, a Mobile Intensive Care Unit, or one of its two Medevac helicopters. A 911 dispatcher, on the other hand, would not be qualified to make that decision.
With a medical professional answering the phone, the average time before a cardiac arrest patient in Israel begins to receive CPR is 43 seconds, usually with the dispatcher instructing the caller how to initiate cardio-compressions until professional help can arrive in just a matter of minutes. By contrast, the goal of next-generation 911 in the US is to initiate CPR within 120 seconds, a goal they are still largely very far from achieving.
In addition, because of the sophistication of the Israeli system, it will simultaneously and instantly dispatch the five nearest first responders, whose locations are instantly determined by GPS. MDA’s system will dispatch a first responder regardless of whether they work or volunteer for MDA or for one of the more than 20 Hatzalah organizations in Israel, including United Hatzalah. The system, as MDA designed it, makes no distinction between MDA and any other certified EMS organization, because in an emergency, saving the patient’s life is what’s most important.
If the patient is in cardiac arrest or in another immediate life-threatening situation, the system can also determine whether there’s a Life Guardian nearby, a person certified in CPR who’s registered with MDA and whose location is instantly identified by the MDA app on their phone.
This technology has also enabled MDA to send patient information ahead to hospitals, enabling doctors to diagnose strokes and heart attacks while the patient is still en route to the hospital and to have MDA admit those patients directly to stroke units or catheter labs instead of the emergency rooms for additional tests, providing lifesaving treatment to patients 30 minutes sooner. It’s also enabled MDA to develop a consumer medical emergency app that every Israeli and visitor to Israel should have on their phone.
Few of these lifesaving technological features would have been developed if MDA didn’t have its own system. This is why I oppose a US-style 911 system in Israel, as do MDA, the police and the fire departments. Because MDA has its own system, they’ve been able to design it to meet their specific needs – or, more importantly, the emergency medical needs of the Israeli people. Their dispatch system is designed completely in-house by 40 full-time coders, many of whom are also EMTs and paramedics, so they understand keenly what information the system must provide the professionals in the field (they still, in fact, do shifts in the field themselves). The result is the most sophisticated EMS response and dispatch system in the world, so much so that it’s seen as an international model and standard by many countries.
About three years ago, MDA met with EMS officials from one of the very largest American cities. The officials there were blown away by the capabilities MDA showed them in their system. MDA literally offered them the technology for free.
However, because the city’s 911 system is primarily designed to meet the needs of their police department and is a cobbled-together system of apps, they were flummoxed about how they could port MDA’s technology into their existing system. Years later, this huge US city still doesn’t have most of the capabilities MDA showed them for EMS use.
United Hatzalah, for one, wishes Israel had a US-style system in Israel. They chafe at the thought of being dispatched by Magen David Adom – an organization they regard for some unfortunate reason as a “competitor.” In fact, they’ve exacerbated the problem of multiple emergency phone numbers in Israel by stubbornly refusing to close down their own proprietary dispatch system, despite repeated shutdown orders from the government. And while MDA’s system automatically dispatches United Hatzalah first responders if they’re among the five nearest the scene of a medical emergency, their system keeps MDA’s life-saving first responders from some emergencies. When Israelis call United Hatzalah for help, United Hatzalah has to call MDA on the phone to summon an ambulance, which does nothing to speed up the process.
The US-style 911 emergency response system doesn’t even work well for the US, and whatever the reasons for that fact, one thing is clear: Let’s not bring that slow, outdated system to Israel.
Note (March 24):  Since the novel coronavirus came to Israel several weeks ago, Magen David Adom has been the army fighting this disease, handling literally hundreds of thousands of calls to its phone number 101, receiving more than 82,000 calls from Israelis concerned about coronavirus in one day last week alone, more than 13 times its normal daily call volume. But it was able to handle the calls — answering them all in an average of 10 seconds — because the infrastructure of its system was designed to handle as many as 150,000 calls and enabled MDA to increase the number of call-answering desks from 93 workstations on a normal day to 397 in response to the coronavirus crisis.
 
These measures have borne fruit. According to the latest statistics from the Health Ministry, about 1,600 cases of coronavirus have been tallied in the entire country, no matter that Israelis are avid travelers. So far, there have been three fatalities.
 
All testing in Israel is free and results are back in 24 hours or less. And this week, MDA opened drive-through testing centers in five cities, which will enable Israel to test 6,000 people a day.

The writer, a brigadier-general (Ret.) in the Home Front Command, is the a former deputy of the National Security Council for Internal Security Issues and Emergency Preparedness under the Prime Minister’s Office and former head of the Israel’s National Emergency Authority under the Defense Ministry.