Emergency medical services in Israel

Infobox Country
common_name = Israel

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capital = JerusalemThe Jerusalem Law states that "Jerusalem, complete and united, is the capital of Israel" and the city serves as the seat of the government, home to the President's residence, government offices, supreme court, and parliament. The United Nations and most countries do not accept the Jerusalem Law (see harvnb|Kellerman|1993|p=140) and maintain their embassies in other cities such as Tel Aviv, Ramat Gan, and Herzliya (see the [https://www.cia.gov/library/publications/the-world-factbook/geos/is.html CIA Factbook] and [http://www.un.org/Depts/Cartographic/map/profile/israel.pdf Map of Israel] ) The Palestinian Authority sees East Jerusalem as the capital of a future Palestinian state and the city's final status awaits future negotiations between Israel and the Palestinian Authority (see [http://www.publicpolicy.umd.edu/IPPP/Fall97Report/negotiating_jerusalem.htm "Negotiating Jerusalem", University of Maryland] ). See Positions on Jerusalem for more information.]

area_km2 = 20,770 / 22,072
area_sq_mi = 8,019 / 8,522
population_estimate = 7,282,000smallsup|2cite web |url=http://www1.cbs.gov.il/reader/mainind/indengnew.html |publisher=Central Bureau of Statistics |title=Main Indicators |date=2008-05-07 |accessdate=2007-09-18]
population_estimate_year = 2008
population_density_km2 = 324
population_density_sq_mi = 839

Emergency medical services in Israel are provided by the Magen David Adom (MDA) organization, supplemented in some areas by the Palestinian Red Crescent Society.

Organization

Land Ambulance

While the MDA currently has approximately 1,200 emergency medical technicians, paramedics and emergency physicians on staff, it still relies heavily on over 10,000 volunteers who serve in both operational and administrative capacities. The organization operates 95 stations with a fleet of over 700 ambulances. The majority of the fleet consists of Basic Life Support (BLS) ambulances. These are supplemented by Advanced Life Support (ALS) ambulances, mobile intensive care units (MICU) and a variety of first responders. First responders sometimes include the United Hatzalah organization. In an unusual feature, armored ambulances are not uncommon nationwide. The system is highly dependent on volunteers, many of whom are from outside of Israel. As a recognized national aid society, according to the Geneva Conventions MDA may become an auxiliary arm of the Israeli Defence Force during wartime. Young people holding dual citizenship, often from the U.S., are permitted to fulfill their national service obligations by serving in MDA, instead of in the regular military.Most major stations also include special units for responding to mass-casualty incidents like natural disasters or terrorist attacks. The system, for the most part, conforms to the Franco-German (as opposed to the Anglo-American) [cite journal |author=Dick WF |title=Anglo-American vs. Franco-German emergency medical services system |journal=Prehosp Disaster Med |volume=18 |issue=1 |pages=29–35; discussion 35–7 |year=2003 |pmid=14694898 |doi= |url=] model of EMS care, and the presence of physicians at high-acuity emergencies is not uncommon. In addition, emergency ambulance service is supplemented by a variety of private carriers who are tasked with interfacility transfers only. [cite web| url=http://www.ambulanceisrael.com/?page_id=5 | title=Ambulance Israel website| accessdate=2008-09-26]

Air Ambulance

Air ambulance service is provided by Israeli Air Force MEDEVAC helicopters, however MDA imported four MBB Bo 105 from Germany and plans to employ them to improve response times in peripheral areas. Previous attempts to integrate independent helicopter service in the 1970s were unsuccessful due to high cost. [cite web|url=http://www.shephard.co.uk/Rotorhub/default.aspx?Action=745115149&ID=740a002d-49f9-4da1-99e7-660482976627] |title=Rotorhub website|accessdate=2008-09-26] Non-emergency and repatriation air ambulance service is normally provided by a variety of private charter carriers. [cite web|url= http://www.airambulance.co.il/air_ambulance.php|title=Air Ambulance website|accessdate=2008-09-26]

tandards

Vehicles

Most of the fleet is made up of regular size vans staffed by the equivalents of "basic" (EMT-B, Hovesh) and "intermediate" (EMT-I, Hovesh Bacir) emergency medical technicians as well as teenage and international volunteers (often qualified as first responders), advanced life support ambulances, staffed by paramedics, and MICUs similar to the US Type II units, staffed by paramedics and physicians respond only to the most medically serious cases. The vehicles compare in general terms with American or European ambulances, however compliance with either the KKK 1822 or CEN 1789 standard is not compulsory. In addition, first responders will often proceed to calls in their own vehicles, and could be anything from a private car to a motor scooter.

Training and staffing

As previously stated, the MDA uses a broad range of staff from First Responders to Physicians, an both volunteers and paid staff. [cite journal|author=Ellis DY, Sorene E|title=Magen David Adom: The EMS in Israel|journal=Resuscitation|volume=76|number=1|year=2008|url=http://cat.inist.fr/?aModele=afficheN&cpsidt=19976417 ] First responders typically receive about one week of training to prepare them for their roles. Paid employees are required to be certified at the Hovesh (EMT-B) level, which requires an additional three weeks of training. The next step is the Hovesh Bacir (EMT-I) which requires a further two weeks of training. Those certified at the Basic level are permitted to use automatic external defibrillators (AED) and those at the Intermediate level are permitted to start IVs. [cite web|url= http://www.international-ems.com/il.htm |title=International EMS website|accessdate=2008-09-26] Paramedics may be trained over a period of 15 months, with nine months of didactic and hospital clinical time, and a six month preceptorship with a qualified paramedic on an MICU ambulance. Increasingly, however, paramedics are choosing another option; obtaining a three year B.Sc. in Emergency Medicine as part of their paramedic training. [cite journal|author=Levy G, Goldstein L, Erez Y, Levite R|title=Physician versus Paramedic in the Setting of Ground Forces Operations: Are They Interchangeable?|journal=Military Medicine|volume=March 2007|pages=2|url=http://findarticles.com/p/articles/mi_qa3912/is_200703/ai_n18755588/pg_2] In an unusual move aimed at raising revenue to offset operating costs, MDA has begun to market its expertise at emergency care and system organization on an international level. [cite web|url=http://www.mdais.org/e/316/3665.htm|title=MDA Training website|accessdate=2008-09-26] They have achieved some success in this endeavour, assisting the nation of Chile with the development of a national EMS system. [cite web|url=http://www.mfa.gov.il/MFA/Mashav%20%E2%80%93%20International%20Development/Publications/1999/Operating%20a%20National%20Emergency%20Medical%20Service%20Net|title=Israeli Ministry of Foreign Affairs website|accessdate=2008-09-26]

Dispatch

All EMS resources are dispatched from a single National Response Centre. This centre uses dispatch technologies such as Automatic Vehicle Locating (AVL) and decision-support software that are comparable with U.S. and European systems. [cite web|url= http://www.encyclopedia.com/doc/1P1-89862917.html|title=Jerusalem Post article|accessdate=2008-09-26] The national emergency number for an ambulance in Israel is 101. This number is answered by MDA around the clock.

Response times

MDA claims response times of under six minutes for major emergencies, the majority of the time. [cite web|url= http://www.pioneerlocal.com/northbrook/news/1129709,nb-medic-082808-s1.article|title=Northbrook News website|accessdate=2008-09-26] It is unclear whether this is the result of extremely dense ambulance coverage (1:10,000 pop.), the high number of volunteer first responders, or the method used for calculating response time.

pecial problems

The long periods of conflict between Jewish and Palestinian Israelis have created some special issues for service delivery. These have included numerous incidents in which Palestinian ambulances have been found transporting bombs, missiles, or terrorists disguised as patients. The result has been a policy by the Israeli Defence Force to stop and inspect all Palestinian ambulances at roadblocks, regardless of the seriousness of the patient’s condition. On the Palestinian side of the dispute, there have been numerous accusations of Israeli Defence Force personnel on the ground and in aircraft deliberately targeting Palestinian ambulances. The result has been an uneasy peace between EMS staff on both sides. Any MDA or Red Crescent ambulance will respond to any emergency if required, and will usually hand off care to the other, when appropriate. The atmosphere is reported to be ‘professional and polite’ but ‘without any smiles or handshaking’.

ee also

*Palestinian Red Crescent Society
*Israeli Defence Force
*Magen David Adom
*Healthcare in Israel

References