EMS Training Lessons from Fire-Based Terror Attack in Israel

On the last week of November 2016, Israel was faced with a security challenge like never before.

Due to extreme weather conditions of dryness and strong winds, fires were burning in multiple zones around the country. But arsonists were setting additional fires in strategic locations, making it difficult for rescue forces to operate.

More than 30,000 acres were burning throughout Israel, leaving 1,000 houses damaged, some even entirely destroyed. Sixty thousand residents were evacuated from their homes and more than 125 people were treated by Magen David Adom (MDA) medical teams for smoke inhalation.

EMS Training Lessons from Fire-Based Terror Attack in Israel

For an EMS organization, this type of incident is unique in its nature. Usually, nationwide incidents are characterized as either a natural disaster or “manmade,” but this one was a combination of both. MDA sought to research the characteristics of arson terror and how it is different than naturally caused wildfires. This article details MDA’s findings and the measures we believe should be taken to improve response quality to future incidents.

Here’s why this “terror by fire” incident was so challenging:

  • Roads were blocked, making it difficult for vehicles to maneuver;
  • Many fires were set in strategic locations specifically aiming to challenge security and rescue forces, such as at the entrance to the Haifa Fire Department station, for example, preventing fire trucks from driving out;
  • Multiple fire zones were burning simultaneously, requiring deployment of large teams and a massive amount of rescue vehicles;
  • The attack was extensive, making medical and rescue teams prone to burnout;
  • Large evacuations of old age homes and hospitals required special preparedness of hundreds of medical vehicles;
  • A massive load of phone calls came into dispatch centers from individuals who weren’t able to evacuate independently or suffered smoke inhalation;
  • Many MDA staff members were not able to work, as their families and homes were affected by the fires;
  • When attackers realized that security forces and emergency services were preoccupied and present with large teams in one location, they were that much more determined to start fires on the opposite side of the country.

EMS Training Lessons from Fire-Based Terror Attack in Israel

Here’s how Magen David Adom tackled these challenges:

Be Anywhere at Any Time

To ensure there was no shortage of medical teams and rescue vehicles anywhere they were needed, MDA deployed 845 ambulances, 61 medi-cycles, 99 MICUs, 2 MCI vehicles, an advanced command and control vehicle, and emergency backup ambulances. EMS organizations around the world might want to strive to own many backup vehicles as incidents like this require double, if not triple, the amount of vehicles required routinely.

Prepare for Large-Scale Evacuations

In cases of fires, large buildings hosting elderly or disabled individuals, as well as hospitals, must be evacuated. In such cases, ambulances are the only feasible means of evacuation since medical equipment is required for transferring patients and helicopters aren’t up to par as they create wind that enhances the flames.

Before the Israeli Home Front Command instructed on any evacuations, MDA had already prepared to “defreeze” and man hundreds of vehicles. This turned out to be a great tactic when MDA was instructed to evacuate two Haifa nursing homes and transport more than 80 patients—including an ICU ward with 22 mechanically ventilated patients.

We suggest EMS organizations around the world become aware of the high volume of medical vehicles large evacuations require, and ensure that their deployment to one mission doesn’t cause a deficiency of vehicles on other fronts.

Rely on a Strong Base of Volunteers & Standby Medics

One of the most challenging aspects of the attack was how extensive it was, risking employee and volunteer burnout. In this case, the organizational structure of MDA, which operates thousands of volunteers, came in handy.

MDA engages in year-round empowerment of its volunteers to ensure high satisfaction and retention rates. Additionally, the organization has many standby paramedics and EMTs who go about their days normally and are summoned only when an incident occurs within their immediate vicinities. During extensive emergencies, this allows MDA staff to work reasonable-length shifts as well as rest during all days of the operation.

Harness Mobile Technology

MDA recently released a mobile app enabling users to instantly call dispatch centers with a tap of a button. The app allows users to plug in personal information such as address, age, name, etc., as well as manage a mini medical record. This dramatically cuts down dispatch time and enables the dispatcher to deploy appropriate medical vehicles to the scene within seconds.

However, the true revolutionary app feature for events of this nature is the ability of users related to individuals who aren’t able to evacuated or call for help independently to manage an in-app medical profile for them and call MDA dispatch centers on their behalf.

Encouraging the Israeli public to use the app for calling MDA dispatch centers also helped MDA reduce workload for dispatchers and maintain a short response time, as app calls tend to be dramatically shorter than regular phone calls.

EMS Training Lessons from Fire-Based Terror Attack in Israel

Cooperate with Other Security Forces & Authorities

As the national emergency medicine service of Israel, a country that faces security challenges on a regular basis, MDA teams have already mastered the art of working in cooperation with the Israel Defense Forces (IDF), police, fire department and other authorities. This is due to real-life experience as well as routine drills and joint exercises.

In the case of this attack by fire, cooperation was vital. For example, evacuation of nursing homes is an operation planned by IDF Home Front Command, but executed by MDA. This requires a flawless system of cooperation between the two bodies. We encourage EMS organizations around the world to also engage in year-round exercises to guarantee maximal preparedness during real-time events.

As we hope that other countries don’t have to face such a complex attack on their territories and residents. We also hope that in case they do, our research and suggested measures help EMS organizations save more lives.

Eli Yaffe is the head of training at Magen David Adom, Israel’s national EMS organization.