Israel’s Magen David Adom provides nationwide EMS response
Israel’s EMS and blood services are based on a national organization, Magen David Adom (MDA), which is also known as Israeli Red Cross Society. MDA serves the entire population of Israel both during peacetimes as well as during conflicts and wars.
MDA is a non-governmental, non-profit organization, established before the state of Israel, and works under direction of the 1950 MDA Law as passed by the Israeli Parliament. The organization is a voluntary one in its core, whereby the volunteers not only take part in the operative activities, but they’re also an inseparable part of its management—the National Council and the Management Council.
Nearly all of MDA’s management started their path in MDA as volunteers, and the same is true for most of the employees who staff the ambulances and Mobile ICUs (MICUs).
MDA operates several arms to provide EMS response on a national level, including a dispatch center, Life Guardians, first responders, BLS ambulances, intensive care ambulances and helicopter EMS. There are currently 162 ambulance stations across Israel, where some 22,000 volunteers (approximately half are youth volunteers) and 2,180 paid employees are active. Although the employees provide the basis of the EMS service, the volunteers are a critical part of the service.
In Israel, the phone numbers for each of the emergency services are different. The phone number for MDA is 101. All dispatch center employees, both call takers and dispatchers, are either EMTs or paramedics, and have some experience in the field.
Dispatch center technology is developed in house, and offers some of the leading technology in dispatch centers today. The Control and Command program allows dispatchers to locate the caller via GPS, transmit information such as previous conditions of the patient, live pictures and video from the scene and even a chat option in as many languages as are covered by Google’s translation services.
The dispatcher can also see the location of any nearby police and fire vehicles, as well as use the social app Waze to locate an accident or any traffic problems.
To reduce abandoned calls, the average time taken to answer a call in the dispatch center stands at only three seconds. The speed of this response is largely made possible by advanced telecommunication systems that locate the first available call taker in any of Israel’s 10 dispatch centers regardless of the caller’s location.
A unique aspect of MDA’s dispatch is that all the centers work on the same system, therefore if someone calls and gets through to a different region, the call taker can still assist and receive the caller’s information.
For example: A caller in Tel Aviv who calls MDA may actually be answered by a dispatcher in Jerusalem, because the time to answer the call in Jerusalem at that moment is shorter. The call is handled in the Tel Aviv dispatch center by the chief of the shift, exactly like it was taken in Tel Aviv, since all the info is in the same system. Any dispatcher in Israel in any dispatch center can see all ambulances, manpower and available resources throughout Israel. The advantages of a national, custom-made system are significant. If a dispatch center goes offline—for any reason—all the calls and all the ambulances can still be dispatched from a different dispatch center.
The MyMDA app is available free to anyone in Israel. It’s a fast and efficient way to dispatch MDA crew, and the app stores all the patient’s details, along with those of the patient’s immediate family. Details such as previous medical history, ECGs, medication and allergies can be entered by the patient along with the patient’s own details and their family members’ details.
Dialing via the app allows for GPS location of the call to appear in the Command and Control program, as well as the patient’s medical file. It also allows a chat option in any language, and facilitates communication with deaf or mute callers. Using the app cuts a considerable amount of time off the call, and allows for faster dispatch of crews. Any call a crew is dispatched to has all the past medical info of the patient available immediately on the tablet in the ambulance or on the crew members mobile phone, allowing them to save valuable time when treating a patient.
Life Guardians & First Responders
Rapid arrival at the scene of medical emergencies is further made possible thanks to the tens of thousands of Life Guardians and volunteers who are spread across the country, and who are located via the Command and Control program and dispatched via a dedicated app.
Life Guardians are doctors, nurses, paramedics, EMTs and many others in Israel who have the knowledge and skill to perform CPR as well as treat choking, bleeding and other medical emergencies. Located throughout the country, Magen David Adom’s dispatch center can activate them by using cellphone location services. Tens of thousands have downloaded a dedicated app to their cell phones that enables MDA to utilize them if they’re within two minutes of a medical emergency. Despite the fact that these aren’t necessarily MDA volunteers, Life Guardians are still willing to be called upon to assist in emergencies, and answers dozens of calls each month.
Dispatching First Responders to emergency calls is a practice that’s done throughout the world, and is usually handled by emergency teams such as fire departments or the police.
MDA uses a different approach: volunteer EMTs. A national unit of 8,000 active volunteer First Responders are dispatched via a dedicated app and a special dispatch center. These volunteers, which include teachers, lawyers, freelancers and others, are active volunteers on the ambulances at MDA stations.
First Responders carry emergency medical equipment that’s identical to what’s carried in an ambulance. Some 500 First Responders use a Medi-Cycle, which is a dedicated motorcycle with first aid equipment, AEDs and other lifesaving equipment. The rest of the First Responders travel in their own private vehicles.
When a call is received and entered into the Command and Control program, the system rapidly searches for the nearest First Responders and sends them a message. The volunteers use the app to confirm whether they’re available to respond or not as well as their arrival on scene. They can even use the app to complete the relevant forms documenting any treatment provided. First responders not only arrive first on scene to provide crucial medical treatment, but they also provide critical help to the ambulance teams when they arrive.
The use of Life Guardians and First Responders means that in both urban and rural areas of Israel, the average arrival time at any emergency call is less than five minutes.
Ground Response & transport
MDA has around 1,000 ambulances in ambulance stations across the country. Over half of these are in active service, while the rest are for use during emergency times or war times—ready to be activated on a moment’s notice.
The Life Support ambulances are spread across the 147 MDA stations nationwide, and are also operated in rural areas by volunteer responders. The basic treatments provided by the crews on these ambulances include CPR, automatic defibrillation, EpiPen administration, aspirin administration, basic first aid, fluid resuscitation, childbirth and hospital transport. Each ambulance is staffed by a crew made up of an EMT driver alongside either adult or youth volunteers. The adult volunteers are all trained to the level of EMT or advanced EMT. The youth volunteers, aged 15–18, qualify as First Aiders, having undergone a 60-hour training course.
There are 379 MICUs or ALS Ambulances that are dispatched to emergency medical incidents that require advanced treatment. These units are operated from MDA stations and are staffed by paramedics alongside EMT and advanced EMT drivers.
MDA has developed an approach that combines “scoop and run” and “stay and play,” to provide the minimal lifesaving treatment without wasting time, especially in trauma. Calls are categorized according to the severity and type of the problem, which means certain calls are treated as Type A (i.e., scoop and run), while other calls will be treated as Type B (i.e., stay and play). A gunshot victim with an abdominal injury, for example, will be a Type A, whereas a patient in acute congestive heart failure will be treated as a Type B.
The paramedic’s authority lies within Health Ministry regulations and allow for paramedics to perform advanced airway treatment by intubation, emergency tracheotomy, needle decompression of the chest, defibrillation, external pacing, administration of IV and intraosseous drugs and many more.
The MDA paramedic can also pronounce death. For purposes of supervision and control, as well as to aid the paramedic in the field, there’s a National Medical Center that’s manned by a board-certified physician and a senior paramedic. They can view the monitor, ECG and vital signs of the patient, speak to the crew on a recorded line, or even by video, in an effort to assist in the clinical decision-making process.
The MICU crew can transfer patients with ST-elevation myocardial infarction or cerebrovascular accident directly to the relevant departments, bypassing the ED. The crew can even send the patient’s data (e.g., their ECG) via a mobile app to a senior physician phone in the cardiology department, where the decision can be made quickly to take the patient directly for percutaneous transluminal coronary angioplasty.
Measuring just 500 km (approximately 290 miles) from north to south, and 100 km (approximately 85 miles) from east to west, Israel is a relatively small country. Nevertheless, the hospitals are in the major cities, and there are large rural areas, particularly in the north and south, that are sometimes a few hundred kilometers from major hospitals.
For this purpose, MDA operates two intensive care helicopters that have been in service since 2007. Each helicopter is manned by two flight paramedics who have undergone specialized training, and are each able to transport two patients simultaneously.
The main purpose of the helicopters is to transfer patients to specialized medical centers when appropriate. This means that the helicopter is usually dispatched after the arrival of the first crew at the scene. In cases where there’s a substantiated assumption that the helicopter will be required, or if the Command and Control center has received pictures or video from the scene, the helicopter will be dispatched even before the arrival of the first crew.
The funding for helicopter EMS operations is a part of Israel’s national health insurance. The Israeli defense forces also operate military helicopter EMS which can be called to enhance the civilian EMS.
Routine Emergency Response
By law, MDA is designated as Israel’s Red Cross organization, and acts a medical auxiliary during states of emergency. The country experiences a high number of war and terror acts which are regularly carried out against the civilian population. MDA provides the immediate medical care given to the population during states of emergency and war times.
Therefore, MDA crews have a great deal of experience in dealing with mass casualty incidents (MCIs) as a result of terrorism. In the last 20 years, there have been approximately 100 terrorism-related MCIs caused by both explosions by suicide bombings and in close-range shootings. During these incidents, MDA utilizes and amasses a considerable response, enabling the teams at the scene—including First Responders as well as ambulances—to evacuate all priority patients within 20 minutes of the first call received at the dispatch center.
Other terrorist incidents, including those without a high number of casualties, occur relatively frequently and require the organization to be on a high level of alert and preparedness. These incidents include stabbings, shootings, vehicle rammings and others.
The organization ensures the safety of the crews who respond to terrorism incidents and provides them with personal protective equipment. Many times, terrorists are intentionally attempting to attack and injure the medical crews and there is often a second explosion that occurs following a first explosion that’s intended to injure MDA personnel.
War acts against the civilian population come mainly in the form missile attacks. Since the Gulf War of 1991 until today, tens of thousands of missiles have landed in Israeli towns and cities, and there have been thousands of injuries. Despite this, MDA crews—both volunteers and employees—act despite life-threatening danger, racing to reach the victims, treating them and transporting them to hospital.
MDA’s preparedness for states of emergency is based largely on volunteers. There are many courses dedicated to train them for their roles, and there’s a support system in place for those who need it. This is especially important for volunteers, and particularly after difficult incidents.
Magen David Adom is sends emergency medical personnel as well as vital equipment to many disaster scenes around the world, in cooperation with the local Red Cross organization. MDA delegations are often among the first to reach disaster areas. This was the case during the Southeast Asia tsunami in 2004, and the earthquakes that hit Haiti in 2010 and and Nepal in 2015, among many others. Along with the aid to the population, MDA crews also assist Israelis injured in overseas terror attacks such as in Bulgaria in 2012.