Israel

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General

Capital – Jerusalem

Land Size – 22,072 sq km

Population – 7,353,985

Language(s) – Hebrew (official); Arabic (official for Arab minority)


Prehospital Care


Overview & History

  • “For such a small country, EMS in Israel is remarkably robust … such a broad range of activities is unusual for a single EMS organization.” (Ellis, 10)
  • Israeli EMS must provide cover for multitude of “eventualities”
    • Everyday medical emergencies
    • MCIs (including prevalence of terrorist attacks)
    • Regional wars
    • International disasters


Magen David Odom (MDA) – “Red Shield of David”

  • Founded in 1930
    • Initially run as volunteer service with series of regional branches that managed locally
    • Regional branches brought together into one centralized operation organization in early 1980s
    • 11 geographically distinct operational regions
    • Sole EMS provider
      • Also carries out functions of a national organization (i.e., Red Cross)
      • Provision of medical support to Israel Defense Forces in time of war
        • Resources and management for large-scale national incident
      • Management of Israeli blood collection and blood product delivery


EMS System Model – Two-tier EMS response

  • Basic:
    • Regular ambulance staffed by 2 EMTs, or 1 EMT and 1 volunteer
    • BLS skills and transport
  • Advanced:
    • MICU
      • Staffed by Physcian, Paramedic and EMT/Driver
      • Provides ALS
      • Usually responds to trauma-related emergencies
    • Intensive Care Ambulance (ICA)
      • Staffed by Paramedic and EMT/Driver
      • Provides ALS, but with narrower scope than MICU
    • Multi-Casualty Response Vehicle (MCRV)
      • Mobile Equipment Stores
      • Mobilized during prolonged MCIs
  • Response Time Goals
    • Urban – 8mins
    • Training emphasis on “Save & Run” (“Load & Go”) in trauma setting; 11min. avg. scene time


Lead Agency

  • MDA
    • Sole certifying agency of paramedics in Israel as mandated by Ministry of health
    • Also trains military paramedics who serve in Israel Defense Forces
  • Palestinian Territories
    • EMS under separate jurisdiction – Palestinian Red Crescent Society (PRCS)


Funding

  • Basically funded piecemeal from a variety of sources
    • Donations from overseas “friends” organizations
    • Local municipalities
    • Small amount from central government
  • Pt pays out of pocket and claims fee back from own health insurance scheme
    • Scheme reimburses for hospitalization or if certain other criteria is met
    • Otherwise, reimbursement can prove difficult


Levels of Care & Education/Training – ALS/BLS

  • EMT:
    • BLS
    • AED
    • Senior EMTs (>3yrs) qualify for new training course
      • Manual defib
      • Prepare drugs
      • Assist in ET Intubation
  • Paramedic:
    • 1.5yrs Training
    • ALS
    • PHTLS
    • PALS
    • Options for university-style academic paramedic courses with degree upon completion
  • Physician:
    • Work for MDA in addition to “regular job”
      • Typically relatively junior hospital MDs working part-time
      • MDA seen by some MDs as “scoop & run” service with little need for MD on-board
        • Little incentive to attract senior MDs into service
    • Majority come from hospital-based acute specialties
    • No formal prehospital training, though there are courses relevant to prehospital care
    • Aside from MDs in MICU, MDA also has:
      • General Medical Director
        • Medical aspects of treatments, including protocols
      • Medical Director for Paramedic Program
        • Training/supervision of paramedics in MDA with various external courses
  • Volunteers:
    • 10,000+
    • Many form integral part of day-to-day frontline ambulance service
    • Large responsibilities/roles in MCI scenarios
    • MDA reliance on volunteers allows them to provide relatively advanced level of training
      • 88h
      • Generic structure for First Aid
      • Advanced training
        • Phlebotomy
        • Ambulance Driver
        • MICU Assistant
        • Communications
    • “On-Call First Responders”
      • Equipped with medical/communication equipment
      • Operate from home; respond to incidents in geographic proximity
      • On-Scene: provide info to advanced providers about Pt conditions and necessity for further resources
      • Include MDs as well as off-duty MDA staff


Medical Direction


Specialty Services

  • HEMS
    • Typically falls to military when required
    • Plans underway to form civilian-run response (2008)
    • Evacuate casualties within country


Dispatch


National Emergency Telephone #

  • 101: Free emergency telephone number (separate from Fire/Police numbers)


Emergency Care & Emergency Medicine

  • All Israeli Citizens (regardless of faith) have an equal right to healthcare.
  • 5 hospitals equivalent to level-one Trauma Centers with all specialties on-site
  • Network of other hospitals with variable specialist services lie between these centers
  • Prehospital team determines which hospital Pt is taken to
  • Teams alert ED of need for immediate attention
    • Otherwise, team is met at ED door, usually by senior nurse, and directed to most appropriate location


Disaster

  • Trained and able to operate overseas in disaster zones
  • Mobile team and field clinic can be mobilized and deployed anywhere in world within hours
    • Most recent deployments:
      • Haiti earthquake
      • Sri Lanka, India and Thailand following Asian Tsunami
        • Complete field clinic set up in Sri Lanka, serving 2,300 Pt’s in just over two weeks


References

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