Emergency medical services in Israel

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

Organization

Land Ambulance

Armoured Mobile Intensive Care Unit

While the MDA currently has approximately 1,200 medics, paramedics and emergency physicians on staff, it still relies heavily on over 12,000 volunteers who serve in both operational and administrative capacities. The organization operates 95 stations with a fleet of over 728 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) ^[1] 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.^[2]

Air Ambulance

Prior to 2008, air ambulance service was provided by the military.

Air ambulance service was provided by Israeli Air Force MEDEVAC helicopters, however, in 2008 civil HEMS was introduced by Magen David Adom in partnership with a private company called Lahak Aviation Ltd, utilizing four German-made MBB Bo 105s staffed with MDA paramedics. Lahak deployed them throughout the country in order to improve response times in peripheral areas. Previous attempts to integrate independent helicopter service in the 1970s were unsuccessful due to high cost.^[3] Non-emergency and repatriation air ambulance service is normally provided by a variety of private charter carriers such as Arrow Aviation in Israel.^[4]

Standards

Vehicles

MDA First Responder

Most of the fleet is made up of regular size vans staffed by "medics" (Hovesh) and "advanced medics" (Hovesh Bacir) as well as teenage and international volunteers (often qualified as first responders) and advanced life support ambulances, staffed by paramedics; mobile intensive care 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, and both volunteers and paid staff.^[5] First responders typically receive 60 hours of training to prepare them for their roles. Paid employees are required to be certified at the Hovesh level, which requires approximately 170–200 hours of training. The next step is the Hovesh Bacir (EMT-I) which requires a further four weeks of training or a part-time 180 additional hours of training. Those certified at the Hovesh level (EMT-B) are permitted to operate AEDs and to start IVs.(AED) ^[6] 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 a mobile intensive care unit ambulance. Increasingly, however, paramedics are choosing another option; obtaining a three year B-EMS in Emergency Medicine from Ben Gurion University in Beer Sheva with the MDA paramedics course as part of their curriculum.^[7] 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.^[8] They have achieved some success in this endeavour, assisting the nation of Chile with the development of a national EMS system.^[9]

Dispatch

Ambulances are dispatched from regional dispatch centres, except during wars or other emergencies when service is provided from a national dispatch 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.^[10] 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.^[11] 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.

See also

• Healthcare in Israel

References