Glossary of basic EMS concepts
Newcomers to this blog should / can start here to understand how it all works
There are three main EMS organizations that operate in Jerusalem, (alphabetically) MDA, TEAM and UNITED. I am a member of all three, but my current motorcycle belongs to United.
In Hebrew, Magen David Adom (MDA) – was established in 1930 and is Israel’s ambulance, blood-services, and disaster-relief organization, serving as emergency medical first responders for the state’s 8 million people. MDA is a national organization, and works in cooperation with other emergency and security authorities. MDA currently has approximately 1,200 medics, paramedics and emergency physicians on staff, but 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 900 ambulances. In 2013, MDA answered and treated 659,226 calls received from all over Israel. The national emergency number for an ambulance in Israel is 101.
In Hebrew, Tzevet Hatzolah (TEAM) – is a community centered, volunteer emergency first response organization based in Jerusalem. They coordinate very closely with MDA on all fronts including EMS training, certification and equipment. In addition, TEAM members regularly volunteer on MDA ambulances and do “shifts” on a consistent basis. This enables them to ensure a very high level of professionalism, and a good “on scene” working relationship with Israel’s main ambulance service. They distinguish themselves however, from MDA, by having a firm Orthodox religious stance on all matters. Their volunteer base is all male; they operate under the guidance of Rabbis, and function with strong adherence to Jewish Law.
In Hebrew, Ichud Hatzalah (UNITED) – is Israel’s first and largest fully-volunteer emergency rapid response service. With a fleet of over 300 ambucycles, United Hatzalah’s 2,300 volunteers respond to nearby emergencies from mobile-alerts and arrive first on scene to administer urgent care within minutes from the initial call of distress – bridging the gap between emergency and ambulance arrival. United Hatzalah is a fully non-profit organization that relies solely on donations. All emergency medical treatment is administered by fully trained volunteers that do not charge for their life-saving service. Annually, United Hatzalah responds to more than 211,000 emergency calls, of which approximately 25% are critical lifesaving situations. The average response time is 3 minutes.
There are three types of calls that an ambulance can get dispatched to – Ambucycles however, normally only respond to Cat A and Cat B calls. That is unless we have to help with the kids at home, in which case we might disappear to a Cat C call…
Category A calls are the most urgent and critical medical emergencies that we are called to. They include heart attacks – unconsciousness – and severe difficulty breathing amongst others. These types of calls are always responded to by NATAN ambulances (staffed by paramedics) and are classified as URGENT.
Category B calls are second level priority and are for calls that, whilst URGENT are probably not immediately life-threatening, and don’t require a paramedic response. These include, faintings, minor injuries, and strokes. If an EMT-B responding to a CAT B call, finds the situation worse than originally described, he will call for NATAN backup.
Category C calls are the lowest level of call and are essentially just requests for transport to a hospital. Examples might be an Old-age home sending a patient to the hospital for treatment or when the hospital sends them back home. These calls get a LAVAN response only, and are Non-Urgent.
Emergency Medical Technicians
There are three types of EMT’s and each has a different level of training. The overall idea is that the personnel with more advanced training get dispatched to the more “serious” calls.
EMT-B’s – get at least 100 hours of training and is the level at which most volunteers are certified. Once in the system, B’s very often upgrade their knowledge and skills, which enables them to do the “cool stuff” like preparing medications and reading ECG’s.
EMT-I’s – have started as B’s and have then done an additional couple of hundred hours of training. They are certified to do a variety of things like, open veins, give certain medications and essentially assist the paramedic with ALS protocol.
EMT-Ps – otherwise known as Paramedic’s – get 1000’s of hours of intense training both in the classroom and in the field. You can recognize them by the orange band on their arm and the conceited look on their faces. Seriously though, these guys are at the top of their game and it’s them you want around in a situation that warrants ALS.
Beepers, Radios, and GPS devices
There are three types of “gadgets” that Control uses to dispatch us. Each one has its advantages and disadvantages. Overall it means I have a lot of extra weight on my belt.
Yes, the very same Beeper that has been around for decades, except that now it’s much thinner and has a cool blue LED light. Whenever it’s turned on, it indiscriminately receives all the emergency calls in your city, sometimes buzzing hundreds of times a day. We are proficient at taking it out, looking at the address, deciding whether we want to respond, and putting it back in the holster in under 1 second.
Also known as MIRS, each organization has their own radio and channel through which they dispatch their teams. A dispatcher gets on, describes the call and should you wish to respond, you tell him “Unit #18 responding to xyz”. The radios are connected to Bluetooth devices inside the helmet so that Control can give you exact directions and details on the way. Once you get to the scene you are expected to report back, describing the patient’s condition, and whether you need additional assistance.
Both MDA and United both have their own GPS communication device, called iMADA and LifeCompass respectively. This is the latest technology and helps dispatch the right person to the right place at the right time. The system draws a virtual perimeter around an incident that has been entered into the computer and then alerts only the medics in a predetermined radius to the incident. Each volunteer knows that when his GPS device alerts him, it is because he is in the immediate vicinity of an emergency incident. Complete GPS guidance to the scene and recording capabilities ensure that every incident is responded to and recorded.
There are three types of ambulance’s that get sent to calls. Although technically each type has a specific duty, in reality Control will dispatch the closest unit to provide immediate assistance, irrespective of the Category of call.
In Hebrew “LAVAN” – This is a BLS (Basic Life Support) ambulance and normally responds to Cat B and Cat C calls. Like their name, these ambulances are white and are staffed by 2 or 3 EMT’s.
In Hebrew “NATAN” – This is an ALS (Advanced Life Support) ambulance and normally responds to Cat A Calls. The NATAN is staffed by Paramedics and sometimes medics in-training. These are the people you want when the “going gets rough”.
This is what I drive! As the name suggests, an Ambucycle is the fusion of an ambulance and a motorcycle. It is essentially an ambulance on two wheels, and is the fastest way to reach any address in the city. We carry all the equipment a regular ambulance has, except for the bed. Our job is to
look cool provide “first responder” assistance and stabilize the patient, until the ambulance arrives to transport.
There are three types of Emergency Services – Ambulance, Police and Fire. There is of course no doubt that Ambulance works the hardest, but I have to give credit to the others as well; they often do a marvelous job.
This of course is what I do – and you’ll hear all about it in the blog.
This is what we call the Police service. The reason is simple – they wear blue. I don’t really have much interaction with them, because they normally arrive after I have left the scene (slowpokes). There is also an elite unit called YASAM – these guys are highly trained ex-special ops and respond to the most serious calls only. They too ride on motorcycles (Kawasaki KLE500) and carry some serious fire-power, namely the Jericho 941 and M4 Carbine. Police can be reached on 100.
This is what I call the Fire service. The reason is simple – the trucks are Red. These guys are not only great at fighting fires but also at solving practical problems. They often help us extricate kids when they get stuck, or extract an injured patient from a difficult location. Fire can be reached on 102.
There are three concepts or words that I will often mention in passing, and you should probably know what they mean. We do “Shifts” and get sent on “Urgent” calls, by “Control”.
In Hebrew “Moked” – This is where calls are received and units dispatched. These guys have a relatively comfortable, albeit sometimes stressful life. They sit in a large air-conditioned room with tens of huge computer screens. Their job is to receive the call, decided on the severity, dispatch units and communicate / coordinate the response until the patient is in the hospital. Unlike other countries, in Israel people that work in Control have a vast amount of on the ground, real-life experience.
In Hebrew “Dachoof” – This means that we drive to or from the call with “Lights and Sirens”. Time-critical and life-threatening illnesses or injuries are transported in this manner. On the way to the emergency the urgency is decided by “Control”. Once the patient has been treated, it is the ambulance driver’s discretion to decide the level of “urgency”.
An Ambulance Shift is when we volunteer to do a shift on a MDA ambulance. There are three shifts in a 24 hour period. Morning = 0700-1500, Afternoon = 1500-2300 and Night = 2300-0700. Every registered MDA volunteer has to do at least one shift every month, to maintain his membership. “Doing a Shift”, entails, turning up to the station 15min before the start, signing in, checking that your ambulance has all the necessary equipment and then waiting for a call to come through. You can be sent to any type of call, at any time, to any address in the city.
There are three types of… Just kidding – these are unrelated. This glossary is almost done, but it wouldn’t be complete without mention of the following.
The Difference of Opinion
In Hebrew “The WAR” – This refers to the years 2010 – 2013 when there was an all-out war between the EMS organizations in Israel. Being a member of all three at that time was (almost) impossible, because each would insist on exclusive membership. By maintaining a low profile, I managed to get along with (almost) everybody. The war ended in 2014 when an official peace agreement was signed. Everybody lived happily ever after – except the media, who had no gossip to report about.
The source of the snake as a universal symbol of healing is mentioned in the Talmud in Tractate Pesachim (56A). While in the wilderness, the Israelites once spoke rebelliously against G-d and against Moses. G-d punished them with a plague of poisonous snakes and many people were killed. After they repented, G-d instructed Moses to fashion a serpent. Moses made the serpent from copper, and all who gazed upon it were healed (Numbers 21:8).
The Rabbis ask – Can a snake cause death, or give life? Rather, at the time that Israel would look upward, and subject their hearts to their Father in heaven, they would be cured, but if not, they would waste away.
In later years people erroneously attributed powers of healing to the image itself, and began worshipping it. The Prophet Hezekiah therefore had it destroyed. This phenomenon repeats itself in our day, whereby patients sometimes put a little too much faith in Doctors and the medicine / treatments they prescribe.
The Jewish day of rest, called Shabbat in Hebrew, begins a few minutes before sunset on Friday evening and ends with the appearance of three stars in the sky on Saturday night. Shabbat observance entails refraining from work and engaging in restful activities to honor the day. Shabbat is ushered in by lighting candles and reciting a blessing. Traditionally, three festive meals are eaten: in the evening, in the morning, and late in the afternoon. Shabbat is a festive day when Jews exercise their freedom from the regular labors of everyday life. It offers an opportunity to contemplate the spiritual aspects of life and to spend time with family.
Jewish law prohibits doing any form of “Melacha” on Shabbat. Though “Melacha” is commonly translated as “work” in English, a better definition is “deliberate activity” or “skill and craftsmanship”. You see it is not the difficulty of the task that decides whether it’s permissible, but rather whether the act belongs to the 39 categories of prohibited activities. Example – Jews can walk for miles on Sabbath, but, they can’t drive in a car! I am telling you all this in anticipation of a simple question. If Jews can’t drive on Sabbath, how do they respond to a medical emergency?
Answer – In the event that a human life is in danger, a Jew is not only allowed, but required, to violate any (Melacha) law that stands in the way of saving that person. The concept of life being in danger is interpreted broadly: for example, it is mandated that one violate Shabbat to bring a woman in active labor to a hospital. Judaism places immense importance and value on Human Life. You can read more about Shabbat here or here.
This is a Hebrew word which, loosely translated means “The Rescuers”. Whilst we are called a lot of things, (medics, cowboys, underpaid & underappreciated persons), “Hatzolah” is both the most popular and the most endearing. When someone in our community has a real emergency, this is what they will scream – “HATZOLAH” – and of course we will be there B’H in under 3 minutes, 24/7. You can read more about Hatzolah here.