about Medicine

There are a number of terms found on this site that may be unfamiliar to the non-medical reader

Please find a glossary below !



The American Heart Association is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. Most EMS services worldwide follow the AHA’s recommendations closely and initiate new or revised BLS and ALS protocols accordingly. In the 2010 update there were several important changes whereby; the famous ABC’s of CPR was changed to CAB, and bystander CPR became a 2 step process of (1) Call for help and (2) Do chest compressions until help arrives. The AHA publishes their advice every couple of years and the next update is scheduled for 16/10/15. Yipeeee !

Allergic reaction

Refers to the body’s response to an allergen, causing minor discomfort and perhaps an itch. In its worst form it can cause Anaphylaxis, which is a serious allergic reaction that is rapid in onset and can potentially cause death. Symptoms including an itchy rash, throat swelling, and low blood pressure. Common causes or triggers include insect bites/stings, foods, and medications. People known to have severe allergic reactions carry Epipens with them always. An Epipen is an automatic epinephrine injector, a medicine that can potentially reverse the effects of a reaction. 


Advanced Life Support is a set of life-saving protocols and skills that extend BLS (Basic Life Support) to further support the circulation and provide an open airway and adequate ventilation. ALS is initiated by paramedics that normally respond in a NATAN ambulance. Bottom line: they have more toys and do cooler stuff than their BLS (Basic Lifting Service :-)) brethren. 


Also known as a MCI or Mass Casualty Incident. An MCI is any incident in which EMS resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties. Technically, an incident where a two-person crew is responding to a MVA with three severely injured people could be considered a MCI. The general public more commonly recognizes events such as building collapses, train and bus collisions and other large-scale emergencies as mass casualty incidents. In Israel, an ARAN is all too often synonymous with a terrorist attack. 


Irregular Heartbeat or rate – There are a dozen types of irregularity, but the common denominator is that they classify as a CAT A call. A normal heart rate is 50 to 100 beats per minute. Faster than that is called Tachycardia and slower is called Bradycardia. A full list of the irregularities is beyond the scope of this glossary, and the scope of my knowledge. 

Assisted Ventilation

AV is a method to mechanically assist or replace spontaneous breathing. This may involve a machine called a ventilator or the breathing may be assisted by a paramedic, by utilizing something called a BVM. AV is indicated when the patient’s spontaneous ventilation is inadequate to maintain life. Because mechanical ventilation serves only to provide assistance for breathing and does not cure a disease, the patient’s underlying condition must be eventually corrected.



Is the way we refer to the particular patient’s normal vital signs. Whilst most peoples “Vitals” fall within a specific range, some patients with pre-existing conditions might have “normal” levels that are quite different than the standard. If you take vitals and something is amiss, it’s worth finding out what the patient’s Baseline is, so that you can decide whether it is an emergency or not. A typical example would be a young lady whose BP baseline is 90 systolic (normal is 120). 


A Bone Injection Gun is an instrument used to enable Intraosseous infusion, by injecting directly into the marrow of a bone to provide a non-collapsible entry point into the systemic venous system. This technique is used in emergency situations to provide fluids and medication when intravenous access is not available or not feasible. Bla Bla Bla – bottom line – you never wanna meet one of these guys in a dark alley.


Bleeding is the loss of blood, and it may be inside the body (internally) or outside the body (externally). Internal hemorrhage is a real emergency, because it can very quickly become life threatening. Funny thing about bleeding though is that sometimes a relatively minor injury can bleed a lot, like a scalp wound, but not be dangerous. Occasionally however, serious injuries don’t cause heavy bleeding and can deceive the patient into thinking all is OK. Patients, who take blood-thinning medication or have a bleeding disorder such as hemophilia, require immediate medical attention. External bleeding can normally be stopped by applying direct pressure; internal bleeding cannot. Ps. Rinsing with water won’t stop bleeding. 


Basic Life Support is the level of medical care which is used for victims of life-threatening illnesses or injuries until they can be given full medical care at a hospital. It can be provided by trained medical personnel, and by laypersons who have received BLS training. BLS is generally used in the prehospital setting, and can be provided with or even sometimes without medical equipment.


A bag valve mask, sometimes known by the proprietary name AMBU, is a hand-held device commonly used to provide ventilation to patients who are not breathing or not breathing adequately. The device is a required part of resuscitation kits for all EMS responders. Use of manual resuscitators to ventilate a patient is frequently called “bagging” the patient and is regularly necessary in medical emergencies when the patient’s breathing is insufficient or has ceased completely. Use of the manual resuscitator force-feeds air or oxygen into the lungs in order to inflate them under pressure. In plain English, we use a BVM instead of mouth-to-mouth, because the latter, is defunct.


This is when someone has miscalculated, and stayed home for too long, instead of going to the hospital. We either get there just in time to deliver the baby, or Mom and Dad get instructions over the phone, and we get there in time to cut the cord. Either way, it’s one of the only “happy” emergencies we respond to. 



Intravenous – Also known as “Opening a Vein” or “Starting a Line” – is when a venous cannula (needle) is inserted into a vein, for the administration of intravenous fluids, or for administering medicines. We decide on an appropriate size cannula based on the age of the patient and the amount of medicine or fluids that need to be given. New EMT’s have been known to practice on each other and lose an immense amount of blood in the process. 


The CardioPump is a device used during CPR, enabling better compressions. The pump, which bears a striking resemblance to a toilet plunger, permits the rescuer to actively re-expand the chest during the decompression phase of cardiopulmonary resuscitation. This results in more blood being returned to the heart (preload). Enhanced preload leads to increased cardiac output on the subsequent chest compression.

Chest Pain

Sometimes a heart attack (MI) and occasionally somebody with a pulled muscle or indigestion. We ask several questions to try and determine which it is. Questions include Onset, Provocation, Quality, Radiation, Recurrence, Relief, Severity, Symptoms, Time, and Interventions. And yes, I just read that out of a textbook. 


Is the obstruction of the flow of air into the lungs. Choking prevents breathing, and can be partial or complete, with partial choking allowing some, although an inadequate, flow of air into the lungs. Choking is normally caused by a physical obstruction of the airway by a foreign body, such as food or a small toy. The Heimlich maneuver can remove a foreign object obstruction, but I can count on one hand the times that I have had to use the maneuver. In most instances the obstruction comes out before we get there, or it was only a partial obstruction, for which the Heimlich wouldn’t help. 


A convulsion is a medical condition where body muscles contract and relax rapidly and repeatedly, resulting in an uncontrolled shaking of the body. Because a convulsion is often a symptom of an epileptic seizure, the term convulsion is sometimes used as a synonym for seizure. However, not all epileptic seizures lead to convulsions, and not all convulsions are caused by epileptic seizures. We get an immense amount of febrile seizure which is a convulsion in a child triggered by a fever. A febrile seizure can be very frightening for any parent or caregiver. However, most of the time, they do not cause any harm and doesn’t mean the child has a more serious long-term health problem. 


Cardiopulmonary resuscitation is an emergency lifesaving procedure that is done when someone’s breathing or heartbeat has stopped. Basic CPR combines rescue breathing, chest compressions and defibrillation. CPR techniques vary slightly depending on the age or size of the patient. The newest techniques emphasize compressions (100 per minute) over rescue breathing and airway, reversing long-standing practice. The AHA currently recommends that untrained bystanders (1) Call for help and then (2) Start chest compressions on the unresponsive patient. Once local EMS arrives, administration of an electric shock to the subject’s heart, termed defibrillation, is usually needed in order to restore a viable heart rhythm. Defibrillation is effective only for certain heart rhythms, namely VF or VT, rather than asystole or PEA. In general, CPR is continued until the patient has a return of spontaneous circulation, or is declared dead. 


Chronic obstructive pulmonary disease is one of the most common lung diseases and makes it difficult for the ailing patient to breathe. There are two main forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus; Emphysema, which involves destruction of the lungs over time. COPD patients normally have below average O2 Saturation levels and are very often connected to Oxygen on a temporary (nighttime) or permanent basis. 


Danger to Human Life

This is a category of call that can include a variety of emergency situations. The common denominator however, is that something funky is going on, and help is needed ASAP. In most instances it means that the health of a patient behind locked doors is in question. In these situations, all three services are called; The BLUES – to give authorization to knock the door down, REDS – to knock the door down, and EMS – to treat whoever lies behind the door.


An automated external defibrillator (AED) is a portable electronic device that automatically diagnoses the life-threatening cardiac arrhythmias of VF and VT in a patient, and is able to treat them through defibrillation, the application of electrical therapy which stops the arrhythmia, allowing the heart to reestablish an effective rhythm. Automatic defibrillators analyze the heart rhythm, and then advise the user to either press ‘shock’ or ‘no shock advised’. AED’s can be used both by laypersons (You) and professionals (Me) 🙂


Difficulty Breathing – we have two categories for this, Mild and Severe, and Control decides which category the patient is in based on a series of questions. One of the main criteria is whether the patient can “complete a sentence”. People with Severe DIB have difficulty speaking normally, and this is because they are essentially gasping for every breath. 


Someone who does drugs. We get a lot of these types of calls, although mostly in the center of town, and not in the residential areas. Sometimes these people are hallucinating and think they are dying. Occasionally they really are. 


Do not resuscitate – this is a legal document expressing the patients wish, not to undergo CPR or advanced cardiac life support (ACLS) if their heart were to stop or they were to stop breathing. 



An electrocardiogram is a test that checks for problems with the electrical activity of the heart. An ECG translates the heart’s electrical activity into line tracings on paper. The spikes and dips in the line tracings are called waves, namely PQRST. 

Emergency Room

ER is where we take our patients to receive further treatment and make them feel better. The ER is staffed by Doctors and Nurses galore, who bless us constantly and consistently, for bringing them more work. 


Frequent Flyers

Every ambulance system in the world has some of these. FF’s are people, sometimes sane, sometimes less so, that call the emergency services daily. They are a huge burden on the system and waste our time and the public’s money. Truth be told though, they become part of our lives, and as long as they aren’t vomiting everywhere, I don’t mind responding to a call for an FF every once in a while. They are after all completely alone in the world. 



Elderly people – we are called to geriatric patients all the time, because they are prone to falling, and well, being sick. Some are very sweet and have beautiful and caring families. Some live alone in unspeakable conditions. Some live in assisted living facilities (or old age homes), which are either bad, or worse than bad. 


Gornisht mit gornisht – German / Yiddish slang that literally means ‘nothing, absolutely nothing’. This is how we refer to the disease of someone complaining about nothingness. If an EMT looks you in the eye and says you have a bad case of GMG – punch him.


Gunshot Wound – I don’t think this needs any description, only to say that it is nothing, I repeat, nothing, like on TV. Jerusalem has an exceptionally low level of crime and specifically homicide, and so we don’t see a lot of GSWs. When we do respond to a shooting, it is either due to terrorism, or suicide.


Head Injury

Head injuries include both injuries to the brain and those to other parts of the head, such as the scalp and skull. A head injury may cause skull fracture, which may or may not be associated with injury to the brain. If intracranial hemorrhage (internal bleeding) occurs, a hematoma within the skull can put pressure on the brain. A head injury can either end “happily” with some stitches and a minor concussion, or it can cause devastating and debilitating long-term effects. The best medicine is prevention. 

Heart Block

A Heart Block is a disease in the electrical system of the heart. This is opposed to coronary artery disease, which is disease of the blood vessels of the heart. While coronary artery disease can cause angina (chest pain) or an MI (heart attack), heart block can cause lightheadedness, syncope, and if left untreated, death.

Heart Rhythms

VF / VT / PEA / Asystole – The normal beating of the heart is called a “sinus rhythm”. The names at the beginning of this paragraph are rhythms that are ultimately fatal, if not treated STAT (immediately). VF and VT, where the heart quivers rather than contract properly, can be shocked by a defibrillator in an attempt to restore a normal heartbeat. PEA which is a situation in which a heart rhythm is observed on the ECG that should be producing a pulse, but is not and Asystole (flat line) cannot be shocked (contrary to what is seen on TV etc.). 


Refers to a person with excessive preoccupancy or worry about having a serious illness. This debilitating condition is the result of an inaccurate perception of the condition of body or mind despite the absence of an actual medical condition. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness. Many thanks to Google for creating a lot of these. The opposite of this is someone in complete Denial about their condition. 


HYPER is the opposite of HYPO (see below). In this instance the blood sugar is too high. HYPER normally progresses more slowly than HYPO, and whilst unhealthy, is not (normally) immediately life threatening. 


HYPO is a condition that occurs when blood sugar (glucose) is too low (below 70 mg/dL) Low blood sugar is most commonly seen in people with diabetes, who take insulin. We measure blood sugar by pricking the finger and testing the drop of blood in a glucometer. HYPO, if left untreated, will eventually cause the patient to lose consciousness and die. 

Hyper and Hypotension

Are fancy words that mean high and low Blood Pressure (BP). Normal Adult BP should be approximately 120/80. 


HY is rapid breathing that can occur with anxiety or panic. When you breathe, you take in oxygen and breathe out carbon dioxide. Excessive breathing creates low levels of CO2 in your blood. This causes many of the symptoms of hyperventilation such as dizziness, tingling in the lips, hands or feet, headache, weakness, fainting and in extreme cases seizures or unconsciousness. Often, panic and hyperventilation become a vicious cycle. Panic leads to rapid breathing, and breathing rapidly can make you feel panicked. HY is real; it causes real symptoms, and needs to be treated. The reason why we might sometimes refer to HY in non-endearing terms, is because there is little we can do to help the patient, other than demonstrate slower breathing. 



We have three categories for this – Minor, Moderate and Serious.  The correct way to measure the extent of the injury is with the Injury Severity Score which is an established medical score to assess trauma severity. The ISS is a bit complicated though, and on the scene we normally estimate the severity of an injury in a matter of seconds using more approximate measures. 


Is the placement of a plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequently performed in critically injured, ill or anesthetized patients to facilitate ventilation of the lungs, and to prevent the possibility of asphyxiation or airway obstruction. Because it is an invasive and extremely uncomfortable medical procedure, intubation is usually performed after administration of general anesthesia. It can however be performed in the awake patient with local or topical anesthesia, or in an emergency without any anesthesia at all. 



This is how an electric shock is measured, and no, you don’t shock a flatline patient. 


Kupat Cholim

Local mini-clinic. Sometimes when someone walks in with a real emergency, the doctors there will call an ambulance to transport the patient to hospital. Some of these clinics are great, and are staffed with dedicated doctors and nurses. Others are useless and are not embarrassed to sit a patient having a fully blown heart attack, in the waiting room with no care whatsoever. 


Lights and Sirens

These are what we use when we are on URGENT, on the way to, or from a call. EMS in Israel normally uses red and white combinations for the lights, whereas police use blue/red. The Ambucycles have three Siren sounds as well as an air-horn, which are activated and changed using buttons next to my right thumb and left pointer. It’s a bit hard to describe the sounds that they make, but it’s approximately a wail, yelp and super yelp. The first sound is a wail, which is a long drawn out tone and is used on long stretches of road. When we get closer to traffic or a junction, we might switch to yelp and then super yelp to tell the drivers that “we’re here now”! The air horn is for people who just refuse to move out of the way – 97% of the population. 


Myocardial Infarction

MI, commonly referred to as a heart attack, occurs when blood flow to a part of the heart is blocked for a long enough time that some of the heart muscle is damaged or dies. Usually this happens because one of the coronary arteries that supplies blood to the heart develops a blockage. A person having an acute MI usually has sudden chest pain that is felt in the center of the chest and sometimes travels to the left arm or the left side of the neck. Additionally, the person may have shortness of breath, sweating, nausea, vomiting, abnormal heartbeats, and anxiety. In some cases however, the person does not have chest pain or other symptoms; this is called a Silent MI. The principal way to determine if a person has had an MI, are ECGs that trace the electrical signals in the heart, and testing the blood for substances associated with damage to the heart muscle. 


Motor Vehicle Accident is when a vehicle of any type collides with another vehicle or person / pedestrian. It is either classified as “Light” or “Severe” and we will normally be told by Control, who or what is involved, for example “Bus vs. Pedestrian”. 


This is when pregnant women use, or maybe abuse, the system to get a free and quick ride to the hospital. There are times when an ambulance for a woman in labor is justified; quick succession contractions for example. There are also times when it’s not. 



Nothing here yet, I’m afraid



Is short for Oxygen, and O2 SATS are Oxygen saturation levels. We measure saturation levels in patients using a pulse-oximeter, which is a small electrical device that has a sensor that goes on the patient’s finger or earlobe. A normal healthy person would be expected to have sats of between 95% – 100%. If the level falls below 95% something might be wrong and if it’s below 90% something is definitely amiss. Patients with chronic breathing problems might have a Baseline that is below 90%. 


OD – Drug overdose, describes the ingestion of a drug or other substance in quantities greater than are recommended. An overdose may result in a toxic state or death. Drug overdoses are sometimes caused intentionally to commit suicide or as self-harm, but many drug overdoses are accidental. 


Panic Attack

Panic attacks are periods of intense fear or apprehension, that begin suddenly and can last anywhere from minutes to hours. Panic attacks usually subside on their own but, many first-time sufferers call for emergency services, fearing they are having a heart attack or a nervous breakdown. Experiencing a panic attack has been said to be one of the most intensely frightening, upsetting, and uncomfortable experiences of a person’s life and may take days to initially recover from. The patient might also hyperventilate thereby exasperating their symptoms. 


Is the absolute 100% best medicine. So many traumatic injuries and even illnesses can, and should be prevented. I can’t begin to describe how many unnecessary tragedies I have been called to. STAY SAFE!!! 

Private Questions

Certain emergencies require certain diagnostic questions to be asked by the attending EMT. Sometimes its uncomfortable and sometimes its downright excruciating. Sometimes the questioner feels awkward and sometimes the patient feels self-conscious. But almost always there is someone standing to the side, family-member or EMT, that finds the tension hilarious. Example questions: are you pregnant – have you had a miscarriage – is it that time of the month – what medications are you taking, etcetera. If you are alone in the room with the patient, great. If the emergency is on the dance floor of a wedding with 230 curious guests – The Best of British Luck.


Pulmonary Edema is an abnormal buildup of fluid in the lungs, which leads to difficulty in breathing. PE is often caused by congestive heart failure, more specifically, increased left ventricular pressure. When the heart is not able to pump blood to the body efficiently, it can back up into the veins that take blood through the lungs to the left side of the heart. As the pressure in these blood vessels increases, fluid is pushed into the air spaces (alveoli) in the lungs. Symptoms of pulmonary edema may include: Difficulty breathing (inability to speak in full sentences), coughing up bloody froth, and a feeling of “drowning”. The initial management of PE, irrespective of the type or cause, is supporting vital functions. Once the patient gets to the hospital, treatment of the underlying cause would be the next priority.



People ask me questions all the time; some I can answer and some I can’t. How do you do the Heimlich? – I can answer! What happened at that call? – I can’t!



Or as we call it SIRUV – this is when a patient Refuses Medical Attention, or transport to the hospital. This can happen either before or after you have checked their Vitals. From time to time it’s the sensible option, but sometimes the patient is putting himself at risk. When we feel very strongly that the patient is harming him or herself, we can call Control and/or Police to take them to the ER by force. 



Shabbat (the Sabbath) is the centerpiece of Jewish life, and has been so since the infancy of the Jewish Nation. According to the Talmud, Shabbat is equal to all the other commandments. Shabbat is a day of rest and a celebration that begins on Friday at sunset and ends on the following evening after nightfall. Shabbat observance entails refraining from work activities and engaging in restful activities to honor the day. (Source Chabad.org)


Signs and symptoms describe the same conditions, but are quite different;

1. Signs are what a doctor sees, symptoms are what a patient experiences.

2. While signs are the physical manifestation of injury, illness or disease, symptoms can be described as what a patient experience about the injury, illness or disease.

3. Signs are objective. Symptoms on the other hand are subjective 


Sudden Infant Death Syndrome, also known as cot death or crib death, is the sudden death of an infant that is not predicted by medical history and remains unexplained even after thorough investigation. Infants are at the highest risk for SIDS during sleep. Typically the infant is found dead after having been put to bed, and exhibits no signs of having struggled. In an effort to prevent SIDS, some parents now use a ‘breathing monitor’ that sounds an alarm, if breathing is not detected.


Is a term used in the medical field and means – NOW !! 


Or CVA (cerebrovascular accident) is the loss of brain function due to a disturbance in the blood supply to the brain. This disturbance is due to either ischemia (lack of blood flow) or hemorrhage. As a result the affected area of the brain cannot function normally, which might result in in an inability to move one or more limbs on one side of the body, failure to understand or formulate speech, or a vision impairment. A stroke is a medical emergency and can cause permanent neurological damage or death. An ischemic stroke is occasionally treated in a hospital with thrombolysis (also known as a “clot buster”), and some hemorrhagic strokes benefit from neurosurgery. 


Commonly known as Fainting, is a sudden, brief loss of consciousness caused by decreased blood flow to the brain. Many different conditions can cause fainting including hypotension, heart problems, anxiety attacks, hypoglycemia, and anemia. While fainting may indicate a particular medical condition, sometimes it may occur in an otherwise healthy individual. In most cases, the individual who has fainted regains complete consciousness within just a few minutes. A vasovagal attack is the most common type of fainting spell and happens because blood pressure drops, reducing circulation to the brain and causing loss of consciousness.



Transient Ischemic Attack – Basically a Mini-Stroke. Patients that are having a TIA have similar symptoms to a stroke, except the symptoms usually resolve by themselves within minutes or hours. If left untreated, TIA’s are very often the forerunner of a major stroke. 


More than the Five Books of Moses, Torah is the guide to living. No word in the Jewish religion is so indefinable and yet so indispensable as the word Torah. Torah is the most comprehensive term for the substance of Judaism. Torah is Teaching. Torah is Law. No one can hope to achieve even a minimal appreciation of the Jewish religion without learning, and then reflecting on, the idea of Torah and its place in the life of the Jew. (Source Aish.com)

Trauma Room

(Almost) every hospital has one of these, and this is where the most immediate life threatening injuries or patients are brought. We radio Control telling them we want the Trauma room – control alerts the hospital – and the hospital ensures that a team of personnel is ready and waiting in the TRAUMA for our arrival. 



Unconsciousness is the condition of being not conscious; i.e. In a mental state that involves complete or near-complete lack of responsiveness to people and other environmental stimuli. We use the AVPU scale (an acronym from “alert, voice, pain, unresponsive”) to measure and record a patient’s responsiveness, indicating their level of consciousness. This is pretty much the worst type of call we can get, because if the person really is unconscious – well, that’s no good. 


Vital Signs

Refers to the patients Pulse, Blood Pressure, O2 saturation, Respiratory rate, Temperature and Blood Sugar. We take the Vital Signs of almost all the patients we see in Emergency situations. 


I try and stay away from calls in this category. Firstly because I don’t know martial arts and second because if people get themselves into a fight, they deserve what’s coming to them. 



The 100% foolproof solution and fix for every single emergency medical situation known to man. Anxious family members have been known to pour it, drink it, moosh it, and spritz it over the patient in a desperate effort to save their limbs or lives. Whilst I don’t doubt the healing properties of Water, there are no studies to prove that it will actually stop a full blown seizure, or head injury. My advice – drink plenty of water (best served chilled) and leave the patient alone. 


Or General malaise. Sometimes these calls are exactly that, a person that just feels unwell. Sometimes however you find that the patient is (a) in Denial (opposite of Hypochondriac) and/or (b) in the throes of death. 


In Medicine, “Gold Standard” refers to a diagnostic test, benchmark, or treatment that is the best available under reasonable conditions. In my humble opinion, Winkies, are the Gold Standard, in “candies for kids at a chaotic emergency scene”. They are the right size (for kids older than 3), they don’t melt or get squashed, and all kids (me included) love them. They are packaged individually, and every pediatric patient, as well as his siblings, gets one.



Is somebody that has passed away (dead to be blunt). We are rarely allowed to declare an “X” without initiating resuscitation attempts. Exclusions to this rule are when the body has signs of Rigor Mortis or Lividity – terms that I’d rather not describe. Sometimes we go to the call knowing it’s probably an “X” and sometimes it comes as a complete shock. 



Whilst I have never attended an emergency on a Yacht, I have had several on an airplane.



I have never, ever, done CPR on a Zebra.