To the ambucycle!

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United Hatzalah offers fast and free response through Israel.

Introduction:

Imagine rush hour in downtown Tel-Aviv, and an emergency call goes out for help at the scene of a motor vehicle collision. A large, white ambulance from the Magen David Adom (the “Red Shield of David”) Organization will take nine minutes to arrive. While the average is nine minutes, the response during peak time traffic in urban areas can often be significantly longer.


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United Hatzalah_SarkarBose - Fig1a

Now, picture a small, bright orange “ambucycle” equipped with medical supplies and a trained first responder darting through these busy streets, arriving in 90 seconds (Fig. 1a-b).

United Hatzalah_SarkarBose --Fig1b


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This swift mobile response minimizes the time between injury and intervention, allowing for rapid delivery of quality care—the core mission of EMS worldwide.

The latter model is that of United Hatzalah (UH), which describes itself as “the largest independent, non-profit, fully volunteer EMS organization that provides the fastest and free emergency medical first response throughout Israel.” UH was founded by Eli Beer, who at a young age witnessed a horrible bus bombing and experienced the chaotic response.

At age 15, he became an ambulance volunteer. In his early 20s, he used those experiences to create a more flexible, community-sourced, technology-driven all-volunteer response team.

Put clearly, UH’s mission is to “arrive at the scene of medical emergencies as soon as possible and provide the patient with professional and appropriate medical aid until an ambulance arrives, resulting in more lives saved.” The non-profit is funded entirely by charitable donations. There is also a “My mitzvah” campaign, a crowd funding effort individuals can join.


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Interview:

After visiting their headquarters in June 2019, we did a follow-up Q&A this year with Raphael Poch (RP), EMT-B and International Media Spokesperson for UH, to learn more about the organization’s conception, implementation and how the COVID-19 pandemic has affected their services.

What makes United Hatzalah unique? How does it work?

RP: The thing that makes us unique as an EMS service is that we are not an “official government service.”  We are a private organization, completely self-funded. We work with the government: we are officially registered and certified by them, but we are not a government organization on any level, city, municipal or federal. We’re talking about people. We’re talking about community.

The way the organization is structured and works is volunteers are given a communication device, which is tracked via GPS by Dispatch (Fig. 2) automatically.

United Hatzalah_SarkarBose --Fig2

Whenever there is a medical emergency that occurs anywhere in the country, it automatically notifies the five closest responders based on location.

At that time, the volunteers, barring any extraneous circumstances, drop whatever they’re doing and respond to the emergency. So, we’re cutting out the time of getting the team into the ambulance, getting the ambulance from their location to the scene and getting through the traffic, and then finding the victim, etc.

So, let’s say it’s an emergency in an office building: it will be a volunteer in the next office over, or two floors down in the building [responding]. Or if it’s in a hotel, it’ll be another volunteer who happens to be staying in the hotel that day who will get to the medical emergency. As well, there are people who live in the neighborhood and know how to get there quickly.

How are your volunteers trained? What types of vehicles do you have?

RP: The capability of each responder is standardized by their level of training. UH is accredited by the Israeli Health Ministry to train members to the EMT level, and licenses between 1,200-1,300 new responders annually to serve in their own local communities.

Membership is also bolstered by readily trained advanced-level responders, including paramedics and licensed physicians who volunteer their time. Each responder is provided with the medical equipment appropriate to their level of training by the organization.

Author’s note: having toured their headquarters each “ambucycle” has different sized aid bags composed of basic IV supplies, tourniquets and hemostatic dressings —akin to our US Army combat medics. Some are equipped with airway management kits, as well.

It’s a little bit different in terms of vehicles. We have about 1,000 of what we call, “ambucycles,” which is a motorcycle reconfigured to have medical equipment. They’re used primarily in areas where there’s a lot of traffic…and mapped out based on the volunteers.

United Hatzalah_SarkarBose --Fig3a

Our 6,000 volunteers are divided into 90 different regions with 215 teams and each region has a Chapter Head, a Logistics Team and volunteers in different roles: logistics, communications and evaluating the psychological state of [other responders], what we call “psychotrauma.”   The chapters tell the organization what they need and we try to supply it (Fig 3a-b).

United Hatzalah_SarkarBose --Fig3b

What changes have you made during the COVID-19 pandemic?

RP: Like all facets of healthcare, the organization had to make adjustments to continue to deliver on their mission once the pandemic took effect, while protecting its personnel. During Israel’s first wave, none of UH’s 6,000 responders were identified as having contracted COVID-19 due to EMS activities. (Sixteen members were diagnosed with the virus, but contact tracing showed that their exposure was not linked with volunteer activities).

It starts with dispatch. For every call that comes in, they ask if someone in [the patient’s] area is a confirmed COVID patient, or if they’re in isolation.

If one of those two is affirmative, then the emergency [notification] that will go out to the responders on their phones will alert them to the fact that they need to wear protective gear. Each volunteer has been given an up-to-standard PPE suit, which they keep with them, so they have one with them at all times with their medical kits.

The organization has taken a very strong stance on protecting its volunteers. Some of our protocols included dividing up all regional volunteers into groups called “capsules.” On a location basis, a volunteer will be on call for a week, and then they take two weeks off. By doing this, we’ll always have people around who can assist, and we won’t have a situation in which there was one call where everyone got exposed, and there’s nobody available anymore.

Also, we expanded our locally-sourced volunteer model by partnering with the Israel Association of Community Centers and Lev Echad (“One Heart,” an emergency civil aid organization), they were able to expand their pool of 6,000 EMS responders to 30,000 all-purpose volunteers. We gave them the same app that we use on our communication devices, so they were notified if there was a humanitarian issue in their area.

This would include bringing a person food [or pharmacy medications], or helping elderly people fix their ovens, or their air conditioner breaks down and it is hot outside, but they’re afraid to have people at their house. One month this summer, we answered over 40,000 humanitarian calls for help!

Conclusion:

United Hatzalah continues to expand its mission, with plans to develop disaster response teams to send trained and equipped volunteers around the globe to continue to answer the call for help as it arises. It is a unique, community-sourced, tech-driven supplemental EMS model.

This model could serve as an example for other countries and regions, including the United States, that recognize the need to improve access to medical care and first response times in targeted areas, both urban and rural.

To learn more about UH and to consider supporting the volunteer organization, please visit https://israelrescue.org/.

ABOUT THE AUTHORS

2LT Bose is a Fourth Year Army Medical Student at the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, MD. He will begin residency in Emergency Medicine at Brooke Army Medical Center in San Antonio, Texas in summer 2021.

Debjeet Sarkar is an attending emergency physician at Howard County General Hospital and Assistant Professor, USUHS SOM, Dept. of Military & Emergency Medicine.

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