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Israel’s Magen David Adom world’s most efficient ambulance service

Daniel AmzallagBy MYRON LOVE
Daniel Amzallag always had a fascination with all things medical, but his path was laid out for him when Magen David Adom came to his high school in Kfar Saba to do a presentation.

 “I immediately signed up with Magen David Adom (Israel’s combination emergency responders and blood Services providers) for a first aid and CPR course and was hooked,”  recalled Amzallag, the now Toronto-based Canadian Magen David Adom (CMDA) national media and volunteer co-ordinator, who was in Winnipeg on Wednesday, November 1, to introduce Winnipeggers to the work of MDA at a presentation at the Berney Theatre.

Amzallag’s first opportunity to put his new training to use came much sooner than he might have expected.  He recalled that immediately after passing the MDA courses, he and a friend were at a local mall when a terrorist blew himself up at the mall entrance, killing the security guard and a teenager and injuring more than 50. Although injured himself, he rushed to the scene of the explosion to offer what help he could.
“The nearest MDA centre was just minutes away,” he said.  “It seemed to take forever for the first ambulances to arrive but in reality it was just two to three minutes.  Within 15 minutes, all of the wounded were in ambulances on the way to hospitals.  I was the last to be evacuated and was released from hospital shortly after.
“Within two to three days, I signed up for the MDA’s First Responder course. The medic who treated me at the explosion became my partner and the ambulance in which I was taken to hospital became the ambulance I drove.”
Amzallag noted that Israel’s 75-year-old MDA is the world’s most efficient medical service when it comes to responding to serious situations.  “In Israel,” he reported, “it takes the first First Responder less than a minute on average to reach the scene of a critical incident with an ambulance arriving within eight minutes.  In Canada, the average wait time is 32 minutes.”
The MDA, he noted, has about 2,000 full time employees and 15,000 volunteers who commit to one or two shifts a week in addition to their regular jobs.  In the case of critical incidents, all volunteers are potentially on call.
The organization also has at its disposal 900 ambulances (three of which were donated by the Winnipeg chapter of the CMDA) and several hundred scooters (two of which have been contributed by the Winnipeg CMDA) to allow first responders to get to critical scenes quickly in cases where traffic may be heavy.

Perhaps surprisingly to some readers, terrorist attacks only account for a small percentage (about 10%) of such critical incidents, he noted.  Most such incidents are the result of traffic accidents.
And it was surprising how Amzallag defined mass casualty incidents. It isn’t the number of deaths and injuries that cause a situation to be labeled a mass casualty incident, but rather whether or not there are enough ambulances, supplies and medical personnel to handle the situation.
There have been only three situations that qualified as mass casualty incidents in his experience. One was the collapse of a banquet hall dance floor that resulted in 100 injuries. The other two were accidents involving trains.
The big one, he noted, would be a major earthquake.  A major earthquake strikes the region every hundred years or so, he reported. The last major quake was in 1917.
“We expect that a major earthquake could damage up to 70% of Israel’s infrastructure,” he said.  “Our hospitals are prepared to treat up to half a million casualties.”
To provide additional support for situations –such as a war or earthquake that may strain Israel’s medical response capability, Amzallag noted, the MDA introduced a program a couple of years ago which recruits doctors in other countries (France and Canada, so far) who are willing to come to Israel to help to be trained in MDA procedures.

Amzallag provided an overview of how assignments are divided up in incidents where there are a number of dead and injured.  The first responder, rather than immediately treating the injured, becomes instead the co-ordinator directing responders who arrive later where to go and which of the injured need to receive priority attention.
This chain of command structure was implemented in response a 1990 terrorist incident on a bus winding its way down the highway leading from Jerusalem. The terrorist forced the bus off the road down the mountain.  As this was before the advent of cell phones, the call came from a motorist who witnessed the incident. The first two MDA personnel who arrived on the scene looked down, saw 60-70 people below in distress and went down to help – leaving the MDA dispatcher in the dark. The second pair of responders did the same.  It was only the third pair on the scene that thought to contact the dispatcher to report on the situation.

Amzallag also pointed out that even though all MDA personnel are trained in CPR, they are not allowed to perform CPR where there are a lot of injured. The priority is first to help those who will benefit from quick treatment rather than those who may be dying.
Amzallag’s most traumatic event, as was noted before, was early in his MDA work when he was among the first at the scene of a terrorist bombing. The first person he saw was a teenage girl on the ground.  “My first impulse was to perform CPR,” he recalled.  “I knelt and checked her pulse.  Although her eyes were open, she had no pulse.   Then I noticed another dozen people laying around.  I left the girl to treat other people.
“The next day, I went to one of the hospitals to visit two of the people I had treated.  As I was leaving, a man in a wheelchair came up to me and said that he forgave me and that he understood.  He was the father of the teenager and had seen me leave her to help others. That was the hardest decision that I have ever had to make and his words broke me up.  I went back every day while he was in hospital to see him and every day he would tell me that he wasn’t mad at me and that he forgave me.”

It is not only in Israel that the Magen David Adom saves lives and trains people in first aid and CPR, Amzallag noted. MDA goes into action worldwide wherever disaster strikes. Whether it’s an earthquake in Haiti or Turkey or major flooding in Houston or Puerto Rico, the MDA is among the first on the scene.
The MDA also trains first responders in a number of countries.
“It’s a great feeling not only to be able to save lives but also to teach others to save lives too,” Amzallag concluded.

If you would like to donate to Canadian Magen David Adom, go to https://www.cmdai.org

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