Across the globe, emergency medical services have come under strain amid a flood of calls to their hotlines, as coronavirus causes illness and stokes fear worldwide. Paramedics, ambulances and phone lines have been stretched to their limits, and sometimes even failed to respond in a timely manner to this urgent outreach, leading to excess mortality not only due to COVID-19 itself but also due to heart attacks and pulmonary distress.
But despite this dismal global record, Magen David Adom (MDA) — Israel’s version of the Red Cross — has managed to keep its own response times to the same as before, an average of only eight minutes from phone call to the arrival of paramedics.
This short and overall average response time is considered exceptionally speedy for an EMS organization that responds to all emergency calls it receives from across the country and does not ever refuse, avoid or in any way decline an inconvenient call or one that is somehow outside its jurisdiction.
“As the national EMS service, we don’t have the option of saying that a medical emergency is too far away and leave it for some other organization to respond,” said Uri Shacham, a medevac paramedic and chief of staff for Magen David Adom. “If a medical emergency is in Israel, it’s our responsibility. We don’t get to cherry-pick which calls we respond to.”
Ido Rosenblat, MDA’s chief information officer and also a medevac paramedic, attributes his organization’s success to numerous factors. “We have a culture of preparedness, which dates to the Second Lebanon War,” he said recently in English. “MDA is ready to intervene in all manner of extreme events, whether that be a terror attack, war, or now the novel coronavirus pandemic.”
MDA’s unique approach has included routing all phone calls — coronavirus or other health concerns — to the regular emergency medical line in Israel, 101, but then when it comes in, creating two “lanes” for the call — one for coronavirus and one for all other calls. “We saw that in other countries the establishment of a separate hotline for coronavirus sometimes confused patients, who were not sure whether their breathing issue was corona or not. There were also issues of spreading the word on the new corona line. We found it was simpler to have everyone continue to call the same number they already knew and then use the dial pad to indicate their reason for calling,” Rosenblat said.
The paramedic service was also fortunate to draw on a deep reserve of trained volunteers numbering in the tens of thousands, the largest volunteer force in Israel. As most workplaces closed, more men and women were available to take more and more volunteer shifts. MDA set up call center “cells,” ensuring that the same dispatchers would spend their shifts together, and thus minimizing the risk of their community spread of the virus. Alone among other emergency systems, all of MDA’s software and systems are proprietary, developed in-house to meet its specific needs. MDA’s daily call volume grew exponentially, from around 6,000 calls to 82,000 on its peak day. But remarkably, these methods allowed the service to keep response times the same.
Helping with the substantial increase in emergency calls has been a full fleet of about 1,200 ambulances — more vehicles than all of Israel’s private ambulance services combined — the organization had a sufficient supply of vehicles it could employ. 850 Basic Life Support Ambulances, 379 Mobile Intensive Care Units, ATV rescue vehicles near beaches, mountains and state parks.
In normal times, the organization typically keeps some ambulances in reserve to have at the ready for large-scale incidents, such as a natural disaster or the outbreak of war or rocket attacks. During the current pandemic, the organization at times put additional vehicles into operation to be at the ready or to transport patients needing to get to testing sites.
The Jewish state has won plaudits for its state-of-the-art management of the coronavirus crisis, using novel medical devices, phone dispatch techniques and tracking data to aid contact tracing and other mitigation efforts. The most recent statistics show that Israel’s case fatality rate is among the lowest in the world, some 300 deaths for more than 22,000 cases — a mortality rate of less than two percent. Israel is now beginning to reopen, as the government green-lights al fresco dining and outdoor assemblies of up to 250 people.
The pandemic has also led individuals of all backgrounds to coalesce behind disease prevention and treatment. Recently, a photo of two religiously observant MDA ambulance medics — one Muslim and the other Jewish — taking a shared prayer break, melted the heart of the Internet, receiving millions of shares and prompting a slew of news articles around the world, from the New York Times to news organizations of multiple languages.
As the premier first responder and paramedic service, MDA has been at the forefront of the war against the virus. Besides its dispatch of ambulances and handing of the nation’s emergency line, MDA has also charged itself with conducting coronavirus testing at drive-thrus and home visits, another herculean task that has enlisted its legions of volunteers.
Calls in Israel’s urban areas and those near MDA’s 169 emergency medical stations can sometimes be responded to in less than two minutes, while calls in rural and more remote areas of the country, have longer response times that can raise the overall average. The organization also relies on two medevac helicopters to reach some very remote areas and uses 650 Medicycle motorcycles and 1000 Life Riders electric bikes to cut through traffic in urban areas.
Now, as a much-feared second wave of the virus comes into view, MDA is prepared to confront it, too, no matter how severe it might be and still maintain its impressive overall eight-minute response time. “I am confident that if and when a second wave comes, we will again be able to guarantee all who need an ambulance and emergency care will receive it in a timely fashion,” said Rosenblat. “We’ve got this.”