Responding to emergencies
Israeli field hospital personnel look after those injured in the earthquake in Nepal. (photo by Sam Amiel)
Cardiac surgeon Lt.-Col. (res.) Dr. Ofer Merin is deputy director general of Shaare Zedek Medical Centre and lectures at the Hebrew University in Jerusalem. He heads the Israel Defence Forces Home Front Command’s field hospital, and was part of the IDF’s relief efforts in Haiti after the 2010 earthquake, in Japan after the 2011 tsunami, in the Philippines after the 2013 typhoon and in Nepal after the earthquake in April this year. With various colleagues, he has written about these experiences, as well as about the provision of trauma care at Shaare Zedek.
From the New England Journal of Medicine, March 2010: Within two days of the earthquake in Haiti in January 2010, Israel had sent “a military task force consisting of 230 people” who “landed in Port-au-Prince 15 hours after leaving Tel Aviv and began to deploy immediately…. In its 10 days of operation, the field hospital treated more than 1,100 patients.”
From the Journal of the American Medical Association, July 2015: After the earthquake in Nepal in April 2015, the IDF sent a medical team of 126, and the field hospital was “deployed as a stand-alone facility 82 hours after the earthquake.” Over 11 days, “we treated 1,668 patients, performed 85 operations and delivered eight babies.”
From the Lancet, April 2015: “There were 11 terror attacks in Jerusalem, Israel, between October–December 2014 alone. Two of the injured terrorists arrived at our institution and, following standing triage protocol, we prioritized one terrorist to undergo surgery first since his medical condition was more critical than that of the victims.”
These are but a few examples of the work Merin and his colleagues do, and the challenges they face. When Merin was in Vancouver recently, he shared some of his experiences and discussed the ethical issues surrounding trauma care. He spoke to the Jewish community on Aug. 20 and to physicians in the trauma unit at Vancouver General Hospital the day prior.
Dr. Rick Schreiber – professor of pediatrics at the University of British Columbia, director of the B.C. Pediatric Liver Transplant Program and president-elect of the Canadian Association for the Study of the Liver – was the catalyst for Merin’s visit. Yet his connection to Merin was not, as it first might appear, through his work as a fellow medical professional, but through Merin’s wife, Ora.
Schreiber was on an adult March of the Living mission earlier this year that was organized by the Montreal Jewish community.
“I’m originally from Montreal. I’ve been out here about 20 years,” said Schreiber, who is very involved with Jewish causes in Israel, overseas and elsewhere, including here with the Jewish Federation of Greater Vancouver. On this recent mission, he explained in a phone interview with the Independent, all of the tours and activities in Israel were organized by Ora Merin and her company,
Giant Leaps. “I was very impressed with how the program was laid out for the Israel aspects of the mission and the level of the people [we met] and the things that we did. We got to places that most people wouldn’t get to….”
Ofer Merin attended the mission’s closing dinner with his wife. With medicine in common, he and Schreiber started talking, and Merin’s involvement with the Israel Defences Forces disaster response team came up.
The next day, as Schreiber was leaving Israel, he saw Ora Merin again. She told Schreiber that her husband had left for Nepal, which had just experienced an earthquake. “I got to tell you,” said Schreiber, “within six hours, they had up and going a launch – and they bring everything.… It’s amazing what the Israelis do to be first responders, and they are recognized around the world as being the best. They get there very quickly and they set up all the units, like an intensive care and operating tents and all this kind of stuff, and triage, and get rescue things going long before other countries are even getting their finances together.”
“It’s amazing what the Israelis do to be first responders, and they are recognized around the world as being the best. They get there very quickly and they set up all the units, like an intensive care and operating tents … long before other countries are even getting their finances together.”
During that conversation, Ora mentioned that their family (she and Ofer have four adult children) was going to be in the United States – Ofer has a brother in Seattle – in the summer, and Schreiber suggested they think about coming up to Vancouver on that trip. He said that it would be good for her, because of her travel agency, to meet with Federation, which runs missions to Israel, and maybe her husband could give a talk on his work. “So, that’s how that all started, back in Israel, back last May,” he said.
In addition to the community meetings and talk, Schreiber also organized for Ofer Merin to speak at VGH. “There is a big group of trauma people at VGH, and they jumped on this because they had heard of him and they knew of him, and we organized for him to give rounds…. There was very good attendance at that rounds, and he talked about what he does. But he didn’t talk about all the people they deal with and how they set up, he talked about a lot of ethical things, like how do you decide to save this person versus that person – you only have limited space to save people.”
Merin spoke at VGH about treating such large numbers of injured after a natural disaster, and about handling the stress of that, said Schreiber. “The next thing he talked about, the ethics. You’re not able to provide the same level of care as you’re accustomed to, like we supply for trauma people in Vancouver, we can’t give the same level of care … you’ve got to treat people and turn them over quickly, so you can treat the next person.”
Merin also discussed how, at Shaare Zedek Hospital in Jerusalem, they have to treat victims of terror attacks, including, at times, the terrorist. Of the victims and the perpetrator(s), who do you take care of first? At Shaare Zedek, Merin said, such decisions are made on the basis of triage, who is the most badly injured.
The Independent caught up with Merin by email after his Vancouver visit.
JI: What interested you in cardiac medicine/surgery versus other specialties? Did you always want to be in medicine?
OM: My decision to go into medicine was relatively late, in my early 20s, not something I was born with. My decision to go into cardiac surgery, I guess, was based first on my “nature” to choose something surgical – more adrenalin, very quick results. Cardiac surgery in specific is a great combination of both surgery and the need of good clinical and physiology understanding.
JI: The burnout rate for doctors in general is quite high. It must be higher for trauma physicians. How do you (and/or your colleagues) manage the stress?
OM: I would divide [my response]. There are things done on the group level – discussions, sharing, etc. Especially these days in Jerusalem, there is an extra challenge – dealing with treatment of terror victims, and many times treatment of the terrorists themselves…. We have a psychologist who is doing some group work especially with the ER people and the intensive care unit. And, on the personal level, everyone has to find his ways to vent. I jog almost every day. For me, it’s a good way to relax. In missions abroad, I write every day. Also a great way to vent.
JI: The enormity of being part of a disaster-response team is almost beyond comprehension for anyone who has not had the experience. If it’s possible to outline a general order of events, from the time a natural disaster hits to when the Israeli unit is on the ground in another country providing care, could you please share the main points?
OM: One of the important things is to work in parallel. We bring in the team way before there is a full understanding of the scale of the disaster, so we are prepared before there is a governmental decision to send a team. Once a decision is taken, we are prepared to leave. We send immediately a small forward team, which can report back, and prepare whatever is needed for deployment. We drill every year, so we maintain a high level of preparedness.
JI: In a couple of articles, you mention collaboration/integration with local facilities in a disaster-response situation. What types of factors enter the decision of where the Israeli unit fits into the overall aid effort?
OM: To be honest, in the last natural disasters around the globe, Israel is almost always the largest and first to be on ground. Therefore, we communicate with the local health providers and make a mutual decision where it is best to deploy.
The decision if to deploy as a self-sufficient unit or to operate (like in the Philippines) as an integrated unit is based mainly on the question if the local services are still functional. If they are, it is many times better to assist them and not “compete” with them, as we are arriving for a short term.