The World Health Organization has recognized Israel’s medical rescue teams and Israel Defence Forces’ field hospital as Type 3, the highest ranking for any foreign medical rescue team and field hospital in the world. (photo from United Hatzalah)
On Nov. 28, the World Health Organization (WHO) began a three-day meeting in Hong Kong, during which they recognized Israel’s medical rescue teams and Israel Defence Forces’ field hospital as Type 3, the highest ranking for any foreign medical rescue team and field hospital in the world. Israeli Deputy Minister of Foreign Affairs Tzipi Hotovely attended on behalf of Israel.
United Hatzalah, Israel’s national volunteer emergency medical services organization, and the Israelife Foundation, a conglomerate of Israel-based rescue organizations that respond to disasters worldwide, welcomed the award.
“We want to praise and thank all of the dedicated volunteers, staff and soldiers in all of the rescue services throughout the country. Their dedication and selfless acts of kindness in saving lives at home and abroad are officially being recognized on the world stage and, due to their efforts, Israel has become a world leader,” said Dov Maisel, United Hatzalah vice-president of international operations.
With the ceremony, Israel became the 17th foreign medical team to be classified by WHO, and it currently boasts the highest ranking. The process to achieve the ranking took nearly a year of in-depth reviews to ensure that Israel’s field hospitals met all of the criteria.
Besides the simple value of recognition, the Type 3 classification will also have some real ramifications. The classification ensures that Israeli rescue and medical teams will be the first allowed on the scene of future disasters regardless of where they happen and it will further cement Israel’s position as a world leader in emergency medicine.
Israel is not only the only Type 3 medical response team in the world, it is also the only one to be recognized by WHO that comprises a “military component” in the form of the IDF field hospital. Some aspects of the classification deal with the ethics of emergency care, and having a military branch receive the Type 3 classification highlights the ethical standing of that body.
The person behind the WHO classification system is Dr. Ian Norton, a specialist in emergency medicine and former head of his native Australia’s emergency response team. Norton developed the WHO system – which ranks foreign medical teams into Type 1, Type 2 and Type 3 – in 2013.
The different types refer to the number of patients that can be treated and the level of difficulty of the procedures that can be offered by a medical response team. Even with the high standards, Israel’s field hospital surpasses the requirements, offering more medical care than is required to be classified as Type 3. For example, the Times of Israel reported that a Type 3 field hospital needs 40 inpatient beds, whereas Israel’s has 86, and a Type 3 ranking requires the hospital to have two operating rooms, whereas Israel’s has four. Israel also qualified for the Type 3 category by employing teams that offer additional “specialized care,” such as burn units, dialysis units, obstetrics and gynecology teams, and reconstructive plastic surgery units. The IDF field hospital also received accolades for its abilities to provide exemplary levels of plastic surgery, and obstetrics and gynecology care. These latter qualifications establish the team as a “Type 3 plus.”
In addition to the field hospital, Israel was praised for the work done by its volunteer evacuation and emergency response teams, such as United Hatzalah, Zaka and Israelife. These teams of volunteer responders have conducted search and rescue operations and provided emergency medical services in disasters all over the world. Most recently, United Hatzalah sent Maisel, an emergency paramedic, to be a medical liaison and consultant as part of the Jet911 multinational response team that responded to the destruction caused by Hurricane Matthew in Haiti in October.
Other disasters to which the IDF field hospital and Israel medical response teams have responded include the earthquake in Turkey in 1999, the earthquake in Haiti in 2010, the typhoon in the Philippines in 2013 and the devastating earthquake that shook Nepal in 2015.
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.