If anybody is reading my blog about my experience in Israel, you already know what I did today on my shift and need no explanation. This is also not the place where I discuss calls, I merely try and compare and contrast the US and Israeli EMS systems and offer my own input on things as I think of them.
Here are some differences I have noticed so far:
1. The chovshim and paramedics have the ability to leave a patient if they deny care even if they have als
2. Chovshim do not administer meds in Israel unlike in the US where we can administer seven as an EMT
3. MDA workers are not always out in the trucks, between calls they hang out at the base. In the US when I worked with the fire department this was true as well, but with my private ambulance I am sometimes sitting in the ambulance for 12 hours straight with a few calls in between to stretch my legs.
These are only a few observations...though I have to say, I really enjoy the rotating medic chair in the back of the Israeli ambulances...
Agreed. x3. Your observations are spot on, and great to see written out. There are a whole bunch of other substantive differences. Some others that come to mind:
ReplyDelete1) Israeli culture promotes voluteerism to a larger extend more then the US. Every high school student has a "side job" volunteering with an organization. Some lead Tzofim (Scouts) groups, some work at a soup kitchen, or virtually anything else. One common "project" is training by MDA as a first responder, and students do it as young as 15. MDA is the equivalent of a non-for-profit, and an arm of the International Red Cross
In the US, especially around Boston, it's all about private companies, making a profit… you work for a company that bills millions for it’s transports. I will venture to guess that the majority of your trips at home are transfers, from facility to facility… with no defined “response area”. With MDA, you are covering a city, or a “zone” of a city. The station you work out of was placed where it is so you can properly cover the city… while not sitting in the truck…
The idea behind putting (poorly) trained First Responders in the back of an ambulance is that any stabilization that needs to occur will be provided on scene… Israeli BLS is highly focused on “high flow diesel” medicine… it allows for very limited field treatment, and much focus on transportation to definitive care. This works excellently for disaster medicine… but I worry not well for standard urban and suburban 911.
2) I describe Israeli EMS as providing very basic BLS services (high flow diesel), and very advanced ALS (Mobile Intensive Care Units, MDs in ambulances, highly trained paramedics). Like I said earlier, BLS is focused on getting the patient to the hospital. The argument is that if the patient really needs advanced care, we can get a doctor to their side. This isn’t in any way a rationalization for not putting very basic drugs on BLS trucks. Working in American EMS (especially in MA), it’s very hard to believe an ambulance can be effective without an epi pen, asprin, glucose, etc… but I know I’m spoiled. WHAT are you going to do with a patient in anaphylaxis, if no Natan is available? Give O2, and watch them choke? That patient with substernal chest pain, you will slap an NRB on them, and watch them as their heart is choked from oxygen?
You will notice, though, that your ambulance carries a few IV start kits. The Chovesh on your ambulance is trained on how to insert and monitor an IV. They won’t do it on a regular basis, but can, if necessary, on the scene of an MCI (terror). There is clear evidence to show that rapid fluid resuscitation is critical to early treatment and longer-term outcomes to victims of terror attacks, whether injuries are immediately apparent or not.
3) My sense of Israeli EMS, compared to the US, has much less emphasis on documentation, litigation and protocol…
I’ll leave my comments here… apologies for the fragmentation…
EMT.Dan
Well said EMT.Dan. I found that the first responders with me today did not monitor vitals, did not try to control bleeding, and really didn't seem to know how to do anything other than operate a stretcher, stair chair, oxygen (they hooked up an NRB better than some other people I know in the States--remembering to inflate the bag), and vitals (debatable). However, the volunteerism breeds many future Paramedics who, I venture to say, are some of the best trained Paramedics in the world.
ReplyDeleteBut yes, I definitely noticed the emphasis on high flow deisel and little to no care in the back of the ambulance. I actually felt very embarrassed palpating one of the patient's stomach because the other two first responders with me didn't know how to do it and were too afraid to do anything without talking to the driver first. Oh and by the way...did I mention that symptoms are just not that important? this according to one of those fine FRs next to me.
Israel has a great MCI response, great ALS, but agreed, BLS could improve but the same goes in the States in many ways as we have talked about in the past. Good to hear from you!
Yeah.. I'm with you... I actually think the volunteerism breeds good civic citizens... Most, if not all of the Israeli volunteers i've seen have been excellent patient care providers... and over time (remember they do this as young as 15), get their own style in the back of the truck... and with medics they know, work autonomously. Remember, that medic driving doesn't spend much time in the back anymore...
ReplyDeleteI am most often disappointed with some of the American volunteers on programs where volunteering is required that i've seen or heard from... but that is a different discussion...
Let's talk reality here... what additional treatment would that patient with abd pain receive with better practitioners? A case like that we cannot do much for... beside O2 for comfort and positioning to minimize pain. The reality is that most EMTs dont know how to palpate correctly... and end up causing additional pain and discomfort or pain... without a further clinical impression (diagnosis), and no capacity for treatment. Think about that exact patient in the US... what different assessment or treatment would they receive?
Dan
Actually chovshim can give aspirin if they have a cardiac patient and no natan is available. Also they can give glucose, not actual glucose, but a gel to put on the gums in a case of hyper/hypoglycemia.
ReplyDeleteAnother difference in EMT-B and Chovshim is that Chovshim can insert IVs in a case dehydration or whenever needed.
Raffi