Volunteer First Responders for Optimizing Management of Mass Casualty Incidents.

OBJECTIVE: Rapid response to a trauma incident is vital for saving lives. However, in a mass casualty incident (MCI), there may not be enough resources (first responders and equipment) to adequately triage, prepare, and evacuate every injured person. To address this deficit, a Volunteer First Responder (VFR) program was established. METHODS: This paper describes the organizational structure and roles of the VFR program, outlines the geographical distribution of volunteers, and evaluates response times to 3 MCIs for both ambulance services and VFRs in 2000 and 2016. RESULTS: When mapped, the spatial distribution of VFRs and ambulance stations closely and deliberately reflects the population distribution of Israel. We found that VFRs were consistently first to arrive at the scene of an MCI and greatly increased the number of personnel available to assist with MCI management in urban, suburban, and rural settings. CONCLUSIONS: The VFR program provides an important and effective life-saving resource to supplement emergency first response. Given the known importance of rapid response to trauma, VFRs likely contribute to reduced trauma mortality, although further research is needed in order to examine this question specifically. (Disaster Med Public Health Preparedness. 2019;13:287-294).

Paramedics' experiences and coping strategies when encountering critical incidents.

Paramedics frequently encounter critical incidents (CIs). Their emotional, cognitive, and behavioral responses to these encounters present them with a variety of difficulties on the way to, during, and after events. The aim of our study was to examine how paramedics working in a large emergency service organization in Israel experienced CIs and the coping strategies they used to deal with these experiences. We interviewed 15 paramedics from this organization. Through data analysis, we revealed two main themes: (1) between connection and detachment and (2) between control and lack of control of the situation. Paramedics, who connected with their feelings regarding the patient and/or the family in different CIs, as well as those who sensed a lack of control, experienced difficult and negative emotions. To achieve detachment, they used a variety of coping strategies. Those who experienced cognitive and functional control of the situation reported a positive and empowering experience.

[Determination of death in mobile intensive care units operating without a physician].

Determination of the death of a person is one of the most complex issues in modern medicine. Therefore, in Israel (like many other countries), the authority to determine death belongs solely to medical doctors. Determination of death is a process built from 3 components: the declaration of death, certification of death and registration of death. Declaration of death is based on well established protocols, and is used as the normative basis for ending or avoiding resuscitation efforts in the pre-hospital setting. Certification and registration of death are essential for completion of the process, in order to enable care for the deceased--according to local custom. The division mentioned above does not exist in Israel. Therefore, declaration and certification of death are carried out solely by medical doctors. This situation necessarily demands the immediate presence of a medical doctor, whenever a process of death determination is being held. When death occurs in a hospital or a medical institute continuously occupied by medical doctors, there is no problem to fulfill this term. However, on the other hand, when death occurs outside the hospital or medical institute, the burden of death determination usually falls on the doctors occupying Magen David Adom ambulances. This leads to irrational use of a limited resource, aimed for emergency pre-hospital care. This review examines the problem and all the aspects involved, and offers possible solutions--based on acceptable guidelines.