EMSResponder.com Contributor

Listen as Greg Friese reflects back on his experience attending MCI and terrorism response training in Israel.

Greg explains how his perceptions of the region from afar turned out to be very different from the reality he experienced there. Despite the ongoing attacks, he felt safe and secure as traveled, and he notes that the region is a vibrant place where people continue to shop and play and live.

He then shares some specific lessons he learned on planning, training, and response, as well as how to apply these principles and practices at home.

“There’s no better teacher than experience,” Greg says, “and for better or worse they’ve had many experiences.”

Listen to this final podcast to hear Greg’s lessons learned, and watch for his in-depth articles this year in EMS Magazine.

To learn more about the program Greg attended, visit the Institute for Terrorism Research and Response at http://www.terrorresponse.org. You can also visit Greg’s website at http://www.Eps411.com or email him at mailto:gfriese@eps411.com.

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In his sixth podcast from Israel, Greg discusses his meeting with national EMS system manager and shares an overview of the system including dispatch regions, equipment, call volume, and the system’s utilization of employees and volunteers. Greg also explains their training process and some of the key differences between the Israeli and U.S. EMS systems.

An important difference Greg notes is that the Israeli system has no difficulty with recruitment, like the U.S. In addition, he explains that most EMS volunteers are youths, who then take additional training to become employed EMTs after turning 21. EMS responders must then spend three years as EMTs before they can train to become paramedics.

Greg also notes that Israeli EMTs can do some of what we consider advanced skills, and that all paramedics and EMTs must cross train as dispatchers. Paramedics also must train at the country’s medical simulation lab, (discussed in Greg’s previous podcast) and must ride ambulances staffed with physicians until they are approved.

Greg also touches on their use of armored ambulances, ambulance targeting issues, and MCI data.

The podcast ends with a rundown of Greg’s lessons learned about Israeli MCI response, which include:

Listen to the podcast to hear more lessons and Greg’s full report.  

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In this fifth report from Israel, Greg Friese reflects on the group’s visits to three prominent medical centers.

Greg first discusses the largest hospital in Israel, with beds for more than two thousand patients and a state-of-the-art center for medical simulation. He describes the center’s manikins, control booths, one-way mirrors for student evaluation, and real human actors. He explains that all graduating medical students must practice there, and that all paramedics must go there for licensure testing. In addition, medical providers use it to practice for upcoming cases or to recreate rare cases. Greg will be writing more on this simulation center in an upcoming issue of EMS Magazine.

Greg also discusses a 500-bed hospital just north of the Gaza Strip which is within range of regular missile fire, and where the staff has had to learn preparedness through trial and error. Greg also shares their chilling experience with a burn patient who was successfully treated, and later caught on video in a suicide bombing attempt. Greg discusses the things the hospital has done to be more secure, and their permanent state of preparedness for mass casualty incidents.

Finally, Greg shares his experience at a 450-bed Level One trauma center in Jerusalem, where the group received a presentation on MCI events and research, and discussed how terror trauma is a unique type of trauma. Providers there handle six to seven such events per year. The group’s presenter there was Professor Shmuel C. Shapira M.D. M.P.H., who is Chairman and CEO of the International Center of Terror Medicine, at http://www.terrormedicine.org.

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On his fourth day of MCI response training in Israel, Greg discusses the perspective he has gained from this international experience where mass casualty incidents are common.

He describes the numerous sites they are visiting, where there often remains a small memorial, and shares how moving it is to see how the conflicts there affect people personally.

Greg explains that his understanding is limited in that he is only learning about the Israeli perspective on the conflict; it is considered unsafe for Americans to travel to the Palestinian occupied areas, and is not part of the program.

However, that does not prevent the group from learning what it means to respond to terrorist attacks – how it feels, what they do - and to learn what it means to lose friends and relatives in such attacks. Greg describes not only the medical but the psychological fallout.

Finally, Greg talks about the medical and emergency management world experts he is meeting, and their discussions on how the international lessons learned might apply to settings in the U.S.

To learn more about this program, visit the Institute for Terrorism Research and Response at terrorresponse.org, or e-mail questions and comments about Greg’s experience to gfriese@eps411.com.

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On Day 3, Greg’s training group attended a presentation by the Israeli Defense Force’s Homefront Command, the military division responsible for coordinating responses within the country during an emergency.

Greg explains the roles and responsibilities of this Command, and how it compares to services in the U.S. The Command assists with activating reserve medical staffing, covering fire departments, responding to damage to facilities, etc. – whatever is needed in an emergency situation.

Greg’s training group also received a second presentation about the Command’s capabilities to perform national or international search and rescue. They have a force on call, similar to FEMA’s urban search and rescue teams. However, the members work full time on the force, and can be rolling in 15 minutes to natural disasters, acts of terror or war. Greg shares examples of some of the international responses they have performed.

Greg also discusses how this Command is activated, and how even this elite response system faces limitations. During the brief Lebannon war in the summer of 2006, as missiles were being sent into Israel, politicians did not activate the Command, which has caused much debate. They explained that the reasons were political as well as economic, and there is always a balance in making these decisions. Greg said they put their hosts in a delicate position to explain this without sharing their opinions, but said it was interesting to see other responders facing frustration with their political process.

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After his second day of training in Israel, Greg highlights his visits with Jerusalem’s fire department, dispatch center, a center for medical simulation and a volunteer organization with a difficult mission, called Zaka.

Listen as Greg describes the nation’s fire/rescue service and how it differs from the U.S. service; differences include national training and coordination, smaller equipment for narrow streets, and different tactics due to different construction materials. In a suicide bombing incident, Greg explains, the rescuers require little time to extinguish fires and are needed primarily for extrication and movement of victims.

Greg goes on to share the origin and mission of Zaka, which in Hebrew is an acronym for Identify Disaster Victims. Greg visited with this organization, which goes to disaster sites to assist with first aid, and then when authorized, to begin recovery of body parts and tissues for burial.

Check back for more updates as Greg continues his MCI and terror response training.

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Listen as Greg Friese describes his arrival in Jerusalem, beginning with the logistics of the trip and a brief background on the history and geography of the region. He goes on to talk about the people he has met there, from his guide to the outgoing MCI training attendees and the incoming attendees.

Greg also shares the understanding he is gaining of the region, its people, and its conflicts by being there first hand. As he becomes friends with his guide, the experience takes on a deeper meaning.

Finally, Greg describes the first day of training, in which he learned more about the area’s security and political issues, and the specific MCI and terror challenges for which the people there must prepare.  

EMSResponder.com Contributor

After every major incident or training emergency responders catalog a list of “lessons learned,” but rarely is there a corresponding list of “lessons applied.” Israeli mass casualty and terrorism experts, unfortunately, have had many opportunities to apply “lessons learned.” From January 22-29 I will visit with Israeli experts to view and discuss the Israeli “lessons applied” as a member of an educational delegation organized by the Institute of Terrorism Research and Response. During my trip I will send podcast reports to EMSResponder.com.

I work as a paramedic for the Plover Fire Department, Portage County EMS , and Saint Michael’s Hospital. I am also a lead instructor for Wilderness Medical Associates. My training company, Emergency Preparedness Systems LLC, produces online continuing education for the EMS Magazine Online Education Center .

Email your questions and comments to mailto:gfriese@eps411.com.