2024-03 Israel

Israel 31,

April 16, 2024,

Hi Everyone,

Yesterday was my 1st real day for working with MDA, Magan David Adom. I receive my orders in the evening as to where I will work in the Tel Aviv area. My 1st assignment was in an area called Holon a 20 minute drive from my hotel. I have learned to use Waze which is very effective in Israel.

I was assigned to an ACLS ambulance. The driver, Rancho is a senior para-medic with many years of experience. A junior para-medic, Shilit was present as well. We were busy all day. As soon as 1 call was finished another call came in. We started work at 6:45 and did not finish until 4:30. We did at least 6 calls during the shift.

In Israel the 1st responder is often a p-m on a motor cycle. A BLS, basic life support ambulance is called for basic resussitation. They can do EKGs, give oxygen, take bloods, BPs, do CPR including shocking the patient if required. An ACLS ambulance can do more in depth diagnosis and treatment including giving major medications. There is also 1 ECMO ambulance, made in France, with an ECMO machine that I will describe later.

My 1st case was rather simple, a DOA that required only paper work. We had several other cases, requiring more advanced care and transport to a hospital. We had 1 CPR case that required cardiac massage and shocking. We saved the patient and he regained consciousness.

We then had 1 case that I have never witnessed before and will never forget. The 1st responder and BLS support team had already been called. They were giving cardiac massage when we arrived. We intubated the patient who had already been shocked to restore his rhythm. ECMO was then called. They are only called for CPR if the patient is under 65, salvageable and the cardiac arrest has been witnessed.

ECMO was called and arrived in another ambulance with 3 physicians. We were still doing CPR. They produced a machine that went around the patient and was able to do extremely effective chest compressions. A doctor then prepared a sterile field in the groin area. He then placed needles in the right femoral vein and artery. This was followed with wires that went up the vein and artery. A 1 cm tube was then inserted into each vessel. These tubes were connected to a portable heart-lung machine to take out the venous blood, re-oxygenate the blood and replace it in the artery. I didn’t even know that such a machine existed.

The patient miraculously regained consciousness. The fire department was called as we could not get the patient and all the equipment into an elevator. A hook and latter truck raised a platform to the 2nd floor. The patient was placed on a hard portable stretcher and moved onto the elevated platform. The platform was then lowered to the awaiting ambulance and transported to a hospital. We later learned that he had undergone an angiogram and will probably require a bypass. The LAD, the main cardiac artery was 99% blocked. ‘Been there, done that’ and played hockey 3 months later. I think that Israel is much more advanced than us for doing advanced CPR in the field. There training must by much more involved than ours.

Love,

Brian

ABSOLUTELY UNBELIEVABLE, miraculously saved the patient, what heroes.