2025-03 Israel

Israel 18,

April 7, 2025,

Hi Everyone,

I wore my Nike running shoes for the first time today and they were wonderful. I was bouncing all over the place each time I took a step, it was a wonder that I didn’t just fly away. I will try running with them in a few days.

I had a new team at MDA today but I was posted on the same base. We checked the ambulance at 6:30 and had our first call at 7:00. We walked up 3 flights of stair and found an 85 year old woman in bed, short of breath. The woman was already on oxygen. The room was 10ft x 10ft. We somehow lifted the patient onto a stretcher. The stretcher is made so that it can turn into a chair which is easier to manage. We then carried her down the stairs to the ambulance and took her to the hospital. She was oedematous and probably in congestive heart failure.

The second case was an elderly man in the very religious sector of Tel Aviv called Bnai Brak. These people have 6-10 children so you see children running around everywhere. It is a shame but religious areas in Israel are often over crowded, run down and dirty. There was garbage everywhere as if people don’t care about cleanliness. The man was short of breath from bradycardia. His pulse was 46 meaning sinus bradycardia, an athlete or a heart block. He was in no acute distress so we took his VS, gave him oxygen and monitored him.

We were on our way to a hospital when we received an emergency call that a child had fallen into the water and was unconscious. When we arrived, the child had already been brought down stairs and 2 paramedics were giving CPR. In a child you give heart massage with your thumbs. They were bagging the child with a mask and oxygen. There was a discussion among the paramedics and it was decided that we had the most experience with children. While continuing with CPR, we transferred our elderly patient to another ambulance and took charge of the child.

The chief paramedic in my ambulance was amazing. He took charge immediately and gave orders to the other paramedics in a calm but direct fashion. We did an EKG and found that the child was flat lined. In this case, defibrilation is not indicated. He got an IV access by directly putting an IV into the knee. He then delivered adrenaline. The ambulance took off at full speed to Schneider Children’s Hospital which is a major children’s hospital in Israel. While the ambulance was moving, he intubated the child which is not an easy manoeuvre to do in a 4 month old child in a moving ambulance. I was very impressed with his work. He obviously has had a lot of experience with infants.

The physicians at the hospital were waiting for us to arrive. By the time we arrived in the hospital we had a pulse with a heart rate and a blood pressure. The chief of the ER took charge immediately. After a few moments, the child started to breath spontaneously but they continued to bag him for support. The child’s pupils were dilated but maybe not fixed which would indicate brain damage.

We left at this point and as usual with MDA, we usually don’t know the final result of our work. The mother looked to be between 25 and 30, ultra religious with a long dress. She had left the child next to the sink for an unknown period of time and for an unknown reason. Somehow the child had rolled over and fallen into the sink, and drowned. We could not find out how long the child was not breathing. The first ambulance was on the scene within minutes and CPR was done immediately. Brain damage begins 4 minutes after a lack of oxygen and is irreversible at 10 minutes. A child can sometimes last longer.

The chief paramedic was sitting alone in the ambulance writing out his report. I went over to him, touched his shoulder and told him that he had done his best. I know that he appreciated my words of support.

The woman sat in the ambulance with us staring ahead with absolutely no emotion. She never spoke or cried. Her husband arrived at the hospital just after us. He was dressed in ultra religious clothes. He also expressed no emotion. The woman will never forgive herself for the 1-2 minutes of inattention. The child is in God’s hands now. Unfortunately, there is no God.

Our last patient was a 6 month old child with a first episode of epilepsy probably viral related. The child had stopped convulsing when we arrived and was waking up. We brought the child to the nearest hospital for further evaluation and treatment.

All in all it was a busy, emotionally packed day.

Love,

Brian

Paramedics

Tel Hashomer Hospital, the 8th best hospital in the world according to Newsweeks evaluation. The country has 9 million people. University of Toronto is 3rd in the world. McGill is in the 90s. It is not surprising if you read my last evaluation of McGill.