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The paramedic profession is relatively new, dating to the 1970's. In Israel, it was introduced in 1980 and paralleled the introduction of advanced life support units (ALS) to Israel's national emergency medical services (EMS), Magen David Adom (MDA).The curriculum and assigned roles were adopted with minor changes from Anglo-American systems. Initially, paramedics were assigned alongside physicians, but in recent years a growing percentage of units operate without an on-board physician. Despite the increasing complexity of required tasks and the move toward paramedic-led crews, paramedic training has changed little. Most are trained through a non-academic, certificate granting tracts. In 1998, a fully academic bachelor's degree program was launched at the Ben-Gurion University (BGU).
The programs aims, curriculum, and experience are described, based on past and current curriculum and on interviews with past and current staff and students.
The BGU program is a three year program that grants its graduates both a University BA and professional paramedic certification. The program is housed as a university department within the Faculty of Health Sciences. First year courses center on basic sciences. The second year centers on classroom and simulation-based learning of the clinical topics. The third is devoted mostly to clinical clerkships, in hospital wards in the first semester and on MDA ALS units in the second. To date, the program boasts more than 300 graduates, many attaining higher academic degrees in healthcare sciences and many who work in Israel's national EMS.
The BGU academic paramedic training program is the only such program in Israel and one of a few worldwide. Questions regarding the increasing responsibility and task complexity require a move from certificate training to University degree granting learning and the possible contribution of such
Israeli Hospitals are required to maintain a high level of emergency preparedness.
To investigate the effect of on-going use of an evaluation tool on acute-care hospitals' emergency preparedness for mass casualty events (MCE).
Evaluation of emergency preparedness for MCE was carried out in all acute-care hospitals, based on an evaluation tool consisting of 306 objective and measurable parameters. Two cycles of evaluations were conducted in 2005 to 2009 and the scores were calculated to detect differences.
A significant increase was found in the mean total scores of emergency preparedness between the two cycles of evaluations (from 77.1 to 88.5). An increase was found in scores for standard operating procedures, training and equipment, but the change was significant only in the training category. The relative increase was highest in hospitals that did not experience real MCE.
This study offers a structured and practical approach for ongoing improvement of emergency preparedness, based on validated measurable benchmarks. An ongoing assessment of the level of emergency preparedness motivates hospitals' management and staff to improve their capabilities and thus results in a more effective response mechanism for emergency scenarios.
Utilization of predetermined and measurable benchmarks allows the institutions being assessed to improve their level of performance in the evaluated areas. The expectation is that these benchmarks will allow for a better response to actual MCEs. The study further demonstrated that even hospitals without “real-life” experience can gear up using preset benchmarks and reach a high standard of mass casualty event preparedness.
Pandemic influenza poses a great challenge to healthcare systems. Vaccinating medical teams and the population against pandemic influenza is the global recommended strategy to contain spread of the disease. As part of the efforts made to overcome the H1N1 pandemic, the Israeli Ministry of Health (MOH) initiated a general vaccination program for medical teams and the total country population. Due to low compliance rates of the medical staff, the MOH conducted regional conferences aimed at providing knowledge and encouraging staff to be vaccinated.
To evaluate the effect of the regional conferences on the compliance rates amongst medical providers to be vaccinated against H1N1.
Medical providers from the primary health care services were invited to conferences that were conducted in 3 regions. Attitudes of the teams regarding compliance to be vaccinated were assessed pre and post the conferences. Additionally, the actual rates of vaccinations were recorded over the period of vaccination program. Actual compliance rates before and after the conferences were compared to detect differences as well as the relationship between teams' attitudes and actual vaccinations.
Vaccination rates of medical providers remained low during the full vaccination period. Among the non-vaccinated, 24% to 29% reported before the conference that they agree to be vaccinated versus 57% to 62% following the conference. Analysis of the actual vaccination data among the medical providers did not demonstrate a change in compliance following the conferences and an overall decrease was noted after the first two weeks of the vaccinated project.
A statistically significant relationship was not found between reported attitudes of medical providers regarding readiness to be vaccinated and their actual vaccination. The MOH intervention did not achieve the expected result and did not raise compliance to be vaccinated.
Inappropriate distribution of casualties in mass casualty incidents (MCIs) may result in patient overload in primary medical facilities.
The aim of this study was to review the consequences of evacuating casualties from a bus accident to a single rural hospital and lessons learned regarding policy of casualty evacuation.
Hospital medical records of all casualties from primary and tertiary hospitals were independently reviewed by two senior trauma surgeons. In addition four senior trauma surgeons reviewed the impact of treatment provided in the primary hospital on patient outcomes.
31 survivors from the accident were transferred to the closest local hospital; 4 died en route to the hospital or within 30 minutes of arrival. 27 casualties were air evacuated from the local hospital within 2.5 to 6.15 hours to level I and II hospitals. Under-triage of 15% and over-triage of 7% were noted. 4 casualties did not receive treatment at the local hospital that might have improved their condition.
Over and under-triage might have been due to minimal trauma related experience of primary hospital personnel. Evacuation of casualties from an MCI to a limited capacity hospital may overwhelm the facility and affect its ability to provide appropriate medical care.
In MCIs occurring in rural areas, only immediate unstable casualties should be transferred to the closest primary hospital. On-site Advanced Life Support (ALS) should be administered to non-severe casualties until they can be evacuated directly to tertiary care hospitals. First responders must be trained to provide ALS to non-severe casualties until evacuation resources are available.
Involvement of local municipalities in promoting emergency preparedness has been recognized as a key factor to build a resilient community. As part of the efforts to build and maintain knowledge and capabilities, the Israeli Ministry of Health initiated a series of conferences aimed at capacity building of city councils to provide services to the population following disasters.
6 conferences have been planned for the years 2010-2011 in which 250 senior administrative employees from all municipalities, responsible for the health status in their communities are expected to participate. Each conference covers a variety of emergency scenarios, including biological events, regional hostilities and management of massive Acute Stress Reactions among the civilian population. Pre-post tests based on Multiple Choice Questions are conducted before and following each conference to identify impact of the training program.
Findings from the pre-post tests conducted up to date showed a significant increase in all elements included in the training program. The average knowledge scores of the pre-post tests were 33% and 79% respectively. The highest increases in level of knowledge were found in regard to deployment of community centers for light casualties in chemical warfare scenarios (48% and 100% respectively) and concerning population that requires evacuation during emergencies (68% to 100% respectively). Overall levels of knowledge regarding community treatment centers in biological events were relatively low both before and after the training (16% and 44% respectively).
Training local municipalities' personnel is crucial in order to promote emergency preparedness. Raising knowledge regarding response to newly emerging threats (such as deployment of exposure centers in biological events) was found to be more complex in comparison to well-recognized hazards (such as deployment of community treatment centers in chemical warfare). There is a need to conduct follow-up studies to determine the retention of knowledge over time.