Dispatch, Crisis and Mental Health. An In-depth Look with UH Medical Director Avi Marcus.

The last two and a half weeks have been extremely busy for United Hatzalah’s Medical Director, Avi Marcus. Avi also runs the organization’s Psychotrauma Unit. The unit is a group of trained mental health professionals and medics responsible for providing psychological first aid in the initial minutes following a traumatic experience to help prevent PTSD.

Last month, Avi was one of the first paramedics on scene at the stampede in Meron, where 45 people lost their lives and hundreds were injured. He also helped manage the chaotic scene on both the medical and psychological side.

During the current escalation in Southern Israel, Avi is making sure that all United Hatzalah volunteers in the region are fully protected with bulletproof vests and helmets, in addition to having all the equipment they need.

In honor of both EMS week and Mental Health Awareness month, we managed to catch Avi for an in-depth conversation about what role the Dispatch and Control Center of United Hatzalah plays in the bigger picture of how United Hatzalah volunteers quickly arrive to medical emergencies in times of crisis.  We also had a chance to discuss how the dispatch center is able to assess when to alert the Psychotrauma Unit to offer give further treatment and help prevent PTSD to both bystanders and United Hatzalah volunteers.

Here is our conversation. 

First off, can you give us a little background of what you do as both the Medical Director of United Hatzalah and the Director of the Psychotrauma Unit?

At United Hatzalah we have close to 6,000 volunteer medics, paramedics and physicians. In short, I make sure all our volunteers have the right equipment at all times. I work alongside 40 paramedic supervisors around the country making sure all the volunteers are doing what they need to do. I also review the educational materials for our ongoing courses. I help decide what equipment is needed in our medic bags and ambulances.  I help write all the medical protocols alongside a committee of high ranking professors and physicians that meet every 3-6 months and check that all our units are operating by those protocols. And lastly, I oversee the medical side of our Psychotrauma Unit, whose main mission is to arrive to the scene of traumatic situations and provide quick,  psychological first aid to help prevent PTSD.

How important is the Dispatch and Command Center in times of crisis?

Dispatch and Command Center are the main piece of United Hatzalah. They are the brain of the entire system.  

The dispatch always needs to know what is going on. Where the crisis is happening. Which people need to respond to that specific emergency. Is it a medic, a paramedic, three paramedics?  Do they need a defibrillator, an epipen? Bulletproof vests?

At the end of the day, they tell every volunteer where they need to go. And once that volunteer arrives to the emergency,  the dispatcher is part of the assessing whether additional medics/paramedics are necessary.

Dispatchers themselves need to be very strong minded and have a very broad perspective.

For example, if there are missiles coming and you are a volunteer on your ambucycle and your siren is going off, you might not hear the warning siren of the missile. The dispatcher will contact you and tell you to stop and pull over.

Or the dispatcher might sometimes warn a medic to avoid a specific area. In short, dispatchers are on top of everything. 

Dispatchers also need to be connected with all the authorities, especially in times of crisis. The army, the police, the fire department. They communicate to gather information, and to relay critical information. It is all connected back to the dispatch. 

How does the Dispatch and Command Center know when to announce a Mass Casualty Incident?

Our dispatchers have a specific questionnaire to understand each situation as soon as they pick up the phone. They know how to ask the right questions in the first 10 seconds to better understand the incident. 

In Meron, they automatically understood it was dozens of injured people and they immediately called it out as an MCI (Mass Casualty Incident).

What do the dispatchers do differently when it is a Mass Casualty Incident?

When an MCI is announced, there is a specific protocol of what the dispatchers have to do. There is a checklist. First on the list is to call the authorities and bring medics from all over the country. 

For example, last week we had another MCI in the town of Givat Zeev, where more than 200 people were injured and two people lost their lives when a set of bleachers collapsed in a shul at the beginning of the Shavuot holiday.

Once the MCI was called, automatically all the ambulances from a 70 km radius (as far as Ra’nana, Petach Tikva and Rechovot) were told to come immediately. In the end we had 13 United Hatzalah ambulances there. There is a protocol for exactly what you have to do. 

In Meron, we actually had enough people on the scene. We had 200 volunteers there. However, you should know that only 60% were on call. 40% of them were just visiting Meron

 

What about during the current escalation in Southern Israel? Are there special protocols?

For missiles targeting the south of Israel, we have our volunteers who live in those regions who are called out to the emergencies. Volunteers who don’t have a bulletproof vest and helmet are not allowed to go out.  Safety is an important part of our protocol.

In Petach Tikva, where I live, we recently had a direct missile hit on an entire building. In this case, 30 medics and 4 paramedics arrived on the scene.

In the towns closest to range of rockets, such as Sderot and Ofakim, we specifically sent additional ambulances to be stationed there during the current situation.

Are our dispatchers used to being under such pressure?

First and foremost our dispatchers have to be medics, and then they can go through specific training to be a dispatcher.

In many places in the world, dispatchers are just there to answer the calls and send for help. Here all our dispatchers are medics.

Since they are medics, they can visualize extremely difficult situations and understand what is needed most at the scene. Should they send a paramedic? An ambulance? So yes, they are definitely used to being under pressure.

Do our Arab volunteers play a role in the Dispatch and Command Center?

United Hatzalah gathers everyone.We truly work together and never differentiate at an emergency if the patient is an Arab, a Jew, a Christian. It is not even on our radar. We really have unity at United Hatzalah. 

When the riots started on the streets of Israel last week, we requested that all our volunteers, Jewish and Arab, not write anything political on social media. Everyone responded very positively. We are working all together. 

Our Arab dispatchers are on call on Shabbat and holidays. They have a big role. Just like everyone else.

Let’s move on to the Psychotrauma unit and how it is connected to the Dispatch and Command Center. 

Today, all the United Hatzalah medics know that the Psychotrauma unit works on two different aspects.

The first aspect is treating all the people that are not connected to United Hatzalah. Meaning, people who have seen the scene. Medics know when they need to call the dispatch center and send for the Psychotrauma unit. Or vice versa.  Dispatchers will ask the medics if they need the Pschyotrauma unit there, especially in traumatic emergencies such as a child drowning.

The unit is comprised of 70 mental health professionals; psychiatrists, social workers, and psychologists. In addition, we have 400 medics that United Hatzalah trained to offer basic psychotrauma response. Sometimes our medics wear two hats. They will finish medical treatment on a patient and then literally flip the vest and will go straight to providing psychological treatment.

The second aspect of the Psychotrauma unit is treating our own people in house.

We either receive a call from the volunteer themselves saying they aren’t feeling well or they can’t sleep at night. Sometimes their spouses call us, or the head of their unit.

There are also specific emergencies where we know the volunteer will need psychological treatment, so we usually wait about 24 hours to let them decompress and then we call the volunteers to check in.

If we see that they have certain symptoms or problems, we will defer them to the mental health professionals from our unit. They will have sessions and meetings. United Hatzalah pays for the treatment.

What role did the Psychotrauma unit play in Meron?

Meron was a very difficult MCI with a lot of casualties in a very small place. Uriel Belams, a member of our unit who was on the scene in Meron, started psychological treatment immediately both to bystanders and our volunteers. On the ground, we had 4 mental health professionals and 7 medics of our Pschyotrauma unit providing treatment. 

By Thursday night, we were already treating our own medics. There were many who were crying, weeping. The mental images they had were unimaginable. We continued treatment on Saturday night, Sunday and Monday all around the country with group sessions. 

Our medics who until today have not yet fully recovered, more than two weeks later, are continuing to receive more treatment. Everything is confidential about each volunteer and their treatment.

It looks like providing psychological treatment to both United Hatzalah volunteers and bystanders is very important to you personally.

It is important for me. It is important for every medic we have. We see scenes that we aren’t supposed to see. We are there because we are medics, but these are scenes that no normal person should see. We need to debrief it, speak it out. 

The main idea of the unit is to prevent PTSD. Medics and paramedics all around the world have PTSD from what they have seen. If you intervene within minutes or hours, and sometimes days, PTSD will not appear. 

We try to treat people at the scene. If you help people to put things together in their brain and give them simple tools right away, you can really defer PTSD. That is why we try to get there so fast. Usually within 2-3 weeks after a traumatic event, if the patient got treatment right away usually they will go back to normal life. 

United Hatzalah is one of the only organizations I know that provide psychological treatment to their volunteers and employees. 

Are you proud of United Hatzalah volunteers’ dedication to saving lives over last two and a half weeks and counting?

Of course. I love our volunteers. It is amazing. People coming to help other people they don’t know. It can be as we said before, Jews or non-Jews. Everyone is with one goal to save lives. 

To see our medics, let’s say in Meron, truly fighting to save lives was just unbelievable. Even though they knew it could affect them psychologically or they could potentially harm themselves. 

There is a special enthusiasm amongst our medics to save lives, especially when they are volunteers and not employees.

I am really, really proud of all our volunteers. 

Thank you so much Avi for taking the time. We are truly inspired by your dedication to United Hatzalah’s mission.

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For those interested to hear more from Avi Marcus, below is an emotional interview on CNN’s Newsroom with Michael Holmes that Avi did from the scene in Meron just hours after the stampede on April 30, 2021. 

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