My Magen David Adom Ambulance Experience....

My Reflections...
My Reflections

After being in Israel for two and half months volunteering as an Emergency Medical Technican for the Magen David Adom Ambulance Service, I have many things to reflect, to comment on, and to talk about in reflecting upon my experience.

To be completely honest, when I first arrived in Israel, I was very overwhelmed by how the Emergency Medical Services operated there. I found the treatment of many patients, especially at the Basic Life Support Level, to be archaic and extremely unfamiliar. After a couple of weeks, I found that my overall feelings changed and that I was starting to get used to and familizarize myself with how to treat patients over there. It was necessary for me to break my treatment habbits that I have learned so well in the United States and adapt to a system that lacks money, training, and sufficient resources. After a couple of more weeks, I found myself fairly proficient operating as an EMT there, and during the last few weeks of my stay in Israel, I genuinely enjoyed my experience and would often time learn new skills. For example, the Magen David Adom station serves a city of 200,000 people and covers a district totally 300,000 has only 1-2 Advance Life Support ambulances operating at a time. As a result, it was necessary for me to adapt and to learn to treat patients with more serious injuries since ALS is only dispatched for the most serious of emergencies. Furthermore, more often than not, the Advanced Life Support ambulances transfers patients to the Basic Life Support ambulance if they’re fairly confident the person will not die during the transport to the hospital. This is a necessary precaution since the distance to the hospital can range from 20-30 minutes with lights and sirens and putting the ALS ambulance out of service all the time would further reduce the city’s capability to treat critical patients. Thus, it was necessary to attempt to stabilize patients in other ways. Sometimes, it was impossible for me as a Basic EMT with limited resources to treat critical patients adequately. It was necessary for me to learn to patiently sit next patients knowing that there was a limit to what I could feasibly to do to treat adequately and anxiously hope that we would make it to the hospital. I call this learning “to deal” with the circumstances. It may seem like something that comes naturally, but I think in this circumstance, it took a bit longer. It may have also taken me longer as a trained EMT coming to Israel from the United States knowing how Emergency Medical Services operates in an ideal environment.

Other things that I learned that I feel are very important to share with you. Although many times in Israel, we were forced to under use ALS since it simply wasn’t available or could not be put out of service all the time, I am confident that we certainly over use ALS in the United States. After my experiences, I know for sure now that it is not necessary to transport all the patients that we do in the United States at the advanced life support level and unnecessarily put paramedics out of service. However, since we have these resources available in the United States, I don’t feel that the harm is that significant. However, to all the Basic EMTs reading this, it is important for you all to know to have great confidence in yourselves, even in the most serious of emergencies.

In terms of people, I found the employees and volunteers in Israel for the most part to be exceptional people. The drivers were very passionate about their work and took is very seriously. The domestic volunteers were exceptional people all around. They did multiple 8 hour shifts a week and were extremely helpful in every respect. They enjoyed learning new skills, taking additional classes, and helping out all around. They were extremely mature for their age and it gave me an eye opening into their compassionate hearts. For me, they were most helpful in teaching me to apply my skills as an EMT to a new EMS system and to helping me learn the necessary Hebrew to ask my patients pertinent questions and to understand my surroundings better.

In terms of the international volunteers- they were such wonderful and amazing people. In Ashdod, for most of my time there, we had seven international volunteers. Towards the end of my volunteer time, we had a total of eleven international volunteers. We had volunteers from all over the world to help out and assist: France, Mexico, Chili, United States, and Canada (Montreal and Toronto). Besides my brother and me, there was one other trained EMT from abroad. The rest took an intensive first aid course in Jerusalem to help prepare them for the challenges of volunteering on an ambulance. All of them were great people to work with on the ambulance. All of them were willing to learn and willing to devote over 40 hours a week to assist. We all became good friends during the summer. We frequented the beaches together, barbequed together, hung out at the malls together, and all went out to dinner frequently. It was also fascinating to talk with the international volunteers about their experiences in their home countries. Furthermore, the experience of hearing many different languages was fascinating- with all of us at dinner, usually four languages were spoken simultaneously: Hebrew, English, Spanish, and French. I hope I will keep in touch with many of these volunteers. I learned so much from all of them.

A common question people ask me now that I’m back is, do you feel like you made a difference? I’m not sure how many lives I can honestly say I know for sure that I personally helped save. It’s not really tangible. However, I know that I made a difference. Magen David Adom is very short of money. As a result, they can only afford to pay a driver on all the Basic Life Support Ambulances. Volunteers are essential to provide drivers (who are trained EMTs) with partners. During the overnight shift, for example, if no volunteers show up, the drivers go out by themselves. This is a difficult concept for many of us to understand, however, under the circumstances, one needs to understand. As a result, all of the international volunteers vowed together that we would do our absolute best to make sure (especially during the night shifts), that all drivers had a partner, and if possible, two partners. As a result, we were even able to put into service an additional ambulance during the overnight shifts. That’s how we made the biggest difference. WE provided the necessary manpower for the EMS crews. That’s a special gift. The drivers were always thrilled to know that they were guaranteed a partner every night.

In terms of Security issues, I have some reflections to talk about as well. Security in Israel is a whole different ballgame so to speak. I know many of you were concerned for my own safety. After being in Israel for 10 weeks, I am convinced it is safer in Israel than in the United States- though like all security, it comes at a price. In Israel, it is the law to carry national identification or passport at all times while in the country. In Israel, any police office, army official, or security personnel can ask for identification and if unable to produce such papers, one is immediately put under arrest. Also, whenever one enters a major restaurant, a mall, a bus station, train station, or other public place Ids may be requested and most civilians are searched for weapons and bomb belts with a wand. All security personnel, whether or not they are affiliated with a police agency, are well trained and armed. Also, one of the biggest differences in securing the country, is that it is perfectly legal to profile civilians regardless of probable cause. I have learned that profiling is an absolute necessary to guarantee security, with the small cost of infringing on the civil rights of some people. Security comes at a price- I have learned that I am at least willing to accept this should the time come in the United States that we have to implement such security measures. However, it is also important just in Israel, that regardless of profiling, every civilian must be respected and their civil rights upheld.

After coming back to the United States, I am also adjusting to my old surroundings. A weird concept for many of you to I can imagine. It’s tough coming back to the United States and starting to volunteer again for my hometown ambulance corps in Scarsdale. Things seem so modern here in the United States. The emergencies seem so different for the most part. The people are different. It’ll take some time…..

Overall, this was the best experience I have ever had and I have learned a lot about international medicine, Judaism, and the Israeli experience. I hope some of you will take the plunge and decide to help out Israel in some small way as well.

My Last Full Day in Israel
Hi Everyone,

Sunday came around the corner quick than I had hoped, though I had an amazing last week. On wednesday, I traveld up to the northern part of Israel to visit my Israeli friend, Boaz, for a couple of days. It's a bit a long journey. WE first had to take a Sharut (communal taxi) from Ashdod to Tel Aviv, then transfer to a bus from Tel Aviv to Kfar Tavor, and then drive with my friend to his hometown in Yav-ne-el. The whole trip took close to 4 hours only to go about 120 miles I think. It was a great experience. Boaz lives in a very very tiny community about 20 minutes south of Tibverias (the main city in the north east part of Israel and right alongside the Kineret. His house is surrounded by trees and mountains in the distance with lots of open space and farmland. On Wednesday night, we took a nice long walk around his community and that evening we went along the boardwalk of Tiberias for dinner. It's a beautiful city that is right beside the Kineret lake. Absolutely beautiful. There are actually a few international volunteers that are volunteering there. It must be a very interesting experience for them. The scenery was absolutely wonderful. I enjoyed the change in atmosphere greatly.

On Thursday, we all woke up very early to go hiking in the golan heights. We headed to the nature research at around 8 am I think an began hiking at around 10 am. We did a hike called Nachal Yehudia- one of the longest and most interesting hikes in the Golan. The hike took us around 6.5 hours to complete. The hike consists of dirt paths, hiking through rivers, swimming through lakes, climbing rocks- it was a very cool experience. TO keep us on track, sicne it's nearly impossible to know your location in this area, various rocks along the way are makred with red and white so that one doesn't accidently wonder off the trail. It was so much fun- a greatly combination of sweating a bit and swimming an dgetting great exercise. The scenery was georgious- mountains and hill tops all around, rocks, canyons, rivers, waterfalls- something out of a movie or story. To prevent all our bags from getting drenched in the water parts of the hike, my friend carries a small inflatable pool raft that we through all our bags on to toe across the water. It's very funny to watch, but a great idea. We also drank tons of water. The recommendation for the hike was about 4 liters (1 gallon of water). In the end, after a few scraped knees and exhausted, we succesfully did the entire hike. Unfortunatley I couldn't bring my digital camera because of the water problem, so I brought a disposable camera- hopefully it didn't get ruined in the process, but I will be sure to show you those pictures as well for those interested. On Thursday evening, Boaz drove us to the bus station where we then headed back to Tel Aviv and then back to Ashdod. It was an absolutely wondeful trip up north and i'm so glad I was able to do it before I left.

On Friday, we met an old family friend of ours in Jerusalem. We then subsequently went to the Kotel in Jerusalem (in the old City) for our last prayers at the WEstern Wall. Afterwards, we went to Maya Sha-arim again (right outside of Jerusalem). It's a very religous community that has wonderful stores and is ussually a great place to do some last minute shopping and get some good deals. My brother and I bought a couple of more things before our journey back home. For the Sabbath, we spend it with the family that was the first to take us in and provide meals for us upon our arrival to the synagogue our very first week here. WE've become very close to his family and I hope w'ell stay in touch over the years. They've really been so kind to us- it's hard to every repay what they've done for us. It was tough saying our last good byes to all the synagogue members that have given us so much enjoyment over these past few months.

Last night, I did my final shift at Magen David Adom. It was actually a very quiet night surprisngly, I only had one call. It was of course a chest pains call. Nothing was particuarly unique about this call, except the fact of what a shock it will be to come back to the United States and experience very different protocols again. I forget how used to it i've become here after volunteering full time for 2.5 months. I had a 65 year old patient last night who was having trouble breathing, chest pain, diaphoretic, Heart rate of 60, Blood pressure of 180/100, and respirations of 24. The Critical Care United was out of service on another call, so I responded with my driver (just the two of us) to the call. We gave him oxygen upon arrival and assessed his vitals. When the critical care unit came, they quickly assessed him, did an EKG, concluded that he would probably not go into cardiac arrest within the next 30 minutes, and then subsequently transferred the patient to our regular ambulance for the transport. I forget how uncommon this practice is in the states. Even though my patient was probably having a heart attack, we literally can't afford to put our only advanced life support ambulance out of service for a prolonged period of time, so we ineveitably have to take patients like this all the tim ein a basic life support ambulance. I think it will be quite a change for me to actually have ALS available most of the time when I actually need them. But, I think overall my skills have improved as a basic EMT since i've seen more serious cases and have had to treat them by myself. In Magen David Adom, the past international volunteers always say you remember your first and last calls the most. Maybe that's true. My first call was a fire fighter with smoke inhalation- my last call was this patient with chest pains. Both were interesting calls, both great patients, and both times I worked with great drivers. My first call here I was not confident and unsure of how things worked, this last patient I could speak the hebrew tha twas necessary, treat as necessary, and fill out all the necessary prehospital care reports.

For the rest of the night, I mostly stayed awake and spoke wiht the various drivers, just laughing outside on the patio of the station, taling and laughing. I had some interesting conversations with my driver. She is the only female employee (driver) of the Ashdod Magen David Adom Station. It was interesting hearing about her experiences as such. She mostly works on the Critical Care Unit, so it was nice to work with a new person during my last shift and hear about her experiences.

As for the rest of my plans. This morning after my shift, I said my various good byes to the Magen David Adom employees, volutneers, and national service women. It was tough saying goodbyes- we've worked together for 2.5 months almost everyday. I took some last pictures as well with my digital camera. WE all said "perhaps next year, we'll return." I will stop by again during the afternoon shift to say some more goodbyes. At 8:30 pm,. there's a small party honoring the Ashdod volunteers that are leaving tomorrow. It will be nice seeing everyone for one last final time before leaving. I've really had a wonderful time here and will be sad leaving. Tomorrow my flight is at 4 pm and I get into New York at 9 pm (the tiem difference is 7 hours). I look forward to speaking with many of you shortly over the phone and in person as well in a few weeks =)

IN a few days, I will post a very long entry regarding my reflections of my experiences. Please keep posted =)

~Dave

My Last Couple of Entries
Hi Everyone,

I hope all is well. It's hard for me to believe that my trip is quickly coming to a close. I leave on Monday to go back to the United States. I've already called a taxi company to pick us up...it's sad to leave, I'll have a lot of memories leaving here that will stick with me for a long time.

Last night, I did a night shift at the ambulance call. One patient was a psychiatric patient (it was my first one I've had so far). She wasn't violent at all- very scared for the most part and a bit hysteric. Unfortunately, with those kinds of patients, there isn't much I can do. I tried comforting a bit- I hardly think it helped. My second call was a 2 week old infant. Very cute baby boy and so tiny. It's one of the youngest infants i've seen as a patient. The mother called the ambulance and panicked because she thought her son had aspirated/choked on his vomit. I think she may have overreacted, but with a 2 week old infant and a new mother, I can completely understand her fears and need to call for an ambulance. There's a saying in pediatric medicine- pediatricians don't treat children for the most part, they treat parents. I think that quote holds up most of the time. think about it for a little bit and I think many of you will end up agreeing.

Today, in a couple of hours, I leave for the northern part of Israel to the Kineret. It's the main fresh body of water in Israel. When I get a few miles south of the Kineret, I will get off the bus and call my friend from the University of Rochester to pick me up. It will be nice seeing him after so many months and catching up. I especially look forward to swimming in the Kineret water, doing a hike or two, and hopefully going up to the Golan Heights. I hope all of you will have a chance to look at my journey on the maps I posted at the very beginning of my journal entries.

Other things which I want to tell all of you about! Monday night through Tuesday evening was T'isah B'Av. This is the day that Jews around the work commemorate the destruction of the first and second temples in Jerusalem. It's a very sad day in Judaism and it is customary for everyone to fast that day. One of the Ashdod International Volunteers has an apartment in the Old City of Jerusalem, and he invited all of us to stay there this past Monday night through the fast. What an experience!!! I never dreamed in my whole life that I would have the opportunity to stay in the Old City for an entire night. On Monday night, we all went to the Kotel (Western wall- the last remnanats of the outer wall of the Temple) to go pray for services and then again on Tuesday. It was amazing to see how many people there were praying. Praying for forgiveness, for the future, to life- to hopefully one day again build the temple in the future. There were literally thousands of people in the tiny plaza in front of the Kotel. It took me 10 minutes just to sift through the crowd to reach the actual wall and pray. I can't even begint to describe to the experience I felt- it was very overwhelming.

When the fast ended, we all took a taxi to the bus station to break our fast there with some pizza and other foods. It was nice to finally eat. I always have trouble with the last couple of hours of fasts like this- with headaches and all. Many jews seem to. Even at the Kotel, I saw Magen David Adom standing by and several times have to go on ambulance runs for Jews passing out. It's just so hot in general now in Israel- one needs to be very careful to be in the shade, out of the sun, and on other days to drink lots of water.

Other than that things are good, I'll probably update this journal again either on Friday and then on Sunday. When I get back to the states, I will write a very long entry in regards to my reflections of my experiences. I hope all of you continue to write comments to me- I always enjoy reading them. Take care.

~Dave

New Volunteers!
Hi Everyone,

I hope all is well. This has been an interesting week in a few respects. On Monday and Tuesday, I mentioned that all the international volunteers headed to Jerusalem for a ceremony for all the international volunteers and to celebrate all of our hard work. It was fun to meet and talk with many of the volunteers that I haven't gotten to known tha tare volunteering in different cities Israel. Many of those volunteers who have been in ISrael for the past few weeks, are now leaving and a new group has recently arrived to help out for the last few weeks of the summer. In Jerusalem, we attended a ceremony Monday night which was followed by several talks from the Jewish Agency on other programs in Israel. Some of the programs sounded interesting like doing different kinds of internships in Israel or volunteering for the Israeli Army and things like that. Maybe i'll be able to an internship in the future, who knows? On Tuesday, many of the international volunteers went on a hike in Jerusalem which was a lot of fun. We had a pretty good tour guide who was knowlegable about the history of the city. THe focus was the sights and places relating to the 1948 Indepedence War. It was very interesting to go on this hike and we walked a couple of miles of the Burma Road which was interesting. This road was extremely important during the 1948 conflict. TO give you a very quick summary of it, during the 1948 conflict, the Arabs were attacking Jewish convoys with medical and food supplies to Jerusalem, whcih was effectively cut off from the other Jewish Residential areas in Israel. As a result, the main highway going from Tel Aviv to Jerusalem was effectively not traveable and any Jew who attempted to take a convoy there was shot. As a result, a new road had to be opened secretly at night, and this was the Burma Road. It effectively bypassed the highway and was a dirt road with the last few miles a small narrow dirt path. Recently, I just finished reading the book "O Jerusalem" which talks about the conflict in great depth and it was nice to see in person what I recently read about.

Other things which are interesting. We have 6 new International Volunteers to help out in Ashdod. Many of the old volunteers i"ve bene working with from Abroad are starting to leave and have been leaivng for the past few days. The New international volunteers are from Paris, Montreal, and the United States. It seems like a good mix. It's kind of interesting to see so many langauges present. We all went out to dinnner the first night they arrived, and the waiter started to laugh a bit and I then undeerstood why. At our table, there were 4 languages being spoken simultaneously: French, English, Hebrew, and Spanish and all at the same time!

I'm putting my hebrew now to a new use. Two of the volunteers speak French, so Hebrew is now our common language for all of us =) It's interesting to know that it really is the unifying language of the Jewish People.

A humorous story to tell you about one of my calls from last night. Last night, I rode with a driver, myself, and the new international volunteer from Paris. So I was kind of showing her the ropes and what to do since I think it's easier learning from an international volunteers at least at first. WEll, I had another pregnant woman whose water broke (40 weeks pregnant). It was her first child, so there wasn't really a huge concern that we'd have to delier the child in the ambulance. THe couple was very young (22 and religous). During the long transport to the hospital, we basicially jsut reassured them that everything was ok (they were a bit scared since the mother had induced diabets from the pregnancy) and monitored her vitals. During the transport, the father takes out a digital camera and starts taking snap shots of his wife and us (the volunteers in the back). It was so funny to see that- we all seemed to have a good time. In my 3 years of being an EMT- that's the first time i've had a patient take pictures in the back of the ambulance. At the end of the transport, the father gave me his cell phone number and told me to call him later in the week and he'll E-mail me the pictures. I think i'll take him up on his offer...it should be fun seeing them.

Other than that, my time is quickly coming to a close. I leave for New York in a week and a half (on August 2nd). Other trips that we have planned are as follows. On Friday, we'll be spending Shabbat in Kiriat Milachi with a paramedic friend of mine from Magen David Adom. On Saturday night, we'll take a camping trip up to the northern part of Israel and explore a bit on Sunday. Next week on Wednesday and Thursday, i'll be traveling to visit an old friend of mine who is Israeli at the Kineret (one of the only fresh water lakes in Israel) and the Golan Heights (it borders Syria). Both are supposed to be lush with green and very pretty, which i'm excited for.

Another interesting story which I forgot to tell about- how silly of me! Last night, one of the high school Israeli volunteers invited me over to her house to have dinner with her family. She's taking a trip to the United States (new york city) and Toronto and she wanted me to speak with her and her parents about her trip and things she might need and places to stay and such. It was a lot of fun- her family was very kind. It was nice to talk about New York for a bit- I miss the states a bit afterwards. It was interesting in some ways to see how irrational some of fears can be. For example, i'm scared to take busses within the city of Ashdod because of suicide bombings. It's a completely irrational fear since the number of successful bombings is so small compared to the number of rides the bus actually takes, however it's still a fear of mine. Her parents were extremely fearful of the subway in New York City for fears of crime and other things. In some ways, it's exactly the same thing. I wouldn't even think twice about taking the subway in NYC- and her family wouldn't think twice about taking hte buses within cities. It's interesting to see that kind of comparison if that makes sense. However, I had a very pleasnat night and when she's in New York City, she's going to give me a call and i'll give her a little informal tour and take her out to lunch or something.

Anyway, my time is running out. Please look for a couple of more entires posted here before I return to the United States. I hope all is well.

Our Tiyul (trip!)
Hi Everyone,

I hope all is well back in the states. It's hard to believe that nearly 8 weeks have passed since I've been Israel and that I only have two more weeks left in Israel. Time goes by very fast and i'm sure these last couple of weeks will go by even faster. I have some interesting stories/experiences to share with all of you.

On Thursday, all the international volunteers in Ashdod (7 of us) decided to take a trip together to the southern part of Israel to visit the Dead Sea, Ein Gedi, and the Flour Caves. I think I may have mentioned that in my last entry. We found a Monit Sharut Driver (mini van taxis here) to take all of us around for the day to anywhere we wanted for 500 shekels (roughly $ 110 for all 7 of us- which is a great deal!). We left promptly at 7 am on Thursday from the Absoprtion Center. The first thing we did on our trip was the Flour Caves. To give you an idea geographicially where this is, it's near the Dead Sea and near the city of Arad, It's on the Eastern Part of Israel that borders Jordon (the Dead Sea separates Israel and Jordon and acts as the border). The thing which is so interesting about these flour caves is it's in the middle of the Dessert in Israel and a series of small caves and tunnels exists tha tone is able to walk through. What's especially fun and interesting about it is the caves are made out of a very fine sand that actually looks and feels like "flour." It was a lot of fun to play in it and go exploring in the different caves. Since it was in the desert, there was literally no civilization for miles and miles. The roads we had to travel for the last part of this journey were dirt roads with rocks on the side used as guidance since it's nearly impossible to find suitable landmarks. For one cave, it was actually so dark that we needed to take hold and everyone's shirt and stand in a line one by one so that we didn't hit anything or trip or fall- it was a lot of fun.

Next on our trip, we went to the Dead Sea or in hebrew, it's called "Yam HaMelach" which literally means the Ocean of Salt. What's unique about this body of water which you can see on the map in the previous entries is that 33 % by volume of the water is salt. Regular ocean water has a salt content approximately 3 %. As a result of the high salt concentration, the water is very dense, and one actually floats in the water with absolutely no effort at all. One does not need to tred or swim to stay afloat. It's a very cool feeling and hard to describe. The reason it's called the Dead Sea in English is since the salt concentration is so high, no living things are able to survive in. From the shore, we were able to see the high mountains of Jordon. The thing which was weird was since we were so close to the Jordanian Border, all of our cell phones were controlled by Jordanian airwaves and all of us received cell phone messages stating "welcome to Jordaninan cell surface...."

It felt great to swim in the ocean since it was so hot in the desert. I think it was definitely over 100 degrees farenheit in the desert, but since there is very little humidity it's somewhat tolerable. However, we all needed to bring tons of water. I think we brought about 5 liters of water per person and we nearly drank all of it by the time the trip was over.

The last part of our trip we went to Ein Gedi, which is a series of beautiful nature reserves and hikes in the desert bordering the Dead Sea. It was absolutely beautiful and we hiked for several hours, looking at the beautiful natural spring waterfalls (and also swimming in them too when we got tired and needed to cool off from the desert heat), looking at the beautiful mountains, and enjoying all that nature has to offer. It was great to actually swim in Fresh water for a change rather than the usual salt water from the Ocean that we're used to being in Ashdod.

After a very long day, we decided to head home back to Ashdod around 5:30 pm (it's about a 2.5 hour drive or so back). Unfortunately,. we had a bit of trouble on the way back home. In the middle of the desert, the car overheated (because of the steep hills in the desert and the intense heat), and the water coolant in the engine exploded. As a result, we had to stop the car. It was a bit worrisome for a little bit since we only had about 1 hour of day light left and were still about 10 miles from the nearest city. Where we got stuck, there was literally no civilization for miles and miles.

After contemplating the different possibilities of what to do since it became clear that the car was going to be undriveable, we called the absorption center who through some connections was able to send us a van to pick us up. We were extremely lucky to find such a person willing to do this since we were in the middle of the desert. It was an experience to say the least, if you want more details later about it, send me an E-mail and i'll tell you the rest of the story.

Oter than that things are going well. ON Friday I did a day shift and last night I did the overnight shift. Last night was an extremely busy shift (I had 5 calls in 8 hours and only got 1.5 hours of sleep). Tiresome to say the least. I had pretty much everything last night, chest pain, motor vehicle accident, intoxications!!!????, the whole bunch. I couldn't believe though I had a 19 year old intox- that's pretty rare here since people are for the most part responsible with their alcohol but he may be one of the first intoxications who actually wanted to go the hospital despite the ambulance crew's unwillingless to take him. HEre, we almost never take intox patients to the hospital and almost always let the police deal with the situation. I think the reason is most cities in ISrael can't afford to take ambulances out of surface for such a call especially since for every call we take, we're out of surface for a minimum of 1.5 hours since we've 20-25 minutes away from the nearest hospital.

Tomorrow morning and Tuesday, I'm going to Jerusalem for a Jewish Agency Event for the Magen David Adom Volunteers. Many of the volunteers in Israel are leaving ISrael by the end of the week so this event is a kind of last trip/celebration for them. One of the volunteers in Ashdod left today to go back to Toronto, CA. It was sad to see her go. I think all of us especially in Ashdod have formed a very nice bond among each other. It's really a great group. It's too bad a few of them will be leaving in the next few days and will be replaced by additional volunteers that are coming from overseas.

Anyway, I hope all is well from everyont back home. Let me know how you guys are doing. Please look forward to my last few entires since I will be leaving for the states in 2 weeks =) ~Dave

All is Safe....
Hi Everyone,

First, I want to let you know that I'm alive and well and was not in the vicinity of yesterday's bombing in Tel Aviv. Below is the article from CNN.

http://www.cnn.com/2004/WORLD/meast/07/11/israel.blast/index.html

At the time, I was just starting my morning shift at the Ashdod Station. This if the first time i've been in Israel during a bombing. In a lot of ways, it's an eery feeling being the first to know of such an attack. Being at the station at the time, we're the first ones alerted to such an explosion since we must prepare ourselves if there is a need for additional ambulances. Literally, everyone is watching the news at the time and praying that no one dies. Unfortunatley, one Israeli soldier did die in the blast. Life at times can be very uncertain here to say the least, however life nevertheless goes on and it's extremely important to realize that the majority of time here is safe and filled with a community happiness.

Onto better things. As I mentioned in my last entry, I went to Jerusalem from WEdnesday through Saturday night. It was a lot of fun- we did many things. For the first night, we stayed over at a family friend who gave us a more personal tour of Jerusalem. We went to Ammunition Hill and other locations where many of the important battles took place during the 1948 War of INdepdnence and the 1967 six day war. I actually got to see the remants of the trenches built by the Jordanians and later used by the Israelis and well as several of the memorials. It was an interesting experience. We also got to see Yad Vashem. It's the main Holocaust Museum in Israel. I had been there many years ago, but I find it's always important to go back especially since many members of my family were killed in it. In Hebrew, the word for holocaust is "Hashoa"- which means the Catastrophe in English. There are a few emotionally powerful things at the museum besides the obvious educational value. One part of the museum is dedicated to all the children that were killed in the Holocaust which amounted to approximately 1 million. In this hall, darkness prevails and as one walks the halls of it, one sees photographs of children with a person on a loudspeaker reading the names of children outloud. At the same time, through all the darkenss you see a candle lit and it is reflected in thousands of small mirrors many many times to try and give one the impression of 1 million candles lit. In Judaism, a candle is very significant and is used at times to represent a human life. Another emotionally powerful part of the museum is a dark room with a fire lit and on the floor are all the names of the concentration camps listed. For some time as well, we went to the part of the outdoor museum to memorialize all the Jewish communities lost during the Hashoa. It consisted of huge stone pililars with thousands of names of what were once Jewish communities who later lost all jewry. I looked hard and found my grandfather's birthplace, Tarnow, Poland on one of the stone pillars. It's sad to see that. Even after the war ended, my grandfather never returned to Europe during his entire life.

Other things that we did in Jerusalem. We went to Mea Hasarim- (literally means 100 gates). It's the name of a section of Jerusalem that has a very large religous community of Jews. There, we did a little shopping since prices are very fair and reasonable. I bought myself a Talit- a Jewish Prayer Shall for not that much money. I've always wanted a longer one (the current one I had was since my Bar-Mitvah). WE also went to this very famous bakery very close by which is known for it's wonderful pastries. I boughts lots of Ruggallach there wihch is a chocolate and doughy mixture- it was absolutely delicious, a real treat. I can't find ones so good in the states.

On Thursday, we stayed with some friends of my brother that are living in an apartment in Jerusalem. They're doing a program called Pardess and are studying at a semi Jewish Yeshiva for a month- it sounds like an interesting program. On Friday, we met up with our Synagogue from back home. Currently, 12 members of the congregation are on a trip exploring Israel. For Friday night Shabbat services, we went to the Kotel (the remants of the Second Temple wall in Old Jerusalem). It's truly an experience seeing so many Jews gathered together and praying. Then late friday night, my brother, myself, and mY Rabbi hung out in his suite in the hotel, drinking a couople of glasses and wine and reminiscing about Israel and life. It was really great to just hang out and for a night and get a little luxury staying in the hotel for a night. Sleeping on a real comfortable bed was a real treat =)

Saturday night we took a bus from Jerusalem to Ashdod and returned late Saturday evening. Yesterday and today we did the day shifts. The past couple of days have been on the busy side, but that's usual for Ashdod =) It's also been getting extremely hot and humid here- ussually it gets in the 80s during the early morning and hits the 90s during the day. Being in an air conditioned place is definitely needed =) Well, that's all ofr now, please don't be afraid to leave me some comments to look forward to =)

~Dave

Updates on Experiences!!
Hi Everyone!!

I hope all is well. Getting onto the internet this week has been very difficult. Here in Israel, no one really has set hours...it's kind of a set your own hours kind of country for the most part (even in the public library where I am right now!)

First, I'd like to tell you about some calls i've had this week. On Friday, I had a very sad call. It was a woman who was 4 months pregnant who looks like she had a miscarriage. She had a lot of vaginal bleeding and she's had a miscarriage before, the situation didn't look good. I've had quite a number of these kinds of calls in the states, and they're always so sad. I never know what to say to these patients, and espcially since there's nothing medicially I can really do to fix the problem in the very least, it makes for a very depressing transport time. The most I can offer is my condolences and good luck and a hand to hold onto- those are always very depressing calls.

Other calls I've had. Today, was especially busy. I had 4 calls in 8 hours (remember too, that at a minimum, each call turn around time is an hour and a half with the long transport time) so I didn't get to hang out at the station that much today. We had one older gentleman who was hit by a bicycle and as a result sustained a head injury. He should be okay- he'll need quite a number of stitches for his scalp, but besides that he'll be find. I had one case of syncope (probably from the combination of th eheat and other factors- it's been getting very hot here lately, 80s and 90s). I had one call for edema and one epileptic seizure. It's really amazing the variety of calls i've been getting here, literally everything.

On other fun and interesting things- Last Thursday, the ashdod international volunteers arranged an informal picnic with the jerusalem international volunteers to have a nice picnic on the Ashdod beach and watch the sun set. TO be honest, it has to be the most beautiful natural thing i've seen. A couple of times a week I just go to the beach to watch the sun set- it's absolutely wonderful. We all sat around and talked up a storm- sharing our experiences on the ambulance, in Israel, just talking =) We sat and cooked hamburgers and hotdogs right on the beach, with cans of pickles, and fried onions, and fruit. It was such a nice social gathering. It's great to just meet new people all the time and enjoy everyone's company. I even met a U of R alum who is doing the program in Tel Aviv- named Yosi- he graduated a year ago- I knew him a little from Hillel. It was nice to see a familiar Rochester face = )

Earlier last week, I went on a trip with the immigration center to the norther part of Israel. We traveled to Haifa, Akko, and Rosh Hanikra. If you look on the map earlier in this journal, you should be able to find all these cities. They're all coastal cities in the northern part of Israel. Haifa is a beautiful port city. It's an interesting city because it's considered ideal in a lot of ways. It has a mixtures of arabs and Jews that live together in one city. In Akko, we visited the old Akko prison that Britain used during the occupation to imprison the Irgun military during the 1948 Independence War. In rosh Hanikra, we toured around, and went through a vast development of caves resulting from the salt water carving them out beside the ocean. Rosh Hanikra borders lebanon and I was actually able to walk up to the fence that borders the buffer zone for Israel/Lebanon. It's a bit scary in a sense. In Israel, as a Jew, i'm afforded all the rights and freedoms of a citizen here. Just a few hundred meters away, I'm afforded no rights at all as a Jew in Lebanon. It was an eery kind of a feeling- I have a couple of pictures as well of it. The land up north is absolutley beautiful though. It's full of trees, and grass, and gardens (unlike Ashdod where all the trees have been planted and where in place of grass there's ussually sand).

Also, earlier in the week (on Tuesday), my Rabbi from my synagogue from back home came to Israel for a week for a conference and wanted to pay us a visit in Ashdod. It was very exciting. He rented a car and drove from Jerusalem where he was staying to Ashdod. Together, we showed our Rabbi the Immigration Center we're staying at, walked along the beach, gave him a brief tour of Ashdod, and ate dinner at one of the small cafes along the beach. It was really great hanging out with him and talking about Israel, Judaism, and other great things. We had a wonderful time together.

On Wednesday, Thursday, Friday, and Saturday- i'm actually going to be in Jerusalem, so it will be a nice little vacation from Magen David Adom. For the first two days, I will be spending the time with an old family friend of ours that lives in the New City of Jerusalem. On Friday and Saturday, we'll be spending our time with members of our temple congregation from back home. Every year, our temple has a trip to Israel for a week. It'll be nice hanging out with the congregants and one of the other Rabbies from our temple. We'll actually be staying at a hotel in Jerusalem with them absolutely for free. Don't ask me how...we were just offered it!! It'll be great to actually sleep on a nice mattress and use a nice bathroom for a couple of days =)

Anyway, I guess that's about it. I hope all is well with everyone and Happy July 4th!!!! Keep the comments comming and i'll respond!

Some General Updates
Hi Everyone!

Sorry it's been a few days since i've written. To give you some updates on my life so far......

First of all, I can't believe it's already been 5 weeks that I've been in Israel....time moves incredibly quickly!

Other things. Last Thursday evening, we had a great night. All of the international volunteers staying in Ashdod had a picnic by the beach. WE all went grocery shopping together and literally ate our dinner while watching the sunset on the shores of the mediterannian- what a beautiful sight. Afterwards, we all walked along the beach together. I will greatly miss that when I return to the states. We all had a really fun time- taking a break from our shifts, talking about life, Israel, Judaism, college, all wonderful things and stories to share.

In terms of calls, mostly the usual stuff. Though, I hate writing that because I want to share with you my experiences. So, I'll tell you about some calls from the past couple of days from my brother and I. My brother unfortunately got the sour end of the deal earlier this week. At about 12:30 he got called for an intrafacility transport from one medical center to another. However, it was a very very very long trip for him....

First, he had to go to Brazilai Medical Center in Ashkelon, Israel (about a half hour trip) to pick up the patient, a physician, and a nurse. Then, he had to transport the patient to BeerSheva Medical Center (in the NEgev Desert). If you look at the maps I gave you earlier in this journal, I think you'll appreciate how far it is in Israel. Afterwards, he had to drop off the hospital staff back in Ashkelon before returning to Ashdod. The whole trip took him about 4 hours until about 4:30 am....very long night.

Last night, for some reason there were quite a number of assaults in Ashdod. To highlight a couple....2 of the other international volunteers also doing the night shift had a sad call where a father abused his 19 y/o son with glass cups ( I know it sounds a bit perculiar), but apparently the result was a badly beaten up teenager who needed hospitalization. very sad.

One of my patients last night was also an assault with a bit of a challenge. A group of teenagers hanging out by th ebeach (drinking and other stuff), beat up this 15 year old boy and pretty much burried him in the sand. We have a special light weight military stretcher for calls on the beach since it's impossible to take the stretcher down. So, we got the boy after some work to the military stretcher and carried him up the beach to the ambulance. He was semi-conscious and his faced was badly bruised. I gave him oxygen and monitored his vitals. I'm not sure if he'll have permanant damage, he was bruised quite badly, but I think probably in the end, he should be okay with some hospitalization. Afterwards, we had to clean out the ambulance of a riduculous amount of sand....

A few days ago, I had an interesting call at the Ashdod port. THe port is I believe the 3rd largest in Israel. We get quite a number of work related accidents there. My patient had a huge concret block of some sort dropped on his head in a sand ditch where the workers were working. When we arrived, a significant part of his scalp was split open with him bleeding pretty profusely. We called urgently for the Natan (critical care unit to come and meet us enroute). After backboarding him quickly, he went unconcious within a matter of a couple of minutes due to the bleeding. I'm not sure what the end result will be of this patient, he was pretty badly injured.

On some happier kinds of calls, I've had quite a few women who were in labor (I sitll haven't had a delivery yet). Most of those women probably delivered within a couple of hours upon arrival to the hospital. It's very exciting to have calls like that most of the time, because the end result is almost always a time of celebration for a new birth comming into world.

In terms of trips, tomorrow I will be going on a trip with my brother with the immigration center to the northern part of Israel for hikes. It's supposed to be an absolutely beautiful area of Israel that is very green!!! (this is a nice change of pace from the mostly sandy Ashdod). It'll be all day which will be wonderful.

On other trips, my brother and I went to Tel Aviv yesterday and did some exploring. As part of our trip, we went up to the tallest buildings in Tel Aviv (kind of like a mini World Trade Center)- I took some great pictures overlooking all of Tel Aviv. I may have even been able to see a little bit of the WEst Bank from up there- but i'm not entirely sure. We also spent a large part of the afternoon walking along the beach/short of Tel Aviv as well as paying our respects to the memorial at the Dolphinarium in Tel Aviv. IT was a dance club that was blown up by a suicide bomber in the summer of 2001.

I've managed to find a way to send people pictures that i've taken. If you're interested in me sending you some pictures, write me a comment with your E-mail address and what kinds of pictures you are interested (ex: Jerusalem, MCI pictures, Tel Aviv, etc) and i'll send them to you! Also, keep your questions coming, I enjoy them!!

The President and Prime Minister!!
Hi Everyone!

An interesting few days. On Friday, my brother and I spent the Sabbath at a friend of ours who works as a Paramedic part time for the Magen David Adom Station in Ashdod. We went to his parents' house in Kiriat Milachi. If you look on the Israel maps in this live journal, it's just a bit East of Ashdod (about a 15 minute car ride).

It was a lot of fun- his parents and his family was extremely welcoming. His family is Morrocan in origin. To say that his parents cooked us a lot of food is an understatement. There was more food on that table than I think I eat in a month. It was a bit overwhelming, but all of it tasty. It was funny because after the first serving (which I honestly though was the meal), several other servings came along afterwards. I was completely stuffed.

During our weekend stay there, we went to a few sephardic synagogues to pray for the Sabbath. Traditionally, Andrew and I are ashkenazic in origin since we have strong roots and customs from Germany and Eastern Europe. Sephardic Jews typicially have strong roots and customs from Africa and Asia. Some things are a bit different such as the encasing of the Torah (old testament parchment). It was a lot of fun to learn something new.

When we were there for the weekend, we learned from the paramedic's family that the President of Israel (President Kasav) goes to his home in Kiriat Milachi every Sabbath and is actually good family friends with the family we were staying at. So, on his way to synagogue, we got to meet and subsequently shake hands with the President of Israel! In English, he said "welcome"- it was so exciting!!! The President of Israel is more a symbol for the country rather than a politician with real executive power. He does some administrative tasks for hte government but for all practical purposes he is more like the Queen the England than the Prime Minister of Britian in terms of legislative powers.

On Sunday evening, like I said in my previous entry, we went to th eGala reception in Jerusalem to celebrate the 75th birthday of the Jewish Agency. The event was held at the amphitheater at Hebrew University in Jerusalem. To say that security was strict there was a complete understaement. Since the Prime Minister (Ariel Sharon) was going to make a speech at the event to the audience, security was very tight.

I was one of the people who after setting off the medical detecter, was quickly swept away to a back room where practicially every square inch of my body was search and wanded with a metal detector. It took about 10 minutes for me to be able to enter the actual theater.

When we arrived, we got to meet some of the other International Volunteers that are stationed in Jerusalem and up in northern Israel. It was a lot of fun. The international volunteers are mostly from the north east United States and Canada and are between the ages of 18-23 for the most part. We all had a really fun time.

The event consisted of lots of dancing, fireworks, some movie clips about the Jewish Agency, and a variety of speakers consisting of holocaust surviors, singers, dancers, and immigratns to the country. And of course, Ariel Sharon gave a speech at the event. It was so great to see him speak in person, it was absolutely exciting. He spoke mostly about this disengagement plan from Gaza and the West Bank. I wished at the event he spoke less about politics, but it's okay. I'm glad he was able to attend the event.

The view from this theater is amazing. It's an outside theater with stone steps and seats that overlooks Jerusalem in the distance with a stage below. Hebrew University seems to have a wonderful campus, though I only got to see a small part of it during my stay there.

In terms of calls, more of the usual. Except the past coupl eof shifts I'v ebeen getting a few assaults. The National Service people here say it's quite common to get. I didn't realize ther was much violence in the city here, and i'm sure ther isn't- i'm probably just seeing a lot of it since i'm volunteering on the ambulance. The night shifts are going well, typicially all the international volunteers in Ashdod try and rotate nights and day shifts.

I've now found a way to connect my laptop here to the internet, so i'm going to try and see if I can post some pictures for all of you guys to see and hopefully ask questions about. Please, don't hesitate to leave me comments as always, and I'm write you back a comment on the date you left it, just below yours. I hope all is well!

Public Relations!
Hi Everyone,

Lots of things to update you on this week. It's been an interesting and different kind of week. Let me start off with a few things to explain why.....

In terms of ambulance rides, the usual calls for the most part. On Monday, I did a shift and we got a call for a woman with very high blood pressure. Upon arriving in the patient's apartment, she greeted us in English!! I couldn't believe it! I have hardly met anyone who speaks any English here, and even fewer Americans. She's a new immigrant to the country who moved here after her husband passed away. She has close family in Ashdod, Israel and decided to make the move. It was a nice call- not because it was so interesting medicially- but because I was able to talk to her with such ease and ask all the questions I wanted to. It was also nice to see that American Jews are still emigrating to Israel despite all the violence for the past few years.

On other news, I'm absolutely loving getting together with the other foreign international volunteer students. During the evenings, we typicially hang out and talk about our experiences from our different home countries. we just sit for hours and hours talking- it's really quite fascinating how we're all so different, yet very much the same. It's a wonderful feeling being with such a diverse group of people.

In other news, as related by the title of this journal, some of the foreign volunteers who have been here for a few weeks (including my brother and I) were asked to attend an event in Tel Aviv to represent Magen David Adom. In the Hilton Hotel in Tel Aviv, the international conference on Terrorism took place and doctors from all over the world (australia, Israel, United States, Europe, etc) came here to listen to how Israel respond to terrorists attacks. They needed American Magen David Adom volunteers to help explain to the English speaking physcians what we do on the ambulances here in Israel.

We left early in the morning in a special ambulance to drop us off in a parking lot right outside of Tel Aviv. Here, we were preparing for a mock mass casualty drill. About 30 ambulances arrived here, we help lay out the equpment for many different types of vehicles that Magen David Adom has in preparation for explanation for the different physicians. THe vehicles that came to represent MaDA were first responder motorcycles, Mass Cassualty response vehicles, blood donor vehicles, Critical Care Unit Ambulnaces, Regular Ambulances, etc.

After the physicians were given guided tours by us in regards to the communication system we use, dispatch system, our medical gear and the different vehicles we use for different situations, the Mass Casualty drill began for all the physicians to watch. Note; this was completely staged and was not an actual incident, so please don't worry.

The Eged Bus bombing from April 2003 was shipped to Tel Aviv to particpate in the excercise. Israeli Defense force soldiers pretended to be on the bus as civilians. The drill started off with one of the tape recorded 101 emergency calls placed by a civilian witnessing the explosion of the public bus. A few minutes later tons of ambulances poured into the scene. The dispatch communication center was set up within a matter of minutes, equipment unloaded just as quickly. Patients were quickly triaged, treated, and transported via ambulance. On average, the first patient is transported from the scene in average of 11.5 minutes. The entire scene (about 50 mock victims) was cleared in about 20 minutes.

Israel is especially great at getting a large number of ambulance to the scene of a bombing almost immediately. Volunteers carry special pagers and when a bombing goes off, the pagers are alerted, and the volunteers from all over the region grab ambulances left and right and bring them to the scene. Patients are triaged and transported rapidly for fear of a second explosion. THe drill was absolutely amazing to watch and I have lots of pictures to show you. It was extremely organized, time efficient, and showed how truly experienced Israel is in dealing with such a horrible tragedy. I hope the foreign physicians really learned something from all of this.

Perhaps some insight as well- this may be the reason primarily that the mentality of the EMTs here is scoop and run. They have probably been trained so vigorously in Mass Casualty Incident training that it's literally hard to break those barriers and treat the patient on scene for a period of time.

The day was a very interesting experience and I'm really glad I was able to particpate in it and help out. We probably had altogether a coupl eof hundred Magen David Adom personnel there, in addition to help by the Mashtara ( police), Israeli Defense Forces, and the Eged Bus company.

After the drill, i went inside the bus to take a look at it. Scary is a word that doesn't even describe it. THe explosion ripped righ tthrough everything, seats and all. It's hard to believe hte inside of the bus was actually a bus at one time with people in it. I hope I never have to experience a call such as that........

On other public relations news, on Sunday the international volunteers have been asked to attend a Gala reception in regards to the Jewish Agency (who sponsors this program with Magen David Adom). So we'll be attending this ceremony in Jerusalem. It should be a very interesting experience to meet with some of the top people in the Jewish Agency. They've really made a world of difference in Israel with all of their donations.

My time on the internet is running out, but please leave me comments as always! I'll always respone to them right where you left the comment, just click on comments and you'll see a response. Have a wondeful weekend!

People.....
Hi Everyone,

Sorry it's taken me a while to post a new entry. This week has been very hectic. I hope all is well.

I have a lot of things to update everyone on, it's been an exciting week. Last week, my brother and I traveled to the New City of Jerusalem (also just known as Jerusalem as compared to the anchient old city). We visited the Knesset (the Israeli government building), the Supreme Court of Israel, and the Israel Museum there. It was a fun trip. The Knesset like any government building in the world, is heavily guarded. The Supreme Court building is absolultely beautiful. IT's very new and very modern. We actually got to sit in on a session for a few minutes. It's very much like the British system and was based on it. Something very interesting to note. When we arrived at teh court house, there were groups of soldiers with their officers there for a tour of the building. We found out that all soldiers are given a tour of the building to show them what they're defending the country for- justice. I thought that was very powerful- probably would be a great thing to do in the US as well.

The Israel museum was also a lot of fun- too bad we couldn't spend more hours there. It's literally filled with ancient artifacts from Israel - some of the pieces there are several thousand years old. We also got to spend a lot of time in the building that houses the Dead Sea Scrolls. For those of you that don't know, the Dead Sea Scrolls were anchient documents found in Israel in caves near the Dead Sea area. What's unique about these documents is they provide bits and pieces of the Hebrew bible and currently are the oldest documents relating to it. IT's amazing to see how tradition and history have survived the test of time. Many of the documents are nearly identical to the scriptures we use today. Very fascinating.

We also traveled to Tel Aviv with the Immigration Center which was a lot of fun. Two full of buses of immigrants went to the Tel Aviv for a guided tour of the older part of the city and Jaffa (the very early remnants of Tel Aviv which later expanded). We did a lot of walking, took some great pictures, enjoyed some stories, watch the sun the set. It was fantastic. We also went on a boat ride on the Mediterannian Sea and coudl see the Tel Aviv coast line from the distance. It was beautiful. All of these immigratns truly enjoyed the trip. At one point, our tour guide asked us for people to announce the different countries they're from and to sing a song about the ocean. People from Argentina, Brazil, Germany, Egypt, and many other countries rose to the ocassion. It's amazing to see what Israel has done for these immigrants- they've literally given them a new start.

On other news. Four more international volunteers arrived in Ashdod to help out with Magen David Adom! It's really great, it'll be awesome to have some company as well as additional help. 1 guy is from Mexico- he's actually done this program 4 times in Ashdod. I give him a lot of credit on how motivated he is. His nickname from the station is "Tobasco." 1 girl is from Chili, 1 girl is from Toronto, Canada, and 1 girl is from New Jersey. It's a nice combination of volunteers. It'll be great having some company and people to hang out at the absorption center that are more my age.

For the past couple of nights, Andrew and I have been doing night shifts. I actually don't mind them so much ,but they're a bit on the busy side and they're very short staffed. Typicially on an overnight, they have 1 critical care unit ambulance running and 2 regular ambulances. They emply 3 drivers during the night (two ussually pair up and one is completely alone). When we come to volunteer, they then open up a third ambulance and everyone has a partner to work with which is especially important. If something goes wrong with a patient in the back, and there's only a driver- things can get very ugly with a 20 -25 min transport time to the hospital. They seem to appreciate it a lot. I think we'll end up doing 2-3 overnights a week. They're pretty busy, each ambulance ussually gets about 3 calls each. I've had my variety of calls, from difficulty breathing, chest pains, COPD patients, pediatric cases including febrile seizures, motor vehicle accidents. I've gotten now pretty good at writing up the Holeh Nifgah- their version of our Prehospital Care Report. It's not nearly as complicated as ours, but with it all in hebrew, it poses a certain challenge to me.

This week, we're planning on taking another day trip somewhere. WE're thinking of going to Haifa, Israel. If you look on the map and follow the coast line of the mediterannian shore of Israel- it's the northern tip of Israel. It's supposed to be a beautiful city as well. I think we may take the train up there. I hear it's only a 2 hour commute and the train ride is supposed to very comfortable. Other trips we're planning to take in the future are to the Dead Sea (the only problem is finding a means to get there), Beer sheva, the Golan Heights (northern Israel), Ashkelon (we typicially deliver patients there), and maybe Ailat- though that's a very long trip and getting there will be extremely difficult.

I also want to spend a few minutes talking about people at the immigration center here. Everyone here is a bit "quirky" in their own way, but the people are a lot of fun. Next door to us lives a Jewish woman from Iran. She escaped a few years ago and showed my brother pictures of her growing up in Iran. She was forced to wear garments all over her body for the exception of her eyes and faced persecution there. Since she escaped there, she's lived in Israel for the past few years. This is very atypical for someone living in these immigrations- ussually it's less than a year. I think she feels a sense of security here and since she's older, I think the admin at the immigration centert have overlooked it. Almost every night she knocks on our door to bring us food, she's brought us bread, cucumbers, watermelons, rice. She considers us "her neighbor sons." It's very cute.

Then down the hall, there's two Jewish women from Bombay, India. They're a bit hyper, but they're interesting to talk with. I think they've enjoyed the change to Israel. Then, there's a gentleman who lives upstairs who's from Brazil. I think he's having a hard time adjusting, but he's a great guy. Unfortuantely, the government took a way a huge percent of his assets -afterwards he then decided to move to Israel. He's struggling a bit with the language and the culture, but he's very friendly and his company is a pleasure. Then there's two boys who are both brothers who are from Morrocco. Both are close to our age. THey're both looking for Jobs in israel- but are really enjoying the change in culture and are glad to be Israel. Then there are some immigrants here from Cuba. It's interesting- no one is allowed to photograph them since they escaped. Israel has a policy that if JEws around the world are being persecuted, they will make every attempt to try and airlift them to israel- sometimes on secret missions in itself. In Cuba, they're told to escape to some nearby country, they are then picked up and airlifted to Israel. A similar mission was done some time ago with the Jews from Eithiopia.

Then there's one woman I met who was from Berlin, Germany. It's amazing to hear about the very small Jewish Community there since the holocaust. It's sad to see a place that once had millions of Jews- now only has Jews in the thousands. She seems to like Ashdod, and has been living here for the past 2 years. She's a volunteer for the Immigration Center to try and help make new Olim- Jewish Immigrants more comfortable.

Then there's a woman here from Egypt. I heard that there are less than 100 Jews still living there which may be accurate. Egypt is a tough country for Israel. There's a very cold peace between the two countries after the 1967 and 1973 war. Jews are allowed to go into Egypt, but it's extremely ill advised by the government since Israel can not guarantee protection. I've heard one can actually see the Egyptian Coast line from Ailat, Israel. If I do travel to Ailat, that will probably be the closest i'll be able to go to Egypt.

Please feel free to post your comments and I will reply to them by writing in a new comment on the date you wrote it. Any questions so far? I look forward to them =)

Some Positive Remarks...
Hi Everyone,

Last Entry, I think I may have focused too much on all things we lack here compared with the United States. Let me though focus on some of the interesting ways that this EMS system has evolved and some things we can learn in the United States.

One of the great things about ALS here is although very short in number of ALS ambulance, every Natan/Atan unit is very staffed. Each Natan/Atan unit has a physician, a nurse, a Paramedic, and sometimes an EMT volunteer. When ALS is needed, more than enough help is available at the actual call. Also, what's interesting is that the paramedic can receive direct medical control orders right on scene and assist if necessary! It's an interesting idea- it seems to work very well here.

Another thing that's interesting is that EMTs can put in IV saline lines in certain situations such as hypovolemic shock, birth, etc (although not give any other medications or invasive procedures). I've always felt that basic EMTs in the states should be able to do this as well, perhaps in the future this will happen as well.

Another very interesting thing is here a lot of money is invested in minimizing response time (transport time is still very long). Every ambulance as a GPS locator in the ambulance. A central dispatch center at the Ashdod Station is in charge of a large region of Israel. After receiving a 101 call here for an ambulance, it is traced, logged into a computer, and a computer program is run with an online map of the region. THe computer decides within a matter of moments which ambulance is the closest to the scene and advises the dispatcher of this. It can also if the dispatcher wants to advise of an appropriate route to the scene and give directions to the driver via radio. I wish such a system was in place in the United States. I've heard of this system used in Indiana and some of the mid west but not really in the north East. In the ALS ambulances here, there is also a small computer that can give formal directions to the driver.

The dispatch control center here is also pretty sophisticated. It's actually bullet proof and code locked for Security reasons should the base be sabotaged or a time of crisis for the nation. I've only been in it in once for an orientation. It's a tough job being the dispatcher. They get around 80 emergency calls a day here. Anyway, my time on the internet today is running oout, look forward to writing some more soon!! Please post your questions if you have any =)

Update on my Experiences....
Hi Everyone,

I'm sorry it's been a few days since i've last written. I've finally found a way to gain reliable access to the internet here. Here, at the absoprtion center, they have a small computer lab that is open 2 hours a week after previously signing up. So, I will try this method from now on.

I want to share many of my experiences with all of you- on a personal level as well.

First, in regards to my experiences volunteering for Magen David Adom. I've had some interesting calls. A few i'd like to share.

One involves an Israeli Soldier. On her days off, she was driving to visit her family, and while driving during hte early morning, she slipped off the high way and flipped her personal vehicle. To my disbelief and the rest of the crew, she was for the most part fine. She was able to self extricate herself with mostly bruises and such. We collared and backboarderd her. During the transport, I had fascinating conversations with her about her experiences in the army, her feelings about the conflict, and her overall duties as an officer. She is 20 years old. I found it especially fascinating to compare our experiences, since they are polar opposites. She has been drafted to the army at a young age of 18, has served her country, and is an officer in charge of a group of young soldiers. I on the other hand, have had the opportunity at also a young age to go to a University. It's really quite amazing the differences....

Another call I had was a febrile seizure of a 2 and 1/2 year old. This is nothing particular new for me, i've had at least a dozen or so of these calls before. This child was born to a very religous family- not quite Hassidic, but pretty close. When we arrived, we found the child literally drenched in cold water with a towel wrapped around it's small body- not a bad solution especially considering the hot climate of Israel. We loaded the child in the ambulance with his father. I literally had to beg the driver in charge for me to administer a small quantity of oxygen via a non-rebreather. That's a bit frustrating, considering the child's lethargy during his postictal period, but that's life here. Use the resources we absolutely need to use. I gave the child about 10 minutes worth. I'm not sure if it made a huge difference- i would have liked to give it during the entire transport time, you do what you can.

I had a pregnant woman who's water had broke. I was in a way looking forward to possibly being able to deliver my first baby- unfortunately this diddn't happen. She had contractions and was probably in the very near future going to deliver. What I couldn't comprehend though is that the mother wanted to deliver her baby in Tel-Aviv. We pleaded with the mother to transport her to the nearest hospital for fear we may have to deliver the baby in the ambulance on the high way- unable to get further assistance if necessary. Nevertheless, she refused and we ended up taking her to Tel-Aviv. Lights and SIrens- it took 45 minutes. It's a long transport time, but in the middle of the afternoon, Tel Aviv Traffice is absolutely horrific. I had my fingers crossed for quite some time.

My brother had an extremely tough and frustrating call on the ambulance. He was dispatched to a person who "possibly fainted." The dispatcher was unable to get accurate information and felt that it was possible the call was more serious. They proceeded lights and sirens to the mall downtown- where the call was in, only to find tha tSecurity wouldn't give them immediate access for security reasons. After a few minutes delay- they entered the mall where they found an elder male, not fainted, but in fact in cardiac arrest. They had no defibrillator on the ambulance. The 2 Natan/Atan Units- our basic equivalent of ALS has lifepak 12s. The other ambulances (approximately 10) do not all have Automated External Defibrillators. There are only 4 which means not all ambulances have one. The one in Andrew's ambulance happened to not have a defibrillator that day because it was being serviced and his ambulance was the only "regular"- our equivalent of BLS to respond. They did CPR for a few minutes and after a 8-10 minute delay, the Natan showed up, defibrillated a few times, gave "adrenaline"- ie: epinephrine. A few minutes later, the person was called Dead on Scene. An interesting difference in Israel. Cardiac arrest patients are not transported to the nearest medical facility. They are worked up on scene and called on scene. If they are lucky and get back a pulse, then they'll transport the patient. Although it's a stretch to say by any means that having the difibrillator immediately would have saved this man's life, not having one surely hurt it. Since this corps is so short on money, there is no means for renting defibs and there is no mutual aid system in place since the entire EMS system is nationalized.

In terms of the people working here, it's an interesting mix. Ussually, my brother have been doing the 7 am- 3 pm shift. It's actually quite busy, with most days each of the rigs in service getting about 5 calls during the 8 hour period. During this shift, the drivers are nearly always paid. In addition, there are some younger people our age that working for MDA for their National Service. In Israel, very observant Jews or women can opt out of service to the army by replacing it with 2 years of National Service. It's interesting working with these people. They have a strong committment to their country, but at the same time I think they are ready to leave. One of them, her name is Anat, my brother and I are helping her prepare for her English exam for entrance into law school. In Israel, almost anyone who pursues an advanced degree must have a strong command of English because non of the textbooks are translated from English to Hebrew.

In Terms of the absoprtions center, it's a fascinating place. Immigrants surrounding you constantly. Children's playing in the halls all the time. Everyone has a strong love for the country. Many of the Jews here were rescued from countries who's political interests were anti-semitic or had poor economies, such as Russia, Latin America, etc. Many are very accepting and i've had sometimes deep conversations with these individuals. It's great to see so many Jews willing to make the hard transition to make "aliya" to Israel- a permanant move to settle here.

In terms of religious establishment, my brother and I have been going consitently every friday night and Saturday (Sabbath) to services at a synagogue about 5 minutes away. It's a nice congregation- modern orthodox sephardic. A bit different in tradition than we're used to, but very pleasant. Andrew and I are Eastern European in origin and have Ashkenazi customs. We've been received with open arms in this synagogue. So far, every Friday night Sabbath meal, Saturday lunch meal. and Saturday evening meal we've had invitations to spend at someone's house. To show you how kind these people have been to us, we already have invitations for the next two weeks and are starting to have to write things down on a calendar. Everytime we go to synagogue, people come up to us and say "it would be a great honor if you could spend Sabbath at our house for dinner." People are very welcoming and we've been thanked countless times for the volunteer serivce we're providing. I think part of this kindness stems from teh fact that there are virtually no Americans in Ashdod and we stand out. It's very pleasant and these families have been so gracious.

Last week, my brother and I went to Jerusalem. What a wonderful city- we prayed at the Western Wall, walked into the Jewish Quarter- it was amazing. We bought a few treasures, it's truly a georgeous city at night. It's a site to see. I really enjoyed it. We are planning to go Jerusalem on Wednesday of this week. We went to see the Old City of Jerusalem last week, so thsi time we will concentrate our time in the new city. We hope to take future trips to Tel Aviv, Haifa, the Dead Sea, possibly even Beer-Sheva.

Does anyone have any questions so far?? about the Israeli EMS? Israel? Jerusalem? I look forward to your comments =)

Experiences so far.....
It's hard to sum up my experience so far. It's complicated with a mixture of emotions. I've learned a few interesting things so far. To my great surprise, ALS care is for the most the equivalent to the states. However, ALS care is scarce and is not wasted at all (in my opinion, perhaps it's even underused). Adequate BLS care really lacks to a strong degree. To give you an idea....we lack the following pieces of equipment 1) splints 2) traction splint 3) adequate backboard related materials in quantity 4) epi pens 5) nebulizers 6) nasal cannulas. Many of you may ask yourselves why do we lack nasal cannulas for breathing oxygen. Here, oxygen is considered expensive and is absolutely only given to patients who are having a substantial amount of difficulty breathing. Thus, if patients require it, we give them oxygen by mouth via a mask- every other patient doesn't get any at all. We have one large tank in the ambulance, and only 1 D cylinder- that's it.

I've had no real interesting calls, but the calls I have had have ranged from smoke inhalation due to fires, motor vehicle accidents, fevers, chest pain- the usual EMS stuff. Many of our patients are Russians and speak very little hebrew. Typicially, the strategy employed at the BLS level here is load and go- don't stay and wait and treat. Transport times are also very long. We take patients either to Ashkelon (brazilie hospital) or to Rochovot (Kaplan hospital). Ussually, if going lights and sirens, transports times are a minimum of 20 minutes and those are on days that are clear with traffic. Sometimes, I find the experience frustrating, since I would like to treat these patients to a much higher standard of care, but then I find myself without the means or paper work to document such information. The PCRs here are very simple in terms of information- it's mostly demographic information about the patient. Virtually no medical history or signs and symptoms are recorded in any way. Virtually no physical examination is given to patients. It's a tough to see to a degree.....

Upon arrival to the hospital, every ambulance goes through a checkpoint- regardless if we're going lights and sirens to the hospital. The ambulance is briefly inspected by an armed security guard and then we're allowed entrance to the ER. the transition to the hospital is quick, we quickly exchange beds, give a copy of our paperwork and we are on our way. We also leave the patient with a bill, ussually approximately $ 125 for services rendered. Anyway, look forward to writing more =)

My first days in israel
Hi Everyone!

Unfortunately my time is very limited today- i'm still trying to find an internet place of some sort- right now i'm using the one in the Absoprtion center in the main office. Just wanted to let you all know that i'm safe and well and have completed my first few shifts at the Magen David Adom Station in Ashdod, Israel. To say the very least, it's very very different. Strugglin quite a bit with the hebrew- hopefully it will get easier with time. Trying to learn a completely new system of treating patients, trying to break old habits as well. Here, we can't provide the same level of care we have in the states- only one in the ambulance base in the city is even somewhat the equivalent of what we have. All the others have a much lower standard level of care and treatment of patients. I promise I will write more once I find a better access for internet. For now, take care! I will write soon, promise.

Trip is Coming up Shortly......
I am now writing in what probably will be my last journal entry before I take off for the state of Israel. For the past few days, my brother have been packing and packing and packing. It's a bit unfortunate we can't take more stuff down there, we're limited to 2 bags per person and one carry on. It'll be a tight squeeze, but I guess it's all part of the fun.

I wanted to share with all of you the link to the place i'll be staying. It's called Beit Canada Absoprtion Center. Here's the link below:

http://www.jafi.org.il/aliyah/abscenters/abscentlist/ashdod/index.asp

It seems to be a comfortable arrangement. Andrew and I will be sharing a small double room with some basic furniture, we'll have our own bathroom and a small kitchenette. In the center, we'll be with approximately 180 other immigrants, possibly some other students in the same program as us volunteering for Magan David Adom (MaDA for short). Perhaps we'll even enroll in some Ulpan hebrew classes if they meet at convenient times and don't charge too much money.

I guess I wanted to share a few goals that I have when i'm down in Israel.

1) To be immmersed in a differet culture and different surroundings
2) to improve upon my existing hebrew knowledge
3) to help others in need of medical attention
4) to learn to use existing resources available more efficiently and learn what to do in situations where advanced resources do not exist or are not available
5) To learn from the experiences of new immigrants to the country
6) and of course to have fun and enjoy the experience

My flight takes off from JFK airport at approximately 5 pm EST and arrives in Ben Gurion Airport (outside of Tel Aviv, Israel) at 10 am Israeli Standard Time. After we pick up our luggage at the airport, my brother and I will buy a ticket on what's known as a Sheyrut. In Israel, there are companies that sell tickets on long distance intercity taxis. We'll be traveling on a sheyrut from Ben Gurion Airport to Ashdod, Israel. After we arrive at the Sheyrut stand in Ashdod, we'll have take a regular taxi to our final destination at the absoprtion center. The trip from the airport to Ashdod will probably take around an hour and a half. I'n hoping to be in our rooms by 2:00 pm Israeli time. It's a long trip to say the least.

When we arrive, we have instructions on who to call to begin orientation and volunteering at the ambulance station. I'm sure the first few days will be a difficult experience getting oriented with a completely new system, meeting complete strangers, and getting to know the city a little. I'm looking forward to the experience.

Please feel free to leave me comments on my live journal as I continue to write in it when i'm abroad and i'll respond back =) Also, if you'd like to E-mail me, just use my Rochester school one, but expect a delayed response since I'm not sure how often i'll have access to internet there. Have an absolutely wonderful summer and I look forward to sharing my experiences with all of you!

Last Hebrew Class....
Today I had my last Hebrew Class...or actually it was really my final. It was great though, i really really enjoyed the class. I took the class as a way to refresh my knowledge of Hebrew when I took it intensly at my Jewish Day School. The class really helped out, and it even taught me a few things as well! After the exam, I spoke with my professor for about a half hour about my trip to Israel, and she gave me all kinds of advice and tips on what to do when i'm there, how to interact with the people, what to expect and things like that. I really enjoyed our conversation grealty! It was a lot of fun....i'll actually miss taking the hebrew class a lot, especially since there is no higher hebrew class beyond Conversational Hebrew.

One Month Mark...
Today is the one month mark. Only 1 month until I depart the United States to Israel. It's a mixture of feeling excited and a bit nervous at the same time. I'm excited to go, but i'm also nervous of the uncertainty to an extent. It does feel like it's happening, and i'm starting to purchase things that will be necessary for my trip, like shorts, clothing, preparing my documents, etc. I will miss my friends a lot, but I'm starting to realize how many people around me have expressed their concern to me going. I know it's risky to some extent, and I assure myself that I will be okay. I think everyone will start to feel calmer when my brother and I arrive safely in the country and get all settled.

Bought my Tickets!
I bought my tickets yesterday!!! Very exciting....it feels like it's really happening now, just a little more than a month until my trip. I also found out a few days ago That I received REACH Funding from the Career Center, which is incredibly awesome! It's been a very exciting week......I can't wait!

Some Maps for you Guys!
So, based on popular demand, let me give you guys a few maps of the middle east and the general vicinity of Ashdod.

Below is the link to show you a map of the middle east.

http://www.lib.utexas.edu/maps/middle_east_and_asia/middle_east_pol_2003.jpg

Israel is the very tiny small country to the west- It's western side borders the Mediteranian Sea. Egypt borders Israel on the southern border, Jordan border Egypt to the Eastern Border, and Syria border Israel to the northern border.

Below is the link to show you a map of the State of Israel.

http://www.templebuilders.com/maps/maphtm.htm

To find Ashdod, first scroll your eyes to the western border of Israel that's next to the Medeteranian Sea. Find Tel Aviv (it's the big city about halfway down the Israel Coast). Next, Find Jerusalem (it's the big city that borders the Judaean Desert). Ashdod is all the way west of Jerusalem and South of Tel Aviv.

Please leave me comments if you have any more questions at all!

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