Israeli EMS Psychotrauma Unit Responds to Mass Casualty Incident

Israeli EMS Psychotrauma Unit Responds to Mass Casualty Incident

Jerusalem - August 23rd, 2016 - Israel’s national volunteer emergency medical services (EMS) organization United Hatzalah, had their Psychotrauma Unit respond to two major incidents over the course of 72 hours. One of the incidents was considered, from a psychological standpoint, a mass casualty incident (MCI).

Jerusalem - August 23rd, 2016 - Israel’s national volunteer emergency medical services (EMS) organization United Hatzalah, had their Psychotrauma Unit respond to two major incidents over the course of 72 hours. One of the incidents was considered, from a psychological standpoint, a mass casualty incident (MCI).

On Thursday afternoon, the unit, whose primary goal is to provide stabilization to people who are involved in a traumatic incident and are currently in a highly activated state, responded to a call of a one-day-old baby who needed resuscitation.

The call came from the southern Jerusalem neighborhood of Armon Hanatziv. The family, not having any insurance, decided not to give birth in a hospital. The birth took place at 2pm on Thursday afternoon, and at 6pm the mother claimed that she could not feed the baby. The family called for an ambulance and the United Hatzalah psychotrauma unit was alerted to the situation.   

“The situation was a difficult one for us,” said Miriam Ballin, Director of the unit. “As neither of the parents spoke Hebrew, we had to mobilize volunteers who spoke English. The police asked for our assistance in order to translate with the family. Thankfully, many of our volunteers are bilingual, some are even trilingual, so we were able to fill that role.”

The mother of the child is a Czech native and the father is of African heritage. “When we arrived, the ambulance teams were taking the mother to the hospital, while the police were questioning the father. Just as we were about to leave the scene, we saw that another six children were arriving home with their grandmother,” added Ballin.

“The kids came home and were in shock and completely overwhelmed. One of the teenagers became hysterical and broke down in tears when he saw the police taking photos of the house,” said psychotrauma unit volunteer Baila Shifra Zakuto. “We talked to the kids and calmed them down. We went over with them what the police and ambulance were doing and we made sure that the children knew that this was just regular procedure and that there was nothing to worry about. Our being there helped stabilize them enough to be able to deal with the situation. They are really terrific kids who are well mannered, and they needed our help during this difficult time,” Zakuto concluded.

After calming the tense children, members of the psychotrauma unit helped the children go through their nightly routine. “We made sure that the children had dinner and helped them get to bed. When Social Services arrived on the scene, the representative was very impressed by what she saw of our work. We handed the scene over to their team and they were very thankful for our presence. Social Services felt that, due to our help, they did not need to disturb the scene once again, and left the area feeling inspired by our activities, with plans to return the next morning for follow up,” Ballin added.  

On Saturday night, another emergency call came in, one that required an immense amount of resources and hard work from the unit. The call began when Ballin received a call from the dispatch about a resuscitation of an ill woman in the neighborhood of Har Nof in Jerusalem. The woman was well known and the matriarch in her family. Ballin described the team’s response to what became a large scale operation as a “mass casualty incident from a psychologically traumatic standpoint.”

“I called one of our volunteers who lived in the same building as the woman who was in need of resuscitation and he immediately went to help. As EMTs and paramedics arrived at the scene to resuscitate the woman, family members began to react tensely towards one another and many were in a highly activated state, which can make it difficult for the EMTs and paramedics to do their job,” explained Ballin.  

Rickie Rabinowitz, a psychologist and team leader of the psychotrauma unit, was among those who responded to the scene. She went into detail regarding how the unit responded to the incident. “Our first volunteer was there while the resuscitation was still going on. He kept outsiders out and insiders in. This is a very important initial job, as it cuts down the amount of unwanted attention given to the family by nosey neighbors, and therefore alleviates tensions. A second volunteer arrived and began to sit with family members of the woman to help them organize their thoughts. This allowed the family members to make clear decisions after they begin the stabilization process.”

Rickie made it clear how delicate the job of the psychotrauma unit is. “When dealing with people in a fragile or highly activated state of mind, we need to treat them gently. Our presence should be felt but not take over the scene,” she added. “Only three of us came with vests, the other volunteers who came wore only ID tags so that people would not get a sense of being overburdened by the unit.”

After the woman was declared dead, there was a lot of grief management that was needed for the family. Rickie explained that the unit shifted focus and began to break up family confrontations, quiet the scene, and create order in the chaos. “It was a very sad situation, but the family needed to grieve and then begin to face reality. We could tell from the family’s feeling of loss and the level of their grieving that the woman was very beloved by the family. It was so intense that one relative even fainted and we had to give her oxygen. That is our place, right there, to be there for the family and to make sure that they feel supported until they can be supportive to one another.”

“People cycle through the stages of grief over and over. In the early stages, people cannot be there to support themselves, let alone be there to support one another. We are there to be the supportive shoulder for people until they can support each other, and then we leave. It’s the nature of the family dynamic. A family will close ranks within itself as soon as people feel grounded. That is where we are trying to get people, to a position of stabilization where they be there for one another. Once they can get past the anger, and get past the sadness and the screaming, they can take the sharpness of the pain out of the picture and be there for one another.”

“The point of the psychotrauma unit is to respond to those suffering a traumatic situation as soon as possible in order to support and stabilize the emotionally injured,” said Ballin. “Just because people are not physically bleeding does not mean that they are not injured by what has happened. Some scars we don’t see, we only feel. Those are the ones that the psychotrauma unit is there to treat.”          


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